Saturday, October 30, 2010

Outstanding Autism Resource for the School Professional



A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools
by Lee A. Wilkinson, PhD, NCSP, was recently honored as an Award-Winning Finalist in the Education/Academic category of the "Best Books 2010" Awards sponsored by USA Book News. USA Book News.com is the premiere online magazine and review website for mainstream and independent publishing houses. Over 500 winners and finalists were announced in over 140 categories covering print and audio books. 
Filling a critical void in the autism literature, this authoritative yet accessible book provides school psychologists, educators, support professionals, and parents with a best practice guide to screening, assessment, and intervention for school-age children with autism spectrum disorders (ASD). Grounded in the latest research, special features include illustrative case examples and an index to 50 evidence-based best practice recommendations. This book makes an ideal text for graduate-level training courses in school psychology and is certain to become a widely used resource that will meet the needs of both experienced psychologists and those new to the profession.
                              ISBN: 978-1-84905-811-7
                                List: $24.95; 208 Pages 
                              
                      Order your copy today!     
                    Toll Free: 1-866-416-1078 or online:
                                         www.jkp.com
                                     www.amazon.com
                              www.barnesandnoble.com 
     

                                                                                                                                   

Saturday, October 16, 2010

Girls with ASD: Suffering in Silence


Although there has been a dramatic increase in the number of children diagnosed with autism spectrum disorders (ASD) over the past decade, statistics indicate that boys are being referred and identified in far greater numbers than girls (Attwood, 2006; Wagner, 2006).  In fact, referrals for evaluation of boys are approximately ten times higher than for girls (Attwood, 2006). Girls are also diagnosed with autism spectrum disorders at later ages relative to boys (Goin-Kochel, Mackintosh, & Meyers, 2006). This gender “gap” raises serious questions because many female students with ASD are being overlooked and will not receive the appropriate educational supports and services (Wilkinson, 2008).
Why are fewer girls being identified?  Why do parents of girls experience a delay in receiving a diagnosis?  Are there gender differences in the expression of the disorder? Answers to these questions have practical implications in that gender specific variations may have a significant impact on identification practices and the provision of educational services. Although few studies have examined gender differences in the expression of autism spectrum disorders, we do have several tentative explanations for the underdiagnosis and late identification of girls with ASD. They include the following.
  • Social communication and pragmatic deficits may not be readily apparent in girls because of a non-externalizing behavioral profile, passivity, and lack of initiative. Girls who have difficulty making sustained eye contact and appear socially withdrawn may also be perceived as “shy,” “naive,” or “sweet” rather than   having the social impairment associated with an autism spectrum disorder (Wagner, 2006).
  • The diagnosis of another disorder often diverts attention from autism-related symptomatology. In many cases, girls tend to receive unspecified diagnoses such as a learning disability, processing problem, or internalizing disorder. A recent survey of women with Asperger syndrome indicated that most received a diagnosis of anxiety or mood disorder prior being identified with an autism spectrum disorder (Bashe & Kirby, 2005).
  • The perseverative and circumscribed interests of girls with autism spectrum disorders may appear to be age-typical. Girls who are not successful in social relationships and developing friendships might create imaginary friends and elaborate doll play that superficially resembles the neurotypical girl (Attwood, 2006).
  • Although Students with ASD are more likely to be the target of bullying than typical peers, this may not be recognized in girls due to gender differences in preferred modes of aggression. For example, girls may use covert verbal, social, and psychological forms of aggression while boys tend to rely on confrontational and direct modes of bullying (Besag, 2006). As a result, the more subtle nature of relational and indirect aggression (social exclusion and rejection) used by girls may be taken less seriously than the more obvious, direct aggression exhibited by boys.
  • Although girls may appear less symptomatic than boys, the genders do share similar profiles. Research suggests that when IQ is controlled, the main gender difference is a higher frequency of idiosyncratic and unusual visual interests and lower levels of appropriate play in males compared to females (Lord, Schopler, & Nevicki, 1982). As a result, the behavior and educational needs of boys are much more difficult to ignore and are frequently seen by teachers and parents as being more urgent, further contributing to a referral bias (Wilkinson, 2010).
  •  Over reliance on the male model with regard to diagnostic criteria might contribute to a gender “bias” and underdiagnosis of girls (Kopp & Gillberg, 1992; Nyden et al., 2000). Clinical instruments also tend to exclude symptoms and behaviors that may be more typical of females with ASD.
If girls do process language and social information differently than boys, then clinical and educational interventions based largely on research with boys may be inappropriate Wilkinson, 2008). If gender specific variations do exist, then the predictive validity of the diagnosis and developmental course may well differ between the sexes. Meanwhile, educators and school personnel should question the presence of an ASD in girls referred for internalizing disorders such as anxiety or depression. Best practice recommends that when a girl presents with a combination of social immaturity, restricted interests, limited eye gaze, repetitive behaviors, social isolation, and is viewed as “unusual” or “odd” by parents, teachers and peers, the possibility of an ASD should be given consideration (Wagner, 2006; Wilkinson, 2010).
Reference List is available and supplied upon request - 

Lee A. Wilkinson, PhD is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.

©Lee A. Wilkinson

Friday, October 15, 2010

Best Practice Research: Hyperbaric Oxygen Therapy (HBOT) for Autism

Parents of children with autism spectrum disorder (ASD) often use complementary and alternative medicine (CAM) treatments with their children as an alternative, or in addition to, conventional treatments. CAM treatments are controversial and, for most, their efficacy has not been scientifically established. Hyperbaric oxygen therapy (HBOT), a scientifically supported treatment for decompression sickness, is being increasingly recommended as a treatment for autism. Although anecdotal evidence may exist, there is a need for rigorous controlled scientific research to evaluate the treatment effects of HBOT on the core symptoms of ASD.
The journal Research in Autism Spectrum Disorders reports the results of a randomized double-blind placebo-controlled trial study comparing HBOT to placebo in children with autistic disorder who received 80 sessions of treatment over a 15-week period. Multiple standardized instruments and direct behavioral observations were used to evaluate treatment effects on ASD symptoms. The results indicated no significant differences between HBOT and placebo groups across any of the outcome measures (social reciprocity, communication, and repetitive behaviors). The study concludes that HBOT does not result in a clinically significant improvement of the symptoms of autism and that it is not recommended for the treatment of ASD symptoms.

The Food and Drug Administration (FDA) recently announced that hyperbaric oxygen treatment is not an approved or effective treatment or cure for autism. Companies and websites claiming hyperbaric oxygen can treat or cure autism are misleading the public, according to the FDA. "Patients may incorrectly believe that these devices have been proven safe and effective for uses not cleared by FDA, which may cause them to delay or forgo proven medical therapies," says Nayan Patel, a biomedical engineer in FDA's Anesthesiology Devices Branch. "In doing so, they may experience a lack of improvement and/or worsening of their existing condition(s)."


Granpeesheh, D., Tarbox, J., Dixon, D. R., Wilke, A. E., Allen, M. S., & Bradstreet, J. J. (2010). Randomized trial of hyperbaric oxygen therapy for children with autism. Research in Autism Spectrum Disorders, 4, 268-275.
Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.


Friday, October 1, 2010

Gluten-Free/Casein-Free Diets for Autism

The gluten-free, casein-free diet (GF/CF diet) continues to be a popular and widely used treatment by parents of children with. The premise is that avoiding gluten and/or casein (proteins found in wheat, barley, rye and dairy) might directly affect brain function and produce improvements in the cognitive and behavioral symptoms associated with ASD. Surveys suggest that nearly a third of parents of children with mild autism have used an alternative diet in the treatment of their children. The use of alternative diets in the treatment of ASD has also been encouraged by anecdotal reports of effectiveness from parents, celebrities, and the popular media. Given that autism has no know cure, parents and advocates will understandably pursue interventions/treatments that offer the possibility to improving symptoms, especially if the treatment appears to do no harm and is generally accepted. However, there continues to be controversy and debate as to effectiveness and risks of diets as a treatment for ASD (Wilkinson, 2010).

A study appearing in the peer-reviewed journal, Research in Autism Spectrum Disorders, examined 14 articles related to research on the effects of gluten-free and/or casein-free (GFCF) diets in the treatment of ASD. Each study was analyzed and summarized in terms of (a) participants, (b) methodological quality (c) specifics of the intervention, (d) dependent variables, (e) outcome, and (e) conclusive evidence. Based on their review, the researchers determined that the published studies do not support the use of GFCF diets in the treatment of ASD (Mulloy, Lang, O’Reilly, Sigafoos, Lancioni, & Rispoli, 2010). They recommend, “Until conclusive evidence is found in support of GFCF diets, restrictive diets should only be implemented in the event a food allergy or intolerance is detected” (p. 335) and “Adverse consequences potentially associated with GFCF diets (e.g., stigmatization, diversion of treatment resources, reduced bone cortical thickness) further the argument against the diet’s therapeutic use.” (p. 337). They also suggest that if future research supports the use of GFCF diets (beyond avoiding allergens), then controlled trials might be initiated to determine whether a GFCF diet has any further benefit for individuals with ASD (Mulloy et al., 2010).

Mulloy, A., Lang, R., O’Reilly, M., Sigafoos, J., Lancioni, G., & Rispoli, M. (2010). Gluten-free and casein-free diets in the treatment of autism spectrum disorders: A systematic review. Research in Autism Spectrum Disorders, 4, 328-339.

Wilkinson, L. A. (2010). A best Practice Guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.



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