Monday, October 27, 2014

Spotting Autism at 18 Months

We’re learning more about autism every year – how families can flourish when a child has autism; how important screening can be early in the life of a child who may be at risk; or the ways in which early interventions before age 5 are helpful.
We are also learning, as a society, how to actively surround and support autism in the simple things of every day life – in school, in work pursuits, in our families, in our circles of friends.
A good example of just how far we are able to imagine autism working in all aspects of society is a highly innovative new play that just opened on Broadway to rave reviews – including a five-star New York Times review that called it “one of the most fully immersive works ever to wallop Broadway.”
“The Curious Incident of the Dog in the Night-Time,” based on the 2003 best-selling book by Mark Haddon, is lit up by checkered, flashing lights and squares on the stage. It’s presented through the eyes of a highly functioning autistic child who is gifted in math, but struggles with daily interactions with friends and family.
 The play, like the book, is mesmerizing for the audience. By the end, it’s nearly impossible not to be drawn deeply into a completely different reality as seen through the mind of an autistic child – a feat that isn’t easy to imagine or pull off, but is well worth the journey.
Now, a comprehensive new study by Yale researchers adds to this growing body of knowledge. It found that signs of autism can be seen as early as 18 months in children who have older siblings who are autistic – an important finding considering that about 20 percent of children who have older siblings with autism also develop autism spectrum disorder (ASD).
“While the majority of siblings of children with ASD will not develop the condition themselves, for those who do, one of the key priorities is finding more effective ways of identifying and treating them as early as possible,” said Katarzyna Chawarska, an associate professor at the Child Study Center at Yale’s School of Medicine.
The large-scale study was designed to identify specific social and communicative behaviors that distinguish infants with autism as early as 18 months of age.
The Yale researchers combined data from eight clinical sites participating in the Autism Speaks Baby Siblings Research Consortium, and then looked carefully at social, communicative and repetitive behaviors in 719 infants when they were 18 months old.
For the study, published in the Journal of the American Academy of Child & Adolescent Psychiatryresearchers looked for patterns that might predict a later diagnosis of autism. They then followed up when the study participants at the eight sites were age 3.
The research team found about half of the siblings who were later diagnosed with autism displayed signs that were suggestive of the disorder at 18 months; while symptoms for those later diagnosed with autism showed signs between the ages of 18 months and 36 months.
The ability to see signs of autism in siblings as early as 18 months allows for early intervention, which is why the study is important.
“Our study reinforces the need for repeated diagnostic screening in the first three years of life to identify individual cases of ASD as soon as behavioral symptoms are apparent,” said Chawarska.
For about half of the siblings studied, a combination of poor eye contact and lack of communicative gestures or imaginative play was most strongly associated with a later diagnosis of autism, the team found.
In a small percentage of those later diagnosed with ASD, eye contact was relatively normal - but they began to display early signs of repetitive behaviors and had limited non-verbal communication skills.
“So not only do the behavioral symptoms appear at different ages, but different combinations of early symptoms may predict the diagnostic outcome (of autism),” Chawarska said.
One of the real advantages of such an early diagnosis is that personalized treatment can be developed for a child – precisely at the age where significant development is occurring, which in turn allows the child to develop meaningful ways to cope with autism.
Broadway plays and media attention around autism helps public understanding of the disorder. Meanwhile, advances in the scientific understanding of the signs of autism in early childhood (like this Yale study) help parents and clinicians intervene at critical times.


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Friday, October 24, 2014

The New Way to Study with ADHD

The weekend is upon us, and it can be a good time to start implementing some of these useful techniques for students with ADHD.


For students with ADHD, studying for a test can be daunting. Luckily, there’s new research that shows that students might not need to spend more time studying, but need to study differently. James and John, identical twins with ADHD, are taking the same biology class. They study for the same amount of time, yet James gets an A on the exam and John gets a C+. Why the difference?
Which Study Technique Works Best?
John studied diligently for three hours on Thursday night, the day before the test. He reread his notes and the textbook, and reviewed the study guide. He studied in his room. James studied for three hours, but did it over four evenings, Monday through Thursday. He used his notes, an old quiz, and the study guide to create a practice test. He studied in different locations, including Starbucks and the library.
Eighty-four percent of students study by rereading the textbook, as John did. The problem is that rereading is the most ineffective way of studying for an exam. Reading is a challenging way for the ADHD brain to learn information. Reading is passive. It’s like learning to play basketball by watching your coach play.
Research shows that the number-one way to study is to make a practice test. Try to predict what your teacher may ask on the exam. Look over your study guide, pull out old quizzes, find important parts of your notes, and ask others in your class what they think is important. Then, create a practice exam.
Cramming Doesn’t Work
What else did James do right? He used a concept educators call “distributed practice.” In other words, he didn’t cram. He studied for three hours over four days, 45 minutes per night. This works for two reasons. The first is that James reviewed the material several times, gaining familiarity with it. Second, and most important, he slept on it. Sleep helps you learn. Your brain is more active at night than during the day. During sleep, you replay the day’s events in your head and you rehash the information you learned. In James’s case, he rehashed the biology material through sleep four times.
John worked hard to study for his exam, and skipped soccer practice on Thursday evening to put in extra time. He stayed in his room without a break. But although John tried to make himself focus, the things in his room (laptop, phone, music) got him off task. John could not regulate his attention while cramming for the test.
James, on the other hand, knew that when boredom set in, he needed shorter work periods or a different place to study. He found, through trial and error, that he was more focused when he studied at locations other than his own house. In other words, James had the concept of metacognition — knowing when and how to use particular strategies for learning — down pat. He knew what helped him to focus and what hindered him. In the end, it wasn’t more time that John needed; he needed to use his time differently.
Here are some other research-based tips that can make a difference for your child with ADHD.
Review Before Bed
Studies show that you remember more when you take 10 to 15 minutes just before you go to sleep to review what you studied or learned earlier in the day. This doesn’t mean that students should do all their studying at bedtime, but reviewing what he has studied allows a a child to process the information as he sleeps.
Exercise Sharpens Focus
Thirty minutes of aerobic exercise a day, four to five days a week, improves focus and executive functioning skills, especially in students with ADHD. If you have a student athlete, encourage him or her to study on the bus or in the car as he travels home from an event. Consider studying right after practice, too. If your child doesn’t play a sport, encourage him to run with your dog or shoot some hoops just before he sits down to do schoolwork. Although any aerobic exercise will do the job, the most helpful exercises for students with ADHD are ballet, yoga, and tai chi, all of which require students to focus on their body and their mind.
Use Your Nose
Smell is a powerful study tool. Research shows that if you are exposed to the same smell when you study and sleep, you may remember more. When your child studies, put a small dish of essential oil nearby; peppermint is a good choice because it relieves stress. Place a small dish of the same scent by her bed while she sleeps. Studies suggest that her brain will associate the scent with the material she studied earlier. This, researchers say, may help her retain more of the information she is trying to remember.
Napping, Breaks, and Memory
Most people need to sleep eight to nine hours a night to retain memories, but teenagers need more. Thirty-minute afternoon naps can help. Be sure these siestas aren’t longer than 30 minutes, since extended naps can interfere with sleep at night.
Taking a break helps all kids learn more, especially those with ADHD. Studies show that students remember more when they take breaks between study sessions instead of studying straight through for an extended period. Having downtime enables a student’s brain to review information and material, even when he doesn’t know he’s processing it.
Sip a Sugary Drink
A drink that contains some sugar helps homework performance. Sugary drinks provide glucose, which is the primary source of fuel to the brain. If you’re low on glucose, you won’t be able to focus or perform well.
Gatorade or apple juice delivers glucose, without overloading a child’s system with sugar. Sodas and other drinks with high levels of sugar (up to 10 teaspoons) provide too much glucose, which results in a sugar crash later, impairing memory and clouding thinking. So ask your child to sip (not gulp) a sugary drink. It can bring improved focus and mood.
In the end, encouraging students who struggle with attention to implement a few of these easy-to-use ideas can make a big difference in your child’s performance at school.