PTSD: Identifying trauma risk in small children early after an accident

Small children also suffer from post-traumatic stress disorders (PTSD) after a serious accident. With the aid of a new test, children with an increased risk can already be identified in the space of a few days.

The test devised by scientists from the University of Zurich and the University Children's Hospital Zurich helps to treat traumatized small children at an early stage.

Accidents also traumatize small children. Around one in ten children still suffers from a post-traumatic stress disorder a year after a road accident or burn injury, reliving aspects of the traumatic experience in the form of flashbacks or nightmares.

In doing so, young children keep replaying the stressful memories while avoiding anything that might remind them of the accident in any way.

As a result of this constant alertness to threatening memories, the children can develop sleeping disorders, concentration problems or aggressive behaviour.

Assessing the risk of illness accurately
Researchers from the University of Zurich and the University Children's Hospital Zurich have now devised and evaluated a systematic questionnaire, which can be used to identify pre-school children with an increased risk of long-term post-traumatic disorders within a few days of an accident.

Markus Landolt

For the first time, it is now possible for first responders such as pediatricians, nursing staff or emergency psychologists to assess small children accurately with regard to their risk of illness.

"Children with an increased risk can thus be identified early and referred to an emergency psychologist for treatment," explains Professor Markus Landolt.

This prevents an acute stress response from developing into chronic mental illness that causes the child to suffer and spells a lengthy and expensive course of treatment.

For the study, Professor Landolt's doctoral student Didier Kramer interviewed a total of 134 parents of two to six-year-old children seven days after a road accident or burn injury.

Didier Kramer

The screening instrument used comprised 21 questions on changes in the child's behavior after the accident and recorded a high degree of accuracy: 85 percent of the children examined who suffered from a post-traumatic stress disorder after six months had already been identified correctly a week after the accident with the aid of the questionnaire.

Markus Landolt is now planning an app for Smartphones in collaboration with IT scientists: "This app will enable the screening to be conducted even more easily and quickly, and above all implemented broadly."

More information: Didier N. Kramer, Matthias B. Hertli, & Markus A. Landolt. Evaluation of an early risk screener for PTSD in preschool children after accidental injury. Pediatrics journal. September 23, 2013. DOI: 10.1542/peds.2013-0713

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.

Divorce early in childhood affects parental relationships in adulthood

Divorce has a bigger impact on child-parent relationships if it occurs in the first few years of the child's life, according to new research.

Those who experience parental divorce early in their childhood tend to have more insecure relationships with their parents as adults than those who experience divorce later, researchers say.

R. Chris Fraley

"By studying variation in parental divorce, we are hoping to learn more about how early experiences predict the quality of people's close relationships later in life," says R. Chris Fraley of the University of Illinois at Urbana-Champaign.

Psychologists are especially interested in childhood experiences, as their impact can extend into adulthood, but studying such early experiences is challenging, as people's memories of particular events vary widely.

Parental divorce is a good event to study, he says, as people can accurately report if and when their parents divorced, even if they do not have perfect recollection of the details.

In two studies published today in Personality and Social Psychology Bulletin, Fraley and graduate student Marie Heffernan examined the timing and effects of divorce on both parental and romantic relationships, as well as differences in how divorce affects relationships with mothers versus fathers.

In the first study, they analyzed data from 7,735 people who participated in a survey about personality and close relationships through yourpersonality.net.

More than one-third of the survey participants' parents divorced and the average age of divorce was about 9 years old.

The researchers found that individuals from divorced families were less likely to view their current relationships with their parents as secure.

And people who experienced parental divorce between birth and 3 to 5 years of age were more insecure in their current relationships with their parents compared to those whose parents divorced later in childhood.

"A person who has a secure relationship with a parent is more likely than someone who is insecure to feel that they can trust the parent," Fraley says.

"Such a person is more comfortable depending on the parent and is confident that the parent will be psychologically available when needed."

Although there was a tendency for people to experience more anxiety about romantic relationships if they were from divorced families, the link between parental divorce and insecurity in romantic relationships was relatively weak.

This finding was important, the researchers say, as it shows that divorce does not have a blanket effect on all close relationships in adulthood but rather is selective – affecting some relationships more than others.

They also found that parental divorce tends to predict greater insecurity in people's relationships with their fathers than with their mothers.

Conclusion
While it is premature to speculate on the implications of this work for decision-making regarding child custody, the work is valuable as it suggests that "something as basic as the amount of time that one spends with a parent or one's living arrangements" can shape the quality of child-parent relationships, write Fraley and Heffernan.

"People's relationships with their parents and romantic partners play important roles in their lives," Fraley says.

"This research brings us one step closer to understanding why it is that some people have relatively secure relationships with close others whereas others have more difficulty opening up to and depending on important people in their lives."

Read the full article here

More information: doi: 10.1177/0146167213491503

Autism: Early brain responses to words predict developmental outcomes

A 2-year-old in the study sits on his mother's lap playing with toys while researchers record his brain's responses to words. 

Credit: Institute for Learning & Brain Sciences, University of Washington. 

The pattern of brain responses to words in 2-year-old children with Autism spectrum disorder predicted the youngsters' linguistic, cognitive and adaptive skills at ages 4 and 6, according to a new study.

The findings, to be published May 29 in PLOS ONE, are among the first to demonstrate that a brain marker can predict future abilities in children with autism.

"We've shown that the brain's indicator of word learning in 2-year-olds, already diagnosed with autism, predicts their eventual skills on a broad set of cognitive and linguistic abilities and adaptive behaviours," said lead author Patricia Kuhl, co-director of the University of Washington's Institute for Learning & Brain Sciences.

Patricia Kuhl

"This is true four years after the initial test, and regardless of the type of autism treatment the children received," she said.

In the study, 2-year-olds – 24 with autism and 20 without – listened to a mix of familiar and unfamiliar words while wearing an elastic cap that held sensors in place (EEG).

The sensors measured brain responses to hearing words, known as event-related potentials.

The research team then divided the children with Autism into two groups based on the severity of their social impairments and took a closer look at the brain responses.

Youngsters with less severe symptoms had brain responses that were similar to the typically developing children, in that both groups exhibited a strong response to known words in a language area located in the temporal parietal region on the left side of the brain.

This suggests that the brains of children with less severe symptoms can process words in ways that are similar to children without the disorder.

In contrast, children with more severe social impairments showed brain responses more broadly over the right hemisphere, which is not seen in typically developing children of any age.

"We think this measure signals that the 2-year-old's brain has reorganized itself to process words. This reorganization depends on the child's ability to learn from social experiences," Kuhl said.

She cautioned that, identifying a neural marker that predicts future Autism diagnoses with assurance, is still some way off.

The researchers also tested the children's language skills, cognitive abilities, and social and emotional development, beginning at age 2, then again at ages 4 and 6.

The children with autism received intensive treatment and, as a group, they improved on the behavioural tests over time.

But the outcome for individual children varied widely and the more their brain responses to words at age 2 were like those of typically developing children, the more improvement in skills they showed by age 6. 

In other studies, Kuhl has found that social interaction accelerates language learning in babies. Infants use social cues, such as tracking adults' eye movements to learn the names of things, and must be interested in people to learn in this way.

Paying attention to people is a way for babies to sort through all that is happening around them and serves as a guide or gauge to determine what is important.

But with autism, social impairments impede children's interest in, and ability to pick up on, social cues. They find themselves paying attention to many other things, especially inanimate objects, instead of people. 

"Social learning is what most humans are about," Kuhl said. "If your brain can learn from other people in a social context you have the capability to learn just about anything."

She hopes that the new findings will lead to brain measures that can be used much earlier in development – at 12 months or younger – to help identify children at risk for autism.

"This line of work may lead to new interventions applied early in development, when the brain shows its highest level of neural plasticity," Kuhl said.

More information: dx.plos.org/10.137… pone.0064967

Good Mental Health starts with early Childhood Relationships

The mental and emotional development of children is just as important as early childhood education, according to Iowa State researchers. 

Credit: Bob Elbert 

Making sure children grow up in a safe and stable environment is the goal of Iowa State University researchers working on a statewide evaluation through the Iowa Department of Public Health and the Maternal, Infant and Early Childhood Home Visiting programs.

Researchers want to improve effectiveness as well as access for families to prevention and intervention programs.

Kere Hughes-Belding

Kere Hughes-Belding, an associate professor of human development and family studies at Iowa State, says the work is critical to the mental and emotional development of children.

It's an aspect that is often overlooked, but is just as important as early childhood education, she said. "This is such a critical age and period of development in a child's life. There really is no better age to intervene and get the most benefit," Hughes-Belding said.

"The more we can do to promote nurturing and caring relationships between parent and child, the better outcomes for the child." Researchers will start by interviewing families who participate in the Maternal, Infant and Early Childhood Home Visiting programs.

Many of these families are also dealing with complex problems such as poverty, unemployment and chronic depression, as well as substance abuse issues.

Hughes-Belding says parents are generally motivated to do what is best for their children, but may lack the skills or ability to improve the situation without outside support.

The research team also plans to work with the home visitors who provide the services and videotape their interactions with families.

They want to get a better idea of what works and what doesn't. "The results from this evaluation project will give us information about the characteristics, training and support needed for effective home visitation with at-risk families of very young children," Hughes-Belding said.

Read More here

Children in Europe start learning foreign languages at an increasingly early age

Children are starting to learn foreign languages at an increasingly early age in Europe, with most pupils beginning when they are 6-9 years old, according to a report published by the European Commission. 

A majority of countries or regions have lowered the starting age for compulsory language learning in the past 15 years and some even offer it in pre-school - the German speaking community in Belgium, for instance, provides foreign language learning for children as young as 3. 

The Key Data on Teaching Languages at School in Europe 2012 report confirms that English is by far the most taught foreign language in nearly all European countries, with French, Spanish, German and Russian following far behind.

"Linguistic and cultural diversity is one of the European Union's major assets," says Androulla Vassiliou, Commissioner for Education, Culture, Multilingualism and Youth. 

"Language learning facilitates communication between peoples and countries, as well as encouraging cross-border mobility and the integration of migrants.

I am happy to see that even our youngest citizens are being exposed to the joys of discovering foreign languages. 

I also encourage people to look beyond the most widely-used languages so they can appreciate Europe's incredible linguistic diversity."

The report highlights that an increasing number of pupils now learn two languages for at least one year during compulsory education. 

On average, in 2009/10, 60.8% of lower secondary education students were learning two or more foreign languages - an increase of 14.1% compared to 2004/05. 

During the same period, the proportion of primary education pupils not learning a foreign language fell from 32.5% to 21.8%.

English is the most taught foreign language in nearly all of the 32 countries covered in the survey (27 Member States, Croatia, Iceland, Liechtenstein, Norway and Turkey) – a trend that has significantly increased since 2004/05. 

In lower secondary and general upper secondary education, the percentage of students learning English exceeds 90%.

Only a very small percentage of pupils (0-5 %, according to the country) learn languages other than English, French, Spanish, German and Russian.

The report also confirms a rather surprising finding - few countries require their trainee language teachers to spend an immersion period abroad. Indeed, only 53.8 % of foreign language teachers who took part in the recently published European Survey on Language Competences (IP/12/679) stated they have spent more than a month studying in a country where the language they teach is spoken. 

But this average masks a wide variation of approaches: 79.7% of Spanish teachers have spent more than one month studying their chosen language in a country where it is spoken, while this applies to only 11% of Estonian teachers . 

These findings raise the question of whether exposing future teachers to on-the-ground experience of using the language should be considered as a quality criterion in teacher training.

The importance of language learning will be a focus of the 'Multilingualism in Europe' conference, which the Commission is organising in Limassol, Cyprus, on 26-28 September. 

Commissioner Vassiliou will deliver the keynote speech.

 

Click here for full press release