ASD is a heterogeneous disorder i.e. no two individuals on the spectrum will have the same set of signs and symptoms. The severity and range of symptoms are highly variable. However, the symptoms or difficulties can be classified into core domains such as difficulty in social interactions, communication deficits, behavioral issues and unusual interests and certain physical attributes. An individual may present with anyone, or a combination of or all of these difficulties/symptoms. Signs and symptoms usually become noticeable in the first three years of life. This section details the range of these signs and symptoms which are usually observed in individuals with autism.

Individuals with ASD face difficulties in communicating and expressing their feelings. They also have trouble in understanding the feelings of the people around them. As they grow up, this social deficit is further affected due to feelings of anxiety and depression. This in turn intensifies the problem with social skills, making it hard for them to adjust or adapt to their surroundings.

Examples of Social Issues related to ASD:

  • Poor or fleeting eye contact
  • Delayed or lack of response to name
  • Isolated play (the child prefers to be aloof)
  • Inability to interpret gestures or non-verbal cues
  • Difficulty in expressing feelings
  • Lack of social awareness (difficulty in understanding personal space and boundaries)
  • Sensory issues (avoids touch or seeks more physical touch for example hugging, kissing, etc.)

Autism is a neuro-developmental condition and the symptoms sometimes may not be evident in the early years of the child. Sometimes the late diagnosis is due to limited awareness of parents as well as denial or hesitancy in accepting their child’s problems. It is important that the parents are alert and aware of child’s behavior and if they spot anything that raises suspicion, they should immediately consult the professionals.

Diagnosis of Autism is done by a multidisciplinary team. Multidisciplinary team is a team of different professionals that look different aspects of child’s development and therefore can provide a more accurate diagnosis.

Professionals involved in diagnosing Autism

Psychiatrist

Pediatric neurologists

Child Psychologist

Occupational Therapist

Development Pediatrican

Speech and Language Pathologist

This team carries out several assessments and tests, which pinpoint the exact areas in which the child has a problem. There are several tests that can be used for screening and diagnosis of autism. Screening of Autism involves identification of early signs and symptoms of Autism during regular visits to the pediatrician and appropriate referrals for details diagnostic evaluation. Diagnostic evaluation is more detailed and involves not only tests but other investigations. Some of the common tests used for screening and diagnosis are Childhood Autism Rating Scale (CARS), Autism Behaviour Checklist (ABC), Autism Spectrum Rating scale (ASRS), Autism Diagnostic Observation Schedule (ADOS) and Indian Scale for Assessment of Autism (ISAA). The criteria used for diagnosing autism by Psychologists is the fifth diagnostic and statistical manual for psychiatric disorders (DSM-V). For detailed DSM-V criteria click here

This assessment will aid in establishing a diagnosis as well as severity of ASD. These details will help to formulate a focused personalized treatment plan for your child.

Prior to diagnosis based on clinical observations and standardized assessment tools, you may be requested to perform one or more of the following investigative procedures for your child. These will help in ruling out other possible problems.

Neuro-imaging studies

Magnetic Resonance Imaging (MRI)

Magnetic Resonance Imaging scan of the brain reveals the structure of the brain and distribution of various tissues in the brain. Therefore, it can spot any structural abnormality including brain malformations, non-formation of any of the brains parts, presence of tumors, abnormal accumulation of the fluid in the brain etc.

Before the test:

Your child may be required to be fasting before the test, therefore consult your doctor for the same. Your child may be sedated during the test to avoid any body movements as the movements interfere with the quality of imaging. Sedation is process of administering special medicines that make him/her fall asleep. The test is conducted in the magnetic field and therefore make sure that your child is wearing no objects or clothes containing metal. If there are any metallic implants in the body, consult with your doctor for the same.

During the test:

Once the child is sedated he / she will be taken in the special room where for scanning. You may or may not be allowed to accompany the child. It may take up- to 30 – 45 mins for the scanning. The test is not painful and there are no side effects.

After the test:

Care should be taken when the effect of sedation is wearing off. There are no special instructions to be followed once the child is awake.

How to interpret the results:

The results will be given to you in two forms, first a print of the films and a CD containing the entire MRI study and second an interpretation and report by a radiologist after having analyzed the study. In most of the cases of Autism the MRI of the brain may be near normal. Therefore you may be advised to do functional neuroimaging

Diagnosing Team For Autism

A typical MRI Machine: It is a non- invasive method which uses a powerful magnetic field and radio frequency impulses. A computer is used to produce detailed images of internal structures like bones, soft tissue, organs, etc.

Image courtesy: Flickr

Children who are diagnosed with Autism are known to have other co-existing problems. A thorough evaluation is needed to rule out whether the comorbidity is directly associated with ASD or is altogether a different condition in the child.

Some of the problems which may be associated with Autism are described below

What Causes Autism, Autism Connect

Parents of children with autism usually have a few unanswered questions such as "How did my child develop autism?" "My child was absolutely fine and had even started to pick up a few words. What happened all of sudden?" "Is autism acquired?" "Could it have been prevented?" "Is it genetic?" "Can my other children also have autism?"

Medical science does not have answers for many of these questions, and although the "why" may never be known, what is becoming clearer with ongoing research is, "What is the fundamental problem in the brains of the children with Autism".

In autism, though the brain structure looks normal, there are functional abnormalities in specific regions of brain. This information, about the functioning of brain areas can be obtained from functional neuroimaging techniques like PET-CT scan and functional MRI scan of the brain. These imaging studies permit the study of the abnormal pattern of cortical activation in autism. These studies indicate that certain areas of the brain show reduced functioning like mesial temporal lobe (innermost part of the brain responsible for learning, understanding, memory, social interaction and abstract thinking), frontal lobe (the front part of the brain responsible for emotions and aggression) and cerebellum (responsible for balance, coordination, muscle tone and speech). Hence the dysfunction of these areas are responsible for problems seen in autism.

Positron Emission Tomography – Computed Tomography Scans showing areas of brain with reduced function

Research has also helped us to know that there isn’t one cause of autism but multiple risk factors that increase the risk of a child developing autism. Most cases of autism seem to be caused by a combination of autism risk genes and environmental factors influencing the early brain development. Over the last five years, scientists have identified a number of rare gene changes or mutations which have been associated with autism. Other factors related to children with autism and their parents that may contribute to increase the risk of Autism have also been identified. Along with these certain environmental factors have also been included in the risk factors for Autism.

Computed Tomography Scans, What Causes Autism, Autism Connect

Below mentioned are a few probable causes of autism:

Patient and Family Related Factors in Autism, What Causes Autism, Autism Connect.

Patient and family related factors:

Gastrointestinal Diseases

It has been observed that gut microbiota affects the brain development and function. This was especially observed during various mice studies which indicated abnormal psychiatric symptoms in mice with abnormal gut microbiota. This theory has been extrapolated in Autism as well. The two gut related factors that are postulated as causes in Autism are firstly, the abnormal micro bacterial population in the gut of the children and second, the impaired carbohydrate metabolism by the intestinal cell lining. Many abnormalities in the intestinal cell lining such as ileo-colonic lymphoid nodular hyperplasia, enterocolitis, gastritis, and esophagitis, have been observed in various studies. A disruption of enterocyte membrane with increase inflammation in the gut has also been seen. Inflammatory markers such as cytokines, immunoglobulins and lymphocyte profiles are known to be altered in children with Autism, which leads to an increased permeability of intestines, and deficient activity of enzymes. Studies have also shown a strong correlation between the severity of autism and gastrointestinal problems. Commonly, the GI disorders observed in children with Autism, are chronic constipation, diarrhoea, gastroesophageal reflux disorder (GERD) and a gluten or casein intolerance..

Genetics Factors

Genetic factors are thought to be some of the most significant causes for autism spectrum disorders. It was earlier estimated that genetics could explain the occurrence of autism in over 90% of patients, however, thorough studies later proved that this was an overestimate.  

In a twin study conducted, it was found that many non-autistic co-twins had learning or social disabilities, thus, making it difficult to explain the occurrence of autism, purely on the basis of genetics. Therefore, whether or not a child would autistic, depends on how different genes interact with one another, what their penetrance or response to a certain feature or characteristic is,  the defect in the gene, environmental triggers and many other factors

A common hypothesis is that autism is caused by the interaction of a genetic predisposition and an early environmental insult. There are several theories based on environmental factors that have been proposed to address the remaining risk. Some of these theories focus on prenatal environmental factors, such as agents that cause birth defects, and others focus on the environment after birth, such as children’s diets.

Environmental factors:

Environmental factors play a role in increasing risk of Autism. With urbanization and industrialization we are exposed to chemical pollutants in air, water, soil and therefore even the food we eat. With advent of technology we are exposed to more and more electromagnetic radiations. These elements are presumed to contribute to increased risk of Autism.

Role Of Electromagnetic Radiations, What Causes Autism, Autism Connect

We've all heard that electromagnetic radiations from the electronic devices we use affect brain function. To get down to the technicality of this statement, electromagnetic radiations can alter  the biological electric activity of the brain, thus, increasing blood brain barrier permeability and inducing epigenetic modifications. This can therefore, potentially alter damage brain cells and thus affect brain development. Wireless radiations, especially, emitted from the gadgets we regularly use, such as cellphones, etc. can potentially contribute to neuroinflammation. Prolonged or regular exposure to wireless radiations during pregnancy may affect not just the mother, but also the fetus. Children exposed to constant wireless radiations early in the childhood may also experience harmful effects of the radiation. These radiations are presumed to interfere with the ability of human body to excrete heavy metals. This can lead to heavy metal accumulation inside cells thus, causing toxicity. Reducing the exposure to wireless radiation has shown reduction in the symptoms of Autism in some instances. Although, the evidence for the causative effect of these radiations is very minimal at the moment, it warrants further investigation.

References:

 

1. Gastrointestinal flora and gastrointestinal status in children with autism-comparisons to typical children and correlation with autism severity. Adams JB, Johansen LJ, Powell LD, Quig D, Rubin RA BMC Gastroenterol. 2011 Mar 16; 11:22.

2. Normal gut microbiota modulates brain development and behavior. Heijtz, R. D., Wang, S., Anuar, F., Qian, Y., Björkholm, B., Samuelsson, A., … Pettersson, S. (2011). Proceedings of the National Academy of Sciences of the United States of America, 108(7), 3047–3052.

3. Impaired Carbohydrate Digestion and Transport and Mucosal Dysbiosis in the Intestines of Children with Autism and Gastrointestinal Disturbances. Williams, B. L., Hornig, M., Buie, T., Bauman, M. L., Cho Paik, M., Wick, I., … Lipkin, W. I. (2011). PLoS ONE, 6(9), e24585.

4. Biological plausibility of the gut-brain axis in autism. Vasquez A. Ann N Y Acad Sci. 2017 Nov;1408(1):5-6

5. Galuska L, Szakáll Jr S, Emri M, Oláh R, Varga J, Garai I, Kollár J, Pataki I, Trón L. PET and SPECT scans in autistic children. Orvosihetilap. 2002 May;143(21 Suppl 3):1302-4.

6. Chugani DC, Muzik O, Behen M, Rothermel R, Janisse JJ, Lee J, Chugani HT. Developmental changes in brain serotonin synthesis capacity in autistic and nonautistic children. Annals of neurology. 1999 Mar 1;45(3):287-95.

7. Schifter T, Hoffman JM, Hatten JR HP, Hanson MW, Coleman RE, DeLong GR. Neuroimaging in infantile autism. Journal of Child Neurology. 1994 Apr;9(2):155-61.

8. Mountz JM, Tolbert LC, Lill DW, Katholi CR, Liu HG. Functional deficits in autistic disorder: characterization by technetium-99m-HMPAO and SPECT. Journal of Nuclear Medicine. 1995 Jul 1;36(7):1156-62.

9. Zürcher NR, Bhanot A, McDougle CJ, Hooker JM. A systematic review of molecular imaging (PET and SPECT) in autism spectrum disorder: current state and future research opportunities. NeurosciBiobehav Rev. 2015 May;52:56-73.

10. Wang C, Geng H, Liu W, Zhang G. Prenatal, perinatal, and postnatal factors associated with autism: A meta-analysis. Medicine (Baltimore). 2017 May;96(18):e6696

11. Modabbernia A, Velthorst E, Reichenberg A. Environmental risk factors for autism: an evidence-based review of systematic reviews and meta-analyses. Mol Autism. 2017 Mar 17;8:13

12. Wakefield AJ, Murch SH, Anthony A, Linnell J, Casson DM, Malik M, Berelowitz M, Dhillon AP, Thomson MA, Harvey P, Valentine A. RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.

13. Plotkin S, Gerber JS, Offit PA. Vaccines and autism: a tale of shifting hypotheses. Clinical Infectious Diseases. 2009 Feb 15;48(4):456-61.

Autism Spectrum Disorder (ASD) and Autism are both common terms used for a group of complex neurodevelopmental disorders. ASD is primarily characterized by deficits in communication and social interactions, unusual behavior and interests, while impacting the nervous system and affecting overall cognitive, emotional, social and physical wellbeing of the individual. The signs and symptoms of autism are typically noticed in the first three years of life. Autism affects the way a child relates to his or her environment and their interaction with other people. Subsequently, this grossly impacts development in the areas of daily functioning and social interaction. Mental capacities may be compromised due to atypical (subnormal) functioning of some areas of the brain. Hence, children with Autism have special needs that must be addressed differently.Autism Connect, What is Autism Spectrum Disorder

Autism is usually diagnosed in early childhood and despite extensive studies, the exact cause of Autism remains elusive. However, with increased awareness, rapidly evolving technology and ever-growing research, it is now understood that an intricate interplay of genetics and environmental factors may be responsible for the onset of Autism. Research has established that early diagnosis and intervention, along with access to appropriate support lead to significantly improved outcomes. When Autism is detected and treated early, disruptive behaviors can be minimized and the quality of life of the individual can be  bettered and moulded significantly.

History of Autism

The root of the term "autism" is derived from the Greek word "autos" meaning "self".

History Of Autism, What is Autism Spectrum Disorder, Autism Connect

Paul Eugen Bleuler, a Swiss psychiatrist, first coined the term in 1911 . He used it to describe a subset of schizophrenic patients who seemed to be self- absorbed and withdrawn. As time passed, our thinking and understanding of autism has evolved dramatically. An analysis of the description of behavior traits observed in several early documented cases suggests that these are in fact cases of what we now recognize as Autism. One famous and well documented example of this would be the story of Victor, the Wild Boy of Aveyron, who was found naked in a French forest. Victor did not understand language and would eat only half-burned or roasted potatoes, walnuts and raw chestnuts. Some even believed that he had been reared by wolves. The French physician Dr. Jean-Marc Gaspard Itard took Victor under his care and brought him to Paris. Dr. Itard spent several years trying to help Victor to integrate into human society and teaching him language. He was not completely successful as Victor only learned some French words, but never fully understood the language. However, there was an improvement in Victor’s fine motor skills and communication. He also developed a friendship with his caregivers. It is now known that Victor may have been autistic and whoever he lived with was unable to understand him. Hence, although Autism seems to be a new condition, a look at its history suggests that it may have always existed..

Dr. Leo Kanner (pronounced "conner") and Dr. Hans Asperger have played the most crucial roles in introducing Autism to the world. In 1943, Dr. Leo Kanner, an Austrian psychiatrist working at Johns Hopkins Hospital, published a paper describing 11 children who displayed a "strong desire of being alone", had a "resistance to change" or a "need for sameness". He introduced the term "early infantile autism" to describe his observations. A year later, Dr. Hans Asperger, also an Austrian psychiatrist, described similar characteristics in a group of children he was treating. It is was eventually accepted as a diagnosis in 1981 and coined as "Asperger’s Syndrome" by Dr Lorna Wing, an English Psychiatrist, who pioneered in child development disorders and advanced the perception of Autism, worldwide.

Prevalence of Autism

According to the World Health Organization (WHO), worldwide, 1 in 160 children has an ASD. This suggests that approximately 1% of the world population has ASD. The prevalence of Autism varies considerably from country to country. No factors have been identified to contribute to the increased prevalence in different countries.

The studies have picked up a steep rise in the prevalence of autism.

Studies have also shown that boys are 5 times more likely to develop Autism than girls.

Prevalaence of Autism, What is Autism Spectrum Disorder, Autism Connect

References:

1. Lord, C., Cook, E. H., Leventhal, B. L., & Amaral, D. G. (2013). Autism spectrum disorders. Autism: The Science of Mental Health, 28(2), 217.

2. Feinstein, A. (2011). A history of autism: Conversations with the pioneers. John Wiley & Sons.

3. Starostina, N. (2016). Victor, the Wild Boy of Aveyron (c. 1788 – 1828), and the Rise of Special Education in Modern France,

4. Baron-Cohen, S. (2015). Leo Kanner, Hans Asperger, and the discovery of autism. The Lancet, 386(10001), 1329-1330.

5. Kanner, L. (1943), Autistic Disturbances of Affective Contact, Nervous Child, 2, pp.217-250.

6. Kanner, L. (1946), Irrelevant and Metaphorical Language in Early Infantile Autism, American Journal of Psychiatry, 103, pp.242-246.

7. Kanner, L. & Eisenberg, L. (1956), Early Infantile Autism 1943-1955, American Journal of Orthopsychiatry, 26, pp.55-65.

8. Bender, L. (1982), In Memoriam Leo Kanner, MD June 13, 1894–April 4, 1981, J Am Acad Child Psychiatry 21(1): 88-89.

9. Asperger, H. (1944), Die ‘Autistischen Psychopathen’ im Kindesalter, Archiv fur Psychiatrie und Nervenkrankheiten, 117, pp.76-136.

10. Asperger, H. (1968), Zur Differentialdiagnose des Kindlichen Autismus, Acta paedopsychiatrica, 35, pp.136-145.

11. Asperger, H. (1979), Problems of Infantile Autism, Communication, 13, pp.45-52

Speech Therapy

Speech therapy is an intervention which aims at enhancing a child's speech skills and abilities to understand and express language, including nonverbal language.

 

what is speech therapy?
quite simply put, Speech therapy is an
intervention service for speech
and language disorders. Read more
does my child
need speech
therapy?
If your child does not meet the age
appropriate milestones of speech,
language, and communication, despite normal
audiology testing, you may be advised to
visit a speech therapist. Read more
How does Speech Therapy
help my child with Autism?
The ultimate objective of speech therapy is to improve the
communication skills of your child on the Autism spectrum,
which is associated with symptoms that do impair his/her
language and communication skills. Read more
what does speech
therapy include?
Speech therapy includes various techniques, exercises,
activities and aids, which work towards improving
coordination of speech muscles through strengthening and
coordination exercises, sound repetition and imitation. Read more
How often does my child
need Speech Therapy?
Your Speech Therapist may suggest
the therapies to be conducted at
least 2-3 times per week. Read more
At what age
should I start
Speech therapy
for my child?
Speech therapy can be started as soon as a child
starts exhibiting the communication and language
symptoms of autism. Read more
who can provide speech
therapy for my child?
Speech Therapy for Autism is performed by a qualified the Speech
Language Pathologist who collaborates with other professionals
to modify and make efficient, the flow of messages and exchange
of information from one person to another. Read more
Can i use speech
therapy at home with
my child? is so, how?
as a parent, the best thing you can do is workin close
association with the speech therapist, as well as
occupational therapist to find ways to continue doing some
vocal, communication, or mouth exercises at home. Read more

Vitamin B12 (Methyl-B12) is a water soluble vitamin which is naturally present in certain food items such as eggs, milk, meat and fish. But, it is commonly deficient in children with autism as they have limited ability to absorb vitamin B12. Lack of vitamin B12 is responsible for the severity of autism.

Diet and Nutrition

There are several theories about the association of symptoms of Autism, to the gut of the child. It has also been observed that several foods or types of foods, have an effect on the child’s behavior, and response. It could also be said that children with Autism face some trouble in getting the right kind of nutrition due to certain sensory processing difficulties. Hence, a modified, or a systematic diet plan becomes an essential part of the conventional interventions for Autism.

 

What is the role of proper diet
and nutrition in Autism?
a healthy, nutritious and balanced, diet plan for autism
needs can make a world of difference in their ability to
learn, how they manage their emotions and how
they process information. Read more
What are the diet plans for
my child with Autism?
it is advisable to consult with your
child’s nutritionist before starting with
any particular diet plan. Read more
What food should I avoid for
my child with Autism?
Simple sugars can be very hazardous
to those with Autism. Read more
What age can I start a diet
for my child with Autism ?
It is better to start the special diet in consultation
with your doctor and your Dietitian as soon as
possible after diagnosis. Read more
Who can provide a
good Diet plan for
my child?
A specific diet or nutrition plan should only be started after consulting
the child’s pediatrician as well as occupational therapist. Our database
online also has an exhaustive list of potential nutritionists and
dietitians sorted by country, state, and city. Read more
What type of food
should I include in my
child's diet?
As parents, it is important to work
closely with the nutritionist to make
sure to follow the specific diet and
nutrition plan. Read more

Medical Management of Autism

Medical management of autism is a method wherein specific medicines and drugs are used in order to alleviate some of the symptoms associated with autism.

 

How can medicines help
my child with Autism?
Most parents have found that symptoms of
hyperactivity, their child’s sleep disturbances, gut
related issues, etc. have shown improvements with
the help of medications. Read more
Which medicines would help
my child with Autism?
You may hear of some common medications
which usually prescribed for children or
individuals with Autism. Read more
Are there any oral supplements
that would help my child?
Vitamins and other supplements help
improve symptoms of self-injurious
behaviour, aggression and tantrums,
and can be taken in combination as
advised by your child’s doctor. Read more
When would it be ideal
for me to begin medically
managing my child?
Medical management of autism can be at done at anytime, since it works
to alleviate the symptoms associated with ASD. This, however, should be
strictly done under a registered medical practitioners supervision. Read more
Is there anything more I can
do for my child at home, in
terms of medications?
As a parent, the most important thing to do at home is to work closely
with the pediatrician and occupational therapist to moderate the
medication being taken by the child. Read more

Occupational Therapy (OT)

As the name itself suggests, Occupational therapy is a systematic practice which assists people in developing the 'skills for the job of living', necessary for independent and satisfying lives.

It is therefore, a means of alleviating some of the social, communication, and behavioral tendencies that are associated with children on the autism spectrum.

 

what is occupational therapy?
occupational therapy essentially means assisting
people of any age group, that are disabled either
cognitively or physically, to achieve their full
potential in doing age appropriate 'jobs'. Read more
does my child need
occupational therapy?
if your child has difficulties in self care,
gross and fine motor skills, sensory
processing skills. academic skills,
emotional regulation or social skills,
occupational therapy would be
advisable to your child. Read more
how does occupational therapy
help my child with autism?
your child with autism spectrum disorder
(asd) may have a variety of issues for
which an occupational therapist can
provide support. Read more
what does occupational
therapy include?
occupational therapy involves the
analysis of the child's functional or
adaptive ability at home, school and in
other environments. Read more
how often does my child
need occupational therapy?
occupational therapy is never a cookie-cutter approach to
alleviating symptoms of autism and consequently, the frequency
of getting occupational therapy depends on each child
as well as each therapists. Read more
at what age should i start
using occupational therapy
for my child?
occupational therapy works best when given
to a child from a young age. Read more
who can provide occupational
therapy for my child?
normally, occupational therapy can be found in most
speciality hospitals dealing with autism, as well as
special schools. our exhaustive database can be
referred to for a list of occupation therapists,
sorted by country, state and city. Read more

Autism Spectrum Disorder (ASD) and autism are both common terms used for a group of complex neuro-developmental disorders Autism is a pervasive developmental disorder that involves abnormal development and function of the brain. Individuals with autism show decreased social communication skills and restricted or repetitive patterns of behaviors or interests.. Autism spectrum disorder impacts the nervous system and affects the overall cognitive, emotional, social and physical health of the affected individual. This section explains some of signs and symptoms of autism, deficits in their social, communication skills, the behavioural issues, associated problems with autism, related causes and the team involved in treating and diagnosing autism.

Standard Treatment

Treatments available for autism individuals are bifurcated by ACA under three broad canopies:

Conventional Treatments: Includes medical management like Antipsychotics, Anti-depressants, Alpha2 antagonists to reduce hyperactivity, anxiety, impulsivity and inattention, mood stabilizers to reduce aggression, repetitive behavior.

Occupational therapy in autism, psychological interventions, ABA, sensory integration for children with autism and speech therapy. Alternative Treatments include aquatic therapy, art therapy, music therapy, dance therapy, play therapy, yoga therapy, diet & nutrition and animal therapy.

For people with disabilities, technology makes things possible. Assistive technologies are "any item, device, or piece of equipment that is used to increase, maintain, or improve the functional abilities of persons with disabilities".

This section tries to educate people and modify their understanding about Autism/ASD with the help of audio podcast and videos.

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