Clinic Notes: Obsessive-Compulsive Disorder (OCD) and the Immune System

Children with OCD are sometimes misdiagnosed with autism. Children with autism do perseverate, line up toys, and like to have their environment a certain way. They also do not like change, will do better on a strict schedule, and often engage in repetitious, self-stimulatory behavior. But usually they have the other symptoms that are not seen in the child with OCD. Low serotonin levels are implicated in both disorders and often both are treated with medications that increase serotonin levels although the improvement, if any, is usually small. A recent study in mice links OCD to problems in the immune system. It was already known that PANDAS, an abbreviation for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, causes OCD in a subset of children and worsens tics in children with Tourette's Syndrome. Children with autism often have more infections than normally developing children and this has led to the hypothesis that autism could be an immune disorder. At this point the evidence for this hypothesis in not compelling, but wouldn't it be interesting if autism turns out to be an immunity problem.

Clinic Notes: Sex Differences in Etiological Predictors of Autism

Recently, we presented the results of some of our research at The American Psychological Society meeting in Boston. In several studies we have noted that the causes of autism are different for males and females. It is established that males are 4 to 5 times more likely to be diagnosed with autism so differences in predictors is not surprising. In our survey of 1806 biological mother of children diagnosed with autism and normally developing children we found that being an older mothers, birth complications, living 20 miles from power lines, and eating fish during the first trimester predicted autism in both males and females. Not having meat aversions predicted autism in males but not females. Mothers smoking during pregnancy was a predictor of autism in females but not males. Baron-Cohen suggests that autism is an evolutionary exaggeration of the male brain

Clinic Notes: Autism and Seizures

Approximately 25-30 percent of children with autism have seizures. And often the medications that are used to control the seizures have side effects that make behavior treatments, such as ABA, more difficult. Speech therapy and occupational therapy can also be adversely affected by seizure medications. At a recent Autism One/Generation Rescue Conference, a seizure survey asked parents of children with autism who also had seizures to evaluate traditional and non-traditional seizure treatments which had been tried on their children. For traditional anti-seizure drug treatment valproic acid, Levetiracetam, Lamotrigine and Ethosuximide were the most effective at controlling seizures and the least detrimental on cognition, language and behavior. For the non-traditional tanti-seizure treatments, the survey found that the ketogenic diet, the Atkins diet and gluten-free/casein-free diet were the most effective in controlling seizures and also were also helpful in treating, language and/or behavior.

Clinic Notes: Acting and Autism

One of the most challenging areas for clinicians who work with children with autism is teaching them to notice social cues in others and modify their behavior accordingly. Most children learn these cues as they interact in daycare and other social encounters. But the child with autism seems not to notice. I've watched many children with autism trying to have a "conversation" with normally developing children and fail to notice the obvious cues of disinterest and boredom. Simon Baron-Cohen notes that social interactions are brief and the window of learning small. He and his associates have developed a series of DVD's with actors in different social interactions. The children with autism can replay these DVD's and learn the "rules" for how to act in certain situations.
I recall reading somewhere that this is what Temple Grandin learned to do. If someone came into her office she had memorized the line, "Would you like a cup of coffee?" She could not understand why she should do this, but had memorized her line in the play of life. Perhaps as Shakespeare wrote, "All the world's a stage, And all the men and women merely players; They have their exits and their entrances,
And one man in his time plays many parts, Perhaps for the child with autism this is more literal than poetic.