Thursday, August 29, 2013

Autism ASD: Researchers discover a potential cause

Topoisomerase inhibitors reduce the expression of long genes in neurons, including a remarkable number of genes implicated in Autism Spectrum Disorders -- 200 kb is four times longer than the average gene. 

Credit: Concept: Mark Zylka. Illustration: Janet Iwasa.

Problems with a key group of enzymes called topoisomerases can have profound effects on the genetic machinery behind brain development and potentially lead to autism spectrum disorder (ASD), according to research announced today in the journal Nature.

Scientists at the University of North Carolina School of Medicine have described a finding that represents a significant advance in the hunt for environmental factors behind autism and lends new insights into the disorder's genetic causes.

"Our study shows the magnitude of what can happen if topoisomerases are impaired," said senior study author Mark Zylka, PhD, associate professor in the Neuroscience Center and the Department of Cell Biology and Physiology at UNC.

"Inhibiting these enzymes has the potential to profoundly affect neurodevelopment—perhaps even more so than having a mutation in any one of the genes that have been linked to autism."

The study could have important implications for ASD detection and prevention.

Mark Zylka
"This could point to an environmental component to autism," said Zylka.

"A temporary exposure to a topoisomerase inhibitor in utero has the potential to have a long-lasting effect on the brain, by affecting critical periods of brain development. "

This study could also explain why some people with mutations in topoisomerases develop autism and other neuro-developmental disorders.

Topiosomerases are enzymes found in all human cells. Their main function is to untangle DNA when it becomes overwound, a common occurrence that can interfere with key biological processes.

Most of the known topoisomerase-inhibiting chemicals are used as chemotherapy drugs. Zylka said his team is searching for other compounds that have similar effects in nerve cells.

"If there are additional compounds like this in the environment, then it becomes important to identify them," said Zylka.

"That's really motivating us to move quickly to identify other drugs or environmental compounds that have similar effects—so that pregnant women can avoid being exposed to these compounds."

Zylka and his colleagues stumbled upon the discovery quite by accident while studying topotecan, a topoisomerase-inhibiting drug that is used in chemotherapy.

Investigating the drug's effects in mouse and human-derived nerve cells, they noticed that the drug tended to interfere with the proper functioning of genes that were exceptionally long—composed of many DNA base pairs.

The group then made the serendipitous connection that many autism-linked genes are extremely long.

"That's when we had the 'Eureka moment,'" said Zylka. "We realized that a lot of the genes that were suppressed were incredibly long autism genes."

Of the more than 300 genes that are linked to autism, nearly 50 were suppressed by topotecan. Suppressing that many genes across the board—even to a small extent—means a person who is exposed to a topoisomerase inhibitor during brain development could experience neurological effects equivalent to those seen in a person who gets ASD because of a single faulty gene.

The study's findings could also help lead to a unified theory of how autism-linked genes work. About 20 percent of such genes are connected to synapses—the connections between brain cells.

Another 20 percent are related to gene transcription—the process of translating genetic information into biological functions.

Zylka said this study bridges those two groups, because it shows that having problems transcribing long synapse genes could impair a person's ability to construct synapses.

"Our discovery has the potential to unite these two classes of genes—synaptic genes and transcriptional regulators," said Zylka.

"It could ultimately explain the biological mechanisms behind a large number of autism cases."

More information: Nature paper dx.doi.org/10.1038/nature12504

Wednesday, August 28, 2013

Medikidz: Comic books to help children understand chronic pain

Comic book superheroes are being used to help children understand more about older relatives suffering from chronic pain, in an innovative project. 

Northumbria University academic Dr Derek Jones has been working on a project led by Teesside University Professor Denis Martin to explore how comic book superheroes can help children understand what an older adult with chronic pain is experiencing.

The research project, also involving colleagues from the universities of Dundee, Aberdeen, and Greenwich, has seen the academics work with Medikidz – an international company which produces award-winning comics featuring Marvel-inspired superheroes to put medical information into plain words which children can understand – to create a comic book about chronic pain.

The comic is one of the products from a collaboration between the university partners in the UK Research Council-funded £1.2 million EOPIC (Engaging with Older People and Their Carers to Develop Interventions for the Self-management of Chronic Pain) Project.

Dr Derek Jones, Senior Lecturer in Occupational Therapy at Northumbria University, said: "Education about pain is really important; it is increasingly recognised that explaining to people the biological processes underlying their experience results in better pain management.

"We will be carrying out research to investigate the value of the Medikidz comic book; from what we have been told so far we think it will prove to be helpful to anyone who comes into contact with someone with chronic pain."

Professor Martin, from Teesside University, said: "The idea for the comic came about as we were talking to older people to find out their ideas on how to improve the lives of older people living with chronic pain."

"We learned that there was a need to help grandchildren to better understand the experiences of a grandparent living with chronic pain."

"It can be difficult for a child to understand because they can't see the pain which is making their grandparent miserable and feeling unable to do day-to-day things. We wanted to use that information to develop a product which would help younger relatives understand what the older person is going through, given the lack of information available to help that communication."

Medikidz already produces material to explain to children about their own medical conditions, but working with the EOPIC team, they focused on material to inform a child about the older relative's condition.

The book, entitled 'What's Up with Moira's Grandad: Medikidz Explains Chronic Pain', portrays a typical scenario, which involves a child not understanding why their grandparent has suddenly cancelled time they'd planned to spend with them.

The child is left upset, thinking the grandparent simply isn't bothered - while the grandparent is frustrated and angry at having felt forced to cancel due to difficulty in coping with chronic pain.

The EOPIC team provided the information and outline of the story to Medikidz, who adapted it to use their superheroes to tell the story.

In the story the child is taken on a journey through the human body, with the Medikidz superheroes explaining about chronic pain and how it impacts on someone's life. The happy conclusion shows the child with a better understanding of their grandparent's situation.

The team now plans to distribute the comics to clinics across the region initially and then to expand nationally and further afield.

Fetal Alcohol Spectrum Disorders (FASD) - South Africa study

Two recently published studies report prevalence data about fetal alcohol spectrum disorders (FASD) in South Africa and find that negative consequences of prenatal exposure to alcohol may be lessened if a child is provided with adequate nutrition and appropriate cognitive and behavioral stimulation in his or her first seven years of life.

Dr. Philip A. May
Dr. Philip A. May, faculty member at the University of North Carolina's Nutrition Research Institute (NRI), research professor of nutrition at the Gillings School of Global Public Health and Principal Investigator at the University of New Mexico's Center on Alcoholism, Substance Abuse, and Addictions (CASAA), is lead author of both papers.

At the NRI, May is conducting a comprehensive study of South African mothers and their children who are affected by FASD.

The work is funded through a $5.3 million grant from the National Institutes of Health's National Institute on Alcohol Abuse and Alcoholism.

The study, titled "Approaching the Prevalence of the Full Spectrum of Fetal Alcohol Spectrum Disorders in a South African Population-Based Study," appeared in the May issue of Alcoholism: Clinical and Experimental Research.

"This is the first population-based study of the prevalence of FASD to diagnose a significant number of alcohol-related disabilities, which are at the mild end of the continuum," Dr. May said of the study.

Employing newly refined diagnostic criteria, the researchers were able to better indicate the scope of the problem.

"There is evidence of advances in diagnosis of the milder effects of alcohol exposure in the prenatal period," Dr. May said. "The rate of FASD is greater than we ever thought in human populations."

In "Maternal Factors Predicting Cognitive and Behavioral Characteristics of Children with Fetal Alcohol Spectrum Disorders," which appeared in the Journal of Developmental and Behavioral Pediatrics in June, May and his colleagues found evidence that good health and nutrition of the pregnant mother provides her child with an advantage for cognitive and behavioral development by age seven.

"In the first seven years of life environmental advantages of cognitive and behavioral stimulation and adequate nutrition can, in many cases, serve to minimize any negative consequences of prenatal alcohol exposure on the children's social, behavioral, and intellectual functioning," May said.

The NIAAA grant is funding a study for children as young as 12 months to improve their development with nutritional supplements and a regimen of cognitive and behavioral interventions.

"There is hope that a good postnatal environment in the early years of life can mitigate some, if not most, of the damage that occurs from alcohol exposure in the prenatal period," May said.

Conclusions
High rates of specific diagnoses within FASD were well documented in this new cohort of children. FASD persists in this community. The data reflect an increased ability to provide accurate and discriminating diagnoses throughout the continuum of FASD.

More informationApproaching the Prevalence of the Full Spectrum of Fetal Alcohol Spectrum Disorders in a South African Population-Based Study

Childhood Obesity: Schools can help by serving up better, healthier options

Schools across the country are taking several steps to fight obesity by providing healthier foods, according to a new report from the Centers for Disease Control and Prevention.

The CDC's 2012 School Health Policies and Practices Study (SHPPS) surveyed more than 800 school districts in all 50 states and the District of Columbia, finding a significant trend in prohibiting junk foods and some positive steps in getting students more active.

The report was applauded by Voices for Healthy Kids movement, a joint initiative of the American Heart Association and the Robert Wood Johnson Foundation that works to ensure schools provide an environment that encourages healthy eating.

"Everyone want children to grow up healthy," says Jill Birnbaum, executive director for Voices for Healthy Kids at the American Heart Association.

"As schools serve up better options and keep ads for junk food and sugary drinks out of their schools, kids will be better fueled to learn."

Several school settings improved at prohibiting junk food , according to the report:

  • A la carte offerings at breakfast and lunch improved from 23.1 percent of schools banning junk food in 2000 to 41.7 percent in 2012. 
  • Vending machines improved from 4.1 percent to 43.4 percent.
  • School stores improved from 3.9 percent to 28.3 percent.
  • And in after-school programs improvement went from 7.3 percent to 21.4 percent.

Some districts required (9.6 percent) or recommended (32.3 percent) that schools make fruits or vegetables available to students whenever other food is offered or sold.

Additionally, more school districts (26 percent) required the availability of healthy beverages, such as water or low-fat milk, during school events and in their stores.

There is a clear need to continue on the path to making healthy choices easier for children throughout the school day, Birnbaum said.

The marketing of unhealthy food to students remains a problem, Birnbaum said. The report found that only 38.3 percent of school districts prohibit advertisements for junk foods or fast food restaurants on school property.

State departments of education play a key role in providing their school districts with model policies and technical assistance.

Whereas almost all states and the District of Columbia helped school districts increase access to free water, only 76.5 percent assisted schools in limiting student access to less nutritious food and beverages.

As for physical activity, many schools have made promising advances, the report found. However, Birnbaum said, there is room for significant improvement.

Most schools require physical education be taught at all grade levels, however very few require the national recommendations of 150 minutes per week for elementary and middle schools and elementary schools and 225 minutes per week for high school students.

Additionally, only 58.9 percent of districts require scheduled recess in elementary schools and a mere 10.8 percent require a break for physical activity in middle schools.

More school districts (61.6 percent) also have formal agreements that allow another organization to use their facilities.

"Sharing recreational spaces allows both children and adults to get the exercise they need to be healthy by providing a place to be active in their community," Birnbaum said.

"Research has shown that people who have parks or recreational facilities nearby exercise 38 percent more than those who do not have easy access."

Monday, August 26, 2013

Preschoolers who stutter do just fine emotionally and socially

Stuttering may be more common than previously thought, but preschool stutterers fair better than first thought, a study by The University of Melbourne, Murdoch Childrens Research Institute and The University of Sydney has found.

A study of over 1600 children, which followed the children from infancy to four years old, found the cumulative incidence of stuttering by four years old was 11 per cent, more than twice what has previously been reported.

However, the study refutes the long held view that suggests developmental stuttering is associated with a range of poorer outcomes in the preschool period.

Interestingly, the study found the reverse was true, with stuttering associated with better language development, non-verbal skills with no identifiable effect on the child's mental health or temperament at four years old.

Surprisingly, researchers found that recovery from stuttering was low, 6.3 per cent, 12 months after onset.

Rates of recovery were higher in boys than girls, and in those who did not repeat whole words at onset than those who did. The study boys were more likely to develop stuttering.

Sheena Reilly
Lead researcher, Professor Sheena Reilly said parents could be happy in knowing that they can take a 'watch and wait' approach to their child's stuttering and it won't be causing harm to their child's language skills or social and emotional development.

"Current best practice recommends waiting for 12 months before commencing treatment, unless the child is distressed, there is parental concern, or the child becomes reluctant to communicate. It may be that for many children treatment could be deferred slightly further," she said.

"Treatment is effective but is intensive and expensive, this watchful recommendation would therefore help target allocation of scarce resources to the small number of children who do not resolve and experience adverse outcomes, secure in the knowledge that delaying treatment for a year or slightly longer has been shown not to compromise treatment efficacy."

Due to the low rates of recovery in the study, researchers were unable to determine what predicts which kids will recover from stuttering, but say this will be the focus of research moving forward.

The study was published in Pediatrics.

More links seen between autism, ADHD

Kids with attention-deficit/hyperactivity disorder (ADHD) are 20 times more likely to exhibit some traits of autism than children without ADHD, according to a new study.

Joseph Biederman
One of every five ADHD kids in the study exhibited signs of autism such as slow language development, difficulty interacting with others and problems with emotional control, said study co-author Dr. Joseph Biederman, director of the pediatric psycho-pharmacology unit at Massachusetts General Hospital.

These kids also showed problems with "executive function," or the ability to plan, organize and conceptualize future action, said Biederman, a professor of psychiatry at Harvard Medical School.

Fewer than 1 percent of kids in the non-ADHD comparison group exhibited any traits linked to autism, according to the study appearing in the September issue of Pediatrics.

"These children are not having the full diagnosis of autism, but they have symptoms of autism," Biederman said.

"It may be important to screen children with ADHD for autistic traits because they may need more support, particularly in the educational and interpersonal domains."

Alice Mao
Previous studies of children with autism have found that many also have severe ADHD symptoms. This is one of the first studies to turn the tables and see if the reverse is true, said Dr. Alice Mao, an associate professor of psychiatry at Baylor College of Medicine. She was not involved with the study.

"Generally, autistic kids with ADHD are challenging to treat because they don't respond well to ADHD medications," Mao said. "You have to treat the autism symptoms and then treat the ADHD.

The conclusion would be that perhaps we should screen these ADHD kids who are not doing well on traditional ADHD treatments to see if they have comorbid autism traits."

The study included 242 kids aged 6 to 18 with ADHD as well as a 227-member "control" group of kids without ADHD.

The children were drawn from an existing large-scale sample pool that excluded any kids who had been diagnosed with autism.

The children and their parents filled out a series of questionnaires to grade their behaviour and compare it to generally accepted definitions of autistic traits.

The researchers found that 18 percent of kids with ADHD exhibited some behaviors that are common in autism, compared with 0.87 percent of kids from the control group.

The ADHD children with autistic traits had many more social problems than typical ADHD children.

They were more likely to fight with and be rejected by other kids, and displayed more school behaviour problems, more difficulties using their spare time and more friction with their siblings, the study authors noted.

The children with both ADHD and autistic traits also tended to more frequently suffer additional psychiatric and learning disorders than either kids with only ADHD or children in the control group.

"Those with autism traits have greater severity of symptoms and dysfunction," Mao said.

"Certainly it would be useful to screen kids with ADHD who have autism traits to see which kids may need more help socially, as well as to make sure they don't have lower intellectual functioning."

"You may be able to give other treatments that would be helpful in terms of improving their functioning."

These findings, along with previous research, point to the strong possibility that ADHD and autism share some genetic link, study author Biederman said.

"The genetic markers for ADHD have also been associated with autism," he said.

"These autistic traits may be present in other conditions as well. I am quite convinced that these traits may be present in children with mood and anxiety disorders."

Thursday, August 22, 2013

Depression in Grandmothers who care for Grandchildren

Grandmothers who care for their grandkids fulltime need help for depression and family strains, report researchers from the Case Western Reserve University's Frances Payne Bolton School of Nursing.

Carol Musil, PhD, RN, FAAN, professor of nursing, recently conducted one the longest-running studies on grandmothers in various family situations, from serving as their grandkids' fulltime caregivers to those not caring for their grandchildren as a comparison.

"Although we expected the primary caregiver grandmothers raising grandchildren would have more strain and depressive symptoms, " Musil said, "we were surprised at how persistent these were over the years examined in the study."

Results of the study, funded by a grant from the National Institute of Nursing Research, were reported in Nursing Outlook, the journal of the American Academy of Nursing and the Council for the Advancement of Nursing Science.

Some 6.2 million, or 5.3 percent of all U.S. households, have a grandparent living in the house, according to U.S. Census data.

Musil said over 1 million grandmothers are responsible for raising grandchildren whose parents do not live in the home.

Musil tracked and focused on the health and wellbeing of 240 grandmothers they studied for 6 1/2 years to see how the responsibilities of caring for their grandchildren 16 years and younger affected their health over time.

The subjects were surveyed about their physical and mental health annually for the first three years, and two more times, 2- 2 ½ years apart at the end of study.

The grandmothers, who averaged 57.5 years old at study onset, were in three caregiving situations: those who are fulltime caregivers for their grandchildren, living in multigenerational homes or non-caregivers.

They were randomly selected throughout Ohio, representing rural, suburban and urban backgrounds.

Despite the signs of depression and family stress, researchers also found that the grandmothers, especially those raising grandchildren, were generally open to receiving various forms of help.

That implies, Musil said, that grandmothers might be open to resourcefulness training, which has helped to reduce depressive symptoms in grandmothers in pilot studies conducted with Jaclene Zauszniewski.

"They need support from others," she said, "but the most important thing is to maintain and perhaps develop new cognitive and behavioral skills and approaches for handling some very challenging family issues."

Boys suffer from their fathers' absence and long working hours

Fathers' extremely long working hours can be detrimental to their sons´ wellbeing.

This is the key finding of a longitudinal study by Jianghong Li (senior researcher at the WZB Berlin Social Science Center) and four Australian co-authors, published in the Journal of Marriage and Family.

The longitudinal study is based on data of more than 1,400 children in Western Australia. Around 19 percent of Western Australian fathers work 55 or more hours per week when their children are 5 years of age.

Almost 20 percent of Australian fathers work so long when their children are 8 years old.

Boys whose fathers worked 55 or more hours per week later exhibited more delinquent and aggressive behaviours than boys whose fathers worked fewer hours.

Their fathers' long work hours did not appear to affect girls' behaviours.

Mothers' work hours did not seem to matter, although few Australian mothers worked long hours and no firm conclusions can be drawn yet from this comparison.

The culture of working long hours which has crept into many jobs in the new economy should be the next policy frontier.

In Germany 15 percent of fathers of children with similar age (3-4) work 55 or more hours per week in 2011.

The data come from the cohort study called "Western Australian Pregnancy Cohort Study" well-known under the name Raine Study. The Study has been following children from pregnancy to adulthood.

More information: Johnson, S. et al. Mothers' and Fathers' Work Hours, Child Gender and Behavior in Middle Childhood. Journal of Marriage and Family, 2013, 75: 56-74.

Antipsychotic drug use in children for mood, behaviour disorders increases type 2 diabetes risk

Prescribing of "atypical" antipsychotic medications to children and young adults with behavioral problems or mood disorders may put them at unnecessary risk for type 2 diabetes, a Vanderbilt University Medical Center study shows.

Young people using medications like risperidone, quetiapine, aripiprazol and olanzapine led to a threefold increased risk of developing type 2 diabetes within the first year of taking the drug, according to the study published Aug. 21 in the journal JAMA Psychiatry.

Wayne A. Ray
While other studies have shown an increased risk for type 2 diabetes associated with the use atypical antipsychotic medications, this is the first large, well-designed study to look at the risk in children, said Wayne A. Ray, Ph.D., professor of Preventive Medicine, and senior author of the study.

The authors note the use of these drugs for non-psychosis-related mood, attention or behavioral disorders in youth/children now accounts for the majority of prescriptions.

"Because we wanted to address this question of risk for indications for which there were therapeutic alternatives, we deliberately excluded those taking antipsychotics for schizophrenia and other psychoses; thus, our entire sample consisted of patients for whom there were alternatives to antipsychotics," Ray said.

State-provided, de-identified medical records were examined for TennCare youths ages 6-24 from 1996 through 2007.

During that time children and youth who were prescribed treatment with atypical antipsychotics for attention, behavioral or mood disorders, were compared with similar youth prescribed approved medications for those disorders.

Even with the further elimination of certain disorders that are commonly associated with diabetes, like polycystic ovarian syndrome, those taking antipsychotics had triple the risk of developing type 2 diabetes in the following year, with the risk increasing further as cumulative dosages increased.

The increased risk persisted for at least a year after the medications were stopped.

Ray and his colleagues point out developing type 2 diabetes is still rare in this age group. Of the nearly 29,000 children and youth in the antipsychotic medication group and 14,400 children in the control group, 106 were ultimately diagnosed and treated for type 2 diabetes.

"That's why this study had to be so large, in order to detect clinically meaningful differences in the risk of type 2 diabetes, a relatively uncommon, but serious condition for children and youth," Ray said.

The take-away message for providers, said Ray, is to carefully examine alternatives to antipsychotic use.

"This is particularly important for high-risk children, for example, those with elevated weight. Children should be monitored carefully for metabolic effects predisposing them to diabetes, and use of the drug should be at the lowest possible dose for the shortest possible time," he said.

More Information:  Antipsychotics and the Risk of Type 2 Diabetes Mellitus in Children and Youth -

Monday, August 19, 2013

Giving preschoolers choice increases sharing behaviour

Getting kids to share their toys is a never-ending battle, and compelling them to do so never seems to help.

New research suggests that allowing children to make a choice to sacrifice their own toys so they can share with someone else, makes them share more in the future.

The new findings are published in Psychological Science, a journal of the Association for Psychological Science.

Nadia Chernyak
These experiments, conducted by psychological scientists Nadia Chernyak and Tamar Kushnir of Cornell University, suggest that sharing when given a difficult choice leads children to see themselves in a new, more beneficent light.

Perceiving themselves as people who like to share makes them more likely to act in a prosocial manner in the future.

Previous research has shown that this idea – as described by the over-justification effect—explains why rewarding children for sharing can backfire.

Children come to perceive themselves as people who don't like to share since they had to be rewarded for doing so. Because they don't view themselves as "sharers" they are less likely to share in the future.

Chernyak and Kushnir were interested in finding out whether freely chosen sacrifice might have the opposite effect on kids' willingness to share.

"Making difficult choices allows children to infer something important about themselves: In making choices that aren't necessarily easy, children might be able to infer their own prosociality."

Tamar Kushnir
To test this, the researchers introduced 3-5 year-old children to Doggie, a puppet, who was feeling sad.

Some of the children were given a difficult choice: Share a precious sticker with Doggie, or keep it for themselves.

Other children were given an easy choice between sharing and putting the sticker away, while children in a third group were required by the researcher to share.

Later on, all the children were introduced to Ellie, another sad puppet.

They were given the option of how many stickers to share (up to three).

The kids who earlier made the difficult choice to help Doggie shared more stickers with Ellie.

The children who were initially confronted with an easy choice or who were required to give their sticker to Doggie, on the other hand, shared fewer stickers with Ellie.

"You might imagine that making difficult, costly choices is taxing for young children or even that once children share, they don't feel the need to do so again," Chernyak says.

"But this wasn't the case: Once children made a difficult decision to give up something for someone else, they were more generous, not less, later on."

Another experiment supported these findings, illustrating that children are more generous after choosing to share valuable toy frogs compared to non-valuable ripped pieces of paper.

Those who initially shared the frogs with Doggie shared more stickers with Ellie later on. Those who readily shared the paper, on the other hand, shared fewer stickers with Ellie.

Therefore, children did not benefit from simply choosing to give something up, but rather from willingly choosing to give something up of value.

"Given the high amount of emphasis we place on choice during early childhood, especially in this culture, it is important to delineate specifically what choice might do—and not do—for young children," Chernyak says.

"Children are frequently taught to share, be polite, and be kind to others. To bring us closer to one day figuring out how to best teach children these skills, it is important to figure out which factors may aid in young children's sharing behaviour," Chernyak concludes.

"Allowing children to make difficult choices may influence their sharing behaviour by teaching them greater lessons about their abilities, preferences, and intentions towards others."

Sunday, August 18, 2013

Preferred Play for Children With Autism

Pushing the arms of the windmill and watching them spin was among the play options enjoyed by children with autism spectrum disorder. Credit: Buffalo State

Play is critical to children's development, including children with autism spectrum disorders (ASD).

Kathy Ralabate Doody, assistant professor of exceptional education at SUNY Buffalo State, observed different play options to determine those most likely to appeal to children with ASD.

The findings were published in the North American Journal of Medicine and Science.

"Children with ASD chose to engage in play that provided strong sensory feedback, cause-and-effect results, and repetitive motions," said Doody.

One novel aspect of the research, conducted by Doody with Jana Mertz, program coordinator at the Autism Spectrum Disorder Center at the Women & Children's Hospital of Buffalo, was that the children with ASD could freely select their preferred activities.

The research was conducted at a monthly event, "Au-some Evening," at Explore & More, a children's museum with exhibits that are designed to engage children through play. The event is open to children with ASD, their families, and their guests.

Kathy Ralabate Doody
The most popular activity among children with ASD was the exhibit "Climbing Stairs." Children who climbed a short staircase could then drop a ball and watch it descend.

Another popular activity involved a windmill. Children can push its arms, causing it to spin. A table filled with rice completed the top three exhibits among children with ASD.

In addition to the well-known senses of sight, smell, touch, taste, and hearing, Doody described others, including the vestibular and proprioceptive senses.

The vestibular sense helps us keep our balance and know where we are in space; proprioception has to do with the way our joints respond to movement and pressure.

"It's the sense that makes deep-tissue massage pleasurable," she said. Children with ADS preferred activities that involved the vestibular and proprioceptive senses as well as other senses.

"Children with ADS sometimes tend to crave motion, and if they can't be moving, they like to look at moving objects," said Doody, noting that motion engages the vestibular, proprioceptive, and visual senses.

"So just watching the windmill engaged them. When the windmill turned in response to their push, it also provided cause-and-effect play. And the repetition of the spinning movement provided a third level of satisfaction."



Climbing the stairs also satisfied multiple senses. Playing with rice provided both tactile and visual stimulation as children felt and watched the rice pour through their fingers.

By knowing the kind of play that children with ASD prefer, educators and clinicians can use such play as positive reinforcement in educational and treatment settings.

"This information is especially helpful for children with ASD who have difficulty communicating their preferences," said Doody.

Parents can also benefit from the information. "A child who is playing alone is developing a degree of independence," said Doody, "and that can enable the parent or caregiver to engage in other activities, like making dinner or attending to another child. "

"Parents might use a snow globe so the child can observe movement. Aquariums or water sculptures provide movement, too."

Some of the behaviours exhibited by people with autism -- hand-flapping, for example -- may reflect a need for sensory stimulation. "Sometimes just giving a child a string of Mardi Gras beads to swing and watch will help the child sit still," said Doody.

Toys that provide sensory stimulation -- sounds, movement, or lights -- in response to an act such as pushing a button also may be well-received. However, Doody noted, the need for, and tolerance of, sensory stimulation varies by individual.

At Explore & More, children with ADS tended to avoid the exhibits that required pretending, such as imagining oneself as a butterfly or as a cook in a play kitchen.

Doody explained that pretending requires a phenomenon called Theory of Mind, which is the ability to imagine oneself in the place of another.

"That develops much earlier in children with typical development than in children with autism, if they develop it at all," said Doody.

Doody hopes that options for children with ASD will be built into a variety of recreational facilities, after-school programs, and playgrounds. The benefit is not only inclusion.

"It also encourages social interaction between children with ASD and their peers," said Doody. "Some children with ASD are academically successful, but they struggle in social situations. So opportunities to play with their peers are really valuable."

Journal Reference: Kathy Ralabate Doody, Jana Mertz. Preferred Play Activities of Children with Autism Spectrum Disorder in Naturalistic Settings. North American Journal of Medicine and Science, 2013 DOI: 10.7156/najms.2013.0603128

Preschoolers Inability to Estimate Quantity Relates to Later Maths Difficulties

Preschool children who showed less ability to estimate the number of objects in a group were 2.4 times more likely to have a later mathematical learning disability than other young people. 

Credit: © iryf / Fotolia

Preschool children who showed less ability to estimate the number of objects in a group were 2.4 times more likely to have a later mathematical learning disability than other young people, according to a team of University of Missouri psychologists.

Parents may be able to help their children develop their skills at approximating group sizes by emphasizing numerals while interacting with young children.

"Lacking skill at estimating group size may impede a child's ability to learn the concept of how numerals symbolize quantities and how those quantities relate to each other," said study co-author David Geary, professor of psychological sciences at MU.

"Not understanding the values numbers symbolize then leads to difficulties in math and problems in school, which our previous studies suggest may be related to later difficulties with employment."

Geary said that parents may be able to improve a child's innate skill at approximating group size and suggested that caregivers draw children's attention to quantities in everyday situations.

For example, after a preschool-aged child completes a series of tasks, a parent can ask the youth how many tasks they completed.

Kristy vanMarle
"Talking to children about how the world can be represented in numbers may help young people develop the ability to estimate the size of a group, which may prepare them for later mathematics education" said co-author Kristy vanMarle, assistant professor of psychological science at MU.

"Asking them 'how many' whenever they encounter a group of objects or images can help them understand that the world can be understood in terms of numbers."

However, the inability to approximate group size was not the only factor related to later math problems.

The MU team also found that preschoolers who lagged behind others in their understanding of the symbolic value of numerals and other related concepts were 3.6 to 4.5 times more likely to show mathematical learning difficulties, which corroborates earlier research by Geary, and extends it to a much younger age.

Doctoral student Felicia W. Chu was the lead author of the study, "Quantitative deficits of preschool children at risk for mathematical learning disability," which was published in the journal Frontiers in Psychology.

"One major reason I came to the University of Missouri was the psychology department's strong reputation for studying children's mathematical education," said Chu.

Geary is Curators' Professor and a Thomas Jefferson Fellow in the Department of Psychological Sciences in MU's College of Arts and Science. vanMarle is the director of MU's Developmental Cognition Lab.

Journal Reference: Felicia W. Chu, Kristy vanMarle, David C. Geary. Quantitative Deficits of Preschool Children at Risk for Mathematical Learning Disability. Frontiers in Psychology, 2013; 4 DOI: 10.3389/fpsyg.2013.00195

Soft Fizzy Drinks Linked to Obesity and Behavioural Problems in Children

Americans buy more soft drinks per capita than people in any other country. 

These drinks are consumed by individuals of all ages, including very young children. 

Image Credit: © sfmthd / Fotolia

Although soft drink consumption is associated with aggression, depression, and suicidal thoughts in adolescents, the relationship had not been evaluated in younger children.

A new study scheduled for publication in the Journal of Pediatrics finds that aggression, attention problems, and withdrawal behaviour are all associated with soft drink consumption in young children.

Shakira Suglia, ScD, and colleagues from Columbia University's Mailman School of Public Health, University of Vermont, and Harvard School of Public Health assessed approximately 3,000 5-year-old children enrolled in the Fragile Families and Child Wellbeing Study, a prospective birth cohort that follows mother-child pairs from 20 large U.S. cities.

Shakira Suglia
Mothers reported their child's soft drink consumption and completed the Child Behaviour Checklist based on their child's behaviour during the previous two months.

The researchers found that 43% of the children consumed at least 1 serving of soft drinks per day, and 4% consumed 4 or more.

Aggression, withdrawal, and attention problems were associated with soda consumption.

Even after adjusting for socio-demographic factors, maternal depression, intimate partner violence, and paternal incarceration, any soft drink consumption was associated with increased aggressive behavior.

Children who drank 4 or more soft drinks per day were more than twice as likely to destroy things belonging to others, get into fights, and physically attack people.

They also had increased attention problems and withdrawal behaviour compared with those who did not consume soft drinks.

According to Dr. Suglia, "We found that the child's aggressive behaviour score increased with every increase in soft drinks servings per day."

Although this study cannot identify the exact nature of the association between soft drink consumption and problem behaviors, limiting or eliminating a child's soft drink consumption may reduce behavioural problems.

Journal Reference: Shakira F. Suglia, Sara Solnick, and David Hemenway. Soft Drinks Consumption Is Associated with Behavior Problems in 5-Year-Olds. The Journal of Pediatrics, 2013 DOI: 10.1016/j.jpeds.2013.06.023

Children with Autism do better with Maths

Children with autism and average IQs consistently did better on math tests than non-autistic children in the same IQ range, according to a small new study.

The superiority in math skills among children with autism was tied to patterns of activation in a particular area of the brain, an area normally associated with recognizing faces and visual objects.

Vinod Menon
"There appears to be a unique pattern of brain organization that underlies superior problem-solving abilities in children with autism," study senior author Vinod Menon, a professor of psychiatry and behavioural sciences at Stanford University, said in a university news release.

The study included 18 children with autism, aged 7 to 12, and a control group of 18 children without autism.

All participants showed normal verbal and reading skills on standardized tests, but the children with autism outperformed their peers without autism on standardized math tests.

The researchers also had all of the children work on math problems while their brain activity was measured using MRI.

The brain scans of the children with autism revealed an unusual pattern of activity in the ventral temporal occipital cortex, an area of the brain specialized for processing faces and other visual objects.

The study will be published online Aug. 17 in the journal Biological Psychiatry.

"[Previous research] has focused almost exclusively on weaknesses in children with autism," said Menon, a member of the Child Health Research Institute at Lucile Packard Children's Hospital.

"Our study supports the idea that the atypical brain development in autism can lead not just to deficits, but also to some remarkable cognitive strengths. We think this can be reassuring to parents."

Menon said children with autism sometimes exhibit exceptional talents or skills. For example, some can instantly recall the day of the week of any calendar date within a particular range of years, and others have outstanding math skills.

"Remembering calendar dates is probably not going to help you with academic and professional success," Menon said.

"But being able to solve numerical problems and developing good mathematical skills could make a big difference in the life of a child with autism."

About one in 88 children has some form of autism, according to the U.S. Centers for Disease Control and Prevention.

Monday, August 12, 2013

Grandparents: Strong bond with Grandchildren reduces Depression in both parties

A new study shows that grandparents and grandchildren have real, measurable effects on each other's psychological well-being long into grandchildren's adulthood.

Sara M. Moorman
"We found that an emotionally close grandparent-adult grandchild relationship was associated with fewer symptoms of depression for both generations," said Sara M. Moorman, an assistant professor in the Department of Sociology and the Institute on Aging at Boston College, who will present the study at the 108th Annual Meeting of the American Sociological Association.

"The greater emotional support grandparents and adult grandchildren received from one another, the better their psychological health."

The study also revealed that giving tangible support to or receiving it from their grandchildren affected the psychological well-being of grandparents but not grandchildren.

Tangible support, also called functional solidarity or instrumental support, includes anything from rides to the store and money to assistance with household chores and advice.

"Grandparents who experienced the sharpest increases in depressive symptoms over time received tangible support, but did not give it," said Moorman, who co-authored the study with Jeffrey E. Stokes, a PhD candidate in sociology at Boston College.

"There's a saying, 'It's better to give than to receive.' Our results support that folk wisdom—if a grandparent gets help, but can't give it, he or she feels badly.

Grandparents expect to be able to help their grandchildren, even when their grandchildren are grown, and it's frustrating and depressing for them to instead be dependent on their grandchildren."

Comparatively, the researchers found that grandparents who both gave and received tangible support experienced the fewest symptoms of depression over time.

"Therefore, encouraging more grandparents and adult grandchildren to engage in this type of exchange may be a fruitful way to reduce depression in older adults," said Moorman.

In their study, the researchers used data from the Longitudinal Study of Generations, a survey of 3- and 4-generation U.S. families that included seven waves of data collection between 1985 and 2004.

The sample was comprised of 376 grandparents and 340 grandchildren. The average grandparent was born in 1917 and the average grandchild in 1963, making them 77 years old and 31 years old, respectively, at the midpoint of the study in 1994.

In terms of the study's implications, Moorman said her research suggests that efforts to strengthen families shouldn't stop with the nuclear family or focus only on families with younger children.

"Extended family members, such as grandparents and grandchildren, serve important functions in one another's daily lives throughout adulthood," she said.

The study also indicates that helping older people remain functionally independent may aid their psychological well-being, according to Moorman.

"Most of us have been raised to believe that the way to show respect to older family members is to be solicitous and to take care of their every need," Moorman said.

"But all people benefit from feeling needed, worthwhile, and independent. In other words, let granddad write you a check on your birthday, even if he's on Social Security and you've held a real job for years now."

More information: The paper, "Does Solidarity in the Grandparent/Grandchild Relationship Protect Against Depressive Symptoms?," will be presented on Monday, Aug. 12, at 4:30 p.m. EDT in New York City at the American Sociological Association's 108th Annual Meeting.

Saturday, August 10, 2013

Children Eat More Vegetables With Flavoured (additives, sugar coated) Dips

Many parents have a difficult time persuading their preschool-aged children to try vegetables, let alone eat them regularly. 

Food and nutrition researchers have found that by offering a dip flavoured with spices, children were more likely to try vegetables -- including those they had previously rejected.

Jennifer S. Savage
"Less than 10 percent of 4- to 8-year-olds consume the USDA (U.S. Department of Agriculture) recommended daily servings of vegetables," said Jennifer S. Savage, associate director of the Center for Childhood Obesity Research at Penn State.

"Even more striking is that over one-third of children consume no servings of vegetables on a typical day. We wanted to figure out a way to increase vegetable consumption."

According to ChooseMyPlate, a USDA initiative, children between the ages of three and five should be eating one and a half to two cups of vegetables every day. Vegetables provide fiber and necessary nutrients.

They can also replace less healthy food choices and combat obesity because they are less calorie-dense.

Savage and colleagues found that children were three times more likely to refuse eating a vegetable alone than they were to eat the same vegetable when paired with a reduced-fat flavoured dip and the children were twice as likely to reject a vegetable with no dip than they were if given the same vegetable with plain dip.

The researchers report in a recent issue of the Journal of the Academy of Nutrition and Dietetics that they worked with 34 children between the ages of 3 and 5 to determine each child's familiarity with vegetables and which were liked or disliked.

The children were then reintroduced to the same vegetables, this time with a dip, and each child's likes and dislikes were reevaluated.

"Repeated exposure is a way to get kids to like new foods," said Savage. "This has been demonstrated in previous studies. But first you have to get them to taste the vegetable. Plus, the servings do not need to be huge -- the key may be to start by offering really small portions."

In as few as four tasting sessions, Savage and colleagues found that preschoolers consumed more of a disliked vegetable when it was paired with a dip flavored with spices than when it was eaten alone.

The children tasted and rated six different vegetables: carrots, cucumbers, celery, green beans, red peppers and yellow squash. After tasting each vegetable, the children were shown three cartoon faces and asked to pick which one best showed how they felt.

Their choices were "yummy," "just okay" and "yucky." The researcher also noted if the child refused to try the sample. "

"In the next session the children were introduced to five different Miracle Whip-based reduced-fat dips, one plain and the other four flavored with different combinations of spices."

"The most well-liked dips were flavoured "pizza" and "ranch;" the least-liked dips were "herb" and "garlic."

After the initial tastings and ratings, the preschoolers were given veggies and dip together. Thirty-one percent of them deemed a vegetable alone to be "yummy," but when paired with a flavored dip 64 percent of the children found the vegetable "yummy."

On the other end of the spectrum, 18 percent of children refused to eat a vegetable by itself, while only six percent would refuse to eat a vegetable when paired with a flavored dip.

In the last part of this study the researchers offered the preschoolers celery and yellow squash, paired with a preferred flavoured dip.

These vegetables were chosen because they were the least liked of the six tested. The children were offered celery one day and squash on a different day.

As expected, overall, the children ate more of each veggie when paired with a dip than when it was served alone.

The amount of squash eaten by the preschoolers more than doubled when paired with a flavoured dip. The quantity of celery eaten increased 62 percent when paired with a flavoured dip.

"Just because a child refuses to taste a vegetable doesn't mean they don't like it," Savage said. "It's foreign -- the key is to try to get them to taste it in a positive light."

Journal Reference: Jennifer S. Savage, Julie Peterson, Michele Marini, Peter L. Bordi, Leann L. Birch. The Addition of a Plain or Herb-Flavoured Reduced-Fat Dip Is Associated with Improved Preschoolers' Intake of Vegetables. Journal of the Academy of Nutrition and Dietetics, 2013; DOI: 10.1016/j.jand.2013.03.013/div>

Bullying: Children who overestimate their popularity less likely to be bullies

Children who overestimate their popularity are less likely to be bullies than those who underestimate or hold more accurate assessments of their social standing, finds new research to be presented at the 108th Annual Meeting of the American Sociological Association.

Jennifer Watling Neal
"The more kids overestimated their popularity, the less aggression they displayed," said Jennifer Watling Neal, an assistant professor of psychology at Michigan State University.

"This means that kids who were more accurate in their assessment of their number of friends or who underestimated their quantity of friends compared to peer report were more aggressive."

Past research has suggested that children who believe they are more competent or well liked than their peers or teachers view them are more aggressive.

Elise Cappella
"But our research suggests there are certain types of positive perceptual biases that have a 'bright side,'" said Neal, who co-authored the study with Elise Cappella, an assistant professor of applied psychology at New York University.

"When kids say they have more friends than their peers say they have, those children are actually less aggressive."

This finding was true for both overtly (e.g., hitting, kicking, or threatening to beat up others) and relationally (e.g., excluding others or spreading rumors) aggressive behaviour.

The study relied on a survey of 421, mostly African American, second through fourth graders from five public elementary schools in an urban midwestern city.

The survey, which was administered in individual classrooms, provided students with the opportunity to identify their friends and the friends of their peers in the class in which they were surveyed. Students also identified classmates who were bullies.

"Children who overestimated their popularity compared to peer report were less likely to be nominated by their peers as overtly or relationally aggressive," Neal said.

The researchers said there could be several reasons why students who overestimate their popularity do not feel the need to bully others.

"Kids who overestimate their social connections may also perceive that more peers are watching and judging their behaviours," Neal said.

"Children may be less likely to engage in aggressive behaviors that may be observed by, and place into jeopardy, their perceived social connections."

Another possible reason is that students who overestimate their social connections may be nice, sociable kids who believe they are friends with everyone.

"On the other hand, aggressive children—especially those who use forms of aggression such as rumor spreading—may be more exclusive in who they report as their friends, leading to less overestimation," Neal said.

As for why some students overestimate their social connections, Neal said, "Kids naturally vary in their ability to accurately perceive classroom social connections and their own social positions in the classroom. It's not surprising that some children think they have a lot more friends than they actually do."

More information: The paper, "The Bright Side of Positive Perceptual Bias: Children's Estimations of Network Centrality and Aggression," will be presented on Monday, Aug. 12, at 4:30 p.m. EDT in New York City at the American Sociological Association's 108th Annual Meeting.

US Public has more empathy for Battered Dogs than Battered Children

People have more empathy for battered puppies and full grown dogs than they do for some humans—adults, but not children, finds new research to be presented at the 108th Annual Meeting of the American Sociological Association.

Jack Levin
"Contrary to popular thinking, we are not necessarily more disturbed by animal rather than human suffering," said Jack Levin, the Irving and Betty Brudnick Professor of Sociology and Criminology at Northeastern University.

"Our results indicate a much more complex situation with respect to the age and species of victims, with age being the more important component. The fact that adult human crime victims receive less empathy than do child, puppy, and full grown dog victims suggests that adult dogs are regarded as dependent and vulnerable not unlike their younger canine counterparts and kids."

In their study, Levin and co-author Arnold Arluke, a sociology professor at Northeastern University, considered the opinions of 240 men and women, most of whom were white and between the ages of 18-25, at a large northeastern university.

Arnold Arluke
Participants randomly received one of four fictional news articles about the beating of a one-year-old child, an adult in his thirties, a puppy, or a 6-year-old dog.

The stories were identical except for the victim's identify. After reading their story, respondents were asked to rate their feelings of empathy towards the victim.

"We were surprised by the interaction of age and species," Levin said.

"Age seems to trump species, when it comes to eliciting empathy. In addition, it appears that adult humans are viewed as capable of protecting themselves while full grown dogs are just seen as larger puppies."

Interestingly, the researchers found that the difference in empathy for children versus puppies was statistically non-significant.

As for considering the opinions of 240 college students, Levin said it is common practice to use homogenous samples for studies such as his that center around an experiment.

"Unlike survey research, experiments usually employ a homogenous sample in order to establish a cause and effect relationship rather than to generalize a large population," Levin said.

"However, there is really no reason to believe that our results would differ very much nationally, particularly among college students."

While the study focused on dogs and humans, Levin thinks the findings would be similar for cats and people as well. "Dogs and cats are family pets," he said.

"These are animals to which many individuals attribute human characteristics."

More information: The paper, "Are People More Disturbed by Animal or Human Suffering? Assessing the Influence of Victim's Species and Age on Empathy," will be presented on Saturday, Aug. 10, at 8:30 a.m. EDT in New York City at the American Sociological Association's 108th Annual Meeting.

Friday, August 9, 2013

Autism: Research focused on Men, Women are different

Autism affects different parts of the brain in females with autism than males with autism, a new study reveals. The research is published today in the journal Brain as an open-access article.

Scientists at the Autism Research Centre at the University of Cambridge used magnetic resonance imaging to examine whether autism affects the brain of males and females in a similar or different way.

They found that the anatomy of the brain of someone with autism substantially depends on whether an individual is male or female, with brain areas that were atypical in adult females with autism being similar to areas that differ between typically developing males and females. This was not seen in men with autism.

"One of our new findings is that females with autism show neuroanatomical 'masculinization'," said Professor Simon Baron-Cohen, senior author of the paper.

"This may implicate physiological mechanisms that drive sexual dimorphism, such as prenatal sex hormones and sex-linked genetic mechanisms."

Simon Baron-Cohen
Autism affects 1% of the general population and is more prevalent in males. Most studies have therefore focused on male-dominant samples.

As a result, our understanding of the neurobiology of autism is male-biased.

"This is one of the largest brain imaging studies of sex/gender differences yet conducted in autism. Females with autism have long been under-recognized and probably misunderstood," said Dr Meng-Chuan Lai, who led the research project.

"The findings suggest that we should not blindly assume that everything found in males with autism applies to females. This is an important example of the diversity within the 'spectrum'."

Dr Michael Lombardo
Dr Michael Lombardo, who co-led the study, added that although autism manifests itself in many different ways, grouping by gender may help provide a better understanding of this condition.

He said: "Autism as a whole is complex and vastly diverse, or heterogeneous, and this new study indicates that there are ways to subgroup the autism spectrum, such as whether an individual is male or female."

"Reducing heterogeneity via subgrouping will allow research to make significant progress towards understanding the mechanisms that cause autism."


Thursday, August 8, 2013

An extra hour of TV diminishes toddlers' kindergarten chances

Every hourly increase in daily television watching at 29 months of age is associated with diminished vocabulary and math skills, classroom engagement (which is largely determined by attention skills), victimization by classmates, and physical prowess at kindergarten, according to Professor Linda Pagani of the University of Montreal and the CHU Sainte-Justine children's hospital.

"This is the first time ever that a stringently controlled associational birth cohort study has looked at and found a relationship between too much toddler screen time and kindergarten risks for poor motor skills and psychosocial difficulties, like victimization by classmates," Pagani said.

"These findings suggest the need for better parental awareness and compliance with existing viewing recommendations put forth by the American Academy of Pediatrics (AAP)."

"The AAP discourages watching television during infancy and recommends not more than two hours per day beyond age 2. It seems that every extra hour beyond that has a remarkably negative influence."

Journalists are welcome to use the following responses in their own reports. Interviews and further information (including the original French text of this document) can be obtained by contacting media relations at the University of Montreal (Université de Montréal).

Question: Why did you conduct this study?

Pagani: Much of the research on school readiness has focused on how kindergarten characteristics predict later success.

Kindergarten entry characteristics predict long-term psycho-social adjustment and economic characteristics like income and academic attainment.

Being innovative, my focus has been to examine what predicts kindergarten entry characteristics. Adding further originality, I also wanted to focus on neglected yet crucial aspects of school readiness such as motor skills, which predict later physical activity and reading skills, likelihood of being "picked-on", which predict social difficulties, and skills at linked to doing what you are supposed to be doing when having been given instructions, which are in turn linked to attention systems that are regulated by the brain's frontal lobe development.

Question: Who participated in this study?

Pagani: 991 girls and 1006 boys in Quebec whose parents reported their television viewing behaviour as part of the Quebec Longitudinal Study of Child Development.

Question: How did you come up with the figure of an extra hour of TV?

Pagani: The standard deviation is a commonly used statistic tool that tells us what is within a normal range compared to the average.

One standard deviation from the average daily amount of television viewed by the toddlers in this sample (105 minutes) is 72 minutes.

Some of the children who participated in the study were two or even three standard deviations away from the average, and their kindergarten indicators were correspondingly worse than those who were one standard deviation away.

Question: Where did you examine television viewing?

Pagani: This study only looks at the most common form of screen time, which is in the home. However, it may be an underestimate because many child care settings use television as an activity during care giving.

Question: Why would these results be important for everyday life?

Pagani: Because of kindergarten's power to predict future productivity, the identification of modifiable factors that foretell not being ready for the transition to formal schooling represents an important goal for a productive society.

By statistical standards, the results show highly controlled modest associations, yet these are net effects which suggest a developmental course which could ultimately compromise achievement, social relations, physical prowess, and preferences and habits toward a healthy lifestyle.

Wednesday, August 7, 2013

The hidden purpose of Games: Tracking, diagnosing ADHD

Noah Madson remembers being exhausted after hours of tests for his attention deficit hyperactivity disorder. "Boy, those were complicated," said his mother, Nancy. "He'd come out and say, 'My brain hurts.' "

Today, Noah's task is less of a headache. After the 14-year-old plays a video game for 20 minutes, his parents and teachers will have data that paint a comprehensive picture of how his mind is functioning.

Better yet, as the St. Louis Park, Minn., teenager plays the game more, his memory and processing speed might actually improve.

Noah is part of a pilot study for CogCubed, a Minneapolis-based startup that develops games to help diagnose and ameliorate cognitive disorders such as ADHD.

The company has already attracted $20,000 in funding from Google and is a semifinalist in the Minnesota Cup, a competition for entrepreneurs.

CogCubed was founded by a husband-and-wife team: game developer Kurt Roots and child psychiatrist Monika Heller.

Their goal is to use sensor technology to produce objective data about symptoms that are often hard to pin down, such as inattentiveness and hyperactivity.

The game that CogCubed is testing now uses Sifteo, a platform that consists of small cubes with screens on them.

The game, called "Groundskeeper," asks the user to use one cube - the mallet - to hit a gopher that pops up on the screens of the other three cubes. As the game goes on, distractions like rabbits and chirping birds come up, and the instructions change.

The cubes produce data on more than 70 different variables, including errors, response times and even whether the player is fidgeting.

Those data come together in a Web portal that clinicians, parents and teachers can use to evaluate a child's cognitive function in a very specific way.

"That's part of our excitement with it, that we're getting so much detailed information," Nancy Madson said. "I can't wait for it to affect (Noah's) education plan for the coming year."

This year, the Centers for Disease Control and Prevention released record numbers for ADHD diagnoses: 11 percent of school-aged children have been diagnosed with the disorder, including nearly 1 in 5 high-school-age boys.

It's not clear what's behind the increased numbers, which represented a 41 percent jump in the past decade and contributed to an FDA shortage of commonly prescribed ADHD medicines in 2011.

But, Heller said, one thing is clear: Caretakers for children with ADHD could use extra help.

"Six to 12 months is the average waiting period to see a child/adolescent psychiatrist (for a comprehensive evaluation)," she said. "How phenomenal would it be if Mom could have an assessment tool at home?"

CogCubed aims to start selling its "Groundskeeper" training game, which adjusts to each player's weaknesses to help improve cognitive skills, in the next few months. Noah and 36 other students with ADHD are testing that game, playing twice a day for three to five days a week.

Another version of the game that serves as a diagnostic tool won't be released until CogCubed receives FDA approval for it, Roots said. The game wouldn't replace comprehensive psychological evaluations, but would provide doctors with data to aid diagnosis.

In a University of Minnesota study, that version of the game matched a psychiatrist's ADHD diagnosis 75 percent of the time. The Continuous Performance Test, a computer-based diagnostic that clinicians often use, has about a 62 percent accuracy rate, Heller said, although that number varies.

"We're really trying to do something that is clinically validated," Roots said. "We don't want to make promises that we can't keep. We're doing the best we can to make sure we're not selling something that gets people's hopes up and doesn't work."

CogCubed is also beginning to partner with local autism centers to test the Groundskeeper games' ability to provide data about autism, Roots said.

It's important that products that tout improvement of cognitive function stay away from broad claims and focus their research on long-term effects, said Max Wiznitzer, a pediatric neurologist who serves on the professional advisory board for Children and Adults with Attention-Deficit/Hyperactivity Disorder.

"Can we improve working memory and teach them little tricks? The answer is yes," Wiznitzer said. "Will it somehow make that person tons better in their day-to-day functioning? ... That's where I'm concerned when people make these kinds of claims. It's not the miracle cure. I wish it were."

The amount of data that CogCubed collects could make it a game-changer in the mental health field, Heller said.

While a computer-based test just measures errors, the Sifteo cubes' sensors measure every move in between. That means there's less room for misdiagnosis - and more room to grow.

The results of the pilot study at Noah's school, Groves Academy, could help teachers customize lesson plans for each student's particular needs, Groves' assistant director of diagnostics Zach Eakman said.

"We'll really have great data, not only pre- and post-testing, but for years to come, to be able to see if there's any discernible differences specifically in those two areas we talked about, processing speed and working memory," he said.

Eakman said the school, which serves children with learning disabilities, was impressed by CogCubed's product.

"Groves gets approached a lot by outside therapies as potential partnerships," he said, adding that this is only the second study the school has agreed to be a part of in 35 years. "It's because of not only their research results, but their approach to research, which includes a commitment to third-party and (long-term) analysis."

Nancy Madson said she's thrilled about the game, which Heller said was designed to be "just boring enough" to prevent overstimulation.

"It's an opportunity for our son to become more self-sufficient with his ADHD and his learning differences," Madson said. "And it's fun."