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Brain Imaging Could Detect Autism Risk in Infants as Young as 6 Months

By ALICE PARK | @aliceparkny

Early intervention may help curb some of the more severe symptoms of autism. The question is, How do we identify at-risk children early enough?

Researchers say they may soon be able to identify babies at high risk of autism as early as 6 months old.

Currently, clinicians can’t diagnose autism until toddlers are about 2, when the first behavioral and language symptoms of the developmental disorder become noticeable. There is a push to identify at-risk babies earlier, though, since early intervention may be critical for halting abnormal development and preventing the most troublesome behavioral outcomes associated with autism. But while scientists are developing more sophisticated screening tests that rely on brain-imaging techniques or eye-tracking technologies that monitor an infant’s gaze to pick up early autistic signs, there is still no reliable way to diagnose the condition in younger infants.

Brain Imaging Could Detect Autism Risk in Infants as Young as 6 MonthsNow, reporting in the American Journal of Psychiatry, researchers say that they may finally have a tool that will select out the highest-risk infants at just 6 months old. The innovative test, known as fractional anisotropy, measures the density of white matter, the part of brain that is rich in nerve fibers and makes up the major neural pathways that connect various regions of the brain. Specifically, the technology measures the diffusion of water through nerve-fiber tracts to gauge the density of myelin, the substance that insulates the sometimes long fibers that connect one nerve cell to another; the density of myelin serves as a rough stand-in for the density of neural connections in the brain.

The scientists, recruited 92 children from the Infant Brain Imaging Study Network, which includes four clinical sites around the country. All the infants were considered to be at higher risk of developing autism because they each had at least one older sibling affected by the disorder.

The researchers monitored the children’s brain and behavior development. At 6, 12 and 24 months, the scientists measured the density of the babies’ nerve fibers in the brain, and then tracked them to see who would end up being diagnosed with an autism spectrum disorder (ASD) by age 2 and who did not.

Children who were eventually diagnosed with ASDs were more likely to show thicker, denser nerve-fiber readings at 6 months, compared with normally developing children. But by the time the infants were 2, the situation was reversed: the ASD toddlers had thinner white matter than those who did not develop autism.

“The findings suggest that early on, there is something different going on in children who develop ASDs,” says Geraldine Dawson, chief science officer of Autism Speaks who is also a professor of psychiatry at University of North Carolina Chapel Hill and a co-author of the paper. “Very early on, before the emergence of behavioral symptoms, these neural networks that connect different brain regions are not developing normally.”

Among the 15 nerve-fiber tracts in the brain that linked various regions together, 12 showed aberrant growth patterns in the 6-month old babies who developed ASDs compared with those who didn’t. This suggests, says Dawson, that “there is a more global change in development of these tracts implicated in autism, and that functional connectivity, or the establishment of neural networks is clearly implicated in these findings.”

That means that whatever biological processes are driving autism, they aren’t limited to one region of the brain. And that makes sense, since the disorder’s hallmark behavioral symptoms involve language and social interactions, which require exquisite coordination of several different brain areas.

Dawson and her colleagues stress, however, that their results do not necessarily suggest that the explosion of white matter at 6 months and its subsequent drop-off cause the abnormal development that leads to autism. For now, it’s just an intriguing potential marker for the disorder, one that may help doctors identify infants at highest risk of developing autism early on. Because the study involved only children with a family history of ASD, the next step will be to compare these infants with those whose families are not affected. (There is evidence that even unaffected siblings of autistic children have similar brain changes to those of their autistic brothers and sisters, and may even exhibit subtle symptoms of the disorder.)

A better understanding of how the autistic brain works could, of course, help scientists develop better therapies to treat the disorder. Better interventions could even help prevent ASDs from progressing to more advanced stages that keep children and adults from becoming functioning members of society.

Detecting the first signs of autism, perhaps even in infants younger than 6 months, may be an important part of that effort as well. Studies show, for example, that toddlers on the road to autism who are engaged in language and social-skills therapy can improve their cognitive development and IQ score by as much as 17 points. “One can imagine a day [when], if a baby is suspected of being at risk of developing autism, one could use a biomarker test like this one to identify infants who should perhaps receive early stimulation in language and social development so they can improve their outcomes,” says Dawson. That’s the goal, and tests like these can bring us one step closer toward achieving it.

Source: http://healthland.time.com/2012/02/17/brain-imaging-could-detect-autism-risk-in-infants-as-young-as-6-months/#ixzz1medl8dGi

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The Joint Statement of the Autism Society and Autistic Self Advocacy Network on the DSM-5 and Autism

The Joint Statement of the Autism Society and Autistic Self Advocacy Network on the DSM-5 and Autism  As two national organizations committed to working to empower the autism and Autistic communities today and into the future, the Autism Society of America and the Autistic Self Advocacy Network issue the following joint statement regarding the definition of Autism Spectrum Disorder within the DSM-5.

The autism spectrum is broad and diverse, including individuals with a wide range of functional needs, strengths and challenges. The DSM-5’s criteria for the new, unified autism spectrum disorder diagnosis must be able to reflect that diversity and range of experience.

Over the course of the last 60 years, the definition of autism has evolved and expanded to reflect growing scientific and societal understanding of the condition. That expansion has resulted in improved societal understanding of the experiences of individuals on the autism spectrum and their family members. It has also led to the development of innovative service-provision, treatment and support strategies whose continued existence is imperative to improving the life experiences of individuals and families. As the DSM-5’s final release approaches and the autism and Autistic communities prepare for a unified diagnosis of ASD encompassing the broad range of different autism experiences, it is important for us to keep a few basic priorities in mind.

One of the key principles of the medical profession has always been, “First, do no harm.” As such, it is essential that the DSM-5’s criteria are structured in such a way as to ensure that those who have or would have qualified for a diagnosis under the DSM-IV maintain access to an ASD diagnosis. Contrary to assertions that ASD is over diagnosed, evidence suggests that the opposite is the case – namely, that racial and ethnic minorities, women and girls, adults and individuals from rural and low-income communities face challenges in accessing diagnosis, even where they clearly fit criteria under the DSM-IV. Furthermore, additional effort is needed to ensure that the criteria for ASD in the DSM-5 are culturally competent and accessible to under-represented groups. Addressing the needs of marginalized communities has been a consistent problem with the  DSM-IV.

Individuals receive a diagnosis for a wide variety of reasons. Evidence from research and practice supports the idea that enhancing access to diagnosis can result in substantial improvements in quality of life and more competent forms of service-provision and mental health treatment. This is particularly true for individuals receiving diagnosis later in life, who may have managed to discover coping strategies and other adaptive mechanisms which serve to mask traits of ASD prior to a diagnosis. Frequently, individuals who are diagnosed in adolescence or adulthood report that receiving a diagnosis results in improvements in the provision of existing services and mental health treatment, a conceptual framework that helps explain past experiences, greater self-understanding and informal support as well as an awareness of additional, previously unknown service options.

Some have criticized the idea of maintaining the existing, broad autism spectrum, stating that doing so takes limited resources away from those most in need. We contend that this is a misleading argument – no publicly funded resource is accessible to autistic adults and children solely on the basis of a diagnosis. Furthermore, while the fact that an individual has a diagnosis of autism spectrum disorder does not in and of itself provide access to any type of service-provision or funding, a diagnosis can be a useful contributing factor in assisting those who meet other functional eligibility criteria in accessing necessary supports, reasonable accommodations and legal protections. As such, we encourage the DSM-5 Neurodevelopmental Disorders Working Group to interpret the definition of autism spectrum disorder broadly, so as to ensure that all of those who can benefit from an ASD diagnosis have the ability to do so.

The Autism Society and Autistic Self Advocacy Network encourage other organizations and groups to join with us in forming a national coalition aimed at working on issues related to definition of the autism spectrum within the DSM-5. Community engagement and representation within the DSM-5 process itself is a critical component of ensuring accurate, scientific and research-validated diagnostic criteria. Furthermore, our community must work both before and after the finalization of the DSM-5 to conduct effective outreach and training on how to appropriately identify and diagnose all those on the autism spectrum, regardless of age, background or status in other under-represented groups.

P.S. The Autism Society will continue to share its thoughts and feelings about keeping the community inclusive as more information about the revisions is known.  In the meantime, we strongly encourage people to get involved in the discussion.

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I Had Asperger Syndrome. Briefly.

By Benjamin Nugent

FOR a brief, heady period in the history of autism spectrum diagnosis, in the late ’90s, I had Asperger syndrome.

Asperger's syndromeThere’s an educational video from that time, called “Understanding Asperger’s,” in which I appear. I am the affected 20-year-old in the wannabe-hipster vintage polo shirt talking about how keen his understanding of literature is and how misunderstood he was in fifth grade. The film was a research project directed by my mother, a psychology professor and Asperger specialist, and another expert in her department. It presents me as a young man living a full, meaningful life, despite his mental abnormality.

“Understanding Asperger’s” was no act of fraud. Both my mother and her colleague believed I met the diagnostic criteria laid out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The manual, still the authoritative text for American therapists, hospitals and insurers, listed the symptoms exhibited by people with Asperger disorder, and, when I was 17, I was judged to fit the bill.

I exhibited a “qualified impairment in social interaction,” specifically “failure to develop peer relationships appropriate to developmental level” (I had few friends) and a “lack of spontaneous seeking to share enjoyment, interests, or achievements with other people” (I spent a lot of time by myself in my room reading novels and listening to music, and when I did hang out with other kids I often tried to speak like an E. M. Forster narrator, annoying them). I exhibited an “encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus” (I memorized poems and spent a lot of time playing the guitar and writing terrible poems and novels).

The general idea with a psychological diagnosis is that it applies when the tendencies involved inhibit a person’s ability to experience a happy, normal life. And in my case, the tendencies seemed to do just that. My high school G.P.A. would have been higher if I had been less intensely focused on books and music. If I had been well-rounded enough to attain basic competence at a few sports, I wouldn’t have provoked rage and contempt in other kids during gym and recess.

The thing is, after college I moved to New York City and became a writer and met some people who shared my obsessions, and I ditched the Forsterian narrator thing, and then I wasn’t that awkward or isolated anymore. According to the diagnostic manual, Asperger syndrome is “a continuous and lifelong disorder,” but my symptoms had vanished.

Last year I sold a novel of the psychological-realism variety, which means that my job became to intuit the unverbalized meanings of social interactions and create fictional social encounters with interesting secret subtexts. By contrast, people with Asperger syndrome and other autism spectrum disorders usually struggle to pick up nonverbal social cues. They often prefer the kind of thinking involved in chess and math, activities at which I am almost as inept as I am at soccer.

The biggest single problem with the diagnostic criteria applied to me is this: You can be highly perceptive with regard to social interaction, as a child or adolescent, and still be a spectacular social failure. This is particularly true if you’re bad at sports or nervous or weird-looking.

As I came into my adult personality, it became clear to me and my mother that I didn’t have Asperger syndrome, and she apologized profusely for putting me in the video. For a long time, I sulked in her presence. I yelled at her sometimes, I am ashamed to report. And then I forgave her, after about seven years. Because my mother’s intentions were always noble. She wanted to educate parents and counselors about the disorder. She wanted to erase its stigma.

I wonder: If I had been born five years later and given the diagnosis at the more impressionable age of 12, what would have happened? I might never have tried to write about social interaction, having been told that I was hard-wired to find social interaction baffling.

The authors of the next edition of the diagnostic manual, the D.S.M.-5, are considering a narrower definition of the autism spectrum. This may reverse the drastic increase in Asperger diagnoses that has taken place over the last 10 to 15 years. Many prominent psychologists have reacted to this news with dismay. They protest that children and teenagers on the mild side of the autism spectrum will be denied the services they need if they’re unable to meet the new, more exclusive criteria.

But my experience can’t be unique. Under the rules in place today, any nerd, any withdrawn, bookish kid, can have Asperger syndrome.

The definition should be narrowed. I don’t want a kid with mild autism to go untreated. But I don’t want a school psychologist to give a clumsy, lonely teenager a description of his mind that isn’t true.

Benjamin Nugent, the director of creative writing at Southern New Hampshire University, is the author of “American Nerd: The Story of My People.”

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Navigating the Social World of Elementary School

By: Diane I. Ferber-Collins MBA, MA, C.A.S.

Navigating the Social World of Elementary SchoolSocial Skills, Social Cognition and Social Thinking are all terminology used to describe the social abilities. As our students develop physically, cognitively and emotionally, their social development also follows a developmental trajectory. For many children, the full repertoire of social skills come easily through everyday interactions with adults and peers, but it is still important for educators and parents to reinforce this casual learning with direct and indirect instruction. For other children, direct instruction and support in navigating the trials and tribulations of skill acquisition are even more important. While there are direct interventions for children with documented difficulties in this arena, including children on the autism spectrum, even more ‘typical’ children can benefit from conscious support.

As experts have pointed out, perhaps the most difficult part for parents and teachers is toaccept that setbacks and uncomfortable situations are part of the growth process; and to recognize that rather than “bubble” a child or swoop in to “fix,” we can use these situations to guide and help empower each child to create his/her own solutions and strategies that will last a lifetime.

Strongly developed social skills will impact a child’s ability to adapt to change and variable situations, as well as to provide resilience across settings. The child with good social skills is more likely to have a positive self image and to meet challenges with confidence. As they mature, these children will have better developed peer resistance and better conflict resolution skills, which also impact tolerance and acceptance of diverse groups. In turn, these areas of comfort will inform life choices into adulthood.

What is “Social?” The ability to share space with others effectively, which requires a complex set of capabilities.

The required capabilities for positive social interactions involve complex and numerous skills. For example, we rely on being able to interpret others’ perspectives, including their emotions, point of view, thoughts, beliefs, prior knowledge and intentions, gleaned and remembered from previous interactions, and read from body language and facial expressions. Successfully sharing space with others also relies on our own ability to reflect on, sort through, process and regulate our own reaction and to adapt across situations. For young children, it requires the developed ability to share one’s experience of an object or event (joint attention) and to successfully wield “pragmatic” everyday informal language. There are hundreds of social cognition and communication skills – from initiating conversations, reading body language and expression, understanding of abstract and inferential communication, to adequate attention and motivation.

Read more @ http://www.pediastaff.com/blog/navigating-the-social-world-of-elementary-school-notes-for-parents-and-teachers-and-those-who-support-them-6735

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Posted by on January 25, 2012 in General

 

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Proposed DSM 5 Changes and Autism: What Parents & Advocates Need to Know

by Lee Anne Owens

Proposed DSM 5 Changes and Autism: What Parents & Advocates Need to KnowIn May of 2013 the new diagnostic criteria for Autism Spectrum Disorder will be distributed to doctors via the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5). Think of the DSM 5 as the Bible of diagnostic criteria, developed and written by the American Psychiatric Association (APA).

One of the most discussed changes in the DSM 5 Autism Spectrum Disorder (ASD) is the removal of Asperger’s syndrome and PDD-NOS as individual diagnoses. Under the new diagnostic criteria, Asperger’s and PDD-NOS will come under the umbrella of ASD. For example a child whose diagnosis is currently Asperger’s syndrome would receive a new diagnosis of Autism Spectrum Disorder with specifiers included, such as “Autism Spectrum Disorder with fluent speech” or “Autism Spectrum Disorder with intellectual disability.” According to Dr. Bryan King, of the APA’s Neurodevelopmental Disorders Workgroup, this change could mean a decrease in the differentiation of services available to those previously diagnosed with Asperger’s syndrome. (http://autism.about.com/od/diagnosingautism/a/Why-Asperger-Syndrome-Will-Disappear.htm) In layman’s terms this means that some children will benefit from a greater availability of needed services because they have a diagnosis of ASD, rather than Asperger’s.

Read the Rest of this Article on SpecialEducationAdvisor.com

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