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Showing posts with label non-verbal. Show all posts
Showing posts with label non-verbal. Show all posts

Thursday, 6 December 2018

Non-verbal Autism


For people born around the year 2000, or before, and diagnosed before 4 years old, having autism very often meant being non-verbal. By my earlier estimations, about 0.3% of children are still non-verbal when their peers are already chatting away. Of that 0.3% some will spontaneously develop speech, some develop speech due to intensive intervention either by parents or therapists and some never develop speech.

Being non-verbal does not mean you cannot communicate; you can use sign language, you can write/type, you can use pictures (Picture Exchange Communication System – PECS) or you can use an augmentative communication device. Such devices used to cost a fortune, but now they are just apps you can install on a tablet computer or smartphone. These apps exist in numerous languages not just English, Spanish, German and French.
In 2007 we used PECS and started to use a special touch screen connected to a PC. Using special software, Monty could show that his vocabulary was much more extensive than we thought, even though he could not speak, read or write; it was all picture-based.
I just saw that one American study is suggesting that the incidence of DSM 5 autism is now 2.5%. I think this will inevitably mean less and less attention for those with non-verbal autism, which I suspect is still around 0.3% of three year olds.

Parents or the State?
Who should be doing something to help those who are non-verbal?
This question recently arose when I was talking to the family of an 8 year old boy with severe autism. He is non-verbal, but goes every day to a special school for autism. I asked if he is going to learn sign language, or is he going to get some other kind of means to communicate? Apparently not.  I explained about augmentative communication devices and suggested asking the school about them, or just go and buy one.  You do have to wonder what they are doing all day long in this special school.
There are many alternative methods to communicate, but they all require someone to teach them.
Whose job is it to choose a method and make sure it is implemented?
I guess this depends on where you live.
In my world, the proactive parent would start to do this by the time the child was three or four years old.  Given not all parents are proactive, you would think that at pre-school or junior/primary school “the State” would step in and take some action; apparently not, at least where we live.
So what happens to little kids who have no means of communication? They become adults who have no means of communication and, not surprisingly, they will have major behavioural issues.


Non verbal vs non conversational

Whilst on this subject, there is another important issue to highlight.  Even when some people with severe autism do start to talk, they very often do not become conversational. They can answer questions and make requests for items they want, but they do not become chatty like typical kids.

Some parents refer to their non chatty child with autism as being non-verbal, this really is not fair to those children who do not have a single spoken word.

Some children with autism can sing but do not talk. This may sound very strange but both Monty's assistants also participate in musical/theatrical group of kids with autism that puts on public performances.  They have such kids.

I think if you can sing, you can be "trained" to talk.  It is just requires a lot of effort by someone - parents, therapists or school assistants. 

Becoming more conversational is a continuing challenge in educating a child who was non-verbal. I have a big pile of books and training manuals on this subject and recently decided to re-emphasize this in Monty's daily schedule. We cut back on physical education (PE) at school and one after-school piano lesson.  We already cut out the two foreign languages at school to make time for 1:1 work with his assistants.

By encouraging longer answers to questions both spoken and written, there is also a net benefit to regular school work.  


Studying Severe Autism 

Researchers tend to avoid studying severe autism, which often also means non-verbal autism. Research is focused on what I would call Asperger's and what researchers would call level 1 autism; in DSM5 terminology there are 3 levels of severity.  Clearly it is much easier to study people who can hold a conversation and have a typical or even high IQ.  

There is an initiative, see below, to study severe autism, but for drug producers the big market is mild autism. You can see this by looking at the types of drugs currently in clinical trials.

What Can We Learn from Studying Severe Autism?





   

Thursday, 5 September 2013

Promoting Speech in a 7 year old Non-verbal Child with Autism

I was recently asked if I would be happy to talk to the parents of a 7 year old non-verbal child with autism.  I agreed to share what I have learned so far from both behavioural interventions and more recently from drug therapy.  I decided that a dedicated post could also be very useful.

When Monty, now aged 10, was diagnosed with autism aged three and a half, he embarked on a home-based ABA programme, soon complemented by the use of PECS (Picture Exchange Communication System).  PECS is great, and when correctly implemented, clearly can work wonders.  Sadly, most people take shortcuts and just laminate a few pictures, stick them on the fridge and say they are “doing PECS”.

Click below to see short training videos:-
 
Once a non-verbal child has a communication system, be it PECS or sign language, then he/she can open up to the world.  Often speech then follows, but not always.

Monty learned to talk using ABA, PECS and special computer software.

With what I have since learned about the possibility of safe and effective drug therapy, I would do things slightly differently.  I would keep all the ABA and PECS and just add Bumetanide, NAC and Atorvastatin.  I can never know if Monty would have then spoken earlier, but I am pretty sure that would have been the effect.
 

Science based, not “Biomedical”, not Complimentary Medicine and not DAN!

Just in case you are wondering, my findings are based on reading the scientific literature on autism and its comorbidities.  I decide what research looks sound and what looks dubious; I draw my own conclusions.  “Biomedical” is a word that has been hijacked to apply to therapies that we would like to work, but usually lack a thorough grounding in science.  DAN seems to stand for trying everything, “Biomedical” and more.  Nonetheless, within the hundreds of DAN therapies are at least one or two that do stand up to scientific investigation.  

By applying a very blinkered view to the existing research, the Medical Establishment’s general view continues to be that autism is pretty much untreatable.  Having accepted this view myself for several years, I have learned that this view is fundamentally flawed; you just have to objectively follow the science and do a little research yourself.
 

7 years old and non-verbal

The longer a child remains non-verbal, the more challenging it becomes.  After a long period of time a child will just not see the point of changing.  It may cease to be a biological problem and become just a behavioural problem.

My combination of Bumetanide, NAC and Atorvastatin is as close as you can ever get with drugs to being risk free.  This has been a prerequisite of mine.  If after 7 years my child was non-verbal, I would probably be willing to take additional risks, but still nothing without clearly understood boundaries.

For the last few years we have had a little box in our kitchen drug cabinet marked “emergency asthma drug, one a half tablets”.  We have never had to actually use this drug.  The drug is Prednisone and it is for use when an acute asthma attack does not respond to the Ventolin “rescue” inhaler.  Prednisone is a corticosteroid, widely available, cheap and saves lives; but long term use can have major side effects. 

Prednisone lowers the body's immune system.  The science suggests that the overactive/damaged immune system in autism is a factor behind the autistic behaviours in children with ASD.  It would seem logical that temporarily lowering the immune system might trigger behavioral change in autsim, such as regaining lost speech or initiating it.  The most serious doctor I could find who is knowledgeable about this subject is Dr Michael Chez, of the Pediatric Neurology and Autism Neurodevelopmental Program, Sutter Neuroscience Institute in Sacramento California.
 
He wrote a paper I have already referred to in this blog called:-
Immune Therapy in Autism: Historical Experience and Future Directions with Immunomodulatory Therapy
In that paper he talks of his knowledge of the effects of prednisone on children with autism and he mentions the dosage used.

. Treatment was usually prescribed with daily prednisone doses of 2 mg/kg/day for 3 to 6 months. Limitations to therapy were usually Cushingoid side effects. As in other chronic conditions requiring steroids, pulse dosing was tried with steroids in the form of prednisone or prednisolone at 5 to 10 mg/kg twice per week.  

Long-term success with no dependence or minimal Cushingoid effects has been noted in several hundred patients treated in this manner (Chez, unpublished data, personal communication).


In all, 17 of 32 patients showed response to prednisone after 2 to 4 months of  treatment (53%). Improvements were seen on EEG and  in language skills of the patients. Other steroid treatment series of regressed language in autistic spectrum patients diagnosed with LKS variant showed improved language with pulse-dose steroids.

Going to California is not an option for most people, but if I had a 7 year old non-verbal child with autism and ABA/PECS did not help initiate speech, then I would certainly read up on what he is suggesting.  I would still focus the time and effort on ABA/PECS and just hope that the drugs provide a little extra push.