Clinic Notes: The Genetics of Autism

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

Clinic Notes: A Biological Marker for Autism?

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

Clinic Notes: Antidepressants and Autism

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

Clinic Notes: iPad Apps for Children with Autism Redux

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

Clinic Notes: Gary James' App Party for Autism

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

Clinic Notes: Developmental Disabilities in Children Are Increasing

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

Clinic Notes: More Links to Autism Reported

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

Clinic Notes: Autism Rates Are Up Again

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

Clinic Notes: Cost of ABA

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

Clinic Notes: The Business of Autism

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

Clinic Notes: Ipad Apps Redux

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

Clinic Notes: Ipad Apps Redux

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

Clinic Notes: "Wretches and Jabberers"

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

Clinic Notes: Virtual Conversations and Autism

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

Clinic Notes: iPad DTT Apps for the Child with Autism

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

Clinic Notes: Serotonin and Autism

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

Clinic Notes: Autism in China

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

Clinic Notes: Diagnosing Autism Redux

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

Clinic Notes: iPad Hypnosis of Children with Autism

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

Clinic Notes: Toxins In Pregnant Women

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