What Causes Autism? Science is slowly approaching an understanding.

"Notes on Autism Assessment and Treatment" are written by Dr. Jim Roche. These autism notes are not meant to provide a guide to either diagnosis or treatment. For information on diagnosis and treatment contact your medical doctor or a registered/licensed psychologist for an appointment and assessment. Information about Dr. Roche's services can be found at these addresses:

Relatedminds: http://www.relatedminds.com
ADHD Help BC: http://www.adhdhelp.ca
At Psychology Today: http://therapists.psychologytoday.com/rms/70682
At the BCPA website: http://bcpa.pixelmountainarts.com/users/jimroche
At CounsellingBC: http://www.counsellingbc.com/listings/JRoche.htm
At Psyris: http://psyris.com/drjimroche
At Autism Community Training: http://www.actcommunity.net/jim-roche.html

What causes autism, Autism spectrum disorder and Asperger's Syndrome? We now know more about the cause of autism than we have for a long long time. But we need to be careful not to allow the anti-vaccine / anti-scient crowd misdirect us. Moises Velasques-Manoff, the author of "An Epidemic of Absence: A new Way of Understanding Allergies and Autoimmune Diseases" has written an excellent summary of the latest research for the New York Times. It can be found here:

http://www.nytimes.com/2012/08/26/opinion/sunday/immune-disorders-and-autism.html?smid=pl-share

Velasques-Manoff points out that one subset of those with autism, which makes up at least if not more than 1/3 of those with autism, seem to have some type of inflammatory disorder. And this inflammatory disease doesn't start as a result of vaccinations - it's starts way before that, in the womb. We know this is true because the brain changes that are associated with autism are noted prior to the age of immunizations, and there is no correlation between those getting these vaccines and those who develop autism. Hopefully, someday, the uninformed will start to notice the basic problems with their science, or maybe start to have some respect for science.

What the research Velasques-Manoff writes about notes is that a large number of mothers of autistic children have had some sort of immune compromising condition while they were pregnant. This leads to a inflammatory reaction, in both the mother and child, and this effects the astroglia and microglia - which ar enlarged from chronic inflammation.

 A population-wide study in Denmark spanning two decades indicates that infections during pregnancy increases the risk of autism in children.  Sounds simple enough, doesn't it? Infections during pregnancy ...must cause autism. So cut down the number of infections. But again, the epidemiology doesn't lead in that direction. Like much of science, it's more complicated than that. You see, while world wide viral and bacterial infections have gone down ....autism rates have gone up. Especially places where there are fewer infections! Somewhat of a contradiction.

You see while infections and other disorders have decreased, the number of inflammatory disorders HAS gone up.  And the relationship between these inflammatory infections and autism is very clear. A mother with rheumatoid arthritis, an inflammatory disorder, has an 80 percent increase in the chance of having a child with autism. A mother with celiac disease increase her risk 350 percent.

So the questions now becomes why we are now so prone to inflammatory disorders, and if there is anything we can do to decrease these risks?  There are several suggested therapies - for the mother - and these oddly follow the idea of doing something about what Velasques-Manoff calls our "microbial deprivation." (Remember: dirt and parasites are "famous for limiting inflammation.")

 Probiotics? "domesticated parasites?"  These are just some of the thoughts Velasques-Manoff and others are looking at. What we do know is that we have spent too much time looking at the effects of dysregulation in the child with autism, and not enough time looking at dysregulation and other problems in parents .... remember, it's a genetic disorder to a great degree.

Click on the above link to get the New York Times article, and check out some of Velasques-Manoff's writing elsewhere.

Autism Risk and Parental Age

Another research paper points to the problem of older men having children, something most thought was not an issue a few years ago. The research shows that older men are more likely than young ones to father a child who develops autism or schizophrenia. This is because of random genetic mutations that become more numerous with advancing paternal age. This study of the effects of parental age on likelihood of having a child with autism is the first study to quantify the effect as it builds each year. The study also notes that the age of mothers had no bearing on the risk for these disorders. What you need to remember is that this is just one of MANY risks that we have associated with autism. One risk that isn't related to autism is vaccinations, which, in spite of the overwhelming evidence is still thought of as an issue by many uninformed parents, especially those who rely on pseudo-scientific research for answers.

Click here for the article in the New York Times, which does a great job of explaining the research these scientists undertook:

http://www.nytimes.com/2012/08/23/health/fathers-age-is-linked-to-risk-of-autism-and-schizophrenia.html?smid=pl-share

Autism and Pets

(From MedPage) "Getting a pet may help autistic children improve their social skills, a small study showed." "Children with autism who acquired a pet after age 5 showed gains in two prosocial behaviors -- "offering to share" and "offering comfort" -- compared with those who had never had a pet (P<0.0014 for both), according to Marine Grandgeorge, PhD, of the Centre Hospitalier Regional Universitaire de Brest in France, and colleagues." "Autistic children who had had a pet since birth, however, showed no differences compared with their pet-less peers, the researchers reported online in PLoS One." "Given the potential ability of individuals with autism to develop prosocial behaviors, related studies are needed to better understand the mechanisms involved in the development of such child-pet relationships," the authors wrote. Click here to read the entire article: Pets Boost Social Skills in Kids with Autism Click http://www.medpagetoday.com/Neurology/Autism/34012 For information on services I provide for children, adolescents and adults with Autism Spectrum Disorder, Asperger's Syndrome and ADHD visit my website at www.relatedminds.com

Sensory Processing Disorder and ASD

According to a policy statement from the section on Complementary and Integrative Medicine of the American Academy of Pediatrics Sensory Processing Disorder should not be used as a medical diagnosis. They express concern with it's overuse, and the application of sensory based therapies for which there is little if any evidence of effectiveness. Regretfully, even with a diagnosis of Autism Spectrum Disorder or Asleger's Syndrome many school district produce IEPs (Individual Education Plans) that rely heavily on these unproven treatment- while they avoid the use of validated behavioural treatments. Often the reason for this is that sensory based treatments are easier to implement with untrained staff, and there is simply a lack of trained professionals in the field of behavioural interventions (or classroom management). Click http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/33018 for the full story The statement says, "Pediatricians should not use sensory processing disorder as a diagnosis, according to a policy statement from the American Academy of Pediatrics. Although there are standardized measures of a child's sensory processing abilities, there is not a widely accepted framework for diagnosing the disorder, members of the AAP's Section on Complementary and Integrative Medicine wrote in the June issue of Pediatrics." The reort notes, "that the committee developing the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has called for further research before officially recognizing sensory processing disorder." In addition, the authors wrote, "it is unclear whether children who present with sensory-based problems have an actual 'disorder' of the sensory pathways of the brain or whether these deficits are characteristics associated with other developmental and behavioral disorders." The report suggests that instead of diagnosing sensory processing disorder, pediatricians should perform a thorough evaluation -- usually with appropriate referral to a developmental and behavioral pediatrician, child psychiatrist, or child psychologist. The report continues, "consideration should be given to other developmental and behavioral disorders that may be associated with difficulty tolerating or processing sensory information, including autism spectrum disorders, attention-deficit/hyperactivity disorder (ADHD), developmental coordination disorders, and childhood anxiety disorders." "Pediatricians should inform families that occupational therapy is a limited resource, particularly the number of sessions available through schools and through insurance coverage," the authors wrote. "The family, pediatrician, and other clinicians should work together to prioritize treatment on the basis of the effects the sensory problems have on a child's ability to perform daily functions of childhood." Here in Bc there has been tremendous growth in school based "sensory rooms." Often children with ADHD, Autism Spectrum Disorder or Asperger's Syndrome are removed from class and sent to the "sensory rooms" in an effort to calm them down, rather than the school completing an appropriate Functional Behavioral Assessment and developing a behavior based intervention plan that either teaches new skills or uses behavioural techniques (long known about and familiar to experts in the field) such as controlled exposure, relaxation and thought stopping interventions to teach the child appropriate ways to deal with unwanted sensory input. Little effort is made to help the child develop coping skills, self-southing skills or other alternative behavioural skills to deal with the sensory issues. Many parents feel that the over use of sensory rooms and removal from the teaching environment do little more than reinforce inappropriate and unwanted behaviours. A second look at the over use of the "sensory Processing Disorder" diagnosis seems like an appropriate place to start. While here in BC excessive removal from a classroom (Time Out / Time Away) due to behavioural issues seems acceptable. In the United States such removal would be considered a "change in educational placement" and would require approval by both the school special education team and parents. An excellent source of information on how behaviours that interfere with learning should be addressed in the classroom through well know and scientifically supported educational and behavioural techniques can be found at this web page: http://www.pent.ca.gov The PENT website offers free materials which any school district could use to address problematic behaviours which interfere with learning. An appropriate Functional Behavioural Assessment (FBA) is the place to start when addressing these kinds of issues. I have used the PENT training materials to implement training programs in completing and writing Functional Behavioural Assessments for almost 10 years and it is really unmatched ....and FREE. All of these training materials are....FREE. Rather than providing easy interventions that are not supported by science. I would hope that every school instead provides science based assessment and intervention programs that directly assess the behaviours of concern and use interventions techniques we know work. The problem comes down to this: If your child has a serious behavioural problem at school, you should expect that the school would implement strong, science based interventions that are designed to directly address the problem AND teach new adaptive behaviours. Changing the child's environment, and removing them from the classroom, is not a plan. Sensory room or not. If your having such problems with your child in school I would suggest contacting an expert in the field, a psychologist or professional educator, to visit the school, observe the situation and complete an FBA (Functional Behavioural Assessment)

What Treatments are there for Adults with Asperger's Syndrome or Disorder?

I am often asked: "What Treatments Are Available for Adults with Asperger Syndrome?" Many adults who have been having low level but continuous problems socially, at college, work or in their own family go on line and seek out a diagnosis. Often they complete a check list somewhere and it tells them they MAY have Asperger's Syndrome or Asperger's Disorder. Of course, one of the problems is the short check list was designed to do nothing more than search out signs and symptoms of Aspeger's, and honestly, there are a lot of people who you see most of those signs or symptoms in. A real diagnosis would have taken a broader view, and looked at alternative causes for these symptoms. This process is called "differential diagnosis" and a licensed psychologist or medical doctor familiar with Asperger's would have ruled in or out several very similar disorders. But, at any rate, you have completed the checklist, it says Asperger's and your symptoms are of concern. Many people wonder why someone would even go through an examination to get a diagnosis, because they aren't sure what "therapies" are even available. For children with Asperger Syndrome (AS) and other forms of autism usually there is a fairly common set of treatment interventions available through the school district. This might include physical, occupational and speech therapy along with some kind of social skills (social reciprocity) training and behaviour support. But for adults it's a very different matter. Most people start treatment because of some event that is currently going on in their lives. They may have had difficulty at school with more complex subjects, and their difficulty is related to Asperger's tendency to limit cognitive flexibility. This can be addressed through psychoeducation, practice and feedback. Others may be having problems at work. They could be similar to those just mentioned, or include time management issues, focus and attention problems very similar to ADHD, or social interaction issues. All of these are addressed through fairly common techniques, and the issue of social interactions, or social cognition, is usually addressed through psychoeducation (readings and discussions about how the brain works in social interactions) and modelling, then practice in using social cognition skills. For the individual with Asperger's this is a very different issue than "social skills training," which many people are pointed to by therapists who are not familiar with the complexity of Asperger's Syndrome or Disorder. As I always do, let me mention the work of Michelle Garcia Winner here. Here web page, www.socialthinking.com explains this issue really well. When adults come to my offices in Burnaby or Vancouver for treatment of aspects of their Asperger Syndrome I often recommend trying to look over Michelle's materials to get a firm grip on what exactly is going on when they have difficulty in social settings. Family issues is another point that often brings individuals with Asperger's Syndrome to the office. Sometimes we work together one-to-one on understanding and improving communications, sometimes we work on things as simple as arranging appropriate schedules and interaction times. Couples often need relationship counselling as well. And of course, educating your spouse can make a big difference. This is another place where a trained professional comes in handy. Finally, many individuals come in for the same symptoms and problems anyone might come to a therapist or psychologist for. They may have anxiety issues, phobias or depression. For these issues we often use an adapted form of CBT - Cognitive Behavioural Therapy to address the thoughts and feelings of loneliness, depression and isolation. Of course others come in because of legal issues after work place incidents, or to help get social services and so on. Some individuals need help with daily living skills like keeping a bank account, eating properly, exercising and finding a job. Others with Asperger's have anxiety because of their limited ability reading social cues at work where they may be a department head, director of research or university faculty. Asperger's is a spectrum disorder and individuals come in with a spectrum of issues they can use support and help with. These are just a few of the reasons individuals come to my office seeking help with Asperger Syndrome symptoms. For more information on the services I provide please feel free to contact me, or check out the information on my web page at www.relatedminds.com

Adolescents and Young Adults with Aspergers and High Functioning Autism

Treatment for adolescents (teens) and young adults with Asperger's Disorder or High Functioning Autism are few and far between. One of the reasons is that many of these individuals are fairly high functioning and reluctant to join in groups, so, we have a really hard time outside of major/major metropolitan areas forming groups. What we often rely upon is individual therapy and coaching for these individuals. What does individual therapy consist of? Well, it usually starts with psycho-education. That is, learning the ins and outs of the disorder. Often this means learning it from the perspective of others, because one of the major difficulties people have is getting and understanding the perspective of others. While there are a lot of materials and training programs out there for younger teens and children with Asperger's Disorder there really aren't many for older teens and young adults. Still, we are able to make use of some of the materials from Michelle Garcia Winner which can easily apply to and be adapted for young adults and the work place. One set of materials we often use is her "social Behavior Mapping" method, which refocuses their attention on how they are perceived by others. This lack of "reciprocity" or use and understanding of "pragmatic language" is a common source of difficulty. An example of this is the individual who, while at work, is asked to sign a get well card for the office manager's daughter, who he has never met. While everyone else in the office signs the card as it is passed around, this individual, let's call him Tom, instead of signing says, "Well, I don't really know her." While this is true, and often family, friends and even therapists spend a lot of time arguing about the "truthfulness" of such statements, it becomes a work issue because such a reaction and comment is simply unexpected in the workplace, where social rules instruct you to sign the card, and if you can't think of anything just....sign your name and write "get well." How many arguments about this I've had with clients with Asperger's I can't tell you. Like Tom they know the social norm, they could recite it to you, but don't implement it because they need to stick to the facts of the situation. The big leap for them is to understand 1 How other's see their actions; and 2) Learn how to use the reaction of others to monitor and adjust their own behaviour. Something that just doesn't go on often enough. Michelle's work addresses these issues, not by going right to a problem area and ...well "sticking a finger in someone's eye while pointing out their problem." Instead we address the learning and thinking process as a who, and give students simple techniques to support their use of appropriate social interactions. Therapy for adolescents, teens, and young adults with Asperger's Disorder also often focuses on some of the same themes you would expect anyone their age to be dealing with. Individuals with Asperger's and high functioning Autism almost always tell me they want to develop relationships, make friends and become close to others. But because of these social cognitive deficits, like the one described above, this can be difficult task. This isolation can lead to anxiety, stress and depression just as it could with anyone else. So often these individuals with Asperger's Disorder and high functioning autism are often seen for the same reasons anyone else is seen. Therapies that are effective with others, such as Cognitive Behavioural Therapy 9CBT) is often just as effective, and can be easily adapted to make use of external and visual support systems. Finally there is the use of self-help books. Often individuals with Aspegers Disorder or high functioning autism can't afford the services of a psychologist or other licensed health professional. For those individuals a coaching mode using self help / self directed materials may be a good place to start. One book I often recommend, especially for young adults entering college or the workplace, is "Social 'Thinking at Work," again, by Michelle Garcia Winner. This is an excellent book, written especially for those with Aspeger's or high functioning autism. I would suggest this is one of the best books around for young adults, and recommend it highly. You can call around and find it at several bookstores, find it through the "suggested readings" link on my web page (at www.relatedminds.com) or borrow it through your local library. Checking out Mitchelle's web page at www.socialthinking.com may also reveal some more recent books and materials. I'd give a look there. I hope this has been helpful. All i can do is recommend you find a clinician, therapist, counsellor or registered psychologist, who has expertise in this field. And that would mean working for several years with all age groups, children, adolescents and dults, in order to understand the complexity of this developmental disorder. The good news is that overall research has shown we are highly successful at helping higher functioning children, adolescents and adults than we could have hoped. 'Good luck in your reading!

ADHD and Autism

"I heard that you can't have autism, or Asperger's, and ADHD at the same time, is that true?" I hear this a lot. Parents go to their MD and their child, whom might have mild or high functioning autism or Asperger's Disorder is also diagnosed with ADHD. But someone "in the know" has told them this can't be true! They then worry that their medical doctor or psychologist is confused, or doesn't know what he or she is doing! Here is the simple answer: The DSM (Diagnostic and Statistical Manual of the American Psychiatric Association) does say that ASD (autism) rules out ADHD. But honestly, we don't always follow every rule stated in the DSM IV. Some of these rules, years after publication, don't make the same sense they once did. That's why there is a new version of the DSM coming out in the next year or so. The rules, or diagnostic criteria, for Autism, Aspergers (which will disappear) and ADHD (Attention Deficit Hyperactivity Disorder) are all changing to meet the real world facts we have been confronted with since the last publication of the DSM. Another reason an MD may diagnose ADHD and Autism is that he or she needs to rationalize the prescription for the ADHD medication. ADHD medications are closely monitored, and giving them to individuals without a diagnosis of ADHD is simply problematic. Do children, adolescents and adults with ASD also have ADHD? I think so. Sometimes it's obvious. But at other times what looks like inattention, focus issues and hyperactivity is nothing more than the symptoms of autism spectrum disorder. One needs to look at the severity of the autism disorder and observe the situation to make a real determination. And sometimes ADHD medications are prescribed to deal with those symptoms. Still worried about this issue? Talk it over with your medical doctor or psychologist. I often recommend that patients write out their concerns and questions before they come in to see me. That way it's easier to stay on track and not leave your appointment with the same concerns and anxiety you went there with.