Thursday, August 14, 2008

Is Secretin an effective treatment for autism?

I see that my friend Steve Edelson, who took over the ARI after Bernie Rimland passed away is promoting secretin as an effective autism treatment over at http://www.ageofautism.com/. I have met Steve at a couple of the national ASA conferences. He was very nice to me and I like him personally, but I still question a lot of positions and treatments that ARI proposes. He bills secretin as one of the most promising autism treatments ever.


Secretin is a hormone that appears in the GI tract and is involved in aiding the process of digestion. It also appears in the brain. As Steve points out, there are studies showing that it appears in parts of the cerebellum and hippocampus and limbic system, areas that have been implicated in the etiology of autism.


Steve cites the initial anecdotal evidence of the effectiveness of secretin in this boy named Parker Beck, and the uncontrolled subjective observations of this boy's improvement. He then mentions a pharmaceutical company which got the rights to the patent of synthetic secretin, which was cheaper to make than the secretin which was extracted from the duodenum of pigs. For some reason, I don't understand, Steve implies that somehow the molecules of the secretin extracted from pigs is somehow different from the kind that can be synthesized in a lab. Maybe someone with more erudition in chemistry than I have can explain to me why the organic secretin would be vastly different than the synthetic variety in its alleged effects on autism. The drug company did some studies using these two different subjective autism rating scales and determined that secretin was not effective overall. Yet when a subset of high functioning autistics were assessed it was found that they had made statistically significant improvements on one of the ratings but not on the other. Steve goes on to define the statistically significant changes on only one but not both of the rating scales as having "improved dramatically".


He then goes on to make the claim that the owner of the pharmaceutical company had a conference telephone call with the company's stockholders claiming that several of the children in the experimental group went from autistic to normal (italics added). How 'normal' was assessed in this alleged phone call I have no idea. As far as I can tell the only measures used in this drug company's study were two autism rating scales. No standardized tests were used to assess the children after the porcine (from pigs) secretin was used, no reports of scholastic placement, and certainly no adult outcomes, how they fared in jobs, heterosexual relations, etc.


Finally Steve tries to show the need for further research on secretin. He cites a study done by Janet Kern in Texas who found that about a quarter of the autistic children in an experimental group who received the porcine (non-synthetic) form of secretin improved in some of their behaviors, in terms of throwing less tantrums and having an improved vocabulary. The only children in Kern's study for whom the secretin seemed to be effective were those with GI problems. Secretin was no different than a placebo for autistic children without GI problems.


It is interesting to note that Kern in a more recent study on heavy metals in the etiology of autism has collaborated with ARI board member James Adams, so it would appear she has some sort of connection to Steve Edelson himself.



Though Steve calls for more research to be done on secretin he neglects to address in his piece the fact that numerous controlled studies have been done showing secretin to be ineffective as an autism treatment.


In a study done by Sandler, et. al in the New England Journal of Medicine a comparison was made between 28 children with autism injected with the synthetic version of secretin and 28 controls. The authors noted no difference between the two groups.


Another study published by Chez in the annals of neurology also showed that secretin was ineffective as an autism treatment.


A review showing 15 studies showing secretin to be an ineffective treatment are reviewed here: http://www.ncbi.nlm.nih.gov/pubmed/15590241?dopt=Abstract


So far as I know, besides Kern's study, the only other published report of secretin being an effective autism treatment was produced by someone named Hvorth published in an obscure publication entitled the journal for the association of academic minority physicians. This study was an uncontrolled study involving only three children.


Steve Edelson really fails to address or mention or critique any of these studies that refute the evidence that secretin may be a worthwhile autism treatment and that further research into secretin as one of the most promising autism treatments should be pursued. As far as I can tell his only criticism of these studies is that they used synthetic secretin rather than the porcine secretin that was extracted from pig intestines. He does not mention why the porcine version would be more effective than the synthetic version or chemically what the difference is. Even in Kern's porcine secretin study, a very small minority of the children improved and only those with GI problems. Out of all the persons with autism in the world, what percentage have these GI problems. Steve does not address this point. Another possible reason that synthetic secretin is used rather than the porcine version is that introducing a substance from a pig could cause the human immune system to have an adverse reaction. Though I will admit I am not an expert in this, it seems to me that it would make sense that because the human immune system would treat this as some sort of foreign agent, treatment with the pig secretin could be harmful to autistic children. Is it possible that after reading this article on the age of autism web page, some parent whose autistic child does not have a GI problem may end up seeking secretin as a treatment. Parents of autistic children are desperate people and easily exploited, so this does present a problem for me. There seems to me no evidence that secretin is a legitimate treatment for autism.

14 comments:

Anonymous said...

"Parents of autistic children are desperate people and easily exploited"

Citation, please.

jypsy said...

SECRETIN IN THE TREATMENT OF AUTISM - DOUBLE BLIND CROSSOVER TRIAL USING SALINE PLACEBO (My children were not a part of this study)

jonathan said...

No citation needed, all of the phony baloney expensive treatments they spend treatment on, enactment of the IDEA, the tons of money spent on bogus treatments like ABA and secretin and not to mention the money on all of these attorneys who went into special ed law because they ran out of ambulances to chase and the ten fold increase in autism diagnoses over the past twenty years explains it all.

Anonymous said...

What percentage of parents Jonathan? How much money per family? How much spent on secretin for example? Facts, please. Not your opinion. Citations are certainly needed when you begin to state that a certain group of people are "desperate".

Autism Reality NB said...

"bogus treatments like ABA"

Bogus jonathan?


The American Academy of Pediatrics - Management of Children with Autism Spectrum Disorders 2007

The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have
been significantly better than those of children in control groups.31–40

No other intervention reviewed by the AAP approached ABA in the quantity or the quality of evidence in support of its effectiveness as an ABA intervention.

New York State Department of Health - Clinical Practice Guidelines - Report of the Recommendations Autism/Pervasive Developmental Disorders 2005 (rev ed)

Intervention Methods

Intensive Behavioral and Educational Intervention Programs

Summary Conclusions

Intensive behavioral and educational intervention programs involve systematic use of behavioral teaching techniques and intervention procedures, intensive direct instruction by the therapist, and extensive parent training and support.

* Articles screened for this topic: The literature search found 232 articles that reported using behavioral and educational approaches in children with autism as well as 68 articles from a comprehensive review article on single-subject design studies.

* Articles meeting criteria for evidence: 5

Several studies done by independent groups of researchers have evaluated the use of intensive behavioral intervention programs for young children with autism. The four studies that met criteria for evidence about efficacy all compared groups of young children with autism who received either an intensive behavioral intervention, a comparison intervention, or no intervention. In all four of the studies reviewed, groups that received the intensive behavioral intervention showed significant functional improvements compared to the control groups.

While none of the four studies used random assignment of subjects to groups, there did not appear to be any evidence of important bias in group assignment. Within each study, the groups receiving different interventions had equivalent subject characteristics. Furthermore, all studies showed similar and consistent results.

Since intensive behavioral programs appear to be effective in young children with autism, it is recommended that principles of applied behavior analysis and behavioral intervention strategies be included as an important element of any intervention program.

It is recommended that intensive behavioral programs include a minimum of 20 hours per week of direct instruction by the therapist. The precise number of hours of behavioral intervention may vary depending on a variety of child and family characteristics. Considerations include age, severity of autistic symptoms, rate of progress, other health considerations, tolerance of the child for the intervention, and family participation. It is recommended that the number of hours be periodically reviewed and revised when necessary. Monitoring of progress may lead to a conclusion that hours need to be increased or decreased.

It is recommended that all professionals and paraprofessionals providing therapy to the child as part of an intensive behavioral program receive regular supervision from a qualified professional.


Report of the MADSEC (Maine Administrators of Services for Children with Disabilities) Task Force Report 2000 (rev ed)



Over the past 30 years, several thousand published research studies have documented the effectiveness of ABA across a wide range of:


• populations (children and adults with mental illness, developmental disabilities and learning disorders)
• interventionists (parents, teachers and staff)
• settings (schools, homes, institutions, group homes, hospitals and business offices), and
• behaviors (language; social, academic, leisure and functional life skills; aggression, selfinjury,
oppositional and stereotyped behaviors)



The effectiveness of ABA-based interventions with persons with autism is well documented, with current research replicating already-proven methods and further developing the field.

Documentation of the efficacy of ABA-based interventions with persons with autism emerged in the 1960s, with comprehensive evaluations beginning in the early 1970s. Hingtgen & Bryson (1972) reviewed over 400 research articles pertinent to the field of autism that were published between 1964 and 1970. They concluded that behaviorally-based interventions demonstrated the most consistent results. In a follow-up study, DeMeyer, Hingtgen & Jackson (1981) reviewed over 1,100 additional studies that appeared in the 1970s. They examined studies that included behaviorally-based interventions as well as interventions based upon a wide range of theoretical foundations. Following a comprehensive review of these studies, DeMeyer, Hingtgen & Jackson (1982) concluded “. . .the overwhelming evidence strongly suggest that the treatment of choice for maximal expansion of the autistic child’s behavioral repertoire is a systematic behavioral education program, involving as many child contact hours as possible, and using therapists (including parents) who have been trained in the behavioral techniques” (p.435).

Support of the consistent effectiveness and broad-based application of ABA methods with persons with autism is found in hundreds of additional published reports.


Baglio, Benavidiz, Compton, et al (1996) reviewed 251 studies from 1980 to 1995 that reported on the efficacy of behaviorally-based interventions with persons with autism. Baglio, et al (1996) concluded that since 1980, research on behavioral treatment of autistic children has become increasingly sophisticated and encompassing, and that interventions based upon ABA have consistentlyresulted in positive behavioral outcomes. In their review, categories of target behaviors included aberrant behaviors (ie self injury, aggression), language (ie receptive and expressive skills, augmentative communication), daily living skills (self-care, domestic skills), community living skills (vocational, public transportation and shopping skills), academics (reading, math, spelling, written language), and social skills (reciprocal social interactions, age-appropriate social skills).

In 1987, Lovaas published his report of research conducted with 38 autistic children using methods of applied behavior analysis 40 hours per week. Treatment occurred in the home and school setting. After the first two years, some of the children in the treatment group were able to enter kindergarten with assistance of only 10 hours of discrete trial training per week, and required only minimal assistance while completing first grade. Others, those who did not progress to independent school functioning early in treatment, continued in 40 hours per week of treatment for up to 6 years. All of the children in the study were re-evaluated between the ages of six and seven by independent evaluators who were blind as to whether the child had been in the treatment or control groups. There were several significant findings:

1) In the treatment group, 47% passed “normal” first grade and scored average or above on IQ tests. Of the control groups, only one child had a normal first grade placement and average IQ.

2) Eight of the remaining children in the treatment group were successful in a language disordered classroom and scored a mean IQ of 70 (range = 56-95). Of the control groups, 18 students were in a language disordered class (mean IQ = 70).

3) Two students in the treatment group were in a class for autistic or retarded children and scored in the profound MR range. By comparison, 21 of the control students were in autistic/MR classes, with a mean IQ of 40.

4) In contrast to the treatment group which showed significant gains in tested IQ, the control groups’ mean IQ did not improve. The mean post-treatment IQ was 83.3 for the treatment group, while only 53.3 for the control groups.

In 1993, McEachin, et al investigated the nine students who achieved the best
outcomes in the 1987 Lovaas study. After a thorough evaluation of adaptive functioning, IQ and personality conducted by professionals blind as to the child’s treatment status, evaluators could not distinguish treatment subjects from those who were not. Subsequent to the work of Lovaas and his associates, a number of investigators have addressed outcomes from intensive intervention programs for children with autism.

For example, the May Institute reported outcomes on 14 children with autism who received 15 - 20 hours of discrete trial training (Anderson, et al, 1987). While results were not as striking as those reported by Lovaas, significant gains were reported which exceeded those obtained in more traditional treatment paradigms. Similarly, Sheinkopf and Siegel (1998) have recently reported on interventions based upon discrete trial training which resulted in significant gains in the treated children’s’ IQ, as well as a reduction in the symptoms of autism. It should be noted that subjects in the May and Sheinkopf and Siegel studies were given a far less intense program than those of the Lovaas study, which may have implications regarding the impact of intensity on the effectiveness of treatment.

...

Conclusions

There is a wealth of validated and peer-reviewed studies supporting the efficacy of ABA methods to improve and sustain socially significant behaviors in every domain, in individuals with autism. Importantly, results reported include “meaningful” outcomes such as increased social skills, communication skills academic performance, and overall cognitive functioning.

These reflect clinically-significant quality of life improvements. While studies varied as to the magnitude of gains, all have demonstrated long term retention of gains made.


Mental Health: A Report of the US Surgeon General 1999

Thirty years of research demonstrated the efficacy of applied behavioral methods in reducing inappropriate behavior and in increasing communication, learning, and appropriate social behavior. A well-designed study of a psychosocial intervention was carried out by Lovaas and colleagues (Lovaas, 1987; McEachin et al., 1993). Nineteen children with autism were treated intensively with behavior therapy for 2 years and compared with two control groups. Followup of the experimental group in first grade, in late childhood, and in adolescence found that nearly half the experimental group but almost none of the children in the matched control group were able to participate in regular schooling. Up to this point, a number of other research groups have provided at least a partial replication of the Lovaas model (see Rogers, 1998).

jonathan said...

Well, Harold, you know so much about the literature, you know that in his 1987 Lovaas claimed that nearly 50% of autistics who undergone ABA were cured. There was a huge discrepancy in the sex ratios of his experimental group versus the control group, with there being the 4:1 ratio of boys to girls in the experimental group and a nearly even number of girls to boys in the control group, so that study really proved nothing. Also, there are no published adult outcomes in the peer reviewed literature.

Has Connor made any progress since you began treating him with ABA? I recall you said that at age 12 he was only reading at the Cat in the Hat level. He has severe cognitive problems. Certainly the coin flip probability of complete normalcy did not apply in his case. I will concede I have not met Connor and did not know what he was like at 3 or age 12 so I can't glean a before and after picture so maybe he made some sort of improvement after you started ABA with him but I am not sure what that is. Even if he made an improvement, you have no evidence of a casual relationship between the improvement and ABA treatment. Seems like you are also worried about leaving Connor alone.

The sad truth is Connor and other children are not peter pans. Someday they will be adults. Someday Connor will be an adult and will have to worry about supporting himself or being taken care of somehow if he can't support himself. Do you think the ABA you are doing now will help him in that end?

We adults are completely ignored by the ABA establishment. We really suffer because a lot of us can't make a living or find a girlfriend. We have problems with funny movements, inability to apply ourselves to tasks and a rejection by society rather than being indistinguishale from our peers. You may not be able to face up to the reality that Connor's prognosis may be rather grim as an adult and perhaps the ABA you are treating him with at age 12 is just an opiate.

Though the children in Lovaas 1987 are now about 40 years old and the claims of positive adult outcomes and the fact that Lovaas and Tristram Smith, his heir apparent have received considerable funding to publish adult outcomes they still have not done so. I wonder why? Could it be that the results were less than stellar?

Anonymous said...

Jonathan:

I'm curious to know whether you identify your own parents in this category: "Desperate people and easily exploited." ?

jonathan said...

Jonathan:

I'm curious to know whether you identify your own parents in this category: "Desperate people and easily exploited." ?


very good question. Not so much anymore, but in the 1960s they sure were. I was sent to private special education schools, had this occupational therapy thing to improve my handwriting and fine motor coordination and perceptual motor problems in the 1960s at a cost of $16/hour, quite a bit of money circa 1967. This was a coupole of times a week. I was also in sessions with a psychoanalyst about four times a week at a cost of $30 a session in like 1966 dollars. There was no IDEA or taxpayer subsized special eduaction or autism services in those days, so my parent had to shoulder a heavy financial burden for treatments that were of no help to me. They were told these would help. They were certainly desperate and exploited in those days, yes.

Autism Reality NB said...

jonathan

Conor did not receive even 20 hours of ABA in the 2-5 year period. The trained personnel to do so did not exist in our area. Now they do because of the advocacy efforts of parents including me.

Conor did receive some limited ABA intervention, a few hours a week in the pre-school period. Amongst other gains that he achieved were:

1)Reduction of self injurious behavior

2)Acquisition of real life practical skills eg. toilet trained by 3 1/2,

3)His ability to communicate with us and vice versa approved dramatically

In school he has now been receiving ABA instruction for almost 4 years, again because we advocated strenuously as parents to have teacher aides and resource teachers trained.

Yes his reading level and math skills are far below his chronological age. But you have to consider his starting point. Conor was initially, like many, diagnosed as PDD-NOS. That was changed shortly afterward to Autistic Disorder with an assessment indicating profound developmental delays.

From that base or starting point Conor has made tremendous gains with ABA.

But the starting point was the notion that ABA is bogus. It is not.

Lisa Jo Rudy said...

I'm curious about the type of ABA that you feel is effective. I've interviewed a number of top ABA people in the USA, and all seem to be somewhat dismissive of the old-style discrete-trials approach which used food as a reinforcer. Instead, they advocate naturalistic settings and more appropriate and social rewards.

One fellow (Jim Partington) told me in essence that if his smile and hug weren't reinforcing to a child, that he was doing ABA wrong!

If you (Harold) agree with this more "humanistic" approach to ABA, then I'd suggest that the old Lovaas research (and horrible mistakes) may be irrelevant to what is now being practiced. In fact, it seems to me that the "new" ABA is more like a cross behind behavioral and developmental therapy - a new kind of hybrid!

Best,

Lisa Rudy
www.autism.about.com

jonathan said...

Hi Lisa, an honor for you to visit my humble blog. Yes, I agree that the ABA being practiced today is irrelevant to what Lovaas did but this exactly proves my point. Lovaas 1987 involved the use of hitting kids and possibly other aversives. He himself in the 1987 study stated it was the aversives that were the key ingredient to the effectiveness of ABA. Aversives have now been outlawed in California where I live and in some other places, yet parents fight for ABA as part of their IEPs and use the 1987 study with its dependence on aversives as evidence so ABA is falsely marketed. Also the 1987 study used trained personnel and under the shannon carter decision by the supreme court the way was paved for unskilled college kids to be ABA therapists. ABA hours of less than 40 hours a week without trained personnel that lovaas calls workshop based ABA rather than more sophisticated clinical ABA can be used with less hours and lesser trained personnel. Lovaas has conceded that the recovery rates for that is less than 20% rather than the nearly 50% he boasts for kids who were hit and received the 40 hours a week, yet workshop ABA can be funded under the IDEA.

So, yes the ABA practiced today is irrelevant compared to the ABA in the past, yet, according to the scientific research that was done that Harold Doherty so proudly presents, the ABA of today should not be very beneficial if at all according to his own arguments. So yes, ABA practiced today has no relevance and the science would sugget it is less effective rather than more.

lurker said...

"The only children in Kern's study for whom the secretin seemed to be effective were those with GI problems. Secretin was no different than a placebo for autistic children without GI problems." That doesn't surprise me considering secretin is important in digestion. Not all autistics have those digestive problems, and the ones without digestive problems likely don't need administered secretin as they likely aren't deficient in it. I think secretin then would only be helpful for those with digestive problems.

Therefore, studies on secretin that have groups of autistics regardless of their digestive condition will be misleading. Just because it doesn't work for all doesn't mean it doesn't work at all. There is too much assumption that the etiology of autism is exactly the same in all cases, which has been disproved.

Let's not be so naive to think that any reputable study produced that shows no effects, was done bona fide. Considering that a treatment like secretin may decrease behavioral problems, I wonder how much that would obviate heavy pharmaceutical medications administered to autistic children that are used to manage their behaviors, which would displease the pharmaceutical companies.

JediKnight2 said...

Jonathan,

You're a genius! I've been trying to figure things out even further, and your comment about you being in psychotherapy and occupational therapy in your days has helped me just a bit further to help me realize the 'truth' just as I predicted!

My conclusion is that therapy programs used while we were growing up were pretty obsolete. My parents did the best they could to help me, so they placed me in speech therapy- the kind used for developmentally disabled children since my parents were told I was too smart to be autistic in the late 1980s, therefore being labeled and classified as a PDD child but still considered autistic.

The speech therapy I had as a child was equivalent to getting a 16-megabyte chip used for the Super Nintendo Entertainment System.

Now the pragmatics/language therapy I've been receiving for over the past year is equivalent to receiving 64 megabytes (like the Nintendo 64 system)and will go higher the more sessions I keep attending.

The psychotherapy you had, Jonathan, was probably like receiving a 32-byte chip, only the occupational therapy was like getting an Atari 2600. The occupational therapy I had was like receiving the amount of megabytes the original Playstation contains, and as I've gotten older, my brain development improved my fine motor skills as if I was being equipped with a Playstation 2 emulator.

What happened with me (and this happens to many people on the spectrum as they get older) is that my body and mind were practically begging me for a huge upgrade so my autism could be as mild as it is for the majority of people with Asperger's as well as others with other ASD lables whose problems are far more trivial than mine. The problem is you've got people who have Asperger's (who didn't have any obvious speech and cognitive problems growing up young) whose problems are usually trivial enough that they don't get help. Therefore, they go online or to support groups in person and tell others with HFA when they get the opportunity to that they were the lucky ones while the truth is most people with an ASD need the kind of therapy program I'm currently in. In the future, there will be improved therapy programs so future ASD individuals will live better lives than most of us are today. I'm assuming, Jonathan, that you've witnessed this growing up which is why you may feel a bit envious toward other autistics you encounter who appear to be successful.

You want to know how many people with an ASD live? Insecure! Regardness of being diagnosed with an ASD early or late in life doesn't cut it for everyone. It all has to do with the lack of knowledge and understanding of autism that's existed since the human race began and wasn't officially discovered until the early 1940s.

What happens as a result? If parents see there's something wrong with their child, they take them to doctors and the parents will do everything they're told by them in desperation. Then if the child does benefit from the speech therapy, guess what happens when that child gets older? The parents gradually tell that child (like me for example) things that are exaggerated in order to protect him/her. Then if siblings are concerned, the autistic child becomes confused and upset because he/she wants to see him/herself like anyone else or like he/she is special and that autism is like a gift, partially due to being in denial, partially from being too young to understand, and partially from being 'slow' to understand abstract concepts and other areas due to being disabled.

Now you want to know what happens to the autistic child (like me growing up) while he's growing up? He gets into situations and misunderstandings that he doesn't know how to handle well or cannot handle well due to things that were never worked on in speech therapy since there was FAR LESS knowledge on how ASD individuals' brains are wired. If you're told things all your life like, "Lower your voice" or "you didn't listen properly" and later discover you can't seem to find places while driving or while you stepped out of your car and need to get somewhere no matter how hard you try, of course you're going to have low self-esteem! It doesn't help when most of our peers are ignorant about autism and growing up with a sibling (or siblings) who don't understand autism until they get even older, especially when they become pessimistic when they're about 7-8, maybe 9 years old. It's especially even more devastating when the autistic individual is older than the neurotypical sibling and the parents don't give a shit. They just tell you never compare yourself to your brother or sister when someone like myself was the one who was able to predict that playing Nintendo with my brother was like trying to get an aspie or autie involved in an elementary classroom group project where that individual is better off working alone within his/her own timing due to processing difficulties among other things. Well, I was NEVER someone who treated his brother like the way NTs treat each other in their houses, and I do thank G-d that my brother wasn't a 'bully' to me my entire life like the way typical NTs are to their siblings, but it's tough being the disabled sibling. Today, I feel more comfortable talking to my brother at home and will usually talk to him on the phone every Sunday.

Anyway, as autistics get older, right around their teenage years, they start figuring things out even further and realize subconsciously that maybe they do have a real problem but try their best to work their way around it and try showing and proving to their family they CAN BE independent. They get insecure about their lack of friends, social life and lifestyle. The truth is there are enough serious problems taking place due to the brain wiring and ways of being raised growing up that they don't feel good enough, and they really do have difficulties doing things they see are easy for NTs so they don't feel good enough to their family or something along those lines. They feel like if they lived in someone else's family or could hang out with certain peers they see and feel they fit in with so they unintentionally start living their lifestyle like in the movie "Napoleon Dynamite", only most of their lifestyle they develop until/unless they get the kind of help I'm getting begins and continues focusing on autism, chatting online and meeting autistic people at support groups and doing and talking about anything that relates to what we believe should be considered our 'culture'. The truth is that most of the individuals autistics like me will encounter are those who are completely or at least 1/4-1/2 different from me. When meeting other ASD individuals, many of them feel like they're truly representing them when they're ARE NOT! Thank goodness for the pragmatics program or else I'd still be Kip Dynamite (Napoleon's older brother)and act like/be like Uncle Rico (Napoleon's and Kip's uncle) and Napoleon in other situations! I also would still be like those other people from WrongPlanet.net and IntensitySquared.com, many of whom need help.

Now I would like to recommend the pragmatics/language therapy program to you, Jonathan, but I don't blame you for feeling like it's too late. Nope, it's never too late (unless you're an elderly autistic because what use would spending insurance and other benefits be to attempt improving oneself or someone else if by the time they're done- assuming it works for that person- if he/she is on the verge of ending his/her longevity . You have plenty of time ahead of you but I wonder if by the time I finish what I started a year ago if yet another new program or two will come into play....reminiscent to buying a Super Nintendo console in 1995 just as the Nintendo 64 was coming out in America in 1996 (it had been previously released in Japan and possibly some other countries like a year or two earlier). Hey! Maybe there's another program out there right now in another country that's better than what I'm currently using. Perhaps some desperate parents could travel out of the U.S. or wherever they live in order to try other speech therapy programs for their children or adults.

Oh yeah, that's another thing that's messed up. The insurance benefits for autistics are only for those who are at under 18 years of age. When I turn 24 in two weeks, my parents are gonna have to figure out what to do since I'm only going to be a part-time student as I'm attempting to take some computer programming courses as a certificate program while I'll be volunteering for 6 months at the medical examiner's department. Hopefully, I can earn my way up to a career there or elsewhere. Then I'll truly have to thank Temple Grandin for her career advice. Anyway, my point is that my parents are going to have to figure out some strategies, and they still haven't figured out the entire picture as to why the pragmatics training I'm in is very important to me. I still need to contact Dr. Herman Fishbein to have him explain to at least my dad as to why it's more than just a frugal matter to me. Hopefully he'll do a great job explaining everything but based on my psychological evaluations since I was under 2 years old and from this one blog of yours, I feel more confident that I'm right about the seriousness of my disability as well as others on the spectrum.

danielthomas said...

I often see regressive behavior in children with Autism in relation to the changing seasons, specifically from winter to spring. Many times it is an underlying problem with yeast that is triggered by seasonal allergies.
Autism Treatment