Social Interaction Difficulties in Autism

Study Challenges Assumptions About Social Interaction Difficulties in Autism

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Autism is characterized in part by an individual’s challenges communicating and interacting socially with others. These difficulties have typically been studied in isolation by focusing on cognitive and behavioral differences in those with autism spectrum disorder, but little work has been done on how exchanges for autistic people unfold in the real world.

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Researchers at The University of Texas at Dallas recently turned the spotlight on social interaction in autism by examining it as a two-way street. Their results, published in December in the journal Autism, suggest that successful interactions for autistic adults revolve around partner compatibility and not just the skill set of either person.

“Most studies attempting to understand social disability in autism focus exclusively on individual characteristics,” said Dr. Noah Sasson, an associate professor in the School of Behavioral and Brain Sciences (BBS) and corresponding author of the study. “This presumes that any difficulties in social interaction are driven solely by the autistic person. But how each person influences and is influenced by the other is key to understanding affiliation and social quality.”

The study focused on the so-called “double-empathy problem,” which predicts that two people who are neurologically different and have distinct modes of communication and understanding may have trouble connecting with each other, as commonly occurs in interactions between autistic and non-autistic adults.

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“It’s not just that autistic adults can struggle to infer the thoughts and motivations of typically developing adults, which has been well documented; the reverse is true as well. Non-autistic people struggle to infer what autistic people are thinking,” Sasson said. “Anecdotally, many autistic people often report better quality of social interaction when engaging with other autistic people. We set out to test this empirically.”

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Kerrianne Morrison MS’16, PhD’19, the paper’s lead author, explained that the concept of a social-interaction difficulty being a two-sided, relational problem — and not simply a shortcoming of the autistic person — is only beginning to take hold.

“Autism is such a young field of study. Examining differences depending on the context of social situations rather than dysfunction across all contexts is starting to gain traction in academia,” she said. “We believe this represents a better understanding of how people with autism can thrive in the right contexts.”

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In the study, 125 adults held a five-minute, unstructured “getting-to-know-you” conversation with an unfamiliar person. Sixty-seven of the participants had been diagnosed with autism. Each participant then independently evaluated the quality of the interaction and their first impressions of their partner.

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Autistic adults were not rated as less intelligent, trustworthy or likable by either the autistic or typically developing cohort, and importantly, autistic participants’ interactions with other autistic adults were viewed by them as more favorable than those with typically developing partners.

“While typically developing participants preferred future interaction with other typically developing partners over autistic partners,” Sasson said, “autistic adults actually trended toward the opposite, preferring future interaction with other autistic adults. They also disclosed more about themselves to autistic partners and felt closer to their partners than did typically developing participants.”

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Autistic adults were rated as more awkward and less socially warm than typically developing adults by both autistic and typically developing partners. Some judgments were more favorable than those from Sasson’s previous studies in which people evaluated autistic adults in videos.

“Direct interaction seems to lessen some negative evaluations of autism,” Sasson said. “This aligns with previous work suggesting that direct experience and knowledge of autism can reduce stigma and promote inclusion.”

Typically developing participants also rated the conversational content with autistic and typically developing partners to be of similar quality. This shows that negative evaluations of autistic adults by non-autistic adults may be based more on social presentation differences and not their actual conversations.

“These findings suggest that social interaction difficulties in autism are not an absolute characteristic of the individual,” Sasson said. “Rather, social quality is a relational characteristic that depends upon the fit between the person and the social environment. If autistic people were inherently poor at social interaction, you’d expect an interaction between two autistic people to be even more of a struggle than between an autistic and non-autistic person. But that’s not what we found.”

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Sasson said that he hopes this work shows that studying actual social interaction elicits a deeper understanding than studying individual abilities alone.

“Social disability in autism is context-dependent and emerges more in interactions with typically developing partners,” he said. “This likely reflects a mismatch in cognitive and communication styles that may improve with increased familiarity and acceptance.”

Morrison believes that this research is illuminating a crucial portion of the story for the autistic community.

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“We’re moving beyond the existing research, which has fixated on social abilities in isolated, standardized contexts, and addressing this blind spot of real-world outcomes,” she said. “Particularly in adults, this is the information we need.”

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Other authors affiliated with the School of Behavioral and Brain Sciences include Dr. Robert Ackerman, associate professor of psychology; cognition and neuroscience doctoral student Kilee DeBrabander; and psychological sciences doctoral student Desi Jones. Daniel Faso PhD’16 is also an author.

The work was funded by the Texas Higher Education Coordinating Board’s Autism Grant Program and internal funding.

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Autism Diagnosis Test Needs Improvement

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Study finds inconsistencies in a broadly used autism test

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Rutgers researchers have found that a test widely used to diagnose whether children have autism is less reliable than previously assumed.

The study is published in the journal Neural Computation.

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The standardized test, known as the Autism Diagnostic Observation Schedule (ADOS), assesses communication skills, social interaction and play for children who may have autism or other developmental disorders.

The researchers digitized the test by attaching wearable technology, like an Apple Watch, to two clinicians and 52 children who came in four times and took two different versions of the test. 

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When researchers looked at the scores of the entire cohort, they found they did not distribute normally – which could mean a chance of false positives inflating the prevalence of autism, among other implications.

The results showed that switching clinicians may change a child’s scores and consequently influences the diagnosis. The researchers found similar results when they analyzed open-access data of 1,324 people ages 5 to 65, said Elizabeth Torres, associate professor of psychology in Rutgers’ School of Arts and Sciences, and director of The New Jersey Autism Center of Excellence.

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“The ADOS test informs and steers much of the science of autism, and it has done great work thus far,” said Torres, whose expertise has brought emerging computer science technology to autism. “However, social interactions are much too complex and fast to be captured by the naked eye, particularly when the grader is biased to look for specific signs and to expect specific behaviors.”

The researchers suggest combining clinical observations with data from wearable biosensors, such as smartwatches, smartphones and other off-the-shelf technology.

By doing so, they argue, researchers may make data collection less invasive, lower the rate of false positives by using empirically derived statistics rather than assumed models, shorten the time to diagnosis, and make diagnoses more reliable, and more objective for all clinicians.

Torres said autism researchers should aim for tests that capture the accelerated rate of change of neurodevelopment to help develop treatments that slow down the aging of the nervous system.

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“Autism affects one out of 34 children in New Jersey,” she said. “Reliance on observational tests that do not tackle the neurological conditions of the child from an early age could be dangerous. Clinical tests score a child based on expected aspects of behaviors. These data are useful, but subtle, spontaneous aspects of natural behaviors, which are more variable and less predictable, remain hidden. These hidden aspects of behavior may hold important keys for personalized treatments, like protecting nerve cells against damage, or impairment, which could delay or altogether stop progression.”

The study was co-authored by Richa Rai, a graduate student in psychology at Rutgers University, Sejal Mistry, a former Rutgers Biomathematics student now at the University of Utah Medical School, and Brenda Gupta from Montclair State University.

2 Million People With Heart Disease Have Used Marijuana

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Marijuana use is on the rise as more states legalize it for medicinal and recreational purposes, and physicians are fielding more questions about its safety.

Although smoking tobacco is responsible for approximately one in four deaths from cardiovascular disease, the effects of smoking marijuana on the heart are not fully understood. Some studies suggest that marijuana can trigger heart attacks and strokes in some users.

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Ersilia DeFilippis, MD, a second-year cardiology fellow at Columbia University Irving Medical Center and NewYork-Presbyterian, first became interested in marijuana’s effect on the heart a few years ago when studying heart attacks in people under 50. “We noted that 10% of patients in a registry of young heart attack patients had used marijuana and/or cocaine,” she says.

DeFilippis and colleagues recently reviewed the medical literature to find out what’s known about marijuana’s effect on the heart and what’s still unknown. Their full report was published Jan. 20 in the Journal of the American College of Cardiology.

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Here are five highlights from the review:

2 Million People with Heart Disease Have Used Marijuana

Marijuana is the most commonly used drug of abuse. It’s estimated that approximately 90 million American adults have used the drug at least once in their life, and more than 39 million have used the drug in the past year.

Based on responses to the National Health and Nutrition Examination Survey from 2016, DeFilippis and her colleagues estimate that about 2 million adults in the United States who have cardiovascular disease currently use marijuana or have used the drug in the past. 

“In addition to the 2 million marijuana users with diagnosed cardiovascular disease, many more may be at risk,” DeFilippis says. “With many adolescents and young adults turning to marijuana, it is important to understand the cardiovascular implications they may face years down the line.”

Marijuana’s Potency Today Is Higher

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The potency of marijuana—the percentage of THC contained in the plant—has steadily increased over the past 30 years, from about 4% in the mid-1990s to 12% in 2014. However, most scientific studies of cannabis tested products with THC levels between 1.5% and 4%.

“Higher potency may translate into greater effects on the conduction system, the vasculature, and the muscle of the heart,” DeFilippis says. “It also highlights the need for real-world data given the variety of marijuana products and formulations available for purchase.”

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THC is the most psychoactive chemical in marijuana, but marijuana also contains more than 100 compounds, called cannabinoids, that are chemically related to THC. 

Receptors for cannabinoids are highly concentrated in the nervous system but also can be found in blood cells, muscle cells, and other tissues and organs. 

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Cannabinoids Can Interact with Drugs Used to Treat Heart Disease

Cannabinoids inhibit certain enzymes in the body, which affects the metabolism of many drugs for heart disease, including antiarrhythmics, statins, calcium-channel blockers, beta blockers, and warfarin.

Researchers believe that cannabinoids may increase the activity of these prescribed drugs in the body, though limited data are available to guide physicians in adjusting dose to compensate for marijuana use.

Marijuana May Be Linked to Heart Attacks and Strokes

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Studies have identified marijuana smoking as a potential trigger of heart attacks, and marijuana use is not infrequently detected in adults who have experienced heart attacks at an early age (under 50).

A small experimental study found that smoking marijuana can bring on angina (chest pain) more quickly in patients with coronary heart disease compared with smoking a placebo.

Though current evidence for a link between marijuana and heart attacks is modest, it’s thought that smoking marijuana may increase cellular stress and inflammation, which are known to be precipitating factors for coronary artery disease and heart attacks.

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Cerebrovascular events, including strokes, also have been associated with marijuana use. It’s thought that marijuana may induce changes in the inner lining of blood vessels or alter blood flow.

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Physicians Should Screen for Marijuana Use

“Although we need more data, the evidence we do have indicates that marijuana use has been associated with coronary artery disease, arrhythmia, cardiomyopathy, and more,” DeFilippis says.

“Therefore, asking patients about marijuana use may help in risk assessment. In addition, we know that marijuana use affects the metabolism of many common cardiac drugs. In order to make sure patients are getting therapeutic doses without untoward side effects, it is important for cardiologists to talk to their patients about marijuana use. 

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The paper is titled, “Marijuana Use in Patients With Cardiovascular Disease,” and was published Jan. 20 in the Journal of the American College of Cardiology. 

The other authors are: Navkaranbir S. Bajaj (University of Alabama at Birmingham, Birmingham, Alabama), Amitoj Singh (University of Arizona), and Rhynn Malloy, Michael M. Givertz, Ron Blankstein, Deepak L. Bhatt, and Muthiah Vaduganathan (Brigham and Women’s Hospital and Harvard Medical School).

Ersilia DeFilippis reports no relationships relevant to the contents of this paper to disclose. (See paper for information on other authors). 

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Columbia University Irving Medical Center provides international leadership in basic, preclinical, and clinical research; medical and health sciences education; and patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the Vagelos College of Physicians and Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Columbia University Irving Medical Center is home to the largest medical research enterprise in New York City and State and one of the largest faculty medical practices in the Northeast. For more information, visit cuimc.columbia.edu or columbiadoctors.org.

Sleep-Deprived Due to the Super Bowl? 40% of U.S. Adults Usually Are

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Fun on Super Bowl Sunday can lead to a tired Monday for many. In a new survey from the American Academy of Sleep Medicine (AASM), nearly 40% of U.S. adults said they are more tired than usual the Monday after the Super Bowl. With pre-game entertainment, high-profile commercials, a star-studded halftime show and high-stakes football, the event can run well into the night.

“It’s easy to stay up too late after enjoying a night of football, food and friends,” said AASM President Dr. Kelly A. Carden. “To get the sleep you need after the Super Bowl, it is recommended that you plan ahead and prioritize your bedtime on Sunday night to avoid a tired day at work on Monday.”

The AASM provides the following tips for a post-Super Bowl sleep game plan:

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  • Avoid food and drinks after halftime. Eating heavy meals or foods that upset your stomach, and drinking caffeine or alcohol too close to bedtime, can negatively affect your sleep. If you’re hungry late at night, eat a light, healthy snack.
  • Shut off the TV and other electronic devices after the game. Avoid the temptation to engage in post-game commentary on social media. Instead, give yourself some time to unwind before going to bed.
  • Prioritize your bedtime. Most adults need at least seven hours of sleep to feel their best during the day. Make sure you get to bed at a reasonable hour to avoid feeling tired on Monday.

Devastating genetic disorder

Helping the world understand, detect and treat a devastating genetic disorder

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Fragile X syndrome may be a debilitating genetic neurodevelopmental disorder that affects people worldwide, but many doctors don’t know anything about it, including have the resources to properly diagnose or treat it.

The UC Davis MIND Institute is home to many of the world’s leading experts in fragile X syndrome and works globally to teach clinicians and families on the way to identify, test and supply look after those born with the disorder, often related to autism.

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This multimedia story documents one such outreach effort in Serbia and therefore the lives of the Cvijetic family and their look for help for his or her 6-year-old son, Demetrije. Diagnosed with fragile X syndrome through the efforts of a MIND Institute-trained physician, the affectionate boy has never attended school, cannot speak or feed himself with a spoon or fork. His parents desperately hope he can someday have a productive life.

MIND Institute experts in fragile X syndrome are available for media interviews about their international work and ongoing research. They include:

Randi Hagerman, a pediatrician and professor at UC Davis, and one among the world’s leading experts on fragile X syndrome and related conditions and their treatment.

Leonard Abbeduto, a psychologist and director of the UC Davis MIND Institute who is internationally renowned for his work on the event and use of language in individuals with intellectual disabilities, including those with fragile X syndrome.

David Hessl, a toddler psychotherapist and professor at UC Davis whose expertise include the cognitive, emotional and behavioral evaluation of youngsters with fragile X syndrome.

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The MIND Institute will next bring their expertise to Cartagena, Colombia for the Pan-American Conference of Neurodevelopment: Autism and Fragile X Syndrome, April 16-17 then to Quito, Ecuador for an additional conference April 20-21.

Signs of Autism

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Three Key Factors to assist Children Avoid Social Rejection Identified

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Neurobehavioral researchers at Rush University center have found three key factors during a child’s behavior which will cause social rejection. The studies are an important step in developing scientifically sound screening tests and treatment planning for social-emotional learning difficulties. The results from the studies are published within the Journal of Clinical Child and Adolescent Psychology.

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Findings from the pair of studies indicate that the power to select abreast of non-verbal cues and social cues in social interaction also as recognize the meaning and respond appropriately to them are key to helping children develop skills to take care of friendships and avoid a number of problems in later life.

A child who experiences social rejection is more likely to suffer from academic failure, drop out of faculty, experience depression or anxiety, and experiment with drugs.

“Children’s ability to develop positive peer relationships is critical to their well-being,” said Dr. Clark McKown, study PI and associate executive and director of research at the push Neurobehavioral Center. “Compared to children who are accepted by their peers, socially rejected children are at substantially elevated risk for later adjustment troubles.”

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Researchers observed two groups of youngsters. One was a random sample of 158 children within the Chicago establishment. the opposite group was a random sample of 126 clinic-referred children.

The studies indicate that some children have difficulty learning on non-verbal or social cues.

According to McKown, “They simply don’t notice the way someone’s shoulders slump with disappointment, or hear the change in someone’s voice once they are excited, or absorb whether a person’s face shows anger or sadness.”

A second major factor is that some children may devour on non-verbal or social cues, but lack the power to connect aiming to them. The third factor is that the ability to reason about social problems.

“Some children may notice social cues and understand what’s happening, but are unable to try to to the social problem solving to behave appropriately,” said McKown.

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A child who can absorb social cues, recognize their meaning and respond appropriately, and who is capable of “self- regulating,” or controlling behavior, is more likely to possess successful relationships.

“The number of youngsters who cannot negotiate of these steps, and who are in danger of social rejection, is startling,” said McKown.

Nearly 13 percent of the varsity age population, or roughly four million children nationwide, have social-emotional learning difficulties.

For some time, behavioral scientists have known the social costs related to this problem. Illinois is one among a couple of states which require school districts to assess and monitor the social-emotional learning needs of its students.

“Because it’s not known exactly which behaviors set a toddler up for failure, or the way to measure these skills, it had been difficult to supply support,” said McKown. “Now, it’ll be possible to pinpoint which abilities a toddler must develop and offer help.”

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According to researchers at Rush, the results of the studies could potentially help develop tests to assess for social-emotional learning that are easy to administer and scientifically sound.

The study was funded by the Dean and Rosemarie Buntrock Foundation and therefore the William T. Grant Foundation.

About Rush University center Rush University Medical Center is a tutorial center that encompasses the quite 600 staffed-bed hospital (including Rush Children’s Hospital), the Johnston R. Bowman clinic and Rush University. Rush University, with quite 1,730 students, is home to at least one of the primary medical schools within the Midwest, and one among the nation’s top-ranked nursing colleges. Rush University also offers graduate programs in allied health and therefore the basic sciences. Rush is noted for bringing together clinical care and research to deal with major health problems, including arthritis and orthopedic disorders, cancer, heart condition, mental disease, neurological disorders and diseases related to aging.

About Rush Neuro Behavioral Center Rush Neuro Behavioral Center (RNBC) serves the medical, psychological and academic needs of youngsters with neuro behavioral issues with a special emphasis on social-emotional learning disorders. .These children have difficulty focusing, forming relationships, regulating behavior, or functioning effectively due to differences within the way their brains receive, process, and manage verbal and nonverbal information. Through research, clinical practice, and education, RNBC seeks to reinforce the understanding of the requirements of these with neuro behavioral disorders, repose on their strengths, and help them achieve their full potential.

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Since 1997, RNBC has treated quite 10,000 children with such problems as Tourette’s Syndrome, Asperger’s Syndrome, autism spectrum disorders, attention deficit hyperactivity disorder, and language-based and non-verbal learning disabilities

Visit http://www.RNBC.org or call 847.933.9339 with any questions or additional information on RNBC services and research initiatives.

System Detects & Translates Sarcasm on Social Media

Technion student develops system that interprets sarcasm on Twitter, and translates it into sarcasm-free language

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Researchers in the Technion-Israel Institute of Technology Faculty of Industrial Engineering and Management have developed a system for interpreting sarcastic statements in social media. The system, developed by graduate student Lotam Peled, under the guidance of Assistant Professor Roi Reichart, is called Sarcasm SIGN (sarcasm Sentimental Interpretation GeNerator).

“There are a lot of systems designed to identify sarcasm, but this is the first that is able to interpret sarcasm in written text,” said Peled. “We hope in the future, it will help people with autism and Asperger’s, who have difficulty interpreting sarcasm, irony and humor.”

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Based on machine translation, the new system turns sarcastic sentences into honest (non-sarcastic) ones. It will, for example, turn a sarcastic sentence such as, “The new ‘Fast and Furious’ movie is awesome. #sarcasm” into the honest sentence, “The new Fast and Furious movie is terrible.”

Despite the vast development in this field, and the successes of sentiment analysis applications on “social media intelligence,” existing applications do not know how to interpret sarcasm, where the writer writes the opposite of what (s)he actually means.

In order to teach the system to produce accurate interpretations, the researchers compiled a database of 3,000 sarcastic tweets that were tagged with #sarcasm, where each tweet was interpreted into a non-sarcastic expression by five human experts. In addition, the system was trained to identify words with strong sarcastic sentiments – for example, the word “best” in the tweet, “best day ever” – and to replace them with strong words that reveal the true meaning of the text. The system was examined by a number of (human) judges, who gave its interpretations high scores of fluency and adequacy, agreeing that in most cases it produced a semantically and linguistically correct sentence.

Automatic identification and analysis of sentiment in text is a very complex challenge being explored by many researchers around the world because of its commercial potential and scientific importance. Sentiment identification could be used in social, commercial, and other applications to improve communication between people and computers, and between social media users.

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The Technion-Israel Institute of Technology is a major source of the innovation and brainpower that drives the Israeli economy, and a key to Israel’s renown as the world’s “Start-Up Nation.” Its three Nobel Prize winners exemplify academic excellence. Technion people, ideas and inventions make immeasurable contributions to the world including life-saving medicine, sustainable energy, computer science, water conservation and nanotechnology. The Joan and Irwin Jacobs Technion-Cornell Institute is a vital component of Cornell Tech, and a model for graduate applied science education that is expected to transform New York City’s economy.

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American Technion Society (ATS) donors provide critical support for the Technion—more than $2 billion since its inception in 1940. Based in New York City, the ATS and its network of supporters across the U.S. provide funds for scholarships, fellowships, faculty recruitment and chairs, research, buildings, laboratories, classrooms and dormitories, and more.

Levels of autism in China

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Joint Chinese-UK study shows Levels similar to the West

The first large-scale study of autism in China has revealed that around one in a hundred people in the country has an autism spectrum condition – the same figure as found in the West.

The research was carried out by an international team of researchers from the University of Cambridge, UK, and the China Disabled Persons’ Federation and Chinese University of Hong Kong. It is the result of an international partnership launched in 2013.

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Autism spectrum conditions – which include autism and Asperger’s syndrome – are characterised by impairments in social interaction and communication, alongside the presence of unusually repetitive behaviour and narrow interests, difficulties adjusting to unexpected change, and sensory hyper-sensitivity.

Autism was first described in Western cultures, and only later recognised in Asian countries. Around one in 100 school age children in the UK is autistic, but autism prevalence in China has been reported to be lower than in the West. The reasons for this difference are that most studies in China have only included the special school population, overlooking the mainstream school population; and that most studies in China have not used validated and reliable screening and diagnostic methods.

“Understanding the prevalence of autism is important because of its relevance to planning services to support those living with the condition, as well as their families,” said Professor Carol Brayne from the Cambridge Institute of Public Health.

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Professor Simon Baron-Cohen, Director of the Autism Research Centre in Cambridge (ARC) added: “We need to study autism outside Western populations, since most of the research to date has only been carried out in the West. This collaboration with colleagues in China is so valuable to help us understand what is universal and what is culture-specific in autism research.”

To address the gap in understanding autism in China, the researchers tested the total autism prevalence in mainstream and special schools in Jilin City, and mainstream school autism prevalence in Jiamusi and Shenzhen cities. They screened children aged 6 to 10?years old in the three cities using the Childhood Autism Screening Test (or CAST), a 37-item questionnaire, completed by parents, and developed and validated by the Cambridge team. The questionnaire gives a score of 0 to 31, and children scoring 15 or above were then given a clinical assessment. The results are published in the journal Molecular Autism.

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In Jilin City, from a total population of 7,258, the team identified 77 cases of autism, equating to a prevalence of 108 per 10,000, very similar to that found in the West.

In Shenzhen and Jiamusi cities, only data for children in mainstream education was available; in Shenzhen City, 42 out of every 10,000 children in mainstream education had autism, and in Jiamusi City this figure was 19 per 10,000. In all three cities, the researchers identified new cases of autism in mainstream schools, confirming that there is under-diagnosis of autism in China.

“Contrary to previous studies, we have shown that the prevalence of autism spectrum conditions in China is in line with that found in the West,” said Dr Sophia Xiang Sun, who conducted this study as part of her PhD at Cambridge University and who is now based in the Star Kay Bridge Research Centre for Children with Autism in Xiamen, China.

Professor Patrick Leung, from the Chinese University of Hong Kong, said: “Previous research into the autism spectrum in China has mainly focused on the most severe subtype, childhood autism. We have been able to use a standardised screening methodology, allowing us to compare the results with Western countries to show that autism occurs broadly at the same rate, irrespective of culture.”

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Dr Carrie Allison, from the Cambridge Autism Research Centre, commented: “Completing this study with colleagues in China has been nothing short of remarkable. It has involved translating Western autism screening instruments into Chinese, training Chinese clinicians in autism diagnosis, and working with national Chinese agencies, screening in three Chinese cities.”

Professor Fiona Matthews, the statistician on the Cambridge team and now based in Newcastle University, noted: “A strength of this study is the near universal response rate that is possible in China, which we rarely achieve in the West, making the epidemiology far more representative.”

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The research was funded by the Autism Research Trust, the NIHR CLAHRC for East of England, the Chinese University of Hong Kong (CUHK), and the Medical Research Council UK.

New Policy Reduces Anti-Psychotic Medications in Foster Children

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Texas strategy reduces prescriptions without compromising care, Rutgers study finds

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Rutgers researchers have found that a Texas strategy to reduce anti-psychotic medication for children can serve as a model for other state Medicaid programs.

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The study was published in the Journal of the American Academy of Child & Adolescent Psychiatry.

“Youth in the United States foster care system are about five times more likely to take antipsychotic medications, a class of medications to manage their mental and behavioral health, than children in the general public,” said Thomas Mackie, assistant professor at Rutgers School of Public Health. In response, over 31 state Medicaid programs nationally are experimenting with different oversight strategies to ensure safe and judicious use of antipsychotic medications. These Medicaid programs are challenged to address these concerns while also ensuring access to antipsychotic medications in cases where these medications are clinically optimal, especially for those youth with psychosis, autism and other U.S. Food and Drug Administration–approved clinical indications.

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An antipsychotic medication oversight strategy implemented in Texas included four elements: a mental health screening administered within 72 hours of the child being removed from the original caregiver; a health passport drawing on claims-based data; a psychiatric consultation line for child welfare staff, caregivers and judges; and a retrospective review of whether prescribed psychotropic medications met state best practice parameters after the antipsychotic medication was prescribed and dispensed.

The study, sought to examine whether the Texas program was effective in reducing the number of youth in foster care prescribed antipsychotic medications off-label to manage symptoms of conditions such as conduct disorders or attention hyperactivity disorders, while not decreasing use for disorders with FDA indications, such as bipolar disorder or autism spectrum disorders.

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After the strategy started, the Rutgers researchers found the program resulted in roughly a 5 percent to 8 percent reduction in antipsychotic use for youth treated off-label for conditions like conduct or attention hyperactivity disorders, whereas no significant changes were found for youth treated for FDA-indicated conditions.

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These findings show that the Texas program effectively reduced use of antipsychotic medications for off-label conditions where clinical concerns are greatest while not reducing antipsychotic medications for FDA-indicated conditions where stronger evidence exists for antipsychotic use among youth.

“Although the Texas model enrolled only youths in foster care, similar innovations are increasingly being extended to the general population of Medicaid-insured youth,” Mackie said.  “This study provides important new evidence suggesting that states continue to incorporate or renew the inclusion of these additional behavioral health services into Medicaid-managed care arrangements.”