Parenting

Among school-aged children in the United States an estimated one in 50 has been diagnosed with autism spectrum disorder, according to a recent survey (.pdf) from the Centers for Disease Control and Prevention. In addition to raising concerns among researchers and parents about why the number of cases has increased, the findings underscored the need to do more autism research and to provide support and services for families caring for autistic children.

To help parents and others in the local community better understand the growing prevalence of autism and to learn about treatments and research advancements, the Stanford Autism Center at Packard Children’s Hospital will host its sixth annual Autism Spectrum Disorders Update on June 1. The event offers an opportunity for exchange between parents, caregivers and physicians and provides an overview of the center’s clinical services and ongoing autism research at the School of Medicine.

In anticipation of the day-long symposium, we’ve asked Carl Feinstein, MD, director of the center, to respond to your questions about issues related to autism spectrum disorder and to highlight how research is transforming therapies for the condition.

At the Stanford Autism Center, Feinstein works with a multidisciplinary team to develop treatments and strategies for autism spectrum disorders. In providing care and support for individuals with autism and their families, Feinstein and colleagues identify ways of targeting the primary autism symptoms, while also paying attention to associated behavior problems that may hold a child back from school or community involvement or seriously disrupt family life.

Questions can be submitted to Feinstein by either sending a tweet that includes the hashtag #AskSUMed or posting your question in the comments section below. We’ll collect questions until Wednesday (May 15) at 5 PM Pacific Time.

When submitting questions, please abide by the following ground rules:

• Stay on topic
• Be respectful to the person answering your questions
• Be respectful to one another in submitting questions
• Do not monopolize the conversation or post the same question repeatedly
• Kindly ignore disrespectful or off topic comments
• Know that Twitter handles and/or names may be used in the responses

Feinstein will respond to a selection of the questions submitted, but not all of them, in a future entry on Scope.

Finally – and you may have already guessed this – an answer to any question submitted as part of this feature is meant to offer medical information, not medical advice. These answers are not a basis for any action or inaction, and they’re also not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and give you the appropriate care.

Previously: New public brain-scan database opens autism research frontiers, New autism treatment shows promising results in pilot study, Autism’s effect on family income, Study shows gene mutation in brain cell channel may cause autism-like syndrome, New imaging analysis reveals distinct features of the autistic brain and Research on autism is moving in the right direction
Photo by Wellcome Images

Daily text messages may be an effective option to help children with asthma manage their symptoms and reduce doctor visits, according to recent research from the Georgia Institute of Technology.

In the study (.pdf), pediatric patients with asthma were randomly assigned to three programs: one group received text messages on alternate days, another received text messages daily and a third served as the control and did not receive any text messages. Participants ranged in age from 10 to 17 years old, owned a mobile phone and could read at the fifth grade level. The text messages asked patients questions about their symptoms and provided health information about asthma. Futurity reports:

Over four months, the intervention groups received and responded to SMS messages 87 percent of the time, and the average response time was within 22 minutes. After the study, the research team analyzed patients who had follow-up visits with their physician and found that sending at least one text message a day, whether it was a question about symptoms or about asthma in general, improved clinical outcomes.

“The results indicate that both awareness and knowledge are crucial to individuals engaging in proactive behavior to improve their condition,” [said Rosa Arriaga, PhD, who led the study].

The findings are noteworthy in light of past data showing texting is teenagers’ preferred method of communication, they get an average of 3,339 texts a month, and previous research showing they are amenable to receiving health information via text message.

Previously: CDC explores potential of using smartphones to collect public health data, Promoting healthy decisions among teens via text and Craving a cigarette but trying to quit? A supportive text message might help
Photo by Summer Skyes 11

Past research suggests that poor sleep during adolescence can have “lasting consequences” on the brain. Now a new study offers additional insights into the negative health effects of sleep deprivation on teens’ health.

In the study, researchers analyzed data collected from more than 10,000 adolescents as part of the National Comorbidity Survey Adolescent Supplement. As MedPage Today reports, their findings show that prolonged fatigue is associated with mood and anxiety disorders among teens:

In a nationally representative sample of adolescents ages 13 to 18, 3% reported having extreme fatigue lasting at least 3 months and about half of those who did also had mood or anxiety disorders, according to Kathleen Merikangas, PhD, of the National Institute of Mental Health in Bethesda, Md., and colleagues.

Having both prolonged fatigue and a mood or anxiety disorder was associated with poorer physical and mental health and greater use of healthcare services compared with having only one of the disorders, the researchers reported online in the American Journal of Psychiatry.

“This suggests that the presence of fatigue may be used in clinical practice as an indicator of a more severe depressive or anxiety disorder,” Merikangas and colleagues wrote.

Stanford physician Michelle Primeau, MD, recently explored the topic of how teen sleep habits affect mood in a recent Stanford Center for Sleep Sciences and Medicine blog entry on the Huffington Post. In her post, she explains why teens in particular are at risk of chronic partial sleep deprivation:

Teenagers need to sleep about nine hours, and as they get older, they tend to sleep less. This is not because they need less, but because they are busier with school, jobs, extracurricular activities, and friends. Their biology also will often shift so that they tend to fall asleep later and want to sleep in later, an occurrence that may represent delayed sleep phase syndrome. This may explains why your teenager is so hard to wake up on Saturdays. But this shift to a later bedtime, both of social and biologic causes, in combination with fixed early school times, means that many teenagers are walking around sleep deprived.

Previously: Can sleep help prevent sports injuries in teens?, Study shows link between lack of sleep and obesity in teen boys, Study shows lack of sleep during adolescence may have “lasting consequences” on the brain, Teens and sleep: A Q&A, Sleep deprivation may increase young adults’ risk of mental distress, obesity, Districts pushing back bells for the sake of teens’ sleep and Lack of sleep may be harmful to a teen’s well-being
Photo by lunchtimemama

Getting through medical school and raising a child are two activities that on their own can each be challenging - not to mention exhausting. But what’s it like to do them simultaneously? In a candid piece on Mothers in Medicine (a blog that I consider a must-read for doctor-moms), a writer shares the less-positive aspect of her juggle:

I judge myself constantly. If I were not a medical student mom, I could have given my child a more even-keel life filled with playgroups, museum activities, more reading and less TV. Should I be doing those things despite needing to study and handle school and fatigue? Should I have done more anyway? Maybe sucked it up, because darn it – medical school moms are supposed to be smart and manage the house and family? Having it all and doing it all, right?

Now I’m looking backwards. I am less than two weeks from graduation as I write this, and I still judge myself for decisions I made in medical school. We did survive the away rotations despite living in a 350-sq ft apartment for one of them. We survived each of the Step exams and third year. We even survived a crazy interview season that involved many flights, and I matched somewhere that is perfect for my family. However, did I do enough of the right things to balance out the wrong ones? Should I just be thankful Sesame Street and Super Why! have taught my toddler all his letters and numbers? (Thanks PBS!) I don’t really know, but I console myself that he is a loving, sweet toddler who seems to somehow really love me…

My daughters spent their first few days of life in the neonatal intensive care unit, and I won’t soon forget padding down the long hospital hallways, decked out in my flimsy gown and fluffy blue slippers, every two hours to go visit and feed them. As emotional as this time was for me and my husband, I recognize it would have been even more so if I wasn’t able to see my baby - which is why I think a new program at a Los Angeles hospital is so cool. Called BabyTime, the Cedars-Sinai program uses iPads to connect parents with their premature or ill newborns.

readwrite’s Brian S. Hall reported yesterday:

Mothers who are confined to recovery rooms following delivery, typically because of a cesarean section or other complications, often can’t see their newborns in the intensive care unit for 2-3 days. “With BabyTime, the new mother can now see their baby in about 2-3 hours,” Yvonne Kidder, a clinical nurse in the hospital’s Neonatal Intensive Care Unit (NICU), told me:

“BabyTime’s been wonderful. For mothers, to see their baby, this absolutely lessens their anxiety. For the fathers, who can become overwhelmed with all the information they are receiving, BabyTime bridges the gap and allows for a direct line between mother and caregivers.”

Previously: The emotional struggles of parents of preemies

Yesterday evening, Rebecca Rialon Berry, PhD, a child psychologist from Lucile Packard Children’s Hospital, participated in a San Jose Mercury News live chat covering topics such as how to recognize that a child has experienced a traumatic event and how to help teens manage their online presence.

A transcript of the chat is now available on the newspaper’s website. During the chat, Berry discussed the issue of empowering teens to be proactive in preventing, or notifying adults about, harmful online or in-person interactions. Below is her exchange with reporter Katy Murphy:

Murphy: Even if a child isn’t being bullied or bullying others, he or she might see it happening — online or in person. What effect do these harmful interactions have on bystanders, and what do you recommend that teens do if they see harmful images or messages shared?

Berry: Bystanders can have a very helpful role in preventing or stopping cyber bullying. Encourage youth who see online activity that might appear to be cyber bullying to print out the message, post, tweet, or email and share this with an adult … Adults can respond to receiving such messages by validating the teen’s openness to speak up and with encouragement to the teen to continue communicating about online activities that he/she does not feel is productive or healthy.

The full chat is worth taking a moment to read.

Previously: Packard Children’s Hospital psychologist to discuss helping children coping with trauma, Talking to children about school shootings and Talking to little ones about 9/11

As the ongoing investigation into the tragic death of California high-school student Audrie Pott has become national news, many parents are wondering how to help their children and teens cope in equally traumatic situations. In an effort to answer parents’ questions, Rebecca Rialon Berry, PhD, a child psychologist from Lucile Packard Children’s Hospital, will participate in a San Jose Mercury News live chat.

The chat begins today at 5:30 pm Pacific time and will cover topics ranging from how to recognize a child has experienced a traumatic event to how to help manage students’ social networking presence.

Previously: Talking to children about school shootings and Talking to little ones about 9/11
Photo by Troy Benson Photography

I don’t have personal experience with food allergies - the most I’ve been affected by the rising numbers of pediatric cases is that I’ve never been able to send my daughters peanut-butter sandwiches to school - but I was nonetheless moved by a MomsRising blog entry on the topic today. In it, a mom shares her anxiety about her young son, who has a life-threatening peanut allergy, starting elementary school. She writes:

I always remind myself (and others) to consider likelihood. What is the likelihood of [insert horrible, devastating thing here] actually happening? There is about a zero percent chance of my child being killed in a school shooting incident. I cannot possibly fathom the anguish that those Sandy Hook families experienced and I certainly don’t want to tempt fate, but I have a limited amount of energy for worry, so I choose not to expend it on the minuscule chance that my child will be shot at school.

What is MUCH more likely, though, and is as life-threatening as if someone pointed a gun at my child’s head, is the chance that my son will eat something with peanuts in it while he’s away from me at school. That’s the fear that keeps me up at night. That’s the stress that eats away at my nerves and at the lining of my stomach.

My son is still eighteen months away from starting school. For now, all I can do is read. And worry. And read. And worry. I’m a do-er. I’m black and white. I want to take action. Fix it. Call the school. Ask questions. Demand answers. But we’re still eighteen months away. So I read.

Previously: Ask Stanford Med: Pediatric immunologist answers your questions about food allergy research, A mom’s perspective on a food allergy trial, Searching for a cure for pediatric food allergies, Helping kids cope with allergies, Peanut bans: An overreaction to food allergies? and What’s causing all those food allergies?

In a recent thought-provoking guest post on the NeuroTribes blog, autism activist Brenda Rothman discusses her personal journey coming to terms with her son’s diagnosis of autism and shares what she’s learned from him. In order to provide better support to autistic people and their families, she argues that society’s perspective of the neurological condition needs to shift from “awareness” to “acceptance:”

We need to challenge how autism is defined — as a set of behaviors and deficits – because this description leads us inexorably to “fixing” autistic people. Autism is a way that the brain takes in, processes, and responds to information. This way of processing results in variations in the way the world is experienced and the ways that learning, communication, and movement occur. Autistic people develop skills on a different timetable or in a different order than expected.

But autism also comes with a set of strengths – a deep passion for interests, the ability to recognize visual, musical, social, or emotional patterns, and a strong individuality. When we ignore autistic strengths, we ourselves become stuck on fixing autistic people, rather than building on their natural talents.

…

We need to examine our response to autism. When we start with the incorrect premise that autistic people don’t understand or misbehave, we end up with behavioral programs directed at training them to act in “normal” ways. By recognizing that they already communicate and understand, we can identify the obstacles that make it difficult for them. We can move from trying to fix the person to giving them the supports they need. These supports include sensory-friendly environments, devices to assist communication, acceptance of moving around and stimming, and methods of learning that come most naturally to them. Creating supports like this are like building ramps for autistic people, instead of forcing them to climb stairs that exhaust and exclude them.

The full entry is worth a read.

Previously: New public brain-scan database opens autism research frontiers, New imaging analysis reveals distinct features of the autistic brain and Using music to improve communication skills in children with neurodevelopmental disorders

Food allergies affect millions of children, who find it difficult to enjoy ordinary activities like birthday parties and restaurant meals because of worries that something they eat could send them into anaphylactic shock. As the New York Times described recently, Stanford scientist Kari Nadeau, MD, PhD, is studying how to desensitize children to their allergy triggers. Here on Scope, she recently took questions on food allergies and her desensitization research.

Many readers asked how they could enroll in Nadeau’s research or in similar allergy treatment trials near their homes. Information for prospective study subjects around the world is available here; enter “food allergy” in the “Search for Studies” field, and after searching, click the “On a Map” tab to see trials grouped by location. For those who live near Stanford, go here for details on participating in Nadeau’s research.

Below are Nadeau’s responses to a selection of questions submitted using the hashtag #AskSUMed the comments section on Scope. As a reminder, Nadeau’s answers are meant to offer medical information, not medical advice. They’re not meant to replace the evaluation and determination of your doctor, who will address your specific medical needs and can make a diagnosis and provide appropriate care.

@vikas_aditya asks: What’s the simplest way to identify the cause of an allergy in kids?

If you suspect an allergy to a specific food or environmental cause, skin prick testing is the simplest and least invasive way to initially identify the allergy but it is not the gold standard. A food challenge in the doctor’s office is the true way to test for food allergies.

Elizabeth P. asks: Is there anyone working to find the exact cause of why so many children, teens and adults are developing life-threatening food allergies today? On a related note, @ceband asks: What do you think of the theory that altered gut microbiomes have led to the rise in allergies and autoimmune disease?

Many scientists and researchers are trying to understand the rising prevalence of food allergies in children. Though there are many theories regarding the increase in this prevalence, we still lack definitive answers. Hypotheses have focused on hygiene, dietary fat, antioxidants, vitamin D and dual-allergen-exposure. Altered gut microbiomes might play a role. It does not appear that genetically modified foods are directly linked to food allergies.

Julie Barnes asks: I am currently pregnant and am wondering if I will possibly be creating a food allergy in my unborn child if I avoid all dairy and egg while pregnant and breastfeeding.

There is recent evidence that a diet in pregnancy and during breastfeeding that is high in Vitamin D, follows features of a Mediterranean diet and includes probiotics may be helpful to prevent asthma and allergies. And a healthy, balanced diet is important to your overall health and the health of your baby. However, we do not have evidence that mothers will create food allergies by food avoidance in pregnancy or breasfeeding. Similarly, there is no evidence from the general population that mothers can create food allergies by eating certain foods during pregnancy or breastfeeding.

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