19 May


by Lirio S Covey, Ph.D.

Imaginary friends (also known as pretend friends or invisible friends) are a psychological and social phenomenon where a friendship or other interpersonal relationship takes place in the imagination rather than external physical reality”. (1)

Many parents notice that their child may talk of an imaginary friend, with whom the child may engage in vivid interactions consisting of play and sharing of stories.

Imaginary friends are not signs of trouble. In fact, they are often practice opportunities for learning how to engage in a range of social activities, or seek as a source of comfort when feeling fearful or sad, even if “pretend”, yet realizing the "friend" is not real.

Having an imaginary friend, however, is thought not to be accessible to children with autism, which would be consistent with a deficit in social skills and emotional understanding, considered a core characteristic of autism.

A recent research study examined whether this assumption is always the case. (2) Parents of 111 children between 24 and 96 months old were asked if they had observed their children engage in imaginary friendships and play. The parents’ responses were compared to parents of children without autism who were seen in a separate study and asked the same question.

The research showed that, although fewer than among children without autism, a subset of children with autism were able to spontaneously create imaginary friends. Further having imaginary friends was observed to begin later than in the children without autism. The lack of comparability in parent samples and methods that limit the exploratory study render the observed results requiring of further study.

Comment: Having imaginary friends would seem consistent with the remarkable creativity in art and music demonstrated by some children with autism. The study finding, if confirmed, suggests the possibility that helping children with autism engage in imaginary friends may improve social skills and alleviate social difficulties characteristic of the autism condition.


(1) Taylor, M. Imaginary Companions and the Children Who Create Them. New York: Oxford University Press, 1999.

(2) Davis, PE, Simon H, Meins E, Robins, DL. Imaginary Companions in Children with Autism Spectrum Disorder. J Autism and Developmental Disorders, on line March 21, 2018.



27 Apr


1 of 68 children in 2012; 1 of 59 children in 2014.​

Among schoolchildren in the United States, autism rates jumped 15% between 2012 and 2014.

Between 2000 and 2014, the increase was 150%. These surveys conducted by the Centers for Disease Control (CDC) involving 8 year old children are conducted every two years.

No clear environmental causes have been identified. Studies have shown a large genetic contribution to autism and that the influence of genes is extremely complex; no specific gene or combination of genes has been reliably identified.

The CDC studies have shown variation in autism prevalence by state. New Jersey has the highest autism rate – 3%, Arkansas has the lowest – 1%. Increasing rates were observed among African-American and Hispanic children, narrowing the gap compared to white classmates.

It has been noted that New Jersey has more resources than other states that are devoted to autism detection and treatment. This observation supports the belief among many autism researchers that improved detection is a significant contributor to the increased autism rates, and that many cases of autism in past years were there but were unrecognized.

This large effect of diagnostic competence on autism rates suggests: 1) autism rates could continue to rise as communities become better equipped to identify autism; 2) where diagnostic competence has been lacking due to limited resources, there are many autistic individuals who are not benefiting from the growing knowledge and use of autism-specific educational assistance.

The prevalence rate of autism in the Philippines is not yet known.


12 Apr


Research on cognitive and perceptual tasks had shown that people with autism generally seem to be less sensitive to “contextual stimuli than neuro-typical individuals”.

A research study examined whether this reduced sensitivity to contextual stimuli led to better making rational decisions, consistency in making choices, and less vulnerability to external influences such as marketing tricks.

Study participants were 90 adults with autism and 212 adults without autism. They were asked to choose 10 pairs of products, with the products in each pair differing on two contextual dimensions – either capacity or longevity.

One condition was characterized by a lower capacity (16 gigabytes) but a longer lifespan (36 months); the other condition was characterized by a higher capacity (32 gigabytes) and a shorter lifespan (20 months). Persons in either condition were presented with a decoy item – a third choice that was a worse condition (28 gigabytes and a lifespan of 16 months) than the other two conditions. A consistent, rational decision consisted of the participants’ making the same choice twice, with or without the decoy. Less rational and more inconsistent choices would involve switching in favor of the decoy.

The study showed that the adults with autism made more consistent choices, with or without the decoy; that is, they switched fewer times than the participants without autism. This means that the autistic adults were better at making judgments independently of its context.

Conclusion: Persons with autism appear to be less susceptible to having their choices biased by the way information is presented to them. Extending this ability to making choices regarding consumer products, the finding suggests that persons with autism are less vulnerable to marketing tricks.

Reference: George D. Farmer, Simon Baron-Cohen, William J Skylark. People with Autism Spectrum Conditions Make More Consistent Decisions. Psychological Science, Vol 28, Issue 8, 2017.


9 Mar

​Book covers and reviewer comments

The author of this book, Naoki Higashida, is a boy who struggles significantly with verbal communication. He prefers to type his thoughts onto a computer, which he finds to be very useful for helping others understand him.

Winner of the 2015 Samuel Johnson Prize for non-fiction.
– A groundbreaking book that upends conventional thinking about autism and suggests a broader model for acceptance, understanding, and full participation in society for people who think differently.

-Sparklingly humane book makes the case that there is no such things as neurologically ‘normal’.

Journalists Donvan and Zucker’s tremendous study keeps autism at its center while telling an extraordinary tale of social change. The authors follow evolving cultural responses to autism and autism spectrum disorders, including intolerance, a desperate quest for successful treatments, and the currently high level of awareness — which doesn’t always prevent misunderstanding.

Instead of classifying “autistic” behaviors as signs of pathology, Dr. Prizant sees them as part of a range of strategies to cope with a world that feels chaotic and overwhelming. Rather than curb these behaviors, it’s better to enhance abilities, build on strengths, and offer supports that will lead to more desirable behavior and a better quality of life.

A new book giving a voice to mothers and fathers captures the continuing journey of unconditional love, utmost devotion and hope. The telling is honest and brave. The book consists of stories of nine families coping with autism, most of them active leaders in the autism community. Every story is unique as the parents recount the impact of finding out their child’s condition. (Review by Olive Tripon, Philippine Daily Inquirer, Feb 25, 2017).

This book’s editor is Dr. Lirio Covey, Ph.D., AAAP President. Co-parents from the Manila autism community contributed to this anthology of narratives on living and raising children with autism: Erick Villacorte, Jennifer Cuaycong, Mel Sabino, Evert Malapad, Josephine Palomares, Grant Javier, Sol and Dennis Bautista, Christine Siruelo.

For hard copy and information on price + postage, email adultautismphil, with your address and the book will be sent by LBC. Also available as an e-book on and barnes &

A Societal Response to Autism

18 Jan

The Four As: a long-term perspective

4 As of a Societal Response to Autism.pptx


27 Nov


​Barista training programs have been widely offered and conducted for persons with disabilities. Barista skills which include understanding the features of the coffee bean and becoming expert in preparing and serving this popular beverage provide opportunities for employment and generating income.

Results of a recent “universal review” of multiple studies of the health outcomes of coffee consumption, offer good news. The published review was a mega-review of 201 meta-analyses of coffee and its health effects, recently published in the British Medical Journal (see Poole et al, BMJ 2017; 359:j5024),

Heavy compared to light, and any versus no, coffee consumption was consistently associated with reduced risk mortality due to cardiovascular disease, cancer, and with liver, gastrointestinal, kidney, musculoskeletal disorders, and neurologic disorders. The lowest risk reduction was observed with three to four cups of coffee daily. A caveat is on order, however, as some evidence for a harmful association of coffee consumption was observed for pregnancy outcomes, (including low birth weight, and first and second trimester pre-birth) and fractures in women (not in men). These assessments were controlled for smoking. Similar health outcomes were observed for decaffeinated coffee consumption.

Learning and practicing barista skills offer a potentially enjoyable and lucrative business endeavor for persons with disabilities. ​

Autism and Mental Health

19 Nov

Many Young Adults With Autism Also Have Mental Health Issues

NPR <email, October 1, 2017

Tara Haelle

People on the autism spectrum are more likely to have mental health diagnoses as well, which can make the transition to adulthood daunting.

Nick Lowndes/Getty Images

College involved "many anxiety attacks and many trips home" for Daniel Share-Strom, an autistic 27-year-old motivational speaker in Bradford, Ontario. It wasn’t just the challenge of organizing his assignments and fighting the disability office for the extra time he needed for tests. It was also managing all the aspects of daily life that most people not on the autism spectrum take for granted.

"Relationships are so much harder to understand or initiate when by default you don’t really know what certain facial expressions mean or what certain actions mean," Share-Strom says.

Young adults on the autism spectrum are more likely to also have been diagnosed with a psychiatric condition, such as depression, anxiety and attention deficit hyperactivity disorder (ADHD) than are typically developing people or those with other developmental disabilities, a study finds. And managing those multiple conditions can make the transition to young adulthood especially difficult.

It’s not clear how much biological factors may contribute to the higher rates, but Share-Strom definitely sees environmental factors playing a major role.

"People with autism aren’t immediately born anxious or with depression," Share-Strom says. "The world is fundamentally not built for us, and people are always judging and trying to change you, whether they have the best intentions or not," he says. "Of course that’s going to cause a higher rate of anxiety and depression and even suicide rates. I’d be surprised if it didn’t."

That makes providing resources for these young adults all the more important during that transitional period.

"When it comes to mental health diagnoses and use of psychiatric services, there’s a really strong need for the entire developmental disabilities community, but it’s an even bigger need for folks on the autism spectrum," says Yona Lunsky, a senior scientist at the Centre for Addiction and Mental Health in Toronto and coauthor of the study. "I think sometimes people will dismiss something as being part of autism when, in fact, it’s not," she adds. "There are people with autism who don’t have psychiatric issues."

Lunksy’s study is not the first to find a higher prevalence of mental health conditions among those on the spectrum compared to those with typical development. But it is the first to compare autistic young adults to those with other developmental disabilities. It also uses a standard method of gathering data, relying on diagnostic codes in administrative health data instead of using surveys.

Their data came from two groups of young adults, ages 18-24, in Ontario, Canada.

One group included 5,095 young adults with an autism diagnosis and 10,487 people with another developmental disability diagnosis and no autism diagnosis. (Those with both were excluded.) The other group was a random selection of 20 percent of young adults in Ontario without a developmental disability diagnosis.

They chose age 18 as a starting place because that’s when people switch from child to adult social and mental services in Canada; they ended at age 24 because Canadians with developmental disabilities usually remain in school until age 22, providing two years of follow-up data. In the U.S., public special education services continue until high school graduation or until age 21 in most states, 22 in some others.

Those on the spectrum were more than five times more likely to have a psychiatric diagnosis than typically developing individuals and nearly twice as likely compared to others with developmental disabilities, the study found.

While 52 percent of autistic young adults had a psychiatric diagnosis, 39 percent of those with other developmental disabilities did and 20 percent of typically developing people did. Those with an autism diagnosis were also more likely to visit the emergency department for psychiatric reasons (8 percent) than those with other developmental disabilities (7 percent) or typically developing (2 percent).

By contrast, non-psychiatric ER visits were similar between autistic and typically developing young adults: 26 percent of those on the spectrum and 25 percent of typically developing adults, compared to 34 percent of those with other disabilities. Those on the spectrum were also less likely to have asthma, high blood pressure or addiction disorders than those with other developmental disabilities.

"We weren’t doing the study to look at mental health," Lunsky says. "It’s just what emerged. Unmet needs have a social cost, so we want to be able to recognize both physical and mental health needs for everyone and get them the right care."

That means recognizing that symptoms and behaviors of depression and anxiety may look different in those with an autism diagnosis than in those without, she adds, and caregivers and providers need to understand that.

Indeed, it is especially important to individualize care for youth on the spectrum, according to Lynn Davidson, a pediatrician and member of the American Academy of Pediatrics executive committee on disabilities.

"Transition for youth with autism is a very challenging process," Davidson says. "It is doable, but it takes a lot of preparation and a lot of time on the part of the families, on the part of the patient and on the part of the providers. The earlier one starts, the better."

Research literature suggests that it’s good to start learning daily living skills, such as laundry, cooking, bathing alone and similar chores, around 12 to 14 years old, Davidson says. But she believes that should start as early as possible, depending on a child’s intellectual, social and mental health disabilities.

"Youth on the autism spectrum may need repetitive modeling and experiences so that they get those skills down and become as independent as possible," Davidson says. Too many families, she says, do tasks for their adolescents long past when the teen could do them on their own. Other youth continue to need support for what might seem like basic tasks, so parents and care providers have to work to learn the boundaries and abilities for each person on the spectrum.

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