THE AUTISM FILE ISSUE 30 2009

info@autismfile.com

Contents What’s in this issue ...

6 Letters 50  ew Frontiers in
N 96 Down Syndrome
10 Polly’s Piece Language and Autism Part 1
by Polly Tommey Restoration by Laurette Janak
by Harry D. 101 Down Syndrome,
12 My Daughter, Schneider, MD
Hannah Poling Autism, Leukemia
by Terry Poling, RN, JD 60 New Jersey Rally for Conscientious & Emily Part 2
Exemption to Vaccination by Laurette Janak
18 Springtime by Teri Arranga
by Jordan Segal 107 Back Issues
64 Moving Toward a Multi- 108 Getting Started with the
20 Orlando Hudson Treatment Approach to Autism
Interview by Verbal Behavior Approach
by Jonathan Alderson, EdM by Mary Lynch Barbera,
Polly Tommey
70 Open Your RN, MSN, BCBA
24 Healing the Gut in Eyes to Autism
Teenagers ...and Beyond 113 Autism on Stage
by Allison Edwards by Valerie Paradiz, PhD
by Pam Ferro, RN
72 Treating the & Danielle Ferrante
28 The Case is Not Closed Common Cold & Flu
on Vaccines & Autism 117 How the Dramatic Arts
by Kim Gould, RPh, MS Helped Me
by Robert J. Krakow, JD
76 Confessions of a by Elijah Wapner
32 DIR/Floortime: Sibling of a Child
Becoming 118 It’s Time We Had A Talk
with Autism -- About Talk
more Matthew by Amanda Hintz
by Joshua by Marion Blank, PhD,
D. Feder, MD 78 Worthwhile Causes... & Mary Beth Cull
by Chantal Sicile-Kira 128 Diary
36 The Science Behind
Treatment Strategies 81 Parallels between 130 Social and Academic Inclusion
by Elizabeth Mumper, MD Dyslexia & Autism through Accommodations and
by Richard E. Frye, MD, PhD Modifications to Curriculum
41 Bibliography
by Elizabeth Mumper, MD 84 Vaccine Damage Denial & by Stephen Shore, EdD
The British Press
44 Recovering Mark 132 Diet for Autism
by Martin J. Walker
by Cynthia Macluskie by Julie Matthews
91 Subscribe to The Autism File
45 Mark Makes a Difference 136 Forcing Change: Autism
by Mark Macluskie 92 Successful Sensory Diets
Advocates’ Long To-Do-List
by Chris Vinceneux, OTR/L
46 Progress by Laura Bono
& Hope in Italy 94 A Star and
Smiles 140 A
 sk Chantal
by Ornella Guadalupi by Chantal Sicile-Kira
by Robin
48 Defeat Autism Now! by Karen Shipman 143 The Doctor Is IN
Dana, Michelle Puopolo & Jim Small

THE AUTISM FILE ADVISORY BOARDS AND COLUMNISTS

Scientific Advisory Board: Federico Balzola, MD; Mark Blaxill, MBA; Jeff Bradstreet, MD; Stephen Edelson, PhD; Wendy Edwards, MD; Sonja Hintz, RN;
Julie Matthews, CNC; Lyn Redwood, RN; Harry Schneider, MD; Paul Shattock, OBE; Carol Stott, PhD; Anju Usman, MD; Andrew Wakefield, MD
Editorial Advisory Board: Marion Blank, PhD; Becky Estepp, Talk About Curing Autism (TACA); Temple Grandin, PhD; Jane Koomar, PhD, OTR/L; Stephanie Lord;
Laurie Mawlam, Autism Canada; Lori McIlwain, National Autism Association (NAA); Jim Moody, Esq; Valerie Paradiz, PhD;
Stephen Shore, EdD; Jill Stacey, Autism South Africa; Kim Stagliano, Age of Autism; William Welsh, Autism Treatment Trust
Columnists: Dean Beadle; Laura Bono; Robert Krakow, JD; Chantal Sicile-Kira
The Doctor is IN: Kenneth Bock, MD; Dan Rossignol, MD; Amy Yasko, PhD

2 ISSUE 30 2009

New Frontiers in
Language Restoration
D
uring an interview I did for The Autism
File in May 2008, I was talking about
our research at Columbia University’s
neuroimaging center, now called the
Program for Imaging and Cognitive Sciences
(P.I.C.S.), where we have been examining
for many years what parts of the brain
function for comprehending, producing, and
memorizing different aspects of language.
These language and memory investigations
encouraged us to develop a research program
to use functional MRI (magnetic resonance
imaging) together with diffusion tensor
imaging (DTI) (a technology used to examine
the connections between brain areas that are
functioning for a specific task, like language)
to examine the brains of children who suffer
with the frustration of autism spectrum
disorder, specifically those who do not
have the luxury and comfort of language or
communication – and to develop a treatment
intervention that will help to restore both.
(For the purpose of this article, children
labeled as “low-functioning” children
with respect to language or “nonverbal”/
minimally verbal children, I am calling
“low-functioning autism children” or “LFA
children,” just to make my communication
with you easier.) We have chosen to limit
our study to these LFA children who need
the most help. Parts of what I describe in
this article occur at Columbia and part at my
medical practice.
With new language rehabilitation
techniques and technology we are studying,
from using music to engage pre-verbal
language and early grammar, to using
electric neuromodulation of brain areas to
re-activate or re-create dormant language
neural networks, we can begin to say that
many children can one day be “declassified”
as autistic. They can become functioning
adults who will be able to communicate in
the society around them. The meaning of
recovery from ASD differs from researcher to
researcher as much as it does from parent to
parent. Most scientists seem to agree that it
encompasses recovering functional language
and communication. Some researchers have
said that recovery is impossible because they
view ASD as a lifelong process. Although
there is no published data, I suspect that
close to 20 percent of the LFA children we
are treating will be able to make the leap
into a successful adulthood, and the rest will
at least have acquired enough language to
BIOMEDICAL
BY HARRY D. SCHNEIDER, MD
Dr. Harry Schneider splits
his day between working in
the Neuroscience Functional
MRI Laboratory (now called
the Program for Imaging
and Cognitive Sciences,
P.I.C.S.) in New York City
investigating autism (very
specifically using functional
MRI to investigate the brain
areas of the language parts
of autism) in the mornings,
and in the afternoons, Harry
goes to his medical practice
in Long Island, New York
where he treats his medical
patients using conventional
and complementary medicine
and administers language
treatments to children with
autism.
ISSUE 30 2009 3
 BIOMEDICAL
recover sufficient activities of daily living to
be more or less independent. This is all based
on one important hypothesis: when a child
finally does acquire a grammar template for
language, he or she still needs to be able to
communicate thoughts and ideas to another
person - each child both listens and initiates
the conversation. Communication means
having a language platform that is functional
enough for a child to communicate with
someone else. “Mommy, I just made two new
friends today.”
Since my last interview for The Autism File,
many parents have asked me to elaborate on
how one actually goes about restoring lost
language, especially the language of infancy.
They want to know how the neurotypical
infant acquired it, why did LFA children
not acquire it, and how we can give it back
to LFA kids. To begin with, you might ask
yourself how you learned to speak English.
No one taught you how to speak; you just
automatically did speak by around age two. I
have been studying this issue for a long time,
as have other linguists, and we still have
not unearthed the magic of spontaneous
unaided language learning by infants. We
do know that neurotypical infants often
spend two years unconsciously learning how
to discriminate between sounds they hear
(phonology), sound pieces that make up
words (“play” + “ing” make up “playing”;
these pieces are called “morphemes”), and
eventually just automatically know what
composes a sentence. At a basic level, a
sentence tries to put the world they see
into an order that makes sense. This is an
advanced brain concept - understanding
unconsciously that a sentence is conceptually
made up of a subject, a verb, and an object,
in that order. For example, infants see a
ball moving in the air, and they see who
threw it and who caught it. They are trying
to interpret the concepts of the world they
see, attach them to sounds and words, and
eventually call upon their inborn “language
-acquisition device” (Chomsky, 1998) to
generate even more complicated sentences
such as, “Mommy is throwing the ball that
the doggie likes.”
Unfortunately, children can’t always tell
us what they do or how they do it, but we
are getting better at scientifically studying
the language-acquisition things they do: for
example, using eye tracking while they are
looking at objects to help figure some of it
4 ISSUE 30 2009
out. If we think of English as a basic subject-
verb-object (SVO) grammar template, like a
“Lego” template, once children “get it down”
and unconsciously know what part of the
sentence goes where, they can easily insert
hundreds of words each into the subject,
verb, and object positions in this language
template. When they later grasp another
idea – inserting additional “little” words
of language (called “functors”) needed to
make a longer sentence, such as the “is,”
“of,” “to,” “if,” “–ing,” etc. - they can
produce quite a large vocabulary very soon
and produce a large number of spontaneous
sentences; they might even tell their parents
after two years that they do not want to
go to bed at their bedtime. Successfully
acquiring a grammar together with nonverbal
parts of language (e.g., stress on a particular
word, inflections of voice, and the rhythm
of language) will automatically become
communication between children and others
around them!
All of this is true of neurotypical infants.
These are universal grammar functions that
will develop in all languages in stages in
all infants of the world, stages that reflect
the biological maturation of a child’s brain.
The fact that these stages of language
development are identical and predictable
in all languages of the world is evidence
that language is a biological phenomenon
- something “hardwired” into human brains
at birth. However one chooses to describe
this language module we are born with, I
had referred to this module in the previous
Autism File interview as the “language
instinct” (Pinker, 1987).
Let’s think a bit more about this instinct
because it is the foundation of what we
address at our foundation, The Autism Family
International (TAFI). As you are reading this
article, you are actually interacting with me
through our mental language. The mental
language you are using while you are reading
might make you think about what I am
“saying” and maybe even consider a mental
response - if you could actually tell it to
me now. This is a natural phenomenon of
the human condition: to affect each other’s
thoughts and emotions with our words.
This is the remarkable ability we simply call
“language,” which we use to communicate to
others. We use it, and we need it to belong
to and communicate with the world we are
in, although we sometimes take for granted
that we are able to do it. It is the nature of
people to want to talk -- to their friends
and family, to their pets and, in the case of
infants, to anything that is around.
There are different brain areas for the
different parts of memory and learning
we have been speaking about: one system
for words (called the “mental lexicon”)
and another system for grammar. The first
system is called the explicit memory system
(what neuroscientists call the “declarative”
memory system), which is made up of
brain areas responsible for learning and
committing to memory the notion of words.
This “declarative” memory system involves
the conscious learning, representation, and
use of knowledge about facts (“semantic
knowledge”) and personal events (“episodic
knowledge”). It is important for very rapid
learning of things we want to remember so
that much of it can be consciously recalled
later on when we need it. Declarative
memory depends mainly on a brain region
called the hippocampal region, which is
connected to surrounding cortical areas
in order to “encode” whatever names we
choose as representations for what we
see (e.g., something round that goes up
and down might be labeled or encoded as
“ball”). This conscious lexical memory system
also supports associative memory, which
allows for generalizations, which are very
important for LFA children. For example,
the memorization of phonologically similar
past tense pairs (e.g., “spring–sprang,”
“sing–sang”) may allow for memory-based
generalizations to new word irregularities,
either from real words (“bring–brang”)
or from novel, made up words (“spling–
splang”). This ability to generalize words
and word meanings underlies the enormous
productivity we expect from the regular
memory system; it allows language to
increase faster.
Language grammar, on the other hand,
can be thought of as emanating from
different parts of the brain: a piece of
biological machinery - something we are
born with in our brain - in which grammar
develops spontaneously, unconsciously
acquiring a set of rules about how to use
all the different parts of language. There is
no formal instruction or conscious effort on
the part of the infant or the parents, and
it is used without the infant’s awareness
of any formal set of rules of the language.
This is the called the implicit learning/
memory system, called by neuroscientists
the “procedural memory” system. The
“procedural memory” system controls the
learning of all new “habits” and “skills,” such
as riding a bicycle and skilled game playing.
Most interesting is that the knowledge
of how to recall these skills is generally
not available to conscious access: we can’t
always tell someone what goes into riding a
bicycle, much less all the rules of speaking
a language. Learning in this unconscious,
procedural system is gradual over weeks
and months. The relations in this automatic
system are rule-like, in that they are rigid,
inflexible, and not influenced by other
mental systems. These rules are applied
and used quickly, such as what happens in
grammar learning. The procedural memory
system is composed of a network of brain
structures rooted in deeper brain areas
(which we sometimes call the “reptile brain”)
than those that we use for regular memory:
names like basal-ganglia and substantia
nigra (which makes dopamine, by the way)
and some portions of the surface brain. See
Figure 1 below:
Having the grammar module functioning
in tip-top shape allows a child to make an
infinite number of sentences he may have
never actually heard from a limited or finite
amount of sentences he has actually heard:
no memorization needed! The idea of what
a sentence is becomes available to children
at the start of their learning and is also the
main guiding principle in their attempts
to organize and interpret all the complex
language input that parents make available
to them. The infant brain, however, is only
forty percent developed at birth, and its brain
will not achieve its final shape for two years.
Noam Chomsky pointed out two basic facts
about child language learning that changed
the way we think about it: 1) young children
often respond to questions and statements
with sentences of their own creation that
are not a reflection of all the types of words
and combinations they had learned before:
they use brand new sentences of their own.
Chomsky also felt the brain must have some
built-in machinery, which he called an innate
“language-learning device” that can make
an unlimited amount of sentences out of
a limited amount of words; and (2) infants
develop the ability to put these sentences
together without any formal instruction (such
as that which we might receive in a classroom
when we are learning a foreign language).
Other infants, however, are not so fortunate
to make use of the language instinct that
neurotypical children have. The children we
call “autistic” are those who cannot simply
tell us with their words what they are feeling
or thinking or make us share what they feel;
they do not have a sufficient language as a
base with which to communicate their feelings
to us. LFA kids do not have full use of the
language instinct that neurotypical children
have. They do, however, possess the requisite
biological machinery all children have for
language; they were born with it. Some of
these brain areas and their connections were
damaged during their development - that is
why they have trouble using it. The LFA kids
never learned grammar!
We have all seen the effect on the children
and the families that have to cope with life
without language. We have witnessed the
devastation of families of LFA children who
do not have language and their desperation
to find a treatment for their children.
At P.I.C.S. we have chosen to study the
language defect in these LFA children.
Whether a child on the spectrum can produce
5 or 150 words, if they cannot consistently
initiate or maintain (casual) conversation or
use novel ways of speaking, such as slang, or
their own unique ways of talking, and if they
cannot communicate with others naturally
(“Hey, Dad, what’s happening?”), we have
chosen to classify all these children as LFA
children. Almost all the words these children
use are consciously memorized. Parents can
often tell me they know their child’s whole
repertoire of words and phrases. The LFA
kids never learned grammar!
To better study language in ASD, we
use functional MRI technology to see what
language areas of the brain become active
when listening to language, combined with
diffusion tensor imaging (DTI) technology
to examine the integrity of the connectivity
of the fiber tracts from one language area to
the other (the “wiring,” so to speak). We get
a look at how the language areas of the brain
actually function – not just a picture of what
it looks like, which we also get from standard
MRI imaging - when these areas are being
used for language. We have demonstrated
that not all language areas are functioning
correctly and that the connections between
certain language-specific areas are not
completely connected. This is in part why,
during the first two years of infancy, the
LFA child could not make full use of his
language machinery to unconsciously acquire
his natural language. The question I am
often asked – especially after parents view
the functional MRI imaging results of their
child – is “what do we do about it?” In other
words, how do we make it work now when it
didn’t before?
What we do at TAFI is try to restore a
child’s grammar module to function again,
to stimulate it with novel language-learning
protocols so that they can begin to re-
acquire the grammar they never had and,
slowly but surely, acquire what it took a
neurotypical infant two years to do: talk
spontaneously, maintain a conversation,
ISSUE 30 2009 5
 BIOMEDICAL
generalize their grammar to new sentences,
and communicate to others. We have created
a grammar acquisition teaching system that
we believe approximates what a neurotypical
infant seems to be able to do naturally when
unconsciously acquiring grammar. We aid and
amplify the child’s re-introduction to the new
world of grammar with various modalities:
movement and language, musicology and
language, and stimulation of the brain
together with language – all in an effort to
acquire a grammar template with which to
communicate! Every modality we use is in
conjunction with carefully designed sessions of
explicit (conscious) and implicit (unconscious)
language sessions involving learning and
memory. I will review some of this for those
of you who have not read the first interview
in The Autism File and expand on how this
process works, what we have seen and
documented so far in terms of the outcomes
for these children, and what to expect for
your child. Remember the title of this article:
“‘Mommy, I just made two new friends today.’
Is this possible in ASD kids?” Can nonverbal
children not only eventually speak, but
also communicate to others? We think it is
possible, given the new technologies we have
been fortunate enough to use.
OVERVIEW OF THE COMPONENTS OF
THE AUTISM RESEARCH PROGRAM
The language rehabilitation program begins
with a two-hour neurolinguistic evaluation,
the results of which will be used to correlate
with the functional MRI/DTI that is later
performed on the child. One of the
neurolinguistic evaluations we use is The
Autism Diagnostic Interview-Revised (ADI-R),
a clinical diagnostic instrument for assessing
autism. The test focuses on behavior in three
content areas: qualities of reciprocal social
interaction (emotional sharing, offering
and seeking comfort, social smiling and
responding to other children); repetitive,
restricted and stereotyped interests and
behavior (unusual preoccupations, hand
and finger mannerisms, unusual sensory
interests); and communication and language
(e.g., stereotyped utterances, pronoun
reversal, social usage of language). Within
the area of communication, for example, the
concept of “delay or total lack of language
not compensated by gesture” is further
broken down into specific behavioral items:
pointing to express interest, conventional
6 ISSUE 30 2009
gestures, head nodding, and head shaking.
This test is supplemented by the Bilingual
Aphasia Test (BAT), Monolingual Version, in
which all aspects of language comprehension
and production are uniformly measured.
There are many language tests used to
assess the abilities of both neurotypical and
children with developmental disabilities; there
is no perfect test to assess the language
capabilities in the child with ASD. We have
chosen the BAT test after considerable
discussion with other linguists throughout
the world because it is one test that seems to
encompass much of the information found in
many tests.
After language testing in Long Island,
parents then schedule a meeting with me
and the Director of Columbia’s functional
MRI lab, Dr. Joy Hirsch, at the Columbia
University Medical Center’s Program for
Cognitive Sciences in New York City. Dr.
Hirsch will explain in more detail the mission
at Columbia where we do the functional MRI/
DTI imaging part of the program. After the
meeting, I take parents on a tour of the lab,
answering all questions before the parents
return home. Although patients may elect
to participate in research on autism, their
subsequent treatment intervention is guided
by standard medical procedures by me at my
medical practice.
The next step is scheduling a scan date
for the child. For all scans, parents will be
shown how to make a recording of their
voices for their children to listen to in the
Reprinted with permission of The Autism File www.autismfile.com
scanner, along with the music of their choice.
We always investigate music and language
together, because music is such a powerful
tool that affects many parts of the brain,
including the language centers. After a
period of about a week after the scan, we will
review with the parents the findings of the
brain images and their interpretations at the
office. They will be discussed at length, and
a treatment plan will be formulated together.
This is a team effort.
From the images we have done thus
far on LFA children (almost 30), we are
beginning to see common patterns: brain
areas that should be activated (functioning)
for language but are not; areas that are
activated on both the right and left side
of the brain (language is usually located
in the left side of the brain); and areas
that should be activated for language that
become activated only when listening to
music. When we examined the neural fiber
connections between these areas using DTI,
we found that some connections between
known language areas either go in the
wrong direction or do not completely go to
their target - there is a disconnect from one
language area to the other. In the picture
below, you can see that the language
comprehension area, Wernicke’s area, in
the back of the brain, does not reach all the
way to the front of the brain where Broca’s
area is located and where speech production
takes place. Below is a functional MRI/DTI
image of two of our patients. See Figure 2.
 Neurotypical: the yellow-orange “blobs”
in the middle of the brain on the left is
Wernicke’s area (the language comprehension
area, right where the ear is) and in the front
of the brain (left side) is a small orange
blob that represents Broca’s area (language
production area); both are active when
listening to language by nerve fiber bundles.
In the autistic six- and seven-year-old brain
on top, we can see smaller activations of
Wernicke’s area, but NO activations of Broca’s
area.
In the connectivity images from the two
autistic images in the bottom panel, the
connections head either backwards or do
not fully connect Wernicke’s and Broca’s
areas. The connections in the six-year-old
are headed backwards, and in the seven-
year-old they go backwards and frontwards
from Wernicke’s area but never quite connect
completely with Broca’s area.
OVERVIEW OF THE LANGUAGE
INTERVENTION
“It looks like someone took a pair of scissors
and cut the wiring” (KW, parent). What can
we do about it?
Language interventions consist of
novel teaching methods directed to
brain areas that are not functioning
to stimulate language networks for
language production. This is language
plasticity! Our goal is to restore
grammar to the child that was never
acquired during infancy, to turn that
grammar into a natural language, and to
have the child use it to communicate to
others: “Mommy, I just made two new
friends today.”
The language interventions and protocols
focus on explicitly/consciously learning
sounds and words and combining these basic
fundamentals with implicitly/unconsciously
acquiring the rules of language. With
respect to sounds and words, we know that
neurotypical Infants have a unique ability to
discriminate between different speech-sound
(phonetic) differences. Babies learn not only
individual speech sounds but also the auditory
forms of words; that is, babies are not only
aware of the pieces that make up a word, but
they are aware of the entire word. Although
they may not know what the words mean,
neurotypical children as early as eight months
old start learning the phonological (sound)
forms of words and are able to recognize
them. These auditory forms of words allow
children to increase their vocabulary and help
them to eventually develop grammar.
We teach LFA children the differentiation
of sounds and parts of words and full words
reinforcing their conscious memory system
to recall these words for the next lesson.
This type of conscious memorizing in word
learning may be enhanced by many different
methods, for example by association of
visual clues to word sounds. The words we
first teach are nouns and verbs. This is best
accomplished by pairing the correct noun
with the correct verb. For example, we teach
and show “daddy throws ball,” or “mommy
eats carrot,” or “Dylan bounces [the] ball,”
using as many sensory modalities during the
session as possible, together with lots and
lots of motivation – it’s all about dopamine!
Although we aim for complete sentences as
soon as possible, Dr. Marion Blank, also here
at Columbia University, has pointed out that
the nouns and verbs must also be paired with
the “little” words as soon as possible, such
as “daddy throws the ball” and “Dylan is
bouncing the ball.”
Once a child has learned the minimal
amount of words, that is, enough words
to form a sentence (usually four words are
appropriate for a child to learn successfully),
we begin to approach the concept of
grammar: our children unconsciously acquire
the rules of grammar. This is the process
through which infants become sensitive
to certain regularities in sequence in the
environment: the relationship of subjects
(“man”) to the things that they do (verbs
- “throws”) and to whom or for what those
things are done (object - “ ball”). This is
a very difficult concept for a child’s brain
to grasp initially. This is all accomplished
implicitly: (1) in the absence of conscious
intention to learn about those regularities;
(2) in the absence of the child’s awareness
that there is learning happening; and (3)
in such a way that the resulting knowledge
the child gains is difficult to express (even
if they could express them, but adults can’t
either; they just say they know “how to do it”
and don’t know why). The notion that LFA
children may never become fluent or be able
to communicate is incorrect: fluency is based
on their getting their grammar back – which
they are slowly doing - and communication
is based on having enough language and
motivation to use it – and they are beginning
to do just that in our program!
What we have learned about LFA children
is based on what we have learned about the
LFA child’s absent or incomplete acquisition
of language. The neurotypical child acquires
a grammar - the correct ordering of words
- in their language, because the grammar
template was “hardwired” into their brains,
and they used the template to figure
out the rules of the language. The LFA
children, however, did not completely and
neuroanatomically acquire this fundamental
grammar. The template for grammar is in
their brain, but, as we have seen, it does
not always interconnect correctly. In short,
the reason that some children speak and
some children do not depends on how
fortunate the child is to have enough fiber
connections hooked up correctly together
in both memory systems in the first 12 to 15
months of life in order to produce speech.
If the language comprehension areas of
the brain do not connect in the right way
to the language production areas, the child
may not become very fluent, spontaneous,
or able to engage in conversation and
spontaneous communication. The result is
that instead of being able to apply the order
of a subject, object, and verb, they have had
to memorize all of the words and the correct
“grammatical” order they are supposed to be
in – not an easy task. They have had to rely
on their regular memory system (the explicit/
declarative system) – not the unconscious
grammar template. Unfortunately, our
conscious memory system is not big enough
to handle all the data (it’s unfortunate we
cannot just put in a bigger computer chip –
yet). Just imagine if you had to memorize a
whole foreign language to work in another
country -- not an easy task!
Our goal is to restore grammar that was
never acquired during infancy to the LFA
child. We provide grammar in context. We
expose children to this without alienating
them to the learning process, something
very delicate for an LFA child who has been
frustrated and often angry about their
inadequacies with respect to other children.
We use short, grammar-based sessions
immediately followed by additional function-
based lessons in which the new grammar
is applied. The fundamental principle of
our implicit grammar protocol is having
the LFA children unconsciously acquire
the grammatical patterns of language with
ISSUE 30 2009 7
 BIOMEDICAL
constant enjoyable, game-like repetition
of a grammatical point using child-specific
motivations, sometimes accompanied by
pleasant distractions, such as a video. These
distractions enable our children to learn the
rules inadvertently, without always paying
much attention - rather than directly telling
them anything about them. (It must seem
odd to the reader that children can often
learn more without paying attention, but it
is often very true!) At first, some children
may seem confused about how to perform
our activities, because they have never
encountered language learning like this, but
they quickly adapt to these novel routines: we
ensure that they are very motivated to want
to participate!
By way of examples, we may guide implicit
grammar learning through the physical
manipulation of color-coded grammar
elements in which students are purposefully
led to discover grammar rules. Implicit
learning integrates grammar more deeply into
students’ long-term memory. Another rather
interesting way of teaching grammar implicitly
is to have children watch their favorite
video (Blues Clues, Baby Einstein) while we
are conversing about the child right next
to him, perhaps engaging in conversation
about things the child did recently that were
enjoyable. Invariably, the child will begin to
engage in the conversation with or without
disengaging from the video. One of our
most fascinating implicit teaching sessions
was one that we came upon by accident:
water therapy. (Don’t many LFA children
enjoy playing with water?) Some children
enjoy playing at the sink, pouring water in
and out of cups. While they are doing that
(and perhaps wearing the brain-stimulation
device at the same time), their mother reads
the alphabet (to reinforce phonology) to
one of our instructors. The instructor and
mom make the alphabet appear as if it’s
the most fun thing in the world to say.
Then they might introduce one-, two-, and
three-syllable words or pictures from a book.
This water “theme park” often concludes
with recounting the day’s events, using
communicational chit chat, not just formal
language. These children entered the program
with no words - maybe “dada.” After two
water therapy sessions, they could say “cup,”
approximate “water,” offer to “share” the
water, and perhaps another 10-15 words.
This example of finding out what motivates
8 ISSUE 30 2009
The self-reinforcement of a child hearing his own speech has
led to spontaneous language, in some cases the beginnings of
maintaining a conversation, and stepping out of the box of the
language they have memorized for speech into a world in which
they enjoy using their own language.
the child and letting the child perform that
action while talking around and about him,
actually motivates the child to begin to want
to verbally respond to the things about him.
This may be one of the best, if not the cutest,
example of implicit learning we have been
fortunate enough to use. Although implicit
learning is a scientifically well-documented
learning/memory system, the ways in which
we conduct the lessons are flexible. Our
experimental research program is, in part, a
work in progress with “on the job training” for
all of us. With the help of parents, we conduct
some sessions in an impromptu fashion,
often with enjoyable, motivational, and new
inspirational ideas, most of which yield good
language production.
Another example of the successful use of
this strategy was with a 22-year-old man,
JL, from the midwestern United States. He
had spent 17 years without uttering more
than “d, d, d, d” to his mom. The parents
said they had “tried everything” beginning
at age four. When he came to the office we
chose to use the tDCS (transcranial direct
current stimulation) unit at the outset,
concentrating first on explicit word learning
networks so he could begin to name at least
four pictures clearly. After that, we placed
the tDCS unit on brain areas involved in
implicit learning networks so he could begin
to acquire grammar with the nouns and
verbs he had memorized. At the end of the
session, his mother took away his CD player
with his favorite music and gave it to his
sisters (all loving and caring siblings who
chose to become accomplices in our “game”
to motivate their brother to “ask” for his CD
player back). After 20 minutes of coveting
the CD, speaking about it, giving and taking
it from others, and always nodding at JL to
see if he wanted to engage in the activities,
JL finally was motivated enough to verbalize,
“give me CD!” This happened within four
days of beginning the therapy! JL had
between 8-15 words that he retained and was
able to verbalize upon request looking at a
picture as a result of four days of therapy.
Children generally seem to enjoy these
grammar play activities and stay on task. The
production of verbal output is our main goal,
a verbal output slightly above the level that
students can already produce on their own.
When this is combined with the meaning
of what they are saying, the two elements
combined constitute successful language
acquisition.
Implicit, unconscious grammar learning,
the way we believe a neurotypical infant
has accomplished this remarkable feat, is
not an easy task. It is being successfully
accomplished at the TAFI foundation learning
center – especially with the help of dedicated
parents, family, and friends who will carry
on at home what we all do together during
rehabilitation language sessions. Thus far, all
of our students are beginning to re-acquire
the backbone of their language, the grammar
of English. Many are beginning to answer
specific questions with generalized answers.
The self-reinforcement of a child hearing his
own speech has led to spontaneous language,
in some cases the beginnings of maintaining a
conversation, and stepping out of the box of
the language they have memorized for speech
into a world in which they enjoy using their
own language.
This protocol will be combined with
musicology. It is necessary in research
on autism to study music, something that
the brain treats as so similar to language.
Music is known to stimulate both speech
comprehension and production areas, as well
as motivational areas that help language
learning. Children are thought to hear music
not just as a series of individual notes, but
rather to assemble these notes into logical
structures. This is what we have called
“syntax,” and it is the same principle in music
as it is in language. A common understanding
of such patterns between music and language
is dependent upon there being a commonly
understood system of syntax for a particular
style of music, just as there is for language.
The syntax of the sentence structure is made
simpler by its organization into three levels:
the word, the phrase, and the sentence. The
syntax of the musical structure of tonal music
is also made up of three levels: the structure
of chords, the rules for voice leading (the
relationship between the successive pitches of
simultaneous moving parts or voices), and the
syntax of chord progressions. As far as Broca’s
area of the brain is concerned, it reacts to
good and bad syntax of music and language
in the same way: the detection of the correct
structure of how words (and notes) are put
together. This is one of the fundamental
reasons why the addition of aspects of music
has been working so well to help LFA children
re-learn their grammar.
The LFA children who come to our facility
often present with significant limitations in
conventional forms of verbal and nonverbal
communication. They respond positively to
music therapy interventions, which involve
active, improvisational, and receptive music
interventions. These programs include
listening to certain types of music during
an implicit language-learning session, using
music therapy in the form of games in which
language has to be produced, and combining
movement and music in singing and dancing.
Certain types of musical combinations called
“chords” have different effects on different
parts of language. A “major” chord may
facilitate one type of verb and a “minor”
chord may facilitate another. Certain rhythms
of music, particularly if they match the
rhythm of the language that a parent is
speaking, facilitate acquisition of grammar –
especially with a metronome ticking not far
away! We have children learn to play simple
tunes on the piano by reading letters on
the keys and matching them to letters on
a sheet of music – transforming the joy of
music production into the joy of grammar
production. We have found that employing
musical activities facilitates motivation,
communication skills, and social interaction,
as well as sustaining and developing
attention. This has led to faster acquisition of
the basic sentence structure and its grammar.
When a child is engaged in a movement game
involving music, the cerebellum is also being
activated for language acquisition, which we
will discuss next under movement therapies
and language. Almost all of the children in
our program have responded to one form or
another of music interventions.
The protocol will also be combined
with movement therapies directed at
cerebellar stimulation. In spite of known
cerebellar pathology in ASD (often seen
as walking imbalances in some children,
known as gait ataxia), we have demonstrated
functional MRI cerebellar activations during
language listening in many of the LFA
children we have scanned. Knowing that the
cerebellum becomes functional for language
has enabled us to use cerebellar activations
for our language acquisition program. The
cerebellum has been found to be part of the
early grammar-learning machinery of the
infant.
With respect to movement and language
therapy, we have to understand the
importance of the cerebellum. Traditional
neurological teaching has been that the
cerebellum, a region in the back of the
brain, principally plays an important role
in the integration of sensory perception,
coordination, and control of physical
movements. We have seen, nonetheless, with
the help of functional MRI, that cerebellar
function, specifically the interactions of
the cerebellum with other frontal parts of
the brain (such as Broca’s area for speech
production), is also responsible for a variety
of cognitive functions including grammar
learning.
Ontogenetic evidence suggests that the
cerebellum is an important organ for speech,
a part of the learning machinery of the infant
for early language. It has been demonstrated
to have a long-distance connection or circuit
to Broca’s area for speech. It establishes
phonologic representations during early
language development, such as how the infant
learns to process and distinguish meaningful
sounds, for example, the difference between
“d” and “p.” An infant’s ability to articulate
and process sounds remain closely coupled:
speech requires sequencing of articulatory
gestures, mediated by parts of the frontal
cortex and the cerebellum. After prenatal
or early injury to the cerebellum, as in ASD,
cases have been frequently presented in the
medical literature: dysprosodia (difficulty
in the expression or comprehension of the
emotional components of speech, such as
melody, emphasis, inflection, and gesturing);
agrammatism; anomia (the inability to name
objects or to recognize the written or spoken
names of objects); reduced verbal fluency
and poor articulation with deficiencies in
understanding and producing certain sounds.
The cerebellum is very involved in the
early grammar of the child helping to make
large sentences into “chunks” of sentences
(i.e., smaller fragments such as “kind of,” “a
lot of people“) so that a long sentence can
be more easily understood. These language
chunks may be even smaller in size, such as a
“syllable” within a word. When seen from this
perspective, cerebellar participation during
language production can be easily seen as a
close partnership between the language and
the motor system.
Our goal with movement therapy is to
activate the cerebellum during implicit
language learning. A child watching a video
with a lot of movement generates the same
cerebellar stimulation as does actually
spinning in a chair. When we have our
grammar learning immediately during and
after the cerebellar stimulation, we always
note a clear increase in word production,
often leading to two- and three-word
sentences, sometimes with the beginnings
of pragmatic effects and generalizations.
We have tested sequence learning ability
both before and after movement exercises,
and we have seen that children are better at
learning sequences after movement exercises.
All sequences, even using physical objects
in place of words, are important in learning
correct grammar: the ability to know what the
correct sequence of subject, verb, and object
is, without memorizing the rule.
We have also seen evidence of a child’s
ability to cope with other nonverbal elements
of language: prosody and pragmatics.
Prosody may be thought of as reflecting the
emotional state of the person speaking to the
child: whether an utterance is a statement, a
question, or a command; whether the speaker
is being ironic or sarcastic; emphasis, contrast,
and focus; and other elements of language,
which may not be encoded by grammar.
Pragmatics is the ability to communicate more
than that which is actually said. The ability
to understand another speaker’s intended
meaning is called pragmatic competence.
Pragmatics deals with the ways we reach
our goal in communication. Suppose a child
wanted to tell his parents to “go away”
for the session (as some children do when
they come with their parents to a language
session). A neurotypical child could do this
by using formal language, such as “please
go, Daddy,” or even “Daddy, please go and
make me lunch.” Many of our children just
say “bye bye” to their parents to get them
ISSUE 30 2009 9
 BIOMEDICAL
Thus far, we have seen a 500% increase in language production using the tDCS unit alone
to leave. This is often the most that our
LFA children can currently do when they
enter the program. This example shows how
important it becomes to teach pragmatics
so that children can speak with real-life
communicative forms and be capable of
engaging in social conversation.
The language-intervention protocol
may be combined with neuromodulation,
specifically, the use of transcranial direct
current stimulation to increase language
production. A portable brain stimulator using
the technology of transcranial direct current
stimulation is used.
Transcranial Direct Current
Stimulation (tDCS)
Debra Schneider working with
patient, Michael Schindlar
The scientific research being done at
Columbia on neuromodulation has shown
it to be a very useful treatment modality
for certain brain disorders. Clinical research
with tDCS is being conducted at the TAFI
foundation. This simple-to-use device
attaches easily to the child’s scalp over brain
areas that may increase verbal production
(as revealed by each child’s functional
MRI images), painlessly stimulating select
brain areas using a small amount of direct
current. The electrodes are placed on the
scalp with two-inch sponges wetted with
saline (salt water). The unit applies weak
electrical currents (1-2 mA) over the scalp,
which is used to modulate the activity of
brain cells below. Several generations of
neurophysiological experiments have shown
10 ISSUE 30 2009
that nerve cells in the
Language Performance Data pre and post
brain react to direct
current electrical
fields by altering their 100
number of words
firing rates. Nerve cell 80
firing increases when 60
the positive pole or
40
electrode (anode) is
20
located near the cell
body or its dendrites 0
1 2
and decreases when
groupA groupB
the field is reversed.
Because the electrodes
are placed on the scalp
with two-inch sponges wetted with saline,
the current actually produced in the brain
is exceedingly small, producing small but
noticeable changes in the way the brain
cells in the stimulated area fire. Transcranial
direct current stimulation does not appear
to cause nerve cell firing on its own and
does not produce discrete effects, such as
the muscle twitches associated with classical
electrical stimulation. It is also important to
distinguish it from electroconvulsive therapy
(shock treatments), which is used to treat
mental illnesses such as major depression with
electrical pulses 1,000 times more powerful
than the tDCS unit we use.
Transcranial direct current stimulation is a
safe, non-invasive, and inexpensive means of
achieving activations of specific brain areas.
It has been shown to be a highly useful brain
stimulation technique for investigating a
variety of visual and cognitive phenomena,
as well as clinical conditions such as loss of
function and language after brain injury,
affective disorders such as depression, and
mood disorders and chronic pain conditions.
It is being used to help people recover use
of limbs. It has been shown to be effective in
increasing memory and language functions.
We are investigating its use for restoration
of language in LFA children. Thus far, we
have seen a 500 percent increase in language
production using the tDCS unit alone. We
discuss with all parents if and when to use the
device to prime language areas that are not
functioning as well as they should: speech
production areas, motor planning areas,
articulation areas, and comprehension areas.
We are preparing to submit these findings
tDCS treatment
pre
post
3 4
groupA groupB
spontaneous total words
Patients
All bars represent matched groupings of 8
similar patients per group (group mean seen
above, CI 99%: N= 16). This graph reflects
only the results of the children’s response to
neuromodulation: the use of tDCS.
for publication so the rest of the autism
community can benefit from the use of
neuromodulation for LFA kids (see bar graph
above).
Article for publication: The article for
publication will reflect the results of using the
tDCS unit alone in our office: a 500 percent
increase in verbal output. See Figure 4.
We will include in the article all patients
who failed to respond to 3-4 years of
standard Applied Behavior Analysis (ABA)
language interventions (or any other
language interventions), speech therapy, and
school-mandated language therapies. The
results of initial assessments of these children
indicated that their language performance
was limited to a total production of a mean of
12 words for group A and 19 words for group
B and spontaneous requests of 1 for group
A and 3 for group B. Both groups had mild
apraxia of speech, and words were included
in assessments only if understood by a non-
family member. Over the course of 12 weeks,
patients were treated in our office with 20-40
minute sessions (2 days/week) of tDCS.
At the end of 12 (pre- and post-bar
graph) weeks, the total number of words
increased from 12 to 66, and spontaneous
(self-initiated) words increased from 1 to 12
for group A; group B increased from 19 to 92
total words and from 3 to 29 spontaneous
words. In addition, parents confirmed that
weekly improvements in speech production
 Language Performance Data pre and post
are the ongoing results of how the brain functions was “not science but
All Modalities Treatment the combined effects of all science fiction”... to believe there was such
our modalities on word and a diagnostic tool (i.e., functional MRI) to do
140
sentence production. There is at that. The mom said to me that that she was
number of words

120
100 least an additional 33 percent
80 pre
60 post
improvement above using tDCS
40 alone when all modalities are
20 combined for the two groups
0
1 2 3 4 labeled A and B – the total and
group A groupB groupA groupB spontaneous words produced.
spontaneous
Patients
total See graph left (Figure 5):
I would like to conclude
This graph reflects same cohort of children with this article with an informative anecdote
verbal responses from all language-learning presented from parents who have recently
modalities combined (musicology, movement, joined our program. They had gone to a
and tDCS). well-known university medical center to
see a physician about how best to deal
were maintained at home. Parents also with the language issue (nonverbal) in their
reported enhanced language comprehension LFA child. They told him that they were
such as following 2-3 sentence commands strongly considering coming to Columbia for
(i.e., do a, b, and then c) and decreased functional MRI in order to see what parts of
response time to performance of tasks asked their son’s brain were being used for language
of the child. No adverse behavioral changes and how they were connected, and then
were noted by examiners or parents. would possibly go to Long Island to utilize a
Not yet included in the study is the data novel intervention for restoring language. The
above being prepared for publication. These dad said to me that he was told that seeing
told that even if such a neuroimaging tool
existed, there was nothing to do about their
child’s lack of speech production because
nothing can help an LFA child restore
language.
I have since heard many similar anecdotes.
I hope that this article can bring together all
those involved in the treatment of autism
-- parents and health care providers alike.
Some researchers today often credit earlier
diagnosis and treatment for creating positive
outcomes in ASD children, but I believe early
intervention is not the whole story. The rest
of the story is diligence and hard science
leading to novel, safe treatment approaches. I
always ask all parents to learn as much as they
can in advance about whatever they hope or
plan to do for their children. It is only if we
work as a team, share our knowledge, keep
an open mind, and cooperate in a dedicated
spirit to solving the issues of ASD that we will
get the job done. “Good job!”

March with us in London

Saturday 28th March 2009
Bring banners. Bring placards. Bring your family.
Route: Gather for 1.30pm, 2pm Set off behind the bagpipers at Temple Place (By Temple
Tube Station) Via Victoria Embankment, Whitehall and ending at Trafalgar Square.
Join our call on Trafalgar Square at 2.45pm
for better services for autistic children and adults.
MAKE THIS A BIG EVENT
For more information please visit www.openyoureyestoautism.com

ISSUE 30 2009 11
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