Tag: kids

A super tool helps kids with autism improve socialization skills

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A team of NIH-funded researchers at Stanford University Medical School has found that children with autism improved measurably on a test of socialization and learning when their therapy included an at-home intervention with Google Glass. Google Glass is a headset worn like eyeglasses that provides augmented reality on a miniature screen, with sound. The smart system of eye wear and mobile-phone-based games helped the children with autism understand emotions conveyed in facial expressions.

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Autism is a complex neurological and developmental spectrum disorder that affects how children interact with others, communicate, and learn. Many children affected by autism spectrum disorder (ASD) are unable to discern facial expressions, so miss out on important cues that aid in learning and socialization.

The Stanford team, led by Dennis P. Wall, Ph.D., associate professor of Pediatrics, Psychiatry and Biomedical Data Sciences, used Google Glass’s built-in camera along with software customized to run on a smart phone as an intervention that care givers used with their children at home to supplement clinic-based therapy.  The study was published March 25, 2019, in JAMA Pediatrics.

“Technology can be a terrific asset to the therapy process, for both physical and neurodevelopmental gains,” said Tiffani Lash, Ph.D., director of the NIBIB programs in Connected Health (mHealth and Telehealth), and Point-of-Care Technologies. “This is a heartwarming achievement and a promising example using a bioengineering approach. The innovative software and hardware solution coupled with the therapeutic component meets a dire need for many children and their parents.”

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Google Glass is lens-less, non-invasive, and peripheral—sitting off to the right side of view for the child. “The system acts as a true augmentation to their reality, keeping them in their natural social world, as opposed to taking them out of it,” Wall said. “In contrast to virtual or mixed reality, augmented reality is potentially a powerful vehicle through which we can teach children social skills to rescue some of these deficits early in their development.”

A camera in the device captures the facial expression of family members in the glasses’ field of view, reinforcing what the child sees by providing an image and audio prompt. It detects up to eight emotions: happy, sad, angry, scared, surprised, disgusted, “meh,” and neutral. The glasses are wirelessly connected to a smartphone device that may be operated in three different play modes. There is ‘find the smile’ game, where the child is prompted to say something that prompts an expression in the family member’s face; the ‘guess the emotion’ game, where the family member asks the child to guess the emotion from the family member’s face; and free play, an unstructured mode of identifying facial expressions.

The device also records a video that parents can observe at a later time to monitor the progress that their child makes with the activities. “Our hope was that the video playback would be a good source of reinforcement learning with the children,” Wall said. “It provides the opportunity for the learner to focus in on certain human emotions that they may or may not be getting right, so they might become more adept at detecting those emotions in real time.”

The researchers recruited 71 children between the ages of six and 12 who all had been enrolled in a program of applied behavioral analysis therapy—the standard care for most children with ASD. Experts recommend 20 hours per week of the standard therapy, in which the child interacts with a therapist who leads learning activities to improve social, motor, and verbal behaviors, as well as reasoning skills through observation and positive reinforcement. The authors cite the current cost for this standard therapy to be between $40,000 and $60,000 per year, noting that parents can often wait up to 18 months for their child to gain access to the therapy.

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Experts suggest that it is important for children with ASD to receive a diagnosis early—which can be assessed by the age of two—so that children can begin treatment as early as possible. According to the authors, learning aids such as the type tested in the study could begin to address this difficult challenge of accessing therapy more immediately, outside the clinic.

Of the 71 enrolled in the study, 40 children also received the augmented reality device to play the programmed games or freely play during 20-minutes sessions, four times per week. After six weeks, the team assessed all 71 children on a standard socialization scale.

The researchers found that children receiving the smart-glasses intervention along with standard therapy scored significantly better in the post-study assessment than those in the control group. Children who used the smart glasses improved 4.58 points on the standard scale above those who did not use the Google Glass intervention. Authors unrelated to the work by Wall and colleagues recently published in Autism Research that changes of 2 to 3.75 points on the scale represent a clinically important difference.

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“This is based on a statistically rigorous approach to the analysis of the data,” Wall said. “We should be excited about the result. While the overall effect is modest, the positive change seen in the treated children is significant and points to a new direction that could help more children get the care they need, when they need it.”

Wall noted that the device represents a short-term learning aid and predicts that in the not-too-distant-future there will be a wider array of available augmented reality wearables. “After a period of time, they take the glasses off and they grow on their own into more complex social scenarios.”

Though a playful intervention, families in the treatment group missed a portion of the prescribed hours in which to practice with Google Glass, and most preferred the structured games over the unstructured free-play option. But the activity was positively received to the point that children who participated in the study created a new name for the tool, calling it Superpower Glass, a moniker the authors adopted in writing their report on the study. The researchers have begun to plan for a larger, follow up study.

For more about autism spectrum disorder, go to: https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/in…

The research was conducted with support from NIBIB (EB025025) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD091500), both at NIH.

The study: Effect of Wearable Digital Intervention for Improving Socialization in Children With Autism Spectrum Disorder: A Randomized Clinical Trial. Voss C, Schwartz J, Daniels J, Kline A, Haber N, Washington P, Tariq Q, Robinson TN, Desai M, Phillips JM, Feinstein C, Winograd T, Wall DP. JAMA Pediatrics. 2019 Mar 25

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Jurassic fossil

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Discovery of a new fossil in China sheds light on when early mammal ancestors first evolved sophisticated thyroid bones that gave them the ability to swallow food like modern-day mammals.

The 165-million-year-old fossil of Microdocodongracilis, a tiny, shrew-like animal, shows the earliest example of modern hyoid bones in mammal evolution The hyoid bones link the back of the mouth, or pharynx, to the openings of the esophagus and the larynx. The hyoids of modern mammals, including humans, are arranged in a “U” shape, similar to the saddle seat of children’s swing, suspended by jointed segments from the skull. It helps us transport and swallow chewed food and liquid – a crucial function on which our livelihood depends.

Mammals as a whole are far more sophisticated than other living vertebrates in chewing up food and swallowing itone small lump at a time, instead of gulping down huge bites or whole prey like an alligator.

“Mammals have become so diverse today through the evolution of diverse ways to chew their food, weather it is insects, worms, meat, or plants. But no matter how differently mammals can chew, they all have to swallow in the same way,” said Zhe-Xi Luo, PhD, a professor of organismal biology and anatomy at the University of Chicago and the senior author of a new study of the fossil, published this week in Science.

“Essentially, the specialized way for mammals to chew and then swallow is all made possible by the agile hyoid bones at the back of the throat,” Luo said.

‘A pristine, beautiful fossil’

This modern hyoid apparatus is mobile and allows the throat muscles to control the intricate functions to transport and swallow chewed food or drink fluids. Other vertebrates also have hyoid bones, but their hyoids are simple and rod-like, without mobile joints between segments. They can only swallow food whole or in large chunks.

When and how this unique hyoid structure first appeared in mammals, however, has long been in question among paleontologists. In 2014, Chang-Fu Zhou, PhD, from the Paleontological Museum of Liaoning in China, the lead author of the new study, found a new fossil of Microdocodon preserved with delicate hyoid bones in the famous Jurassic Daohugou site of northeastern China.Soon afterwards, Luo and Thomas Martin from the University of Bonn, Germany, met up with Zhou in China to study the fossil.

“It is a pristine, beautiful fossil. I was amazed by the exquisite preservation of this tiny fossil at the first sight. We got a sense that it was unusual, but we were puzzled about what was unusual about it,”Luo said. “After taking detailed photographs and examining the fossil under a microscope, it dawned on us that this Jurassic animal has tiny hyoid bones much like those of modern mammals.”

This new insight gave Luo and his colleagues added context on how to study the new fossil. Microdocodonis a docodont, from an extinct lineage of near relatives of mammals from the Mesozoic Era called mammaliaforms. Previously, paleontologists anticipated that hyoids like this had to be there in all of these early mammals, but it was difficult to identify the delicate bones.  After finding them in Microdocodon, Luo and his collaborators have since found similar fossilized hyoid structures in other Mesozoic mammals.

“Now we are able for the first time to address how the crucial function for swallowing evolved among early mammals from the fossil record,” Luo said. “The tiny hyoids of Microdocodonare a big milestone for interpreting the evolution of mammalian feeding function.”

New insights on mammal evolution as a whole

Luo also worked with postdoctoral scholar Bhart-Anjan Bhullar, PhD, now on the faculty at Yale University, and April Neander, a scientific artist and expert on CT visualization of fossils at UChicago, to study casts of Microdocodonand reconstruct how it lived.

The jaw and middle ear of modern mammals are developed from (or around) the first pharyngeal arch, structures in a vertebrate embryo that develop into other recognizable bones and tissues. Meanwhile, the hyoids are developed separately from the second and the third pharyngeal arches. Microdocodonhas a primitive middle ear still attached to the jaw like that of other early mammals like cynodonts, which is unlike the ear of modern mammals. Yet its hyoids are already like those of modern mammals.

“Hyoids and ear bones are all derivatives of the primordial vertebrate mouth and gill skeleton, with which our earliest fishlike ancestors fed and respired,” Bhullar said. “The jointed, mobile hyoid of Microdocodoncoexists with an archaic middle ear — still attached to the lower jaw. Therefore, the building of the modern mammal entailed serial repurposing of a truly ancient system.”

The tiny, shrew-like creature likely weighed only 5 to 9 grams, with a slender body, and an exceptionally long tail. The dimensions of its limb bonesmatch up with those of modern tree-dwellers.

“Its limb bones are as thin as matchsticks, and yet this tiny Mesozoic mammal still lived an active life in trees,” Neander said.

The fossil beds that yielded Microdocodonare dated 164 to 166 million years old. Microdocodonco-existed with other docodonts like the semiaquatic Castorocauda, the subterranean Docofossor, the tree-dwellingAgilodocodon, as well as some mammaliaform gliders.

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The study, “New Jurassic mammaliaform sheds light on early evolution of mammal-like hyoid bones,” was published in Scienceon July 19, 2019. The research was supported by the University of Chicago Division of Biological Sciences (Luo); the Deutsche Forschungsgemeinschaft (Martin); and the National Natural Science Foundation and Ministry of Land Resources of China, Shenyang Normal University, and Shandong University of Science and Technology (Zhou).

Autism Study Stresses Importance of Communicating with All Infants

Photo by Zoltan Tasi

Language Skills Can Benefit from Parents’ Early Support, Interactions.

University of Texas at Dallas

Dr. Meghan Swanson, assistant professor at The University of Texas at Dallas, is the corresponding author of the study, published online June 28 in Autism Research. It is the first to extend research about the relationship between caregiver speech and infant language development from typically developing children to those with autism. The findings could inform guidelines for earlier action in cases of developmental difficulties.

A new language-skills study that included infants later diagnosed with autism suggests that all children can benefit from exposure to more speech from their caregivers.

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“You can diagnose autism at 24 months at the earliest; most people are diagnosed much later. Early intervention, from birth to age 3, has shown to be effective at supporting development in various cohorts of children,” said Swanson, who joined the School of Behavioral and Brain Sciences in January as the director of the Infant Neurodevelopment & Language Research Lab, known as the Baby Brain Lab.

She said there has been a push to identify autism earlier or demonstrate that the same techniques that help most children develop language skills also benefit those eventually diagnosed with autism.

The study involved 96 babies, 60 of whom had an older sibling with autism. Swanson said that this “baby-sibling” research design was necessary.

“How do you study autism in infancy when you can’t diagnose it until the kids are age 2 at least?” she asked. “The answer relies on the fact that autism tends to run in families. These younger siblings have about a 20% chance of being diagnosed eventually with autism.”

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Indeed, 14 children from the high-risk subset of 60 were diagnosed with autism at 24 months.

The study results directly tied the number of words an infant hears, as well as the conversational turns he or she takes, to the performance on the 24-month language evaluation — both for typical children and those with autism.

“One conclusion we’ve come to is that parents should be persistent in talking with their babies even if they aren’t getting responses,” Swanson said.

Swanson emphasized how important large, longitudinal studies — tracking the same individuals across an extended period — like this one are in her field.

“You have to follow the same children for years to learn anything conclusive about development,” she said. “You can’t simply shift from a group of 2-year-olds to a different group of 3-year-olds and so on.”

Correcting the misunderstanding of parents’ influence in autism has been a gradual fight against outdated conceptions, Swanson said.

“When parents receive an autism diagnosis for a child, some might wonder, ‘What could I have done differently?’” she said. “There is no scientific backing for them to think in these terms. But there is a dark history in autism where parents were wrongly blamed, which reinforced these thoughts. To do research involving mothers as we have, you must approach that topic with sensitivity but also firmly reinforce that the logic that parenting style can cause autism is flawed.”

The children’s interactions with caregivers were recorded over two days — once at nine months and again at 15 months — via a LENA (Language Environment Analysis) audio recorder. The children’s language skills were then assessed at 24 months.

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“The LENA software counts conversational turns anytime an adult vocalizes and the infant responds, or vice versa,” Swanson said. “The definition is not related to the content of the speech, just that the conversation partner responds. We believe that responding to infants when they talk supports infant development, regardless of eventual autism diagnosis.”

The project was undertaken by the Infant Brain Imaging Study (IBIS) network, a consortium of eight universities in the United States and Canada funded by the National Institutes of Health as an Autism Center of Excellence. Before joining UT Dallas, Swanson was a postdoctoral fellow at the University of North Carolina at Chapel Hill, one of IBIS’ study sites. The other study sites are Children’s Hospital of Philadelphia, Washington University in St. Louis, the University of Washington in Seattle and the University of Minnesota Twin Cities campus.

Dr. Joseph Piven, the IBIS network’s principal investigator, is the director of the Carolina Institute for Developmental Disabilities at UNC-Chapel Hill. For parents, the results should highlight the long-term effect of initiating conversations from an early age, he said.

“Talking to your kids makes a big difference,” Piven said. “Any impact on early language skills will almost certainly have an impact on a wide range of later abilities in school-age children and significantly enhance their probability of success.”

Swanson said the most important takeaway from this work is that parents can make a significant difference in language development, even in children who are eventually diagnosed with autism.

“Parents can be amazing agents of change in their infants’ lives from as early as 9 months old,” she said. “If we teach parents how to provide their children with a rich communication environment, it helps support their children’s development. I find that incredibly hopeful — the power that parents have to be these positive role models.”

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In addition to UT Dallas and the IBIS study sites, researchers from Temple University, Perelman School of Medicine at the University of Pennsylvania, McGill University and the University of Alberta contributed to this study. The Simons Foundation also supported the research.

Autism rates increasing fastest among black and Hispanic children

Autism rates among racial minorities in the United States have increased by double digits in recent years, with black rates now exceeding those of whites in most states and Hispanic rates growing faster than any other group, according to new University of Colorado Boulder research.

The study, published this month in the Journal of Autism and Developmental Disorders, also found that prevalence of autism among white youth is ticking up again, after flattening in the mid-2000s.

While some of the increase is due to more awareness and greater detection of the disorder among minority populations, other environmental factors are likely at play, the authors conclude.

“We found that rates among blacks and Hispanics are not only catching up to those of whites — which have historically been higher — but surpassing them,” said lead author Cynthia Nevison, an atmospheric research scientist with the Institute of Arctic and Alpine Research. “These results suggest that additional factors beyond just catch-up may be involved.”

For the study, Nevison teamed up with co-author Walter Zahorodny, an autism researcher and associate professor of pediatrics at Rutgers New Jersey Medical School, to analyze the most recent data available from the Individuals with Disabilities Education Act (IDEA) and the Autism and Developmental Disabilities Monitoring (ADDM) Network.

IDEA tracks prevalence, including information on race, among 3-to-5-year-olds across all 50 states annually. ADDM tracks prevalence among 8-year-olds in 11 states every two years.

The new study found that between birth year 2007 and 2013, autism rates among Hispanics age 3-5 rose 73%, while rates among blacks that age rose 44% and rates among whites rose 25%.

In 30 states, prevalence among blacks was higher than among whites by 2012.

In states with “high prevalence,” 1 in 79 whites, 1 in 68 blacks and 1 in 83 Hispanics born in 2013 have been diagnosed with autism by age 3-5.

Other states like Colorado fell in a “low-prevalence” category, but the authors cautioned that differences between states likely reflect differences in how well cases are reported by age 3-5. They also said the real prevalence is substantially higher, as many children are not diagnosed until later in life.

“There is no doubt that autism prevalence has increased significantly over the past 10 to 20 years, and based on what we have seen from this larger, more recent dataset it will continue to increase among all race and ethnicity groups in the coming years,” said Zahorodny.

In 2018, the Centers for Disease Control reported that about 1 in 59 children of all races have been diagnosed with autism and that rates had risen 15 percent overall from the previous two year period, largely due to better outreach and diagnosis among historically underdiagnosed minority populations. The new study challenges that explanation.

“Our data contradict the assertion that these increases are mainly due to better awareness among minority children,” said Zahorodny. “If the minority rates are exceeding the white rates that implies some difference in risk factor, either greater exposure to something in the environment or another trigger.”

Established risk factors associated with autism include advanced parental age, challenges to the immune system during pregnancy, genetic mutations, premature birth and being a twin or multiple.

The authors said that, based on current research, they cannot pinpoint what other environmental exposures might be factoring into the increases in autism. But they would like to see more research done in the field.