Michael-AsselWe were fortunate to have Michael Assel, Ph.D present a webinar  about Autism Spectrum Disorder in ECE settings on March 25, 2015. Many of the participants had questions that we were unable to ask Dr. Assell.  He was kind enough to answer them and they are posted below. Link to the recording of the webinar, Autism Spectrum Disorders in the Early Childhood Setting: The Role of Administrators, by Michael A. Assel, Ph.D.


Q.1.     How much of the change in prevalence of ASD  is attributed to increased ability to identify children younger?

A.1.     There is a belief that the change in diagnostic strategies has led to a large percentage of the increase in diagnosis of ASD.  Here is a nice summary article about increases in diagnoses of ASD.

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Q.2
.     Just as with anxiety, can fatigue or tiredness lead to an increase in repetitive actions?

A.2.     Yes– In my clinical work, I have noticed a tendency for repetitive behaviors to increase as a child’s system is taxed by any type of stress (anxiety due to working with a new person), fatigue, or other biological states.  I have begun to see some repetitive behaviors as serving a self-soothing function.

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Q.3.      So what do you do if a student/child has been diagnosed by a doctor for having a SPD, but the parents are making it very clear it is not ASD? [This question was asked 5 times during the session.]
A.3.      This is a tough one.  I would imagine that the best way would be to work with the family to determine what services/supports could be provided by the district/program to help the child become successful.  In short, focusing on the services required (e.g., speech, social group, occupational therapy), you can avoid the “label/diagnosis” and focus on the child.

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Q.4.      How do we go about screening when the parent of the child is in denial and refuses screening?
A.4.      This really a two-part answer.  School districts have procedures in place that allow them to assess children when consent can’t be obtained.  Here is a section of text from the Department of Education that describes how a school district might be allowed to assess a child when it lacks consent of parents….

(i) If the parent of a child enrolled in public school or seeking to be enrolled in public school does not provide consent for initial evaluation under paragraph (a)(1) of this section, or the parent fails to respond to a request to provide consent, the public agency may, but is not required to, pursue the initial evaluation of the child by utilizing the procedural safeguards in subpart E of this part (including the mediation procedures under Sec. 300.506 or the due process procedures under Sec. Sec. 300.507 through 300.516), if appropriate, except to the extent inconsistent with State law relating to such parental consent.

As you can see, there are specific recourses set forth for school districts in these situations.
In my opinion, the broader issue (2nd part of the answer) surrounds having an open and honest conversation with parents about a child’s struggles within the educational placement and determining the best way to support that child.  For example, some parents might avoid asking to have their child assessed because they are afraid of receiving bad news.  However, these same parents might respond differently if an administrator has a conversation with them about the inability to access services if the child has not been evaluated.  In other words, a parent might be deathly afraid of the word “autism” but be willing to allow their child to be evaluated to determine whether or not they can participate and speech and language therapy services or be enrolled in a social group.

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Q.5.    [This person is responding to the discussion about vaccines and autism] That’s a LIE because over 3 BILLION dollars has been awarded to families with vaccine injured children, including autism.
A.5.     There is a difference between what happens in court and what happens in terms of research.  As I’m not an attorney, I will not comment on what might occurred within the confines of a trial about vaccines.  However, I will provide the readers with the latest evidence set forth from multiple research studies by the American Academy of Pediatrics
https://www2.aap.org/immunization/families/faq/vaccinestudies.pdf  .
“The established medical community does not feel that there is a link between vaccinations and autism.  I recognize that others disagree”.

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Q.6.    Are children ever misdiagnosed?
A.6.     Psychologists, neurologists, developmental pediatricians, educators, diagnosticians, speech therapists, and other helping professionals are human and it would be foolish to us assume that mistakes aren’t made (by myself and others). That is why that many agencies and school districts tend to utilize a treatment team approach to the diagnosis of ASDs.  There is less likelihood of mistakes being made when more people interact with an individual child.

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Q.7.      [I believe this question is about screening processes and services] How do we find out what those processes are for our district/state?
A.7.       This is a tough one and I can’t answer.  They have to dig.

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Q.8.      What other screening tools are recommended for ASD?
A.8.        Here is some information about the screening measure I spent time talking about (i.e., M-CHAT)
http://pediatrics.aappublications.org/content/early/2013/12/18/peds.2013-1813 .

Here is a link to a decent summary of measures that can be used for both diagnosis and screening.
http://www.txautism.net/uploads/target/AutismScreen_Assess.pdf

I honestly don’t really have a strong bias about the particle measure.  I tend to push to get the child into a clinic or professional that understands ASDs.  A researcher at a conference I attended said something to the effect that there seems to be a whole lot of attention being paid to the instruments that are used to diagnose and screen for autism.  In reality, more emphasis needs to be placed on the clinicians, rather than the tools.

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Q.9.     Where can we find advocates to help a parent that is just starting out with their child who is receiving early intervention in preschool?
A.9.       It is especially important for families to develop connections within their local autism communities.  I tend to refer families to well known organizations (e.g., Families for Effective Autism Treatment, Autism Speaks, etc.).  Support groups often provide families with names of advocates.  I think it is important to look within the Autism Community rather than the advocacy community.  This is due to the fact that advocacy for a child with Dyslexia is often very different than advocacy for a child with an ASD.
In addition, for parents receiving a new diagnosis , I would certainly steer them toward The Autism Speaks 100 Day Kit for Newly Diagnosed Families of Young Children.  Here is a link
https://www.autismspeaks.org/family-services/tool-kits/100-day-kit

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Q.10.      I also heard that vaccinations may cause Autism.  Is this a myth or fact?
A.10.      I think I’ll let my other answer stand for this question.

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Q.11.   Do you believe there is a link between ASD and chemicals/preservatives in foods and items(drugs and alcohol)  ingested ?
A.11.   There is a great deal of research going on investigating the link between environmental factors and autism.  At this point, it is probably safe to conclude that the jury is still out.

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Q.12.   Is there any information on the average age of ASD diagnosis in Canada?
A.12.   I found a 2009 article that said that the age of diagnosis in Canadian provinces is variable.  The abstract for the article stated that Newfoundland and Labrador had the lowest median age of diagnosis at approximately 39 months and southeastern Ontario had the highest at approximately 55 months .  Here is a link to the article  http://www.ncbi.nlm.nih.gov/pubmed/19722339.

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Q.13.   How DO YOU WORK WITH A CHILD THAT IS 18 MONTHS OLD AND IS COMPLETELY NON-VERBAL, NON-RESPONSIVE?
A.13.   In these cases, the first thing that I would recommend is a comprehensive evaluation from a medical professional. If that has been completed then I think it is up to the treating professionals to help you develop an educational plan for the classroom. In children with severe forms of the disorder I would often encourage parents to learn about and participate in an Applied Behavioral Analysis program (ABA).

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Q.14.   What is the difference between normal echolalia vs echolalia in a child with an ASD?
A.14.   If taken at face value, “normal echolalia” sounds the same as “echolalia that occurs in a child with an ASD”. In short, words are repeated. For me, it is very important to evaluate the overall social functioning of the child as they engage in echolalia.  For instance, if a child is actively engaged with caregivers or peers, engaging an excellent eye contact, makes other communicative attempts, and is routinely using social gestures (e.g., pointing, waving, showing objects to others), then I would not be as worried.  This is especially true if a child has a documented language delay and is just trying to be social by repeating words that they have heard spoken by someone else.

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Q.15.   My daughter was pick up early for early intervention. It made a world of difference. Only complaint is they used sweets as a reward. It still lingers in her adult life. She needs to be rewarded Do you see this problem?
A.15.    I think it’s important to find out what motivates a child and use that within intervention efforts. In other words, I think it all comes down to the individual child. For one child an appropriate motivator might be food/treats and for another child it might be time on an iPad.

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Q.16.   Is it true that there are more children with autism who were conceived using IVF?
A.16.   There was literally an article published about this association earlier this week. Here is the link
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302383 .  The author of the study was Bearman.

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Q.17.   Can a high amount of Mercury in the brain cause autism symptoms.
A.17.   At this point, I do not think that the science exists that will allow someone to definitively say ____causes Autism.  Here is what the National Institute of Child Health and Development says about the causes of Autism  https://www.nichd.nih.gov/health/topics/autism/conditioninfo/Pages/causes.aspx

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Q.18.   If a child adheres to specific nonfunctional routines (e.g. mac and cheese story), do you recommend that parents and teachers NOT accommodate the child according to his or her wishes?  Or parents and teachers simply need to be prepared for issues when it is impossible to accommodate (e.g. babysitter/substitute)?
A.18.  This is a tough question.  The answer is it depends.  With children, I have a “rule of thumb” that works a lot of the time.  The rule states, “When it comes to parenting, you are probably safe to pick the option that is the toughest for the parent”.  In the example mentioned above, I believe that the hardest option for the parent would be to figure out a way and build in time to teach a child about how to be less rigid.  Once the pattern is firmly established, parents might have to work with a behavioral specialist to “retrain” the child to be more adaptable.  Early on in the development of an obsessive pattern of behavior, parents might have been better served by tolerating a few tantrums when nonfunctional routines were challenged.  In ASD, there is no “easy way”.

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Q.19.   [Two people challenged the incidence of ASD you provided] I was under the impression that the number was changed in May 2013 to 1 in 68 instead of 1 in 88.
A.19.   The audience is correct.  The newer number is 1 in 68.  Regardless, they are both alarming statistics.

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Q.20.   Have any studies been done to ascertain of there is a link between microwaves, electrical currents, cell tower proximity and use during pregnancy in relation to autism?
A.20.   I’m not aware of the studies that have investigating this link. However, I am sure they are out there somewhere.  I will make one general comment about the types of studies that you choose to read about autism.  Please confine your reading to peer reviewed journals.  In most cases, I would recommend tracking down the original source for specific information.  Most peer-reviewed journals require that authors provide a fairly easy to read synopsis (i.e., abstract).

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Q.21.   Do all kids that are diagnosed with Autism most likely show signs of aggressiveness or does it depend?
A.21.   Not all children who were diagnosed with autism show aggressiveness.  In fact, a very small proportion of the children with whom I work with who have been diagnosed with autism are aggressive. For instance, I have worked with many children who display absolutely no aggressive behavior. These children might be extremely aloof, shy, or too lost in their own world to notice others in the environment.

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Q.22.   Why don’t Amish children have the same incidence of autism and they are not vaccinated?
A.22.   I don’t know and I would refer people to the American Academy of Pediatrics position paper on vaccines and autism.

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Q.23.   I have children in my care that show many of these behaviors but not all of them, so how would I address that? Does that mean they all have some sort of Autism Spectrum Disorder?
A.23.   I’ll attempt to answer this question in a somewhat unusual way. Most psychologists have to take undergraduate and graduate coursework in psychopathology. As you read about different disorders (e.g., obsessive-compulsive disorder, depression, bipolar disorder, autism) you will recognize that some portions of the description apply to people you know or yourself.  In contrast, I don’t think that we all have an Autism Spectrum Disorder. This is one instance where I think it is important to remember what these disorders were called in the DSM-IV (e.g., Pervasive Developmental Disorders). The key word is “pervasive”. For instance, my eye contact might not be that good if you observe me in an uncomfortable social situation (e.g., a social event with people I don’t know). However, my ability to engage in eye contact is good across most other social settings.  It would be unreasonable to take my behavior in one situation (e.g., eye contact in unfamiliar social situations) and assume that that was an indication of autism. In conclusion, there are times when we all wish we were somewhat more social or had better eye contact.

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Q.24.   Is it true that there are more boys than girls who are diagnosed with autism spectrum disorders?
A.24.   This is from the CDC website, “ASD is almost 5 times more common among boys than girls”. 1 in 42 boys .   1 in 189 girls .

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Q.25.   Does Sensory Integration Dysfunction appear on the spectrum at all?
A.25.   Prior to publication of the DSM – 5, clinicians routinely reported that children with autism presented with sensory integration difficulties. However, there was little to no mention of sensory difficulties included in the DSM –IV.  With the publication of the DSM – 5, the category evaluating restricted, and repetitive patterns of behavior includes a mention of sensory integration difficulties. Specifically, the 4th criteria states that “ hyper – or hypo reactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).  Therefore, if it’s in the diagnostic criteria, it should be considered as being “on the spectrum”.

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            About Dr. Michael Assel, Ph.D

Dr. Assell is an Associate Professor of Pediatrics at the Children’s Learning Institute at the University of Texas Health Science Center at Houston. Dr. Assel received his doctorate from the University of Houston in Counseling Psychology and interned in the Houston Independent School District’s Psychological Services Department. Following completion of his degree, Dr. Assel completed post-doctoral training at UTHSC-Houston. As one of the staff psychologists in the Dan L. Duncan Neurodevelopmental Clinic, Dr. Assel routinely evaluates children with a range of development differences (e.g., Autistic Spectrum Disorders, Language Delays, Learning Disabilities, and ADHD). Dr. Assel is a Core Faculty Member of the LoneStar LEND (i.e., Learning and Education in Neurodevelopmental Disabilities) which is a postdoctoral training program which seeks to improve global service delivery, including increased identification and diagnosis of Autistic Spectrum and other Neurodevelopmental Disabilities. Dr. Assel also performs Independent Educational Evaluations on numerous children whose parents are struggling to obtain effective school based interventions for ASDs. His research interests include assessment, instrument construction, large program evaluations, and observational coding systems used to evaluate teaching environments.