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Archive for the ‘Autism Spectrum Disorders’ Category

possible autism cure?

In Autism Spectrum Disorders, Medication, Psychiatry on Friday, 28 March 2014 at 04:08

http://www.stonehearthnewsletters.com/autistic-brain-could-be-rebalanced-with-low-doses-of-antianxiety-drugs/autism/

Gene Linked to Asperger Syndrome, Empathy

In Autism Spectrum Disorders, Genes, Genomic Medicine, Neuropsychology on Friday, 20 December 2013 at 16:52

 

Gene Linked to Asperger Syndrome, Empathy

Scientists have confirmed that variations in a particular gene play a key role in the autism spectrum condition known as Asperger Syndrome. They have also found that variations in the same gene are also linked to differences in empathy levels in the general population. 

A study published this month in the journal Molecular Autismconfirms previous research that people with Asperger Syndrome (AS) are more likely to carry specific variations in a particular gene. More strikingly, the study supports existing findings that the same gene is also linked to how much empathy typically shown by individuals in the general population.

The research was carried out by a team of researchers led by Professor Simon Baron-Cohen at the Autism Research Centre at Cambridge University. Asperger Syndrome is an autism spectrum condition. The researchers looked for sequence variations (called single nucleotide polymorphisms or SNPs) in the gene known as GABRB3 in a total of 530 adults- 118 people diagnosed with AS and 412 people without a diagnosis.

The team found that certain SNPs in GABRB3 were significantly more common in people with AS. They also discovered that additional genetic variations in the same gene were linked to scores on an empathy measure called the Empathy Quotient (EQ) in the general population.

AS is diagnosed when a person struggles with social relationships and communication, and shows unusually narrow interests and resistance to change, but has good intelligence and language skills. Most genetic studies of autistic spectrum conditions treat autism as if they are all very similar, whereas in reality there is considerable variation (e.g., in language level and intellectual ability).

Rather than studying people on the autistic condition spectrum, this new study looked only people with AS, as a well-defined subgroup of individuals within this range. The researchers examined the gene GABRB3 which regulates the functioning of a neurotransmitter called gamma-aminobutyric acid (GABA) and which contains a number of SNPs that vary across the population.

The volunteers were tested for 45 SNPs within this key gene. The team had previously found that SNPs in this gene were more common in adults with AS and also showed a relationship with empathy levels and tactile sensitivity (how sensitive people are to being touched) in the general population.

 

Testing a new sample of volunteers who had not taken part in previous studies, the researchers found that three of the SNPs were again more common in adults with AS, and two different SNPs in the same gene were again related to empathy levels in the general population, confirming that the gene is involved in autism spectrum conditions.

Baron-Cohen said: “We are excited that this study confirms that variation in GABRB3 is linked not just to AS but to individual differences in empathy in the population. Many candidate genes do not replicate across studies and across different samples, but this genetic finding seems to be a solid result. Research now needs to focus on where this gene is expressed in the brain in autism, and how it interacts with other genetic and non-genetic factors that cause AS.”

The team was co-led by Dr. Bhismadev Chakrabarti from the Department of Psychology at Reading University. “Genes play an important role in autism and Asperger Syndrome. This new study adds to evidence that GABRB3 is a key gene underlying these conditions. This gene is involved in the functioning of a neurotransmitter that regulates excitation and inhibition of nerve cell activity so the research gives us vital additional information about how the brain may develop differently in people with Asperger Syndrome,” he said.

Varun Warrier, who carried out the study as part of his graduate research at Cambridge University, added: “The most important aspect of this research is that it points to common genetic variants in GABRB3 being involved in both AS and in empathy as a dimensional trait. Although GABRB3 is not the only gene to be involved in this condition and in empathy levels, we are confident that we have identified one of the key players. We are following this up by testing how much protein GABRB3 produces in the brain in autism, since a genetic finding of this kind becomes more explanatory when we can also measure its function.”

Source: Cambridge University

Retrieved from: http://www.biosciencetechnology.com/news/2013/12/gene-linked-asperger-syndrome-empathy?goback=%2Egde_2514160_member_5819480722708119555#%21

Asperger Syndrome Revisited

In Autism Spectrum Disorders, General Psychology, Psychiatry, School Psychology, Special Education on Wednesday, 11 December 2013 at 05:59

Asperger Syndrome Revisited

By: Lee Wilkinson, Ph.D.

The deletion of Asperger’s disorder (Asperger’s syndrome) as a separate diagnostic category from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has been widely publicized. The new DSM-5 category of autism spectrum disorder (ASD), which subsumes the previous DSM-IV diagnoses of autistic disorder (autism), Asperger’s disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS), reflects the scientific consensus that symptoms of the various DSM-IV subgroups represent a single continuum of impairment that varies in level of severity and need for support.

An important feature of the DSM-5 criteria for ASD is a change from three symptom domains (triad) of social impairment, communication deficits and repetitive/restricted behaviors, interests, or activities to two domains (dyad); social/communication deficits and fixated and repetitive pattern of behaviors. Several social/communication criteria were merged to clarify diagnostic requirements and reflect research indicating that language deficits are neither universal in ASD, nor should they be considered as a defining feature of the diagnosis. The criteria also feature dimensions of severity that include current levels of language and intellectual functioning as well as greater flexibility in the criteria for age of onset and addition of symptoms not previously included in the DSM-IV such as sensory interests and aversions.

DSM-IV Criteria in Practice

Problems in applying the DSM-IV criteria were a key consideration in the decision to delete Asperger’s disorder as a separate diagnostic entity. Numerous studies indicate that it is difficult to reliably distinguish between Asperger syndrome, autism, and other disorders on the spectrum in clinical practice (Attwood, 2006; Macintosh & Dissanayake, 2006; Leekam, Libby, Wing, Gould & Gillberg, 2000; Mayes & Calhoun, 2003; Mayes, Calhoun, & Crites, 2001; Miller & Ozonoff, 2000; Ozonoff, Dawson, & McPartland, 2002; Witwer & Lecavalier, 2008). For example, children with autism who develop proficient language have very similar trajectories and later outcomes as children with Asperger disorder (Bennett et al., 2008; Howlin, 2003; Szatmari et al., 2000) and the two are indistinguishable by school-age (Macintosh & Dissanayake, 2004), adolescence (Eisenmajer, Prior, Leekam, Wing, Ong, Gould & Welham 1998; Ozonoff, South and Miller 2000) and adulthood (Howlin, 2003). Individuals with Asperger disorder also typically meet the DSM-IV communication criterion of autism, “marked impairment in the ability to initiate or sustain a conversation with others,” making it is possible for someone who meets the criteria for Asperger’s disorder to also meet the criteria for autistic disorder.

Treatment and Outcome

Another important consideration was response to treatment. Intervention research cannot predict, at the present time, which particular intervention approach works best with which individual. Likewise, data is not available on the differential responsiveness of children with Asperger’s disorder and high-functioning autism to specific interventions (Carpenter, Soorya, & Halpern, 2009). There are no empirical studies demonstrating the need for different treatments or different responses to the same treatment, and in clinical practice the same interventions are typically offered for both autism and Asperger’s disorder (Wilkinson, 2010). Treatments for impairments in pragmatic (social) language and social skills are the same for both groups.

Application of the New Criteria

It’s important to remember that in the DSM, a mental disorder is conceptualized as a clinically important collection of behavioral and psychological symptoms that causes an individual distress, disability or impairment. The objective of new DSM-5 criteria for ASD is that every individual who has significant “impairment” in social-communication and restricted and repetitive behavior or interests should meet the diagnostic criteria for ASD.  Because language impairment/delay is not a necessary criterion for diagnosis, anyone who demonstrates severe and sustained impairments in social skills and restricted, repetitive patterns of behavior, interests, or activities in the presence of generally age-appropriate language acquisition and cognitive functioning, who might previously have been given a diagnosis of Asperger’s disorder, will now meet the criteria for ASD.

The new DSM-5 criteria for ASD have created significant controversy over concerns that it would exclude many individuals currently diagnosed with Asperger syndrome and PDD-NOS, and thus make it difficult for them to access services. However, recently published field trials suggest that the revisions actually increase the reliability of diagnosis, while identifying the large majority of those who would have been diagnosed under the DSM-IV-TR. Of the small numbers who were not included, most received the new diagnosis of “social communication disorder.” Moreover, the accuracy of non-spectrum classification (specificity) made by DSM-5 was better than that of DSM-IV, indicating greater effectiveness in distinguishing ASD from non-spectrum disorders such as language disorders, intellectual disability, attention-deficit/hyperactivity disorder (ADHD), and anxiety disorders. It is also important to note that all individuals who have a DSM-IV diagnosis on the autism spectrum, including those with Asperger syndrome and PDD-NOS, will be able to retain an ASD diagnosis. This means that no one should “lose” their diagnosis because of the changes in diagnostic criteria.  According to DSM-5, individuals with a well-established DSM-IV diagnosis of Autistic Disorder, Asperger’s Disorder, or PDD-NOS should be given a diagnosis of ASD.  Those who have marked deficits in social communication, but whose symptoms do not meet the criteria for ASD, should be evaluated for Social (Pragmatic) Communication Disorder.

Conclusion

In conclusion, the DSM-5 category of autism spectrum disorder (ASD), which subsumes the current diagnoses of autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS), better describes our current understanding about the clinical presentation and course of the neurodevelopmental disorders. Conceptualizing autism as a spectrum condition rather than a categorical diagnostic entity is in keeping with the extant research suggesting that there is no clear evidence that Asperger’s disorder and high-functioning autism are different disorders. As Gillberg (2001) notes, the terms Asperger’s syndrome and high-functioning autism are more likely “synonyms” than labels for different disorders. Lord (2011) also comments that although there has been much controversy about whether there should be separate diagnoses, “Most of the research has suggested that Asperger’s syndrome really isn’t different from other autism spectrum disorders.” “The take-home message is that there really should be just a general category of autism spectrum disorder, and then clinicians should be able to describe a child’s severity on these separate dimensions.” Unfortunately, many individuals may have been advised (or assumed) that a diagnosis of Asperger’s disorder was separate and distinct from autistic disorder and that intervention/treatment, course, and outcome were clinically different for each disorder. While including Asperger’s Disorder under the DSM-5 category of ASD will likely continue to require a period of transition and adjustment, the proposed dimensional approach to diagnosis will likely result in more effective identification, treatment, and research for individuals on the spectrum.

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders. Washington, DC: Author.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders(4th ed., text rev.). Washington, DC: Author.

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders(5th ed.). Washington, DC: Author.

Attwood, T. (2006). The complete guide to Asperger’s syndrome. London: Jessica Kingsley.

Carpenter, L. A., Soorya, L. & Halpern, D. (2009). Asperger’s syndrome and high- functioning autism. Pediatric Annals, 38, 30-35.

Eisenmajer, R., Prior, M., Leekam, S., Wing, L., Ong, B., Gould, J. & Welham, M. (1998)

Delayed Language Onset as a Predictor of Clinical Symptoms in Pervasive Developmental Disorders. Journal of Autism and Developmental Disorders, 28, 527–34.

Gillberg, C (2001). Asperger’s syndrome and high functioning autism: Shared deficits or

different Disorders? Journal of Developmental and Learning Disorders, 5, 79-94.

Howlin, P. (2003). Outcome in high-functioning adults with autism with and without early language delays: Implications for the differentiation between autism and Asperger syndrome. Journal of Autism and Developmental Disorders, 33, 3–13.

Leekam, S., Libby, S., Wing, L., Gould, J. & Gillberg, C. (2000) Comparison of ICD-10 and Gillberg’s criteria for Asperger syndrome. Autism, 4, 11–28.

Lord, C. et al. (2011). A multisite study of the clinical diagnosis of different autism spectrum disorders. Archives of General Psychiatry. doi:10.1001/archgenpsychiatry.2011.148

Macintosh, K., & Dissanayake, C. (2006). Social skills and problem behaviors in school aged children with high-functioning autism and Asperger’s disorder. Journal of Autism and Developmental Disorders, 36, 1065–1076.

Macintosh, K.E., & Dissanayake, C. (2004). Annotation: The similarities and differences

between autistic disorder and Asperger’s disorder: A review of the empirical evidence. Journal of Child Psychology and Psychiatry, 45, 421–434.

Mayes, S., & Calhoun, S. (2003). Relationship between Asperger syndrome and high functioning autism. In M. Prior (Ed.), Learning and behavior problems in Asperger syndrome (pp. 15-34). New York: Guilford Press.

Mayes SD, Calhoun SL, Crites DL (2001) Does DSM-IV Asperger’s disorder exist? Journal of Abnormal Child Psychology, 29, 263–271.

Miller, J. N., & Ozonoff, S. (2000). The external validity of Asperger disorder: Lack of evidence from the domain of neuropsychology. Journal of Abnormal Psychology, 109, 227–238.

Ozonoff, S., Dawson, G., & McPartland, J. (2002). A parent’s guide to Asperger syndrome and high-functioning autism: How to meet the challenges and help your child to thrive. New York: Guilford Press.

Ozonoff, S., South, M., & Miller, J. N. (2000). DSM-IV-defined Asperger syndrome: Cognitive, behavioral and early history differentiation from high-functioning autism. Autism, 4, 29–46.

Szatmari, P., Bryson, S.E., Streiner, D.L., Wilson, F.J., Archer, L., & Ryerse, C. (2000). Two year outcome of preschool children with autism or Asperger’s syndrome. American Journal of Psychiatry, 15, 1980–1987.

Szatmari, P., Bryson, S., Duku, E., Vaccarella, L., Zwaigenbaum, L., Bennett, L. & Boyle, M.H. (2009). Similar developmental trajectories in autism and Asperger syndrome: from early childhood to adolescence. Journal of Child Psychology and Psychiatry, 50, 1459-1467.

Wilkinson, L. A. (2008). Adults with Asperger syndrome: A childhood disorder grows up. The Psychologist, 21, 764-770.

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for Asperger syndrome and autism in schools. London: Jessica Kingsley Publishers.

Wilkinson, L. A. (Ed.) (in press). Autism spectrum disorder in children and adolescents: Evidence-based assessment and intervention in schools. American Psychological Association (APA): Washington, DC.

Williams, K., Tuck, M., Helmer, M., Bartak, L., Mellis, C. & Peat, J.K. (2008). Diagnostic labelling of autism spectrum disorders in NSW. Journal of Paediatrics and Child Health, 44, 108-113.

Wing, L. (2005). Problems of categorical classification systems. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.),Handbook of autism and pervasive developmental disorders: Vol. 1. Diagnosis, development, neurobiology, and behavior (3rd ed., pp. 583–605). New York: John Wiley.

Witwer, A.N., & Lecavalier, L. (2008). Validity of autism spectrum disorder subtypes. Journal of Autism and Developmental Disorders, 38, 1611–1624.

Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.

Retrieved from: http://bestpracticeautism.blogspot.com/2013/12/asperger-syndrome-revisited.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+BestPracticeAutism+%28Best+Practice+Autism%29

 

Autism at School: DSM or IDEA

In Autism Spectrum Disorders, School Psychology, Special Education on Sunday, 24 March 2013 at 08:10

Autism at School: DSM or IDEA
AUTISM & EDUCATION
  MARCH 22, 2013  BY: LEE WILKINSON

More children than ever before are being diagnosed with autism spectrum disorders (ASD). The U.S. Centers for Disease Control and Prevention (CDC) now estimates that 1 in 88 eight year-old children has an ASD. This dramatic increase in the prevalence of children with ASD over the past decade, together with the clear benefits of early intervention, have created a need for schools to identify children who may have an autism spectrum condition. It is not unusual for children with milder forms of autism to go undiagnosed until well after entering school. In fact, research indicates that only three percent of children with ASD are identified solely by non-school resources. As a result, school professionals are now more likely to be asked to participate in the screening and identification of children with ASD than at any other time in the past.

The Individuals with Disabilities Education Act of 2004 (IDEA) and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV) are the two major systems used to diagnose and classify children with ASD. The DSM-IV is considered the primary authority in the fields of psychiatric and psychological (clinical) diagnoses, while IDEA is the authority with regard to eligibility decisions for special education. The DSM-IV was developed by clinicians as a diagnostic and classification system for both childhood and adult psychiatric disorders. The IDEA is not a diagnostic system per se, but rather federal legislation designed to ensure the appropriate education of children with special educational needs in our public schools. Unlike the DSM-IV, IDEA specifies categories of ‘‘disabilities’’ to determine eligibility for special educational services. The definitions of these categories (there are 13), including autism, are the most widely used classification system in our schools. According to IDEA regulations, the definition of autism is as follows:

(c)(1)(i) Autism means a developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child’s educational performance is adversely affected primarily because the child has an emotional disturbance, as defined in this section.

(ii) A child who manifests the characteristics of ‘‘autism’’ after age 3 could be diagnosed as having ‘‘autism’’ if the criteria in paragraph (c)(1)(i) of this section are satisfied.
This educational definition is considered sufficiently broad and operationally acceptable to accommodate both the clinical and educational descriptions of autism and related disorders.

While the DSM-IV diagnostic criteria are professionally helpful, they are neither legally required nor sufficient for determining educational placement. It is state and federal education codes and regulations (not DSM IV-TR) that drive classification and eligibility decisions. Thus, school professionals must ensure that children meet the criteria for autism as outlined by IDEA and may use the DSM-IV to the extent that the diagnostic criteria include the same core behaviors (e.g., difficulties with social interaction, difficulties with communication, and the frequent exhibition of repetitive behaviors or circumscribed interests). Of course, all professionals, whether clinical or school, should have the appropriate training and background related to the diagnosis and treatment of neurodevelopmental disorders. The identification of autism should be made by a professional team using multiple sources of information, including, but not limited to an interdisciplinary assessment of social behavior, language and communication, adaptive behavior, motor skills, sensory issues, and cognitive functioning to help with intervention planning and determining eligibility for special educational services.

Legal and special education experts recommend the following guidelines to help school districts meet the requirements for providing legally and educationally appropriate programs and services to students with ASD.

1. School districts should ensure that the IEP process follows the procedural requirements of IDEA. This includes actively involving parents in the IEP process and adhering to the time frame requirements for assessment and developing and implementing the student’s IEP. Moreover, parents must be notified of their due process rights. It’s important to recognize that parent-professional communication and collaboration are key components for making educational and program decisions.

2. School districts should make certain that comprehensive, individualized evaluations are completed by school professionals who have knowledge, experience, and expertise in ASD. If qualified personnel are not available, school districts should provide the appropriate training or retain the services of a consultant.

3. School districts should develop IEPs based on the child’s unique pattern of strengths and weaknesses. Goals for a child with ASD commonly include the areas of communication, social behavior, adaptive skills, challenging behavior, and academic and functional skills. The IEP must address appropriate instructional and curricular modifications, together with related services such as counseling, occupational therapy, speech/language therapy, physical therapy and transportation needs. Evidence-based instructional strategies should also be adopted to ensure that the IEP is implemented appropriately.

4. School districts should assure that progress monitoring of students with ASD is completed at specified intervals by an interdisciplinary team of professionals who have a knowledge base and experience in autism. This includes collecting evidence-based data to document progress towards achieving IEP goals and to assess program effectiveness.

5. School districts should make every effort to place students in integrated settings to maximize interaction with non-disabled peers. Inclusion with typically developing students is important for a child with ASD as peers provide the best models for language and social skills. However, inclusive education alone is insufficient, evidence-based intervention and training is also necessary to address specific skill deficits. Although the least restrictive environment (LRE) provision of IDEA requires that efforts be made to educate students with special needs in less restrictive settings, IDEA also recognizes that some students may require a more comprehensive program to provide FAPE.

6. School districts should provide on-going training and education in ASD for both parents and professionals. Professionals who are trained in specific methodology and techniques will be most effective in providing the appropriate services and in modifying curriculum based upon the unique needs of the individual child.

References and further reading:

Individuals with Disabilities Education Improvement Act of 2004. Pub. L. No. 108-446, 108th Congress, 2nd Session. (2004).

Mandlawitz, M. R. (2002). The impact of the legal system on educational programming for young children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 32, 495-508.

National Research Council (2001). Educating children with autism. Committee on Educational Interventions for Children with Autism. C. Lord & J. P. McGee (Eds). Division of Behavioral and Social Sciences and Education. Washington, DC: National Academy Press.

Twachtman-Cullen, D., & Twachtman-Bassett, J. (2011). The IEP from A to Z: How to create meaningful and measurable goals and objectives. San Francisco, CA: Jossey-Bass.

Wilkinson, L. A. (2010). Best practice in special needs education. In L. A. Wilkinson, A best practice guide to assessment and intervention for autism and Asperger syndrome in schools (pp. 127-146). London: Jessica Kingsley Publishers.

Wrightslaw: Special Education Law, 2ndEdition (2007).

Yell, M. L., Katsiyannis, A, Drasgow, E, & Herbst, M. (2003). Developing legally correct and educationally appropriate programs for students with autism spectrum disorders. Focus on Autism and Other Developmental Disabilities, 18, 182-191.

Lee A. Wilkinson, PhD is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.

Retrieved from: http://www.examiner.com/article/autism-at-school-dsm-or-idea?goback=%2Egde_2191897_member_225669404

autism rate now 1 in 50…

In Autism Spectrum Disorders on Wednesday, 20 March 2013 at 07:17

http://www.cbsnews.com/8301-204_162-57575282/1-in-50-u.s-school-kids-has-autism-govt-survey/

genes, genes…

In ADHD, ADHD Adult, ADHD child/adolescent, Autism Spectrum Disorders, General Psychology, Genes, Neuropsychology, Neuroscience, Personality Disorders, Psychiatry on Friday, 1 March 2013 at 06:15

i love gwas and really feel it will continue to broaden our understanding of psychiatric illnesses and, hopefully, lead to better treatment options.

Five Major Psychiatric Disorders Genetically Linked

By: Caroline Cassels

In the largest genetic study of psychiatric illness to date, scientists have discovered genetic links between 5 major psychiatric disorders.

Investigators from the Cross-Disorder Group of the Psychiatric Genomics Consortium have found that autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia share common genetic risk factors.

Specifically, the results of the genome-wide association study (GWAS) reveal single-nucleotide polymorphisms (SNPs) in 2 genes —CACNA1C and CACNB2 — both of which are involved in the balance of calcium in brain cells, are implicated in several of these disorders, and could provide a potential target for new treatments.

“This analysis provides the first genome-wide evidence that individual and aggregate molecular genetic risk factors are shared between 5 childhood-onset or adult-onset psychiatric disorders that are treated as distinct categories in clinical practice,” study investigator Jordan Smoller, MD, Massachusetts General Hospital, Boston, said in a release.

The study was published online February 28 in the Lancet.

Potential Therapeutic Target

The researchers note that findings from family and twin studies suggest that genetic risks for psychiatric disorders do not always map to current diagnostic categories and that “doubt remains about the boundaries between the syndromes and the disorders that have overlapping foundations or different variants of one underlying disease.”

“The pathogenic mechanisms of psychiatric disorders are largely unknown, so diagnostic boundaries are difficult to define. Genetic risk factors are important in the causation of all major psychiatric disorders, and genetic strategies are widely used to assess potential overlaps,” the investigators write.

The aim of the study was to identify specific variants underlying genetic effects shared between 5 major psychiatric disorders: ASD, ADHD, BD, MDD, and schizophrenia.

The researchers analyzed genome-wide SNP data for the 5 disorders in 33,332 cases and 27,888 control participants of European ancestry. They identified 4 risk loci that have significant and overlapping links with all 5 diseases. These included regions on chromosomes 3p21 and 10q24, and SNPs in the gene CACNA1C,which has previously been linked to bipolar disorder and schizophrenia, and in theCACNB2 gene.

Polygenic risk scores confirmed cross-disorder effects, most strongly between adult-onset disorders BD and MDD and schizophrenia. Further pathway analysis corroborated that calcium channel activity could play an important role in the development of all 5 disorders.

“Significant progress has been made in understanding the genetic risk factors underlying psychiatric disorders. Our results provide new evidence that may inform a move beyond descriptive syndromes in psychiatry and towards classification based on underlying causes.

“These findings are particularly relevant in view of the imminent revision of classifications in the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases,” said Dr. Smoller.

The investigators add that the study results “implicate a specific biological pathway — voltage-gated calcium-channel signalling — as a contributor to the pathogenesis of several psychiatric disorders, and support the potential of this pathway as a therapeutic target for psychiatric disease.”

In an accompanying editorial, Alessandro Serretti, MD, PhD, and Chiara Fabbri, MD, from the University of Bologna, Italy, assert that “the main innovative contribution of the present study is the combination of qualitative and quantitative analyses of the shared genetic features associated with vulnerability of these 5 disorders.”

They add, “the present study might contribute to future nosographic systems, which could be based not only on statistically determined clinical categories, but also on biological pathogenic factors that are pivotal to the identification of suitable treatments.”

The authors and editorialists have reported no relevant financial relationships.

Retrieved from: http://www.medscape.com/viewarticle/779979?src=nl_topic

Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis

Background

Findings from family and twin studies suggest that genetic contributions to psychiatric disorders do not in all cases map to present diagnostic categories. We aimed to identify specific variants underlying genetic effects shared between the five disorders in the Psychiatric Genomics Consortium: autism spectrum disorder, attention deficit-hyperactivity disorder, bipolar disorder, major depressive disorder, and schizophrenia.

Methods

We analysed genome-wide single-nucleotide polymorphism (SNP) data for the five disorders in 33 332 cases and 27 888 controls of European ancestory. To characterise allelic effects on each disorder, we applied a multinomial logistic regression procedure with model selection to identify the best-fitting model of relations between genotype and phenotype. We examined cross-disorder effects of genome-wide significant loci previously identified for bipolar disorder and schizophrenia, and used polygenic risk-score analysis to examine such effects from a broader set of common variants. We undertook pathway analyses to establish the biological associations underlying genetic overlap for the five disorders. We used enrichment analysis of expression quantitative trait loci (eQTL) data to assess whether SNPs with cross-disorder association were enriched for regulatory SNPs in post-mortem brain-tissue samples.

Findings

SNPs at four loci surpassed the cutoff for genome-wide significance (p<5×10−8) in the primary analysis: regions on chromosomes 3p21 and 10q24, and SNPs within two L-type voltage-gated calcium channel subunits, CACNA1C and CACNB2. Model selection analysis supported effects of these loci for several disorders. Loci previously associated with bipolar disorder or schizophrenia had variable diagnostic specificity. Polygenic risk scores showed cross-disorder associations, notably between adult-onset disorders. Pathway analysis supported a role for calcium channel signalling genes for all five disorders. Finally, SNPs with evidence of cross-disorder association were enriched for brain eQTL markers.

Interpretation

Our findings show that specific SNPs are associated with a range of psychiatric disorders of childhood onset or adult onset. In particular, variation in calcium-channel activity genes seems to have pleiotropic effects on psychopathology. These results provide evidence relevant to the goal of moving beyond descriptive syndromes in psychiatry, and towards a nosology informed by disease cause.

Funding-National Institute of Mental Health.

Retrieved from: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)62129-1/abstract

Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis
Cross-Disorder Group of the Psychiatric Genomics Consortium
The Lancet – 28 February 2013
DOI: 10.1016/S0140-6736(12)62129-1

flapping hands and wagging tails…

In Autism Spectrum Disorders, Child/Adolescent Psychology, Humane Education, Life with dogs, Pets, School Psychology on Tuesday, 26 February 2013 at 06:02

Your Hands Tell Me When You’re Happy

By: Stewart Duncan

Christmas was one week away, the excitement building as we prepared presents for friends and family. We laughed as we changed the words to our favorite Christmas songs, drank Egg Nog and opened the next door to find out what shape the next chocolate was in our advent calendars.

 

As we talk about Santa and what each of us is hoping for, I lean over to my son Cameron and say “Do you know how I always know when you’re happy?”

 

He said “No, how?”

I replied “Your hands tell me.”

He smiled and said “because I flap my hands!”

At that point, he began bouncing on his toes and flapping his hands so hard that I thought he might fly.

Beside us, sitting up against my hip, was my dog Spirit. She is Cameron’s best friend and, I think, Cameron is her best friend too.

I said to Cameron “Cameron, do you know how I always know when Spirit is happy?”

He said “No.”

I told him “Because her tail tells me.”

Again, the excitement building as he flapped his hands really hard, “She wags her tail!!”

I explained to him that Spirit doesn’t have hands so she wags her tail but I imagine that it’s very much the same feeling. There’s just so much happiness inside that it has to come out.

I told him that I know some people might bug him about it, some people might say silly things or tell him that he shouldn’t… but I’ll never stop him from showing me how happy he is.

He got up and gave me a big hug.

*******

About Stuart Duncan

My name is Stuart Duncan, creator of http://www.stuartduncan.name. My oldest son (Cameron) has Autism while my younger son (Tyler) does not. I am a work from home web developer with a background in radio. I do my very best to stay educated and do what ever is necessary to ensure my children have the tools they need to thrive. I share my stories and experiences in an effort to further grow and strengthen the online Autism community and to promote Autism Understanding and Acceptance.

Retrieved from:  http://www.stuartduncan.name/autism/your-hands-tell-me-when-youre-happy/

gender may have more to do with autism than we thought…

In Autism Spectrum Disorders, Genes, Genomic Medicine on Thursday, 21 February 2013 at 15:33

Female Sex May Protect Against Autism

By: Megan Brooks

Autistic behaviors may be less common in girls because girls are less susceptible to some of the genetic and environmental factors that increase risk for autistic spectrum disorders (ASDs), new research suggests.

“There is a well-established sex bias in ASDs — specifically, the overall male to female ratio is about 4:1,” Elise Robinson, ScD, of the Analytic and Translational Genetics Unit, Massachusetts General Hospital and Harvard Medical School, Boston, told Medscape Medical News.

“We were interested in better understanding that pattern through the lens of a potential female protective effect. In other words — are females affected less frequently because they are less susceptible to some of the genetic and environmental factors that create risk for ASDs? That is the primary implication of the study, and it will need to be replicated in future efforts,” Dr. Robinson said.

The study was published online February 19 in Proceedings of the National Academy of Sciences.

Investigators examined data from 2 large, independent cohorts of fraternal twins: 3842 12-year-old twin pairs in the UK-based Twin’s Early Development Study, and 6040 9- to 12-year-old twin pairs in the Swedish Child and Adolescent Twin Study.

In both groups, they compared sibling autistic traits between female and male probands, who were identified as scoring in the top 90th and 95th percentiles of the population autistic trait distributions.

In both study groups, siblings of female probands displayed significantly greater average impairments than the siblings of male probands. This suggests that girls may require greater “etiologic load” to manifest autistic behavior, the authors note.

Reached for comment, Richard E. D’Alli, MD, chief of the Division of Child Development and Behavioral Health from Duke Medicine in Durham, North Carolina, who was not involved in the study, cautioned that there really “isn’t anything new here,” and he does not think it “moves the science forward.”

“If you really believed that the female organism was different in some way to the male organism, that would explain why 5 times as many boys are afflicted with autism. Then you’d be looking for something that has something to do with the development of the disease,” he told Medscape Medical News.

“For example, if there are certain circuits in the brain that we know or certain biochemical events that occur during development that predisposes a kid to autism, you’d ask, ‘Is there a kind of difference in either the neurohormonal makeup of the female brain compared with the male brain that makes the male brain more sensitive to development of these aberrant circuits?’ You would be looking for a neurochemical, or a neurohormonal, or a neuroelectrical circuity difference,” Dr. D’Alli said.

Dr. Robinson said her team pursued the study “primarily for its research implications.”

“A female protective effect, which we found evidence for, would suggest that a greater average concentration of risk factors may be associated with ASDs in girls as compared to ASDs in boys. If our findings are replicated, this knowledge could help us pursue genetic and environmental studies of ASDs more efficiently, and better interpret our findings,” she said.

The authors and Dr. D’Alli have disclosed no relevant financial relationships.

Proc Natl Acad Sci. Published online February 19, 2013. Abstract

Retrieved from: http://www.medscape.com/viewarticle/779650?src=nl_topic

Examining and interpreting the female protective effect against autistic behavior

Elise B. Robinson, Paul Lichtenstein, Henrik Anckarsäter, Francesca Happé, and Angelica Ronald

Abstract

Male preponderance in autistic behavioral impairment has been explained in terms of a hypothetical protective effect of female sex, yet little research has tested this hypothesis empirically. If females are protected, they should require greater etiologic load to manifest the same degree of impairment as males. The objective of this analysis was to examine whether greater familial etiologic load was associated with quantitative autistic impairments in females compared with males. Subjects included 3,842 dizygotic twin pairs from the Twins Early Development Study (TEDS) and 6,040 dizygotic twin pairs from the Child and Adolescent Twin Study of Sweden (CATSS). In both samples, we compared sibling autistic traits between female and male probands, who were identified as children scoring in the top 90th and 95th percentiles of the population autistic trait distributions. In both TEDS and CATSS, siblings of female probands above the 90th percentile had significantly more autistic impairments than the siblings of male probands above the 90th percentile. The siblings of female probands above the 90th percentile also had greater categorical recurrence risk in both TEDS and CATSS. Results were similar in probands above the 95th percentile. This finding, replicated across two nationally-representative samples, suggests that female sex protects girls from autistic impairments and that girls may require greater familial etiologic load to manifest the phenotype. It provides empirical support for the hypothesis of a female protective effect against autistic behavior and can be used to inform and interpret future gene finding efforts in autism spectrum disorders.

Retrieved from: http://www.pnas.org/content/early/2013/02/13/1211070110.abstract?cited-by=yes&legid=pnas;1211070110v1#cited-by

 

 

eating troubles and autism…a link?

In Autism Spectrum Disorders on Sunday, 10 February 2013 at 09:11

http://www.disabilityscoop.com/2013/02/07/study-eating-troubles-autism/17266/

Top 10 Parenting Books on Autism

In Autism Spectrum Disorders on Monday, 21 January 2013 at 10:42

Top 10 Parenting Books on Autism

by Lee Wilkinson, Ph.D.

Many authors of parenting books on autism often comment that they wrote their book because of difficulty in finding a practical, informative book on the topic of raising a child with autism spectrum disorder (ASD). However, over the past few years many autism parenting books have been published and parents of a newly diagnosed child with autism can find some very good offerings. TheSpecial Needs Book Review has listed theirTOP TEN Books for parents raising a child with autism. Please note that Special Needs Book Review is not paid for reviewing books. The reviews and TOP TEN Books on autism are entirely their opinions. The ten books are in random order. Readers can follow the link in each paragraph to the complete review of each book. Many of the authors have participated in the Special Needs Book Review Author Interview Series and you will find a link to the interviews with the review of their book.

TOP TEN Parenting Books on Autism

1. Different . . . Not Less: Inspiring Stories of Achievement and Successful Employment from Adults with Autism, Asperger’s, and ADHD -by Temple Grandin, PhD. ~ Dr Temple Grandin found the perfect words, Different…Not Less, to describe herself and the fourteen contributors of her new book who all have autism or Asperger’s. In the foreword, Dr Tony Attwood writes, “This is an inspiring book.” Each contributor has a chapter and their story is told in their own words. Dr. Grandin chose individuals from a wide variety of skill sets, from different countries, ranging in age from their 30’s to 60’s but the topics addressed are similar: early years, school years, parental support, bullying, college, family relationships, employment, diagnosis, mentors, etc. Review

2. 1001 Great Ideas for Teaching & Raising Children with Autism or Asperger’s: Expanded 2nd Edition -by Ellen Notbohm and Veronica Zysk ~ Looking for advice, support and encouragement in your overwhelming journey raising a child with autism or Asperger’s? This is the book you need. Teachers, friends, and family of autistic children read this empowering book crammed with information, solutions, and explanations to make the lives of these children better.Review

3. What I Wish I’d Known About Raising a Child with Autism: A Mom and a Psychologist Offer Heartfelt Guidance for the First Five Years ~ Bravo to authors Bobbi Sheahan and Kathy DeOrnellas, Ph.D. in achieving what they set out to do. Write a book to assure those who love and care for an individual on the autism spectrum that life goes on; it doesn’t have to be all depressing, hard work. If you are an educator, or know a family with an autistic child, this book is also for you because you will understand the challenges these families face. Reading their book will bring understanding and compassion to others… hopefully those standing in line with you at the checkout counters. Review

4. Look at my Eyes: Autism Spectrum Disorders: Autism and PDD-NOS -by Melanie and Seth Fowler~ I love this gem of a book from cover to cover! I recommend it to the general public so they can know what it is like to raise a child with autism, in this case a boy diagnosed with PDD-NOS (pervasive developmental disorder-not otherwise specified). I recommend this book to new parents who are questioning if their toddler is on track with his developmental milestones. Most of all Look at my Eyes in a must-read if you have a child newly diagnosed as being on the autism spectrum.Review

5. Thinking Person’s Guide to Autism: What you really need to know about autism from autistics, parents, and professionals ~ Edited by Shannon Des Roches Rosa, Jennifer Byde Myers, Liz Ditz, Emily Willingham and Carol Greenburg. This awesome book has fifty-five essays written by contributors from the autism community in all walks of life. The autism spectrum disorder community, especially parents of newly diagnosed children, needs this book. It is filled with positive, evidence-based autism information and advice. There are nine broad themes/chapters and the essays are grouped together accordingly. To quickly retrieve an essay on a particular topic, Thinking Person’s Guide to Autism has a comprehensive index… something so many books lack. Review

6. Crazy Love: A Traumedy about Life with Autism -by Sharie Walter ~ This book tickles your funny bone from cover to cover. In her memoir, Sharie keeps you entertained with her amusing stories of life with autism raising her 5 year old daughter. Ms. Walter is surely a talented wordsmith that keeps you chuckling with her brilliantly written snippets of life with autism. Laugh a lot and learn a lot from Sharie Walter’s beautifully written book. Review

7. The Way I See It: A Personal Look at Autism and Asperger’s -by Temple Grandin, Ph.D. ~What an amazing accomplishment on the part of her parents, the professionals, caregivers and friends who helped her and on Temple herself to have overcome or learned to cope with many of her challenges caused by autism. Readers will rejoice and be filled with hope for their own loved ones with autism or Asperger’s as they read Temple’s story on how she was motivated to forge ahead and adapt. Review

8. The Child with Autism at Home & in the Community: Over 600 Must-Have Tips -by Kathy Labosh and LaNita Miller ~ 600 bullet points providing practical tips and tried-out strategies for families and educators to use to meet the needs of autistic children. You will find TIPS to make your home life happier and easier on picky eating, shampoos, and locking doors to prevent elopements, etc. Then you find the hundreds of suggestions on how to go out and enjoy your community. Learn what to do to enjoy the community playground, restaurant, mall, grocery store, movie theater, church, library, and sporting events, etc. Review

9. Challenging the Myths of Autism: Unlock New Possibilities and Hope -by Jonathan Alderson, Ed.M ~ In this book, Jonathan examines seven stereotypical characterizations or “myths of autism”. He has a chapter on each of these perennially inaccurate descriptions. Each chapter explains the origins of the seven myths and discusses the evidence refuting them. The author invites the reader to put aside their preconceived notions of autism which can mislead parents, therapists, and the general public to underestimate the potential of children with autism. Alderson’s book is crammed with heartwarming stories and useful information. Review

10. Developing Leisure Time Skills for Persons with Autism: Structured Playtime Activities with Valuable Support Strategies for Adults -by Phyllis Coyne, Colleen Nyberg, and Mary Lou Vandenburg ~ This book is a detailed guide with comprehensive, structured strategies to help adults introduce meaningful, leisure activities to children with ASD. The method used is to narrow down the personal preferences and strengths of these individuals and use this knowledge to assist them to be more independent and self-directing in participating in more enjoyable and meaningful leisure activities. Review

Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published byJessica Kingsley Publishers.

Retrieved from: http://www.examiner.com/article/top-10-parenting-books-on-autism

early intervention and autism

In Autism Spectrum Disorders, Intervention, School Psychology, Special Education on Friday, 4 January 2013 at 11:21

Early Intervention Program Alters Brain Activity in Children with Autism

Clinical study of Early Start Denver Model intervention shows that it improves not only social skills, but also brain responses to social cues

Decades of research have shown that behavioral therapies for autism can improve cognitive and language skills. Still, it remained unclear whether behavioral interventions simply reduced autism’s symptoms or actually “treated” the developmental disorder. In other words, could an effective behavioral intervention change the brain biology that underlies autism spectrum disorder?

This year, researchers delivered compelling evidence that the Early Start Denver Model(ESDM), an intensive early intervention program for toddlers with autism, improves brain activity related to social responsiveness. The Journal of the American Academy of Child & Adolescent Psychiatry published the findings in its November issue.

“This may be the first demonstration that a behavioral intervention for autism is associated with changes in brain function as well as positive changes in behavior,” commented Tom Insel, M.D., director of the National Institute of Mental Health.

Psychologists Sally Rogers, Ph.D., and Geraldine Dawson, Ph.D., developed the ESDM therapy program in the 1990s. It adapts key techniques from Applied Behavioral Analysis(ABA) for toddlers, with an emphasis on interactive play between children and their therapists and parents. Dr. Rogers is a professor and researcher at the University of California, Davis, MIND Institute. Dr. Dawson was a professor and researcher at the University of Washington, Seattle, when she and Dr. Rogers developed the program. She is now the chief science officer of Autism Speaks and a professor at the University of North Carolina, Chapel Hill.

Three years ago, Drs. Dawson and Rogers published the first results of a clinical trial comparing ESDM with conventional autism therapy services. They randomly  48 toddlers (ages 18 to 30 months) to receive either ESDM therapy or the early intervention services routinely available in their communities (Seattle). Both groups received roughly 20 hours of weekly therapy for two years. Overall, those in the ESDM group showed greater increases in IQ, language and adaptive behavior than children in the community-intervention group.

In this year’s report, the research team published their analysis of brain activity monitoring performed on both groups of children at the end of their two years of therapy. For comparison, they also performed the brain activity tests on a group of age-matched children without autism.

Noninvasive electroencephalography (EEG) showed that the children in the ESDM group showed greater brain responses to social information compared to children in the community group. When they viewed women’s faces, their brain activity patterns were virtually identical to those of the children without autism. This more-typical pattern of brain activity was associated with improved social behavior including improved eye contact and social communication.

By contrast, children in the community intervention group showed greater brain activity when viewing objects than faces. Previous research has shown that many children with autism have this unusual pattern of brain activity.

“By studying changes in the neural response to faces, Dr. Dawson and her colleagues have identified a new target and a potential biomarker that can guide treatment development,” Dr. Insel said.

“So much of a toddler’s learning involves social interaction,” Dr. Dawson added. “As a result, an early intervention program that promotes attention to people and social cues may pay dividends in promoting the normal development of brain and behavior.”

The American Academy of Pediatrics recommends autism screening for all children twice before 24 months. “When families receive a diagnosis, it’s vitally important that we have effective therapies available for their young children,” Dr. Dawson urged. Currently ESDM is the only early intervention evaluated in clinical trials.

As methods for earlier detection become available, infants flagged at risk for ASD may likewise benefit from early intervention, many experts agree. Research suggests that adults with autism can benefit from interventions that promote social engagement as well.

Dawson G, Jones EJ, Merkle K, et al. Early behavioral intervention is associated with normalized brain activity in young children with autism. J Am Acad Child Adolesc Psychiatry. 2012; 51(11):1150-9.

Retrieved from: http://www.autismspeaks.org/science/science-news/top-ten-lists/2012/early-intervention-program-brain-activity-children-autism

autism night before christmas…

In Autism Spectrum Disorders, Inspiration on Tuesday, 25 December 2012 at 11:54

Autism Night Before Christmas
by Cindy Waeltermann

“Twas the Night Before Christmas
And all through the house
The creatures were stirring
Yes, even the mouse

We tried melatonin
And gave a hot bath
But the holiday jitters
They always distract

The children were finally
All nestled in bed
When nightmares of terror
Ran through my OWN head

Did I get the right gift
The right color
And style
Would there be a tantrum
Or even, maybe, a smile?

Our relatives come
But they don’t understand
The pleasure he gets
Just from flapping his hands.

“He needs discipline,” they say
“Just a well-needed smack,
You must learn to parent…”
And on goes the attack

We smile and nod
Because we know deep inside
The argument is moot
Let them all take a side

We know what it’s like
To live with the spectrum
The struggles and triumphs
Achievements, regressions…

But what they don’t know
And what they don’t see
Is the joy that we feel
Over simplicity

He said “hello”
He ate something green!
He told his first lie!
He did not cause a scene!

He peed on the potty
Who cares if he’s ten,
He stopped saying the same thing
Again and again!

Others don’t realize
Just how we can cope
How we bravely hang on
At the end of our rope

But what they don’t see
Is the joy we can’t hide
When our children with autism
Make the tiniest stride

We may look at others
Without the problems we face
With jealousy, hatred
Or even distaste,

But what they don’t know
Nor sometimes do we
Is that children with autism
Bring simplicity.

We don’t get excited
Over expensive things
We jump for joy
With the progress work brings

Children with autism
Try hard every day
That they make us proud
More than words can say.

They work even harder
Than you or I
To achieve something small
To reach a star in the sky

So to those who don’t get it
Or can’t get a clue
Take a walk in my shoes
And I’ll assure you

That even 10 minutes
Into the walk
You’ll look at me
With respect, even shock.

You will realize
What it is I go through
And the next time you judge
I can assure you

That you won’t say a thing
You’ll be quiet and learn,
Like the years that I did
When the tables were turned…….”

DSM-V…out with the old and in with the new…

In Autism Spectrum Disorders, General Psychology, Psychiatry, School Psychology on Thursday, 6 December 2012 at 11:20

http://www.cbsnews.com/8301-204_162-57556754/aspergers-syndrome-dropped-from-american-psychiatric-association-manual/

inclusion for all?

In Autism Spectrum Disorders, School Psychology, Special Education on Tuesday, 27 November 2012 at 15:36

Study Questions Benefits of Inlcusion for Autism

By: Lee Wilkinson, Ph.D.

The Individuals with Disabilities Education Improvement Act of 2004 (IDEA) (P.L. 108-446) (idea.ed.gov/) guarantees a free and appropriate public education (FAPE) in the least restrictive environment (LRE) for every student with a disability. The LRE provision mandates that “to the maximum extent appropriate, children with disabilities, including children in public or private institutions or other care facilities, are educated with children who are not disabled, and special classes, separate schooling, or other removal of children with disabilities from the regular educational environment occurs only when the nature or severity of the disability of a child is such that education in regular classes with the use of supplementary aids and services cannot be achieved satisfactorily.” In general,inclusion (or inclusive education) with typical peers is often considered to be the best placement option for students with disabilities. However, a study published in Pediatrics, the official journal of the American Academy of Pediatrics, calls into question whether or not inclusive education actually leads to better outcomes in the long term for children with autism.

The Study

Researchers from the University of Alabama at Birmingham and Johns Hopkins University sought to determine whether the proportion of time spent in an inclusive educational setting, a process indicator of the quality of schooling for children with autism, improves key outcomes. The participants were 484 children and youth educated in special education with a primary diagnosis of autism in the National Longitudinal Transition Study-2 (NLTS2). The NLTS2 is a 10-year study of youth with disabilities who were receiving special education services in public or state-supported special schools. The NLTS2 uses a nationally representative sample of youth in special education who were between the ages of 13 and 16 on December 1, 2000.

The primary exposure of interest in this analysis was the proportion of time the youth spent in a general education classroom. A school program questionnaire was used to collect data on the courses that each student took during the 2003 school year and whether each course was taken in a general education or special education classroom. The proportion of time spent in an inclusive setting was categorized as 0%, 1% to 74%, or 75% to 100% of courses taken in a general education classroom.

Key Outcomes

Three outcomes were assessed in the study’s analysis: (1) not dropping out of high school, (2) any college attendance, and (3) a cognitive functional scale. Youth were coded as not dropping out if the parent reported that they graduated, received a certificate or General Educational Development certificate, or were still in high school at the time of data collection. Any college attendance was based on parent report of whether the youth attended any type of postsecondary school in the previous 2 years, including postsecondary classes to earn a high school degree, a 2-year or 4-year college, or postsecondary vocational school. The functional cognitive scale measured a combination of parent-reported cognitive, sensory, and motor skills used in performing daily activities (such as counting change). Parents rated their child on a scale of 1 (“not at all well”) to 4 (“very well”) for each of these skills. The rating for each skill was added to create the functional cognitive scale, which ranged from 4 (not at all well for any of the skills) to 16 (very well for all of the skills).

Results

Compared with children with autism who were not educated in an inclusive setting, children with autism who spent 75% to 100% of their time in a general education classroom were no more likely to attend college, not drop out of high school, or have an improved functional cognitive score after controlling for key confounders. The researchers state that “In general, our analyses suggest that inclusivity does not improve educational or functional outcomes for children with autism.” They also note that although the link between inclusivity and outcome remains weak, “inclusive education” that is well implemented and supported might have substantial benefits. Recommendations for further research include investigation of educational and functional outcomes from data on large samples of children in real-world settings. There is also a need for developing future indicators to measure the “quality” of special education for children with autism. This includes a careful description of the learning environment and experiences within and between communities as well as key measures specific to the characteristics and education of children with autism. The authors conclude that the study illustrates the challenges of understanding the effect of real-world services and treatments and that a “A fuller understanding of inclusively and other potential measures of educational quality may have to wait for better data and methods.”

Foster, E. M., & Pearson, E. (2012). Inclusivity an Indicator of Quality of Care for Children With Autism in Special Education? Pediatrics, 130, S179-S184.

Lee A. Wilkinson, PhD is the author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome from Jessica Kingsley Publishers.

Dr. Wilkinson can be reached at bestpracticeautism.com.

Retrieved from: http://www.examiner.com/article/study-questions-benefits-of-inclusion-for-autism

give a hoot, don’t pollute!

In Autism Spectrum Disorders on Tuesday, 27 November 2012 at 15:26

High Levels of Pollution May Boost Autism Risk

By: Pam Harrison

Exposure to the highest levels of traffic-related air pollution during pregnancy and the first year of life increases the risk for autism, a case-control study shows.

Heather Volk, PhD, MPH, and colleagues from the Keck School of Medicine at the University of Southern California, in Los Angeles, found that children exposed to the highest levels of both particulate matter and nitrogen dioxide during pregnancy and the first year of life were 3 times more likely to have autism than children with the lowest levels of exposure.

“Previously, we looked at how far an individual lived away from a freeway or a busy road as a proxy for pollution exposure,” Dr. Volk told Medscape Medical News.

“In this study, we looked at modeled traffic-related pollution exposure and data from a regional air quality monitoring system so we could look at the actual amount of pollution to which the mother was exposed.

“Based on our data, it does seem to be the estimated level of exposure that increases the risk of autism, as there wasn’t any effect on autism risk from any of the other risk factors we analyzed.”

The study was published online November 26 in the Archives of General Psychiatry.

Hazardous to the Brain

In 2010, Dr. Volk and colleagues published an article reporting an association between the risk for autism in the Childhood Autism Risks from Genetics and the Environment (CHARGE) study cohort and living within 1000 feet of a freeway.

In this study, 279 children with autism and 245 control children with typical development from the same CHARGE study were analyzed.

Eight-four percent of the children in the study were boys.

Investigators used regional air quality data for exposure to particulate matter less than 2.5 μm (PM 2.5) and less than 10 μm (PM 10) in diameter as well as exposure to ozone and nitrogen dioxide.

The data were derived from the US Environmental Protection Agency’s Air Quality System data.

Unlike exposure to the highest levels of traffic-related air pollutants, exposure to the second and third quartiles of traffic pollutants was not associated with an increased risk for autism.

On the other hand, exposure to the highest quartiles of traffic-related air pollutants during pregnancy increased the risk for autism almost 2-fold compared with exposure to the lowest quartiles of air pollutants.

The authors also found that during all 3 trimesters of pregnancy, there were associations with the highest quartile of exposure to air pollutants and autism risk compared with the lowest quartile of air pollutants.

High levels of exposure to PM 2.5, PM 10, and nitrogen dioxide were also associated with an increased risk for autism.

In contrast, investigators did not find any association between exposure to regional ozone and autism.

Table: Risk for Autism for 524 Children, by Quartile of Traffic-Related Air Pollution

  4th Quartile 3rd Quartile 2nd Quartile
1st year of life (adjusted odds ratio) 3.10 1.00 0.91
All pregnancy (adjusted odds ratio) 1.98 1.09 1.26

 

“From studies conducted in the lab, we know that we can breathe in tiny particles, and they can produce inflammation,” said Dr. Volk. “Particles have varied composition, and there are many chemicals that can bind to them. The components of these particles could be hazardous to the brain.”

Highly Prevalent Disorder

In an accompanying editorial, Geraldine Dawson, PhD, University of North Carolina, Chapel Hill, points out that the prevalence of autism spectrum disorder (ASD) has increased by 78% in the past 6 years alone.

“The alarming rise in prevalence has led to more scrutiny of environmental risk factors, such as the study on air pollution as a risk factor for autism,” she added.

Although the study by Dr. Volk and colleagues was not the first to report an association between air pollution and autism risk, “the study is notable for its regional measurement of nitrogen dioxide and particulate matter,” Dr. Dawson states.

Moreover, results from the current study could not be attributed to ethnicity, parental education, smoking during pregnancy, or living in a densely populated region, she also notes.

According to Dr. Dawson, more research on risk factors and ASD is needed to develop strategies for preventing or reducing the disabling symptoms associated with this “highly prevalent and costly neurodevelopmental disorder.”

The study was supported by a grant from the National Institute of Environmental Health Sciences and by the MIND Institute. Dr. Volk reports receiving support from Autism Speaks to present research findings at the International Society for Environmental Epidemiology Meeting in 2012. Dr. Dawson has disclosed no relevant financial relationships.

Arch Gen Psychiatry. Published online November 26, 2012. AbstractEditorial

Retrieved from: http://www.medscape.com/viewarticle/775077?src=nl_topic

Emotional Intelligence and Autism Spectrum Disorders

In Autism Spectrum Disorders on Saturday, 24 November 2012 at 07:29

Emotional Intelligence (EI) and ASD

By: Lee Wilkinson, Ph.D.

Emotional intelligence (EI) is broadly defined as the ability to identify, assess, and control the emotions of oneself, of others, and of groups. The interest and research relating to EI has grown dramatically over the past decade. Currently, there are two emotional intelligence constructs: ability EI (or cognitive-emotional ability) and trait EI (or trait emotional self-efficacy). They are differentiated by the type of measurement used in the operationalization process. For example, the ability perspective conceives EI as a form of intelligence best assessed via performance tests and has stronger relationships with cognitive ability hierarchies. Thus, ability EI refers to individual differences in the ability to process and use emotional information to promote effective functioning in everyday life. Trait EI concerns behavioral dispositions and self-perceived abilities and is measured through self-report. Trait EI has stronger relationships with personality and concerns people’s perceptions of their emotional abilities (how good we believe we are in understanding and managing our own and other people’s emotions, rather than how good we actually are). These perceptions are generally stable over time and have a direct influence on mood, behavior, achievement, and action. In other words, trait EI is defined, not as a cognitive ability, but as a collection of personality traits concerning people’s perceptions of their emotional abilities.

Trait EI and ASD 

The defining feature of autism spectrum disorders (ASD) is impairment in interpersonal relating and communication. This includes difficulty communicating with others, processing and integrating information from the environment, establishing and maintaining reciprocal social relationships, taking another person’s perspective, inferring the interests of others, and transitioning to new learning environments. While all individuals with ASD experience core social-communication deficits, we now recognize that autism-related traits are quantitatively distributed in the general population and that autism is best conceptualized as a spectrum disorder, rather than a categorical diagnosis. Even mild degrees of what might be called autistic social impairment can significantly interfere with adaptive behavior. Likewise, a combination of mild autistic symptomatology and other psychological liabilities (e.g., attention problems, mood problems, aggression) can have an adverse effect on social and emotional adjustment. Unfortunately, the core features of ASD may not diminish with development. Typically, individuals do not ‘‘outgrow’’ their deficits. Distress may actually increase as the social milieu becomes more complex and challenging. These difficulties may then persist well into adulthood and lead to comorbid emotional symptoms. Indeed, high stress, anxiety and depression are regularly present in persons with ASD.

ASD involves deficits that are directly relevant to the constellation of emotional self-perceptions encompassed by trait EI. Trait emotional intelligence (trait EI) encompasses many of the aspects of social-emotional functioning that have been shown to be impaired in ASD in the form of self-perceptions. Research has begun to examine the link between higher functioning ASD (e.g., Asperger syndrome) and trait EI. A recent study compared the trait EI profiles of men and women diagnosed with AS with those of a normative sample, group-matched on age and gender. Participants were thirty adults diagnosed with AS (16 women and 14 men) who volunteered for the study and were subsequently group-matched with 43 typically developing adults (22 women and 21 men). There were no significant differences in the mean age of the participants with and without AS and no significant between-group differences in the distribution of gender. All participants completed the Trait Emotional Intelligence Questionnaire (TEIQue), a self-report inventory specifically designed to comprehensively measure the trait EI construct. The TEIQue consists of 153 items rated on a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree) and includes 15 subscales (facets) organized under four factors (Well-Being, Self-Control, Emotionality, and Sociability) and global trait EI. It has been shown to have satisfactory psychometric properties in various studies. Below is a list of the 15 trait EI facets, along with a brief description of each.  These facets comprise the current sampling domain of trait emotional intelligence in adults and adolescents.   

Facets                                                     High scorers perceive themselves as…

Adaptability                                              flexible and willing to adapt to new conditions.
Assertiveness                                           forthright, frank, & willing to stand up for rights. 
Emotion perception (selfothers)  clear about their own & other people’s feelings. 
Emotion expression                              capable of communicating their feelings to others.
Emotion management (others)        capable of influencing other people’s feelings. 
Emotion regulation                               capable of controlling their emotions.
Impulsiveness (low)                              reflective & less likely to give in to their urges.
Relationships                                           capable of having fulfilling personal relationships.
Self-esteem                                               successful & self-confident.
Self-motivation                                       driven & unlikely to give up in the face of adversity. 
Social awareness                                     accomplished networkers with excellent social skills.
Stress management                               capable of withstanding pressure & regulating stress.
Trait empathy                                         capable of taking someone else’s perspective.
Trait happiness                                       cheerful & satisfied with their lives.
Trait optimism                                        confident & likely to “look on the bright side” of life.

Findings and Implications 

The researchers hypothesized if individuals with Asperger syndrome have limited understanding their social-communication deficits, then they would score similarly to typical adults on the TEIQue. However, if they have an accurate understanding of these deficits, then they would score significantly lower. The researchers also sought to shed light on the gender discrepancy routinely observed in ASD, particularly in those more able individuals diagnosed with ASD.

The results showed that individuals with AS had significantly lower scores on most TEIQue variables, including the global trait EI score. The Asperger group scored significantly lower on 12 out of the 15 facets of the Trait Emotional Intelligence Questionnaire (TEIQue). They rated themselves particularly low on questions relating to social awareness, emotion management, adaptability, empathy, and emotion perception. The finding appears to be consistent with the clinical presentation of this ASD. Differences were much smaller, or non-existent, on questions relating to self-control (especially, impulse control and emotion control). With respect to gender, males scored higher than females, albeit with small effect sizes. Overall, the findings suggest that individuals with Asperger syndrome have insight into the nature of their condition and are aware of the strengths and weaknesses of their personality. These data also suggest that the female phenotype of AS may be associated with greater impairment than the male phenotype.

This research contributes to the evidence documenting the effect of trait EI self-perceptions and dispositions on socio-emotional development and overall psychological well-being. The well-being component of trait EI may be especially relevant in the adjustment process, since positive emotions contribute to the development of those physical, intellectual and social resources necessary to cope successfully with the demands of the social world. There are extensive individual differences in people’s perceptions of their emotional abilities. Because trait EI affects behavior, self-referent cognitions and mental health, it is an important variable to consider in the evaluation and treatment of higher functioning individuals with ASD. Although individuals with ASD appear to be aware of their social-communication deficits, further study is needed into the capacity for insight and how it may be utilized in treatment/intervention. Likewise, further study is also needed to examine the relationship of trait EI variables to symptom severity and determine to what extent individual self-perceptions predict outcomes (e.g., life satisfaction, coping strategies, and job performance).  Perceived emotional self-efficacy also plays an important role in emotion management and regulation in education. Consequently, further research on trait EI should include children with ASD. A child version of the TEIQue (TEIQue-Child Form) is available for children aged between 8 and 12 years of age and measures nine distinct facets. An examination of trait EI profiles of children with ASD may assist with identification, intervention, and progress monitoring.

Petrides, K. V., Hudry, C., Michalaria, G., Swami, V., & Sevdalis, N. (2011). Comparison of the trait emotional intelligence profiles of individuals with and without Asperger syndrome. Autism, 15, 671–682. doi 10.1177/1362361310397217

Detailed information about trait EI and the various facets of the TEIQue can be found athttp://www.psychometriclab.com

The online version of this article can be found at http://aut.sagepub.com/content/15/6.toc

Retrieved from: http://bestpracticeautism.blogspot.com/2012/11/emotional-intelligence-ei-and-asd.html

autism in korea…

In Autism Spectrum Disorders on Friday, 23 November 2012 at 17:24

this is an older article, but worth posting.  interesting.

Study in Korea Puts Autism’s Prevalence at 2.6%, Surprising Experts

By CLAUDIA WALLIS

An ambitious six-year effort to gauge the rate of childhood autism in a middle-class South Korean city has yielded a figure that stunned experts and is likely to influence the way the disorder’s prevalence is measured around the world, scientists reported on Monday.

The figure, 2.6 percent of all children aged 7 to 12 in the Ilsan district of the city of Goyang, is more than twice the rate usually reported in the developed world. Even that rate, about 1 percent, has been climbing rapidly in recent years — from 0.6 percent in the United States in 2007, for example.

But experts said the findings did not mean that the actual numbers of children with autism were rising, simply that the study was more comprehensive than previous ones.

“This is a very impressive study,” said Lisa Croen, director of the autism research program at Kaiser-Permanente Northern California, who was not connected with the new report. “They did a careful job and in a part of the world where autism has not been well documented in the past.”

For the study, which is being published in The American Journal of Psychiatry, researchers from the Yale Child Study CenterGeorge Washington University and other leading institutions sought to screen every child aged 7 to 12 in Ilsan, a community of 488,590, about the size of Staten Island.

By contrast, the Centers for Disease Control and Prevention in the United States and most other research groups measure autism prevalence by examining and verifying records of existing cases kept by health care and special education agencies. That approach may leave out many children whose parents and schools have never sought a diagnosis.

In recent years scientists have come to see autism as a spectrum of disorders that can include profound social disconnection and mental retardation, but also milder forms, likeAsperger’s syndrome, that are pervasive and potentially disabling but that often go undiagnosed.

“From the get-go we had the feeling that we would find a higher prevalence than other studies because we were looking at an understudied population: children in regular schools,” said the lead researcher, Dr. Young-Shin Kim, a child psychiatrist and epidemiologist at the Yale Child Study Center.

South Korea was chosen not only because autism prevalence had not been measured there, but also because its national health care system, universal education and homogeneous population made it a promising region for a planned series of studies that will also look at genetic and environmental factors in autism.

The study, which was largely financed by the research and advocacy group Autism Speaks, raises the question of whether a similarly high prevalence would be found in the United States if all children were screened.

Dr. Marshalyn Yeargin-Allsopp, chief of developmental disabilities at the National Center on Birth Defects and Developmental Disabilities of the C.D.C., acknowledged that her agency’s records-based approach probably missed some autistic children — especially among the poor, among racial minorities and “potentially among girls” — and said the agency was interested in taking part in a population-based approach like the Korean study.

“We believe this will be a way to get as complete an estimate of A.S.D. prevalence as possible,” she said in an e-mail, using the abbreviation for autism spectrum disorder.

Most cases of autism spectrum disorder in the Korean study, the researchers said, turned up among children in regular schools who had no record of receiving special education ormental health services. A third were found among a “high-probability group” of 294 children who were attending special-education schools or were listed on a registry of disabled children.

The children in that high-probability group were similar in many ways to children with autism in the United States and elsewhere. Fifty-nine percent were intellectually disabled, or mentally retarded; more than two-thirds had full-blown autism, as opposed to milder forms like Asperger’s; and boys outnumbered girls five to one.

Among the children with autism spectrum disorder in regular schools, only 16 percent were intellectually disabled, more than two-thirds had a milder form of autism, and the ratio of boys to girls was unusually low: 2.5 to 1.

In addition, 12 percent of these children had a superior I.Q. — a higher proportion than found in the general population.

Researchers used a two-step process to identify autism among ordinary schoolchildren: parents and teachers completed a 27-item questionnaire on each child, and children who scored in the autistic range on that questionnaire were individually evaluated.

“If we had only looked at the high-probability group, we would have come up with about 0.7 percent, which is in line with C.D.C. statistics for the U.S.,” said the study’s senior author, Roy Richard Grinker, a professor of anthropology and international affairs atGeorge Washington University.

The surprisingly large proportion of cases uncovered in ordinary schools, he noted, may in part reflect the low level of awareness and high degree of stigma attached to autism in South Korea. In addition, children with autism spectrum disorders may stand out less in South Korean schools, which follow highly structured and predictable routines and emphasize rote learning.

Other experts said that more “population based” studies, though costly, could help determine how broadly the Korean findings could be generalized to other societies.

Craig J. Newschaffer, chairman of epidemiology and biostatistics at the Drexel School of Public Health in Philadelphia, praised the new report, calling it “quite a strong study,” but he added that the results were based on information about 63 percent of the schoolchildren, a good response rate but not ideal.

“It is just one area of Korea,” he said, “and we know that there’s random variation in how diseases are distributed.”

Retrieved from: http://www.nytimes.com/2011/05/09/health/research/09autism.html

 

autism grows up…

In Autism Spectrum Disorders, School Psychology on Friday, 23 November 2012 at 17:19

Experts Brace for a Wave of Autistic Adults

by: Erin Allday

Guido Abenes appreciates their concern, but he’d really like his parents to stop worrying about him.

He’s 25, he says, and he’s doing fine. But he’s also autistic, part of the generation of young adults who were born during the first big wave of autism cases in the United States two decades ago and are now struggling to strike out on their own.

“I tell them sometimes, ‘Stop it, I’m doing things, I’m resourceful,’ ” said Abenes, who is a student at Cal State East Bay. “They’re getting the message, I think. But they still worry.”

Abenes, who wants to be a therapist someday and travel the world, is fortunate. He joined the College Internship Program in Berkeley, which provides him with a two-bedroom apartment he shares with a roommate, along with intensive, daily academic and developmental support to help him continue to thrive into adulthood.

But Abenes’ situation is unusual, say autism advocates and experts, who are bracing for a flood of adults with autism who lack the support they had as children, and are entering a world that isn’t ready for them.

Skyrocketing rates

It was in the late 1980s and early ’90s that rates of autism started skyrocketing in the United States. A condition that once was considered rare, with fewer than 2 cases per 1,000 births in the United States, is now thought to afflict 1 in 88 children, according to the Centers for Disease Control and Prevention. It’s unclear exactly what has caused the increase, but factors could include greater awareness and better diagnosing of the condition, as well as an actual rise in cases, perhaps related to environmental factors.

For those born in that first wave and now entering adulthood, it’s a tough, uncertain future. Some, like Abenes, will go to college or find jobs and eventually move out on their own.

But most will not, studies show. Most will continue to live at home and will, at best, find part-time, minimum-wage work – or no work at all. Many will suffer setbacks in their condition. Two recent studies found that only about a third of autistic young adults had jobs or went to school.

“A majority of our adults are underserved or not served at all. They can’t access the same services as adults that they had as children,” said Jim Ball, board chairman of the Autism Society, a national advocacy group. “We are doing a lot for our kids, but these kids are going to live to 80 or 90 years old – they’re going to live the majority of their lives as adults. What are we doing for them in that realm?”

Twenty-two years old is an important turning point for many young people with autism. That’s when they officially age out of the public school system that offered them educational and other supportive services.

Kids in the middle

Kids with intellectual disabilities – most notably, an IQ under 70 – often have post-high school opportunities for continued improvement and some measure of independent living. Most of them will continue to get supportive care daily for the rest of their adult lives from state and federal programs.

And the young people at the opposite end of the spectrum – the ones identified as having Asperger’s syndrome, a mild form of autism, who may have above-average IQs or skills that will aid them in college and careers – often manage adult life just fine.

It’s the ones in the middle who suffer the most, autism experts said. They don’t have enough of a disability to get major supportive care, but they’re clearly disabled enough that they have a hard time finding, and keeping, jobs or attending college classes.

“These are kids who seem like they could do things and be successful, and they just end up staying at home because there are very few resources for them,” said Dr. Carl Feinstein, director of the Stanford Autism Center at Lucile Packard Children’s Hospital.

“Their parents are frustrated because they don’t know how to help and they aren’t so happy with their kids living in their home,” he said. “Meanwhile, these kids grew up thinking they would have a driver’s license and an apartment of their own, and they’d get married and have all these things that aren’t happening.”

That’s where something like Berkeley’s College Internship Program comes in. The program was started in the 1980s on the East Coast by a man who was diagnosed with Asperger’s in his 50s. It serves young adults ages 18 to 26 who have autism or other types of learning disabilities, many of whom fall in that middle range of needing support.

Preparation for life

The goal of the program is to provide the support services these young people may need to be successful in school and start a career, as well as teaching life skills to help them become independent adults.

The students live in housing provided by the program in downtown Berkeley, and they usually attend classes at nearby community colleges. At the program center, students get lessons in cooking and banking and other basic living skills. They learn how to budget their time, how to apply for jobs and how to get along with co-workers and bosses.

But it’s expensive: The program costs $30,000 to $70,000 a year, not including housing or tuition at other academic institutions. Scholarships are available and insurance may cover some or all of the expenses.

For those who can afford it, or whose parents have the time and energy to seek the help, there are other, similar programs. Many college campuses, including Cal State East Bay, offer extra services for autistic students.

Some businesses are starting special programs for hiring autistic employees, especially if those employees possess skills like focus and an attention to detail that can come hand-in-hand with autism. One company, Palo Alto-based Semperical, is based entirely around a model of hiring high-functioning autistic employees as test engineers.

But those jobs and support programs aren’t large and there aren’t many of them. Meanwhile, the group of autistic adults needing these services is only going to grow. The first generation is entering its 20s – but they’ll be hitting middle age soon enough, and there are even larger generations on their heels.

Worried parents

It’s not just a problem for the autistic children and adults, but for their families – especially for the parents, many of whom worry they won’t be able to care for their adult children much longer.

“I hear from parents in the Baby Boomer generation who have kids in their 30s now,” said Kurt Ohifs, executive director of Pacific Autism Center for Education in Santa Clara. “They come to me and say, ‘I’m afraid to die, because who’s going to care for my son or daughter?’

Retrieved from: http://www.sfgate.com/health/article/Experts-brace-for-wave-of-autistic-adults-3921071.php#ixzz2D58PzgN2

Sensory Integration Therapy ineffective for Treatment of Autism, Study Finds

In Autism Spectrum Disorders, General Psychology, School Psychology on Wednesday, 21 November 2012 at 14:35

Sensory Integration Therapy ineffective for Treatment of Autism, Study Finds

By: Pasha Bahsoun

Parents of children with autism are faced with many options when it comes to therapy and education for their children, from applied behavior analysis (ABA) to floortime. A new study out of the University of Texas at Austin has found that one form of therapy, sensory integration therapy, is ineffective for the treatment of autism.

Many children on the autism spectrum experience sensitivities towards sensory stimuli such as sounds, light and touch. Those who practice sensory integration therapy seek to offer children small amounts of sensory input with the goal of improving how their nervous system reacts to certain stimuli. This is accomplished through objects such as weighted blankets, weighted vests and swings.

The researchers evaluated 25 studies on sensory integration therapy and found that there was no scientific evidence that symptoms of autism were improved. Three of the studies suggested that the treatment was effective and 14 studies reported no benefits. They went further to indicate that several of the studies, including the three studies reporting positive results, had serious methodological flaws. Therefore, based on this evaluation, they were not able to support sensory integration therapy for the treatment of children with autism.

The researchers noted that sensory integration therapy may even exacerbate the symptoms of autism because it provides reinforcement for unwanted behaviors by providing access to desirable activities, like bouncing on balls, and being allowed to escape tasks like homework. In addition, children who receive this form of therapy are oftentimes also receiving other behavioral interventions simultaneously, which would undermine their effectiveness.

Agencies providing services for children with autism, as well as insurance companies, are now mandating that only evidence and research-based practices be used in interventions, which at the moment is only applied behavior analysis.

If you enjoy my articles, you can follow me on Twitter:@ThePashaB.

Retrieved from: http://www.examiner.com/article/sensory-integration-therapy-ineffective-for-treatment-of-autism-study-finds

***

Sensory Integration Treatment for Autism Spectrum Disorders: A Systematic Review

Abstract

Intervention studies involving the use of sensory integration therapy (SIT) were systematically identified and analyzed. Twenty-five studies were described in terms of: (a) participant characteristics, (b) assessments used to identify sensory deficits or behavioral functions, (c) dependent variables, (d) intervention procedures, (e) intervention outcomes, and (f) certainty of evidence. Overall, 3 of the reviewed studies suggested that SIT was effective, 8 studies found mixed results, and 14 studies reported no benefits related to SIT. Many of the reviewed studies, including the 3 studies reporting positive results, had serious methodological flaws. Therefore, the current evidence-base does not support the use of SIT in the education and treatment of children with autism spectrum disorders (ASD). Practitioners and agencies serving children with ASD that endeavor, or are mandated, to use research-based, or scientifically-based, interventions should not use SIT outside of carefully controlled research.

Highlights

► Research involving sensory integration therapy to autism was reviewed. ► Out of 25 studies, three studies had positive results. ► Serious methodological flaws were found across studies. ► The evidence-base does not support the use of SIT in the treatment of autism.

Retrieved from: http://www.sciencedirect.com/science/article/pii/S1750946712000074

Children With Autism Developmentally Normal at 6 Months

In Autism Spectrum Disorders, Neuropsychology, School Psychology, Special Education on Tuesday, 6 November 2012 at 15:24

Children With Autism Developmentally Normal at 6 Months

Pam Harrison

Infants who go on to develop autism spectrum disorder (ASD) are developmentally normal by the age of 6 months, and the earliest signs of developmental disruption are subtle and not specific to autism, prospective, longitudinal data show.

In the largest prospective, longitudinal study to date comparing children with early and later diagnosis of ASD with children without ASD, Rebecca Landa, PhD, Kennedy Krieger Institute, Baltimore, Maryland, and colleagues found that the earliest signs of developmental disruption in children with ASD are likely to be nonspecific to ASD, such as communication or motor delay.

At 6 months, development within both the early-onset ASD children and those with later-onset ASD was comparable both to each other and to non-ASD control children.

“The standard clinical tools that we use to assess early development are not identifying abnormalities in babies midinfancy that go on and have autism,” Dr. Landa told Medscape Medical News.

“So the assumption that any infant who is going to have autism would be obviously autistic in midinfancy is a myth because this just isn’t happening.”

The study was published online October 30 in Child Development.

Developmental Trajectory

Studying the developmental trajectory of multiple systems — motor, cognitive, social, and language — in the first 3 years of life in children with and without ASD could shed light on the susceptibility of the developing brain to the impact of genetic, epigenetic, and environmental factors in children with ASD.

Therefore, the investigators examined language and motor development in children aged 6 to 36 months and social development from 14 to 24 months, the time during which ASD regression usually occurs.

Participants included 204 infant siblings of children with autism as well as 31 infants with no family history of autism.

The Mullen Scales of Early Learning provided measures of motor and language functioning, and the Communication and Symbolic Behavior Scales Developmental Profile provided measures of 2 social functions related to the diagnostic criteria for ASD.

By 14 months, the early-onset group exhibited significantly lower expressive language and shared positive affect scores than the later ASD group (P < .001 for both endpoints).

By 18 months, the early ASD group also had greater delays in receptive (P < .001) and expressive language development (P = .001) compared with the later-onset group.

Gap Closes

At 24 months, however, “the gap between the Early- and Later-ASD groups had closed, and no differences from the Later-ASD group were detected at subsequent ages,” the investigators write.

These findings indicate that the early-ASD group manifested earlier development disruption, especially as it affected language and social functioning, than children with later-onset ASD but that they were no more severely affected than later-onset ASD children at either 30 or 36 months.

“There are different developmental pathways to ASD,” said Dr. Landa.

Children who manifest symptoms by their first birthday are more globally impaired at 14 months than children who have later manifestations of ASD.

On the other hand, children with later-onset ASD do have some signs of developmental delay at 14 months, but these signs are not specific to ASD and include motor and communications delays.

However, by 36 months, both groups are comparable in their social and developmental characteristics, she added.

“Many pediatricians screen for autism at around 18 months, as the American Academy of Pediatrics recommends, but they don’t continue screening after that,” Dr. Landa said.

“But screening should be repeated through early childhood, and if concerning signs of delay associated with ASD are observed in a child who scores normally on standardized tests, further assessment is warranted.”

Need for Early Intervention

Deborah Fein, PhD, University of Connecticut, in Storrs, told Medscape Medical News that it is important to appreciate that the ASD children included in this study were infant siblings of children with ASD.

As such, “this is not the population at large, so these findings might not be generalizable,” Dr. Fein said

On the other hand, infant siblings of children with ASD are a small enough population that they could be followed very closely throughout their preschool years, and subtle delays in motor or social communication development could be identified.

Other children at risk for ASD, including premature infants or infants who have had obstetric complications, are also at risk for ASD and could be similarly followed, she added.

“There are preclinical signs of ASD, but in a sense, it doesn’t matter because if you know a child has some mild delay in cognitive or motor or social communication function, you still want to deliver early interventions,” she said.

“Then if full-blown autism does emerge, you’ll be on top of it.”

The authors and Dr. Fein have disclosed no relevant financial relationships.

Child Dev. Published online October 30, 2012. Abstract

Retrieved from: http://www.medscape.com/viewarticle/773990?src=nl_topic

sensory defensiveness can be a gift!

In ADHD, ADHD Adult, ADHD child/adolescent, Autism Spectrum Disorders, Sensory defensiveness on Friday, 2 November 2012 at 06:57

Five Gifts of Being Highly Sensitive

By THERESE J. BORCHARD

Today I have the pleasure of interviewing Douglas Eby, M.A./Psychology, who is a writer and researcher on the psychology of creative expression, high ability and personal growth. He is creator of the Talent
Development Resources series of sites (includingHighlySensitive.org) at http://talentdevelop.com. I know many of you are “highly sensitive” and enjoy articles on that topic, so I am excited to pique his highly-sensitive brain today!

Question: If you had to name the top five gifts of being highly sensitive, what would they be?

Douglas:

1. Sensory detail

One of the prominent “virtues” of high sensitivity is the richness of sensory detail that life provides. The subtle shades of texture in clothing, and foods when cooking, the sounds of music or even traffic or people talking, fragrances and colors of nature. All of these may be more intense for highly sensitive people.

Of course, people are not simply “sensitive” or “not sensitive” — like other qualities and traits, it’s a matter of degree.

Years ago, I took a color discrimination test to work as a photographic technician, making color prints. The manager said I’d scored better, with more subtle distinctions between hues in the test charts, than anyone he had evaluated.

That kind of response to color makes visual experience rich and exciting, and can help visual artists and designers be even more excellent.

2. Nuances in meaning

The trait of high sensitivity also includes a strong tendency to be aware of nuances in meaning, and to be more cautious about taking action, and to more carefully consider options and possible outcomes.

3. Emotional awareness

We also tend to be more aware of our inner emotional states, which can make for richer and more profound creative work as writers, musicians, actors or other artists.

A greater response to pain, discomfort, and physical experience can mean sensitive people have the potential, at least, to take better care of their health.

4. Creativity

Psychologist Elaine Aron, author of The Highly Sensitive Person,estimates about twenty percent of people are highly sensitive, and seventy percent of those are introverted, which is a trait that can also encourage creativity.

As examples, there are many actors who say they are shy, and director Kathryn Bigelow, who recently won an Academy Award, has said, “I’m kind of very shy by nature.” The star of her movie The Hurt Locker, Jeremy Renner (who was reportedly shy as a child), has commented that “in social situations she can be painfully shy.”

5. Greater empathy

High sensitivity to other people’s emotions can be a powerful asset for teachers, managers, therapists and others.

Question: And, if you had to name five curses, what would they be? And how best do we overcome them or co-exist with them?

Douglas:

1. Easily overwhelmed, overstimulated

The biggest challenge in high sensitivity is probably being vulnerable to sensory or emotional overwhelm. Taking in and processing so much information from both inner and outer worlds can be “too much” at times and result in more pain, fatigue, stress, anxiety and other reactions.

An intriguing neuroscience research study I came across that may explain some of this said people with nervous systems having decreased latent inhibition are more open to incoming stimuli. Which can be a good thing, or not so good.

Actor Amy Brenneman once commented, “I’m too sensitive to watch most of the reality shows. It’s so painful for me.”

That kind of pain or discomfort can mean we don’t choose to experience some things that might actually be fun or enriching. Though I don’t mean reality shows.

2. Affected by emotions of others

Another aspect of sensitivity can be reacting to the emotions — and perhaps thoughts — of others. Being in the vicinity of angry people, for example, can be more distressing.

As actor Scarlett Johansson once put it, “Sometimes that awareness is good, and sometimes I wish I wasn’t so sensitive.”

3. Need lots of space and time to ourselves

We may need to “retreat” and emotionally “refresh” ourselves at times that are not always best for our goals or personal growth. For example, being at a professional development conference, it may not be the most helpful thing to leave a long presentation or workshop in order to recuperate from the emotional intensity of the crowd.

4. Unhealthy perfectionism

There can also be qualities of thinking or analyzing that lead to unhealthy perfectionism, or stressful responses to objects, people or situations that are “too much” or “wrong” for our sensitivities.

5. Living out of sync with our culture

Living in a culture that devalues sensitivity and introversion as much as the U.S. means there are many pressures to be “normal” — meaning extroverted, sociable and outgoing.

Dr. Ted Zeff, author of The Highly Sensitive Person’s Survival Guide, points out that other cultures, such as Thailand, have different attitudes, with a strong appreciation of sensitive or introverted people.

Jenna Avery, a “life coach for sensitive souls,” counsels people to accept or even pursue being “out of sync” with mainstream society, and be aware of other’s judgments of people as too sensitive, too emotional, or too dramatic.

And if we are sensitive, we may use those kinds of judgments against ourselves, and think, as Winona Ryder said she did at one time, “Maybe I’m too sensitive for this world.”

Certainly, there are extremes of emotions that are considered mood disorders, for example, and should be dealt with as a health challenge.

But “too emotional” or “too sensitive” are usually criticisms based on majority behavior and standards.

Overall, I think being highly sensitive is a trait we can embrace and use to be more creative and aware. But it demands taking care to live strategically, even outside popular values, to avoid overwhelm so we can better nurture our abilities and creative talents.

Retrieved from: http://psychcentral.com/blog/archives/2010/03/28/5-gifts-of-being-highly-sensitive/

asd…intervene early, see positive changes.

In Autism Spectrum Disorders, Psychiatry, School Psychology, Special Education on Friday, 2 November 2012 at 06:04

Early Autism Intervention Normalizes Brain Activity

Pam Harrison

Early behavioral intervention is associated with normalized patterns of brain activity along with improvements in social behavior in young children with autism spectrum disorder (ASD), a new nationwide study shows.

The multicentre study conducted by investigators at the University of North Carolina, Chapel Hill, showed that 73% of children who received the Early Start Denver Model (ESDM) intervention showed greater brain activation when viewing faces than when viewing objects.

This was very similar to typically developing children, 71% of whom showed the same brain activation pattern when viewing faces rather than objects.

In contrast, 64% of ASD children who received the control community intervention showed a greater response to objects than to faces, the opposite response from that seen in ESDM recipients.

Previous research has shown that ASD children typically respond more to nonsocial than to social stimuli.

“Those of us in the intervention field always assumed that improving children’s learning had to change brain function — that is how we learn,” Sally Rogers, PhD, University of California, Davis, MIND Institute, told Medscape Medical News.

“This evidence confirms how we understand learning — it’s not a surface change [but rather] a change in brain activation and patterns of brain connection.

“So I think behavioral intervention can be seen as a biological intervention because it changes the biology of brain activity.”

The study is published in the November issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Intensive Therapy

A previous report from a randomized trial indicated that ESDM, a developmental behavioral intervention, resulted in gains in IQ, language, and adaptive behavior in children with ASD (Pediatrics 2010;125:e17-e23).

The current report describes electroencephalographic (EEG) activity, a secondary outcome measurement from the same study.

A total of 48 children aged 18 to 30 months who had been diagnosed with ASD were randomly assigned to receive ESDM or referral to community intervention for 2 years.

Children randomly assigned to ESDM received the intervention for 2 hours, twice a day, 5 days a week for 2 years.

The community intervention group received comprehensive diagnostic evaluations, interventional recommendations, and community referrals.

The children enrolled in the study represented the full range of severity of ASD in early childhood, and as Dr. Rogers emphasized, they were not picked because they had mild symptoms.

Two types of brain activity measurements were collected in response to social (faces) and nonsocial (toys) stimuli.

“The first reflected early-stage perceptual processing of faces versus objects,” the authors state, “[and] the second set of measurements reflected the degree of attention engagement…and active cognitive processing of the stimulus.”

Children randomly assigned to either intervention arm did not differ from typical children in early-stage perceptual face processing, the researchers point out.

In contrast, EEG measurements reflecting patterns of attention engagement and active cognitive processing of social stimuli showed that children who received the ESDM intervention exhibited brain activity that was comparable to age-matched typical children in that both allotted greater attentional and cognitive resources during viewing of social stimuli than to nonsocial stimuli.

These patterns were different from patterns observed in children who received the community intervention, who allotted greater attentional and cognitive resources to viewing of nonsocial stimuli than to social stimuli.

Powerful Intervention

“This is a very powerful intervention,” Dr. Rogers emphasized. For example, almost none of the children had speech prior to the ESDM intervention.

The average IQ prior to the intervention was only 65, she added.

Following the intervention, the average IQ was in the 80s.

“This means that these children no longer had intellectual disability as a group, so it was a huge change, and almost all of the children were able to use language effectively and functionally as well,” Dr. Rogers said.

Children with good EEG data who received the ESDM intervention also differed significantly on behavioral outcomes in autism symptoms, IQ, language, and adaptive and social behavior.

“Many public services provide interventions for young ASD children, but too many children are getting a hodgepodge of interventions,” Dr. Rogers observed.

“But national standards require we use evidence-based intervention, and what this study demonstrated is the importance of using evidence-based interventions and delivering them with enough intensity so they can have maximal effect.”

New Target, Potential Biomarker

Thomas Insel, MD, National Institute of Mental Health, noted in a press release on the study that this may be the first demonstration that a behavioral intervention for autism is associated with changes in brain function as well as positive changes in behavior.

“By studying changes in the neural response to faces, Dawson and her colleagues have identified a new target and a potential biomarker that can guide treatment development,” Dr. Insel added.

The study was funded by the National Institute of Mental Health. Dr. Dawson and Dr. Rogers are authors of the book Early Start Denver Model for Young Children with Autism, from which they receive royalties. Dr. Insel has disclosed no relevant financial relationships.

J Am Acad Child Adolesc Psychiatry. 2012:51:1150-1160. Abstract

Retrieved from: http://www.medscape.com/viewarticle/773641

Early Behavioral Intervention Is Associated With Normalized Brain Activity in Young Children With Autism 

 

 

 

http://www.jaacap.com/article/S0890-8567(12)00643-0/abstract

Objective

A previously published randomized clinical trial indicated that a developmental behavioral intervention, the Early Start Denver Model (ESDM), resulted in gains in IQ, language, and adaptive behavior of children with autism spectrum disorder. This report describes a secondary outcome measurement from this trial, EEG activity.

Method

Forty-eight 18- to 30-month-old children with autism spectrum disorder were randomized to receive the ESDM or referral to community intervention for 2 years. After the intervention (age 48 to 77 months), EEG activity (event-related potentials and spectral power) was measured during the presentation of faces versus objects. Age-matched typical children were also assessed.

ResultsThe ESDM group exhibited greater improvements in autism symptoms, IQ, language, and adaptive and social behaviors than the community intervention group. The ESDM group and typical children showed a shorter Nc latency and increased cortical activation (decreased α power and increased θ power) when viewing faces, whereas the community intervention group showed the opposite pattern (shorter latency event-related potential [ERP] and greater cortical activation when viewing objects). Greater cortical activation while viewing faces was associated with improved social behavior.

Conclusions

This was the first trial to demonstrate that early behavioral intervention is associated with normalized patterns of brain activity, which is associated with improvements in social behavior, in young children with autism spectrum disorder.

Retrieved from: http://www.jaacap.com/article/S0890-8567(12)00643-0/abstract

autism and schizophrenia…kissing cousins.

In Autism Spectrum Disorders, Genes, Genomic Medicine, Neuroscience on Thursday, 25 October 2012 at 16:29

http://www.eurekalert.org/pub_releases/2012-10/afot-asa102312.php

Are autism and schizophrenia related?

Posted on October 23, 2012 by Stone Hearth News

Autism Spectrum Disorders (ASD), a category that includes autism, Asperger Syndrome, and Pervasive Developmental Disorder, are characterized by difficulty with social interaction and communication, or repetitive behaviors. The U.S. Centers for Disease Control and Management says that one in 88 children in the US is somewhere on the Autism spectrum — an alarming ten-fold increase in the last four decades.

New research by Dr. Mark Weiser of Tel Aviv University’s Sackler Faculty of Medicine and the Sheba Medical Center has revealed that ASD appears share a root cause with other mental illnesses, including schizophrenia and bipolar disorder. At first glance, schizophrenia and autism may look like completely different illnesses, he says. But closer inspection reveals many common traits, including social and cognitive dysfunction and a decreased ability to lead normal lives and function in the real world.

Studying extensive databases in Israel and Sweden, the researchers discovered that the two illnesses had a genetic link, representing a heightened risk within families. They found that people who have a schizophrenic sibling are 12 times more likely to have autism than those with no schizophrenia in the family. The presence of bipolar disorder in a sibling showed a similar pattern of association, but to a lesser degree.

A scientific leap forward, this study sheds new light on the genetics of these disorders. The results will help scientists better understand the genetics of mental illness, says Dr. Weiser, and may prove to be a fruitful direction for future research. The findings have been published in the Archives of General Psychiatry.

All in the family

Researchers used three data sets, one in Israel and two in Sweden, to determine the familial connection between schizophrenia and autism. The Israeli database alone, used under the auspices of the ethics committees of both the Sheba Medical Center and the Israeli Defense Forces, included anonymous information about more than a million soldiers, including patients with schizophrenia and ASD.

“We found the same results in all three data sets,” he says, noting that the ability to replicate the findings across these extensive databases is what makes this study so significant.

Understanding this genetic connection could be a missing link, Dr. Weiser says, and provides a fresh direction for study. The researchers are now taking this research in a clinical direction. For now, though, the findings shouldn’t influence the way that doctors treat patients with either illness, he adds.

Retrieved from: http://www.stonehearthnewsletters.com/are-autism-and-schizophrenia-related/autism/

genes, genes, genes…more awesomeness in genomic medicine!

In Autism Spectrum Disorders, Genes, Genomic Medicine, Neuroscience on Thursday, 25 October 2012 at 14:26

http://boards.medscape.com/forums?128@410.Oln9aayNn1L@.2a35a68e!comment=1

Multiple papers recently published have documented links between de novo mutations and autism, schizophrenia, and intellectual disability. Here, I review the topic and raise some of the key questions on this issue going forward.

References:
– Kong A, et al. Rate of de novo mutations and the importance of father’s age to disease risk. Nature. 2012;488:471-475.
– Wang J, et al. Genome-wide single-cell analysis of recombination activity and de novo mutation rates in human sperm. Cell. 2012;150:402-412.
– Rauch A, et al. Range of genetic mutations associated with severe non-syndromic intellectual disability: an exome sequencing study. Lancet. 2012 Sept 26. [Epub ahead of print]
– de Ligt J, et al. Diagnostic exome sequencing in persons with severe intellectual disability. N Engl J Med. 2012 Oct 3. [Epub ahead of print]

______________________

Below is a transcript of Dr. Topol’s post “De Novo Mutations and the Implications for the Father’s Biological Clock.” We look forward to your feedback.
Our topic is de novo mutations and the implication of these new mutations for expectant fathers. This is a really important topic that was highlighted by the cover article in August 2012 in Nature. It was also in recent multiple papers in Cell, where sperm was sequenced for the first time, as well as in multiple papers on de novo mutations in Nature and Nature Genetics.

While we have known about the possibility for new mutations to occur that are not heritable, the quantification of this has become possible now that we can do sequencing of sperm and compare that to the germline DNA of the father. What is fascinating is that there have been now multiple papers that have come out in recent weeks to demonstrate the link between de novo mutations and intellectual disability, schizophrenia, and autism — and especially the paper coming from the Icelandic group DECODE, which linked the father’s age with the incidence of de novo mutations.

These new mutations are not frequent, of course, but if there’s just one per exome, that is, throughout the coding elements of the genome, that can be quite damaging. In fact, it is characteristic of de novo mutations that they tend to be bad and have adverse consequences.

While there are many more in a typical genome, somewhere around 70 or more of various types of mutations, whether they’re single nucleotide polymorphisms or insertions/deletions, most of them do not fall in protein coding elements. But when they do, the data we have so far from this collective work suggest that they can be damaging.

The big issue going forward is — what can we do about this? Is this de novo mutation related to our environment? Can we try to reduce the age of fathers and set up the “male biological clock,” which, for all of the years, has been largely restricted to the mother’s story? Can we someday screen sperm for de novo mutations, screen them out or at least get a sense of the frequency? It seems unlikely that we would sequence and then use the sperm for in vitro fertilization, but perhaps we can leverage this knowledge. Of course, the age relationship is tricky because, so far, we don’t have much data to suggest an age range, but clearly there is a relationship with age of the father as it extends to 40 and beyond with a higher rate of de novo mutations.

We also know that, concurrently, the rate of diagnosis of autism is increasing. Could this have something to do with this de novo mutation increase and the overall trend of a higher paternal age?

There is a lot here to consider on a theme that is showing up in multiple papers: the way to quantify de novo mutations, understand their increased frequency as fathers age, and this very interesting link to multiple neurologic, neurocognitive, and neuropsychiatric conditions.

Over time, it’s likely that these de novo mutations will exert a phenotype that is beyond the neurology world. It will also be interesting to see how de novo mutations could potentially have a beneficial role. But one thing for sure is that this is part of the story about missing heritability: we couldn’t account for things that were happening in a new generation that were not present from the parents, and de novo mutations are certainly a part of that story.

Thanks for your attention. I look forward to your comments about de novo mutations and especially the father’s biological clock phenomenon.

Retrieved from: http://boards.medscape.com/forums?128@410.Oln9aayNn1L@.2a35a68e!comment=1

autism and asanas…new information

In Autism Spectrum Disorders, Fitness/Health, Meditation, Mindfulness on Saturday, 13 October 2012 at 09:50

Yoga Helps Children With Autism Remain Calm, Improves Social Bonding

BY AMBER MOORE

New York University researchers say that daily yoga can boost social bonding and focus in children who have been diagnosed with autism.

The intervention program, “Get Ready to Learn,” (GRTL) uses yoga and breathing techniques to calm children who have Autism Spectrum Disorder. The program has five steps that are done for 17 minutes each day. According to NYU researcher Kristie Koenig, this program can lower the levels of aggression, social withdrawal and anxiety in children with ASD.

“We found that teachers’ ratings of students who participated in the daily yoga routine showed improved behavior compared with teachers’ ratings of students who did not. Our aim in this research was to examine the effectiveness of an occupational therapy yoga intervention,” said Koenig, assistant professor of occupational therapy at NYU.

Currently, there is no cure for autism. However, studies suggest that certain intervention programs may help improve a child’s development. Interventions are most efficient when started early, before age 3.

Another study published last year in the Journal of Alternative and Complementary Medicine had also said that movement-based therapy including yoga and dance can help treat some behavioral problems associated with autism.

“Children with Autism often exhibit characteristics of ‘fight-or-flight’ response. They are in a constant state of stress and struggle with staying calm, trying to concentrate, communicating clearly, or even controlling their movements,” said Anne Buckley-Reen occupational therapist and yoga instructor.

The present study was published in The American Journal of Occupational Therapy.
Retrieved from:  http://www.medicaldaily.com/articles/12640/20121011/yoga-helps-children-autism-remain-calm-improves.htm#5Uri5TY1f6SU5fUp.99

Occurrence and Family Impact of Elopement in Children With Autism Spectrum Disorders

In Autism Spectrum Disorders, School Psychology, Special Education on Thursday, 11 October 2012 at 11:58

Running Away Common with Autism

By Genevra Pittman

NEW YORK (Reuters Health) Oct 08 – Almost half of children with autism in a new study had run away at least once – and many of them were missing long enough to cause concern.

Researchers found that kids most often wandered off from their home, school or a store, and some tried to run away multiple times a day.

But rather than being confused about where they were, kids typically left to find a place they enjoyed, to explore or to avoid an anxious or uncomfortable situation, based on their parents’ reports.

“It’s rooted in the very nature of autism itself,” said Dr. Paul Law, who worked on the study.

“Kids don’t have the social skills to check in with their parents, and to have that communication and social bond that most children have when they’re approaching a road or at a park.”

Dr. Law directs the Interactive Autism Network Project at the Kennedy Krieger Institute in Baltimore. With funding from a number of autism research and advocacy groups, he and his colleagues used their registry to survey the parents of 1,218 kids with an autism spectrum disorder.

Of those kids, 598 – or 49% – had tried to run away at least once, their parents reported. And 316 were missing long enough to cause concern – an average of more than 40 minutes.

In comparison, the same parents reported 13% of their non-autistic children had ever wandered off after age four.

Most of the kids with autism who went missing were in danger of getting hit by cars, and others could have drowned. Police had to be called for one-third of missing children.

“Amongst the families we did interview, there were many reports of injuries, close calls with drowning (and) close calls with traffic accidents,” Dr. Law told Reuters Health.

“There’s an enormous burden that all families are undergoing to keep their families safe. The amount of diligence, and not going out in public, and staying up late at night… just the general anxiety that families live under because of concerns with this is just torturous.”

Children with more severe autism were more likely to have bolted, according to findings published Monday in Pediatrics.

Autism researcher Russell Lang from Texas State University-San Marcos said the prevalence of running away or “eloping” in children with autism “absolutely surprised” him.

“It’s a very dangerous behavior, and it’s a little bit deceptive because it can seem somewhat benign compared to other challenging behaviors,” Lang, who wasn’t involved in the new study, told Reuters Health.

Those other “challenging behaviors” common in kids with autism include self-injury and property destruction, he said. They often get lumped together with running away, which is why researchers haven’t had a good estimate of the prevalence of elopement until now.

The new study couldn’t estimate how many children with autism die every year due to running away and getting into danger, the researchers said.

“This is not simply a case of parents being remiss in some way regarding their supervision of their children,” Lang said. “The child with autism doesn’t realize what danger they’re putting themselves in. They have a propensity to elope, it seems, regardless of parental care.”

He said therapy that rewards kids for not wandering off may help prevent them from disappearing in the future.

Dr. Law advises parents to reach out to advocacy groups to learn about safe locks for their doors and tracking devices for kids. And emergency responders can be better prepared for getting the call when a child with autism goes missing.

Still, he added, “we haven’t totally come to consensus on what some of the best practices are” to prevent running away.

SOURCE: http://bit.ly/RLrO7s

Retrieved from: http://www.medscape.com/viewarticle/772243?src=nl_topic

Occurrence and Family Impact of Elopement in Children With Autism Spectrum Disorders

Connie Anderson, PhDaJ. Kiely Law, MDa,bAmy Daniels, PhDa,c Catherine Rice, PhDdDavid S. Mandell, ScDeLouis Hagopian, PhDa,b, and Paul A. Law, MD, MPHa,b

 ABSTRACT:

OBJECTIVES: Anecdotal reports suggest that elopement behavior in children with autism spectrum disorders (ASDs) increases risk of injury or death and places a major burden on families. This study assessed parent-reported elopement occurrence and associated factors among children with ASDs.

METHODS: Information on elopement frequency, associated characteristics, and consequences was collected via an online questionnaire. The study sample included 1218 children with ASD and 1076 of their siblings without ASD. The association among family sociodemographic and child clinical characteristics and time to first elopement was estimated by using a Cox proportional hazards model.

RESULTS: Forty-nine percent (n = 598) of survey respondents reported their child with an ASD had attempted to elope at least once after age 4 years; 26% (n = 316) were missing long enough to cause concern. Of those who went missing, 24% were in danger of drowning and 65% were in danger of traffic injury. Elopement risk was associated with autism severity, increasing, on average, 9% for every 10-point increase in Social Responsiveness Scale T score (relative risk 1.09, 95% confidence interval: 1.02, 1.16). Unaffected siblings had significantly lower rates of elopement across all ages compared with children with ASD.

CONCLUSIONS: Nearly half of children with ASD were reported to engage in elopement behavior, with a substantial number at risk for bodily harm. These results highlight the urgent need to develop interventions to reduce the risk of elopement, to support families coping with this issue, and to train child care professionals, educators, and first responders who are often involved when elopements occur.

Retrieved from: http://pediatrics.aappublications.org/content/early/2012/10/02/peds.2012-0762.abstract

 

School psychologists and autism training

In Autism Spectrum Disorders, Education, School Psychology on Tuesday, 9 October 2012 at 06:47

no matter how good we think we are, how many ‘letters’ are behind our names, or  long we have been practicing, in this ever-evolving field, we ALWAYS need to keep up with the latest research and literature and adapt.  when we stop learning, we stop living.  there are lessons all around us…

School Psychologists Need More Training to Meet the Needs of Students with Autism Spectrum Disorders (ASD)

Lee Wilkinson, Ph.D.

More children than ever before are being diagnosed with autism spectrum disorders (ASD). The U.S. Centers for Disease Control and Prevention (CDC) now estimates that 1 in 88 eight year-old children has an ASD. The occurrence of autism is also evident in the number of students with ASD receiving special educational services. Data collected for the Department of Education indicate that the number of children ages 6 through 21 identified with autism served under the Individuals With Disabilities Act (IDEA) quadrupled between 2000-01 and 2009-10; rising from 93,000 to 378,000 students and increasing from 1.5 to 5.8 percent of all identified disabilities.

Given the dramatic increase in ASD, school psychologists and other school-based professionals are now more likely to be asked to participate in the screening, identification, and educational planning for students with ASD than at any other time in the past. Moreover, the call for greater use of evidence-based practice has increased demands that school psychologists be knowledgeable about evidence-based assessment and intervention strategies for students with ASD. Guidelines and standards have been developed recommending best practice procedures for the assessment and treatment of ASD. There is a large and expanding scientific literature base that documents the existence of two major elements of evidence-based practice: assessments shown to be psychometrically sound for the populations on whom they are used and interventions with sufficient evidence for their effectiveness. Although school psychologists are often called on to assume a leadership role in evaluating, identifying, and providing interventions for students with ASD in our schools, there is little research to show how closely school psychologists align their practices with the parameters of best practice. Due to the increase in the number of children receiving special education services under the classification of autism, research is needed regarding the preparedness of school psychologists and schools to address the needs of children with ASD.

Recent Surveys

Although there is a paucity of research focusing on the delivery of school psychological services for students with ASD, there are several national and state-wide surveys which provide exploratory information regarding school psychologists’ level of knowledge in the area of autism assessment and intervention; assessment methods, measures, and techniques; level of training; and perceived level of preparation and confidence.

  • Aiello & Ruble (2011) investigated school psychologists’ knowledge and skills in identifying, evaluating, and providing interventions for students with ASD. A total of 402 participants from 50 states completed their survey. Results indicated that despite a limited amount of training received during their graduate education or pre-service training for working with the autism population, most school psychologists’ self-reported knowledge of ASD was in the expected direction for agreement. However, there were gaps in knowledge regarding the differences between emotional and behavioral disorders and autism, developmental delays and autism, and special education eligibility versus DSM-IV diagnoses that need to be addressed through more training. The survey also indicated the need for additional training opportunities in providing interventions, strategies, and supports for students with autism in the following areas: developing family-centered educational plans; training peer mentors; and translating assessment information into teaching goals and activities.
  • Rasmussen (2009) also completed a national survey of school psychologists to determine their level of knowledge in the area of autism assessment; level of training; and perceived preparation and confidence in providing services to children with ASD. Results indicated that training positively affected school psychologists’ knowledge about autism; their levels of involvement with students with autism; and their perceived levels of preparation to work with this population. Of the 662 participants, the majority accurately identified diagnostic features and true and false statements about autism, suggesting an adequate understanding of autism. Participants with more training reported an increased level of involvement on multidisciplinary teams and an ability to diagnose autism when compared to those with less training. Brief rating scales were among the most commonly used instruments, while more comprehensive and robust instruments were among the least-often employed, suggesting school psychologists are either not trained or are limited in the time and resources needed to use evidence-based instruments. Participants felt more prepared to provide consultation and assessment services and less prepared to provide interventions. Although a majority (96.5%) of the respondents reported they had attended workshop presentations or in-service trainings on autism, less than half (43.7%) had completed formal course work in autism in their training program and less than one third (32.3%) had internship or residency experience with autism. These data and previous research suggest school psychologists need more formal training and experience in meeting the needs of individuals identified with autism.
  • Singer (2008) surveyed 199 school psychologists regarding the frequency with which they were called upon to provide services to students with an autism spectrum disorder (ASD); services they actually provided to those students; and their perceptions of the training and experience they had pertaining to the assessment and treatment of ASD. Additionally, the study surveyed 72 graduate programs in school psychology to determine the extent to which these programs prepared new school psychologists to work with children who have ASD. A majority of respondents (64%) reported using only brief screening instruments to identify students. Although able to identify the “red flag” indicators of ASD, very few school psychologists perceived their training as adequate. Only 12.6 % of respondents indicated that they had sufficient coursework in ASD and only 21% indicated that they had sufficient practicum experience. Just 15% indicated that their overall training with ASD was “completely adequate.” Only 5 of the 72 (16.9%) school psychology programs surveyed offered a specific course in ASD; most indicating that the topic was addressed in other courses. According to the author, the survey data suggest that school psychologists lack adequate knowledge about evidence-based instruments and procedures available to screen, assess, and intervene for ASD.
  • Pearson (2008) surveyed a group of Pennsylvania school psychologists regarding their training, knowledge and evaluation practices when assessing and diagnosing ASD. The aim of the study was to determine the extent to which school psychologists are prepared to meet the rapidly increasing demand for using best practice procedures when assessing and diagnosing ASD. An electronic survey was sent to 1,159 certified school psychologists with 243 completed surveys returned. Survey results found the majority of respondents indicated that they rely on the use of brief screening instruments and do not use or recommend “gold standard” instruments with students suspected of having ASD. Only 32.2% of the respondents reported they were very much prepared to recommend an IDEA classification of Autism. Less than 5% of the school psychologists surveyed received formal training in ASD at graduate institutions or internships. The overwhelming majority of school psychologists surveyed believed there is         a need for more training for school psychologists concerning the characteristics of ASD, best practice in the assessment of ASD, and differentiating ASD from other developmental or coexisting disorders.
  • Small (2012) used an online survey of 100 members of the Massachusetts School Psychology Association (MSPA) to obtain information pertaining to demographics, participants’ experiences with the ASD population, participants’ knowledge of ASD, as well as their use, competency, and feelings of usefulness of various assessment techniques and treatments/interventions. The results indicated that overall, school psychologists demonstrated adequate knowledge of ASD, felt competent conducting assessments, and reported that the assessment tools were useful. School psychologists spent less time on treatment/intervention and while they considered many of the treatments/interventions helpful, they did not feel competent implementing them. The results suggest that school psychologists need more training in ASD, especially regarding treatments/interventions, at the pre-service level through graduate school training and experiences (e.g., practica and internships), as well as at the practitioner level through professional development opportunities.

Conclusion and Recommendations

As more and more children are being identified with ASD and placed in general education classrooms, school psychologists will play an ever increasingly important role in identification and intervention, as well as offer support, information, consultation, and recommendations to teachers, school personnel, administration, and families. Therefore, it is essential that they be knowledgeable about evidence-based assessment and intervention strategies for this population of students.  Despite the limitations inherent in survey research, the data from these studies suggest that school psychologists are not adequately prepared to provide evidence-based assessment and intervention services to children with ASD. The survey research illustrates a significant discrepancy between best practice (evidence-based) parameters and reality when it comes to the practice of school psychology and ASD in the schools. Federal statutes require that school districts ensure that comprehensive, individualized evaluations are completed by school professionals who have knowledge, experience, and expertise in ASD. Although surveys indicate sufficient knowledge of the signs and symptoms associated withASD, there is a critical need for school psychologists to be trained and develop competency in evidence-based assessment and identification practices with children who have or may have an ASD. For example, a majority of survey respondents reported using brief screening measures such the GARS and/or GADS in assessment and identification, both of which are not recommended for use in decision-making (Brock, 2004; Norris, M., & Lecavalier, 2010; Pandolfi, Magyar & Dill, 2010; Wilkinson, 2010). In contrast, evidence-based tools such as the ADOS, ADI-R, CARS, and SCQ were used less a third of the time in ASD assessment. Thus, while evidence-based instruments are available for the reliable, thorough assessment of students with ASD, school psychologists either do not have access or lack sufficient training to make them a part of their practice in the schools.

Because the knowledge base in ASD is changing so rapidly, it is imperative that school psychologists remain current with the research and up to date on scientifically supported approaches that have direct application to the educational setting. School psychologists can help to ensure that students with ASD receive an effective educational program by participating in training programs designed to increase their understanding and factual knowledge about best practice assessment and intervention /treatment approaches. Recommendations culled from the survey findings include the following: (a)school psychologists need more in-depth, formal training complete with supervision and consultation; (b) school psychology training programs should focus more energy on teaching intervention strategies for students with autism and include a separate course in ASD as part of the curriculum; (c) increase the use of more psychometrically sound autism instruments such as the ADOS and ADI-R in schools to provide better identification and more complete intervention strategies; (d) consider resident ASD specialists within the school and train teams of school professionals to work as a unit with the autism-related cases to ensure that the personnel are well-trained and have the experience necessary to conduct reliable and valid assessments and treatment planning; (e) provide training for all school psychologists on best practice guidelines for screening and assessment of ASD and identify measures with and without empirical support; and (g) develop closer relationships with ASD experts and service providers in the community. School districts may also want to consider levels of training, levels of education, and years of experience when assigning school psychologists who work with children who have ASD.  Finally, the National Association of School Psychologists (NASP) may consider developing guidelines and recommendations regarding the minimal competencies needed in order to work with special populations such as students with ASD.

Aiello, R., & Ruble, L. A. (2011, February). Survey of school psychologists’ autism knowledge, training, and experiences. Poster presented at the annual convention of the National Association of School Psychologists, San Francisco, CA.

Brock, S. E. (2004). The identification of autism spectrum disorders: A primer for the school psychologist. California State University, Sacramento, College of Education, Department of Special education, Rehabilitation, and School Psychology.

Norris, M., & Lecavalier, L. (2010). Screening accuracy of level 2 autism spectrum disorder rating scales: A review of selected instruments. Autism, 14, 263-284.

Pandolfi V., Magyar C. I., & Dill C. A. (2010). Constructs assessed by the GARS-2: factor analysis of data from the standardization sample. Journal of Autism & Developmental Disorders, 40, 1118-30.

Pearson, L. M. (2008). A survey of Pennsylvania school psychologists’ training, knowledge and evaluation practice for assessing and diagnosing autism spectrum disorders. PCOM Psychology Dissertations. Paper 112. http://digitalcommons.pcom.edu/psychology_dissertations/112

Rasmussen, J. E. (2009). Autism: Assessment and intervention practices of school psychologists and the implications for training in the united states. Ball State University). ProQuest Dissertations and Theses, 192. UMI Number: 3379197

Small, S. H. (2012). Autism spectrum disorders (ASD): Knowledge, training, roles and responsibilities of school psychologists. University of South Florida). ProQuest Dissertations and Theses, 220. ISBN: 9781267519658 UMI Number 3308958

Wilkinson, L. A. (2010). A best practice guide to assessment and intervention for autism and Asperger syndrome in schools. London: Jessica Kingsley Publishers.

© Lee A. Wilkinson, PhD

Posted by Lee A. Wilkinson Lee Wilkinson at Sunday, October 07, 2012

Retrieved from: http://bestpracticeautism.blogspot.com/2012/10/school-psychologists-need-more-training.html

 

Young Adults With Autism Seek Out White-Collar Careers For First Time

In Autism Spectrum Disorders on Tuesday, 9 October 2012 at 06:40

Young Adults With Autism Seek Out White-Collar Careers For First Time

Posted: 09/27/2012 9:16 am EDT Updated: 09/27/2012 9:16 am EDT

Christina Wilkie

A few weeks ago, Matthew Koenig, 24, was doing data entry for below minimum wage at a supervised employment center for people with disabilities in St. Paul, Minn.

Koenig, who has autism, was happy to have a job in a tough economy, but soon realized the workplace wasn’t well suited to him. His co-workers “had too broad of a range of [disabilities],” he said. “Some people had really serious problems.”

Moreover, employees were graded using “a time study to measure efficiency,” he said, “but the nature of my disability means I lack certain kinds of motor skills, so I can’t type as quickly as other people.”

A sleep disorder caused Koenig to be late a few times, and since then, “they haven’t asked me to come in for a few weeks.” He acknowledged that “part of it was my fault,” but the combination of a menial job and an abrupt dismissal “made me feel like I’m not worth anything.”

Koenig, who scored a 1450 out of 1600 on his SATs, knows this isn’t true. “Despite my autism, I have good instincts about people, and I try to do the right thing,” he said in a self-assured staccato. “I’m perfectly willing to stick around, and ultimately my goal in my career is to make sure the job gets done.”

The simple, repetitive tasks of his last job didn’t match his intelligence, needs or aspirations. Instead, he said he wants to use the unusual outlook afforded by autism to build a meaningful career in the tech sector.

“I’d like to help come up with ideas for entertainment and video games,” he said, “because one of my strengths is that I have an unconventional train of thought that other people don’t have.”

Mindful and ambitious, Koenig is one of a growing number of young people with high-functioning autism who are increasingly focused on building meaningful careers. A cadre of groups have begun developing new ways to prepare these young people for white-collar jobs.

AN ‘AUTISM TSUNAMI’

They face a daunting set of obstacles. Job prospects for adults with autism in the U.S. are crushingly bleak. Nationwide, their combined unemployment and underemployment rate is around 90 percent.

The employment situation owes much to the basic nature of autism spectrum disorders (ASDs). Typically diagnosed in early childhood, autism is a developmental disability that can impair communication skills, speech, fine motor skills and behavior. In very mild cases, symptoms may be limited to impaired social skills and difficulty registering empathy. In severe cases, individuals face enormous challenges with verbal communication, show little interest in other people, exhibit extreme sensitivity to light and sound, and develop obsessive behaviors.

Some researchers estimate that up to 1 percent of U.S. adults have ASDs — about 3 million people — but the range in severity and the historical stigmas surrounding autism have made it hard for scientists to collect population data. The unemployment estimates take the entire population into account, including those with severe symptoms.

There is currently no established cause of autism (though theories abound), nor is there a cure.

Another pressing mystery for researchers is why diagnoses of autism among children in the U.S. jumped 70 percent between 2002 and 2008 — from one in every 150 kids to one in every 88. Autism Speaks, a large national nonprofit, has estimated that during the next 10 years, more than 500,000 young people with ASDs will turn 18.

But if current trends continue, many of them won’t receive the basic education required to join the competitive workforce.

According to a 2011 study, only 56 percent of young adults with autism in the U.S. graduated from high school, and only 14 percent started college. How many graduated from college is unknown, but experts say it’s likely to be fewer than half of those who started.

The high dropout rates among students with ASDs are due in part to the structure of school itself. People with autism often have difficulty meeting deadlines, managing their time and asking for help when they’re confused — all basic academic skills.

“Schools still struggle to understand autism and how it’s different from other disabilities,” said Peter Bell, executive vice president of programs at Autism Speaks. “One of the fallacies we have to overcome is that IQ is a meter of disabilities. In 2003, we learned that 60 to 70 percent of people with autism have average or above average intelligence, up from what was thought for decades to have been only 30 to 40 percent.”

Despite the evidence, Bell said, some educators are still unequipped to address the needs of kids with developmental disabilities and above-average IQs.

“We clearly have a crisis looming,” said Brenda Weitzberg, the founder of Aspiritech, a Chicago nonprofit that employs young adults with autism. She warns that unless there are adequate jobs available, even the most effective skills training will be of little use.

“I have no doubt that more of these kids are going to be better prepared” for high school and college, Weitzberg said. “But after they finish school, then what’s going to happen to them?”

“Some people refer to it as the ‘autism tsunami,'” said Bell. Unless more employment opportunities are created for people with autism in the coming years, hundreds of thousands of young adults with autism will join the ranks of the unemployed or underemployed.

THE NEXT BEST HOPE

The news isn’t all bad. Two decades of well-funded research and treatment have produced young adults with autism who are better prepared to join the workforce now than ever before.

“The skill sets of these kids are so much higher than we ever gave them credit for and what people in the norm tend to give them credit for,” said Gary Moore, founder of a recently opened autism career-training school, the nonPareil Institute, in Plano, Texas.

Bell at Autism Speaks noted much the same thing. “There’s no question that there’s a segment of the [autism] population that has tremendous skills and that can be quite successful in sectors that we never considered before,” he told The Huffington Post.

For workplace disability researcher Laurie Gutmann Kahn at the University of Oregon, it’s all part of a broader trend toward viewing “people with ASD as having a different way of navigating the world, which can be extremely useful in a variety of professions,” she said.

Marc Lazar, program director at Aspiritech, takes it a step further. “There’s a growing recognition that high-functioning ASD individuals have qualities that neurotypicals don’t,” he said. (The autism community coined the term “neurotypical” to describe someone who is not on the autism spectrum.) “They can find details that most people miss, they’re able to focus for long periods of time, and they really savor specific kinds of work like software testing, lab work and proofreading.”

All of which leads to one conclusion, in Bell’s view: “The autism population represents a pool of potential employees that corporate America needs to explore.”

This is where autism career-training programs come in. By focusing on those young people with autism who appear best suited to function in a competitive workplace, organizations like Aspiritech and the nonPareil Institute are offering a small group of high-functioning adults the opportunity to decide for themselves whether to integrate into the neurotypical world.

In Chicago, Aspiritech aims to prepare people for competitive workplace demands while they hone their skills on software testing. Since it was founded in 2008, Aspiritech has employed more than two dozen adults with high-functioning autism, most of whom still work out of its main offices. Weitzberg, the founder, said she is proud of the fact that they have 18 corporate clients, including a number of large U.S. companies with which Aspiritech has competitive contracts.

In Plano, a different model is being developed with the same goal: to prepare each of the school’s students, who have high-functioning autism, for an individualized, personally fulfilling white-collar career. Founded in 2009, the nonPareil Institute operates as part university campus, part vocational center. Students learn the finer points of video game and computer app design, while also building up their social skills and life strategies.

Both programs are also designed to create cultures of self-determination and healthy personal ambition.

“I didn’t have a professional life before I came to nonPareil,” said Renee McMurtry, a 21-year-old student from Fort Worth, Texas, who was diagnosed with Asperger’s syndrome. Today, she has “opportunities that didn’t exist before. … I see myself doing a lot in the next few years, making money and being successful.”

SILENT BARRIERS

As the autism community rallies together to prepare young people for the workforce and for white-collar careers, many of the nation’s biggest employers have yet to return the favor. A number of them are still wrestling with basic questions about hiring individuals on the autism spectrum.

As Matthew Koenig, the young man in Minnesota, put it, “the conveyor belt of traditional employment puts you at a huge disadvantage with high-functioning autism, because you talk the way you do, and that’s an automatic strike one.”

Under the Americans with Disabilities Act, it is illegal to discriminate against qualified job applicants because they have autism, but experts say widespread discrimination continues. “They still do it. They’ll just find another reason not to hire the person [with autism],” said an autism advocate, one of a half-dozen activists and autism experts who spoke to HuffPost about the slow pace of integrating people with autism into the white-collar workforce. None were willing to speak about employment barriers on the record, however, citing the sensitive nature of the subject. Employers were equally reluctant to be identified as having hired people with ASDs for white-collar jobs, noting issues of employee privacy and potential legal liability.

The conversations revealed three distinct concerns about hiring people with ASDs that persist for some employers, serving as silent barriers despite the law.

First, employers worry that they don’t know enough about autism in adults to wade into the community, lest they make a mistake. Two people also said some employers don’t know how to discuss job expectations, performance issues and potential limitations comfortably and respectfully with employees who have autism.

Second, some white-collar employers expressed hesitation about the administrative steps in providing “reasonable accommodation” for someone with autism, a requirement under the Americans with Disabilities Act.

One such accommodation in particular was cited more than once as a source of frustration: autism-related “job coaches.” People with autism often need more help adjusting to new jobs and responsibilities than neurotypical workers do, and the coaches help them navigate new workplaces and learn their tasks.

Coaches are typically paid for by state employment agencies, not the employers themselves. But in interviews with HuffPost, autism advocates relayed complaints they had received that job coaches were “disruptive and didn’t fit in with the rest of the staff” and “didn’t know their way around the office.” In one situation, an employer said, “the coach just came in and did the guy’s job for him, while he sat there.”

Kahn, the University of Oregon researcher, defended the provision of additional support for people with autism early in a new job, even if it is sometimes inconvenient. “A person with autism might not understand that you’re supposed to talk to people at the water cooler. In those situations, they need someone who can explain it to them,” said Kahn, “and maybe coach them and say, ‘People are going to ask you about your weekend when you’re at the water cooler. If you want to, you can tell them, “I’m really busy and need to get back to work.”‘ That’s what they need to hear.”

The third silent barrier to hiring people with autism is by far the thorniest. Employers said privately that company lawyers suggested that hiring someone with autism could put them at a greater risk for legal liabilities, as well as higher health care costs.

Last year, a San Diego-area Comfort Suites hotel paid $132,500 to settle an Equal Employment Opportunity Commission lawsuit filed on behalf of a front-desk clerk with autism, who said he had been illegally denied a job coach when he requested one. Cases like this one have apparently bolstered the myth that hiring people with autism is especially complicated or that people with autism are somehow less reliable and more risky than neurotypical employees.

“ASDs still carry the ‘Rain Man’ stigma for a lot of the general public,” said an autism advocate who requested anonymity to speak frankly. “[Employers] are just covering their asses.”

To this day, many Americans have never met a person with autism, and millions rely on stereotypes and movies for the bulk of their opinions about people with ASDs.

Yet a huge wave of high-functioning young people with autism, like Matthew Koenig, are beginning to explore the possibility of meaningful work. Members of this new generation have learned to view their diagnoses less as disabilities per se and more as different sets of abilities. As they push the limits of their potential, one at a time, they simultaneously push the ball forward for the entire autism community.

“The reality of having autism is that in order to find our strengths, you’ve got to get to know us,” Koenig said. “It’s like an onion. You have to peel back the layers.”

Retrieved from: http://www.huffingtonpost.com/2012/09/27/autism-employment-white-collar-jobs_n_1916611.html

 

autism and schizophrenia…a collision

In Autism Spectrum Disorders, Psychiatry, School Psychology on Tuesday, 9 October 2012 at 06:35

When the autism and schizophrenia spectrums collide

Spectrum. The name conjures up white light separating out through a prism, the multi-coloured rainbow, and even that wonderful 8-bit computer made by Sir Clive Sinclair (yes, I had one of those you Commodore people).

When it comes to autism and schizophrenia,the concept of a spectrum invokes similar ideas of different variations or colours on a theme, separate but linked, patterns of symptoms which stem from a single source but diffuse outwards with fuzzy boundaries. It almost sounds a little bit ‘Sixties’ if I’m truly honest.

For quite a few people, including those on the DSM-V ‘how are we going to redefine autism‘ committee, spectrum is something really being taken on board as the ever-approaching deadline for revision comes closer and closer into view. That’s not to say everyone is particularly happy with the formal spectrum-ing of autism as per this recent review by Luke Tsai* (open-access) who prefers the term ‘autism continuum disorder’, but there you go. Indeed scroll down to the descriptor of autism at the bottom of this blog and I use the word ‘tapestry’ which also might be a good description of the heterogeneity present. (Note to self: this description will need updating next year).

You’re probably wondering why I’m going on about spectrum; well its all to do with this paper by Prof. Kenneth Gadow** and how the autism spectrum and the schizophrenia spectrum might be colliding a little more than we perhaps first thought.

This is not the first time that I’ve talked about autism and schizophrenia overlapping as per this post on some very interesting research indicating that around about 40% of one cohort of people with schizophrenia also presented with symptoms congruent with an autism diagnosis.

Prof. Gadow reports a few interesting things from the other direction insofar as his cohort of children diagnosed with an autism spectrum disorder (ASD) presenting with quite a few characteristics more usually associated with the schizophrenia spectrum disorders (SSDs). In a little more detail (sorry that I can’t link to the full-text paper):

  • Building on previous research by the author***, the aim of the study was multi-fold primarily looking at the risk of SSD symptoms in ASD and also looking at how a comorbid diagnosis of ADHD may moderate that risk of SSD symptoms.
  • Consecutive child referrals (aged 6-12 years) to a developmental or child psychiatry outpatient clinic were included for study.
  • Samples were divided up as follows: Autism (N=147) of which n=50 were diagnosed with an ASD only and n=97 diagnosed with ASD & attention-deficit hyperactivity disorder (ADHD). Controls (N=335) included n=146 asymptomatic and n=188 (I assume the missing participant was excluded for some important reason).
  • The primary schedule of choice was the Child and Adolescent Symptom Inventory-4R (CASI-4R) completed by mums and teachers of participants. In particular, the subscales on Schizoid Personality and Schizophrenia and their combining to form a global SSD score were a focus for this study.
  • Results (a few of them anyway): well, mums and teachers showed some overlap in their scoring of participants (always a relief for a questionnaire) bearing in mind contextual differences. Both children with ASD with and without ADHD “had more severe global SSD ratings than their respective controls” but as with many things linked to autisms, there was quite a bit of variability among participant scores.
  • A diagnosis of ADHD whether associated with ASD or not, seemed to confer a greater risk of SSD symptoms pointing to a likely link between ADHD and SSD.
  • An interesting finding this one: the combination of ASD and ADHD and the pattern of SSD symptoms appearing (e.g. disorganised behaviour and negative symptoms – inappropriate laughter, crying and little interest in doing things) “supports the more general notion that certain combinations of disorders may be better conceptualized as unique clinical conditions“. Now think back to that spectrum – continuum argument and the DSM-5 move away from discrete diagnoses….?
  • Another quote from the paper: “findings provide additional support for an interrelation between ASD and SSD symptoms“.

A few things come to mind from these results. First is this suggestion that some cases of childhood ASD present with patterns of symptoms more readily tied into SSD. As per my previous post on this ‘overlap’, the great scientific machine seems to be doing yet another revolution as autism, once considered to be pretty ‘similar’ to schizophrenia (remember childhood schizophrenia) then departed on it’s own journey, and now appears to be heading back towards schizophrenia or at least SSD.

I’m making no value judgements either way on this process given the likely opinions that might be raised on this matter in terms of diagnostic identity, management options and indeed how autism and schizophrenia have tended to become represented among the general population. If there is an upside to this partial reunification, I suppose it is that shared genetics (and epigenetics), biochemistry (see this post for example) and other areas might open up some interesting avenues for further study. With my own research hat on, I’m thinking Dohan and his hypotheses on gluten in cases of schizophrenia and autism. There are most likely going to be others.

Second is this issue of discrete clinical conditions potentially being present from the current study. Again its all about historical trends in science, and whether people talk about specific clinical entities (diagnostic boxes with names and formal criteria) or ‘lumping things together’ as per the use of terms like spectrum. I admit also to being pretty intrigued by the suggestion of a possible new clinical entity represented by ASD, ADHD and SSD symptoms. I’m no expert, and please don’t take my word as Gospel, but there seem to be some hints of diagnoses like pathological demand avoidance (PDA) also being detailed here. Just a thought.

Finally bearing in mind the Gadow study was based on a paediatric population, one has to wonder how this complex pattern of symptoms will eventually play out into adulthood. Bearing in mind that autism is seemingly protective of nothing when it comes to comorbidity, I think many working at the coalface will know of people diagnosed with autism who seem to develop clinical signs and symptoms more readily associated with the schizophrenia spectrum disorders as maturity sets in. The question is whether the criteria used in the current study could somehow be predictive of those who are at greater risk and whether plans and processes could be set in place to moderate this risk.

I’m going to stop there save any charges of over-analysing the paper from Prof. Gadow and its important findings. Reiterating the complex nature of both ASD and SSD and the areas of overlap which seem to be present, how we understand such conditions and indeed label them actually might turn out to be an important point not just from a identity point of view but also conceptually, onward to planning for / mitigating risk and improving overall quality of life.

Without trying to make light of spectrums, may be you remember this theme tune by the Spectrum?

*Tsai L. Sensitivity and specificity: DSM-IV versus DSM-5 criteria for autism spectrum disorder. Am J Psychiatry. 2012; 169: 1009-1011.

** Gadow KD. Schizophrenia spectrum and attention-deficit/hyperactivity disorder symptoms in autism spectrum disorder and controls. J Am Acad Child Adolesc Psychiatry. 2012; 51: 1076-1084.

*** Gadow KD. & Devincent CJ. Comparison of children with autism spectrum disorder with and without schizophrenia spectrum traits: gender, season of birth, and mental health risk factors. JADD. February 2012.

Gadow KD (2012). Schizophrenia spectrum and attention-deficit/hyperactivity disorder symptoms in autism spectrum disorder and controls. Journal of the American Academy of Child and Adolescent Psychiatry, 51 (10), 1076-84 PMID: 23021482

Retrieved from: http://questioning-answers.blogspot.co.uk/2012/10/when-autism-and-schizophrenia-spectrums.html

Treating autism with a supplement? New research says yes.

In Autism Spectrum Disorders, Genes, Genomic Medicine on Sunday, 7 October 2012 at 07:18

New Form of Autism May Be Treatable With Supplement

Pam Harrison

October 1, 2012 — A homozygous mutation that silences the gene involved in the metabolism of branched-chain amino acids (BCAAs) has been identified in a group of children who have autism and either epilepsy or abnormalities on electroencephalogram (EEG), an international team of investigators has reported.

Gaia Novarino, PhD, from the University of California, San Diego, and multicenter colleagues identified a mutation in the branched-chain ketoacid dehydrogenase kinase (BCKDK) gene in families among whom parents were cousins and whose children had autism, epilepsy, and intellectual disability.

“The normal role of the BCKDK gene is to shut off the metabolism of the BCAAs,” coauthor Joseph Gleeson, MD, University of California, San Diego, told Medscape Medical News. “And the end result of these mutations is hypermetabolism of the BCAAs and their depletion in patients who carry them.”

In mice, the researchers were able to show that a BCAA-enriched diet abolished the neurologic deficits within a week.

The study was published online September 6 in Science.

Related Families

As Dr. Gleeson noted, investigators set out specifically to study families in which parents were related to each other to allow them to identify recessive causes of disease.

They identified 2 consanguineous families, one of Turkish descent and a second of Egyptian ancestry, in which children had autism, intellectual disability, and either seizure or abnormal electroencephalograms (EEGs). Whole-exome sequencing was carried out in both families.

Researchers focused on the identification of homozygous variants that were predicted to result in loss of protein function, which would be consistent with the presumed mode of recessive inheritance.

“In each of these families, we identified a distinct, null, homozygous mutation in the [BCKDK] gene,” investigators write, “and no other homozygous loss-of-function mutations segregating with affected status were identified in either family.”

Investigators also studied the effect of a chow diet containing 2% BCAAs or a BCAA-enriched diet, consisting of 7% BCAAs, on Bckdk mice deficient in the same gene. These mice have reduced levels of BCAAs in various tissues.

“Mice raised on the BCAA-enriched diet were phenotypically normal,” the authors observed, “[whereas] on the 2% BCAA diet…Bckdk mice and not wildtype had clear neurological abnormalities such as seizures…that appeared within 4 days of instituting the 2% BCAA diet.”

The same neurologic deficits were completely abolished within a week of the same mice starting the BCAA-enriched diet, suggesting that Bckdk mice have an inducible yet reversible phenotype.

“What was really surprising to us is that the children [we studied] could have come into any autism clinic because they looked like any child with autism, there was no way to differentiate them clinically,” Dr. Gleeson said. “The only way we were able to make the discovery was by sequencing the DNA, which was where we found the mutation.”

Dr. Gleeson added, too, that it was “very surprising” to find mutations in a potentially treatable metabolic pathway specific for autism, namely through BCAAs supplementation in patients with this specific mutation.

Investigators would welcome any parents whose children have the same constellation of autism with accompanying epilepsy or EEG abnormalities into their screening program.

Translation Medicine

Valerie Hu, PhD, from George Washington University, Washington, DC, told Medscape Medical News that she liked how the study translated novel genetic findings from exome sequencing to a functional/biochemical phenotype, demonstrating reversibility in the mouse model through nutritional supplementation.

“I think that recent research in the field is really opening up new horizons,” she added.

Dr. Hu is herself pursuing research related to the genetic underpinnings of autism.

The study was funded in part by the National Institutes of Health. Dr. Gleeson and his co-investigators have filed for a patent on the genetic diagnosis and potential treatment of this particular form of autism. Dr. Hu has no disclosed no relevant financial relationships.

Science. Published online September 6, 2012. Abstract

Retrieved from: http://www.medscape.com/viewarticle/771886?src=nl_topic

Early detection of ASDs

In Autism Spectrum Disorders, Neuropsychology, School Psychology on Wednesday, 26 September 2012 at 06:54

ASD’s Can Be Diagnosed in Patients as Young as 12 Months

Fran Lowry & Hien T. Nghiem, MD

Clinical Context

Autism-spectrum disorders (ASDs) are neurodevelopmental disorders diagnosed by clinical observation of core behavioral symptoms. The prevalence of ASDs is estimated to be approximately 1% of the general population and is typically diagnosed in the preschool years. However, it has been reported that behavioral risk signs of ASDs may be evident before 12 months of age.

By 9 to 12 months of age, infants who will eventually receive a diagnosis of ASD may demonstrate the absence of social communicative features, such as shared affective engagement, imitation, social orienting, and joint attention, and present with unusual sensory features such as repetitive play, sensory preoccupations, emotional dysregulation, hyporesponsiveness to novel stimuli, and atypical motor behaviors. The First Year Inventory (FYI) is a parent-report measure designed to identify 12-month-old infants at risk for ASD. FYI taps behaviors that indicate risk in the developmental domains of sensory–regulatory and social–communication functioning.

The aim of this study is to determine an effective FYI scoring cutoff for most accurately indentifying infants who are at risk for a later diagnosis of ASD. The aim was met by conducting a follow-up of 699 children at 3 years of age from a community sample whose parents completed the FYI when their children were 12 months old.

Study Synopsis and Perspective

A questionnaire for parents is a promising tool for identifying 12-month-old infants who are at risk for an eventual diagnosis of ASD, new research shows.

A longitudinal follow-up study showed that 31% of children identified by the inventory as being at risk for ASD at 12 months had a confirmed diagnosis by age 3 years.

In addition, 85% of the children identified at 12 months had a developmental disability or concern by age 3 years, coauthor Grace Baranek, PhD, from the University of North Carolina School of Medicine, Chapel Hill, told Medscape Medical News.

“These children have the advantage of being enrolled in an intervention sooner and being tracked sooner than they would normally be, because most of the screenings that are recommended by the American Academy of Pediatrics happen at 18 or 24 months of age,” Dr. Baranek said.

Led by Lauren M. Turner-Brown, PhD, who is also from the University of North Carolina School of Medicine, the study was published online July 10 in Autism: The International Journal of Research & Practice.

Critical Changes

The FYI was developed specifically for 12-month-old infants because this age seems to map onto a period of critical developmental and neurobiological changes that are occurring in many infants who will eventually be diagnosed with ASD, she explained.

The current study was carried out to determine the effectiveness of the inventory in identifying infants at risk for a later diagnosis of ASD. In it, the parents of the 699 children who had completed the FYI when their child was 12 months old completed the additional screening questionnaires when their child reached the age of 3 years.

The parents and children were recruited through a community mailing that was based on North Carolina birth records.

In addition to the FYI, parents received the Social Responsiveness Scale–Preschool Version and the Developmental Concerns Questionnaire, which asked specific questions about parent concerns and child diagnoses. They also received $5.00 to encourage participation in the study.

The inventory identified 6 children with ASD and 3 children with pervasive developmental disorder–not otherwise specified.

Sooner Is Better

A high score in the sensory regulatory domain, which looked at such things as unusual behaviors with play, repetitive behaviors, unusual responses to sensory things such as light and sounds, and day-to-day regulatory patterns such as feeding, sleeping, and eating, was an important predictor of a future diagnosis of ASD, Dr. Baranek said.

Scoring badly in the social communication domain, especially when accompanied by a high score in the sensory regulatory domain, was also predictive, she said. “What we are finding is that although we can identify a lot of children who go on to have autism through their lack of social communicative abilities, the sensory regulatory items help us to more specifically identify the kids with autism so we’re not overidentifying just children with language delay.”

Once the FYI tool is refined, Dr. Baranek said, she and her team would like to see it used in primary care settings at the 12-month baby check, where physicians, nurse practitioners, and early interventionists could screen the child and use the inventory as a basis for progressive surveillance.

“The sooner we can identify any child who has a concern, the sooner they can be referred for more comprehensive evaluation and be connected with support services,” she said.

Significant Impact

Autism Society board chairman Jim Ball agreed. Commenting on this work for Medscape Medical News, Ball said: “Early screening and diagnosis can have a significant impact in an individual’s life, leading to improved educational and social outcomes, as well as employment and independent living in adulthood.”

He added that it is a priority of the Autism Society “to ensure all families know the signs of autism, have access to expert diagnosticians, receive appropriate services, and transition effectively into adulthood.”

The study was funded in part by the National Institutes of Health, Autism Speaks, and the Ireland Family Foundation. Dr. Turner-Brown, Dr. Barane, and Ball have disclosed no relevant financial relationships.

Autism. Published online July 10, 2012.

Study highlights

  • Families who participated in the FYI normative study and who gave consent to be recontacted were invited to participate in this longitudinal follow-up.
  • There were 2 phases: the initial FYI screening mailing at 12 months of age and the subsequent follow-up mailing at age 3 years.
  • At 3 years, parents of 699 children completed the Social Responsiveness Scale–Preschool version and the Developmental Concerns Questionnaire to determine developmental outcomes.
  • In addition, children deemed at risk for ASD on the basis of liberal cut points on the FYI, Social Responsiveness Scale–Preschool, and/or Developmental Concerns Questionnaire were invited for in-person diagnostic evaluations.
  • 38 families participated in the in-person diagnostic assessments. In addition to the FYI, Social Responsiveness Scale–Preschool, and Developmental Concerns Questionnaire, the 38 children who received further in-person diagnostic evaluation also completed the Mullen Scales of Early Learning, the Vineland Adaptive Behavior Scale, and the Autism Diagnostic Observation Schedule.
  • A “best estimate” diagnostic outcome was determined and divided into 1 of 4 categories: diagnosis of ASD; diagnosis of other developmental disability; no professional diagnosis, but developmental concerns noted or observed; and no developmental concerns.
  • 9 children had a confirmed diagnosis of ASD from the sample of 699 children, representing 1.3% of this sample.
  • A total of 43 children (6%) were in the diagnosed or treated group for non-ASD developmental problems.
  • An additional 82 (12%) children were in the developmental concerns group.
  • Finally, 574 (82%) of 699 children were in the no concerns group.
  • According to the receiver operating characteristic (ROC) analyses, “a total risk score…of 19.2, which is at or above the 96th percentile, was chosen as the best cutoff score.”
  • A second ROC analysis was performed to calculate the optimal cutoffs for each of the 2 FYI domains.
  • For the social communication domain, “a domain score of 22.5, which is at the 94th percentile, yielded the optimal classification of children with ASD at age 3.”
  • “For the sensory-regulatory domain, a score of 14.75, which is at the 88th percentile, yielded optimal classification of children with an ASD diagnosis at age 3.”
  • The ROC analyses determined that a 2-domain cutoff score yielded optimal classification of children: 31% of those meeting algorithm cutoffs had ASD and 85% had a developmental disability or concern by age 3 years.
  • Limitations of the study included the following:
    • lack of design as an epidemiological study,
    • lack of generalizability because the families who participated in the study tended to be more educated and less racially diverse,
    • that unidentified children were probably missed by current measures, and
    • the feasibility of such large-scale diagnostic protocols.

Clinical Implications

  • By 9 to 12 months of age, infants who will eventually receive a diagnosis of ASD may demonstrate the absence of social communicative features and the presence of unusual sensory features.
  • These results suggest that the FYI is a promising tool for identifying 12-month-old infants who are at risk for an eventual diagnosis of ASD.

Retrieved from: http://www.medscape.org/viewarticle/769367

 

Drug Therapy for Autism

In Autism Spectrum Disorders, Medication, Neuropsychology, Psychiatry, Psychopharmacology on Monday, 24 September 2012 at 16:10

Autism Patients Might Benefit from Drug Therapy

By SYDNEY LUPKIN | ABC News – Wed, Sep 19, 2012 2:37 PM EDT

Researchers have found a drug that can help patients with Fragile X syndrome, the most common cause of inherited intellectual impairment (formerly known as mental retardation), stay calm in social situations by treating their anxiety.

Dr. Elizabeth Berry-Kravis and her team found that a drug called Arbaclofen reduced social avoidance and repetitive behavior in Fragile X patients, especially those with autism, by treating their anxiety. The drug increases GABA, a chemical in the brain that regulates the excitatory system in Fragile X patients, who have been known to have too little GABA to do the job otherwise, causing their excitatory systems to “signal out of control” and make them anxious.

Such patients have been known to cover their ears or run away at their own birthdays because they are overwhelmed by the attention, but one trial participant said he was able to enjoy his birthday party for the first time in his life while he was on Arbaclofen, she said.

“I feel like it’s kind of the beginning of chemotherapy when people first realized you could use chemotherapy to treat cancer patients instead of just letting them die,” said Berry-Kravis, a professor of neurology and biochemistry at Rush University Medical Center in Chicago who has studied Fragile X for more than 20 years.

She said people used to think Fragile X patients couldn’t be helped either, but she and her team have proven that by using knowledge from existing brain mechanism studies, doctors can select medications to target specific problems in Fragile X patients’ brains.

Fragile X syndrome is a change in the FMRI gene, which makes a protein necessary for brain growth, and studies indicate it causes autism in up to one-third of patients diagnosed with it. Unlike Fragile X syndrome, which is genetic, autism is a behavioral diagnosis characterized by an inability to relate to other people or read social cues. Autism and Fragile X are linked, but not mutually exclusive. A core symptom of both is social withdrawal.

Sixty-three patients with Fragile X participated in Berry-Kravis’s placebo-controlled, double-blind clinical trial from December 2008 through March 2010. Of those, the patients with autism showed the biggest improvements in social behavior, Berry-Kravis said.

To psychologist Lori Warner, who directs the HOPE Center at Beaumont Children’s Hospital, the study is exciting because when her autistic patients are anxious, they often have a harder time learning the social cues they can’t read on their own.

“Reducing anxiety opens up your brain to be able to take in what’s happening in an environment and be able to learn from and understand social cues because you’re no longer frightened of the situation,” Warner said.

She works mostly with autism patients, and although some do have Fragile X as well, most do not.

Fragile X affects one in 4,000 men and one in 6,000 to 8,000 women, according to the Centers for Disease Control and Prevention.

Although Arbaclofen worked best on autistic Fragile X patients, further studies will be needed to prove whether it can help all autism patients, not just those with autism caused by Fragile X.

“There’s a difference between one person’s brain and another in how it’s set up,” Berry-Vargis said. “This is not a magic cure. It’s a step.”

Retrieved from: http://gma.yahoo.com/autism-patients-might-benefit-drug-therapy-183744169–abc-news-health.html

ASD interventions

In Autism Spectrum Disorders, School Psychology on Thursday, 20 September 2012 at 04:29

Interventions for Adolescents and Young Adults

By: Lee Wilkinson, Ph. D

Although it would seem obvious that children with ASD will eventually transition to adolescence and adulthood, there is a paucity of information about effective interventions for these age groups compared to data for younger children. Even though the core symptoms of ASD (impairments in communication and social interaction and restricted/repetitive behaviors and interests) may improve overtime with intervention for many individuals, some degree of impairment typically remains throughout the lifespan. Consequently, the focus of intervention/treatment must shift from remediating core deficits in childhood to promoting adaptive behaviors that can facilitate and enhance ultimate functional independence and quality of life in adulthood. This includes new developmental challenges such as independent living, vocational engagement, post-secondary education, and family support. Unfortunately, there is evidence to suggest that improvements in symptoms and problem behaviors may decrease or end once youth with ASD transition from school-based programs. This is likely due, at least in part, to the termination of services received through the secondary school system upon exiting from high school, as well as the lack of adult services. The lack of services available to help young adults with ASD transition to greater independence has been noted by researchers for a number of years and has become an increasingly important issue as the prevalence of ASD continues to grow and as children identified with ASD reach adolescence and adulthood.

Comparative Effectiveness Review

What are the effects of currently available interventions/treatments on adolescents and young adults with ASD? To answer this question, researchers at the Vanderbilt Evidence-based Practice Center systematically reviewed evidence on therapies for adolescents and young adults (ages 13 to 30) with autism spectrum disorders (ASD). Their review focused on the outcomes, including harms and adverse effects, of interventions addressing the core symptoms of ASD; common medical and mental health comorbidities occurring with ASD; the attainment of goals toward functional/adult independence; educational and occupational/vocational attainment; quality of life; access to health and other services; and the transitioning process (e.g., process of transitioning to greater independent functioning). Researchers also addressed the effects ofinterventions on family outcomes including parent distress and satisfaction with interventions.

Of more than 4,500 studies on autism interventions published between 1980 and 2011, only 32 focused on interventions/therapies for individuals ages 13 to 30. Most of the studies available were of poor quality, which may reflect the relative recency of the field. Five studies, primarily of medical interventions, had fair quality. Behavioral, educational, and adaptive/life skills studies were typically small and short term and suggested some potential improvements in social skills and functional behavior. Small studies suggested that vocational programs may increase employment success for some individuals. Few data are available to support the use of medical or allied health interventions in the adolescent and young adult population. The medical studies that have been conducted focused on the use of medications to address specific challenging behaviors, including irritability and aggression, for which effectiveness in this age group is largely unknown and inferred from studies including mostly younger children. However, antipsychotic medications and serotonin reuptake inhibitors were associated with improvements in specific challenging behaviors. Similarly, little evidence supports the use of allied health interventions including facilitated communication.

Conclusion

Despite an increasing population of adolescents and young adults identified with an ASD and the need for effective intervention across the lifespan, very few studies have been conducted to assess treatment approaches for adolescents and young adults with ASD. Moreover, the available research is lacking in scientific rigor. As a result, there is little evidence available for specific treatment approaches in this population; especially for evidence-based approaches to support the transition of youth with ASD to adulthood. In particular, families have little in the way of evidence-based approaches to support interventions capable of optimizing the transition of teens with autism into adulthood. Research is needed across all intervention types on which outcomes to use in future studies. “Overall, there is very little evidence in all areas of care for adolescents and young adults with autism, and it is urgent that more rigorous studies be developed and conducted,” commented Melissa McPheeters, director of Vanderbilt’s Evidence-Based Practice Center and senior author of the report. “There are growing numbers of adolescents and adults with autism in need of substantial support. Without a stronger evidence base, it is very hard to know which interventions will yield the most meaningful outcomes for individuals with autism and their families,” said Zachary Warren of Vanderbilt who also contributed to the report.

Lounds Taylor J, Dove D, Veenstra-VanderWeele J, Sathe NA, McPheeters ML, Jerome RN, Warren Z. Interventions for Adolescents and Young Adults With Autism Spectrum Disorders. Comparative Effectiveness Review No. 65. (Prepared by the Vanderbilt Evidence-based Practice Center under Contract No. 290-2007-10065-I.) AHRQ Publication No. 12-EHC063-EF. Rockville, MD: Agency for Healthcare Research and Quality. August 2012. http://www.effectivehealthcare.ahrq.gov/reports/final.cfm

The complete report is available at: http://effectivehealthcare.ahrq.gov/ehc/products/271/1196/CER65_Autism-Young-Adults_20120723.pdf

Lee A. Wilkinson, PhD, CCBT, NCSP is author of the award-winning book, A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools, published by Jessica Kingsley Publishers.

Dr. Wilkinson can be reached at: http://bestpracticeautism.com

Retrieved from: http://www.examiner.com/article/interventions-for-adolescents-and-young-adults-with-asd?goback=.gde_58284_member_165763295

 

New autism research (with promising findings…)

In Autism Spectrum Disorders, Neuroscience, Psychiatry on Tuesday, 18 September 2012 at 16:24

some promising new studies on autism.  the first discusses the development of a genetic test that may be able to predict the risk of developing an asd.  while gene studies bring up both ethical and moral concerns for some, the findings and possible implications can not be dismissed.  the next study discusses the possibility of a drug involving glutamate receptor antagonists as a treatment for asd.  good stuff…ENJOY!

Genetic Test Predicts Risk for Autism Spectrum Disorder

Australian researchers have developed a genetic test that is able to predict the risk of developing autism spectrum disorder (ASD). (Credit: © Lucian Milasan / Fotolia)

ScienceDaily (Sep. 11, 2012) — A team of Australian researchers, led by University of Melbourne has developed a genetic test that is able to predict the risk of developing autism spectrum disorder (ASD).

Lead researcher Professor Stan Skafidas, Director of the Centre for Neural Engineering at the University of Melbourne said the test could be used to assess the risk for developing the disorder. “This test could assist in the early detection of the condition in babies and children and help in the early management of those who become diagnosed,” he said. “It would be particularly relevant for families who have a history of autism or related conditions such as Asperger’s syndrome,” he said.

Autism affects around one in 150 births and is characterized by abnormal social interaction, impaired communication and repetitive behaviours. The test correctly predicted ASD with more than 70 per cent accuracy in people of central European descent. Ongoing validation tests are continuing including the development of accurate testing for other ethnic groups.

Clinical neuropsychologist, Dr Renee Testa from the University of Melbourne and Monash University, said the test would allow clinicians to provide early interventions that may reduce behavioural and cognitive difficulties that children and adults with ASD experience. “Early identification of risk means we can provide interventions to improve overall functioning for those affected, including families,” she said.

A genetic cause has been long sought with many genes implicated in the condition, but no single gene has been adequate for determining risk. Using US data from 3,346 individuals with ASD and 4,165 of their relatives from Autism Genetic Resource Exchange (AGRE) and Simons Foundation Autism Research Initiative (SFARI), the researchers identified 237 genetic markers (SNPs) in 146 genes and related cellular pathways that either contribute to or protect an individual from developing ASD.

Senior author Professor Christos Pantelis of the Melbourne Neuropsychiatry Centre at the University of Melbourne and Melbourne Health said the discovery of the combination of contributing and protective gene markers and their interaction had helped to develop a very promising predictive ASD test.

The test is based on measuring both genetic markers of risk and protection for ASD. The risk markers increase the score on the genetic test, while the protective markers decrease the score. The higher the overall score, the higher the individual risk.

“This has been a multidisciplinary team effort with expertise across fields providing new ways of investigating this complex condition,” Professor Pantelis said.

The study was undertaken in collaboration with Professor Ian Everall, Cato Chair in Psychiatry and Dr Gursharan Chana from the University of Melbourne and Melbourne Health, and Dr Daniela Zantomio from Austin Health.

The next step is to further assess the accuracy of the test by monitoring children who are not yet diagnosed over an extended study. The study has been published today in the journal Molecular Psychiatry.


Story Source:

The above story is reprinted from materials provided by University of Melbourne.

Note: Materials may be edited for content and length. For further information, please contact the source cited above.

University of Melbourne (2012, September 11). Genetic test predicts risk for autism spectrum disorder. ScienceDaily. Retrieved September 18, 2012, from http://www.sciencedaily.com­ /releases/2012/09/120912093827.htm?goback=.gde_2514160_member_163245605

Retrieved from: http://www.sciencedaily.com/releases/2012/09/120912093827.htm?goback=.gde_2514160_member_163245605

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Disorder of Neuronal Circuits in Autism is Reversible

14 September 2012 08:43 Universität Basel

People with autism suffer from a pervasive developmental disorder of the brain that becomes evident in early childhood. Peter Scheiffele and Kaspar Vogt, Professors at the Biozentrum of the University of Basel, have identified a specific dysfunction in neuronal circuits that is caused by autism. In the respected journal „Science“, the scientists also report about their success in reversing these neuronal changes. These findings are an important step in drug development for the treatment for autism.

According to current estimates, about one percent of all children develop an autistic spectrum disorder. Individuals with autism may exhibit impaired social behavior, rigid patterns of behavior and limited speech development. Autism is a hereditary developmental disorder of the brain. A central risk factor for the development of autism are numerous mutations in over 300 genes that have been identified, including the gene neuroligin-3, which is involved in the formation of synapses, the contact junction between nerve cells.

Loss of neuroligin-3 interferes with neuronal signal transmission

The consequences of neuroligin-3 loss can be studied in animal models. Mice lacking the gene for neuroligin-3 develop behavioral patterns reflecting important aspects observed in autism. In collaboration with Roche the research groups from the Biozentrum at the University of Basel have now identified a defect in synaptic signal transmission that interferes with the function and plasticity of the neuronal circuits. These negative effects are associated with increased production of a specific neuronal glutamate receptor, which modulates the signal transmission between neurons. An excess of these receptors inhibits the adaptation of the synaptic signal transmission during the learning process, thus disrupting the development and function of the brain in the long term.

Of major importance is the finding that the impaired development of the neuronal circuit in the brain is reversible.  When the scientists reactivated the production of neuroligin-3 in the mice, the nerve cells scaled down the production of the glutamate receptors to a normal level and the structural defects in the brain typical for autism disappeared. Hence, these glutamate receptors could be a suitable pharmacological target in order to stop the developmental disorder autism or even reverse it.

Vision for the future: Medication for autism

Autism currently cannot be cured.  At present, only the symptoms of the disorder can be alleviated through behavioral therapy and other treatment. A new approach to its treatment, however, has been uncovered through the results of this study. In one of the European Union supported projects, EU-AIMS, the research groups from the Biozentrum are working in collaboration with Roche and other partners in industry on applying glutamate receptor antagonists for the treatment of autism and hope, that in the future, this disorder can be treated successfully in both children and adults.

http://www.unibas.ch/index.cfm?uuid=BF9F46B0ADFE4138B2556373D7286FD5&type=search&show_long=1

  • Full bibliographic information: Baudouin S. J., Gaudias J., Gerharz S., Hatstatt L., Zhou K., Punnakkal P., Tanaka K. F., Spooren W., Hen R., De Zeeuw C.I., Vogt K., Scheiffele K.
    Shared Synaptic Pathophysiology in Syndromic and Non-syndromic Rodent Models of Autism
    Science; Published online September 13 (2012) | doi: 10.1126/science.1224159

 

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