Misophonia

http://www.webmd.com/mental-health/what-is-misophonia

Misophonia

Misophonia, also known as selective sound sensitivity syndrome, starts with a trigger. It’s often an oral sound — the noise someone makes when they eat, breathe, chew, yawn, or whistle. Sometimes a small repetitive motion is the cause — someone fidgets, jostles you, or wiggles their foot.

Symptoms and Triggers

 

The literal definition of misophonia is hatred of sound but a person with misophonia does not simply hate all sound. People with misophonia have specific symptoms and triggers and are sensitive to only certain sounds (and occasionally to visual triggers). Any sound can become a problem to a person with misophonia but most are some kind of background noise. People call the collection of sounds that they’re sensitive to their trigger set. It is possible to add to one’s trigger set over time.

List of common triggers

Please note, some people find that reading about triggers has the potential to make them take on new triggers. Some people also avoid hearing or imagining sample trigger sounds for the same reason. If you think that learning about new trigger sounds could in any way be a problem for you, then there’s no need to read the lists below.

Mouth and Eating: “ahhs” after drinking, burping, chewing, crunching (ice or other hard food), gulping, gum chewing and popping, kissing sounds, nail biting, silverware scraping teeth or a plate, slurping, sipping, licking, smacking, spitting, sucking (ice, etc), swallowing, talking with food in mouth, tooth brushing, flossing, tooth sucking, lip smacking, wet mouth sounds, grinding teeth, throat clearing and jaw clicking.

Breathing/Nasal: grunting, groaning, screaming, loud or soft breathing, sniffling, snorting, snoring, sneezing, loud or soft talking, raspy voices, congested breathing, hiccups, yawning, nose whistling and wheezing.

Vocal: humming, muffled talking, nasally voices, overused words such as um or ah (repeated words), sibilant sounds (S, P, T, CH, K, B sounds), singing, gravelly voices, bad singing, soft whisper-like voices and whistling.

Environmental: clicking from texting, keyboard/mouse, TV remote, pen clicking, writing sounds, papers rustling/ripping, ticking clocks, texting and cell phone ringtone.

Utensils/metals: dishes clattering, fork scraping teeth, silverware hitting plates or other silverware and rattling change in pockets.

Plastic: water bottle squeezing/crinkling, breaking hard plastic and bouncing balls.

Wrappers: plastic bags crinkling/rustling, plastic bags opening or being rubbed and crinkling food packages.

Cars: sitting idling for long periods of time, beep when car is locked, car doors slamming, keys banging against steering column and turn signal clicking.

Heavy equipment: lawnmowers, leaf blower, air conditioners and chain saws.

Impact sounds: other people’s voices, muffled bass music or TV through walls, doors/windows being slammed and basketball thumps.

Animal noises: dogs barking, bird sounds, crickets, frogs, dogs or cats licking, drinking, slurping, eating, whining, dogs scratching themselves and trying to bite their fleas and claws tapping.

Baby: Baby crying, babbling, adults using baby talk and kids yelling.

TV: loud TV or radio.

Body Movement related: Foot shuffling (dry feet on floor/carpet) or tapping, finger snapping, foot dragging, heels, flip flops, knuckle/joint cracking, eye blinking, nail biting and clipping, eating, chewing, fidgeting, hair twirling, movements out of the corner of eyes, repetitive foot or body movements, jaw chewing/movement.

If you have a mild reaction, you might feel:

  • Anxious
  • Uncomfortable
  • The urge to flee
  • Disgust

If your response is more severe, the sound in question might cause:

  • Rage
  • Anger
  • Hatred
  • Panic
  • Fear
  • Emotional distress
  • A desire to kill or stop whatever is making the noise
  • Skin crawling
  • Suicidal thoughts

This lifelong condition usually starts between the ages of 9 and 13 and is more common with girls. It comes on quickly, but isn’t related to any one event.

Because your ears are normal and your hearing is OK, the doctor may have trouble with a diagnosis. Misophonia is sometimes mistaken for anxiety or bipolar or obsessive-compulsive disorder. Some doctors think it should be classified as a new disorder.

Medical Professionals That Can Help

Audiologists
An audiologist may help by evaluating whether a person has misophonia or some other audiological issue. Audiologists can suggest the use of earplugs and fit them to an individual. These can be made to supply white noise or other sounds to mask problem noises.

Psychologists
Psychologists can help people by evaluating and studying behavior and mental processes. A plan for reducing stress and coping with the symptoms of misophonia could be developed by a psychologist familiar with the condition.

Psychiatrists
A psychiatrist is a medical practitioner specializing in the diagnosis and treatment of mental illness. Although misophonia is not thought to be a psychiatric condition, psychiatrists can prescribe medication to treat symptoms such as anxiety, insomnia, feelings of rage/fear, and depression.

Neurologists
Changes in sensory perception can be evaluated by a neurologist.

Occupational Therapists
An occupational therapist may help with assessing treatments to develop, recover, or maintain the daily living and work skills of people with a physical, mental, or cognitive disorder.

 

Fragile X

http://patienttalk.org/fragile-x-the-most-common-genetic-cause-of-autism-spectrum-disorders-find-out-more-here/

Fragile X – the most common genetic cause of Autism Spectrum Disorders.

Having spent the last six years of my life very closely involved with the autism community I often cannot see the wood because of the large forest surrounding me. Let me explain. Out son, John, has moderate ASD – indeed his autism has been described as “classic”. You know the sort of thing all the triad boxes ticked.

Which means that I have often ignored other types of autism and similar conditions on this blog.

Well today I want to rectify this. In this blog post we would like to focus on a condition related to autism called Fragile X Syndrome. They are related in so far as around 50% of children with FXS also have a diagnosis of autism. So I’d like to share the brilliant infographic below. If you could share it on I would be very grateful.

As you may know Fragile X Syndrome which is also known as Martin–Bell syndrome or Escalante’s syndrome is the most common genetic intellectual disability. According to most figures it affect 1 in 4,000 boys and 1 in 6,000 girls. Around 50% of people with FXS will also have a diagnosis of autism. There are also high rates of ADHD within the Fragile X community.

That being said one of the best ways of increasing awareness, acceptance and understanding of a condition is to get people to share their stories. It would be great if people with FXS or their loved ones would consider telling your story in the comment section below. Anything you would like to share will be of great interest but you might like to consider the following question:-

a) Do you have FXS or what is your relationship to a person with Fragile X Syndrome?
b) What were the earliest signs and symptoms of Fragile X Syndrome?
c) What treatments and therapies were used and how effective were they?
d) How many people in your family have Fragile X?
e) What one bit of advice would you give to a family who discovered they were carrying FXS?

Thanks very much for your help and can we ask you to share this blog post and infographic once again?

Fragile X Infographic
Fragile X Inforgraphic by the National Fragile X Foundation – See more at: https://fragilex.org/2013/foundation/fragile-x-infographic/#sthash.toNC99S0.dpuf

Study finds altered brain growth patterns that predict autism

https://www.autismspeaks.org/blog/2017/02/15/study-finds-altered-brain-growth-patterns-predict-autism

Experimental brain-imaging method predicts autism based on early differences in brain growth; potential for earlier diagnosis and therapy for high-risk infants

University of North Carolina research specialist Leigh Anne Weisenfeld works with an IBIS participant. Image courtesy UNC.

The newest study out of the Infant Brain Imaging Study (IBIS) found early differences in the growth rate of the brain that distinguished which infants at high risk for autism would develop the condition.

If larger studies confirm the findings, the method could become the first to accurately predict autism in the first year of life – allowing for earlier detection and behavioral treatment for high-risk babies. Due to the expense and technical difficulty of the method, it would probably not be appropriate for universal screening.

The paper appears online in the journal Nature.

Autism Speaks helps fund IBIS through a grant to senior investigator Joseph Piven, a developmental psychiatrist with the University of North Carolina School of Medicine. IBIS is also part of the Autism Speaks Baby Siblings Research Consortium. The study and the consortium follow babies born to parents who already have a child on the autism spectrum. Because autism tends to run in families, these “baby sibs” are at relatively high risk for developing the condition.

“The results of this new analysis are directly in line with our organization’s goal to lower the age of autism diagnosis to enable earlier intervention,” comments Mathew Pletcher, Autism Speaks’ interim chief science officer. Earlier this month, researchers reported that the average age of diagnosis remains stubbornly stuck around age 4, even for severe forms of autism. This is despite the fact that the condition usually can be diagnosed around age 2 through a behavioral assessment.

In the new study, the investigators tracked 106 high-risk baby siblings of children who had autism. For comparison, the study also included 42 low-risk infants who had no immediate family members with autism. All the babies underwent behavioral evaluations and noninvasive brain imaging at 6, 12 and 24 months.

Of the 106 high-risk infants, 15 developed autism, as diagnosed through their behavioral assessment at age 2. None of the low-risk babies developed autism.

Looking at the brain images taken at 6 and 12 months of age, the investigators found an increased rate of brain-surface expansion in the infants who later developed autism. This hyper-expansion did not occur in any of the babies who did not develop autism.

The investigators also found that the early hyper-expansion of the brain’s surface led to an overall overgrowth in brain volume between 12 and 24 months. What’s more, the volume overgrowth corresponded with the appearance of social difficulties, and the degree of overgrowth corresponded with the severity of these difficulties.

Finally, the researchers developed a computerized formula (machine-learning algorithm) that could predict autism with 80 percent accuracy based on the brain-images taken at 6 and 12 months.

“This study strongly suggests that we will be able to identify useful clinical biomarkers of autism before the emergence and consolidation of symptoms,” Dr. Piven says. “This will enable intervention during a time when the brain is most malleable.”

In addition, the study’s findings may stimulate further research into the relationship between early brain overgrowth and autism, which some previous studies have likewise documented.

For example, the researchers note that the brain overgrowth they detected occurred primarily in parts of the brain linked to processing sensory information (sound, sight, touch, etc.). In recent years, there has been increasing interest in the role that sensory issues may play in autism’s hallmark communication and social difficulties and repetitive or restricted behaviors.Color highlights the expanded brain surface areas that the researchers found between 6 and 12 months in babies who went on to develop autism. The color scale shifts from yellow to deep red to indicate greater expansion over typical development. (Image from Hazlett et al, Nature 2017. Copyright Nature Publishing Group.)

The Autism Speaks blog features opinions from people throughout the autism community. Each blog represents the point of view of the author and does not necessarily reflect Autism Speaks’ beliefs or point of view.

The Scary Downside of a Gluten-Free Diet

The Scary Downside of a Gluten-Free Diet

Getty Images

Gluten-free diets are crazy popular. In fact, recent research found that *way* more people in the U.S. are eating GF than the number of people who have celiac disease—about 1 million more, to be specific. Now, new research has revealed a reason that might make those folks want to reconsider. (Thinking about giving up gluten? Here are six common gluten-free myths.)

A new study published in the journal Epidemiology showed that people who follow a GF diet are exposed to higher levels of arsenic and mercury, both considered to be toxic chemicals. Yikes! If you’ve ever heard about mercury poisoning, you know this is a big deal. Both arsenic and mercury have been linked to cancer and other chronic diseases, even in low amounts of exposure. Alarmingly, when the authors tested people who follow gluten-free diets, they found that they had twice the normal amount of arsenic in their urine and 70 percent more mercury in their blood on average than is considered normal. To be clear, the amounts of these substances are not enough to actually poison you. But scientists are concerned about the negative health effects they could have on people over time.

So why were levels of these two toxic metals so high? Gluten-free replacement products usually substitute rice flour in the place of regular flour. Rice flour is more likely to contain small amounts of both arsenic and mercury that the rice absorbs from fertilizer, soil, and water. So if you’re eating large amounts of bread, cookies, or crackers made with rice flour, you could unintentionally up the levels of these substances in your body. Eating a lot of regular rice can up your levels, too. Of course, it’s possible to be gluten-free without eating rice. But since it’s one of the most common GF grains, it’s a mainstay in many gluten-free diets. (Did you know that gluten sensitivity can now be diagnosed with a finger prick?)

Of course, for those who suffer from celiac disease (an autoimmune disorder where the ingestion of gluten leads to damage in the small intestine) or a gluten intolerance, maintaining a gluten-free diet isn’t a choice—you’ve just got to do it! But plenty of people still voluntarily follow gluten-free diets in the name of health and weight loss. It’s worth noting that there aren’t many benefits to cutting out gluten if you don’t have an intolerance, and research shows that gluten-free diets aren’t so great for long-term weight loss. While it’s one thing to go gluten-free if you need to, more and more research—including this new study—shows it’s simply not the healthiest diet you can follow.

In Breakthrough, Researchers Detect Autism Signs In Infants

In Breakthrough, Researchers Detect Autism Signs In Infants

Disability Scoop

by Michelle Diament | February 15, 2017

A man holds a young child

New research suggests that it may be possible to predict a child’s risk for autism before behavioral symptoms present. (Thinkstock)

For the first time, a new study suggests it’s possible to predict within the first year of life if a child will develop autism.

Researchers say they were able to identify with more than 90 percent accuracy which babies would go on to be diagnosed with the developmental disorder by age 2.

The findings published Wednesday could be a game changer, pointing to the possibility of identifying children on the spectrum at far younger ages and before behavioral symptoms become apparent, researchers said.

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“The results of this study are a real breakthrough for early diagnosis of autism,” said Robert T. Schultz who directs the Center for Autism Research at the Children’s Hospital of Philadelphia and worked on the study published in the journal Nature. “While we have known for some time that autism emerges in subtle, gradual ways over the first few years of life, this study offers the first firm evidence before a child’s first birthday predicting whether certain high-risk children are likely to be diagnosed with autism.”

Currently autism can reliably be diagnosed as early as age 2, but most kids aren’t flagged until after age 4, according to the U.S. Centers for Disease Control and Prevention.

Research suggests that autism intervention is most successful the earlier it begins, so scientists are eager to find reliable methods of spotting the disorder at younger ages.

The study looked at 106 infants considered to be at high risk for autism because they had an older sibling with the developmental disorder and 42 low-risk infants. Magnetic resonance imaging, or MRI, scans were conducted on each child at 6, 12 and 24 months of age.

In children who ultimately developed autism, growth of the brain’s surface area was significantly more rapid between ages 6 and 12 months as compared to other kids, the study found. What’s more, the overall size of affected children’s brains grew at a faster rate between ages 12 and 24 months.

Among babies at high risk, the brain differences between ages 6 and 12 months alone could predict whether a child would have autism with 80 percent accuracy, researchers said.

However, by considering other factors as well including additional brain measurements and the child’s sex, the researchers used a statistical approach known as machine learning to assess with near perfect accuracy who would develop autism.

“If we are able to replicate these results in further studies, these findings promise to change how we approach infant and toddler screening for autism, making it possible to identify infants who will later develop autism before the behavioral symptoms of autism become apparent,” Schultz said.

The findings could point to opportunities for new treatments and the potential to intervene before brain differences progress substantially, researchers said.

“We haven’t had a way to detect the biomarkers of autism before the condition sets in and symptoms develop,” said the study’s senior author, Joseph Piven of the Carolina Institute for Developmental Disabilities at the University of North Carolina. “Now we have very promising leads that suggest this may in fact be possible.”

75+ Feeding Therapy Tips & Strategies – ARK Therapeutic Services INC.

75+ Feeding Therapy Tips & Strategies

http://www.arktherapeutic.com/

For any therapist seeking to specialize in feeding, the best piece of advice I could give you is to become a sponge.  Take courses and workshops, read as many articles as you can, talk to and learn from your colleagues, join special interest groups on Facebook and ASHA etc., follow blogs, observe other therapy sessions, and don’t forget – learn from the children you treat as well.  They will be your best teachers.

 

Feeding issues are complex.  So take in as much information as you can from as many outlets as you can.  But, take it all in with a grain of salt, because not every strategy will work for every child.  Over the past 35 plus years, a number of people have told me that their way was the only way.  Although that certainly would have made my job easier if it were true, I’ve never been able to use any one method “by the book.”  Each child is different, so it will be up to you to evaluate their needs and cater treatment accordingly.

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A long time ago my father-in-law gave me a piece of advice that has stuck with me ever since – listen to what everyone suggests, consider it graciously, and then do what’s right for you.  In therapy, this means learning all of the different techniques out there, having all of it in your “bag of tricks” as resources, and then deciding which strategies are appropriate in which situations.

 

To any parents who may be reading this:  if you’re concerned about your child’s feeding development or any eating problems, I cannot stress enough the importance of finding an experienced feeding therapist to do an evaluation.  No article online or otherwise is an adequate substitute for an in-person evaluation with a trained professional.  We don’t bite – trust me!  But we will do our best to help your child take a bite.

 

Below are some tips and tricks that have been effective with the children I have personally seen for feeding therapy.  It is my sincere hope that some of these tips are helpful for you as well:

 

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General:


  Be an investigator.  Any underlying medical reasons for refusing foods must be managed first, so discuss with the pediatrician, study the medical history, and refer out for additional tests/evaluations when necessary.  Are there any GI issues for instance?  Reflux?  If so, those must be handled first.  I don’t recommend any oral intervention until all medical issues have been handled, as that can create more aversions.  Don’t forget seeing a dentist to rule out any underlying issues there, too.


  Consult with other professionals:  a nutritionist, a physical therapist for positioning, an occupational therapist for sensory, etc.  Treating individuals with feeding problems requires a team approach.


 Try to get to the root of why they are refusing foods and work from there.  Is it oral motor and/or sensory related?  Is it oral defensiveness?  Texture aversions?  Perhaps they didn’t go through a mouthing phase?  Etc.


  Establish trust first.  Assess the situation – if the child seems hesitant or not fully at ease with you in the first session, just talk and play games and be goofy.  It’s important that the child feels comfortable with you before starting any feeding intervention.  This may take a few sessions or even longer to establish rapport.


  Be calm and supportive.  Children can be very adept at sensing any frustration, overeagerness, being in a rush, etc. so constantly monitor what emotions you are displaying.  Work at maintaining a stress-free therapy atmosphere by staying relaxed, patient, and showing them that you care.


  Never force a child to mouth, bite, chew, lick, or taste anything.  I can’t emphasize this enough.


  Be flexible and willing to adapt on a whim.  If the child is showing interest in a particular doll – Great!  Use that doll in therapy.  Feed the doll.  Have the doll feed you.  Have the doll feed the child.  What kinds of foods does the doll like?  And so forth.  The same goes for speech therapy as well.  Use the child’s interest(s) to your advantage to get the best results.


  Get the parents involved – they must follow through at home.


  Get anyone else who has direct contact with the child (aunts, siblings, grandparents, friends, interventionists, ABA therapists, etc.) on board as well.  The best results happen when therapy is reinforced at home in between sessions.  The more opportunities presented, the better.


  Keep in mind that food refusals are often because of a very real fear.  Respect this fear and support them through it.


  Follow the child’s lead.  If he likes potato chips – great!  We can work from there.  If he’s showing signs of grimacing, pushing away, turning his head away, etc., stop and move on to something else.  It’s important to stop BEFORE the individual gets overloaded.

 

Biting & Chewing

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Before feeding:

 

  Establish a routine.  At the beginning of feeding therapy, my kids know to come in and wash their hands first.  I have a visual schedule in the kitchen showing them to turn on the faucet, get some soap, wash their hands, get a paper towel, dry their hands, throw it away, and then come to the table.  This routine lets them know what to expect and gives them confidence in that, alleviating some of the “fear of the unknown.”  It also works on following directions, sequencing, and independence.
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  Make sure the child understands the vocabulary involved – bite, chew, etc.  Demonstrate how to bite so that the child can see and learn what the word actually means.  Knowing the vocabulary will be an important part of therapy as you encourage the child to bite and chew.  Over-exaggerate the movement to help teach the concept.


  Start by talking about and exploring pretend food first if necessary.


  Get the child involved in the kitchen.  If they have a hand in preparing the food (even if it’s a small task like bringing their bowl from the kitchen to the table), they may be more willing to try it.  And even if they don’t end up trying it, interacting with the food is still a positive step.


  Do sensory stimulating activities before feeding, such as sensory play, exploring a tactile wall, stimulating the lips, tongue, and cheeks with the Z-Vibe, etc.


  Encourage chewing on / mouthing a Textured Grabber and/or Y-Chew.  Especially if a child didn’t go through a normal mouthing phase, this helps introduce them to new textures and sensations, allows them to safely explore the pockets and shapes with their mouth and tongue, increases sensory awareness, provides tactile input, etc.  Try dipping these in puréed foods later on.


  If there are any sensitivities throughout the body, these will typically need to be addressed first before you can fully normalize sensitivities in the mouth.  This is one area where an occupational therapist can really help.  They may recommend things like swinging or jumping before therapy, weighted blankets, sensory play, vibration, etc. to regulate the sensory system.  Once it’s regulated, the child will usually be more open to exploring new foods.

 

Feeding Therapy Tips

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Presentation


  Use cookie cutters to cut food into different fun shapes.  Have the child help you.


  Use divided plates for kids who don’t like their foods to touch.  Try putting a new food in one of the sections.  They don’t have to try it – it’s progress even if they just allow it to be there.


  Give foods playful names, like “banana boats” or “pretzel light sabers.”


  Taste the food yourself to make sure it actually tastes good.


  Offer lots of dipping options.  Take what they like and try dipping it into something new.  Can just be a TINY bit.


  Use spoons that are fairly shallow and easy to remove food from.  They should also be smaller rather than bigger so that the spoon is not overloaded with giant sized bites – it’s a spoon not a shovel :).  Our Spoon Tip was designed with this in mind.


  Use proper spoon feeding technique.


 For any tools/utensils you use, talk about them and let children feel and explore them first.


  Use clear or translucent cups/bottles so that they can see what’s in it before they take a sip, which may help reduce stress.


  If a child won’t eat with a spoon, use whatever he/she WILL accept.  Their fingers, a Grabber, Z-Vibe, Animal Tip, carrot, twizzler, etc.  Sometimes something other than a traditional spoon/fork is less threatening.


  If a child won’t eat from a bowl, try putting it in a cup OR right on the high chair / clean table.  Mix it up.

 

Animal Vibrating Spoon

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Feeding:


  Make sure the feet are stabilized solidly on the ground with the back flat against the back of the chair.  Consult with a PT on positioning if necessary.


  Use what they already like as a bridge to transition to new foods.  If the child likes applesauce, put a little applesauce on a cracker.  They might just try that too, or at least lick it off.


  Try making very small changes to foods that they already accept.  Do they like carrots?  Try steaming them slightly or presenting them differently.  Do they like crackers?  Try putting a TINY bit of a mild condiment on it.  Try a different brand of the same food, or a different shape.  Add a tiny bit of a certain spice.  And so forth.  People in general don’t like change, and kids are no exception, so keep the changes very small.


  Give them control where possible by letting them make choices.  Let them choose which spoon they want, if they want juice or water, if they’d like to kiss the apple 3 times or lick it once, etc.  Two choices are usually best – enough for them to have options without be overwhelmed by them.


  Throughout the intervention, make sure that you’re telling the child what you’re doing and why.  Knowing what’s coming can be very helpful in reducing anxiety.


  Try new foods at snack time instead of mealtimes, so there is less pressure to get mealtime calories in.


  Model by eating the foods yourself (kids often learn through imitating).  You can also model on a puppet or stuffed animal.


  Take breaks between bites.  Swallow, count to three, take a sip of water, bite again.


  Let them feed you and/or mom, grandma, etc.


  Chew the food yourself to see how many chews are required.  Then count it out loud with the child as he/she chews, or chew to a beat / song.  This can help set a pace if they’re eating too fast.  Ideally you want a rhythmic chewing pattern.  It can also help make sure they’re fully chewing the food.


  Don’t be afraid to make a mess.  I have parents who bring a change of clothes for after feeding therapy :)

 

Feeding Therapy - Get Messy!.


  Encourage the parents to resist cleaning up, wiping off the child’s face/hands, etc. until the end of the meal.


  Take the pressure completely off.   Let the child know that if they don’t like something, it’s ok to spit it out.


  If the child doesn’t want to try something, that’s ok.  Let them know they can put it in the “no” bowl to be done with it – they may just touch it if it’s to move it off their plate.


  Teach the child how to do a lingual sweep to remove food from their mouth, with their tongue and/or with their finger if they can’t do it with their tongue yet.  If the child has an “exit strategy” on how to remove food from their mouth, they’ll likely feel safer giving new foods a try.


  Try telling the child NOT to eat something (reverse psychology).  I once said to a child, “would you like to give that graham cracker a kiss?  Don’t eat it, just a quick kiss.”  And lo and behold, she tried it.  I said with animation, “Oh you’re not supposed to eat it!  You’re supposed to just kiss it!”  Ohhh she giggled and thought it was hilarious.  Now I know that to get her to try something, I tell her not to try it.  For most of my kids it’s just about finding what makes them tick / what motivates them.


  When it comes to food aversions, children first need to become comfortable with food, which is usually a gradual process.  What I do is introduce foods through play – I put food in front of the child and let them explore it with their hands – they can smash it, squeeze it, swirl it on the table, paint with it, etc.  You may need to demonstrate and get involved in the play.  It will get messy, and that’s ok!  The child may end up eating or tasting the food, which would be great, but the main goal is to get them playing with food, experiencing new sensations, and feeling more comfortable and safe around food.


  Use the element of surprise.  I have literally taken a container of yogurt before and plopped the entire tub upside down onto the table (see the picture below).  The child was so surprised 1. that I did that and 2. that she could play with it, that she ended up tasting food for the first time that day.  It turned her usual associations with / expectations of food upside down (literally), which in turn made her more open to exploring it.

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Yogurt Food Play

 


  Play with food without any pressure to actually eat it.  Let them learn about it in a fun, comfortable, non-threatening way.  Talk about it, using all 5 senses to describe it.  See if they will touch it, blow on it, or kiss it.  If they don’t want to, that’s ok.  See if they will play with it with their fork, or maybe even use a carrot or another type of food to touch it instead (which would still be a win).  And so forth.


  Try having the child blow food across the table – any kind of interaction with the food can be progress.  See if they’ll blow it across the table with a veggie stick or one of those twizzlers with a hole in the middle.


  Very averse children may not even be able to tolerate being in the same room as a certain food.  Gradually, over time and with other interventions, you can start moving the food just inside the door, then to the table, then to their plate, etc.  Eventually they may touch it or even lick it, then they may hold it in their mouth for a moment before spitting it out.  Eventually they will be comfortable enough to chew and maybe swallow it.  Take your time, and allow the child to take their time.  This process may take a looong time and that’s ok – don’t rush.


  For oral defensiveness, do gum massage before mealtimes and throughout the day.  Work on normalizing sensation.


  Try providing oral input with the Z-Vibe.  It has a smooth gentle vibration that can help “wake up” the mouth.  Sometimes kids simply need a little extra input to know where there lips are, to feel the food, etc.  Vibration can also help de-sensitize orally averse children.


  For low oral awareness, use a mirror and let kids watch themselves eating.  This may help them better see and be more aware of what’s happening.  Put some peanut butter, yogurt, pudding, etc. in their cheeks and have them fish it out with their tongue (this is great oral motor practice, too).  Make it a game!  Have the parents change up the type of toothbrush, toothpaste, and how the child brushes as well.  For instance, if they always starts on the right side, have them start on the left side.  The goal is to “mix things up” orally to increase awareness.


  Place the Probe, chew tool, Z-Vibe tip, etc. in the freezer to make it cold.  The cold can help increase awareness / focus.


  Use the Probe, Grabber, and/or Y-Chew as “dipper spoons” for purées.  This helps to introduce new textures and to practice biting/chewing in preparation for more advanced foods.

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  Be careful what you put in front of children with oral motor delays, as they may not be able to orally manage certain foods yet.  Try the foods yourself to make sure they are at the right level.  Work on rotary chewing.


  Assess the child’s oral motor skills.  If the child is functioning at an 8-month-old age level, for example, go back to the skills that a child should have at that age and build from there.  The main oral motor skill to watch out for when it comes to manipulating food is tongue lateralization.  The child will also need lip closure, jaw strength, jaw grading, tongue tip elevation, back of tongue elevation, tongue bowl, etc.


  When feeding, try to position the food to the sides of the mouth and/or in the cheeks (not always on the middle of the tongue).  The goal of this is to encourage the tongue to move from side to side to develop tongue movement and lateralization.


 Be creative.  Or as I like to say in relation to feeding therapy, “think outside the plate.”  Use pinterest for inspiration of all kinds of fun things you can do with food.  Make a marshmallow snow man.  Play tic tac toe with pieces of food as the “players.”  Make up a story and have pretzel people jump into a pool of yogurt and swim laps.  And so forth.  The sky is the limit.

 

More:


  Skip sippy cups – go straight to straw drinking for the most oral motor benefit, ideally with a Lip Blok.


  When teaching cup drinking, if thin liquids are too difficult for the child to manage, try thickening it with puréed baby foods or try letting them drink a tiny bit of the puréed food from a cup.


  Have the parents keep a food diary, documenting everything the child eats and drinks for 3-5 days.  Have them note quantities AND any problems so that you can have more background.


  Take a look at preferences of family members – if mom doesn’t like xyz, the kids might not either.  Personally, I hate coffee and mushrooms, and guess what – so do my own kids.  Some food preferences can be environmental.


  Individuals being fed via tube may still have the urge to bite/chew.  Provide stimulation to the tongue, lips, cheeks, and gums with the Probe or Z-Vibe as if they were eating while being fed via g-tube.  Let them chew on a Grabber or Y-Chew during tube feedings.
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  Keep the environment calm and relaxed.  For some children, that may mean sitting on the floor instead, or at a desk or craft table (perhaps child-sized), in another room of the house, outside, etc.  The kitchen may be too stigmatized, so getting them out of that setting may help.  It may also help to keep environmental distractions (other stuff in the room) to a minimum.

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Feeding Therapy Y-Chew

 

  Try using a mirror for visual feedback.  Just keep in mind that for some children, this may be too distracting.


  A note on reflux – I have known parents to take their children off their medication without consulting the pediatrician.  They usually do this between the age of 2 and 3 years because their child appears to be symptom-free.  But then feeding issues begin or begin again.  So, please remind parents to consult with their pediatrician first before doing so.


  If the child doesn’t like a food after the first presentation, keep trying.  It may take 8-10 exposures or more before the child will be willing to try it.


  Keep in mind that it’s completely normal to not like certain foods.  I can’t eat mushrooms because the texture is too slimy/spongy for me.  The smell of coffee gives me a headache.  And I stay away from powdered sugar because I tend to inhale it as I eat, which causes me to cough.  All of this is 100% okay.  I dare you to find someone who likes every food out there!  So if you can’t get a child to eat say pumpkin – that’s ok.  The goal is not to become an omnivore.  The goal is to expand the diet to the point where the child can eat a healthy variety of foods.


  Remember to praise, praise, praise.  Use reinforcements that cater to the child’s interests.  Get excited about every milestone, no matter how small it may seem.


  Count on curveballs.  It may not be a straight path, but you will get there.

 

Helping a child through feeding problems can be a long process.  It’s a marathon – not a sprint.  So hang in there!  Each child is different;  there is no “one way” to do feeding therapy.  What works for one child, may not work for the next, so this list is by no means all-inclusive or relevant for everyone.  Kids don’t come with instructions, so be prepared for trial and error, and trying again.  Play detective to get to the root of the problem.  Trust your instincts.  Listen to the parents.  Listen to the child and follow their lead.  Be creative.  And don’t forget to have fun!

 

Happy feeding,

Debbie

Autism detectable in brain long before symptoms appear

Autism detectable in brain long before symptoms appear

  • 15 February 2017
  • From the sectionHealth
BabyImage copyrightTHINKSTOCK

Brain scans can detect autism long before any symptoms start to emerge, say scientists.

The earliest that children tend to be diagnosed at present is at the age of two, although it is often later.

The study, published in the journal Nature, showed the origins of autism are much earlier than that – in the first year of life.

The findings could lead to an early test and even therapies that work while the brain is more malleable.

One in every 100 people has autism, which affects behaviour and particularly social interaction.

NHS: What is autism?

The study looked at 148 children including those at high risk of autism because they had older siblings with the disorder.

All had brain scans at six, 12 and 24 months old.

‘Very early’

The study uncovered early differences in the part of the brain responsible for high level functions like language – the cerebral cortex – in children who went on to be diagnosed with autism.

Dr Heather Hazlett, one of the researchers at the University of North Carolina, told the BBC News website: “Very early in the first year of life we see surface brain area differences, that precede the symptoms that people traditionally associate with autism.

“So it gives us a good target for when the brain differences might be happening for children at high risk of autism.”

The study opens up possibilities for big changes in the way autism is treated and diagnosed.

Giving children brain scans, particularly those in high-risk families, could lead to children being diagnosed earlier.

In the long run, it might be possible to do something similar for all infants if DNA testing advances enough to become a useful tool to identify children at high risk.

If it can be diagnosed early, then behavioural therapies such as those that train parents in new ways of interacting with an autistic child can be introduced earlier when they should be more effective.

Intervene early

Prof Joseph Piven, another researcher on the project, told the BBC: “Now we have the possibility that we can identify those who are most likely to go on to to get autism.

“That allows us to consider intervening before the behaviours of autism appear, I think there’s wide consensus that that’s likely to have more impact at a time when the brain is most malleable and before the symptoms have consolidated.

“So we find it very promising.”

The researchers fed the brain scan images into an artificial intelligence. It was able to predict which children would develop autism with 80% accuracy.

Carol Povey, director of the National Autistic Society’s Centre for Autism, said: “It’s possible that MRI scanning of this type could be developed to help families who already have an autistic child to access earlier diagnosis for subsequent children.

“This would mean those children could receive the right support as early as possible.”

However, she warned that autism was manifested in many different ways and “no single test is likely to be able to identify potential autism in all children”.

The study also pours further cold water on the debunked claims that the MMR jab causes autism.

One of the reasons the link took hold was that autism tends to be diagnosed around the time that the vaccine is given to children.

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No. Autism is Not Caused By Vaccinations, And It’s Not on the Rise

No. Autism is Not Caused By Vaccinations, And It’s Not on the Rise

Getty

IN BRIEF
  • Donald Trump said that autism cases are on the rise, but evidence suggests that’s not true.
  • This is a common talking point of the anti-vaccine movement, thus, it is important to reiterate that there is no link between vaccines and autism. At all.

President Donald Trump told a roomful of teachers on February 14 that there’s been a “tremendous amount of increase” in autism. The president made the remarks during a listening session with parents, teachers and education secretary Betsy DeVos.

“So what’s going on with autism?” Trump said after a principal at the meeting told him she worked at a special education center in Virginia that serves children with autism.

“When you look at the tremendous increase, it’s really, it’s such an incredible, it’s really a horrible thing to watch the tremendous amount of increase,” the president said. “Do you have any idea? And you’re seeing it in the schools.”

When the principal told him that one in sixty-eight children has autism, Trump again suggested the number was on the rise, adding “Well, maybe we can do something about that.”

Experts on autism, however, haven’t found evidence that incidence of the condition is increasing.

New York Magazine’s Jesse Singal, who first highlighted the president’s claim, interviewed autism expert and NeuroTribes author Steve Silberman about the remarks. Here’s the key excerpt:

There’s no consensus as to whether or not there’s been any significant increase in the actual prevalence of autism, period,” says Silberman. “The real debate is whether or not there has been a small increase, and there are a number of factors that could play a role in that small increase. For instance, it’s well established that older parents have more autistic kids and people are waiting longer to get married and have kids now… But the consensus is that there has been no huge, startling, ‘horrible,’ as Trump said, increase in autism. And the CDC estimate has been flat for a couple of years… because the major source of the increase that started in the 1990s was broadened diagnostic criteria and much more public awareness of what autism looks like.

In other words, there may be a few cultural changes that make autism rates fluctuate slightly over time, but the gradual increase in diagnoses can most likely be attributed to researchers getting better at spotting autism, rather than more people having autism.

Other autism experts agree with Silberman. The genticist Santhosh Girirajan found in 2015that the increase in autism diagnoses matches a general decline in more generic “intellectual disability” cases — suggesting kids are just being shifted from one category to another.

Autism as it’s understood today is in fact a fairly new diagnosis. As recently as the 60s and 70s, some researchers falsely thought the disease was caused by “refrigerator mothers” who didn’t love their children enough. Autism wasn’t understood as a genetic issue until the 1980s, and schools only began treating autism as a special education category in the 1990s.

There’s a good chance you’ve met someone in their 60s, 70s, or 80s who might have been diagnosed with autism if they’d been born today, but were just seen as exhibiting unusual behavior in their childhood.

The notion that autism is on the rise is a talking point of the anti-vaccine movement — a group that believes parents shouldn’t vaccinate their kids based on research from a fraudulent 1998 study.

Trump has referenced anti-vaxxer claims before. Here’s a tweet from 2014:

Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes – AUTISM. Many such cases!

More recently, Trump met with Robert Kennedy Jr., an anti-vaccine activist who has published books about the alleged dangers of the treatment. He claims (without scientific evidence) that a cabal of scientists are poisoning children for profit by giving them vaccines. After his meeting with Donald Trump, Kennedy reportedly thought he’d be selected to chair a presidential panel on” vaccine safety and scientific integrity.”

Andrew Wakefield, the author of the fraudulent 1998 study, also attended Trump’s inaugural ball.

The recent opposition to vaccines has caused concern among scientists and medical professionals, since there’s evidence that the movement has led to a measurable spike in measles outbreaks in the US. Measles can be fatal to children, as can pertussis and other ailments that vaccines prevent.

The estimated number of lives saved by childhood vaccinations measures in the hundreds of thousands.

Here’s the video of the president’s exchange: