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The Study of Nonverbal Autism Must Go Beyond Words, Experts Say

This article was originally found on SFARI.org

Author: Sarah DeWeerdt
2 September 2013

The study of nonverbal autism must go beyond words, experts say. Interactive devices do not hinder nonverbal children with autism from learning to speak, and may even help them. Roughly 25 percent of people with autism speak few or no words. A generation ago, that figure was closer to 50 percent. Most researchers agree that the decline is due to the recognition of more people with milder forms of autism, as well as to the advent of early intervention programs that have helped more children develop language than in the past.

“One of the primary success stories of early interventions is that they promote language development,” says Helen Tager-Flusberg, director of the Research on Autism & Developmental Disorders program at Boston University. “Nevertheless,” she says, “there are clearly individuals who are diagnosed early, do have access to high-quality interventions, and still fail to acquire spoken language.”

Paradoxically, many researchers now argue that in order to better understand and treat this subgroup of nonverbal people with autism, the field needs to move beyond focusing on speech production. Emerging research suggests that seemingly unrelated issues, such as motor skills and joint attention, may instead be key.
Language delay gets a lion’s share of the attention perhaps because it is often the first and most compelling sign of autism. “Parents, pediatricians, psychologists — everyone, we all focus on word production,” says Joe McCleery, lecturer in developmental neuroscience at the University of Birmingham in the U.K.

But factors that are usually thought of as being outside the realm of speech and communication, such as memory or motor problems, may also play a role, McCleery says. If an infant can’t coordinate movements — such as babbling while rhythmically banging hands on a table or high-chair tray — which is thought to contribute to later language development, then speech may be stymied1.

“It’s very likely that the reasons for why they’re not speaking may be related to a range of different underlying mechanisms,” says Tager-Flusberg. “Once we understand them a little bit better we’ll be able to target the therapies toward the specific kinds of problems that we identify in different children.”

Defining silence:

At the moment, though, children with autism who speak few or no words have received so little research attention that the most basic questions are still on the table.

“We don’t have a really clear definition of what it means to be minimally verbal,” says Connie Kasari, professor of human development and psychology at the University of California, Los Angeles.

Without a firm definition, it’s difficult to compare the findings of different studies. For example, various studies have defined children who use anywhere from 5 to 30 functional words as minimally verbal.

“Most kids are not truly nonverbal, which indicates that they have no words and no sounds,” Kasari says. Instead, they may say single words such as “Mama” and “Dada,” and even a few phrases, often ones that they repeat over and over without regard to context.

The number of words isn’t the only thing that determines whether a child is minimally verbal. Age also matters, as researchers are learning. A child who isn’t speaking at age 2 or 3 might be better thought of as pre-verbal, albeit with a language delay. But one who doesn’t speak at 6 or 7 years, especially after many hours of intervention, is much less likely to ever learn.

One study published earlier this year analyzed data from 535 children with autism enrolled in the Simons Simplex Collection, an autism registry funded by SFARI.org’s parent organization. These children weren’t speaking in two-word phrases at age 4, but 70 percent reached the milestone by age 8, and nearly half were speaking fluently by that time2.

“We found that more children did go on to gain phrase speech than previously thought,” says study leader Ericka Wodka, a neuropsychologist in the Center for Autism and Related Disorders at the Kennedy Krieger Institute in Baltimore.

Wodka and her team also found that children with low levels of social impairment and high nonverbal intelligence quotients (IQs) are the most likely to learn to speak.

“I think what our research points to is that social goals really must be considered in intervention as well,” Wodka says. That is, she says, therapies need to focus on not just the ability to produce words, but the motivation to use them.

IQ is clearly also a thorny issue. Many minimally verbal children are intellectually disabled, but Kasari says she has known some children who could not speak, but could read.

“It can be difficult to tell how intellectually impaired somebody is,” says Nancy Brady, assistant professor of speech, language, hearing sciences and disorders at the University of Kansas. “If they can’t speak, then we maybe undershoot them when we assess them and assume that they are much more impaired than they actually are.”

To circumvent this problem, Brady is developing the Communication Complexity Scale to assess nonverbal communication. This test assesses, for example, whether a child uses gestures to request help with opening a clear plastic jar to obtain a toy3.

“Now we’re looking at what they can do, instead of just what they can’t do,” Brady says. “It allows us to identify more attainable short-term goals.” Therapists may work to help make a child’s gestures clearer and help parents interpret them as a stopgap measure while also working on spoken language development.

Treatment trials:

Children can communicate nonverbally using a variety of approaches, including cards featuring simple line drawings (known as the Picture Exchange Communication System), by typing on an iPad, or with the aid of a speech-generating device that can be programmed to say words aloud for the child.

“There are a lot of people out there who don’t want to use some sort of augmentative system, because they think the kid won’t talk,” Kasari says.

But in fact, the opposite may be the case. Kasari has unpublished data showing that minimally verbal children who also used a speech-generating device early in therapy have more socially communicative utterances after six months than those who get the device later. It’s not clear why, but “it seems to augment their own ability to talk,” Kasari says.

Still, little is known about how to match minimally verbal children with the best therapies to encourage them to develop spoken language. “We have no idea which kids are going to respond to which interventions,” McCleery says. “The more information we can gather on that, the better.”

There are a few glimmers of promise. Tager-Flusberg and her colleagues are planning a randomized trial of auditory-motor mapping training, a therapy that combines rhythmic hand movements with a sing-song intonation. The approach has been successful in treating people who have lost the ability to speak after a stroke, and pilot studies suggest it can also help those with autism4.

Another intervention that may be particularly helpful for minimally verbal children, called JASPER, emphasizes joint attention and play skills that precede, and may underlie, spoken-language development.

“Most kids look to their parents; they look to objects; they show toys; they point to things; they do all of these things before they ever learn words,” says Kasari, a developer of the therapy. “So I think teaching those particular skills helps fill in those gaps, and helps kids learn language faster.”

Kasari and her colleagues have found that working on these skills is particularly helpful for children with the lowest language abilities5, even those who are intellectually impaired6.

With better treatments, almost every child with autism could learn to speak, Kasari says. But even if a few rely on nonverbal or augmentative systems for the long term, that might still be counted a success, she says. “Every child needs access to communication.”

References:

1. McCleery J.P. et al. Front. Integr. Neurosci. 7, 30 (2013) PubMed

2. Wodka E.L. et al. Pediatrics 131, e1128-1134 (2013) PubMed

3. Brady N.C. et al. Am. J. Speech Lang. Pathol. 21, 16-28 (2012) PubMed

4. Wan C.Y. et al. PLoS One 6, e25505 (2011) PubMed

5. Kasari C. et al. J. Consult. Clin. Psychol. 76, 125-137 (2008) PubMed

6. Goods K.S. et al. J. Autism Dev Disord. 43, 1050-1056 (2013) PubMed

ADHD Drugs Don’t Lead To Better Performance In School: Focused Children Still Need Direction, Study Says

Source: Currie J, Stabile M, Jones L. Do Stimulant Medications Improve Education and Behavioral Outcomes for Children with ADHD? The National Bureau of Economic Research. 2013.

Giving a child Ritalin or Adderall won’t make him necessarily more focused on school, especially in the long term.

It’s perhaps the most controversial disorder of the 21st century: opponents say it’s unnecessarily medicated, while advocates call it a breakthrough. Attention deficit hyperactivity disorder (ADHD) has received even more attention lately, as one study has found that medicating a child with ADHD has almost no chance of resulting in better grades.

The most common medications used to treat ADHD are Ritalin and Adderall, two stimulants that have been proven to enhance cognitive function in the short term, including focus, memory, and attention. According to a number of studies testing for kids’ academic performance with and without the drugs, over a long timeline, the effectiveness of these benefits disappears.

“The possibility that [medication] won’t help them [in school] needs to be acknowledged and needs to be closely monitored,” said economics professor Janet Currie, director of the Center for Health & Wellbeing, a health policy institute at Princeton University.

Currie helped author an 11-year study on 4,000 Quebec students who took ADHD medication. The study found that boys who took the drugs performed substantially worse than those who didn’t. Girls reported being more emotional while taking the medication, according to a working paper published by the National Bureau of Economic Research.

“Our results are silent on the effects on optimal use of medication for ADHD,” the researchers wrote, “but suggest that expanding medication use can have negative consequences given the average way these drugs are used in the community.”

Currie argues that children whose performance suffers while taking the drug could simply be taking an incorrect dosage or have stopped taking it because the side effects outweigh the benefits.

The question remains, however, as to why short-term cognitive processes soar with ADHD drugs but wane in the long term.

The answer may be found in a simple review of ADHD’s symptoms and the effects of its medication.

ADHD is a neurobehavioral disorder that gets diagnosed most often in children, after signs that the child has trouble paying attention and controlling impulsive behaviors. The Centers for Disease Control and Prevention (CDC) report that some 2.7 million parents, as of 2007, medicate their child in some form for ADHD.

When a child with ADHD takes Ritalin or Adderall, he or she experiences heightened focus, greater concentration, less hyperactivity, and more overall clarity. For this reason, says University of Pennsylvania cognitive neuroscientist Martha Farah, students who take the drugs must exercise more control in what they focus on. Give them the wrong stimulus, and the child is just as unproductive academically.

According to the Wall Street Journal, if one of Farah’s ADHD students “keeps her head down and studies, she gets very absorbed in her work and accomplishes a tremendous amount. But if a friend stops by, she becomes equally engrossed in the chat.”

This is why little evidence exists to show ADHD drugs help students perform better in school. Focus and concentration are only helpful tools when used correctly. Students who take Adderall and clean their entire bedroom are still shirking the responsibilities of their studies, even if it isn’t the Internet that’s distracting them.

In one major, U.S. government-funded study known as the MTA that looked at the long-term effects of ADHD treatment, 579 children with the condition were randomized to one of three different kinds of treatment or a control group for 14 months.

During the first year of the study, eight and nine year olds did perform nominally better than students with ADHD who hadn’t taken the drugs. However, as the study progressed, the effects leveled off and the students became academic equals.

At the most recent set of assessments, the eight-year follow-up, there were no differences between any of the groups on symptoms or academic achievement measures, suggesting that there wasn’t any long-term residual benefit of the treatments during childhood, the Wall Street Journal reports.

Farah’s findings mirror these as well. When she and her colleagues gave IQ and neurocognitive tests to students with ADHD, those who were taking medication performed the same as those who weren’t on the drugs.

These findings highlight the importance of fostering a well-rounded support system for children. Family encouragement, positive motivation, and structured education end up contributing more to a child’s education than medication alone.

In a separate study performed by Farah, a statistical review of existing data on the topic, still unpublished, suggests there are “very small effects,” she said, “not zero, but not a whole heck of a lot difference.”

Published by: http://www.Medicaldaily.com

‘Boys Will Be Boys’ in U.S., but Not in Asia

Taken from Science Daily
Story Source: This story is reprinted from materials provided by Oregon State University

———————————————————————————————————

May 22, 2013 — A new study shows there is a gender gap when it comes to behavior and self-control in American young children — one that does not appear to exist in children in Asia.

In the United States, girls had higher levels of self-regulation than boys. Self-regulation is defined as children’s ability to control their behavior and impulses, follow directions, and persist on a task. It has been linked to academic performance and college completion, in past studies by Oregon State University researchers.

In three Asian countries, the gender gap in the United States was not found when researchers directly assessed the self-regulation of 3-6 year olds. The results appear in the new issue of the journal Early Childhood Research Quarterly.

“These findings suggest that although we often expect girls to be more self-regulated than boys, this may not be the case for Asian children,” said Shannon Wanless, lead author of the study.

Wanless began conducting the research during her doctoral studies at Oregon State University under Megan McClelland, an associate professor in OSU’s Hallie E. Ford Center for Healthy Children and Families. Wanless is now on the faculty at the University of Pittsburgh.

One interesting part of the researcher’s findings: Although there were no gender differences in self-regulation when the children were directly assessed using a variety of school-readiness tasks, teachers in Asia perceived girls as performing better on self-regulation even when they actually performed equally to boys.

“Teachers are rating children’s behavior in the classroom environment, which has a lot of distractions and is very stimulating,” Wanless said. “It is possible that boys in the Asian countries were able to self-regulate as well as girls when they were in a quiet space (the direct assessment), but were not able to regulate themselves as well in a bustling classroom environment (teacher ratings).”

In addition, McClelland said cultural expectations of girls’ behavior versus that of their male peers may be influencing teachers’ assessments.

“In general, there is more tolerance for active play in boys than in girls,” McClelland said. “Girls are expected to be quiet and not make a fuss. This expectation may be coloring some teachers’ perceptions.”

The researchers conducted assessments with 814 children in the United States, Taiwan, South Korea and China. Their study showed that U.S. girls had significantly higher self-regulation than boys, but there were no significant gender differences in any Asian societies. In addition, for both genders, directly assessed and teacher-rated self-regulation were related to many aspects of school readiness in all societies for girls and boys.

“We know from previous research that many Asian children outperform American children in academic achievement,” McClelland said. “Increasingly, we are seeing that there is also a gap when it comes to their ability to control their behavior and persist with tasks.”

Wanless said this study paves the way for future research to explore why there is such a large gender gap in the United States, and what can be learned from Asian schools.

“What can we learn from Asian cultural and teaching practices about how we can support girls and boys to be successful in school?” she said. “When we see differences in developmental patterns across countries it suggests that we might want to look at teaching and parenting practices in those countries and think about how they might apply in the United States.”

Both researchers emphasized the importance of working with young children, regardless of gender or culture, on their self-regulation skills. Practicing games such as Simon Says and Red Light, Green Light are a few ways that parents can work with their children to help them learn how to follow instructions, persist on a task, and listen carefully.

“In our study, self-regulation was good for academic achievement for boys and girls,” Wanless said. “That means this skill is important for both genders and we should be supporting self-regulatory development for all children, especially boys. Low self-regulation in preschool has been linked to difficulties in adulthood, so increased focused on supporting young boys’ development can have long-term positive benefits.”

——————————————————————————–

Journal Reference:
1.Shannon B. Wanless, Megan M. McClelland, Xuezhao Lan, Seung-Hee Son, Claire E. Cameron, Frederick J. Morrison, Fu-Mei Chen, Jo-Lin Chen, Su Li, Kangyi Lee, Miyoung Sung. Gender differences in behavioral regulation in four societies: The United States, Taiwan, South Korea, and China. Early Childhood Research Quarterly, 2013; 28 (3): 621 DOI: 10.1016/j.ecresq.2013.04.002

Interventions Offer New Hope For Autistic Children Who Never Learn To Speak

Source (Medical News Today)

An Autistica consultation published this month found that 24% of children with autism were non-verbal or minimally verbal, and it is known that these problems can persist into adulthood. Professionals have long attempted to support the development of language in these children but with mixed outcomes. An estimated 600,000 people in the UK and 70 million worldwide have autism, a neuro-developmental condition which is life-long.

Scientists at the University of Birmingham have published a paper in Frontiers in Neuroscience showing that while not all of the current interventions used are effective, there is real hope for progress by using interventions based on understanding natural language development and the role of motor and “motor mirroring” behaviour in toddlers.

The researchers, led by Dr Joe McCleery, who is supported by autism research charity Autistica, examined over 200 published papers and more than 60 different intervention studies, and found that: • Motor behaviours, such as banging toys and copying gestures or facial expressions (“mirroring”), play a key role in the learning of language.
• Children with autism show specific motor impairments, and less “mirroring” brain activity, particularly in relation to strangers in whom they show very little interest. This finding may hold the key to language problems overall.
• Despite extensive use of sign language training to improve speech and communication skills in non-verbal children with autism, there is very little evidence that it makes a positive impact, potentially due to the impairments in motor behaviours and mirroring.
• Picture exchange training can lead to improvements in speech. Here, children gradually learn to “ask” for things by exchanging pictures. This may work well because it does not depend on complex motor skills or mirroring.
• Play-based approaches which employ explicit teaching strategies and are developmentally based are particularly successful.
• New studies involving a focus on motor skills alongside speech and language intervention are showing promising preliminary results. This is exciting because these interventions utilise our new understanding of the role of motor behaviours in the development of speech and social interaction.
With the support of Autistica, the UK’s leading autism research charity, Dr McCleery’s team have now embarked on new work which builds on these findings to design interventions which specifically target the aspects of development where there are deficits in non-verbal autistic children.

Dr McCleery says: “We feel that the field is approaching a turning point, with potentially dramatic breakthroughs to come in both our understanding of communication difficulties in people with autism, and the potential ways we can intervene to make a real difference for those children who are having difficulties learning to speak.”

Christine Swabey, CEO of Autistica, says: “80% of the parents in our recent consultation wanted interventions straight after diagnosis. Dr McCleery’s work shows how critical it is for all intervention to be evidence-based, and that the best approaches are based on a real understanding of the development of difficulties in autism. We are proud to be supporting the next steps in this vital research which will improve the quality of life for people with autism.”

Alison Hardy, whose son Alfie is six, says: “As a parent of an autistic child, who is non-verbal, I feel quite vulnerable. People are always saying “try this, it worked wonders for us”. But you can’t try everything. We need a proper, scientific evidence base for what works and what does not. Then we can focus our time and our effort, with some confidence that we have a chance of helping our children. The publication of this research is an exciting step in giving us that confidence, it is great that Autistica is supporting this vital work.”

New Hope for Autistic Children Who Never Learn to Speak

Found on: Science News

Apr. 24, 2013 — An Autistica consultation published this month found that 24% of children with autism were non-verbal or minimally verbal, and it is known that these problems can persist into adulthood. Professionals have long attempted to support the development of language in these children but with mixed outcomes. An estimated 600,000 people in the UK and 70 million worldwide have autism, a neuro-developmental condition which is life-long.

Scientists at the University of Birmingham publish a paper in Frontiers in Neuroscience showing that while not all of the current interventions used are effective, there is real hope for progress by using interventions based on understanding natural language development and the role of motor and “motor mirroring” behaviour in toddlers.

The researchers, led by Dr Joe McCleery, who is supported by autism research charity Autistica, examined over 200 published papers and more than 60 different intervention studies, and found that:
•Motor behaviours, such as banging toys and copying gestures or facial expressions (“mirroring”), play a key role in the learning of language.
•Children with autism show specific motor impairments, and less “mirroring” brain activity, particularly in relation to strangers in whom they show very little interest. This finding may hold the key to language problems overall.
•Despite extensive use of sign language training to improve speech and communication skills in non-verbal children with autism, there is very little evidence that it makes a positive impact, potentially due to the impairments in motor behaviours and mirroring.
•Picture exchange training can lead to improvements in speech. Here, children gradually learn to “ask” for things by exchanging pictures. This may work well because it does not depend on complex motor skills or mirroring.
•Play-based approaches which employ explicit teaching strategies and are developmentally based are particularly successful.
•New studies involving a focus on motor skills alongside speech and language intervention are showing promising preliminary results. This is exciting because these interventions utilise our new understanding of the role of motor behaviours in the development of speech and social interaction.

With the support of Autistica, the UK’s leading autism research charity, Dr McCleery’s team have now embarked on new work which builds on these findings to design interventions which specifically target the aspects of development where there are deficits in non-verbal autistic children.

Dr McCleery says: “We feel that the field is approaching a turning point, with potentially dramatic breakthroughs to come in both our understanding of communication difficulties in people with autism, and the potential ways we can intervene to make a real difference for those children who are having difficulties learning to speak.”

Christine Swabey, CEO of Autistica, says: “80% of the parents in our recent consultation wanted interventions straight after diagnosis. Dr McCleery’s work shows how critical it is for all intervention to be evidence-based, and that the best approaches are based on a real understanding of the development of difficulties in autism. We are proud to be supporting the next steps in this vital research which will improve the quality of life for people with autism.”

Alison Hardy, whose son Alfie is six, says: “As a parent of an autistic child, who is non-verbal, I feel quite vulnerable. People are always saying “try this, it worked wonders for us.” But you can’t try everything. We need a proper, scientific evidence base for what works and what does not. Then we can focus our time and our effort, with some confidence that we have a chance of helping our children. The publication of this research is an exciting step in giving us that confidence, it is great that Autistica is supporting this vital work.”

10 Art Projects for Kids with Sensory Issues

Written By: Erin McNeill

Kids with sensory issues are sometimes resistant to art projects because they don’t enjoy being messy or they don’t enjoy touching the mediums that are squishy, wet, or are made up of smaller parts, such as sand or rice. If you want to engage your child in art projects, it’s best to start with non-messy experiences for your child and build up to bigger projects. Go slowly and encourage your child to try new things, even if it’s just for a very short time. Here are some projects and activities to get you started.
1.Plastic baggy painting – This is a great project to start with for kids with sensory issues as it doesn’t require the child to actually touch the paint and get messy, but it still gives them the opportunity to move and squish the paint around in the bag. This gives a more mild sensory experience. Simply squirt a small amount of paint into a zip top plastic bag (the freezer type are stronger), use multiple colors for mixing, close the top and tape to the table or the window and have your child “paint” inside the baggy. Observe what happens to the paint and discuss the mixing of colors and what colors make up other colors.
2.Water play – Set out a large tub, fill up some smaller containers with water and a few drops of food coloring, pick out some utensils to play with and go to town! Your child can experiment by mixing the containers of colored water and transferring liquids from container to container. Water is generally a non-threatening item to most children and can create a calming experience for a child. Be prepared with plenty of towels and a dry change of clothes!
3.Model Magic Clay – Model Magic Clay can be found at any craft store or big box store. It will provide a non-messy clay experience for children. It is light-weight and easy to manipulate for children of all ages and it dries in about 24 hours for those little ones that can’t wait to play with their creations. Once dry you can paint your creation if you’d like!
4.Sensory tubs – As your child becomes more and more adapted to touching the world around them, a sensory tub can be a great place to really dig in, so to speak. Fill a medium tub with rice, dry pasta, sand or whatever else you can find. Food grains are generally a good option, and you can save them for another time. You will want to label them for crafts. Bury small objects for your child to find. It may take them a bit to be willing to dig for the items, but the surprise of what they’ll find usually wins out! Give your child tools to use in the tub to move around the objects and the grains. It’s best to start with one tactile substance in the tub at a time. As your child is more willing to touch different things, you can start mixing what you put in the tub.
5.Color Wonder – Color Wonder provides art experiences for children without the mess. The markers or finger paints will only show up on the special Color Wonder paper, which means that they are clear and won’t show up on your child’s skin as they are creating their masterpiece.
6.Painting with tools – Finger painting may be a long stretch for children with sensory issues, but creating an experience where your child won’t have to touch the paint is a step between no painting and finger painting. Have your child paint with unusual objects, such as a fly swatter, spoons, rolling a car or marbles in a tray of paper with paint squirted on top or using string. Let your imagination go wild; just make sure whatever you paint with is washable.
7.Shaving cream play – Playing and painting with shaving cream is a messy project that your child may be resistant to, but knowing that clean-up will be easy may help them start this project. Once your child has started playing in the shaving cream, you might want to see if they’d like to create marble paper with the foam. If your child is sensitive to smells, use unscented shaving cream so the smell isn’t overwhelming to them.
8.Puffy paint in squeeze bottles – You can make this puffy paint at home and put it in squeeze bottles. Have your child squirt out designs and write with the paint. Allow the paint to dry and then you can have your child trace the paint with their fingers, creating an entirely different experience for your child.
9.Styrofoam sculptures – Save Styrofoam from packaging and use it to create art projects! Have your child create sculptures with the Styrofoam; you can use toothpicks, skewers or craft glue to keep items together while building.
10.Gak – Once your child has gotten used to handling objects and substances that are messy, squishy or even kind of gross, it’s time to make gak! Gak is a science experiment with a very fun result. Making the gak is incredibly overwhelming for a lot of children, but that portion of the experiment only lasts for a short while and soon you have transformed some ordinary ingredients into a wonderful play substance that will provide hours and hours of entertainment!

Keep encouraging your child to try new things. You can start with just having them touch it, then put it away for another day if it’s too much for them. It will take time to introduce your child to different substances and textures, and may take repeated exposure to get them to enjoy the experience. Praise them for their efforts and make the experience fun for them!

Scientists Find Age-Related Changes in How Autism Affects the Brain

In the study, titled “Developmental Meta-Analysis of the Functional Neural Correlates of Autism Spectrum Disorders,” Daniel Dickstein, M.D., FAAP, director of the Pediatric Mood, Imaging and Neurodevelopment Program at Bradley Hospital, found that autism-related changes in brain activity continue into adulthood.

“Our study was innovative because we used a new technique to directly compare the brain activity in children with autism versus adults with autism,” said Dickstein. “We found that brain activity changes associated with autism do not just happen in childhood, and then stop. Instead, our study suggests that they continue to develop, as we found brain activity differences in children with autism compared to adults with autism. This is the first study to show that.”

This new technique, a meta-analysis, which is a study that compiles pre-existing studies, provided researchers with a powerful way to look at potential differences between children and adults with autism.

Dickstein conducted the research through Bradley Hospital’s PediMIND Program. Started in 2007, this program seeks to identify biological and behavioral markers — scans and tests — that will ultimately improve how children and adolescents are diagnosed and treated for psychiatric conditions. Using special computer games and brain scans, including magnetic resonance imaging (MRI), Dickstein hopes to one day make the diagnosis and treatment of autism and other disorders more specific and more effective.
Among autism’s most disabling symptoms is a disruption in social skills, so it is noteworthy that this study found significantly less brain activity in autistic children than autistic adults during social tasks, such as looking at faces. This was true in brain regions including the right hippocampus and superior temporal gyrus — two brain regions associated with memory and other functions.

Dickstein noted, “Brain changes in the hippocampus in children with autism have been found in studies using other types of brain scan, suggesting that this might be an important target for brain-based treatments, including both therapy and medication that might improve how this brain area works.”

Rowland Barrett, Ph.D., chief psychologist at Bradley Hospital and chief-of-service for The Center for Autism and Developmental Disabilities was also part of the team leading the study.

“Autism spectrum disorders, including autistic disorder, Asperger’s disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS), are among the most common and impairing psychiatric conditions affecting children and adolescents today,” said Barrett. “If we can identify the shift in the parts of the brain that autism affects as we age, then we can better target treatments for patients with ASD.”

The above story is reprinted from materials provided by Lifespan, via EurekAlert!, a service of AAAS.

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

Journal Reference:
Daniel P. Dickstein, Matthew F. Pescosolido, Brooke L. Reidy, Thania Galvan, Kerri L. Kim, Karen E. Seymour, Angela R. Laird, Adriana Di Martino, Rowland P. Barrett. Developmental Meta-Analysis of the Functional Neural Correlates of Autism Spectrum Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 2013; 52 (3): 279 DOI: 10.1016/j.jaac.2012.12.012

Why Girls May Be Protected Against Autism

Author: Maia Szalavitz

Boys outnumber girls when it comes to autism diagnoses, and researchers may have uncovered one reason why.

Boys are four times more likely to be diagnosed with autism than girls, but whether that trend is rooted in biological differences between the genders or the fact that girls might simply hide their symptoms better, hasn’t been clear.

The gender-based difference could be due to factors that increase the risk among boys, or, alternatively, factors that protect girls. Researchers led by Elise Robinson of Harvard Medical School decided to investigate the latter, and determine whether there might be something about being female that protected girls from the the developmental disorder. The team analyzed data from two large samples of twins, one from Sweden and the other from the U.K. They theorized that if something were protecting girls from autism spectrum disorders (ASDs), then families of girls who actually did develop them should have a greater than average risk, and that risk would overwhelm whatever protection they received from their gender. In other words, girls would have a higher threshold for developing ASDs — they would have to be faced with a heavier burden of whatever genetic or environmental risk factors cause ASD in order to actually develop it.

Such family-based risk can be measured by studying levels autistic symptoms in unaffected siblings: in families at high risk of developmental and psychiatric disorders, even unaffected members tend to have mild symptoms, but not enough to qualify for a diagnosis.

“If greater familial [risk] is required to produce autistic impairments in girls, the family members of affected females should on average carry greater risk than the family members of affected males,” the authors write. Because identical twins share the same genetics, they studied fraternal twins only, comparing sets in which only one had an autism spectrum disorder. Nearly 4,000 British twins and just over 6,000 Swedish twins were included in the research, which was published in the Proceedings of the National Academy of Sciences.

The study found that if a girl scored in the top 10% on autistic traits, the odds of her twin scoring in a similarly high range were 37% greater than those for a boy. That meant the girls came from families with significantly greater risk levels. Because the study looked at autistic traits in a sample from the general population, rather than from those who sought treatment, the results do not simply reflect the fact that girls are less likely to be diagnosed, even if they have the condition.

“It is a really interesting and generally well-done study,” says Marjorie Solomon, associate professor of clinical psychiatry at the University of California Davis MIND Institute, who was not associated with the research. She adds, “The differences in gender ratio in ASD have been a source of great curiosity, given their many implications.”

The study was only designed to test the theory that families of girls with ASDs might have higher than risk of the disorders, and was not structured to test for exactly what it is that seems to protect girls. But that knowledge could lead to potentially better treatment options for both genders. Based on earlier research, experts see genes, rather than social or environmental factors, as the most likely explanation for lower risk among girls.

What might some of those genetic factors be? It’s possible that they may involve the social bonding hormones, oxytocin and vasopressin. “The basic thought is that girls have less vasopressin and higher natural oxytocin,” says Solomon, “And oxytocin is a social hormone, so that would be protective.” The lower levels of vasopressin might also be helpful: while this hormone is thought to be involved in social connections—particularly for boys, who tend to have higher levels — in animals it is also linked to aggressive defense of territory and mates.

Or it may involve other metabolic systems that aren’t as obviously connected to social development. Either way, the findings raise interesting questions about how developmental disorders like ASDs are seeded, and open up intriguing new possibilities for treating them. “An understanding of the biology underlying female advantage could greatly aid progress in understanding,” autism and “in identifying prevention factors for ASDs,” the researchers write.

About the Author: Maia Szalavitz is a neuroscience journalist for TIME.com and co-author of Born for Love: Why Empathy Is Essential — and Endangered.

Szalavitz’s latest book is Born for Love: Why Empathy Is Essential — and Endangered. It is co-written with Dr. Bruce Perry, a leading expert in the neuroscience of child trauma and recovery.

Read more: http://healthland.time.com/2013/02/22/why-girls-may-be-protected-against-autism/#ixzz2M19twjDS

Can Breakfast Make Kids Smarter?

Feb. 5, 2013 — New research from the University of Pennsylvania School of Nursing has found that children who regularly have breakfast on a near-daily basis had significantly higher full scale, verbal, and performance IQ test scores.

In one of the first studies to examine IQ and breakfast consumption, researchers examined data from 1,269 children six years old in China, where breakfast is highly valued, and concluded that children who did not eat breakfast regularly had 5.58 points lower verbal, 2.50 points lower performance, and 4.6 points lower total IQ scores than children who often or always ate breakfast after adjusting for seven sociodemographic confounders.

“Childhood is a critical period in which dietary and lifestyle patterns are initiated, and these habits can have important immediate and long-term implications,” said lead author Jianghong-Liu, PhD, RN, FAAN, associate professor at Penn Nursing. “Breakfast habits appear to be no exception, and irregular breakfast eating has already been associated with a number of unhealthy behaviors, such as smoking, frequent alcohol use, and infrequent exercise.”

At age 6, a child’s cognitive ability as both the verbal and performance levels is rapidly developing. Both the nutritional and social aspects of breakfast play a role. After a whole night of fasting, breakfast serves as a means to supply “fuel” to the brain. Meanwhile, social interaction at breakfast time with parents may promote brain development. Mealtime discussions may facilitate cognitive development by offering children the opportunity to expand their vocabulary, practice synthesizing and comprehending stories, and acquire general knowledge, noted the authors.

The researchers suggest that schools play a role in stressing the importance of eating breakfast by delaying start times and/or providing breakfast to allow students to profit from the cognitive benefits of eating before a morning curriculum.

“Because adequate nutrition in early childhood has been linked to increased IQ through childhood, which is related to decreased childhood behavioral disorders, better career satisfaction, and socioeconomic success in adults, breakfast consumption could ultimately benefit long-term physical and mental health outcomes as well a quality of life,” said Dr. Liu. “These findings may reflect nutritional as well as social benefits of breakfast consumption on children and hold important public health implications regarding regular breakfast consumption in early young children.

This study was based on data collected from the China Jintan Child Cohort Study, led by Dr. Liu, an on-going prospective longitudinal study with the main aim of assessing the early health risk factors for the development of child neurobehavioral outcomes. The study was funded by the National Institute of Environmental Health Sciences.

The above story is reprinted from materials provided by University of Pennsylvania School of Nursing.

The University of Pennsylvania School of Nursing is one of the premier research institutions in nursing, producing new knowledge in geriatrics, pediatrics, oncology, quality-of-life choices, and other areas. Researchers here consistently receive more research funding from the National Institutes of Health than any other private nursing school, and many Master’s programs are ranked first in the country.

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

Using Whole Body Listening to Increase Executive Functioning Skills

Written by: Elizabeth Sautter, MA, CCC-SLP & Sarah Ward, MS, CCC-SLP

How many times have we, as parents and teachers, said to our children, “Pay attention!” or asked “Why aren’t you listening to me?” in a not-so-nice tone of voice. We give our children many directives, “Clean up the bathroom!”, “Get your backpack!”, “Put your homework in your bag!”, “It’s bedtime! Go get ready!” or “Don’t forget your …”. We assume our children know what we mean by those words and what to do. When they don’t respond, it can be incredibly frustrating.

When we say “Pay attention!” or “Put your homework in your bag!” we are not simply asking the child to do the explicit task but rather we are expecting them to use situational awareness to observe what is happening around them, ‘create a mental image’ of what the situation should look like in the future and finally compare the two images to understand the ‘why’ of the required action of the moment.

So when we said, “Pay attention!” we really meant:

[Situational Awareness]‘Please observe that right now all your friends in the cub scout troop are attending to our guest speaker’s lesson on how to tie knots and you need to listen to his words, watch his demonstration and respect your friends who are listening’ so that

[Memory for the Future] ‘when you go back to the work tables you will know how to tie the knots on your own and can use this skill for the upcoming pack trip’.

“Put your homework in your bag!” really meant:

[Situational Awareness] ‘Please notice that the assignment that you just spent the last 35 minutes working on and printed out, is still on the printer tray and the required notecards you made for the research are still on the table.’ so that

[Memory for the Future] ‘when you get into class tomorrow and Mrs. Smith asks for the notecards and the rough draft of your research paper you have it and do not lose points for not turning it in on time.’

In school, when children struggle to pay attention, they are thought of as “lazy”, “non-compliant” or having a “behavioral problem.” We expect children to learn how to focus, listen, and follow directions intuitively, using their “built in” social and self regulation skills. However, not all children acquire these skills automatically and it is our job to teach them.

When we think of a student who has difficulties with executive function we think of that child being disorganized. Executive functioning has become a real buzz word in schools and it’s important to know what is really causing that disorganization. Self regulation (self control) is the foundation of executive functioning and essential for listening and task execution. World renowned expert on attention deficit disorder, Dr. Russell Barkley, defines self regulation as an aspect of executive function skills involving three key components: 1) any action that allows the student to stop and direct themselves so as to 2) result in a change in their behavior in order to 3) change the likelihood of a future consequence or attainment of a goal.

So when we ask a student to listen and follow directions for task execution we are really asking them to momentarily stop (inhibit) their own actions and thoughts to consider the what, where and when of the desired future as well as why it is important. We are asking them to stop, listen, ‘read’ the situation and see/feel the future. This can be very difficult for children to learn and adults to teach.

In 1990, Susanne Poulette Truesdale created the concept of whole body listening which she describes in her article, “Whole-¬Body Listening: Developing Active Auditory Skills” (Language, Speech, and Hearing in Schools, Volume 21, 183-¬?184, July 1990). A forward thinker, she astutely recognized that while we provide practice in listening, “do we teach students how to listen?” She noted that it entails more than hearing with our ears, “we also listen with our brain, eyes, mouth, hands, feet and even your seat!” Nita Everly, author of Can You Listen with Your Eyes, tailored the whole body listening concept to the preschool population and added the “heart” to the list of body parts that are needed to increase empathy and perspective taking.

Inspired by Truesdale and Everly, Elizabeth Sautter and Kristen Wilson created the character Whole Body Listening Larry and two children’s books (Whole Body Listening Larry at Home and Whole Body Listening Larry at School, 2011). Larry inspires preschool and early elementary school students to use their:

• eyes to look at the person talking

• ears to hear what is being said

• mouth by remaining quiet

• hands by keeping them by their side or in lap

• feet by placing them on the floor and keeping them still

• body by facing the speaker or sitting in chair

• brain to think about what the speaker is saying

• heart to care about what the speaker talks about

Larry also teaches children to increase their perspective taking skills by thinking about why these skills are important and how their behavior changes the thoughts and feelings of others.

To reduce frustration when asking students to listen and execute a direction, it is helpful to provide strategies such as whole body listening and creating a future image of what the end goal should look like.

Listening skills are foundational executive and self-regulation skills for children to posses in order to be successful in both academics and social situations. If students are able to attend and listen, they are more available to absorb academic and social content and be successful in managing tasks and social situations. Whole body listening is a concept to support this fundamental skill, as well as a powerful means to increase their executive function skills.

Note from Authors: To learn more about developing independent executive function skills, mark your calendars and attend Sarah Ward’s upcoming conference in the Bay Area on March 2nd and March 3rd. For more information and to register, click here.

Also, help us document Larry’s travels and support his mission of teaching children how to listen with their whole body. We are tracking Who’s Listening to Larry Now? by posting testimonials, stories, or activities to share on his Facebook page: http://www.facebook.com/WholeBodyListeningLarry . Once we hear from you, we will pin your location on our Who’s Listening to Larry Now? map located at his home at Communication Works in Oakland, CA. Join the fun, we look forward to hearing from you!

Elizabeth Sautter is the co-director/owner of Communication Works. She is a licensed and certified speech-language pathologist who has? been working with clients and their families since 1996. She is experienced in the areas of autism, developmental disabilities, social cognitive deficits, and challenging behaviors. Elizabeth has worked with individuals ranging from preschoolers to adults in private practice, schools, and hospitals.

Sarah Ward is the Co-Director of Cognitive Connections and has over 15 years of experience in diagnostic evaluations, treatment and case management of children, adolescents and adults with a wide range of developmental and acquired brain based learning difficulties and behavioral problems.

For more information, visit www.cwtherapy.com and www.cognitiveconnectionstherapy.com