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'The Doctors Are In' June Transcript

On Thursday June 7th Autism Speaks Head of Medical Research Joe Horrigan, M.D., a clinical child and adolescent psychiatrist, was joined by guest hosts Dan Coury, M.D., medical director of Autism Speaks Autism Treatment Network (ATN) and ATN Program Director Nancy Jones, Ph.D., for our monthly 'The Doctors Are In' webchat. Here's the full transcript. 

 

 

2:50
  Hello everyone! Hang tight our chat is about to begin!
2:56
  Hi Everyone, 
Today Autism Speaks Head of Medical Research Joe Horrigan, M.D., is joined by guest hosts Dan Coury, M.D., medical director of Autism Speaks Autism Treatment Network (ATN), and ATN Program Director Nancy Jones, Ph.D. 

Drs. Horrigan, Coury and Jones welcome your questions on the diagnosis and treatment of medical conditions and behavioral issues in children and adults on the autism spectrum, as well as autism support services. They will also be fielding questions about the upcoming Autism Speaks National Conference for Families and Professionals: Treating the Whole Person with Autism: Providing Comprehensive Care for Children and Adolescents with ASD, to be held in Columbus, Ohio, this August. A limited number of conference fee waivers are being made available to families in financial need.

3:00
  While we're waiting for the first answers, we want to let you know about our upcoming National Conference for families and professionals. YOU are invited to attend this two-day conference , in Columbus, Ohio, on August 3 and 4. 

The conference, “Treating the Whole Person with Autism: Providing Comprehensive Care for Children and Adolescents with ASD,” will offer families and professionals an opportunity to learn about comprehensive and integrated care that addresses the medical, emotional and behavioral needs of children and adolescents with autism. 

It will feature science sessions and interactive workshops led by ATN specialists focused on medical issues such as gastrointestinal issues, sleep problems, immune dysfunction, psychiatric disorders and seizures. It will also provide sessions on helping families coordinate care for their child affected by autism. The conference is open to families, physicians, allied health professionals, psychologists, social workers, nurses, educators, speech-language pathologists and other behavioral specialists. 

Keynote speakers include Ricki Robinson, M.D., author of Autism Solutions, and Peter Gerhardt, Ed.D., director of the McCarton School for children with autism. 

For more information, email us at atn@autismspeaks.org 

3:01
 
Comment From Maria 

Hello, I would like to ask you about the gfcf diet & methylcobalamine, to what extend it can influence the autistic child, and are there any new trends in teaching a 3 y-old autistic child? Thank you very much. (HFA)

3:02
  Maria, the gfcf diet can be helpful for some individuals with GI symptoms or with celiac disease. When people feel better, they generally behave a bit better. However, there are no good studies of the gfcf diet showing marked improvement in core ASD symptoms. The same is true for methylcobolamine at this point. The latest trends in teaching are to use intensive behavioral interventions along with developmentally based teaching by parents and teachers, as is used in the Early Start Denver Model.
3:03
 
Comment From Joan

Is their any correlation with ASD and Gender Identity Disorder, My sons psychiatrist seems to think all his symptoms are a result of G.I.D?????

3:04
  Hi Joan - this is Dr. Horrigan - the short answer is "no", there is no evidence that I know of, that connect the two, particulalry in a causal way. It could be that the two diagnoses are simply co-occurring. In terms of therapeutic approaches, it would be unfortunate if the therapist has been focusing explicitly on the GID and as a consequence is forgoing some proven (evidence-based) treatment approaches for ASD (e.g. ABA, social skills training, etc.) that can be very effective in ameliorating ASD symptoms.....
3:09
 
Comment From JULIA

My 5yr. Old son was just diagnosed with autism in May. He does not have a good diet all he wants is sweets. How do I get him to eat more meats and veggies.

3:10
  Julia, this is Dr. Coury. Limited or restricted diets are common in people with ASD. Our treatments are the same as for individuals without ASD, assuming there is no food allergy present. Offering small amounts of a new food, with the goal of tasting it or just a bite at first, is the plan. Often we will permit a bite of the preferred food (the sweet) if they earn it by trying the new food. With typical children it usually takes 12-15 exposures to a food before they like it, and it can take longer in ASD.
3:10
 
Comment From Rose

I'm looking forward to attending this conference in August. My interest is as a person in the research field who would like to know what sort of research those families who experience this condition are hoping to participate in.

3:11
  To Rose: Dr. Jones here. We are pleased to hear you will be attending. Families are often very interested in participating in research, especially in areas they feel will have an impact for their familes and others in the community. In general, the areas of interest can be quite diverse. At the conference we are focusing on medical issues which are common areas of concern and an area where more research is needed. As a reminder, more detail on the conference can be found atwww.autismspeaks.org/2012nationalconference 

Look forward to having you there in August!

3:12
  Advance question from Julie 
My son is currently 21, diagnosed with Asperger's Syndrome, with co morbid disorders of anxiety and depression. He has learned that taking his depression medication makes him feel much better. Finally. As we all know there is not a handbook that tells parents what to expect as he gets older, any new findings on Asperger's? 
3:13
 
Comment From Maria

Thank you, is there a link to some web page, because I would like to learn more about that Denver plan? I am from central Europe, and we have never heard anything about it.

3:13
  To Marie: Dr. Jones here. Are you talking about the Early Start Denver Model? You can find more information at this link:
3:15
  Julie - this is Dr. Horrigan - I am glad that your son is feeling better. Anxiety and depression are common, residual issues for individuals with Asperger's as they grow older and become increasingly self-aware of the challenges that they are facing every day. But the good news is that anxiety and depression are quite treatable, and you have given us an example here (related to the use of antidepressant medicine). The cardinal features of Asperger's itself tend to diminish with time, especially for individuals that have continuing access to therapy (e.g. psychosocial therapy) as they get older. As an example, individuals with Asperger's with normal/higher IQs can really benefit from mindfulness training (including many of the methods used in mindful meditation) and this is probably an underappreciated treatment modality for these individuals
3:15
 
Comment From George

Are there any speech therapists or therapists/clinics.. in general who work exclusively with sensory feeding disorders that seem to pague Aspergers kids?? like my son???

3:15
  George, this is Dr. Coury. I'm not aware of any speech therapists or clinics that work exclusively with sensory feeding disorders. One option to consider is the Family Services section of the Autism Speaks web site, where you can look for a variety of services that are near your zip code. Another option is to check with your nearest autism evaluation program, or one of the Autism Speaks Autism Treatment Network sites that is near you. YOu can find more on this on the Autism Speaks web site.
3:16
  Here's the link to the resource pagehttp://www.autismspeaks.org/family-services/resource-guide
3:20
 
Comment From Non

Hi My question is with regards to auto-immune issues that often run alongside autism. My 28 year old sister is severly Autistic (cannot speak and has severe learning difficulties) but has always been phsyically able. In recent years she has developed ongoing stomach/bowel problems and more recently what appears to be terrible arthritis. Her feet are swollen and deformed to the point that she is currently in a wheelchair and in constant pain while the rheumatologist tries to treat the issue. What is your experience with these sorts off 'side effects' of Autism...? Thanks, Non Jenkins, Wales, UK

3:21
  Non, this is Dr. Coury. The auto-immune issues are being more recognized now, and their role in autism is not clear. What we know at this point is to treat the auto-immune problem as aggressively as the doctor would in a patient without autism. We sometimes see physicians who are a bit hesitant, but the general feeling is that the problem will respond as it would for others. That said, some of these immune problems are difficult to treat for any person. The stomach / bowel problems are also recognized more often nowadays, and may need to be studied for motility problems.
3:22
 
Comment From sue

how can we separate out compulsions that are "ocd" and those that are part of autism?

3:23
  Sue - this is Dr. Horrigan - the "obsessions" that are part of OCD are ego-dystonic (a fancy medical way of saying "unwelcome" or "not wanted" - like being worried that something bad is going to happen to a loved one, or being worried about getting sick from germs) and often this is the oppostite of the obsessions or restricted interests of individuslas with ASD, who often find these to be highly interesting/comforting/gratifying. Accordingly, in OCD, the "compulsions" are the behaviors that the individual engages in, to try to take the edge off his/her anxiety, to try to feel less troubled by the systematic worries. Sometimes this is true in ASD, too, but in addition, individuals with ASD will engage in 'compulsions (repetitive behaviors) when under-stimulated or when needing to feel more calm in general
3:27
 
Comment From KC

I have systemic lupus and took Heparin and baby aspirin while pregnant with my ASD son, does taking medications while pregnant (of any kind) have an effect on a ASD child while in utero. Also, with lupus being an autoimmune disorder is there a link?

3:27
  Sorry. Wrong KC question. Let me try this again... 
3:27
 
Comment From KC

Can you briefly explain the Early Start Denver Model. We have a 3 y.o. who was just diagnosed with ASD this week. He will be entering 3K program in the Fall. We met his teacher and saw the classroom he will be in wondering if all public schools employ this model.

3:28
  KC, this is Dr. Coury. The Early Start Denver MOdel (ESDM) is fairly new, and not all schools are using it. The research on it looks very good, and involves intensive behavior intervention in the classroom along wiht a functional developmental component with a lot of parent involvement. It looks like a model that could be used more widely and help more children.
3:29
 
Comment From Julia

where do I start as far as getting some sort of communication going between my son with autism. he says minimum words.

3:30
  To Julia: Dr. Jones here. There are a number of approaches y ou can take to get some communication going with your son. You did not mention his age so the specific approach may vary. Individuals with very limited verbal skills can take advantage of alternative means for communication such as using picture symbols, typing boards, or sign language (these are called Augmentative and Alternative Communication methods). You can also take advantage of other types of visual supports to help you communicate . Of course, you can also work with a speech or behavioral therapist to help you develop a specific plan for your son. More infromation can be found in the links below.
3:31
 
Comment From Taryn Hill

I also have Asperger's Syndrome. Is a fear of balance part of having it?

3:32
  Taryn - this is Dr. Horrigan - it is interesting that you ask this question, becuase we have been talking a lot here about the under-appreciation of neuromotor issues in ASD (inlcuding Asperger's) and the issues with developmental coordination disorder that many individulas with ASD face. Fortunately, skilled OT and PT therapists can be really helpful, as well as thoughtfully and skillfully taught (e.g. slow, supportive) music lessons and martial arts (e.g. karate and aikido, as examples), esp. if done in dyads rather than large groups, provided that the sensei/teacher is compassionate and engaging. A pearl is that low-dose stimulant medication, if chosen carefully and prescribed carefully, can give even better bang for the buck when these types of treatment modalities are implemented (e.g. kids with Asperger's/ADHD/coordination issues can learn the kata better when they take low-dose dex-methylphenidate, for example).
3:33
  The following answer is for KC's first questions....
3:33
  KC, this is Dr. Coury. There does appear to be a link between autoimmune disorders and ASD, but it isn't clear how tight the link is. Not every mother with an autoimmune disorder will have a child with ASD; the risk seems to be higher but not a sure thing. So, whether your child's ASD is related to your lupus or if it would have occurred anyway can't be determined. The same goes for the heparin and baby aspirin.
3:39
  The doctors are typing furiously ... more on the way
3:40
 
Comment From Heather

My son has been diagnosed with Asperger’s and mood disorder NOS. The doctors say it’s such a rare case because of his extreme violence and aggression. He’s currently in a residential facility for 1-2 years. I’m trying to prepare myself for when he comes home. Are there any online classes you recommend for crisis intervention and to learn how to handle his anger better? I’ve tried organizations in my area (Wisconsin), but no one seems to know how to help with that. Thank you!

3:40
  Heather, this is Dr. Coury. The residential program should be able to provide you with some training, so that you use the techniques that they have found effective. I would start there. The Autism Speaks resource directory would be another place to look for services close to your area.
3:41
 
Comment From Aj

My name is aj and i'm a 23 y/o with aspergers syndrome. I'm going to school to be a paramedic, found the ambulance is the one place im not scared. Ive found that if you give me psychostimulants, like adderall etc. and my symptoms go away and I can act like a normal human. I was wondering if you could explain this. Does it have to do with perfusion in the brain? Neurotransmitters? Just wishing I could understand the science in my head a little more.

3:42
  NOn, this is Dr. Coury. OCD appearing as self injurious behavior is difficult to treat. There are behavioral strategies such as restraint or distraction but with adults this is difficult due to their size. Medication may also help. However, with her stomach / bowel problems I recommend that they be treated first. We have seen individuals who had these repetitive behaviors who were doing this in response to GI discomfort. These may resolve with good treatment of the GI problem.
3:43
  Dear AJ - this is Dr. Horrigan - I think it's great that you re becoming a paramedic. You are going to help a lot of people, and that is very cool. In terms of the Aderall, you are asking a tricky question because I don't want to unintentionally encourage the use of stimulants in an "off-label" way, but you have picked up on something important (see my answer to Taryn about the role of stimulants in learning in kata, for example). The easiest way to say "it's okay, or a good thing, to use some low dose Adderall" if you have unidentified/undertreated ADHD. A lot of times when i am trying to get a clear answer on that i will use something like the computerized CPT (on my laptop) to look at errors of ommission/commission both on and off the low-dose Addreall, and to compare them aginst age-appropriate norms. If I see a big gap between the two condtions, I am will work harder to ascertain a bona fide medical reason for the continued prescribing of Addreall (for example) - sometimes you'll see clinicans utilize the diagnosis of ADHD NOS (314.9), to justify this approach. For caregivers like you, I always will go the extra mile to help assure that you can do your very best (e.g. when you are on the job, trying to save lives)
3:43
 
Comment From Non

OCD, in my sister's case - self harm (slapping her face or hitting the table) are one of the most painful behaviours to watch as a carer and no obvious way to break the pattern. Any advice?

3:43
  oops. Wrong answer to questions. Hold on for switched question and answer. First Non's question
3:44
  Now for the answer to AJ's question...
3:45
  This is Dr. Horrigan - we are getting a lot of questions and i have been cutting in front of my colleagues here, trying to answer some, so I apologize if I have interruted the queu. My slow computer connection today is messing things up a little bit, i think 
3:46
  Rose - this is Dr. Horrigan - "kata" is the sequence of hand/foot/body movements that make up the unit of action in karate (e.g. upper block with the forearm)
3:48
 
Comment From LeeAnn

What do I do if I think my child has Central Sleep Apnea. What type of informaiton is out there on this type of problem with Autistic children?

3:48
  To LeeAnn: Dr. Jones here. If you suspect your child has sleep apnea, you should work with your physician to get a medical evaluation. Ruling out medical issues are the first step in managing sleep problems. 

General information about managing sleep are addressed in our sleep toolkit: 
http://www.autismspeaks.org/science/resources-programs/autism-treatment-network/tools-you-can-use/sleep-tool-kit 

And at this link: http://www.autismspeaks.org/what-autism/treatment/treatment-associated-medical-conditions

3:49
 
Comment From Debbie W

Hi I hope you don't mind me joining you. I am based in the UK. My son is 8 and was diagnosed to be on the spectrum, he is going through a transition realising that he is different from his peers and says he is angry with his brain and his body (he also has hyper mobility in his joints resulting in him not being quite at the same strength as his peers) any advise gratefully received

3:50
  Debbie W, this is Dr. Coury. If your son is able to realise he is different from peers and angry about it, I would work on teaching him the philosophy that we are all unique and different from each other. Each of us has strengths and weaknesses, and your son has special skills that his peers lack. Each of us has extraordinary coded within us, waiting to be released. Help him find his extraordinary aspects and appreciate them.
3:54
  Three answers in the works ...
3:55
 
Comment From Brian Maxwell

What are your thoughts on the use of edible medical cannabis in young autistic children who have trouble sleeping at night?

3:56
  Brian - this is Dr. Horrigan - I don't recommend the use of cannabis in young autistic children. It really hasn't been studied, and there are potential cognitive side efefcst that may be under-appreciated in the very young. But I understand why you might think about it (I tend to be a very practical person, especially when it comes to the suffering that a whole family can suffer when there is insomnia in the house). High-quality melatonin is a more evidence-based approach, if 'sleep education' has falied. There are lots of finesse points about how to use melatonin so that it is most effective. However, you probably already know that melatonin only helps with sleep onset, not sleep continuity (middle-of-the-night-awakenings). For the latter, we have to make sure that aren't any hidden madical factors (e.g. obstrucive apnea), and then we think about "off-label" trazodone (there are caveats around using this with a boy) or mirtazapine or clonidine/Kapvay or low-dose doxepin or gabapentin, all done at very low doses...I can talk/write more about these ideas in a bit.....
3:56
 
Comment From CDL

How can you figure out if your child is just a sensory child, or could have mild Autism? I have a 20 month old who has some red flags, and we are in the process of testing.

3:56
  To: CDL. Dr. Jones here. I am glad to hear that you have been looking out for the early signs of ASD and have followed through with testing. For a child to have a diagnosis of autism, he or she would have signs in all three of the core symptoms including delayed/impaired language, social problems and repetitive/restrictive behaviors. The thorough evaluation you are doing can help distinguish if your child has all these symptoms. In any case, the evaluation can help identify the best types of support for your child's needs whether or not she or he ends up with an autism diagnosis.
3:57
 
Comment From Janis

My son is 4 years old and has been diagnosed as being on the spectrum, my question is, what are the chances he will develop another thing like ADHD, ADD, or anything else? My son already has a sleep disorder that they attribute to his ASD.

3:57
  Janis, this is Dr. Coury. We see ADHD or ADD symptoms in a large portion of individuals wiht ASD, about half the time. It is hard sometimes to tell if it is the ASD or a second diagnosis. It does not always require medication but certainly would need behavioral strategies to keep him on task, etc.
3:58
 
Comment From Karen

My son who is 7 dx with PDD..verbal...on the go all the time and can't concentrate...Could he possibly be ADHD? and I think he is having anxiety attacks...is that possible..?

4:00
  Hi Karen - this is Dr. Horrigan - we are almost out of time here. The short answer is that lots of young people with ASD also have a number of the signs/symptoms of ADHD and these signs/symptoms can respond uite well to typical ADHD therapies, albeit the dose-response curve is differnet if there is ASD (e.g. we usually start with untraditionally low doses, and then carefully go up...). Also, I tell people all the time to remember that not all stmulants (for example) are the same for any given individual
4:00
 
Comment From Joan

Hi my son has been diagnosed with ASD HF ADHD Expressive Language Disorder. Specific Reading Difficulties and Sensory Integration problems, also his adaptive function ive been told is seriously globally impaired, Q1) i dont understand what the latter means Q2) Do they all not fall under the one Disorder ASD or are they all stand alone disorders?

4:01
  Joan, this is Dr. Coury. Seriously globally impaired means that your son is having problems in many areas and these are affecting his functioning in many ways. Yes, these could all be just the ASD. Sometimes the symptoms are so prominent that the doctors do use each disorder name, sometimes the doctors use the disorder names to help families understand the different problem areas that they are addressing in their treatments.
4:03
  Karen - this is Dr. Horrigan - I forgot to mention that your son's anxiety is something I should have taken note of, too - not uncommon to see ADHD/anxiety together - we usually approach this by carefully treating the ADHD first (e.g. very low-dose stimulant medicine, sometime trying two or three different preparations to see which one is the 'best fit', with the least/no side effects) and then we look at the residual anxiety after that...
4:03
 
Comment From Guest

What would you recommend in lieu of ABA therapy for my young 3 yr old autistic son? Our insurance denied the ABA therapy? Thank you.

4:03
  For the individual with a question about ABA: Dr. Jones here. There are a number of alternatives for early behavioral intervention. What you choose may depend on your child's learning preferences and what suits your family's needs. These include Floortime, Pivotal Response Training, and the Early Start Denver Model among others. You can find more information on these options here: 

http://www.autismspeaks.org/what-autism/treatment 

If you have questions about what you can potentially do with respect to advocating for coverage or finding services in your area, you can contact someone in our Autism Response Team.

4:04
  Folks, thanks for your thoughtful questions this afternoon. I hope we've been able to provide some answers and hope you will check in again soon! 

Dr. Coury

4:07
  Here is a link to the Autism Response Team!http://www.autismspeaks.org/family-services/autism-response-team
4:10
  Dr. Jones signing off. Thanks for your questions.
4:10
 
Comment From Kansas

My 9 year old brother with mild autism (and many food allergies) is for the most part non-verbal, but when he has the flu or a high fever he communicates much more. Do you have any idea why this is?

4:12
  Dear Kansas - this is Dr. Horrigan - I have to go in just a minute, but we get questions like yours a lot. There is no question that inflammatory condtions, in anyone, can effect mood/behavior/cognition, and in some people with developmntal disabilities, it can go either way (you see detriment, or benefit, ironically) when the immune system is fired up. We are trying to better understand the biological underpinnings for this (e.g. does it relate to unique genetic variants of microglia? of interleukins/cytokines? that sort of line of questioning), but there is a lot of reserach that is underway in this area, which is really good. I am hoping that we will have some breakthrough insights soon, becuase my sense is that for some people with ASD whose symptoms clarly fluctuate when their is a clear inflection in their inflammatory response (for example), some currently available treatments may be helpful for their CNS as well as their bodily symptoms especially if there is clear evidence of a co-occurring immune disturbance
4:13
  Hi - this is Dr. Horrigan - I have to go now - thanks everyone for your wonderful questions - take good care
4:13
  Thanks, everyone. Sorry we couldn't get to all your questions. 

We will close with an invitation to join us for the next "Docs Are In" webchat on Thursday, July 5th, same time, same station. Autism Speaks Chief Science Officer Geri Dawson will be joined by the co-authors of her new book "An Early for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate and Learn." They will be answering your questions on early intervention and the roles that parents and other caregivers can play in supporting the development of young children on the autism spectrum. You can send us advance questions - on these and other topics - at ScienceChat@autismspeaks.org 

 

3:27
 
Comment From KC

Can you briefly explain the Early Start Denver Model. We have a 3 y.o. who was just diagnosed with ASD this week. He will be entering 3K program in the Fall. We met his teacher and saw the classroom he will be in wondering if all public schools employ this model.

3:28
  KC, this is Dr. Coury. The Early Start Denver MOdel (ESDM) is fairly new, and not all schools are using it. The research on it looks very good, and involves intensive behavior intervention in the classroom along wiht a functional developmental component with a lot of parent involvement. It looks like a model that could be used more widely and help more children.
3:29
 
Comment From Julia

where do I start as far as getting some sort of communication going between my son with autism. he says minimum words.

3:30
  To Julia: Dr. Jones here. There are a number of approaches y ou can take to get some communication going with your son. You did not mention his age so the specific approach may vary. Individuals with very limited verbal skills can take advantage of alternative means for communication such as using picture symbols, typing boards, or sign language (these are called Augmentative and Alternative Communication methods). You can also take advantage of other types of visual supports to help you communicate . Of course, you can also work with a speech or behavioral therapist to help you develop a specific plan for your son. More infromation can be found in the links below.
3:31
 
Comment From Taryn Hill

I also have Asperger's Syndrome. Is a fear of balance part of having it?

3:32
  Taryn - this is Dr. Horrigan - it is interesting that you ask this question, becuase we have been talking a lot here about the under-appreciation of neuromotor issues in ASD (inlcuding Asperger's) and the issues with developmental coordination disorder that many individulas with ASD face. Fortunately, skilled OT and PT therapists can be really helpful, as well as thoughtfully and skillfully taught (e.g. slow, supportive) music lessons and martial arts (e.g. karate and aikido, as examples), esp. if done in dyads rather than large groups, provided that the sensei/teacher is compassionate and engaging. A pearl is that low-dose stimulant medication, if chosen carefully and prescribed carefully, can give even better bang for the buck when these types of treatment modalities are implemented (e.g. kids with Asperger's/ADHD/coordination issues can learn the kata better when they take low-dose dex-methylphenidate, for example).
3:33
  The following answer is for KC's first questions....
3:33
  KC, this is Dr. Coury. There does appear to be a link between autoimmune disorders and ASD, but it isn't clear how tight the link is. Not every mother with an autoimmune disorder will have a child with ASD; the risk seems to be higher but not a sure thing. So, whether your child's ASD is related to your lupus or if it would have occurred anyway can't be determined. The same goes for the heparin and baby aspirin.
3:39
  The doctors are typing furiously ... more on the way
3:40
 
Comment From Heather

My son has been diagnosed with Asperger’s and mood disorder NOS. The doctors say it’s such a rare case because of his extreme violence and aggression. He’s currently in a residential facility for 1-2 years. I’m trying to prepare myself for when he comes home. Are there any online classes you recommend for crisis intervention and to learn how to handle his anger better? I’ve tried organizations in my area (Wisconsin), but no one seems to know how to help with that. Thank you!

3:40
  Heather, this is Dr. Coury. The residential program should be able to provide you with some training, so that you use the techniques that they have found effective. I would start there. The Autism Speaks resource directory would be another place to look for services close to your area.
3:41
 
Comment From Aj

My name is aj and i'm a 23 y/o with aspergers syndrome. I'm going to school to be a paramedic, found the ambulance is the one place im not scared. Ive found that if you give me psychostimulants, like adderall etc. and my symptoms go away and I can act like a normal human. I was wondering if you could explain this. Does it have to do with perfusion in the brain? Neurotransmitters? Just wishing I could understand the science in my head a little more.

3:42
  NOn, this is Dr. Coury. OCD appearing as self injurious behavior is difficult to treat. There are behavioral strategies such as restraint or distraction but with adults this is difficult due to their size. Medication may also help. However, with her stomach / bowel problems I recommend that they be treated first. We have seen individuals who had these repetitive behaviors who were doing this in response to GI discomfort. These may resolve with good treatment of the GI problem.
3:43
  Dear AJ - this is Dr. Horrigan - I think it's great that you re becoming a paramedic. You are going to help a lot of people, and that is very cool. In terms of the Aderall, you are asking a tricky question because I don't want to unintentionally encourage the use of stimulants in an "off-label" way, but you have picked up on something important (see my answer to Taryn about the role of stimulants in learning in kata, for example). The easiest way to say "it's okay, or a good thing, to use some low dose Adderall" if you have unidentified/undertreated ADHD. A lot of times when i am trying to get a clear answer on that i will use something like the computerized CPT (on my laptop) to look at errors of ommission/commission both on and off the low-dose Addreall, and to compare them aginst age-appropriate norms. If I see a big gap between the two condtions, I am will work harder to ascertain a bona fide medical reason for the continued prescribing of Addreall (for example) - sometimes you'll see clinicans utilize the diagnosis of ADHD NOS (314.9), to justify this approach. For caregivers like you, I always will go the extra mile to help assure that you can do your very best (e.g. when you are on the job, trying to save lives)
3:43
 
Comment From Non

OCD, in my sister's case - self harm (slapping her face or hitting the table) are one of the most painful behaviours to watch as a carer and no obvious way to break the pattern. Any advice?

3:43
  oops. Wrong answer to questions. Hold on for switched question and answer. First Non's question
3:44
  Now for the answer to AJ's question...
3:45
  This is Dr. Horrigan - we are getting a lot of questions and i have been cutting in front of my colleagues here, trying to answer some, so I apologize if I have interruted the queu. My slow computer connection today is messing things up a little bit, i think 
3:46
  Rose - this is Dr. Horrigan - "kata" is the sequence of hand/foot/body movements that make up the unit of action in karate (e.g. upper block with the forearm)
3:48
 
Comment From LeeAnn

What do I do if I think my child has Central Sleep Apnea. What type of informaiton is out there on this type of problem with Autistic children?

3:48
  To LeeAnn: Dr. Jones here. If you suspect your child has sleep apnea, you should work with your physician to get a medical evaluation. Ruling out medical issues are the first step in managing sleep problems. 

General information about managing sleep are addressed in our sleep toolkit: 
http://www.autismspeaks.org/science/resources-programs/autism-treatment-network/tools-you-can-use/sleep-tool-kit 

And at this link: http://www.autismspeaks.org/what-autism/treatment/treatment-associated-medical-conditions

3:49
 
Comment From Debbie W

Hi I hope you don't mind me joining you. I am based in the UK. My son is 8 and was diagnosed to be on the spectrum, he is going through a transition realising that he is different from his peers and says he is angry with his brain and his body (he also has hyper mobility in his joints resulting in him not being quite at the same strength as his peers) any advise gratefully received

3:50
  Debbie W, this is Dr. Coury. If your son is able to realise he is different from peers and angry about it, I would work on teaching him the philosophy that we are all unique and different from each other. Each of us has strengths and weaknesses, and your son has special skills that his peers lack. Each of us has extraordinary coded within us, waiting to be released. Help him find his extraordinary aspects and appreciate them.
3:54
  Three answers in the works ...
3:55
 
Comment From Brian Maxwell

What are your thoughts on the use of edible medical cannabis in young autistic children who have trouble sleeping at night?

3:56
  Brian - this is Dr. Horrigan - I don't recommend the use of cannabis in young autistic children. It really hasn't been studied, and there are potential cognitive side efefcst that may be under-appreciated in the very young. But I understand why you might think about it (I tend to be a very practical person, especially when it comes to the suffering that a whole family can suffer when there is insomnia in the house). High-quality melatonin is a more evidence-based approach, if 'sleep education' has falied. There are lots of finesse points about how to use melatonin so that it is most effective. However, you probably already know that melatonin only helps with sleep onset, not sleep continuity (middle-of-the-night-awakenings). For the latter, we have to make sure that aren't any hidden madical factors (e.g. obstrucive apnea), and then we think about "off-label" trazodone (there are caveats around using this with a boy) or mirtazapine or clonidine/Kapvay or low-dose doxepin or gabapentin, all done at very low doses...I can talk/write more about these ideas in a bit.....
3:56
 
Comment From CDL

How can you figure out if your child is just a sensory child, or could have mild Autism? I have a 20 month old who has some red flags, and we are in the process of testing.

3:56
  To: CDL. Dr. Jones here. I am glad to hear that you have been looking out for the early signs of ASD and have followed through with testing. For a child to have a diagnosis of autism, he or she would have signs in all three of the core symptoms including delayed/impaired language, social problems and repetitive/restrictive behaviors. The thorough evaluation you are doing can help distinguish if your child has all these symptoms. In any case, the evaluation can help identify the best types of support for your child's needs whether or not she or he ends up with an autism diagnosis.
3:57
 
Comment From Janis

My son is 4 years old and has been diagnosed as being on the spectrum, my question is, what are the chances he will develop another thing like ADHD, ADD, or anything else? My son already has a sleep disorder that they attribute to his ASD.

3:57
  Janis, this is Dr. Coury. We see ADHD or ADD symptoms in a large portion of individuals wiht ASD, about half the time. It is hard sometimes to tell if it is the ASD or a second diagnosis. It does not always require medication but certainly would need behavioral strategies to keep him on task, etc.
3:58
 
Comment From Karen

My son who is 7 dx with PDD..verbal...on the go all the time and can't concentrate...Could he possibly be ADHD? and I think he is having anxiety attacks...is that possible..?

4:00
  Hi Karen - this is Dr. Horrigan - we are almost out of time here. The short answer is that lots of young people with ASD also have a number of the signs/symptoms of ADHD and these signs/symptoms can respond uite well to typical ADHD therapies, albeit the dose-response curve is differnet if there is ASD (e.g. we usually start with untraditionally low doses, and then carefully go up...). Also, I tell people all the time to remember that not all stmulants (for example) are the same for any given individual
4:00
 
Comment From Joan

Hi my son has been diagnosed with ASD HF ADHD Expressive Language Disorder. Specific Reading Difficulties and Sensory Integration problems, also his adaptive function ive been told is seriously globally impaired, Q1) i dont understand what the latter means Q2) Do they all not fall under the one Disorder ASD or are they all stand alone disorders?

4:01
  Joan, this is Dr. Coury. Seriously globally impaired means that your son is having problems in many areas and these are affecting his functioning in many ways. Yes, these could all be just the ASD. Sometimes the symptoms are so prominent that the doctors do use each disorder name, sometimes the doctors use the disorder names to help families understand the different problem areas that they are addressing in their treatments.
4:03
  Karen - this is Dr. Horrigan - I forgot to mention that your son's anxiety is something I should have taken note of, too - not uncommon to see ADHD/anxiety together - we usually approach this by carefully treating the ADHD first (e.g. very low-dose stimulant medicine, sometime trying two or three different preparations to see which one is the 'best fit', with the least/no side effects) and then we look at the residual anxiety after that...
4:03
 
Comment From Guest

What would you recommend in lieu of ABA therapy for my young 3 yr old autistic son? Our insurance denied the ABA therapy? Thank you.

4:03
  For the individual with a question about ABA: Dr. Jones here. There are a number of alternatives for early behavioral intervention. What you choose may depend on your child's learning preferences and what suits your family's needs. These include Floortime, Pivotal Response Training, and the Early Start Denver Model among others. You can find more information on these options here: 

http://www.autismspeaks.org/what-autism/treatment 

If you have questions about what you can potentially do with respect to advocating for coverage or finding services in your area, you can contact someone in our Autism Response Team.

4:04
  Folks, thanks for your thoughtful questions this afternoon. I hope we've been able to provide some answers and hope you will check in again soon! 

Dr. Coury

4:07
  Here is a link to the Autism Response Team!http://www.autismspeaks.org/family-services/autism-response-team
4:10
  Dr. Jones signing off. Thanks for your questions.
4:10
 
Comment From Kansas

My 9 year old brother with mild autism (and many food allergies) is for the most part non-verbal, but when he has the flu or a high fever he communicates much more. Do you have any idea why this is?

4:12
  Dear Kansas - this is Dr. Horrigan - I have to go in just a minute, but we get questions like yours a lot. There is no question that inflammatory condtions, in anyone, can effect mood/behavior/cognition, and in some people with developmntal disabilities, it can go either way (you see detriment, or benefit, ironically) when the immune system is fired up. We are trying to better understand the biological underpinnings for this (e.g. does it relate to unique genetic variants of microglia? of interleukins/cytokines? that sort of line of questioning), but there is a lot of reserach that is underway in this area, which is really good. I am hoping that we will have some breakthrough insights soon, becuase my sense is that for some people with ASD whose symptoms clarly fluctuate when their is a clear inflection in their inflammatory response (for example), some currently available treatments may be helpful for their CNS as well as their bodily symptoms especially if there is clear evidence of a co-occurring immune disturbance
4:13
  Hi - this is Dr. Horrigan - I have to go now - thanks everyone for your wonderful questions - take good care
4:13
  Thanks, everyone. Sorry we couldn't get to all your questions. 

We will close with an invitation to join us for the next "Docs Are In" webchat on Thursday, July 5th, same time, same station. Autism Speaks Chief Science Officer Geri Dawson will be joined by the co-authors of her new book "An Early for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate and Learn." They will be answering your questions on early intervention and the roles that parents and other caregivers can play in supporting the development of young children on the autism spectrum. You can send us advance questions - on these and other topics - at ScienceChat@autismspeaks.org