Category: counseling

The Frustration of Autism

What are Autism Spectrum Disorders?

Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders (PDDs), cause severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. These disorders are usually first diagnosed in early childhood and range from a severe form, called autistic disorder, through pervasive development disorder not otherwise specified, to a much milder form, Asperger syndrome. They also include two rare disorders, Rett syndrome and childhood disintegrative disorder.

Signs & Symptoms

Parents are usually the first to notice unusual behaviors in their child. In some cases, the baby seemed “different” from birth, unresponsive to people or focusing intently on one item for long periods of time. The first signs of an autism spectrum disorder can also appear in children who had been developing normally. When an affectionate, babbling toddler suddenly becomes silent, withdrawn, self-abusive, or indifferent to social overtures, something is wrong.

Possible Indicators of Autism Spectrum Disorders

  • Does not babble, point, or make meaningful gestures by 1 year of age
  • Does not speak one word by 16 months
  • Does not combine two words by 2 years
  • Does not respond to name
  • Loses language or social skills

Some Other Indicators

  • Poor eye contact
  • Doesn’t seem to know how to play with toys
  • Excessively lines up toys or other objects
  • Is attached to one particular toy or object
  • Doesn’t smile
  • At times seems to be hearing impaired

Social Symptoms

From the start, typically developing infants are social beings. Early in life, they gaze at people, turn toward voices, grasp a finger, and even smile.

In contrast, most children with ASD seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction. Even in the first few months of life, many do not interact and they avoid eye contact. They seem indifferent to other people, and often seem to prefer being alone. They may resist attention or passively accept hugs and cuddling. Later, they seldom seek comfort or respond to parents’ displays of anger or affection in a typical way. Research has suggested that although children with ASD are attached to their parents, their expression of this attachment is unusual and difficult to “read.” To parents, it may seem as if their child is not attached at all. Parents who looked forward to the joys of cuddling, teaching, and playing with their child may feel crushed by this lack of the expected and typical attachment behavior.

Children with ASD also are slower in learning to interpret what others are thinking and feeling. Subtle social cues—whether a smile, a wink, or a grimace—may have little meaning. To a child who misses these cues, “Come here” always means the same thing, whether the speaker is smiling and extending her arms for a hug or frowning and planting her fists on her hips. Without the ability to interpret gestures and facial expressions, the social world may seem bewildering. To compound the problem, people with ASD have difficulty seeing things from another person’s perspective. Most 5-year-olds understand that other people have different information, feelings, and goals than they have. A person with ASD may lack such understanding. This inability leaves them unable to predict or understand other people’s actions.

Although not universal, it is common for people with ASD also to have difficulty regulating their emotions. This can take the form of “immature” behavior such as crying in class or verbal outbursts that seem inappropriate to those around them. The individual with ASD might also be disruptive and physically aggressive at times, making social relationships still more difficult. They have a tendency to “lose control,” particularly when they’re in a strange or overwhelming environment, or when angry and frustrated. They may at times break things, attack others, or hurt themselves. In their frustration, some bang their heads, pull their hair, or bite their arms.

Treatment

There is no single best treatment package for all children with ASD. Decisions about the best treatment, or combination of treatments, should be made by the parents with the assistance of a trusted expert diagnostic team.

Transcript of and interview with Dr. Bearman on Autism

Dr. Peter Bearman is the professor of Sociology at the College of Arts and Sciences at Columbia University. He also serves as co- director of the Robert Wood Johnson Foundation Health and Society Scholars program at Columbia. Recently, Dr. Bearman came to the National Institute of Mental Health to talk about the focus of his work, autism prevalence. NIMH’s Director, Dr. Thomas Insel, sat down with Dr. Bearman to discuss autism research and began by referencing recent studies that indicate an increase in autism prevalence.

Dr. Insel:  So, as you look at this that question that everyone is asking is when they see the numbers now from the CDC where it’s gone from 1 in 1500 to 1 in 150 and apparently here in the fall of 2009 the figure that’s emerging is closer to 1 in 100. Meaning, that even since 2002 there has been a very profound increase in the number of children being diagnosed with autism.

Dr. Bearman: And Autism Spectrum Disorders.

Dr. Insel:  Autism Spectrum Disorders?

Dr. Bearman: Well that’s, an important distinction. I mean obviously there’s a profound increase in Autism and Autism Spectrum Disorders.

Dr. Insel: Is there an increase in the number of children with the disorder or with the Autism Spectrum Disorder or does this largely reflect the change in the way the diagnosis is used or some sort of increase in ascertainment?

Dr. Bearman: Well, I think that’s the big million dollar question. Our work which arises from California can, show that changes in diagnostic processing and diagnostic criteria I would say the period from 1992 to 2005 the changes in diagnostic criteria over that period that operate on the border between autism and mental retardation can be associated with about a quarter of the increase prevalence. Over that same period there has been a really fundamental change in the ascertainment, you can see that in lots of ways, but the most obvious way to see the changes in ascertainment, is to see that the social economic status gradient that used to be present for autism, the fact that children living and residing in wealthy communities are more likely to get a diagnosis, and that gradient largely disappears.

Dr. Insel: What seems important Peter in the way you’ve done this rather than you answering the question to say it’s increase, not increased your answering the question by what proportion of increase can be explained by separate factors because everybody’s pointing to changes in diagnosis, changes in ascertainment the way in which services may affect the use of the diagnosis. So what everybody really wants to know at the end of all this, is that actually are more children affected with the disorder or will 100 percent of this increase in prevalence be explained by these other factors?

Dr. Bearman: Our strategy is to try to decompose this increase into its constituent elements. Some component of that is increased ascertainment, some component of that is diagnostic change in diagnostic criteria, some component of that arises from already known risk factors, such as increases in parental age are associated with greater probability of genome mutations that could lead to copy errors that are associated with neurodevelopmental disorders. So social demographic changes that are affecting all western countries, the United States, and also California, can express themselves in increased incidence of autism on top of diagnostic ascertainment dynamics. I think the trick to figuring out how to decompose this increase into its constituent elements is to pay attention to the two dimensions that are important. The first dimension is temporal just the fact of temporal change, we are in the period of increased prevalence and if we’re in a period of increased prevalence and at the same time for example there’s also an increase in older parents. The risk associated with older parents will naturally appear to be greater now than it was a decade ago. So paying attention to temporal heterogenic is important. The other part of our work I think that’s  the most exciting is to pay attention to the spacial heterogenic and the fact that we can observe very strong,  very distinct, very stable clusters of increased risks for autism at very fine spacial resolution. For example, in California, there’s a very clear cluster in about 20 kilometers by 50 kilometers in which the relative risk for autism not, Autism Spectrum Disorders but autism itself is significantly higher over every year of observation that we make than any other place in California. That invites a couple of considerations, first, it invites the recognition that if you observe local spacial clustering whatever causes some components of the increased prevalence in autism it is not a global treatment. Secondly, it invites us to ask, well is there something in that local area that is driving an increased prevalence that could be a shared toxicological environment, it could be a virus that moves through and spreads from person to person and affects children in utero. Or it could be a piece of an ascertainment process which would be the diffusion of information from parent to parent as they learn how to recognize some symptoms for autism which have no biological markers.

Dr. Insel: From what you know now when you add all of those together how much of the increase can you explain?

Dr. Bearman: Well that’s a complicated question, but I think we can pretty uniquely associate about a quarter of the increase from the birth cohorts from 1992 to 2001 which is a lot, to diagnostic change on the border between diagnosis and mental retardation in autism. I think we can associate about 16 percent of the increase on the other border between autism and other neurodevelopmental disorders on the spectrum: Asperger’s, PPDNOS etc. And those are largely non over-lapping components of increase, so that’s about 40 percent. I think the spacial clustering itself adds another few percent. I would say I am confident that 40 percent of the increase I think I know what caused that. That leaves a lot of increase left, 50 percent is a lot to look for still.

Dr. Insel: Any ideas about what’s driving that other 50 percent?

Dr. Bearman: Well, some is genetic. I think that the increased parental age accounts were 11 percent of the increase over this period and that’s a lot and the mechanism by which increased parental ages expressing itself I think likely largely genetic. I think the tricky part is going to recognize that it would be harder now to find that 50 percent. It would look like it should be some toxicological environment that’s shared because of the spacial clustering. Because there’s a very strong process of amplification of the understanding of autism that leads to increased diagnosis as parents learn how to recognize symptoms a very, very, small event that would transform the environment five years ago, ten years ago, even you could imagine, 40 years or 50 years ago, when the moms of children with autism now were in utero as eggs- a very small event could cascade into a larger epidemic now.

Dr. Insel: So what do you tell parents who ask about this if you have friends who have autistic children and they say “What’s going on here? Why this epidemic?” What do you say in response?

Dr. Bearman: Well, I think parents are struggling to just enormously difficult to have a child with autism. It makes it very hard. I think parents are naturally searching for explanations, and I think that the message now is the search for a quick and dirty explanation might not be advancing science.

Dr. Insel: Thank you very much.  Good discussion.

Links on Autism

http://www.nimh.nih.gov/health/publications/autism/index.shtml

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Intensely Loved, but Definitely Broken, [Reality]

bryondeck-2For everyone who loves Jesus, but yet has had an experience of terrible loss, sickness or the death of a loved one…this post is meant for you.

I am evangelical, a former pastor, and a Bible college instructor. I also have bipolar depression, and a bit of paranoia and delusional thinking. I have been hospitalized in mental hospitals seven times in 10 years.  But, I love Jesus more than anything. And I’ve been told by many who repeatedly insist that He loves me as well.

I have experienced the darkest and most crippling depressions.  There are some weeks (months?) I could not get out of bed, shower or even eat.  For this Bipolar, I must take Lithium, Zoloft, and Lamictal.  These meds hold me in place. I’m being treated for a seizure disorder, and have had surgery to remove a tumor in my brain. I now walk with a cane.

“He comforts us in all our troubles so that we can comfort others. When they are troubled, we will be able to give them the same comfort God has given us.”

1 Corinthians 1:3

This blog is geared for the mentally ill believer, the terminally ill, habitual sinners and all who are confused and dismayed by their own brokenness. But you don’t need a diagnosis to read this blog.

It seems like failures—

  • the mentally feeble,
  • lame,
  • chronically ill
  • blind, and deaf
  • sinners, great and small
  • and mentally ill have not always been welcome in the Church. I think that is about to change.

I’m honestly convinced that it has been the churches’ loss. How is the Church ever going to learn to love the unlovely without us to ‘train’ them? We the disabled are sprinkled into each fellowship to tutor them through our illnesses.

The church need not look to new ‘fund raising ideas’ or to pave the parking lot, it just needs to reach out to the broken– one at a time.  I think God will bless every church who will do this. This is the work and passion of Jesus. This is what Jesus’ church looks like. “For the Son of Man came to seek and to save the lost.” (Luke 19:10.)

The Church needs us, whether it realizes it or not.  It is as broken people that we model our fallenness as the paradigm to intimacy with Jesus.  We often are the first to know that it has never been about our giftedness, but our intimacy. 

We are a witness, a tangled but tangible reminder, of how God’s grace gives His power to the weak and despised (2 Cor. 2).

“For I have come to call not those who think they are righteous, but those who know they are sinners.” 

Matthew 9:13

“Then Jesus said, “Come to me, all of you who are weary and carry heavy burdens, and I will give you rest. 29 Take my yoke upon you. Let me teach you, because I am humble and gentle at heart, and you will find rest for your souls. 30 For my yoke is easy to bear, and the burden I give you is light.”

Mathew 11:28-30

I simply can not say anything more. Just please love us.

“The power of the Church is not a parade of flawless people, but of a flawless Christ who embraces our flaws. The Church is not made up of whole people, rather of the broken people who find wholeness in a Christ who was broken for us.”

–Mike Yaconelli

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All scripture quotations are from the New Living Translation.

Schizophrenia Understood

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Understanding the World of the Schizophrenic

Schizophrenia is a chronic, severe, and disabling brain disorder that has affected people throughout history. About 1 percent of Americans have this illness. People with the disorder may hear voices other people don’t hear. They may believe other people are reading their minds, controlling their thoughts, or plotting to harm them. This can terrify people with the illness and make them withdrawn or extremely agitated.

People with schizophrenia may not make sense when they talk. They may sit for hours without moving or talking. Sometimes people with schizophrenia seem perfectly fine until they talk about what they are really thinking. Families and society are affected by schizophrenia too. Many people with schizophrenia have difficulty holding a job or caring for themselves, so they rely on others for help.

Treatment helps relieve many symptoms of schizophrenia, but most people who have the disorder cope with symptoms throughout their lives. However, many people with schizophrenia can lead rewarding and meaningful lives in their communities. Researchers are developing more effective medications and using new research tools to understand the causes of schizophrenia. In the years to come, this work may help prevent and better treat the illness.

The symptoms of schizophrenia fall into three broad categories:

  1. positive symptoms,
  2. negative symptoms, and
  3. cognitive symptoms.

Positive symptoms

Positive symptoms are psychotic behaviors not seen in healthy people. People with positive symptoms often “lose touch” with reality. These symptoms can come and go. Sometimes they are severe and at other times hardly noticeable, depending on whether the individual is receiving treatment. They include the following:

Hallucinations are things a person sees, hears, smells, or feels that no one else can see, hear, smell, or feel. “Voices” are the most common type of hallucination in schizophrenia. Many people with the disorder hear voices. The voices may talk to the person about his or her behavior, order the person to do things, or warn the person of danger. Sometimes the voices talk to each other. People with schizophrenia may hear voices for a long time before family and friends notice the problem.

Other types of hallucinations include seeing people or objects that are not there, smelling odors that no one else detects, and feeling things like invisible fingers touching their bodies when no one is near.

Delusions are false beliefs that are not part of the person’s culture and do not change. The person believes delusions even after other people prove that the beliefs are not true or logical.

People with schizophrenia can have delusions that seem bizarre, such as believing that neighbors can control their behavior with magnetic waves. They may also believe that people on television are directing special messages to them, or that radio stations are broadcasting their thoughts aloud to others. Sometimes they believe they are someone else, such as a famous historical figure. They may have paranoid delusions and believe that others are trying to harm them, such as by cheating, harassing, poisoning, spying on, or plotting against them or the people they care about. These beliefs are called “delusions of persecution.”

Thought disorders are unusual or dysfunctional ways of thinking. One form of thought disorder is called “disorganized thinking.” This is when a person has trouble organizing his or her thoughts or connecting them logically. They may talk in a garbled way that is hard to understand. Another form is called “thought blocking.” This is when a person stops speaking abruptly in the middle of a thought. When asked why he or she stopped talking, the person may say that it felt as if the thought had been taken out of his or her head. Finally, a person with a thought disorder might make up meaningless words, or “neologisms.”

Movement disorders may appear as agitated body movements. A person with a movement disorder may repeat certain motions over and over. In the other extreme, a person may become catatonic. Catatonia is a state in which a person does not move and does not respond to others. Catatonia is rare today, but it was more common when treatment for schizophrenia was not available. “Voices” are the most common type of hallucination in schizophrenia.

Negative symptoms

Negative symptoms are associated with disruptions to normal emotions and behaviors. These symptoms are harder to recognize as part of the disorder and can be mistaken for depression or other conditions. These symptoms include the following:

  • “Flat affect” (a person’s face does not move or he or she talks in a dull or monotonous voice)
  • Lack of pleasure in everyday life
  • Lack of ability to begin and sustain planned activities
  • Speaking little, even when forced to interact.

People with negative symptoms need help with everyday tasks. They often neglect basic personal hygiene. This may make them seem lazy or unwilling to help themselves, but the problems are symptoms caused by the schizophrenia.

Cognitive symptoms

Cognitive symptoms are subtle. Like negative symptoms, cognitive symptoms may be difficult to recognize as part of the disorder. Often, they are detected only when other tests are performed. Cognitive symptoms include the following:

  • Poor “executive functioning” (the ability to understand information and use it to make decisions)
  • Trouble focusing or paying attention
  • Problems with “working memory” (the ability to use information immediately after learning it).

Cognitive symptoms often make it hard to lead a normal life and earn a living. They can cause great emotional distress.

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Much of this article came from an outside source. I’m just the errand boy on this post.

A Failure to Understand [An Excerpt]

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Excerpt from “A Firm Place to Stand”

BY MARJA BERGEN

I’m disappointed when friends and family who know me well say things that reveal a gross misunderstanding of depression and how it affects those of us who suffer from it. One person close to me thought depression was something we bring on when we feel sorry for ourselves. Perhaps she thought we liked the attention.

Sufferers of depression would do anything to feel happy and vibrant again. When I’m depressed, many friends keep me at arm’s length. I don’t blame them. It’s not pleasant to be around me when I can’t find anything to talk about except my pain. Depression does that to you: It turns your thinking inward; all you can wrap your mind around is the misery you feel. You end up feeling very alone.

Another person complained to me about an acquaintance with depression who couldn’t manage to do anything more than lie on the sofa. “Couldn’t he just try and make himself do something?” she asked. Nothing I said could convince her that this was an illness that, like other illnesses, couldn’t be helped by simple willpower. Those who have never experienced depression find it difficult to understand how profoundly a brain disorder can affect the entire body.

A long time ago, when I was bordering on psychosis, my doctor put me in a seniors’ care facility for a few days to give me relief from the stress I faced at home. I called a close family member to let her know where I was. She advised me, “You’ve got to pull yourself together and be strong. You have to try harder.” That was insensitive. I was at the facility because I was doing my best to recover – I wasn’t living with eighty and ninety-year-olds for fun. She should have known I always try my best. When I’m trapped in this state, extricating myself is extremely hard. I need time and medication to recover. If I sound angry and hurt, yes, I was.

A person I worked with recommended strongly that I get counseling. “You don’t need those pills you’re taking. All you need is to talk to someone at my church.” She knew nothing about mental disorders like mine. She had no idea what I was dealing with. Again, I seethed, remembering how psychotic I was when I was first admitted to hospital. I could become sick like that again if I didn’t take the medication my mental stability depended on. Would this person tell a diabetic to stop taking insulin?

Christian psychiatrist and author, Dwight L. Carlson, writes, “There are legions of God-fearing Christians who – to the best of their ability – are walking according to the Scriptures and yet are suffering from emotional symptoms. Many of them have been judged for their condition and given half-truths and clichés by well-meaning but ill-informed fellow believers. ‘Pray for God’s forgiveness,’ some are told. ‘A person who is right with the Lord can’t have a nervous breakdown.’”

Fortunately, I have not been treated in this way. The church congregations I’ve belonged to were understanding, yet the stigma continues. It hurts me deeply that Christians who should be compassionate are often judgmental. Church communities need to learn the medical basis for mental disorders and how that differs from the spiritual. They are in the best position to help those in crisis. But when they don’t understand, they are in danger of doing a lot of damage. For Christians, there is nothing worse than to be told our emotional problems are our own fault, the result of unconfessed sin. We suffer so much already. Having to shoulder blame multiplies our mental anguish.

 

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1 Dwight L. Carlson, Why do Christians Shoot Their Wounded? Helping (Not Hurting) Those With Emotional Difficulties,(InterVarsity Press, 1994)

Marja Bergen has lived with bipolar disorder for over forty years. Her mission is to dispel the lingering stigma attached to mental health conditions and to encourage people to lovingly welcome the sufferers into congregations by understanding them better and supporting them in practical ways.

She is the author of Riding the Roller Coaster (Northstone, 1999) and A Firm Place to Stand: Finding Meaning in a Life with Bipolar Disorder (Word Alive). Marja is the founder of the growing faith-based support group ministry, Living Room.  Visit her website and her blog.

 

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