New guidelines employ a team approach to autism diagnosis and care

Fred Volkmar

Improving diagnosis and treatment for individuals with autism has been the focus of a growing body of research. 

New information from these studies led the American Academy of Child and Adolescent Psychiatry (AACAP) to revise key parameters for evaluating and treating autism. 

Researchers led by Yale Child Study Center director Dr. Fred Volkmar have published the new practice parameters in the Feb. issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"Early diagnosis of children with autism spectrum disorders means treatments will be introduced that lead to more positive outcomes for children," said Volkmar the Irving B. Harris Professor of Psychiatry, Pediatrics, and Psychology at the Yale School of Medicine.

According to the parameters, clinicians should routinely look for symptoms of autism spectrum disorder in young children undergoing developmental assessments, and in all psychiatric evaluations.

If significant symptoms are detected, clinicians should then coordinate a careful medical, psychological, and communication evaluation.

These evaluations should differentiate between autism and a variety of developmental and other disorders, as well as intellectual and behavioral disabilities.

"Our goal was advocacy for individuals with autism and their families, and to ensure that services are coordinated across clinical care," said Volkmar.

"Our field is changing rapidly, and these parameters are meant to promote effective care and move professional medical methods closer to current practices."

Volkmar and his co-authors reviewed abstracts from 9,481 research articles on autism that were published between 1991 and 2013.

They then fully studied 186 of those articles based on their quality and ability to be applied more generally.

"Treatment should involve a team approach," said Volkmar, who notes that under these treatment parameters, psychiatrists will closely coordinate diagnosis and treatment with teachers, behavioural psychologists, and speech and language pathologists, and look for commonly occurring conditions.

A key addition to the new parameters is a focus on how clinicians should address the use of non-traditional therapies, like chelation and secretin.

Clinicians are urged to ask families if they are using alternative/complementary treatments and to discuss the therapies' risks and potential benefits.

Volkmar estimates that about 90% of parents of children with autism use some kind of alternative or complementary therapies.

"It is important to encourage a discussion with parents about the potential harms of some of these therapies, as well as to educate them about evidence that supports what they're doing."

More information: Journal of the American Academy of Child & Adolescent Psychiatry: www.jaacap.com/article/S0890-8567(13)00819-8/fulltext

Stepparents are not always evil: Parents' need a strategy to love their children

Contrary to common belief, parents do not generally treat their stepchildren less favourably than their own. Until now, many researchers believed in the so-called "Cinderella effect."

It states that it is biologically inevitable that parents care less for stepchildren because they do not spread their genes.

Kai Willführ

Researchers at the Max Planck Institute for Demographic Research (MPIDR) in Rostock, Germany, have discovered an important exception.

If there is a reasonable chance of increasing wealth in the parents' environment then no difference is made between one's own children and stepchildren.

Thus, parental care depends on more than just the biological relationship.

Alain Gagnon

This is the result of a study published by MPIDR researcher Kai Willführ together with Alain Gagnon from the University of Montreal, Canada, in the scientific journal "Biodemography and Social Biology."

"We are now able to prove that the Cinderella effect is not an inevitable reflex of stepparents," says Kai Willführ.

The scientists investigated if and how strongly parents neglected their stepchildren by looking at the mortality of children in historic patchwork families from the 17th to 19th century.

They compared the Krummhörn region of East Frisia (Germany), which was a densely populated area with little space for economic development, and the growing Canadian settlements in Québec.

For both areas they calculated how the children's chances of survival changed when a stepmother moved in.

The conclusions showed that only in Krummhörn, which offered fewer opportunities for economic growth, the stepmother had a negative influence.

In Krummhörn children from a father's first marriage died more often before the age of 15 if a stepmother moved in.

This effect was not seen in Québec. The "Cinderella effect," therefore, does not inevitably seem to occur. The stepmothers must have treated their children in East Frisia and Canada completely differently.

When do stepchildren die young?
The extent of this effect is striking: if a Krummhörn girl lost her mother early, the likelihood of her dying before the age of 15 more than doubled compared to a girl whose mother did not die.

If the father remarried and the stepmother joined the family, mortality doubled again. Thus, the arrival of a stepmother affected the girls in East Frisia as much as the death of their own mother.

In Québec, however, the risk of dying young barely changed when the new mother moved in.

"The stepmothers in Québec seemed to understand that the offspring from their husband's first marriage were not competition for their own children with their new husband," says MPIDR researcher Kai Willführ.

In fact, the Canadian half siblings were considered to be allies of the biological children. On the contrary, according to the "Cinderella effect", stepparents would always consider foreign children to be competitors to their own children and thus neglect them.

Love for children is strategy
But that only happened in Krummhörn, where siblings competed for basic needs. "We assume that stepmothers neglected, exploited or even abused the children from their husband's first marriage," says socio-biologist Willführ.

The fact that this only happened in East Frisia shows that the context in which patchwork families are living - whether there is room for economic development or not - strongly influences how parents allocate their affection to their own children and stepchildren.

Although the scientists used historic data, their results have fundamentally challenged the veracity of the "Cinderella effect.

"It is therefore also true today, that stepparents are not always evil," says researcher Kai Willführ. For their study, Willführ and Gagnon traced thousands of children up to age 15 in East Frisia and Québec.

By individually reconstructing whether and when a parent died, a stepmother or stepfather moved in, and whether half-siblings were born during this period, they were able to calculate the influence of all those events on the survival rate of boys and girls.

Dates of births, christenings, weddings and funerals were taken from old church registers. For the Krummhörn region in East Frisia the researchers looked at the birth cohorts from 1720 to 1859, and for Québec at those from 1670 to 1750.

More information: Kai Willführ, Alain Gagnon, Are step-parents always evil? Parental death, remarriage, and child survival in demographically saturated Krummhörn (1720-1859) and expanding Québec (1670-1750) Biodemography and Social Biology, DOI: 10.1080/19485565.2013.833803

Homeless and abused children benefit from animal-assisted therapy

Researchers at MIRI have completed a pilot study that used guinea pigs and rabbits as therapists to teach children who have experienced domestic violence situations empathy and coping skills. 

Credit: Erna Vader 

There were almost 32,000 substantiated cases of severe abuse, neglect and violence in Australia last year with some children dying as a result.

According to the Australian Institute of Criminology, the age group most likely to be murdered is 0-12 months.

One particular group amongst the homeless cohort is women with children fleeing violent domestic relationships and living in transitional housing.

Essentially these mothers and children are in hiding. It is known that children who experience traumatic events early in life, particularly abuse and violence, often develop social, emotional, health and behavioural problems as adolescents and adults.

Researchers at the Monash Injury Research Institute (MIRI) have recently completed a pilot study that used animals, such as guinea pigs and rabbits, as therapists to teach children who have experienced domestic violence situations empathy and coping skills.

WAYSS, a registered not-for-profit community based agency in Southern Metropolitan Melbourne region provides family violence and homelessness support services and transitional housing for women and children.

While anecdotal evidence indicated the children who attended the groups showed dramatic improvements in their lives, WAYSS approached the Child Abuse Prevention Research Centre (CAPRA), a specialist unit in MIRI to conduct a two year pilot program to determine whether the program was in fact of benefit.

Neerosh Mudaly

The study was run by Dr Neerosh Mudaly, a Senior Research Fellow. Children are assessed and prepared for entry into the program by a WAYSS Children's Case Worker and they are transported to the program by WAYSS.

The group program is managed by EE&T. The guinea pigs and rabbits, used in the program are carefully chosen and their temperament and health are managed by EE&T.

The group caters for up to 10 children, who attend weekly sessions of 1-1.5 hours.

The children engage in a series of activities which include animal handling (grooming, comforting), animal care (feeding and observing) and art and photography that complement the activities.

According to Dr Mudaly, children who come to the program often do not trust adults. They do not respond to traditional counselling as they are often filled with persistent fear. They may be sad, withdrawn or acting out in aggressive ways.

"These behaviours can make it difficult for the children to settle at school – often resulting in the child either being bullied or becoming a bully," Dr Mudaly said.

"In the group, the children recognise that they are in charge of a vulnerable being such as a guinea pig. They learn empathy and control – and often take these lessons back into their own families where perhaps they bullied their more vulnerable younger siblings."

Dr Mudaly said repeated experiences of gentle, calming contact with small animals in a safe environment appears – from the pilot study – to have had a dramatic effect in helping children heal from abuse and violence.

"It may also help break the cycle of violence and abuse that these children may carry into adolescence and adulthood," Dr Mudaly said.

Eleven children participated in the pilot evaluation, and the results validated a more rigorous evaluation.

According to Dr Mudaly – if funding is found – the next phase of the study would involve in-depth interviews with children, their supportive parent, caseworkers and teachers.

Psychometric measures of trauma and empathy will be administered at entry and again at completion to provide concrete evidence of changes in the children.

"This research has the potential to contribute to international knowledge on effective therapy for traumatised children and the prevention of violence," Dr Mudaly said.

Case study: 
Dr Mudaly talks of one five-year-old girl who witnessed terrible violence towards her mother when the child was injured during one of these episodes.

"When she came into the program she was mute, did not speak for months and would not leave her mother's side," Dr Mudaly said.

The first words she spoke were to a guinea pig in the animal therapy program: "what's your name?" A year later Dr Mudaly saw the child again.

"She was flicking her long hair, talking about how she might work with animals when she grew up. She had so much to say and would not stop talking," Dr Mudaly said.

Childhood reading can turn nightmares into life dreams

Edinburgh City Libraries’ reading champion Niall Walker talks about his work with young people who stay in residential care units

‘I don’t read books, I just don’t . . . oh, is that one about a dog?”, asked the 12-year-old girl in residential care.

It was. She liked it. Hopefully, next time I see her she’ll have picked up another.

Young people in Britain’s care system have experienced significant adversity and this can often affect their chances at school and beyond.

In adulthood they may have difficulty finding work, training or studying, and some will be at risk of becoming homeless or imprisoned. Their life chances have been hit hard by the negative experiences that brought them into care.

I believe that reading offers hope. In fact, we know that reading for pleasure is a more powerful indicator of a child’s educational performance than their socio-economic status or their parents’ education.

This creates better life chances for young people of any background – and, crucially, for our most vulnerable young people, reading can lead to emotional resilience, confidence, functional literacy, empathy and the ability to form attachments to others more easily.

This is where libraries come in. We are working hard to cater for vulnerable young people. This means improving access to books and other reading that matches their interests and abilities, and ensuring our libraries are always welcoming, safe and interesting spaces.

As reading champion, my objective is to develop strong and sustainable links between care staff and librariy staff so that young people are encouraged to use their local library and its resources at all stages of life.

In the past week, residential care staff have been volunteering to receive training in paired reading and literacy development to better support our looked-after children. Together, we are tailoring this service to each individual.

Funding from the National Literacy Trust’s Young Reader’s Programme is being used to provide them with books.

So far, 156 books have been chosen by Edinburgh’s young people in residential care.

Hopefully, that number will have increased by the time you’re reading this, as I’m due to visit a young woman who will almost certainly love Malorie Blackman’s Boys Don’t Cry, a teenage radical who will lap up George Orwell’s Animal Farm and a girl in need of some laughs, which Jeff Kinney’s Diary of a Wimpy Kid can provide.

My message to any young person who is searching for something fun to read is to visit your library and ask the professionals there for help and advice. Tell us what you’ve enjoyed reading before and we will find you one of many books you’ll enjoy.

The recent boom in publishing books for teenagers is unsurpassed in history. There are books written entirely about things you already love, and at a level you’ll be comfortable with. I’ve witnessed children and teenagers finding that “first book” about gamer records, kitten care, gross facts, otherwordly manga, cinematic graphic novels, Lionel Messi, and the best works of fiction.



The Reading Champion Project works closely with other partners, carers, teachers, families and, primarily, children in care. We must never underestimate how each individual can be full of surprises, with a lifetime of enjoying reading – and its benefits – ahead of them.

“Those books on hip hop you got me were good. Yeah I’ve finished them now. How about something about boxing . . . or y’know what, a couple of years ago I had to read a Rabbie Burns poem for school. Could you get me something by him?” This was a 15-year-old boy in a secure unit. My response: “Umm, yeah buddy. I think we’ll manage that.”

n World Book Night tonight is a celebration of reading and books which sees tens of thousands of people gift books to spread the joy and love of reading.

Five titles are selected and printed in their thousands in World Book Night editions. Givers apply to give away a particular book, which they must commit to give to those who don’t regularly read. Each giver receives 24 copies, which they will have picked up from their local bookshops and libraries in the week before April 23.

Edinburgh City Libraries staff will be giving out books at libraries and other locations and much-in-demand author Maggie O’Farrell will be at Central Library on George IV Bridge at 6.30pm – a real coup for Edinburgh.

Find out more at www.worldbooknight.org.

Ben Foss talks about HBO's Journey Into Dyslexia - YouTube

Care Innovations was pleased to join Parents Education Network on April 15, 2011 for the world premiere pre-release screening of HBO's Journey Into Dyslexia, a documentary by acclaimed filmmakers Alan and Susan Raymond.

Join us online at community.careinnovations.com.