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Autism, Parenting, Pediatrics, Research, Stanford News

Parents can learn autism therapy in groups to improve kids’ verbal skills, Stanford study shows

Parents can learn autism therapy in groups to improve kids' verbal skills, Stanford study shows

HoldingHandsAutism is more than twice as common than it was 15 years ago. But the number of clinicians who treat the developmental disorder is growing more slowly than the number of new cases, prompting caregivers to look for novel ways to share their expertise as widely as possible.

One possible approach: Teach groups of parents an autism therapy they can deliver at home. A new study from Stanford and Lucile Packard Children’s Hospital Stanford, published today in the Journal of Child Psychology and Psychiatry, found that small groups of parents could learn to deliver a scientifically validated autism treatment to their own children in a short series of classes.

The therapy, called pivotal response training, which has been validated in several prior studies, was targeted to kids’ language skills. The therapy gives parents a structured method for nurturing children’s verbal skills during everyday interactions.

The approach of having parents give treatment is meant to complement, not replace, one-on-one therapy with autism professionals. But it can still be valuable to children and their families, as our press release explains:

“There are two benefits: The child can make progress, and the parents leave the treatment program better equipped to facilitate the child’s development over the course of their daily routines,” said study co-author Grace Gengoux, PhD, clinical assistant professor of psychiatry and behavioral sciences and a psychologist specializing in autism treatment at the hospital. “The ways that parents instinctually interact with children to guide language development may not work for a child with autism, which can frustrate parents. Other studies have shown that learning this treatment reduces parents’ stress and improves their happiness. Parents benefit from knowing how to help their children learn.”

… To use the treatment for building language skills, parents identify something the child wants and systematically reward the child for trying to talk about it. For instance, if the child reaches for a ball, the parent says, “Do you want the ball? Say ‘ball.’”

“The child might say ‘ba,’ and you reward him by giving him the ball,” [lead author Antonio] Hardan, MD, said. “Parents can create opportunities for this treatment to work at the dinner table, in the park, in the car, while they’re out for a walk.”

The researchers are now following up with studies that will give them more information about which children and families are most likely to benefit from this therapeutic approach.

Previously: Using Google Glass to help individuals with autism better understand social cues, Using theater’s sensory experience to help children with autism and “No, I’m not ready yet”: A sister’s translation for her brother with autism
Photo by Wilson X

Autism, Parenting

Growing up with an autistic sibling: “My sister has a little cup”

Growing up with an autistic sibling: "My sister has a little cup"

It was the photo that first draw my attention: the big sister and little sister, with their bed-head hair and pink-and-purple pajamas, hugging each other happily. It was like a scene straight out of my house, and I’m a sucker for stories about sisters – so I began reading. The Huffington Post piece was, indeed about two close, loving little siblings – but, more specifically, about the writer-mom’s concerns over how her youngest daughter’s autism has affected her daughter Phaedra.

Neither of my girls has autism, but Janel Mills is such a gifted writer (and her older daughter, with her maternal, sensitive ways, reminded me so much of mine) that it wasn’t difficult to feel what it would be like in this mother’s shoes. And this portion of the story, with Mills’ beautiful, simple description of what was going on in her younger daughter’s mind, brought me to tears:

One day, as we were driving to my mom’s house, Bella started having a full-blast, take-it-to-eleven, screeching meltdown because she dropped a toy somewhere in the car and neither she nor I could reach it. Phaedra hates the car meltdowns most of all because she can’t go anywhere to escape them. Listening to Bella melt down hurts her physically (the screams are LOUD) and emotionally (she’s a sensitive soul). When we finally pulled into my mom’s driveway and I got Bella her toy, Phaedra asked me with a shaky voice why Bella reacted the way she did. I must have heard this or read this somewhere, because there’s no way I was this clever on the spot, but this is what I told her:

“Everyone has a cup in their head. We pour all of our feelings, like happy, sad, mad, scared, anything, into that cup. Most people have regular-size cups. When you pour out your feelings into your cup, you have more than enough room for them. Bella has a cup, too, but her cup is little. When she pours her feelings out, her little cup can’t hold all of them, and it overflows. Does that make sense, honey?”

Apparently it did, because she uses this story to explain to others how Bella is different. She shares it with teachers, friends, basically anyone who will stand still and listen to her talk about her family.

“My sister Bella has a little cup.”

Previously: “No, I’m not ready yet”: A sister’s translation for her brother with autism and A mother’s story on what she learned from her autistic son

Autism, Pediatrics, Research, Stanford News

Stanford research clarifies biology of oxytocin in autism

Stanford research clarifies biology of oxytocin in autism

For years, scientists have been trying to sort out the role oxytocin plays in autism. The developmental disorder affects one in 68 U.S. children, causing social and communication deficits, repetitive behaviors and sensory problems. Oxytocin, which functions in the blood as a hormone and in the brain as a neurotransmitter, has long been known to have roles in enhancing social ability. Based on research in animal models, some people have speculated that oxytocin deficiency might contribute to autism. But prior human studies of the purported connection have produced a confusing picture.

The previous hypotheses saying that low oxytocin was linked to autism were maybe a little bit simplistic. It’s much more complex…

Now, a new Stanford paper publishing online this week in Proceedings of the National Academy of Sciences adds interesting details to our understanding. The study is the largest ever to examine blood oxytocin levels in children with autism and two comparison groups without autism: kids who have autistic siblings and children who do not have siblings with autism.

The researchers found the same range of blood oxytocin levels across all three groups, with similar numbers of children with low, medium and high oxytocin levels in each category. Although, as expected, the kids with autism had social deficits, blood oxytocin level was clearly linked to social ability within each group. Children with autism who had low blood oxytocin had poorer social ability than autistic children with high blood oxytocin, for example, and typically developing kids with low blood oxytocin also had poor social ability compared to other typically developing children.

From our press release on the research:

“It didn’t matter if you were a typically developing child, a sibling or an individual with autism: Your social ability was related to a certain extent to your oxytocin levels, which is very different from what people have speculated,” said Antonio Hardan, MD, professor of psychiatry and behavioral sciences and the study’s senior author. Hardan is a child and adolescent psychiatrist who treats children with autism at [Lucile Packard Children's Hospital Stanford].

“The previous hypotheses saying that low oxytocin was linked to autism were maybe a little bit simplistic,” he said. “It’s much more complex: Oxytocin is a vulnerability factor that has to be accounted for, but it’s not the only thing leading to the development of autism.”

The findings suggest that, although oxytocin deficiency may not explain all cases of autism, some kids with autism may still benefit from oxytocin-like medications. The researchers caution that their study needs to be repeated with measures of oxytocin in cerebrospinal fluid, since this liquid that bathes the brain may give better information about the nuances of oxytocin biology.

A Duke University scientist commented for a story on NPR’s health blog, Shots, about what the findings imply for the potential value of oxytocin therapy:

“It could be that if a kid has low oxytocin levels then they might benefit,” says Simon Gregory, a genomics researcher at Duke University who was not involved in the study. He is part of another group investigating the use of oxytocin to treat people with autism.

Gregory says it’s not surprising that children with autism have widely varying levels of oxytocin. “Autism isn’t a disease, it’s a spectrum” that can’t be linked to any one cause, he told Shots.

Stanford’s research team is also doing more work to clarify further details of the biology of oxytocin in autism.

Previously: Volunteers sought for autism drug study, Using Google Glass to help individuals with autism better understand social cues and “No, I’m not ready yet”: A sister’s translation for her brother with autis

Autism, Neuroscience, Pediatrics, Research, Stanford News

Finding of reduced brain flexibility adds to Stanford research on how the autistic brain is organized

Finding of reduced brain flexibility adds to Stanford research on how the autistic brain is organized

A Stanford brain-imaging study has just shown that the brains of children with autism are less able to switch from rest to taking on a new task than the brains of typically developing children.

According to the study, which appears this week in the scientific journal Cerebral Cortex, instead of changing to accommodate a job, connectivity in key brain networks of autistic children looks similar to connectivity in the resting brain. The degree of inflexibility was linked to the intensity of children’s autism symptoms: those with less flexibility had more severe restrictive and repetitive behaviors, one of the hallmarks of the developmental disorder.

From our press release on the research:

“We wanted to test the idea that a flexible brain is necessary for flexible behaviors,” said Lucina Uddin, PhD, a lead author of the study. “What we found was that across a set of brain connections known to be important for switching between different tasks, children with autism showed reduced ‘brain flexibility’ compared with typically developing peers.” Uddin, who is now an assistant professor of psychology at the University of Miami, was a postdoctoral scholar at Stanford when the research was conducted.

“The fact that we can tie this neurophysiological brain-state inflexibility to behavioral inflexibility is an important finding because it gives us clues about what kinds of processes go awry in autism,” said Vinod Menon, PhD, the Rachel L. and Walter F. Nichols, MD, professor of psychiatry and behavioral sciences at Stanford and the senior author of the study.

The study is the first to examine unusual patterns of connectivity in the brains of children with autism while they are performing tasks; Menon’s team has previously published research on connectivity between different regions of the autistic brain at rest. Some regions of the autistic brain are over-connected to each other, that work has shown, and the degree of over-connection is linked to children’s social deficits, perhaps in part because it interferes with their ability to derive pleasure from human voices. Menon’s lab has also explored how differences in the organization of the autistic brain may contribute to better math performance in some people with autism.

“We’re making progress in identifying a brain basis of autism, and we’re starting to get traction in pinpointing systems and signaling mechanisms that are not functioning properly,” Menon told me. “This is giving us a better handle both in thinking about treatment and in looking at change or plasticity in the brain.”

Previously: Greater hyperconnectivity in the autistic brain contributes to greater social deficits, Unusual brain organization found in autistic kids who best peers at math and Stanford study reveals why human voices are less rewarding for kids with autism

Autism, Big data, Stanford News, Technology, Videos

Using Google Glass to help individuals with autism better understand social cues

Using Google Glass to help individuals with autism better understand social cues

The 2014 Big Data in Biomedicine conference was held here last month, and keynote speakers, panelists, moderators and attendees are now available on the Stanford Medicine YouTube channel. To continue the discussion of how big data can be harnessed to benefit human health, we’ll be featuring a selection of the videos this month on Scope.

At the Big Data in Biomedicine 2014 conference, Dennis Wall, PhD, associate professor of pediatrics in systems medicine at Stanford, discussed how he and colleagues are leveraging home videos and a seven-point parent questionnaire to diagnose autism. In a pair of Behind the Scenes at Big Data videos, Wall discusses the research and its potential to speed up the standard diagnosis process, as well as another project aimed at using Google Glass to help autistic individuals better read others’ emotions. Watch the above clip to learn how the wearable technology could be used for a new type of behavioral therapy.

Previously: Rising to the challenge of harnessing big data to benefit patients and Home videos could help diagnose autism, says new Stanford study

Autism, Behavioral Science, Pediatrics, Stanford News

Home videos could help diagnose autism, says new Stanford study

Home videos could help diagnose autism, says new Stanford study

Autism is more complex to diagnose than many other childhood conditions. There’s no physical sign or lab test; rather, making the diagnosis requires careful observation for clues such as poor language and social skills or repetitive behaviors. Standard diagnostic tests take several hours of a professional’s time, and families may wait months to see someone who can assess their child.

But new research from Stanford and Harvard Medical School suggests that faster diagnoses might become possible. The research team, whose findings appear today in PLOS ONE, tested whether short home videos could be harnessed to speed the process. Using a scoring system that was pared down from the “gold standard” diagnostic test, they assessed kids’ behavior in 100 short videos pulled from YouTube. About half of the videos showed children with autism; the rest did not. The scoring system classified 97 percent of the videos accurately.

The system is unlikely to replace traditional diagnostic methods, but could help relieve the diagnostic bottleneck, study author Dennis Wall, PhD, explained in our press release:

“For instance, we could use this system for clinical triage, as a way to channel traffic so that children can get the kind of attention they need as early as possible,” Wall said. Children who clearly have autism might be diagnosed primarily with videos and quickly started on therapy, freeing clinicians to spend more time evaluating children whose diagnosis is less clear-cut.

Home videos also provide information that is otherwise unavailable to those making the diagnosis, Wall said:

Another potential advantage of using video for diagnosis is that young children often behave differently in a doctor’s office than at home.

“Clinical settings are often stark, artificial and can elicit behaviors that are abnormal,” Wall said. “The odds are stacked against the diagnostic professional because the child is in an unknown environment with strangers.”

The researchers plan to explore whether the same method could also be used for making other behavior-based diagnoses, such as detecting attention-deficit hyperactivity disorder or adult-onset neurologic conditions such as Alzheimer’s or Parkinson’s disease.

Previously: Using Kinect cameras to automate autism diagnosis, Director of Stanford Autism Center responds to your questions on research and treatment and New imaging analysis reveals distinct features of the autistic brain

Autism, In the News, Pediatrics, Research

Using theater’s sensory experiences to help children with autism

Using theater's sensory experiences to help children with autism

Gesamkunstwerk, my favorite German word and a term commonly associated with the operas of Richard Wagner, can be translated as a “total work of art” playing to many of the senses and synthesizing numerous art forms. The word came to mind as I read about a pilot study using theater as an environment for children with autism-spectrum disorders  to explore “communication, social interaction, and imagination skills – the ‘triad of impairments’ seen in autism,” a New Scientist piece notes, “engaging all the children’s senses at once.”

Twenty-two children ages 7-12 attended one weekly 45-minute session for 10 weeks involving improvisation exercises led by trained performers in enclosed make-believe environments such as a forest or outer space.

From the piece:

As well as looking at whether behaviours used to diagnose autism changed after the drama sessions, the researchers also assessed emotion recognition, imitation, IQ and theory of mind – the ability to infer what others are thinking and feeling. Subjective ratings were also gathered from parents and teachers and follow-up assessments were conducted up to a year later.

At the early assessments, all children showed some improvement. The most significant change was in the number of facial expressions recognised, a key communication skill. Nine children improved on this. Six children improved on their level of social interaction. The majority of these changes were also seen at the follow-up assessments.

The project’s lead psychologist, David Wilkinson, PhD, at the University of Kent, told New Scientist, ”It’s an opportunity for children to create their own narratives in an unconstrained, unfamiliar environment.” He continued, “They find this empowering, and we know from the psychology literature that individuals who are empowered enjoy increased attention skills and an improved sense of well-being.”

Previously: Making museums more inviting for autistic children and their familiesStanford study reveals why human voices are less rewarding for kids with autismDirector of Stanford Autism Center responds to your questions on research and treatment and A mother’s story on what she learned from her autistic son

Autism, Genetics, Neuroscience, Research, Videos

Building a blueprint of the developing human brain

Building a blueprint of the developing human brain

In an effort to identify and better understand how genes turned on or off before birth influence early brain development, scientists at the Allen Institute for Brain Science have created a comprehensive three-dimensional map that illustrates the activity of some 20,000 genes in 300 brain regions during mid-prenatal development.

A post on the NIH Director’s blog discusses the significance of the project, known as the BrainSpan Atlas of the Developing Human Brain:

While this is just the first installment of what will be an atlas of gene activity covering the entire course of human brain development, this rich trove of data is already transforming the way we think about neurodevelopmental disorders.

To test the powers of the new atlas, researchers decided to use the database to explore the activity of 319 genes, previously linked to autism, during the mid-prenatal period. They discovered that many of these genes were switched on in the developing neocortex—a part of the brain that is responsible for complex behaviors and that is known to be disrupted in children with autism. Specifically, these genes were activated in newly formed excitatory neurons, which are nerve cells that send information from one part of the brain to another. The finding provides more evidence that the first seeds for autism are planted at the time when the cortex is in the midst of forming its six-layered architecture and circuitry.

In the above video, Ed Lein, PhD, an Allen Institute investigator, talks about the atlas and explains how it will allow researchers to examine genes that have been associated with a range of neurodevelopmental disorders and pinpoint when and where that gene is being used.

Previously: NIH announces focus of funding for BRAIN initiative, Brain’s gain: Stanford neuroscientist discusses two major new initiatives and Co-leader of Obama’s BRAIN Initiative to direct Stanford’s interdisciplinary neuroscience institute

Autism, Medicine and Literature, Medicine and Society

“No, I’m not ready yet”: A sister’s translation for her brother with autism

Over on Medium.com, Abby Norman shares experiences from her youth in a family with a brother, Caleb, who has autism and a mother with an eating disorder. Able to observe and interpret Caleb’s ways of communicating, Abby acts as a translator to give him a voice that others will hear and, one hopes, understand.

From the piece:

What calmed him was lying on the bed for hours, motionless, watching the numbers of the digital clock change.

He did not potty train on schedule. Instead, he had somewhat of an intense penchant for smearing feces all over the rug and walls of the house. This was his way of saying, “No, I’m not ready yet.” … His relationship to the toilet had nothing to do with his bodily needs: the toilet was his method of rejecting objects. If he didn’t want something, he’d flush it down the toilet.

He was only aggressive in the sense that, when startled or overwhelmed, he would kick and scream. They started out seeming like normal tantrums; but while most kids could be consoled, Caleb could not be, and he would have to literally wear himself down before he would stop.

The author notes that even in understanding her brother’s differences, she was not necessarily his ideal caretaker. The piece continues:

Once he started school, the nightmare only intensified. I say that not to describe what life was like for us, but for him. School, with its unpredictable nature and constant social interaction, its lack of structure for kids who needed anything other than “normative learning.” The truth was, Caleb wasn’t really special needs. He was extremely intelligent.

At home, his day to day life was more or less consistent. While my experience growing up with a mum with an eating disorder was difficult, for Caleb, the obsessive-compulsive nature of her lifestyle was exactly what he required to stay calm and safe. He and my mother had, and to this day still have, a very symbiotic relationship.

Previously: Inspired by his autistic son, a Stanford researcher works to understand the biochemistry of autismThe Reason I Jump: Insights on autism and communication, A mother’s story on what she learned from her autistic son and Autism therapies: It still comes down to parents

Autism, In the News, Pediatrics, Research, Stanford News

Inspired by his autistic son, a Stanford researcher works to understand the biochemistry of autism

Inspired by his autistic son, a Stanford researcher works to understand the biochemistry of autism

dolmetschIn a Q&A published today in the New York Times, Stanford neurobiologist Ricardo Dolmetsch, PhD, tells reporter Claudia Dreifus that his immediate reaction to learning his son was diagnosed with autism was, “We’re not going to leave any stone unturned to help him.”

Leaving no stone unturned included changing the focus of his research to better understand the biochemistry of autism and leading an effort to create a technique that involves reprogramming skin cells from autistic children into neurons. As reported previously on Scope, this approach allows scientists to better study brain function in children with autism.

Dolmetsch, who is currently on leave from Stanford and working at Novartis, tells Dreifus that his main goal is to develop new pharmaceutical therapies for autism. When she asked him how he identifies patients to participate in his research, he responded:

Through social media. We’re often interested in groups or families who have specific kinds of mutations. Some of them are rare — 5,000 people worldwide.

So we have a committee that decides what’s the next mutation we’re going to work on. Then we find children with it. It used to be we’d spend half of our budget locating people. Now, we go to the families with a Facebook page for people with X, Y, or Z mutation. Then I’ll post a call. Parents will come forward.

The aim is to develop a database of the mutations we think are causative of the neuropsychiatric diseases. If we can get samples through stem-cell-derived neurons and create a library of them, we could change the way the diseases are diagnosed.

Previously: Using stem cells to advance autism research, Stanford Magazine spotlights scientists’ efforts to untangle the root causes of autism and Research on autism is moving in the right direction
Photo by Steve Fisch

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