Read the review of the evening

Research
Dr. Baird started by outlining the current research work of the multi-disciplinery team at Guys Hospital. She explained that it is very hard to get funding for work in the field of developmental difficulties. For the last 4 years Dr. Baird has tried to get money to research the causes of autism but has not been successful. However, she still hopes to look at a group of children for several possible factors, such as whether there is a difference in the immune systems of autistic children or whether they have 'leaky guts', and compare them with a group of children who have special needs other than autism.

In recent years the team have done a lot of research into early diagnosis and developed the Checklist for Autism in Toddlers (CHAT) to be used by health visitors at the 18 month check-up. They are currently looking at prevalence rates (the numbers of children being diagnosed), whether different forms of intervention have different outcomes, and medications used for other conditions that can occur with autism such as phobias or hyperactivity. Dr. Baird's team is also involved in the international studies into genetics and autism. It is thought that there are probably 4 or 5 genes involved in autism, and researchers have found two promising sites for further research.

Newly diagnosed
The evening then moved on to questions from the audience. A parent whose child had only just been diagnosed asked what she should do now. Dr. Baird recommended coming to support groups meetings such as ours because there is an enormous range of experience amongst the members. She advised against reading too many books as they can become overwhelming. Instead she suggested asking yourself 'what is my child not doing that I want him to do? What might the reason be? How could he be taught it? What resources would I need? Who should I ask? What is the best environment for him to do it?', and then either teach it yourself or find someone else who would be good. The way children with autism learn is through something being made very clear, done in a repetitive way (usually visually), practised and made fun and enjoyable.

Dr. Baird praised the work of the outreach teachers from Linden Bridge and Freemantles Schools. Diana Ennis, the Linden Bridge outreach teacher, was at the meeting and explained the help she gives to families and mainstream schools (see previous issue of Surrey News). Dr. Baird also had great praise for the Little Group nursery in Epsom, which she described as absolutely superb.

Feeding and sleeping
The issues of feeding and sleeping problems were raised. Dr. Baird felt that as long as the child was gaining weight and eating a reasonable amount of food, then it might not be worth putting all the parents' efforts into changing eating patterns, as this was a battle which was almost always lost. She said that although it was a common problem in younger children, it was very rare in older ones or adolescents and often got better naturally over time as the child's sensitivities decreased.

Sleep problems are more difficult as they can disrupt the whole family's life and may occasionally persist into the teenage years if not tackled. Both eating and sleeping are problems which can affect all children although they are more difficult to deal with in autistic children because autism means that our children find it harder to learn and therefore to change their behaviour using standard behavioural programmes. The medication Melatonin can help to get children to sleep, and there is now a slow-release Melatonin which may help with those children who wake after a few hours.

Asperger Syndrome and language Somebody asked about the overlap between language problems and Asperger Syndrome (AS). Dr. Baird explained that 'Asperger Syndrome' has become a shorthand way of describing someone who is high-functioning (in terms of being intelligent), has language skills which they like to use but has social impairments, special interest and may be clumsy.

The official diagnostic manuals classify people with AS as having normal language and behaviour until at least the age of 3, which rules out a lot of children who had early language delay etc. By the teenage years there are few significant differences in outcomes between those AS children who had normal speech at 3 and those who didn't; what matters is the difference in overall ability, language level and severity of autism.

Almost everyone with an autistic spectrum disorder will have problems with language - when to say things, what the meaning is, appropriate conversation, and within the spectrum there is a huge range of language difficulties. The professionals are still grappling with the most meaningful way of describing children. Dr. Baird sees some where the language difficulty is the more severe problem although they also have social impairments, and they are often diagnosed with Semantic Pragmatic Language Disorder. Dr. Lorna Wing has encouraged the use of the term 'autistic spectrum disorder', although the drawback of this is that it applies to so many children that it does not convey an individual description of the child.

A question was asked about different therapies. Dr. Baird explained that Applied Behavioural Analysis (ABA) programmes involve working intensively with the child on particular behaviours by rewarding so that they are repeated. Son-Rise/Options is another intensive programme but it is child led. The therapists follow the child's interests and imitate what the child does. Higashi is yet another programme, which involves group teaching. Dr. Baird feels that all the programmes can help if a child enjoys them and they are done frequently, but each has advantages and disadvantages. Ideally a mix of all approaches is used. There have been difficulties when children who have just been using Son-Rise try to integrate into schools, as it is necessary for the children to be able to conform to requests and the child-led approach does not prepare them for that.

Dr. Baird currently has a waiting list of 2 years, although when a new colleague joins her in January that should reduce to 'only' one year. We are very grateful to her for coming to talk to us.

Listen to RealAudio recording

Research

Introduction; Early Diagnosis; Intervention Studies. Length 5 minutes 56 seconds.

Changing Prevalence Rates; Cause of Autism; other difficulties and disorders associated with autism. Length 6 minutes 4 seconds.

Genetic Studies. Length 2 minutes 57 seconds.

Questions from the audience. Note: In most cases each of the following recordings start with a question from the audience. In some cases additional follow-up questions are asked during the talk. The sound of the questioner has been amplified during production but may in some cases still be inaudible. The basic thrust of each question is included in each of the links below.

"Can you please elaborate on the study of early intervention that you have done". Length: 2 minutes 21 seconds.

"Are there any suitable natural alternatives to Ritalin?" Length: 1 minute 27 seconds.

"I've just had my son diagnosed with autism. If you were me, what would you do now?" Length: 4 minute 21 seconds.

"In your research, are you going to look at the link with the MMR vaccine?". Length: 4 minutes 57 seconds.

"Is there any fundraising being done for research into autism?". Length: 1 minutes 48 seconds.

"How can I persuade my GP to refer to a specialist? - he turned me down last time". Length: 1 minutes 57 seconds.

"My son is 4 and half and has a severe eating disorder...". Length: 3 minutes 39 seconds.

"Would you consider diagnosing a child who is considered to have 'communication disorders'?". Length: 1 minute.

"Can you talk about the overlap between language disorders and Asperger's syndrome?". Length: 6 minutes 35 seconds.

"It seems that my autistic son may have Prader-Willi syndrome. Is this different to autism - or is it an 'addition'?" Length: 2 minutes 22 seconds.

"I have four children, two have ASD, one has a language disorder and my daughter has juvenile chronic arthritis. Is there any link between autism and juvenile chronic arthritis?". Length: 45 seconds.

You said that with feeding problems that you just really have to wait and it will go away. Does the same thing apply to sleep?". Length: 2 minutes 36 seconds.

"What about night terrors - are they caused by the Asperger's or by Ritalin?". Length: 59 seconds.

"I'd like to know what the current known recurrence rates are if your first child is autistic". Length: 24 seconds.

"There's been a lot in the media recently about excess metals in the blood of autistic children....". Length: 8 minutes 45 seconds.

"Why is it so difficult to persuade people to give money for research?". Length: 1 minutes 26 seconds.

"Can you talk about ABA, Lovaas and Options (and what these terms mean)?". Length: 4 minutes 57 seconds.