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.