Saturday, November 28, 2009

Clinic Notes: What do Emotions Look Like to a Child with Autism?

Children with autism have problems identifying emotions in other people. It seems this has to do with facial expressions. But children with autism also have problems identifying and managing their own emotions. Anger, sadness, anxious, happiness, and other emotions are difficult to describe. Joseph and Silvana Karim have two children on the spectrum and after working with their children wrote a book using color to express emotion. For example, anger is hot and therefore red. This approach makes a lot of sense since children with autism seem to do better in the visual modality. Their book also has drills to help the child with autism identify emotions in the facial expression of others and describe their own emotions using their own words. I plan to see if this could be used in a discrete trial format in my ABA clinic.

Tuesday, November 17, 2009

Clinic Notes: Hyperbaric Chambers and Autism

"Treating" autism is big business. Anecdotal reports have reported that children with autism have shown remarkable gains following exposure to increased oxygen in hyperbaric chambers. Supposedly, the increased oxygen increases blood flow thereby decreases inflammation, which changes the brain chemistry that causes autism. Of course, this is all hypothetical and no double blind randomized studies have been done until now. Researchers at Center for Autism and Related Disorders found no significant effect following hyperbaric therapy. I'm not surprised at the results. What I wonder about is how all this got started? Hyperbaric chambers have a long history in medicine and while there are legitimate uses there are also many times that hyperbaric chambers are used with scant data supporting their use. Furthermore, many of the studies are funded by the manufacturers of the hyperbaric chambers. (See the New York Times review by Jane E. Brody

Thursday, November 12, 2009

Clinic Notes: Treating Autism in a Rural Area While Waiting for Healthcare Reform

Many children with autism have ADHD like behavior and do well on stimulant drugs. Most pediatricians and family practice physicians have no problem prescribing these medications. But I am a psychologist practicing in a rural area and often see children who have no health insurance or their health insurance won't pay for the treatment of autism. So I'm supposed to treat a child with autism who has no access to a physician, and no way to pay for medication. Well, people in a rural area learn to get by with what they have available and I guess that includes me. Caffeine contains methylxanthine, which is a mild stimulate similar to what is found in ADHD stimulate drugs. (Stimulate drugs often have a paradoxical effect on ADHD behavior--decreasing it rather than increasing it.) Coffee can sometimes be used as a replacement ADHD drug sometimes in children as well as "energy drinks" like Red Bull. The problem is dosage. A child would have to drink a lot of coffee to get the equivalent stimulant effect of a large dose of an ADHD drug. But when only a small dosage in needed caffeine can work.

Friday, November 06, 2009

Clinic Notes: So Long Asperger's. I Hardly Got to Know You.

In 1944 Viennese physician Hans Asperger described a sample of children with high functioning autism who had normal intelligence and language, but were socially awkward and obsessed on various topics. In 1994 the term Asperger's Syndrome was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV. With the autism epidemic more and more children with Asperger's are being diagnosed and treated effectively. Now I have learned that in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (D.S.M.-V) the "experts" are proposing that the term Asperger's Syndrome be eliminated and simply called Autism Spectrum Disorder. Well what could go wrong there? Asperger's is just now being accepted by the public, and more importantly kids who are diagnosed with Asperger's and call themselves Aspies. Furthermore, there are over 200 thousand websites devoted to Asperger's (many maintained by Aspies) and countless books and articles. Are these going to become obsolete by the vote of a committee?