Embracing Different

When Ezra Bertram, 8, began kindergarten in 2018, he started to notice something. He was a little different from his many of his peers in social settings: the way they played, the way they learned, the way they interacted with each other.

Ezra had been diagnosed with autism at the Thompson Center when he was 4 years old, but he never had the opportunity to notice the differences between himself and other kids until he was a few years older. Noticing that he was different began to bother him, so his family jumped in to help.

“We started to see how challenging it was for Ezra to realize that he was different from other kids his age,” said Christa, Ezra’s mother. “We wanted him to know that being different is not only ok, it’s great! So we worked together to help him embrace different.”

And embracing different they did! As a tradition, the Bertrams make shirts every year for the annual Columbia Autism Walk each spring, hosted by the Thompson Center and other University of Missouri organizations. In 2019, they used the theme “Embrace Different” for their shirts, as well as included art of a giraffe: Ezra’s favorite animal.

“Ezra has always loved giraffes, so we worked with him and his artist aunt to create a character that could help him embrace different, and that is how Audie was born,” Christa said. “Ezra loved Audie and everything about the character, so we got Ezra a stuffed giraffe and he takes it everywhere as a companion.”

Ezra, 8, holds a copy of his new book, “Audie Embraces Different.”

During the ongoing pandemic and shutdown, as were many families, the Bertrams were stuck at home with a lot of time on their hands. They decided to make use of that time to expand the vision of Embracing Different. With input from Ezra and the rest of the family, Christa began writing children’s book on what it means to embrace different.

“We really wanted to use Ezra’s experiences to drive the book, to show what it feels like to be different,” Christa said. “Many of the situations and feelings discussed in the book come directly from Ezra. We’d ask him ‘when you experience this, how does that make you feel?’ In many instances we used his direct quotes as a part of the story.”

The book, “Audie Embraces Different” uses the Audie character to highlight the differences we all share among each other. While acknowledging that we are all different, some of us more than others, Christa hopes the book also spreads that message that being different isn’t only ok, it’s wonderful!

“We want to share the message that ‘different’ isn’t a bad word,” Christa said. “Everyone is different, God made us all different and that is why we are all special in our own ways.”

Christa also said the experience of writing “Audie Embraces Different” was a great one for their own family to learn more about Ezra and what makes him tick.

“This really was an awesome opportunity for myself and my husband, as well as Ezra’s brothers (Nehemiah, 9, and Eliot, 4) to learn how certain situations really make Ezra feel,” Christa said. “It really has made us closer and know each other better.”

The Bertrams are currently running a Kickstarter campaign to help raise money to produce stuffed giraffes that look like Audie. They hope to raise $8,000 for an initial run of Audies.

Nehemiah, 9, and Ezra, 8, display some new Audie merchandise.

“Having an Audie has been so great for Ezra,” Christa said. “He truly views Audie as a friend and companion. Audie helps him experience new things, he’ll often run and grab him before watching a movie or going somewhere new. We hope other kids with autism can also find a similar companion in Audie as well.”

To receive a copy of the book “Audie Embraces Different,” you can donate at least $20 to their Kickstarter campaign. That donation not only will get your family a copy of the book, but will also allow a book donation to a non-profit organization as well. The Bertams also plan on making the book available for sale on Amazon and other bookstores nationwide soon.

To stay up-to-date on when the book becomes available for purchase, you can follow the Audie Facebook page.

Ezra begins 2^nd grade in August and with Audie by his side, he will surely be better prepared to Embrace Different.

Trainee Spotlight — Dr. Erin Kennedy

The Thompson Center takes pride in fulfilling its three-part mission of autism treatment, research and training on a daily basis. One of the highest priorities in fulfilling this mission is the training of psychology interns and post-doctoral fellows. This practice not only helps increase the number of patients Thompson Center providers can diagnose and treat, but it also helps fill the huge need for trained autism specialists around the country.

Over the next few weeks, the Thompson Center will highlight a few of our outgoing trainees to see how training at the Thompson Center has helped direct their career paths. First up is Dr. Erin Kennedy, who has served as a psychology intern at the Thompson Center for the last year. As an intern, Dr. Kennedy participated in the Thompson Center’s neuropsychology and autism diagnostic clinics. Her main responsibilities were conducting clinical interviews, assisting with psychological assessments, and providing feedback to our patients and families.

When did you arrive at the Thompson Center?

I arrived at the Thompson Center in July of 2019.

What is your bio and educational background before the TC?

I grew up in Dallas and earned a bachelor’s degree in psychology at Texas A&M University. I then moved to Denver and earned a master’s degree in Clinical Mental Health Counseling at Denver Seminary, then beginning work as a Applied Behavior Analysis therapist. My last stop before Columbia was Biola University in California, where I earned my doctorate in Clinical Psychology.

Where are you headed now that you have finished your time training at the TC?

I will be starting my postdoctoral residency as a pediatric neuropsychology fellow at Children’s Health Medical Center in Dallas.

What created the passion within you to pursue a career in this field?

Through various babysitting and ministry opportunities, I often provided care to children with various neurodevelopmental disabilities, neurological conditions, and other illnesses. Caring for these children and their families instilled a passion to support them by learning how different disabilities and injuries in development can impact a child and how best to provide support and education to children and families to enhance their quality of life.

How did your time at the TC influence the direction of your career?

My time at the TC continued this passion and broadened my knowledge and skill set to feel confident to move forward in becoming a pediatric neuropsychologist.

What is the most valuable thing you learned while working at the TC?

I learned a great deal about serving a rural population and the benefits of working in a collaborative multi-disciplinary clinic.

Any last thoughts about working at the TC?

I appreciate the strong collegial atmosphere at the TC. Additionally, it is very evident how much the TC focuses on training, and not just with skills, but with developing professionalism and independence. Everyone was wonderful and welcoming and will be greatly missed!

The Thompson Center Values Social Justice

The Thompson Center is committed to workplace diversity and to cultivating, fostering and preserving a culture of inclusion. We believe that diversity and inclusion is everyone’s responsibility. This commitment extends beyond the care we deliver within our facilities, and means we must lead the way and take responsibility and action to stand against hatred, discrimination and prejudice while living the values of respect, responsibility and compassion.

In light of recent events, we understand that taking a visible and active stance against systemic racism is important to show support for our Black and Brown faculty, staff, learners and the families we serve. We are dedicated to cultivating an environment that is free of racial, gender or any other form of oppression.

We can only do this together. We recognize that all of us can grow and do better by listening, learning and then taking action that is meaningful to who we are.

We are committed to making all who come through our doors – whether they are employees, learners, patients or visitors – feel welcome, included and respected. We must also recognize that as an organization, community and society we must work together to champion efforts that lead to real change.

Changing Jobs, Changing Lives

When Myles Hinkel first attended a town hall meeting in 2005 about the newly created Thompson Center, little did he and his wife Lora know how impactful the Center would be in their family’s life over the next 15 years. The Thompson Center has meant so much to his family, in fact, that Myles has agreed to take over as the director of the Thompson Foundation for Autism, which is the nonprofit organization dedicated to raising money and support for Thompson Center programs and families.

For the Hinkels, autism is personal. Their son, Blake, was diagnosed with ASD 15 years ago. Myles says having the Thompson Center and its providers serve as a support system in those difficult early years helped his family tremendously in learning to live with autism.

“I don’t think there is any aspect of our lives that autism hasn’t affected,” Myles said. “Autism definitely takes its toll emotionally, financially, relationship-wise with friends and family, and in many other ways. However, it has also taught us the beauty of unconditional love, seeing the true soul of a person, empathy, and what is really important in life.”

With years of experience in fundraising at the University of Missouri, as well as years of experience with autism and the Thompson Center, having Myles step into a leadership role with the Foundation seems like a match made in heaven for the Foundation.

“Myles brings a passion to his new role and describes this as his ‘dream position,’” said Ron Ashworth, chair of the Thompson Foundation board. “He has experience in dealing with autism in his family and has worked with his wife Lora in service to the Thompson Center for many years. With his depth of experience in Advancement with the University, he already has plans to pursue significant fundraising initiatives for the Thompson Foundation in order to benefit the Thompson Center.”

Myles says his deeply personal relationship with autism and the challenges it creates for families was a driving factor in his decision to take on this new role.

“The Foundation enjoys the leadership of incredible volunteers with unparalleled experience and expertise,” Myles said. “The board knows that autism families are resilient and relentless! The Foundation will continue to be resilient and relentless in our pursuit of the mission and the opportunity to join this mission was impossible to pass up.”

Myles began at the Foundation on June 1, replacing the retiring director, Al Eberhard. Myles has already hit the ground running.

“We have some exciting initiatives for the near future,” Myles said. “We’re going to increase critical services, training and education by enhancing and building new partnerships; we’re going to build technology and infrastructure; expand the external and internal awareness of the Thompson Foundation brand; and finally, we will seek philanthropic partners to help us change lives!”

And changing lives is the number one mission for both the Center and the Foundation.

For more information about how to support the Thompson Foundation for Autism, visit: http://thompsonfoundation.org/

COVID-19 Safety Guidelines for Patients and Staff

Due to the ongoing COVID-19 pandemic, the Thompson Center has enacted several new safety guidelines for in-person clinic visits. These guidelines are meant to keep our patients, their families, and our staff as safe as possible. If your family has an upcoming scheduled in-person appointment, please review the following guidelines before arriving.

Parking and Screening
• Utilize the identified car loading/unloading area so that patients maintain social distancing guidelines.
• For patients receiving Applied Behavior Analysis (ABA), speech/language, and occupational therapy services, your service provider will meet you at the screening area to walk you to your room.
• Only one (1) adult guardian is to accompany patients to their appointment. No additional children will be allowed in the building at the current time.
• At our entrance, patients and guardians will be screened for temperature and possible COVID-19 symptoms.
• PLEASE RESCHEDULE IF YOU ARE SICK OR HAVE BEEN AROUND OTHERS WHO MAY HAVE BEEN EXPOSED TO COVID-19.

Masks

Our clinicians and staff will be wearing masks per hospital regulations except for certain services (see below). Patients and guardians should wear masks as well, except for certain services (see below). You are welcome to bring your own mask or we can provide one for you.

For patients receiving speech/language, occupational therapy, and psychological testing, some outcomes may be impacted by children wearing masks. For these services, we request that children not wear masks unless otherwise directed by their service provider. If you are uncomfortable allowing your child to participate in these services without a mask, we can reschedule the appointment.

For patients receiving Applied Behavior Analysis (ABA), patients may wear a mask, but are not required to if they struggle to tolerate the mask.

Other Safety Measures
• Our furniture and rooms are arranged to allow for 6-foot social distancing.
• Floor signage will indicate 6-foot distances to help with social distancing.
• To reduce contact, patient appointments have been staggered and the number of patient appointments have been significantly reduced.
• Both our café area and water fountain are currently closed. You may bring your own snacks/water.
• All furniture, toys, and materials are sterilized between patients.
• Staff will wear stickers to indicate that they have been screened for symptoms.

Thank you for trusting the Thompson Center with your care. We aim to continue providing the high-quality care you expect from us while assuring safety of our patients, families, and staff. We are also offering video visits for some of our services. Please click here to learn more.

Social learning during social distancing

During the COVID-19 pandemic, families around the world are looking for ways to help further their children’s education. This process can be especially stressful for families with children with autism who might be missing vital services. Eliminating their access to schools, teachers and other children could further perpetuate already existing social isolation. Thompson Center autism experts say keeping children with autism connected and engaged is particularly important.

In recent years, special education researchers at the University of Missouri have developed a social competence intervention (SCI) curriculum that has proven through published studies to improve the social skills of children with autism and other special needs. Dr. Janine Stichter, a professor of special education in the MU College of Education, first developed the program when she was an associate director at the MU Thompson Center for Autism & Neurodevelopmental Disorders.

“At the time, there was no organized comprehensive curriculum for children with social deficits,” Stichter said. “With work from a number of outstanding graduate students and faculty, we were able to develop the SCI and prove that it works in helping teach vital social skills that do not come naturally to children with autism.”

The next challenge was making this program accessible to all children, especially those in rural and urban environments that do not have regular access to trained special educators. Dr. James Laffey, a professor emeritus in the MU School of Information Science & Learning Technologies, helped Stichter adapt the program to a virtual environment so children anywhere in the world could participate.

The virtual curriculum, called iSocial, features children in small groups of 4-6 fellow peers. The curriculum asks the children to complete tasks in groups, teaching them the skills needed to work and communicate with others along the way.

“The virtual world affords us perks that can’t be achieved in person,” Stichter said. “Remarkably, we have found that children with autism show the same tendencies and personalities in a virtual environment as they do in real life. A fidgety kid in a chair is a fidgety avatar online. For example, a child who tends to wander physically, he will also tend to wander virtually, clicking on items and activities that are not part of the program. In our program, his avatar can be locked in a certain space and coded to guide him, teach him systematically and set him up for success.”

After years of development, the program is currently available for families to participate in from home. Stichter says this is a great way for children to continue learning valuable social skills even during social distancing.

“The program was designed to work even during these times when we can’t meet each other face-to-face,” Stichter said. “Because it is entirely virtual, children with autism can still work with and learn from their peers and instructors from their own home.” The company Nascent purchased the licensing rights for the MU-developed iSocial program in 2017 and have been implementing it ever since. iSocial currently is offering virtual sessions of the program during the pandemic. For more information about iSocial, visit: https://www.isocl.net/ or contact Bob Etzel at: 785-221-4436 or betzel@isocl.net.

Autism Prevalence Rate Increases

Lost in the shuffle of the current global pandemic, the CDC in March released a study causing the organization to increase their estimate of autism spectrum disorder (ASD) prevalence to one in 54 children. This changes the CDC’s previous prevalence estimate of 1 in 59 children, which was released in 2018.

Dr. Benjamin Black, director of medical services at the Thompson Center believes this change shows the need for increased autism resources around the country.

“The increase in autism spectrum disorder prevalence to 1 in 54 children is important, and highlights the continued need for resources to be devoted to this area,” Dr. Black said. “However, equally important is the disparities that this study noted geographically and across socioeconomic groups. The Thompson Center strives to be a leader in challenging these disparities through its educational, research, and clinical care programs.”

Dr. Connie Brooks, head of the clinical psychology department at the Thompson Center, believes this change is important as it highlights previously underrepresented groups in the autism evaluation process.

“The increase in the ASD prevalence rate seems to indicate that autism specialists are doing a good job in identifying children with autism, particularly with the new data indicating similar prevalence rates for black and Asian/Pacific Islander children. The results also suggest, however, that we still have to work to do, especially in improving identification of Hispanic children as well as with earlier diagnosis of Black children. I’m proud that the Thompson Center continues to focus on health disparities in our training and clinical work to reduce these differences.”

The Thompson Center has performed more than 700 autism diagnostic evaluations in the last year. While many families remain on the waiting list to receive an evaluation, the Thompson Center continues to search for ways to increase how many families we can serve each year.

Thompson Center Expands Online Visits!

Would you like to schedule an appointment with your Thompson Center provider? During this time of social distancing, we are now offering video visits with many of our providers, including from our medical clinics and ABA!

Check in, receive advice and treatment from our autism experts via easy-to-use video chats. All it takes is a computer, a smartphone or a tablet!

Current services offering video visits include:

Medical Clinics: Current patients can schedule visits with their developmental pediatricians, general pediatricians, psychiatrists, and nurse practitioners.

Health Professions: Current patients can schedule visits to continue their occupational therapy and speech/language therapy. Concussion therapy and concussion evaluations are also being offered via telehealth. Patients are also being contacted for telehealth interviews to complete one part of their diagnostic appointments. While in-person testing will occur at a later date, telehealth interviews can help families get connected to resources prior to their testing appointment. They also will help the diagnosticians create a thorough testing plan and complete part of the appointment so that the follow-up appointment is shorter. Additional patients on our diagnostic wait lists may also be contacted for telehealth interviews.

Applied Behavior Analysis: We are offering new initial consultations for ABA services. Families will be placed on our ABA wait list following these consultations. For our ongoing/current clients, our ABA providers are offering behavioral parent training, parent training, including sessions for families with clients normally receiving 1-on-1 Intensive Behavioral Intervention services, and parent/staff training for our Severe Behavior Clinic clients.

To schedule a video visit, call our main line at: 573-884-6052.

To learn how to set up a video visit, check out this document: https://thompsoncenter.missouri.edu/wp-content/uploads/2020/03/Zoom-Meeting-for-Patients.pdf

You can also watch this video to learn more:

WISC Away the Time

For decades, neuropsychologists have used the Wechsler Intelligence Scale for Children (WISC) test as the gold-standard IQ test to determine the intellectual abilities of children with special needs. However, this comprehensive test takes more than hour—sometimes two hours—to complete and many children with special needs have a difficult time participating in such long tests.

Now, researchers from the University of Missouri and the Thompson Center have succeeded in shortening the current version of the WISC test, the WISC-V, while still maintaining its accuracy in determining a child’s IQ.

For the study, John Lace, a doctoral student at Saint Louis University who is completing an internship in clinical neuropsychology in the MU School of Health Professions, studied data from Thompson Center neuropsychological evaluations where the WISC-V was utilized. Lace and colleagues were able to identify which measures of the WISC-V were vital for accurate results and were able to remove as many as 4-5 measures that appeared to be repetitive. When recalculating the results of the tests after removing those repetitive measures, Lace found that the results remained similar.

“We think that by removing these measures, we can shorten the WISC-V while maintaining efficacy,” Lace said. “Even 15 or 20 minutes shorter would make a huge difference for children with special needs and their ability to complete the test. It would greatly increase the accessibility for children and make their evaluation process much easier.”

Neuropsychologists use the WISC-V as an important part of their evaluation of children with special needs. They use the results to help inform decisions about treatment and educational plans. Dr. Mike Mohrland, a neuropsychologist at the Thompson Center, says the WISC-V is often the most important test in both diagnostics and treatment planning.

“Decreasing the time it takes to test kids is an ever-increasing need in today’s culture,” Mohrland said. “Testing kids faster helps with their motivation and optimal stamina. Another benefit is that it allows more time to test other vital cognitive skills. This study is a showcase of the impressive caliber of trainees we get to work alongside at the Thompson Center.”

The researchers say the next step is to expand their shortened WISC-V version into clinical application. The study has recently been accepted for publication pending revisions. Co-authors include Zachary Merz, Dylan Seitz, Tara Austin, Erin Kennedy, Bradley Ferguson and Mike Mohrland.

Hiding in Plain Sight

At its roots, autism is a social communication disorder, which often makes it difficult for people with ASD to communicate with others and function appropriately in social situations. To combat these challenges, adolescents and adults with autism often learn how to blend in socially so as not to stick out as awkward or anti-social. This process of blending in socially is referred to as “camouflaging.”

A new study by researchers at the Thompson Center shows that girls and women with autism increase the use of camouflaging as they age, while males with autism actually reduce the practice as they mature. The study also showed that girls have higher levels of camouflaging than boys regardless of age. Understanding how and why people with autism practice camouflaging is important for determining how to best help them integrate successfully and meaningfully into society.

“Previous studies have shown that camouflaging can result in increased levels of depression and stress, so it’s important to understand in what situations people with ASD use camouflaging so we can help provide them with healthy alternatives,” said lead author Courtney Jorgenson, a doctoral student in the University of Missouri Department of Psychological Sciences.

For the study, Jorgenson surveyed adolescents with and without autism between the ages of 13-18 in order to determine when and how they used camouflaging in order to “fit in.” Behaviors she measured included, but where not limited to: consciously monitoring their body language and eye contact; learning appropriate behaviors by watching and imitating peers; thinking about the social impression they are making on others; and thinking about how much they are performing and not being themselves.

Jorgenson found that girls with autism used camouflaging more than boys regardless of age. She also found that while girls increased their use of camouflaging as they aged, boys tended to decrease the use of camouflaging as they matured. Jorgenson says these results are important because they show the need for increased vigilance when looking for which individuals on the spectrum need support.

“Because they increase camouflaging as they age, girls with autism tend to look more like their neurotypical peers,” Jorgenson said. “They grow better at hiding their autism, which makes them harder to identify as needing support. When you feel like you are constantly putting on an act and not being yourself, your levels of stress and depression can understandably increase, so it is important to identify those who are camouflaging and make sure they are receive the support they may need.”

This pilot study used data from 140 participants. Future research will use the newly created SPARK research match program to recruit additional participants. The study is currently under review for publication.