What is the best treatment for Asperger's?

If your child has ASD, autism or Aspergers you most likely wonder what is the most useful, powerful and successful treatment for him or her? How can you help your child meet their potential? Simply, what is the most effective Aspergers treatment and help for aspergers? Many parents of aspergers children worry that their child will never be able to develop strong friendships let alone a human-romantic relationships that could eventually lead to marriage and children and a full life. Relationships during childhood, who you have as friends and how well you get along and attach, as Dr., John Gottman has pointed out, are the #1 factor in determining outcome later in life. They correlate to employment success, to later relational success and even to life span. People who related better in the 4th grade earn more money, are happier and live longer. It's more important that academic grades, prizes in science or awards in sports.

So can your child with Asperger's do well in relationships? The truth is, it is possible, but it takes a lot of work, the right advice, access to the right information and treatment interventions. Which ones work best? Regretfully, the answer is "it depends." What we do know is there are treatments know to work, and those for which there is no scientific support.

Here are the top 4 methods of aspergers treatment:

1. Applied Behavioural Analysis

2. Floor Time

3. Speech Therapy

4. Social-Cognitive Therapy (training in theory of mind)

Notice "social skills" isn't in this list. We are always teaching social skills, but there is a difference between a lack of social skill knowledge and the social-cognitive deficits children and adults with Asperger's suffer from. (I recently posted two great videos that explain "theory of mind" and urge you to watch those. Understanding the difference between a social skills deficit and a deficit in theory of mind is critical for successful treatment for you or your child. And many schools and therapists don't understand the difference.

At different times your child my need one or all of these treatment interventions. They each have their place at the appropriate developmental time, and can be adapted to use at different developmental moments. Heres a little more detail on each:

1. Applied behavioural analysis (ABA)
ABA is a method of teaching that involves breaking tasks into small, discrete 'teachable' steps. At each step appropriate behaviours are reinforced. ABA selects developmentally appropriate behaviours as teaching targets. These can range from maintaining eye contact to complex responses such as social interaction. The child is given enough support to ensure success, which is then positively reinforced by consequences that are reinforcing for that child. Gradually the amount of support and reinforcement is reduced.

Early intervention programmes for children with autism and Asperger's have the potential to produce positive changes in development and consequently reduce the need for later interventions. Therefore in many ABA programmes parents are trained to become the primary therapists and their children receive one-to-one tuition in their own homes. There is evidence that intervening in a child's development in this way can help children with autism to be more successful in mainstream schools (Keenan et al., 2000). Often parents want to avoid this step, especially if their child is a little most socially developed, verbal etc. DON'T AVOID ABA! ABA training is necessary for you as a parent to understand the basics of behavioural interventions. Exposing your child to good, competently taught ABA prepares them with tools you can use later to teach new skills. It's a tool best learned young, and then used again and again.

ABA is not everything, however, and for some schools and intervention programs it seems to be. There are other, more complex skills that cannot be taught through ABA. But ABA is the foundation of your future work.

2. Floor Time
Here is one description of ABA I really like, "During floor time, your child will stretch his imagination and logical understanding of the world as he stages make-believe games and locks horns with you over rules. He'll use gestures and words to express his needs and to explore a broad range of emotions, from exhilaration to anger. He will also hone his physical skills as his muscles strengthen and grow." Yes, floor time means getting down on the floor and MODELLING appropriate make believe games, using your imagination, and exposing your child to the idea of "sharing the floor" with another person. It's the environment you use to generalize behavioural skills you have taught. Later Floor Time can be thought of as becoming Social Cognitive Therapy I mention below in 4. Floor time has not been shown to change "autistic" behaviours (self stimulation etc.) but it has been shown to improve the quality of the relationship between the child and parent. I expect research will show it does the same with the child and therapist, teacher, teacher aide and so on. Some positive play time involving the reciprocal interactions between the child and adult needs to be part of any program. And it needs to be fun, reinforcing and relaxing!

3. Speech Therapy
Speech Therapy may help their child with communication difficulties. The difficulties are not in how the child speaks or pronounces words, but rather in how the child perceives the meaning of other people's speech. A speech therapist focuses on issues of social reciprocity, understanding the second level of communication in speech. Often this is more about what is not said than what is said. In speech therapy I would expect a child to learn to understand how what he or she says effects others. And in addition, a speech therapist is able to measure our overall progress in terms of "pragmatic language and help with simple speech difficulties that make communication, already difficult, even more difficult. Every child with Asperger's should be seen by a speech pathologist.

4. Social Cognitive Therapy
The I-LAUGH Model of Social Cognition developed by Michelle Garcia Winner is a framework of social cognition designed to explain the multiple skills and concepts that we must process and react to in order to succeed at social interaction and personal problem solving. Each of these elements of social cognition affects not only our ability to make and keep friends, but also our ability to process complex information in the classroom and the workplace. The I-LAUGH Model is evidence-based in that each aspect of it has been researched and defined as a trait of persons with social relatedness issues. A brief summary of the I-LAUGH framework from her web page is below. You can find out more about here work at her website at www.socialthinking.com:

I = Initiation of Communication (Kranz & McClannahan, 1993)
Initiation of communication is the ability to use one’s language skills to establish social relations and to seek assistance or information from others. Many students with autism spectrum disorders have significant problems initiating communication in stressful situations or when information is not easily understood. Language retrieval is difficult in anything other than calm, secure situations. Even within the higher functioning population with autism spectrum disorders, the student’s ability to talk about a favourite topic of interest can exist in sharp contrast to how that student communicates when needing help or when attempting to gain social entry into peer groups. Yet, these two skills – asking for help and understanding how to join a group for functional or personal interaction - are paramount for any student’s future success.

L= Listening With Eyes and Brain (Mundy & Crowson, 1997; Kunce and Mesibov, 1998; Jones & Carr, 2004)
Many persons with autism spectrum disorders and other social cognitive deficits have difficulty with auditory comprehension. From a social perspective, listening requires more than just taking in auditory information. It also requires the person to integrate information seen with that which is heard, to understand the full meaning of the message being conveyed, or to make an educated guess about what is being said when one cannot clearly understand it. For example, classroom teachers expect students to “listen with their eyes” when they point to information that is part of the instruction. They also indicate to whom they are speaking in a class, not by calling the student’s name but instead by looking at the student or moving closer. Students repeatedly relate to their peers through nonverbal cues, ranging from rolled eyes to signal boredom, to raised eyebrows to indicate questioning, to gazing at a particular item to direct a peer’s attention. Clearly to “listen with one’s eyes” requires students to have mastered the concept of joint attention – a skill that seems to effortlessly develop by the time a child is 12 months to 15 months old in neurotypical children, but may be missing from the social repertoire of the student with autism spectrum disorders, ADHD and similar challenges. Instruction in this essential and fundamental function of social interaction begins with teaching students that eyes share social information. Not all students understand this concept, nor do they grasp that listening requires full attention to both verbal and nonverbal cues. It can then expand to teaching students to relate to each other’s thoughts through play and other activities of social relatedness, followed by extending the student’s realm to attending to and processing increasingly complex cues that help students “listen with their whole bodies.”

A = Abstract and Inferential Language/Communication (Minshew, Goldstein, Muenz & Payton, 1992)
Most of the language we use is not intended for literal interpretation. Our communication is peppered with idioms, metaphors, sarcasm and inferences. Societies around the world bestow awards to writers, and even comedians, who are most creative with language. Each generation of teens creates its own slang; kids who follow along are in; those who don’t, are often out. Advertising and other forms of mass media follow these cues. The abstract and inferential component of communication is huge and constantly in flux. It is a mistake to assume that our students with social thinking deficits understand our society’s non-literal use of language. In fact, most of them don’t! Literal interpretation of language is a hallmark characteristic of individuals with ASD. Yet, as educators and parents, we either miss this impairment entirely – thinking our smart kids must understand our nuanced communication - or we address it in the briefest of ways, with instruction dedicated only to explaining idioms, irony and metaphors as part of English class.

U = Understanding Perspective (Baron-Cohen & Jolliffe, 1997; Baron-Cohen, 2000)
To understand the differing perspectives of others requires that one’s Theory of Mind (perspective taking) work quickly and efficiently. Most neurotypical students acquire a solid foundation in ToM between the ages of 4 to 6 years old. Perspective taking is not one thing, it represents many things happening all at once meaning it is a synergistic and dynamic process.

G=Gestalt Processing/Getting the Big Picture (Shah & Frith, 1993; Fullerton, Stratton, Coyne & Gray, 1996)
Information is conveyed through concepts, not just facts. When involved in conversation, the participants intuitively determine the underlying concept being discussed. When reading a book of literature, the purpose is to follow the overall meaning (concept) rather than just collect a series of facts. Conceptual processing is a key component to understanding social and academic information. Difficulty developing organizational strategies cannot be isolated from conceptual processing. Students with conceptual processing challenges often have difficulties with written expression, organizational skills, time management and being overly tangential in their social relations. (All of these concepts require us to stay focused on a central theme or main idea and to keep our writing, discussions or planning focused to this central point. Many of our folks struggle with this, over-focusing on details and not focusing in the concept (an intuitive skills for neurotypicals).


H= Humor and Human Relatedness (Gutstein, 2001; Greenspan, & Wieder, 2003; Prizant, Wetherby, Rubin, Laurent & Rydell, 2006)
Most individuals with autism spectrum disorders, Asperger’s and similar challenges have good senses of humour, but they feel anxious since they miss many of the subtle cues that help them understand how to participate successfully with others. It is important for educators and parents to work compassionately and with humour to help minimize the anxiety these children are experiencing. At the same time, many of our clients use humour inappropriately; direct lessons about this topic are needed and relevant.

Human relatedness - the ability to bond emotionally with others - is at the heart of human social relationships and the fuller development of empathy and emotional regulation. Teaching students how to relate and respond to other people’s emotions as well as their own, while also helping them feel the enjoyment that arises through mutual sharing, is critical to the development of all other aspects of social development.

Michelle Winner's "Social Thinking" approach may sound overwhelming, but it is in reality simply, fun and reinforcing for children. She has numerous books, workbooks, videos and other resources for use at home and in the school. One of my favourite is a book called "Superflex," a book for kids/students that teachers about the way the mind of a person with Asperger's works, and steps you can take to overcome many of the problems this brings. She demonstrates this through an exciting and funny set of stories involving super-heros battling super villains like "RockBrain," an evil doer who keeps you from using your brain in a flexible manner. If you have a teen, or are an adult with Aspergers, you'll understand and like this story.

This is a lot to think about, and most parents need to find someone to guide them through this maze of techniques, programs and new language. Often I see parents jump at quick and easy answers that make promises based upon "testimonials" of others. These include the use of "brain tuning," "hearing training," ""sound tuning," biofeedback or neuro-therapy and many miracle diets and supplements. None of these have any scientific basis, and many plainly don't make sense. These four treatment methods should be the foundation of your plan. They are supported by research, used in most schools and intervention programs, and are accepted by the professional community. If you insist on "testimonials" I can even say, although I am reluctant, that these are the programs most highly recommended by parents.

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My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other social-cognitive deficits and learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.

Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com

Theory of Mind Explained

If your a parent of a child with Asperger's disorder, or high functioning autism, or even an adult yourself with Asperger's disorder, you have likely heard the term Theory of Mind. We all have a theory of mind, of how our mind works, and how the minds of others work. Professor Robert Seyfarth from the University of Pennsylvania talks briefly on how the early years of child development are when we learn to form the basics of a theory of the mind in the video blow. With time and age we change and refine our theory as we try to account for the complexity of social interactions. I often explain the problem that happens as not getting feedback information because you need to understand that the other person, and how they are reacting to you, is not just telling you about them, but about you, and how you are seen by them. It is through the eyes of others we learn to change our behaviour. This is often the missing component with children, adolescents and adults with Aspergers and related deficits of social cognition.


Here is an excellent explaination from the Richard Dawkin's Foundation on what Theory of Mind is. Click here: http://richarddawkins.net/videos/471561-theory-of-mind


In the second video Rebeca Saxe speaks about "reading" other people's minds, and shows a wonder video demonstrating this idea. Click here:http://www.ted.com/talks/rebecca_saxe_how_brains_make_moral_judgments.html

If your having difficulty explain Aspergers to your friends, teachers, relatives or others, these simple videos may help.


Dr. Jim Roche
www.socialcognitivetherapy.com

Intervention Fails to Reduce Autism Symptom

Medical News: Intervention Fails to Reduce Autism Symptoms - in Pediatrics, Autism from MedPage Today

A social communication intervention for children with autism improved parent-child interactions but failed to reduce the severity of autism symptoms, a British randomized trial found. Children who received the intervention had a reduction in symptom severity of 3.9 points during 13 months, while those who had treatment as usual showed a reduction of 2.9 points, for a between-group effect size of −0.24 (95% CI −0.59 to 0.11), according to Jonathan Green, FRCPsych, of the University of Manchester, and colleagues.

The Preschool Autism Communication Trial (PACT) explored whether children with autism would respond with enhanced social and communication skills if parents adapted their interactions to the child's impairments. It was the largest autism trial of its kind.


What does this mean?: Communication-focused intervention did not reduce autism symptom severity, but did improve parent-child social interaction.

"On the basis of our findings, we cannot recommend the addition of this PACT intervention to treatment as usual for the purpose of reduction in autism symptoms," the researchers stated.

"The intervention does, however, significantly alter parent-child dyadic social communication in ways that are associated with subsequent positive child outcomes in longitudinal studies of autism, and are likely to be also positive for parents themselves," they said.

Small studies, including a randomized pilot trial, have shown benefits for direct communication interventions, but effects on core autism symptoms have not been assessed. So while programs might be advertising that they are shown to be "effective" you really need to ask what that means. A social-communications based intervention for a young child with moderate to severe autism might related better with his or her parents after intervention, but there may be no changes in the core behaviours of concern with autism (repetitive behaviours, lack of social interaction, difficulty with changes etc.).

Many parents chose these interventions because they are more "humane" or socially acceptable to them than ABA (Applied Behaviour Analysis) programs, which they see as "robotic." And when engaged in the program they may feel, and experience, more positive relationship with their child. But there is simply no support for these interventions changing autism specific symptoms.

Autism, however, is a spectrum, and high functioning children, children diagnoses with Asperger's, and young adolescents often need social based interventions (such as Michelle Winner's "Social Thinking" program." One of the difficulties with autism research, and reporting it to the public, is that "autism" can mean very different things to different people, and the range of symptoms is so varied. When programs promote their particular intervention method they often promote it based upon outcome factors that are far removed from the symptoms of greatest concern to parents or teachers. Often it's best to ask for the research in hard copy and finding a professional to review it with you. Wasting time (and money) on such a serious developmental disorder is a mistake. The NIH in the US does list programs that have been shown to be effective, and that is a good place to start.


My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.

Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com

MRI Test Shows Diagnostic Promise for Autism - in Pediatrics, Autism from MedPage Today

Medical News: MRI Test Shows Diagnostic Promise for Autism - in Pediatrics, Autism from MedPage Today\

Does this new research mean we can get a quick, easy and absolute diagnosis of Autism from a simple MRI scan? No, regretfully not, although that's how the mainstream press presents it. MRI scans of the brain in this research protocol focused on two specific regions in the temporal lobe was able to diagnose high-functioning autism with 94% sensitivity in a preliminary evaluation. There are, however some serious limitations with this study included the small sample size, lack of a comparator group with developmental disorders other than autism, and use of highly selected features for evaluation. These limitations mean that we don't know if this type of scan can or ever will (although ever is a long time) tell us if a child has autism, a language disability or other disorder. So far, and for the near future, the scan can't tell these different disorders apart, and that's why we use more complex tests for autism such as the ADOS (Autism Diagnostic Observation Scale) and the ADI-R (Autism Diagnostic Interview0-Revised). These remain, and most likely will remain, the standard for assessment here in British Columbia.

Autism, like many other social and learning disorders present on a scale, and it is necessary for the treating clinician to understand the unique way the disorder presents itself. Two children with identical brain scans may, I would expect, present very differently in terms of behaviours and immediate intervention needs because the disorder interacts with their temperament, other co-morbid issues (such as sensory sensitivities), environmental factors such as parenting skills/temperament/siblings and developmental experiences. Add on to this factors relating to the larger social environments such as schools. An MRI, blood or urine test may be helpful, and may very well become necessary for diagnosis or government funding in some locations, but a good clinical interview, observation in multiple settings, history taking and appropriate "hands-on" diagnostic assessment are still the foundation for building a good treatment and intervention plan.

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My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.

Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com

Medical News: Docs Organize to Promote Unproven Therapies They Believe In - in Public Health & Policy, General Professional Issues from MedPage Today

Medical News: Docs Organize to Promote Unproven Therapies They Believe In - in Public Health & Policy, General Professional Issues from MedPage Today

Thisa is an interesting article on how doctors who have out of the mainstream ideas and unorthodox therapies organize themselves to make their positions look stronger. Take a look, and you'll wonder how we can ever know what's scientifically supported and what isn't. A good read.

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My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other social-cognitive deficits and learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.

Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com

Medical News: Groups Assail Vision Therapy as Remedy for Learning Disabilities - in Pediatrics, General Pediatrics from MedPage Today

Link to the original article: Medical News: Groups Assail Vision Therapy as Remedy for Learning Disabilities - in Pediatrics, General Pediatrics from MedPage Today

I don't like to cross post, and Google hates it when I do, but this is an excellent article on "vision therapy," a form of therapy that many of my clients come to me and ask about. Here's what the medical professionals have to say:

"Behavioral vision therapy, eye exercises, and colored lenses have no role in treatment of dyslexia and other learning disabilities, according to the American Academy of Pediatrics. The academy came down hard on these "scientifically unsupported" alternative treatments in a joint statement with the American Academy of Ophthalmology and other vision organizations. Because learning disabilities are difficult to treat and have long-term consequences for education and socioeconomic achievement, unproven therapies have become highly visible, Sheryl Handler, MD, of the AAO, and colleagues wrote in the August issue of Pediatrics. "Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child's learning difficulties are being addressed, may waste family and/or school resources, and may delay proper instruction or remediation," they cautioned.

I'm not too sure there really is much more to say than that. Read the article, watch the video. The world is full of people telling parents of children with autism, Aspergers, ADHD and related learning disabilities they should spend thousands of dollars on medical treatment that fixes their child. Often, rather than research, we see many many parent testimonials. I've heard them from parents in my office. Vision therapy CURED my child. While that was going on there was a change in classroom teacher, a new support teacher tried a new methods, the child matured and a medication was tried. But the providers of these services stressed how without them nothing would have changed. Do not rely on testimonials. Talk to your doctor. Make science based choices.

This web page/blog is NOT meant as medical advice. NEVER get your medical advice from a blog, or from the internet. If you find something, press print. Take it to your medical doctor and ask what he or she thinks. Go to someone who has the training and experience to help you make good medical and educational choices.

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My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.

Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com

Mitochondrial Dysfunction Seen in Some Kids with Autism

Medical News: Mitochondrial Dysfunction Seen in Some Autistic Kids - in Pediatrics, Autism from MedPage Today

In medical news: A small exploratory study has found that children with autism seem more likely to have problems with their mitochondria than children with typical neurodevelopment. Children recruited from an ongoing case-controlled study found those with autism appeared to have lower oxidative phosphorylation capacity, as well mitochondrial DNA abnormalities, Cecilia Giulivi, PhD, of the University of California Davis, and colleagues reported in the Dec. 1 issue of the Journal of the American Medical Association. Although this small study suggests that mitochondrial defects in children with autism may be more common than in controls, it is a cross-sectional study and causality cannot be determined. That seems to be something missed in the mainstream press, which tout this report as proof of causation. Findings from this preliminary cross-sectional study, which included only 10 cases and 10 controls, cannot establish a causal relationship between mitochondrial dysfunction and autism.

"Whether the mitochondrial dysfunction in children with autism is primary or secondary to an as-yet unknown event remains the subject of future work," the authors wrote. But, they further note that "mitochondrial dysfunction could greatly amplify and propagate brain dysfunction, such as that found in autism, given that the highest levels of mitochondrial DNA abnormalities are observed in postmitotic tissues with high energy demands (e.g., brain)." Giulivi and her colleagues analyzed a subset of children ages 2 to 5 participating in the ongoing Childhood Autism Risk from Genes and Environment (CHARGE) study in California. The researchers looked for mitochondrial problems in the peripheral blood lymphocytes of the 20 children included in the analysis.

"The team identified several factors indicative of defective or abnormal mitochondria in children with autism. Additionally, although there were no between-group differences in glycemia or lactate levels, there was a significantly higher mean plasma pyruvate level in the children with autism (P=0.02) -- consistent with the lower pyruvate dehydrogenase activity seen among the cases. Defects in pyruvate dehydrogenase activity result in insufficient energy production, according to the researchers." The authors acknowledged some limitations of the study, including the relatively small sample size, the possibility of type I errors, and the fact that the children with autism in this substudy were higher functioning than those from the original study.

If a correlation eventually leads to us accepting a causation, what does this mean? mitochondria are called the "powerhouses" of cells, they create energy for cellular metabolism and when they are dysfunctional, cells do not operate efficiently. Essentially they are the key to concerting what we eat into energy within the cell. Poor performance of the mitochondria is disruptive for cells, and we would assume especially for brain cells which have high very energy demands. A lack of energy in brain cells during early development could explain why the brains of children with autism spectrum disorder don't function properly. Mitochondria have already been shown to accompany other neurological conditions, including Parkinson's disease, Alzheimer's disease, schizophrenia and bipolar disorder. What does this mean for treatment? Nothing right now. i'm sure within a week every supplement out there will be mentioning how they help address this issue with this pill or that diet, but the truth is, as you can see, this research is in its very basic stage. While many want to make giant leaps to specific supplements they either sell or advertise, we do not yet understand this relationship clearly enough,m nor do we know what to do about the dysfunction of the mitochondria. What I am sure of is that fish oil pills are not an easy answer.

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My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as ADHD and many other learning disabilities. These posts, however, are not meant to provide medical advice. NEVER use internet blogs as your key to making medical decisions. Print out things you find and wonder about and take them to your medical doctor and ask the expert.

Please feel free to visit my website at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.

Autism and ADHD assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com

Study shows autism linked to education....sort of. (But not)

NPR (National Public Radio) may have gotten the title wrong, but the news article itself got the information correct. Click HERE to go to NPR's web page and listen to the radio broadcast.

This story is about research that looks at clusters of children diagnosed with autism and how they tend to occur in places where parents are older, more educated, and white. The study (U of California, Davis) found, and this is important to those who are convinced otherwise, there is no link to local pollution or chemical exposures. This particular result is important to all those parents that want to have all the "toxins" removed from their children, or who over protect them with fad diets and social isolation because they hear about "toxins" in the air, water and food.

The study results suggest that areas in California with apparently high rates of autism spectrum disorders are probably just places where parents are more likely to obtain a diagnosis for their child. In other words, they look like areas with high autism rates, but they are in fact the same as other areas of California, except the parents can afford medical care, psychologists and ....lawyers to help with school issues. And these are of course areas where parents have jobs that require higher education, and therefore ..... not much in the therefore area here. It's as simple as it sounds.

"It doesn't necessarily mean that higher education causes autism," says Irva Hertz-Picciotto, one of the study's authors and a researcher at the UC Davis MIND Institute. "It gets you the diagnosis more frequently."

The UC Davis study looked at the geographic distribution of about 10,000 children who were born in California from 1996 through 2000 and later diagnosed with an autism spectrum disorder. A "cluster" was defined as a community in which the proportion of children diagnosed with autism was at least 70 percent higher than in surrounding areas. 70%. That's pretty high, and tells you what money and education get for children. A diagnosis, and treatment! (This study should be done by the department of political sciences, with an action plan.)

The study found that differences in parents' age, education and ethnicity explained the cluster most of the time. It doesn't necessarily mean that higher education causes autism. Having parents with a higher education, and I suppose salary and better medical insurance, gets you the diagnosis more frequently. The study found that children of parents who finished college were at least four times more likely to be diagnosed than children of parents who didn't finish high school.Interestingly, children were also more likely to be diagnosed if they were born in a community near a regional service center for people with autism. (Some, I suppose, would think that living near a regional service center causes autism....but most of us get the point.)

The study may be most interesting because it did not find any environmental explanation for higher autism rates, says Steven Novella, a neurologist at Yale University and the author of the blogs "Neurologica," and "Science-Based Medicine." "You can't prove a negative," Novella says. But the results of this and other studies suggest that "if there are environmental factors, they're small."

The California results also show how widely autism diagnosis rates can vary from place to place, Novella says. In some areas of the state, children were four times as likely to be diagnosed as in other areas.That suggests that in many areas there are still a huge number of children with autism spectrum disorders who are slipping through the cracks, Novella says. I wonder how many, and what that says about us here in Canada, where the government won't pay for private practitioners..licensed and registered medical and psychological professionals.... to perform a diagnosis but instead put you on a long waiting list for Provincial services. (When is that going to change? WHY can't the government pay for a private practitioner to administer a diagnostic exam? Could it be a way to avoid paying for services for those they would diagnose? No, that couldn't possibly be it.)

This is a nice article, and it's an excellent way to look at what science tells us, and what it doesn't. As we always say, "correlation does not equal causation."

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My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.

Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com

Autism Caught On Tape - Technology To Help Children With Autism

Click here for the link and video. (http://www.sciencedaily.com/videos/2007/1103-autism_caught_on_tape.htm)

ScienceDaily () -- Computer scientists have devised two tools to help people interact with autistic children. Videotaping interactions allows teachers or parents to replay situations and evaluate the cause of particularly good or bad behavior. Cataloging actual data, rather relying on memory or interpretation, proves to be a more accurate measure of a situation. These tools are demonstrated in a simple but startling video. You need to watch this video and ask yourself, "How close to this can I get my child's school?"

For a couple years, as a provincial consultant with POPARD, my job was to drive or get on a plane and arrive at a school where there were severe behaviour problems going on. The tool I used to figure out the problem was simple: I watched. That's what this video system does for the teacher, it watches. And more important, it avoids the many pitfalls of relying upon memory of what happened. When teachers try to remember what happened before and after a behaviour of concern they are often unaware of the environment (watch the video!) or they may already have preconceived notions of what is causing the behaviour, and look for that "thing" to happen. Coming in as an outside observer I am often able to avoid both these problems. But this video system...well, I've been replace!

Some simple variations on this tracking system would be to just video times of the day when you know there will be a problem. But you need to collect data to understand the issues.

What the tape skips is the reason we are doing this. Watching you'll see a young boy starts hitting himself. Why? Often times we will hear 1) To get attention , or 2)for self stimulation. Neither of these were the reason in this case, and usually are not. Self abuse and violence with young children with autism is often for communication. Data, information, helps us understand the FUNCTION of a behaviour. Once we understand the function we can do two things: 1) Change the environment so the child doesn't need to engage in the behaviour, and 2) Teach a new skill to meet the function. In the video the child want's something, and can't communicate quickly and easily enough to get what he wants. Yes, he needed to get someone's attention to get it, but attention is not the goal. By watching the situation carefully we can understand the function of the behaviour and teach a new skill to meet that function. MAybe in this case the child needs some visual supports to help communicate (a communication book or pad?). Maybe he needs to practice and be successful at using a sign? I don't have enough details about this child's level of communication skills, but what is important is that we always need to specify how we are going to gather data, gat information, to answer our questions. Video is one possible means. And if your child is having a severe problem at school, I'd have the school watch this video and figure out how they intend to collect that data they need to complete a reliable Functional Behaviour Analysis (FBA).

This blog is not offered as medical advice or as a means of diagnosing or treating autism, Asperger's disorder or any other disorder. Don't go on-line and take an "autism test." The diagnosis is complex, and it involves not just looking for symptoms of autism, but also ruling out other disorders that might look just like autism, Aspergers and other disorders related to ASD. So avoid these on-line "tests" which are nothing more than a collection of symptoms. You need to see a licensed or registered professional for that. Medical doctors can diagnose autism, but the diagnosis is complex and often they will make a referral to a Registered Psychologist. You can obtain a referral from the British Columbia Psychological Association for a psychologist near you. The Ministry of Family Services can also advise you on obtaining many diagnostic services for free in your community.

My web page lists a number of resources you can make use of yourself in dealing with Autism Spectrum Disorder and Asperger's, as well as many other learning disabilities. Please visit it at www.socialcognitivetherapy.com, or one of my other sites at: Psychology Today, AAMFT, PSYRIS or my professional site or www.adhdhelp.ca.

Autism assessment and treatment services are offered for individuals, couples, families, children, adolescents and adults in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education assessments, autism assessments as well as behavioural and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

Dr. Jim Roche
Registered Psychologist, British Columbia 01610
778.998-7975
www.relatedminds.com

Autism study reveals how genetic changes rewire the brain

ScienceDaily (2010-11-08) -- Using a blend of brain imaging and genetic detective work, scientists have illustrated how genetic variants rewire the brain. The discovery offers the crucial missing physical evidence that links altered genes to modified brain function and learning.

"In children who carry the risk gene, the front of the brain appears to talk mostly with itself," explained first author Ashley Scott-Van Zeeland, now a Dickinson Research Fellow at Scripps Translational Science Institute. "It doesn't communicate as much with other parts of the brain and lacks long-range connections to the back of the brain."

Researchers could test whether specific therapies actually change brain function by measuring connectivity of patients before and after therapy, she added.
The authors emphasized that the patterns of connectivity found in the study still fall along the spectrum of normal gene variation. "One third of the population carries this variant in its DNA," noted Geschwind. "It's important to remember that the gene variant alone doesn't cause autism, it just increases risk."

The story can be found by following this link CLICK HERE

For information about my private practice you may go to my website at www.relatedminds.com and look for autism services. You can also find out more about my services for children, adolescents and adults with autism or Asperger's Disorder at my PsychologyToday website or my BCAMFT/AAMFT website.

The Vaccine Song

What services are available to my child with autism or Aspergers in BC schools?

I am often asked this very simple question by parents of children who come in for assessments of autism and Aspergers. And the answer is: It depends.

It depends on your specific school district, it depends on the funding the school has in total (your child's funding is often put in a big pot by the school district and divided up between several different children with special education needs...yes, it's hard to believe but in many districts this is true), and finally, it depends upon the training and availability of staff.

For the next few posts I'm going to try and walk you through this process as best I can. We will start with information about getting your child services at all. That means having him or her "designated" with a "code." And from their I will talk about what you should expect, and what you might actually get.

The process begins with a diagnosis. Depending upon your child's age he (I will be using he from now on to make this simpler to understand, although I know girls are OFTEN overlooked in this process) needs to diagnosed by an appropriately registered and trained professional. This can be done for free through several provincial services, however there is a waiting list. You start with a referral from your medical doctor. Usually the referral is to your regional autism program, and your MD should know how to do that. Start on this process early, as there is a significant wait and early treatment is important.

Children under 6 need to be assessed by a "team" including a medical doctor, speech pathologist and usually a psychologist. Children over six need only one professional, either a medical doctor or psychologist. Whoever does this needs to use two important assessment tools. These are the ADOS (Autism Diagnostic Observation System) and the ADI-R (Autism Diagnostic Interview-Revised. YThey may use additional tools, but the MUST use these, and they need to have appropriate training and experience using these. These assessment take a few hours to complete. In addition to these tools/tests the team or individual professional needs to do other investigations as well in order to rule out other possible causes of your child's behaviour of concern. This includes a cognitive test (intelligence), an academic assessment (usually the WIAT or WRAT-4) and speech/language assessments (sometimes the Test of Pragmatic Language or a similar test). Finally, you will need to complete some form of behaviour evaluation such as the ABAS. There may be other tools/tests used, but these are the basics. Depending on the age of your child and the complexity of the assessment the cost can run from $1,800 to $2,400 or higher. It usually takes three, four or five sessions to complete the assessment.

IF the assessment leads to a diagnosis of autism or Asperger's Disorder (the final diagnosis is not made by the numbers and scores but by the professional's overall judgement of your child) you will need to complete an application for funding from the Ministry of Children and Family Development if you are seeking provincial funding. You can click here and download a brochure from the ministry that takes you through all these steps. I would download this in any case.

After the assessment is complete you should get funding form completed by the professional, and he or she will attached a written report that goes with the application. You should also get a report to take to your school. Your report needs to clearly state your child's diagnosis.

The Ministry issues above are unrelated to school services and funding, they are totally separate issues and should not be confused.

Now take a copy of your report and a cover letter requesting that the school's Committee on Special Education or Support Team (different names are used in different district) evaluate your child for coding. Coding is a process where the School Based Support Team, usually, meet and determine what is going to happen about coding and what services your child will get. You should request that you be informed of ALL MEETINGS at which your child is discussed, and make sure you are asked to attend. Do this in writing even if you already know you work and can't attend these meetings. Insist on your right to be informed and attend.

I would give a copy of the report to the school based team or principal, and bring a copy to your school district's Support Services or Special Education department. Get a dated note that says they have received this, or send an email and ask for acknowledgement that it has been received. This things get lost, overlooked and forgotten, don't let that happen!

You should not be asked to attend a Support Meeting where your child is "coded," that is, given a special education designation, (for Autism the coding is G) and at that meeting an IEP or Individual Education Plan should be written. This plan looks at your child's needs and should say how they will be addressed, and how they will measure the effectiveness of their interventions (not how your child is doing!). If there are significant behaviour problems you should also request a Functional Behaviour Analysis take place by someone trained to do it and a formal Positive Behaviour Support Plan be written from that. In later posts I will go into detail about what those look like and what you should expect.

What next? Your child should be getting INDIVIDUALIZED services to help with their deficits and needs. This should include, at the least, someone supervising your child's program who has training and experience in the field of autism. The most appropriate person would be his or her teacher. The province provides training for teachers through workshops during teacher training days, and through certificate programs at POPARD, the Provincial Outreach Program for Autism and Related Disorders. Someone woking with your child should have attended these workshops - at a minimum.

When a child is "coded" for autism the school district receives money to help support that child. This is not enough money to do the job so school districts need to take those funds and combine them to create staff positions that are then shared by several children. Yes, some children with more severe behaviour problems get more staff time. You can be aware of this, monitor it, and make sure your child is getting the support they need, but also be sensitive to the fact that there is not enough funding to do what needs to be done, and districts are doing the best they can. You can make sure that funds for children with an autism coding isn't moved over to deal with children with other coding that didn't get enough funds. This does happen.

Once your child is found eligible for autism services in school you should ask to meet with the schools autism team, or with the staff member in charge of students with autism. Often there is a staff member assigned to work as a partner with the Provincial Outreach Program for Autism and Related Disorders (POPARD). This person usually has the title of "POPARD District Partner." Find this person and immediately request a consultation from the POPARD consultant. Always put your request in writing, and send a copy to the Director of Support Services or Special Services in the district.

The POPARD consultant can come to the school, review your child's case, do an observation of your child in the classroom and then meet with the staff and present a written support plan. Often they also come to the school and provide direct training to staff, as well as observation and consultation. Each school district has a specific number of hours of POPARD consultation time, it gets used fast, and there is never enough, so get on this early! If all the time that is allotted by Ministry funding is already use remember, school districts can pay for extra time, consultation and training! These are excellent professionals, highly trained with years of experience. You can find out more about POPARD by clicking here and going to their site. They have an abundance of information and videos demonstrating the services and techniques you should be seeing in your child's class.

So to review: to obtain services for your child with autism or Asperger's Disorder in British Columbia you first need to have your child diagnosed. This can be done either through a referral from your family doctor to an appropriate provincial program (such as Children's hospital) or through a private practitioner if you don't want to wait or simply want to use your own professional. The ministry website for information on this process can be found above. Next, you bring your assessment and diagnostic letter to the school and request a meeting to discuss "coding" for your child. The school should code your child, write an IEP and if necessary a behaviour plan. Finally, you should check to see that the staff working with your child are properly trained and receive appropriate supervision and consultation. Try to get your school's POPARD consultant involved.

In the next few weeks I will discuss the IEP process, writing behaviour plans, and where to go for help with curriculum. I hope this has been helpful.

For information about my private practice you may go to my website at www.relatedminds.com and look for autism services. You can also find out more about my services for children, adolescents and adults with autism or Asperger's Disorder at my PsychologyToday website or my BCAMFT/AAMFT website.

Naturopaths a good choice for Autism Treatment? Read what this SFU report says

Beyerstein BL, Downey S. Naturopathy. In: Sampson W, Vaughn L, eds. Science Meets Alternative Medicine: What the Evidence Says About Unconventional Treatments. Amherst, NY: Prometheus Books; 2000:141-163. There is suppose to be a free draft copy of this report available from SFU, but since my original reading it seems to have been taken off line. :(

But ...not to be undone, I have located some passages on Science Based Medicine where Kimball Atwood, MD blogs about this topic. In this piece, Atwood has a great quote from the book by Barry Beyerstein (the above author)and one of the fathers of the skeptics and science based medicine movement:

"In our research for this chapter, we provided naturopaths and their professional associations ample opportunity to refute the conclusions of several major commissions of inquiry over the years that deemed their therapeutic rationale lacking in scientific credibility. None of our informants was able to convince us that the field had taken these earlier critiques to heart; in fact, precious few seemed to recognize that a problem still exists. [O]ur own bibliographic searches failed to discover any properly controlled clinical trials that supported claims of the profession, except in a few limited areas where naturopaths’ advice concurs with that of orthodox medical science. Where naturopathy and biomedicine disagree, the evidence is uniformly to the detriment of the former.

We therefore conclude that clients drawn to naturopaths are either unaware of the well-established scientific deficiencies of naturopathic practice or choose willfully to disregard them on ideological grounds."

Atwood further writes that naturopaths tend to be "strongly affiliated" with the antivacciation movement and goes on to state that:

"Naturopathic beliefs — including those of “naturopathic physicians” — are rooted in vitalism, the pre-20th-century assertion that biological processes do not conform to universal physical and chemical principles. Naturopaths describe a “healing power of nature,” which is compromised by modern medicine."

Well, looking up autism on the web here in BC we see ND's (Naturopathic Doctors) who offer "chiropractic treatment" and "homeopathic vaccines" to children. What exactly is a "homeopathic vaccine" and what studies are there that show they work to prevent disease?

I. for one, eagerly await the publication of this book. I just wish the public would pay more attention to science, and less to wishful and magical thinking.

How do you find good, science based information to make your medical choices? Go to the National Academy of .....whatever field. Go to the NIH (National Institute of Health), look the topic up on Quackwatch, the science-based medicine blog or simply type the search words in to your browser adding the words "quackwatch," or "skeptic." This will usually lead you to some more critical reading. Finally, go to your medical doctor and ask.

Tips for School: Getting your child with Asperger's / Autism Ready for School.

Yes, it's almost time for the school sales, and along with it it's time for parents to start thinking about getting their child ready for school, and making sure their school is ready for their child. Children with Asperger's and autism (ASD) are at special risk at the beginning of the year, as schools are full of changes, excitement and confusion. Nothing our kids deal with very well.

So here we go with some school tips for children with Asperger's or ASD:

1. First, get to know who's who in your school, and your district. Prepare a contact list of everyone you might need to work with during the year. The time to do this is now, while there are no problems, and there is time. Your phone calls and initial contacts will also be more welcomed as your a parent trying to be prepared, rather than a parent with a complaint.

These individuals might include the Director of Special Education or Support Services (whatever your district might call this person), the supervisor of the program your child is in (there may be one in the school, and one in the district office), the chair of the special education or support committee at the school, the head of your school's parent group, your local schools school psychologist, counsellor and of course the school principal, secretary and if its an older child there may be a department head or dean you should know. Also, you may want to get the contact information for your schools Ot or PT, who often can be very useful with developing plans and interventions. Get their phone numbers, and school emails. The emails are very important because you may use those to leave important messages, and especially messages that might need to be revisited later. Remember, if it wasn't in writing, it didn't happen.

2. Has your school set up a consultation with POPARD, the Provincial Outreach Program for Autism and Related Disorders? Every school district in BC has a "POPARD Partner" who can arrange for these consultative services. Find out who this person is and see if you can get an appointment. POPARD can provide your child's teacher with excellent feedback, suggestions and most of all, a plan!

2. Gather copies of last years IEP (individual education plans), behaviour plans of FBAs (Functional Behaviour Analysis) school grades, previous correspondence, doctor's diagnosis and psycho-educational assessments. Clearly mark any suggested interventions you find on your child's IEP or behaviour plan. Never go to a meeting without these documents in hand. After every meeting take a few minutes to write up a short summary note for yourself. Especially note who was suppose to do what, by when, and how they were suppose to measure success. I recommend punching holes in them and putting them together in a binder so that they never get lost. (And you thought kids were the only ones who lost important papers!).

3. As soon as you can meet with the classroom teacher and whoever is the supervisor of your child's program. Remember, the classroom teacher is SUPPOSE to be the person designated to implement an Individual Education Plan (IEP). That's not always the way it is, and often classroom teachers have not even read the child's IEP.

Now, let's address some strategies that should be seen in use in the classroom:

4. Make sure there are classroom rules posted prominently somewhere. If appropriate, have your child repeat the rules back to you to make sure he or she understands them. These rules should be stated in the positive. We do this, or do that. Not in the negative. We don't do this or that. Have them written down separately and included in your child's notebook. For children with Asperger's and autism there should be a set of rules with visual supports. No matter how functional you may feel your child is, there needs to be a continuation of universal visual supports for your child in the classroom.

5. Your child's schedule needs to be posted on the board, on their desk, and if they use a PECS system, on the PECS booklet. While some parents want to get their kids away from visual supports as they grow older, the real key is to get your visual support system to change and be developmentally appropriate for your child. The usefulness of visual supports never goes away, just ask anyone with a date book, iphone or checklist in their pocket!

5. Make sure your child will be seated close to the teacher, and away from distractors such as doors, windows, pencil sharpeners and so on. In no way should your child be seated separately, or made to feel different or pointed out. If there are times your child needs to be seated separately there are positive ways to do this that don't make your child stick out like the kid with problems!

6. The most effective means we have of modifying behaviour with students with Aspergers or Autism is through immediate feedback and consequences. Consequences should be positive and reinforcing rather than punitive and reactionary. Make sure there is a way to monitor how many positive reinforcing statements are made, compared to corrections. If corrections worked, you would have no worries and their would be no IEP for your child.

7. Positive point systems are the most effective means we have to teach new skills to children with Asperger's and autism. Make sure there is one in place in class. It should be a system that always get's your child closer to his or her goal, rather than one that leaves them two points short at the end of the day. (Hey, you earned 98 points! Only two more to go, bet you'll earn those early in the morning!)

8. Make sure your child is allowed physical breaks, is allowed to walk around (with permission) and stand if necessary to do work. Many of these breaks can be built into your child's day with tasks like handing out papers, erasing the board and so on.

9. Use visual cues to help your child follow rules, switch activities and transition throughout the day. Visual supports are less likely to make your child prompt dependent than verbal reminders (which quickly become nagging and turn a child off). Ask to meet with last year's teacher and teacher aide and make up a list of what worked, and what made things better. MAke sure the school does more of those things this year.

10. Make sure there is a "time away" program for your child, that is, a positive time, scheduled if need be, when they can get out of the larger social world and be by themselves to relax and calm down. Time away is not "Time Out," which is used as a punishment or removal or reinforcers with children. Those interventions are inappropriate with children with Asperger's or ASD / autism.

11. Reduce the total workload, and reduce homework! There are numerous papers out there about the need to reduce homework for children on the autism spectrum. The goal is to work hard, not to finish everything. It's to make a good effort, the best effort you can. And that's enough.

12. Make sure when giving instructions the teacher get an initial recognition from your child (hey, look here for a minute. Great. ....) and then repeats back the instructions. This will vastly increase the chances a task will actually get done. And any task with more than 3 steps, should be written down.

13. Reduce (get rid of) copying from the board! This is one of the most difficult tasks there is for a student with Asperger's or high functioning autism. There is simply no reason to insist on this.

14. Use visual timers, not just clocks, to help your child stay focused and understand how long a task will take to complete. There are a number of these available commercially (Time-Timer) or you can make one with a few pieces of tape and coloured paper around your clock.

15. Do not use loss of recess or any social time as a punishment for a student on the ASD spectrum. Why would you remove an activity that will most likely lead to the child doing better the rest of the day?

16. Schedule the difficult tasks and subjects early if you can. The more tired your child is, the more difficulty they will have with focus and attention. Do the hard stuff first, then take it easy. Just like adults do!

17. Use a peer buddy. Yep, someone for your child to look at, follow, get social cues from. He or she should be allowed to look at that student's work as an example, and ask that student questions to clarify.

18. Remember to use visual supports as much as possible. They help with anxiety, switching mental sets, changing tasks and schedule changes. And make sure the staff is trained in using them. If last year the teacher or aide were good at using PECS or other appropriate visual supports, arrange a time to meet with them and this years staff to discuss how they implemented these strategies. Focus on successes, what made things better, and what worked!

19. Visit the school before school starts. Even if your child attended there last year. Visit the building, walk around, find his or hers new rooms, walk from their to the library and cafeteria.

20. Practice the drop off and pick up routine prior to the first day, and try to practice it three or four times. This will make a difficult day go smoother.

If you have time for a little reading before school starts, two books I would suggest are: "The Incredible 5-Point Scle" by Buron and Curtis and "Social Behavior Mapping" by Michelle Winner. Other reading suggestions can be found on my web site.

For more information about child and adolescent parenting you can visit my web page at www.relatedminds.com, for information about services I provide for families and children with Aspergers or autism spectrum disorder, click here, for children with ADHD click here, and for adults with ADHD click here (ADHDHelp.ca) or my Psychology Today Website. You can also call my office at 778.998-7975 to make an appointment for a consultation. My AAMFT listing (Registered Marriage and Family Therapist) can be located by clicking here.

Does it make sense to use Time Out with children with Asperger's?

Another parent comes by with tales of woe from attempting to use "Time-Out" to change behaviour. Well, this doesn't surprise me at all. Time Out is a very difficult procedure, and it really isn't designed to do what most people expect: get a new behaviour started. It is especially difficult to use with children with ADHD, autism, Asperger's and other disorders that have a high percentage of problems with executive function.

Time Out is designed to reduce the frequency of a behaviour by reducing the reinforcement it gets. If a behaviour isn't reinforced, eventually it will fade away. The problem with this is that often times we don't do Time Out well, and because we argue, occasionally give in, and sometimes the child simply wins or gets other reinforcement (like attention) Time Out is very hard to do. This is especially true with children with attention deficit hyperactivity disorder, autism or those kids we think of having paediatric bipolar disorder. Even if we do it wrong one time out of five, we are providing what we call "intermittent reinforcement" and the child will become even more difficult to change. Intermittent reinforcement is what keeps people going back to gamble, in spite of the fact they only win occasionally. Face it, if you've watched "Super Nanny" you know she uses Time Out a lot, calling it the "naughty circle." And in every episode she needs to return and retrain the parents.

But eventually things do improve, and that's often because other behaviour techniques are being used that work better for ADHD, autism and bipolar disorder. These include setting up a family visual schedule, which helps reduce anxiety and depersonalizes the parent-child interactions, and there is always a positive reinforcement system (sometimes a token system) being used.

Whatever the inappropriate and unwanted behaviour is, somehow it works for the child. Somehow it is reinforcing. It may not have been at first, but sooner or later something about the behaviour and the response to it is reinforcing. Otherwise the behaviour would have stopped. It's our job to find out what is reinforcing the behaviour, what its "function" is, and teach our children new, more appropriate and functional "replacement behaviours." Behaviours that serve the same function as the original one, but are appropriate. We call this behaviour the FERB or Functionally Equivalent Replacement Behaviour. Every behaviour plan worth it's salt has a FERB. The replacement behaviour is taught, reinforced, and at the same time the inappropriate behaviour is ignored (as much as humanly possible ....we aren't all Super Nanny!). In this way we are teaching a new skill, and ignoring something we want to go away. We also make environmental changes to decrease the need to engage in the inappropriate behaviour (that's the purpose of that visual family schedule).

Notice, we are ignoring, and teaching, but what are we not doing? We aren't punishing. It isn't really a "naughty circle." It's a Time Out space where what your doing doesn't get reinforcement. Punishment is seldom an important component of successful parenting!

A really good book to learn interaction techniques to deal with children who have frequent and excessive temper tantrums is Dr. Ross Green's "The Explosive Child." It teaches you the skill and philosophy behind providing positive behaviour support to your child rather than trying to use punishment, which, you may have noticed, might stop a particular behaviour, but fails in one big way: It doesn't teach new skills!

For more information about child and adolescent parenting you can visit my web page at www.relatedminds.com, or www.adhdhelp.ca or my Psychology Today Website. You can also call my office at 778.998-7975 to make an appointment for a consultation.

(1/2) Do Vaccines Cause Autism? Correlation vs. Causation

This is an excellent little video about the use, and misuse, of data. In spite of all the information out there that clearly shows vaccines have no relationship to autism some individuals and groups continue to confuse correlation and causation. Watch this for a simple explanation.



For information about my diagnostic services (ASD / autism diagnostic services are available within 10 days to 2 weeks) and my science based treatment programs please read the information provided on my website at www.relatedminds.com or go to my Psychology Today website to find out more about me.

Therapies to Avoid

In addition to my personal list I wanted to add this short page of "questionable" therapies. Several parents have come by lately and were disappointed in the lack of guidance they get from local or national professional organizations about which treatments work, and which don't. Here is a good website that I often use to start. Of course, like everything else, you need to question this list as much as others: Click here to go to the Quackwatch therapies page.

For more information on science based practice in mental health you can visit my web page here.

Choosing Treatments for Autism

I wanted to make this link available to everyone as it provides a great video on choosing treatments for autism, something parents have a difficult time figuring out.



If you'd like more information about treatment choices, please go to my web site or contact me for an appointment. My web site is at www.relatedminds.com

Brian Cox: Why we need the explorers

A little aside that we should all watch. This is the kind of thinking that solves problems.

Social Skills and Social Thinking for Student's With Asperger's and High Functioning Autism

Again today a patient asked me what book or video product they should get to start to understand their child's Asperger's disorder. The answer was easy: Thinking About YOU Thinking About ME, 2nd Edition by Michelle Garcia Winner

This is the best book I have found to start to understand how to help a child or student with Asperger's, high functioning autism, ADHD or a "NVLD. " This is where to start to learn more about social interaction and social awareness. It demonstrates how understanding the perspectives of others is key to all interpersonal relationships. It gives wonderful examples, and had easy to use charts, graphs, photo and pictorial supports for students.

"Michelle's model of perspective-taking makes research into Theory of Mind practical for teaching these students and even students who may be considered "neurotypical." Specific lessons, and how to apply them in different settings, are explored. The Four Steps of Communication creates a framework for understanding the complexities of social thinking and for enhancing perspective-taking in students. Social Behavior Mapping and IEPs are examined. How to focus concepts for ages and skill levels are presented through practical handouts, activities and lesson ideas. This second edition of Thinking About YOU Thinking About ME contains much expanded content, including two new chapters and an updated philosophy. The assessment chapter now includes the Social Thinking Dynamic Assessment Protocol®, with more detailed assessment techniques." This book is useful for grades K-adulthood. I use it continually in my practice, and Michelle has numerous videos / DVD's to help support this material.

The book includes:
Michelle's perspective-taking model
How understanding the perspectives of others is the foundation of interpersonal relationships
How to address specific deficits in this area
The four steps of communication - enhancing perspective-taking
Specific, related treatment activities
Sample IEP goals and benchmarks
The ME Binder: teaching your students their IEP goals, why this helps
Social Behavior Mapping (another book Michelle has edited address this great technique in detail)
Visual ways to teach students the impact of behaviors on others and themselves
Sample maps and make your own!
The Social Thinking Dynamic Assessment Protocol
Why assessments fall short
Michelle's practical informal assessment strategy
25 pages of templates to use for the Social Thinking Dynamic Assessment Protocol
Additional concrete strategies and user-friendly templates to help your student(s) build their own more dynamic social thinking abilities and see the rewards of doing so.

This is where I often start with parents and teachers, and it is useful for years to come. Parents who have been struggling with finding an appropriate treatment / intervention focus are always pleased to find this book. Too often parents have been alone, working with "naturopaths," chiropractic doctors and other providers of alternative, unproven techniques and never hear about or read some simple, these well tried and scientifically supported interventions. So for those parents who ask "Where can I start?" this is my suggestion.

More information on Michelle's books and theory of mind can be found at my website www.socialcognitivetherapy.com

British Medical Council Bars Andrew Wakefield for ethical lapses.

HEALTH
British Medical Council Bars Doctor Who Linked Vaccine With Autism
By JOHN F. BURNS
Published: May 24, 2010
Dr. Andrew Wakefield was banned for ethical lapses, including conducting invasive medical procedures on children that they did not need. I've been watching the response to this action from the anti-vaccine group and it seems amazing, they see it as a reason to support the ex-doctor even more! This seems impossible, but it's true. Maybe this will clarify:

Dr. Andrew Wakefield published an article which used data inappropriately, it made claims that could not be supported by the data, and used data that was gathered in an unethical manner.

Dr. Wakefield also was involved in a financial deal to provide a new vaccine with a corporation that would replace the one he was claiming caused autism.

Finally, he involved children in the research, taking blood samples and using their data without proper consent.

Dr. Wakefield IS big pharma. Please understand and look elsewhere for an explanation.

Dealing with Angry, Aggressive and Explosive Children

I just posted this on my ADHD blog and realized it may very well apply to some children with Asperger's or higher functioning ASD. This article refers to a technique called Collaborative Problem Solving that can be used in conjunction with some of the techniques you would find in Michelle Garcia Winner's book "Thinking About You Thinking About Me." This technique is really about supporting children with executive disorders and may be of interest. Here it is:

There are a number of children who parents, siblings, schools and friends have a difficult time dealing with because of their apparent mood swings, what appears to be angry attitude towards others and often explosive, angry and sometimes aggressive response to requests or instructions.
Sometimes these children are diagnosed with a mood disorder (paediatric bipolar disorder, mood disorder NOS), sometimes with ODD (oppositional defiant disorder) and often with related neurological disorders which might be referred to as NVLD (non-verbal language disorder), high functioning autism, Asperger’s disorder or even a sensory disorder.
Treatment interventions range from simple behavioural programs using reinforcement schedules to the use of visual cues and prompts and medication. While one of the main interventions I teach in my office is a simple 8 part behaviour management program based upon the book Your Defiant Child by Dr. Russell Barkley. However, with certain children there is more to the problem than can be fixed with behavioural interventions in the home. This is especially true because for behavioural interventions to work they must be done in an environment we can control, and finally, besides changing an inappropriate behaviour and replacing it with a new appropriate one, there is often a much more complex task we need to teach- problem solving.
With these children we often use the work of Dr. Ross Green and his “Collaborative Problem Solving” approach. To teach this technique we strongly recommend parents read the book The Explosive Child (available on my web site, go to the home page and click “books recommended by Dr. Roche). We also suggest parents watch the video Parenting the Explosive Child and then practice the skills taught for several weeks under the support and supervision of a trained clinician.
What is the Collaborative Problem Solving approach?
Dr. Green thinks that challenging children have often been poorly understood. All to often their challenging and difficult behaviour is seen as willful and goal oriented. (In spite of the fact it rarely gets them to their goal.) In other words the explosive and angry behaviour is seen as a means to getting attention and coercing people to give in to their demands. In fact, based upon research by Dr. Green and others, the basis of their difficult and explosive behaviour can best be seen as a learning disability or developmental delay in the executive functions of the brain that support flexibility in thinking and frustration tolerance. When the situation calls for the cognitive skills that are part of mental flexivbility (seeing things from the perspective of others) or handling frustration, they have difficulty. They may appear to be choosing to be non-compliant and explosive, but they are making that choice no more than the child who acts out in reading class when the work becomes too hard due to a reading disability. Dr. Green compares the typical view of these acting out children: “Children do well if they want to,” with the collaborative problem solving approach’s philosophy of, “Children do well if they can.”
How do these children get this way? Is it poor parenting?
There are a number of different factors that leads to this lack of appropriate developmental skills. For some it is a developmental issue. For others it might be a combination of neurological (hard wiring) and neurobiological (chemical) issues. Dr. Green has identified five major areas of deficit that may be at the heart of the problems:1. Executive Function Skills; 2. Language Skills; 3. Emotional Regulation Skills; 4. Social Skills; 5. Cognitive Flexibility Skills. Luckily we have simple and effective ways to evaluate and determine where the child’s weaknesses as well as strength are. This can help us make intervention choices on a day to day basis that begin to address skill deficits rather than just make life more quiet and peaceful temporarily.
That’s a nice philosophy, but how do you make changes in my families day?
The approach Dr. Green and others have developed (actually this is a rather old idea, you can find it in the treatment interventions of the Teaching Family Model at Boy’s Town) is called the Collaborative Problem Solving Approach (CPS). There are three major goals to this approach: 1. Allow adults to pursue expectations; 2. Teach lacking thinking / cognitive skills, and; 3. Reduce meltdowns and angry outbursts.
We do this by first understanding what are called the pathways (skills deficits) that underly the explosive behaviour; decide which plan will be used to handle any specific problem or situation (There are three plans, A,B,C); and then executing some form of plan B to teach the lacking skills. Plan be is the teaching of collaborative problem solving. Teaching your child how to work out a conflict with another person, whether it is another child, adult, teacher or you. Using this plan B is a way to support your child’s lack of executive control. Making up for and supporting your child with a structured interaction that naturally leads to solving problems. What’s in your mind and mouth are the phrases, “Let’s work it out,” and “We worked it out.”
How does this interaction style help control anger and meltdowns?
The plan consists of three steps. First: Empathy and reassurance, then we define the problem, and next there is what is called the invitation. (This process is similar to other interventions taught for working with aggressive individuals such as CPI, the Boy’s Town Teaching Family Interaction, most mediation training, the approach to parenting found in Dr. John Gottman’s book Bringing up Emotionally Intelligent Children and many others. Green, however, has made it simple and emphasized the philosophy behind this positive support approach.)
Empathy is communicated through reflective listening and letting the child know that “you heard them.” This may sound simple, but we need practice, practice and more practice. This helps the child calm down, and ensures them that their issues are “on the table” and being heard. In a very specific order we ask what is going on with the child, let them know they have been heard, get them to tell us more (this is where language deficits might come in) and give them reassurance (Green says, “I’m not saying no....”)
We then clearly define the problem and invite the child to use problem solving skills to solve our mutual problem. All through the process you are teaching and modelling skills that address the child’s deficits as defined in the pathways assessment. This is a process that takes practice, can often use feedback, and honestly doesn’t guarantee there will be no more blowouts. But it does reduce the risk of them, it increases the chances you will have a pleasant and successful interaction with a usually angrey and easily frustrated child, and it will, over time, teach you child the executive problem solving skills they need to be not just compliant with your commands and requests, but able to negotiate and collaboratively problem solve with others out in the real world.
How long does this process take? And who comes to therapy? 
It’s my kid who needs therapy, not me.
Honestly, while in my practice I see your child for an initial evaluation, and then may see them a few more times throughout the process, the most effective and successful way to treat children with anger problems of this magnitude is through education those who they interact with during the majority of their day. This usually means parent meetings and sometimes training and consultation with schools. It’s hard to give a length of time or number of sessions that you can expect. What I can say is that I have divided the process into eight parts, and each week we review some of Green’s work, usually watch and discuss Dr. Gottman’s video or book on emotionally intelligent children and review the basics of parenting skills found in Dr. Barkley’s program. Eight weeks is the usual length of family treatment. We then often meet a month later for a check up and then as needed. (Even Super Nanny comes back to visit!) I’m afraid that many people expect children can see a therapist in their office and play therapy or other interventions will make a dramatic change. There isn’t really any scientifically based proof that this kind of therapy is effective. Your best changes for significant positive change involves everyone, and we need to remember it’s about your relationship with your child.
Final Word
Finally, I want to remind you that there are other techniques and interventions that are effective and may be used in conjunction with collaborative problem solving, and sometimes are more appropriate. These include using visual supports, teaching anxiety reduction skills, using cognitive behaviour therapy through a structured child focused program like “The Incredible Five Point Scale” and positive behavioural supports. Often school is a critical area where we need to intervene. This might include an assessment aimed at “coding” to obtain school based support, conducting a functional behaviour analysis (FBA) and developing a positive behaviour support plan and the possibility of medical interventions. Whenever there are serious behavioural concerns you should start by visiting your medical doctor for a full check up.

Therapy and counselling may involve just your child, your child and parents, the entire family constellation or in some cases consultation with schools and other agencies. Each case is unique and after our initial consultation and evaluation we will develop a plan together.

For more information on services I provide to children, adolescents and adults with ASD or Aspergs please visit my web site at either www.relatedminds.com or www.socialcognitivetherapy.com