Autistic Spectrum Disorders (ASD)

Plaintiff lawyers contribute b…

Plaintiff lawyers contribute big bucks to stae officials & win state business. This should STOP in California. Other states have reforms.

California NOT named as one of…

California NOT named as one of the states that ARE reforming “the cozy relationship between elected state officials and plaintiff lawyers…

Aptos psychologist: Even MORE people will be diagnosed “austistic spectrum disorder”

Change in DSM-V for Autistic Spectrum Disorder

The next version of the Diagnostic and Statistical Manual (DSM-V) more than likely will collapse Asperger’s Disorder and PDD-NOS into “Autistic Spectrum Disorder” (ASD). If you want to comment go to the following web site.

I think the new definition of ASD is cleaner and well written. It still needs something in the diagnostic criteria that addresses how substantially handicapped the person is by his/her particular symptoms.

The flip side of diagnosis is treatment. A diangosis of “Autistic Spectrum Disorder” should include the specific deficits — and degree of deficit — so as to suggest appropriate, individual interventions.

Aptos psychologist: parents teach autistic children via distance learning www.freedomOK.net/wordpress

Exciting news how parents CAN successfully help autistic children via distance learning!

Too often Applied Behavioral Analysis (ABA) commercial programs come into the home, work exclusively with the child and parents are not the central players in helping autistic children to communicate.

The tools for helping the child need to be in the hands of the parents. DVD is one promising tool for giving parents the necessary tools they need.

“Pivotal response training” is the lingo used by ABA to discuss what normal folks call “generalization” — the ability to perform the skill in other settings. Clearly whatever is taught via ABA methods needs to be “generalized” to the home setting and implemented by the parents and other family members.

By instructing the family members in a flexible manner — on their schedule — generalization of skills may happen much faster.

See the article below. This is based on research done at the University of California at Santa Barbara. Exciting! written by Cameron Jackson, Ph.D., J.D. DrCameronJackson@gmail.com

Distance Education For Parents Of Children With Autism Found Effective
Article Date: 02 Feb 2010 – 7

“Through the use of instructional DVDs, parents of children with autism can learn how to teach their child to communicate and improve their behavior, according to research published in the January 2010 issue of The Journal of Positive Behavior Interventions (published by the Hammill Institute on Disabilities and SAGE).

“Family members play a central role in the education and treatment of children with autism. However, training parents in appropriate techniques can provide unique challenges.

“Often, mothers and fathers are not available at the same time to participate in training. Contemporary work schedules no longer conform to a traditional 9 to 5 schedule, further complicating efforts to help parents with their child. And, many families are simply too far away from training opportunities to participate on a regular basis. Providing family members with the type of flexibility they need to participate in training is often beyond the capability of most of these programs.
Researchers at the University of California, Santa Barbara (Nicolette Nefdt, Robert Koegel, George Singer and Michael Gerber) explored whether providing training to parents through DVDs could help bridge this gap. The good news is that parents did improve their skills through watching the training videos, and there were improvements in child behavior as well.

“Many parents of children with ASD are motivated and able to implement evidenced based intervention with minimal support,” said researcher Nicolette Nefdt. “Once provided with a rationale, step by step instructions and video examples, parents were able to change their behavior and begin teaching their child to communicate. Parents who completed the program commented mostly on the ease and flexibility of use of a program such as this one, the value of the video examples and the enjoyment of working with their child”.

“This is very exciting to us, as we are now able to help many more people more quickly than we could otherwise,” said co-author Robert Koegel.

The article “The use of a self-directed learning program to provide introductory training in pivotal response treatment to parents of children with autism” is available free for a limited time at http://pbi.sagepub.com/cgi/reprint/12/1/23. SAGE
Source:
Jim Gilden
SAGE Publications

DDS wastes money on research that finds more cases of autism located close to regional centers?

At times one wonders why huge sums of money are spent on research! The article below finds more autism is diagnosed close to regional centers and that more education and race is connected than environmental factors.

This money could have been better spent on what probably can reduce autistic spectrum disorders — reduce use of ultra sound and other invasive technology to medical necessity and reduce use of chemicals and pollutants in the home environments What goes on pre-birth, such as use of drugs and alcohol, has huge effects on development.

This study found that more cases of autistic spectrum disorder (ASD) are found to be located close to places that diagnose ASD — regional centers. Why? It is not that there are more cases close to regional centers but that there is access to a services that can diagnose ASD.

Take San

ta Cruz County which has a large agricultural population in Watsonville which is Hispanic and a more highly educated population in Santa Cruz and Scotts Valley. Far more children of Caucasian higher educated parents are routinely diagnosed than are children from less educated farm workers.

Why? Because lower income, less educated Hispanics are working 10-12 hours a day six days a week. Many do not have the time, energy or money to take their children to regional centers for a diagnosis.

So far as I can see this sort of research is a huge waste of time and money. What do you think? Read below what the researchers found:

“Researchers at UC Davis have identified 10 locations in California where the incidence of autism is higher than surrounding areas in the same region. Most of the areas, or clusters, are in locations where parents have higher-than-average levels of educational attainment. Because children with more educated parents are more likely to be diagnosed with an autism spectrum disorder, one need look no further for a cause, the authors say. The other clusters are located close to major autism treatment centers.

“The clusters are located primarily in the high-population areas of Southern California and, to a lesser extent, in the San Francisco Bay Area. The researchers said that, while children born within the clusters during the study period were more likely to be diagnosed with autism, the majority of the state’s children with autism were born in adjacent areas outside the clusters.

“For the rigorous study, published online today in the journal Autism Research, scientists examined nearly all of the approximately 2-1/2 million births recorded in the state of California from 1996 through 2000. About 10,000 children born during that five-year period were later diagnosed with an autism spectrum disorder, according to the state Department of Developmental Services (DDS).

After mapping the state’s birth cohort based on where the mothers lived at the time when their children were born, the researchers pinpointed birth locations of children who were later diagnosed with autism. The study looked for areas of higher incidence within each of the service zones of DDS’s regional centers, which coordinate services for individuals with developmental disorders like autism.

“This is the first time that anyone has looked at the geography of autism births in California in order to see whether there might be some local patches of elevated environmental risk. This method ignores unknown widespread factors (such as a regional pollutant) that could increase autism incidence,” said Karla Van Meter, the study’s lead author. Van Meter is an epidemiologist and was a doctoral student in the UC Davis Department of Public Health Sciences and at the Center for Animal Disease Modeling and Surveillance when the study was conducted.

“This spatial study was extremely rigorous because we developed a methodology that greatly improved accuracy in identifying areas of higher autism incidence. With so many possible environmental health risk factors, we see this method as generally useful for focusing studies on exposures that are elevated in such clusters,” Van Meter said.

However, the researchers said that in this investigation the clusters probably are not correlated with specific environmental pollutants or other “exposures.” Rather, they corellate to areas where residents are more educated.

“What we found with these clusters was that they correlated with neighborhoods of high education or neighborhoods that were near a major treatment center for autism,” said senior author Irva Hertz-Picciotto, a professor of public health sciences and a researcher with the UC Davis MIND Institute.

“In the U.S., the children of older, white and highly educated parents are more likely to receive a diagnosis of autism or autism spectrum disorder. For this reason, the clusters we found are probably not a result of a common environmental exposure. Instead, the differences in education, age and ethnicity of parents comparing births in the cluster versus those outside the cluster were striking enough to explain the clusters of autism cases,” Hertz-Picciotto said.

Autism is a neurodevelopmental disability characterized by impaired social development and communication and restricted, repetitive behaviors. It is considered a lifelong condition that develops by the time a child is 3 years old. The researchers limited their study to the five-year period between 1996 and 2000 in order to allow all of the children born during that time to grow to an age by which they probably would have received a diagnosis – 6 years old.

Van Meter said that the increased risk of autism in these areas is roughly a doubling of the incidence of autism over the incidence in the surrounding zone. For example, for the cluster area located in the service zone of the San Diego Regional Center, the autism incidence was 61.2 per 10,000 births and, in the rest of the Regional Center service zone, 27.1 per 10,000 births. For the Harbor Regional Center the incidence was 103.4 and 57.8, respectively. Van Meter added that it is important to remember that most of the children with autism were not born in the cluster areas.

In Southern California, the areas of increased incidence were located within these Regional Center service zones:

The Westside Regional Center, headquartered in Culver City, Calif., which serves the communities of western Los Angeles County, including the cities of Culver City, Inglewood and Santa Monica; The Harbor Regional Center, headquartered in Torrance, Calif., which serves southern Los Angeles County, including the cities of Bellflower, Harbor, Long Beach and Torrance; The North Los Angeles County Regional Center, headquartered in Van Nuys, Calif., which serves the San Fernando and Antelope valleys – two clusters were located in this regional center’s service zone. The South Central Los Angeles Regional Center, headquartered in Los Angeles, which serves the communities of Compton and Gardena; The Regional Center of Orange County, headquartered in Santa Ana, Calif., which serves the residents of Orange County; and The Regional Center of San Diego County, headquartered in San Diego, which serves people living in Imperial and San Diego counties.

In Northern California, the areas of increased incidence were located within these regional centers’ service zones:

The Golden Gate Regional Center, headquartered in San Francisco, which serves Marin and San Mateo counties and the City and County of San Francisco. Two clusters were located within the Golden Gate Regional Center’s service zone; and The San Andreas Regional Center, headquartered in Campbell, Calif., which serves Santa Clara, Santa Cruz, Monterey and San Benito counties.

Two areas of increased incidence were located in Central California regional centers’ service zones:

The Central Valley Regional Center, headquartered in Stockton, Calif., which serves Fresno, Kings, Madera, Mariposa, Merced and Tulare counties; and The Valley Mountain Regional Center, headquartered in Fresno, Calif., which serves Amador, Calaveras, San Joaquin, Stanislaus and Tuolumne counties.

The South Central and Valley Mountain Regional Centers autism clusters were listed as “potential clusters” because their clusters met a reduced set of statistical conditions.

All of these areas were identified using a sophisticated new biostatistical testing procedure developed by Van Meter in collaboration with study co-author Lasse Christiansen and constructed on Christiansen’s earlier statistical work. This method looked for combinations of events, in this case, autism, within a set of locations, in this case, births, whose occurrence would not be expected to occur at random. This is the first application of that method. UC Davis undertook the epidemiological study as a step toward identifying geographic risk factors for autism in California, Van Meter said.

The study also examined demographic factors recorded on the children’s birth records that are known to be associated with both autism and residential location. These included having an older parent – a known autism risk factor. The researchers found a statistically significant but small association of the cluster areas with older parental age at the time their child was born.

Hertz-Picciotto said that the findings do not counter the idea that the environment plays a role in autism, but rather, help to focus attention toward certain types of exposures.

“Because of the strong link between demographics, particularly parental education, and the locations of clusters, other explanations for these pockets of high autism incidence, such as localized sources of exposure, are not likely,” Van Meter explained.

“The risk for a child with highly educated parents to be diagnosed with autism is probably not caused by the location of the mother’s residence or any local shared environmental exposures,” she said. “Our result indicates that the most likely sources of environmental hazards for autism in California are in or around the home or else are widespread.”

“The strong link between demographics, particularly parental education, and the locations of the clusters validated the effectiveness of the statistical method that we employed because it successfully identified areas where a known risk factor was concentrated,” she added.

Keywords: Autism, Conservation, Developmental Disabilities, Developmental Disorders, Ecology, Environment, Environmental Health, Epidemiology, Neurology, Pediatrics, Public Health, University of California – Davis – Health System.

What is fastest way to get rec…

What is fastest way to get records from Snata Cruz County Mental Helath? Get the therapist to request records. http://www.FreedomOK.net/wordpress

Autism Speaks is a US wide + organization

Go to www.autismspeaks.org for listings of resources all across the U.S. re autism. Autism Speaks

Autism Speaks lists where to …

Autism Speaks lists where to get assessments for AUTISM & similair disorders. In Santa Cruz and Monterey go to http://www.freedomok.net/wordpress

Aptos psychologist: How well does the ADOS assess for autism in toddlers?

The Aptos Psychologist says: The Autism Diagnostic Observation Schedule (ADOS) is a tool wherein an adult observes a child’s behavior in a structured setting. The ADOS does not include observations of the child with other children in real life settings.

Children often act very differently with adults than they do with same age peers. That there is no inclusion of real life ratings how the child does with other same age peers is a weakness of the ADOS. Further, in the original ADOS there was no examination of the 3rd category (repetitive behaviors) required for diagnosis of 299.0 Autistic Disorder.

Does the Model T module for under 3 children distinguish with “sensitivity” and “specificity” 299.00 Autistic Disorder from Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS)? It seems that the ADOS will distinguish “autistic spectrum disorders” (PDD-NOS, Autistic Disorder, Asperger’s Disorder) but does not distinguish between the ASD disorders.

Diagnosing autism in toddlers: The new ADOS Toddler Module enters the field
Written by Nestor Lopez-Duran PhD on Wednesday, May 20.2009
The Autism Diagnostic Observation Schedule (The ADOS) is a diagnostic instrument that was created by the University of Michigan Professor Dr. Kathy Lord.

During the last 2 decades, the ADOS has become the most accepted diagnostic tool for autism spectrum disorders. The ADOS has 4 different overlapping â€˜versionsâ€™ (or modules) that were designed to be used with individuals of various ages and abilities â€“ including non-verbal individuals.

“However, the original ADOS is not very useful in the diagnosis of children under the age of 3. For these children, the ADOS is not specific enough. That is, it incorrectly identifies ASD in many children who actually have a non-ASD developmental delays.

“But why do we need an autism diagnostic instrument for children under 3?
There are actually a number of valid and important reasons in support of the early diagnosis of autism. When conducting evaluations of children with autism I hear parents describe how they knew that â€™something was wrongâ€™ since their child was very young. This phenomena is not just a clinical anecdote, as it has supported by research studies (see for example Chawarska et al. 2007 DOI:10.1111/j.1469-7610.2006.0185.x) suggesting that in some children, clear symptoms of autism can be identified very early. In addition, a number of studies have shown that early intervention is extremely important in the treatment of autism, thus early identification would help families obtain the interventions they need.

“Given the need to have a diagnostic instrument that can be used with children under 3, Dr. Lord and her team at the University of Michigan have been working on a new ADOS module that would reliably identify autism in these young children. The results of these efforts have now been presented in an article to be published in the Journal of Autism and Developmental Disorders. In the article, the authors described in detail the process that led to the development of the ADOS new toddler module (ADOS-Module T). However, I will limit this post to a description of the validation procedures.

In order to test this new module, the authors used the ADOS-Module T in 360 clinical evaluations with children under age 3 conducted at the University of Michigan Autism and Communication Disorders Clinic, and at the University of California-San Diego Autism Center of Excellence. These children included those who eventually would receive a diagnosis of non-ASD developmental delays, ASDs, or no diagnosis at all (typically developing). The ASD children had their clinical diagnoses of ASD based on a â€œbest estimateâ€ procedure conducted by specialists, and based partly on a modified version of the ADI-R. The non-ASD developmental disorder group as well as the typically developing group were also evaluated for ASDs with the ADI and they did not meet standards for ASDs.

So in essence, the ADOS-Module T was employed on 3 groups of children: Children with ASD, children with a non-ASD disorder, and typically developing children. The clinicians administering and scoring the ADOS-Module T were unaware of the eventual diagnoses of these children. This allows the researchers to examine the specificity and sensitivity of the new ADOS module in the correct identification of autism spectrum disorders.What is sensitivity and specificity? Sensitivity refers to how accurate the instrument is in the identification of autism when autism exist. For example, when a test has 80% sensitivity, this means that 80% of the time when a condition is present the test will â€˜catch itâ€™. Specificity however, refers to how well the test differentiates the target condition from other conditions. So for example, a test may have very high sensitivity in that every time the target condition (in this case autism) is present, the test gives you a â€˜positiveâ€™ result. But the same test my have very low specificity, in that it also gives you a positive result when a different condition is present, so that it incorrectly identifies the target condition as present when itâ€™s not there!

How did the new ADOS Module T perform?

1.The sensitivity of the ADOS Toddler module was 91%. That is, the test was able to correctly identify 91% of the cases of ASD (based on a cut off score of 12).
2.The specificity of the ADOS-Module T when tested against non-ASD disorders was also 91%. This means that only in 9% of the cases, the test suggested a diagnosis when the child had been previously identified as not having an ASD.
3.The specificity of the ADOS-Module T when tested against typically developing cases was 94%. That is, only in 6% of the cases, the test suggested a diagnosis in children who were actually typically developing kids.
These are actually excellent numbers and indicate that the ADOS Toddler Module has excellent sensitivity and specificity. However, the authors also described some general concerns and limitations.

The ADOS, although it is the most reliable and valid diagnostic instrument available, it is still only a clinical tool that must be used in the context of a comprehensive clinical evaluation and it is subservient to clinical judgment. Specifically, a diagnosis of autism is provided only when the person meets the DSM-IV diagnostic criteria. Therefore, clinicians must use their judgments in interpreting and applying the results from the ADOS. There will be cases when the ADOS suggests a diagnosis but the clinician will not provide the diagnosis because the child doesnâ€™t meet full diagnostic criteria based on the DSM-IV.

So you may ask, what is the point? Why do we have the ADOS if all a clinician has to do is go down the list of the DSM-IV criteria and add up the check marks? The ADOS provides for a reliable and valid tool to assess for the specific symptoms included in the DSM-IV criteria and it helps the clinician interpret the childâ€™s clinical presentation as it applies to the DSM-IV criteria. The ADOS standardizes this process so that diagnoses are less dependent upon other factors, such as biases in parental reporting of symptoms, or the skills or training of the clinician in properly indentifying such symptoms. Therefore, the ADOS greatly improves the validity and accuracy of our â€˜clinical judgmentâ€™.

On a personal note and disclaimer. Dr. Luyster (lead author of the study), Dr. Richler, and Dr. Oti were all my classmates in graduate school and I congratulate them for their wonderful work. In addition Dr. Lord, creator of the ADOS and founder of the University of Michigan Autism and Communication Disorders Clinic, will be my collague this Fall when I join the University of Michigan faculty.

The Reference: Luyster, R., Gotham, K., Guthrie, W., Coffing, M., Petrak, R., Pierce, K., Bishop, S., Esler, A., Hus, V., Oti, R., Richler, J., Risi, S., & Lord, C. (2009). The Autism Diagnostic Observation Scheduleâ€”Toddler Module: A New Module of a Standardized Diagnostic Measure for Autism Spectrum Disorders Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-009-0746-z

Posted under: All Posts, Autism
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4 Responses to â€œ Diagnosing autism in toddlers: The new ADOS Toddler Module enters the field â€
#1 Brandon Says:
May 20th, 2009 at 1:43 pm
Very interesting. Mr. Lopez I hope you enjoy coming to the U of M. I am in the Adult Autism Social Group up there, so I know some of the researchers. I find the ADOS-T very interesting I will be sure to ask Katie Gotham more about it.

#2 Nestor Lopez-Duran PhD Says:
May 20th, 2009 at 4:11 pm
Thank you Brandon for your comment. Iâ€™m sure I will enjoy Michigan. I went to graduate school there and coming back to join the faculty feels like coming back home. Cheers, Nestor.

#3 JulieL Says:
May 22nd, 2009 at 9:29 pm
I listed to a recent podcast with Professor Margot Prior. She noted that there is recent research in the US and UK stating that children can be, as she stated â€œpicked up as at riskâ€ for autism, at the age 12-24 months old. She was clear to state that this was not to say these would be always accurate, but it would be say a marker for close observation for that child. Do you know of anything regarding the research she speaks of? This new research article you present here seems to be adding to that body of agreement.

Thanks

#4 Pregnancy Questions Says:
June 16th, 2009 at 11:45 pm
Do you plan to keep this site updated? I sure hope soâ€¦itâ€™s great.

To: the MD whistleblower on b…

To: the MD whistleblower on blogspot. You can get “mdwhistleblower” as your name on Twitter. Then tweet to your blogspot. DrCameron

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