Clinic Notes: Ecstasy for Autism?

A few anecdotal reports have reported success in treating autism with marijuana. Proper investigational protocols were not followed and the therapist often got in trouble professionally and sometimes legally. Now the rave drug, MDMA better known as ecstasy is being suggested as a treatment for autism because reportedly it increases sociability, communication, and empathy in adult subjects with autism. The reported changes remained long after the drug had worn off. MDMA increases the level of vasopressin, a neurochemical known to mediate sociability, and oxytocin, a hormone that affects love and bonding. So pilot studies are being reviewed and should start soon. Interesting.

Clinic Notes: French Politics and the Treatment of Autism

In 1943, after American psychiatrist Leo Kanner published the first paper on autism, psychoanalytically oriented psychiatrists, blamed moms for autism. These so-called “refrigerator mothers”, who were emotionally cold and rejecting, caused a psychosis in their children which was similar to schizophrenia. (Very few autistic children actually develop adult schizophrenia.) Unfortunately, mothers at the time not only had to deal with an autistic child they also had to deal with their guilt. Psychoanalyst Bruno Bettelheim wrote extensively about the relationship between emotionally distant mothers and their autistic children. In the 60’s, following the publication of Bernard Rimland’s Infantile Autism many psychologists, psychiatrists, and of course neurologists, thought biological factors caused autism. I had dinner with Bettelheim in the early seventies and I tried to discuss the role of biological factors in autism with him. He refused to accept the possibility and told me in no uncertain terms to go read his books. There I would find everything I find all of the answers about autism. At the time I thought he was a relic from the past and did not think about him until I read recently that in France Bettelheim’s legacy is flourishing. Parents of children with autism are offered psychoanalysis as treatment for their children with autism despite research showing that it is ineffective. Apparently, French politics is heavily influenced by the psychoanalytic community.

Clinic Notes: Symptoms, Syndromes, and the Autism Spectrum

If you spent a few hours in the waiting room at The Children’s Treatment Center where I treat children, most of whom have Autism or Asperger’s diagnosis, you would be confused. Children on the Autism Spectrum are different—very different. At the lower end of the Spectrum we have children who are low functioning and often have a comorbid diagnosis of Mental Retardation, and are in special education classes at school. At the high end of the Spectrum we have children with high functioning autism and/or Asperger’s, who usually mainstreamed in school, but have more than their share of social problems. To add to the confusion you would also see kids with a dual diagnosis such as ADHD and Autism or Autism and ADHD, which even confuses me. Of course, part of the problem is there is no biological marker for Autism. But part of the problems is a carelessness among clinicians in diagnosing a syndrome, which is a collection of symptoms, and then adding a syndrome such as ADHD, which is a symptom often that makes up the syndrome Autism. In my view, this is a recklessness among clinicians that confuses parents, teachers, and other caregivers.

Clinic Notes: Children with Autism Have Unique Faces

A recent study at the University of Missouri found that different facial characteristics could be used to diagnosis children with autism. The facial characteristics are not so prominent that children could be picked out in a crowd as is the case with Down’s or Fetal Alcohol Syndrome. The diagnostic facial features are measured from 3 dimensional images taken of the face. Children with autism had statistically broader upper faces, wider eyes, a wider mouth and a wider philtrum. These features were formed before birth so this would imply a genetic cause of autism.

Clinic Notes: Dr. Gary Brown's Autism Diagnosis and Treatment Plan for Parents and Caregivers

Parent and caregivers hear so much discussion and get so much advice about autism that they are confused. Many times they go in so many different directions that they are not efficient in managing time and money and providing effective therapy for their child with autism. Over the years countless parents and caregivers have asked me to write a summary of what they should do to provide the most effective treatment for their child with autism. So on my website, www.aba4autism.com, I have provided a 7 page summary titled, Dr. Gary Brown's Autism Diagnosis and Treatment Plan for Parents and
Caregivers. All of the issues regarding diagnosis and treatment of autism are covered.

Dr. Gary Brown's Autism Apps Party

Dr. Brown's Apps is participating in the A4cwsn 3rd FB App Party thru 10/3! 50% of the proceeds from our app sales this weekend go towards helping children with special needs. Our Colors app will be $5 and all our other apps and packs will be only $2 each! Check out A4CWSN for free apps and promos all weekend long!!! And don't forget A4cwsn - Australia and A4cwsn - Canada

Clinic Notes: Different Strains of Autism

In previous blogs I have discussed that obvious variability that exist in the behavior of the children with an autism diagnosis who come to our clinic. The Autism Spectrum ranges from children at one end who are low functioning to children at the other end who are high functioning children with autism and Asperger’s. It has never been clear if we are dealing with one disorder with varies in its severity or multiple disorders. A recent study form the University of California Davis MIND Institute sheds some light on this. In a study that started in 2006, brain growth, exposure to environmental variables, and genetic factors were examined. The 350 children in the study ranged in age from 2 to 31/2. Two sub types of autism were identified. A group of boys with enlarged brains developed normally until 18 months of age and then regressed into an autism diagnosis. Another group did not regress but showed sighs of autism early and had compromised immune systems. The investigators theorized that other subtypes would emerge in future studies. Of course identifying groups early would allow clinicians, such as myself, to individualize treatment plans.

Clinic Notes: Brain Imaging and Autism

There is no biological marker for diagnosing autism as there is for other chronic disorders. This makes research more difficult because we are not sure if our “autism group” is “contaminated” by children with other neurological disorders. Treatment is not hampered so much because these kids need treatment no matter the diagnosis and at this point treatment is pretty much the same for different neurological disorders—treat the symptoms. Researchers at Stanford are using a new Mri technology called called "multivariate searchlight classification." In this method the brain is divided into a three-dimensional grid, and each cube of the brain is examined for its volume of gray matter. Hopefully, this procedure will allow a diagnostically useful comparison between normally developing children and children with autism. Of course, the cost of diagnosis will be phenomenal.

Clinic Notes: Marriage Patterns and Autism

I see thirty or forty children diagnosed with autism in my clinic each week. The children are a good sample of the spectrum ranging from low functioning non-verbal to high functioning very verbal. The children at the high end of the spectrum are usually diagnosed with Asperger’s, a diagnosis that will not appear in the next DSM because it has been voted out. Hmm. These children with Asperger’s—excuse me—High Functioning Autism are very interesting—remarkable talents in tech areas, but not up to par in conversation and social skills. It is clear that more females are showing up in this category over the last several decades. This can be seen in the number of female college graduates in math, science, and engineering. Well, what would happen if the male High Functioning Autism met a female with High Functioning Autism. Perhaps love and marriage and a meshing of genes that would produce offspring that could account for the growing number of children diagnosed with autism over the last decade according to well known autism researcher Simon Barron-Cohen of the Autism Research Center at the University of Cambridge. An interesting hypothesis that needs data.

Clinic Notes: Something Nice

Okay I know that I usually blog about clinical and research issues concerning kids on the Spectrum, but this was just too nice to pass up. The Theater Development Fund has said that it will present “The Lion King “in an autism friendly presentation on Broadway. The usual visual and auditory stimuli that would be too much for a child with autism will be toned down and a guide for families will be sent out prior to the performance so the child will know what to expect. This will be the first Broadway show in history to play to present a special performance for children with autism. The October 2 matinee tickets will be reduced for the autism audience.

Clinic Notes: Who Should Be Licensed to Do ABA?

ABA has established itself as the treatment of choice for autism and with the rates of autism becoming epidemic pressure is on private insurance companies to pay providers for ABA. Virginia and California have passed laws to require insurance companies to pay, but the question of licensure is standing in the way. Many Psychologists who are licensed as health care providers by the state are providing behavior therapy and ABA are getting reimbursed. Board Certified Behavior Analysts (BCBA) are sometimes reimbursed by insurance companies, but they are not licensed by state health boards. Their program is a certificate program administered by their organization. Some “providers” of ABA are self-taught perhaps attending a workshop or two and are not reimbursed by insurance companies. So what should a parent do? On my website, www.ABA4Autism.com, I tell caregivers that the ABA provider for their child should at least be a BCBA. It will be interesting to see how this plays out.

Clinic Notes: The Genetics of Autism

Most of us who have been treating autism for a long time have accepted that autism is a genetic disorder. When parents, who have a child with autism, inquire about having another child, we often recite the concordance rates for them. In other words, what are the odds of having another child with autism? But I have always wondered if autism is a genetic disorder, why the sudden rise that is now epidemic. What changed all of a sudden genetically to cause the epidemic? It is unlikely that people with the autism gene(s) started mating together all at once. Something more than genetics have to be involved to account for the dramatic in autism.
In a recent study, the genetics of autism has been turned upside down. Twins were identified in the California Department of Developmental Services database who had an autism diagnosis. Of these 192 pairs of twins, which had at least one twin diagnosed with autism, the study found a concordance rate of 77% for identical twins and 31 % for fraternal. These figures are in similar to previous studies. But when these results were analyzed by a computer model that looked at the role of genetic and environmental factors the story changed. Now genes accounted for 38% of the risk factors and environmental 58%. Of course the study has been criticized.

Clinic Notes: A Biological Marker for Autism?

One big problem in conducting studies on the causes of autism is reliable diagnosis. There are no biological markers of autism so autism is inferred from the child's behavior. The problem arises then that there such obvious variably from one child with autism to another that a "spectrum" is required to "explain" this variability. So is autism one disorder or many? Obviously, this is a fundamental question that must be answered before much progress can be made in discovering the cause of autism and developing more effective therapies. A study at the University of California at San Diego found differences in functional magnetic resonance image (fMRI) scans of children diagnosed behaviorally with autism and normal controls. The fMRI's, taken while the children were sleeping, found that the two hemispheres of the brains of the children with autism were not "syncing."
Well, if this is replicated in other studies it will certainly advance our understanding. The only downside I see is that research will then be done in large universities with large grants. The cost for a fMRI and a MRI suite can run $500,000.

Clinic Notes: Antidepressants and Autism

According to a California study, mothers who use selective serotonin reuptake inhibitors (SSRI's), a common medication for depression, during pregnancy have a higher rate of children with autism. The net effect of these drugs is to increase the amount of serotonin in neurons in the brain that use serotonin as their neural transmitter. There are studies that indicate that children with autism have higher levels of serotonin in their circulatory systems. Sounds good. But there are also studies that show that children with autism have lower levels of serotonin and often children with autism are given SSRI's to increase serotonin. Confused? Me too. Because I have seen children with autism in my clinic improve when they are given SSRI's. I do not know how to explain this. But I do know that in this study and others serotonin levels are measured peripherally in the blood usually. No one has demonstrated that peripheral measures of serotonin correspond to central levels in the brain. I am getting to the point that I want to see a study that finds something that doesn't cause autism.

Clinic Notes: iPad Apps for Children with Autism Redux

At the Children's Treatment Center I see 40 plus kids per week. Most of these children, 89-90%, have autism or some related disorder. The age range is 18 months to 12 years of age and ABA, behavior management; touch screen computer drills are the therapies we have employed. But, as I mentioned in a previous blog, the iPad has beena game changer. All children, but especially children on the spectrum, are drawn to the iPad and work better on the apps that they do live or with the touch screen computer. We just put out DDT Sight Words app in the store after testing it in our clinic for weeks. Just like DTT Colors, DTT Shapes, DTT, Letters, and DTT Numbers, the kids learned much quicker, stayed on task without being prompted, (most did not want to take a play break). If I had a wish for children with autism it would be their very own iPad loaded with apps--ours--amd the many other great apps that are out there. If you are a parent, teacher, or therapists check out this amazing technology. If you have an iPad and would like recommendations for apps let me know.

Clinic Notes: Gary James' App Party for Autism

As I've mentioned in previous blogs, Apple's iPad is a wonderful tool for children with autism. The children in our clinic have what appears an almost Zen like relationship with the iPad. They calmly work on drills on the iPad like Discrete Trial Training (DTT) with greater ease and prompting than they would with flashcards. The only downside is the costs of the iPad and the apps. This past weekend, Gary James who tests and reviews apps for children with autism on his website A4cwsn, helped out by throwing an app party. iPads were give away and leading app developers either discounted or gave away free apps. To help out, Dr. Gary Brown's Autism Apps gave away 3,100 FREE copies of the Autism/DTT Shapes app and discounted our other apps. If you are interested in learning about apps for children with autism visit A4cwsn. And while you are there thank Gary James for throwing a great app party!

Clinic Notes: Developmental Disabilities in Children Are Increasing

According to a recent article in Time Magazine by Meredith Melnick, developmental disorders in children are rising. She draws on a recent study in the journal Pediatrics which found that 15% of children in the U.S. were diagnosed with a developmental disability in 2006-2008 compared to 12.8% in 1997-1999. Autism and ADHD are the disorders showing the biggest increases with autism rates 4 time greater and ADHD going up 33%. The rates in male children were twice that of females. Children from low-income families had higher rates of developmental disabilities. According to the study authors, more preterm births, older parents, less stigma, better screening, more awareness among parents and child-care professionals, are possible explanations. Their study was based on CDC surveys.

Clinic Notes: More Links to Autism Reported

This week two studies found links to an increased risk of having a child with autism. A study at the University of California at Davis found mothers who had fever during pregnancy and a difficult labor were more likely to have a child with autism.
A second study also from the University of California at Davis found that women who were obese before becoming pregnant, or suffered from hypertension, or diabetes were more likely to have children with autism. Some of these correlations were large--mothers were as much as twice as likely to have a child with autism if these factors were present. Well, anybody who keeps up with the research into the causes of autism is seeing a steadily increasing list. I am almost to the point of asking what does not cause autism. Forty years ago when I was a graduate student in a medical psychology program the research on cancer was very similar. It seemed that everyday a new study came out reporting an association between a variable and cancer. Often the follow up research was not supportive, but we still do not know exactly what causes cancer. Fortunately, we understand enough about cancer to develop effective therapies. And it will be the same with autism.

Clinic Notes: Autism Rates Are Up Again

What would a recent study on the rates of autism find? Well, if you guessed another increase you would be correct. Autism rates in South Korea are reported at 1 in 38 children. The sample was large 55,000 ages 7-12. That compares to 1 in 110 in the United States. While most studies, including the one in the US, looked at children in special ed programs, the one in South Korea looked at the prevalence of autism in the entire population.
www.autismsupportnetwork.com

Clinic Notes: Cost of ABA

As most parents of children with autism know, Applied Behavior Analysis (ABA) as a treatment for children with autism was pioneered 25 or so years ago by Ivar Lovaas. This was before autism was epidemic and somewhat of a novelty diagnosis. Many parents and some therapist say that ABA cures autism and will spend anything to see that their child get ABA. ABA does not cure autism. Lovaas's studies did not show that ABA cured autism, but that children with 40 hours of ABA weekly were more likely to be mainstreamed. Most children with autism will need speech and occupational therapy for fine motor problems in addition to ABA. Some families are spending $100,000 yearly for ABA. Sometimes insurance companies will pay for ABA and even have a billing code for ABA. But then again in some states the same insurance will deny payment saying that ABA is experimental. Now I am a psychologist in the ABA business and live in a rural community. I don't know of anyone spending six figures on ABA. Licensed Psychologists and Board Certified Behavior Analyst (BCBA's) are qualified providers of ABA. Someone who has been to a workshop on ABA is not. Spend your money wisely.

Clinic Notes: The Business of Autism

I see 40 children each week at the Children's Treatment Center. In addition, I blog weekly, trying to keep everyone informed about the autism war in the trenches, process orders and answer emails at my website www.aba4autism.com, trying to provide materials worldwide for parents who cannot afford professional services. I also design apps for the iPad, iPhone, and iPod touch for children with autism who are hooked on these devices. Now, last month and this I have a new product in my autism world--putting on a 5k run and 1 mile fun walk with the proceeds going to Autism Speaks. Much of my research into the causes of autism is on the back burner for now. Maybe after the 5K I will have time to get back into it. Hmm--if someone discovered a cure for autism I wonder how I'd spend the rest of my life. Smiling.

Clinic Notes: Ipad Apps Redux

As I mentioned in an earlier blog, the iPad is the pied piper for kids with autism. Many apps for children with autism are available now in the iTunes store, including our Discrete Trial Training (DTT) apps for teaching colors, shapes, letters, and coming this week numbers. I have a list of over 20 apps in development for children. Our apps have been well received and have had good reviews. If you are using our apps I would be interested in your comments as well as any other apps that you have found useful for children with autism. Visit our Facebook page at http://www.zbobbapps.com/to get redeem codes for free app downloads.

Clinic Notes: Ipad Apps Redux

As I mentioned in an earlier blog, the iPad is the pied piper for kids with autism. Many apps for children with autism are available now in the iTunes store, including our Discrete Trial Training (DTT) apps for teaching colors, shapes, letters, and coming this week numbers. I have a list of over 20 apps in development for children. Our apps have been well received and have had good reviews. If you are using our apps I would be interested in your comments as well as any other apps that you have found useful for children with autism. Visit our Facebook page at http://www.zbobbapps.com/to get redeem codes for free app downloads.

Clinic Notes: "Wretches and Jabberers"

Tracy Thresher, who is nonverbal because of autism, and friend Larry Bissonnette call themselves "wretches" and people who can speak they call "jabbers." Their message, the subject of a new documentary being released in 40 cities, is simple. They are intelligent, but intelligent in a different way--a way that requires people to look beyond the "wacky, goofy behavior." Disability does not equal dumb is the message they try to spread as the travel to Sri Lanka, Japan and Finland.

Clinic Notes: Virtual Conversations and Autism

My clinic experience with autism and technology, such as computers and iPads, and reports of children with autism interacting with robots, has led me to believe that effective treatment of autism has to involve technology. So I was glad to see a report this week which found that adults with autism improved when they interacted with a virtual partner. The study was reported in "Cyberpsychology, Behavior, and Social Networking. The adults with autism in the study were high functioning and were given onscreen dialog options for their conversations with their virtual partner. They were able to initiate and maintain a conversation on a variety of topics. Perhaps one day these can be implanted and cue the child to converse appropriately in different social situations.

Clinic Notes: iPad DTT Apps for the Child with Autism

Our third iPad DTT app for teaching letters to the child with autism is now in the iTunes store. Our Facebook page has free redeem codes. I have been treating autism for a long time and I am amazed at how well the iPad works with children with autism. Contact me at www.aba4autism.com and I will send you suggestions for apps from other developers that we use in our clinic.

Clinic Notes: Serotonin and Autism

Serotonin is a neural transmitter involved in a variety of functions. Many pediatric neurologists and neural psychiatrists routinely put children with autism on Selective Serotonin Reuptake Inhibitors (SSRI's). The net effect of these drugs is to increase the availability of serotonin at the synapse because theoretically children have low serotonin levels. The SSRI's were originally developed to treat depression and include drugs like Prozac and Zoloft, which are well known. Some animal studies, using mice models of autism have confirmed that these drugs do indeed increase serotonin and alleviate some of the symptoms of autism. But any clinician who regularly treats autism will tell you that they do not always work. It seems to me that the SSRI's work about half the time in children and are well worth a trial. But why don't they work all of the time? In my view, it is because we may very well be dealing with different neurological mechanisms. We put kids who meet certain diagnostic criteria on the spectrum, but since there are no known biological markers for autism we do not know that the same neurological mechanism are the same.

Clinic Notes: Autism in China

Except for a few isolated countries autism seems to be a worldwide problem. We are having our Discrete Trial Training apps translated into Chinese for the Itunes store in China and I have been researching autism in China and how services are being provided. Accurate information is hard to gather, but it seems that autism is common and that there are only a few private facilities that provide treatment. Most Chinese, especially in rural areas, cannot find or afford treatment. The Chinese government has not set up any treatment programs. Interestingly, the main concern of the government is with their "retirement program". Traditionally, in China the children take care of their elderly parents (attractive to companies moving to China) and the government is concerned that the children with autism will not be able to care for their parents when they are old.

Clinic Notes: Diagnosing Autism Redux

Every clinician knows that the earlier autism is diagnosed and treatment started the better. Unfortunately, autism is not diagnosed until the child is between 2 and 3 and a delay in language sends up the autism flag. Recently at Children's Hospital in Boston researchers using brainwave data from an electroencephalogram (EEG) and a high tech computer analysis were able to correctly identify 9-month old infants who were likely to develop autism with a 80% success rate. Of course, this diagnostic tool must be replicated with another sample of infants, but the results sound promising. The next problem will be in getting the insurance companies to pay for services for a nine-month old infant who statistically has a chance of developing autism.

Clinic Notes: iPad Hypnosis of Children with Autism

In a previous blog, I discussed the iPad fascination that children with autism have. Just about every child with autism that I have handed my iPad to has become enthralled, almost hypnotized, and quickly learned to navigate through different iPad apps. At the Children's Treatment Center for Autism or Related Disorders we are testing Discrete Trial Training (DTT) apps that we have developed, several are in the iTunes store now, (Autism Colors and Autism Shapes) and they are being well received. Other apps that are being developed by us and other developers are also doing very well. As I reported in a previous blog the iPad works much better for kids with autism than the touch screen computer. No one has a clue why this is so. The new iPad, coming sometime this spring, will be different. I only hope the children will find it just as hypnotizing. In my 40 years of working with these special kids I have never seen anything like this.

Clinic Notes: Toxins In Pregnant Women

A question I am asked every day in my clinic is what causes autism. Well the short answer is we don't know. Most clinicians and scientists working in the autism field suspect something in the environment that is somehow affecting brain development of the infant either pre or post natal or both. Studies have shown that autism rates go up the closer children live to a freeway or agriculture field. But there may be much more to the story. A recent study in the journal Environmental Health found 43 chemicals in 268 pregnant women, many banned since the seventies. Some have been shown to affect brain development and hormone regulation. Well that is certainly going to be a challenge for researchers.

Clinic Notes: Family Planning in the Age of Autism

The only family planning my wife and I did was to wait until I was out of graduate school. I was 27 and she was 26 when our first child was born and our second child was born 5 years latter. Both were female and normally developing, as are their children now. But now, family planning in the age of autism just got a lot more difficult.
A study reported in the journal Pediatrics found that the closer together children were spaced in date of birth the greater the chance of the second child having a diagnosis of autism. We already knew that older mothers and or older fathers increased the chances of autism, but this new study complicates that finding. So to increase the odds of our children staying off the autism spectrum we have to have our children early, but not too close together, both parents should be young--I've seen young moms and older dads have children with autism--something about old sperm--so no more younger trophy wives. And of course it is better to have girls than boys because the ratio of autistic males to females is 4 or 5 to 1. Living close to a freeway or an agriculture field increases the chance of autism so couples may need to move before having a family. And higher education is correlated with autism so drop out of school. I don't recall seeing a young teenage mother with a child with autism in my clinic, but perhaps there are some.
There is nothing funny about autism and I don't mean for this blog to be humorous, but this is what the data are telling us at this point.

Clinic Notes: Wakefield Redux

No one knows why Autism is epidemic. In my clinic 75 to 80% of the children I see each week have an autism diagnosis. From the studies we have published, the literature we have reviewed, and the histories we have taken of our patients I believe autism will be like cancer and have multiple causes. Like cancer, we have good treatment protocols for autism without knowing the cause, but it would be nice to know the cause--just one simple cause. It was reported to day that Andrew Wakefield, who published a study in a British medical journal linking autism to the MMR vaccine altered the medical histories of his patients. This was not a case of careless research, but an "elaborate fraud" as quoted by the British medical journal. Since Wakefield's article vaccination rates have gone down and predictably cases of measles and other diseases have gone up. Wakefield has lost his medical license, no one can reproduce his results, his co-authors have removed their names from the article, and the journal Lancet retracted the article. But all this will do little to dissuade Wakefield's supporters. Usually, autism is diagnosed between the second and third year of life. And the only thing that happened that year according to the parent's recollections was the vaccinations. It is very hard for parents to let go of that.