Friday, June 22, 2012

PEERS

The UCLA Program for the Education and Enrichment of Relationship Skills (PEERS) is a manualized, social skills training intervention for adolescents and young adults. It has a strong evidence-base for use with teens and young adults with autism spectrum disorders, but is also appropriate for teens and young adults with ADHD, anxiety, depression, and other socioemotional problems.

The UCLA PEERS Program staff train mental health professionals and educators who are interested in learning and/or implementing the PEERS intervention and research in their clinical practice. The UCLA PEERS Program is a Regional Center Vendor.

Background:
Social skills training attempts to address one of the core deficits exhibited by individuals with autism spectrum disorders. The Program for the Education and Enrichment of Relational Skills (PEERS; Laugeson & Frankel, 2010) is a parent-assisted intervention for teens with autism that teaches social rules and routines to foster friendships. PEERS focuses on strategies for developing and maintaining friendships as a way to buffer the deleterious effects of social difficulties. The efficacy of the PEERS intervention was demonstrated by an increase in social knowledge and interactions for teens enrolled in PEERS relative to teens in a delayed treatment control group (Laugeson, Frankel, Mogil, & Dillon, 2009).

Objectives:
This study examined the effectiveness of PEERS in a community-based mental health setting.

Methods:
Participants included seven adolescents (range: 13-18 years old; four males) and their parents. Inclusion criteria were less restrictive than those used in Laugeson et al. (2009), so participants in the group included teens with an autism spectrum disorder, ADHD, apraxia, major depression, anxiety, and adjustment disorder. Four therapists with graduate training implemented the intervention and fidelity was maintained through weekly supervision with one therapist who is a clinical psychologist trained by the developers of PEERS to administer the intervention. Teens and parents completed the four outcome measures that yielded significant differences in the initial efficacy study. Teens completed the Test of Adolescent Social Skills Knowledge (TASSK; Laugeson & Frankel, 2006), Friendship Qualities Scale (FQS; Bukowski, Hoza, & Boivin, 1994), and the Quality of Socialization Questionnaire for Adolescents (QSQA; Frankel & Merkel, 2008), and parents completed the Social Skills subscale of the Social Skills Improvement System (SSIS; Gresham & Elliott, 2008). Parents also completed the TASSK as an additional measure of social skills knowledge gained during PEERS.

Results:
Results reflect within-subjects outcome data at the end of the 14-week intervention. Paired t-tests were conducted with a correction for multiple comparisons (a=.01). Results revealed that teens (p=.004, Cohen’s d=1.30) and parents (p<.001, d=2.7) showed an increase in their knowledge of social skills on the TASSK. In contrast, there was no significant change (all ps>.1) reported for general social skills (SSIS Social Skills subscale, d=.7), quality of friendships (FQS, d=.03), and frequency of social get-togethers hosted by teens (QSQA, d=.8).

Conclusions:
This study demonstrated that the PEERS model could be applied in a clinical, community-based mental health setting with a heterogeneous group of teenagers with impairments in social functioning. Preliminary findings suggest that teen and parent participants reported an increase in their knowledge of social skills (TASSK), but the quality (FQS/SSIS Social Skills) and quantity (QSQA) of social interactions did not show significant improvement post-intervention. Effect sizes for the SSIS Social Skills subscale and QSQA suggest that failure to detect differences on these measures may have resulted from the small sample size and lack of statistical power. Furthermore, while teens may have learned the skills presented during the PEERS intervention, additional practice with generalization may be needed to facilitate an increase in the quality and quantity of real world, social experiences.


          
          


Monday, June 4, 2012

Not Forgotten from Autism Live

This 20 minute documentary, titled "Not Forgotten," exposes the secret of Autism in Ukraine and what can be done to aid and educate professionals and parents.

Description
In a nutshell: This 20 minute documentary, titled "Not Forgotten," exposes the secret of Autism in Ukraine and what can be done to aid and educate professionals and parents.

Our primary mission? To aid in education of professionals who work with Autism in Ukraine and to create a support system for parents of children with Autism.

Our success stories with our mission?
We have worked in the field of Autism for the past 5 years, taking professional and parents of children with Autism who are Americans and have worked with teachers both on the university level as well as in the classroom. We have successfully taught parents basic skills with living with and raising a child on the Autism Spectrum.


Sunday, June 3, 2012

Better understanding of autism genes

A number of genes are believed to be involved in autism, but so far there have been only mixed results in the effort to identify them.

The reason for this is that autism is influenced by many different genes, and different genes are involved in different individuals, making it hard to find the common genetic ground between patients.

The research, conducted by Dr. Sagiv Shifman and his doctoral student Eyal Ben-David at HU’s genetics department, has potential implications for early diagnosis and for future treatment of autism, and was published in the journal PLoS Genetics.Now, research conducted at the Hebrew University has shown that despite this, the various genes that play a part in autism all tend to be involved in specific processes in the brain.

Autism spectrum disorders are neurodevelopmental syndromes characterized by social deficits, language impairments and repetitive behaviors. Recent studies indicate that autism is considerably more common than previously supposed, with a prevalence rate as high as one percent in some regions.

Boys are more likely to have it than girls.

The main goal of the project was to test the contribution of rare genetic mutations, as well as the genetic variations common in the population and to see whether these genetic risk factors are related.

Instead of testing individual genes, the researchers chose to study gene collections, in an attempt to understand the general pathways involved in autism.

To that end, the scientists constructed a network based on the expression pattern of genes across different brain areas. This allowed them to discover groups of genes with shared function in the brain.

Next, based on genetic data from thousands of families with autistic children, the researchers studied the contribution of different groups of genes to autism.

To their surprise, they found – when looking at mutations found in autism as well as thousands of common gene variants that are more frequently seen in autistics – that these mutations and variations are located in specific functional groups.

When looking at families with only one autistic individual (sporadic cases) and in families where there is more than one affected individual (multiplex cases), the same variants were seen acting in both cases. These groups of genes are highly active in the first year of life, and are involved in processes of learning, memory and sensory perception.

The researchers believe their work could pave the way for large-scale genetic scans in the future that could lead to early diagnosis of autism. The results of their study may also provide a ray of hope that by concentrating on specific gene groups, it will one day be possible to design drugs for alleviating symptoms in autistic people with different genetic backgrounds.

Sleep apnea, in which people stop breathing momentarily many times a night because of obstructions in their respiratory system, is a serious business. It can be relieved by continuous positive airway pressure (CPAP) devices, which are quite expensive but very effective. Research at Ben-Gurion University of the Negev and Soroka University Medical Center in Beersheba has found that cost deters many people from getting help, as the devices are not paid for by the health funds. The study by Profs. Ariel Tarasiuk and Haim Reuveni and colleagues was recently published in the journal PloS One.

As a matter of health policy, they recommend financial incentives to encourage CPAP treatment, especially among vulnerable populations. Such a policy would prioritize out-of-pocket expenditures based on service value and not its cost.

“Implementation of a value-based insurance strategy for CPAP treatment would prioritize high-value care based on its potential clinical and economic benefit,” the two argue.

The disorder, which affects two to nine percent of the adult population, can lead to significant cardiovascular morbidity and mortality. If used on a regular basis, CPAP can effectively decrease daytime sleepiness; reduce cardiovascular morbidity, improve quality of life and reduce health care costs.

Yet many patients, mainly of lower socioeconomic status, do not purchase the CPAP device if the healthcare system requires high cost sharing, they write. Cost sharing is an accepted expenditure-control strategy. It reduces consumer demand for health care services in every health care system studied.

Here, according to the National Health Insurance Law, CPAP treatment requires a mandatory out-of-pocket copayment, ranging from 25% to 50% ($330 to $660) of the cost of a CPAP device (average cost of the device is $1,320), depending on the patient’s supplementary health insurance coverage.

Financial incentive polices in the health care system have been proposed as a strategy to promote high-value health care as in the case of CPAP treatment based on the potential for clinical benefit and to minimize the health risk of not treating with CPAP.

Simple Autism Test for Infants


Friday, June 1, 2012

Gluten-Free/Casein-Free Diets for Autism

Autism spectrum disorders (ASD) are developmental disorders that affect children by disrupting their ability to communicate and interact socially. To reduce a child's symptoms of autism, parents often try alternative treatments such as specialized diets. Lately, the gluten-free/casein-free diet has grown in popularity. Some parents report improvements in autism symptoms with this dietary regimen.

Little research has been done, though, on the gluten-free/casein-free diet for autism. Consequently, many parents wonder whether this diet really does, in fact, make a difference in the symptoms of children with autism.

What is a gluten-free/casein-free diet for autism?
A gluten-free/casein-free diet is also known as the GFCF diet. It is one of several alternative treatments for children with autism. When following this strict elimination diet, all foods containing gluten and casein are removed from the child's daily food intake.

Some parents of children with autism believe their children are allergic or sensitive to the components found in these foods. Some seek allergy testing for confirmation. Yet even when no allergy is confirmed, many parents of autistic children still choose to offer the GFCF diet. Among the benefits they report are changes in speech and behavior.

How does a gluten-free/casein-free diet for autism work?
The gluten-free/casein-free diet is based on the theory that children with autism may have an allergy or high sensitivity to certain foods. In particular, the theory targets foods that contain gluten and casein. Children with autism, according to the theory, process peptides and proteins in foods containing gluten and casein differently than other people do. Hypothetically, this difference in processing may exacerbate autistic symptoms. Some believe that the brain treats these proteins like false opiate-type chemicals. The reaction to these chemicals, they say, leads a child to act in a certain way.

Based on this theory, diets free of gluten and casein are given to children with autism. The intent is to reduce symptoms and improve social and cognitive behaviors and speech.

There may be some scientific merit to the reasoning behind a gluten-free/casein-free diet. Researchers have found abnormal levels of peptides in bodily fluids of some people who have symptoms of autism. Still, the effectiveness of a GFCF diet for autism has not been scientifically substantiated in randomized clinical trials. In fact, a review of recent and past studies concluded there is a lack of scientific evidence to say whether this diet can be helpful or not.

Unfortunately, eliminating all sources of gluten and casein is so hard that conducting randomized clinical trials in children may prove to be very difficult.

Which foods contain gluten?
Gluten is a protein found in the seeds of several grains such as barley, rye, and wheat. A huge number of foods contain gluten. Gluten provides structure or binding to baked products. While it's quite difficult to avoid gluten, many stores, particularly natural food stores, display foods in a gluten-free area of the store. Still, it's important to read nutrition labels to see if there are additives containing gluten.

When someone is on a gluten-free diet, most bread and grain products are forbidden. Therefore, it is important to make sure that the child (or other person) receives ample fiber, vitamins, and minerals. Supplementation can help make up for the lack of these nutrients when foods containing gluten are eliminated.

Which foods contain casein?
Casein is a protein found in dairy products and other foods containing dairy or lactose. Even foods proclaiming to be dairy-free or lactose-free contain casein. Because many soy products and imitation dairy products also contain casein, it's important to read labels carefully when following a strict casein free diet.

Because the GFCF diet for autism restricts dairy products, you'll need to make sure the child's diet has other good sources of calcium and vitamin D. Both are necessary for strong bones and teeth. Talk with your child's doctor about fortified foods and/or supplementation to avoid any nutritional deficiencies.

Are there tips for eating at home or eating out on a gluten-free/casein-free diet?

There are a large number of online retailers who specialize in food products for people following the GFCF diet. Some parents make GFCF food in large quantities and freeze portions for a later meal.

Before making the change to a GFCF diet, consult your child's doctor. A licensed dietitian can educate you about the GFCF diet and help you tailor the diet to your child's health needs and taste preferences.

In addition, before starting a child with autism on a gluten-free/casein-free diet, beware the hidden sources of gluten. Gluten can be found in fried foods that are dusted in flour and even in cosmetics. Whole foods may be safe. But avoid using packaged mixes because there may be traces of foods containing gluten that are not listed on the nutrition label.

Some restaurants are now categorized as GFCF-friendly. If you are concerned, talk to the manager or obtain food ingredient lists before eating there. Vegetarian/vegan restaurants are often used to people on special diets frequenting their restaurants. They may be more willing to prepare dishes that adhere to the restrictions of a strict GFCF diet.