Tuesday, December 31, 2013

FASD: Heart defects caused by altered function, not structure?

Recent data shows that more than 500,000 women in the U.S. report drinking during pregnancy, with about 20 percent of this population admitting to binge drinking.

Even one episode of heavy drinking can lead to the collection of birth defects known as fetal alcohol syndrome (FAS).

Along with growth retardation, head and face abnormalities, and neurological problems, FAS also causes heart problems in just over half of those with this condition.

Though much research has focused on looking for the cause of these alcohol-induced heart defects, they remain largely a mystery.

To investigate this question, Ganga Karunamuni of Case Western University and her colleagues studied heart formation in quail embryos, whose heart development is very similar to that of humans.

The researchers used an innovative imaging technique, optical coherence tomography, to compare embryos exposed to a single, large dose of alcohol to those who hadn't received alcohol.

They looked both at how alcohol changed the function of the developing hearts as well as their structure.

They found that significant changes in heart function appeared to come well before changes in structure that are hallmarks of the well-known FAS heart anomalies.

These changes in function, the study authors suggest, might be the cause of the structural problems that arise later by exerting forces on the heart that change its development.

The article is entitled "Ethanol Exposure Alters Early Cardiac Function in the Looping Heart: A Mechanism for Congenital Heart Defects?"

It appears in the Articles in Press section of the American Journal of Physiology – Heart and Circulatory Physiology, published by the American Physiological Society.

As expected, the researchers found that the hearts of embryos exposed to alcohol had dramatic defects close to hatching, including thinner walls separating the heart's four chambers and damaged valves.

Long before these defects formed, the researchers saw significant differences in heart blood flow between embryos that weren't exposed to alcohol and those that were.

In those whose shells weren't injected with alcohol, a small portion of the blood flowed backward through the heart circuit after each beat.

In those exposed to alcohol, a much larger portion of blood flowed backward in the circuit.

These malfunctioning hearts had smaller "cardiac cushions"—collections of cells that later become chamber walls and valves—compared to unexposed hearts.

More information: ajpheart.physiology.org

Monday, December 30, 2013

Landmark NIMH ADHD study backed drugs over therapy at a cost

Many children with attention-deficit hyperactivity disorder (ADHD) may have missed out on valuable counseling because of a widely touted study that concluded stimulants such as Ritalin or Adderall were more effective for treating the disorder than medication plus behavioral therapies, experts say.

That 20-year-old study, funded with $11 million from the U.S. National Institute of Mental Health, concluded that the medications outperformed a combination of stimulants plus skills-training therapy or therapy alone as a long-term treatment.

But now experts, who include some of the study's authors, think that relying on such a narrow avenue of treatment may deprive children, their families and their teachers of effective strategies for coping with ADHD.

"I hope it didn't do irreparable damage," study co-author Dr. Lily Hechtman, of McGill University in Montreal, stated. "The people who pay the price in the end [are] the kids. That's the biggest tragedy in all of this."

Professionals worry that the findings have overshadowed the long-term benefits of school- and family-based skills programs.

The original findings also gave pharmaceutical companies a significant marketing tool—now more than two-thirds of American kids with ADHD take medication for the condition.

And insurers have also used the study to deny coverage of psychosocial therapy, which costs more than daily medication but may deliver longer-lasting benefits.

An insured family might pay $200 a year for stimulants, while individual or family therapy can be time-consuming and expensive, reaching $1,000 or more.

About 8 percent of U.S. children are diagnosed with ADHD before the age of 18, according to the U.S. Centers for Disease Control and Prevention.

People with the condition may have trouble paying attention, often act without thinking and may be hyperactive, making school work and the acquisition of essential skills extremely difficult.

Drugs that improve attention make it easier for the children to learn, but when the drug wears off or if the users stop taking the drugs, benefits are less apparent.

Some experts today cite limitations of the original study, which looked at classic ADHD symptoms such as forgetfulness and restlessness over academic achievement and family and peer interactions.

This gave medication an edge over therapy from the get-go, several people involved with the study reported.

"When you asked families what they really liked, they liked combined treatment," said Dr. Peter Jensen, formerly head of child psychiatry at the National Institute of Mental Health (NIMH) who oversaw the study for the institute.

"They didn't not like medicine, but they valued skill training. What doctors think are the best outcomes and what families think are the best outcomes aren't always the same thing."

For the study, the NIMH enlisted more than a dozen experts to determine the best ADHD treatment.

Close to 600 children with ADHD, aged 7 to 9, received one of four treatments for more than a year: medication alone, behavioural therapy alone, a combination of both treatments, or nothing in addition to their current treatment.

The study authors concluded in a 1999 paper that medication was superior to behavioural treatment.

But when the children in the study were followed into adulthood, the study results looked less conclusive.

Use of any treatment "does not predict functioning six to eight years later," a follow-up paper from the study determined, the Times reported.

Thursday, December 26, 2013

Childhood Autism: English Arsonists destroy boy's Xmas surprise treat

An arson attack which destroyed a sensory room built as a Christmas present for a severely autistic boy has been condemned as a "disgusting and cowardly crime".

Fiona and Wesley Ratcliff, from Woodhouse Park in Wythenshawe, Manchester, had spent the last two weeks transforming the summer house into a safe play space for their seven -year-old s on Harvey, who suffers from Phelan-McDermid syndrome, (22q13) a rare genetic disorder.

They had planned to show Harvey the sensory room for the first time on Christmas Day, but instead they discovered it had been destroyed in an arson attack.

Wesley Ratcliff, 32, said: "Everyone was devastated. We had family come down from Scotland. They had put in the money towards helping us build it. They had all come down to see his face.

"We are all in shock. The consequence with what could have happened; it being so close to the house - I think we are lucky."

A guinea pig hutch next to the summer house had also been set alight, but the two guinea pigs escaped unharmed.

Mr Ratcliff, who is a support worker with autistic adults, said: "We bought the summer house at the beginning of the month, and the idea was to get it up and ready for Christmas.

"We painted it, put the flooring down, put the lights in, decorated it with pictures and painted it sky blue because Harvey is a Manchester City fan. It was just somewhere where he could go when he was having a hard time. I had put the final touches in on Christmas Eve."

But yesterday morning Mr Ratcliff found that the summer house had been destroyed by a fire.

He said: "The disco lights and a digital radio had been stolen. We had put soft floor mats inside which were completely burnt by the fire. The bean bag chair and a little stool and easel table were all destroyed as well.

"My opinion is that we have not been targeted, but that it was just a random attack. It was probably just some drunk teenagers, a one off. My wife is really upset and she is scared about being alone with the kids in the house."

Detective Inspector Jane Curran said: "This truly is heartbreaking, the family, like every other family across Greater Manchester, were really looking forward to showing their son his Christmas present when they woke on Christmas Day.

"Whoever did this really has no morals whatsoever.

"It is a disgusting and cowardly crime and I really would like anyone who may have seen anything or who has any information about this to contact us.

"Thankfully we think that the weather overnight extinguished the fire otherwise we may have been dealing with a much more serious incident yesterday."

Monday, December 23, 2013

Revised checklist improves detection of autism in toddlers

The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F) is an effective screening tool for autism spectrum disorders (ASDs) in low-risk toddlers, according to research published online Dec. 23 in Pediatrics.

Diana L. Robins, Ph.D., of Georgia State University in Atlanta, and colleagues used the M-CHAT-R/F to screen 16,071 toddlers at 18-month and 24-month well-child care visits.

M-CHAT-R/F uses an algorithm based on three risk levels and is intended to reduce age of diagnosis and hasten early intervention.

The researchers found that the M-CHAT-R/F was reliable and valid.

Children scoring 3 or higher at initial screening and 2 or higher at follow-up had a 47.5 percent risk of being diagnosed with ASD and a 94.6 percent risk of having any developmental delay or concern.

According to the report, compared with the original M-CHAT, the revised tool detects ASD at a higher rate and reduces the number of children who need follow-up.

In the current study, children received a diagnosis of ASD at an age that was two years earlier than the national median age of diagnosis.

"The M-CHAT-R/F detects many cases of ASD in toddlers; physicians using the two-stage screener can be confident that most screen-positive cases warrant evaluation and referral for early intervention," the authors write.

Several study authors disclosed financial interests in the M-CHAT.

More information: 'Validation of the Modified Checklist for Autism in Toddlers, Revised With Follow-up (M-CHAT-R/F)' peds.2013-1813.full.pdf/html 

Diagnosing Autism: A better approach

Mary Beth Bruder, director of the A.J. Pappanikou Center for Excellence in Developmental Disabilities Research, demonstrates one of the techniques she would use to diagnose an autistic child. 

Credit: Shawn Kornegay /UConn Photo

As the number of children with autism increases nationwide, the need for effective and consistent clinical diagnosis is growing.

A statewide committee recently published new guidelines designed to ensure health professionals, educators, parents, and all involved in diagnosing a child with autism are using proven and consistent practices.

The guidelines stress, among other things, that effective autism diagnosis and treatment requires a collaborative approach.

Mary Beth Bruder, a professor in UConn's Neag School of Education and in the UConn School of Medicine, was co-chair of the committee, which spent four years developing the "Connecticut Guidelines for a Clinical Diagnosis of Autism Spectrum Disorder."

"Diagnosing autism doesn't require a snapshot, it requires a comprehensive, interdisciplinary look at the child," says Bruder, who heads a doctoral program in early childhood intervention in the Department of Educational Psychology and is director of UConn's A.J. Pappanikou Center for Excellence in Developmental Disabilities Research, Education, and Service.

"Physicians, educators, social workers, and speech pathologists are among the many professionals that should be involved in first the diagnosis, and then the treatment of a child with autism. A complete picture is required. And parents play a crucial role."

Laura Kern, a third-year doctoral student in educational psychology at the Neag School, is both the mother of a 9-year-old son with autism and one of the parents involved in providing the data and insights needed to craft the new guidelines.

She says one of the things she learned during her son's diagnosis is that as many as 51 percent of parents report dissatisfaction at the lack of continuity in the process.

The new Connecticut guidelines provide a step-by-step, interdisciplinary guide.

"The guidelines address parents' concerns in a systematic way, and if you approach a diagnosis systematically, you're more likely to reach needed services and early interventions more effectively and efficiently," Kern says.

"It was incredible to be part of the process of creating the guidelines, and to see so many different state agencies, parents, and professionals come together to create a united message about what a good diagnosis should look like."

Funded with an $86,000 grant from the U.S. Centers for Disease Control and Prevention (CDC), the guidelines are the result of a collaboration among members of the Connecticut Act Early Project, a partnership that includes experts from a wide range of leading childhood health and disabilities agencies, including the National Center on Birth Defects and Developmental Disabilities (NCBDDD).

The rising number of children with autism makes this extremely important work, Bruder notes.

"Scientists are working very hard to determine why this increase is happening," she adds, "but essential to the process is consistency in how these diagnoses are being made.

Autism affects every aspect of a child's life, so it only makes sense to have people from each of those areas involved in realizing the positive outcomes that can come from appropriate and early interventions."

Education experts give tips on apps for your kids

Kids these days have a penchant for high-tech and would rather play with smartphones and tablets than board games and building blocks.M

And they start younger and younger. A whopping 83 percent of children age 6 and younger use some form of screen media, according to the Kaiser Family Foundation.

Although screen time has been linked with diminished creativity, childhood obesity, sleep disturbance and the like, it doesn't all have to be negative, said University of Alabama at Birmingham education experts.

"When used appropriately, technology and media can enhance children's cognitive and social abilities," said Jennifer Summerlin, an instructor in the UAB School of Education.

"Interactions should be playful and support creativity, exploration and authentic learning."

Summerlin offers some tips and to help ensure children make the most of their screen time:

  • Have a plan: When choosing media for your child, be informed and intentional and make appropriate choices. It should be appropriate for their age, individual nature, cultural upbringing and linguistic abilities.
  • Make sure their brain is put to work: Select apps that are active, hands-on, engaging, empowering and give the child control.
  • Enable fun: Be sure to provide your child with any accessories needed to make the device easy to use.
  • Don't let the app be the sole teacher: Let the device be one of many other options to support learning.

UAB instructor and elementary school teacher Allison Hodges, Ph.D., recommends these applications for toddlers and preschool-age children:

Hodges suggests these applications for elementary school-age children:

  • Toontastic allows children to create amazing multi-scene cartoons with musical scores.
  • ABCmouse.com lets children explore the habitats of various animals.
  • Stack the States makes learning the 50 states fun.
  • Marble Maths Junior uses fun mazes to teach kids to solve math problems.
  • Marble Maths, based on the Common Core Curriculum, is an engaging way to learn mental maths.
  • Numbers League lets kids practice basic math facts while helping superheroes fight evil villains.
  • Questimate! is a math-estimation game that directly involves kids in making word problems with just enough guidance to keep the problems relevant and challenging.

Sunday, December 22, 2013

TOSCA Study: Concerta® and Risperdal®, help adolescents with ADHD, aggression

Prescribing both a stimulant and an antipsychotic drug to children with physical aggression and attention-deficit/hyperactivity disorder (ADHD), along with teaching parents to use behaviour management techniques, reduces aggressive and serious behavioural problems in the children.

This is the result of a study conducted by researchers at the Ohio State University Wexner Medical Center.

The study was conducted in conjunction with the University of Pittsburgh, Stony Brook University in New York and Case Western Reserve University in Ohio.

The findings published online this week ahead of publication in the January issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"Combination pharmacotherapy is becoming common in child and adolescent psychiatry, but there has been little research evaluating it," said first author Michael Aman, director of clinical trials at Ohio State's Nisonger Center and emeritus professor of psychology.

"Our findings may be considered somewhat controversial because they appear to support the use of two drugs over one for treating children with aggression and disruptive behaviour when things do not seem to be going well.

Many practitioners have been taught to 'Keep things simple and safe' in their medical training. In general, this is good advice."

For the "Treatment of Severe Childhood Aggression (TOSCA) Study," 168 children ages 6 to 12 who had been diagnosed with ADHD and displayed significant physical aggression were divided into two groups.

All study participants received a psychostimulant drug called OROS methylphenidate (Concerta®) and their parents received behavioural parent training for nine weeks.

The researchers called this treatment combination "basic" because both are evidence-based and have been shown to be helpful for improving both ADHD and aggression.

Researchers wanted to see if they could expand or augment this treatment by adding a second medication. If there was room for improvement at the end of the third week, a placebo was added for the "basic group," while the antipsychotic drug Risperidone (RISPERDAL®) was added for participants in the "augmented group."

Compared to the "basic group," the "augmented group" who received the stimulant drug and parent training plus risperidone showed significant improvement (on average with moderately better behaviour) on the Nisonger Child Behavior Rating Form (NCBRF) Disruptive-Total Scale, the NCBRF Social Competence subscale and the Reactive Aggression part of the Antisocial Behaviour Scale.

While there is always some risk with the addition of a second drug to the treatment package, the two drugs seemed to neutralize some of each other's potential side effects.

For instance, children in the augmented group did not seem to have as much trouble falling asleep, once the risperidone was added, Aman said.

"We conducted this study because we viewed the combination of ADHD and significant physical aggression – especially the aggression – as a serious situation," Aman said.

"It is not uncommon to use more than one medicine for other serious situations, such as when treating cancer or epilepsy for instance."

"Although doctors have often used stimulants and antipsychotics together in recent years, we did not have good evidence until now that they would work more effectively when carefully staged and given together."

More information: "Treatment of Severe Childhood Aggression (TOSCA) Study,"

Friday, December 20, 2013

Clinical histories reveal surprising evidence of multiple, distinct 'autisms'

Simple patterns can emerge from even the most chaotic, complex data.

Analyzing the electronic medical records of thousands of patients diagnosed with autism spectrum disorder, or ASD, a group of researchers at the Harvard Medical School Center for Biomedical Informatics found three distinct kinds of autism, which suggests that "autism" is perhaps an umbrella term comprising several illnesses with different genetic and environmental causes and different potential treatments.

Isaac Kohane
"Rather than there being one 'autism,' these findings show that there are several autisms, each with its own specific course," said Isaac Kohane, the Lawrence J. Henderson Professor of Pediatrics at Boston Children's Hospital, co-director of the Center for Biomedical Informatics and leader of the research team. The results appeared Dec. 9 in Pediatrics.

By separating diagnoses out in six-month segments over the first 15 years of each child's life, the researchers found one group of patients whose autism symptoms were associated with epilepsy and other seizure disorders.

In a second, ASD patients had increased rates of bowel and infectious ear and respiratory symptoms.

In a third, children had higher levels of psychiatric disorders, including ADHD, depression and schizophrenia.

NB: A fourth group of patients could not be further characterized due to statistical limitations of the available data.

The patterns of symptoms in the first three groups also correlated with different levels of expressive language disorder, timing of developmental delays and other core diagnostic measures for ASD.

Just as an understanding of the whole suite of symptoms that accompany a fever is crucial for determining whether a patient has strep or flu, Kohane said, it's crucial to understand the entire complex of symptoms associated with the different subsets of ASD in order to advance our understanding of what causes autism.

"Doing a genetic study of 'autism' is like studying fever and looking for a single cause," Kohane said.

Since most primary caregivers might see only a few ASD patients, and since the symptoms manifest differently at various periods of the child's development, having a massive, shareable database of clinical data in searchable electronic medical records was crucial to making sense of the complex picture of autism.

In a previous study, Kohane and colleagues used the Shared Health Research Information Network (SHRINE), a web-based query tool, to analyze 15,000 electronic health records of patients with ASD from HMS-affiliated hospitals.

They found that people with ASD suffer from a higher burden of seizures, psychiatric illness and gastrointestinal disorders than the general population.

While parents of children with autism and other patient advocates had long suggested that this was the case, the smaller population studies conducted without information infrastructure like SHRINE were not able to find evidence that incidences of these illnesses were significantly correlated with ASD.

This current study builds on Kohane's previous findings by showing that the related illnesses are not distributed randomly throughout the ASD population.

"The next step is to look at these subgroups to search for common genetic or environmental factors," Kohane said.

Electronic medical records shared in a flexible, open-source database like SHRINE provide a bird's-eye view of the medical system that offers researchers unique insights into disease and treatment.

"We spend tons of money to construct these databases and open record-sharing systems," Kohane said.

"We should take advantage of all that data not just to bill people for our services, but to better understand and treat disease."

More information: "Comorbidity Clusters in Autism Spectrum Disorders: An Electronic Health Record Time-Series Analysis." Finale Doshi-Velez, PhDa, Yaorong Ge, PhDb, and Isaac Kohane, MD, PhDa. Pediatrics, December 9, 2013. DOI: 10.1542/peds.2013-0819

Thursday, December 19, 2013

Antidepressant drug use during pregnancy not linked to autism

Large study finds little connection between mother's use of drugs like Prozac and children's autism risk.

Despite some concerns to the contrary, children whose moms used antidepressants during pregnancy do not appear to be at increased risk of autism, a large new Danish study suggests.

The results, published Dec. 19 in the New England Journal of Medicine, offer some reassurance, experts said.

There have been some hints that antidepressants called selective serotonin reuptake inhibitors (SSRIs) could be linked to autism.

SSRIs are the "first-line" drug against depression, and include medications such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and paroxetine (Paxil).

In one recent U.S. study, mothers' SSRI use during pregnancy was tied to a twofold increase in the odds that her child would have autism. A Swedish study saw a similar pattern, though the risk linked to the drugs was smaller.

But both studies included only small numbers of children who had autism and were exposed to antidepressants in the womb.

Anders Hviid
The new study is "the largest to date" to look at the issue, using records for more than 600,000 children born in Denmark, said lead researcher Anders Hviid, of the Statens Serum Institute in Copenhagen.

And overall, his team found, there was no clear link between SSRI use during pregnancy and children's autism risk.

Hviid cautioned that the finding is still based on a small number of children who had autism and prenatal exposure to an SSRI—52, to be exact.

The researchers noted that it's not possible to rule out a small increase in autism risk.

But, Hviid said, "at this point, I do not think this potential association should feature prominently when evaluating the risks and benefits of SSRI use in pregnancy."

Christina Chambers
Commenting on the findings, Christina Chambers, director of the Center for the Promotion of Maternal Health and Infant Development at the University of California, San Diego, stated, "I think this study is reassuring."

One "important" point, Chambers added, is that the researchers factored in mothers' mental health diagnoses—which ranged from depression to eating disorders to schizophrenia.

"How much of the risk is related to the medication, and how much is related to the underlying condition?" Chambers said. "It's hard to tease out."

More Information: 'Use of Selective Serotonin Reuptake Inhibitors during Pregnancy and Risk of Autism': doi/full/10.1056/NEJMoa1301449

Wednesday, December 18, 2013

Rapid Automized Naming (RAN) tests: A study on dyslexic versus average children

In an article by Zoccolotti, De Luca, Lami et al, published in Child Neuropsychology, Rapid Automized Naming (RAN) tests were conducted on 43 average children and 25 with developmental dyslexia.

The task involved naming colours, digits, pictures words and word lists displayed multiple times and in discrete form.

Participants' response times and error rates were recorded. Dyslexic children not only have trouble identifying strings of letters, but also programming eye movements and synchronizing speech output.

Thus reading is a multiple component task presenting difficulty for dyslexic children. During the article the authors outline the results of the tests and analyse reasons for the differences between the two groups.

Children chosen to participate were comparable for age, gender and IQ. They were required to read a passage aloud for 4 minutes and scores were taken for speed and accuracy.

Children were also asked to identify colours and numbers, in both discrete and multiple forms. Finally children were given 5 letter and 7 letter words to read, both in singular fashion and in lists. Participants were individually tested.

Single stimuli tests were conducted on a pc, children requested to name colour, shape or word as fast and as accurately as possible. Multiple stimuli tests were given on paper and children were timed with a stopwatch and errors noted.

In typically developing children, during discrete and multiple naming tests, errors such as hesitation, self-correction and word substitutions accounted for 1.4% and 7.3% of the response. In dyslexic children, equivalent results accounted for 3.3 and 9.5%.

In the reading tests, average candidates were significantly faster at reading multiple than single words.

Dyslexic participants were slower when reading multiple 7 letter words but showed no speed difference when reading discrete or multiple 5 letter words.

The authors have illustrated that in average children, they are able to process the next visual stimulus whilst articulating the current item.

Dyslexic children showed sensitivity on word length to speed of reading, hence illustrating that their difficulty integrating eye movements, word decoding and speech synchronisation, increases with tasks presenting a greater challenge.

Previous research has shown that dyslexic children are challenged at word decoding level. Zoccolotti et al via their study have revealed that apart from shortfalls in reading single words, dyslexics also have a further deficit when reading multiple words.

During the colour and digit naming, results for the 2 groups showed a similar pattern. Normal children had overall advantage but dyslexic children showing a larger negative difference for multiple rather than single stimuli.

The authors conclude that "multiple subcomponents of RAN tasks may indeed be critical in mediating the relationship with reading" hence children with dyslexia are slower in RAN tests due to difficulty in combining processing of visual stimuli with vocalising words.

More information: "Multiple stimulus presentation yields larger deficits in children with developmental dyslexia: A study with reading and RAN-type tasks." Zoccolotti, De Luca, Lami et al. Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence. Volume 19, Issue 6, 2013. DOI: 10.1080/09297049.2012.718325

Tuesday, December 17, 2013

FDA warns of dangerous erections from ADHD drugs

The Food and Drug Administration is warning that a stimulant used in treatments for the childhood condition attention deficit-hyperactivity disorder can trigger painful, long-lasting erections in rare cases.

The federal agency says it is updating drug labels to include information about priapism, a condition that can permanently damage a patient's penis.

The stimulant, methylphenidate (meth-ihl-PHEN'-ih-dayt), is found in treatments including Ritalin, Concerta and Daytrana.

ADHD is a common childhood disorder that hampers a child's ability to pay attention and control behaviour.

The FDA says the median age of patients taking methylphenidate who had priapism was 12 and a half years old.

The FDA says people should talk to their doctors before halting the drugs. Parents should talk to boys taking the drug so they are aware of warning signs.

Disabled Students restrained, secluded in school

This is a graph of Instances of Restraint and Seclusion Per 100 Students. Credit: Carsey Institute at UNH

The restraint and seclusion of students in U.S. public schools in response to student behaviour problems are used much more frequently on students with a disability than on students without a disability, and especially in affluent school districts, according to new research at the Carsey Institute at the University of New Hampshire.

Restraint is a practice that uses physical or mechanical means to restrict a student's freedom of motion.

Seclusion is a practice that usually involves the involuntary isolation of a student for a period of several minutes.

Douglas Gagnon
The research is presented in the Carsey Institute brief "Variation in rates of restraint and seclusion among students with a disability."

The research was conducted by Douglas Gagnon, doctoral candidate in education at UNH and a research assistant at the Carsey Institute; Marybeth Mattingly, director of research on vulnerable families at the Carsey Institute and research assistant professor of sociology at UNH; and Vincent Connelly, associate professor of education at UNH.

Vincent Connelly
On average across school districts nationwide, there were 2.6 instances of restraint for every 100 students with a disability for the 2009-2010 school year, compared with only 0.1 instances for every 100 students without a disability, the researchers found. Seclusion rates followed a similar pattern.

Add caption
This is a graph of Percentage of Districts Reporting Restraint/Seclusion For Students with a Disability. Credit: Carsey Institute at UNH

The researchers found there was wide variability in the use of restraint and seclusion on students with a disability in school districts, with the vast majority of school districts not employing these techniques.

According to the researchers, 59.3 percent of school districts report no instances of restraint of a student with a disability and 82.5 percent do not report a single instance of seclusion.

However, a small proportion of districts report exceedingly high rates.

"Schools today are tasked with implementing positive techniques that can effectively manage the difficult and sometimes violent behaviors of the most challenging students with a disability, which might lead some schools to more extreme measures," the researchers said.

The researchers also found that school districts with higher concentrations of poverty and larger black and Hispanic populations are associated with lower rates of restraint and seclusion. In fact, average rates of restraint and seclusion are more than twice as high in school districts of low poverty and low diversity.

"If certain disability types elicit more frequent restraint and seclusion, and the frequency of such disabilities differs by school type, this may help explain why rates differ across school poverty and racial composition," the researchers said.

More information: This research is based on data from the 2009-2010 Civil Rights Data Collection and the 2009 Small Area Income and Poverty Estimates. The research brief "Variation in rates of restraint and seclusion among students with a disability" is available at carseyinstitute.unh.edu/publication/969

Scientist find Gene linked to Asperger Syndrome and empathy

Scientists have confirmed that variations in a particular gene play a key role in the autism spectrum condition known as Asperger Syndrome.

They have also found that variations in the same gene are also linked to differences in empathy levels in the general population.

A study to be published later this month in the journal Molecular Autism confirms previous research that people with Asperger Syndrome (AS) are more likely to carry specific variations in a particular gene.

More strikingly, the study supports existing findings that the same gene is also linked to how much empathy typically shown by individuals in the general population.

The research was carried out by a team of researchers led by Professor Baron-Cohen at the Autism Research Centre at Cambridge University.

Asperger Syndrome is an autism spectrum condition. The researchers looked for sequence variations (called single nucleotide polymorphisms, SNPs) in the gene known as GABRB3 in a total of 530 adults - 118 people diagnosed with AS and 412 people without a diagnosis.

The team found that certain SNPs in GABRB3 were significantly more common in people with AS.

They also discovered that additional genetic variations in the same gene were linked to scores on an empathy measure called the Empathy Quotient in the general population.

AS is diagnosed when a person struggles with social relationships and communication, and shows unusually narrow interests and resistance to change, but has good intelligence and language skills.

Most genetic studies of autistic spectrum conditions treat autism as if they are all very similar, whereas in reality there is considerable variation (e.g., in language level and intellectual ability).

Rather than studying people on the autistic condition spectrum, this new study looked only people with AS, as a well-defined subgroup of individuals within this range.

The researchers examined the gene GABRB3 which regulates the functioning of a neurotransmitter called gamma-aminobutyric acid (GABA) and which contains a number of SNPs that vary across the population.

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

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

Professor Baron-Cohen said: "We are excited that this study confirms that variation in GABRB3 is linked not just to AS but to individual differences in empathy in the population.

Many candidate genes do not replicate across studies and across different samples, but this genetic finding seems to be a solid result.

Research now needs to focus on where this gene is expressed in the brain in autism, and how it interacts with other genetic and non-genetic factors that cause AS."

The team was co-led by Dr Bhismadev Chakrabarti from the Department of Psychology at Reading University. He commented: "Genes play an important role in autism and Asperger Syndrome."

"This new study adds to evidence that GABRB3 is a key gene underlying these conditions."

"This gene is involved in the functioning of a neurotransmitter that regulates excitation and inhibition of nerve cell activity so the research gives us vital additional information about how the brain may develop differently in people with Asperger Syndrome."

Varun Warrier, who carried out the study as part of his graduate research at Cambridge University, added: "The most important aspect of this research is that it points to common genetic variants in GABRB3 being involved in both AS and in empathy as a dimensional trait."

"Although GABRB3 is not the only gene to be involved in this condition and in empathy levels, we are confident that we have identified one of the key players."

"We are following this up by testing how much protein GABRB3 produces in the brain in autism, since a genetic finding of this kind becomes more explanatory when we can also measure its function."

More information: "Genetic variation in GABRB3 is associated with Asperger syndrome and multiple endophenotypes relevant to autism." Varun Warrier, Simon Baron-Cohen and Bhismadev Chakrabarti. Molecular Autism 2013, 4:48 DOI: 10.1186/2040-2392-4-48

Dyslexia: Empowering Learning - Olive Hickmott

Call for fresh approach to develop accelerated learning skills in school

December 2013 News from Olive Hickmott of Empowering Learning

– Neuroscience research shows that effective mental imagery skills are missing for those with poor literacy, numeracy, concentration and also many with Specific Learning Difficulties (SpLD), such as Dyslexia.

Olive Hickmott, expert learning coach and founder of Empowering Learning, has observed and studied the learning strategies employed by skilled and confident learners.

Observing best practice amongst skills and confident learners, it is clear that the ability to generate mental images and control their location, motion, size, brightness, etc are essential skills.

She has developed a teaching model which both enhances and controls mental imagery and has taught 100s of Practitioners worldwide.

100% of those who are diagnosed with Dyslexia are not using mental imagery for words or numbers and many can’t keep even a single letter still.

The skills to control mental images can be taught quickly and used immediately to accelerate progress. 

Mental imagery offers a fresh, enjoyable and simple skill for teachers, parents and children with SpLD.

In England there is an increase in the pupil premium available in 2013/14, with the amount per child in primary school, rising from £900 to £1300.

Hickmott is calling for this increase to be used most effectively to ensure children are not just supported in their confusion, but are taught new skills that will last a lifetime.

As we digest the OECD’s test results, literacy and numeracy levels in the English speaking countries still have much room for improvement.

As English has many irregularities and homophones to confuse our children, using mental imagery effectively accelerates learning and helps children to develop the necessary skills to overcome many of their challenges.

Teaching these skills within schools and to families has created exceptional results. Several symptoms of SpLDs can be reduced or even eliminated.

Hickmott quotes that, “The National Curriculum calls for multi-sensory teaching and learning”.

She comments, “Being in control of your mental imagery is the fundamental basis for visual learning. Teachers however are not being taught how to help a child hone their mental imagery skills for literacy, numeracy and concentration."

"Teachers can add the skills, as Continuous Professional Development (CPD), in just a few hours on-line or through INSET training."

"This will enhance their teaching and provide a very sustainable and cost effective way of addressing the challenges of conditions such as Dyslexia."

"This is particularly vital amongst children aged 4-7 years as a preventative measure and also to ensure that they do not lose confidence and self-esteem”.

Hickmott observes, “This is not just another spelling or reading strategy, it enables teachers and families to understand more about how we learn."

"Mental imagery has been used in sport for many years to model excellence and every day we see dramatic results in working with children, particularly those with Dyslexia."

"Following the latest figures from OECD, the strategy to teach the skill that experts already use, must be considered."

"Developing the use of mental imagery as a technique in schools offers an effective starting point for all aspects of literacy teaching. If you know something works why wouldn’t you try it? ”

Not only do the children benefit, the family benefits as a whole and Hickmott actively encourages parents to get involved.

One such family is that of Jane Smith. Jane’s partner and nine-year old daughter both showed signs of Dyslexia and as a result sought help from Hickmott. Jane comments,

“When I sent my partner and daughter to see Olive, I expected them to come home with some new skills to help them improve their reading and spelling. I was not prepared to be totally amazed at the results!”

She continues, “The stress levels in the house have gone right down, confidence has grown, there is more co-operation and some very happy people.”

Hickmott concludes, “We have a great opportunity to make a real difference in teaching children with poor literacy, Dyslexia and other SpLDs."

"The bonus of using this approach is that it will accelerate any techniques that are already in place. The increased pupil premium offers a real opportunity to address Dyslexia and other learning difficulties."

"Let’s not waste this opportunity and instead take up this challenge to enable our children to learn in a way that best suits them.”

www.empoweringlearning.co.uk , www.cpdoutofthebox.co.uk and the blog at www.olivehickmott.co.uk

Sonocent's Audio Notetaker

Read more about this Audio Note Taking tool at www.sonocent.com/

Wednesday, December 11, 2013

Empathy versus Sympathy - RSA Animation

What is the best way to ease someone's pain and suffering? 

In this beautifully animated RSA Short, Dr Brené Brown reminds us that we can only create a genuine empathic connection if we are brave enough to really get in touch with our own fragilities.

Dr Brené Brown is a research professor and best-selling author of "Daring Greatly: How the Courage to be Vulnerable Transforms the Way We Live, Love, Parent and Lead" (Penguin Portfolio, 2013).

She has spent the past decade studying vulnerability, courage, worthiness, and shame.

Voice: Dr Brené Brown
Animation: Katy Davis (AKA Gobblynne) 


Tuesday, December 10, 2013

Cutting-Edge Tech Gives A Synthetic Voice To The Voiceless

Influencers and Innovation: VocaliD
A tech breakthrough is letting people who are physically unable to speak talk out loud in their own, unique voice.

When a person can't use audible speech to communicate, technology already exists that can allow some people to talk using a computerized voice.

Generally people need to use apps or computer programs where you type in what you want to say and the phone or tablet speaks it aloud.

Until now, every person who utilized the technology has had the same voice -- which sounds deep and computerized. But thanks to VocaliD, that's changing.

"You see a 3-year-old girl using that voice, and then you see a 40-year-old male using that voice, and it's odd. It can't really be an extension of the individual if someone else has that same voice," Rupal Patel, associate professor at Northeastern University and the developer behind VocaliD told reporters.

"That was when we first started thinking: 'Isn't there a way to make these voices more personalized?"

Patel uses technology to blend a person's unique speech with a healthy speaker's voice to create a sound that is "understandable but unique to the person that we want to build it for."

For Samantha Grimaldo, the teenager with whom Patel is working to develop the speech program, the information in her brain doesn't flow to the muscles used for speech.

"I don't use my voice to talk, but I use my iPhone," Grimaldo said. Grimaldo called the default voice she's been using "weird."

"Because of the way it sounds, she doesn't want to use the phone as much, especially in public," Grimaldo's mother, Ruane, said.

To create a special voice for Grimaldo, Patel took recordings of Grimaldo saying different vowels and blended them with another speaker's voice.

Grimaldo's mother said she was thrilled with the result, and that she could hear some of Samantha's voice in it.

"We're just so grateful that this could happen for her," Ruane said. "She's going to have a full life because of people like Rupal, who really want to help."

"There's nothing better than seeing the person who's actually going to use it, seeing their reaction, seeing their smile," Patel said.

Monday, December 9, 2013

Childhood Ashtma: Cat and Dog Allergens on your pets' soft toys

Children's soft toys can harbour high levels of cat and dog allergens as well as house dust mite allergens, according to new research by the University of Otago, Wellington.

After house dust mite allergens, exposure to cat and dog allergens is the next most common indoors. All are strongly associated with asthma.

Children often sleep with soft toys close to their airways, so any allergens present can be a potential problem for asthmatics, says Associate Professor Rob Siebers.

"What that means is that exposure to allergens on toys tends to be great than exposure to mattresses," Professor Siebers says.

The study analysed dust collected from 40 children's soft toys and mattresses. Most had detectable cat and dog allergen levels even in homes without cats or dogs.

Thirty-five of the 40 soft toys (87.5%) had detectable cat allergen levels, and 34 (85%) had detectable dog allergen levels. By comparison, 80% of mattresses had detectable levels of the allergens.

Furthermore, while all mattresses and soft toys had detectable house dust might allergen levels, soft toys contained about three times the level of those on mattresses.

Rob Siebers
While soft toys have long been recognised as a source of house dust mite allergens, this is the first major study of its kind to confirm they are also a source of cat and dog allergens, regardless of whether the home has pets, Professor Siebers says.

"Cat and dog allergens are aerodynamic and can be transported on clothing into animal-free areas, even in cat-free areas such as the Antarctic."

Professor Siebers says the good news is that a regular cold wash in the washing machine has been proven to get rid of cat and dog allergens.

"My advice to parents, particularly of children who are sensitised asthmatics, is to put the toy their child sleeps with through the wash at least weekly."

The research has just been published in the online Journal of Asthma, and was carried out in association with colleagues at the Show Chwan Memorial and Changhua Christian hospitals in Taiwan.

Saturday, December 7, 2013

UK Police Taser teenage boy with complex learning difficulties

A teenage boy with complex learning difficulties has been Tasered by police in the grounds of a special school owned by the exclusive Priory Group.

Devon and Cornwall Police were called to Chelfham Senior School near Plymouth, which specialises in children with learning difficulties including behavioural, emotional and social difficulties and autism, after reports of an alleged assault on a teacher.

The force confirmed officers deployed a Taser during the incident at 9.20pm on December 1, which involved three boys, a 15-year-old and two 14-year-olds, after reports that knives were brandished at officers.

The day and residential school for boys and girls aged seven to 19 is owned by the Priory Group, a private company known for its addiction clinics favoured by celebrities.

It is in the village of Bere Alston in the Devon countryside, close to Dartmoor National Park.

Sophie Khan, a solicitor-advocate and legal director at Police Action Centre, said: "The use of a Taser on this occasion has to be called into question. The police action may have been excessive."

"The use on children is only allowed if it is the only feasible method of restraining the child. It's only there if there are no other alternatives to restrain the child," she said.

"Often officers can say they weren't aware of behaviour issues, but in this case they must have been aware."

"Using a Taser on someone suffering some kind of behavioural difficulty or disability is something the policy or guidance doesn't allow."

Devon and Cornwall Police are being investigated by the police watchdog over an incident in which a man who doused himself in petrol burst into flames when he was shot with a Taser. Andrew Pimlott, 32, suffered horrific injuries in the confrontation outside his house and died in a hospital burns unit five days later.

However, the Independent Police Complaints Commission (IPCC) has not been contacted in relation to the incident at Chelfham.

The teacher was treated at the scene by paramedics for chest and head injuries before being taken to Derriford Hospital.

All three boys involved in the incident were jointly charged with affray and will appear at Plymouth Magistrates' Court on December 20.

A spokeswoman for the school said it was "an isolated incident on the school grounds and as legal proceedings are ongoing it would be inappropriate to comment further".

Figures released to UK Parliament earlier this year showed armed officers discharged, targeted or threatened to use Tasers against youngsters more than 320 times in 2011 - an 11-fold increase from the first year they were cleared for use against under-18s in 2007.

In the first year of officers being cleared to Taser children, they were used 29 times in England. By 2009, this had increased to 135.

In 2010, the weapons were used 339 times against children and by 2011 - the latest year that figures are available - the total stood at 323.

The figures were released following a parliamentary question asked by Lib Dem backbencher Julian Huppert.

In 2004, following a trial in five forces, it was agreed to allow chief officers of all police forces in England and Wales to make Tasers available to authorised firearms officers.

Friday, December 6, 2013

Breaking the link between ADHD and addiction

Dr Melanie White

Adult sufferers of ADHD are two to three times more likely to experience substance abuse or dependence, but a research project which will map the genetic markers of the condition will help sever ties with addiction and could lead to customised treatments.

Dr Melanie White from QUT's Institute of Health and Biomedical Innovation (IHBI) said testing for specific genes associated with actions of the reward centre of the brain involving dopamine - a neurotransmitter which plays a major role in reward-motivated behaviour - would give a better understanding of how the brain works in those with ADHD (Attention Deficit Hyperactivity Disorder).

"I'm looking at genetic markers of symptoms of ADHD in adulthood as well as whether people have used a range of different types of substances, and the interaction between these genetic markers and aspects of the environment," Dr White said.

"Given ADHD medication is typically a stimulant, I'll be investigating whether it improves their symptoms in the short term and the role of this medication in future substance use or symptoms."

Dr White, who was awarded a Churchill Fellowship to progress her research, said most children diagnosed with the neurodevelopmental disorder carried it into adulthood.

While symptoms, which include restlessness in work and relationships and impulsivity, can be adapted to fit in with the demands of life, the link between ADHD and substance abuse is impossible to ignore.

"One theory is that people are using substances to redress the chemical imbalance in their brain, or that the reward centre and dopamine activity is wired differently in those with ADHD versus the rest of the population," Dr White said.

"However, the theory I'll be investigating is whether early stimulant medication use when the brain is still developing, results in the brain responding differently when exposed to substance use later in life.

"There are diagnostic differences in terms of whether your symptoms are predominantly inattentive or hyperactive-impulsive, but I have no doubt there are several different genes that might lead to susceptibility to substance abuse on top of the risk for these ADHD symptoms."

Dr White carried out research at the Federal University of Rio Grande do Sul in Brazil, which has studied the largest group of adults with ADHD in the world.

However, she is looking for expressions of interest from Australian adults with ADHD for future studies.

"Hopefully in the future, this type of information will enable us to make customised plans based on people's specific genetic profile amongst other characteristics, often called 'personalised medicine'," she said.

"We hope to be able to effectively say 'this medication would be more effective for you because of your genetic makeup', or conversely 'we don't believe this medication would be a good idea because it may increase some risks for you down the track'."

Thursday, December 5, 2013

FASD: Alcohol during pregnancy causes impaired social skills in children

A recent study published in Child Neuropsychology has found that drinking alcohol while pregnant means your child is more likely to develop issues with social skills as they grow older.

The results of the study indicate that children with prenatal alcohol exposure (PAE) who do not have a global intellectual disability are at high risk of developing significant problems in a broad array of cognitive, emotional, behavioral, and social domains.

125 children aged between 6 and 12 participated in the study, 97 of whom met diagnostic criteria for a Fetal Alcohol Spectrum Disorder (FASD).

The children underwent a comprehensive multi-informant assessment of neurocognitive, emotional, social, behavioural, and adaptive functioning.

The results of the study indicated that the children who had prenatal alcohol exposure (PAE), returned significantly poorer scores compared to the non-exposed group on tests measuring executive functioning (the processes that help us connect past experience with present action, the skills we use for organization and planning), attention, working /visuospatial memory, linguistic abstraction, adaptive behaviour, emotional/behavioural functioning, and social cognition (understanding of why people do the things that they do).

The study showed that while the children with PAE and the non-exposed children attributed hostile intentions towards provocative behaviors by their peers, e.g. pushing and shoving, the children affected by PAE were more likely to attribute hostile intentions to situations that did not involve physical provocation e.g. asking if they can play and being told 'no'.

The parents of children with PAE also gave greater reports of inattentive and hyperactive/impulsive behavior and the children were shown to also be more likely to show depressive symptoms.

The group of children with PAE were also shown to have more social problems according to assessments involving parents and teachers. These results maintained their significance past controlling for IQ, demonstrating that relying on IQ alone to guide parental, peer, and school expectations may be misleading.

The study also notes that this may also suggest that the negative effects of PAE are above and beyond the control of intelligence.

The study concludes by suggesting that the results mean it is becoming increasingly more evident that there is a pressing need for early identification of social issues related to prenatal alcohol exposure and intervention in order to take advantage of the developing brain's plasticity and to maximise the likelihood of effecting meaningful functional improvement.

More information: Justin L. Quattlebaum & Mary J. O'Connora "Higher functioning children with prenatal alcohol exposure: Is there a specific neurocognitive profile?" Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence Volume 19, Issue 6, 2013 DOI: 10.1080/09297049.2012.713466

Tuesday, December 3, 2013

Micromovements hold hidden information about severity of autism

Movements so minute they cannot be detected by the human eye are being analyzed by researchers to diagnose autism spectrum disorder and determine its severity in children and young adults, according to research presented at the 2013 Society for Neuroscience annual meeting in November.

Jorge V. José
The research is the work of Jorge V. José, Ph.D., vice president of research at Indiana University, and Elizabeth Torres, Ph.D., the principal investigator for the study and an assistant professor in the Department of Psychology in the School of Arts and Sciences at Rutgers University.

They are building on earlier findings involving the random nature of movements of people with autism.

Earlier research looked at the speed maximum and randomness of movement during a computer exercise that involved tracking the motions of youths with autism when touching an image on the screen to indicate a decision. That research was reported in July in the Nature journal Frontiers of Neuroscience.

Elizabeth Torres
In the new study, the researchers looked at the entire movement involved in raising and extending a hand to touch a computer screen.

The device they use can record 240 frames per second, which allows them to measure speed changes in the millisecond range.

"We looked at the curve going up and the curve going down and studied the micromovements," said Dr. José, who also is the James H. Rudy Distinguished Professor of Physics in the IU Bloomington College of Arts and Sciences and a professor of cellular and integrative physiology at the IU School of Medicine.

"When a person reaches for an object, the speed trajectory is not one smooth curve; it has some irregular random movements we call 'jitter,'" he said.

"We looked at the properties of those very small fluctuations and identified patterns." Those patterns or signatures also identify the degree of the severity of the person's autism spectrum disorder, he said.

"Often in movement research, such fluctuations are considered a nuisance," Dr. José said.

"People averaged them away over repeated movements, but we decided instead to analyze the movements on a smaller time scale and found they hold lots of information to help diagnose the continuum of autism spectrum disorder.

"Looking at the speed versus time curves of the motion in much more detail, we noticed that in general many smaller oscillations or fluctuations occur even when the hand is resting in the lap."

"We decided to carefully study that jitter. Our remarkable finding is that the fluctuations in this jitter are not just random fluctuations, but they do correspond to unique characteristics of the degree of autism each child has."

Wu said the more detailed information allows subtyping autism spectrum disorder, Asperger's and identify typically developing individuals much better than what had been done before in terms of the global distribution of movements.

The next step is to compare the output of the new methodology in individuals with autism of idiopathic origins with those with autism of known etiology.

The new refinement may help advance research in autism spectrum disorder to develop treatments tailored to the individual's needs and capabilities. A collaborative effort with the Torres lab at Rutgers is underway.

More Information: Autism: the micro-movement perspective July 2013

Monday, December 2, 2013

Oxytocin spray improves brain function in children with autism

Spacefilling model of oxytocin. Image: Wikipedia.

A single dose of the hormone oxytocin, delivered via nasal spray, has been shown to enhance brain activity while processing social information in children with autism spectrum disorders, Yale School of Medicine researchers report in a new study published in the Dec. 2 issue of Proceedings of the National Academy of Sciences.

"This is the first study to evaluate the impact of oxytocin on brain function in children with autism spectrum disorders," said first author Ilanit Gordon, a Yale Child Study Center postdoctoral fellow, whose colleagues on the study included senior author Kevin Pelphrey, the Harris Professor in the Child Study Center, and director of the Center for Translational Developmental Neuroscience at Yale.

Gordon, Pelphrey, and their colleagues conducted a double-blind, placebo-controlled study of 17 children and adolescents with autism spectrum disorders.

The participants, between the ages of 8 and 16.5, were randomly given either oxytocin spray or a placebo nasal spray during a task involving social judgments.

Oxytocin is naturally occurring hormone produced in the brain and throughout the body.

Kevin Pelphrey
"We found that brain centers associated with reward and emotion recognition responded more during social tasks when children received oxytocin instead of the placebo," said Gordon.

"Oxytocin temporarily normalized brain regions responsible for the social deficits seen in children with autism."

Gordon said oxytocin facilitated social attunement, a process that makes the brain regions involved in social behavior and social cognition activate more for social stimuli (such as faces) and activate less for non-social stimuli (such as cars).

"Our results are particularly important considering the urgent need for treatments to target social dysfunction in autism spectrum disorders," Gordon added.

More information: "Oxytocin enhances brain function in children with autism," by Ilanit Gordon et al. www.pnas.org/cgi/doi/10.1073/pnas.1312857110