You Asked

Questions from Dr. Leventhal's Lecture
November 1, 2011

Since people with Autism lack social skills, what do you suggest parents/caregivers do after age 22 to keep their children involved in social activities?

Individuals with Autism, similar to others, often have specific areas of interest. To promote social interactions, it is sometimes helpful to find places (structured or unstructured) in which individuals with Autism may be able to find others who share their same interests (i.e. social clubs, game rooms, martial arts, etc…). This may help reduce anxiety due to the familiarity of the topic and should provide opportunities to engage in reciprocal conversations. For more ideas about possible social activities please visit:
http://autism.lovetoknow.com/Social_Skills_Activities_for_Autistic_Adults

I am working with a student with Asperger’s who seems to have a difficult time with honesty and taking responsibility for his actions. How can I help him in a middle school setting?

The ability to take perspectives other than one’s own lends itself to being able to adapt or function within social interactions. This is often referred to as “Theory of Mind” or “TOM” (somewhat related to “having empathy”), which is a socially adaptive function and often limited in people with Asperger’s syndrome. Another reason for a display of dishonesty in young people with Asperger’s is due to their attempts to find ways to fit in with their peers as they often are ostracized for their poor social skills. Young people with Asperger’s may honestly feel they are telling the truth and are taking responsibility, which may appear as a lie/irresponsibility to others. Therefore, it is crucial to help young people with Asperger’s syndrome talk about their perspective as well as help them process others’ perspectives in concrete terms (thoughts, feelings, and consequences) to decrease what may or may not be dishonesty or irresponsibility.

Any suggestions in working with individuals with echolalia to improve communication?

Echolalia involves the immediate or delayed repetition of a phrase or sentence, and is considered by some to a positive prognostic sign for individuals diagnosed with Autism. Although the language may lack specific meaning, it shows an effort on the part of the child to communicate verbally. Lovaas (1977) found that echolalia was a significant predictor of future language growth. Research suggests that echolalia may represent a general strategy for responding to misunderstood verbalizations, so it is important to consider the context in which echolalia occurs. Some echoed phrases may be used when the child does not have the appropriate language to label, request, or respond to questions, while other examples of echolalia may be non-focused or self-regulatory.

Different strategies may be helpful for reducing echolalic responses. Early research recommended that the child be provided with a more appropriate verbal response, such as "I don't know." Although this phrase may become echoed, it indicates to the adult that the child needs help understanding and may be viewed as an appropriate response in a variety of social contexts. Modeling appropriate responses from the perspective of the child and using a picture exchange system may also be helpful strategies. These methods may be most effective when employed within an Applied Behavior Analysis framework (i.e., rewarding positive behavior or vocalizations and ignoring repetitive, non-meaningful vocalizations). Additional information useful for parents may be found at the following websites
http://www.bbbautism.com/pdf/article_59_echolalia_and_autism.pdf
http://teachmetotalk.com/2008/06/02/echolaliawhat-to-do-about-it/

What is the easiest way to work with a person that is blind along with having Autism?

Children with both autism and visual impairment have complex learning needs. Parents, other caretakers, teachers, and therapists can refer to sources such as Autism Spectrum Disorders and Visual Impairment: Meeting Students' Learning Needs by D. Jay Gense, Ed.S., Marilyn H. Gense, M.A. Other books that might be helpful are: Teaching Social Skills to Students with Visual Impairments: From Theory to Practice; Tactile Strategies for Children Who Have Visual Impairments and Multiple Disabilities; and Tactile Learning Strategies.

Do children with ADHD share the lower level symptoms of Autism? Is ADHD like a “lesser Autism”?

Both children with Autism and children with ADHD may share some similar characteristics with regard to symptoms of inattention and social difficulties. However, the mechanisms by which they demonstrate these characteristics are very different. Children with Autism have underlying differences in the social cues they attend to and in their social motivation, which contribute to over-attention to certain environmental stimuli (e.g. focusing on a light switch or a ceiling fan) as well as to inattention to stimuli that people would often like them to focus on (e.g. their teacher talking or completing their school work). Likewise, children with ADHD may have social difficulty due to their impulsivity, but not due to the innate deficits in social communication seen in children with Autism. As such, although there may be some overlapping symptoms, ADHD is not a form of “lesser Autism.”

For adults with Autism – are anti-seizure drugs like Lamictal or Neurontin helpful in combating the attention deficit disorder symptoms like lack of focus or trouble processing information?

There is one case report of Lamotrigine (Lamictal) helping an adult with autism with anxiety symptoms. There is even less data for the use of Gabapentin in autistic adults. Stimulant medications (methylphenidates and amphetamines) have been studied for treatment of attention deficits in autism. The small trials conducted so far indicate that there is some benefit to using stimulant medications for attention deficits in some people with Autism.

Is it possible to cure autism? -At 3-4 years of age my son had Autism, developmental delay, speech delay and them as eligibilities on his IEP in 1st grade. At 17 years of age, the school says he does not have Autism.

For many children, symptoms improve with treatment and with age, however there is no cure. People with an ASD usually continue to need services and supports as they get older, but many are able to work successfully and live independently or within a supportive environment.

Why does my 3-year-old high functioning grandson refuse to let me sing in church when he loves for me to sing to him and with him at home or in the car?)

It is possible that your grandson is hypersensitive to certain sounds, depending on their pitch and volume. It could also be that he experiences sensory overload at church, where there might be a lot of new sounds and images that are not present when he is in more familiar settings, such as your home and car.

How do you explain glaring splinter skills versus severe “retardation” in certain areas (e.g., simple math, money) in the same individual?

There are a certain percentage of children with Autism who also carry a comorbid diagnosis of intellectual disability, formerly called “mental retardation.” However, a large percentage of children on the spectrum do not meet criteria for intellectual disability, but do tend to show splinter skills in certain areas of cognitive functioning. Many individuals with ASD have strengths in rote memorization and are often classified as above average in areas of vocabulary, simple math, etc. However, they often tend to have more difficulty with areas that involve complex problem solving and comprehension, such as verbal comprehension or math reasoning. This, however, is in contrast to those individuals with Autism who demonstrate intellectual disability across all areas of cognitive functioning.

With some children with Autism does the language acquisition problem seem to be a lack of innate language learning structure in the brain?

It is well-established that the left hemisphere of the brain specializes in language abilities. A reduced cerebral dominance in this area is also consistent with other findings indicating atypical regional specialization of brain function in Autism. So language disturbances in Autism may be related to an atypical development of left-hemispheric specialization for language skills.

Please address mental retardation (association/prevalence) in autism and fragile X syndrome.

While most males who have Autism also have intellectual impairment, only one third to one-half of females who have autism have significant intellectual impairment; the rest have either normal IQ or learning disabilities. Math is often a particular challenge for girls. Emotional and behavioral problems are common in both sexes.
Approximately 30 percent of boys with fragile X syndrome meet full criteria for Autism. Most boys and some girls who have fragile X syndrome have some symptoms of Autism, but many tend to be very social and interested in other people.

If one of my 3 kids has an Autism Spectrum Disorder, what is the likelihood that my other kids will have this?

Twin and family studies strongly suggest that some people have a genetic predisposition to Autism. Identical twin studies show that if one twin is affected, there is up to a 90 percent chance the other twin will be affected. In families with one child with ASD, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population.
http://www.ninds.nih.gov/disorders/autism/detail_autism.htm#189053082
http://www.child-psych.org/2009/10/autism-rates-in-the-usa.html

Could you comment on the efficacy and current thoughts about diet therapy (such as gluten exclusion diets) for Autism?

There have been many attempts to identify factors including dietary that may contribute to the development of Autism. Currently, research has provided scarce evidence to support the efficacy of diet therapies in improving the symptoms of Autism.
http://www.edb.utexas.edu/education/assets/files/ltc/gfcf_review.pdf

How do parents of a child with Autism navigate all the information thrown at them?

There are many “treatments” for Autism and information about Autism that are incorrect. Not only does this information make it confusing for parents, but there are individuals who take advantage of parents. Some ways to help navigate the volumes of information are to find Autism support groups, work with competent professionals, and verify the validity of treatments before using them. Professionals you work with should have training specifically in the area of Autism. Also feel free to ask if the treatment your professional is using is empirically supported. Finally, check various resources to see if the treatments suggested are valid treatments for Autism. An excellent source for this information is http://www.autismspeaks.org.

What to do in the poorest state in the U.S. where there aren’t even $$ to do a census of people with Autism let alone provide services for the folks already on the DD waiver?

New Mexico is one of the poorest states in the U.S., but that does not have to limit what each of us as individuals can accomplish! This is especially true if we join together, as a collective voice carries more impact. One way to find other people who feel mental health is a priority is to participate in the local branch of nationally recognized support groups, such as the National Alliance on Mental Illness (NAMI). Here is one local link:
http://www.nami.org/MSTemplate.cfm?MicrositeID=86

Another alternative is to let the people who represent you in our government know how important you feel these issues are. Writing or calling your legislator can effect change! Here is a link: http://www.usa.gov/Contact/Elected.shtml