Helping Your Child Face Fears and Anxiety: Exposure Therapy.

One of the most basic therapeutic interventions we use in dealing with Anxiety (stress, fears and phobias) is Exposure Therapy. It's also one of the most complicated ones, and one that can go wrong easily. Children with Aspeger's Disorder, autism (ASD), ADHD and other related disorders relating to anxiety need, eventually, to "face their fears" and become exposed to what scares them. The complication with children who have Asperger's and autism is that some of the normal responses we would expect during exposure don't happen. These children have difficulty switching mental sets...transitioning from one mental or emotional state to another- and some of their anxiety is more related to neurological causes that need careful intervention. (A good resource for help with issues such as sensory issues would be your school's Ot or Occupational Therapist.)

Still, there are two good resources I can recommend on this topic, both are provided by the BC government.

1) AnxietyBC has an excellent handout, downloadable and free, that is part of their overall Anxiety Program for children. You'll find this at their website: AnxietyBC.  The name of this handout is "Helping Your Child Face Fears: Behavioural Exposure.  Thi set of materials helps you develop an understanding of fears and anxiety that your child suffers from, and helps you develop a clear program for address it. This includes building a "Fear Ladder," telling you how to appropriately reward brave behaviour, and how to do "exposure" and "Face Their Fears."  Over and over they give you an important piece of advice: Don't Rush, Practice, Set Goals.

2) AnxietyBC also has a couple of excellent videos that walk you through the process, actually demonstrating these techniques. I'd recommend watching the DVD "Separation Anxiety" and the DVD on Obsessive Compulsive Disorder." I'd watch both of these because the more exposure to use of these techniques you have, the greater your chances you will do them correctly. And the more information, knowledge and practice you have the less anxiety you will have yourself. And nothing is more important than doing this in a relaxed manner. There is a third excellent DVD for adults: Effectively Managing Panic Disorder: A Self Help Guide that might also help you understand the process.

All of these DVDs are available through AnxietyBC, and most can be found at the public library. Remember, you can go on-line and reserve a DVD (or book) and as soon as it is available the library will email you and you can pick it up at any branch. If your anxious about doing this, just drop in to your local library and ask for a demonstration or walk-through.

While there are other programs and materials that I suggest and use in my practice with children and adolescents with Anxiety and Stress issues, especially children with Asperger's Disorder, autism (ASD) and related problems, these are great materials to start with.  If your going to help your child with Anxiety, you need to become an Anxiety expert. This is possible with these types of supports.

About Dr. Roche:

Dr. Jim Roche is a Registered Psychologist and a Registered Marriage and Family Therapist with offices in Vancouver and Burnaby, BC. He has been in practice for over 25 years and has served as a Provincial Consultant on Asperger's/Autism/ASD as well as Director of Behaviour Programming for several school districts here in Canada, in New York and California. In addition to being a Registered Psychologist he is a Certified/Licensed Teacher of Special Education and School Psychologist.

Other information about Dr. Roche can be found at:  <a href="http://relatedmnds.com">www.relatedminds.com</a> or <a href="http://www.relatedminds.com/adhd">www.relatedminds.com/adhd</a>. Other information on my practice can be found at: <a href="http://Therapists.Psychologytoday.com/70682">http://Therapists.Psychologytoday.com/70682</a>, http://www.bcpsychologist.org/users/jimroche or <a href="http://psyris.com/drjimroche">http://psyris.com/drjimroche</a>.

Specific Information about his services for children with autism and Asperger's Disorder can be found at: http://www.relatedminds.com/autism/

Increase in Autism Rates Noted in Korean Research

New York times Article:
click here: http://www.nytimes.com/2011/05/09/health/research/09autism.html

The New York Times has an article about an ambitious six-year effort by Korean researchers to gauge the rate of childhood autism in a middle-class city which has yielded a figure that stunned experts and is likely to influence the way the disorder’s prevalence is measured around the world. What's the number? The study shows that 2.6 percent of all children in the Ilsan district of the city of Goyan (aged 7 to 12). This is more than twice the rate usually reported in the developed world. note that even that rate, about 1 percent, has been climbing rapidly in recent years — from 0.6 percent in the United States in 2007, for example.

“This is a very impressive study,” said Lisa Croen, director of the autism research program at Kaiser-Permanente Northern California, who was not connected with the new report. “They did a careful job and in a part of the world where autism has not been well documented in the past.” So, the study, while comprehensive, doesn't necessarily show an increased rate, but a rate higher than we expected. We have simple looked more closely and found more cases.

The study was published in The American Journal of Psychiatry. It was produced by researchers from the Yale Child Study Center, George Washington University and other leading institutions. Together they sought to screen every child aged 7 to 12 in Ilsan, a community of 488,590, which is about the size of Staten Island.

This new number is in contrast to the Centers for Disease Control and Prevention in the United States and most other research groups measure autism prevalence by examining and verifying records of existing cases kept by health care and special education agencies. That approach may leave out many children whose parents and schools have never sought a diagnosis.

In recent years scientists have come to see autism as a spectrum of disorders that can include profound social disconnection and mental retardation, but also milder forms, like Asperger’s syndrome, that are pervasive and potentially disabling but that often go undiagnosed.

“From the get-go we had the feeling that we would find a higher prevalence than other studies because we were looking at an understudied population: children in regular schools,” said the lead researcher, Dr. Young-Shin Kim, a child psychiatrist and epidemiologist at the Yale Child Study Center. So, in effect, this study focused on finding children who may have a form of autism that is much less likely to cause school problems, and therefore be less detectable.

The New York Times reports that, "Dr. Marshalyn Yeargin-Allsopp, chief of developmental disabilities at the National Center on Birth Defects and Developmental Disabilities of the C.D.C., acknowledged that her agency’s records-based approach probably missed some autistic children — especially among the poor, among racial minorities and “potentially among girls” — and said the agency was interested in taking part in a population-based approach like the Korean study. “We believe this will be a way to get as complete an estimate of A.S.D. prevalence as possible,” she said in an e-mail, using the abbreviation for autism spectrum disorder."

The Times article itself goes into good detail about the study and is an easier read than the actual article itself. IT's nice to see decent science reporting that doesn't sensationalize a problem or a statistical change. Click above and read the entire article, there is also a link on the Times available to bring you to the original published research as well.

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For information about services for autism spectrum disorder, including Asperger's Disorder, that I provide in my office, please feel free to check my web page or contact me directly.
Dr.jim Roche
www.relatedminds.com
www.adhdhelp.ca

Dr. Roche is a Registered Psychologist and Registered Marriage and Family Therapist with offices in burnaby and Vancouver, BC. His practice focuses on children, adolescents and adults with autism spectrum disorder, Asperger's Disorder, Attention Deficit Hyperactivity Disorder (ADHD/ADD) and similar behavioural issues. He can be reached at 778.998-7975

Learning "styles," an idea whose time has come and gone

While a teacher in Brooklyn, actually East New York, I took several of my graduate courses at Brooklyn College through the teacher's union education program. One course focused on the "learning styles" of children. We were taught, for the entire semester, about different learning styles that our students had, and taught that if we didn't cater to these different and individual learning styles, our students would suffer. We were taught how to assess students, asking them questions and watching their facial, eye and hand movements in reaction to our questions. If a student looked up to the right...she was "accessing visual memory" and if the student looked down to the left she was "accessing auditory memory." Or it may have been the other way around, I don't remember. But the point is we assessed all of our children and then addressed their learning styles in their IEP's (Individual Education Plans).

Like so many interventions in education this one was simply based upon someone's idea they had at breakfast that morning, and was supported by little and poor research. Really poor research. (One thing we never were required to take in graduate school - in the education department - was a course in statistics ...or research design for that matter, so we were easy victims to the woo science of education). As the years went by I realized individual children might have specific learning disabilities, or actual physical disabilities that made learning certain information difficult, but individual learning styles? No, not really. And finally this theory of how to educate our students is falling by the wayside under the pressure of real science, real research and a basic understanding of what learning really is. Here is what one recent paper on "Learning Styles" concluded:

"Our review of the literature disclosed ample evidence that children and adults will, if asked, express preferences about how they prefer information to be presented to them. There is also plentiful evidence arguing that people differ in the degree to which they have some fairly specific aptitudes for different kinds of thinking and for processing different types of information. However, we found virtually no evidence for the interaction pattern mentioned above, which was judged to be a precondition for validating the educational applications of learning styles. Although the literature on learning styles is enormous, very few studies have even used an experimental methodology capable of testing the validity of learning styles applied to education. Moreover, of those that did use an appropriate method, several found results that flatly contradict the popular meshing hypothesis.nWe conclude therefore, that at present, there is no adequate evidence base to justify incorporating learning-styles assessments into general educational practice. Thus, limited education resources would better be devoted to adopting other educational practices that have a strong evidence base, of which there are an increasing number."

For more about this click here.

Here is an excellent video about learning styles and current research. IT's pretty good at explaining this issue: http://www.youtube.com/watch?v=sIv9rz2NTUk&tracker=False

I write about this because many parents still consider schools to be failing them if they don't cater to their child's particular "learning style." This is especially true in the past few years as so much money and effort has been put into teaching children with autism disorder "visually" because people think that children with autism are "visual learners." That's not true, and what's worse is this "visual learner" idea has infiltrated the general education classroom.

We learn about art by looking at it, but we understand it by thinking about it. Same with reading, same with math. What we all need to understand is that learning is about thinking, and we might use different methods to understand something,to get information about it, to see or hear it, but these are not the same as different "learning styles" or different styles of thinking. We all think, pretty much, alike.

That goes for children with autism and Aspeger's as well. Sooner or later it comes down to a very similar process of thinking something out. And while some individuals may use visual tools or auditory tools to help with memorization and other specific cognitive processes, they are not really visual or auditory learners in the sense some educators want us to believe. When we ask a child to look at a photo and tell us what is going on, or alternatively to read or listen to a story and tell us what is going on, the cues and prompts may be different in each case, but the learning and thinking is not. So it's difficult to sit through a discussion at an IEP and hear how student X is a "visual learner." He isn't! People make some assumption that this student has superior visual abilities, well, his visual abilities and skills may be higher than auditory, true, but he is not a "visual thinker." Thinking is a complex cognitive process and for all of us it's pretty much the same. The video clip listed above gives a great example of this, and in spite of the fact that some proponents of "learning styles" have spammed the site with negative feedback, the science is strong and learning styles are not supported by most research.

Now does this mean that visual supports are not appropriate for children with autism or Asperger's disorder? NO! Visual supports are great, and honestly, just this past week I had to convince three parents to return to using visual supports with their children who they thought had grown out of them. Figuring out and using visual supports is a critical component to success with these children. I use visual supports all the time. I need a pencil and paper to figure out math problems, I take notes in meetings, I draw and write out plans and use pen and paper to try out different ideas when rebuilding my house. My daily calendar is a visual support. My to do list. I am surrounded by visual supports that provide an external way of planning, seeing and explaining my ideas. My learning and thinking, however, goes on in my head...supported by external visual and auditory (I listen to a lot of books on CD or MP3) input. The visual supports we provide are external devices, sometimes used to help with input, sometimes output. But when your child uses a PECS board to tell you they need to use the toilet, or wants to go outside, or likes something and wants more (maybe even you!) the learning and thinking didn't go on visual on the PECS board. The PECS board or other visual communication system was the input or output device that supported your child in communicating and ultimately understanding. We can't understand and think about things that can't be communicated. And visual supports are communication supports.

I decided to write this and provide the explainatory video because too often parents and school get into protracted arguments when every single learning situation isn't somehow reflective of the idea that their child is "a visual learning." I even have kids tell me this. Research shows that specific handicaps aside, learning is just learning. How you get the information into your child's mind is a different matter, but we shouldn't confuse the two.

Thank you for reading my blog, provided to you on your visual communication support system (computer, ipad, or maybe even printed out). You now can either agree or disagree ....but that happens in your head, not in the computer.

This web page is not meant as a medical aid, not meant to provide specific advice, treatment protocols or diagnosis. Please see your medical doctor or register psychologist for specific advice. You can also visit my web page at www.relatedminds.com.


Here is an excellent video on learning styles: click here.

For more information on this Click here.

ADHD and Autism

Kids with ADHD deserve action

Here is an excellent letter to the editor from the local Burnaby paper (click above).

Every year kids come to school with a variety of learning disabilities and mental health disorders, these include Autism, ADHD/ADD, depression, anxiety and related disorders. And recently studies have shown that BC is one of the places in Canada that is very unlikely to be prepared to help children with one of the most common of these disorders, ADHD, or ADD as many people mistakenly call it.

As the writer of this letter states, "Our Ministry of Education, as well as school communities, needs to know that ADHD is not a behaviour issue, that it can't be "cured" by changing diet, that it's not a result of poor parenting and that the kids who suffer from it aren't bad kids. And they need to know that I am not unnecessarily "drugging" my child. They need to know it's a genuine medical condition, that many kids with ADHD are very bright, that it affects up to 12 per cent of school children, that it's stressful for parents and hard to deal with for kids."

Well, I couldn't have said it better myself, and I am often frustrated by the way ADHD/ADD is treated or should I say not treated in the schools. This is especially important to parents of children with ASD or Asperger's Disorder. Treatment is often non-existant for ADHD. There is an assumption that behaviours are the result of choice, that the problems and failures are purposeful. While the provincial government had taken steps to address the need to provide treatment in the schools and community for autism and Asperger's Disorder, there is really very little available in the schools for children with ADHD/ADD. While there is a large percentage of children with ADHD/ADD you very seldom find a school district providing ADHD specific training for it's staff or parents. While I have spoken in dozens and dozens of schools throughout BC on autism and Asperger's Disorder, and provided training, consultation and observations focused on children with autism, it is nearly impossible to get a school to ask for a workshop, training session or a consultation on ADHD. And often our children with autism and Asperger's have ADHD as a co-morbid disorder. It is seldom addressed in Individual Education Plans (IEPs) and when a school does deal with the symptoms / behaviours that result from ADHD they apply "warnings" and punishments as the "treatment." This is something that sooner or later has to be addressed by our schools. This week alone three of the children seen in my practice were being punished for their ADHD symptoms. A school would never punish a student for their behaviours-symptoms of anxiety, or punish a student for behaviours-symptoms of Tourette's syndrome (although I have to admit, I have spent more than one full semester dealing with just this issue in a major school district in California). More than ny other disorder I have heard negative comments from teacher's and staff when addressing the simplest behaviours relating to ADHD/ADD. Sometimes it's like they have either never heard of the disorder, or if they agreed it existed out entire society would fall.

For parents I have suggested reading "So I'm Not Lazy, Crazy or Stupid," Mel Levine's "The Myth of Laziness" or Dr. Barkley's many works on ADHD. (All of these can be found on my web page.

Often different disorders have separate"camps" of supporters. There are "autism awareness" days, walks, Depression awareness days...all sorts of support groups and programs. Oddly, there is no ADHD walk or ADHD day in any school's or towns I've been to. That's too bad. ADHD more than any other disorder needs to be brought out of the closet and addressed, and those who deny that it is a real disorder, or that it's really a choice a ten year old is making to fail all his subjects and lose all his friends needs to be confronted and dealt with.

I can offer this one piece of advice to parent. Get a copy of the diagnosis for both Autism/Aspergers AND ADHD. Make a copy. LEarn it. Mark the important terms in yellow, underline them. Make a copy for everyone on your child's IEP team. And then make sure everyone know that punishment for symptoms went out about 100 years ago. We don't punish individuals who have a diagnosed disorders like autism, Aspergers, Tourette's syndrome or ADHD for exhibiting their symptoms. Ever. If they try, ask for the research that shows such a "technique" is a good idea. What supports that as an intervention? Instead redirect everyone back to answering how we as a team, parents and school, are going to provide positive behavioural support through the IEP process to teach your child how to do better and succeed. That's what an IEP is all about!

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The Autism blog is not offered as medical advice or as a means of diagnosing or treating Autism or Asperger's Disoder. The diagnosis of autism is complex and involves not just looking for symptoms of autism, which is all that those “web tests” do, but also involves ruling out other disorders that might look just like autism. Often individuals who think they or their child has autism or Asperger's Disoder have other disorders, and may have co-morbid disorders such as depression, anxiety or OCD. A simple check off sheet of “symptoms” doesn’t differentiate these. 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 a real diagnosis. Medical doctors can diagnose autism, but the diagnosis is complex and often they will make a referral to a Registered Psychologist for a full understanding of a patient’s symptoms. You can obtain a referral for a psychologist with expertise in autism from the British Columbia Psychological Association (BCPA). The professional you select needs specific training and needs to use specific tools in British Columbia, including the ADI-R and ADOS, and also needs to complete a psycho-educational assessment. The government of BC provides these services for free, there is a waiting list, and some parents prefer private practitioners.

In my practice I offer autism assessment and treatment services for individuals, couples, families, children and adolescents in the Burnaby, Vancouver, Coquitlam, Port Moody, New Westminster and Maple Ridge areas of the lower mainland. This includes neuro-developmental assessments, psycho-education, cognitive rehabilitation for problems with memory and concentration and cognitive behaviour therapy. I also provide diagnostic assessments for autism and Asperger's Disorder in my Burnaby office.

My web page lists a number of resources you can make use of yourself in dealing with Attention Deficit Hyperactivity Disorder (ADHD). Please visit it at www.adhdhelp.ca or one of my other sites at either Psychology Today, AAMFT, PSYRIS or my professional site. Please feel free to call if you have questions about ADHD or other cognitive issues.

My autism web page can be found by clicking here. (www.socialcognitivetherapy.com)


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

Vaccines DO NOT cause autism. Something else does and we don't know what.

"Can Vaccines cause autism?" NO, but when I scan the internet these are the kinds of idiotic scar mongering headlines I see all over the web, I'm always thinking there is some new study supporting this idea. You see these headlines in newspapers and magazines and on TV. And these are the headlines for articles that are going to CORRECT this false notion that there is some connection when there is NOT! There are articles that will eventually, after scaring you, tell you the facts. Regretfully few people remember the article and just remember the headline. This nonsense, this cheap thrill garbage reporting has to stop once and for all! People are failing to get their kids vaccinated, and as a result children and adults are dying of diseases that are preventable. It has to stop!

Let's make this clear: There is no research connecting vaccines to autism.

Although signs of autism often begin to appear around the same time that children are vaccinated, it is just a coincidence, not a cause. We give kids vaccines at the time when their language centres are developing, and then, looking back, think one caused the other. Well research has looked at that over and over again, and it just ain't so. See the many research articles listed below.

The truth is vaccines are extremely important for providing protection against illnesses and many long-term side effects of illnesses for everyone, not just children, but adults. Especially adults with compromised immune systems. For example, natural exposure to polio could cause lifelong paralysis. The mumps can cause hearing loss and meningitis and measles can sometimes be fatal. Vaccinations can prevent these types of illnesses and the disease-related side effects from occurring. People are dying, right now, because they made the choice not to be vaccinated. And others are dying because they were infected by one of those people. Am I making this up? check out the epidemics happening in California and the West Coast.

Back to these articles published in local papers and on the web using these misleading scar tactic headlines. one reader wrote: "I do wish those working to counter the misinformation and propaganda spread by the anti-vaxxers would stop using the question to headline their positive efforts. There is not a question involved here. There is only vaccine which does prevent disease and does not cause autism and on the other hand there are these wildly irresponsible scaremongerers who have made names for themselves and put entire populations of children at risk. These two things are not equal. Please stop the pretence of giving them equal consideration in a rational argument."

One of these recent articles was published by a hospital! Why? To get reader's attention. A lot of us thing these kinds of articles do more damage than good because the short headlines continue to reinforce misinformation. And there is a lot of misinformation out there. Too much.

For those that prefer research over hype and emotion, here are some useful references:

California study: "The DDS data do not support the hypothesis that exposure to thimerosal during childhood is a primary cause of autism." Click here:
http://archpsyc.ama-assn.org/cgi/content/abstract/65/1/19

Independent testing of Wakefield's MMR/autism hypothesis - test failed to support Wakefield's conclusions. Has links to several other supporting studies: Click here:
http://www.sciencedaily.com/releases/2008/09/080904145218.htm

Italian study looking at kids who received different levels of thimerosal, comparing their brain development 10 years later. Click here:
http://pediatrics.aappublications.org/cgi/content/abstract/123/2/475

Danish study of 440,000 kids who got MMR and 97,000 who didn't. No significant different in autism and ASD rates. Click here:
http://www.nejm.org/doi/full/10.1056/NEJMoa021134#t=abstract

Japanese study to see if switching from MMR to single-dose vaccines affected autism rates. It didn't. Click here:
http://www.medicine.ox.ac.uk/bandolier/booth/Vaccines/noMMR.html

Montreal study of 27,000 children actually found somewhat LOWER rates of developmental disorders in the children exposed to thimerosal. Click here:
http://www.ncbi.nlm.nih.gov/pubmed/16818529

2010 Detailed study of 250 ASD kids versus 750 controls. No relationship between ethyl mercury exposure and ASD: Click here:
http://www.ncbi.nlm.nih.gov/pubmed/20837594

Comprehensive list of science-based resources on vaccines and autism: Click here:
http://sciencebasedmedicine.org/reference/vaccines-and-autism/

But now there is even more damaging information coming forward about the non-relationship between vaccines and autism. Here is what was published by NPR this week: (For an excellent analysis of the article and the research it's based upon I would click here and read the review in Science-Based Medicine: http://www.sciencebasedmedicine.org/?p=9552

Here is the NPR report: Click here.

Now I know there are still those who think the research is ...well...lies. That big pharma is making these things up to make a profit, and doctors are poisoning their patients to make money. (Actually, most doctors and hospital provide vaccines at a financial loss!). One of their heros is Dr. Wakefield. They believe there is a giant conspiracy on the part of the government, medical licensing boards, medical journals, medical associations and corporations to hide the truth that Dr. Wakefield has to tell. This NPR story clearly points out what was really going on. Why the articles Wakefield published falsely claiming a connection between vaccines and autism were withdrawn, and why his medical license was taken away. Here is some of what the report says:

"The first study to link a childhood vaccine to autism was based on doctored information about the children involved, according to a new report on the widely discredited research.

The conclusions of the 1998 paper by Andrew Wakefield and colleagues was renounced by 10 of its 13 authors and later retracted by the medical journal Lancet, where it was published. Still, the suggestion the MMR shot was connected to autism spooked parents worldwide and immunization rates for measles, mumps and rubella have never fully recovered.

A new examination found, by comparing the reported diagnoses in the paper to hospital records, that Wakefield and colleagues altered facts about patients in their study."

Let's make this clear, the study shows some of the children ALREADY had signs and symptoms of autism or neurological disorders BEFORE they were vaccinated, that Wakefield knew this and that he used the information anyway.

"The analysis, by British journalist Brian Deer, found that despite the claim in Wakefield's paper that the 12 children studied were normal until they had the MMR shot, five had previously documented developmental problems. Deer also found that all the cases were somehow misrepresented when he compared data from medical records and the children's parents."

"In an accompanying editorial, BMJ editor Fiona Godlee and colleagues called Wakefield's study "an elaborate fraud." They said Wakefield's work in other journals should be examined to see if it should be retracted. Last May, Wakefield was stripped of his right to practice medicine in Britain. Many other published studies have shown no connection between the MMR vaccination and autism. But measles has surged since Wakefield's paper was published and there are sporadic outbreaks in Europe and the U.S. In 2008, measles was deemed endemic in England and Wales."

Yes, surges of measles.... and whooping cough and other preventable diseases.

Why did Wakefield do this? Some think that it may have something to do with the fact he prepared the report while being paid by a law firm that wanted to sue vaccine makers and they needed proof...and that he was connected to a proposed alternative vaccine. Hmmmm.... Yes, big pharma and corporations ARE at the heart of this, but not the way people think. They wanted to make money convincing people that vaccines were dangerous. And regretfully, that part of this plot seemed to work out.

A final note: again this week one of my articles supporting the idea that parents get their children vaccinated against deadly childhood diseases upset someone and they made a phone call and made threatening statements. This has happened before, sometimes at 3 a.m. I really don't understand this behaviour. These are people who seem to believe in vast and complicated conspiracy theories, they are convinced the government and big business are poisoning their children. But I'm not the only one who is threatened because we try to spread science and data. Dr. Paul Offit (who wrote "Autism's False Prophets") can't even go to a book signing because he and his family have been threatened and book stores fear violence (read this article in the NYTimes: click here). And then there are parents who often report top me that they too are harrassed and often bullied because they make some public statement about medicine, vaccines and science. Click here for one report from Canada: http://www.leaderpost.com/technology/Vaccine+book+brings+hidden+support+Author/1301769/story.html?id=1301769 At some point we all have to take a stand for science and modernity before we slip into another dark ages.

We can start by being careful with how we title articles. Autism is something that is destroying individuals, families, schools ....and we still don't have any idea what causes it or how to prevent it. Our skills for treating it are improving, but minimal. We need to stop wasting time and money on false accusations, phoney data and conspiracy theories and start focusing on science.

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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
www.socialcognitivetherapy.com

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

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

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.

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.