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Diagnosing and treating autism is a complex process that requires assessment of many factors. Evaluations of children's sensory (sight, sound, smell, touch and taste) processing functions are often conducted as part of a multidisciplinary assessment. However, new research suggests that, because children with autism are unlikely to properly self-report their experiences, interviewing their parents may add important information to help families understand and better respond to the needs of their children, thereby easing challenges in daily routines.

This method – called the Critical Incident Technique – asks parents to determine situations where their child had a "good" sensory experience, situations where their child had a "bad" sensory experience and provide their own perception of how these experiences felt to the child.

According to the study conducted by University of North Carolina at Chapel Hill researchers published in the latest issue of the American Journal of Occupational Therapy, the most common negative reactions for both typically-developing children and children with autism are related to sound, and the most common pleasant experiences for both groups involve touch and movement. Children with autism were reported to have more "unusual" sensory experiences and negative food-related experiences than their typically-developing peers.

"The ability of parents or other caregivers to adapt to their child's sensory processing problems can influence the number, type or quality of shared experiences, both in a positive and negative way, and may facilitate or constrain engagement in daily family routines," says study co-author Dr. Grace T. Baranek, professor in the Division of Occupational Science at The University of North Carolina at Chapel Hill. "Qualitative studies like this one can add to our knowledge of both autism and the sensory processing issues associated with it."

In the study, a higher percentage of children with autism (59 percent) interpreted various sounds as unpleasant sensory experiences compared to typically-developing children (28 percent). Loud and unexpected sounds, such as fire alarms, dogs barking and fireworks, were the most common examples. In some cases, unpleasant sounds were predictable and both parents and children took measures to avoid or control the experience. Children expressed their discomfort with particular sounds in a number of ways, from stating they didn't like the sound to covering their ears.

Parents tried to make sense out of their children's responses to sound. "Being able to understand what bothers a child, and under what circumstances, makes it possible for the parent to avoid the situations, prepare the child or employ other strategies to diminish the impact on the child," says Dr. Baranek.

Touch as a positive experience was reported by 24 to 29 percent of parents in both groups. The majority of the positive touch accounts for both groups involved interpersonal touching (i.e., cuddling or snuggling with a parent, having a backrub, being tickled, etc.). Negative touch experiences, which were reported by only a small number of parents, were related to the face and head – not wanting to have ears cleaned, wiping food off the tongue, having the face touched and aversion to haircuts.

A quarter of parents in both groups reported positive movement-related experiences. The type of positive movement did not vary between the groups – swinging, jumping, spinning, etc. – but parents of children with autism emphasized, in some cases extreme and repetitive, jumping.

Food-related experiences were reported as positive examples for 21 percent of the typically-developing children but only for 4 percent of the children with autism. In contrast, 15 percent of the typically-developing children and 26 percent of the children with autism reported negative food-related experiences. Issues related to food were not limited to one sensory aspect, but rather included texture, taste, smell, visual aspects of the food itself and having the food on hands or tongue, as well as other considerations such as predictability, routine and novelty. Positive food experiences were briefly described in terms of taste (sweet, sour, spicy), temperature (cold), and/or texture (crunchy, soft).

"Unusual" sensory experiences were reported by 36 percent of parents of children with autism. Reports focused on behaviors such as hand flapping, having to chew on things, not responding to extreme cold, and as one mother said, being "dull to things." Parents described some of these activities as self-stimulation and linked them to their child's diagnosis.

"Children in both groups reacted negatively to some sounds, responded positively to movement and disliked certain foods or sensory aspects of foods," says Dr. Baranek. "We did, however, sense a qualitative difference in the way parents reported these experiences. Parents of children with autism were more likely to recognize elements in their children's experiences as being sensory and likely to attribute responses to aspects of autism, per se. And while some of the parents in both groups reported strong reactions to sensory input, such accounts by the parents of children with autism described more extreme responses, and sometimes included unusual behaviors."

For more information, visit www.aota.org.

(4-28-09)

Quitting smoking is one of the best things parents can do for their health and the health of their children. Now they can get assistance from an unexpected source – their child's pediatrician.

A new resource offers pediatricians the tools they need to screen parents for smoking, offer counseling and enroll parents in a free smoking-cessation helpline. Using the existing state quit line known as "QuitWorks," Massachusetts is promoting "QuitWorks for Child and Family Health Care Practitioners" statewide this month. The program is based on research from the Clinical Effort Against Secondhand Smoke Exposure (CEASE) program of the American Academy of Pediatrics (AAP), which is also available free to other public health departments and pediatric offices across the nation.

Because of their regular, frequent contacts with families, pediatricians are uniquely positioned to help parents quit smoking, says Dr. Jonathan Winickoff, assistant professor of pediatrics at MassGeneral Hospital for Children and founder of CEASE. "Tobacco use is a serious health issue for all members of a family," Dr. Winickoff says. "We're getting the biggest return on our investment by targeting parents who smoke. Not only do we hope to reduce children's exposure to second-hand and third-hand smoke, but if more parents quit smoking, fewer children will grow up to be smokers."

CEASE is available through the AAP Julius B. Richmond Center of Excellence, whose mission is to improve child health by eliminating children's exposure to secondhand smoke and tobacco. The Massachusetts Department of Public Health worked with the Massachusetts chapter of AAP to incorporate CEASE materials into the QuitWorks program for statewide dissemination.

Dr. Carole Allen, president of the AAP Massachusetts chapter, says local pediatricians are enthusiastic about implementing parent-focused smoking cessation strategies in their practices. "If you smoke, the best way to protect your child's health is to quit," says Dr. Allen. "Now pediatricians can do more than just tell you to quit – they can help you to quit. It's a big difference."

Massachusetts is the first state to deliver CEASE materials to all pediatric offices. The module can be adapted to suit any state's smoking cessation program. "The American Academy of Pediatrics believes that every state should invest some of its tobacco control resources in programs that will help pediatricians help parents protect children from secondhand smoke," says Dr. David T. Tayloe, Jr., president of the AAP, which represents more than 60,000 pediatricians.

For more information about CEASE and other resources for clinicians and families, see www.aap.org/richmondcenter/resources.html. To see a video demonstration of the program, visit www.ceasetobacco.org.

Learn more by reading the following articles:

Smoking While Expecting: The Latest Research on Smoking and Pregnancy

Smoke into the Mouths of Babes: The Effects of Secondhand Smoke on Babies and Toddlers

Third-hand Smoke: The Dangers Smoke Residue Poses to Small Children

(4-28-09)

New moms to twins or more have an increased risk (43 percent) to have moderate to severe depression nine months after delivery compared to moms who have single babies, according to a study in the journal Pediatrics.

The study looked at a nationally representative sample of more than 7,000 mothers of singletons and 776 mothers of multiples. Of both groups of mothers, only 27 percent of those who had moderate to severe depressive symptoms reported talking about it with a mental health specialist or general medical care provider.

The authors note that undergoing a high-risk pregnancy and delivering multiple babies are stressful life events, and the unique demands of caring for multiples, including fatigue and social isolation, can contribute to parental stress and depression. The authors conclude that greater attention is needed in pediatric settings to address maternal depression in families with multiple births.

(4-28-09)

Infants born one to three weeks early are at risk for developmental delays, according to a study in the journal Pediatrics. Researchers found that the last weeks in the womb – when brain maturation and growth occur – are associated with the baby's future development and school success.

Researchers found healthy children born at 34 to 36 weeks' gestation had a 36 percent higher risk of developmental delay or disability through the first five years of life compared with healthy term infants (born at 37 to 41 weeks' gestation).

Researchers found late preterm infants were more likely to be suspended in kindergarten or held back in kindergarten. These infants represent a significant portion of preterm deliveries in the United States. It has been estimated that 70 percent of preterm births are born at 34 to 36 weeks' gestation.

(4-28-09)

Autism spectrum disorders cover a wide span of conditions and symptoms, from severe mental retardation to mild social impairment, making a quick definitive diagnosis difficult. It wasn't until 1980 that autism became an official clinical diagnosis, separate from childhood schizophrenia or retardation.

Dr. Catherine Karni, associate professor of psychiatry at UT Southwestern Medical Center and medical director of outpatient services at the Center for Pediatric Psychiatry at Children's Medical Center Dallas, says patients often display a distinctive pattern of symptoms rather than just one. The main characteristics include impairments in social interaction, impairments in communication, restricted interests and repetitive behavior. Parents are usually the first to notice the unusual behaviors, while pediatricians initially hear their concerns.

"Autism cannot be diagnosed with a simple diagnostic test," Dr. Karni says. "Having a team of specialists conduct specific assessments means there is a better chance for children to be diagnosed correctly and for the right treatments to be enacted. Many parents take their child to a pediatrician because the child is not talking. But there are many possibilities for this behavior. Autism is only one."

Learn more by reading One up on Autism: Learn the Signs and Act Early.

(4-28-09)

According to the Autism Society of America, Autism impacts 1 in 150 children. Children who may have autism tend to meet age-appropriate milestones until about 18 months, when symptoms including decreased language, lack of emotional response and repetitive motor movements appear more prevalently.

ChicagoHealers.com practitioner Dr. Malina Chin says that the diagnosis of the symptoms include lack of social/emotional interaction, repetitive stereotypical behaviors, impaired communications, lack of spontaneity, poor initiation, little reciprocity and impaired non-verbal communication.

"If the child is under 3 years old, impaired language, social interactions and symbolic play may be signs of autism," says Dr. Chin. "Occupational therapists can screen children under 1 year old for early delay in attention, impaired coordination and emotional expression."

Dr. Chin further explains that a key part of autism is Sensory Integration Dysfunction (SID), which is the inability of the brain to correctly process information brought in by the senses. It results in interpreting sensory as uncomfortable, overly reactive or under reactive as well as difficulty in understanding the messages from the body."

Dr. Chin provides the following tips for treating autism holistically:

Occupational Therapy – Occupation is what people do to be in a healthy, balanced life that includes self care, work, play and relationships. Occupational therapists intervene to regain function, improve function or make accommodation to how we spend our time.

Parental Management Technique – Teaching coping methods to parents can help a child regulate his or her body so they can be in an alert but calm state. This allows the child to participate in his or her occupation, whether it be play, exploration, developing skills or social/emotional interactions.

Manual Therapy – Manual Therapy uses the hands to place pressure, oscillate, manipulate, stretch and compress any part of the body. Using these therapy techniques with a specialist may help the skin, muscle, fascia, ligaments, organs, circulation and movement of the body.

Healthy Diet – A diet with vegetables, fruits, good protein, healthy fats and fiber helps the body with the nutrition needed for repairing cells.

Avoid the Sugar, Fats and Processed – Sugars, breads, fried, greasy, animal fats and artificial sweeteners increase inflammation while providing little nutrition for the body to use. Many of us end up storing the byproducts in our fat cells as toxins. Children should not eat foods that are processed or out of packages due to the amounts of fats, salt and sugars in those products.

Learn more by reading One up on Autism: Learn the Signs and Act Early.

(4-21-09)

Respiratory syncytial virus (RSV) isn't the flu, but its cold- and flu-like symptoms are showing up more often in children, says Dr. Octavio Ramilo, professor of pediatrics in the Cancer Immunobiology Center at UT Southwestern Medical Center. RSV infection now is the most frequent cause for hospital admission among children less than 1 year of age in the U.S.

"RSV causes bronchitis and pneumonia in young children and can be especially severe in high-risk groups such as prematurely born infants, children with heart disease or immune deficiencies, and children who suffer from chronic lung ailments," Dr. Ramilo says. "For these high-risk groups we can administer a preventive antibody therapy."

Dr. Ramilo also advises medical care for any infected baby up to 6 weeks of age. "Be sure to suction their noses to help infants breathe," he says. "RSV is mild in most adults, but the elderly, transplant recipients and others with immune deficiencies are at high risk."

Dr. Ramilo says to help prevent infection of babies, protect them from exposure to school-age siblings or other relatives with cold symptoms and maintain good hygiene with careful hand washing.

Learn more by reading A New Look at RSV: The Facts and Latest Research on Respiratory Syncytial Virus.

(4-21-09)

Promoting the principle that all children deserve an equal start in life, Jennifer Garner – actor, advocate and mother of two – is joining Save the Children's U.S. Programs as an Artist Ambassador. The U.S. division of Save the Children operates early education, literacy, nutritional and disaster relief programs that give a vital boost to children in struggling families.

As an Artist Ambassador for Save the Children's U.S. Programs, Garner will focus on advocating for the expansion of the organization's early education program. This public-private partnership brings highly trained experts into homes, providing parents with child-rearing and cognitive development tools for infants and toddlers. Today, 1 in 6 children in America live in poverty.

Garner recently traveled to California's Central Valley and visited with Ysenea and her 12-month-old son Xavier, who live in public housing in Farmersville. Garner read to Xavier, played learning games that will help with his development and finger painted with him. She also listened to Ysenea describe the challenges she faces as a struggling young mother.

Following a tour of the area, she attended a book exchange program at the Sheridan School in Orange Cove where children with limited access to books at home or at school receive tote bags of books to keep for two weeks at a time. Garner read Baby Bear, Baby Bear, What Do You See? to 3-, 4- and 5-year-olds at the school.

"Three-year olds don't even have bootstraps to pull on," says Garner, a native of West Virginia and the daughter of a schoolteacher. "Our leaders in Washington and in the states must commit every resource to put all children on an equal path to success. Working with Save the Children, I hope to help young mothers give the same educational boost to her son that I try to give my own toddler and newborn."

Next month, Garner will be the spokesperson for Save the Children's State of the World's Mothers report, which will focus on Early Childhood Education around the world and in the United States.

Photo courtesy of The March of Dimes. (4-21-09)

The International Playground Equipment Manufacturers Association (IPEMA) is reminding parents and caregivers of the importance of providing safe play environments during National Playground Safety Week (April 19-25). IPEMA's playground safety experts have compiled a list of helpful hints to help safely maximize their child's experience on the playground – to help take advantage of the many benefits of play.

"Even more than ever, during these difficult economic times, parents are turning to simple activities such as free play to create family fun," says Tom Norquist, past president of IPEMA and leader of the Voice of Play advocacy initiative. "Going outside to encourage children to play is one of the most important things parents can do to help a child's development, and playground safety is a critical first step in creating a positive play experience."

IPEMA's experience in safety certification of playground equipment and surfacing has prompted them to issue a list of five important steps that communities should take to help ensure safety on the playground.

"Spring is the perfect time to brush up on playground safety," Norquist says. "Performing equipment and surfacing maintenance upgrades can help contribute to a great play experience."

Don't forget what's below your feet! Grass is not an acceptable surfacing for playgrounds. One of the leading causes of injury on playgrounds is falling from playground equipment. To minimize the frequency and severity of injury from playground falls, it is crucial to have certified playground surfacing, such as engineered wood fiber, poured-in-place or rubber mulch surfacing installed under and around the equipment on any public playground. This surfacing is certified to have sufficient depth or thickness to minimize impact injuries from falls.

Be an advocate for safety standards. Playground equipment and surfacing have been carefully evaluated by the United States Consumer Product Safety Commission and the American Society for Testing and Materials (ASTM). The standards set by these organizations help ensure that playground equipment and surfacing is age appropriate and designed with the measurement of children's physical dimensions, skills and abilities in mind. IPEMA runs an industry-leading certification program to test and validate playground equipment and surfacing to meet ASTM standards.

Proper installation is key to safety! Playground equipment should be installed by individuals experienced in assembly directions and knowledgeable about the environment surrounding the playground, including soil, drainage and the use of other construction materials, tools, equipment and machinery. The manufacturers of specific pieces of equipment can provide certified installers, or the International Playground Contractors Association can provide assistance.

Check, re-check and then check again. Once the equipment and surfacing are installed, have a post-installation safety audit performed by a person certified in playground safety prior to use. This audit will determine if any equipment or surfacing is non-compliant and will help prioritize any issues that should be corrected before the playing begins. Proper installation also includes posting signage about the age-appropriateness of specific equipment.

Don't underestimate maintenance and upkeep. Proper maintenance can be forgotten – but is one of the most important aspects of ensuring safety on a playground. Maintenance processes must be in place on both a routine and long-term basis. Equipment and surfacing must be checked for signs of damage following severe weather and for signs of vandalism or any other man-made or natural catastrophe. In addition, equipment and surfacing will show natural wear and tear each year and regular maintenance inspections and replacement processes should be in place to minimize hazards.

"Parents and caregivers should advocate maintenance and safety in their local communities and to playground owners and officials," Norquist says.

To learn more, visit www.voiceofplay.com or www.playgroundsafety.org.

(4-21-09)

Five billion gallons of bottled water were consumed in 2000, an increase of more than 200 percent from a decade earlier. Whether consumers drink more bottled water because it is an alternative to soda, or because it is convenient to do so is unclear, but one thing is certain: They are missing out on the valuable fluoride found in tap water, which helps to protect teeth from cavities, according to a study published in General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer-reviewed journal.

Researchers tested the fluoride content in more than 100 different samples of bottled water, which fell into six categories: distilled, drinking/purified, spring/artesian, mineral, fluoride-added and flavor-added. Of the total 105 samples, the fluoride concentrations in the majority of the samples fell below the U.S. government's recommended range of 0.7-1.2 parts per million (ppm), the ideal range to prevent cavities. Only five samples met the recommended range.

Lead author of the study, Ryan L. Quock, DDS, recommends that consumers speak with their dentist about their primary drinking water source. "Understanding consumers' water drinking habits is extremely important," he says. "Determining if they are drinking appropriately fluoridated water, especially when they have or are at risk for cavities, is crucial information, because fluoridated water is an automatic way for them to help improve their oral health. Talking to them also allows us to have a conversation about fluoride's effects, mainly focusing on its relationship to dental caries and fluorosis."

Receiving the appropriate amount of fluoride is critical to consumers' oral health – especially children's oral health – as it strengthens the teeth and protects them against cavities. Dr. Patricia Meredith, AGD spokesperson, advises parents to do their research before handing their child a water bottle. "Parents should be in charge of how much bottled water their kids drink, in order to make sure that that they also receive the proper amount of fluoridated water that will keep their teeth healthy," says Dr. Meredith. Fluoride in toothpaste, water supplies and other oral hygiene products is one of the basics of keeping children's mouths healthy, Dr. Meredith says. "With soda and energy drinks being as popular as they are, not to mention the attractiveness of sugary snacks, children's mouths are constantly fighting cavity-causing bacteria. Something as simple as drinking water from the tap is a no-nonsense and cost-effective way to prevent cavities."

The AGD supports the use of fluoride and adopted a position statement based on the Center for Disease Control's Recommendation for Using Fluoride, which states, "When used appropriately, fluoride is safe and effective in preventing and controlling dental caries. Regular use throughout life will help protect teeth against decay. All water supplies, including bottled water, should have appropriate fluoride levels. All fluoridated items, including toothpaste, should be used as recommended by your dentist."

To learn more, visit www.agd.org or www.knowyourteeth.com.

(4-21-09)