Tuesday, July 22, 2014


The following first appeared on this blog in July 2013. When a recent routine check up with my son's neurologist, I was dismayed to be told that several parents who's children receive special education services at public school, and are diagnosed with Asperger's Syndrome, had their services eliminated from school. Sharing this post again, which explains the new changes to the DSM 5.

MONDAY, JULY 1, 2013
"New DSM-5 includes changes to autism criteria"
Copyright © 2013, The American Academy of Pediatrics
New DSM-5 includes changes to autism criteria
Susan L. Hyman, M.D., FAAP
The American Psychiatric Association has just published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The diagnostic criteria for autism spectrum disorder has been modified based on the research literature and clinical experience in the 19 years since the DSM-IV was published in 1994.
Changes include:
The diagnosis will be called Autism Spectrum Disorder (ASD), and there no longer will be subdiagnoses (Autistic Disorder, Asperger Syndrome, Pervasive Developmental Disorder Not Otherwise Specified, Disintegrative Disorder).
In DSM-IV, symptoms were divided into three areas (social reciprocity, communicative intent, restricted and repetitive behaviors). The new diagnostic criteria have been rearranged into two areas: 1) social communication/interaction, and 2) restricted and repetitive behaviors. The diagnosis will be based on symptoms, currently or by history, in these two areas
Although symptoms must begin in early childhood, they may not be recognized fully until social demands exceed capacity. As in the DSM-IV, symptoms must cause functional impairment.
All of the following symptoms describing persistent deficits in social communication/interaction across contexts, not accounted for by general developmental delays, must be met:
Problems reciprocating social or emotional interaction, including difficulty establishing or maintaining back-and-forth conversations and interactions, inability to initiate an interaction, and problems with shared attention or sharing of emotions and interests with others.
Severe problems maintaining relationships — ranges from lack of interest in other people to difficulties in pretend play and engaging in age-appropriate social activities, and problems adjusting to different social expectations.
Nonverbal communication problems such as abnormal eye contact, posture, facial expressions, tone of voice and gestures, as well as an inability to understand these.
Two of the four symptoms related to restricted and repetitive behavior need to be present:
Stereotyped or repetitive speech, motor movements or use of objects.
Excessive adherence to routines, ritualized patters of verbal or nonverbal behavior, or excessive resistance to change.
Highly restricted interests that are abnormal in intensity or focus.
Hyper or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment.
Symptoms must be present in early childhood but may not become fully manifest until social demands exceed capacities. Symptoms need to be functionally impairing and not better described by another DSM-5 diagnosis.
Symptom severity for each of the two areas of diagnostic criteria is now defined. It is based on the level of support required for those symptoms and reflects the impact of co-occurring specifiers such as intellectual disabilities, language impairment, medical diagnoses and other behavioral health diagnoses.
Rett syndrome is a discrete neurologic disorder and is not a subdiagnosis under ASD, although patients with Rett syndrome may have ASD.
Because almost all children with DSM-IV confirmed autistic disorder or Asperger syndrome also meet diagnostic criteria under DSM-5, re-diagnosis is not necessary. Referral for reassessment should be based on clinical concern. Children given a PDD-NOS diagnosis who had few DSM-IV symptoms of autism or who were given the diagnosis as a “placeholder” might be considered for more specific diagnostic evaluation.
Patients may wish to continue to self identify as having Asperger syndrome, although the DSM-5 diagnostic category will be ASD.
Clinicians should note that children with ASD also should be evaluated for a speech and language diagnosis in addition to the ASD to inform appropriate therapy.

Monday, July 7, 2014

Reducing the risk of elopement and wandering

Originally published July 2013

The issue of elopement and autism is very common. According to www.nationalautismassociation.org, nearly half, or 49% of all children  with autism will attempt to elope from a safe or known environment.

In 2009, 2010, and 2011, accidental drowning accounted for 91% total U.S. deaths reported in children with an ASD ages 14 and younger subsequent to wandering and elopement.
32% of parents reported a “close call” with a possible drowning.  
62% of families of children who elope were prevented from attending/enjoying activities outside the home due to fear of wandering
40% of parents had suffered sleep disruption due to fear of elopement
Half of families with elopers report that they had never received advice or guidance about elopement from a professional
Only 14% had received guidance from their pediatrician or another physician
Interactive Autism Network Research Report: Elopement  and Wandering (2011)
National Autism Association, Lethal Outcomes in ASD and Wandering (2012)

We hear about it on the news, or read it in the paper or online. It is difficult to know what motivates someone with autism to wander from home, and to go away from people when lost, instead of towards people. What makes this critical for autistics, is that they may not respond when called, they have little sense of danger, and they may be non verbal. Lack of public information also makes this critical. Most people do not know how to communicate effectively with children who have autism. If an unfamiliar adult tried to ask your child safety information such as 'Where are your parents?' Would your child respond?
Many parents report their child gravitates towards water, so nearby lakes, ponds, and creeks may continue to be a desired destination.  Too, someone with ASD is likely aware when attention has shifted away from them, and will take the opportunity to slip out quickly in order to reach a desired area or item of interest.  Family gatherings or other events may give a false impressions of “all eyes on” someone with ASD.  However, heavy distractions can present opportunities to leave unnoticed.  Visiting relatives or episodes of distress also may increase the risk for wandering.  This holds true in warmer months when persons with ASD are more likely to play outside or attend summer or day camps.

Just like any behavior, there are many different ways you can reduce the risk of your child wandering from home, or bolting away from you when out in public.
Three main techniques used by an ABA therapist are:

Reducing Risk
Antecedent Interventions
Consequence Intervention

Reducing risk: Before going out in public, explain to your child where you are going. Use simple language, and talk about your expectations for their behavior. Teach your child to respond to their name, (verbally or non verbal). Provide praise for staying near you in public. Plan the outing in advance, know where the exits are, if its a crowded location, or near a busy street, bring another adult with you to help catch the child in case they attempt to elope. Consider getting an ID badge or bracelet for your child, and carry a recent photo ID of your child at all times. If your child is verbal, teach them to respond to safety questions such as "What's your full name? What is your phone number and address?"

Antecedent Interventions:
This would involve changing the triggers that precede elopement. Some children wander away when they see an interesting object. Some children may wander away because its loud and crowded, and they are seeking a quiet place. Pay attention to how your child acts before they attempt to elope, such as covering their ears, walking slowly behind you, staring intently at items or objects. Get to your child's level, and ask if they need to take a break. If the child is non verbal, you can teach them to hand you a break card, and when they do, they can have a supervised break. Teach the child to request a supervised break, instead of just wandering off.
Once you have identified the triggers, teach your child replacement behaviors.  If they wander in the middle of the night, teach them to stay in bed when they cannot sleep.  If they wander outside, teach them that they need permission first.  Use picture cards if your child is non verbal.  Put the picture card away at night, to signify that going outside at night is not an option.

Consequence Intervention:
This would involve changing the way you react to your child wandering away, or attempting to do so. Once you determine why they elope, whether its to gain attention, or to escape, do not give them the response they are seeking. If the child bolts at the grocery store because you are striking up a conversation with another shopper, then do not provide huge amounts of attention for their elopement behavior. Go get the child with minimal eye contact and language, and bring them back to where the cart is. You also want to be sure to teach them how to get your attention appropriately. You can teach your child to request your attention, such as tapping you, or saying your name. Practice appropriate behaviors for bring in public, and staying near an adult. Use praise and encouragement.
Other ways to reduce risks of wandering:

Secure your home. Consider contacting a professional locksmith, security company, or home improvement professional to promote safety and prevention in your home.  This may require installing dead bolt locks that require keys for both sides, a home security system, inexpensive battery operated alarms on doors and windows, hook and eye locks above child’s reach, and adhering printable STOP signs on doors, windows and other exits such as gates.

Tracking devices such as Project Lifesaver or LoJack SafetyNet services.  Various GPS tracking systems are also available.  

ID bracelets that include your name, telephone number, and other vital information.  They may also state that your child has autism and is non verbal, if applicable.  If your child will not wear a bracelet or necklace, consider a temporary tattoo with your contact information.  You can use a Sharpie or other marker, and seal with liquid bandage for a temporary tattoo.

Alert your neighbors.  It is recommended that caregivers plan a brief visit with neighbors to introduce their loved one, or provide a photograph.  Decide what information to present to neighbors; like attractions or fears, sensory issues or meltdown triggers.  

Alert first responders.  Provide key information before an incident occurs may improve response.  Favorite song, toy, or character, important phone numbers, favorite attractions and locations, likes, dislikes, fears, triggers, and de-escalation techniques, method of communication, whether verbal or nonverbal, uses sign language, picture boards or written words. Map and address guide to nearby properties with water sources and dangerous locations highlighted.
In Corpus Christi, Robin Palmer Blue is a board certified behavior analyst (BCBA) specializing in Applied Behavior Analysis, and a Music Therapist at Therapy Connections.
Sources for this article, and others that may be of help:
www.missingkids.com 1-800-THE-LOST

Water Safety Tips

This post originally appeared in July 2013. Sharing this again.

Summer is here, and it's a great time to explore the outdoors with your children. Autism presents a unique set of safety concerns for parents. The advocacy and awareness groups, Unlocking Autism, (UA), and the National Autism Association, (NAA), have teamed up to provide the following safety information for parents. Not all suggestions listed below are right for every family in every neighborhood. You should carefully consider the best safety options for your individual child, according to www.autismspeaks.org.

Some things to consider...

Teach your child to swim

Too often, children with autism are often attracted to water sources such as pools, ponds, and lakes. Drowning is a leading cause of death for a child or adult who has autism. Be sure your child knows how to swim unassisted. Swimming lessons for children with special needs are available at many YMCA locations. In Corpus Christi, the YMCA is located at 417 S. Upper Broadway.
Call 361-882-1741, or visit www.ymca-cc.org, for more information.
 The final lesson should be with clothes on.

The May Institute, www.mayinstitute.org,  has this advice:
• Find the right (typical or adaptive) life jacket that best meets your child's needs to wear anytime the child is near water- pool, lake, river, fountain, pond, hot tub, or any open water.
• Always be within arm's reach of the child when he or she is in or around any open water.
• Be sure to drain bathtubs, and other small containers of water when you are finished using them. Put safety locks on toilet seats; motion detector alarms / safety locks on all hot tubs, landscape ponds, or other water sources around your home.
• Take adaptive swim classes with your child at an early age. Many YMCAs and Parks and Recreation Departments offer these classes. If your child has difficulty learning conventional swimming strokes, teach him or her drown-proofing, a water survival technique that will help a child stay afloat until help arrives.


Wednesday, July 2, 2014

Book Fair in July

Save the date! Saturday, July 26, at Barnes & Noble Booksellers in Corpus Christi, will be a book fair benefitting the Autism Spectrum Resource Center library. The library is a wonderful resource of information and education for individuals with autism; children, teenagers, young adults, and for parents of individuals with autism, as well as educators of students with autism spectrum disorders. The book fair theme is 'Share Your World', and several guests will be appearing and sharing their world with us. Barnes & Noble will have their own theme that day, of superheroes! The book fair will begin at 9:00 a.m., and will continue all day, until 11:00 p.m. Online sales will be credited at www.bn.com/bookfairs, with this code 11392206, until July 31, for friends and family unable to attend in store. Remember to say you are with the book fair, to the cashier, whether it's food, drinks, or cheesecake at the cafe, books, DVDs, Nook tablets and accessories, and pre purchased gift cards at the register, all count towards the book fair. Arts and crafts, story time, superheroes from Texas Toyz, and the talented cast from the Harbor Playhouse's current musical,'Legally Blonde', will be there!