Autism: Dispelling Myths

Here are my notes from one of the sessions at the 

Converge Autism Summit. This presentation was: Autism: Dispelling Myths by Dr. Matthew Fisher (Adolescent Psychiatrist at Springbrook Autism Behavioral).

Research GI Flora (Gut Bacteria):

• November 2021 Australia
• 99 Patients with ASD
• 51 Siblings
• 97 Unrelated Children (Picky Eaters)
• Stool samples showed no differences in gut flora between ASD and Picky Eaters

Waiting for the Diagnosis: 

• Prior to Pandemic wait times ~12 months
• “Post” Pandemic wait times ~18+ months
• Waiting for a formal diagnosis potentially misses critical developmental stages and windows for improved interventions
• Get referrals for Occupational Therapy, Speech Therapy, and Possibly Dietary

Occupational Therapy:

• Improve Fine Motor Skills
• Regulate Sensory Needs
• Assist in Education
• ADLs (Activities of Daily Living)
• Social Interactions and Participation
• Special Note: OT is not intended to find you a job!!!

Dispelling the myths of OT:
Contrary to popular belief:

• Not every child needs a weighted vest Not every child has sensory issues
• Not every child needs OT
• OT is not Physical Therapy

Speech Therapy:
Speech and Language Pathologists: 

• Improve Verbal Communication
• Improve Nonverbal Communication
• Feeding and Swallowing Concerns

Dispelling the myths of ST:

Speech and Language Pathologists:

• Improve Verbal Communication
• Improve Nonverbal Communication
• Feeding and Swallowing Concerns

Direct Contact is Overrated:

• Direct eye contact can be overwhelming and sensory averse
• Best to have them face you so show that they are listening

Communication and ASD:

• Many believe that teaching augmentative communication (sign language, picture boards, etc.) will decrease the likelihood of speaking
• Alternative Augmentative Communication (AAC) facilitates the development of speech

Overly focused on a single goal/skill:

• Too much focus is often given to mastering a single communication goal
• Best to cycle through functional communication, social skills, and language skills to expose them to a variety of skills needed for daily functioning

Fixation on a single mode of communication:

• Signs, picture communication, rudimentary gestures, and verbal communication should ALL be targeted.
• A Total Communication approach expands skills faster than a single focused approach

Picky Eaters:

• Some children may be picky eaters however, others may overeat as they crave sensory input.
• Some children may appear picky but have sensory aversions (texture, tastes, smells)

Other Explanations for Picky Eaters:

• Perhaps your child just doesn’t like certain foods. . .and that’s OK!!!
• Maybe it’s genetic (ie: Broccoli)

Early Childhood Intervention Programs:
BabyNet

Making the Diagnosis:

• Formal Diagnosis should come from a Medical Doctor
• Child and Adolescent Psychiatrist or Developmental & Behavioral Pediatrics. . .if you can find them
• Many states “require” CARS or ADOS assessment to meet requirements for services

CARS vs. ADOS:

• CARS: Childhood Autism Rating Scale
• Questionnaire answered by someone familiar with the patient (parent, teacher, daycare worker)
• ADOS: Autism Diagnostic Observation Scale
• Structured and detailed assessment that involves tasks of varying complexity

CARS:

• A Questionnaire designed to identify those who might have developmental delays and/or ASD traits
• The form is filled out by someone familiar with the child so results can be quite subjective
• Results can vary widely

ADOS:

• Modules based on functioning level
• You must be specifically trained in ADOS and have the proper assessment kit
• The scores are based entirely on the results of the test
• Testing can take an extended amount of time

IQ Testing:

• Intelligence Quotient
• Often a “cut off” for services
• Typical cut off score is 70
• Highly dependent on the administrator of the test ◦ Requires active engagement by the child
• You can always “fake” a low score
• Unreliable Indicator

IQ vs. Functional Skills:

• IQ provides a number to qualify for services
• Adaptive Functioning – Actual Abilities
• Tests may include: 
• Vineland (VABS)
• Woodcock-Johnson

ID vs. ASD

• Intellectual Disability: The diagnosis formerly known as Mental Retardation (MR)
• Borderline Intellectual Functioning: IQ 70-85
• Ranges: Mild, Moderate, Severe
• Mild: IQ 50-69
• Moderate: IQ 35-49
• Severe: IQ 20-34
• Independent from ASD

Observation is the best assessment!

The Academic Diagnosis of ASD:

• A medical/clinical diagnosis does not necessarily entitle a child to additional school resources or services
• An academic diagnosis does not mean that the child will meet clinical criteria for the diagnosis.

What’s Up With Nonverbal ASD:

• Nonverbal vs Minimally Verbal vs Echolalia
• Do they use other forms of communication??? 
• Sign Language
• Communication Boards
• Typing

Receptive vs Expressive Communication Can they follow commands?

• Can they follow multi-step commands?
• Indicator/Marker for overall progress if still nonverbal by 4 years of age

No Cause for Behaviors:
Just because you aren’t aware of a cause doesn’t mean there isn’t an actual cause!!! (antecedent)

Don’t Forget Medical Diagnosis:

• Children with ASD often struggle to communicate discomfort, pain, or to indicate the presence of medical conditions
• Even verbal patients often fail to recognize or convey information regarding physical symptoms

Children with ASD:

• 25% lifetime chance of Seizure Activity
• 25% with some form of Gastrointestinal Problems
• Diarrhea (runny stools the most common) Constipation
• Esophageal Reflux (GERD)
• Eosinophilic Esophagitis (EoE)

Special Diets:

• Gluten Free
• Casein Free
• Soy Free
• You’re already dealing with picky eaters
• Do they have a medical diagnosis or allergy? Often more trouble than it works Starting an unnecessary battle

Fish Oils:

• Fish Oil has been found to have mild mood stabilizing properties 
• Natural Sources yield broader health benefits than Supplements (change diets if possible)

They’ll Never Be Able To:

• Hold a Job. . .
• Live Alone. . .
• Function Independently. . .
• Complete Neurologic Maturity reached at 25 years old (18 isn’t remotely an adult brain)
• Meanwhile in Ancient Rome. . .

Neural Wiring and Dendritic Pruning

Dendritic Pruning streamlines neural firing and functioning


Undiagnosed ASD:

• Reactive Attachment Disorder (RAD) Abuse/Neglect/Trauma
• Emerging Psychosis
• ADHD & Anxiety

What happened to Aspergers?

• “Former” Diagnosis that encompassed higher functioning ASD with no speech delays
• Normal IQ range
• No higher risk of medical diagnoses
• Blame DSM-V

Closing Thoughts/Tips/Tricks:

• Schedules
• Logs
• Maps
• Pattern Recognition
• Prescriptions