On Sunday February 7, 2010, Dr. Robert Moradi gave a presentation to ACDS members entitled “Father in the Triangle.”  Dr. Robert Moradi is a Jungian analyst and Board Certified Psychiatrist in private practice in Los Angeles. Dr. Moradi is an Associate Clinical Professor of Psychiatry at the UCLA School of Medicine.  He teaches at the Graduate Center for Child Development and Psychotherapy, Cedars Sinai Medical Center, Reiss-Davis Child Study Center and the C.G.Jung Institute of Los Angeles.  Dr. Moradi has published and presented extensively on the treatment of adults, children and their families.

A man’s relationship to his wife is altered profoundly with the arrival of a baby; as new mothers are swallowed up by the needs of the infant, the father is often marginalized and lonely.  He finds himself in the same category as his father and his ideas about being a father, and has to try and integrate this past sense of his father, his past sense of self, and the new expectations of him.  As a consequence of experiencing being left out, the father’s defensive reactions might include envy, anger and shame which can result in behaviors (too much work, substance abuse or an affair) and projections which can come to define the family’s psyche.

When the child becomes a toddler, the father has the opportunity to connect with his child in a more central way.  The parenting that he provides for his child can give him the opportunity to connect to his own vulnerabilities, the struggles of his wife and the vulnerabilities of his child.  In the empathetic connection learned by fathering, a man can move toward developing a mature masculinity.  This mature masculinity allows for the differentiation of the child, increased empathy for the man’s own father, and increased compassion for his wife.

Fathers who are psychologically involved have children who are more compassionate toward others, have increased cognitive competence, less sexual stereotyping and greater internal locus of control than children who come from families where the father is not psychologically involved.

Dr. Moradi spoke of the usefulness of therapy groups with fathers to help them become less isolated and more aware of the commonality of their position.  This reduces their stress and increases their compassion for their partner which in turn strengthens the family.

On March 14, 2010 Diane Danis spoke to ACDS about autism in a lecture entitled “Evolving Concepts: My Journey to Understand Autism’s Biomedical Roots.”

Autism was first termed by a physician named Leo Kanner in the 1940’s.  This problem historically has shifted from being viewed as a problem in the mother child relationship to being known as a biologically based disorder that is genetically based.  It is defined behaviorally and observationally.  Symptoms include impaired social interaction, impaired non verbal cues, difficulties with spoken language, restricted, repetitive, stereotyped patterns of behavior and delays in symbolic or imaginative play. The risk to siblings is 20% higher than in the normal population.  There are differences in the structure and function of people with autism; it is a brain-behavior problem.  These children do not all present in the same fashion so each intervention needs to be customized.

Lots of these children have gastro intestinal problems, allergies and family histories of autoimmune disorders. Dr. Danis has observed that many of these children are sicker than the general population and so she looks for sleep disorders, dental problems, allergies and gastro-intestinal problems in the children that are brought to her.

A question that has been raised by researchers is whether or not gene expression can be effected by the environment?  In addition, can the immune system be affected by the environment?  Are there mitochondrial disorders in children who are affected with autism?  It is thought that there may be multiple systems that can lead to autism.  Researchers are also wondering how different body systems are interacting with the brain.  In different children multiple systems are affected differently.

Dr. Danis observes that autism seems to be a disorder of interconnectivity not only between the children affected and others but possibly of interactivity of these children’s internal systems.  There are thoughts that there might be a cumulative toxic load rather than a specific toxin that is affecting these children’s systems.

Recommended therapies include speech, school, sensory integration, a reduction in the toxic load and specific diets.  Dr. Danis recommends that parents educate themselves about Floortime and become sophisticated about using it.  When a child comes in to see Dr. Danis she does an observation and gets a history (family and personal).  She advises families to eat organic and unprocessed foods and get rid of all pesticides and household toxins.

When she refers families to mental health professionals she is expecting that the professional will facilitate the relationship between the parent and child, that there will be a great deal of talk about the relationship between the parent and child.  She has found that the most important thing is the mobilization of the family to get services and to begin to have fun and joy in the relationship between the parent and the child.  She has noted that when the clinician is able to have fun with the child this greatly helps the parents have fun with the child.

Dr. Danis uses the National Standards Reports to determine the status of therapies she encounters; they break out therapeutic interventions into proven, emerging and unproven therapies.  She recommends that professionals learn to be well informed judges of claims and reports.  She has found that SSRI’s are the medications of choice for the most part with these autistic children when medications are necessary.

Her overriding message is that it takes a team- a village- to help these children and families.

On January 10^th Dr. Alessia De Paolo Gottlieb came to talk to ACDS about “Assessing Children on the Pervasive Developmental Disorder Spectrum”.  Dr. Gottlieb is board certified as a developmental pediatrician as well as both a child and adolescent psychiatrist.  On February 1^st she will begin working on a child assessment team at New York Presbyterian Hospital that will focus on development, biology, neurobiology and family systems.  Dr. Gottlieb will continue returning to Los Angeles every two months for two weeks in order to attend to the needs of her patients.

Dr. Gottlieb began by talking about how social babies are from birth, that they have a good deal of joint attention, they imitate and are filled with affect.  A child at risk for a neurodevelopmental disorder (autistic spectrum disorder or pervasive developmental disorder is)  often not expressive and does not register social cues.  A delayed child will look at your finger when you point instead of your eyes and then the item.  He has diminished focus on your eye gaze and instead tracks your mouth, the edges of your face and the item being shown rather than your eyes.   Most children are brought in with parents reporting growing concerns since birth or a sudden loss of functioning beginning at 18 months.

Dr. Gottlieb stated that it is never enough to look at symptoms only and that the professional must always look at the etiology of the disorder.  Children with obsessive compulsive disorder, anxiety, Sensory Integration issues, ADHD and selective mutism all can compensate with behavioral symptoms that can be very rigid and look autistic to the non discriminating eye.  When looking at a child one must take in temperament, caregiving environment, attachment, family system and the child’s relationship to his environment.  In doing her assessments Dr. Gottlieb meets with various family members multiple times during the course of an evaluation.

She meets with the parents alone initially (2 hours) and gets a sense of the difficulties they are experiencing with their child.  Included in this is their sense of both parenting and being parented.  She then will do a visit where she can observe the child in his environment without the child knowing her.  She might do a home or a school visit.  She will include standard testing sessions with a child where she uses a developmental screener (the ADOS, Bayley, Mullen or another tool).  And finally, a session with the parents where she discusses the child with the parents.  Dr. Gottlieb’s profile of the child is one that is as descriptive as possible rather than exclusively diagnostic.  Her goal is to help the family understand how to help the child move through the child’s own developmental needs; to have the parenting adjusted to the child’s specific profile.  She gives the parents a picture of their child that will inform their choice in terms of education and daily interactions.  Dr. Gottlieb continues to follow families after she has done an assessment; she views herself as their ongoing coordinator of care and as such is available to families 24 hours a day seven days a week.

A question was raised about sensory integration.  Dr. Gottlieb reported that the American Medical Association does not include it in their standards of care for ASD (they recommend lots of behavioral intervention and medication) although she does use it in some cases.  She stated that SI treatments are often helpful when treating anxiety, ADHD or autism.  In her experience 10-20% of her patients have sensory integration issues without another disorder.

In being asked about the origins of autism Dr. Gottlieb stated that the field simply does not know what causes it.  The medical field is looking at both genetics and the environment as possible contributors to neurodevelopmental disorders.  Regardless of the cause what the doctor made clear is that it takes a village of caring, patient and compassionate people to help manage a child who is experiencing difficulties.