Cervical Cancer Symptoms And Signs

(announcer)major funding for second opinion is provided by the blue cross and blue shield association,an association of independent, locally-operated and community-based blue cross and blue shieldcompanies, supporting solutions that make safe, quality, affordable healthcare availableto all americans. (announcer)second opinion is produced in association with the university of rochester medical center,rochester, new york. (music) (dr. peter salgo)welcome to second opinion, where you get to

see firsthand how some of the country’sleading healthcare professionals tackle health issues that are important to you. now each week our studio guests are put onthe spot with medical cases based on real life experiences. by the end of the program, you’re goingto learn the outcome of this week’s case and i hope you’ll be better able to takecharge of your own healthcare too. i’m your host dr. peter salgo and todayour panel includes dr. susan hyman of the university of rochester medical center, dr.catherine lord from the institute for brain development new york presbyterian hospital,special guest tom mcgurk, dr. gary stobbe

of the university of washington medical centerand our second opinion primary care physician dr. lisa harris of rochester, new york. welcome back lisa. lisa harris)thank you. peter salgo)let’s get back to work, shall we? our patient today is harry, harry is six yearsold and he’s in his pediatrician’s office with his parents. harry is having a difficult time adjustingto kindergarten. his teacher describes him as “very smart”,these are quotes from the chart, and “one

of her top readers” but she says “he’sdifficult to manage, he fixates on the wrong things, he’s moody, he has trouble gettingalong with his classmates”. now upon further review as they say, it turnsout harry has never been in day care, he’s never been in nursery school. so, his teacher and his parents thought atfirst he just needed some more time to adjust to this new environment but four months havegone by and he doesn’t seem to be making any progress. in fact, his teacher says he is, and thisis another word directly from the chart, “regressing” both in the classroom and at home.

the teacher then says “harry may have attentiondeficit disorder; you’ve got to take him and get him some drugs”. i think she used the word medication. lisa, what do you think? he’s in your office, are you going to sendhim home with a prescription? lisa harris)sure. peter salgo)i’m assuming that’s a sarcastic sure? lisa harris)that’s a very sarcastic sure. it just seems that attention deficit disorderhas become the buzzword so any child that

is not being managed appropriately in theclassroom whether because of classroom management from the teacher or because of other issues,has been labeled with attention deficit disorder. so we get a lot of referrals with parentsbringing kids in asking for medication because someone has suggested that they have attentiondeficit disorder. peter salgo)harry’s pediatrician says it’s too soon to consider any medication and she refersharry and his parents for diagnostic workup. this included a neurologist, a speech therapist,and a psychologist. now after all of this, all these experts seeharry, they schedule a follow up appointment with their pediatrician, lisa.

they learn that based on the evaluation ofall of these folks harry has been diagnosed with autism, specifically asperger’s syndrome,so a lot to talk about here. first of all why don’t we get some definitionsout of the way, what’s autism? gary stobbe)autism is a condition that is involving the development of the brain and what we see isa developmental pattern in which the social and language development goes astray and isnot developing on a correct trajectory. in addition to the language and social deficitsthat we see, we see also an usual pattern of developing repetitive behaviors and restrictedinterests and it’s these three components; the language and communication, the social,and the repetitive behaviors and restricted

interests that we have to see for the diagnosis. peter salgo)and asperger’s which was apparently given to them as a form of autism, how does thatdiffer from autism, syntactically at the very least? susan hyman)kathy you wrote the rules. peter salgo)you wrote the rules? catherine lord)not quite but asperger’s is a term used to describe children and adults who have autismwho don’t have language deficits. so many kids and adults with autism have languageproblems and some of them get better, a lot

of them get better but asperger’s was reallycoined to describe people that have never had language problems and have at least averageintelligence. susan hyman)but the language problems are subtle. catherine lord)right, they are subtle that is true. in fact people with asperger’s syndromestill do have pragmatic language problems. peter salgo)what does that mean? catherine lord)that means problems carrying on conversations or they may choose unusual words, they maysay things in a more formal fashion, they may say you know, “i decline to answer thatquestion”.

peter salgo)this sounds like a very complex, subtle diagnosis to make. is it hard to make this diagnosis? gary stobbe)sometimes it is. i mean sometimes a case like this that presentsat age six and really the problem isn’t seen until you put the child in to the socialenvironment. there are a variety of forms which is veryconfusing for people and we see some kids that present at a very young age, age oneand a half and two where you can see these repetitive behaviors and it becomes very apparentearly and you see other cases like this one

that are more subtle. peter salgo)he’s six, six and a half years old. don’t his parents have a hint something’snot right? (tom mcgurk)i find it hard to believe that at six they wouldn’t have seen something. susan hyman)actually for the kids with the highest functioning it is not unusual; the main age of diagnosisfor asperger’s syndrome is probably early school age. a lot of the kids we see the parents willsay they were reading very early.

i saw a child the other day, a three yearold, who was literally reading. i looked at the parents and said “did youteach him to read” and they said “oh no, he just figured this out on his own” andhaving hyperlexia like that is something that people think is cool. in reality it’s not normal brain wiring. peter salgo)i just want to be very clear. you’re not saying it’s bad for a kid tolearn to read? susan hyman)no, just that there are atypical things of development for a child who is proficientat video games the parents may say this is

really great but in reality this is an isolatedarea of brain development. or a child is a fabulous musician but isn’tconversational in speech. gary stobbe)if you have a kid that is an only child and hasn’t gone to preschool he really hasn’thad a lot of opportunity to see the difference between the other kids’ development. (tom mcgurk)that’s how my wife knew because we were in a peps group in seattle. peter salgo)what’s a peps group? we should make it clear, you’re a dad.

(tom mcgurk)i’m a dad. peter salgo)and i know we’re going to get to this in a minute but here you are, you have a childthat has a problem. (tom mcgurk)who has autism, that’s his diagnosis. peter salgo)ok. (tom mcgurk)a peps group is a group of moms that all basically have their babies around the same time andthey get together to support each other and stuff and the kids develop and they developfriendships over time. so my wife was watching our son develop andall the milestones that all our friends’

kids were hitting, he wasn’t, and she wasseeing that. she was saying to me there is something goingon here and i was saying there’s nothing wrong with my son. peter salgo)the numbers that i’ve seen are very interesting, about a third as i recall, of all parentsknow that the games afoot by the first birthday. if you wait until the second birthday eightout of ten parents, whether or not they’re talking about it, suspect something’s up. lisa harris)i think that’s very true for autism but not necessarily true for asperger’s becauseasperger’s is so much more subtle.

particularly for adults that show up in apractice and want to say that they have asperger’s then we have to deal with borderline personalitydisorders and other neurodegenerative disorders and other things that come in to play. susan hyman)it’s not at all uncommon for a child to come in for diagnosis and for the parentsto look at each other and the mother says to the father “i know where he got it”because these are multi-genetic traits and many people with asperger’s syndrome arevery high achieving and are totally flying under the radar screen. peter salgo)tom, how old was your child?

(tom mcgurk)two and a half. peter salgo)two and a half, so pretty young actually? (tom mcgurk)we had a really good pediatrician who basically said get him in to speech therapy. once he was in speech therapy i was stillmassively in denial and my wife was not. so the speech therapist called us in one dayafter hours and she said i need to talk to you guys and sat us both down at a table andi will never forget this for as long as i live, she looked at me and said “mr. mugirk,do you think your son is going to go to college?” and i said “of course my kid is going togo to college” and she leaned in and said

“then spend all the money now”. this chill went down my spine but it was thepunch in the stomach i needed to get me out of the world of there’s nothing wrong withmy kid to i have to start working with him now. peter salgo)tell me more about this punch in the stomach. first of all, was that the only diagnosticprocedure that your son had? (tom mcgurk)oh god, good lord no. he went to the chdd, which is over at theuniversity of washington. peter salgo)what is chdd?

gary stobbe)it’s a center at the university of washington that does diagnostic evaluations. (tom mcgurk)that was an all-day event, it was actually two days. peter salgo)what kinds of tests do they do? (tom mcgurk)everything, you have psychologist there, a regular physician, neurological work up, walkinghim through where you would have someone playing with him for different specific times andtaking tests and then at the end of the day they say “come back tomorrow, we’ll talkto you”.

you sit at a table that’s probably abouttwelve feet long with seven doctors looking at you at the other end and they look at youand say “well, it is our opinion that your son has autism”. gary stobbe)i think it’s important; an important point of that story is that this diagnosis is basedon a clinical evaluation. it’s not based on a blood test. i wish we had an x-ray or blood test. peter salgo)tell me more about this clinical evaluation. gary stobbe)the evaluation is observing behavior and then

also getting a very accurate and detailedhistory of developmental patterns. it’s really that combination of that historicalaspect of development along with what we observe in the clinic. the observation is looking at behaviors suchas eye contact, does the child turn to and reference the parent and reference the personthat’s talking? does the child share in advance like if youhave a toy, do they share in the enjoyment of the toy, do they form a triangle betweenthe object and the person and themselves which is called joint attention? there are these particular aspects that arelooked at and this is a process that is, i

think to a parent it’s a little bit unsatisfyingbecause you want that more objective piece of data that we don’t have and some of thesekids it takes time. you have to do this evaluation; you have tocontinue to follow to really feel confident that the diagnosis has been made. lisa harris)it’s very important that you do the observation. i’ve seen some parents come in with a diagnosiswhen they’ve only spoken with the parents and there’s been no direct observation withthe child in and of themselves. susan hyman)one of the other things that comes in to this initial evaluation, that goes in to this fullday, is thinking about it dimensionally.

it’s not just autism that you’re lookingat; you’re looking at intellectual ability, language ability, motor ability, whether ornot there’s also adhd, whether or not there’s also other mental illness. all these things effect how this front ofautism might present and i’m sure it’s overwhelming. (tom mcgurk)it’s frightening and in my family my brother already had a child with autism and my sisterhad a child with autism as well. peter salgo)so as devastating as that news was to you. (tom mcgurk)and it was, it was the worst day of my life

probably. peter salgo)tell me about that. (tom mcgurk)it’s a horrible, horrible comparison but when you get a cancer diagnosis they say nowyou’re going to see an oncologist and you’re going to go to virginia mason or whereverand we’re going to do this to you, we’re going to give you radiation treatment; here’show we’re going to help you. when you get that diagnosis, at least whenwe did which was eight years ago, it was here’s your diagnosis. peter salgo)thank you and goodbye, good luck?

(tom mcgurk)good luck. basically what they did was send us over tochildren’s hospital and we went to this program called autism 101. the first thing they tell you is well, ifyou want to get aba, which is applied behavioral analysis, which is the treatment everyonesays at that time was helping the most you’re going to be on a waiting list for six monthsto a year to get a therapist. catherine lord)i think that’s an area that we desperately need help in are those gaps. there are established treatments and theyvary hugely regionally.

for example, i just can’t believe that howmany more researchers there are in the new york area for example than michigan. also, that gap between here’s the diagnosisand here are the things as a parent we want you to think about and then what do we dowhile you’re on those waiting lists. peter salgo)harry’s parents, devastated, fair word? (tom mcgurk)absolutely. peter salgo)and then harry’s father, because it’s often the father, says “wait a minute, mykid’s verbal, he’s a great reader, i’ve been reading about autism, i’ve seen thelocal news, how could this be autism?”

can it be? gary stobbe)well it can be. again there are these higher functioning formsof autism where the intellectual ability is normal or sometimes even higher than normaland it is often difficult for somebody that has not experienced autism and has not experiencedthese different varieties to really understand and accept this diagnosis. this is a big blow for a parent, i mean you’rebasically taking their view of the future and erasing it and really not replacing itwith anything. the providers at this moment in time aren’ttelling you what’s going to happen with

my child. (tom mcgurk)i went to see, we got very involved in the community and i went to see a speaker. it was a guy who was 45 who had autism andhe had been to college and even now starting to feel something because after he spoke irealized connor was seven at that time, that was the first time since he was two and ahalf i had allowed myself to picture his future beyond the next day. for the first two years i was in, how do ifix him mode? peter salgo)what was worse for you, hearing the diagnosis

or looking in to the void left by no therapybeing offered to you? (tom mcgurk)hearing the diagnosis was horrible at the onset of it. i was lucky that my sister-in-law, becauseof my brother’s son, she was a massive advocate for her child and he was diagnosed much earliertime wise, 90’s, so she really worked very hard to get him all the help he needed. any time i ran in to a severe problem i wouldcall her. peter salgo)to put a button on this, autism is the word you heard?

(tom mcgurk)yes. peter salgo)asperger’s has come up in this group, would you have used autism or asperger’s herefor a child who’s verbal, a child who’s reading? gary stobbe)asperger’s is a form of autism and so i’ve got in the habit of using both terms so theyreally understand that they are still going to be facing these difficulties with regardsto the social engagement of that child. susan hyman)asperger’s is not a diagnosis that i would, when we’re counseling parents we preparethem that the rules are going to change.

it’s not randomly that we come up with thesebehavioral criteria, there’s a formal diagnostic and statistical manual that tells us. peter salgo)the dsm. (tom mcgurk)and my wife knows what the number is for autism, she knows that number. susan hyman)not to pick on kathy again but you’re involved with changing the rules. catherine lord)i think that the general proposal is to just have autism spectrum disorders.

peter salgo)asd, and throw poor dr. asperger out. catherine lord)no, i think there’s a place for asperger in the sense of self advocacy, in terms ofdescribing but the trouble is that it’s not a fixed category; kids move in and out. we really worry that we can make a diagnosisof autism in a child for example that has a language delay, which gets a lot better,suddenly people start calling them asperger’s. then they need help, for example, in supportedemployment and we need to call them autism again and so it seems to make more sense tojust say there’s a whole spectrum. peter salgo)ok, let’s take the whole spectrum if you

will; we’ll call it autism for the sakeof this discussion, for now any way. everything i’m seeing, everything i seein the popular press says it’s on the rise. there’s a lot more autism now than therewas. is that because we’re getting better atdoing what you do, for example, and diagnosing it? or do you guys really think there’s simplymore autism out there? gary stobbe)it’s definitely being influenced by awareness. the age of diagnosis has gotten to a youngerage so we do a better job of identifying it with educated pediatricians better so theyrecognize it.

there’s a recent study last year done inthe uk that suggests in the adult population the prevalence is just as high as in our pediatricpopulation. that would suggest that maybe it isn’t reallya true epidemic that it has been around, but we have just not recognized it. peter salgo)let’s put some number on this, out of every 100 kids in america if you will, how manyof them will have some form of autism? susan hyman)overall the average is one in 100. peter salgo)one percent? susan hyman)yeah, one percent.

peter salgo)i don’t know where they practice medicine that that’s not a large number but to me1% is enormous. (tom mcgurk)and it’s growing, at my son’s school i see he was in the inclusion program at publicschool and it started out with two special ed teachers, there were three for each one,now there are three and there’s, i think there’s fifteen in the school. lisa harris)i think susan made a very important observation that in the midst of the evaluation you’renot just looking for autism spectrum disorder, you’re looking for other things.

we have to be very careful; we did this yearsago when attention deficit disorder became very common and everybody had attention deficitdisorder. everybody doesn’t have autism or autismspectrum disorder, some of it is familial issues, some of it is cultural issues, someof it is behavioral, some of it is mental health and some of it is autism and we reallyhave to pull that whole context together. susan hyman)there was a study that was just published in south korea where they did school age screeningand found an astronomical number of kids that screened positive, and lisa just to buildon that, is that one of the important things is this is a functional diagnosis.

susan hyman)that means that you can be repetitive, you can be fixated, but if it’s not a problemthen you haven’t stepped over the line to diagnosis. gary stobbe)that’s a good point. let’s say why would we make a diagnosisif it’s not functionally impairing you and the difference between a disorder versus traits. the genetics are such that families will oftenhave these traits in other family members but they may not meet the full diagnosticcriteria. peter salgo)again i just want to go back, since 2002 i

think, almost a 60% increase in the numberof cases recognized. again is this just because we’re doing abetter job of screening? catherine lord)i think it’s a 60% increase when you’re using educational figures. the cdc just in the last five years has donesurveillance studies where they’re systematically used the same methods over time and therewe still are getting increases but not the 60%. the 60% is who’s in school who gets a diagnosis. peter salgo)the reason i bring that up, it is going to

become important in a moment because afterleaving the pediatrician’s office, you know where i’m going with this. harry’s parents throw themselves in to researchingautism and their first question is why? what happened? what do we have for them? what causes autism? susan hyman)to just build on what gary said, if you think about autism as a multi-genetic trait, a multi-geneticdisorder where you’re inheriting some genes from one side of the family and some genesfrom the other, you have a critical mix of

predisposition that in the face of environmentalfactors that turn these genes on and off, you get a pattern of behavioral traits andthat’s why it’s so heterogeneous, why it’s so different. that you have these genes but if in one pregnancythere was one set of risk factors and another pregnancy not, the two children aren’t goingto look alike. gary stobbe)of course that was a long answer to say i don’t know why. susan hyman)i never say i don’t know. (tom mcgurk)my sister has six children, one is autistic.

my brother has three, one is autistic. i have one child and one is autistic. my other brother has three boys, nothing. peter salgo)but you know that what’s happened out there and i’m just going to unroof this boil ifyou will, 60% increase, we’re seeing a lot more autism. we’re vaccinating all our kids; you knewthat this vaccine strong man was going to come up. if we’re vaccinating more, we’re seeingmore autism, 60% increase, true-true related

or true-true unrelated. susan hyman)if you look at what’s happened, say 1960, the amount of plastics we use, look at thechange in our food supply. look at the ingredients of what was on yourbreakfast, processed food. the water supply has changed. true, vaccines have changed but that’s onething that we have control over and have knowledge of the components. to date i believe that the evidence wouldsuggest that there probably are environmental factors.

the evidence does not support vaccines atthis point. peter salgo)can we put this one to rest? susan hyman)i’m wearing my academy of pediatrics hat, the evidence does not support vaccines buti’m a true believer that there are environmental (tom mcgurk)can i step in as a parent? peter salgo)please. (tom mcgurk)as a parent i will tell you this, first do no harm. i do not know what caused my son’s autism,vaccine’s stopped with us.

if i’m going to vaccinate i’m going toblood test first to make sure something took, i’m not going to do an mmr, i’m goingto do an m. i don’t want to do a measles, mumps, and rubella and bomb the system. i believe i live in a first world country,i’m not going to say vaccines are bad, but i’m going to say allow me as a parent ofa child in an at-risk population to take the measles, give it to him, wait six months,see what happens with him, blood test him to see if it took, then give him another one. don’t attack his system at the same timewith all of that because we have the wherewithal to do that with our at-risk population.

that’s what i would ask. gary stobbe)i think when you look at the onset of autism when you typically start to notice it around18-24 months and especially a group of kids with autism that have what we call the regressiveform of autism where they actually lose language, you can understand why parents would be fearfulabout vaccines because we are giving so many more vaccines at that age. also we have not come up with a good answerto replace the fear; we haven’t been able to say here is the cause. we believe it’s genetics and environmentbut the way we are able to give those answers

we don’t have the detail to satisfy parents. it’s understandable that parents are fearful,it’s understandable that parents go on the internet and find all kinds of informationand unfortunately a lot of times misinformation. we have to do a better job of understandingthe cause or we’re never going to get rid of this fear. peter salgo)i’ve got to tell you, i heard two things that i just want to mention. i’ll do your job for you for a moment. i heard one “i’m going to put on my americanacademy of pediatrics hat”, that’s a political

ad. i don’t want to hear it if i’m a parent. i don’t want to hear what the consensusgroup thinks. then i heard “i don’t know what causes,but i do know it isn’t that”. if i’m a parent those two don’t sit wellwith me, do you understand that? what do we know? susan hyman)what we know is we know that the genes that have been identified are genes that are involvedwith early synapse connection. peter salgo)synapse is the connection between the nerves

in the brain. susan hyman)we know that the neurobiological findings that have been documented in people with autismare things that happen very, very, very early in brain development. with the ability for the brain to imitateinvolves neuro connections that are made very early before the time of vaccination. we know a fair amount about what doesn’tcause autism but the research; it’s harder to put together the moving parts for the causesof autism. peter salgo)i hear all that but do you hear what he’s

saying and you know what our viewers are thinking,especially those with young children who are really worried about their kids. i’m not ascribing ill motives to anybodybut do you understand their fear? catherine lord)yes and i guess from my perspective as a psychologist who works with families, so not a physician,i think there are two different issues. there’s the public health issue that saysthe more vaccines you get together the more people will get those vaccines and the fewerpeople will be ill and there’s the parent saying i want to be a good citizen, i don’twant my child to be giving diseases to other children, but i need to do the things thati can think of to protect my child and i can

sympathize we that. lisa harris)if we look at third world countries that immunize on a regular basis and have a 90% plus vaccinationrate, we don’t see the same levels of autism. you could argue that maybe you’re not screeningbut it’s a western world phenomenon. peter salgo)there’s another kettle of fish isn’t there? lisa harris)and we know it’s not mercury. peter salgo)we know it’s not mercury because mercury was in the vaccines in the third world countrybut it goes to what you were talking about. maybe something else in the environment istriggering something.

gary stobbe)here’s my problem with this discussion is that this takes us away from the real work. this is what i get afraid of is again, becausei can’t give that answer you have the parent that’s spending two hours on the internetwhen they need to spend those two hours on the floor interacting with their child becausethat’s the real treatment. (tom mcgurk)and it is the truth; time is the most important thing with these kids. peter salgo)so you can spend time drilling backwards or time going forwards.

(tom mcgurk)you have to take the realization, as a parent you come to the realization that your lifehas changed like any other diagnosis, forever. peter salgo)let me just pause for a minute because we are spinning along on this, this is a greatdiscussion but occasionally we should draw a deep breath and figure out what we covered. so let’s try to sum up what we’ve talkedabout, just a little bit any way. autism spectrum disorder is a range of complexneurodevelopment disorders. it varies widely in severity and symptomsand may go unrecognized, especially in mildly affected children.

getting an accurate diagnosis requires a comprehensiveevaluation from a multidisciplinary team and that’s what your son had. we are here today and we’re discussing harry. harry is six years old; he’s recently beendiagnosed with autism spectrum disorder. our guest tom mugirk is also here, your son’sname is connor by the way. harry is six years old and connor, when hewas diagnosed, was much younger, peter salgo)two. what is on the forefront? what are we doing now for treating autism?

where do we even start? catherine lord)i think there are a number of interventions that start very early and that involve bothdirectly working with the children and also working with parents. i think as tom said parents can engage childrenand understanding the fact they need to engage their child, that their child isn’t makinga conscious decision, that they don’t care about interacting but that they don’t reallyknow how to do it. they’re not making a conscious decisionthat they only like to line things up but they may not know how to do other things.

peter salgo)what is this applied behavioral analysis all about? you keep hearing about that. catherine lord)that’s the idea that you can teach a child if you do something, something good wouldhappen so that good thing ideally is part of the environment. you figure out if i put this object in thistoy something fun happens with the toy or if i throw a ball to you, you’ll throw itback to me. but it can also be much more formal if thatdoesn’t make sense to a child you literally

put this in and i will clap. (tom mcgurk)connor’s precision teaching aba, they take constant notes about everything he does. we have two books that are like that thickabout his development but aba i’ve seen amazing things with it. peter salgo)what about medication? i mean everybody wants a magic pill right? does medication work? gary stobbe)we have medications that work effectively

at treating certain symptoms that are associatedwith autism spectrum disorders but we don’t have a medication currently that truly getsat the core deficits. we are seeing development; we’re seeingsome very promising novel therapeutics that are still being researched but really ourmedication management is when we see certain symptom complexes such as anxiety. we do see some kids with autism that do haveattention deficit that responds to add medications and sometimes we even have to use a strongermedication to manage more severe behaviors for a select population. peter salgo)but you know what i’m hearing; i’m hearing

i’m going to play with connor. i’m going to play with harry and we’regoing to teach him to focus better or maybe to interact better with me. or i’m going to give him medication to helptake care of some of these associated symptoms. what i haven’t heard you say is i’m goingto bring in kids to play with him. tell me about that. what i hear from you is it’s a sociallyinteractive problem, what about peer interaction? gary stobbe)it’s critical. susan hyman)it’s critical.

(tom mcgurk)it’s huge. susan hyman)it’s huge and i think that in talking about this it’s not just play, that these arechildren whose brains don’t see that social reciprocity so you actually have to teachthe underlying components that go in to language and go in to pretend and go in to play. it’s not just saying go home and play withyour child. there’s a very scientific approach to buildingskills, not every child is going to respond to aba. someone like harry who’s in a school programis going to want to have or the educational

team will want to put in a more socially basedset of skill developments so that he can go to college and work in the community. peter salgo)can you give me an example, i mean i heard socially based but i don’t really know whatthat means? tell me about it. (tom mcgurk)you’ve touched on a huge thing that is very important, it takes a village. these kids are not going to be fixed easily. if people really want to address this situationand this problem you’re going to have to

have community involvement. when you get a child gets been diagnosed withautism the family tends to draw close together. they start to try and help the child out butwhat do you really need? the kids in the neighborhood to come overand model typical play behavior with that kid and allow him to be on the fringe fora time, draw him in when he wants to play and let him go out when he’s not comfortablebecause of his sensory issues. there’s a whole boat load of stuff thatgoes on there with that kid that you just got to let him be but also try to bring himin. peter salgo)but that sounds hard.

(tom mcgurk)and imagine trying to ask a three year old to do that with his mom to come over for aplay date. peter salgo)did i say that sounds hard? is it hard? lisa harris)and as they get older sports, sporting events. catherine lord)music. lisa harris)absolutely. peter salgo)i don’t want to leave this by the way without going back to something you mentioned, diet.

you know that there’s a whole theory, awhole group of folks who ascribe to gluten-free diets, dairy-free diets, and one of them isright here, vitamin b. does diet play a role? susan hyman)i don’t believe that diet plays a role in the way that many people commonly believe. i believe any intervention in autism or anyother disorder needs to have an evidence base and we’re in this point is society wherethere’s this conflict between belief and evidence and that you know, sitting aroundthis room, we’re believers in evidence. we’re believers in that you can test a theoryand see if it works and to date there are aspects about diet in autism that have beentested and don’t work but retain common

belief. peter salgo)let me speak for you for a minute because what i heard you say is what i hear abouta lot of therapies and then i hear what patients tell me which is diet hasn’t been provento be related, we really don’t know and the patients say if you don’t know and you’regoing to wait for the evidence that’s too late for my kid. (tom mcgurk)that’s what i was thinking. you guys all have a theory, i have a kid. i have to get him to eighteen.

gary stobbe)there’s certain things like a dietary modification that can be done, if it can be done safely. i think well if i was a parent why not trysomething that’s safe. (tom mcgurk)it’s not hurting him to not have a lot of sugar. gary stobbe)and the thing is that the average number of treatments that a family is doing with a childwith autism is in the range of seven to ten treatments. think how difficult it is then for us as cliniciansand researchers to tease out which one of

these treatments is responsible for progressso it almost becomes impossible to figure those things out. peter salgo)but isn’t research one thing and what you said the profound moment is i got to get mykid to eighteen. susan hyman)if i can make a comment, you know we’re talking about autism as a discrete disorder. kids with autism are kids and kids have lactoseintolerance and feel crummy with sugar, kids have celiac disease and are disregulated withgluten. we have to think of them as kids, as individualpatients and even though the gluten-free case,

gluten-free diet in formal studies is nota cure. there are individual children who respondto different things in their diet, for things that are related to, they’re kids. they’re put together with the same moleculesas the rest of us. gary stobbe)as a neurologist i think about autism like i think about other neurological conditionswhere if you have a neurological condition you tend to be more sensitive to your environment,you don’t tolerate things as well as other individuals. so if you have alzheimer’s or multiple sclerosisand you get a cold or a urinary tract infection

your neurological symptoms get worse whenyou have that stress on your body. so you’re going to be more sensitive toa lactose intolerance if you have autism than general kids and how’s it going to manifest? it might manifest with worsening autism behaviorsso the importance of wellness becomes, it’s raised even higher in a child with autism. (tom mcgurk)you’re moving back to what we spoke about earlier. my son has had applied behavioral analysis,speech therapy, we have had biomedical, we have done naturopath, we’ve also done audiointegration therapy, we have done playtime

the floor method that dr. greenspan did. we have a therapist at our house three daysa week, constant. it’s not like any other diagnosis wherewe have this thing that’s going to help your kid. you’re constantly trying to figure out whatto do to help him. peter salgo)let me move this along and tell you a little bit more about harry because yeah they werereluctant to accept the diagnosis but once they did they joined a parent’s supportgroup and they found that group very helpful. their son is doing well academically, he’sbeen able to remain in his school with some

additional services but now they’re concernedthat his asperger’s will make him socially isolated and they’re worried about bullying. other kids ganging up, oh boy i saw your eyebrowsgo up. (tom mcgurk)well we’re lucky; we’re in a very good school. when we started with our school they had ameeting when the inclusion program came in and they had all the parents sit down. some of the things that came out of highlyeducated people’s mouths were frightening. peter salgo)give me an example.

(tom mcgurk)i’m afraid that your son is going to dumb down the room. peter salgo)you’re kidding. (tom mcgurk)i’m not kidding but we had a wonderful woman from the school district who said that’sinteresting, flipped open a pad and said actually statistically ____ which are the state testinggrades increase ten percent when you have a child with this in the classroom becausehe usually has extra help which means more teachers in the room and they’re not helpingthat kid all the time which means that other kids in the classroom benefit from it as well.

so it raises all the kids at the same time. peter salgo)being proactive is what i hear you saying. (tom mcgurk)hugely proactive but that goes back to the whole it takes a village thing. everybody gets involved; the school administrationgets involved when they’re going to bring that program in to let the parents talk aboutthe fact that they’re afraid. we had a meeting where everybody agreed we’regoing to say what’s on our minds and we said we’re afraid that your kids are goingto bully our kids. you’ve got to talk to them about the factthat our kid is different; he’s quirky,

he’s weird, he’s not going to talk toyou, he’s going to go off in to the corner of the playground. have your kids understand that and have themknow that for him to get better one of the best things is you have got to engage him. lisa harris)what’s amazing is that it clicked for you. that you understand that he’s going to bequirky in the corner and that’s okay. he’s going to be a little different andthat’s okay. we have so many parents that come in and they’rescreaming and yelling at their kid because they expect him to have “normal” behavior.

they want them to sit quietly. (tom mcgurk)i still scream and yell at my kid too. lisa harris)you know what i mean, appropriately so but the expectation is that he is going to behavelike all the other children. (tom mcgurk)it took me two and a half years though to even get there. gary stobbe)we’ve got a lot of progress our society needs to make in accepting differences. but that age, the middle school especially,for these high functioning kids, the high

functioning kids tend with autism, tend tohave enough self-awareness that they pick up on the bullying or the comments and weall know that middle school is not the kindest time for humans and so it can be a real toughtime and we see anxiety levels can become a real problem at that age group. susan hyman)and as tom said the treatment is not just for the child it’s for the school, the wholeschool community. catherine lord)the schools really can stop it by setting an appropriate atmosphere and communicating. (tom mcgurk)that’s part of the treatment, to have the

community involvement. peter salgo)you’ve been at this now a long time. peter salgo)at this point you’ve had plenty of time to look at your son, see his progress. (tom mcgurk)which has been phenomenal. peter salgo)what are your expectations for him going forward? (tom mcgurk)now i want him out of the house. i want him to go to college. gary stobbe)every parent’s dream.

peter salgo)what do you think, realistically now? what is going to happen to him? (tom mcgurk)i believe he will go to college. peter salgo)that’s great. (tom mcgurk)i think he’s going to have a meaningful life. i mean one of the big fears you see is willmy child have a meaningful relationship when i’m gone? is he going to have friends?

is he going to have happiness, ya know? is he going to find people who accept thequirks that he has so he can interact with them and still feel love and affection fromother people. that is, that’s like why you go crazy andyou get so scared. that fear factor his house is on fire, i’vegot to put this out somehow, ya know? because time ticks away, i can’t believehe’s in fifth grade. gary stobbe)ultimately the job of the parent is the same. you know, it is trying to help your childbe happy and but for some families, for some individuals with autism they don’t makethe progress like your son has.

then it becomes an issue of the parent needingto redefine what is happiness for my child and how will my child be happy as an adult. lisa harris)and then as they get older, what are the long term care issues? once they hit adolescence and adulthood allof these supports go away and you really run in to issues with the aging parent. peter salgo)which brings me, catherine, to what’s on the horizon for treating autism both as childrenand as adults? catherine lord)i think we know a lot about things we can

do, it’s just the services are not organized. i mean i think we know things we can do tohelp college students who have autism in terms of providing them with a little bit more structuredsocial opportunities and back up. we know about supported employment but atthis point that just falls through the cracks. peter salgo)will we cure this? susan hyman)no. catherine lord)it would be so wonderful. susan hyman)i think but if you think about a cure you get so caught up that you can’t treat it.

that if you can’t take one step at a timeand as tom has described treat the next thing on the horizon, if you have you’re, youknow obviously we don’t want anyone to have autism except as it enriches society. we have interventions and we’re lookingfor interventions and we’re looking for ways to treat each of the component parts. peter salgo)let’s take a break just for a moment because there’s some things i think we really shouldsum up. there is no cure for autism spectrum disorderbut therapies and behavioral interventions can remedy specific symptoms and bring aboutsubstantial improvement.

the ideal treatment plan coordinates therapiesand interventions that meet the specific needs of individual children. most health care professionals agree thatthe earlier you intervene the better. fair enough? let me tell you a little bit more about harry. he’s receiving both cognitive behavior andtalk therapy to help him manage his emotions and he seems to be showing improvement inhis kindergarten setting too. now in the few seconds we have, i don’twant to put any time pressure on you, but i’m going to give you the last word.

what advice do you have for families facingthis diagnosis, autism? (tom mcgurk)number one is when you hear it don’t be afraid of it because there have been so manydevelopments even within the last ten years. number two; get help immediately because ifyou start therapies with your child and there’s nothing wrong with him all you’re doingis making him smarter but if you wait you’re harming him by not admitting to yourself thatthere might be a problem. number three would be, it takes a village. if people who know people have a neighborwho has a child with autism the best thing you could do is go over, introduce yourselfand say i understand your child has autism.

i’d love for our kids to play together buti don’t know how to do it. open up that door so that people can starthelping out because that’s when the kids start to develop as well. even if they’re lower functioning thosekids love to be involved. it’s just that it’s not the way that you’renormally used to seeing things. peter salgo)i’m going to speak for all of us here, your america’s dad. you’re great. (tom mcgurk)and most of the guys who i know have kids

with autism; this is the way we are. peter salgo)i think you’re being too generous but i hope you’re right. (tom mcgurk)thank you. peter salgo)thank you all for being here but unfortunately we are out of time. if you’d like to continue this conversationand i hope you do, please go to our website. there you are going to find the transcriptof this show, more videos about autism, and links to resources.

the address is secondopinion-tv.org. thanks for watching, thank all of you forbeing here and you, and you just spectacular. it’s hard to talk about this sometimes andyou shared it with us, i think it’s just been great. (tom mcgurk)well thanks for the opportunity. peter salgo)you’re more than welcome. i’m dr. peter salgo and i’ll see you nexttime for another second opinion.