Understanding Autism Spectrum Disorder

A deeper understanding and more accepting view.


Published:

Thomas Jefferson. Albert Einstein. Isaac Newton. According to Charlotte-based psychologist Frank Gaskill, these creative, brainy leaders probably had Asperger’s Syndrome.

Gaskill produces the “Dr. G Aspie Show,” an online video series that covers a range of autism-related issues, and he has also written a graphic novel about a superhero with Asperger’s. Gaskill’s goal: Help individuals with Asperger’s feel comfortable with their identity. “Part of that,” he says, “is getting the message out to non-Aspies.”

Asperger’s, along with autism and certain developmental disabilities that can cause social, communication and behavioral challenges, are defined collectively as autism spectrum disorder. The spectrum is broad.

Thanks to therapists and doctors like Gaskill, as well as parents, teachers, advocates and adults with ASD, public awareness and understanding of this disorder has improved dramatically over the last few years. This means ASD is more likely to be recognized and diagnosed at an early age. It also means specialized treatment has become more accessible, and more time and money has been directed toward research into the causes, diagnosis and treatment of ASD.


Acceptance and Early Identification

Since 2000, the number of children diagnosed with ASD has risen from 1 in 150 to 1 in 68. In North Carolina, it’s 1 in 58. Over the course of his 30-year career, Dr. Kurt Klinepeter, chief of developmental and behavioral pediatrics at Wake Forest Baptist Medical Center in Winston-Salem, has seen firsthand the increase in diagnoses of children with ASD and the changing public perception.

“A diagnosis of autism used to be a surprise,” Klinepeter says. “Now families come in and bring it up on their own.” This increase may be the result of improved efforts at diagnosis, a broader definition of ASD and/or more children with ASD.

Before 2013, doctors made separate diagnoses for autism, Asperger’s, pervasive developmental disorder not otherwise specified and childhood disintegrative disorder. Today, in accordance with the fifth edition of the American Psychiatric Association’s diagnostic manual (DSM-5), these disorders are all diagnosed as Autism Spectrum Disorder in one of three levels of severity. Mild cases (level 1) are defined as “requiring support,” mid-spectrum cases (level 2) require “substantial support,” and the most severe cases (level 3) require “very substantial support.”

“Professionally speaking, it makes sense that these disorders are grouped together — the breadth of the DSM-5 definition helps doctors diagnose children at earlier ages, but the single definition is hard for lay people to understand,” Klinepeter says.

The DSM-4 terms were in place for 20 years, and many doctors and families still find the terms, such as Asperger’s, useful descriptors.


A Diagnosis of Difference

Klinepeter calls ASD “a diagnosis of difference.” Every child with ASD has unique symptoms and needs. Some children appear to have ASD, when what they actually have is attention deficit disorder or a learning disability. Some children grow out of their symptoms, other children grow into them. Autism experts suggest that parents not take the “wait-and-see” approach. Early intervention is valuable — the earlier the better.

“There’s nothing exclusive about behavioral therapy that couldn’t be helpful for any language/learning problem,” Klinepeter says.

In an effort to catch ASD early, the American Academy of Pediatrics recommends that every child be screened for developmental delays starting at his or her 9-month wellness visit. Even before that, parents should watch to make sure their child is meeting developmental milestones.

Symptoms can be spotted as early as 6 months and include concentrated interest in objects rather than people, less babbling than a typical infant, failure to respond when his or her name is called and decreased social smiling. At 12 months, a parent may see delayed gestures, delayed language and a failure to copy actions or sounds.

Older children and adults with ASD may have trouble with social, emotional and communication skills, and may display unusual behavioral tics, such as rocking and twirling, or self-abusive behavior such as biting or head-banging. Children with ASD tend to start speaking later than other children, though a high-functioning/high-IQ child (like the “Aspies” Gaskill referred to) might have good language skills by age 5, but use odd speech patterns, unusual accents and give monologues about a single topic without regard for the person listening.


Mentors and Support

A keystone of North Carolina’s autism community is the Autism Society of North Carolina, which provides a broad range of support services. What started as a small group of parents in the late ’60s is now a statewide organization with headquarters in Raleigh and offices in Asheville, Charlotte, Greensboro, Greenville and Fayetteville.

“We provide lifelong partnerships for families and individuals with autism,” says David Laxton, director of communications.

Highly cognitive children with ASD might require less intensive, though no less critical support. Gaskill has found that his patients — ages 4-18 — respond well to social skills groups. “They come to these groups and you can see them breathe a sigh of relief — I’m home,” he says.

Gaskill’s goal is for these kids to be comfortable with their identity, which often includes addressing the bullying or misunderstanding they receive at school.


Treatment Options

Some treatments require hours of behavioral therapy every week and involve some form of applied behavioral analysis. In the simplest terms, ABA-based models work to change behavior by encouraging positive behaviors and discouraging negative behaviors. Popular ABA treatments include the Early Start Denver Model for children younger than 18 months, a relationship-based approach known as “Floortime,” and the University of North Carolina TEACCH (Treatment and Education of Autistic and Communication-related Handicapped Children) program, which focuses on visual cues. Other treatments include occupational therapy, sensory therapy and speech therapy.

While there are no medications that cure ASD, some help with related symptoms. For example, some medications might help manage high energy levels, inability to focus, depression or seizures. Dietary treatments have also been developed, though they do not have the scientific support needed for widespread recommendation. An unproven treatment might help one child, but not another.


Educational Approach

There are also educational options. ABC of NC Child Development Center in Winston Salem, was originally conceived by a group of parents eager for services for their children with autism. The cohesive activism of that group is a hallmark of North Carolina’s autism community.

“These parents are wonderful,” says Selene Johnson, executive director of ABC of NC and a board certified behavior analyst who often goes to Raleigh with parents to lobby for various ASD issues, most recently for an autism insurance bill.

Cary mother of three Denise Sasseman chose to send her 6-year-old child, Oliver to The Mariposa School for Children With Autism in Cary. This nonprofit organization enrolls children ages 16 months through 16 years and attracts families from throughout North Carolina and beyond.

“We’re one of only a few schools offering one-on-one applied behavioral analysis,” says Jacinta Johnson, the school’s director. “We set goals for each student: for one it might be to enter preschool, for another it might be potty training. We define success specific to each child.”

For Sasseman and her son Oliver, success meant leaving The Mariposa School for Children With Autism to enroll full-time in public school. “We wouldn’t have considered it possible a couple years ago,” says Sasseman. “Oliver had no functional communication, and now he’s thriving in public school. He gained so many skills at Mariposa. It’s an amazing place.”

Oliver is now receiving special services at his public school, Oak Grove Elementary in Cary, and Sasseman has been pleasantly surprised.

“It is often considered best practice to include kids with ASD in regular classrooms,” says Leica Anzaldo, one of two lead therapists/trainers with the Autism Society. Anzaldo provides outreach and education to public schools throughout the state.

“We need to educate teachers and classmates about what it means to have ASD, and how they can help students with ASD learn and thrive.”

In addition to providing training for public schools, the Autism Society, Mariposa School for Children With Autism and similar organizations provide in-home training to individuals and families.

“ASD is a family condition,” Johnson says. “The entire family needs to understand their child’s treatment so they can provide a consistent learning environment at home.”


Cutting Edge ASD Research in North Carolina

North Carolina has several cutting-edge research centers exploring the causes and treatments of ASD, including the TEACCH center at the University of North Carolina, which specializes in community-based interventions; and the North Carolina Center for Autism and Developmental Disabilities Epidemiology, one of five national research centers funded by the Centers for Disease Control and Prevention.

The most recent addition is the Duke Center for Autism and Brain Development. The interdisciplinary clinical and research facility is led by Geraldine Dawson, former chief science officer for Autism Speaks, who developed and validated the Early Start Denver Model — the first comprehensive early intervention program for very young children with autism. She is also the author of several books on autism, including “An Early Start for your Child with Autism.”

“We are still learning so much about autism, from early brain development to the other end of the continuum, adults with autism,” Dawson says, noting that several hot topics being researched include genetic causes, environmental causes, drug treatments and gender differences (ASD is five times more common in boys than in girls, and experts are studying if this is because girls are underdiagnosed and/or if there are neurological differences).

“There is hope that in the next few years, some of the clinical trials going on now will translate genetic findings into drug targets,” Dawson says. A Duke study seeks to determine whether infusions of umbilical cord blood — either that of the children themselves, or someone else’s — can reduce core ASD symptoms. A second study is looking at the potential benefits of oxytocin, a hormone used anecdotally in smaller clinical trials. Dawson notes that the Duke Center would love to partner with families for their studies. They offer free diagnostic and clinical assessments for those interested in participating. To register to take part in research studies at Duke University, go to autismcenter.duke.edu/research/registry-autism-research.

Klinepeter suggests that parents who suspect their child might have symptoms of ASD get connected to services as early as possible. “There’s a parallel system/universe for children with developmental issues,” he says. “Inform yourself as much as possible. Understand that it’s a condition that responds to treatment. Be steadfast and push for your child.”

Sasseman believes it’s worth the effort.

“We’re so lucky,” says Sasseman, of her son Oliver. “He’s an amazing kid. He’s got a great temperament. He works so hard. And he’s happy — he wakes up every day filled with joy.”


Caitlin Wheeler is a freelance writer living in Durham.


See Also: NC Senate Bill Offers Relief for ASD Patients

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Calendar

November 2017

Step back in time with a 19th-century costumed interpreter and watch the millstones at work grinding corn into meal. Registration encouraged online. Tickets available at the...

Cost: $5/adult, $3 ages 7-16. Free for ages 6 and younger

Where:
Historic Yates Mill County Park
4620 Lake Wheeler Rd.
Raleigh, NC
View map »


Telephone: 919-856-6675
Website »

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Celebrate the wonderful world of exotic animals and reptiles. Enjoy live specimens, presentations, raffles, vendors and much more. Purchase tickets online.  

Cost: $12 ages 13 and older, $5 ages 5-12.

Where:
N.C. State Fairgrounds, Kerr Scott Building
1025 Blue Ridge Rd.
Raleigh, NC
View map »


Website »

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Take part in a class that teaches individualized ways to foster motor development for your child. Learn about tummy time alternatives, best positions for your baby, how to help your child learn to...

Cost: $18

Where:
Open Arts
1222 Copeland Oaks Dr.
Morrisville, NC  27560
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Sponsor: Babies On The MOVE
Contact Name: Rebecca Quinones
Website »

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Join Mindful Families of Durham, a Buddhist-inspired spiritual community that supports area parents, caregivers, and their children in the practice of mindfulness and the understanding of the...

Cost: Free

Where:
Erwin Road
Durham, NC  27705
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Sponsor: Mindful Families of Durham
Contact Name: Adam, Laura, Josh, Sumi
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Take part in a class that teaches individualized ways to foster motor development for your child. Learn about carry positions, best positions for your baby, how to help your child learn to crawl,...

Cost: $18

Where:
Open Arts
1222 Copeland Oaks Dr.
Morrisville, NC  27560
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Sponsor: Babies On The MOVE
Contact Name: Rebecca Quinones
Website »

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Kicks off the holiday season with local art, music, food, and family activities at various locations in Durham’s historic downtown district. Presented by the Durham Arts Council with support...

Cost: Free and open to the public.

Where:
Downtown Durham
120 Morris St.
Durham, NC  27701
View map »


Sponsor: Durham Arts Council
Telephone: 919-560-2719
Contact Name: Susan Tierney
Website »

More information

Participants develop their naturalist skills and understanding of local nature. Ages 5-8 with parent. Register online.

Cost: $8/resident, $10/nonresident

Where:
Stevens Nature Center/Hemlock Bluffs
2616 Kildaire Farm Rd.
Cary, NC
View map »


Telephone: 919-387-5980
Website »

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Celebrate the natural world and where favorite Thanksgiving foods come from. Make a craft. All ages with adult. Register online.

Cost: $1/person

Where:
Crowder District Park
4709 Ten-Ten Rd.
Apex, NC
View map »


Telephone: 919-662-2850
Website »

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Search the preserve for hidden holiday-themed clues and learn about native wild turkeys. Make a turkey decoration. Ages 5 and older with parent. Register online. Choose course code...

Cost: $1/person

Where:
Horseshoe Farm Nature Preserve
2900 Horse Shoe Farm Rd.
Wake Forest, NC
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Website »

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Search for salamanders, owls and more. Ages 10-13. Register online.

Cost: $12/resident, $16/nonresident

Where:
Stevens Nature Center/Hemlock Bluffs
2616 Kildaire Farm Rd.
Raleigh, NC
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Telephone: 919-387-5980
Website »

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Park West Village hosts Winter Wonderland in the District. This year’s event will take place the weekend of November 17th. Take the family to enjoy train rides, magical winter lights, live...

Cost: Free; $5 donation for sledding

Where:
Park West Village
3400 Village Market Place
Morrisville, NC  27560
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Telephone: 919-234-6710
Contact Name: Conner Dixon
Website »

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See ponies, hunters and jumpers compete in an event that benefits Duke Children's Hospital. Visit the website for hours and fees.

Cost: See website for fees

Where:
Gov. James B. Hunt Horse Complex
4601 Trinity Rd.
Raleigh, NC
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Website »

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Children ages 18 months-4 years and their parents enjoy free creative movement and music classes. The creative movement class focuses on the development of gross motor skills and...

Cost: Free

Where:
Saint Raphael Preschool
5801 Falls of Neuse Rd.
Raleigh, NC  27615
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Sponsor: St. Raphael Preschool
Telephone: 919-865-5725
Contact Name: Sarah Rapp
Website »

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Make crafts celebrating turkeys. All ages with adult. Meet at the Cardinal Shelter. Registration not required. 

Cost: Free

Where:
Crowder District Park
4709 Ten-Ten Rd.
Apex, NC
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Telephone: 919-662-2850
Website »

More information

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Children ages 18 months-4 years and their parents enjoy free creative movement and music classes. The creative movement class focuses on the development of gross motor skills and...

Cost: Free

Where:
Saint Raphael Preschool
5801 Falls of Neuse Rd.
Raleigh, NC  27615
View map »


Sponsor: St. Raphael Preschool
Telephone: 919-865-5725
Contact Name: Sarah Rapp
Website »

More information

Kids ages 6 and younger enjoy stories. Take part in an optional arts and crafts session after storytime for $5.

Cost: Free

Where:
Read With Me Book Shop
111 E. Hargett St., $110
Raleigh, NC  27601
View map »


Website »

More information

Learn what it was like to be a kid at the first Thanksgiving. Play games and make a food collage. Choose either the 10:30-noon and 2-3:30 p.m. session. Ages 7 and older. Register online.

Cost: $6/child

Where:
Historic Yates Mill County Park
4620 Lake Wheeler Rd.
Raleigh, AL
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Telephone: 919-856-6675
Website »

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Toddler Time is a special time for ages 5 and younger to bounce under the supervision of their parents, and without interference from the big kids. Purchase tickets online.

Cost: $7-$10

Where:
Sky Zone Durham
1720 Guess Rd., Ste. 90
Durham, NC  27701
View map »


Website »

More information

Children ages 18 months-4 years and their parents enjoy free creative movement and music classes. The creative movement class focuses on the development of gross motor skills and...

Cost: Free

Where:
Saint Raphael Preschool
5801 Falls of Neuse Rd.
Raleigh, NC  27615
View map »


Sponsor: St. Raphael Preschool
Telephone: 919-865-5725
Contact Name: Sarah Rapp
Website »

More information

Explore the woods and shoreline for signs of nature and collect treasures to make a craft. Take a full water bottle, snack and a bag lunch. Ages 6-11. Meet at the Cypress Shelter. Advance...

Cost: $16/child

Where:
Harris Lake County Park
2112 County Park Dr.
New Hill, NC  27562
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Sponsor: Harris Lake County Park
Telephone: 919-387-4342
Contact Name: Jackie Trickel
Website »

More information

Kids ages 6 and younger enjoy stories. Take part in an optional arts and crafts session after storytime for $5.

Cost: Free

Where:
Read With Me Book Shop
111 E. Hargett St., $110
Raleigh, NC  27601
View map »


Website »

More information

Listen for the sound of silver bells and climb aboard in your pajamas for a first-class journey on the Polar Express. Come early to meet Santa and enjoy kid-friendly activities and a traditional...

Cost: $14-$29

Where:
Meymandi Concert Hall
2 E. South St.
Raleigh, NC  27601
View map »


Website »

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Athletes improve their flexibility, balance, joint mobility, as well as body and breath awareness. Special attention will be paid to core strength and posture and its importance in performance and...

Cost: Call for fees

Where:
Little Guru Kids Yoga and Creative Arts
215 Glenwood Avenue, Suite A
Raleigh, NC  27603
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Sponsor: Little Guru Kids Yoga
Telephone: 919-345-5873
Contact Name: Jen Bluestone
Website »

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Children ages 18 months-4 years and their parents enjoy free creative movement and music classes. The creative movement class focuses on the development of gross motor skills and...

Cost: Free

Where:
Saint Raphael Preschool
5801 Falls of Neuse Rd.
Raleigh, NC  27615
View map »


Sponsor: St. Raphael Preschool
Telephone: 919-865-5725
Contact Name: Sarah Rapp
Website »

More information

Show More...
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Celebrate what you're thankful for. Play a game and make a pine cone turkey craft. All ages with adult. Drop-in program. Registration not required.

Cost: Free

Where:
Historic Yates Mill County Park
4620 Lake Wheeler Rd.
Raleigh, NC
View map »


Telephone: 919-856-6675
Website »

More information

Shop more than 20 local vendors offering amazing gifts this holiday season. Enjoy daily raffles with proceeds benefiting local animal rescue Paws in the City. Kids can enjoy crafts...

Cost: Free

Where:
Cary Crossroads
333 Crossroads Blvd
Cary, NC  27518
View map »


Website »

More information

Children ages 18 months-4 years and their parents enjoy free creative movement and music classes. The creative movement class focuses on the development of gross motor skills and...

Cost: Free

Where:
Saint Raphael Preschool
5801 Falls of Neuse Rd.
Raleigh, NC  27615
View map »


Sponsor: St. Raphael Preschool
Telephone: 919-865-5725
Contact Name: Sarah Rapp
Website »

More information

A wonderfully kid-paced hour featuring music, play and dancing with toddler stars singing on the mic at Cotton's gently amplified & participatory music show. Children delight in...

Cost: Free with admission

Where:
Pump It Up Raleigh
10700 World Trade Blvd, #112
Raleigh, NC  27617
View map »


Sponsor: Pump it Up
Telephone: 919-828-3344
Contact Name: Owner/manager Kellie Paterson McHugh
Website »

More information

Read the story by Karma Wilson and make a Thanksgiving-themed craft. All ages. Registration not required.

Cost: Free

Where:
Historic Yates Mill County Park
4620 Lake Wheeler Rd.
Raleigh, AL
View map »


Telephone: 919-856-6675
Website »

More information

See a contemporary re-imagination of Tchaikovky's timeless music. Purchase tickets online.

Cost: $35-$55

Where:
Durham Performing Arts Center
123 Vivian St.
Durham, NC  27701
View map »


Website »

More information

See the classic holiday story brought to life onstage featuring favorite characters Santa and Mrs. Claus, Hermey the Elf, Bumble the Abominable Snow Monster, Clarice, Yukon Cornelius and...

Cost: $15 and up

Where:
Fletcher Theater
2 E. South St.
Raleigh, NC  27601
View map »


Website »

More information

See the classic holiday story brought to life onstage featuring favorite characters Santa and Mrs. Claus, Hermey the Elf, Bumble the Abominable Snow Monster, Clarice, Yukon Cornelius and...

Cost: $15 and up

Where:
Fletcher Theater
2 E. South St.
Raleigh, NC  27601
View map »


Website »

More information

See a contemporary re-imagination of Tchaikovky's timeless music. Purchase tickets online.

Cost: $35-$55

Where:
Durham Performing Arts Center
123 Vivian St.
Durham, NC  27701
View map »


Website »

More information

Catch this comedy classic on the big screen—as the symphony plays the charming and delightful score by John Williams live. Purchase tickets online.

Cost: $14-$29

Where:
Meymandi Concert Hall
2 E. South St.
Raleigh, NC  27601
View map »


Website »

More information

Show More...
Show Less...

Fit & Able Productions presents the Turkey Chase trail festival at Umstead Park. Take part in a 5K, 10K or 20K. After the race, enjoy fruit, brownies and other...

Cost: $25-$45

Where:
Umstead Park
8801 Glenwood Ave.
Raleigh, NC  27617
View map »


Sponsor: Fit and Able Productions
Telephone: 919-673-4689
Contact Name: Travis
Website »

More information

Celebrate what you're thankful for. Play a game and make a pine cone turkey craft. All ages with adult. Drop-in program. Registration not required.

Cost: Free

Where:
Historic Yates Mill County Park
4620 Lake Wheeler Rd.
Raleigh, NC
View map »


Telephone: 919-856-6675
Website »

More information

Toddler Time is a special time for ages 5 and younger to bounce under the supervision of their parents, and without interference from the big kids. Purchase tickets online.

Cost: $7-$10

Where:
Sky Zone Durham
1720 Guess Rd., Ste. 90
Durham, NC  27701
View map »


Website »

More information

Shop more than 20 local vendors offering amazing gifts this holiday season. Enjoy daily raffles with proceeds benefiting local animal rescue Paws in the City. Kids can enjoy crafts...

Cost: Free

Where:
Cary Crossroads
333 Crossroads Blvd
Cary, NC  27518
View map »


Website »

More information

The Raleigh Boychoir makes an appearance before its big Christmas concert.

Cost: Free

Where:
Quail Ridge Books
4209-100 Lassiter Mill Rd.
Raleigh, NC  27609
View map »


Website »

More information

Kids ages 6 and younger enjoy stories. Take part in an optional arts and crafts session after storytime for $5.

Cost: Free

Where:
Read With Me Book Shop
111 E. Hargett St., $110
Raleigh, NC  27601
View map »


Website »

More information

See the classic holiday story brought to life onstage featuring favorite characters Santa and Mrs. Claus, Hermey the Elf, Bumble the Abominable Snow Monster, Clarice, Yukon Cornelius and...

Cost: $15 and up

Where:
Fletcher Theater
2 E. South St.
Raleigh, NC  27601
View map »


Website »

More information

Take a 30-minute tour to view the main power drive and milling machinery. Tickets available inside the park's visitor center. Online registration encouraged.

Cost: $5/adult, $3 ages 7-16. Free for ages 6 and younger

Where:
Historic Yates Mill County Park
4620 Lake Wheeler Rd.
Raleigh, NC
View map »


Telephone: 919-856-6675
Website »

More information

Explore the historic nature of Leigh Farm Park with a friendly guide. Venture inside the historic farmhouse while being captivated by tales about life at Leigh Farm throughout the years.

Cost: Free

Where:
Leigh Farm Park
370 Leigh Farm Rd.
Durham, NC  27707
View map »


Sponsor: Durham Parks and Recreation
Telephone: 919-560-1116
Contact Name: Natalya Buckel
Website »

More information

See the classic holiday story brought to life onstage featuring favorite characters Santa and Mrs. Claus, Hermey the Elf, Bumble the Abominable Snow Monster, Clarice, Yukon Cornelius and...

Cost: $15 and up

Where:
Fletcher Theater
2 E. South St.
Raleigh, NC  27601
View map »


Website »

More information

Catch this comedy classic on the big screen—as the symphony plays the charming and delightful score by John Williams live. Purchase tickets online.

Cost: $14-$29

Where:
Meymandi Concert Hall
2 E. South St.
Raleigh, NC  27601
View map »


Website »

More information

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Show Less...
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