Thursday, March 12, 2009

Inside the autism treatment maze

No single approach is best for every child

Every child who receives the diagnosis of autism may be different, but the families of those children face the same overwhelming challenge — finding the best treatment for the complex condition.

While there has been significant progress in easing symptoms of autism and educating children diagnosed with the disorder, there is little agreement among doctors, parents and researchers over which type of treatment most effectively helps an affected child grow into an independent adult.

Parents can find themselves confronted with a confusing maze of often expensive strategies and methods, some of them promising miracle cures but backed by little or no medical evidence.

"With autism, the variation in treatments is huge," says Laura Schreibman, an autism researcher and professor of psychology at the University of California at San Diego. "Parents not only have to deal with the emotional impact of the devastating diagnosis, [but] there’s no clear course of where to go. The amount of garbage that's out there and what parents have to sift through is truly astounding."

For many kids, autism treatment involves some combination of intensive behavioral therapy, speech and language therapy and special education in public schools. Anecdotal reports support newer forms of play-based behavioral therapies and alternative methods involving vitamins and dietary restrictions, although many autism experts vigorously disagree over whether these offer benefit.

'The beginning of this journey'
"We do have some important knowledge in treatment of autism, but we’re still very much at the beginning of this journey," says Geraldine Dawson, a professor of psychology at the Center on Human Development and Disability at the University of Washington in Seattle.

Since autism was first recognized in 1943, the search for an effective treatment has been frustrating for those involved. Once promising medical treatments have later been shown in tests to have no benefit. Research supporting newer or alternative treatments is lacking.

The causes of autism are unclear, and the wide range in the type and severity of a patient's disabilities can make it particularly challenging to select a specific therapy.

In 2001, a report from the National Academy of Sciences found that children with autism should receive at least 25 hours a week of intensive training beginning as young as age 2. Early diagnosis, now being given to children as young as 8 months, improves the chances of treatment success, experts say.

"We know that most children, but not all because we can’t guarantee, do well with early intervention," says Dr. Fred Volkmar, a professor of child psychiatry at Yale University and an expert on autism.

But the report stopped short of endorsing any particular treatment beyond education and support for parents, noting that the type of treatment might differ depending on the child.

"There is no one treatment that is going to work for all children or one treatment that is going to do everything for any given child over a long period of time," says Catherine Lord, director of the autism and communication disorders program at the University of Michigan in Ann Arbor and chairwoman of the National Academy of Sciences expert panel.

Many children with autism have additional problems such as gastrointestinal illnesses, sleeping difficulties or anxiety that can complicate treatment, researchers also note.

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Guide to treatment options

A treatment program called Applied Behavior Analysis (ABA), which is based upon a rewards system, is widely accepted by parents and doctors largely because it is the most researched and is supported by numerous anecdotal success stories. ABA is considered especially beneficial for children with more severe symptoms.

ABA calls for one-on-one interaction between a teacher and a child for up to 40 hours a week. In the highly structured program toddlers receive positive reinforcement for initially learning simple actions like identifying colors and then gradually working up to more advanced activities that target deficits in learning, language, play-interaction and attention.

Advocates of this behavioral therapy pioneered by Dr. O. Ivaar Lovaas, professor emeritus at the University of California at Los Angeles, point to a study published in 1987 that suggested that with a comprehensive ABA program of 40 hours a week, about half of kids with autism were indistinguishable from other kids at age 7. But even within the field, the research has been questioned.

"No one else has been able to replicate that," says Lord. "That finding was an anomaly."

Monday, March 2, 2009

Study uses music to explore the autistic brain's emotion processing

Music has a universal ability to tap into our deepest emotions. Unfortunately, for children with autism spectrum disorders (ASD), understanding emotions is a very difficult task. Can music help them? Thanks to funding from the GRAMMY Foundation Grant Program, researchers at UCLA are about to find out.

Individuals with ASD have trouble recognizing emotions, particularly social emotions conveyed through facial expressions — a frown, a smirk or a smile. This inability can rob a child of the chance to communicate and socialize and often leads to social isolation.

In an innovative study led by Istvan Molnar-Szakacs, a researcher at the UCLA Tennenbaum Center for the Biology of Creativity, music will be used as a tool to explore the ability of children with ASD to identify emotions in musical excerpts and facial expressions.

"Music has long been known to touch autistic children," Molnar-Szakacs said. "Studies from the early days of autism research have already shown us that music provokes engagement and interest in kids with ASD. More recently, such things as musical memory and pitch abilities in children with ASD have been found to be as good as or better than in typically developing children."

In addition, he said, researchers have shown that because many children with ASD are naturally interested in music, they respond well to music-based therapy.

But no one has ever done a study to see if children with ASD process musical emotions and social emotions in the same way that typically developing children do.

In this study, Molnar-Szakacs will use "emotional music" to examine the brain regions involved in emotion processing.

"Our hypothesis is that if we are able to engage the brain region involved in emotion processing using emotional music, this will open the doorway for teaching children with ASD to better recognize emotions in social stimuli, such as facial expressions."

The overarching goal of the study, of course, is to gain insights about the causes of autism. Molnar-Szakacs will use neuroimaging — functional magnetic resonance imaging, or fMRI — to look at and compare brain activity in ASD children with brain activity in typically developing kids while both groups are engaged in identifying emotions from faces and musical excerpts.

"The study should help us to better understand how the brain processes emotion in children with autism; that, in turn, will help us develop more optimal interventions," Molnar-Szakacs said. "Importantly, this study will also help us promote the use of music as a powerful tool for studying brain functions, from cognition to creativity."

Approximately 15 children with ASD, ranging in age from 10 to 13, will participate in the study, which is being conducted under the auspices of the Help Group–UCLA Autism Research Alliance. The alliance, directed by UCLA's Elizabeth Laugeson, is an innovative partnership between the nonprofit Help Group, which serves children with special needs related to autism, and the Semel Institute for Neuroscience and Human Behavior at UCLA, and is dedicated to enhancing and expanding ASD research. The project is also being conducted in collaboration with Katie Overy, co-director of the Institute for Music in Human and Social Development at the University of Edinburgh, Scotland.

"The hope, of course, is that this work will not only be of scientific value and interest, but most of all, that it will translate into real-life improvements in the quality of the children's lives," Molnar-Szakacs said.

USC researchers identify gene variant associated with both autism and gastrointestinal dysfunction

Altered expression of MET gene may contribute to increased risk of co-occurring medical conditions

A study led by researchers at the University of Southern California (USC) and Vanderbilt University have identified a specific gene variant that links increased genetic risk for autism with gastrointestinal (GI) conditions.

The findings suggest that disrupted signaling of the MET gene may contribute to a syndrome that includes autism and co-occurring gastrointestinal dysfunction, says principal investigator Pat Levitt, Ph.D., director of the Zilkha Neurogenetic Institute at the Keck School of Medicine of USC and chair-designate of the Department of cell and neurobiology.

The study will appear in the March Issue of the journal Pediatrics and is now available online.

Autism is a developmental disorder characterized by deficits in communication abilities, social behavior disruption and inflexible behavior. While gastrointestinal conditions are common among individuals with autism, researchers have long debated whether co-occurring GI dysfunction represents a unique autism subgroup, Levitt and lead author Daniel Campbell, Ph.D., say.

"Gastrointestinal disorders don't cause autism. Autism is a disorder of brain development," Levitt says. "However, our study is the first to bring together genetic risk for autism and co-occurring GI disorders in a way that provides a biologically plausible explanation for why they are seen together so often."

In the brain, the MET gene is expressed in developing circuits that are involved in social behavior and communication. Disturbances in MET expression result in alterations in how these critical circuits develop and mature, Levitt explains. Research indicates that MET also plays an important role in development and repair of the GI system.

Researchers analyzed medical history records from 214 families in the Autism Genetic Resource Exchange (AGRE). They found that a variant in the MET gene was associated with autism specifically in those families where an individual had co-occurring autism and a GI condition.

The study brings researchers closer to understanding the complex genetic risks for autism. However, further research is needed, as different combinations of genes are likely to result in different types of autism features, Levitt says.

"We believe that there are other genes that will help identify different subgroups of individuals who have autism spectrum disorder," he says. "We also believe that there needs to be research looking at whether the children with co-occurring GI dysfunction and autism have unique features that will help us predict what treatments will be best for them."