Thursday, February 11, 2010

The Abdominal No Man

The therapist was doing an intake of an 11 year old male who was in a school program for emotionally disturbed students. He allegedly had a problem with explosive outbursts of aggression and anger. He was being treated with psychoactive medication that apparently had no impact on his behavior. The fellow was born to a drug using mom, tested positive for drugs at birth, was taken at the hospital by a community social worker. He was fortunate because he was adopted.

His adoptive father came in for the first visit. A psychologist needs to ask medical questions because these are infrequently considered significant by medical mental health professionals when treating and diagnosing. Billy had a very significant problem with constipation. His father reported that it was not unusual for him to go longer than a week or two to have a bowel movement. These were difficult events for him. His parents tried to help by providing over-the-counter laxatives. They talked to his pediatrician, who informed them that there were no pediatric gastroenterologists in the area.

The therapist easily convinced the father to take him to one of the closest medical teaching hospitals. A pediatric gastroenterologist diagnosed his problem and has been treating him. He does not have constipation any longer. Here is the surprise (perhaps) - his behavior problems have disappeared.

Wednesday, February 10, 2010

Red Lipstick

Way back in 1968, the student in Abnormal Psychology class was working on an on-going project to get a 19 year old institutionalized autistic female to say a specified sound. The technique used was to hold an M & M close to his mouth to get her attention, say the sound, and when she said it, give her the candy. Repeat throughout the session. The young woman had others doing the same thing. The class never got to learn whether she could ever speak on her own.

One thing that we have known about autistic children for a long time is that they frequently have disordered/disrupted sensation/perception. Some clinicians have used this to help people with autism.

It is now 2010. Methods for getting autistic children to look at a mouth have not changed much. It is especially difficult for young children. There has actually been research with two to four year old children that found (using sophisticated equipment) that focusing on the mouth is diagnostic. Regardless of age, children with Autistic Spectrum Disorder spent significantly less time looking at the mouth than typically developing children (Chawarska and Shic, 2009). When a person considers that the research is basically an expansion on the theme of figure ground perception, a perceptive person can consider ways to enhance the facial features so that they may stand out from ground. Doing this can, and should help autistic children learn.

I recently began mentioning the use of red lipstick by parents and therapists to acquire and maintain the attention of autistic children on the mouth for the purpose of conducting speech therapy. A parent of a set of autistic children (not from twin or other multiple births) reacted to my suggestion with astonishment because she does not ordinarily wear lipstick. She bought some bright red lipstick on a whim, applied it, and was amazed at how much attention her children were paying to her mouth. Her children ranged in age from 8 years old to 13 years old. One child was a girl, and the others were boys.

There is a shortcoming with red lipstick. Male therapists are unlikely to use it. Fathers working with their children are unlikely to use it. There are two possible solutions. Men can apply the lipstick and wear it only during therapy. That is an easy solution, but one that is unlikely to sit well with many of them.

The second solution would involve the purchase of a small theatrical moustache that can be worn multiple times on the upper lip. The hair should be dyed the same shade of red as lipstick. Men can use this to draw their child's/client's attention to the mouth. As much as many men are loath to wear red lipstick under any circumstances, women are likely to reject the option of wearing a bright red colored theatrical moustache on their upper lip. However, when a woman does not want to wear red lipstick, the bright red theatrical moustache can be an option for them.

A secondary aspect of speech therapy can involve having the child look in the mirror. An autistic child is unlikely to look at themselves AND their mouth to practice speaking. When the child does not have a sensory sensitivity to wearing lipstick, it may be possible to apply bright red lipstick to them to wear during speech practice in front of a mirror. Of course, under the same awareness of possible sensory sensitivity, they could also wear a bright red colored moustache during practice sessions. Perhaps having the parent use either option during speech practice would make the use of the same option on them in front of mirror more acceptable.

It would be excellent to get some feedback on the use of red lipstick. Please respond with comments.


Chawarska, K. & Shic, F. (2009). Looking but not seeing: Atypical visual scanning and recognition of faces in 2 and 4-year-old children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 39, 1663-1672.

Monday, February 1, 2010

Do asthma medications cause behavior problems?

A nurse at work recently asked for a consultation. She was concerned about a 2 year, 4 month old boy who was displaying extreme mood swings, and very aggressive behavior. The nurse casually mentioned that the child was taking Singulair for breathing treatments. I casually asked if she thought that the behavior might be related to the Singulair.

The thought really concerned me so I researched the web. Behavior problems are listed as a rare but serious side-effect of montelukast sodium (aka Singulair). There were blogs written by parents who noticed this problem and reported that the behavior problems disappeared when they discontinued the medication. One such blog could be found at

Another horrible thought crossed my mind. What if other asthma/allergy meds did the same thing? Take a look at I also found similar, disturbing notes about Advair.

I talked to the pediatrician at work. Her first response was classical (for her). She asked if I thought that she did not know about it. I said, that this was not the point. The question was, "What should we tell parents who bring their child to us because of severe behavior problems, and we learn that they take medication?" She suggested that we tell them to talk to their pediatrician. There is a problem here - many pediatricians do not believe that a child could be having this side-effect. She then said it came down to a choice between wheezing kids who had trouble breathing, or violent kids with severe mood swings. There is another way.

A number of years ago, I read that children in Israel are rarely prescribed asthma medications. Instead, they are given behavioral treatment. They are taught to "belly breath" their way through an asthma attack. Would you be surprised if I told you that I did this with a kid? I did. The child's mother was in my waiting room with a rescue inhaler. I put him through the process of learning belly breathing while he was having an asthma attack. His attack subsided.

Now, about twenty years after the therapist stopped an asthma attack in his own patient, there was an article that was summarized at
This presents a summary of Anbar et al. (2010) Adding hypnosis to the therapeutic toolbox of pediatric respiratory care. Pediatric Asthma Allergy Immunology

Questions: Why is it that we do not treat asthma by teaching belly breathing instead of prescribing medications that can change their behavior in such a way that they seek psychiatric or psychological assessments often resulting in the prescription of psychoactive medications that cause other side-effects (ad nauseam, ad infinitum)? Why not try hypnosis?