Article # 329. How Autism Prevention Works

People ask us all the time, "What is autism and How does autism prevention work?"
First, let's clarify what autism means under today's generally accepted definition. It is a mental (note: NOT physical) disorder. People with autism have difficulties communicating, forming relationships with others and find it hard to make sense of the world around them.
Second, and since autism is behaviorally diagnosed, some skeptics say you can't prevent autism because the "experts" haven't found the *physical* cause of autism yet.

And we agree. The "experts" have not found THE exact cause of autism yet.
However, did you know that dozens of medical doctors across the country are helping their patients avoid getting autism by using some very basic (yet REALLY important) ways of living?

If we remove some of the biggest risk factors (all of which the "experts" are currently studying to see which one causes autism) we can certainly reduce the risk for your child.
It's kind of like knowing that lots of people get seriously injured when they become a boxer. Simple solution, don't become a boxer.

Or similarly, if you know that smoking cigarettes is highly likely to cause cancer, you don't become a smoker.

Now, what if you spent the hours and days and months and years doing all of the research we've done on autism and we said there are about 12 things that might cause autism?
Simple, you would AVOID those things.

It's not complex.
It's not a list of more things to do.
It's not a list of things to buy.
It's simply a list of things to not do or take now.

Article # 328. Risk factors and Preparing for your appointment

Risk factors

Autism affects children of all races and nationalities, but certain factors increase a child's risk. They include:

·         Your child's sex. Boys are four to five times more likely to develop autism than girls are.

·         Family history. Families who have one child with autism have an increased risk of having another child with the disorder. It's also not uncommon for the parents or relatives of an autistic child to have minor problems with social or communication skills themselves or to engage in certain autistic behaviors.

·         Other disorders. Children with certain medical conditions have a higher than normal risk of having autism. These conditions include fragile X syndrome, an inherited disorder that causes intellectual problems; tuberous sclerosis, a condition in which benign tumors develop in the brain; the neurological disorder Tourette syndrome; and epilepsy, which causes seizures.

·         Parents' ages. There may also be a connection between children born to older parents and autism, but more research is necessary to establish this link.

Preparing for your appointment

Your child's doctor will look for developmental problems at regular checkups. If your child shows any autism symptoms, he or she will likely be referred to a child psychologist, pediatric neurologist or developmental pediatrician for a thorough clinical evaluation.

What you can do: To prepare for your child's appointment:

·         Bring a list of any medications, including vitamins, herbs and over-the-counter medicines, your child is taking.

·         Make a list of all the changes that you and others have observed in your child's behavior.

·         Bring notes of any observations from other adults and caregivers, such as baby sitters, relatives and teachers. If your child has been evaluated by an early intervention or school program, it would be helpful to bring this assessment.

·         Bring a record of developmental milestones for your child, such as a baby book, if you have one.

·         Bring a video of your child's unusual behaviors or movements, if you have one.

·         Try to remember when your other children began talking and reaching developmental milestones, if your child has siblings, and share that information with the doctor.

·         Be prepared to describe how your child plays and interacts with other children, siblings and parents.

·         Bring a family member or friend with you, if possible, to help you remember information and for emotional support.

Make a list of questions that you want to ask your child's doctor. Don't be afraid to ask questions any time you don't understand something. Questions to ask might include:

·         Why do you think my child does (or doesn't) have autism?

·         Is there a way to confirm the diagnosis?

·         If my child does have autism, is there a way to tell how severe it is?

·         What changes can I expect to see in my child over time?

·         What kind of special therapies or care do children with autism need?

·         How much and what kinds of regular medical care will my child need?

·         What kind of support is available to families of children with autism?

·         How can I learn more about autism?

What to expect from your child's doctorYour child's doctor is likely to ask you a number of questions. Be ready to answer them to reserve time to go over any points you want to focus on. Your doctor may ask:

·         What specific behaviours prompted your visit today?

·         When did you first notice these symptoms in your child? Have others noticed signs?

·         Have these behaviours been continuous or occasional?

·         Does your child have any other symptoms that might seem unrelated to autism, such as stomach problems?

·         Does anything seem to improve your child's symptoms?

·         What, if anything, appears to worsen your child's symptoms?

·         When did your child first crawl? Walk? Say his or her first word?

·         Does your child have delayed speech?

·         What are some of your child's favourite activities? Is there one that he or she favours?

·         How does your child interact with you, siblings and other children? Does your child show interest in others, make eye contact, smile or want to play with others?

·         Have you noticed a change in your child's level of frustration in social settings?

·         Does your child have a family history of autism, language delay, Rett syndrome, obsessive-compulsive disorder, or anxiety or other mood disorders?

Article # 327. Practical Tips to Make your Classroom Autism-Friendly

 

In this post, you can find a list of interventions and strategies to help teachers make their classroom Autism-friendly. As with all of my other articles, Readers must remind that students with Autism are very different from each other, hence some of these strategies may not apply to all of them. Advice from author is to ‘personalize’ each of these strategies based on your students’ personalities, skill-set, social and academic abilities. It is also helpful to keep a written record of the interventions you have put in place and their effectiveness (or lack thereof). This will help you plan future interventions, and will also serve as evidence for annual reviews and/ or school inspections.

RULES AND REWARDS

·         Define classroom rules as early as possible. Boundaries should be clear and concise. Make sure that all rules are fair to everyone in the classroom and that are any ‘special’ arrangements made for students with ASD are explained to mainstream students.

·         Reinforce rules with pictures and words that are clearly visible to the students.

·         Establish a reward system. Rewards could be visible for everyone, or only to individual students.

PLACE IN THE CLASSROOM

Students with Autism need to sit away from distractions as most of them find it difficult to ‘tune-out’ sensory stimulations.

 

·         Keep them away from the classroom doors as they may be distracted by people coming in and out of the class (more than your average student).

·         Keep them away from windows – passers-by are distracting enough for others.

·         If you are in a mainstream school, especially primary school, your classroom may be full of colorful posters and displays which could be very distracting to students with ASD. Make sure you place students with ASD in a seat where they are not in front of any colorful displays.

·         Make sure that they sit next to a good role model. Being seated next to a student who is hyperactive, talkative or just generally unpredictable can be very unsettling to students with ASD.

·         Establish a permanent space or spot for your students with ASD would sit every time your class have Circle time and Carpet time. This aids predictability.

VISUAL REPRESENTATIONS

·         Most people with Autism prefer visual representations, especially of timetables. It is useful to have individual Visual timetables for students with ASD. It helps them organize their day and it helps them predict what will happen next. Physically putting pictures on visual timetables at the start of every school day helps students prepare themselves for the day ahead. Below are a few examples of how visual timetables could look like (taken from  asdteacher):

·         Make sure that any change in the students’ or the class’ routine is represented in their timetables. Make sure that such changes are explained, too.

·         Non-verbal students may be helped by introducing PECS, or Picture Exchange Communication System. In simple terms, PECS is communication through pictures, i.e. students show their teachers a picture of what they want (e.g. the toilet) and the teacher honours that request.

COMMUNICATION

Make sure that you have their attention before communicating with them. Make sure you call on their names everytime you want to speak to them.

·         Do not demand eye contact. People with Autism struggle to give eye-contact for various different reasons. It has been suggested that quite a lot of them are not able to process Auditory and Visual stimuli simultaneously. Others found that eye-contact is avoided when people with ASD are thinking and/ or concentrating.

·         Use concrete language. Keep it simple and straight to the point.

·         Be careful with metaphors, sarcasm and irony. People with ASD have a very literal understanding of language.  Most of them may not get phrases like ‘Pull your socks up’, or ‘Toast the Bride’. I remember this one student of mine a few years back who was extremely puzzled when I told him to ‘Hold that Thought’.

·         Explain everything that has a double meaning.

·         Allow extra processing time. The National Autistic Society recommends practitioners to wait at least six seconds before repeating an instruction (Six-second rule).

TEAM APPROACH

·         Teachers, parents and students should all be involved in planning interventions. A healthy relationship between schools and parents are an excellent platform for success.

·         Keep a home-school diary to increase communication with parents and to ensure that interventions are followed-through.

Article # 326. Common signs of Autism in the classroom

Does my student have Autism? Common signs to keep an eye on

Autism is a spectrum of conditions which affect different areas of people’s lives. Since its manifestation is very different from one person to the next, it is very difficult to tell whether a child has it or not, especially in the classroom. Students who have Autism but is not diagnosed are often labeled as ‘stupid’, ‘lazy’, or ‘odd’, amongst other things, which could lead to many different negative consequences such as bullying, and/ or depression. Therefore, it is important for teachers and teaching assistants to know what signs to look out for in order to determine whether a child needs to be referred to professionals to be assessed and diagnosed.

Below are a few common characteristics which majority of students with Autism present. Having worked with people of various ages (3-16 y/o) who have been diagnosed with Autism for a long time, It’s been noticed that they display some common behavioral patterns (AGAIN, REMEMBER THAT AUTISM IS A SPECTRUM OF CONDITIONS). I must warn you that this list is only a guideline and not official diagnostic criteria.

PLEASE NOTE that it is easy to go down the road of ‘home-based diagnosis’ and that teachers must remember not to do so.It is also important to remember that Autism manifests in different ways, therefore the magnitude of each characteristic, and the combination of characteristics WILL vary from one person to another. Students who exhibit these characteristics should be referred to the school’s Special Educational Needs Coordinator (or equivalent). It is better to flag up a student as possibly having Autism (or another Special Need) and be proven wrong, than to ignore the signs and risk not getting the right help and interventions for the student.

Here is the list of characteristics/ behaviors:

1.       Makes very little or no eye-contact. Some children may give eye contact but would only look at you from the corner of their eyes.

2.      Can only understand questions (even simple ones such as what the weather is), when phrased in a specific way. If certain words or if the sentence structure is changed, despite the meaning staying the same, they will appear clueless and may not give any response.

3.      Has difficulties imagining a situation or ‘putting themselves in other people’s shoes’.

4.      Takes spoken language literally and has a very limited understanding (if at all) of metaphors. If told ‘would you like to come and sit on the carpet?’ because it is carpet time, a students with Autism may respond with ‘No’.

5.      Instead of talking to people, they talk AT them. Conversations are led by them all the time, and the topics only revolve around the things that they like. They may lose interest  (or ignore you) if you speak about something that they do not find interesting.

6.      Finds it difficult to read facial expressions and emotions. 

7.      Displays inappropriate emotions. May laugh even if someone’s crying. May ignore someone’s cry for help.

8.     Does not obey your instructions unless their name is mentioned or unless you are talking to them face-to-face.

9.      Gets upset when routines change, e.g. when a lesson is cancelled, when a substitute teacher is taking the lesson or when moved seats.

10.  Repeats phrases they have heard, even inappropriate ones.

11.   Has little or no interest in seeking out other children to play with or interact with.

12.  Play with toys in an unusual way, e.g. instead of rolling cars to pretend they are real cars, students with Autism may line them up.

13.  May be overly fascinated by patterns or strong visual stimuli, e.g. brightly colored poster on the corner of your classroom wall.

14.  Can be overly active or much less physically active than their same-age peers.

15.   Developmental milestones may be achieved in a pattern that is not the same as everyone else

Article # 324. DSM 5 and its implication to Autism Spectrum Disorders (ASD)

 

 

DSM 5 and its implication to Autism Spectrum Disorders (ASD)

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), also known as the ‘bible of psychiatric diagnosis’ has been approved last month. Although the actual publication will not be until May of this year, the revisions seems to be final.

Along with this new revision is a major overhaul of the diagnostic criteria and a new conceptualization of Autism Spectrum Disorders (ASD). The proposed changes have been based on a large body of research and have been discussed by qualified professionals. They are aimed to improve the diagnosis for ASD and to aid professionals to give specific interventions to specific needs of each individual.

Here are the changes:

1. A blanket term of Autism Spectrum Disorders will be used. Asperger’s Syndrome and Pervasive Developmental Disorders Not Otherwise Specified (PDD-NOS) will be removed- The DSM-5 panel decided to remove the sub-categories of ASD since there is no sound evidence to suggest that there really is a need for them. For instance, people with Asperger’s Syndrome and High Functioning Autism are not substantially different from one another, i.e. their symptoms overlap a lot. Additionally, PDD-NOS is not very clear and diagnosis varies from one professional to another- you can be diagnosed with PDD-NOS with mild symptoms or only one or two symptoms.

It is important to note that people who are currently diagnosed as having Asperger’s Syndrome  and PDD-NOSwill be given a new diagnosis after re-evaluation. I personally believe that this change will have a significant effect on people with AS and PDD-NOS since a large number of them identify greatly with their diagnosis (although some welcome the change).

2. No longer a TRIAD of IMPAIRMENTS: Most of the literature in Autism describe it as having three main symptoms: Communication impairments, Limited Imagination and Repetitive Behaviours, and Impairments in Social Interactions. In the DSM-V however, it is reduced into two. Firstly,  Social and Communication Domain- which combines social interaction aspects and verbal/ non-verbal communication aspects. Secondly, Restricted and Repetitive Interests and Behaviours, which includes  ’Stereotyped and Repetitive Speech’ and ‘Hyper- or Hypo-Sensitivity to Sensory Aspects of the Environment’. It is important to note that deficits in each of these areas must be ‘impairing’ before one can be diagnosed with Autism.

3. Symptoms may not fully manifest until demands exceed capacity: Although the DSM-V requires most symptoms to be present in early childhood (before age 3), it also acknowledges that children may not have other symptoms because of their environments, or any other reason.

4. Clinicians should include Specifiers: Along with an ASD diagnosis, clinicians will be asked to include a description of each children in order to monitor the onset and (if applicable) the progression of each determinants. Specifiers include Intellectual Ability, Language Competence, Motor Co-ordination, difficulties in Literacy/Numeracy, and other disorders.

Sources:

Autism Speaks

American Medical News

DSM5.org