"The Doctors Are In" - 04.05.12 Transcript

Thursday, April 5, 2012 View Comments Autism Speaks

“The Doctors Are In” Live Chat

On Thursday, April 5th, at 3 pm ET/noon PT, Autism Speaks Chief Science Officer Geri Dawson, Ph.D., and Head of Medical Research Joe Horrigan, MD, were joined by guest host Alessio Fasano, MD, a gastroenterologist specializing in GI issues related to autism. Here is the complete transcript:

3:00
  Hi everyone. Thank you so much for joining us. 

Joining Dr. Dawson today as her guest host is gastroenterologist and autism specialist Alessio Fasano, M.D., director of the Center for Celiac Research at the University of Maryland School of Medicine. 

Dr. Horrigan is en route from Europe, where he was attending an international meeting on the development of new medicines for autism. He hopes to join us once he touches down.

3:03
  Hello, This is Dr. Dawson. I am responding to the question from a guest at 2:56 - does a child ever grow out of autism? Children with autism develop and change like all children. With treatment, such as behavioral interventions, children with autism gain skills and their symptoms often improve. in some cases, the child actually loses their diagnosis. Most children continue to improve with age throughout their lifespan.
3:03
 
Comment From Guest

does a child who is artistic ever grow out of this

3:06
  Advance question from Stacie:
I have a twin sister with severe Autism. I did not develop any sort of mental handicap, however, I am wondering if anybody knows how likely it will be that I will have a child with any sort of mental disorders. Her and I are not identical and are twelve minutes apart. Other than her Autism and seizure disorder, she is very healthy. Thank you for your time!
3:07
  Hi Stacie. This is Dr. Dawson. It is unlikely that your child will be at any greater risk for autism than the general population. If you are at higher risk, the risk will be only slightly increased.
3:08
 
Comment From Yvette

I have had a hard time with my Son and his Aspergers. He spends a lot of time eating his shirt, pages of books, chewlery, plastic, pencils ect. ect. ect. Is there anything else that will work with this issue that can help him be more successful at school and not make him "different" to the other kids?

3:08
  Dear Yvette, This is Dr. Dawson. Some children with autism spectrum disorder, including Asperger syndrome, chew on things as your son is doing. A concern is that you make sure that your son is not chewing on things that could be toxic or harmful in any other way. I suggest that you find a good behavior analytst who can develop a behavioral intervention for your son. The behavioral intervention will involve substituting other appropriate behavior, such as chewing gum, and rewarding him for periods of time when he is not chewing on inappropriate things.
3:09
 
Comment From Avril

My son who is Autistic has Crohn's disease. I have read recently that there is a link between lack of certain digestive enzymes and autism......?

3:09
  Hi Avril, this is Dr. Fasano. Concerning your question, there have been several reports on the link between Autism and lack or malfunction of digestive enzymes. However the data are anecdotal and we do not have undisputable evidence that links defective digestive enzymes with autism.
3:12
 
Comment From Guest

I hear so much about diet to control symptoms of autism, but not anything from the pediatrician. Would a diet help my severely autistic grandson?

3:12
  Hi There, this is Dr. Fasano. Among the 50 plus treatments that have been proposed to treat autism, elimination diets, including gluten- and casein-free diet, are among the most popular and, based on parents' judgment, effective remedies for treatment of autism. However, not all autistic kids benefit from these diets. Autism is the final destination and children can follow different paths to get there. Most likely, only those that went through the food intolerance path can benefit from these elimination diets. 
3:12
 
Comment From cheryl

My son has asperger's how can I help him be more social?

3:13
  Hi Cheryl, This is Dr. Dawson. There are many ways to help children with Asperger syndrome become more helpful. These include social skills groups in which he can learn how to make a friend, carry on a conversation, and son on, as well as the use of video modeling. You should bring these up with your son's teacher and see if there is someone in the school, such as a speech therapist or occupational therapist who could be trained to lead a social skills group in your school. Many children could benefit. Another technique is to establish a "peer buddy" - a typically developing child who is willing to be your son's friend, help him navigate the social situations at school, and spend time outside of school. Many typical kids find this rewarding. Finally, joining clubs, especially ones that are related to your son's specific interests can help him relate socially to other children.
3:15
 
Comment From Kristin

What are your thoughts on ABA as intense intervention? Do you agree with some research articles that say it does not address any social communication issues or emotional development issues? Does its benefits outweigh its limitations?

3:15
  Hi Kristin, This is Dr. Dawson. ABA intervention program should address the social communication issues that a child with autism has. The therapist will target goals such as making eye contact, social play, conversational skills, and so on as part of the ABA program. ABA has strong empirical evidence to support it.
3:16
  We have more information on ABA on our website:http://www.autismspeaks.org/what-autism/treatment/applied-behavior-analysis-aba
3:17
 
Comment From Jeanne

Can parents learn the skills to do the behavioral interventions?

3:18
  Hi Jeanne, This is Dr. Dawson. Yes! Parents can learn how to deliver behavioral interventions. In fact, behavioral interventions work best when they are also carried out by parents. Studies have shown that parents can master the techniques of behavioral intervention and do as well as trained paraprofessionals. Supervision with a trained professional is important. Later this year, my colleague Sally Rogers and I are publishing a book that outlines behavioral strategies that parents can use everyday with their child.
3:18
 
Comment From Guest

Hello....my Aspie 7 YO son is VERy constipated and has nighttime bed wetting issues. We currently give him miralax in the morning ans afternoon, have limited his dairy intake and uped his fiber. What else can we do to help?

3:18
  Hi There, Dr. Fasano here. Constipation and bed wetting are a very frequent sympotms experienced by autistic children. Sometime remedies like miralax are very effective in controlling constipation. However, in order to be successful, the tretment with miralax requires a two-steps approach: 
1. First of all there is the need of clean out the impacted stools. Without this first passage, miralax given to soften stools may not work. The clean out can be obtained by aggressive miralax treatment for 2 days (for example 1 full capo in 7 oz of water 3 times a day for two ocnsecutive days) or, if does not work and fecal impaction is to advanced, it may be necessary to admit the child for clean out in the hospital; 
2. Once the clean out has been obtained, then maintainance with miralax the way you are implementing right now may work 
3:20
 
Comment From Guest

Is the increase in Autism being seen worldwide or just within the US?

3:20
  Hello, this is Dr. Dawson. We are seeing a rise in the prevalence of ASD in the US as well as other developed nations, such as the UK and Japan. In most developing countries, we don't have good estimates of prevalence yet. In a study published last year funded by Autism Speaks, it was found that 1 in 38 children in South Korea have a diagnosis of ASD.
3:22
 
Comment From Renee

My son is 12 years old, diagnosed with Autism at age 3. He has been a picky eater since he was a toddler. Recently he has had issues with leaky bowels while asleep. Is this a necessary concern I should get a referral from his pediatrician to see a gastroenterologist? It does not occur every night, approx 1-2/weekly.

3:22
  Hi Renee, Dr. Fasano here. It is not unusual that autistic children are picky eaters or that they have specific taste for some foodstuff. The leaky bowels are most likely related to the development of constipation that often is associated to poor feeding habits. Most definitively it is time to have his pediatrician referring him to a pediatric gastroenterologist.
3:25
 
Comment From Guest

My 25 year old son was diagnosed with Asperger's at age 21 along with an earlier diagnosis of ADHD at age 17. He lives at home, is unemployed, has tried school, goes to therapy, and is heavily into online gaming. There is so much more, but how do we as parents help him? I feel as if we are on a merry-go-round that never stops!

 

 

3:25
  Hello, this is Dr. Dawson. The situation your are describing with your adult son is unfortunately very common. Many capable adults with autism are unemployed. It is important to help your son acquire the skills he needs to be successful in a job, such as how to interview and relate to other co-workers. In addition, it is important to carefully select a job placement where he will be successful. There now are businesses, such as Walgreen's, that are very receptive to hiring people with ASD. I recommend that you check out Autism Speaks' tool kit for transitioning into adulthood that provide many helpful suggestions for how to find employment. The link is below.
3:26
 
Comment From cheryl

is aspergers a form of autism

3:27
  Hi Cheryl, This is Dr. Dawson. Yes, Asperger syndrome is a form of autism. In fact, the diagnostic criteria are being revised such that there will no longer be a distinction between Autism and Asperger syndrome. All forms will be referred to as "Autism Spectrum Disorder."
3:27
 
Comment From Guest

can behavioral interventions work when the child is experiencing a GI issue that is causing the behavior?

3:27
  Hi there, Dr. Fasano here. If there is a strong suspicion that the behavioral problems are secondary to GI issues, it would be unlikely that behavioral intervention will resolve the problem. To make a parallel, it is like that your son has fever because of pneumonia and you give him Tylenol. Of course the fiver will go away, but only temporarily. Indeed, you treated the symptoms (fever or, in your case, the behavioral problems), but not the cause (pneumonia or, in your case, the GI issue). If you really want to resolve the problem you need to treat the cause (i.e.; giving antibiotics for the pneumonia or, in your case, treat the GI issues).
3:31
 
Comment From Natalie

Are there any good reports, books, videos, resources, for those parents who children are high performing, mainstreaming but have social and common sense issues? Everyone expects our kids to be "normal" and do not believe that our boys actually have a diagnosis.

3:31
  Hi Natalie, There are many books on Asperger syndrome and High Functioning Autism. My colleague, Sally Ozonoff, and I wrote a book for parents on Aspeger syndrome and high functioning autism that you can buy through Amazon. It provides many helpful suggestions. Also, check out our resource library under family services on the Autism Speaks website. There are several books and videos listed there.
3:32
  Here's the link: RESOURCE LIBRARY:http://www.autismspeaks.org/family-services/resource-library
3:32
 
Comment From Heather

I have an eleven year old Aspie who is one of the pickiest eaters known, has been through so many therapies, and is finally eating "normal" foods. He doesn't eat much fruit or veg though, so he takes really good vitamins. Any probiotics or other supplements we should look at to keep his GI track and immune system functioning well?

3:32
  Hi Heather, Dr. Fasano here. Many kids with aurtism are picky eaters and, in general, the problem improves over time. Paradoxically, the more we force them to eat, the later the problem resolves. The best indicator for proper calorie intake is his growth. If his weight and height are proportional over time, I do not see any major reason for concerns. Multi-vitamins are most definitively good supplements in kids with limited fruit and vegetable intake. At the moment there is no strong rationale for probiotics supplementation to improve the gut immune system 
3:34
  Dr. Horrigan has just joined us!
3:36
 
Comment From Lynne

has son Rory has autism, hypotonia, &learning disabilities. He has very loose bowel movements at all times. He is 9 now. Is there any chance this will ever improve?

3:36
  Hi Lynne, Dr. Fasano here. Irregular bowel movements are very frequent among children with autism. The problem is even more frequent in kids that also experience hypotonia. If Rory has no problem in gaining weight, you should not have too much concern about the situation, since most likely he will grow out of it over time. If he also has difficulty to gain weight, then it is time to refer him to a pediatric gastroenterologist for further evaluation of possible malabsorption and/or maldigestion of foodstuff
3:37
 
Comment From renee

I have a 4yr old still in diapers. I know there is no magic age, bu I am wondering the best ways to start and where t get more info? I am not ure that she ecognizs the signs and she is non-verbal.

3:37
  Hi Renee, Even if your daughter is nonverbal, you can get started on toilet training. There are a number of books that might be helpful, such as "Toilet Training for Individuals with Autism and other Developmental Disabilities" by Maria Wheeler. Later this month, Autism Speaks will be publishing a tool kit on toilet training so check later on our website for some useful information.
3:39
 
Comment From Linda

My grandson is 4 years and 4 months old and is basically non-verbal. He does understand some things and when he wants something he takes your hand and leads you to show what he wants. I only pray that someday he will speak and be able to let us know what he needs. He also at times holds hs ears and seems upset. I try to calm and hold him until he feels better. I wish I knew what is happening. He goes to speech, OT and also is in a special class for autistic children.

3:39
  Dear Linda, Your grandson is fortunate to have such a caring grandmother. Many children with autism have not yet learned to speak by 4 years. Some don't talk until elementary school age. If he remains nonverbal, there are many ways to communicate using pictures (such as the Picture Exchange Communication System) and even the iPAD. You can learn more about these techniques on the Autism Speaks website - the link is below.
3:40
 
Comment From Andrea F.

I have a 15 year old son who was diagnosed at age 14 with high functioning autism. My husband and I struggled for years to get him help. His first diagnosis was at age 10 having ADHD, then anxiety disorder, then OCD and childhood depression. After all of this was exhausted we were referred to a specialist (which took 9 months on a waiting list) to finally get his autism diagnosis. Is this common or did I miss telling the doctors details or asking the right questions? I guess he is not severe enough to have been diagnosed earlier. My son is being treated for Asperger's through therapy and a psychiatrist handles his medications. This has made a huge difference...it helps to have a proper diagnosis to get the proper help. Are there other things I should be doing for my son nutrition wise to help him be more successful? (I have heard go gluten free, no dyes in drinks etc.) thanks!

3:41
  Andrea - this is Dr. Horrigan - I just joined the web chat. It is not uncommon for kids with good verbal facilities and higher IQs to be diagnosed later than others, and it is not unusual for the concurrent problems with anxiety and ADHD to be the first focus for these kids. In terms of what you might want to think abut with regard to your son's nutrition, I would contemplate the obvious things, in terms of foods that you might have already noticed as causing problems for him, and also I would pay attention to whether there are types of food intolerance that run in the family. I would do this before i would commit to a fastidious elimination diet. In conjunction with this, some artificial food color can exacerbate behavior, especially ADHD-type behaviors.
3:42
 
Comment From Karla Fisher

I cannot find any documentation that actually talks about how the overall physical well being of an autistic person dirrectly correlates to their symptoms but yet autistic adults always talk about this. Why is there such a disconnect in the industry/resources about this do you suppose?

3:43
  Karla, This is Dr. Dawson. Autism Speaks is funding the Autism Treatment Network, a network of medica care centers serving children with autism. The focus is on treatment the physical health of the child, as well as behavioral interventions. They have found that behavior and quality of life can be affected by medical issues such as GI problems, sleep disturbances, seizures, and other medical issues. It is important to treat the whole child. See the link below to find out more about the Autism Treatment Network.
3:43
 
Comment From Guest

hi my 6 year old son diet is horrible. limited with what he eats as well as refuses to eat vegetables - partly because of the texture. he also smells all his food and if he doesn't like it pushed the dish away. any tips to help us get beyond and pass the smell test to him eating better. we're also thinking of transition to gluten and dairy free but in the end when he is hungry bad behaviors will come of it.

3:43
  Hi there, Dr. Fasano here. What you describe is a not unusual attitude of autistic kids toward "healthy food", like fruits and vegetable. What he is trying to communicate to you is his food taste. Not surprisingly and like all kids of his age, most likely your son has preference for sweat and "junk" food. Best thing you can do, also to prevent his aggressive behavior, is to accomodate his taste using a touch of fantasy. for example, if he likes pizza but not vegetables, just make pixxa with vegetables on it cut very thin. The smell will be gone and the texture will be mixed with that of the pizza.
3:45
 
Comment From Ann

Why do you think is is sudden rise in autism? Enviorment - vaccine- or something else

3:45
  Hi Ann, The prevalence of autism is now 1 in 88, up from 78% since 2002. Broader diagnosis, better awareness, and access to services explain part of this increase but do not explain all of it. Autism Speaks is now funding research to explore environmental risk factors that could be part of the answer to why we are seeing an increase. To find out more about the environmental research we are funding see the link below.
3:47
 
Comment From Cassie

My son is 2 and a half and was diagnosed 5 months ago with Autism...I have seen many things where they are now saying that taking depression pills while pregnant can cause Autism in the child...I did not take depression pills while pregnant with him but I did start taking them when he was about 1 month old and he was breastfed untill he was 18 months old...I was on Zoloft the whole time....Could that have anything to do with him now being Autistic?

3:48
  Cassie - this is Dr. Horrigan - the link between ASD and SSRI use during pregnancy is still difficult to interpret, and it is not clear if it is an association or if it is just a correlation.There are a number of studies underway to try to bring clarity to this. In terms of a potential relationship of ASD to breast-feeding while taking an SSRI, I believe that the likelihood is quite low that there will be relationship established, especially in the instance of Zoloft/sertraline, because the levels of sertraline in breast milk are typically very, very low.
3:48
 
Comment From Guest

How can you tell if your child went through the food intolerance path and would benefit from a special diet?

3:48
  We are just learning our to identify the paths that kids follow to reach the autistic final destination. As concern food intolerances, there is a very active effort in identifying specific biomarkers indicative of food intolerances. For example, for gluten sensitivity, anti-gliadin antibodies can be good biomarkers.
3:51
 
Comment From Emily

I understand that there is not research to support the "vaccine" related cause to Autism - but there is research relative to genetics and environmental causes/triggers. Can you please speak to your thoughts/findings on this. What environmental factors do you feel can be labeled at triggers? A lot of emphasis is now being directed to genetics.

3:51
  Hi Emily, A number of environmental risk factors that could contribute to autism are being studied. The most replicated findings thus far are "older parents" especially older age of the father at conception, and prematurity. Other factors that have some research to support them but need replication include low levels of folic acid before and at conception, severe maternal infection during pregnancy, complications at birth, and maternal exposure to high levels of pesticides and air pollution during pregnancy. These are all factors that could potentially influence early brain development. Each, alone, would only modestly increase risk. But in a genetically susceptible child, could act as a trigger for the development of autism. Autism Speaks is funding research on these factors.
3:54
 
Comment From Bri

Do you know why more boys have autism then girls?

3:54
  Dear Bri - this is Dr. Horrigan - I can give you a relatively quick answer - there is something protective about having two X chromosomes. It is likely a function of what the genes on the X chromosome are influencing downstream - many of these X-based genes have a regulatory function on other genes that are important in the central nervous system an the functioning of neurons/nerve cells (a good example is the gene that is responsible for Fragile X syndrome). Remember that boys have only one X chromosome, so if there are any problems with any of their X-based genes, they are more prone to be clinically impactful.
3:54
 
Comment From Bri

Is ADHD a form of Autism?

3:54
  Hi Bri, Autism and ADHD are two different conditions. Autism involves difficulties in social communication and repetitive behaviors, whereas ADHD involves difficulty sustaining attention and hyperactivity. However, many children with autism also have ADHD.
3:55
 
Comment From Mikey

How can one even try a gluten free diet when my son has severe food aversion and eats only a handful of foods...raisin toast w peanut butter, choc. whip yogurt, quaker peanut butter granola

3:56
  Hi Mikey, Dr. Fasano here. Implementation of special diets in autistic kids are indeed a challenging proposition. That is the reason why we typically do not recommend to "give it a try", rather to make an effort in establishing whether the kid has indeed gluten sensitivity that would justify the effort in trying the diet. If indeed that is the case, then the implementation of the diet need to be gradual and creative. In the case of your son, I would try substituting the raisin tos with gluten free raisin bread and then gradually trying GF granola, and so on. 
3:59
 
Comment From Jeanna

I am convinced that my daughter is a responder to the GFCF diet due to changes in her bowel movements. Do I treat this as if she is allergic to gluten?

3:59
  Hi Jeanna, Dr. Fasano here. The fact that your daughter responded to GFCF diet with improvement of her bowel habit is very indicative of some form of gluten and/or casein reaction, not necessarely allergic in nature. Most likely, she can be affected by gluten sensitivity, since gluten allergy manifest itself with different symptoms, including skin rash (like urticaria) and, sometime, asthma-like symptoms.
3:59
 
Comment From Brianna

Why are some children Non-verbal?

3:59
  Hi Brianna, This is Dr. Dawson. There are many reasons why a child with autism has difficulty speaking. The child may have trouble with perceiving the units of speech (auditory-linguistic processing impairment) or trouble making the complex motor movements required for speech (dyspraxia) or may not understand yet how language "works", i.e. that words can be used to communication - which is an abstract concept. The good news is that the majority of children with autism can learn to speak with behavioral interventions and speech-language therapy. For those whose remain nonverbal, there are many visual methods that can be used, such as pictures and the iPAD.
3:59
 
Comment From Sara

My son is turning 7 this month and was diagnosed at 2 1/2 with PDD-NOS. He is constantly asking questions that he already knows the answers to. Do you have any suggestions on why he is doing this and how to decrease the frequency?

4:00
  Sara - this is Dr. Horrigan - a lot of times these types of repetitive questions are a youngster's way of dealing with anxiety and they serve a self-soothing function (calming), even though these repetitive questions can be very tiring for others. The two approaches that come to mind are to try to address any underlying anxiety problems that might exacerbate the repetitive questions (whether through talk therapy, cognitive-behavioral theraopy or medication) and also seeking one or more substitute ways to self-soothe - there are lots of ideas in that regard, and you probably need to work with a behavior therapist to get a good menu that is directly tailored to your son's style and needs
4:02
 
Comment From lori

how do we find out when the tool kit is available and how do we get it?

4:02
  Dear Lori, On the Autism Speaks website (www.autismspeaks.org ), under the link "Family Services" you will find many tool kits ranging from those that focus on helping families who have just received a diagnosis all the way through adulthood. You can download them from the website. We are always adding new tool kits, so check back frequently.
4:04
  This is Dr. Dawson. I am signing off. I think Drs. Horrigan and Fasano are still on. Thank you all for joining us today. We hold the "Doctors are In" webchat every month so if you didn't get your question answered, please check back with us. My best to each of you!
4:05
 
Comment From Guest

Ho my son has Autism he is 7 years old and high function but he will not go poop on the potty. He holds it all day and then will go in his undies. How can we get him to go on the potty? He will pee on the potty just not poop.

4:05
  Hi there, Dr. Fasano here. This kind of behavior anmong autistic kids in not infrequent at all. The best way to approach the problem is being positive and not punitive. I would start with bowel cleanout by giving him stool softners like miralax, so that the stools will become soft or mushy so much so that he is not able to hold them anymore. Then, I would continue with miralax maintainance and then start a toilette routine, so that he is aware that there is private time during the day for sitting on the commode and read for a few minutes, even if he does not feel to go to the bathroom. That could be a good start. If it does not work, then it would be approrpiate to see a pediatric gastroenterologist. 
4:05
 
Comment From Marianne

Dr Horrigan - Many psychotropic medications are used to treat aggressive behaviors in people with autism. Unfortunately, weight gain is a side effect of these meds. What is the least-weigh gaining med in this class?

4:06
  Marianne - this is Dr. Horrigan - I think you are talking about "antipsychotic" medications, which have subsequenly been tested an proven to be effective in treating a number of other condtions (e.g. irritability, recalcitrant depression, mania, etc). And there is evidence that the probelm with weight gain is even more acute with children taking these medications than adults. The ones that are more likely to be weight-neutral would be aripiprazole, ziprasidone, molindone, and a couple of the very new ones that just came out. Another good option might be quetiapine. Quetiapine is also less likely to cause rampant weight gain, when compared, for example, to olanzapine. I hope this is helpful.
4:07
  Hi everybody, it is time for me to sign off. You guys have posted very interesting questions. Looking forward to next round. 
Cheers, 
4:07
  Hi everyone - this is Dr. Horrigan - I have to sign off now - thank you very, very much for all of your great questions today. Take good care everyone
4:07
  Thanks so much and forgive us for not being able to get to all your questions. Please join us again on the first Thursday of next month – May 3rd at 3 pm ET/noon PT.