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Archive for April, 2010

Autism in the News – Wednesday, 04.28.10

Missing autistic man found unharmed (North Port, Fla.)
An autistic North Port man reported as missing Monday has been found safe and unharmed, police said. Read more.

AstraZeneca Reaches $520 Million Settlement (CBSNews.com)
Today, the federal government announced a $520 million dollar settlement with AstraZeneca in a case that accused the pharmaceutical company of promoting an antipsychotic drug for unapproved uses. Read more.

Jury acquits Saginaw man charged with sexually assaulting student with autism (Saginaw, Mich.)
To this day, Todd L. Pesta says, he doesn’t know if he touched a female student’s breasts as he tried to escort her to lunch in October 2008 at the Millet Learning Center in Bridgeport Township. Read more.

Cuts mean fewer hours for disabled (Montgomery County, Md.)

Roger Pollin has worked as a custodian at the Potomac Library since 1992. As an adult with autism, the work helps keep him busy and fulfilled, his job coach Justina Nelson said. Read more.

Fighting to bring out his best Gloves are on against autism (Canada)
Colton Tomchuk is a 12-year-old boy with the heart of a champion. Read more.

New Autism Clinic Opens in Dubuque (Dubuque, Iowa)
A new center in Dubuque aims to improve the lives of people living with autism. Read more.

Autistic Gray man, 22, killed by his father (Gray, Maine)

A father shot and killed his autistic son Tuesday at their home on Yarmouth Road before turning the rifle on himself, Maine State Police said. Read more.

Jury gets murder case against ex-Lincoln-Sudbury student (Woburn, Mass.)
A Middlesex Superior Court jury yesterday began deliberating the fate of a teenager who was described as both a methodic murderer and a student whose mental sickness drove him to kill, punctuating a high-profile three-week trial that raised questions about the treatment of mental illness in schools and in the courts. Read more.

In Memoriam: Dr. Stanley Greenspan

April 28, 2010 7 comments

Stanley I. Greenspan, M.D., the world’s foremost authority on clinical work with infants and young children with developmental and emotional problems, passed away on April 27, 2010.

Dr. Greenspan was Clinical Professor of Psychiatry and Pediatrics at George Washington University Medical School and Chairman of the Interdisciplinary Council on Developmental and Learning Disorders. The world’s foremost authority on clinical work with infants and young children with developmental and emotional problems, his work has guided parents, professionals and researchers all over the world.

Memorial contributions may be made to the Stanley Greenspan Memorial Scholarship fund, established by the Greenspan family to support future leaders in the field of infant mental health and developmental disorders, currently enrolled or applying to the ICDL Graduate School. Applications for this scholarship will be made available online soon.

We sincerely thank Dr. Greenspan for all of his contributions to the autism community.

Source: http://stanleygreenspan.com/

Did You See “Frontline” Last Night?

April 28, 2010 14 comments

Did you see “Frontline” last night? Their special, The Vaccine War aired on PBS at 9 p.m. If you missed it, you can catch it online here, and join in the “Frontline” discussion here.

To learn more about Autism Speaks’ position on vaccines, please read our policy statement and an interview with our chief science officer, Geraldine Dawson, Ph.D.

Autism Speaks recently awarded 16 new autism research grants, totaling over five million dollars. You can learn more about them here.

Advocates and Health Experts Meet to Discuss Vaccine Safety System

On April 11-13, 2010, over 30 individuals from a range of sectors and perspectives met in Salt Lake City to provide thoughtful input on the enhancement of the national vaccine safety system. Named the “Salt Lake City Writing Group”, the meeting was convened by the Vaccine Safety Working Group (VSWG) of the National Vaccine Advisory Committee (NVAC). Invited attendees included Peter Bell, Autism Speaks’ executive vice president of programs and services, and Sallie Bernard, Autism Speaks board member and Executive Director of SafeMinds. For the purposes of this meeting, participants were asked to bring their experience and expertise to bear on this issue, but were not asked or expected to represent the official views of their organizations of affiliation.

The NVAC advises the U.S. Department of Health and Human Services (HHS) on issues of vaccine policy. In 2008, NVAC formed a Vaccine Safety Working Group (VSWG) with two charges: first, to review and provide comment on the Centers for Disease Control’s Immunization Safety Office’s draft Scientific Agenda; second, to review the current federal vaccine safety system. Specific to the second task, the VSWG is charged with developing a White Paper (for consideration and possible adoption by the NVAC) describing the infrastructure needs for a federal vaccine safety system.

As part of these efforts, NVAC committed to meaningful public and stakeholder engagement. For the VSWG’s second charge, that process includes both the recently concluded meeting in Salt Lake City and a meeting of a broader group of stakeholders is expected to take place in Summer 2010 in Washington, D.C.

The accompanying memorandum from the Writing Group provides some highlights of the discussion that took place on April 11-13.

Autism in the News – Tuesday, 04.27.10

Help sought locating missing man with autism (Venice, Fla.)
The Sarasota County Sheriff’s Office is asking for the public’s help in locating a missing man who suffers from autism. Read more.

Measured doses of fact, friction in ‘Vaccine War’ (Boston.com)
There are no bad guys in “The Vaccine War,’’ no hiss-worthy villains who make it easy to decide which side we’re on. Read more.

Psychiatrist says Odgren not delusional (Woburn, Mass.)
After weeks of gruesome testimony and assertions of insanity, a state-certified psychiatrist told jurors yesterday that John Odgren was well aware of his actions and the consequences when he fatally stabbed a fellow student in the boys bathroom at Lincoln-Sudbury Regional High School three years ago. Read more.

Student fights to overcome autism (The Rocky Mountain Collegian)
By all appearances, Patrick McCaffrey seems like your average CSU student. He has a girlfriend, is a freshman having fun in the dorms and is adjusting to college life. Read more.

Child Health Director Has Background in Genetics (NYT.com)
Dr. Alan Guttmacher, a Harvard-trained geneticist and pediatrician, is the new acting director of the National Institute of Child Health and Human Development, the federal agency that finances research into child and maternal health. Dr. Guttmacher, 60, previously worked with Francis Collins on the Human Genome Project and then as the deputy director of the National Human Genome Research Institute of the National Institutes of Health. We spoke for three hours in his Bethesda, Md., offices and then later by telephone. An edited version of the conversations follows. Read more.

Autistic Surfer Clay Marzo Masters Waves but Struggles on Land (ABCNews.com)
When pro-surfer Clay Marzo rides the waves off Maui’s coast, it’s hard to imagine that a man so gifted in the water could struggle so much on land. Read more.

What is the value of combination therapies in autism?

April 26, 2010 3 comments

This Top 10 Research Achievements of 2009 post comes from guest blogger Evdokia Anagnostou, M.D., a Clinician Scientist at Bloorview Research Institute and an Assistant Professor, Department of Pediatrics at the University of Toronto. Dr. Anagnostou leads a program of experimental therapeutics and neuroimaging in autism and is leading a series of clinical trials to study the efficacy of oxytocin, memantine, and other compounds for symptoms associated with autism.

The last decade has been fairly productive when it comes to research in psychopharmacology.    Large scale multicenter studies have been conducted and more than one medication has shown benefit for the treatment of symptoms associated with autism.    Still, our approach to pharmacology research has been relatively limited. We have examined the similarities between symptoms associated with autism and symptoms in other disorders, assumed  that similar symptoms across disorders have similar neurobiology, and “borrowed” medications from other disorders with “overlapping “ symptoms to test in autism.  The approach has been somewhat successful.  We now have evidence from large multisite studies to support the efficacy of some atypical antipsychotics for irritability and aggression (risperidone (1) and aripiprazole (2)), and stimulants for the treatment of ADHD-like symptoms (3).  This approach also has its limitations.  An example may be the failure of large multisite studies to show effectiveness for the treatment of repetitive behaviors for serotonin re-uptake inhibitors (SSRIs). Although much remains to be explored and many questions still remain, one cannot help but wonder whether it is time for a paradigm shift in the way we approach pharmacology research.  There are plenty of approaches that still remain to be tested in this population.  Firstly, we have not yet done truly translational work.  In other words we have not yet used the findings from genetics/ animal models/ pathology to develop treatments based on the neurobiology of autism itself, as it is revealing itself to us over the past few years. Secondly, we have not addressed what we really do in real life which is combine medications with psychosocial interventions.  In fact, we have no data to date that any of the medications we use actually treat autism. Medications do not teach skills. It is the psychosocial interventions that treat autism.  What we attempt to do with medications for the most part, is to enhance learning from such interventions either indirectly by reducing behaviors that interfere with learning ( e.g. irritability, aggression, hyperactivity, repetitive behaviors) or by directly facilitating learning processes (potential examples in trials: memantine, oxytocin).  The question remains whether the combination of medications with psychoeducational treatment is favorable compared to medications alone or the psychoeducational treatment alone. Previous studies in other neurodevelopmental disorders, such as ADHD, (4) have taught us that when the effect of medication is large, it may be hard to show additional benefit from psychosocial interventions.  As such both comparisons: combination treatment vs. medication, and combination treatment vs. psychosocial intervention are worth exploring.

Recently, the RUPP group published the first randomized controlled trial that tested the combination of a medication with a parent training curriculum based on ABA principles for the treatment of irritability/aggression (link to Top 10 story on combination therapy) (5).   This was a 24 week randomized trial of combination treatment vs. medication only (risperidone/aripiprazole alone).  124 children ages 4-13 with frequent aggression, self injury and tantrums were recruited.  The primary outcome measure was a modified for autism version of the Home Situations Questionnaire (HSQ), a 20 item questionnaire aimed to measure non compliance in every day circumstances. Secondary measures included the Aberrant Behavior checklist, the Clinical Global Impressions measure and the Children Yale Brown Obsessive – Compulsive Scale-PDD version.  The parent intervention consisted of 11 sessions with a certified therapist, three additional optional sessions and up to 3 booster session for a total of up to 17 sessions, lasting 60-90 min and delivered individually to the families. The curriculum included teaching on visual schedules, positive reinforcement, compliance, functional communication and adaptive skills.  The sessions were fairly individualized to the child’s level and needs. The medication was risperidone dosed by weight and was switched to aripiprazole by week 8 if the risperidone was ineffective.  The study reported that combination treatment was more effective than medication alone as measured by the HSQ, irritability hyperactivity and stereotyped speech as measured by the ABC. They also reported that the mean dose of medication required in the combination group was less than that required in the medication alone group (1.98 mg/d vs. 2.26 mg / day respectively).

In summary, combination treatment was more effective at improving everyday outcomes than medication treatment alone.  This Top 10 paper provides initial evidence that such trials are feasible and worth exploring. The authors argued that this study aimed at a different outcome (real life situation improvement) than the original risperidone studies, and as such, suggests that integrated trials can be successful when the outcome measure for the medication is somewhat different than that for the psychosocial intervention / combination treatment.   In fact, as previously discussed, it makes sense that generalizability of the medication effect is accomplished by parent training given that the medication itself is not likely to teach the child or the family any skills.  The question still remains in the blogger’s mind whether the effects of combination treatment should be tested against intensive parent training alone. Although I agree with the authors that the effect size of the risperidone is large, these medications are associated with a relatively unfavorable side effect profile and it would be of great interest to learn how much of the effect size observed with the combination treatment can be achieved by using parent training alone, given that decisions on the using a medication are not solely based on the efficacy profile of medications. Such studies may have implications for systems delivery and the generalization of results may be more difficult given the differential insurance coverage for medications vs. psychosocial interventions, but may have significant impact in the way we treat children with autism

The study is very important as it is the first such trial in autism and highlights the need for integrated medication/psychosocial intervention trials. Future studies will likely focus on integrated treatments targeting both decrease of maladaptive behaviors as well as skills acquisition.

1. Research Units on Pediatric Psychopharmacology Autism Network. Risperidone in children with autism and serious behavior problems. N Engl J Med. 2002;347:314Y321.

2. Owen R, Sikich L, Marcus RN, Corey-Lisle P, Manos G, McQuade RD, Carson WH, Findling RL. Aripiprazole in the treatment of irritability in children and adolescents with autistic disorder. Pediatrics. 2009 Dec;124(6):1533-40.

3. Research Units on Pediatric Psychopharmacology Autism Network. Randomized, controlled, crossover trial of methylphenidate in pervasive developmental disorders with hyperactivity. Arch Gen Psychiatry. 2005 Nov;62(11):1266-74.

4. MTA Cooperative Group. National Institute of Mental Health Multimodal Treatment Study of ADHD follow-up: 24-month outcomes of treatment strategies for attention-deficit/hyperactivity disorder. Pediatrics. 2004 Apr;113(4):754-61.

5. Aman MG, McDougle CJ, Scahill L, Handen B, Arnold LE, Johnson C, Stigler KA, Bearss K, Butter E, Swiezy NB, Sukhodolsky DD, Ramadan Y, Pozdol SL, Nikolov R, Lecavalier L, Kohn AE, Koenig K, Hollway JA, Korzekwa P, Gavaletz A, Mulick JA, Hall KL, Dziura J, Ritz L, Trollinger S, Yu S, Vitiello B, Wagner A; the Research Units on Pediatric Psychopharmacology Autism Network. Medication and Parent Training in Children With Pervasive Developmental Disorders and Serious Behavior  Problems: Results From a Randomized Clinical Trial. J Am Acad Child Adolesc Psychiatry. 2009 Oct 23. [Epub ahead of print]

Autism in the News – Monday, 04.26.10

April 26, 2010 2 comments

Nadia Bloom: ‘I Thought I Was Never Going To Be Found Out There’ (ABC News)
The 11-year-old girl who was missing for four days described how she survived the dangerous Florida swamp and said she was scared and worried no one would ever find her. Read more.

Class helps autistic kids learn to socialize (Mansfield, Ohio)
Several programs tackle educational or physical barriers, but the Friendly House and the Independent Living Center know there’s more to living for children with autism and attention deficit disorders. Read more.

Jury’s task is unenviable (Boston.com)
There’s an old, classic movie — “Twelve Angry Men’’ — in which the dozen members of the jury bring all their life experiences into the jury room. It makes for gripping drama. Read more.

Autism and its effects on siblings, family members and the community (Brownsville, Texas)
“Tommy” walked down the aisle at his favorite store, Target. He spotted what he was after, a small toy elephant. Tommy loves elephants. He turned to his parents and his sister “Jenny”. Read more.

Police say missing autistic teen has been found (Canada)
Toronto Police say a missing autistic teen who went missing from a home in Scarborough Saturday has been found. Read more.

Rodney Peete learns from autistic son (ESPN.com)
Last month I took my 13-year-old to the mall to buy jeans. Then he ate a burger, took a nap and now I need to buy new, larger jeans. Read more.

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