Clinic Notes: Selective Mutes

Children who are selective mutes have acquired speech, but never use speech. They point and gesture to get what they want; sometimes tantruming if their needs are not met promptly until caregivers begin to anticipate their needs. When I moved to Tennessee the first case I had in my clinic was a 6 year old girl with a dual diagnosis of autism and mental retardation who had not spoken in years.
In order to change this behavior I instructed everyone to not anticipate the child's needs or respond to pointing and grunting. Now everyone must wait until the child made a sound that approximated a word to get what she wanted. Once this was accomplished, everyone had to wait longer until the approximation more closely resembled a word. After several weeks speech was re-established in this child. Several months later I received a call from the caregivers saying the child was talking too much now and could they bring her back to my clinic.

Clinic Notes: Self-Injurious Behavior

Nothing is more frightening to parents of a child with autism or some other neuropsychological disorder than to see their child engage in self-injurious behaviors such as head banging, biting, or hitting themselves. Self-injurious behavior can occur in children with autism or mental retardation, as well as in children with numerous other neuropsychological disorders, and is the most common reason for institutionalization. Some children injure themselves for attention or to control the people in their environment. (See ABA program number 5 on my ABA4Autism website) With other children, the social environment doesn’t seem to matter. According to Frank Symons, 80 percent of self-injurious behavior is to 5 percent of the body--the hands and face. (The same areas often involved in acupuncture pain reduction.) The hands and face are innervated by areas of the brain, which lie adjacent to each other. Apparently, some autistic children injure themselves to release endorphins (naturally occurring brain opiates). Naltrexone, a drug which blocks opiate receptors, reduces head banging and hand biting in about a third of the kids with self-injurious behavior. Improved eye contact, socialization, and a reduction in self-stimulatory behavior also occurs in some kids with autism if they are receiving Naltrexone, leading to the hypothesis that autism is caused by an excess of endorphins. (North Carolina State Professor James Kalat suggests that in some ways autistic kids act like opium addicts going through withdrawal and then taking more opium.) Excerpted from "Little Bubba's Not Ready for Nashville Yet" available at http://www.ABA44Autism.com

Clinic Notes: ABA4Autism on eBay

This weekend we placed my ABA eBook and Case History eBook for sale on eBay. Both eBooks can be downloaded or we will mail them to you on CD-ROM. We will add individual ABA programs, individual Case Histories, and my online ABA course to eBay if caregivers find eBay a useful outlet. Just type ABA and Autism in eBay's search feature to find us. Of course, all of our ABA materials are still available at http://www.ABA4Autism.com.

Clinic Notes: Autism in Pakistan

A few weeks ago I received an email from Saadia Haseeb, who is the editor of Motherhood, Pakistan's first parenting magazine. She asked me if I would write an article on autism for her magazine. I found the magazine's web site and was amazed. There were articles concerning adopting homeless children who's parents were killed in the recent earthquake and other serious topics, as well as articles and columns on "lighter" topics like health and beauty. With all of the tragedy that Pakistan has endured this magazine wanted an article on autism. I finished the article and sent it in today and the editor was grateful. I'm left wondering how autism in Pakistan ranks with other diasters there?

Clinic Notes: Discussion Board

As promised, I have added a discussion board to my website. Visit http://www.aba4autism.com and read the posts and add your input or ask questions. I have posted several topics for discusion. Students in my ABA class will be posting weekly as a part of their practicum experience and the ABA therapist who work for me will also be posting.

Clinic Notes: The First ABA Program for a Child with Autism

I get many emails, letters, and phone calls from parents who want to start ABA. They give me a "shopping list" of behavioral problems in their child--usually starting with serious problems like self-injurious or aggressive behavior and continuing with sensory problems, compliance problems and communication problems. While all these behavior problems need to be addressed they leave out the behavior problem that needs to be dealt with first in many children with autism. Eye contact, both on command and spontaneous. It has been my experience that ABA is going nowhere if eye contact is not established. This is the first ABA program in my eBook and the one we always take up first in children who do not make eye contact.

Clinic Notes: Autism and Mirrors

Many parents who bring their children with autism to my clinic complain that their children are fascinated--really happily obsessed with mirrors. They tell me that their child will spend countless hours watching themselves in mirrors---posing--performing different movements over and over again. Not all children with autism are interested in mirrors but a significant number are. Some parents take all of the mirrors down and then find their child looking at their reflections in glass windows or doors. In my case history eBook, Little Bubba would look at his reflection in the toilet bowl water.
No one knows what causes this obsession and no one has a good procedure to treat it that I know of besides taking all of the mirrors down or redirection the child to some other activity.

Clinic Notes: Autism and Fever

It's winter and the kids who come to my clinic are catching colds, stomach viruses, and other types of infections. Of course, some are too sick to make it to their appointments. But a few of those that are sick with a fever actually do better. The change in the child's behavior is so dramatic that some parents have learned that when their child with autism or some other neuropsychological disorder starts acting unusually normal they feel their child's forehead to see if the child has a fever.
The improvement can be very dramatic, sometimes like a metamorphosis in which the child with autism or some other neuropsychological disorder suddenly becomes almost normal.
In the case history eBook on my website, Little Bubba's Not Ready for Nashville Yet, I present a case, "The Sometimes Son," where I document the first case I observed. As I state: "Not only parents, but also the staffs at institutions report improvements in autistic children with high fever. 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."

Clinic Notes: Some Children with Autism Live in a Third World Country

Several times a week I get an email or a phone call from a mother who has a child with autism. The school system is not providing ABA services or if they are it is with a special ed teacher who has been sent to a one day workshop on ABA and told to provide ABA for too many children. If the child is receiving speech it is in a group and only several times a month. No evaluation by a pediatric neurologist, often no evaluation or services by an OT.
Mom wants to know if I can help. I tell her that I can see her child weekly and set up ABA programs to be run at home and hopefully in the school. And I can make the necessary referals that her child needs. Just talk to the special ed supervisor and see if they will pay for your child's services. Of course, after 35 years I know which school systems will pay and which ones won't. In some school systems the child with autism gets just about the same level of services if he or she lived in a third world country. Autism is treatable if you live in the right place or have money.

Clinic Notes: Viruses and Autism

This morning I published a summary of a study on my web site which found that cerebral palsy was twice as frequent in children exposed to the herpes B virus perinatally. I was reminded of the studies that have implicated the Borna virus in schizophrenia.
In a study we presented at a conference earlier this year,(And posted in this blog),infections in the biological mother were a predictor of autism. Unfortunately,we did not ask mothers the type of infection they had.
In a second survey that we are conducting now, we will gather as much information as we can as to the type of infections in mothers of children with autism. We have nearly 900 surveys that we are analyzing, but it is not too late to go to my web site (ABA4Autism.com) and take the survey. We can use surveys from mothers of children on the Autism Spectrum as well as mothers of normally developing children. Thanks for your participation

Clinic Notes: Alternative Therapies for Autism

When a child is first diagnosed with autism parents are confused with all of the therapies available. I receive countless emails, phone calls, letters, and personal visits asking my opinion.
I have been practicing for 35 years and I have found ABA along with medications such as the selective serotonin reuptake inhibitors, Resperidol, and occassionally Adderal to be effective, along with speech, occupational, and sometime physical therapy. Children with autism do much better when they get these therapies at an early age. (I see a lot of two year olds in my clinic) and they seem to do better if they are in daycare, at least some of the time.

I have watched parents try alternative therapies--diet--vitamin supplements, etc. and have yet to see significant improvement. I read and hear anecdotal reports of children who are much improved on these alternative therapies, and I hope that thhese reports are true, but I have yet to see it.

Supreme Court Ruling

I published the following on my web site. I am publishing it here for wider distribution.

The following is taken from the Shaffer Report, November 16, 2005, Vol 9 No 182. For more information go to www.sarnet.org.

The Supreme Court Rules Against Special Education Parents

Parents who demand better special education services for their child have the burden of proof in challenges according to this weeks Supreme Court decision. Sandra Day O’Connor, writing for the 6-2 court indicates that if parents challenge a program, they have burden of proof, if schools bring a complaint, the burden rests with them.

The decision required the high court to interpret the Individuals With Disabilities Act (IDEA) which does not specify burden of proof. The law currently covers more than 6 million students.

The case is Shaffer v Weast, 04-698.
Denise Jones

Autism and Christmas

I posted this on my website www.ABA4Autism this morning. I am posting it here for wider distribution to families.
Autism and the Christmas Holidays
I have had many parents of children with autism or other neuropsychological disorders tell me that the Christmas holidays are an especially difficult time for them. Of course, any holiday can be difficult for any child with the changes in routine. But Christmas is usually the most difficult holiday for parents of children with autism or other neuropsychological disorders.
There are no sure-fire techniques to use with your child that will insure a "Martha Stewart Christmas." Families who have children with autism or other neuropsychological disorders have used the following 10 tips to make their Christmas better. And this year I'm adding a new suggestion to the list.
Several years ago Leigh Grannon and I did a study using pictures to increase social interactions in a child with autism. Children with autism are visual learners, and I have suggested to parents that they take pictures of what is going to happen at Christmas--the tree, the gifts, the relatives--and starting several weeks before Christmas show these pictures repeatedly to the child with autism. Tell a little story to the child while he/she is looking at the picture about how to behave, what's going to happen, and what the child can do if it is too much. Include your child in the pictures if possible. A picture of the child going to his room to escape the noise and confusion when he/she gets overloaded seems to help, too.
1. Try to keep your child in his or her usual routine as much as possible.
2. Sensory over stimulation—the lights, the sounds, the smells, the relatives touching your child--are the main culprits during the holidays. Eliminating or minimizing these culprits are your best bet.
3. Some families who have children with autism or other neuropsychological disorders wait until Christmas Eve to put up their tree and decorate.
4. Some families let their children with autism or other neuropsychological disorders do all of the decorating. Children with autism or other neuropsychological disorders may line up or stack decorations rather than decorate in the traditional way, but so what.
5. Rather than try to do the Christmas shopping with children with autism or other neuropsychological disorders in a crowded, noisy mall, many families shop by catalog or online and let the child point to or circle the toys he/she wants. Websites, such as www.stars4kidz, offer a variety of toys for children with autism or other neuropsychological disorders. Just type "autism toys" in your search engine.
6. Tactile toys are often a better choice for children with autism or other neuropsychological disorders. Toys that make sounds or involve too much stimulation or are too complex may not cause an aversive reaction in the child. As mentioned above there are web sites that sell toys designed for children with autism or other neuropsychological disorders. Try ordering some of these toys and then let your child select the ones to play with as they are unwrapped.
7. Talk to relatives before they come over about the best way to behave with children with autism or other neuropsychological disorders. Have them read my article, “What Horses Tell Us About Autism,” which is available for free on the second page of my website.
8. Generally, kids with autism or other neuropsychological disorders do better in the morning than in the late afternoon or evening when they are tired. It may be better to schedule Christmas events at these times.
9. The parents of children with autism or other neuropsychological disorders need to relax themselves. Often the child with autism picks up on the parents’ stress and that is enough to ruin Christmas.
10. And last but not least, realize that you are probably not going to have a perfect food, perfect decorations, and perfect gifts. Christmas with children with autism or other neuropsychological disorders may not be traditional, but it can still have real meaning. (Sometimes I wonder if children with autism or other neuropsychological disorders know that Christmas has become too commercial.)
I wish you and your child the happiest of holidays.
Gary Brown, Ph.D
Psychologist/HSP
(Thanks to the mothers of children with autism or other neuropsychological disorders who help with this post.)

Clinic Notes: New Discussion Board and Questions and Answer Feature

My on line ABA course will feature a discussion board in the near future. Students taking my on line course may posts questions, observations they have made while applying ABA procedure, or ask for help with specific behavioral problems. Other students may respond to posts or I may respond when necessary.In additions, I will require my on campus ABA students to post weekly to the discussion board. Caregivers who visit www.ABA4autism may ask questions about ABA and autism or ABA and other neuropsychological disorders. Of course, questions and comments are always welcome on my blog.

Clinic Notes: Pictorial Prompts and Autism

Several years ago my student, Leigh Grannon and I, presented a paper titled "The Effect of Pictorial Prompts on Verbal Interactions in a Child Diagnosed with Autism." This study used a personalized set of pictures with verbal prompts to establish verbal social interactions in a child with autism. Results indicated that the number of verbal social interactions made by the child with peers in a daycare setting increased and generalized to children and adults and in other settings.
I am now working on a paper that will use pictorial prompts to teach children with autism and other neuropsychological disorders how to behave at Christmas time. Many parent who bring their children to my clinic complain that the Christmas holidays are an especially difficult time for them. I plan to have the paper on my web site in time for the holidays.

New Autism Survey

ABA4Autism.com and the Psychology Department at the University of Tennessee at Martin are conducting a second survey on the causes of Autism Spectrum Disorders (ASD). This survey is for mothers of children with ASD as well as mothers of normally developing children who are ten years of age or younger. Mothers who participate in the survey will receive a free ABA program to teach their child to follow directions as well as free ABA mini programs for common problems like sharing. To take the survey please go to http://www.aba4autism.com

The preliminary results of the first survey may be found at http://aba4autism.blogspot.com/.

ABA4Autism's New Web Page

Check out ABA4Autism's newly designed web site at http://www.ABA4Autism.com. For three years we have been trying to reach families with low costs ABA eBooks, Case Histories, and an online ABA course. Our old web site was not professionally designed and no doubt many visitors had problems navigating the site. Now our web site is professionally designed and easy to use. We will be adding new features soon such as a question and answer feature with Dr. Brown and a chatroom option. Both of these new features will be free. Check us out and take our new survey on the causes of autism if you have not done so already.

Clinic Notes: Autism in the News

I published the study below on my website this morning. I am also publishing here for wider distribution.

Treating Autism with Applied Behavioral Analysis
(For full story go to http://tinyurl.com/9lvh4)
A recent California study finds that intensive Applied Behavior Analysis (ABA) was more effective in treating preschool children with autism than other methods provided in many community-based education and treatment programs.
ABA uses the concepts of repetition and reinforcement of specific desirable behaviors to increase their frequency. At the same time, harmful or undesirable behaviors are not reinforced. This study reinforces the idea that early intervention for children diagnosed with Autism is a major step in producing successful and independent children in the schools and at home.
The research team includes a pair of California State University, Stanislaus psychology professors, Dr. Jane Howard and Dr. Harold Stanislaw and their colleagues Colleen Sparkman, Director of The Kendall School in Modesto; Dr. Howard Cohen, Clinical Director of Valley Mountain Regional Center in Stockton; and Dr. Gina Green of San Diego

Clinic Notes: Etiological Factors in Children Diagnosed with Autism or Pervasive Developmental Disorder-Preliminary Results

*Poster session II Human Behavior and Evolution Society Conference. June 1-4, 2005. Austin, Texas
Angie S. MacKewn, Sherry D. Jones, Gary E. Brown & Esther J. Plank
The purpose of the current study was to develop a predictive model of more frequently occurring pre and postnatal etiological factors in children diagnosed with autism. A survey of biological mothers of children diagnosed with autism or PDD and of children without developmental delays were matched on gender (n=134 males and 56 females) and age (M=6.54 years, SD=2.78 in autistic); (M=6.23 years, SD= 2.90 in controls). The developmental survey asked several questions including, pregnancy food cravings and aversions, childhood ear infection, presence of tubes, vomiting and nausea patterns, and speech development. A logistic regression equation found that not vomiting in the first trimester, the mother having an infection while pregnant, and the child having over 7 ear infections, were significant predictors of whether a child was diagnosed with autism or not. Of mothers of autistic children, 40% vomited in the first trimester compared to 53% of the control mothers. The “embryo protection hypothesis” suggests that morning sickness has an evolutionary basis and protects the embryo from teratogens by causing pregnant women to purge (Profet, 1992).

Clinic Notes: Performance deficits

ABA Program for Eliminating Performance Deficits

After you have your child making eye contact, following directions, and have eliminated behaviors that interfere with learning, such as tantrums, aggressive behavior, and self-injurious behavior, you are ready to start teaching skills so that your child can overcome developmental delays. (ABA Program Number 9 for toilet training is a good place to start if your child is not toilet trained.)
ABA Program Number 10, Teaching Stimulus Discriminations (Colors, Shapes, Letters, etc.), covers Discrete Trial Training (DTT), one of the most useful ABA techniques for teaching skills to children with autism or other neuropsychological disorders. But with many children DTT doesn’t work as well as it should. Usually, this is because caregivers, as well as clinicians, have not determined if the child they are working with has skill deficits or performance deficits before they start DTT.
A child with skill deficits cannot perform a task because the task has not been learned for one reason or another. For example, the child may have sensory, motor, or cognitive problems that interfere with learning. However, with performance deficits, the child has learned the task and can perform the task. But the child has learned that giving the wrong answer, or simply not performing the task when asked to do so, results in more reinforcement (usually in the form of attention) than performing the task.
Generally, if a child can perform a task at one time and not another time, or perform the task with one caregiver and not another caregiver, then we know we are dealing with a performance deficit. (There are exceptions to this. Some children with neurological problems fatigue easily and cannot perform a task consistently.) Often caregivers tell me that their child can name different colors or shapes, but then seems to “forget.” Most of the time the child did not forget. The child has learned not to perform.
Once you have determined that your child has performance deficits, stop all drills. The following drill should be the only drill you run until performance deficits are eliminated:
1. Choose material that you know your child knows. For example, flash cards the child can name or shapes or colors the child can identify.
2. We only want to practice giving correct answers so only run 3-4 trials at a time. Wait 20-30 seconds between trials so we can be sure that we are eliminating fatigue as a variable.
3. On trial one present the stimulus that you are using. For example, ask the child to tell you what is on a flash card that you know the child can name. Only ask one time. If the child gives the correct answer, then give tangible reinforcement plus praise. Tell the child, “Good, you gave the right answer.” If the child gives the wrong answer say, “No, you gave the wrong answer” and do the body part drill 25 times (See ABA Program number 7). Then ask the child again. If the child gives the correct answer, follow the directions above for correct answers above. If the child gives the wrong answer, repeat the body parts drill 25 times until the child gives the correct answer. If the child gives the correct answer while you are doing the body part drill, stop and follow the instructions above for correct answers. If the child does not give the correct answer when you ask again, repeat the directions above for incorrect answers.
4. Once the child gives the correct answer, wait 20 to 30 seconds and go to the next trial.
5. After 3-4 trials, give the child a short play break.
6. Once the child is answering correctly 100% of the time, slowly increase the number of trials, one trial a day, until you get to ten trials. Once the child is performing consistently on ten trials, then this should be the number of trials you use before a short break in most cases.