Virtual Autism

Autism Calling

Please bear with us a moment.

We have a story to tell you. A telling story alright. Germane to the autism correlation to follow.

Good kids with, potentially, bad devices. Over time, really bad devices.

The Hughes Brothers know a talented and compassionate man named Dave. We’ve known him for well more than forty years. We used to play basketball together at the wondrous private school where we taught: half-court, three faculty versus three kids, two of whom went on to play Divisional I ball. We never lost. Not once. In large part because we had Dave..

Tennis, the U.S. Open, the Waldorf Astoria, and some really, really bad devices.

John Howard Hughes left teaching after three rigorous, impossibly rewarding years. But Dave stayed. He’s still there, at that school, no longer teaching the history he loves – American mostly, but European as well and, now and then, ancient, the Greeks and the Romans and the Egyptians.

He coaches tennis. Oh Lord, does he coach tennis. Umpteen Kansas state titles, girls and boys alike, year after year that high school turning out superb athletes who hit the ball hard, well-placed and hard, strategized under days and weeks of Dave’s teaching.

So.

In gratitude for all that he has accomplished, a year ago the parents of the players — current, past, and long past – sent Dave, his wife, and all the youngsters to see the U.S. Open.

Dave sent John Howard a picture of his team, in front of that famous hotel, waiting on a limo there to take them to Forest Hills, to the Open itself, to see the best tennis players in the world have at each other.

Fifteen love. Game. Set. Match.

Dave and his wife are beaming in that photo, full of obvious anticipation. One of the kids seems to share their excitement.

But the others.

The others.

Fifteen of them looking down, transfixed, at the smart phones in their hands.

Stupid, stupid telephony.

The question comes: what, possibly, could be more interesting on those telephonic screens than a night in the Waldorf and the Open waiting a few miles down the road?

For tennis players!

Tennis players.

The World Cancer Research Fund on kids with phones.

We’ll skip past the dozen cancers waiting for young people with the sedentary lifestyles that excess interaction with phones, tablets, and gaming consoles inevitably obtain. We’ll not address the WCRF’s “brain imaging research showing how overuse of screens can affect the brain’s frontal cortex in the same way cocaine does.

We live in a world where over ninety percent of one-year-olds – one-year-olds have already used a mobile device.

Oh my gosh: the collective response from the Hugheses.

Autism among the young, very young social media crowd.

Doctors have been forced to fabricate a new term for little ones over-exposed to digital devices.

Virtual autism.

Behaviors same as autistic.

Case in point: Dr. Leah Light, founder of the Brainchild Institute in Hollywood, Florida, describes the repetitive actions of a two-year-old boy whose parents, concerned and rightly so, brought him to her clinic. The doctors report: “The boy is non-verbal. He does not respond to the calling of his own name. He emits a few repetitive sounds. He appears to be hearing impaired. He makes extremely poor, if any, eye contact. He does not point. He runs out of control. He does not walk quietly. It is very, very difficult to keep him engaged.”

Virtual autism, brought on by an average of four hours of screen time day to day. The little guy’s parents’ explanation for it all: “With a screen in front if his face, we can persuade him to eat, to get dressed, to remain reasonably calm. With that screen he becomes sedated, zoned out, in a world of his own.

Who needs virtual autism?

A powerful question for you, for the Hughes Brothers, for all of us. With the incidence of real autism on the rise, this phone-based nonsense must somehow be stopped.

Your guess thereto is just as good as ours.

Yet More Lessons For Us All From Dr. Temple Grandin

Few people in the world are more qualified to speak and write about autism than Temple Grandin, PhD. Ms. Grandin has confronted her autism since early childhood, has done so with accumulating wisdom, it the product of her own prodigious efforts and the knowledgeable, persistent help and encouragement fem her family and her first teachers.

The Hughes Brothers continue now with advice from this remarkable woman.

Dr. Grandin insists that parents and teachers use concrete visual methods to teach numerical concepts. She remembers the set of blocks around which she learned to add and subtract — blocks with different sizes and colors to represent the numbers one through ten. Similarly, she learned basic fractions from a wooden apple cut into pieces.
In some cases, it might be easier — and far better — to skip past the teaching of cursive, even printed, handwriting. The random motor controls that trouble so many little kids with autism can lead to major frustrations with a pen or pencil. Typing, however, comes much easier to these children, and so immediate, direct access to a computer keyboard might solve so many issues surrounding this critical phase of early learning.

Reading presents an altogether different set of problems and potential solutions. Some autistic children will learn to read, quickly and accurately, with the use of phonics. Some others will learn best by memorizing words in their entirety. Still other will respond better to flash cards and picture books, with all the words associated thereto, picture and the printed word on the same side of the card. Simultaneous voicing of the world by parent or teacher is a must.

Protect, as much as possible, the child from sudden, loud sounds. Ms. Grandin remembers a “school bell that hurt my ears like a dentist’s drill hitting a nerve.” All the other aural sensations of academia fit the same category of shock and pain: the public-address system, the buzzers of a basketball game, desks suddenly moved, a teacher’s chair scraping on floor. Who can say what sound might once cause terror in an autistic child, that sound then imprinted, now capable of producing bad behavior each time the child hears it again. If teachers or parents ever observe children covering their ears, an alert should sound in their own minds. Then, various ways of de-sensitizing the child to the noise can begin — everything from somehow muting the sound to recording the sound on a tape recorder, allowing the child to innate the sound, to control its gradual increase in volume, the child always in full control.

Similarly, visual distractions bother some kids with autism. Fluorescent lights, in particular, trouble many children, in their hypersensitivity these children fully, uncomfortably aware of the flickers of sixty-cycle electricity. A couple of possible solutions here: move the child’s work or study table toward natural light, the nearest window or one far away from the subtly blinking fluorescent; use a lamp with an incandescent bulb at the child’s work station; if fluorescent lighting cannot be avoided, use new bulbs through, since the newer the bulb the less the flicker.

The Hughes Brothers have written throughout these pages about the comforts weighted objects bring to children with autism. Hyperactive kids, their fidgeting non-stop, will often calm themselves once wearing a padded, appropriately weighted vest, its gentle pressure slowing the child’s central nervous system.
We Hughes Brothers are always happiest when the ideas we bring for helping children, parents, and teachers arrive in this easy, straightahead
solutions to common problems associated with ASD. Bulbs and vests and flash cards and tape recorders and blocks and keyboards and wooden fruit.
And, of course, we are so very grateful to such pathfinders as the venerable Temple Grandin.


Tips For Parents And Teachers of Autistic Children: From Someone Who Should Know

The Hughes Brothers have expressed our admiration for Temple Grandin elsewhere in the pages. First, for what she taught us a long time ago, about the cattle business. And now, for all she’s teaching us about autism.

Now a professor at Colorado State University in Fort Collins, she published quite a long time ago (2002) an article for the University of Indiana’s Resource Center for Autism, a straightforward, easily understood set of ideas for dealing with young people along the spectrum.

Her ideas come along in a series of tips, of suggestions, of firm but gentle requirements for success.

“Firm but gentle,” her first description in fact of the manner in which parents, teachers, and other authority figures should deal with children with autism. From the beginning. Gentle. Firm.

Structure, structure, structure. She remembers her early childhood, toddler years in which she was not allowed to freely manifest the impulses of her autism but for one hour after lunch. At all other times, her family or her nanny were suggesting and then controlling the activities that filled the hours of her toddler days.
Families should eat together, with the child with autism engaged through these happy times with parents and siblings, practicing good manners, learning to engage and to enjoy. (As Temple herself wrote, “The combination of the nursery school, speech therapy, play activities, and “miss manners” meals added up to forty hours a week, in every one of which my brain was kept connected to the world.”

Visuals. Visuals. Visuals. Professor Grandin emphasizes that many people with autism think visually. “All my thoughts are like videotapes running in my imagination. Pictures are my first language, and words are my second language,” she writes. As a little girl, she liked nouns, found them the easiest words to learn. Makes sense, since nouns represent people, places, and things — all easily visualized. For more abstract words — she uses “up” as an example — she recommends attachment to a visual object. As in , lifting a toy airplane higher and higher after takeoff from a desktop runway, and repeating the word over and over again. “Up . . . up . . . up.” Sometimes, cards help. A card with the word “up” is attached as the toy plane rises, a card with the word “down” as it descends.

Avoid long verbal instructions. Sequence presents problems for many children with autism. Once the child learns to read, instructions might often be written on a nearby piece of paper. Ms. Grandin tells us she can remember only directions of three steps — how to find the nearest gas station, for instance. “I also have difficulty remembering phone numbers because I cannot make a picture in my mind” too.

As a logical corollary, many children with autism exhibit genuine talent for, and an impulse toward, drawing and other sorts of visual artistic expression. (In this regard, the Hughes Brothers were not at all surprised to learn that many people with autism have become ground-breaking computer programmers.)

Parents and teachers should look every day for emerging interests in the children in their care, and then use those interests in motivating the kids in their lessons. Ms Grandin uses trains as an example: “Formulate a math problem according to those interests, calculate how long it takes for a train to go between New York and Washington.”

We’ll pause now to elaborate on that last bulleted point. Instead of focusing on such inabilities or limitations as the child might exhibit, look the other way. Off toward innate talent, interests that can be turned toward the development of skills. Skills that may then contribute to a long, happy life full of achievement and reward.


Can Autism Be “Edited”?

The Hughes Brothers are way over our heads already. This research stands way on out there, and then some. It comes to us from the Department of Cellular and Integrative Physiology at the University of Texas Health Science Center in San Antonio.

Using breakthrough genetic techniques, the scientists at work there report that they have – their word – edited away traits of autism. The results of the trial: a significant reduction of repetitive behavior so frequently associated with the disorder.

The Hughes Brothers remind themselves that these results have, to date, been manifested only in mice. “Mice models” actually, a non-human species studied extensively in an attempt to understand particular biological phenomena, with the expectation that discoveries made in the organism model will provide insight into the workings of other organisms, homo sapiens, included. The tests down in Texas indicate, however, that the editing technique might be developed to treat conditions ranging from epileptic seizures and opioid addiction to schizophrenia and neuropathic pain.

Prepare yourself.

“Technical” doesn’t begin to describe the following.

The researchers injected gold nanoparticles covered in a (another research-specific term) “forest” of DNA chains to alter the genetic code of mouse models with a form of autism called Fragile X Syndrome (FXS).

Here’s the official name for the technique: CRISPR-Cas9 gene editing.

Seems the mice were digging and jumping pretty much non-stop. The edit resulted in in a thirty per cent reduction in the mice’s clawing at the dirt, and a whopping seventy percent reduction in their leaping about.

This jumping over and over again, just like the relentless digging suggest autism.

Our friend, gold

Because the editing DNA arrived attached to gold particles, the researchers could control how much of the crucial Cas9 protein was delivered, this protien the editing agent

According to the team’s leader, Hye Young Lee, “There are no treatments or cures for autism yet, and many of the clinical trials of small-molecule treatments targeting proteins that cause autism have failed. This is the first case where we were able to edit a causal gene for autism in the brain and show rescue of the behavioral symptoms.”

The skeptics take on the research.

The Hughes Brothers are still hiding under cover as we bring you opinion from knowledgeable folks who just don’t want to be disappointed once again.

Some docs worry about comorbidity with Fragile X Syndrome and autism, believing that FXS is a condition in its own right, not simply a form of autism. Consequently, the results of this research do not necessarily address children diagnosed without FXS.

Others don’t think this finding will help suchpeople with non-syndromic ASD. (Syndromic being autism associated with other neurological disorders or syndromes.)

Still other scientists argue that the reported reduction in digging and leaping may not necessarily indicate a reduction in repetitive behavior as opposed to a drop in levels of energy. These doctors wonder that if the San Antonio testing conditions demonstrated that the mice were really channeling their energies into more varied, more productive activities. As opposed to the mice just going oh so slowly to sleep.

Where to from here?

The Hughes Brothers will continue to scour the Net, indeed any reputable source we can find, looking for news of any sort related to Autism Spectrum Disorder. As always, we’re mere reporters on this far-out scientific stuff – although we’re learning how to, we trust, translate the technical language into more widely understood vocabulary. This article was tough. We found ourselves googling every other minute for more information about an unavoidably technical phrase.

You can trust us on product reviews.

Yes, you can. With every product reviewed by the Hughes Brothers, we have concrete, substantial evidence to support our opinions. We write only to best serve these children and the people who love and care for them.


A Closer Look at Dr. Goldberg’s Work and Some Reactions to It

Over the past twenty years, Michael J. Goldberg MD has examined hundreds of children diagnosed as autistic. As his clinical investigations continued, he discovered that nine in ten of those children tested positive for a virus whose attacks upon the brain, to his mind, account for the manifestation of the symptoms, the behaviors we now place somewhere along the autism spectrum. Dr. Goldberg has also discovered that an extremely high percentage of children heretofore diagnosed with autism suffer from a broad bunch of allergies. Allergies which, in his opinion, sufficiently stress the immune system that it cannot fend off the assaulting virus.

Accordingly, Dr. Goldberg has achieved widespread success with his use of anti-viral and anti-fungal medications. Further, he addresses children’s diets with an eye to the elimination of certain foods with known allergenic properties capable of stressing kids’ immune system.

“Miracle worker” is a term the Hughes brothers encountered frequently in our reading about Dr. Goldberg, this from families of children whom he had treated directly.

Dr. Goldberg’s Autism theories and their effect on his colleagues

Other clinicians are supporting with their observations Dr. Goldberg’s theories, most especially in the light of the pace of modern life and its eating habits. These clinicians are seeking still more research to either support or to refute his hypotheses.

These same doctors and nurse practitioners have discovered a great deal of overlap among children with various disorders including autism, OCD, ADHD, learning disabilities, and allergies. To be sure, medical literature has largely ignored this correlation, although unofficial recognition of the overlap is growing.

Since the mid-Nineties, medical academicians admit to no known connection between allergies and learning disabilities, much less between allergies and ASD. That said, many therapists routinely ask parents about allergies in every child referred for learning disabilities, even if they’re not indicated on a medical background investigation.

Dr. Goldberg’s Autism theories and Other Approaches

Some families have invested thousands upon thousands of dollars in advanced therapies such as Applied Behavior Analysis or in intense occupational and speech therapies, all to little or no positive effect.

Of course, any book with such a radical, at least seemingly radical, thesis will provoke argument on both sides of a very complex issue. We’ll begin with those who have found in the good doctor’s research hope for a new life for their children and grandchildren.

These parents and their doctors find Dr. Goldberg’s hypotheses make a good deal of sense in terms of the complicated interactions among body’s complex and interconnected parts, of how these interactions can play havoc on some children whose immune systems has been compromised in ways perhaps not yet known.
At the pinnacle of Dr. Goldberg’s research come findings that brain scans demonstrated real, observable, documentable changes in brain function in children who have followed his methods of treatment and recovery.

Dr. Goldberg’s Autism theories and Disparate views

The criticism arrives from readers convinced that autism remains anything but a “myth.” Usually these critics agree, however, that Dr. Goldberg’s research presents interesting new options by looking at what we now call autism as a series, a collection of smaller discreet disorders. Apart from this novel way of addressing the behaviors, some readers were disappointed in the book’s inability to bring along practical new ways of helping a child diagnosed with autism. They must not have noticed the part about anti-fungal and anti-fungal injections.

Too many threads.

Even as the Hughes Brothers were completing our beginning look at Dr. Goldberg’s thesis (more articles to come), we stumbled upon a clinical trial in England arguing that the traits of autism might be “edited” through the use of newfound genetic techniques.

Here we go again.

MORE INFO: The Myth of Autism: How a Misunderstood Epidemic Is Destroying Our Children, Expanded and Revised Edition

Is Autism Routinely, Radically Misdiagnosed?

In this, the first in a series of articles about supposedly mistaken diagnoses of children allegedly confronting autism, the Hughes Brothers say loudly and right up front here, “We are making no judgments. We’re not qualified to make judgments. We’re reporting. We’re gathering information on every side, the top and the bottom, every last nook and cranny of medical research into Autism Spectrum Disorder (ASD), by whatever name shall ye call it.”

And so please. Please, please use our discussions, our reportage as grist for your own personal investigation into the various clinical issues swirling about the rapidly increasing instance of diagnosed autism in our children. Draw your own conclusions, we beg of you.

In the meantime, we will do our non-professional very best to uncover the nuances of current medical thinking – pro, con, up, down, and all around –the behavioral and developmental patterns surrounding a child you love. As always, we will try to help you make some sense of the daily challenges you face as a parent, a sibling, a guardian, a teacher, a relative, a friend who cares so very deeply about a little one whose little life refuses to conform to any number of societal, of clinical, of individual norms.

Read on, please.

Together, we might make some sense of all this.

Autism by the numbers

The numbers, their multiplication, their seeming random aggregation toward an epidemic

In the past thirty years, diagnosis of autism in children has skyrocketed from, back then, one in five thousand to one in just over a hundred, these numbers the calculations of the Centers for Disease Control and Prevention. Elsewhere in these pages, the Hughes Brothers have documented incidence of diagnosis but seventy percent of that last CDC number: one child in sixty-eight now determined to be somewhere along the autism spectrum.

Kindly forgive the vulgarity.

But what the hell is going on here?

That problematic, that slapdown nowhere word “epidemic.”

Here comes bedrock fact, indisputable dictionary-definition truth about the spread of a physical illness, the sad collective state of infection we call an epidemic.

Know this.

The rapid proliferation, by whatever means, of any developmental or genetic disorder is – yesterday, today, tomorrow – scientifically impossible.

Genetics, the manifestation of at least nine months of one-on-one-on-one progression, simply cannot produce the sweeping, all-at-once phenomenon of what qualifies as an epidemic.

It just can’t happen.

Autism Epidemic

So, what if it’s not an epidemic at all?

In some articles immediately forthcoming, we’ll barge into the turgid waters surrounding specific scholarship proving, maybe, that autism just cannot be genetic. Rather, the learned doctors, the investigative geniuses we are about to trot before you, will argue with some scope and some heft that what we call autism, for the most part, remains a symptom of a treatable neurological disease attacking the brain’s immune system. Autism, they will argue, comes forward as a medical problem, a disease, not by any means a psychological or developmental issue.

Rather, occurring as a result of a dysfunction in the neuro-immune system, autism rides along with, oh, AIDS, ADD/ADHD, and chronic fatigue syndrome as examples of secondary neurotropic viruses. And the damage, the deep-down damage, they can do.

Meet Dr. Michael J. Goldberg.

In no, no way might the Hughes Brothers better begin our discussion of alternative diagnoses of autism than with the overpowering, the all-inclusive credentials of Dr. Goldberg.

· Received his medical degree from UCLA and trained at LAC-USC Medical Center

· President of the Neuro-Immune Deficiency (NIDS) Medical Advisory Board

· On the clinical teaching staff at both UCLA and Cedars-Sinai Hospitals

· Seventeen years’ experience in evaluating and treating autism, ADD/ADHD, and chronic fatigue syndrome

Hang on. The ride might bump around a bit.

Signs of Autism in Girls, Part 2

The criteria described here below and in our preceding article should serve as potential indicators, and nothing much more. No singly symptom alone can suggest autism. If a symptom or two become more pronounced as the years pass, parents or guardians should be able to look back and see there a pattern of behavior enduring from the toddler years onward. And crucially, always and always, look for limitations of daily functioning. If, the presence of symptoms aside, your daughter is progressing with her school work, enjoying her life, making and keeping friends, then not to worry overmuch.

Regardless, if you believe that some of these signs, collectively, describe your loved one, then evaluation by an expert clinician is probably in order. Be certain, however, that the evaluator, or team of evaluators, you select has specific experience with girls on the autism spectrum.

Some more signs then

· The young lady is typically described as “shy” or “quiet” by her teachers and classmates. Diffidence, in and of itself, does in no way indicate autism, not at all. At the same time though, difficulties with language – either receptive or expressive, or both – could be inhibiting a more active role in conversations, a quicker and more natural response to unfolding social situations or to engagements in the classroom.

· In the same vein, unusual passivity, a sign that your loved one doesn’t know what to say or do. She may be playing it safe, sitting silently, choosing to say nothing out of fear saying something wrong, something inappropriate. Know too that some people with autism are anything but passive, displaying self-assertion, if not outright aggression, at every turn. This conflicting sets of indicators again demonstrate the difficulties of diagnosis.

· You notice changes in her behavior as she enters the teenaged years, a tumultuous time in everyone’s life, with autism or not. The changes will usually come in her social communication, easy and forthright as a young girl, but now troubled, increasingly hard for her. The Hughes Brothers have read accounts of young girls with high-functioning autism coping with the difficulties of social interaction, masking their feelings, allowing even encouraging others to speak in their place. Even the best adaptors, the brightest of young girls, find that this strategy disappoints them amid the whirlwind of social expectations as a teenager. The old tactics of darting and feinting in social encounters no longer work.

· And, finally, a dramatic, inescapable indicator – epileptic seizures. Again, while these seizures may arise from all sorts of disorder in the brain, studies show that seizures are more common among girls with autism than among the male counterparts.

The Hughes Brothers give all the credit, all the sympathy in the world to a young lady who has confronted her difficulties, has found away to function amid those challenges. Should you discover that your daughter is, in fact, autistic, take comfort in the depth and scope of treatments, of potential responses to the disorder. Most public school systems can create a plan appropriate for her particular needs. And many parents consider charter or private schools, where smaller classes, more individual attention can serve her well.

Another alternative perhaps

At the Children’s National Health System, and specifically the Center for Autism Spectrum Disorders there, clinicians have developed a cognitive behavioral intervention program called “Unstuck and on Target”, a complete program created to teach autistic kids flexibility, goal setting, and planning. Early trials show the program to be especially for children of elementary-school age placing somewhere on the autism spectrum. Meanwhile, further testing is going forth on the program’s effectiveness for middle- and high-school-aged kids, who face many more challenges each day to their decision-making skills.



Autism in Girls

The Hughes Brothers report these numbers with sadness.

One American child in sixty-eight is affected by autism, with boys included in that fraction at a rate five times that of girls.

New research suggests, however, the diagnostic methods currently recognized as best medical practice often overlook girls, a distressing thought meaning that even more young people may find themselves on the spectrum of autism disorder.

Three principal reasons for this newfound disparity

· Findings – from both behavioral analysis and preliminary neuroimaging – manifest themselves differently in girls, most specifically in that young females with autism are closer in their social skills to males developing typically.

· Almost all of the criteria for diagnosing autism have been built around boys, including behaviors that in girls might heretofore have been diagnosed as obsessive-compulsive disorder or attention-deficit/hyperactivity disorder or, even, anorexia.

· Until recently, prevailing clinical opinion held that, if autism were to manifest itself in girls, the symptoms would be far more severe than in boys, particularly in intellectual disability. Not necessarily so, the new research says.

Compensation and clinical bias, unintended, of course

Autism’s skewed gender ratio may arise, first of all, from girls ability to hide or to compensate somehow for the symptoms of ASD. The abilities in social situations cover for some of the underlying behavioral symptoms of the disorder. Further, ongoing research tells us that biological factors – girls and boys are indeed different – might prevent the development of the condition, beginning at birth.

The bias, based on all best thinking at the time, has historically called for more, and more serious, behavior problems or more troubles intellectually, or both, in girls before a diagnosis of autism might be made.

The unfortunate conclusion researchers are coming to, then: clinicians are missing many young females appearing on the less disabling end of the autism spectrum, what has traditionally been called Asperger’s syndrome.

“Restricted interests,” as an indicator of autism in girls

Tightly focused, repetitive all day long, and peculiarly personal, the intense fixation on a particular subject or objects can be a key indicator of autism at its less severe. (The Hughes Brothers have already reported on our little buddy Charley, up in Minneapolis, whose passion in life involves cassette tapes. No CDs. No vinyl, thank you very much. Just audio cassettes, the music thereon not much of a concern but, man oh man, the individual tape must, must, must be in its proper case.) Now, the studies referenced earlier reports that girls exhibit far fewer of these restricted interests. Could it be, however, that this differential might arise from the examples used in the diagnosis being more oriented toward boys. That is, the diagnostic factors might involve dinosaurs or toy trains far more than stereotypically female interests, dolls for instance, or pretty shoes. This weighted value of typically boyish interests contributes as well to the frequent failure of diagnosis of ASD in girls.

A nationwide, prestigiously academic effort in the study of women and girls with autism

The Hughes Brothers know of a major study of girls with autism, and adult women as well, being conducted in collaborative research at Harvard University, the University of California, Los Angeles, and the University of Washington. This study, a far-reaching and ongoing search for clinical information, will follow participants through their childhood and on to early adulthood. The researchers are spending time with, asking pointed questions of families of these girls, these women because they know firsthand the most problematic behaviors, the most troublesome symptoms of ASD. And the most helpful solutions thereto.

The study goes far beyond autism: brain scans, genetic testing and other such measures will tell us much about developmental differences in girls and boys attributable to autism, as opposed to gender. But also raising questions about whether autism affects sex differences in the brain and, ultimately how genetic and environmental factors come together in the production of gender-particular behaviors.

The Hughes Brothers have much more to say on the subject.

Please stand by.

The telltale signs then, the key indicators of a need for evaluation

As promised in the article just previous, the Hughes Brothers have gathered these most frequent, strongest signs that a girl – your daughter perhaps — should see an expert clinician.

We’ll try to be succinct, as academically accurate as we can. Serious business here. You should be concerned if the following behaviors assert themselves repeatedly, unavoidably.

· Your daughter depends on other children for help through her day, friends who guide her social interaction, who sometimes even speak for her. These friends, almost always other girls, take her through the school day and on into those hours of free time when their influence may change, but remain strong and present nonetheless.

· A particularly poignant and altogether predictive behavior here, as she turns to very specific, very limited, very focused interests, interests for which she shows intense, passionate, ongoing and enduring enthusiasm. Look especially for a subset of interests, her gathering of information about the details of a book or a movie or a television show; that is, the overreaching scope of the plot, the development of main characters prove less absorbing to her than the minutiae behind them – the props in the production, perhaps, or its locale, maybe the actors themselves far apart from the roles they play. Listen here for her talk. Is it repetitive, seemingly endless? Does she seem uninterested in the larger story involved, focusing instead on these restricted, almost obsessive details so very important to her?

· Your daughter demonstrates unusual sensitivity to intrusive sensory inputs – a sudden burst of loud music maybe or the sudden turning on a light in a darkened room or the odor of fried foods coming from a nearby hamburger stand. This sensitivity goes far beyond surprise or momentary discomfort. We’re talking over-the-top reaction to sensory stimuli that should present no more than a momentary, a fleeting response. The Hughes Brothers advise that these sorts of challenges are by no means restricted to autism. They remain, however, an indicator of the possible presence of the disorder.

· Her conversation concerns herself only, her interests alone. On the topics of her fascination, she may talk at length, with verve and humor. On the other hand, she seems uninterested in, even dismissive, of other people’s topics of conversation. This standoffishness may very well be interfering with her friendships, her ability to function in groups of her peers.

· Frustration is not her friend. She has no “medium” setting. Her feelings, and their expression, fly out of control at the first sign of frustration. She may melt down, reverting to the raging tantrums of a three-year-old. Unfortunately, such episodes may likely occur at school or in another setting where such behavior will lead to quick disciplinary action, further compounding her heartache.

· Watch for indications of anxiety or depression. While such feelings are far from unusual in teenagers, her symptoms may run much deeper, much more painful than the expectable angst of being an adolescent.

· Her friendships come and go. The longevity of her relationships with her other girls just disappears. And then, so sadly, when she loses a friend, she remains clueless, utterly unable to recognize her role in the damaged relationship. Sometimes, these difficulties arise – in the competitive, peer-pressurized environment of middle school – because of her inability to fit into the cultural norm of the moment, whether in choice of clothing, styling of one’s hair, or the vocabulary of the clique. She has just such a very hard time keeping pace with the demands of fitting in, however nonsensical and fleeting those demands might be.

More to come on this subject from the Hughes Brothers. Excuse us while we regroup.

Might a little girl you love be autistic?

A parent might confront few questions more troubling than this determination of if, and where, a loved one might place of the spectrum of autism disorders. And the answers do not come easily: the signs of autism in girls and women differ significantly from those in boys – a difficulty compounded by the fact that these signs, these indicators of a diagnosis, can be so often missed, overlooked, especially in cases of high-functioning autism.

Autism Under-diagnosis in girls

Only very young girls exhibiting overt, severe, obvious symptoms are, typically referred for evaluation. These behaviors include repeated and exaggerated self-stimulation (“stims,” as discussed in another Hughes review of chewable objects), major challenges with speech and language, little or no social communication, or significant learning disabilities and cognitive inabilities.

Diagnosis becomes much more uncertain, in some cases, impossible in young ladies whose symptoms present themselves with subtlety, with learned subterfuge. Girls with higher IQs may mask their symptoms, copying the behavior of peers, only to delay diagnosis to, at best, the pre-teen years.

Blame, in part, the culture.

Cultural assumptions, indeed some prevailing stereotypes, may further missed diagnoses in girls. For example, the politics of feminism notwithstanding, girls may be expected to be more reserved, quiet, far less assertive than boys. Femininity, to the popular mind, finds no quarrel with girls who seem shy and withdrawn, just that way little girls are. A boy showing forth the same characteristics – passivity, shyness, silence in social situation – will almost always, right now, be labeled atypical. In the same, a young girl who lives in a world of her own creation attracts little or no attention, even as a boy with the same behaviors will draw immediate scrutiny, much of it negative.

Some indications of autism in girls

The Hughes Brothers emphasize that a single, solitary symptom among the behaviors recounted below need suggest autism. On the other hand, some of these symptoms may become more visible, more easily recognized, as a little girl ages. In retrospect, parents may then be able to identify patterns of autistic behavior present since toddlerdom. Before you worry overmuch, the Brothers ask that you take concern only if one or more of these behaviors is interfering with events of daily life, with your loved little girl’s happiness and progress in school, at home, and in the usual social situations of being a kid. Not to worry, even if a couple of symptoms of autism appear, so long as the young woman seems to be enjoying life, demonstrates an ability to adapt to the situation of the moment and, particular, succeeds in school and in her other chosen endeavors.

Only when you notice the prevalence of these behaviors over the years, when they begin to interfere with functionality of any sort in the girl’s life, you might want to consider clinical evaluation. Time then for the experts to become involved, beginning – in our opinion – with your family doctor.

Not to rely too heavily on the Hughes Brothers, however, here are some scholarly references to give you detailed background on the behaviors of girls potentially somewhere on the autism spectrum. Remember, the more highly functioning your daughter or niece might be, the more difficult the diagnosis. A case in which her intelligence might be a bit of an obstacle to, at least, early indication of the disorder.

The bibliography, then.

DeWeerdt, S. Autism characteristics differ by gender, studies find. Simons Foundation, 27 March 2014.

Dworzynski K. et al. J. Am. Acad. Child Adolesc. Psychiatry 51, 788-797 (2012)

Nichols, Shana. A Girl’s-Eye View: Detecting and Understanding Autism Spectrum Disorders in Females. Interactive Autism Network at Kennedy Krieger Institute, December 2009.

Sarris, M. Not Just for Boys: When Autism Spectrum Disorders Affect Girls. Interactive Autism Network at Kennedy Krieger Institute, February 19, 2013.