Clinic Notes: Autism and Fever

A recent study in the journal Pediatrics reports that high fever decreases the symptoms of autism. Many parents have already observed this relationship, but this is the first study that documents the effect. Clinicians have also documented this effect. In 1980, a viral epidemic causing high fever hit Bellevue Psychiatric Hospital in New York. All of the staff there noticed an improvement in the autistic children they worked with. Sadly, after a few days, the fever dissipated and all of the children became autistic again." The improvement can be very dramatic, sometimes like a metamorphosis in which the child with autism or some other neuropsychological disorder becomes almost normal when they are running a high fever. I present such a case history, titled the "The Sometimes Son" in my case history eBook, Little Bubba's Not Ready for Nashville Yet. (http://www.aba4autism.com)

Clinic Notes: Early Signs of Autism

Pediatricians are recommending that children be screened for autism at 18 months and again at 2 years of age. There is no question that early intervention helps and this is certainly a step in the right direction. Usually, parents are the first to notice that something is wrong, but are sometimes hesitant to take action for one reason or another. Without question this early screening will result in more false positives but that can't be helped. I have a link on my website, www.aba4autism, for parents who are interested in reading about the early signs of autism

Clinic Notes: The Autism-Vaccine Debate: Stat 101. Correlation and Causality

Autism takes two forms: Infantile, which is present form infancy, and regressive where the child develops normally and then between 2 and 3 years of age begins to loose language and appropriate social behavior. Often self-stim and sensory problems also put in an appearance at this time. Of course, concerned parents look for a cause and the only thing that they note that was different was the MMR vaccine that there child received before autism began to develop. Further inquiry by the parents finds that the vaccine contained mercury, which is known to be toxic to the brain.
Congressional hearings have been held, research supporting and refuting the mercury-autism link has been presented and mercury has been removed from vaccines, but the debate goes on.
Stat 101. Much of the retrospective research on health issues relies on a statistical test know as correlation. A correlation will tell you if two variables are statistically related. So height and weight are correlated, intelligence and grades are correlated, and cigarette smoking and cancer are correlated. Since vaccinations are mandatory for the most part in the US and everyone receives the MMR vaccine it is hard to come up with an accurate. In parts of Europe where vaccinations are not mandatory the rates of autism are the same in vaccinated and non-vaccinated groups of children. What most people don't understand is that a correlation will tell you if two variables are related, but it will tell you nothing about causality. Just because autism follows the MMR vaccination does not mean that the vaccination caused the autism. Maybe mercury does play a role in autism. Increasingly there is more mercury in our environment as well as other neurotoxins. But a correlation cannot make a statement about causality.

Clinic Notes: Is There An Autism Epidemic?

According to a recent Associated Press article by Mike Stobbe, The 'Autism Epidemic' Largely Fueled By Special Ed Funding, Shift In Diagnosing (www.signonsandiego.com/news/health/20071102-1304-autismepidemic.html).
It is true that as the number of cases of children diagnosed with autism increases the number of children diagnosed with mental retardation and learning disabilities are decreasing. And in my practice I see this everyday. But I also see many, many more kids that have autism and there is no question about the diagnosis. The number of children with autism is increasing at an exponential rate in my little corner of the world.

Clinic Notes: New Autism Screening Recommendations

This week the American Academy of Pediatrics recommended that all children be screened for autism at 18 months of age and again at 24 months. No doubt early interventions by Speech-Language Pathologists, Psychologists, ABA Therapists, and other professionals will better lives for children with autism. At least that's the theory. But I'm worried about logistics. I already have a full clinic schedule and waiting lists of children that I can't get to or refer anyplace. If we are serious about treating all the children diagnosed then we are going to have to mobilize more financial and manpower resources then we have now.

Clinic Notes: Video Clip Diagnosis of Autism

Today's Schafer Report (October 16, 2007) has an article on a free new web site that features video clips of toddlers displaying autistic behavior such as stimming, echolalia, fascinated by a spinning cup, and other early signs of autism. The creators of the tape caution that these behaviors can be seen in normally developing children, but alert parents to the fact that an early evaluation might be advisable. As the article points out parents are often the first to recognize that something is not right. Unfortunately, parents, especially first time parents, wait too long. If you have concerns about your child or are just interested in the video clips go to http://www.autismspeaks.org

Clinic Notes: Predicting Autism

We just completed a study, which found among other things, that the mother having an infection while pregnant was a statistically significant predictor of autism in male children. Now a new published study finds that there is a link between schizophrenia, autism, and flu in the mother. Previous studies have found that flu in mothers during pregnancy
http://www.physorg.com/news110641743.html
increases the risk of schizophrenia 3-7 times. Schizophrenia and autism are thought to have a genetic component triggered by some pre or postnatal factor. As many as 21% of the cases of schizophrenia may be related to flu in the mother. It is not the virus itself that causes schizophrenia but the body's immune system reacting to the infection. The immune system's response to an infection at the cellular level releases proteins called cytokines. Theoretically, the fetus is affected by a cytokine called interleukin-6. If a pregnant mouse is injected with interleukin-6 her off spring display schizophrenia or autistic like behavior.

Clinic Notes: Anorexia and Autism

Kids with autism are often finicky eaters, rejecting foods on both taste and/or texture. The consensus is that this is just another one of those sensory issues which plague kids with autism. But now an interesting hypothesis carries the finicky eating problem one step further. Prof Treasure suggests that anorexia and autism share the same genetics. According to her, twenty percent of patients with an anorexia diagnosis could also be on the autism spectrum. Furthermore, anorexia might be the female form of Asperger's. It is true that perseveration occurs in autism and anorexia, as well as communication and social problems. But this hypothesis seems long on speculation and short on data.
http://tinyurl.com/2bcvka

Clinic Notes: Bipolar Disorder in Children and ABA?

According to a recent news report Bipolar Disorder is being diagnosed more frequently in children. Recently, a pediatrician referred a two-year old girl to my clinic whose psychiatrist had diagnosed with Bipolar Disorder and prescribed Depkote, and lithium, which are commonly used to treat Bipolar Disorder in adults. These are powerful medications, not approved for children, and this two-year old girl ended up in the hospital because of the drug's side effects. I evaluated this child and took a detailed history from the parents. I saw nothing but a spoiled child who ignored her parents when she didn't get what she wanted and then got very upset and threw tantrums if that did not work. After several weeks of ABA, teaching the parents some much-needed parenting skills, this child was okay. I was curious if the psychiatrist who diagnosed this child with Bipolar Disorder had children of his own.

Clinic Notes: Girls with Autism and ABA

Boys are three to four times more likely to be diagnosed with autism than girls. Last week I saw 35 children in my clinic with an autism diagnosis. Only 7 were girls. Not only is autism diagnosed less frequently in girls, it seems to me that the autism in not as severe. (Of course there are exceptions and I do occasionally see girls with moderate to severe autism.) Most of the girls I see with autism do okay with their academic subjects. They have problems handling concepts, and are very literal in their reading. Idioms and other peculiarities of language cause them problems, but for the most part academics is not their biggest problem. Girls with autism tend to have more problems socially than any other area. But then the same could be said of normally developing girls as well.

Clinic Notes: The Science Behind ABA

Applied Behavior Analysis (ABA) is the most popular and effective therapy for autism. However, ABA also has it critics who say it is too rigid and creates kids who are robotic. (I have been working in ABA for nearly 40 years and have yet to see ABA produce a robotic child.) A second criticism states that the research behind ABA is modest. Well, I think these critics do not know the history of learning theory and the countless experiments with experimental animals and humans that can be traced back to Thorndike's trial and error experiments with cats in 1898. B.F. Skinner's Functional Analysis of Behavior, which is the backbone of ABA, examined human behavior using behavior principles tested on years of animal experiments. Even today, countless scientific journals publish peer-reviewed studies examining ABA with various clinical populations. Based on decades of research, ABA is recommended as the treatment of choice in treating autism by CDC and other health agencies. How much science do the critics want?

Clinic Notes: ABA and Time Out

Time out means time out from positive reinforcement. If there is no positive reinforcement in the child's environment then time out will not work. Recently, a child with autism in Iowa school was left in time out for 3 hours. Of course, the parents were outraged and called a lawyer. But before the case came to trial the family moved and the school system continues to use its time out rooms in the same way. http://www.kcci.com/education/13826532/detail.html.
There has always been controversy about time out and the Iowa school is not the first to get into trouble over improper use of time out. Parents are always telling me that they have tried time out with their child but it does not work. Time out is a very good procedure when done right and ineffective when done wrong. The standard time out procedure below is the procedure I have been using for 30 + years and it works. It will not work for a child with autism that is removed from an environment that has no reinforcers. For example, an environment where there is too much stimulation or too many demands being placed on the child. Being placed in time out would be reinforcing. And time out should never be used by itself, but always combined with a reinforcement procedure for the appropriate behavior.
Time out 101:
Time out is an often used and misused procedure. If done properly, time out is a very effective, humane procedure. Find a place in your house where a time out chair, preferably a chair with arms and not a bench, can be left. The chair should face a blank wall and not be close to a window, shelves, glass, electrical outlets, or storage cabinets containing chemicals. Hallways and alcoves often work. Do not use bathrooms or closets. The time out chair should be close to the play area so the child can be placed in time out quickly. Think safety, especially for small children.
Use an egg timer and teach the child that he or she cannot get out of time out until the egg timer goes off. The child has to stay in time out for three minutes plus one minute of good behavior. In other words, the child has to be quiet and cannot be arguing, complaining, or tantruming for one full minute before he or she can get out of time out.
Do not be surprised if the child comes up with a whole bag of new inappropriate behaviors in order to get out of time out. Kids have been known to gag, vomit, and one of my own kids even hit herself in the face several times. Do not respond and thereby reinforce these new inappropriate behaviors or they will increase in their frequency. Only good behavior gets the child out of time out.
In the beginning of this procedure it's not unusual for a child to be in time out for fifteen to twenty minutes before he/she quiets down, and to go to time out as often as twenty times a day. After a few days the child learns the requirements of the time out procedure and he/she gets out in the minimum four minutes. The number of times the child goes to time out each day also drops dramatically. (Record the frequency and length of time outs and you will see the child's progress.)
When the child gets out of time out, remind your child of why he or she had to go to time out in a firm tone. Tell your child that he/she will have to go again if your directions are not followed immediately. Do not be timid with your voice or body language. (Go to www.AbA4Autism.com for ABA programs using time out and reinforcement that eliminate inappropriate behavior and establish appropriate behavior.)

Clinic Notes: Public Awareness of Autism and ABA

According to a recent Schafer Report the mayor of Albuquerque has called for a Town Hall meeting on Developmental Disabilities. One of the panels at the meeting will be devoted to autism. I think this is a great idea. And If I were the mayor I would require all city employees to attend. Policemen, firemen, teachers, anyone who might come in contact with a child or adult with autism should be there. And perhaps a special workshop should be offered as a follow up. I am in the process of trying to organize a day camp for children with autism. Games and other activities would be available, all run by qualified staff. While the children with autism were involved in recreation I would talk to teachers, parents, and other interested adults about ABA and autism and Speech-Language Pathologists, Occupational Therapists, and others ould do their part. And hopefully the community to come together to help fight the epidemic.

Clinic Notes: Diagnosis and Denial--Denial and Diagnosis the Chicken and Egg of Autism

Everyone will agree that early diagnosis of autism and intense ABA, along with other therapies, is effective. Sometimes it is possible to diagnosis autism as early as 18 month and start intervention. But only half of all autism cases are diagnosed before kindergarten most of these the second and third year when language delays and other symptoms of autism become apparent. Parents can be in denial before and after a diagnosis. Last week a mother brought her three-year old child in to my clinic. She had thought something was wrong since the child was two but dad kept saying the child was just hard headed. Mom took a trip with her friends and left the three year old with dad. When she returned home dad told her to make an appointment because something was wrong. In this case the child was able to get a diagnosis and treatment at an early but often we do not see children for the first time until they are six or seven. The parents knew something was wrong but were in denial. And the parents did not seek services until the school system insisted. And it is not always denial in the parents that prevents a child diagnosed with autism from getting services. More often costs, both in time and money are to blame.

Clinic Notes: An ABA Army to Combat Autism

A friend of mine has just returned from Iraq. I was asking him about how the war was going and he told me that the press is not giving enough credit to our military forces. They are well-trained professionals, doing an excellent job, under extremely difficult conditions. This got me thinking about my "war" with autism. Everyday I am asked to travel here and there--sometimes to foreign countries--to set up ABA programs for children with autism. If I can't go then I'm asked to recommend someone. Professional, well-qualified ABA therapists are in short supply. Parents around the country, and the world, cannot find ABA services, and if they do fined someone they are either not qualified or too expensive. I'm retiring from my university appointment, staying on to teach an ABA course and direct ABA students in internships, but most of my time now will be devoted to my practice. What we need is some kind of national program to train ABA therapists--an army of ABA therapist to go out and fight the autism war. Of course we will also need OT's, SLP's, and pediatric neurologists in the army too. If we don't do this we will loose the autism war and there will be a large fraction of a generation incapacitated by autism. Autism research needs to be better supported too, but until we find some answers the ABA army will have to fight the battle.

Clinic Notes: The "Autos" in Autism

In 1943, American psychiatrist Leo Kanner published the first paper on autism. The word “autism” comes from the Greek word “autos” or “self” and was first used by Eugen Bleuler, a Swiss psychiatrist, in 1912. Bleuler described “autistic thinking” as not involving outside reality, but only the individual's inner thoughts or feelings. He thought schizophrenics were locked into this way of thinking. Kanner used the term autism to describe the extreme social disinterest he observed in eleven young children, and thought the disorder was congenital. The stereotype of the child with autism being aloof locked in his or her own little world is still with us. However, I think that I have seen a change in this stereotype during my 37 years of clinical experience. Many of the kids who come to my clinic now with an autism diagnosis are very social or at least interested in being very social. Unfortunately, their verbal communication holds them back so they do not do well socially. Social stories and modeling social interactions can help, but unfortunately many kids do not solve their communication problems earlier enough to develop socially.

Clinic Notes: Jobs for People with Autism

Parents who bring their children diagnosed with autism to my clinic want to to know what the future holds. Of course, they ask about the immediate future, but they also ask about vocations and employment for adults with autism, even if their children are only two-years old at the time. I cannot predict the future, but I was glad to read about a new job placement service for people on the autism spectrum. Natural Learning Concepts which offers books and other materials has a job placement resource at http://www.nlconcepts.com
/autism-jobs.htm. Pro autism employers can post jobs and employees looking for jobs can "network." No word yet on the number of successful job placements.

Clinic Notes: The "Brat Syndrome" and Autism

When I was first starting out in ABA 30 + years ago I recall reading an article titled "The Brat Syndrome." The thesis of the article was that noncompliant behavior and tantrums or "brat behavior" in a child does not by itself constitute any psychiatric disorder or neuropsychological disorder. At the time ADHD was being over diagnosed and often children would receive an ADHD diagnosis just because they were noncompliant and had frequent tantrums (brat like). Now I see the same thing happening with autism. Noncompliant children are coming to my clinic with an autism diagnosis, usually conferred by a Special Ed teacher rather than a psychologist, pediatric neurologist, or psychiatrist. Many of my colleagues and associates do not like me to tell a parent that their child has the "Brat Syndrome." And I certainly do not tell a lot of parents that even when it is true. But a lot of parents are relieved when they hear that their child has the "Brat Syndrome" rather than autism.

Clinic Notes: It's the Season for the IEP's

If you are a parent of a child with behavior problems you have probably had to battle the school system in an IEP to get needed services. Often parents do not know what to ask for in an IEP meeting nor do they know their rights. (Unfortunately, school systems are equally in doubt about the law or play like they are.) For help go to a great website http://www.wrightslaw.com/nltr/07/nl.0516.htm
for help.

Clinic Notes: ABA Workshops: The Good, Bad, and the Ugly

At least several times a week I am invited someplace to give an ABA workshop. The workshop audience that I am invited to speak to may be parents or other caregivers and that's good, but often the workshop is for professionals--therapists, teachers, classroom aides, etc. Nowadays my clinic is so over run with children with autism and my waiting list is so long that I politely decline, but even if I weren't busy I would decline most invitations. The problem is that with the popularity of ABA as a treatment for autism everybody wants to get into the ABA business. Most of the invitations come from organizations that want me to train their staff in ABA. In one day. Then the newly trained staff can go out and do their own ABA. And bill. Families and school systems do not know that the "ABA therapists" they are contracting with only have one day training and know just enough to be dangerous.

Clinic Notes: Asperger's and Bullying

Whenever I get young children in my clinic who have been diagnosed with high functioning autism or Asperger's I think about how they are going to fare in school. Of course, I know that if they are not compliant and verbal and have age appropriate skills they are not going to do well so these are the ABA programs that I run first. ABA programs to develop social skills are not run for a while and if they are then they are run with a lesser intensity. I want these kids to do well socially from the beginning but if I cannot get to the programs I know that social problems such as bullying don't usually start until middle school. I may have to rethink my ABA programming. According to a recent Schafer report Five elementary school student is Oregon are going to be charged with assault after they beat a classmate with autism with sticks.

Clinic Notes: The Two Faces of ABA

In a previous blog I discussed who was qualified to do ABA. With the increase in children with autism, and ABA being recognized as the best therapeutic approach, the number of people holding themselves out to be ABA therapists and preying on an uninformed public is geometrically increasing. Psychologists and Behavior Analysts are big on qualifications. At the same time they say paraprofessionals can do ABA. On my website I tell caregivers that anyone can learn to do ABA and I believe that. But to do ABA independently with someone else's children, without supervision of a Behavior Analyst or Psychologist can be risky.

Clinic Notes: Who is Qualified to Do ABA?

Recently a school system nearby had an ABA consultant come in to give a workshop on ABA for a day. The special education aides were asked to attend as well as the cafeteria ladies. The parents of the children with autism were then told that their children would be given several hours of ABA each week.
ABA is riding a wave of popularity with the onset of the autism epidemic. And many people are offering their services to families and schools. This brings up an important question. Who is qualified to do ABA? Under supervision anyone can do ABA. But without supervision a little bit of ABA knowledge can be harmful. I think that it is very clear that only Board Certified Behavior Analyst or Licensed Psychologists should be doing ABA unsupervised. I have seen many children in my clinic who received ABA from unqualified therapists and did not progress. It is accepted that with autism the earlier the interventions the better. Parents cannot afford to waste a year with an unqualified therapist.

Clinic Notes: Chelation

I've been in practice long enough to remember when children severed brain damage from lead poisoning. Most of the lead poisoning was caused by children eating paint that was peeling off the walls. Now paint does not contain lead and most clinicians have never seen a case of lead poisoning in children. Removing the lead (Chelation) was a popular therapy back the. This week police raided a doctor's office in Pennsylvania who was using Chelation therapy to remove mercury in a child suffering from autism. Chelation therapy for autism is not an approved therapy and is highly controversial. This week police searched a doctor's office whohad used chelation for treating autism in a 5 year old boy who had died. (This is the third death reported.) The family's attorney stated that the physician was ... "giving a treatment that's not an approved treatment for autism. He gave the wrong drug in the wrong dose and he gave it the wrong way."
http://www.pittsburghlive.com/x/pittsburghtrib/s_502280.html
Of course this statement should not imply that's there is a right drug and a right doss and a right way to do chelation.

Clinic Notes: Preventing Autism in Babies

In a previous blog I cited studies suggesting that intensive ABA can prevent autism in high- risk children. (Preventing Autism Now: A Possible Next Step For Behavior Analysis, Philip W. Drash, Autism Early Intervention Center). Now Geraldine Dawson, a University of Washington Psychologist is running intensive ABA programs for children younger than two. Much of her 25-30 hour per week program focuses on social development in order to facilitate language development. Language development by age five is an important predictor of how high functioning a child with autism will be.

Clinic Notes: Catch a Falling Star

A recent cover story in time magazine talked about our failing public education system and possible ways to fix it. According to a recent article (The Painful Parallel Universe of Special Ed Parenting By Bob Sipchen in the LA Times.
latimesblogs.latimes.com/schoolme/2007/01/emotions_best_d.html#more)
much the same criticism could be made of our failing special education program for children with autism and other neuropsychological disorders. Special Ed teachers have too many students with to many diagnoses and a crippling curriculum. They are often pressured into advancing special ed children even though they have not mastered the material or else they may loose funding. Aides in the special ed classroom often do the work for the child because they are not showing progress A child's rate of learning and learning style may not be considered in such an environment. No child left behind is a noble goal but special ed teachers must have the resources and the time to achieve such a goal.

Clinic Notes: ABA for Normally Developing Children

Thirty-seven years ago when I was in graduate school ADHD was in the new as much, if not more than autism is today. Parents were rushing their kids to pediatricians, many begging that they be put on Ritalin. Now it's déjà vu all over again. Parents of small children are now concerned that their child could have autism because they have not reached their developmental milestones as rapidly as some of their peers. These children do not have developmental delays because they still have not reached the end o their maturational period, but their parents are running scared. Reassuring parents that their child is developing normally is not enough. They want ABA to speed up the acquisition of skills for their child. This presents an interesting dilemma. Do I provide ABA for these children or say "sorry" and go to a child on my waiting list who has a diagnosis of autism?

Clinic Notes: Asperger's and ABA

Without question Asperger's is often misdiagnosed as ADHD or bipolar mood disorder and children are given psychotropic medications that do nothing for the conceptual problems and the social problems that are the core of Asperger's. It wasn't that long ago that in my clinic children diagnosed with Asperger's did not usually present until their preteens or teens. But now I am getting children referred with a diagnosis of Asperger's at a much earlier age, often 5-6 years of age. This makes it much easier to run Discrete Trial Training (DTT) on stimuli and concepts that will cause problems later in school. Socialization drills can also be started much earlier when children are kinder to children that are different.

Clinic Notes: Autism Questions Redux

When people find out that I have a clinic for children with autism the first question they usually ask me," Is autism increasing?" And the second question is usually, " What cause autism?" I can throw our some stats and research findings, but, unfortunately, I can't answer either question with any degree of certainty. And I can't do much better on the third question: "Does the mercury in vaccinations really cause autism?" I simply say this question is hotly debated and I am undecided myself at this point. A recent article, (Regressive Autism: Putting Together the Pieces By Michael Wagnitz
(www.americanchronicle.com/articles/viewArticle.asp?articleID=21973)
makes a strong argument for mercury. He cites data from first baby haircuts that find children with autism have seven time higher levels of mercury than normal children. Wagnitz also cites data which finds that monkey brains dosed with mercury have cellular changes which are already known to cause neurodegeneration and these cellular changes are found in autopsies of brains of children previously diagnosed with autism. In the future perhaps I can give better answers

Clinic Notes: What Causes Autism?

Everyone has a theory but know one knows what causes autism according to a recent article (No Easy Answers In Autism
Theories abound, but no known cause or cure for baffling disorder By Lisa Schencker, for the Californian
http://www.bakersfield.com/102/story/104427.html)
Well that's obvious and as the article points out there is no cure and a lot of "businesses" will prey on the ignorance of parents desperately looking for help. Genetics are one of the culprits but something in the environment is also responsible. The data on vaccines being the culprit is equivocal. I think we can rule out social and psychological causes. So that leaves the environment. Well what could be wrong with today's environment? How about the air, the ground, the food, the water, etc. And it is going to be hard to track down the causes or causes. Like everyone else I have a theory. I use to enjoy hunting quail. "Birds" as they are called in the south. Dogs would point the birds, we'd walk in and flush them, and when they flew we would shoot. Quail are delicious, all white meat. But the quail in the south are gone. There are many theories why--almost as many as there are about the causes of autism. I think it has to do with agriculture--fertilizer, pesticides etc. Larger animals survive but the smaller animals are always affected first by poisons. In parts of the south, like Texas, where there is only pasture or open land and no agriculture the quail are still around. Something is killing the quail and something is causing autism. I wouldn't be surprised to see that it was the same culprit.

Clinic Notes: Loosing Children with Autism

One of the first drills we run in my clinic after we have children compliant is the come here drill, so that children with autism and other neurodevelopmental disorders will come when they are called. Obvious safety issues are involved with this drill and most kids do learn to come when called. But every year I have a child or two with autism or some other neurodevelopmental disorder get lost. Some get out of the house at night while their parents are asleep. Others bolt when a parent is carrying on groceries and thinks their child is right behind them. That's what happened most recently. Mom was carrying in groceries from the car and thought her four year old was right behind her. But when she sat the groceries down and turned around she was not there. Mom ran out of the house and noticed a few small footprints leading to a 100-corn field. She called and called but the child was non-verbal. Night was falling and mom frantically called family and numbers to search the cornfield. Two hours later she was found sitting on the ground paying shucking corn. Fortunately, it was a warm night and this story had a happy ending. The parents purchased a GPS tracking bracelet the next day. According to a recent Schafer Report (http://tinyurl.com/2bczkp) parents can now purchase sneakers with a GPS chip. A monthly subscription costing $19.95 is also required. A small price to pay considering that sometimes there is not always a happy ending for children with autism or some other neurodevelopmental who get lost.

Clinic Notes: ABA, Autism, and a College Education

According to a recent article in the Schafer Report (3/7/07) an increasing number of children with autism want to go to college. (By Shaya Tayefe Mohajer for The Associated Press, Huntington, WV. http://tinyurl.com/3y49da). We have children with ADHD, Bi-Polar Disorder, Depression, and a host of neurological disorders attending college now so I don't why students with a diagnosis should be left out. And I'm sure that I already have students with Asperger's or high functioning autism in my classes now. My question as a college professor is what accommodations do we make for students diagnosed with autism. My question as a clinician is how do we make these accommodations. For students with a diagnosis of ADHD we have to give them all of the time they want on tests and let then take their test alone in a quite room. What accommodations will we have to make for children with autism who have sensory issues? And will we have to adapt out teaching methods--perhaps using ABA to teach college classes? This could be interesting especially if the federal government gets involved.

Clinic Notes: ABA and Criminal Intent

In recent Schafer Report (3/2/07) an article stated that early diagnosis of autism, when the brain has more neuroplasticity, is critical for effective treatment and yet very difficult. Part of the problem is getting parents, pediatricians, and other caregivers to recognize the early signs of autism and part of the problem is finding effective ABA, speech, and OT that is affordable and accessible. In the state where I practice the "Tennessee Early Intervention System" will pay for service up to age three. So if we can screen and identify kids by age two we have a year to work with them. After age 3 the school system is responsible for services and this is when the system often breaks down. Some school systems are very good about paying for services. Other schools systems depend on their special education programs to treat autism. Of course, most special education teachers are not trained in ABA so the school system usually sends the teachers to a few wrkshops. This does not solve the problem. It keeps the children with autism in special education and builds the census and funding. But the children with autism usually do not get the level of professional services that they are entitled to. The school systems know this and I think withholding services for these kids is criminal. There is no other word for it.

Clinical Notes: Autism in the News

There's no doubt about it. Autism is in the news and everyone has questions whether they are directly affected by autism or not. I was waiting to see a doctor at Vanderbilt several days ago. My wife started a conversation with a woman beside her and eventually the small talk got around to what I did. When my wife said that I was a psychologist who worked with children with autism a hush fell on the room. Everyone in the room looked at me and I couldn't hide behind my magazine. Then the questions started. First, from parents and grandparents, and teachers who had been directly affected by autism, and then by the curious who had read some article in the popular press. There were specific questions about specific children and then more general questions: Is one out of every 150 children affected? Do vaccines cause it? How can it be cured? I answered all of the questions as best I could and everyone was very appreciative. And then I was called back to the doctor's ofice. I was thinking about the questions I wanted to ask the doctor about my own health when he walked in. After a brief introduction the first question out of the doctor's mouth was, "what happens to children with autism when they grow up?" Autism is in the news.

Clinic Notes: Special Education and Autism Stats

According to some reports we are in the midst of an autism epidemic with one out of every 150 children diagnosed. At the same time the number of children diagnosed with learning disabilities or mental retardation is declining. Now we hear that for the first time in history the number of children in Special Education declined by 2.4%. (http://tinyurl.com/yuh59z) Furthermore, the number of children age 3-5 entering public education with speech/language impairments dropped 5%.
So what's happening? Are the speech/language impaired kids, which make up half of the kids with disabilities, now being diagnosed with autism and going into private autism schools where they can get more ABA? I'm confused

Clinic Notes: Thomas the Train, Bob the Builder, and ABA

There is some literature that suggests that children do not make eye contact because they perceive eye contact with another person as threatening. In fact some studies fine that if children with eye contact do look at faces they only see the mouth and nose. Interestingly, the face on Thomas the train and the construction equipment on Bob the Builder attract many children with autism. A recent study in Great Britain (http://news.bbc.co.uk/1/hi/health/6241733.stm) used vehicles with human faces to try and teach children with autism to overcome their fear of looking at faces. In my clinic I have been using Thomas the Train and Bob the Builder videos to teach children with autism how to label emotions with some success and plan a controlled study in the near future.

Clinic Notes: ABA and the Neurosciences

Most ABA therapists have little background in the neurosciences. Unfortunately, this often results in a "one size fits all" approach to ABA. In our clinic some children with neurological impairment resulting in low muscle tone get fatigued very quickly doing Discrete Trial Training (DTT). With these children we slow down, have longer intervals between trials and give frequent breaks. I've seen ABA therapist push these kids to the point that they break down and profit little from ABA. Other kids with ADHD types of behavior may need shorter intervals between trials and less frequent breaks to keep them on tasks. In my few view, at least one course in basic neuroscience.

Clinic Notes: The Autism Genome Project

What is being hailed as the largest genome scan ever has come up with two genetic abnormalities in families with at least two member diagnosed with autism. The gene neurexin 1 located on chromosome 2, which is know to be associated with the neurotransmitter glutamate, is one suspect as is several locations on chromosome 11. As many as 30 other genes are also suspects in the disorder and are under investigation. Research in genetics is an important part of the puzzle and these are interesting findings. But I am still puzzled. When you read genetic studies somewhere in the write up autism is referred to as a highly inheritable disorder. However, the concordance rate for identical twins is only 60% and drops to 4-8% for fraternal twins and non-siblings. Without doubt something else is involved in the etiology of autism.
(See Nikhil Swaminathan. http://tinyurl.com/ynr6ey)

Clinic Notes: Autism Myths

The sign hanging in front of my clinic building says, "The Children's' Treatment Center." And in small letters under the name, "For Autism or other Childhood Developmental Disorders." I am located in an old historic part of town where buildings build in the late 1800's have been restored; surrounded by lawyers, CPA's, and upscale retail stores. I am always asked the question by people aroung me, "What is autism?" That is a difficult question to answer and difficult for people to understand. The movie "Rain man" is the only exposure most people have had to autism until recently when autism has been in the popular media.
Part of the problem in answering this question for the general public is the lack of consensus for those of us who work in the field. Simple questions such as "Is autism increasing in children," cannot be answered to everyone's satisfaction. We are not even close to answering the question, "What causes autism."
There are so many controversies that "experts" at the 2006 annual meeting of the American Association for the Advancement of Science tried to separate "fact" from myth. Unfortunately, the experts could only argue about the interpretation of the limited amount of data, often contradictory, that we do have.
(See Ped Med: Autism Myths Abound
By Lidia Wasowicz for UPI.)

Clinic Notes: The New Autism Numbers

In a recent study, CDC reports that 1 in every 150 school age children are affected by autism. When I started practicing 35 years ago the numbers were more like 1 in 10,000. The lower rates are reported in the South and the higher rates in North Eastern cities. Whether this difference is real or because more services are available and a diagnosis is more likely in the North Eastern cities than the South is not known. The authors of the study say that the rise in autism rates could be related to better surveillance procedures now than in the past. Personally, I don't think 1 child out of every 150 has any chronic disease, Including autism. (Diaper rash could be the exception.)
(See Morbidity and Mortality Weekly Report Source reference: MMWR 2007, 56;SS-1;1-28.)

Clinic Notes: ABA, Music, and Autism

I see many children with autism in my clinic who are music savants. They have perfect pitch and can play a song on the keyboard after hearing it one time. The percentage of child with autism that have special music abilities is not know, but it is estimated that 10% of children with autism are savants.
In addition, many children with autism like music and we use it as a reinforcer in ABA programs. (Some kids with autism find music, and sounds in general aversive and cover their ears.) Neuroscientists tell us that infants are born with music preferences and even seem to enjoy music while still in the womb.
Some years back I had a 3 year-old girl come to my clinic with a diagnosis of autism. When I was taking her history her mother said she was not verbal, but she could sing. I then asked if she could follow directions. The mother said yes as long as she sang them. I then watched mother sing a direction and her daughter sang back her reply.
Tere is no music center in the brain. Pitch, loudness, and dimensions of music are in circuits of nerve cells, which are spread around in different parts of the brain. Why some children with autism have savant abilities is not even close to being understood.

Clinic Notes: ABA and the Rising Number of Children Diagnosed with Autism

In the January 31, 2007 Schafer Report (http://www.SARnet.org/), two separate articles dealt with the rising number of children diagnosed with autism. In California, 3385 new were added last year. The second article discussed the difficulty in determining whether or not the increase was real, and if it was, what was causing the increase.
Without doubt, I think there is an increase in the diagnosis and miss-diagnosis of autism. I see that almost everyday in referrals made to my clinic. But I also think there is something else going on. Autism does have a genetic link, but I'm not sure more people carrying the autism gene or genes are breeding and having more children with autism. I have no data to support that belief, but that is my belief. I think our attention needs to be directed towards the environment.
At any rate, it is getting very difficult for those of us in ABA to offer intense ABA for a child when we have so many children diagnosed with autism on our waiting list. Do I schedule one child for 10 hours of ABA a week? Or do I see ten children for one hour?

Clinic Notes: Risperdal, ABA, and Autism

A recent government study by the HHS' Agency for Healthcare Research and Quality found problems associated with off-label uses of Atypical Antipsychotic medications. Atypical Antipsychotic medications were developed to treat schizophrenia and bipolar disorders, but are now being prescribed for the elderly with dementia as well as children with autism. One atypical antipsychotic medication, Risperdal is approved for treatment of agitation and irritability in children ages 5-16 diagnosed with autism. Prescribing medications to children should be a last resort, only undertaken after all other therapies have been tried. But I can tell you that in many children with autism Risperdal is a necessary drug

Clinic Notes: Asperger's, ABA, and Crime

I see a number of children diagnosed with Asperger's Syndrome in my clinic. When they first present academic performance is the problem parents complain about the most followed by social problems. Children with Asperger's generally do well in math, spelling, and have trouble in science and social studies where they have to summarize information. Discrete Trial Training (DTT) and other ABA procedure are usually effective in managing the academic problems that Asperger's children have. The social problems associated with Asperger's are more difficult. We use a lot of social stories to teach social skills and how to behave in various situations and this works fairly well. But there is always a social situation that we did not anticipate that causes problems, especially for the adolescent. I wasn't surprised to see the news report this week where, allegedly, a teen with Asperger's stabbed a fellow student to death. The Asperger's defense has been used successfully in murder cases as well as other criminal charges, but I take no comfort in that. Seeing that no child with Asperger's commits a crime is a serious responsibility for ABA therapists.

Clinic Notes: ABA and Eye Contact Revisited

In a post last week I mentioned a study that found that children with autism perceived faces as threatening and that was the reason they did not make eye contact. The first ABA program in my ABA eBook is on eye contact. And I know from many years of clinical experience that a child with autism is not going to advance until they are making eye contact on command and are also making spontaneous eye contact.
A project in Great Britain is using cartoons of human faces on vehicles such as trains and cars to teach children with autism to make eye contact and understand human emotions. I have ordered their DVD and will evaluate this approach. In a future blog I will post the results

Clinic Notes: Mysteries and Autism

The best account that I have ever read of what it is it is like to have autism is a novel titled, The Curious Incident of the Dog in the Nighttime by Mark Haddon. A recent issue of the Schafer Report (Friday, January 12, 2007) describes a ten-year old child with autism who writes mysteries, which include people he knows in as various characters such as villain (the principal).
The mystery story has a long history in neurology. As I mention in the preface in my case history eBook, Little Bubba's Not Ready for Nashville, Yet, the most famous detective in fiction, Sherlock Holmes, was based on one of Sir Arthur Conan Doyle’s medical school professors at the Royal Infirmary in Edinburgh where he was a student in the late 1800s. Apparently, like Holmes, neurologist Joseph Bell mystified Doyle and his fellow students with his gift for clinical diagnosis. As I do research into the causes of autism and work with children with autism in my clinic and try to unravel the mystery of autism I often wonder what Holmes would do.

Clinic Notes: Eye Contact and Autism

A recent study at the University of Wisconsin suggests that children with autism do not make eye contact because they see faces as threatening. http://www.sciencedaily.com/releases/2005/03/050309151153.htm
Perhaps children with autism do see faces as threatening. I won't argue that. And I am familiar with the controversy about whether or not we should require that children with autism make eye contact. Many of the children with autism who come to my clinic, especially the young children, do not make eye contact on command or spontaneous eye contact. Of course, this results in social impairment, but it also results in impairment in observation learning or modeling and numerous developmental delays. The first ABA program in my eBook is on establishing eye contact. And the ABA program for eye contact is not first by accident. Thirty-five years of clinical experience has taught me that if eye contact is not established, the child with autism is not going to advance.