Blog entry/article

Autism: Psychology and Neurology Working Together

We are very happy to announce a very unique diagnostic and treatment option for individuals with autism spectrum disorders and ADHD. In conjunction with HCA’s new Women’s and Children’s Hospital and the Children’s Specialty Clinic, Athena is part of a new Neurobehavioral clinic. This will enable families and children to be seen by a Pediatric Neurologist and Psychologist in the same visit. We are starting this venture with Dr. Javier Valero-Fonseco, a Pediatric Neurologist, and it has been a joy to work with him. Today was our second day of clinic. The ability to discuss and work hand in hand with the neurologist provides a unique level of care. We are hopeful that as these efforts progress we can add: Applied Behavior Analysis, Advocacy, Speech Therapy, Occupational Therapy, and other integrative services to the clinic. We will keep you updated on our progress. In the meantime, if you are interested in scheduling, please call our office at 320-1155 for more information.

Aeronautical Neuropsychological Evaluations with Cogscreen AE

Pilots are required to adhere to very strict standards to be medically cleared to fly. This is to assure the safety of the public, especially their passengers. However, like the rest of the American public many will suffer from depression, anxiety, or other psychological conditions during the course of their lives. When pilots seek treatment there are limited medications that they are allowed to take and maintain their license to fly. The review process involves release of detailed treatment information, including: physical and neuropsychological assessment. A particular test is required, the Cogscreen AE (Aeronautical Edition). Athena is pleased to be the newest provider and only provider of this service in Middle Tennessee.

Obsessions vs. Preoccupation and Rituals vs. Repetitive Behaviors

Individuals diagnosed with conditions such as Autism Spectrum Disorder and/or Obsessive Compulsive Disorder are often mischaracterized when their behaviors are described. While there is some overlap in the way these conditions manifest, there are core differences in what is happening neurologically and experientially. Persons with OCD struggle with underlying anxiety that causes fear of situations or objects. This fear causes discomfort. Maladaptive strategies to ease this anxiety are formed to ease such anxiety. A classic example is someone who has an intense fear of germs or sickness and engages in repetitive hand washing. This hand washing begins to take time which is taken from other daily activities and can cause irritation and damage to the skin.  In contrast, a classic example of such in the ASD patient is an interest in an activity that is enjoyable such as astronomy or Thomas the Train. These interests are often perceived as more juvenile but not in all situations. The repetitive behaviors involve researching, playing, or talking about such subjects.

The key distinction between these two conditions is that OCD components cause discomfort and are painful to the patient. These similar presentations in the ASD patient are found to be comforting and a process to avoid anxieties caused by other situations and interactions such as sensory overload or social anxieties. Similarities exist in that if behaviors are forced to stop without appropriate interventions those interventions can be damaging to the patient. In the case of OCD, anxieties can become out of control and overwhelming to the patient. They can decompensate quickly as they are raw and exposed to their phobias. In the case of the ASD patient, their anxiety escalates and they become overwhelmed as well.

If all of this sounds somewhat confabulated, it can best be understood as a chicken or the egg analogy. For the ASD patient the behavior is soothing and without it, they are more anxious. For the OCD patient, the anxiety comes first, they perform the behavior, and the behavior is not enjoyable or fully effective at relieving their pain. OCD patients will describe their behavior as problematic and the ASD patient will not and become excited at even talking about their activities.

At Athena, we offer diagnosis and treatment for both of these conditions. ASD patients respond to a broad range of therapeutic interventions that are based on the particular presentation and age of the patient. The generally accepted form of treatment for OCD includes Exposure Response Prevention Therapy and in most cases conjunctive therapy with medications.

Autism and Intellectual Disability Linked to Environmental Factors According to Research

The University of Chicago Medical Center issued the following news release:

Autism and intellectual disability incidence linked with environmental factors An analysis of 100 million US medical records reveals that autism and intellectual disability (ID) rates are correlated at the county level with incidence of genital malformations in newborn males, an indicator of possible congenital exposure to harmful environmental factors such as pesticides. Autism rates–after adjustment for gender, ethnic, socioeconomic and geopolitical factors–jump by 283 percent for every one percent increase in frequency of malformations in a county. Intellectual disability rates increase 94 percent. Slight increases in autism and ID rates are also seen in wealthier and more urban counties. The study, published by scientists from the University of Chicago March 13 in PLOS Computational Biology, confirms the dramatic effect of diagnostic standards. Incidence rates for Autism and ID on a per-person basis decrease by roughly 99 percent in states with stronger regulations on diagnosis of these disorders. “Autism appears to be strongly correlated with rate of congenital malformations of the genitals in males across the country,” said study author Andrey Rzhetsky, PhD, professor of genetic medicine and human genetics at the University of Chicago. “This gives an indicator of environmental load and the effect is surprisingly strong.”

See Link:

Autism is more prevelant according to new CDC numbers

The Centers for Disease Control’s Developmental Disabilities Branch released new data indicating a surge in the diagnosis of autism to 1 in 68 children. This appears to be the result of increased prevalence as well as increased identification. The new awareness among physicians and other healthcare professionals as well as among parents and teachers is getting children identified earlier. Many children who would have previously gone unidentified are less likely to slip through the cracks.

“The most important thing for parents to do is to act early when there is a concern about a child’s development,” said Dr. Marshalyn Yeargin-Allsopp, chief of CDC’s Developmental Disabilities Branch. “If you have a concern about how your child plays, learns, speaks, acts, or moves, take action. Don’t wait.”

Most children are diagnosed with an Autism Spectrum Disorder after the age of 4. The truth is our diagnostic tools and ability to identify symptoms get better with older children, but we can identify ASD in many cases very early. There are some symptoms that become obvious as early as 6 months. Our objective tests for ASD improve greatly at the landmark ages of: 6, 14, and 18. Prior to age 6, clinicians with more experience and observational tools are able to identify very accurately.

The best take away from this new information is to have your child tested and retested if concerns continue.

Diagnosis and Statistics Manual version 5

There has been a great deal of controversy regarding the new diagnostic criteria with the new Diagnosis and Statistics Manual version 5 by the American Psychiatric Association.  We are now beginning to use the new manual and all of our profession should have made the conversion by October of this year.  Many of the controversy’s are warranted as some of the changes are rather pronounced.  However, the changes have been generally thoughtful and are more researched based in most cases.  I will be posting more about our experiences as we move forward.

Inside the Mindful Mind: How Mindfulness Enhances Emotion Regulation Through Improvements in Executive Control

The new edition of Current Directions in Psychological Science offers a new article:
Inside the Mindful Mind: How Mindfulness Enhances Emotion Regulation Through Improvements in Executive Control by Rimma Teper, Zindel V. Segal, and Michael Inzlicht

The Abstract goes as follows:

Although the psychological benefits of mindfulness training on emotion regulation are well-documented, the precise mechanisms underlying these effects remain unclear. In the present account, we propose a new linkage between mindfulness and improved emotion regulation—one that highlights the role played by executive control. Specifically, we suggest that the present-moment awareness and nonjudgmental acceptance that is cultivated by mindfulness training is crucial in promoting executive control because it increases sensitivity to affective cues in the experiential field. This refined attunement and openness to subtle changes in affective states fosters executive control because it improves response to incipient affective cues that help signal the need for control. This, in turn, enhances emotion regulation. In presenting our model, we discuss how new findings in executive control can improve our understanding of how mindfulness increases the capacity for effective emotion regulation.

Comments: While mindfulness is a recent and highly stressed focus of late in the field of psychology, understanding of the state of mindfulness and area of research offers new understanding and utility in clinical practice.

The full article can be found here.