“Be sure to screen children for delays” said the first lecture at the Disability conference held in San Francisco March 11 & 12, 2010. One in five (1/5th) of all children have some kind of delay when they enter school — hence it is very important that physicians and other health professionals screen for delays.
One screening tool for autistic spectrum disorders (ASD) is the CHAT. The CHAT is just one of various tools available to screen for ASD.
Do you have concerns about your child? There are certain signs to watch for in children age six months to one year old. Many of these are non-verbal signs: not turning head when child’s name is called, lack of smiling and eye contact, not engaging in “joint attention” .
I will provide free screenings for autistic spectrum disorder. Contact Dr. Jackson at 831 688-6002 (Aptos, California phone) or email to DrCameronJackson@gmail.com
Identify autistic spectrum disorder (ASD) early. Treat it appropriately. And many children will substantially improve.
written by Dr. Cameron Jackson DrCameronJackson@gmail.com
Special diets for children with autism? Cut out all dairy? Cut out all wheat? According to a speaker at the Disability Conference at U.C. San Francisco March 11 & 12, there is no research support for any special diet limiting or eliminating certain foods.
Some autistic children have very limited food interests — many autistic children will only eat a few foods. So often I hear from a parent that their child will only eat white pasta and a few other foods. It makes sense to try to supplement a child’s diet if the child is very picky.
But eliminate certain foods for children with autism?
That there is very little good research on the food habits of small children was pointed out by the speaker. And there are some research projects in place that will give better information in the not too distant future. But that does not help the parent to decide today how to feed their autistic child.
For now, talk to your doctor. And work with a nutritionist if you do modify your child’s diet. And be careful. For example, limiting dairy products greatly cuts down on protein sources. Lack of protein can have long term effects on health as an adult.
There are lots of wacky things parents do. Well before the explosion in autism.
Here’s a personal experience: Thirty years ago a good friend of mine had a baby. My friend did not believe in giving cow’s milk to her daughter because, as she put it, “the molecules were too big…” So the child got no milk or dairy.
Instead of milk the child got only rice water. What happened? At age two the child’s hair was wispy white. Later as a young adult she had teeth and bone problems. Bone and teeth problems have persisted throughout her life. Are her problems related to an early lack of protein (no milk or milk products) as a infant and child? My guess is yes.
So, be careful when considering a special diet for a young, autistic child. To date, there is no research support for limiting or eliminationg certain kinds of foods.
written by Dr. Cameron Jackson DrCameronJackson@gmail.com
www.FreedomOK.net
Wake an autistic child for ABA treatment?
According to Dr. Bryna Seigel, for treating autism Applied Behavioral Analysis (ABA) IS the best method and it needs to be done from a developmental perspective.
That’s the problem. The ABA folks far too frequently do not use a developmental framework. Too often the ABA trainers do not use anything other than the one tool they know: stimulus – response. And far too often, ABA trainers do NOT know what is appropriate developmentally or culturally for that child.
The bottom line is that the ABA folks are narrowly trained and practise a narrow technique. It is good that they stay within the boundaries of their knowledge. Thank god for that! It is not good that they think that their method is the only way to go.
For example, too often ABA trainers will train the child during a time of day that typically the child naps. Does that make sense? Not from a developmental perspective. The ABA trainer’s response? We’ve got to get more INTENSITY says the trainer so let’s keep little Johnny up during his nap time.
And how much is enough? It’s NEVER enough say many ABA trainers. Dr. Siegel mentioned a 16 year old who has had ABA almost all his life. When is time to stop? His trainers don’t want to stop. From the ABA perspective, it is always possible to incrementally make progress. That may be true. But at what cost? And who should pay for it?
I’m thinking of a case of two children – twins — with mental retardation and autism. Neither could speak more than a handful of words, if that. Their parents wanted ABA to continue indefinitely although both had plateaued years before. Incremental progress meant maybe a little more shaping towards a sound over many 40 hour weeks. Should the taxpayers pay for this kind of incremental gain?
Dr Siegel was asked how she thought FloorTime proponents might comment on her view that ABA is the best method. Frankly, I don’t remember a clearly defined answer.
So what is the Holy Grail for treating autism? Remember the elephant and everyone holding on to a different part? So does the trunk you are holding feel like the elephant’s back? The truth that people have depends on their experience.
I understand that of course ABA can be implemented from a developmental perspective. In my experience, too often it is not done in either a developmentally or culturally sensitive manner. I am interested in seeing programs such as the Early Start Denver method — that uses both the FloorTime relational approach and the ABA approach.
Dr. Siegel spoke March 11, 2010 at the Developmental Disabilities: Update for Health Professionals at the Laurel Heights Conference Center, San Francisco, CA
Diploma earned by CA youth with autism
There are stories of courage and faith all around us. This one is about a Catholic family with a special needs child. Recently, now age 18, I had the opportunity to assess their son.
This young person has substantial, multiple difficulties. To protect the family’s privacy, some information has been changed.
I will call their son Thomas. Not Thomas the Doubter but Thomas the Tenacious.
Early on, Thomas’ family knew that their middle child was very different. Though not a problem at home, he got kicked out of a private pre-school for behavior issues. By age four, assessment suggested that he had substantial communication and social delays. Other assessment suggested an array of delays.
In Kindergarten, Thomas’ parents turned down an SDC placement (more than 50% in special ed setting) and insisted on mainstreaming him. His family wanted and got a regular ed placement. He had an aide.
Assessment in second grade showed that Thomas had normal, average cognitive IQ abilities and quite low other abilities. However, thereafter when Thomas’ cognitive IQ abilities were tested his scores were in the bottom 5 out of 100.
“No, we are not going to use the mental retardation label,” the parents said to themselves and to professionals. To Thomas they said, “You can and will graduate from high school”.
The parents set the bar high for Thomas. The parents helped him every night at home and negotiated with the schools for support services to assist Thomas. At times he had an aide. He had Occupational Therapy and Speech services. Throughout high school he had RSP support.
Outside school, Thomas was able to complete religious classes and in high school was confirmed in his church. But he never had any friends.
“If Thomas misses 1 class it is as though he missed 3″ said his mother to me when I tried to set up an appointment to assess him. ” And absolutely don’t take him out of History …” And I did set up appointment times that did not conflict with any of his academic subjects.
And guess what — this June Thomas age 18 will graduate with a high school diploma. True — he has not been able to pass the California exit exams. However, he has completed all the work and taken all the necessary classes. Thomas has worked hard and long to get a diploma.
It has been a hard road for Thomas. It takes him 2-3 times as long to finish his homework compared to fellow students. Though he would like friends — he has no friends. And he cannot drive a car. And except for work experience through Special Education, he has had no part time jobs.
Thomas has a disability called Autistic Spectrum Disorder. It substantially affects his communication and social abilities. Sometimes he mumbles and sometimes he nearly shuts down in his abilities to communicate with people.
When assessing Thomas, one thing shined through — Thomas has sold, normal, average cognitive intelligence. That Thomas has normal, average intelligence is a real strength that will help him in all of life’s situations.
All of us have strengths and relative weaknesses. Thomas has strong intelligence and incredible tenacity. Once he knows what to do and how to do it, he persists and keeps on trying until the task is done. And that willingness to persist and keep on trying was passed along to Thomas by the faith and courage of his parents.
There is a saying, “the devil is in the details…”Â
Assessment of autism with the ADOS is fraught with difficulties. The ADOS per the Manual does not assess for Category 3 behaviors — repetitive, stereotypic behaviors.Â
 There must be substantial Category 3 behaviors for a DSM-IV-TR diagnosis. It sounds like, per Assessment of Autism Spectrum Disorders (2009) that a new algorithm published in 2007 takes care of the problem. But does it?Â
Which algorithm makes a significant difference. What algorithm do psychologists use when using the ADOS to assess for autism? The one in the manual or the one published later  in 2007? If someone buys an ADOS in 2010 are they given instructions to use the 2007 algorithm or the one in the Manual?Â
The following is from  Assessment of Autistic Spectrum Disorders, pg. 65:Â
“The ADOS uses cutoff scores for two separate domains (Social Interaction and Communication) as well as a Communication-Social Interaction total cut-off score, in order to make the diagnostic distinction between autism and the broader category of ASD.Â
“Although the ADOS has many similarities to the DSM -IV-TR and International Classification of Diseases… models of diagnosing ASD, the ADOS algorithm included in the manual does not include a measure of restricted, repetitive and stereotyped patterns of behavior ...In addition the ADOS does not include information about the age of onset or early history required for a DSM-IV-TR or ICD-10 diagnosis.Â
“Recently, however, new algorithms for the ADOS have been published (Gortham, Risi, Pickles & Lord, 2007 that do includerestricted/repetitive/stereotyped behaviors and no longer have separate Social Interaction and Communication domains…”
So, are the authors of Assessment of Autism Spectrum Disorders (2009) suggesting that the new algorithm should be used? Are psychologists using the ADOS using the Manual or the new algorithm? Â
Where to find the algorithm:Â
Gotham, K., Risi, S., Pickles, A., & Lord, C. (2007). The Autism Diagnostic Observations Schedule: Revided Algorithms for Improved Diagnostic Validity. Journal of Autism & Developmental Disorders, 37 (4), 613-62
sensitive parenting helps autistic childrenYes! Parenting styles matter! Sensitive parenting — using language to help teach your child about his/her enviornment — helps ease dificulties that later become defined as autism.
When little Mary is playing with a ring, a sensitive mother says, this is a green ring … and this, over here, is a red ring…. the mother is teaching her daughter about the environment.
A new study by researchers from the University of Miami shows that maternal sensitivity may influence language development among children who go on to develop autism. Although parenting styles are not considered as a cause for autism, this report examines how early parenting can promote resiliency in this population. The study entitled, “A Pilot Study of Maternal Sensitivity in the Context of Emergent Autism,” is published online this month and will appear in an upcoming issue of the Journal of Autism and Developmental Disorders.
“Language problems are among the most important areas to address for children with autism, because they represent a significant impairment in daily living and communication,” says Daniel Messinger, associate professor in the department of psychology at the University of Miami (UM) College of Arts and Sciences and principal investigator of a larger study of infants at-risk for autism, which includes this study.
Maternal sensitivity is defined in the study as a combination of warmth, responsiveness to the child’s needs, respect for his or her emerging independence, positive regard for the child, and maternal structuring, which refers to the way in which a mother engages and teaches her child in a sensitive manner. For example, if a child is playing with colored rings, the mother might say, “This is the green ring,” thus teaching the child about his environment, says Messinger.
In this study, maternal sensitivity (and primarily, sensitive structuring) was more predictive of language growth among toddlers developing autism than among children who did not go on to an autism diagnosis. One possible explanation is that children with autism may be more dependent on their environment to learn certain skills that seem to come more naturally to other children.
“Parenting may matter even more for children with developmental problems such as autism because certain things that tend to develop easily in children with typical neurological development, like social communication, don’t come as naturally for kids with autism, so these skills need to be taught,” says Jason K. Baker, a postdoctoral fellow at the Waisman Center, University of Wisconsin-Madison, who conducted the study with Messinger while at UM.
For the study, 33 children were assessed in the lab at 18, 24, 30 and 36 months of age. Some of the children had an older sibling diagnosed with autism and were considered high risk for autism.
At the 18-month assessment, the researchers videotaped a five minute period of mother and child free play in which the mothers were asked to play as they would at home. Aspects of maternal sensitivity were scored on seven-point scales ranging from absence of sensitive behavior to extremely sensitive behavior. Children’s language was assessed at 2 and 3 years. At the 3 year visit, when the children were old enough to be evaluated, 12 of children from the high risk group received an autism-spectrum diagnosis.
The study was funded by the National Institutes of Health. Its findings parallel previous treatment research indicating that when children with autism increase their connection to the environment they do much better, Baker says. Understanding the benefits of sensitive structuring in the development of language among young children with emergent autism provides scientific support for early intervention programs that focus on parent-child interactions. “We know that parenting doesn’t cause autism. The message here is that parents can make a difference in helping their children fight against autism,” Baker says.
Jo Ann Riniti, Ph.D. specializes in infant attachment, developmental issues with young children, family therapy and adolescents with Asperger’s issues. She provides individual, couples and family sessions as well as group therapy. Her California License Number is PSY 12418.
Dr. Riniti facilitates various educational talks including: Knowing What We Know: How to Cultivate and Communicate Our Truth; What is Your Hurry? – The Disappearance of Creativity and Play; A Sense of Play: The Value of Active Engagement and Emotional Attunement.
Dr. Riniti’s office is located at 9099 Soquel Drive, Suite 11, Aptos, CA 95003. Telephone 831 427-8282
This is a true story with some information changed to protect privacy.
The boy, I will call him Mark, is nearly seven years old. He was diagnosed with Autistic Disorder a year ago.
The diagnosis was given after a thorough assessment by a licensed California psychologist up in the Bay Area. Mark and his parents live in the Monterey Bay area. Mark goes to a public school kindergarten.
In the course of just one year, Mark’s functional abilities have improved considerably. He no longer meets criteria for a diagnosis of Autistic Disorder.
Since the diagnosis , Father, a computer type, now spends much more time engaged with Mark has an Individual Education Plan (IEP) which provides a full time aide and public school speech services. Mother also takes him to private social learning classes and to horseback riding classes for children with disabilities. And there is a normally developing same age boy who lives close. The parents put in an outside hot tub and child oriented playground to encourage other children to come visit.
Of note: There was no Applied Behavioral Analysis (ABA) services in place. Mother appears to use a soft, developmentally oriented approach. And it IS working! So, YES, children can dramatically improve in one year. Instead of having 6 out of 9 functional areas quite low, now there are only three. What more improvements will happen over the next year? I expect more great, positive changes ….
written by Cameron Jackson DrCameronJackson@gmail.com
DiagnosisMedical Diagnosis: You go to a doctor. He/She says that you have a diagnosis of cancer. You say, what do I do …? The doctor suggests various treatments. Here, diagnosis is the flip side of treatment. Nobody BUYS or WANTS a diagnosis of cancer. If a person has cancer then treatment may involve radiation, surgery or chemotherapy or a combination of all three. All these treatments have significant medical side effects. None of these should be undertaken lightly.
Psychiatric/psychology diagnosis: Parents are concerned about mental and emotional development of their child. They take their child to a doctor — this one is a psychologist and / or psychiatrist. The parents want maximum services to address the concerns they see in the development of their child. So long as the services don’t hurt the child why not maximize them? That is the parents point of view.
Does the doctor conservatively diagnose or? Most of the treatments offerred for children with a diagnosis of autism do not have substantial side effects as in cancer. No lose of hair or feeling lousy because of radiation. So why not maximize treatment to assist the child? Why not “err” and offer maximum kinds of treatment?
Ethics: I say that it is best to do as accurate a diagnosis as possible and not “err” in order to maximize services. Better to incrementally come back and add necessary services rather than overload at the beginning.
This is an ethical dilemma. Does the MD give out drugs that are not necessary but the patient came all that way, waited an hour and expects to get “something”? Does the psychologist diagnose Autistic Disorder 299.0 and not PDD-NOS knowing that one will probably maximize all possible services and the other may not?
Another issue is who pays. If the patient pays for it akin to buying groceries then he may decide that some services are crucial and others can wait. If the “government” is paying the tab — how does that affect decisions?
looking at eyes an important abilityPersons with autism often cannot make eye contact. They often will look at mouths rahter than focus on the eyes, Oxytocin increased the abilitiy of autistic persons to pick up non-verbal social clues.
“Autism is characterized by difficulties in communicating effectively with other people and developing social relationships. The team led by Angela Sirigu at the Centre de Neuroscience Cognitive (CNRS) has shown that the inhalation of oxytocin, a hormone known to promote mother-infant bonds and social relationships, significantly improved the abilities of autistic patients to interact with other individuals.
To achieve this, the researchers administered oxytocin to 13 autistic patients and then observed their social behavior during ball games and during visual tests designed to identify ability to recognize faces expressing different feelings. Their findings, published in PNAS on 15 February 2010, thus reveal the therapeutic potential of oxytocin to treat the social disorders from which autistic patients suffer.Oxytocin is a hormone that promotes delivery and lactation. It plays a crucial role in enhancing social and emotional behavior. Previous studies that measured the levels of this hormone in the blood of patients showed that it was deficient in those with autism.
First of all, the researchers observed the social behavior of the patients while they were interacting with three other people during a ball tossing game. Three profiles were represented: a player who always returned the ball to the patient, a player who did not return the ball, and finally a player who indiscriminately returned the ball to the patient or to other players. Each time the patient received the ball, he or she won a sum of money. The game was restarted ten times in order to allow the patient to identify the different profiles of his/her partners and act accordingly. Under a placebo, the patients returned the ball indiscriminately to the three partners. However, patients treated with oxytocin were able to discriminate between the different profiles and returned the ball to the most cooperative partner.
The scientists also measured the patients’ degree of attentiveness to social signals by asking them to look at series of photographs of faces. Under a placebo, the patients looked at the mouth or away from the photo. But after inhaling oxytocin, the patients displayed a higher level of attentiveness to facial stimuli: they looked at the faces, and indeed it was even possible to see an increase in the number of times they looked specifically at the eyes of the faces in the photographs.
During these tests, the scientists also verified these behavioral effects by measuring physiological plasma oxytocin levels before and after nasal inhalations. Prior to the inhalations, plasma oxytocin levels were very low, but they rose after an intake of the hormone.
The results of these tests thus showed that the administration of oxytocin allowed autistic patients to adjust to their social context by identifying the differing behaviors displayed by those around them and then acted accordingly, demonstrating more trust in the most socially cooperative individuals. Oxytocin also reduced their fear of others and promoted closer social relations.
This is one of the first studies to have demonstrated a potential therapeutic effect for oxytocin on social deficits in autism. Evidently, variations between individuals were observed in terms of their response to treatment, and the researchers acknowledged the importance and necessity to pursue this work. They will in particular be studying the long-term effects of oxytocin on improving the everyday living disorders of autistic patients, and its efficacy at an early stage of the disease.
