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Saturday, September 5, 2009

Rebuilding the ‘Grammar Machinery’ in Autistic Children, Part 1

'Dr. Harry,' Debra Schneider, and Fridrik Grundvig (James Ottar Grundvig)
An interview with Harry D. Schneider, M.D.
By James Ottar Grundvig

In January 2009, my son Fridrik was diagnosed with Pervasive Developmental Disorder (PDD) and underwent an active MRI scan in a Columbia University Study on children with low-functioning language. At that time, Dr. Harry Schneider started his long-term treatment program on Fridrik.

Schneider developed the treatment using transcranial direct-current stimulation (tDCS). The goal was to repair Fridrik’s neural pathway, while teaching him language vis-à-vis “implicit learning” techniques.

“Dr. Harry,” as his spectrum [autism spectrum disorder] patients call him, does not work alone. Besides teaming up with Columbia University Medical Center (CUMC) on the MRI Study, his office in Plainville, N.Y., is co-run by his wife, Debra Schneider. Together, with her business efficiency to schedule clients in the New York City metro area, North America, and the world—sometimes seven days a week to accommodate the “out-of-towners—they form a formidable, but approachable team. They are adept at connecting not only with their clients, but with the parents of the children as well.

The following is a 10-question interview James Ottar Grundvig (JOG) conducted with Dr. Schneider (Dr. Harry) this summer regarding his program treating children like my son with severe speech impairment in conjunction with the Columbia University Study.

JOG: What was the single item or idea that triggered the "Aha! moment” that tDCS, along with the active MRI, was the path to go in treating ASD kids?

Dr. Harry: That moment came after we performed our first functional MRI (fMRI) on what we now call LFA kids: low-functioning language in children with autism. Our original intention in the project at CUMC was to discover the neuropathophysiology of brain areas and connectivity in these children.

The first mother who looked at the image was both happy and sad to [see] the brain image of her child who could not speak. She told us: “The images finally tell me what is wrong with my child. Thank you. Now what are you going to do for my son?”

Aha! I thought. We had the technology to re-establish speech in adults with aphasia due to stroke and in people with traumatic brain injury. These patients, however, were all born with neurotypical brains.

What about the autistic brain? Well, now we had a way to generate a “roadmap” of sorts into the neural workings of the LFA kid, and we had a technology that modulates brain plasticity to bring about speech.

We wondered if we could combine the two modalities—the demonstration of the lack of connectivity revealed by functional MRI of a child with ASD and transcranial direct-current stimulation (tDCS)—to try to restore language to these kids.

That mother and all the subsequent parents thought that such an investigational study was worth a shot. Aha! I thought to myself. We have a plan!

JOG: How long has the Columbia University Study been conducted?

Dr. Harry: About 18 months to two years.

JOG: How long—or how many kids—before a true sampling of spectrum kids have wended their way through the program?

Dr. Harry: For the imaging program at Columbia, we are almost there: about 100 children. For the language rehabilitation program at the Plainview facility, our goal is to study 250 to 500 children to generate the power we need to draw significant conclusions.

JOG: What are the long-term goals or objectives of the study-program-treatment?

Dr. Harry: The long-term goals of the language protocol are to have children re-acquire functional language: the ability to initiate and maintain a meaningful dialogue. This means virtually starting from scratch with grammar they never acquired and subsequently adding pragmatic aspects of language, which constitutes more than half of what we say.

Next week: Part 2: About the new frontier in neuroscience and neuropsychology.
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