Signs of Autism

Many of us have heard of autism, perhaps in conversation with family members, through media outlets, or from our pediatricians. Though the term seems to be more prevalent today, many parents may not be aware of what autism is, including early signs of the disorder.

The Center for Disease Control estimates that 1 in 88 children will be diagnosed with autism by age 8 (Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report, March 30, 2012). Given the prevalence rate of the disorder, many efforts are underway to educate parents and the public about the disorder. Autism, or autism spectrum disorder, is a neurodevelopmental disorder that leads to deficits in social communication and interactions, as well as to repetitive, stereotyped, or restricted patterns of behavior. The disorder varies in terms of severity and its unique characteristics. So, what does all of that mean? It means that, from early ages, your child should be making attempts to communicate verbally and non-verbally. He or she should be relating to and interacting with others and the world that surrounds him or her. It also means that your child should be flexible in his or her thoughts and behaviors. For example, your child should be able to adjust to slight changes in schedule or environment without significant tantrums. Below are possible early indicators of autism:

• No babbling before 12 months

• No response to his/her name being called by 12 months

• No pointing to show interest in objects by 14 months

• No use of single words by 16 months

• No pretend play (e.g., pretending to bathe a doll) by 18 months

• No use of two-word phrases (e.g., “My ball” or “Want juice”) by 24 months

• Loss of acquired language or social skills

• Delays in language skills

• Repeats words and/or phrases over and over for no apparent reason (i.e., echolalia)

• Excessive interest in particular toys or items

• Poor eye contact

• Unusual body movements, such as posturing hands or fingers, hand flapping, body rocking, or spinning in circles

• Unusual sensory interests (e.g., odd reactions to smells, sounds, tastes, touch, or sights)

• Prefers to be alone

• Excessive lining up of toys or objects

• No smiling or back-and-forth play

There are also signs parents and providers can look for in order children, including the
following:

• Difficulty making friends with peers

• Difficulty starting and continuing conversations with others

• Lack of or delays in make-believe and social play

• Unusual use of language, such as repetitive use of certain phrases

• Restricted patterns of interest that may seem unusual and excessive in intensity or focus

• Preoccupation with certain objects or topics

• Lack of flexibility to changes in specific routines or rituals

Parents, especially first-time parents, may be unaware of the ages their child should be obtaining certain skills. As such, it is important to speak with your pediatrician or a psychologist who specializes in early childhood so that developmental milestones (i.e., markers for first steps, first words, etc.) can be discussed. If you have concerns about your child’s development, reach out to others around you, especially your pediatrician or a child psychologist. Many pediatricians have parents complete early screeners for autism, which are questionnaires relating to the early signs of the disorder. If such screeners come back elevated, your pediatrician will likely refer you to a child psychologist who specializes in autism assessment and intervention. You can also directly contact a child psychologist, who will likely meet with you to discuss your concerns, as well as complete autism screeners. Information about autism is also available online from reputable sites, including Autism Speaks (http://www.autismspeaks.org), the Centers for Disease Control and Prevention (http://www.cdc.gov/ncbddd/autism/index.html), and the Autism Society of America (http://www.autism-society.org). These sites often provide tool kits or resource guides for parents and professionals regarding the disorder. So if you are noticing possible early signs of autism in your child, do not be afraid to ask questions. Early identification is crucial to intervention. And if it turns out that all is fine, all that can be said is that you are a concerned parent. However, if it turns out that voicing your concerns leads to an early diagnosis of autism, you have just started your child on the best path for treatment and long-term outcomes.

Twyla L. Mancil, Ph. D.

Marriage

Recently, I celebrated my 10-year wedding anniversary.  What a busy and amazing journey this has been!  There have been several big events along the way from changing jobs, moving states, and creating a family with the addition of now almost four children!  To celebrate our decade milestone, my husband whisked me away for a quick getaway out of town, a trip without children, pets, or work!  I can’t recall the last time we had such an opportunity to be alone with each other.

I had a few revelations during this trip and most of them were about the struggle and gift of marriage.  It did not take long for my husband and I to settle into the relaxed freedom of a schedule free day.  We had no children to get ready for school or papers to prepare or dinner to plan.  We did not jockey to be free from the responsibility of the next dirty diaper, or plan evening bath time chores and kitchen duty.  Free from the sacrifices of daily family life, our relationship was easy and carefree.  There was time not just to focus on each other, but on ourselves.  In a manner that felt decadent, I read books by the hotel pool for hours without concern about anyone’s schedule but mine!  Naptime was about me, and not the daily battle with tired preschoolers!

The contrast of early-married life, free of the many responsibilities of family life that come later in the life-cycle of marriage was brought into focus during this trip.  Marriage has it’s own evolution, a growth cycle that requires adjustments, sacrifices, and even new skills.  So what is the difference between the families that remain intact, and those that fall to divorce and separation?

Over the years of working with families and couples struggling to stay together, and those that don’t make it, the difference seems to be a sense of an elevated common purpose.  So what does that look like, and why is it “elevated?”  Many couples come into marriage with a common purpose and unfortunately it is limited to making each other happy.  This is an impossible and rather immature goal.  Although marriage is often a source of happiness, there will inevitably come a time when the joy is missing or diminished.  When happiness is the common purpose the objective is a finicky goal that also grants permission for someone to walk away from the union if they are not happy enough or having enough fun.

Many couples also choose raising children as a common purpose that effectively unifies the spouses until the children reach adulthood and then the couple is left wondering what’s next and who is this person I am married to?  Other external goals of wealth accumulation or social status are also transient goals that are at best weak unifiers in a marriage.  Furthermore, none of these afore mentioned common purposes have the ability to give us strength and motivation to push through the hard times and shoulder the sacrifices of family and married life with meaning, satisfaction, and ultimately joy.  Yes, joy in the sacrifices of family life!

It goes without saying that the messages of modern culture have made us ill prepared to entertain the sacrifices of married life.  Pleasure and happiness are sold in car commercial and fast food advertisements alike!  If one’s marriage does not meet this standard than individuals wonder what else lies outside of marriage to satiate this need.  Infidelities and unhealthy addictions follow. 

So what is the common purpose in your marriage?  What is the mission statement for your family life?  Are you just keeping each other company until something better comes along or is there a unifying elevated purpose that makes the daily work of family life meaningful and joyful?  If your marriage is buckling under the stress of life and contradictory priorities have lead to conflict and heartache it is time to find help.  A trusted therapist can help bring the focus back into your union and set the proper course for a future of healthy growth for your family.  It is never too late to correct course, but don’t wait until the emotional damage is so great that the road back to marital joy is all up hill. 

Disordered Eating

Emotional eating, binge eating, calorie counting, over-exercising, fasting to reduce food intake, overuse of laxatives…. These are all various forms of disordered eating. Many people assume that disordered eating involves starving one’s self or vomiting after eating, however; there is a broad spectrum of eating patterns that can be troublesome.

Psychologists use terms like “Anorexia” and “Bulimia,” which can be misunderstood by the general population. An anorexic individual restricts eating and/or “purges”

to a point of being severely underweight and oftentimes results in serious health and medical concerns. An individual who struggles with Bulimia often binge eats (overeats) and then uses any number of methods to reduce the amount of food absorbed. Some of the more commonly observed methods used involve vomiting after a meal, over-use of laxatives, extreme exercise and fasting. Some individuals struggle with extreme overeating without food restriction or purging, which nonetheless represents unhealthy eating patterns. All of these patterns can lead to physical and mental health concerns as well as social problems. 

Disordered eating can affect anyone in any social or cultural group. Television, magazines, advertisements and the like often portray unrealistic and idealistic standards of beauty for women. This can cause a lowered sense of self-esteem, feelings of inadequacy, and a continual obsession with conforming to unrealistic ideals.  While the majority of those affected are women (over 90%), men can also be affected.

From plastic surgery to fashion, women are often encouraged to spend time, energy and money trying to meet unfair and impossible standards. One of the main mental health concerns stemming from cultural and social pressure is an obsession with “thinness.” While many women feel the effects of such pressures, there are certain vulnerabilities that increase the likelihood of developing a disordered eating pattern to attain this ideal. Some of these vulnerabilities can include other mental health issues, such as anxiety and depression, family tension, peer pressure, history of trauma, and/or perfectionistic tendencies.

You may be asking yourself what to do to support a significant other, friend or family member who may display some of these vulnerabilities. Some of the practical things you can do include: avoiding comments or jokes about weight or eating habits, encouraging healthy but realistic eating and exercise, starting a discussion about unrealistic standards of beauty in today’s culture, and communicating openly about body image and acceptance.

If you are wondering if you or someone you care about is struggling with these issues, take a few minutes to answer the following questions.

Do you or someone you care about:

1. Ever intentionally force vomiting, use laxatives, or enemas to reduce weight gain?
2. Ever exercise to an extreme (hours a day)?
3. Regularly skip meals to reduce weight?
4. Avoid social gatherings at which food is consumed (holidays, parties)?
5. Feel a sense of shame around “normal” food consumption?
6. Feel a sense of shame about one’ s body after eating?
7. Over-consume food when feeling emotionally upset (angry, sad, lonely, worried)?
8. Engage in a rigid and planned eating regimen, such as eating the same few foods every day to determine the exact amount of calories consumed?

If you answered “yes” to any of these questions, this may suggest the need for a professional consultation to further assess any potential disordered eating.

Here at Mosaic Psychological Services, LLC, all of our clinicians are trained in the assessment and treatment of problematic eating and body image concerns. Please contact us if we can provide assistance regarding your concerns.

Kids and the Internet: What parents should know.

Kids and the Internet:  What parents should know.

The Internet is full of endless information and when used responsibly it can be a wonderful resource.  I don’t think there is a day that goes by that I do not “Google” a topic to research more information.  I use the Internet to research papers, communicate with other people, shop as well as many other things.  We are in the computer age and computers are everywhere with access to the Internet through laptops, tablets, and phones. Easy and prolific access to the internet can also be a hazard if used inappropriately in the wrong hands. That's why it's important to be aware of what your kids see and hear on the Internet, who they meet, and what they share about themselves online.

Just like any safety issue, it's wise to talk with your kids about your concerns, take advantage of resources to protect them, and keep a close eye on their activities.

Internet Safety Laws

A federal law, the Children's Online Privacy Protection Act (COPPA), was created to help protect kids online. It's designed to keep anyone from obtaining a child's personal information without a parent knowing about it and agreeing to it first.

COPPA requires websites to explain their privacy policies on the site and get parental consent before collecting or using a child's personal information, such as a name, address, phone number, or Social Security number. The law also prohibits a site from requiring a child to provide more personal information than necessary to play a game or participate in a contest.

But even with this law, your kids' best online protection is you. By talking to them about potential online dangers and monitoring their computer use, you'll help them surf the Internet safely.

Getting Involved in Kids' Online Activities

Aside from these tools, it's wise to take an active role in protecting your kids from Internet predators and sexually explicit materials online. To do that:

• Become computer literate and learn how to block objectionable material. Many Internet providers provide parent-control options to block certain material from being seen on your computer.  Many sites use "cookies," devices that track specific information about the user, such as name, email address, and shopping preferences. Cookies can be disabled. Ask your Internet service provider for more information. There is also software you can buy that helps block access to certain sites.  You can also use filtering programs to block sites from appearing on your computer and restrict personal information from being sent online.  Other programs can monitor and track online activity.  But no software is 100%.
• Keep your computer in a common area, not in individual bedrooms, where you can watch and monitor its use.  When you are not home make sure the computer cannot be used without your monitoring.  This includes taking the monitor cord with you or locking up your laptop.  Make sure you child has your permission to be on the Internet.
• Share an email account with your child so you can monitor messages.  Connect this email to your cell phone so you get notified of incoming emails.  Routinely check this account.
• Bookmark kids' favorite sites for easy access.  This reduces the potential of typing in the wrong search word or website and stumbling on inappropriate content. 
• Spend time online together to teach your kids appropriate online behavior.  Sit with your children while they are on the Internet. 
• Set rules for your child:  Never trade personal photographs in the mail or scanned photographs over the Internet.  Never reveal personal information, such as address, phone number, age or school name or location. Use only a screen name. Never agree to meet anyone from a chat room in person.  Never respond to a threatening email or message.  Always tell a parent about any communication or conversation that was scary.  If your child has a new "friend," insist on being "introduced" online to that friend. Do not pretend to be someone else. 
• Never share personal details, like name and address. Never share your passwords but make sure you have all your children’s passwords and check those accounts frequently. 
• Monitor your credit card and phone bills for unfamiliar account charges and atypical use.
•  Find out what, if any, your child’s school, after-school center, library, friends’ homes offer online protection, or anyplace where kids could use a computer without your supervision. 
• Forward copies of obscene or threatening messages you or your kids get to your Internet service provider and contact your local law enforcement agency or the FBI if your child has received child pornography via the Internet.  Understand the site's rules and know how to flag other users for misbehavior.  Recognize "red flags," like if someone asks you personal questions like your name and address.

Warning Signs

Warning signs of a child being targeted by an online predator include spending long hours online, especially at night, phone calls from people you don't know, or unsolicited gifts arriving in the mail. If your child suddenly turns off the computer when you walk into the room, ask why and monitor computer time more closely. Withdrawal from family life and reluctance to discuss online activities are other signs to watch for

Should I let my kid get a Facebook page?

This is the most common question I get from the parents.   The legal age for Facebook use is 13 years old; however, kids younger then 13 are on Facebook by registering with a fake birthdate.  If parents are allowing your children to place false information on the Internet this sends mixed messages to your children.  That it is ok to lie, and some “rules” about the internet are ok to be broken.  Also, by making children older then their real age this allows any of the safety controls Facebook has put in place null and void.  I suggest to at least wait until they are of the legal age for Facebook for both safety and privacy reasons. Even when they are 13 and on Facebook stay involved and help them follow these rules:

• Think before you post. Once the post is out there you cannot take it back.
• Ask your parents before visiting other Facebook pages.  Facebook pages can be created by anyone and can expose your children to sexually graphic pictures and language. 
• Notify parents if they see any cyberbullying of friends or themselves. As well as any “friend requests.”  Have you child get your permission before accepting any “friend requests.”   
• Share an email account with your child to help you monitor their incoming messages. Children should provide their parents with their passwords and parents should continue to randomly and regularly check their site and settings.  Email accounts that are created without the parent’s permission and without the parent’s access are not allowed and may result in loss of internet privileges.
• Know that anything you post online can be used in ways you never intended.  Pictures of your child and their friends should be limited postings and profile pictures should be of other objects or characters, and not your child.  Be sure to check with other parents about posting pictures of their child on your page or your child’s page.  Many parents do not wish to allow any pictures of their child on the internet.
•   Use privacy settings.  Stress the importance of privacy settings and parents should continue to check your children’s privacy settings as they can be altered by the child with each and every post.  
• Be intentional about who you allow your child to be “friends” with on Facebook.  Allowing your child to be “friends” with other children you do not know may result in your child having access to information through that child’s unmonitored page.  Also, allowing a child to be “friends” with adults who are family and/or friends of the family may present the child with some unintended access to adult comics or salacious language that may not be anything more than racy for an adult, but inappropriate for a 13 year old.  
• The same rules apply for communication and internet access through cell phones.  All text messages and pictures on a cell phone must be monitored by parents. 

If all these rules seem like too much of a hassle, you might be right.  When the risk outweighs the benefit of allowing your child to participate in an online social networking page, then you may wish to wait it out until your child is much older.  Just because “Facebook” allows access to 13 year olds does not mean that 13 is the right age for your child to begin to participate on Facebook.  The rule for use of technology with teens is trust but verify.  When your child objects to this oversight and monitoring remind them that you believe they have the integrity (desire to do the right thing) but not the judgment (knowledge of right or wrong) yet and this will develop with maturity.  Don’t be bullied by your child into capitulating.  If you cannot monitor your child’s use of technology properly, than they simply cannot participate online.  Also, once the privilege is abused and the rules set forth by the parent are violated, the child should lose access to the internet and their page may be deleted. 

A chainsaw is a powerful and useful tool in the right hands.  So is the internet.  Some mistakes have consequences for children that are not easily recoverable.  Consider carefully the needs of your child and the responsibility you as a parent will have to monitor their use of technology.  Many parents initially monitor their child closely and later become lacks until they receive a phone call from another parent about their child’s online behavior.  If you grant your child permission to use this technology, you as the parent must make a commitment to monitor their activity consistently.

Common Questions about ADHD

Does my child have ADHD?

I hear this question from parents all the time in my office and from people I meet around town.  I am also surprised at how often parents and teachers mistakenly misattribute the “symptoms” for ADHD when the source of the child’s learning or behavioral problems is something environmental either in the home or the learning environment.  For example a child who is being bullied might have trouble paying attention in the same way that a child with ADHD misses half the lesson because they are distracted by noise in the hallway. 

So how can my child get an accurate diagnosis?

There are many symptom checklist and the like that are often employed by clinicians trying to determine the nature of a child’s inattention and hyperactivity.  These lists are helpful; however, they are a measure of symptoms, and not a sample of the child’s performance.  Although teacher and parent interviews are essential, as well as cognitive and achievement testing, Mosaic Psychological Services chooses to also use the Test of Variables or Attention (TOVA).  This test is like a computer game that the child plays.  While the child plays the game the test measures and calculates the child’s responses and response time thus giving the clinician an objective measure of the child’s performance.  Also, because the test does not include the use of language or numbers (only symbols), the test is able to rule out any skill deficit as a source of poor performance on the ADHD assessment. 

I have a diagnosis so what now?

Many parents tell me that they believe their child to have problems with ADHD, but they won’t bother with an ADHD evaluation because they have no plan to give their child medication.  Of course any parent would have concerns about starting psychotropic medication.  Although medication is often a treatment option for children and adults with ADHD, it is not the only form of intervention.  Behavioral modification and therapy is often very helpful in improving functioning for individuals with ADHD.  Additionally, ADHD medications may be prescribed in a stimulant and/or non-stimulant form.  For individuals who already utilize medication as an option and do not feel that they are receiving the desired effect, the TOVA may be administered while using ADHD medication in order to determine the medication/dosage efficacy.  Ultimately, research suggests that a combination of medication plus therapy is the most effective intervention.

Please feel free to contact our office for additional information on the TOVA and other services for ADHD. 

www.mosaicpsychological.com 

Welcome!

Each month the clinical staff from Mosaic Psychological Services will be offering helpful insights and information to provide direction and motivation for those interested in exploring ways to improve their family and personal functioning.  Although these postings do not attempt to replace the appropriateness of seeking out professional consultation and treatment, it is our hope that the psychoeducation offered through this blog will assist you in your personal goals toward wellness.

Additional information about our staff and services can be found at www.mosaicpsychological.com


Shannon D. Mullen, Ph.D.