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The Cow Says Moo  

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What are Autism Spectrum Disorder Specifiers?

Posted on August 26, 2013 at 9:55 AM

In May 2013 the American Psychiatric Association published its most recent edition of the Diagnostic and Statistical Manual (DSM). The DSM is used by clinicians and psychiatrists to diagnose mental health disorders, including Autism Spectrum Disorder.  With the release of this latest edition (DSM-V), the previously three separate categories of Autistic Disorder, PDDNOS and Asperger's Syndrome were eliminated and combined under the one term Autism Spectrum Disorder (ASD). 


In addition to this change, a diagnosis of ASD will now include severity levels, referred to as specifiers, which are based on the amount of support an individual will need due to challenges with social communication and restricted interests and repetitive behaviors.  Co-occurring conditions will also likely impact the assigned severity level.  There are three severity levels, detailed in the following table:

DSM-5 Table of Severity Descriptors

Social Communication Disorder

Posted on August 19, 2013 at 9:25 AM Comments comments (0)

In May 2013 the American Psychiatric Association published its most recent edition of the Diagnostic and Statistical Manual (DSM).  The DSM is used by clinicians and psychiatrists to diagnose mental health disorders.  Included in this latest edition (DSM-V) is the new diagnostic category of Social Communication Disorder (SCD).  It is targeted to children who have difficulty in the social use of language (pragmatics) that impacts comprehension and social skills.  In order to meet the criteria for SCD, the difficulty cannot be the result of delayed cognition or other language delays.  Unlike children diagnosed with Autism Spectrum Disorder (ASD) who also present with language pragmatics deficits, children diagnosed with SCD will not have met the criteria of restricted interests or repetitive behaviors necessary for a diagnosis of ASD.  



Therapeutic Listening

Posted on August 12, 2013 at 11:55 AM Comments comments (2)



Listening and hearing are not one in the same. When we listen, we are using our entire body, not just our auditory system. According to Porges (1997), sound stimulation alone facilitates the process of listening and social engagement. 


The Listening Program® is a music listening therapy that provides engaging brain stimulation to improve performance in school, work and life. Some children experience problems processing auditory information from birth. In other instances, difficulties may develop later in life as a result of illness, injury or other challenges. The Listening Program® addresses auditory processing by gently providing psychoacoustically modified classical music designed to train the brain to process sound more efficiently. 


The meaningful sound vibrations provided by The Listening Program® travel from the outer ear to the middle ear and then to the inner ear. The sound is converted to nerve impulses which move through the brainstem to the brain. The brain can establish new neural pathways and organize new synapses when presented with specific sensory sensation with appropriate frequency, intensity, and duration. Hearing is intimately connected with other sensory pathways within the brainstem and brain. We hear with our entire body and proper sound processing may lead to improvements in many areas, including:



•Attention and Listening



•Social Engagement

•Sensory Processing

•Self Regulation

•Musical Ability

•Daily Living


•Brain Fitness.


 I highly recommend The Listening Program®.

Can Sensory Processing Disorder Be Seen On A Brain Imaging Scan?

Posted on August 5, 2013 at 8:20 AM Comments comments (11)

(Credit: Image courtesy of University of California - San Francisco)



Can Sensory Processing Disorder be seen on a brain imaging scan?  Scientists from the University of California in San Fransisco believe it is possible and have the evidence to support their theory.  "Until now, SPD hasn't had a known biological underpinning," said senior author Pratik Mukherjee, MD, PhD, a professor of radiology and biomedical imaging and bioengineering at UCSF. "Our findings point the way to establishing a biological basis for the disease that can be easily measured and used as a diagnostic tool," Mukherjee said.  Read the full article for details on this ground-breaking study.


Above: Brain images showing water diffusion within the white matter of children with sensory processing disorders.

Row FA: The blue areas show white matter in children with sensory processing disorder where water diffusion was less directional than in typical children, indicating impaired white matter microstructure.

Row MD: The red areas show white matter in children with sensory processing disorder where the overall rate of water diffusion was higher than in typical children, also indicating abnormal white matter.

Row RD: The red areas show white matter where children with sensory processing disorder have higher rates of water diffusion perpendicular to the axonal fibers, indicating a loss of integrity of the fiber bundles comprising the white matter tracts.




Early Intervention: How Much is Enough?

Posted on July 29, 2013 at 11:50 AM Comments comments (0)




There is an ongoing debate in the field of Early Intervention as to whether one hour a week of direct service is enough for children with or at risk for developmental delays. Although many factors must be considered when determining the frequency of services for a child, the single most important factor that will increase the likelihood of a child’s success is the extent to which family members follow-through with the strategies provided by the Early Intervention practitioners. It is a common misconception that Early Intervention is a home-based therapy service, and while I recognize that in practice it can sometimes be just that, it is not designed as such. Early Intervention is designed to be a family training program. It is designed to offer strategies, materials and resources that family members can use to help them achieve the goals they set for their child. It is much more than home-based therapy and done right can make a tremendous difference in the lives of each family member. The following article, reprinted from The OARACLE: The Organization for Autism Research’s Monthly E-Newsletter, discusses how parent training programs can lead to lasting changes in toddlers with Autism.


Can One Hour per Week of Therapy Lead to Lasting Changes in Young Children with Autism?


While all professionals recommend early intervention for children diagnosed with autism, there is often a delay between diagnosis and receiving interventions. This can cause added stress for parents while processing the diagnosis. Many parents feel helpless knowing they need to obtain services but not yet being able to. In this study, researchers investigated training parents one hour a week for 10 sessions to deliver services to their children, ages 0-2. Past studies have focused on interventions for children over the age of two. As diagnosis age decreases, more research-based interventions are needed for young infants. Other research on parent-directed interventions have shown an increase in verbal skills and appropriate behavior. This study focused on parent-directed interventions for younger infants. Parents were trained using a manual based on the Denver Model and Pivotal Response Training. This intervention was designed using research-based techniques to increase language skills and relationship development. Eight families were recruited to participate in this study. Children in the study were under 36 months old and diagnosed with autism. Parents participated for 12 weeks: two weeks of baseline and 10 weeks of training to implement the strategies. Parents were encouraged to use the strategies at home during usual daily activities. During the first two sessions, researchers gathered baseline data on targeted behaviors and asked parents to complete checklists and assessments. Targeted behaviors were “number of spontaneous functional verbal utterances” and “number of imitative behaviors.” During the following weeks, researchers videotaped play between the child and parent and child and therapist. These videos were used in data collection on target behaviors in 10-minute intervals. Parents were also assessed in competency of using the interventions. Researchers found that most parents implemented the strategies at or above criterion by the sixth session. During baseline, all child participants showed little to no imitative behaviors or spontaneous verbal utterances while playing with parents or therapist. After intervention, all children increased imitative behaviors and spontaneous verbal utterances. Children maintained high levels of targeted behaviors during follow up three months later. Researchers determined this increase in targeted behaviors was due to parent training rather than child interactions with therapists as behaviors increased as parents became more skilled at the strategies, therapists had high skill levels in implementing the strategies from the beginning of the intervention.


This study suggests that short-term parent training programs, as little as one hour a week for 10 weeks, does lead to changes in young children with autism. This is an important finding suggesting that parents can be trained in strategies immediately following diagnosis and begin.



Vismara, L.A., Colombi, C., and Rogers, S.J. (2009). “Can one hour per week of therapy lead to lasting changes in young children with autism?” Autism, 13, 93-115


Social Emotional Development in Infants and Toddlers

Posted on July 22, 2013 at 11:40 AM Comments comments (0)


Social emotional development simply refers to a child's capacity to experience emotions and respond appropriately. By learning proper responses to emotional matters, children are more likely to lead healthy, more productive lives as adults. Some aspects of social emotional development include:


• Self-confidence and self-esteem


•Self-control and behavior


•Empathy and compassion

•Cooperation and cooperative play.



Examples of typical social emotional development include laughing and smiling at a mirror reflection (7 months); wanting to be near adults and needing reassurance that a caregiver is nearby (14 months); imitating grown-up activities (16 months); claiming ownership of personal things (mine!) (24 months), and; pretending to be a Mommy or Daddy (24 months).



The reason for a child to be experiencing a delay in social emotional development is not always clear. Children with Autism especially have difficulty in this area of development. These children often avoid social interaction, prefer solitary play, and have difficulty interpreting body language and reading facial expressions. Children with Autism may say "ow" when they are being tickled or laugh when being scolded. For these children, proper social emotional responses do not develop as naturally as with typically developing children.



Environmental risk factors have also been known to impact a child's social emotional development. Examples of these types of risk factors include:

•Exposure to infection, alcohol or drugs prior to birth

•Poor nutrition

•Lead poisoning or exposure to other toxins

•Premature birth

•Poor prenatal care

•Life experiences.



It is important to remember that a child's social emotional skills do not development in isolation. Delays in other areas of development, including communication, motor, and cognition, may impact social emotional development as well.



Regardless of the reason for a social emotional delay, the earlier the intervention, the greater the likelihood that the delay can be successfully addressed.

Language Acquisition in Babies

Posted on July 15, 2013 at 11:25 AM Comments comments (0)

Research by Patricia Kuhl, co-director of the Institute for Brain and Learning Sciences at the University of Washington, emphasizes that the most productive period for language acquisition ends around age seven, after which ease of learning sharply declines. Kuhl’s research has played a key role in demonstrating the importance of early exposure to language. Implications of her work are especially meaningful for children with developmental delays and those in the field of Early Intervention.





Are six-month old babies sophisticated enough to understand their world? Check out this short video and decide for yourself: Patricia Kuhl: The Linguistic Genius of Babies.

Top 20 Signs to Teach a Special Needs Toddler

Posted on July 8, 2013 at 10:45 AM Comments comments (0)

As an Early Intervention Special Educator, I use simple signs to help children communicate on a regular basis. Although some parents express concern that the use of sign language may discourage their child from talking, research has shown that this is not the case. In fact, the opposite is true. Sign language helps to alleviate frustration and gives a child who is not yet able to verbalize a way to communicate.


When choosing which signs to teach a child, I typically recommend starting with signs for food, objects or activities that a child likes. If you think about it, it makes total sense. Why teach a child to sign for something he/she does not want? There is no motivation in that. Here is a list of the simple signs I teach most often and recommend for speech-delayed toddlers:


1.All done









10.Candy (use this for fruit snacks)


12.Block (I typically use the sign for build as the sign for block is difficult for young children)





17.Me (I also use this for "my turn")

18.Give me / want


20.TV / movie


Sometimes children make up their own signs; this is perfectly acceptable. In fact, I would encourage it. Remember, it is the intent that matters most!


4 Ingredients Gluten-Free

Posted on July 8, 2013 at 10:40 AM Comments comments (0)


I recently attended a presentation by Australian author Kim McCosker on her new book, "4 Ingredients Gluten-Free" (co-authored by Rachel Bermingham). The delightful presentation was held in New Jersey’s Barnegat Public Library where the attendees were not only treated to Kim’s entertaining stories, but also tasty samplings of food made from the recipes in her book.




I was drawn to the presentation because many of the children that I treat in Early Intervention are on gluten-free diets and I wanted more information on the subject. Although some research suggests that a gluten-free diet is not a remedy for developmental disorders like attention deficit or autism, many parents vehemently disagree. Gluten-free diets are not only about easing the symptoms of developmental disorders, however. Eliminating gluten from your diet can reap you all sorts of benefits, some of which are listed here and here.


If you are wondering what gluten is, simply put, gluten is a composite protein of wheat, barley and rye. (You can find a more in-depth definition here.) Gluten is found naturally in the environment. It is also used as a thickener, binder, flavor enhancer and protein supplement and as a result it is found in food that you would not otherwise expect to find wheat, barley or rye. (As an example, Walmart’s Great Value brand of salsa contains wheat, whereas Paul Newman’s organic brand does not.) Some people have a sensitivity or intolerance to gluten and symptoms can range from subtle (indigestion) to overt (Celiac Disease , Irritable Bowel Syndrome). Additional information on wheat and gluten sensitivities and allergies can be found here.


I purchased Kim’s book and look forward to trying out her recipes when I start a gluten-free diet in April. I have never been tested for gluten sensitivity. (I do not see the point as the tests can be inaccurate and misleading.) I am curious, however, and want to experience first-hand the benefits of a gluten-free diet.