BY RAPHAEL BERNIER Associate professor, University of Washington / 31 MAY 2016
Many children with autism show unusual features in their play starting early in life. These include reduced creativity and imagination, such as recreating scenarios from a television show verbatim. The play of children with autism also tends to have a persistent sensorimotor or ritualistic quality. For example, a child might repetitively arrange toys to mimic some observed play activity.
These play characteristics were part of the diagnostic criteria for autism for many years, but are not listed in the newest edition of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5).
Children with autism are often typical in their functional and sensorimotor play at age 3, but they show poorer pretend play skills than their typical peers do. If we did not see the intact functional play, we might attribute the unusual pretend play in children with autism to cognitive challenges. But because functional and sensorimotor play require an array of learning and memory skills, we think that differences in pretend play do not result solely from cognitive problems.
Cognitive abilities, language skills and executive functions such as self-control and mental flexibility all influence the development of play and its application to clinical settings. Autism affects all these domains.In children without autism, pretend-play abilities are associated with performance on measures of self-control more than cognitive ability (learning and memory). For example, differences in the ability of typical preschoolers to pretend to do something and suspend reality relate to their performance on tests of self-control that require waiting or choosing a counterintuitive response.Play skills are also tied to language. Some researchers have proposed that the ability to talk to yourself draws from executive function, such as working memory, and allows typically developing preschoolers and young children to engage in pretend play.Likewise, in children with autism, the nature of pretend play appears to correspond with language ability and intelligence, even in minimally verbal children, and preschool play skills can predict the later language development in these children.Earlier this year, my colleagues and I reported that individual differences in executive function — specifically, self-control and working (short-term) memory — predict pretend-play skills in children with autism both at the time of their assessment and later in life. Interestingly, this pattern depends on language ability: For children with significant language difficulties, cognitive ability — not executive function — predicts later pretend-play skills.
Teaching with toys:
Together, these findings highlight pretend play as an important arena for clinical care. Many children with autism are missing out on the opportunities and benefits of pretend play. Still, the relationship between executive function, language and pretend play provides new avenues for treatment. Developing therapies to improve executive function, for example, can help children with autism benefit from pretend play, which creates natural learning opportunities for a prepared mind. Pretend play itself can be considered a form of treatment — one that costs nothing, requires no professional training and can happen anywhere. What’s more, by capitalizing on existing therapies designed to improve language abilities, clinicians can enhance a child’s executive function — thereby maximizing a child’s ability to engage in pretend play. Doing so should then feed back into a child’s cognitive and social skills and emotional well-being. Play is critical for every child, providing opportunities to practice the skills that we employ as adults during social interactions, academic pursuits and professional responsibilities. As I consider the mess of toys in my living room, I hope every parent has the opportunity to see their child take advantage of the therapeutic richness provided simply by playing.
Gestational diabetes increases autism risk
Published 14th April 2015, Research Autism
Children are slightly more likely to develop autism if their mothers were diagnosed with diabetes early in pregnancy, a new study shows.
Women newly diagnosed with diabetes by the 26th week of pregnancy were 42% more likely to have a child diagnosed with autism, according to the study of more than 322,000 children born between 1995 and 2009.
Overall, about 1% of all children in the study were diagnosed with autism by a median age of age 5½. Having gestational diabetes, the kind diagnosed during pregnancy, increased the chance of having a child with autism to 1.4%.
Researchers found no increase in autism risk if mothers were diagnosed with diabetes after 26 weeks of pregnancy. A typical pregnancy lasts 40 weeks.
Authors also found no increased risk of autism if women had type 2 diabetes before becoming pregnant, possibly because these women already had their blood sugar under control, according to the study, published in the Journal of the American Medical Association.
Diabetes interferes with the body’s ability to move the sugar provided by food into cells. That can lead the levels of sugar in the blood to rise to unhealthy levels, damaging blood vessels.
Anny Xiang of the Kaiser Permanente Southern California Department of Research & Evaluation says the study doesn’t reveal why developing diabetes in pregnancy increases the risk of autism. It’s possible that high blood sugar levels have long-lasting effects on a fetus’ organ development and function, says Xiang, the study’s lead author.
Gestational diabetes increases a number of risks for a fetus, including death, says Susan Levy, an associate professor of pediatrics at Center for Autism Research atChildren’s Hospital of Philadelphia, who was not involved with the study.
The new study adds to a growing body of research that suggests the brain changes related to autism occur long before delivery, says pediatrician Paul Wang, head of medical research at Autism Speaks, an advocacy organization, who was not involved in the new study. He notes that brain scans can now detect differences between autistic children and other kids when they’re only a few months old.
Several studies have found an increased risk of autism in the children of mothers who develop the flu or other infections during pregnancy.
Pregnant women also are more likely to have children with autism if they don’t get enough folic acid, if they’re exposed to pollution or if they take the anti-seizure drug valproic acid, research shows.
Autism ‘begins long before birth’
BBC News Health 27 March 2014
Scientists say they have new evidence that autism begins in the womb. Patchy changes in the developing brain long before birth may cause symptoms of autism spectrum disorder (ASD), research suggests. The study, in The New England Journal of Medicine, raises hopes that better understanding of the brain may improve the lives of children with autism. It reinforces the need for early identification and treatment, says a University of California team. US scientists analyzed post-mortem brain tissue of 22 children with and without autism, all between two and 15 years of age. This reinforces the importance of early identification and intervention”
Insel National Institute of Mental Health used genetic markers to look at how the outermost part of the brain, the cortex, wired up and formed layers. Abnormalities were found in 90% of the children with autism compared with only about 10% of children without. The changes were dotted about in brain regions involved in social and emotional communication, and language, long before birth. “Autism can have a profound and devastating impact but the right support can make a huge difference.”
Autism treatment in infancy “may prevent further symptoms”
Medical News Toady 9 September 2014 at 8 am PST
A study finds that autism symptoms can be significantly reduced if treatment begins at the earliest age symptoms appear. The researchers – who also developed the treatment – claim in their study that symptoms were reduced to the extent that most children receiving the therapy had neither developmental delay nor autism spectrum symptoms by the age of 3.
Study Finds That Brains With Autism Fail to Trim Synapses as They Develop
The New York Times, by Articles by PAM BELLUCK” PAM BELLUCK Aug. 21, 2014
As a baby’s brain develops, there is an explosion of synapses, the connections that allow neurons to send and receive signals. But during childhood and adolescence, the brain needs to start pruning those synapses, limiting their number so different brain areas can develop specific functions and are not overloaded with stimuli. Now a new study suggests that in children with autism, something in the process goes awry, leaving an oversupply of synapses in at least some parts of the brain. The finding provides clues to how autism develops from childhood on, and may help explain some symptoms like oversensitivity to noise or social experiences, as well as why many people with autism also have epileptic seizures.