Karen Ratliff-Schaub

Randomized controlled trial of transdermal secretin on behavior of children with autism

Previous trials of secretin for the treatment of autism have utilized a single or double dose administered intravenously. This is a report of a double-blind, randomized, controlled crossover trial of transdermally applied secretin in 15 children diagnosed with autism or pervasive developmental delay. Secretin or placebo was applied daily, in ointment form, to the backs of the children in randomized, successive 4 week periods with an intermediate 6 week washout period. Behavioral outcomes were measured by parents and teachers using the Autism Treatment Evaluation Checklist. Overall, there were no statistically significant differences in speech, sociability, sensory, and health scores for treatment versus placebo periods. In addition, there were no differences in such scores for children with a history of diarrhea. Severity of autism was significantly greater at baseline in children receiving concomitant medications. Improvement in speech was found during the treatment phase of the trial (p = 0.0479 for secretin versus placebo) only in children not using other medications.

Primary care of children and adolescents with down syndrome: an update.

D own syndrome is perhaps the most recognizable and well-described genetic syndrome encountered in pediatrics. Undoubtedly seen in ges past, John Langdon Down was the first to escribe it in great detail in his landmark paper titled Observations on an Ethnic Classification of Idiots” in 866. He believed that a certain group of people with ental retardation had physical features similar to that f the Asian or Mongolian races. The terms “Mongoian” or “Mongoloid” became widely used to describe hese individuals. It was not until the 1970s that this erm became pejorative and fell into disuse. It was eplaced by the eponym, Down syndrome. In the 19th nd early 20th centuries, there were a variety of heories regarding the cause of Down syndrome inluding maternal tuberculosis or hypothyroidism. In 959, Lejeune and coworkers confirmed the presence f trisomy 21 as the cause of Down syndrome. In the early part of the 20th century, parents were iven a very bleak outlook for their infant with Down yndrome. They were often told that the child would ot live long, or that he or she would never walk, talk, r even recognize their own parents. Parents were also dvised to place their child in an institution and the arents should tell everyone that the baby had died. ortunately, attitudes began to change, both socially

NUTRITIONAL INTERVENTIONS AND THERAPIES IN AUTISM A SPECTRUM OF WHAT WE KNOW: PART 2

Part 1 in this series (“Nutritional Intake and Therapies in Autism”) addressed the nutrient intake of children with autism and the myriad factors likely to affect dietary intake and nutritional sta...

Comparison of Systematic Developmental Surveillance With Standardized Developmental Screening in Primary Care

Many physicians use surveillance questions to assess development; the American Academy of Pediatrics recommends screening at 9-, 18-, and 24-month health supervision visits (HSVs). There are no studies directly comparing surveillance with screening. The authors directly compared systematic surveillance with standardized screening using a cross-sectional observational study of children with no known delays. Surveillance questions were completed at each HSV. The Ages and Stages Questionnaire (ASQ) was administered following the 9-, 18-, or 24-month HSV. The authors compared detection of delays by surveillance with ASQ screening. Using surveillance, 11/95 subjects were identified as delayed. Using the ASQ, 15/95 subjects scored fail; 28/95 scored monitor. Among the 11 delayed surveillance subjects, 5 scored fail on the ASQ and 5 scored monitor. Ten of the 15 subjects scoring fail on the ASQ were not identified by surveillance. The study’s findings support the American Academy of Pediatrics recommendations for periodic formal screening in addition to continued surveillance.

Improving Access to Care at Autism Treatment Centers: A System Analysis Approach.

OBJECTIVE: The prevalence of autism spectrum disorder is steadily increasing and placing more demands on already overburdened diagnostic and treatment systems. A thoughtful, systematic reorganization of autism service delivery may reduce delays and better meet the growing need. METHODS: Two clinical centers in the Autism Intervention Research Network on Physical Health, Cincinnati Children’s Hospital Medical Center (CCHMC) and Nationwide Children’s Hospital (NCH), undertook a year-long access improvement project to reduce delays to care by using system analysis to identify sources of delay and to target changes by using a set of defined access principles. Although both sites addressed access, they focused on slightly different targets (reducing number of patients with autism spectrum disorders waiting for follow-up appointments at NCH and reducing delay to new diagnosis at CCHMC). RESULTS: Both sites achieved dramatic improvements in their complex, multidisciplinary systems. A 94% reduction in number of patients on the waitlist from 99 to 6 patients and a 22% reduction in median delay for a new ongoing care appointment were realized at NCH. A 94% reduction in third next available appointment for new physician visits for children 3 to 5 years old was realized at CCHMC. CONCLUSIONS: This article demonstrates that 2 different clinical systems improved access to care for autism diagnosis and follow-up care by identifying sources of delay and using targeted changes based on a set of access change principles. With appropriate guidance and data analysis, improvements in access can be made.

Behavioral and Physiological Factors Associated With Selective Eating in Children With Autism Spectrum Disorder.

Selective eating is common in children with autism spectrum disorder (ASD), but it is not yet well understood. The objectives of this study were to examine a new definition of selective eating, compare behavioral measures between children with ASD and selective eating and those without selective eating, and determine relationships among behavioral measures and measures of selective eating. Participants were assigned to groups on the basis of number of foods eaten compared with a population-based sample. Results of one-way multivariate analysis of variance indicated no overall effect of group for challenging behaviors, sensory reactivity, or repetitive behaviors. Between-participant tests indicated that scores for compulsive behaviors were significantly lower (p = .036) for the selective eating group. Correlations were moderately strong among variables relating to food intake and behavioral variables, but were not significant between selective eating and behavioral variables. Further research is needed to validate the definition of selective eating and to identify targets for intervention.