Predicting treatment effectiveness for adults with autism

A collaboration between the Center for BrainHealth at The University of Texas at Dallas and the George Washington University created a protocol to predict individual treatment effectiveness for adults on the autism spectrum. Using functional magnetic resonance imaging (fMRI), the researchers identified certain brain regions that significantly correlate with an increase in social abilities following a virtual environment based training program. Adults on the autism spectrum who showed greater activity in the social brain network prior to the training improved more in emotion recognition than those who showed less activity.

“We found that when participants showed more brain activation in certain regions within the social brain network, while viewing digitally represented biological motion — motion that symbolizes something a human might do, such as playing pat-a-cake — the intervention was more beneficial to the participants,” explained Dr. Daniel Yang, assistant research professor at the George Washington University and Children’s National Health System. “Whereas if these social brain network regions did not show much activation, we observed that the person may not benefit from the intervention at this particular time but, as the brain is constantly changing, could benefit in the future, for example, by increasing pretreatment activation in these regions.”

The U.S. Interagency Autism Coordinating Committee (IACC) named Dr. Yang’s finding utilizing this predictive method with pediatric populations in a separate study one of the top 20 advances in autism research of 2016.

“This study advances us one step closer toward the goal of targeted, personalized treatment for individuals with autism,” said Dr. Yang. “We are very happy that this predictive method may be potentially able to help children, as well as adults on the spectrum, know which training might be worth their time and money based on their current brain function.”

For the study, seventeen participants between the ages of 18 and 40 years diagnosed with autism spectrum disorder were recruited from the Center for BrainHealth and the Yale Child Study Center at Yale University where Dr. Yang worked at the study’s inception. Participants completed a five-week training program that met twice a week for one hour. The clinician-led, strategy-based intervention allowed participants to role play social interactions in a virtual environment.

“The training focuses on three core social strategies: recognizing others, responding to others and self-assertion,” explained Tandra Allen, head of virtual training programs at the Center for BrainHealth, who provided the trainings. “We use avatars to make the complex social situations such as dealing with confrontation, job interviews, or a blind date feel more approachable to practice while still drawing on the same emotions that a person would experience in the real world.”

Before the 10 hours of training, participants underwent brain imaging. While in the fMRI scanner, the participant passively viewed a series of animations. Some of the images represented a human in motion, such as a person playing pat-a-cake, while other images were scrambled and did not represent something a human would do.

Two clusters of activity stood out as significantly correlating with training success. The first is an area on the left side of the brain responsible for language processing, specifically conflicts in meanings. The other resides on the right side of the brain and is responsible for processing non-verbal social-emotional cues, for example, being able to look at a person’s facial expression and ascertain emotional states such as fear, anger or joy.

Treatment effectiveness was measured by behavioral changes in two distinct domains of social abilities: 1) emotional recognition, or the change in socio-emotional processing abilities and 2) theory of mind, or the change in socio-cognitive processing abilities.

“There is very limited intervention research for adults on the autism spectrum, so being able to help make a leap forward in creating individualized treatment programs for them is very important to the field,” said Dr. Yang.

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Socioeconomic background linked to reading improvement

About 20 percent of children in the United States have difficulty learning to read, and educators have devised a variety of interventions to try to help them. Not every program helps every student, however, in part because the origins of their struggles are not identical.

MIT neuroscientist John Gabrieli is trying to identify factors that may help to predict individual children’s responses to different types of reading interventions. As part of that effort, he recently found that children from lower-income families responded much better to a summer reading program than children from a higher socioeconomic background.

Using magnetic resonance imaging (MRI), the research team also found anatomical changes in the brains of children whose reading abilities improved — in particular, a thickening of the cortex in parts of the brain known to be involved in reading.

“If you just left these children [with reading difficulties] alone on the developmental path they’re on, they would have terrible troubles reading in school. We’re taking them on a neuroanatomical detour that seems to go with real gains in reading ability,” says Gabrieli, the Grover M. Hermann Professor in Health Sciences and Technology, a professor of brain and cognitive sciences, a member of MIT’s McGovern Institute for Brain Research, and the senior author of the study.

Rachel Romeo, a graduate student in the Harvard-MIT Program in Health Sciences and Technology, and Joanna Christodoulou, an assistant professor of communication sciences and disorders at the Massachusetts General Hospital Institute of Health Professions, are the lead authors of the paper, which appears in the journal Cerebral Cortex.

Predicting improvement

In hopes of identifying factors that influence children’s responses to reading interventions, the MIT team set up two summer schools based on a program known as Lindamood-Bell. The researchers recruited students from a wide income range, although socioeconomic status was not the original focus of their study.

The Lindamood-Bell program focuses on helping students develop the sensory and cognitive processing necessary for reading, such as thinking about words as units of sound, and translating printed letters into word meanings.

Children participating in the study, who ranged from 6 to 9 years old, spent four hours a day, five days a week in the program, for six weeks. Before and after the program, their brains were scanned with MRI and they were given some commonly used tests of reading proficiency.

In tests taken before the program started, children from higher and lower socioeconomic (SES) backgrounds fared equally poorly in most areas, with one exception. Children from higher SES backgrounds had higher vocabulary scores, which has also been seen in studies comparing nondyslexic readers from different SES backgrounds.

“There’s a strong trend in these studies that higher SES families tend to talk more with their kids and also use more complex and diverse language. That tends to be where the vocabulary correlation comes from,” Romeo says.

The researchers also found differences in brain anatomy before the reading program started. Children from higher socioeconomic backgrounds had thicker cortex in a part of the brain known as Broca’s area, which is necessary for language production and comprehension. The researchers also found that these differences could account for the differences in vocabulary levels between the two groups.

Based on a limited number of previous studies, the researchers hypothesized that the reading program would have more of an impact on the students from higher socioeconomic backgrounds. But in fact, they found the opposite. About half of the students improved their scores, while the other half worsened or stayed the same. When analyzing the data for possible explanations, family income level was the one factor that proved significant.

“Socioeconomic status just showed up as the piece that was most predictive of treatment response,” Romeo says.

The same children whose reading scores improved also displayed changes in their brain anatomy. Specifically, the researchers found that they had a thickening of the cortex in a part of the brain known as the temporal occipital region, which comprises a large network of structures involved in reading.

“Mix of causes”

The researchers believe that their results may have been different than previous studies of reading intervention in low SES students because their program was run during the summer, rather than during the school year.

“Summer is when socioeconomic status takes its biggest toll. Low SES kids typically have less academic content in their summer activities compared to high SES, and that results in a slump in their skills,” Romeo says. “This may have been particularly beneficial for them because it may have been out of the realm of their typical summer.”

The researchers also hypothesize that reading difficulties may arise in slightly different ways among children of different SES backgrounds.

“There could be a different mix of causes,” Gabrieli says. “Reading is a complicated skill, so there could be a number of different factors that would make you do better or do worse. It could be that those factors are a little bit different in children with more enriched or less enriched environments.”

The researchers are hoping to identify more precisely the factors related to socioeconomic status, other environmental factors, or genetic components that could predict which types of reading interventions will be successful for individual students.

“In medicine, people call it personalized medicine: this idea that some people will really benefit from one intervention and not so much from another,” Gabrieli says. “We’re interested in understanding the match between the student and the kind of educational support that would be helpful for that particular student.”

Licensing and motor vehicle crash risk among teens with ADHD

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are licensed to drive less often and, when this group is licensed, they have a greater risk of crashing, according to a new study published by JAMA Pediatrics.

The defining symptoms of ADHD (inattention, hyperactivity and impulsivity) have been linked to unsafe driving behaviors.

Allison E. Curry, Ph.D., M.P.H., of the Children’s Hospital of Philadelphia (CHOP), and coauthors linked electronic health records to New Jersey traffic safety databases for more than 18,000 primary care patients of the CHOP health care network born from 1987 to 1997. Study analyses were restricted to 2,479 adolescents and young adults with ADHD and 15,865 without ADHD who had at least one full month of follow-up after becoming age-eligible for licensure, which in New Jersey is at the minimum age of 17.

Compared with individuals without ADHD, the probability that individuals with ADHD would be licensed six months after eligibility was 35 percent lower. Newly licensed drivers with ADHD also had a 36 percent higher first crash risk than those without ADHD. Among those individuals with a driver’s license, 764 of 1,785 with ADHD (42.8 percent) and 4,715 of 13,221 without ADHD (35.7 percent) crashed during the study period. Few individuals with ADHD (12.1 percent) had been prescribed medication in the 30 days before they were licensed to drive, according to the results.

Limitations of the study include that the prevalence of ADHD in the study group was somewhat higher than U.S. estimates and the results may have limited generalizability because New Jersey has an older licensing age at 17 and it is highly urbanized.

“Future research is needed to examine parent and clinician management of licensure decisions and crash risk among patients with ADHD, elucidate sex-specific mechanisms by which ADHD influences crash risk to develop countermeasures, and examine real-world effectiveness of medication use and detrimental effects of distractions,” the article concludes.

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Largest study to date finds autism alone does not increase risk of violent offending

A diagnosis of autism alone does not increase the risk of violent offending suggests a study published in the June 2017 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).

The study analysed data from 295,734 individuals in Stockholm County, Sweden, of whom 5,739 had a diagnosis of autism. The researchers tracked these individuals for violent crime convictions between ages 15 to 27 years using records from the Swedish National Crime Register.

The team, led by researchers at University of Bristol’s Population Health Science Institute and the Karolinska Institute in Stockholm, found that individuals diagnosed with autism initially appeared to have a higher risk of violent offending. However, this risk was significantly reduced once the presence of additional attention-deficit/ hyperactivity disorder (ADHD) or conduct disorder were taken into account.

The study reported that having these co-occurring conditions, along with other, later-onset psychiatric disorders and alcohol and drug misuse, were the most important individual predictors of violent criminality in autism, not autism by itself.

Interestingly, when researchers considered individuals with ADHD or conduct disorder, an additional diagnosis of autism was actually found to reduce the risk of violent criminality, compared to individuals with ADHD or conduct disorder alone.

Dr Ragini Heeramun, Consultant Forensic Psychiatrist at the Avon & Wiltshire Partnership NHS Mental Health Trust in Bristol, said: “We know that some people with an autism diagnosis have challenging behaviour and may come into contact with the criminal justice system, however, whether having autism increases the risk of violence or not has previously not been clear.”

“Our findings, from the largest study to date, show that at the population level, autism in itself doesn’t seem to be associated with convictions for violent crimes. However, other conditions, such as ADHD, which can co-occur with autism, may increase such risks.”

Dr Dheeraj Rai, Consultant Senior Lecturer in Psychiatry at the University of Bristol, said: “Interestingly, the additional presence of an autism diagnosis with attention-deficit/ hyperactivity disorder (ADHD) or conduct disorder was actually associated with a relatively lower risk of convictions, compared to having these conditions without autism.

“These findings are important for autism services, which often focus on providing a diagnosis of autism, rather than the identification of, and support for, the conditions that commonly occur alongside it.”

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Children in Head Start who miss more preschool show fewer academic gains

A new study has found that children in Head Start who miss 10% or more of the school year have fewer gains in academics than their peers who attend preschool more regularly. Many researchers see high-quality preschool programs as a way to reduce long-term disparities in education. Placing an emphasis on attendance in preschool programs may be important to maximizing benefits.

The study, from researchers at the University of Virginia and The Ohio State University, appears in the journal Child Development.

“Preschool absences may undermine the benefits of high-quality preschool education,” explains Arya Ansari, postdoctoral research associate at the University of Virginia, the study’s lead author. Ansari cautioned that while the findings of the study are not causal, they highlight the scope and consequences of preschool absences. “Given the large investments in early childhood programs, we need to consider the ramifications of more frequent absences for children’s early learning, especially in programs such as Head Start, the largest federally funded preschool program in the United States.”

Little is known about absences in preschool, in part because, unlike in K-12 schooling, attendance is not mandated by law for preschoolers and programs like Head Start do not always track it. In this study, researchers looked at nationally representative data from the Family and Child Experiences Survey 2009 Cohort, which included 2,842 children ages 3 and 4 years who attended Head Start in all 50 U.S. states and the District of Columbia. Most children in the study were from ethnic-minority households (e.g., Latino, Black, Asian), and most came from single-parent families and had a mother who was not employed. Most families had incomes at or below the federal poverty level.

At the end of the school year, parents reported on their children’s school absences, and direct assessments provided information on children’s academic performance in language, literacy, and math.

On average, children missed eight days of the school year. In addition, 12% of children were chronically absent — defined as missing 10% of the school year or more — and missed an average of 22 days of school. Children who missed more days of school, especially those who were chronically absent, demonstrated fewer gains in math and literacy during the preschool year, the study found. Moreover, excessive absenteeism was especially problematic for the early academic learning of children who entered Head Start with a less developed skill set, meaning that they started school with the lowest language and literacy skills. The study also found that minority children were less likely to be absent than White children. In addition, children were less likely to be absent when they were enrolled in classrooms that operated for more hours per week, and in larger and bilingual classrooms. The quality of interactions between teachers and children facilitated children’s development of literacy skills, but the benefits were roughly twice as large for children who were absent less often.

The findings of this study have implications for both practice and policy, the authors suggest. “Preschool teachers and administrators, as well as researchers and policymakers, should make efforts to reduce preschool absences,” says Kelly M. Purtell, assistant professor of human sciences at The Ohio State University, who coauthored the study. “One way to do this is to discuss the challenges to attendance that parents face and work with them to reduce these barriers.” Early childhood educators may also want to develop ways to ensure that parents understand the importance of preschool to their children’s learning, and see it as education as well as care.

The authors recommend that researchers pay closer attention to the implications of these absences in evaluating the quality and effects of preschool programs.

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Through a child’s eyes: Classroom study measures vision and academic achievement

QUT researchers have investigated how vision can affect a child’s ongoing learning, with results showing 30 per cent of Year 3 students tested had uncorrected eye problems that could affect their academic performances.

Importantly, the children referred for further optometric examination had significantly lower NAPLAN scores in Reading, Spelling, Grammar and Punctuation, and Numeracy subtests.

The study has been published in the International Journal of Education Research.

Dr Sonia White, Senior Research Fellow from QUT’s Faculty of Education said 109 Year 3 students were involved in the multidisciplinary study that combined optometry and education research, and was funded by the Ian Potter Foundation.

“Children’s eyes need to be tested early in primary school and throughout schooling to ensure they can fully engage with the visual aspects of classroom learning,” Dr White said.

Joined by Professor Joanne Wood, Dr Alexander Black and Dr Shelley Hopkins from QUT’s School of Optometry and Vision Science, Institute of Health and Biomedical Innovation (IHBI), Dr White said the ongoing research has involved six schools across South-east Queensland.

“In our current follow-up project, funded by the Lord Mayor’s Charitable Foundation (Eldon & Anne Foote Trust Donor Advised Program 2015), we are investigating whether vision intervention one year earlier, in Year 2, can ameliorate the differences in achievement we saw in the Year 3 children,” Professor Wood said.

“We hypothesise that early vision interventions could support children’s development of literacy and numeracy and subsequent classroom learning and achievement.”

Dr White said vision screening and assessment was not currently mandated prior to children commencing school, which may mean that some of the children will have vision and visual processing difficulties that remain undetected by parents and teachers.

Dr White said schools that were involved in the study had anecdotally reported big improvements, with some children showing a marked increase in their reading level and greater classroom participation.

As well as vision assessment, children completed a range of near vision learning tasks, such as reading and mathematics, while eye tracking was used to examine specific visual processing behaviours underlying these activities.

“The aim is to level the playing field in terms of vision and provide every opportunity for learning and academic achievement for children in school and later life,” Professor Wood said.

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Speech and language deficits in children with autism may not cause tantrums

Speech or language impairments may not be the cause of more frequent tantrums in children with autism, according to Penn State College of Medicine researchers. The findings could help parents of children with autism seek out the best treatment for behavior problems.

Children with autism experience more tantrums than children without, according to the researchers, and speech therapists, preschool teachers, parents and others often blame these frequent outbursts on speech and language problems. Some children with autism spectrum disorder are not able to speak or have speech that is not clear or well-understood by others.

To investigate this correlation, the researchers studied the relationship between language and tantrum frequency in 240 children with autism between the ages of 15 and 71 months of age. The researchers, who published their results in a recent issue of the Journal of Development and Physical Disabilities, said that the children’s IQ, their ability to understand language and their ability to use words and speak clearly, explained less than 3 percent of their tantrums.

“We had children in our sample with clear speech and enough intelligence to be able to communicate, and their tantrums were just as high in that group,” said Cheryl D. Tierney, associate professor of pediatrics, College of Medicine, and section chief, behavior and developmental pediatrics, Penn State Children’s Hospital.

The researchers also found that children who spoke at the level of a 2-year-old with normal development had more tantrums than children with lower speech skills.

“There is a common pervasive misbelief that children with autism have more tantrum behaviors because they have difficulty communicating their wants and their needs to caregivers and other adults,” Tierney explained. “The belief is that their inability to express themselves with speech and language is the driving force for these behaviors, and that if we can improve their speech and their language the behaviors will get better on their own. But we found that only a very tiny percentage of temper tantrums are caused by having the inability to communicate well with others or an inability to be understood by others.”

In the study, Tierney and co-investigator Susan D. Mayes, professor of psychiatry, addressed the limitations in previous research by including a larger sample of children and capturing more measurements. They add that their study is unique because it measures IQ and it separates speech and language as different variables that might affect tantrum behavior in children with autism.

“IQ is extremely important because a child that has the mental capacity to understand and use language may display different behaviors compared to a child who doesn’t have the mental capacity and comprehension to use language,” Tierney said.

She also explained the difference between language and speech in the study of children with autism.

“Language is a child’s ability to understand the purpose of words and to understand what is said,” she said. “Speech is their ability to use their mouth, tongue, lips and jaw to form the sounds of words and make those sounds intelligible to other people.”

The study doesn’t answer the question of what causes tantrums in children with autism, but mood dysregulation and a low tolerance for frustration — two common traits — are likely factors that should be studied further, Tierney said.

Tierney suggests enough evidence has accumulated to shift the emphasis from improving speech to improving behavior.

“We should stop telling parents of children with autism that their child’s behavior will get better once they start talking or their language improves, because we now have enough studies to show that that is unlikely to happen without additional help,” she said.

That help should come in the form of applied behavior analysis, and having a well-trained and certified behavior analyst on a child’s treatment team is key to improved outcomes, Tierney added.

“This form of therapy can help children with autism become more flexible and can show them how to get their needs met when they use behaviors that are more socially acceptable than having a tantrum,” Tierney said.

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Phonics works: Sounding out words is best way to teach reading, study suggests

Research published today in the Journal of Experimental Psychology: General has shown that learning to read by sounding out words (a teaching method known as phonics) has a dramatic impact on the accuracy of reading aloud and comprehension.

There has been intense debate concerning how children should be taught to read. Researchers from Royal Holloway, University of London and the MRC Cognition and Brain Sciences Unit tested whether learning to read by sounding out words is more effective than focusing on whole-word meanings. In order to assess the effectiveness of using phonics the researchers trained adults to read in a new language, printed in unfamiliar symbols, and then measured their learning with reading tests and brain scans.

Professor Kathy Rastle, from the Department of Psychology at Royal Holloway said, “The results were striking; people who had focused on the meanings of the new words were much less accurate in reading aloud and comprehension than those who had used phonics, and our MRI scans revealed that their brains had to work harder to decipher what they were reading.”

English-speaking countries should replicate UK use of phonics

In England, the provision of systematic phonics instruction is a legal requirement in state-funded primary schools. The impact of phonics is measured through a screening check administered to children in Year 1. The results of this screening check have shown year-on-year gains in the percentage of children reaching an expected standard — from 58% in 2012 to 81% in 2016.

However there are objections to the use of systematic phonics. Many practitioners argue in favour of a less-prescriptive approach, consisting of a variety of phonic- and meaning-based skills. One frequent objection is that while phonics may assist reading aloud, it may not promote reading comprehension.

“There is a long history of debate over which method, or mix of methods, should be used to teach reading,” continued Professor Rastle “Some people continue to advocate using a variety of meaning-based cues, such as pictures and sentence context, to guess the meanings of words. However, our research is clear that reading instruction that focuses on teaching the relationship between spelling and sound is most effective. Phonics works.”

Schools Standards Minister Nick Gibb said, “Our plan for Britain is built on ensuring every child has equal opportunity to gain the knowledge and skills they need to succeed in the future. Teaching all children to read fluently by the time they leave primary school is fundamental to this ambition.

“This research highlights the potential benefits of learning to decode using phonics. Thanks to the hard work of teachers, our continued focus on raising standards and our increased emphasis on phonics‎, there are now 147,000 more six-year-olds on track to becoming fluent readers than in 2012.”

Reading aloud with understanding; phonics works

The paper describes how people who are taught the meanings of whole words don’t have any better reading comprehension skills than those who are primarily taught using phonics. In fact, those using phonics are just as good at comprehension, and are significantly better at reading aloud.

Dr Jo Taylor, also of the Department of Psychology at Royal Holloway argues “People frequently argue that phonics disadvantages reading comprehension. Our work puts that claim to rest. Phonics actually enables reading comprehension by relating visual symbols to spoken language. The laboratory method that we’ve developed in this study offers strong evidence for the effectiveness of phonics, and has also helped us to understand why phonics works, in terms of the brain systems responsible for reading.”

The researchers are continuing this work by investigating how reading expertise develops in the brain.

This research was funded by the Economic and Social Research Council.

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Intelligible speech despite noisy surroundings

Prof Dr Dorothea Kolossa and Mahdie Karbasi from the research group Cognitive Signal Processing at Ruhr-Universität Bochum (RUB) have developed a method for predicting speech intelligibility in noisy surroundings. The results of their experiments are more precise than those gained through the standard methods applied hitherto. They might thus facilitate the development process of hearing aids. The research was carried out in the course of the EU-funded project “Improved Communication through Applied Hearing Research,” or “I can hear” for short.

Specific algorithms in hearing aids filter out background noises to ensure that wearers are able to understand speech in every situation — regardless if they are in a packed restaurant or near a busy road. The challenge for the researchers is to maintain high speech transmission quality while filtering out background noises. Before an optimised hearing aid model is released to the market, new algorithms are subject to time-consuming tests.

Researchers and industrial developers run hearing tests with human participants to analyse to what extent the respective new algorithms will ensure speech intelligibility. If they were able to assess speech intelligibility reliably in an automated process, they could cut down on time-consuming test practices.

New algorithm developed

To date, the standard approaches for predicting speech intelligibility have included the so-called STOI method (short time objective speech intelligibility measure) and other reference-based methods. These methods require a clear original signal, i.e. an audio track that’s been recorded without any background noises. Based on the differences between original and filtered sound, the value of speech intelligibility is estimated. Kolossa and Karbasi have found a way to predict intelligibility without needing a clear reference signal, which is still more precise than the STOI method. Consequently, Kolossa and Karbasi’s findings might help reduce test processes in the product development phase of hearing aids.

The RUB researchers have tested their method with 849 individuals with normal hearing. To this end, the participants were asked to assess audio files via an online platform. With the aid of their algorithm, Kolossa and Karbasi estimated which percentage of a sentence from the respective file would be understood by the participants. Subsequently, they compared their predicted value with the test results.

Research outlook

In the next step, Kolossa and Karbasi intend to run the same tests with hearing-impaired participants. They are working on algorithms that can assess and optimise speech intelligibility in accordance with the individual perception threshold or type of hearing impairment. In the best case scenario, the study will thus provide methods for engineering an intelligent hearing aid. Such hearing aids could automatically recognise the wearer’s current surroundings and situation. If he or she steps from a quiet street into a restaurant, the hearing aid would register an increase in background noises. Accordingly, it would filter out the ambient noises — if possible without impairing the quality of the speech signal.

About the project

The main objective of the project “Improved Communication through Applied Hearing Research” was to optimise hearing aids and cochlear implants to ensure that they fulfil their function for their wearer even in very noisy surroundings. RUB researchers worked in an international team together with researchers from the UK, Switzerland, Denmark, and Belgium. Prof Dr Rainer Martin from the RUB Faculty of Electrical Engineering and Information Technology headed the EU-funded project. Industrial partners were hearing aid manufacturer Sivantos and cochlear implant company Cochlear. “I can hear” ended in December 2016.

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Food insecurity in early childhood linked to young children’s skills in kindergarten

In the United States, estimates show that a substantial number of children under age 5 live in households that are food insecure. That means that they do not have food, or they lack sufficient quantity or quality of food to fuel a healthy and active lifestyle. A new study has found that children who experience food insecurity in early childhood are more likely to start kindergarten less ready to learn than their peers from homes that are food secure.

The findings come from researchers at Georgetown University and the University of Virginia. They are published in the journal Child Development.

“Timing of food insecurity matters,” notes Anna Johnson, assistant professor of psychology at Georgetown University, who led the research. “In our study, food insecurity in infancy and toddlerhood predicted lower cognitive and social-emotional skills in kindergarten, skills that can predict later success in academics and life.” Food insecurity during the preschool years was less consistently related to performance in kindergarten, Johnston adds, but when it was, associations were also negative.

In addition to finding that the timing of food insecurity matters, the study found that the number of times (or episodes) a child experienced food insecurity also makes a difference. Researchers considered three episodes — one when children were 9 months old, one when they were about 2 years old, and one when children were about 4 years old. “Having more episodes of food insecurity in early childhood — that is, having three episodes of food insecurity versus one or two — was linked with poorer outcomes in kindergarten across all areas of development,” explains Johnson.

The study looked at how food insecurity across the first five years of life affects cognitive and social-emotional skills and behaviors as children start kindergarten. It used nationally representative data (from the Early Childhood Longitudinal Study-Birth Cohort), focusing on the 3,700 low-income households in the sample for whom there were data on food insecurity, as well as children’s outcomes. Researchers investigated ties between the timing and intensity of food insecurity in early childhood and children’s reading, math, and social-emotional scores in kindergarten. They interviewed parents and assessed children when they were 9 months old, and again when they were 2, 4, and 5 years old, looking at the children’s reading and math skills when they started kindergarten, as well as their levels of hyperactivity, conduct problems, and approaches to learning.

This study addresses a gap in understanding associations between food insecurity in early childhood and skills at kindergarten entry. The authors caution that the estimates are noncausal, that is, they cannot rule out the possibility that an unobserved factor caused both increased food insecurity and decreased kindergarten skills, for instance.

“Nevertheless, these findings are worrisome,” suggests Anna Markowitz, postdoctoral research associate in the Curry School of Education at the University of Virginia, the study’s coauthor. “Increasing the generosity of food assistance programs and ensuring that they reach children whose families are food insecure or at risk for food insecurity in the earliest years — when children are 2 or younger — could boost the early school success of these vulnerable children.”

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Defect in non-coding DNA might trigger brain disorders such as severe language impairment

The human genome is made up of ~3 billion letters of DNA and at each position it is possible to have different letters, called variants. Some variants are harmless but others can be detrimental, making it a mammoth task to find out which variants cause a disorder. Researchers often choose to search only the 1-2% of the genome that carries the information to make proteins. While this has been successful for a few disorders, most neurodevelopmental disorders are still largely unexplained, making it clear that looking elsewhere in the genome is necessary.

“The remaining 98% of the genome offers a lot of untapped potential to find changes that can cause disorders” Paolo Devanna, co-author of the study explains. “These parts of the genome are known as ‘non-coding’, but that doesn’t mean that they are not important. They have very vital jobs to do, for example to control when, where and how much protein is made. So if this process gets messed up, it could have severe consequences, like neurodevelopmental disorders.” For this reason, Devanna and his colleagues decided to look at the so called 3’UTRome. This is a part of the non-coding genome that regulates how much protein is made.

Searching for causes of language impairment

To test this approach, the researchers looked at the DNA of children with severe language problems and identified genetic variants in the 3’UTRome. “Language disorders are a very complex neurodevelopmental disorder and finding their genetic causes has been particularly challenging — we have only a small number of candidate genes thus far” said Dr. Sonja Vernes who led the study. She runs a research group at the Max Planck Institute for Psycholinguistics and is part of the Donders Institute for Brain, Cognition and Behaviour at the Radboud University, both in Nijmegen, the Netherlands.

The researchers tested the impact of each 3’UTRome variant on the expression of the candidate genes for languages impairment. One of the variants has a significant effect on the expression of a gene known as ARHGEF39. “If a cell carries this single letter change in the 3’UTRome, they express more ARHGEF39. We were very excited by this finding because this is the first time we have found a variant associated with specific language impairment that we can show has a clear biological effect” said Devanna. “Having too much of a protein at important points in development could affect how neurons and neuronal circuits develop and function, which could in turn could affect how children develop their language skills” Vernes explains.

Non-coding variants are widespread in genetic disorders

Given this success, the researchers went on to explore the 3’UTRome in other neurodevelopmental disorders. They identified 25 further genetic changes in the DNA of individuals with autism, schizophrenia and bipolar disorder that are thought to control protein levels in the same way. “We are tapping into a new and promising source of genetic variation” Vernes said. “Our study shows that the identification and testing of non-coding variants will foster our understanding of the genetic causes of neurodevelopmental disorders, which is crucial in the long term for the design of new and effective therapeutics.”

Neurodevelopmental disorders (NDDs) like schizophrenia, autism and bipolar disorders encompass a wide range of disabilities associated with the functioning of the brain. Severe NDDs are currently known to affect approximately 5% of the population, making understanding their causes and in turn, their possible treatments an important area of study.

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Children experience long wait times for developmental and behavioral specialists

An estimated one in six children in the United States have development disorders such as autism, attention deficit hyperactivity disorder or cerebral palsy, according to the Centers for Disease Control and Prevention. Children can benefit from the care of developmental pediatricians who are specially trained in the field. However, a new study from Rutgers offers evidence confirming what many parents already know: the wait to see one of these experts — only 1,000 of whom exist nationally — is lengthy and delays diagnostic evaluations that could be important for early intervention strategies that help families manage behavioral, emotional, social and educational struggles. In addition, the study found that there is an insufficient number of programs that offer accommodations for non-English speaking families.

“Relative to the number of children who would benefit from seeing a developmental pediatrician, the number of specialized physicians in the field is relatively few,” said Manuel Jimenez, MD, MS, assistant professor of Pediatrics, and Family Medicine and Community Health at Rutgers Robert Wood Johnson Medical School, who led the study. “This has the potential to limit access to rigorous diagnostic evaluations which in turn can ensure access to specialized services and therapies. Given that individuals with limited English proficiency often have difficulty navigating the health care system, we were especially interested to see if there would be differences when we called in English versus Spanish.”

Published in the Journal of Developmental & Behavioral Pediatrics, the study explored the barriers to obtaining an appointment for an initial evaluation, after finding no documented evidence on the subject. Members of the research team posed as a “mystery shoppers” calling specialized developmental pediatric programs associated with children’s hospitals across the country to request an appointment. Of the 140 unique programs that were called, 75 provided a wait time with an average of nearly five and a half months. Among these, 62 were reached in Spanish within a 24-hour period of the initial call. Only 55 percent offered a wait time estimate and nearly one-third did not offer any Spanish-language services for the caller.

Although Dr. Jimenez said he was unsurprised at finding long wait times nationally, he was surprised at the number of programs that did not offer a wait time when called in Spanish, although a wait time had been offered in English just 24 hours prior. He was equally surprised at the lack of accommodations for families for whom English is a second language.

“Our study serves as a reminder to physicians to be mindful of the difficulty our patients experience to obtain an initial assessment including an extended waiting period and barriers to language services,” said Dr. Jimenez, who also is an attending developmental and behavioral pediatrician at PSE&G Children’s Specialized Hospital. “For researchers and policy makers, our findings underscore the importance of evaluating different care models to leverage the strengths of professionals to ensure that children with developmental concerns reach the appropriate providers at the appropriate time.”

Dr. Jimenez emphasized that more work is needed to identify strategies that provide better access to all children who are in need of specialized services, as developmental and behavioral problems are among the most prevalent health concerns faced by children.

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Outdoor adventure program is a promising treatment for Autism Spectrum Disorder

A new Tel Aviv University study finds outdoor challenge-based interventions may be effective in reducing the overall severity of Autism Spectrum Disorder (ASD) symptoms. The research found significant improvements in the social cognition, social motivation, and autistic mannerisms of the young subjects after outdoor adventure activities and describes a new path for enhancing the social and communication skills of children with ASD.

The study was published in Developmental Medicine and Child Neurology and led by Prof. Ditza Antebi-Zachor of the Pediatric Department at TAU’s Sackler Faculty of Medicine and Director of Assaf Harofeh Medical Center’s Autism Center, together with Prof. Esther Ben Itzchak of Ariel University.

One in 68 children in the US is diagnosed each year with ASD, a neurodevelopmental disorder characterized by socio-communicative impairments and restricted and repetitive behaviors and interests. The developmental disorder takes a deep social, emotional and economic toll on the child and his/her family. But research has also shown that the early diagnosis and early treatment of ASD can lead to vast improvements in the cognitive functioning and socio-communicative skills of children on the spectrum.

Getting out of the classroom

Fifty-one children from seven special-education kindergartens in Tel Aviv participated in the study, which was conducted in collaboration with ALUT, the National Israeli Association for Children with Autism, and ETGARIM, a nonprofit that sponsors outdoor activities for disabled people. The children, aged 3-7, all followed the same educational protocols, but the intervention group, comprising 30 students, also participated in an outdoor adventure program (OAP).

The intervention group underwent 13 weekly sessions of challenge-based activities with instructors. Each 30-minute session took place in urban parks near the participants’ kindergartens and kicked off with a song. Afterward, the children used the outdoor fitness equipment, moving from one to another throughout the session. The activities required the children to communicate with the instructors and with their peers, to ask for assistance or be noticed, for example.

Prior to the adventure program, the children’s cognitive and adaptive skills were assessed by the kindergarten instructors using the Social Responsiveness Scale (SRS), a questionnaire that assesses autism severity in different domains, and the Teachers’ Perceived Future Capabilities questionnaire. The information was obtained prior to and after completing the program.

Meeting goals and building trust

“Outdoor adventure programs are designed to improve intrapersonal skills and interpersonal relationships by using adventurous activities to provide individual and group problem-solving and challenge tasks,” says Prof. Zachor. “The necessary tools for a successful OAP include establishing individual and group goals, building trust among participants, and providing activities that challenge and evoke stress but are nevertheless enjoyable.

“Our study shows that outdoor adventure activities benefit children with autism and improve their social communication skills. We suggest including these fun activities in special education kindergartens and in communication classrooms at school in addition to traditional treatments. Parents of children with ASD can also enroll their kids in afterschool activities based on the principles of our research. It will allow the children to have fun during their leisure time while improving their communication skills.”

According to Prof. Zachor, future studies should examine the contribution of this type of intervention over longer periods of time and encourage other researchers to explore new treatments that improve social communication skills in an entertaining, engaging way. “We’re interested in studying the long-term effect of this intervention, not just on ASD symptoms but on functioning in different domains, including behavioral problems, language skills, and attention span,” she says.