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Broadcast:
Latest Developments in Autism: Research to Therapy

Latest Developments in Autism: Research to Therapy
November 3, 2008
7:00 PM EST

From NewYork-Presbyterian Hospital, NYC, NY


The mystery of autism continues, but important advancements in the assessment and treatment of the disorder have been made, and research -- such as exploring the genetic makeup of individuals with autism and imaging the brains of children with autism to map abnormalities – offers hope for this complicated disorder.

This webcast discusses current concepts in the assessment, treatment and research of autism, and features BJ Casey, PhD, who is the Director of the Sackler Institute and Neuroscience Graduate Program at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and the Sackler Professor of Developmental Psychobiology at Weill Cornell Medical College; and Bradley S. Peterson, MD, the Chief of Child Psychiatry Services at NewYork-Presbyterian/Columbia University Medical Center, who is also the Director of Child and Adolescent Psychiatry, Director of MRI Research, and the Susanne Crosby Murphy Professor of Pediatric Neuropsychiatry at Columbia University College of Physicians & Surgeons and the New York State Psychiatric Institute.

The mystery of autism continues, but important advancements in the assessment and treatment of the disorder have been made, and research -- such as exploring the genetic makeup of individuals with autism and imaging the brains of children with autism to map abnormalities – offers hope for this complicated disorder.

This webcast discusses current concepts in the assessment, treatment and research of autism, and features BJ Casey, PhD, who is the Director of the Sackler Institute and Neuroscience Graduate Program at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, and the Sackler Professor of Developmental Psychobiology at Weill Cornell Medical College; and Bradley S. Peterson, MD, the Chief of Child Psychiatry Services at NewYork-Presbyterian/Columbia University Medical Center, who is also the Director of Child and Adolescent Psychiatry, Director of MRI Research, and the Susanne Crosby Murphy Professor of Pediatric Neuropsychiatry at Columbia University College of Physicians & Surgeons and the New York State Psychiatric Institute.

One very important realization is that the optimal assessment and treatment of a child with autism requires a multidisciplinary approach. In many places it is at present a sole clinician who spends time with the child and offers a diagnosis. But, as Dr. Peterson pointed out, "you need people from multiple disciplines, including either a child psychiatrist, a pediatric neurologist, or a developmental pediatrician, to do a very thorough and standardized assessment of the child's social interactions, repetitive behaviors, and unusual interests, for instance. You also need a very careful developmental history of the child, and need a psychologist who will assess cognitive functioning. A thorough review of medical and neurological issues needs to be conducted, as well as an assessment of problem behaviors. Frequently, speech and language evaluations need to be performed, as do social work assessments, in order to get these children the intensive services they need." A multidisciplinary assessment service, called the Developmental Neuropsychiatry Service, is located at Columbia University Medical Center.

"Many people suggest that the earlier you intervene the better," Dr. Casey noted. "Unfortunately, it is difficult to reliably diagnose autism in the first or even second year of life, and I am very concerned with the message this sends to parents who as a result may feel that they didn't intervene soon enough." Families, Dr. Casey added, have had an enormous impact on lobbying for the government to fund more research in autism. "Unless we understand how the typical child's brain develops and how that development goes awry in these neurodevelopmental disorders, we will be hard-pressed to find the underlying etiology and the interventions needed to help this population."

Dr. Casey's work at Weill Cornell Medical College attempts to identify types of interventions that are helpful to improve core aspects of the disorder. As an example, a computer program is being developed that may help children with autism address their reluctance to engage in eye contact, which is so important for reading other people's emotions. The computer screen shows a face with targets that appear in the eyes, but also at other places on the screen, such as in the mouth or off the face entirely. "If there is a way to get individuals to look at eyes more through these activities, then that is a type of early intervention. The combination of these eye-tracking paradigms that can be done in the first few months of life – and downloaded to home computers, or be web-based – and genetic testing may lead to a change in the way we treat this disorder." Dr. Casey also discussed research using knockout and knock-in mouse models. Genes that are fundamental to learning are identified and their impact on learning is assessed. Colleagues Barbara Hempstead and Francis Lee are developing mouse models for neurotrophin, important in the development of the brain and for communication among the brain's regions.

Dr. Peterson stressed that treatment, like assessment, also demands a multidisciplinary team approach. For example, a pediatric neurologist may be needed to address the seizure disorders that develop in as many as 40% of children with autism. Problem behaviors like aggression towards others or themselves require behavioral and child psychologists. Gastroenterologists need to be available since many of these children suffer from gastrointestinal discomfort. "Nonverbal children have a great deal of difficulty communicating their physical discomforts, so having a good medical team to look for such things as ear and respiratory infections is very important," Dr. Peterson said. Occupational and physical therapists are needed to address gross motor coordination and hypotonic musculature. Child psychiatrists must work to reduce the frequent obsessive-compulsive symptoms seen in this population, which can be very distressing to both the patient and those in his or her environment.

It is now known that there are multiple genetic causes for autism and that therefore there are multiple autisms. Dr. Peterson noted that large-scale genetic studies are underway looking at how these genetic and possible environmental causes of autism exert their effects on the brain. To that end, Dr. Peterson heads state-of-the-art brain imaging studies, in which regions of the autistic brain are mapped and compared to normally developing children. "What are the functional consequences, and what precisely are the abnormalities in how the brain is wired up? We can now image that, and we can even look at chemical concentrations of key neurotransmitters in children with autism to understand how those may play a role."

Dr. Peterson, in discussing the future of autism research, said, "My most ardent wish is that we gain a better understanding of the various causes of autism and of the neurobiological mechanisms by which those causes exert their effects on brain structure, function and behavior, because only when we understand those pathways will we really identify targeted treatments that make rational sense."

The future of autism research is underway right now at NewYork-Presbyterian Hospital. Those interested in learning the latest developments in the assessment and treatment of autism, as well as ground-breaking research in this disorder, should view this webcast featuring two of the innovators in the field.

Participants

Featuring:

Bradley Peterson

Bradley Peterson, MD

Director of Child & Adolescent Psychiatry and Director of MRI Research in the Department of Psychiatry, New York State Psychiatric Institute

BJ Casey

BJ Casey, PhD

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