Children With Autism Respond Well to Puppets

A new study by researchers at the Yale Child Study Center demonstrates that puppets can attract and hold the attention of children with autism spectrum disorder (ASD), raising the potential for developing more engaging therapies that strengthen social engagement and facilitate learning.

The study, published in the journal Autism Research, is the first to test anecdotal evidence that children with ASD, like most youngsters, pay attention to puppets.

In a series of experiments, the researchers examined the visual attention patterns of young children with ASD, alongside a control group of typically developing children, in response to a video depicting a lively interaction between Violet, a brightly colored puppet, and a human counterpart.

They found that the attention patterns of children with ASD were similar to those of children in the control group when Violet spoke, with both sets of children spending a similar proportion of time watching her face and exhibiting a strong preference for the talking puppet over the listening person.

“Children with autism are less likely to attend to and to engage emotionally with their social partners, which limits their exposure to a host of important learning opportunities and experiences. In the present study, we found that while children with autism paid less attention than typically developing peers when an interactive partner was human, their attention was largely typical when the interactive partner was Violet, the puppet,” said study co-author Katarzyna Chawarska, the Emily Fraser Beede Professor of Child Psychiatry at Yale School of Medicine, and director of the National Institutes of Health Autism Centre of Excellence at the Yale Child Study Centre.

“Our findings highlight the attentional and affective advantages of puppets which, hopefully, can be harnessed to augment the therapeutic efforts in children with ASD.”

The researchers created the experiment in collaboration with Cheryl Henson ’84 B.A., who is a daughter of celebrated puppeteer Jim Henson and president of the Jim Henson Foundation.

“For many years, I’ve observed how puppets can engage children with ASD in meaningful ways, often establishing an uncommonly emotional connection,” said Henson, who was a puppet builder on “The Muppet Show” and worked with “Sesame Street” in the 1990s, among other productions. “I was thrilled when the Yale Child Study Center expressed interest in conducting the first-ever clinical research exploring how puppets are seen by kids with ASD.

The findings lend scholarly weight to our anecdotal experiences and suggest that puppets could be a powerful tool to help children with ASD improve their social engagement, which is very exciting.

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Researchers Begin Clinical Trial to Test CBD in Autism

UC San Diego researchers are looking for participants for a clinical trial to study the effectiveness of cannabidiol, or CBD, in treating symptoms of severe autism in children.

Cannabidiol is a chemical compound found in cannabis. CBD does not contain THC, the psychoactive ingredient in marijuana that produces a high.

CBD oil has been approved by the U.S. Food and Drug Administration as an epilepsy medication, and the chemical has been studied as a treatment for several other conditions.

The goal of the UCSD study “is to determine whether CBD reduces the problem behaviours that we see in children with severe autism,” said the study’s principal investigator, Dr. Doris Trauner, a paediatric neurologist and professor of neuroscience at UCSD’s School of Medicine.

Trauner said the behaviors the study will target “are specifically aggressive behaviors, self-injurious behavior [and] persistent repetitive behaviors, what are called stereotypic behaviors,” such as shaking or other repetitive movement that “interferes with their ability to function.”

“What we’re trying to identify is whether CBD reduces the problem with behaviors and then, in turn, whether that could improve their ability to function,” Trauner said.

The study is looking for 30 boys ages 7-14, with a second phase for girls planned for later.

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How We Fail Children With Developmental Language Disorder

Developmental language disorder (DLD) is a neurodevelopmental condition that emerges in early childhood and frequently persists into adulthood. People with DLD have significant difficulty learning, understanding, and using spoken language. Under U.S. Public Law 101-476 (Individuals with Disabilities Education Act [IDEA], 2004; first issued in 1990 and reissued in 2004), children may be eligible for school-based services, typically under the category “speech-language impairment,” if their DLD affects educational performance and requires specially designed support. DLD is one of the most common neurodevelopmental disorders. With an estimated prevalence of 7.58% (Norbury et al., 2016; see also Tomblin et al., 1997), it is nearly 7 times more common than autism spectrum disorder (ASD; prevalence = 1.1%; Brugha et al., 2012) and 46 times more common than permanent childhood hearing impairment (prevalence = 0.165%; Fortnum et al., 2001).

As a population, people with DLD face significant risks. Compared to other students, those with DLD are 6 times more likely to have reading disabilities, 6 times more likely to have significant spelling problems, 4 times more likely to struggle with math, and 12 times more likely to face all three of these difficulties combined (Young et al., 2002). People who have DLD are 6 times more likely than others to experience clinical levels of anxiety and 3 times more likely to have clinical depression (Conti-Ramsden & Botting, 2008). Girls with DLD are 3 times more likely to experience sexual abuse (Brownlie et al., 2007). Boys with DLD are 4 times more likely to engage in delinquent behavior (Brownlie et al., 2004). Adults with DLD are twice more likely to go over a year without employment than other adults (Law et al., 2009).

Without a doubt, DLD is a common condition that limits the health, happiness, and success of many who live with it. Nevertheless, people with DLD are underserved, and the condition itself is under-researched. The reasons are complicated, but the consequences of continued failure are dire. This clinical focus article is a call to action. I will provide evidence to demonstrate the ways that we, as a profession, are failing children with DLD; explore the reasons for these failures; and encourage change. The institutions and policies that dictate, support, or constrain clinical services and research efforts vary widely from country to country. This review is admittedly United States–centric, with some attention paid to the United Kingdom as well, but it is my hope that some of the points raised here are universally relevant.

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A World Without Meaning.

Sadly the XXY community is awash with people like Callie where parents, siblings, loved ones and work colleagues complain about not “getting us” most within the community are medicated with anti depressive and /or amphetamines, resulting in our creativity being quenched. Those who are impacted struggle to fit in, to blend but, as her grandfather pointed out we live in an un-blendable society albeit mostly one with little time for people who are different to themselves.

The Promises and Pitfalls of Sex Difference Research

It’s been hypothesised that XXY’s are biological females dressed in male clothing, that being so we ask you keep in mind when reading how an XXY experience might have greater similarity to females than males, of course none of this would be necessary if researches were to include Intersex as a variable. Still comparing the binary sexes is a step in the right direction but should by no means be the final step.

The XXY Project

In 2016 the USA National Institutes of Health (NIH) mandated that all pre-clinical research must include sex as a biological variable (SABV), unless strongly justified otherwise. This has substantially increased attention to sex differences research, with good reason. Studying how biological sex contributes to our health can help understanding of disease etiology, manifestation, progression, and treatment. Indeed, males are more likely to be diagnosed with autism spectrum disorders or develop Parkinson’s disease whereas females are more likely to be diagnosed with major depressive disorder, anxiety disorders, autoimmune disease, and multiple sclerosis.

Sex differences are also noted in specific disease subsets, thus more females than males display the relapsing-remitting type of multiple sclerosis than men. Similarly, whereas the incidence of epilepsy is higher in males than females, only women are susceptible to a catamenial epilepsy, where seizures are tied to the menstrual cycle, and up to 70% of females with epilepsy show a variant of catamenial type. Perhaps less well known, there are also sex differences in the timing or onset of neuropsychiatric disorders. Onset of obsessive compulsive disorder is more likely to occur in early adolescence for males but during the perinatal period for females.

Even when prevalence of disease shows no sex bias, such as in schizophrenia, there can be profound differences in timing onset. Males are more likely to present with schizophrenia as teens, but females are more likely to present a couple of years later than males with a secondary peak in middle-age. Each of these examples gives us important clues on the nature of the disease. Yet, sex differences in onset and prevalence are rarely explored despite that studying these sex differences could yield powerful clinical and pre-clinical models of disease, and clues to disease etiology and pathology.

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NHS in Disarray with Dispensing Hormones

Given the treatment of XXY individuals is (questionably) a sub speciality of Endocrinology it is envisaged that XXY’s regardless of how they identify their gender would be exposed to the same difficulties experienced by GD and Trans Individuals.

If you are an XXY individual we would love to hear of any difficulties you are experiencing with getting the care you believe you deserve, please comment below. Thanks.

Gender dysphoria can be difficult terrain for primary care doctors. Gender identity and gender dysphoria are not part of the GP curriculum. Patients face an average 18 month wait for specialist referral. And the NHS’s frontline doctors may bear the brunt of some patients’ distrust of a system that can’t cope with the current demand for services.

Specialist gender identity clinics (GICs) have seen referrals at least double over the five years to 2018, said James Palmer, medical director for specialised services at NHS England. As of 2019, about 7839 adults were waiting for a first appointment. Some 4000 young people are waiting for a specialist appointment.

Chris Preece, a GP in North Yorkshire, told The BMJ that the two year wait for patients to be seen by his local gender identity clinic puts pressure on GPs to provide bridging prescriptions for hormone treatment, even though they lack formal training in treating gender dysphoria.

General Medical Council guidance recommends that GPs consider prescribing hormone treatment to adult transgender patients who try to medicate themselves while awaiting specialist care. Preece says that waits can create “perverse incentives” for patients to buy hormones on the internet or elsewhere. Without training, and given the media controversies about trans care, Preece adds, many GPs “actively choose not to prescribe
[hormone treatments]—which protects us, but is unhelpful to the patient.”

Last year the Royal College of General Practitioners published a statement on caring for gender questioning and transgender patients. This says that long waits for patients to see a specialist are putting pressure on GPs to provide services beyond their remit and with limited access to specialist support if they do so. The college adds, “GPs should not be expected to fill the gaps in commissioned gender identity specialists and clinics.”

This month the Royal College of General Practitioners launched an e-learning course on gender variance this year.

A recent study by Anna Carlile, a sociologist at Goldsmiths University of London, investigated the experience of trans children and their parents in English healthcare. She told The BMJ that participants reported experiencing direct discrimination and being referred to by a previous name in GP surgeries and other clinical settings and believed that GPs “lack clinical and therapeutic knowledge,” particularly concerning the prescribing of drugs to delay puberty.

GPs are wary of prescribing without robust research into the outcomes and side effects of puberty blockers and cross sex hormones, and the co-occurrence of gender dysphoria and autism can complicate diagnosis and treatment. The UK has no nationally recognised training programme for gender identity healthcare, although there are apprenticeship training models in specialist clinics and guidelines from international professional bodies

Nearly two in five adult trans respondents to a large government survey reported dissatisfaction with NHS services related to their gender identity. Jane Fae of the charity Trans Media Watch, which campaigns for better media coverage of trans issues, says that many trans people now view GPs as “an obstruction to overcome.” Some trans groups, including Non
Binary London and Trans Forum UK, circulate lists of GPs they deem to be sympathetic or unsympathetic to requests for referrals to gender identity clinics or to prescribe treatments that patients have asked for.

Some areas in in the UK are showing signs of service reconfiguration. Cardiff’s new gender identity clinic has GPs on site. A model is being trialled in Manchester in which GPs work with gender identity clinics to improve their diagnostic skills. And the Royal College of Physicians intends to introduce a professional development programme for GPs about gender
identity this year.

NHS England, meanwhile, is considering a decentralised service for adults in which GPs can prescribe cross sex hormones without specialist involvement if they have sufficient expertise.

The royal college recommends that the GP curriculum should cover gender dysphoria and trans issues, that expanding specialist gender services be a priority, and that NHS IT systems be updated to record patients’ gender identity and trans status.

Preece would welcome such changes. “The hardest thing about being a GP is when you know that the service being offered to patients falls short of what you believe they need and deserve,” he says. “That chasm is at its greatest when dealing with patients with gender dysphoria.”

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New DNA ‘clock’ could help measure development in young children

Scientists have developed a molecular “clock” that could reshape how paediatricians measure and monitor childhood growth and potentially allow for an earlier diagnosis of life-altering development disorders.

The research, published this week in PNAS, (Full Study) describes how the addition of chemical tags to DNA over time can potentially be used to screen for developmental differences and health problems in children.

The study was led by researchers at BC Children’s Hospital, the University of British Columbia (UBC) and the University of California, Los Angeles. It is the first study to describe a method specifically designed for children, called the Paediatric-Buccal-Epigenetic (PedBE) clock, which measures chemical changes to determine the biological age of a child’s DNA.

Small chemical changes to DNA, known as epigenetic changes, alter how genes are expressed in certain tissues and cells. Some of these changes happen as a person ages and others may be in response to a person’s environment or life experiences.

Steve Horvath presents research on: Universal Epigenetic Aging Clock

In adults, these patterns of epigenetic changes are well established. They can be used to accurately predict a person’s age from a DNA sample or, if a person’s epigenetic age differs from their actual age, it can point differences in health, including age-related diseases and early mortality.

“We have a good idea how these DNA changes occur in adults, but until now we didn’t have a tool that was specific for children,” says Dr. Michael Kobor, senior author of study. “These DNA changes occur at very different rates in kids and so we adapted this technique for younger ages.”

“This powerful and easy-to-use tool could be used by clinicians to identify why some children aren’t meeting early milestones and potentially diagnose children with developmental disorders earlier in life, this would enable doctors and paediatricians to intervene sooner in a child’s life leading to better outcomes for kids.”

Dr. Lisa McEwen, first author on the study

Kobor is an investigator at BC Children’s Hospital and the Centre for Molecular Medicine and Therapeutics, a professor in the Department of Medical Genetics at the University of British Columbia, the Tier 1 Canada Research Chair in Social Epigenetics and the Sunny Hill BC Leadership Chair in Child Development.

The PedBE clock was developed using DNA methylation profiles from 1,032 healthy children whose ages ranged from a few weeks old to 20 years. The researchers found 94 different sites in the genome that, when tested together, could accurately predict a child’s age to within about four months. The team also found that children who spent longer in the womb showed an accelerated rate of DNA change by three months, demonstrating that this tool could be used to indicate an infant’s developmental stage. The analysis can be done cheaply and efficiently on cells collected from a cheek swab.

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What are the Differences Between Developmental Language Disorder (DLD) and Autism Spectrum Disorder (ASD)

Neurodevelopmental conditions is a name doctors and scientists give to differences from the expected brain and behaviour development during childhood.  There are many ways that brain development can be different. One of the most well known neurodevelopmental conditions is autism, which has some similarities with Developmental Language Disorder (DLD), but also some important differences.

Autism is a broad term that includes a wide variety of challenges, but people with this neurodevelopmental condition all share the following two traits:

Challenges with Social Communication can range from being unable to speak and/or understand language, to difficulty reading body language and facial expressions and understanding what others are thinking and feeling.

Repetitive Behaviours and Restricted Interests can range from self-harm such as banging one’s head or biting one’s hands to less severe behaviours like hand flapping or rocking back and forth.  Restricted interests in autism often look like obsessions or fixations on certain kinds of objects or themes. It can be difficult for individuals to change from one activity to another.

DLD Awareness Day 18 October 2019

Individuals with DLD, like individuals with autism, struggle with social communication. In DLD, these challenges relate mostly to expressing one’s thoughts and comprehending what others are saying, while in autism the problems tend to go beyond just language and extend to difficulty understanding the meaning behind a person’s facial expression or body language.

Patterns of restricted interests and repetitive behaviours, as described above, are specific to autism and are not a characteristic of DLD.

​Children with autism often have other serious medical conditions, such as seizures, digestive system problems, or sleep disorders.  These additional medical problems make it more likely for children with ASD to see a medical provider, which in turn makes diagnosis more likely.  In contrast, children with DLD might not have any other obvious medical conditions that would make diagnosis by a professional more likely, which is part of the reason that DLD can often go unrecognised.​

​Finally, although autism receives more attention in the public consciousness, DLD is far more common than autism.  The latest studies show that almost 2% of children have autism, while more than three times as many (about 7%) have DLD.​

Additional resources from around the world, if your country is not listed and you are aware of an organisation that should be included, then please bring it to our attention and we will add it.

American Speech-Language-Hearing Association

Speech-Language & Audiology Canada (SAC) | Orthophonie et Audiologie Canada (OAC)

Irish Association of Speech and Language Therapists

New Zealand Speech-language Therapists’ Association

Royal College of Speech and Language Therapists

Speech Pathology Australia

The St. John Aphasia Support Group

American Academy of Private Practice in Speech Pathology and Audiology

Federazione Logopedisti Italiani

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Study Challenges Idea that Autism is Caused by an Overly Masculine Brain

Of the many proposed triggers for autism, one of the most controversial is the “extreme male brain” hypothesis. The idea posits that exposure to excess testosterone in the womb wires both men and women to have a hypermasculine view of the world, prioritizing stereotypically male behaviors like building machines over stereotypically female behaviors like empathizing with a friend. Now, a study is raising new doubts about this theory, finding no effect of testosterone on empathy in adult men.

The extreme male brain hypothesis was first proposed by psychologist Simon Baron-Cohen at the University of Cambridge in the United Kingdom. In 2011, he and colleagues found that women given a single hefty dose of testosterone fared significantly worse at the Reading the Mind in the Eyes test (RMET), which asked them to gauge the emotional states of others based on their facial expressions. The women’s performance seemed to track with a controversial metric called the 2D:4D ratio, the relative lengths of the second and fourth fingers. Men—and people with autism—tend to have a longer ring finger than index finger, and some researchers believe that is due to higher prenatal exposure to testosterone.

To Melissa Hines, a neuroscientist at Cambridge, the team’s inability to replicate earlier findings is “unsurprising.” The small size of past studies and the unreliability of the 2D:4D measure make it unlikely that the results would replicate in women either, she says.

Still, Baron-Cohen finds it “strange” that Nadler’s team conducted the study exclusively in men “because to expect to see an effect of testosterone, one needs to study people who at baseline have relatively low” testosterone, he says—in other words, women.

But Nadler says Baron-Cohen’s objection is “incongruous” with the original paper’s hypothesis, which predicted that people with higher prenatal testosterone levels would be more sensitive to the empathy-blunting effects of testosterone. That means men should show “more pronounced effects [than women], not less,” he says.

Nadler cautions, however, that the study can’t disprove any theories about testosterone’s impact on the developing brain. “What we’re saying is that giving people testosterone as adults has no influence on their ability to understand people’s emotions.

He hopes the study will dispel any misconceptions that by controlling testosterone—for example, using medications to block it in pregnant women—it might be possible to prevent autism. “If there’s no relationship, then we shouldn’t give people false hope.”

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