About Autism

Autism is a common complex neurobiological disorder with a wide spectrum of presentations, a strong familial genetic pattern and an uncertain cause. Family history is very important as is making sure there are no hearing or vision problems.

Published statistics for the prevalence of autism continue to increase. The most recent statistics suggest prevalence to be between 1 in 68 and 1 in 40 for school-aged children. The cause of this increase in prevalence is uncertain. Likely, an increased awareness about autism and improved diagnostic capabilities has led to the prevalence increases. Autism is a major global concern that is not limited by geography, culture or ethnicity. It is found much more commonly in boys than girls (5 times more common in boys than girls) but it is felt many girls with autism are underdiagnosed due to relative sparing of social and communication skills. Children from socio-economic groups who have limited access to medical, educational and developmental services also have a lower prevalence.

Children and adults with autism have core deficits in communication, social skills and typical behaviors. The reactivity and regulation difficulty that accompany these deficits often lead to behavioral challenges for both the individual with autism and the family.

About one-third of children and adults who are diagnosed with autism also have an intellectual disability. Two-thirds have normal to above average intellectual skills and very high functioning capabilities are seen in many individuals with autism.

Three primary deficit areas include social reciprocity, language and repetitive patterns of behavior, activity or interests. Patterns of interest include unique or unusual fascinations, excessive attachment to objects, sensory aversions to sounds, food and clothing and repetitive motor activity such as hand flapping or running or spinning in circles.

Skills that suggest your child does not have autism include reciprocal smiling by 2 months, laughing and giggling by 5 months and name response by 12 months. Reassuring social skills include eye contact during early infancy, playing peek-a-boo by age 9 months and the ability to copy your gestures such as waving, clapping and pointing by 12 months and waving bye-bye by 15 months of age. For toddlers an interest in imitating you is also a sign of normal development. The ability to share focus and attention by pointing at objects prior to 18 months is another reassuring skill. Remember, all infants and children are different and it is best to not over compare developmental milestones in children. If you have doubts about your child’s development you should talk to your pediatrician.

Autism traits vary with age. For infants and toddlers irritability and a lack of social interaction interests are common. Delays in language, shared gaze and interest or pleasure are the most common complaints. Excessive, unusual, unique, peculiar or repetitive behaviors, activities and interests are also common. For the school-aged child, a delayed ability to connect with others and a rigid and inflexible behavior pattern is the most common historical complaint. Social issues include being overly bossy, a lack of interest in being with people or preferring isolation. Language delay and abnormal language patterns such as word or phrase repetition, repetitive questioning and unusual speech tonality are the most common language difficulties. For teens and adults difficulty with social relationships, shared social interests, communication, rigidity, a lack of social cue awareness and executive function disturbances are the most common signs.

What is Keratosis Pilaris?

This is a common problem where small bumps like “goose bumps” appear on your skin. It is a disorder of keratinization where small papule (bumps) form with occasional redness around the bumps. It is commonly seen and felt on the anterior thighs, triceps area and cheeks. It is commonly seen in children who previously were diagnosed as having atopic dermatitis. Up to 10% of all children may experience this rash. It is commonly seen in children and teens and can be seen in infants.

The cause is not clearly known. There appears to be a familial pattern. Under a microscope plugs of skin cells (keratin) with one or more twisted hairs block hair follicle openings. The most common complaint is “rough and raised” bumps on the skin. It increases during the winter months and seems to be worsened by friction from clothing. Although it often persists into adulthood it usually improves after the teen years. It may increase during pregnancy.

Patience, lubrication and time are usually the best treatments. Emollients and topical keratolytic medications containing lactic acid, salicylic acid or urea can help soften the plugs. They do not help with any surrounding redness. A common preparation has 2% salicylic acid in 20% urea cream. It must be applied consistently for several weeks to see a benefit.

If your child does not respond to the above treatment then topical retinoids such as tretinoin 0.05% cream or adapalene 0.1% cream may be used. These usually require 2-3 months of treatment to see benefits. If there is redness and signs of inflammation then a topical low to medium strength corticosteroid can be used for several weeks.

Your Child Has Autism

“Are you sure?” She asked. “Yes, I am,” I answered. She and her husband leaned into my words. Unwavering and unbroken eyes filled with strength, vulnerability, confidence and dignity met mine. Without turning they reached out to one another and held hands. “Can you help us?” I nodded and took their hands in mine. “I believe in both my heart and my mind that your child is a perfect blessing. I can and will help you.”

The diagnosis of autism is given more often every year. The frequency of your newborn child being diagnosed with autism has increased 30% in two years. This is an estimated prevalence of one in 68 children and one in 42 boys. Although about one-third of children diagnosed with autism have an intellectual disability 23% have borderline intellectual disability and 46% score in the average or above average range of intellectual ability.

Children with an autism spectrum disorder (ASD) must be identified early if we are to ensure proper services for each child and every family. Early identification and intervention are the duty and responsibility of everyone. We must work together to deliver and coordinate the services every family deserves and requires. Each of us must find the time, energy and commitment to serve as thoughtful stewards to make this happen.

What can you do? First, you must believe. You must believe the diagnosis of autism is not a death sentence imposed on the weak, the less fortunate and the unwilling. This diagnosis is a blessing for us, the child and the family. Through understanding we can seek acceptance and allow the words autism spectrum disorder to fill our hearts and our minds with compassion, understanding and empathy.

When most people hear the word autism they see the words marginalization, limitation and grief rather than perfection, inclusion, opportunity and happiness. Children and adults with autism have been forged from love and designed for glory. Each of us has the responsibility to allow children and adults with autism to live a life not of perfection but rather of contribution. Every child and family who lives with this diagnosis blesses each of us with the opportunity to give more than to receive. They provide each of us the opportunities to learn to live life rather than manipulate life. They teach us to seek balance rather than success as well as the opportunity to create a life based on love and contribution rather than money, self-interest, praise and achievement.

Children and adults with autism provide each of us with the opportunity to discover and live a life filled with kindness, compassion and an understanding of both the perfection and equality found in life and death. The month of April is Autism Awareness Month. I challenge each of you to reach out to a family of a child, teen or adult with autism and share in this perfection.

Boiling Point

Have you ever wondered what your words sound like to your child?

“I am sorry,” The little girl said to her mom. “I can’t believe you did this again!” The mother screamed angrily. “You know those markers will not come off no matter how hard we scrub.” The child looked down at her feet. “I should make you scrub the walls instead of eating dinner! Wait until your father sees this! He told you what he would do if you did this again. You never seem to listen. Go to your room and don’t come out until your father comes home!”

Yelling can help in the short term but rarely in the long term. Parents who yell and shout at their children are teaching communication skills that can last a lifetime.  These patterns often lead to long term problems with relationships and the ability to handle future negative emotions and failure.  It many ways the anger, reactivity and demeaning comments that yelling represent teach your child behaviors you do not intend to teach and prevent the development of a healthy resiliency built on openness and optimism rather than shutting down and hopelessness.

Parents who are aware of the negative effects of physical or corporal punishment (spanking) are now resorting to yelling, screaming or shouting. More than 75% of all parents report yelling at their child at least once a month. Raising your voice in moderation to attract the attention of your child is reasonable if it is not associated with anger or threatening tones, words or intent.

The ability to recognize and respond to one’s own emotions is called emotional competency. It is one of the fundamental developmental skills a child needs to acquire during early childhood. The ability to respond to anger in a controlled way supports relationship building and problem solving.

Parents who take a child’s behavior personally are more prone to frustration and becoming overwhelmed to a point where yelling and screaming occur. Yelling not only disrupts a teaching moment but it also causes a downward spiral in the relationship you have with your child and fuels emotional reactions that prevent and hinder problem solving for both you and your child.

Be on the lookout for signs of a blow-up. Avoid situations where time constraints place added pressure on you or your child. This is when yelling is most likely to occur. Another cause is taking your child’s comments or behaviors personally. This often causes a parent to become overwhelmed, upset and even threatened by their child’s behavior. The end result is yelling and often a personal attack on the child where the child is belittled or blamed for the feelings the parent is experiencing.

Try some relaxation strategies and take a step back if you are reaching your boiling point. If issues of safety are not present then wait to respond or an emotional reaction called emotional flooding will take place. In this situation increasingly loud and negative verbal outbursts are exchanged between you and your child or teen as shouts and even insults elicit progressive negative thoughts, words and eventually can elicit negative actions.

Always express your feelings in a non-threatening and non-judgmental fashion and respect and recognize rather than trying to change your child’s feelings. Your child is the master of his or her own emotions and you do not have the right or ability to change them. Remember to seek calm approaches that foster mutual growth and problem solving and help prevent negative behaviors from occurring again.

Newborn Skin Care

The skin of a newborn is different from adult skin. When you choose a topical skin treatment used on an infant’s skin parents must take these differences into consideration. An infant’s skin is about 50% thinner than compared to adult skin and has a more alkaline rather than an acidic pH. It takes about one year for an infant’s skin to mature to adult skin. These differences make it more difficult to keep good things in and bad things out.

Skin plays a role in infection protection, body hydration, electrolyte and water function. When an infant is born, the vernix (vernix caseosa) found on the body of an infant born after 36 weeks of gestation helps the infant stay healthy. It fights infection and has antimicrobial properties that help prevent infection. It is important to leave the vernix on for the immediate period after delivery and not remove it with bathing during the first day of life. It provides a hydrating and naturally moisturizing function.

The top layer of an infant’s skin is low in collagen and the adhesion between the two top layers (epidermis and dermis) of infant skin is less than in adult skin. The skin is also alkaline in pH as opposed to an acidic pH for adult skin. An acidic pH helps protect adult skin from infection.

The large area of skin coverage relative to body mass in an infant compared to an adult is why infants are prone to heat and water loss as well as the passage of substances across the skin barrier. Certain topical exposures are especially dangerous to babies. This is why it is important for parents to read labels to find out the composition of the topical agent. Rashes due to contact can be triggered by these agents.

Topical corticosteroids can lead to skin atrophy, and neomycin can lead to neural deafness. Silvadene can cause kernicterus and providone-iodine can cause hypothyroidism. Surfactants and antiseptics included in these topical agents can cause irritant dermatitis reactions and fragrances, preservatives, surfactants and parabens can cause contact sensitization after multiple exposures. Preservatives are often blamed but are essential to increase shelf life for many of these topical agents.

Some topical agents describe so-called organic or natural agents as being safer and healthier. Not all organic or natural agents are equally safe and the definition of what is organic is often vague. Sunflower oil appears to be better than olive oil, which may cause some disruption in the skin barrier. Botanical oils can cause skin sensitization reactions, and fragrance free products may have a masking agent that makes the product fragrance free, while still having a sensitizing agent present.

Parents must read labels and decide what topical agents are helpful and necessary in the care of their infant. The use of topical agents in infants who have a personal or family history of skin reactions should limited. The general rule in infant skin care is less is best. Early exposure increases an infant’s risk of skin sensitization and reading labels is always the best way to prevent future problems.

Self Esteem

A strong and healthy sense of self is one of the greatest gifts a parent can give to a child. Building strong self-esteem is the first step.  Self-esteem is the name given to the way we perceive ourselves.  Our perception is based on our own thoughts and feelings as well as how we perceive others think and feel about us. Our own perception of our ability to achieve also affects our self-esteem.  When our perception matches our ideal self, we have a higher sense of self-esteem.

Developing self-esteem takes time and effort.  An infant or child must experience secure attachment and a strong sense of security. At the same time the infant and young child must feel she is loved and accepted by others. This starts within your family and extends to friends and acquaintances. Involvement in and acceptance by groups such as school, church, a sport team and community organizations are also important. Without such involvement children feel lonely and isolated.

Children must have a sense of purpose.  Identifying and pursuing goals based on interest and ability is also essential. This allows every child to engage with others and channel energy towards achievement and self-expression. This prevents children from becoming resentful and bored or being excessively influenced by the desires of another.  These activities allow a child to develop not only competence but also a sense of pride that prepares a child to meet the challenges ahead.  This ability to have the personal power and interest to solve problems and set appropriate personal expectations is essential for life long success.

Trust in oneself and in those you love is essential if opportunities for success are to be realized and achieved. One of the components of trust is an understanding of both making and keeping promises. Children must be given the opportunity to keep promises and tell the truth even when the truth is difficult. This builds honesty, responsibility and a respect for the feelings and rights of others. Trust leads to a sense of faith in others and the ability to “let go” and rely on those you trust.

As your child’s ability to pursue a goal matures a sense of commitment develops. A child needs to feel they are able to contribute and participate in meaningful activities. This type of involvement must be authentic and lead to real choices and real decisions. These decisions are age and ability dependent and must be reasonable from a developmental perspective.

Throughout this process children and teens require honest and meaningful encouragement, support and rewards for a job well done even when mistakes or failure occur. Every child will make mistakes.  Perseverance and resiliency uncover within your child the ability not to feel defeated or embarrassed. Such feedback is essential if shame, guilt and anger are to be avoided.  Positively-directed feedback encourages lifelong improvement and motivation as well as the realization of healthy self-esteem.

A New Year’s Resolution

The eyes of so many parents tell the tale of fatigue, confusion and love. There is so much to do but so little time. Here is my resolution for this year. I hope it helps you.

The goal of every parent must be to encourage independence while discouraging both dependence and co-dependence. Dependence leads to low self-esteem, limited assertive communication, devalued feelings, poor boundary and limit setting behaviors and a lack of resilience. When independence is not supported problem solving, free expression, equality and healthy communication all suffer.

Signs of a healthy life balance include contentment, a zest for life, flexibility, resilience, a tolerance for stress, a sense of purpose and a healthy attitude at both work and play. When parents do not support the mutual sharing of feelings, thoughts and values, balance is difficult to achieve. The foundation of a healthy balance is an ability to discuss and accept your child’s feelings while also respecting your child’s boundaries. By nurturing resilience and setting reasonable rules a parent fosters independence, responsibility and decision making.

The first step in maintaining balance is to recognize, understand and respond to stress. Without this capability parents and children are prone to withdrawal, depression, anger and isolative behavior. When stress is managed effectively skills can be developed to allow both parent and child to trust their feelings and retain their own perspective while continuing to support one another.

The second step is to explore and clarify your own feelings. This allows you to respond to your own needs by understanding your own thoughts and actions. Once your personal needs have been met you are ready to support another. Focus on support that is kind, factual and optimistic. Non-judgmental support allows you to maintain your viewpoint while allowing the person you help to retain their own perspective and independence.

The final step to a healthy life balance is the ability to express gratitude and personal emotion while continuing to dream. 

Acetaminophen and Asthma

Although acetaminophen has been used for many years there is evidence to suggest the liberal use of it is not healthy. It can lead to the development of wheezing disorders and can exacerbate wheezing and asthma symptoms in children known to have asthma.

Some drug manufacturers point to the association of viral infections with the use of acetaminophen and say the respiratory problems are due to the viral infection and not the medication but studies do not support this.

At the present time it is best to avoid using acetaminophen by all children with asthma or at risk to develop asthma and use an alternative medication such as ibuprofen when possible. In general, for all children over age 3 months who do not have an allergy to ibuprofen the substitution of ibuprofen for acetaminophen is reasonable.

Future studies will provide more information about the safety of acetaminophen. Until then, caution is the best policy as is limiting the use of acetaminophen to clinical situations where no alternative is available.

A Christmas Birthday

What does your birthday mean to you?

It was the week before Christmas, and we were making construction paper Christmas cards for our parents.  Glitter, glue and crayons were scattered across the table-top. Sister Marie Rene walked over to my table, put her hands on my shoulders and announced to the class, “Joey’s birthday is on the most special day of the year, Christmas!”  “Do you get extra presents?”  My friend sitting next to me asked.  “No,” I answered.” “So why is it so special?” He countered.

It took me many Christmas birthdays to realize love was the reason my Christmas birthday was so special. My birthday, forever paired to Christmas became a time of giving, sharing, receiving, acceptance and love.

Have you wondered why children only ask for food, warmth, love, comfort and protection yet are often worshipped with favors and material gifts? As perfect beings children do not ask for bows, ribbons, cakes, candles, birthday parties or gifts. What they ask for is love.

After birth infants require love, attention and affection. By age one freedom, encouragement and respect are added as every child develops a sense of self-worth. By the mid elementary years a child learns to give, share, be non-judgmental, accept others and tell the truth. Birthdays come and go, lessons are learned and love is given and received. These lessons are the greatest birthday gift every parent can give a child.

As parents we are prone to forget the simplicity of parenting. We over-engage, indulge and worship rather than teach our children. As we fail to set and enforce boundaries and limits, behavior problems become increasingly apparent.

Many children today drown in a sea of plenty. Your child’s birthday is the perfect time each year to remind yourself and your child about the transience of material gifts and the simplicity of love. Make your child’s next birthday about the essence of Christmas. Be a model for your child. Teach your child the difference between needs and wants and live a life based on giving not receiving. When you teach your child to listen, to touch, to give and to heal you will also be teaching the meaning of love.

Happy Holidays and a Merry Christmas to all!

The Greatest Gift

What are your three wishes?

“If you had three wishes for anything in the world what would you wish for?” The eight year old looked at me with a puzzled look. “Take time to think,” I told him. His gaze drifted to the ceiling and his breathing slowed. His eyes lowered and met mine. “I want my dad to be okay,” he answered.  “Where is he?” I asked. “Away in the army,” he answered. There was something about his determined look that prevented me from turning away. “You love him very much, don’t you?”  He nodded and his eyes shimmered without tears. “Mom told me he will be coming home soon,” he replied. “You and your dad are my heroes,” I said to him. “I am so proud of you.” The boy nodded and wiped his cheek.

The gleaming eyes of children taught me the gift of gratitude is the greatest gift one person can give to another. I saw how a kind word, a pat on the back, a push on a swing or a bounce of a ball made gratitude visible. Young children do not hide gratitude. They hug, they smile, and they sing to us. They wear it loose and visible like a scarf and often leave it behind without regret. We as adults are the ones who forget to show gratitude for what we have and for what we are given by others as gratitude, our greatest gift, is replaced by material acts of giving.
Gratitude empowers and refreshes all who experience it. It comes from the heart and freely given, enriches everyone. It awakens joy, breeds satisfaction and inspires giving. Gratitude built upon humility, acceptance and trust is the ultimate gift. It helps us to understand, accept and love others.

During the coming holiday season make gratitude your greatest gift. Give it to others freely. Don’t hide it. Display it proudly and watch how others become inspired. Show your gratitude for having the opportunity to wake another morning, take another step, and sing another song or blow out another candle. Make every day a new day, a new chance and a new opportunity. Show gratitude for the love of others near and far. Give thanks for what you have already received. Hear the music. Feel the vibration. Reach out to another and dance. Allow gratitude to become your greatest gift.