Clinic Notes: ABA and Time Out

Time out means time out from positive reinforcement. If there is no positive reinforcement in the child's environment then time out will not work. Recently, a child with autism in Iowa school was left in time out for 3 hours. Of course, the parents were outraged and called a lawyer. But before the case came to trial the family moved and the school system continues to use its time out rooms in the same way. http://www.kcci.com/education/13826532/detail.html.
There has always been controversy about time out and the Iowa school is not the first to get into trouble over improper use of time out. Parents are always telling me that they have tried time out with their child but it does not work. Time out is a very good procedure when done right and ineffective when done wrong. The standard time out procedure below is the procedure I have been using for 30 + years and it works. It will not work for a child with autism that is removed from an environment that has no reinforcers. For example, an environment where there is too much stimulation or too many demands being placed on the child. Being placed in time out would be reinforcing. And time out should never be used by itself, but always combined with a reinforcement procedure for the appropriate behavior.
Time out 101:
Time out is an often used and misused procedure. If done properly, time out is a very effective, humane procedure. Find a place in your house where a time out chair, preferably a chair with arms and not a bench, can be left. The chair should face a blank wall and not be close to a window, shelves, glass, electrical outlets, or storage cabinets containing chemicals. Hallways and alcoves often work. Do not use bathrooms or closets. The time out chair should be close to the play area so the child can be placed in time out quickly. Think safety, especially for small children.
Use an egg timer and teach the child that he or she cannot get out of time out until the egg timer goes off. The child has to stay in time out for three minutes plus one minute of good behavior. In other words, the child has to be quiet and cannot be arguing, complaining, or tantruming for one full minute before he or she can get out of time out.
Do not be surprised if the child comes up with a whole bag of new inappropriate behaviors in order to get out of time out. Kids have been known to gag, vomit, and one of my own kids even hit herself in the face several times. Do not respond and thereby reinforce these new inappropriate behaviors or they will increase in their frequency. Only good behavior gets the child out of time out.
In the beginning of this procedure it's not unusual for a child to be in time out for fifteen to twenty minutes before he/she quiets down, and to go to time out as often as twenty times a day. After a few days the child learns the requirements of the time out procedure and he/she gets out in the minimum four minutes. The number of times the child goes to time out each day also drops dramatically. (Record the frequency and length of time outs and you will see the child's progress.)
When the child gets out of time out, remind your child of why he or she had to go to time out in a firm tone. Tell your child that he/she will have to go again if your directions are not followed immediately. Do not be timid with your voice or body language. (Go to www.AbA4Autism.com for ABA programs using time out and reinforcement that eliminate inappropriate behavior and establish appropriate behavior.)

Clinic Notes: Public Awareness of Autism and ABA

According to a recent Schafer Report the mayor of Albuquerque has called for a Town Hall meeting on Developmental Disabilities. One of the panels at the meeting will be devoted to autism. I think this is a great idea. And If I were the mayor I would require all city employees to attend. Policemen, firemen, teachers, anyone who might come in contact with a child or adult with autism should be there. And perhaps a special workshop should be offered as a follow up. I am in the process of trying to organize a day camp for children with autism. Games and other activities would be available, all run by qualified staff. While the children with autism were involved in recreation I would talk to teachers, parents, and other interested adults about ABA and autism and Speech-Language Pathologists, Occupational Therapists, and others ould do their part. And hopefully the community to come together to help fight the epidemic.

Clinic Notes: Diagnosis and Denial--Denial and Diagnosis the Chicken and Egg of Autism

Everyone will agree that early diagnosis of autism and intense ABA, along with other therapies, is effective. Sometimes it is possible to diagnosis autism as early as 18 month and start intervention. But only half of all autism cases are diagnosed before kindergarten most of these the second and third year when language delays and other symptoms of autism become apparent. Parents can be in denial before and after a diagnosis. Last week a mother brought her three-year old child in to my clinic. She had thought something was wrong since the child was two but dad kept saying the child was just hard headed. Mom took a trip with her friends and left the three year old with dad. When she returned home dad told her to make an appointment because something was wrong. In this case the child was able to get a diagnosis and treatment at an early but often we do not see children for the first time until they are six or seven. The parents knew something was wrong but were in denial. And the parents did not seek services until the school system insisted. And it is not always denial in the parents that prevents a child diagnosed with autism from getting services. More often costs, both in time and money are to blame.

Clinic Notes: An ABA Army to Combat Autism

A friend of mine has just returned from Iraq. I was asking him about how the war was going and he told me that the press is not giving enough credit to our military forces. They are well-trained professionals, doing an excellent job, under extremely difficult conditions. This got me thinking about my "war" with autism. Everyday I am asked to travel here and there--sometimes to foreign countries--to set up ABA programs for children with autism. If I can't go then I'm asked to recommend someone. Professional, well-qualified ABA therapists are in short supply. Parents around the country, and the world, cannot find ABA services, and if they do fined someone they are either not qualified or too expensive. I'm retiring from my university appointment, staying on to teach an ABA course and direct ABA students in internships, but most of my time now will be devoted to my practice. What we need is some kind of national program to train ABA therapists--an army of ABA therapist to go out and fight the autism war. Of course we will also need OT's, SLP's, and pediatric neurologists in the army too. If we don't do this we will loose the autism war and there will be a large fraction of a generation incapacitated by autism. Autism research needs to be better supported too, but until we find some answers the ABA army will have to fight the battle.

Clinic Notes: The "Autos" in Autism

In 1943, American psychiatrist Leo Kanner published the first paper on autism. The word “autism” comes from the Greek word “autos” or “self” and was first used by Eugen Bleuler, a Swiss psychiatrist, in 1912. Bleuler described “autistic thinking” as not involving outside reality, but only the individual's inner thoughts or feelings. He thought schizophrenics were locked into this way of thinking. Kanner used the term autism to describe the extreme social disinterest he observed in eleven young children, and thought the disorder was congenital. The stereotype of the child with autism being aloof locked in his or her own little world is still with us. However, I think that I have seen a change in this stereotype during my 37 years of clinical experience. Many of the kids who come to my clinic now with an autism diagnosis are very social or at least interested in being very social. Unfortunately, their verbal communication holds them back so they do not do well socially. Social stories and modeling social interactions can help, but unfortunately many kids do not solve their communication problems earlier enough to develop socially.

Clinic Notes: Jobs for People with Autism

Parents who bring their children diagnosed with autism to my clinic want to to know what the future holds. Of course, they ask about the immediate future, but they also ask about vocations and employment for adults with autism, even if their children are only two-years old at the time. I cannot predict the future, but I was glad to read about a new job placement service for people on the autism spectrum. Natural Learning Concepts which offers books and other materials has a job placement resource at http://www.nlconcepts.com
/autism-jobs.htm. Pro autism employers can post jobs and employees looking for jobs can "network." No word yet on the number of successful job placements.

Clinic Notes: The "Brat Syndrome" and Autism

When I was first starting out in ABA 30 + years ago I recall reading an article titled "The Brat Syndrome." The thesis of the article was that noncompliant behavior and tantrums or "brat behavior" in a child does not by itself constitute any psychiatric disorder or neuropsychological disorder. At the time ADHD was being over diagnosed and often children would receive an ADHD diagnosis just because they were noncompliant and had frequent tantrums (brat like). Now I see the same thing happening with autism. Noncompliant children are coming to my clinic with an autism diagnosis, usually conferred by a Special Ed teacher rather than a psychologist, pediatric neurologist, or psychiatrist. Many of my colleagues and associates do not like me to tell a parent that their child has the "Brat Syndrome." And I certainly do not tell a lot of parents that even when it is true. But a lot of parents are relieved when they hear that their child has the "Brat Syndrome" rather than autism.

Clinic Notes: It's the Season for the IEP's

If you are a parent of a child with behavior problems you have probably had to battle the school system in an IEP to get needed services. Often parents do not know what to ask for in an IEP meeting nor do they know their rights. (Unfortunately, school systems are equally in doubt about the law or play like they are.) For help go to a great website http://www.wrightslaw.com/nltr/07/nl.0516.htm
for help.

Clinic Notes: ABA Workshops: The Good, Bad, and the Ugly

At least several times a week I am invited someplace to give an ABA workshop. The workshop audience that I am invited to speak to may be parents or other caregivers and that's good, but often the workshop is for professionals--therapists, teachers, classroom aides, etc. Nowadays my clinic is so over run with children with autism and my waiting list is so long that I politely decline, but even if I weren't busy I would decline most invitations. The problem is that with the popularity of ABA as a treatment for autism everybody wants to get into the ABA business. Most of the invitations come from organizations that want me to train their staff in ABA. In one day. Then the newly trained staff can go out and do their own ABA. And bill. Families and school systems do not know that the "ABA therapists" they are contracting with only have one day training and know just enough to be dangerous.

Clinic Notes: Asperger's and Bullying

Whenever I get young children in my clinic who have been diagnosed with high functioning autism or Asperger's I think about how they are going to fare in school. Of course, I know that if they are not compliant and verbal and have age appropriate skills they are not going to do well so these are the ABA programs that I run first. ABA programs to develop social skills are not run for a while and if they are then they are run with a lesser intensity. I want these kids to do well socially from the beginning but if I cannot get to the programs I know that social problems such as bullying don't usually start until middle school. I may have to rethink my ABA programming. According to a recent Schafer report Five elementary school student is Oregon are going to be charged with assault after they beat a classmate with autism with sticks.

Clinic Notes: The Two Faces of ABA

In a previous blog I discussed who was qualified to do ABA. With the increase in children with autism, and ABA being recognized as the best therapeutic approach, the number of people holding themselves out to be ABA therapists and preying on an uninformed public is geometrically increasing. Psychologists and Behavior Analysts are big on qualifications. At the same time they say paraprofessionals can do ABA. On my website I tell caregivers that anyone can learn to do ABA and I believe that. But to do ABA independently with someone else's children, without supervision of a Behavior Analyst or Psychologist can be risky.

Clinic Notes: Who is Qualified to Do ABA?

Recently a school system nearby had an ABA consultant come in to give a workshop on ABA for a day. The special education aides were asked to attend as well as the cafeteria ladies. The parents of the children with autism were then told that their children would be given several hours of ABA each week.
ABA is riding a wave of popularity with the onset of the autism epidemic. And many people are offering their services to families and schools. This brings up an important question. Who is qualified to do ABA? Under supervision anyone can do ABA. But without supervision a little bit of ABA knowledge can be harmful. I think that it is very clear that only Board Certified Behavior Analyst or Licensed Psychologists should be doing ABA unsupervised. I have seen many children in my clinic who received ABA from unqualified therapists and did not progress. It is accepted that with autism the earlier the interventions the better. Parents cannot afford to waste a year with an unqualified therapist.

Clinic Notes: Chelation

I've been in practice long enough to remember when children severed brain damage from lead poisoning. Most of the lead poisoning was caused by children eating paint that was peeling off the walls. Now paint does not contain lead and most clinicians have never seen a case of lead poisoning in children. Removing the lead (Chelation) was a popular therapy back the. This week police raided a doctor's office in Pennsylvania who was using Chelation therapy to remove mercury in a child suffering from autism. Chelation therapy for autism is not an approved therapy and is highly controversial. This week police searched a doctor's office whohad used chelation for treating autism in a 5 year old boy who had died. (This is the third death reported.) The family's attorney stated that the physician was ... "giving a treatment that's not an approved treatment for autism. He gave the wrong drug in the wrong dose and he gave it the wrong way."
http://www.pittsburghlive.com/x/pittsburghtrib/s_502280.html
Of course this statement should not imply that's there is a right drug and a right doss and a right way to do chelation.

Clinic Notes: Preventing Autism in Babies

In a previous blog I cited studies suggesting that intensive ABA can prevent autism in high- risk children. (Preventing Autism Now: A Possible Next Step For Behavior Analysis, Philip W. Drash, Autism Early Intervention Center). Now Geraldine Dawson, a University of Washington Psychologist is running intensive ABA programs for children younger than two. Much of her 25-30 hour per week program focuses on social development in order to facilitate language development. Language development by age five is an important predictor of how high functioning a child with autism will be.

Clinic Notes: Catch a Falling Star

A recent cover story in time magazine talked about our failing public education system and possible ways to fix it. According to a recent article (The Painful Parallel Universe of Special Ed Parenting By Bob Sipchen in the LA Times.
latimesblogs.latimes.com/schoolme/2007/01/emotions_best_d.html#more)
much the same criticism could be made of our failing special education program for children with autism and other neuropsychological disorders. Special Ed teachers have too many students with to many diagnoses and a crippling curriculum. They are often pressured into advancing special ed children even though they have not mastered the material or else they may loose funding. Aides in the special ed classroom often do the work for the child because they are not showing progress A child's rate of learning and learning style may not be considered in such an environment. No child left behind is a noble goal but special ed teachers must have the resources and the time to achieve such a goal.

Clinic Notes: ABA for Normally Developing Children

Thirty-seven years ago when I was in graduate school ADHD was in the new as much, if not more than autism is today. Parents were rushing their kids to pediatricians, many begging that they be put on Ritalin. Now it's déjà vu all over again. Parents of small children are now concerned that their child could have autism because they have not reached their developmental milestones as rapidly as some of their peers. These children do not have developmental delays because they still have not reached the end o their maturational period, but their parents are running scared. Reassuring parents that their child is developing normally is not enough. They want ABA to speed up the acquisition of skills for their child. This presents an interesting dilemma. Do I provide ABA for these children or say "sorry" and go to a child on my waiting list who has a diagnosis of autism?

Clinic Notes: Asperger's and ABA

Without question Asperger's is often misdiagnosed as ADHD or bipolar mood disorder and children are given psychotropic medications that do nothing for the conceptual problems and the social problems that are the core of Asperger's. It wasn't that long ago that in my clinic children diagnosed with Asperger's did not usually present until their preteens or teens. But now I am getting children referred with a diagnosis of Asperger's at a much earlier age, often 5-6 years of age. This makes it much easier to run Discrete Trial Training (DTT) on stimuli and concepts that will cause problems later in school. Socialization drills can also be started much earlier when children are kinder to children that are different.

Clinic Notes: Autism Questions Redux

When people find out that I have a clinic for children with autism the first question they usually ask me," Is autism increasing?" And the second question is usually, " What cause autism?" I can throw our some stats and research findings, but, unfortunately, I can't answer either question with any degree of certainty. And I can't do much better on the third question: "Does the mercury in vaccinations really cause autism?" I simply say this question is hotly debated and I am undecided myself at this point. A recent article, (Regressive Autism: Putting Together the Pieces By Michael Wagnitz
(www.americanchronicle.com/articles/viewArticle.asp?articleID=21973)
makes a strong argument for mercury. He cites data from first baby haircuts that find children with autism have seven time higher levels of mercury than normal children. Wagnitz also cites data which finds that monkey brains dosed with mercury have cellular changes which are already known to cause neurodegeneration and these cellular changes are found in autopsies of brains of children previously diagnosed with autism. In the future perhaps I can give better answers

Clinic Notes: What Causes Autism?

Everyone has a theory but know one knows what causes autism according to a recent article (No Easy Answers In Autism
Theories abound, but no known cause or cure for baffling disorder By Lisa Schencker, for the Californian
http://www.bakersfield.com/102/story/104427.html)
Well that's obvious and as the article points out there is no cure and a lot of "businesses" will prey on the ignorance of parents desperately looking for help. Genetics are one of the culprits but something in the environment is also responsible. The data on vaccines being the culprit is equivocal. I think we can rule out social and psychological causes. So that leaves the environment. Well what could be wrong with today's environment? How about the air, the ground, the food, the water, etc. And it is going to be hard to track down the causes or causes. Like everyone else I have a theory. I use to enjoy hunting quail. "Birds" as they are called in the south. Dogs would point the birds, we'd walk in and flush them, and when they flew we would shoot. Quail are delicious, all white meat. But the quail in the south are gone. There are many theories why--almost as many as there are about the causes of autism. I think it has to do with agriculture--fertilizer, pesticides etc. Larger animals survive but the smaller animals are always affected first by poisons. In parts of the south, like Texas, where there is only pasture or open land and no agriculture the quail are still around. Something is killing the quail and something is causing autism. I wouldn't be surprised to see that it was the same culprit.

Clinic Notes: Loosing Children with Autism

One of the first drills we run in my clinic after we have children compliant is the come here drill, so that children with autism and other neurodevelopmental disorders will come when they are called. Obvious safety issues are involved with this drill and most kids do learn to come when called. But every year I have a child or two with autism or some other neurodevelopmental disorder get lost. Some get out of the house at night while their parents are asleep. Others bolt when a parent is carrying on groceries and thinks their child is right behind them. That's what happened most recently. Mom was carrying in groceries from the car and thought her four year old was right behind her. But when she sat the groceries down and turned around she was not there. Mom ran out of the house and noticed a few small footprints leading to a 100-corn field. She called and called but the child was non-verbal. Night was falling and mom frantically called family and numbers to search the cornfield. Two hours later she was found sitting on the ground paying shucking corn. Fortunately, it was a warm night and this story had a happy ending. The parents purchased a GPS tracking bracelet the next day. According to a recent Schafer Report (http://tinyurl.com/2bczkp) parents can now purchase sneakers with a GPS chip. A monthly subscription costing $19.95 is also required. A small price to pay considering that sometimes there is not always a happy ending for children with autism or some other neurodevelopmental who get lost.

Clinic Notes: ABA, Autism, and a College Education

According to a recent article in the Schafer Report (3/7/07) an increasing number of children with autism want to go to college. (By Shaya Tayefe Mohajer for The Associated Press, Huntington, WV. http://tinyurl.com/3y49da). We have children with ADHD, Bi-Polar Disorder, Depression, and a host of neurological disorders attending college now so I don't why students with a diagnosis should be left out. And I'm sure that I already have students with Asperger's or high functioning autism in my classes now. My question as a college professor is what accommodations do we make for students diagnosed with autism. My question as a clinician is how do we make these accommodations. For students with a diagnosis of ADHD we have to give them all of the time they want on tests and let then take their test alone in a quite room. What accommodations will we have to make for children with autism who have sensory issues? And will we have to adapt out teaching methods--perhaps using ABA to teach college classes? This could be interesting especially if the federal government gets involved.

Clinic Notes: ABA and Criminal Intent

In recent Schafer Report (3/2/07) an article stated that early diagnosis of autism, when the brain has more neuroplasticity, is critical for effective treatment and yet very difficult. Part of the problem is getting parents, pediatricians, and other caregivers to recognize the early signs of autism and part of the problem is finding effective ABA, speech, and OT that is affordable and accessible. In the state where I practice the "Tennessee Early Intervention System" will pay for service up to age three. So if we can screen and identify kids by age two we have a year to work with them. After age 3 the school system is responsible for services and this is when the system often breaks down. Some school systems are very good about paying for services. Other schools systems depend on their special education programs to treat autism. Of course, most special education teachers are not trained in ABA so the school system usually sends the teachers to a few wrkshops. This does not solve the problem. It keeps the children with autism in special education and builds the census and funding. But the children with autism usually do not get the level of professional services that they are entitled to. The school systems know this and I think withholding services for these kids is criminal. There is no other word for it.

Clinical Notes: Autism in the News

There's no doubt about it. Autism is in the news and everyone has questions whether they are directly affected by autism or not. I was waiting to see a doctor at Vanderbilt several days ago. My wife started a conversation with a woman beside her and eventually the small talk got around to what I did. When my wife said that I was a psychologist who worked with children with autism a hush fell on the room. Everyone in the room looked at me and I couldn't hide behind my magazine. Then the questions started. First, from parents and grandparents, and teachers who had been directly affected by autism, and then by the curious who had read some article in the popular press. There were specific questions about specific children and then more general questions: Is one out of every 150 children affected? Do vaccines cause it? How can it be cured? I answered all of the questions as best I could and everyone was very appreciative. And then I was called back to the doctor's ofice. I was thinking about the questions I wanted to ask the doctor about my own health when he walked in. After a brief introduction the first question out of the doctor's mouth was, "what happens to children with autism when they grow up?" Autism is in the news.

Clinic Notes: Special Education and Autism Stats

According to some reports we are in the midst of an autism epidemic with one out of every 150 children diagnosed. At the same time the number of children diagnosed with learning disabilities or mental retardation is declining. Now we hear that for the first time in history the number of children in Special Education declined by 2.4%. (http://tinyurl.com/yuh59z) Furthermore, the number of children age 3-5 entering public education with speech/language impairments dropped 5%.
So what's happening? Are the speech/language impaired kids, which make up half of the kids with disabilities, now being diagnosed with autism and going into private autism schools where they can get more ABA? I'm confused

Clinic Notes: Thomas the Train, Bob the Builder, and ABA

There is some literature that suggests that children do not make eye contact because they perceive eye contact with another person as threatening. In fact some studies fine that if children with eye contact do look at faces they only see the mouth and nose. Interestingly, the face on Thomas the train and the construction equipment on Bob the Builder attract many children with autism. A recent study in Great Britain (http://news.bbc.co.uk/1/hi/health/6241733.stm) used vehicles with human faces to try and teach children with autism to overcome their fear of looking at faces. In my clinic I have been using Thomas the Train and Bob the Builder videos to teach children with autism how to label emotions with some success and plan a controlled study in the near future.

Clinic Notes: ABA and the Neurosciences

Most ABA therapists have little background in the neurosciences. Unfortunately, this often results in a "one size fits all" approach to ABA. In our clinic some children with neurological impairment resulting in low muscle tone get fatigued very quickly doing Discrete Trial Training (DTT). With these children we slow down, have longer intervals between trials and give frequent breaks. I've seen ABA therapist push these kids to the point that they break down and profit little from ABA. Other kids with ADHD types of behavior may need shorter intervals between trials and less frequent breaks to keep them on tasks. In my few view, at least one course in basic neuroscience.

Clinic Notes: The Autism Genome Project

What is being hailed as the largest genome scan ever has come up with two genetic abnormalities in families with at least two member diagnosed with autism. The gene neurexin 1 located on chromosome 2, which is know to be associated with the neurotransmitter glutamate, is one suspect as is several locations on chromosome 11. As many as 30 other genes are also suspects in the disorder and are under investigation. Research in genetics is an important part of the puzzle and these are interesting findings. But I am still puzzled. When you read genetic studies somewhere in the write up autism is referred to as a highly inheritable disorder. However, the concordance rate for identical twins is only 60% and drops to 4-8% for fraternal twins and non-siblings. Without doubt something else is involved in the etiology of autism.
(See Nikhil Swaminathan. http://tinyurl.com/ynr6ey)

Clinic Notes: Autism Myths

The sign hanging in front of my clinic building says, "The Children's' Treatment Center." And in small letters under the name, "For Autism or other Childhood Developmental Disorders." I am located in an old historic part of town where buildings build in the late 1800's have been restored; surrounded by lawyers, CPA's, and upscale retail stores. I am always asked the question by people aroung me, "What is autism?" That is a difficult question to answer and difficult for people to understand. The movie "Rain man" is the only exposure most people have had to autism until recently when autism has been in the popular media.
Part of the problem in answering this question for the general public is the lack of consensus for those of us who work in the field. Simple questions such as "Is autism increasing in children," cannot be answered to everyone's satisfaction. We are not even close to answering the question, "What causes autism."
There are so many controversies that "experts" at the 2006 annual meeting of the American Association for the Advancement of Science tried to separate "fact" from myth. Unfortunately, the experts could only argue about the interpretation of the limited amount of data, often contradictory, that we do have.
(See Ped Med: Autism Myths Abound
By Lidia Wasowicz for UPI.)

Clinic Notes: The New Autism Numbers

In a recent study, CDC reports that 1 in every 150 school age children are affected by autism. When I started practicing 35 years ago the numbers were more like 1 in 10,000. The lower rates are reported in the South and the higher rates in North Eastern cities. Whether this difference is real or because more services are available and a diagnosis is more likely in the North Eastern cities than the South is not known. The authors of the study say that the rise in autism rates could be related to better surveillance procedures now than in the past. Personally, I don't think 1 child out of every 150 has any chronic disease, Including autism. (Diaper rash could be the exception.)
(See Morbidity and Mortality Weekly Report Source reference: MMWR 2007, 56;SS-1;1-28.)

Clinic Notes: ABA, Music, and Autism

I see many children with autism in my clinic who are music savants. They have perfect pitch and can play a song on the keyboard after hearing it one time. The percentage of child with autism that have special music abilities is not know, but it is estimated that 10% of children with autism are savants.
In addition, many children with autism like music and we use it as a reinforcer in ABA programs. (Some kids with autism find music, and sounds in general aversive and cover their ears.) Neuroscientists tell us that infants are born with music preferences and even seem to enjoy music while still in the womb.
Some years back I had a 3 year-old girl come to my clinic with a diagnosis of autism. When I was taking her history her mother said she was not verbal, but she could sing. I then asked if she could follow directions. The mother said yes as long as she sang them. I then watched mother sing a direction and her daughter sang back her reply.
Tere is no music center in the brain. Pitch, loudness, and dimensions of music are in circuits of nerve cells, which are spread around in different parts of the brain. Why some children with autism have savant abilities is not even close to being understood.

Clinic Notes: ABA and the Rising Number of Children Diagnosed with Autism

In the January 31, 2007 Schafer Report (http://www.SARnet.org/), two separate articles dealt with the rising number of children diagnosed with autism. In California, 3385 new were added last year. The second article discussed the difficulty in determining whether or not the increase was real, and if it was, what was causing the increase.
Without doubt, I think there is an increase in the diagnosis and miss-diagnosis of autism. I see that almost everyday in referrals made to my clinic. But I also think there is something else going on. Autism does have a genetic link, but I'm not sure more people carrying the autism gene or genes are breeding and having more children with autism. I have no data to support that belief, but that is my belief. I think our attention needs to be directed towards the environment.
At any rate, it is getting very difficult for those of us in ABA to offer intense ABA for a child when we have so many children diagnosed with autism on our waiting list. Do I schedule one child for 10 hours of ABA a week? Or do I see ten children for one hour?

Clinic Notes: Risperdal, ABA, and Autism

A recent government study by the HHS' Agency for Healthcare Research and Quality found problems associated with off-label uses of Atypical Antipsychotic medications. Atypical Antipsychotic medications were developed to treat schizophrenia and bipolar disorders, but are now being prescribed for the elderly with dementia as well as children with autism. One atypical antipsychotic medication, Risperdal is approved for treatment of agitation and irritability in children ages 5-16 diagnosed with autism. Prescribing medications to children should be a last resort, only undertaken after all other therapies have been tried. But I can tell you that in many children with autism Risperdal is a necessary drug

Clinic Notes: Asperger's, ABA, and Crime

I see a number of children diagnosed with Asperger's Syndrome in my clinic. When they first present academic performance is the problem parents complain about the most followed by social problems. Children with Asperger's generally do well in math, spelling, and have trouble in science and social studies where they have to summarize information. Discrete Trial Training (DTT) and other ABA procedure are usually effective in managing the academic problems that Asperger's children have. The social problems associated with Asperger's are more difficult. We use a lot of social stories to teach social skills and how to behave in various situations and this works fairly well. But there is always a social situation that we did not anticipate that causes problems, especially for the adolescent. I wasn't surprised to see the news report this week where, allegedly, a teen with Asperger's stabbed a fellow student to death. The Asperger's defense has been used successfully in murder cases as well as other criminal charges, but I take no comfort in that. Seeing that no child with Asperger's commits a crime is a serious responsibility for ABA therapists.

Clinic Notes: ABA and Eye Contact Revisited

In a post last week I mentioned a study that found that children with autism perceived faces as threatening and that was the reason they did not make eye contact. The first ABA program in my ABA eBook is on eye contact. And I know from many years of clinical experience that a child with autism is not going to advance until they are making eye contact on command and are also making spontaneous eye contact.
A project in Great Britain is using cartoons of human faces on vehicles such as trains and cars to teach children with autism to make eye contact and understand human emotions. I have ordered their DVD and will evaluate this approach. In a future blog I will post the results

Clinic Notes: Mysteries and Autism

The best account that I have ever read of what it is it is like to have autism is a novel titled, The Curious Incident of the Dog in the Nighttime by Mark Haddon. A recent issue of the Schafer Report (Friday, January 12, 2007) describes a ten-year old child with autism who writes mysteries, which include people he knows in as various characters such as villain (the principal).
The mystery story has a long history in neurology. As I mention in the preface in my case history eBook, Little Bubba's Not Ready for Nashville, Yet, the most famous detective in fiction, Sherlock Holmes, was based on one of Sir Arthur Conan Doyle’s medical school professors at the Royal Infirmary in Edinburgh where he was a student in the late 1800s. Apparently, like Holmes, neurologist Joseph Bell mystified Doyle and his fellow students with his gift for clinical diagnosis. As I do research into the causes of autism and work with children with autism in my clinic and try to unravel the mystery of autism I often wonder what Holmes would do.

Clinic Notes: Eye Contact and Autism

A recent study at the University of Wisconsin suggests that children with autism do not make eye contact because they see faces as threatening. http://www.sciencedaily.com/releases/2005/03/050309151153.htm
Perhaps children with autism do see faces as threatening. I won't argue that. And I am familiar with the controversy about whether or not we should require that children with autism make eye contact. Many of the children with autism who come to my clinic, especially the young children, do not make eye contact on command or spontaneous eye contact. Of course, this results in social impairment, but it also results in impairment in observation learning or modeling and numerous developmental delays. The first ABA program in my eBook is on establishing eye contact. And the ABA program for eye contact is not first by accident. Thirty-five years of clinical experience has taught me that if eye contact is not established, the child with autism is not going to advance.

Clinic Notes: Ballet and Autism

A recent Schafer Autism Report had a story on a dance instructor in New York who was teaching a ballet class for girls with autism. Many children with autism have body orientation problems. For example, they will sit in front of the TV and not understand that other people cannot see the TV because of them. Or they will look at pictures in a book and think everyone in the room can see the pictures even though they are on no position to do so. One child with autism who comes to my clinic won an award at school. The principal asked her to come to the stage and stand beside him so he could present the award. Obligingly, she went to the stage and stood beside him, but facing away from the audience. Of course, everyone laughed and she got embarrassed. She thought she was doing what she was asked to do.
Spatial concepts and body orientation are difficult for a child with autism and I hope ballet helps the girls in the class. My qestion is since autism is four to five times more common in males why only a class for girls. I'm curious who decided the class would only be for girls. The teacher or parents of male children with autism

http://tinyurl.com/ylmc75

Clinic Notes: Preventing Autism Redux

In a previous post I described several studies, which found that intensive ABA in young children at risk for autism seemed to work. Of course, identifying children at risk for autism while they are young is a major hurdle. Some kind of early screening system, perhaps involving pediatricians and early well-baby exams, would have to be established. But there is a second hurdle and that is accepting the idea that intensive ABA changes the mis-wiring in the brain. Most everyone now accepts the idea that autism is a neurological disorder. But not everyone accepts the idea that ABA is rewiring faulty brain circuits.

Clinic Notes: Autism and the Christmas Holidays

I am reposting this for the holidays:
I have had many parents of children with autism or other neuropsychological disorders tell me that the Christmas holidays are an especially difficult time for them. Of course, any holiday can be difficult for any child with the changes in routine. But Christmas is usually the most difficult holiday for parents of children with autism or other neuropsychological disorders.
There are no sure-fire techniques to use with your child that will insure a "Martha Stewart Christmas." Families who have children with autism or other neuropsychological disorders have used the following 10 tips to make their Christmas better. And this year I'm adding a new suggestion to the list.
Several years ago Leigh Grannon and I did a study using pictures to increase social interactions in a child with autism. Children with autism are visual learners, and I have suggested to parents that they take pictures of what is going to happen at Christmas--the tree, the gifts, the relatives--and starting several weeks before Christmas show these pictures repeatedly to the child with autism. Tell a little story to the child while he/she is looking at the picture about how to behave, what's going to happen, and what the child can do if it is too much. Include your child in the pictures if possible. A picture of the child going to his room to escape the noise and confusion when he/she gets overloaded seems to help, too.
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, 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. As mentioned above there are web sites that sell toys designed for children with autism or other neuropsychological disorders. Try ordering some of these 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. Have them read my article, “What Horses Tell Us About Autism,” which is available for free on the second page of my website.
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 a 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. (Sometimes I wonder if children with autism or other neuropsychological disorders know that Christmas has become too commercial.)
I wish you and your child the happiest of holidays.
Gary Brown, Ph.D
Psychologist/HSP

Clinic Notes: Autism as a Neurological Disorder vs. Autistic Behavior

Presently we are analyzing data from over 2500 surveys from mothers of children diagnosed with autism and mothers of normally developing children. The survey, which can be found at http://www.ABA4Autism.com, has a variety of pre and post-natal questions. In the biographical portion of the survey we ask mothers to give us their child's diagnosis. We thought we would get several different diagnostic labels such as autism, PDD-NOS, or Asperger's. Instead we have so many diagnostic labels that we are not sure how to proceed. We have many comorbid diagnoses such as Down's syndrome and autism, Fragile X syndrome and autism, Autism Spectrum Disorder, with and without comorbid disorders, and countless more. Physicians or psychologist made all of these diagnoses. There are many problems in diagnosing autism and I certainly don't have the answer for all of the problems. But I think much of the confusion is caused by professionals who talk of atism as a neurological disorder and professionals, sometime the same professionals, who talk about autistic behaviors such as self-stim, OCD, sensory issues, etc. These "autistic behaviors" can be seen in a wide variety of neurological disorders. Before we can do definitive research in autism we need to be clear on what we are talking about when we make a diagnosis.

Clinic Notes: The Combating Autism Act

According to a recent note in the Schafer Report funding for investigating the role of environmental factors as a possible cause of autism has been removed in the House by Energy and Commerce Chair Joe Barton. The Senate has already voted 100 to 0 to fund special centers that would focus on the role of environmental factors as possible cause of autism. I don't know how this will all turn out in this lame duck congress. Last summer the Senate voted to exclude money that would look into vaccines containing thimerosal as a possible cause of autism. So both houses are trying to play to special interest and hogtie science. But science doesn't work that way. I have no idea whether thimerosal or environmental factors are involved in autism. We are now analyzing data from over 2500 surveys from mothers of children with autism and normally developing children and we will look at what we damn well want to. And the rest of the scientific community should do the same. Many in Congress have already demonstrated that they are cntrolled by special interest and are not concerned with finding a cure for autism. Science should find away to do the research without government funding.Schafer Autism Report Nov. 20, 2006

Clinic Notes: Mercury and Autism

In 1971, Iraq was given 90,000 metric tons of wheat seed by the United States. The seed was supposed to be planted by the Iraqis and had been treated with the fungicide methylmercury. Unfortunately, the Iraqis ground the seed and baked it into bread. Six thousand people were hospitalized with mercury poisoning and 450 died. Pregnant women gave birth to children with mental retardation, seizures, and other birth defects. The number of children, if any, who developed autism, is unknown. Without question mercury causes brain damage in children and adults. And like other poisons size matters. The same dose can be 100 times more harmful in a child than an adult. Mercury is now a part of our environment. Common products such as tuna fish, as well as other fish, and many vaccines other than the MMR vaccine contain mercury. Mercury is also a byproduct of industry. The question is how much mercury can the body tolerate without damage. We have some guidance, such as eating fish no more than 2-3 times per week. But supposed you eat fish 2-3 times per week and also live in an area contaminated with mercury because of industrial pollution? The EPA estimates that 1 woman in 5 during their childbearing years have mercury levels in their blood that exceed EPA safety guidelines. Perhaps we should be worrying more about mercury levels in the environment and not just confine our worries to vaccines.

For more information read the article by Lidia Wasowicz http://tinyurl.com/y4k46t

Clinic Notes: Blaming Moms Blaming Dads for Autism

In the 1940's, after Leo Kanner had described autism in children, psychoanalyst Bruno Bettelheim wrote extensively about the causal relationship between emotionally distant mothers (refrigerator mothers) and their autistic children. Of course, you can imagine the guilt this caused moms. Now maybe it's dad's turn. A recent study by epidemiologist Avi Reichenberg of the Mt. Sinai School of Medicine found that dads older than forty were six times more likely to have children diagnosed with autism than younger dads. Theoretically, the DNA in the older sperm has decayed.

(See James Ottar Grundvig for The Epoch Times at
http://www.theepochtimes.com/news/6-11-13/48039.html)

Clinic Notes: The CDC's Proposed Autism Study

The Center for Disease Control and Prevention (CDC) announced a large-scale study that will look for pre and postnatal causes of autism. The $7.8 million dollar study will be conducted in 5 or 6 states and is the largest federally autism study to date. The press release said that the study would include as many as 2700 hundred children. Their sample includes both children with autism and normally developing children. For $7.8 million dollars I would expect a larger sample. We are now analyzing data on more than 2000 children with autism and normally developing children and even if we include our faculty salaries we are well under a $150,00 and we are not working on the study full time. I hope the autism community gets what they are paying for.
http://www.edweek.org/ew/articles/2006/11/08/11health-1.h26.html

Clinic Notes: Mirror Neurons and ABA

If I am shopping with my wife and I see her pick up a man's shirt and smile and look at me I not only observe her behavior I know her intentions. Furthermore, we could monitor my wife's brain activity and see which neurons were involved in her behavior. The interesting thing here is that if we also monitored my brain activity as I observed my wife's behavior the same neurons would be firing in my brain. These so-called mirror neurons in my brain are thought to be templates for specific behaviors. One hypothesis suggests that mirror neurons do not function in children with autism and cause social problems. If this is true then how might we use ABA to improve mirror neuron functioning in children with autism? I would suggest a first step would be to teach children with autism to model behavior in a normally developing peer. Once the child with autism is modeling the behavior we would then ask the child with autism questions about the peer's behavior and itentions. No doubt we would have to use verbal prompts to establish the correct intention to the modeled behavior. Hopefully, with repetition we could set up circuits of functioning mirror neurons in the child with autism. In my clinic I am exploring this and we will see what happens.

Clinic Notes: ABA and other Neuropsychological Disorders

Approximately half of the children who come to my clinic now are diagnosed with one of the Autism Spectrum Disorders, such as Rhett’s Disorder, Pervasive Developmental Disorder Not Otherwise Specified, Asperger's or just plain Autism. And that is not surprising. Autism is in the news now reportedly increasing at epidemic rates. The rest of the children who come to my clinic have some other neuropsychological disorder,sometimes a rare disorders such as Aarskog Syndrome or Alternating Hemiplegia of Childhood (see http://www.rarediseases.org/search/rdblist.html). More commonly, a child comes in who has obvious neurological problems, but no diagnosis can be made. No matter what the diagnosis or lack of, most of these children have compliance problems when they first come in and parents and other caregivers do not know which behaviors are related to the syndromes and which behaviors are simply noncompliant behaviors. In order to deal with the behaviors related to the syndromes, it is usually necessary to first manage the behaviors having to do with compliance. The first ABA programs we run in our clinic almost always have to do with compliance issues, such as making eye contact, following directions consistently, and eliminating behaviors that interfere with compliance, such as tantrums, aggressive behavior, or self-injurious behavior. Then ABA programs dealing with specific problems, such as attention deficits, etc., are implemented. Having your child compliant and under verbal control is also important so other therapists can work effectively with your child.
Additional information and ABA programs for the behavioral problems and an online ABA course for caregivers can be found at http://www.aba4autism.com/.

Clinic Notes: California Reports 2nd Highest Number of New Autism Cases In 37 Years

The California Department of Developmental Services (DDS) reported 841 new cases of autism during the 3rd quarter. Most of the increase was due to older children entering the system as opposed to younger children in the past. Various explanations for this difference are offered in the article. My question is where have these older children been? Why did they all show up during the third quarter? I am seeing more case of autism in my clinic, but I am also seeing more cases of misdiagnosis. Children diagnosed with autism that would have received a different, or no diagnosis, in the past. I still think the question regarding an autism epidemic has not been answered,

The California DDS numbers are here:
http://www.sarnet.org/lib/QrtData-AllCategoryChange.xls

Clinic Notes: Tourette’s Syndrome

Tourette's is easy to spot in public. The motor and verbal tics are obvious. Haloperidol is an effective but unpopular treatment for Tourette’s. In animal models of Tourette’s, nicotine potentiates the effects of haloperidol. In other words, a smaller dose of haloperidol can be effectively given. I don’t know of any studies that have used nicotine to potentiate haloperidal in humans with Tourette’s. Patients with schizophrenia are deficient in nicotinic cholinergic neural transmission. Many smoke to make up for their nicotine deficiency.
See "Tourette Turtle" at www.ABA4Autism.com

Clinic Notes: Having An Autistic Sibling

Many parents who bring their children to my clinic ask what effect will a child with autism have on a normal sibling. The studies that have been done on the effects of having a sibling with a neuropsychological disorder such as autism are conflicting. Some studies and anecdotal reports show an adverse effect on the sibling without the neuropsychological disorder while others do not. Girls seem to be more adversely affected than boys. Psychological problems in the parents such as depression and a host of other factors must be also considered when examining this issue. (Howling, P. “Living with Impairment: the Effects on Children of having an Autistic Sibling.” See http://mugsy.org/howlin.htm.)
See Case Number 12 "Twinship" at www.ABA4Autism.com

Clinic Notes: Preventing Autism

Autism in not usually diagnosed until the second or third year of life. A recent article suggests that autism and behaviors that correlate with the later development of autism may be identified as early as 6-8 months. Furthermore, there are studies, which suggest that intensive ABA may prevent autism if begun at an earlier enough age. One study reported that a one-year-old child at high risk for developing autism was completely after three years of ABA therapy. This doesn't surprise me. I have always thought that ABA "rewired" or appropriately wired the brains of young children.
(Preventing Autism Now: A Possible Next Step For Behavior Analysis, Philip W. Drash, Autism Early Intervention Center)

Clinic Notes: Denial in Parents of Children with Autism

I don't know the exact percentage of parents with children diagnosed with autism that are in denial. In my clinic I would estimate it is much less than half. When I first tell parents the time and money they will need to invest in ABA, Speech, OT, and other services many never blink and want to know what else they can do to help their children. But with others, one or both parents tell me their child is not really that bad off and ABA, speech, and OT services are not needed. Sometimes these parents wake up and come back, but most do not. They continue their lives without providing any services for their child except what the school has to offer. In a rural area I often get to watch these children languish in special ed while I wonder what might have been.

Clinic Notes: Discrete Trial Training

I have posted below the general procedure for discrete trial training from my web site. This is a very useful procedure for teaching children with autism or other neuropsychological disorders. In future posts I will have specific programs. If you are having problems teaching a child let me know and I will help.

10. Applied Behavioral Analysis (ABA) Program for Teaching
Children Shapes, Colors, Numbers, and Letters

Some children with neuropsychological disorders fail to learn different shapes, colors, numbers, or letters because of compliance problems, while other children with neuropsychological disorders do not learn because of sensory and/or neurological processing problems associated with certain disorders. If a reward is given to the child for a correct response, performance often dramatically improves in noncompliant children. On the other hand, the rate of improvement in children with actual sensory/neurological problems is much, much slower. In the beginning the best thing to do when we are trying to teach a child to learn the differences between stimuli, such as two colors or two shapes, is to run intensive drills using bite size rewards for all children, which we then fade out. The rate by which the child improves tells us if we are dealing with a noncompliant child or a true sensory processing problem. See Case History Number 1 in Little Bubba’s Not Ready For Nashville Yet for an example. (Available at http://wwwABA4autism.com).
Discrete Trial Training
Teaching discriminations between stimuli is easier if only two stimuli are used in the beginning. For example, take two objects, which are different colors. Start with the easiest discriminations first. The difference between blue and red should be easier to learn than the difference between red and orange.
Behavioral Assessment
Use objects which are identical but have different colors, such as pieces of cloth or pieces of construction paper. (It is better not to use different colored toys which the child would want to play with.) Ask the child to point to or hand you one color and record the number of correct responses and incorrect responses on the attached form. Do this for several days without comment or reward in order to obtain a baseline. (If you run blocks of ten trials, then it is easy to calculate the percentage of correct responses.) Only wait 3-5 seconds for a response and 3-5 seconds between trials. Be sure to switch the different colored objects from side to side so the child will not learn a position habit. (In other words, a child can learn right or left side rather than the color and still be correct.)
Behavioral Intervention
After you have a baseline, reward the child immediately for each time he/she correctly picks the right color with a bite size treat. (A Tupperware bowl full of bite size goodies is what we use as tangible reinforcers for most kids in our clinic. The child only gets to pick one bite size piece.) If the child gets it wrong say, “no,” and ask the child again. After the child receives a “no” response twice in a row, prompt the child with the correct answer (give no reward). Point to the correct color; move it closer--anything that will make the discrimination between the two colors easier for the child. Then fade the prompt on later trials by gradually moving the correct colored object back so it is in line with the colored object. Continue to wait 3-5 seconds for a response and 3-5 seconds between trials. And be sure to switch the objects from side to side so the child will not learn a position habit.
Once the child is picking the correct color, ask the child to point to or hand you the other color. When the child can discriminate between the two colors, move to another color. Again, make it easy for the child. Red and green would be easier than red and yellow. Children with neuropsychological disorders may not generalize from one set of colors to another so be prepared to spend a long time in discrete trial training. If you get no improvement after a large number of trials, try black and white discrimination because the child may be color blind.
Maintenance and Generalization
Deliver social reinforcement in the form of praise, hugs, pats on the back, etc. as often as you can once the child learns the difference between stimuli. Edible reinforcers, such as candy or other treats, may be faded out once a significant change from baseline is achieved. Only give the tangible reinforcer every other time, then every third time, etc. until it is no longer required to maintain appropriate behavior. Of course, social reinforcement should be given as often as possible.
If you are not getting anywhere after several weeks, contact a psychologist versed in ABA in your area, if at all possible. (Go to http://www.aabt.org/ to locate ABA therapists.) One possibility for the ABA program not working is satiation. In other words, your child is getting tired of whatever reinforcer you are using.
(See http://www.polyxo.com/discretetrial/ for a good overview of discrete trial training.)

Clinic Notes: Asperger's Syndrome and Bi-polar Disorder

There's is a lot in the literature about bi-polar disorder being co-morbid with the Autistic Spectrum Disorders, especially Asperger's Syndrome. Children with Asperger's Syndrome perseverate and also have social problems. One common perseveration in children with Asperger's is being right. Often I have been running ABA drills in my clinic with a child with Asperger's and noticed that if the child gives the wrong answer and I tell the child that they have made an error they will often insist that they have given the correct answer. When I try and explain why the answer is wrong the intensity of arguing often increases, sometimes to the point that it resembles manic behavior. Once the child calms down they seem often to become "hyper-calm" almost moody and depressed. I have also had two-year old children come to my clinic with a diagnosis of bi-polar disorder, and often heavily medicated. In our assessment we find that the child does display "manic" like bhavior, but the "manic" like behavior always follows the child being given a direction that the child did not want to follow. If the child is made to mind then they also become moody and depressed. These children do well on ABA programs for compliance.

Clinic Notes: Why the Causes of Autism Are so Illusive

Recently, a pediatrician who had just had a child diagnosed with autism, emailed me. "The neurologist told me that autism is a brain disorder," she wrote. "And the gastroenterologist told me that autism is a gut disease, and the immunologist says that it is an immune disorder. Please tell me what autism is and how to treat it."
Of course, I told her about ABA, speech, OT, and the meds pediatric neurologist prescribe, but I could not answer her question completely. I don't think her question will be answered until we get a better classification system of autism spectrum then we have now. If you saw the kids in my clinic who are diagnosed with autism you would see so much variation in symptoms that you would wonder if they all had the same disorder. Some self-stim others don't, some are verbal others are not, some are compliant others are not, some have sensory issues others don't, some are remote ohers are very loving, some have digestive problems others don't, some have immune problems others don't, and so on. If all these children all have the same disorder, then why the wide variation in symptoms? I think autism will turn out to be a disease like cancer. There are many different types of autism with different causes and different treatments.

Clinic Notes: Social Stories for Children with Autism or Other Neuropsychological Disorders

What is a Social Story?
Social stories are short descriptions of how a child should behave in a wide variety of situations. Children with autism and Asperger's, as well as children with other disorders, have problems socially because of an inability to understand the point of view of others and their expectations. Everyday activities such as how to behave during circle time, what to say if someone compliments you, or how to handle bullying can be addressed by using social stories.
How to Use Social Stories.
Social stories are useful in teaching a child how to behave in situations when the therapist cannot be there to prompt and reinforce appropriate behavior. For example, if a child becomes aggressive at day care when another child takes a toy away then a social story about sharing or how to behave when a child takes a toy away can be very useful. A social story describing what the child should do to obtain a positive outcome, personalizing as much as possible the story for the child, is written. After reading the story to the child several times the child can be asked, "What do you do when Billy takes a toy you are playing with and starts playing with it himself?" If the child cannot remember the story or the answered then he/she can be cued. The correct answer may vary for different children in different settings. Telling the teacher might be appropriate in one situation; playing with another toy may be appropriate in another. At any rate the story is repeated until the child has memorized the correct answer. If the therapist finds out that child did engage in the appropriate behavior described in the social story then reinforcement in the form of praise and tangible reinforcement can be given at a later time.
How to Write a Social Story.
Social stories should be written from the point of view of the child and provide information on how to behave, what other expect, and the positive consequences of appropriate behavior. Social stories should be short and the child may have to memorize the correct way to behave and then replay the social story in his or her head when in the actual situation.

Clinic Notes: When Time Out Does Not Work for Children with Autism

In my last blog I discussed how to do time out properly. As I mentioned time out is a often used and misused procedure. But even when used properly time out can have limited success with children with autism. Time out means time out from positive reinforcement. So if a child with autism is engaging in a reinforcing activity such as playing with a toy, watching a video, etc, and you send the child to time out for some inappropriate behavior such as not following directions then time out will in all probability be effective. On the other hand, if you are running discrete trial training and trying to teach a child with autism letters of the alphabet, which is hard for the child, then sending the child to time out for an inappropriate behavior such as not paying attention will not be effective. The drills are not reinforcing so time out will not work. In this situation we usually run the body parts drill. In this drill we take the child’s wrist and use the child’s hand to point to different body parts. Fade the physical prompts as the child begins to do the drill on his or her own. In other words, use less and less force to move the child’s hand as the child becomes compliant. (This is the same behavioral principal a rider would use to get a horse that balks to cross a ditch or go up a hill. The rider would pull the reins to the right or left and make the horse go around in a circle several times. If the horse did not comply then the rider would have the horse go around in circles several more time and try again.

Clinic Notes: Time out and Autism

Time out is an often used and misused procedure. If done properly, time out is a very effective, humane procedure. Find a place in your house where a time out chair, preferably a chair with arms and not a bench, can be left. The chair should face a blank wall and not be close to a window, shelves, glass, electrical outlets, or storage cabinets containing chemicals. Hallways and alcoves often work. Do not use bathrooms or closets. The time out chair should be close to the play area so the child can be placed in time out quickly. Think safety, especially for small children. (If the child is very young, then the baby bed will do, and no, the child will not develop an aversion to the baby bed and have sleep problems. An alternative time out procedure for a young toddler is to sit him/her down on the floor with his/her back to you and hold them there for thirty seconds. Do not talk to the child except to tell him or her at the beginning and end of time out why he or she is in time out.) For young toddlers you can just count to thirty in your head. For older children, use an egg timer and teach the child that he or she cannot get out of time out until the egg timer goes off. The child has to stay in time out for three minutes plus one minute of good behavior. In other words, the child has to be quiet and cannot be arguing, complaining, or tantruming for one full minute before he or she can get out of time out. Do not be surprised if the child comes up with a whole bag of new inappropriate behaviors in order to get out of time out. Kids have been known to gag, vomit, and one of my own kids even hit herself in the face several times. Do not respond and thereby reinforce these new inappropriate behaviors or they will increase in their frequency. Only good behavior gets the child out of time out. (Initially, some kids have to be held in time out. Gradually, decrease the restraint you have on the child and make sure he/she is sitting there quietly for one minute before he/she gets out. If the child is too large to safely hold in time out, then use a response cost procedure instead. In response cost something the child values is taken away temporarily. Examples include watching TV, going outside, videos, the opportunity to play games with caregivers, favorite foods or beverages, a favorite toy, etc.) In the beginning of this procedure, it is not unusual for a child to be in time out for fifteen to twenty minutes before he/she quiets down, and to go to time out as often as twenty times a day. After a few days the child learns the requirements of the time out procedure and he/she gets out in the minimum four minutes. The number of times the child goes to time out each day also drops dramatically. When the child gets out of time out, remind your child of why he or she had to go to time out in a firm tone. Do not be timid with your voice or body language. (Excerpted from my ABA eBook available at www.aba4autism) In my next blog I will discuss why time out does not always work with children with autism

Clinic Notes: Autism and Hearing

Parents and professionals expect auditory processing problems when they see a child with autism cover his or her ears with their hands. Other children with autism act as if they are deaf. Many children with autism, who have partially recovered, report sensory distortions. The sound of a vacuum cleaner or hair dryer may be so loud that it frightens the child with autism. A single voice may be so soft that it is not heard, while several voices, as in a classroom, may be deafening. Temple Grandin’s governess used to punish her when she was a child by popping a paper bag. In my clinic we often run an ABA program to desensitize a child to aversive sounds. Desensitization also works well for the child with autism or other neuropsychological disorders who are distracted by sounds when they are trying to concentrate. Go to my website aba4autism.com for a desensitization program for your child.

Clinic Notes: Autism in Malaysia

Last week I noticed that an order on my website for one of my ABA eBooks was from a woman in Malaysia. I receive orders from all over the world, but I think this was the first one that I have from Malaysia. I recall wondering at the time what services were available for children with autism in Malaysia. I'm still not sure what all the services are like, but a recent report indicates that there was some abuse by parents of the so-called "naughty" children. The National Autism Society of Malaysia (Nasom) has set up 13 Nasom centers nationwide to provide early behavioral management for children with autism. In addition, Nasom plans to train 2000 preschool and primary school teachers on how to teach children with autism. Perhaps things aren't so bad for children with autism in Malaysia.
http://tinyurl.com/mk

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Clinic Notes: Sex Differences and Autism

Autism is 4 to 5 times more prevalent in boys than girls and often more severe. In a recent study at the University of Washington, researchers found that different genes may be involved in autism in males and females. Furthermore, different genes may cause early onset autism and regressive autism. (http://www.emaxhealth.com/37/6827.html).

Clinic Notes: Down Syndrome and Autism

Last year I had a child come to my clinic with Down Syndrome who had recently developed autism. Recent studies find that 7 to 10 percent of children with Down Syndrome also have autism. I think that it is more appropriate to say that they exhibit some autistic behavior. In 1959 the genetic basis of Down Syndrome was found to be trisomy 21 in 95 percent of the cases and the extra chromosome is usually maternal in origin. People with Down Syndrome are depicted in ancient art; so apparently the disorder has been around for a long time. In 1866 Dr. John Langdon Down wrote about the facial similarities of many of his patients with mental retardation using a racial description (Mongol), which unfortunately stayed around for nearly a century. Once the genetic basis of the disorder was known ,the terminology changed and now the correct terminology is to refer to them as persons with trisomy 21 or a person with Down Syndrome. See http://www.nas.com/downsyn/trumble.html for a detailed discussion of Down Syndrome.
Women older than forty or mothers who already have a child with Down Syndrome are more likely to give birth to babies with Down Syndrome, and routinely undergo amniocentesis at sixteen weeks. Taking into account surgical and spontaneous abortions the incidence of Down’s is approximately one in every eight hundred births. Younger mothers who do not undergo amniocentesis deliver the majority of Down’s babies because they don’t get tested. A new test, which combines blood tests and an ultrasound, is 90 percent accurate in the first trimester and can be done four to six weeks earlier than the standard Triple Test. (We understand more about genetics now than we did in John Donne’s day. But it seems like fate still plays a role.)
Children with Down’s have a variety of physical characteristics. Most of these children do not reach adult height. The head is usually smaller (microcephaly) and the nose may be flattened. The tongue protrudes and the eyes slant upward. Many children with Down’s have a rounded fold of skin (epicanthal fold) in the inner corner of the eye. The hands and fingers are broad and have a single crease in the palm. Medical problems may include congenital heart defects, gastrointestinal problems, hypotonia, and acute lymphocytic leukemia. The average mental age is eight years.
Some newborns with Down Syndrome have visual and hearing deficits. Cataracts occur in 3 percent of the cases and glaucoma is more likely also. Hearing should be tested on a yearly basis according to some experts. Hypotonia not only affects mobility it also affects feeding. The protruding tongue means feeding will take longer and dysphagia (difficulty in swallowing) and choking episodes are common. The usual developmental milestones are globally delayed.
Ten percent of kids with Down Syndrome have seizure disorders which are usually tonic clonic. In older patients with Down Syndrome, seizures associated with Alzheimer’s often develop.
Children with Down Syndrome usually do well with ABA. When autistic behavior develops with Down Syndrome the ABA is more difficult.
Go to http://www.aba4autism.com and read case number 15 for additional information on Down Syndrome.

Clinic Notes: The Curious Incident of the Dog in the Nighttime Redux

Last year I read the novel, The Curious Incident of the Dog in the Nighttime by Mark Haddon. The protagonist in the novel is a boy with autism and is one of the best descriptions of the disorder that I have read. In a recent Schaffer Report reporter Jim Maniaci (http://www.gallupindependent.com/
2006/july/071206deaddog.html)
describes another "curious incident" in which a New Mexico woman returned home to find her autistic grandson's dog shot. She put the dog's body in a box by the road and her child frequently visited the temporary grave a number of times. The deputy investigating the case returned several days later and advised the grandmother she would have to bury the dog or call animal control because of the flies

Clinic Notes: Prenatal Exposure to Recreational Drugs

Prenatal exposure to recreational drugs causes a host of physical and neuropsychological problems in children. Some disorders, such as Fetal Alcohol Syndrome, are stereotypical while exposure to other drugs cause problem behaviors, which are more diverse. Investigative techniques used to study the precise neurological mechanisms involved in prenatal exposure to various drugs are too invasive to use with children as subjects so it is necessary to turn to animal models. The research is limited here, but we do know that prenatal exposure to alcohol produces abnormal spines on the dendrites of the neuron and reduces neural plasticity. In other words, it is more difficult for the neural circuits underlying various neurological functions to form when alcohol has been ingested.

Clinic Notes: Paying for ABA

Recently, I was in a meeting with the Commissioner Of Mental Health in Tennessee. After the meeting the psychologist who works for the Commissioner told me that TennCare, the states program for the uninsured, was now paying for ABA. Unfortunately, the reimbursement rate was only $27.00 per hour. Normally, ABA costs from $30,000 to $80,000 depending on the number of hours per week. Alberta Province in Canada pays up to $60,000 per year for ABA. At the Tenncare rate I would make $28,000 per year if I saw a child for 20 hours a week. When school systems and insurance companies agree to pay for ABA, which does not always happen, the pay rate is 2-3 time what Tenncare pays. I wonder who is doing ABA for $27 an hour? Probably not anyone qualified. It's unlikely that many kids on Tenncare are getting ABA. I guess if you want ABA for your child with autism and you cannot pay or get anyone else to pay do what many Canadians from other provinces are doing. Move to Aberta.
http://www.cbc.ca/canada/calgary/story/2006/07/10/
autism-therapy.html

Clinic Notes: Where is the Best Placement for a High Functioning Child with Autism?

One question I always get in my clinic from parents of high functioning children with autism is what program is best. Of course, the school system usually wants to put them in special ed classes or a separate autism program in the larger school systems. But then you run into a modeling problem. Children with or without developmental delays are going to imitate their peers. So if you have a class of children with autism who is the high functioning child going to imitate?
I have a mother of a high functioning child coming to my clinic now. She and her husband are traveling all over the country looking for the best autism program. I'd mainstream this child, while at the same time providing the ABA services the child needs. I've done this many time and it works well.

Clinic Notes: Wild Child

In graduate school I’d read The Wild Boy of Aveyron, an account of a ten to twelve year old who was captured in 1799 by French peasants in the forest where he had been living. The child acted like a wild animal running around on all fours, eating off the ground, smelling everything. There have been other published cases of abandoned kids, found living in the wild, like Amala and Kamala, the so-called “Wolf Children” found in India in the 1920s and “Wild Peter” discovered in Germany in 1724. Bruno Bettelheim argues that these wild or feral children were really abandoned autistic children. Since they couldn’t speak, it was assumed by the people who found them that these kids were raised in the wild by animals. There is some doubt about authenticity of these cases. None of them responded to "therapy" and their behavior was similar to more recent, confirmed cases of isolation and deprivation: infants and young children who have been kept in captivity, locked up in small rooms, closets, or attics, isolated from the outside world, and oten abused. I often wondered if these accounts of feral children led Bettelheim to propose his refrigerator theory of autism back in the forties. I had dinner with him in the seventies and asked him directly. But he was a grouchy depressed man and waved his hand at me and would not answer.
(See "Wild Child" at www.aba4autism.com)

Clinic Notes: Designing Non-Autistic Babies

Scientists in the UK already have approval to screen embryos for genetic disorders that would shorten life expectancy before implantation. Now ethicists are upset because these scientist want to only use female embryos for implantation in families with a high risk for autism. Since the incidence of autism is four to five times more likely in males than females this would cut the risk considerably. The ethicist argue that such screening procedures will create a society were only perfect children are tolerated. Well I don't know about that. But I do know there will still be plenty of children with autism around, both male and female. http://tinyurl.com/fwgcm

Clinic Notes: What Horses Tell Us About Autism

I grew up in Texas, and in high school my life was horses and rodeo. I’m certainly not an expert on horse behavior by any means, but the first time I came in contact with a child with autism, I thought that some of their behavior looked horse-like--unbroken horse-like. For example, many unbroken horses, and many children with autism, will become uneasy if you try to approach them head on. You have to approach them from behind or at a forty-five degree angle. Horses and kids with autism also seem to know by your body language and touch whom they can ride/manage them and who they can take advantage of. I wrote Monty Roberts, a well known, practicing horse whisperer. He told me several clinicians had already recognized the similarities between autism and horse misbehavior and were applying his horse training techniques in their work with kids with autism. (See montyroberts.com)
Go to www.ABA4Autism.com for a longer article on horses and autism ad to learn how horse whisperer might help you manage your child with autism.

Clinic Notes: What does a Diagnosis of Autism Mean?

The first thing parents who bring their children to my clinic want to know is does my child have autism. If the child is older and already diagnosed with autism parents will often ask if their child still has autism. A recent study found that most children diagnosed with autism when they were two also were still diagnosed with autism at age nine. On the other hand, children diagnosed with pervasive developmental disorder not otherwise specified (PDD-NOS) when they were young had their diagnosis changed to autism when they were older. (Autism Diagnosis Remains Through Early Childhood So much for recovery? SOURCE: Archives of General Psychiatry, June 2006.)
I see some health care professionals diagnose a child with PDD simply because they do not to alarm parents by using the "a" word. I don't worry too much about diagnosis because with ABA you simply treat the problem behaviors, which vary from child to child with a diagnosis of autism or PDD. I also tell parents who have children with a high functioning autism or PDD diagnosis that they are probably better off not telling the school system the child's diagnosis. Teachers are will always notice more behavior problems in a child with a diagnosis.

Clinic Notes: Early Biological Markers of Autism and ABA

Autism is usually diagnosed between the second and third year of life. Everyone agrees that the earlier autism can be diagnosed and treatment started the better. Now if the research at Yale University School of medicine holds up it may be possible to diagnose autism at birth. The found that children with autism were three times more likely to have trophoblast inclusions which reflect abnormal folding of microscopic layers in the placenta and are caused by altered cell growth. It was already known that trophoblast inclusions were more common in cases of chromosome abnormalities and genetic diseases. Citation: Biological Psychiatry, Published online (June 26, 2006).
It may very well be in the future that we start ABA and other therapies at an earlier age if this biological marker is a reliable indicator of autism.

Clinic Notes: Cruelty Toward Animals

In The Dragons of Eden, Carl Sagan presented the thesis that the cortex evolved to repress and control our lower reptilian brain, making civilized human behavior possible. I don’t know it this is true, but I do know that damage to the cortex that causes disinhibition is a significant clinical problem in children I see in my clinic, especially when aggression toward pets, care givers, and other kids is involved.
Aggressive behavior is common in kids with various neuropsychological disorders. Nonverbal kids learn to use aggression as a way to communicate. Neurological damage to the cortex of the brain, caused by trauma or drugs taken by the mother while she is pregnant, can cause cortical disinhibition in the child and further increase the level of aggression. Children with neuropsychological disorders, as well as those without, also learn violent, abusive behavior from adult role models, video games, and the media.
Twenty-five percent of men imprisoned for violent crimes had a history of cruelty toward animals in their childhood. A comparison sample of men convicted for nonviolent crimes had no history of cruelty toward animals. Aggressive women prisoners show a similar history. Cruelty toward animals is also associated with child abuse. Apparently, the abused child takes out his frustration on family pets.
See "Just Another Serial Killer Thriller" at http://www.aba4autism.com for the rest of this case history

Clinic Notes: Dopamine 101

Tourette’s is caused by an excess of the neural transmitter, dopamine. Parkinson’s disease is caused by a depletion of dopamine producing neurons in an area of the brain called the substantia nigra. Dopamine agonist such as L-dopa can temporally alleviate the paralyzing effects of Parkinson’s just as dopamine antagonists, like haloperidol, temporally relieve the Touretter of his tics.
In the 1980s, synthetic heroin contaminated with MPTP appeared on the streets. Several addicts who injected this contaminated heroin became “frozen” and were admitted to psychiatric hospitals with a diagnosis of catatonic schizophrenia.
On closer examination, animal studies indicated that MPTP metabolized to a neurotoxin that destroyed dopamine neurons in the substantia nigra just like Parkinson’s. These frozen addicts were nearly mute, and somewhat like patients with locked-in syndrome.
See Case History # 9 in Little Bubba's Not Ready for Nashville Yet at http://www.aba4autism.com

Clinic Notes: Transiet hemiplegia and Alternating Hemiplegia of Childhood

Transient hemiplegia (one-sided paralysis) can be caused by low blood sugar in childhood diabetes and other organic conditions, such as transient ischemic attacks (TIA’s), and also some types of migraines. Like adults, children can have strokes with permanent paralysis. Sometimes the term transient hemiplegia refers to a rare condition known as Alternating Hemiplegia of Childhood. In this disorder, one side is paralyzed one day, and the other side is paralyzed on other days, which seems to defy basic neuroanatomy. The only minimally effective treatment reported for Alternating Hemiplegia of Childhood is a calcium channel blocker called Flunarizine. The FDA has not approved this drug, and since so few cases of Alternating Hemiplegia of Childhood exist, they are not likely to do so. Only 250 children worldwide are affected by this disorder so there’s a real shortage of patients for studies into the causes. Years ago, I saw a young child in my clinic with a diagnosis of Alternating Hemiplegia. I didn’t think it likely that such a rare disorder would pop up in my clinic and was suspicious of the diagnosis from the beginning. After several months it turned out to be a case exactly like Jamie’s. See http://www.rarediseases.org and The 2000 June-August issue of the online publication of Perspectives: A Mental Health Magazine at http://mentalhelp.net/perspectives/ for a brief account of this case.
Go to www.aba4autism.com for a complete case history in Little Bubba's Not Ready for Nashville.

Clinic notes: "The Longest Running Horror Movie."

David M. didn't have an appointment. I found him standing in my doorway one afternoon, his body trembling, a look of desperation on his face. After a few moments of silence, he sat down in the chair I pointed to across from my desk and began his history with a twenty-year flashback.
His father's car was parked beside a cemetery on a lonely country road. Of course, it was a dark and stormy night and a scream from the back seat "pierced the darkness."
"I know this sounds like the beginning to a second-rate horror movie," David conceded in a nervous voice. "But that's exactly what my life's been- -a second-rate horror movie."
For the rest of this case history go to http://www.aba4autism.com

Clinic Notes: Biting in Children

Recently my daughter called to tell me that my 14 month-old granddaughter had just bitten another child. Children age 13-24 months are bitten most often in day care centers and usually the biting is most likely to occur at the beginning of the school year. The arms and face of the child are the areas most frequently bitten, but only one bite in fifty actually breaks the skin. Occasionally, children get kicked out of day care for biting other children and staff.
More serious biting of others or one’s self is often seen in children with neuropsychological disorders like autism, Fragile X Syndrome, and mental retardation. In rare neuropsychological disorders, like Lesch-Nyham syndrome, children compulsively bite their lips, fingers and arms, and bite others as well. A variety of extreme measures, including teeth extraction have been used to try to control biting in this disorder. Physical restraints are te only effective remedy, and many Lesch-Nyham patients will ask to be placed in restraints when they feel a biting episode coming on.
See Case History # 6 in Little Bubba's Not Ready for Nashville Yet at http://www.aba4autism.com

Clinic Notes: Autism and Down Syndrome

I once had a set of twins coming to my clinic. One twin was developing normally, and the other twin had Down Syndrome and then developed Autism at the age of four four. Recent studies find that 7 to 10 percent of children with Down Syndrome also have Autism.
In 1959 the genetic basis of Down Syndrome was found to be trisomy 21 in 95 percent of the cases and the extra chromosome is usually maternal in origin. People with Down Syndrome are depicted in ancient art; so apparently the disorder has been around for a long time. In 1866 Dr. John Langdon Down wrote about the facial similarities of many of his patients with mental retardation using a racial description (Mongol), which unfortunately stayed around for nearly a century. Once the genetic basis of the disorder was known,the terminology changed and now the correct terminology is to refer to them as persons with trisomy 21 or a person with Down Syndrome. See http://www.nas.com/downsyn/trumble.html for a detailed discussion of Down Syndrome.
Women older than forty or mothers who already have a child with Down Syndrome are more likely to give birth to babies with Down Syndrome, and routinely undergo amniocentesis at sixteen weeks. Taking into account surgical and spontaneous abortions the incidence of Down’s is approximately one in every eight hundred births. Younger mothers who do not undergo amniocentesis deliver the majority of Down’s babies because they don’t get tested. A new test, which combines blood tests and an ultrasound, is 90 percent accurate in the first trimester and can be done four to six weeks earlier than the standard Triple Test.
Why some children with Down Syndrome develop autism and other do not is not known.
See Case History # 15 in Little Bubba's Not Ready for Nashville Yet at http://www.aba4autism.com

Clinic Notes: Aggressive Behavior in Children

Aggressive behavior is common in the kids we see in our clinic who present with various neuropsychological disorders. Nonverbal kids learn to use aggression as a way to communicate. Neurological damage to the cortex of the brain, caused by trauma or drugs taken by the mother while she is pregnant, can cause cortical disinhibition in the child and further increase the level of aggression. Children with neuropsychological disorders, as well as those without, also learn violent, abusive behavior from adult role models, video games, and the media.
Twenty-five percent of men imprisoned for violent crimes had a history of cruelty toward animals in their childhood. A comparison sample of men convicted for nonviolent crimes had no history of cruelty toward animals. Aggressive women prisoners show a similar history. Cruelty toward animals is also associated with child abuse. Apparently, the abused child takes out his frustration on family pets.
Since aggression is, at least partially, a learned response ABA programs can reduce and usually eliminate aggression. Occasionally, certain psychoactive drugs must be used along with the ABA programs.
See case Histories # 6, 16, and 20 in Little Bubba's Not Ready for Nashville Yet at http://www.aba4autism.com

Clinic Notes: Alternating Hemiplegia of Childhood

Transient hemiplegia (one-sided paralysis) can be caused by low blood sugar in childhood diabetes and other organic conditions, such as transient ischemic attacks (TIA’s), and also some types of migraines. Like adults, children can have strokes with permanent paralysis. Sometimes the term transient hemiplegia refers to a rare condition known as Alternating Hemiplegia of Childhood. In this disorder, one side is paralyzed one day, and the other side is paralyzed on other days, which seems to defy basic neuroanatomy. The only minimally effective treatment reported for Alternating Hemiplegia of Childhood is a calcium channel blocker called Flunarizine. The FDA has not approved this drug, and since so few cases of Alternating Hemiplegia of Childhood exist; they are not likely to do so. Only 250 children worldwide are affected by this disorder so there’s a real shortage of patients for studies into the causes. Years ago, I saw a young child in my clinic with a diagnosis of Alternating Hemiplegia. I didn’t think it likely that such a rare disorder would pop up in my clinic and was suspicious of the diagnosis from the beginning. After several months it turned out to be a case of the parents reinforcing the child whenever he was "paralyzed". The child could not remember which arm was "paralyzed" and often alternated his "paralysis" from day to day. See http://www.rarediseases.org and The 2000 June-August issue of the online publication of Perspectives: A Mental Health Magazine at http://mentalhelp.net/perspectives/ for a brief account of this case. This case is also available on my website http://www.ABA4Autism.com

Clinic Notes: Autism and Faces

Children with autism do not show interest and are not proficient in recognizing people’s faces. If they do look at a person’s face, they concentrate only on one part, such as the eyes or the mouth. In a paper presented to the Society for Research in Child Development, Geraldine Dawson showed groups of three-and four-year-old children with autism, mental retardation, or normal children, pictures of their mother and a stranger and pictures of their favorite toy and a strange toy. The brain wave recordings registered to pictures of mom and the favorite toy in the children with mental retardation and the normal children. The brain waves of the children with autism responded to the picture of the favorite toy, but there was no difference in the response to their mom’s face and the face of a stranger.
Excerpted from Little Bubba's Not Ready for Nashville Yet: Case Histories of Children with Autism or Other Neuropsychological Disorders. Available at http://www.ABA4Autism.com

Clinic Notes: ADHD

Parenting characteristics are a better predictor of ADHD than genetics. Smoking by the mother while she is pregnant has also been associated with ADHD. For the child who does not calm down Ritalin or Adderal is okay for the short term, but special parenting skills for handling the child with ADHD need to be acquired at some point. Even then ADHD may be a problem through the teen years and into adulthood. And normal tasks such as driving a car may be a problem for ADHD kids when they get older. Teens with a history of ADHD are four times more likely to have a wreck. As far as I know, insurance companies have not picked up on this because medical records are confidential, at least to a certain extent. Obviously, if insurance companies knew a teenager they were about to insure had ADHD their rates would go up.

Clinic Notes: Refrigerator Mothers

After American psychiatrist Leo Kanner published the first paper on autism in 1943, psychoanalyst Bruno Bettelheim wrote extensively about so-called “refrigerator mothers,” who were emotionally cold and rejecting. According to Bettelheim these mothers 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. In the 1960s, 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 1970s and I tried to discuss with him the role of biological factors in autism. He refused to accept the possibility and told me in no uncertain terms to go read his books. There I would find all of the answers to my questions. At the time he was still saying, for a fee, that moms caused autism. I experienced Bettelheim as a grouchy, depressed old man, and I’ve often wondered if he knew he was wrong and felt badly about all of the guilt he’d caused mothers. (I’d like to think there’s a certain amount of justice in the world.) Excerpted from Little Bubba's Not Ready for Nashville Yet" Available at http://www.ABA4Autism.com

Clinic Notes: Stem Cell Transplants for Batten Disease

StemCells, Inc. will soon begin clinical trials to evaluate their line of stem cells in the treatment of Batten disease, a rare fatal disorder in children. Children with Batten disease have seizures, loss of motor skills, vision, cognitive function, and speech. This is the first trial of stem cells as a potential therapy in children.
I hope the clinical trials are successful and I wonder if stem cell technology will ever have application with other neurodevelopment disorders in children such as autism.

Clinic Notes: Preventing Autism

I'm just like any other parent or grandparent. I worry about autism. When I see my grand babies staring at lights or fans I immediately re-direct them. I have been relieved to note that they were not rigid when picked up and they never banged their heads against the side of the crib. One had a slight language delay and the pediatrician suggested a possibility of autism, which scared my daughter, but fortunately, turned out to be a false alarm.
There are other early signs of autism, such as being a younger sibling of a child with autism. The concordance rate for identical twins is 60%, fraternal twins 4.5%, and non-twin siblings 4.5%.
What should a caregivers do if their child shows early signs of autism? Can autism be prevented with early intervention? Next week on my web site www.aba4autims.com I will post a discussion of some recent research.

Clinic Notes: ADHD?

Many parents already have an ADHD diagnosis for their child before they bring them to my clinic. I always separate the parents from their child and then observe the child in our playroom while the child is alone with my assistant and me. If the child appears ADHD, we do not say anything. We let the child run around the playroom as much as he or she wants. Often the child will calm down after a few minutes and play appropriately with the toys and then we will praise the child. Occasionally, we ask the child questions and praise the child if he or she answers the question the first time, but we ignore the child for not answering. Once the child has learned to pay attention to us and played calmly for twenty minutes or so, I ask the parents to come into the playroom. If the child becomes ADHD when the parents come in to the room, and do not settle down, I know the ADHD has been conditioned by the parents’ attention. In other words, the parents ignore the child whenever he or she is not being ADHD, and give the child attention whenever ADHD behaviors occur. This attention is reinforcing for the child and the ADHD behavior increases in its frequency. In cases like this I give the parents an ABA program for staying on task and decreasing other ADHD behaviors. The parents have to learn to reverse their behavior at home and give attention in the form of praise for non-ADHD behaviors and ignore ADHD behaviors. This is hard for the parents to do even with my weekly monitoring and guidance, but when they are successful this simple change in the parent’s behavior can decrease ADHD behavior without having to resort to medications.
Excerpted from Case History # 7. "The Night Life Ain’t No Good Life" Available at: http://www.ABA4Autism.com