Posts Tagged ‘concrete thinking’

Books About Autism

Sunday, November 4th, 2012

This is my first post reviewing autism in literature. Patients recommend various books, as do other professionals, there are publishers’ tables at conferences, and titles that appear in various other autism information that I peruse each day. I plan to set aside a separate section in this blog so that readers may offer their choices and opinions, as well. Also, I would like to use this venue for discussions about autism in other media forms, such as movies, TV or the theater.

One problem of our digital age is that it’s more difficult to actually share books. In their pixelated form, I’m the only one who gets to see them. So, I can only provide the URL and the reader will have to ultimately decide whether the purchase is worth it. Above all, these are just my opinions – yours are welcome.

The Curious Incident of the Dog in the Night-Time by Mark Haddon

A parent in my medical practice first recommended this 2003 novel. The characterizations are vivid and compelling. The narrator-protagonist is very familiar to our ASD community, since he is a teenage boy who is ‘on the spectrum.’ Because of the first person point-of-view, we are forced to see the world through the eyes of an affected individual, and I think that Mr. Haddon does a splendid job in that endeavor.

I’ll get back to the story in a bit. The middle-age British author was so convincing in his descriptions of the mental processing of the story’s 15 year-old “writer” that I believed that he must be autistic himself. This is not the type of description that Temple Grandin supplied in her book, Thinking in Pictures. Christopher (the central figure) asks the reader to follow his line of reasoning in real-time. Chapters are presented as 2,3,5… prime numbers – not I, II, or III – because that is what makes the most sense to Christopher. Sound familiar? He suffers from a lack of understanding jokes, repetitive thoughts, restricted interests, few friends, sensory issues – all from the first person viewpoint. That creates a 3D picture of what it must be like to be a “15 years, 3 months, 2 days” old ‘spectrum’ resident.

Mr. Haddon has written and illustrated several children’s books. He is not affected by Asperger’s or autism, and asks readers to get “the real thing” from authors who are, in fact, actually affected with the condition. Having examined so many ASD infants, children, teens, and even adults, I think that his background working with disabled people, writing children’s stories and creating art has given him the unique ability to paint a very accurate picture. His interpretation of Asperger thoughts adds to my knowledge and can enlighten many people’s understanding about how such individuals are different. Readers learn that the character is not dumb, or retarded, or a “spazzer” (Christopher, in the book, insists that he is not one of them), but that he is really smart, clever, and worthy of listening to and learning from.

The author is able to take us into Christopher’s mind by offering detailed discussions how the boy perceives truth, logic, relationships, and social situations. Readers are witness to the terror of a crowded railway, shutting out the world with behaviors and even the thoughts associated with dreams and daydreams. Mr. Haddon uses italics and bold-face type to express scripting, pictures to express the narrator’s obsessive thinking and scheduling, and offers an appendix to further explain the workings of such a complicated mind. We get a better understanding of how jokes are perceived and there is even a Theory of Mind discussion, from the subject’s viewpoint.

The story itself revolves around Christopher’s sleuthing (he loves Sherlock Holmes’ novels) of the murder of his neighbor’s dog. In his search to solve the crime, we see his world expand; from his room, to his small neighborhood, to the city of London. In the end, it’s not the murder mystery at all, it’s a complex story of one family’s struggle with ASD. The story covers elopement, tantrums, sensory overload, the struggles involved in caring for such individuals, and their struggle to live with the rest of humanity.

I highly recommend this short, insightful, interesting and instructive story that brings such empathy and understanding to the world of Asperger’s Syndrome and other ASD diagnoses.

Apples, Arsenic & Autism

Sunday, January 15th, 2012

Just this past Fall, Dr. Oz featured an episode about several brands of apple juice that contained up to 3-1/2 times the amount of arsenic that is considered safe in our drinking water. The Department of Health and Human Services sent investigators from the Food and Drug Administration and responded that the Nestle/Gerber food product that they examined was in the acceptable range.

The FDA chastised the show for “irresponsible and misleading statements.” In another correspondence, the FDA pointed out the difference between the organic and inorganic arsenic forms, only the latter being of concern since it is a known cancer-causing agent.

Consumer Reports joined in the fray, and recently reported high levels of the bad kind of arsenic in 10% of samples, higher-than-acceptable levels of lead in 25% of the products, grape juice containing similar poisons, plus other disturbing findings about toxic exposure. My medical practice has fielded more than a few questions about this controversy. The arsenic comes mostly from the soil, even from ‘organic’ orchards, and even if the poison is no longer used as the local pesticide. For example, one of our patients who had his urine tested after this report did, indeed, have elevated levels of arsenic. However, fortunately, his blood level of this and other toxins was negligible, meaning that his body was detoxifying correctly.

In addition to the inorganic form of arsenic as being a known carcinogen, it also increases the risk of cardiovascular disease and diabetes. In the practice of developmental medicine, I am concerned about arsenic being related to immunodeficiency because so many of our children with ASD have autoimmune symptoms. Plus, we should be concerned about studies showing the effects of arsenic on intellectual function and psychologic changes in children exposed to the poison.

There does not seem to be any totally safe method for removing arsenic from the body, though proposals for treatment have been offered and DMSA (a chelating agent) has been used when toxic levels are present in the blood. Foods which are rich in sulfur are said to be helpful (I give my patients glutathione – a sulfur containing supplement), as are fiber-rich foods. WebMD offers advice on ways to limit intake here.

All of the above notwithstanding, I am writing this post to offer a different point of view about this issue.

Whenever our government agencies are questioned about safety, why is the usual immediate response “It’s not what you think, everything is OK, don’t worry, we’ve got it covered,” and “You don’t know what you are talking about?”

I am aware that most agency bureaucracies are staffed with underpaid, overworked, and probably well-meaning individuals. So, why not answer Dr. Oz’s report with, “Really? Geez, we need to look into that problem and make sure that the population is safe.” I can’t believe that people wouldn’t be OK with that response. I can’t believe that the first responders would get fired over saying that “they don’t know” if something is true or not, or if they proclaim that a problem “deserves further investigation.”

Confidence in our governmental oversight agencies would only be bolstered if the staff and administrators would demonstrate a healthy skepticism about what is considered “safe”. We are not children who need to hear platitudes and unsubstantiated explanations, let alone reprimands and threats, as the FDA responded in the present case. There are bad medicines, unsafe products, high-risk emissions, and toxins that abound in the air, food and water.

And, that is just from the home-grown stuff! What about the poorly regulated products that arrive from other countries (demonstrating even higher levels of toxins)? The powers-that-be should be setting an example by confirming that they don’t have all of the answers, and that more knowledge is needed.

Finally, we would all do well to monitor the part that we play amplifying this toxic world and our own consumption in such a manufactured environment.

Happy Father’s Day from an ASD Child

Tuesday, June 14th, 2011

Try to read this all the way through and imagine how difficult it must be for the children:

To read this letter “the regular way” click here

Dear Dad,

I don’t speak much (or at all), so you might not hear me say how much I appreciate all that you do. Fathers and kids are supposed to be outside and playing together on a day as special as this. I can do that! Maybe I’m not playing catch or kicking the soccer ball, but I’m having a good time.

I might not show as much love or affection as other children, so you may not see me trying to get your attention and praise. But, some of my stims are doing exactly that – getting your attention. I know that you are trying to figure me out, so thanks for being patient.

I sense things in a different way from others so the foods that everyone eats at this time may not be OK for me to eat. Even if they were, that Dr. Udell has taken away all of the good stuff! Someday I hope to tell you that I know how difficult it is to prepare a GF/CF barbecue.

Lots of people can be a problem for me, so ball games or crowded parks are not my favorite place. Thanks for understanding my issues, and taking us to the beach or just playing by the house so I won’t have a meltdown.

I don’t make friends very well and neighbors or even relatives increase my anxiety, so there won’t be a busy household on your special day. Thanks for keeping me safe and helping me work things out at my own pace.

Everyone is fussing around you today, so I know that they think that you are special, too. Somewhere, inside, I am just like every other kid who loves their Dad, even if I’m not sure what day it is.

Love you, Dad,

Your sons and daughters

I believe that reading this way may represent the experience of many ASD patients.

Thanks to all the Dads of autistic children for your endurance and support.

Happy Father’s Day


Brian D. Udell MD

Not Thinking in Pictures

Friday, February 4th, 2011

The various types of autistic behaviors that I see in my medical practice are sometimes bizarre (self-mutilation), sometimes informative (below-the-tummy-rubbing indicating G-I disturbances), sometimes annoying (dropping on the floor and screaming is particularly so), and always interesting to observe. Occasionally, however, a patient presents with such an unusual combination of behaviors that it defines that individual as a category unto itself.

Temple Grandin wrote about her abilities in Thinking in Pictures. She described how language took a back seat to the images that she processed in her unique brain, and wrote that many ASD patients have similar abilities and brain structures.

Just to keep me on my toes, I met a 4 year-old patient this week who thinks in word patterns. Actually, he doesn’t seem to think in the neuro-typical sense, yet he appears to be connected to some of his surroundings. However, he processes the world in a completely unusual fashion. He makes fair eye contact with strangers and seems to communicate well with his mother. He is very well behaved and answers to his name. He “reads” everything – books, posters, signs, anything with words on it.  If there is a picture of a dolphin and the word “dolphin”, Jonathan points to the word and says it correctly. The picture is totally ignored. And, it doesn’t seem that Jonathan has any idea that the word and picture are related. Or what a dolphin is. This remarkable young man can read just about any word, and he can sound out those that he doesn’t recognize right away.

Echolalia is one thing. Practice with language. Scripting is another step in that direction. Complex repetition without any sign that there is comprehension is another level altogether.

One of my first ASD patients was an aggressive 11 year-old who could recite a half-hour TV show in, like, 15 seconds (his mother pointed out to me what he was doing). But, it took dozens of viewings to get that information. Jonathan can memorize the dialog of a video the first time, according to his Mom. From what I’ve observed so far, that’s pretty accurate.

Patterns are what seems to make the most sense to Jonathan. He can assemble a complex puzzle (>100 pieces, 6+ years) by himself, and he completes it in his own special way. Most of us would do the outside pieces first, then work toward the middle. This interesting child does “clumps” – putting patterns together until they make up the whole. But it’s the smaller patterns that he seems to appreciate, not the “big picture”.

Were it not for his wonderful Mom and family who have provided conventional interventions, I believe that Jonathan would have appeared similar to the “typical” autistic patient who I first saw in 1975 at Jefferson Hospital. That was a five year-old male, jumping up and down in a painted wooden crib, flapping away and totally unaware of his surroundings or the 20-or-so medical students who were observing him in his hospital room. At the time, the reported incidence was said to be “one-in-five-to-ten-thousand” children (which only meant that it was really rare since there were no Internet registries and few support groups). Those were the days when doctors told parents to put such patients into an institution with the other “retarded” children.

This child has several medical conditions, including G-I symptoms and allergies, which require attention. As we begin to get Jonathan on a more healthy path, I can’t help but wonder what will happen to some of his special qualities. There is a profound block somewhere in his processing that is, rightly so, his mother’s chief concern. I am fortunate that the family has sought my advice and allowed me to be part of their journey.

So little time, so much to learn. Stay tuned.

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Brian D. Udell MD
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