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Different Levels of Severity in Autism
Dr. Smith describes how the great variation of symptoms seen in children with autism make judging the severity of the disorder very difficult.
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Odd or Inappropriate Intonation in Autism
Dr. Smith describes the differences in the intonation, rate or volume of speech found in some children with autism spectrum disorders.
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Lack of Inhibitory Control in Autism
Dr. Smith discusses the difficulties sometimes experienced by parents and caregivers when children with autism fail to recognize and adjust their behavior to social customs or rules.
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The First Early Warning Signs Reported by Parents
Dr. Smith describes the first symptoms and concerns typically reported by parents of children on the spectrum, including a lack of pointing, delayed speech, poor eye contact, difficulty being soothed and a lack of attachment or connection to their caregivers.
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Understanding Parents' Feelings That "Something is Wrong"
Dr. Chris Smith emphasizes the importance taking parents' concerns about their child's development seriously, as parents' initial "gut reactions" or sense that "something is not right" may be crucial, early indications that their child is lacking key communication and social skills indicative of an autism spectrum disorder.
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Introduction to the Job
Dr. Jeremy Greenberg, Clinical Supervisor at the Children's Center, discusses the many facets of his job, which include making important programming and curriculum decisions as well as designing novel data collection methods to improve the efficiency and effectiveness of these programs.
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Favorite Part of the Job; Watching the Children's Progress
Dr. Jeremy Greenberg considers the inherent challenges, but also incredible rewards of being an ABA therapist. He describes that though many children come to him with almost no social or language skills, they may graduate from the program talking and interacting with people, a monumental progression he finds inspirational and affirming.
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What the Children Learn in the Classroom
Dr. Greenberg discusses the varied curriculum and format of an early intervention program, which can include both group and one to one instruction, core ABA and social skill programs, as well as art, music and physical eductaion specials.
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The Difference Between Autism and Speech Delay
Dr. Greenberg explains the differences between autism and a language delay. Though speech delays are often common in children with autism, autism also involves notable difficulties with attention, nonverbal learning and communication and social motivation that require more tailored interventions than are needed for a child with an isolated language delay.
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The Importance of Early Intervention
Dr. Greenberg explains that early intervention is critical because it teaches children how to learn at a critical point in their development. By eliminating inappropriate, ineffective behaviors and replacing them with adaptive skills, early intervention helps children with developmental deficits learn the skills they will need to function socially and academically.
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Functional Behavior Assesment
Dr. Greenberg describes functional behavior assessments and behavior replacement plans, wherein inappropriate behaviors are replaced with appropriate behaviors through the careful use of positive reinforcement. He notes the benefits of applying functional behavior plans early, when the history of a child's inappropriate behavior is relatively brief and thus easier to interrupt.
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Gagging: A Sensory Stimulation
Dr. Smith explains that gagging is another type of sensory stimulation that can be included in the repetitive and restrictive behavior domain of the DSM criteria for autism.
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Lack of Spontaneous Imitation
Dr. Smith explains that a lack of spontaneous imitation can be a key early indicator of autism spectrum risk, though it is sometimes very difficult for parents to identify as a symptom. Given this difficulty, spontaneous imitation is an important area of inquiry for pediatricians when interviewing parents regarding their child's development.
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ABA Applied Behavioral Analysis
In this clip Thomas Gelb, the Executive Director of the Children's Center, explains what applied behavioral analysis, or ABA, is, and how it is used at the Children's Center to help children on the spectrum build social and daily living skills.
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The Importance of Early Intervention
Thomas Gelb, the Executive Director of the Children’s Center, sends a message to parents and caregivers to always err on the side of early intervention whether it be through a school like his or private therapy.
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Imitation
In this clip evaluator Connor Puleo discusses the tendency of typically developing children to imitate both their parents and their peers. She explains the importance of this behavior and describes how imitation provides opportunities for children to learn from others as well as share enjoyment with others.
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History of Diagnosis for Jack (ASD) and Riley (ASD)
Dr. Forletti, the pediatrican of siblings, Jack and Riley, discusses how he was involved in the diagnostic process of both children. Dr. Forletti explains that when a child comes into his office he carefullly observes his/her behavior, particulaly noting how the child interacts with others. Dr. Forletti describes how pediatricians may tailor their interviews to probe for autism symptoms as well as help parents know what to look for in terms of their child's typical or atypical development between visits.
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When to Tell Parents of Your Concerns and Refer for an Assessment
Dr. Forletti, a pediatrican, discusses how he decides when to tell parents that they should take their child to either Early Intervention and/or a developmental pediatrian for further evaluation. Dr. Forletti describes how he combines both clinical judgment with the use of standardized questionnaires to guide his decision. He also describes the risks of the "wait and see" approach, and shares how he supports parents who are hesitant to seek further evaluation of their child.
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Where to Refer Children for Early Intervention
Dr. Forletti discusses the general and specific places where he refers children when he suspects that they have an autism spectrum disorder. He discusses the importance of contacting Ealrly Intervention services as well as pursuing evaluation through a developmental pediatrician or, in some cases, a psychologist to confirm a child's diagnosis. Finally, Dr. Forletti dsicusses how parents can become both advocates and teachers, well versed in their child's therapies and supporting their child's development.
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Approach to Take When Parents Show Concern for Their Child
Dr. Forletti discusses how he talks with parents who are concerned about their child's development. Dr. Forletti discusses how pediatricians can both investigate and validate early parent concerns without jumping to a premature diagnosis.
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Early Warning Signs to Look for in the Child
Dr. Forletti discusses what early warning signs for autism spectrum disorders he looks for during well child visits and how he observes these signs within the context of the visit. He explains that by attending to social as well as verbal and physical developmental milestones, he can often tell if a child is at risk for atypical development by 12 months of age.
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Primarily Asks How the Child Plays with Toys
Dr. Forletti discusses the types of questions he asks parents to gain information about a child's development. Given that many children at risk for autism spectrum disorders do not develop age appropriate play skills or may play with their toys in an odd or repetitive fashion, Dr. Forlette explains that he often asks about his patients' play skills, particularrly, with regard to imitative or imaginative play.
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Using Questionnaires and MChat in Assessing Child Development
Dr. Forletti explains that in his pediatric office, he routinely supplements his clinical judgment with standarized parent report questionnaires, including the Denver Developmental Questionnaire and the Modified Checklist for Autism in Toddlers (M CHAT). These questionnaires help to document a child's development and make parents aware of delays and atypcial behaviors that their child may exhibit. These questionnaires also help doctors discuss concerns that they may have during the well child visit.
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Assessing the Child's Progress with the Parents
Dr. Forletti discusses the importance of considering a referral for further evaluation when parents express concerns about their child's development, even if pediatricians do not observe clear evidence of a delay in a single well child visit. He encourages pediatricians to keep a low threshold for referral and resist the temptation to delay because they fear upsetting parents. On the contrary, parents expressing concerns to their pediatricians are parents who already hold some fears, which are often best addressed through a more comprehensive evaluation.
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Difficulty of Examining a Child with Autism Riley (ASD) Example
Dr. Forletti describes how a well child visit differs for a typically developing a child versus a child who already has a diagnosis of an autism spectrum disorder (ASD). Dr. Forletti describes how he tailors the well child visit for one of his patients with ASD, Riley.
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Progress of Children with Autism from Therapies
Dr. Forletti explains that the progress a child with autism makes through therapy varies greatly depending on the child. He describes that after therapy some children are able to attend a typical school and be very successful although they may still exhibit some social delays. By contrast, other children may require specialized educational settings throughout their schooling.
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Advice to Parents with Children who have Autism
Dr. Forletti gives advice to parents about how to help their child make the most progress. He emphasizes the importance of parents' involvement and familiarity with their child's therapy. Parent involvement has been linked to better outcomes for children, including a greater generalization of skills learned in therapy to children's daily lives. Finally, Dr. Forletti urges parents to prioritize applied behavioral analysis and other empirically supported interventions for their children as opposed to untested, alternative approaches or excessive research.
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Advice to Pediatricians: Always Listen to the Parents
Dr. Forletti advises other pediatricans to always listen to what parents have to say and never dismiss their concerns about their child's development. Rather, he notes that pediatricians must be impartial observers who help guide parents in the right direction.
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Why the Increase in Autism
Dr. Joseph Buxbaum discussed three main reasons why the prevalence of autism is rising. He also clarifies that although there has been an increase in the prevalence of autism, the incidence, or number of children born each year with autism, has likely not increased.
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Neurobiology of Autism; Brain Growth
Dr. Joseph Buxbaum discusses the difficulties of studying brain development in children with autism. Despite these difficulties, initial studies suggest that the head growth of children with autism is initially accelerated and then reaches a plateau relative to the brain growth of children without autism. One possible explanation for this is that extra connections are made and then pruned at a slower rate in children with autism.
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Defining Autism
Dr. Joseph Buxbaum provides definitions for autism, asperger's syndrome, and pervasive developmental disorder not otherwise specified (PDD NOS). He highlights what core deficits link these disorders and talks about how diagnostic standards may change in the future.
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Genetics in Autism
Dr. Buxbaum explains that previous studies have found that autism is primarily a genetic disorder, possibly one of the most genetic disorders in psychiatry. He then discusses how treatments may or may not be informed by genetics and considers some of the hypothesized genetic causes of autism, including de novo mutations.
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No Evidence of Environmental Causes in Autism
Dr. Joseph Buxbaum explains that to date there is no compelling evidence for any environmental factors that increase the risk for autism. Further, he discusses that there is no current data to support that environmental factors exist which influence genetic changes that may cause autism. However, he recognizes that this is an area that warrants more research.
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Autism, Largely Genetic, Starts at Birth
Dr. Joseph Buxbaum explains that autism is a disorder that is largely genetic and present at conception. Despite this, the behavioral manifestations of autism may not be present until months after the child is born.
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Regression in Autism
Dr. Joseph Buxbaum provides the definition of regression and explains how genetics are related to this process, using Rett Syndrome as an example.
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Why Autism More Common in Boys than Girls
Dr. Joseph Buxbaum explains that autism is more common in boys than in girls. He provides a possible explanation for why this is true for some forms of autism, but also states that we do not fully understand why boys appear more vulnerble to autism than girls generally.
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Importance of Intensive Behavioral Therapies
Dr. Joseph Buxbaum discusses the importance of intensive behavioral therapies for children with autism. He explains that many studeis have shown that children make profound progress after receiving intensive behavioral interventions. Dr. Buxbaum further explains that brains have the most plasticity at younger ages, making intervention during these time periods critically more powerful than at later ages.
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New Research in Genetic Causes of Autism
Dr. Joseph Buxbaum explains two major benefits for discovering genetic causes for autism. First, it gives parents an explanation for their child's disorder which helps them to move forward accordingly, perhaps seeking guidance from a genetic counselor or monitoring their child for other associated symptoms. Second, once genetic causes are found, those genes can be studied in model systems, such as in mice, with the goal of coming up with novel drugs to treat these causes.
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New Research in Naming New Genetic Disorders of Autism
Dr. Joseph Buxbaum describes how new genetic disorders of autism are often named. He explains that a clinical geneticist will refer to a new genetic syndrome based on the genetic etiology of the discovery in addition to referring to the behavioral manifestations of the disorder. He discusses how knowing new genes related to autism can inform new drug targets.
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Matching the Right Program for Each Child with Autism
Dr. Joseph Buxbaum discusses the importance of matching treatment and academic programs to each child's specific learning process and skills. Inividualizing treatment in this way will help each child reach their best outcome.
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The Mystery of Odd or Unusual Behaviors in Autism
Dr. Joseph Buxbaum discusses that we still do not fully understand why children with autism develop certain behavioral manifestations, such as hand flapping. However, it appears as though some children exhibit these manifestations as a response to anxiety or different social situations. Further, Dr. Buxbaum explains that some of these behavioral symptoms of autism may be linked to specific genes.
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Older Parents More at Risk to Have Children with Autism
Dr. Joseph Buxbaum discusses that studies focusing on parental age have found that older parents are at a slightly higher risk of having a child with autism than younger parents. Although the reason for this is not fully known, it is suspected that with age there is a greater risk for mutations to occur in the sperm or the egg that are then passed down to the child.
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Defining Autism
Dr. Jeremy Silverman provides the definition for autism and explains why it is considered a spectrum disorder.
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Role of Genetic Factors in Autism
Dr. Jeremy Silverman explains how twin studies conducted several decades ago indicate that genetics play an important role in autism.
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Defining Phenotype
Dr. Jeremy Silverman provides the definition for a phenotype and describes how it is related to a genotype.
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No Single Gene that Causes Autism
Dr. Jeremy Silverman explains that since autism is a genetically complex disorder, meaning that no single gene causes autism, it is difficult to study autism by looking at the whole disorder. Therefore, Dr. Silverman, among others, often focuses on traits associated with autism that may be related to a single gene.
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Gene Research in Autism Example: Repetitive Behavior
Dr. Jeremy Silverman describes ongoing research in which scientists look at large groups of families to determine if certain characteristics of autism run in families. These types of studies often then lead to research that investigates if particular genes are related to these specific characteristics, given that many genes rather than a single gene likely contribute to the numerous features of autism.
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Defining Endophenotypes
Dr. Jeremy Silverman provides the definition of an endophenotype and offers information on how it relates to phenotypes and genotypes.
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Environmental Role in Autism
Dr. Silverman describes why environmental causes are suspected to contribute to autism, though research has yet to identify specific environmental risk factors. He considers why identifying an environmental cause or trigger is a goal for many families and researchers.
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Reasons for Increase in Autism
Dr. Silverman discusses why autism rates may be increasing over time, including expanded diagnsotic criteria, increased sensistivity and awareness of autism, and, potentially, more environmental triggers of autism risk. Notably, environmental contributions are indicated given that increasing prevalence rates cannot be easily explained by purely genetic explanations. Dr. Silvermam also discusses how de novo mutation theories factor into growing prevalence rates.
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Explanation of Why Older Parents More at Risk for Having Children with Autism
Dr. Silverman explains potential reasons why older paternal age is thought to contribute to autism risk.
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Why More Boys Diagnosed with Autism
Boys have a significantly greater risk of developing autism than girls. Dr. Silverman discusses how associations between paternal age and increased autism risk may influence the distinct susceptabilities of male and female offspring and point to distinct pathways of autistic risk.
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Maleness as a Factor in More Boys with Autism
Dr. Silverman of the Mount Sinai School of Medicine's Seaver Autism Center for Excellence discusses some theories about why males may be more susceptability to autism than females.
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Developmental Surveillance and Screening
Dr. Laroque, chief of general pediatrics at the Mount Sinai School of Medicine, describes the process of developmental surveillance and how it compares to developmental screening. She emphasizes the importance of monitoring a child's strengths and weaknesses as well as using validated tools to screen for childhood disorders, such as autism.
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Advice to Doctors Listen to the Parents
Dr. Laroque, chief of general pediatrics at the Mount Sinai School of Medicine, describes how she incorporates parent concerns about a child's development into her own assessments of that child. She notes that parents have the greatest breadth and depth of knowledge about their child's typical social interactions.
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Electronic Records, Web Portals: Important Aide for Pediatricians
Dr. Laroque, chief of general pediatrics at the Mount Sinai School of Medicine, describes how electronic medical records contribute to developmental surveillance and help integrate the recommendations of the American Association of Pediatrics regarding screening into a pediatrician's standard practice.
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Importance of Early Intervention
Dr. Laroque, chief of general pediatrics at the Mount Sinai School of Medicine, describes how identifying children with autism and their families early and connecting them to evidence based interventions can improve outcomes for both that family and the community in which they live.
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Importance of a Dialogue Between Parents and Pediatrician
Dr. Laroque, chief of general pediatrics at the Mount Sinai School of Medicine, discusses the importance of empowering parents to be invested in their child's care and work collaboratively with providers to determine appropriate next steps. For this innovative approach to healthcare to be successful, pediatricians and parents much be partners, rather than simply providers and consumers.
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Importance of Parent Support Groups
Dr. Laroque, chief of general pediatrics at the Mount Sinai School of Medicine, discusses the unique quality of support that families of children with autism can provide to one another.
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Describing a Pediatrician Well Child Visit
Dr. Laroque, chief of general pediatrics at the Mount Sinai School of Medicine, describes how she uses well child visits to encourage families to look for the signs of autism in their child and seek further evaluation when necessary.
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