Possible Biomarker for Autism

1. Possible Biomarker for Autism • Roberts, T.P., Khan, S.Y, Monroe, J.F., Cannon, K., Blaskey, L., Woldoff, S., Qasmieh, S., Gandal, M., Schmidt, G.L., Zarnow, D.M., Levy, S.E., and Edgar, J.C. (February, 2010). MEG Detection of Delayed Auditory EvolkedRepsonses in Autism Spectrum Disorders: Towards an Imaging Biomarker for Autism. Autism Research, 3 (1), 8-18. • Roberts, T.P.L., Schmidt, G.L., Egeth, M., Blaskey, L., Rey, M., Edgar, C., and Leyy, S.E. (May, 2008). Electrophysiological Signatures: Magnetoencephalographic Studies of the Neural Correlates of Language Impairment in Autism Spectrum Disorders. International Journal of Psychophysiology, 68 (2), 149-160. Kevin T. Blake, Ph.D., P.L.C.

2. Possible Biomarker for Autism Bosl, W., Tierney, A., Tager-Flusberg, H. and Nelson, C. (2011). EEG Complexity as a Biomarker for Autism Spectrum Disorder Risk. BMC Medicine, 9 (18): http://www.biomedcentral.com/1741-7015/9/18 Kevin T. Blake, Ph.D., P.L.C.

3. Isolation and The Immune System • Lonely people have more active genes that promote inflammation and less active genes that inhibit inflammation. • This puts them at risk for some cancers, degenerative neurological disorders and cardiovascular problems. • Lonely people’s immune systems are geared toward fighting bacteria not viruses. • Sociable people have immune systems geared toward viruses. Kevin T. Blake, Ph.D., P.L.C.

4. Isolation and The Immune System Azar, B. (May, 2011). The Psychology of Cells. Monitor On Psychology, 42 (5), 32-35. Miller, G., Chen, E., and Cole, S. (January, 2009). Health Psychology: Developing Biologically Plausible Models Linking the Social World and Physical Health. Annual Review of Psychology, 60, 501-524. Cole, S.W., Hawkley, L.C., Arevalo, J.M., Sung, C.Y., Rose, R.M., and Cacioppo, J.T. (2007). Social Regulation of Gene Expression in Human Leukocytes. Genome Biology, 8 (9), doi:10.1186/gb-2007-8-9-r189. Cole, S.W., Hawkley, L.C., Arevalo, J.M.G., and Cacioppo, J.T. (February 15, 2011). Transcript Origin Analysis Identifies Antigen-Presenting Cells as Primary Targets of Socially Regulated Gene Expression In Leukocytes. Proceedings of the National Academy of Sciences of the United States of America (PNAS), 108 (7), 3080-3085. Kevin T. Blake, Ph.D., P.L.C.

5. 25% or Americans Socially Isolated • From 1985 to 2005 the typical American said the average number of people they could rely upon to help them with a significant concern dropped from 3 to 2. • In 2005 twenty-five percent reported they had no trusted friend they could rely upon which is double the rate of 1985. McPherson, M., Smith-Lovin, L., and Brashears, M.E. (2006). Social Isolation in America: Changes in Core Discussion Networks Over Two Decades. American Sociological Review, 71 , 353-375. Kevin T. Blake, Ph.D., P.L.C.

6. Korean ASD Prevalence Study • Found that 2.64% of school children from the city of Goyang in the Ilsan province of South Korea met criteria for ASD • Found that 2/3rds of the cases were undiagnosed in mainstream school population • These findings suggest more rigorous screening for ASD, and stresses the need for better assessment and detection. Kim, Y.S., et al. (May 9, 2011). Prevalence of Autism Spectrum Disorders in a Total Population Sample. American Journal of Psychiatry [E-published ahead of print], http://ajp.psychiatryonline.org/cgi/reprint/appi.ajp.2011.10101532v1.pdf Kevin T. Blake, Ph.D., P.L.C.

7. Multisensory Processing in ASD • Found that ASD children did not integrate multisensory (auditory-somatosensory) stimuli as well as non-disabled children. • Will next investigate Sensory Integration Training for efficacy given these results. • Molholm stated ASD children have difficulty simultaneously processing faces and voices. Russo, N., Foxe, J.J., Brandwein, A.B., Gomes, T., Altschuler, H., Molholm, S. (October, 2010). Multisensory Processing with Autism: High-Density Electrical Mapping Auditory-Somatosensory Integration. Autism Research, 3 (5), 253-267. Hamilton, J. (June 2, 2011). Looking for Early Signs Of Autism In Brain Waves. Washington, DC: National Public Radio: http://www.npr.org/2011/06/02/136882002/looking-for-early-signs-of-autism-in-brain-waves Kevin T. Blake, Ph.D., P.L.C.

8. One Year Medication Follow-Up Study of Adults with ADHD • 116 adults with ADHD • Double-blind crossover trial of methylphenidate and placebo • Responders put on a one year open-label trial of methylphenidate • 50% decline in symptoms and severity. General Adaptive Functioning (GAF) improved significantly. • “ADHD adults, who responded to methylphenidate in the short-term, placebo-controlled trial, responded to long-term treatment with marked improvements in ADHD symptoms and psychosocial functioning.” (p. 36) Wender, P.H., Riemherr, F.W., et al. (January, 2011). A One Year Trial of Methylphenidate in the Treatment of ADHD. Journal of Attention Disorders, 15 (1), 36-45. Kevin T. Blake, Ph.D., P.L.C.

9. Manual Corrections Kevin T. Blake, Ph.D., P.L.C.

10. How to Assess Developmental Prosopagnosia • Cambridge Face Memory Test • Test My Face Recognition- Internet test • Duchaine, B. and Nakayama, K. (2006). The Cambridge Face Memory Test: Results for Neurologically Intact and an Investigation of It’s Validity Using Inverted Face Stimuli and Prosopagnosic Participants. Neuropsychologia, 44, 576-585. From web site: • www.faceblind.org/social_perception/papers/duchaine06neuropsychologia • Test My Face Recognition (From web site): www.faceblind.org/facetests/index.php. Kevin T. Blake, Ph.D., P.L.C.

11. Computer Programs to Treat Prosopagnosia • “Gaining Face”: www.StoneMountainSoftware.com • Paul Ekman, Ph.D. (“Lie to Me”/SPOT – Surveying Passengers by Observational Techniques) CD ROMS: Micro Expression Training Tool (METT) Subtle Expression Training Tool (SETT) Repeated presentations of METT & SETT to those with Autism Spectrum Disorders Available from: www.paulekman.com Kevin T. Blake, Ph.D., P.L.C.

12. Americans with Disabilities Act, Amendments Act of 2008 • Was enacted on September 25, 2008 • Became effective on January 1, 2009 • It redefined the term “disability” under ADA • It directed the U.S. Equal Employment Opportunity Commission (EEOC) to amend its ADA regulations to reflect the ADAAA. • The final regulations were approved by congress on March 25, 2011 Kevin T. Blake, Ph.D., P.L.C.

13. Americans with Disabilities Act, Amendments Act of 2008 • Congress made it easier for a person to seek protection under the ADA if they have a disability-The term disability is now interpreted more broadly. • The term “substantially limits” now requires a lower degree of functional limitations than has been applied in the courts. • “Substantially limits” is now to be considered more broadly. Kevin T. Blake, Ph.D., P.L.C.

14. Americans with Disabilities Act, Amendments Act of 2008 • One still needs an “individualized assessment” to determine an impairment in a major life activity. • “Mitigating measures” like medication for ADHD no longer can be used to determine level of impairment (glasses and contacts excluded). • An impairment that is episodic or in remission is still considered a disability. • Determination of disability should not require extensive analysis. Kevin T. Blake, Ph.D., P.L.C.

15. Americans with Disabilities Act, Amendments Act of 2008 • Reading, standing, communicating, bowel movements, autoimmune functions, etc. are now considered “major life activities.” From: Fact Sheet on the EEOC’s Final Regulations Implementing the ADAAA: www1.eeoc.gov//laws/regulations/adaaa_fact_sheet.cfm?renderforprint=1 Kevin T. Blake, Ph.D., P.L.C.

16. 2011 DSM-5 AD/HD Changes • Attention-Deficit/Hyperactivity Disorder: • Specify based on current presentation- • Combined Presentation • Predominately Inattentive Presentation • Predominately Hyperactive/Impulsive Presentation • Inattentive Presentation (Restrictive) • Other Specified Attention-Deficit/Hyperactivity Disorder Kevin T. Blake, Ph.D., P.L.C.

17. 2011 DSM-5 ADHD Changes • Need to have symptoms of AD/HD prior to age 12 • 22 symptoms (age relevant); up from 18 child based • 9 symptoms of Inattention: Need 6 up to age 17; need 4 over age 17 • 13 symptoms of Hyperactivity/Impulsivity: Need 6 prior to age 17; need 4 over age 17 • Inattentive Presentation (Restrictive): Must meet Inattentive criteria and have no more than 2 Hyperactive/Impulsive symptoms Author (2010). Attention-Deficit/Hyperactivity Disorder. Washington, DC: American Psychiatric Association: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=383. Kevin T. Blake, Ph.D., P.L.C.

18. DSM-5 Severity of ASD • Level 3 (Requiring Very Substantial Support): Very limited initiation and minimal response to others. Extremely difficult to refocus from fixed interests. • Level 2 (Requiring Substantial Support): Limited initiation and limited response to others. Difficult to redirect from fixed Interests. • Level 1 (Requiring Support): Without support has difficulty initiating and atypical response to others. Will resist efforts to redirect from special interests. Author (January 26, 2011). Autism Spectrum Disorder, Severity. Washington, DC: American Psychiatric Association: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=94#. Kevin T. Blake, Ph.D., P.L.C.

19. 2011 DSM-5 Learning Disorder Changes • There will be a generic term of Learning Disability which will cover such things as reading comprehension problems not related to Dyslexia. • They are still trying to figure out what to do with Disorder of Written Expression. Author (2010). Learning Disorder. Washington, DC: American Psychiatric Association: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=429. Author (2010). Dyslexia. Washington, DC: American Psychiatric Association: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=84. Author (2010). Disorder of Written Expression. Washington, DC: American Psychiatric Association: http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=86. Kevin T. Blake, Ph.D., P.L.C.

20. Books On Bonobos & Chimpanzees De Wall, F., and Lanting, F. (1997). Bonobo: The Forgotten Ape. Berkley, CA: University of California Press. Van Lawick-Goodall, J. (1971). In The Shadow of Man. Boston, MA: Delta Books. Kevin T. Blake, Ph.D., P.L.C.