The Principle of Perspective part two

Joining me for this post is Dr Bob Sears. In addition to being a husband, father, and an incredible pediatrician, He is the Author of “The Autism Book” and the Director of TACA’s Medical Advisory Board. He is also on Facebook. :)



Hi Dr Bob, Thanks so much for joining me for the beginning of this series! I am very thankful for your book and how you present the Bio-medical information for our families…and for the fact that we can then take the information in the book to our own doctors! With that, I am curious on what made you decide to get more involved with *Autism* within your practice?


Dr Bob- Ten years ago a parent brought her daughter into my office and asked me to help her with some treatments for her child with autism. Her ideas sounded “crazy” to me at the time, but I’m open minded and like to help. So I started investigating what she wanted to do for her child and it made sense. I trained with some open pediatricians who were already treating autism, and the rest is history.


KD- On page 61, you wrote “I believe that parents should not wait around for the mainstream scientific world to tell them what to do for their child. Yes Science will give them the answer someday, but that day will come too late for those reading this” I love this statement Dr Bob, because it shows how there is a bridge that needs to happen between evidence based medicine and validating what parents and physicians see with their children and patients. Can you briefly talk about Leaky Gut and Vitamin, Mineral, and nutritional deficiency?


Dr Bob- Leaky gut occurs because the intestinal lining is so irritated by inflammation from allergies and bacterial/yeast overgrowth that it acts like a net with holes in it. The net is normally only supposed to let digested food into the body. Instead, larger particles of undigested food (which are more allergenic) and toxins (that normally should pass out in the stools) are absorbed into the body. Vitamin and mineral absorption is poor and the child can because deficient in various nutrients.


KD- Great, and I know you go into detail about Leaky gut in your book. I also wanted to ask questions about the first five supplements to start as you mention in your book.


Dr Bob- The five primary supplements that help replace what most kids with autism are deficient in (or that are designed to help improve the neurologic and metabolic deficits that exist in most kids with autism) are digestive enzymes (to help calm down the leaky gut), taurine (an essential amino acid needed for a variety of metabolic functions), omega-3 oils (which help with inflammation, gut function, and neurologic function), multivitamins/minerals (to replenish deficiencies), and probiotics (to help make the gut a healthier environment).


KD- I can really relate to your recommendations. Enzymes and Probiotics made a huge difference in my younger sons body chemistry! My younger son who is now 9, was also Diagnosed with Low muscle tone like so many of our kids. Can you review some of what is in your book concerning this?


Dr Bob– Many kids with autism have low muscle tone. This is hypothesized to be due, in part, to dysfunctional mitochondria (the “batteries” in each cell that generate the energy molecules each cell needs to function). Less cellular energy results in lower muscular function. Taking various supplements that help improve mitochondrial function may help with muscle tone and coordination. Supplements include various B vitamins, Co-Q 10, and L-acetyl-Carnitine.


KD-I do know many families struggle with ADHD too. What are your recommendations for supplements that improve cognitive abilities and attention.


Dr Bob – Antioxidants are the basic approach here. I like pycnogenol and quercetin, two plant-based compounds that are very potent anti-oxidants. These help improve the function of various brain chemicals that are needed for attention and focus.


Methyl B12 (most effective when given as shots) along with glycine (an amino acid) and folinic acid (the active form of folic acid) can also help.


KD- Thank you again for giving us a preview of the Bio-medical information in your new book. “The Autism Book”. You have a heart of Gold when it comes to helping families! I can only hope that more mainstream doctors are able to be open minded and listen to the research…and include the parents as part of the team like you do! You strike a balance of mainstream medicine and a natural approach for all children!


Speaking of balance, I was also able to listen to the Autism One conference on Ustream last month. I loved the different speakers and their perspectives. One quote that I loved was from Dr Kartzinel “We don’t treat Autism, we treat the underlying medication conditions associated with Autism”


Here is another doctor who *gets it.* With our children, there was a tipping point in their neurology that halted development. With each child, that point is unique.


We cannot just address the behaviors that our kids exhibit, we need to start building the foundations of that which was halted…typical development. Like a one -two punch. Another quote from Dr Kartzinel at the Autism one conference is “Nothing is a cure all, we need to build a foundation”


Just as important to our children’s biochemistry is our children’s developmental function. That foundation will be talked about in detail as we continue. We, as parents, want our kids to have a foundations for theory of mind! We want our kids bodies healed, and their minds!


RDI is a program that restores a child’s natural development path before Autism affected their neurology. Just as Bio medical treatments are effective for the underlying medication conditions associated with Autism, RDI is effective in treating the developmental core deficits that were halted in Autism. The goal of RDI is to go back to the precise point where the child stopped developing typically and systemically allow the opportunities for a second chance at these developmental milestones. RDI uses the model of typical development with the parent or caregiver guiding the child with intruistic motivation to improve self awareness, co regulation and experience sharing so they are no longer obstacles to the child. These theory of mind functions are extremely difficult for children on the spectrum. RDI has simply taken the research on the development of typical children and applied that research to help our children revisit what they could not get the first time because of Autism.


I know you mention RDI in your book Dr Bob. How did you first hear about Relationship Development Intervention?


Dr Bob- I originally heard about it from other pediatricians involved in treating autism as an adjunctive therapy for children with autism to help them improve their social abilities. I have since learned that it is much more than that.


KD- What do you generally tell your patients regarding RDI?


Dr Bob- I have started to recommend it more and more as a primary developmental therapy (just as OT is a primary therapy) for my patients with autism.


KD- That is great! This is so important because we want our kids to understand what we understand… the very core of what makes us *care* about why we act the way we do. We want to fill in those developmental milestones which will prevent gaps and regression as our children get older. Relationship Development Intervention is the remediation program that accomplishes this goal by allowing our children with Autism to have a second chance to make those discoveries they missed the first time. This gets them back on the track of typical development, where their continued growth then flows naturally. Biomedical intervention can be needed to treat the underlying causes of the initial tipping point. Simultaneously, RDI ® follows the cognitive developmental sequence from the effects of the halted functioning, and builds a strong neurological foundation.


This foundation, the ability to “think” will be our first chapter in “the Cradle of though”
Once again, thank you so much Dr Bob Sears. You are invaluable to all of us in the Autism Community!
For all who are reading- Please feel free to ask any questions during this series as we explore *thinking.*
KathyDarrow@autismremediationforourchildren.com

The Principle of Perspective Part One

Thought, desire and feelings. How do they integrate? I never dreamed this would be something I would give a second thought too. My world changed after my son was Dx with Autism. Like many, I was told my children ( I have two with ASD) would never lead a normal life, and need to be placed in an institution, This was my first sense that convention wisdom when it came to Autism had a long way to go in understanding what Autism * is*. I also discovered that while mainstream medicine needed an update, there were many cutting edge developmental scientists and Doctors that were leading the way to greater understanding. I am finally at a point where I see that we are ALL trying to unravel Autism and how to effectively help children live a quality of life that they want!


This is what is leading me to concentrate the next month or so in reviewing the Book * The Cradle of thought* by Peter Hobson. I read this book a few years ago, and I found this book helped me to understand what I needed to focus on with my children, as this book is one of the dozen that Dr Steven Gutstein used to help all children on the spectrum through Relationship Development Intervention ® .


Fast forward a few years later, both my children are doing fabulous and they have effectively returned to their own developmental tracks in development. My youngest is not with his peers yet, but he will be…. And they both are able to share perspective and understand social cues ( theory of mind)


Back to thought, desire and feelings. These are the foundations to subjective perspective in infancy. In turn, this subjective perspective matures into taking on another’s perspective.


Taken from a book by Peter Walsh PhD- “No, and ways parents can say it”

A fascinating experiment helped map this change. A group of toddlers at fourteen months and then eighteen months were presented with raw broccoli and Goldfish crackers and then asked to share. As the author Malcolm Gladwell explained in a January 10, 2000 article in The NewYorker:

Some years ago, the Berkeley psychology professor Alison Gopnik and one of her students, Betty Repacholi, conducted an experiment with fourteen-month-old toddlers. Repacholi showed the babies two bowls of food, one filled with Gold¬fish crackers and one filled with raw broccoli. All the babies, naturally, preferred the crackers. Repacholi then tasted the two foods, saying "yuck" and making a disgusted face at one and saying "yum" and making a delighted face at the other. Then she pushed both bowls toward the babies, stretched out her hand, and said, "Could you give me some?"

When she liked the crackers, the babies gave her crack¬ers. No surprise there. But when Repacholi liked the broccoli and hated the crackers, the babies were presented with a diffi¬cult philosophical issue—that different people may have dif¬ferent, even conflicting, desires. The fourteen-month-olds couldn't grasp that. They thought that if they liked crackers everyone liked crackers, and so they gave Repacholi the crackers, despite her expressed preferences. Four months later, the babies had, by and large, figured this principle out, and when Repacholi made a face at the crackers they knew enough to give her the broccoli.

Toddlers are not doing things parents don't want them to do JUST to be contrary. They are exploring this newly discovered difference between themselves and others.

Now that we see when theory of mind starts to emerge….we can look at Autism, and that lack of emergence, and ask… What happened? What was the cause of how the brain was deprived from this typical growth of thinking?


We know genetics could play a role. We know that our environment and the toxins a child is exposed to could play a role. We also know that it could be a combination of both and that each child’s tipping point that lead to the brain deprivation in development is unique. We know that there is regressive Autism and Infantile Autism. We will be exploring all these possibilities, going over Peter Hobson’s “The cradle of thought” and talking about effective interventions and why they are effective. I hope that you find this series in my blog helpful.


Since I am not a medical Doctor, Dr. Bob Sears will join me in part two to discuss some Bio-medical information regarding Autism.


Kathy

Utube

my utube channel-
ok now that one more thing is done I can finish working on my next blog which will be featuring a special guest :)  Hoping to have it up within the next few days!


Kathy

New website and idea for post

Hey Everyone!  I finally made an official website  click here .  I will be working on that in the coming weeks.  In addition to that, I am planning to start a series of posts based on the book by Peter Hobson "The cradle of thought".   Hobson and his wife are involved in research studies for RDI and his book is foundational to why Dr G knew our kids could attain theory of mind.


I hope to start those in the next two weeks!


Kathy

Our children's future!

Here is a recent study concerning outcomes for Quality of life for our young adults on the spectrum aging out of the educational system-

quality of life into adulthood

This is obviously not good news.  That said, I do believe we have made strides in how we,  as a society, view Autism and how we treat the deficits of Autism.  While there are still treatments that focus on behaviors and getting a child to perform static skills,  studies like these show that the long term benefits to teaching skills in hopes of generalization to thinking is very limited.  We now know that children with Autism can obtain theory of mind in a developmental fashion just like their Neuro typical peers.  Theory of mind/mindfulness however cannot be taught as a set of discreet skills to master.  A child's developmental gaps must be remediated and the neurology of the brain will  begin to repair itself.  Developmental/Cognitive programs like RDI(R) Relationship Development Intervention, provides a child a do over in development.   On page 15 of "The RDI Book"  Dr Gutstein states that Dynamic Intelligence ( Theory of mind) and Neural integration have a circular relationship with one another.  Dynamic Intelligence is a product of a neurally integrated brain.  Neurally integrated brains development through dynamic problems that challenge the brains current neural architecture.  The observable product of dynamic neural development us Dynamic intelligence."

Static vs Dynamic intelligence chart

Keeping in mind when we refer to IQ,  we are looking at static skills.  Someone with a 4.0 grade average from Princeton or YALE is not guaranteed a quality of life ( good job, marriage/relationships, etc) simply on their IQ.  The determining factors take into consideration ones ability to have the mindfulness of all those dynamic functions mentioned on the chart.  Life is not the sum of knowledge and IQ,  but of experience and being able to share experience and perspective.  This is NO different for a child on the spectrum.  They may have some obstacles in their neurology for this to come naturally,  but that is certainly no reason to concentrate on static abilities only with the thought that they are not needed,  or that they *can't* do it. 

When I look at my own children,  of course I want them to do well with static skills.  Those tend to come naturally for them...as I definitely can't memorize like my boys can!  However,  I know I needed to look further then *school* and sitting in a classroom learning skills.  Beyond school is an entire world that does not play by the *rules* and is constantly changing.  How would I prepare them for that?  How can I make sure they don't fall into the statistics of functioning as a child with ASD,  getting by, only to have the demands of adult life too much for them to handle.  As the study shows, we need to do better!  We can't sit by and hope that they will develop dynamic thinking by teaching our children static skills.  We know that brain neurology does not work that way. The ability to solve problems, prioritize demands, have meaningful relationships and achieve long terms goals is acheived by the foundations of developmental neurology which are in place in a typical functioning child.  We can have the same for the child with ASD as we go back to  their * breaking point* in neurology and fill in those gaps.  That is building a mind on a strong foundation.  Our kids deserve that second chance!!

Level 5

The fifth level of intersubjectivity is in regards to after 36 months in a typical child, and after stage 3 in the RDI objectives. This level represents My mind - past, present and future to Your mind ( child) past, present and future. Both minds are able to collaborate their experiences with one another. Included are the abilities of reminscing and reflection!  This level is a level where of course there is always room for improvement. As adults we want to be able to balance our plans with a partners plans, and collaborate with one another instead of one person trying to control the entire interaction.  Also included in this stage is being able to look at a situation that another is going through and put yourself into their perspective ( or to think of the different possible perspectives then just what meets the eye)  Speaking of that,  take a  look here , here and here  to take a comical look on what happens when we lack being able to apply the intersubjective relationship to a situation!


 As far as what I see in my child with ASD, they both are able to share about the past experiences, the present and collaberate on the future. For a child, a good clue that they are could be in this stage is they are able to just come up to you, and say something like Mom, remember when * fill in the blank* and it is an experience or an interaction that you both can reflect and share on. One thing that could be a clue that a child with ASD may not have all the levels in place is that the conversation is very rote. The Parent is asking all the questions* how was your day, what did you do? etc* and the child is just responding. The parent is doing the work in the conversation to keep it going. Without that work, the conversation would fizzle pretty quickly.
 RDI addresses the different elements of the intersubjective relationship in Guiding the child and working on those first foundational skills. This work ensures there are no gaps when these elements are  remediated. An example of gaps would include having to prompt a child for the interaction. If a prompt is needed to have a child *look* at the parent, then that child is not developing the intersubjective element. Without gaze, a child cannot take on the caregivers perspective. You can see how, with RDI, getting to the root of the intersubjective relationship goes much deeper then just getting a child to be social or learning skills only. In RDI, we believe we must start at the beginning. Starting anywhere else is insufficient in order to progress through the natural developmental stages.




My goal as a Mom was to restore these developmental milestones for my children with ASD.  As an RDI consultant my goal is to help other parents restore this relationship within their child .

Intersubjectivity - levels 3 and 4

The third level of Intersubjectivity are for the ages from 15-24 months.
Inter is My actions/My intention and subjectivity is Your actions/your intentions ( child). This demonstrates the expectations of knowing the partners next actions without him or her telling you. Since my younger son on the spectrum is in stage 4 of RDI, he has this level of intersubjectivity mastered since this is a milestone for a 2 year old. An example of this includes one morning when  I was cleaning up, I had a bunch of wrappers and papers in my hand to throw away. My son and daughter were dancing in the living room and a wrapper must of flown out of my hand back onto the floor. I glanced back with the intention on coming back to that once I threw everything away. What happened next was my son picked up the wrapper and ran to the kitchen ( I was heading back from the trash when we met up) he walked around me and threw the wrapper away. He then went back to his fun time with his sister. He was able to take my intention of throwing the items away, and without me saying a word, he picked up that I dropped the item and he was able to carry out my intention of throwing the item away. This was all without saying a word to him, which is very important when assessing if your child has this level mastered.  I of course said, "thanks Jes!" I sort of chuckle with this level because I think that children at this age ( or children with ASD at this level) happily interact with you and feel very competent when they can help. This level gets alittle clouded once the teenage years come into play since then I am sure my teen would simply say ( well I figured you were coming back to get it)~grin~ So the thought is there :) There are many more examples of this level. I know for my Neurotypical daughter she would play and be able to know the next step in the interaction because of my previous intentions and actions.


Then we come to the fourth level. This level continues at ages 24-36 months. At this level, partners are balancing reference points. it goes from level three where the child knows intentions, to level four where the child trusts the parent and knows intentions, but is also developing that awareness of balance in blending the parents perspective within their own perspective. This level is the higher functioning of curiosity. They certainly dont call it the terrible twos for nothing! Sometimes I will hear that the terrible twos go well into the threes! :) It just depends on how long it takes for the child to balance that external and internal reference points to be able to blend perspectives. What this would look like is a child would take your perspective ( if you were to hand them an item and say *Yuck*) they would more then likely say yuck too...take on your perspective. Where you would see the development of this fourth level is if they then take another look at the item and want to also make their own conclusion. For example, the Child thinks...Mom says yuck, must be yuck. Wait, I don't know, let me look at it again.  The child would then revisit the item to try and work out *their* feeling compared to Mom's feeling.   Before this level, the neurotypical child ( and the child who is around stage 3 in RDI objectives),  took your perspective pretty much without question.