ASD Brains Show Decrease in Neuronal Autophagy, Underlying Oversensitivity and Deficits in Social Interaction

SOURCE: New York Times article by Pam Belluck

A recent study led by David Sulzer at Columbia University Medical Center showed that in children and adolescents with autism, brain tissue within the temporal lobe exhibit a decrease in neuronal autophagy (the brain’s process of clearing out old and degraded cells), which underlies oversensitivity and deficits in social interaction.

NY Times: Guomei Tang, PhD and Mark S. Sonders, PhD/Columbia University Medical Center

In early development, synapses—connections that allow neurons to communicate with each other—allows for infants to develop with as much external stimuli and information as possible. However, in childhood and adolescence, these synapses are gradually “pruned” so that the brain can develop more specific and advanced functions by not being overloaded with stimuli. As one can imagine, brains of children with autism fail to “prune” these synapses, causing them to be constantly overloaded with stimuli. In this study, young children with and without autism show roughly the same number of synapses, suggesting a “pruning” problem in autism, rather a problem with overproduction. Dr. Sulzer’s team also found biomarkers in the brains of children and adolescents diagnosed with autism, which suggested malfunctions in the process of autophagy (the neural degradation of old cells and damaged cell organelles). Without autophagy, the synaptic pruning process can’t occur.

These findings give us some insight into how autism develops from childhood onward, and help explain symptoms like oversensitivity and deficits in social interactions. Whether autism is a problem of brains with too little connectivity or too much of it has been of debate in recent years in the field of autism research. Ralph-Axel Müller, at San Diego State University, found in his studies that there was too much connectivity within brains of individuals with autism. “Impairments that we see in autism seem to be partly due to different parts of the brain talking too much to each other,” he reported to the NY Times. “You need to lose connections in order to develop a fine-tuned system of brain networks, because if all parts of the brain talk to all parts of the brain, all you get is noise.1

Eric Klann, a professor at New York University, also acknowledged an autophagy decrease in ASD brains. “The pruning problem seems to happen later in development than one might think,” Dr. Klann informed the Times. “It suggests that if you could intervene in that process that it could be beneficial for social behavior.”1 With further research into how this decrease in autophagy—and thus the synaptic pruning process in brains of children with autism—can be addressed earlier in a child’s development, there is hope that symptoms of autism may be preventable in the future.

1 “Study Finds That Brains With Autism Fail to Trim Synapses as They Develop.” New York Times. 21 Aug. 2014. Web. <http://www.nytimes.com/2014/08/22/health/brains-of-autistic-children-have-too-many-synapses-study-suggests.html>.

Federal Ruling Ensures that Insurers Must Cover ABA Therapy

GavelFederal Judge Michael H. Simon in Oregon ruled last week that insurance providers cannot deny coverage of Applied Behavior Analysis (ABA) therapy for children diagnosed on the autism spectrum. The ruling was in response to a lawsuit against Providence Health Plan, an insurance provider that denied coverage of ABA therapy for children diagnosed with autism, while simultaneously granting coverage for children without a diagnosis. ABA therapy, which can cost over $50,000 a year, involves a behavioral interventionist working with a child in the family’s home or in his school to address behavioral deficits for up to forty hours a week.

Oregon State Governor John Kitzhaber also agreed with this ruling and will adjust state health plans to reflect Judge Simon’s decision. The discrepancy between insurance policies and what providers actually cover arises because the medical community views ABA as “a medically necessary treatment of autism,”1 whereas some insurance providers accept it as an educational service that is provided in schools. Since autism is also classified as a “developmental disability,” instead of a mental health disorder, insurers exclude ABA coverage for those with autism, which is also a violation of mental health parity laws.

In some states like California, several warnings have been issued to insurance companies after several denials of ABA coverage had been overturned on appeal. Regional centers now fund ABA therapy by service providers, as well as insurance companies. With President Obama’s signing of Autism CARES last week, the federal ruling will hopefully set a precedent for insurance companies across the country to allow coverage of ABA therapy for families of children diagnosed with autism. ABA therapy is the most influential and widely cited form of therapy for autism, showing the most promise and efficacy in the treatment of autism.

1 http://exm.nr/1oJvnxa

Obama Signs Autism CARES to Renew Funding for Support

Late last Friday, August 8th, President Obama signed the Autism Collaboration, Accountability, Research, Education and Support Act (Autism CARES), a reauthorization of the U.S.’s primary autism legislation, which includes over a billion dollars in federal funding for autism research, services, and support.

Autism CARES is a renewal of what was previously called the Combating Autism Act, which was first enacted in 2006. The renewal calls for $260 million in funding per year through 2019 for autism research, prevalence tracking, screening, professional training, and other initiatives. It will also ensure a new point person in the U.S. Department of Health and Human Services to oversee research and support services and activities related to autism. Amendments will also be made to the Interagency Autism Coordinating Committee, mandating that a new report be conducted on the needs of young adults and youth during transition.

“The Autism CARES Act will allow us to continue to build on these efforts. It will increase understanding of the barriers that youth and young adults with an autism spectrum disorder or other developmental disability face as they transition from school-based services to those available during adulthood by charging federal agencies with assessing the particular needs of this population,” said Taryn Mackenzie Williams, Associate Director of the White House Office of Public Engagement.

To find out more about how the Department of Health and Human Services is supporting autism, visit their website here.

Tip of the Week: Minimize Tantrums with High and Low-Quality Attention

Recently I began working with a family who has a six year old boy with autism named Austin (all names and identifying details have been changed to protect confidentiality). His mother was describing Austin’s behaviors when he couldn’t have something he wanted. She told me about him hitting his parents and younger brother, sweeping all materials off tables and shelves, and throwing himself on the floor. She was worried that he might hurt himself or hurt someone else. She told me that when he started this behavior, they would say, “Stop hitting.” They had been doing this for months, but his behavior had not improved.

Later that week, she sent me a video of Austin having one of his “mega-tantrums.” It was exactly as she described, though there was one important detail she had missed. Austin consistently sought out eye contact and physical contact with both of his parents. If they were moving around to pick up an item, he would move his body and face to maintain eye contact. If one of them sat down, he would quickly clamber into their lap while screaming and pounding their arms or the furniture. If one parent walked out of the room, he would immediately run to the other parent. This behavior was clearly maintained by attention. In order to decrease the behavior, his parents had the very difficult task of ignoring it ahead of them.

The next week I went out to their house to help them practice ignoring the behavior. We put in place a three-pronged plan:

  • When Austin wanted something he was not allowed to have, he would be given a choice of options. The options should be for preferred activities. For example, if he wants to watch TV but isn’t allowed to right now, the parent can say, “Austin, you can play with trains or you can do a puzzle.”
  • Once Austin starts hitting or screaming, he does not receive any attention. This includes eye contact, physical contact, and verbal prompts/reminders from his parents.
  • The parents can start one of the motivating activities in another location. For this family, the parents sat with the younger brother at the dining room table and the mother read a book out loud.

As I had forewarned the parents, Austin’s behavior initially intensified as he realized he was getting zero attention. He took a box of toys, turned it upside down, and dumped it all over the floor. His mother kept reading to his brother. He ran over to his father and hit his legs while screaming, the father got up and walked away. Then, Austin did something he had never done before. He climbed up onto the table and started walking around on the edge of it.

His mother looked at me and said, “How do I avoid giving him attention for that?” This is when it’s important to consider high-quality attention and low-quality attention. In order to keep him safe, his mother needed to be more proximal. She walked near where he was on the table, but did not pick him up, did not make eye contact, and did not speak to him. (I let her know that if she felt he was very unsafe, she could pick him up and remove him from the table but quickly letting him go, and withholding eye contact and verbal interaction.) She stayed nearby to catch him if he fell, but she did not provide attention for this dangerous behavior. Her proximity (or if she had chosen to pick him up off the table without eye contact or verbal interaction) constitutes low-quality attention. High-quality attention is only saved for appropriate behavior.

Think about what high-quality attention means for a young child: big facial expressions, expressive tones of voice, big movements, and physical contact. Prior to our intervention, Austin was getting all of those types of high-quality attention for inappropriate behaviors. But now he wasn’t getting any of that type of attention.

However, Austin had been engaging in inappropriate behaviors for attention for 2-3 years now, so changing this behavior takes a little time. For our first day of the intervention, Austin continued to yell and throw items for 40 minutes before he finally went over to where his mom was sitting and reading aloud the story (actually, the third story in a row). When he was near and quiet, his mom started reading in a wonderfully expressive tone, adding voices to the characters. Austin came closer. When a funny part of the story happened, Austin laughed. And then Austin’s mother encouraged him and his brother to imitate the characters in another part of the story. After he imitated the characters, he sat next to his mom and she put her arm around him. All of these high-quality forms of attention were now being given for appropriate interaction.

Sometimes you have to provide some attention in order to keep a child safe, but think to yourself what is high-quality attention for your learner: it may be tickles, silly faces, expressive speaking, or physical contact. Reserve those things for appropriate behaviors.

A few final notes about this intervention: (1) Austin’s inappropriate behaviors will probably still continue for a little bit longer. I’m certain that he will test it out a few more times, and his parents will have to stick to the intervention in order to completely get rid of what they had deemed as “mega-tantrums”; (2) This intervention only works for behaviors maintained by attention. If you’re uncertain about the function of a behavior, confer with a BCBA or an ABA provider for help; and (3) If you’re not certain you can follow through if the behavior persists for a long time (such as 40 minutes in Austin’s case) then give in the first time the learner asks. For more information on this, look back at my tip on Choosing When to Battle.

Simplifying the Science: Using Evidenced-Based Practices to Increase Food Variety for Children with Autism

An essential part of ABA is providing evidence-based treatment. Research is consistently being done all around the world to determine best practices for working with learners with autism, as well as addressing many issues outside of the realm of special education. This week, we’re pleased to introduce the first in a new month series: Simplifying the Science. In this feature, BCBA Sam Blanco will highlight one paper from the world of research to help provide you with a deeper resource base. She’ll delve into the study and offer some strategies on how the findings apply to your programming needs. Our hope is that these monthly tips will shed a different light for you on the importance of looking to research for guidance.

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When faced with feeding issues, many parents or caregivers may not consider seeking out help from a BCBA or behavior analyst. There is a tendency to associate ABA with sitting at a table and completing discrete trials, but this is only one tool in a behavior analyst’s extensive toolkit. Whether you are providing intervention for feeding issues or seeking more information, it is essential to look to scientific research for help.

There are several studies available about feeding issues, and many of these studies are specific to feeding issues in individuals with autism. One such study was published in 2010 in the Journal of Applied Behavior Analysis (JABA) by Hildur Valdimarsdóttir, Lilja Ýr Halldórsdóttir, and Zuilma Gabriela SigurÐardóttir. “Increasing the Variety of Foods Consumed by a Picky Eater: Generalization of Effects Across Caregivers and Settings” provides one detailed case in which a five-year-old boy with autism refused to eat anything beyond meatballs, fishballs, fruits, and cereal. While his school had had some success with getting him to eat a few new items, the boy’s parents were unable to reproduce the same results at home.

The intervention the researchers used involved multiple steps that would require the assistance of a BCBA or skilled behavior analyst if you wanted to replicate it at home. In order to increase the number of foods this boy ate, the intervention included several behavioral techniques such as escape extinction (not allowing the child to escape mealtime upon refusing to eat or engaging in inappropriate behavior), stimulus fading (setting goals of increasing difficulty), and a schedule of reinforcement (frequency of reinforcement for appropriate behavior) that was systematically thinned as the child experienced success. By the end of the intervention, the boy was consuming 39 new, “non-preferred” foods, including 14 vegetables.

You can read the research study here, which I recommend you share with your child’s ABA provider. I also suggest taking a peek at the references listed at the end for insight into other resources. This particular study is of a five-year-old boy with autism, but you may find studies that are more relevant for your particular child.

In the end, when you’re feeling at a loss for strategies on improving your child’s eating, there is a lot of research out there. It takes time to go through it and set up a similar system for your own child, but the end result can have a huge impact on your child’s health as well as the stress-level in your home during mealtimes. It is definitely worth the effort to attain more information.

Written by Sam Blanco, BCBA

Sam is an ABA provider for students ages 3-12 in NYC. Working in education for ten years with students with Autism Spectrum Disorders and other developmental delays, Sam has developed strategies for achieving a multitude of academic, behavior, and social goals.

Different Roads iOS Apps Now Feature Family Sharing

Apple has recently introduced a new Family Sharing feature, which allows up to 6 family members to browse and access each other’s iTunes, iBooks, and App Store purchases, as well as share photos, calendars, and locations with each other. We’re excited to announce that all of our Different Roads apps in the iTunes App Store have also begun to support this feature. Family Sharing also includes parental controls, enabling parents to approve purchases and downloads initiated by children first.

Different Roads to Learning Apps

Clean Up Cateogory Sorting AppClean-Up: Category Sorting  This highly-rated interactive program develops language, reasoning, and sorting and classifying skills in young learners. Players must “clean up” by putting 75 photographic images of toys, food, and clothing away in the correct shopping cart, refrigerator, or toy box. Each target is introduced by its label (“Where does the Apple go?”) in each round where players see 15 unique images. Correct responses receive visual and auditory reinforcement while incorrect answers are corrected by a visual prompt of the correct answer flashing. This app builds foundational sorting skills for students just developing their sorting and classifying skills. Available on iPhone and iPad.

Whats that Sound App

What’s that Sound? Learning to Listen and Identify Sounds  This interactive and easy-to-grasp game develops auditory discrimination and processing skills in young learners. Players will improve their skills by matching objects and their associated sounds. Simple auditory processing skills lay the foundation for learning how to read, speak and spell.
Available on iPhone and iPad.

 

What Goes Together App

What Goes Together?  This interactive program develops language, discrimination, and reasoning skills in young learners. Clear, colorful images of everyday objects promote an understanding of functions and the relationships between items that children encounter on a daily basis. With built-in reinforcement and error correction, this game provides a solid foundation in building critical expressive and receptive language skills. Available on iPhone and iPad.

Tell Me About It App

Tell Me About It!  Featured as Editor’s Choice on Best Apps for Kids, this universal app is specifically designed for children with autism and other speech and language delays. Based on the Applied Behavioral Analysis approach, this program mimics an actual one-on-one instructional session with a therapist. The app provides 15 categories of language targets, such as body parts, household items, clothing and food, and six levels of difficulty, which progressively become more difficult, from labelling to shared feature, function, and category. This app also features an easy-to-read report card, which provides tracking data for each child and an option to e-mail the report card results. Available on iPhone and iPad.

To discover all of our current apps and what Family Sharing can do for your family, visit our iTunes App Store page.

Tip of the Week: Teaching Money Skills to Students with Autism in Natural Social Situations

Recently I took a thirteen-year-old boy with autism grocery shopping for the first time. We had practiced all of the steps for paying: looking at the total on the register, taking out the necessary bills or coins, waiting for change, making sure we had correct change, returning the money to the wallet, etc. While I thought he was ready to do this in a natural environment, I did not expect what actually happened.

Standing at the counter with a line of people impatiently waiting behind us, my student dumped all the change from his wallet on the counter and slowly began counting out the exact amount. I could hear other store patrons grumbling behind us when my student finally finished paying, then dropped coins all over the floor, and swept his remaining money back into his wallet.

The concern here is that some of the behaviors associated with autism can place an individual in danger if misunderstood by a cashier or store patron. My student appeared to be oblivious to the frustration of the people around him, offering no apology or explanation. There are many resources out there for teaching children with autism about identifying coins, counting out exact change, etc. But it’s essential that we think beyond the fundamentals of managing money to the more complex skills of managing the social situations that arise during money transactions on a daily basis.

Here are some social skills related to money to practice with your students:

  • Keep your wallet in your hand, do not lay it on the counter.
  • Look for the total on the register. If there is not a place to see the total, ask for it after all the items have been rung up.
  • Put the money in the cashier’s hand.
  • Put your hand out to receive change.
  • Once you have completed payment, make sure your wallet is securely back in your pocket or bag.
  • Understand how to respond if a cashier asks “Do you have exact change?” or “Do you have a smaller bill?” or any variation of those questions.
  • Pay with speed.
  • Understand how to ask to put an item back if you do not have enough money.
  • Know basic scripts for what to say in challenging situations, such as if you accidentally bump into someone with your shopping basket or you are taking a long time and another patron says something rude about it.

My takeaway from this experience was that I needed to provide practice in the natural environment much sooner than I had thought. I must consider the fact that we simply can’t contrive the broad range of possible interactions with strangers in a home or classroom setting. My students require dozens, if not hundreds, of opportunities to practice a skill before mastering it, and generalization is frequently challenging, so presenting them with a variety of natural environment experiences is important. I also must recognize that a student’s behavior will often vary from one environment to another, so the sooner I know what he or she is doing in the natural environment, the sooner I can implement meaningful instruction and intervention to address any problems. Finally, because ABA providers and teachers have more limited access to the natural environment than parents and caregivers, we should provide specific goals and teaching strategies to help them practice with the learner when we’re not present.

Pick of the Week: “Expanding and Combining Sentences” Interactive Workbook

For students who are already able to talk or write in simple, choppy sentences, this interactive workbook will open gateways to success in language and literacy! Save 15%* on your purchase of Expanding and Combining Sentences by speech and language pathologist Marilyn M. Toomey this week only, by applying or mentioning our promo code EXPAND8 at check out!

Color picture pages, along with specific instructions, provide a means of evoking interesting and descriptive sentences from students.

Students will learn how to expand their sentences by using the color cues provided in the book, as pictures become progressively colorful and a new detail is added to the sequence. In no time at all, young learners will be able to tell an entire story by using complex and detailed sentences!

97 pages in total with 40 colored pages.  Preview the book.

This interactive workbook will be the perfect resource to teach the challenging task of making sentences more interesting with descriptive words.  Don’t forget – this week only, take 15% off* your order of Expanding and Combining Sentences by applying code EXPAND8 at checkout!

Marilyn M. Toomey is also the author of several other popular speech and language workbooks, such as Talking in SetencesVerbal Reasoning ActivitiesThe Language of Perspective Taking, and much more.

*Offer is valid until 11:59pm EDT on 6/10/2014. Not compatible with other offers. Be sure there are no spaces or dashes in your code at checkout!

Modified Instructions for Shopping List Memory Game

We’re excited to bring you the fourth installment of our series of Modified Instructions, created by Sam Blanco, BCBA.  Sam’s Modified Instructions present 3-4 additional ways to play a mainstream game to make it most useful and accessible for our students with special needs.  These alternative instructions break down each adapted game by:

  • Age/Skill Level
  • Number of Players
  • Object
  • Skills Required
  • Materials Needed
  • Prep
  • Instructions
  • Considerations

In this installment, we’re introducing Sam’s Modified Instructions for Shopping List, one of our favorite memory games. Shopping List is an adorable memory game that also develops personal and social skills.

The goal of the game is to be the first to fill your cart with all of the items on your shopping list.  It is designed with the objective to have players fill a trolley with the items on their shopping list. However, there are multiple games and activities that can be played with these materials to meet the specific needs of your learners.

Included in the game are 4 cardboard carts, 4 shopping lists, and 32 beautifully illustrated items with dry-erase surfaces. Don’t forget to download our free Modified Instructions for Shopping List today!

Tips for Traveling with Kids with Autism

Taking any long trip when you have a child with autism can be daunting, especially when it involves long periods of time in the car or on an airplane. Below are a few tips for reducing stress during travel time.

  • Create a visual or textual schedule for your child.  Because trips don’t always go as planned (e.g. planes are delayed, you get caught in traffic), it’s probably not a good idea to list specific times that activities will be occurring. But it is helpful to show the order in which they will be happening.
  • Prepare your child for potential problems.  If possible, talk about coping methods ahead of time and practice them if possible. What can you do if you’re stuck in traffic that isn’t moving? What are your choices if we experience turbulence on the plane?
  • Provide information for your child.  Show photos, books, maps, etc. of the locations you’ll be traveling to. You can also read books or show photos of activities you’ll be participating in, such as swimming or skiing.
  • If possible, pack more than one activity bag.  Bags filled with a few favorite activites or small toys can be useful for keeping kids entertained on trips. For long trips, your child may get bored with items in an activity bag. It’s useful to keep a second one stashed in a suitcase or other bag if you’ll be on a very long flight or car ride. It can also be useful to have a separate activity bag for the return trip if you know your child may lose interest in the first one.
  • Provide options when possible.  Access to choices can go a long way in keeping kids calm. Choices can include what videos to watch, snacks to eat, etc.
  • Check in advance with guest services at hotels, resorts, or theme parks.  Ask what modifications and accessibility options they may offer. Many places offer special accommodations and are open to any unique requests you may have.
  • Prepare in advance for any sensory concerns.  Bring noise-cancelling headphones, ear plugs, fidgets, etc. to have available, as needed.

Remember that long trips are difficult for all children, and many of the tips listed above are beneficial for siblings who do not have special needs.