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Be Well for Parents - April 2011 Issue

Autism: Be Wise, Be Aware, but Don’t Worry

Autism: Be Wise, Be Aware, but Don’t Worry

As understanding of autism spectrum disorder (ASD) has grown, so has parents’ anxiety about what is and what isn’t autism.

ASD reflects a wide range of problems and functional abilities. “Children at the severely affected end tend to have more problems, and more pronounced problems, so the diagnosis is usually more clear,” says Kimberly Giuliano, MD, a pediatrician with a special interest in autism.

Children at the milder end of the autism spectrum are those with Asperger’s syndrome or pervasive development disorder/not otherwise specified (PDD/NOS). “Parents may perceive their problems to be variants of normal and not bring them up with the pediatrician,” says Dr. Giuliano.

Difficulties with verbal communication and social skills, and repetitive behaviors or narrowed interests are hallmarks of autism. But gray areas overlap both normal development and ASD:

Delayed speech. “What separates autism from primary speech delay is that children who are autistic have social problems as well,” says Dr. Giuliano.

Social difficulties. Children with autism find it difficult to interact with peers and with people familiar to them. “Normally developing children may hesitate to interact with strangers, but once they develop a relationship, they interact better. Children with autism struggle with relating to most people,” she says.

Most shy children will eventually warm up to a new situation or will feel OK if someone they know helps them adjust to it. But even a familiar face won’t reassure an autistic child. “Children with autism might be overwhelmed, feel scared or cry in situations that other kids would really enjoy, such as a park or play area where other kids are running around and having a good time,” says Dr. Giuliano.

Narrowed interests. “Autistic children tend to have intense interests that we normally don’t think of as exciting for kids, such as ceiling fans or parts of objects,” she says. A 2-year-old’s obsession with a cartoon character or toy cars is not a sign of autism.

Anger/frustration. A frustrated child with autism can look a lot like a toddler going through the terrible twos. “Yet some parents worry that kids who have temper tantrums, throw themselves on the floor or bang their heads are showing symptoms of autism,” says Dr. Giuliano.

Sleep problems. “Autistic children may wake up in the middle of the night and be ready for their day — and not necessarily tire out or want to nap the next day,” she says. This is far different from kids who settle back to sleep after getting a glass of water or a little TLC from their parents.

Seizures/sensory problems. Children with autism are more likely to develop neurological problems such as seizures and heightened sensitivity to light, sound or touch. “But not every child who has these issues is autistic. For example, some kids with seizures otherwise develop completely normally,” Dr. Giuliano says.

Gastrointestinal problems. Children with autism often experience constipation and diarrhea. “But constipation is a common problem, especially around the toilet-training years,” she says. Frequent diarrhea can be caused by drinking too much juice, lactose intolerance or a medical condition, such as inflammatory bowel disease.

Toe-walking. Toe-walking that persists after age 2 may be a sign of autism — but it may also represent a muscle-related problem. “Once children have been walking for several months, we expect them to become more flat-footed,” says Dr. Giuliano.

When in doubt, talk to your pediatrician

It is always appropriate to share concerns about your child’s development with your pediatrician, she says. Even for an isolated developmental delay, occupational therapy, speech therapy or social skills training will serve your child well.

And if multiple delays point to ASD, then prompt evaluation, appropriate therapies and medications will allow a child to reach his or her full potential — including college, careers and marriage for some.

“We see some children significantly affected by the disorder progress along the spectrum to become very high-functioning,” says Dr. Giuliano. “And some higher-functioning children have what appears to be a normalization of their behaviors or problems.”

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Tip - 3-D handheld games: ‘Just say no’ to kids under 6

The new 3-D handheld computer games may seem like a blast for kids. But their eyes may not be ready for them until they’re age 6 or older. Encourage healthy eye and brain development by limiting kids’ viewing time on handheld games, big-screen TVs, computers and smart phones. Learn more about protecting kids’ eyes in a free webchat with our experts on Thursday, April 21, from noon to 1 EST.

Parents Children's Health Essentials – April 2011 Issue

Sleep Secrets: How to Get Those Zzzz’s You Crave

Sleep Secrets: How to Get Those Zzzz’s You Crave

It’s 2 a.m. and, as on so many other nights, you can’t fall asleep. You take a sleeping pill, but nothing happens. What’s wrong?

“It is better to try good sleep behavior approaches first. If you work against the natural sleep process, then sleeping pills won’t help you,” says Cleveland Clinic sleep psychiatrist Douglas Moul, MD.

The irony about insomnia is that the harder you work at it, the worse it gets. “Get out of the way,” says Dr. Moul, and let natural forces take over.

In addition, keep these three tips in mind, he says:

1. Decrease mental activity at bedtime.

An active mind will keep wakefulness going, so reserve your bed for sleep and sex. If you are awake in bed, get up and do something boring elsewhere. “This tactic helps lots of people,” says Dr. Moul.

2. Say ‘no’ to naps.

Good, deep sleep requires a buildup of wakefulness. Use daytime to increase the pressure to sleep. Sneaking naps during the day will dissipate that pressure.

3. Aim for improved — not perfect — sleep.

Some wakefulness at night is normal — being asleep is not like being unconscious. If you try good sleep behaviors every night for three weeks and still have insomnia, talk with your doctor. You may need extra help: coaching from your sleep doctor or a sleep psychologist, or sleep medications.

To derive the greatest benefit from sleeping pills, you must use them correctly — and separate myth from fact, says Dr. Moul.

Here are five common myths about sleeping pills — and the facts behind them:

Myth 1: Sleeping pills are supposed to knock you out.

Fact: Sleeping pills only help you get to sleep. A sleeping pill should be taken when you are getting a little sleepy to facilitate this process. “If it is taken before you start to wind down, you will only get angry and frustrated, and this will defeat the pill,” says Dr. Moul.

Myth 2: Sleeping pills are a long-term solution.

Fact: Sleeping pills may not work if they are taken nightly. It depends upon the person.

Myth 3: If a sleeping pill stops working, all you have to do is ‘up’ the dose.

Fact: If your sleeping pill stops working, increasing the dose may not make it work.

Myth 4: Sleeping pills are addictive.

Fact: Addiction to sleeping pills is rare unless people already have substance abuse problems.

Myth 5: Choosing the right sleeping pill is easy.

Fact: Finding the medicine you need to combat chronic insomnia may take time. “Be patient and don’t get upset if the first medication doesn’t work. You may have to try many different medications to find one that offers stable benefits without side effects,” says Dr. Moul. 

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Parents Children's Health Essentials– April 2011 Issue

Video - Teens & breakfast: Think 'outside the cereal box'

Twenty-five percent of teens skip breakfast. Studies show that students who eat breakfast regularly are less likely to be late or to miss school. Learn how to tempt your teens with a breakfast they’ll find appealing.

Recipe: Roasted Italian Vegetable Pasta Salad


1 pound cherry tomatoes, halved
1 medium zucchini, quartered and cut into ½-inch cubes
1 medium summer squash, quartered and cut into ½-inch cubes
1 shallot, minced
1 fennel bulb, cut into ½-inch slices and diced
1 small red bell pepper, seeded and cut into ¾-inch cubes
1 garlic clove, quartered, plus 1 clove, minced
1½ tablespoons extra virgin olive oil
½ teaspoon kosher salt, optional
Freshly ground pepper
8 ounces whole wheat rotini (spiral-shaped pasta)
2 tablespoons balsamic vinegar
2 tablespoons freshly grated Parmesan cheese
¼ cup fresh basil, torn into large pieces


Preheat the oven to 425°F.

  1. Place the tomatoes, zucchini, squash, shallot, fennel, bell pepper and quartered garlic clove in an ovenproof nonstick skillet.
  2. Toss with the oil, salt (if using) and ground pepper.
  3. Roast for 6 minutes; turn and continue to roast for another 6 minutes. Remove from the oven.
  4. While the vegetables are roasting, cook the pasta, following package directions.
  5. Drain the pasta, reserving 2 tablespoons of the cooking water, and return to the pot.
  6. Toss the pasta, roasted vegetables with their juices, reserved pasta water, vinegar and minced garlic.
  7. To serve, plate the vegetable pasta salad and top with the cheese and basil.

Makes 4 Servings

Nutrition Information

Per Serving:

  • 330 calories (19% calories from fat)
  • 7 g total fat (1 g saturated fat)
  • 12 g protein
  • 60 g carbohydrate
  • 12 g dietary fiber
  • 0 mg cholesterol
  • 65 mg sodium
  • 950 mg potassium

One of more than 150 heart-healthy recipes from the Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook, available from Broadway Books and wherever books are sold.

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Parents Children's Health Essentials – April 2011 Issue

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