Autism Apps

http://www.latimes.com/business/la-fi-apple-autism-20130430,0,2782344.story

Can an ipad application help autistic kids communicate? The answer is nobody knows and everyone, especially those at Apple, those in the educational community, and families with autistic members, would like to think so. There is no evidence to suggest that any app can be useful, and yet there are “a search for “autism” in Apple’s App Store brings up 1,449 apps for the iPad, and 1,259 for the iPhone. And Apple has even created a “Special Education” section of the App Store.

The range of these apps has expanded well beyond the initial focus of helping people with autism communicate and improve social skills to learning about emotions and delivering basic educational lessons in a format that’s better suited to autistic learners, Shih said.

The creators appear to be drawn by a mix of instincts to help others and the sense that there is potentially a sizable market for these apps since, according to the Centers for Disease Control and Prevention, 1 in 50 school-age children in the U.S. have been diagnosed with some form of autism, an increase of 72% from five years ago.”

So, are we looking at a market which is highly suggestible, or is this the next great intervention? My intuition tells me that for children and adults with social/communication issues, the ipad or iphone is a tool, which although could be useful, for the most part, it cannot compensate for face to face time of social interactions. We learn to be social through experience, and yes, virtual experience can serve as a rehearsal, but the bulk of cooperation and reciprocity is learned on the playground. I am excited about the notion of health-care apps, where folks can carry around tools at their fingertips which can remind them to eat better, exercise and breathe deeply, but as with all interventions, there does need to be scientific studies to guide us how we can use these tools to most effectively shore up our deficits. Right now, we seem to be working with, and selling, hope.

Mirror Neurons

Marello Dapretto PhD http://faculty.bri.ucla.edu/institution/personnel?personnel%5fid=46838 spoke today about how mirror neurons are abnormal in those with ASD-autism spectrum disorder. It was one of those lectures where I felt like I already knew this, and so I was not learning anything, but at the same time, she was demonstrating with pretty fMRI pictures that what I/we have suspected for years, is finally being proven with our imaging technology. That is, we now can demonstrate that those individuals with ASD have a defective wiring in their ability to imagine what others are thinking or imagining. In other words, their “theory of mind” is impaired, and the level of their impairment matches the level of defect in their mirror neurons. In other words, this is a continuum of damage, resulting in the “S” or the spectrum concept. Sure, there are workarounds to the mirror neuron system. Children can learn to understand human behavior and they can learn empathy, but they will have to bring in another neurological system since their mirror neurons do not fire properly. For years, in my training from 1986-1991, we told families of those with ASD that there was a “wiring problem” without any specific knowledge about what that wiring problem might be. We felt certain that parents should not blame themselves for the social awkwardness of their children, but at the same time, parents can help fix the problem. Listening to Dr. Dapretto today, confirmed what we told parents, back in the day. Phew!

Social Awkwardness

Ned, thirty-three, “stiffens up” as he relates to me how his wife describes his behavior. “Well, we were watching a play, and we had to sit separately since my wife could not get two seats together. She always has me hold her cell phone. I don’t know why. She got three text messages during the play, so as soon as the play was over and we came together, I told her that her phone was going off. She got upset with me that I did not connect with her about the performance, or that I did not ask her how her seat was. She said I was socially awkward.” “Did you agree with her?” I asked, thinking that I am sympathetic to the wife’s point of view that she was probably anticipating reconnecting with her husband after the show and he was hyper-focused on making sure she knew she had messages to attend to. I could well imagine that this conflict of expectations created a large amount of tension, which had Ned been more socially astute he could have handed her the phone and asked her about the play at the same time. “Yes, of course, I am socially awkward,” Ned, readily agrees, “but I don’t know what to do about it.” Ned says with the innocence and sweetness of a child. “So, it was not intuitive for you to try to emotionally connect with her after seeing a show,” I ask, knowing the answer. “Yep, it was not intuitive,” Ned says with a confused tone as to how something like that would be intuitive. “Maybe you need to keep in mind that the moment of reconnecting, after a day’s work, or after any separation for that matter, is a sensitive time, and you should take extra care  to be attentive to your wife as a whole person, and not get so focused on one issue.” I say, stating what is obvious to most people, but what seems to need to be spelled out to Ned.

As I describe this interaction with Ned, I imagine my readers asking me about his diagnosis. Do I think Ned has Asperger’s? I imagine Shelly and Jon asking me. I think that social skills, like all skills are on a continuum, as are athletic skills, musical skills, math skills, etc. Ned’s social skills are weak, but I would not extend that to say that he has a social communication disorder. Ned is, for the most part, happily married, a father of two young children, and successful socially at work in that he gets along well with his colleagues. His issue is that he lacks social intuition that is helpful in close relationships.  However, he understands his deficit and so he is religious about coming to psychotherapy. He is motivated to make his wife feel more comfortable with him. Psychotherapy may help him be more socially conscious,  in a wooden way at first, in that he may sound rote, rather than warm, but over time, the warmth will be added to his reactions and so I am hopeful for the future of their marriage.

Job Excitement

    Frank, twenty-six, took seven years to slog through college. He started in community college, that lasted for three years. He then transferred to a four-year college, and after multiple withdrawals, finally finished after four more years. He was passionate about engineering, but he had a terrible issue with procrastination. High school did not go well for Frank, and for that matter, neither did middle or elementary school. He was relentlessly teased for “not fitting in,” which, as he says “was true.” Frank, one might say is shy, but in the view of multiple mental health professionals, they told him he was on the “spectrum.” I started seeing Frank at age ten, consistently arguing against putting him on the “spectrum,” the autistic spectrum, that is. Frank has theory of mind. He understands how other people think. He is kind, considerate and extremely thoughtful. Yet, he is profoundly afraid of being disliked, which makes him awkward, while at the same time, making others ill-at-ease.

    Frank worked at his job search in the same way he slogged through school. He was tenacious and resistant at the same time. He felt determined to find a job, but when the employer showed interest, he stalled. It was like he asked a girl out and when the girl said yes, then he would “get sick” so as not to close the deal. His fear overwhelmed his desire for independence. Yet, just like with his studies, he persevered and he landed a job, despite his reluctance and despite the economy which tilts against his age group. Sure, technical skills are in high demand, and that helped Frank, but what also helped him was his belief in himself, despite his fears, and despite his track record of delaying adulthood. Uncharacteristically, Frank came to my office with enthusiasm. He landed a job. He was proud of himself. His “spectrum” behavior disappeared. I can say with certainty that his “spectrum” diagnosis would be more  accurately labeled low self-confidence. At twenty-six, he is starting his life, on so many levels. Go Frank!