Tag Archives: Autism

Quote of The Day

“During any moment of any given day, I’m either obsessed with what I’m doing or bored with what I’m doing.”

–Student with Asperger’s explaining the difficulty navigating everyday activities.

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January 11, 2013 · 3:22 am

Autism Diagnosis: Now What?

Many families that come to my office for an appointment with an existing diagnosis tell me that they received a “general autism spectrum diagnosis” and the clinician did not really discuss treatment options beyond the diagnosis.  If this is actually the case, then it is frustrating to hear.  I can only imagine the frustration that these families must be experiencing: so many questions and so few answers.  Indeed, I often spend my time calming parents down and gaining their trust as an advocate and ally for them who is ready to give very specific suggestions based on their child’s specific developmental profile.  For the families that do not have the opportunity to be seen in our clinic or who are going to be making an appointment in the near future, I thought I would share what the science says you should do following your child’s autism diagnosis.  I will reserve my thoughts on alternative treatments that are not based on the science for a  future blog posting.  For now, I prefer to guide my families toward treatments that science supports as effective.  So here are the main starting points for treatment following autism diagnosis that are based on the National Science Council Research Report:

1)      20-25 hours per week of intervention

2)      With a 1:1 or 1:2 teacher to child ratio

3)      That is engaging

4)      Has a strategic direction

5)      And starts early (Between the ages of 18 months to 6 years)

Typically these interventions (which count toward the 20-25 hours per week) include:

Two highly recommended websites:

1)      Your Child: Autism Spectrum

2)      P.L.A.Y. Project

Another nice resource for what can be done during the First 100 Days following diagnosis can be found here.

Dr. Mark Bowers is a Licensed Pediatric Psychologist and Autism/Anxiety expert at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.

© 2009 Mark Bowers, Ph.D.

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Filed under Autism, DIR, PDD-NOS, PLAY Project

“Cats are Autistic Dogs”: Notes on Asperger’s

The title of this posting is taken from Dr. Tony Attwood’s discussion on Asperger’s last week.   As indicated in a previous posting, I had the opportunity, or shall I say privilege, to spend an entire day hearing Tony speak his thoughts on Autism and more specifically Asperger’s Syndrome.  I thought I would share some talking points as they relate to Asperger’s for those of you who were unable to attend.  Please note that the term ‘Aspie’ is not derogatory and is instead embraced by many individuals with Asperger’s when describing themselves.

  • Aspies use intellect, not intuition.  Only logic works when trying to discipline…punishment does not work!
  • Handwriting is a huge problem for Aspies, but handwriting is a 19th Century skill.  Teach kids to type!
  • Aspies may tune out because if it is not one of their key interests, then why learn it?
  • Preoccupation with specific topics of interest produces euphoria and enjoyment that Aspies cannot obtain otherwise.
  • Girls are able to hide their symptoms so well that diagnosis may be missed or delayed as much as 10 years.  Girls will often escape into imagination, fantasy, and fiction and “pretend to be normal.”
  • Asperger’s includes all neurotypical characteristics magnified to the most extreme degree.
  • There is a compulsion to complete tasks that Aspies experience which makes transitions difficult.
  • Aspies generally DON’T learn from mistakes..and they don’t naturally know what else to do when faced with a challenging social situation.
  • Anxiety begins to be expressed in the form of avoidant or controlling behaviors as a means of coping with uncomfortable feelings.
  • When emotions run high, there are three ways Aspies try to repair them: 1) Aggression/Rage, 2) Isolation, and 3) Avoidance via heightened special interests (e.g., video games).
  • Sadness and anxiety are expressed by Aspies in the form of anger, especially in school when Aspies are not allowed to use one of the above three ways of coping/repairing heightened emotions.
  • For Aspies, anger is the ‘acceptable’ way to express sadness.  It also allows the individual to get the uncomfortable rise in emotional feelings over with by exploding and then feeling better quickly as if nothing ever happened.
  • Top three trigger words guaranteed to get a rise out of Aspies: 1) No, 2) Wait, and 3) Change
  • An Aspies’ need for affection can fit inside a cup.  A neurotypical’s need for affection can fit inside a bucket.
  • Aspies generally have an intense dislike for public praise.
  • ‘Cats are Autistic Dogs’ is an observation by Attwood meant to illustrate the differences in social abilities/interests of the two animals.
  • For More on this Topic, view Part II of this post here.

Dr. Mark Bowers is a Licensed Pediatric Psychologist and Autism/Anxiety expert at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.

© 2009 Mark Bowers, Ph.D.


Filed under Asperger's, Autism

Autism and OCD in Children

hand_washingAutism Spectrum Disorders (ASDs) and Obsessive-Compulsive Disorder (OCD) can and do occur at the same time.  OCD is a specific diagnosis under a larger umbrella of anxiety.  Children with OCD experience unwanted and intrusive thoughts that they can’t seem to get out of their heads (obsessions), often compelling them to repeatedly perform ritualistic behaviors and routines (compulsions) to try and ease their anxiety.  Children with ASD generally have repetitive, perseverative thoughts that are intense in nature, much like children with purely OCD symptoms.  The big difference is that children with OCD do not like the experience of having repetitive thoughts and would do anything to get rid of the thoughts (such as washing one’s hands 25 times).  Children with Autism Spectrum diagnoses are not bothered by their repetitive behaviors and thoughts, and instead are usually comforted by them (such as playing with a train in a repetitive fashion for hours at a time).

Anxiety is highly prevalent among children with Autism Spectrum diagnoses (greater than 35% of children experience both).  This is due to a combination of genetics, brain development, and higher levels of stress.  The error that many schools and therapists often make is attributing a child’s anxiety symptoms to his or her Autism diagnosis (i.e., “The only way to really reduce  anxiety and aggression is to treat the Autism.”)  For example, many children are referred into social skills groups when what they really need is help with anxiety that is interfering with their social functioning.  Highly anxious children with OCD may begin to act out behaviorally in school prompting teachers to encourage (some might say ‘coerce’ or ‘force’) parents to begin medicating the behavior.  The concerns here is twofold: 1) the behavior is numbed with medication and the root anxiety is never truly addressed (i.e., stop the medication and everything returns to the way it was), and 2) the school may begin to implement safety nets such as increased para support to keep the behaviors from occurring while again failing to adequately address the underlying anxiety symptoms.

The question often asked is, “Can you really treat a child who has both an autism spectrum diagnosis and OCD?”  The answer is “yes” and new research is beginning to show that there are some exciting recent behavioral treatments out there for these children.  Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for anxiety that has been established by the American Psychological Association as effective for children.  A recent study of CBT for neurotypical children with anxiety (Wood et al., found):

  • Childrens’ school performance improved & they attended school more regularly
  • Children had more friends & better quality friendships
  • Children got along better with family members
  • Children had higher self-esteem

The authors of that study have adapted the neurotypical CBT protocol for children with autism spectrum and are finding some promising results.   In general the results suggest that the authors’ adaptations of the pre-existing CBT manual can be effective for treating anxiety such as OCD in children with autism (research article link).  This treatment manual is available to practitioners and families, a sample of which can be viewed here.   Thus, there is hope for effective anxiety treatment for your child who also has an autism spectrum diagnosis.  It is highly recommended that you seek out services from a pediatric specialist who has training and experience treating children with co-occurring anxiety and autism spectrum diagnoses.

On a personal note and aside, I will be spending tomorrow with noted Asperger’s guru Dr. Tony Attwood  so stay tuned for a blog later this week where I hope to share some new ‘nuggets’ of information.

Dr. Mark Bowers is a Licensed Pediatric Psychologist and Autism/Anxiety expert at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.

© 2009 Mark Bowers, Ph.D.


Filed under Anxiety, Asperger's, Autism, CBT, OCD, PDD-NOS

Scripting and The Autistic ‘Veil’

trainsThe nature of Autism is the brain’s desire to keep the world the same.  This is why one of the hallmark diagnostic features of Autism is repetitive, perseverative, and stereotypical behaviors.  One of the most common is scripting in which the child takes dialogue that he or she heard someone else say (usually a favorite cartoon or television character) and applies it in a repetitive and often nonfunctional fashion.   Scripting is often referred to as a Comfort Zone behavior.  This posting attempts to provide some strategies for how to deal with scripting as well as some reflections on the nature of Comfort Zone behaviors.

For children with Autism, the Comfort Zone is what the child will do when you let them do whatever they want to do.  Examples include: playing with/lining up cars, watching portions of the same video, flipping through familiar books, scripting, opening/closing doors/drawers, visually stimulating on an object (e.g., spinning), and staring off in the distance as if in a trance or daydream.  By the way, ever wonder why the fascination with trains?  The answer is that there is not likely anything much more linear and repetitive than a train going from one place to another and then back again.  I digress, so in this comfort zone, children are not connected or engaged with the world.  In fact, by the time kindergarten starts, one measure of school readiness is that the children are connected with the social environment most of the time and turn consistently to their names.  You probably notice that your child does not turn to his or her name being called consistently if they are absorbed in a particular activity.  If your child is ‘stuck’ inside their comfort zone and not paying attention to the environment, not easily engaged, not able to interact in a back-and-forth fashion; then they are going to need help leaving this comfort behavior for longer periods of time (i.e., you will need to engage them more and not allow them to be off on their own in a perseverative or repetitive behavior).  The key to remember here is that as engagement with others increases, perseverative/repetitive behaviors such as scripting decreases.  Thus, we must be aware of when the child is in his or her comfort zone and not allow them to remain there for too long.

I do want to take a moment to acknowledge, however, how it must feel for a parent to see the Autistic ‘veil’ drop in front of the child’s eyes as they check out from the real world for a moment and become absorbed in a repetitive behavior.  Especially for parents who have been working with their child for a number of months or years and have begun to see progress; the child’s return into scripting and other stereotypical behaviors is a glaring reminder that the child has Autism.  It also serves as a reminder to the world that something is not quite connecting in the child’s brain.  I often conceptualize this as a neurological tug-of-war that is taking place inside the child’s brain.  The hardwiring of the Autistic brain is determined to keep the world simple and the same, with little (if any) interest in relationships or social connections.   However, as the child makes progress and begins to learn how much fun can be had with others and the value of having play partners, another part of the brain begins to compete for dominance.

I see a similar phenomenon take place among children with OCD that I treat.  They experience what I refer to as “brain hiccups” that play tricks in one’s mind, often convincing the child that unless he washes his hands 15 times in a specific fashion, for example, something awful will certainly happen.  This thought will not go away (hence the ‘hiccup’) until the child engages in the ritual of the brain’s liking.  What these children describe to me, however, is the rational part of their brain telling them that they don’t really want to have to wash their hands that many times (or at all for that matter) to make the thoughts go away.  There are often strong similarities between the brains of children with OCD and brains of children with Autism.  However, one critical difference is that the OCD brain ultimately wants the repetitive thought to go away while the Autistic brain is comforted by the repetitive and familiar nature of the thought.


  • The child in their comfort zone seems like they don’t want to be part of our world.  However, this is not regression or a lack of progress.  In fact…
  • Perseverative and stereotypical behaviors are not ‘bad’.  These behaviors help child regulate a chaotic world.
  • However, these behaviors may become habits & keep the child isolated.  These are potentially addictive for the child and need to be monitored.
  • ‘Joining’ in these behaviors helps our engagement with the child.
  • As our engagement with the child increases, the perseverative and repetitive behaviors naturally decrease!

For more information on this topic, visit the work of Dr. Rick Solomon and the PLAY Project.

Dr. Mark Bowers is a Licensed Pediatric Psychologist at the Ann Arbor Center for Developmental & Behavioral Pediatrics in Ann Arbor, Michigan.

Mark Bowers, Ph.D. © 2009

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Filed under Autism, Child Development, Parenting, PDD-NOS, Scripting

Autism Rates on the Rise?

Chances are, if you are reading this blog, you have heard about the new Autism prevalence study that was just published in Pediatrics earlier this week.  If you haven’t heard, a recent study found that the prevalence of parent-reported rates of autism was higher than previous estimates. Specifically, they found that 1.1% of all children ages 3 to 17 had autism (1 in 91) as compared to previous estimates of approximately 1 in 150.

Whether or not these new numbers are truly representative of a increase in the rates of diagnosis, autism is an epidemic.   The previous numbers of 1 in 150 births were evidently staggering enough that the Obama administration stepped in to help.  President Obama has made autism a priority from the first days of his presidency.  Less than a week after he was sworn in, The Department of Health and Human Services’ Interagency Autism Coordinating Committee released its first-ever strategic plan for government autism research. President Obama has backed this plan by adding $1 billion to his budget for autism over the next eight years.  Altogether, the federal government will provide nearly twice as much funding for autism research in the upcoming fiscal year as we had just three years ago.

On the genetic front, new genes and genomic regions that might be associated with autism have been identified by an international research team.

The researchers identified a single-letter change on chromosome 5 near a gene called semaphorin 5A, which is believed to help guide the growth of neurons and their long progressions, called axons. The activity of this gene appears to be reduced in the brains of people with autism.

The scientists also found a possible link between autism and parts of chromosomes 6 and 20.

In other news regarding the origin of autism, The Drexel School of Public Health will use a $14M NIH grant to establish a network of research sites nationwide that will study possible risk factors and biological indicators for ASD during the prenatal, neonatal and early postnatal periods. The researchers aim to follow 1,200 mothers of children with autism at the start of a new pregnancy and document the development of the newborn through 36 months of age.

In response to the new study of autism prevalence, Bob Wright, co-founder of Autism Speaks stated, “These new numbers should serve as a renewed call to action to take on what is clearly a major public health crisis not only in this country, but around the world.  People with autism are still not getting the therapies they need and adequate medical care for the medical conditions often associated with this disorder. And our society has yet to come to grips with the fact that this growing population of children with autism will become adults with autism who require a lifetime of services and support. We must act now to address these short and long-term challenges.”

We are attempting to address the treatment concerns of the growing population of children diagnosed with autism at the Ann Arbor Center for Developmental & Behavioral Pediatrics.  My colleague, Rick Solomon, M.D. has been awarded a $1.85 million grant from the National Institute for Mental Health (NIMH) that will fund a randomized, controlled study of The P.L.A.Y. Project intervention for autism.  We are now another step closer to our goal of addressing the national need for play-based intensive autism services.  You can read more about this exciting news here.


Filed under Autism

To Spank or Not To Spank…

A paper presented at the International Conference on Violence, Abuse and Trauma on Sept. 25 by sociologist  Murray Straus has caught my attention this week.  Straus and his colleague Mallie Paschall followed children over the course of four years and determined that those who were spanked had up to a 5-point lower IQ than their peers who were not spanked.  Further, the more the children were spanked, the lower their IQs.

This debate is not new.  In fact, I find myself in this debate at least a few times each month with some of the families I see.  The age old question is whether or not spanking is an effective form of discipline.  My professional stance (in conjunction with the science that supports it) is that spanking is actually punishment (not discipline) and is only effective in the short-term.  Try telling that to the ‘old school’ father who swears, “It worked on me when my father spanked me!”  With a little more investigation in my office, I am often able to reveal that while it may have garnered attention in the short-term, it fueled resentment toward the parent over the long-term.

I truly believe that the majority of spanking occurs in the form of a parental temper tantrum in which the parent has lost control and is at a loss for an effective discipline strategy.  There are a number of problems with punishment that I encourage parents to consider when deciding if they really want to employ spanking as a method of punishment.

  • Spanking focuses anger on the parent doing the spanking.  When we resort to punishment it gives children someone else to be mad at or something else (the spanking) to blame.
  • Spanking causes the behavior to stop quickly, but in the absence of spanking, the negative behavior returns.
  • Spanking does not teach accountability. The “punisher” (parent) is responsible to see that the child’s behavior changes.   The child learns nothing on their own as a result of the spanking.
  • Punishment denies a child the right to experience the real consequence of their actions.  If your child hurts someone else, for example, the other child may not want to play with your child anymore.  Your child quickly forgets this possibility when spanking is introduced.
  • A big error comes when we think that the punishment has taught the child what to do the next time a similar situation occurs. It has taught the child NOT to do something… but it has not taught them what they should do!

In case those reasons were not enough, we also know that spanking makes children anxious (especially toward the parent using this method) and spanking can lower self-esteem.  A report endorsed by the American Academy of Pediatrics in 2008 looked at 100 years of research and concluded, “There is substantial research evidence that physical punishment makes it more, not less, likely that children will be defiant and aggressive in the future.”

The full report can be read at www.phoenixchildrens.com/discipline

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Filed under Anxiety, Autism, Child Development, Parenting