Dr. Siegel Chat Transcript

Friday, September 14, 2012 View Comments Autism Speaks

 

Family Services hosted a Live Chat with Dr. Matthew Siegel in conjunction with the launch of our Challenging Behaviors Tool Kit.

Dr. Siegel attended Amherst College and Stanford Medical School. He completed a Triple Board Residency at Brown University in child psychiatry, psychiatry, and pediatrics. He is the Director of the Developmental Disorders Program of Spring Harbor Hospital and Maine Medical Center, and is actively publishing in the area of autism and serious behavioral disturbance. He is a Clinical Investigator at the Maine Medical Center Research Institute, an assistant professor in the Department of Psychiatry of Tufts University School of Medicine, and the founder of a national inpatient research collaborative on children with developmental disorders. He has been a consultant and speaker for hospitals, agencies and school systems on treatment approaches for children with autism and behavioral challenges.

 

4:03
  Hi everyone, I'm Matthew Siegel, a Child Psychiatrist & Pediatrician and researcher in Autism and Developmental Disorders.
 
4:04
 
Comment From Stan Hartke

Hello Dr. Siegel, We have been dealing with a behavioral problem with 8 year old autistic daughter. She has begun to pinch and bite. It seems to happen when there is change to her focus or moving from one activity to another. We have had her allergy tested thinking it may be something environmental causing this.

 
4:07
  Hi Mr. Hartke, This is a common problem behavior in ASD, particularly at transitions. The question of what is causing a behavior can be looked at in terms of does it occur at discrete times, or does it occur across settings. In this case, since the behavior happens at transitions, it more likely related to either transition anxiety, communication frustration or avoidance than to a across setting issue such as allergies.
4:08
 
Comment From Aja

My son is a little over two years old. He says only about 5 words total. We can tell that he comprehends a lot, but he screams a lot when he wants to communicate. We think it is because he is frustrated that he can't verbalize his needs. How do we handle this type of behavior. Do we accept it as part of his communication or what can we do to correct it.

4:10
  Hi Aja, Undoubtedly your son is experiencing some communication frustration, as a 2 year old will typically have about 200 words, so I think you are right to look at this as a communication issue and not a straight behavior issue. The emphasis should be on working with a speech language pathologist on strategies to enhance his communication, which is the single most important predictor of long term outcome in ASD.
4:10
 
Comment From Barbara Mack Moore

My 9-year-old son always wants to be first in line and gets aggravated when he has to wait. Do you have any suggestions for this recurring problem?

4:13
  Hi Barbara, This is somewhat normative behavior in a 9 year old boy, but if this is interferring with his relationships or functioning then you could add some positive reinforcment by providing a small reward each time he stays in line and doesn't push to the front. You could also consider putting him on a budget by giving him 3 "cut the lines" coupons if his teacher was willing to oversee this.
4:14
 
Comment From Jennifer Bolick

My son gets very frustrated and will as a result display aggressive behaviors. For example, at school today he became frustrated because the computer wasn't working fast enough so he hit the mouse on the desk. The teacher made him quit using the computer as a consequence. He became very upset and threw a chair. He is non-verbal so he can't say that he is upset or mad, he just reacts. How can we help him?

4:16
  Hi Jennifer, Helping a child with minimal communication express themselves appropriately is a huge challenge. Strategies to try include: enhancing communication with PECS (picture exchange communication system), reinforcing appropriate communication by placing a "help please" icon on their desk and doing trials to teach them how to utilize it, and then reinforcer appropriate communication.
4:16
 
Comment From Christina

I'm a 22 year old autistic adult and I was wondering how can I deal with noisy situations. I react by getting upset and whatnot. Is there anything I can do about it?

4:18
  Christina, thank you for joining us as an adult on the autistic spectrum. Occupational therapists often have strategies to reduce sound stimuli. I have had a few of my patients obtain individualized ear plugs that are molded specifically to their ear, which cut the decibel level evenly across all frequencies, but still allow you to hear. This is the type of device worn on stage by rock stars! An audiologist can do this for you.
4:19
 
Comment From Hp

I am a teacher of student's with special needs. One of students with autism screams, loudly, to avoid any work. I really can't ignore, because it bothers the other students so much. He is very intelligent. What can I do?? Its not a sensory issue- he also head bangs and tries to head butt other students. I think the head banging is sensory.

4:21
  Dear HP, thank you for writing as a teacher of an child with ASD. I would suggest obtaining behavioral consultation through your district for a behavior at this level. If the function of the behavior is determined to be escape from work, then continuing to represent the task, with positive reinforcement for compliance and quiet voice, will likely be helpful. Due to the head banging, a medical provider should also check his ears and mouth for any infections or other issues.
4:22
 
Comment From valeria

my son is 18 years old he has austism , adhd , seizures and much much more , but his behavior has been something else lately ... he hits and kicks me i have done everything with him and just getting worse my family a friend to leave me alone dont know what to do wondering if you can help he at metally a 6 year old leavel thou

4:24
  Dear Valeria, It is possible that your son is experiencing challenges related to his emerging identity as an adolescent, as his peers are now graduating high school. Mood and anxiety issues increase at this age. Given his complex pictures of ASD, adhd and seizures, I think he should be evaluated by a child psychiatrist to look for co-occuring mental health problems.
4:24
 
Comment From Angela

My 2yo son has started needing my hand to hold to fall asleep or he sleeps in my bed. He does not sleep well in his bed and wakes up a lot and demands to go in my bed. I try to resist, but I need sleep too. Also, he hardly ever eats at the table. He would prefer to eat walking around with finger foods. He is perfect at the sitter tho. I have a 3yo boy as well, so letting him just eat wherever or sleep with me is not the best option unless I want them both to do it. Thoughts?

4:27
  Hi Angela, Sleep is so very important for you and your son. Most sleep problems in ASD are like those in typically developing children - they are determined by the environmental response. So, the best course of action, as difficult as it will be, is to invest a couple week period in repeatedly returning him to his bed and getting him used to falling asleep on his own. You may need guidance from a child psychologist or pediatrician ins trategies of how to slowly remove yourself from the room to help him learn how to fall asleep on his own.
4:27
 
Comment From JMichele

I have a child with Aspergers and we struggle with negative outbursts daily - it is especially rough at school. Also she has suicidal thoughts and expresses these out loud. Any insight?

4:30
  Hi JMichele, We do see higher rates of mood disorders and even suicidal statements in children with Aspergers, particularly adolescents. One of the challenges of being on the higher functioning end of the spectrum is dealing with the knowledge that you are somehow different. Suicidal statements have to always be taken seriously, so your child needs to be evaluated by a mental health professional to understand the risks and etiology of these statements.
4:31
 
Comment From Kathryn Breed

Hi Dr. Siegel you have treated my son in the past. I m interested to know your thoughts about oxytocin? My son is 19 now has this been shown to b effective in older kids/young adults?

4:32
  Hi Mrs. Breed, Oxytocin is the subject of intense interest in autism research right now. Thus far there have only been very limited trials of limited dosing, which appeared to possibly have a positive effect. There are currently large scale trials being performed by a number of investigators, which will tell us the answer. Until the evidence comes in, we will not know if this is an effective treatment.
4:33
 
Comment From Ingrid

My 8 year old son has Autism he is chewing all his clothing and licking everything ( floor, walls grass . bathroom floors in public) I can not seem to stop this new behavior we have chew tubes straws and lots of other items to change out with but nothing seems to work. We have spoken to his developmental Ped. at chops and She put him on prozac and Methylphenida. but this too does not help any suggestions Im tired of having to buy new shirts every week.

4:36
  Hi Ingrid, Pica, the eating of non-nutritive substances, and other oral behaviors such as licking and spitting, are somewhat common in younger children with ASD, or those more intensely affected by ASD. Very rarely, this can be caused by a mineral deficiency such as zinc, but this tends to only occur in chidlren who have a very restrictive diet. Psychotropic medications are rarely helpful with PICA, and none have shown efficacy under study. The most helpful professional for this are typically Occupational Therapists who are experienced with kids with ASD.
4:37
 
Comment From Eileen

My 8 yr old PDD-NOS son tends to get anxious out on the playground during school recess. As a result, he rarely seeks out any interaction with his peers. He has mentioned that he "does know what the rules are" or that "what if he doesn't know what the other kids are playing". Any strategies for him. He tends to be a perfectionist in many areas of his life and becomes very upset and disregulated when he loses(a game) or fails at a task(soccer skills).

4:40
  Hi Eileen, Having an anxious, rigid, rule-bound and perfectionistic personality is quite common for kids with PDD-NOS. Sometimes an anxiety medication, such as prozac or zoloft, can be helpful with this - if the anxiety and rigidity are significantly interferring with life. In addition, higher functioning children certianly struggle with "not knowing the rules" of social situations, and there are a number of strategies to help them build social awareness. One series of work in this area is by Michelle Winner and is called Social Thinking. Though there is no solid evidence for the effectiveness of Social Thinking at this time, it does appear to help some children to make progress in socialization. Other treatments are currently under study.
4:42
 
Comment From Guest

my daughter was diagnosed with autistic tendancies and i was wondering what you suggest for things to look for to know if she should see a specialist to see if she is for sure autistic i truelly believe she is and some believe me and some think its her age

4:44
  Dear Guest, If there is significant concern that your child may have autism, then she should receive a diagnostic evaluation, using standardized assessment tools, such as the ADOS or ADI-R, by a psychologist or physician with experience performing these evaluations.
4:45
  Hi Folks, Many wonderful questions are flooding in, and I am answering them as fast as I can, so hang in there!
4:45
 
Comment From Kellie

my son is 13, and I am having trouble knowing what is age appropriate behavior and what s autistic behaviors

4:47
  Dear Kellie, 

It certainly can be difficult to separate what is normal for ASD behavior, what is normal for age, and what is beyond both. A provider who is experienced with evaluating challenges in children with ASD can listen to what is happening and help you sort this out. For example, it is normal for a 4 year old boy to become hyper at times, ASD or not, but not normal to run through the house for 2 hours straight bouncing off the walls.

4:48
 
Comment From Tim Kane

Hi Dr Siegel, our 12 year old son with autism becomes very upset when he hears a child crying or whining. He can become aggressive towards himself and others when he hears another child in distress. To your knowledge, have there been any studies in this area? The clinical director at school is trying to create a program to desensitize and we would like to help with any possible research. Thank you.

4:50
  Dear Tim, We have encountered this a number of times where the distress of another child causes the child with ASD to become upset/aggressive. I am not aware at the moment of any research in this area, but I think a slow systematic desensitization program makes sense, perhaps using an audio tape of a child in distress. Doing a graduated exposure with rewards for participation may help.
4:51
 
Comment From Maine Mom :-)

My 3rd grade son who is PDD-NOS will talk all night about what he wants to talk about but whenever I ask him about difficult subjects(hurt feelings, his lack of friends, difficulties controlling his frustration in public) he says he doesn't want to talk about it. He might then walk away or even let out a little scream in protest. I am desperate to know how he feels and worry all the time that he lonely or sad. Should I pursue the subject any futher?

4:53
  Hello Maine Mom, I think it is normative behavior for an 8-10 year old boy to have no desire to talk about feelings/negative topics. Best approach is to try gentle probes, perhaps by drawing a picture or writing a story together, which may draw him out. If he is truly lonely or sad you will know.
4:53
 
Comment From John S.

Are there any type of diet or nutritional supplements that are better for children with ASDs?

4:57
  Hi John, This is a big topic. There have been several good reviews of supplements and diet in ASD - see Susan Levy, MD on pubmed. At this point I am not aware of any strong scientfic evidence that nutritional supplements help your avergae child with ASD. Supplements that have strong evidence of no effect include B6 and Magnesium, which have been tested in large trials and showed no benefit. There was also a large randomized controleld trial of the Glutein Free Casein Free diet and IVIG that showed no effect. There are, of course, rare vitamin deficiencies and metabolic disorders that require dietary changes, and these can be diagnosed by you physician. There are, of course, practitioners in the community who disagree with what I have just written. I would be wary of anyone who makes their living by selling you that which they prescribe to you, which is sometimes down with supplements.
4:57
 
Comment From Della Simmoms

I have an 25yr old son which lashes out when angry he bites his hands,he literally has teeth markings on them, he's non verbal

5:00
  Hi Della, When you have serious behavioral disturbance, such as repeated self injury or aggression, it is time to get an experienced child psyhciatrist, psychologist or developmental pediatrician involved. If these behaviors do not respond to outpatient treatment, and become very severe, one can consider utilizing a specialized hospital unit for treatment. A list of these can be see at www.inpatientdevelopmental.com, and you can also receive futher guidance from the Autism Speaks Challenging Behaviors ToolKit, which will be released tommorrow on the Autism Speaks website.
5:01
  Ok folks, thanks for all the wonderful questions and I wish you continued strength and curiosity in helping children with ASD. Dr. Siegel
5:02
  And be sure to stay tuned for the Autism Speaks Challenging Behaviors Tool Kit that will be out tomorrow! It has lots of helpful tips and resources for families and individuals experiencing challenging behaviors.
5:03
  And as always, if you have any questions or need any assistance, you can always feel free to contact our Autism Response Team at 888-288-4762 orfamilyservices@autismspeaks.org
5:03
  The Autism Response Team is happy to help!
5:03
  Visit our website tomorrow at www.autismspeaks.org/family-services to check out our tool kit. Have a great day everyone!