Posts Tagged ‘autism puzzle’

The AMAZING Siblings of Patients with Autism

Sunday, October 16th, 2016

siblingAt the Child Development Center of America, it is our custom to request that parents bring the patient’s neurotypical siblings. Staff and interns can learn to appreciate the differences. I get a sense of the challenges faced by the children who are affected. An added bonus has been our observation that some of the most heroic family members are child’s brothers and sisters.

It never ceases to amaze me that even the youngest sibling will play with, fight with, endure – and teach – their affected friend. There is no correction, no repetition, and no prompting. It’s true love – even if they take each other’s stuff.

Brothers and sisters demonstrate patience and perception about the other’s wants and needs. It is a constant reminder of the important role these sometimes forgotten family members play in the affected child’s development. Their maturity frequently exceeds their chronological age.

One parent recently provided this beautiful essay written by the 11 year-old sister of a very affected patient, who has only recently begun to seek and interact with others and with his environment. Without being asked, here is what Jillie wrote:

jillie-barton   An autistic kid’s brain is like a computer keyboard. A keyboard has a chip that sends signals to the other keys. A fixed one sends a message to the keyed it gets there. When you press the key a letter appears on the screen.
  But a broken one doesn’t. The chip sends a message down the right route. But the right route isn’t working right, so the message tries to find another way.
   But the message doesn’t get there. So when you hit the key nothing happens.
   It’s sort of like an autistic kid’s brain. the brain sends a message down the nervous system. But the route isn’t working correctly. So the message tries to find a new way. But sometimes it works.

Siblings of children with autism are the subject of a number of scientific studies. Twenty years ago, one paper described, “Sibling encounters provide a unique opportunity for such children to learn about social relationships.”

A decade ago, another study demonstrated …”strong and positive changes in joint attention and modest changes in social behavior for the latter…” but lamented, “however, the results did not provide strong evidence for generalization of increased social interactions to different settings.” Who cares? A buddy is a buddy. Another paper that year, Teaching Pretend Play Skills concluded, “… the child with autism may benefit from sibling-oriented interventions

In 2007, Sibling Interaction of Children with Autism: Development Over 12 Months showed, “… social interaction and imitation in children with autism and the special role that sibling interactions can play.”

Literature describing family challenges followed. One study summarized, “When siblings were dissatisfied with differential parenting, quality of the sibling relationship was compromised.” Another concluded, “treatment programs may need to address parental stress, which in turn will help optimize treatment outcome for the child and the family.” In Siblings of individuals with an autism spectrum disorder, the authors wrote, “Adolescents engaged in more shared activities and reported more positive affect in their sibling relationship when their sibling with ASD had fewer behavior problems… For adults, more shared activities were observed when the sibling with ASD was younger in age and had fewer behavior problems; greater positive affect in sibling relationships was predicted by greater parental support.

This year, several papers arrive at similar conclusions involving, “contradiction. Participants recognized difficulties (decreased parental attention, extra responsibility, bothersome behaviors, communication difficulties) and positive aspects (became empathetic, loved and appreciated the child, realized the experience was life-changing) of living with a young person with ASD. Younger siblings frequently reflected on childhood experiences, wished they could play together… Adolescent siblings learned life lessons from the experience, talked about life changes when ASD was diagnosed, and seemed introspective and protective toward the young person with ASD. Male siblings often wished they played more often while growing up with the young person, and frequently mentioned the child/adolescent’s aggressive behaviors; female siblings focused on relationship and communication difficulties of the young person ASD.”

Brothers and sisters get it. Preteen Jillie gets it! Her description of processing difficulties is spot on. Perhaps, one day, it will be the sibling of an affected child who will make the key discoveries for effective remediation of the signs and symptoms displayed in Autism Spectrum Disorder.

I Watched Vaxxed

Monday, October 3rd, 2016

I am not against childhood vaccinations.

I have expressed that opinion in more than a few blogposts. Nonetheless, it appears that more information is needed, and controversies must be addressed, before the gods of modern medicine can simply dismiss the thousands of parents who feel that their child developed autism shortly after one of the childhood inoculations.


(L-R) Jenny, Jacqueline&Chris Laurita (housewives of NJ), Nico&Davida LaHood, Del Bigtree, Dawn&Ryan Neufeld, Jodi Gomes

This week, at the Autism Summit, Jenny McCarthy expressed that same opinion in her opening video, and throughout the panel discussion. Frankly, I would not have even written this story if there wasn’t a controversy when an Express-News reporter was prevented from attending the conference. He wrote, “The summit is being put on by Generation Rescue, a non-profit led by Jenny McCarthy, an anti-vaccine activist.”

One of the panelists was a San Antonio area District Attorney Nico LaHood. “In a promotional video filmed in his office, LaHood said “vaccines can and do cause autism,” and has made clear he doesn’t accept scientific evidence as proof to the contrary.” Another celebrity was Del Bigtree, the producer of Vaxxed.

So, I paid my four bucks, and watched the movie. Del Bigtree presents a compelling story surrounding the information supplied by CDC whistleblower, William Thompson, who claims that data that would have implicated vaccinations as a cause of autism was altered, so that the MMR would appear safe.

There is a fair amount of anecdotal and perhaps, overly dramatic presentations of individual case histories, which will turn off the ‘real’ scientists. Mr. Bigtree describes that as the conundrum as we, “…study the disconnect between science and parents.”

Dr. Doreen Granpeesheh, founder of CARD, appears as a credible expert. A nobel prize winner weighs in, adding validity to the story. After reviewing the data, a traditional pediatrician and family practitioner seem truly amazed – and changed their opinion about the safety studies. Cool, calm, and well-spoken, Wakefield looks to be anything but a raving zealot. His conclusion is that if the MMR were separated, that would be best solution and the issue of ‘herd immunity’ would not be breached.

I’m not against childhood vaccinations.
Hillary has declared, “The sky is blue and vaccinations work.” She doesn’t know, for sure, if they are safe for all, however. Why deliver an increasing number of antigens to an immature immune system? Why do we have a vaccine compensation fund? Why does the package insert say ‘seizures‘?

If such a movie only adds fuel to the fire, why not just refute the questions that are raised with a prospective, randomized, double blind study, considered to be the gold standard for proving efficacy and safety? Rather, people who even view the film are marginalized and considered kooky, conspiratorist, poorly informed, and ignorant.

The movie is considered to be the problem. Andrew Wakefield is the problem. Leo Kanner, a Freudian from the first half of the last century, assigned the diagnosis to the realm of psychiatry. Bruno Bettleheim, a media darling at the time, popularized the ‘refrigerator mom’ theory that persisted for another 30 years. We are still arguing if there even IS an epidemic. There is plenty of blame to go around regarding our confusion about this mysterious illness.

I’m old enough to have experienced neighbors, relatives and patients who have suffered serious consequences from childhood diseases, such as polio, measles, and congenital rubella. Furthermore, I am aware of the mountain of ‘scientific evidence’ that documents a lack of association to Autism Spectrum Disorder. In my own practice, the majority of parents do not feel that vaccines caused their child’s autism, and there are many children with ASD who never received any inoculation.

However, great concern is raised when there are stories, such as the mismanagement of vaccines in public clinics, and issues with government oversight connected to Big Pharma (documented in this movie).

This is one of the most polarizing issues that impedes real progress in our understanding of the epidemic of childhood autism. In the present circumstance, perhaps it was the fault of the conference organizers, not allowing a possibly negative story to emerge. This highlights the need for both sides to step back and listen to each other in order to uncover the truth.

Finally, I want to document that, I’m not against childhood vaccinations.

Processing Disorders and Autism

Sunday, September 18th, 2016

EEGleftThere are a number of newly-minted diagnoses that have been invented to explain many of the symptoms of the modern epidemic that covers autism.

They include:

 Sensory Processing Disorder
→ Visual Processing Disorder
→ Auditory Processing Disorder
→ Oppositional Defiance Disorder
→ Attention Deficit Disorder
→ Hyperactivity Disorder

→ Attention Deficit / Hyperactivity Disorder
→ Anxiety Disorder
→ Obsessive Compulsive Disorder
→ Explosive Disorder
→ Social Processing Disorder

These conditions frequently display such similar general patterns that, depending on a practitioner’s inclination to be a ‘splitter’ or a ‘lumper’, the available treatment regimens could vary widely. For example, AD and HD are usually treated as ADHD, with stimulant medications, even though inattention, poor focus, distractibility and hyperactivity may arise from a variety of physiological conditions.

Likewise, aggression, obsessive – compulsive behaviors, and opposition are usually prescribed anti-anxiety medications, such as Risperdone, Abilify, Intuniv, or even Prozac and Zoloft.


Some are more or less related, and others may be merely due to immaturity, therefore patience and time will yield preferable results.

It is not difficult to imagine that processing difficulties in vision, hearing, touch, and the other senses, can lead to signs, such as repetitive behaviors or ‘stimming’, to alleviate the sensory overload. Supplements, such as magnesium, turmeric, epsom salt baths, essential oils and even HBOT could address those issues, in addition to traditional therapies. Most parents of children with ASD own at least one trampoline.

Restricted interests and repetitive behaviors are core problems in patients with autism. They are not OCD, and the usual medications are rarely effective, even though the diagnosis prompts traditional physicians to prescribe higher, more frequent doses, and/or a combination of pharmaceutical preparations.

The recognition that processing difficulties underly these unusual behaviors has engendered the protocols that include ABA, PT, OT and other specialty therapies. They require significant resources, but have demonstrated improved outcomes. Certainly this approach is not as risky or potentially harmful as potent medications.

Anxiety appears to be a result of a combination of the other processing difficulties, and social processing disorder is as real as any of the other contrived diagnoses. Early socialization is, therefore, a useful intervention. The fewer pharmacological interventions, the less chance that they will poison the growing brain.

On another hand, certain abnormalities seem to be a result of difficulties in other-than-CNS processing. Aggression, opposition, and explosive behaviors are frequently gut-related. The recognition that autistic behaviors can be ameliorated by restoring the gastrointestinal microbiome has assisted many patients who have been suffering for years.

The biomedical approach is unique in the treatment of this myriad of medical conditions because the basic assumption is that they are due to a variety of upstream difficulties.

The recognition that, in patients with autism, some neural pathways proceed down the right path, others stumble upon an incorrect route, some thoughts don’t propagate at all, while other symptoms are emanating from elsewhere, goes a long way to assisting patients in their improvement.

Medical Academy of Pediatric Special Needs – Fall 2016

Sunday, September 11th, 2016

This week, the Medical Academy of Pediatric Special Needs held its semiannual conference in downtown Atlanta, GA. This is ‘Ground 0’ for practitioners, researchers and professors from all over the world to meet, learn, explore and discuss a myriad of relevant topics.

Members who have been returning for 100’s of lecture hours generally choose the advanced courses. For some, the conference has become a group of ~50 experienced and knowledgeable practitioners who meet to discuss ‘workups’, basic science, relevant research and treatment protocols for those who are most affected with ASD.

Notes and Observations
Day 1 – Tough Cases
I really enjoyed our lectures by the plain-speaking Dr. John Green, of Portland, OR. Dr. Green not only reviewed those who improved because of his medical expertise, but those who got better in spite of him, those who haven’t gotten better, those who got better but he can’t figure out why, and the most frustrating – patients who improve only to suffer frequent relapses.

Dr. Sid Baker, a pioneer of the biomedical movement, described his early medical experiences in Africa that morphed into his lifelong dedication to treating patients with ASD. He expressed his disappointment that so many conventional colleagues disagree with our practice.

Dr. Baker elucidated how he initiates care with new patients. He discussed increasingly resistant cases, covering topics from severe speech apraxia to the approach to children with injurious behaviors.

The first day was filled with the most frustrating and difficult cases you can imagine. Eminent practitioners Drs. James Neuenshwander, Michael Elice, and Julie Buckley challenged our diagnostic and therapeutic knowledge, attempting to navigate the complicated courses of those who improved and those who didn’t.

Day 2
Dr. Daniel Amen‘s morning lecture was entitled “3D Brain SPECT Imaging”. The takeaway message was that SPECT scans – technology – could/should/will become a mainstay for a multitude of CNS disorders. His manner and stories of research, technical evaluation, and clinical practice, were positively spellbinding and inspirational.

Dr. Theoharides presented his research and extensive knowledge about the important role of allergy in ASD. Dr. Theo continues to publish a mountain of monumental works, not only on the topics of autism and the role of mast cells, but treatments, as well.

Toxins were the subject of the afternoon’s lectures. We learned about the identification of substances in the environment that are dangerous, how they are measured, how damage is done, and the means to control and treat. For the skeptical reader, there was a plethora of supporting scientific evidence of the relationships to autism (and many other modern conditions).

As has become customary, Dr. Dan Rossignol rounded up the day with a roundup of all of the latest scientific research. Rapidly.

Day 3 – Advanced Clinical Cases
Severe behaviors and speech apraxia. For patients who are most resistant to conventional and alternative treatments, essential oils, acupuncture, and even worms were explored as possible solutions.

Throughout the afternoon, cases got even tougher! Lyme, Persistent Lyme, Non-Lyme Lyme, PANDAS, PANS, parasites… an increasing number of reasons to have signs and symptoms that are called autism. Such information extends our knowledge and leads to better diagnoses for our patients, and possibilities for treatment.

Dr. Green discussed biomarkers. Though these ‘labs’ are not specific to ASD, per se, this will become a necessary next step to document level of involvement and response to treatments.

A brand new treatment, repetitive Transcranial Magnetic Stimulation was presented by Dr. Arun Mukherjee. The jury is still out on this expensive intervention.

One important reason that I return to this meeting, is simply that I feel at home among like-thinking practitioners. Members don’t agree on every subject, but we are respectful and actually enjoy our practices.

In traditional medicine, conferences are basically show-and-tell affairs, where researchers report their data, previously published in medical journals. When doctors think outside the box, practitioners with diverse skills, who are scattered over the globe, discover improved results by networking in this fashion.

Patients, parents, and families can feel confident that progress is being made (slowly), as serious, dedicated doctors continue to try to unravel this modern mystery.

Finally, I am proud to report that, at this meeting, I was awarded Fellowship status in the Medical Academy of Pediatric Special Needs.

Home Schooling Children with Autism Issues

Monday, September 5th, 2016

Home schoolADHD, aggression, bullying and being bullied, meltdowns, oppositional, auditory, visual and other Sensory Processing Disorders, are among the many challenges of modern school-aged children who are recovering from the conditions that are categorized under Autism Spectrum Disorder.

Individualized educational plans have gone a long way toward providing an increasing number of affected youngsters with a more appropriate academic environment. Yet, there remain numerous educational situations in which young children face significant obstacles.

Considering such challenges, an increasing number of families have chosen to home school their neuro-diverse offspring. Here is some of the valuable information that parents have provided about the decision to undertake such a situation.

What are the common characteristics of families who choose to home school?
The most disruptive children require additional medication, and/or one-on-one supervision. Sometimes, only a family member or therapist can achieve control, performed at home (or equivalent).

Families live in locations where there is an serious shortage of appropriately trained personnel.

The IEP and associated adjudication of services do not appear adequate to meet their child’s need. This could involve a lack of classrooms with ‘higher’ functioning individuals, or not enough services for those who have more troubling signs and symptoms of autism.

Parents concerned that, inattention, lack of focus, and hyperactivity in the neurotypical academic environment – by their own child and others – will likely negatively affect performance, grades, and self esteem. Indeed, the psychological profile scores are usually ‘all over the place’, indicating that processing is affected, not IQ.

Sometimes, the choice is influenced by the reluctance to administer stimulant and/or anti-anxiety medication, especially in the youngest students.

What are the biggest challenges?
Relationships with affected children, neurotypical siblings, and blending teaching with family activities, takes a quantum leap in patience, time and effort.

The discipline to prepare lessons and implement the required syllabus is a full-time job.

The outcome of all of this work requires evaluation to assess whether avoiding a traditional program is the preferable course. Has it been worth it?

Caretakers need to determine the best means to ensure exposure to others, and additional ways to foster socialization.

Ultimately, there needs to be a decision if/when to merge the children into a traditional academic environment.

Home schooling enables the ‘teacher’ to maximize learning by individualizing. Caretakers notice when affected children are ‘present’, or allow the necessary time to ‘get the jitters out’. If a youngster is able to avoid taking a test on a particularly squirrelly day, their score will probably be higher. Self esteem improves and anxiety abates.

For those under the age of 6, any suggestion that medication will ‘improve the academic situation’ should be carefully scrutinized. When there is a stay-at-home-parent, additional help, and other resources, home schooling may be the better option, especially for those who are most affected with ASD.

Though it’s not for every parent, or child, this path does provide some families with the most optimal opportunity to guide their offspring to their highest potential.

A More Complete Special Needs Practice

Sunday, August 28th, 2016

SherryjpgIn order to achieve optimal outcome in a world of constantly changing complex medical problems, a modern practice needs to embrace the benefits and safety of natural interventions.

Towards that end, The Child Development Center of America welcomes Dr. Sherry Eshraghi of Natural Health Power Works.

Sherry, a mother of a child with autism, has a Doctorate and PhD in Natural Medicine*, and is certified by the Board of the American Alternative Medical Association. She is an expert in autism and associated disorders and uses a natural, holistic approach to improve health and well-being.

This insightful and empathetic professional will complement our services by interviewing and counseling the family as a whole, providing additional health and lifestyle advice.

Sherry writes:
In order to improve the special needs child’s wellness, parents need to be healthy – physically, mentally, emotionally and spiritually.

Families with autism spectrum disorders experience certain underlying conditions, such as allergies, depression, diabetes, gastrointestinal and/or autoimmune problems, toxic overload, and more. In natural and preventative medicine, the aim is to reduce the chances of those disorders manifesting themselves by providing specific diets and lifestyle changes. The modalities used are:

  1. • Nutritional counseling for the whole family, such as specific foods to be added, or avoided, in the daily diet. Bio-individual, nutritional assessment, and practical advice can be provided, in order to get our kids to eat what is good for them, taking into account that so many are extremely picky eaters.
  2. • Mind/ Body medicine that addresses, but is not limited to, stresses in the family that arise from caring for a child with special needs.
  3. • Detoxification, orthomolecular therapy, environmental health: when our body’s natural detoxification pathways are impaired, we need to detox in order to restore the body’s natural ability to get rid of toxins by itself. With orthomolecular therapy, we adjust deficiencies and excesses of minerals and vitamins in the body. In addition, we can identify possible toxic environmental exposures.
  4. • Herbal medicine: in natural medicine, you can often avoid harsh chemical drugs with herbal remedies that have less side effects. Plus, they can be used for longer periods of time and heal root causes, instead of simply suppressing symptoms.
  5. • Homeopathy and essential oils: many homeopathy protocols and essential oils can help the body heal itself.

To set up a meeting with Dr. Eshraghi, please call our office at 954 873 8413 or 305 720 9099

Rebecca Sherry Eshraghi, DNM, Ph.D.

*DISCLAIMER: Natural/ holistic health care is not intended as diagnosis, prescription, treatment or cure for any disease, mental or physical, and is not a substitute for regular medical care. Rebecca Sherry Eshraghi is a certified Doctor of Natural Medicine, not licensed in the state of Florida.

School Preparation for Special Needs Students

Sunday, August 14th, 2016

Boy in streetBoundless advice is offered on all forms of media that suggests the best ways to handle the coming school year. Here are some tips that may help your not-so-neurotypical youngster who faces the challenges of the next academic season.

  1. ◊ Don’t wait to begin a daily routine; sleep time, awakening, toileting, dressing and morning breakfast should be consistent. Try to make that First Day as mundane as possible. Resist the urge to gush over the child, since such shows of affection may add to anxiety.
  2. ◊ Get sleep under control now. Consider warm epsom salt baths, essential oils, and special quiet time, especially free of digital devices. Melatonin should be considered. It is safe and effective; so, as the commercials say, “Ask your doctor today.”
  3. ◊ If there has been a lapse, re-start the supplements and medications a week or two before The Day. In addition, be prepared for the Fall stressors that may make parents want to re-think the medication schedule, and try to persevere, rather than get on the stimulant +/- anti-anxiety merry-go-round.
  4. ◊ When school starts, make sure that the child’s day includes some type of exercise, even if it’s just walking for a half hour. Sometimes, substituting traditional after-school interventions with social activities, such as marshall arts or hippo-therapy, can be quite helpful to the bigger picture.
  5. ◊ Double down on previously helpful diets. Consider trying safe supplements, such as probiotics, magnesium, or 5-hydroxy-tryptophan.
  6. ◊ Practice reading, math, etc. Those non-preferred activities are not going to get easier on their own. Your child is not lazy, dumb, or forgetful; continued difficulties with processing create challenges beyond those of typical peers.
  7. ◊ If necessary, construct easy-to-use, easy to institute, readable lists for teachers, administrators, school nurses, and kitchen staff.
  8. ◊ Consider whether the IEP created 3 months ago matches your child’s present skill set. Children who are recovering from autism often experience better improvement when placed in the company of neurotypical role models, rather than aggressive, non-verbal peers.
  9. ◊ Meeting the staff, and introducing the child to those individuals can be a great stress reliever. When starting at a new institution, just visiting the school, or even simply driving by, may assist in reducing First Day Anxiety.
  10. ◊ Especially in the early part of the semester, pay more attention to behaviors than grades.

Of course, many of these suggestions could assist the neurotypical child, as well.

To NEBA or Not to NEBA? That is the ADHD Question.

Sunday, August 7th, 2016

EEGleftThe traditional method of achieving a diagnosis of Attention Deficit – Hyperactivity Disorder has involved reviewing the patient’s clinical history, utilization of a variety of scales and psychological criteria, and the exclusion of other medical problems.

For the past few years, an additional diagnostic tool called the Neuropsychiatric EEG-Based Assessment Aid (NEBA), has become available. It is a specific type of electroencephalogram (EEG) that focuses on certain brain waves associated with children who are diagnosed with ADHD.

1) NEBA can be done in any doctor’s office. The reading is accomplished via computer evaluation of specific brain wave patterns. Results are interpreted by professionals, then transmitted to the practitioner.

2) It is relatively simple for some children, aged 6-18 years, to sit still for ~15 minutes, watching a video or being read to by Mom.

3) The FDA approved test has supporting scientific literature, which adds to validity.

4) It may assist parents who are uncertain about the diagnosis or treatment.

1) The cost is ~$450. In South Florida, patients have rarely succeeded in obtaining medical insurance coverage. The company does offer helpful resources.

NEBA 22) There are more than a few patients who cannot sit still while the electrodes are applied and the test is administered.

3) There are experts who feel that NEBA testing is not fully proven, and/or necessary.

4) It doesn’t take the place of a formal EEG, and if a patient has other neurologic signs or symptoms, such as staring spells.

All the FAQs about NEBA, plus supporting literature, can be found at their website.

One opposing point of view was offered by the director of the Center for Children and Families at Florida International University. Dr. Pelham asked, “What’s the point? We’re not going to run out and buy one of these machines to do diagnoses, because it is totally unnecessary.”

Clinicians do not purchase the equipment. It is rented at a reasonable cost on a monthly basis. The physician receives a portion of the payment for administration and interpretation.

There are options. A thorough medical evaluation may reveal nutritional deficiencies or gastrointestinal conditions that correct signs and symptoms that are falsely diagnosed as ADHD. Getting sleep under control is essential for proper focus and attention.

In younger patients, patience may provide the best outcome. Certain diets can be quite effective. Supplements, such as 5-HTP, magnesium, and essential oils may provide enough relief.  Mild medications, such as guanfacine (Intuniv®), Vayarin®, or even caffeine, can buy a symptomatic child more time without stronger pharmaceuticals.

Without performing formal testing, a trial of one kind or another of stimulant medication is often attempted. Since there are so many types of meds, in so many different forms, with a wide range of therapeutic dosing, this approach can be hit-or-miss.

Without a more reliable objective test, ADHD remains an elusive condition. Parents often feel better when there is more evidence, especially when exploring the possibility of strong stimulant medications.

NeBa 3As a doctor caring for so many patients who present with this diagnosis, I have appreciated the format in which the results are provided to the pediatrician. Based on the score, we are presented with 3 categories; confirmation, support for further testing, and support for testing other conditions. The clinician and the family then discuss additional evaluation and treatment options.

With caveats, and at a cost, this technology represents an additional opportunity to get more complete information about your child’s development.

Scripting and Autism

Sunday, July 31st, 2016

lettersFrequently accompanying the emergence of language in children with speech apraxia, are parental concerns that easy questions are only repeated back, or that the child merely recites phrases from videos, etc. They wonder, “How can we fix this?” Well, maybe, it doesn’t need to be fixed.

It is interesting to note that, one meaning of the word, as it relates to autism, is as a treatmentScripting involves presenting learners with a verbal and/or written description about a specific skill or situation that serves as a model for the learner.”

An end-of-the-century research paper described scripting as, “…high rates of delayed echolalia.” A previously desired goal has been the extinction of that form of language, in order to help the patient appear more ‘normal’.

Described by one speech pathologist is the more commonly accepted definition, “Reciting lines from movies, commercials, books, etc. is a common occurrence… Some experts predict it is a coping mechanism that is used during high stress periods, hence, a form of ‘stimming’.”

Amythest Shaber (“Ask an Autistic”) presents her insightful point of view, by describing two types, echolalial and social scripting. The former is referred to as “TV talk”, while the latter represents language that the individual entrains to express their thoughts about an emotional or complicated situation. Both are forms of communication or opportunities for potential socialization.

Children are exposed to constant prompting and repetition by therapists, teachers and family. It’s natural. This is one reason that siblings are often so helpful, because they seem to be the ones who best understand their brother or sister, without demanding or correcting.

There is frequent exposure to digital media. Often, an affected child may view just one section of a video over and over. Without constraints on the volume or frequency of viewing time, how can they not have these songs or scenes playing in their head?

You won’t see a 28 month old scripting. Children acquiring language in their second year are not able to observe and recall details like an intelligent 4 year-old. The timing of language acquisition is altered and so the patterns are transformed.

It is the manifestation of limited expressive language. If an individual has only 1/3 of the possibilities for output, repeating a phrase 3 times makes up the difference, regardless of the meaning.

In Life, Animated, Pulitzer Prize-winning author Ron Suskind, chronicled his success in reaching his son by encouraging this form of communication.

Likewise, the Son-Rise program advises ‘joining’ your child when they display repetitive scripting behaviors, so that they may be more likely to let the parent into their world.

Parents wish to understand whether such a strategy can be generalized to the ‘real world’? At The Child Development Center, we counsel that this is a good start to useful communication, leading to more coherent speech.

Viewed through the lens of a patient who is recovering from ASD with verbal apraxia, scripting (frequently accompanied by echolalia) represents an expected developmental phase.

Taken one step further, communication reduces frustration and inspires confidence. This encourages more contact with the outside world, and maturity. Parents can then believe in their child’s abilities to enjoy a wider variety of experiences.

When scripting is considered in this light, other new strategies, and successful present ones, should be formalized and tested, in order to help the next generation of patients with ASD to achieve their highest potential.

Observations on Autism Therapies

Sunday, July 17th, 2016

The purpose of biomedical treatment is better health, so that the patient can achieve the goals set by the other professionals. The bedrock of autism recovery lies in the traditional therapies, including Applied Behavioral Analysis, Speech and Language, Physical and Occupational interventions.

At The Child Development Center, we have watched thousands of children who undergo a myriad of treatments, and spoken to the parents who part with their valuable resources of money and time. These are some observations that may help other professionals achieve their goals in a more effective manner.

“Just ignore those negative behaviors.” It depends on the specifics. Sure, an annoying stim or persistent request may diminish over time. But, try overlooking a child who has gotten out of the car seat and is pulling Mom’s hair. Also, advice delivered by providers who only spend 45 minutes is not the same thing as living with a problem  24/7. The child needs to be admonished, placed at arm’s length, admonished, and repeat until they get it. Biting, pinching, punching is never cute or harmless, and must be extinguished at the earliest age.

“Try to reduce the echolalia or scripting.” Let’s get this straight – you’ve been telling the kid to speak for 2 (or more) years, and now your telling them not to speak? That’s too confusing. Scripting is only possible because the intelligent child CAN memorize long paragraphs.
Also, if age appropriate expressive language is supposed to contain, say, 1000 phrases, and the recovering child only has 300, they will probably repeat the same phrase 3 or more times just to take up the space. The content doesn’t really need to make sense.

It’s SPEECH therapy, mostly, not Speech and Language. I have yet to meet a child who is really confused by multiple languages. Spanglish is fine. It’s all communication.”I think that he has speech apraxia.” Or, “I don’t think he has speech apraxia.” Or, “I don’t think that he’s really autistic.” If a person wants to speak but can’t, it’s speech apraxia. If they also exhibit repetitive behaviors and social isolation, it’s ASD.

“He’s falling behind in academics.” Consider the developmental stage. Is the child talking, talking to his toys, taking to other children, playing with other kids? They probably know their letters, numbers, and colors, anyway. However, socialization is paramount.

“She needs more focus and attention, with less hyperactivity and distractibility.” The behavior is mostly due to immaturity. Patience and persistence pays. Watch it… someone is going to want to prescribe stimulant drugs. Administering potent medications to a toddler rarely produces the desired effect.

“He’s anxious.” Given that a child has difficulty connecting, that would be an appropriate response. As they improve, children will observe others at play so that they learn the correct responses. Watch it… someone is going to give antipsychotic drugs. Administering potent medications to a toddler rarely produces the desired effect.

“I can’t help this child… he’s too affected.”
Doesn’t that mean, “You need to hire a better therapist?

Sometimes, setting goals, such as, “The child will put the correct shape into the cup 3 out of 5 times,” is appropriate. Others, such as not wandering, joining circle-time, or answering to their name, should be 100%, if the child is to succeed in a neurotypical classroom.

“Mom or Dad is not doing the right thing.” The parent is not the therapist, so part of a professional’s job is to devise a solution, not criticize.

Autism recovery is molded by hard-working, highly trained professional therapists. The newly emerging epidemic of ASD has created the need to re-think solutions.

Ultimately, we are all trying to achieve the same goals of getting children on the right path.

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Brian D. Udell MD
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