---
title: "Autism Services | Diagnosis and Support | Sutter Health"
description: "Sutter’s autism services provide autism spectrum disorder (ASD) evaluations, early intervention and personalized treatment to help people thrive at every age."
url: "https://www.sutterhealth.org/services/autism"
---

1.  [Home](https://www.sutterhealth.org/) /
2.  [Services](https://www.sutterhealth.org/services) /
3.  Autism services

![Smiling father holding his joyful young child outdoors, representing the positive impact of early intervention for autism.](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealth/Images/Hero-Images/autism-2.jpg?h=2100&iar=0&w=3150)

# Autism

Autism spectrum disorder (ASD) is a complex brain development condition. We provide comprehensive diagnosis and care to help reduce symptoms and enhance daily life.  

[Find an autism specialist](https://www.sutterhealth.org/find-provider-results?staticFilters=%5B%7B%22displayName%22%3A%22Autism%22%2C%22selected%22%3Atrue%2C%22filter%22%3A%7B%22kind%22%3A%22disjunction%22%2C%22combinator%22%3A%22%24or%22%2C%22filters%22%3A%5B%7B%22kind%22%3A%20%22fieldValue%22%2C%22fieldId%22%3A%22c_relatedConditions.name%22%2C%22value%22%3A%22Autism%20Spectrum%20Disorder%22%2C%22matcher%22%3A%22%24eq%22%7D%5D%7D%7D%5D&verticalKey=healthcare_professionals)

[Request a referral](https://www.sutterhealth.org/referrals)

![Smiling father holding his joyful young child outdoors, representing the positive impact of early intervention for autism.](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealth/Images/Hero-Images/autism-2.jpg?h=2100&iar=0&w=3150)

## Why choose Sutter?

The CDC estimates that 1 in 31 children in the U.S. have autism spectrum disorder. ASD affects how people communicate, interact and experience the world. It's also often marked by differences in social behavior, communication, sensory processing and repetitive or highly focused interests.

We use evidence-based tools to diagnose autism across the spectrum. Our team offers both medical and nonmedical treatments tailored to you or your child’s unique needs to support skill-building and ease daily challenges.

Care is centered on the whole family, not just the [autism diagnosis](https://www.sutterhealth.org/health/autism-symptoms-parents-should-watch-for). We collaborate with specialists in clinical psychology, speech and occupational therapy, social work, genetic counseling and pulmonology to create a coordinated care plan.

### By the numbers

### 150+

Neurologists

provide comprehensive neurology care that guides people from prevention to recovery. 

### 40+

Neurology Studies

are bringing you care advancements for a full range of complex neurological disorders.

### 10

Sutter Hospitals

honored as America's best for 2024 by Healthgrades.

### 1 in 100

Americans

receive their healthcare from Sutter.

## Need a referral?

Chat live with our team Monday through Friday, 8:00 am — 5:00 pm, or call us at [888-834-1788](tel:+18888341788).

[Request a referral](https://www.sutterhealth.org/referrals)

## Conditions

-   Asperger's Syndrome
-   [Autism spectrum disorder](https://www.sutterhealth.org/services/autism)
-   Development Disorder

## Diagnostics

-   Autism Spectrum Disorder Screening

## Related services

-   [Sensory-friendly clinics](https://www.sutterhealth.org/services/sensory-friendly-clinics)

Specialty programs

**Developmental-Behavioral Pediatrics Program**

Our Developmental-Behavioral Pediatrics Program in the Bay Area assists families by providing recommendations for children with developmental and behavioral delays or disabilities. Our providers work with you on your child’s needs, including diagnostic clarification, treatment options, management plans, consultation and support.

Ask your primary care doctor about referrals to this Palo Alto Medical Foundation program. You can call [408-523-3960](<tel:\(408\) 523-3960>) if your child is not a PAMF patient or if you have questions about the referral process.

**Kalmanovitz Child Development Center**

Our specialists at Kalmanovitz Child Development Center in San Francisco provide comprehensive assessments and treatment programs for infants, preschoolers, school-age children and adolescents with developmental delays or differences.

The largest multidisciplinary clinic of its kind in Northern California, we have about 18,000 visits per year. We interpreter services and bilingual staff in English and Spanish.

Our services include evaluation and treatment for physical therapy, occupational therapy and speech therapy, as well as parental consultations for developmental, behavioral and education concerns. For more information, call [415-600-6200](<tel:\(415\) 600-6200>).

## What you need to know

Hear from Michael Chez, M.D., about autism spectrum disorder, how it’s diagnosed and why early intervention can make a big difference for many children.

![young-child-and-mother](https://edge.sitecorecloud.io/sutterhealt962c-sutterhealt8fce-production57cc-4860/media/Project/SutterHealth/SutterHealth/Images/people/family/young-child-and-mother.jpg?h=1414&iar=0&w=2121)

## Understanding autism

ASD can shape how someone communicates, connects with others and experiences their environment. Noticing signs early on can open the door to meaningful support.

[What is autism?](https://www.sutterhealth.org/ask-an-expert/answers/what-is-autism-2014179369)

[What are common signs of autism?](https://www.sutterhealth.org/ask-an-expert/answers/common-signs-of-autism-2014179537)

## Sutter spotlight

Health & wellness

### [A Look at Early Child Development](https://www.sutterhealth.org/health/a-look-at-early-child-development)

There's a wide range of normal in young children.

Health & wellness

### [Preschool Pointers – How to Give Your Preschooler a Healthy Start](https://www.sutterhealth.org/health/how-to-give-your-preschooler-a-healthy-start)

From toilet training to exercise and vaccinations, here’s what you need to know to give your little one a great start.

Health & wellness

### [How to Handle Toddler Tantrums](https://www.sutterhealth.org/health/how-to-handle-toddler-tantrums)

Tantrums are a normal part of development that peaks between the ages of 2 or 3. Learn why they happen.

## Patient stories

[View all stories](https://www.sutterhealth.org/patient-stories)

-   [Patient story
    
    ### Both kids, adults on autism spectrum have help just for them
    
    ](https://www.sutterhealth.org/patient-stories/both-kids-adults-on-autism-spectrum-have-help-just-for-them-2023563955)
-   [Patient story
    
    ### A mother’s relentless love past autism
    
    ](https://www.sutterhealth.org/patient-stories/a-mothers-relentless-love-past-autism-2057319019)

[View all stories](https://www.sutterhealth.org/patient-stories)

## Trusted autism care

Our specialists provide evaluations and autism treatment options to meet everyday needs and support long-term progress.

[Find an autism specialist](https://www.sutterhealth.org/find-provider-results?staticFilters=%5B%7B%22displayName%22%3A%22Autism%22%2C%22selected%22%3Atrue%2C%22filter%22%3A%7B%22kind%22%3A%22disjunction%22%2C%22combinator%22%3A%22%24or%22%2C%22filters%22%3A%5B%7B%22kind%22%3A%20%22fieldValue%22%2C%22fieldId%22%3A%22c_relatedConditions.name%22%2C%22value%22%3A%22Autism%20Spectrum%20Disorder%22%2C%22matcher%22%3A%22%24eq%22%7D%5D%7D%7D%5D&verticalKey=healthcare_professionals)

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CHEZ: It's a pleasure to be here today,\nand I would like to just give an overview of a lot of aspects\nof autism from a medical neurology perspective\nand some general guidelines.\nAnd hopefully, we can cover the topic in the time period\nwe have in a fairly broad and thorough way.\nBut we'll take questions at the end, from what I'm told.\nSo anyway, I'm going to start the slide show.\nLet me see here.\nAutism was first described officially\nwith the word autism in the 1940s\nby a doctor named Kanner at Johns Hopkins University.\nThere was a doctor in Europe who's\nbeen a little bit less well-described lately,\nbut Asperger was also describing similar behaviors in Austria\nin the 1930s to '40s.\nAnd clinical definitions have been based on observations\nof how patients act.\nAnd it basically noted core problems in development\nin communication skills, socialization abilities,\nand what we call stereotypic or stereotypic behaviors, also\ncalled self-stemming behaviors, where children may do things\nlike do funny things with their hands in front\nof their eyes or hand flap, toe walk, spin,\nrock, or do other types of behaviors\nwhich are sensory and motor-involving behaviors.\nCommunication is of course speech delay,\nnot being normal in their speech acquisition.\nSo as infants, they're not saying\nwords you expect them to say by 12 months of age.\nA good thing to screen for autism, for instance,\nis if your child turns and looks at you when\nyou call their name, between 10 months and 14 months of age\nis when that normally should happen.\nAnd if they don't consistently look at you\nwhen you call their name, that's a concern for hearing,\nas well as possibly autism.\nAnd if they don't have words like \"mama\" and \"dada\"\nby 12 months of age, 15 months of age,\nthose are concerns, as well.\nSo those are things to look for in terms of early communication\ngaps.\n\nSo anyway, what is autism spectrum disorder\nand how do we define it?\nIt's kind of a broad, heterogenous, or multiple\ncaused group of conditions that go under the umbrella of autism\nspectrum disorder, or autism.\nAnd basically, diagnosis is usually at two years of age\nor above, officially.\nYou can know in infancy to early--\none to two years of age that some children are at risk.\nThere is not a single cause.\nThere's environmental causes.\nThere's genetic causes.\nThere's traumatic causes.\nThere's infectious causes and injuries\nthat people occur at birth or after birth.\nAnd then you can have it from other medical conditions,\nwhere other diseases may affect the brain and cause autism.\nAnd then there is a majority of them,\nwhich is we don't really know what causes them.\nThere isn't an obvious cause.\nAs of 2021, according to the CDC surveys\nthat are done at 8 years of age across the country\nand how many kids have autism, they're saying it's up to 1\nin 44 children.\nBoys outnumber girls about between 4 and 6 to 1.\nAnd in comparison, cerebral palsy since the 1940s\nthere's been about 1 in 3,000 births,\nand it's still at 1 in 3,000 births.\nIn the 1980s, autism was felt to be 1 in 10,000.\nBy 1990, it was at 1 in 1,000.\nAnd now it's at 1 in 44.\nSo there's definitely something evolving here.\nAnd I don't know if anybody has the perfect answer for that,\nbut there's probably multiple reasons.\n\nThere is something called the Diagnostic and Statistical\nManual, also known as the DSM.\nThis is the Fifth Edition, which restricted the autism diagnosis\na little bit more than in the past,\nbut they did away with other categories, something\nthat used to be called Asperger's or high functioning\nautism, specifically, in that category, and also pervasive\ndevelopmental delay.\nThey are now grouped into the autism spectrum conditions.\nAnd it's repetitive, restricted behavior patterns,\nstereotypic behaviors, narrow interests,\nand the stereotypic motor speech or object\nuse where they do repetitive things\nand either hypersensitive or less sensitive, hyposensitive\nto their environment.\nThey present at an early period, usually under two years of age.\nThere is impairment in social, educational, and occupational\nactivity.\nAnd these can not be explained by intellectual disability\nor a neurological injury, like cerebral palsy, seizures,\nor stroke-like injury, or infection of the brain.\nAnd so it's something that's basically not\ngot a secondary cause, specifically,\nat an acute way that could be reversible.\nAnd also add with or without, is there intellectual or language\nimpairment with it?\nSo this is something separate from just being intellectually\ndisabled or language impaired.\nThis is a combination of all these behaviors.\nAnd it requires a lot of substantial support,\nin the worst cases, to substantial report\nin moderate cases, to just some support in mild cases.\nSo they've changed it from high functioning, low functioning,\naverage, to substantial support, just support.\nAnd that's the range they now kind of use\nthis categorization.\nI'm not sure it's better, but that's\nwhat the most recent changes were.\nSo by definition, it's the defects\nin communications, socialization,\nand stereotypical behaviors.\nWe can screen for that between 12 and 18 months of age\nwith something called the mCHAT questionnaire, which\nis 10 questions, which you answer Yes or No to.\nAnd defined on those answers, there's\na higher or lower risk of autism.\nOne of those questions, does your child turn and look at you\nwhen you call their name, that's about 80% predictive,\nand that's one of the questions.\nIt's a lifetime diagnosis.\nThey've done work with the ADOS, which\nis the gold standard sort of test\nthat people do if they're psychologists,\nto sit and try and play with the child\nand mark how the child responds.\nThat test, developed by Catherine Lord\nat University of Chicago and then University in Michigan,\nnow she's at, I think, Columbia, that has\nbeen shown to be a lifetime diagnosis if they\nhave a positive ADOS at age 2 or above.\nSo autism is lifetime.\nIt can be acquired.\nThere are 2/3 of patients who seem to regress\nin under two years of age.\nSo that means they had some skills and lost them.\nNow, with careful history, there are always some deficits\nin many of these patients.\nRarely has someone become autistic acutely for no reason.\nBut there can be kids who get brain injury, trauma,\nenvironmental deprivation, which can lead to autistic behavior.\nSo you can acquire autism in a number of different ways.\nIntellectually, they can range from very low,\nwith IQs less than 40 or 50 to the superior IQ range.\nMost people are borderline to low normal IQ,\nwith the majority of patients having an IQ 60 to 80.\nBut verbally, they may be delayed with that\nor they may be some higher or some lower, like I said.\nBut roughly 40% to 50% are in that middle range\nof borderline to low normal IQ.\n\nSo what causes autism?\nI said there's been 1 in 44 children.\nScience supports that 80% of it might\nbe in a genetic type of determination,\nalthough there's not one single gene that causes it.\nDiseases like cystic fibrosis, for instance, or Fragile X,\nthere is a gene that specifically causes it.\nHowever, muscular dystrophy, there's\na gene that specifically causes Duchenne's muscular dystrophy.\nBut this is a disease that doesn't have one gene.\nIn fact, there's been over 2,300 major genes identified,\n65 which are most common.\nAnd we know from identical twin studies\nthat were early genetic studies and more recent ones\nthat 60% are likely to have autism, even if they've\nbeen adopted or separated at birth for some rare cases that\nhave happened.\nGirls are less likely than boys.\nHowever, when girls do have it, they\nare more likely to have abnormal EGs or epileptic activity\nwith their autism diagnosis.\nThere are multiple genes, and currently we're\nrecommending doing something called an exome, which\nlooks at around 25,000 genes, or a genome which\nlooks at hundreds of thousands of genes, which gives us\nabout a 50% or more chance of picking up\na genetic defect, again, depending\non the accuracy of the company that's doing it.\nSome companies do a visual review\nor a machine only review.\nThose that do both usually have better yields.\nSo there's different genetic companies out there,\nas well, that do similar things, almost the same equipment,\nbut they have different standards of seeming\nto have better yields.\nSo part of that, your doctor helps you sort through.\nUsually, there is a new deletion or duplication\nare the most common new gene findings\nthat neither parent have.\nThere is something called de novo, which\nis meaning new gene change.\nIt's not from either parent.\nCopy number variants are you might\nhave more than a certain number of genes in a certain part\nof the gene that's abnormal.\nSo these are all things that we look for.\nAnd even knowing this doesn't necessarily\nchange our treatments because these aren't necessarily\nreversible with the current technology, but at least\nit helps us understand what may have caused it, especially\nin families where autism may run.\nAnd it's helping us understand some\nof the defects in the brain and what kind of changes\ngo on to cause problems with the brain\nas it develops autistic symptoms.\nSo this is just a slide that I wanted to show you,\nthat these are just like 65 of the most common genes.\nAnd you can see there is a lot of different names, which\nare sort of addresses on different genes.\nBut what the common theme in the second sentence\nis basically that these all have something to do with the way\nthat DNA gets uncoiled and translated, neural transmission\nof certain biochemicals, the stability of receptors that\ntransmit information between the nerve cells,\nsomething called neuroconnectivity,\nwhere the brain connects the different parts of the brain\nso that they can communicate to each other,\nand also inflammation genes that can\ncause changes and pruning to the brain and the connectivity.\nSo these are the most common problems\nthat the genes tend to point to, but there is not\none specific gene alone that causes autism.\nAnd we know that some of these genes\nare also seen in epileptic conditions called\nLennox-Gasteaut syndrome, or epileptic encephalopaties\nof childhood.\nCertain language delay genes.\nAnd so they may overlap other conditions,\nand not just autism.\nAnd there are also diseases that overlap\nautism, things like tuberous sclerosis, which may or may not\nhave cognitive impairment, may or may not have autism.\nFragile X, like I said, is 1 in 3,000,\nbut it's a different disease that has autism tendencies.\nRhett's syndrome in girls.\nIt's again a genetic disorder that affects girls only,\nalthough there may be rare male ones.\nMost people feel the male ones don't live to survive.\nBut the bottom line is these are separate and identifiable\nspecific genetic diseases that also have autistic features.\nIn tuberous sclerosis in a something called 7q35 deletion,\nthe children may develop epilepsy.\nAnd if they develop a type of epilepsy\ncalled infantile spasms and tuberous sclerosis\nbut you treat it or catch it early,\nthose children don't get autism.\nIf you don't catch it early or treat it successfully,\nthey do get autism.\nSo the types of seizures that overlap\nsome of these genetic conditions cause autism\nif the seizures aren't stopped, which again, infantile spasms,\nwhich is caused by many things, is sometimes\nassociated with autism, just like certain brain infections\nor brain injuries.\nThe 7q35 is a disease where there is abnormal nerve brain\nmalformations, called heterotopias.\nThese are found in Amish families and other families.\nThey develop epilepsy between 1 and 2 years of age.\nIf they treat it with a certain epilepsy\ndrug called valproic acid, it reverses the autism risk.\nIf you do not treat it between age 1 and 2 on time,\nthey can develop autism.\nThe importance of these type of conditions\nis there are some times where autism\ncan be avoided or prevented if you have these diseases.\nIt's not inevitable that you get autism with these genes.\nAnd in other conditions, it doesn't seem to matter\nor it may not have a reversible phase.\nSo these are things that give us research ideas\nthat we can look into and see what else we can do.\nSometimes people blame hypoxia or stroke\nor intraventricular hemorrhage or bleeding in the brain.\nPrematurity, very premature babies at 23,\n24, 25 weeks of maturity who are born very early,\nafter say just six months instead\nof nine months of gestation, are at a much higher risk\nof autisms than, say, children born\nafter 30 weeks or 40 weeks.\nLoss of oxygen is a risk factor.\nStrokes are a risk factor if they're\nin the frontal part of the brain,\nas is bleeding in the frontal part of the brain that\nmay cause damage to parts of the brain that can make\nyou act autistically, with the nerve connections being\ndamaged.\nRepeated concussions have rarely caused autism or autism\nfeatures in some older children who were normal,\nbut they had repeated head injuries\nand ended up having autistic features afterwards.\nCertain infections, such as herpes encephalitis,\nwhich affects the frontal or temporal lobes\nof the brain, other forms of meningitis\nor infection of the brain that can cause damage\nto these areas.\nMeasles, which people forget about,\ncan cause damage to the brain, which\ncan cause autistic features, cytomegalovirus, and others.\nSo infections can sometimes cause damage to the brain.\nThere is brain malformations which\ncan occur, which can cause autistic overlapping features,\nespecially when the frontal lobe or executive\npart of the brain that monitors how we look at other people\nand socialize gets affected.\nYou can have autistic features.\nAnd then really severe epilepsies,\nlike infantile spasms, Dravet syndrome, Lennox-Gasteaut,\nif it's not treated successfully,\nwhich some of these are very difficult to treat, 80% to 90%\nof these folks will have autistic overlap.\nSo severe epilepsy in childhood early on often\nlead to autism as a secondary diagnosis.\n\nSo in utero factors, sometimes there's\nmothers who have antibodies who've\nalready had an autistic child or they have autoimmune disease.\nThere is a higher rate of autoimmune disease in mothers,\nlike Hashimoto's and things like that, that are associated\nwith more risk for autism.\nThere is also things like experiments\nthat I've done at UC Davis Mind Institute and other places\nwhere they've taken blood from mothers who've\nhad autistic children on multiple births\nand they've given that to like Rhesus monkeys who then have\nthe blood that they're given, these antibodies\ntend to cause the monkeys developing\nin the pregnant monkeys to become autistic-like behaviors\nwhen they're born.\nSo there may be immune factors that happen in utero.\nThat's still a work in progress, but it definitely\nsuggests there is some environmental or immune factor\nthat may alter developing brains and cause autism.\nWe know that certain toxins or medications, pesticides,\nacute mercury poisoning, which is\nfrom spills of mercury like where a smelting factory\nor something like that happens, or fish\nthat are severely poisoned with mercury in that area\nand are eaten a lot by populations in that area.\nIt's not from shots that contain thimerosal, which are not\nthe type of mercury that our body absorbs or uses,\nthough there is no thimerosal in most shots today,\nand so immunizations are not the cause.\nBut mercury poisoning from environmental mercury disasters\ncan occur, or too much seafood, which\nis why they say not to eat as much seafood\nanymore because of the mercury in the oceans.\nNeglect.\nPeople have been put in institutions\nlike in Romania, Russia, and people adopt these babies.\nAnd the babies from these less developed countries where\nthe babies are put in like a factory orphanage\ndon't get a lot of cuddling or touches,\nbabies can sometimes develop autism\nfrom lack of socialization early in infancy.\nSo there's environmental factors like that.\nAlso, children who have been neglected in abusive families,\nsometimes they're taken out by protective services.\nThose children may have autistic features\nbecause of lack of early stimulation and neglect\nas an infant.\n\nSo how does the brain organize?\nThere's lots of things and controversy about what exactly\ngoes wrong.\nMRIs, if I take a typical MRI in most kids\nwith autism who've not had a brain injury or malformation,\nthe brains are usually normal appearing relative\nto a mother toddler.\nBut when they use special programs that really dissect\nout millimeter by millimeter differences\nin the white matter or gray matter,\nthere can be differences and more white matter\nin kids with autism.\nThere may be differences between the way the brain connects\nbetween, say, the frontal lobe and temporal lobe\nversus the frontal lobe, within the frontal lobe.\nSo intrabrain region connections may\ndiffer with autism versus non-autism in some studies.\nThere also may be increased astrocytes or glial cells\nor immune cells found on microscopic review of brains.\nCertain immune markers may be up.\nThat's some of the research I've done and others have done.\nAnd then genetics can affect how the brain's connected.\nLike I said, many of the genes we're finding\nare playing a role in how the brain evolves and makes\nconnections.\nThis is an example of some pictures showing\nparts of the brain, where the white matter may not\nbe the same in autism as the other.\nAnd this one black and white picture,\nFigure 2 on the right side of the slide,\ntends to show differences of where the white matter is not\nnormal.\nSo the dark gray connections are abnormal versus the more normal\nwhite connections.\nAnd so they show how the connections may not\nbe the same.\nThis is just to show you that there\nis very sophisticated ways we're looking at this.\nAnd again, more and more sophisticated\nstudies genetically are being done.\nThis is an example of how the genes that\nare making markers and proteins have\nbeen studied in autism, schizophrenia,\nand bipolar, for example.\nAnd what these schematics really show\nis that there is closer relationships between the way\nthe brain makes certain chemicals that\nhelp transmit neural information,\nmake connections in the brain.\nThey're more similar between autism and schizophrenia\nand bipolar than they're different, even though they're\ndifferent conditions.\nIn other words, the brain connections\nin the frontal executive areas of the brain\nare abnormal in these conditions and they\nhave some similarities.\nCerebral palsy, for instance, or ADHD\nis different than these type of patterns.\nSo I thought this was a very interesting thing\nto know, as well.\nAnd then there's theories about multiple hits in epigenetics.\nEpigenetics is a fancy name.\nI'm going to say it's more than just genetics,\nit's factors that could influence\nhow the genetics are expressed.\nLike I said, you can get an infection\nwhich causes inflammation, which may change\ncertain genetic expression.\nYou can have environmental differences,\nlack of stimulation.\nBut then there is also just a stressful fetal maternal\nenvironment and other things that if you-- you\nneed more than one thing.\nThe gene only is a problem if you develop seizures.\nAnd if you don't develop seizures, it's not a problem.\nSo there's more than one thing going\non that can cause a problem.\nWe know that there's differences in blood-brain barrier\nand lymph nodes in the brain, things they didn't know existed\na few years ago, which we all thought must have existed\nbut we weren't quite sure how it worked.\nWe're starting to discover how the brain and the immune system\ninteracts with the immune system in your body,\nhow the brain is somewhat protected\nfrom the typical immune, and the immune cells in the brain\ndo pruning and neural connections\nas well as fighting off infection.\nSo there's a lot of things we're learning about that,\nthat could influence autism.\nAnd that's part of what the research going on\nis looking at in some areas, both genetically\nas well as with the immunological research.\nAnd some people have looked at can we\nalter the treatment with this, including some of my research.\nAnd we can talk about that a little bit.\nBut the immune system has got different roles in the brain.\nAnd so at different parts of the brain, if you get an infection,\nif you get stress, your immune system\nmay alter how the brain connects and that\ncould cause some higher risk for autism, we think.\n\nSo let's talk about what if you're born\nand you have autism, what other things can happen or be\nassociated with that condition?\nWell, we know neurologically that epilepsy\nis common in autism compared to normal non-autistic infants.\nEpilepsy is more likely to occur through the lifespan.\nPeople with lower verbal ability, lower IQ\ntend to have more epilepsy than people with higher functioning\nautism.\nThe range of having a physical seizure ranges from 10% to 30%.\nIn higher functioning, that's more like 2% to 10%.\nIn abnormal EEGs, which could make you prone to epilepsy,\nyou can have 40% to 50% of children under age five\ncould have an abnormal EEG compared to normal controls.\nAnd of course, through teenage years, some of those people\nmay develop actual physical seizures.\nSometimes they develop physical seizures earlier in life.\nWe know that if you develop seizures in infancy,\nyou're at higher risk for autism.\nIf you have seizures or loss of oxygen at birth,\nyou're at higher risk for autism.\nAnd so there's a lot of factors where epilepsy and autism sort\nof overlap.\nSo it's very important to look for whether children\nare at risk for epilepsy if they get diagnosed with autism,\nand also to make sure they don't have the risk for it\nwith testing of EEG and things like that.\nThere can be sleep disorders.\nChildren with autism have trouble regulating\ntheir emotions, their sleep, their alertness,\ntheir attention.\nAnd so it makes sense that the parts of the brain that\nconnect to the frontal executive part of the brain,\ncalled the cortical reticular activating\nsystem, the brainstem talking to the higher brain,\nthat can lead to sleep disorders and problems with sleep\ndisruption.\nThere is anxiety and obsessiveness and frontal lobe\nperseveration and things where these kids may not\nregulate their sleep, their emotions, their anxiety.\nThere could be GI problems.\nChildren with autism may have problems\nwith their autonomic nervous system,\nlike a lot of kids with cerebral palsy\nand other developmental delays may have.\nSo your bowel motility may be different.\nYour reflex tendency may be different.\nMaybe it's from anxiety.\nMaybe it's from muscle tone being lower.\nThere is ADHD and learning problems.\nChildren with autism have a lot shorter attention spans.\nThey might have trouble with verbal learning, especially\nauditory processing.\nThat is almost universal a problem in autism.\nThere is also problems with motor planning--\nhow do you tie a shoe, how do you write with a pencil?\nMany children never do learn to write well or button\nthings well, and you make adaptions like instead\nof shoelaces, you have Velcro.\nInstead of buttons, you have snaps or other things.\nBut the other thing is keyboarding instead of--\nor symbolic language devices instead\nof trying to learn to write.\nSo speech delay is one of the most common and biggest\nproblems with autism.\nIt's one of the core problems, as I said.\nAs far as medical problems go, sleep, GI problems,\nconstipation, reflux, diarrhea, discomforting things\noften tied into the autonomic nervous system, as well.\nAnd then epilepsy, those are the three biggest comorbidities\nthat we deal with.\nSo like I said, 10% of higher functioning autism\nmay develop epilepsy.\n30% to 50% of the lower functioning people with autism,\nmeaning their IQs are lower, their language\nis lower and more likely to have other brain issues\nand connection problems.\nAbnormal EEG clinically occurs without seizures in 40% to 50%\nof the younger children if you look at an overnight EEG.\nThat's part of my research.\nOther people have duplicated it.\nThere have been multiple studies.\nIf you have clinical seizures, there's\nabout a 70% chance you will have an abnormal EEG\nat some point with your autism.\nAnd then convulsive seizures, grand mal seizures,\nthey tend to happen more in adolescents and adults\nthan in younger children.\nAnd in children who don't have a structural brain damage,\nfocal seizures can happen if you have\nstructural or malformed brains that cause autism\nas a secondary diagnosis.\nSo EEG and medical work up, knowing\nwhat's wrong with the brain structurally,\nwill help us with managing some of those comorbidities.\nIf you control seizures, you have better language,\nbetter cognitive, better development,\nso earlier diagnosis is good.\nAnd the other thing is children who\nhave conditions with autism that have\nabnormal EEGs tend to have worse behavior,\nworse language, worse problems than children whose seizures\nare controlled or managed.\n\nSo what do you do when you're a neurologist\nand see a child with autism?\nYou do a history and physical exam.\nSome of the older testing guidelines\nare just basically doing lead levels and that kind\nof stuff, thyroid functions.\nThat-- it's all good, but it's not\ngoing to tell you what the bulk of autism is caused by.\nA 24 hour EEG versus a one hour EEG\nis much more effective, because you\nneed at least six hours of sleep to pick up\nsometimes the epilepsy that only occurs in sleep.\nWhen they're awake, it may be completely normal.\nThis could also cause some of the sleep disruption issues\nin some children.\nGenetic testing is an absolute must in developmentally\ndelayed or autistic children.\nWe recommend at least an exome and a genome\nwith a trio referring to both parents being tested\nat the same time, so that we can see\nif these are de novo new genes or if they're\nsomething the parents have which may not be as severe.\nAnd you might want to do a microarray, which\nis an older tool, look at bigger gene defects.\nAnd also Fragile X or Rhett's, Fragile X in boys,\nRhett's in girls, because that's not always covered completely\nwith some of the more detailed tests,\nalthough the newer tests are picking up those, as well.\nIf they have GI problems, constipation, stomach pain,\nreflux, diarrhea, you want to see\na pediatric gastroenterologist to make sure.\nThere is more food allergies in this group.\nThey may have eosinophilic gastritis\nif they have sensitivity to foods.\nAnd so getting a GI specialist involved\nwith kids who have a lot of stomach problems is important.\nA geneticist would be helpful to make sense out\nof the tests that come back and also advise you\nabout other children in the future, what\nthe risks would be.\nSleep studies, if you have sleep apnea, snoring,\nthat kind of thing are very important.\nMost sleep studies only tell you about apnea.\nThey maybe tell you a little bit about restless legs,\nalthough it's not a formal diagnosis for that.\nAnd most of the sleep problems in autism\nare either a combination of anxiety, night terrors, sleep\nparasomnias, like sleepwalking type effect,\nor it's epilepsy can cause disruption\nto sleep at night, as well.\nSo these are the things you might need to get.\nAnd then psychological or psychiatric comorbid issues,\nanxiety, depression, ADHD, sometimes neurologists\ncan help with some of that.\nSometimes you need a child psychiatrist.\nBut those are things that you want to work on together\nfor that kind of thing.\n\nSo anyway, it takes a team of specialists\nand putting that together that's helpful.\nWhat do we do for support?\nWell, in California we have something called\na regional center system.\nThey help with 0 to 3.\nAnd then there is county and city 0\nto 3 programs that often can get play therapy, speech therapy,\noccupational therapy going.\nBut sometimes you can't get a formal diagnosis till age 2,\nand there is quite a few people, 1 in 44 with autism.\nSo part of the problem is early diagnosis, earlier\nthe better by your pediatricians and the system.\nFrom 12 months, to 18 months, you can screen.\nThe official recommendation is to screen\nbetween 18 and 24 months by the American Academy of Pediatrics.\nEarlier is better, because by the time\nyou get to regional center, it might\ntake a month or two to get in.\nThen it might take some time to get services.\nYou have to go through an insurance denial for things\nlike ABA, applied behavioral analysis therapy,\nwhich is a behavioral modification of speech\ntherapy and all those things.\nAnd sometimes if you don't get in there until age 2,\nyou're pretty close to age 3 and then\nthey go to the school district for services.\nSo it's really important if you think\nyour child has a problem in, say, between 10 and 15\nmonths of age, to get them looked at right away so they\ncan get referred into the centers\nand get early help even before a formal diagnosis at age 2,\nwhich is kind of the legal definition of where\nthe tests are valid.\nSo basically, 20 to 40 hours of this applied behavioral therapy\ndoes help.\nIt doesn't help everyone, but it certainly\nis a good way to get early language\nand certain social behavior started.\nAnd it can help with toilet training,\nwhich is often delayed.\nIt can help with other things.\nVery important we get language going early.\nLanguage delays are what delays progress in autism the most.\nAnd the earlier we get language going, the better.\nSo basically, this little slide shows you we\nget a history and exam.\nWe may obtain an EEG, genetics, blood tests.\nThen we decide if we need an MRI based\non their history, physical findings,\nand what the EEG shows.\nThen we may treat the EEG, if they have abnormal EEG,\nto see if it improves language, because often it's\nin the language areas that you see abnormalities,\nand also depending on the MRI findings and things like that.\nAnd then if they have clinical seizures, of course\nwe treat those.\nI'm talking about treating subclinical seizures\nbased on clinical judgment of EEG and other factors.\nIf they have clinical seizures, we always treat those.\nAnd then if there is behavioral aggression, anxiety,\nsleep problems, OCD, psuedobullbar,\nrapidly changing mood swings, we have different medicines\nfor irritability, including atypical antipsychotics,\nanxiety medicines like SSRIs.\nMelatonin is the most commonly studied and most commonly used\nsleep tool to start initially.\nAnd then there's other sleep medicines, if needed.\nAnd then if there is mood anxiety,\nand other drugs for those.\nAnd then ABA therapy and speech therapy\nand occupational therapy for some of the sensory motor\nissues, physical therapy if they're\ndelayed with big physical problems\nare all important to add in.\nAnd so, as you can see every child's\ngoing to be a little bit different.\nYou're going to have to individualize\nsome of the therapies.\nAnd this is sort of a global guide.\nSo this isn't what everybody gets the same thing.\nIt's not a cookie cutter.\nSo when you hear about treatments\nthat are a lot of gimmicks, everybody should be detoxified,\neverybody should be this and that,\nthere is no proof mean that's valid,\nbut there is no one cookie cutter\nthat cures autism, since it's not one disease.\nIt's a spectrum of disease.\nAnd you have to really individually diagnose and find\nwhat's wrong and try and maximize that child's response,\nas well as that child's treatment best outcome.\nSo we try to treat seizures and EEG, try to improve speech,\nif that sometimes helps.\nWe do the speech therapy and supportive stuff, of course.\nBut from a medical point of view,\nif there's mood swing issues, there\nare medicines that we've studied to look at those issues.\nThere is ADHD.\n30% of kids with autism respond to typical drugs\nlike Ritalin when they're ADHD, usually higher functioning\nautism kids.\nBut some of the other kids get a negative response\nto that, need other medicines to control moods\nand that kind of thing.\nAnd if you need a child psychiatrist\nbecause the doctor who's your pediatrician\nor your neurologist is uncomfortable, then\nsometimes child psychiatrists get\ninvolved with some of these more psychiatric comorbidities.\nI talked about melatonin for sleep,\nand also treating sleep apnea, large tonsils.\nSometimes these kids get lots of infections.\nTheir immune systems don't work as well.\nThey get ear infections, large tonsils, and adenoids.\nSometimes they get sleep apnea.\nTreating that can help sleep, as well.\nAnd we talked about reflux, food allergies,\nand pediatric gastroenterologists.\nAnd ferritin, these kids don't have great diets.\nThey don't like red meat or things with ferritin, iron.\nSo if the ferritin levels are low\nand they're restless in sleep, sometimes giving them\nan iron vitamin will help with some of that.\nAnd if they have allergies to foods or things,\nreferring to allergists is important.\nSo to date, the only medications approved for irritability\nin autism, specifically for irritability in autism\nare Risperdal and Aripipazole, which\nare two psychotic dopamine-blocking meds, which\nare also used for childhood bipolar.\nThey can cause weight gain and other side effects,\nbut they are appropriate when the child is\nself-injurious or aggressive to others,\nand they do also help anxiety and other mood swings.\nSo again, judicious use.\nIt doesn't mean every child with autism needs these medicines,\nbut there are no other specific medicines\napproved at this point.\nWe treat epilepsy with drugs for epilepsy.\nWe treat anxiety with drugs for anxiety.\nWe treat ADHD with drugs for ADHD.\nWe treat reflux and sleep with drugs for sleep or reflux.\nSo we treat comorbidities, mostly.\nThere is no definitive studies using cannabidiol,\nespecially not using THC, which is damaging to young brains.\nAnd getting your child stoned on THC is not an answer.\nIt's a bad answer to helping kids who\ndon't sleep or are irritable.\nCBD studies are going to be going on.\nThere some out of Israel that say some behaviors improve,\nbut it's not a cure.\nAll and some kids actually get hyper.\nAnd you can have the rare chance of liver irritation\nwith CBD or THC drugs.\nSo a lot of people don't tell you that.\nSo it's very important to work with a doctor who's\nvery well aware of all this and not\nto just jump on internet anecdotal treatments.\nIt's not necessarily helpful.\nAnd anyway, look for peer reviewed articles\nthat have maybe not got FDA approval\nbut valid scientists and valid medical researchers\nhave shown that this may help.\nI did a stem cell study, one of the first\nin the world using cord blood stem cells in autism.\nWe got an inconclusive plus/minus result, which really\ndidn't show dramatic changes.\nDuke has had some similar experience, maybe\nsome positive results, but in double blind studies, less\nconclusive.\nThere is people overseas in Panama\nand other places making huge claims about STEM cell therapy.\nThe official stem cell society recommendation\nis still experimental and participate in valid research\ntrials.\nDon't go off and pay big money for STEM cell trials\nat this time.\nWe don't have any ongoing research at the current time.\nAnd at this point, our facilities\ndon't really have the resources for that.\nBut I can tell you that it's not at this time a proven therapy.\nThe other last thing I want to talk\nabout is children with autism have a lifetime diagnosis.\nThey do grow up.\nI've been doing this 32 years, and I've\nhad my own experience with family members\nwith autism spectrum.\nAnd transition to adult care can be difficult.\nWe did start a clinic with one of my colleagues, Dr. Kyle here\nin Sacramento, and we did make some adult onset diagnoses.\nPeople never knew they had high functioning autism.\nWe also-- we thought we'd be a lot busier,\nbut we had a lot of times people end up\nin group homes or parents get older,\nthey're less seeking advice or help.\nAnd so it's important that people get support\nthrough their adult years.\nAnd finding doctors who are willing to take\non adult patients with pediatric neurology\nor pediatric conditions like autism can be challenging.\nSo we've kind of got doctors here like,\nDr. Kyle, who is willing to do it.\nThere can sometimes be a long wait to get in.\nI keep my patients often, and most pediatric neurologist\nkeep their patients into their early 20s\nbecause there's nowhere to send them.\nWe try to give a transitional support as much as we can.\nThere is less support than in the preschool programs\nfor therapies and things like that,\nbut there are adult programs, some supported living and group\nhome options, although with the numbers,\nthe demand far exceeds the numbers\nand there can be long wait lists.\nSo it's very important that our system, and it's something\nwe can do better, I'll be honest with you,\ndevelops long term care options for people with autism.\nAnd you might need a psychiatrist,\nand we might need to study how these people age.\nThere may maybe earlier dementia and earlier\naging effects in some people with genetic and other forms\nof autism.\nThey're on a lot of medication.\nThey may not have a healthy diet they may be overweight,\nand all these things can add other burdens\nto their life health issues, secondary diabetes, Type 2,\nthings like that, that we have to try and manage\nwith the internists and the family practice doctors\nand the neurologists and the psychiatrists as people age.\nSo I think that these are things we can aim as a culture,\nboth within Sutter and within our state and our country\nin general, to help with these type of changes.\nSo in conclusion, autism is the number one\ndevelopmental disorder in neurology and pediatrics.\nIt's 1 in 44 kids.\nThis 1 in 48's a typo.\nIt should have been 1 in 44.\n5 to 6 to 1 boy to girl ratio.\nIt's heterogenous, multiple causes, not one cause.\nIt can be in multiple generations in families\nand affect the siblings, as well as the parents\nand grandparents, in terms of needing support\nfor the whole family.\nBe aware there can be multiple things that cause autism.\nEpilepsy can cause autism, infections, injuries.\nBut also, if you have genetics, not every gene is the same.\nYou might have a severe case or a mild case with the same gene.\nAnd let's do appropriate referrals and testing\nto get the support from gastroenterologists,\ngeneticists, and other doctors.\nAnd our goal is to try and improve therapy\nas much as we can and functional life.\nSo I'm going to conclude on that.\nI think it's time for questions and answers\nand thank you for tuning in and giving your attention today.\nMODERATOR: Thank you, Dr. Chez, for all that great information.\nAnd we do have many, many questions today,\nso we are going to do our best to get to as many of them\nas we can.\nAll right, Dr. Chez, so our first question today is can you\ntalk about what the difference is between autism\nand Asperger's and ADHD?\n\nMICHAEL G. CHEZ: Sure.\nSo the difference between autism--\nfirst of all, autism is a spectrum disorder\nthat includes high functioning and low functioning.\nAsperger was an Austrian German Doctor\nwho at the time of the Nazis in Europe\nwas kind of discovered, forgotten about, rediscovered,\nand now kind of negatively portrayed\nbecause he may have participated in some bad experiments\nin the Nazi era.\nBut the bottom line is that high functioning IQ,\nhigh functioning people are often\nsort of synonymously referred to as Asperger's patients.\nThat is, people who have higher IQ\nand have autistic social disabilities,\nmaybe some communication gap socially,\nbut they tend to be fluent in language\nand they tend to be fairly functional, even if they don't\nhold as good a job as they should for their intelligence\nlevel.\nThey may not be as independent as you think\nthey would be with their IQ.\nADHD is a condition where you have trouble paying attention\nassociated with the cingulate gyrus and the anterior\npart of the brain.\nKids can have ADHD with very commonly in childhood.\n1 in 15 kids may have ADHD.\nAutism is 1 in 44 kids.\nThey overlap.\nWhen you have problems with the frontal executive\npart of the brain, you may have aged symptoms\nas a comorbid factor in autism.\nSo you can have ADHD and autism.\nYou can have ADHD alone.\nIf you have Asperger's, you have a type\nof high functioning autism.\nI hope that explains it.\n\nMODERATOR: Yes, that does.\nThank you so much.\nCan you talk about-- going back to Asperger's\nor high functioning autism, can you\ndescribe what some of those symptoms would look like?\nMICHAEL G. CHEZ: Well, in childhood, they're\nusually delayed in language until around age 2 to 3.\nThen when they start to talk, they\nmay talk like a mini professor, or they\nmay have narrow interests, or they may read early\nand be seeming very bright.\nThey may have all the knowledge in the world about dinosaurs\nthat most adults don't have, or they\nmay know everything about, say, a certain topic like the cosmos\nor the stars or astrology or whatever,\nbut they don't necessarily know how to socially function\nor ask for a drink or do common daily things, you know?\nAnd they have trouble socializing with other kids.\nAnd it's usually associated with they're very smart, very\nhigh functioning, but they seem overly mature for their ages.\nThey may read early, but they don't quite\nhave the skill set to manage socially.\nAnd they may not like hygiene or showering\nor remember to brush their teeth,\neven though they're very intelligent.\nSome of these kids grow up, they need\nreminders for daily activities, remember to take a shower,\nremember to clean up.\nThey may get good grades, but then they\ndon't apply themselves where those grades translate\ninto a job or career.\nNow, some can become engineers.\nSome can become computer scientists.\nSome, there are stories of people doing amazingly well.\nThere are famous people who probably\nhad Asperger's, like Albert Einstein, we think,\nprobably had it.\nBut they are deficient in socialization\nand often have an initial delay in language.\nSo it's a different presentation.\nSo they're usually the higher functioning autistic kids\nwho often seem really intelligent\nin the preschool years in some ways.\nBut then they may be slow starting in other ways\nand have social deficits their whole life.\nSo again, I'm giving up a stereotypic picture.\nThere is a range of almost not noticeable\nto very noticeable differences, so bear that in mind.\nMODERATOR: Great.\nThank you so much for explaining that, Dr. Chez.\nSo our next question is how can extended family\nsupport and interact with an autistic child and his family\nduring gatherings like birthday parties and holidays?\nHow can they support that child?\nMICHAEL G. CHEZ: I think one of the biggest\nfears parents of autism have is being judged that they're not\ngood parents if their child has a behavior that's atypical,\nlike they do self-stimulating noises\nor they are hand flapping or they're disruptive at a family\nmeal or they get stressed out that being-- loud noises\nor crowds may bother them.\nSo I think that families can be supportive by minimalizing\nbackground noise, maybe keeping the gatherings in smaller\nbatches of groups, sitting people\nin smaller tables instead of one big large table,\nmaybe being considerate of not criticizing the parents\nif the child's acting up that all they need\nis more discipline.\nBecause sometimes yelling and screaming\nat a child or discipline in a typical way\nthat some people think is appropriate\nmay actually make that child more stressed\nand act out worse.\nCalm, slow talking is better than screaming or yelling\nat a kid who doesn't process language well, for instance.\nSo getting mad at them doesn't necessarily help.\nAnd so behavioral modification, and that's a tough job.\nAnd I think a lot of parents need supportive people\nunderstanding and allow their kid\nto be different allow them to manage their own child's\ndiscipline.\nDon't try to step in.\nLearning how to work with the parents' behavioral plan\nand being able to give the parents some respite\nis another way families can be supportive.\nIf they can keep that child in a comfortable environment\nwhile the parents get a break, they\ncould support them that way would\nbe great at family gatherings.\nGive the parents a chance to socialize and not\njust manage the kid.\nSo extended family that's interested in helping\ncould do that.\nSo I think parents are dying for support.\nThey just don't want critical support, you know?\nMODERATOR: Great information, Dr. Chez.\nThank you.\nWhat about teenagers?\nWe've had a number of people ask questions about teenagers\nand young adults who don't really even acknowledge\nthat they have--\nthat they are on the autism spectrum.\nAnd how can they support them and help them\nas they grow into an adult?\nMICHAEL G. CHEZ: That's a really tough short answer.\nLet me just say that high functioning autistic people,\nespecially with legal rights issues\nand when you can have parents involved or not,\nif the child refuses they have the parent get involved,\nit often leads to a lot of risk for legal and social problems.\nCause and effect, planning ahead,\nthese are problems autistic people they have.\nThey may be naive in terms of seeing\nall the social consequences to certain behaviors.\nThey may be taken advantage of legally or sexually or other\nways.\nThey could be misled by other kids.\nSometimes they have different priorities or interests.\nSo they may want to play the latest video\ngame instead of doing their studying or going to school.\nWe've had some kids who get straight A's then a new video\ngame comes out and then they flunk the next semester\nbecause they've just played video games the whole time.\nSo it's a hard group of high functioning\ncan sometimes be harder to manage than lower functioning\nobviously impaired children.\nAnd so I think what you have to do is get them counseling\nand support so they can have someone to talk to and help\nthem, educate them.\nBesides, sometimes a parent telling you something\nisn't the same as a professional telling you something.\nI think getting some type of behavioral agreement in place\nto help them manage their difficulties that they\nmay have, give them support if they get depressed or anxious.\nA lot of depression and anxiety, realizing their difference\ncomes out in adolescence, making sure they get support for that.\nAnd trying to-- by time-- before they're 18,\nhave honest conversations of can you manage your checkbook?\nCan you manage this?\nDo you want to sign me on to help you manage these things,\nwhich legal processes above 18, conservation\nfor legal or monetary or health care decisions\ncan be arranged so that family can support that person as they\nget older.\nIf you go to college and you don't\nhave a family member allowed to talk to you,\nit's just like HIPAA laws in medicine.\nThe professor won't recognize when you have a bad problem,\nbut if your mom or dad are allowed\nor a family member is allowed to talk to the professor\nfor you to help communicate some of those gaps\nand work with the university, recognizing those gaps,\npeople can put those models into place,\nsimilar to like an IEP in school.\nBut without the person's permission or willingness,\nonce they're 18, if you don't have that in place,\nthat can be a problem.\nSo I definitely think thinking ahead and not\nwaiting till they're 17 and a half or almost 18\nto make those decisions is important.\nStart when they're 14 or 15 and start\ngetting an idea of where that child is\ngoing to be able to function.\nCan they go to college?\nCan they live independently?\nIf not, you have to step up and really\nmake some tough decisions and make\nsure they understand that you're not trying to control them,\nbut be supportive.\nSo those are tough ages for anybody.\nRaising a teenager is hard in the best of circumstances,\nand it's even tougher with this.\nMODERATOR: Great.\nThank you so much, Dr. Chez.\nWe've had a couple people asking about language.\nThey have written in about that their child was not speaking,\nand then around age seven they have\nstarted saying a few words.\nWill that language continue to improve as they get older\nso that they'll have regular conversations,\nor will it just stay limited?\n\nMICHAEL G. CHEZ: Well, that's a really broad question.\nLet me just try and be--\nanswer it as best I can.\nMost children and languages develop before age 4 to 5.\nUp for age 6 is the most chance you have\nof getting a normal sounding fluent language in.\nFor instance, when people go to a foreign country,\nthey have an accent if they moved\nafter age 6 or 7 years of age.\nIf they move before age 6 or 7, their language skills\nsound like a native speaker, OK?\nSo we know that language changes the way you learn after age 6\nor so.\nThe brain is wired differently to learn language\nafter age 6 than before age 6.\nThings change and rewire.\nIf you don't have language age 6 or 7,\nit's very hard to say you're going to ever have language,\nbecause it's much harder to get new language after age 6 or 7\nif your mouth than your body doesn't make language by then.\nBut if someone's already starting\nto make language all of a sudden at age 7,\nthen it should continue to improve to some degree,\nbut will probably always be impaired.\nStatistically, that's the most likely answer.\nThe more language you have before age 5,\nthe better you are.\nBut again, I'm not going to say someone\nwho gets some some at age 7 won't continue to get more.\nThey probably will.\nIf there is anxiety holding people back\nand they can talk like they just don't, those kids\nwill have the best chance of any more language at an older age.\nThat's kind of the general answer.\nMODERATOR: Thank you so much, Dr. Chez.\nSo Dr. Chez, if autism is caused by some sort of a trauma,\nis there a chance that it can be cured at some point?\nMICHAEL G. CHEZ: Well, it depends\nif the trauma is temporary or if it's repetitive.\nLike, if you have a stroke or someone hit you in the head\nand you have a massive bleed in your brain\nand it causes permanent damage and that causes you a change,\nit's hard to fix that kind of damage to the brain, right?\nBut in other cases, what I can tell\nyou is that if it's like swelling of the brain\nor after a concussion or if it's from seizures\nand you treat those things, those type of things\nmight be reversible, OK?\nSo it really depends on the cause\nand how bad the damage is.\nSo it's a case by case analysis.\nI'm not saying it's impossible.\nThere is some possibility.\nAnd we're doing more stuff with stem cells for stroke and stem\ncells for other things.\nAnd those type of researches, maybe\nin the next 5 to 10 years, we can repair damaged brain\nbetter.\nSo there may be some hope there.\nBut that's actually putting brain cells back\ninto the brain, research type of things that have\nbeen done for stroke victims.\nSo maybe there is some hope there, as well.\nBut it's awfully early to say how successful that\nwill be for that kind of thing.\nBut I will say it's a case by case question, you know?\nMODERATOR: Thank you so much.\nSo Dr. Chez, can you talk about the benefits\nfor having a neurological evaluation\nif a child has already been diagnosed\nand is currently receiving ABA support?\nCan you elaborate on that, please?\nMICHAEL G. CHEZ: Well, I am biased\nbecause I am a neurologist, so I would say it's very valuable.\nBut all kidding aside, having a diagnosis\nfrom a psychologist or a school or a regional center therapy\nperson who gives the diagnosis is great,\nbecause it gets you services.\nSo there the side of the coin is what services can\nhelp my child, speech therapy--\nyou don't need a neurologist to get those things, ABA, speech.\nWhat you need the neurologist for\nor someone medically is to say, what are the causes?\nDid we make sure that the brain was formed normally\nand the physical exam suggests it's working correctly?\nWhat is the maximal function this child\ncould have neurologically?\nDo they have seizures, potentially?\nAre there secret seizures going on that I don't see?\nIs there sleep a problem?\nDo I need help with that?\nAre there other physical things that\nare going on in their nervous system that\nare affecting their gut, their sleep,\ntheir potential for seizures?\nTheir language isn't coming along.\nIs there a physical reason?\nWould treatments of some type help with that?\nAre there mood swings getting in the way of their therapy?\nIf they're having tantrums all day long\nbut you can control their mood swings\nor tantrums or attention, will they\nlearn better and get better therapy?\nSo I mean, that's the benefit of seeing someone with expertise\nin neurology, to help you.\nIt's a neurological disease.\nIt affects the brain.\nTherefore, you should see a neurologist,\njust to make sure you're not missing something else.\nMODERATOR: Great.\nThank you so much.\nAnd unfortunately, we are out of time.\nI know we did not get to all of our questions,\nbut we are out of time.\nSo I would like to turn things back over to you to wrap it up,\nDr. Chez.\nMICHAEL G. CHEZ: OK, thank you.\nSo-- let me see if I can get this to work here.\nThis is my office number.\nObviously, you can call our general pediatric neurology\nnumber, as well, to get referrals\nand to have your child evaluated.\nI work with three other child neurologists and two nurse\npractitioners.\nAnd we have a team of psychologists\nwho can see some of the patients, not all,\nbecause of the backlog.\nIt gets high.\nAnd then adult neurology, Dr. Kyle\nruns a clinic downtown that you can try and get into his stand\nclinic in Sacramento.\nBut other areas may have people, as well.\nBut I can tell you that I also wrote a book that's\na nice, easy read, and it's fairly up to date\non autism and its medical management,\ntalking about a lot of things we talked about today.\nAnd you can get that your library.\nYou don't necessarily have to buy it.\nI'm not trying to sell you a book, but it's a resource."}
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