The question of whether to place children with special needs in grades K–12 into inclusive educational settings or into segregated classrooms is a persistent one among education researchers and policymakers. Results from an analysis published in the Campbell Systematic Reviewssuggest that, in general, inclusion neither increases nor decreases learning and psychosocial adjustment of children with special needs.
The analysis of 15 studies from 9 countries included children with multiple types of disabilities such as learning disorders/intellectual disabilities, autism spectrum disorders, ADHD, physical handicaps, visual impairments, and Down syndrome.
The findings point to the importance of individual assessments of the specific child’s educational and psychosocial needs.
“It is time to realize that when it comes to educational placement of children with special needs, one size doesn’t fit all and not all special needs children benefit from inclusive education,” said corresponding author Nina Thorup Dalgaard, PhD, of Vive, the Danish Center for Social Science Research.
The trial medication, AB-2004, is designed to soak up certain toxins produced by bacteria in the gut to prevent them from entering the bloodstream and reaching the brain. Scientific studies have shown there may be a link between changes and irregularities in gut bacteria and the brain, which could contribute to certain neurological conditions, including irritability in children with autism. Gut bacteria are influenced by anxiety, poor diet and an unsettled sleep and stomach.
Murdoch Children’s Professor David Amor, who is leading the randomised-controlled trial in Melbourne alongside Dr Catherine Marraffa, said the study would test whether lowering levels of certain substances produced by gut bacteria could be a potential treatment for irritability in teenagers with autism spectrum disorder.
“There is a significant difference in the gut bacteria of children with autism compared to those who are not on the spectrum,” he said. This difference may lead to higher levels of certain substances that are produced by bacteria in the gut.
“The therapy we are trialling is designed to absorb the substances associated with some autism characteristics in the gut to reduce their entry into the brain via the bloodstream. We hope this will improve traits of irritability and anxiety, offering families an alternative to anti-psychotic treatments.”
The medication is designed to act in the gut only and does not enter other bodily tissues, lessening the potential for side effects across other parts of the body. AB-2004 was shown to be safe and well tolerated in a previous study involving adolescents on the spectrum.
Murdoch Children’s Dr Kylie Crompton said the severity of daily challenges faced by some children with autism, combined with the lack of safe and effective treatment options, had resulted in a significant unmet need for innovative medical interventions.
“Children with autism need better options formanaging anxiety and irritability or distress,” she said. This trial offers potential hope for children who too often struggle with anxiety and irritability in all aspects of their daily life.”
The trial, sponsored by Axial Therapeutics, across 25 hospital sites in Australia, the US and New Zealand, is seeking 140 participants. Axial is a pharmaceutical company dedicated to improving the lives of people with neurological conditions.
Dr Crompton said the trial was possible with the backing of The Lorenzo and Pamela Galli Charitable Trust, administered by the University of Melbourne, which supports researchers across the Parkville medical precinct in the areas of cancer and developmental disorders.
“With the support of the Galli Trust we can generate new evidence about the causes of neurodevelopmental disability and determine whether new and existing therapies are effective in improving outcomes and quality of life for these children and their families,” she said.
The 16-week trial includes taking the medication for eight weeks, six in-clinic visits and three telehealth appointments and the collection of blood, urine and stool samples as well as completing questionnaires.
The medication, a powder taken by mouth three times per day, is tasteless and odorless and is mixed with any soft food.
To see if your child is eligible for the study a pre-screening questionnaire can be accessed by visiting www.theautismstudy.com
Despite the big smile on this little swimmer’s face, a pool isn’t always fun and games. It can be dangerous and more so if a child has autism. Statistics show drowning is the leading cause of death for children with autism . It’s a concern for Jo Renshaw of Australia, whose son Keidis, 7, is on the autism spectrum. That’s why an organization called Autism Swim developed a program just for kids like Keidis.
“This evidence demonstrating enhanced pain sensitivity warrants changing the common belief that autistic individuals experience less pain,” according to the report by Prof. Irit Weissman-Fogel of University of Haifa, Israel, and colleagues. They believe their findings highlight the need for increased awareness, which may impact effective treatment of pain in people with autism.
New evidence questions the assumptions about pain in autism
The researchers aimed to test the “prevailing assumption” that people with autism are hypo-sensitive to pain. Current diagnostic criteria suggest that autistic people demonstrate “apparent indifference” to pain or temperature. Yet most previous studies have not shown differences in pain sensitivity in autistic individuals.
Prof. Weissman-Fogel and colleagues performed in-depth laboratory tests of pain perception in 104 adults, 52 with autism. This sample is the largest as of yet testing pain psychophysics in autism. The two groups had similar scores on a brief cognitive test. People with autism had higher use of psychiatric medications, and rated themselves as having greater anxiety as well as higher sensitivity to pain and to daily environmental stimuli (such as smell, noise, light). This research project was funded by the Israel Science Foundation (ISF; 1005/17).
On quantitative sensory tests, there were no differences in thermal and pain detection thresholds between the autistic and non-autistic groups. This indicates normal pain and thermal thresholds, suggesting “normal functioning of the peripheral nervous system” among participants with autism.
However, the autistic group gave consistently higher pain ratings in response to various stimuli above their pain threshold, proving pain hypersensitivity. The tests also provided evidence that people with autism can successfully inhibit short pain stimuli but not long-lasting pain stimuli. Importantly, experiencing long-lasting pain in daily life is a risk factor for developing chronic pain.
New findings may lead to early treatment and better quality of life
Together, the findings suggest that people with autism have a “pro-nociceptive” pain modulation profile: their brain appears more active in facilitating pain experience and less active in inhibiting continuous pain. This is consistent with the theory of excitatory/inhibitory imbalance as an underlying mechanism of autism spectrum disorder – but one that has been neglected in terms of pain processing.
The study questions the perception that people with autism experience less pain, and instead suggests that they may have enhanced pain sensitivity. Prof. Weissman-Fogel and colleagues write, “This misinterpretation can lead to late diagnosis and poor treatment causing suffering and exacerbating the autistic symptoms” – potentially increasing the risk of developing chronic pain conditions. While their study focused on a group of autistic people with essentially normal cognitive function, the researchers write, “these results may also apply to people with autism whose cognitive and verbal communication impairments may eliminate their ability to communicate their pain.”
Prof. Weissman-Fogel and coauthors conclude: “These findings may raise physician, parent, and caregiver awareness to the pain phenomenon in autism, and thus lead to early and effective treatment to improve the wellbeing and quality of life for autistic individuals and their families.”
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