Q & A from Dr. Mike Assel’s Webinar: Autism in the Preschool Classroom

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Here are the questions which Dr. Assel answered as a follow-up to his Webinar:

I had several questions about the link between ASDs (Autism Spectrum Disorders) and Obsessive Compulsive Disorders (OCD).  Here are a few examples:

“Is this similar to OCD?”

“How do you determine it is not OCD? Because being inflexible in adhering to specific routines or rituals is often considered OCD.”

ANSWER:  There are several similarities with the two disorders.  If you remember, restrictive and repetitive behaviors are one of the key diagnostic features of ASDs.  They often seem very similar to behaviors associated with Obsessive Compulsive Disorder.  However, some of the differences would include the fact that ASD children often struggle with language and social skills.  In addition, the average age of onset for OCD is typically much older than children with ASDs.  Specifically, children are typically diagnosed with OCD between the ages of 6 and 15.

There were a few questions about sharing concerns with certain individuals (for example, concerns about a child or relative).  These individuals might be parents, teachers, or administrators.  Here are a couple of the questions, and here are a few examples:

“I am struggling about talking with my son and daughter-in-law about my grandson.”

“The problem I have had is the parents who are in denial of their child. I had one mother who would not acknowledge anything.”

ANSWER:  This reminds me of the old saying, “you can bring a horse to water but you can’t make them drink”.  There are a couple of things we need to remember:

  1. In my talk I tried to focus on providing teachers with some red flags (that is, things they should be looking for) so that a referral could be made.  No one is expecting a classroom teacher to diagnose an ASD.
  2. As a teacher, you have a responsibility to follow the official channels set forth in your organization surrounding referring children who might be at risk for any type of learning difference (for example, speech delay).
  3. In relation to parents, I will say that keep it short, truthful, and avoid any diagnostic jargon.  Tell them what you are worried about (for instance, Jimmy typically isolates himself from the other students and struggles following directions) and what the school, center, or district is prepared to do (such as, when I am worried about a child’s development, these are the procedures that are followed).

There were a couple of questions about measures:

“What is the best test to have given to children to diagnosis autism?”

“ My understanding is that a multidisciplinary approach is the best but can you go with just one test?”

ANSWER:  There is no “best test.” Certain measures have been accepted as standards within research studies (for example, ADOS, ADI). This provides consistency in the research studies that are investigating ASDs.  At another symposium I was attending, another clinician said the following…..”Too much emphasis in being placed on the measure and NOT enough attention is being placed on the clinician”.  This is very true.  I have seen incredibly good evaluations completed by individuals who just observed children playing.  I have seen horrible evaluations completed by multidisciplinary teams that use what are thought to be the “best” instruments.   I have seen many reports completed by multidisciplinary teams that were in no way integrated (except that they were stapled together). It all comes down to the working with a clinician or group of clinicians who are familiar with the disorder.

There was a good question about mitochondrial disorders:

“What is a mitochondrial disorder?”

ANSWER:  I am definitely not an expert.  However, I am going to provide a good link for those who are interested.

This information comes from the CDC (Centers for Disease Control): http://www.cdc.gov/ncbddd/autism/mitochondrial-faq.html

What are mitochondrial diseases or disorders?
Mitochondria are tiny parts of almost every cell in your body. Mitochondria are like the power house of the cells. They turn sugar and oxygen into energy that the cells need to work.

In mitochondrial diseases, the mitochondria cannot efficiently turn sugar and oxygen into energy, so the cells do not work correctly. There are many types of mitochondrial disease, and they can affect different parts of the body: the brain, kidneys, muscles, heart, eyes, ears, and others. Mitochondrial diseases can affect one part of the body or can affect many parts. They can affect those part(s) mildly or very seriously.

Not everyone with a mitochondrial disease will show symptoms. However, when discussing the group of mitochondrial diseases that tend to affect children, symptoms usually appear in the toddler and preschool years. Mitochondrial diseases and disorders are the same thing.

Is there a relationship between mitochondrial disease and autism?
A child with a mitochondrial disease:

  • may also have an autism spectrum disorder,
  • may have some of the symptoms/signs of autism, or
  • may not have any signs or symptoms related to autism.

A child with autism may or may not have a mitochondrial disease. When a child has both autism and a mitochondrial disease, they sometimes have other problems as well, including epilepsy, problems with muscle tone, and/or movement disorders.

More research is needed to find out how common it is for people to have autism and a mitochondrial disorder. Right now, it seems rare. In general, more research about mitochondrial disease and autism is needed.

There were several questions/comments about specific symptoms and ASDs.  Here are a couple of examples:

“Sometimes with the poor eye contact, they may be just a shy child (mainly at the beginning of the school year) and we have to take in the consideration of the culture.”

“I have a little boy in my classroom that has behaviors of concern. He loves to stay on the computer and I have to constantly tell him that it is not his day. He answers questions correctly all the time but I am wondering if he has some signs of autism.”

ANSWER:  These questions highlight some important information.  For instance, when evaluating symptoms, we always have to consider the context.  For instance, we should evaluate the culture and language of a child.  If a child does not speak English and is surrounded by English speakers, he might have a tendency to withdraw.  Similarly, shy children are going to have more difficulty joining into group activities. It is also important to remember that some children can be highly interested in certain areas (such as, dinosaurs, blocks, or computers).  These heightened interests do not necessarily indicate that an ASD is present.   I like to remind myself that in order to diagnose an ASD, it is important to evaluate the entire body of evidence (what is he like at home, school, how does he interact in the community, how does he approach familiar and unfamiliar people, do the unusual behaviors change across settings, etc).

There was a good question/comment about ABA programs:

“Our local ABA center believes that ABA alone is the only way for kids with autism to learn and encourage their clients to remove their child from any other group or program and attend them only.  “

ANSWER:  I will first acknowledge that to date ABA programs have been the most widely studied intervention for ASDs.  In addition, ABA therapies show fairly consistent positive results.  However, I will also tell you that there is tremendous variability in the quality of the ABA services provided within center-based programs.   Once again, I will reiterate that it is not the specific program (for instance, ABA versus Floor time) but the quality of the intervention services being provided by a well trained interventionist that leads to positive outcomes for children.

Other questions:

“What is the name of the author for the “Quirky Kids” book?”

ANSWER:  Perri Klass, MD.  Here is a link.

http://www.amazon.com/Quirky-Kids-Understanding-Helping-Doesnt/dp/0345451430

There were several really good questions asking about the causes of ASDs…

Here is some information from the National Institute of Neurological Disorders and Stroke:

What causes autism?

Scientists aren’t certain about what causes ASD, but it’s likely that both genetics and environment play a role. Researchers have identified a number of genes associated with the disorder. Studies of people with ASD have found irregularities in several regions of the brain. Other studies suggest that people with ASD have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that ASD could result from the disruption of normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how brain cells communicate with each other, possibly due to the influence of environmental factors on gene function. While these findings are intriguing, they are preliminary and require further study. The theory that parental practices are responsible for ASD has long been disproved.

 What role does inheritance play?

Twin and family studies strongly suggest that some people have a genetic predisposition to autism. Identical twin studies show that if one twin is affected, there is up to a 90 percent chance the other twin will be affected. There are a number of studies in progress to determine the specific genetic factors associated with the development of ASD. In families with one child with ASD, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population. Researchers are looking for clues about which genes contribute to this increased susceptibility. In some cases, parents and other relatives of a child with ASD show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as bipolar disorder, occur more frequently than average in the families of people with ASD.

We would like to thank Dr. Assel for following up on these very important and excellent questions. We trust this answers most of the questions he received and provides some valuable information about Autism Spectrum Disorders, particularly for those who work in early childhood settings. Check out the slides & recording of the webinar online and please feel free to share with your parents and partners.

 

If you would like to know more about the work Dr. Assel and his colleagues do at the University of Texas-Children’s Learning Institute, please visit http://www.childrenslearninginstitute.org/ . They have many wonderful resources for early childhood programs and educators.

About Dr. Mike Assel