FEAT DAILY NEWSLETTER Sacramento, California

"Healing Autism: No Finer a Cause on the Planet" ________________________________________________________________

CARE

Letters to the Editors

* Not Treating Mental Illness Has High Costs

* Autism verses Mental Illness

* Mental Health Parity Bill (AB 88) in California, A Model?

* Services, Compassion For Autism Rare In Colorado

* 'It Restores Your Faith In People'

TREATMENT

* Student's Inspiration Aids Therapy 'Steamroller' Calms Kids

RESEARCH

* Facial Identity And Facial Emotions: Speed, Accuracy, And Processing

Strategies in children and adults.

* DOPA Decarboxylase 'Candidate Gene' for Autism

* Craniosynostosis, Telecanthus, Scalp Hair Abnormalities,

And Sensorineural deafness in two sibs.

* Nociceptive Changes In Rats After Prenatal Exposure To Valproic Acid

Not Treating Mental Illness Has High Costs

Letter to the Editor, St. Petersburg Times

Re: Mental health bill is a dilemma by Sara Fritz, April 29.

As a business owner and a psychologist, I understand that the issue of mental health parity is complicated. The costs of providing mental health care would increase the cost of insurance at a time when premiums are already rising 15 percent per year on average. However, the National Alliance for the Mentally Ill estimates that the annual cost of untreated mental illness exceeds $300-billion.

The column by Sara Fritz emphasizes increased insurance costs and how some employers may be tempted to eliminate health insurance for employees altogether. This risk is real, as our company had to require an employee contribution toward health insurance premiums for the first time when we renewed our policy this year. However, her column fails to mention that the cost of limiting access to care results in larger general medical expenses and decreased worker productivity. More than 50 percent of patient beds occupied in hospitals are the direct result of emotional problems or behavioral excesses, such as substance abuse. Meanwhile, American businesses lost $29-billion per year due to absenteeism resulting from depression.

As a psychologist, I witness the shock of patients who seek care in the midst of a family crisis only to discover the limitations of their health insurance. autism, Tourette's syndrome and learning disabilities are but a few of the diagnoses that may not be covered by a company health plan. If a condition is covered, most managed care companies limit the number of sessions allowed per year. Patients who suffer from chronic conditions (such as bipolar disorder) may exhaust their annual benefits and then have to discontinue care prematurely. Finally, the higher deductibles and co-insurance associated with mental health services can discourage patients from seeking treatment in the first place.

The other major issue related to mental health parity is the constitutional guarantee of equal opportunity. Most people who need mental health care have a brain disorder. Research breakthroughs have unlocked many of the brain-based mysteries of bipolar disorder, obsessive-compulsive disorder, social anxiety disorder and attention deficit/hyperactivity disorder. Maintaining a double standard for physical health and mental health constitutes discrimination against individuals with brain disorders.

-- Michael T. Smith, Ph.D., Clearwater

* *

Autism verses Mental Illness

Letter from the Editor

Brief Commentary: Autism is not a mental illness. Disjointed thought processes are not at its core. Some students of the disorder are starting to think it may be a toxin-triggered, genetically vulnerable immune disorder resulting in a broken brain, resulting in strange behavior and other things.

But science is also discovering the crazy irony that mental illness is not a mental illness, either. Like autism, mental illnesses are increasingly being thought of, if not discovered as something physiological, biomedical -- the brain's genetically coached 'moving parts', being out of whack.

As catagoric distinctions between ASDs and mental illnesses blur medically, so do the forensics of medical insurance. Insurance providers are increasingly told by state lawmakers and judges, "If you're going to cover a broken arm, you'll have to cover a broken brain, too." And autism gets lumped in with mental illness along the way.

–Lenny Schafer

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* *

Mental Health Parity Bill (AB 88) in California, A Model? Letter to the Editor, Sacramento Bee

The above bill, which the Sacramento Bee refers to as a model for other states to follow has some severe flaws. First, it took a considerable amount of time after its passage for some insurers to come into line with its provisions. Before its inception, primary care physicians (for the most

part) controlled referrals for services necessary for autistic syndrome children. In many, if not most, cases, these referrals for service were denied for such things as speech therapy. occupational therapy, and the like, because these services were considered too long-term to fit the criteria for short-term fixes. This is an oversimplification but enough of a short explanation to make my point.

Some of the larger HMOs are now turning all coverages for autism over to their mental health providers. Because of the California state restriction on creating vendor contracts with only "mental health practitioners" (Psychiatrists, neuropsychologists, psychologists, or marriage and family counselors), these mental health insurance companies do not coordinate through the child's primary care physician. In fact, the HMOs cannot vendorize other than those mental health professionals identified above. They make individual contracts for each child when they approve speech, ot, or other auxiliary services. This leaves the doctor out of the loop and requires the family to request these services directly.

This absence of coordination and cooperation certainly leaves California and its "Parity" law lacking.

There's much more too it, but I couldn't let the Bee's editorial comments pass without comment.

Peter McLean [peter@webaccel.net]

* *

Services, Compassion For Autism Rare In Colorado

Letter to the Editor, Denver Post

Re: "Mom held in boy's 3-story fall; Autistic child, 7, was pushed out of window, police say," April 24 news story.

As the mother of two young children with autism, I am following the story of the Denver autistic boy who fell from a third-story window with heartbreak and anguish. I think I can imagine what the life of the mother and son have been like for the past several years.

I am an advocate for children and families affected by autism, and sadly the story is very much the same for the dozens of families I have worked with. From identification, to diagnosis, to early intervention, to special education, to social and family support, the services for children with autism in our communities are woefully inadequate or simply nonexistent.

The state of Colorado continues to look the other way when it comes to providing basic educational and social services for children and families affected by this disorder. Perhaps this tragic event will cause us to pause and question how we address autism in Colorado. Perhaps it will cause Gov. Owens to pause and reflect on his rationale for vetoing HB 1389 in the summer of 2000. This bill would have provided Medicaid coverage for intervention for children with autism similar to that provided in other states.

Perhaps it will cause people responsible for special education policy to take notice when Dr. Bernard Rimland, founder of the Autism Research Institute, makes a comment about our state. He said, "... Colorado is exceedingly negligent in providing needed services for autistic children" in a September 2001 letter to hundreds of his Colorado clients.

You see, from my perspective, children with autism in Colorado are "thrown out the window" every day. How sad that in the Denver case, the mother is the only one being charged.

Michelle a. Linn

Colorado Springs

* * *

'It Restores Your Faith In People'

Shawna Boller hopes the fence 5-year-old Ryan found a way through Thursday keeps him in. Ryan, who is autistic, likes to run. His older brother, also autistic, doesn't like to leave the house, putting their mother in a bind. The Bollers moved to their home outside Woodland Park to get away from traffic in case Ryan ran away.

"It restores your faith in people," she said Tuesday from her log home in a rural subdivision north of Woodland Park.

Ryan Boller was found safe in the woods Friday, curled in the fetal position and wearing his Teletubbies underwear. He was missing for more than 24 hours and survived a brief snowstorm and freezing temperatures. He took off the sweat shirt and jeans he was wearing before he was found.

What complicated the search was Ryan's autism, which prevents him from communicating with people. It also makes him run whenever he's unattended. That's what happened Thursday afternoon when Shawna took her eyes off him for a few minutes. Ryan managed to find a way through a fence in the yard and into the neighboring Manitou Experimental Forest.

The Bollers had known this was a possibility. For the past year, Ryan has loved to run. That's why they moved from Woodland Park to their mountain property in November, thinking it would be safer for Ryan to live away from traffic.

The fence around their yard is reinforced with chicken wire and looks secure. But Ryan wiggled out.

"When he runs, he's laughing and giggling," said Shawna, 37. "He thinks it's a game. I don't know why he does it. He can't tell you. Maybe it's the excitement of the chase or the feeling of freedom."

When Shawna noticed Ryan wasn't in the yard, she panicked. Her other son, 6-year-old Jesse, also is autistic but hates going outside. Shawna couldn't leave Jesse alone to look for Ryan, so she put him in the car and drove to the neighbors. They watched Jesse while she searched the woods briefly before calling 911.

Shawna says now that she is frustrated that it took so long for the Teller County Sheriff's Office to respond to her call and to call out search and rescue. By her account, it took hours.

But Sheriff Frank Fehn said records show his office received her call at 5:05 p.m. and a deputy was on the scene in eight minutes. He immediately called search and rescue.

"I can understand her frustration," Fehn said. "But I think it's a case of being upset that her child is missing and minutes seem like hours."

The search lasted through the night. The boy's father, Shawn, was out looking while Shawna was at home with about 20 people - neighbors, her husband's co-workers and people from Ryan's school - who gathered there. They kept Shawna updated, but there was no good news.

"The next morning, I was asking, what child could survive 27-degree temperatures," she said. "I kept asking when does hypothermia set in. No one would tell me."

About noon, searchers found the boy's shoes near a creek. By that time, hundreds of volunteers joined the search, taking time off work and joining rescue crews.

The sun was starting to set Friday when Shawna got the best news of her life. They found Ryan. The cell phone conversation was breaking up, so Shawna had to go to a corner of the house to hear it.

"I said, 'Is he alive?' Is he alive?'" she said.

He was. Dave Douglas, who is in the Colorado Army National Guard with Ryan's father, found the boy while riding a motorcycle on a trail about three miles northwest of the Boller home. Ryan was curled up under a tree. He had a sunburned face, but everything else was fine, doctors later concluded.

"It's a miracle," his mother said Tuesday while Ryan was at school in his kindergarten class.

"The child didn't even have a bug bite. The paramedics couldn't believe it. People have been coming up to me and saying they didn't believe in God until now. There isn't any other explanation."

Today, the fence has been fortified. But the Bollers know this could happen again. They also believe that living in the woods is better than living in a city near traffic.

Shawna said she needs help, that she can't possibly watch two autistic boys at the same time. For now, however, she'll continue doing what she's always done. And she just hopes next time the gate will stay shut.

* * *

Student's Inspiration Aids Therapy 'Steamroller' Calms Kids

Occupational therapy student Alicia Wells never thought of herself as an inventor but then years of experience with special needs children and anxiety over a looming school project collided during a trip though the car wash.

The 22-year-old University of New England student needed to find a way to help children deal with high sensitivity to touch. In a moment of inspiration, Wells realized sliding a child though rollers, like a car in a car wash, could provide the kind of deep, steady pressure that often calms oversensitive children.

So she conceived of a device with two padded, thick rolling pins on a tension spring that children - and adults - can roll through on their tummies.

The "Steamroller" can be used to help kids with everything from autism to ADHD (attention-deficit/hyperactivity disorder) to cerebral palsy by calming the central nervous system.

"It allows the child to focus to work and play," said Wells, standing next to the foot-high device.

Wells could visualize how she wanted the Steamroller to look, but she didn't have the supplies to build it. So she called Andy Ruse, a representative with Southpaw Enterprises, a catalog retailer of therapeutic devices and described her concept.

Three weeks later the plywood and plastic device arrived and the Steamroller began to catch on.

It's been almost two years since Wells handed in her project but now the therapeutic device is making waves at local clinics and the national catalogue that manufactures and sells the roller device, priced at $279, can't keep it in stock.

"The kids and the adults loved it," said occupational therapist Molly Arnold of UNE. "It was really a lot of fun."

Arnold is the coordinator of UNE Community OT Clinic on Saco Island. The clinic was the first facility to use Wells' invention and the kids and therapists there helped demonstrate its clinical benefits.

For several months they used the roller on its own and as part of therapeutic obstacle courses to help youngsters attending therapy sessions learn to better control their bodies.

"After they've gone though the roller they're a little calmer and when they're calm they can focus a little better," said Arnold. "It can help the nervous system feel just right instead of off kilter."

* * *

Facial Identity And Facial Emotions: Speed, Accuracy, And Processing Strategies in children and adults.

ds=11992203&dopt=Abstract <- - address ends here.

De Sonneville LM, Verschoor CA, Njiokiktjien C, Op het Veld V, Toorenaar N, Vranken M. Pediatric Outpatients Clinic, Vrije Universiteit Medical Center, Amsterdam, The Netherlands

As yet, nearly all studies in face and facial affect recognition typically provide only data on the accuracy of processing, invariably also in the absence of reference data on Abstract information processing. In this study, accuracy and speed of abstract visuo-spatial processing, face recognition, and facial emotion recognition were investigated in normal school children (7-10 years) and adults (25+/-4 years).

In the age range of 7-10 years, accuracy of facial processing hardly increased, while speed did substantially increase with age. Adults, however, were substantially more accurate and faster than children. Differences between facial and abstract information processing were related to type of processing strategy, that is, configural or holistic processing versus featural or piecemeal processing. Improvement in task performance with age is discussed in terms of an enhanced efficiency of the configural organization of facial knowledge (facial information processing tasks), together with a further increase in processing capacity (all tasks).

The differential developmental course of speed and accuracy levels indicates that speed is a more sensitive measure when children get older. Moreover, it also suggests that speed of performance, in addition to accuracy, might be successfully used in the assessment of clinical deficits, as has recently been demonstrated in children with autistic disorders of social contact.

PMID: 11992203 [PubMed - in process]

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* * *

DOPA Decarboxylase 'Candidate Gene' for Autism

"Investigation of two variants in the DOPA decarboxylase gene in patients with autism."

ds=11992572&dopt=Abstract <- - address ends here.

Lauritsen MB, Borglum AD, Betancur C, Philippe A, Kruse TA, Leboyer M, Ewald H. Department of Psychiatric Demography, Institute for Basic Psychiatric Research, Psychiatric Hospital in Aarhus, Risskov, Denmark.

Though genetic risk factors are important for the development of autism, no specific risk alleles have yet been identified. DOPA decarboxylase (DDC) is involved in both the catecholaminergic and serotonergic pathways and may be considered a functional candidate gene for autism. The present study is the first to test if two new variants of possible functional significance in the DDC gene increase the susceptibility to autism.

A total of 90 parent-offspring trios recruited in Denmark and France were investigated using the transmission disequilibrium test (TDT). We found no evidence of linkage disequilibrium between autism and either of the two polymorphisms. Nor did we find linkage disequilibrium between autism and haplotypes of the two variants using a multiallelic TDT. These findings suggest that the DDC gene is unlikely to play a major role in the development of autism in our data set. Copyright 2002 Wiley-Liss, Inc.

PMID: 11992572 [PubMed - as supplied by publisher]

* * *

Craniosynostosis, Telecanthus, Scalp Hair Abnormalities, And Sensorineural deafness in two sibs.

ds=11992488&dopt=Abstract <- - address ends here.

Megarbane A, Hersh JH, Chouery E, Fabre M.

Unite de Genetique Medicale, Laboratoire de Biologie Moleculaire et Cytogenetique, Faculte de Medecine, Universite Saint-Joseph, Beirut, Lebanon.

A sister and a brother with anomalous skull configuration, facial abnormalities, abnormal scalp hair growth, sensorineural hearing loss and, in the boy, proven craniosynostosis, severe mental retardation, and autism were reported in 1986 in an abstract by Hersh et al. We reexamined this family and here review the literature focusing on the major clinical findings, and suggest that their clinical manifestations may represent a previously unreported syndrome. Copyright 2002 Wiley-Liss, Inc.

PMID: 11992488 [PubMed - as supplied by publisher]

* * *

Nociceptive Changes In Rats After Prenatal Exposure To Valproic Acid.

ds=11990073&dopt=Abstract <- - address ends here.

Schneider T, Labuz D, Przewlocki R.

Institute of Applied Psychology, Jagiellonian University, Krakow, Poland.

Abnormalities in anatomy and function of the cranial nerve motor nuclei and brain stem structures have been demonstrated in some people with autism and can be modeled in rats by exposure to valproic acid (VPA) during very early nervous system developmental stages (neural tube closure).

The aim of this study was to investigate if VPA will have an impact on nociception in rats because of reported hypoalgesia in a subgroup of autistic patients. Pregnant females were treated ip with 600 mg/kg of sodium valproate on day 12.5 of gestation.

Nociception was measured in offsprings by tail-flick and thermal paw withdrawal tests in two developmental stages: prepubertal (80-90 g) and adulthood (360-440 g). Results showed significant differences in pain sensitivity with hypoalgesia in male rats treated with VPA compared to male control in both developmental stages.

The outcome of our study suggests that rats exposed prenatally to VPA show abnormalities in nociception similar to those observed in human autistic patients. Interestingly, naloxone (1 mg/kg) had no impact on nociception in offsprings of VPA-treated rats.

PMID: 11990073 [PubMed - in process]

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Lenny Schafer, Editor@feat.org • CALENDAR EVENTS@feat.org Michelle Guppy

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