Clinic Notes: Asperger's and Bullies

All of the children with an Asperger's diagnosis that I see in my clinic are mainstreamed. And that's good until Middle School when testosterone kicks in at puberty and bullying starts. It's like kids with Asperger's have a target on their back that says bully me. Of course other kids besides Asperger's kids are bullied, but for kids with Asperger's it is especially bad because they don't understand social behavior much less anti social behavior. I was especially glad to see that the American Academy of Pediatrics is publishing a policy statement on bullying and recommending a prevention model developed in Norway by Dan Olweus. The Olweus program focuses on the bystanders rather than the bully or the victim. The bystanders are taught that the bully has an anger management problem and they can protect the victim. Hopefully schools will adopt this model and provide training to stop bullying of children with Asperger's as well as the other ¼ surveyed who say they have at times been bullied.

Clinic Notes: Autism in Adults

In a recent article in "Time Magazine" the brother of a man with severe autism describes the life of his autistic brother and the ordeal his parent and now him are dealing with. Noah, who cannot speak or care for himself, bangs his head and pinches himself, and grabs people, spent 15 years in a state facility. His "therapy" has mainly been drugs, which unsuccessfully managed his symptoms. The article was taken from Karl Taro Greenfield's book, Boy Alone: A Brother's Memoir.
Greenfield notes that his parents were exhausted after years of caring for Noah at home and had no choice but to place him in an institution for children with developmental disabilities. They visited weekly and the family served as Noah's support group until he was moved to an assisted living facility. Greenfield notes, as I did in a previous blog, that we are not prepared for the explosion of adults with autism that will be here in a few years. All of the money now is being spent on services and research for children who are growing up.

Clinic Notes: Terrorists Recruiting Asperger's Suicide Bombers?

Apparently, terrorists using the internet helped a British citizen with Asperger's plant a bomb in a restaurant. The bomb went off prematurely injuring the man with Asperger's and causing a stampede in the restaurant. Sentenced in the Old Bailey Court to 18 years in prison the suspect is now undergoing test in a mental hospital. Many of the children with Asperger's that I treat in my clinic have problems with social concepts so I'm not surprised that the terrorists were successful. I suppose this is an isolated incident?

Clinic Notes: Where Will All of the Children with Autism Go

Everyone is concerned now with the rising number of children with autism. Autism diagnoses in California have increased twelve fold in two decades and rates are rising elsewhere. Providing services for these children with autism has placed a heavy burden on education and healthcare with many children unable to get the services they desperately. I practice in a rural area and at The Children's Treatment Center (http://www.childrenstreatmentcenter4autism.com) 70 to 80% of the children that we see have an autism diagnosis. Everyone who provides services for children with autism is overwhelmed. Research is increasing and that is good, but autism likely has more than one cause and there are no good animal models of autism. Since autism involves impaired communication I doubt that we will ever have a good animal model so it's likely that a cure is a long way off. When the children with autism reach adulthood and the school system is no longer responsible for them where will they go? Some will be able to have careers and live independently, but many will require continuing services. I used to be able to get special needs children in sheltered workshops and group homes in a few months, but now the wait is years and because of funding cuts some existing facilities are closing. Unfortunately, the majority are going to be with their parents. Furthermore, these children with autism will probably outlive their parents and who will take care of them then? It is time to start planning.

Clinic Notes: Recovering from Autism

Now there is evidence, some of it anecdotal on You Tube that perhaps 10% of children can recover from autism. Most of these children have received years of Applied Behavior Analysis (ABA), which started at a very young age. As I wrote about in an earlier blog previous studies have shown that it may be possible to prevent autism in high-risk toddlers with intensive ABA. While this is good news getting insurance coverage for ABA is still a problem. Blue Cross Blue Shield tells parents in the state where I live that ABA is experimental and not covered while Blue Cross Blue Shield in other states has treatment plan forms and suggest CPT codes to the provider for billing for ABA. Come on these are children's lives we are talking about.

Clinic Notes: Vitamin D Deficiency and Autism

The building next door to my clinic is full of tanning beds. Everyday I see a stream of people going in and out year round getting that golden tan under the lights. In the past I have shook my head and pitied them for risking skin cancer just for that back from vacation look. But now I'm not so sure. Some recent research suggest that avoiding the sun causes vitamin D deficiency and may contribute to the development of certain cancers such as prostrate cancer. And a recent study suggests that vitamin D deficiency may be involved in autism. The evidence comes from studies in Minnesota and Sweden involving Somalis immigrants. Their African home was on the equator and they got plenty of sunshine and vitamin D. There was no autism in their native land. In fact, there was no word in their language for autism. But when the Somalis moved the Minnesota and Sweden the incidence of autism in the Somalis soared. The Somalis in Sweden even call it the "Swedish Disease." I wonder now if parent should be dragging their kids to the tanning beds with them. With all the video games and childhood kids don't get outside as much as they used to. Maybe a few minutes in the tanning bed, equipped with video games of course, would cut the rate of autism.

Clinic Notes: The Music of the Spheres and ABA

In normally functioning brains, neurons fire in rhythm. However, in brains which are impaired by various disorders like schizophrenia or autism, the neurons oscillation frequencies are not tuned correctly and fire out of rhythm like band instruments each playing a different song. This behavior of neurons in the brain reminds me of the ancient Pythagoraian concept of universal music or music of the spheres where the sun, the moon, and the planets move in harmony--not an audible harmony, but a geometrical mathematical harmony that prevents chaos. Likewise the neurons in the brain must fire in a normal rhythm in order to process sensory information, thoughts and feelings, and implement speech and movement. In autism, it is obvious that at least parts of the brain are not working right and seem to have different rhythms. Although I have not done any empirical research and know of no studies, in my clinic the pacing or the rhythm of how we do ABA makes a difference in how kids progress. The frequency of breaks, the intensity of the drills makes big difference in the effectiveness of ABA. It's like a dance that must be learned between therapist and child. Perhaps a dance out of autism.

Clinic Notes: Autism as an Insanity Defense

According to a recent Schafer Report, a number of violent criminal cases around the country have employed an insanity defense claiming autism affected the person's ability to distinguish right from wrong. Most insanity defenses rely on schizophrenia or some mental impairment. Individuals with autism or Asperger's Syndrome do have problems with socialization and are often awkward and don't understand social norms. They can be aggressive at times, but rarely violent. Fortunately, "expert doctors" called to testify for the defense or prosecution can be sure to disagree, and juries are usually unwilling to accept the insanity defense anyway. I doubt that anyone will successfully be able to prove that "autism made me do it." At least I hope not. I don't want autism to get a bad name because it is used too often as an insanity defense.

Clinic Notes: Robots, Autism, and ABA

The Today Show recently had a piece on robots, which were designed to "interact" with children with autism. Previous observations have found that children with autism interact with mechanical devices such as touch screen computers or computer generated speech devices better than they do with humans. Hopefully, these specially designed robots could become "playmates" for children and teach them how to make eye contact and develop social skills. In my clinic, and other clinics, we do much the same thing with ABA and at a much cheaper price. Anyone in private practice will tell you that overhead is a curse and no one in private practice would be able to buy or rent one of these robots. Another curse in private practice is dealing with insurance companies. I would worry that even if the price of the robots came down and were affordable, would the insurance companies reimburse the provider for the robots' services?

Clinic Notes: Using Cartoons To Detect Autism at An Early Age

Everyone agrees that the earlier that you start treatment for children with autism the better. In fact some studies indicate that early ABA can even prevent autism. Yale University researchers may have come up with a novel way to detect autism using stick figures playing pat-a- cake in various orientations. They found that whichever way they oriented the figures--upside down--right side up did not mater. The young children with autism paid no attention to them. However, when the figure started clapping and singing in time with the nursery rhyme the child with autism paid attention. Auditory-visual synchronicity was what caught the child's attention. Normal children paid more attention to the figure's movements and ignored the auditory-visual synchronicity.

Clinic Notes: A New Autism Drug

According to several reports online Curemark has received FDA clearance for a Phase III clinical drug called CM-AT for the treatment of autism. CM-AT would be given with meals to help a small subset of children with autism who do not digest protein. Problems in protein digestion can lead to other problems in digestion and a decrease in neurotransmitters.
I recall several years ago a physician who's two year old had just been diagnosed with autism. She took the child to the gastroenterology department of the hospital where she worked and they told her that autism was a gastric disorder, which they could treat. Not satisfied she went to the immunology department and they told her that autism was caused by an immune disorder, which they could treat. Still not satisfied she went to the neurology department where she was told that autism was a neurological disorder, which they could treat. Confused she emailed me and asked what autism was. I told her in the end autism was a neurological disorder, however a subset of children with autism have gastric and immune problems. Hopefully, this new drug will help those children with autism who have gastric problems and perhaps even help us understand autism in general.

Clinic Notes: ABA for ASD, ADD, ADHD, SD, ODD, OCD, TS, and Whatever Else is That is Left in the Alphabet

A syndrome is a collection of symptoms. So if we say a child has Attention Deficit Hyperactivity Disorder (ADHD) we know that this child has problems paying attention, is easily distracted, will not stay on task, will not sit still, will get out of his seat, not listen to the teacher, etc. Naming a syndrome such as Autism (ASD), Obsessive Compulsive Disorder (OCD), or Oppositional Defiant Disorder (ODD), is the short hand of clinicians as they communicate with each other, patients and their families, and the public. Clinicians also have shorthand for therapies. For example, Applied Behavior Analysis includes a long list of behavior therapies.
In a recent Schafer Report, an article titled, "The Rise of the Alphabet Kids," the author asks if the rise in the use of acronyms, such as ADHD, ASD, or ODD is helping or hindering treatment. In his view many British children have a list of diagnostic letters following their names because they have overlapping disorders. In my clinic I see this all the time. A child comes in with a diagnosis of Autism (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). Does the child have both? Or does the child have autism? Or does the child have ADHD? Usually, the child has autism. Many kids with autism have problems paying attention and many kids with autism are hyperactive. In my view, the added ADHD diagnosis is only describing a common feature of autism. The same is true of some of the other alphabet disorders. The added diagnosis is describing a feature of another diagnosis and is redundant. Of course, when you define behavior problems behaviorally (what is observable and measurable) then the problem disappears.

Clinic Notes: Boy Locked Away by Parents for Seven Years

In a recent Schafer report (March 6, 2009) there was a report of a young boy who had been locked in a dark barren room for seven years. He never played with other children, been to the doctor, gone to school, and was beaten by his father. Inquiring neighbors were told by the parents, that the boy was autistic and receiving treatment at home. The parents are going to jail and the young boy will receive therapy and probably be placed in an orphanage or possibly a foster home. Unfortunately, incidents like this happen periodically and I documented several in a case history titled "Wild Child" (Available at http://www.aba4autism.com). Not only are cases like this barbaric, they tend to occur when the child is young and critical periods for the formation of language and other skills are programmed to occur. If this is prevented by the limited environment, then the child does not develop these skills because by the time they are rescued the critical periods are past. In this particular case I see hope. The police said that when they found the boy and took the father into custody, the boy said, "He won't hit me this evening." So it seems that he has some language development.

Clinic Notes: Survey on Physicians Feeling Ill-Equipped to Treat Autism

In a recent survey, (see Schafer Autism Report, March 4, 2009) over 2000 physicians were surveyed about their views on treating autism in their practice. Of note, only 19% responded and those that did respond felt unprepared to treat autism. Primary care physicians, especially pediatricians, are being encouraged to screen young children for autism. And I think they are responding. I am getting more physician initiated requests to do autism evals. Of course, some physicians, such as pediatric neurologists, are involved in treating autism, prescribing medications that are helpful and doing evals. But I'm not sure what the role of primary care physicians should be in treating autism. I'm always looking for a pediatric neurologists to refer children to for medication. But often there is a long waiting period. I guess, with additional training, perhaps primary care physicians could help out there. Also some children with autism have digestive problems and that could possibly be another useful role for primary care physicians. Now pediatric gastroenterologists handle most of these cases and again there is a long wait for appointments usually. Many parents of children with autism are wary of traditional medicine, often blaming vaccines for causing their child's autism. Furthermore, many parents have turned to alternative medicine in treating autism. Other concerns reported by physicians in the survey were reimbursement problems and a lack of training. I think the real question that should be asked is do primary care physicians want to be involved in the treatment of autism.

Clinic Notes: God and ABA

In almost 40 years of clinic work with children I thought I'd seen every problem imaginable and successfully dealt with most. But then a dedicated mother of a child with Asperger's, who was working hard to mainstream him, told me about her child's struggle with the power of prayer. "School is getting harder and harder for me," her child had told her. "Why won't God help me? I pray and pray but He won't help me. Why won't God help me? Mom tried to explain that maybe God was helping by leading the family to my clinic where he received speech and ABA. But I don't think her child bought that. I live and practice in a small southern town and most of the children that I see attend Church regularly. They learn in Sunday School that God answers prayers and Asperger's kids tend to take everything literally. He was praying for help in school, but school wasn't getting any easier. In fact it was getting harder and harder and he couldn't keep up. What could I say? What could I do? I kept up the ABA drills, offered tangible reinforcers and praise. But this child wanted more than I could offer. Tonight, when this child comes for his appointment, I am going to do something I have never done. We are going to say a little prayer before we start.

Clinic Notes: Where Were All the Asperger's Children When I was Growing Up?

Children with Asperger's Syndrome tend to have social problems and eccentric behavior. Their verbal behavior, especially conversation, is often described as unusual. Speech is often abnormal with problems in inflection and their speech also tends to be repetitive. Children and adults with Asperger's tend to perseverate on certain topics in their conversation and not understand that they may be boring others. Although the diagnosis has been around since 1944, only recently are children being regularly diagnosed with Asperger's. This got me to thinking about kids I grew up with, teachers I had in school, and "characters" I have run into or heard people talk about that were described as weird, geeks, strange, not all there, delinquents, etc. Did any of them have Asperger's? And if they did what happened to them?
I do remember many of these kids were bullied and picked on and everyone made fun of them. They were also always in trouble. Interestingly, I don't remember any of them being in special ed or receiving special services such as speech, OT, or ABA. Recently, I was able to track down some of these kids I had known in elementary school on my high school website. Of course this is not a precise statistical scientific study, but they all seemed to be doing ok. They had families and good jobs. I wish I had been nicer to them back then. But now that I've tracked them down I don't worry as much now about how the kids with Asperger' who come to my clinic are going to turn out. I'm thinking they will do just fine.

Clinic Notes: Is the Increased in the Number of Children Diagnosed with Autism Real?

In a previous blog I responded to this question, but now a new study came out and in the February Issue of Epidemiology, which found that most of the increase is real. The authors state that only a third of the increase could be accounted for by changes in diagnostic criteria. Other researchers conclude that the autism epidemic is caused by diagnosing children with mental retardation and learning disabilities as autistic. I don't buy it. In my clinic I am seeing the same number of children in other diagnostic categories, but a geometric increase in the number of children with autism. We need to be looking for the cause of the increase and not arguing about whether or not it is real.

Clinic Notes: Do You Know Where Your Child with Autism Is?

Every year one or two of the kids with autism who comes to my clinic gets lost. Mom is carrying in the groceries and thinks her child is behind her, but they have darted off someplace. Or a child with autism can't sleep and gets up during the night and wanders out of the house. I caution parents about security and double locks on the doors, but some child always gets away. A civic organization in my community brought GPS bracelets for all of the children with autism who live in the county and a GPS tracker for the Sheriff Department and that has helped a lot. But some of the children don't get the bracelets or take them off and get lost. So far all have been found safe, but tragedies have been reported in other communities.
Google upgraded its mobile maps and tracking people who have a mobile phone is now going to be as easy as surfing the internet. Of course, some type of sensor will have to be made available for children with autism, hopefully something they can't take off easily, but that shouldn't be a big problem. I don't know how many children with autism are lost each year and drown or suffer some injury or other fatality each year. If this new Google technology saves just one child it would be worth it. And I wouldn't be surprised if Google would foot the bill.

Clinic Notes: Parenting a Child with Autism

Most of the children I see in my clinic each week have a diagnosis of autism. Over half of the children we see we are able to mainstream, but it is apparent to everyone that these children will never be completely normal. Parents of these higher functioning children with autism will be able to lead a semi-normal life. For parents of children with moderate to severe autism are not as fortunate. In a recent Schafer Report (January 23, 2009), two articles discuss how having a child with autism "wrecks a parents' life." Furthermore, Dr. Fitzpatrick, author of Defeating Autism: A Damaging Delusion argues that various biomedical treatments that promise to defeat autism now are offering a "false promise" to "grieving " parents.
In my experience, biomedical treatments have not lived up to their promise and multiple disciplines-speech, occupational therapy for fine motor deficits, ABA, and for some kids medication are the only effective therapies. While these therapies can make life better for the child and the parents they do not come anywhere close to curing autism. Certainly, having a child with autism can wreck a parents' life, but getting competent services can help.

Clinic Notes: What the Future Holds for the Child with Autism

Here's a stat to think about. At least 80% of 19 to 30 year old adults with autism are still living at home. Now factor in the increasing numbers of children with autism and it is not hard to forecast a crisis coming in a decade or so. It wasn't long ago that when one of the children in my clinic reached 18 and graduated from high school that I could get them in a group home and a sheltered workshop in a few months. Now it takes years, if it ever happens, because the waiting list is so long and few new group homes and sheltered workshops are being built. In my clinic we mainstream over 50% of the kids with autism we see. I don't know many of these kids will be able to find mainstream jobs when they grow up. So more kids being diagnosed with autism now means more adults with autism in the future. For those of us who work in the autism field it looks like we are getting an autism sandwich.

Clinic Notes: Testosterone in the Womb Related to Autistic Characteristics in Children

Professor Simon Baron-Cohen and his associates at Cambridge have found that babies exposed to high levels of testosterone in the womb have autistic traits such as poor social skills, a lack of imagination, a lack of empathy, less eye contact, and slower language development. This finding supports Baron-Cohen's hypothesis of "extreme male brains" in children with autism. (I note excessive body hair in any of the children with autism that I see in my clinic so I am not surprised.) This finding could lead to a prenatal test for autism and ABA could be started at an early age perhaps preventing autism.

Clinic Notes: Scientology and Autism

Jett Travolta's death is tragic. There is a lot of speculation regarding the role of Scientology in his death with some suggesting that his seizures could have been easily controlled with medication. In my clinic I see many children with various seizure disorders, as well as children with autism, 30%, of whom have seizures. Any pediatric neurologist will tell you that sometimes seizures can be hard to control with medication or a combination of medications. Usually the next step is to implant a vagus nerve stimulator, which delivers a mild shock to the brain when seizures start. Often this works, but not always. Surgery is the next step--cutting the corpus callosum, which connects the 2 hemispheres of the brain or more drastically removing a hemisphere. All of these procedures have side effects and often a decision has to be made as to whether or not the patient would be better off without treatment. I don't know the details of the Travolta case and I certainly take issue with Scientology's view of autism. But in this tragic case I think it is best for everyone to stop writing and speculating and give the family some privacy. And peace.

Clinic Notes: Autism and Timeout

Well it happened again. A child placed in a "seclusion room" or timeout room without supervision hanged himself. Timeout is an often used and mis-used procedure. When done properly it is very effective. When done improperly it is not effective and is some rare cases deadly. No child should be placed in a room alone without an responsible person observing the child all the time. On my website, www.aba4autism.com I give specific information for using timeout and when not to use time out. There needs to be rules enacted to regulate the use of timeout. Timeout does not need to be banned or abuse will increase.

Clinic Notes: The Cost of Autism

According to a recent Schafer Report article, over half a million families who have a child with autism are having financial problems. They pay more for autism treatment than parents of children who have other chronic diseases. I am not surprised. In my clinic I see this everyday. Children with autism need ABA, which insurance companies call "experimental" and do not want to pay for. School systems do not want to pay either even though ABA is the most effective treatment. Sending teachers to an ABA workshop is enough they tell parents. Of course, OT, SLP, and other therapies are also necessary and expensive. And these therapies may be needed for years. If we can start these therapies early we can mainstream many kids with autism and ultimately save money if these children can become self-supporting as many can. Hopefully, the new administration's health care plan will provide some relief to these families.

Autism and the Christmas Holidays

I am reposting this from a previous blog for the holidays
12-1-05
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 catalogue or online and let the child point to or circle the toys he/she wants. Websites, such as www.stars4kidz.com, 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
(Thanks to the mothers of children with autism or other neuropsychological disorders who helped me with this post.)

Clinic Notes: Will We Ever Find the Cause of Autism

Recently, it was reported that a link between rainfall and autism had been found. Children who live in cold rainy areas such as the Pacific Northwest have a higher rate of autism. The author of the study theorizes that the rain keeps the children inside where they are exposed to more toxins, electromagnetic waves, etc. It is possible to find statistical correlations with the increasing rate of autism and anything else that has increased since the early 1990's. Normally, correlations give us a clue as where to conduct more controlled studies to establish causal relationships. The problem is that science has to be ethical. So obviously we could not randomly choose a group of children and raise them in a rainy environment to see if they developed more autism cases compared to a control group. One way out of this is to develop animal models of autism as is done with other diseases. But then another problem arises with animals because a prominent feature of autism is language which is not present in experimental animals. I expect that we will see numerous studies correlating autism with numerous other variables (we have published correlation studies in this area), but then we will have great difficulty in establishing causality.

Clinic Notes: Denis Leary on Autism

"Why We Suck: A Feel-Good Guide to Staying Fat, Loud, Lazy and Stupid," by actor Denis Leary is apparently not on the New York Times Best Seller List. What to do? How about a few stupid SAVAGE statements about autism that will make the news and get some free publicity. And I quote from Mr. Leary: "There is a huge boom in autism right now because inattentive mothers and competitive dads want an explanation for why their dumb-ass kids can't compete academically, so they throw money into the happy laps of shrinks . . . to get back diagnoses that help explain away the deficiencies of their junior morons. I don't give a [bleep] what these crackerjack whack jobs tell you - yer kid is NOT autistic. He's just stupid. Or lazy. Or both."
I sure hope sales don't increase!

Clinic Notes: Who Pays for ABA?

ABA is the treatment of choice for autism. But finding qualified ABA therapists, Board Certified Behavior Analyst (BCBA) and not someone who has been to a few ABA workshops, and paying for ABA are two roadblocks. Insurance companies argue that they should not pay because ABA is really more educational than medical and education is the responsibility of the public schools. Furthermore, the insurance companies argue that if they pay for ABA everyone's premiums will go up. Of course, the public schools make much the same argument--money and staff. Okay so who should pay? I know of wealthy families paying six figures a year for ABA and I know of families who cannot get any ABA. One point is who is going to pay when the kids are 21 and sitting in their parents living room with no place to go. And a parent has to stop working to stay home with their child with autism..

Clinic Notes: Mental Health Parity and ABA for Autism

Well today the Mental Health Parity bill passed in the House after decades of close votes. Oddly, the Mental Health Parity bill passed because it was linked to the 700 Billion Wall Street Bailout bill. The President says he will sign the bill. Mental Helath parity requires insurance companies to not discriminate in coverage for mental illness and physical illness. Okay this sounds great, but I'm wondering how autism will fare. Often when we seek pre authorization from insurance companies to cover services for a child diagnosed with autism we are told that we should submit to the insurance companies BHO (Behavioral Health Organization.) Some states have passed an autism equity act stating that autism is a neurological disorder and that if the insurance company's policy cover other neurological disorders it must pay for treatment for autism. (Some insurance companies will not pay for ABA because it is considered experimental despite the fact that the Surgeon General and NIMH recommend it as the treatment of choice.) So what, if anything, does the Mental Health Parity Bill do to ABA and autism coverage? Will BHO's disappear? Stay tuned.

Clinic Notes: NIH Cancels Autism Study

Chelation removes heavy metals from the body and is an effective treatment for lead poisoning. Many people believe that mercury in childhood vaccines causes autism so removing the mercury by chelation should be an effective treatment for autism. There are risks associated with chelation and the NIH decided that the risk of exposing children to chelation was unwarranted. Since many studies do not show a causal relationship between mercury and autism this was probably a wise move. Furthermore, the single case reports on chelation as an effective therapy are lacking. I have kids coming to my clinic who are undergoing chelation and I cannot see any improvement. I wish there was a quick fix for autism like chelation. I'd send all of my ABA patients.

Clinic Notes: Autism and Puberty and ABA

There is an old maxim in neuroscience, which states that anything that affects the normal brain affects the neurologically impaired brain to a greater extent. So usually fatigue, fever, injury, etc. will show up sooner and be more detrimental to a child with autism or other neurodevelopment disorders. Puberty, with its unleashing of hormones, is a difficult time for all children, but sometimes has a greater impact on children with autism. Longitudinal studies on children with autism find a setback in less than a forth of the children followed by recovery. In males I see an increase in aggression and in females difficulty in making decisions. I set up or re-initiate the ABA programs for compliance, which we run we often run with children with autism and related disorders when they first come into our clinic. In females I have found that birth control pills in addition to the compliance programs usually help.

Clinic Notes: Is Savage Right? Are Children with Autism Just Brats?

Nationally syndicated talk show host, Michael Savage said on his July 16 radio talk show "I'll tell you what autism is. In 99 percent of the cases, it's a brat who hasn't been told to cut the act out. That's what autism is. What do you mean they scream and they're silent? They don't have a father around to tell them, 'Don't act like a moron. You'll get nowhere in life. Stop acting like a putz. Straighten up. Act like a man. Don't sit there crying and screaming, idiot.' " Savage concluded, "If I behaved like a fool, my father called me a fool. And he said to me, 'Don't behave like a fool.' The worst thing he said -- 'Don't behave like a fool. Don't be anybody's dummy. Don't sound like an idiot. Don't act like a girl. Don't cry.' That's what I was raised with. That's what you should raise your children with. Stop with the sensitivity training. You're turning your son into a girl, and you're turning your nation into a nation of losers and beaten men. That's why we have the politicians we have."
Well, you can imagine the response of parents with children with autism and the autism support groups. Autism is a neurological disorder and there is impairment in communication, sensory processing, and other neurological processes. Children with autism need multiple services such as Applied Behavior Analysis (ABA), speech, Occupational Therapy, and often medication. Autism also has a genetic basis. Certainly autism is more than brat behavior; however, some children with autism are noncompliant and do not follow directions. Often in our clinic one of the first ABA programs we run is following directions. Sometimes this is related to autism and sometimes noncompliant brat like behavior. But even after these children are compliant and not tantruming there are many behavior left over that are related to autism and the usual parenting techniques do not work. Parents of children with autism who have heard Savage's remarks have all told me one thing. They would like Savage to spend a day with their child with autism.

Clinic Notes: The Children's Treatment Center for Autism or other Childhood Developmental Disorders

Go to http://www.childrenstreatmentcenter4autism.com and check out our new web page.

Clinic Notes: What does the Child with Autism See?

Most of the sensory information humans process is in the visual modality. And while children with autism often do not make eye contact it is assumed that most of the sensory issues in autism are in the auditory and tactile modality. This is most obvious when children with autism cover their ears in the presence of certain sounds or are tactile defensive refusing to wear certain fabrics or not liking to be touched. Problems in the visual modality are less apparent at times, but research has identified problems. For example, some anecdotal studies as well as empirical studies suggest that human faces are seen as either distorted or blank. Furthermore, children with autism seem to focus more on the mouth of the person speaking rather than the eyes. Some studies suggest that some children with autism have Prosopagnosia or face blindness, which cause social as well as other problems. Of course, these studies have an inferential component and I am still wondering what a child with autism really sees. I have planned a series of drawings that I hope can capture what I think the child with autism possibly sees.

Clinic Notes: Prosopagnosia (Face blindness), Autism, and Art Therapy

Prosopagnosia is a neurological condition where people have difficulty recognizing faces. The disorder may be genetic, caused by strokes, or head trauma. Children with autism or Asperger's may also have Prosopagnosia. Some studies have shown that children with autism and Prosopagnosia have less difficulty sometimes if faces are presented upside down. Other studies suggest that children with autism fixate on certain parts of a face and do not see the entire face. It as been suggested that one reason that children with autism have problems understanding emotions in other people is because of Prosopagnosia.
I remember when I was working in a head trauma clinic I encountered patients with Prosopagnosia and the only thing I could suggest was for everyone to wear name tags. Now I wonder if children with Prosopagnosia would profit from "art therapy" where they learned to draw faces. In my clinic we are in the process of identifying children with Prosopagnosia and starting art therapy.

Clinic Notes: Would it be Better to Know if Your Child Is Going to Have Autism?

Autism is usually not diagnosed until the second year of life when language begins to develop. There is some evidence that signs of autism are present much earlier and also that very early ABA intervention might even prevent the development of autism. So the hunt is on to develop a screening instrument for very young children. But some parents are up in arms. They are afraid that the idea that bad parenting will come back. I don't understand their concern. With any disease early detection is always better. So why not with autism?

ABA for Iraqi Child with Autism

I received the email below at my website and with permission reproduced it below. Parents worldwide have problems getting services. This Iraqi mother makes the most of her situation.
Dear Dr.Brown;
Thank you very much, I am really appreciate every single word I read from the ABA e-book, ABA course & Case History eBook. I was completely lost in this country. I am Iraqi dentist and live in United Arab Emirates. I did assessment for my son, age 3 years and 6 months, here by the only specialist in Dubai who had certificate in Autism from Birmingham in UK. She gave him diagnosis of Autism. I showed her a video which helped a lot in the assessment and she told me we will start our treatment with Resperidal. I was surprise by her treatment because she didn't start with any behavior management first to see if the child can be improve or not. I left her clinic and never went back. I visited few autism centers in UAE. They are just starting to give attention to Autism in this country and they gives the priority to the local people (UAE citizenship) and put the others on the waiting list for a years. So I have been dedicated my time searching and reading about Autism since I got the diagnosis trying to help my son. I made food intolerance test for him and the result shows that he should avoid Dairy and wheat product and some other foods also. I already start with him 3 months ago Casein Gluten free diet according to the research I saw from internet. This diet is really effective it improve his eye contact, he stop searching for hair to eat (pica), he start imitate , decrease in hyperactivity, improve in the relation with siblings. He has normal manual dexterity (eating by himself, walking, wearing his cloths with simple assistants). I engaged him in playing group (nursery for typical children ) and he is happy with that but no communication with other children. Before I read your course I start doing my best with him to start verbal communication (he has no words at all), so I start taking pictures for the different foods he eat, bath room, swing,.etc,every time I gave him a food I showed him the picture and tell him the name, after few days I start to show him the pictures especially the fruit that he likes to eat and every time he say the name I say bravo and give him that fruit as reinforcement (ex. if I showed him picture of grapes and he said grapes. I take him directly to the kitchen and give him grapes). It was very effective way and he has now 11 words so far. After I read your course I start with him ABA program. He refused riding bicycle and by using method of successive approximations (shaping);
1- I holding him and let him sit on the bike ( good boy, he will riding bicycle ) then as he stay few second sit ,I give him reinforcement ( I used mixed fruit sweet it is with out milk as he should avoid dairy ) .
2- I fixed his foots on the puddle and I stand in front of him and pulling the bike toward me by (saying come to me Hamza) his foots just pushed the puddles ,(good boy , riding bicycle. and give him reinforcement directly )
3- I stand little bit few steps away and call him (come to me), he push the puddles and once he touch me I give him the reinforcement directly, I never so him happy as he was that day (at that time I wish you Dr. brown be there so I can give you a kiss over your head, God please you).
4- After I that I increase the distant and the direction gradually .actually this improve this eye contact, follow the direction and compliant all at the same time.
Now I am working with caregiver in the nursery to make him stop the behavior excess (dangerous climbing).
I will answer all your quizzes and send it to you.

Sorry for the long email

Kindest Regards
I. H.
UAE

Clinic Notes: ABA for Grandmothers with Autism

When I came in the clinic this morning I checked the messages on the answering machine like I always do. The messages were the usual--parents wanting evaluations on their children--others with a diagnosis wanting treatment. Other messages were from school systems, doctors, speech language pathologists, and other agencies and professionals wanting information on children that I was seeing--nothing different. I thought. I returned as many calls as I could before my appointments started and ran into something different. A grandmother with several grandchildren requested an autism evaluation. I asked her how old her grandchildren were and she informed me that I didn't understand. The autism evaluation was not her grandchildren. The autism evaluation was for her. I apologized and asked her why she thought she had autism. It was because her grandchildren were acting different she said. She thought they might have autism and had got it from her. That's a backward way of looking at autism I thought to myself. Then I wondered if indeed this backward way of looking at autism was autistic behavior. And I wondered if anyone was doing ABA with grandmothers with autism.

Clinic Notes: Language and Autism

Language and speech problems are apparent in children with autism. Many children with autism only understand the literal aspects of language and not what is implied or metaphorical. For example, I was recently trying to get a new child diagnosed with autism to interact with me. I rolled a ball to him and said, "Roll it back". He picked up the ball, put it behind his head and let it roll down his back. I had not said, "Roll the ball back to me." The implied part of the sentence did not register. Idioms are another real problem. If I say to a child with autism, "It's raining cats and doges," they look at me like I'm crazy. One of the children I see with autism got mad at one of her relatives that she ad not seen in a while. The relative said, "You are growing like a weed." The child was insulted because she thought the relative was calling her a weed and did not get the metaphor.

Clinic Notes: Autism Week is Almost Over and There's Not Much to Celebrate

Forty years ago I saw a case or two of autism every couple of years. Now seventy to eighty percent of the children that I see each week have a diagnosis of autism. I have a long waiting list and most of the kids on my waiting list will also end up with an autism diagnosis. We do mainstream fifty percent of the children with autism that we see on a regular schedule and that's certainly something to celebrate. But I worry about the other fifty percent and the children that I see and the other children in the rural area where I practice that I don't see because of funding or other issues. Every Psychologists, Board Certified Behavior Analysts (BCBA), Speech Language Pathologists, Occupational Therapists, and Pediaric Numerologists I know tell the same story. Too many kids with autism and not enough providers. Parents of children with autism from all over the world email me at my website and complain about finding and paying for services. I feel like we are at war and our children are being taken from us in ever increasing numbers. And it is long past the time for mobilization. Hopefully, when autism week comes around next year there will be more to celebrate.

Additional Online Survey Question: Veins and Autism

We are conducting a survey on the potential causes of autism. We are analyzing data now from a larger study and hope to have the report completed by summer 2008. Currently, we have almost 3000 surveys. We have an additional issue we wish to explore concerning the presence of veins on the temples. We need mothers of normally developing children as well as those mothers with autism so we have a comparison group.
There are only 8 questions and will only take a couple of minutes to complete. By clicking on the submit button you are consenting to participating in this study. If you have any questions or concerns you can contact Dr. Angie MacKewn in the psychology department at the University of Tennessee at Martin at amackewn@utm.edu or 731-881-7370.
Thank you for taking the time to complete this brief survey.
If your child is normally developing thanks for participating so we can have a control group. Please go to http://www.aba4autism.com and click on the survey link. Thanks Dr. Brown

Twilight's Children:#1

Twilight's Children:
Research and Clinic Notes on ABA and Autism #1
Forward
The soft light that appears when the sun is still below the horizon, either at daybreak to sunrise or sunset to nightfall is defined as twilight. The children with autism that I treat in my clinic are like the twilight. With intensive therapy they are going to brighten like the earth brightens at sunrise, or unfortunately, as is sometimes the case with severe regressive autism or a failure to continue therapy, dim like the earth dims as night falls. What follows are some of my clinic and research notes on these extraordinary children whose numbers are now epidemic.

Introduction: A Short History of Autism

The history of autism is relativity short, unless you accept Bruno Beitleheim's suggestion that feral or wild children were really children with autism. He argues that feral children were 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. (For a case history and modern day examples of feral children see my eBook at http:www.aba4autism.com).
The history of autism starts in 1943, when an American psychiatrist named Leo Kanner published the first paper on autism. The word “autism” comes from the Greek word “autos” or “self” and Swiss psychiatrist Eugen Bleuler, first used the term in 1912. “Autistic thinking” did not involve outside reality, but only the individual’s inner thoughts or feelings. Bleuler thought schizophrenics were locked into this way of thinking. Kanner used the term autism to describe the extreme social disinterest he observed in a small sample of young children, and thought the disorder was congenital.
In 1944, paper published by Austrian psychiatrist Hans Asperger described a similar sample, which developed speech and functioned at a much higher level. The diagnostic label “Asperger’s Syndrome” was later coined for these children and added to DSM to go along with Kanner’s autism. Whether the kids Asperger observed were just high functioning autistic kids or a different syndrome is still debated. (At present we have a large-scale study underway, which will hopefully break down the Autism Spectrum into more definitive diagnoses.
Psychoanalyst Bruno blamed all the moms for autism. These so-called “refrigerator mothers,” who were emotionally cold and rejecting, caused a psychosis in their children which was similar to schizophrenia. (Actually, 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.
Bad parenting does not cause autism. There is a genetic component to autism that is being investigated extensively. But genetics cannot be the whole story. Something else has to be involved either pre or post natal. The MMR vaccinations that children receive, viruses, allergies and food sensitivities, toxins and pollution in the environment, and dysfunctional immune systems are all being investigated as possible causes of autism. I expect that after more research is done--perhaps years more--that autism will be like cancer. Many types of autism and many causes of autism will be found. And of course, many treatments. Fortunately, autism is treatable now with ABA, speech therapy, occupational therapy, and a handful of medications.

Clinic Notes: Broken Promises in a Bottle

Broken promises in a bottle is not a lyric in a country song, but it could be a title to a bad country song that five year old Janie hears three or four times a week. Janie's mom is an alcoholic and former recreational drug user who has lost custody of her children. The court awarded custody to the grandparents. When mom calls every night she tells Janie that that she is going to come and get her the next day and take her to a movie, or the playground, or perhaps McDonalds for lunch. Janie gets excited and the next day waits patiently for her mom to pick her up. But mom never comes. Now Janie cries when she hangs up the phone after talking to her mother, because she knows that mom is going to not come the next day as she promised. Of course, Janie is learning to not trust people. Alcoholics and drug addicts are always going to leave causalities in their wake. Janie has a learning disability because her mom did drugs while she was pregnant and I had been doing ABA and behavior management for school problems. Her grandparents asked me if I could help. Social Stories are the only therapy that I know of that would be appropriate in a case like this. So I have been writing social stories on alcohol and drugs and broken promises and going over them with Janie. It's a lot for a five year old to take in. But Janie is not crying anymore.

Through the Looking Glass: ABA in Wonderland

A diagnosis of autism in a child can be horrible news for the family. Of course, after the diagnosis the physician or psychologist discusses the services the child will need to overcome autism and hopefully mainstream in the school system. According to the CDC and other government heath care agencies, as well as and most health care professionals now realize that Applied Behavior Analysis (ABA) is the treatment of choice. ABA will teach the child with autism to follow directions, not tantrum or be aggressive, and make it easier for speech, OT, teachers, and other professionals to work with these children. After getting a diagnosis of autism and information on services the real fun begins for parents. Usually, finding someone competent to do ABA with their child and how to pay becomes an issue. (Usually insurance companies say that ABA is experimental and will not pay.) ABA providers range from Psychologists with Ph.D's who are licensed Health Care Providers (HSP) to someone who has been to a few workshops. Board Certified Behavior Analyst (BCBA) hold Master's degrees and have specified graduate courses in ABA, a long supervised internship, and must pass a comprehensive national exam. In my view BCBA's hold the minimum qualifications. Of course there are not enough Psychologist and BCBA's around and the ones that are around are booked up and have long waiting lists. So many parents find themselves looking for ABA because it is the single most effective treatment for autism and wondering why it is not more widely available.

Clinic Notes: Prognosis for a Child with Autism

Every parent wants to know what the future holds for his or her child. And this is especially true for a child with a disability such as autism. What is the prognosis for a child with autism? Well years ago I remember reading articles asking what happens to children with autism when they become adults? Back then children with autism just seemed to disappear--absorbed into society in one-way or another. The stats were 1 in 2500, later 1 in 500. But now with 1 in 150 children with an autism diagnosis how will the picture look like when these kids are grown?
Last week one parent told me that a speech-language pathologist told her that her child had severe autism and would never amount to anything. This seemed to me a very cruel thing to say to a mother, but setting that aside how accurate was this prediction? I remember reading that 50% of children with autism also had mental retardation and 10% were savant. But I wonder about the accuracy of this statement because I know a lot of children with autism have performance deficits. In other words, they know the correct answer to a question, but choose to not give the correct answer for one reason or another. If 50% of children behave as if they have mental retardation what programs will be available for them after they leave the school system? (Group homes and sheltered workshops now have long waiting lists.) I have not seen this problem addressed by any candidate running for any office. Maybe children with autism will just be absorbed into society when they grow up like they were in the past. But I doubt it.

Clinic Notes: Does the Autism Apple Fall Far from the Tree?

When I have a new child come into the clinic, and I am taking a history, I ask the parents if anyone else in the family has an autism diagnosis. The answer is almost always no. But often, after weeks of therapy, one or both parents, after having learned more about autism, often state that they wonder if they have autism. (And sometimes after getting to know the parents I wonder too.) Parents of children with autism analyze their past development and either interpret or misinterpret some of their behavior as autistic. This seems to be especially true of certain high tech professions.
Much the same thing is true of other maladies such as bipolar disorder, depression, and alcoholism. But these disorders usually show up in adults and not children. So instead of parents seeing themselves as perhaps having the same autistic behaviors as their children, children, especially grown children, see (blame) their bipolar, depressive, alcoholic behaviors in their parents.

Clinic Notes: Autism and Fever

A recent study in the journal Pediatrics reports that high fever decreases the symptoms of autism. Many parents have already observed this relationship, but this is the first study that documents the effect. Clinicians have also documented this effect. In 1980, a viral epidemic causing high fever hit Bellevue Psychiatric Hospital in New York. All of the staff there noticed an improvement in the autistic children they worked with. Sadly, after a few days, the fever dissipated and all of the children became autistic again." The improvement can be very dramatic, sometimes like a metamorphosis in which the child with autism or some other neuropsychological disorder becomes almost normal when they are running a high fever. I present such a case history, titled the "The Sometimes Son" in my case history eBook, Little Bubba's Not Ready for Nashville Yet. (http://www.aba4autism.com)

Clinic Notes: Early Signs of Autism

Pediatricians are recommending that children be screened for autism at 18 months and again at 2 years of age. There is no question that early intervention helps and this is certainly a step in the right direction. Usually, parents are the first to notice that something is wrong, but are sometimes hesitant to take action for one reason or another. Without question this early screening will result in more false positives but that can't be helped. I have a link on my website, www.aba4autism, for parents who are interested in reading about the early signs of autism

Clinic Notes: The Autism-Vaccine Debate: Stat 101. Correlation and Causality

Autism takes two forms: Infantile, which is present form infancy, and regressive where the child develops normally and then between 2 and 3 years of age begins to loose language and appropriate social behavior. Often self-stim and sensory problems also put in an appearance at this time. Of course, concerned parents look for a cause and the only thing that they note that was different was the MMR vaccine that there child received before autism began to develop. Further inquiry by the parents finds that the vaccine contained mercury, which is known to be toxic to the brain.
Congressional hearings have been held, research supporting and refuting the mercury-autism link has been presented and mercury has been removed from vaccines, but the debate goes on.
Stat 101. Much of the retrospective research on health issues relies on a statistical test know as correlation. A correlation will tell you if two variables are statistically related. So height and weight are correlated, intelligence and grades are correlated, and cigarette smoking and cancer are correlated. Since vaccinations are mandatory for the most part in the US and everyone receives the MMR vaccine it is hard to come up with an accurate. In parts of Europe where vaccinations are not mandatory the rates of autism are the same in vaccinated and non-vaccinated groups of children. What most people don't understand is that a correlation will tell you if two variables are related, but it will tell you nothing about causality. Just because autism follows the MMR vaccination does not mean that the vaccination caused the autism. Maybe mercury does play a role in autism. Increasingly there is more mercury in our environment as well as other neurotoxins. But a correlation cannot make a statement about causality.

Clinic Notes: Is There An Autism Epidemic?

According to a recent Associated Press article by Mike Stobbe, The 'Autism Epidemic' Largely Fueled By Special Ed Funding, Shift In Diagnosing (www.signonsandiego.com/news/health/20071102-1304-autismepidemic.html).
It is true that as the number of cases of children diagnosed with autism increases the number of children diagnosed with mental retardation and learning disabilities are decreasing. And in my practice I see this everyday. But I also see many, many more kids that have autism and there is no question about the diagnosis. The number of children with autism is increasing at an exponential rate in my little corner of the world.

Clinic Notes: New Autism Screening Recommendations

This week the American Academy of Pediatrics recommended that all children be screened for autism at 18 months of age and again at 24 months. No doubt early interventions by Speech-Language Pathologists, Psychologists, ABA Therapists, and other professionals will better lives for children with autism. At least that's the theory. But I'm worried about logistics. I already have a full clinic schedule and waiting lists of children that I can't get to or refer anyplace. If we are serious about treating all the children diagnosed then we are going to have to mobilize more financial and manpower resources then we have now.

Clinic Notes: Video Clip Diagnosis of Autism

Today's Schafer Report (October 16, 2007) has an article on a free new web site that features video clips of toddlers displaying autistic behavior such as stimming, echolalia, fascinated by a spinning cup, and other early signs of autism. The creators of the tape caution that these behaviors can be seen in normally developing children, but alert parents to the fact that an early evaluation might be advisable. As the article points out parents are often the first to recognize that something is not right. Unfortunately, parents, especially first time parents, wait too long. If you have concerns about your child or are just interested in the video clips go to http://www.autismspeaks.org

Clinic Notes: Predicting Autism

We just completed a study, which found among other things, that the mother having an infection while pregnant was a statistically significant predictor of autism in male children. Now a new published study finds that there is a link between schizophrenia, autism, and flu in the mother. Previous studies have found that flu in mothers during pregnancy
http://www.physorg.com/news110641743.html
increases the risk of schizophrenia 3-7 times. Schizophrenia and autism are thought to have a genetic component triggered by some pre or postnatal factor. As many as 21% of the cases of schizophrenia may be related to flu in the mother. It is not the virus itself that causes schizophrenia but the body's immune system reacting to the infection. The immune system's response to an infection at the cellular level releases proteins called cytokines. Theoretically, the fetus is affected by a cytokine called interleukin-6. If a pregnant mouse is injected with interleukin-6 her off spring display schizophrenia or autistic like behavior.

Clinic Notes: Anorexia and Autism

Kids with autism are often finicky eaters, rejecting foods on both taste and/or texture. The consensus is that this is just another one of those sensory issues which plague kids with autism. But now an interesting hypothesis carries the finicky eating problem one step further. Prof Treasure suggests that anorexia and autism share the same genetics. According to her, twenty percent of patients with an anorexia diagnosis could also be on the autism spectrum. Furthermore, anorexia might be the female form of Asperger's. It is true that perseveration occurs in autism and anorexia, as well as communication and social problems. But this hypothesis seems long on speculation and short on data.
http://tinyurl.com/2bcvka

Clinic Notes: Bipolar Disorder in Children and ABA?

According to a recent news report Bipolar Disorder is being diagnosed more frequently in children. Recently, a pediatrician referred a two-year old girl to my clinic whose psychiatrist had diagnosed with Bipolar Disorder and prescribed Depkote, and lithium, which are commonly used to treat Bipolar Disorder in adults. These are powerful medications, not approved for children, and this two-year old girl ended up in the hospital because of the drug's side effects. I evaluated this child and took a detailed history from the parents. I saw nothing but a spoiled child who ignored her parents when she didn't get what she wanted and then got very upset and threw tantrums if that did not work. After several weeks of ABA, teaching the parents some much-needed parenting skills, this child was okay. I was curious if the psychiatrist who diagnosed this child with Bipolar Disorder had children of his own.

Clinic Notes: Girls with Autism and ABA

Boys are three to four times more likely to be diagnosed with autism than girls. Last week I saw 35 children in my clinic with an autism diagnosis. Only 7 were girls. Not only is autism diagnosed less frequently in girls, it seems to me that the autism in not as severe. (Of course there are exceptions and I do occasionally see girls with moderate to severe autism.) Most of the girls I see with autism do okay with their academic subjects. They have problems handling concepts, and are very literal in their reading. Idioms and other peculiarities of language cause them problems, but for the most part academics is not their biggest problem. Girls with autism tend to have more problems socially than any other area. But then the same could be said of normally developing girls as well.

Clinic Notes: The Science Behind ABA

Applied Behavior Analysis (ABA) is the most popular and effective therapy for autism. However, ABA also has it critics who say it is too rigid and creates kids who are robotic. (I have been working in ABA for nearly 40 years and have yet to see ABA produce a robotic child.) A second criticism states that the research behind ABA is modest. Well, I think these critics do not know the history of learning theory and the countless experiments with experimental animals and humans that can be traced back to Thorndike's trial and error experiments with cats in 1898. B.F. Skinner's Functional Analysis of Behavior, which is the backbone of ABA, examined human behavior using behavior principles tested on years of animal experiments. Even today, countless scientific journals publish peer-reviewed studies examining ABA with various clinical populations. Based on decades of research, ABA is recommended as the treatment of choice in treating autism by CDC and other health agencies. How much science do the critics want?

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.