Children with Autism: Blood-oxytocin levels in normal range

Spacefilling model of oxytocin. Created using ACD/ChemSketch 8.0, ACD/3D Viewer and The GIMP. 

Credit: Wikipedia.

Autism does not appear to be solely caused by a deficiency of oxytocin, but the hormone's universal ability to boost social function may prove useful in treating a subset of children with the developmental disorder, according to new findings from the Stanford University School of Medicine and Lucile Packard Children's Hospital Stanford.

Low levels of oxytocin, a hormone involved in social functioning, have for years been suspected of causing autism. Prior research seeking a link has produced mixed results.

Now, in the largest-ever study to test the purported connection, the range of blood oxytocin levels has been shown to be the same in children with autism as that observed in two comparison groups: children with autistic siblings and children without autistic siblings.

In other words, similar numbers of children with low, medium and high oxytocin levels were found in all three groups.

A paper describing the new findings will be published online Aug. 4 in Proceedings of the National Academy of Sciences (PNAS).

Although autism was not directly linked to oxytocin deficiency, the Stanford team found that higher oxytocin levels were linked to better social functioning in all groups.

All children with autism have social deficits, but in the study these deficits were worst in those with the lowest blood oxytocin and mildest in those with the highest oxytocin.

In the comparison groups, children's social skills also fell across a range that correlated to their oxytocin levels.

"Oxytocin appears to be a universal regulator of social functioning in humans," said Karen Parker, PhD, assistant professor of psychiatry and behavioural sciences and the lead author of the study.

"That encompasses both typically developing children as well as those with the severe social deficits we see in children with autism."

Autism is a developmental disorder that affects 1 of every 68 children in the United States. It is characterised by social and communication deficits, repetitive behaviours and sensory problems.

The new study included 79 children with autism, 52 of their unaffected siblings and 62 unrelated children without autism. All of the children were between the ages of 3 and 12.

"It didn't matter if you were a typically developing child, a sibling or an individual with autism: Your social ability was related to a certain extent to your oxytocin levels, which is very different from what people have speculated," said Antonio Hardan, MD, professor of psychiatry and behavioural sciences and the study's senior author.

Hardan is a child and adolescent psychiatrist who treats children with autism at the hospital.

"The previous hypotheses saying that low oxytocin was linked to autism were maybe a little bit simplistic," he said.

"It's much more complex: Oxytocin is a vulnerability factor that has to be accounted for, but it's not the only thing leading to the development of autism."

The researchers caution, however, that blood oxytocin measurements may be different than oxytocin levels in the cerebrospinal fluid bathing the brain, which they did not measure.

In addition to examining blood oxytocin levels, the researchers examined the importance of small variations in the gene coding for the oxytocin receptor.

Certain receptor variants were correlated to higher scores on standard tests of social ability, the study found.

The team also discovered that blood levels of oxytocin are highly heritable: The levels are influenced by inheritance to about the same degree as adult height, which is often described as being strongly influenced by genetics.

"What our study hints at is that social function may be heritable in families," Parker said.

The study will help to guide future research to determine whether oxytocin is a useful autism treatment.

The study's findings suggest that some children with autism, such as the subset of kids with autism who have naturally low oxytocin levels, or those with oxytocin receptor gene variants associated with worse social functioning, might benefit most from oxytocin-like drugs.

"Autism is so heterogeneous," Parker said. "If we can identify biomarkers that help us identify the patients most likely to benefit from a specific therapy, we expect that will be very useful."

More information: "Plasma oxytocin concentrations and OXTR polymorphisms predict social impairments in children with and without autism spectrum disorder," by Karen J. Parker et al. PNAS, www.pnas.org/cgi/doi/10.1073/pnas.1402236111

Making your child into an Accomplished Liar

A primary rule for parents when dealing with lying is don't badger or corner children! Imagine you give a child the third degree about whether or not she has homework.

She denies it six times and finally, after your seventh question, she admits that, Yes, she has some.

What has happened?

By this time, of course, you are furious. More important, however, you also have given your child six times to practice lying!

You may think to yourself, "Sooner or later she'll realize she can't fool me and she'll give up." Wrong. Many children will continue to take the easy way out: they will simply attempt to avoid any confrontation with you and become better liars.

Either You Know the Truth or You Don’t
Look at it this way: you either know the truth or you don't. If you don't know what is going on, ask once and don't badger.

It's a good idea here not to ask "impulsively”.

Many kids simply respond back impulsively. They lie, but their real desire is just to end the conversation, get rid of you, and avoid trouble.

If you are going to ask, you might say something like, "I want you to tell me the story of what happened, but not right now. Think about it a while and we'll talk in fifteen minutes."

If she tells you the story and you find out later that the child lied, punish her for whatever the offense was as well as for the lie. No lectures or tantrums from you.

Deal with the problem and try to fix things, as best you can, so that lying does not seem necessary to the child.

If you do know what has happened, tell her what you know and deal with it. If she has done something wrong that you know about, simply punish her reasonably for that and end the conversation with, "I'm sure you'll do better next time."

Keep Your Perspective
Some parents still prefer to ask a child what happened, even when they already know what it was. This is OK if you do it right.

You should say something like, "I got a call from the school today about an incident at lunch. I'm going to ask you to tell me the story, but not right now. I want you to think about it for a while, and then when you're ready you can tell me, but remember I already pretty much know what happened."

Lying is not good, but it certainly isn't the end of the world either. It happens from time to time. It doesn't mean that your kids don't love you or that they are bound to grow up to become professional criminals.

However, over time, frequent emotional overreactions on your part, combined with badgering and cornering, can produce a very Accomplished Liar.

Autism: Parents advised to get a dog

Many families face the decision of whether to get a dog.

For families of children with autism, the decision can be even more challenging.

Now, a University of Missouri researcher has studied dog ownership decisions in families of children with autism and found, regardless of whether they owned dogs, the parents reported the benefits of dog ownership included companionship, stress relief and opportunities for their children to learn responsibility.

"Children with autism spectrum disorders often struggle with interacting with others, which can make it difficult for them to form friendships," said Gretchen Carlisle, a research fellow at the Research Center for Human-Animal Interaction (ReCHAI) in the MU College of Veterinary Medicine.

"Children with autism may especially benefit from interacting with dogs, which can provide unconditional, nonjudgmental love and companionship to the children."

Carlisle interviewed 70 parents of children with autism. Nearly two-thirds of the parents in the study owned dogs, and of those parents, 94 percent reported their children with autism were bonded to their dogs.

Even in families without dogs, 70 percent of parents said their children with autism liked dogs.

Many dog-owning parents said they specifically chose to get dogs because of the perceived benefits to their children with autism, Carlisle said.

"Dogs can help children with autism by acting as a social lubricant," Carlisle said. "For example, children with autism may find it difficult to interact with other neighbourhood children."

"If the children with autism invite their peers to play with their dogs, then the dogs can serve as bridges that help the children with autism communicate with their peers."

Parents of children with autism should consider their children's sensitivities carefully when choosing a dog in order to ensure a good match between pet and child, Carlisle said.

"Bringing a dog into any family is a big step, but for families of children with autism, getting a dog should be a decision that's taken very seriously," Carlisle said.

"If a child with autism is sensitive to loud noises, choosing a dog that is likely to bark will not provide the best match for the child and the family."

"If the child has touch sensitivities, perhaps a dog with a softer coat, such as a poodle, would be better than a dog with a wiry or rough coat, such as a terrier."

Carlisle recommends parents involve their children with autism when choosing a dog.

"Many children with autism know the qualities they want in a dog," Carlisle said. "If parents could involve their kids in choosing dogs for their families, it may be more likely the children will have positive experiences with the animals when they are brought home."

Although her study only addressed dog ownership among families affected by autism, Carlisle said dogs might not be the best pet for every child with autism.

"If you know one child with autism, you know one child with autism," Carlisle said. "Dogs may be best for some families, although other pets such as cats, horses or rabbits might be better suited to other children with autism and their particular sensitivities and interests."

"This research adds scientific credibility to the benefits of human-animal interaction," said Rebecca Johnson, a professor at the MU College of Veterinary Medicine, director of ReCHAI, and the Millsap Professor of Gerontological Nursing in the MU Sinclair School of Nursing.

"This research helps us understand the role of companion animals in improving the lives of children with autism and helps health professionals learn how to best guide families in choosing pets for their families."

The study, "Pet Dog Ownership Decisions for Parents of Children With Autism Spectrum Disorder," was published in the Journal of Pediatric Nursing earlier this year.

Bullying affects most Adolescents, Popularity Increases the Risk of Getting Bullied

Bullying affects more than just those children who are seen to be isolated and marginalised, according to sociologists.

In fact, researchers have found that the 'popular' students are affected and may actually suffer more from a single act of social aggression.

"We did find that students who are isolated do get bullied," said Diane Felmlee, professor of sociology, Penn State.

Diane Felmlee

"However, for most students, the likelihood of being targeted by aggressive acts increases as a student becomes more popular, with the exception of those at the very top."

In a study of students and their friendship networks in 19 North Carolina schools, the researchers found that the risk of being bullied drops dramatically only for the adolescents in the top five percent of the school's social strata.

Bullying may be a tactical form of aggression, according to the researchers, who report their findings in the current issue of American Sociological Review (pdf).

Young people who are attempting to climb in status may increase their risk of victimization.

Robert Faris

"When youth are vying for status, they probably gain little from attacking students who are already marginalised, in fact, it might backfire," said Felmlee, who worked with Robert Faris, associate professor, University of California Davis.

"But, if adolescents put down someone who is trying to be a leader in their group, or who constitutes a threat to their status, then there is a lot more to be gained."

Faris and Felmlee also found that girls are more likely to be victims of both male and female bullies. Girls who date are at increased risk of physical violence.

"Girls may pose particular threats to other female students' social standing and represent potential rivals when it comes to securing a boyfriend," said Felmlee.

"For boys, girls who date represent rewarding, often popular and relatively easy targets who are unlikely to retaliate physically."

Students who have an aggressive friend tend to avoid being victimized. This may be further evidence that bullying is rarely an individual act, but associated with how friends establish and maintain hierarchies by protecting their own, according to the researchers.

There are serious costs associated with bullying over time, Felmlee said. Victims suffer elevated levels of anxiety, depression and anger. They tend to develop negative feelings about their schools, as well.

Bullying's detrimental effects can be even more pronounced among relatively popular students, according to the researchers.

Higher status students experienced significantly larger increases in depression, anxiety and anger than low-status students.

The friendships of these students also deteriorated.

"The effects of social aggression were magnified by the student's friendship status," said Felmlee.

"It may be that the kids who are extremely popular and rarely victimized had farther to fall than those more accustomed to being a target, so, although socially vulnerable youth suffer significantly from frequent harassment, more central victims of bullying, those who may be 'hidden in plain sight' face serious consequences."

The researchers examined data from the Context of Adolescent Substance Use study, which surveyed about 4,200 middle and high school students twice during the school year.

The surveys included questions on serious verbal and physical harassment, but did not include minor incidents, such as playful teasing.

The students were asked to provide information about their friendships, as well as information about students whom they believe they harassed and about those who they believe harassed them.

UC PlayScape: Educational and health benefits of specially created outdoor play environments

UC PlayScape

University of Cincinnati (UC) researchers are reporting on the educational and health benefits of specially created outdoor play environments for children.

Victoria Carr, a UC associate professor of education and director of the UC Arlitt Child and Family Research and Education Center, and Eleanor Luken, a former UC research associate for the Arlitt Center and current doctoral student at City University of New York, take a look at this growing trend around the world in an article published this month in the International Journal of Play.

The researchers say nationally, children are spending less time on playgrounds as well as less time in just play.

Victoria Carr

"The advantages of building playscapes over traditional playgrounds are considerable," write the authors.

"Children have opportunities to learn about scientific inquiry, mathematics and other embedded concepts as required by curricular methods."

"Not only does it engage children in science, technology, engineering and math (STEM) education at an early age, but it also fosters future stewards for a sustainable environment while providing a developmentally appropriate play and learning venue for the 21st century," the authors state in the article.

The article highlights other countries, Sweden, Australia, Scandinavia, Germany and the United Kingdom among the examples, which are making strides in reconnecting children with nature through play venues in natural settings, as well as international research indicating that these environments not only sharpen attention skills but also reduce depression and symptoms of attention deficit disorders.

Eleanor Luken

"They provide a sense of play that also addresses parental concerns about safety, creates pleasant play environments, supports child development and nurtures nature exploration, setting the stage for environmental stewardship."

"In essence, playscapes can sanction play and recess as an academic learning venue while serving as an early educational model for the next wave of environmentalism," write the authors.

"It appeals to a child's sense of being in a special place, promotes curiosity and demonstrates sustainable practices."

 

Published by Routledge, the International Journal of Play is an interdisciplinary publication that focuses on all aspects of play.

The $401,000 signature UC PlayScape is a wheelchair-accessible outdoor play and learning lab.

The concept was developed as part of a partnership with the Cincinnati Nature Center (CNC) to promote children's free play in natural settings.


The UC PlayScape is believed to be the nation's first college campus, architecturally designed outdoor play and learning environment.

UC's PlayScape is open to the public and is also a spot for adults to take in nature. Here are some of the features:

• A tree house to elevate children into the tree canopy and give them a clear view where they play.
• An open lawn for running, rolling and even sledding.
• A controlled water feature for children to drink and use for play and learning.
• A log fort for children to play, hide and look out over the landscape.
• A sensory garden for children to plant, grow and harvest vegetables and herbs.
• A "bird blind," which is a discreet observation area where children can watch birds in action.
• Gathering decks for children to play, draw, do dramatic work or projects, or rest.
• An observation post for education researchers to examine how this natural setting enhances learning for young children.
• A perimeter fence, providing a safe and secure environment for children to explore within the PlayScape.

Don't suffer from Dyslexia

Credit: LearningAlly.org

More Reading, more talking, and longer sentences help babies' brains

The sooner parents start explaining the world to their baby, the better.

That does not mean flash cards for tots, or merely pointing out objects: "Here's an orange. That's a bowl."

New research shows that both how much and how well parents talk with babies and toddlers helps tune the youngsters' brains in ways that build crucial language and vocabulary skills—a key to fighting the infamous word gap that puts poor children at a disadvantage at an even younger age than once thought.

The idea is to connect words and meaning, so the brain becomes primed to learn through context: "Let's put the orange in this bowl with the banana and the apple and the grapes."

Anne Fernald

"You're building intelligence through language," is how Stanford University psychology professor Anne Fernald explains it.

And forget dumbed-down baby talk: Longer, more complex sentences are better.

Erika Hoff

"The advice I give mothers is to have conversations with your babies," said Erika Hoff, a psychology professor at Florida Atlantic University.

"Children can hear lots of talk that goes over their head in terms of the meaning, and they still benefit from it."

The research, presented Thursday and Friday at a meeting of the American Association for the Advancement of Science, comes amid a growing push for universal preschool, to help disadvantaged youngsters catch up.

But it also begs the question of whether children from low-income, less educated families need earlier intervention, such as preschool that starts at age 3 instead of 4, or higher quality day care or even some sort of "let's talk" campaign aimed at new parents to stress talking, singing and reading with tots even before they can respond.

That can be difficult for parents working multiple jobs, or who may not read well or who simply don't know why it's important.

Scientists have long known that before they start kindergarten, children from middle-class or affluent families have heard millions more words than youngsters from low-income families, leaving the poorer children with smaller vocabularies and less ready to succeed academically.

Fernald said by some measures, 5-year-olds from low-income families can lag two years behind their peers in tests of language development, an achievement gap that's difficult to overcome.

Kimberly Noble

Brain scans support the link, said Dr. Kimberly Noble of Columbia University Medical Center.

Early experiences shape the connections that children's brains form, and kids from higher socioeconomic backgrounds devote more "neural real estate" to brain regions involved in language development, she found.

How early does the word gap appear? 
Around age 18 months, Stanford's Fernald discovered when she compared how children mentally process the language they hear.

Lower-income kids in her study achieved at age 2 the level of proficiency that more affluent kids had reached six months earlier.

To understand why language processing is so important, consider this sentence: "The kitty's on the bench." If the youngster knows the word "kitty," and his brain recognizes it quickly enough, then he has can figure out what "bench" means by the context but if he's slow to recognize "kitty," then "bench" flies by before he has a chance to learn it.

Next, Fernald tucked recorders into T-shirts of low-income toddlers in Spanish-speaking households to determine what they heard all day—and found remarkable differences in what's called child-directed speech.

That's when children are spoken to directly, in contrast to television or conversations they overhear.

One child heard more than 12,000 words of child-directed speech in a day, while another heard a mere 670 words, she found.

The youngsters who received more child-directed speech processed language more efficiently and learned words more quickly, she reported.

But it's not just quantity of speech that matters—it's quality, Hoff cautioned. She studied bilingual families and found that whatever the language, children fare better when they learn it from a native speaker.

In other words, if mom and dad speak Spanish but aren't fluent in English, it's better for the child to have a solid grounding in Spanish at home and then learn English later in school.

Next, scientists are testing whether programs that teach parents better ways to talk to tots really do any good.

Fernald said preliminary results from one of the first, a program called Habla Conmigo that enrolls low-income, Spanish-speaking mothers in San Jose, California, are promising. She analysed the first 32 families of the 120 the program will enroll.

Mothers who underwent the eight-week training are talking more with their toddlers, using higher-quality language, than a control group of parents—and by their second birthday, the children have bigger vocabularies and process language faster, she said Thursday.

Parenting Skills: Positive Reframing

Positive reframing can shore up children’s confidence as well. Credit: iStock

Leo Kanner, author of the first textbook on child psychiatry, used to tell anecdotes about two mothers he knew.

One complained that her sons would spread the Sunday comics on the living room floor to read them.

The other, whose sons had done the same thing as children, said it was one of her fondest memories.

He used to argue that the second mother was the better parent, because she had a more positive attitude.

But what was behind that positive attitude?

Perhaps the mother was thinking about how her children were honing their reading skills. Or, how they were sharing both comics and floor space without fighting.

In other words, she was most likely engaging in what we now call positive reframing, the practice of either focusing on the positive aspects of a bothersome situation or just looking at it differently.

Positive reframing helps us see our children, and our children see themselves in a more favourable light.

If this approach is applied to how we view children, the technique can prevent us from overreacting.

Adolescents
When an adolescent does all those adolescent things, such as leaving her room a mess and spending too much time texting, we can take refuge in the knowledge that by challenging authority and connecting with friends, she is working through an important developmental stage.

Positive reframing can help us understand children from different cultures, too.

For example, Native American students often resist participating in competitive learning games such as spelling bees, causing some teachers to see them as disengaged.

However, when the students' resistance is understood as an expression of a cultural bias toward cooperation over competition, the teacher can see strength in it.

Overcoming Aversions
Applied to helping kids interpret their own behaviour, positive reframing can foster growth. It can help overcome aversions, as it did for one young boy who hated bath time.

Knowing he enjoyed war play, his mother got him to see the bath as a place to enact sea battles, bringing in toy ships and using bubble bath to simulate foamy waves.

The mother of a reluctant eater presented broccoli as "dino trees"—which her "brontosaurus" son would then devour.

Fighting Sleep
A couple with a daughter who resisted going to sleep because her room was dark and scary held a dance party in the dark, after which she associated being in the dark with having a good time.

Positive reframing can shore up children's confidence as well.

On the last play of an important ball game, the right fielder on a children's team I coached, dropped a line-drive fly ball (???), which allowed our opponents to score the winning run.

When the boy came to me distraught, I shared what the pitcher had told me, that his last pitch was too easy to hit, resulting in a hard-to-catch line drive.

I also reminded the boy that before the game, I had denied him time in the outfield to practice 'shagging fly balls.'(???)

He went from thinking he had blown the game to understanding that several factors had contributed to our team's loss.

Finally
Even some of the toughest behaviour problems often respond to positive reframing. For instance, when a first-grader made a beeline for the coloured pencils by walking on chairs and desktops, his teacher said, "That's a great idea to use coloured pencils for your journal and you got them all by yourself."

She went on to suggest that in the future, he keep his feet on the floor, which he agreed to do.

Another teacher, faced with a student, James, who suddenly jumped up from a class meeting and started to dance, turned to his classmates and said matter-of-factly, "James likes to dance." James responded by sitting down and rejoining the meeting.

The developmental psychologist Jerome Bruner praises the unflappable Head Start teacher who, while reading "Little Red Riding Hood" to her young students, was stopped short at the famous lines "All the better to eat you!" line.

At this point, one little boy leapt to his feet, furious, and began cursing the wolf, swearing like a sailor. The teacher simply reflected to herself on how much meaning the boy was finding in the story and then asked him how he would have written it differently. The question got him thinking and quieted him down.

We might try to emulate that teacher's self-possession and know-how the next time a kid's shenanigans drive us to salty language ourselves.

Remember, looking on the bright side is for anyone who wants to help children develop while preserving their own sanity.

Being overweight makes children less active

A new study from the University of Copenhagen's OPUS Research Centre reports that being overweight makes children less active.

The findings underscore that parents of overweight children have an obligation to keep their children active, as physical activity is vital for the general health of all children.

The study also shows that slender children do not become overweight due to a lack of activity.

Over time, children with a higher fat mass reduce their level of physical activity and increasingly pursue sedentary activities such as watching TV or computer gaming.

Conversely, low levels of physical activity or too much time in front of the TV or computer do not cause normal-weighted children to put on weight.

The findings stem from a large study that has just been published in the esteemed journal, the 'International Journey of Obesity'.

New knowledge about the linkage between physical activity and overweight children

The study presents an entirely new body of knowledge about the links between physical activity and being overweight because it investigates developments among test participants over time.

In contrast, most other studies have measured activity at a single point in time, making it impossible to establish whether activity levels affect being overweight, or whether being overweight influences the level of activity:

"The defining characteristic of our work is that we have left a period of six months in between our measurements of activity and weight."

Mads Fiil Hjorth

"Thus, we have been able to investigate how an overweight child's level of activity develops over a half-year," says Mads Fiil Hjorth, a researcher of physical activity, sleep and obesity at the University of Copenhagen's OPUS Research Centre.

Mads Fiil Hjorth emphasises that physical activity is of great value to children.

"Even though our study, in part, shows that a lack of physical activity and lots of TV and computer do not cause children to gain weight, physical activity is obviously very good for children's general health and welfare in a number of other ways.

We have not focused on these areas in this study. Instead, we have specifically focused on the link between physical activity and fat mass."

Danger not limited to those who are overweight

Anders Sjödin

Associate Professor Anders Sjödin, head of OPUS' research into children's activity patterns, points out that the problem also extends to a segment of normal-weight children:

"It wasn't only those children who are classically understood as being overweight who demonstrated poor development in activity levels."

"There were also normal-weight children with slightly larger fat masses," according to Sjödin.

"So, there is no doubt that if someone has a child with a bit too much to pinch around the midsection, parents need to stay attuned to the child's level of activity."

The Method
The study included 600 third and fourth grade children who were equipped with an activity tracker on two occasions, for seven days at a time.

The activity tracker was worn at the start of the project and again after six months. The tracker was able to register around the clock activity levels.

These measurements were compared with measurements of fat mass at both the beginning and end of the project.

Among other things, this demonstrated that children with the highest fat mass experienced the greatest reduction in the amount of activity over the half-year period.

The study's results can be read in the article, Fatness predicts decreased physical activity and increased sedentary time, but not vice versa: support from a longitudinal study in 8-11 year old children', published in the 'International Journey of Obesity'.

More information: "Fatness predicts decreased physical activity and increased sedentary time, but not vice versa: support from a longitudinal study in 8- to 11-year-old children." M F Hjorth, J-P Chaput, C Ritz, S-M Dalskov, R Andersen, A Astrup, I Tetens, K F Michaelsen and A Sjödin. International Journal of Obesity (5 December 2013) | DOI: 10.1038/ijo.2013.229

Rett sufferers: Australian researchers produce new recommendations ease challenges

"Since publication, we have developed leaflets for clinicians and a booklet for families based on the recommendations, which provide information in a readable and understandable format," Dr Helen Leonard says. 

Credit: Bradley Gordon

The Telethon Institute for Child Health Research together with international collaborators have created a comprehensive approach to tackle feeding and growth problems in Rett Syndrome sufferers.

A rare neurodevelopmental disorder caused by a mutation in the X-linked MECP2 gene, Rett Syndrome mainly affects girls and is associated with loss of hand and communication skills between the ages of one and two years.

The children, although apparently normal at birth and in the early months of life, become severely intellectually and physically impaired following this regression.

Impairments include feeding difficulties related to problems with chewing and swallowing, hypersalivation and hyperventilation, which leads to poor growth and weight gain.

Helen Leonard

Telethon Institute expert and lead author Dr Helen Leonard says the project included a literature review, parental input and contributions from a multidisciplinary international panel of 27 clinicians.

The result is a comprehensive set of management recommendations to do with clinical assessment of factors such as growth, feeding difficulties and management to increase energy intake.

"The project pulled together data from 77 articles and three sets of guidelines, which we used to create 34 open–ended questions to inform areas in which the literature was lacking," Dr Leonard says.

"We then received feedback from a range of specialists, including gastroenterologists, paediatricians, child neurologists, clinical geneticists, dieticians, speech pathologists and nurses.

"Using a two–stage Delphi process, agreement was achieved on 101 of 112 statements, which inform recommendations we hope will have a major impact on managing the gastrointestinal and growth problems in Rett Syndrome.

"Since publication, we have developed leaflets for clinicians and a booklet for families based on the recommendations, which provide information in a readable and understandable format."

Dr Leonard says drawing together experts was difficult at times and involved contacting practitioners directly by phone and sending encouraging emails at regular intervals to elicit responses.

Dr Leonard established the first Australia–wide register in 1993 to determine the prevalence of Rett Syndrome, and has managed an international register since 2003.

"I first met girls with this condition over 20 years ago as a doctor working at Disability Services Commission in WA, when the cause of the condition was unknown," she says.

"Since 1993, I have published over 70 journal articles and am continuing my research, including developing guidelines for bone health and evaluating the benefits of gastrostomy feeding."

More information: Leaflets and the booklet for families can be accessed here: rett.childhealthresearch.org.au

Toddlers' Aggression Strongly Associated With Genetic Factors

The development of physical aggression in toddlers is strongly associated with genetic factors and to a lesser degree with the environment, according to a new study. 

Credit: © nadezhda1906 / Fotolia

The development of physical aggression in toddlers is strongly associated with genetic factors and to a lesser degree with the environment, according to a new study led by Eric Lacourse of the University of Montreal and its affiliated CHU Sainte-Justine Hospital.

Lacourse's worked with the parents of identical and non-identical twins to evaluate and compare their behaviour, environment and genetics.

Eric Lacourse

"The gene-environment analyses revealed that early genetic factors were pervasive in accounting for developmental trends, explaining most of the stability and change in physical aggression, " Lacourse said.

"However, it should be emphasized that these genetic associations do not imply that the early trajectories of physical aggression are set and unchangeable."

"Genetic factors can always interact with other factors from the environment in the causal chain explaining any behaviour."

Over the past 25 years, research on early development of physical aggression has been highly influenced by social learning theories that suggest the onset and development of physical aggression is mainly determined by accumulated exposure to aggressive role models in the social environment and the media.

However, the results of studies on early childhood physical aggression indicate that physical aggression starts during infancy and peaks between the ages of 2 and 4.

Although for most children the use of physical aggression initiated by the University of Montreal team peaks during early childhood, these studies also show that there are substantial differences in both frequency at onset and rate of change of physical aggression due to the interplay of genetic and environmental factors over time.

Genetically informed studies of disruptive behaviour and different forms of aggression across the lifespan generally conclude that genetic factors account for approximately 50% of the variance in the population.

Lacourse and his colleagues posited and tested three general patterns regarding the developmental roles of genetic and environmental factors in physical aggression.

• First, the most consensual and general point of view is that both sources of influence are ubiquitous and involved in the stability of physical aggression.
• Second, a "genetic set point" model suggests a single set of genetic factors could account for the level of physical aggression across time. 
• A third pattern labeled 'genetic maturation' postulates new sources of genetic and environmental influences with age.

"According to the genetic maturation hypothesis, new environmental contributions to physical aggression could be of short duration in contrast to genetic factors," Lacourse explained.

About the twins cohort
This twin study was initiated by Michel Boivin of Laval University and Richard Tremblay, who is also affiliated with the University of Montreal and University College Dublin.

All parents of twins born between April 1995 and December 1998 in the Greater Montreal area (Canada) were invited to participate, which resulted in the participation of 667 monozygotic and dizygotic twin pairs.

Monozygotic means the twins originated from the same embryo -- they are genetically identical. Dizogytic means they developed in separate embryos, meaning they are not identical.

Mothers were ask to rate their twins physical aggression, by reporting behavior such as hitting, biting, kicking and fighting, at the ages of 20, 32 and 50 months.

"The results of the gene-environment analyses provided some support for the genetic set-point hypotheses, but mostly for the genetic maturation hypotheses," Lacourse said.

"Genetic factors always explained a substantial part of individual differences in physical aggression."

"More generally, the limited role of shared environmental factors in physical aggression clashes with the results of studies of singletons in which many family or parent level factors were found to predict developmental trajectories of physical aggression during preschool."

Our results suggest that the effect of those factors may not be as direct as was previously thought.

Long-term studies of physical aggression clearly show that most children, adolescent and adults eventually learn to use alternatives to physical aggression.

"Because early childhood propensities may evoke negative responses from parents and peers, and consequently create contexts where the use of physical aggression is maintained and reinforced, early physical aggression needs to be dealt with care," Lacourse said.

"These cycles of aggression between children and siblings or parents, as well as between children and their peers, could support the development of chronic physical aggression."

"We are presently exploring the impact of these gene and social environment interactions."

Journal Reference: 
Eric Lacourse, PhD, Michel Boivin, PhD, Mara Brendgen, PhD, Amélie Petitclerc, PhD, Alain Girard, MSc, Frank Vitaro, PhD, Stéphane Paquin, PhD candidate, Isabelle Ouellet-Morin, PhD, Ginette Dionne, PhD and Richard E. Tremblay, PhD. A longitudinal twin study of physical aggression during early childhood: Evidence for a developmentally dynamic genome. Psychological Medicine, January 2014

Childhood Autism: Evidence-based Interventions helps parents make better choices

More children than ever are being diagnosed with autism, which means more parents than ever face a dizzying array of often expensive treatment options. 

Giving parents and professionals authoritative information is the purpose of a new review spearheaded by the Frank Porter Graham Child Development Institute at the University of North Carolina at Chapel Hill.

Without a thorough review of autism interventions, Allison Smith of Pawtucket, R.I., might never have asked to try video-modeling to help her twin sons, age 4, develop the key motor skill of blowing a feather, a steppingstone to speech.

Allison Smith

"Knowledge is power," said Smith, who found video-modeling on a list of proven interventions from the US National Professional Development Center (NPDC) on Autism Spectrum Disorders, a multi-university center to promote the use of evidence-based practices.

UNC is one of three NPDC operating sites.

"Knowing what works has given us the upper hand in acquiring appropriate therapy and tools."

Autism incurs an average lifetime price tag of $3.2 million per person, according to a 2007 research study in the Archives of Pediatric and Adolescent Medicine but the Autism Society estimates that early diagnosis and effective interventions can reduce that lifetime cost by two-thirds.

Samuel L. Odom

"Parents often pay for interventions that have no evidence behind them," said FPG director Samuel L. Odom, who co-headed the new review.

"This report will allow them to make the best choices."

In this five-year update for the NPDC, UNC scientists screened 29,000 articles about autism spectrum disorders to find the ones proven to work best.

Compared to the 24 proven interventions in the 2008 report, the new report lists 27.

Applying even more stringent criteria this time, the FPG team dropped "structured work systems" and added five practices: "exercise," "structured play groups," "scripting," "modeling" and "cognitive behaviour intervention."

After considering more studies, scientists also renamed and broadened one category, "technology-aided instruction."

Kristine Ganley

"Expanding the list offers more tools to educators and service providers. This improves outcomes for children with ASD," said Kristine Ganley, a training and technical assistance provider at George Mason University.

NPDC's report on evidence-based practices provides important guidance for professionals and families.

Before NPDC's list, parents and professionals often searched for practices online, with unreliable results.

Connie Wong

"Some interventions may seem cutting-edge, but we don't yet know if they have any drawbacks or trade-offs," said FPG investigator Connie Wong, the new report's lead author and co-head of the review of research.

"Our report only includes what's tried and true."

More information: Report: autismpdc.fpg.unc.edu (PDF)

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

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

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

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

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

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

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

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

Rob Siebers

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

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

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

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

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

Autism and prenatal screening

The internet was ablaze last week with the news that health authorities in Western Australia (WA) have given approval for IVF clinics to 'screen' embryos to reduce the chances of a couple having a child with autism.

The Reproductive Technology Council will now allow certain women undergoing IVF treatment to be selectively implanted with female embryos only.

The rationale for this practice is that autism is more likely to affect males than females (approximately 4 males for every 1 female), and by selecting female embryos, the chances of this child developing autism are reduced.

The West Australian reported that: "only families at high risk of having a child with autism, such as families who already have two boys with severe autism, would be considered for embryo screening".

The reaction to this report was swift and furious, and came from all corners of the globe.

Some were concerned about the science underpinning this approach, and pointed to recent evidence that autism may be under-diagnosed in females, and that the gender imbalance in autism may not be as skewed towards males as we once thought.

These critics argue that the selective implantation of female embryos may not actually reduce the chances of a child developing autism.

Others opted for a more extreme attack on health professionals and families, branding the developments as eugenicist - a scientific discipline that advocates practises that are aimed at improving a population's gene pool.

The connotation of this label is a deeply negative one, and will be forever linked to Nazi regime, who used eugenics as a justification for the genocide of Jews, Gypies, homosexuals and others during World War II.

Prenatal screening for autism
This is an extraordinarily sensitive topic and the arguments on both sides of the debate are impassioned.

The concern about the current state of the science is valid. It is a very blunt technique to 'screen' embryos for autism based on sex alone.

Autism is likely to be caused by dozens of gene sets, perhaps in interaction with the environment. It is also quite possible, perhaps probable, that the genetic causes of autism are quite different between individuals.

There is absolutely a link between an individual's sex and their chances of developing autism, but this is only one factor among a constellation of others – many of which remain unknown to us.

To a certain extent, the concern about the validity of the current science is a moot point. Despite constant hype in the recent years, there is currently no genetic test for autism. Importantly, however, this won't always be the case.

The extraordinary developments in genetic technology in the recent past and the immediate future will undoubtedly lead us to a point, not too far from now, where we have the techniques and information to identify whether a person has autism by their genetic make-up alone.

Science is moving fast and this is a debate that needs to be had.

Pre-implantation genetic diagnosis/screening
And this is where we come to the argument about eugenics. Informed opinions are vital here, and it is important that we understand very clearly the exact technology that has been approved.

Pre-implantation genetic diagnosis/screening (PGD) is an IVF technique that occurs at the embryo stage prior to implantation.

An egg from a woman and a sperm from a man are combined outside of the body (i.e., in a petri dish) to create an embryo (a fertilized egg).

That embryo can then be 'screened' to determine whether its genetic make-up increases risk for a given disorder.

If an individual embryo is found to contain a genetic risk factor for this disorder, then it would not be implanted into the woman's womb.

This technique is used in many countries around the world to identify embryos that contain a gene mutation known to definitively cause a disorder, such as cystic fibrosis, haemophilia A and Huntington's disease.

PGD is not the abortion of a developing baby in the womb. It is the screening of fertilized eggs prior to being implanted in the womb.

Two sides of the debate
Understandably, PGD is a technique that causes concern within certain parts of the autism community. Some autism advocates argue that PGD will eventually be used to select autism out of the gene pool.

This is certainly something I would not want. I have forged dozens of friendships with autistic people and their families, and have seen first-hand the skills, talents, smiles and diversity these individuals bring to the lives of those around them. The world is immeasurably improved by their presence in it.

I also imagine how I would feel if I were a person with autism and I heard a discussion about prenatal screening for 'me'.

I imagine how I would feel if the 'all clear' had been given to screen embryos for short-sightedness or for extraversion, both of which are part of who I am.

Angry, outraged, and certainly more than a little unwanted.
The flip-side of the debate is that autism sometimes associated with significant disability that can affect quality of life.

It is without question that a person's life would be improved if they were free from intellectual disability, if they had the facility to communicate more freely, and if they had the capacity to live independently.

To want a person to live without disability does not diminish in any way our love for people in these circumstances, nor their irreplaceable importance in our lives.

Only a minority of our community know the challenges (and joys) of raising a child with significant disability. It is just plain wrong for people who have never been in this position to judge the wants and desires of those who have.

A debate that needs to be had
The discussion about PGD for autism and other developmental disabilities is an important moment in the intersecting paths of science and society.

It is a debate that requires considerable thought, a debate that needs to remain respectful, and a debate that must include autistic people and their families but the science is coming fast, and so above all, it is a debate that needs to be had.

Credit: Andrew Whitehouse at The Conversation AU

TV and video game distractions linked to sleep loss in boys with Autism (ADS/ADD)

Exposure to television and video games could play a role in the sleep problems of children with autism, new research suggests.

Boys with the neurodevelopmental disorder who have TVs and game consoles in their bedrooms get less sleep than other boys with equal screen access, the study authors found.

"If parents of children with autism are noticing that their child struggles with sleep, they might consider monitoring—and perhaps limiting—pre-bedtime exposure" to video games and TV, said study lead author Christopher Engelhardt, a post-doctoral research fellow at the University of Missouri Thompson Center for Autism & Neurodevelopmental Disorders in Columbia, Mo.

It's not clear if the boys in the study get too little sleep, or if they're watching TV and playing video games because they have trouble sleeping.

The findings, reported online Nov. 18 in the journal Pediatrics, don't provide insight into whether the positive aspects of TV watching and video game playing might offset any effect on sleep.

It's estimated that 1 out of every 88 U.S. children has an autism spectrum disorder, according to the U.S. Centers for Disease Control and Prevention.

Symptoms include problems with communication and socialization, and can range from mild, as in Asperger's syndrome, to severe autism. Boys face a much higher risk of autism than girls.

Certain Sleep problems appear to be a hallmark of autism.
"Some sleep problems, such as taking longer to fall asleep and waking up at night, occur in 50 percent to 80 percent of children with autism," Engelhardt said.

"The reasons for these problems are numerous, including trouble with sleep cycles and regulating hormones that are important and necessary for sleep."

Compared to typically developing children, children with autism also seem to be particularly drawn to TV and video games, Engelhardt pointed out.

"We suspect that this is the case, particularly with video games, because the environments, emotions and social interactions are much easier to control and interpret than in real life," he said.

For this study, the researchers wanted to explore the possible impact of TV-watching and gaming on the sleeping patterns of kids with autism.

They surveyed parents of 49 boys with an autism spectrum disorder, 38 with attention-deficit/hyperactivity disorder, and 41 who had neither disorder. The boys were between 8 and 17 years old.

When computers were in the bedroom, sleep differences were significant: about 7 hours for boys with autism compared to more than 8.5 hours for the others.

Boys with autism and a bedroom TV also got less sleep: fewer than 8 hours a night compared to about 8.5 hours for the other boys.

However, the parents weren't asked questions designed to determine if the kids weren't getting enough sleep. And the research doesn't prove that media use deprives these boys of sleep.

It's possible that boys with autism and easy access to TV and video games need less sleep, Engelhardt said. Or they might watch and play because they are awake more.

Still, it's known that sleep disturbances can worsen problematic behaviors of children with autism and interfere with learning and family functioning, the authors noted.

Sleep problems are "one of the top complaints in families who are dealing with autism," said Matthew Belmonte, a neuroscientist at Groden Center in Providence, R.I.

But parents, not professionals, are key to figuring out the proper role of TV and video games in a child's life, added Belmonte, who was not involved with the study.

"You don't need an M.D. or Ph.D. to tell you when a child is just relaxing with a video game or when it's keeping that child awake unnecessarily."

Engelhardt said he enjoys playing video games himself and isn't on a crusade against them. Video games and TV can benefit children with autism, he noted.

"Researchers have known for a long time that video games are excellent teachers, so it's possible that these media can be used to develop and shape the types of behaviours generally valued by society, such as behaviours intended to help and assist others," Engelhardt said.

It's even possible, he added, that relaxing video games and TV shows could help kids with autism sleep better.

Children with Autism: New Study questions traditional 'top down' research

The paper describes that rather than a single entity, autism is multiple disorders. Credit: CampASCCA

Information from the families of 1200 children with autism will be collected from next month to begin the largest autism data study in Australia which includes a team of WA researchers.

Telethon Institute of Child Health Research's Andrew Whitehouse says the project involves several prominent research groups across the nation under the umbrella of the Autism Co-operative Research Centre for Living with Autism Spectrum Disorders which received $31 million over eight years from the Federal Government earlier this year.

Professor Whitehouse says the centre will further extensive work by Telethon including its recent "proof of principle" research which advocates a new approach to autism investigation and whose findings have been documented in the Frontiers of Human Science Journal.

Prof Whitehouse says rather than using the traditional "top-down" approach to investigate the causes of autism, it takes the other end of the "causal pathway," starting with the factors that may produce the disorder.

The paper describes that it is now widely accepted that rather than a single entity, autism is multiple disorders. The variability in the nature and severity of behaviours is thought to exceed that of any other.

"What researchers tend to do is look at behaviours, classify people based on that and then look for genetic or biochemical markers that might be associated with those behaviours," Prof Whitehouse says.

"What we're suggesting is going at it the other way; look at genetic or environmental factors that are known to be associated with autism and look at whether they are then associated with behaviours."

He says after 70 years, researchers are frustrated by not being able to find a clear causal pathway but the only way research can proceed is through large collaborations.

"One lab group alone is not going to be able to solve the riddle of autism—that's just not going to happen," he says.

"We need large numbers of participants who can do both the "top-down" and "bottom-up" approach and that's what we're proposing."

The recently published "bottom-up" study selected participants from the WA Autism Biological Registry to analyse two areas previously linked to ASD diagnoses; low birth weight and maternal use of selective serotonin reuptake inhibitors (SRIs) during pregnancy.

These are found in medications used to treat anxiety and major depression.

Prof Whitehouse says the study provides a blueprint for a "bottom-up" approach, which creates smaller homogenous sub-groups with the autism spectrum, compared with a costly top down approach which requires larges sample sizes.

More Information: 'A “bottom-up” approach to aetiological research in autism spectrum disorders' Lisa M. Unwin1, Murray T. Maybery, John A. Wray and Andrew J. O. Whitehouse.