Siblings of Autistic Children

Managing life with autistic children often tests the abilities of even the heartiest of people.  Daily schedules taken for granted by the rest of us requires persistence, patience, and planning by them.  Let’s touch briefly on issues facing siblings of autistic children.

Firstly, there are medical and mental health considerations.  While specific molecular causes of “non-syndromic” autism( i.e, not associated with some described medical/genetic condition) is uncommon, siblings have approximately 20x greater likelihood of having autism themselves (for identical twins almost 50/50).  Curiously, an older autistic sister appears a greater association than brothers.  Also note that autism is associated with “co-morbidities” like ADHD, anxiety, learning disorders and intellectual impairment, all having a tendency towards familial association.  So siblings themselves should be carefully monitored.  Considering the above, by far still the most common occurrence between 2 siblings is for one to be affected and the other unaffected.  So please keep that in mind.

The other aspect to touch upon are coping skills for the sibling.  The autistic child is  going to require more attention and effort by the parent; there is no way around that.  Its so important to not allow others to be “lost in the mix.”  This is a complex situation depending on many parameters like the degree of disability in the involved child, sibling number and birth order, temperament of all living in the home, marital status and nuclear and extended family dynamics, community and school types, and parental physical and mental health(studies suggest greater influence from the mother’s status here).

There are a variety of difficulties for children living with an autistic sibling: anger, resentment, fear, embarrassment, loss, isolation.  Normal childhood play and sibling rivalry can become troubled.  Siblings can struggle with interpersonal relationships, school functioning, and use of leisure time, as well as perceived or real expectations to assume more adult caretaker roles not typically assigned to youth of their age.

Happily, as is often the case, there can be an “up side.” Many of these kids can develop greater empathy, earlier and deeper maturity, and stronger coping skills from their home experience. Children who have a greater understanding of their sibling’s disability and receive positive reinforcement from parents and peers in their interactions with their siblings can do very well.  This can be aided by honest, open, age appropriate communication, endeavoring to develop and maintain “normal” family life activities (restaurants, sports, vacations), providing individual and undivided parental attention(“quality time”) and “safe space” for the sibling(including toys and possessions), as well as helping that child through periods of loneliness or isolation and developing strategies to address questions and comments from peers. Counseling can be beneficial with the last 2.  As always, these can all become more fraught during adolescence .

Being proactive about siblings’ physical and mental health is a foundation for all of the above, so please give me a call.  I’m here to help.

Some of the information presented here was detailed in Pediatric News by Dr. Jeremiah Dickerson of University of Vermont and from Indiana University’s Resource Center for Autism.  I am grateful to those sources.

 

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Arsenic in baby food

There have been numerous reports regarding arsenic levels in a variety of foods, with particular concern for rice and rice based infant cereals.  The rice plant tends to take up soil arsenic at a higher rate compared to other grain plants.  As a result, there are arsenic levels reported at 0.1mcg/serving in cereals to 7.2mcg/serving in brown rice.  Now, arsenic is a naturally occurring metal which exists in a variety of sources, mostly in the non-toxic organic form (for example, seafood).  Inorganic arsenic–the toxic type–can be found in minute amounts in drinking water (the Institute of Medicine sets safe level as 10 parts per billion) Inorganic arsenic was banned from use in home products by the EPA in 1991 but remains in use in agricultural and industrial agents.  As a result, there are routes for toxic arsenic to find its way into the water we drink and the soil growing our food and under our feet. There can be numerous serious health effects in children from chronic arsenic poisoning–from intellectual disability, damage to lung and kidney, and skin cancer.

The good news is that, while there are no specific arsenic levels established as “safe” in food, most toxicologists still feel that the levels found in foods, including rice based, are not generally of great concern for most people.  So no cause for alarm.  However, there are steps that parents can take to further limit exposure risk.  For one, be sure to offer your child a varied diet.  I follow current AAP guidelines and recommend infants start vegetables first(yellow, then green) followed by meat, THEN cereal and fruit.  Use more non-rice cereals like barley, buckwheat, oatmeal, or quinoa.  When preparing rice dishes, boil in 1:10 ratio to water and drain all excess out before eating.

Finally, advocacy:its no secret that the current political trends are focusing more attention on the outlook of industry with respect to the use of chemicals as aids to our economy as opposed to the effects on our environment.  Certainly, we should seek balance between those two legitimate needs.  However, we should all try to remember that these rules as they apply to the regulation and de-regulation of chemicals like arsenic can cause real and permanent harm to real children.  Let’s keep that in mind going forward.

Send along questions and comments, and thanks for following.

Concussion Update

Concussion is an ongoing concern to healthcare professionals and people in all areas of sports and at levels from the pro’s to pee-wee leagues.  A large and fraught subject that evolves constantly is impossible to address fully here, so I wish only to review a few updated developments.  One reason the subject is so challenging is that a fully accepted definition still eludes us: a blow to the head followed by loss of consciousness; or is it followed merely by “change in mental status?” And “followed by” in what time frame?

Nowadays we are beginning to recognize various concussion “subtypes:”

  1. Vestibular (dizziness)
  2. Oculomotor (vision and balance)
  3. Post traumatic migraine
  4. Cervical (neck) symptoms
  5. Anxiety/mood
  6. Cognitive (concentration/confusion/fatigue)

Obviously, there is a veritable smorgasbord of overlap and combinations of the above.

A recent symposium of concussion experts noted that there are about 4 million concussions annually.  Ages 14-18 tend to have the longest course and recovery time for girls > boys.  Those with eye muscle problems (lazy eye, misalignment), motion sickness, or migraines are at greater risk for concussion.  The TEAM (Targeted Evaluation Active Management) group developed a 16 point statement of agreement generally stating that concussions are characterized by adverse symptoms, impairments, and evolving clinical profiles; recovery rates vary by injury severity, modifying factors, and treatments; and additional research is essential.

Notably they concluded that the “absolute rest” approach is no longer accepted as beneficial.  Medical literature and experience indicate that it is typically unhelpful and even sometimes detrimental to recovery.  Taking that approach conveys a sense of “punishment” to many children who then tend to sneak around or disregard recommendations out of a sense of defiance to that conclusion which can delay improvement; can increase anxiety and worry which often will itself exacerbate symptoms and hurt recovery; can of itself prolong or worsen vision or balance symptoms due to lack of use; and lead to de-conditioning which can cause re-injury when the athlete returns to competition (particularly if he/she is cleared to make it back just in time for “the big game”).

Therefore the “graded approach” now appears better.  I try and have the injured child begin homework and reading for at least short periods promptly and return to school by day 3-4 for at least part time attendance.  Light training first with cautious and step wise increase back to full sports participation, particularly for contact sports.  “If it hurts or causes symptoms, stop” is my motto.  Part time jobs later, and “blue light” entertainment(computer, cellphone, video games LAST (as always).

Of course we are just scratching the surface here.  If you have questions or concerns regarding head injury and your child please give me a call, and thanks for following.