Category Archives: Treatment

Nutritional Therapy for Parents

Autism spectrum disorders (ASD) are developmental disorders that affect children by disrupting their ability to communicate and interact socially. To reduce a child’s symptoms of autism and improve social and cognitive behaviors in speech, parents can try nutritional therapy. This is because many children with ASD have reported to have allergies and high sensitivity to foods, especially gluten and casein. Children with autism, according to the theory, process peptides and proteins in foods containing gluten and casein differently than other people do and this difference in processing may exacerbate autistic symptoms.

Identify those food allergies as soon as possible can be vital to the developmental progress of a child with ASD.  Gluten (found in wheat, barley and rye) and casein (found in milk and dairy products), are important in caring for an Autistic child and is worth trying out as many parents have reported changes in speech and behavior after utilizing nutritional therapy.  Parents can seek allergy testing for confirmation or keep a food diary, and remove certain foods from your diet, to determine exactly what your child is allergic to.

Before going to the grocery store, you can make a list of what your child can have.  You can give pictures of foods the child can eat and have them participate in choosing the foods they would like to eat, that way the child gets a choice but the choice is within a list of acceptable food.

You can have the child with ASD help you cross items off the list while shopping with you. Or you can say the name of the item, point to the item, have the child hold the item or put into the basket so the child starts expanding their vocabulary via sight and sound. You can describe color of the apple, the texture as child holds item, is it a hard or soft object. You can make it a game where she has to help you find what’s next on the list, help you grab it off the shelf, and help you count how many items are left on the list.  Every moment can be a teachable moment that you can do with the child, and even thought at first it seem they aren’t getting it, keep trying, like all children they need lots of repetition and imagery to learn something new.

You can use stickers, stamps, tokens as reward for good behavior. Make sure the rules for earning the tokens are clear and consistent. For example: “Listen to mommy, calm voice, hands to myself.” Stay away from vague rules like “Be good,” and avoid telling her what NOT to do “No crying.” Then when she exhibits the behaviors in the rules, you reward her with a token and praise the good behavior you saw. You might say something like, “Wow, great job listening to mommy/daddy. You earned a happy face!” Once the child with ASD has all the tokens, the child can have a reward. This will help the child with ASD to tolerate the delay in getting what she wants, because she can see that she is working towards it. Here’s a simple example of what it might look like.



States Slow to Move on Mandated ABA Coverage

Months after the federal government passed legislation requiring states to include coverage of therapeutic autism services such as applied behavior analysis (ABA) in their Medicaid programs, progress is slowly being made. 

It was determined in July of this year that Medicaid programs nationwide must cover “medically necessary diagnostic and treatment services” to children with autism spectrum disorders (ASD) including behavioral therapy, occupational and speech therapy, personal care services, and medical equipment. 

California is the first state to comply, issuing a bulletin to plan administrators September 15 explaining that Medi-Cal, California’s Medicaid program, will cover evidence-based behavioral intervention services including ABA for autistic children up to the age of 21. Coverage is available immediately for those who qualify for the program and will be retroactive to July 7, 2014. 

Connecticut and Nevada are expected to be the next states to expand their Medicaid coverage of autism services in compliance with the federal mandate, but no official announcements or timelines have been released. 

Despite warnings from the Centers for Medicare & Medicaid Services (CMS) back in July that it would likely take some time to for states to come into compliance with new regulations, a class action lawsuit has been filed in Hawaii over the state’s failure to provide Medicaid coverage for ABA therapy. We will have to wait and see if this gets the gears of Hawaiian state bureaucracy to move faster and whether similar suits are filed in other states that are slow to comply. 

Navigating Medicaid and obtaining services is complicated and different in every state. Many parents find it much easier to obtain the right services and coverage with the help of local autism advocates and service administrators. Organizations like Shema Kolainu Hear Our Voices School and Center for Children with Autism, serving children in all five boroughs of New York City help parents with Medicaid service coordination, early intervention programs, evaluations, speech therapy, occupational therapy,  physical therapy, and applied behavior analysis.



Video Game Therapy for Autistics

A recent study from Vanderbilt University found that what children with autism hear is often out of sync with what they see. Dr. Mark Wallace, who lead the study, describes it as, “a badly dubbed video.”

By comparing 32 high-functioning children with autism to 32 typically developing children, matched by age, sex, and IQ, researchers found that the children with autism had an enlargement in their temporal binding window (TBW). Simply put, their brains had trouble linking visual and auditory events that happened within a certain period of time.

“Children with autism have difficulty processing simultaneous input from audio and visual channels. That is, they have trouble integrating simultaneous information from their eyes and their ears,” said co-author Stephen Camarata, Ph.D., professor of Hearing and Speech Sciences. “It is like they are watching a foreign movie that was badly dubbed, the auditory and visual signals do not match in their brains.”

The second part of the study found that the autistic children also showed weakness in how strongly they associated audiovisual speech stimuli. Dr. Wallace believes this explains why autistic children often cover their ears or eyes. “We believe that one reason for this may be that they are trying to compensate for their changes in sensory function by simply looking at one sense at a time. This may be a strategy to minimize the confusion between the senses.” 

Building on the findings of this study, researchers are now in the testing phase of an interactive video game that they designed to retrain autistic brains in how they link different sensory input. As Dr. Wallace describes, “It basically takes the tuning of the nervous system and shapes it, so that they get better.”



Tablets Help Autistic Kids Maximize Language Skills

A recent study published in the Journal of the American Academy of Child & Adolescent Psychiatry suggests that using tablets with speech generating applications in the context of blended, adaptive treatment can help minimally verbal children make significant and rapid gains in their language skills.

For the study, 61 minimally verbal children with autism aged 5to 8 years old participated in six months of therapy geared towards improving language skills, play skills, and social skills. Half of the children were given a tablet to use during the therapy sessions loaded with a speech-generating app programmed with pictures objects used during the therapy. These children were able to touch a picture of an object they were using in therapy and hear an audio file of the objects’ names.

The study found that the children with tablets were much more likely to begin using language on their own, especially when they used the tablets from the beginning of therapy. The children appeared to have retained their skills when followed up on three months later.

“It was remarkable how well the tablet worked in providing access to communication for these children,” said Connie Kasari of the University of California, Los Angeles. “Children who received the behavioral intervention along with the tablet to support their communication attempts made much faster progress in learning to communicate, and especially in using spoken language.”

Shema Kolainu Hear Our Voices School and Center for Children with Autism is launching it’s iPad program this year. We will be sure to keep you posted!



Can Babies Exhibit Symptoms of Autism?

Sally Rogers, professor of psychiatry and behavioral sciences at the University of California-Davis MIND Institute, conducted a study that looked at treating subtle but telling signs of autism in babies. The findings, recently published in the Journal of Autism and Developmental Disorders, gives further evidence to support the idea that early intervention can help your child be more successful as their brains are still so flexible as a baby. Though study was quite small, including only seven infants who exhibited potential symptoms of autism, the results were promising. It is difficult to find infants who are likely to have autism since it is usually diagnosed in the toddler years.

Dr. Rogers explains that babies who may be at risk of developing autism exhibited the following symptoms:

  • Spending too much time looking at an object. Typically developing babies do look at objects but eventually they’ll do something with it for example, banging it, showing it to someone else, etc.
  • Showing signs of repetitive behaviors. For example, one little boy kept dropping the lid in a certain way to try to get it to spin.
  • Don’t exhibit any sort of communication or connection to parent. For example, they rarely make eye contact, smile, or look at the parent even if the parent is doing something interesting
  • They’re not trying to use their vocal chords often as typically developing babies do. Laughing and making baby sounds is part of them learning and wanting to communicate with the people and things in their environment.
  • Babies exhibiting these symptoms consistently for over two weeks are a good indicator that you may consider getting your baby screened for ASD.

Dr. Rogers helped the parents take the lead in the treatment process by coaching them on the “Denver Model,” which is all about having the child enjoy the rewards of social interaction. For example one mom, while playing patty-cake with her baby’s feet started playing a little too roughly and her baby made a sound, signaling the mom to stop. While smiling is enough to establish a connection for typically developing babies, others respond to different cues. The aim of this model is to give parents and caregivers the tools and knowledge to help their baby if they see symptoms.

She states, “I am not trying to change the strengths that people with ASD bring to this world…My goal is for children and adults on with autism to be able to participate in everyday life and in all aspects of the community in which they want to participate.”

For more information, click HERE



The “Little Brain” & It’s Big Influence

(Applied to autism, cerebellar injury could hinder how other areas of the brain interpret external stimuli and organize internal processes. Based on a review of existing research, the researchers found that a cerebellar injury at birth can make a person 36 times more likely to score highly on autism screening tests, and is the largest uninherited risk. Credit: Samuel Wang)

As researchers dig into the root causes for autism, they are finding that our cerebellum or “little brain” may play a bigger role in shaping our cognitive and language abilities than previously thought, especially in the prenatal phase. The cerebellum actually only makes up a total of 10 percent of our brain’s mass, but is the home of 50 percent of it’s neurons. The cerebellum is usually associated with movement and coordination, so a doctor checking for damage in the cerebellum would conduct a number of tests that check balance and motion. However, a recent study published in the journal Neuron suggests that dysfunction in the cerebellum in crucial moments during development could be one of the leading contributors to autism spectrum disorders as well as other neurodevelopmental disorders.

Dr. Samuel Wang, associate professor of molecular biology and neuroscience at Princeton University, and his research team, put forward the theory that the cerebellum is not only responsible for movement but also for helping developing minds process more complex sensory information that also aids in establishing social bonds. He explains, “Some of the clinical and animal-research evidence for cerebellar involvement in autism has been known for years, but this evidence doesn’t fit into the textbook wisdom that the cerebellum controls sensory processing and movement. At some level, researchers have been trapped by whatever framework they learned in college or grad school.”

In their study, Dr. Wang found that for children who experience damage to their cerebellum at birth are at an increased risk for ASD that he shows is comparable to the risk of a smoker developing lung cancer. So how is the cerebellum connected to developing “higher functioning” social and language capabilities? The study explains that a baby seeing their parent smile will eventually connect that experience to certain rewards that come along with it, for example being fed, which would overtime lead to the child’s ability to understand these social cues—a connection that is facilitated by the cerebellum. These connections that will eventually help with social behavior are especially vulnerable in the prenatal environment.

In Dr Wang’s words, “because the risk factor from cerebellar injury is bigger than any other know environmental risk, we think this provides deep insight into the basic biology of how ASD brains go off track. Problems in cerebellar function aren’t the (only) cause of autism, but they are potentially a significant cause of autism.” 

Studies like this one are important in developing best practices for treatment and therapy for those on the spectrum. Another recent clinical study published in the American Academy of Pediatrics issued new guidelines for physicians in diagnosing specific intellectual and developmental disabilities. The report argues that it is important to know the root of the child’s disability whenever possible in order to find the most appropriate treatment plans. Moreover, a better diagnosis will help families manage expectations and advocate for their child in the best way possible.



Connecting the Dots: Leaky Gut, Gluten-Free, Casein-Free, Low-Carb, and Probiotics

We’ve been talking a lot lately about the impact of diet on Autism Spectrum Disorders (ASD), even though they are typically considered a neurological condition.  Many people with an ASD experience chronic digestive symptoms that, when treated often results in the alleviation of behavioral and neurological symptoms. But we talk so much about gluten-free diets, casein-free diets, low-carb diets, probiotics, and leaky gut syndrome separately from each other that it gets really confusing. Do these approaches contradict each other? Is one better than the others? What does it all mean?

We’ll start with leaky gut. The Centers for Disease Control and Prevention (CDC) concluded that children with ASD are three times more likely to suffer from leaky gut syndrome, inflammation in the digestive tract that is characterized by chronic diarrhea or constipation. People with leaky gut syndrome are said to have increased intestinal permeability, which means the lining of their digestive tract allow things to be absorbed that shouldn’t, including gluten, bad bacteria, undigested food particles, even toxic waste. A strong indication of leaky gut is multiple food sensitivities. Partially digested proteins (like gluten) and fats are absorbed into the blood stream, causing an allergic reaction aka inflammation. This allergy won’t cause sneezing, but bloating, fatigue, joint pain, headaches, skin issues, weight gain, or digestive issues and can develop into inflammatory bowel disease, arthritis, eczema, psoriasis, depression, anxiety, migraines, muscle pain, and chronic fatigue.

Leaky gut also affects the brain. Proteins like gluten and casein can act similarly to an opioid drug on the brain when absorbed and recirculated by the bloodstream. This is why autistic people respond so well to gluten-free, casein-free, and low-carb diets. All of these approaches minimize the proteins and food allergens that are most likely to wreak havoc when absorbed inappropriately by a leaky gut.

So where do probiotics come in? One of the main causes of leaky gut syndrome, in addition to poor diet, chronic stress, and toxin overload, is bacterial imbalance. Many of us are born with an imbalance of good and bad gut bacteria inherited from our mothers, or develop them through an overuse of antibiotics, sensitivity to chlorinated or fluoridated drinking water, or a lack of probiotics rich foods in our diets. Research from Arizona State University revealed that children with autism tend to have significantly greater risk for imbalanced bacteria levels, which can cause leaky gut, which causes inflammation, which triggers an autoimmune response. So, probiotics taken in supplement form and in foods like yogurt and kefir rebalance digestive bacteria and help the leaky gut that makes gluten and casein a problem in the first place.

So, while we often talk about these different nutritional approaches separately, they are related and should be integrated for maximum effect. It’s a good idea to be tested for food allergies and eliminate them immediately from your or your children’s diet. If you suspect leaky gut syndrome, you can find many different diet protocols to set you on your way to a healthy gut, which may someday process proteins like gluten and casein without adverse reaction. Add foods rich in probiotics to your or your child’s diet like yogurt and kefir. Other foods thought to help heal the gut include bone broth, fermented vegetables, coconut (in every form), and sprouted seeds.



Environmental Enrichment – At Home Sensory Stimulation Supplements Autism Therapies

Environmental enrichment is a simple, low-cost program that parents can implement at home to support sensory input therapies their children with Autism Spectrum Disorders (ASD). A recent clinical study led by Dr. Michael Leon, PhD of the University of California Irvine indicates a significant improvement of autism symptoms in children whose therapy was supplemented with environmental enrichment over those who stuck solely with their regular therapies.

The process is simple. Start by introducing a changing set of sensory exercises every morning and evening that engage at least two of the senses in any combination, like pairing a new fragrance with a gentle rub on the back or listening to classical music at bedtime while petting a soft blanket. Change the exercise every two weeks, making them increasingly more challenging, building to games like squeezing objects of different shapes, colors, and textures or pulling a specific toy out of a bag containing other items.

Sensory input therapies have been proven effective for children with ASD and have been increasingly incorporated into special education programs. Shema Kolainu – Hear Our Voices School and Center for Children with Autism in Brooklyn, NY features a Snoezelen Sensory room where children with autism can improve their auditory, visual, and motor skills by stimulating their senses while relaxing in a safe environment.

The clinical study indicated that 42% of the children receiving environmental enrichment in addition to their regular therapies saw a significant improvement after six months – more than 10 points on the Leitner International Performance Scale. However, like all ASD therepies, symptoms, and theories, results vary by individual. The good news is, environmental enrichment offers parents an opportunity to participate in their children’s growth, at little to no cost. There are no possible negative side effects, and it can be fun for both parent and child.



The Struggle for ABA Coverage

When 2-year-old Tony Burke was diagnosed with autism, his parents like many in their shoes, wanted to get him the best services they could that would serve their child’s needs. After doing some research they decided to start him with applied behavioral analysis therapy or ABA therapy, which is considered to be one of the most effective treatment methods for those on the spectrum. After some time, Tony’s grunting noises turned into words and then smaller sentences—the therapy was working. But then something happened that slowed down all his hard work—his family’s insurance started to deny claims.

In Pennsylvania, health insurance laws require ABA therapy to be covered, though in Tony’s case, his therapy was not covered in school, where he needed the most help. His family all of a sudden could not afford o pay therapy costs—adding up to $80,000 a year. These autism coverage acts were passed since 2010 in states like Pennsylvania and New Jersey, but coverage for ABA therapy still remains hard to obtain.

The prevalence of complaints can be hard to assess since the law also requires Medicaid to cover autismservices leaving providers who don’t get paid by private insurance with the option to just bill Medicaid. Some insurers also avoid covering therapies a child can get at school, including ABA, by dumping cost onto public schools or other agencies.

Another major problem is delayed payments. Kara Matunas from New Jersey had her claims for her 2 year old autistic daughter repeatedly denied. Her daughter Reagan, was receiving early intervention, speech, developmental, and occupational therapy. Two of the denials were reportedly “incorrectly generated due to a manual handling error.”

“They’re just purposely delaying coverage,” Mrs. Matunas explains. Even when the claims are eventually paid, the family is left paying $400-$500 a month which can be especially hard on even middle-class families. Autism laws apply only to fully insured plans where companies have a contract with insurance companies to pay claims. However, as more and more large firms are converting to self-funded plans where they have to pay for care more directly from their own wallets, coverage seems harder to come by.

Shema Kolainu – Hear Our Voices is a non-profit school and center for children with autism that offer a variety of services at no cost to families all over New York City. They not only offer center-based services, including ABA, speech, art, occupational, therapies to name a few, but also home based services that reach hundreds of families. Organizations like Shema Kolainu have had great success in helping children on the autism spectrum from early intervention to school-age children, and hope to offer services to families like the Burke’s and Matunas who need these services to help their children succeed.



Virtual Reality Programs as a Social Learning Tool for ASD

Does using technology to assist children with ASD further alienate them because social interaction is missing, or can it actually effect the opposite- by teaching them to socially interact? While some researchers say that    sitting at a computer screen reinforces isolation and brings out obsessive traits, another study done in Spain defends the use of special programs using virtual reality environments that are designed to stimulate awareness in children on the spectrum, while helping them feel safe.

As children with all forms of autism share a difficulty in attention, interpreting social cues as well as following directions, the goal of these Virtual Reality applications is to increase their understanding of body language, facial expressions, the use of imitation and environmental interactions, such as crossing the street. Avatars or characters have long been shown to help children to identify emotions, however, when they are in the protective computer generated environment, children can gain confidence by learning the rules and repeating the tasks. Verbal and gesture based interaction go hand in hand with these skills.

These applications are designed to be used not only on computers but also with more mobile technology such as phones and tablets. As a therapeutic accessory, they complement any other teaching method employed.  By helping the child build confidence through virtual reality learned interactions, we can help them adapt these skills into their every day lives.

Click Here for original study.