(upbeat music) - Hello and welcome to "Prairie Pulse."

Coming up a little bit later in the show, we'll profile Minnesota sculptor, Mary Williams.

But first, my guest joining us now is Dr. Whitney Rolling, the Sanford Health Specialist in Behavioral and Developmental Pediatrics.

Thanks for joining us today, Dr. Rolling.

- Thanks for having me.

- As we get started, tell the folks a little bit about yourself.

- Sure, absolutely.

So I grew up northwest the Twin Cities.

And then I ventured up to Duluth for my undergraduate degree where I met my husband, and we continued our travels for my education.

So we were in Kirksville, Missouri at the Kirksville College of Osteopathic Medicine to complete my medical degree.

And then we were in Sioux Falls, South Dakota at the University of South Dakota Sanford Pediatric Residency.

And then I completed my developmental behavioral fellowship at Children's Mercy in Kansas City.

And then we ended up here.

- Well, okay.

- Yeah.

- Well, you're here to talk about autism, and April is Autism Acceptance Month.

- Yeah.

- Let's start with that one.

What is Autism Acceptance Month and how did it get started?

- Yeah, absolutely.

So for Autism Acceptance Month, it started in the 1970s with an autism researcher psychologist.

So he kind of started this special time period to talk about autism.

And it kind of became more publicized in the 1980s when Ronald Reagan kind of made a more public announcement regarding kind of the special time of year.

And then in 2021 it actually, the terminology changed from Autism Awareness Month to Autism Acceptance Month, just to kind of make that extra step forward to not only having people become more aware of autistic people or people with autisms.

Everyone likes describing it in a different way, describing their diagnosis, but having a time to acknowledge and kind of encourage inclusion and also kind of supporting people with autism.

- Well, for everybody out there, what is autism?

So what's the definition of autism?

- Sure, yeah.

So for providers that work with autism, we actually use a diagnostic criteria from something called the Diagnostic and Statistical Manual for Mental Disorders.

It's called or called the DSM-5 or the Fifth Edition Text Revision.

So sorry to get technical, but we use that definition.

So autism is what we call a neurodevelopmental disorder, meaning it's something that either starts the symptoms in early childhood and it has two main criteria, or two foundational areas that people have deficits in.

So they have deficits in their social communication and interactions, and they also have what we call repetitive restricted behavior.

So some of those social deficits can be things like having a hard time with reciprocal conversations, maintaining friendships, understanding nonverbal communication.

And then when we talk about the other aspect of it, the repetitive restrictive behaviors.

It can look very different in each person.

Some people can be either more hypo or hypersensitive to things in their environments that says like lights, sounds, textures, those types of things.

People can potentially be very rigid thinkers or have routines that they like to maintain to.

People can also have, people with autism or autistic people can have repetitive movements, repetitive kind of ways of speaking.

And then they can also, I'm trying to think that last one.

And they can also have a very, sorry, sensory differences, repetitive behaviors and restricted, oh, my last one was the restricted interest.

They can be very highly interested in certain things.

Like I'll meet, I actually work with children, so I'll meet children that really like space, so I'll learn that day about really cool things about space I never knew about.

So there's some really cool interests that they like.

- Yeah.

Let's talk about this because maybe I don't understand everything about autism.

I know I don't, but are there different levels, or ranges of autism?

- Sure, good question.

So yeah, typically at diagnosis, people would get diagnosed with a certain level.

I try not to talk about it too much unless they ask just because there's no, like, necessarily prognostic factors.

But yeah, there's three levels of autism.

A level one by terminology needs support for the symptoms of autism.

A level two needs substantial support for the symptoms of autism.

And level three needs very substantial support.

So in a sense it's kinda like mild, moderate, severe in regards to the impairment from their symptoms of autism.

So typically only given that diagnosis just to help kind of better understand the challenges that they're having.

And then typically we also, I think it gets a little confusing with autism too, is autism, like we talked about, is just the deficits in social communication interactions and those repetitive restricted behaviors.

People with autism or autistic people necessarily have to have developmental delays, but a lot will.

So usually when we're diagnosing autism, we try to clarify if they have autism, like with developmental delays or like with intellectual disability or if it's associated with anything else, like other neurodevelopmental disorder and another like genetic condition potentially.

- Yeah.

How do other disorders on the spectrum like Asperger's syndrome?

- Sure.

- Are they related or not related to autism?

- Good question.

Yeah, so the terminology is, it's sometimes feels like it's constantly changing.

So Asperger's is now under the umbrella term of autism spectrum disorder.

So in the past it was a separate diagnosis, but now it's kind of under the same umbrella, but it's kind of known in the past as being someone with autism that was less impaired or in a more kind of functional in their day-to-day activity.

But now it's just under the same umbrella term of autism spectrum disorder.

- Okay.

Do we know what causes autism in children?

- Yeah, that's a good question.

And we still don't have a super clear answer, but typically what we discuss with families is autism, there's typically what we like to think about as a genetic predisposition.

We know that there are some specific genetic conditions that have a high risk of having autism, something like Fragile X syndrome.

So there's likely a genetic predisposition, and then there's likely other environmental factors or other risk factors that kind of come together as that kind of final presentation of autism spectrum.

So I usually like, and it's not a perfect analogy, but I usually like to kind of tell families, like thinking about, we think about type 2 diabetes, like, and I'm not an adult doctor, but I usually like to kind of say that like there's a genetic predisposition to having something like type 2 diabetes and then other risk factors, right?

So people might, if they're not exercising as well or eating right or those kind of things, they have those risk factors that kind of come together to present.

So similar to autism, that genetic predisposition and then other risk factors.

And some unfortunately are uncontrollable.

But anyways, that's what we typically think about when we talk about the etiology or cause for autism.

- When was it first diagnosed or named as a condition?

- Oh, sure, yeah.

So back in the 1940s, there was, and it was kind of a term that was used before that, but it wasn't quite similar to the term we used today.

But there was a psychiatrist by the name of Leo Kanner that he first started describing people with, or autistic people.

And they were kind of first seen as people that were very withdrawn.

So they tend to, sometimes for kids with autism, like we talked about with those social deficits, they won't use eye contact quite as well or converse or talk to people as well.

So it was kind of first described at that time in like the 1940s, - How many people in the United States have been diagnosed with autism?

- Yeah.

Oh, great question.

So there's roughly around 7 million people, we typically say for kids.

And granted the statistics are changing, but it's like 1 in 36 kids have autism and for adults it's like 1 in 45.

So roughly around 2 to 3% of the population.

- Is it identified in childhood, or sometimes is it not identified till you become an adult?

- True.

Yeah, absolutely.

So every person is different in kind of their autism diagnostic journey.

We really like, if we can, we would love to have kids diagnosed with autism just because we can put in those behavioral interventions and other developmental supports if they have developmental delays just to make sure we can kind of decrease that impairment from the symptoms.

So if we can do early diagnosis, that would be great.

I think this day and age, just because of different factors, we are diagnosing adults with autism that are still having some of those social deficits and repetitive restrictive behaviors that maybe weren't as clear when they were in childhood.

But early diagnosis tends to have better prognostic factors in regards to- - Well, with that said, what are the early symptoms that parents or doctors might notice in a child?

Because sometimes a child's just a child.

You can't really tell maybe.

- Yeah.

- So what do you look for?

- Yeah, it definitely is challenging.

Some symptoms can actually be identified in early infancy or just kind of things to start looking for.

Like you might see a child that maybe isn't quite as interactive, like babies in general will be, they'll typically, you know, infants look, look at family members, smile, do those kind of things.

And it's not with every autistic person or person with autism, but sometimes families, and granted, it's kind of like a retrospective, kinda like, "Hey, did you notice anything in childhood that was different?"

And they'll say, "Oh yeah, I just noticed that maybe they weren't quite as interactive as my other kids may be."

Or so they might have those social deficits that are seen, they're not quite as in tune with their parents or caregivers.

And then typically another first sign that a lot of families see and like we talked about, not all people with autism have language disorders, but a lot of kids will have language disorders.

So there'll be parents that are coming in and say, "You know, I feel like my child isn't talking as much as they should be talking."

So that's another kind of big sign we typically...

Families start to present with a noticing that their child is not having the expressive language that they expect them to have.

- What about behavioral issues that you might see in an autistic child?

- Sure.

Yeah, absolutely.

So I always talk to families.

So behaviors are a form of communication.

So lots of times when we see behaviors and kids, whether they have autism or not, it's trying to tell us something, right?

So specifically for people with autism, or autistic people, we can see some of those repetitive behaviors.

We talked about like our things like hand flapping, tiptoe walking, spinning.

I like to describe those as sensory-driven behaviors.

Also sometimes too, and just because of the special team I'm in, lots of parents will present with more undesired behaviors like disruptive behaviors.

And sometimes children with autism or autistic children will have those just because they have that hypo or hypersensitivity to things.

So maybe they hear a sound or lights that are very aversive to them, so they might start having more stereotypies or movements or they might scream or vocalize or have other disruptive behaviors that are very concerning to families 'cause they don't know what's going on.

- Okay.

Well, as you know, there's been a me measles outbreak in Texas recently and there've been some concern that measles vaccine, maybe it is been controversial and believe can trigger autism.

- Yeah.

- Can you comment on this and talk about that?

- Yeah, and I think it's a very sensitive topic sometimes for families 'cause I do think a lot of families wanna know why their child has some of the deficit that they have.

But we know from, referring to is there was some studies back done by a gentleman named Andrew Wakefield and the first study was published in "The Lancet," which is a very well known, a very good research journal, and it linked the MMR with autism.

But we know that when looking back at the study, there was a lot of errors, a lot of, even some scientific misrepresentation in the study.

So the study was actually retracted from the journal because it wasn't accurate.

And there was other studies later published on, but too that we later found out that they were not accurate.

So unfortunately, with that publication, even though it was retracted, the repercussions of having that data or that information out to families, I think really, it's made some people really aversive to vaccines because they did still believe that data that unfortunately that was incorrect.

So I usually like to tell families like right now, or we know that the MMR does not cause autism, so I do highly recommend if their child can receive a live vaccine to do the MMR 'cause it is really important.

These are preventable deaths for children that aren't vaccinated.

So I really encourage families to get the vaccination also too, unfortunately with the timing of the MMR is typically given around the 12-month visit, the 1-year-old visit.

And for people with autism or autistic people, that's a lot of times when we might see regression.

And it's not with every child or every person with autism, autistic person, but if they are gonna have a period of regression, it typically is around roughly around 18 months, so the one to 2-year-old level.

They might regress, many times they regress in their language skills or those social skills.

And unfortunately, that's a couple months after when they get the vaccine.

So a lot of times they feel like that's the cause, but we know that research does not support that.

- Is autism more commonly diagnosed now than in past years?

- Oh, great question.

So in regards to autism, I think there's a lot of factors that go into those statistics.

So kind of like with Autism Acceptance Month, I think there is more information out there.

I think families are more aware of autism and aware of things.

I think the acceptance part too, I think families just generally are not as, I don't know if scared to be the right word, but they're not as apprehensive about maybe the diagnosis as much as maybe in the past.

And I think we do have better screening methods for autism.

So the American Academy of Pediatrics has autism screening called the M-CHAT at the 18 month and the 24/30 month that's recommended to hopefully screen children and find children that are at risk for having autism.

So I think screening's better.

And I think we are expanding our ability to diagnose better to communities that maybe didn't have that before.

And so I think there's, yeah, many factors that come together.

And as with our diagnostic manual, generally the diagnosis of autism or the criteria is becoming a little bit more broader, kind of enveloping things like Asperger's and those kind of things, so the criteria has changed.

So yeah, I think there's a lot of factors coming together that are increasing the statistics or the incidents of the diagnosis.

- Yeah, do couples who already have one child on the spectrum have a greater chance of having another child on the spectrum as well?

So is it genetically passed on?

- Yeah, so good question.

So roughly about, there's kind of like a 20% risk if there's another sibling, if the other sibling has autism.

So yeah, in regards to genetics, if the family does have that genetic predisposition that they passed down to their child, so it can be genetically inherited.

And sometimes too though for any child that has, or any person that has a genetic disorder, sometimes it can be a brand new change or the genetics can be a brand new change to them, and then they could potentially pass that down.

But yeah, it is, it can be genetically inherited.

- So is it lifelong for someone, or do patients ever kind of grow out of it or, you know, what?

- Yeah, great question.

So autism spectrum disorder, like something, like it's in this same, it's a neurodevelopmental disorder, kinda like ADHD, right?

So it is a lifelong diagnosis, but I tell families not necessarily the impairment from it.

So if we can diagnose early and get people in for behavioral interventions and if they have developmental delays, developmental interventions, our hope is that impairment from their symptoms will continue to decrease.

So hopefully once they hit adulthood they will have more strengths in those like kind of social environments and those types of things.

- Yeah, can you talk a little bit about maybe some of the research that's going into factors that cause it and then I assume possible cures even?

- Yeah, so great question.

So yeah, there's a constant research going on in regards to is there other risk factors or other environmental kind of contributors to things like kind of a big thing on the research realm is there like an inflammatory or is a cause or some kind of inflammation, or is there other nutrient deficiencies, those types of things?

So yeah, research is ongoing regarding those things.

At this time we don't have any specific recommendations or evidence-based interventions that go off of inflammation or like a nutrients deficiency.

We don't know yet.

Could it be something in 10 or 20 years?

Potentially.

So we always tell families in regards to helping, if we're seeing younger children, helping their child with autism or autistic child trying to identify the strengths that they have and celebrate those, but also identify those challenges, those challenging areas and provide behavioral interventions and developmental therapies if we can at this time.

So yeah, maybe in 10 or 20 years we might have more information about other interventions, but yeah, at this time we don't necessarily have anything else to offer families in regards to like a certain medication, per se.

I will say too, in regards to autism in general, I like to kind of describe it to families as a different, I like a different way people learn and a different way they kind of, you know, process their environment.

So I always try to be really careful with using certain terminology just because everyone will have different strengths and difficulties with autism.

So yeah.

- So what medication, supplements or things do you prescribe, I guess, for different levels I guess, different children out there?

- Oh yeah, yeah, absolutely.

So typically when I talk about like supplements or those types of things and other interventions, I try to focus on any, what we call comorbidities, other things that can come with autism.

So some autistic children and children with autism, they'll have very restricted eating because they might have that difference in their sensory.

So we might have them be on extra multivitamins to make sure they have complete nutrition.

- Yeah, well we are running out of time.

And we had more, 'cause I've got a few more questions.

But if people wanna find out more information, where can they go, who can they contact?

- Oh, sure, absolutely.

So there's some great programs.

There's the Autism Society.

I mean, Autism Speaks is a great society as well, the CDC.

And if families have specific questions, they can always ask their primary care provider as well.

- Yeah.

Well, Dr. Rolling, thanks so much for coming and talking to us.

- Thanks for having me.

- Stay tuned for more.

(upbeat music) Mary Williams of Clitherall, Minnesota makes breathtakingly beautiful cement, stone and clay sculptures in her cozy little work area at her home.

She favors sculpting the female body in various forms.

And her amazing energy and commitment to working belies her age.

(gentle music) - Well, you just lose yourself.

My husband has to yell at me and say, "It's time for coffee now," or "come on for lunch."

I live in this little area and I'm so happy here.

(chuckles) I'm happy.

It makes you happy.

That's what it's all about.

My name is Mary Williams and I live in Clitherall, Minnesota on Stewart Lake, and I'm a sculptor.

I work in clay and stone and cement.

(lighthearted music) Well, I've probably been doing this my whole life, but I went to the University of Kansas for two years.

I was going to be an interior designer because my father said you had to make money.

So I went up to the Art Institute in Chicago.

And when you take classes up there, you take a little bit of everything, and I took a sculptor class and I was gone.

I work every day, practically every day in my studio from about 9:00 in the morning till about 3:00 in the afternoon.

And then I have fun, I just have fun.

(chuckles) Stone sculpture came very, very easy.

I just went for it.

(gentle music) I did a little studying, but I think you just have to love a stone and it just blossoms.

Clay, I worked hard on.

I had taken many classes in clay, and I enjoyed it and I learned a lot, just anatomy classes and all that.

Cement, I got a grant from the Lake Region Arts Council.

Few people were asking me to do outdoor work, and I did the "Ladies in the Garden."

I've worked hard on that.

It's not as easy as it looks.

When people drive over the little hill there and see the ladies in the hosta garden, I'm always surprised that they're so, "Oh," like that.

And it still, to me to this day, it's really nice to see that.

My stone, I use pneumatic tools, so I have an air compressor and I carve with that.

I taught so long and I've done this so long that I've got every tool that you can have.

So I just pick and choose as I do that.

It's a little abstract, it's a little figurative, whatever the stone kind of dictates.

Right now I'm working on a flower, which I've never done before.

So I'm just a little bit of everything, whatever the stone kind of tells me.

(chisel buzzing) I think the female form is one of the most perfect forms.

It's got beautiful line and curves.

It's graceful, it's soft.

I think you need to have that in art rather than harsh and cruel lines.

So I just have always gone to the female figure because it's a representative of all the grace that I can think of.

Well, one of my favorites is called "The Hug," and it's a stone.

My son gives me great hugs and that's where that came from.

I just love the stone.

It's just rewarding to work on it.

Few years ago, I was contacted by the Historical Society in Fergus Falls to do Ojibwe women, and I did three mock-ups.

One was a tall lady holding a baby on the back, and then I did a very modern one.

And then I did the woman holding the basket full of fruit, and that's the one they picked.

Took me about six weeks, and I worked every day.

It was cold and rainy and awful, but it was fun to do it.

I sold one piece out of the yard.

And my family got so upset with me that they won't let me sell anymore out of the yard.

So the pieces that are in the yard now stay.

(gentle music) I'm just blessed.

It's kept my sanity.

(laughs) Moving around as much as we have and just a daily living, I think I would've been really a depressed person.

But this has kept me joyful.

I'll never stop.

It's ingrained.

I'm like other ladies that I know are 90 years old and they're still doing it, and I hope to do it to 102.

(chuckles) - Well, that's all we have on "Prairie Pulse" this week.

And as always, thanks for watching.

(upbeat music) - [Announcer] Funded by the Minnesota Arts and Cultural Heritage Fund with money from the vote of the people of Minnesota on November 4th, 2008.

And by the members of Prairie Public.