A little aside that we should all watch. This is the kind of thinking that solves problems.
Friday, June 18, 2010
Monday, June 14, 2010
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
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.
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
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
Sunday, June 13, 2010
Researchers Blast Another Link Between Autism and Vaccines
Researchers Blast Another Link Between Autism and Vaccines
"Some myths never go away; they just change form." that includes the debate about vaccines and childhood autism. One that never seems to go away. Here are the simple facts: there's no link between the disorder and thimerosal. So the anti-vacciners have simply changed the rules and now say that it's not the thimerosal, but vaccines still cause autism because children get too many vaccines too soon. "Their little bodies are overloaded." How they have determined this is hard to understand, and they have come up with alternative vaccine schedules, seemingly out of thin air.
The Los Angeles Times reports "an increasing number of parents are asking their pediatricians to space out vaccines and booster shots." But, "There's no need to do that, according to pediatric infectious disease specialists Drs. Michael J. Smith and Charles R. Woods of the University of Louisville School of Medicine." See the study here.
ULSM released a study in the medical journal Pediatrics, the leading journal in the field, that states unequivocally there is no relation between autism and the frequency of childhood vaccines. The authors, Smith and Woods, analyzed data on 1,047 children from a previous study investigating the thimerosal claim.
The children were born between 1993 and 1997, and had been vaccinated on a schedule of their parents' choosing. Later they were given a series of 42 neuropsychological tests between the ages of 7 and 10. Smith and Woods report roughly 47 percent of the children received their vaccines on a regular schedule. Another 23 percent received their vaccines, but not on schedule, and the remaining children received only some of their shots. From the results it is clear that the spacing of the vaccines had no effect on whether or not the children developed autism. The authors state "This study provides the strongest clinical outcomes evidence to date that on-time receipt of vaccines during infancy has no adverse effect on neurodevelopmental outcomes 7 to 10 years later....These results offer reassuring information that physicians and public health officials may use to communicate with parents who are concerned that children receive too many vaccines too soon." There simply were no differences, none.
Over and over again, with research study after research study, we see that vaccines have no relationship to autism, Asperger's Disorder or any neurological deficits.
What we should learn from these studies is that there is a group of individuals who for some philosophical or political reason seem to want to spread discontent among parents, who want to scare them, and for some reason return us to the medicine of 100 years ago. I fail to understand it. I just hope that the overwhelming evidence will sooner or later keep parents from wasting their time and money of treatments (like chelation, chiropractic and homeopathy) that are based upon the same woo science.
Dr. Jim Roche is a registered psychologist in Vancouver, British Columbia. He has offices in Burnaby (Coquitlam, Port Moody, Maple Ridge and New Westminster) and downtown Vancouver. His website can be seen at www.relatedminds.com and www.socialcognitivetherapy.com
"Some myths never go away; they just change form." that includes the debate about vaccines and childhood autism. One that never seems to go away. Here are the simple facts: there's no link between the disorder and thimerosal. So the anti-vacciners have simply changed the rules and now say that it's not the thimerosal, but vaccines still cause autism because children get too many vaccines too soon. "Their little bodies are overloaded." How they have determined this is hard to understand, and they have come up with alternative vaccine schedules, seemingly out of thin air.
The Los Angeles Times reports "an increasing number of parents are asking their pediatricians to space out vaccines and booster shots." But, "There's no need to do that, according to pediatric infectious disease specialists Drs. Michael J. Smith and Charles R. Woods of the University of Louisville School of Medicine." See the study here.
ULSM released a study in the medical journal Pediatrics, the leading journal in the field, that states unequivocally there is no relation between autism and the frequency of childhood vaccines. The authors, Smith and Woods, analyzed data on 1,047 children from a previous study investigating the thimerosal claim.
The children were born between 1993 and 1997, and had been vaccinated on a schedule of their parents' choosing. Later they were given a series of 42 neuropsychological tests between the ages of 7 and 10. Smith and Woods report roughly 47 percent of the children received their vaccines on a regular schedule. Another 23 percent received their vaccines, but not on schedule, and the remaining children received only some of their shots. From the results it is clear that the spacing of the vaccines had no effect on whether or not the children developed autism. The authors state "This study provides the strongest clinical outcomes evidence to date that on-time receipt of vaccines during infancy has no adverse effect on neurodevelopmental outcomes 7 to 10 years later....These results offer reassuring information that physicians and public health officials may use to communicate with parents who are concerned that children receive too many vaccines too soon." There simply were no differences, none.
Over and over again, with research study after research study, we see that vaccines have no relationship to autism, Asperger's Disorder or any neurological deficits.
What we should learn from these studies is that there is a group of individuals who for some philosophical or political reason seem to want to spread discontent among parents, who want to scare them, and for some reason return us to the medicine of 100 years ago. I fail to understand it. I just hope that the overwhelming evidence will sooner or later keep parents from wasting their time and money of treatments (like chelation, chiropractic and homeopathy) that are based upon the same woo science.
Dr. Jim Roche is a registered psychologist in Vancouver, British Columbia. He has offices in Burnaby (Coquitlam, Port Moody, Maple Ridge and New Westminster) and downtown Vancouver. His website can be seen at www.relatedminds.com and www.socialcognitivetherapy.com
Chiropractic Treatment of Behavior Problems: When Is Evidence Not Evidence?
Today on my ADHD blog I posted information about the use of chiropratic with children who have behaviour problems. I'd like to repeat the information here because I think it applies to autism as well.
An excellent article/blog at Psychology Today.
Jean Mercer, PhD, blogs today on Psychology Today about a recent article claiming to prove that chiropractic treatment of children for behaviour problems works. Here is the actual article: (Alcantara, J., & Davis, J., The chiropractic care of children with Attention Deficit/Hyperactivity Disorder: A retrospective series) was published in 2010 in Explore: The Journal of Science and Healing (pp. 173-182).
The authors examined 4 cases from their records in which children and adolescents had received spinal manipulations and advice about dietary supplements from chiropractors over several months. (Note, these are not randomly chosen cases, just four cases picked out that worked out. ) They used a 15-item checklist of ADHD symptoms showed that the symptoms improved from the pre-treatment to the post-treatment period. From this very small amount evidence Alcantara and Davis concluded that the treatment was an effective way to alleviate ADHD. They attempt to prove something remarkable with just a hint of support.
There are some serious problems with not only the amount of this evidence, but with it's nature. First, to just pick four cases and make any assumption out of that data is, well, dangerous. You wouldn't use this method to prove any drug therapy worked! But with chiropractic, it's seems OK. (I mean, who will get hurt, besides your wallet?) This "evidence" is so prone to being affected by chance to use it is silly at best, and misleading at worse. Scientifically, before making these kinds of claims we need a large number of cases. Especially when there are so many different things that could affect the outcome. Mercer explains this really nicely with an analogy about picking four black socks out of a hugh pile of socks. The larger the pile, the less likely the first four are really telling you much about the pile. The next four in a row might be white, green or yellow! Probability studies tell any scientist NOT to do this.
Alcantara's study is also basically a "before and after" study. You follow someone who gets a certain treatment and compare how they were doing before the treatment and after the treatment. On it's face this sounds logical, but it's not. There are so many things that could have an effect. Age, time, parent's expectation, getting attention from the study itself, teachers and parents being relieved that after years of problems their child or student is now in a study and professionals are helping them! This is one of the dangers of this type of study, and one of the reasons you need a large sample of subjects to make sure these influences are't confounding your data. Four is not a large number, it's a number that increases the possibility for this kind of mistake.
There is no control group to compare these kids to. What if we took just four other students and did nothing, or had them take part in a sham study where the treatment might be made up? Would the results be any different? This is one way we avoid the problems of expectations and time and all the other things that can mislead us. But there is none of that, none. And this "study" is about a medical intervention for a serious life long disability!
There are also other problems with this study, it was not blinded properly, so people taking part knew what outcome was expected (scientific research has so clearly shown that not blinding these sorts of research studies causes problems with validity). And we don't know what other treatment interventions these children were involved with that might have had an effect on the outcome.
The problem here is that this study will be used by "holistic" treatment providers who will make claims to the public that there is a "published" and "peer reviewed" study that shows chiropractic manipulation is a helpful treatment for behavioural problems and ADHD in children.
THERE IS NO SUCH STUDY.
A much more in-depth analysis of the use of Chiropractic treatment on children can be found at Science Based Medicine. This article clearly shows that the use of chiropractic treatments is simply scientifically indefensible.
I suggest any parent thinking about using alternative medicine for behavioural problems read this article ....twice!
This week, in my practice, two more parents showed up who had been using "alternative medicine" with their children. Here in BC children below the age of 6 get nearly $20,000 to use for the treatment of their choice ...to a limit. Both had used all their monies on chiropractic, homeopathic and "auditory retraining" programs. None was left for basic interventions by a behavioural or speech specialist to teach communications skills or parenting techniques. These were sad situation. But when searching the internet for tretments what they found was a list of these "wholistic" practitioners offering everything from massage, diets, sound therapy to chelation therapy. None of which are supported by science. Again this week I went on line and found a local Naturopathic Physician (NP sometimes is referred to as "Not a Physician") offering" homeopathic vaccinations."
These parents were mislead by what they thought was legitimate research they found on the web. Research like the research above. One way to prevent this from happening to you is to use your medical doctor for advice, not a practitioner of holistic medicine! Look to web pages like Science-Based Medicine (which has a nice list of similar pages and resources) and I often send people to look up treatments on a very good skeptical site: Quackwatch.
When considering any treatment you can also simply try typing in the treatments name and words such as "skeptic."
Finally, because so many individuals are taking their children to homeopaths for unproven or disproven treatments, I'd like to suggest watching Richard Dawkin's video on homeopathy found here. It's an excellent place to start. And if you have a sense of humour (and watching people spend their money on these treatments you need a sense of humour, you could watch this funny video from Mitchell and Web.
For more information about scientifically validated interventions for children and adolescents with behaviour problems, ADHD, autism, Aspergers and related disorders please visit my web page at www.relatedminds.com or www.socialcognitivetherapy.com I have offices in Burnaby (serving New Westminster, Coquitlam, Port Moody and Maple Ridge) as well as offices in downtown Vancouver. I am a registered psychologist and registered marriage and family therapist, and would be more than happy to speak with you about possible treatments and interventions.
An excellent article/blog at Psychology Today.
Jean Mercer, PhD, blogs today on Psychology Today about a recent article claiming to prove that chiropractic treatment of children for behaviour problems works. Here is the actual article: (Alcantara, J., & Davis, J., The chiropractic care of children with Attention Deficit/Hyperactivity Disorder: A retrospective series) was published in 2010 in Explore: The Journal of Science and Healing (pp. 173-182).
The authors examined 4 cases from their records in which children and adolescents had received spinal manipulations and advice about dietary supplements from chiropractors over several months. (Note, these are not randomly chosen cases, just four cases picked out that worked out. ) They used a 15-item checklist of ADHD symptoms showed that the symptoms improved from the pre-treatment to the post-treatment period. From this very small amount evidence Alcantara and Davis concluded that the treatment was an effective way to alleviate ADHD. They attempt to prove something remarkable with just a hint of support.
There are some serious problems with not only the amount of this evidence, but with it's nature. First, to just pick four cases and make any assumption out of that data is, well, dangerous. You wouldn't use this method to prove any drug therapy worked! But with chiropractic, it's seems OK. (I mean, who will get hurt, besides your wallet?) This "evidence" is so prone to being affected by chance to use it is silly at best, and misleading at worse. Scientifically, before making these kinds of claims we need a large number of cases. Especially when there are so many different things that could affect the outcome. Mercer explains this really nicely with an analogy about picking four black socks out of a hugh pile of socks. The larger the pile, the less likely the first four are really telling you much about the pile. The next four in a row might be white, green or yellow! Probability studies tell any scientist NOT to do this.
Alcantara's study is also basically a "before and after" study. You follow someone who gets a certain treatment and compare how they were doing before the treatment and after the treatment. On it's face this sounds logical, but it's not. There are so many things that could have an effect. Age, time, parent's expectation, getting attention from the study itself, teachers and parents being relieved that after years of problems their child or student is now in a study and professionals are helping them! This is one of the dangers of this type of study, and one of the reasons you need a large sample of subjects to make sure these influences are't confounding your data. Four is not a large number, it's a number that increases the possibility for this kind of mistake.
There is no control group to compare these kids to. What if we took just four other students and did nothing, or had them take part in a sham study where the treatment might be made up? Would the results be any different? This is one way we avoid the problems of expectations and time and all the other things that can mislead us. But there is none of that, none. And this "study" is about a medical intervention for a serious life long disability!
There are also other problems with this study, it was not blinded properly, so people taking part knew what outcome was expected (scientific research has so clearly shown that not blinding these sorts of research studies causes problems with validity). And we don't know what other treatment interventions these children were involved with that might have had an effect on the outcome.
The problem here is that this study will be used by "holistic" treatment providers who will make claims to the public that there is a "published" and "peer reviewed" study that shows chiropractic manipulation is a helpful treatment for behavioural problems and ADHD in children.
THERE IS NO SUCH STUDY.
A much more in-depth analysis of the use of Chiropractic treatment on children can be found at Science Based Medicine. This article clearly shows that the use of chiropractic treatments is simply scientifically indefensible.
I suggest any parent thinking about using alternative medicine for behavioural problems read this article ....twice!
This week, in my practice, two more parents showed up who had been using "alternative medicine" with their children. Here in BC children below the age of 6 get nearly $20,000 to use for the treatment of their choice ...to a limit. Both had used all their monies on chiropractic, homeopathic and "auditory retraining" programs. None was left for basic interventions by a behavioural or speech specialist to teach communications skills or parenting techniques. These were sad situation. But when searching the internet for tretments what they found was a list of these "wholistic" practitioners offering everything from massage, diets, sound therapy to chelation therapy. None of which are supported by science. Again this week I went on line and found a local Naturopathic Physician (NP sometimes is referred to as "Not a Physician") offering" homeopathic vaccinations."
These parents were mislead by what they thought was legitimate research they found on the web. Research like the research above. One way to prevent this from happening to you is to use your medical doctor for advice, not a practitioner of holistic medicine! Look to web pages like Science-Based Medicine (which has a nice list of similar pages and resources) and I often send people to look up treatments on a very good skeptical site: Quackwatch.
When considering any treatment you can also simply try typing in the treatments name and words such as "skeptic."
Finally, because so many individuals are taking their children to homeopaths for unproven or disproven treatments, I'd like to suggest watching Richard Dawkin's video on homeopathy found here. It's an excellent place to start. And if you have a sense of humour (and watching people spend their money on these treatments you need a sense of humour, you could watch this funny video from Mitchell and Web.
For more information about scientifically validated interventions for children and adolescents with behaviour problems, ADHD, autism, Aspergers and related disorders please visit my web page at www.relatedminds.com or www.socialcognitivetherapy.com I have offices in Burnaby (serving New Westminster, Coquitlam, Port Moody and Maple Ridge) as well as offices in downtown Vancouver. I am a registered psychologist and registered marriage and family therapist, and would be more than happy to speak with you about possible treatments and interventions.
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