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ADEQUATE SLEEP VERSUS SLEEP APNEA IN KIDS WITH AUTISM

10 Jun

Does your child with autism have difficulties with sleep?

by Lirio Sobrevinas-Covey, Ph.D.

Sleep apnea is a disorder characterized by shallow breathing and frequent breathing pauses during sleep. Breathing pauses can occur 30 or more times an hour, and normal breathing can start again, sometimes with a loud sound. The quality of sleep is poor, and the person will feel tired and sleepy during the day.

Sleep apnea is known to occur more frequently, up to about 50% of children with autism spectrum disorder (ASD).

It has been reported that sleep difficulties may be a cause of behavioral problems in children. Overall, children need good quality sleep for the proper development of the brain.

A common treatment for sleep apnea is adenotonsillectomy (AT) which involves the removal of the adenoids and tonsils. It is one of the most common surgical procedures performed on children. AT is usually performed on an outpatient basis. The patient goes home from the hospital the same day as his or her surgery, although overnight hospital admission is sometimes done in special circumstances such as when there is a co-occurring medical condition.

Evidence of improved attention and behaviors after AT for sleep apnea led a group of pediatric researchers in Japan to evaluate the effect of AT in children with ASD.

Measures of several behavioral indices taken at two time points, six months apart, were taken from two groups of children with autism. The study group was comprised of 30 children with autism and sleep apnea ; the comparison group comprised 24 children with autism without sleep apnea (regarded as the control group representing the natural course of the target behaviors).

Assessments using the Children’s Behavioral Checklist were made contemporaneously for the treated group and the control group before the AT treatment and six months later. The researchers found no changes over the two time points in the control group of children with autism and no sleep apnea. By contrast, in the children with autism and sleep apnea who were treated with AT, thought problems, social problems, attention problems, and aggressive behaviors were significantly decreased, suggesting an important beneficial effect of AT.

Why sleep problems occur more often in children with ASD is unclear. Some hypotheses include malfunction in the body’s 24-hour biological clock (the circadian rhythm), effects of medications taken for autism symptoms, and dysregulation of the hormone melatonin which is involved in the sleep cycle. Also hypothesized is a shared neurobiological etiology of sleep apnea and autism.

The study results suggest an important role of adequate sleep quality in the mental development of children with ASD and, relatedly, attention to and treatment of sleep difficulties in the clinical care of children with autism.

It bears noting as well that, whereas AT is the first-line choice for pediatric sleep apnea, as with any surgical intervention, it also carries some risks.

Citation: Kids With Autism Who Have Adenotonsillectomy for OSA Show Behavioral Improvement – Medscape – Jun 06, 2017.

Reference: Murata E, Mohri I, Kato-Nishimura et al, Evaluation of behavioral change after adenotonsillectomy for obstructive sleep apnea in children with autism spectrum disorder, Research in Developmental Disabilities, 65, 127-139, June 2017.

VIDEO GAMES – NOT AS BAD AS WE THOUGHT.

8 Jun

Active video games can help children with autism.

Deficits in motor skills deficits are a key characteristic of many developmental disorders, including intellectual disabilities, Autism Spectrum Disorder, Down syndrome and Cerebral Palsy.

A review of 19 studies on children’s and adolescents’ use of active video games, like Nintendo WII, found that these interactive games can help non-typically developing children improve critical motor skills.

In addition, these children improved their perception of their own motor competence and physical abilities after playing these games.

“These games involve moving the body during play and often mirror the naturalistic settings of the particular activity or sport, helping kids to master a particular skill in a low-pressure environment.”

Reference: Do Active Video Games Benefit the Motor Skill Development of Non-Typically Developing Children and Adolescents: A Systematic Review, Zoey E. Page, Stephanie Barrington, Jacqui Edwards, Lisa M Barnett, Journal of Science and Medicine in Sport, doi: 10.1016/j.jsams.2017.05.001, published online 18 May 2017.

 

FIDGET SPINNERS AND AUTISM

5 Jun

FIDGET SPINNERS AND AUTISM: A PEDIATRICIAN’S OPINION

Excerpts from a comment by Dr. Alok Patel, MD, an associate professor of clinical pediatrics at Columbia University College of Physicians and Surgeons and a critical care pediatrician at Morgan Stanley Children’s Hospital of New York-Presbyterian in New York City. Published in Medscape, June 5, 2017,

When I talk to parents of autistic children about these colorful little devices in the inpatient setting, they all report very interesting uses for them. They are aware of the safety risk and they use the toy primarily as a way to bond with their children. One father used it as a way to reward his daughter for taking her medications on time or completing certain tasks. Another mom was laughing and said that she and her daughter put them on a table, spin them, and race. They see whose spinner outlasts the other one. As long as they know exactly what they’re getting themselves into, I say do your thing.

In the end, what I tell parents is that the device is not a replacement for evidence-based occupational or behavioral therapy. Even though they are really cool and flashy, there are hidden safety risks. Those bearings are not delicious little donuts; they can get lodged in a child’s throat. Parents need to be smart about these just as with any other toy.

Dr. Isabelle Rapin, Modern Autism Pioneer has passed away

29 May

Dr. Isabelle Rapin, noted clinician, scientist, scholar, and teacher has passed away. She was gentle, warm and empathetic.She was my son’s first neurologist, referred to us through Dr. Oliver Sacks. Both are now gone. It was 1982, she told me my son Mikey had pervasive developmental disorder and treated him effectively for his seizure disorder. Discouraged me from trying out untested autism "cures", despite my insistences. She encouraged me (Lirio Covey) to prepare him for a life no longer fully in our family household when he would reach adulthood. I thank her for that advice and for her personal touch. Some years into our interactions as clinician and patient’ s mother, she ended telephone conversations calling me- my friend. May she rest in peace. .

Below is the New York Times obituary for Dr. Rapin.​

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http://www.legacy.com/obituaries/nytimes/obituary.aspx?pid=185620903

Oxytocin, the “love hormone” and autism

25 May

Why oxytocin could be a treatment for autism.

by Lirio Sobrevinas-Covey, Ph.D.

Prior research has suggested that administration of oxytocin, a natural hormone produced in the brain, could enhance socialization behaviors in persons with autism (see Young & Barrett, Science, Feb 20, 2015).
The article referenced below describes research findings of vast, positive effects of oxytocin, sometimes referred to as “the love hormone”, in general populations, which could underlie the beneficial effect of oxytocin in persons who experience difficulties in social interactions and relationships, such as individuals with autism.
http://www.medicalnewstoday.com/articles/317556.php
The oxytocin-autism relationship is of interest for a number of reasons – genetic associations between autism and oxytocin have been identified; oxytocin deficiency could be involved in autism; oxytocin receptor activity could identify those at risk of autism, and conversely, oxytocin treatment could confer improvements in socializing abilities. Although several other candidate medications have been examined (sertraline, naltrexone, etc), no conclusive evidence indicating effectiveness of those medications in treating the fundamental symptoms of autism have been observed. Oxytocin treatment could be a possible approach for alleviating difficulties in social interactions, one of the two core symptom that define autism spectrum disorder (the other is repetitive, stereotypical behaviors). Clinical trials testing this possibility are ongoing.

MEET DR. SUSAN SARABIA-REYES, D.M.D., SPECIAL DENTISTRY EXPERT

16 May

​    Oral health is one of the most significant aspects of health living. It is also one of the greatest challenges experienced by persons with autism and their caregivers. The strange smells, loud noises, formidable-looking equipment, and especially the uncommon sensations during a dental visit (much less a dental treatment), make dental visits an especially fearsome experience for persons with autism. Dental visits are often put off for as long as possible, causing significant dental problems that require special expertise of the treating dentist. By the time some persons with autism first see the dentist, they have already developed serious dental problems that may even require surgery and hospitalization.

Dental care and treatment of persons with autism and other special conditions are areas of specialization that have been nurtured in her practice by Dr. Susan S. Reyes, D.M.D.  Dr. Reyes has accepted an agreement with AAAP to establish and maintain a Special Dentistry Clinic for A Special Place, the upcoming residential and work community to be located in Alfonso, Cavite, spearheaded by AAAP. Dr. Reyes’ background makes her uniquely positioned for this role. She is a passionate advocate of persons with special needs and that personal quality is buttressed by her training as a Doctor of Dental Medicine (Centro Escolar University, Manila, 1995), completion of a Master of Arts in Special Education (2011), and several years as a Dentist III and Training Officer with the Department of Hospital Dentistry at the Philippine Government’s Eastwood Avenue Medical Center in Quezon City. She is one of a very few dentists in the Philippines who practices Special Care Dentistry. Recently, she traveled to North Carolina where she presented a workshop on the topic of “Dental Rehabilitation of Autistic Persons with Anemia and Tuberculosis “ at the 29th Annual Meeting on Special Care Dentistry. Welcome to the AAAP Family, Dr. Reyes!

Grandmothers, granddaughters and risk for autism

5 May

SMOKING WHEN PREGNANT COULD RAISE THE RISK OF AUTISM IN GRANDDAUGHTERS

In a study of 14,500 participants conducted by researchers from the University of Bristol in the UK, which involved three generations of parents and children from the Avon Longitudinal Study of Parents and Children (ALSPAC), 177 OF 7000 grandchildren with autistic traits were diagnosed with autism spectrum disorder.

An association between autism or autism-like traits and maternal grandmother’s (but not grandfather’s) smoking was seen. The association was not related to the mother’s smoking status. Speculation is that the damage is carried in the mitochondria which are passed down via the mother. But the effect of this process was not seen for grandsons.

Lesson learned? "We already know that protecting a baby from tobacco smoke is one of the best things a woman can do to giver her child a healthy start in life. Now we’ve found that not smoking during pregnancy could also give their future grandchildren a better start too." (Professor Jean Golding, author).

Comment: The finding suggests a role of an environmental factor, tobacco smoking, as an epigenetic risk factor for autism.

Reference: Golding J, Ellis G, Gregory S et al, Grand-maternal smoking in pregnancy and grandchild’s autistic traits and diagnosed autism. Scientific Reports, Article Number 46179, 2017.

http://www.medicalnewstoday.com/articles/317146.php

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