Category Archives: General

Changes to the Spectrum Classifications

Clinicians, pediatricians and teachers are looking to understand the classification changes made in the May 2013 publication of the 5th Diagnostic and Statistical Manuel of Mental Disorders (DSM5).  These changes have made a huge impact on the autism spectrum disorders.  As previously discussed in our blog on Feb 18th the classification of Autism Spectrum Disorders used to include, Aspergers, PDD-NOS and Autism.  Now under the new classification system both aspergers and PDD-NOS disappear and are grouped under the umbrella classification of autism.  All categories (regardless of severity and differing symptoms) will be under the same diagnostic code.  In brief here are some of the changes to the DSM5.

  • If a child was previously diagnosed with a spectrum disorder they are still considered autistic.
  • While there is just one autism spectrum disorder umbrella diagnostic code, clinicians are urged to also implement additional criteria which include levels of severity and specifiers to describe the unique features of his or her autism based upon two categories:social communication impairment and restricted interests/repetitive behaviors.
  • If a person is newly evaluated or re-evaluated, and his or her features don’t fit the criteria below, he or she may be given a brand new diagnosis, Social Communication Disorder, which looks suspiciously like the old PDD-NOS. Many are concerned that this new diagnostic category may wind up being a catchall which includes many people who have autism-like symptoms but are not eligible for the same services as people with autism.
  • Symptoms must begin when a person is very young — but even if symptoms have disappeared, a person is still considered to be autistic if they were ever diagnosed as autistic. his appears to suggest that even if a person has actually been successfully treated to the point that he or she is “indistinguishable from typical peers,” he or she is not considered to be cured.
  • In addition to the diagnosis, each person evaluated will also be described in terms of any known genetic cause (e.g. fragile X syndrome, Rett syndrome), level of language and intellectual disability and presence of medical conditions such as seizures, anxiety, depression, and/or gastrointestinal (GI) problems.
  • For a direct link to the five major areas of the classification changes please click here for Autism Speaks summary.  Autism Speaks Classification Changes.

While these changes were not unexpected after a fourteen year review, they have parents worried that the new diagnosis may overlook the needs of their children.  Mental health professionals and school officials don’t anticipate any major changes in services as a result but it is still a matter that you should discuss with your child’s school and teachers.  Autism spectrum disorder looks different in each child and hopefully now each child’s services and needs will be carefully examined as to the severity and specific manifestation of the disorder.  Please contact Milestones to discuss what this may mean for your child if you have any questions. 

 

Benefits of Early Intervention – Spectrum Disorders

 

All children grow and develop at different rates, but when a child has been screened and placed on the Autism Spectrum these delays become even more worrisome.  Early intervention programs are available to identify and treat very young children in an effort to minimize the long-term impact on the child of any develop- mental delay. Let’s look at what Early Intervention is and how experts believe it will help your child. 

What is Early Intervention?

Early Intervention is a federal program that originated in the 1975 Education of All Handicapped Children Act. In its current form as Part H of the Individuals with Dis- abilities Education Act (IDEA), the law helps states provide services to babies and toddlers under the age of 36 months who have been diagnosed with a disability, who are not learning and growing at the same rate as other children their age, or who are at risk of having develop- mental delays in their learning and growing.

Why Intervene Early?

Decades of rigorous research show that children’s earliest experiences play a critical role in brain development. The Center on the Developing Child at Harvard University has summarized this research:

  • Neural circuits, which create the foundation for learning, behavior and health, are most flexible or “plastic” during the first three years of life. Over time, they become increasingly difficult to change.
  • The brain is strengthened by positive early experiences, especially stable relationships with caring and responsive adults, safe and supportive environments, and appropriate nutrition.
  • Early social/ emotional development and physical health provide the foundation upon which cognitive and language skills develop.
  • High quality early intervention services can change a child’s developmental trajectory and improve outcomes for children, families, and communities.

Children whose special needs are identified and addressed during these crucial early years have a greater chance of reaching their full potential.

 

 

Travelling with an autistic child

“Are we there yet?”

Traveling with children can be trying for any family. But traveling with a child with special needs can be a bit overwhelming without some careful planning.  Don’t be paralyzed by the thought of leaving home with your autistic child.  Going on an adventure or beach vacation could be an enjoyable experience for everyone.  You know the needs of your child the best but here are some tips and resources that may help you plan your dream family vacation. 

Travel Tips

  • Do your research. Many airlines, theme parks and hotels have begun catering to families of all types.  Call ahead and find out what special accommodations they may be able to make for you.  For example. Jet Blue and American Airlines offer special seating and programs to prepare children on the spectrum for what an airplane will be like prior to their trip.  Wings for Autism at Boston’s Logan airport allows for a pre-tour of the plane for parents and children to simulate what it will be like once the gate and doors close on the plane.  The Transportation Security Administration Cares Help Line can help families calmly get through security.  (1-855-787-2227)
  • Choose well. Before choosing a location think about whether your child would do better in a condo that might give your family more privacy or a hotel that could assists with your families special needs.  Consider also the time of year that you are planning the vacation.  Is it school break week that tends to see massive number or is it off season?  Look for places that offer special programs for special needs visitors.  For example, the Children’s Museum in Portsmouth NH offers special hours for  families with a child with autism. 
  • Bring Familiar items.  We all love the comforts of home but children on the spectrum come to need their special items to help them cope with over stimulation such as crowds, strange noises and new smells.  In your travel bag keep books, loveys, and any items that will keep your child distracted. 
  • Headphones and other noise cancelling items.  If loud noises are troubling to your child bring ear buds or other headphones so music or movies can cancel out any unfamiliar sounds. 
  • Practice. If it is at all possible to practice with your child in a similar area or situation do so to be prepared for stimuli that your child will react to. 
  • Stick to your home routine.  Whenever it is possible,  stick to the same routine to ease the tension of your child.  Remember to move at your child’s pace to be sure your entire family enjoys their time together. 

What is the Autism Spectrum?

The numbers of children with autism are on the rise.  One out of every 88 children in the U.S. are being diagnosed with symptoms “on the spectrum” known as ASD or Autism Spectrum Disorder.  With the wide array of diagnoses each ranging from  mild to severe, it is easy to get confused by the terminology.  While each case of autism is different it does impact the same areas of development: socialization, communication and behaviors.  

What are the different types of autism that make up the spectrum?According to the Centers for Disease Control the three main types of ASD are:

  • Asperger’s syndrome
  • Pervasive developmental disorder, not otherwise specified (PDD-NOS)
  • Autistic disorder

The American Psychiatric Association also includes two rare but severe autistic-like conditions — Rett syndrome and childhood disintegrative disorder.

Aspergers is the mildest of all autism forms and affects boys three times more often than girls.  A child with Aspergers has impaired social skills and can be seen as awkward and uncoordinated.  Someone with this disorder, while intelligent, can not read social cues to see that the behavior they are exhibiting is different from their peers.  For example, many children at this point in the spectrum become obsessed about an object or subject to the exclusion of all others.  Doctors will many times describe this as “high functioning” autism.

Pervasive developmental disorder, not otherwise specified (PDD-NOS) Children at this point on the spectrum are seen as having a level of autism more severe than Asperger’s syndrome but not as severe as autistic disorder are diagnosed with PDD-NOS. Autism symptoms in kids with PDD-NOS vary widely, making it hard to generalize. Here are several of the symptoms that differentiate this level: impaired social interaction, better language skills than kids with autistic disorder but not as good as those with Asperger’s syndrome, fewer repetitive behaviors than children with Asperger’s syndrome or autistic disorder and a later age of onset.

Autistic Disorder  Children who meet more rigid criteria for a diagnosis of autism have autistic disorder. They have more severe impairments involving social and language functioning as well as repetitive behaviors. Often, they also have mental retardation and seizures.

Early Signs of Autism

As parents we delight in the milestones that our children reach.  Smiling, walking, talking and the list goes on.  But what happens when you begin to notice that your child is struggling in one or more areas?  What are some early symptoms that should raise a red flag for parents so that they may get treatment or intervention as early as possible?  As a parent, you know your child best and will most likely be the first to spot any signs of Autism.  

Autism is a spectrum of closely related disorders with a shared core of symptoms that  appear in infancy and early childhood.  It can cause delays in many basic areas of development such as learning to talk, play, and interact with others.  As a parent you may first notice problems with social interaction and communication as your child grows.  The group Autism Speaks has several warning signs that parents should be aware of that are based upon the checklist M-CHAT (Modified Checklist for Autism in Toddlers).  If your child exhibits any of the following, please don’t delay in asking your pediatrician or family doctor for an evaluation:

  • No big smiles or other warm, joyful expressions by six months or thereafter
  • No back-and-forth sharing of sounds, smiles or other facial expressions by nine months
  • No babbling by 12 months
  • No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months
  • No words by 16 months
  • No meaningful, two-word phrases (not including imitating or repeating) by 24 months
  • Any loss of speech, babbling or social skills at any age

Every child develops at different rates so don’t panic if your child is not meeting milestones right on time. Just be conscience of your  child’s behaviors and immediately bring them to the attention of your pediatrician if you suspect your child may be at risk for autism.  Almost all experts agree that early and intensive intervention helps children showing early signs of autism.

What is and IEP and how can it benefit your child?

Finding out that your child is struggling in school can be heartbreaking for a parent.  The worry, the fear and the onslaught of educational jargon terms can be overwhelming.  The good news is that there is help and it comes in the form of one of those educational terms – an IEP.  This stands for Individualized Education Plan.  Let’s look at what this is, how to get your child on one and what it can mean for your child in the classroom.  

What is an IEP?

An IEP is simply a written document, prepared by a team of teachers, psychologists, specialists and the child’s parents regarding the child’s needs in the classroom.  This could involve any special accommodations needed and measurable goals to be met annually.  Before an IEP is written however, a child must be evaluated and be deemed eligible for special education services.  You, your child’s teacher  or your child’s pediatrician may request an evaluation by your local school.  

How does an IEP benefit your child?

The IEP lists your child’s special education needs and describes in detail the services the school will provide for your child both in and outside the classroom.  The services are wide and varied but may contain the use of a special education teacher to support the lessons in the classroom, other professional specialists or accommodations to the work going on in the class.  Services may be academic in nature or cover a variety of adjacent areas listed below.  

Services offered may include one or more of the following:

  • Speech therapy
  • Audiology services
  • Mental health services
  • Physical therapy
  • Occupational therapy
  • Counseling services
  • Medical services for diagnostic or evaluation purposes
  • School health services
  • Social work services in schools
  • Parent counseling & training

As the child grows so might his/her needs.  The IEP is meant to be reviewed annually by the special education team including the child’s parents.  These annual meetings will allow for a check on the progress of the child to see if further services are needed.  Read up on your child’s specific learning disability to stay informed without getting overwhelmed by the education jargon. 

Dyslexia: Origins and Differences

Previously reported differences in gray matter volume (GMV) in individuals with dyslexia are not the root cause of the disorder, new research shows.

Instead, it is likely that some of these differences come about because typical readers grow brain areas as they acquire reading skills, whereas those with dyslexia do not grow them at the same pace.

“It makes sense that typically reading children are experiencing reading-induced brain matter increases, and these types of increases are likely to be reduced in children with dyslexia who read poorly and, most likely, engage in reading less frequently,” senior author Guinevere F. Eden, PhD, director of the Center for the Study of Learning at Georgetown University Medical Center in Washington, DC, told Medscape Medical News.

The study was published in the January 15 issue of the Journal of Neuroscience.

Unresolved Question

Whether reductions in GMV are the cause of reading problems or a consequence of the disordered reading experience of people with dyslexia has been an unresolved question.

The investigators attempted to shed more light on the subject by looking at anatomic differences in dyslexia by using a reading level–matched design in which dyslexic children were compared not only with age-matched control individuals but also with younger control individuals who read at the same level as the dyslexic patients.

The researchers used functional magnetic resonance imaging (fMRI) and structural MRI scans of the study participants, and they used voxel-based morphometry, an automated software program, to estimate the amount of brain tissue volume.

“Going into the study, we fully expected to show that the differences in brain anatomy in the dyslexics would be observed when compared to both control groups, those matched on age and those matched on reading level,” said Dr. Eden.

“This was because the reported differences in brain anatomy have been localized to brain areas involved in language, and this is consistent with theories that dyslexia is a language-based learning disability,” she added.

The study included 6 boys and 9 girls, 13 of whom were recruited from a private school that specializes in teaching students with dyslexia, and 2 from a public school, as well as 30 typically reading children (17 boys and 13 girls), who were recruited from the general population to serve as control participants.

The children with dyslexia had to have a documented history of dyslexia as reported by the school; a single real-word reading standard score of less than 92 on the Letter-Word Identification subtest of the Woodcock-Johnson III Tests of Achievement; and a full-scale IQ score of less than 80 on the Wechsler Abbreviated Scale of Intellligence. Each participant also had to be a monolingual English speaker with no significant medical, neurologic, or psychiatric illness.

The control children were similar, and in addition, they had no history of learning disabilities and had real-word reading standard scores of greater than 92.

The researchers looked at the volume of brain tissue in children with and without dyslexia. Consistent with previous reports, they found that the dyslexic children had less GMV in multiple left- and right-hemisphere regions, including the left superior temporal sulcus, when compared with age-matched control participants.

Surprise Finding

To test whether these differences caused the reading problems in dyslexia or were a consequence of these reading problems, the researchers also did a comparison between the dyslexic children and younger children without dyslexia who were matched on a reading level to the group with dyslexia.

“Surprisingly, we did not find that all of the areas in the brain that came out from the first comparison also differed in this second comparison,” Dr. Eden said.

A significant difference between the reading level–matched groups of children was found only with regard to the right precentral gyrus (P < .5 Bonferroni-corrected for multiple comparisons).

“This means the explanation of these findings being causal is ambiguous,” Dr. Eden noted. “It raises the possibility that some of the differences are in part likely due to the increases in brain anatomy that occur in typical readers when they learn to read.”

But although the results came as a surprise, the investigators recognized other research that explains their findings.

“As we discuss in our paper, it has been shown that when adult illiterates learn to read and are compared to adult illiterates who did not have the opportunity to learn to read, there are profound differences in gray matter between these 2 groups, showing that learning to read as an adult increases brain tissue. This is from Carreiras et al, Nature 2009. Learning-induced increases in gray matter have been shown for a wide range of skills, from studying for college exams to learning how to juggle balls, a finding from Draganski et al, Nature, 2004,” Dr. Eden said.

Currently, the findings do not have any clinical applicability, but they do raise the possibility of whether MRI data have the potential for diagnosing dyslexia.

“We use MRI as a research tool to better understand dyslexia. It does not affect clinical practice at this time, but it does raise an interesting discussion about whether MRI data can be used to diagnose dyslexia at any time in the future,” Dr. Eden said.

“At this time, MRI is not used diagnostically, and people with reading problems should seek a careful psychoeducational evaluation to determine the nature of their reading problems, and based on the outcome, seek the appropriate behavioral treatment, such as intensified reading instructions and tutoring,” she added.

Two Important Take-homes

Asked to comment on this research, Judy Willis, MD, from the University of California, Santa Barbara, and American Academy of Neurology spokesperson, told Medscape Medical News that the noteworthiness of this study comes from the “powerful” reminder that correlation is not the same as causation.

Dr. Willis noted that 2 important messages emerge from the study’s findings.

“With regard to learning disabilities and developmental disorders, brain volume change is not adequate support for causal interpretation. The other message regards interventions for dyslexia and strategies to build reading skills in all children,” she said.

How much do physicians in private practice give their staff for raises and bonuses?

 

“A decade ago, the changes in density of a ‘brain glitch’ area on scans was hailed as support for a particular phonics-heavy reading instruction. This study reveals that most of the GMV differences associated with dyslexia appear to be consequences of the decreased experiences with reading resulting from the dyslexia rather than the cause of the dyslexia,” Dr. Willis added.

Although the study should not be overinterpreted as proof that more reading experiences will eliminate dyslexia, it is supportive of promoting more reading experiences to improve reading skills, she said.

“The most powerful booster for the amount a child reads is the opportunity to read enjoyable and comprehensible material. As additional studies about dyslexia causes and interventions are done, let’s follow the research suggestions and the smiles of joyful young readers and be sure all children have access to lots of books they want to read and enough time to read them for pleasure and not just to prepare for tests,” Dr. Willis said.

The study was supported by the National Institutes of Child Health and Human Development. Dr. Krafnick, Dr. Eden, and Dr. Willis report no relevant financial relationships.

Beyond Man’s Best Friend

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Are dogs truly “Man’s Best Friend”? The answer for students at Milestones Day School and Transitional Program is a resounding “yes”! The small private day school services autistic children in elementary grades through high school and even services young adults through the transitional program. For the last year, two loveable German Shepherds have been “attending” school with their owner and teacher Marianne Walker. Nala, a petite and calm eight-month-old female and Kona, a fourteen month old, energetic-ball-of-fur have become not only the school’s beloved mascots but also a huge part of the therapeutic curriculum.

If you have ever watched a service dog aide a person with a physical disability then it shouldn’t come as a surprise that canine companions can also be trained to help people with autism. To an autistic child, communication and social interaction can be a struggle. For the students of Milestones, Nala and Kona have the wonderful ability to balance energy and mood levels. If a student is frustrated or sad the dogs can counter those emotions by lifting the mood with kisses, a game of catch or even with a walk around the grounds to take a much needed breather from the stress of school work.

The dogs also act as “social catalysts” by helping students understand their own emotions and become aware of behavioral cues. The students rate their moods through a color coded system – green being calm and happy, while red means frustrated and agitated. John, a middle school student, explained that by learning to read Nala and Kona’s behaviors as “red” or “green” has helped him explain his own moods and even other people’s moods and social cues. These playful pups build on other social skills by encouraging conversations and by helping students gain self confidence just by having the dog by their side.

What if the dogs run, jump or pull hard on the leashes? All of these behaviors are typical of young dogs and even that can aid autistic children who struggle with sensory input, awareness, and regulation. Nala and Kona provide not only comfort but constant sensory stimulation for students. Michael, a high school student, loves walking the dogs and has learned to anticipate when Kona, the more rambunctious shepherd may pull or tug on the leash. Nala, the calmer canine is always prepared for rubs, hugs and petting which is a vital source of varied sensory input. One enamored student states that Nala and Kona make everything better.  He went on to say that “they are a wonderful pair with love to spare!”

While the school will tout the ability of these pooches to help their students communicate, socialize and grow from the world around them there is one aspect that any visitor to this unique program will easily see – these furry friends have an infinite capacity for love and comfort without prejudice or question. They treat each student with the kindness and compassion that every human deserves. They bring smiles and joy on a daily basis and ask for little in return. Nala and Kona go well beyond the title – “man’s best friend”.

Transitions Workshop: Presented by Mary Ellen Sowyrda, JD

Attorney Mary Ellen Sowyrda provided an overview of the legal obligations that pertain to transitional planning for special needs students.  In addition to an overview of the law, she discuss recent cases which have addressed the obligation of school districts to conduct appropriate transitional planning and review practical steps to avoid liability in this area.  Following her presentation, she took questions regarding legal obligations related to transitional planning for special needs students and there was an optional tour of Milestones.