28 April 2011

The Subtle Signs - The Beginning Of Autism

Parents Often Miss Subtle Autism Signs

The symptoms of autism tend to emerge in children after six months of age, with a loss of social and communications skills that is more common and more subtle than previously thought, according to a new study that questions previous assumptions about the progression of the condition.

At six months, children with autism spectrum disorder demonstrated behavior similar to other children, gazing at faces, sharing smiles, and vocalizing with similar frequency, researchers reported online in the Journal of the American Academy of Child and Adolescent Psychiatry.

However, autistic children displayed fewer of these behaviors as as they got older, and from six months to 18 months the loss of social communication and skills typically became clear.

While doctors typically caught early signs of autism, the declines were more subtle than previously suggested and most parents -- 83 percent -- did not report regression in the social behaviors and skills.

"These findings lead us to two major conclusions," Sally Ozonoff of University of California Davis Health System in Sacramento and colleagues wrote.

"First, the behavioral symptoms of autism spectrum disorder appear to emerge over time, beginning in the second half of the first year of life and continuing to develop for several years.

"Second, our most widely used and recommended practice for gathering information about symptom onset, parent-provided developmental history, does not provide a valid assessment of the slow decline in social communication that can be observed prospectively."

Autism is thought to emerge in two ways: an early onset pattern and a regressive pattern.

A majority of autistic children are thought to experience the early onset pattern, showing clear signs of the disease in the second year of life but in some cases showing signs before the first birthday.

Those with the regressive pattern are thought to develop normally for the first year of life, then begin losing communications and social skills.

However, most previous studies have been retrospective in design, and some children don't appear to fit either of the typical patterns, bringing into question the validity of this two-pronged model of onset.

More recently, a third category has been suggested, in which children develop normally and then seem to hit a developmental plateau, but not regress.

In an accompanying editorial, Tony Charman of the Institute of Education in London wrote that the design of the new study heralds a new wave of descriptive developmental studies of autism, or features of autism, in infants and toddlers.

"Previously, the only source of information we had about infancy and toddlerhood of children with autism was retrospective reports from parents at the age of diagnosis (often years after the onset)," he wrote.

"Parental report of early history and development still is an important component of the autism diagnostic evaluation. However, the retrospective parental informant biases, particularly through the lens of autism, might lead both to over- and underestimation of atypical features."

Ozonoff and colleagues conducted a study that compared 25 high-risk infants later diagnosed with an autism spectrum disorder with 25 gender-matched, low-risk children later determined to have typical development.

The children were recruited for the study at University of California Davis and University of California Los Angeles. The high-risk children were identified based on having a sibling who had already developed autism.

The children were evaluated at 6, 12, 18, 24 and 36 months of age for frequencies of gaze to faces, social smiles, and directed vocalizations, which were were coded from video and rated by examiners.

"The results of the current prospective study suggest that the traditionally defined categories of early onset and regressive autism do not portray accurately how symptoms emerge, nor does the newer-onset category involving a developmental plateau," the authors wrote.

They found that specific social communicative behaviors clearly decreased, rather than failing to progress, as previously thought, with losses especially dramatic between 6 and 18 months.

They concluded that this suggests onset of autism spectrum disorder, marked by loss of social communication behaviors, occurs much more often than has been recognized using parent report methods.

However, rather than the rapid and marked losses typically reported, they saw relatively subtle and gradual declines, which were often preceded by earlier parental concerns and often followed by failures to progress in other areas.

"We urge professionals to refer to intervention any infant or toddler who displays a sustained reduction in social responsivity over time," they wrote.

"Given the gradual course of symptom emergence and the paucity of diagnostic tools for infants and toddlers with suspected autism, the diagnostic process can be quite protracted and intervention may be needlessly delayed."

Kidzcare: Autism -- The Choir

Autistic Umar sings ' I Dreamed A Dream.'

26 April 2011

Welcome To Recovery Land by Spectrum Mum in Malaysia.

Cereen and her little prince

I was pleased to hear yet another child has recovered from Autism. Cereen is a Super Mum from Melaka, Malaysia. I first met her after her son was diagnosed with Autism, she attended one of my presentations last year. She was already on her biomedical journey by then, as we chatted little did we know that just one year later she will be sharing her own recovery story with the public.

Please read Part 1 of Cereen’s journey in recovering her son from Autism in the China Press published on 17 April 2011. The article is originally written in Chinese, please use Google Translate if required.
http://www.chinapress.com.my/node/208169

Cereen, thank you for sharing your journey with us. This is an inspiring story and will give hope to many families affected by Autism. Your family has been through so much heartache and challenges, Zhezhe’s recovery is a testament to your hard work and determination. Know that your friends at KL Biomed are incredibly proud of you and we are very happy for you and your family. I look forward to reading more of your journey in Autism. Well done Cereen and Zhezhe, welcome to Recovery Land……

23 April 2011

Support group for parents of children with autism

Sunday April 24, 2011
Empowering parents
By MARISSA BAGSHAW

A support group for parents of children with autism and related neuro-developmental disorders will hold a meeting in Melaka for the first time.

AUTISM resources in Malaysia are ever growing. KL Biomed is a support network for parents of children with autism, attention deficit hyperactive disorder (ADHD), pervasive developmental disorder-not otherwise specified (PDD-NOS), apraxia, behavioural disorders, speech delay, and related neuro-developmental disorders in Malaysia and neighbouring countries.

It advocates complementary and alternative healthcare treatments for children affected by autism, and hopes to empower parents to seek effective treatments for their children.
You can sign up for the KL Biomed Health Forum at http://health.groups.yahoo. group/klbiomed if you are a parent involved in the care and treatment of of a child diagnosed with Autism Spectrum Disorder, PDD-NOS, ADHD, Aspergers, apraxia, and other related behavioural and neuro-developmental disorders.

KL Biomed provides support and practical advice for families doing biomedical intervention and holistic treatments, including naturopathy, homeopathy, hyperbaric oxygen therapy, cranial-sacral therapy, neurofeedback, Traditional Chinese Medicine (TCM), and many other alternatives to mainstream drug treatment.

Biomedical intervention are non-drug treatments consisting of dietary interventions, vitamins, minerals, enzymes, essential fatty acids and amino acids.

It provides integrative treatment by addressing the root causes of autism, such as vitamin deficiency, allergies, food intolerance, oxidative stress, inflammation, gastrointestinal issues, malabsorption, maldigestion, chronic infections, metabolic disorders, mitochondria disorders, heavy metal toxicity and many more.

For more information on biomedical intervention, please visit www.autism.com. You can also sign up for the KL Biomed Health Forum at http://health.groups.yahoo.group/klbiomed if you are a parent involved in the care and treatment of of a child diagnosed with Autism Spectrum Disorder, PDD-NOS, ADHD, Aspergers, apraxia, and other related behavioural and neuro-developmental disorders.

All parents interested in biomedical, dietary, alternative, and holistic interventions are encouraged to sign up to this forum. Here, you can post questions or share information, and other parents will reply and share their experience.

This way, everyone benefits by learning from the collective experience of the group, rather than just relying on one source of information.

KL Biomed started as a small group of parents interested in exploring biomedical treatments based on the protocol and research by the Autism Research Institute (www.autism.com).

We held our first support group meeting sitting on the floor of my tiny living room. We would take turns holding the meeting in each other’s homes, or wherever we could find.

Little did we know that the group would grow to have so many members today.

Though the number of members have grown, everytime we meet, old and new parents tend to form bonds and friendships quickly.

Though initially set up as a source of educational information, many of our members have made good friends and have found support, companionship, and empathy in each other.

KL Biomed parents are also fondly refered to as Warrior Mums and Super Dads.

They are passionate, resourceful and committed in improving their child’s health. Initially started as a Kuala Lumpur-based support group, it has grown to include members from all over Malaysia and neighbouring countries. Our children range from 1.5 year-old toddlers to 26-year-old adults.

Apart from support group meetings, we have an online KL Biomed Health Forum. Please sign up at http://health.groups.yahoo.group/klbiomed.

We are always working towards creating a more dynamic format online with the latest events, more resources, and new updates on medical information.

We also have parent mentor programmes, connecting families with other parents whose children face similar health issues, or according to location.

A parent mentor is a parent of a child with autism or related disorder who has at least a year’s experience with biomedical and alternative treatments.

A parent mentor provides support and practical advice on a volunteer basis.

KL Biomed holds a support group meet in the Klang Valley every two months.

Here, parents can meet and network with other parents, as well as discuss specific agendas and topics of interest.

This year, the KL Biomed Support Group is attempting to extend its reach to other towns and cities in the country.

There’s an upcoming KL Biomed Support group meet in Melaka. Please see below for details:

Date: Saturday April 30, 2011

Time: 7.30pm – 9.30pm

Fee: RM10.00 per person (payment in cash, to be paid on the day of the event)

Venue: Mahkota Medical Centre, No. 3, Mahkota Melaka, Jalan Merdeka, 75000 Melaka

Please RSVP by Thursday 28th April 2011. Kindly RSVP by email toAutismResourcesMelaka@yahoo.com . Alternatively RSVP by SMS with Mdm Ng (019-6699285) or Ms Tracy (012-3623268). Please include your name(s), email, and phone number.

Thank you to Madam Ng Kek Kuan (Director of Autism Resources, Advisor to Persatuan Autisma Melaka Tengah and former President) for organising this meeting and bringing the support group to Melaka and families in nearby cities. A big appreciation to Mahkota Medical Centre for supporting our Autism Awareness campaigns.

We can’t promise you Onde-Onde/ Buah Melaka, but we do promise hope, support and encouragement.

See you soon,

Marissa & Rafidah

Diet May Help ADHD Kids More Than Drugs

Study: Diet May Help ADHD Kids More Than Drugs

According to Dr. Lidy Pelsser's study, 64 percent of children diagnosed with ADHD are actually experiencing a hypersensitivity to food.
iStockphoto.com

According to Dr. Lidy Pelsser's study, 64 percent of children diagnosed with ADHD are actually experiencing a hypersensitivity to food.

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March 12, 2011

Hyperactivity. Fidgeting. Inattention. Impulsivity. If your child has one or more of these qualities on a regular basis, you may be told that he or she has attention deficit hyperactivity disorder. If so, they'd be among about 10 percent of children in the United States.

Kids with ADHD can be restless and difficult to handle. Many of them are treated with drugs, but a new study says food may be the key. Published in The Lancet journal, the study suggests that with a very restrictive diet, kids with ADHD could experience a significant reduction in symptoms.

The study's lead author, Dr. Lidy Pelsser of the ADHD Research Centre in the Netherlands, writes in The Lancet that the disorder is triggered in many cases by external factors — and those can be treated through changes to one's environment.

"ADHD, it's just a couple of symptoms — it's not a disease," the Dutch researcher tells All Things Considered weekend host Guy Raz.

The way we think about — and treat — these behaviors is wrong, Pelsser says. "There is a paradigm shift needed. If a child is diagnosed ADHD, we should say, 'OK, we have got those symptoms, now let's start looking for a cause.' "

Pelsser compares ADHD to eczema. "The skin is affected, but a lot of people get eczema because of a latex allergy or because they are eating a pineapple or strawberries."

According to Pelsser, 64 percent of children diagnosed with ADHD are actually experiencing a hypersensitivity to food. Researchers determined that by starting kids on a very elaborate diet, then restricting it over a few weeks' time.

"It's only five weeks," Pelsser says. "If it is the diet, then we start to find out which foods are causing the problems."

Teachers and doctors who worked with children in the study reported marked changes in behavior. "In fact, they were flabbergasted," Pelsser says.

"After the diet, they were just normal children with normal behavior," she says. No longer were they easily distracted or forgetful, and the temper tantrums subsided.

Some teachers said they never thought it would work, Pelsser says. "It was so strange," she says, "that a diet would change the behavior of a child as thoroughly as they saw it. It was a miracle, a teacher said."

But diet is not the solution for all children with ADHD, Pelsser cautions.

"In all children, we should start with diet research," she says. If a child's behavior doesn't change, then drugs may still be necessary. "But now we are giving them all drugs, and I think that's a huge mistake," she says.

Also, Pelsser warns, altering your child's diet without a doctor's supervision is inadvisable.

"We have got good news — that food is the main cause of ADHD," she says. "We've got bad news — that we have to train physicians to monitor this procedure because it cannot be done by a physician who is not trained."

20 April 2011

儿童孤独症(儿童自闭症)
郭卜乐 中国心理热线 http://www.zgxl.net

  儿童孤独症又被人们称为儿童自闭症,是一类以严重孤独,缺乏情感反应,语言发育障碍,刻板重复动作和对环境奇特的反应为特征的精神疾病。最初 称为婴儿孤独症,现今又统称孤独性障碍。它属于普遍性发育障碍。无论在成因、发展方式和治疗手段和成年人的孤独症都有很大区别,它是一种严重的婴幼儿发育 障碍。以社会相互作用、语言动作和行为交往三方面的异常,及以三岁前起病为特征。
  通常发生于3岁之前,一般在3岁以前就会表现出来,从婴儿期开始出现,一直延续到终身,是一种严重情绪错乱的疾病。
  孤独症无种族、社会、宗教之分,与家庭收入、生活方式、教育程度无关。据欧美各国统计,约每1万名儿童中有2-13例。目前,估计在我国约有 50万左右孤独症患儿。本症多见于男孩,男女比例为2.6-5.7:1。北医大精神卫生研究所1989-1992年统计60例中,男∶女为7.5∶1,我 院1995年-1997年儿童心理门诊统计19例中,男∶女为6.3∶1。1984年6月至1986年5月南京儿童心理卫生研究中心收住来自全国很多地区 的精神病患儿l70名,其中诊断孤独症15例,占8.82%,这数字只代表已患精神障碍的儿童中检出率。
  
  [病因]
  已从遗传因素、神经生物学因素、社会心理因素方面作了大量研究,然而迄今为止,仍未能阐明儿童孤独症的病因和发病机制但至少把它看成是多种生物学原因引起的广泛性发育障碍所致的异常行为综合征。
  
  [历史]
  1943年Kanner最初加以描述。并称之为"情感接触孤独障碍"。当时他报告的11例均在婴儿出生后就起病,故称为婴儿早期孤独症。以后,他和其他学者观察更多病例后,发见有些患儿开始一、二年发育尚正常,以后才起病。现今一般人将起病年龄定为30月以内。
  由于孤独症起病如此之早,征状奇特和预后严重,故引起学者的广泛兴趣及社会的关注。美国、英国、加拿大等国家设有孤独症专门学会、办有专门杂志,并且从社会、心理、神经生理、生化、遗传等多方面作了深入探讨,写了不少专著和文章。
  
  临床表现和诊断
  儿童孤独症的表现(症状)
  主要症状就是不与别人交往和建立正常的社会关系。患儿沉静在自己的世界里,无法用语言、表情、动作跟别人甚至自己的父母进行沟通、交流。有的 孩子在开始时会被误认为是弱智或性格内向,还有的孩子在一两岁时看起来很正常,到3岁左右才发现有异类表现。孤独症患者学习正常人的语言会很困难,与人交 流及与外界沟通也很困难,他们可能会重复几种动作(拍手、摇摆)。当日常生活中出现变化,他们会强烈抵制。孤独症对行为的影响,除了语言和社交困难外,还 会有父母、家人面前表现得极为亢奋或沮丧。
  具体:
  1.早期表现,极度孤独,不会对亲人微笑。喂奶时,患儿不将身子紧贴大人。伸手去抱时,患儿无迎接姿势,不会伸手做被抱的准备,不会将身子贴近母亲,眼睛也不看抱他的人。
  2.社交困难,特别孤独,与人缺乏交往,缺乏感情联系,即使对父母也毫不依恋,如同陌生人。但与陌生人相处,又不感到畏缩。正常儿童常以凝视 对方表达自己的感情与要求,而患儿缺乏与人眼对眼的凝视,不会以这种方式表达感情与要求。不爱玩,不爱做游戏。患儿到5岁左右,常还无朋友,很少与小朋友 一起玩耍,缺乏情感反应,常常说出或做出一些不合社交的事情来。
  3.语言发育迟缓或障碍。患儿通常缄默,或说话呈模仿语言,象鹦鹉学舌似地模仿别人的语言。对语言的理解表达能力低下,无法理解稍微复杂一点 的句子,不会用手势表示“再见”。不会理解和运用面部表情、动作、姿态及音调等与人交往。缺乏想象力和社会性模拟,不能像正常儿童一样去用玩具“做饭”、 “开火车”、“造房子”。有的患儿语言刻板,代词错用,如“我要”说成“你要”,或将自己称为他。与外界交流困难,不能将生词与其含义相联,用手势而不是 语言与人交流。
  4.仪式性和强迫性行为。由于缺乏变化与想象力,患儿常常坚持重复刻板的游戏模式,重复一些身体工作,重复相同的生活,如反复给玩具排队,总 要玩弄自己的脚趾,穿衣顺序相同,坚持某些物件的摆置形式,不能变动。一旦有所变化,他们会极为沮丧,别人变动,患儿便大吵大闹。对自己房间的任何变化也 都会表示反对和不安,加家具的移位、装饰品的变化等。
  5、脑部智力大多低于正常人,只有20%的人智商高于正常人或与正常人相当。
  6、对某些物件,如一只杯子、一块砖,表示出特殊兴趣,甚至产生依恋,而对亲人却不产生依恋。
  此外,有的患儿还可能有感知障碍,对视、听、触等多种感觉迟钝或过敏。有的存在认知障碍,智力低下,抽象思维能力很差,少数患儿可能伴有癫痫 发作。患孤独症的孩子有时会聋,对声音没反应。正常孩子会被声音例如狗叫惊吓,而孤独症小孩会无动于衷。他们对疼痛、冷热也不太敏感,不爱交朋友,宁肯独 自一人,很少会接触别人的眼睛或笑。
  
  对于孤独症患儿来讲,只有早发现、早干预、进行行为矫治,才能帮他们缩短与正常社会的差距,让他们早日融入社会。如何才能发现孩子在早期的孤独症倾向呢?
  以下的18种行为就是孤独症的早期表现,如果发现孩子同时具备以下7种行为,就应该怀疑他有孤独症倾向了。
  1.对声音没有反应
  2.难于介入同龄人
  3.拒绝接受变化
  4.对环境冷漠
  5.鹦鹉学舌
  6.喜欢旋转物品
  7.莫名其妙地发笑
  8.抵抗正常学习方法
  9.奇怪的玩耍方式
  10.动作发展不平衡
  11.对疼痛不敏感
  12.缺乏目光对视
  13.特别依赖某一物品
  14.不明原因的哭闹
  15.特别好动或不动
  16.拒绝拥抱
  17.对真正的危险不惧怕
  18.用动作表达需求
  
  [鉴别诊断]
  1、脑部迟钝:大多脑部迟钝的人在技能上也不会有所发展,而孤独症患者在良好指导下脑部会有所发展,可掌握一些技能。
  
  儿童孤独症的病因
  儿童孤独症的起因尚不太清楚,病因尚无定论。最近调查认为,孤独症与脑部生理结构或神经病学有关,是几种“原因”的结果。与遗传因素、器质性因素以及环境因素有关。
  (1)遗传因素:患儿的同胞发生本病的同病率较其他人为高,单卵双生子的同病率较高,41%患儿为长y染色体。他们的父亲和兄北也发现有长y染色体,从而提示与遗传因素有关。
  (2)器质性因素:如脑损伤、母孕期风疹感染,生下后患过脑膜炎、脑炎等。近年来,研究发现本症患儿脑室左颞角扩大较多见,提示颞叶内侧结构 的病变,可能是由于脑组织的变态反应所致。最近的研究证明,患幼年孤独症的儿童,其免疫系统可能将一个基本的脑蛋白误为异体,而被吞噬掉。因此导致脑损 伤,可能是造成此病的特征。此病同时出现情绪、智力和交际的缺陷,亦是与脑病变有关。
  (3)环境因素:过去有人认为早年生活环境中冷淡的和过分理智化的抚育方法,缺乏丰富和适当的刺激,没有教以社会行为,是发病的重要因素。长 期处在单调环境中的儿童,会用重复动作来进行自我刺激,对外界环境就不发生兴趣。本症患儿的父母大多是专业技术人员,受过高等教育,比较聪明,但做事刻 板,并有强迫倾向,对孩子冷淡和固执,家庭缺乏温暖。现在,否定了这种看法。经研究证实,是由于某种脑病变的关系,其发生原因,是病毒,还是代谢失调,目 前尚无定论。
  
  儿童孤独症的治疗
  孤独症患者病情从温和到严重有许多类型。由于发病原因不明确,仍不太清楚孤独症对人的影响以及怎样同孤独症患者有效沟通,尤其在配合治疗方面 会有很大难度,至今还无法找到一种有效的治疗方法。是一种终生的慢性疾病,影响正常脑功能,不能正确理解他们所见所闻所感。治愈,难以有可能终身不治。
  1943年首次提出这一症状以来,孤独症的治疗已有了很大发展。有些患者随着年龄增长症状会减轻。研究者目前也在积极寻求方法。他们认为在正确知道下孤独症症状可得以改善。有特殊训练的老师,特殊的教育方法,孤独症患者可逐渐适应正常生活。
  本症预后大多不良,往往残留行为障碍,以致适应困难,不能独立生活,仅少数人年长后,能适应社会生活。预后与智力水平有关,智力障碍严重者预后差。
  
  对儿童孤独症要采用综合性的治疗方法。
  治疗上最重要的是教育和行为治疗,目的是促进对患儿正常行为的教育,特别是社会性行为的矫正,纠正异常行为,如刻板支作等,消除睡眠障碍、发脾气、多动等继发性症状等。患儿的家庭成员也要注意克服焦虑、自责、急躁情绪,方能对患儿的治疗产生良好的效果。
  父母要改变养育方式,多接近,多关心患儿,给小孩以温暖。此病预后大多不良,往往残留行为障碍,以致适应困难,不能独立生活。少数病人年长后能适应社会生活。智能好的患儿比智能差的患儿预后好。
  药物治疗仅对个别症状可能有效,如短期严重失眠,可用安定,有攻击行为,可用奋乃静,促进脑功能的药物可选用脑复新、脑复康,或γ-酷氨酸, 此外,利他林对治疗孤独和语言障碍有效。近年来,有人报告,服用芬氟拉明(fenfluramine)治疗孤独症获得疗效,该药是苯丙胺的衍生物,服用后 可使中枢神经系统血清素水平降低,减轻多动及刻板动作,改善注意力,对有些病例尚可提高智商。氟哌啶醇可改善儿童的孤僻、退缩及某些刻板的行为,药物的选 择要取决于儿童的年龄、疾病的严重程度及病程的长短,剂量也应根据每个孩子的具体情况从最小剂量开始,逐渐缓慢加量,直至出现适当的疗效或副反应为止。
  虽然许多家长都信服分泌素,但研究人员星期二报告说,分泌素不是治疗孩子们孤独症的有效药物。分泌素引起人们广泛关注的原因,是NBC去年关 于一名叫帕克的儿童的报道。帕克接受了内窥镜检查,什么也没查出来,又吃了一些分泌素,于是孩子睡觉和说话都恢复了。家长于是认为这种只吃一次的消化不良 的诊断药,与孩子不说话的孤独症的好转有关。几家主要报纸刊登了帕克的新闻,于是,三、四千名患有孤独症的儿童,吃了至少一次分泌素。孤独症研究学会收集 了一千多名儿童的反映,发现相当一批孩子表现出明显的好转。但是,当科学家们再次认真地分析分泌素的效果时,发现一剂分泌素对付孤独症是无效的。
  患孤独症的儿童,一般病程都比较长,所以用药治疗的时间也相对长一些。家长应注意治疗时药物的副作用,如锥体外系反应、肝功能及心血管以及血象的异常,因此,对患儿定期复查是必要的。
  上述药物对孤独症的患儿确定具有重要的治疗作用,可使某些症状减轻,有利于行为及心理治疗的进行,但目前还达不到根治的效果。药物本身还不能 提高孩子的学习认识能力,也不能建立正常的行为,但有效的药物可使儿童对环境和管理更为适应。通过药物、特殊训练和行为矫治等综合措施,患儿的症状能够得 到较理想的改善。
  研究者正积极寻求各种治疗的方法来帮助孤独症患者,包括语言疗法、感官综合、视觉疗法、音乐疗法、听觉疗法等。
  实验证明,在良好的方法下患者病情会有所控制和好转。一种好方法应包括一些交流治疗,社会技能发展,感官损害治疗等。专家认为,通常病情越重效果越好,并提倡一个老师针对一个患者的专门治疗。孤独症患者需要整个社会的支持、帮助、不仅是家人、老师。
  
  社会康复
  儿童孤独症患者一般可做重复性强的工作。像艺术家、调琴师、画家、办公室人员、洗碟子人员、流水线工人等。
  通常喜爱音乐、游泳、打猎、猜谜等。
  成年后需要职业训练,就业机会,监督部门等。
  
  
  
  参考资料:
  临床特点
  孤独症的基本临床特征为"Kanner"三联征。
  (一)社会交往障碍社会缺陷是孤独症的核心,有的患儿在婴儿期就可表现症状,可拒绝别人的拥抱,对父母无依恋感,而当父母回来时也没有愉快的 表示。当感到不愉快或受到伤害时也不会去寻找母亲的安抚和父母易于分离,有时跟随陌生人和跟他们父母一样,有时亲人呼唤他们的名字,常常不理会,无反应, 表现视而不见,听而不闻。缺乏眼与眼的对视往往被看成是孤独症的特殊表现。
  (二)言语发育障碍孤独症的语言障碍是一种质的全面损害,以此症状来就医占大多数。   1.沉默不语或较少使用语言。   2.言语运用能力的损害,表现在不会主动与人交谈,不会提出语题或维持语题,他们常是自言自语,但讲什么内容,别人听不懂;他们常有自己的小天地,以此为乐。而毫不注意周围的环境。有的患儿还不会用代词或代词运用颠倒;以致他们的言语变得毫无意义或不知所云。   3.刻板重复的言语或模仿言语。   4.言语音调,节奏的障碍。   5.出于自我刺激的使用言语:有时尖叫,或发出别人不能听清或不可理解的"话",常称"自我中心语言"。   6.非语言性交流的损害
  (三)兴趣范围狭窄以及刻极、僵硬的行为方式。   1.对环境倾向于要求固定不变或不正常反应。   2.不寻常的兴趣和非同一般的游戏方式:表现对某些物件或活动的特殊迷恋。   3.刻板、重复的行为和特殊的动作姿势。   4.对物体的非主要特性的兴趣,以及特殊的接触方式。
  (四)感知常见的异常。
  (五)智力和认知缺陷。   
   张庆松
  张庆松脑瘫癫痫网
  
  儿童孤独症的小常识   儿童孤独症又称儿童自闭症,与儿童感知、语言和思维、情感、动作以及社交等多个领域的心理活动有关,属于发育障碍。很多国家对儿童孤独症的患病率进行 调查,加拿大为万分之十,美国为万分之四,日本为万分之七。我国尚未进行流行病学调查,从有关临床病例的统计中发现:男性发病率高于女性,比例大约为 5.1左右。调查研究发现一些有趣的现象:儿童孤独症患者的父母具有较高的社会经济地位;在孪生子女中,单卵孪生子中若有1个患孤独症,另一个的患病率高 达36%左右,而双卵孪生子中却没有这种现象。这说明孤独症的发生与遗传有一定的关系。
  最新医学研究发现,儿童患者脑中鸦片素含量过多,故常出现孤独、麻木症状和感情交流障碍等。到目前为止当前有多种病因学说,但究竟是什么原因引起的儿童孤独症,尚未明确。
  儿童孤独症常见以下行为特征:
  (1)与周围人的情感交流受限,孤独症患儿不同程度地分不清亲人或陌生人,在与人交往过程中,不望对方的脸,回避眼光的接触。喜欢独处,一人玩反而自在,缺乏同情心。
  (2)保持固定生活模式:对生活环境要求刻板,家具的移动,以至饮食起居的改变都会引起他们情绪变化,比如:发怒或恐慌,有些患儿严重得甚至连吃饭时坐的位置、碗和筷放在什么地方,甚至上厕所用哪个便池都不能改变。
  (3)言语障碍,儿童孤独症患者多言,但领会能力低,常用词不当。发音不正,发出怪腔怪调。
  (4)孤独症患儿常坐不住,活动过度,以脚尖走路。他们的注意力分散,习惯东张西望,或作伸颈、装相等怪异姿势。
  一般来说,具有以下三个基本特征,就可诊断为儿童孤独症:
  (1)对人普遍缺乏情感反应,严重影响社会性相互作用;
  (2)语词性和非语词性交往和想象性活动严重减少;
  (3)刻板、重复或仪式性行为,严重约束生活活动。通过治疗,可减少行为症状、促进发育,常见的治疗方法有:游戏、拥抱、家庭、药物疗法等。
  如需进一步了解,请查阅《医学心理学》与《心理保健》。
  
  儿童孤独症是一种什么病 2001年1月11日16:54:4北大精神卫生研究所杨晓玲
  儿童孤独症是一种发生在儿童早期的全面性精神发育障碍性疾病,主要有以下表现:
  (1)孤独离群,不会与人建立正常的联系。即是缺乏与人交往。交流的倾向,有的患儿从婴儿时期起就表现这一特征,如从小就和父母亲不亲,也不 喜欢要人抱,当人要抱起他时不伸手表现期待要抱起的姿势,不主动找小孩玩,别人找他玩时表现躲避,对呼唤没有反应,总喜欢自己单独活动,自己玩。有的患儿 虽然表现不拒绝别人,但不会与小朋友进行交往,即缺乏社会交往技巧,如找小朋友时不是突然拍人一下,就是揪人一下或突然过去搂人一下,然后自己就走了,好 像拍人、揪人不是为了找人联系而只是一个动作,或者说只存在一个接触的形式,而无接触人的内容和目的。他们的孤独还表现在对周围的事不关心,似乎是听而不 闻,视而不见,自己愿意怎样做就怎样做,毫无顾忌,旁若无人,周围发生什么事似乎都与他无关,很难引起他的兴趣和注意,目光经常变化,不易停留在别人要求 他注意的事情上面,他们似乎生活在自己的小天地里。另外他们的目光不注视对方甚至回避对方的目光,平时活动时目光也游移不定,看人时常眯着眼,斜视或余光 等,很少正视也很少表现微笑,也从不会和人打招呼。
  (2)言语障碍十分突出。大多数患儿言语很少,严重的病例几乎终生不语,会说会用的词汇有限,并且即使有的患儿会说,也常常不愿说话而宁可以 手势代替。有的会说话,但声音很小,很低或自言自语重复一些单调的话。有的患儿只会模仿别人说过的话,而不会用自己的语言来进行交谈。不少患儿不会提问或 回答问题,只是重复别人的问话。语言的交流上还常常表现在代词运用的混淆颠倒,如常用“你”和“他”来代替他自己。还有不少孤独症儿童时常出现尖叫,这种 情况有时能持续至5~6岁或更久。
  (3)兴趣狭窄,行为刻板重复,强烈要求环境维持不变,孤独症儿童常常在较长时间里专注于某种或几种游戏或活动,如着迷于旋转锅盖,单调地摆 放积木块,热衷于观看电视广告和天气预报,面对通常儿童们喜欢的动画片,儿童电视,电影则毫无兴趣,一些患儿天天要吃同样的饭菜,出门要走相同的路线,排 便要求一样的便器,如有变动则大哭大闹表现明显的焦虑反应,不肯改变其原来形成的习惯和行为方式,难以适应新环境,多数患儿同时还表现无目的活动,活动过 度,单调重复地蹦跳、拍手、挥手、奔跑旋转,也有的甚至出现自伤自残,如反复挖鼻孔、抠嘴、咬唇、吸吮等动作。
  (4)大多智力发育落后及不均衡。多数智力发育比同龄儿迟钝,少数患儿智力正常或接近正常。但其在智力活动的某一方面有的又出奇地好,令人不 可思议,有不少患儿的机械记忆能力很强,尤其对文字符号的记忆能力。如有位3、4岁患儿特别喜欢认字,见字就主动问念什么,并且只问一次就记住,为此他能 毫不费力地流利地阅读儿童故事书,说明他掌握不少词汇,但当他要用词来表达自己的意思时则存在明显的困难,说明他们存在理解语言和运用语言能力方面的损 害。
   儿童孤独症主要症状
  (2001-09-2612:59:03)
  儿童自闭症又称孤独症,是一种较为严重的发育障碍性疾病。该病男女发病率差异显著,在我国男女患病率比例为6—9:1。其主要症状为:
  1、社会交流障碍一般表现为缺乏与他人的交流或交流技巧,与父母亲之间缺乏安全依恋关系等。
  2、语言交流障碍语言发育落后,或者在正常语言发育后出现语言倒退,或语言缺乏交流性质。
  3、重复刻板行为。
  4、智力异常70%左右的孤独症儿童智力落后,但这些儿童可能在某些方面具有较强能力,20%智力在正常范围,约10%智力超常,多数患儿记忆力较好,尤其是在机械记忆方面。
  5、感觉异常表现为痛觉迟钝、对某些声音或图像特别的恐惧或喜好等。
  6、其他常见行为包括多动、注意力分散、发脾气、攻击、自伤等。这类行为可能与父母教育中较多使用打骂或惩罚有一定关系。
  
  婴儿孤独症会影响小儿智力发育吗?
  婴儿孤独症是一种年幼时起病的精神障碍,与先天性风疹有关,常伴有癫痫。孤独症患儿大多智力落后,但可在音乐、记数字方面有特殊的才能。
  关于婴儿孤独症病因的意见目前还不统一,多数研究者认为此类行为异常是由于器质病变。患儿往往有较多的体格异常及脑电图变化。
  本病的表现常见有言语困难和社会交往困难。出生后2个月还不出现笑,4个月在母亲拥抱之下不感快慰,不能与人有眼对眼的注视。不能与周围人保 持良好的社会交往,遇环境改变不能很好适应,多有刻板动作,智力落后占75%以上,仅1/3的病儿可勉强独立自主,有些伴有癫痫或其他神经系统显著异常。
  本病的治疗仍处于探索阶段,语言训练、行为矫正和心理指导,是较重要的治疗手段,较常用药物有氟哌啶醇、舒必利、氟苯丙胺等。
  因此当家长发现小儿出生后2个月还不会笑,对周围事物反应差,要密切观察小儿成长情况,如不愿与小朋友一起玩耍,不愿参加集体游戏,不喜欢模 仿大人的动作,语言单调,经常说重复语言、刻板语言或自造词句,社交活动中面部表情、身体姿势或手势运用不当,要高度怀疑本病,送医院治疗。同时加强语言 训练,矫正异常行为。
  
  
  
  参考:儿童孤独症护理||儿童孤独症的其他看法或研究成果||营养不良与儿童孤独症
  
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19 April 2011

Health in the movies

Sunday February 27, 2011

Health in the movies

By TAN SHIOW CHIN
starhealth@thestar.com.my


The sense of frustration and triumph of those struggling with sickness have been aptly captured in many films that have been brought to us by Hollywood over the years.

FOR movie fans out there, tomorrow will be an interesting day as the 83rd Academy Awards gets underway at 8.30am (5.30pm, Feb 27, in Los Angeles, California).

We will find out which movies are deemed the best of 2010 by the Hollywood movie industry in 24 categories ranging from Best Picture and Best Actor/Actress to Cinematography and Film Editing.

What does this have to do with health, you might ask.

King George VI (Colin Firth, right) delivering his radio broadcast without stammering, with the help of Logue (Geoffrey Rush) in The King’s Speech

It so happens that two of this year’s Best Picture nominees feature health-related conditions as an integral part of their story.

They are The King’s Speech (featured below) and Black Swan.

The King’s Speech focuses on how the United Kingdom’s King George VI overcame his stammering problem, while Black Swan is about a disturbed ballerina who slowly loses her grip on reality as she tries to perfect her performance of the deceitful, seductive Black Swan in the ballet Swan Lake.

Illnesses, mental health issues and developmental disorders are fertile fodder for movie-makers as they provide a solid hook around which to build a story, and are usually guaranteed to elicit emotional responses from audiences.

Schizophrenia not only affects the patient, but also their family members, as shown by Nash (Russell Crowe, left) and his wife Alicia (Jennifer Connelly) in A Beautiful Mind .

Often, these films are inspired by or based on real people and their lives.

Many such movies have won or been nominated for an Oscar over the years. We take a look at some of them here:

The Three Faces of Eve (1957)

Won: Best Actress in a Leading Role (1958) – Joanne Woodward

This film is based on the true case of Christine Costner Sizemore, an American woman who suffered from multiple personality disorder, now called dissociative identity disorder (DID).

Dustin Hoffman (right) quite accurately portrays the typical behaviour of a person with autism in Rain Man – avoiding eye contact, exhibiting little emotion, and repetitive behaviour. However, it should be noted that not all autistic people have savant abilities, nor are all savants autistic.

Woodward plays Eve White, a timid housewife who suffers from frequent headaches and blackouts. During her sessions with psychiatrist Dr Curtis Luther (Lee J. Cobb), two other distinct personalities emerge under hypnosis – sexy, outgoing Eve Black, and the stable Jane.

After realising that the cause of her split personalities is due to a traumatic childhood incident, only Jane’s personality is left in the body and she goes on to have a normal, happy life.

While the movie seems to show a fairly quick resolution of the disorder, the fact is DID takes many years to treat.

Sometimes, treatment does not focus so much on merging the personalities into one, but on treating the symptoms of the disorder to allow the patient to live a functional life.

The number of personalities a patient might manifest can range from two to over 100. Sizemore actually had over 20 distinct personalities in real life.

Tom Hanks won an Oscar for his portrayal of Andrew Beckett in the film Philadelphia, one of the first mainstream Hollywood movies to tackle the issue of HIV/AIDS and homosexuality.

Most mental health professionals believe that DID is caused by some form of trauma in the person’s past, as the movie shows.

Rain Man (1988)

Won: Best Picture (1989); Best Actor in a Leading Role – Dustin Hoffman; Best Director – Barry Levinson; Best Writing, Original Screenplay.

Nominated: Best Art Direction (Set Decoration); Best Cinematography; Best Film Editing; Best Music, Original Score.

Hoffman stars as the autistic Raymond Babbitt, whose existence is newly discovered by his brother Charlie (Tom Cruise) after their father dies and leaves his multi-million dollar fortune to him.

Charlie takes Raymond on a road trip from the Ohio mental institution he lives in to California, in his bid to get half of the inheritance.

Along the way, he discovers Raymond’s savant abilities in memory recall and mathematics, and even takes advantage of his abilities to gamble in Las Vegas.

Many movies focusing on health issues are inspired by real people or events, like the movie Awakenings, which was based on Dr Oliver Sacks’ non-fiction book of the same name.

Hoffman quite accurately portrays the typical behaviour of a person with autism – avoiding eye contact, exhibiting little emotion, and repetitive behaviour.

However, it should be noted that not all autistic people have savant abilities, nor are all savants autistic.

Like Raymond, savants demonstrate genius-level abilities in one or more areas – like music, art and mathematics – in sharp contrast to their impaired functioning in daily life.

The character was inspired by real-life savant Kim Peeks, who however, was not autistic.

My Left Foot (1989)

Won: Best Actor in a Leading Role (1990) – Daniel Day-Lewis; Best Actress in a Supporting Role – Brenda Fricker

Nominated: Best Picture; Best Director – Jim Sheridan; Best Writing, Screenplay Based on Material from Another Medium.

Based on the true story of spastic quadriplegic Christy Brown (Day-Lewis), My Left Foot is about how he overcame his limitations to become a painter, poet and author.

Able only to control his left foot and only make guttural sounds, Brown is mistakenly believed to be mentally retarded until he is 10-years-old.

But his mother (Brenda Fricker) sees there’s more in him, and teaches him to write and draw with his left foot.

Spastic cerebral palsy is the most common type of cerebral palsy. Most people tend to assume that patients with cerebral palsy are mentally challenged, but as this movie shows, these people can have normal, and even, above-average intelligence.

As it is a lifelong disorder, the main goal of treatment is to enable the patient to live as independently as possible through physical and occupational therapy, and medication.

It is quite possible for a cerebral palsy patient to live independently or with only some help, depending on the severity of their condition.

Awakenings (1990)

Nominated: Best Picture (1991); Best Actor in a Leading Role – Robert De Niro; Best Writing, Screenplay based on Material from Another Medium.

Starring Robin Williams and De Niro, this movie is about a doctor who discovers a way to “wake up” a ward full of comatose patients who have encephalitis lethargica, or the sleepy sickness.

Based on a non-fiction book by Dr Oliver Sacks recounting his efforts to treat patients with the condition in the 1960s, the movie shows how Dr Malcolm Sayers (Williams) – the fictional Dr Sacks – comes up with the idea to use the then-new drug L-dopa to treat the patients, and the effects that the drug and their long comatose state has on the patients, and those around them.

Awakenings shows us the most severe manifestation of the disease, where patients enter a coma-like state called akinetic mutism.

More typical symptoms include high fever, headache, double vision, delayed physical and mental response, and lethargy.

As mentioned in the movie, there was an outbreak of encephalitis lethargica cases between 1917 to 1928 around the world, the effects of which were patients like those shown.

The cause of the illness is unknown, and treatment is still with L-dopa or other similar drugs, although the effects, as shown in the movie, can be shortlived.

Lorenzo’s Oil (1992)

Nominated: Best Actress in a Leading Role (1993) - Susan Sarandon; Best Writing, Screenplay Written Directly for the Screen

This movie is based on the real-life story of two parents who are determined to find a cure for their son’s rare degenerative brain disorder after being told by doctors that there is no treatment for the disease.

Lorenzo has adrenoleukotrophy, which is an inherited disease that slowly damages the myelin sheath on the body’s nerves, as well as the adrenal glands, through the accumulation of very long-chain fatty acids (VLCFA) in the body.

This results in progressive disability as more and more nerves become damaged as the disease advances.

The movie shows the most common, and most severe, form of the disease.

At the time of Lorenzo’s diagnosis, there was no treatment for the disease, and there is currently still no cure for it.

However, his parents — Augusto (Nick Nolte) and Michaela Odone (Sarandon) — discover that the progression of the disease can be slowed down by taking a special blend of oils, which is now called Lorenzo’s Oil.

This oil, combined with a diet low in VLCFA, worked for Lorenzo by slowing down the progress of the disease.

However, it has been found that this treatment does not work for all patients, and research is currently ongoing to determine the reasons behind this, and hopefully, improve the treatment.

Philadelphia (1993)

Won: Best Actor in a Leading Role (1994) – Tom Hanks; Best Music, Original Song – Streets of Philadelphia

Nominated: Best Makeup; Best Music, Original Song - Philadelphia; Best Writing, Screenplay Written Directly for the Screen

Philadelphia was one of the first mainstream Hollywood movies to tackle the issue of HIV/AIDS and homosexuality.

Inspired by the real-life story of Geoffrey Bowers, who sued his law firm for unfair dismissal in one of the first AIDS discrimination cases in America, Hanks plays attorney Andrew Beckett, who is starting to display visible signs of AIDS.

A closet homosexual, Beckett is unfairly dismissed by his law firm because of his health status, and decides to sue them for their actions.

The movie shows the many misconceptions about the disease, and the unwarranted discrimination against those with HIV/AIDS, including the belief that HIV is passed on through skin contact.

Homophobic lawyer Joe Miller (Denzel Washington) initially also has misconceptions about how HIV is contracted, but changes his attitude when a doctor explains to him how HIV is really passed on.

Miller eventually represents Beckett in his lawsuit, and comes to know and accept Beckett as a friend.

A Beautiful Mind (2001)

Won: Best Picture (2002); Best Actress in a Supporting Role - Jennifer Connelly; Best Director - Ron Howard; Best Writing, Screenplay Based on Material Previously Produced or Published.

Nominated: Best Actor in a Leading Role – Russell Crowe; Best Editing; Best Makeup; Best Music, Original Score.

Starring Russell Crowe as Economics Nobel laureate John Forbes Nash Jr, this movie is based on the life of the brilliant mathematician, who has schizophrenia.

The hallucinations, paranoia and delusions of grandeur experienced by Nash in the movie are typical symptoms of paranoid schizophrenia. These symptoms severely affect his ability to function as a normal member of society, and even prove to be dangerous to those around him.

As the movie is from Nash’s point of view, it gives an insight into the way a schizophrenic patient sees his world, and how real his symptoms feel to him.

The movie also shows how family members – in this case, his wife Alicia (Jennifer Connelly) – are affected by the disease, and the hardship they have to undergo.

The problems with treatment and patients not complying with their medication are also highlighted.

While A Beautiful Mind is not an entirely accurate portrayal of Nash’s life, it gives a true picture of the disease and the effects it can have on patients and their families.

The King’s Speech (2010)

Won: To be announced tomorrow.

Nominated: Best Motion Picture of the Year (2011); Best Performance by an Actor in a Leading Role – Colin Firth; Best Performance by an Actor in a Supporting Role – Geoffrey Rush; Best Performance by an Actress in a Supporting Role – Helena Bonham Carter; Best Achievement in Directing – Tom Hooper; Best Achievement in Art Direction; Best Achievement in Cinematography; Best Achievement in Costume Design; Best Achievement in Editing; Best Achievement in Music Written for Motion Pictures, Original Score; Best Achievement in Sound Mixing; Best Writing, Screenplay Written Directly for the Screen.

The Duke of York (Colin Firth), who later becomes King George VI, has stuttered, or stammered, since he was a child.

Unfortunately, his disability is a big issue as he is required to speak frequently in public.

He seeks the help of many doctors, but has no success dealing with his stutter until he meets Australian speech therapist Lionel Logue (Geoffrey Rush).

The movie is a fairly accurate portrayal of the events it shows, starting from the speech filled with stuttering that the duke delivers at the close of the 1925 British Empire Exhibition, to the smooth-flowing radio broadcast he made with Logue’s help after the 1939 announcement that the British Empire is at war with Germany.

Many of the techniques used by Logue, who was considered ahead of his time, are still being used today to help stutterers.

However, while the film suggests that the duke’s stutter was caused by nervousness and emotional distress, research has shown that stutterers are not more prone to nervousness or anxiety than people who speak smoothly.

Many children stutter, but eventually grow out of it, and the true cause of continued stuttering into adulthood is not really known.

It is thought that factors like genetics, child development and neurophysiology might play a role in the condition.


How monologues can help your child

9 February 2011

By PANG HIN YUE

FANS of sports and movies have something in common. They display similar intensity as the players and actors even though they are mere spectators. The brain cells that are responsible for the range of gestures and emotions expressed are called mirror neurons and they have created quite a buzz among researchers.

They believe mirror neurons could well be the key to understanding and overcoming developmental delays. So much so that the New York Times declares: “The discovery (of mirror neurons) is shaking up numerous scientific disciplines, shifting the understanding of culture, empathy, philosophy, language, imitation, autism and psychotherapy.”

At the forefront expounding the theory is neuroscientist Marco Iacoboni. In his book Mirroring People, he says mirror neurons are “smart cells in our brain that allow us to understand others.”

Activating articulation: Wendy Goh found that Mediated Soliloquy has helped her six-year-old daughter Cassandra with speech.

Technological advancement has enabled Iacoboni and his counterparts to conduct non-intrusive imaging of brain activities and establish the connectivity in language, emotions and behaviour vis-à-vis the firing of mirror neurons.

Weighing nearly 2kg with a fat content of 60%, the brain is as complex as it is fascinating. For the professionals and caregivers working with special needs children, the discovery of mirror neurons in Italy a decade ago and their links to language acquisition, empathy and social behaviour offers them a fresh way to reach out to those who have deficits in these areas.

In fact, researchers believe that autism is the result of impaired mirror neurons. So the solution, they figure, is to repair the neurons by creating opportunities for them to be activated and enhanced.

Eminent psychologist Dr Reuven Feuerstein in his book Soliloquy And Beyond, which he co-authored with Prof Dr Louis Falik and Krisztina Bohacs, says the breakthrough in the study of mirror neurons validates the belief that he has held over the past 60 years. “The brain is modifiable when given the right mediation,” he says.

Whether it is due to genetics or brain injury, persons with disabilities can still realise their full potential when given the right input to rewire the brain. He calls his approach “mediated learning-experiencing”.

Supporting the assertion that there is a direct, reciprocal relationship between the active (and motor) expression of language and neural development, he notes that mediation entails providing language models for the developing learner. In doing so, “we activate neural circuits in the brain that in turn further activate other cortical functions.”

Thus, he purposes Mediated Soliloquy (MSL) which would have the great English poet and writer, William Shakespeare smiling. The function of soliloquy or monologue or self-talk in Shakespeare’s Hamlet, for instance, is for the main character to speak his thoughts aloud for the benefit of the audience.

Drawing on the art of soliloquy and merging it with the findings in neurosciences and his own experiences in training families with learning issues, MSL is probably best described as a marriage between “behavioural sciences and neurophysiology.”

“The purpose is to mediate language awareness, acquisition and development. Parents verbalise within the hearing of the child but without expectation that the child will or should respond. The verbalisation is designed to be overheard but not responded,” he explains. In short, MSL is a precursor to a child acquiring language.

To Feuerstein and colleagues, talking to oneself is a natural aspect of thinking and is thus accessible for both adult and child. Stressing that MSL is adult language in form and structure, they say it exposes the child to speech in a very intentional manner directed initially towards language stimulation.

“Soliloquy in MSL presents the learner with language models, incorporating elements of articulation, semantics, syntax and pragmatic meaning,” they note. All of which with the purpose of helping the child overcome deficits, stimulate growth and bring the learner into a more normal social environment.

So instead of despairing that their child has yet to utter his first word or is inattentive with poor eye contact, parents are urged to create a “rich linguistic environment” by way of having monologues.

These soliloquies, however, are by no means random, meaningless rumblings. They are to be based on intentionality, reciprocity, transcendence (generalisation) and mediation of meanings.

Nevertheless, MSL , the writers remind, is not a recipe book to be applied in a cookie cutter manner but a road map which is followed in accordance with preferred routes, conditions of desired experience and the like.

“Mediation creates a need – implicitly at first – to participate in the communication, to feel a need for engagement at the receptive level,” they say.

It is for this very reason that Wendy Goh, a mother of three, sought help from Feuerstein-certified therapists Foo Siang Mun and K.C. Soo.

Although her daughter Amanda Goon, 11, and her son Joshua, seven, are smart children with good grades, she noticed that they seemed to be struggling internally.

“They appeared to be unable to articulate their thoughts aloud. Added to that, Joshua had problems with memory retention. All of which had affected them behaviourally,” she explains.

But as Wendy learns how to mediate, shaping and modelling language with meanings, both her kids are better at expressing themselves.

“Previously, the house was pretty quiet as everyone just went about doing his or her own thing. But these days, I am pleased to hear chatter and see better interaction among the siblings,” she says.

Wendy is happy that her youngest daughter, Cassandra, six, has made great strides in language and social interaction.

Cassandra, who has Down syndrome, had little speech and used to crawl under the table to hide when Wendy first brought her to see Foo and Soo six months ago. She had been undergoing speech therapy elsewhere but there was no progress. Under Foo and Soo’s guidance, Cassandra is turning into a spunky girl, ever willing to engage in games and breaking out in spontaneous speech.

“Just the other day, Cassandra told her brother: ‘No, no, no, no TV. Eat lunch first. Naughty Josh!” recalls Wendy. That is truly music to her ears because Cassandra used to struggle to even utter single syllables.

For Foo and Soo, nothing is more gratifying than to see children under their care making significant progress. After more than five years as a therapist, Soo, a science graduate, continues to challenge himself to read and apply what he learns about the brain to help his students.

“We create the demands (for the students) to learn, with the goal that they will transcend the skills they gain to other activities that require similar cognitive skills,” he explains.

To do so, the students must acquire language. “Language is the key to a child’s development,” he says. Only then are they modifiable, flexible and can adjust accordingly to the environment, he adds.

To achieve their goals, Soo and Foo have become rather creative in finding solutions to help their students enhance their audio and visual processing. Visor and blinkers are used to help students limit their visual range in order to stay on task. Aquarium hose is used, as what Foo calls, a “whisper phone” to reduce ambient noise so that the students are able to focus on what is being said to them.

Foo, who holds a masters in environmental sciences and has been a therapist for the past nine years, says she has no regrets trading her previous job in management consultancy to work with persons with learning difficulties. The tangible progress made by her students using the Feuerstein approach has more than made up for the perks she had enjoyed working in a multinational corporation.

In his famous soliloquy, Hamlet says: “To be or not to be.” For Soo and Foo, the choice is obvious.

> Professor Dr Louis Falik, a member of the Feuerstein Institute and the co-author of Soliloquy And Beyond, will be conducting a two-day seminar (March 25-26) on Mediated Self-Talk For Language Development at Tropicana Golf and Country Resort, Petaling Jaya, Selangor. Dr Falik, a seasoned clinical psychologist and Emeritus Professor of Counselling from San Francisco State University, is also available to conduct individual clinical assessments. For those who register before Feb 21, the fee for a single participant is RM790 and for a group of three, RM730 per person. For details, contact Foo (019-3222 952 / foosiangmun@gail.com) or Soo (017-8868 295 / kcsoo@gmail.com).


My daughters had autism


By MARISSA BAGSHAW


A mother recalls her struggle with autism, and assures other parents that children with autism can improve and even recover, with the right treatment.

I AM the proud mother of two wonderful daughters, Maya, who is now five-and-a-half years old, and Yasmin, who just celebrated her fourth birthday recently. They are both in a mainstream Montessori kindergarten now.

Very soon Maya will be enrolled for Year One. Just a short two years ago, we didn’t dare dream that Maya would be ready for a big mainstream school with other neurotypical children. But now Maya is thriving in the mainstream school, with no shadow aide or additional support therapy. Looking at her, she seems like any typical girl.

Maya was diagnosed with moderate autism at age two years and eight months in June 2008. She showed many autistic symptoms, eg spinning, tip toe walking, looking out of the corner of her eyes, no eye contact. She had many tantrums and mood swings, was very hyperactive and would climb everything.

She was a very picky eater, had terrible constipation, and constantly licked everything, even the floors. She would wake up at night crying or laughing, she was lost in her own world, and couldn’t bear to be in strange places.

Maya was self-abusive. She would scratch herself until she bled, sometimes pull her hair out by the clumps. She banged her head against the floor or walls repeatedly.

Maya had a lot of auditory and visual sensory issues. She lost many of the skills and words she had previously learnt. Maya had terrible echolalia (repeating words or sentences over and over). She still knew some words, but all her speech was unmeaningful or out of context. She had very little language comprehension or receptive language.

Maya never called me mummy.

Autism Spectrum Disorder affects each child differently. Every child is unique, and presents different sets of physical and physiological symptoms. The treatments are not one-size-fits-all. – AP

A gradual descent

We didn’t immediately notice Maya’s regression. I had just given birth to Yasmin, and was very preoccupied with a newborn baby. We dismissed Maya’s worsening behaviour as attention-seeking ploys.

Within the next year, she became more and more uncontrollable and extreme. My maternal instincts told me something was very wrong with Maya, and my research on children’s behaviour led to the suspicion of autism.

I finally found a developmental paediatrician, and she confirmed my suspicions and diagnosed Maya with moderate autism. Another child psychiatrist and a clinical psychologist also concurred.

Her sister Yasmin regressed after a rotavirus illness at age one year and 10 months. She started showing many autistic behaviours, eg terrible tantrums, mood-swings, incredibly non-compliant, constantly jumping and climbing. Yasmin became very hyper. She would scream and shout all day long.

She had a lot of sleep issues, and from being a good eater, she lost all her appetite and lost weight. For the next one year, her bowel movements would alternate between diarrhoea and constipation. For nine months, she had chronic diarrhoea. Yasmin would constantly knock on the walls, patting and rubbing surfaces. Her development plateaued, though she still had adequate speech and language skills.

Yasmin’s regression was very rapid compared to Maya, but by then we were familiar with autism signs and symptoms. Together with biomedical doctors, we worked very hard to prevent her from developing autism fully. She was never formally diagnosed with autism. Gradually she improved, and is no longer at risk of autism.

Both girls had normal age appropriate development until they regressed.

First reactions

When we first received Maya’s autism diagnosis, my reaction must have seemed shocking. Whereas most parents felt anger and were in denial, I felt relief. I knew what we were fighting against. My husband was shocked and in denial, but soon after, he fully accepted the diagnosis, and we both worked together as a team to help Maya.

It also made us understand why Maya behaved the way she did. It wasn’t because she was naughty, or we were bad parents. Maya had a developmental disorder which caused her to behave and act the way she did. However, at times, the sadness and pain affected us, but we still had to move forward.

Our children needed treatment as soon as possible, so we couldn’t afford to wallow in our own grief.

When I was researching autism, I noticed similarities between certain children and Maya. She was addicted to milk and bread. After she drank milk, she seemed dazed and woozy. But one hour later, she would have massive tantrums and meltdowns. Even my husband noticed Maya’s behaviour after drinking milk, and how she seemed addicted by wheat-based foods.

We immediately started Maya on the Gluten Free and Casein Free Diet (GFCF diet) on the day she was diagnosed with autism.

We replaced her favourite fresh cow’s milk with soy formula, threw out all bread and biscuits made of wheat, and replaced them with rice crackers and gluten-free bread.

I also improved her diet by eliminating all MSG, preservatives, additives, colourings, artificial flavourings, and artificial sweeteners such as aspartame and high fructose corn syrup.

Within one week on the diet, Maya made her first meaningful one -word request. She looked me in the eyes and said “milk”. Before this, whenever she wanted something, she would either pull me to the kitchen, take my hand to point it to the fridge or cupboard, or she would scream and shout while we tried to figure out what she wanted.

Gradually, she learnt to ask for “cookies”, “toy”, or “tv”. Her tantrums, brain-fog, and mood swings were less frequent and she seemed more aware.

Later on, we refined the diet to a soy-free, egg-free, and low sugar diet, and substituted soy milk with rice milk, and saw more improvements. We later found out through medical testing that both the girls had food intolerance to casein and gluten. Casein is the protein in cow and goat’s milk, whereas gluten is the protein in wheat, oats, barley, and rye.

I started researching traditional therapies recommended by doctors. Instead of speech therapy, occupational therapy, and special education, we decided Applied Behavioural Analysis (ABA) was the most appropriate therapy for Maya.

We noticed small but gradual improvements in the first six months, but once we started intensive biomedical treatment, everyone noticed how fast Maya was progressing. The diet and biomedical supplements helped with her sleep issues, calmed down her hyperactivity, and enabled her to concentrate and focus.

A combination of diet and vitamins healed her body and she was no longer in constant pain. This enabled her to be well rested and able to focus during therapy sessions.

Allergy issues

Many children with autism, ADHD, Aspergers, allergies, and even asthma, have many allergies and sensitivities to food and other environmental elements. The GFCF diet does not cure autism. Rather, it eliminates allergens from a sensitive child.

Food allergies and food intolerance can cause physical and physiological symptoms such as dark circles under the eyes, red-rimmed eyes, and other allergy symptoms, such as runny nose, hives or rashes. It may also cause many gastrointestinal (GI) symptoms, such as tummy pains, bloating, wind pain, reflux, abnormal stools, constipation or diarrhoea in some children.

We have been doing the GFCF diet and egg-free diet for both girls since June 2008. At times, we also implemented the low-salicylates diet, corn-free diet, and rotation diet.

Now that Maya and Yasmin’s guts have healed tremendously, they can now tolerate reasonable amounts of gluten and casein.

What helped Maya to recovery was a combination of the GFCF diet, ABA, and intensive biomedical intervention. For Yasmin, the GFCF diet, biomedical treatments concentrating on GI disorders, and homeopathy helped her.

Biomedical interventions are non-drug treatments which consist of vitamins, minerals, probiotics, essential fatty acids, amino acids and naturopathic remedies. It seeks to address the root causes of autism, namely nutritional deficiencies, GI disorders, chronic infections such as bacterial, fungal, viral and parasitic, immune modulation, oxidative stress, inflammation, reducing the toxic load, detoxing, and repairing the damaged metabolic and mitochondrial issues.

I consult with integrative health practitioners who are MDs (medical doctors) and have received training with the Autism Research Institute (ARI). Maya had multiple medical issues such as GI disorders, multiple infections, nutritional deficiency, maldigestion, malabsorption, high oxidative stress, gut and brain inflammation, metabolic and mitochondrial disorder, and immune dysfunction.

We have addressed many of these issues, though there are still lingering health issues to treat.

The road to recovery

Maya slowly but gradually improved. Her behaviour, cognition, and self-help skills became better. From a pre-verbal child, Maya gradually learned to speak in two to three words sentences. I remember counting each word she uttered in a sentence, and I finally stopped counting when she reached nine-word sentences.

Soon, she went on to multi-sentence speech and back-to-back conversations. It took us a lot of time and hard work. Blood, sweat and tears got us here. There is no such thing as a quick fix or miracle pill. Autism is a complex disorder, there are no shortcuts to recovery.

Maya recovered in two years. In June 2010, at age four years and eight months, after a thorough psychological assessment by two clinical psychologists, Maya was declared to be within the non-autistic range. She no longer has an autism diagnosis.

In essence, Maya has recovered from autism.

She no longer requires specialised therapy. She is in a mainstream Montessori kindergarten with no shadow aide. Her current school does not know of her previous diagnosis, and they have never noticed anything different about Maya.

Maya now enjoys school, has lots of friends, and enjoys many activities. She is a very good reader, she enjoys music, and self-taught herself to play the piano. She goes to ballet and jazz dancing classes.

Maya is loving, affectionate, sociable, and well-behaved. Her future is very bright indeed.

Yasmin is no longer at risk of autism. We have successfully prevented her from developing autism. We are now working towards improving her health issues, namely gastrointestinal disorders and immune dysfunction. She is a happy and loving child, very chatty and charming, and absolutely loves her big sister.

Nearly three years ago, Maya’s future was very bleak. Indeed, we were told there is no cure, no hope.

Maya was prescribed mind-numbing neuropsychopathic medications, which we refused. We were told to plan for special schools and long-term care for Maya when she gets to adulthood, possibly institutionalisation.

I’m glad I didn’t listen to those experts.

Though autism was devastating to our family, in the end, it brought us closer and stronger. Maya’s and Yasmin’s strength and resilience in overcoming autism offers hope to us all.

Autism Spectrum Disorder affects each child differently. Every child is unique, and present different sets of physical and physiological symptoms. The treatments are not one-size-fits-all.

Keep a close eye on your child’s development, and consult a developmental paediatrician if you suspect autism. The earlier the diagnosis, the earlier the treatment, and the better chances for recovery. Regardless of your child’s age now, you still have hope. Do your own research and listen to your own instincts. You know your child better than any doctor or professional.

If your child has been diagnosed with autism, do try the GFCF diet. Please consult with a biomedical doctor, regardless how young or old your autistic child is.

Please sign up to the KL Biomed forum at http://health.groups.yahoo.com/group/klbiomed/. My blog, Rainbow in the Sky, is inspired by our journey through autism. Please visit www.mayaviktoria.blogspot.com.

Autism is treatable, and there is always hope.

Maya and Yasmin are blossoming into wonderful little girls, I see the young women they will turn out to be in the future. Maya wants to marry Prince Charming, and Yasmin wants to be a ballerina. You can do it!

This is not to be construed as medical advice. I am not a medical doctor nor am I qualified to offer professional advice. This is based on my experiences with my two daughters, as well as my research and understanding from what I learnt at various seminars and conferences. Please consult with a biomedical doctor to manage your child’s treatment.



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Aktiviti PKKII - Feb 2010

26 Feb 2010 - Lawatan Dan Sumbangan
daripada Pon 72

Pon 72前来参观大爱之家。他们除了捐赠一些生活用品之外,还派送红包给大爱的儿童。

Pon 72 membuat lawatan. Di samping itu mereka juga memberi sumbangan berbentuk barang-barang keperluan dan angpau kepada budak PKKII.


28 Feb 2010 - Rumah Terbuka PKKII

顾问与理事们也一同参与其盛欢庆元宵节。
Penasihat dan penyokong turut hadir memberi sokongan sempena meraikan Chap Goh Meh.

裴瑞亭顾问也在当天捐了RM 1,500给大爱。
Penasihat Pay Wee Hing turut memberi sumbangan sebanyak RM 1500.


众人也参与分发红包给大爱的孩子。
Orang awam juga memberi angpau kepada kanak-kanak PKKII.


18 April 2011

How to Interact With a Child With Autism









Autism was once thought an "incurable" disorder, but that idea is falling by the wayside in the face of knowledge and understanding that is increasing every moment. Every day, children & adults with autism are showing us that they can overcome, compensate for and otherwise manage many of autism's most challenging characteristics. Educating those around our children with a simple understanding of autism's most basic elements has a tremendous impact on their ability to move & grow towards productive, independent adulthood.

Autism is an extremely complex disorder but four major areas can be identified: sensory processing challenges, speech/language delays & impairments, lack of social interaction skills and whole child/self-esteem issues. These four elements may be common to many children, keep in mind the fact that autism is a "spectrum disorder": no two (or ten or twenty) children with autism will be exactly alike in their abilities. Every child will be at a different point on the spectrum. Just as importantly, every parent, teacher and caregiver will be at a different point on the spectrum as well. Child or adult, each will have a unique set of needs.

There is a grammar school in South Jersey that has implemented a program called "Inclusion Education" for the neurotypical students & peers of children with Autism and the teachers who have not experienced a student with autism. A Therapist from the program goes into the classrooms weekly to talk about what autism is and who these children are. They are given strategies and ideas on how to help include them and how to calm them if they are agitated. My personal experience with this program is that the neurotypical students go over and above with their attempt to include these children as part of their group. The compassion is touching to observe and it absolutely helps the child with autism to adjust, and appropriately respond to their environment and the people around them.

Here are 10 ways to interact with the child with Autism. These are adapted & reprinted from a separate article entitled "10 Things A Child With Autism Wishes You Knew". The main thing is to set aside pre-conceived notions about what autism is. If you see an apparent "bratty child throwing a tantrum" in a store, think again. Instead of being afraid or quick to judge, ask instead how can you help.

Difficulty:


Moderately Challenging

Instructions


things you'll need:

  • An open mind
  • willingness to learn
  • compassion
    • 1
      Keep in mind that these children & young adults are first and foremost a child. they have autism. They are not primarily "autistic." Autism is only one aspect of their total character. It does not define them as a person. Are you a person with thoughts, feelings and many talents, or are you just fat (overweight), myopic (wear glasses) or klutzy (uncoordinated, not good at sports)? Those may be things that we see first when we meet you, but they are not necessarily what you are all about.

      As an adult, you have some control over how you define yourself. If you want to single out a single characteristic, you can make that known. As a child, they are still unfolding. Neither you nor they yet know what they may be capable of. Defining them by one characteristic runs the danger of setting up an expectation that may be too low. And if a child-any child- gets a sense that you don't think they "can do it," a natural response will be: Why try?
    • 2
      Imagine that your sensory perceptions are disordered. Sensory integration may be the most difficult aspect of autism to understand, but it is arguably the most critical. It his means that the ordinary sights, sounds, smells, tastes and touches of everyday that you may not even notice can be actually painful for a person with autism. The very environment in which we have to live often seems hostile. It may appear that the child is withdrawn or belligerent to you but they are really just trying to defend themselves. Here is a personal account of why a "simple" trip to the grocery store may be hell:

      "My hearing may be hyper-acute. Dozens of people are talking at once. The loudspeaker booms today's special. Musak whines from the sound system. Cash registers beep and cough, a coffee grinder is chugging. The meat cutter screeches, babies wail, carts creak, the fluorescent lighting hums. My brain can't filter all the input and I'm in overload!

      My sense of smell may be highly sensitive. The fish at the meat counter isn't quite fresh, the guy standing next to us hasn't showered today, the deli is handing out sausage samples, the baby in line ahead of us has a poopy diaper, they're mopping up pickles on aisle 3 with ammonia ??’"?.I can't sort it all out. I am dangerously nauseated.

      Because I am visually oriented (see more on this below), this may be my first sense to become overstimulated. The fluorescent light is not only too bright, it buzzes and hums. The room seems to pulsate and it hurts my eyes. The pulsating light bounces off everything and distorts what I am seeing -- the space seems to be constantly changing. There's glare from windows, too many items for me to be able to focus (I may compensate with "tunnel vision"), moving fans on the ceiling, so many bodies in constant motion. All this affects my vestibular and proprioceptive senses, and now I can't even tell where my body is in space." Wow. Imagine a life like this every day. That is a day in the life of a child or person with autism.
    • 3
      Please remember to distinguish between won't ( choosing not to) and can't (not being able to).

      Receptive and expressive language and vocabulary can be major challenges for a child with autism. It isn't that they don't listen to instructions. It's that they can't understand you. When you call from across the room, this is what is heard: "*&^%$@, Billy. $%^*&^%$&* ??’"? ??’"? ??’"?" Instead, come speak directly to the child in plain words: "Please put your book in your desk, Billy. It's time to go to lunch." This tells exactly what you want done and what is going to happen next. Now it is much easier for them to comply.
    • 4
      Try to remain a concrete thinker as the child with autism is.This means language is taken very literally. It's very confusing when you say, "Hold your horses, cowboy!" when what you really mean is "Please stop running." Don't say something is a "piece of cake" when there is no dessert in sight and what you really mean is "this will be easy for you to do." When you say "It's pouring cats and dogs," They really do see pets coming out of a pitcher and it is very confusing. Please just say "It's raining very hard."

      Idioms, puns, nuances, double entendres, inference, metaphors, allusions and sarcasm are lost on a person with autism.
    • 5
      Please be patient with children who have a limited vocabulary. It's hard for them to tell you what they need when they don't know the words to describe their feelings. They may be hungry, frustrated, frightened or confused but right now those words are beyond their ability to express. Be alert for body language, withdrawal, agitation or other signs that something is wrong.

      Or, there's a flip side to this: A child may sound like a "little professor" or movie star, rattling off words or whole scripts well beyond their developmental age. This is called "scripting" & are messages they have memorized from the world around in order to compensate for language deficits because they know they are expected to respond when spoken to. They may come from books, TV, the speech of other people. It is also called "echolalia." The child doesn't necessarily understand the context or the terminology, they just know that it gets them off the hook for coming up with a reply.
    • 6
      Understand that because language is so difficult for a child with autism, they are very visually oriented. Please show them how to do something rather than just telling them & please be prepared to repeat this many times. Lots of consistent repetition helps learning.

      A visual schedule is extremely helpful either words or pictures. Like your day-timer, it relieves the child of the stress of having to remember what comes next, makes for smooth transition between activities, helps manage time and meet your expectations. 

      Usually these children won't lose the need for a visual schedule as they get older, but the "level of representation" may change. Before they can read, they need a visual schedule with photographs or simple drawings. As they get older, a combination of words and pictures may work, and later still, just words.
    • 7
      Focus and build more on what the child CAN do rather than what they can't do. Like any other human, they can't learn in an environment where they constantly made to feel not good enough and that they need "fixing." Trying anything new when its almost sure to be met with criticism, however "constructive," becomes something to be avoided. Look for strengths and you will find them. There is more than one "right" way to do most things.
    • 8
      Try to find opportunities for and help with social interactions. It may look like the child doesn't want to play with the other kids on the playground, but sometimes it's just that they simply do not know how to start a conversation or enter a play situation. If you can encourage other children to invite the child to join them at kickball or shooting baskets, it may be that the child will be delighted to be included.

      Structured play activities that have a clear beginning and end seem to be the best choice for a child with autism. They don't know how to "read" facial expressions, body language or the emotions of others, so ongoing coaching in proper social responses is a great help. (For example, laughing when another falls off the slide- it's not that the child thinks it's funny, but rather that he doesn't know the proper response. Teach him to say "Are you OK?"
    • 9
      Learn to anticipate & to identify what triggers emotional meltdowns. Meltdowns, blow-ups, tantrums or whatever you want to call them are even more awful for the autistic child than they are for you. They occur because one or more of the senses has gone into overload. If you can figure out why the meltdowns occur, they can be prevented. Keep a log noting times, settings, people, activities. A pattern may emerge.

      Try to remember that ALL behavior is a form of communication. It tells you, when words cannot, how the child perceives something that is happening in his or her environment.

      Parents, keep in mind as well: persistent behavior may have an underlying medical cause. Food allergies and sensitivities, sleep disorders and gastrointestinal problems can all have profound effects on behavior.
    • 10
      Love & respect the child unconditionally. Banish thoughts like, "If he would just...." and "Why can't she...." You did not fulfill every last expectation your parents had for you and you wouldn't like being constantly reminded of it. These children did not choose to have autism, But remember that it is happening to them, not you. Without your support, the chances of successful, self-reliant adulthood are slim. With your support and guidance, the possibilities are broader than you might think. I promise you -- they are worth it.
    • 11
      And finally, remember these three words: Patience. Patience. Patience. Work to view autism as a different ability rather than a disability. Look past what you may see as limitations and see the gifts autism has given us. It may be true that a child with autism is not good at eye contact or conversation, but have you noticed that they don't lie, cheat at games, tattle on classmates or pass judgment on other people?

      The answer to Alzheimer's, the enigma of extraterrestrial life -- what future achievements from today's children with autism, lie ahead?

      All that they might become won't happen without you and I as the foundation. Think through some of those societal 'rules' and if they don't make sense, let them go. Be an advocate, be a friend, and we'll see just how far we all can go. Also true that the child with autism probably won't be the next Michael Jordan. But with the attention to fine detail and capacity for extraordinary focus, they could be the next Einstein. Or Mozart. Or Van Gogh.

      They had autism too.