How parents can help ADHD & Autistic children be happier & achieve goals

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

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 information below:

National Autism Center
_____________

” Parents and caregivers everywhere are eager for credible, research-based information on the most effective treatments for Autism Spectrum Disorders (ASD).

To address this need, the National Autism Center has released its newest manual, “A Parent’s Guide to Evidence-Based Practice and Autism.” The Center is a nonprofit organization dedicated to supporting effective, evidence-based treatment approaches for individuals with ASD.

The 134-page manual focuses on helping parents as they make decisions about how to best help children with ASD reach their full potential. It begins with a review of the autism spectrum, symptoms, and co-occurring conditions, and identifies and describes effective treatments. Other topics include the importance of professional judgment, the role of family preferences and values in the decision-making process, and factors to consider when choosing a team of professionals to help their child.

“Finding information about autism is easy. It is much more difficult to find reliable information that has withstood the rigors of science, is comprehensive in scope, and is accessible and easy to read,” says Hanna C. Rue, Ph.D., BCBA-D, Director of Evidence-based Practice for the National Autism Center and one of the manual’s authors. “Even for a trained professional, sorting through the clutter to find information that is most relevant to a child’s needs is a complicated and challenging process.”

One of the features that make this manual different from most others is that it was co-authored by professionals and parents of children with autism. “As professionals, we think about treatment from an entirely different perspective than a parent,” Dr. Rue continues. “We felt it was critical that the parent experience be reflected in every aspect of the manual.”
“To have a trusted resource that you can go to for reliable information, or to check your own gut instinct, is essential for any parent of a child with autism,” explains Janet Amorello, one of the manual’s parent experts. “My hope is that this manual will help families assess the options and obtain services that ultimately result in a better outcome for their child.”

The manual is the latest in a series of publications by the National Autism Center. Visit the Center’s website to download a free copy, watch a video, or learn more.

About the National Autism Center

The National Autism Center is May Institute’s Center for the Promotion of Evidence-based Practice. It is dedicated to serving children and adolescents with Autism Spectrum Disorders (ASD) by providing reliable information, promoting best practices, and offering comprehensive resources for families, practitioners, and communities.

The Center works to shape public policy concerning ASD and its treatment through the development and dissemination of national standards of practice.

For more information, please call 877.313.3833 or visit www.nationalautismcenter.org

Contact: Susan G. Lauermann, APR(781) 437-1257slauermann@nationalautismcenter.org

SOURCE National Autism Center

Read more: http://www.sacbee.com/2011/12/12/4116440/national-autism-center-publishes.html#ixzz1gM2uAq6m

Special Diets help children with autism & epilepsy

Roughly 25-35% of individuals with autism eventually develop seizures and many of the remainder have subclinical seizure-like brain activity. However, little is known about which traditional epilepsy treatments and commonly used non-traditional alternative treatments are effective for treating seizures or epilepsy in children and adults with autism spectrum disorder.

A study just published in BMC Pediatrics by Dr. Richard E. Frye from the University of Texas in Houston and Dr. James B. Adams from the Arizona State University in Tempe has now provided insight into which traditional and non-traditional medical treatments are most beneficial for individuals with autism spectrum disorder and seizures. These researchers surveyed 733 parents of children with autism spectrum disorder and seizures, epilepsy and/or subclinical seizure-like brain activity to rate the effectiveness of 25 traditional and 20 non-traditional medical treatments on seizures. The survey also assessed the effect of those treatments on other symptoms (sleep, communication, behavior, attention and mood)and side effects.

Overall, anti-epileptic drugs were reported by parents to improve seizures but worsened other symptoms. Overall, non-antiepileptic drugs were perceived to improve other symptoms but did not improve seizures to the same extent as the anti-epileptic drugs. Four anti-epileptic drugs, valproic acid, lamotrigine, levetiracetam and ethosuximide, were reported to improve seizures the most and, on average, have little positive or negative effect on other symptoms. Certain traditional non-anti-epileptic drug treatments, particularly the ketogenic diet, were perceived to improve both seizures and other symptoms.“The information gained from this study will help physicians more effectively manage children with autism spectrum disorder and seizures,” says Dr Frye.

Prof. Adams states that, “This study suggests that several non-traditional treatments, such as special diets (ketogenic, Atkins, and gluten-free, casein-free), are worth further investigation as adjunctive treatments for treating seizures.”

Source: Autism Research Institute

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.

MONDAY, March 21 (HealthDay News) — Scientists report that mutating a single gene produced mice with two of the most common autism traits, a finding they say could one day lead to the development of drugs to treat autism.

Currently, there are no effective drugs to treat the disorder.

Mutating the shank3 gene led to compulsive repetitive behavior and avoidance of social interaction in the mice, apparently caused by impaired communication between brain cells, said the researchers at Duke University and the McGovern Institute for Brain Research at the Massachusetts Institute of Technology.

The shank3 gene has been implicated in human autism.
The study was published online March 20 in Nature.

“We now have a very robust model with a known cause for autistic-like behaviors,” senior author Guoping Feng, a professor of brain and cognitive sciences at MIT, said in a McGovern Institute news release. “We can figure out the neural circuits responsible for these behaviors, which could lead to novel targets for treatment.”The genetically altered mice also provide a way to assess experimental autism drugs before they’re tested in humans.

Scientists acknowledge that research involving animals often fails to result in beneficial treatments for humans.

The U.S. National Institute of Neurological Disorders and Stroke has more about autism

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

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.

Parents cannot ask children with Asperger’s Disorder, “What did you do today?” Think of Asperger’s Disorder children like a computer with files. You have to find the right file and open it. Likewise, a parent has to inquire, when you were on the playground during recess what game did you play? That kind of specific questioning — akin to opening a specific file — helps a child to know how to answer a question.

It’s important that parents “cut the white space” – the unstructured time. When children with Asperger’s Disorder know exactly what to do they talk less about their current intense interest. Many children with Asperger’s Disorder have sensory regulatory issues which Dr. Leventhal-Belfer thinks are related to anxiety. Asperger children can be so loud themselves and yet over sensitive to noise. Usually when doing an intake some family members are identified as having Asperger symptoms.

Dr. Laurie Levanthal-Belfer likes the Robert’s test for assessment. The Robert’s test is a projective test that shows social situations. She uses kinetic family drawings to see how family members relate to each other. Often one parent has traits highly similar to the child with Asperger’s Disorder. Dr. Levanthal-Belfer has found that the same strategies that work with children also work with the spouses that have Asperger’s Disorder traits.

Concerning assessment: Dr. Levanthal-Belfer asks for home videos, does school observations, takes a developmental history and does a parent interview. She will use the Wechsler IQ tests for assessing cognitive abilities. She assesses how the parent and child interact by having them build a house out of blocks, do clean up, do a learning task (puzzle, read a book, teach the child how to be President). She wants to see how the parent leads the child and vice versa.

Of note for therapists: Dr. Levanthal-Belfer said that insurance pays for treatment but not for diagnosis. She asks, but how do you do appropriate treatment without accurate diagnosis? Linda Lotspeich, M.D. suggests that therapists give 3 different diagnosis depending on the audience.

She tells graduate students to first rule out Autism before considering Asperger’s Disorder.

California schools take the position that if the child can do age appropriate work then they will not offer an IEP.

The key part to The Friends Program is the parent component. And generalization is key. written by Cameron S. Jackson DrCameronJackson@gmail.com

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

See the following research article:

“Hyperactivity, distractibility, and impulsivity are common symptoms in children with autism and other pervasive developmental disorders (PDD). Children with PDD who experience these symptoms are not considered to also have Attention Deficit Hyperactivity Disorder (ADHD). This is because their symptoms of hyperactivity and inattention are thought to be secondary to the autistic symptoms and/or intellectual disability, and also the response to treatment may be different. A number of studies have explored the use of stimulants such as methylphenidate in typically developing children with ADHD, but few have examined the use of methylphenidate in children with PDD. This study sought to determine the efficacy and safety of methylphenidate in children with PDD and hyperactivity.

Seventy-two children with PDD and moderate to severe hyperactivity participated in a 1 week test-dose phase to see how well they tolerated methylphenidate. Each child received placebo for 1 day, then increasing doses of methylphenidate (low, medium, high) for 2 days each. The 66 children who tolerated the test-dose were then randomly assigned to the next 4 week phase. The trial was double-blind, meaning that neither child, parent, nor doctor knew whether the children were receiving active drug or placebo. It was also a crossover trial. In a crossover trial subjects are randomly allocated to one of two groups. Subjectsallocated to the methylphenidate group receive methylphenidate first, followedby placebo. Vice versa subjects in the placebo group receive placebo first, followed by methylphenidate treatment. This designallows contrasting the response of a subject to placebowith the same subject’s response to methylphenidate. Each child therefore received placebo and the 3 different dosage levels (provided they were able to tolerate the dosages during this longer phase). Children who responded positively during the crossover phase were then entered into an 8 week open label (i.e. no longer blinded) continuation phase at their best dosage. The primary outcome measure of the study was the hyperactivity scale of the Aberrant Behavior Checklist (ABC).

The investigators found that methylphenidate was more effective in improving symptoms of hyperactivity and inattention than placebo in children with PDD (49% response rate). Adverse effects were more frequent with methylphenidate than placebo and included irritability, decreased appetite, difficulty falling asleep and emotional outbursts. There was an 18% discontinuation rate due to adverse effects. The 49% response rate is less than the 70% – 80% response previously reported in a large study of children with ADHD; the 18% adverse event rate for children with PDD was higher than the 1.4% rate reported in the aforementioned study of children with ADHD.

Conclusions

The investigators conclude that methylphenidate is a reasonable choice for treating hyperactivity in the context of PDD given the response rate of 49%, with the caution that there is a strong possibility of adverse effects.

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.

So for people with Autistic Spectrum Disorders and compromised executive functioning abilities – what to do?

Routine and patterns creating ingrained habits may assist. So first, figure out how to get to sleep at a set time. Then start moving that time back so you can sleep when it is dark and get up when it is light – or as close that as possible. In the evening stop both mental and physical exertion a couple hours before going to bed and plan to be in bed by around 10 pm. Do boring if need by, relaxing tasks the couple hours before bed. Using either a prescription or other means plan to go to sleep around 11 and up by 8 or so.

By Martin W. Schwartz
The best time to sleep varies from person to person, but as a general rule the internal human clock (Circadian Clock) gears people to sleep when it is dark outside and remain awake during hours of light.

Some people, like this writer, are “night owls” meaning that their Circadian rhythms are such that becoming tired does not set in until the “wee” hours of the morning (between 2 AM and 5 AM). For us, going to sleep early is a chore, often requiring the use of prescription (Ambien, Sonata, Lunesta) or non prescription (.3 mg of Melatonin) sleep aids.

Although the Circadian clock can be “reset” in a sleep laboratory or by a routine that gradually has the person going to sleep 10 minutes earlier each night, for “night owls” it is very easy to slip back into the old routine simply by sleeping late on a single day.

For people with no disturbances in their Circadian rhythms, the best time to sleep is about 5-6 hours after eating their dinner, which works out to sometime between 11PM and Midnight. Going to sleep the same time every night, seven days a week, avoiding late evening snacks with caffeine, theobromine (chocolate) or salt, will help to prevent insomnia by keeping the Circadian clock in synch with the actual time of day/night. And AVOID NAPS during the day. If you must take one it should be no lnger than 45 minutes.

Sleep deprivation is a huge problem in industrialized nations and other than spending time in a sleep laboratory, medical science has come up with very little to treat chronic or intermittent insomnia.

” The new data provide more evidence that D-cycloserine enhances the efficacy of exposure therapy in people with phobias. An earlier study conducted at Emory University demonstrated similar results in individuals with acrophobia, the fear of heights. According to Stefan Hofmann, associate professor of clinical psychology and lead investigator of the BU study, his team’s research offers a number of complementary features: it represents the use of DCS in a common anxiety disorder known for its marked distress and disabling effects; it examines treatment outcomes for a condition that has been the target of large-scale combination treatment trials, with little advantage shown for the addition of drugs over behavior therapy alone; it utilizes a longer course of therapy; and, it utilizes clinicians from several sites and both individual- and group-treatment formats that are consistent with the ways in which behavior therapy is provided in clinical settings.

“Studies like this may usher in a new strategy for combining medications and cognitive-behavior therapy,” suggests Dr. Otto. “Instead of simply combining medications and therapy that are each designed to reduce anxiety and avoidance, the use of DCS is directed toward making the therapeutic learning in cognitive-behavior therapy stronger. Medication use is limited to only a few doses, taken before therapy sessions.”

Researchers from the anxiety clinics at Massachusetts General Hospital and Southern Methodist University also participated in the study.