Group therapy for children with autism

Group therapy can help children with autism better cope socially.

In the framework of group therapy developed at Goethe University Frankfurt, children and adolescents with high functioning ASD can learn how to cope better in the social world and also achieve a lasting effect.

Social difficulties are one of the main problems for children and adolescents with Autism Spectrum Disorder (ASD). Especially when their intelligence is unaffected, they become more and more conscious in the course of their development of the fact that they are different. In the framework of group therapy developed at Goethe University Frankfurt, children and adolescents with high functioning ASD can learn how to cope better in the social world and also achieve a lasting effect. This is confirmed by clinical trials which examined 209 children and adolescents between the ages of 8 and 18 over the course of three years.

"We often encounter children and adolescents with Autism Spectrum Disorder in clinical practice who would like to communicate with youngsters of their own age and at the same time experience every day that they meet with rejection because they are unable to understand many of their classmates' behaviour patterns. And this causes them to despair," explains Professor Christine Freitag, Head of the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy. Together with Dr. Hannah Cholemkery, she has developed a behavioural group therapy programme with instructions and exercises for the improvement of social skills.

To date, group therapies for the training of social skills for people with ASD have predominantly been investigated in the USA in the framework of smaller trials without any measurement of stability. The objective of the "SOSTA-net Trial," led by Christine Freitag and coordinated by Hannah Cholemkery and in which six university hospitals in Germany participated, was to examine whether the social responsiveness of children and adolescents with ASD could be raised by means of group-based behavioural therapy. This took place with the aid of a standardized questionnaire (on the basis of a Social Responsiveness Scale -- SRS), in which 65 behaviour patterns were evaluated by the parents before the start of group therapy, at the end of the intervention as well as three months after the end of the intervention in order to measure stability.

Therapy took place once a week over the course of three months in a group with four to five youngsters of the same age and two therapists. There were also three parent evenings. The results were compared with those of a wait list control group. There was a clear improvement in social behaviour in the intervention group, which also remained stable after three months when examined again.

In particular children with severe symptoms and a higher IQ at the beginning of the therapy were able to profit from it.

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Study: Children with autism can learn social skills

A recent study indicated that children with autism can learn how to be social.

When Debra Kamps, senior scientist at the University of Kansas Life Span Institute, first began researching how to improve the social and communication skills of children with autism in natural settings like schools in the 1970s, it was hard to find children with autism spectrum disorders (ASD) who were in classrooms with their typically developing peers.

Today, Kamps and her colleagues from KU and the University of Washington can say with certainty that they know how teachers, speech therapists and others can teach social and communication skills to kids with ASD and their peers in the classroom, at lunch and even at recess after the results of the first large randomized study of a social communication intervention verified years of earlier research.

"We know how to do this, and our research has shown us that it is not hard to teach people how to do it," she said.

The four-year study, funded by the U.S. Department of Education, involved 95 students with ASD in Kansas and Washington. Of that group, 56 children participated in a two-year intervention from kindergarten through first grade in which each child was grouped with two to three typically developing classmates in a peer network, while the remaining 39 were the control group.

The social peer network focused on teaching social communication skills such as requesting, commenting and saying "niceties" such as please and thank you while playing with toys and board games.

To find out if the children were continuing to use social skills, the researchers followed up with probes outside of the intervention sessions at four points in time.

"We found that the children who participated in the social network not only made significant progress in social communication during the intervention but also made many more initiations to their peers in general," Kamps said. "Teachers also reported that children in the intervention were more social and had better classroom behavior."

Although peer networks are still not used routinely in schools, often due to lack of resources, Kamps hopes that the promising results from larger studies will change that, and she said that some teachers who participated in the study have adopted the Peer Networks intervention in their classrooms.

"Seeing the expression on the faces of the children when their peer buddies come to class -- that's what's kept me going all these years," she said.

See video from the project here: http://autismconnections.ku.edu/connecting-kids/play-tips

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Study: Autistic children with pets are more assertive

A study shows that having pets acts as a social catalyst for children, especially those with autism.

Dogs and other pets play an important role in individuals' social lives, and they can act as catalysts for social interaction, previous research has shown. Although much media attention has focused on how dogs can improve the social skills of children with autism, a University of Missouri researcher recently found that children with autism have stronger social skills when any kind of pet lived in the home.

"When I compared the social skills of children with autism who lived with dogs to those who did not, the children with dogs appeared to have greater social skills," said Gretchen Carlisle, research fellow at the Research Center for Human-Animal Interaction (ReCHAI) in the MU College of Veterinary Medicine. "More significantly, however, the data revealed that children with any kind of pet in the home reported being more likely to engage in behaviors such as introducing themselves, asking for information or responding to other people's questions. These kinds of social skills typically are difficult for kids with autism, but this study showed children's assertiveness was greater if they lived with a pet."

Pets often serve as "social lubricants," Carlisle said. When pets are present in social settings or a classroom, children talk and engage more with one another. This effect also seems to apply to children with autism and could account for their increased assertiveness when the children are living in a home with pets, Carlisle said.

"When children with disabilities take their service dogs out in public, other kids stop and engage," Carlisle said. "Kids with autism don't always readily engage with others, but if there's a pet in the home that the child is bonded with and a visitor starts asking about the pet, the child may be more likely to respond."

Carlisle also found that children's social skills increased the longer a family had owned a dog, yet older children rated their relationships with their dogs as weaker. When children were asked, they reported the strongest attachments to smaller dogs, Carlisle found.

"Finding children with autism to be more strongly bonded to smaller dogs, and parents reporting strong attachments between their children and other pets, such as rabbits or cats, serves as evidence that other types of pets could benefit children with autism as well," Carlisle said.

Carlisle surveyed 70 families who had children with autism between the ages of 8 and 18.The children were patients at the MU Thompson Center for Autism and Neurodevelopmental Disorders. Almost 70 percent of the families that participated had dogs, and about half of the families had cats. Other pets owned by participants included fish, farm animals, rodents, rabbits, reptiles, a bird and even one spider.

"Dogs are good for some kids with autism but might not be the best option for every child," Carlisle said. "Kids with autism are highly individual and unique, so some other animals may provide just as much benefit as dogs. Though parents may assume having dogs are best to help their children, my data show greater social skills for children with autism who live in homes with any type of pet."

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ADHD affects school performance as early as 2nd grade

A study claims that ADHD can negatively affect a child's performance in school as early as the 2nd grade.

Attention-deficit/hyperactivity disorder can harm a child's academic performance and social skills as early as the second grade, a new Australian study contends.

Children between 6 and 8 years old who were tested and scored high for ADHD symptoms were more likely to get lower grades in elementary school and have trouble fitting in with other kids, compared with children without ADHD, the study authors reported.

Kids with ADHD also were more likely to have other mental health or developmental disorders, including anxiety, depression and autism, according to the study.

"Already at this stage, which is relatively young, it's very clear the children have important functional problems in every domain we registered," said study lead author Dr. Daryl Efron, a developmental-behavioral pediatrician with the Royal Children's Hospital Melbourne. "On every measure, we found the kids with ADHD were performing far poorer than the control children."

The researchers also said they discovered that about 80 percent of the young children with ADHD symptoms had not been diagnosed with the disorder, a finding called "striking" by Dr. David Fassler, a clinical professor of psychiatry at the University of Vermont College of Medicine.

"For this reason, I would fully agree with the authors' conclusion that the results of the study underscore the need for earlier recognition and treatment of ADHD in young children," Fassler said.

The study, published online Sept. 29 in the journal Pediatrics, is one of the first reports from the Children's Attention Project, a long-term examination of ADHD funded by the Australian government.

The researchers tested nearly 400 children between 6 and 8 years of age at 43 Melbourne schools, identifying 179 with ADHD and another 212 without ADHD who will serve as a "control group." These children will be observed throughout their academic careers.

By the second grade, the children with ADHD were already struggling. They were more likely to score below-average in reading and mathematics, and more likely to have problems connecting socially with their peers, the researchers said.

For example, 33 percent of kids with ADHD were reading below average and 46 percent had math skills below average. For non-ADHD kids, only about 6 percent were reading below average and nearly 15 percent had below-average math skills, the researchers found.

And the ADHD children were more likely to have other mental health or developmental problems -- such as anxiety, obsessive-compulsive disorder, depression, mania and autism, said Efron, who's also a senior lecturer at the University of Melbourne.

"Some people think it's only when kids get older you can pick up these comorbidities [overlapping health issues]. But we've shown you can pick them up at this early stage if you are looking for them," he said.

What's more, these problems seem to accumulate in some kids with ADHD, with 30 percent having two such impairments and 24 percent having three. By comparison, about 6 percent of non-ADHD kids had two such impairments, and about 1 percent had three, according to the study.

The investigators found that boys and girls with ADHD were equally impaired by the disorder.

"There hasn't been that much research into girls with ADHD, so we don't know that much," Efron said. "When we do see girls, in my experience, they are as impaired as the boys. But it is a novel research finding."

In another study published in the same issue of Pediatrics, researchers presented disappointing results for a drug that some had hoped would ease the insomnia experienced by many children with ADHD.

The drug, eszopiclone, failed to help children aged 6 to 17 with their ADHD-related insomnia. Both low and high doses of the drug proved ineffective, the researchers found.

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Language problems more common in children with ADHD

A study found that children with ADHD are more likely to have language problems.

Children who have attention-deficit/hyperactivity disorder are nearly three times more likely to have language problems than kids without ADHD, according to new research.

And those language difficulties can have far-reaching academic consequences, the study found.

The study, published online April 21 in Pediatrics, looked at 6- to 8-year-olds with and without ADHD in Australia.

"We found that 40 percent of children in the ADHD group had language problems, compared to 17 percent of children in the 'control' group," said Emma Sciberras, a clinical psychologist and post-doctoral research fellow at the Murdoch Children's Research Institute in Victoria, Australia. "Rates of language problems were similar in boys and girls with ADHD," she added.

Children with ADHD commonly have trouble with school performance and social functioning. The impact that language problems might have on these factors hasn't been well-studied, the study authors noted.

"The differences in academic functioning between children with ADHD and language problems, compared to those with ADHD alone, were quite large and clinically meaningful," said Sciberras.

Language problems refer to spoken language -- both receptive and expressive language. Receptive language is the ability to listen and understand what's being said; expressive is the ability to speak and be understood.

In a separate study in the same issue of the journal, Sciberras and her colleagues looked at almost 400 children with ADHD, aged 5 to 13, and found almost two-thirds had one or more anxiety disorders.

When children with ADHD had two or more anxiety disorders -- this was true for one-third of the kids -- their quality of life, behavior and daily functioning suffered, the researchers said.

"It is very common for children with ADHD to experience additional difficulties," said Sciberras. "Both of these studies demonstrate that the additional difficulties that go along with ADHD, in this case anxiety and language problems, can make daily functioning even harder for children with ADHD."

The language study included 179 children diagnosed with ADHD and 212 without the attention disorder. Fewer than half of the children with ADHD were taking medications to help control their symptoms.

After adjusting for sociodemographic factors and other conditions, such as autism spectrum disorders, the researchers found that the risk of language problems was 2.8 times higher in children with ADHD.

When the researchers looked at how those language problems affected school work, they found lower math, reading and academic scores.

However, the researchers didn't find that language problems had an impact on social functioning.

"We were surprised that language problems were not associated with poorer social functioning for children with ADHD," Sciberras said. "It could be that children with ADHD are already experiencing poorer social functioning due to other factors including their ADHD symptoms or other associated difficulties."

However, Sciberras cautioned that language troubles might become more problematic as these kids get older because social relationships get more complex with age.

One outside expert said the study is a good reminder for parents and physicians.

"If a child has ADHD and they're struggling in school, even though their ADHD symptoms are well-controlled, in addition to getting tested for learning disabilities, they should also be looked at for language difficulties as well. And that's not something we always think of," said Dr. Bradley Berg, medical director of McLane Children's Pediatrics at Baylor Scott & White Healthcare in Round Rock, Texas.

Whether speech-language interventions will help the youngsters with ADHD isn't clear, however.

Berg also pointed out that this issue is a "chicken-and-egg" problem. "Do these kids have a language disorder that's causing them to not understand what's going on at school and that's making them restless and fidgety because they're bored. Or do they have ADHD and that's causing difficulty understanding the language. Or is there something going on in an area of the brain that creates both of these problems?" he said. "We don't know."

It's possible that the findings from this Australian study might not translate to a U.S. population. For one thing, medication trends might differ, Berg said.

For children with ADHD who also suffer anxiety, Sciberras said medications might help, and a type of psychotherapy called cognitive behavioral therapy could also be useful. The researchers are currently conducting a study to treat anxiety in children with ADHD.

"If parents are concerned that their child with ADHD has anxiety, language or any other additional difficulties that are not currently being managed, we encourage them to discuss their concerns with their child's treating clinician," she said.

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Social skills could suffer after head injuries in children

A study shows that after children have a head injury, their social skills could suffer.

Serious head injuries may be linked to children's lack of ability to interact with others, a new study indicates.

Researchers looked at a group of children who had suffered a traumatic brain injury three years earlier, most often in car crashes.

Those with lingering damage in the brain's frontal lobes had lower-quality social lives, according to the Brigham Young University (BYU) study in the April 10 issue of the Journal of Head Trauma Rehabilitation. The study did not determine a cause-and-effect relationship, only an association.

"The thing that's hardest about brain injury is that someone can have significant difficulties but they still look OK," neuropsychologist and study author Shawn Gale said in a university news release.

"But they have a harder time remembering things and focusing on things as well, and that affects the way they interact with other people. Since they look fine, people don't cut them as much slack as they ought to," Gale explained.

The researchers found that the problem may be something called cognitive proficiency, a combination of short-term memory and brain-processing speed.

"In social interactions we need to process the content of what a person is saying in addition to simultaneously processing nonverbal cues," study co-author Ashley Levan, a doctoral student at BYU, said in the news release. "We then have to hold that information in our working memory to be able to respond appropriately. If you disrupt working memory or processing speed, it can result in difficulty with social interactions."

Attention-deficit/hyperactivity disorder also affects the frontal lobes, and previous research has shown that therapy can improve working memory in children with ADHD.

"This is a preliminary study, but we want to go into more of the details about why working memory and processing speed are associated with social functioning and how specific brain structures might be related to improve outcome," Gale said.

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Families with autistic children see benefits from dog ownership

A study found that dog ownership is extremely beneficial for children with autism.

Many families face the decision of whether to get a dog. For families of children with autism, the decision can be even more challenging. Now, a University of Missouri researcher has studied dog ownership decisions in families of children with autism and found, regardless of whether they owned dogs, the parents reported the benefits of dog ownership included companionship, stress relief and opportunities for their children to learn responsibility.

"Children with autism spectrum disorders often struggle with interacting with others, which can make it difficult for them to form friendships," said Gretchen Carlisle, aresearch fellow at the Research Center for Human-Animal Interaction (ReCHAI) in the MU College of Veterinary Medicine. "Children with autism may especially benefit from interacting with dogs, which can provide unconditional, nonjudgmental love and companionship to the children."

Carlisle interviewed 70 parents of children with autism. Nearly two-thirds of the parents in the study owned dogs, and of those parents, 94 percent reported their children with autism were bonded to their dogs. Even in families without dogs, 70 percent of parents said their children with autism liked dogs. Many dog-owning parents said they specifically chose to get dogs because of the perceived benefits to their children with autism, Carlisle said.

"Dogs can help children with autism by acting as a social lubricant," Carlisle said. "For example, children with autism may find it difficult to interact with other neighborhood children. If the children with autism invite their peers to play with their dogs, then the dogs can serve as bridges that help the children with autism communicate with their peers."

Parents of children with autism should consider their children's sensitivities carefully when choosing a dog in order to ensure a good match between pet and child, Carlisle said.

"Bringing a dog into any family is a big step, but for families of children with autism, getting a dog should be a decision that's taken very seriously," Carlisle said. "If a child with autism is sensitive to loud noises, choosing a dog that is likely to bark will not provide the best match for the child and the family. If the child has touch sensitivities, perhaps a dog with a softer coat, such as a poodle, would be better than a dog with a wiry or rough coat, such as a terrier."

Carlisle recommends parents involve their children with autism when choosing a dog.

"Many children with autism know the qualities they want in a dog," Carlisle said. "If parents could involve their kids in choosing dogs for their families, it may be more likely the children will have positive experiences with the animals when they are brought home."

Although her study only addressed dog ownership among families affected by autism, Carlisle said dogs might not be the best pet for every child with autism.

"If you know one child with autism, you know one child with autism," Carlisle said. "Dogs may be best for some families, although other pets such as cats, horses or rabbits might be better suited to other children with autism and their particular sensitivities and interests."

"This research adds scientific credibility to the benefits of human-animal interaction," said Rebecca Johnson, a professor at the MU College of Veterinary Medicine, director of ReCHAI, and the Millsap Professor of Gerontological Nursing in the MU Sinclair School of Nursing. "This research helps us understand the role of companion animals in improving the lives of children with autism and helps health professionals learn how to best guide families in choosing pets for their families."

The study, "Pet Dog Ownership Decisions for Parents of Children With Autism Spectrum Disorder," was published in the Journal of Pediatric Nursing earlier this year.

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Too much TV hurts children's chances at kindergarten success and social skills

This study claims that extra TV time beyond recommendations hurts children's chances for kindergarten readiness and certain social and developmental skills.

Every hourly increase in daily television watching at 29 months of age is associated with diminished vocabulary and math skills, classroom engagement (which is largely determined by attention skills), victimization by classmates, and physical prowess at kindergarten, according to Professor Linda Pagani of the University of Montreal and the CHU Sainte-Justine children's hospital.

"This is the first time ever that a stringently controlled associational birth cohort study has looked at and found a relationship between too much toddler screen time and kindergarten risks for poor motor skills and psychosocial difficulties, like victimization by classmates," Pagani said. "These findings suggest the need for better parental awareness and compliance with existing viewing recommendations put forth by the American Academy of Pediatrics. The AAP discourages watching television during infancy and recommends not more than two hours per day beyond age 2. It seems that every extra hour beyond that has a remarkably negative influence."

Pagani conducted the study to discover the effect of television viewing prior to kindergarten. He said, "Much of the research on school readiness has focused on how kindergarten characteristics predict later success. Kindergarten entry characteristics predict long-term psycho-social adjustment and economic characteristics like income and academic attainment. Being innovative, my focus has been to examine what predicts kindergarten entry characteristics. Adding further originality, I also wanted to focus on neglected yet crucial aspects of school readiness such as motor skills, which predict later physical activity and reading skills, likelihood of being "picked-on," which predict social difficulties, and skills at linked to doing what you are supposed to be doing when having been given instructions, which are in turn linked to attention systems that are regulated by the brain's frontal lobe development."

991 girls and 1006 boys in Quebec whose parents reported their television viewing behaviour as part of the Quebec Longitudinal Study of Child Development.

One extra hour of TV

Pagani noted that the standard deviation is a commonly used statistic tool that tells us what is within a normal range compared to the average. One standard deviation from the average daily amount of television viewed by the toddlers in this sample (105 minutes) is 72 minutes. Some of the children who participated in the study were two or even three standard deviations away from the average, and their kindergarten indicators were correspondingly worse than those who were one standard deviation away.

This study only looks at the most common form of screen time, which is in the home. However, it may be an underestimate because many child care settings use television as an activity during care giving.

Pagani said that "because of kindergarten's power to predict future productivity, the identification of modifiable factors that foretell not being ready for the transition to formal schooling represents an important goal for a productive society. By statistical standards, the results show highly controlled modest associations, yet these are net effects which suggest a developmental course which could ultimately compromise achievement, social relations, physical prowess, and preferences and habits toward a healthy lifestyle."

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