Tag: children healty

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.

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.

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.

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.”

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.”

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.

Early Intervention in Autism Improves Language, IQ and Social Skills

Credit: UC Davis Health
Sally Rogers, PhD works with a child.

Breakthrough research demonstrating that children with autism as young as 18 months can vastly improve their language, cognition and social skills with an early intervention developed by UC Davis Professor Sally Rogers has been replicated in a major new study.

Rogers, a professor of Psychiatry and Behavioral Sciences at the MIND Institute, began work on a novel developmental approach to autism in Denver in 1981, and in partnership with her colleague and co-author Geraldine Dawson developed an approach to improving long-term outcomes for very young children. The Early Start Denver Model has since become a method used throughout the U.S. and around the world.

But until now ESDM had not been tested in the most rigorous fashion − a multi-site randomized trial, comparing the approach with community-based autism interventions. The study, which appears today in Journal of the American Academy of Child and Adolescent Psychiatry, began in 2007 at three university sites around the country. The new research replicates an ESDM study published in 2010. Rogers emphasized that replication studies are rare and costly but critical to validate novel scientific findings.

The new study found that children receiving intensive ESDM in their homes for an average of 15 hours per week made significantly greater language gains than did children in the community interventions, and this was true for both children with more severe delays and those with less.

In addition to validating the efficacy of ESDM for language development, the study also found that children receiving services in the community settings made large gains in several areas.

“The idea that little children with autism who are getting good treatment can make this much IQ and language gain means we should expect this from quality early-intervention experiences,” Rogers said. “These findings should raise families’ hopes a whole lot.”

Pioneering autism treatment was a new idea

What distinguishes ESDM from the more traditional, behavioral interventions used with children with autism is that it combines developmental and behavioral approaches and is carried out within in everyday routines. ESDM is built on moment-to-moment interactions that young children typically have with other people, especially their parents, and uses children’s interests and favorite activities to assure that social interaction is interesting and fun.

“Unlike other approaches popular at the time that the Denver Model began, we used a typical preschool physical environment and focused on the learning opportunities that existed in social interactions between children and adults to accelerate children’s development,” Rogers said. “This was a new idea at the time.”

In 2012, TIME magazine named ESDM one of the top 10 medical breakthroughs because their work demonstrated that brain function among young children with autism can normalize with effective early intervention in profound, enduring ways.

For the current study 118 children with autism, ages 14 months to two years, were enrolled and randomly assigned to either ESDM or community interventions for 27 months. Children assigned to ESDM intervention received three months of weekly parent coaching followed by 24 months of one-on-one treatment about 15 hours per week in homes or daycare settings from supervised therapy assistants. Parents received coaching four hours monthly from a certified ESDM therapist. In the community setting, hours of treatment varied by site.

What researchers found was that at two of the three sites, children receiving ESDM had significantly more language improvement than the children in the community interventions, and there was no significant difference in language gain at the third site between the two modalities. When results from all three sites were pooled, there was a significant advantage for the children in the ESDM group overall.

“Language is the bridge to learning,” Rogers said. “Language is the door that opens up social communication and education and interactions with people in your community. It’s how you share with people. It’s a main vehicle for social interaction once you pass infancy.”

Autism treatment in the community greatly improved over time

 The study also found that in terms of cognition and social skills, both the ESDM and community treatment groups made significant gains. Fortunately, Rogers said, laws requiring insurance coverage for early autism intervention and new knowledge about effective treatment have greatly improved community options for families seeking help for young children diagnosed with autism.

Rogers said families with a child diagnosed with autism should take some comfort knowing that the early treatments now widely available do make a difference.

“It says the autism scores at the time of diagnosis are just a starting point,” she said. “It says that the developmental paths and learning capacity of young children with autism are more plastic than we knew, and there are many ways to get learning opportunities to them.”

In addition to Rogers, UC Davis authors on the study were Marie Rocha, Laurie Vismara and Meagan Talbott. Other co-authors on the study included: Annette Estes and Jessica Greenson of the University of Washington; Catherine Lord and Jamie Winter of Weill Cornell Medicine, Cornell University; Costanza Colombi of University of Michigan; Geraldine Dawson of Duke University, and Gerhard Hellemann of UCLA.

This study was supported by individual Autism Speaks grants to Annette Estes and to Sally Rogers and by NIMH/NICHD award number R01 081757 as part of the Autism Centers of Excellence (ACE) Treatment Network, clinicaltrials.gov identifier NCT 00698997.

“Could My Child Have Autism?”

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Ten Signs of Possible Autism-Related Delays in 6- to 12-Month-Old Children

Though autism is often not diagnosed until the age of three, some children begin to show signs of developmental delay before they turn a year old. While not all infants and toddlers with delays will develop autism spectrum disorders (ASD), experts point to early detection of these signs as key to capitalizing on early diagnosis and intervention, which is believed to improve developmental outcomes.

According to Dr. Rebecca Landa, director of the Center for Autism and Related Disorders at the Kennedy Krieger Institute in Baltimore, Md., parents need to be empowered to identify the warning signs of ASD and other communication delays. “We want to encourage parents to become good observers of their children’s development so that they can see the earliest indicators of delays in a baby’s communication, social and motor skills,” says Dr. Landa, who also cautions that some children who develop ASD don’t show signs until after the second birthday or regress after appearing to develop typically.

For the past decade, Dr. Landa has followed infant siblings of children with autism to identify red flags of the disorder in their earliest form. Her research has shown that diagnosis is possible in some children as young as 14 months and sparked the development of early intervention models that have been shown to improve outcomes for toddlers showing signs of ASD as young as one and two years old. Dr. Landa recommends that as parents play with their infant (6 – 12 months), they look for the following signs that have been linked to later diagnosis of ASD or other communication disorders: 1. Rarely smiles when approached by caregivers2. Rarely tries to imitate sounds and movements others make, such as smiling and laughing, during simple social exchanges3. Delayed or infrequent babbling4. Does not respond to his or her name with increasing consistency from 6 – 12 months 5. Does not gesture to communicate by 10 months6. Poor eye contact7. Seeks your attention infrequently8. Repeatedly stiffens arms, hands, legs or displays unusual body movements such as rotating the hands on the wrists, uncommon postures or other repetitive behaviors9. Does not reach up toward you when you reach to pick him or her up10. Delays in motor development, including delayed rolling over, pushing up and crawling

“If parents suspect something is wrong with their child’s development, or that their child is losing skills, they should talk to their pediatrician or another developmental expert,” says Dr. Landa. “Don’t adopt a ‘wait and see’ perspective. We want to identify delays early in development so that intervention can begin when children’s brains are more malleable and still developing their circuitry.”

About the Kennedy Krieger Institute Internationally recognized for improving the lives of children and adolescents with disorders and injuries of the brain and spinal cord, the Kennedy Krieger Institute in Baltimore, MD serves more than 16,000 individuals each year through inpatient and outpatient clinics, home and community services and school-based programs. Kennedy Krieger provides a wide range of services for children with developmental concerns mild to severe, and is home to a team of investigators who are contributing to the understanding of how disorders develop while pioneering new interventions and earlier diagnosis. For more information on Kennedy Krieger Institute, visit: www.kennedykrieger.org.

Autism and Divorce

Study Details Autism’s Heavy Toll Beyond Childhood on Marriages

Photo by Eric Ward

The parents of grown children with autism are more likely to divorce than couples with typically developing children, according to new data from a large longitudinal study of families of adolescents and adults with autism.The study, published in the August issue of the Journal of Family Psychology by researchers from the University of Wisconsin-Madison’s Waisman Center, paints a new picture of the prospects of long-term marital success for parents raising a child with autism.

The study is the first to track marital history of parents of adult children with autism. It reveals that, in contrast to previous assumptions, parents do not have a greater risk of divorce when their son or daughter with autism is young.

However, as the child with autism grows into adolescence and adulthood, parents are more likely to divorce than are parents of typically developing children. Although findings reveal diminished prospects for a lasting marriage for parents raising a child with autism, the majority of marriages in this study survived. The study compared the marital fates of 391 couples — the parents of adolescent and adult children with autism — to a sample drawn from another large longitudinal study, the National Survey of Midlife in the United States (MIDUS). The goal of the study was to document the rate and timing of divorce of parents of children with autism, explains Sigan Hartley, a UW-Madison assistant professor of human development and family studies and lead author of the report.

The study revealed that the divorce rate for parents of children with autism mirrors the divorce rate of the parents of children without disabilities until the child reaches 8 years of age. After that, the divorce rate goes down for parents of children without disabilities but remains high for parents of children with autism.“There seems to be a prolonged vulnerability for divorce in parents of children with autism,” says Hartley. “Typically, if couples can survive the early child-rearing years, parenting demands decrease and there is often less strain on the marriage. However, parents of children with autism often continue to live with and experience high parenting demands into their child’s adulthood, and thus marital strain may remain high in these later years.”

Autism, also known as autism spectrum disorder or ASD, has symptoms that vary considerably in severity between individuals, but core characteristics of the disorder include difficulty establishing and maintaining social relationships, delayed communication skills, and repetitive motions such as rocking back and forth and hand flapping. Children with autism frequently require high levels of care and continue to live with parents as adults.

“There is a lifelong profile of challenging behaviors and symptoms associated with autism,” Hartley notes. “Few developmental disabilities appear to be more taxing on parents and there is a great need for support services for families when the child is an adolescent and adult. Providing support for couples to help them work on their marriages is an obvious step. If we can get information and support to these families, we hope to be able to support lasting marriages.”

The new study compares data from two large longitudinal studies, the Adolescents and Adults with Autism Study, directed by Marsha Mailick Seltzer, a UW-Madison professor of social work and director of the Waisman Center, and MIDUS, directed by UW-Madison psychology professor Carol Ryff. Both studies are funded by the U.S. National Institutes of Health.

Protecting kids from risky drinking

Alcoholism: Clinical & Experimental Research

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Many parents permit their adolescent children to drink alcohol, believing this helps teach them responsible use and avoids the appeal of ‘forbidden fruit’. In research studies, greater parental permissibility for alcohol has been linked to earlier and heavier drinking in adolescence. However, it is not clear whether parents allowing adolescents to drink is itself to blame, or if this kind of permissibility is simply a marker for other factors (relating to the family, parents or child) that increase the risk of problem alcohol use among adolescents. For example, parents’ own heavy drinking, family sociodemographics, and adolescents’ friends’ use of alcohol can all affect the likelihood of alcohol misuse among adolescents, and each of these risk factors might also be underlying causes of parents allowing drinking. In a new report published in the journal Alcoholism: Clinical & Experimental Research, researchers from Pennsylvania State University have used intergenerational data from a contemporary UK study to examine whether parents allowing adolescents to drink is itself associated with risky drinking in adolescence, beyond other such risk factors.

The Millennium Cohort Study (MCS) has collected data from over eleven thousand parents and children from infancy through to 14 years, using regular interviews. Children were asked questions about their alcohol use when they were aged 11 and 14 years; the data showed that by age 14, half had drunk more than a few sips of alcohol, around 10% had drunk heavily, and 3% had drunk heavily at least 3 times in the past year. Seven percent had made a rapid transition to heavy drinking, defined as escalating to having at least five drinks at a time, within a year of having their first drink.  

Parents of 14-year olds were asked if they permitted their child to use alcohol, with about 16% of parents indicating that they did allow this. Using a series of statistical analyses, the researchers found that these teenagers faced an elevated risk of heavy alcohol use at age 14, even after accounting for a large host of other risk factors measured earlier when children were age 11. Specifically, children who were permitted to drink alcohol had over twice the odds of engaging in heavy or frequent heavy drinking by age 14, and almost double the risk of a rapid transition to heavy drinking, than those whose parents did not permit alcohol use.

These findings do not support the idea that allowing children to drink alcohol inoculates them against alcohol misuse, and will help to target prevention and screening efforts to reduce underage drinking. However, the researchers note that because adolescent heavy drinking and parental permissiveness about alcohol were measured at the same point in the survey (at around age 14), the findings represent an association rather than cause and effect; further research will be needed to establish whether parental permissiveness leads to adolescent heavy drinking, or whether adolescent drinking over time leads parents to become more permissive.

Parents Allowing Drinking is Associated with Adolescents’ Heavy Alcohol Use. J. Staff, J. Maggs (pages xxx).

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