Wednesday, July 31, 2013

Childhood Obesity: How many extra calories does it take?

Overweight kids may be consuming far more calories than their doctors or parents realize, a new study suggests.

The study, which is published in the July 30 online issue of The Lancet Diabetes & Endocrinology, updates the mathematical model doctors use to calculate the daily calorie needs of children and adolescents.

The new model tries to more accurately estimate the energy requirements for growing girls and boys.

It also accounts for kids' higher metabolisms, relative to adults, and takes into account the drop in physical activity that happens with age as frenetic toddlers turn into sluggish teens.

Lastly, study authors factor in the increased energy required to maintain a bigger body size with age.

In sum, the model predicts that it takes far more calories for children to gain weight than experts had realized.

For example, the old model estimates that for a girl who's a normal weight at age 5 to become 22 pounds overweight by the time she's 10, she'd need to eat around 40 extra calories a day—the equivalent of the calories in a small apple.

The new model predicts that she'd actually need to eat far more than that—about 400 extra calories a day, or the calories in a medium serving of fast-food french fries—to get the same result.

That's one case, but the number of calories it takes to gain weight is slightly different for boys and girls at every age.

"It's a bit of a moving target," admitted study author Kevin Hall, a senior investigator at the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

"The point of these examples is that the excess calorie consumption is much larger than most folks would have suggested in the past."

Using historical data collected by the U.S. Centers for Disease Control and Prevention, Hall and his co-authors calculated that children today are an average of 13 pounds heavier than kids were in the late 1970s, before the start of the obesity epidemic.

To gain those extra pounds, kids have consumed about 200 more calories a day. At different ages, and depending on the amount of weight a child has gained, the differences can be even more stark.

For example, the model estimates than an 11-year-old boy who is about 18 pounds overweight has eaten roughly 320 more calories a day than his healthy-weight peers.

Meanwhile, a girl who is the same age and also 18 pounds overweight has taken in an extra 301 daily calories.

Hall said the new numbers give parents and doctors a road map for "how we got here" with overweight and obese kids, but they aren't exactly the way back to a normal weight.

Kids who cut calories by the amount their currently overeating may stop gaining, for example, but they'd likely need to cut even more to shed their extra pounds.

Dr. David Katz, director of the Yale Prevention Research Center, praised the new model, and said it clarifies energy intake levels needed to achieve public health goals.

"Importantly, given the rather large calorie excesses fueling childhood obesity, this model is a rebuttal to the food industry arguments that exercise alone can be the answer," said Katz, who is also editor of the journal Childhood Obesity.

"For our kids to achieve healthy weight, control of calories in, not just calories out, will have to be part of the formula," said Katz, who was not involved in the research. But there's some good news in the new numbers, too.

As doctors and parents have long suspected, some kids appear to be able to outgrow their extra pounds when they shoot up in height during puberty, though that feat may be easier for boys than girls, because boys gain more calorie-burning muscle during puberty than girls.

"If you haven't reached puberty and haven't yet reached that growth spurt, that might be the ideal time to institute a weight management intervention to harness the power of the growth to decrease fat mass and increase fat-free mass," said study author Hall.

Autism: Does Impaired Attention explain Autism symptoms?

Autism is marked by several core features—impairments in social functioning, difficulty communicating, and a restriction of interests.

Though researchers have attempted to pinpoint factors that might account for all three of these characteristics, the underlying causes are still unclear.

Now, a new study suggests that two key attentional abilities—moving attention fluidly and orienting to social information—can be checked off the list, as neither seems to account for the diversity of symptoms we find in people with autism.

Kami Koldewyn
"This is not to say that every aspect of attention is fine in all children with autism—children with autism very often have attentional disorders as well," explain psychological scientists and lead researchers Jason Fischer and Kami Koldewyn of MIT.

"However, our study suggests that attention impairments are not a key component of autism itself."

The study is published in Clinical Psychological Science, a journal of the Association for Psychological Science.

Attention has long been targeted as a possible causal mechanism in autism research: "Problems with attention early in life could have far-reaching consequences," say Fischer and Koldewyn.

"For example, if young children with autism don't pay close attention to the behaviours of the people around them, they might never learn to read body language and other social cues."

But much of the previous research on attention, social learning, and autism had been mixed.

"Some of the most fundamental questions remain debated," Fischer and Koldewyn explain.

Jason Fischer
"Our goal was to conduct careful, systematic, relatively large-scale studies of some of the mental processes most often implicated in autism to discover which of them are actually disrupted in autism and which are not."

To investigate this, Fischer, Koldewyn, and their team had children with high-functioning autism and children without autism complete an attention task while tracking their eye movements.

Critically, the participants were matched on age and IQ before participating in the study to rule out the possible influence of global developmental delays that aren't specific to autism.

The task was intended to answer two questions:

  • Are children with autism less able to re-orient to a new stimulus (a plausible precursor of restricted interests)? and,
  • Are children with autism slower to respond to social stimuli, such as faces?

Overall, children with and without autism showed clear signatures of shifting attention and orienting to social stimuli, but there was no difference in either ability between the two groups, challenging the hypothesis that impaired attention might be at the root of autism symptoms.

Fischer and Koldewyn underscore that these aren't simply null results—they do contribute in a meaningful way to our understanding of autism.

"Understanding which mental capacities are intact in autism is not only encouraging, but also helps families and educators design effective interventions to work on those cognitive skills that are true areas of weakness in autism."

While finding those true cognitive impairments, and their antecedents, has proved difficult, it's not for lack of effort.

"We believe that the crux of autism lies in a difficulty interpreting the nuanced and complex information present in real life social situations," Fischer and Koldewyn conclude.

"We plan to test children with autism in more natural scenarios than the typical laboratory environment in order to understand how social context interacts with attentional abilities in autism."

Sunday, July 28, 2013

Joint custody? Overnights away from home affect children's attachments

Babies have an innate biological need to be attached to caregivers. Attachments during that critical first year serve as the basis for healthy attachments and relationships later in life. 

Credit: © Konstantin Yuganov / Fotolia

But what happens when babies spend a night or more per week away from a primary caregiver, as increasingly happens in cases where the parents share custody, but do not live together?

In a new national study, University of Virginia researchers found that infants who spent at least one night per week away from their mothers had more insecure attachments to the mother compared to babies who had fewer overnights or saw their fathers only during the day.

The finding is reported in the August edition of the Journal of Marriage and Family.

Attachments are defined as an enduring, deep, emotional connection between an infant and caregiver that develops within the child's first year of life, according to Samantha Tornello, the study's lead author and a Ph.D. candidate in psychology in U.Va.'s Graduate School of Arts & Sciences.

Samantha Tornello
Attachments during that critical first year serve as the basis for healthy attachments and relationships later in life, including adulthood, Tornello said.

She notes that growing numbers of parents are living apart due to non-marital childbirth, the breakup of co-habitating parents, separation and divorce.

Parents increasingly are choosing to share child rearing in some form of joint custody, and often the legal system must determine custody arrangements for the children of parents who do not live together.

"Judges often find themselves making decisions regarding custody without knowing what actually may be in the best interest of the child, based on psychology research," Tornello said.

"Our study raises the question, 'Would babies be better off spending their overnights with a single caregiver, or at least less frequently in another home?'"

Tornello pointed out that either the mother or father could be the primary caregiver, but the point would be that the child ideally would be in the care each night of a loving and attentive caregiver and that there may be something disruptive about an infant spending nights in different homes.

"We would want a child to be attached to both parents, but in the case of separation a child should have at least one good secure attachment," she said. "It's about having constant caregivers that's important."

Tornello and her co-authors at U.Va. and the American Institutes for Research, including U.Va. psychology professor Robert Emery, analyzed data from the Fragile Families and Child Wellbeing Study, a national longitudinal study of about 5,000 children born in large U.S. cities from 1998 to 2000.

Robert Emery
The data was collected by researchers at Princeton University and Columbia University and consisted of interviews with both parents at the time of the child's birth, and at ages 1 and 3.

Additional in-home assessments of the children were conducted when they were 1 and 3.

Of parents who were not cohabiting at the time of the study, 6.9 percent of babies under the age of 1 and who lived primarily with their mother spent at least one overnight a week away with their father.

Among toddlers ages 1 to 3, 5.3 percent spent between 1 percent and 35 percent of overnights away with their fathers. Another 6.8 percent spent 35 percent to 70 percent of overnights with their fathers.

Infants who spent at least one overnight a week away from their mothers were discovered to have more insecure attachments to them compared to babies who had fewer overnights or stayed with their father only during the day.

Forty-three percent of babies with weekly overnights were insecurely attached to their mothers, compared to 16 percent with less frequent overnights.

In the case of toddlers the findings were less dramatic; greater attachment insecurity was linked to more frequent overnights, but the findings there were not statistically reliable, Tornello said.

"I would like infants and toddlers to be securely attached to two parents, but I am more worried about them being securely attached to zero parents," said Emery, Tornello's research adviser.

He advocates parenting plans that evolve, where day contact with fathers occurs frequently and regularly, and overnights away from the primary caregiver are minimized in the early years, then are gradually increased to perhaps become equal in the preschool years.

"If mothers and fathers can be patient, cooperate and take a long view of child development, such evolving plans can work for both children and parents," he said.

Journal Reference: Samantha L. Tornello, Robert Emery, Jenna Rowen, Daniel Potter, Bailey Ocker and Yishan Xu. Overnight Custody Arrangements, Attachment, and Adjustment Among Very Young Children. Journal of Marriage and Family, 1 JUL 2013; Volume 75, Issue 4, August 2013, Pages: 871%u2013885 DOI: 10.1111/jomf.12045

Monday, July 22, 2013

UK Childline asks; Do you know your children well enough?

A growing “worry gap” between the problems children actually face and the issues that most concern their parents could be putting young people at risk, experts warned last night.

Most parents of primary school children choose “traditional” concerns such as stranger-danger or bullying when asked what most worries them about youngsters’ well-being, polling seen by The IoS shows.

Yet records from the UK charity ChildLine show their most common calls from children relate to depression, self-harm or thoughts of suicide.

More than half of all parents polled by YouGov for the helpline picked stranger-danger as an issue that worried them, while two-thirds chose bullying.

Yet fewer than one in five parents identified mental health as something they would worry about with a child – despite it being the most common thing for which children seek help.

Of ChildLine’s 1.5 million phone calls and online counselling sessions last year, more than 42,000 related to mental health problems, suicidal thoughts or self-harm.

Esther Rantzen, the charity’s founder, said: “It’s really important for us to hear the message that’s coming from young people who ring ChildLine. The fact is that unhappiness of this seriousness has not been on our agenda as parents and we need to take time to see what our children’s attitude to life is.”

Mental health-related issues are also among the fastest growing concerns for UK youngsters. In 2012 more than 16,000 children called ChildLine about self-harm, up 68 per cent on the previous year.

There were 12,000 calls about suicide, an annual increase of 39 per cent, and 14,000 calls about depression and mental health, up 19 per cent.

Siobhan Freegard, the founder of the parenting website Netmums, said: “We see it here at Netmums, that when parents start noticing mental health problems it actually seems quite late.

Because we’re not so aware of it and it’s not on our list of key worries it seems to me we don’t pick it up early enough, and by the time we’re aware it’s often fully entrenched.

“It’s still a bit of a taboo that your child could have a mental health problem. People need to realise that this absolutely could be my child.”

Parents did not identify the impact of troublesome family relationships as a major worry, but this was the second most common source of concern for children and young people seeking help from ChildLine.

Almost 40,000 phone and online counselling sessions by the charity last year were about family relationship issues, such as parents getting divorced.

Peter Liver, director of ChildLine, said: “There have been notable changes in the problems children contact us about since ChildLine launched in 1986. Originally, sexual abuse was the major issue but now the pendulum is swinging towards family problems, self-harm and suicide.

We know from polls of parents that they are still having more traditional conversations with their children about issues such as stranger-danger, which is great, but are unlikely to speak to them about emerging issues like self-harm.”

He added: “It can be hard for parents to keep up and I think it’s easier to understand more traditional issues as we’ve been through them ourselves or were warned about them by our own parents.”

Mothers and fathers are not entirely out of touch, however. One in 10 ChildLine counselling sessions – more than 30,000 – related to bullying and around 16,000, or 5 per cent, of their counselling sessions were about sexual abuse.

Two-fifths of parents were worried about their children accessing pornography – though this did not feature in the top 10 worries of children contacting the charity.

Thursday, July 18, 2013

Adaptive assistive technologies for people with disabilities

''Assistive technologies'' (AT) have developed rapidly in recent years, allowing people with motor disabilities to live more independent and comfortable lives.

Now assistive technology systems that can open a door, turn on a light or connect to the internet at the blink of an eye, a head movement or even a thought, are being made more flexible and customisable for individual users - thanks to the work of EU-funded researchers.

An estimated 2.6 million people in Europe have mobility problems affecting their upper limbs, and around 1.3 million of them require assistive technologies, or the help of human carers, to be able to perform everyday tasks. Across developed countries, the figure rises to 2.5 million.

They include people suffering from a range of diseases, including multiple sclerosis and amyotrophic lateral sclerosis, as well as varying degrees of paralysis, among them locked-in syndrome in which a person may only be able to move their eyes.

While many people already make use of assistive technologies -an umbrella term that includes assistive, adaptive and rehabilitative devices for people with disabilities - in most cases the systems and applications are designed to perform one specific function or assist someone with a specific form of disability.

''What I would call the "old" AT-market is dominated by isolated applications and devices, each addressing a specific disability or focusing on a specific ability of the user. This is in principle good, since it means that each device can be brilliantly optimised in its functionality,'' explains Stefan Parker, a project coordinator and researcher at KI-I in Austria.

''The trouble is that in most actual use cases these devices only manage to take advantage of a part of the user''s abilities or, in other cases, are not properly adaptable to the user''s needs, leaving him or her with a device that is merely semi-optimal for their use case.''

The problem is that disabilities cannot be categorised. Every person is different and even two people suffering from the same disease will often have very different degrees and types of impairment, or a combination of different disabilities at the same time.

Additionally, an individual sufferer will usually need systems to be adjusted, or new devices to be used, as their symptoms evolve over time.

To address the issue, a consortium of research institutes, universities and private companies from seven countries have developed an affordable and scalable platform to implement AT in a much more personalised and flexible way.

Their system, developed over two years in the ''Assistive technology rapid integration and construction set'' (ASTERICS) project with the support of EUR 2.65 million in funding from the European Commission, has already gone into commercial production.And on-going research is set to enhance it further.

Assistive systems, centred on the user
''The AT market is currently subject to great change. On the one hand, mobile devices like smart phones and tablet PCs are conquering the world, and this has a great influence on the AT market.

On the other hand, more user-centred and more flexible approaches towards AT are being generated - ASTERICS being the first and therefore most important,''says Mr Parker, who helped coordinate the project.

Unlike traditional AT systems, the ASTERICS platform can be configured to meet the specific needs of individual users.

It is possible to choose from a wide variety of sensors, from simple switches or webcams to advanced ''brain-computer interfaces'' (BCI), for interaction with the system depending on the requirements and abilities of each person.

The input data, no matter how it is generated, is processed by the ''ASTERICS Runtime Environment'' (ARE).

The software can easily be installed on a Windows-based machine and uses so-called ''models'', configured for each user, to process and execute user commands on any device in order to use their smart phone or computer,and to control their air conditioning or open a window in their home.

The models are built and configured via a dedicated configuration programme, the ''ASTERICS Configuration Suite'' (ACS) in which, through a graphical interface, it is possible to combine several plug-ins for input, signal processing and output and connect them via data-channels and event-channels.

Once completed, a model is simply uploaded to the ARE, where several models can be stored, so the user can have different options for different use cases.

There are also extension modules for the connection of sensors, which can be connected either to the platform or to any other computer via a standard USB cable, along with a HID actuator - a small USB-interface that acts like a standard wireless plug-and-play device, emulating mouse, keyboard or joystick.

''The approach results in a completely user-centred on-site development of AT - the user no longer needs to adapt to the device, it''s the other way round. This goes so far that users can even make small adaptations themselves, or their carer can make them for them, to react to changes in the daily situation,'' Mr Parker notes.

''Also the system can be adapted every time a user''s condition changes for better or worse - usersno longer need to buy a new device every time their condition changes - or use the old one despite having a hard time doing so - they can continue to use the system they are accustomed to and like, but with a new means of input or just with refined settings.''

People suffering from motor disabilities, as well as specialised carers and AT experts, were consulted by the ASTERICS team throughout the design and development process, and prototype platforms received overwhelmingly positive feedback in trials.

''ASTERICS was really appreciated by users and during the course of the user tests we were able to give possibilities to people that they wouldn''t have had without the system. Some users have continued to use the ASTERICS system since the user tests and are very happy with it,'' Mr Parker says.

''Crucially, the system is relatively cheap to install, and can make use of users'' existing devices, such as the webcam on their laptop, to reduce costs further.

Mr Parker estimates that most people would need to spend around EUR 500, excluding the cost of buying a laptop or home PC, for a suitable set up, though it could run to several thousand euro if more expensive equipment such as a brain-computer interface is required.

IMA, a project partner based in the Czech Republic, is currently producing commercial hardware, including input/output modules for use with the system, while Harpo in Poland, another partner, is the prime distributor of the complete system and provides adaptation and customisation services.

The team's goal now is to continue their research and launch a follow-up project to extend the system to mobile devices such as smart phones and tablets.

The King Louie Effect: Children want to be like you, ooh, ooh!



Children are socially motivated to learn at a much younger age than previous studies have suggested, according to new research undertaken by the Cardiff University, School of Psychology in Wales.

Experimental studies have determined that from 15 months of age children begin to imitate the behaviour of other people more faithfully and less selectively than in earlier months.

Principal investigator of the study, Dr Merideth Gattis of the Cardiff School of Psychology, said:

"The study demonstrates that faithful imitation begins earlier than previous scientific studies had indicated.

"It also shows that faithful imitation is socially motivated.

"In the past, some scientists have proposed that children copy faithfully because they do not understand how things work, with others arguing that children copy other people faithfully because they are interested in social relationships.

"Our study shows that babies copy faithfully because of their social motivation to interact with other people. We call this the King Louie Effect. Much like the orang-utan in The Jungle Book, when babies copy you, they are communicating: 'I wanna be like you, I wanna walk like you, talk like you.'

"So there seems to be a bit of King Louie in all of us. As children develop and become more aware of social relationships, they copy what others do in more detail, including the unnecessary things."

This newly-identified social motivation to learn through shared experiences creates important educational opportunities.

Social relationships are important throughout life, but these findings indicate that the second year is an especially important time for relationships to influence learning.

More Information: Selective and faithful imitation at 12 and 15 months

Autism: No benefit from Oxytocin

Mark Dadds
The so-called trust hormone, oxytocin, may not improve the symptoms of children with autism, a large study led by UNSW researchers has found.

Professor Mark Dadds, of the UNSW School of Psychology, says previous research suggested that oxytocin – a hormone with powerful effects on brain activity linked to the formation of social bonds – could have benefits for children with the disorder.

"Many parents of children with autism are already obtaining and using oxytocin nasal spray with their child, and clinical trials of the spray's effects are underway all over the world.

Oxytocin has been touted as a possible new treatment, but its effects may be limited," Professor Dadds says.

Autism is a complex condition of unknown cause in which children exhibit reduced interest in other people, impaired social communication skills and repetitive behaviours.

To determine its suitability as a general treatment Professor Dadds' team conducted a randomised controlled clinical trial of 38 boys aged between seven and 16 years of age with autism. Half were given a nasal spray of oxytocin on four consecutive days.

The study has been accepted for publication in the Journal of Autism and Developmental Disorders.

"We found that, compared to a placebo, oxytocin did not significantly improve emotion recognition, social interaction skills, repetitive behaviours, or general behavioural adjustment," says Professor Dadds.

"This is in contrast to a handful of previous smaller studies which have shown some positive effects on repetitive behaviours, social memory and emotion processing.

"These studies, however, were limited by having small numbers of participants and/or by looking at the effects of single doses of oxytocin on specific behaviours or cognitive effects while the participants had the oxytocin in their system.

"The results of our much larger study suggest caution should be exercised in recommending nasal oxytocin as a general treatment for young people with autism."

The boys in the new study were assessed twice before treatment, three times during the treatment week, immediately afterwards and three months later, with a parent present. Factors such as eye contact with the parent, responsiveness, warmth, speech, positive body language, repetitive behaviours, and recognition of facial emotions were observed.

Wednesday, July 17, 2013

Silencing the extra chromosome responsible for Down syndrome

Scientists at the University of Massachusetts Medical School are the first to establish that a naturally occurring X chromosome "off switch" can be rerouted to neutralize the extra chromosome responsible for trisomy 21, also known as Down syndrome, a genetic disorder characterised by cognitive impairment.

The discovery provides the first evidence that the underlying genetic defect responsible for Down syndrome can be suppressed in cells in culture (in vitro).

This paves the way for researchers to study the cell pathologies and identify genome-wide pathways implicated in the disorder, a goal that has so far proven elusive.

Doing so will improve scientist's understanding of the basic biology underlying Down syndrome and may one day help establish potential therapeutic targets for future therapies.

Details of the study by Jiang et al. were published online in Nature.

Jeanne B. Lawrence
"The last decade has seen great advances in efforts to correct single-gene disorders, beginning with cells in vitro and in several cases advancing to in vivo and clinical trials," said lead author Jeanne B. Lawrence, PhD, professor of cell & developmental biology at the University of Massachusetts Medical School.

"By contrast, genetic correction of hundreds of genes across an entire extra chromosome has remained outside the realm of possibility.

Our hope is that for individuals living with Down syndrome, this proof-of-principal opens up multiple exciting new avenues for studying the disorder now, and brings into the realm of consideration research on the concept of "chromosome therapy' in the future."

Humans are born with 23 pairs of chromosomes, including two sex chromosomes, for a total of 46 in each cell.

People with Down syndrome are born with three (rather than two) copies of chromosome 21, and this "trisomy 21" causes cognitive disability, early-onset Alzheimer's disease; and a greater risk of childhood leukemia, heart defects and immune and endocrine system dysfunction.

Unlike genetic disorders caused by a single gene, genetic correction of a whole chromosome in trisomic cells has been beyond the realm of possibility, even in cultured cells.

Harnessing the power of the RNA gene called XIST, which is normally responsible for "turning off" one of the two X chromosomes found in female mammals, UMass Medical School scientists have shown that the extra copy of chromosomes 21 responsible for Down syndrome can be silenced in the laboratory using patient-derived stem cells.

This finding opens multiple new avenues for translational scientists to study Down syndrome in ways not previously possible.

Determining the underlying cell pathologies and gene pathways responsible for the syndrome has previously proven difficult, because of the complexity of the disorder and the normal genetic and epigenetic variation between people and cells.

For example, some prior studies suggested that cell proliferation in Down syndrome patients may be impaired, but differences between people and cell lines made it difficult to conclude this definitively.

By controlling expression of the XIST gene, Lawrence and colleagues were able to compare otherwise identical cultures of the Down syndrome cells, with and without expression of the extra chromosome.

What they showed is that the Down syndrome cells have defects in cell proliferation and in neural cell differentiation, both of which are reversed by silencing one chromosome 21 by XIST.

"This highlights the potential of this new experimental model to study a host of different questions in different human cell-types, and in Down syndrome mouse models" said Lawrence.

"We now have a powerful tool for identifying and studying the cellular pathologies and pathways impacted directly due to over-expression of chromosome 21."

"Dr. Lawrence has harnessed the power of a natural process to target abnormal gene expression in cells that have an aberrant number of chromosomes," said Anthony Carter, PhD, of the National Institutes of Health's National Institute of General Medical Sciences, which partly supported the study.

"Her work provides a new tool that could yield novel insights into how genes are silenced on a chromosomal scale, and into the pathological processes associated with chromosome disorders such as Down syndrome."

More information: DOI: 10.1038/nature12394

ADHD: Single dose of Ritalin (MPH) can reduce fall risk in older adults

Ben-Gurion University of the Negev (BGU) researchers have discovered that a single dose of Ritalin (methylphenidate or MPH), used to treat Attention Deficit Hyperactivity Disorder (ADHD) and narcolepsy, helps to improve balance control during walking, hence reducing the risk of falls among elderly adults.

Falls in older adults are the leading cause of hip fractures and other injury-related visits to emergency rooms and of accidental death. Age-related deterioration in gait and balance is a major contributor to falls in older adults.

According to a study published in The Journals of Gerontology, the BGU researchers found that a single dose of MPH improves walking by reducing the number of step errors and the step error rate in both single and dual tasks.

"Our results add to a growing body of evidence showing that MPH may have a role as a therapeutic option for improving gait and reducing fall risk in older adults," said Itshak Melzer of BGU's Schwartz Movement Analysis and Rehabilitation Laboratory, Department of Physical Therapy, Faculty of Health Sciences.

"This is especially true in real-life situations, where the requirement to walk commonly occurs under more complicated, 'dual task' circumstances with cognitive attention focused elsewhere (e.g., watching traffic, talking) and not on performing a specific motor task."

The study participants were 30 healthy older adults who were at least 70 years-old and had the ability to walk 70 feet (20 meters) without personal assistance or an assistive device.

The participants were given a single dose (10 mg.) of MPH and were assessed under four task conditions of single and combined motor and cognitive tasks.

"The enhanced attention that comes about as a result of MPH may lead to improved balance control during walking, especially in dual task conditions," Meltzer explains.

"Our findings that MPH improves gait can be explained not just by its effect of attentional improvements, but also by indications that it has a direct influence on areas of the brain that deal with motor and balance control."

More Information: "Effect of Single Dose Methylphenidate on Walking and Postural Stability Under Single- and Dual-Task Conditions in Older Adults—A Double-Blind Randomized Control Trial"

Tuesday, July 16, 2013

Autism: Young children benefit regardless of high-quality treatment model

Brian Boyd
Researchers at the University of North Carolina at Chapel Hill have found that preschoolers with Autism Spectrum Disorder (ASD) who receive high-quality early intervention benefit developmentally regardless of the treatment model used—a surprising result that may have important implications for special-education programs and school classrooms across the country.

"This is the first study designed to compare long-standing comprehensive treatment models for young children with ASD," said Brian Boyd, a fellow at UNC's Frank Porter Graham Child Development Institute (FPG) and one of the study's co-principal investigators.

Boyd also is an assistant professor in occupational science and occupational therapy in UNC's School of Medicine.

"We know that more children are being diagnosed with ASD each year, and that it can cost an estimated $3.2 million to treat each child over a lifetime. Understanding that a child can benefit from a high-quality program, rather than a specialized program, may help reduce those costs by decreasing the need for teachers and other school practitioners to be trained to deliver multiple specialized services," Boyd said.

He stressed it remains important to ensure educators are trained to provide high-quality programs that meet the special behavioural, communication and other needs of children with ASD.

Previous research has shown that when children with ASD have access to early intervention via treatment programs, they improve developmentally. Until now, however, debate has persisted over which approach to use, said Boyd.

The study appeared in the June issue of Journal of Autism and Developmental Disorders.

Two frequently used comprehensive treatment models have a long history: LEAP (Learning Experiences and Alternative Program for Preschoolers and their Parents) and TEACCH (now known only by its acronym).

FPG's study examined the relative effects of the LEAP and TEACCH school-based comprehensive treatment models when compared to each other and to special-education programs that do not use a specific model.

The multisite study took place only in high-quality classrooms and enrolled 74 teachers and 198 3- to 5-year-olds in public school districts.

The study found that children made gains over the school year regardless of the classroom's use of LEAP, TEACCH or no specific comprehensive treatment model.

Kara Hume
"Each group of children showed significant positive change in autism severity, communication and fine- motor skills," said Kara Hume, FPG scientist and co-author.

"No statistically significant differences were found among models, which challenged our initial expectations—and likely the field's."

"This study may shift the field's thinking about comprehensive treatment models designed for young children with ASD," said co-author Samuel L. Odom, FPG's director and the study's principal investigator.

"Perhaps it's not the unique features of the models that most contribute to child gains but the common features of the models that most influence child growth."

More information: "Comparative Efficacy of LEAP, TEACCH and Non-Model-Specific Special Education Programs for Preschoolers with Autism Spectrum Disorders," Journal of Autism and Developmental Disorders, published online June 2013. link.springer.com/article/10.1007/s10803-013-1877-9

Music decreases perceived pain for children in Pediatric ER

Newly published findings by medical researchers at the University of Alberta provide more evidence that music decreases children's perceived sense of pain.

Faculty of Medicine & Dentistry researcher Lisa Hartling led the research team that involved her colleagues from the Department of Pediatrics, as well as fellow researchers from the University of Manitoba and the United States.

Their findings were published in the peer-reviewed journal JAMA Pediatrics today.

The team conducted a clinical research trial of 42 children between the ages of 3 and 11 who came to the pediatric emergency department at the Stollery Children's Hospital and needed IVs.

Some of the children listened to music while getting an IV, while others did not. Researchers measured the children's distress, perceived pain levels and heart rates, as well as satisfaction levels of parents, and satisfaction levels of health-care providers who administered the IVs.

The trial took place between January 2009 and March 2010.

"We did find a difference in the children's reported pain – the children in the music group had less pain immediately after the procedure," says Hartling.

"The finding is clinically important and it's a simple intervention that can make a big difference. Playing music for kids during painful medical procedures would be an inexpensive and easy-to-use intervention in clinical settings."

The research showed that the children who listened to music reported significantly less pain, some demonstrated significantly less distress, and the children's parents were more satisfied with care.

"There is growing scientific evidence showing that the brain responds to music and different types of music in very specific ways," said Hartling.

"So additional research into how and why music may be a better distraction from pain could help advance this field."

The study noted that previous research has shown that the mood of the music, whether it has lyrics, and whether it is familiar to the listener could have an impact on pain perception as well.

ADHD: FDA approves first brain wave test (NEBA)

Christy Foreman
US regulators on Monday approved the first brain wave test for attention deficit hyperactivity disorder, saying it may improve the accuracy of diagnoses by medical experts.

Cases of ADHD are on the rise in the United States, as are the number of prescriptions for stimulants doled out to young people who appear to have difficulty concentrating or controlling impulses.

The new test, known as the Neuropsychiatric EEG-Based Assessment Aid (NEBA) System, measures electrical impulses given off by neurons in the brain.

A 15-20 minute test calculates the ratio of certain brain wave frequencies known as theta and beta waves in children age six to 17.

"The theta/beta ratio has been shown to be higher in children and adolescents with ADHD than in children without it," the US Food and Drug Administration said.

"Diagnosing ADHD is a multistep process based on a complete medical and psychiatric exam," cautioned Christy Foreman, director of the Office of Device Evaluation at the FDA's Center for Devices and Radiological Health.

"The NEBA System along with other clinical information may help health care providers more accurately determine if ADHD is the cause of a behavioral problem."

The FDA said the test "can help confirm an ADHD diagnosis" or help decide if further treatment should focus on "other medical or behavioral conditions that produce symptoms similar to ADHD."

The FDA approved the device after a reviewing it as a new and "low- to moderate-risk medical device."

Studies supplied by the manufacturer evaluated 275 patients using both the NEBA system and other standard protocols for diagnosing ADHD which include behavioral questionnaires, behavioral and IQ testing and physical exams.

An independent review found the device "aided clinicians in making a more accurate diagnosis of ADHD when used in conjunction with a clinical assessment for ADHD, compared with doing the clinical assessment alone," the FDA said.

The device is made by NEBA Health in Augusta, Georgia.

ADHD is believed to occur in five to 10 percent of US children. A recent analysis of US government data by the New York Times found that as many as one in five teenage boys is diagnosed with the disorder.

A study in the journal Pediatrics last year found a 46 percent rise in ADHD prescriptions from 2002 to 2010.

Monday, July 15, 2013

Children with fever: Researchers distinguish between bacterial from viral infections

Using microarray technology, researchers can distinguish between viral and bacterial infections in children with fever by profiling the activity of genes in a blood sample.

While more research is needed, the new technology could one day help to identify the cause of illness and ensure that children get the right treatment. 

Credit: Robert Boston, Washington University in St. Louis

In children with fever but no other symptoms of illness, it is difficult to know whether a child has a viral infection that will resolve on its own or a potentially serious bacterial infection that requires antibiotics.

Now, researchers at Washington University School of Medicine in St. Louis report that they can distinguish between viral and bacterial infections in children with fever by profiling the activity of genes in a blood sample.

In a small study, analyzing genes in white blood cells was more than 90 percent accurate, far better than the standard diagnostic test, which is only correct about 70 percent of the time.

The research is published July 15 in the Proceedings of the National Academy of Sciences Online Early Edition.

While more work is needed, the study's results support the notion that analyzing the activity of the body's genes in response to childhood infections could help to identify the cause of illness and ensure that children get the right treatment.

Gregory Storch
"It's a common problem that children develop a fever without any apparent cause," says senior author Gregory Storch, MD, the Ruth L. Siteman Professor of Pediatrics and chief of the Division of Pediatric Infectious Diseases at Washington University School of Medicine and St. Louis Children's Hospital.

"Some of these kids have serious bacterial infections that can be life threatening, but the largest number have viral infections. The trouble is, from a practical standpoint, it's hard to know which is which."

As a precaution, many children who have a fever without an apparent cause are treated with antibiotics even though the drugs don't work against viruses and overprescribing them contributes to antibiotic resistance.

The new study involved 30 children ages two months to 3 years who had fevers above 100.4° F but no obvious signs of illness, like a cough or diarrhea.

Twenty-two of the children were known to have viral infections based on previous extensive genomic testing that is not yet practical to use in a clinic setting, and eight others children had bacterial infections.

But Storch and his colleagues at the university's Genome Institute and the Genome Technology Access Center wanted to know whether a test called a gene expression microarray could identify patterns of gene activity in white blood cells that could discriminate children with viral infections from those with bacterial infections.

White blood cells are the immune system's first line of defense against foreign invaders, and the scientists theorized that they would respond differently to viruses than to bacteria.

The researchers also had access to results of a standard diagnostic test performed when the children initially were evaluated with fevers at St. Louis Children's Hospital.

That test involves analyzing the number of white blood cells in a blood sample. Generally, the counts are elevated for bacterial infections and either low or normal for viral infections.

More information: Storch GA, Crosby SD, Yu J, Hu X. Gene expression profiles in febrile children with defined viral and bacterial infection. Proceedings of the National Academy of Sciences. Online July 15, 2013. www.pnas.org/cgi/doi/10.1073/pnas.1302968110

Saturday, July 13, 2013

Raising adopted children: Supportive Cooperation is more important than sexual orientation

A new study by psychology researchers suggests that whether parents are gay, lesbian or straight, how well they work together as a couple and support each other in parenting is linked to fewer behaviour problems among their adopted children and is more important than their sexual orientation.

Rachel H. Farr at the University of Massachusetts Amherst and Charlotte J. Patterson at the University of Virginia report their findings from this first empirical examination of differences and similarities in co-parenting among lesbian, gay and heterosexual adoptive couples and associations with child behavior in the July/August issue of Child Development.

Farr, who led the study, says, "While actual divisions of childcare tasks such as feeding, dressing and taking time to play with kids were unrelated to children's adjustment, it was the parents who were most satisfied with their arrangements with each other who had children with fewer behaviour problems, such as acting out or showing aggressive behaviour."

"It appears that while children are not affected by how parents divide childcare tasks, it definitely does matter how harmonious the parents' relationships are with each other," she adds.

Farr and Patterson also observed differences in division of labour in lesbian and gay couples compared to heterosexual parents.

Rachel H. Farr
The study suggests that lesbian and gay couples may be creating new ways to live together and raise children outside of traditional gender roles, the authors say, and results are important to adoption professionals and others who work with adoptive families.

Further, the research is informative for those debating legal, political and policy questions about family dynamics and outcomes for children raised by same-sex couples.

For this study, Farr and Patterson recruited families from five adoption agencies across the United States.

In total, 104 families agreed to participate, 25 headed by lesbian partners, 29 by gay male partners and 50 by heterosexual couples.

Their adoptive children had been placed with them at birth or within the first few weeks of life; at the time of the study the children were all around three years old.

Charlotte J. Patterson
Parents were asked to report on the division of child-related labour between them and on factors of their child's adjustment.

They were also observed by researchers who coded their co-parenting behaviour during videotaped parent-child play sessions along scales rated for "supportive" and "undermining" interactions, using an established test.

The researchers discovered that lesbian and gay couples were more likely to equally share childcare tasks, while heterosexual couples were likely to specialise, with mothers doing more work than fathers in these families.

In addition, Farr says, from the videotaped observations of family interactions, "it was clear that other aspects of co-parenting, such as how supportive parents were of each other, or how much they competed, were connected with children's behavioral problems."

Parents' dissatisfaction with division of child-care labour, not the actual division of these tasks, was significantly associated with increased child behavior problems.

As the researchers had expected, supportive co-parenting interactions, such as greater pleasure and engagement between parents, were associated with positive child behaviour for all three types of parents.

Overall, whether parents shared child care tasks or had a more specialized division of this work was not related to children's adjustment.

The best predictor of child behaviour problems was competition between the parents and dissatisfaction with child care labour divisions, which were not related to parents' sexual orientation.

Thursday, July 11, 2013

Obese Fathers pass on Obesity and Metabolic Disorders to their Children

If you are obese and hope to be a father, here's another reason to lose weight: your children and grandchildren may inherit your waistline or metabolic disorders.

That's because scientists have discovered in mice that obese fathers, even those who did not show any signs of diabetes, passed this negative trait on most frequently to their daughters.

Sons don't entirely dodge this genetic bullet either—both sons and daughters of obese fathers have increased risks of developing metabolic diseases, such as diabetes.

"If these findings hold true in humans, then a father's diet and body composition at the time of conception is likely to affect his future child's health and risk of lifelong disease," said Tod Fullston, Ph.D., a researcher involved in the work from the Department of Obstetrics & Gynaecology at the Robinson Institute, Research Centre for Reproductive Health at the University of Adelaide in South Australia.

"Fathers should aim to be as healthy as possible at the time of conception to give future generations the best possible chance of good health."

To make this discovery, Fullston and colleagues used two groups of male mice. One was fed a high-fat diet that resembled a "fast food" diet and the other was fed a nutritious control diet.

When compared to the control group, the group fed the "fast food" diet gained weight and had an increase in fat (obesity) without any indications of diabetes.

The two groups of male mice were then mated to normal weight control diet-fed females to produce first generation mice, which were also mated to normal weight control diet-fed mice to produce the second generation.

Both generations of mouse offspring had metabolic disorders and obesity, with the only difference being their father's/grandfather's diet, although male/female offspring had different health problems.

By comparing small RNA molecules (microRNAs) in sperm from the obese mice as compared to the control mice, researchers deduced that changes in these molecules might be partly responsible for the transmission of these conditions from father to offspring.

This suggests that diet changes the molecular makeup of sperm, which in turn, program embryos and their risk of metabolic and reproductive health problems.

Gerald Weissmann
The research also suggests that these adverse health outcomes may be transmitted into the second generation as well.

"We've known for quite some time that obesity is a serious problem for children of expectant mothers," said Gerald Weissmann, M.D., Editor-in-Chief of The FASEB Journal, "and now we see that obesity is likely a serious problem for children of obese fathers as well. Hopefully as more research emerges to support these findings, future fathers will find ways to slim down, if not for themselves, then for their children and grandchildren."

More information: Tod Fullston, E. Maria C. Ohlsson Teague, Nicole O. Palmer, Miles J. DeBlasio, Megan Mitchell, Mark Corbett, Cristin G. Print, Julie A. Owens, and Michelle Lane. Paternal obesity initiates metabolic disturbances in two generations of mice with incomplete penetrance to the F2 generation and alters the transcriptional profile of testis and sperm microRNA content. FASEB J, doi:10.1096/fj.12-224048

Autism Training program meets 'critical need' for earlier identification

A Vanderbilt research program that trains community pediatricians to diagnose autism within their individual practices may lead to more effective treatment of the disorder that now affects an estimated one in 88 children.

Vanderbilt University Medical Center researchers released today in the journal Autism the results of a three-year study that evaluated the effectiveness of a training program designed to enhance autism spectrum disorder (ASD) identification and assessment within community pediatric settings across Tennessee.

After participating in training to learn strategies for conducting rapid diagnostic assessments following positive ASD screenings, pediatricians reported significant changes in their screening and consultation practices, with 85 percent reporting an increase in numbers of children with autism evaluated within their practice.

The study also found that pediatric providers were nearly as accurate as specialists in their diagnoses, with agreement seen in more than 90 percent of all cases.

"Ideally, definitive early diagnosis of ASD would be rapidly accomplished by a team of developmental specialists, and children at risk for diagnosis would obtain services immediately after screening positive.

Zachary Warren
The reality is that such diagnostic teams, or even individual professionals, are not available in most locations," said corresponding author Zachary Warren, Ph.D., associate professor of Pediatrics, Psychiatry and Special Education and director of the Vanderbilt Kennedy Center's Treatment and Research Institute for Autism Spectrum Disorders (TRIAD) at Vanderbilt University.

"Even when available, the waitlists for diagnostic services are so long that children referred for evaluation wait extended periods of time for diagnosis. As a parent, I cannot fathom how stressful it would be to be told that your child may have autism, and we'll let you know the answer to that question in six to 12 months."

Despite screening initiatives, advocacy efforts and increased public awareness, the most recent Centers for Disease Control and Prevention data regarding autism prevalence suggest that the diagnosis is still not made until 4-5 years of age.

The increased prevalence of autism and documented benefits of early intensive intervention have created a need for flexible systems for obtaining accurate, time-efficient diagnoses, the authors wrote.

"Although the field has made great advances in early screening for autism, the steps taken after a positive ASD screening in community settings are much less clear and often problematic for clinicians, families and systems of care alike," Warren said.

"Essentially, more children are being referred for a very limited number of expert diagnostic assessment resources. Because of this, wide-scale screening for ASD at young ages may in fact increase wait times for diagnostic assessment. Given this context, it is critical to develop enhanced ASD-specific diagnostic training programs if we hope to shift the age of diagnosis and promote earlier access to early intervention."

Amy Swanson
The training was designed to teach enhanced diagnostic consultation and interactive screening procedures to community pediatricians so that they could offer families the opportunity to be rapidly evaluated within practice rather than being referred to a specialty clinic, where they would likely have to wait many months before being seen.

"The findings provide initial evidence suggesting early accurate diagnosis of autism may be possible and appropriate within many community pediatric practices," said Amy Swanson, M.A., TRIAD Research and Training Coordinator and lead author of the study.

"Given the potentially harmful consequences of lengthy waits for comprehensive diagnostic evaluations, the potential impact of such training programs for advanced autism diagnosis within community practice settings could be quite powerful."

Key findings:

  • Community pediatric providers were more likely to conduct independent autism assessments within their practice, rather than referring the child for outside evaluation.
  • Community pediatric providers showed high agreement in ASD classification with expert clinicians.
  • A dramatic shift was seen in pediatric providers' sense of the appropriateness for a child to receive a diagnosis from his or her primary care provider, without or before a comprehensive evaluation.
  • A dramatic shift in the comfort level of discussing ASD diagnoses with caregivers was seen.
  • There was a significant increase in the number of diagnoses made within respective provider practices.


This study builds on pilot findings from 2009 by presenting a more comprehensive evaluation of the training model and utilizing a broader sample of pediatric providers.

Although this training program targeted the state of Tennessee, Vanderbilt's research team has also provided this training in several other states and presented the model to the Society for Developmental and Behavioural Pediatrics.

Bilingual Children have a Two-track Mind

Skott Freedman
Adults learning a foreign language often need flash cards, tapes, and practice, practice, practice. Children, on the other hand, seem to pick up their native language out of thin air.

The learning process is even more remarkable when two languages are involved.

In a recent study examining how bilingual children learn the two different sound systems of languages they are acquiring simultaneously, Ithaca College faculty member Skott Freedman has discovered insights that indicate children can learn two native languages as easily as they can learn one.

"At first glance, the process of learning a language can seem incredibly daunting," said Freedman, an assistant professor of speech language and pathology and audiology.

"Environmental input presented at a fairly rapid rate must be mapped onto detailed representations in the brain. A word's meaning, sounds, and grammatical function all must be extracted from the incoming speech stream. Yet this potentially arduous task is typically executed with little effort by children barely a year old. In fact, studies show that children can learn a word in as little as one exposure."

But how complex is the process when a child grows up learning two languages?

"It has commonly been debated whether a bilingual child has one large set of sounds from both languages or, conversely, two separate sound systems," Freedman said.

"A way of testing this theory is to measure a child's language productions in both languages using some measure of complexity and then comparing the two languages."

Freedman's study measured complexity in terms of the word shape, such as the presence of word-final consonants and consonant clusters.

He also measured the degree to which the children could approximate their languages. For example, if a child said "tar" for the word "star," he or she produced three of four possible sounds, therefore approximating the word with 75 percent accuracy.

"A hypothesis proposed several years ago predicts that, though bilingual children may differ in their productions between languages, they will nevertheless maintain a similar level of overall approximation," Freedman said.

"The hypothesis was confirmed in a study using an English-Hungarian bilingual child, but no study to date has tested the hypothesis in Spanish, the fastest-growing language in the United States."

Freedman's study compared the language productions of five English-Spanish bilingual children during a picture-naming task to the productions of five English-only and five Spanish-only speaking children.

The results confirmed the hypothesis, with some added insights.

"While bilingual children produced more complex forms in Spanish than in English, they nonetheless approximated English and Spanish to the same degree. Perhaps while learning a language, some inner algorithm determines how much one needs to articulate in order to be understood regardless of the different kinds of sounds between languages. Otherwise, children should have been more easily understood in Spanish."

In addition, Freedman found that no production differences emerged between the bilingual children and their monolingual counterparts in English or Spanish, indicating a sufficient amount of independence between a bilingual child's two sound systems.

"Bilingual children manage not only to learn two sets of words at one time and keep these two systems separate, they even keep the two sound systems separate," Freedman said.

"This result makes a case against not exposing children to more than one language at birth because they might be confused or overwhelmed."

The results of Freedman's study were published in the December 2012 issue of the International Journal of Bilingualism.

Drinking Problems have roots in early childhood

Danielle Dick
Most risk and protective factors for alcohol use have roots in early childhood.

In other words, an individual enters adolescence with personality characteristics and life experiences that have accumulated during the first decade of life.

An evaluation of measures of temperament from children six months through to five years of age has found that childhood temperament prior to age five predicts adolescent alcohol use and problems at age 15.5 years, even after controlling for socio-demographic factors and parental alcohol problems.

Results will be published in the December 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Most scientists who study alcohol use start studying people in adolescence, since that is when alcohol use is usually first initiated/experimented with," explained Danielle Dick, associate professor of psychiatry, psychology and human and molecular genetics with the Virginia Institute for Psychiatric and Behavioural Genetics at Virginia Commonwealth University.

"But people don't enter adolescence as blank slates; they have a history of life experiences that they bring with them, dating back to early childhood. This is one of the most comprehensive attempts to understand very early childhood predictors of adolescent alcohol use in a large epidemiological cohort."

Matt McGue
"A question largely unanswered by the existing literature concerns the origins of personality differences in adolescents or adults who do and do not have drinking problems," added Matt McGue, Regents Professor in the department of psychology at the University of Minnesota.

"In my opinion, the major contribution of the current study is that it shows that these personality differences emerge very early in life."

"All things considered," said Dick, "it's not just 'problem kids' who get involved in alcohol use. It's also the highly sociable kids as well. Parents should be aware of this."

Read the full article here

Autism: Six apps to help children learn

With reports of autism among children continuing to rise at a meteoric rate, it's hardly surprising that scores of apps have been developed to help these kids cope, academically and socially.

Many of the apps, used primarily on iPads and other tablets, help children process information as well as social cues through games and instant audio rewards, such as clanging bells and applause.

Others are designed to give parents and teachers tools to recognize behavioural patterns and schedule and coordinate care.

"I'm a big fan of these tablets," noted autistic activist Temple Grandin told reporters.

Debbie Drennan
"Especially with nonverbal individuals, kids can type and the print appears right there on the screen, versus a computer where the keyboard and printed words are further apart. That's a huge advantage."

Debbie Drennan, an assistive technology specialist with Parents Helping Parents in San Jose, Calif., demonstrated some of her favourite apps, for both autistic kids and their parents:

BITSBOARD: Bitsboard helps kids with both literacy and emotional enrichment, using brightly colored flashcards and pop quizzes to teach them vocabulary as well as how to recognize visual cues in photos of people.

The app is "great for anyone on the autism spectrum, because it helps kids learn vocabulary using real objects in a consistent and repetitive way," Drennan said. "So they can touch that picture 100 times and nobody cares."

For social cues, kids can call up "Emotions," then click on people whose faces show anger, disgust or boredom. By familiarizing children with these common expressions, the kids will be more comfortable when they see them in real life and perhaps not look away, as autistic kids often do when confused by social stimuli.

MODEL ME GOING PLACES: This app uses "video modeling," in which a parent-created clip can virtually take an autistic child to a place before they actually go there.

"Having someone on the (autism) spectrum do a new task or go to a new place, like the dentist office, can be very scary for the child," Drennan said.

"This app uses video-modeling or what we call 'front-loading' to show them the place before they go and teach them how they should react once they get there."

On a visit to the "Hairdresser," slides show a young boy and his mom walking into a barbershop, while the audio and on-screen text say things like

"I'm getting a haircut." One slide has the boy saying, "This feels good," a nice warm-up for the first real-time visit to get a haircut.

AURASMA: Using an augmented-reality platform, Aurasma's image-recognition technology allows users to create their own augmented-reality interactions.

Drennan says the software's perfect for helping older autistic children master increased independence from their parents.

She uses the office speaker phone for a demo: Point the iPad at the phone. Record a short video explaining how the device is used. Name the demo. Then snap a photo of the phone for the image-recognition software to recognize.

Now for the fun part: As the child walks around the house, pointing the tablet briefly at an item, the corresponding video tutorial magically pops up.

AUTISM TRACKER LITE: Drennan said one of the greatest challenges for parents of an autistic child with flawed communication skills is knowing what's bugging the child when he or she's having a bad day.

"They can't tell you why they're upset," she said, "but this app helps monitor their behavior and with its feedback can help identify what could be the cause of the stress they're feeling."

Using several tools in the app to describe the child's "Happiness" - "Not at all," "Just a little," or "Somewhat," for example - as well as his activity level and even the weather outside, the Tracker lets a parent chart a kid's behaviour across a period of time.

Often, Drennan said, a pattern will emerge to indicate what might be causing a child to act out. For example, a child may show signs of stress at the beginning of each week, or after a change in diet, or even during certain types of weather.

VISUAL SCHEDULE PLANNER: A fully customizable, cleanly designed audiovisual scheduler and calendar, this app helps the parents of autistic kids who need a clearly defined path through their days.

"This app," Drennan said, "makes everyone's lives easier. It helps both you and the child, because you can add photos to calendars so scheduled activity that day is easy to understand. A photo of an ATM on Monday morning, for example, tells the child that that's when they'll go visit the bank."

The parent shows the child the day's events or what's coming later that week, so the ATM image might be followed by a lunch or shopping icon of some kid.

This way, she said, "the kids can see clearly what's going to happen to them each day, removing a lot of the stress that comes from any sort of confusion."

CARE CIRCLES: This app can be a godsend for those watching after autistic children. They create an account, then regularly update it by entering notes on medications, doctor-visit reports, even behavioural observations, sharing it all with their team of care providers.

"This way, everyone can share, in real-time, what's going on with the child," Drennan said. "So you know, for example, that he didn't have a snack at school or didn't go to the library that day like you thought he would. Everyone knows everything and there are no surprises, which decreases confusion and anxiety among everyone."