Archive for February 2017

Monthly Archive

Ask Dr. Emily – Behaviors and Co-occurring Conditions

Welcome to the February 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

Q: My 12 year grandson with autism is having trouble with portion size on everything, like how much shampoo to use, soap, using butter, mayo, just everything! He fixates on eating one thing at a time and is getting very picky about not liking foods he use to like. He is also getting very OCD. Does this go along with having autism?

A: It is not uncommon for individuals with autism spectrum disorder (ASD) to present with executive functioning challenges. That means that things like thinking ahead, planning, weighing consequences, resisting impulses, and stopping yourself when it’s time to stop, are difficult to do. Portion control is another one of those things that is processed in the executive functioning center of the brain (i.e., the frontal lobe), so it makes sense that this is something that is challenging for your grandson to do.

With regard to “OCD” symptoms, one of the diagnostic criteria for ASD involves “repetitive patterns of behavior or interest.” This can include “ritualized patterns of verbal or non-verbal behaviors” (e.g., eating foods one at a time in the same order, repeating words a specific number of times, closing every door in the house), “insistence on sameness” (e.g., needing the same green plastic cup for dinner) or “inflexible adherence to routines” (e.g., insisting that you drive home the same way every day). Often sensory sensitivities (another diagnostic criteria for ASD) play into food preferences (or lack there of) too. While many of these symptoms can mimic OCD (or obsessive compulsive disorder), much of the time these are expected behaviors to see with an ASD diagnosis. In conclusion, while OCD can occur with ASD, most individuals with ASD do not have “true” OCD.


Q: I have 13 year old fraternal twin boys, one was diagnosed with autism when he was 7-years-old, and the other with Tourette’s when he was 10. Now I am being told that my son with Tourette’s is showing signs of autism and my son with autism is showing signs of Tourette’s. How can this be happening at different ages and times? I need help to understand this.

A: While autism spectrum disorder (ASD) presents early in development, symptoms may not become notably impactful until later in an individual’s life. This might lead to a diagnosis that occurs later in life. Conversely, ASD symptoms that develop early in life may present as significantly impactful right away, which would lead to earlier diagnosis. With regard to Tourette’s, this can develop at different times for different children; one may develop it in elementary school while another’s symptoms may present around puberty. Tourette’s and ASD have been known to co-occur more often than would be expected by coincidence. For more information, you may be interested in the following book: Kids in the Syndrome Mix of ADHD, LD, Autism Spectrum, Tourette’s, Anxiety and More! By M Kutscher and T Attwood


Q: When puberty hit our 16-year-old Trey, OCD hit his high functioning autism really hard. He went from mildly medicated and in all mainstreamed classes to highly medicated (and yet unaffected) to moved into several special education classes. His anxiety has the entire family in tears at this point. We don’t know how to help him. Lights on and off, clothes on and off, food in and out, it is never ending. It doesn’t help that he is 6’6 and 400 pounds. We really need help. Any advice?

A: It is not uncommon for mental health challenges (anxiety, depression) to present with onset during puberty. I suggest you consult with your primary care provider and ask for a referral for a mental health evaluation. You will want this to occur with a psychiatric provider who has training in assessing, diagnosing, and treating obsessive compulsive disorder (OCD) and who also understands autism spectrum disorder (ASD). That provider, based on the diagnostic conclusions, will be able to provide treatment recommendations from there.



Autism & Infant Siblings Study

While kids (and their parents) were making Valentine’s Day cards last week, a paper was released in the prestigious journal, Nature that garnered some attention in the media.

The paper reported the results of a very large, longitudinal imaging study of younger infant siblings of children with autism. The study is the result of several years of work by a research network, called Infant Brain Imaging Study (IBIS), which is directed by Joe Piven at University of North Carolina, and includes several scientists around the country, including scientists here in Seattle at the University of Washington.

The scientists first used magnetic resonance imaging (MRI) to scan the brains of almost 150 infants, 106 of which have an older sibling with ASD. These infant siblings are 20 times more likely to get an ASD diagnosis than a child in the general population. The scientists measured brain volume and surface area using MRI when the children were 6, 12, and 24 months of age and conducted a diagnostic evaluation when the children turned 2 years old.

Of the 106 infant siblings, 15 received an ASD diagnosis at 2 years old. Those that were diagnosed with ASD had brain surface area that grew much faster between 6 and 12 months, then had overall brain volumes that increased faster between 12 and 24 months of age.

Using complicated statistics, called machine learning, they then looked at brain scans collected from additional baby siblings for whom the diagnosis was known. They then looked back at the scans collected from those baby siblings at 6, 12 and 24 months and used these brain growth patterns to classify which infants would have ASD and which would not. The statistical algorithm correctly predicted an ASD diagnosis for 81% of the infant siblings.

The study provides insight into neural changes that seem to be occurring in young children who go on to develop ASD. However, there isn’t any evidence to suggest this pattern of growth applies to all children who develop ASD. So, for parents, it’s important to know that the predictions were based on data from infant siblings of children with ASD. As such, it’s unclear what the implications are for families without a child with ASD already.

Finally, using brain scans as a screening tool for ASD is unlikely to be adopted given the practical challenges of using MRI with infants. In fact, only 1/3 of the infants in the IBIS study were able to complete the brain scans at all 3 ages.

Science moves forward incrementally. This study is an important step. The next step is to more clearly understand this rapid-growth phenomena.

This Month’s Autism 200 Class – Autism Genetics: What Parents Should Know

This month’s Autism 200 Series class  “Autism Genetics: What Parents Should Know” will be held Thursday, February 16, 2017 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.

Over the past decade, there have been major advances in our understanding of autism genetics, and genetic testing is often offered to patients and families. The tests (and sometimes the results) can be overwhelming and confusing. We will review what is known about autism genetics and what kinds of genetic tests are available to families. In addition, we will discuss the pros and cons of genetic testing and what types of results you might expect to receive. Finally, we will highlight research opportunities and exciting advances in genetic testing that are expected to become available in the near future. This class will be led by Heather Mefford, MD, and Jennifer Gerdts, PhD.

Mindful Monday-The Faces We Wear

Remember the line in the Beatles song, Eleanor Rigby, “wearing the face that she keeps in the jar by the door”?  I don’t know what Paul had in mind when he wrote that but it makes me think of the different faces we wear depending on the time of day, the people we’re with, and the environment we’re in.

Here’s a mindfulness exercise to help us notice what face we wear when, where and with whom. Pay attention to the face you present in the following situations. Make a mental note or jot down a note about each. You can even use emojis to help capture your face, For example, for those who aren’t early birds, your waking up face might be a grumpy face. If you feel stressed driving to work, a tense face might fit.

Waking up face:

Driving/commuting face:

Arriving at work face:

Arriving home face:

Greeting partner face:

Greeting kids face:

Going to bed face:

Now review your faces and decide if there are any that you want to change, particularly if you often wear that face and it reflects a not-so-happy you. We’re often unaware of the face we present to others. Here’s a chance to notice.




The Autism Blogcast with Jim and Raphe February Edition

News Flash: The February 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.

These two have too much energy to be contained in written format so our plan is to capture them in 2-5 minute videos that we’ll post the first week of each month. We welcome your questions and comments. Tell us what you think of our dynamic duo!

In this edition of the Blogcast, our reporters discuss research and children who could (in the future) benefit from certain behavioral treatments.  Reporters also highlight important bills from this current legislative session specifically targeting education.