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Tuesday, April 30, 2013

Athletes 4 Autism Sports for Kids on the Spectrum Sunday, May 5 in Weston, MA

From The Rivers School

This Sunday afternoon (May 5), at the Rivers School in Weston, MA, there will be a great opportunity for your children to participate in a fun afternoon of sports.

Athletes 4 Autism will be organizing soccer and basketball games for kids on the spectrum. This is a great opportunity for kids on the autism spectrum to participate in games and events with college and high school athletes who have been specially trained to play sports with spectrum kids.

Kids of all levels and abilities are encouraged to attend. No prior athletic experience is necessary!

When:   1:00 - 3:00pm Sunday, May 5, 2013

Where: The Rivers School
                333 Winter Street, Weston, MA

Free, on-site parking is available. Refreshments and snacks will be provided. Please join in the fun!

If you have any questions about this event, please contact Jake Goldberg at
j.goldberg@rivers.org. For additional information about Athletes 4 Autism, visit their website.

Diagnosing the Wrong Deficit

From The New York Times - Sunday Review

By Vatsal G. Thakkar
April 27, 2013

In the spring of 2010, a new patient came to see me to find out if he had attention-deficit hyperactivity disorder. He had all the classic symptoms: procrastination, forgetfulness, a propensity to lose things and, of course, the inability to pay attention consistently.

But one thing was unusual. His symptoms had started only two years earlier, when he was 31.

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Related Health Guide: ADHD

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Though I treat a lot of adults for attention-deficit hyperactivity disorder, the presentation of this case was a violation of an important diagnostic criterion: symptoms must date back to childhood. It turned out he first started having these problems the month he began his most recent job, one that required him to rise at 5 a.m., despite the fact that he was a night owl.

The patient didn’t have A.D.H.D., I realized, but a chronic sleep deficit. I suggested some techniques to help him fall asleep at night, like relaxing for 90 minutes before getting in bed at 10 p.m. If necessary, he could take a small amount of melatonin. When he returned to see me two weeks later, his symptoms were almost gone. I suggested he call if they recurred. I never heard from him again.


Many theories are thrown around to explain the rise in the diagnosis and treatment of A.D.H.D. in children and adults. According to the Centers for Disease Control and Prevention, 11 percent of school-age children have now received a diagnosis of the condition. I don’t doubt that many people do, in fact, have A.D.H.D.; I regularly diagnose and treat it in adults. But what if a substantial proportion of cases are really sleep disorders in disguise?

For some people — especially children — sleep deprivation does not necessarily cause lethargy; instead they become hyperactive and unfocused. Researchers and reporters are increasingly seeing connections between dysfunctional sleep and what looks like A.D.H.D., but those links are taking a long time to be understood by parents and doctors.

We all get less sleep than we used to. The number of adults who reported sleeping fewer than seven hours each night went from some 2 percent in 1960 to more than 35 percent in 2011. Sleep is even more crucial for children, who need delta sleep — the deep, rejuvenating, slow-wave kind — for proper growth and development. Yet today’s youngsters sleep more than an hour less than they did a hundred years ago.

And for all ages, contemporary daytime activities — marked by nonstop 14-hour schedules and inescapable melatonin-inhibiting iDevices — often impair sleep. It might just be a coincidence, but this sleep-restricting lifestyle began getting more extreme in the 1990s, the decade with the explosion in A.D.H.D. diagnoses.

A number of studies have shown that a huge proportion of children with an A.D.H.D. diagnosis also have sleep-disordered breathing like apnea or snoring, restless leg syndrome or non-restorative sleep, in which delta sleep is frequently interrupted.

A 2004 study, published in the journal Sleep, looked at 34 children with A.D.H.D. Every one of them showed a deficit of delta sleep, compared with only a handful of the 32 controls.

A 2006 study in the journal Pediatrics showed something similar, from the perspective of a surgery clinic. This study included 105 children between ages 5 and 12. Seventy-eight of them were scheduled to have their tonsils removed because they had problems breathing in their sleep, while 27 children scheduled for other operations served as a control group.

Researchers measured the participants’ sleep patterns and tested for hyperactivity and inattentiveness, consistent with standard protocols for validating an A.D.H.D. diagnosis.

Of the 78 children getting the tonsillectomies, 28 percent were found to have A.D.H.D., compared with only 7 percent of the control group.

Even more stunning was what the study’s authors found a year after the surgeries, when they followed up with the children. A full half of the original A.D.H.D. group who received tonsillectomies — 11 of 22 children — no longer met the criteria for the condition.

In other words, what had appeared to be A.D.H.D. had been resolved by treating a sleeping problem.

But it’s also possible that A.D.H.D.-like symptoms can persist even after a sleeping problem is resolved. Consider a long-term study of more than 11,000 children in Britain published last year, also in Pediatrics. Mothers were asked about symptoms of sleep-disordered breathing in their infants when they were 6 months old.

Then, when the children were 4 and 7 years old, the mothers completed a behavioral questionnaire to gauge their children’s levels of inattention, hyperactivity, anxiety, depression and problems with peers, conduct and social skills.

The study found that children who suffered from sleep-disordered breathing in infancy were more likely to have behavioral difficulties later in life — they were 20 to 60 percent more likely to have behavioral problems at age 4, and 40 to 100 percent more likely to have such problems at age 7.

Interestingly, these problems occurred even if the disordered breathing had abated, implying that an infant breathing problem might cause some kind of potentially irreversible neurological injury.

Clearly there is more going on in the nocturnal lives of our children than any of us have realized. Typically, we see and diagnose only their downstream, daytime symptoms.

There has been less research into sleep and A.D.H.D. outside of childhood. But a team from Massachusetts General Hospital found, in one of the only studies of its kind, that sleep dysfunction in adults with A.D.H.D. closely mimics the sleep dysfunction in children with A.D.H.D.

There is also some promising research being done on sleep in adults, relating to focus, memory and cognitive performance. A study published in February in the journal Nature Neuroscience found that the amount of delta sleep in seniors correlates with performance on memory tests.

And a study published three years ago in Sleep found that while subjects who were deprived of sleep didn’t necessarily report feeling sleepier, their cognitive performance declined in proportion to their sleep deprivation and continued to worsen over five nights of sleep restriction.

As it happens, “moves about excessively during sleep” was once listed as a symptom of attention-deficit disorder in the Diagnostic and Statistical Manual of Mental Disorders. That version of the manual, published in 1980, was the first to name the disorder. When the term A.D.H.D., reflecting the addition of hyperactivity, appeared in 1987, the diagnostic criteria no longer included trouble sleeping. The authors said there was not enough evidence to support keeping it in.

But what if doctors, before diagnosing A.D.H.D. in their patients, did have to find evidence of a sleep disorder?

Psychiatric researchers typically don’t have access to the equipment or expertise needed to evaluate sleep issues. It’s tricky to ask patients to keep sleep logs or to send them for expensive overnight sleep studies, which can involve complicated equipment like surface electrodes to measure brain and muscle activity; abdominal belts to record breathing; “pulse oximeters” to measure blood oxygen levels; even snore microphones. (And getting a sleep study approved by an insurance company is by no means guaranteed.)

As it stands, A.D.H.D. can be diagnosed with only an office interview.

Sometimes my patients have resisted my referrals for sleep testing, since everything they have read (often through direct-to-consumer marketing by drug companies) identifies A.D.H.D. as the culprit. People don’t like to hear that they may have a different, stranger-sounding problem that can’t be fixed with a pill — though this often changes once patients see the results of their sleep studies.

Beyond my day job, I have a personal interest in A.D.H.D. and sleep disorders. Beginning in college and for nearly a decade, I struggled with profound cognitive lethargy and difficulty focusing, a daily nap habit and weekend sleep addiction. I got through my medical school exams only by the grace of good memorization skills and the fact that ephedra was still a legal supplement.

 I was misdiagnosed with various maladies, including A.D.H.D. Then I underwent two sleep studies and, finally, was found to have an atypical form of narcolepsy. This was a shock to me, because I had never fallen asleep while eating or talking. But, it turned out, over 40 percent of my night was spent in REM sleep — or “dreaming sleep,” which normally occurs only intermittently throughout the night — while just 5 percent was spent in delta sleep, the rejuvenating kind. I was sleeping 8 to 10 hours a night, but I still had a profound delta sleep deficit.

It took some trial and error, but with the proper treatment, my cognitive problems came to an end. Today I eat well and respect my unique sleep needs instead of trying to suppress them. I also take two medications: a stimulant for narcolepsy and, at bedtime, an S.N.R.I. (or serotonin-norepinephrine reuptake inhibitor) antidepressant — an off-label treatment that curtails REM sleep and helps increase delta sleep.

Now I wake up without an alarm, and my daytime focus is remarkably improved. My recovery has been amazing (though my wife would argue that weekend mornings are still tough — she picks up the slack with our two kids).

Attention-deficit problems are far from the only reasons to take our lack of quality sleep seriously. Laboratory animals die when they are deprived of delta sleep. Chronic delta sleep deficits in humans are implicated in many diseases, including depression, heart disease, hypertension, obesity, chronic pain, diabetes and cancer, not to mention thousands of fatigue-related car accidents each year.

Sleep disorders are so prevalent that every internist, pediatrician and psychiatrist should routinely screen for them. And we need far more research into this issue. Every year billions of dollars are poured into researching cancer, depression and heart disease, but how much money goes into sleep?

The National Institutes of Health will spend only $240 million on sleep research this year. One of the problems is that the research establishment exists as mini-fiefdoms — money given to one sector, like cardiology or psychiatry, rarely makes it into another, like sleep medicine, even if they are intimately connected.

But we can’t wait any longer to pay attention to the connection between delta sleep and A.D.H.D. If you’re not already convinced, consider the drug clonidine. It started life as a hypertension treatment, but has been approved by the Food and Drug Administration to treat A.D.H.D. Studies show that when it is taken only at bedtime, symptoms improve during the day. For psychiatrists, it is one of these “oh-we-don’t-know-how-it-works” drugs. But here is a little-known fact about clonidine: it can be a potent delta sleep enhancer.

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Vatsal G. Thakkar is a clinical assistant professor of psychiatry at the N.Y.U. School of Medicine.

Wayside's Mental Health Month Special Events Calendar

From Wayside Youth & Family Support Network

April 29, 2013

May is Mental Health Month and a lot of events have been scheduled. Those listed below, all of them free and open to all, are sponsored by Wayside Youth & Family Support Network, an organization that provides multiple services, including counseling, support, family-based, community outreach, residential, day and educational programs, in communities across Eastern and Central Massachusetts.

Schedule

On Wednesday, May 8, from 7:00 - 9:00pm in Waltham, we will be presenting members of TADS (Teenage Depression and Anxiety Solutions), as they share with their experiences with their own children and sharing ways in which you can open a dialogue with your children about Mental Illness. Our Waltham office is at 118 Central Street, Waltham. For more information, contact judi_maguire@waysideyouth.org.

On Thursday, May 9, from 7:00 - 9:00pm at Employment Options in Marlborough, we will be hosting Bob Larsted, author of `Witness to the Dark', a remarkable account of his daughters struggle with schizoaffective disorder. This is the third time that Bob has spoken for Wayside Youth and Family. We can promise a wonderfully moving presentation.

This event is jointly sponsored by Wayside Youth and Family, NAMI MetroWest and Employment Options. Employment Options is located at 82 Brigham Street in Marlborough. For information, contact judi_maguire@waysideyouth.org.

On Monday, May 13, from 6:00 - 7:30pm in Framingham, parents can enjoy a night out, take some time to distress, relax and enjoy a simple activity. There will be pizza, and babysitting will be provided. Our Framingham office is at 88 Lincoln Street, Framingham, opposite the MetroWest Medical Center Hospital. Please RSVP with the number of children and their ages attending to: John Allen 508-620-0010, ext.189, or by email to: John_allen@waysideyouth.org

On Wednesday, May 22, from 7:00 - 8:30pm in Framingham, a panel of experts will talk about Mobile Crisis Intervention (MCI) and Jail Diversion Programs. We know that parents often worry about the consequences for their children and the family if they call for help. Our panel will be available to answer questions. Our Framingham office is at 88 Lincoln Street, Framingham, opposite the MetroWest Medical Center. For more information, please contact John Allen at 508-620-0010, ext. 189, or by email to: John_allen@waysideyouth.org

Don't forget Wayside's support groups, and to sign up for the next BASICS education program taking place in Marlborough starting June 1st. The BASICS program is free and all materials are provided.

For additional information, please contact:

Judi Maguire, Parent Support Coordinator/Parent Partner
Wayside Youth and Family
118 Central Street
Waltham MA 02453

judi_maguire@waysideyouth.org,_.___

Monday, April 29, 2013

How Social, Emotional and Academic Success is Affected by Past Trauma

Sponsored by the Cambridge PACSE
(Parent Advisory Council on Special Education)
 
Please join the Cambridge PACSE for a special presentation featuring trauma experts from the Greater Boston area:
  • Melody Brazo - School Climate Coordinator, Cambridge Public Schools
  • Gail Council - Family Advocate, The Guidance Center
  • Janie Crecco - Trauma Specialist, The Federation for Children with Special Needs
  • Joel Ristuccia - School Psychologist, co-author of "Helping Traumatized Children Learn"
When:   6:30pm Wednesday, May 1, 2013
 
Where: Cambridge Rindge and Latin High School
                359 Broadway, Cambridge, MA
 
Free and open to the public. Free childcare available.
 
For more information or to register, please contact Melissa Bulyko at 617-803-5376. Information is also available here: http://cambridgepacse.org.
 
 
To find out how to help children who may have experienced trauma and are on IEPs, contact Emily at 617-399-8342 or by email to rtsc@fcsn.org to learn about becoming a Special Education Surrogate Parent in your area.

I’m Ready for College But I Can’t Find My Backpack

A Roger A. Bauman Parent Lecture Presented by
The Lurie Center for Autism

Executive Functioning Strategies for Transition to and Success in College

Speakers: Margaret Dillon Katz is the CIP National Presentation Coordinator and the Transition Counselor at The College Internship Program. Margaret has been working with families for over twenty years as they consider and search for the right educational choice for their student. She works with students and families during the critical transition from high school to college

Travis McArthur, Admissions Coordinator, CIP Berkshires. Before working in admissions at CIP, he was residential coordinator for the Berkshires CIP program, and he did one-on-one sessions on executive functioning with individual students as well as groups. He is also getting his masters with an emphasis in autism.

When:    6:30 – 8:30pm, Thursday, May 16 2013

Where:  Charles River Center
                   Paul Merritt Bldg. Basement Conference Rm.
                   59 East Militia Heights Road
                   Needham, Massachusetts
                   (located at the top of Dwight Road off Central St.)

                   www.charlesrivercenter.org

Registration required. To register, please contact:

Julie O’Brien, M.Ed., LMHC
Family Support Clinician, Lurie Center
Phone: 781-860-1726
Email:  jobrien20@partners.org

It's Different for Girls with ADHD

From The Atlantic - Wire

By Maria Yagoda
April 23, 2013

When you live in total squalor—cookies in your pants drawer, pants in your cookies drawer, and nickels, dresses, old New Yorkers, and apple seeds in your bed—it’s hard to know where to look when you lose your keys.

The other day, after two weeks of fruitless searching, I found my keys in the refrigerator on top of the roasted garlic hummus. I can’t say I was surprised. I was surprised when my psychiatrist diagnosed me with ADHD two years ago, when I was a junior at Yale.

In editorials and in waiting rooms, concerns of too-liberal diagnoses and over-medication dominate our discussions of Attention Deficit Hyperactivity Disorder, or ADHD.

The New York Times recently reported, with great alarm, the findings of a new Center for Disease Control and Prevention study: 11% of school-age children have received an ADHD diagnosis, a 16 percent increase since 2007.

And rising diagnoses mean rising treatments—drugs like Adderall and Ritalin are more accessible than ever, whether prescribed by a physician or purchased in a library. The consequences of misuse and abuse of these drugs are dangerous, sometimes fatal.

"...also harmful are the consequences of ADHD untreated, an all-to-common story for women...(who) have symptoms—disorganization and forgetfulness, for instance—that look different than those typically expressed in males."

Yet also harmful are the consequences of ADHD untreated, an all-to-common story for women like me, who not only develop symptoms later in life, but also have symptoms—disorganization and forgetfulness, for instance—that look different than those typically expressed in males.

While the New York Times’ Op-Ed columnist Roger Cohen may claim that Adderall and other “smart” drugs “have become to college what steroids are to baseball,” these drugs have given me, a relatively unambitious young adult who does not need to cram for tests or club until 6 a.m., a more normal, settled life.

The idea that young adults, particularly women, actually have ADHD routinely evokes skepticism. As a fairly driven adult female who had found the strength to sit through biology lectures and avoid major academic or social failures, I, too, was initially perplexed by my diagnosis.

My peers were also confused, and rather certain my psychiatrist was misguided.

“Of course you don’t have ADHD. You’re smart,” a friend told me, definitively, before switching to the far more compelling topic: medication. “So are you going to take Adderall and become super skinny?” “Are you going to sell it?” “Are you going to snort it?”

The answer to all of those questions was no. I would be taking Concerta, a relative of Ritalin. Dr. Ellen Littman, author of Understanding Girls with ADHD, has studied high IQ adults and adolescents with the disorder for more than 25 years. She attributes the under-diagnosis of girls and women—estimated to be around 4 million who are not diagnosed, or half to three-quarters of all women with ADHD—and the misunderstandings that have ensued about the disorder as it manifests in females, to the early clinical studies of ADHD in the 1970s.

“These studies were based on really hyperactive young white boys who were taken to clinics,” Littman says. “The diagnostic criteria were developed based on those studies. As a result, those criteria over-represent the symptoms you see in young boys, making it difficult for girls to be diagnosed unless they behave like hyperactive boys.”

ADHD does not look the same in boys and girls. Women with the disorder tend to be less hyperactive and impulsive, more disorganized, scattered, forgetful, and introverted. “They’ve alternately been anxious or depressed for years,” Littman says. “It’s this sense of not being able to hold everything together.”

Further, while a decrease in symptoms at puberty is common for boys, the opposite is true for girls, whose symptoms intensify as estrogen increases in their system, thus complicating the general perception that ADHD is resolved by puberty. One of the criteria for ADHD long held by the Diagnostic and Statistical Manual, published by the American Psychiatric Association, is that symptoms appear by age 7. While this age is expected to change to 12 in the new DSM-V, symptoms may not emerge until college for many girls, when the organizing structure of home life—parents, rules, chores, and daily, mandatory school—is eliminated, and as estrogen levels increase.

“Symptoms may still be present in these girls early on,” says Dr. Pat Quinn, cofounder of The National Center for Girls and Women with ADHD. “They just might not affect functioning until a girl is older.” Even if girls do outwardly express symptoms, they are less likely to receive diagnoses. A 2009 study conducted by at The University of Queenland found that girls displaying ADHD symptoms are less likely to be referred for mental health services.

In “The Secret Lives of Girls with ADHD,” published in the December, 2012 issue of Attention, Dr. Littman investigates the emotional cost of high IQ girls with ADHD, particularly for those undiagnosed. Confused and ashamed by their struggles, girls will internalize their inability to meet social expectations.

Sari Solden, a therapist and author of Women and Attention Deficit Disorder, says, “For a long time, these girls see their trouble prioritizing, organizing, coordinating, and paying attention as character flaws. No one told them it's neurobiological.”

Often, women who are finally diagnosed with ADHD in their twenties or beyond have been anxious or depressed for years. A recent study published in the Journal of Consulting and Clinical Psychology found that girls with ADHD have high rates of self-injury and suicide during their teenage years, at last bringing attention to the distinct severity of ADHD in females.

In Pediatrics, a large population study found that the majority of adults with ADHD had at least one other psychiatric disorder, from alcohol abuse to hypomanic episodes to major depression.

This poses a particular threat to females, for whom ADHD diagnoses tend to come later in life.

For the two decades prior to my diagnosis, I never would have suspected my symptoms were symptoms; rather, I considered these traits—my messiness, forgetfulness, trouble concentrating, important-document-losing—to be embarrassing personal failings. Matters really deteriorated in college, when I was wrongfully allowed a room of my own, leaving me with no mother to check up on “that space between your bed and the wall,” where moldy teacups, money, and important documents would lie dormant.

I maintained a room so cluttered that fire inspectors not only threatened to fine me 200 dollars if I didn’t clean, they insisted it was the messiest room they had ever seen (boys’ included!) in their twenty years of service. Throughout college, I would lose my ID and keys about five times a semester. I’d consistently show up for work three hours early or three hours late. I once misplaced my cellphone only to find it, weeks later, in a shoe.

“Often, if girls are smart or in supportive homes, symptoms are masked,” Solden says. “Because they’re not hyperactive or causing trouble for other people, they’re usually not diagnosed until they hit a wall, often at college, marriage, or pregnancy. A lot of things that are simple and routine to other people—like buying groceries, making dinner, keeping track of possessions, and responding to emails—do not become automatic to these women, which can be embarrassing and exhausting.”

As a recent college graduate cautiously negotiating adulthood in New York City, I am both embarrassed and exhausted by my struggles to keep track of objects and time. While the stakes have become significantly higher—credit cards, passports, and cameras have slipped through my fingers—medication has minimized the frequency of these incidents.

I can’t say that I know what part is ADHD, what part is me, or whether there’s a difference. I can say that ADHD medication (in conjunction with SSRIs) has granted me a base level of functionality; it has granted me the cognitive energy to sit at my jobs, to keep track of my schedule and most possessions, and to maintain a semblance of control over the quotidian, fairly standard tasks that had overwhelmed me—like doing laundry, or finding a sensible place to put my passport.

Medication is certainly not a cure-all, but when paired with the awareness granted by a diagnosis, it has rendered my symptoms more bearable—less unknown, less shameful.

And while I’m certain I’ll continue to misplace and forget objects, I have discovered the virtues of a little self-love, a lot of self-forgiveness, and even using different drawers to store different things.

The drawer thing, though, is a work in progress. The next time I misplace my keys, the fridge will be the first place I look.


You can email the author atmlyagoda@gmail.com. You can share ideas for stories on the Open Wire.

Sunday, April 28, 2013

Autism, Schizophrenia and Other Psychiatric Disorders Share Genetic Underpinnings

From the Boston.com Blog "Science in Mind"

By Carolyn Y. Johnson, Globe Staff
February 27, 2013

An international consortium, including researchers from Boston, has for the first time discovered a handful of common genetic underpinnings for five distinct psychiatric illnesses, providing evidence that disorders such as schizophrenia and autism overlap—and may share fundamental biological causes.

The study is one step in an ambitious effort that could ultimately redraw or blur the boundary lines between psychiatric illnesses, based on a precise understanding of the underlying biology.

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Read HealthDay.com's Report on This HERE.

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Over the past five years, many teams have focused on analyzing genetic variants—spots in the genome that commonly differ among people—to pinpoint the risk factors for particular disorders. In the new work, published Wednesday in The Lancet, researchers examined genetic data from people with autism, depression, schizophrenia, bipolar disorder, and attention deficit-hyperactivity disorder, and found clues that genes involved in signaling within the brain may go awry in a broad set of psychiatric illnesses.

“This is the first time we’ve seen specific genetic variants that seem to confer risk across traditional boundaries, to a broad range of child- and adult-onset disorders,” said Dr. Jordan Smoller, a professor of psychiatry at Mass. General Hospital and Harvard Medical School, and a leader of the study.

“Each one of them, by themselves, still accounts for a small amount of the risk. The fascinating thing is there might be such variants that cross our clinically-distinct syndromes.”

Smoller and colleagues analyzed genetic data from more than 33,000 people with the five disorders and compared them with nearly 28,000 people without mental illness. They found four spots in the genome that were more common among those with psychiatric disease, two of which occurred in genes involved in communication between brain cells.

They also found that genetic risk factors for bipolar disorder and schizophrenia had the most overlap. Interestingly, autism, a disorder that emerges in childhood, overlapped with both disorders, which typically emerge in adulthood.

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See More on the NBC News "Vitals" Blog HERE.

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Those are tantalizing clues for scientists, who now have a range of starting points for teasing out more about the shared biological basis of these psychiatric diseases—a way to pry open the black box of illnesses that are poorly understood.

What the new study cannot do is provide a way of predicting mental illness with a gene test; all of the genetic variants are very weak risk factors.

Dr. Daniel Weinberger, director of the Lieber Institute for Brain Development, a nonprofit research institution based in Maryland, compared deciphering the genetics of psychiatry to trying to divine what causes something with a diverse array of causes, such as car accidents.

“What you would discover, across a diverse population of car accidents, is a factor common to most of them, which may in any individual case not explain much risk,” Weinberger said. “What you end up with is a driver’s license.”

But he added that such an approach is helping to elucidate mechanisms and the biology behind disorders.

“They are the first objective clues as to what mental illnesses are at a basic biological level,” Weinberger said.

Dr. Judith Rapoport, chief of the child psychiatry branch at the National Institute of Mental Health, the agency that funded the research, said the work resonated with her own.

Rapoport studies a rare form of schizophrenia that occurs in childhood. She has looked at “copy-number variations,” in which DNA segments are repeated an unusual number of times in samples taken from patients.

Strikingly, in her samples, she has seen copy-number variations associated with intellectual disability, schizophrenia, autism, and epilepsy.

“There’s a sense in psychiatry there may be some very common genetic variants that, let’s say hypothetically, very early on affect very early brain development. Then, maybe environment, or interactions with other genes” causes a particular illness to develop, Rapoport said.

She said the new study also may help explain why a person with one psychiatric disease is often at risk of developing other problems.

The next step will be to investigate further the gene variants flagged by the study, to see whether scientists can understand what role they might play—and whether they might reveal new targets for treatments. The researchers also hope to include more disorders in their sample to see whether other shared risk factors emerge.

About Science in Mind

Science in Mind chronicles the discoveries, ideas, inventions, and people that make Boston a scientific hub. Like scientists, we're driven by curiosity. Carolyn Y. Johnson joined the Health team as a science writer in 2008. She also has covered telecommunications and tech culture for the Business section. Johnson was a physics and English major at Amherst College, and earned her master’s degree in science writing from MIT. Contact her at cjohnson@globe.com or follow her on Twitter @carolynyjohnson.

Understanding Social and Emotional Development in Preschoolers

From Get Ready to Read!

By Kristin Stanberry
April 3, 2013

It’s easy to monitor your preschooler’s physical development as he or she grows taller, bigger, and stronger. But how can you measure your child’s development in other areas? For example, can you tell if his social and emotional development is on track for his age?

As your child’s parent and first teacher, you’re in a good position to observe and assess whether he’s developing skills appropriate for a 3- to 4-year-old child.

The milestones and tips that follow will help you understand what your child should be doing and learning, and how you can support his or her development.

Is Your Child Developing Age-Appropriate Social and Emotional Skills?

It’s helpful to know what social and emotional skills your child should be developing by age 3 or 4. Review the following milestones for a child’s social and emotional skills, and note how your child is doing. My child:
  • Can correctly state his gender and age.
  • Can recite her first and last names, and the names of parents.
  • Takes care of his own needs, such as washing hands and dressing.
  • Enjoys helping with household tasks.
  • Adjusts to new situations without an adult being present.
  • Is starting to notice other people’s moods and feelings.
  • Is beginning to recognize his limits and ask others for help.
  • Is starting to learn to take turns, share, and cooperate.
  • Expresses anger with words rather than acting out physically.
Encouraging Social/Emotional Development at Home

Now that you understand some of the social and emotional skills your child should have, you can reinforce those skills and help him develop further where necessary.

It’s natural (and fun!) to practice these skills with your child throughout the day. Here are some ideas to get you started:
  • Provide structure and daily routines at home; this creates a secure environment for your child.
  • Encourage your child’s independence. As he practices and masters skills such as getting dressed, brushing his teeth, or feeding a pet, be sure to praise him.
  • Teach your child to recite his first and last names, his parents’ names, his gender and age, and his home address.
  • Make sure your child has regular social contact with other children his age, both one-on-one and in a group. Observe him playing with others, and listen to what he says about his friends. This is an opportunity for you to teach him to cooperate with peers, resolve conflicts, and build and maintain friendships.
  • Play games that require your child to cooperate with others, wait his turn, and learn to be a gracious winner or loser.
Note: If your child has a regular babysitter or daycare provider, be sure to pass these tips along to the caregiver.

Promoting Social and Emotional Growth at Preschool

In preschool your child will enter into the world filled with structured and informal learning, and one that places high value on good behavior and cooperation. To keep track of your child’s social and emotional progress, you’ll want to:
  • Ask the teacher what opportunities your child has to learn and practice social and emotional skills in the classroom and at play. Also ask how well your child is doing in the area of social and emotional development
  • Find out what social skills and behaviors your child will need to demonstrate in order to make the best transition to kindergarten.
  • Encourage your child to talk about school, and try to gauge how he feels about, his classmates, and any situations or activities he finds especially interesting (or challenging).
Cause for Concern? Where to Turn for Assistance

“Normal” social and emotional skills and awareness don’t develop in exactly the same way for all preschoolers. However, you may want to seek help if your child:
  • Has difficulty joining in and maintaining positive social status in a peer group.
  • Has a hard time maintaining self-control when frustrated.
  • Throws long, drawn-out, or frequent tantrums, or bullies other children.
  • Is unusually withdrawn or seems sad. (Be sure to look for this behavior in group activities as well as solo play and artwork.)
  • Suffers from extreme anxiety when separated from you, even in a familiar setting.
Discuss your concerns with your child’s preschool teacher, pediatrician, and, if necessary, a specialist (such as a child psychologist). If you’re concerned that your child may have a learning disability or delay, you should contact your public school system and request (in writing) that a diagnostic screening (at no cost to you) be conducted.

This is available to you under the Individuals with Disabilities Education Act.

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Kristin Stanberry is a writer and editor specializing in parenting, education, and consumer health/wellness issues. Her areas of expertise include learning disabilities and AD/HD, topics which she wrote about extensively for Schwab Learning and GreatSchools.

10 Things We Know About Autism That We Didn't Know a Year Ago

From The Huffington Post Healthy Living Blog

By Geraldine Dawson
Chief Science Officer, Autism Speaks

April 2, 2013

Just two decades ago, autism was a mysterious and obscure disorder, commonly associated with the movie Rain Man and savantism. It affected an estimated 1 in 5,000 children.

How times have changed.

Today, thanks to awareness and advocacy efforts, people now have a much better understanding of autism.

The Centers for Disease Control (CDC) now estimates that a staggering 1 in 88 children, including 1 in 54 boys, in the United States has been diagnosed with an autism spectrum disorder. Another recent federal report presented data that autism prevalence among school-aged children, as reported by parents, is 1 in 50.

An Autism Speaks-funded South Korean study, which used a more rigorous methodology, found a prevalence of 1 in 38 students.

With the increase in reported prevalence and overall awareness has come a significant expansion in the field of autism research. Piece by piece, we are starting to get a much better picture of what this disorder is and the extent of its complexity. We now know there is not one autism, but rather, a spectrum of disorders that have different causes and different manifestations. We know that both genetic and environmental factors are involved.

April is Autism Awareness Month, a good opportunity to reflect on the notable progress made by researchers, as well as the critical importance of building on this success and advancing the science much further.

Here are ten important things we've learned about ASD in the past twelve months that not only hold interest for researchers and clinicians, but also offer new insights and actionable information for parents:

1. High-quality early intervention for autism spectrum disorder (ASD) can do more than improve behaviors; it can improve brain function. Read more.

2. Being nonverbal at age 4 does NOT mean children with autism will never speak. Research shows that most will, in fact, learn to use words, and nearly half will learn to speak fluently. Read more.

3. Though autism tends to be life-long, some children with ASD make so much progress that they no longer meet the diagnostic criteria for autism. High quality early intervention may be key. Read more.

4. Many younger siblings of children with ASD have developmental delays and symptoms that fall short of an autism diagnosis, but that still warrant early intervention. Read more.

5. Research confirms what parents have been saying about wandering and bolting by children with autism: It's common, it's scary, and it doesn't result from careless parenting. Read more.

6. Prenatal folic acid, taken in the weeks before and after a woman becomes pregnant, may reduce the risk of autism. Here's the story.

7. One of the best ways to promote social skills in grade-schoolers with autism is to teach their classmates how to befriend a person with developmental disabilities. Read more.

8. Researchers can detect presymptom markers of autism as early as 6 months -- a discovery that may lead to earlier intervention to improve outcomes. Read more.

9. The first medicines for treating autism's core symptoms are showing promise in early clinical trials. Read more.

10. Investors and product developers respond to a call to develop products and services to address the unmet needs of the autism community. Read more.

Throughout April Autism Awareness Month, as we celebrate the contributions of people with autism to our lives, it's important that we also recognize autism as a public health crisis in this country that demands a commensurate response.

Quite simply, we need a national action plan for autism, a coordinated approach to funding research and critical services for people with autism across their lifespan.

We must do more to help the millions of people living with autism today maximize their potential and lead fulfilling lives. They and their families -- our friends, relatives and neighbors -- deserve nothing less.

Saturday, April 27, 2013

In Defense of Parents: A Child Therapist’s Dissent

From KennethBarrish.com

By Kenneth Barish, Ph.D.
 March 31, 2013

"The answer is not less parenting or Tiger parenting, but highly involved, positive, supportive parenting, informed by advances in clinical and developmental research."

Perhaps it has always been this way, but recently it seems that parents are under attack. Criticisms come from all sides.

We are over-involved or overly permissive. We fail to teach traditions and values. We over-diagnose, over-medicate, and over-accommodate our kids, often to excuse our own poor parenting.

Especially, the critics believe, our children are indulged. We are so concerned that they not feel any disappointment and with their self-esteem, that we no longer insist that they learn to master challenges – experiences of mastery that lead to the strengthening of character and real, earned, self-esteem.

Like curling athletes, we try to smooth their path through life, eliminating any friction. We are afraid of their tantrums, afraid to let them fail (and then learn from their mistakes) and afraid to say, “No.”

My clinical experience suggests a different diagnosis. Yes, we may be too indulgent. More fundamentally, we are too stressed – more burdened and more alone. Both children and parents now have fewer places to turn when they are in need of practical and emotional support.

In three decades of working with children and families, I have, of course, met some indulgent parents. Far more often, I meet thoughtful parents, struggling to find the right balance, in their own lives and in the lives of their children.

Most parents want more for their children than individual achievement. They also want them to be “good kids” – children who act with kindness and generosity toward their families, their friends, and their communities.

Too often, however, families get stuck. Concerned and caring parents become, against their best intentions, angry and critical. And children, in turn, become argumentative and stubborn, or secretive and withdrawn. These vicious cycles of criticism and defiance then undermine children’s initiative, confidence, and sense of responsibility.

There are answers to these problems. The answer is not less parenting or Tiger parenting, but highly involved, positive, supportive parenting, informed by advances in clinical and developmental research.

In parenting debates, it is easy to lose sight of what is most important. We do not stop often enough, I believe, to consider how our children look up to us and how we remain for them, throughout their lives, sources of affirmation and emotional support. On this point, developmental research is clear: From kindergarten until they are young adults, children who are doing well in their lives have the benefit of emotional and practical support from their parents, mentors, and friends.

Here are the essential elements of a balanced, supportive approach to raising successful and caring children. It is not either/or. We can encourage our children’s self-expression and also teach them self-restraint.


• We support our children with our warm and enthusiastic encouragement of their interests and talents. Great teachers intuitively understand this, and they should be our role models as parents.

• We offer support to children when we listen patiently and sympathetically to their concerns and their grievances, and when we are willing to repair the conflicts that occur, inevitably, in our relationships. Children learn invaluable lessons from moments of repair. They learn that, although it is not always easy, moments of anger and misunderstanding are moments and can be repaired.

• We provide emotional support for our children when we accept and value their feelings – and then talk with them about the needs and feelings of others.

• We support children when we play and work with them often. Essential social skills are learned in the course of playful interactions. They are not learned in front of a screen, or from lectures and admonishments. When parents play and work with their children, children come to understand and accept, deeply and for the right reasons, the limitations imposed by adult authority. Even 5 minutes a day of interactive play between parents and children is helpful in strengthening parent-child relationships and promoting cooperative behavior in young children.

In many ways, interactive play is to children’s social development what talking with them is to vocabulary development and exercise is to their physical development.

• Then, we help them solve problems. When we engage children in the solution of a problem, they become less stuck in making demands or continuing the argument. They begin to think, if just for that minute, less about how to get their way and, instead, about how to solve a problem – about how their needs and the needs of others can be reconciled, an important life lesson, for sure.

• And we should let them know that we are proud of them, for their effort and for the good things they do for others. A child’s confident expectation that her parents are proud of her is an essential good feeling, and an anchor that sustains her in moments of discouragement, temptation, and self-doubt.

In these ways, we strengthen our children’s inner resources and we become an inner presence – a voice of encouragement and moral guidance. Our children will then be more successful in all aspects of their lives. They will have better peer relationships. At home, we will see less argument, less defiance, and less withdrawal. They will also work harder and achieve more in school. And we will have prepared them, as best we can, for coping with the challenges and responsibilities they will face as adults.

About Kenneth Barish, Ph.D.

Kenneth Barish, Ph.D., is clinical associate professor of psychology at Weill Medical College, Cornell University. He is also on the faculty of the Westchester Center for the Study of Psychoanalysis and Psychotherapy, and the William Alanson White Institute Child and Adolescent Psychotherapy Training Program. He graduated from Yale University in 1972, and earned his Ph.D. in Clinical Psychology form the New School for Social Research in 1980.

Dr. Barish has worked with children and families for over three decades. He teaches post-graduate classes in adolescent development, psychoanalysis, neuropsychological testing and child psychotherapy, and he has published several widely read articles on child psychotherapy. He is also the author of Pride and Joy:A Guide to Understanding Your Child's Emotions and Solving Family Problems.

His popular blog, Pride and Joy, appears regularly on PsychologyToday.com.

(This post was originally published in The Huffington Post, March 20, 2013)

10 Best Apps for Pre-K Kids With Autism

From Parents.com

By Lisa Quinones-Fontanez
April 21, 2013

A mom who has a son with autism tells about the mobile apps that have helped him and other children with autism.

Ole Ivar Lovaas, Ph.D., a world-renowned autism expert, once said, "If a child cannot learn in the way we teach, we must teach in a way the child can learn."

Technology -- specifically in Tablet form -- has revolutionized the way kids with autism learn and communicate, and mobile apps have given parents, educators, and therapists multiple approaches to teaching a child who develops at a different pace than his peers.

The apps included in this list focus on and reinforce pre-K concepts, such as reading and math, while encouraging imaginative play skills and art in kids with autism.

Starfall ABC/Learn to Read

Starfall ABCs (available only on iTunes) teaches the alphabet by helping kids sound out the letters. Gen Holder, an Applied Behavior Analysis (ABA) therapist, even uses it as a teaching and positive reinforcement tool in her therapy sessions with young children. "It's like interactive alphabet flash cards," she says.

Once children have mastered letters and sounds, the Starfall Learn to Read app helps emerging readers by introducing 15 simple sentence stories and fun songs with friendly characters such as Zac the Rat and Peg the Hen.

Every word in the story is sounded out phonetically to help children recognize various letter sounds.($2.99; Android, iPhone, iPad)

Development Skills: Language, Reading and Vocabulary



Super Why!

This Sesame Street app allows your child to go on a hunt identifying letters with Alpha Pig, trace letters with Princess Presto, practice rhyming words with Wonder Red, and help Super Why himself select words to finish a story.

Dani, mom of 8-year-old Brodie, says, "Reading is Brodie's splinter skill, but her comprehension doesn't match her reading ability." The Super Why app offers fill-in-the-blank games within each story, so it improves reading comprehension because of the familiar stories and characters.($2.99; Android, iPhone, iPad)

Development Skills: Fine Motor, Imagination, Handwriting, Language, Reading and Vocabulary

The Monster at the End of This Book

A favorite for many parents and kids, this playful app, also from Sesame Street, is bright, colorful, and laugh-out-loud funny. This storybook app features notes for parents on helping children through their fears, along with 31 helpful tips, such as "Encourage kids to mimic Grover's over-the-top movements and gestures as you read along."

It's fantastic for teaching cause and effect because kids will learn that with a touch of their fingers, they can interact with the story by "turning" pages, untying knots, and knocking down bricks. ($4.99; iPhone, iPad)

Development Skills: Fine Motor, Imagination, Language and Vocabulary


Emotions and Feelings - Autism

Kids with autism often have difficulty recognizing emotions and facial expressions. Created by TouchAutism.com, this app uses social stories and simple illustrations to show what different feelings look like. The app also explains why people may feel a certain way. It's excellent for use in special education classrooms and could be beneficial during speech therapy sessions. ($2.99; Android)

Development Skills: Emotional, Recognition and Social

Pop Math (Lite)

This Lite version of this Wired Kids Choice Award app introduces basic addition and makes it fun for your kids. Six pairs of colored bubbles with numbers float around the screen, some showing equations and some showing the answers. Kids must pop the correct pairs to advance to different levels, and words of encouragement are given to keep kids going after each one.

A child who has mastered addition can progress to the full version ($0.99) to learn subtraction, multiplication and division. (Free; Android, iPhone, iPad)

Development Skills: Fine Motor, Math and Numbers

Toca Boca

Let your child apply a bandage or examine a patient with Toca Doctor, send out invitations and set a table with Toca Birthday Party, or cut, color, and style hair with the Toca Hair Salon -- just a few user-friendly apps in the Toca Boca app series. Many of the apps take real-life scenarios and allow children to create their own stories.

The apps provide "great interaction, appealing characters, and role play," says Karla, mom of a 4-year-old daughter. They love the Toca Boca Store app: "I love that the games teach basic money-handling skills and math -- and the kid in me loves the fun and beautifully drawn items in the store catalog," Karla adds. ($0.99 and up; iPhone, iPad)

Development: Imagination, Math, Money Handling and Social

Agnitus - Games for Learning

This app offers a variety of interactive games, some of which focus on identifying and matching shapes, colors, letters, and managing self-help skills. Your kids will love "Icky Bathtime Fun," a game that teaches hygiene lessons such as showering and tooth brushing. Many of the games feature Olly or Icky, cute and mischievous characters, and the app tracks your child's performance level.

A "report card" provides detailed reports on study time and completed skills, which is useful to determine strengths and weaknesses. (Free; iPhone, iPad)

Development Skills: Fine Motor, Letters, Math, Memory, Numbers and Recognition


Fruit Ninja Free

Alysia, mom of three boys (ages 4, 7, and 10, the two youngest with autism) loves this free version of Fruit Ninja, which is "fun, short, and not intimidating." She says, "My kids like the fast pace of the game and the exploding fruit. I like that they are using fine motor skills to chop the fruit and are practicing their game-playing skills."

The boys learn and "work on good sportsmanship," playing against each other using the Zen Dual feature. (Free; Android, iPhone, iPad)

Development Skills: Coordination, Fine Motor and Focus

Doodle Buddy

Kids can draw, scribble, write, and color on a blank canvas or upload photos to personalize with stamps, stencils, and quote bubbles. This app is so much more than a drawing app, though; it allows kids to develop creativity and game-playing skills. A variety of backgrounds, like nature scenes and games such as tic-tac-toe and hangman, are provided. Other cool features include mazes to navigate as well as a connect-the-dots background. (Free; iPhone, iPad)

Development Skills: Creativity, Fine Motor, Imagination and Writing

Nick Jr. Draw and Play

Kids create their own artwork by choosing different backgrounds (featuring favorite Nickelodeon characters like Dora the Explorer and Team Umizoomi) to decorate with coloring tools (crayons, brushes, chalk), special effects (fireworks, splatter tops, magic wands), and animated stickers. Kids also have the option of drawing and coloring on a blank background. The HD iPad version includes coloring pages and eCards. All creations can be saved and printed out. ($2.99; iPhone, iPad)

Development Skills: Creativity, Fine Motor, Imagination and Writing

Friday, April 26, 2013

How to Choose A Special Education Lawyer

From The Law Office of Lillian Wong's Blog

By Lillian Wong, Esq.
April 22, 2013

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NOTE: This is the 2nd of two guest posts by Attorney Lillian E. Wong. The first, "5 Reasons You Shouldn't Hire a Special Education Attorney," appeared on April 23rd.

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By the time you decide to hire a special education attorney, the stakes are high. You are frustrated with the school and worried about your child. Not only can retaining the wrong lawyer waste your time and money, it can permanently damage your child's education.

So, how do you choose the right law firm?

1. Find a Specialist. Special education law is complex and not part of the traditional law school curriculum. Just because an attorney passed the state bar doesn't mean that he or she is qualified to represent your child! The more specialized the law practice, the more likely the attorney is to understand the intricacies of special education law.

2. Ask about Experience. Just because a lawyer specializes in special education law doesn't mean he or she has experience. The ideal lawyer has participated in IEP / 504 Meetings, Manifestation Determinations, Informal and Formal Settlement Negotiations (including settlement conferences at the BSEA) and Due Process Hearings (including expedited hearings).

Make sure the lawyer has drafted their own settlement agreements and understands the dangers of simply signing a settlement agreement drafted by the school.

Here in Massachusetts, most special education disputes end in settlement, so you may be surprised to find that an attorney who has practiced for five or even ten years has never brought a case to hearing before the Board of Special Education Appeals. Even if your case never results in a hearing, it is important to hire an attorney who understands the process from start to finish.

3. Inquire about Relationships. A good special education attorney understands the role of all the key players in the special education process and has a relationship with these individuals and institutions. He or she can recommend educational advocates, evaluators, and other experts. Your lawyer should be familiar with the reputation of the schools' lawyers and special education directors and be regarded by them as a knowledgeable and reasonable advocate. 

4. Locate a Listener. The attorney's job is to represent you and your child. This is impossible to do if the lawyer doesn't understand your situation and your goals. How do you make sure the lawyer is listening to you? The attorney should ask relevant questions, take notes, and ask for clarification when he or she doesn't understand.

5. Assess Communication Skills. When you hire a lawyer, you are finding someone to speak (and write) on your behalf. Look for an attorney who comes across as both knowledgeable and understandable. The best attorneys know how to make the most complex laws and confusing facts accessible to the lay-person.

6. Reward a Realist. Special education law is far from perfect. Beware of attorneys that make unrealistic promises - reimbursement of fees, guaranteed private school placements, and elimination of future special education conflicts. An effective special education attorney understands the law and its limits and sets realistic expectations from the start.

7. Prioritize Professionalism. Make sure the lawyer establishes professional boundaries. Without boundaries, the attorney-client relationship can erode, leading to poor communication, billing-controversies, and mutual-frustration. So how can you assess professionalism in your initial interactions with the lawyer? Read over the agreement of representation. Does it:
  • Clearly define the responsibilities and rights of both the attorney and the parent?
  • Are you informed of the payment structure and frequency of billing?
  • Think about your initial conversations with the lawyer. Did the attorney inquire about the best way to communicate with you? Did the attorney inform you about the best way to communicate with him? Did the attorney set expectations about the frequency of your communication? Without good communication and expectation-setting, the relationship will fail.
8. Discuss the Forest and the Trees. The special education journey is a long one. You need to find a lawyer that will address your immediate concerns (the "trees") while simultaneously helping you achieve your long-term goals for your child (the "forest"). A good special education lawyer will inquire about your short-term and long-term concerns help you formulate a step-by-step plan that addresses both.

9. Contract with a Child-Centric Firm. The best special education lawyers became education attorneys, not for the money or the prestige, but to help children. Look for an attorney who redirects conversations to your child's needs and shows sensitivity to your parental concerns. Special education law shouldn't be about money, revenge, and "winning;" it's about helping your child get the education he or she needs and deserves.

About Lillian Wong, Esq.

Lillian Wong is a special education attorney who has represented clients at IEP meetings, manifestation determinations, due process hearings and settlement negotiations. Read her client reviews here.

Ms. Wong is a graduate of UCLA Law School and Dartmouth College (Summa Cum Laude), and a member of the Massachusetts Bar Association (MBA), the Council of Parent Attorneys and Advocates (COPAA), The Special Needs Advocacy Network (SPAN), and Massachusetts Advocates for Children's Coalition to Defend Special Education. She also sits on the Advisory Board of Autism Asperger's Digest.