Monterey Bay Forum

Intriguing as a possible early sign of autism: Lag in motor development (control of head and neck) found in infants who are more likely to develop autism. This study needs to be replicated before the public puts much weight on this finding.

This is a simple test that any mother can do at home. Any suspected delays can lead to early intervention by Early Start services. Parents who suspect motor delays can seek assistance from the Early Start program funded by the federal government.

“Typically, red flags that might lead to an autism diagnosis are issues with social and communicative traits, such as avoiding eye contact or not playing with others. But Dr. Rebecca Landa, the study’s author and director of the Center for Autism and Related Disorders at Kennedy Krieger Institute in Baltimore, says certain disruptions in a child’s motor development may provide important clues.

“For the study, researchers assessed infants in a simple “pull-to-sit” task that measures posture control by firmly – yet carefully – pulling a child’s arms from a position of lying flat on his/her side back into a sitting position (as seen in the videos below). Typically infants achieve this type of posture control by the time they are four months old.

“In one experiment, researchers gave this task to 40 infants who were considered to be genetically high-risk for the disorder because a sibling has autism. They researchers were looking specifically at “head lag” – the inability to control head posture – at 6, 14, 24 and 30 months of age.

“The researchers found 90 percent of subjects eventually diagnosed with autism exhibited head lags as infants, and 54 percent of kids who met social and communication delays criteria exhibited head lag, while 35 percent of children who did not meet that criteria exhibited the lag.

“In a second experiment, Landa and her team examined only six month olds at a single point in time to check for head lag, and found 75 percent of the high risk infants displayed head lag compared with 33 percent of low-risk infants, further emphasizing that head lag is more common in infants that may develop autism.

Landa’s study is to be presented at the International Meeting for Autism Research on May 17 in Toronto.

“While previous research shows that motor impairments are linked to social and communication deficits in older children with autism, the field is just starting to examine this in younger children,” she said in an Institute news release. “Our initial research suggests that motor delays may have an important impact on child development.”

“If some parents try the test at home and are worried, Landa emphasized to The Baltimore Sun that a head lag at six months does not mean a child is definitely going to have autism, but rather is a potential sign that a pediatrician should explore further. http://www.baltimoresun.com/health/blog/bal-poh-autism-test-for-infants,0,1502094.story

“We don’t want to scare parents,” she said. “If I go to the doctor because I’m having problems with balance, he’s not going to assume I have a brain tumor. When a baby shows a head lag there are so many other things it can be. But this is a very real indicator of something wrong with development and easy things can be done to help.”

Dr. Alycia Halladay, director of environmental research for the advocacy and research group Autism Speaks, told WebMD that the findings are “intriguing” but a head lag’s diagnostic value remains uncertain.

“The first step is to replicate these outcomes in larger studies in multiple sites,” she said.

The study adds to recent research aimed at diagnosing autism at an early age. A recent study found differences in nerve connections seen in infants’ brain scans might signal autism, CBS News medical correspondent Dr. Jon LaPook reported.

About 1 in 88 children has autism, according to recent government estimates.

Hearing loss in babies has huge effects on their general development: hearing loss impacts language acquisition, speech, psycho-social well being and overall learning.

Research shows that the critical time to stimulate the auditory and brain pathways is during the first six (6) months of your child’s life. So pay particular attention during your child’s first six months that he or she continues to hear normally.

The good news is that children with all degrees of hearing loss — who receive appropriate interventions prior to 6 months of age– can obtain speech and language skills comparable to their normal hearing peers when age 3 years.

What parents can do:
Check and re-check that your baby’s hearing remains normal. Visit your pediatrician for screenings as your doctor recommends. Research recommends hearing screening every 2 months until age one year — and every three months until age two. (more…)

Some simple techniques can assist children with attention deficit hyperactivity disorder (ADHD) and/ or autistic spectrum disorder (ASD)to be happier and achieve appropriate goals. These techniques are easy for parents and teachers to implement.

Of course a child is not a car but think of the following analogy:

Every car to get to a destination needs a driver. Parents can assist children to get into the driver’s seat and drive their ‘car’ to appropriate ‘destinations’.

Here’s how to assist children who have difficulties with focus, attention, concentration, ‘executive functioning’ or ‘working memory’ difficulties. Executive functioning and working memory are words used by school psychologists. What the parent sees is a child who can’t seem to figure out what comes first and appear disorganized.

What to do: Get a pad of 8 by 12 inch lined paper.

On one per sheet of paper —
1) Write at the top, a Goal that parents/teachers want the child to achieve.
2) Write out all the Steps required to accomplish the Goal.
3) Order the steps from first to last using KISS (Keep It Simple, Simple)
4) Figure out an appropriate Reward for child accomplishing the steps.
Set it up so child can get partial reward for partial completion.
5) Decide the number of Days child needs to complete the Goal.
6) Draw up a Graph with Days across Top of Page and Goals listed on left.

Here’s an example of a Behavior Plan for a child who shows symptoms of both ADHD and ASD:

Gina is 8 years old and was exposed in utero to illegal drugs and alcohol. Her biological mother lost parental rights and Gina has been in foster care since age two. Since age four, Gina has received County Mental Health therapy and medication to assist with focus, attention and concentration. The therapy provided by County Mental Health focuses only on helping Gina to label emotions and better express her emotions appropriately.

Gina’s foster mother and her teacher agree that Gina’s adaptive functioning abilities are considerably below what they expect for her age. Her foster mother wants Gina to 1) wash her face & brush her teeth; 2) make her bed; 3) put toys in basket in her room; 4) set the table with utensils and plates before dinner.

Goals:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Wash face & clean teeth
Make bed
Put toys in basket
Set table with utensils & plates

Spiritual/ religious beliefs need to be integral to a successful Behavioral Plan.
For example, Gina’s foster mother goes to church and rests on Sunday. Therefore the behavior plan is for six days a week and no work on Sunday, their day of rest. Six days a week time four goals = 24 Goals for Gina to achieve. For each Goal achieved she earns one (1) dime. During the week she puts stickers on the sheet and gets her motivators (dimes) which she puts into a plastic, clear jar. That way she can see exactly what she has earned towards a new toy on the weekend. Her foster mother believes Gina can find age appropriate toys for around $2.50 to $3.00 a toy.

What makes a Behavioral Plan successful?
The answer is simple: practice and more practice so the Steps are as simple as possible and the child gets rewarded for partial and then complete finishing the Goal.

For example, Gina when we started could not make her bed said her foster mom. Well, the cover was too big and too heavy for a thin, small 8 year old to move around. Thus, by simplifying and making a bed simply tossing a light duvet (down comforter) on a twin bed and putting the pillow in place — then making a bed by an 8 year old is simple and possible.

A second example:
Gina has never set the table for dinner. Part of the reason is that the plates are too high for her to reach and they are china easily breakable. Also, the utensils are not easy to get to. This is easily solved by moving plastic plates and smaller folks and spoons to one drawer that the child can reach. The point is to set it up so the child can successfully achieve the Goals.

Overall point: Parents can set simple ‘destinations’ for their child to drive their ‘car’ towards and by keeping the steps simple and practising the steps again and again their child can achieve those destinations to goals that parents set.

Very important: the hugs and ‘You did great!’ and ‘Keep trying!’ are as important and at times more important than any reward system. Parents – whether biological parents or foster parents – are the fire to ignite important, life long change in children.
Send comments to DrCameronJackson@gmail.com

Parents can download for free a research based manual “A Parent’s Guide to Evidence-Based Practice and Autism.” This manual is co-authored by parents with autistic children and professionals.

If possible I will put a copy up on the Autism page for Monterey Bay Forum. Go to http://www.nationalautismcenter.org to download a copy. (more…)

About one-third of children with autistic spectrum issues also have epilepsy. Diet does help with both per study discussed below. (more…)

Probably there are multiple genes and multiple avenues for the development of autistic traits in children. There is recent news that one particular gene — the shank3 gene — may be responsible.

Some children strongly avoid social interactions (they arch their back & look away) as infants. Other children develop normally only to suddenly lose all language and social interests typically around the age of 18-24 months. Fascinating, about one quarter of U.S. children who meet criteria for a diagnosis of autism at age 3 will “shed” that diagnosis before they reach adulthood.

So, one wonders whether a single gene is responsible for such wide variations in how autistic behaviors are expressed during a child’s development. See below what scientists say about the shank3 gene. (more…)

Sufficient, restful sleep and absorption of appropriate food is crucial to health and well being. True for every one and particularly difficult for many persons with autistic spectrum issues.

Remember grandmother – or mother – with the spoon of that awful tasting cod liver oil? Research shows that cod liver oil helps many children with autistic spectrum disorder difficulties. Ever had problems with jet lag and difficulties re-establishing a natural sleep rhythm? Melatonin is a natural enzyme your body produces which may be low or lacking in persons with autistic spectrum difficulties.

Many children and adults with autistic spectrum disorders have sleep and digestive disorders as well. Many are “picky eaters”. Many as children had constant diarrhea. Many have difficulties falling asleep and difficulties staying asleep.

What help is there? Autism Research Institute compiles information from parents as to what helps. Go to Autism Research Institute and take a look at the non drug supplements that help.

Of note, cod liver oil made 55% Better and 4% Worse for N = 2,550
folic acid made 45% Better and 5 % Worse for N = 2, 505
melatonin made 66% Better and 8% Worse for N= 1, 687

Of course, first consult with your pediatrician and read the literature.

Please comment what works for your child or spouse with autistic spectrum issues. What about the liquid vitamins? What about iron supplements?
DrCameornJackson@gmail.com

DrCameronJackson@gmail.com

The Friends Program, located in Palo Alto, California, is a therapeutic group designed to address the developing needs of young children with Asperger’s Syndrome and their families.

Laurie Levanthal-Belfer, Ph.D. is the Director of The Friends Program and can be reached at Dr.LaurieLB@gmail.com and on the web at www.thefriendsprogram.com

Dr. Levanthal -Belfer was the speaker for Asperger’s Disorder: A Developmental Approach to Understanding Asperger’s Disorder, Assessment and Intervention held in Aptos, CA on 2-26-2011. This was a conference attended by psychologists, nurses, marriage and family counselors and interested public.

What did attendees learn? Some notes:

Asperger’s Disorder became diagnosis in 1994 and will not be a separate diagnosis in the next DSM-V expected out in a year or so. Asperger’s Disorder will be eliminated. Instead there will be Autistic Spectrum Disorder.

What I learned looking at my notes: Asperger’s Disorder children at age 4 or 5 play more like a child of 2 or 3. They have intense interests which may change but the intensity of the interest is notable. Transitions are difficult for them. They have one way to go to school and if a parent or other person deviates that will spark a melt down. They cannot take the perspective of the other. The therapy groups work a lot on white lies and how to tell them. Children with Asperger’s Disorder are “black-white” children that think there is only one way to do things. (more…)

Ritalin helps about 70-80% of children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) with a 1 1/2 percent who discontinue due to side effects. Now research shows that Ritalin helps children with Autistic Spectrum Disorders — not to the same extent and with more side effects. A 2005 study shows that Ritalin helps 50% of children on the spectrum with a an 18% discontinue rate due to side effects.

My question: What is helped the most? Executive functioning abilities (attention, planning, sequencing) or impulsively or what? (more…)

Is it time to view autism as a psychological trait similar to intelligence? Some researchers say yes.

If true, that most Americans have some “autistic traits” and a few of us are very low or very high in “autistic traits”. If autism is normally distributed — in the shape of a bell curve — then it’s time that standardized tests for measuring autism are developed similar to how intelligence is measured.

If true, then the supposed “gold standard” for assessment of autism in toddlers may not be so golden after all. Why?

The ADOS developed by Lord et al measures autistic spectrum traits the way a thermometer or a ruler does. The difference between 2 and 3 is the same as between 12 and 13. But if autism is normally distributed then different measures — with a different kind of “ruler” need to be used.

Background to how intelligence (I.Q.) is measured:

The intelligence of 2 out of 3 persons in the U.S.lies between 85 and 115. Only 2 or so persons have an I.Q. of 70 or lower. Likewise, only 2 or so have an I.Q. of 130 or higher.

In Feb., 2008, Carrie Allison et al published a paper: The Q-Chat: Quantitative Checklist for Autism in Toddlers. A normally distributed measure of autistic traits.