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Sunday, August 31, 2014

Environmental Enrichment May Help Treat Autism — and Help Us All

From Scientific American's Blog "Mind & Brain"

By Michael Leon
August 26, 2014

Evidence for a surprisingly simple therapy.

The power of exposure to a variety
of stimulations. Credit: Thinkstock
I had been working quite happily on the basic biology of the brain when a good friend of mine called for advice about his daughter, who had just been diagnosed with autism.

I could hear the anguish and fear in his voice when he asked me whether there was anything that could be done to make her better. I told him about the standard therapies, including Intensive Behavioral Intervention, Early Intensive Behavioral Intervention, Applied Behavior Analysis, and the Early Start Denver Model (ESDM). These therapies are expensive, time-consuming and have variable outcomes, with the best outcomes seen for ESDM.


There are, however, few ESDM therapists, and the cost of such intensive therapy can be quite high. Moreover, my friend’s daughter was already past the age of the oldest children in the study that demonstrated the efficacy of ESDM.


My feeling was that there was a good chance that there was an effective therapy for her using a simple, inexpensive at-home approach involving daily exposure to a wide variety of sensory stimulation. This is a partial list of the disorders whose symptoms can be greatly reduced, or even completely reversed, with what is known as “environmental enrichment”:
  1. Autism
  2. Stroke
  3. Seizures
  4. Brain damage
  5. Neuronal death during aging
  6. ADHD
  7. Prenatal alcohol syndrome
  8. Lead exposure
  9. Multiple sclerosis
  10. Addiction
  11. Schizophrenia
  12. Memory loss
  13. Huntington’s disease
  14. Parkinson’s disease
  15. Alzheimer’s disease
  16. Down syndrome
  17. Depression

But why haven’t you heard about this? The reason is that all of these disorders that have been successfully treated only in animal models of these neurological problems. However, the effects seen in lab animals can be dramatic. For example, experimental animals living in an enriched environment and exposed to a serious brain toxin such as lead, actually have better memory than those living in a standard environment without lead exposure.

But you’re probably thinking that this approach certainly couldn’t work for people. We live in a world in which we seem to be over-stimulated. My guess is that we get plenty of visual stimulation, but our environment may lack the enrichment that it needs from other sensory pathways.

I knew that a remarkable one-third of children who had been deprived of normal sensory stimulation while they were living in orphanages developed what has been called post-institutional autistic syndrome, with symptoms quite similar to autism. If decreasing sensory stimulation could increase the probability of expressing autism symptoms, then perhaps increasing sensory stimulation might decrease that probability.

Furthermore, I knew of some parents who had tried environmental enrichment successfully with their children. So, even though it had not been evaluated by biomedical researchers, I thought there was a chance it could help my friend’s daughter — and was unlikely to cause any harm.

My friend’s daughter was then led through environmental enrichment program, based on our work with experimental animals. She showed a significant improvement in her behaviors and was eventually able to join regular classes in her school. Impressed with this, we initiated a randomized clinical trial in which we recruited children with autism and then compared those given an enriched environment by their own parents at home, to those receiving only the standard treatments.

For the environmental enrichment, we asked parents to provide a changing set of sensory exercises each morning and evening. The children were exposed to several different fragrances each day, paired each time with a light rub on their back; they listened to classical music before bedtime; and in the morning and evening, the parents engaged their child in several of 34 exercises in which at least two senses (sound, touch, temperature, vision, and motor) were paired in somewhat arbitrary combinations.

The parents changed the set of exercises every two weeks and the exercises became increasingly challenging. For example, the children were asked to place their hands in water of different temperatures, or they were asked to squeeze objects of different shapes and textures, or they were asked to pick out a specific toy from a bag that contained several objects.

After six months, all of the children were evaluated by assessors with no knowledge of their group assignment. We found that 42% of the enriched children showed clinically significant improvement in their autism symptoms, according to the Childhood Autism Rating Scale, while only 7% of those receiving standard care did.

In addition, the cognitive score of the enriched children (measured with the Leiter International Performance Scale – Revised) was more than 10 points higher than those receiving standard care. We have now repeated and extended the original study with many more children.

Among many additional questions that need to be answered regarding this therapy, it’s important to know both whether these improvements are long-lived and whether these children can keep on improving. While we don’t have these answers, we did follow the progress of one girl who was diagnosed with autism at 2.5 years old. She was inattentive, uncommunicative, and did not interact much with anyone. She had received standard-care therapies until she was eight years old, and showed some improvement. At that time, she started environmental enrichment therapy with no concurrent treatments, and continued it for 18 months. Her behavior significantly improved.

About a year ago, I received an email from her father saying that they had been to a TEDx conference and he included a link to a talk that he thought I would find particularly interesting. On that video, the previously uncommunicative, non-interactive child, who was now in high school, was delivering a brilliant, engaging talk to a large audience; it was difficult to imagine her as a child with profound autism symptoms. Later that day, her father and I shared a wonderfully emotional time recalling where she started and where she is now. She has now been accepted to a top college and her father subsequently built a Web site that leads other parents through the therapy.

It looks like environmental enrichment is a way to improve the treatment of children with autism and perhaps other mental disorders. Moreover, the therapy can be done at almost no cost and with no need for any kind of expertise. But the really big idea is that there may be no reason to wait until you or your child has a neurological disorder to enrich your mind. We are currently working to evaluate the notion that it may be possible to use this approach to maximize our mind’s capabilities throughout our lifetime.

About the Author

Michael Leon, Ph.D. is Professor of Neurobiology and Behavior, a member of the Center for Autism Research and Translation, a member of the Center for the Neurobiology of Learning and Memory and Associate Dean of Biological Sciences at the University of California Irvine. He was recently given the 2014 W.G. Marquis Award from the American Psychological Association for his work on autism.

Saturday, August 30, 2014

Sleep Before Class, Not in It

From Bloomberg View - Education 


August 26, 2014

Teenagers need more sleep. They also need more time in school. A national push is now under way to address the first problem, which is encouraging -- but the second one is no less important.

The American Academy of Pediatrics announced this week what a growing body of research has found: Teenagers would benefit from a later start to the school day.

Like everything else, a teen’s body clock goes a little haywire during puberty, and the hormone that induces sleep (melatonin) is typically not released until about 11 p.m. The glow from electronic devices can delay the release still further -- one reason reading a history textbook may help teens fall asleep better than playing "Candy Crush."

Research shows that the typical teen needs 8.5 to 9.5 hours of sleep to function normally. A 2006 survey by the National Sleep Foundation found that 87 percent of high school students were getting less than that. A big reason is the school day: More than 40 percent of U.S. public high schools start their day before 8 a.m., with 10 percent starting before 7:30.

There’s much more at stake here than reducing the number of yawns in first-period social-studies class. When adolescents are sleep-deprived, the consequences can be serious: an increased risk not just for auto accidents and poor performance on tests, but also for weight gain and depression.

The pediatrics academy recommends starting high school no earlier than 8:30 a.m. That's easier said than done. Later start times can require more money for busing. Many parents like to get the kids out of the house when they leave for work, which is often before 8. And many teachers -- who don’t have the same sleeping schedules as their students -- prefer an early start and the early dismissal that comes with it.

Nevertheless, schools exist to serve students, and the health benefits of later start times are clear. Objections about logistics or finances don’t negate the science.

Allowing students to arrive at school later is not the only scheduling change that would improve academic achievement. In the mid-19th century, urban schools typically ran year-round, with about 250 school days, compared with today’s standard of 180. The 10-week summer vacation came to be largely because school buildings were considered unsanitary during the hot summer months and elites feared too much time in the classroom would create a nation of pointy-headed weaklings incapable of performing the hard labor necessary to make America great.

As U.S. Secretary of Education Arne Duncan said five years ago: “Our school day is too short. Our school week is too short. Our school year is too short.”

Some schools that have experimented with longer school days, weekend classes and a slightly longer school year have seen impressive results, as have schools that have delayed their start time. But change has been slow. And some districts are moving in the opposite direction, shortening their days and starting them sooner.

Students need 40 winks a night and more than 40 weeks of school. It shouldn’t be so hard to make sure they get both.

...................................................................

To contact the senior editor responsible for Bloomberg View's editorials: David Shipley at davidshipley@bloomberg.net.

About a Boy

From Aeon Magazine

By Kent Miller
August 18, 2014

Movies and memoirs give us a romantic view of living with a child with Asperger’s but the reality is very different.

In high school, my son Carson developed a fascination with Fred Phelps, the way a more typical teenager might obsess about the Marvel universe or The Vampire Diaries.

Phelps, who died on March 19, was the bilious founder and leader of Topeka’s Westboro Baptist Church, infamous for setting up godhatesfags, a website dedicated to ‘opposing the fag lifestyle of soul-damning, nation-destroying filth’ and for staging noisy protests at the funerals of fallen soldiers and plane-crash victims.

After Carson read about Phelps on Wikipedia, the man’s name quickly became a joke obvious only to him. ‘Fred Phelps,’ he’d sing out, grinning mischievously. Apparently, Phelps’s congregation had a funny name, too – ‘Westboro Westboro Westboro,’ he’d repeat. Over and over.




Carson has high-functioning autism – otherwise known as Asperger’s syndrome – and he would recite these jokes, such as they were, dozens of times a day. For weeks on end. Since he had no real friends, just some kids in his special-ed classroom whom he’d talk with fitfully, I was his sole audience. Carson’s mother and I had divorced when he was nine, after which Carson went to live with her in California. But he returned to me in Seattle a few years later, when he was about to enter the eighth grade, and I was to embark on life as a single dad.

Aspergians, like others on the autism spectrum, are socially awkward: they have trouble understanding other people and can find it overwhelming to look someone new in the eye. They often persevere with subjects and activities; given half a chance, Carson would bend my ear for hours about Australian Aboriginal linguistics, Mayan aquaculture, ancient Chinese sailing technology, and other subjects I’ve no interest in.

Sometimes very nice people tell me that Aspergians are quite special. ‘Didn’t Einstein have Asperger’s?’ they ask. They press upon me books by Temple Grandin, a livestock professor who has made a second career writing for The New Yorker, or John Elder Robison, an Aspergian who has a wife and kids and an eclectic career that has included building guitars for Kiss.


While I admire Grandin and Robison, who live independently and who have found ways to get along with people in everyday life, hearing them held up as examples of what Carson might achieve saddened me. He was not progressing. This went far beyond being a moody teenager, which Aspergians are no more immune to than your neighbourhood goth: in all his time with me, Carson never formed a friendship.

It was incredibly difficult to get him to do things he didn’t want to do, such as his English homework, which he claimed was boring. Nor would he try anything new. He would never have done anything in the least out of his routine if I hadn’t taken the lead. When we went camping – the Southwest, the East Coast – he showed no interest in setting up the tent or cooking or cleaning. Instead, he’d tramp about the campsite, regaling me with information about Han Dynasty sails.

Meanwhile, I consulted psychologists who specialised in Aspergian teenagers. I took him to social-skills classes for Aspergians. I hired nursing students to be his companions. Even with insurance co-pay arrangements, none of this was cheap – and that doesn’t include the time I took off work. Eventually, I lost a contract job with a software company because I left work early so often. And then I spent endless days pleading, bribing, cajoling and yelling at Carson to do his homework, take out the trash, stop going on and on about Aboriginal linguistics.

Boredom, anxiety, exhaustion and anger were constant companions. Which is not to say that Carson couldn’t be sweet, and wonderful. Once, for example, when I was broken-hearted over being left by yet another girlfriend, he baked me a chocolate cake. But such lovely moments were few and far between.

There was something else, too. When you are raising a child with a developmental disability, if you are not careful, you can get a little fatheaded about it. Everyone tells you that you’re a wonderful parent. There are no end of books and magazine articles and movies telling you that you stand shoulder-to-shoulder with legions of Autism Heroes and Mother Warriors. And while I wanted to help my son, there was part of me that badly wanted people to say, ‘There goes Kent. God, what a great father. What an amazing guy.’ It clouded my judgment.

One day, my son came home with the news that Fred Phelps – or, to be exact, his followers – were coming to protest at his high school. Carson attended Garfield High, an ethnically diverse school with a rich tradition of arty types – Michael Jackson’s producer Quincy Jones and Jimi Hendrix were both alumni. Garfield strongly supports lesbian, gay, bisexual and transgender (LGBT) students, which doubtless drew Phelps’s ire, but probably of greater interest to him was its proximity to Seattle’s major TV stations.

At first my biggest concern was noise. Like many people with autism, Carson hates loud, unexpected noises. Something as innocuous as a vacuum cleaner being switched on can make him clamp his hands to his ears with pain. And, as surely as the earth spins, there’d be plenty of noise when Phelps’s minions showed up.

By this time – spring 2009 – the roles played by all parties involved in the Westboro roadshow were as familiar as the squabbles in a seventh-season episode of Friends. A handful of Westborians would scream and wave placards; they’d be outnumbered by reporters and then ringed in by stone-faced cops. Given Seattle’s colourful liberal politics, I had no doubt that a boisterous crowd of counter-protesters would be on hand.


Like many intelligent teenagers, Carson is yper-opinionated. When Obama and McCain ran for president, he lectured frat boys outside Seattle’s nightclubs on what a terrible president George Bush was

In what follows, it’s important to realise that my son is African-American. The brutal fact is that in any sort of dispute, he was far more likely than any white kid to be suspected, get arrested, go to jail. Yet he was oblivious to these ugly facts. As long as he lived with me, in a fairly benign and tolerant city, I could protect him. Somewhat. But I couldn’t watch over him my entire life. One day he might find himself in a place that was a great deal less tolerant of an oddly-acting young black man.

Besides, Carson is more than intelligent enough to get into trouble. When he’s excited about something – which is often – he talks faster than any character actor in The Social Network. Like many other intelligent teenagers, Carson is hyper-opinionated. During the fall of 2008, when Obama and McCain were running for president, Carson’s brainstorm was to go and lecture the frat boys waiting in line outside Seattle’s nightclubs on what a terrible president George Bush was.

‘Don’t do it Carson. Please don’t do it,’ I’d beg him.

‘Why not? I have the right to say whatever I want.’

‘Sometimes it’s better to just, you know, not say anything.’

‘But George Bush is evil.’ And so it went.

I’d feel my breathing become quick and shallow, and a tenseness would spread across my shoulders. I’m gonna have a coronary, I’d think. But I’d keep trying. I’d tell him that people didn’t always act with reason.

‘They should,’ he retorted. ‘Feelings are not efficient.’

‘Let me finish. OK? Can I finish? This is important.’

‘So is behaving ethically. Which is what I will do if I tell people about George Bush.’

‘Listen. There may be a fight. Someone may hit you.’

He was pacing quickly, but then he stopped and held up an admonishing finger. He didn’t look me in the eye, though. ‘That would be morally wrong,’ he said.

In the years since then, I don’t think much has changed in the way people talk about autism. In spite of cogent arguments from campaigners such as Emily Willingham, many parents continue to believe that vaccinations cause autism. From publishers there comes a never-ending stream of memoirs by parents proclaiming a connection, a breakthrough, a success, however halting, with their child. There's Jenny McCarthy’s Mother Warriors: A Nation of Parents Healing Autism against All Odds and Ron Suskind’s Life, Animated: A Sory of Sidekicks, Heroes and Autism.

The Boston College sociologist Amy Sousa has studied 33 such memoirs and finds the dominant self-image of these writers is that of ‘warrior-hero’. Regardless of whether or not most parents of children with Asperger’s are able to live up to the hype, this is quite a swing from the old notion, notoriously championed by the Austrian-born psychologist Bruno Bettelheim in the 1960s, that emotionally distant ‘refrigerator mothers’ caused autism.

Had I been more aware, I might have noticed that in the days before Westboro’s arrival, Carson had stopped joking about them. The night before the protest, he was nervously pacing the house. Finally he admitted to being scared about what might happen the following morning. I had him sit on the couch next to me and held his hand while we talked. Carson worried that he might be caught in a clash between Westboro followers and counter-protesters. Specifically, he worried that people from the Westboro church might single him out because he is black.

His teachers and I had talked to him about what might happen. But the high-school rumour mill has a life of its own. For someone with Carson’s limited social skills, it exerted even more sway than usual. He’d heard a rumour that the Westboro people made money by using racial slurs to goad black people into assaulting them. Then they’d sue and collect lots of money.

In life, Phelps always denied that he was racially prejudiced, and perhaps he wasn't. But when you launch a website called godhatesfags this is rather too subtle a point to convey clearly. Intellectually, Carson knew his history. He knew about Jim Crow and Emmett Till, and the back of the bus. But this was the first time that he had felt personally threatened by potential racists.


It was another significant step in the loss of childhood, and it was made especially poignant because he was giving voice to a fear that I, as a white man, would never experience myself. I can read all the books in the world about racism, but I'll never know first-hand what it is like for its victims. That night, Carson did. He worked his mind over the rumours.

‘Maybe they’ll come after me because I’m phenotypically African-American,’ he said. Well in that case, I told him, he might be better off staying inside the school all day.

‘Oh! I wouldn’t go anywhere near them. But what about when I have to get off the bus?’

I explained that the school would not allow any trouble, and that there’d be many police there too.


We discussed in great detail which of his classrooms would offer the best view of the protesters, and whom he could talk to if he had any worries. Together we made sure to pack a sponge ball in his backpack. If he felt stressed, he could squeeze it. When Carson went to bed, it struck me that this evening had been one of those special moments when the veil of normality is punctured, allowing us to draw closer.

The next afternoon the door slammed emphatically as Carson rushed in with more-than-usual gusto. He was incredulous. ‘Dad – they said we were all baby-eaters!’ And: ‘That just doesn’t make any sense, saying Obama is both a gorilla and a Nazi!’ He breathlessly rat-a-tat-tatted his surprise at the day’s events: how puny and churlish the Westboro gang appeared, the billowing masses of well-behaved counter-protesters, the zestful political discussions with classmates and teachers, the unexpectedly tranquil journeys to and from school.

And then he laughed, gales of bright, pealing laughter. To my ears, that was the best music in the world. Fred Phelps and his gang had bumbled into making my Carson a little braver. And for that, I am very thankful. Perhaps, if this were a typical magazine article, I would say that this was a breakthrough, that after that he started making friends, or at least acting a little more independently, or confidently. But that would not be true. My son’s brush with the Westboro protesters was a high point of his ability to cope with the world.

Lately I have noticed books such as Jennifer Elder’s Different Like Me and Jennifer Cook O’Toole’s The Asperkid’s (Secret) Book of Social Rules, which promise to deliver guidance to young Aspergians. I don’t know who reads these books, but even if they’d been available in 2009, they would have been no use to Carson: he simply wasn’t interested in getting along in the world.

Sometimes I wonder why Carson became obsessed with Fred Phelps. I wonder if, in Phelps, he sensed a kindred spirit; not an Aspergian, perhaps, but someone who absolutely did not care what anyone thought and yet had been successful in bending those around him to his will. Then again, Carson detested homophobia. So maybe the pull was his very human fascination with evil.

All are possible explanations. That I have no idea which is most accurate only goes to show that a person with autism is just like any other person, in that there’s a lot you’ll never know for sure. Carson is now 22 and lives with his mother in California. I don’t know what will become of him – if he’ll become independent and happy, or not. However, I do I know that if I keep wishing and hoping for him to ‘get better’, I’ll go crazy.


...........................................................................

Kent Miller is an English teacher in Shezhen, China. He has written for The Guardian, Proto magazine and Nintendo Power.

Friday, August 29, 2014

Prenatal Alcohol Exposure Alters Development of Brain Function: Neural Basis for Symptoms of Fetal Alcohol Spectrum Disorders

From ScienceDaily

August 8, 2014

Summary: Medical researchers have found that children with fetal alcohol spectrum disorders (FASD) showed weaker brain activation during specific cognitive tasks than their unaffected counterparts.

In the first study of its kind, Prapti Gautam, Ph.D. and colleagues from The Saban Research Institute of Children's Hospital Los Angeles found that children with fetal alcohol spectrum disorders (FASD) showed weaker brain activation during specific cognitive tasks than their unaffected counterparts.

These novel findings suggest a possible neural mechanism for the persistent attention problems seen in individuals with FASD. The results of this study will be published in the journal Cerebral Cortex on August 4.

"Functional magnetic resonance imaging (fMRI) has been used to observe brain activity during mental tasks in children with FASD, but we are the first to utilize these techniques to look at brain activation over time," says Gautam. "We wanted to see if the differences in brain activation between children with FASD and their healthy peers were static, or if they changed as children got older."

FASD encompasses the broad spectrum of symptoms that are linked to in utero alcohol exposure, including cognitive impairment, deficits in intelligence and attention and central nervous system abnormalities. These symptoms can lead to attention problems and higher societal and economic burdens common in individuals with FASD.

During the period of childhood and adolescence, brain function, working memory and attention performance all rapidly improve, suggesting that this is a crucial time for developing brain networks. To study how prenatal alcohol exposure may alter this development, researchers observed a group of unaffected children and a group of children with FASD over two years. They used fMRI to observe brain activation through mental tasks such as visuo-spatial attention -- how we visually perceive the spatial relationships among objects in our environment -- and working memory.

"We found that there were significant differences in development brain activation over time between the two groups, even though they did not differ in task performance," notes Elizabeth Sowell, Ph.D., director of the Developmental Cognitive Neuroimaging Laboratory at The Saban Research Institute and senior author on the manuscript.


"While the healthy control group showed an increase in signal intensity over time, the children with FASD showed a decrease in brain activation during visuo-spatial attention, especially in the frontal, temporal and parietal brain regions."

These results demonstrate that prenatal alcohol exposure can change how brain signaling develops during childhood and adolescence, long after the damaging effects of alcohol exposure in utero. The atypical development of brain activation observed in children with FASD could explain the persistent problems in cognitive and behavioral function seen in this population as they mature.

Journal Reference

P. Gautam, S.C. Nuñez, K.L. Narr, S.N. Mattson, P.A. May, C.M. Adnams, E.P. Riley, K.L. Jones, E.C. Kan, and E.R. Sowell. Developmental Trajectories for Visuo-Spatial Attention are Altered by Prenatal Alcohol Exposure: A Longitudinal FMRI Study. Cereb. Cortex, August 4, 2014 DOI:10.1093/cercor/bhu162

New Study Suggests Treatment Possibility for Autism

From MSN News

August 23, 2014

People with autism have too many synapses -- the connectors by which brain cells send and receive signals -- according to a new study that may point to a treatment for the complex disorder.

The extra synapses in autistic brains are the result not of overproduction, but of a failure in the normal process of discarding old and degraded cells.

Researchers at New York's University of Columbia were able to re-establish the brain's "pruning mechanism" in mice genetically modified to simulate autism.

To do it, they used a drug called rapamycin to block a protein, mTOR, which in autistic patients goes hyperactive and blocks the brain's natural ability to cull synapses.

The researchers saw a reduction in typical autistic behaviors, such as avoiding contact with others, in the treated mice, according to findings published this week in the US journal "Neuron."

"We were able to treat the mice after the disease had appeared," said Columbia University Neurobiologist David Sulzer, lead author of the study.

This is crucial because autism does not become apparent at birth but later in childhood, "so you need a treatment that works after diagnosis," he said.

"If we were correct we should be able to have quite effective treatment even after diagnosis," he told AFP.

One in 68 US children is diagnosed on the autism spectrum, according to the most recent government estimates.

Newborn brains produce an enormous quantity of synapses as they grow, but later in childhood and adolescence they prune many of these connections to allow the different sections of the brain to develop without being overwhelmed, neurologists said.

This study analyzed tissues from the cerebral cortex -- which is involved in speech and social behaviors -- from 48 cadavers of subjects ranging in age from two to 20 at their deaths.

Of the subjects, 26 had been diagnosed with autism, and 22 were not.

Early in childhood, both groups had similar numbers of synapses, the study found.

However, a 19-year-old without autism had around 41 percent fewer synapses than a young child, while an autistic 19-year-old had far more -- their brains had shed only around 16 percent compared with a young child's.

The neurologists noted also that the excess of synapses increased the risk of epilepsy, since there were more electrical signals crossing through the brain.

Sulzer and his team also discovered biomarkers and proteins in the brains of children and teenagers with autism that indicated the pruning mechanism was not functioning normally.

Sulzer said it might be possible to adapt rapamycin to treat some autistic patients to help lessen the sometimes debilitating symptoms.

However, he noted that the drug in its current form, which is in testing as a treatment for Tuberous sclerosis, a rare genetic disorder often associated with autism, is also an immuno-suppressant, and may not be ideal as a long-term treatment, especially for children and teenagers, whose bodies are still developing.

Thursday, August 28, 2014

Childhood Mental Disability Rates Up

From EverydayHealth

By Kathleen Doheny, HealthDay News
August 18, 2014

Rates of developmental and mental disabilities -- ranging from speech problems to attention-deficit/hyperactivity disorder -- have jumped 21% among U.S. children, according to a new report.

Overall, parent-reported disabilities rose 16 percent -- from almost 5 million children to about 6 million between 2001 and 2011, said study author Dr. Amy Houtrow, associate professor of physical medicine and rehabilitation and pediatrics at the University of Pittsburgh.

"We know that disabilities have been on the rise for decades," Houtrow said. Understanding the trends helps practitioners know where and how to better direct services, the study noted.

Children from poor families are more likely to have a disability than richer kids, but the surge in neurodevelopmental and mental troubles was most notable among wealthier families, the researchers found.

Although the study didn't look at why this is so, Houtrow said there is less stigma about getting help for a disability than in the past. She also speculated that wealthier families have better access to care.

A Florida pediatric neurologist agreed. Dr. Sayed Naqvi, of Miami Children's Hospital, said he's observed a surge in requested services for autism, attention-deficit hyperactivity disorder (ADHD) and speech delay. Many of those families have easy access to pediatric information on the Internet and a growing awareness that their kids can be helped, he said.

"The more affluent parents come prepared, they know what services are there," Naqvi said. "We spend a lot more time nowadays discussing [treatments]."

For the study, published online Aug. 18 in Pediatrics, Houtrow analyzed data from the U.S. National Health Interview Surveys taken in four time periods between 2001 and 2011.

Parents first reported if their child had a limitation or disability. Next, they chose from a list of limiting physical, developmental or mental health conditions.

While ADHD increased 22 percent,
learning disabilities dropped 13 percent.

Physical conditions included: asthma or breathing problems, vision problems, hearing problems, bone/joint/muscle problems, injury.

Mental/neurodevelopmental conditions included: epilepsy or seizures, speech problems, learning disability, ADHD, mental retardation, other mental/emotional/behavioral problems, and other developmental problems.

Autism spectrum disorders, now thought to affect one in 68 U.S. children, was not one of the specific developmental disorders that parents could report. "Autism probably would have been listed by the parent as either 'other developmental problem,' 'other mental, emotional or behavioral problem' or 'intellectual disability' (also referred to as mental retardation)," Houtrow said.

Birth defects or other impairment problems were considered unclassifiable conditions.

Physical disability cases declined almost 12 percent over the decade, the study authors noted.

Significant increases were reported in "other mental, emotional or behavioral problems," which rose 65 percent, and speech problems and mental retardation, each up 63 percent, Houtrow said.

While ADHD increased 22 percent, according to parent reports, learning disabilities dropped 13 percent, the investigators found.

Reports of asthma fell 24 percent, and hearing problems increased 16 percent, the findings showed.

Families earning $89,400 or more in 2011 had the greatest increase in reported disabilities -- nearly 29 percent, the study found. Households earning below the poverty level had a rise of about 11 percent.

Is it healthy or not to label kids as disabled? The study didn't address that, but Houtrow said that "a disability is a normal part of life. We should work to maximize a child's ability."

While there is still some stigma linked with disability, she said, the focus needs to be on understanding a child's limitation and making plans to overcome it.

"The disability doesn't just describe the limitation," she said. "It affects the [child's] interaction with the world."

Acknowledging it and making a plan, she said, "is better than ignoring it."

Study on 'Extreme Male Brain' Theory of Autism Draws Critics

From SFARI.org
The Simons Foundation Autism Research Initiative

By Nidhi Subbaraman
August 25, 2014

Gender games: According to the extreme male brain theory, men are more interested in systems and patterns, and women are more keenly attuned to others' emotional states.

Credit: Vin Ganapathy

The controversial theory that characterizes autism as the result of an ‘extreme male brain’ gets fresh support from a large new survey, published 16 July in PLoS One (1). But critics question basic assumptions of the theory and the methods used in the new study.

Simon Baron-Cohen, director of the Autism Research Center in Cambridge, U.K., proposed the extreme male brain hypothesis more than a decade ago as an explanation for why four times as many boys as girls are diagnosed with autism (2).

The theory holds that men are better ‘systemizers’ — more interested in patterns and quicker to spot them in natural, mathematical or mechanical systems. And women are better ‘empathizers,’ more keenly tuned to the emotional state of others.

Men and women with autism are both keen systemizers, but less able empathizers, Baron-Cohen has proposed. He suggests that autism is related to
overexposure to testosterone while in the womb.

His group has previously made this case based on online questionnaires given to small groups of high-functioning adults with autism. The new study includes the largest sample to date — 4,700 adults, including 811 men and women with autism. In the autism group, both men and women scored higher on the systemizing survey, and lower on empathizing, than did their counterparts in the control group.

“It’s suggesting that males and females with autism are shifting along this dimension which you could call a masculinized direction,” Baron-Cohen says. He argues that the new results have the statistical power to validate the basic tenets of his theory.

Other researchers, however, are not convinced.

“The idea that people with autism lack empathy is wrong,” says
David Skuse, chair of behavioral and brain sciences at University College London. People with autism can feel others’ pain, but they are slower to process this emotion, he says. “[The study] does not explain anything.”

Question Marks

The new study included adults between 18 and 75 years of age. The participants with autism are all high-functioning, and the control group excludes people with any condition that can alter perception of reality, such as bipolar disorder,
epilepsy or schizophrenia.

The participants each took three surveys online. The Systemizing Quotient-Revised asks responders whether they are drawn to tables and charts when they read the newspaper and whether they enjoy mathematics and spotting trends in groups of numbers, among other questions. The researchers use these answers as a measure of ‘systemizing’ tendency, an affinity for picking out details and patterns in everyday life.

The Empathizing Quotient includes questions about a person’s social interactions, asking whether they share their feelings with others, or can tell when a friend is uncomfortable or unhappy, for example.

The participants also took a third survey, the Autism Spectrum Quotient, which Baron-Cohen developed to measure features of autism in the general population. The results of this survey are used to indicate what Baron-Cohen calls 'autistic tendency.'

The men in the control group scored much higher on the systemizing test than the women did, and the women scored higher on the empathizing survey.

But among men and women with autism, this difference between the sexes is less pronounced. Both men and women scored higher in the systemizing test than the typical adults of their corresponding sex. Also, women with autism scored lower on the empathizing test than women in the control group.

The differences are small, however. “I find the interpretation of such small differences as support for some sort of male brain not particularly convincing,” Skuse says.

The survey uses self-reported accounts of behavior, which are notoriously unreliable because researchers can’t verify the answers, Skuse adds.


Catherine Lord, director of the Center for Autism and the Developing Brain at New York-Presbyterian Hospital, is similarly unconvinced about the new findings.

"It's a bigger sample but there's not much new here," she says. "It doesn't prove that there are differences in anything except on the scales [Baron-Cohen] has created."

She calls for an independent touchstone to verify the assumptions driving the extreme male brain theory: for example, a definition from another expert, behavioral observations or physiological responses to certain stimuli.

Lord says she would also like to see more information about the survey respondents themselves. "If you’re trying to reach conclusions about the nature of human beings, you need to know where they came from," she says. She is concerned that people who are predisposed to less social behavior may choose to avoid such a survey altogether — in which case Baron-Cohen's sample would not be representative of the larger population.

Baron-Cohen acknowledges that Internet questionnaires have limitations, but says the tradeoff is worth it. “The great advantage is statistical power,” he says. “Even if some are overestimating [their abilities] and some people are underestimating, the noise in the data is likely to be canceled out by the sheer size.”

Other critics take issue with the participant pool, however. Of the 811 participants with autism, 454 are women. This is in striking contrast to the usual gender bias in autism, and so may not represent the bulk of people with autism, says
Thomas Frazier, director of the Center for Autism at the Cleveland Clinic.

It's possible that these effects are driven less by innate biological differences and more by cues from their parents and siblings about what it means to be a man or woman, Frazier says. People with autism may ignore those cues more than the control group, for example, but the researchers do not account for this social conditioning. “The theory still leaves me saying, ‘So what?’” he says.

Frazier and the others say they do value the survey as a rare look at high-functioning individuals with autism, particularly women, who are an
under-researched and underdiagnosed group (3).

The researchers collected a variety of demographic information, such as employment status, as part of the surveys. “The implication that if you have a diagnosis of autism, this is going to blight your life forever, this has caused huge alarm to parents,” Skuse says. But, he notes, the 13 percent unemployment rate in the study’s autism group is encouragingly low.

References


1. Baron-Cohen S. et al. PLoS One 9, e102251 (2014) PubMed

2. Baron-Cohen S. et al. Science 310, 819-823 (2005) PubMed

3. Dworzynski K. et al. J. Am. Acad. Child. Adolesc. Psychiatry 51, 788-797 (2012)
PubMed

Wednesday, August 27, 2014

Labels for Unexplained Language Difficulties in Children: We Need to Talk

From BishopBlog

By Dorothy Bishop
August 23, 2014

"... diagnostic labels and criteria were being used creatively in disputes over access to services both by those seeking to obtain services for children, who could be accused of ‘diagnostic shopping,’ and also by those seeking to deny services (often due to financial constraints) who may use particularly restrictive criteria in order to reduce the number of children qualifying for services." 

This week saw the publication of a special issue of the International Journal of Language and Communication Disorders, focusing on labels for children with unexplained language difficulties. Two target articles, one by Sheena Reilly and colleagues, and one by me, are accompanied by an editorial by Susan Ebbels, twenty commentaries, and a final paper where Sheena and I join forces with Bruce Tomblin to try to synthesise the different viewpoints. These articles are free for anyone to access.

Terminological battles are often boring and seldom come to any consensus, so why are we putting time into this thorny issue? Quite simply, because it really matters. As we argue in the articles, having a label affects how a children are perceived, what help they are offered, and how seriously their problems are taken.

'Specific Language Impairment' has very poor name recognition compared to dyslexia and autism, despite being at least as common.

Furthermore, unless we can agree on some common language, it's difficult to make progress in research, and to discover, for instance, the underlying causes of language difficulties, how common they are in different parts of the world, or what interventions work.



I was first confronted with the full extent of the problem when I tried to analyse the amount of research and research funding associated with different developmental disorders (Bishop, 2010). There are other conditions, notably autism and dyslexia, where there is plenty of debate about diagnostic criteria, or even about whether the condition exists. But even so, the terminology is reasonably consistent.

For children's language difficulties, this is not the case - they can be described as cases of language difficulty, disorder, impairment, disability, needs or delay, with various prefixes such as 'developmental', 'specific' or 'primary'. Some researchers will use such labels with precise meanings, often excluding children who have co-existing conditions, whereas others use them more descriptively. This made it extremely difficult to do a sensible internet search to estimate the amount of research funding associated with children's language difficulties.

The confusion over labels has, I think, also contributed to the lack of public recognition of language difficulties in children. A couple of years ago, I joined together with Courtenay Norbury, Maggie Snowling, Gina Conti-Ramsden and Becky Clark with the goal of remedying this situation. We started a campaign for Raising Awareness of Language Learning Impairments (RALLI) (Bishop et al., 2012), and set up a YouTube channel to provide basic information.

We spent some time debating what terminology to use: "Language learning impairment" was our preferred choice, but many of our videos talk of Specific Language Impairment, simply because that is a more familiar label. The lack of an agreed label proved a real stumbling block for our attempts at public engagement, and we decided that, as well as producing videos, one of our goals would be to get the terminology issue discussed more widely, in the hope of achieving some consensus.

It was a very happy coincidence that Sheena Reilly and colleagues were crystallizing their own position on this question in an article in IJLDC, and that they, and the Editors, were willing to include my article, and the commentaries of other RALLI founders, in the published debate.

One thing that came across when reading commentaries on our articles was the disconnect between research and practice. One point on which I agree with Sheena and colleagues is that there is no justification for drawing a distinction between children whose language problems are comparable with below average nonverbal ability, and those who have a mismatch between good nonverbal skills and low language. Research has failed to find any difference between children with uneven or even nonverbal-verbal profiles in terms of responsiveness to intervention or underlying causes.

Such a distinction is, however, widely used in educational and clinical settings to decide which children gain access to extra support in school. Another issue raised by the Reilly et al paper is whether it is logical to use other exclusionary criteria, and to distinguish, for instance, between children who do and don't have autistic features in association with a language problem.

As Susan Ebbels noted in her editorial, in everyday settings, "diagnostic labels and criteria were being used creatively in disputes over access to services both by those seeking to obtain services for children (often parents and their lawyers) who could be accused of ‘diagnostic shopping’ and also by those seeking to deny services (often due to financial constraints) who may use particularly restrictive criteria in order to reduce the number of children qualifying for services".

We can't afford to ignore this confused situation any longer. The time has come to have a wider debate on these issues, with the aim of reaching a consensus about how terms are used. The Royal College of Speech and Language Therapists has set up a moderated discussion forum where people can give their views on the best way forward. Please do consider adding your voice: it is important that all those affected by this issue have a say, whether you are a speech-language therapist/pathologist, psychologist, teacher, health professional, legal expert, policymaker, a parent of a child with language difficulties, or someone who has experienced language difficulties. We'd also love to hear from those outside the UK - whether English-speaking or not. You can access the discussion forum here.

Finally, to raise awareness of this debate, during the week of 24th-31st August I will be taking over the @WeSpeechies Twitter handleas guest curator. On Tuesday 26th at 8.a.m. BST there will be a live twitter debate on this topic. Feel free to join in, even if you aren't a regular tweeter.

References


Bishop, D. (2010). Which Neurodevelopmental Disorders Get Researched and Why? PLoS ONE, 5 (11) DOI:10.1371/journal.pone.0015112

Bishop, D., Clark, B., Conti-Ramsden, G., Norbury, C., & Snowling, M. (2012). RALLI: An internet campaign for raising awareness of language learning impairments Child Language Teaching and Therapy, 28 (3), 259-262 DOI: 10.1177/0265659012459467

About Dorothy Bishop

Dorothy Bishop is a Professor of Developmental Neuropsychology at the University of Oxford, where she is Principal Investigator for the Oxford Study of Children's Communication Impairments (OSCCI). She has published books on handedness and developmental disorders, language development in exceptional circumstances, and children’s comprehension, as well as numerous research articles. She is a fellow of the British Academy and the Academy of Medical Sciences and has a supernumerary fellowship at St John’s College, Oxford.

As Deevy Bishop, she has published three humorous crime novels as Kindle e-books. The latest is The Case of the Disappearing Dongle.

This Is Your Brain on Poverty - with Audio from NPR (48:46)

From Connecticut's WNPR News

By John Dankosky, Lydia Brown, Tucker Ives & Catie Talarski
August 21, 2014

A recent poll from the the Robert Wood Johnson Foundation and the Harvard School of Public Health found that poverty leads to stress, affecting people’s ways of thinking and their overall health. In our region, researchers and doctors have found that living in poverty can actually hinder brain development.

This hour, we learn more about the psychology of poverty, and find out what’s being done to combat some of the the stresses it brings on. We also talk to one researcher who has been looking at the impact of noise pollution on the brain development of children in low-income communities.


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Listen HERE (48:46)
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Guests
  • Kathleen Weldon - Research Coordinator for the Roper Center for Public Opinion Research at UConn
  • Johannes Haushofer - Assistant Professor of Psychology and Public Affairs at Princeton University
  • Erika Skoe, Ph.D. - Assistant Professor in the Department of Speech, Language and Hearing Sciences at UConn

Tuesday, August 26, 2014

Concussions are Brain Injuries — Sit Your Kid Down

From LiveScience


By Dr. Nirav Shah
CentraState Medical Center

July 26, 2014

According to the U.S. Consumer Product Safety Commission, every three minutes a young athlete from 7- to 19-years-old is taken to an emergency room for concussion treatment.

Children between the ages of 12 and 15 accounted for almost 50 percent of those injured. One of the latest questions for researchers studying the short- and long-term effects of concussions isn't when student-athletes can safely get back in the game but, more importantly, how long to wait before they can safely return to the classroom.

As young athletes start to gear up for fall sports, including football, soccer, cheerleading and wrestling, parents, coaches and teachers should know how to recognize and properly respond to head injuries, particularly concussions.

Studies have shown head injuries are more likely to occur in the spring and summer months and on weekends, when children are most active outdoors. They can just as easily occur when children are playing in the backyard or riding their bicycles as they do on the sports field.


But how do you know when to seek medical treatment for a head injury? As a neurosurgeon, this is a question I am often asked, but usually after the brain injury has already taken place. Keep in mind, "head injury" and "brain injury" are not necessarily the same thing — not every head injury will impact the brain.

New research out of UCLA shows that the side effects from concussions can linger long after physical symptoms — dizziness, headaches and light sensitivity — have disappeared.

Clinical findings reported in the Wall Street Journal have also found that the mental exertion of normal, routine class work can actually worsen the effects of a concussion and impede successful recovery. The study found that the harder recovering students try to focus on any mental activity, the more severe the resulting headaches or dizziness may become.

General Concussion Symptoms

A concussion is an injury to the brain that changes how the brain normally works. It is usually caused by a significant, sudden blow or jolt to the head.

Here's an analogy I use with patients to describe what happens during a concussion: Your brain is like jello in the skull. When the impact takes place, the jello is swished around the hard skull. That movement of the brain is what causes the concussion symptoms.

Throughout life, most children bump or hit their heads more than once without causing damage to the brain. But for accidents or injuries that result in a significant impact to the head, adults should be ready to recognize the most common physical signs of a concussion. Also keep in mind that following a concussion, some children will continue to experience symptoms for weeks after, which often include:
  • A brief period of confusion or memory loss following the injury;
  • Headache, vomiting, dizziness;
  • Acting dazed or losing consciousness for even a brief time. 

When to Call 911

I recommend to patients that if a child has sustained a significant trauma to the head, bring them to your pediatrician immediately, or go to your local hospital for evaluation and treatment by a medical doctor with expertise in head trauma.

If the child is unconscious for more than a minute, is bleeding heavily, or experiences any mental confusion, do not move the child or sit him/her up. Call 911 for emergency medical care and transport to the nearest hospital.

Why Are Concussions So Serious?

Make no mistake — a concussion is an academic injury, in the sense that it is detrimental to the capacity for future learning. Many parents still don't realize that children who have experienced concussions will have some degree of negative impact on their academic performance.

Scientists studying the effects of concussions are challenged by the fact that not all concussions affect the brain the same way. A child who bumps her head on the door is not in the same situation as someone who hits her head diving for a soccer ball.

The cognitive effects of a blow to the head can temporarily make focusing on studies, taking tests or listening in classrooms more difficult. Concussion-related memory problems, mental sluggishness and inability to focus can affect grades, standardized test scores and classroom placement.

New research suggests the younger the injured athlete, the more long-lasting the cognitive effects from the concussion. Teens, for example, are more vulnerable than adults to lingering effects of a concussion on short-term memory.


When Can Kids Get Back in the Game?

There is no clear-cut protocol for concussion recovery in comparison to the way a doctor would provide therapy for a broken arm. The way the human brain recovers from an injury is different for every person. You should consult with your child's doctor about when and if it is safe to return to sports.

Concussion care is challenging because doctors are dependent on symptom feedback from patients. That said, the treating doctor will schedule regular office visits with a child to monitor and assess his or her condition, hopefully revealing a continual lessening of the original symptoms. The doctor determines when the patient can resume any degree of normal activities — not parents, the injured child, coaches or teachers.

What Can You Do to Protect a Child?

With the expanded concentration on the study and treatment of concussions, physicians now have vastly improved tools and understanding to help younger patients return to normal brain function even after the brain has been compromised.

As neurosurgeons, our ultimate goal is to restore the child's ability to pursue normal social, emotional and intellectual pursuits with renewed vigor and enjoyment.

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To learn more about concussions, the Centers for Disease Control (CDC) offers helpful information on their website at cdc.gov/concussion. Follow all of the Expert Voices issues and debates — and become part of the discussion — on FacebookTwitter and Google +.

Are Athletes Playing Too Soon After a Concussion?

From the University of Oregon
via Futurity

August 21, 2014

High school athletes who return to the field less than a month after a concussion may have trouble walking and performing mental exercises at the same time, a new study shows.

Researchers tested 19 athletes and found that 12 showed signs of regression in balance and/or speed. Seven who didn’t return for more than 20 days performed similarly to uninjured control subjects.

The findings, published online ahead of print in Medicine & Science in Sports & Exercise, take a closer look at data from a 2013 study in the same journal.

That study showed that 25 concussed high school athletes had compromised abilities to focus and switch tasks for up to two months after their injuries. Six of the athletes did not return to action in the study period and were excluded in the new analysis.

In the course of the original research, athletes reported on when they had been cleared to resume practicing. At 28 days post injury, the data suggested a regression, says principal investigator Li-Shan Chou, professor of human physiology at University of Oregon.

“We had seen this same type of curve in an earlier study of college athletes,” he says. “We didn’t have any evidence linking it to a return to activity, but we did discuss that possibility, because we knew that they usually were permitted to return to practice two weeks after a concussion.”

"For many of us, that is just a blink of the eyes, but for athletes
to be sure their bodily position is ready to perform a very skillful
avoidance maneuver or prepare to safely take a collision,
30 milliseconds is a critical length of time for assuming
that posture," says Li-Shan Chou.

A Turn in Recovery

For the new analysis, lead author David Howell, looked at when the athletes—13 from football, four from soccer, and one each from wrestling and volleyball—returned to activity.

He focused on individual data, comparing return-to-activity status with the results of three tests: simply walking, separately doing simple computerized mental exercises, and a combination in which they walked and performed mental exercises simultaneously.

“There had been a continuous improvement prior to the athletes’ return to activity,” Chou says. “But at the data point taken after their return to activity, we saw a turn in their recovery in the opposite direction.

“When the athletes did a simple walking test, there was no regression. Just using the computer task to probe their cognitive functioning, we didn’t see a regression. However, put together, we did.”

Slower Reaction Time

In the dual task exercise, the athletes, while walking, heard a spoken word and identified whether it was delivered in a low- or high-pitched tone. In other variations, the subjects’ were told, as they began walking, to recite months backward from October or subtract 7 repeatedly, beginning from 100.

The more complex a secondary task the greater the effect on a concussed individual than a non-injured control subject, Chou says.

The earlier published study found slowed reaction time of 30 to 40 milliseconds among concussed athletes two months after injury.

“For many of us, that is just a blink of the eyes, but for athletes to be sure their bodily position is ready to perform a very skillful avoidance maneuver or prepare to safely take a collision, 30 milliseconds is a critical length of time for assuming that posture,” he says.

Control subjects were healthy individuals of the same sex, body size, age, and sport of the injured athletes. The research focused on frontal regions of the brain responsible for working, or short-term, memory and executive function.