Brain - Ronit Molko, Ph.D., BCBA-D | Investment Consultant

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What Pediatric Traumatic Brain Injury Can Teach Us About Autism

Nearly three million Americans suffer a traumatic brain injury (TBI) each year, one quarter of them children. Most of these are mild, resulting in concussion, but 50,000 deaths result from TBI annually.

At the same time, one in 59 children is diagnosed with autism spectrum disorder each year. Three and a half million Americans live with autism spectrum disorder (ASD).

These two conditions share more than a surprisingly large impact on our children: they share many biologic mechanisms and symptoms. Researchers have begun inquiring into how diagnosis and treatment of ASD and TBI might inform each other and lead to breakthroughs in one or both.

Children with traumatic brain injuries exhibit many of the same challenges as children with autism. These include deficits in intelligence, memory, attention, learning and social judgment. Anatomical changes to the brain resulting from TBI can impair emotional decision-making, self-regulatory behavior, emotional perception and the ability to recognize non-verbal cues. These are also classic characteristics of autism.

Children with ASD often present with decreased diversity of microflora in their intestines, which can hinder brain development. For children suffering TBI, reduced metabolism can also lead to a lack of microflora diversity. Whether the nature of this reduced diversity is similar in the two groups will require more study, but administration of probiotics has had success in both.

Brain plasticity – the ability of one region of the brain to rewire itself to execute functions normally performed by a damaged region – offers a ray of hope to TBI patients and autistic individuals. With intense therapy, brain stimulation and intervention, children with these two conditions can learn new skills by “training” their brains to process information in new ways.

Applied behavior analysis (ABA) is considered the gold standard in autism treatment given the extensive research conducted on its efficacy. It is employed to redirect behavior from harmful and counterproductive to useful and beneficial, and to teach critical skills for independence. Begun early in a child’s life, the progressive learning process of ABA therapy has demonstrated success in addressing multiple deficits – e.g., verbal, attentional, and learning – associated with ASD. ABA is now being used to readapt pediatric TBI patients to their home environment. As with ASD, this therapy yields optimum results when begun early and maintained over time.

ABA requires children to verbalize (or express using assistive communication devices) the instructions they have been given in an iterative approach that builds beneficial habits. This progressive learning process is applied to multiple behaviors characteristic of ASD and TBI. Additional strategies such as Pivotal response treatment (PRT), based on the principles of ABA, targets “pivotal” areas of a child’s development instead of working on one specific behavior. By focusing on pivotal areas, PRT produces improvements across other domains of skill development.

Verbal behavior therapy is a comprehensive language program that focuses on understanding the purpose of words and how they are used to communicate specific ideas. Also built on an ABA foundation, verbal behavior positively reinforces correct use of verbal and non-verbal communication that connects the speaker and the listener.

Although ASD and TBI present similar symptoms, there is no evidence that ASD is caused by trauma or injury to the brain. Its causes appear to be multifaceted and complex, including genetics, fetal conditions and various maternal and paternal factors. Like TBI, skill development and expansion can be optimized with behavioral treatment that begins as soon as possible.

February 28, 2020March 3, 2021

Wiring the Growing Brain: How Habits Shape Brain Development in Youth

Portrait Of A Young Woman With Colorful Cogwheel Brain Above Hea

The brain is a complex and wondrous organ whose basic structure is a web of electrical impulses. The early journey of brain development is vital to its functioning for the rest of its owner’s life.

Brain development begins in utero and isn’t complete until roughly age 25. A baby is born with 85 billion neurons, or nerve cells, that transmit these signals to other neurons through synapses. A web of interconnected neurons is called a neural network and is crucial to the brain’s function.

The Role of Neural Pathways

Neuroscience research has determined that the most critical ages for brain development are zero to six, when the brain is building and reinforcing the neural connections that will last a lifetime. Each new encounter a baby has with their environment through the five senses creates new neural pathways, with repeated encounters strengthening those connections. Neural pathways that are not reinforced in this manner are literally culled by the brain in favor of others. Hence the phrase “neurons that fire together, wire together”.

Because babies’ brains are in the acquisition phase, this is the critical time for positive brain stimulation. Research shows that early brain stimulation leaves positive fingerprints on the brain throughout life.

The brain also favors encounters that bring pleasure. When babies’ needs are met and expectations fulfilled, their brains are stimulated to perform optimally. When babies endure persistent negative experiences, their emotional and social development suffer, as does the ability to learn and develop language. For these reasons, early childhood experts encourage new parents to talk, sing, smile at, read to their children as much as possible; to hold, hug and snuggle with them often; and to turn everyday moments into teaching moments.

The Autistic Brain is Different

Recent research suggests the brains of autistic children are different. Their brain cells are hyper-connected, with many more neural pathways than neuro-typical children have, particularly in the area of the brain that affects sight. The more severe the symptoms of autism, the more hyper-connected the brain. These excess connections appear to be the result of a deficiency in the culling process. The brain of a neuro-typical two-year-old begins weeding out roughly half the synaptic connections it has produced. The brain of an autistic two-year-old eliminates only about one-sixth of the synaptic connections, leaving what might be understood as clutter in the brain. These remaining pathways amount to a neural overload – akin to the sensation of attempting to drink water out of a fire hose.

“Our findings suggest that the imbalance of excitation and inhibition in the local brain circuits could engender cognitive and behavioral deficits observed in autism,” said Vinod Menon, Ph.D., a Stanford researcher who co-produced the research.

The Importance of Early Detection and Treatment

This breakthrough research finding may lay the groundwork for early detection of autism and improve diagnosis and treatment. Because the brain is so plastic – able to adapt, re-wire and create new neural pathways – earlier treatment can establish new and stronger neural connections, behaviors and skills. Evidence suggests that diagnosis and treatment starting by age three confers lifelong benefits on autistic children.

The optimal time for intervention is before the second major culling period in adolescence. For children with developmental and learning disabilities, reinforcing the pathways that lead to constructive behaviors and skills must be accomplished before those synaptic connections are erased for lack of use. Stimulating the brain with positive skills and behaviors before the culling period reinforces helpful synaptic connections and allows unhelpful ones to move to the head of the line for pruning.

In this way, it becomes evident that brain performance is neither all nature nor all nurture, but a combination of genetics and experiences working together. Engagement and contemporary, early intervention can support autistic children in learning the skills critical to leading fulfilling lives as independently as possible.

Train Your Child’s Brain

One method of re-training your child’s brain: select one simple task and practice it 10 times daily. Observe whether your child is able to complete the task faster each time. Optimize your child’s brain development by engaging with them verbally and visually during regular daily activities like playing, diaper changing, feeding and bathing.

Examples of simple instructions include “drink from the cup,” “give me that book” or “show me the train ” Opportunities to practice these one-step tasks abound during the day. For autistic children, just as for neuro-typical children, perhaps even more, everyday moments can be teaching moments. Additionally, for children determined to be at risk for a developmental disorder, early intervention is critical to capitalize on the brains’ plasticity.

By Ronit Molko, Ph.D., BCBA-D

May 24, 2019March 3, 2021

Supporting Neurodiversity in the Classroom

One concept frequently lost in the education of autistic children is that the purpose of education is to prepare them, not only for managing childhood but for succeeding in adulthood as well. Autistic adults are seeking the same markers for happiness as neurotypical adults. They are looking for as much independence as possible—a job to support themselves, a strong social network, the pursuit of their passions and fulfilling relationships.

The current services provided by the autism industry are ill-equipped to provide autistic individuals with the skill sets they need to live and thrive independently. While our science provides for the tools to make this happen, there are too few providers focusing on what needs to be learned in adolescence to prepare young autistic adults for employment and independent living. Too few providers are truly engaged in measuring the long-term outcomes and quality of life indicators of the services they are providing to the child and their family. They fail to view their young clients as the adults they will become. Autistic adults and their families have a myriad of frustrating and distressing tales about the mismatch between their early education and the tools they need to function as adults.

Most younger autistic adults today were educated under the law now known as IDEA, the Individuals with Disabilities Education Act, which mandates that physically and mentally disabled children be educated in the “least restrictive environment.” This led to the mainstreaming of many autistic students. The goal of this law is to provide disabled students with the same opportunities to participate and succeed in life as neurotypical students.

Teaching autistic children in a class of neurotypical students requires a new kind of thinking on the part of teachers and administrators. However, not all teachers and school districts are prepared or equipped to manage the variety of student needs, which can be overwhelming. This is one area in autism services that could use significant improvement.

When we think about educating students with autism and their unique needs, it’s crucial that we remember these students should not be viewed as “broken,” needing to be “fixed” or normalized. This is an old viewpoint that drove much of the research and intervention in the early years of treating this disorder. Instead, our educational system needs to equip them with the skills and tools they will need to navigate the next 60-70 years after they leave high school. Most of the autistic adults with whom I have spoken want to be viewed as themselves, as diverse individuals who perceive the world differently, adding to the diversity of our population with a unique matrix of strengths and stretches.

The “neurodiversity” approach to classroom education recognizes and respects the mosaic of neurological differences as part of human variation, like eye color and personality. It focuses on aiding autistic individuals to interact successfully with their environments, and learn how to communicate with and navigate a world designed around the neurotypical majority.

Dr. Thomas Armstrong, executive director of the American Institute for Learning and Human Development, and author of books about neurodiversity, advocates for embracing the strengths of a neurodiverse student ecosystem by incorporating new approaches into school curricula. Some of his ideas include:

Computer programs and applications that allow students with special needs to overcome obstacles.
Networks of experts with whom educators can consult to support the social and emotional lives of neurodiverse students.
Innovative learning strategies that are tailored to each student’s unique strengths.
Guidance towards future career paths for which a student’s particular passions and preferences might be a good fit.
Modifications in the school environment that allow for seamless inclusion of neurodiverse students in the regular classroom.

Dominican University of California offers a course called “The Gifts of Autism” to educate teachers on how to take an asset-based approach towards educating students with autism. The class encourages teachers to consider how the strengths and weaknesses of autistic students in their classrooms are supported. Assignments require the study of methodologies and strategies to improve that support and explain how they will be deployed.

Classroom neurodiversity advocates point out that there is nothing particularly novel about the idea of employing multiple teaching methods within a single class. Even in classrooms comprising only neurotypical students, educators must accommodate a variety of learning styles like auditory, visual, tactile, and so on.

“Just as we celebrate diversity in nature and cultures, so too do we need to honor the diversity of brains among our students who learn, think, and behave differently,” says Dr. Armstrong.

April 4, 2019March 3, 2021

Measure What Matters: Redefining Neurotypical Intelligence Standards for Autistic Individuals

Man Hands Holding A White Paper Sheet With Two Faced Head Over A

I’ve written previously about how we misunderstand the intelligence of people on the autism spectrum. We evaluate their intelligence with tests and observations that measure a narrow slice of the intelligence continuum and then judge them by their ability to socialize with us.

Neurotypical vs. Autistic Culture
Neurotypical people—a term for individuals without autism coined by people with autism—living in a neurotypical world, consider our present culture and socialization methods to be “correct,” and never pause to think how woefully we socialize with autistic people based on those standards. For example, we may become flustered while conversing with an autistic person when they fail to make eye contact with us. They might just as easily perceive us as poorly socialized when we insist on staring at them during a conversation.

Neither group is wrong; we’re just different. In order to better help autistic people navigate the neurotypical world, perhaps we ought to re-shape parts of that world to conform to their differences. This is precisely what we’re doing when we build ramps for people in wheelchairs or post signs in other languages for foreign visitors.

I’ve spoken about this at length with Dr. Sue Fletcher-Watson, a Chancellor’s Fellow at the University of Edinburgh’s Centre for Clinical Brain Sciences. She has done significant research on intelligence and socialization of individuals on the autism spectrum. Her conclusions reverberate with me and my experiences in the field.

Some Simple Adjustments
An autistic friend visited Dr. Fletcher-Watson for dinner and asked in advance what time she should leave. She knew that she would not be able to read the subtle cues neurotypical people understand as indicating it is time to go. Armed in advance with a time to leave, her departure avoided the awkwardness that might otherwise have ensued.

Dr. Fletcher-Watson has proposed involving autistic people in designing environments for others like them. She is also developing peer support models that match newly-diagnosed autistic adults with those who have learned how to accommodate their autism to the neurotypical world and pairing parents of autistic children with autistic adults.

Dr. Fletcher-Watson described for me how that might work: “Just imagine having an autistic guy come ’round and look in your house and say, ‘The hum from your fridge is very loud for me, so maybe you can find a way to make that quieter.’ Or, ‘These lights are very harsh.’ Or, you know, ‘This fabric feels uncomfortable.’ Articulating all of those things that maybe a child would not be able to articulate.”

Let’s Measure What Matters
Greater dedication to the real-world needs of autistic people might lead us to a different set of metrics. Maybe reading and writing aren’t nearly as important for some autistic people’s ability to function in the world as other skills and areas of learning. For example, a young man I know runs a food delivery business. He takes orders from various companies, reliably gets the orders right and makes correct change, and generally possesses the skills necessary to complete the job.

As a boy, he was removed from public school because of his behavioral issues. When his parents brought him home, they eliminated many of the sensory inputs in his home environment and were able to foster his learning and independence through different therapeutic approaches. Now, with a little support and mentoring, he has a job, a girlfriend, a roommate, and a self-determined life. Maybe he can’t check all the right the boxes on an assessment test of skills that measure standard conceptions of intelligence, but he is functioning well in the neurotypical world.

A more strategic approach to analyzing how we measure success for individuals with autism is indicated, to replace the rudimentary box-checking now in place. It must take into account real-world skills that accrue to the long-term benefit of those affected. Accomplishing this would be one small but significant step forward in their care and education.

You can find further reading on this and other subjects in autism services in my book, Autism Matters.

June 26, 2018March 3, 2021

The Benefits of Neurodiversity in the Workplace

Multiracial friends having fun and laughing drinking coffee in coffeehouse

Large corporations such as SAP, Hewlett Packard, Microsoft, Ford, IBM, and others have recognized the competitive advantage of neurodiversity and begun to utilize the special gifts and talents of individuals with autism and other neurological differences to improve the workplace. Small businesses as well can and should utilize these benefits.

The Rising Tide carwash in Parkland, Florida is not your typical carwash. Customers laud their attention to detail and exemplary service. Rising Tide’s primary mission is to employ adults with autism.

“We view autism as one of our competitive advantages,” says the company’s COO Tom D’Eri. “[Our staff] have a great eye for detail.”

In 2013, Tom’s father, John D’Eri, founded Rising Tide. His hope was that the car wash would provide his then 24-year-old son, Andrew, with purpose, fulfillment, and the ability to live an independent life.

Like many parents of individuals with autism, John was afraid of what would happen to Andrew once he was gone.

“I don’t want him to sit in a room, taken care of by others once I’m gone,” John says in this video report on the Rising Tide carwash. “I want him to have a job, I want him to have friends.”

The carwash has fostered purpose and independence for Andrew as well as many others. The company’s staff is almost entirely made up of autistic individuals; something which Tom believes gives them a competitive advantage:

“There are really important skills that people with autism have, that make them, in some cases, the best employees you could have.”

What John and Tom understand is something many small businesses could benefit from: the value of neurodiversity in the workplace. This is something that many large corporations are already using to their advantage.

In 2015, Microsoft announced it would begin hiring more autistic people. Corporate vice-president Mary Ellen Smith stated that “People with autism bring strengths that we need at Microsoft.”

A company like Specialisterne, for example, is a big reason why hiring neurodiverse individuals has become more and more common for large companies like Microsoft. The worldwide social innovation enterprise is dedicated to helping neurodiverse people enter the workforce at high levels. According to the company’s website, Specialisterne has set the “gold standard” for neurodiversity employment, working with companies like SAP, IBM, and PricewaterhouseCoopers to find placement for people on the autism spectrum and other neurodiverse individuals. Specialisterne’s Irish branch, hosted by SAP, is helping the software giant increase its number of neurodiverse employees from seven individuals to one-percent of its global workforce (roughly 650 people).

Individuals with autism see the world differently than neurotypicals do. They have unique talents, perspectives, and skills that can be tremendously beneficial to businesses and society. The problem is that autistic individuals face stigma rooted in misunderstanding and ignorance. Additionally, individuals with autism often have eccentricities, lack social skills, have sensory intolerance issues, and can be blatantly honest. Because of these traits, individuals with autism often have trouble getting past the interview stage for a job or maintaining a position once they are hired.

All businesses looking for dedicated employees should strongly consider what neurodiversity can bring to their organization. John and Tom at Rising Tide carwash are just one example. They’ve now opened a second location, and have started Rising Tide U, a training organization that provides a blueprint for families who want to start a business to help their loved one with autism gain purpose and build a future for themselves.

While it is tremendous to see large corporations recognizing the value of neurodiversity, Rising Tide shows the potential for small business to do the same with their workplace. Not only does an autistic staff with an extraordinary attention to detail provide a competitive edge for the company, it is also a powerful way to change people’s perception of individuals with autism while also providing employment opportunities to a sector of our population who deserve the opportunity to contribute to society.