Autism: Birth hormone controls the expression of the syndrome in animals

Researchers found that a drug affecting chloride levels improves autistic-like behaviour in offspring of mouse models of autism. 

The drug restores the so-called GABA switch in the neurons of fetal mice when given to the mother one day before delivery. 

Credit: D.C. Ferrari

The scientific community agrees that autism has its origins in early life—foetal and/or postnatal.

The team led by Yehezkel Ben-Ari, Inserm Emeritus Research Director at the Mediterranean Institute of Neurobiology (INMED), has made a breakthrough in the understanding of the disorder.

In an article published in Science, the researchers demonstrate that chloride levels are elevated in the neurons of mice used in an animal model of autism, and remain at abnormal levels from birth.

These results corroborate the success obtained with the diuretic treatment tested on autistic children by the researchers and clinicians in 2012, and suggest that administration of diuretics to mice before birth corrects the deficits in the offspring.

They also show that oxytocin, the birth hormone, brings about a decrease in chloride level during birth, which controls the expression of the autistic syndrome.

This work is due to appear in the 7 February 2014 issue of Science.

Neurons contain high levels of chloride throughout the entire embryonic phase. As a result, GABA, the main chemical messenger of the brain, excites the neurons during this phase instead of inhibiting them, in order to facilitate construction of the brain.

Subsequently, a natural reduction in chloride levels allows GABA to exercise its inhibitory role and regulate the activity of the adolescent/adult brain.

In many brain disorders (childhood epilepsy, cranial trauma, etc.), studies have shown abnormally high chloride levels.

Having made various observations, Dr Lemonnier's team (Brest), and Yehezkel Ben-Ari's team at Inserm carried out a clinical trial in 2012, based on the hypothesis of high chloride levels in the neurons of patients with autism.

The researchers showed that administration of a diuretic to children with autism (which reduces neuronal chloride levels) has beneficial effects.

The results of the trial supported this hypothesis, but because high neuronal chloride levels could not be demonstrated in children with autism, it was not possible to prove the mechanism proposed or justify the treatment.

In the present study, the researchers therefore used two animal models of autism, a genetic model, Fragile X syndrome, which is the genetic mutation most frequently associated with autism, and another, generated by injecting the pregnant mice with sodium valproate, a product known to generate abnormalities in children, including autistic spectrum disorder.

A high level of chloride in the brain
For the first time, the researchers recorded the activity of neurons at the embryonic stage and immediately after birth to observe modifications in chloride levels.

These observations showed that neuronal chloride levels are abnormally high in both young and adult animals used in the autism model.

GABA strongly excites neurons, and the researchers recorded aberrant electrical activities in the brain, which persist in adult animals.

The fall in chloride level, a particularly impressive phenomenon seen at birth in control animals, is absent in both of these animal models, and the neurons have the same chloride level before and after birth.

These high levels are due to reduced activity of a chloride transporter, thus preventing transport of chloride out of the neuron. As a result, a major feature of neurons during birth is abolished in animal models of autism.

Clinical trials of the drug bumetanide administered in young children with autistic symptoms are showing progress. 

Credit: D.C. Ferrari

"Chloride levels during delivery are determinants of the occurrence of autism spectrum disorder," explains Yehezkel Ben-Ari, an Emeritus Research Director at Inserm.

Beneficial effects of the diuretic on brain activity.
The researchers administered a diuretic treatment to the mother (in both animal models) for 24 hours shortly before delivery to see if this would restore brain inhibition in the offspring.

They showed that the drop in chloride level was re-established in the neurons several weeks after a single treatment during birth.

According to the research team, antenatal treatment restored brain activity to approximately normal levels, and corrected the "autistic" behaviour in the animals once they became adults.

"These results thus validate the working hypothesis that led us to the treatment we developed in 2012," states the principal author of the study.

Oxytocin, the birth hormone, naturally reduces chloride levels
The role of oxytocin in reducing neuronal chloride was also studied. The researchers had previously shown in 2006 that this hormone, which triggers labour, also has many beneficial actions on the brains of newborns, including protective effects in the event of complications during delivery, and even analgesic properties.

Oxytocin acts like the diuretic, reducing the intracellular chloride levels.

By administering the drug bumetanide to pregnant mice with models of autism, the researchers were able to reduce chloride levels in the brains of their offspring to their appropriate levels -- and in turn, to restore the GABA switch mechanism required for healthy brain development. 

Credit: D.C. Ferrari

In the present study, the team tested the long-term effects of blocking the actions of the hormone before birth.

A drug that blocks the signals generated by oxytocin was injected into pregnant mice.

The researchers evaluated the effects of this blockage on the offspring, and showed that it reproduced the entire autism-like syndrome in them, both with respect to the electrical and behavioural aspects (identical to the two animal models of autism).

As a result, the hormone's natural actions, just like those of the diuretic, are crucial to this delicate phase, and may control the pathogenesis of autism via the cellular chloride levels.

"These data validate our treatment strategy, and suggest that oxytocin, by acting on the chloride levels during delivery modulates/controls the expression of autism spectrum disorder," states Yehezkel Ben-Ari.

Taken together, these observations suggest that earliest possible treatment is essential for maximum possible prevention of the disorder.

This work raises the importance of carrying out early epidemiological studies in order to better understand the pathogenesis of the disorder, especially through analysing data on deliveries where a drop in chloride has occurred.

Indeed, complicated deliveries with episodes of prolonged lack of oxygen, for example, or complications during pregnancy, such as viral infections, are often suggested as risk factors.

Finally, given the role of oxytocin in triggering labour, "although it is true that epidemiological data suggesting that scheduled caesarean deliveries may have increased the incidence of autism are controversial, it nonetheless remains that these studies should be followed up and extended to confirm or refute this relationship, which is still possible," insists Yehezkel Ben-Ari, who concludes,

"To treat this type of disorder, it is necessary to understand how the brain develops and how genetic mutations and environmental insults modulate brain activity in utero."

More information: : "Oxytocin-Mediated GABA Inhibition During Delivery Attenuates Autism Pathogenesis in Rodent Offspring," by R. Tyzio et al. Science, 2014. DOI: 10.1126/science.1247190

Autism: 'Receptive Joint Attention' in Chimpanzees provides insight

A discovery that variation in "receptive joint attention," or the ability of chimpanzees to follow another's gaze or look in the direction someone is pointing, has a genetic basis that could provide insight into Autism Spectrum Disorders (ASD).

Following another's gaze or looking in the direction someone is pointing, two examples of 'Receptive Joint Attention,' is significantly heritable according to new study results from researchers at the Yerkes National Primate Research Center, Emory University.

Determining such communicative cues are significantly heritable means variation in this ability has a genetic basis, which led the researchers to the vasopressin receptor gene, known for its role in social bonding.

The study results, which are published in Scientific Reports, give researchers insight into the biology of disorders in which receptive joint attention is compromised, such as autism spectrum disorders (ASD), and may ultimately lead to new diagnosis and treatment strategies.

Larry Young

According to Yerkes researchers Larry Young, PhD, and Bill Hopkins, PhD, co-authors of the study, receptive joint attention is important for developing complex cognitive processes, including language and theory of mind, and poor joint attention abilities may be a core feature in children with or at risk of developing ASD.

Young is division chief of Behavioral Neuroscience and Psychiatric Disorders at Yerkes, director of the Center for Translational Social Neuroscience (CTSN) at Emory and William P. Timmie Professor in the Emory University School of Medicine Department of Psychiatry and Behavioral Sciences.

Bill Hopkins

Yerkes researcher Hopkins is also a core faculty member in the Neuroscience Institute of Georgia State University and newly named science director of the Iowa Primate Learning Sanctuary.

Young and Hopkins led a collaborative team of researchers from Yerkes, the CTSN, the Neuroscience Institute at Georgia State University and the University of Texas M.D. Anderson Cancer Center.

They studied chimpanzees to determine the extent to which the animals follow gaze or pointing by a human.

"We used chimpanzees in this behavioural study because their 'Receptive Joint Attention' abilities are well documented and their closeness to humans makes the study results the most likely to be 'generalizable' (sic) to humans," says Hopkins.

Young's previous research in which he showed the vasopressin receptor gene was necessary for remembering individuals (or social memories) and for social bonding in male rodents was key to designing the current study.

According to Young, variation in the length of a stretch of repetitive DNA, known as junk DNA, in the control region of the vasopressin receptor gene predicted if a male prairie vole was likely to form monogamous bonds with a mate.

Human-based studies suggest that a similar repetitive element, referred to as RS3, in the control region of the human vasopressin receptor gene predicts romantic relationship quality and generosity.

"We can provide insights into the evolution of human social behaviors, and because of the similarities between chimpanzees and humans, we can work toward better understanding the role of biological mechanisms and how they influence cognitive and communicative abilities of primates, including humans," Young continues.

The team's continuing work will include more sophisticated behavioural studies as well as exploration of the contribution of the oxytocin receptor gene on social behaviour and cognition in chimpanzees.

More Information: 'Genetic Influences on Receptive Joint Attention in Chimpanzees (Pan troglodytes)' William D. Hopkins, Alaine C. Keebaugh, Lisa A. Reamer, Jennifer Schaeffer, Steven J. Schapiro & Larry J. Young - Scientific reports: doi:10.1038/srep03774

The Brains of Autistic Children create more information while at rest

Quinn, an autistic boy, and the line of toys he made before falling asleep. 

Repeatedly stacking or lining up objects is a behaviour commonly associated with autism. 

Credit: Wikipedia.

New research from Case Western Reserve University and University of Toronto neuroscientists finds that the brains of autistic children generate more information at rest – a 42% increase on average.

The study offers a scientific explanation for the most typical characteristic of autism – withdrawal into one's own inner world.

The excess production of information may explain a child's detachment from their environment.

Published at the end of December in Frontiers in Neuroinformatics, this study is a follow-up to the authors' prior finding that brain connections are different in autistic children.

This paper determined that the differences account for the increased complexity within their brains.

Roberto Fernández Galán

"Our results suggest that autistic children are not interested in social interactions because their brains generate more information at rest, which we interpret as more introspection in line with early descriptions of the disorder," said Roberto Fernández Galán, PhD, senior author and associate professor of neurosciences at Case Western Reserve School of Medicine.

The authors quantified information as engineers normally do but instead of applying it to signals in electronic devices, they applied it to brain activity recorded with magnetoencephalography (MEG).

They showed that autistic children's brains at rest generate more information than non-autistic children.

This may explain their lack of interest in external stimuli, including interactions with other people.

The researchers also quantified interactions between brain regions, i.e., the brain's functional connectivity, and determined the inputs to the brain in the resting state allowing them to interpret the children's introspection level.

José L. Pérez Velázquez

"This is a novel interpretation because it is a different attempt to understand the children's cognition by analyzing their brain activity," said José L. Pérez Velázquez, PhD, first author and professor of neuroscience at University of Toronto Institute of Medical Science and Department of Pediatrics, Brain and Behavior Center.

"Measuring cognitive processes is not trivial; yet, our findings indicate that this can be done to some extent with well-established mathematical tools from physics and engineering."

Henry and Kamila Markram

This study provides quantitative support for the relatively new "Intense World Theory" of autism proposed by neuroscientists Henry and Kamila Markram of the Brain Mind Institute in Switzerland, which describes the disorder as the result of hyper-functioning neural circuitry, leading to a state of over-arousal.

More generally, the work of Galán and Pérez Velázquez is an initial step in the investigation of how information generation in the brain relates to cognitive/psychological traits and will begin to frame neurophysiological data into psychological aspects.

The team now aims to apply a similar approach to patients with schizophrenia.

More Information: José Luis Pérez Velázquez and Roberto Fernández Galán published this Original Research article.'Information Gain in the Brain’s Resting State: A New Perspective on Autism'

Dyslexic and Loving Words - Video

A film by Vicky Morris

Made for Off the Shelf Festival of Words 2013

Dyslexic and Loving Words asks the question -- "What if you're dyslexic but you love to write or use words?"

Through interviews with seven practicing wordsmiths, the film highlights how it's possible to overcome dyslexic issues or work around the challenges they present if you have a passion for words.

Within the testimonials we find a poet and author, a storyteller, a spoken word artist, a creative writing student, a novelist and the founder of an initiative for dyslexic writers.

John Stein

There are also insights from Mel Hunt, Principal Specialist Teacher at Dyslexia Action Sheffield and Professor John Stein, of the Dyslexia Research Trust.

Check out: 
National Dyslexia Action Charity;
RASP: Rebelling Against Spelling Press (RASP) A publishing company for dyslexic writers.
DYSPLA: Celebrating dyslexic story makers 

Recognise your Parenting Style

Promoting the self-discipline and self-esteem of one’s children often requires an emotional juggling act by parents.

It is not easy to be firm and demanding one minute, then warm and affectionate the next.

In addition, some adults naturally have personalities or temperaments that predispose them toward one parenting style or the other.

Authoritarian Parenting
Parents who tend to overemphasize the discipline side of the equation are referred to as authoritarian.

Authoritarian parents are demanding in the worst sense of the word.

They are intimidators, requiring obedience and respect above all else. They become overly angry and forceful when they don’t get that obedience and respect.

Their love and acceptance appear totally conditional to the child. They do not listen to their kids or explain the reason for their expectations, which are frequently unrealistic.

They often see their children’s individuality and independence as irrelevant or threatening.

Research has shown that authoritarian parents tend to produce children who are more withdrawn, anxious, mistrustful and discontented.

These children are often overlooked by their peers. Their self-esteem is often poor.

Permissive Parenting
Parents who overemphasize the self-esteem side of the equation are referred to as permissive. They may be warm and supportive, but they are not good disciplinarians.

They make only weak demands for good behaviour and they tend to avoid or ignore obnoxious behavior.

They seem to believe that children should grow up without any anger, tears or frustrations.

They reinforce demanding and inconsiderate behaviour from their children. Their love and acceptance are “unconditional” in the worst sense of the word, for they set few limits on what their children do.

Research has shown that permissive parents tend to produce children who are more immature, demanding and dependent. These children are often rejected by their peers.

Their self-esteem is often unrealistic and hard to interpret, for they often blame others for their misfortunes.

Authoritative Parenting Model
Parents who are able to provide for both the discipline and self-esteem needs of their youngsters are referred to as authoritative.

They clearly communicate high—but not unrealistic—demands for their children’s behavior. They expect good things from their kids and reinforce those things when they occur.

When kids act up, on the other hand, authoritative parents respond with firm limits, but without fits of temper.

They are warm, reasonable and sensitive to a child’s needs. They are supportive of a child’s individuality and encourage growing independence.

The Balance
Parents who are able to provide for both the discipline and self-esteem needs of their youngsters are referred to as authoritative.

They clearly communicate high—but not unrealistic—demands for their children’s behavior. They expect good things from their kids and reinforce those things when they occur.

When kids act up, on the other hand, authoritative parents respond with firm limits, but without fits of temper.

They are warm, reasonable and sensitive to a child’s needs. They are supportive of a child’s individuality and encourage growing independence.

Another study Claims effective reduction of ADHD 'Symptoms' using Vitamins

A recent study suggest that vitamins and minerals could be useful for treating the 'symptoms' of ADHD.

As we know, the condition itself is a neurological disorder with no effective cure or treatment.

The small scale study claims that adults with ADHD, given supplements for eight weeks had a "modest" improvement in their concentration span, hyperactivity, and other 'symptoms.'

"A wide range of nutrients, including vitamin D, iron and calcium, may improve brain function." said psychologists in New Zealand.

Another study claims to have found that medication reduced road accidents in men with ADHD.

As many as one in 20 adults has a form of ADHD (attention-deficit hyperactivity disorder), marked by symptoms such as lack of attention, concentration difficulties and impulsiveness.

A variety of medications are prescribed to treat the symptoms of ADHD, such as central nervous system stimulants, which affect brain function and allegedly, improves symptoms.

According to the research, published in The British Journal of Psychiatry (JAMA), taking a broad range of vitamins and minerals may also help reduce ADHD symptoms.

In the study, 80 adults with ADHD were given either supplements containing vitamin D, vitamin B12, folate, magnesium, ferritin, iron, calcium, zinc and copper, or a dummy pill.

After eight weeks of treatment those on supplements reported greater improvements in both their inattention and hyperactivity/impulsivity compared with those taking the placebo.

Julia Rucklidge

Psychologists from the University of Canterbury, in Christchurch, New Zealand, say the effects of vitamins and minerals (micronutrients) are more modest than medication but may be useful for some people, particularly those seeking alternative treatments.

"Our study may provide preliminary evidence of the effectiveness for micronutrients in the treatment of ADHD symptoms in adults," said Prof Julia Rucklidge, who led the study.

"This could open up symptom treatment options for people with ADHD who may not tolerate medications, or do not respond to first-line treatments."

Philip Asherson

Prof Philip Asherson, professor in molecular psychiatry at the Institute of Psychiatry, King's College London, was unconvinced.

He said the suggestion that vitamins and minerals improved brain metabolism was intriguing but needed further investigation.

"It's an interesting study, but it really needs replicating," he told reporters. "The mechanisms behind ADHD and its associated symptoms, remain unclear."

Road accidents
Meanwhile, a separate study on ADHD in Sweden suggests medication could save lives on the road.

Research indicated almost half of transport accidents involving men with ADHD could be avoided if they were taking medication for their condition.

Scientists from the Karolinska Institute studied 17,000 individuals with ADHD over a period of four years using data from health registers.

They found individuals with ADHD had a higher risk of being involved in serious transport accidents, such as car or motorcycle crashes, compared with those without ADHD.

Transport accidents were lower among men with ADHD who were on medication than among men with ADHD who did not take medication.

Calculations showed 41% of transport accidents involving men with ADHD could have been avoided if they had received medication and carried on taking it during the course of the study.

A similar effect was not found in women. It is known that ADHD and its associated symptoms affect men and women differently.

Henrik Larsson

"Even though many people with ADHD are doing well, our results indicate that this serious nerological disorder may have very serious consequences," said Henrik Larsson, associate professor at the Department of Medical Epidemiology and Biostatistics.

"Our study also demonstrates in several different ways that the risk of transport accidents in adult men with ADHD decreases markedly if their condition is treated with medication."

The effect of ADHD on road accidents research is published in the journal JAMA Psychiatry.

Chindren with Autism: EphB Link through Family Genes

Harvard Medical School researchers at McLean Hospital have found that a gene family linked to autism, EphB, is essential for proper brain wiring during development.

The findings suggest that the abnormal brain wiring that results from mutations in this gene family could contribute to autism symptoms.

"Using animal models, we were able to see that EphB is required for normal brain development. Mutations in EphB that compromise its function led to abnormal connections between key brain regions involved in processing of sensory information," said Christopher Cowan, HMS associate professor of psychiatry at McLean Hospital.

The findings were reported by McLean Hospital researchers and collaborators in the Proceedings of the National Academy of Sciences on Jan. 22, 2014.

Christopher Cowan

Recent genetic analysis had revealed an EphB gene as a new candidate risk factor for human autism, so investigators targeted the gene in animals to assess its role in the proper development of communication networks between the thalamus and the cortex, the regions of the brain responsible for processing information from the senses, such as touch and hearing.

"Some individuals with autism show abnormalities in sensory perception and processing, including touch, sound and vision," Cowan explained.

Investigators, from left: Yuhong Guo, Jesse Kumar, Laura Smith, Chris Cowan, Adam Harrington, Maria Carreira, Makoto Taniguchi and Rachel Penrod-Martin. 

Not pictured: Carly Hale and Mike Robichaux. 

Image: Patrick O'Connor.

"We found that EphB genes are essential for normal wiring of at least two key parts of the brain that process sensory information, particularly regions involved in touch and sound," Cowan said.

"Our findings suggest that defects in early brain wiring might underlie at least some of the sensory-associated symptoms found in individuals with autism spectrum disorders."

Future work, supported in part by the Simons Foundation Autism Research Initiative, seeks to extend these findings to better understand the relationship between EphB genes and the risk for developing autism.

Understanding the underlying causes of autism may help in the development of effective treatments.

More information: "EphB receptor forward signaling regulates area-specific reciprocal thalamic and cortical axon pathfinding." Robichaux MA, Chenaux G, Ho HY, Soskis MJ, Dravis C, Kwan KY, Sestan N, Greenberg ME, Henkemeyer M, Cowan CW. Proc Natl Acad Sci U.S.A.. 2014 Jan 22. 

Dyslexia: Able readers damaged by phonics, UK academic

The interests of able readers are being threatened by an insistence primary school pupils are taught to read using phonics, an academic has said.

The UK Department for Education wants English schools to use the reading system, which requires children to blend common sounds into words.

But Durham University researcher Andrew Davis says those already starting to read are likely to be put off.

The UK DfE's 'One Size Fits All' policy, insists synthetic phonics is the best way to teach reading.

The teaching method encourages children to sound out words rather than recognising the whole word and reading it for meaning.

The government strongly encourages schools to use reading schemes based on synthetic phonics, and part-funds a range of books approved as meeting its criteria.

It has also introduced a phonics test for all Year 1 pupils to ensure they are using this method to decode simple words, as well as some made-up words.

It argues this is the best way to ensure no child falls behind with their reading.

But Dr Davis, a former primary school teacher, says in his pamphlet a small minority begin school able to read and understand sentences, while a larger group are able to recognise some words.

'Form of abuse'
He argues those well on their way to reading could be put off by reading books featuring only words for which they have been taught the phonetic rules in class.

He says: "To subject either the fully fledged readers, or those who are well on their way, to a rigid diet of intensive phonics is an affront to their emerging identities as persons.

"To require this of students who have already gained some maturity in the rich and nourishing human activity of reading is almost a form of abuse."

He agrees that phonics can be very useful for teaching reading, but argues it should not be rigidly imposed on all.

'Mechanical exercise'
"Being forced to move back from reading for meaning to a mechanical exercise of blending and decoding is likely to be off-putting," he said.

He added that the fundamentalist approach to synthetic phonics "threatens the interests of a minority of children who arrive at school already able to read".

"The vast majority of Early Years teachers handle this kind of challenge with their usual professionalism, and will continue to do so if they are not troubled by rigid prescriptions from policy makers," he said.

A UK Department for Education spokeswoman said: "Too many children are not reaching the expected levels of reading at a young age, do not catch up, and then struggle in secondary school and beyond.

"Research shows overwhelmingly that systematic phonics is the most effective way of teaching reading to children of all abilities, enabling almost all children to become confident and independent readers.

"Thanks to the phonics check 177,000 six-year-olds will this year get the extra reading help they need to catch up with their peers."

Epilepsy in Children: Good outcomes with staged surgery

A staged approach to epilepsy surgery—with invasive brain monitoring followed by surgery in a single hospital stay—is a safe and beneficial approach to treatment for complex cases of epilepsy in children, reports the February issue of Neurosurgery, official journal of the Congress of Neurological Surgeons.

"Staged epilepsy surgery with invasive electrode monitoring is safe in children with poorly localized medically refractory epilepsy," write Drs. Jonathan Roth and Howard Weiner of NYU Langone Medical Center, New York City, New York.

Their 13-year review suggests that complication rates decrease further as surgeons gain experience with staged epilepsy surgery.

Staged Surgery for the Most Complex Cases of Childhood Epilepsy
From 1996 to 2009, the researchers performed staged surgery in 161 children with refractory epilepsy that could not be controlled with anti-seizure medications.

The children averaged about seven years old. Most had "multifocal" epilepsy originating from more than one area of the brain, often related to a genetic condition called tuberous sclerosis complex.

In the staged approach, children underwent two or more surgical procedures for epilepsy during one hospital admission.

The first step was invasive monitoring—surgery to place electrodes, which were used to map the "epileptogenic" areas of the brain from which seizure activity was originating.

Eighty percent of children subsequently underwent surgery to resect the epileptogenic brain areas.

In a total of 200 hospitalizations, the children underwent nearly 500 surgical procedures for invasive monitoring, resection, and electrode removal.

Dr. Roth and colleagues write, "Most children underwent only one admission, most of which included two or three surgeries."

The current study focused on the safety of staged epilepsy surgery. Complications occurred at rates expected for children undergoing neurosurgical procedures.

This included serious but less-common complications, such as neurologic abnormalities and central nervous system infections; as well as minor complications such as bone absorption or noninfectious fevers.

Twenty-five children had complications requiring surgery.

Benefits of Staged Surgeries Outweigh the Risks
"Notably, surgical experience appeared to lower the complication rate," Dr. Roth and coauthors write.

Complications decreased from 30 percent during the first six years of the experience, to 15 percent in the last six years.

Complication rates were similar in different subgroups of patients, including those with more surgeries or more hospital admissions.

Surgery is an important treatment option for epilepsy that does not respond to medications. However, in some complex cases, the epileptogenic area can't be readily identified or seizures are originating from multiple sites.

The authors' department has previously reported good outcomes with staged surgery for children with complex epilepsy, producing large reductions in seizures for most patients.

However, this approach is still not widely used, perhaps reflecting concerns that it might lead to high complication rates.

The new analysis suggests that staged epilepsy surgery in children is "relatively safe," with no higher than expected types and rates of complications.

However, "When considering the risk-benefit profile in these children with severe epileptic disorders, we found that the benefits outweigh the risks," Dr. Roth and colleagues write.

They believe the staged surgical approach is especially appropriate, given the high risks of severe and repeated seizures in complex childhood epilepsy.

The researchers have no single explanation for the reduction in complications over their 13-year experience, but it may reflect close attention to key technical details and patient care routines.

Helping families cope with autism and aggression

Madeline Rainey

Madeline Rainey holds a portrait of herself with her son when he was a child. 

Rainey hopes a UAlberta study on aggression in kids with autism will spur more research and raise awareness of how families are affected. 

Credit: Richard Siemens

Madeline Rainey admits she compares her son's existence to a life sentence.

"I watched him suffer and be blamed and judged," says Rainey, whose son Eric has autism spectrum disorder with aggression.

"I keep asking, 'When is someone going to do something and recognize the lifelong pain that my kid and I have to live with?'"

Though autism and aggression are not synonymous, many children with autism spectrum disorder (ASD) show aggressive behaviour, which has a significant and lifelong impact on families, according to a University of Alberta study.

"Little has been done to understand families coping with autism and aggression, and if these families don't receive the support they need, things can get bad very quickly," says Sandy Hodgetts, assistant professor of occupational therapy in the Faculty of Rehabilitation Medicine and lead author of the study.

Sandy Hodgetts

"The percentage of children with ASD and aggression is not known because aggression is not a core symptom of autism."

Though the study was small, it was the first to look at families dealing with autism and aggression.

The researchers followed 15 families with male children and young adults with varying levels of autism.

Nine of the 15 families brought up their child's aggression as a barrier to services.

Parents described the impact of the aggression as "constant," "never-ending" and "almost unbearable."

One mother said her son's aggression had become so bad that she was "about ready to be locked up."

Hodgetts says families dealing with aggressive behaviour struggled with social isolation, lack of respite care and limited professional supports.

"The aggressive acts are not malicious. There needs to be better understanding and mechanisms in place to train and support respite care providers and health-care professionals in this area."

Rainey agrees that specialized training could make all the difference. When Eric was in grades 11 and 12, he had a teacher who majored in special education.

She was able to be creative, understand Eric and not be deterred by his aggression.

"I'm grateful for her and we still keep in touch," says Rainey.

Though her son is now 21, Rainey hopes this study can spur more research on autism and aggression. "It raises awareness on the impact on families and can hopefully help remove the social stigma for children and parents."

She hopes that with positive change and awareness, perhaps one day other families don't have to go through what she went through.

"We went from daycare to daycare, from caregiver to caregiver. I was told the reason my son was aggressive was that I was too domineering as a mother and I was told I was too permissive.

I was told to feed my child only organic food so he wouldn't have these behavioural problems. They assumed he was some kind of monster and I was to blame," she says. "It takes a piece of your soul."

More information: Sandra Hodgetts, David Nicholas, and Lonnie Zwaigenbaum. "Home Sweet Home? Families' Experiences With Aggression in Children With Autism Spectrum Disorders." Focus on Autism and Other Developmental Disabilities. September 2013 28: 166-174, first published on January 18, 2013 DOI: 10.1177/1088357612472932