Category Archives: Treatment

Tips for Helping Your Child with Social Interaction

Autism can sometimes be characterized by a person’s inability to connect with people, even their own families in a constructive and relationship-building way. The National Center for Learning Disabilities promotes that “guiding your child through various social scripts will enable him or her to navigate such situations with greater ease and less apprehension, especially when he or she is interacting with other children. Research has shown that adolescents with learning disabilities have difficulty in making and keeping friends, spend lots of free-time alone, especially watching television or on their computers.

Here are some activity ideas for helping your child prepare for certain types of social interactions they are likely to face throughout their lives:

- Read storybooks with themes on family and friendship and try to engage your child in storyline to help them understand the interactions between the characters.

- Identify specific social situations that are challenging for your child and role-play how to handle them one-on-one

- Give your child a scenario that he/she can understand and ask them to help you finish the story. Afterward, talk about their ending and other possible endings.

- While watching TV or a movie, point out social cues that may not be so obvious and talk about them with your child

- Make playdates for your child so they can get comfortable with interacting with other children. Supervision is an important part of helping your child along at first.

- If your child seems to have a particular interest, enroll them in an activity that can build on that interest and put them with other kids who have similar interests.

In helping them through these interactions, make sure to be actively listening at all times. For children who have a hard time communicating, you have to also try to understand their emotions, which can be expressed in a variety of ways including but not limited to: outbursts and repetitive behaviors. Also make sure to work with your child’s school and other professionals to make sure your child is having their needs met and that they are receiving appropriate services.

For more resources, click HERE



Earlier Autism Detection Raises Questions About Early Intervention

Autism is a genetic disorder that affects about 20% of younger siblings of those on the spectrum. Researchers are now saying that they often show symptoms as early as 18 months, according to a study published in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). The study used 719 younger siblings of those with autism, otherwise known as ‘high risk’ siblings, who were assessed at 18 months and then 36 months to identify any social, communications, and repetitive behaviors that could be early symptoms. Warning signs such as poor eye contact and/or repetitive behaviors were observed in 57% of siblings and among those without symptoms at 18 months, for the ones who were later diagnosed, started showing signs by 36 months. Researchers note that about half of the children had poor eye contact combined with limited gestures and imaginative play while other children exhibited repetitive behaviors and lacked nonverbal communication skills.

Although it is important to detect these warning signs or early symptoms of autism, John Elder Robison, author of Raising Cubby, Look Me in the Eye, My Life with Asperger’s and Be Different–adventures of a free range Aspergian, and member of the Interagency Autism Coordinating Committee of the US Dept. of Health and Human Services, expresses his concern over early intervention. According to people on the spectrum who had received early intervention treatments as children, their experiences seemed half positive and half negative.

While many people talk about how wonderful it was to have that support throughout their childhood, “others talk about suppressing behaviors that embarrassed parents…[and] imposing their will where it was not wanted.” Robison argues that this is something to take into serious consideration as we move forward with creating new treatments and therapies for early intervention. He critiques our abilities to deter autism in infants now as young as 6 months old, asking what interventions are actually appropriate at this stage and to what end?

When providing intervention for a four-year-old, we are able to see the progress we make in the child’s behaviors and adjust our plans accordingly. However, with an infant, the issues are not very clear, Robison says, “We may pick up a sign of autism, but what kind of autism? Will the child be verbal or silent? Will the child be lovable, eccentric, unable to care for themselves or talk…it’s too early to know.”

As we continue to move forward with autism diagnoses at earlier stages, we also need to move forward in the methods and treatments we use for early intervention.

To read the original study, click HERE

To read John Elder Robison’s article, click HERE



ABA Therapy Continues Its Success

PHOTO: The Rogersons are happy their sons Tom (L) and Jack (R) are close but don't think Tom should be responsible for Jack as he grows older. (ABC: Australian Story)

Jack Rogerson was diagnosed with autism as a toddler and written off by many medical professionals as low-functioning and limited to special education schooling. He was a hyperactive child who could not express affection and could barely speak but his parents believed that with the right tools and support, their son would eventually be able to live independently and engage in all the same activities as his peers.

After meeting Dr. Elizabeth Watson, a speech pathologist and therapist, Jack’s parents learned about Applied Behavior Analysis (ABA) that is used for early childhood intervention for kids on the spectrum. ABA therapy is essentially “a teaching technique that breaks down every skill that a child needs to learn into very small discrete steps, each of which is taught individually with painstaking repetition and they joined together to complete the task. It is applied to everything from tying shoelaces to social skills and conversation.”

Living in Australia, they found no centers or schools offering ABA therapy and the resources that Jack needed. Wanting to expose Jack to ABA therapy in the hopes that it would help him, Ian and Nicole dedicated themselves to giving Jack the support he needed and turned their house into their own early intervention center. “You’d walk into the house and there’d be labels on things and a big whiteboard and words written on it…and computer screens,” Ian Rogerson explains. “We decided he needed roughly 25 hours a week in that first year of one-on-one therapy,” Nicole said.  

Ian and Jack were determined to mainstream school their son and were eventually able to place him in a public school in Sydney. Jack had an ABA trained helped with him at all times at first to help him adjust to certain routines and behaviors but by the end of his elentary years his ABA helped was only needed for a few hours a week.

Jack went on to the Special Education Inclusion Program where he learned academics as well as domestic life skills. Director of students, Adam Lewis, says, Jack’s help a leadership role this year as a house monitor…He speaks well and politely to the younger guys, he has very high standards himself in terms of how he presents and his own conduct.”

In 2003 Nicole Rogerson decided to team up with Elizabeth Watson to open and establish their own center that specialized in ABA therapy for children on the spectrum. Nicole says she was impressed with Jack’s progress after the therapy. And is now CEO if the non-profit Autism Awareness Australia. She says, “Intensive ABA programs are still the only thing that come out as showing any evidence whatsoever of efficacy, and they’re still not funding it. Unless the government makes a genuine investment in this area, so many children are not going to reach their best outcome and I think that’s a tragedy.”

Shema Kolainu is committed to providing resources for parents and families in all five boroughs and offers a variety of therapies. All of our programs are individualized and based on the science of Applied Behavioral Analysis. To read more about ABA therapy and all the therapies offered by Shema Kolainu, click HERE

HELP MORE CHILDREN RECEIVE ABA SERVICES, CLICK HERE  

To read the original story, click HERE



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.