Preventing Autism - 12 do's and don'ts before and during pregnancy

The Autism Revolution - whole-body strategies for making life all it can be by Martha Herbert, MD, PHD with Karen Weintraub, not only makes sense of current medical understanding of Autism, but it offers some very specific suggestions. One of the questions I've been asked often is about prevention. What can a mom-to-be do to minimize the risk of her child suffering from autism? I've heard this question from mothers of those who are struggling as well as from future moms who realize that the statistics alone put everyone at a rather high risk. So I've collected here some of Dr. Herbert's suggestions, and I hope this will encourage you to read the whole book by yourself. 

So here are a few things you can do before and during pregnancy. And yes, the book includes things you can do after your baby is born. 

1. Eat organic foods, stay away from processed foods and from pesticides. Maintain a diet that is high in nutrient density and plant-based - try to consume veggies and fruit of many colors, high quality proteins and whole grains. See also http://www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm081839.htm

http://www.fda.gov/Food/FoodborneIllnessContaminants/PeopleAtRisk/ucm083308.htm

2. Take a good prenatal vitamin. Supplements that are considered important are folic acid, essential fatty acids and vitamin D (did you know that a study showed a 60% increased risk of having a child with autism in women who did not take prenatal vitamins?). Consider also Zinc, vitamin B12 and Selenium

3. Avoid environmental triggers and foods that cause you allergy problems

4. Stay away from mold

5. Use green household products

6. Don't remodel your house now while you're pregnant. Remodeling introduces toxins to your environment.

7. Get a flu shot before getting pregnant

7. Avoid elective surgery, unnecessary medications and dental work. 

8. Don't do a detoxification program during your pregnancy or even 6-12 months before becoming pregnant, if possible, because this may release substances that will then circulate in your body and may end up in your child

9. Avoid colds and other contagious bugs and the flu - wash your hands often, don't share food with others (that includes your kids, if you have any). Reduce your risk of getting insect-borne illnesses (long clothes can increase your protection from mosquitoes). Now is not a good time to travel to the tropics: minimize the risk of tropical diseases

10. Have someone else clean the cat box. Cats can transmit toxoplasmosis which can affect your child's brain.

11. Exercise regularly - an evening walk, gentle yoga etc.

12. Get plenty of sleep. These last two can reduce your stress - and stress during pregnancy is known to affect development. 

A Few Thoughts About Acceptance

I recently read the book A Regular Guy: Growing Up With Autism by Laura Shumaker. If your life seems like a series of meltdowns, and you think you'll enjoy discovering that you're not alone, read it. I think my favorite part, however, was a description of Camphill in Pennsylvania, a special school for young folks with developmental disabilities. 

Near the end of the book, in a chapter called "Acceptance", Shumaker describes her reaction to a phone message her brother left her about new treatment modalities for autism. Here's what she writes:

"I have grown to dread the news reports on autism breakthroughs and the phone calls that followed them because of the way they make me feel. Angry. Offended. Insecure. Guilty.

 "I feel angry because I have tried so many treatments already: speech therapy, psychotherapy, auditory training, behavior modification, psychotropic drugs. Can't people see how hard I've worked?

 "I'm offended because they can't accept Matthew as he is. Can't they appreciate his honesty, his humor, and the pureness of his soul?"... "Matthew is now an adult, and I accepted long ago that he will not be cured of autism. I want others to accept this, too." 

This issue comes up often in my conversations with teachers and parents. I hope that you, the reader, explore the subject too.  And let's take this beyond autism, to any challenge your loved one or student or client has. 

Acceptance can mean Okay. They're alright the way they are. They can be respected for who they are. Recognized for who they are. Loved for who they are. Such acceptance does not need to get in the way of helping them take their next step, or searching for new ways to address their challenges.

Acceptance can mean acknowledgment. Acknowledging that a person has a disability that may always get in their way, for example, rather than denying it. I think this is the kind of acceptance that Shumaker was hoping to get from her brother and others.

But then we need to watch out for that fine line between acknowledgment and resignation, the giving up, the surrender. "I want these parents to understand that this child will never speak!" a teacher's aide told me just a couple of days ago. She thought she was talking about acceptance. I disagree. Just like I disagreed with Shumaker, and wished she'd found a way to let go of her "Angry. Offended. Insecure. Guilty" feelings, let go of the "how hard I've worked", and kept her mind open to new modalities and new discoveries. Her son can't do this by himself. 

About introverts, sensitive persons and those who are shy. A few thoughts.

Perhaps you recognize yourself or your child in this story: A bright young girl came in to see me for a HANDLE screening. She was slow to warm up (she preferred for quite a while to sit away from me and let Mom take care of the conversation) but eventually she joined me and took her time answering each of the questions I asked her. I was told that the child’s teacher was concerned about her shying away from social interaction, and I was asked if there was something I could do to help. During the screening I explored, among other things, her level of sensitivity to touch, to sound, to light, etc. I knew that if any of these issues came up, I could address them in her activity program and make her more comfortable in her environment. But in this case, these issues came up minimally if at all.

The question of how much overlap there may be between shyness, sensitivity and introversion has been interesting for me for quite some time, not just because of my work, but because of my personal life experience. So let’s start with sensitivity. I think you’ll enjoy Elaine Aron’s questionnaires that will help you find out if your child or you are highly sensitive:

http://www.hsperson.com/pages/test.htm

http://www.hsperson.com/pages/test_child.htm

You’ll note that sensory hypersensitivities are only one element of being “highly sensitive”. Some 15-20% of people fall under this category. It is normal, it is innate, it happens in many species of animals (at about 20% of the population) and it has advantages, such as heightened awareness, as well as disadvantages, such as getting overwhelmed more easily. The majority of people who are highly sensitive (about 70%) are introverts, according to Aron.

So what are introverts? I’ve recently read Susan Cain’s book Quiet: The Power of Introverts in a World That Can’t Stop Talking, and found that it’s been very helpful in getting some answers. There doesn’t seem to be one definition. Any one of us is somewhere on the spectrum of introversion/extroversion as a result of our innate temperament and other personality traits, as well as of our life experiences. Here’s Susan Cain’s quiz. Introverts prefer less stimulation. They often work more slowly and deliberately than extroverts, and often prefer to focus on one task at a time. Introverts may have strong social skills but prefer to devote their social energies to close friends and family. They listen more than they talk, think before they speak, enjoy deep conversations and dislike conflict. They often take on professions that involve much study, introspection or solitude (think: authors, scientists, truck drivers).They do their best work on their own, rather than in teams. They are not risk takers and they enjoy solitude. 

Now just like you can be calm or anxious whether you’re an introvert or an extrovert, you can be shy, or not, whether you’re an introvert or an extrovert. Shyness is a fear of social disapproval or humiliation. It is learned, and it is inherently painful. A shy person may turn inward, since socializing causes anxiety, and an introvert may feel shy if she always gets the message that something’s wrong with her. Different cultures treat introverts differently. The same child I described above could have been, in another culture, been admired for her careful consideration of every question before answering. But in the US, her preference to spend time with one or two friends, rather than a large group, is treated as if it is a “problem”.

What am I suggesting? That diversity in temperament and preferences, both in adults and in children, be accepted and embraced.

iPad apps for Autism

iPads apps can be used for communication, learning and entertainment. Some of the apps I list below can be fun and useful for people who don't have autism, so take a look. I owe what I know to Dawn Ferrer, SLP, of Morning2Moonproductions, co-author of the That's Silly app, whose lecture/demonstration I attended recently. Before we even go into the apps themselves:

• Consider protecting the iPad with a very strong rubber cover, preferably with a strap that will allow you to hold it, rather than hand it over. Gumdrop is one such cover. 
• Dawn recommends holding the iPad by your face, so that when you move the iPad away, eye contact may be maintained. 
• If you buy an app you can use it on up to 5 devices that you own. Some of these apps can be used on iPhones and other devices.
• An iPad can be used for communication through pointing, as well as for learning various skills. Take note, however, that communicating through sign language tends to transition to verbal communication more easily than communication by pointing does. 
• Moms with Apps is a blog that supports family friendly developers. Every Friday is app Friday, and often several apps are offered free or at a reduced price.
• Autism Apps lists various relevant apps by categories and makes recommendations. It is not comprehensive, but it is searchable 
• In addition to the list below, consider looking up learning to sign using apps.

And now to some recommended applications

• Image Finder allows you to search for images, which you can use then for discussion, comparisons and description. Best if you do the scrolling and choosing. Even when you set the program to prevent inappropriate images from showing up, there could always be some that you'd rather not share with your child/client.
• Mytalk, for communication using images and recorded words and phrases.
• Special Stories - which allows you to put together quickly a series of images with text and sound. It can be used to work on routines or explore an event as it happens: take a couple of pictures with the iPad, add to them a written sentence and a short recording, and voilà, you've got a motivating social story.  
• Cake Doodle by Shoe the Goose allows you to "Make a cake" on your iPhone or iPad (much less messy than in your kitchen). It has sounds but they don't tend to be overstimulating. Different hand movements are required to grate, sift, squeeze etc. 
• Speech Tutor - is a fascinating app with an animated mouth demonstrated what needs to be done to create a particular sound.  
• I Write Words - to work on handwriting
• Dexteria - a set of hand exercises to enhance fine motor skill development and promote handwriting readiness. 
• Use Eric Sailers apps for speech 
• Geek SLP has good apps for language development, as well as interviews and info about free apps.
• The Buddy Bear series from Iinguisystems addresses categories, basic questions, comparatives/superlatives, opposites and other language topics. These apps are rather expensive, however.
• My first AAC is a communication application for toddlers and preschoolers with delayed speech or severe speech disorders.
• Toca Boca, which are Swedish apps, are excellent. Toca Band allows you to play with sounds (it's really funny. Watch their trailer). Toca Store is another recommended one. Toca Boca often announced freebees. 
• Watch mouth movements while singing Happy Birthday and other familiar songs in Vast 1 Songs, 
• AppMATes are toys that interact with the iPad. They support finger grasp and other skills. They seem to be cheaper at Target.com - 2 for $10.40
• Hamaguchi has fantastic apps for language development. 
• Speech with Milo, which can be used with or without music (I liked it better without) can be used for first phrases.

ADHD Without Drugs - A Guide to the Natural Care of Children with ADHD by Sanford Newmark, MD

Read this one. Really, don't just skim it. You'll have a better understanding about what ADHD really is, when it can be managed without drugs, and how to go about changing your child's diet - reasonably, gently, without going into extremes. You'll find out about a few blood tests that are really important, and suggestions regarding several relevant holistic approaches. There's an important chapter about parenting, which if you take to mind is likely to lessen the conflicts and stress at home. 

What I'd love to see in a future edition: a segment on the importance of supporting a child's neurodevelopment - gently, respectfully, playfully. Yes, I think HANDLE is very compatible with Dr. Newmark's work.