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Living with Autism

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February 25, 2012

Neuropsychiatry for Autism?

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“Epilepsy is more common in individuals with autism than in the general population,” says a 2009 Institute of Clinical Sciences and Institute of Neuroscience and Physiology report...“study of young adults with autism showed high rates of epilepsy… A diagnosis of AUTISM in children with intractable epilepsy remained after surgical intervention.”

“One must be aware that AD, Asperger syndrome and autistic-like conditions are behaviorally defined diagnoses, in contrast to…eg infantile spasms, Landau Kleffner syndrome or the syndrome of continuous spike-and-wave during sleep. These diagnoses are based on specific EEG findings together with clinical symptoms and signs and affect both previously healthy children and children with neurodevelopmental disorders. Acquired functional deficits, including cognitive and/or language regression, seen in these children are potentially reversible [cured] and treatable as they are presumed to be caused by epileptiform activity.”

“In a retrospective follow-up study on a clinical series of
130 individuals 18-35 years old diagnosed with autism in childhood and without a known associated medical condition epilepsy was found in 25% (Hara 2007).”

Parents of autistic children and adults spend many years and hundreds of hours floating between primary care physicians, gastroenterologists, geneticists, psychiatrists and neurologists. I’m finally down to three. It would be great to narrow the medical maze to TWO doctors. This may sound like it’s no big deal, but it is when you spend half your life traveling for an hour in a car, sitting for another hour in an office and waiting 45 minutes in an exam room with a severely- autistic son. By the end, I often feel like making myself an appointment with several psychiatrists. Or at least picking up some dark chocolate and a bottle of Pinot Noir on the way home.

Study by Olsson et al. (1988), three quarters of all children with autism and epilepsy had partial seizures only or in combination with other seizure types, as did three quarters of adults with active epilepsy”

Finally, the report noted it hopes information provided will “increase awareness of individuals with both epilepsy and autism, so that optimal support and interventions can be provided and planned for through the collaboration between psychiatry and neurology”.

So, we must ask: Why are autistics with epilepsy and behavioral issues constantly bounced back and forth between psychiatry and neurology? Interestingly, there is growing support for the rapprochement of neurology and psychiatry. Neuropsychiatry becoming a specific branch of medicine that could better medically manage moderate to severely autistic patients.


February 23, 2012

Self-Injurious Behavior in Autism Spectrum Disorder

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Self-injurious behavior is a hallmark feature of autism. Yet, unless it’s severe it’s often undiagnosed. Much like autism spectrum, there is a self-injurious behavior spectrum: Mild to Severe.

We find parents reporting self-injury among children with Aspergers:

  1. Jan 23, 2011 ... Moms and dads have a natural tendency to run to their Aspergers ... in a tantrum
    that cause them self-harm (e.g., banging head, hitting self, etc.)
    www.myaspergerschild.com/.../aspergers-temper-tantrums-15-tips-for.html
  2. Dec 20, 2010 ... Children and teens with Aspergers may engage in self-harming behaviors (also
    called ... What can be done to prevent self-injurious behavior?
    www.myaspergerschild.com/2010/12/aspergers-and-self-injury.html
  3. Nov 10, 2011 ... Individuals who engaged in self-injurious behaviors as children may return to
    these as adults during times of stress, illness or change.
    www.autism.org.uk/living-with.../self-injurious-behaviour.aspx  
We find Academy of Child and Adolescent Psychiatry website reporting self-injury among autism:

  1. Children diagnosed with autism tend to process and respond to information in the environment in unique ways. In some cases, parents are frightened because they exhibit aggressive and/or self-injurious behaviors which are difficult to manage…” http://www.aacap.org/cs/autism_resource_center/faqs_on_autism

We find Autism Society reporting: “Early Indicators: High Functioning Autism and Aspergers Syndrome… The disorder makes it hard to communicate and relate to the social world. In some cases, aggressive and/or SELF-INJURIOUS BEHAVIOR may be present (Autism Society of Delaware, 2005); Source: http://www.disabled-world.com/artman/publish/article_2255.shtml.



Because Aspergers individuals don’t possess a clinically significant cognitive delay and are of average or above average intellect, self-injurious behaviors often go unnoticed.
Self-injurious behaviors (ie… scratching arms, pulling hair, slapping or punching face) may occur in isolation. Or occur covertly, often triggered by high stress, bullying, sudden changes or being trapped in highly-illogical situations triggering extreme frustration.
For example, an Asperger’s man sitting in a meeting listening to something he can’t process, or finds inanely nonsensical, may hide arms under table and pinch himself. Or, later go into bathroom and yank hair. You’d never know it. Or a high-functioning autistic woman who is hyper-focusing on reading and constantly interrupted may, when the person interrupting leaves, slam fists into face. Thus, behavior may go unnoticed. In contrast, a severely-autistic individual—with more severe sensory and processing issues, let’s loose in any situation, by no fault of their own. Thus, it’s noticed.
SIB seen in higher functioning autistics differs in intensity, frequency and duration. For example, a severely-autistic child may hit head daily for several minutes. In contrast, an Asperger child may slap head five times once a week. In both cases, it’s self-injurious behavior.
Though there are differences between HF autism and LF (low functioning) autism, there seems a major connection with tendency to engage in self-injury. Hence, self-injurious behavior is a core feature of actual autism.

Here it is again mentioned: “Many symptoms that occur on the autism spectrum…severe anxiety and difficulty in communication…result in significant reduction of quality of life. More URGENTLY, certain symptoms such as self-injurious behavior represent an immediate danger of self harm.” http://www.aspergerssyndrome.org/PDF/AutismSubtypes.pdf

Clearly, self-injurious behavior exists across autism spectrum and as such, can no longer be ignored by researchers as being something else.

Of great interest is self-injurious behaviors among autistics DIFFER differ from other diagnostic groups.

Severely-autistic individuals tend to target above neck (head/face hitting, face slapping, face scratching and pulling hair). Higher functioning individuals also target head, as well as arms. Interesting, HEAD is major target, given autistic individuals often experience sensory overload and processing challenges rooted within brain, as if head hitting is natural reaction to incoming assaults and internal chaos.

Let’s compare self-injury seen in GENETIC conditions with self-injury seen in actual autism.  

Self-Injury seen in Cornelia de Lange syndrome presents as biting fingers and putting fingers in mouth.

Individuals with Rett Syndrome present with: hand wringing, hand mouthing and digging fingernails into opposite hand.

Individuals with Prader-Willi Syndrome present with obsessive skin-picking causing tissue damage.
Individuals with Lesch-Nyan present with eye-poking, tongue and cheek biting, head banging, nose gouging.   

Individuals with Fragile-X/Angelman’s syndrome may display SIB, but these are not true autism. These too are genetic conditions identified by distinctive characteristics and chromosomal abnormalities, thus separating them from actual autism.

Some researchers think autism is genetic. But there’s no concrete evidence. Until there is, we should contain what we know to be factual and logical about self-injurious behaviors among autistics and not swirl different diagnostic groups into autism behavioral research.

It would make sense to study together high and low functioning autistics who exhibit self-injurious behaviors to identify common underlying mechanisms fueling or triggering their SIB.
 
© Kim Oakley February 23, 2012
selbst verletzungen bei autismus

February 18, 2012

Autism Treatments That May Help

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Things That Have Helped My Severely-Autistic Son and May Help Others:

Challenge: Disruptive vocalizations. I’m not talking about baseline vocalizations. I’m referring to extremely loud, repetitive screaming.

1st Line Treatment:   L-Tyrosine 500 mg-1000mg. Given either @ 7 AM before breakfast or PRN in afternoon before lunch. Not given @ night. Often reduces incessant vocalizations. I thought L-Tyrosine could help after analyzing research on disruptive vocalizations in elderly patients in nursing homes (L-tyrosine is a natural way to elevate dopamine).

2nd Line Treatment: Green Tea Powder mixed in oatmeal or yogurt. Or strong lukewarm Green tea with a little sugar.

Challenge: Self-Injurious Behaviors (SIB) (punching head, temples and chin extremely hard with fists)

Current Maintenance Treatment: Prescribed NICOTINE Transdermal Patch 7mg applied to dry skin @ 7am, removed at 5pm.

Challenge: Constipation (one of many triggers to SIB) 

1st line Treatment: Minced, Pureed Diet. Power Purees (lots of organic berries, yogurt, flaxseed, apple juice, etc…)  
2nd line Treatment: Suppository
3rd line Treatment: Lactalose PO (by mouth) mixed with juice or Ensure with Fiber

Challenge: Preventing Colds, Flu, and other Illness Known to Increase his Self-injurious Behaviors

Preventative Care#1:  2-3 Kyolic #105 Garlic Capsules with lunch.

Preventative Care #2: Warm bath 2 xs daily with Epsom Salt and aromatherapy (lavender and tea tree oil). If needed, turn on sink faucet until bathroom is saturated with steamy mist, to loosen mucus.

1st line treatment: Drops of Echinacea/Goldenseal tincture by mouth.

2nd line treatment: See Primary Care Doc to rule out sinus or ear infection.

Challenge:   Up All Night-Insomnia: Underlying medical issues ruled out

1st line treatment: Massage Therapy

2nd line treatment: Weighted Blankets to help with restless legs, sensory overload or general anxiety. Wrap up to neck only. Monitor closely. Move blankets down to shoulders when asleep.

3rd line treatment: Leave Headphones ON to block out noises, keep room EXTRA quiet, lights down, until falls asleep.

Challenge: Avoiding Hospital-Acquired Infection/Illness

1st line treatment: Second he arrives home, he’s in the bath. Hair washed. Body scrubbed. A little Tea Tree Oil Conditioner left in hair. Don’t want to carry home what’s floating around hospital settings. Teeth brushed with baking soda and hydrogen peroxide. Ears swabbed with Tea Tree Oil pads. Shoes cleaned with Lysol wipes.

Challenge: Avoiding Day Program-Acquired Infection/Illness

Preventative Care: Take him straight from car to bathtub. Hair and body washed. Ears cleaned.

Challenge: Increased Seizure Activity

Preventative Care: Frequently feed foods high in Omegas (sardines, flaxseed, and salmon).

1st line treatment: Prescribed 0.5 mg clonazepam, as prescribed, as needed.

Some Helpful Antidotes I’ve Used for My Autistic Son:

After my son was given too many “benzodiazepines” (repeated doses of ativan) inside a hospital, I bought the herb Bacopa Monnieri. I gave it as directed, it reversed the benzo fog. In case a health professional plagued with compulsive doubting, uptight reading this….thinking, Gee, she’s just a parent of an autistic child, who does she think she is… what rubbish…here’s evidence. Notice research is done by National Institute of Health.
Jan 13, 2008 : As Benzodiazepines are known to produce amnesia by
involvement of the GABAergic system, we examined Bacopa monniera, ...
The degree of reversal by Bacopa was significant www.ncbi.nlm.nih.gov/pubmed/18193203
Antidote I’ve used at home to help my son recover after given too much Tylenol at hospital: N-acetylcysteine, as directed.Antidote to acetaminophen overdose is N-acetylcysteine (NAC)….www.emedicinehealth.com/acetaminophen_tylenol.../article_em.htm
N-acetyl cysteine is used to
counteract acetaminophen (Tylenol) and carbon monoxide poisoning www.webmd.com/.../ingredientmono-1018-N-ACETYL%20CYSTEINE.aspx
Legal disclaimer: Please consult with a physician or other (love this next part, as if we're morons) "qualified"
healthcare provider before trying any new or suggested treatment. What is an unqualified healthcare provider? Your grandmother? Nothing here is intended to diagnose, treat, cure or prevent anything, though some information found here may cure or prevent autism ignorance.
Kim Oakley

February 12, 2012

Self-Injurious Episodes in Non-Verbal Autistics

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                 10 Things to Consider When a Non-Verbal Autistic Person Has a Sudden Self-Injurious Episodes: 


1.              Environment. Auditory: Are loud noises (car alarms, dogs barking, others talking too loud, music or TV blasting) triggering behavior? Olfactory: Sudden onset of strong smells, such as fresh paint, perfume, popcorn in microwave? Tactile: Sits on chair with book on it. Visual: Sunlight in eyes. Scary show on TV. Frightening picture on wall? Scan area for everything possible that could startle or cause fear or discomfort. Re-direct autistic person to safe, quiet area, if needed.  


2.              Clothing. Is something like underwear or diaper pinching? Pants too tight? Sleeves wet? Clothing bunched? Itchy? Sweater tag scraping neck? Check for insects, as in Ants in pants (yes, this happened once on a field trip to park). Overdressed? Underdressed? Too hot? Too cold?

3.              Shoes. Rocks, pebbles or stickers in shoe. Shoes or socks too tight. Or wet. Or have holes. Also check toe-nails. Long nails can cut other toes. Check for blisters.

4.              Hunger or Thirst. ESPECIALLY if autistic person is on MEDICATIONS. Drug-induced hypoglycemia presents with low blood sugar and cause automatic behaviors, ataxia, anxiety, dilated pupils, confusion, myoclonus, tingly skin, shakiness, sweating and heart palpitations. Such symptoms lower self-injurious threshold in a behaviorally-fragile autistic person (BFAP). Check for de-hydration. Non-verbal autistics often can’t tell you they’re thirsty. Offer frequent sips of water or juice. Keep hydrated. Know when they last ate. Offer food.

5.              Sleep deprivation. Acute or chronic. If you suspect insomnia or other sleep issues, which are common among autistics, look for appetite changes, constant yawning, changes in vision (bumping into things), off-baseline [not normal for person] distractibility, bloodshot eyes, extreme agitation, elevated histamine levels in blood (request blood test if suspected as this can also be sign of gut bacteria), hand tremors, sensitivity to cold and/or unusual re-actions to noise.  

6.              Underlying, undetected medical issues: Infection. Allergies. Impaction. Constipation. Bladder infection. Sore throat. Ear infection. Adverse reactions to medications. Cavities (one of the hardest things to detect, since many severely- autistic persons with behavioral issues can’t tolerate dentist looking inside mouth, and so have to be put under general anesthesia just to have a check up).  Remember, they can't tell you if they're in pain. Watch for changes in behavior, eating, sleeping. That's called "off baseline" meaning your child isn't acting like he or she normally does. Be sure to tell doctor this, so they don't think it's part of the autism.  

7.              Acute Injury. Stubbed toe. Scraped knee. Bumped head. Treat (apply ice packs or Bactine spray for pain relief, as needed). Remember pain caused BY self-injury triggers MORE self-injury. Do all you can to STOP the pain. Remember: They may have paradoxical reaction to some medications.  Ie...Ativan or Benadryl used for calming may cause mania in autistic children and adults. 

8.              Defense Mechanism. Is autistic person being rushed, let’s say, to go to bus? Rushed to get into car? Rushed to change classrooms? Forced to board airplane? All these can be triggers to self-injury, as pressure and stress of situation becomes overwhelming. Slow down, if possible. Obviously, in an emergency, if you need to vacate a building, you have to move quickly, but if you can, prepare autistic person prone to self-injury by moving slowly and calmly from place to place. Provide extra time and space to process things.

9.              Boredom. Sitting in a classroom staring at wall for hours could be a trigger. Staying in one place too long could trigger self-abuse. Some autistics get “stuck.” They need re-direction. They need you to help them get unstuck. Introduce new assistive technology, toys and settings, as tolerated. Read to them. Try hand over hand assistance and prompting.


10.       Subnutrition. Chronic exposure to inadequate nutrition. State and private-run facilities and other programs serving autistic populations offer junk food because it’s cheap. Common foods served include crackers, bread, chips, cake, canned vegetables, French fries, hot dogs, pizza, puddings and TV dinners. Subnutrition can also occur when autistics with nutrient absorption issues don’t receive MINCE or PUREE foods to enhance digestion. Even great food can’t be digested if it’s being swallowed whole, which some autistics tend to do. In cases where autistic won’t chew slowly, ask doctor to order minced or pureed diet. Subnutrition affects mood and lowers self-injurious threshold. Every bite counts. It’s essential to evaluate and improve diet and nutritional status of self-injurious autistics. Remember: They may refuse to eat and drink several times before finally eating.  If you give up, they won’t receive proper nutrition and hydration. Keep trying. Move them to a different room. Come back. Try again. Food preferences may change. One week the autistic person may prefer crunchy, salty foods. The next, sweet and sour, the next warm foods only, the next cold foods only, and finally, they may refuse any food unless it’s minced or pureed foods.  It’s is critical to learn as much as you can about the autistic individual’s behaviors and preferences.


        Autistic people are smarter than they appear. Even if they’re sitting alone and appear in own world, they still need stimulation. Give them sensory toys to chew on or play with. Placing them in front of a TV for hours— in some cases— isn’t therapeutic. TV today is not like when I was young. Visual pictures move FAST. Commercials are annoying and loud. It can overexcite the brain and later trigger undesirable behaviors. Sitting in a garden, with a little sunshine, proper hydration, reading them a book and playing Mozart would be a good alternative.