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The Autism Blogcast – October Edition

News Flash: The September edition of The Autism Blogcast, featuring autism experts Raphael Bernier, PhD and James Mancini, MS, CCC-SLP.

 

In an effort to keep you up to date on the latest news in research and community happenings, we welcome two of our favorite providers best known as Jim and Raphe, the autism news guys.

In this edition they discuss research on fevers lessening behavioral problems in children with autism, promoting inclusion for people with disabilities and events that promote inclusion.

Watch our first installment in a new series from our team of reporters sent into the field! Lindsey Miller, ARNP starts off this special series asking the question “What does inclusion mean to you?”.

 

 

 

Ask Dr. Emily – Facial Behavior and Daydreaming

Welcome to the September edition of Ask Dr. Emily!

We often receive questions that we want to share with all our readers. To help with this, Dr. Emily Rastall, a clinical psychologist at Seattle Children’s Autism Center, will share insights in a question and answer format.

We welcome you to send us your questions and Dr. Rastall will do her best to answer them each month. Send your questions to theautismblog@seattlechildrens.org.

Q: My son is 7 years old, and he has autism spectrum disorder. When he watches television, he makes faces with his eyes closed and lips out. Is that part of autism?

 A: One of the diagnostic criterion for autism spectrum disorder is described as this facial behavior that you describe sounds to me like it fits the description of a “stereotyped or repetitive motor movement,” one of the diagnostic criteria for autism spectrum disorder. These behaviors can be present when one is excited, relaxed, and/or upset.   

Q: I am an individual with autism. I want to touch on daydreaming. When I was in school, my biggest hurdle was “zoning out.” If I didn’t understand a topic, I would “check out” until the instruction ended. This sounds awful, but my family sometimes has to snap at me to bring me back to reality. I “pass” as typical, but every day is an exhaustive process of trying to stay focused and “in touch” with what’s happening around me. Is this something that happens with autism spectrum disorder?

A: Thank you for writing in and for sharing your experiences. Executive functioning (like paying attention, planning, thinking ahead, switching attention or tasks) is often affected (to varying degrees, of course) for individuals with autism spectrum disorder. This can make it challenging to maintain attention, multi-task, and stay present, especially in overwhelming, chaotic environments. It can be even more challenging to stay focused on topics or people that we don’t find especially interesting or appealing.

 Q: My son is 12 and has high functioning autism. He has also been diagnosed with anxiety, skin picking, ADHD, and we recently discovered he has two genetic duplications as well. He has had some real challenges at school: Social challenges (cannot read social cues from others, oversteps boundaries with peers, had trouble fitting in), behavioral challenges (aggression towards peers, incontinence), and emotional challenges (verbal outbursts, threats of harm to self and property). He was expelled from public school last year; he now attends an alternative school, but things have not gotten better. What should we do?

 A: First, let me empathize with how hard this must be for you, your son, and your family. His profile appears complex with his recent genetic findings, mental health symptoms, behavioral issues and potentially a number of medical and mental health providers involved. Might his primary care provider be “the quarterback” of his care/education team, with a coordinated comprehensive evaluation and treatment plan? This would hopefully shed some light on the function of his behavioral challenges and inform treatment next steps.

 

Patients with Autism in the Emergency Department (ED)

Going to the Emergency Department (ED) with any child is unnerving. Taking a child with Autism Spectrum Disorder (ASD) is even more so with all the complications that autism brings. Waiting is hard. Explaining baseline behavior is too.

There are many unknowns with kids with ASD such as unusual reactions to medications and elevated behavioral responses to procedures as simple as blood pressure and temperature. In addition, parents face the scrutiny of everyone within earshot of our kids who frequently are loud and draw lots of attention. We feel the stares and we sense the judgment. We’ve been here before in the grocery store, the restaurant, and yes, even at Seattle Children’s Hospital as we wait along with others for services.

Will your child ever need to go to the Emergency Department? Hopefully not but you might be surprised to learn how common a trip to the ED is for ALL kids, including ours. Given that, is it possible to be prepared ahead of time? For answers, we went straight to the source with Seattle Children’s Emergency Department staff. We have also included a handy glossary of terms that you may encounter in an ED visit. If a provider uses a term you are unfamiliar with, don’t hesitate to ask for an explanation!

How many children and adolescents with ASD do you see in the ED?
• What are some of the concerns that families bring to the ED?

 

• What are some of the common challenges that occur for patients and parents in the ED?
• What are some of the common challenges that occur in the ED for providers serving patients with ASD?

 

• What can parents do to prepare before their child has reason to need a visit to the ED?
• Upon arrival in the ED, what can parents do to lessen the stress for all?

 

• What has been done at Seattle Children’s to lessen the stress for patients and families in the ED?
• What do you want patients with ASD and their parents to know if they need to see you in the ED?

Glossary of Terms You Might Hear in the ED

Attending: a physician/medical doctor who is in charge of your care and supervises trainees such as residents and fellows.

Resident: a physician/medical doctor who practices medicine in a hospital or clinic under the supervision of an attending physician.

Fellow: a physician/medical doctor who has completed residency and has chosen additional training in a specialty or subspecialty and practices under the supervision of an attending physician.

Labs: usually refers to a blood draw, urine or stool sample for diagnostic testing

Triage: the process of determining the priority of patients’ treatments based on the severity of their condition

Medication reconciliation: the process of updating the record of current medications

Imaging/Scans: refers to diagnostic procedures such as MRI, CT, X-ray

NPO: nil per os – Latin term meaning nothing by mouth (food or liquids)

PRN: pro re nata – Latin term meaning as needed or when necessary

Tips
• If you are concerned that your child will resist doing something in the standard way, ask if it is possible to do it a different way. I recall an ED visit with my child in which an X-ray was needed. She would not lie down for it so we tried it standing up and it worked. This won’t be possible in every single case but it’s always worth asking.
• Providers in the ED are always busy and won’t always have time to check your child’s chart if they are patients at Seattle Children’s. You can help by having answers ready to some key questions. Take a look at this card we use at our Autism Center.

We hope that your child never is in need of an emergency department visit. It’s always good to be prepared, so just in case bookmark this blog!

Why Do Kids With Autism Do That? Part II

legosAnd here is Part II of our most popular blog!

To date, our most popular blog is Why Do Kids with Autism Do That? Not surprising I suppose, as we are always trying to figure out why our kids do what they do. We gathered more puzzling questions for our panel of providers and invite those of you who offered your own insight and perspective last time to join in. This time we asked Brandi Chew, PhD, Jo Ristow, MS, CCC-SLP, and Soo Kim, MD to share their thoughts and this is what they had to say.

Why do some kids with autism . . .

Learn unevenly – seem to take one step forward and then one back

Jo: The answer to this question could fill a book! In my practice, I see a lot of this unevenness when kids have difficulty translating (or generalizing) learned skills to different people, environments and items/activities. For instance, I’ve seen kids learn that they can touch a photo on the iPad to activate voice output and request a Skittle, but then not be able apply that learning to touching different photos Read full post »

Why Do Kids With Autism Do That?

To date, our most popular blog is Why Do Kids with Autism Do That and most of the questions that Dr. Emily gets pertain to the often perplexing behaviors our kids are known for.

This week we bring back this favorite in a two part series. If it prompts a question or two on your child’s behavior, send them our way and we’ll put them in Dr. Emily’s queue!

When my kids were young, my son Justin was quite curious about the many odd mannerisms his sister with autism demonstrated.

We welcomed his questions as well as those from his curious neighborhood friends who we were determined to include in our friendly and oh-so-unconventional home. I did my parental best to offer up ideas as to why she does what she does, and thankfully they didn’t question me or ask to see the evidence behind my hypotheses.

We asked a panel of providers to give us their best answers as to why our kids do what they do. Shelley O’Donnell is an Occupational Therapist specializing in children with autism at Seattle Therapy Services. Jim Mancini is a Speech Language Pathologist and Emily Rastall is a Clinical Psychologist, both at Seattle Children’s Autism Center. Read full post »