Robin Post, the program director of the autism and Shakespeare study at Ohio State University Wexner Medical Center, works with students at an elementary school in Columbus.
Researchers at Ohio State University Wexner Medical Center’s Nisonger Center are working with a group of middle school students in Columbus to see if Shakespeare’s plays can help children with autism spectrum disorders make gains in communication and in understanding and expressing emotions.
The study is based on the Hunter Heartbeat Method, which was developed about 20 years ago by Kelly Hunter, an actress with the Royal Shakespeare Company in London. Hunter’s theory, according to Marc Tassé, director of the Nisonger Center, is that Shakespeare’s work, because of its meter and exaggerated expression of emotion, is particularly well suited for theater interventions for autism.
The Ohio State researchers are using “The Tempest” to teach the study’s 20 participants subtle clues about emotions; they will study the children over the course of 42 weeks to see if the method yields results.
The students “practice how to express emotions differently, and observe how that emotion may present itself differently in the facial reaction and tone of voice of others,” said Tassé, the principal investigator of the study. . “Sometimes that’s a challenge for kids with autism, reading those subtle social cues.”
According to Tassé, Hunter believes the iambic pentameter of Shakespeare’s verse mimics the rhythm of a heartbeat, and each session begins with students tapping their chests. Participants then re-enact scenes from the play to work on expressing emotions.
“They go around the circle and take turns doing an angry voice, with an angry face, and observe the other students and the theater students doing angry, then sad, then happy,” Tassé said.
The study is broken into two groups of 10 students from across the autism spectrum. One group is working with members of the theater department at Ohio State on the Hunter Heartbeat Method for about an hour once a week through next May (with a break for the summer). Members of the other group will receive only the therapy or services they normally would get, Tassé said.
At the end of the study, both groups will be assessed on their use of language in social situations, social skills and ability to recognize others’ emotions. A pilot study last year looked at results in 14 students over the course of 10 weeks. In that study, Tassé said, researchers noticed significant improvements in communication, peer relations and adaptation skills.
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Doctors at Children’s National Medical Center are looking for families affected by autism, in the testing of a novel drug that targets the symptoms at its core. It is part of a nationwide program calledConnectMe.
Dr. Adelaide Robb, Principal Investigator for the ConnectMe research program at Children’s National Medical Center says, “It is looking at, for the first time, the core symptoms of autism. That means difficulty with social relatedness. How do you play with kids, how do you communicate with other kids?”
Dr. Robb says the medicine may also boost language skills, and cut down on repetitive behaviors and mannerisms that make it hard for children on the autism spectrum to communicate.
The program is for children between the ages of 6 to 12 and may last up to 52 weeks. For families who are interested in the DC area you can call the research study line at Children’s (202) 476-6067. For those outside of the metro area check the website for the nearest research site near you. www.clinicaltrials.gov.
- Special Edition – Aspergers (education.com)
Frustrated by the elusiveness of the origins of the mysterious disorder, scientists have put forth a range of (sometimes far-reaching) theories.
Thanks to improved diagnostic tools, doctors are identifying autism spectrum disorders at “unprecedented rates.” And yet, the causes of the disorder continue to elude us. While the widely discussed notion that childhood vaccines cause autism has effectively been debunked, a whole host of studies have popped up since, fostering fear around purported risk factors both in and out of our control. The most recent revelation offers a rather complicated connection — variations in DNA that may predict whether a person will develop the disorder — but previous hypotheses have targeted more everyday elements and activities. Here, 13 things reportedly linked to autism:
1. Older dads
In August 2012, a study released in the journal Nature suggested that older fathers pass on more genetic mutations to their offspring, which can give rise to autism. With each year they age, men are likely to develop as many as two new mutations.
2. Older moms
A previous study had found that that it was older moms who elevated the autism risk. The chances of having a child with the disorder increased by 18 percent for each five-year increase in maternal age.
3. Overweight moms
Researchers studied more than 1,000 children in California and found that the risk of autism and other developmental delays was 60 percent higher among those born to mothers who were obese, hypertensive, or diabetic. But, as one author noted in April 2012, drawing a definitive connection is difficult, since there could be “environmental factors that contribute to both” issues.
4. Having the flu during pregnancy
A Danish survey that came out in November 2012 found that mothers who reported having the flu during pregnancy were at least twice as likely to have a child with autism. Those whose fever persisted for a week or more before their third trimester were three times as likely to have a child on the autism spectrum.
5. Back-to-back pregnancies
A study published in early 2011 found that children conceived less than 12 months after the birth of an older sibling were three times as likely to be diagnosed with autism as their peers. The study examined the medical records of 662,730 second-born children.
6. Vitamin D deficiency
One U.S. researcher put forth this controversial hypothesis in August 2011 — that lagging levels of vitamin D during fetal development and early childhood are related to autism. The evidence, vague at best, comes down to the coincidence of autism rates having “skyrocketed in lockstep with medical advice given to the public since the late 1980s to avoid all exposure to bright sunlight.” Yeah, it’s a stretch.
7. “Assortative mating”
Let’s say a place, a city, a neighborhood, attracts a particular type of person. That person, in this instance, is a science nerd. A theory, proposed in August 2011, assumes that what science nerds have in smarts, they lack in empathy and the ability to relate to others — characteristics also found in autism. So, in this place filled with science nerds, it’s possible that two might meet, marry, and have a child, who, the theory continues, may grow to develop the same deficiencies as his or her parents but to an even more pronounced degree. This theory is largely unsupported.
8. Too many brain cells
Some compelling evidence came out of a small study in November 2011. Comparing the brains of seven deceased autistic children to those of deceased kids who didn’t have the disease, researchers found that the autistic brains had, on average, 67 percent more neurons than those without. And those neurons were concentrated in the prefrontal cortex, which is key to complex thoughts and behaviors, including language, social behavior, and decision-making.
9. Low birth weight
In October 2011, a study in the journal Pediatrics suggested that babies who are unusually small at birth have a higher-than-average risk of developing an autism spectrum disorder later in life. The long-term study followed more than 1,000 premature babies over 21 years and found that 5 percent of them met the criteria for an autism-like disorder. At the time, that rate was roughly five times higher than the rate among the general population of children. The “striking” findings urged for more developmental screenings.
Researchers in 2010 took a page from a prior study that hinted at a connection between autism and jaundice — a common condition among newborns characterized by a yellowing of the skin. In the newer and larger study, scientists dug deep into Denmark’s national registries, analyzing the records of the 733,826 babies born between 1994 and 2004. They found that the children born full-term with jaundice had a 56 percent greater chance of developing an autistic spectrum disorder than those without the condition.
11. Air pollution
A November 2012 study compared the early proximity to air pollution of children with and without autism. It found that kids in the top 25 percent of pollution exposure (found out of the home — including traffic volume and vehicle emissions — and excluding second-hand smoke) were far more likely to develop autism than children in the bottom 25 percent. In fact, children in the highest tier were two to three times as likely to be diagnosed with the disease.
12. Chemicals found in plastics
Bisphenol A, a chemical present in plastic food packaging and water bottles, was reported in June 2011 to interfere with the body’s natural estrogen system. Anti-microbials, an additive in soaps, toothpaste, and other things, were also a concern for artificially enhancing androgenic activity, which, in plain speak, means these regular household items “could potentially play a role in autism or other neurodevelopment disorders,” one researcher said.
13. The typical American diet
A study in April 2012 went so far as to connect the “epidemic of autism” among our nation’s children with the “typical American diet,” which is to say, an unhealthy one. Manufactured ingredients like high-fructose corn syrup, for example, may be preventing the body from ridding itself from common toxic chemicals. Consuming high-fructose corn syrup, the study noted, has been associated with dietary loss of zinc, and such an insufficiency can have a negative impact on the body’s ability to eliminate heavy metals, which can then have an adverse effect on young children’s brain development.
Jennifer Cohen and Michelle Ruha of the Banner Good Samaritan Medical Center in Phoenix said metal-binding agents such as DMPS have received significant attention amid the controversy over the alleged link between mercury and autism.
Even though no causal relationship between mercury in vaccines and autism has been proven, some practitioners treat their patients with mercury-binding agents in an effort to help the body eliminate mercury and treat autism.
One of these agents is a formulation of DMPS applied to the skin, which is approved in Europe for the treatment of heavy metal toxicity, but is not approved by the United States, but it can be purchased on the Internet.
Cohen and the research team looked at whether topically applied DMPS is absorbed into the body by measuring levels in the blood 30, 60, 90, 120, and 240 minutes after application. They also measured whether DMPS applied to the skin resulted in an increased excretion of mercury in the urine 12 and 24 hours after application.
The study comprised eight healthy adult volunteers and one control subject, Cohen said.
The study, published in the Journal of Medical Toxicology, found none of the urine samples collected from the healthy subjects contained detectable DMPS and DMPS was not detected in 40 of 41 blood samples, with the single sample containing DMPS considered by the authors to be contamination of the sample.
“Our results show that the drug is not absorbed and does not work as a metal-binding agent, when applied to the skin,” Ruha concluded.
- Autism treatment is more than skin deep (eurekalert.org)
Funny feeling: A rubber hand starts to feel like a person’s real hand, but more slowly to children with autism than to controls.
Children with autism are less susceptible to an illusion involving sight and touch, according to unpublished research presented Monday at the Society for Neuroscience annual meeting in New Orleans.
Several studies have shown that people with autism are less susceptible to illusions involving sight and sound. These findings are thought to reflect problems in integrating information from multiple senses.
“We know that multisensory integration is different in [individuals with autism], but it hadn’t been looked at in visual-tactile information before,” says Carissa Cascio, assistant professor of psychiatry at Vanderbilt University, who presented the work.
Cascio and her colleagues tested the ‘rubber hand illusion’ in 21 children with autism and 28 controls. The participants sat with their hands on a table in front of them, but with one hand hidden under a box. The researchers placed a rubber hand next to the box, then simultaneously brushed both the rubber hand and the hidden hand with a small paintbrush.
When controls undergo this procedure, “they experience the perception that what they’re seeing is causing what they’re feeling,” says Cascio. That is, they begin to feel as if the rubber hand were their own hand.
Children — particularly those with autism — might have trouble describing this experience. So to assess the experiment objectively, the researchers asked the children to close their eyes and point to a spot on a ruler atop the box corresponding to where they thought their hidden hand was.
The controls say they their hidden hand is closer to the rubber hand after the brushing than they do at the start of the experiment, suggesting that their minds are fusing the real hand and the rubber hand into a single entity.
Among children with autism, this ‘drift’ towards the rubber hand doesn’t occur as rapidly, the researchers found.
These children identify the position of their hidden hand just as accurately at the beginning of the experiment as do controls, indicating that they don’t have trouble judging the position of their body in general. Instead, the lack of drift suggests that they are less susceptible to the illusion, the researchers say.
However, if the experimenter brushes the rubber hand and the hidden hand half a second apart, children with autism are more likely to experience the illusion than are controls.
Another study presented Monday suggests an explanation for this curious result.
In that study, conducted by Mark Wallace’s team at Vanderbilt University, researchers showed 32 children with autism and 32 controls videos with slightly misaligned sound tracks.
The interval over which people perceive asynchronous sounds as happening simultaneously is longer for people with autism than it is for controls, the researchers found. In scientific terms, those with autism have a wider temporal binding window.
Cascio suggests that this may also apply to their perception of sight and touch. “It could be that [half a second] wasn’t long enough for those asynchronous inputs to be perceived as asynchronous,” she says.
Scientists have suggested that abnormal integration of sight and sound may play a role in the language impairment seen in many children with autism. Similarly, abnormal integration of sight and touch or sound and touch may contribute to social deficits in the disorder.
“Social cognition involves the ability to map one’s own body [perceptions] to an external location,” Cascio says — that is, the ability to put oneself in another’s place. In fact, the researchers found that children with greater impairments in empathy are also less susceptible to the rubber hand illusion than others.
Integration of sight and touch may be just as important early in life as the more frequently studied pairing of sight and sound, Cascio says. “Touch is a sensory system that before we learn to talk is very critical to our communication and social interactions,” she says.
I have to admit: I don’t know what my kids’ pediatricians know about Autism. It is unlikely that they were taught more about Autism than I was when I went through my Physician Assistant training. Now as I look back as a parent, knowing the curricula that medical students and Physician Assistant students are taught, only confirms that earlier suspicion. Not that my kids’ pediatricians didn’t know about autism; they simply accepted that diagnosis which was made by someone else (a developmental pediatrician) and went on from there. It was just another diagnosis they worked with, like Chicken Pox. Treatments prescribed by a specialist like a pediatric neurologist were also just simply accepted; I don’t remember anyone asking about side effects or anything else. I don’t ever recall one of the pediatricians asking about gluten- or casein-free diets, chelation or hyperbaric oxygen therapy. Perhaps, like most parents on the Spectrum, my wife and I researched and learned about all these things on our own, much like navigating a CSE meeting for the first time. Pediatricians, for the most part, are taught to accept things published in respected medical journals, so any notion of treatment not in the mainstream would never have been discussed, as compared with DAN doctors who address immune deficiencies, environmental toxins, vaccines, etc. Many parents swear by DAN doctors, but like many others like me, tend to keep one foot in traditional medicine for general wellness and the other foot learning about Autism treatments/educational models/socialization/transitioning issues/etc. all on my own. Besides, if there’s something about Autism that my kids’ pediatricians want to know, my wife and I could probably fill them in.-Ed
Many Parents of Kids With Autism Don’t Put Faith in Pediatricians
Likewise, many pediatricians don’t think they have the knowledge — or time — to devote to children with autism, with some citing reimbursement policies that don’t allow for payment for lengthier appointments or for managing complex cases.
The pediatricians interviewed for the study also said they felt especially uncomfortable advising parents on alternative therapies, which are commonly used by families with autistic children.
“Most parents are not going to pediatricians with questions about treatments. They looked to them for referrals to specialists or to community resources, but they really weren’t going to them for guidance about what sort of treatments they should pursue,” said study author Dr. Susan Levy, who directs the Regional Autism Center and the Center for Autism Research at Children’s Hospital of Philadelphia.
“And the pediatricians didn’t feel informed enough to make those recommendations,” she added.
Autism experts said the findings point to a problem that needs a solution.
“This study validates what previous studies and parents have told us: Many pediatricians are not prepared to provide the kind of advice and information that parents need after receiving a diagnosis of autism for their child,” said Geraldine Dawson, chief science officer for Autism Speaks.
She added: “Without advice and information from their primary care provider, families must navigate treatment options on their own, which can be confusing and complex. This adds to the already high levels of stress that families are experiencing. We need greater emphasis on autism training for primary care physicians so they can help parents make informed decisions about their child’s care.”
The research, to be presented Wednesday at the International Meeting for Autism Research in Toronto, involved interviews with 20 parents of children aged 3 to 5 with an autism spectrum disorder and 20 pediatricians affiliated with Children’s Hospital.
Ideally, pediatricians would do more than refer patients elsewhere, Levy said. They would serve as a “medical home,” managing all aspects of the child’s care, receiving reports, consulting with specialists and helping parents integrate autism treatments with the child’s overall development and health needs.
Key to this arrangement is shared decision-making, in which pediatricians advise parents on, say, the evidence available about alternative treatments, and together parents and doctors decide the best course of action, she added.
In reality, that’s rarely what happens, Levy said. “What the pediatricians should do and what they think they should do is very different from what actually happens,” she said.
Many families, for example, turn to alternative treatments to help with autism, since there aren’t any medications that treat the core symptoms of autism.
But many doctors find it difficult to frankly discuss those treatments with parents, because there is little evidence that they work even though some parents think they do, Levy said.
“Complementary and alternative medicine was an area pediatricians mentioned frequently as an area of discomfort. They knew they wanted to protect families from harm and figure out how to communicate risk and evidence,” Levy said.
Parents, on the other hand, perceived pediatricians as frequently dismissive or negative toward alternative therapy, and so often didn’t bother to bring it up, the study showed.
Families also said pediatricians offered little support to them in dealing with the stress of autism, and that instead they turned to friends, family or other community resources.
Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.
SOURCES: Susan Levy, M.D., director, Regional Autism Center, Center for Autism Research, Children’s Hospital of Philadelphia; Geraldine Dawson, Ph.D., chief science officer, Autism Speaks; May 16, 2012, presentation, International Meeting for Autism Research, Toronto
More than 30 percent of fathers of grown children with autism experience symptoms of depression so severe that they warrant clinical attention, first-of-its-kind research indicates.
In a study presented Friday at the International Meeting for Autism Research in San Diego, researchers found that fathers of adolescents and young adults with autism experience high levels of depression and are pessimistic about what the future holds for their son or daughter, much more so than dads whose kids have other disabilities like Down syndrome and fragile X.
“Fathers of adolescents and young adults with autism are really faring the worst,” says Sigan Hartley, a University of Wisconsin-Madison researcher who led the study, which was recently accepted for publication in the journal Family Relations.
Hartley said her findings mirror what researchers already know about mothers of those with autism — that they experience higher stress than other moms and that stress remains even as their children age. But this is the first time anyone has looked at how dads cope as their children get older.
For the study, Hartley and her colleagues looked at self-reported data collected between 2000 and 2005 from fathers of 240 individuals with autism, Down syndrome and fragile X syndrome ranging in age from 10 to their early 20s.
After controlling for the child’s age, family income and the marital status of the father, the research team found that dads of those with Down syndrome fared best out of the three disability groups while those with a child who had fragile X syndrome fell in the middle.
Factors such as the child’s behavior, the likelihood of having more than one child with a disability, the father’s age and the mother’s well-being did seem to play a role in fathers’ experiences. But Hartley says more research needs to be done to better understand what’s leading to elevated levels of depression symptoms in dads of those with autism in particular.
“This is the first step to drawing attention to dads,” Hartley says. “We need to get away from just looking at moms.”