Autism: Testing, Therapies and Services
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Kylie Jackson : Autism is a development disorder that appears in the first three years of life and affects the brain's normal development of social and communication skills, and its on the rise. What are some of the signs that parents can look for at home, why is the diagnosis important and how can you get services. My name is Doctor Kylie Jackson and I'm a psychologist specializing in child and adolescent assessment, diagnosis and treatment, and this is Parent Savers, episode 35.
KC Wilt : Welcome to Parent Savers, broadcasting from the Birth Education Center of San Diego. I'm you're host, KC Wilt. Parent Savers is all about helping new parents from the baby years to the toddler years. We are so lucky to have amazing experts in our show, so shoot us an e-mail or call our hot-line and we'll get your questions answered. We also have a free app, a free newsletter, you can like us on Facebook, you can send us an e-mail, you can call our hot-line, there are so many ways to be a part of our show. Also, did you miss an episode that's been archived that you're interested in? Or you want to keep talking to the experts when the episode stops? We have a Parent Savers Club where you can download all the archived episodes, get exclusive content and so much more. So I'm a new parent myself, my son Carson just turned two, and I am joined here by two new parents, actually one parent in the studio and one on phone. So, Jody, why don't you go first, you're calling in.
Jody Roberts : OK, I'm Jody Roberts, I'm a schoolteacher and my 22 months-old is named Ted.
Carlen Corowsky : Hi, I'm Carlen Corowsky and I'm an elementary school special ad teacher, and I also have a 2 year-old daughter.
KC Wilt : Before we begin today's show, here Johner Riehl to tell us about some great apps for new parents.
Johner Riehl : Hey new parents! I'm Johner Riehl, founder of Familyfriendlyvideogames.com, I'm here to talk about helpful apps for new parents. Today I want to talk to you about Doodle buddy, which is a great free app for kids, that's a drawing app and it has stamps and it has a lot of different things. It is potentially the perfect app to hand to your child when you want to get a little of free time, whether its in a restaurant or somewhere else, just to keep them occupied for a little bit. What Doodle buddy has is: kids can easily change the colors of each of the drawings and the thickness, but there's also a really extensive selection of stamps, such as smiley faces, or cleaver leafs or kissing that each make a funny noise whenever the kids hit the string. So before you know it they'll have hundreds of little kissing faces on their screen as the app imitates the kissing sound. Doodle buddy is a great app and best of all it's free, you can find the link to download it on this week's episode page of ParentSavers.com, and make sure to listen to future episodes of Parent Savers for more great apps for new parents.
KC Wilt : Today on Parent Savers we have psychologist Dr. Kylie with us. This is our second part of our two part series about autism, so I'm excited to have a different perspective than the one we did last week. So, Dr. Kylie, what are some of the early signs of autism that parents should be aware of?
Kylie Jackson : Before I get started I just want to let parents know that there are a number of signs and symptoms, and not just hearing one symptom that I talked about indicates that your child may have autism, but having a series, a pattern of symptoms shows that kids may have an autism diagnosis. So the concerns can be: not babbling before the age of 1, so that could be a big concern. Things like not orienting to human voice, maybe showing more interest in objects and things rather than their parents or guardians or other people. Another huge concern is not really turning and looking when their parents call their name.
KC Wilt : Well, my son does that all the time but that's just him being mean.
Kylie Jackson : Yeah, that's why I said, it could be that, you know... But let's say he does it, like he never turns and look, or he is so focused on objects that he won't even look you when you walk into the room. Let's say that he's just not as interested, maybe even appears to be in his own world, and just seems to not kind of be interested socially, you know, and not looking at you, making eye contact. Just because a child may not have eye contact doesn't mean that their on the spectrum and it doesn't mean that their not. But it's one of those signs to kind of keep an eye out for.
KC Wilt : So if you notice those symptoms in your child, what's the next step? Where do you go from there?
Kylie Jackson : Well, in the US if you have a child from 1 to 3, the regional centers are a great resource, they develop and assess children from 1 to 3. If by chance your child's over, than you may want to contact your insurance and look for someone who specializes in autism assessment, who is a psychologist, and what you want to check for is someone who has a background in testing and using some of the important tools, like the Eidos, which is very reliable. It's a social sort of interview and an evaluation that looks that, really interviewing, getting a development history, and someone who sort of has that background in assessing and evaluating for autism spectrum disorders.
KC Wilt : Before we go further into that, what is the first step? Let's say you kind of think: “Well, he's not looking at me, should I be concerned, should I not be concerned?”, because I fell like in the first year I got friends and their kids don't babble, is that a speech problem? That kind of step, because I think parents are afraid for the label of autism, so, instead of jumping on these early detection signs, you just write it off or whatever. Or maybe they want to, you know, seek out more but they don't want to jump to the fact that it's autism. Who do you talk to? Just the little stuff, just asking. The pediatrician?
Kylie Jackson : A pediatrician is a good start, a lot of times a pediatrician will have screens, like the M-CHAT. The M-CHAT is something that parents can even Google on-line, and have access to that for free, sort of checklist that asks like, “Does your child enjoy bouncing on your knee?”, “Does he look at you in the eye”, “Does he enjoy bringing things and showing things to you”, it has a lot of these questions and it's a great just screen. That's a first start, sometimes just doing the screening measure. But I want parents to be aware because I have a lot of patients that come in, where their pediatricians are not as well educated in autism spectrum disorders and I hear them say, you know, “Why didn't my pediatrician tell me?”, and so there are some pediatricians that aren't as tuned to some of the symptoms and the parents bringing that up, and I always say, you know, trust your maternal instinct. If you see your child and you feel like they're very different from other kids, or you feel like something is just not right, you know there could be something. It doesn't hurt to go to a regional center, maybe call a psychologist, ask other friends, teachers are great resources of information. Just to kind of get an idea, it never hurts to pursue that. You know, ten years ago we had the wait and sea, even 15 years ago, it was more like let's wait and see what happens. A little bit of that's OK, but when it hits to that point where there's a lot of other concerns going on, your maternal instinct is saying “There's something not right!”. It doesn't hurt to have it investigated. We'll talk about early intervention because that's important.
KC Wilt : We talked about that in the last episode, the earlier you detect it, the better of for the child, but Jody, what where you going to say?
Jody Roberts : Don't be afraid of, you know, looking it out and finding someone to diagnose them, what does that exactly mean for your child to be considered autistic? For not only the child but the parents?
Kylie Jackson : Excellent question, I get that a lot, and that's why something I talk with parents a lot in the beginning stages is what are the pro's and con's of an early diagnosis? And I also educate parents that the autism spectrum is huge, it doesn't just mean a child is classically autistic and I think that's what a lot of us think, that child who's sitting in the corner, or hand flapping and not interested at all but now we know that there are kids who are very mild on the spectrum and just have more problems with rigidity and that social nuances, and what I say is that it's better to have the diagnosis, especially like in California right now, we have a lot that was been recently passed for these kids to start receiving early ABA treatment, or Applied Behavior Analysis, which is excellent treatment for kids on this spectrum; speech therapy and OT...
Jody Roberts : Right, so will they be able to improve socially, like for example during these programs?
Kylie Jackson : Absolutely, actually, I see kids who, you know, let's say ten years ago their parents paid 120,000 a year, or something crazy like that, to get these early services; you can see tremendous improvements in these kids and, I mean I have some kids that come in, you wouldn't even know that they were on this spectrum. There are some that I've seen that are in high-school, who had early interventions services, and you know, I don't like the term “cured”, but I like “recovery”. They really significantly improved their symptoms to where you would hardly even know they are on the spectrum. They have friends, they're doing well; they may just have some slight “sub-clinical” symptoms as I like to say. So yeah, the early intervention works. And it doesn't mean you have to tell everybody, you know. It may be that you just want to inform, but you know, you as parent have to know you're able to scaffold these skills early on in your child, like, OK, “Look me in the eye” before giving them juice, having them articulate that and look at you when they ask you. So some of these even small parent training tools can make a huge difference early on, to where the child won't even be noticed sometimes to be on the spectrum as they get older.
KC Wilt : And you said about this spectrum we've got, so not necessarily if your child's not looking at you in the eye but he's doing everything else normally, and you start to do one of those tests that you see on-line and you see that they actually go somewhere on this spectrum, this could be something like I've talked with you before, you've mentioned someone you've seen and they're just like you said, rigid, and so as a parent you just say “Oh, they just like to be ordered”, order to their life, like their routines, and so we could just ignore that but actually you're saying that could be a cause of a spectrum disorder, and getting help for it could help.
Kylie Jackson : Well, I've recently had a parent and I've seen a lot of these kids that are just very mildly on the spectrum and she brought him in because he had a lot of hard time transitioning between different tasks in the classroom with tantrum, had a huge tantrum reaction, but was very social. And so I did a full evaluation on the child and what I saw was is he has minor I would even say characteristics of this spectrum, but I did not diagnose him on the spectrum. I said that these are the things to be aware of, because I see a little bit of difficulty understanding how his actions impact other. And that's a mark of kids on this spectrum. But the main thing he has a problem with is this rigidity, so I said that he has a behavioral problem, and I want you to do these intervention techniques early on, you guys, to try reinforcing him for when he does this transition a little bit better to different tasks in the classroom. I want you to try just being aware of social nuances and really reinforcing him for playing appropriately with peers, and just kind of monitor him as he gets older. And I explained that doing these early even parent type skills are going to prevent this child from having problems later on.
KC Wilt : Well, is it possible that, let's say he's got this temper tantrum issue, can it get worse, will he then go on the spectrum eventually, or can autism increase as they get older?
Kylie Jackson : Well, yeah. For kids that are very mild, what we see is as they get into junior high and high-school, that's when social nuances become very complex, that's when kids picking up and bullying and noticing, you know, they fit in fine, when playing games on the playground, but when you put them in with high-schoolers and junior higher students and they're older and there's no longer that playground to hang out and understand how to interact in the group, all of these nuanced things, that's when sometimes mild kids start having more challenges. So if you know that they could have that tendency to go there, that's when you see girls in this spectrum get diagnosed, in junior high, 'cause they can be a little bit more mild than other kids, and so sometimes if you know early on and you're using lets say some Michel Garcia Winning social thinking type of curriculum with your kids, and you're helping them with transitioning and you're just being more aware during their play dates and say “Oh! You get along awesome with Johnny!”, you know, like I'm really proud of that, and you're kind of reinforcing a lot of these skills, you're going to prevent those problems later on and even prevent the diagnosis, versus these parents who say that they're going to grow out of it and then by the time junior high hits, they kept thinking they were going to grow out of it, and now their depressed because they don't have any friends, they don't know how to deepen relationships at their developmental age. So if you can think of an autism spectrum disorder it's more like their social and emotional maturity level is a little bit lower than other kids. So if you can kind of work on that a little bit more you can prevent that gap as they get older.
KC Wilt : Well, all I see is dollar signs so... when we come back we're going to talk about psychological evaluations and how they work, as well as ways to access these services. We'll be right back.
KC Wilt : Today on Parent Savers we have psychologist Dr. Kylie Jackson talking to us about autism. So, Dr. Kylie, what does a psychological evaluation involve and how do parents find a clinician who is qualified to assess this test?
Kylie Jackson : I worked for a few years at Kaiser's Autism Spectrum Disorder Center, we use sort of the gold standard of what autism spectrum evaluation should be. It usually includes a detailed parent interview looking at prenatal history, as well as birth and all the way up until their present age, doing an IQ evaluation – that's just to rule out and look at how their intellectual functioning is doing.
KC Wilt : Do kids with autism have higher or lower IQs?
Kylie Jackson : It actually depends, and that's very varied. I mean, it's a huge spectrum, it ranges from kids who are very impacted and may have some intellectual disability, may be lower functioning, to kids who are Asperger and may have like higher than normal IQ, like off the charts. But socially and emotionally they are a little bit more immature. So doing that IQ test helps us to see where they are intellectually, so that you know when interventions start how likely they are to pick things up, are they more of an auditory learner or more of a visual learner, that's important to know in the classroom as well as when you're teaching your child different skills.
KC Wilt : How does one find a clinician near them to do this? Because we've got people from all over listening.
Kylie Jackson : OK, so one thing would be – you could either call your insurance and ask for providers in the network who may have experience testing younger children with development delays or other syndromes in this spectrum diagnosis, or you could even sometimes do a Google search or go to the autism speaks network website, where they have a variety of different clinicians in different areas who may do autism specific assessments, so they can give a good recommendation as well. But I would say for parents to do their research, talk to other parents, call a local like parenting type place or do research on-line to find someone who really specializes in doing autism evaluations.
KC Wilt : Is this something that insurance can cover?
Kylie Jackson : Absolutely. Yeah, I would say almost all insurances will cover autism spectrum disorder evaluation, because it is a medical, a neurodevelopmental disorder, and getting early treatment really helps with the child through their lives.
Jody Roberts : Could it be too late for a child to receive a diagnosis?
Kylie Jackson : Excellent question! Right now I've been a part of a lot of autism research as well, and I'm actually starting to do some research on adult evaluation and assessment, so, the earlier the better, but it's never too late to get a diagnosis, like I said, in junior high and high-school students have been diagnosed. It helps the parents and the teachers to understand, it's almost like a learning disability, a child who has a math disability is going to work harder on that. With a social disability you can't literally see it and measure it, but if parents know they're a little bit lower socially and emotionally, they know how to adjust their expectations. Let's say that they're developmentally a 12 year-old, but socially maybe they're more like a 9 year-old, than you don't want to place the same expectations and maybe just keep that in mind as you're explaining things to them and expecting things of them. Yeah, and from a teacher's perspective, it's great when kids can already come into our classroom with an IEP, and Individualized Education Plan, where the assessment has been done by a speech and language pathologist, occupational therapist, a school psychologist, and a teacher, and we can really get into detailed information of where that child is in all of these areas, and then it's a very detailed plan of what are our next steps and what are some reasonable expectations for their progress throughout the next year. Younger children can get an individualized family service plan, an IFSP, and I believe it's children from 3 to 5, so preschool aged, and they can be getting services and have a plan in place for their whole family to be receiving the support from those providers, speech and language pathologists and professional teachers.
KC Wilt : And is that through the school system, Kylie?
Kylie Jackson : It is. You get to the regional center that we talked about before and they can refer you to your local school. You can even check with your local elementary school, their school psychologist should have contact information about where to start to get those assessments.
KC Wilt : So my child is 3 and hasn't started school, what would I do?
Kylie Jackson : You can still check with the elementary school, a lot of speech and language pathologists see children from the elementary school as well as children from a SEEC program, which is Special Education Early Childhood, as young as 3 years-old they have the preschool programs.
KC Wilt : When we talked a little bit about labeling, Dr. Kylie, is this why parents are concerned that they don't want their child to be labeled, that's not a autistic case, you know, they look at the disorder we talked about a little bit before, Kylie, people look at the disorder rather than the kid. You know the word about the child being labeled, why is it important to seek out this diagnosis?
Kylie Jackson : Well, I think the importance is, I love the explanation of just the school being aware, coming in with that full evaluation.
KC Wilt : And I think as a the teacher it helps you so much to... teach.
Jody Roberts : Actually, especially when it comes to other people, other students. I had an autistic student and the parents were so concerned about the label, that even though I knew how to deal with them, the students still didn't know how to deal with him, they were so concerned that wouldn't allow me to tell the students why he is the way he is. And that was really really hurtful, because I though that if they knew, than they would be able to treat him better in different ways instead of, well, just making fun of him.
Kylie Jackson : Yeah, and sometimes teacher can explain that everyone has strengths and weaknesses, and if the parents are OK with it, he has more social weaknesses, and how can you help a friend with social weaknesses, these are some ways you can help them. But yeah, having the teacher understand... I've had parents coming to me and say teachers say that their child's rude can they're not looking at them in the eye, and that they aren't saying “please” and “thank you”, you know, just these kind of small things, and that may start to hurt their self-esteem when their teacher or people don't understand them and why they're doing those things. And so having that diagnosis it helps others to understand them. I worked with some nice parents who say “Oh, yeah, that was me when I was a child, if my teachers and parents would have understood they wouldn't have put so much pressure on me and they would've been more understanding, I wouldn't have been bullied as much”, so I see more positives with that but I definitely talk a lot with parents about pros and cons of what could happen and what their biggest fears are. Sometimes a lot of their fears, now in this day and age, with more people being aware, they're not as bad as they were.
KC Wilt : There isn't the stigma anymore. It's so out there, it's so prevalent that people are a lot more understanding, and kids are a lot more understanding, you have to give these kids more credit, they can be a wonderful instrument for progress in a child's life, they understand. If you build that kind of community of tolerance in your classroom, in your neighborhood, in your community, it's really amazing to these kids really bloom.
Kylie Jackson : Yes, actually there have been studies showing that if other kids are aware and you look at a peer buddy situation, that is one of the best ways to help these kids learn, social skills is in the natural peer environment, where you actually have some buddies that are working with them and saying “Oh, you know, I had a really hard day” and then they're like “Oh, you're going to ask me about my day?”, really teaching them how to have those ways of building their social skills.
KC Wilt : Well, its true, 'cause we all know someone who is a little off, and we all just didn't know how to deal with them, so they got made fun of, they got pushed aside. However, if you ask any child, most children who have some sort of... anything, they have compassion, and so whether they are bullied or not, there's got to be a child that will be like, “Oh, well, I would've had more compassion if I'd knew that something was off”, I mean children who had mental disabilities and they were getting made fun of. I remember going up and standing up for them when they were on the playground, but the autistic children who they were just socially off, they were just made fun of and you don't give them the same compassion as a child 'cause it's not a visible sign.
Kylie Jackson : No, it's not visible and that's the hard part.
KC Wilt : Well, what can parents expect as their child ages throughout this course?
Kylie Jackson : Great question, like I kind of eluded to earlier, as kid gets older he becomes more socially nuanced and that's like where in junior high or high-school it becomes a little bit harder. But really getting those early interventions skills and having parents aware and them working socially with their child can make a huge difference to help those years go a little bit easier. As they get into high-school, in addition to some of this social challenges, I see that they have a lot of those sort of executive function challenges, in junior high and high-school. Those include planning, organization, turning in homework, having to be more responsible for things. Those are some of the things why it's important to have an IEP, 'cause as they age the challenges look different at each stage. So maybe when they're younger it looks more like the frigidness in the classroom, and the difficulties standing to close, invading other people's space, to transitioning is a huge one... but as they get older, than it's like when they have to change classes in junior high and be organized, and then also social intergroup gets done. So kind of knowing developmental each stage looks a little bit different, so having the IEP and those supports and awareness of the teacher and parents is important at each stage and kind of revisiting it as a team, you know the treatment team that's working with them.
KC Wilt : So do you revisit this every year?
Kylie Jackson : Yeah, educationally yeah. Educationally he needs an IEP every year, at least, and to talk about plans and then also parents should look into these new laws coming in place, with the insurance covering more, and really access their medical team as well, their psychologist, or OT, or speech therapy, ABA providers that maybe they can get through their insurance as well. Having a team approach really helps.
KC Wilt : Thank you Dr. Kylie for helping us learn about autism. If you want more information, go to today's show in our episodes page on our website, or visit Dr.KylieJackson.com. Our conversation will continue with Dr. Kylie after the show for our Parent Savers Club members. Go to our website to sign up. We'll be talking about ways parents can teach their kids with autism at home.
[Featured Segments: Daddy Doing Work]
Richards : Hi everybody, this is me, Richards, from my blog daddydoinwork, which is all about being a new dad, and today I'm talking about something that's near dear to me, which is the challenges of being a black dad. Now here's the thing: I'm an African-American guy, you know, there are some stereotypes about us that if you look on the news or something you may see some African with nine kids, or things like that, or they're in jail. It's funny to me, I keep thinking to myself: If there were an alien coming from Mars, and wouldn't know about these race differences, and this alien landed in Los Angeles and turned on a TV, and start looking at local news, that alien might think that black guys are just not so great. But most of us, I would say that vast majority of us are just normal dads, like you and me, you know? We love our kids, we are all about being strong, we're all about being disciplinary, we're also very loving and care for our kids, so, as I look back at some of the things that people say, like “Hey! You're actually taking care of kids, that's a good thing!”, you know, and it doesn't really get me angry, I actually laugh at it now, 'cause I know I'm a good dad, I know how to care about my kids, so it's really all about being colored-blind. When we raise kids we want our kids to know that everyone is equal, I'm no different than you guys are. I'm just a guy who loves his kids. So, that being said, I want to thank you so much for listening, if you've got an idea or parent topic that you want to talk to me about, please e-mail me to my blog or you can contact me on my Facebook page. Thanks a lot, see you next time, bye bye!
KC Wilt : That raps up today's episode, we'd like to hear from you. If you have any questions for our expert about today's show or the topics we discussed, call our Parent Savers hot-line at 619.866.4775, or send us an e-mail through our website parentsavers.com or Facebook page and we'll answer your question in an upcoming episode. Don't forget to tune in to behind the scenes Parent Savers Club to keep listening. Next week, we're educating ourselves about SIDs. Thanks for listening to Parent Savers, empowering new parents everywhere!
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
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