Autism: Research focused on Men, Women are different

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

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

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

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

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

Simon Baron-Cohen

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

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

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

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

Dr Michael Lombardo

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

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

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

An extra hour of TV diminishes toddlers' kindergarten chances

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

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

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

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

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

Question: Why did you conduct this study?

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

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

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

Question: Who participated in this study?

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

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

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

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

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

Question: Where did you examine television viewing?

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

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

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

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

The hidden purpose of Games: Tracking, diagnosing ADHD

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why children with autism are often bullied

A study of hundreds of teachers and parents of children on the autistic spectrum has revealed factors why they are more or less likely to be bullied.

Dr Judith Hebron and Professor Neil Humphrey from The University of Manchester, say older autistic children are more likely to be bullied than youngsters – going against prevailing thought.

The survey of 722 teachers and 119 parents also revealed that the children would be more likely to be bullied at mainstream, rather than special schools.

However, smaller class sizes and a higher ratio of adults to pupils are two of a number of reasons why there may be fewer opportunities for bullying in special schools.

Bullying is less likely if they have strong support networks of friends and teachers and when parents actively engage with their school.

But poor behaviour associated with the condition also leads to bullying as can use of public transport to travel to and from school.

And those children without a 'statement' – entitling them to specific support and provision - are also less likely to be bullied than children at School Action Plus.

School Action Plus is not legally binding and less extensive than a statement. Because younger students have less complicated social groupings, they may be more tolerant of autism, argue the researchers.

However, as they grow older, tolerance of difference may decrease because teenagers often want to adhere more closely to peer group norms, they say.

Dr Judith Hebron

The results are published in the journal Autism.

Dr Hebron said: "Children with autism are easy targets because their behaviour may be regarded as odd or different, and our research tells us this is likely to result in bullying, teasing and provocation.

"At its most extreme, bullying results in suicide, self-harm, low self-esteem, mental health problems and difficulties at school.

"But not all of these children are bullied, and as researchers, we are interested in finding out why."

She added: "Our results send out a message to parents and teachers to help them identify opportunities where they can intervene to prevent bullying."

"Having an adult on public transport, for example, might be a way to decrease the likelihood of bullying: unstructured social situations with little or no adult supervision are, according to our results, likely to lead to bullying."

"Contrary to what people may think, many children on the autistic spectrum, with support from their school and parents, wish to and are able to make friends, so our findings on the importance of social networks are potentially important."

"Peer groups can be very inclusive and a positive culture within a school with a zero tolerance of bullying can nurture this type of environment."

The article is titled "Risk and protective factors Exposure to bullying among students with autism spectrum conditions: A multi-informant analysis of risk and protective factors."

Parents: Reading Picture books to children is good for them

Parents who read picture books to their two-year-olds could improve their children's language skills, regardless of whether the book contains long sentences or just one or two words, according to new research.

Dr Thea Cameron-Faulkner and Dr Claire Noble from The University of Manchester say simple books with just one or two words per page, like Jez Alborough's Hug, are as beneficial as more traditional storybooks, such as Kipper by Mick Inkpen.

And the key to success, they find, is as much about talking about the books with children as the text itself.

The child language researchers' study of 23 parents reading both books with their children is good news for mums and dads who struggle with reading themselves.

Parent less likely to read books to their children themselves because of poor literacy skills, they say, will still help their children even if they use books which are easier to read.

When the researchers looked at the language in the books in combination with the language the parents used when discussing the books, both simple and more traditional storybooks were equally valuable sources of linguistic input.

Kipper's more complex dialogue was stimulating, so less discussion was needed ,whereas the more simpler text of Hug stimulated more complex discussion.

Both books generated more complex language than a free play situation in which the parent and child played with a toy kitchen, they also found.

Dr Cameron-Faulkner, who is based at the University's School of Arts, Languages and cultures, said: "It's pretty well established that sharing books with young children improves their vocabulary and literacy development, and that language skills are linked to academic attainment generally – including maths.

"Recent studies indicate that one of the key predictors in children's mathematical skill is early language experience, and so the rich linguistic experience associated with shared book reading may have benefits above and beyond language development.

"But what hasn't really been understood is how it impacts on children's ability to learn grammar – a hugely important part of their language development.

"Our research shows quite clearly that books are a valuable source of language input: the language used when sharing books contains more complex, structurally rich constructions than everyday child directed speech.

"And because a simpler book is just as valuable as a more complex one, this is good news for parents who may struggle with their reading."

A previous study by the team of twenty picture books best selling on Amazon,aimed at 2-year-old children, also revealed the types of utterances found in children's books It compared the books to utterances used in everyday speech to children, and is just published in the journal First Language.

The books contained many more utterances important in the development of children's grammar than everyday speech to children, showing the value of reading books to young children.

Dr Noble, who is based at the University's Max Planck Child Study Centre said: "The overarching message of our study is that reading to kids is a good thing to do – and gives children a rich language experience which may not be found in other situations."

"Young children's books often consist of a predictable story, with illustrations acting as cues to aid understanding of the language in the text.

"There's a strong debate in child language research between those who believe language development is innate and those who think it is learned.

"Our view is that language isn't innate, which is why reading to children is such a crucial way to develop their language.

"But children have a range of cognitive skills which in combination with exposure to their native language helps them to learn grammar. This research provide strong evidence for the value of book reading in language development."

Childhood Obesity and Sleep Issues

A sleepless night makes us more likely to reach for doughnuts or pizza than for whole grains and leafy green vegetables, suggests a new study from UC Berkeley that examines the brain regions that control food choices. The findings shed new light on the link between poor sleep and obesity.

Using functional magnetic resonance imaging (fMRI), UC Berkeley researchers scanned the brains of 23 healthy young adults, first after a normal night's sleep and next, after a sleepless night.

They found impaired activity in the sleep-deprived brain's frontal lobe, which governs complex decision-making, but increased activity in deeper brain centers that respond to rewards.

Moreover, the participants favoured unhealthy snack and junk foods when they were sleep deprived.

Matthew Walker

"What we have discovered is that high-level brain regions required for complex judgments and decisions become blunted by a lack of sleep, while more primal brain structures that control motivation and desire are amplified," said Matthew Walker, a UC Berkeley professor of psychology and neuroscience and senior author of the study published today (Tuesday, Aug. 6) in the journal Nature Communications.

Moreover, he added, "high-calorie foods also became significantly more desirable when participants were sleep-deprived.

This combination of altered brain activity and decision-making may help explain why people who sleep less also tend to be overweight or obese."

Previous studies have linked poor sleep to greater appetites, particularly for sweet and salty foods, but the latest findings provide a specific brain mechanism explaining why food choices change for the worse following a sleepless night, Walker said.

Stephanie Greer

"These results shed light on how the brain becomes impaired by sleep deprivation, leading to the selection of more unhealthy foods and, ultimately, higher rates of obesity," said Stephanie Greer, a doctoral student in Walker's Sleep and Neuroimaging Laboratory and lead author of the paper.

Another co-author of the study is Andrea Goldstein, also a doctoral student in Walker's lab.

In this newest study, researchers measured brain activity as participants viewed a series of 80 food images that ranged from high-to low-calorie and healthy and unhealthy, and rated their desire for each of the items.

As an incentive, they were given the food they most craved after the MRI scan.

Food choices presented in the experiment ranged from fruits and vegetables, such as strawberries, apples and carrots, to high-calorie burgers, pizza and doughnuts.

The latter are examples of the more popular choices following a sleepless night.

On a positive note, Walker said, the findings indicate that "getting enough sleep is one factor that can help promote weight control by priming the brain mechanisms governing appropriate food choices."

Recession onset spurs harsh parenting

The onset of the Great Recession and, more generally, deteriorating economic conditions lead mothers to engage in harsh parenting, such as hitting or shouting at children, a team of researchers has found. But the effect is only found in mothers who carry a gene variation that makes them more likely to react to their environment.

The study, conducted by scholars at New York University, Columbia University, Princeton University, and Pennsylvania State University's College of Medicine, appears in the journal Proceedings of the National Academy of Sciences (PNAS).

"It's commonly thought that economic hardship within families leads to stress, which, in turn, leads to deterioration of parenting quality," said Dohoon Lee, an assistant professor of sociology at NYU and lead author of the paper.

"But these findings show that an economic downturn in the larger community can adversely affect parenting—regardless of the conditions individual families face."

Dohoon Lee

The researchers found that harsh parenting increased as economic conditions worsened only for those with what has been called the "sensitive" allele, or variation, of the DRD2 Taq1A genotype, which controls the synthesis of dopamine, a behaviour-regulating chemical in the brain.

Deteriorating economic conditions had no effect on the level of harsh parenting of mothers without the 'sensitive allele'. Just more than half of the mothers in the study had the sensitive, or T, allele.

Likewise, the researchers found that mothers with the 'sensitive allele' had lower levels of harsh parenting when economic conditions were improving compared with those without the sensitive allele.

Irwin Garfinkel

"This finding provides further evidence in favor of the orchid-dandelion hypothesis that humans with sensitive genes, like orchids, wilt or die in poor environments, but flourish in rich environments, whereas dandelions survive in poor and rich environments," said Irwin Garfinkel, a co-author of the paper and the Mitchell I. Ginsberg Professor of Contemporary Urban Problems at the Columbia University School of Social Work (CUSSW).

The findings were based on data from the Fragile Families and Child Wellbeing Study (FFS), a population-based, birth cohort study conducted by researchers at Princeton and Columbia of nearly 5,000 children born in 20 large American cities between 1998 and 2000.

Mothers were interviewed shortly after giving birth and when the child was approximately 1, 3, 5, and 9 years old. Data on harsh parenting were collected when the child was 3, 5, and 9 years old. In Year 9, saliva DNA samples were collected from 2,600 mothers and children.

Harsh parenting was measured using 10 items from the commonly used Conflict Tactics Scale—five items measured psychological harsh parenting (e.g., shouting, threatening, etc.) and five gauged corporal punishment (e.g., spanking, slapping).

The researchers supplemented these data with measurements of economic conditions in each of the 20 cities where the FFS mothers lived.

Specifically, they examined city-level data on monthly unemployment rates, obtained from the Bureau of Labor Statistics' Local Area Unemployment Statistics, and the Consumer Sentiment Index, obtained from the Thomson Reuters/University of Michigan Surveys of Consumers.

In their analysis, they controlled for age, race/ethnicity, immigration status, educational attainment, poverty status, family structure, and child gender and child age (in months) at the time of interview.

The results showed that, contrary to common perceptions, harsh parenting was not positively associated with high levels of unemployment among those studied.

Rather, these behaviours were linked to increases in a city's unemployment rate and declines in national consumer sentiment, or confidence, in the economy.

The researchers concluded that it is the anticipation of adversity i.e the fear of losing one's job due to deteriorating economic conditions, that is a more important determinant of harsh parenting than poor economic conditions or even actual economic hardship a family faces.

Sara McLanahan

"People can adjust to difficult circumstances once they know what to expect, whereas fear or uncertainty about the future is more difficult to deal with," said Sara McLanahan, Princeton's William S. Tod Professor of Sociology and Public Affairs and a co-author of the paper.

In the past, researchers have focused on "bad" or "risky" genes and difficult environments without giving enough attention to how people with these genes may perform in high-quality environments, McLanahan said.

More information: www.pnas.org/cgi/doi/10.1073/pnas.1306440110

FASD impacts brain development throughout childhood and adolescence

Highlighted areas are some of the white matter tracts the research group studied. Credit: U of A

Medical researchers at the University of Alberta recently published findings showing that brain development is delayed throughout childhood and adolescence for people born with Fetal Alcohol Spectrum Disorder (FASD).

Christian Beaulieu and Carmen Rasmussen, the two primary investigators in the research study, recently published the results of their work in the peer-reviewed journal, The Journal of Neuroscience.

Carmen Rasmussen

Their team scanned 17 people with FASD, and 27 people without the disorder, who were between 5 and 15 years old.

Each participant underwent two to three scans, with each scan taking place two to four years apart.

This is the first research study involving multiple scans of the same FASD study participants.

Researchers used an advanced MRI method that examines white matter in the brain. White matter forms connections between various regions of the brain and usually develops significantly during childhood and adolescence.

Those who took part in the study were imaged multiple times, to see what kinds of changes occurred in brain development as the participants aged.

Those without the disorder had marked increases in brain volume and white matter – growth that was lacking in those with FASD.

However, the advanced MRI method revealed greater changes in the brain wiring of white matter in the FASD group, which the authors suggest may reflect compensation for delays in development earlier in childhood.

Sarah Treit

"These findings may suggest that significant brain changes happened earlier in the study participants who didn't have FASD," says the study's first author, Sarah Treit, who is a student in the Centre for Neuroscience at the U of A.

"This study suggests alcohol-induced injury with FASD isn't static – those with FASD have altered brain development, they aren't developing at the same rate as those without the disorder. And our research showed those with FASD consistently scored lower on all cognitive measures in the study."

Treit said the research team also made other important observations. Children with FASD who demonstrated the greatest changes in white matter development also made the greatest gains in reading ability – "so the connection seems relevant."

Christian Beaulieu

And those with the most severe FASD showed the greatest changes in white matter brain wiring. Scans also confirmed those with FASD have less overall brain volume – this issue neither rectified itself nor worsened throughout the course of the study.

The team is continuing their research in this area, in hopes of finding a biomarker for FASD, and to examine how the brain changes from adolescence into adulthood in those with the disorder.

The advanced MRI imaging the team used can pinpoint brain damage present in those with FASD, and could one day guide medical interventions for those with the disorder, which affects one in every 100 Canadians.

American Thoracic Society: Clinical Practice Guideline on ILD in infancy

The American Thoracic Society has released new clinical practice guidelines on the classification, evaluation and management of childhood interstitial lung disease (chILD) in infants.

Childhood ILD includes a diverse group of rare lung diseases found in infants, children and teens that involve the interstitial tissues of the lung, which surround the air sacs (alveoli) in the lung and airways (breathing tubes).

It is not known how many children have these disorders. Some types of chILD are caused by other diseases, while the cause is unclear in others, and prognosis varies by disease type.

The new guidelines appear in the August 1 American Journal of Respiratory and Critical Care Medicine.

"The characteristics and natural history of ILD differ in children and adults," said Geoffrey Kurland, MD, of the Division of Pediatric Pulmonology at the Children's Hospital of Pittsburgh and a member of the committee that drafted the guidelines.

"These new guidelines specifically address the diagnostic evaluation and management of chILD in neonates and infants, as most of the new diagnostic entities that have been recently described affect infants disproportionately."

The guidelines' recommendations include the following:

Diagnosis:

• Once other possible causes of lung disease symptoms have been eliminated, "chILD Syndrome" can be diagnosed if at least three of the following four criteria are present: (1) respiratory symptoms (cough, rapid and/or difficult breathing, or exercise intolerance), (2) respiratory signs (tachypnea, adventitious sounds, retractions, digital clubbing, failure to thrive, or respiratory failure), (3) hypoxemia, and (4) diffuse abnormalities on a chest radiograph or computed tomography (CT) scan. 
• In patients with chILD Syndrome, diagnostic testing should be performed to determine the exact chILD diagnosis and echocardiography should be performed as part of the initial evaluation to rule out structural cardiovascular disease and pulmonary hypertension.
• If thin section CT is performed, the lowest radiation dose that provides adequate diagnostic information should be used.
• For neonates and infants with chILD Syndrome in whom other diagnostic investigations have not identified the precise chILD disease, or in whom there is clinical urgency to identify the precise chILD disease, surgical lung biopsy should be performed, preferably using video-assisted thoracoscopy rather than open thoracotomy. 
• Appropriate genetic testing should be performed.

Management:

• As there have been no controlled trials of any therapeutic interventions in chILD Syndrome, management is based upon indirect evidence, case reports and clinical experience. 
• For infants with severe, life threatening chILD diseases, referral to a pediatric lung transplantation center after discussion with the family is recommended.
• Given the limited evidence of a beneficial effect on clinical outcomes and the well-known side effects of immunosuppressive medications, the decision about whether or not to initiate a trial of immunosuppressive therapy must be made on a case-by-case basis. Considerations include the severity of disease, rate of progression, prognosis without treatment, co-morbidities and family values and preferences. 
• All patients with chILD Syndrome should receive supportive and preventive care, including treatment of co-morbidities and prevention of infection. 
• Families of patients with chILD Syndrome should receive education and support from care providers.

Research priorities:

• Establish accurate incidence and prevalence rates of specific chILD diagnoses. 
• Determine the natural history and clinical phenotypes of specific chILD diagnoses and their relationships to adult pulmonary disease through international databases. 
• Further delineate the mechanisms underlying chILD diagnoses. 
• Conduct multicenter studies of protocol-driven diagnostic, therapeutic and quality approaches to chILD Syndrome to ascertain the optimal methods of clinical evaluation and management. 
• Create high-quality, accessible tissue repositories and biobanks to enhance research efforts 
• Promote common terminology for chILD diagnoses and their continued inclusion in future revisions of The International Classification of Diseases (ICD).

"As our understanding of the distinctions between adult and child ILD developed, the need for clinical practice guidelines on the diagnosis and management of chILD became clear," said Dr. Kurland.

"These guidelines should help clinicians navigate the evaluation and management of children with this complex constellation of diseases."

Childbirth: Both parents experience Surges in Sexuality

Partners of new mothers often experience shifts in sexuality, and these shifts are often unrelated to biological or medical factors pertaining to childbirth.

The findings, which are published in a recent issue of The Journal of Sexual Medicine, expand current understanding of postpartum sexuality, and may help health professionals as they counsel new parents.

Research on postpartum sexuality has typically focused on female reproductive biology in birth mothers—for example, how hormonal changes that accompany pregnancy, birth, and breastfeeding affect sexual desire, or how birth-related interventions affect sexual activity.

Few studies have looked at sexuality in the partners of postpartum women, even though it may be important for postpartum women's perceptions of their own sexuality.

Sari van Anders

Sari van Anders, PhD, of the University of Michigan in Ann Arbor, and her colleagues designed a study to examine postpartum sexuality as a social and relational process, focusing on co-parents.

A total of 114 partners (95 men, 18 women, 1 unspecified) of postpartum women completed an online questionnaire about their sexuality during the three months following their youngest child's birth.

Attention was paid to physical, social, psychological, and relational experiences.

The researchers found that partners experience shifts in sexuality, just as birth mothers do. The changes that they experienced were linked to relational and social processes, not just biological or medical factors.

In fact, low desire in partners was largely influenced by factors related to caring for a new baby—such as fatigue and stress—rather than by factors related to the birth and/or birth mother, as more typically presumed.

"Our findings help to clarify how co-parents experience sexuality in myriad ways that are contextualized within partner and parenting relationships," said Dr. van Anders.

"What is of note is that we have come to recognize that sexual health of one partner may be related to the sexual health of the other, no matter the cause of the change in sexuality. It is important to publish studies in all aspects of sexual health," explained Irwin Goldstein, editor-in-chief of The Journal of Sexual Medicine.

More information: "Exploring co-parent experiences of sexuality in the first 3 months after birth." Sari M. van Anders, Lauren E. Hipp, and Lisa Kane Low. The Journal of Sexual Medicine; Published Online: August 1, 2013 DOI: 10.1111/jsm.12194