Blue light waves are emitted from TVs, computer screens and some light bulbs including some fluorescent and the high efficiency light bulbs. Turns out that blue light is alerting and more than that, it can limit or prevent melatonin production in the evening when we need melatonin for our sleep cycle. After seeing blue light, it can take up to 90 minutes for the alerting effects to subside and melatonin production to kick in. During this time, you may have a very antsy child happy as a clam, dancing on his bed.
This problem can be avoided by limiting TV and computer in the evening. A child who is very sensitive to light may also benefit from wearing blue-light glasses at night 1-3 hours before bedtime. The glasses are orange and do not allow blue light waves to penetrate. There is evidence for the glasses working in adults. There is anecdotal evidence for children - but I haven't seen a formal study.
Another option is to install yellow light bulbs. They come in a variety of forms including the new energy-efficient cork-screw style bulbs, and can be purchased on-line. Stay posted - I'm going to buy one for the hallway outside my bedroom to see how well the yellow lights work in general.
Here is a web site to check out: LowBlueLights.com. They offer junior sizes of glasses and the yellow bulbs.
Sunday, July 31, 2011
Monday, April 25, 2011
More Video Modeling
Mary Beth Palo began videotaping "everything" she wanted her son with autism to learn - turn the lights on and off, put on clothing, tie shoes, behavior for the grocery store, etc., etc. He watched the videos and learned how to do it all. He was tying shoes at age 5. His language increased. She helped him learn his ABA lessons using video taping, too. Child Net has a wonderful video of Ms. Palo describing her work with her son. Watch it here. This is great stuff!
When she realized how successful that could be, she created a combined ABA/video modeling program with the endorsement of James Partington, PhD, BCBA-D, a behavior analyst who developed the ABLLS-R model for assessing the skills of a child with autism. Both Ms. Palo and Dr. Partington market it on their websites. Go to her website: WatchMeLearn.
When she realized how successful that could be, she created a combined ABA/video modeling program with the endorsement of James Partington, PhD, BCBA-D, a behavior analyst who developed the ABLLS-R model for assessing the skills of a child with autism. Both Ms. Palo and Dr. Partington market it on their websites. Go to her website: WatchMeLearn.
Friday, February 11, 2011
ADHD Meds and Therapies Update
I have mixed feelings about meds. Here is a little about the pros and cons, and an update on therapies.
The teachers who want to see a child with ADHD takes meds are right when they say it will help keep him from falling behind in school. Once behind he may have a hard time catching up.
However, meds do not cure , they only help with attention, etc. for the hours after the child takes the pill. And the side effects can sometimes be difficult. There is a new med out called Intuniv that works in a different way, lasts 24 hours and appears to have fewer side effects. This is an option for parents to consider and discuss with their doctor.
A lot of the experts these days are suggesting that you try to not go the meds route until you have tried other things for 6-12 months. Here are things to try:
1. Neuro-feedback, which is expensive but has the best results record around.
2. Interactive Metronome (IM) - usually found in a pediatric occupational therapy setting. I sometimes mix IM with sound therapy and get good results - but you'd have to find an OT who knows how to do that.
3. Cognitive therapy in which a psychologist or social worker helps the child to see what his challenges are and offers some approaches to meeting them.
4. Self Management techniques in the classroom in which the child scores himself for staying attentive and then is rewarded at the end of the day if he succeeded 75% of the time. (To get this started, another adult scores with him so that he understands what is expected).
5. There are also programs that help with working memory (another problem for kids with ADHD) - I do not have personal experience with this, but evidence is good.
6. Nutritional help - some children have food sensitivities that mimic ADHD symptoms. The best way to find out is to eliminate a variety of common allergens - milk (cheese, yogurt and whey), wheat, soy (soy oil is everywhere), and corn (don't forget corn syrup) are the usual culprits. Do them one at a time for 2 weeks and be religious about it - reading the labels of everything. And forget about eating out while you are doing it unless the restaurant you are going to has an allergy menu.
By the way, new research shows that a daily vitamin with minerals is very helpful. So is a high protein breakfast. And if he is a picky eater or has poor bowel movements, a visit to a DAN doctor (austim) may help to correct gastric issues.
The children who do best with getting rid of ADHD symptoms are those who have done multiple therapies. Which means that the parent has to shell out for lots of pricey therapy. How a parent with limited means accomplishes that is to browse the book store books, settle on an approach and go from there - working step by step through the book. And then on to another one.
The teachers who want to see a child with ADHD takes meds are right when they say it will help keep him from falling behind in school. Once behind he may have a hard time catching up.
However, meds do not cure , they only help with attention, etc. for the hours after the child takes the pill. And the side effects can sometimes be difficult. There is a new med out called Intuniv that works in a different way, lasts 24 hours and appears to have fewer side effects. This is an option for parents to consider and discuss with their doctor.
A lot of the experts these days are suggesting that you try to not go the meds route until you have tried other things for 6-12 months. Here are things to try:
1. Neuro-feedback, which is expensive but has the best results record around.
2. Interactive Metronome (IM) - usually found in a pediatric occupational therapy setting. I sometimes mix IM with sound therapy and get good results - but you'd have to find an OT who knows how to do that.
3. Cognitive therapy in which a psychologist or social worker helps the child to see what his challenges are and offers some approaches to meeting them.
4. Self Management techniques in the classroom in which the child scores himself for staying attentive and then is rewarded at the end of the day if he succeeded 75% of the time. (To get this started, another adult scores with him so that he understands what is expected).
5. There are also programs that help with working memory (another problem for kids with ADHD) - I do not have personal experience with this, but evidence is good.
6. Nutritional help - some children have food sensitivities that mimic ADHD symptoms. The best way to find out is to eliminate a variety of common allergens - milk (cheese, yogurt and whey), wheat, soy (soy oil is everywhere), and corn (don't forget corn syrup) are the usual culprits. Do them one at a time for 2 weeks and be religious about it - reading the labels of everything. And forget about eating out while you are doing it unless the restaurant you are going to has an allergy menu.
By the way, new research shows that a daily vitamin with minerals is very helpful. So is a high protein breakfast. And if he is a picky eater or has poor bowel movements, a visit to a DAN doctor (austim) may help to correct gastric issues.
The children who do best with getting rid of ADHD symptoms are those who have done multiple therapies. Which means that the parent has to shell out for lots of pricey therapy. How a parent with limited means accomplishes that is to browse the book store books, settle on an approach and go from there - working step by step through the book. And then on to another one.
Sunday, June 6, 2010
Video Modeling
I am becoming a big fan of video modeling for kids with behaviors. The idea is to show a child a video of himself or someone else successfully performing a behavior that he has difficulty doing. Over time, the child will start to mimic the behavior.
I see a boy who is afraid to ask his teacher for help. When he is given something that he can't figure out or feels is too difficult, he'll stare at it for a few minutes, become frustrated and then move into a meltdown. His mom told me about this while I was putting together some video footage for a lecture. I asked for and got permission to use the boy as a guinea pig for my video taping.
We set up a date, and he did a variety of videos with me: an obstacle course, IM, and headphones. Finally, it was time for the video modeling piece. I asked him if he would do some acting for me in a short film about asking for help. He said okay. This was the script: He was to sit at a table, open his book to a page and start working. Then he would decide that he needed help, raise his hand and say, "I need help". We practiced it one time and then as chance would have it, a real teacher, a friend of mine, happened to come into the room. I told the boy "What luck, we have a real teacher for our video, Ms. Smith can be the teacher while I shoot the video". To my surprise, he got up from the table and ran and hid under some pillows in the clinic. It took me a while to coax him out and then I had to promise him that Ms. Smith would hold the camera while I played the teacher. We shot the video a couple of times and got a good video.
Later, I showed it to him, then showed it to his parents. He was very proud of it.
Typically, you show a video to a child every morning for a week or so until they start mimicking their own behavior, but this one worked quickly. Without additional viewings, the boy self-advocated for himself in a difficult situation that happened soon after taping. His teacher moved desks around in the classroom and he was given a spot in which he couldn't see the chalkboard. He tried out his new desk, and instead of having a melt-down, he raised his hand and said, "I can't see the chalkboard". His seat was reassigned. Later when he got home from school, he advocated for himself with his mother, as well, something that he had not done before. A real success for him.
I certainly got lucky in my first attempt, but research shows that this is a good therapy for kids on the spectrum. I am hoping to explore video modeling in conjuction with self-management techniques in the near future to see if the combined methods help to address multiple (and more serious) behaviors.
I see a boy who is afraid to ask his teacher for help. When he is given something that he can't figure out or feels is too difficult, he'll stare at it for a few minutes, become frustrated and then move into a meltdown. His mom told me about this while I was putting together some video footage for a lecture. I asked for and got permission to use the boy as a guinea pig for my video taping.
We set up a date, and he did a variety of videos with me: an obstacle course, IM, and headphones. Finally, it was time for the video modeling piece. I asked him if he would do some acting for me in a short film about asking for help. He said okay. This was the script: He was to sit at a table, open his book to a page and start working. Then he would decide that he needed help, raise his hand and say, "I need help". We practiced it one time and then as chance would have it, a real teacher, a friend of mine, happened to come into the room. I told the boy "What luck, we have a real teacher for our video, Ms. Smith can be the teacher while I shoot the video". To my surprise, he got up from the table and ran and hid under some pillows in the clinic. It took me a while to coax him out and then I had to promise him that Ms. Smith would hold the camera while I played the teacher. We shot the video a couple of times and got a good video.
Later, I showed it to him, then showed it to his parents. He was very proud of it.
Typically, you show a video to a child every morning for a week or so until they start mimicking their own behavior, but this one worked quickly. Without additional viewings, the boy self-advocated for himself in a difficult situation that happened soon after taping. His teacher moved desks around in the classroom and he was given a spot in which he couldn't see the chalkboard. He tried out his new desk, and instead of having a melt-down, he raised his hand and said, "I can't see the chalkboard". His seat was reassigned. Later when he got home from school, he advocated for himself with his mother, as well, something that he had not done before. A real success for him.
I certainly got lucky in my first attempt, but research shows that this is a good therapy for kids on the spectrum. I am hoping to explore video modeling in conjuction with self-management techniques in the near future to see if the combined methods help to address multiple (and more serious) behaviors.
Monday, February 8, 2010
Landfills and Autism
Driving back today from an errand, I passed a garbage hauler headed for the landfill 4 miles away. It reminded me that our landfill not only serves the S.E. Michigan area (including Detroit), but garbage from the city of Toronto is also hauled there. This arrangement has been in place for about 10 years. That's a big landfill.
It appears to me that the rate and severity of autism are higher in my area than in other areas where I've lived and worked. If so, is the proximity of this landfill a coincidence? It will be a while before epidemiologists are able to answer my question. But I did find one preliminary study addressing the topic. When I googled "autism" and "landfills," this article appeared first:
Autism Spectrum Disorders and Identified Toxic Land Fills: Co-Occurrence Across States, by Xue Ming, Michael Brimacombe, Joanne H. Malek, Nisha Jani and George C. Wagner in Environmental Health Insights 2008:2. It was dated Aug 20, 2008. In their words:
It appears to me that the rate and severity of autism are higher in my area than in other areas where I've lived and worked. If so, is the proximity of this landfill a coincidence? It will be a while before epidemiologists are able to answer my question. But I did find one preliminary study addressing the topic. When I googled "autism" and "landfills," this article appeared first:
Autism Spectrum Disorders and Identified Toxic Land Fills: Co-Occurrence Across States, by Xue Ming, Michael Brimacombe, Joanne H. Malek, Nisha Jani and George C. Wagner in Environmental Health Insights 2008:2. It was dated Aug 20, 2008. In their words:
We hypothesize that ASD are associated with early and repeated exposures to any of a number of toxicants or mixtures of toxicants. It is the cumulative effects of these repeated exposures acting upon genetically susceptible individuals that lead to the phenotypes of ASD.In a nutshell, the authors found that the occurrence of autism is higher near Superfund landfill sites than in areas without landfills. They go on to give results of a simple first look at the situation.
The residence of 495 ASD patients in New Jersey by zip code and the toxic landfill sites were plotted on a map of Northern New Jersey. The area of highest ASD cases coincides with the highest density of toxic landfill sites while the area with lowest ASD cases has the lowest density of toxic landfill sites. Furthermore, the number of toxic Superfund sites and autism rate across 49 of the 50 states shows a statistically significant correlation...
There is a superfund site within 20 miles of where I live (in addition to the big landfill down the road). It's quite a complex situation and I'm not sure that we want to wait for the epidemiologists. Last week, the health advocate, Dr. Weil (DrWeil.com), wrote:
Environmental toxins such as lead, mercury and dioxin are serious hazards to human health. Fortunately, there are ways to both minimize your exposure to and lower the quantity of toxins in your body ... Avoid living or working near hazardous sites such as reclaimed landfills or toxic waste dumps.In my opinion future parents should truly think about where they work, what they do and where they live in order to decrease their likelihood for genetic mutation and the risk of autism in their children.
Wednesday, December 30, 2009
Overlap in Sensory, ADHD and Autism
I am doing tons of reading right now to prepare for a class on self-regulation I'm giving in April.
Current literature is looking at ways to separate out ADHD from Autism and to identify sensory characteristics of each. This is a technical post, but if you read lightly, you can find some interesting tidbits.
There is a technical term: nosology that refers to the hieracrchy of diagnoses. The new nosology for sensory processing disorder (SPD) has several layers. There are 3 types of SPD: Sensory Modulation, Sensory Motor Issues (motor planning and posture) and Sensory Discrimination. Here is a quick look at it. See the Miller article referenced below for details.
Sensory Processing Disorder (SPD):
1. Sensory Modulation
------Over response
------Under Response
------Seeking/ Craving
2. Sensory Motor Issues
-----Dispraxia (Motor Planning)
-----Posture Disorder
3. Sensory Discrimination
-----Visual
-----Auditory. touch, vestibular, proprioception, etc.
The reason I taxed you with the nosology is to highlight the modulation piece. Modulation from sensory causes appears similar to ADHD, but ADHD is not caused by sensory issues. An assessment such as the Sensory Profile can tease out which is which.
ADHD as you probably know has characteristics of impulsivity, poor attention, hyperactivity, etc. that can also be found in SPD. Typically, ADHD is treated with therapies, patience, etc, etc or meds. SPD is treated with sensory therapy. Completely different.
Now we get into autism. What they are finding is that 42-88% of children with autism have sensory processing disorder. Some also have a sensory modulation disorder. 50%-80% of children with autism have ADHD. However (back to nosology) ADHD in the DSM-IV (Psychiatric Manual) is a level 2 disorder. Autism is a level 1 disorder and takes precedence. So technically, if a child has autism, they cannot be also diagnosed with ADHD (a disservice in my opinion).
Children with ADHD have communication and social issues, but they are not the same sort of issues as those found in autism. Hartley & Darryn (2009) pose the question "Is high functioning autism distinguishable from ADHD and from anxiety in older children?" The short answer is yes, but they share a number of seemingly similar characteristics in the areas of communication skills, social skills, and repetitive behaviors. Lots of overlap to sort through with children who are neurotypically different than their peers.
1. Miller, L., Anzalone, M., Lane, S., Cermak, S., & Osten, E. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. American Journal of Occupational Therapy , 61, 135-140.
2. Hartley, S., & Darryn, M. S. (2009). Which DSM-IV-TR criteria best differentiate high-functioning autism spectrum disorder from ADHD and anxiety disorders in older children? Autism , 13, 485-509.
Current literature is looking at ways to separate out ADHD from Autism and to identify sensory characteristics of each. This is a technical post, but if you read lightly, you can find some interesting tidbits.
There is a technical term: nosology that refers to the hieracrchy of diagnoses. The new nosology for sensory processing disorder (SPD) has several layers. There are 3 types of SPD: Sensory Modulation, Sensory Motor Issues (motor planning and posture) and Sensory Discrimination. Here is a quick look at it. See the Miller article referenced below for details.
Sensory Processing Disorder (SPD):
1. Sensory Modulation
------Over response
------Under Response
------Seeking/ Craving
2. Sensory Motor Issues
-----Dispraxia (Motor Planning)
-----Posture Disorder
3. Sensory Discrimination
-----Visual
-----Auditory. touch, vestibular, proprioception, etc.
The reason I taxed you with the nosology is to highlight the modulation piece. Modulation from sensory causes appears similar to ADHD, but ADHD is not caused by sensory issues. An assessment such as the Sensory Profile can tease out which is which.
ADHD as you probably know has characteristics of impulsivity, poor attention, hyperactivity, etc. that can also be found in SPD. Typically, ADHD is treated with therapies, patience, etc, etc or meds. SPD is treated with sensory therapy. Completely different.
Now we get into autism. What they are finding is that 42-88% of children with autism have sensory processing disorder. Some also have a sensory modulation disorder. 50%-80% of children with autism have ADHD. However (back to nosology) ADHD in the DSM-IV (Psychiatric Manual) is a level 2 disorder. Autism is a level 1 disorder and takes precedence. So technically, if a child has autism, they cannot be also diagnosed with ADHD (a disservice in my opinion).
Children with ADHD have communication and social issues, but they are not the same sort of issues as those found in autism. Hartley & Darryn (2009) pose the question "Is high functioning autism distinguishable from ADHD and from anxiety in older children?" The short answer is yes, but they share a number of seemingly similar characteristics in the areas of communication skills, social skills, and repetitive behaviors. Lots of overlap to sort through with children who are neurotypically different than their peers.
1. Miller, L., Anzalone, M., Lane, S., Cermak, S., & Osten, E. (2007). Concept evolution in sensory integration: A proposed nosology for diagnosis. American Journal of Occupational Therapy , 61, 135-140.
2. Hartley, S., & Darryn, M. S. (2009). Which DSM-IV-TR criteria best differentiate high-functioning autism spectrum disorder from ADHD and anxiety disorders in older children? Autism , 13, 485-509.
Monday, November 16, 2009
Weighing in on Asperger's
With the DSM-V powers-that-be thinking about removing the Asperger's diagnosis from the DSM next edition, it's time for all of us to weigh in our two cents. Here's mine.
The Asperger label is critical to the people who are diagnosed as such. With the label, researchers can more readily target them as a group for study and treatment. Employers see the label and understand the constraints. Therapists see the label and can get right to work on appropriate therapies.
Let's look at it. There are 3 categories of autism that make a difference to me when I treat children:
- True autism with it's social and communication issues.
- PDD-NOS - a form of high functioning autism in which children can get rid of many, many symptoms with multiple therapies to the degree that you can no longer tell that it's autism.
- Asperger's - the other form of high functioning autism with good language skills, the desire to interact with others and a lack of understanding social rules (making interaction very challenging).
The authors of the DSM complain that it is difficult to distinguish Asperger's from autism and that that is the reason that the diagnosis can be removed. I disagree. A child with Asperger's has very good language skills (and in fact can be a chatterbox). Also, he/she lacks social skills in a different way than a child with typical autism does. The child with autism does not typically care to have social interaction and is content in his/her world. The child with Asperger's desperately wants friends but is often clueless on how to get and keep them.
These are easily observed differences. I say leave Asperger's in. And by the way, the same set of arguments are going to apply to PDD-NOS. Leave it in, too.
On another day, I'll talk about the impact of sensory, modulation, ADHD and obsession/compulsion comorbidity.
The Asperger label is critical to the people who are diagnosed as such. With the label, researchers can more readily target them as a group for study and treatment. Employers see the label and understand the constraints. Therapists see the label and can get right to work on appropriate therapies.
Let's look at it. There are 3 categories of autism that make a difference to me when I treat children:
- True autism with it's social and communication issues.
- PDD-NOS - a form of high functioning autism in which children can get rid of many, many symptoms with multiple therapies to the degree that you can no longer tell that it's autism.
- Asperger's - the other form of high functioning autism with good language skills, the desire to interact with others and a lack of understanding social rules (making interaction very challenging).
The authors of the DSM complain that it is difficult to distinguish Asperger's from autism and that that is the reason that the diagnosis can be removed. I disagree. A child with Asperger's has very good language skills (and in fact can be a chatterbox). Also, he/she lacks social skills in a different way than a child with typical autism does. The child with autism does not typically care to have social interaction and is content in his/her world. The child with Asperger's desperately wants friends but is often clueless on how to get and keep them.
These are easily observed differences. I say leave Asperger's in. And by the way, the same set of arguments are going to apply to PDD-NOS. Leave it in, too.
On another day, I'll talk about the impact of sensory, modulation, ADHD and obsession/compulsion comorbidity.
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