Autism Information for Parents

Parenting Children With Asperger's And High-functioning Autism

Mark Hutten, M.A is a practicing counseling psychologist and a professional parent-coach with experience of over 20 years in the field of High-Functioning Autism (HFA) and Asperger's. being the executive director of online parent support, LLC, Hutten presents several workshops and conducts numerous training courses for both professionals and parents dealing with HFA and Asperger's; besides, he works with hundreds of teenagers and children with HFA and Asperger's. Hutten is also an author of several articles that highlight parenting techniques based on highly effective research for dealing with children with HFA and Asperger's. The founder of the support group has published 'My out of control Child' and 'My out of control teen' eBooks. Most of Hutten's columns and articles discuss several ways of parenting young ones with conduct disorder, ODD, ADHD, Autism, Asperger's syndrome, Bipolar disorder, reactive attachment disorder, and many more conditions. The helpful parenting toolkit is all about a system that enables parents to minimize the child's meltdowns, low frustration tolerance, and tantrums, physical and verbal aggression, school-related behavior problems, social skills deficits, picky eating, attention difficulties, rigid thinking, problems completing homework, sleep problems, rituals and obsessions, and many more behavioral problems. The eBook is available for download. More here...

Parenting Children With Aspergers And Highfunctioning Autism Summary


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My Parenting Children With Aspergers And Highfunctioning Autism Review

Highly Recommended

Recently several visitors of websites have asked me about this manual, which is being promoted quite widely across the Internet. So I ordered a copy myself to figure out what all the publicity was about.

My opinion on this e-book is, if you do not have this e-book in your collection, your collection is incomplete. I have no regrets for purchasing this.

Developmental Disorders The Case Of Autism

Autism is a neurodevelopmental disorder with a strong genetic component and a heterogeneous neurological substrate. Abnormalities have been reported in the limbic system (anterior cingulate, amygdala, hippocampus, and orbitofrontal cortex), cerebellum, frontal lobes, superior temporal gyrus, and subcortical structures including the thalamus and the basal ganglia (Lord, Cook, Leventhal, & Amaral, 2000). This broad range of neurological abnormalities is matched at the behavioral level by a broad phenotype that includes motor, linguistic, social, and emotional deficits (Joseph, 1999). Individuals with autism exhibit stereotypic and repetitive motor behavior, and their use of language is both delayed and disrupted. At its core, however, autism is a disorder of social interaction and communication. Poor eye-gaze following is a specific marker of autism, and one of its earliest signs, evident in children as young as 18 months of age. Some children with autism even fail to use gaze as a cue...

Asperger Syndrome a mild form of autism

Before you all cry out in horror at this subtitle, let me tell you that it was written with much sarcasm Those of you parenting, teaching or caring for someone with Asperger Syndrome or with AS yourself will know only too well that the difficulties that come along with being 'differently wired' are far from mild. However, a simple definition is needed in order to explain the group of symptoms which, when found together, are called Asperger Syndrome. AS is a form ofautism, part of the autistic spectrum, an autistic spectrum disorder .call it what you will. Though it manifests itself in many ways, autism is autism. As I have already written in Chapter 4 on autism, both autism and Asperger Syndrome are characterized by the triad of impairments in Repetitive behaviours and obsessions along with the triad of impairments all blend together to produce the cocktail of characteristics we know as Asperger Syndrome. AS is a form of autism and therefore many of the difficulties and interventions...

Asperger Syndrome in the family

I truly believe that the best way to discover the depths and intricacies of the AS mind is to listen to what an AS person has to say for him- or herself (stating the obvious rather ). It is therefore for that reason (and a little bit of motherly pride) that I have quoted from and mentioned Luke's book Freaks, Geeks and Asperger Syndrome many times already in earlier chapters. Luke gives a valuable insight into how he thinks, feels

Siblings of children with autism and AS

That is guaranteed to turn such harmony squarely on its head is the presence of a child with autism (or indeed any other special need). Whilst we all have to learn in life that some things just aren't fair, siblings ofchildren with special needs learn this far more quickly than others. Ultimately I believe this to be a good thing and I truly believe that my girls are already much more understanding and accepting of difference, much more able to look beneath the surface rather than judging people, and much more able to tolerate and even see the funny side of others' 'unusual' antics. At these difficult times in their lives when they are living under the stress ofexams and their hormones are on the rampage, I don't think the girls appreciate such a blessing just yet Each member of a family unit subconsciously teaches another many things. However, when a child has autism or indeed any other kind of disability, then that teaching tends to become more obvious. Siblings of children with...

Some Promising Leads Into The Genetics Of Autism

Significant progress in the genetic and neurobiological understanding of PPDs related to autism, such as Rett syndrome and Fragile X, provides new models of pathogenesis that may shed some light on autism. For example, drawing a parallel between the clinical characteristics of Rett syndrome and autism, Zoghbi has proposed that autism may be due to a disruption in postnatal, or experience-dependent synaptic activity40. More specifically, she proposed that proteins involved in synapse formation and stability may be implicated in several PPDs. Similarly, Fragile X syndrome mutation 1 (FMR1), which causes a specific dysmorphic syndrome that is often associated with autistic features is more and more perceived as a disorder of the synapse (see Chapter 30). Indeed, it is now believed that FMR1 protein plays a key role in the regulation of dendritically localized mRNA where regulation of synaptic protein synthesis may influence synaptic structure, stability, and plasticity41. Given the...

Childhood autism Clinical features

Social deficits of a particular type remain a hallmark of autism. The nature of this deficit varies, somewhat, over time but remains a source of great disability to the affected individual throughout life.(24) In younger and more impaired individuals there may be little interest in social interaction less impaired individuals may come to a passive acceptance of social interaction. Social interest may be more marked among those functioning at a higher level, but it is often eccentric and one-sided. (25,) Manifestations of the social dysfunction include difficulties in the use of eye contact or other non-verbal social cues, in social emotional reciprocity and empathy, in

Atypical autismPDD not otherwise specified

Atypical autism in ICD-10, and the term 'Pervasive developmental disorder not otherwise specified' ( PDD-NOS) in DSM-IV, refers to what is a residual diagnostic category. ICD-10 provides the possibility for various forms of special coding for example, failure to meet the onset criteria for autism, failure to meet developmental behavioural criteria, failure to meet both, and so forth. Essentially this diagnostic concept refers to a 'subthreshold' condition that has similarities to autism and the other explicitly defined PDDs but which does not meet criteria.

Autism and Asperger Syndrome

Tony Attwood's homepage with lots of information about all aspects of Asperger Syndrome. http Autism Society of America (ASA). Online Asperger Syndrome Support (OASIS) (American site). http Autism Society Ontario. http stories.html A website all about Social Stories.

Anxieties of Asperger Syndrome

Unfortunately the world is fraught with danger for any child. It is a sad fact but we have to teach our children far more than basic safety issues such as safety in the home and road safety. From a very early age both at home and at school, children are taught to say no to strangers, what to do if someone touches them in an unwanted seems that all sorts of sinister dangers lurk around the corner. For any child these are hard messages to grasp but for a child with Asperger Syndrome understanding such abstract messages is as hard as walking on stilts on thin ice (Holliday-Willey 1999). How I managed to do so without collapsing I don't know, but I told Luke that I was nipping out to buy him a drink and dashed outside to make a phone call to Mick Connelly, the head ofthe local complex difficulties team. Hardly able to speak for sobbing, I blurted out what had happened and he managed to calm me down and told me to go back in again and ask them to phone him. When I returned to the...

Autism And Theory Of Mind

Since the emergence of the theory-of-mind hypothesis of autism over 15 years ago, autistic symptomatology has been considered to be the psychopathological consequence of a lack of appreciation of minds. Autism is an early-onset neurodevelopmental disorder characterized by the presence of markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activities and interests (American Psychiatric Association, 1994, p. 68). Two to five people per 10,000 are affected, and the disorder is four to five times more prevalent in males than in females. The social impairments and the restricted and repetitive patterns of behavior must be evident prior to 3 years of age in order to meet the diagnostic criteria for autism. Individuals with autism have been consistently reported to perform poorly on theory-of-mind tasks, yet show preserved capacities in other domains (see Baron-Cohen, 1995, for a review). For example, these individuals...

Asperger Syndrome in adolescence

Whilst Luke is one of five teenagers living in the Jackson household, having AS means that he dances to a rather different tune to the rest of the children, so although I have written a chapter later on about 'typically developing' adolescents (Chapter 9), I thought it necessary to write a separate brief section about AS and adolescence. The book Asperger Syndrome in Adolescence, edited by Liane Holliday-Willey, is an excellent read and co-written by many authors (myself being one of them) it gives valuable help and information about virtually every previously untouched topic such as sexuality, depression, making friends and many others. I therefore am not going to say too much here other than I strongly advise parents of AS adolescents to read this book. the need to find a sense of identity make adolescence an immensely trying time for a young person - indeed it is a trying time for a parent too At a time of life when peer pressure is at its greatest and social rules and rituals are...


At the end of the 1990s, concerns about the safety of the measles, mumps and rubella (MMR) and thimerosal-containing vaccines as possible causes of autism and other neuro-developmental disorders were raised. Various careful designed studies have been undertaken (particularly in Denmark, Finland, Sweden, the United Kingdom and the United States) to evaluate if there is any evidence for an association between MMR and thimero-sal-containing vaccines and neuro-developmental disorders, particularly autism. Recently, two major independent vaccine safety committees (the Immunization Safety Review Committee of the Institute of Medicine, US National Academy of Sciences and the Global Advisory Committee on Vaccine Safety) examined the hypotheses. The main conclusions of the committees are as follows the evidence favors rejection of a causal relationship between MMR vaccine and autism as well as a causal relationship between thimerosal-containing vaccines and neuro-developmental disorders...

An Autism Cocktail

Add a liberal dose of autism, a pinch of Asperger Syndrome, a generous helping of AD HD and a dash of sensory and motor problems to an already frantic family and one may be excused for thinking that it would be a recipe for disaster In fact the situation is quite the opposite .it produces a taste of diversity, a zest for knowledge and a yearning for understanding. Many people object to the use of a spectrum as an analogy to define the many variations of autism. It is considered to be too two dimensional. Too flat. Whilst many people prefer to speak of the autistic landscape or continuum, I personally believe that no terminology can be fully accurate in describing the complexities of autism and related differences and I like to think of a kaleidoscope of colour, so the term 'spectrum' suits me. I love kaleidoscopes and the way a different picture is made with each twist. As the sun shines through my bevelled windows, a myriad of different hues and colours are thrown around the room and...

Autism nightmares

It is crucial that all parents and professionals recognize that autistic children think differently, feel differently and react differently to typically developing children. It is imperative that we teach their siblings this and that we are confident that others understand just how impor tant safety issues are - particularly for autistic children who often react differently to pain or cannot tell us they are in distress. Our educational psychologist, Julia Leach, talks of looking at the world through 'autism lenses' (Cumine, Leach and Stevenson 1998), asking Where could they hide How could they escape What could they use to stand on in order to reach doors with high locks What could do them harm if they tried to eat it or put it in their mouths For non verbal children there is also the issue of what would happen if they did manage to get out. One idea is to get the child used to wearing an SOS talisman with contact details. (OK, easier said than done I know ) I may seem paranoid, but...

Sensory Integration Dysfunction

Whilst apparently so different, both Joe and Ben have sensory issues that cause major problems in their everyday life. Forty years ago, Dr A. Jean Ayres, OTR, pioneered work which highlighted SID as a neurological disorder. Dr Ayres sought to explain the relationship between behaviour and the function of the brain and found SID to be a very real problem for many children (and adults). Again, there are differing views as to whether SID is a separate disorder or another part of the rich and colourful autistic spectrum. Personally I believe that most children with autism have sensory issues to some degree, but what sets them apart from children with only sensory issues is that the triad of impairments (see Chapter 4) and rigidity of thought is evident in every situation and not just those where they experience sensory overload.

Language and communication

The impairment in communication in a person with autism can differ in its level of severity. One autistic person may never speak at all whilst another may use language well. Some children bombard people with questions or talk constantly some children have echolalia, merely repeating back what they have heard. Many autistic children simply Although Ben speaks at a very immature level with many sound systems not yet in place, and although he didn't speak at all till he was nearing five years old, a recent assessment by a speech and language therapist stated that Ben has no evidence of a language disorder . He has recently begun to speak about himself in the first person, does not confuse his pronouns too often now, and is generally progressing amazingly in both his receptive and expressive language. Nevertheless, even if Ben no longer fits the criteria for a language disorder, he certainly has an impairment in communication. To live with a child who is so literal that almost every...

Repetitive behaviours

Many children with autism engage in some kind of self-stimulatory behaviours. Some children flap their arms or their hands, some spin things in front of their eyes, some flick their fingers .some don't do anything at all. Ben flaps his hands and spins (boy, does he spin) at home and flicks his fingers in front of his eyes. However he now does such things mainly at home, though when he is out he flicks his fingers when stressed. For me, the finger flicking when away from home is a useful indicator of Ben's stress levels and not something I need to stop. When talking about such behaviours in his book, Freaks, Geeks and Asperger Syndrome, Luke writes 'I try to find a balance between making an effort to mix with others without standing out too much, and accepting the inevitable - that I am always going to seem a little different'. Wise words indeed and as parents we can learn much from his way of thinking.

Therapies and interventions

As a parent of children with special needs, I know far too well how it feels to bombarded with information about 'treatments', therapies and interventions for our children. I also know that our job as parents is to help our children reach their full potential whatever that may be, so each of us needs to research the various methods available and decide on what we think will suit both our child's needs and the family's. In my personal opinion, the difficulties of autism need a multi-pronged approach. To only focus on the biological without also viewing things from a behavioural angle, or to work only on behaviour without addressing environmental and sensory issues, is akin to dressing a septic ulcer by sticking on a plaster. Unless antibiotics are given to clear up the infection, the underlying cause discovered and addressed and the wound cleanly dressed, then all that will happen is other ulcers will appear elsewhere. Just as a number of triggers seem to blend together to produce the...

Further biological interventions

For Ben, Joe and Luke to get to the stage they are at now, I have researched and tried many forms of intervention, some of them biological. The Sunderland Protocol (Shattock and Whitely 2000) details a logical sequence of biological interventions, and many places, including the autism research unit in Sunderland and the Autism Research Centre in San Diego, continue to research the biological differences in autistic people, producing a growing amount of evidence that shows that autism is more than simply genetics. Other forms of biological intervention are as follows Removal of excito toxins - Aspartame (artificial sweetener) and monosodium glutamate (flavour enhancer) have been shown to have adverse effects on many people, not just those with autism. Anti fungal treatment - There is evidence that candida in the gut is linked with autism (see Useful Websites). Epsom salt baths - People with autism often have a sulphation problem (as a starting point for more information on this, see...

Parenting an ADHD child

When I listen to Luke drone on for hours on end about his current 'specialist subject' or I watch Ben spin around in circles, flicking his fingers in front of his eyes, I smile to myself on good days and other days I am crushed with feelings of despair as I worry how they will ever manage in the big wide world. One thing I do not do however, is blame myself. Even if it is not evident to those without knowledge, or in other settings when the children are running effective 'emulators', those of us who know my children can see autism quite clearly and I cannot see any way in which poor parenting skills could make children behave in such bizarre ways. Joe however, is another kettle of fish

Looking on the positive side

Joe seems to have a 'sixth sense' and can often tell me why Ben is behaving the way he is, and when Ben was non verbal, could explain to me why he was screaming. If I ask him how he knows things, he just shrugs and says that he does - these feelings need to be recognized and nurtured. If I could charge for hiring Joe out to parents of autistic children, I would make a fortune because he can get the most 'far away' child to engage with him.

Language and the ADHD child

All things need to be spelled out clearly to any child, but a child on the autistic spectrum needs things spelling out to them more than most. In a way they are like foreigners. (Jackson 2002) Luke wrote this in his book Freaks, Geeks and Asperger Syndrome and while he wrote the book primarily about Asperger Syndrome, he does live with Joe and is aware of his needs too. As he says, the need to speak clearly and precisely is important for all of our colourful kids. Much misunderstanding and frustration could be alleviated at school if teachers realized a child's problems in these areas and adjusted the way they spoke to the child accordingly. While children with autism are accepted to have problems with communication even if they have excellent spoken language, the speech and language problems of children with AD HD are often overlooked. According to the speech and language pathologist, Philippa Greathead (Speech-Language-Learning Centre, Westmead, NSW, Australia), the child or...

Behaviour Modification

It is widely known that children with autism are very visual but the same techniques are rarely applied to children with AD HD. Whilst Joe has excellent language skills (understatement ), like many children with an autistic spectrum 'difference', his auditory processing skills are very weak and he is a very visual learner. I have made schedules for Joe to follow and these make a vast difference to the stress levels in our life. When he comes in from school I merely hand him a marker pen (dangerous thing to do but it works) and he proceeds to work through I can only apologize again for the fact that I seem to be jumping from one topic to another but as I have said, that is exactly how life is here a hilarious, infuriating and chaotic blend of ages, abilities and personalities. I have so far written primarily about the two youngest boys and therefore about autism and AD HD, these being their predominant diagnoses. Whilst Joe and Ben certainly make the most noise and the most mess in the...

Calming the chaos tips for mealtimes

For those of you experiencing mealtime madness either because of your autistic children and their restrictions and rigidity, because ofthe For those of you with children like Ben who insist on the same routine every morning, use a story board with pictures and words and detail exactly how breakfast or another meal is to be carried out. Although picture schemes such as PECS, PCS and Social Stories (see Useful Websites) are primarily for our autistic children, they also give a quick reference for our non autistic children and help them to follow the routines that are so important. If your autistic children will only have certain bowls, cups, spoons, etc. then keep them in a separate cupboard and if at all possible, buy more than one set of everything. I have lost count of the number of times we have all had to ransack the house while Ben screamed hysterically for the right spoon Although in an ideal world we would all like to have the perfect family setting and all of our children...

Siblings of children with ADHD

Whilst many of the tips I have given for siblings in general and indeed, siblings with autism, may apply to families with a child with AD HD, children with AD HD have their own particular qualities that have an enormous impact on the rest of the family. In our house and I am sure in many others with an AD HD child, Joe is more often than not the aggravator. Like lighting a touch-fuse to a firework, Joe dashes around the house and amuses himself, sometimes by sneaking up to Luke and closing down one of the programmes he is working on then running off and waiting to be chased, sometimes by teaching Ben to do inappropriate things such as kick or bite someone and sometimes by poking at the girls or Matthew. In these scenarios he is often merely spoiling for a game of cat and mouse but I can fully understand how infuriating their noisy and mischievous little brother can be.

Teenage transformations

It is all too easy to fall into the trap of lumping my children into certain categories. The autistic ones and the teenagers. The boys and the girls. Nothing is ever so simple and nor would any of us want it to be. The different colour of each child's personality is reflected back in some way through the others and I am sure that our household, and indeed any other, would take on a different shade if a family member were removed. Each family has their own unique set of dynamics. In our family the children's personalities, different blends of hormones and different tints of autism all serve to give us our particular mix of multicoloured mayhem one is different and each hue of autism and adolescence results in a very different colour emerging. Matthew has now finished his A levels and is working through a difficult time in a need to find his way in life and search for a career. Rachel is well on the way to taking her A levels and will soon be knocking Matthew off his post as she begins...

A change is as good as a rest

If anyone has any ideas that a holiday away from home, familiarity and all that home life entails may actually mean a break from autism, then unfortunately my advice would be.don't bother However on the other hand you may also be pleasantly surprised. Whilst we were in Florida, Ben ate rice (a definite no in his usual fussy diet), tolerated a different yellow dummy, albeit for only ten minutes, to his usual special one, wore a pair of shorts even in the villa and hardly licked anyone or anything all the time we were away. Luke coped admirably with all aspects of the holiday and thoroughly enjoyed it and Joe delighted in having space and freedom to be as noisy and as speedy as he possibly could. Many autistic children behave very differently at school to the way they do at home or at grandparents' houses, so it may well be that they realize they are in a different environment when away on holiday and so accept change far more readily than usual. For those ofyou who are thinking of...

The Parents Survival Guide

If anything at all is going to be remembered from this book, I would like it to be this chapter. It is not at the end ofthe book because it is ofleast importance - it is here because I wanted you to remember this above all else If we as parents don't survive both mentally and physically, then our children lose their source oflove, support, encouragement and advocacy. Our children need us to be strong and well. Whether you are parenting a young child or a teenager, whether you have a large multicoloured family like my own or one or two children, whether you have children without any 'added extras' or are parenting a child with autism, AD HD, dyspraxia, dyslexia, AS or any shade in between one thing that is absolutely certain is that mentally, emotionally and physically, it is often an exhausting task and any tips that can make life that bit easier are gems to be treasured.

A time for everything

If you are reading this and are at this stage, indeed if you are at the unfortunate stage of realizing that your child is on the autistic spectrum but have not yet been listened to by kind to yourself. One day that knot in the pit of your stomach will start to loosen and you will feel able to eat again, one day that unseen hand that has a vice-like grip on your heart will let go and the sadness will be replaced by relief that you can finally move forward and start to work with your child in order to help him or her and the rest of the family to live happy and fulfilling lives. Take time to grieve and cry for lost dreams, hopes and aspirations. Take time to rant and shout at the injustice of it all. However it is imperative to remember that it is our aspirations for our children that will not be realized, our expectations that we have to change and our hopes that have been shattered. Accept this grieving as natural and inevitable and indeed, indulge in it occasionally...

Conclusion to the Chaos

The experiences of parenting a severely autistic child who smears poo, harms him- or herself and is unhappy with the world cannot be equated with the experiences of parenting a 'high functioning' child. Moreover the cocktail of difficulties that an impulsive AD HD child presents makes the parenting and caring experience very different to that of parenting a rule-bound AS child. Nevertheless one thing that all parents, carers and professionals dealing with any child on the autistic spectrum have in common, is recognizing that each child brings his or her own kaleidoscope ofcolour to enrich, and sometimes distort, the family dynamics.

Diet and biological intervention

The Feingold diet for the USA and worldwide. http Allergy-induced autism website with useful links and forum. The website of the Autism Research Unit containing the Sunderland Protocol A logical sequencing of biomedical interventions. http ari The Autistic Research Institute in San Diego. Information about recent research into autism. Organizers of DAN (Defeat Autism Now) conferences.

Holidays Coping with Change 183

Autism nightmares 205 A tribute to Emma-Jane 207 AD HD hazards 211 Anxieties of Asperger Syndrome 213 Dangers of dyspraxia 217 Safety suggestions 220 DSM-IV 315.4 - Diagnostic criteria for Developmental Coordination Disorder (Dyspraxia) 239 DSM-IV 299.00 - Diagnostic criteria for Autistic Disorder 239 DSM-IV and DSM-IV 315.00 - Diagnostic criteria for Reading Disorder (Dyslexia) 241 DSM-IV 299.80 -Diagnostic criteria for Asperger's Disorder 241 Gillbergs criteria for Asperger's Disorder 242

Gluten and caseinfree diet Opiod excess theory

Whilst I love my boys and their differences dearly, I would give the world to ensure they are healthy and happy. For them, that meant eradicating their bowel problems. Many children on the autistic spectrum have bowel problems - not all, but many. Indeed there seems to be a growing number of autistic children who have a combination of autism, food intolerances and bowel disorders. As I have already written in Joe's story, Joe had horrendous and seemingly inexplicable diarrhoea. Luke had always suffered from a lesser degree of diarrhoea, stomach pains and bloatedness and always looked ill, having a white face and black rings around his eyes. Ben on the other hand suffered from dreadful constipation necessitating an outreach nurse to visit weekly and administer enemas. Over the years, he has been given every laxative available, had anal stretches, torn his back passage and generally had a life of torment, so severe was the constipation. Watching them suffer in this way has been heart...

Applied Behavioural Analysis ABA Lovaas Institute for Early Intervention

Are you left scratching your head and wondering where (or if) to start now This list of therapies and interventions merely skims the surface of the amount of approaches for parents to think about when searching for ways in which to best help their child. All I can say is to research fully, listen to other parents, and if possible watch the approach and the child. As a parent you need to find an approach that fits in with the needs of your autistic child, your family belief system and your family life as a whole and there is no reason why a package of approaches cannot be used in order to best suit your child. Much evidence suggests that early intervention in autism gives rise to a much better overall quality of life for the child (and therefore the family). If as a parent, you are still on the diagnosis treadmill, then you can still get onto the internet or into the library and find ways to help your child whilst you are waiting for an official diagnosis. Good luck

Holidays Coping with Change

Whether they are teenagers or toddlers, as I have already written, one common perception about autism is that autistic people do not like change. In some ways this is most definitely the case, although personally I don't think it is quite that simple - is anything to do with autism simple Ben has, for a long time, insisted on the same yellow cup, the same yellow spoon, the same bowl, the same bedtime routine.Mr Rigidity himself. If I am silly enough to do something more than once with him in the same way, then I have inadvertently imposed a routine on him (and the rest of us) never to be broken .until he decides otherwise. At four years old Ben, though non verbal, would insist that every ornament be in the same place yet didn't seem bothered one iota whether I had moved tables, chairs and sofas around. Now he has changed. The ornaments are commented on (with words now) but not worried about, yet any change of furniture would cause a spinning, flapping panic. For some reason known only...

A tribute to Emma Jane

I would like to say a big thank you to my lovely, brave friend Sam, who has given me permission to write about what happened to Emma-Jane in the hope that it will make everyone who works with, and cares for, an autistic child be that extra bit vigilant in their watch over him or her. As Sam, Emma-Jane's mum, underwent the early difficulties of gaining a diagnosis that so many of us parents are familiar with, she fought on in her indomitable way. Fairly early on in Emma-Jane's life, she was diagnosed with a rare genetic disorder, a ring 8 chromosome, that manifested itself as severe autism. Meanwhile, Ben and I had been going through our own diagnostic process, the result of which you have already read about. Sam and I went everywhere together with our two little blond cherubs in tow. The children attended various therapies together, went to nursery groups together - in fact they were like twins in many ways, or opposite sides of the same coin. So different yet so alike, Ben and...

Language difficulties and siblings

Children can relate to how bizarre these conversations can seem to the outsider. I am sure those of you with children of any colour of the autistic spectrum will sit and smile (or groan ) as you remember similar conversations occurring in your own family. Whilst these conversations can seem hilarious to those of us who know something of how our children think and feel, they can also highlight the fact that when such conversations occur at school or other places, it is all too easy for our colourful children to be misinterpreted or bullied because oftheir differences.

Meet the Jackoons

Have adolescents, pre-adolescents and many shades of the autistic spectrum all under one roof, then life can certainly be .colourful I have seven children, all very special, all very much loved and all very different - seven different colours of the rainbow. There are four boys and three girls the boys all being various colours of the autistic spectrum. In our house we have dyslexia, dyspraxia, Asperger Syndrome (AS), Attention Deficit, Hyperactivity Disorder (AD HD), Sensory Integration Dysfunction (SID) and autism to add that extra 'oomph' to an already manic family. Next, meet Luke (if you have not already done so). Luke is fourteen years old and has Asperger Syndrome and dyspraxia. He has written two books now and is well on the way to finishing his third. His second book, Freaks, Geeks and Asperger Syndrome, tells of Luke's perspective on life, Asperger Syndrome and the difficulties of adolescence. Luke's main passion is computers. Over his life Luke has had 'obsessions' that...


Many children on the autistic spectrum also have dyslexia. Dyslexia comes from the Greek meaning 'difficulty with words' and is a difference in the brain area that deals with language. Again, like dyspraxia, there is no 'only' about dyslexia - it pervades many areas of life. Interestingly, dyslexia and dyspraxia often go hand in hand and many difficulties that are present in one are also present in the other. As with a dyspraxia child, a dyslexic child may be clumsy, often tripping, have problems with tying shoe laces and ties. Overlaps are evident in so many of these 'disorders' that it really is impossible to fit each child neatly into little boxes and although that is exactly how it should be, no two people being the same, this causes problems for professionals, parents and children alike. One thing we all need to learn is that although a label is needed as a signpost in order to gain help for our unique children, they often have threads of many different parts of the colourful...

A few more colours

As I have illustrated, Joe seems to fit the criteria for many other 'conditions' though I prefer to think of Joe as having an autistic spectrum 'difference' with a predominant label of AD HD - Joe is simply (well maybe it's not so simple ) Joe. I have written briefly how added extras such as dyspraxia, dyslexia and sensory issues affect us as a household, just as I have written about autism, AD HD and Asperger Syndrome in later chapters. Other colours of the autistic spectrum and labels which our children often acquire, either separately or along with autism, are listed below

Social interaction

When Ben was younger and before the many interventions and therapies we embarked on in a bid to reach him, it was very obvious that he had difficulties in social situations .he just didn't interact at all. In his own world he laughed and flapped and flicked and lined things up and people were merely objects to be used to gain access to his needs or wants. Now autism is much harder to spot in Ben - in fact I am sure there are those who would dispute the diagnosis (or maybe I am fooling myself). Ben wants desperately to interact with people. He chats to everyone he meets, follows strangers around asking them the familiar questions (what is their name and what is their website called ) but yet his interaction is certainly not like other children. Lorna Wing (Wing and Gould 1979) noted that autistic children fell into certain categories 'aloof', 'passive' or 'active but odd'. Ben is most definitely the 'active but odd' autistic child. Ben now wants to interact with people but to do so he...

The story ofLuke

He was eventually referred to what was then called the Autistic Research Team and underwent another onslaught of assessments and observations. There was much discussion with the school and me and eventually, after having been passed from pillar to post for what seemed to me like an eternity, he was diagnosed by a paediatric neurologist as having Asperger Syndrome. I was relieved. I had always known that Luke was different from the minute he was born and now I knew why. I thought at that time that the search was finally over. Little did I know that this was only the beginning of another journey

Theory of mind

Rita Jordan (1999) stated that 'it is not just that children with autism do not understand what others are thinking and feeling but that they do not understand that they are thinking and feeling' (cited by Cumine, Leach and Stevenson 2000) - they are not capable of putting themselves in someone else's shoes or even of realizing that other people are wearing shoes (This saying would cause my boys to don my shoes and prove me wrong.) This lack of'theory of mind' in autistic children seems to impact many areas of their lives - indeed it impacts many areas of their parents', carers' and teachers' lives too One ofthe ways it affects Luke


Whilst the above scenario seems amusing, can you imagine the trouble a child would get into if the conversation were carried out with a teacher rather than a parent Undoubtedly there are some teachers who may indeed understand an autistic child's way of thinking, however I am certain that there are far more who don't and would be forgiven for thinking that a child was merely being cheeky. All parents with an autistic child at any place on the spectrum know far too well the difficulties that arise when trying to find appropriate education for our children. To be fair, most professionals working with children on the autistic spectrum know how hard these children are to place. The nature of autism is that the children have an uneven profile and so whilst a child may have limited communication they may not have learning difficulties at all or may indeed have problems in one area but be way above average in another. Autism is pervasive and school is one place that causes stress for the...


The TEACCH approach was first developed in North Carolina in 1966. On reading more about TEACCH, many parents realize that they inadvertently adopt the same kind of methods without realizing it. How many of us have set up a working area for our autistic child How many of us use schedules, pictures and social stories to enable our children to make sense of their environment The TEACCH approach aims to help children make sense of their environment thus ameliorating stress and fear rather than addressing autism directly. The structured teaching approach starts on the premise that autistic children access the world mainly in a visual way and also that structure and predictability is vital. The physical environment is structured both at home and at school and the child is told in visual form (pictures, words etc.) exactly what to expect next.


Joe's diagnosis is predominantly severe AD HD but underlying the blindingly obvious AD HD runs a subtle blend of different shades of autism, SID, dyspraxia and tics. Given the fact that autism plays a large part in making Joe the delightful little chap he is, one area that creates confusion is the misconception that autistic people are unable to tell lies. I have thought long and hard about why Joe is so literal, has such difficulties understanding facial expressions, body language and receptive language but yet has the imagination worthy of a commendation by Walt Disney Having lived with Joe and his 'lies' for so many years, I have come to the conclusion that this ability to tell the most amazingly far-fetched and believable stories, is yet another one ofthe triad ofimpairments in clever disguise. 'Impaired' is maybe the wrong word for the way Joe can expand on the truth, invent full scenarios from just one word or action and omit aspects of a story in order for it to have a...

Awaiting a diagnosis

How often have you heard Well they all do that or He looks fine to me Most parents of AS children already have a pretty good idea that something is different about their child so to be 'reassured' can be infuriating. Whilst many children do have their funny little ways and many children may indeed have characteristics of autism but not enough to impair them sufficiently to warrant a diagnosis, there are also numerous children who could benefit from support in school and understanding from family and friends, yet are not receiving such help because of a lack of diagnosis. Children with autism rather than AS can usually be spotted by professionals and diagnosed far earlier than those with AS. Because children with AS meet their milestones at the expected age, it is often only as they begin nursery or school that their difficulties become apparent to anyone other than their parents. If you are a parent reading this and your child has already been diagnosed with Asperger Syndrome, you...

Life with Luke

After Luke was diagnosed, I felt relieved that at last I had a name for the collection of differences that made Luke so special but yet so unusual. However .although I knew what was different about Luke, although it had been given a name, I have to say that I still didn't quite take it on board. I read up on AS, I talked to the school about how best they could help him, I liaised with the autism team and tried hard not to overload Luke with sensory experiences and unpredictability. With others however, a stony silence hung in the air as Luke talked and behaved in his odd ways. How could there be anything wrong with Luke After all, he looked fine Surely he was merely a bit eccentric - a little odd .and so I bowed down to pressure and kept quiet, never mentioning the dreaded 'A' word in front of my husband and family. I had Anna, a delightful and placid little baby by then, and soon after, Joe was born. So Luke, I suspect, muddled his way through life as I tried to perform an amazing...

Treasured memories

Most families have special events and family gatherings which they can look back on and talk about, smile about and even cringe over in years to come. When children in the family have a special need, particularly one as unpredictable as autism, then there seem to be far more of these occasions to remember - all of them with hilarity (and maybe some embarrassment ). Whilst trips down memory lane for other children mainly consist of fond memories of days out with their parents, particular treats and fun times, my elder children regularly sit and reminisce over the boys' antics and laugh hysterically as they remember past events. The boys and their differences add a special depth to the family, give the girls a rare understanding of others and create a wealth of hilarious memories for us all to cherish forever. If you ask my children to recall Christmas, they will be quite matter of fact about the way Ben has to be introduced slowly to the idea. Whilst one room is full of sacks of...

Large families

If you are one of these people who, like me, automatically answers when someone shouts Mum regardless of where you are or who is with you, if you have to count your children when you are out, or you go through a few names before you hit on the right one then undoubtedly you have mayhem in your house too As parents ofmore than one child, the difficulties we face and the fun we have will differ from those with only one or maybe even two children, and the presence of any shade of adolescence, autism, AD HD and AS can sometimes be entertaining When reading snippets in magazines (OK so it is only when I am sitting in a doctors', or hospital waiting room ) or on the internet about large families, most say that what they cherish about having a large family is that the younger children learn from the older ones and they all become self-sufficient far earlier in life. It seems that unless my parenting skills are seriously defunct then autism has stamped its hobnail boots over this theory too...

Food for thought

Any kind of writing on family life would not be complete without mentioning mealtimes. In mine and maybe all other large families, mealtimes, and indeed anything relating to food, seem to be one area that causes even the most placid ofchildren to sharpen their claws and fight. Maybe in a large family it really is seen as survival of the fittest. Regardless of the size of the family however, the presence of autism, AD HD or any related difference can cause an explosion of colour that is blinding

And now time to eat

Many of us have images, either from our past or from the television, of family dinners. All the children sit around a table, behaving impeccably, not an argument to be heard. Mother smiles sweetly as she serves delicious looking meals to her grateful children and all sit down to eat and exchange family your dreams If any of you with autistic children or even with more than one child experience anything remotely resembling this then I really must hear of your secret Mealtimes are one area where autism really does equal mayhem. Most of us with children anywhere on the autistic spectrum are painfully aware of how potentially explosive any mealtime can be. Autistic children often self-restrict their foods, are extremely particular about the presentation of the food, dislike certain temperatures, colours, textures and smells, loathe their foods touching in fact mealtimes and autism really are a recipe for disaster The rigidity of an autistic child can turn a supposedly pleasurable...

Eating disorders

In addition, more and more research is producing both qualitative and quantative evidence to indicate that there is a link between eating disorders and autism, and although the research is by no means conclusive, I for one am not taking any chances and do all I can to ensure my children's mental and physical well-being. Teenagers in particular need their self-confidence boosting frequently and I make sure, as much as I can (a virtually impossible task ), that the boys know that any personal comments about the girls' appearance should aim to be positive and the girls know that any comments made by the boys are not meant to be derogatory. I quietly watch for any warning signs and talk clearly and honestly about the dangers of taking exercise, dieting or anything else to excess. I also make sure they understand that 'different is cool' and the variety of shapes and sizes, colours and differences all serve to make the world a much richer and fuller place in which to live.

Sibling Situations

Any parent is well aware of the fact that as soon as that tiny bundle enters into your family, you automatically take on the role of nurse, teacher, counsellor, cleaner, chauffeur .the list is endless. Whilst I accept and even enjoy most of these roles (well maybe enjoy is not quite the right word, especially when it comes to the cleaning role ), one I would give up instantly is that of .referee Whilst I have just written about family fun, an aspect of family life that certainly is not fun is that in a household with more than one child, friction will undoubtedly occur - and when there is the added presence of any shade of the autistic spectrum then corners tend to be chipped off each family member in rather painful chunks I have already apologized earlier for the fact that this book is a hotchpotch of children, ages, abilities and 'disorders'. That's my family I am sure many of you reading this have your own combination of age, ability and difference and there is nothing surer than...

On the positive side

Furthermore, the presence of autism in the family has taught the girls to accept that things are not always as black and white as they first seem. If they see a child having a tantrum in a shop or if someone at Where oh where did those years go The memories of their baby and childhood years are as clear in my mind as if they were only yesterday yet no longer are the arguments about whether or not they have washed or changed their clothes, but whether or not they have 'borrowed' my clothes, make-up and toiletries. Even without any added extras the girls have their own difficulties to negotiate in their path to adulthood and life with 'typically developing' teenagers is just as hard, (sometimes more so) as life with teenagers on the autistic spectrum. In my household, as you have seen, I have a combination ofrather unusual characters with very different personalities and so have to help Luke and Matthew as they negotiate their pathway to adulthood. Dyslexia is making it harder for...

Avoiding conflict

I am asked so many times ifmy girls help me with the little boys or the housework - in short.the answer is no I can ask one or other of them to put Ben to bed or try to calm Joe down and they do occasionally try, but teenagers are naturally self-absorbed. Each one of them has his or her own personality, worries and difficulties to attend to. Whether it is a spot on their nose, a fall out with a boyfriend or school pal, or just a hormonal mood, the girls and the boys seldom mix. In a large house and with so many sorts of autism and personalities, my job is that of a mediator, a negotiator, a referee .call it what you like but I am sure all of you parents of more than one child know all too well how hard it is to balance so many differing needs.

Setting boundaries

With so many teenagers at different stages on their pathway to adulthood and such a colourful mix of autism scattered around the house, it is particularly hard for me to set boundaries and stick to them. In a large family there is always the ever familiar cry of How come they can do that and I can't and it is particularly hard for the boys to understand that one set of rules doesn't apply to all. However, I do try to be consistent, and the only real problems we have in our home revolve around everyone doing their fair share (they don't ) ofchores. Though I can't say that I am always successful in setting boundaries for my technicoloured family, rebellion is not a major problem so here are some tips that work for us.

Put Safety First

Whether on holiday or at home, for any parent or carer of children of any age, safety issues are of the utmost importance. Whether we worry about our teenagers engaging in risk-taking, the lack of forethought in our AD HD children, the lack of awareness in our autistic children or the clumsiness of our dyspraxic children, nothing is surer than the fact that as parents .we worry I feel that I would be neglecting my duty to other parents and children if I didn't write separately about safety issues, particularly for children with autism, AD HD, AS and dyspraxia. By illustrating the difficulties and dangers using examples of traumas that my own children have experienced, I may be able to play some part in raising awareness of safety issues surrounding children anywhere on the autistic spectrum.

Safety suggestions

Whilst all these examples make chilling reading and show exactly what can happen to our children, the following general tips may help all those dealing with a child anywhere on the autistic spectrum and save you a few grey hairs Child proof your house. Don your autism, dyspraxia and AD HD glasses and take a fresh look around your house.

Count your blessings

Many parents take such incidences for granted. Indeed whilst all parents are joyful at their child's first smile, first step or first word, whilst most parents delight in each new antic their child performs, how much more do we parents of special needs children delight in their achievements Those of you with children with bowel problems will know the delight when they have a 'normal' bowel movement for the first time (strange how many times poo and autism are in the same sentence ), those of you with non verbal children will understand the euphoria when they make a sound or utter their first word, and those of you with children with AD HD will undoubtedly jump for joy

Sleeping sickness

Sleep problems seem to come in a variety of forms - problems getting to sleep, problems staying asleep - with so many shades of autism and such colourful children, I am lucky enough to have an exciting mixture ofboth My children are the world's worst sleepers and I have already written about the horrific incident that happened as a result of Luke trying to find a way to sleep. However what works for one child may not do for another and just because something hasn't worked at one time in a child's life, it does not mean that it never will. The secret is to try things periodically and find what works best for the family as a whole. Blackout curtains are a must for children on the autistic spectrum. Children on the autistic spectrum seem not to produce enough melatonin, the hormone produced in the pineal gland and the retina that regulates our bodies' capacity to recognize night and day. Therefore it needs to be dark before their bodies can shut down and sleep. Any annoying sounds in...

Survival skills

Whilst I endeavour to impart any wisdom I have gained over the years to parents, carers and professionals reading this, I may even attempt to practise what I preach My wonderful online friends are all parents of children with autism or a related condition and try their best to encourage me to take time out for myselfand to learn to relax. That is not something I am good at doing. In fact I find it impossible. Personally I need to be doing a dozen jobs at once otherwise I get bored. Everyone is different so the secret is to find what works for you and embrace it. It is, however, imperative that each one of us finds our own survival techniques in order to ensure that not only are we happy and healthy parents, but we are also happy and healthy people in our own right. In my humble opinion, surviving and enjoying life as a parent is all about prioritizing. As parents ofchildren with autism, AS, AD HD or any other special needs, our priorities need to be slightly different from those...

Recommended Reading

Cumine,V., Leach, J. and Stevenson, G. (1998) Asperger Syndrome A Practical Guide for Teachers. London David Fulton Publishers. Cumine,V., Leach, J. and Stevenson, G. (2000) Autism in the Early Years A Practical Guide. London David Fulton Publishers. Dowty, T. and Cowlishaw, K. (2001) Home Educating Our Autistic Spectrum Children Paths are Made by Walking. London Jessica Kingsley Publishers. Jackson, L. (2001) A User Guide to the GF CF diet for Autism, Asperger Syndrome and AD HD. London Jessica Kingsley Publishers. Jackson, L. (2002) Freaks, Geeks and Asperger Syndrome A User Guide to Adolescence. London Jessica Kingsley Publishers. Le Breton, M. (2001) Diet Intervention and Autism Implementing the Gluten Free and Casein Free Diet for Autistic Children and Adults A Practical Guide for Parents. London Jessica Kingsley Publishers.

Multicoloured Mayhem

Parenting the Many Shades of Adolescents and Children with Autism, Asperger Syndrome and AD HI) Freaks, Geeks and Asperger Syndrome A User Guide to Adolescence A User Guide to the GF CF Diet for Autism, Asperger Syndrome and AD HD Asperger Syndrome in Adolescence Reweaving the Autistic Tapestry Autism, Asperger Syndrome and ADHD Lisa Blakemore-Brown ISBN 1 85302 748 0 Diet Intervention and Autism for Autistic Children and Adults A Practical Guide for Parents Foreword by Rosemary Kessick, Allergy Induced Autism ISBN 1 85302 935 1 Parenting the many shades of adolescents and children with autism, Asperger Syndrome and AD HD Extract reproduced with permission from A Guide to Asperger Syndrome by Christopher Gillberg, Copyright 2002 Cambridge University Press. Multicoloured mayhem parenting the many shades of adolescents and children with autism, Asperger syndrome, and AD HD Jacqui Jackson.-- 1st American pbk. ed. p. cm. 1. Autistic children--Care. 2. Autistic children--Family...

Dangers of dyspraxia

Many of you parents reading this will have dyspraxic children, even if dyspraxia is an 'added extra' amidst other shades of autism. You will know all too well how many cups of coffee have been knocked over by your child, how many plates have been smashed and how many bumps and bruises you have nursed over the years. I am no different. Parents or carers ofchildren with dyspraxia should be given automatic passes to the emergency room at the local hospital

Routine and change

Most writings on autism state that autistic people do not like change and need routine. Whilst this may be true in most cases, there are always exceptions. In fact a friend ofmine has an undoubtedly autistic son who certainly doesn't seem to show any noticeable difference in his behaviour regardless of where he is taken, how his routine is disrupted or how his environment changes. However he is non verbal and most definitely has the triad of impairments. As I have stated so many times, autism presents as uniquely in each individual as their own particular fingerprint.


Over the years, dyspraxia has been given several names. Clumsy child syndrome, developmental coordination disorder, minimal cerebral dysfunction .call it what you will, dyspraxia is a very real problem to many people, children and adults alike. Dyspraxia or developmental coordination disorder is likely to affect many people with autism. It is debatable as to whether dyspraxia is an autistic spectrum disorder in itselfor whether it is a co-morbid condition that accompanies another

Sense of self

One area that is particularly problematic for Ben and I am sure many other autistic children, is his sense of self. For many years, I, Portage (the pre-school home education service) and anyone else working with Ben, spent a great deal of time and effort attempting to teach him that he was Ben. When I realized that Ben was not deaf, I very much wanted him to turn to his name or to know that he was the Ben that I was talking to and talking about. Every single day without any exception at all for at least thirty-six months I spent some time each day saying, Where is Ben - There he is and touching his chest. This actually proved more difficult than I first thought because if I pointed to Ben's chest and said There he is, he eventually learned to repeat my actions .fully believing that his chest and indeed everyone else's chest was this Ben that everyone was so keen to talk about I therefore tried with photographs of all the family, pointing out Ben. However he only noticed some tiny...

Different is cool

Whilst I have written deliberately about AS from my perspective and what it is like living with Luke, one thing he makes perfectly clear throughout his book is the fact that he doesn't see Asperger Syndrome as a disorder. His motto is 'different is cool' and although he says that when things get tough, he sometimes has to use that as his mantra and repeat it over and over to himself in a bid to convince himself of its accuracy, all in all he wouldn't change the way he is one iota not many of us could say that The various shades of autism touch Luke's world with splashes of colour, making him see many aspects of life in a way that enriches and lights up, not only his world, but that of those around him. In a chaotic, fast moving and multicoloured family, Luke still ambles on through life, unperturbed by the chaos and noise around him, still taking time to process life in his own unique way and stopping to see the beauty that often passes us by amidst the rush of life. Luke is convinced...

An unseen guest

I have heard all too often that children with autism are not capable of lying. Joe's blurring of fact and fiction throws a slightly different angle on that idea, however all four of the boys are quite capable of lying about whether or not they have done something wrong. The difference between them and the girls is that the boys cannot work out how their lies will be received. Matthew often refuses to admit that he is the one who took the last bar of chocolate, even when he has been

The pace of scientific advance

Advances in genetics and in the neurosciences have already increased knowledge of the basic mechanisms of the brain and are beginning to uncover the neurobiological mechanisms involved in psychiatric disorder. Striking progress has been achieved in the understanding of Alzheimer's disease, for example, and there are indications that similar progress will follow in uncovering the causes of mood disorder, schizophrenia, and autism. Knowledge of genetics and the neurosciences is so extensive and the pace of change is so rapid that it is difficult to present a complete account within the limited space available in a textbook of clinical psychiatry. We have selected aspects of these sciences that seem, to us and the authors, to have contributed significantly to psychiatry or to be likely to do so before long.

Is There A Relation Between Executive Functioning And Theory Of Mind

Of course, this shared developmental timetable could be entirely coincidental. However, two other sources of evidence suggest that it might not be. First, individuals with autism are known to have profound deficits in ToM (Baron-Cohen, Tager-Flusberg, & Cohen, 2000). It turns out, however, that these individuals also have severe executive deficits (Russell, 1997), suggesting that these two abilities might be connected in some more substantive way. Second, brain imaging studies indicate that adjacent and or overlapping neural circuits are active when people carry out either EF tasks or ToM tasks (Kain & Perner, 2005). These additional links between EF and ToM are admittedly circumstantial. Nonetheless, they provide a rationale for a direct examination of whether the two constructs are fundamentally related.

Data analysis Clinical analysis

Structural MRI is most often used in clinical practice to exclude non-psychiatric causes for psychopathology. For example, it is routine in many centres to obtain an MRI examination in all first episodes of psychotic illness to exclude tumours, arteriovenous malformations, or other rare (but surgically treatable) causes of psychosis. Clinical examination of these cases may also sometimes reveal abnormalities such as hippocampal sclerosis or callosal agenesis which suggest that psychopathology has been determined by birth injury or abnormal development. In assessment of a patient with dementia, MRI may usefully demonstrate signs of vascular disease (such as infarcts or periventricular white matter changes), or a focal pattern of grey matter atrophy suggestive of Pick's disease (frontal cortex) or Huntington's disease (caudate nucleus and frontal cortex). All of these abnormalities may be detected simply by skilled visual examination of the data. However, clinical diagnosis of the...

Psychophysiological parameters

About 40 to 60 per cent of schizophrenic patients fail to show an electrodermal orienting response to simple sensory stimuli (e.g. sounds). This electrodermal non-response is not due to hospitalization or medication effects, but reflects a profound attentional disturbance. Electrodermal non-response in schizophrenia has a number of interesting clinical correlates. For instance, electrodermal non-response has been found to be related to poor premorbid adjustment, negative and or more severe schizophrenic symptoms (e.g. blunted affect), poor response to neuroleptics, CT scan abnormalities (e.g. increased ventricular brain ratios), and poor long-term social functioning. d1 Thus, even though electrodermal non-response is neither a sensitive (i.e. only a subgroup of schizophrenic patients exhibit the phenomenon) nor a specific (there are other conditions such as autism and schizotypical personality disorder in which the phenomenon occurs) marker of schizophrenia, it is a clinically...

Eyegaze Perception A Window Into Mental State Attribution

There is no doubt that encoding and following eye gaze are important social skills for both human and nonhuman primates. Nor is there any doubt that normal human adults often make mental state attributions about the eye-gaze patterns they detect when an agent directs his or her eyes to an object, adults infer that he or she is seeing the object (i.e., creating a mental representation that can be used for guiding future behavior, enriching knowledge, and so forth). For normal human adults, the behavioral description (eye gaze) and its mentalistic redescription (seeing) almost always go hand in hand. Moreover, during development, the covariance between the mentalistic and nonmentalistic levels (i.e., between the looking at and the alignment of gaze direction and attended object) may play a role in fostering the emergence of mental state attribution. That is, such covariance may help to bootstrap mental state attribution in typically developing human infants who are experience-ready. But...

Differential Diagnosis

Developmental or Behavioral Food Refusal. Children with developmental disabilities (including mental retardation and autistic spectrum disorder) may shut down feeding efforts as a behavioral response to their environment. Typically, developing children (especially around age 2 years and in summer) can also go on hunger strikes, but rarely will they cease all oral intake for more than a day if mealtime structure is maintained.

AM a Vasoactive Hormone

Numerous studies defining the circulating AM plasma concentration in different clinical settings showed an elevated AM plasma concentration in a variety of pathological conditions including essential hypertension, chronic heart failure, acute myocardial infarction, pulmonary hypertension, chronic renal failure, diabetes, hyperthyroidism, hyperparathyroidism, sepsis, schizophrenia, autism, bipolar affective disorders, surgical interventions, or during normal pregnancy. Because such a broad range of conditions are associated with elevated AM levels, it seems likely that increases in AM are not causative of disease but rather are compensatory to these pathological events. The results from transgenic mice overexpressing AM gene support the idea of a protective role for AM.

Communication metacommunication and language

The connections here between individual and social, thought and language, are many and complicated. For example, joint attention behaviour is arguably (one of) the earliest signs in the infant of the capacity for representing the other's mental states, this being in turn at the basis of acquiring the 'theory of mind', problems with which may be implicated in autism (Baron-Cohen 1991). It has been noted above and in the first chapter (Section 1.1.2) that selective attention is one aspect of consciousness. The capacity to say what rules one is following is another aspect of consciousness, linked to what we call self-consciousness, as noted in the first chapter (Section 1.3.2).

Regulation Of Dendritic Spine Morphology And Synaptic Function By Scaffolding Proteins

Glutamate receptors on central nervous system (CNS) synapses are directly or indirectly associated with various scaffold proteins, most of which are localized at the postsynaptic density (PSD). Although the function of a number of these proteins is still unknown, it is now generally accepted that some regulate dendritic spine morphology and synapse function. Scaffold proteins bind and recruit proteins that regulate actin cytoskeleton remodeling and signaling transduction, thus linking neurotransmitter receptor activation to intracellular cytoskeletal and signaling modifications. Interestingly, mutations of some of these scaffold proteins have been implicated in the manifestation of severe forms of mental retardation and autism, which suggests that they are fundamental elements for synapse and dendritic spine structure and function. The aim of this review is to summarize recent findings concerning the scaffold protein functions involved in regulating the morphology of dendritic spines...

Chapter References

Fombonne, E., Du Mazaubrun, C., Cans, C., and Grandjean, H. (1997). Autism and associated medical disorders in a French epidemiological survey. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1561-9. 43. Bolton, P.F. and Griffiths, P.D. (1997). Association of tuberous sclerosis of temporal lobes with autism and atypical autism. Lancet, 349, 392-5.

Affective Interpersonal Aspects of Antisociality

There is also growing interest in the neurobiology of attachment, which is clearly deficient in antisocial individuals, although to our knowledge, this line of research has not yet extended to antisociality. Animal studies have demonstrated the central role of two neuropeptides, vasopressin and oxytocin, in the attachment system (Panksepp, 1998 Insel, 1997). Based on these findings, a number of studies have investigated the role of oxytocin in autism, another psychiatric disorder characterized by attachment deficits (Green et al, 2001). Oxytocin and vasopressin, nine-amino acid peptides (nonapeptides) synthesized in the hypothalamus, differ only by 2 amino acids. Receptors for both peptides are distributed throughout the limbic system and the brain stem. Both are part of a family of nonapeptides that date back to invertebrates. Earlier versions of nonapeptides have been associated

Psychological testing

Detailed assessment of intellectual ability requires special training and, with low-functioning or pervasively developmentally disordered children (e.g. autistic children), a good deal of special experience. A good psychological evaluation should include subtest performances on an IQ test like the Wechsler. (28) Measures of language, reading, and mathematical ability can be invaluable diagnostic tools, particularly when educational failure is a part of the clinical picture. It is important to remember, however, that the diagnosis of mental retardation is not simply based upon IQ scores, but also upon functional disability which must also be measured (for instance, with the Vineland Adaptive Behavior Scales(29)). The results of relatively 'general' tests such as these may be supplemented by the addition of more specific individual neuropsychological tests or reasonably well-normed test batteries. An excellent introduction to the topic of psychological testing in child and adolescent...

Primary prevention approaches can be subdivided

If the aim is to reduce the incidence of a condition, two broad approaches may be taken ( Fig., 2). A whole population may receive an intervention at an early age a universal approach. Alternatively, a subpopulation thought to be at particular risk for a condition may be targeted. This can be further subdivided into selective (when groups are the target of a prevention activity) or indicated (when a preventive measure is addressed to individuals). An example of a selective intervention is a programme of parent management training for lone teenage parents in socially disadvantaged areas, whereas genetic counselling for parents who have a single child with autism is an indicated intervention.

Development of diagnostic concepts

Autism was first recognized by Leo Kanner(3) in his classic report of children with 'autistic disturbances of affective contact'. Kanner noted that these children appeared to be unable to relate apparently from the beginning of life they also exhibited atypical language, unusual responses to the environment, and difficulties in dealing with change. He used Bleuler's earlier term 'autistic' to convey the children's social isolation. Although children with autism had undoubtedly previously been observed 4,) it was Kanner's particular genius to so precisely describe the condition. At the same time certain of his initial impressions were incorrect, for example his use of the term autism introduced an (originally) unintended confusion with schizophrenia and assumed that the children had normal intellectual potential. Subsequently, it became clear that autism and schizophrenia were distinct and that attribution of low IQ scores to 'poor testability' were incorrect. (5) While non-verbal...

Epidemiology and demographics

Over 20 epidemiological studies of autism have been conducted, with reported prevalence rates ranging from 0.7 per 10 000 to 21.1 per 10 000 with a median value of prevalence estimate of 4 to 5 per 10 000.(35) Several recent studies have reported somewhat higher rates of the condition, in the order of 1 per 1000 it remains unclear whether the condition has actually increased or whether the apparent increase relates to broader definitions of autism or other factors. Epidemiological studies have clarified that there is no association of autism with upper socioeconomic status. Early impressions of such associations were the result of referral bias. A number of studies, including both epidemiological and clinically referred samples, report higher rates of autism in boys than in girls (typically 3.5 1 or 4 1). This ratio varies with IQ level, i.e. females with autism who have IQs in the normal range are probably 50 times less common than males. (3.6) The explanation for this sex difference...

Aspergers syndrome Clinical features

This condition is characterized by impairments in social interaction and restricted interests and behaviours as seen in autism. However, the child's early development is marked by a lack of any clinically significant delay in spoken or receptive language, cognitive development, self-help skills, and curiosity about the environment. Consistent with Asperger's 3' original report all-absorbing and intense circumscribed interests as well motor clumsiness are typical, but are not required for diagnosis. The validity of this condition, apart from high-functioning autism and PDD not otherwise specified ( PDD-NOS) is controversial. Available research is difficult to interpret given the markedly different ways in which the diagnostic concept has been used. Differences are more likely to be noted relative to autism if a rather stringent diagnostic approach is used. Evidence for external validity of the condition relative to autism includes differences in neuropsychological profiles, patterns of...

Course and prognosis

Given the recency of official and consensual definitions there are few systematic follow-up studies. Asperger's original (13 impression was of a favourable long-term prognosis. Although he tempered this view somewhat over time, he continued to insist that the condition had a better outcome than autism. (Z4 Many individuals can attend regular school with some additional support unfortunately such children may be seen as eccentric and are often prime targets for being victimized. Better verbal skills can mislead educators about the child's vulnerability in other areas, and difficulties academically may be misattributed to wilful non-compliance. There is the impression that these individuals are capable of greater degrees of personal and occupational self-sufficiency than those with autism, but definitive data are lacking. It does appear that the social difficulties persist into adulthood.

Educational approaches

Children with autism and other PDDs generally require an intensive and highly structured intervention programme. More able children may be able to tolerate regular classroom situations, with appropriate support, but more impaired children often need higher levels of teacher supervision and a more intensive classroom setting. ( ) For lower-functioning children areas of priority include the ability to tolerate adult guidance and intrusion, to follow routines, to develop communicative abilities, and

Behavioural interventions

Behaviour modification techniques are helpful in increasing the frequency of desired behaviours while simultaneously diminishing problem behaviours. Typically, a functional analysis of the target behaviour is initially performed, and then a plan developed for prompting or decreasing the behaviour. (78) While there is general agreement that children with autism PDD profit from a behaviourally based intervention, there is more controversy over the degree to which progress can be made for instance, there have been some claims for dramatic improvement and even 'cures' of autism.

Clinical features Neurodevelopmental disorders

Developmental psychopathology considers child psychopathology from a developmental perspective by applying developmental concepts to neurodevelopmental disorders. Thus, the relationship of disordered to non-disordered behaviour is considered, as are the early origins of maladaptive behaviours that do not appear in clinical form until adulthood. Knowledge of normal development is utilized to study children whose development is atypical, in order to understand the natural history of their disorder. Conversely, investigation of such deviant behaviour is considered in regard to our understanding of normal development. For example, attention-deficit hyperactivity disorder has been investigated as a disorder of executive function, and autistic disorder as a disorder of social cognition and communication. In both instances, new knowledge about brain functions has been derived from these formulations. Among the neurodevelopmental disorders, the age of onset varies, multiple causes are...

More Bad Press For Mmr Vaccine

The safety of the MMR vaccination was brought into question in 1998 following a report by UK researchers suggesting a link with inflammatory bowel disease (IBD) and autism.691 2 Concerns over the MMR vaccine were raised again in 1999 following the publication of another study by the same researchers in April linking atypical viral infections in childhood with IBD in later life.757 2 However, one of the study researchers, Dr Scott Montgomery, later emphasised that this study did not show any link between IBD and MMR vaccine, because they did not study the vaccine. The media coverage of the study findings was criticised by the UK Department of Health. Furthermore, a panel investigating the study concluded that there was no evidence indicating a link between the MMR vaccine and IBD (or autism) so there is no reason to change the MMR vaccination policy. Results of another study conducted by Professor Brent Taylor and colleagues from the United Kingdom also indicated that there is no...

Good News For Vaccines

Concerns over a potential link between measles, mumps and rubella (MMR) virus vaccine and inflammatory bowel disease and autism were first raised in 1998, but were subsequently refuted by the UK Department of Health. In 2000, the potential links were refuted again by the American Academy of Pediatrics, by Britain's Medical Research Council,798 2 and by a study conducted by the US Centers for Disease Control and Prevention.823 3

Diagnosis and classification

There is controversy and lack of agreement regarding approaches to the classification and description of the phenomenology of psychopathology in young people with mental retardation. One approach is the application of DSM-IV(7) or the ICD-10(8) systems to the findings of a clinical assessment. The reliability and validity of this approach when applied to children with mental retardation has still to be fully established. Many of the diagnostic categories in these systems require information from the young person on their emotions and perceptions such as the experience of persistent intrusive and inappropriate thoughts that cause anxiety in obsessive-compulsive disorder, or the presence of delusions and hallucinations in schizophrenia. Some diagnoses require a judgement that the symptoms are inconsistent with the developmental level of the child as is the case for attention-deficit hyperactivity disorder ( ADHD).(7) These clinical judgements become increasingly difficult, if not...

Contributing factors and context

The cognitive subtest profile may also assist diagnosis and management. For example children with autism usually perform significantly better on performance tasks that involve visual motor skills such as remembering the visual pattern of how to turn on a video recorder. However, they perform relatively poorly on verbal and social comprehension tasks.(20) Attention to detail of the cognitive profile may also assist education and management. For example, a child might learn better if information is presented in a visual manner, or disturbed behaviour might settle when help is provided to improve fine motor skills.

Behavioural phenotypes

The fragile X syndrome is the most common genetic cause of mental retardation and is associated with some characteristic behavioural problems. Boys are usually shy, gaze avoidant, and anxious, and often have problems with attention, hyperactivity, and stereotypy such as hand-flapping. (3,34) Girls have similar problems to boys, but not usually as pronounced except that they may be more vulnerable to schizotypal disorder. (35 Fragile X is probably not a cause of autism, although about 5 to 10 per cent of males with fragile X also have autistic disorder. (36 Children with fragile X are usually able to form close attachments and are responsive to social cues in contrast to children with autism.(37)

Environmental influences

Apart from the range of potential adverse psychosocial experiences that children in the general community might experience, children with mental retardation are more likely to experience further potentially adverse experiences such as respite and institutional care, social rejection, teasing and school adjustment problems, abuse, and neglect. Limited cognitive ability to understand and discuss socially stressful experiences may compromise adaptation and contribute to behavioural disturbance. Parental grief, guilt, hostility, ambivalence, and rejection, increased financial burden of care, and family stresses are further factors likely to impair attachment, relationships, and the quality of the care environment. (52 Behavioural problems, impaired responsiveness and capacity for reciprocal social interactions, communication difficulties, and low resilience, particularly in some vulnerable groups of children with mental retardation such as those with autism, further impairs attachment and...

Specific psychopathological disorders in children with mental retardation Behavioural disorders Attentiondeficit

The diagnostic criteria in ICD-10 and DSM-IV are relatively straightforward to apply in children with mental retardation because they are based on observable behaviours such as distractability and fidgeting, rather than verbal reports of perceptions and emotions. However, diagnostic difficulty may be encountered in determining if the observed behaviour is 'inconsistent' with the developmental level of the child. (7) For example the attention span of a 9-year-old child with moderate mental retardation is likely to be similar to that of a 3-year-old child without mental retardation. According to DSM-IV the diagnosis of AdHd should not be made in a child with a pervasive developmental disorder. However, there is some research to indicate that a comorbid diagnosis of ADHD can be made in some children with autism and that, in these cases, there may be a therapeutic response to stimulant medication.(57) Symptoms of ADHD are required to be present in at least two settings such as at home and...

Pervasive developmental disorders

About 75 to 80 per cent of children with autism also have mental retardation and there is also an association with a number of medical conditions such as epilepsy, tuberous sclerosis, congenital rubella syndrome, and phenylketonuria. (20) Autism is associated with high levels of emotional and behavioural problems and burden of care. The DSM-IV and the equivalent ICD-10 diagnostic criteria for pervasive developmental disorders have assisted in providing an international consensus in diagnosis, although some diagnostic dilemmas still remain. The diagnosis of Asperger's disorder is excluded by the presence of mental retardation and delayed and deviant language development, yet there are some children with mental retardation who have non-deviant language development consistent with their developmental level who fulfil the specific social deficit and behavioural criteria for Asperger's disorder. Children with autism also frequently present with additional comorbid symptoms such as ADHD,...

Administrative prevalence of mental retardation in adulthood versus childhood

Although there is now a trend towards mainstreaming children with special needs, and providing extra support, separate special schools for children with moderate and for severe learning difficulties are still provided in many places. At school-leaving age many young people with mild or moderate learning difficulties (roughly equivalent to IQ over 50) will not receive special services only people who have severe mental retardation, and those with additional disabilities, including epilepsy, autism, mental illness, and or behavioural problems will be referred to adult specialist services. The administrative prevalence of adults with mental retardation is thus much lower in adulthood as it is a measure of those in contact with services, that is typically 3 to 4 per 1000 of the population. (2) The administrative prevalence rates should not be confused with true prevalence rates, which are far more difficult to assess.

Residential and vocational programmes for people with dual diagnosis

Staff find working with people with mental retardation and mental health problems stressful. Giving them skills in this area so that they can manage, with support, people with challenging behaviour and mental illness enables them to find this work more rewarding. The most basic and vital role of support staff in this context is the awareness that a person with mental retardation may suffer a mental illness, as we all may. They need to be aware of the range of therapeutic options that might be helpful, including environmental changes, behavioural strategies, psychotherapeutic techniques, drugs, and so on. A fuller knowledge and consideration of this topic will help to dispel myths and prejudices, for example that medication is to be avoided at all costs, or that its use signifies that staff have in some way failed the client. Specific knowledge about some disorders will provide insights into why and how interventions must be tailored around someone's strengths and needs, for example...

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