New Study looks at the development of Autism in Infants

The University of California at Davis issued the following news release:

A study of the development of autism in infants, comparing the behavior of the siblings of children diagnosed with autism to that of babies developing normally, has found that the nascent symptoms of the condition — a lack of shared eye contact, smiling and communicative babbling — are not present at 6 months, but emerge gradually and only become apparent during the latter part of the first year of life.

Researchers conducted the study over five years by painstakingly counting each instance of smiling, babbling and eye contact during examinations until the children were 3.  They found that by 12 months the two groups’ development had diverged significantly.

Intentional social and communicative behavior among children developing normally increased, while among infants later diagnosed with autism it decreased dramatically.

The study is published online early and will appear in the March issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

“This study provides an answer to when the first behavioral signs of autism become evident,” said Sally Ozonoff, the study’s lead author, a professor of psychiatry and behavioral sciences and a researcher with the UC Davis MIND Institute.

“Contrary to what we used to think, the behavioral signs of autism appear later in the first year of life for most children with autism.  Most babies are born looking relatively normal in terms of their social abilities but then, through a process of gradual decline in social responsiveness, the symptoms of autism begin to emerge between 6 and 12 months of age.”

Autism is a pervasive developmental disorder of deficits in social skills and communication, as well as in repetitive and restricted behaviors, with onset occurring prior to age 3.   Abnormal brain development, probably beginning prenatally, is known to be fundamental to the behaviors that characterize autism.  Current estimates place the condition’s incidence at between 1 in 100 and 1 in 110 children in the United States.

Children with a sibling already diagnosed with autism are known to be among those at greatest risk of developing the disorder. The current study included 25 high-risk children who met criteria for autism at 3 years of age, matched with 25 low risk peers who were developing normally. It was conducted at the MIND Institute and the University of California, Los Angeles. The sole inclusion criterion for the high-risk group was having a sibling with autism; low-risk participants had to have been born after 36 weeks gestation and have no autistic family members.

The children’s development was evaluated at 6, 12, 18, 24 and 36 months of age using a series of widely implemented diagnostic tools, including the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R). Examiners were not told which babies were at high- or low-risk when evaluating the participants’ development.

The researchers found that there were few discernable differences between the two groups at the outset but that after six months, 86 percent of the infants who developed autism showed declines in social communication that were outside the range for typical development.

“After six months,” the study found, “the autism spectrum disorder group showed a rapid decline in eye contact, social smiling, and examiner-rated social responsiveness.” Group differences were significant by 12 months in eye contact and social smiling and all other measures by 18 months, the study found.

The study is notable because of the accuracy and precision of its prospective methodology, assiduously recording exact numbers of social and communicative behaviors during lab visits. Previously, researchers have constructed evidence of autism’s earliest manifestations by interviewing parents about when they believed their children’s symptoms first arose or by reviewing home movies for clues to when children begin exhibiting symptoms of autism.

“Until now, research has relied on asking parents when their child reached developmental milestones. But that can be really difficult to recall, and there is a phenomenon called the “telescoping effect” where people usually say that they remember something happening more recently than when it occurred,” Ozonoff said. In addition parents frequently will turn off the video camera when their children are behaving poorly –  precisely when autistic symptoms may appear.

Ozonoff said that the study provides a deeper understanding for parents, caregivers and health-care providers and for future research of the developmental trajectory for very young children with autism.  “We need to be careful about how we screen, and we need to know what we’re looking for,” Ozonoff said. “This study tells us that screening for autism early in the first year of life probably is not going to be successful because there isn’t going to be anything to notice. It also tells us that we should be focusing on social behaviors in our screening, since that is what declines early in life.”

“This study also found that the loss of skills continues into the second and third year of life,” she said. “So it may not be adequate, as the American Academy of Pediatrics currently suggests, that providers screen for autism twice before the end of the second year. Autism has a slow, gradual onset of symptoms, rather than a very abrupt loss of skills.”

“Screening may need to continue into the third year of life, since symptom emergence takes place over a long time. If a child starts exhibiting a declining trajectory and a sustained reduction in social communication we want to refer them into therapy, especially if they are at risk,” Ozonoff said, “even before we might be able to make a definitive diagnosis.”

Ozonoff said that the study does not address the etiology of autism or causality. In this study, the infants who participated were at high risk due to having strong family histories of autism, suggesting that genetics play a major role in the later autism diagnoses, despite the fact that their symptoms were not apparent at birth.

Sensory Processing Disorder

Every person has his or her own unique way of processing and responding to different sensations.  Our senses work together to give us information about the environment and our place in it.  Vision, hearing, touch, smell and taste are the five senses most of us are familiar with.  There are two additional internal sensations that we process: vestibular, information that our middle ear relays about movement and balance, and proprioceptive, information we receive from our muscles and joints about the position of our body in space. Once our brain registers sensory information from our body and surroundings, it interprets this information, organizes it and executes our response. For most of us this sensory integration occurs without conscious effort, although each one of us has our own sensory profile that determines sensory preferences and aversions.  When the processing differences are extreme enough to interfere with everyday functioning, it is referred to as Sensory Processing Disorder.

 

Sensory Processing Disorder (SPD), also known as Sensory Integration Dysfunction or Sensory Modulation Disorder, was first recognized by occupational therapist Dr. A. Jean Ayres in the 1950s.  It causes an individual’s central nervous system to have difficulty understanding, organizing and integrating sensory information.  SPD may occur on its own or in conjunction with another developmental disability; such as attention deficit, autism, cerebral palsy, down syndrome, fetal alcohol syndrome and fragile X.  SPD looks differently from person to person and its severity can vary with fatigue, stress and physical discomfort.  It affects a child’s ability to regulate attention and behavior while experiencing different sensations.  This impacts the child’s relationships, communication, learning, behavior and sense of safety.

 

There are three main sensory processing types: over-responsive, under-responsive and mixed.  These refer to modulation or how the individual balances their reaction to match the situation.  Children who are over-responsive experience certain sensations intensely, which triggers a fight or flight response.  They react as if the situations are dangerous or painful and try to avoid them.  They may pull away if someone touches them, demand that tags be removed from their clothing, become agitated if their hands get dirty, scream during hair washing or brushing, be picky eaters, gag on certain textures of food, complain about odors that others don’t notice, cover their ears if they hear a vacuum cleaner, be unable to tune out a ticking clock, feel overwhelmed when there is too much to look at, cover their eyes when it is too bright, be uncomfortable making eye contact, experience motion sickness, avoid movement activities like swings and slides. Children who are under-responsive have a low registration of sensory information, take longer to react, need higher levels of stimulation in order to respond to their environment and often seek stimulation. They may have a high pain tolerance, walk outside barefoot, constantly touch objects or people, bump or crash into things, chew on inedible objects, ignore unpleasant odors like dirty diapers, sniff things, have difficulty following verbal directions, speak loudly, miss visual cues, fixate on objects such as the reflection of the sun in a mirror, crave fast and spinning movement without getting dizzy, enjoy swinging and rocking, take excessive risks like climbing trees or jumping off tall furniture, be unable to sit still, move constantly.  People with mixed reactivity may be over-responsive to certain types of sensory information and under-responsive to others.

 

If your child or a child you work with has signs of Sensory Processing Disorder, an occupational therapist who specializes in sensory integration can do a thorough assessment and prescribe sensory diet activities that the child’s nervous system is craving.  Early intervention can help a child’s brain better process sensory information, enable all of the senses to work together, and improve the child’s ability to plan and implement what he or she needs to do.

 

Interested in learning more?  Sensory Processing is one of the topics covered in the Autism Certificatation Program available online through Antioch University.  For more information visit:   http://antiochsbonline.coursehost.com 

Autism – Treatment Interventions

It can be very overwhelming to learn that your child has received the diagnosis of autism.  As a parent it is important to keep hope alive, build a support system, and find a treatment program that is tailored to your child’s unique strengths and needs.  Research has shown that it is best to begin treatment as early as possible.  There are several treatment options that have been found to be effective for children.  This article is intended to provide an overview of a variety of current approaches and not to make any specific treatment recommendations.  The information is a summary of descriptions provided by the programs and is presented in alphabetical order.      

 

Applied Behavioral Analysis (ABA)

Description: Also known as positive behavior support, ABA is the science of applying experimentally derived principles of behavior to improve social behavior. ABA takes what we know about behavior and applies it to bring about positive change. Behaviors are defined in observable and measurable terms in order to assess change over time. The behavior is carefully analyzed within the environment to determine what factors trigger the behavior and what happens after that behavior to reinforce it. The idea is to reduce these triggers and reinforcers in the child’s environment. New reinforcers are then used to teach the child a more socially acceptable behavior in response to the same trigger.

Goal: Breaks down skills into manageable pieces and then builds upon those skills so that a child learns how to learn in the natural environment.

Techniques: ABA treatment can include any of several established teaching tools: discrete trial training, incidental teaching, pivotal response training,  and fluency building.  The Lovaas Model of Applied Behavior Analysis uses both incidental teaching and discrete trial teaching.  It was developed by Dr. O. Ivar Lovaas based on 40 years of research at UCLA.  Pivotal Response Treatment, which is offered at the Koegel Autism Clinic at UCSB, is based on the teaching of pivotal behaviors and uses specific motivational principles.

Treatment sessions:  Intensive one-on-one structured training sessions provided by certified behavior analysts.  35 to 40 hours per week.

For more information:  http://www.abainternational.org/

 

The Developmental Individual Difference Relationship-Based Model (DIR)

Description: DIR provides a framework for a comprehensive assessment and the development of an intervention program tailored to the unique challenges and strengths of children with Autism Spectrum Disorders (ASD) and other developmental challenges. The model looks at the Developmental level of the child as compared to six basic developmental milestones that children must master for healthy emotional and intellectual growth.  These are attention and self-regulation, engagement, two-way purposeful communication, shared social problem-solving, symbolic play and building bridges between ideas and emotional thinking, which leads to the capacity for abstract gray area thinking.  DIR also takes into account the child’s Individual differences in sensory processing, motor planning and sequencing.  Relationship-based, refers to the learning relationships through which growth occurs.

Goal: To build healthy foundations for social, emotional, and intellectual capacities rather than focusing on skills and isolated behaviors.

Techniques: DIR/Floortime works on the fundamental capacities for relating, communicating and thinking, and tends to help the child use fundamental skills capacities in a wide range of naturally occurring situations.  DIR uses playful, affect based interactions to help children master each of the developmental levels.  The model is child-centered and multidisciplinary, with professionals from special education, mental health, speech, physical and occupational therapy.  It was developed by  Dr. Stanley Greenspan and Dr. Serena Weider, and based on years of studying typical child development.   

Treatment sessions: Therapists train parents to conduct 20 minute Floortime sessions several times a day.  Treatment may also include sensori-motor activities, semi-structured problem-solving and peer play groups.    

For more information: http://www.icdl.com

 

 

Relationship Development Intervention Program for Autistic Spectrum Disorders (RDI) 

Description: RDI is a clinical intervention program that addresses the debilitating core deficits of autism, such as rigid thinking, aversion to change, inability to understand other’s perspectives, failure to empathize and absolute “black-and-white” thinking.  It does this by teaching the skills of experience sharing, dynamic analysis, flexible and creative problem-solving, episodic memory, self-awareness and resilience.  It aims to provide a path for people on the autism spectrum to learn friendship, empathy, and a love of sharing their world and experiences with others.     

Goal:  To produce successful adults by building the many different abilities that are essential for success in dynamic systems.  

Techniques: Dynamic intelligence skills are taught in a step-by-step program that focuses first on building the motivations so that skills will be used & generalized, followed by carefully and systematically building the skills for competence and fulfillment in a complex world.  RDI was developed at The Connections Center in Houston, Texas, which was established in 1995 by clinical psychologists Steve Gutstein, Ph.D. and Rachelle Sheely, Ph.D.

Treatment sessions: RDI is a parent-based intervention program where parents are provided the tools to effectively teach Dynamic Intelligence skills and motivation to their child.

For more information: http://www.rdiconnect.com

 

 

Social Stories 

Description: A Social Story™ describes a situation, skill, or concept in terms of relevant social cues, perspectives, and common responses in a specifically defined style and format.  

Goal: To improve the individual’s understanding of events and expectations which may lead to more effective responses. 

Techniques: Social Stories or scripts are created that are specific to an individual, describing social situations that the person may encounter. The Stories are designed to share accurate social information in an easily understood, patient and reassuring manner.  Half of the stories should affirm something that the individual does well.  This technique was developed by Carol Gray in 1991.   

Treatment sessions: Social Stories may be read to or by the individual multiple times in advance of a social situation to help them anticipate what may happen and how to respond.

For more information: http://www.thegraycenter.org/   

 

 

Treatment and Education of Autistic and related Communication-handicapped CHildren (TEACCH)

Description: TEACCH developed the concept of the “Culture of Autism” as a way of thinking about the characteristic patterns of thinking and behavior seen in individuals with this diagnosis.  The “Culture of Autism” involves relative strength in processing of visual information, attention to detail but difficulty understanding how those details fit together, difficulty combining ideas, difficulty organizing ideas, difficulty with attention, communication problems, difficulty with concepts of time, tendency to become attached to routines, strong interests, marked sensory preferences.

Goal: To develop skills and fulfill fundamental human needs such as dignity, engagement in productive and personally meaningful activities, and feelings of security, self-efficacy, and self-confidence. 

Techniques: TEACCH uses a structured teaching approach that is individualized, rather than a standard curriculum.  The physical environment is structured using visual supports to make the sequence of daily activities predictable and to make individual tasks understandable. Support is provided from early childhood through adulthood. TEACCH was founded in the early 1970s by the late Eric Schopler, Ph.D. and is administered through the University of North Carolina at Chapel Hill.

Treatment sessions: Structured teaching using organizational strategies and visual learning modalities, such as  visual schedules or visual work stations.  Services can be provided in a variety of settings, including school and work, up to 25 hours per week.  Parents are included as co-therapists.   

For more information: http://www.teacch.com

 

Biomedical Approaches

There are several dietary interventions that are being tried for children with autism.  Claims have been that vitamin and mineral supplements, such as vitamin B and magnesium, may improve the symptoms.  It is important to have a laboratory assessment and consult with someone who is knowledgeable in nutritional therapy, if you are considering adding any supplements to your child’s diet.

The second type of dietary intervention involves removing certain types of food if allergies or sensitivities are present.  Many families have found a gluten and casein free diet to be helpful.  Research has found elevated levels of certain peptides in the urine of children with autism spectrum disorders that suggests foods containing gluten and casein are not broken down properly which can affect brain function. For more information: http://www.gfcfdiet.com/   

 

 

Additional Services 

When developing a comprehensive treatment program, in addition to addressing any biomedical needs and choosing intervention techniques that meet the child’s developmental, educational, social-emotional and behavioral needs; decide whether any of the following ancillary services may be beneficial.  All should be available to the child and can be used in combination with any of the above interventions.    

• Speech therapy
• Augmented communication systems (picture exchange, electronic) 
• Physical therapy
• Occupational therapy (sensory integration, Wilbarger brushing protocol)
• Therapeutic riding programs (improve coordination and motor development, while creating a sense of well-being and increasing self-confidence) 
• Art and Music.

 

Innovative Learning is providing this forum for families to share information, resources and support.  We do not endorse any particular treatment approach.  If you have tried any of these or other interventions, please tell us about your experience!

Early Signs of Autism

The early signs and symptoms of autism was one of the topics discussed last Thursday in a seminar hosted by Innovative Learning and The Eden Family of Services in association with Santa Ynez Valley Special Education Consortium and Buellton Unified School District.  The seminar on “Assessment and Goal Selection for Students with Autism”  was presented by Anne S. Holmes, M.S., C.C.C., B.C.B.A.  

Lack of relatedness and warmth is an early warning sign, observed in infants as young as 4 months.  Between 9 and 12 months, if babbling is not becoming more complex it may be a sign of a language delay.  Another sign that can emerge at this age is a lack of joint attention or shifting, for example looking from a toy to a caregiver to share the pleasure of the toy.  Symptoms observed from 12 to 14 months include: single words not emerging, lack of reciprocity or back and forth interactions, and lack of problem solving.  From 18 months on, lack of motor gestures, inability to pretend and limited use of language for social interaction may be cause for concern.

If you are a parent or early childhood educator and you notice any of these signs in a child, do not wait, have the child evaluated.   Research on children with autism shows that the earlier intervention is started, the greater the progress.  The same is true if you are concerned about a delay in any area of development; motor, cognitive, communication, social or emotional.  The child’s pediatrician can do an initial screening and let you know about resources in your area. Evaluation and early intervention services are available free of charge to children under 3 through the Individuals with Disabilities Education Act (IDEA) in the United States.  Each state has its own system for providing these services.  In California, for example, you would contact the Regional Center.  To find out who to call in your state, check the State Resource Sheet at http://www.nihcy.org.  For children with developmental delays who are age 3 and over, special education services are available.  Your local elementary school can tell you how to arrange an evaluation with the special education system in your district.

How Safe is Your Soap?

As the number of children diagnosed with autism continues to rise, so does the controversy around possible causes.  Added to the list of suspects is triclosan, a chemical found in antibacterial soaps and several other household products.  Recent research conducted at the University of California, Davis, on the effects of triclosan and similar chemicals that we use daily to fight germs, suggests these chemicals may be hazardous.   

The study, which was published in Environmental Health Perspectives in September of 2008, was part of the national Superfund Basic Research Program that is assessing the effects of environmental substances on human health.  Daniel Chang, of the Department of Civil and Environmental Engineering at U.C. Davis, says their studies indicate that “there may be sensitive periods in development (such as pregnancy, early childhood and adolescence) when these compounds could have a very subtle detrimental effect”       

Isaac Pessah Ph.D., director of the U.C. Davis Children’s Center for Environmental Health, looked at how triclosan may affect brain development.  The studies found that the chemical attaches to certain molecules on the surface of brain cells, raising calcium levels inside the cells, causing the cells to get overexcited and burn neural circuits.  This is the reason Pessah named triclosan as a “prime target for research into environmental factors that might cause autism.”

Scientists, trying to identify what causes autism, agree that it is probably a combination of factors.  One theory is that certain genes make individuals more sensitive to or less able to rid the body of environmental toxins which affect neurological development. The U.C. Davis M.I.N.D. Institute, a multidisciplinary research center dedicated to studying and treating autism, responded to media coverage about the studies in June with a press release stating that “there is no evidence that triclosan is implicated in promoting autism.”  However, while “triclosan was previously believed to affect only bacterial cells, it also has diverse biological activities in mammalian cells … and has been found to accumulate in the environment and in human tissue” which is “cause for concern.”     

It is estimated that consumers spend about $! billion dollars a year on antibacterial products.  Triclosan is found in 76% of all liquid soap sold and is also added to toothpaste, mouthwash, cosmetics, fabrics and plastic kitchenware.   Triclocarban, the other subject of the U.C. Davis study, is a common additive in antibacterial bar soap and deodorant and was found to amplify the effects of hormones.  Triclosan and triclocarban were developed in the 1950s to be used as antiseptic agents in hospitals.    

Concerns about both of these chemicals have been raised before.  The American Medical Association has opposed routine use of antibacterial soaps since 2002.  In 2005, the Food and Drug Administration concluded that antibacterial soaps don’t prevent illness any better than ordinary soap and may be contributing to the rise of antibiotic resistant bacteria.  In 2007, a study by A.D.Dayan found triclosan in a majority of breast milk samples.  Another study published in Environmental Health Perspectives in March 2008, found triclosan in 75% of urine samples.  The chemicals are absorbed into the body from personal care products.  Exposure can also occur through food.  These chemicals are building up in the environment, where over a million pounds are dumped every year.  Sewage treatment captures only a small percentage.  The rest ends up in the waterways and in sludge which is spread on farm fields.

The Environmental Protection Agency is in the process of reevaluating triclosan.  A draft report published in the Federal Register in May 2008 concludes that it doesn’t pose any serious safety concerns for consumers.  In light of the fact that the U.C. Davis researchers are realizing effects on the nervous and endocrine systems that were not detected before, the general consensus seems to be that further research is warranted.  In the meantime, it may be a good idea to start reading labels and questioning why we spend so much money on these products when washing hands with chemical free soap and warm water is just as effective.