Personalized interventions help autistic children

Personalized interventions help improve communication in children with autism.

A UCLA-led study has found that the communication skills of minimally verbal children with autism can be greatly improved through personalized interventions that are combined with the use of computer tablets.

The three-year study examined different approaches to improving communication abilities among children with autism spectrum disorder and minimal verbal skills. Approximately 30 percent of children with ASD overall remain minimally verbal even after years of intervention.

UCLA professor Connie Kasari, the paper's senior author, worked with researchers at Vanderbilt University and the Kennedy Krieger Institute. They found that children's language skills greatly improved when spoken- and social-communication therapy was tailored based on their individual progress and delivered using computer tablets.

The trial involved 61 children with ASD, ages 5 to 8. For six months, each child received communication therapy focusing on social communication gestures, such as pointing, as well as play skills and spoken language.

Half of the children were randomly selected to also use speech-generating applications on computer tablets for at least half of the time during their sessions. The tablets were programmed with audio clips of words the children were learning about during their therapy sessions and images of the corresponding objects. Working with a therapist, the child could tap a picture of a block, for example, and the tablet would play audio of the word "block." The researchers found that children who had access to the tablets during therapy were more likely to use language spontaneously and socially than the children who received the communication intervention alone -- and that incorporating the tablets at the beginning of the treatment was more effective than introducing it later in the therapy.

"It was remarkable how well the tablet worked in providing access to communication for these children," said Kasari, professor of human development and psychology in the UCLA Graduate School of Education and professor of psychiatry at UCLA's Semel Institute for Neuroscience and Human Behavior. "Children who received the behavioral intervention along with the tablet to support their communication attempts made much faster progress in learning to communicate, and especially in using spoken language."

Researchers also conducted follow-up visits with the children three months after the initial study period and found that their improvement had been maintained during that time. The study was the first ASD research to use a sequential multiple assignment randomized trial, or SMART, design. The approach, which enables researchers to tailor interventions according to how each child in the study responds, was designed by Daniel Almirall and Susan Murphy, biostatisticians at the University of Michigan who were members of the research team. It also was the first randomized, controlled trial on this underserved population of children to use a computer tablet combined with an effective behavioral intervention.

Other study authors were Rebecca Landa of Kennedy Krieger and Johns Hopkins University, and Ann Kaiser of Vanderbilt. The study was funded by a High Risk High Impact grant from the Autism Speaks Foundation.

The findings were published in the June issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

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iPad access could help children with autism speak

A study shows that iPad access may help speaking skills for children with autism.

Adding access to a computer tablet to traditional therapy may help children with autism talk and interact more, new research suggests.

The study compared language and social communication treatment -- with or without access to an iPad computer tablet -- in 61 young children with an autism spectrum disorder (ASD) and found that the device helped boost the effect of the treatment.

"All the children improved, but they improved more if they had access to the iPad," said Connie Kasari, professor of human development and psychology and psychiatry at the University of California, Los Angeles' Semel Institute for Neuroscience and Human Behavior.

The children used the iPad when they were engaged in play, she said. "It focused on helping them initiate conversation, using the iPad to comment on what they were doing. The iPad worked because it is a visual stimulant with auditory feedback," she explained. For instance, children would mispronounce a word, hear it pronounced correctly on the iPad, and then learn to say it correctly, she said.

But, Kasari emphasized, "The iPad is just a tool." It worked because it was used within a treatment aimed at helping improve the children's communication skills, she noted.

The study was published in the June issue of the Journal of the American Academy of Child & Adolescent Psychiatry. Autism Speaks, a research and advocacy organization, funded the study.

Autism spectrum disorders are a group of developmental disorders. Communication and social problems are hallmarks of ASDs. As many as one in 68 U.S. children has an autism spectrum disorder, according to estimates from the U.S. Centers for Disease Control and Prevention.

Children in the study were between the ages of 5 and 8. All were considered "minimally verbal," which experts define as speaking fewer than 20 functional words, Kasari said. "The majority had far fewer." About 30 percent of children with an autism spectrum disorder are minimally verbal, she said, sometimes even after years of treatment.

For the first three months, all of the children received two sessions a week, totaling two to three hours a week. At the three-month mark, nearly 78 percent of children in the iPad-added group had an early response, but just 62 percent of those in the group without it did, the investigators found.

An early response was defined as an improvement of 25 percent or more in half of the 14 measures, such as the number of spoken words and the use of new words, Kasari said.

If a child was not progressing at the three-month mark, the researchers added the tablet. But adding it later was not as effective as using it from the start, Kasari's team found. The researchers followed the children for three years.

"The idea of using an iPad is a novel approach," said Dr. Ruth Milanaik, an attending physician at the Cohen Children's Medical Center in New Hyde Park, N.Y. Milanaik treats children with autism and reviewed the study's findings.

"The idea of technology being used to help children who really need different approaches is so important," she said. It's crucial, however, she agreed, to understand that the iPad "was simply a tool" and that it was an adjunct to the traditional interventions that aimed to improve communication and other developmental advances.

While a 25 percent improvement -- the measure used to define response -- may not seem like much to some, Milanaik said that "every small step, for the parents of an autistic child, is monumental."

Kasari and her team are continuing to study the iPad, planning to enroll about 200 children in four cities during a planned five-year study.

If the research continues to bear out, the hope would be to use the iPads in school programs and to train parents in its use at home, both experts agreed.

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Technology hurting your sleep

Light from phones, tablets and computers can interfere with a person's natural melatonin production and interfere with sleep.

Smartphones and tablets can make for sleep-disrupting bedfellows. One cause is believed to be the bright light-emitting diodes that allow the use of mobile devices in dimly lit rooms; the light exposure can interfere with melatonin, a hormone that helps control the natural sleep-wake cycle. But there may be a way to check your mobile device in bed and still get a good night's sleep. A Mayo Clinic study suggests dimming the smartphone or tablet brightness settings and holding the device at least 14 inches from your face while using it will reduce its potential to interfere with melatonin and impede sleep.

The research was among Mayo Clinic studies being presented at SLEEP 2013, the Associated Professional Sleep Societies annual meeting in Baltimore.

"In the old days people would go to bed and read a book. Well, much more commonly people go to bed and they have their tablet on which they read a book or they read a newspaper or they're looking at material. The problem is it's a lit device, and how problematic is the light source from the mobile device?" says co-author Lois Krahn, M.D., a psychiatrist and sleep expert at Mayo Clinic in Scottsdale, Ariz.

"There's a lot of concern about using mobile devices and that prompted me to wonder, are they always a negative factor for sleep?" Dr. Krahn says. "We found that only at the highest setting was the light over a conservative threshold that might affect melatonin levels. If it's at the mid setting or at a low setting it's bright enough to use."

In the study, researchers experimented with two tablets and a smartphone in a dark room, using a meter on its most sensitive setting to measure the light the devices emitted at various settings when held various distances from a person's face. They discovered that when brightness settings were lowered and the devices were held just over a foot from a user's face, it reduced the risk that the light would be bright enough to suppress melatonin secretion and disrupt sleep.

Other Mayo research presented at the conference includes the finding that some sleep apnea patients may not need annual follow-up visits. Patients with obstructive sleep apnea being treated with positive airway pressure are less likely to need a yearly check-up.

The researchers suggest developing a screening tool to assess which of these patients need annual follow-up visits.

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