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New URMC Studies Search for What Autism Treatments Work

$3.25M in Grants Look at ADHD and Language in Children with Autism

Thursday, August 06, 2009

There are dozens of treatment options for children with autism, but it’s difficult for parents to choose one for their children because so many haven’t been scientifically studied. University of Rochester Medical Center (URMC) researchers are working to give families a better idea of what might work best for their children.

Two recent National Institutes of Health grants to URMC, totaling more than $3.25 million, are aimed at finding effective ways of addressing hyperactive behaviors and language development in children with autism.

“These grants acknowledge the University of Rochester Medical Center as a center for studying behavioral treatment options for children with autism spectrum disorders. For local families, this gives them the opportunity to participate in cutting-edge research. Dr. (Tristram) Smith will be studying the delivery of educational and behavioral interventions for young children with ASD (autism spectrum disorders) in the most efficient and effective manner possible,” said Susan Hyman, M.D., chief of URMC’s Division of Neurodevelopmental and Behavioral Pediatrics. “For families, world-wide, it gives them hope that we will help find the best interventions for their children with ASD to reach their fullest potential."

Children with ASD often also exhibit symptoms of attention deficit hyperactivity disorder (ADHD), but many don’t respond well to stimulants, which comprise the most commonly used ADHD medications. URMC’s Department of Pediatrics has teamed up with the University of Pittsburgh and Ohio State University to determine whether a non-stimulant ADHD medication or parent training or a combination of both work best for children with ASD and ADHD.

“This is important work because, right now, we don’t really know what to do for children with both autism and ADHD,” said Tristram Smith, Ph.D., associate director for Research of the Division of Neurodevelopmental and Behavioral Pediatrics and the Strong Center for Developmental Disabilities. “Some of these children have a lot of ADHD behaviors and the medications that have traditionally worked best for children with only ADHD often don’t help children who also have autism.”

The $1.386 million, five-year grant from the National Institutes of Health’s National Institute of Mental Health will allow the study to enroll 144 children from 5- to 13-years-old across the three sites. The University of Rochester’s Golisano Children’s Hospital has already enrolled five and anticipates enrolling 43 more.

The results should go a long way to helping parents, doctors and autism specialists determine the best course of treatment for children with both ASD and ADHD, potentially setting up a standard of care, Smith said.

URMC received a separate grant to address severe language delays in children with autism. Typically developing preschoolers usually know a thousand words and can speak in full sentences by 3-years-old. Many children with autism lag behind their typically developing peers, but a smaller subset of these children develop no words at all by preschool.

Smith and his colleagues at several partnering institutions are looking at whether these children are best taught through a standard behavioral approach or through an interpersonal, developmental approach. The differences between the approaches are subtle but could significantly influence how a child develops. There is some question about whether children who learn through the standard approach are only memorizing typical interactions expected of them or if they are truly connecting with other people. The interpersonal approach works to find natural teachable moments that arise during social exchanges in which children can acquire and use new skills.

For example, in standard training, the teacher sits the child down in a chair and instructs the child over multiple sessions to imitate a word spoken by a teacher such as “baby.” After the child masters this skill, the teacher spends many more sessions instructing the child to say the word when the teacher holds up a baby doll and asks, “What is it?” In the interpersonal approach, the child is given an opportunity to play. The child might reach for a baby doll during play times. Over many sessions, the teacher works on playing a variety of games with the doll together with the child and encourages the child to identify the doll as “baby” during these games.

“We aren’t sure which method would work best with these children. Obviously children who haven’t learned to speak by 3-years-old are already far behind most children without autism, so we can’t waste time with them trying to figure out what will help them most. We need to know what method is most successful and start it as early as possible,” Smith said.

The $1.87 million, five-year grant incorporates URMC,University of California - Los Angeles and the Kennedy Kreiger Institute and expects to enroll 192 preschool-age children across the three sites. URMC will begin recruiting patients early in 2010 with the help of local early intervention agencies, such as Stepping Stones Learning Center in Irondequoit and KidStart in Geneseo.

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