Autism Part 1

“Our two year-old son is a beautiful boy but we have become concerned. He still does not speak, actually, he doesn’t really look at you when you speak or appear to have any interest in what you say. We had his hearing tested by our physician and nothing appeared wrong. Our son does not initiate play with other children nor does he actually appear to have any interest in his peers. While he is a loving little boy, he does not really hug you back. Someone suggested that we have him tested for autism and we’re scared. Is he autistic? What do we do?”

Autism refers to a neuro (brain) developmental disorder that affects an estimated 1/166 to 1/500 children each year in the United States with an annual growth rate in diagnoses of 10 – 17%. Staggering statistics? Surely, but even more importantly notice the incidence of 1/166 to 1/500. Why the significant range?

I recall being horrified (as a youth) when Dalton Trumbo in Johnny Got His Gun indicted the United States government when he revealed that their own offices could not provide an accurate statistic on the number of soldiers who died in Vietnam, often missing the number by thousands. Were the lives lost so insignificant? I now find myself in a somewhat similar position. Why the significant variability or range in estimates of the incidence of autism? Why doesn’t someone know how many children have autism? Are the children with autism lost and insignificant? Hmmmm…

The answer may lie in the fact that autism is not a thing but rather the diagnosis refers to a constellation of symptoms/problems with a developmental onset or emerging during first three years of life. The diagnostic criteria or symptoms/problems required for the diagnosis of autism reads something like a Chinese Restaurant menu including “A total of six (or more) items from (1), (2) and (3) with at least two from (1), and one each from (2) and (3)”… that should clear everything up. Want to know what criteria (1), (2) and (3) are? Google Autism Disorder DSM.

But what are the core or essential characteristics of autism? Hmmm… the answer is that the symptoms vary as a function of age. What is normal in a one-year old may be abnormal in a four year-old.

• Early signs (during the first 6-12 months of life) of an autism spectrum disorder may include poor eye contact during parent-child interactions, an absence of cooing/babbling, an absence of reciprocal smiling and apparent indifference to others that may include tactile sensory features ranging from recoiling from touch to requirements for swaddling/holding close.
  
• During the 12 – 24 month age range, symptoms of a potential autism spectrum disorder include persistence of early signs along with no attempts to speak with associated gestural communications, limited communicative intent, limited play, repetitive body movements (ie., hand flapping, rocking, etc.), fixation on objects (ie., moving fans, prisms, balls, etc.), resistance to change and a tendency for the child to become overwhelmed in high stimulation settings.
  
• Later (age 24 months+) emerging features of a potential autism spectrum disorder include (in addition to persistence of other symptoms noted previously) a lack of initiation to engage in reciprocal play with peers, limited play, emergence of over-select behaviors (ie., lines up objects, requirements for sameness, etc.) and difficulties following the gaze of others. In addition, emergence of exaggerated fear responses ranging from extreme rage to total indifference (ie., to pain) is often observed.

So, does your child have an autism spectrum disorder? I do not know but I tend to have infinite faith in the gut feelings of mothers. If a mother informs me that she has fears that something may be amiss in the development of her child, I generally believe that something may be wrong. The answer? Sorry if I sound repetitive on this… but… you may wish to consider an evaluation to shed some light on the fears. So, if it is an autism spectrum disorder, what causes it? Hmmmm… let me think about that one (see you next week)…

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Dr. Richard Dowell is a Neuropsychologist located in Pennsylvania. Dr. Dowell evaluates upwards of 400 children and adolescents each year. In addition, Dr. Dowell is recognized as one of the top Forensic Neuropsychological witnesses in the North East.

Dr. Dowell can be contacted at DrDowell@NeuropsychologicalServices.net

For more information on Neuropsychology visit NeuropsychologicalServices.net

HWAT's a Paretn to oD? dyslexia and your Child

“My child cannot read. She’s in second grade and she still reverses letters, omits letters in common words, guesses words when she reads rather than actually reading the words. It’s a constant struggle to get her to read. It takes all evening to get through a book, she gets so frustrated and is constantly in tears and we (her parents) feel horrible. Its not supposed to be like this. We took her to a professional who told us she has dyslexia but, now what?”

Dyslexia simply refers to a disturbance (dys) of reading (lexia). Enlightening, huh? Hope you didn’t pay too much to have it revealed that your daughter has a disturbance in reading (which, by the way, I assume you actually told the professional about two minutes into the interview).

The real challenge is to understand the underlying breakdown in processing that result in dyslexia or a reading disorder.

Reading is like a chain with each link providing its own unique and necessary contribution to reading. While professionals with different educational backgrounds and training may identify some different individual components (or links) that compose reading, most breakdowns of reading indicate links that include:

(a) visual acuity (can the child see)

(b) oculomotor functions (can the child scan a row of letters/words),

(c) visual-perception (can the child recognize and discriminate visual configurations)

(d) auditory acuity (can the child hear)

(e) auditory perception (can the child recognize and discriminate speech sound units)

(f) grapheme (letters) - phoneme (speech sounds) integration (can the child link sounds with letters)

(g) sequential grapheme-phoneme processing of units (can the child read individual words)

(h) sustained attention (can the child keep track of what was read)

(i) storage of data (can the child store a series of words)

(j) linking ideas/themes with words (can the child create mental pictures/images of what the words “say”)

(k) development of a general theme (can the child understand what was intended in the written communication)

(l) development of a response (can the child respond to the written words) and motor programming a response (can the child articulate the words or formulate a motor plan based on what was read)

So… your child has dyslexia? What are you supposed to do? It all depends on the stage at which reading breaks down. A chain is only as strong as the weakest link. Therefore, interventions directed towards “weak links” or components in the reading process are likely to result in the greatest benefits. The first step… complete a comprehensive evaluation of reading components or links. The intervention?… direct or focus interventions on weak links to obtain the greatest benefits or “bang for your buck.”

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Dr. Richard Dowell is a Neuropsychologist located in Pennsylvania. Dr. Dowell evaluates upwards of 400 children and adolescents each year. In addition, Dr. Dowell is recognized as one of the top Forensic Neuropsychological witnesses in the North East.

Dr. Dowell can be contacted at DrDowell@NeuropsychologicalServices.net

For more information on Neuropsychology visit NeuropsychologicalServices.net

Mustard Seeds and the Two Poles

“My ten-year old son has dramatic mood swings. He can be happy one minute and another minute, he’s in a rage for no apparent reason.”

“What sets him off?”

“Mustard seeds.” (I love this one… an actual quote).

“He is irritable all the time, overly aggressive with his peers at school and defiant (ie. yells, curses at parents, etc.) to the point of belligerence towards us. We went to see a professional (ie. physician, psychiatrist, psychologist, etc.) who said that he has bi-polar disorder!! We’re terrified. Does this mean that he will have this the rest of his life?”

Bi-polar disorder implies that a child has two (bi) (polar) opposite emotions or behaviors with some implication that transitions from one pole (depression) to other pole (anger, mania, etc.) may occur rather abruptly and with minimal (mustard seeds) or no apparent cause. Does your child present with features of “bi-polar”? The answer is “yes” and most likely your child would meet the diagnostic criteria for bi-polar disorder. But, this diagnosis is a symptom-based diagnosis, it refers to a cluster of symptoms (such as “headache”) and does not actually have a defined etiology or cause (such as “trigeminal neuralgia, cervical neck strain, brain tumor”, etc.).

Does he have bi-polar disorder? Hmmmm… From a process perspective, bi-polar disorder symptoms may be related to the presence of primitive limbic system-driven “fight or flight” activation (ie., gas pedal for emotions, drives, instincts, etc.) that is not adequately or effectively modulated by higher level frontal lobe inhibitory systems (ie., brakes, social rules, etc.). In other words, symptoms of bi-polar disorder are related to limbic system activation and/or frontal lobe dysfunction.

• Limbic system activation may be causally related to biological/genetic factors (possibly “true” bi-polar disorder with a higher state of background arousal) or in response to environmental factors including trauma, unmet needs for safety or security, abuse, neglect, etc. (possibly post-traumatic stress disorder).
  
• Frontal lobe dysfunction may be related to biological/genetic factors with associated failure to establish limbic-frontal lobe subcortical connections (possibly Fragile-X syndrome, Asperger’s Syndrome, prematurity, etc.) or environmental factors including neglect, deprivation, etc. (possibly Reactive Attachment Disorder).

The solution?, consider completion of a comprehensive evaluation that may facilitate identification of etiological factors contributing to your child’s symptoms/problems so that subsequent treatment interventions may focus on treating the cause, not medical management of superficial symptoms!