From A Judge

Dear Dr. Federici:

I’m very sorry that we have not met, but I’d like to introduce myself.  I was a circuit judge in PLACE_REDACTED for 10 1/2 years, and retired on July 1st.  NAME_REDACTED came before me in 2007 when I was assigned to the Juvenile division.  She had been arrested for a minor offense, but the striking part of her first court appearance was her adoptive parents’ position that they would not allow her to return to their home.  NAME_REDACTED was very unstable, very child-like, and I found her situation unbelievably sad.  That court appearance led to many others, and ultimately to the situation we are all dealing with now.

As you might imagine, I have dealt with hundreds (probably thousands) of children, many of whom have very sad, very troubled backgrounds, but none have touched me like NAME_REDACTED.  She is not an easy child to deal with, but no other child in court possessed the kind of background she arrived with:  adopted from PLACE_REDACTED, unadopted by her Virginia family, adopted and unadopted by NAME_REDACTED, institutionalized in Florida, and then disappointed by yet another potential adoptive family.  Unlike most children in court, she has no one, and she is adrift.  From my perspective as the judge handling her case, I received report after report and evaluation after evaluation, but ultimately, little information that I found helpful or particularly on-target.  She was diagnosed with every possible mental illness, over-medicated, admonished by her caretakers to behave properly, chastised for running away, and given little meaningful help.  To the extent that I could intervene, I did, but it was (regrettably) too little too late. To ask a child in her situation to just cease her self-destructive behaviors seemed foolish, and no one was inclined to get to the heart of the problem.

When I made the decision to retire, I did not feel I could just walk away from NAME_REDACTED without doing what I could to help her.  In some respects, my position as a retired judge seemed to provide more flexibility in how I could assist, which has proven correct in many respects.  But nothing has helped NAME_REDACTED’s plight more than your exceptional evaluation.  Your thorough consideration of her background, her present situation, the results of the tests you administered, and your conclusions have provided us with an authoritative, professional, complete, and uniquely insightful evaluation of a complex child.  It is more than a little embarrassing that none of our Florida evaluators could approach the level of professional expertise you possess, but I am very grateful that we found you.  More importantly, I wanted to personally thank you for your generosity and patience with all of us, because I know that we have repeatedly enlisted your assistance in our quest to secure a meaningful placement for NAME_REDACTED.  I also know that you have not been properly compensated by the State of Florida for your expertise or your expenses, and I deeply regret that.  Although it may be of little comfort, I have pledged my personal resources for plane tickets or whatever else proves to be an impediment to try to help NAME_REDACTED; your selfless assistance, however, is of a much greater magnitude.

To advocate for the NAME_REDACTED placement, I have told the highest level bureaucrats that your evaluation is, by far, the best I have seen in my time on the bench, and they have responded very favorably.  I told them that because it is the truth, but you should know how exceptional, and how valuable, it has been in the life of this child.  If we succeed in talking Florida into placing NAME_REDACTED in Virginia, it is without a doubt thanks to you, your professionalism, and your generous expenditure of time.  I know that you may be contacted today during a placement staffing (I will attend with NAME_REDACTED), and I apologize again for imposing yet again on your valuable time, but it will be a crucial event in this process.  I am very grateful that you will consider providing your opinion and insights to the powers-that-be, and I acknowledge the imposition.  Rest assured, however, that your opinion and recommendation carries tremendous weight.

I would, in closing, also note that during my long career as a public servant (30 years!), I have never seen a Guardian Ad Litem work as tirelessly as NAME_REDACTED has on NAME_REDACTED’s behalf.  Were she not as diligent, capable, persistent and dedicated as she is to NAME_REDACTED’s best interests, I do not think Virginia would be an option.  She found you, and for that we are all eternally grateful.  I hope that you understand her tenacious efforts to help NAME_REDACTED are not designed to wear you out or trouble you, but at this point you are our lifeline.  Forgive us both, then, for imposing on your good graces.

Again, thank you Dr. Federici, for everything you have done for NAME_REDACTED.  You are an extraordinary human being.  If there is anything I can ever do for you, please do not hesitate to call on me.

Most sincerely,
NAME_AND_CONTACT_DETAILS_REDACTED

“She’s Had a Peace I Haven’t Seen Before” (Thank You, Dr. Ronald Federici)

Dr. Federici,

Thank you for faxing her testing results.  We interviewed two Christian schools and enrolled in one we feel will be of significant help to her.  We feel this new school will pray for her and work towards her total healing.  She will also be enrolled in their NILD and other helpful programs there.

Since your work with her, I’ve felt she’s had a peace I haven’t seen before.  We are glad you were able to help her open up about the abuse she suffered while living with her birth family.  Whatever happened during your working with her about that evidently brought great release for her.

Sincerely,

“Thanks Again A Million Times”

Hello Dr. Federici, I just wanted to say thanks again a million times for your help with Irina. We took your advice on the Risperdal and kept her on it. It has been 2 weeks now on the medication and 1 month out of school and she is like a different child. She is so much better. She is sleeping good and her mood swings, hyperness and anger have greatly improved. We can see some hope now! Just wanted to share with you the good news about her and say thank you so very much for doing what you are doing for the kids. Lori and Mike, VA Beach, VA

“Thanks Again” – US Department of State

“Hi. Just want to thank you (Dr. Ronald Federici) for finding the time to meet with the Boyle child and the state department family/parents (from Africa). I read the report of your eval and just get blown away. This was the BEST evaluation and treatment plan we have ever seen for one of our state Department kids adopted from Ukraine. Actually, it was the best Neuropsychological Evaluation we have seen altogether. This is a life long challenge for these parents. Your eval/recommendations was certainly something deeply needed and appreciated by them. Thanks for all the great support to our families serving abroad Thanks again”

D. Supervisor, Exceptional Programs, US Department of State

The Best Book For The Toughest Kids

Here’s a review of Help for the Hopeless Child by Dr. Ronald Federici:

“Finally, finally, an expert who gets the whole picture. We have struggled with our adopted Romanian and Russian children for years, and have seen all the other “experts” out there who had all types of tricks, but no solutions. We used all the drugs in the world, got sick of play, attachment and family therapy, and finally got to the heart of the problem with Dr. Federici’s common sense approach. We wish we would have done this years ago (and tons of money ago). Maybe the others out there who claim to know about post institutionalized children will read his book and learn something.”

Mom of 2 Says: “We Checked It All Out”

All we know is that we checked it all out..lots of people, and all the qualifications through the state boards. We were just tired of untrained or unlicensed people, so we really did our homework after tons of wasted $$$… We did not go to Dr Gindin as he is a school psychologist/clinical psych person . We hear he is great with language, but he is not board certified in kid neuropsych like Dr Federici and a few others we talked to in CA and CO.

We checked Dr Federici out real good before going, and he even sent us all his Vita, licenses and advanced training. Then we asked the Virginia Board, and they told us he was one of the best qualified in his field and the state, as they had to check him out before giving him a license. We found out later that some of our other providers were not even licensed! With Dr Federici being a more medical person as neuropsych, we got lots more back from the insurance for his fees. And he worked with us on money issues ( we still are broke), where everyone lese charged tons for evals like 2500 and 3000 and even more! Hope this helps..real important to find people with good PI training in stuff, as we started off with ADHD and found out it was lots more… Cindi, Mom of 2

Reactive Attachment Disorder and Rebirthing Therapy

Comments by Dr. Ronald Federici on Reactive Attachment Disorder (RAD) and Rebirthing Therapy:

Reactive Attachment Disorder is a very complicated childhood-neurodevelomental disorder that should only be diagnosed by people who have extensive experience on the doctoral level in terms of child development issues. The diagnostician should be experienced in the assessment and treatment of various neuropsychological and psychological disorders of childhood, and know how to use differential diagnosis as opposed to just lumping every child who ‘meets the check list criteria’ for RAD. There are so many other disorders that look just like RAD, especially many neurological disorders such as autistic-spectrum disorders, retardation, and the more severe cases of abuse and neglect.

Rebirthing therapy is not held in any regard by well-trained child therapists and has no validity in the medical or psychological research. It was an offshoot of bizarre therapies of the 60s and has been continually practiced by many individuals untrained in proper child assessment and therapy teqhniques to where they make up their own (or offshoot) ideas, who tout this as being the only way for damaged children to ‘have a new life’ with their new families. Furthermore, it only serves to retraumatize children due to the aggressive nature which is in the same fashion as rage reduction therapy which was big in the 80’s.

Traumatized children may need certain types of holding therapy to contain aggressive urges, but the majority has to be done in a reconstructive family modality. The entire thought of rebirthing, which was done to Candace Newmaker, was both bizarre, psychotic on the part of the therapist, and further traumatizing to the child while she was alive and before she met a most gruesome death according to the coroner. People who practice this type of treatment are often unlicensed and untrained, but make a lot of money by enticing the most needy and desperate families.

Articles of Interest

Amminger GP, Berger GE, Schäfer MR.  Omega-3 fatty acids supplementation in children with autism: A double-blind randomized, placebo controlled pilot study. Biol Psychiatry 2007; 61(4):551-553.

Researchers found that treatment with Omega-3 fatty acids was superior to placebo in controlling symptoms autism and associated symptoms including hyperactivity and stereotypy.  Amminger and colleagues conducted a double-blind, randomized, placebo-controlled pilot study.  The primary outcome measure was a change in scores from baseline to week 6 on the Aberrant Behavior Checklist (ABC).

Cicchetti, D. (2001). The impact of child maltreatment and psychopathology on neuroednocrine functioning. Development and Psychopathology 13, 783-804.

The findings of this study concluded that maltreated children with reported clinical-level internalizing problems have higher cortisol levels compared to non-maltreated boys who had lower levels of cortisol. The findings conclude that maltreatment and different forms of psychopathology have an effect on neuroendocrine regulation.

Chisholm, K. (1998). A Three year follow-up of attachment and indiscriminate friendliness in children adopted from Romanian orphanages.  Child Development, 69 (4), 1092-1106.

This research article examines attachment and indiscriminately friendly behavior in children who spent at least 8 months in a Romanian orphanage (RO). The findings of this research indicate that RO children displayed significantly more insecure attachment behaviors in comparison to the control groups.  These children had significantly more indiscriminately friendly behavior, behavior problems, and parents reported more parenting stress.

Delahanty, D., Nugent N., Christopher, N., Waltsh, M. (2005).  Initial urinary epinephrine and cortisol levels predict acute PTSD symptoms in child trauma victims.  Psychoneuroendocrinology, 121 (2).

Results of this study indicated that elevated initial cortisol and epinephrine levels immediately following a traumatic event continued to predict the development of acute PTSD symptoms; particularly in boys.

Forbes, H., Dziegielewski, S. (2003) “Issues facing adoptive mothers of children with special needs.”  Journal of Social Work, 3 (3):  301-320.

The purpose of this article is to identify and understand the challenges that mothers face after they adopt special needs children.  The study examines adoptive mothers who sought therapeutic assistance after the placement of their child and the difficulties they endured.

Federici, R.S. (1999).  Neuropsychological evaluation and rehabilitation of the post institutionalized child.  Dr. Federici Articles.  Retrieved October 21, 2007 from http.drfederici.com/post_child.htm

Dr. Federici evaluates post-institutionalized children and the factors associated with inadequate care.  Assessment and treatment modalities are examined as are comprehensive neurological approaches.

Federici, R.S (n.d.).  Raising the post-institutionalized child risks, challenges and innovative treatment.  Dr. Federici Articles.  Retrieved October 21, 2007 from http.drfederici.com/rasing_child.htm

Risk factors of adopted children who have been in an institutionalized setting are evaluated along with current statistics of medical conditions associated with these settings.  Innovative treatments for infants and toddlers are summarized along with guidelines for parents.

Ghuman J. K., (2007). Comorbidity moderates response to methylphenidate in the preschoolers with attention deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 17 (5), 563-580.

According to a recent analysis of data from the Preschoolers with ADHD Treatment Study (PATS), funded by the National Institutes of Health’s National Institute of Mental Health (NIMH), preschoolers who are diagnosed with ADHD  and who also have three or more coexisting disorders, are not likely to respond to treatment with the stimulant methylphenidate, regardless of dosage,

Goodman, W.K., Murphy, T.K, Storch, E.A. (2007).  Risk of adverse behavioral effects with pediatric use of antidepressants.  Psychopharmacology, 191 (1), 87-96.

This article reviews the Food and Drug Administration’s (FDA) decision to issue a “black box” warning about the risks associated with children and adolescents during the treatment of antidepressants.

Gunnar, M.  (2001). Effects of early deprivation. Findings from orphanage-reared infants and children.  In C. Nelson and M. Luciana (Eds.) Handbook of developmental cognitive neuroscience (617-629).

The focus of this article is to discuss and review the research concerning physical, cognitive, and emotional development of children adopted from Romanian orphanages over the last 15 years.  The trends of early deprivation and possible outcomes are also evaluated.

Gunnar, M. & Cheatham, C. (2003).  “ Brain and behavior interface:  stress and the developing brain.”  Infant Mental Health Journal, 24 (3), 195-211.

Research on infants and children who have been maltreated early in life is reviewed to show stress hormone activity.  The researchers focus on enhancing care later in development and the possible reversal of the effects on behavior and neurobiology of early experiences.  The authors review literature in the field and conclude that the longer the child is neglected the higher degree of developmental delays occur.  Studies on the neuroendocrin systems show the effects on the HPA system and CORT systems in response these stressors.

Hughes, J.W., Watkins, L., Blumenthal, J.A., Kuhn, C., Sherwood, A. (2004). Depression and anxiety symptoms are related to increased 24-hour urinary norepinephrine excretion among healthy middle-aged women.  Journal of Psychosomatic Research, 57; 353-358.

The objective of this study was to evaluate the relationship between levels of self-reported symptoms of depression and anxiety and 24-hour urinary catecholamine excretion.  Norepinephrine, epinephrine and cortisol are examined.

Levy, F., Swanson, J. M. (2001).  Timing space and ADHD: the dopamine theory revisited.  Australian and > New Zealand Journal of Psychiatry, 35, 504-511.

The objective of this study was to review the dopamine theory of Attention Deficit Hyperactivity Disorder (ADHD) in terms of the advances made in research over the past decade.  Serotonergic agents were found to have a calming affect on psycho-stimulants in which the dopamine transporter (DAT) gene was disrupted.

Moms who dine on fish could boost baby’s brain (2007). Pharmacy Times, 82.

This article comments on research from the US National Institutes of Health (NIH), which found that women who eat seafood during pregnancy may increase brainpower of their children.  The authors list fish oil supplements as an alternative, and found that women who took these supplements during pregnancy had children with better developmental skills.

Oades, R.D. (2005).  The control of repsonsiveness in ADHD by catecholamines: evidence for dopaminergic, noradrenergic and interactive roles.  Developmental Science, 8 (2), 122-131.

The neurological base of Attention Deficit Hyperactivity Disorder (ADHD) from a neurochemistry and psychopharmacology standpoint, as well as the catecholamine based behavioral systems, are evaluated by Oades and colleagues. Dopamine and noradrenalin neurotransmission to the motor and cognitive symptoms of ADHD were studied.

Purvis, K.B., Cross, D.R., & Kellerman, G. (2006). “An experimental evaluation of targeted amino acid therapy with at-risk children. Journal of Alternative and Complementary Medicine, 12 (6), 591-592.

This article explains the connection that neurotransmitter levels and ratios have on the behavior of at-risk youth.  This comprehensive study found that targeted amino acid therapy, in conjunction with scheduled feedings and behavioral interventions, regulated the brain chemistry in children adopted from Russian orphanages.

Watts-English, T., Fortson, B., Gibler, N., Hooper, S. De Bellis, M. (2006).“ The psychobiology of maltreatment in childhood.”  Journal of Social Issues, 62 (4) 717-736.

Authors of this article review empirical findings of neuropsychological functioning in children with Post Traumatic Stress Disorder (PTSD).  Serotonin deregulation, cortisol, the limbic system and neuro-imaging techniques are evaluated in regards to brain development.

Weidman-Becker, A. (n.d.).  Child Abuse and neglect:  effects on child development, brain development, and interpersonal relationships.  International Adoption Article Directory.  Retrieved October 17, 2007 from http://www.adoptionarticlesdirectory.com/article.php?id=42&act=print

This article is intended for parents and individuals in the mental health field.  It clearly defines the correlation between neglect and abuse early in life and the long lasting effects it has on brain development.

Weidman-Becker, A. (n.d.).  Recognizing attachment concerns in children.  International Adoption Article Directory.  Retrieved October 17, 2007 from http://www.adoptionarticlesdirectory.com/article.php?id=45&act=print

The focus of this article is to provide the audience with background information on attachment, how attachment disorders develop, and why healthy brain chemistry is reflective of healthy attachment in the first two years of life.  The author describes what attachment disorders look like in all developmental stages of childhood.

Yehuda, R., Southwick, S., Giller, E.L., Ma, X., Mason, J.W., (1992).  Urinary catecholamine excreation and severtiy of PTSD symptoms in Vietnam combat veterans.  Journal of Nerv. Mental Disorders, 180 (5), 321-325.

This study found that urinary dopamine and norepinephrine levels were significantly correlated with the severity of PTSD symptoms.  The researchers concluded that these findings supported the theory that enhanced sympathetic nervous system (SNS) activation plays a major role in PTSD and that increased SNS arousal may be closely linked to the severity of certain PTSD clusters.

Fatal Delivery

Jeane Newmaker, Hoping to Save Her Troubled Child, Chose a Therapy That Cost Her Life Instead

For 70 minutes on the morning of April 5, jurors in Jefferson County, Colo., sat in stunned disbelief, some shaking their heads, others weeping, as they watched a videotape of the dying moments of 10-year-old Candace Newmaker. Throughout the video the child is tightly swaddled from head to toe in a blue flannel sheet that is meant to symbolize the womb. Her adoptive mother, Jeane Newmaker, 47, had paid $7,000 for two weeks of intensive therapy, including a “rebirthing”—a reenactment of the birthing process—in hopes it might help Candace break with her troubled past.

“I can’t breathe,” Candace cries 10 minutes into the ceremony.

“You have to push hard and want to be born,” answers one of the four adults who, to simulate contractions, press upon the girl’s 70-lb. frame with gold pillows and their combined weight of 673 lbs.

“I’m sick,” Candace cries eight minutes later. “Get off.” Then, “I just threw up. I gotta poop.”

“Lay in there with the poop and vomit,” comes the answer.

At 49 minutes the child lapses into silence. When the sheet is removed 21 minutes later, Candace is no longer breathing. The following day, April 19 of last year, the cause of death is determined: mechanical asphyxiation—or, as prosecutors explain, choking in her own vomit.

That Candace died during the rebirthing is not in dispute. As defendant Connell Watkins, 54, the therapist in charge, told investigators the day of the tragedy, “The videotape is going to hang us. It is going to look awful to people who don’t understand what we are doing.” But in fact, it also looks bad to people who do understand. “It’s a bizarre treatment, akin to witchcraft,” says Dr. Ronald Federici, a developmental neuropsychologist who works with severely disabled children in McLean, Va. “It has no basis in reality or psychiatric care.”

When the defense presents its case this week, Watkins and her codefendant, therapist Julie Ponder, 40, who have each pleaded not guilty to a charge of child abuse resulting in death, appear poised to argue that Candace died of heart failure induced by the medications she was taking. (The two others who participated, Watkins’s office manager Brita St. Clair, 41, and Jack McDaniel Jr., 48, who have since married, will be tried on the same charge in September.) Each faces from 16 to 48 years in prison. Candace’s mother, who goes on trial in November for criminally negligent child abuse resulting in death, faces four to 16 years.

Newmaker, a former nurse practitioner, began looking into alternative therapies because she felt traditional remedies were not working for her only child, whom she took into her Durham, N.C., home at age 6. “It was,” the single mother tearfully told the court, “the last chance to save my family.”

While testifying against Watkins and Ponder, Newmaker said that the report from the Department of Social Services in Hickory, N.C., where Candace spent her early years, described the girl as stubborn and willful. It also indicated a multigenerational family history of poverty, abuse and abandonment. Candace’s biological grandmother Mary Davis, 48, grew up in 17 foster and group homes. Her biological mother, Angela Elmore, 30, passed through 12 such homes before reuniting with Davis as a teen. Candace and her two younger siblings were removed from the Elmore home because of neglect. According to Candace, she had been thrown from a second-floor window. “When I went to pre-parenting classes, I knew she would be dealing with issues of loss,” testified Newmaker, who tried for three years to adopt a child. “But I was not prepared for the level of dysfunction I saw.”

In tears, she described how Candace pulled down ceiling-to-floor bookcases, shredded books and had hour-long “meltdowns” during which she kicked, scratched and bit. She also testified that Candace deliberately killed her pet fish. Another time, Newmaker said, her daughter bullied two young girls to remove their clothes, then threatened them. She also burned holes in a sheet and mattress. “I was so frightened for her,” Newmaker said. Her concern heightened last year, she testified, when she learned that Candace’s biological sister Chelsea, now 10, had been removed from an adoptive home after attempting to strangle their younger brother Michael, 8.

Over the years, Newmaker consulted a succession of doctors, resulting in a growing list of diagnoses: attention deficit disorder, posttraumatic stress syndrome, oppositional defiance disorder. When other specialists suggested reactive attachment disorder, Jeane, who routinely complied with physicians’ advice, signed up for a workshop. There she met Dr. Bill Goble, a clinical psychologist who labeled Candace’s problems severe and suggested she approach someone like Watkins in Evergreen, Colo., for rebirthing, which in theory helps a child overcome early trauma and forge a bond with a new parent. At the time, Candace was taking the antipsychotic drug Risperdal, the amphetamine Dexedrine for her ADD and the antidepressant Effexor. By the time they arrived in Evergreen, Jeane described herself as just “trying to hold it together.”

On the video Jeane is seen heeding instructions to sit by Candace’s head and encourage her to be born as the rebirthing ceremony gets under way. “I’m so excited about my new baby,” she says, role-playing. “She is going to be very close to me and safe.” Seven times the girl claims she is sick. Eight times she says she cannot breathe. Sixteen times she pleads for help. Only once does any of the five adults present check on the child. Instead, at 23 minutes, a pillow is pressed in the vicinity of Candace’s covered head. After that she grows quiet.

An hour into the session, Watkins says that Candace “is not ready to be born yet,” and Newmaker is sent from the room to watch the proceedings on a monitor. Ten minutes later Watkins pulls back the sheet, then Ponder feels for a pulse and cries out the girl’s name. Newmaker runs back into the room and screams, “She’s dead!” She falls upon her daughter, begins CPR and yells, “Call 911,” which Watkins does.

The following month the Colorado Mental Health Grievance Board issued a cease-and-desist order barring Watkins and Ponder from practicing psychotherapy. Neither, it turns out, had complied with Colorado’s registration guidelines for unlicensed therapists. Dr. Goble, who gave Watkins’s name to Newmaker, continues to maintain that she “is one of the most knowledgeable people in the field.”

Institutional Autism

Institutional Autism is not a genetically induced autism like most diagnosed  in the United States, but one learned from years of neglect and sensory deprivation. Dr. Ronald Federici, a renowned adoption psychologist has done a vast amount of research on this topic and written numerous articles. He and Michael Rutter, an American psychologist, indicate some of the major symptoms of institutional autism as:

1. Sensory and social deprivation can result in the autistic-like behaviors.
2. These behaviors may diminish after the child is removed from the initial deprived environment.
3. A substantial minority of children will continue to exhibit these difficult behavior patterns for many years.

Risk Factors:

1. Heredity and neurological make-up of the adopted child.
2. Lack of postnatal care and negative conditions of development before institutionalization.
3. Age when placed in an institution and the length of institutionalization.
4. Conditions in institution/country of adoption.

Basically, children learn to be autistic because of their experience in the orphanage…stimulating themselves to pass the time or to entertain themselves. In our case, we believe AJ was swaddled for a decent amount of the two years he was there. He was chronically ill will bronchial infections due to an undiagnosed milk intolerance and an oat and banana allergy (the two main foods in his diet there ). Thus, if he was ill he would have either been swaddled and placed on his back in his crib or left to sleep in the playpen off to the side.

Now, if you were 1-2 years old with nothing to do, no toys to play with…what would you do????

AJ learned to play with toys inappropriately (line up and spin all toys because what else can toys do?), poke his eyes, spin in circles, stare out windows, throw monster tantrums at ANY change in movement (if you were in the same place ALL day, would you like to be moved?), stare at lights to keep from sleeping, attentive to every sound (in his crib he could not make eye contact but could hear everything)…I could go on but those are the MAJOR items.

Now, those things have diminished, as have most of his sensory issues. As Federici and Rutter state, most children will recover from Institutional Autism given the right home life. Thank goodness he has been given that.

One thing that we are specifically working on is making sure that AJ has the right resources to improve, not just the “positive dynamic in the child’s development of appropriate behaviors in the family.” If he truly does have organic autism we need to make sure to have him tested on a regular basis. Now that AJ has been home two years and has made some language improvements we need to start chronically his improvements. If he does not make any improvements (or falls behind) we should be looking at organic autism, not just institutional autism.