The iPad is a marvelous device.  I love mine.  The special needs community also loves them.  The screen size is perfect for kids with poor fine motor skills.  The crisp display is visually pleasing.  And like all things electronic, it seems these kids are born knowing how to use them.

HOWEVER – you have to be very careful with them.  There are some wonderful educational apps out there.  Since most kids on the spectrum are visual learners, this leads to many tools to aid their learning.  However, there are many games and entertaining apps available.  The American Academy of Pediatrics recommends NO entertaining screen time before the second birthday, and 10 hours or less per WEEK for all other children and adolescents.  This includes TV, video games, DS and Gameboys, computer games, and handheld phones and tablets (including the iPhone and iPad – gasp!)  Entertaining electronics are highly addictive to all kids, due to the constant positive feedback.  They are even more addicting to kids on the spectrum, to the point where my some refer to them as “autistic porn”.  Also, the light from all these devices inhibits melatonin release in the brain, interfering with sleep.  They need to be turned off at least an hour before bedtime, or they can interfere with attaining sleep onset and deeper sleep.  Good sleep is essential for good neurologic function, and these addictive devices and interfere with it.

I am constantly asked about appropriate Apps for kids with special needs, especially those with autism spectrum disorders.  It is impossible to keep up with them, much less review them.  Luckily, there are people who have made the effort.  I have listed several links below to sites that have extensive reviews and recommendations.  Note – I am not recommending specific apps, or the sites since I can’t review every app in detail.   As always, judge them for yourself.

http://www.autismpluggedin.com/

http://momswithapps.com/apps-for-special-needs/

http://a4cwsn.com/

http://www.scribd.com/doc/24470331/iPhone-iPad-and-iPod-touch-Apps-for-Special-Education

http://blog.friendshipcircle.org/2011/03/02/10-websites-to-find-special-needs-apps-for-the-ipad-iphone/

http://supportforspecialneeds.com/2011/05/23/shannon-des-roches-rosas-ipad-app-list-for-special-needs/

Everyone who is new to the autism spectrum should spend time viewing the Video Glossary on the Autism Speaks site.  It shows brief video examples of many aspects of autism.  You can see examples of joint attention, repetitive behaviors, and communication difficulties.  They have examples of different therapy approaches, including Floortime, ABA, RDI, and SCERTS.  It is an incredible collection and worth spending time with.

Another good article was published about how IQ tests underestimate intelligence in children on the autism spectrum.  I tell parents to not allow IQ testing in their children until they have fluent spontaneous language.  Most IQ tests are really language tests.  My son’s measured IQ at 3 was 60, as were all his language tests.  His score on the original Leiter (the one with the blocks) was 133.  As his language improved, so did his other IQ scores.  By 12, his WISC score was – drum roll – 133!  The only time you want a low IQ score is when qualifying for government programs, like SSI or Medicaid waiver programs.  Many things can pull a score down, but you can’t fake a high score.  So often schools use lower scores to lower expectations for our kids.  They then live down to the low expectations.  This led to us removing our son from public school in third grade.  I now proudly watch him going to community college and working hard every day.  We would never have made it this far if we allowed the public school to continue to teach to low expectations.  The article is found at:

Never lower expectations due to a test number.  Look at your child and aim for the best possible outcome.  Shoot for the fence, you land on the dirt.  Shoot for the moon, and you get over the fence.

I just read an article by Barry Prizant about ABA and what proponents claim it can do versus what is really known.  It’s a balanced presentation and reflects my views on ABA versus other therapies.  He makes several good points, and I urge everyone to read it:

I especially like how he talks about badly families can feel when told “it’s the only approach with research supporting it” and “there’s a window that closes for intervention”.  He sees people with autism spectrum disorders learning and developing throughout their lives, just as we all do.

At a recent conference by Amy Wetherby, who codeveloped the SCERTS model, she showed clips of their technique. As we watched, the RDI consultant said “that looks like RDI”, as I said “that looks like Floortime (DIR), and the ABA people in the crowd said “but that looks like ABA/VB”. I think many people have come to similar approaches with a lot of overlap. I happen to like Floortime the best, because a parent can learn to do it themselves fairly readily. They don’t have to spend a fortune. We did lots of Floortime over the years with our son, and though he’s very “aspie”, many people meeting him would call him “recovered”.  Personally, I hare the word “recovered”.  My view is we have to teach these kids things other kids learn naturally, like how to hug.  I remember teaching my son how to hug me when he was 2 – a year before the diagnosis.  On the other hand, they learn things we normally have to teach average kids – like math.

When talking about therapies, please don’t forget the fundamentals – Speech/Language therapy and Occupational therapy addressing sensory and motor difficulties.  OT tends to fly under the radar, but it is one of the most important interventions needed by most of these kids.

People often ask about the new definition of Autism Spectrum Disorders (ASD) to be released with the DSM-5.   They are concerned about restricting the diagnosis and about Asperger Syndrome and PDDNOS disappearing as diagnoses and if their child may no longer qualify for services.

I have been to several presentations on the new criteria, including some with some of the authors.  I think the new system makes sense.  It collapses the social deficits and communication deficits into one area, because they are so intertwined.  They then add sensory processing problems to the Repetitive Behaviors area.  Adding this makes all sorts of sense.  While you can have sensory problems without having an ASD, nearly everyone with an ASD has sensory processing problems.  So everyone will have the same diagnosis – Autism Spectrum Disorder.  Then a severity level will be assigned ”support needed, significant support needed, and full support needed.  This is not the same as “mild, moderate, severe”.  It is to indicate the level of support needed by the person to live as independently as possible.  Any child should automatically have at least “significant” support needed, because they are children!  They need support for feeding, shelter, daily care, education, etc, just as any chid does.  Then a qualifier will be added.  Some may be “associated with epilepsy”, “associated with language regression at 24 months”, or “associated with Fragile X”.  I suspect for those currently diagnosed with Asperger Syndrome, it may be “associated with the pattern of strengths and weaknesses associated with Asperger Syndrome”.

What about adults?  By definition, it is a disorder if it interferes with some life domain – work, community, home.  If it isn’t – it is not a disorder.  If it does, then some level of support is needed.  Nobody diagnosed with Asperger Syndrome should lose the diagnosis if they need support.  If they don’t need support, do they have a disorder?

I predict the new criteria will still be variably applied, depending  on the clinician making the diagnosis.  People whose experience is more with severely affected people will still be reluctant to diagnosis higher functioning people, but those who are used to seeing the higher functioning people will continue to diagnose them.  There will still be controversy, there will still be debate, and there will still be disagreement over how to apply the criteria.  What should not change is people with ASD getting the services they need, regardless of severity or age.