Autism: What have we learnt so far?

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Autism is a neurodevelopmental disorder in which individuals have difficulties with social interactions and communication and a reliance for routines and/or repetitive behaviours (Read this NIH fact sheet for more information). Individuals with autism also tend to display sensory seeking behaviour and according to more recent scientific endeavours, experience high rates of gastrointestinal issues.

It’s a disorder which receives much attention in both the press and in research. But research findings, despite advancing at the pace of greyhounds chasing a bunny on the race track, don’t always accompany news stories. The public’s understanding and awareness of this disorder is still work-in-progress, even though local resources for autism has vastly improved.

Research links the use of joint attention — the ability to use gaze and gestures to share attention — to autism, but a recent study points to a more accurate red flag for autism — a social smile during joint attention. This 2014 study observes that infants at 8 months tend to look at an object of interest and then smile at the person they are interacting with, before looking back at the object of interest, during joint attention. In contrast, infants at risk for autism tend not to direct the social smile at the other person in between looking at object and at the other person.

Other research has established that individuals with autism find faces aversive, and as a result have difficulties recognising the emotions of others (more about their difficulties with empathy here). In fact, a hot-off-the-press study finds that individuals with autism focus on areas of contrast and colour of real photographs and the centre of the image, whereas those who don’t have autism look almost exclusively at faces in the same photographs. And this tendency emerges at a young age: a 2014 study observes infants at 6 months to fixate on faces when someone is speaking. In contrast, infants diagnosed with autism later look away from the eyes and mouth when someone is speaking.

Recent research has also identified two other markers useful for screening autism among children aged 9 to 12 months. A 2014 study finds that babies with a head circumference that is at or higher than the 75th percentile at 9 months and infants who fail the tonic neck reflex (also known as the head tilt reflex) are at a higher risk for autism.

With slightly older children, nonverbal screening tools may be useful. A 2015 study proposes a novel way of screening for autism: It turns out that individuals with autism don’t reduce their sniffing of unpleasant smells (and conversely increase their sniffing of pleasant ones). In contrast, their peers who don’t have autism “stop” a wiffy smell in about 305 ms. Another 2015 study finds a higher proportion of children who are subsequently diagnosed with autism among families where parents voiced concerns about their child’s sensory and motor abilities from the age of 6 months, and their child’s language and social communication abilities from the age of 12 to 15 months. So although autism cannot be diagnosed till 2 years of age, there are clear indications and red flags which are proving to be effective for screening autism at a much younger age.

Screening for autism aside, there are still no clear answers to what contributes to autism. Recent research does however indicate differences in brain structure between individuals with autism and peers who don’t have autism. Apart from differences which have been observed in the brain structures which connect the two brain hemispheres to each other, a 2014 study observes a lack of neural pruning — the process by which neural connections which we don’t use are eliminated — among children with autism (for a more in-depth discussion, read this article). Genetic factors are acknowledged to contribute to autism, but environmental factors are also considered to play an important role. Increasing evidence that the composition of gut bacteria differs in individuals with autism from that of their peers who don’t have autism, has led some to suggest that gut bacteria to be a possible contributing factor to autism. While a 2015 study definitively excludes MMR vaccines as a contributing factor to autism (read more about the study here), another 2015 study speculates that other chemicals, such as solvents and pesticides, to which expectant mothers may have exposure, can adversely affect foetal development.

Despite the mixed findings about the cause of autism, more recent research does offer some promising news about effective interventions and strategies found to be useful for helping children and adolescents with autism. Just as children who don’t have autism can be trained to enhance their ability to identify emotional expressions and young preschoolers with autism can be taught social skills, recent research demonstrates that early intervention programmes play an important role in helping children with autism improve their social skills, as well as cognitive and language abilities.

One 2012 study has reported that an intensive programme comprising 20-hours-a-week one-to-one training with interpersonal exchanges over a period of 2 years, yields improved brain responses to faces among infants with autism aged 12 to 30 months. Use of this therapeutic intervention by parents has been shown to be effective on even young infants with autism. In this 2014 study, at-risk 6-month-olds, who showed signs of autism at the start of intervention (e.g., a lack of interest in social interactions and communication), had better cognitive and language skills 12 to 30 months later. In a follow-up study of these infants, further improvements were observed after 2 years of intervention. Infants’ cognitive, communication, and adaptive skills (skills for everyday living) were observed to undergo greater improvement compared to peers with autism who attended a preschool programme and who were given speech therapy.

Other groups of researchers have also shown that parent training is also an effective way to improve the quality of social interactions between parents and infants with autism. A 2014 study has shown that teaching parents to support their children’s learning during everyday activities results in better language and social communication among toddlers with autism. In another recent study, one-year-olds with autism whose parents received coaching on how to attract their infant’s attention and interest their infant in social interaction games produced better outcomes than peers receiving community-based early intervention and monitoring. A separate 2015 study has also shown that the benefits of parent training over a period of 24 weeks to include a reduction in disruptive and aggressive behaviours among children with autism aged 3 to 7 years (Supernanny also some useful tips…). It’s evident that there are various effective therapeutic options available to families of children with autism.

Interventions which reduce the severity of children’s autistic behaviours are important. But support for families are as, if not more, important. This is particularly true for caregivers and parents of children with autism, who experience a high level of caregiving stress on a daily basis and can be at risk for caregiver burn out. Journal writing has been found to help mothers manage their stress levels, while mothers are less likely to experience depression if their partners share the burden of caregiving. But it’s often easier said than done. Respite care — which provides parents and caregivers with time off to take of themselves — can play an important role for helping parents and caregivers manage their stress. And more public awareness won’t do anybody any harm either.

World Autism Awareness Day is a few months away but there’s no time like the present to support a greater public awareness of autism.

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What do smartphones do for your child’s brain?

Boys Laughing with Video Game

Research is clear about the benefits of face-to-face parent-child interactions over watching TV. Children have a much better chance to learn new vocabulary from human interactions than from a TV programme (here’s why), including even those which have been designed with a very young audience in mind. A new experimental study shows that parents interact less and say fewer things to their toddlers, when the TV is on in the background than when it is not. Another new study shows that having TV on in the background diverts young children’s attention away from play and learning. In this latter study, exposure to non-age-appropriate TV is associated with poorer cognitive abilities.

But time spent on TV and other media impacts not only young children’s language and cognitive abilities. Time spent on TV and gaming adversely affects the development of young children’s social skills and emotional understanding. A recent experimental study found that children’s emotional intelligence (specifically, their ability to recognize emotions) improved when they had the opportunity to interact with their peers for 5 smartphone-free days. A recent nation-wide study in the UK involving 5,000 children aged between 10 and 15 years, also reveals fewer emotional and social problems among those who spend less than an hour a day on video games.

Research about the psychological impact of children’s access to smart phones is still playing catch-up, but findings from a 2014 study involving 3,604 children links longer use of electronic media to poorer mental well-being among children as young as 2 to 6 years of age. In this study, young children’ emotional problems increase with each additional hour they spend watching TV and/or playing electronic games.

In short, it’s important to provide your children with opportunities to learn through social interactions and face-to-face conversations. Looking for some alternatives to electronic media and TV programming? Here are some ways to boost your child’s learning:

1. Read to your kids
“The number of words a child hears in early life will determine their academic success and IQ in later life”. This fact is the one reason why boosting your child’s early spoken language skills and capacity for understanding speech is so important.

A host of studies find that reading to young children promotes their language, reading, thinking, motor, emotional and social skills (here’s the science explained). The tendency for mums to read and talk to their babies while breastfeeding them, may also be the reason why breastfed children score well on IQ tests and at school.

A new study shows that reading to children as early as 9 months of age boosts school readiness in terms of their maths and reading skills.

2. Choose picture books with a story
Reading benefits children’s language in the long-term, when parents read picture books with a story rather than flashcard-type picture books. A 2014 study shows that toddlers could learn sophisticated animal facts when parents read to them from a book where animals were part of a story.

3. Engage in conversations with your baby
Babies often sound like they’re just making gurgly sounds when they haven’t learnt to say words which we use. But a new study shows that if mothers vocally respond to their baby’s babbling as if having a conversation with their baby, infants are more likely to develop language earlier.

4. Napping is good for the young ones too
A 2014 study shows that infants and preschoolers are better at retaining newly learnt information after they nap. Here’s a bit more evidence for the importance of sleep.

5. Feed your baby’s brain with frequent snacks
A 2013 local study found that toddlers whose parents spent more time reading to their children and who had snacks in addition to their main meals, to have relatively larger vocabularies. A 2007 study finds that breakfast foods which provide a steady supply of glucose to the brain (which, not surprising consumes far more energy among young children than adults), such as oats, helps children maintain their attention in class.

Television for babies

TV for babies

Recent reports and forum letters question the promotion of an ipad baby seat (e.g., “Infant iPad seats raise concerns about screen time for babies“, Washington Post, 11 Dec 2013; “Some unanswered questions“, Straits Times, 17 Dec 2013; see Psychology Today for some answers). These highlight a growing concern about using ipad games and youtube video programming as babysitters.

Research findings are clear about the benefits of real human interactions for language development. As this TED talk demonstrates, learning from a human being is different from listening to the same words overheard from an audio-video source, such as TV (here’s the science behind it all).

Numerous studies show that precocious language development in infancy is associated with parents who speak often to their babies. In contrast, there appears to be only moderate benefits for language acquisition from watching an educational programme like Dora the explorer. In fact, TV is strongly discouraged for toddlers and infants (AAP).

It has been suggested that longterm exposure to TV programming at an early age is associated with shorter attention spans (“Limit your child’s TV time“, Straits Times, 29 Dec 2013; NY Times, 9 May 2011). But that evidence is correlational in nature. Children who have shorter attention spans tend to watch more television. It may not be the case that TV shortens their attention span. Instead, attention deficits are recognised to have other causes (The US CDC has this useful factsheet).

Social interactions are also opportunities for learning. Which is what makes play an important element for children’s learning, as this commentary in The Independent (12 Jan 2014), “Give childhood back to children: if we want our offspring to have happy, productive and moral lives, we must allow more time for play, not less” explains. And time spent watching TV is not time spent playing.

On the other hand, playing together with young children on the iPad provides similar benefits to that gained with a picture book, as others have suggested (“Parenting in the age of apps: Is that iPad help or harm?“). iPads aren’t all that bad as long as they’re not the babysitter.