Leslie E. Carter, Ph.D.

Contact Information

Plaza West
9600 SW Oak Street, Suite 325
Tigard, OR 97223
(503) 807-7413
Click here for a map to this location.
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DrLeslie.Carter (503) 935-5884 (503) 807-7413 (503) 807-7413



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Page Index

• Directions to Office
• Autism & Asperger's Parents Support Group
• How to be Happy with an Autistic Child
• Asperger’s Syndrome: Natural steps toward a better life
• Life Planning Class for Asperger's Young Adults
• Keeping Your Loved Ones Safe
• Diagnosis of Asperger's Disorder
• Is the GFCF diet the right choice for my family?
• How to Convert Your Favorite Receips to GFCF
• Healthier Gluten Free Chocolate Chips
• Ideas for Parenting Special Needs Children
• Links to Resources
• Email Form


From Downtown Portland: Go South on I-5 past the Tigard Exit to Hwy 217. Turn right (North) on Hwy 217. Go to the Greenburg Road Exit (third exit). Turn right on Greenburg Road. Immediately turn right on the first street (Oak Street). Turn right into the first building's parking lot, which should be the Plaza West Building. Plaza West is a five story white concrete building easily seen from the freeway or street. Come inside and up to Suite 525.

 

From Beaverton or Hwy 26: Go South on Hwy 217 toward Tigard. Take the Greenburg Road Exit. Turn left onto Greenburg Road. Cross over the highway and turn right on the first street (Oak Street). Turn right into the first building's parking lot, which should be the Plaza West Building. Plaza West is a five story white concrete office building easily seen from the freeway or street. Come inside and up to Suite 525.

 

From Sherwood or 99W: Go east on 99W to Greenburg Road in Tigard. Turn right on Greenburg Road. Immediately after the Hwy 217 overpass and the third traffic light turn right onto the first street (Oak Street). Turn right into the first building's parking lot, which should be the Plaza West Building. Plaza West is a five story white concrete office building easily seen from the freeway or street. Come inside and up to Suite 525.

 




AUTISM, ASPERGER'S,
PERVASIVE DEVELOPMENTAL DISORDERS,

AND RELATED CONDITIONS

PARENTS AND CAREGIVERS
SUPPORT GROUP


MEETS THE FIRST THURSDAY OF THE MONTH
FROM 7:00 TO 8:30 PM

FREE OF CHARGE

 

This professionally facilitated group will focus on support regarding resources, diet, stress management, parenting, productive expression of grief and frustration and other topics.

Address: 9600 SW Oak Street, Suite 525 , Tigard, OR 97223
(just off
Greenburg Road near Hwy 217 and Washington Square Mall)

For information contact Leslie Carter, Ph.D. at (503) 807-7413.




How can I be Happy when I have an Autistic Child?

By Dr. Leslie Carter

(503) 807-7413 www.DrLeslieCarter.com

I am often asked, “How can I be happy when I have an autistic child?”   I am a parent of an autistic child.  Some days are very difficult, trying and sad.  Others days seem more routine and less stressful.  I have come to accept that my family life will always be different from other families because of autism.  I do not love autism, but I do love my autistic child.  I have come to accept that some autistic children get better and others do not.  If my child does not get better is not my fault.  I have tried many different treatments to help him get better.  Other treatments are too expensive, experimental, or far away to try.  I have spent more hours than some parents trying to help my child and spent fewer hours than some parents.  I am only human.  In times of acceptance, I find peace and happiness.   

I have come to accept many things about life with autism:

1)      I accept that I am raising an autistic child.  I may not always like it, but it is a fact of my life.

2)      I do not love autism, but I do love my autistic child.  I will do my best to care for and love him/her as I would any other child.   

3)      I accept that raising my autistic child may not be an 18 year project, but may be a 30+ year project.  I cannot wait to start caring for myself or living my life until he/she moves out.  I must find balance in my life now.  

4)      I accept that this is not a sprint to the finish, but a marathon.  I pace my progress along the way so I don’t get burned out.  I am never critical of someone who is tired of parenting their autistic child.  It is very difficult. 

5)      I accept that even though my child may not show much love I will find ways show my love to them anyway.

6)      I accept that I am the parent and when my child is having a bad day I must be the bigger person.  I enforce sensible rules they can understand.  I forgive their angry outbursts, just like I forgive my own.  I try not to hold grudges.

7)      I accept that sometimes I must be my child’s advocate.  Nobody else is going to do it. 

8)      I accept that my greatest challenge is to help my child discover what his/her strengths/gifts are and learn to embrace them.  This is the mystery of autism.         

9)      I accept that ultimately I am responsible for deciding what treatment my child does or does not get.  Autism is not well understood.  There are lots of different types of treatment.  No one knows for sure what is best for any child.   

In times of acceptance, I find peace and happiness.




Asperger’s Syndrome: Natural steps toward a better life

A book review by Dr. Leslie Carter, Tigard. Oregon (503) 807-7413

 

            As the sudden increase in Autistic children has gotten more media focus the news spot light also begins to pan onto the higher functioning cousin of Autism – Asperger’s Syndrome.   Asperger’s Syndrome is a relativity new diagnosis coming into use in the psychiatric community in the 1990s.  Asperger’s is associated with focused interests and excellent memory as well as problems with social awareness and difficulties keeping conversations going.  While Asperger’s individuals have some hall mark symptoms in common with autism their medical profile is often less severe and therefore more subtle.  Asperger’s individuals can struggle with reflux, constipation, air born allergies or just a proneness to get sick often and recover more slowly than others.  These problems can wear down affected people, contribute to difficulty holding jobs, and add to the isolation that people with Asperger’s already struggle with.   

There is an understanding that like autistic people some Asperger’s individuals also have medical problems, but few authors have written specific medical recommendations for the Asperger’s population.  Dr. Suzanne Lawton in her book “Asperger’s Syndrome:  Natural steps toward a better life” has met this challenge.  She is a skilled naturopathic physician with many years of experience treating adults and children with neurological conditions like Asperger’s, Autism, Attention Deficit Disorder, and other learning disabilities.  She is a leader and instructor at the Learning Disabilities Clinic at the Northwest College of Naturopathic Medicine in Portland, Oregon.  Her text sorts out what currently appear to be the most important medical problems seen in the Asperger’s community.  She provides clear instruction in dietary and naturopathic interventions that are easy for most people to understand.  She provides antidotal examples and research citations for why her treatment recommendations are sound.    She uses medical terminology skillfully, defines her terms and clearly explains her suggestions.

As a psychologist this approach has changed my referral strategies and hope for many of my clients.  For years I have viewed the irritability, emotionality, frequent illnesses, low stress tolerance, and occasional psychosis among Asperger’s individuals as psychological symptoms to be treated.  The treatment approach outlined in this book can ease the Asperger’s anxiety, rigidity, and irritability making clients feel better and be more open to life changes that I as a psychologist might suggest.  Some of these symptoms may be medically based problems that naturopathic techniques can gradually heal or control.  Psychosis, delusions, agitation, and paranoia sometimes seen in Asperger’s or other psychiatric populations may have natural treatment options that have fewer side effects than traditional pharmaceutical approaches.  More treatment options help me guide clients to solutions that match their values and help them feel better and respond more flexibly to psychotherapy.           

For those who are hesitant about drug based treatments or short on cash, Dr. Lawton’s commitment to naturopathic and herbalistic approaches will be a welcome departure from the norm.  Many individuals on the Autistic spectrum are sensitive to medications, so minimal use of pharmaceuticals can be particularly beneficial.  Dr. Lawton is also very conscious about the cost of any treatment and offers inexpensive or free options for diagnosis and treatment whenever possible.          

Although Dr. Lawton’s book does not replace direct consultation with a naturopathic physician it provides important guidance for both the clinician and patient about where to look among the reams of data coming from the Autism community that appear to be most relevant to the Asperger’s patient.  Her opinions, in my experience, are well balanced between providing new innovative information, but do not go past the cutting edge so that the reader is guided into completely uncharted territory or fields based strictly on medical conjecture like other authors.  This book provides a fresh perspective for living better with Asperger’s that gives hope to many chronic suffers and can improve the sense of well being for many affected individuals.  More clinicians, patients, friends, and family need to learn these treatment priniciples so they better understand their treatment options.                

 




 

The

After School . . . Now What?

Group

 

 

    How do I manage money?

    How do I handle friendships?

    College? Job? Work? School?

    How do I live on my own?

    Keeping myself safe?

 

Tools for young adults (17–25 years) with Asperger’s, high-functioning autism, or pervasive developmental disorders.

 

 

Call for the Next Group Schedule

 

 

$50 per 90-minute group meeting for 11 weeks.

Skills Notebook and other materials included.

Insurance billing available.

 

 

 

For more information or to schedule a screening interview, contact:

Peggy Piers, M.Ed. (503) 977-2411

or Leslie Carter, Ph.D. (503) 807-7413




Keep Your Loved Ones Safe

By Leslie Carter, Ph.D.

Tigard, Oregon

(503) 807-7413

 

Sometimes in the news we hear sad stories about a child or an aging grandparent wandering away from home and getting lost.  If you have a family member who might not be able to find their way home or would not be able to say their address to police there are ways to protect them.  The people who really need this type of help are people who can not talk well, have bad memory, or who wander away from home sometimes.

 

    
  1. Register your family member with the 911 emergency services system.  This way police and firemen will know if a person who sometimes wanders away lives in the area.  In Oregon, you can call the business phone number for the local Fire Department.  They will take your information and do this for you.  They will call you each year to make sure the information is the same.

 

    
  1. The Fire Department will also send you a red card in the mail.  Fill out the red card and put it on the refrigerator of the home where your loved one lives.  The card will include name, address, phone numbers, health problems, medicine, and other information.  When firemen or other emergency workers come into a home they are trained to look for the red cards.  These cards help them know how to care for your child or aging parent if you are not able to help when they arrive.

 

    
  1. Put an identification bracelet on person that lists name, address, phone number.  These are available on-line through many sites like:   (list some)

 

    
  1. Give them a small card they carry in a pocket that lists names, addresses and phone numbers of family and friends who can help them if they are lost or in trouble.  It can look like a business card.  Train your family member to give people the card when they are asked, “Who are you?”.

 

Having a family member who can not talk or who has memory problems can be stressful.  Doing the things listed above does not guarentee that during an emergency your loved will be safe, but every little bit helps. 




Asperger’s Disorder:  The Diagnosis Beyond DSM-IV

By Dr. Leslie Carter

 

While the most common diagnosis for children in the Pervasive Developmental Disorder category of DSM-IV is Asperger’s Disorder, few clinicians understand how to diagnosis this condition with confidence.  Furthermore, DSM-IV was published many years ago and clinicians who specialize in Asperger’s now understand the condition much better than the old DSM-IV diagnostic criteria suggests.  This article is intended to expand the clinician’s view of the Asperger’s diagnosis using our current level of understanding of the topic, knowing that the criteria ultimately published in the new DSM-V may be slightly different.

Social Functioning:  There is little argument that individuals with Asperger’s have difficulty making friends and tend to be viewed as socially odd.  A critical diagnostic feature of Asperger’s is the inability to easily use information provided through non-verbal body language.  People with Asperger’s often do not use body language to punctuate their own speech, which makes them appear stiff and unexpressive.  They also do not read other people’s body language well and often misunderstand social intensions.  Furthermore, many affected people have a poor ability to distinguish faces of friends from strangers.  In extreme cases, face blindness might be a problem.  There may also be a profound lack of understanding of the larger picture of social hierarchy (i.e., who is in charge).  So when an Asperger’s individual joins a circle of people talking, because of their social learning disability they often do not understand who is leading a conversation or whether they know those present.  They may not understand what their own role in the conversation should be.  They probably do not know how to insert their opinion appropriately into the conversation or what the emotional tone of the conversation is.  If they make a social error in the conversation they may not know how to fix the mistake.   

The Empathy Myth:  Many people have the misunderstanding that people with Asperger’s or Autism lack empathy or attachment to others.  Assuming that there is no history of severe abuse or lack of attachment opportunities young Asperger’s children are very attached and even emotionally dependent on their parents and caregivers.  They can have tender loving moments with those who know them well, just like other children.  Many children with Asperger’s don’t seem to be able to experience or understand the complexity of emotions that other children feel.  They understand happiness, sadness, fear and anger, but not the more complex emotions like teasing, contempt, and conceit.  This limited emotional repertoire is confused with lack of empathy at times as well.  Because they don’t use social gestures well they may need to be taught how to ask for hugs or use physical comfort when they are distressed.  If they have been abused, bullied, physically ill or overwhelmed by sensory problems Asperger’s children can become very distant, cold, and angry like any other child.          

Sensory Integration:  Many experts now agree that sensory integration problems contribute significantly to the anxiety, rage, temper tantrums, or isolation and detachment seen in child with Asperger’s or Autism diagnoses.  The concept of sensory integration, however, is better known in the fields of speech, vision, auditory, and occupational therapies rather than in psychology.  According to Jane Ayres, Ph.D. (2000) sensory integration is defined as “the organization of sensory input for use.”  She clarifies by saying, “The many parts of the nervous system work together so that a person can interact with the environment effectively and experience appropriate satisfaction.”  From this perceptive, Asperger’s is seen as a neurological disorder which can include dysfunction in the ability to be sensitive to and properly utilize the senses of hearing, gravity and movement (i.e., vestibular), muscles and joints (proprioceptive), touch, and vision.  The ability to properly integrate these senses is theorized to be the foundation onto which the proper use of basic skills like language, speech, balance, coordination, motor planning, eating, emotional stability, and emotional attachment are built.  Proper development of these basic skills is theorized to be required for successful use of even more complex experiences like good concentration, reading comprehension, mental organization, self control and even abstract reasoning to result.

Over Sensitivity:  Common in the diagnosis of Asperger’s is sensitivity to light, sound, touch, and texture in the mouth and on the skin.  Sometimes Asperger’s children appear odd because they wear sunglasses, hats or hooded sweatshirts at inappropriate times.  This can be a coping strategy for sound or light sensitivity.  During a classroom observation, I witnessed an Asperger’s child turn off the lights in his kindergarten classroom.  I intervened between the child and the enraged teacher who thought he was a trouble maker.  I asked the child why he had turned off the lights.  He said, “The lights are too bright.” This would be an example of light sensitivity particularly to florescent lighting.  Asperger’s children may wear odd clothing, because fashionable clothing does not feel good.  They may avoid hugs or physical touch from others because it makes their skin hurt.  They may be picky eaters because certain food smells or textures seem revolting.   They may suddenly scream and put their hands over their ears because some sound is overwhelming to them.  A very careful hearing examination of one child revealed that his bone conduction hearing was so sensitive that he could be overwhelmed by very low sounds that most humans do not even hear.  We discovered he tended to become irritable in class when the school heating system at the far end of the building started up.

Under Sensitivity:  Conversely, some children seem to be insensitive to some sensations as well.  Some individuals with Asperger’s are suspected of being hard of hearing due to insufficient sensitivity to sound.  Some children can be difficult to toilet train due to lack of sensitivity to the experience of being wet.  High pain tolerance may also be present.     

Motor Clumsiness:  In part, the senses of vestibular and proprioceptive functions are related to movement of the body and the sensation of joints.  Motor clumsiness can be a symptom of Asperger’s including: odd gait, poor balance, lax joints, poor rhythm, and problems synchronizing movements with others.  Associated with these problems can also be poor manual and fine motor dexterity including unreadable hand writing.  Learning to type on a computer is often a good solution for this problem. 

Compulsive Behaviors:  DSM-IV describes one group of Asperger’s symptoms to include repetitive patterns of behaviors, interests and activities (i.e., obsessive compulsive symptoms).  They may have preoccupations with focused interests.  In higher functioning or older children this symptom may take a more socially appropriate form like compulsively collecting facts and items associated with Japanese Anime, Star Wars, or Lord of the Rings movies.  In younger children it can be associated with unusual interests like manhole covers, plumbing fixtures, or street signs.  Nonfunctional rituals can develop surrounding these interests.  For example, a child may run from their mother’s arms into the street to compulsively read the label on a manhole cover.  Or a child interested in plumbing compulsively flushes the school toilets due to the desire to repeat the visual sensory experience of the whirling water (light) while holding their hands over their ears (sound).  Asperger’s individuals may also have repetitive motor mannerisms.  They may chew on string, twist their fingers, flex their hands or other behaviors.  We now understand that many of the seemingly “nonfunctional” repetitive behaviors described in DSM-IV in fact have basis in sensory integration problems.  When a child performs repetitive activities in some cases they may be trying to put together some sensory experience (i.e., treating themselves) giving the symptom a useful function. Often therapists can help Asperger’s children identify the function that a behavior serves and provide a more acceptable or mature alternative behavior, thus helping the child fit in better socially.

Detail Oriented Cognitive Style:  Most people with Asperger’s take a very detail oriented approach to life.  When you live with sensory integration problems the details are important.  These children may tend to use toys in a very repetitive way.  They may line toys (e.g., cars or horses) up into displays to be admired, but not to be played with in an imaginative fashion.  Some very young children may enjoy spinning the wheels of an upside down car rather than rolling it on the floor.  Often this is again a type of sensory play. 

Thinking from the Bottom Up:  A complexity this detail orientedness can cause in school or work settings is a tendency to loose track of the conceptual whole of a project or the “point” from other people’s perspectives.  Many students are taught in school to organize essay assignments using outlining.  Using this method of organization, a writer starts with the main thesis or point, builds in sub topics, and then adds interesting details to flesh out the paper.  This is an example of “Top down” thinking.  Individuals with Asperger’s may not think this way at all.  They may know the general topic or thesis they have been assigned to write about very well.  Their natural tendency, however, is to build from their vast fund of details up to the general thesis.  The problem is that it is also possible to become sufficiently distracted by the details that they loose track of the point of the paper or create a paper on a totally different topic accidentally.  Some intellectually gifted students with Asperger’s have IEP support in paragraph organization and paper writing for this reason.  One benefit of this thinking style is that they are very skilled at writing procedures for how things should to be done, but not necessarily writing a coherent creative story.

The Gift of Memory:  The blessing of being detail oriented is that people with Asperger’s are often gifted at rote visual or auditory memory.  They are unbeatable at games of trivia in their field of interests.  They love to talk about their favorite topics and can have encyclopedic knowledge in those areas.  This memory skill, however, can also result in over-estimation of intelligence and emotional maturity.  If they can find employment in the area of their interests they can quickly become experts in their field.  Children may play repetitively by reciting scripts from movies or reenacting favorite scenes.  Some children use this memory skill to teach themselves to read during preschool years.  Often this early reading is learned using whole word visual memory (i.e., remembering the word as a whole piece) rather than sounding the word out phonetically.  These skills can make some Asperger’s children precocious readers (e.g., 5th grade level readers while in kindergarten) and spellers.   Often this early reading advantage is lost by middle school years.  Be aware that despite these children’s ability to read older children’s material it is important that they read material appropriate for their level of emotional maturity.

Disorganization:   Despite great memory skills, many people with Asperger’s are quite disorganized.  Many children with Asperger’s are initially diagnosed with Attention Deficit Disorder in early grade school until their lack of social skills become more obvious in late grade school or middle school.  They may struggle to learn money and household management skills.  Other life skills may need to be specifically taught, like use of the bus systems, how to organize homework, etc.  This problem can be a major impediment to employment for some people.       

            Use of Language:  Although DSM-IV specifically defines Asperger’s Disorder as not including language delay symptoms we now understand that this may not be completely accurate.  History of speech delay in early childhood can be present in some Asperger’s children.  Their current language may use an odd tone of voice, pitch, or rhythm.  Asperger’s children may choose very formal sounding language, avoid slang words, not understand the double meanings in jokes, and have a very literal understanding of language.  They may not understand the more abstract meanings of words and phrases like “might not”, enough, estimate, “judgment call”, “wave the right” (to an attorney), etc.  They may also not understand instructions that rely heavily on the use of pronouns (e.g., you, me, I, and we).  Children with Asperger’s can become angry and accuse teachers or parents of lying because they did not follow the letter of what they said.  When an Asperger’s child says a person’s nose is big or a picture is ugly; it probably is.              

            Emotional Reactivity:  Many children with Asperger’s can be very emotionally sensitive and over reactive.  They can have temper tantrums and rages easily.  These strong emotions often result from sensory over load (e.g., exposure too much noise in cars), granting control to adults or confusion about understanding language.  While it may be tempting to suspect Borderline Personality, Bipolar, or manipulative tendencies often these concerns are not justified.  Manipulative tendencies, in particular, are not common in this population because they are such literal thinkers and blunt speakers.  It is important to know that children with Asperger’s may appear to be talkative and fluent in their use of language, but when emotionally overwhelmed their ability to speak can be greatly reduced or completely lost until the upset passes.  If this happens it can be very frightening to the child; quiet, patient support until it passes (e.g., usually a few minutes) is best.        

Medical Complications:  Many clinicians are unaware that as much as 60% of the Autistic/Asperger’s population may struggle with rarely diagnosed chronic gastrointestinal problems.  Harvard Medical School is currently organizing a national research project and database to better track, diagnose and teach physicians about the seriousness of these intestinal endopathies and malabsorption conditions.  Symptoms of these conditions include: poor sleep, being awake at odd hours of the night, pale skin complexion, dark circles under the eyes, fatigue, chronic gas, constipation, bowel pain, irritable bowel syndrome, reflux, and nausea.  When these conditions are not adequately treated children can show anxiety, hyperactivity, inability to relax, fatigue, anger and irritability, confusion, forgetfulness, odd giggling, or worsening of sensory integration symptoms.  Associated conditions include: Celiac Disease (inability to digest gluten (a protein found in most grains)), Crones Disease (difficulty digesting food fiber), Malabsorbtion (difficulty absorbing vitamins, minerals, and other components in food), food intolerances (e.g., sugar, dairy, wheat, gluten, or soy), yeast infections (that only manifest themselves inside the body), poor liver and kidney function, and epilepsy (rates as high as 25% with onset in adolescence).  Since the majority of physicians still have little information about the prevalence of these conditions in the Autistic/Asperger’s population and have little knowledge of nutritional interventions, naturopathic physicians do much of this type of treatment.  An organization called Defeat Autism Now (DAN) has piloted a medical protocol for these conditions.  The DAN website lists doctors in each state that have developed expertise in their treatment protocol.  Other groups have developed similar treatment protocols as well.   

Evaluation Tips:  One of the unique symptoms of Asperger’s and many Pervasive Developmental Disorders is the inability to read social cues.  A fairly reliable method of assessing this skill is to give the Roberts Apperception Test or some similar task.  The Roberts, like the Thematic Apperception Test (TAT or CAT), has gender specific pictures of social dilemmas.  The child is asked to tell a story about each picture.  Asperger’s individuals often have significant difficulty accurately identify the emotions present based on the non-verbal cues present.  Furthermore, their stories are often weak in plot and content.  Remember, Asperger’s children often can repeat stories that they know, but will rarely give creative original stories.  An exceptionally low Weschler Picture Arrangement subtest score can suggest related social sequencing problems.  Listen for the tone of voice, odd rhythm, pitch, literal use of language, and problems with pronouns.

The Asperger’s Syndrome Diagnostic Scale (ASDS) is a short check list that can be used to guide interview questions.  It can be used to help clarify the likelihood of an Asperger’s diagnosis and includes many of the sensory and cognitive symptoms listed in this article.   

Medical problems can be diagnosed by a knowledgeable naturopathic or medical physician.  Sensory integration problems can be interviewed for and observed.  Appropriately trained audiologists, occupational, and speech therapists will be able perform a more formal sensory integration evaluation and provide treatment guidelines.

Other Diagnostic Considerations:  Other conditions to rule out when considering Asperger’s as a diagnosis include: Attention Deficit Disorder, Obsessive Compulsive Disorder and Obsessive Compulsive Personality, Cluster A Personality Disorders (e.g., paranoid, schizoid, and avoidant), Tourett’s Syndrome, Tic Disorders, Anxiety Disorders, Nonverbal Learning Disability, and Social Phobia.  Some adults with Asperger’s have old diagnoses of Schizophrenia.  When Autistic or Asperger’s individuals become extremely stressed and regress their reality contact can change, they may compulsively recite memories to themselves, become paranoid and withdraw.  Sometimes during these episodes Schizophrenia can be diagnosed.  When evaluating individuals with Asperger’s it can be tempting to list all of the Asperger’s symptoms in other formal diagnosis (e.g., Asperger’s Disorder, ADD, OCD, Anxiety Disorder, NOS, Avoidant and Schizoid Personality Disorders).  Given the significant impact of our diagnostic paper trails on children’s lives and this broader understanding of Asperger’s symptoms I prefer to list the impairments present in the text, but no over label a child.              

High Functioning Autism versus Asperger’s Disorder: Many clinicians ask, “What is the difference between high functioning Autism and Asperger’s Disorder?”  DSM-IV suggests that significant language delay in preschool years is a characteristic of Autism, but not Asperger’s.  Tony Attwood, a leading expert, offers the interesting perspective that Autism and Asperger’s are different ends of the same continuum of symptoms (i.e., Autistic Spectrum).  He has observed that some children are originally diagnosed with Asperger’s symptoms.  Other children can have the history of low functioning or classic Autism (e.g., age 2), mature into higher functioning Autism (e.g., age 11), then seem indistinguishable from Asperger’s later in life (e.g., age 30).  Dr. Attwood, stated in a recent training video that the difference between high functioning Autism and Asperger’s is “the way they are spelled”. 

The movie Napoleon Dynamite is a good study of two Asperger’s brothers becoming men in a small town.  It affectionately shows the characteristic strengths and weaknesses of these people.  They can be socially naïve and yet loyal friends.  They can be brilliant and passionate in their favorite topics and yet become paralyzed by fears of the unknown.  They can be brutally honest and demand that we speak truthfully as well.  When they function well they can be good parents, spouses and friends. 

I am constantly struck by how hard this population works to try to do what the rest of us do fairly easily; make friends and be accepted.  A little understanding can go a long way.           




Is the GFCF diet right for my family?

Autism, Asperger’s and the Gluten Free Casein Free (GFCF) Diet

 

By Dr. Leslie Carter

(503) 807-7413  www.DrLeslieCarter.com

                                           

I am often asked, “Is the GFCF diet a good choice for my child with Autism?”  The answer to this question needs to be decided by each family.  Here are some of my ideas for thinking about this decision. 

The Gluten Free Casein Free (GFCF) diet helps the gut problems found in 50 - 70% of people with autism.  People who try the GFCF diet must not eat food with gluten or casein in them.  Gluten is a protein found in wheat, rye, barley, oats, triticale, and spelt.  Casein is a type of cow’s milk protein.  The GFCF diet might help people who have stomach pain, gas, constipation, bloating, or diarrhea.  These people often get sick after they eat or have trouble sleeping.  Sometimes these people do not eat very many foods.  They may eat too much milk or bread than is healthy.   They might get a red face or ears after eating.  They can also have dark circles around their eyes.   

Not everyone who needs the GFCF diet has to eat this way for life.  Most people who need the GFCF diet only need to be on it for one or two years.  By not eating gluten and casein the stomach can get well.  After healing happens they can try eating wheat or milk again.  If they do not get sick then it may be safe to eat wheat and milk again.  Some people, however, have many people in their family who cannot eat wheat or milk.  For these people the GFCF diet may need to be life long.     

People with Asperger’s Syndrome often feel better with changes in their diet too.  They can usually eat more types of food than autistic people can.  People with Asperger’s Syndrome may only get sick from one or two types of food.  The most common problem foods for these people are wheat, milk or sugar.  Most Asperger’s people can eat gluten without getting sick. 

If you think a person in your family is sick always try to see a doctor.  Not all doctors know about these types of stomach problems or how to treat them.  Ask your regular doctor (pediatrician, internist, or family practice doctor) about this first.  He or she may want you to a specialist.  Gastroenterologists (medical doctors who specialize in stomach and gut problems) can help spot some of these problems. Naturopathic physicians (ND’s) also know about how diet can help gut problems.  Both types of doctors can do tests to find out if you are sick.  

When a food makes a person sick they may have a food intolerance.  Food intolerances may be caused by gut problems.  They often cause diarrhea, gas, constipation and many of the problems listed above.  Food allergies are different.  For example, a person with a peanut allergy can get a skin rash or have breathing problems if they eat peanuts.  Autistic people may have both food allergies and intolerances.  This article, however, is mostly about food intolerances.  A dermatologist or allergist (i.e., an MD specializing in skin problems or allergies) can test for allergies. 

It is possible to get tested for food intolerances to find out if diet changes would be useful.  A blood test testing for IGG mediated food intolerances is often used and can be requested through a doctor (e.g., MD or ND).  This test will show a list of foods eaten recently and the degree a person seems to be sensitive to them.  Some NDs also offer electro dermal testing of food intolerances, which gives quick results and does not require a blood to be taken.  Both types of tests are estimated to be accurate at about 85%.  Remember food intolerances are only one reason to make diet changes.   

Because testing takes time, is costly, and is not 100% accurate some families decide to try the diet without formal testing.  There is no problem with this approach.  Because, however, the stomach and gut illnesses that make diet changes needed are very serious and can be life threatening, having a doctor (MD or ND) help with treatment (whether testing is done or not) is strongly recommended.  If you live in the country, many doctors will talk with out-of-town families using the Internet or telephone after meeting them in person once.  This type of arrangement can help keep travel costs down.  For a list of doctors who may be able to help see www.cgiworker.com/danlist/danlist.html.

Sometimes treatment includes the use of nutritional supplements, large doses of vitamins, and minerals (more than an over-the-counter multivitamin) in addition to diet changes.  I do not recommend anyone use nutritional supplements or large doses of vitamins and minerals without the direction of a doctor who is trained in their use.  Nutritional supplements, vitamins and herbs are real medicine and should be used carefully.

While diet changes can be complicated so can taking care of a person with autism when he or she does not feel well.  If a family member has the symptoms listed about see a doctor of your choice who is good at this type of treatment to see if it might make a difference for your family. 




How to Convert Your Favorite Recipes to Gluten Free/Dairy Free

By Dr. Leslie Carter  (503) 807-7413 www.DrLeslieCarter.com

My family converted to mostly gluten free dairy free cooking about 8 years ago when my son was diagnosed with a celiac like gastric condition.  Later, my husband was diagnosed with a similar condition.  It took quite a while to learn to bake gluten free.  I found Bette Hagman’s cookbooks The Gluten Free Gourmet and Lisa Lewis’ cookbooks Special Diets for Special Kids invaluable.  Having been a “from scratch” cook most of my life I eventually missed my favorite recipes from childhood which I could not find good matches for in gluten free cookbooks.   So I worked out a method that is usually successful in converting many of my favorite quick bread or baking powder/baking soda based recipes to GF/CF. 

Let’s take a minute to understand gluten free flour.  Gluten is a protein found in wheat flour and other grains which helps wheat flour rise and stick together nicely.  Without gluten cookies and muffins are crumbly, dry, and fall apart.  Unfortunately, there is no single flour which completely copies what wheat does so easily.  While there are many gluten free flour recipes available I have discovered two favorites both from Bette Hagman.  One is a pastry flour mix which is rice flour based.  It is sweet and light in flavor.  I use it for cookies and cakes or projects where children want to eat the dough.  The other flour mix is garbanzo bean based.  It has a hearty nutty flavor and adds protein.  This flour, however, tends to taste bitter until cooked.  So batter or dough tasting is an acquired taste when using a bean flour mix.  These mixes are as follows:

Bette Hagman’s Gluten Free Featherlight Rice Flour Mix (Pastry Flour):

1 Cup Rice Flour, 1 Cup Tapioca Flour, 1 Cup Corn Starch, 1 teaspoon per cup potato flour.  (Sometimes I can’t find potato flour.  I find leaving it out works ok.) 

Bette Hagman’s Gluten Free Four Flour Bean Flour Mix:

2/3 Cup Garbanzo bean flour or combined Garbanzo/Fava Bean flour, 1/3 Cup Sorghum Flour, 1 Cup Corn Starch, 1 Cup Tapioca Flour.    

Bob’s Red Mill sells a Gluten Free Baking Flour Mix which is very similar to the bean flour listed above. 

Gluten Free recipes don’t rise as well as wheat based recipes.  So I usually double the baking powder the wheat based recipe calls for when cooking gluten free.  If a recipe calls for baking soda that is not complimented with vinegar in the same recipe then I change it to baking powder.  For example, some chocolate chip cookie recipes call for both baking soda and baking powder.  I have had little success using baking soda in gluten free baking. 

Because gluten free baking needs help to stick together and not get crumbly Xanthan gum is commonly used.  It helps the cookies or muffins rise as well as stick together.  Add ¼ teaspoon Xanthan gum for each cup of flour your recipe calls for.  The average cookie recipe calls for about 2 cups of flour so adding ½ teaspoon Xanthan gum should be about right.  Gluten free cookies, muffins, and cakes can easily become tough and rubbery.  My experience has been that this problem is usually caused by over mixing after the Xanthan Gum is added.  It is, after all, a gum.  Once Xanthan gum or any other gum is added very little stirring is recommended after that.  As a result I hold the gum until all mixing is done and sprinkle it on top of the dough or batter.  Gently mix it to the dough or batter using 5-10 strong stirring strokes then prepare my project for baking as needed. 

Converting a recipe to dairy free is relatively easy with all the new products available these days.  I use a dairy free margarine in place of butter or dairy based margarine.  I like Earthbalance stick margarine for baking.  It is soy based.  Tub margarines often have a lower melting temperature and therefore do not work as well for baking as stick margarine.   Earthbalance and other companies also have dairy free shortening substitutes as well.  Replace milk with the dairy free drink of your choice.  Almond, soy, coconut, or rice milks all work fine.  If your recipe calls for sour milk use a 1-2 teaspoons of rice vinegar to sour the milk substitute you choose.   There are also several companies that offer chocolate chips and cocoa powders these days that are dairy free as well (e.g., Ghiradelli, Dagoba, Woodstock farms).  Regrettably, Baker’s Chocolate has not created a dairy free option yet for its baking chocolate squares or its German’s Chocolate yet.  I can always dream. 

Usually pan preparation, baking temperature and time remain the same.  Use a toothpick or knife to check if muffins or cakes are done.  Brownies and cookies that remain soft when they are eaten are the most difficult to decide baking time.  Do not over bake them.  When in doubt bake a shorter period of time and put the project back into the oven if needed.    

So in summary, to convert a recipe to GF/CF perform the following steps:

1)      Double the baking powder

2)      Use a gluten free flour mix

3)      Use dairy free milk and margarine substitutes as needed

4)      Add ¼ teaspoon Xanthan gum per cup flour, but stir in the Xanthan gum last after all other ingredients are already mixed in. 

5)      Bake at the same temp and about the same amount of time.

Remember converting a recipe is tricky.  It may take several trials to get the recipe just right.  We keep a notebook in the kitchen of all the converted recipes or we write the changes into our recipe books.   This method of record keeping allows us to remember what worked last time and make progressive changes if needed.  Be patient.  It will probably be worth the small amount of trial and error needed to get a recipe right.  Allow your taste buds to adjust.  The flavors probably will not be identical, but should be close.  Good Luck!!   

                                     




Healthier Gluten Free/Dairy Free Chocolate Chip Cookies

 

From the kitchen of Dr. Leslie Carter

(503) 807-7413 www.DrLeslieCarter.com

I took these cookies to on a group camping trip to accommodate some children with special diets.  Almost everyone liked these cookies better than the traditional Tollhouse cookies that were also provided. 

1 Cup Earthbalance stick margarine or some other heathy margarine with good baking qualities.

¾  Cup White Sugar

¾  Cup Brown Sugar

2 eggs or egg replacer

1 teaspoon Vanilla

1 Cup almond meal or Flour

1 teaspoon baking powder

1/3 cup + ¼ cup Rice flour

1/3 cup + ¼ cup potato starch

1/3 cup + ¼ cup Corn Starch

½ Cup Sorghum flour

1- 2 Cups Dairy Free Chocolate Chips (like Ghiridelli, Woodstock, Dagoba)

½ teaspoon xanthan gum
Put the first five ingredients (margarine, sugar, eggs, vanilla) together in a bowl and using an electric mixer beat them until creamy.  

Then measure the flour, baking powder, and almond meal into the bowl and beat until well mixed.  Do not over mix.  With a spoon gently stir in Xanthan gum and 1-2 cups good quality chocolate chips.  Grease cookie sheet with margarine or bake on parchment paper on a cookie sheet.  Bake at 375 degrees for 7 – 11 minutes.  Cool on cooling rack. 

Note:  This flour mixture is complicated.  You can also use 2 ¼ Cups Bob’s Red Mill Gluten Free Baking Mix Flour, but the cookie dough tends to taste bitter until it is cooked due to the bean flour.   You can also make these cookies using 2 ¼ Cups wheat flour, just leave out the Xanthan gum and the GF flours (rice, potato, corn, and sorghum).    

 

 

 




Ideas For Parenting Special Needs Children

Leslie Carter, Ph.D.

(503) 807-7413         www.DrLeslieCarter.com

 

Communication:

1)     Use names for people and objects not pronouns (e.g., he, it, I, you).

2)     Keep it short and simple.  No abstract language. 

3)     Check for Understanding.  Don’t just assume they got it.

4)     Use social stories, pictures, or PECs if needed. 

Behavior: 

1)     Set a few simple rules that you can easily enforce or that are really important.

2)     Post the rules and the related consequences somewhere in the house.

3)     One place for each task if possible.  One place to study.  A different place to sleep, etc.

4)     Have a household schedule that is more or less consistent.

5)     No surprises.  Let your child know the plan for the day with a visual schedule if possible.  

6)     Let your child have a few minutes to finish one task before being required to move to the next task (e.g., 5 minutes).

7)     Eat on a regular schedules.  Give more protein and less sugar and carbohydrates. 

Emotions:

1)     Temper Tantrums happen.  Have a safe place to have them where no one gets hurt.

2)     Generally, an adult should stay nearby, but out of arms reach during a temper tantrum. 

3)     It is your child’s responsibility to calm down from the temper tantrum.

4)     Keep yourself calm during a temper tantrum.  Don’t make things worse.   

5)     Use a stress thermometer or red and green signs to monitor stress levels. 

6)     Teach your child to know their stress level and what to do at each level.

7)     Teach your child’s support people what to do.

8)     Hitting and damaging property is not OK.

9)     Children mimic what parents do.  Don’t expect your child to behave better than the adults in their environment.  The adults are the role models. 

10)Keep your cool. 

Compulsions:   

1)     Limit TV, video games and electronic media to 2 hours a day or less. 

2)     Be consistent and firm with rules.  Give an inch and they may take a mile.

3)     Children must learn that special displays or projects need to remain in designated areas.

4)     Use access to favorite activities as a reward for doing things you want done.

5)     Help your child learn good life skills by starting good habits young (e.g., toothbrushing, bathing, hairbrushing, setting the table).  Use their compulsiveness to your advantage.

6)     Most children can learn simple chores to help around the house (e.g., taking out small trash cans or setting the table or helping pick up toys).

7)     Teach flexibility.  Your child should allow others to help them or move objects or change things without huge upsets.   

8)     All good things must come to an end or get put away.  Learning limits is important.

School:

1)     One year at a time.  Evaluate your IEP and child’s placement each year. 

2)     Know your rights and advocate for your child as you need.

3)     Be willing to think out of the box.  (e.g., Alternative school, tutoring, PCC). 

4)     Get help if you don’t know what to do.

You and the Rest of the Family:

1)     This is a marathon not a sprint.  A burned out parent is of little to use to the child.  Self maintenance is critical.

2)     Do not forget siblings.  They need attention too and can have emotional reactions to their special needs sibling and his or her behavior.

3)     Maintain your marriage.  Raising a special needs child is easier with a partner who understands. 

4)     Get family education if it is needed to get everyone on board with the treatment plan.

5)     Know when you need help.  Many times it is very beneficial to hire people to help with problem behaviors.  Sometimes agencies can help pay for this.  Know when there is not enough of you to go around. 

6)     Don’t blame yourself for your child’s problems. 

Remember:

 We are only the first or second generation to be keeping special needs children (some very impaired) in our homes with little or no government funding or professional support.  

 

 

Leslie Carter, Ph.D. (503) 807-7413 www.DrLeslieCarter.com




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