All Articles in the Category ‘General’

Ask Dr. Emily- Sensory Sensitivity and Ritualized Behaviors

Welcome to the June 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 here, on the last Friday of each month, 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


Q: I have a 4 year old grandson, who is diagnosed with autism. He comes to stay with me every other week, and I am learning a lot about him. Ever since he learned to walk, he has a fighting fit when his diaper or pants are taken off him. I’m worried about the diaper rash that he gets as a result. He doesn’t like when anyone tries to wash or wipe him. What is going on?

A: Because you mentioned a rash, the first thing to do is to have your pediatrician assess the area and give treatment recommendations. While I can’t say specifically what might be happening in your case, I can speak to one thing that could be playing a part. Specifically, it is not uncommon for children with autism to present with sensitivities to certain sensory input. In fact, one of the diagnostic criteria for autism spectrum disorder (ASD) is what we call “sensory sensitivities.” We call the sensitivities having to do with touch, “tactile sensitivities.” Children with tactile sensitivities could be sensitive to certain types or textures of clothing, may not like water on their skin or heads, might resist clothes being put on or taken off, may dislike haircuts or teeth brushing, and/or may dislike certain textures of food in the mouth. We can think of sensory sensitivities as the “senses on steroids;” everything feels stronger and more intense than you or I might feel it. Occupational therapy can be one way of helping children with ASD learn to tolerate sensory input more effectively. Like I mentioned earlier, the first step when there is a medical concern (like a rash) is to visit your pediatrician, who can make a referrals or recommendations based on their assessment of the issue.


Q: My 3-year-old daughter has autism, and I’m learning more and more about her every day. I’m curious as to why she walks around objects in certain ways. For example, she will walk around a table that is pushed up against a wall or will sometimes even walk around her younger brother’s toys that are on the floor. Sometimes I try to move things so that she doesn’t have to walk around them, but then she gets upset. What’s going on here?

A: One of the diagnostic criteria for autism spectrum disorder (ASD) is what is called “ritualized behavior.” This means repetitive patterns of behavior that may or may not appear to serve a purpose. A lot of the time these patterns of behavior don’t make a lot sense to us, but they make complete sense to our kids with ASD. Other examples of rituals might include stacking papers before bedtime, eating foods or doing tasks in one order (and one order only), requiring that parents take the same route home each day, or requiring that others say things in a certain order or certain way. It’s not uncommon for kids to become upset if they are not able to complete the ritual in the way they think it should be performed. The good news is that many times, these rituals are fairly benign. However, if you are finding that rituals are taking a great deal of time and interfering significantly with daily life, talk to your pediatrician about a possible treatment options and/or referrals.

Transition to Adulthood-Community Based Housing Options for Adults with Disabilities- This Month’s Autism 200 Class


This month’s Autism 200 Series class “Transition to Adulthood-Community Based Housing Options for Adults with Disabilities” will be held Thursday, June 16, 2016, at Seattle Children’s Hospital in Wright Auditorium from 7 to 8:30 p.m. These classes are designed for parents, teachers and caregivers. The topics associated with the majority of classes are applicable to all age ranges and for a wide variety of children diagnosed with autism. This class will be led by Vicki Isett & Pam Blanton, Community Homes, inc.

Autism Re-examined: Ethical challenges in care, support, research and inclusion


 This year, Seattle Children’s Annual Pediatric Bioethics Conference is focused on autism. It will be held July 22 and 23 at Bell Harbor International Conference Center in Seattle.





Some of the questions to be explored include:

  • How have changes in the way we understand autism over time influenced ethical issues in diagnosis and treatment?
  • How and why do health disparities occur in diagnosis, treatment and support, and what are the impacts? How can we reduce and ultimately eliminate disparities?
  • How can we incorporate knowledge of cross-cultural differences to provide better care for children with autism and their families?
  • What are the ethical challenges in the transition from adolescence to adulthood? How can they be addressed?
  • What are some of the ethical issues in autism research? How can research findings result in more effective care and support for children with autism?


For more information and to register for the conference.


We hope to see you there!

Autism and Folic Acid: Another Association Study




Quiz: Which of the following factors have been identified in association studies as increasing the risk for autism? Mark all that apply.



Rainy climates

Living near a freeway

Use of flea/tick powder

Older moms

Older dads

Close spacing between birth of children

Vitamin D deficiency


Selective Serotonin Reuptake Inhibitors (SSRI) use in pregnant women

All of the above

If you marked all of the above, you are correct, but get ready to add one more.

If you were anywhere near a computer or television last week, you’re aware of the buzz surrounding a new study that identifies too much folic acid in pregnant women as a risk factor for developing autism.

Folate is the naturally-occurring form of Vitamin B9 found in leafy green vegetables and other foods and folic acid is the synthetic form of this nutrient important in the role of neural tube development in fetuses. In the late 1990’s in an effort to reduce the risk of neural tube defects, folic acid was added to many processed foods such as flour, cereal, and bread and figured prominently in prenatal vitamins.

This recent study was presented at the International Meeting for Autism Research and has not yet been peer-reviewed or published in a professional journal, but it got much attention in the media. Here are links to two of the media reports:

The Atlantic

Concerns About Folate Causing Autism Are Premature

May 12, 2016 By James Hamblin


Why Fears Over Folic Acid and Autism Need to be Properly Understood

May 12, 2016 By Alexandra Sifferlin


Take-Away from this study

The take-away from this (and all association studies) is first to remember that association does not mean causation. This was a small study that has not yet been peer-reviewed so until it has passed through peer review and been published in a scientific journal, we should be curious but cautious. And, even after publication, we want to watch for more rigorous studies to corroborate the findings, before we feel more confident in the finding. If you have any questions about folate/folic acid, ask your health care provider for guidance.

And for more on understanding association studies, we direct you to our own Dr. Gary Stobbe and his blog on the topic.



Free Autism 101 Class-This Thursday

Please join us this Thursday, April 28, from 7 to 8:30 p.m. at Seattle Children’s Hospital for our free quarterly lecture, Autism 101. Autism 101 is intended for parents and families of children recently diagnosed with an autism spectrum disorder (ASD). In this free lecture, participants will learn about:

  • Up-to-date, evidence-based information regarding the core deficits of ASD
  • Variability and presentation of behaviors associated with autism
  • Prevalence and etiology (study of the cause of the disorder)
  • Treatments available
  • Resources for families

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