Child and Adolescent Psychiatry Consulting

Archive for the ‘Autism, Apserger's, and PDD’ Category

Free time is not always a fun time for people with autism. Giving them the power to choose their own leisure activities during free time, however, can boost their enjoyment, as well as improve communication and social skills, according to an international team of researchers.

“For many of us, we look at recreation as a time to spend on activities that are fun and that are designed for our enjoyment,” said John Dattilo, professor of recreation, park and tourism management, Penn State. “But for some people with disabilities, particularly those who have autism, these activities can be a source of frustration, simply because they didn’t have a chance to make their own leisure choices.”

Dattilo said that a group of 20 autistic adults who participated in a yearlong recreation program that offered them a chance to choose activities, scored higher on personality tests that measure social and communication skills than the control group of 20 autistic adults who were randomly assigned to the program’s waiting list. Participants met for two hours each weekday and could choose among several activities that promoted engagement and interactivity, including games, exercises, crafts and events.

The researchers, who released their findings in the current issue of Research in Autism Spectrum Disorders, said that after completing the program, participants showed significant improvement at recognizing and labeling emotions. The participants scored about 24 percent higher than the control group in the ability to recognize emotions in a person in a picture. The score of the participants’ ability to label those emotions correctly was 50 percent higher than the control group’s score.

Since people with autism are less willing to interact socially, caregivers are particularly interested in programs that help improve social and communication skills, according to Dattilo, who worked with Domingo Garcia-Villamisar, professor of psychopathology, Complutense University of Madrid, Spain.

“The big measure for us in this program was the improvements in social behavior and interaction,” said Dattilo. “The defining quality of people with autism is that they have difficulty in social situations.”

The participants also improved their ability to carry out executive functions, such as setting goals and maintaining attention.

Dattilo said recreation programs that encourage people with autism to make their own leisure choices create a cycle of increasing independence, rather than a pattern of reliance on caregivers to provide recreational activities.

“While people are learning, you can also give them choices,” said Dattilo. “And as they make those choices, they are also learning and are empowered to make even more choices.”

The works of University of Rochester psychologist Edward Deci and author and psychologist Mihaly Csikszentmihalyi inspired the researchers to pursue the experiment, Dattilo said. Deci and Csikszentmihalyi emphasize self-determination as a critical component of human fulfillment.

SOURCE: http://live.psu.edu/story/51689

A joint research project between Harvard University and University of Utah scientists has resulted in the development of a new biological test for autism.

The test  uses magnetic resonance imaging (MRI) to measure deviations in brain circuitry, and  is an objective way of identifying individuals with the disorder that could someday replace the subjective methods that are currently used.

Today, Autism is diagnosed  with clinical interviewing  and  observation of the child for another hour or so.  It is hoped that this MRI will provide a more definitive way of determining autism early on, by pointing to something in the brain that is biologically based

Dr. Lange, Nicholas Lange, ScD, associate professor of psychiatry at Harvard Medical School,  was the senior study author, and with  Janet E. Lainhart, MD, from the University of Utah, Salt Lake City, and other colleagues, they set out to explore the hypothesis that study of white matter microstructure in regions of the brain responsible for language, emotion, and social cognition would further the understanding of autism neuropathology.

Diffusion tensor imaging measures white matter microstructure by mapping directions of water diffusion in a local brain tissue frame of reference.

Other types of MRI scans, such as those that compare the sizes of various parts of the brain between healthy individuals and individuals with a particular brain disorder,have not shown much difference in autism.

The researchers took white matter microstructure measurements from the superior temporal gyrus and temporal stem in 30 males aged 7 to 28 years who were diagnosed as having autism by the standard subjective scoring system and in 30 matched controls.

In the subjects with autism, less information was being exchanged in the key areas of the brain responsible for language, social functioning, and emotional behavior.

The test was able to detect autism in this study with 94% accuracy, by identifying less organized wiring.

The findings correlate with the clinical impairments of autism, such as the inability to read body language, and the resulting lack of friendships.

“There appears to be a lack of ordered directional diffusion along the axons to help them make those connections, and we were able to pinpoint just where this is occurring through this brain circuitry imaging,” Dr. Lange noted.

Dr. Lange is hopeful that this test will someday be used clinically to make  accurate and prompt diagnoses in young children.

Early diagnosis may allow intensive, individualized, and early interventions to minimize the impact of the disorder.

This test is NOT YET ready for clinical use. At the present time, child and adolescent clinicians must continue to rely upon careful clinical assessments to diagnosis Autism.

The study was sponsor by the National Institutes of Mental Health. Dr. Lange and Dr. Lainhart have disclosed no relevant financial relationships.

Autism Res. Published online November 29, 2010.

Have you ever wondered how newborns can learn so quickly about the world, despite sleeping 16 to 18 hours a day?

It appears that part of the explanation for this is that they engage in a basic form of learning while sleeping.

Univeristy of Florida researcher, Dana Byrd, in collaboration with her colleagues, tested the learning abilities of sleeping newborns by repeating tones that were followed by a gentle puff of air to the eyelids. After about 20 minutes, 24 of the 26 babies squeezed their eyelids together when the tone was sounded without the puff of air.

Learned eyelid movement reflects the normal functioning of the circuitry in the cerebellum.

This study’s method may provide a unique non-invasive tool for early identification of infants with atypical cerebellar structure, who are potentially at risk for a range of developmental disorders, including autism and dyslexia.

The brain waves of 24 1- or 2-day-old infants were  compared with a control group using EEG and video recordings.

The brain waves of the infants were found to change, providing a neural measurement of memory updating.

This is the first study to document this type of learning in newborns who are sleeping, though past studies demonstrated this type of learning in awake infants.

The capacity of infants to learn during sleep contrasts with some researchers’ stance that learning new material does not take place in sleeping adults, Byrd said.

The immature nature of sleep patterns in infants, and the increased neural plasticity of infants’ brains, could help explain why infants have the capacity to learn during sleep

Byrd collaborated with William Fifer, Michelle Kaku, Joseph Isler, Amanda Tarullo, all of Columbia University; Inge-Marie Eigsti, of the University of Connecticut; Jillian Grose-Fifer of the City University of New York; and Peter Balsam of Barnard College.

A mirror neuron is a cell in the brain that fires when we observe another person perform an action. For example, if we watch another person pick up a cup, place it to their mouth and drink, mirror neurons fire, and give us an idea about how it feels to hold the cup, to lift the cup, to feel the cup touch our lips, to feel the liquid in our mouths.

Neuroscientists have hypothesized that mirror neurons are responsible for the human capacity to empathize with others, and to understand how another person might be thinking or feeling–how we can understand another person’s pain, how we understand how they are feeling when they smile. In the April edition of the journal Current Biology Dr. Itzhak Fried,  a UCLA professor of neurosurgery and of psychiatry and biobehavioral sciences, Roy Mukamel, a postdoctoral fellow in Fried’s lab, and their colleagues (Arne D. Ekstrom, Jonas Kaplan and Marco Iacoboni) have provided the first direct evidence that mirror neurons truly exist, by making a direct recording of their actions, in the motor regions of the brain, as well as in regions responsible for vision and memory.

When a research subject performed an activity, specific subsets of mirror cells in the research subject’s brain increased their activity. When a research subject only observed another person performing an action, these subsets of mirror cells decreased their activity. The researchers hypothesize that the decreased activity from these subsets of mirror cells occurs to prevent an observer from automatically performing the action that they are observing the action of another person, and to help us distinguish our own actions from those of others.

The researchers implanted electrodes into the brains of 21 patients with intractable epilepsy, so that seizure foci could be identified for potential surgical treatment. The researchers obtained consent from the patients to use the same electrodes for their clinical research.

The experiment included three parts: facial expressions, grasping and a control experiment.

Activity from a total of 1,177 neurons in the 21 patients was recorded as the patients were asked to observe various facial expressions and grasping actions performed by others in videos on a laptop computer. They were then shown visually presented words and asked to perform the action. Finally, for the control task, the words were presented, and patients were instructed not to perform the action.

The mirror neurons in the medial frontal cortex (responsible for movement) and medial temporal cortex (responsible for memory) showed their greatest activity both when the individual performed a task and when they observed a task. This finding demonstrates that mirror neurons are located in more areas of the human brain than was previously thought, and that the mirror neurons provide detailed and complex mirroring of the actions of other people–and it is very likely this mirroring of others that helps us understand the actions, intentions, and feelings of others automatically.

This study is important because:

1. it provides evidence that mirror neurons–neurons that link the activity of the self with that of others–really exist

2. it suggests that the distribution of mirror neurons is wider than was previously thought

3. it is suspected that dysfunction of mirror cells may be involved in disorders such as autism, since autism is a condition where verbal and nonverbal communication, imitation, and empathy for others is impaired. If we can better understand the mirror neuron system, we may be able to find ways to treat this disorder.

The project was supported by the National Center for Research Resources, a component of the National Institutes of Health (NIH).

A special federal court ruled Friday March 12, 2010 that there is no connection between the vaccine additive thimerosal and autism.

The court expressed empathy for the families coping with a child with autism, but concluded the families failed to  show a connection between the mercury-containing preservative and autism.

The ruling came in “vaccine court”, a special branch of the U.S. Court of Federal Claims established to handle claims of injury from vaccines. The courts set the bar low, so that families need only demonstrate that their children’s injuries or deaths COULD have been linked to vaccines, but no scientific evidence was presented to support the link.  

 The parents presented expert witnesses who argued mercury can have a variety of effects on the brain, but the ruling said none of them offered opinions on the cause of autism in the three specific cases argued. They testified that mercury can affect a number of biological processes, including abnormal metabolism in childrenIt can be appealed in federal court. One difficulty is that the amount of mercury in vaccinations is exquisitely small, and the amount that reaches the brain is even smaller, and far larger amounts of mercury from other sources has not been shown to cause such devastating effects.

Friday’s decision that autism is not caused by thimerosal alone follows a parallel ruling in 2009 that autism is not caused by the combination of vaccines with thimerosal and other vaccines.

The originally published article in the British Medical Journal, Lancet linking vaccines to autism was retracted in February 2010, due to findings that the principal investigator, Wakefield,  was paid by lawyers to prove a link, and that he used a laboratory that used techniques that resulted in cross-contamination, which contributed to false positives. Follow up studies by other researchers has failed to replicate the findings in this original study.  

The cases had been divided into three theories about a vaccine-autism relationship for the court to consider.

• The 2009 ruling rejected a theory that thimerosol can cause autism when combined with the measles-mumps-rubella vaccine.
• After that, a theory that certain vaccines alone cause autism was dropped.
•  Friday’s decision covers the last of the three theories, that thimerosal-containing vaccines alone can cause autism.

The ruling doesn’t necessarily mean an end to the dispute, since the decision can be appealed in federal court.   

The ruling was welcomed by Dr. Paul Offit, author of  Autism’s False Prophets and physican at Children’s Hospital of Philadelphia, who said the autism theory had “already had its day in science court and failed to hold up.”

But the controversy has cast a pall over vaccines, causing some parents to avoid them, he noted, “it’s very hard to unscare people after you have scared them.”

However, parents backing the theory feel that the government is biased.”The deck is stacked against families in vaccine court. Government attorneys defend a government program, using government-funded science, before government judges,” Rebecca Estepp, of the Coalition for Vaccine Safety said in a statement.

SafeMinds, another group supporting the parents, expressed disappointment at the new ruling.

The advocacy group Autism Speaks said “the proven benefits of vaccinating a child to protect them against serious diseases far outweigh the hypothesized risk that vaccinations might cause autism. Thus, we strongly encourage parents to vaccinate their children to protect them from serious childhood diseases.”

However, while research has found no overall connection between autism and vaccines, the group said it would back research to determine if some individuals might be at increased risk because of genetic or medical conditions.

Meanwhile, in reaction to the concerns of parents, thimerosal has been removed from most vaccines in the United States.

More than 5,500 claims have been filed by families seeking compensation through the government’s Vaccine Injury Compensation Program, and the rulings dealt with test cases to settle which if any claims had merit.

Autism is best known for impairing a child’s ability to communicate and interact. Recent data suggest a 10-fold increase in autism rates over the past decade, although it’s unclear how much of the surge reflects better diagnosis.

In 1998, the British medical journal The Lancet published an article claiming that there may be a link between the MMR vaccine — measles, mumps and rubella — and the development of autism in children.

The publicity this article received led to a debate about the safety of vaccines, and scared many parents into avoiding immunizations for their children.

The researchers hadn’t actually proved a link between the vaccine and autism.

The lead researcher, Andrew Wakefield was paid nearly half a million pounds to pursue a link between vaccines and autism.

Wakefield  was paid by lawyers who were trying to prove that the MMR vaccine caused autism.

He utilized a laboratory for the studies that had techniques andthat frequently contaminated samples, so that there were falsely positive results.

In February 2010, Lancet editors admitted that this journal article was scientifically inaccurate. ”We fully retract this paper from the published record.” It was a humbling admission. It came too late.

The article, combined with stories of vibrant, lively toddlers who, within days or weeks of receiving a vaccine, retreated from human contact and showed other signs of autism, scared people. Many parents decided that the dangers of vaccines far outweighed the risks. And that created some significant health risks.

Measles was once prevalent, and in the United States, measles caused 450 reported deaths and 4,000 cases of encephalitis annually before measles vaccine became available in the mid-1960s.

Measles was nearly eradicated,but it has been making an alarming comeback.

As the rate of immunization has decreased, the number of measles cases reported during January 1–July 31, 2008, is the highest year-to-date since 1996.

This poses a danger to the unvaccinated kids and even to some kids who got the vaccine. Vaccines don’t activate immunity in every patient who receives them. As long as 95 percent of kids in a group are vaccinated, the others are protected by a “herd immunity.” The virus, for lack of enough hosts, won’t survive long enough to be transmitted. Since an increasing number of parents are choosing to forego immunizations, there are larger groups of children attending school that aren’t immunized.

When parents avoid immunizing their children, there is a greater risk of losing that herd immunity, and localized outbreaks of measles will occur.

A dozen epidemiological studies have not found a link between the MMR vaccine and autism.

But the fear of a link remains. And some parents complain that kids receive too many vaccines. In 1960, young children were routinely vaccinated against five diseases: diphtheria, pertussis, tetanus, polio and smallpox. The CDC now recommends vaccination by age 2 against 13 diseases.

Vaccines have become safer since the 1960s.

They require far fewer antigens — the molecules of bacteria or virus used to cause a reaction from the immune system. One example: the pertussis vaccine once used 3,000 antigens. Now it uses five. That decreases the likelihood and severity of side effects.

A child is  exposed thousands  more antigens from a strep infection (such as strep throat) than when they are vaccinated.

Some parents report seeing the onset of autism soon after their child received some standard vaccines. But that doesn’t mean vaccines cause autism. It is often diagnosed around the age of 2, which is when kids are scheduled for some routine vaccinations. Autism is a mysterious disorder, but it is not caused by vaccines. And, if more parents refuse to vaccinate their kids, it is more likely that several nearly forgotten diseases will enjoy a renaissance.

As for the scientific community, we hope even more effort is poured into discovering the cause and treatments for all of the autism spectrum disorders.

Too many resources have already been spent trying to replicate the flawed science of Dr. Wakefield, instead of trying to focus on the real causes and trying to treat them.