Oxytocin for autism spectrum disorders

by Benison O'Reilly on Wednesday, June 30th, 2010

As reported in the latest issue of Aspects magazine from Autism Spectrum Australia, there is some interesting autism research happening in my home town, Sydney.

The Centre for Autism Research, Evaluation, and Service (CARES), at the Brain & Mind Research Institute, recently conducted a small study to determine whether oxytocin nasal spray could enhance emotion understanding in high-functioning teenage males with an ASD.

As you probably know, oxytocin is often called the ‘hormone of love’.  Although best known for its role in facilitating labour, delivery, and breast-feeding, it is also important in promoting trust, love, and social recognition.

In this double-blind*, randomised trial, oxytocin nasal spray or a placebo was administered as a single dose to each of 16 participants in a cross-over design, and their performance was assessed using a standard test of emotion recognition, the Reading the Mind in the Eyes Task. The researchers found oxytocin nasal spray improved emotion recognition compared with placebo, and the results were published in the April 1 2010 issue of Biological Psychiatry.¹

Inspired by this success, the researchers now wish to determine whether oxytocin nasal spray can improve long-term social function in ASD, and hence be used as a treatment for autism. Recruitment is underway for a new trial involving males aged 12 to 18 with ASDs. Participants will use oxytocin spray or a placebo twice a day for eight weeks, with social function  assessed before, immediately after, and three months following completion of the trial.

CARES is looking for males aged 12–18 years with an ASD to participate in the trial. If you know anyone who may be interested they should contact the Brain & Mind Research Institute on (02) 9351 0881 or email: autismcares@med.usyd.edu.au.

Unfortunately my little guy, Joe, is too young for the current trial, but once this study is completed—and if improvements are found—trials in different age groups and females will be conducted. Let’s keep our fingers crossed for a good outcome.

*A trial in which neither the participants nor the researchers know who is receiving the active drug and who is receiving placebo.

1. Guastella AJ, Einfeld SL, Gray KM, Rinehart NJ, Tonge BJ, Lambert TL, Hickie IB. Intranasal oxytocin improves emotion recognition for youth with autism spectrum disorders. Biological Psychiatry 2010;67:692-694

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The gluten-free casein-free diet in autism revisited

by Benison O'Reilly on Wednesday, June 23rd, 2010

In the Australian Autism Handbook, published a couple of years ago now, we discuss the gluten-free casein-free (GFCF) diet and the evidence for its use in ASDs.

We include mention of an ongoing— at that time—double-blind randomised controlled trial (RCT):

Currently the US National Institute of Mental Health (NIMH) is supporting a double-blind RCT to study the effectiveness and safety of GFCF diet. Thirty children following a GFCF diet will either be challenged with snacks which contain gluten and casein or receive identical placebo snacks. All children in the study will be receiving intensive behavioural intervention so that the effects of their early intervention program cannot influence the results. Researchers will try to identify the characteristics of children who are responders and the nature of that response. You can read about this trial at: http://clinicaltrials-nccs.nlm.nih.gov

Well, the preliminary results of that trial are now in and were presented at the recent International Meeting for Autism Research (IMFAR), held last month in Philadelphia. Unfortunately we only have an abstract to go on, and should probably reserve complete judgement until the full published paper is available for review, but this is a summary of  the research:

Children aged 30-54 months, receiving at least 10 hours/week of early intensive behavioural intervention (EIBI) were recruited. They were screened for milk/wheat allergies, coeliac disease, and anaemia prior to starting treatment.

After a strict GFCF diet for at least 4 weeks, they received weekly randomised, double-blind challenges (snacks) containing either 20 g wheat flour, 20 g evaporated milk, both, or neither on three separate occasions over 12 weeks . The snacks appeared identical and were similar in taste and texture.  Behavioural and other data was collected at baseline and at regular intervals throughout the 30-week trial; as well as prior to, and two and 24 hours after, the snack challenges.

In the end twenty one children were recruited. Of these, seven were eventually excluded from the analysis for medical or other reasons, leaving only 14 participants (12 male), with an average age of just over three and half years.

The researchers found no statistical change in frequency or quality of stools, sleep, activity measured by actigraphy*, or parent/teacher/observer scores of attention or activity when children’s baseline (before diet) measures were compared with treatment (during diet) measures. Nor did they detect any changes pre/post the gluten and/or casein challenges. In fact, one group measure of behaviour** actually improved 2 hours-post gluten &/or casein challenge, although in light of the small patient numbers this might be a chance finding.

The authors concluded:

This is the first study to examine the behavioral effects of a nutritionally monitored GFCF diet on attention, sleep, stool pattern, and core symptoms of ASD. While no favorable effects of the GFCF diet on attention, sleep and stool patterns were identified in group analyses, such effects may occur for individuals or for subgroups of children   (e.g. with significant GI disease), providing the basis for positive anecdotal reports.  Future studies need to address the potential effects of nutrition on behavior in children with ASD and be powered to evaluate subtle changes in core symptoms.

The abstract is available below:

http://imfar.confex.com/imfar/2010/webprogram/Paper6183.html

This is the second double-blind study to find no effect for the GFCF diet in young children with ASD. It may be, as the authors say, that there is a subgroup of children—possibly those with significant gastrointestinal symptoms—who do benefit dramatically from the diet, and more trials with greater patient numbers are clearly needed.  Nonetheless this adds to the body of evidence that not all kids on the autism spectrum will respond to the GFCF diet.

Those who are interested might also want to check out the latest Cochrane Review of the GFCF diet, updated in 2009 but prior to presentation of this latest study:

www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003498/frame.html

*According to Wikepedia, actigraphy is a relatively non-invasive method of monitoring human rest/activity cycles, commonly using a wrist-watch-like package. The unit continually records movements, which are later analysed by computer.

** The Ritvo Freeman Real Life Rating Scales (RFRLRS). This scale was developed to assess effects of treatment on 47 recognised behaviours of patients with autism. It is applicable in natural settings & can be used by nonprofessional raters.

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Two Useful Teachers’/Professionals’ Resources

by Seana Smith on Thursday, June 17th, 2010

I’ve heard of some terrific learning resources recently and want to share here two which are particularly useful for teachers and speech pathologists.  They’re also of interest to families too, so do read on.

1.   The first is the Jill Sherlock Memorial Learning Assistance Library.  This is a library which provides resources and equipment to schools and families all over NSW for their children with learning difficulties.   The library is run jointly by the NSW Department of Education and Training and the Jill Sherlock Memorial Trust.

On its website it describes itself thus: “This state facility provides resources to teachers, allied professionals, parents and others who support the teaching and learning needs of students with learning difficulties in the context of syllabus and curriculum requirements.”

For teachers and for parents this is a very handy resource, you can browse the catalogue online and can also get in touch to ask advice of a specialist librarian.

http://www.sherlocklibrary.det.nsw.edu.au/

With apologies, I have to admit this library is for those in NSW only, but I thought it’s worth telling everyone about – maybe there are similar libraries in other states.  And if now, why not?  Time to pester the your Dept of Ed into setting one up!

2.  Social Times The second item comes from the USA, from the Autism Aspgerger Publishing Company. This is a magazine called “Social Times” which is produced nine times each school year and which deals with the sorts of social issues our children need to practise.

The magazine is aimed at teachers and others who are running social skills groups.  You need to buy it in batches of 10 copies.

The writing is gaimed directly at young people, the magazines are bright and colourful, they wouldn’t look out of place at all to young people.  Topics include:  Giving and Receiving Compliments, What Does Embarassment Mean?, Body Language- a Must Read, Fixing Social Bloopers and Giving the Right Gift.

These magazines seem a marvellous resource, do have a look at the website which has heaps of information and a free downloadable copy.

http://www.asperger.net/social_times/index.htm

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Childhood allergies – how can they be prevented

by lisaguy on Friday, June 11th, 2010

Allergic diseases have almost doubled over the last 25 years. We are seeing an increasing prevalence in childhood allergies such as eczema, hay fever, asthma and food allergies.

Scientists have different theories as to why this is happening. Recent findings from the University of Montreal, attributed excessive cleanliness to the increase in childhood allergies. Apparently the more sterile a child’s environment the greater the risk of them developing allergies.

Over sterilizing a child’s environment not only kills off harmful bacteria but beneficial microorganisms that help build a diverse range of intestinal flora.

A healthy balance of intestinal flora is needed for a strong immune system, proper digestion, and synthesis of B vitamins and vitamin K. Without this children are at a greater risk of developing allergic conditions.

What early measures can we take to reduce the risk of children developing allergies?

PROBIOTICS: Probiotics contain beneficial bacteria that help enrich baby’s intestinal flora, strengthening their immune system and reducing the risk of allergies. Mothers consuming probiotics during pregnancy can also help reduce allergies in childhood.

BREASTFEEDING: Breastfeeding for at least 6 months and ideally for 1-2 years reduces the risk of baby developing allergies. Breast milk is rich in important immune boosting factors to protect baby against a number of infections and diseases.

WEANING: Introducing solids too early can increase the likelihood of your baby developing allergies or food intolerances. Before 6 months of age infants are less likely to handle immune challenges from new foods as their intestinal flora and metabolism are underdeveloped.

FOODS: Common food allergies seen in children are milk, wheat, gluten, eggs, soy and peanuts. Allergies have a strong genetic link, so if there is a family history of a food allergy wait until your child is over one year old before introducing that food.

By following these helpful tips you can help reduce the risk of your child developing allergies.

Wishing you all good health,
Lisa.

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A window into autism?

by Benison O'Reilly on Thursday, June 10th, 2010

On Tuesday night, after the homework was done and the dinner eaten, and I was washing up before sitting down to write my next blog (which I planned to be about the latest research on the gluten-free casein-free diet)—kapow!—our electricity went off.  There were howls of protest from eldest son, who was on Facebook, and middle son, who was playing his new X-Box 360, and Joe, who was just about to have a bath.

It turned out to be a blackout.

Fortunately we were well equipped with lanterns, torches and candles. Joe and his dad are used to these situations, being experienced campers. We also had our wonderful gas fire to keep us warm, but no electronic games, TV or Internet.

It went on for almost three hours in the end.  We all sat by the fire, me sipping a consoling glass of red wine. Joe played with his ever-expanding Super Mario collection & talked about his toys with his brothers. Then, we he went to bed, big brothers sat down & had a proper conversation with me (although by this stage the biggest one was dreadfully missing his Facebook).

I was telling big boys that they may as well go to bed – that clearly we weren’t going to have any electricity restored that night, when—bang!—everything came back on:  lights, computers, clocks, the lot.

And I developed a sensory processing disorder.   All the noise and light were completely overwhelming after hours of candles and conversation and warm fires. I retreated to the calm of my bedroom.

So, for a brief few minutes, I think I experienced what it is like for many people on the autism spectrum all the time. I’m not saying everyone with an ASD has sensory processing issues–I refuse to generalise to that extent—but from my reading of books by adults with ASD it seems to be an extremely common experience.   It also makes sense that it would be common, if we believe the latest theories that autism is a largely a disorder of neural connectivity.

Anyway— just possibly, maybe—I was granted a small window of enlightenment into what many people with ASD have to endure every day and I’m telling you it wasn’t fun.  These people deserve our respect for just exiting the front door each morning.

I will write about the GFCF diet in my next blog, by the way, but in the meantime thought some of you might want to check out a new blog, written by a mum, Suz, whose little boy was only recently diagnosed with an ASD. Best wishes to Suz and her family and particularly Batsman – he sounds a real cutey.

http://www.theiloveyousong.blogspot.com/

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Mood Surfing Workshop – I need it!

by Seana Smith on Wednesday, June 2nd, 2010

ASPIA's website

Have you heard of ASPIA? As far as I am aware (corrections welcome) ASPIA is the only organisation in Australia providing support and information for those living with a partner who has Asperger’s Syndrome.  ASPIA is based in Sydney and it runs some terrific workshops and information sessions.

The next workshop is to be presented by Clinical Psychologist Dr Julie Peterson, who runs the Embracing the Other Half Psychology Clinic in Sydney.  It is called:

“Mood Surfing:  The Art of Emotion Regulation” Challenges and Interventions.”

Here’s what the flyer says:

Individuals in everyday life regularly experience both strong positive and negative emotions within themselves and those around them. While strong emotions themselves are not inherently bad and often serve a very important role in our daily lives, the over-expression of strong emotion can at times be confronting, challenging, terrifying and exhausting for all involved if emotions are not regulated well.

Emotions often take on a wave like quality with some individuals experiencing larger and more frequent waves. Unfortunately, without the appropriate knowledge, skills and strategies many individuals, couples and families find themselves being dumped or drowned by the waves. This is particularly so for individuals with Autism Spectrum Disorders, ADHD and other significant mood disorders.

This workshop incorporates the latest neuroscience and clinical research in the area of emotion regulation and covers the essential knowledge and skills needed to surf, negotiate, ride and survive emotional waves.

This is a workshop I really need to attend as we are currently having all sorts of challenges and I certainly need some assistance with interventions.  Here’s an example:

My son Tom is 13 years old now and he has discovered girls and is most interested in the entire topic.  In fact, he has a huge crush on one girl.  He gets incredibly agitated when he thinks and talks about her, his emotions explode, he can’t keep still and needs to jump around. Tom’s language skills certainly can’t keep up with his emotions and it’s clear that this adds to his frustration.

I’m sure most 13 year old boys don’t discuss their crushes the way Tom does with me, but he just cannot contain himself.  He is a seething mass of hormones and emotions- a very volatile mixture.

Having a lovestruck teenager in the house has made the decades crash away and I can vividly recall my own feelings as a teenager, when I was first succumbing to the charms of the opposite sex.  (Sadly my first crush never succumbed to mine and gave me up so he could spend more time with his ferrets.)

I, too, was a wreck… but I kept it inside most of the time, and certainly didn’t give my mum a blow-by-blow account of the gory emotional details.

Tom had been sending a text to the (oblivious) object of his emotional explosions one evening and was all a’flutter and then dashing about the house…. I made the silly error of then suggesting he get on with some homework… he really did explode and in fact I thought he was going to land a huge punch on me.

Well, I wouldn’t really have blamed him.  I chose the worst possible moment to discuss homework.

Anyway, oh dear… teeangers with ASD plus hormones plus a love interest… a mere mum can’t be expected to cope alone.  I need that workshop!

If anyone reading has information about similar organisations and workshops, please do pass them on and we will add them to the archives here.

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