Traverse

cumberland

Sean,

If you want to stay up-to-date on autism news you could use a Google service called "Google alerts."
Go to the Google home page and click on "more." Then click on "Alerts." Pretty good explanation given on line.
You could set up news and web alert on up to 10 topics. ie. "coast guard" + helicopter, etc. It will return a daily email about any and all stories on your chosen topic.

Good luck with it.

Gerry

New York Times

http://www.nytimes.com/pages/health/healthspecial2/index.html

Links to Check Out:

http://www.autismforum.net/

http://www.aspiesforfreedom.org/

http://www.autistics.org/

http://www.chatautism.com/

Scientists suggest autism involves more than genes

05:16 PM CDT on Sunday, September 12, 2004

By SUE GOETINCK AMBROSE / The Dallas Morning News

Houston scientists and their colleagues have proposed a new explanation for what causes autism, a neurological disorder that affects about one in 1,000 children.

While many researchers believe inheritance of faulty genes is at autism's root, the new idea suggests that the cause is more complex. Errors in genes may combine with so-called "epigenetic" errors, and either may be inherited or occur for the first time in the affected child, says Dr. Art Beaudet, a geneticist at Baylor College of Medicine. Epigenetic errors cause cells to use genes abnormally, but are distinct from errors in genes themselves.

An article describing the new theory appeared online last week in the American Journal of Medical Genetics Part A.

Dr. Huda Zoghbi, also a geneticist at Baylor, said the proposal offers a fresh idea to researchers still struggling to figure out what causes autism, even after many years of research.

"I think Art's model is the most efficient," says Dr. Zoghbi, who is also a researcher with the Howard Hughes Medical Institute. "It reconciles all the issues. He really thought about all these different scenarios and pulled them together to come up with a solid hypothesis to explain autism."

Autism has many variations, but it typically begins in childhood. It can impair thinking, language and the ability to relate to others. Boys with autism outnumber girls by a ratio of more than 3-1. And in recent years, for reasons that are still unclear, the number of reported cases of autism has skyrocketed.

Researchers have focused on finding a genetic cause for the disorder because autism runs in families. For instance, if one identical twin has autism, the other twin's chance of having autistic symptoms are as high as 90 percent. Fraternal twins and siblings are also at increased risk if a brother or sister has the disorder.

"So one argument has been," Dr. Beaudet says, "that there are many genes involved – maybe 10 or 15 or 20 – and that some magical combination causes autism."

But there are other hints about how autism occurs. In rare cases, children develop autism when they inherit a faulty gene from one parent, but not when they inherit it from the other. This is the hallmark of an "epigenetic" effect, a modification to genetic information that changes how the gene is used but does not affect the makeup of the gene itself. Epigenetics is a relatively new frontier in biomedical research, and scientists are just beginning to look for epigenetic links to disease.

Dr. Beaudet says he hopes scientists will have more success at finding the cause of the vast majority of autism cases by broadening their search for clues. In addition to considering epigenetic – instead of only genetic – effects, Dr. Beaudet says scientists should look beyond inherited causes.

Genetic or epigenetic errors could pop up for the first time in each patient individually, instead of being inherited from parents. The medical community already knows of genetic disorders that occur for the fist time in a new generation. A classic example is Down syndrome, a mental retardation condition caused by an extra chromosome.

If autism is really popping up new in most children, Dr. Beaudet says, it could explain why the many large studies that focus on genes passed from parents to children haven't found culprit genes for the majority of cases.

In the new study, Dr. Beaudet proposes that problems with a gene linked to a neurological condition called Angelman syndrome also may cause autism. Dr. Beaudet and his colleagues found epigenetic changes to that gene in the brain of a patient with autistic features. Examination of many other brains of autism patients, however, didn't show the same change.

Data to support Dr. Beaudet's theory are scarce at this point, he says. He concedes that the whole idea may even be wrong. But at present, he contends, the theory fits with everything scientists know about autism, and deserves further study.

His own studies, he says, will focus on the UBE3A gene and others in mice. One theory he'd like to test is whether nutrients such as folic acid can result in epigenetic changes to genes linked to autism. Other studies have shown that nutritional supplements that include folic acid cause epigenetic alterations of other genes. And, he says, an increase in dietary folic acid – from prenatal vitamins and fortification of the food supply – has overlapped the increase in cases of autism.

It's pure speculation at this point, Dr. Beaudet says, but "in my mind there's a potential connection."

E-mail sgoetinck@dallasnews.com

Measles Vaccine Not Linked to Autism in Children, Lancet Finds

Sept. 10 (Bloomberg) -- The childhood vaccine for measles, mumps and rubella doesn't raise the risk of autism and similar conditions, according to a Lancet study, adding to evidence that there's no link between the immunizations and autistic disorders.

Children with autism, Asperger's syndrome and related ailments were vaccinated at about the same rate as other children, London School of Hygiene and Tropical Medicine researchers found. Some 78 percent of 1,294 autistic children had MMR shots, compared with 82 percent of 4,469 non-autistic children, the study said.

The share of U.K. children being vaccinated fell to 82 percent last year from 92 percent in 1996, the Lancet said in an e-mailed release. Some parents began avoiding the MMR vaccine after a 1998 study of 12 children linked it to autism. Ten of 12 authors retracted that study's findings earlier this year.

``We have found no convincing evidence that MMR vaccination increases the risk of autism or other pervasive developmental disorders,'' said Liam Smeeth, the Lancet study's lead researcher, in the release. ``These are severe diseases for which very little is known about causation; this absence of knowledge itself might have contributed to the misplaced emphasis on MMR as a cause. Research into the real origins of autism is urgently needed.''

Autism and related disorders affect as many as 6 of every 1,000 children, according to the U.S. Centers for Disease Control and Prevention. About two in five autistic children don't speak, while others repeat phrases or actions over and over, and many don't interact normally with other children or adults, the CDC says. Autism strikes more boys than girls.

A 2002 Danish study of 537,303 children's medical records found no connection between MMR immunizations and autism.

Vaccines Since 1970s

MMR vaccines made by companies including GlaxoSmithKline Plc and Merck & Co. have been used worldwide since the early 1970s. The vaccines contain live parts of the three viruses, prompting the body to make antibodies to fight off the diseases.

Measles infects more than 31 million people a year, killing 770,000, according to the World Health Organization. The disease is the top cause of child deaths that could be prevented through vaccines, WHO says. Rubella can lead to miscarriages and birth defects if pregnant women are infected. In rare cases mumps causes deafness and swelling of the brain or brain lining.

The number of measles cases in Europe fell 78 percent from 1991 to 2001, while rubella cases rose 75 percent, according to WHO, the United Nations health agency. The current rate of MMR immunizations in the U.K. isn't high enough to prevent measles epidemics, according to the Medical Research Council, which funded the Lancet study.

The Lancet researchers used patient records entered into the U.K. General Practice Research Database between 1987 and 2001. They didn't find any significant differences when they focused on those with autism as opposed to similar developmental disorders and those vaccinated before the age of 3 or before media coverage of the study connecting the vaccines to autism.

To contact the reporter on this story: Martiga Lohn in Berlin   mlohn1@bloomberg.net



To contact the editor responsible for this story: Mark Rohner at   mrohner@bloomberg.net

Last Updated: September 9, 2004 19:01 EDT

Simple Screening Test Allows Early Detection of Autism

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP

Disclosures
To earn CME credit, read the news brief along with the CME information that follows and answer the post test questions.
Release Date: August 5, 2004; Valid for credit through August 5, 2005
Credits Available
Physicians - up to 0.25 AMA PRA category 1 credit(s)


Aug. 5, 2004 —The Checklist for Autism in Toddlers (CHAT-23), a simple two-part screening test, aids in the early detection of autism in Chinese children aged 18 to 24 months, according to the results of a cohort study described in the August issue of Pediatrics.

"There is a recent trend of a worldwide increase in the incidence of autistic spectrum disorder. Early identification and intervention have proved to be beneficial," write Virginia Wong, FRCP, FHKAM, FHKC, from the University of Hong Kong, and colleagues. "The original version of CHAT was a simple screening tool for identification of autistic children at 18 months of age in the United Kingdom. Children with an absence of joint attention (including protodeclarative pointing and gaze monitoring) and pretend play at 18 months were at high risk of autism."

The first section of this instrument is a self-administered parent questionnaire addressing rough and tumble play, social interest, motor development, social play, pretend play, protoimperative pointing (pointing to ask for something), protodeclarative pointing (pointing the index finger to indicate interest in an object), functional play, and showing. The second section consists of five items recorded after observation by general practitioners or health visitors: eye contact, ability to follow a point (gaze monitoring), pretend (pretend play), produce a point (protodeclarative pointing), and make a tower of blocks.

In this cross-sectional cohort study, 212 Chinese children with mental ages of 18 to 24 months were tested with the CHAT-23, a new checklist translated into Chinese. Of the 212 children, 125 were not autistic, and the remaining group had autistic disorder (n = 53) or pervasive developmental disorder (n = 33).

Based on discriminant function analysis, there were seven key questions that could best discriminate autism from nonautism, addressing areas of joint attention, pretend play, social relatedness, and social referencing. On the parental questionnaire, failing any two of seven key questions yielded a sensitivity of 0.931 and specificity of 0.768. Failing any six of all 23 questions produced a sensitivity of 0.839 and specificity of 0.848. The seven key questions included on the parental questionnaire were: does your child imitate you; does your child ever pretend to talk on the telephone, take care of dolls, or other pretend behaviors; does your child ever use his/her index finger to point or to indicate interest in something; does your child look at your face to check your reaction when faced with something unfamiliar; does your child ever bring an object to you to show it to you; if you point at a toy across the room, does your child look at it; and does your child take an interest in other children?

On the observational portion of CHAT-23, failing any two of four items produced a sensitivity of 0.736, specificity of 0.912, and a positive predictive value of 0.853. These items were making eye contact, looking to see what the examiner was pointing at, pretending to pour out or drink tea, and pointing with the index finger at a light.

Study limitations include increased chance of identifying autism because 41% of the cohort was autistic, and higher age of autistic subjects compared with nonautistic subjects.

"We found that integrating the screening questions of the M-CHAT [Modified-CHAT] (from the United States) and observational section B of the original CHAT (from the United Kingdom) yielded high sensitivity and specificity in discriminating autism at 18 to 24 months of age for our Chinese cohort," the authors write. "We recommend identifying the possible positive cases with part A (parental questionnaire) and then proceeding to part B (observation) with trained assessors.... Whether this approach is feasible in the United States depends on the local medical system and screening procedures."

Pediatrics. 2004;114:e166-e176

Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:

* Describe behaviors predictive of autism at a later age.
* Identify appropriate screening questions and tools for autism in younger children.


Clinical Context

Although autism may manifest itself in certain behaviors when children are younger than 24 months, predicting children who will go on to develop this disorder is not easy. Baron-Cohen and colleagues demonstrated in the February 1996 issue of the British Journal of Psychiatry that the absence of three key items at age18 months: protodeclarative pointing (pointing the index finger to indicate interest in an object), gaze response (the child looks at an object the interviewer describes), and pretend play (the child acts out pretend activities), reliably predicted 83.3% cases of autism among all children screened. Follow-up of these children with autism demonstrated that the diagnosis remained valid at 3.5 years of age.

CHAT first espoused by Baron-Cohen and his fellow group of researchers has been since modified to improve both positive predictive value and efficiency. The current research incorporates two versions of the CHAT in an attempt to create an autism screening algorithm for young children.

Study Highlights

* This cross-sectional study was performed on children with autism, developmental delay, and normal development recruited from clinics in Hong Kong. Children were between the chronologic ages of 13 to 86 months and tested to have mental ages between 18 to 24 months. The authors used mental age as their main criteria for study entry because they could not find a sufficient number of children between 18 to 24 months chronologic age diagnosed with autism. The diagnosis of autism in this cohort was confirmed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.
* Children with other active medical conditions or receiving antiepileptic medications were excluded from participation.
* The authors created combined several elements of the original CHAT test as well as the M-CHAT and administered these examinations to study participants. 23 questions from the M-CHAT were included, along with section B of the original CHAT. Answers to the questionnaire completed in part A of the new CHAT-23 were modified so parents could rate the frequency of behaviors. Part B of the new CHAT examination was performed under the supervision of trained researchers examining children's behavior. Part A took approximately 10 minutes for parents to complete, while part B allowed for less than 5 minutes of direct observation time. Interobserver reliability for part B of the examination was good.
* 87 children with autism or pervasive developmental disorders and a mean chronologic age of 51.3 months were included, along with 67 children with developmental delay (mean age, 33.5 months) and 58 children with normal development (mean age, 23.9 months).
* Only 2 questions of the 23 questions of part A of the examination, one regarding whether the child enjoyed being swung or bounced and another focused on the ability to walk, were found not to discriminate between autism and nonautism.
* Seven questions from part A were found to have the best discriminating value between children with autism and the other groups. These questions regarded (in descending order of value): imitative behaviors, pretend play, protodeclarative pointing, whether the child checks the parents reaction before reacting on his/her own when faced with a new situation, whether the child brings objects to show parents, gaze response, and whether the child takes an interest in other children. The best balance of sensitivity and specificity for screening for autism was found when children failed 2 of these 7 questions (sensitivity 93.1%, specificity 76.8%).
* Using the criteria of failing any 6 of the 23 total questions on part A of the examination, the sensitivity of screening for autism decreased to 83.9%, but specificity improved to 84.8%.
* All of the 4 items (making eye contact, gaze response, pretend play, and protodeclarative pointing) used in part B of the examination were discriminatory for autism vs. nonautism. Failing any 2 of these 4 items correlated with a sensitivity of 73.6% and a specificity of 91.2%.
* Based on these data, the authors recommend a two-part screening process for young children with autism. The questionnaire from part A of their examination (using either failing 2 of the 7 key questions or 6 of the 23 total number of questions as a "positive" screen) would serve as the initial screening tool. Children with a positive screen could then be evaluated with the more specific observational component of the examination.


Pearls for Practice

* The absence of the following three key items at age 18 months reliably predicted 83.3% cases of autism among all children screened: protodeclarative pointing (pointing the index finger to indicate interest in an object), gaze response (the child looks at an object the interviewer describes), and pretend play (the child acts out pretend activities).
* A two-stage screening process for autism in children with mental age between 18 to 24 months represents a reasonably sensitive, specific, and efficient screening tool.


Post Test

1. Using the CHAT-23 parental questionnaire, which of the following questions can potentially predict a diagnosis of autism in young children as indicated in the study by Baron-Cohen and colleagues?
  a. When pointing to a toy across the room, does the patient look towards the toy?
  b. Does the patient ever mimic actions of others?
  c. Does the patient interact with other children?
  d. Does the patient bring objects of interest over to you?
  e. All of the above
 
2. Which of the following was not a screening questionnaire item that discriminated between autism and nonautism in the current study by Wong and colleagues?
  a. Inability to walk
  b. Lack of pretend play
  c. Lack of protodeclarative pointing
  d. Lack of imitative behavior
  e. Lack of bringing objects to parents to examine
 

Links

Sibling Support Project
Donald J. Meyer

http://www.thearc.org/siblingsupport/



KidsHealth Website
Voted World's Best Health Site

http://www.KidsHealth.org/

Val,
Bonnie, Kelly and I are going to the Penn State Autism Conference this upcoming week. We leave on Monday and will return Wednesday night. We will send you any information that is available.
Jerry

Thu Jul 29 07:38:08 2004 Pacific Time

      Carnegie Mellon and University of Pittsburgh Scientists
 
Discover Biological Basis for Autism
      
PITTSBURGH, July 29 (AScribe Newswire) -- A team of brain scientists at Carnegie Mellon University and the University of Pittsburgh have made a groundbreaking discovery into the biological basis for autism, a mysterious brain disorder that impairs verbal and non-verbal communications and social interactions.
       Using functional magnetic resonance imaging (fMRI) scans, the researchers have found numerous abnormalities in the activity of brains of people with normal IQs who have autism. The new findings indicate a deficiency in the coordination among brain areas. The results converge with previous findings of white matter abnormalities in autism. (White matter consists of the "cables" that connect the various parts of the brain to each other). The new findings led the researchers to propose a new theory of the basis of autism, called underconnectivity theory, which holds that autism is a system-wide brain disorder that limits the coordination and integration among brain areas. This theory helps explain a paradox of autism: Some people with autism have normal or even superior skills in some areas, while many other types of thinking are disordered. The team's study will be published in the August edition of the British journal Brain and is available online at www.brain.oupjournals.org.
       In explaining the theory, Marcel Just, one of the study's lead authors and director of Carnegie Mellon's Center for Cognitive Brain Imaging, compared the brain of a normal person to a sports team in which the members cooperate and coordinate their efforts. In an autistic person, though some "players" may be highly skilled, they do not work effectively as a team, thus impairing an autistic's ability to complete broad intellectual tasks. Because this type of coordination is critical to complex thinking and social interaction, a wide range of behaviors are affected in autism.
       The research team believes these are the first findings in autism of differences in the brain activation patterns in a cognitive (non-social) task. The study produced two important new findings that help make sense of previous mysteries: The autistic participants had an opposite distribution of activation (compared to the control group) in the brain's two main language areas, known as Broca's and Wernicke's areas. There was also less synchronization of activation among key brain areas in the autistic participants compared to the control group.
       To obtain technically acceptable fMRI data from high-functioning autistic participants, the researchers flew in people with autism from all over the eastern United States. High-functioning participants with autism (with IQ scores in the normal range) are rare, accounting for about 10 percent of all people with autism.
       Using non-invasive fMRIs, the team looked at the brains of 17 people with autism and 17 control subjects as they read and indicated their comprehension of English sentences. In both the healthy brains and in the brains with autism, language functions were carried out by a similar network of brain areas, but in the autism brains the network was less synchronized, and an integrating center in the network, Broca's area, was much less active. However, another center, Wernicke's area, which does the processing of individual words, was more active in the autism brains.
       The brain likely adapts to the diminished inter-area communication in autism by developing more independent, free-standing abilities in each brain center. That is, abnormalities in the brain's white matter communication cables could lead to adaptations in the gray matter computing centers. This sometimes translates into enhanced free-standing abilities or superior ability in a localized skill.
       These findings provide a new way for scientists and medical researchers to think about the neurological basis of autism, treating it as a distributed system-wide disorder rather than trying to find a localized region or particular place in the brain where autism lives. The theory suggests new research to determine the causes of the underconnectivity and ways to treat it. If underconnectivity is the problem, then a cognitive behavioral therapy might be developed to stimulate the development of connections in these higher order systems, focusing on the emergence of conceptual connections, interpretive language and so on. Eventually, pharmacological or genetic interventions will be developed to stimulate the growth of this circuitry once the developmental neurobiology and genetics of these brain connections are clearly defined by research studies such as these.
       The research team is jointly headed by Just, the D.O. Hebb Professor of Psychology at Carnegie Mellon, and Dr. Nancy Minshew, professor of psychiatry and neurology at the University of Pittsburgh School of Medicine and director of its Center for Autism Research. Individuals with High Functioning Autism and Asperger's Syndrome between 10 and 55 years of age who are interested in participating in similar studies can send email to autismrecruiter@upmc.edu or call Nikole Jones at 412-246-5481.
       CONTACT: Jonathan Potts, CMU Media Relations,
       412-268-6094, jpotts@andrew.cmu.edu

"Refrigerator Mothers" Documentary To Re-Air July 27 On PBS



The award-winning documentary film "Refrigerator Mothers" is set 

to air again on PBS on July 27, 2004. The film, which was developed by 

J.J. Hanley, the parent of a child with autism, "explores the legacy of 

blame, guilt and self-doubt suffered by a generation of mothers," who during the

1950s were blamed for their children's autism and labeled "refrigerator

mothers."



The captivating documentary tells the story the story of autism 

from the early years to the present time and includes archival footage from 

old training films, interviews with ASA leaders, such as founder Bernard

Rimland, Ph.D., and interviews with several parents of children who 

attended the school created by Bruno Bettleheim, the self-proclaimed 

psychoanalyst who popularized the "mother blame" theory.



Since it first aired in 2002, "Refrigerator Mothers" has won 

numerous awards, including Best Documentary at the 2002 Sedona International 

Film Festival, Best of Show at the 2002 Indiana Film Festival, Grand Jury 

Prize at the 2002 Florida Film Festival, and ASA's Media Award in 2003.



"Refrigerator Mothers" was directed and produced by David 

Simpson, Gordon Quinn, and J.J. Hanley, and funded and supported by a variety of

organizations, including the Independent Television Service (ITVS), the

National Endowment for the Arts, Kartemquin Films, among others. It is 

set to be re-broadcast on July 27 at 10pm (EST) on PBS; however, check your

local listings for exact times.



For more information about "Refrigerator Mothers," including

information about participating in discussion groups and information on 

how to find your local PBS station go to

www.pbs.org/pov/pov2002/refrigeratormothers/.

Expert: Significant Results From Early Treatment Of Autistic Children

By Peggy Andersen for the Associated Press.


Early intervention and treatment of autistic children can yield
significant results, an expert said Thursday.

Persuading the insurance industry that treatment is worthwhile is
complicated by a lack of studies, but that situation is changing, said
Dr.Geraldine Dawson, director of the University of Washington Autism
Center, in a keynote address to the Autism Society of America's 35th annual
conference.

The three-day session began Wednesday.


Autism is a brain disorder that can profoundly affect language
skills and social interaction. There are varying levels of disability in the
autism spectrum, ranging from those who are totally cut off from others to
high-functioning individuals who can excel in the mainstream.

The National Institutes of Health is collaborating now with the
National Alliance for Autism Research to pool the available research -
in genetics, brain structure and chemistry, diagnosis and treatment.

“I think that's going to change the landscape ... over the next
three to five years,” Dawson said, urging parents, who often blame themselves
for a child's lack of progress, “not to put much weight on studies done
even 10 years ago.”

For example, while scientists long believed most progress in
challenging autism was made before age 6, researchers now find
tremendous changes are made at elementary school age, between 5 and 10.

“We're really getting a very different picture,” Dawson said.

The belief that 50 percent of autistics would “never develop
connective speech” has changed for the better. Now the figure is 25
percent, and the goal is zero to 10 percent.

“I believe we'll probably be able to get there,” Dawson said.

Some studies suggest the disorder might affect 1 in 250 newborns.
That's 10 times the estimates of a decade ago, though many scientists
believe the increase reflects better diagnosis. As many as 1.5 million
people nationally have some form of autism, the society said.

The optimum amount of intervention is a subject for debate. For a
time, experts recommended 40 hours weekly of one-on-one instruction - a
tough standard for working families.

“We have no idea if that's necessary,” Dawson said, or even
feasible with toddlers, who need naps and other care.

But the general rule for intervention, she said, is the sooner
the better.

Diagnostic tools have improved to the point that autism can be
reliably detected by age 2, but the average age of diagnosis is about
age 4, Dawson said. While she and other experts are working to make earlier
diagnosis possible, Dawson said alert parents and pediatricians will
always be crucial to the process.

Genetics is a factor in the disorder, she said. If an identical
twin has autism, in 95 percent of cases the other twin has at least social
or language difficulties. Genetic research could lead to a blood test
allowing diagnosis as early as three to six months, she said.

Other possible factors that could contribute to the disorder
include infection, injury, diet or chemical toxins, she said.

Researchers have not yet identified the gene at issue in autism.
Nor are its physical effects fully understood.

Clinical & Research News
With Vaccine Theory Discredited, Hunt for Autism Etiology Continues
Mark Moran

Further research to find the cause of autism should be directed to more promising fields of inquiry than the effects of vaccines.

Neither the mercury-based vaccine preservative thimerosal nor the measles-mumps-rubella (MMR) vaccine are associated with autism, according to a report from the Institute of Medicine (IOM) of the National Academies.

The IOM committee that wrote the report concluded that hypotheses regarding how the MMR vaccine and thimerosal could trigger autism lack supporting evidence and are theoretical only. Further research to find the cause of autism should be directed toward other lines of inquiry that are supported by current knowledge and evidence and offer more promise for providing an answer, according to the report.

Thimerosal is an organic mercury compound still used as a preservative in some adult vaccines. It began to be removed from vaccines for children in 1999, and as of mid-2000, vaccines that are recommended for universal use in infants and young children are available in forms that do not contain or have only trace amounts of thimerosal.

"The overwhelming evidence from several well-designed studies indicates that childhood vaccines are not associated with autism," said committee chair Marie McCormick, who is the Sumner and Esther Feldberg Professor of Maternal and Child Health at the Harvard School of Public Health in Boston. "We strongly support ongoing research to discover the cause or causes of this devastating disorder. Resources would be used most effectively if they were directed toward those avenues of inquiry that offer the greatest promise for answers. Without supporting evidence, the vaccine hypothesis does not hold such promise."

The report updates two earlier IOM reports, published in 2001, on possible links between autism and the MMR vaccine and thimerosal. At that time, the committee determined that the evidence did not show an association between the MMR vaccine and autism, but there was not enough evidence to determine whether thimerosal was associated with neurodevelopmental disorders such as autism.

The finding will "allow research funding to be appropriately channeled into the investigation of the actual causes of autism...."

Given that mercury is known to have a toxic effect on the nervous system and that prenatal exposures to another form of mercury have been shown to affect early childhood development adversely, the committee concluded in 2001 that it was possible to hypothesize that thimerosal might trigger neurodevelopmental problems. The committee revisited these issues because several studies exploring the epidemiology and biological mechanisms of possible links between vaccines and autism have been undertaken during the past three years.

The committee based its latest conclusions and recommendations on a careful review of the literature it had assessed to develop its previous reports; subsequent studies; and other information provided by researchers, parents, and others. Epidemiological studies that looked at autism rates and exposures to vaccines carried the most weight in the committee's assessment of causality, but it considered other kinds of studies as well.

The AMA applauded the IOM report. This finding will reassure parents and "allow research funding to be appropriately channeled into the investigation of the actual causes of autism, a complex set of severe developmental disorders," said AMA Trustee Ron Davis, M.D.

The IOM report, "Immunization Safety Review: Vaccines and Autism," is posted online at ; click on "childhood vaccines" and then the name of the report.

Posted by: GB / 6:57 AM

Health - HealthDay
HealthDay
Early Intervention Helps Kids With Autism

Fri Jun 18, 7:02 PM ET

FRIDAY, June 18 (HealthDayNews) -- Early intervention reduces the impact of autism, says a University of Michigan expert on the disorder.

Children encouraged to speak at an early age can make real progress against the condition, said Catherine Lord, director of the university's Autism and Communication and Disorders Center, which has been conducting a longitudinal study of children with autistic spectrum disorders (ASD).

"One-third make incredible progress, with almost all children making real gains, even if they continue to have significant difficulties. About 5 percent of the children we have followed do not have symptoms of autism at age 9," Lord said in a prepared statement.

The study began when the children were 2 years old, continuing on as they grew. Most of the study participants are now in their teens.

Lord said that children in the study who had developed some simple speech skills prior to the first time they were evaluated at age 2 were far more likely to overcome their autism disorder.

The study has also revealed that, contrary to the popular belief that half of autistic children will never speak, just 14 percent of autistic children are unable to talk by age 9, and nearly 40 percent are able to speak fluently.

Lord said that another 10 percent of the children in the study are doing well, but still have some mild social difficulties and or repetitive behaviors or interests. Another 10 percent clearly have behaviors associated with autism but are able to compensate enough to spend much of their time in mainstream activities and classes.

The remaining children do improve but continue to have ASD-associated behaviors and difficulties, Lord said.

New Hope for Students with Autism?

Fairfax County parents and school officials are optimistic they are implementing a more effective approach.
By Brian McNeill

Eighteen months ago, Lila Hoggan, a rambunctious eight-year-old girl living in Vienna, could neither speak nor understand much of anything her parents said. Lila, who is diagnosed with severe autism, was interested in little more than eating or playing with a piece of string.
But then one of her many tutors tried a new tactic in educating the non-communicative child. The new approach couples two approaches: the more traditional "Applied Behavior Analysis," along with techniques based on "Analysis of Verbal Behavior."
Her parents say it marked a 180-degree improvement in Lila’s ability to learn.
She began to better understand her parents, she started to use sign language to convey simple messages, and she became interested in the world around her — playing with puzzles, jumping on her neighbor’s trampoline and looking at picture books.
"She wasn’t communicating her wants or needs until we started the VB," said her father, David Hoggan. "Right away she was able to communicate with signs."
Now educators with Fairfax Public Schools are hoping the improvements evident in Lila Hoggan’s private education can be replicated for children with autism throughout the county. Last week, the Fairfax County School Board allocated $3 million to implement the ABA/VB program through increased training, new specially-certified instructional assistants and expanded services offered throughout the summer.
"What the school board is providing for our autistic students is really extraordinary and far more than is required," said Alice Farling, deputy superintendent for special services.
In the coming weeks and months, the school system will hire 19 new instructional assistants who are experts in the innovative techniques, nine "instructional coaches" to train teachers and other instructional assistants, and a new administrator to oversee the program.
By increasing staff and training, Farling said the school system will be able to educate students with autism more effectively at an earlier age.
"Now we can tailor the types of services the children need from the get-go," Farling said.

FAIRFAX COUNTY’S new program is not expected to bring about marked improvements in every one of the county’s estimated 1,000 students with autism, though it should help the majority, Farling said.
Autism is "spectrum disorder," meaning it has a range of symptoms that vary from person to person. On one end of the spectrum, a person with autism can be a savant, brilliant in a particular field, whereas on the other end of the spectrum, a person with autism can be entirely incapable of verbal and non-verbal communication. Most people with autism suffer from some degree of communication difficulties and they often lack social skills.
"You can have students who are highly-gifted and you can have students with more difficulties," she said.
Because of the range of symptoms and varying degrees of the condition, autistic education is largely a science of finding what works for each student. But the ABA/VB approach is an educational method that has been proven to work for autistic people across the spectrum.
A behaviorist approach conceived by psychologist B.F. Skinner involves positive reinforcement in developing language skills. By incorporating things a child likes — say, a favorite toy or food — the student is taught how to ask the teacher for the item, who then gives it to the child as a reward.
"By finding a word they are highly motivated to learn, they become more likely to learn," said Patricia Addison, the school system’s director of special education.
Eventually, the child with autism begins to learn vocabulary without being given the reward, which can also include words of encouragement. For example, the child might learn to jump when told by the teacher, who would then tell the child she did a good job. The ultimate goal would be for the child to jump without expecting to be praised, Addison said.
"This helps them to understand the language going on around them all the time," Addison said. "I’m very optimistic that our students will benefit. It’s going to enable them to communicate with their family and peers. It’s critical."

THE ABA/VB APPROACH worked in the education of Ian Campbell, a six-year-old autistic child who lives in Falls Church and attends Beech Tree Elementary School.
"Without a doubt, we have seen more improvement in his abilities in one month of VB than we have in the last year," said his father, Scott Campbell.
Ian Campbell cannot speak, but with the ABA/VB program used by his tutors, he can communicate some of his desires by using pictures of things like water, rice cakes or French fries.
Largely because of the tangible gains made in Ian Campbell’s education, his parents said they have hope he will one day be able to speak and function in society.
"We hope he will recover. We hope that one day he will walk into a room and you won’t know he had autism," Scott Campbell said. "You don’t get cured of autism. You learn how to live with it."
Both Scott Campbell and David Hoggan were instrumental in the school system’s decision to implement the ABA/VB program throughout the county. Last December, they led a push to create a charter school for autistic children in Fairfax County that incorporated ABA/VB. The initiative was blocked by the school board, which immediately voted to implement the program for all autistic children enrolled in the school system.
In January, a panel was convened of school officials, parents and independent experts to develop a strategy for implementing ABA/VB. Last week, the panel’s findings were presented to the school board and roundly praised for applying a modern, scientifically proven method to educate children with autism.
"This program is going to be the envy of a lot of municipalities around the country," said School Board Member Janet Oleszek (at large).

Simple Screening Test Allows Early Detection of Autism

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP

Aug. 5, 2004 —The Checklist for Autism in Toddlers (CHAT-23), a simple two-part screening test, aids in the early detection of autism in Chinese children aged 18 to 24 months, according to the results of a cohort study described in the August issue of Pediatrics.

"There is a recent trend of a worldwide increase in the incidence of autistic spectrum disorder. Early identification and intervention have proved to be beneficial," write Virginia Wong, FRCP, FHKAM, FHKC, from the University of Hong Kong, and colleagues. "The original version of CHAT was a simple screening tool for identification of autistic children at 18 months of age in the United Kingdom. Children with an absence of joint attention (including protodeclarative pointing and gaze monitoring) and pretend play at 18 months were at high risk of autism."

The first section of this instrument is a self-administered parent questionnaire addressing rough and tumble play, social interest, motor development, social play, pretend play, protoimperative pointing (pointing to ask for something), protodeclarative pointing (pointing the index finger to indicate interest in an object), functional play, and showing. The second section consists of five items recorded after observation by general practitioners or health visitors: eye contact, ability to follow a point (gaze monitoring), pretend (pretend play), produce a point (protodeclarative pointing), and make a tower of blocks.

In this cross-sectional cohort study, 212 Chinese children with mental ages of 18 to 24 months were tested with the CHAT-23, a new checklist translated into Chinese. Of the 212 children, 125 were not autistic, and the remaining group had autistic disorder (n = 53) or pervasive developmental disorder (n = 33).

Based on discriminant function analysis, there were seven key questions that could best discriminate autism from nonautism, addressing areas of joint attention, pretend play, social relatedness, and social referencing. On the parental questionnaire, failing any two of seven key questions yielded a sensitivity of 0.931 and specificity of 0.768. Failing any six of all 23 questions produced a sensitivity of 0.839 and specificity of 0.848. The seven key questions included on the parental questionnaire were: does your child imitate you; does your child ever pretend to talk on the telephone, take care of dolls, or other pretend behaviors; does your child ever use his/her index finger to point or to indicate interest in something; does your child look at your face to check your reaction when faced with something unfamiliar; does your child ever bring an object to you to show it to you; if you point at a toy across the room, does your child look at it; and does your child take an interest in other children?

On the observational portion of CHAT-23, failing any two of four items produced a sensitivity of 0.736, specificity of 0.912, and a positive predictive value of 0.853. These items were making eye contact, looking to see what the examiner was pointing at, pretending to pour out or drink tea, and pointing with the index finger at a light.

Study limitations include increased chance of identifying autism because 41% of the cohort was autistic, and higher age of autistic subjects compared with nonautistic subjects.

"We found that integrating the screening questions of the M-CHAT [Modified-CHAT] (from the United States) and observational section B of the original CHAT (from the United Kingdom) yielded high sensitivity and specificity in discriminating autism at 18 to 24 months of age for our Chinese cohort," the authors write. "We recommend identifying the possible positive cases with part A (parental questionnaire) and then proceeding to part B (observation) with trained assessors.... Whether this approach is feasible in the United States depends on the local medical system and screening procedures."

Pediatrics. 2004;114:e166-e176

Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
Describe behaviors predictive of autism at a later age.
Identify appropriate screening questions and tools for autism in younger children.
Clinical Context
Although autism may manifest itself in certain behaviors when children are younger than 24 months, predicting children who will go on to develop this disorder is not easy. Baron-Cohen and colleagues demonstrated in the February 1996 issue of the British Journal of Psychiatry that the absence of three key items at age 18 months: protodeclarative pointing (pointing the index finger to indicate interest in an object), gaze response (the child looks at an object the interviewer describes), and pretend play (the child acts out pretend activities), reliably predicted 83.3% cases of autism among all children screened. Follow-up of these children with autism demonstrated that the diagnosis remained valid at 3.5 years of age.

CHAT first espoused by Baron-Cohen and his fellow group of researchers has been since modified to improve both positive predictive value and efficiency. The current research incorporates two versions of the CHAT in an attempt to create an autism screening algorithm for young children.

Study Highlights
This cross-sectional study was performed on children with autism, developmental delay, and normal development recruited from clinics in Hong Kong. Children were between the chronologic ages of 13 to 86 months and tested to have mental ages between 18 to 24 months. The authors used mental age as their main criteria for study entry because they could not find a sufficient number of children between 18 to 24 months chronologic age diagnosed with autism. The diagnosis of autism in this cohort was confirmed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.
Children with other active medical conditions or receiving antiepileptic medications were excluded from participation.
The authors created combined several elements of the original CHAT test as well as the M-CHAT and administered these examinations to study participants. 23 questions from the M-CHAT were included, along with section B of the original CHAT. Answers to the questionnaire completed in part A of the new CHAT-23 were modified so parents could rate the frequency of behaviors. Part B of the new CHAT examination was performed under the supervision of trained researchers examining children's behavior. Part A took approximately 10 minutes for parents to complete, while part B allowed for less than 5 minutes of direct observation time. Interobserver reliability for part B of the examination was good.
87 children with autism or pervasive developmental disorders and a mean chronologic age of 51.3 months were included, along with 67 children with developmental delay (mean age, 33.5 months) and 58 children with normal development (mean age, 23.9 months).
Only 2 questions of the 23 questions of part A of the examination, one regarding whether the child enjoyed being swung or bounced and another focused on the ability to walk, were found not to discriminate between autism and nonautism.
Seven questions from part A were found to have the best discriminating value between children with autism and the other groups. These questions regarded (in descending order of value): imitative behaviors, pretend play, protodeclarative pointing, whether the child checks the parents reaction before reacting on his/her own when faced with a new situation, whether the child brings objects to show parents, gaze response, and whether the child takes an interest in other children. The best balance of sensitivity and specificity for screening for autism was found when children failed 2 of these 7 questions (sensitivity 93.1%, specificity 76.8%).
Using the criteria of failing any 6 of the 23 total questions on part A of the examination, the sensitivity of screening for autism decreased to 83.9%, but specificity improved to 84.8%.
All of the 4 items (making eye contact, gaze response, pretend play, and protodeclarative pointing) used in part B of the examination were discriminatory for autism vs. nonautism. Failing any 2 of these 4 items correlated with a sensitivity of 73.6% and a specificity of 91.2%.
Based on these data, the authors recommend a two-part screening process for young children with autism. The questionnaire from part A of their examination (using either failing 2 of the 7 key questions or 6 of the 23 total number of questions as a "positive" screen) would serve as the initial screening tool. Children with a positive screen could then be evaluated with the more specific observational component of the examination.
Pearls for Practice
The absence of the following three key items at age 18 months reliably predicted 83.3% cases of autism among all children screened: protodeclarative pointing (pointing the index finger to indicate interest in an object), gaze response (the child looks at an object the interviewer describes), and pretend play (the child acts out pretend activities).
A two-stage screening process for autism in children with mental age between 18 to 24 months represents a reasonably sensitive, specific, and efficient screening tool.
Post Test
1. Using the CHAT-23 parental questionnaire, which of the following questions can potentially predict a diagnosis of autism in young children as indicated in the study by Baron-Cohen and colleagues?
a. When pointing to a toy across the room, does the patient look towards the toy?
b. Does the patient ever mimic actions of others?
c. Does the patient interact with other children?
d. Does the patient bring objects of interest over to you?
e. All of the above


2. Which of the following was not a screening questionnaire item that discriminated between autism and nonautism in the current study by Wong and colleagues?
a. Inability to walk
b. Lack of pretend play
c. Lack of protodeclarative pointing
d. Lack of imitative behavior
e. Lack of bringing objects to parents to examine

Simple Screening Test Allows Early Detection of Autism

News Author: Laurie Barclay, MD
CME Author: Charles Vega, MD, FAAFP

Aug. 5, 2004 —The Checklist for Autism in Toddlers (CHAT-23), a simple two-part screening test, aids in the early detection of autism in Chinese children aged 18 to 24 months, according to the results of a cohort study described in the August issue of Pediatrics.

"There is a recent trend of a worldwide increase in the incidence of autistic spectrum disorder. Early identification and intervention have proved to be beneficial," write Virginia Wong, FRCP, FHKAM, FHKC, from the University of Hong Kong, and colleagues. "The original version of CHAT was a simple screening tool for identification of autistic children at 18 months of age in the United Kingdom. Children with an absence of joint attention (including protodeclarative pointing and gaze monitoring) and pretend play at 18 months were at high risk of autism."

The first section of this instrument is a self-administered parent questionnaire addressing rough and tumble play, social interest, motor development, social play, pretend play, protoimperative pointing (pointing to ask for something), protodeclarative pointing (pointing the index finger to indicate interest in an object), functional play, and showing. The second section consists of five items recorded after observation by general practitioners or health visitors: eye contact, ability to follow a point (gaze monitoring), pretend (pretend play), produce a point (protodeclarative pointing), and make a tower of blocks.

In this cross-sectional cohort study, 212 Chinese children with mental ages of 18 to 24 months were tested with the CHAT-23, a new checklist translated into Chinese. Of the 212 children, 125 were not autistic, and the remaining group had autistic disorder (n = 53) or pervasive developmental disorder (n = 33).

Based on discriminant function analysis, there were seven key questions that could best discriminate autism from nonautism, addressing areas of joint attention, pretend play, social relatedness, and social referencing. On the parental questionnaire, failing any two of seven key questions yielded a sensitivity of 0.931 and specificity of 0.768. Failing any six of all 23 questions produced a sensitivity of 0.839 and specificity of 0.848. The seven key questions included on the parental questionnaire were: does your child imitate you; does your child ever pretend to talk on the telephone, take care of dolls, or other pretend behaviors; does your child ever use his/her index finger to point or to indicate interest in something; does your child look at your face to check your reaction when faced with something unfamiliar; does your child ever bring an object to you to show it to you; if you point at a toy across the room, does your child look at it; and does your child take an interest in other children?

On the observational portion of CHAT-23, failing any two of four items produced a sensitivity of 0.736, specificity of 0.912, and a positive predictive value of 0.853. These items were making eye contact, looking to see what the examiner was pointing at, pretending to pour out or drink tea, and pointing with the index finger at a light.

Study limitations include increased chance of identifying autism because 41% of the cohort was autistic, and higher age of autistic subjects compared with nonautistic subjects.

"We found that integrating the screening questions of the M-CHAT [Modified-CHAT] (from the United States) and observational section B of the original CHAT (from the United Kingdom) yielded high sensitivity and specificity in discriminating autism at 18 to 24 months of age for our Chinese cohort," the authors write. "We recommend identifying the possible positive cases with part A (parental questionnaire) and then proceeding to part B (observation) with trained assessors.... Whether this approach is feasible in the United States depends on the local medical system and screening procedures."

Pediatrics. 2004;114:e166-e176

Learning Objectives for This Educational Activity
Upon completion of this activity, participants will be able to:
Describe behaviors predictive of autism at a later age.
Identify appropriate screening questions and tools for autism in younger children.
Clinical Context
Although autism may manifest itself in certain behaviors when children are younger than 24 months, predicting children who will go on to develop this disorder is not easy. Baron-Cohen and colleagues demonstrated in the February 1996 issue of the British Journal of Psychiatry that the absence of three key items at age 18 months: protodeclarative pointing (pointing the index finger to indicate interest in an object), gaze response (the child looks at an object the interviewer describes), and pretend play (the child acts out pretend activities), reliably predicted 83.3% cases of autism among all children screened. Follow-up of these children with autism demonstrated that the diagnosis remained valid at 3.5 years of age.

CHAT first espoused by Baron-Cohen and his fellow group of researchers has been since modified to improve both positive predictive value and efficiency. The current research incorporates two versions of the CHAT in an attempt to create an autism screening algorithm for young children.

Study Highlights
This cross-sectional study was performed on children with autism, developmental delay, and normal development recruited from clinics in Hong Kong. Children were between the chronologic ages of 13 to 86 months and tested to have mental ages between 18 to 24 months. The authors used mental age as their main criteria for study entry because they could not find a sufficient number of children between 18 to 24 months chronologic age diagnosed with autism. The diagnosis of autism in this cohort was confirmed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.
Children with other active medical conditions or receiving antiepileptic medications were excluded from participation.
The authors created combined several elements of the original CHAT test as well as the M-CHAT and administered these examinations to study participants. 23 questions from the M-CHAT were included, along with section B of the original CHAT. Answers to the questionnaire completed in part A of the new CHAT-23 were modified so parents could rate the frequency of behaviors. Part B of the new CHAT examination was performed under the supervision of trained researchers examining children's behavior. Part A took approximately 10 minutes for parents to complete, while part B allowed for less than 5 minutes of direct observation time. Interobserver reliability for part B of the examination was good.
87 children with autism or pervasive developmental disorders and a mean chronologic age of 51.3 months were included, along with 67 children with developmental delay (mean age, 33.5 months) and 58 children with normal development (mean age, 23.9 months).
Only 2 questions of the 23 questions of part A of the examination, one regarding whether the child enjoyed being swung or bounced and another focused on the ability to walk, were found not to discriminate between autism and nonautism.
Seven questions from part A were found to have the best discriminating value between children with autism and the other groups. These questions regarded (in descending order of value): imitative behaviors, pretend play, protodeclarative pointing, whether the child checks the parents reaction before reacting on his/her own when faced with a new situation, whether the child brings objects to show parents, gaze response, and whether the child takes an interest in other children. The best balance of sensitivity and specificity for screening for autism was found when children failed 2 of these 7 questions (sensitivity 93.1%, specificity 76.8%).
Using the criteria of failing any 6 of the 23 total questions on part A of the examination, the sensitivity of screening for autism decreased to 83.9%, but specificity improved to 84.8%.
All of the 4 items (making eye contact, gaze response, pretend play, and protodeclarative pointing) used in part B of the examination were discriminatory for autism vs. nonautism. Failing any 2 of these 4 items correlated with a sensitivity of 73.6% and a specificity of 91.2%.
Based on these data, the authors recommend a two-part screening process for young children with autism. The questionnaire from part A of their examination (using either failing 2 of the 7 key questions or 6 of the 23 total number of questions as a "positive" screen) would serve as the initial screening tool. Children with a positive screen could then be evaluated with the more specific observational component of the examination.
Pearls for Practice
The absence of the following three key items at age 18 months reliably predicted 83.3% cases of autism among all children screened: protodeclarative pointing (pointing the index finger to indicate interest in an object), gaze response (the child looks at an object the interviewer describes), and pretend play (the child acts out pretend activities).
A two-stage screening process for autism in children with mental age between 18 to 24 months represents a reasonably sensitive, specific, and efficient screening tool.
Post Test
1. Using the CHAT-23 parental questionnaire, which of the following questions can potentially predict a diagnosis of autism in young children as indicated in the study by Baron-Cohen and colleagues?
a. When pointing to a toy across the room, does the patient look towards the toy?
b. Does the patient ever mimic actions of others?
c. Does the patient interact with other children?
d. Does the patient bring objects of interest over to you?
e. All of the above


2. Which of the following was not a screening questionnaire item that discriminated between autism and nonautism in the current study by Wong and colleagues?
a. Inability to walk
b. Lack of pretend play
c. Lack of protodeclarative pointing
d. Lack of imitative behavior
e. Lack of bringing objects to parents to examine

Devereux CARES Operational Information

http://www.devereuxcares.org

Location

The school is located in a newly renovated facility on the grounds of the Devereux Day School at 620 Boot Road in Downingtown, PA. The ample educational space accommodates 1:1 and group instruction, as well as after school/recreational activities. The school is run in conjunction with the Devereux Kanner Center, located at 390 East Boot Road in West Chester, PA.

Licensure

Devereux CARES is licensed as an Approved Private School by the Pennsylvania Department of Education, which includes licensure for autism.

Student Population

The school serves up to 30 children, ages 5 through 21, with a confirmed primary diagnosis of Autism, Asperger's Syndrome, or Pervasive Developmental Disorder-Not Otherwise Specified (PDD/NOS).

Operational Time

The school operates 5 days per week, 180 days per year. A 39-day (approximate) extended school year program is available, pending eligibility. The instructional day begins at 8:45 a.m. and ends at 2:45 p.m.

Funding

Students placed at CARES are funded through an approved PDE form 4010, filed following acceptance and prior to enrollment. Students between the ages of 4 years 6 months and 5 years are funded by the placing county intermediate unit according to CARES' daily per diem.

Transportation

Transportation is arranged, provided, and funded by the placing school districts or intermediate units according to each student's specific transportation needs. Parents may elect to transport their child personally.

Staffing

Each of CARES' classrooms maintains a rich staff:student ratio (typically 4:5). Classrooms are staffed by a certified special education teacher, primary instructional coordinator, and instructional coordinators. The ratio of primary instructional coordinators and instructional coordinators may vary depending on the needs of each classroom.

Do physical ills play role in child autism?


By The Associated Press

PORTLAND - When 6-year-old William Mead of Portland was diagnosed with autism three years ago, his mother, Tory Shirley Mead, was told her son might have to be sedated and institutionalized.

But once she found doctors who would treat her son's physical ailments, she said, his behavior has improved dramatically.

Physicians at Massachusetts General Hospital discovered that William had food allergies, had an inflamed and ulcerated lower intestine, and was missing key digestive enzymes.

But because of his medical treatment, William now can speak more than 1,000 words, can talk in short sentences and, with an aide, attends a Montessori school.

On Thursday, officials at Oregon Health & Science University and the Northwest Autism Foundation announced that OHSU joined a groundbreaking national program to see how treating the medical problems of autistic children might alleviate symptoms of the disorder.

OHSU and four other medical centers across the nation are participating in a consortium called the Autism Treatment Network.

The network, headed by Harvard Medical School's Massachusetts General Hospital for Children, will gather information from thousands of autistic children to develop ways of treating their physical ills. The network also includes Columbia University Medical School, Baylor College of Medicine and the University of Washington.

The treatment network will build a computerized database to let medical specialists in a variety of fields and from different parts of the country compare notes on methods of treatment. Eventually, researchers will use the results to develop standard ways of treating autistic children.

Dr. Brian Rogers, director of OHSU's Child Development and Rehabilitation Center, said such a multicenter approach has helped to improve treatments in children with cerebral palsy and mental retardation.

OHSU's participation is significant because Oregon has one of the highest rates of autism in the United States, said Steve Edelson, director of the Center for the Study of Autism in Salem and president of the Autism Society of Oregon. Edelson said about one Oregonian in 1,000 has autism compared with a national average of one in 2,400.

What Do BCBA and BCABA Mean?

Families, school districts and agencies are becoming more familiar with the professional behavior analyst certification acronyms BCBA and BCABA, but it is often unclear what those designations mean.  The following information is from the Behavior Analyst Certification Board's website (www.bacb.com), which can be used to check the certificant registry, review qualification guidelines and knowledge areas, and access information on becoming certified.  It is worth noting the board recommends that BCABA certificants continue to be supervised by BCBAs.

"The Behavior Analyst Certification Board®, Inc. (BACB®) is a nonprofit 501(c) (3) corporation established to meet professional credentialing needs identified by behavior analysts, state governments, and consumers of behavior analysis services.  The BACB’s mission is to develop, promote, and implement a voluntary national and international certification program for behavior analyst practitioners.  The BACB has established uniform content, standards, and criteria for the credentialing process.

The Behavior Analyst Certification Board credentials practitioners at two levels.  Individuals who wish to become Board Certified Behavior Analysts™ (BCBA®) must posses at least a Masters Degree, have 180 classroom hours of specific Graduate-level coursework, meet experience requirements, and pass the Behavior Analyst Certification Examination.  Persons wishing to be Board Certified Associate Behavior Analysts™ (BCABA®) must have at least a Bachelors Degree, have 90 classroom hours of specific coursework, meet experience requirements, and pass the Associate Behavior Analyst Certification Examination.

Board Certified Behavior Analyst™ (BCBA®):

The Board Certified Behavior Analyst is an independent practitioner who also may work as an employee or independent contractor for an organization.  The BCBA conducts descriptive and systematic (e.g., analogue) behavioral assessments, including functional analyses, and provides behavior analytic interpretations of the results.  The BCBA designs and supervises behavior analytic interventions.  The BCBA is able to effectively develop and implement appropriate assessment and intervention methods for use in unfamiliar situations and for a range of cases.  The BCBA seeks the consultation of more experienced practitioners when necessary.  The BCBA teaches others to carry out ethical and effective behavior analytic interventions based on published research and designs and delivers instruction in behavior analysis.  It is strongly recommended that the BCBA supervise the work of Board Certified Associate Behavior Analysts and others who implement behavior analytic interventions.

Board Certified Associate Behavior Analyst™ (BCABA®):

The BCABA conducts descriptive behavioral assessments and is able to interpret the results and design ethical and effective behavior analytic interventions for clients.  The BCABA designs and oversees interventions in familiar cases (e.g., similar to those encountered during their training) that are consistent with the dimensions of applied behavior analysis.  The BCABA obtains technical direction from a BCBA for unfamiliar situations.  The BCABA is able to teach others to carry out interventions once the BCABA has demonstrated competency with the procedures involved under the direct supervision of a BCBA.  The BCABA may assist a BCBA with the design and delivery of introductory level instruction in behavior analysis.  It is strongly recommended that the BCABA practice under the supervision of a BCBA, and that those governmental entities regulating BCABAs require this supervision.

The trademarks "Behavior Analyst Certification Board, Inc.," "BACB," "Board Certified Behavior Analyst," "BCBA," "Board Certified Associate Behavior Analyst," and "BCABA" are owned by the Behavior Analyst Certification Board. All rights reserved.  Copyright © 1998-2004 by BACB® All rights reserved.

Autistic children are gifted with outstanding musical skills!
Washington | May 26, 2004 2:42:02 PM IST

Dr Pamela Heaton and Dr Francesca Happe, researchers at the University of London have said that specialist individual music lessons could hugely benefit autistic children.

The study has suggested that many children with this disorder have outstanding abilities in tone recognition.

"A lot of work has been done on musical savants with exceptional musical memory and rarely found absolute pitch ability. But our research shows that even children without these special talents and no musical training can have highly developed musical splinter skills," said Dr Pamela Heaton, who led the research. he had also worked as a musician before gaining a doctorate in sychology

"If we could develop effective non-verbal music teaching methods, we might be able to understand more about the way these children learn and process other information," added Heaton.

A series of music workshops are currently being planned in which autistic children will be taught to read musical notation.

Heaton and Happe's research compared the skills of six to 19 year old individuals with autism, and a control group with matching age, IQ and level of musical background, on a series of tasks into tone memory and discrimination. They were asked to identify musical notes by moving the image of a boy up and down a flight of stairs by using a touch-screen laptop computer.

Although the children with autism had the communication difficulties associated with this disorder, a sub-group of them produced exceptional results. In one of the tests four children from the autism group achieved a score of 89 per cent compared to an average score of 30 per cent.

"These findings were surprising, especially given that two of these children had intellectual impairment and none had experienced musical training. Autistic children can be highly analytical listeners and are able to access musical details more readily than typically developing children," concluded Heaton. (ANI)









Michelangelo di Ludovico Buonarroti (1475-1564) was considered to be ‘one of the greatest artists of all time.’ Dr Muhammad Arshad presents new evidence in the current issue of the Journal of Medical Biography, published by the Royal Society of Medicine Press, suggesting he suffered from Asperger’s disorder, or high-functioning autism.

Characteristics of high-functioning autism
Asperger’s is similar to autism but sufferers can function better than autistic individuals and have normal intelligence. The disease is characterised by communication problems, difficulties with social skills, repetitive behaviours, a limited range of interests and coordination problems. These symptoms are sometimes accompanied by a talent or skill in a particular area.

Early life
Michelangelo, the second oldest in a family of five boys, did not get along with his family and suffered physical abuse by his fathers and uncles. He was ‘erratic’ and ‘had trouble applying himself to anything’, and was very insecure but ambitious. The men in his family ‘displayed autistic traits’ and ‘features of mood disturbances’ were common in his entire family.

Evidence of criteria
Impairment of social interaction
Michelangelo was ‘aloof, a loner and had few friends.’ He found it difficult to maintain relationships. although, the article says, this was perceived at the time as a necessary condition to being able to create works of art. Dr Arshad writes that even when Michelangelo needed help on a project he always ‘preferred to work independently’ but, when he did hire an assistant, he refused to nurture their own talents and hired those that did not threaten his ‘supremacy.’ Michelangelo’s failure to attend his brother’s funeral underlined ‘his inability to show emotion’ and he was a boy who was unsure about himself outside his talent as an artist. In 1505, he wrote, ‘Anything might happen to shatter my world.’

Control issues and obsessive routines
Michelangelo was obsessed with work and controlling everything in his life – ‘family, money, time and much else.’ Dr Arshad writes, ‘He was a loner, self-absorbed and gave his undivided attention to his masterpieces – a feature of autism.’ He was also obsessed with money and nudity and was focussed so much on his work that he toiled eight years over The Last Judgement.

Communication problems
Michelangelo was ‘not a great public speaker’ and had difficulty holding up his end of a conversation, often walking away in the middle of an exchange. He had a short temper, a sarcastic wit and was ‘paranoid at times, narcissistic and schizoid.’ The author claims he ‘was strange, preoccupied with his own reality and almost always worked alone.’


For further information, contact:
Michelle Clarke
The Press Office
The Royal Society of Medicine
1, Wimpole Street
London W1G 0AE
Tel: +44 (0) 20 7290 2904
Fax: +44 (0) 20 7290 2992

Penn State University
National Autism Conference August 2004

http://app.outreach.psu.edu/Autism/

Interview with Dr. Temple Grandin


Dr. Temple Grandin is in a unique position to provide parents and professionals insight into autism because she has autism. She was diagnosed at age 2 and has lived a very challenging and adventurous life. Dr. Grandin has presented lectures on autism around the world and has appeared on many national television programs. Her first book, Emergence Labeled Autistic, is considered one of the classic books in the field and is must reading for everyone involved with autistic children. Her new book, Thinking in Pictures, is already starting to receive much attention, and it will likely become another classic. Stephen Edelson first met Temple Grandin in the early 1980's when they were both graduate students at the University of Illinois at Champaign-Urbana. We are honored to present an interview with Temple Grandin (TG) conducted on February 1, 1996 by Dr. Stephen Edelson (SE).

SE: What is your earliest recollection, and how old were you?

TG: I was in a summer program when I was just a real little child about three. I can remember playing around in a wading pool. When I was 3 1/2 years old, I can also remember quite a few things. I can remember the frustration of not being able to talk. I knew what I wanted to say, but I could not get the words out, so I would just scream. I can remember this very clearly.

I can remember a time when I was in speech therapy in nursery school. The teacher was using a blackboard pointer to point to the students to do something, and I was just screaming every time she aimed the pointer at me. I screamed because I was taught at home that you should never point an object at a person because it could poke out your eye. I could not tell the teacher that I was taught at home not to point things at people.

I can also remember someone playing the piano and marching around the piano. And I remember, which I think is my earliest memory, when I was taken into a hospital for a hearing test. I do not remember anything about the hearing test, but I remember I stayed overnight in the hospital. They let me sleep in a small bed with all kinds of stuffed animals and dolls.

SE: When a parent tells you that he or she has a child who was recently diagnosed with autism, what do you usually tell them?

TG: Well, first of all I want to know how young a child it is.

SE: First, let's say the child is under 5 years of age.

TG: I am a big believer in early intervention. You have got to keep autistic children engaged with the world. You cannot let them tune out. I can remember when I tuned out, I would just sit and rock and let sand go through my hands. I was able to shut the world out. If you let the child do that they are not going to develop. Many early intervention programs have different theoretical bases, but I have observed that good teachers do the same things regardless of the theoretical basis. And I think it is really important to keep them engaged. When I was a little child I was expected to sit at the table and have proper manners. Research is starting to show that a child should be engaged at least 20 hours a week. I do not think it matters which program you choose as long as it keeps the child actively engaged with the therapist, teacher, or parent for at least 20 hours a week.

I am also a believer in an integrated treatment approach to autism. One of my sensory problems was hearing sensitivity, where certain loud noises, such as a school bell, hurt my ears. It sounded like a dentist drill going through my ears. I was also very touch sensitive; scratchy petticoats felt like sandpaper ripping off my skin. There is no way a child is going to function in a classroom if his or her underwear feels like it is full of sandpaper. There are other serious sensory problems such as vision problems similar to what Donna Williams has described. I want to emphasize that sensory problems are different from person to person. There are going to be some children who have a lot of sound problems. Other children will have a lot of visual problems. Still other children will have a mixture of both, and other children, such as the classical Rain Man type, will have only a mild hearing sensitivity. I just cannot emphasize enough the variability of the problem.

Some children may need a behavioral approach, whereas other children may need a sensory approach. Autism is an extremely variable disorder. I really want to emphasize this point. A treatment method or an educational method that will work for one child may not work for another child. The one common denominator for all of the young children is that early intervention does work, and it seems to improve the prognosis.

SE: What advice would you give to parents who have a recently diagnosed autistic child between the ages of five and ten?

TG: Children between the ages of five to ten years are even more variable. They are going to vary from very high functioning, capable of doing normal school work, to nonverbal who have all kinds of neurological problems. For some children, I question whether autism should be the proper primary diagnosis. I have seen children who could hardly walk attend an autism meeting, and they also have a diagnosis of autism. Many, not all, of these cases appear tome as being very different from autism. You have got to look at each case, and do what is appropriate.

SE: You were one of the first people in the field to stress the importance of sensory problems in autism. What are your current thoughts about this issue?

TG: I have been a big believer in making people aware of the sensory problems in autism, and these sensory problems are variable. They are going to vary from a mild hearing sensitivity to a person who cannot see and hear at the same time. Their senses jumble together, and they are not able to locate their body boundary. This type of person needs a different approach than a highly verbal child who can do normal school work. In fact, some of these nonverbal children need a very gentle approach. Donna Williams wrote about a mono-channel approach, where she either has to listen to something or see something; but she cannot do both. I was the type of child where they could just jerk me out of autism by saying 'Now come on, pay attention!' But you cannot do this with children with more severe sensory problems. In these cases, you have to question whether there is a biological reason for the bad behavior or a behavioral reason. If sound hurts a child's ears, there is no way you can make him not be scared of the school bell.

SE: Several people sent questions for me to ask you. A mother who has a 5 1/2 year old child with PDD wants advise. Her son attends a pre-kindergarten classroom with 22 other students, and he is starting to become aggressive. The mother says that her child has selected a particular child in the classroom and places him in a choke-hold position.

TG: I do not have enough information to give full advice. Since PDD and autism are strictly behavioral diagnoses, they are not absolute diagnoses such as Down Syndrome. There is a tremendous range of children with a PDD label. From talking to parents, there seems to be two types of children who end up receiving a PDD diagnosis. One is a very mild case where the child is verbal, and he has only a few mild autistic traits. The other type of PDD child is neurologically disordered. He is nonverbal and has autistic sensory problems. The PDD label is used because he is affectionate and interested in people. These are two very different types of PDD labels, and they are like apples and oranges.

Since the child is aggressive towards one particular child, we need to figure out why is this is happening. Is the other child teasing him? In any case, a behavior intervention is needed to stop this behavior.

SE: Could it be the tone of the other child's voice?

TG: This is also possible. Some autistic children cannot stand the sound of certain voices. I have come across cases where teachers tell me that certain children have problems with their voice or another person's voice. This problem tends to be related to high-pitched ladies' voices. This is not true for every case.

I think you have to be a very good detective to determine what is causing the aggression. Maybe the child is just being bad. Unfortunately, there are many behaviorists who ignore sensory problems. For example, let's say that a child is afraid to go into the gym. I have heard several cases of this. The child is afraid because the scoreboard buzzer blasts his ears out. So he watches the clock, cringing when he knows the scoreboard is going to go off. No one wants to enter a room where a sound will feel like a dentist's drill being shoved down their ears. Fluorescent lights may be bothering him, or sometimes certain ventilators and fans in a room can make sounds that just drive him nuts. I had to have an operation one time in a hospital, and there was a ventilation fan in my room. I absolutely could not stand it. The fan had a broken bearing on it, and it squealed. I would use the bathroom in the dark. I just could not stand the noise.

There are some cases where children do things, and it is simply bad behavior. This problem needs to be dealt with behaviorally. But this is when you have got to be a good observer and figure out what is causing the behavior so you can use the right intervention. Unfortunately, I cannot give this mother specific advise because there is not enough information.

SE: Here is another question. A teacher writes that she has been working with a 9-year old girl with PDD for 2 years. The girl is super sensitive to touch, especially when she is being redirected to challenging activities, such as cutting, counting and gym. She reacts by saying "do not touch me, that hurts." However, she can be redirected in the same manner during reading; and there is no negative response.

TG: In other words, her touch sensitivity is changing depending on what she is doing. One problem is that there are many echoes in a gym. When I was a little child I had problems with eating in the cafeteria. The chairs would be jerking in and out, and there was a noise overload. Since most gyms are pretty noisy places, the noise maybe getting her nervous system excited, and her senses become more sensitive. In contrast, the place where she is reading and counting is a quiet place which helps her nervous system calm down. It would probably be a good idea to do some tactile exercises to decrease the sensitivity. One good exercise is deep pressure, such as rolling up in mats and lying under a mattress. Physical activities also help and a brushing method is quite effective in calming down the nervous system.

SE: What seemed to help you the most while growing up?

TG: There were a variety of things. People are always looking for the single magic bullet that will totally change everything. There is no single magic bullet. I was very lucky to receive very good early intervention with very good teachers, starting at age 2 1/2 years. I cannot emphasize enough the importance of a good teacher. A good teacher is worth his or her weight in gold. Some teachers just have a knack for working with autistic children. Other teachers do not have it. If you find a good teacher, hang on to him or her tight. My mother worked on teaching me how to read. I was on the right track by third grade, and I did quite well for about 3 years.

Junior high was a real mess for me and then came puberty. My anxiety attacks came during puberty, and then all of my nerves started. This period of time was awful. I had a good science teacher who got me interested in science. Later on I had employers who were very helpful. There were many people who helped me.

I started taking anti-depression medication in my early thirties. I would not be here now if I did not have anti-depressants. I know a number of autistic adults that are doing extremely well on Prozac. I want to give just one warning about anti-depressants. I want to explain how anti-depressants work. This applies to both the new medications, such as Prozac and its clones, and the older tricyclic anti-depressants. Anti-depressant drugs work on two circuits in the brain. The first circuit calms down anxiety and nerves, and the second circuit is excitatory. I will refer to this second circuit as the anti-depression circuit. After all they are called 'anti-depressants' because they eliminate depression. For people who are depressed, a large dose of an anti-depressant will take the person 'out of depression.' Since most autistic people are not really depressed, too large of a dose of an anti-depressant can cause irritability, agitation, and excitement. If a person overdoses on the drug, he or she may also become aggressive and suffer insomnia. Occasionally I hear about someone going nuts on Prozac. This was likely caused by an overdose. The trick is to calm down the nerves without sending the other circuit into a hyper-manic irritability. A common mistake is to give more drugs when insomnia and irritability start. This is the worst thing you can do. You have got to lower the dose. I have been on the same dose of anti-depressants for 15 years, and my nerves still go up and down in cycles; but my nerves are cycling at a lower level than they were before. You need to resist the urge to take more medication every time there is a little relapse. You cannot get 100% control. You can get about 90% control if things are really working properly. I would like to add one more thing about anti-depressant drugs--they are not for everybody.

Since there are many types of people who are given the label 'autism,' it is important to mention that what works extremely well for some people may not work at all for other people. And while we are on the subject of medication you always need to look at risk versus benefit. When a person takes a medication, you better look for a WOW reaction-"this stuff really works." This makes it worth the possible risk of taking a drug. If you start using a medication in a person with autism, you should see an obvious improvement in behavior in a short period of time. If you do not see an obvious improvement, they probably should not be taking the stuff. It is that simple.

SE: Unfortunately, some people are given a prescription and simply take the medication, whether or not it helps.

TG: When you take a drug to treat high blood pressure or diabetes, you have an objective test to measure blood pressure and the amount of sugar in the blood. It is straight-forward. With autism, you are looking for changes in behavior. The only way you can tell whether a drug really works, regardless of what it is, is when teachers and parents notice changes. When the child is brought to a doctor's office for 5 minutes, the child will either bounce off the walls, or he will probably act like a perfect angel. The doctor cannot see an accurate picture of behavior in 5 or 10 minutes. You only get an accurate understanding of the child's behavior from people who see this child or see the adult for many hours. Medications should provide obvious dramatic improvements. If there is no obvious improvement, then the drugs should be thrown away. If the person has been taking the drug for many months or years and you wish to discontinue it, the drug must be withdrawn very gradually. Drugs that have been taken for only a few days or weeks can usually be withdrawn abruptly.

SE: What type of feedback are you receiving from parents and professionals about your hug box?

TG: Many parents have told me that their sons or daughters seek pressure, especially some of the nonverbal adults. They get under the sofa cushions, wrap themselves up in blankets even when it is really hot, and lay between the mattress and the box spring. Pressure is calming to the nervous system. In little children, there are many inexpensive ways to provide deep pressure, such as gym mats and bean bag chairs. To help hyperactive children sit still in class, a weighted vest is often helpful. This is similar to a photographer's vest, and it is pad and weighted. In fact, just a little bit of pressure helps calm them down. I think the squeeze machine or hug box would be most valuable with adults, but I was also pleased to hear the results from your research study on the squeeze box. The results from your experiment makes sense to me; only a certain kind of child had big benefits. This is the kind of child with a hyperaroused sympathetic nervous.

The squeeze machine is not going to cure anybody, but it may help them relax; and a relaxed person will usually have better behavior.

SE: Some people do not realize that you have a doctorate in animal science. Briefly, what was the focus of your dissertation and what were your results?

TG: I did my dissertation on the environmental effects on dendritic growth in the somato-sensory cortex of the pig. There has been much research on rats in which one group of rats lived in a plastic laboratory shoebox, and the other group of rats lived in a Disneyland playground with all kinds of toys to climb, and the toys are changed everyday. The results clearly showed that the rats in the Disneyland environment had more nerve endings in their visual cortex. So I thought, let's try this experiment on the pig. I had some pigs live in a Disney-Pig-Land, with toys and straw bedding, and other pigs lived in a little commercial plastic pen. And guess what happened? We were very surprised--the results came out backward. The pigs in the little plastic pen had more nerve endings in their cortex. We then asked why this happened? We looked at the videotapes which were filmed during the night, when nobody's around; and we found that these pigs were doing a lot of rooting. They were rooting the floor and rooting each other. They were just doing stereotypic behaviors when nobody was around them. These extra nerve endings were probably very abnormal. This is one of the reasons that I feel very strongly that you should not let little autistic children sit in a corner and tune-out 6 hours a day. They may be forming 'Dendrite Highways' in places where they are not suppose to have them.

I would also like to mention, even though this is only theory at this point, that there is a possibility of secondary brain damage in autistic children. The child is born with immature brain development in the limbic system and cerebellum. But if these children withdraw, due to sensory or other problems, maybe other parts of their brain are not going to develop properly. This is only theory; I cannot prove this, but there are some experiments on animals that supports this idea. For example, if baby animals do not get proper stimulation when they are young, they are permanently messed up. As you may know, some of the stereotyped behaviors exhibited by autistic children are also found in zoo animals who are raised in a barren environment. Why would a zoo animal exhibit the same behaviors as an autistic child? Well, the autistic child withdraws because the world is a hurtful place--sound hurts, touch hurts, vision hurts, everything hurts--so they withdraw. Zoo animals are exhibiting these behaviors because of their deprived environment,where there is nothing to do. The lion in the zoo lives in a concrete box. Fortunately, zoos are making an effort to have nicer exhibits these days; but in the past, the lion in the zoo had nothing to do. As a result, their brains were not receiving enough input needed to develop, and stereotyped behavior developed due to boredom. Research has shown that a barren environment is much more damaging to baby animals than it is to adult animals. It does not hurt the adult animals the same way it damages babies.

This is one of the reasons why I am a believer in early intervention. We have got to work on keeping these children engaged with the world. There are some 3 year olds where you can go in and just jerk them out of it, and say "Come on, pay attention!" There are other children where this type of strategy does not work. With these children, if you start forcing eye contact, you are going to send the nervous system into sensory overload. They will then shut down, and nothing is going to get through to them. They are "mono channel," and they can use only one sense at a time. You need to sneak in the back door with this type of child. Try whispering to them very softly in a room free of visual distractions. You may also try to sing to them using a low, soft voice. Then maybe you can get through to them. There is great variability with autistic children.

SE: Do you feel you are missing something in life because of your autism?

TG: Just in the last couple of years, when I was working on my book, Thinking in Pictures, I realized that I am missing something that everybody else has-emotional complexity-and I have replaced it with intellectual complexity. I obtain great satisfaction out of using my intellect. I like to figure things out and solve problems. This really turns me on. When I observe emotional complexity in others, it is sort of a rhythm that goes on between a boyfriend and a girlfriend. I often observe this on airplanes. Sometimes I get to sit next to them. It is similar to observing beings from another planet. The relationship is what motivates them; but for me, it is figuring out how to design something, such as figuring out better ways to treat autism. I use my mind to solve problems and invent things. I get a tremendous satisfaction from inventing things and doing innovative research. We have just finished up several good experiments at the University. We came out with really good results, and it turns me on. My life is basically my work. If I did not have my work, I would not have any life. This brings up the importance of getting autistic people in high school and junior high school interested in something they can turn into a career. They need to build on their talents, such as art work and computer programming.

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