very interesting well before we go into that lesson do so your target audience tell us where you were born or something about your growing up years but i was born in the bronx and i grew up in a housing co op i went to  local public school my brothers attended a initially a public school autism program but it was a cooperative agreement with columbia university and it was actually located in columbia university  it was a wonderful program i remember that the teacher would try to get me involved in the class my mom wanted me to see what my brother school was like so i would go down there and sit there at circle time and i remember the teacher would try to get me involved and doing things with my brothers she had books she made let these little books for me to do on the weekends to go with them today i did this or that it was a really nice experience the only thing i did as a child because i went to a local and a half my mom decided something is wrong their language wasn't coming in they were rocking back and forth on the couch and she took them to a specialty clinic and over there she was told that they had they were disabled and that's when she got them some special help initially when my mom went to take them for special help my parents were blamed for the problem the woman at the clinic told my parents that she should institutionalize my was shocked and when she took the car to go home she actually drove the car over a barrier she was unable to think properly where that happened so it was you know it was a difficult time but you know they did find help regular nursery school the st regular nursery school threw them out then she found the nd one and the teacher was really nice she said just don't send them at the same time the teacher was also the director and she said just some one in the morning and one in the afternoon so my mom you're did you realize there was something wrong with your brother i used to wonder when they were going to talk i kept thinking i talked when i was four years old so they should be talking when they're four years old and i was wondering when are they going to talk i remember that ok they general psychiatry i did general psychiatry for a while and i just figured other psychiatry is going to win i'm doing ok you know and i felt by specializing on autism i could offer something that most of my colleagues couldn't are yes especially you college and then i did my fellowship at mount sinai hospital in what to some research ok that's a lot of schooling doing that i always hear physical activity how do you be paid your if i was never into physical activity very much because i had very negative experiences when i went to public school as a child i don't have the best gross motor skills and i had trouble even throwing a ball and i would get bullied or if the teacher had two students choose teams i'd be the last one sitting there so of course that was very bad on my self esteem and eventually my mom got a note from the doctor that i had asthma so i was able to get out the gym class and i absolutely no interest in physical activity when i was younger and if you told me when i was younger that one day i'd be running a marathon i would a surge of delusional but that that changed when i was much older actually when that changed and i found out i it was the day after thanksgiving when i was one hundred and thirty one and then my husband went out and he bought an elliptical and on a black friday deal and i started using and i remember the st time after ten minutes i had to get off it my muscles were all messed up  and i just couldn't do it anymore and i kept that up about a year or so and then one day it broke and you know i realized in life sometimes when something seems bad at the time it actually turns out to be a good thing so i felt i still had to exercise so then faith he read a post about him so he always posting about you what he thought he would create distance at that time you know he started running before me actually he became diabetic and that's when sort of him to exercise he started biking and running after he was diagnosed with o'clock in the morning on tuesdays and fridays and it's gotten me a real motivation to do speed running and interval training it's been really a great experience and they're such lovely people i love running with them so at this time i here are a full blown your fetich a fellowship with autism well that's your st job after after get a your medical degree i worked in an e r only like once or twice a week at times just because i wanted to be home with my kids when they were babies and then what happened was i went to an autism conference they said that they had an opening for a fellowship program in autism so this was a good opportunity for me to get that fellowship and i did and at the time even though i really wanted to wait till my kids were a little bit older to do more hours i did it a year and a half and i had the option to do it another year or other continue because i love doing research but what happened was my my daughter with autism i had to pay her therapy expenses and her school expenses and it was just too much and i really couldn't afford to stay in research i really had to clerical to pay all those expenses of ok this is so sad so you have one daughter  reassuring me but it just even the pediatrician was reassuring me and i was like i better get her evaluated her language wasn't coming in and it was at the fifteen month old checkup i remember and the pediatrician told me i could wait six months i said i don't want to wait i yeah yeah that's a whole big spectrum you have people you know that are very low functioning then you know people who are geniuses with autism but socially they run into problems yeah indications skills aren't there or they're getting obsessed with things family yeah it does worry my family have a lot of cousins with autism it is always a fear of mine and in fact before i had kids i had the genetic work up done the in my husband and they told me there was only a three percent chance that my child would have autism and also i was initially reassured because when i was pregnant i found out she was a girl elderly people with autism and my family before were boys so i said ok it's a girl and won't happen have you thought you would have her have a girl that was in the family to bac risk but the risk of not getting wrecks that's unaided is so much greater than any risk of getting a vaccine we're not seeing in this country anymore people walking around without limbs because they got polio we're not seeing it you know when polio vaccine st came out in this country for a lined up to get that vaccine these illnesses are very serious i've seen patients who came from countries where they didn't have rubella they got they got congenital rubella cause they didn't have the rebel a vaccine and they were very high doses of vitamin b six can cause nerve damage some people are advocating for it she lay ssion therapy which is very dangerous and can kill and has killed so it's you have to really look at the science behind things and as you know from the title of my book my book says don't medicate educate so i i don't believe we should be giving out medications or any chemicals and less the scientific evidence shows that that's what's indicated and that's what's going to help and that we have brothers had it and it was a life saving for him and i think it's in massachusetts if you want a brother wholly different events for him he said new york it is quite different so tell us what is and why people are against it what a verse of therapy does is an aversive is basically a procedure that you do to the crits uncomfortable procedure that decreases the frequency of the behavior occurring again so positive reinforcement is well let's say somebody does their work and give them some music or you give them a toy or you might give them a piece of food and then they're more likely to engage in that behavior going or even verbal praise for a lot of people  aversive is a procedure where well for my brother it was a two nd skin shock and he hasn't even had one in over four years only a massachusetts although he's had the word device at times and what that did was it stopped him from his head banging because he needed surgery to close his head years ago when he was in the hospital over five months and the school in massachusetts the judge rotenberg center was the only school in the country that would accept him he was in the hospital were heavily medicated very sedated he had symptoms even before he went to the hospital neuroleptic malignant syndrome which could be deadly sometimes we didn't even realize how severe it was we didn't take him to the hospital that happened on how to which we took him off right away this psychiatrist said to take them off and that what happens is the muscles break down and it can be deadly and you know a lot of people with autism can communicate their side effects if they're getting symptoms in the middle of the night we won't know that they're getting no symptoms because they can't communicate right or they're not going to call you for help and sarah feeling well you get things too late and he also became obese he was drooling all the time and he lost his ability to communicate because of the medications and it got was really sad also because you know improved communication also can help of behavior right right right we don't want to see him going backwards morbidly obese a mess and just sleeping sixteen hours a day and in this school they took him off all those medications so the judge rotenberg center yeah he's on six positive behavior plans he earns reinforcers all day long for engaging in positive behaviors he now actually has a job at the school he's working he's earning money on he sweeps the floors he it's amazing and he loves it he's a more independent house now and they take her shopping he picks out his own food but yet centers are packed all i know i know and i think that's so unfortunate it gets we now have seventy percent of people with autism age eight and are on psychotropic medications and every year millions of people go to the hospital from adverse effect from side effects thousands of people die and it's awful that we're just getting these kids medications that are in adults rather than giving them decent behavior effective behavior plans and a lot of times you know the parents don't know the schools push it on the children the day programs the residences they're just pushing it on the the adults and they're getting toxic side effects they're dying much earlier than they should be you have to look at the alternative if the alternative is to take drugs that can give you heart disease and diabetes  impairments people with autism can have a sensory impairment it's actually in the current criteria from the diagnostic and statistical manual and what happens is they are they don't feel pain the same way other people feel pain sometimes and so normally we don't bang our heads or go out in the middle of the winter which is the bathing suit on it's going to hurt and the reason we feel pain is to keep us safe but their pain system isn't working naturally so it's giving it to my brother in a tornado right because what he brings his head it's not hurting him he'll do it again and again it's actually giving him some positive reinforcement because he gets attention kind of attention not necessarily even attention because he's like even here he has in the past also scratched his fingers to bleeding and he'll look when nobody's watching and that's when he'll do it because for him for everything for other people it would purchase for hand it's actually feeling good yeah so what is the alternative to a verse of therapy more drugs for that's what it is because if you look at the research on just using positive therapy alone you can only suppress behavior ninety percent of the frequency of a behavior ninety percent and only half your subjects the other half you cannot get that suppression and when you talk about a life threatening behavior you need to get that suppression close to one hundred percent absolutely ok so i was also reading that drugs have side effects so they're taking other drugs to offset the side effects because it's adept at the fact the pharmaceutical companies just makes a ton of money doing this i believe they are part of the problem the pharmaceutical industry this was in two thousand  estimate was two two to three point five billion dollars a year they make medicating this population my brother stuart who could not get access to the versa treatment he was recently lower from twenty than one thousand medications and most are psychiatric or the treat the side effects and he is sleeping late in the afternoon he has no life and he's also had seizures from these medications which people with autism are more prone to the more time to side effects from the medication but what's happening is these groups when i research them i've noticed some of these which i talk about in the book that are against the aversive treatment have been getting money from you know the pharmaceutical companies or the retailers at the corrupt system that used to work corrupt chris overused political climate supporting the elderly the disabled but they haven't yet to act together terms up to apply the right kind of treatment get to cation speech therapy and something happened to twenty one after twenty one the individuals with disabilities education improvement act doesn't apply anymore and we really do need some legislation passed because what's happening is these people often don't get served i have patients just sitting home with elderly parents that are scared from their behaviors and they don't know what to do no program wants them and they have no rights it's i've had parents who had to quit their jobs parents who families who had to go on welfare for who wanted to go to work because they're stuck taking care of these people that nobody else wants to have any idea why more of it is being reported one thing is that we're reporting it much better than years ago years ago people were not getting diagnosed even in girls today it's a problem because usually we think of obsessions and  with things like trains but a lot of girls will have actually age appropriate obsessions but they may have let's say a one hundred pieces of makeup or something like that or you know i'm obsessed with some show that we would consider age appropriate so we're not taking up a lot of the girls now ok  and the other thing also with that is that there's other things in the environment like air pollution is actually a risk factor for autism so there are environmental contributed to prague fear a lot of trouble audio highway well so if there are any good do is here the good news is that we have to fight to get our children applied behavior analysis that that is treatment available and that we need to do things in the system so that it's more available to other people one of the suggestions i make in the book is that just like all criminals have lawyers children with disabilities should have the right to a lawyer this would force the public school systems to fix up so that they're getting effective treatment to all the children who need it give the you know the school districts all have their lawyers why shouldn't the parents how their lawyers by gosh take a look at the out of pocket medical talk cover you know they don't cover and that you know and also that's another thing they need to be covering applied behavior analysis they need the school districts need to be covering this for kids a lot of parents i find don't even know what it is and the kids come in to me much older and you know when they say to me well i wish i knew about applied behavior analysis years ago course and you know they don't know how to do basic skills that they should have learned you work involves working with people with autism and dealing with the families that have to be terribly depressing are you very knowledgeable and i was sure there to throw it to have us there doctor because you could relate  to get some good advice but how do you feel at the end of the day a lot of times i actually feel in the way i feel how fortunate i am because i realize i have the funds together i have the support and i have the education to get my daughter what she needs and how well my brother in massachusetts is doing and i realize i have a lot that my patients don't have because i'm working in the medicaid clinic in the bronx with mostly poor patients but the heartbroken when you go home you know brush her teeth almost independently now we did a task analysis where we broke the steps down to twenty three steps brush your teeth brushed it when you try to three steps to brush teeth i hope paper would task analysis on it and you know and what you do is you work on one step at a serve people with developmental disabilities and we accept medicaid i was just speaking to a hospital child psychiatrist a few days ago she did not know what applied behavior analysis a b a was she did not know and i think that's really sad because then when people come in communications trading the well i guess a verse of therapy is not available in new york it's available only in one place in massachusetts unfortunately because it's so hard legally there's so many obstacles to getting it so that's why you have to go to massachusetts there are other schools that do use it actually in the united states there are not the only school that does but i don't even want to mention the names of those schools on the camera because i worry about them and  book that they use aversives because they were worried they would be attacked there is some good news but not enough of it there are people who do need psychiatric medications who don't benefit from them yet were over medicating and doing it in place of giving them a good education with applied behavior unannounced inspections the amount of psychiatric medications are regulated by the federal government with these inspections whereas the developmental disabilities with population we don't have those protections thank you