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Explore Alternative Treatment of Depression as Research Links SSRIs During Pregnancy with Increased Risk of Autism

Monday, January 25, 2016


Should I take SSRIs for depression while I'm pregnant?" This is a vital question to discuss with your Dr. since there's an increased risk of autism in your childOnce again a study links taking SSRIs (Prozac, Zoloft or Paxil) during pregnancy with increased risk of autism in the child. Anick Bérard of the University of Montreal an internationally known expert in the field of pharmaceutical safety during pregnancy published the finding in the journal JAMA Pediatrics. The researchers factored into the study genetic predisposition or family history, maternal age, socioeconomic factors such as poverty, and the affects of depression itself. And they found that you double the risk of Autism if SSRIs are used.

Bérard and her team followed 145,456 children from birth to 10 years of age. Significantly, 1,054 of those children were diagnosed with autism. When interviewed she said:

“Using antidepressants, especially selective serotonin reuptake inhibitors (SSRI), during the 2nd/3rd trimesters of pregnancy increases the risk of having a child with autism (87 percent increased risk of autism with any antidepressants; more than doubling the risk with SSRI use specifically) – this risk is above and beyond the risk associated with maternal depression alone (maternal depression was associated with a 20 percent increased risk of autism in our study). Given the mounting evidence showing increased risk of adverse pregnancy outcome with antidepressant use during pregnancy, our study shows that depression should be treated with other options (other than antidepressants) during this critical period.

Indeed, 80-85 percent of depressed pregnant women are mildly to moderately depressed; exercise and psychotherapy have been shown to be efficacious to treat depression in this sub-group. Therefore, we acknowledge that depression is a serious condition but that antidepressants are not always the best solution.

Our study is not out to scare women. It’s 2015 and women can make informed decisions, but they need to have evidence-based data. A discussion with their physician is warranted in order to fully consider all treatment options.”

The prevalence of autism amongst children is increasing. So is depression. According to the World Health Organization, by the year 2020 depression will be the second leading cause of disability throughout the world, after heart disease. Therefore, it’s likely that antidepressants will remain widely prescribed, including during pregnancy.

Today six to 10 percent of pregnant women are currently being treated for depression with antidepressants. Since 80 to 85 percent of depressed pregnant women are mildly to moderately depressed, it is advantageous to use medication as the last resort. This degree of depression can often be effectively treated with alternative methods such as exercise, Cognitive Behavioral Therapy and a holistic health approach.

If you’re depressed and plan on becoming pregnant, please learn about your medical choices. If you’re already taking SSRIs please consult your doctor. It would be harmful to stop taking them without your doctor’s supervision. And it’s harmful to leave depression untreated for the duration of the pregnancy, since depression itself increases the risk of autism.

If you live near Portland, OR/Vancouver, WA and would like to be fully informed about treating depression with holistic health options, please contact my office and schedule an appointment.

What Happens to Autistic Children Aging Out of School?

Monday, April 20, 2015


what programs are there for aging out autisticsAccording to experts, within the next 10 years, an estimated 500,000 autistic children will become too old for education through the local school districts. At the age of 21, these children graduate and have to find their own way in the world that is ill prepared for them.

Autistics (the term they prefer to be called) don’t grow out of their disability. So losing their structured routine is terrifying to them. It can undo the progress they’ve made and send them spiraling back into self destructive or isolating behavior. Many parents who have already experienced this describe it as falling off of a cliff or even being pushed off of a cliff.

Recently on a must-see Dateline Show, On the Brink, they followed the stories of two autistic boys for three years, chronicling their experiences as they aged out of the school system. The struggle these families go through in order to find specialized care for their sons is both heartwarming and heartbreaking.

It’s required that each school district has a transition plan, a set of measurable goals to prepare autistics for adulthood. The reality falls far short of what is needed.

Let’s raise awareness of this issue and give continuing support to those we know personally in addition to everyone across the nation who struggles with Autism Spectrum Disorder. It’s a growing problem that we cannot afford to ignore.

I realize the caregivers of those with ASD need extra support and comfort as they carry a heavy load. I’ve formed a supportive network through international teleconferences and local meetups called Asperger Syndrome: Partners & Familiy of Adults with ASD. And I’m happy to now let you know that there are groups forming around the country so you may soon be able to meet in your own local area. Check here for the currently scheduled meetups. Please come and join us. You’re not alone.

Listen to the full Dateline Show here.

Check out Autism Speaks Transition Tools here.

What’s Happening to the Aging Autism Population?

Saturday, September 20, 2014


What's happening to the aging autism populationAutism was first described as a syndrome in 1943 by Leo Kanner. That’s over 70 years ago. However, most of the autism research still mainly focuses on children. This is important, as we desperately want to understand how to best assist children to reach their potential.

However, the challenges of autism follow these individuals throughout their lives. And some of them are well into their 70’s. How does autism affect the different stages of life?

CNN contributor, Francesca Happe, reported recently on a number of studies of older ones with autism. Here are a few of the highlights:

  • Adults with autism have higher rates of hypertension, diabetes and obesity. This might be because they can’t communicate health difficulties and due to their sensory issues, they can’t tolerate the standard physical exams that physicians give.
  • One group of severely affected older adults with autism showed high rates of Parkinson-like movement problems. They can only speculate as to reasons at this point. More study is required to discover the answers.
  • There is some good news. At the International Meeting for Autism Research last weekend Marsha Mailick, director of the Waisman Center at the University of Wisconsin-Madison, shared data gleaned from 10 years of following the lives of more than 400 people with autism, starting in 1998. It found that “Autistic symptoms, such as impaired verbal and nonverbal communication and social interaction, and rigid/repetitive behaviors, decreased over time among one-third to half of the study participants, and stayed stable in many others. Independent living skills remained stable in this group, as well.

The evidence indicates that people with autism need continued research, support, and services throughout their lives. Since they are more prone to anxiety and depression, it’s vital that their mental health is evaluated and assisted by a specialist trained in autism spectrum disorder.

And not to be forgotten are the life long caregivers for those with ASD. They require continued support as well to cope with the demands put upon them. Are you ready to reach out? Do you need to talk with someone who understands the dynamics of a relationship with someone with autism? If you live in the Portland, OR/Vancouver, WA area, please contact my office and set up an appointment.

New Research into the Link between Autism and Suicidal Thoughts

Wednesday, August 06, 2014


autism and suicidalityRecently I was interviewed by Sarah DeWeerdt for an article, Suicidal thoughts alarmingly common in people with autism. At the suggestion of Dr. Oren Shtayermman, PhD, MSW, she spoke with me about what it’s like to have an autistic child express suicidal thoughts. I shared with her the story of my daughter, who used to beg me to kill her so that we both wouldn't suffer any more. She was in so much emotional pain, and that was the only way she could tell me that she felt helpless. While this is a painful topic, I was glad that I could contribute to further understanding an issue that has for too long been ignored.

The alarming statistics show that both children and adults with autism have a much higher likelihood of suicidal thoughts and behavior. One study the article quoted says that “two-thirds of a group of adults diagnosed with Asperger syndrome said they had thought about committing suicide at some point, and 35 percent had made specific plans or actually made an attempt.” Research is showing that the very cognitive patterns that people with autism or Asperger’s Syndrome possess make them more vulnerable to suicidal tendencies.

Because those on the Autism Spectrum can’t express their feelings well, it’s been assumed that they don’t feel depressed. When they are asked if they feel depressed, they may say “No”. Yet at that same moment, they may be harboring thoughts of wanting to end their lives. They don’t make the connection. As a result, I am so grateful that research into this connection between autism and suicide is increasing.

It’s important to note that our autistic loved ones may have these suicidal feelings, but be unable to express them. It’s imperative then that we be alert and sensitive to hear their unusual way of crying for help.

Asking for help is another social skill that those with autism may be lacking. If you or someone you know is struggling with hopelessness or deep sadness, I urge you to get help immediately. If you live near Portland, OR/Vancouver, WA please contact my office and set up an appointment. I assure you no matter how bleak your life looks, it can get better.

Read more on my website – Overcoming Depression and Asperger Syndrome.

How Can Families Thrive When It’s Mom Who Has Asperger’s Syndrome?

Tuesday, July 15, 2014


mom has aspergers syndromeEven though it is more common for a husband to have Asperger’s Syndrome, it’s quite possible for a mother to have it too. Recent statistics from the Center for Disease Control and Prevention show that five times more males are diagnosed with Asperger Syndrome (AS) than females. And while males can reliably be diagnosed as early as 18 months to two years of age; females are often not diagnosed until adulthood.

This presents a real challenge to family happiness, because culturally women are revered as the nurturers of the family. And while women with Asperger’s generally accept that it is a woman’s duty to care for the children and maintain the household and in general keep the family happy and healthy, they just are not very well equipped to handle this role. As a result they are viewed as cold, uncaring, and selfish because they can’t live up to what’s expected of them.

Because women often go undiagnosed, dads are clueless as to why their family dynamics aren’t working. Nuero-Typical (non-Asperger) men need to learn about Asperger Syndrome and be able to talk about their experiences in order to learn how to cope and indeed help themselves and their families to thrive under these challenging circumstances.

How do many Neuro-Typical (NT) dads react when they are faced with a spouse that has Asperger’s Syndrome?

On the surface their reaction is the same as many NT mom’s. They’re angry and hurt. And since they see their wives as neglectful of and abusive to their children, because they expect their wives to be the more nurturing parent, these feelings are magnified for an NT dad. Without help, the NT father gets angrier and angrier. This clouds the real problem—his undiagnosed Asperger’s wife and her limited parenting skills. Anger and withdrawal are common ways NT dads deal with parenting problems associated with marriage to an Aspie wife.

NT dads should recognize the anger for what it is, depression. They feel trapped by the double bind of wanting to protect their children and wanting to be free of the emotional neglect in their marriage. Even in our contemporary society, the role reversal for NT dads is hard. Besides working full-time, these dads must come home and do much of the cooking, cleaning and caring for the children.

Something that exacerbates the problem is that many NT dads grew up in families with members who are autistic. These men may unconsciously have sought out an Aspie spouse, because it is a dynamic with which they are familiar. If they have not learned how to cope with Asperger’s in their childhood, which is very likely the case, they will carry this dysfunctional behavior into their married lives.

What can NT dads do to help their families to thrive?

Recognizing the problem is an important first step. If you’re a dad dealing with an AS spouse, get professional help immediately for your own sake and that of your family. Trust that your anger is not without reason, and realize that staying angry will only make you sick and destroy the family. Family counseling is good, but it’s also advisable for dads to find a personal therapist, separate from the marital therapist. NT dads need a safe place to talk and resolve their feelings of anger without being destructive.

Read a free chapter of “Our of Mind – Out of Sight: Parenting with a Partner with Asperger Syndrome (ASD)”. This book discusses the science behind Aspie behavior and how you can initiate the rules of engagement that help your Aspie give you and your children the emotional support you need.

Are Mental Disorders More Prevalent in Children of Older Fathers?

Tuesday, April 22, 2014


kids of older dads may be more prone to mental disorders such as bipolar disorder, autism and schizophreniaMany men postpone having children until they are financially established. As a result, they are becoming parents in their 30’s, 40’s and even 50’s. We’ve known for years that women aged 40 and over run a greater risk of having children who are autistic. Now, according to a recently published study, the age of the father may also be a factor in the increase of mental disorders such as bipolar disorder, autism and schizophrenia.

Science reporter, Benedict Carey reported on this hotly debated issue in a recent New York Times article. The study was conducted in Sweden and compared siblings within families. The children born when the father was young differed from the children that came years later. They found that the risk for mental disorders rose as the paternal age increased.

Why may this be happening? The article explains:
“Any increased risk due solely to paternal age is most likely a result of the accumulation of genetic mutations in sperm cells. Unlike women, who age with a limited number of eggs, men have to replenish their supply of sperm cells. Studies suggest that the cells’ repeated reproductions lead to the accumulation of random errors over time, called de novo mutations. Most such mutations are harmless, geneticists say, but some have been linked to mental disorders.”

Should you be concerned? This certainly shouldn’t panic you. We have to be careful how studies are interpreted. It would be unfounded to jump to the conclusion that producing children after the age of 30 means they are certain to having mental disorders. But it’s good to be aware that this may be a contributing factor. And it should be included in your discussion as a couple about whether or not you want to have children.

There’s no guarantee that any child will be born without serious health problems. The issue is how will you handle the challenge if your child does suffer a birth defect or has a mental disorder. My advice is not to worry excessively, but if you see indications that your child is not responding as he or she should be, seek the advice of a professional who is trained in diagnosing such disorders. Working closely with your child’s pediatrician, these professionals will be able to assess the situation, educate you on what the diagnosis means and help you and your child to cope as a family.

Are you looking for guidance regarding your relationship with a family member with Asperger Syndrome? For further Autism Spectrum Disorder resources see Remote Education Asperger Relationships.

April – Autism Awareness Month – What Can We Do About It?

Thursday, April 10, 2014


april autism awarenessEvery time I look at the statistics for the number of people with Autism it changes, and not for the better. Back in 2006 the Center for Disease Control and Prevention reported that it was 1 in 110. In 2008 it was 1 in 88. As of March 24, 2014 the CDC, declares that 1 in 68 children have been identified with Autism Spectrum Disorder.

They cited studies to support the following data:

  • “If one identical twin has ASD, the other will be affected about 36-95% of the time.
  • If one non-identical twin has ASD, the other is affected about 0-31% of the time. 
  • If one child has ASD, there’s a 2%–18% chance the second child will also.
  • About 10% of children with autism are also identified as having Down syndrome, fragile X syndrome, tuberous sclerosis, or other genetic and chromosomal disorders.
  • 46% of children identified with ASD have average to above average intellectual ability.
  • Children born to older parents are at a higher risk for having ASD.
  • On average, children identified with ASD were not diagnosed until after age 4, even though children can be diagnosed as early as age 2.
  • Parents of children with ASD notice a developmental problem before their child's first birthday. Concerns about vision and hearing were more often reported in the first year, and differences in social, communication, and fine motor skills were evident from 6 months of age.”

Since this disorder is so prevalent, it’s important to educate ourselves about it. Teachers and first responders such as police, fire, and EMT personnel especially need special skills to help those with ASD.

April 2nd was Autism Awareness Day and many joined Autism Speaks in their Light It Up Blue initiative. In honor of this 7th annual United Nations sanctioned commemoration, many landmarks, buildings, and structures “went blue”.

During this Autism Awareness Month, let’s express appreciation for all the people who are working hard for this disorder. If you know any of them personally, take a moment to thank them for their hard work. If your circumstances allow, look into how you can make a difference. Every little bit helps! Then join me on Facebook and share with our community what you’ve done. It’s time to toot your own horn and encourage others to take action, too.

I’m passionate about providing education that will lead to the betterment of lives. Recently I’ve made myself available for providing Remote Education so many more people can be reached with this important information. Please, check out my Remote Education on Asperger Relationships

, a high functioning form of ADS, to learn more about this service.


The High Cost of Special Education for Children with Autism

Monday, March 03, 2014


special education for children with autism spectrum disorderWhile more states are passing laws that mandate treatment of autism to be covered by insurance, there are more than medical costs associated with autism. One area of growing concern is the amount our school systems are shouldering in order to teach children with autism.

CNN Medical Supervising Producer, Caleb Hellerman recently wrote about the Harvard School of Public Health report that estimates conservatively that the dollar cost of an autism diagnosis is more than $17,000 a year through age 17. $8,610 of that amount is what the educational system is picking up annually.

Children with autism (ASD) require different forms of Special Ed services. Some need one-on-one attention from a teacher, others can be placed in a small group setting, while others can be fully integrated into a classroom.

In the year 2000, there were federal grants for special Ed totaling $5 billion. In the year 2005 it went up to $12 billion. Since then the amount has been dropping, as can be seen from the fact that in 2013 the Special Education Personnel Preparation program only received $84 million in federal funding.

Michael Ganz, Assistant Professor of Society, Human Development, and Health at Harvard School of Public Health, released the following information about the direct and indirect cost of Autism in 2006: “The Direct costs of Autism include direct medical costs, such as physician and outpatient services, prescription medication, and behavioral therapies (estimated to cost, on average, more than $29,000 per person per year) and direct non-medical costs, such as special education, camps, and child care (estimated to annually cost more than $38,000 for those with lower levels of disability and more than $43,000 for those with higher levels).

Indirect costs equal the value of lost productivity resulting from a person having autism, for example, the difference in potential income between someone with autism and someone without, and the value of lost productivity for an autistic person’s parents due to reduced work hours or not working altogether. The estimated annual indirect costs for autistic individuals and their parents range from more than $39,000 to nearly $130,000.”

The financial cost of autism is hard to pin down. Some say that autism costs a family $60,000 annually. Whatever the amount, it’s costing all of us not to do all we can to research, diagnose and treat this disorder. Early behavioral training can save society a great deal of money. And doesn’t every child deserve the best care we can give them? Many children who begin treatment before turning three improve to the point where they are able to thrive right alongside their fellow classmates.

Please join me on Twitter and share your thoughts as we continue the discussion on the cost of Autism to families, school districts, and taxpayers. Please use #autism and @KathyMarshack in your comments so I see them.

More than 35 States Have Enacted Autism Insurance Reform Laws – Has Yours?

Monday, February 24, 2014


enacted autism insurance reform lawsThis month, Mississippi joins the line up of progressive states that are recognizing the need for enacting autism insurance reform laws as reported on by Emily LeCoz of the ClarionLedger. Their House of Representatives passed it 120-0. As a mental health care provider in Oregon and Washington it’s of interest that Oregon became the 34th state to enact insurance mandated laws. However, Washington at the time of this writing has not yet done so.

The cost of treatment for Autism is a huge financial burden for families. The Harvard School of Public Health estimates conservatively that the dollar cost of an autism diagnosis is more than $17,000 a year through age 17. Medical costs make up less than 20% of that amount.

Are the benefits of these laws being rolled over into the Obama Affordable Care Act?

The rules passed by individual states do not automatically extend to new health insurance Marketplaces. Each state must specifically require it. The Affordable Care Act says that all insurance plans within state Marketplaces must cover 10 essential benefits, including “behavioral health treatment” and “rehabilitative and habilitative services and devices.” However, the Department of Health and Human Services declined to specify treatment of autism as an essential health benefit and is leaving it up to each state to decide.

Many insurance companies in the past have refused to cover behavioral therapy because they consider it experimental or educational. This short-term thinking is failing to take into consideration the fact that early behavioral intervention is essential in a child’s life to make the greatest difference in the health and quality of life as an adult. Rather than treating symptoms, it teaches skills that help children with autism to cope and flourish.

According to a report by The PEW Charitable Trusts, “…Only 24 States and D.C. have applied the same requirements to policies that will be sold on their insurance exchanges under the Affordable Care Act.”

To learn more about your state, check out Autism Speaks State Initiatives. They provide a clickable map plus a list of states so you can see where your state stands on this issue at present. They also list whom you can contact if you wish to show your support.

I’m passionate about providing education that will lead to the betterment of lives. Recently I’ve made myself available for providing Remote Education so many more people can be reached with this important information. Please, check out my Remote Education on Asperger Relationships to learn more about this service.

Can Marriage Survive When You Have a Child with Autism?

Friday, July 05, 2013


Happy marriages and happy family

There’s a lot of confusing data and misinformation out there, such as the oft repeated, but unsubstantiated, statistic that 80 percent of parents of autistic children will divorce. Granted, raising an autistic child does add more stress, especially since parents must suddenly become experts in education, health care, early intervention, insurance policies and so much more amidst the storm of emotions connected with learning of your child’s diagnosis. But that in no way means your marriage is doomed. 


To the contrary, researchers have found that, if the marriage has a strong foundation of good communication, flexibility and conflict resolution, then these qualities will draw you closer together as you work to provide your child with the training and attention needed. You can read more about this in the Psychology Today article, “Love in the Time of Autism”.

Parents are encouraged to draw boundaries to preserve the quality of life with each other, with their neuro-typical children, family, friends and careers. You can’t let the guilt and grief of autism consume you. It’s important to discuss a division of labor between you and your life partner so you make decisions together and express appreciation for what each is doing. It’s damaging to spring emotionally charged decisions on a mate who is already stressed out.

Another crucial element to keeping your marriage strong in these circumstances is to reach out for support and not try to go it alone. If there are strains in marriage before the diagnosis of ASD, then these will be magnified. The good news is that even strained marriages can be salvaged by consulting with a mental health professional who specializes in autism and Asperger’s Syndrome. If you’re ready to talk, contact my office and set up an appointment in Portland, Oregon or Vancouver, Washington.

Download a free chapter of “Out of Mind - Out of Sight: Parenting with a Partner with Asperger Syndrome”. It’s my new book that addresses the unique issues that comes from co-parenting with an Aspie partner and how you can detach from the emotional distress.


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