ABA4Autism or other Neuropsychological Disorders

Clinic Notes: Ecstasy for Autism?

2011-12-29T11:50:00.001-08:00

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

2011-12-09T08:35:00.000-08:00

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

2011-11-29T14:26:00.001-08:00

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

2011-11-01T16:14:00.001-07:00

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

2011-10-11T13:38:00.001-07:00

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

2011-10-01T11:14:00.000-07:00

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

2011-09-24T08:21:00.000-07:00

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

2011-09-07T11:35:00.001-07:00

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

2011-08-26T14:06:00.000-07:00

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

2011-08-19T12:28:00.001-07:00

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?

2011-08-12T11:39:00.000-07:00

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

2011-07-26T12:39:00.000-07:00

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?

2011-07-15T08:36:00.002-07:00

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: A Biological Marker for Autism?

2011-07-15T08:36:00.001-07:00

Clinic Notes: A Biological Marker for Autism?

2011-07-15T08:36:00.000-07:00

Clinic Notes: Antidepressants and Autism

2011-07-08T13:53:00.001-07:00

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

2011-06-28T13:13:00.000-07:00

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

2011-06-16T12:38:00.000-07:00

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

2011-06-10T07:03:00.000-07:00

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

2011-05-19T13:54:00.001-07:00

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

2011-05-14T09:34:00.000-07:00

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

2011-04-21T16:34:00.001-07:00

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

2011-04-14T13:27:00.000-07:00

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

2011-04-07T13:47:00.003-07:00

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

2011-04-07T13:47:00.001-07:00

Clinic Notes: "Wretches and Jabberers"

2011-03-31T14:38:00.001-07:00

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

2011-03-24T10:22:00.000-07:00

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

2011-03-17T14:39:00.000-07:00

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

2011-03-10T13:52:00.001-08:00

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

2011-03-04T08:58:00.001-08:00

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

2011-02-24T12:38:00.001-08:00

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

2011-02-04T09:10:00.000-08:00

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

2011-01-28T07:35:00.001-08:00

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

2011-01-12T16:16:00.001-08:00

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

2011-01-06T13:53:00.001-08:00

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.

Clinic Notes: Technology for Treating Autism

2010-12-29T11:31:00.001-08:00

Many parents who bring their children with autism to my clinic ask what they can do at home to help progress their child. Of course, we have then run the ABA programs for compliance that we run in the clinic and other ABA programs for skill building. But many parents want more. After looking at all of the autism products online they ask about their usefulness. We advise many parents to buy lap top computers if their child is high functioning and we point out software that is useful and that we use in our clinic. But they always want more. And the more has arrived in the Apple iPad. As I have mentioned in previous blogs children with autism are fascinated with the iPad. If you type "autism apps" in the search box in the iTunes store you will find a number of useful apps with more coming each day. If readers would like help in choosing apps for their child please let me know.

Clinic Notes: Children with Autism and the iPad

2010-12-16T12:38:00.000-08:00

Apple's iPad is causing a lot of excitement in the autism community. Many parents of the children with autism who I see in my clinic have asked me if they should buy one for their child. So I thought I would blog about what I have seen in the app testing we are doing. First of all, I read an online article about a mother who won an iPad in a raffle and handed it to her child with autism. When she came back a few minutes later he had turned it on and was navigating through the different functions without having ever seen one or being instructed in how to use it. I thought this seemed farfetched so I handed my iPad to a child with autism who comes to our clinic. He looked it over and then proceeded to turn it on and navigate through the different functions without having seen it being used or given any instructions. So it is true--many children with autism have an intuitive feel for the iPad. I have even heard a rumor that Steve Jobs invented the iPad for children with autism, which he denies. In next weeks blog I will review some apps and tell readers the best way to use the iPad with a child with autism.

Autism Apps for the iPhone, Ipod Touch, and the iPad

2010-12-07T11:55:00.000-08:00

Just about everyone who keeps up with what is going on in the autism world knows by now that children with autism are fascinated with computer technology. Apple's iPad seems to almost hypnotize them. I have handed my iPad to a child with autism and they learn to use it on their own in a few minutes. The iPad seems to work even better than the touch screen computers that we use in our clinic and I didn't think that was possible. The iTunes store has apps that are especially suited to the child with autism and we have been testing them in our clinic. Prolog2go is a communication app that turns the $400 dollar iPad into an $8000 dollar assisted communication device. We are putting our Discrete Trial Training apps (DT) in the store now. Our DTT apps have been tested in our clinic with children with autism and work very well. Go to http://itunes.apple.com/us/app/autism-colors/id406336763?mt=8#ls=1 and check them out.

Autism and the Christmas Holidays

2010-12-01T10:28:00.000-08:00

Every December I repost my blog on Autism and the Christmas

The Christmas holidays can be a difficult time for parents of children with autism or other neuropsychological disorders. Of course, any holiday can be somewhat difficult for any child with all of the changes in their routine, especially when they get tired. But Christmas, with all the lights, the music, the relatives, and the crowded malls, is an especially difficult holiday, because children with autism or other neuropsychological disorders are often hypersensitive to visual, auditory, and tactile stimuli.
Children with autism are visual learners, and a month before Christmas you should take pictures of what is going to happen--the lights on the tree, the gifts, the music, the relatives that touch and hug. These pictures should be shown repeatedly each day to your child with autism or other neuropsychological disorders. While he/she is looking at the pictures, tell the child a little story about what's going to happen at Christmas, how to behave, and what your child can do if the stimulation is too much. Include your child in the pictures if possible. A picture of your child going to his or her room to escape the noise and confusion when he/she gets overloaded seems to help, too.
There are no sure-fire techniques to use with a child that will ensure a "Martha Stewart Christmas." But many families who have children with autism or some other neuropsychological disorder have used the visual learning procedure above and the ten tips that follow to have a better Christmas.
1. Try to keep your child in his or her usual routine as much as possible.
2. Sensory over stimulation—the lights, the sounds, the smells, and the relatives touching your child--are the main culprits during the holidays. Eliminating or minimizing these culprits are your best bet.
3. Some families who have children with autism or other neuropsychological disorders wait until Christmas Eve to put up their tree and decorate.
4. Some families let their children with autism or other neuropsychological disorders do all of the decorating. Children with autism or other neuropsychological disorders may line up or stack decorations rather than decorate in the traditional way, but so what.
5. Rather than try to do the Christmas shopping with children with autism or other neuropsychological disorders in a crowded, noisy mall, many families shop by catalog or online and let the child point to or circle the toys he/she wants. Websites, such as www.stars4kidz, offer a variety of toys for children with autism or other neuropsychological disorders. Just type "autism toys" in your search engine.
6. Tactile toys are often a better choice for children with autism or other neuropsychological disorders. Toys that make sounds or involve too much stimulation or are too complex may not cause an aversive reaction in the child. Try ordering some of these autism friendly toys and then let your child select the ones to play with, as they are unwrapped.
7. Talk to relatives before they come over about the best way to behave with children with autism or other neuropsychological disorders.
8. Generally, kids with autism or other neuropsychological disorders do better in the morning than in the late afternoon or evening when they are tired. It may be better to schedule Christmas events at these times.
9. The parents of children with autism or other neuropsychological disorders need to relax themselves. Often the child with autism picks up on the parents’ stress and that is enough to ruin Christmas.
10. And last but not least, realize that you are probably not going to have perfect food, perfect decorations, and perfect gifts. Christmas with children with autism or other neuropsychological disorders may not be traditional, but it can still have real meaning. I wish you and your child the happiest of holidays. Visit us at http://www.childrenstreatmentcenter4autism.com if you have questions about your child.

Clinic Notes: Handwriting and Autism

2010-11-26T08:43:00.000-08:00

Many children with autism have fine motor problems and are receiving services from Occupational Therapists (OT's). Buttoning, tying shoes, coloring, puzzles, and stacking blocks can all be issues. A recent study (Schafer Report, November 24, 2010) found that handwriting problems persist into the adolescent years. I think this reinforces what I have been telling parents for years. Do not discontinue OT even if the Ot tells you that your child with autism has met all of the goals unless handwriting is easy for the child. Letters should not only be well formed but completed in a timely manner. I have seen children with autism make bad grades simply because they cannot write fast enough to finish assignments and tests.

Clinic Notes: Desensitizing a Child with Autism to Swallow Pills

2010-11-18T14:35:00.000-08:00

About half of the children who come to The Children's Treatment Center are on medication. Many children with autism have issues with swallowing pills so parents have to hide the pills in food or find the medication in liquid form if available. Usually, this is only a short term fix. I use a desensitization procedure similar to a procedure covered in a recent Lovaas Institute Newsletter which works well. Begin by having the child swallow all of the liquid in a spoon in one swallow. Start with just a small amount of liquid and gradually increase the amount until the chills can easily swallow the entire spoon full. Do this with a variety of different liquids. Next add a small amount of juice powder to the liquid and gradually increase the amount by decreasing the amount of liquid. Follow this with a spoon of the child's favorite juice as a reinforcer. Small ice chips can then be placed on the spoon for the child to swallow and gradually increased in size. The transition can then be easily made to small pills.

Clinic Notes: Biomed and Autism

2010-11-10T16:39:00.000-08:00

Many parents tell me that raising a child with autism is just more than they can do. Keeping up with all of the ABA programs they are supposed to run in the home, speech therapy, OT, meds, it's just too much. Well, as a clinician I have to agree. Keeping clinical progress notes is often just too much for me too. There's a new app for the iPad called Biomed, which tracks patient care. A patient profile is created--name, birth date, diadnosis, etc. Next a treatment history is entered and quantified if possible. Once all of the information is entered updates are added. Biomed then summarizes everything and you can review all of the information that you have entered on a topic--say ABA-with a tap. We have started using this app at the Children's Treatment Center and we will report in a future blog how it goes.

Clinic Notes: Bad Autism "News"

2010-11-04T15:29:00.001-07:00

Last night, after working all day with children with autism in my clinic, I was scanning the autism news, looking for something to blog about. I found the usual scientific studies on genetics, brain function, therapies -- all of great interest, and countless stories about all of the good things that were being done to help children with autism. But what really caught my attention was what a bad day it had been for some children with autism. A substitute teacher was accused of biting a child with autism, a babysitter poured scalding water on a child with autism because of a toileting accident, a student was charged for bullying a child with autism, and a school in Scotland built a cage for a child with autism to "play" in at recess. Maybe tomorrow will be a better day.

Clinic Notes: Autism and Robots

2010-10-28T12:42:00.001-07:00

Children with autism have problems understanding where to look. They often do not make eye contact and often do not look where others are looking. ABA programs for establishing eye contact are usually the first thing we do in the clinic and these programs work well. But getting a child to look where others are looking can be more difficult. A recent study by psychologist Andrew Meltzoff and his associates at the University of Washington let 18 month-old infants play with toys. Then a screen hiding a robot was removed. Half of the children observed an adult talking to the robot and play a game with it while half sat the adult not pay attention to the robot. Then the adult left the room, the robot beeped, and turned its head toward a toy. The children in the group that had seen the adult interact with the robot were four times more likely to look at the toy the robot was looking at. The children in this study were normally developing, but perhaps in the studies that are developing "robot therapies" for children with autism observing a little human-robot interaction could be important.

Clinic Notes: Autism and Lying

2010-10-23T07:40:00.000-07:00

It is widely accepted that children with autism do not have insight into the thoughts and feelings of other people. But in a recent study it was found that children with autism are just as likely as control children to tell a white lie in order to not hurt other people's feelings. In the study children were told they were going to get a wonderful gift. They were then given a bar of soap. When the researcher asked if they like the gift they said yes and did not say they were disappointed.

Clinic Notes: Illegal Immigrants and Autism

2010-10-17T06:21:00.000-07:00

I have noticed an increase in the number of Hispanic children in my clinic lately. I don't know if their parents are documented or illegal immigrants or not. And I don't care. They do work at jobs that provide no health insurance so they all pay cash. Usually, just one parent is present. After the evaluation, regardless of he outcome, they want a letter addressed to "whom it may concern" describing the diagnosis and the need for the absent to join them. As I understand it autism and other childhood developmental disorders is classified a as a "exceptional and extremely unusual hardship" and could be a factor in avoiding deportation. On the other hand, I also hear of Hispanic parents who are afraid to seek treatment for their children who they suspect have autism because they fear deportation. I really don't know how to advise these parents.

Clinic Notes: Seriously now, Girls with Autism and ADHD

2010-10-07T13:41:00.000-07:00

Often when women complain about symptoms, which could indicate heart diseases, the physician does not take them as seriously as they would a male. Fewer test are run and fewer medications are prescribed. Now a recent study finds the same is true when girls in Sweden seek help with symptoms indicating ADHD or autism. The parents of were concerned about the behavior of the girls early in life, but had not been given a diagnosis. When they were older and re-examined because their symptoms persisted nearly half were diagnosed with autism or ADHD. Socioeconomic status was ruled out as a factor.

Clinic Notes: Yawning and Autism

2010-09-29T11:49:00.001-07:00

Most of us yawn during the day. The exact reason is not known, but boredom or a lack of sleep, are likely causes. Some studies have found that a yawn causes a sudden intake of oxygen, increases heart rate, and ventilates the lungs resulting in increased alertness. While the data on why we yawn is not clear it is clear that yawning is contagious. When one person yawns others around him or her are more likely to yawn. But there is one exception. Children with autism do not yawn contagiously. This makes sense to me and other clinicians who work daily with children with autism. Usually, imitation is not common in children with autism, especially those who are low functioning. The fact that children with autism do not yawn when others yawn tells me that yawning contagiously is a learned response.

Clinic Notes: Eye Tracking and Autism

2010-09-22T14:44:00.001-07:00

Clinically, I think a lack of eye contact or infrequent and un-sustained eye contact is a good indicator of autism in young children. Scientists at the University of California, San Diego School of Medicine tracked eye movements in toddlers and found that those with autism spent significantly more time looking at geometric patterns than social pictures. The children who spent more than 69% of their time looking at the geometric patterns could be diagnosed with autism. Some of these infants were as young as 14 months. This could turn out to be a useful diagnostic tool.

Clinic Notes: Special Education and Autism

2010-09-15T15:40:00.001-07:00

Unfortunately, many children with autism are in a Special Education classroom along with children with other diagnoses. Many Special Ed teachers tell me that they don't have time or don't know what to do with the children with autism. This problem can be even more difficult when you have children with autism who are at different places on the spectrum and teachers who are not trained in Applied Behavior Analysis (ABA) for managing behavior and ABA procedures such as Discrete Trial Training (DTT) for teaching skills. In our clinic everyone is well trained in these procedures and this is out primary focus with many of our children. But with some of our children who have trouble focusing there is a variety of software available from companies like Super Duper Inc. for children with autism. Children with autism function best in their visual modality and the animation in the software holds their attention. So Special Ed teachers need to find several computers, old computers will do fine, add a touch screen and some software, (neither are expensive) and they can quickly be in the business of educating children with autism.

Clinic Notes: Too Much Noise in the Brains of Children with Autism

2010-09-08T10:38:00.001-07:00

Anyone who is around a child with autism for very long will notice problems in focusing on the relevant aspects of the environment. A recent study by Jeffrey Hutsler, assistant professor of psychology at the University of Nevada, Reno provides some answers to why this is so. He examined postmortem tissue samples and found that children with autism have a 20% higher density of synaptic connections in the outer layer of the brain's cortex. The outer layer of the cortex is the last to develop and the connections are formed as the child interacts with the environment. Apparently, the excessive synaptic connections create "noise" making it more difficult for the proper connections to occur. Early interventions with the behavior therapies can help form the appropriate connections between neurons and thereby improve behavior.

Clinic Notes: Plastics, Testosterone, and Autism

2010-09-01T11:15:00.000-07:00

A recent study has found that the chemical BPA, found in plastics, including some baby bottles, and cash register receipts raises testosterone levels in men. This is interesting because Simon Baron Cohen of Cambridge University found that high testosterone levels in the amniotic fluid of the womb was related to later autistic behaviors in children. Furthermore, autism is 4-5 times more common in males than females suggesting that high levels of testosterone over masculinities the male brain. Of course, our exposure to plastics has increased over the last several decades so this could be an important etiological variable in the increased number of children with autism.

Clinic Notes: Environmental Causes of Autism

2010-08-26T10:27:00.001-07:00

As I mentioned in an earlier blog, I used to enjoy quail hunting. Flushing a covey that your dogs have pointed and having fried quail for breakfast was a real treat in the South where I live. But those days are gone. In Texas, where I'm from there are still quail, but the difference seems to be that in Texas there is ranch land and in the area of the South where I live it's farmland. Farmland means chemicals-pesticides-herbicides-fertilizer-etc. There are studies that show the closer you live to an agricultural field the higher the incidence of autism. I think there is a good chance that whatever killed the quail is also getting into our children either pre or post-natal. Humans are larger than quail so the unknown chemical culprits are not in high enough concentration to be fatal, but in high enough concentration to mess with the wiring of the brain. I was glad to see that more research into the environmental causes of autism was suggested to the Interagency Autism Coordinating Committee (IACC). Autism has a genetic component, but the concordance rate is low and other etiological factors have to be investigated. There is already some evidence to suggest that ADHD is related to environmental chemicals so the hypothesis seems reasonable.

Clinic Notes: Is the Autism Epidemic for Real? Redux

2010-08-18T13:04:00.000-07:00

The argument regarding the autism epidemic goes on. One side saying we are in the midst of an autism epidemic with 1 in 110 children being born ending up with an autism diagnosis. The other side saying changes in the diagnostic criteria for autism which resulted in a drop in the number of children diagnosed with mental retardation and learning disabilities explains the increase. A recent study by Peter Bearman at Columbia University in New York sheds some light on the controversy. He and his colleagues identified three variables, which account for much of the increase in the number of cases of autism. Diagnostic changes, parents being more aware of autism, and older parents. However, when they quantified these 3 variables to see what percentage of the increase they accounted for they found that these 3 variables only accounted for half of the increase in the number of autism cases. So it sounds like both sides are right--half right anyway.

Clinic Notes: Autism and SSRI's

2010-08-12T12:43:00.000-07:00

A class of drugs called selective serotonin reuptake inhibitors (SSRI's) are commonly used to treat autism in children as young as two. SSRI's are better known as antidepressants by their trade names--Prozac, Zoloft, Celexia, etc. Serotonin is a neural transmitter in the brain involved in a variety of functions and some studies have implicated low serotonin levels in the brains of children with autism. Serotonin is measured peripherally in the blood or urine and no one has proved that peripheral measures of serotonin correspond to serotonin levels in the brain. A recent study concludes that there is not clear evidence that the SSRI's help children with autism. And I believe that when you look at the group statistics that is true. In our clinic many of the children with autism are prescribed SSRI's at some point. In some children I see no improvement. But in others, usually the younger children with poor muscle tone I see significant improvement so I think a trial is warranted.

Clinic Notes: Autism and Lupron

2010-08-06T06:55:00.000-07:00

Autism is 4-5 times more common in males than females. This observation led Simon Baron-Cohen to suggest that autism is caused by an extreme “male brain” which is in turn is caused by exposure to high levels of testosterone in utero. Research has shown that both males and females exposed to high levels of testosterone in the womb develop behaviors characteristic of autism. In my opinion, this is the best theory of autism that we have to date. In thinking about studies to test this theory I thought of a study that would test this theory, but was potentially harmful and could not be done. Then, this week to my surprise I read that if was being done--sort of anyway. Lupron is cancer drug, which blocks the body from making testosterone. Taking advantage of desperate parents, a group of doctors in South Florida are giving the drug to children with autism. But this is not a test of the extreme male brain theory. This is an attempt to remove mercury from the body, which is "believed" by some to be the cause of autism. There's no evidence that the Lupron removes mercury or that mercury is excessive in children with autism. Futhermore, there are significant health risk in giving Lupron treatments, which cost around $5000 a month, to children.

Clinic Notes: Autism and Feeding Problems

2010-08-03T14:33:00.000-07:00

A recent large-scale study published online in Pediatrics reports that children with autism are "slow feeders" at 6 months and at 15 months are finicky eaters compared to normally developing children. However, these feeding problems do not appear to affect growth or energy levels. The authors suggest that feeding problems may be early diagnostic signs of autism so clinicians should ask about feeding problems. I think this is a good idea, but maybe the finicky eating has nothing to do with food. In my clinic I often note that children with autism are finicky eaters at all ages. But I think this could be because children with autism are just as likely to reject food on the basis of texture as taste and I also know that children with autism do not like change and characteristically follow rigid routines. I've seen cases where a rigid diet would be followed for years and I don't think it had anything to do with food, but simply routine. I know of one adult with autism who had eaten the same exact lunch, a peanut butter and jelly sandwich, for 20 years and on the few occasions when some other food was given to him he had tantrums. He would eat the other foods that were offered to him just not at lunch.

Clinic Notes: Munchausen Syndrome by Proxy and Autism

2010-07-28T10:16:00.000-07:00

On my website and in my clinic I recommend that parents of children with autism seek help from multiple professionals such as Speech Language Pathologists, Occupational Therapists, sometimes Physical Therapists, and Pediatric Neurologists in addition to the psychological services that I provide. And many parents follow my advice. Now I hear that some mothers of children with autism, so far none who come to my clinic, have been accused of Munchausen Syndrome by Proxy (MSBP). In MSBP mothers seek excessive medical care, sometimes for a disease they have caused or fabricated, and the multiple treatments may threaten or actually harm the child. Mothers accused of MSBP often have their children taken away from them by the court and now there is at least one case in court where a mother of a child with autism is being accused of MSBP and is in danger of having her child taken away from her. I guess no good deed goes unpunished.

Clinic Notes: Making Sense of Autism Research

2010-07-24T09:39:00.000-07:00

As a clinician, who also does research into the etiology (causes) of autism, I am often overwhelmed by the explosion of research findings. Which findings are useful in diagnosis? Which findings are useful in revising treatment options? Which findings are useful in designing future studies? It is simply too much--too much data in too many places with no organization. I was thrilled to read about the National Institute of Health's (NIH) new autism database. The National Database for Autism Research (NDAR) that will have research findings in one place that can be accessed by clinicians and researchers. As I read further though I was less thrilled. The database will only contain data from NIH sponsored research and will not be operational until 2012. Oh well, one small step . . .

Clinic Notes: Asperger's and God

2010-07-15T11:34:00.001-07:00

In last week's blog I discussed a teenager with Asperger's who had murdered a classmate after years of rejection by his peers. Now a big switch to a study that examined how Asperger's folks see purpose in their lives. People without Asperger's who believe in God saw His purpose behind many events in their lives. Similiarly, in terms of thinking, a group of atheists stated that things just happen there is no Devine intervention. This study supports the idea that children and adults on the Spectrum lack a "theory of mind" an ability to see or hypothesize what others are thinking.

Clinic Notes: Asperger's and Murder

2010-07-08T14:46:00.001-07:00

Children with Asperger's have problems socially. Often they are isolated and friendless and cannot understand why. Theoretically, children with Asperger's lack a theory of mind. In other words they cannot hypothesize what others are thinking and therefore cannot adjust their behavior in social situations. Recently, a child with Asperger's who had been rejected all of his life commited murder. Children with Asperger's have obsessions and this child committed murder because of his obsession with Stephen Ling novels--one of which said that the 19th would be a day of doom. So on the 19th he took a kitchen knife to school and stabbed another student to death in the restroom. The jury did not buy his insanity defense. I see a number of Asperger's children in my clinic each week and have yet to see any that are violent. Interestingly, in the new DSM revision, which is the bible of psychiatry and psychology, Asperger's will be deleted and children with Asperger's will be diagnosed with high functioning Autism. In my next blog I will discuss Asperger's and belief in God.

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

2010-06-30T10:34:00.000-07:00

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

2010-06-23T14:39:00.000-07:00

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

2010-06-17T11:23:00.001-07:00

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

2010-06-08T11:31:00.001-07:00

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.

Clinic Notes: Bullies and Asperger's

2010-05-22T08:33:00.001-07:00

I always worry about the Asperger's kids that I see who are mainstreamed. In the early grades other children are kind to them, but is middle school and high school the bulling starts, especially in schools where there is poor supervision. A recent article on a program in Toronto caught my attention. The program takes a novel approach, deprogramming bullies by Teaching Kindness 101. The school was concerned after the suicide of a15 year old in Massachusetts that was caused by bullying. After reviewing all of the anti-bullying the school found that the programs that worked the best taught positive behaviors such as kindness and empathy. The program starts in the early grades and includes bringing a mother and baby into the classroom to help children understand empathy and the perspective of others. If the baby cries the teacher helps the children understand the reason and what could be done to help the baby. Google Roots of Empathy (ROE) for more information and see if you can get an anti-bullying program started in your school.

Clinic Notes: Parents' Age and Autism

2010-05-13T12:39:00.001-07:00

A recent study in the journal Autism Research looked at parents' age in over 5 million births in California. Previous studies have found that the risk of having a child with autism increases with the age of the father. And in the new study the effect of the father's age was strong even when the mother was young. If the father was over 40 and the mother under thirty there was a 59% greater likelihood of autism. More mothers over 40 gave birth during the study period, but the increase in mothers over 40 could not account for all of the increase in autism. In my clinic I do notice lots of older parents with autism. I don't think I have ever seen teenage parents with a child with autism and I have not seen any stats on very young parents and autism.

Clinic Notes: School and Autism

2010-05-07T07:40:00.000-07:00

Many parents who have children with autism have problems deciding on what to do about school. Most public schools put children with autism in special ed classes along with children with a variety of other diagnoses. Usually, the education and behavioral management is not adequate in these special ed classes for the child with autism. The school may say that they offer ABA, which usually means that they have sent a special ed teacher to a one day ABA workshop. If parents home school the child with autism the child may fare better because sensory issues are often less and the parent can target their child's educational needs. The downside of home schooling is the lack of socialization. A recent study in Australia found that children with autism who went to weekly play groups developed social skills. A lack of exposure to play groups delayed social development on the other hand. I think some parents, depending on their child's special needs, should consider home schooling in the early years along with weekly playgroups. Home school curricula that meets state requirements are easily available and if the parent can get some ABA training then this may be a better option for many children with autism.

Autism and Ipads

2010-05-01T07:47:00.000-07:00

Autism is a communication disorder. Some children with autism are completely non-verbal, some have articulation problems and are difficult to understand, while others have problems with pronouns, tense, or sentence structure. Some children with autism learn to communicate by pointing and/or tantruming when the do not get what they want. Many of the behavioral problems seen in children with autism are due to the frustration over not being able to communicate. Sign language and Picture Exchange Communication System (PECS) have been used in the extensively to try and establish communication in children with autism. Recently, electronic communication systems where a child presses a button with a picture on it and a computer generates a voice which "speaks" for the child has been the treatment of choice. These systems work very well, they are easy for the child to use, and the frustration over not being able to communicate disappears along with the behavioral problems. Unfortunately, these communication devices cost around $8000. The Apple Iphone can be converted into a mini electronic communication device with a download from the Istore and I understand that the new IPad has a similar app. The Ipad will be much more affordable but will not have as many options or be as indestructible as the $8000 device. Since language acquisition by age 5 is a good predictor of how children will do the cheaper IPad is something to consider.

Clinic Notes: The Onset of Autism

2010-04-22T13:38:00.000-07:00

Everyone knows by now that the earlier ABA is started for children with autism the better. The problem is there are no biological markers so inferences have to be made from behavior. The categorization of autism into infantile, where the disorder is supposedly present at birth, and regressive, where development is normal until between 2 and 3 has fallen out of favor. According to one study that looked at homemade videos signs of autism were present in children latter diagnosed with regressive autism. As a clinician, I was never satisfied with this study. I think there are cases of regressive autism where signs were missed but I still think most parents are right when they tell me everything was normal until 21/2 years or so. A new study from the Kennedy Krieger Institute finds this "lost" distinctions may be vital as far as prognosis. When children with early onset of symptoms (infantile) were compared to children with later onset (regressive) it was found that children with regressive were more severely impaired and need more services. Of course, the earlier the ABA the better for the early onset children, but apparently no biological or behavioral markers for the children with regressive autism.

Clinic Notes: Autism and Driving

2010-04-08T10:42:00.001-07:00

For most teenagers driver's ed and getting a driver's license is a rite of passage that they can't wait for. However, many kids with high functioning autism and Asperger's find the thought of driving stressful. I have had a number of kids on the spectrum in my clinic that simply had no interest in driving. Others found driver's ed very stressful. Some had no problem learning the necessary skills for driving, but once driver's ed was over they had no interest in taking the test to get their license. Sydney University in Australia has begun a specialized driving program for kids with Asperger's. They also report high anxiety levels because of the coordination of sensory and motor systems that driving involves. So far there are no reports on the success of their program. I am interested because in the kids that we are able to mainstream a lack of public transportation in the rural area where I practice is going to mean driving to a job.

Clinic Notes: World Autism Awareness Day

2010-04-01T10:35:00.000-07:00

World Autism Awareness Day is being celebrated April 2. The Secretary of the United Nations is calling for a "Community of Voices to Promote Greater Awareness." For those of us who work everyday with children with autism and for parents of children with autism it is hard to believe that there is a need for more awareness since it occupies our time 24-7. But there is. Many people just don't understand the battle that is being waged over funding, research, and treatment. I do think there is some good news. Parents of children with autism and professionals who work with children with autism are becoming more aware of what works and what does not work. Of course, there are still intense arguments about causes of autism--especially over vaccinations. But most caregivers are settling into mainstream treatments like ABA, speech, occupational therapy, and when necessary medication. More and more parents who come to our clinic are already acquainted with ABA and other mainstream treatments and have decided that ABA should be the treatment for their child. Funding for ABA and finding qualified experienced ABA professionals is now the challenge, as it is for other mainstream treatments. And the waiting line for diagnosis is still too long.

Clinic Notes: The New Heath Care Bill and ABA

2010-03-23T12:27:00.000-07:00

As everyone knows by now, the Health-Care Reform Bill has passed both Houses and been signed into law by President Obama. The Autism Society issued a statement saying "that Congress took a step in the right direction, . . but we have much more work to do to ensure that families affected by autism have access to appropriate services . . ." The new bill requires coverage for ABA therapy, which many insurance companies were denying saying that ABA was experimental. Good news so far. Now we will see how it's implemented. Thirteen states have filed lawsuits contesting the passage of the bill. We will have to wait a while to see how the ABA coverage is implemented and the actual coverage required. TennCare will pay for ABA in the state where I live and practice. The problem is the the reimbursement rate is $18 dollars an hour. With my overhead I cannot afford to take TennCare patients. Hopefully, the new law will be better.

Clinic Notes: Medication and ABA Redux

2010-03-18T13:46:00.000-07:00

My last blog on medication and ABA prompted several insightful comments that I would like to address. First of all I am not pro med. Medication should only be used as a last resort after more conservative behavior therapies have been implemented. And this is what I tell parents who bring their children to my clinic. Furthermore, medications may facilitate other therapies but they will not "cure" or manage the behavior problems by themselves. Medication trials should only be initiated when the potential benefits of the medication clearly outweigh the potential side effects of the medications. If the medication trials do not show a clear effect in increasing the quality of life for the child then the medication should be discontinued. THIS "BEST PRACTICE" GUIDELINE SHOULD BE FOLLOWED BY EVERY CLINICIAN AND PARENT.
Now potential medications can be evaluated in a multi-child study with as much scientific control and safety guidelines as possible. It is difficult to get approval for these studies because the committees in charge of protecting subjects usually turns them down. Often, when these studies are done they are post hoc where medical records of subjects receiving the medications and a control group are examined. These studies usually show no differences between the control group and the medication group. More commonly medications are "evaluated" off-label in a clinical setting. A child having problems in school is given an ADD drug because the parents and teachers complain that he child will not stay on task. Ideally, a behavior program should be implemented first but that is not always done. And the criteria for success should be clear. Parents and teachers may report that the child on the ADD drug is paying attention better. But an examination of the child's grades often show no improvement. The child is easier to manage but that is not enough.
Clearly, there are many children who are over medicated and/or miss-medicated. But there are also a lot of children who could not function without their medication. Clinicians and the public need to be very careful in distinguishing between the two groups.

Clinic Notes: Medication and ABA

2010-03-13T08:28:00.000-08:00

The popular press has carried a number of stories recently about the large number of children in our society being over-medicated with psychoactive drugs like Prozac, Ritalin, or Risperdal. These stories quote the possible multiple side effects of these drugs and the harm that could be done to these innocent children. Uncaring parents that don't have time for their kids and careless doctors prescribing, "dope" is the image that is portrayed. Often the first thing parents tell me when they bring their children to my clinic is, "We don't want medications." So where are the uncaring parents and careless doctors? Well, actually they are hard to find. A child on medication is usually a sign of good parenting. I tell parents we will try to do everything we can behaviorally and then see if medications are necessary. And often, about half the time medications are necessary. About 80-90 percent of the children I see each week are on the Autism Spectrum and about half are on medication. Applied Behavior Analysis (ABA) seems o be facilitated by medication in many cases.

Clinic Notes: Does Early ABA Rewire the Brain?

2010-03-05T12:40:00.000-08:00

In the developing infants brain billions of axons (nerve fibers) that conduct electro/chemical messages follow growth cones through a tangled web of other axons to arrive at their final destination and connect different areas of the brain. Genes that encode the molecules that guide the growth codes somehow go awry and miss the pathway they are supposed to be following. This mis-wiring is likely the cause of autism, Parkinson's disease, and perhaps other disorders. During development, as different areas of the brain are wired up, the infant then displays new behaviors. Around age four, the majority of the connections are made and there is a die of neurons. The wiring process continues throughout life, but at a much much lower rate. Hence the importance of early intervention. I think that early intervention, especially with ABA, rewires the brain and improves the behavior of the child with autism. Studies support the improvement of children with autism following ABA but do not specify the mechanism.

Clinic Notes: Autism's Earliest Symptoms and ABA

2010-02-27T11:42:00.000-08:00

At the Childrens Treatment Center (www.Childrenstreatmentcenter4autism.com) I see 40+ kids a week. Most of these children have autism and are helped by ABA. Naturally, with autism being epidemic, I have been looking for signs of autism in my grandchildren from birth on. Studies have found that if intensive ABA is started early enough the symptoms and the diagnosis of autism may disappear and I want to be ready. Normally developing infants show some signs of autism at times--staring at objects--not responsive to stimuli--avoiding eye contact--etc. The question is when in the infant's development are these signs clinically significant. A recent study from the MIND Institute finds that symptoms like eye contact--smiling and communicative babbling are not present at 6 months, but develop gradually and only become observable during the latter part of the first year of life in infants. Furthermore, these behaviors appear they decline slowly, not suddenly in infants with autism. So watch your infant from 6 to 12 months and be prepared to start ABA if you notice these declines.

Clinic Notes: Children with Developmental Disabilities and God

2010-02-24T12:34:00.000-08:00

According to a recent Schafer Report, Bob Marshall, a legislator in Virginia, said in a press conference that disabled children are God's punishment because mom's had prior abortions. The press conference was a group of 20 or so clergy who were opposed to state funding for Planned Parenthood who provides abortions. Well, I see 40 plus kids in my clinic each week and their parents are struggling with the stress of raising a child with special needs and the last thing they need is to hear is that it's God's punishment. I guess I'm going against God for providing ABA and behavior management for these families. It will be interesting to see what fellow Republican Sarah Palin says about this. And by the way Mr. Marshall, none of the moms of disabled children who come to my clinic had an abortion.

Clinic Notes: Mandatory Insurance Coverage for ABA for Autism

2010-02-17T10:53:00.001-08:00

The Virginia Senate Passed a bill requiring insurance companies to pay for ABA, the most effective treatment for autism. The lobbyist for the health insurance company fought hard, but lost. Other opponents argued that the mandated coverage would result in higher coverage, perhaps even forcing some employers to drop insurance coverage for their employees. Autism Speaks said that mandated coverage would increase the cost by $10 to $25 per year. Tennessee, the sate where I live and practice, passed the Autism Equity Act several years ago which said that if insurance companies cover other neurological disorders then they must pay for autism. Parents have told me that when they have called the insurance companies to remind them of this they say their home office is not in Tennessee so they do not have to comply with the bill. Also ERISA, or employee funded insurance companies are exempt. If mandatory insurance coverage for ABA becomes law in Virginia I hope families fare better than Tennessee.

Clinic Notes: Autism and Wakefield

2010-02-12T07:41:00.001-08:00

Lancet has formally retracted Dr. Wakefield's paper that purportedly found a link between autism and the MMR vaccine. His "finding" made so much sense. Mercury is toxic to the nervous system and autism is usually diagnosed between the second and third year shortly after the MMR vaccine is given to children. But it was a flawed study and better-done research has found no link. Many parents are still convinced though and yelling cover up by government and the pharmaceutical industry. Recently, it was time for my grandchildren to get their MMR vaccines. I'll admit that I cringed. I know that's it's very difficult for a parent who has a normally developing child to see them regressing after the MMR vaccine. It is not a causal link, but so emotional and hard for parents to put aside. But it is time to move on and look for the real cause of autism.

Clinic Notes: Successful Treatment of Autism Depends on Parental Involvement

2010-02-02T13:00:00.000-08:00

Many studies have shown that early diagnosis and intensive therapy is the key to the successful treatment of autism. Multiple therapies including Applied Behavior Analysis (ABA), speech therapy, occupational therapy, and medication are essential. Parents must not only find a way to pay for these services, but get their children to therapy, which is usually weekly. (Unfortunately, money, or the lack of it, determines what services, if any, a child with autism will receive.) Only a small percentage of parents can afford, or find qualified therapists who will see their child more than once a week. Autism is epidemic and money speaks. Lovaas recommends 40 hours of ABA a week, but who can afford that or find a therapist who will give a single child an entire workweek. So the majority of the therapy--ABA, speech, ot, etc falls to the parent. It's a burden--but one that pays off in the long run.

Clinic Notes: Let's Just Bury our Heads in the Ground and Autism Will Go Away

2010-01-27T15:09:00.000-08:00

Well here's a cheap and quick way to cure autism--just say it is not a medical disorder or disability but a "socially created disability," whatever that is. Apparently, that's what President Obama's nominee Ari Ne'eman to a national disability council is saying. Mr. Ne'emans, who has very mild Asperger's, is against investing money in anti-cure autism research. Well, that's going to thrill parents who bring their children with autism to my clinic. I glad that Mr. Ne'emans has overcome his disorder and is in a position to be nominated, but I don't think he would be any parent of a child with autism first choice. I doubt that he has seen children with autism banging their heads or biting themselves. Or children with autism who have developmental delays in all areas including language. I don't know how this was socially created. Perhaps the next time a mother brings her child with autism to my clinic complaining that throwing feces is a problem at home and school I will just say, "That's just a socially created disability."

Clinic Notes: Darwin and Autism

2010-01-19T14:19:00.001-08:00

Autism is considered to be a genetic disorder by many and numerous researchers are looking for the "autism gene." The concordance rate for autism (the probability for getting autism) is 60% for identical twins, but drops to between 4-8% for fraternal twins and non-twin siblings. In most cases, the number of individuals with a genetic disorder remains constant in within a population unless an individual with the disorder breeds. In the past ten years there has been an explosion in the number of children diagnosed with autism. If autism is a genetic disorder, then why the dramatic increase? Is it evolving in the population? That would not make sense. Natural selection couldn't be operating here and mutations are unlikely with such an explosion of cases. I wonder if epigenetic markers could be a factor. Epigenetic markers sit on genes and tell them to switch on and off. Stress, diet, etc can cause epigenetic marks can switch genes on and off and affect what is passed on the offspring. So if this idea is correct, and I admit this is a long shot, what happened to the parents of the children with autism that perhaps affected the wiring of their brains? Please email me with your hypotheses.

Clinic Notes: Autism and Diet Redux

2010-01-07T14:03:00.000-08:00

Okay another study, this one by Dr. Timothy Buie of Harvard Medical School, says that digestive problems are not more common in kids with autism and special diets do not work. Furthermore, there is no evidence of a "leaky gut" as reported by Andrew Wakefield who first suggested the link between autism and the mercury preservative in measles vaccine. The scientific evidence is overwhelming, but the myth persists. Many children who come to my clinic are on a gluten free diet, but I've never seen any improvement and I have seen very few children with autism who have digestive problems other than being finicky eaters. The special diets cause no harm, other than in some cases, depriving the child of therapies like ABA, which require more effort

Clinic Notes: Does Acetaminophen Cause Autism?

2009-12-30T12:18:00.000-08:00

Many parents of children with autism blame the vaccinations that their children were given between 2 and 3, more specifically the Thirmosal preservative (Mercury) used in the vaccine, as the cause of their children's autism. The scientific data do not support this but the argument goes on. Now a new culprit related to the vaccine has been suggested. Acetaminophen, which physicians suggests be given to reduce the fever that can occur following the injection instead of aspirin, which can cause Reye's Syndrome. Well, the change from aspirin to acetaminophen does correlate with the increase in autism, but children are given acetaminophen to reduce fever whenever they are sick and they, along with most children who receive acetaminophen following the vaccines do not get autism. Statistically, anything that has increased along with the increase in autism will correlate. The increase in the use of cell phones would correlate with the increase in autism. But cell phones don't cause autism. Or do they?

Clinic Notes: Help Wanted. Need People with Autism

2009-12-19T13:03:00.001-08:00

The children with autism that I see in my clinic are very young, usually between 2 and 6. Most of the older children that I see in my clinic have been coming for years. They all progress at different rates and I wonder about their future. Where will they work, where will they live, will they marry and have children? Well, a report this week gives me a clue into the work future for some of them. Several companies such as Wrigley have hired people with autism as computer systems developers because they are able to focus for long periods of time on detailed tasks that others would get bored. A company in Denmark and another in Chicago hire and train people who have high functioning autism as consultants on data entry and code checking and send them out to work in various industries. So it looks like there will be jobs for the children that I see in my clinic if I can get them to the point that they can manage their sensory problems, follow directions, and communicate.

Clinic Notes: Social Skills and Autism

2009-12-11T06:29:00.000-08:00

Autism is primarily a communication disorder. Children with autism may lack functional language or may have language that is functional, except in social situations. For children with autism who lack language then ABA and therapy with a Speech Language Pathologist is essential. But what about the high functioning children with autism or Asperger's.. How do they develop social skills? First of all, they need to be in a classroom where there are other children at their level or above, or they need to be mainstreamed. Of course, just putting them in a regular classroom without social skills training and attention to situations where the stimulation is too great could be a disaster. A child with autism may do find socially in a quiet classroom and have a meltdown in a noisy lunchroom. Second, social skills can be taught using social stories and practicing social skills in a controlled environment where the sensory stimulation can be controlled, as well as potential bullying. This is a lot to ask of a teacher so extra staff need to be trained to work with these higher functioning children. Go to: http://www.washingtonpost.com/wp-dyn/content/article/2009/12/02/AR2009120202884.html?hpid=moreheadlines for an interesting account of how one school is accomplishing this.

2009-12-09T11:33:00.001-08:00

This week another study has confirmed what those of us who work with children with autism already know--he earlier the intervention the better. In fact in previous blogs I have mentioned that with ABA started early some children are able to loose their autism diagnosis. That is certainly good news. The bad news is that services are expensive and hard to find. Everyone has a waiting list.
If you child is diagnosed with autism early find out about your state's early intervention program. States are responsible for providing and paying for services until your child reaches age 3. Go to http://www.disabilityresources.org/DRMreg.html and search for services in your state. After age 3 the school system are responsible and this is where the real problems in getting services become apparent. Some school systems are very good about providing and/or paying for services while others are not. Know your rights. Get an advocate to accompany you to your IEP meeting if necessary.
Check your private health insurance policy. Some policies will pay while others will not. As other parents of children with autism what they are doing and also ask your pediatrician for referral information. Unfortunately. Finding services for your child may be a bigger battle than dealing with your child's autism.

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

2009-11-28T06:29:00.000-08:00

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.

Clinic Notes: Hyperbaric Chambers and Autism

2009-11-17T15:43:00.001-08:00

"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 http://www.nytimes.com/2009/03/10/health/10brody.html?_r=2&ref=science

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

2009-11-12T12:45:00.000-08:00

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.

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

2009-11-06T08:34:00.000-08:00

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?

Clinic Notes: What Has More Research on Autism Told Us?

2009-10-30T13:13:00.001-07:00

A decade or so back, when it became apparent that we were in the midst of an "autism epidemic" the call was repeatedly made for more research into the potential causes of autism and effective treatment options. Now so much autism research is being done I have trouble keeping up with it. Well, I think it is time to ask the question, "What have we learned?" from all of the research. Of course trying to answer this question will generate a lot of arguments--some very volatile, but I have no agenda and will try to answer these questions as I see them.
I think the evidence is compelling that in most cases of autism mercury is not involved. When mercury was taken out of vaccines rates did not drop and in countries where vaccinations are not mandatory the rates of autism are the same in vaccinated and non-vaccinated groups.
Secondly, I don't think in most cases of autism gastrointestinal disorders are a factor. Most of the children with autism who have come to my clinic over the years do not have gastrointestinal problems. A recent study at the Mayo Clinic confirmed this. Gastrointestinal disorders do not occur at a higher rate in children with autism.
Chelation therapy, gluten free diets, and hyperbaric chambers do not cure or even improve the lives of children with autism. All evidence to the contrary is anecdotal and has not been confirmed in double-blind studies. I realize this will not set easy with many people. But I am in the trenches, treating autism daily and I just don't see progress in children who have had these therapies and I think the research is as conclusive as research can be. Research should continue, but it is time to move on to areas of research that have more potential.

Clinic Notes: Mercury Levels in Children with Autism

2009-10-24T09:32:00.001-07:00

Science is a slow process and sometimes it's not a discovery that is made in a study that is important, but a study or studies that can rule out something as a cause. No one knows what causes autism but several recent studies, combined with previous studies, in my judgment have gone a long way in ruling out two causes of autism. Previously, I wrote a blog on a large Mayo Clinic study that found no differences in the frequency of gastrointestinal disorders in children with autism and normal controls. And now from the Mind Institute at UC Davis we have a large sample study that finds that there was no differences between mercury levels in the blood levels of children with autism and a control group. This study, combined with previous studies that found no relationship, tells me that it is time to move on and investigate other variables that have more potential.

Clinic Notes: There's an App for That

2009-10-16T09:25:00.001-07:00

Applied Behavior Analysis (ABA) is the most effective treatment for autism. Unfortunately, well-trained ABA therapists are expensive and hard to find. On my website (www.aba4autism.com) I offer an online ABA course for caregivers as well as ABA eBooks, ABA Case Histories, and individual ABA programs. Many parents and other caregivers who have not been able to find and/or pay for an ABA therapist have told me how helpful my website has been for their child with autism. I was watching an iPhone commercial the other day that was talking about all of the apps that could downloaded to the iPhone--apps for everything imaginable and I got to thinking. Why not iPhone apps for ABA? I'm working on it.

Clinic Notes: Autism in Adults

2009-10-08T13:45:00.000-07:00

As I have mentioned in previous blogs the incidence of autism is rising. This is well documented by stats put out by the CDC and I see many more children in my clinic now with an autism diagnosis then I did in the past. In the last decade or so many researchers label the rise as an explosion. Well autism is a lifelong disorder and one question that has not been answered is where are the adults with autism now? And how are they functioning? Are we going to have to have massive programs to aid adults with autism when the children we are seeing now grow up? A recent study in England attempts to answer some of these questions. England's National Health Service conducted surveys on the prevalence of psychiatric disorders in adults. In regard to autism, the finding of interest was how many adults with autism there were. Most were unmarried males and the frequency was 1 in 100 adults, which was in line with the stats reported for children. Furthermore, the study did not look at adults with autism living in institutions, which would have raised the incidence of adults with autism even higher. This was a small study, but if it is replicated with a larger sample it is hard to argue that an autism epidemic is taking place.

Clinic Notes: Body Language and Autism

2009-10-01T12:50:00.000-07:00

Several years ago I published an article titled, "What Horses Tell Us About Autism." (Available at www.aba4autism.com). In my clinic I had noticed that when given directions children with autism seem to respond much like horses to body language and tone of voice. If the caregiver is hesitant or indicates nonverbally that they do not expect the child to follow directions then the child does not. And vice versa. A recent study in the UK at Durham University investigated the way adults with autism see and/or process body language and then infer inner feeling and emotions. When shown video clips without sound or facial movements the adults had difficulty interpreting emotion even when it was "obvious" such as shaking a fist. As the authors point out this could greatly effect daily social interactions.

Clinic Notes: Autism and Gastrointestinal (GI) Disease

2009-09-25T11:28:00.000-07:00

Some parents, autism researchers and clinicians think that autism is caused by GI disease, hence the gluten and casein free diets, and various vitamins and supplements that are given to children with autism. So is there a link between autism and GI disease? A recent large scale Mayo Clinic study has some interesting findings. Most of the children diagnosed with autism and the control subjects had received their care at the Mayo Clinic and detailed information was available for the study. The most interesting finding was that the children with autism did not differ from the control group in the frequency of GI disease. Two symptoms--feeding difficulties and constipation were found more often in the autism group. The researchers note that these two symptoms are probably related to autistic behavior--restrictive diets--lack of fiber, rather than a GI disease. Neither group had celiac disease, which is intolerance to gluten. The authors of the study conclude that GI disease should be treated when it is diagnosed independently from autism. But treating autism without verification of GI disease is not warranted.

Clinic Notes: Early Detection of Autism Redux

2009-09-19T07:48:00.001-07:00

Autism is usually diagnosed between the second and third year of life when language fails to develop. (This is also the time when children receive vaccinations for common childhood diseases hence the association between the mercury in the vaccines being the cause of autism, which is still being hotly debated.) As I mentioned in a previous blog some research finds that ABA started as early as 18 months can actually prevent autism. There are no reliable early biological or behavior markers of autism and everyone agrees that if we could diagnosis at an earlier age and start ABA and other treatments then autism could be more effectively treated. According to a recent study, signs of autism appear in the first few weeks of life. Researchers at Flinders University found differences in attention, cognitive, temperament, and sensory processing between children who later developed autism and children who developed normally. If this study is replicated then therapist may be starting ABA and other therapies at a very early age.

Clinic Notes: Autism as a Systemic Disease

2009-09-10T16:38:00.001-07:00

As I mentioned in a previous blog, a pediatrician, who's two year old had just been diagnosed with autism, contacted me. She had taken her child to the gastroenterology department at the hospital where she worked and the doctors there told her that autism was a gastric disorder. She went to the immunology department and they told her that autism was an immune deficiency disorder. In the neurology department she was told that autism was a neurological disorder. What is autism she asked me exasperated? I told her that autism is a neurological disorder although some children with autism have gastric and/or immune problems. Mark Hyman, MD now says that our current thinking about autism is all-wrong and autism is a systemic disorder that affects the brain. According to his theory a "toxic environment" triggers genes that cause frequent infections, gut problems, and finally neurological problems that cause the faulty wiring that causes the behavior abnormalities seen in autism. While this is an interesting theory I don't see it in my practice. Usually, I see between 35-40 kids on the autism spectrum each week. Some of these kids are frequently sick and have obvious immune problems. But others are never sick. Some have digestive disorders. Others do not. Some have a positive history of autism in the family while others do not. All have neurological disorders that underlie the symptomatic disorders of autism, which also vary. So what kind of systemic disease causes such variable problems? Are their different types of autism? Different etiologies? I don't see it.