ChildsWork News, June 12, 2012: A Personal Take on the New Autism Diagnosis and New Treatment for Childhood Anxiety
This morning my RSS fee came across a lovely article from one of my favorite parenting columnists, Sean Bean. And, yes, I said columnists as I usually read Sean’s writing in the physical copy of Parenting magazine, but I digress. Sean’s article today is about his oldest son, Jackson and his former autism diagnosis. Though the Bean family’s experience is by no means universal, his understanding about the difficulties for both the families affected by autism (especially so-called “high functioning” autism) and the medical community’s quest to define this disorder is new and refreshing. Next, a press release from Tel Aviv University describes an exciting new way that researchers have developed to treat childhood anxiety. I have blogged about anxiety quite extensively, since it is one of those issues that is easy to sweep under the rug (“Oh, she just worries too much”). This new treatment which uses computers may be able to bring real, helpful, non-drug-related treatment to school counselors across the country with very little investment. This treatment is all the more encouraging since it focuses on lifetime health – anxious children are far more likely to become severely anxious adults. Do you feel it would be affective in your schools? My Son Had Autism. Then He Didn’t. By Sean Bean, for Parenting I'm trying to hold him, but he's squirming. The airport lounge is packed with people, and I can feel all eyes on me: the dad who cannot appease his toddler. Brandy sees me struggling, and comes up with a quick fix. She flips over the stroller. She places Jackson next to it. He begins to spin one of the wheels with his hand. He keeps spinning it. Over and over and over. He's completely absorbed. I look at Brandy quizzically. She shrugs. That snapshot of my oldest son Jackson appeared in a feature story I wrote for Babytalk roughly two years ago: “Solving the Autism Mystery.” (There may be no other story I’m more proud of.) Jackson was 3 years old at the time, and by all accounts—from mother’s intuition to the experts’ definition—he was on the spectrum. The behavioral psychologists saw what we saw, but were hesitant to make an official diagnosis. The brain is still developing. So much can change in six months. So time passed. 4Ts became 5Ts. Birthday candles were lit, blown out, and saved in the kitchen drawer. By age 6, the appointments with the behavioral psychologist were over. The books came off the nightstand. The tears were redirected to other things like sad movies and kindergarten graduations. That’s the thing with autism: There is no pathology. It’s not in the blood. It doesn’t appear when you shine a penlight into the pupil. Injuries don’t cause it. Biopsies don’t detect it. Medicine can’t fix it. It’s behavior—averted gaze, preoccupation with patterns and repetition, hyper-sensitivity to certain sounds and textures, etc.—that earns the diagnosis. Earlier this week, some parents picked up the New York Times and discovered their child may no longer have autism. The New York Times reported that the American Psychiatric Association is considering a new definition of autism, which would no longer include many of the children and adults currently diagnosed with Asperger’s Syndrome or Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS). In other words, high-functioning people on the spectrum would no longer fit the bill. Put away your picket signs. Delete that angry email from your “drafts” folder. There isn’t anything to scream or rant about. How can you blame the experts for changing the definition of something they're still struggling to define? A study highlighted in Pediatrics focused on 61 children aged 14 to 35 months who were on the spectrum. Two years after their initial diagnosis, 20 percent of those children no longer met the ASD criteria, which suggests that either the children are improving or were misdiagnosed from the start. And consider this: Approximately 1 in every 91 children ages 3 to 17 was on the autism spectrum in 2007, according to the American Academy of Pediatrics. Five years earlier, that figure was 1 in 150. Four years before that, it was 1 in 1,000. Is it our increasing awareness that’s making those figures skyrocket? Is something mutating in our DNA? Does it lurk in our cleaning products or groundwater? For our family, the autism spectrum was like the Alaskan winter. There was no light. All day, all night. On and on and on. It seemed like the darkness would never stop. Then one day, a yolk-hued color broke across the horizon. And it stayed. But we haven't forgotten what the darkness was like. Treating Childhood Anxiety with Computers, Not Drugs Press Release from American Friends of Tel Aviv University According to the Anxiety and Depression Association of America, one in eight children suffers from an anxiety disorder. And because many anxious children turn into severely anxious adults, early intervention can have a major impact on a patient's life trajectory. The understandable reluctance to use psychiatric medications when it comes to children means child psychologists are always searching for viable therapeutic alternatives. Now Prof. Yair Bar-Haim of Tel Aviv University's School of Psychological Sciences and his fellow researchers are pursuing a new method to address childhood anxiety. Based on a computer program, the treatment uses a technique called Attention Bias Modification (ABM) to reduce anxiety by drawing children away from their tendency to dwell on potential threats, ultimately changing their thought patterns. In its initial clinical trial, the program was as effective as medication and cognitive therapy for children — with several distinct advantages. The results of the trial were reported in the American Journal of Psychiatry. Computers instead of capsules Children are comfortable with computers, explains Prof. Bar-Haim. And because of the potential side effects of medications or the difficulty in obtaining cognitive behavioral therapy, such as the need for highly trained professionals, it is good to have an alternative treatment method. ABM treatments can be disseminated over the Internet or administered by personnel who don't have to be Ph.D.s. "This could be a game-changer for providing treatment," he says. Anxious individuals have a heightened sensitivity towards threats that the average person would ignore, a sensitivity which creates and maintains anxiety, says Prof. Bar-Haim. One of the ways to measure a patient's threat-related attention patterns is called the dot-probe test. The patient is presented with two pictures or words, one threatening and one neutral. These words then disappear and a dot appears where one of the pictures or words had been, and the patient is asked to press a button to indicate the dot's location. A fast response time to a dot that appears in the place of the threatening picture or word indicates a bias towards threat. To turn this test into a therapy, the location of the dot target is manipulated to appear more frequently beneath the neutral word or picture. Gradually, the patient begins to focus on that stimulus instead, predicting that this is where the dot will appear — helping to normalize the attention bias pattern and reduce anxiety. Prof. Bar-Haim and his colleagues enlisted the participation of 40 pediatric patients with ongoing anxiety disorders and divided them into three groups. The first received the new ABM treatment; the second served as a placebo group where the dot appeared equally behind threatening and neutral images; and the third group was shown only neutral stimuli. Patients participated in one session a week for four weeks, completing 480 dot probe trials each session. The children's anxiety levels were measured before and after the training sessions using interviews and questionnaires. In both the placebo group and neutral images group, researchers found no significant change in the patients' bias towards threatening stimuli. However, in the ABM group, there were marked differences in the participants' threat bias. By the end of the trial, approximately 33 percent of the patients in this group no longer met the diagnostic criteria for anxiety disorder. New methods for personalized treatment These indications of the method's success in treating children warrant further investigation, says Prof. Bar-Haim. In collaboration with the National Institute of Mental Health in the US, a large international trial involving his computer program is now being carried out at more than 20 sites across five continents. The more options that exist for patients, the better that clinicians can tailor treatment for their patient's individual needs, Prof. Bar-Haim observes. There are always patients for whom medication or cognitive therapy is not a viable option, he explains. "Psychological disorders are complex, and not every patient will respond well to every treatment. It's great to have new methods that have a basis in neuroscience and clinical evidence."