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Solving the Problem

By: Donnie Byers


             Autism is a growing problem in the U.S. with no end in sight.

            The brain disorder affects one in 68 children, making it more common than childhood cancer, cystic fibrosis and multiple sclerosis combined. It is the most common condition in a group of developmental disorders known as autism spectrum disorders (ASD).

            Children with autism can be affected in three areas: verbal and non-verbal communication; social interaction; and repetitive behaviors. They can also have sensory problems or obsessive traits, ranging from mild to severe.

            No one really knows what causes autism, and it can go undiagnosed for years in its milder forms. Some theories point to a genetic link affecting the way the brain processes language and communication. As a result, autistic children have problems comprehending what they hear, see and sense, according to Kenneth Fleishman, M.D.

“They’re kind of in their own world,” he said. “You have to engage them frequently. If you don’t, they can be distant or even robotic during conversation.”

            Dr. Fleishman is a child psychiatrist and a nationally respected expert on autism. He’s spent the last 20 years working with autistic children at Emory University in Atlanta, Georgia. The Fayetteville native recently moved back to the area to head Cape Fear Valley Health’s new Child Behavioral Services program.

            Launched this past summer, the program looks to continue providing behavioral health services to area children who need it. The county previously provided such services at the now-closed Bradford Avenue mental health clinic. But those services were often limited in scope and funding, due to continual state and federal budget cuts for mental healthcare.

            Dr. Fleishman said Cape Fear Valley’s goal is to grow its children’s behavioral program over time, because it’s a valuable service to the community. He and his staff of child therapists will treat autistic children, as well as patients with:

• Developmental delays

• Emotional issues

• Mental illness, including schizophrenia, bipolar disorder and depression

• Panic attacks

• Anxiety disorders

• Attention Deficit Hyperactivity Disorder (ADHD) and ADD

• Eating disorders

            Children and adolescents can be referred to the program through pediatricians, school officials, behavioral healthcare providers, Emergency Department staff and the patient’s own family. Dr. Fleishman will initially consult with new patients and their family, determine if medication is needed, then decide if ongoing treatment is needed. All the treatments are provided on an outpatient basis.

            The Child Behavioral Health Services program recently moved from Cape Fear Valley’s main Owen Drive campus to the fourth floor of 711 Executive Place.

            Children in immediate crisis can still be screened and evaluated at the Community Mental Health Center at Cape Fear Valley, which has a walk-in crisis evaluation center. The Roxie Avenue facility screens children of all ages from 8:00 a.m. to 10:00 p.m., seven days a week.

            Doug Webster is the Service Line Director for Behavioral Health Services at Cape Fear Valley Health. He says the Child Behavioral Services program moved off the health system’s main Owen Drive campus because of rapid expansion and the need for more space.

            “Treating children can involve many family members,” Webster said. “That requires bigger offices, so you can have family consultations. The better the treatment we provide, the better it is for our community in the long term.”

            The Child Behavioral Services program recently added a second child psychiatrist toward that goal. The physician, Parkavi Chellappa, M.D., completed her fellowship in child and adolescent psychiatry at Cedars Sinai Medical Center in Los Angeles, California. She is board certified in psychiatry.

            In years past, children needing crisis intervention often ended up in Cape Fear Valley’s Children’s Emergency Department. Now parents can have their children seen at the Community Mental Health Center at Cape Fear Valley, which is faster and more cost-effective.

            Dr. Fleishman’s arrival to the area is good news for families with autistic children. Statistics show autism is more prevalent in North Carolina, affecting one in every 58 children. Statewide, there are more than 60,000 people living with some form of ASD, according to the Autism Society of North Carolina.

            Since ASD covers a wide “spectrum,” it takes a trained eye to properly make a diagnosis. ASD signs and symptoms can include repeated behaviors or an inability to understand changes in daily routines. Those with ASD also have different ways of learning, paying attention or reacting to things.

            Children with classic autism often appear aloof or uninterested in others. Children with milder forms of ASD, such as Asperger’s Syndrome, want to fit in and socially interact with others, but don’t know how. They can have good language and cognitive skills, but may avoid eye contact or not understand the use of hand gestures during conversation.

            ASD patients often have a hard time in school. These children are not only easily distracted, but can also have problems controlling frustration or anger. As a result, they lash out or strike others and can be subsequently labeled violent or troublemakers. But the actions are often a defense mechanism when children don’t feel safe.

            Dr. Fleishman said a family history of mental illness, childhood depression or abuse may be underlying factors. He wants his program to begin working with area school counselors, for this reason.

            “People who work in child behavioral healthcare can help in the school system,” he said, “and ensure kids get the attention they need. Our ultimate goal is to meet those needs.”