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Thursday, January 31, 2013

The United States of Autism Official Trailer

A Soon-to-be-Released Documentary Film by Richard Everts


If ever there were a story that embodies the heart of America, it's the story found in families and individuals affected by autism.

As people often fret about America, one can't help but hear the daily drumbeat of how folks have their best days behind them. To many so-called authorities, the situations faced by individuals and families dealing with autism are hopeless, as they seek to define for others what is "normal."

Many parents attempt to navigate a system that is corrupt and/or inept and lose hope while their support systems crumble, leaving them to go it alone. Yet, in the face of such obstacles, some manage to rise above the fray. What drives them? Who are these people and how are they changing their communities?

This was the quest of one man who undertook a 40-day journey across the American landscape to find the answers for his family and son. With interviews that include the widest spectrum of backgrounds -- each conducted in the participants' original language - the film weaves a broad and compelling tapestry across the spectrum of American life in all its faiths, disparities, colors, and cultures.

What he learns along the way will change not only his life, but the lives of those he meets, forever. It's a story about the best days that still lie ahead for our nation, the families, and the people who give America its heart.

Mood Disorders and Teenage Girls

From the Child Mind Institute

By Ron J. Steingard, M.D.
Associate Medical Director and Senior Pediatric Psychopharmacologist, Child Mind Institute

January 22, 2013

Why girls are more vulnerable than boys, and what signs and symptoms you should look for.

Anxiety and depression occur in both genders, but by the teenage years, girls are much more at risk than boys. Before puberty, the prevalence of mood disorders is about the same in boys and girls—3 to 5%. But by mid-adolescence girls are more than twice as likely to be diagnosed with a mood disorder as boys, with the prevalence at adult levels, 14 to 20%.

Why such a big disparity in mood disorders? We know from looking at brain scans that there are differences in the way girls and boys process emotional stimuli. Girls mature, in terms of their emotional recognition, faster than boys—and that sensitivity could make them more vulnerable to depression and anxiety.

It's plausible that that these gender differences around the time of puberty can be traced to evolutionary advantages: Girls may be wired to tune in earlier to emotional stimuli because they were advantageous for their role in nurturing babies; for young men, given their roles as hunters and tribe protectors, emotional responsiveness might have been an important attribute not to have.




The argument that the differences in emotional sensitivity are hard-wired is underscored by the fact that even as women's lives have clearly changed—even as there are many more women living professional, competitive, Type-A lives comparable to those of their male counterparts—the rate of depression in girls and women hasn't dropped.

Even the participation of far more girls in sports and other intense physical activities hasn't reduced the rate of depression, though physical activity is important to emotional well being, and one effective way to help jump start recovery in someone who's depressed.

Symptoms of Depression in Teenagers

In adolescent depression, the thing people tend to notice first is withdrawal, or when the teenager stops doing things she usually likes to do. There might be other changes in her affect, including sadness or irritability. Or in her behavior, including, appetite, energy level, sleep patterns and academic performance. If several of these symptoms are present, be vigilant about the possibility of depression.

This is especially important because by the time family members and other people around a teenager note her lack of interest in most things, or what we call anhedonia, she's usually been depressed for some time. Depression is an internalizing disorder, i.e. one that disturbs a patient's emotional life, rather than an externalizing one, which manifests in the form of disruptive or problematic behavior. As such, it takes a while for not only others to recognize it, but often the patient herself to realize that her thinking, and emotional responses, are disturbed.

Note that there are actually two kinds of depression. In major depressive disorder—the most familiar form of depression—the cluster of symptoms that define depression occur in what may be severe episodes that tend to last from seven to nine months. But there is also another form of depression called dysthymic disorder, in which the symptoms are milder, but they last longer, measured in years.

So, while the experience of dysthymia may be less debilitating for the child at any given moment, the risk is that there is more accrued damage, more time in which the child is kept out of the healthy development process.


John T. Walkup, MD, is a leader in the treatment of anxiety in
children and adolescents and chief of the department of
child adolescent psychiatry at New York-Presbyterian hospital
and the Weill Cornell Medical Center.

Symptoms of Anxiety

Anxiety is a normal adaptive system that lets the body know when it's in danger. However, a youngster's anxiety is maladaptive if it interferes with her ability to function; she withdraws from activities because she's too scared or anxious; the anxiety is out of proportion to the situation; and it doesn't go away with reassurance.

A teenager who has been anxious since childhood may have a lifestyle built around her anxieties: the activities and environments she chooses and those she rules out, the friends she is comfortable with, the expectations and limitations she has trained her family, friends, and teachers to accept. That's why it's more challenging to treat anxiety the longer a child has lived with it, and developed unhealthy coping mechanisms to manage it.

Why Early Intervention is Critical

When a child is depressed or anxious, her suffering isn't the only reason it's important to get help.

In addition to the disorders themselves, there are add-on effects that may cause lifelong issues. With depression comes low energy and poor concentration, two factors that are likely to have a significant impact on social and academic functioning. Anxiety, and the withdrawal that may accompany it, is likewise a detriment to social and academic progress.

It's easy to see the effects of poor academic functioning: falling behind in school undermines a child's confidence and self-image, and can impact her future if it's prolonged. But social learning is just as critical as academic learning in childhood and adolescence. This is a time when a girl would normally be learning such things as how to be a daughter, a sister, a friend; with either depression or anxiety, she may miss or fall behind on these critical kinds of learning. These deficits not only put her behind her peers, but in themselves they can compound her depression or anxiety.



Dr. Neal Ryan discusses cognitive behavioral therapy to
repair a child's negative thinking and
interpersonal therapy to repair relationships.

Other Disorders

It's important to understand that anxiety and depression often occur in the same teenager, and may need to be treated as two separate disorders. Anxiety is more likely to occur without depression than depression without anxiety. It may be that depression leads to anxiety—the negative state of mind of a depressed teenager lends itself to uncertainty. If you're not feeling good about yourself, or confident, or secure, or safe, anxiety may find fertile ground. It may also be because the regions of the brain affected by anxiety and depression are close together, and mutually affected.

Two serious problems that are directly associated with teenage depression and anxiety are suicidal thinking (or behavior), and substance abuse. Suicide is the third leading cause of death among adolescents and young adults aged 15 to 24, and we know that most kids who commit suicide have been suffering from a psychiatric illness.


Especially at risk are teenagers who hide their depression and anxiety from parents and friends. That's why it's important to be alert to signs of these disorders—withdrawal, changes in school performance, eating habits, sleeping patterns, things she enjoys doing—even when teenagers aren't forthcoming about how they feel.

Similarly, the majority of teenagers who develop substance abuse problems also have a psychiatric disorder, including, most commonly, anxiety or depression, which is another important reason to get treatment in a timely way.

Two other problems associated with teenage girls—that is, occurring with greater frequency in girls than boys—are eating disorders and self injury, or cutting. While both of these can overlap with depression, the common assumption that they're caused by depression is not borne out by research. They have different etiologies and reasons for being.


Girls who have eating disorders often show no signs of depression; indeed, they are often very high-functioning, competitive girls who have a distorted body image, but not the symptoms of depression. 

Similarly, self-injurious behavior is a kind of dysfunctional coping mechanism kids get into to alleviate emotional pain, or numbness they've developed as a result of that pain. It can occur with, and be complicated by, a mood disorder, but isn't thought to be a result of the latter. Antidepressants, the medication of choice for mood disorders, don't usually alleviate eating disorders or cutting, which receive different kinds of treatment.

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When Teenagers Self-Medicate

Drinking or doing drugs may start as a way to cope with depression, but once it becomes serious substance abuse, both problems must be treated.

READ MORE.

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Treatments for Anxiety and Depression

Fortunately, early involvement of health care professionals can shorten the period of illness and increase the likelihood of her not missing important life lessons.

The most common treatment a mental health professional is apt to use is some form of cognitive behavioral therapy, and depending on how young the child is, it may involve teaching the parents as well. Cognitive behavioral therapy is based on the idea that a person suffering from a mood disorder is trapped in a negative pattern of thought. Depressed kids tend to evaluate themselves negatively, interpret the actions of others in a negative way, and assume the darkest possible outcome of events.


Similarly, a child suffering from anxiety is overwhelmed by fears of negative outcomes long before events occur. In CBT, we teach sufferers to challenge those negative thoughts, to recognize the pattern and train themselves to think outside it. And in many cases we see real improvement in teenagers with depression and anxiety.

If the anxiety or depression is moderate to severe, treatment may involve medications such as antidepressants. For both anxiety and depression, a combination of psychotherapy and medication usually works better than either alone.

NESCA Announces 2nd Annual Transition Tuesday Evening Workshop Series

Sponsored by NESCA - Neuropsychology & Education Services for Children & Adolescents
 
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To register (required), please call 617-658-9800.
 
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 NEWTON, MA - NESCA today announced that once again this year, they will host a series of special evening seminars on Transition: the long-term process--beginning with assessment--in which students with special needs and their families should actively engage in preparation for life beyond high school.

All sessions will take place in the lower lobby of their building at 55 Chapel Street in Newton, from 7:00 – 9:00pm. There is ample free, off-street parking in the lot opposite the main entrance, which is marked with a blue, Chapel Bridge Park banner.

The cost is $15 per individual session or $60 for the full series of five. Seating is limited; advance enrollment is required. To register, please call Amanda Renzi at 617-658-9800 or email
nesca@nesca-newton.com.
 
February 26, 2013

But She’s Only 12! The Importance of Starting Early

Led by Transition Specialist Kelley Challen-Wittmer, Ed.M., C.A.G.S., who will be joining NESCA full-time early in July, participants will discuss how families of children with special needs can and should start thinking about post-secondary transition even before the age of 14, when MA schools are mandated to provide assessment, planning and services.

After Challen- Wittmer's opening remarks, the audience will divide into small discussion groups, each facilitated by an educational advocate and NESCA clinician, before reconvening for Q & A.

March 5, 2013

Using the TPF to Your Child’s Best Advantage

Veteran Educational Advocate Marilyn Weber, a pioneer in transition consultation and planning, will explain the Massachusetts TPF (Transition Planning Form), step-by-step. Attendees will again divide into small discussion groups, each facilitated by an educational advocate familiar with the planning process, and a NESCA clinician.

April 2, 2013

Transition Assessment – A Comprehensive Approach

NESCA neuropsychologists Dr. Jason McCormick and Dr. Kate DellaPorta, who perform both in-house testing and community-based evaluations, present The Blueprint for Transition Assessment, their modular, highly-individualized approach to transition assessment. Where are your kids now, where do they want to go and what’s necessary to help them get there, successfully?

April 9, 2013

Special Education Law as it Applies to Transition

Super Lawyer Magazine’s “Rising Star” Michelle Moor, Esq. formerly of Kotin, Crabtree & Strong and now practicing special education law privately, discusses state and federal laws relating to transition, after which participants will again break out into small, educational advocate-led discussion groups. Q & A follows.

Moor’s presentation last spring was a highlight of the series.

April 30, 2013

Schools and Agencies with Strong Transition Programs

A panel discussion with representatives from at least six schools and agencies (TBD) with strong transition programs. Learn about the population each serves, their programs, facilities and admissions criteria. NESCA Founder/Director Ann Helmus, Ph.D. moderates.

The Antivaccine Movement and “Autism Biomed” vs. “Outgrowing” Autism

From ScienceBasedMedicine.org

By David Gorski
January 21, 2013

A commonly misunderstood aspect of autism and autism spectrum disorders (particularly by antivaccinationists and believers in the quackery known as “autism biomed”) is that autism is not a condition of developmental stasis. It is a condition of developmental delay.

Autistic children can and do exhibit improvement in their symptoms simply through growth and development. However, parents who subject their children to “autism biomed” quackery of the sort championed by Jenny McCarthy and others seem to view autism as a condition of developmental stasis. That’s why they so easily and predictably attribute any improvement in their children to whatever quackery du jour they are using on them.

It’s also why, in order to determine whether a given intervention in autism has any real effect, randomized controlled trials are required.

Indeed, it’s not so difficult to see why, if you take into account the widespread belief that autistic children do not improve, along with parents’ imperfect human memories riddled with confirmation bias, confusing correlation with causation, and other confounders like regression to the mean, so many parents believe that “autism biomed” treatments have actually helped their children.

Moreover, improvements observed in autistic children tend to be uneven, with periods of little change interspersed with periods of rapid development. Should such a period of rapid development appear after a “biomed” intervention, guess what gets the credit for the improvement?

But how much improvement is possible? Do autistic children “recover,” and, if they do, how much can they recover? The autism biomed movement is rife with stories of “recovered” children, but often, if you investigate these stories, they turn out to be less than convincing, not unlike the way that alternative medicine cancer “cure” testimonials tend not to be so impressive when examined closely. However, in the case of autism, this isn’t always the case.

There are clearly children who lose their diagnosis of autism or ASD, with observations published as far back as 1970, when Rutter reported that 1.5% of adults who had been diagnosed with autism were functioning normally, while 30 years later Sigman et al reported that 17% of autistic children in their group lost their diagnosis and 10 years after that Kleinman et al reported that up to 19% of autistic children “lose their diagnosis.”

The reason for this observation is hotly debated, and until fairly recently it was often assumed that these children’s recoveries were in fact not true recoveries but children who were either misdiagnosed or overdiagnosed. Such an assumption made intuitive sense because such an outcome is more likely with children diagnosed with Asperger’s disorder or pervasive developmental disorder, not otherwise specified (PDD-NOS), both of which are categories that resulted from the expansion of the diagnostic criteria for autism.

Be that as it may, when you boil it all down, it is estimated that between 3% and 25% of autistic children“ lose their diagnosis.” However, few of these studies address whether the social and communication abilities of these children are fully typical.

A recent study might help clarify what degree of recovery is and is not possible. Most of the previous studies before this have been small and did not look specifically at the outcomes people are curious about. Published in The Journal of Child Psychology and Psychiatry by Fein et al and entitled Optimal Outcome in Individuals with a History of Autism, this study got some news coverage last week under titles such as Some With Autism Diagnosis Can Overcome Symptoms, Study Finds; Scientists seek clues in kids who outgrow autism symptoms; Some children outgrow autism: study; Health Buzz: Can Autism Fade Over Time?; and Children ‘may grow out of autism’.

The authors set the stage in their introduction after surveying the literature, some of which I’ve touched on above:

"Several tentative conclusions thus seem warranted based on prior research: (a) losing the ASD diagnosis is a possibility for a minority of children and, at least for some children, is not due to misdiagnosis; (b) ‘optimal outcome’ is associated with higher cognitive functioning and somewhat milder initial symptoms; (c) residual difficulties with language, attention, executive or emotional functioning may persist and need to be characterized.

Definitively documenting the existence and characteristics of individuals who lose the diagnosis of autism has important implications for understanding the neurobiology of autism, the impact of intervention on functioning, and the mechanisms underlying improvement. Structural and functional imaging of this group may shed light on whether brain anatomy and function have normalized, or whether normal behavior has been achieved through compensatory mechanisms. The current project aims to document a group of such OO individuals, explore possible persistent weaknesses in areas central to ASD, characterize the range of treatments they received, and look for biological characteristics through structural and functional MRI."

Basically, what the authors did was to characterize these children who would be referred to by antivaccinationists as “recovered.” To do this, they identified a group of 34 children who had had a diagnosis of autism/ASD but no longer meet the criteria for the diagnosis, referred to as “optimal outcome” (OO) above. These children were compared with a group of 44 age- and nonverbal IQ-matched children with high functioning autism (HFA) and 34 children undergoing typical development (TD).

What makes this study stand out is that the investigators did something very critical. They were very careful to accept only children whose diagnosis had been made by a physician or psychologist specializing in autism before the age of five verified with a written diagnostic report provided by the parents. Then, as a second step to confirm the diagnosis, the investigators took each report, removed language about the diagnosis, summary, and recommendations but leaving descriptions of the child’s behavior.

These redacted reports were then reviewed in a blinded fashion by one of the co-investigators, along with a bunch of “foil” (a.k.a. control) reports from children with non-ASD diagnoses, such as global delay or language disorder. All foils were correctly rejected, and four OO children’s reports were rejected for inadequate documentation of diagnosis.

The second screen was to have the child’s current status evaluated, with clinicians with at least 15 years of experience, who reviewed that the child’s Autism Diagnostic Observation Schedule (ADOS) scores were below ASD thresholds and that in their clinical judgment an ASD was not present.

The overall schema is summarized below:


Other criteria included that the children in the OO group had to be fully included in regular education classes with no one-on-one assistance and no education services to address autism deficits (e.g., no social skills training) and that scores on another communication-related test had to be at or above a certain level.

So what next? Well, the authors interviewed the parents and tested the children using several measures, with, where knowledge of group could affect scoring, the tests scored by a researcher blinded to what experimental group the children. These measures included ADOS, Autism Diagnostic Interview-Revised (ADI-R); Social Communication Questionnaire (SCQ); Wechsler Abbreviated Scale of Intelligence (WASI); Vineland Adaptive Behavior Scales (VABS); Benton Facial Recognition Test; Clinical Evaluation of Language Fundamentals-IV (CELF-IV); and the Edinburgh Handedness Inventory.

Sex, age, and handedness didn’t differ between the three groups, but verbal IQ was 7 points lower in the HFA group, compared to the OO and TD groups, where it was in the high-average range.

The investigators reported a number of observations of their groups. First, communication and socialization ADOS scores didn’t differ between the OO and TD groups, although the authors do note that “seven OO participants were judge to have social functioning mildly affected by nonautism conditions, such as anxiety, depression, or impulsivity” and that they will report a full exploration of the psychiatric functioning of all three groups in a separate study.

They also noted that by early history the OO group demonstrated somewhat milder social symptoms than the HFA group but that they did not differ in communication or repetitive behavior symptoms. A small number of OO children demonstrated some weakness in the facial recognition test, but it was not statistically distinguishable from what would be expected in the population at large. Overall, by the measures used, the OO children were for the most part indistinguishable from TD children.

It was also reported that the children who fell into the OO group also tended to have slightly milder autism upon diagnosis than the HFA group by the ADI-R and SCQ-Lifetime results. Basically, their social deficits seemed to be less marked. However, their language delay and repetitive behaviors were similar to those of the HFA group, at least within the limitations of recollections an documentation from a decade or more before (the mean ages of the groups ranged from 12.8 to 13.9 years).

Of coure, the biggest limitation of this study is that it says nothing about what percentage of autistic children can achieve the “optimal outcome” of losing their ASD diagnosis about what interventions are most likely to facilitate such improvements. The review article from Helt et al that I mentioned before estimated that between 3% and 25% of children diagnosed with an ASD “lose the diagnosis.” However, the percentage who would have achieved this without intervention is unknown. Clearly, a lot more study is needed.

This most recent study (Fein et al) is in line with a study from last year by Fountain et al, which showed up in some media reports last spring. This study reported that approximately 10% of children diagnosed with autism/ASD by age 3 “bloomed”; i.e., they improved rapidly, to the point that by age eight they were high functioning. Similar to Fein et al, Fountain et al observed that repetitive behaviors don’t seem to change as much and that it’s mainly the social and communication dimensions where huge variability in outcomes is seen.

Fountain et al also found these correlates with “blooming”:

"Bloomers differ from other children with respect to intellectual disability and socioeconomic characteristics. Among young children with severe autism, those most likely to “bloom” are those without intellectual disability and those with more educated, non-minority mothers.

Although we are unable to identify the specific mechanisms through which socioeconomic status affects trajectory outcomes, the intervening variables likely include home and neighborhood environments, quality and intensity of treatment, quality of education, the efficacy with which parents are able to advocate for their children with institutions providing services, and many other factors in various permutations.

If this heterogeneity in outcomes is associated with parental and community resources, then equal access to early intervention and treatment resources for less-advantaged children is vital. Although some trajectories may be associated with different etiologic drivers, if etiology alone were driving outcomes, we would be less likely to observe the strong socioeconomic effects unless socioeconomic status was associated with exposure to some biological risk factor for a particular autism subtype."

Not surprisingly (at least not to those of us who have followed the antivaccine movement), it is the autistic children born to the types of parents most likely to be antivaccine (more educated, non-minority, higher socioeconomic status) who are most likely to “bloom,” no “biomed” intervention necessary. That’s why, when evaluating whether an intervention of any kind, be it behavioral, medication, or even “biomed,” “works” in autism, it is essential to have a prospective randomized controlled trial.

To see what I mean, I’ll refer you to a blog post that is six years old but still very relevant. It’s by Prometheus and entitled, appropriately enough, Listening to Autism. He begins by pointing out that parents, because they observe their children every day, believe that they understand their autism better than anyone else, even experts.

Of course, it’s equally, if not more, likely that they are so close to their children that they can’t be objective and that their lack of objectivity can profoundly color their observations and thus lead them astray (confusing correlation with causation, for instance, or mistaking regression to the mean for real improvement), but few of them ever seem to acknowledge, much less accept, this possibility. Prometheus then goes on to discuss the prototypical example of an autism “biomed” treatment: Secretin.

Secretin first hit the scene in 1998, when it was first reported that a single injection of secretin, used as a routine part of endoscopy, appeared to dramatically improve the language and functions of an autistic child. This report led to a lot of excitement, a lot of use of secretin, and a bunch of studies of many varieties, short-term, long-term, case series, and, eventually randomized trials. Many of these studies did not support the initial results.

Finally, there was a randomized clinical trial done by Repligen, the company that sells Secretin, that was negative. Today, the scientific consensus, as described in a Cochrane Review and multiple other reviews of the literature, is that secretin does nothing for ASD symptoms, and that its use in ASD warrants no further study.

None of this stops the autism biomed crowd from advocating and using secretin. If you go to, for instance, the antivaccine crank blog Age of Autism, you will from time to time find commenters extolling the virtues of secretin, long after the science has been settled.

Other websites still tout it, as well. Indeed, the Florida branch of the Scientology front group Citizens Commission on Human Rights (CCHR) recently argued that the reason the scientific trials of secretin were negative was because the investigators used a “synthetic” version of secretin, while the “dramatic improvements” came from a “natural version” of the hormone from pigs.

In other words, some parents and quacks still swear by secretin, even though the evidence is even clearer that secretin does nothing for autism than it is that vaccines do not cause autism.

To explain this, combined the results that I just discussed above with a tale that Prometheus tells, which he calls the Tale of the Lucky Stockbroker:
"Long, long ago, a smart fellow decided that he would try to make a lot of money in the stock market. Having watched the market for some time, he realized that the best way to make money on stocks wasn’t to buy and sell them, but to sell expert advice.

Knowing that most people who invested in stocks were wary of advice, he set out to prove to people that he had a special power for knowing when stocks were about to go up or down. He got a list of a ten thousand people who were avid stock traders and sent each of them an e-mail describing his services (and fees) and giving them a “sample” stock pick.

Half of the prospective customers got an e-mail saying that the stock would go up in the next week, and half of them got an e-mail saying that the stock would go down. At the end of the week, the stock he picked had gone down, so he sent another e-mail to the five thousand people who had received the “correct” stock advice.

Half of the five thousand got an e-mail saying that another stock would go up in the next week; half got an e-mail saying it would go down. At the end of the week, he sent out another e-mail to the remaining 2500 would-be customers.

At the end of six weeks, he was down to a little over 150 potential customers, but those 150 has seen him make six correct stock predictions in a row! The last e-mail he sent them was to tell them that they could continue to get these predictions only if they bought a five-year subscription to his service."


There is no claim that autism “biomed” quacks are deliberately doing something like this, although perhaps a few are. However, in effect they are doing something like this. Parents who seem to see results, nearly always due to random chance alone and the human tendency to confuse correlation with causation, will convince themselves that whatever treatment they have chosen is “working.”

Given that the very parents who tend to gravitate towards autism biomed treatments tend to be the same parents who blame their children’s autism on vaccines, this should not be surprising. They are already likely to easily confuse correlation with causation. Because children, autistic and non-autistic, develop in “spurts,” it’s very easy to think that a treatment that by chance alone happened to be started right before a period of rapid development, was the reason for the improvement in the autistic child’s symptoms, even if it were homeopathy (i.e., water) that was used.

Meanwhile, the parents who don’t see any improvement will drift away from the “treatment,” frustrated that it “didn’t work.” Others lash out at any suggestion that autistic children can “recover” spontaneously or with something other than quackery, for instance, Kim Stagliano of Age of Autism:

"Oh! And did you hear some kids “outgrow” their autism. Yuppers. In the Catholic Church we call that a miracle. When Jenny McCarthy told the media her son had lost his diagnosis she was called a liar. Turns out that the only way to lose the diagnosis is by doing nothing. Jeez, I’m always the last to know… I could be driving that Camaro I’m constantly talking about on Facebook with the money we’d have saved."

I’m not sure why there is such hostility here. My guess is that it’s the implicit conclusion that a significant but unknown percentage of children with autism/ASD can develop rapidly and ultimately fall into the neurotypical group. It doesn’t even much matter, for purposes of the observation that “outgrowing” autism is possible what the mechanism is. The authors propose other possible explanations besides development resulting in brain function that is more neurotypical, for example:

"A pressing theoretical question is to what extent brain structure and function have normalized in the OO children. It is possible that effective early intervention plus maturation have resulted in the normalization of pathways and functions or even anatomical structure.

Dawson et al. (2012) were able to show EEG evidence of normalization of cortical activation in response to faces versus objects in children receiving Early Start Denver Model intervention for 2 years in early childhood, supporting this possibility.

Alternatively, successful intervention may have resulted in compensatory functions, such that overt behavior is normal, but atypical pathways or levels of activation are needed to achieve these behavioral results, as has been shown, for example, in dyslexia by Eden et al. (2004).

Structural and functional MRI data were obtained from a subset of each group in the present study and are being analyzed."

More likely, it is a combination of factors. Whatever the case, if anything, Fein et al should provide hope to parents of autistic children by emphasizing that autism is not static and that it should be possible, depending upon the mechanism at work in these children who “grew out of” their autism, to identify science-based personalized strategies to maximize the potential of each autistic children, not to mention the chances that they can eventually function as fully independent members of society living productive lives.

Wednesday, January 30, 2013

Concussions in Youth Sports and in Play: Presentation at Weston High School 7:00pm Thursday, February 28

Sponsored by the Weston PTO

Dr. William Meehan will discuss Concussions in Youth Sports and in Play at the Weston High School Media Center, 444 Wellesley Street, Weston at 7:00pm on Thursday, Feburary 28.

Meehan will speak about concussive brain injury, its symptoms, potential long term effects and what parents and athletes can do to facilitate recovery. He is Director of the Sports Concussion Clinic in the Division of Sports Medicine at Children's Hospital, and an instructor of pediatrics and orthopedics at Harvard Medical School.
A panel, including parents and Weston athletic administrators, will join Dr. Meehan for discussion/Q&A following his presentation.
Please contact Deb Sullivan (sullyweston@comcast.net) or Ali Farquhar (alison@been-farquhar.com) for additional information.

Talkin' Team Meeting Blues

Brought to You by Educational Advocate Extraordinaire (and Rukus Racer) Maureen Finaldi, via Facebook...

Prenatal Inflammation Linked to Autism Risk

From the Autism Speaks Science Blog

January 25, 2013

“While research has shown that maternal infection is a risk factor for autism, this is the first study to identify a biomarker of that infection during pregnancy.”

Researchers have found more evidence that inflammation during early pregnancy increases autism risk. The new study found high autism rates among children born to mothers with elevated levels of C-reactive protein (CRP).

High CRP is an established marker of body-wide inflammation.


“Elevated CRP is a signal that the body is responding to inflammation from, for example, a viral or bacterial infection,” says study leader Alan Brown, M.D., M.P.H.

“The higher the level of CRP in the mother, the greater the risk of autism in the child."

Dr. Brown is a professor of clinical psychiatry and epidemiology at Columbia University College of Physicians and Surgeons, the New York State Psychiatric Institute and the Mailman School of Public Health.

The new report appears in the journal Molecular Psychiatry. The National Institute of Environmental Health supported the research, which grew, in part, from a 2007 Autism Speaks pilot grant.
 
The analysis found that autism risk increased by 43 percent among children of mothers with CRP in the top 20th percentile. This means that their CRP levels were higher than 80 percent of those tested. Autism risk increased by 80 percent among children of mothers with CRP in the top 10th percentile (higher than 90 percent of those tested).

The findings add to mounting evidence that an overactive immune response can alter brain development during pregnancy. However, Dr. Brown emphasizes that the vast majority of mothers with increased CRP levels will not have children with autism.

“We don’t know enough yet to suggest routine testing of pregnant mothers for CRP for this reason alone,” he says. “However, exercising precautionary measures to prevent infections during pregnancy may be of considerable value.”

Dr. Brown’s team analyzed information from the Finnish Maternity Cohort. This national biorepository contains blood samples collected during early pregnancy from more than 800,000 women. Finland also maintains a national registry of children diagnosed with autism.

This allowed the researchers to analyze CRP in pregnancy blood samples from mothers of 677 children with autism. For comparison, they also looked at samples from an equal number of pregnant women whose children did not develop autism. The strong link between elevated CRP and autism risk was not associated with parental age, previous births, socioeconomic status, preterm birth or birth weight.

“While research has shown that maternal infection is a risk factor for autism, this is the first study to identify a biomarker of that infection during pregnancy,” adds Alycia Halladay, Ph.D., Autism Speaks senior director of environmental and clinical sciences. “Future studies may help explain how infections or other inflammatory events during pregnancy interact with known autism risk genes,” she says.

“Such studies may also lead to protective intervention measures.”

Friendship Circle Blog Launches The Special Needs App Review

From The Friendship Circle Blog - Special Needs Resources for Parents & Educators
 
By Rabbi Tzvi Schectman
January 29, 2013

"Finding the right app for a child with special needs can make a huge difference in a child’s development!"

With hundreds of apps now available to help individuals with special needs it has become increasingly difficult to find and choose the right special needs app.

After hearing from so many people how difficult it was to find a good special needs app, we decided to create a directory of apps for individuals with special needs.

 


A Sample Page From The Special Needs App Review


The Friendship Circle App Review will give you the ability to browse through hundreds of special needs apps in such categories as:
  • Communication
  • Social skills
  • Life skills
  • Behavior
  • Education
  • Scheduling
  • Games

Searchable and Sortable

The App Review gives you the ability to search for an app by name, category or keyword. You can also filter apps based on price, category and platform.

Once you find your perfect app a simple click of the mouse directs you to the Apple iTunes store or Google Play store to complete your purchase.


Get started by visiting www.friendshipcircle.org/apps.

Submit An App

Is there an app that should be on this site that isn’t there? Please tell us about it!


Whether you are an app developer or someone who would like to share a special needs app that they have found useful we encourage you submit it to the Special Needs App Review by visiting www.friendshipcircle.org/apps/submit.

Like and Share

If you know a friend or family member that would benefit from this resource, please consider sharing the Special Needs App review with them. Finding the right app for a child with special needs can make a huge difference in a child’s development!

How Technology Can Improve Post-Secondary Outcomes for Students with Autism

From the Edutopia Blog Brain-Based Learning

By Dana Reinecke
January 24, 2013

The challenges associated with autism are costly to the affected individuals, their families, and society. Individuals with autism face difficulties in communication and socialization, as well as increased risk of behavior problems that can severely impact their ability to participate in everyday activities.

Children with autism grow into adults with autism, and current statistics show that the majority of these adults do not keep up with their peers by attending college or getting competitive employment after high school (Taylor & Seltzer, 2011 (1)).

The tragedy is that many of these students are capable and could live and succeed independently given the proper supports and tools.

Until recently, such support has generally consisted of individualized programming, one-to-one intervention, and ongoing interaction with teachers, coaches, and therapists. This high-intensity programming is costly and not always within reach for individuals and school districts charged with providing an adequate education.


Furthermore, school district support ends at age 21, turning young adults over to systems typically set up for maintenance and safety, not growth and achievement.

Technology as an Educational Tool for Students with Autism

We are starting to see an impact of the technology revolution on our ability to support students with autism and other disabilities, however. The availability of handheld devices that are intuitive and easy to use, such as tablets, has opened doors for children and adults in so many ways.

Perhaps most crucial is the use of these devices as a means of communication. Augmentative and alternative communication is nothing new for people with disabilities, but today’s tablets and smartphones provide access to communication apps and programs that are more affordable and easier to use than older devices.

Modern technology is also incredibly engaging for students with disabilities. Access to the Internet, videos, music, interactive games, and
digital learning platforms can be highly motivating to children and adults on the autism spectrum (2). Research strongly supports the use of video models for teaching a variety of skills (3) to students with autism. Many of these individuals find that socialization is easier and more pleasant when conducted online, via text, or even simply around the presence of technology.

The child with an autism spectrum disorder who dislikes sports or finds verbal exchanges difficult will happily join other kids in a video game or SMART Board activity at school. Teens who want to have friends but feel uncomfortable negotiating phone calls or school clubs can ease themselves into such experiences with texting and Facebook interaction (4).

Teachers and parents find that technology can be useful and practical in helping their students and children in other ways, as well. Apps for
data collection (5) allow for ongoing analysis of behavior in a way previously impossible. Companies, like Rethink Autism (6), make training and support materials available in geographic areas that lack trained professionals. The Sage Colleges’ highly regarded master’s and certificate in applied behavior analysis and autism (7) programs are offered completely online, bringing training to professionals all over the world.

Enhancing Future Post-Secondary Learning for Students with Autism

A logical next step is to apply technology to the delivery of higher education to support adolescents and adults on the autism spectrum. Technology allows for accommodations to be built directly into the curriculum, individualized programming, and support for students in new and effective ways. In the online classroom, content can be offered in multiple formats, allowing students to choose the style that best matches individual learning needs.


Those who are visual learners can read the information, auditory learners can listen to it, and anyone can access content multiple times as needed. Assessments can also be offered in multiple formats, allowing professors and students to think outside the box. Auditory essays, choice of test format, and other accommodations can be readily available with a little preparation on the instructor’s part, reducing stress on the student and maintaining focus on the learning.

One common complaint of high school students on the autism spectrum who are struggling in mainstream settings is that each teacher does things a little differently. These small differences can be extremely challenging to students who are limited by deficiencies in executive functioning.


Not only does an online education remove the challenges of navigating a campus and filtering out extraneous social and other stimuli, but it also allows for consistency in formatting. Students can focus on the material, rather than worrying about relearning systems and procedures with each new professor and each new class.

Technology can maintain personal contact between college students and those who support them by removing geographic and time barriers, as well. Skype, phone, email, and other ways of connecting are excellent tools for connecting at whatever level is needed for the student to succeed.


Some college students might Skype with a professor or mentor on a daily basis, while others might benefit from text messaging to remind them of upcoming due dates and provide small doses of support and encouragement.

Individuals on the autism spectrum of all ages can benefit from these and other uses of technology. Families and school districts have eagerly engaged with the growth in technology.
The Achieve Degree (8) at The Sage Colleges is a fully online bachelor’s program for students with autism and other special needs that takes full advantage of technology to create unique opportunities for students who would not otherwise be willing or able to attend college.

As colleges like Sage use technology to create unique opportunities for students who would not otherwise be willing or able to attend college, perhaps we will start to see a shift in the outcomes that can be expected for students with autism after high school.

About Dana Reinecke

Dr. Dana Reinecke is a Board Certified Behavior Analyst. She earned her doctorate in Learning Processes and Behavior Analysis Psychology from the Graduate Center of the City University of New York. Dr. Reinecke joined The Sage Colleges (1) in 2009 as an Assistant Professor, and is now the Department Chair for the Center for Applied Behavior Analysis (2).

She is pleased to teach, advise, and work with candidates in the Master’s of Science in Applied Behavior Analysis and Autism and Certificate in Applied Behavior Analysis programs, and to work with the other department faculty on expanding and improving program offerings.

Dr. Reinecke initiated and consults with the Achieve Degree (3) at the Sage Colleges. The Achieve Degree is a fully online Bachelor’s degree program that is designed to meet the needs of students on the autism spectrum who are academically capable, but socially reluctant, to attend college. Recent awards include the Sage Colleges’ President’s Award for Innovation for her work on the Achieve Degree, and the Elija Foundation Chariot’s Award.

Dr. Reinecke provides consultation in behavior analysis to schools, school districts, and families of children with disabilities. She has co-authored books and book chapters in behavior analysis and autism, and published research in peer-reviewed journals. Dr. Reinecke has presented workshops and research at local, national, and international conferences. She has also provided training and consultation in Mexico, Ireland, and Australia.

Tuesday, January 29, 2013

Children's Mental Health: Experts Urge Focus On Screening Kids

From The Huffington Post Parents Blog

By David Morgan (Reuters)
January 24, 2013

"Experts Warn About 'Huge Gaps' In Kids' Mental Health."

The U.S. mental health system has huge gaps that prevent many children with psychological problems from receiving effective treatment that could prevent tragic consequences later in life, experts told U.S. lawmakers on Thursday.

Just over a month after the shooting rampage in Newtown, Connecticut, mental health experts said psychological disorders usually emerge before people enter high school, but that only one-quarter of children with problems see trained professionals and often the care is not enough.

"We see the results of insufficient mental healthcare in school failure and suicide. How do we do better?" Michael Hogan, head of the President's New Freedom Commission on Mental Health, said in written testimony to the Senate Health, Education, Labor and Pensions Committee.

"While the gaps in children's mental healthcare are huge, there is also reason for hope," he added. "In part, this is because we know more about what works, and what doesn't."

Hogan, a former New York mental health commissioner, was scheduled to appear with two other experts Thursday at the Senate committee's first hearing on mental health issues since the presidency of Republican George W. Bush, who set up the commission Hogan now chairs.

The hearing was scheduled in response to the shootings at Newtown's Sandy Hook Elementary School where Adam Lanza, a young man described as having mental issues, gunned down 26 people including 20 young children with an AR-15-type assault rifle on December 14, 2012.

The tragedy and other mass shootings in recent years have ignited a debate about gun control and mental health, including a push by President Barack Obama for stronger gun controls and better mental health training for schools and communities.

Robert Vero, chief executive of a network of Tennessee clinics called Cornerstone, said mental health professionals who work with children also lack access to parents and other relatives whose problems may contribute to a child's troubles, sometimes due to inadequate insurance coverage.

"We need to be able to teach parenting skills if we want the child's behavior to change," said Vero. "We need to be able to address the parent's depression or addiction."

The experts credited Obama's healthcare reform law, the Patient Protection and Affordable Care Act, with making a step forward by requiring insurers including Medicaid to provide coverage for mental health issues.

But they said the American social safety net still fails to provide adequate access for the poor and elderly, noting that state mental health funding declined $4 billion from 2009 to 2012 as a result of budget constraints posed by recession and the weak economic recovery.

February 8: SPaN’s 3rd Annual Special Education School Fair

Presented by the MA Special Needs Advocacy Network

More than 50 special education schools (click HERE for a complete list) will be exhibiting at the Fair. Representatives from each will be present to describe and discuss how their programs can, or cannot, address various student profiles.

You'll learn about their programs' capacities to meet different levels of student need in academic, cognitive, social, emotional, behavioral, clinical, therapeutic, physical, sensory, medical, adaptive living and vocational domains.

You can also learn about:
  • Academic and Therapuetic Staffing
  • Unique Program Services
  • Academic Methodologies
  • Physical Plant and Facilities
  • Admissions Requirements
  • Placement Options

There will be a complimentary networking luncheon for all full-day participants!

When:     8:00am - 3:00pm, Friday, February 8, 2013

Where:  The Westin Waltham Hotel,
                   70 Third Avenue, Waltham, MA (directions)

Costs:

1.) Morning program: School Fair 8:00am - 12:00 noon ( includes 1 catalog) - Non-Member $40; Member $30 (Price at the door will be $65, checks only).

2.) Afternoon program: "Implementing the New Social-Emotional Guidelines" - Non-Member $60; Member $50 Please note: Morning Attendees staying for the afternoon program are invited to a complimentary buffet lunch. (Price at the door if available: $70, without lunch). Checks only.

3.) Cancellation/Weather Policy: No refunds will be offered if a program is held. Written cancellation requests received at least a week prior to the Fair may transfer payment to an upcoming program in the 2012-2013 program calendar. In case of severe weather, please check www.spanmass.org for information, or call 508-655-7999 for a recorded message.

Afternoon Workshop

Following the School Fair and buffet lunch, MA Commissioner of Education Mitchell Chester, Scott McCloud, Executive Director of MGH Aspire, Madeline Levine of the DESE Office of Special Education Planning and Policy and a school-based team of educators will present information and insights about implementation of the new Massachusetts social-emotional guidelines.

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The sponsors of this special event are Kotin, Crabtree & Strong, LLP, NESCA (Neuropsychology & Education Services for Children & Adolescents), Easter Seals of Massachusetts, UMass Medical School/E.K. Shriver Center and Berkshire Hills Music Academy.