'The Doctors Are In' July Transcript  

Hi everyone. Thanks so much for joining us. Today, our regular host Autism Speaks Chief Science Officer Geri Dawson, Ph.D., is joined by psychologist Sally Rogers, Ph.D., and behavior analyst Laurie Vismara, Ph.D., both of the MIND Institute at the University of California-Davis. They are Dr. Dawson’s co-authors of the newly published An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate and Learn.

Thanks to those of you who sent advance questions toScienceChat@autismspeaks.org. We’ll try to get to as many as possible in addition to the live questions coming in over the next hour.

One more quick reminder before we start: 

You are invited to our two-day National Conference for Families and Professionals, 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
 

Hi everyone, this is Laurie Vismara. Thank you for joining us.

Hello everyone, This is Dr. Dawson. I'm glad you are here with us. We are excited to tell you about our new book - An Early Start for Your Child with Autism - and to answer your questions about early intervention. Please feel free to submit a question.

HI, all. THis is Sally Rogers, here at the MIND Institute in sacramento. Glad to be with you today. 
 

Advance question from Judi 
In your book, you have described the nurturing of necessary skills that support verbal language development.
What if the child has great verbal skills but has inconsistent gesture, gaze and joint attention? Can we skip some steps or must we follow your instructions in order?
<

Hi Judi, This is Dr. Dawson. It’s great to hear that your grandson has strong verbal skills. I do recommend starting with the early steps that focus on eye contact, gesture, and joint attention. This will provide a solid foundation for teaching your child how to integrate his verbal skills with nonverbal skills. Given his delays in motor development, an occupational therapist should be involved in his preschool program and offer suggestions for improving those skills.

Hello, This is Dr. Dawson I see that there are several people on the webchat - please feel free to submit your questions. We are eager to start the conversation.

Hi, Jennifer, 
The book contains both general chapters for parents of newly diagnosed young children, focused on topics that are of typical concern for young families - how to get good evaluations, services, etc and how to cope with this new life, and also specific chapters on how to help your child build needed skills step by step. Some families have to wait a long time for outside services, and the book helps parents get started right away, themselves, creating new learning opportunities in their daily life activities. Parents are the absolute best teachers.

Advance question from Patty
Are there research on use of computer applications on tablets such as Ipad to assist children with autism in learning skills; and if so, can they give a few suggestions of apps that seem to help?
 

Hi Patty, This is Dr. Dawson. Check out this spot on Autism Speaks website: http://www.autismspeaks.org/family-services/autism-apps . We describe a wide range of apps that can help children with autism learn. Good luck!

Advance question from Kim 
My daughter is almost 33 months old, she'll be 3 in September. She's nonverbal, doesn't respond to her name, doesn't seem to hear loud noises and doesn't point at things. She was diagnosed at about 18months on the spectrum and has definite sensory issues. (for ex. everytime we put her in the tub she violently throws up, but if her dad holds her in shower she still gets very upset at times but doesn't vomit.) I've been told that if she doesn't talk by age 6 more than likely she will not. Is this true in your experience and does her dx of asd sound correct to you?? I feel in my heart that she is ASD and I've felt that at a very early age with her, but some friends and family disagree, at times listening to them and their opinions is the hardest part for me. She's in speech therapy and we are seeing progress in other areas but definitely not pointing or speaking at all. Someone suggested instead of using ipad apps or pec cards because she's so young it may be a good idea to take pictures of things that actually belong to her, like her swing, her bike, her baby, etc. and make our own picture cards to help teach her to communicate with us. She's an absolute joy and just the sweetest thing and a wonderful blessing from God along with my two beautiful older daughters and we just want to help her be the best God had planned for her and are open to any thoughts/suggestions. Thank you, from her dad and I.
 

Hi Kim, this is Dr. Dawson. The behaviors and challenges you are describing fit with a diagnosis of ASD. Many kids with ASD have difficulty learning to talk and many have sensory issues. Some children don’t talk until elementary school age or even older. Speech therapy can be very helpful, but your daughter might also be helped by a more comprehensive behavioral intervention program that focuses on the early building blocks for language development, such as social skills, gesture, and imitation. By starting with these fundamental skills, your daughter’s speech development may be helpful. In addition, children who haven’t yet learned how to speak are helped by using visual supports, such as pictures. Autism Speaks has a tool kit that describes how to use visual support. We will send you the link. Given that your daughter has sensory issues, she might benefit from a therapy call sensory integration therapy which many occupational therapists can offer. Autism Speaks has a resource guide that describes how to find services in your area. We will send you the link to the resource guide too. In the meantime, you might want to try some of the strategies that we describe in our book – An Early Start for Your Child with Autism (http://www.amazon.com/Early-Start-Your-Child-Autism/dp/1462503896 ). We describe simple strategies you can use at home to promote learning, play, and language development.

Comment From Guest  

My son is 29 months old and been in occupational therapy for over a month. He can say two words. "Yum Yum" and "Ma Ma." Since occupational therapy he is now saying "up, off, out, and crash." I try to use the same methods at home that they use in occupational therapy, but my son will never say the four words at home. Do you have any tips I can do at home?

Hi, This is Dr. Dawson in response to the question posted about the 29 month old child who is in occupational therapy. Children with autism often have difficulty generalizing what they learned in one context in another context. Try prompting the use of these words using the same prompts and stimuli (e.g. toys) that the occupational therapist is using. Start with one word, not all four at a time. You can also observe what the occupational therapist is doing in the therapy session and use these same strategies. She may be using specific prompting strategies that you can try.

Advance question from Suzanne G
My son Liam has PDD-NOS and is very high functioning. He currently attends Developmental Kindergarten. Up through February, he was doing very well. Academically he is off the charts. Social skills were lacking, which is no surprise. Recently, however, around mid-March, Liam began exhibiting disruptive behaviors in class such as making loud noises and running around (while laughing like it was a big joke) a few days a week and getting very little done in school. In the last few weeks, he has started with these behaviors every single day, to the point where he has to be removed from class. 

A Behavior Therapist now goes into the classroom a few days a week to try and find a solution. She says this behavior is deliberate attention-seeking. The behaviors are minimal at home, and most of the time nonexistent. Unfortunately his father and I are divorced so he does split time between both households. The Behavior therapist has gone over a behavior plan for Liam to get us all on the same page for consistency. Any ideas or advice? We are all at a loss.
 

Hi Suzanne, 

This is Laurie. Having a Behavior Analyst on your child's educational team is a good start to understanding why the problem behaviors are happening in the classroom. Since the behaviors are specific to the classroom, they will be have to be evaluated and addressed there. Working together to implement the behavior plan in the classroom with the Behavior Analyst carefully monitoring progress will be critical. If he is removed from the classroom before the problem behaviors are addressed and improved in the classroom, there is the risk that he will generalize those behaviors to future classrooms. So, it's really important to join with the school team to follow up with a good behavior plan and carry it out in his current classroom.

Comment From tiffany  

Hi this is Tiffany again. My son is on a gluten free casein free diet and is doing much better. I want to make sure he is getting all of his essential vitamins. Is there a mutivitamin you recommend for a 2 year old with autism?

Dear Tiffany, This is Sally writing. I'm glad you are thinking about the nutritional implications of the gluten-free casein-free diet. In addition to vitamin intake, there are other aspects of your child's nutrition to consider. We recommend that you discuss with your child's physician the dietary restrictions involved in the diet and ask for advice. Your physician may refer you to a pediatric nutritionist, who has much expertise in this area as well. Young children's brains and bodies are growing quickly and good nutrition is a very high priority at this important time in children's lives.

Hey everyone,
Huge apologies. We need to go offline for ONE or two minutes. When we do, we'll briefly lose all of you. Then you'll need to rejoin the chat when we go live again. Pretty please?! Thanks so much for bearing with us.

And we're back!

Advance question from Kim
HELLO! I have a child 6 yesterday but developmentally at 3 yo. EI and early ABA/Floortime helped immensely but entering the school system did not do anything and now I have a behavioral completely verbal but frustrated twin girl who has no friends, high anxiety and we are in ed court for a placement out of district. Sadly what I let go was what I COULD DO. Is it too late to help her regarding early intervention - I am grieving her now missed potential. I am eager to help but a bit washed out emotionally for the past 3 years I've had a 3 year old. She wants to get better and knows how different she is and is not happy. Academics on track.
 

Hi Everyone - we are back! please feel free to submit a question. Dr. Dawson

Dear Kim, This is Dr. Dawson. The transition from preschool and early intervention to elementary school is often a difficult one. Your child’s developmental profile suggests that in some areas she is like a 3 year old (perhaps her social skills, for example) but in other areas she is at age level. So, it makes sense that she will feel frustrated. It is important that her individualized educational program (IEP) address the areas in which she is having difficulty (e.g. social skills) and at the same time challenge her in the areas she excels in (academics). Autism Speaks provides a guide to the IEP process that might be helpful to youhttp://www.autismspeaks.org/sites/default/files/iep_guide.pdf . Once your daughter gets into a program that adjusts for her learning style and helps her develop friendships, her anxiety likely will lesson. Autism Speaks school tool kit might be helpful to you as well http://www.autismspeaks.org/family-services/tool-kits/school-community-tool-kit . When children get into a program that addresses their needs, they usually make progress. Most children will continue to gain skills given the right program.

Advance question from Kathryn
Many of us are still struggling to get our insurance companies to help cover the very expensive early-intervention treatment options. Do you have any tips to get self-insured companies to include ABA (or any other autism-related therapies) in their insurance plans?

Dear Kathryn, 
This is Sally writing. Insurance coverage is such an important issue right now. Some states are now requiring that insurance companies provide evidence based treatment for ASD. You can contact your state board of medical insurance or your local autism society to determine whether your state has such a law. Many autism soceities and groups have advocates who can provide you with additional information. Another strategy is to appeal the denial of coverage, and submit evidence of the efficacy of early intervention from various review papers and research papers. You can involve the state board as well in appealing denials. FIndining other famileis who are receiving insurance benefits may help provide you with ideas as well. Asking your physician to have a discussion with the person at the insurance company who is making benefits decisions may have some effects. FInally, here is a link to a site on Autism Speaks site that may be help.

http://www.autismvotes.org/site/c.frKNI3PCImE/b.5216007/k.EE12/Resources.htm

Comment From jennifer gutierrez 

my 10 year old son has autism i find out 4 years ago can you tell me what is different having ADHD and autism

Hi Jennifer. This is Dr. Dawson. Children with autism have three types of symptoms: Difficulties in social interaction, challenges in communication, and repetitive behaviors. Children with ADHD have difficulties with paying attention, often are overly active, and have poor impulse control. It is possible for children to have both autism and ADHD.

Comment From tiffany 

My son is 29 months old with Autism. He drinks large amounts of water, I met a mother who's child is autistic and she said her son also drinks a lot of water. Is this common? He goes through 10-15 diapers a day.

Hi Tiffany, 

This is Laurie writing. I can understand your concern here. I would speak directly to your pediatrician about this issue since it's an unusual behavior and can have medical implications.

Advance Question from Kelly 
I have a grandson who is now almost 4 years old and is Autistic. There seems to not be a lot of motivation on getting him help. Parents found out that (Duke Energy) husband’s employment won’t take mental illness cases so expenses may be high. Can you enlighten me on some type of schooling he should be in at this point and possibly some type of financial assistance they may look in to?
Very Concerned Grandmother
 

Dear Kelly, 
Thank goodness for grandparents! Young families need all the support they can get when they are facing ASD, and it helps so much to have extended family support. Your child has legal rights to an appropriate preschool education due to his ASD, and the place to begin is with his public school district. The child's parents can call the district and say that their 4 year old has ASD and needs preschool services. The district will then eityher set up an evaluation for him to determine his needs, and develop a plan to address them, or refer you to another similar service. Your tax dollars are at work here, so there should not be any charges to you for school services. Your child's doctor should also be able to help you start the process of finding services, but the school is the most important call for a child this age already diagnosed. In addition, The Autism Speaks website has a link to services in specific areas. Here it is:

Autism Speaks Local Resource Page (click on state):http://www.autismspeaks.org/family-services/resource-guide

Comment From sally 

average age to potty train a child with autism how long usually takes

Hi Sally, This is Dr. Dawson. Most children with autism can be potty trained when they are preschool age (sometimes earlier). Autism Speaks has recently published a tool kit on toileting that can provide lots of information about how to potty train and how long it takes. 
http://www.autismspeaks.org/science/resources-programs/autism-treatment-network/atn-air-p-toilet-training

Advance question from Jessica
My daughter is nearly 7 years old, diagnosed with PDD-NOS over a year ago and has sleeping issues. Her brain just doesn't shut off when her body wants to go to sleep and so she assumes she's not tired and doesn't want to go to bed. We are trying to make sure her environment is suitable (no TV, quiet room, adequate lighting as she's scared of the dark) but its beginning to interfere with school and I'm wondering if homeopathic sleep aids like melatonin or Hyland's Calms Forte for children would be useful. But I'm wondering if they truly are safe, if not taken all the time? Also I've heard that melatonin is not necessarily safe for children unless they truly have a lack of melatonin, and is there any way to test these levels to find out if she truly has a deficiency or not?
 

For starters, here's the link to the free ATN/AIR-P parents tool kit on sleep:

http://www.autismspeaks.org/science/resources-programs/autism-treatment-network/tools-you-can-use/sleep-tool-kit

Hi Jessica, 

This is Laurie. Thank you for talking about such an important issue. When children don't sleep, it affects everyone in the family! It sounds as if you already have some good plans in place- creating a consistent routine to bedtime, quieting the house, and adjusting nap schedules if necessary to make going to bed easier, have been very effective methods. Daily exercise can also be very helpful with sleep. For more information on helping children improve their sleep habits, check out "Sleep Better" by Vincent Mark Durand in addition to the link on the Autism Speaks site.

Thanks so much for joining us today. We enjoyed having a chance to communicate with you. Please remember to look for resources on Autism Speaks website - there are toolkits and other information about a wide range of issues. Drs. Dawson, Rogers, and Vismara

Thanks everyone. Geri and Joe will be back the first Thursday of next month, August 2nd, for our next “The Docs Are In” chat. Please join us and tell your friends! Between now and then you can send advance questions toScienceChat@autismspeaks.org. Be well!