Posted on Autism

Sensory-adapted dental rooms can significantly reduce physiological and behavioural stress in autistic children during teeth cleanings.

Sensory adaptations ease dental care for autistic children

In the SADE research clinic at Children’s Hospital Los Angeles, sensory adaptations to the environment were found to significantly reduce autistic children’s physiological and behavioral stress during dental cleanings. CREDIT: Phil Channing/USC

New research conducted by USC researchers at Children’s Hospital Los Angeles reveals that creating a sensory adapted dental clinic environment can significantly reduce the distress experienced by autistic children during oral care.

“According to lead author Leah Stein Duker, assistant professor at the USC Chan Division of Occupational Science and Occupational Therapy, our research has demonstrated that utilizing a combination of carefully selected visual, auditory, and tactile adaptations can significantly reduce behavioral and physiological distress in autistic children during dental cleanings. These adaptations are easy to implement, relatively inexpensive, and do not require specialized training to use.”

Autistic children often face more difficulties with oral health care compared to their typically developing peers. These challenges are often linked to heightened responses to sensory input. The dentist’s office can be overwhelming for them due to bright fluorescent lighting, loud electric hand tools, and reclining chairs. Stein Duker and the Sensory Adapted Dental Environments (SADE) research team, along with colleagues from the Ostrow School of Dentistry of USC, are working on identifying and testing novel approaches to help address these challenges and improve access to effective oral care.

This study involved providing dental cleanings to autistic children in both a standard clinic environment and an adapted one. In the adapted setting, the dentist wore a surgical loupe with an attached lamp, blackout curtains were hung over the windows, and a slow-motion visual effect was projected onto the ceiling. The children could choose between a “Finding Nemo” underwater scene or lava lamp-style abstract colors. Additionally, a portable speaker played calming nature sounds and quiet piano music. To provide deep pressure and a hugging sensation, a traditional lead X-ray bib was placed on the child’s chest, and a “butterfly” wrap was secured around the dental chair, from shoulder to ankle, which has been shown to calm the nervous system.

Electrodes were placed on the child’s fingers to measure electrodermal activity, which is a physiological marker of sympathetic nervous system activation, similar to the fight-or-flight response. The researchers also noted the frequency and duration of distressed behaviors displayed by the child during the cleaning, such as pulling away from the dentist, clenching the jaw, attempting to bite the dentist or prevent tools from entering the mouth, crying, and screaming.

The researchers found no differences in the quality of care provided in the adapted environment compared to the regular environment. They also did not find significant differences in the amount of time required to get the child seated and ready for the cleaning, demonstrating that adaptations do not create logistical hurdles.

“So many interventions try to change the person,” Stein Duker said. “Instead, this intervention sees children for who they are. It does not try to fix or change them. The focus of the intervention is to modify problematic environmental factors in order to empower the child and family to successfully engage in occupation.”

Adaptations can make all the difference

This publication is the most recent output from the SADE research project, which is led by Principal Investigator Professor Sharon Cermak and has been ongoing since 2011. The SADE intervention has been tested in pilot studies with various populations in several countries. However, Stein Duker noted that this study is the first to have a sample size large enough to achieve full statistical power.

“Because it’s a fully-powered study, we were able to identify some other very exciting findings,” Stein Duker said. “For example, our data showed that children’s Did you mean “physiological”?stress dropped as soon as they entered the adapted dental cleaning room before the actual cleaning even began, and that level of physiological stress predicted behavioral distress during the cleaning.”

The researchers also identified factors predicting the success of the intervention for each participant: Younger age, lower IQ, and/or lower expressive communication level were each associated with a greater reduction in participants’ stress.

“My daughter cannot even hear the word ‘dentist,’” said one participant’s parent. “But after being in the [SADE] room for a bit, she was able to have her teeth looked at for the first time in over a year.”

The study aims to address oral care disparities experienced by autistic children, with a focus on narrowing ethnic disparity gaps. 72% of enrolled children’s parents identified as Hispanic. Data shows that 52% of Hispanic youth aged 2-19 have dental caries, the highest prevalence compared to other ethnic groups. Bilingual team members ensured the full participation of Spanish-speaking participants.

Stein Duker and her Tailored Environmental Modifications lab will next study the effectiveness of a modified SADE for typically developing children with dental fear and anxiety, a major challenge in pediatric dentistry experienced by approximately 20 percent of all US children. In the near future, she is also planning to collect preliminary data studying adolescents and adults with intellectual developmental disabilities and/or autism, populations she gets frequently asked about at dental conferences and research meetings.

“Stein Duker advises dental professionals and parents to collaborate and use cost-free adaptations like weighted X-ray bibs, sunglasses, or a beanie hat to improve the clinic experience for those with sensory sensitivities.”

Posted on Diet

“Want to feel less stressed? Give the Mediterranean diet a try!”

Mediterranean diet

Consuming components of the Mediterranean diet is associated with lower levels of perceived stress and mental distress, according to new research from Binghamton University, State University of New York. Credit Alachua County

Following the Mediterranean diet rather than the traditional Western diet might reduce stress, according to new research conducted by a team from Binghamton University, State University of New York.

Lina Begdache, associate professor of health and wellness studies, said the findings suggest that people can lower their perception of how much stress they can tolerate by following a Mediterranean diet.

“Stress is recognized to be a precursor to mental distress, and research, including our own, has demonstrated that the Mediterranean diet lowers mental distress,” she said. “Thus, one element of the puzzle may be explained by the fact that the Mediterranean diet may be associated with a decrease in the negative components of perceived stress and an improvement in its positive attributes.”  

The Mediterranean diet is plant-based, with healthy fats, and mainly includes wholesome food and a spectrum of natural colours. It stands in sharp contrast to the Western diet, which is known for its high concentration of high-glycemic and low-quality processed foods.

While the Mediterranean diet is known for its benefits to both mental and physical health, little is known about its effect on perceived stress, which is how much stress you are under at any particular time.

To assess this, Begdache and her students surveyed over 1,500 people, asking them what foods they ate and evaluating their perceived stress levelsss. Using a machine learning model, the results show that consuming components of the Mediterranean diet is associated with lower levels of perceived stress and mental distres,s while consuming Western dietary components is correlated with perceived stress and mental anguish.

Begdache said these results close a gap in the literature because most studies on diet and stress focused on how stress affects dietary choices and quality. She and her team are looking at different aspects of brain function and behaviours about dietary patterns.

Posted on ADHD

ADHD medications hit by supply shortages essential to improve quality of life

How to Remember To Take Your Meds: Never Forget Again! #Shorts​

Research conducted by the University of Southampton indicates that while medications are important for improving the quality of life for individuals with ADHD, the authors suggest that additional support is necessary alongside medications.

The findings, published online on 8 August 2024 in The Journal of the American Academy of Child and Adolescent Psychiatry, highlight the potential impact of shortages of certain ADHD medications.

“It is deeply concerning to think of the impact on individuals who cannot access their medication due to supply shortages or for other reasons,” Professor Samuele Cortese from the University of Southampton, the senior author on the paper, expressed.

Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by symptoms of inattention, hyperactivity, and impulsivity, which can have negative effects on various aspects of life such as social interactions, work, education, and daily tasks.

“People with ADHD report lower quality of life in areas such as work productivity, social and family life, and self-esteem, compared to their neurotypical peers,” stated Dr. Alessio Bellato, a lecturer in Psychology at the University of Southampton and the lead author of the paper.

“This study demonstrates that medications play a crucial role in enhancing the quality of life for individuals with the condition.”

The researchers conducted the first systematic review and meta-analysis to investigate the effects of stimulant (amphetamines and methylphenidate) and non-stimulant (atomoxetine) drugs for ADHD on the quality of life.

They included 17 placebo-controlled trials, encompassing over five thousand participants in the analysis. Trials were drawn from the MED-ADHD dataset the largest dataset of trials of ADHD medication, set up by Professor Cortese and international collaborators.

Both stimulant and non-stimulant drugs were significantly more effective in improving quality of life than placebo. However, the study also found that while the effects of these drugs on the core ADHD symptoms are usually medium to high, the impact on quality of life was in the small-to-medium range.

Professor David Coghill from the University of Melbourne, a co-author on the paper, added: “This disparity shows that, for most people, targeting core symptoms through medication alone is unlikely to counter the impact of ADHD on quality of life. More research is needed to find out whether combining medication with other approaches can lead to further improvements in well-being and what types of support might be most effective in situations where medication is not available.”

“More research is also needed to better understand how these medications affect quality of life,” says Dr Bellato. “It could be that reducing the core symptoms of ADHD (inattention, hyperactivity, impulsivity) leads to more efficient task management and this results in better academic and professional outcomes. Medications may also help stabilise emotional dysregulation, promoting emotional well-being and higher self-esteem.”

“Considering that ADHD medication might not be acceptable, effective, or well tolerated for everyone with ADHD, more research is needed to evaluate alternative approaches, including psychological interventions.”

Posted on Multiple Sclerosis

The Role of Epstein-Barr Virus in Multiple Sclerosis

This week’s “Ask an MS Expert” will cover the most recent evidence regarding the role of the Epstein-Barr virus in triggering multiple sclerosis. Dr. Bruce Bebo, the executive vice president of research programs at the National MS Society, and host Jon Strum will discuss the implications of this information for the MS community and share the Society’s plans for utilizing this new knowledge.

Posted on ADHD, Autism

“New Study: Link Found Between Neighborhood Conditions and ADHD Signs in Autistic Children”

Study finds poverty, lack of services may play a role
A study suggests that poverty and the lack of services may have an impact.

Children with autism who were born in underprivileged neighbourhoods are more likely to exhibit more significant symptoms of attention deficit hyperactivity disorder (ADHD) than those born in more affluent communities, according to a new study led by researchers at the UC Davis MIND Institute.

This groundbreaking study is the first of its kind to explore the relationship between neighbourhood factors and ADHD in both autistic and non-autistic children. The research offers new perspectives on mental health conditions and could play a key role in shaping public policy changes to enhance health equity.

“We discovered that certain neighbourhood factors are closely linked to ADHD symptoms in autistic children”” stated Catrina Club, the primary author of the study. Calub is a postdoctoral researcher working in the laboratory of Julie Schweitzer, who is a professor in the Department of Psychiatry and Behavioral Sciences and the MIND Institute.

“In our study, we found that this effect was only present in autistic children and not in typically developing kids or in kids with other developmental disabilities. It suggests that when autistic children live in neighbourhoods with fewer resources, they tend to exhibit more pronounced ADHD symptoms,” explained Club.

ADHD symptoms may include higher rates of inattention, hyperactivity, and impulsive behavior. It is associated with:

  • Challenges in school performance and relationships with friends
  • Lower self-esteem and greater risk for anxiety and depression
  • Higher potential for substance use disorders and accidents
  • Emotional dysregulation and conduct problems

Study expands findings from long-term research

The researchers utilized data from two studies: the long-running Childhood Autism Risks from Genetics and the Environment (CHARGE) study led by Irva Hertz-Picciotto at the MIND Institute and the ReCHARGE follow-up project.

The research team examined 246 children with autism, 85 with developmental delays but not autism, and 193 neurotypical children. They then used the Child Opportunity Index, which utilizes census data to analyze over 30 neighbourhood characteristics. These characteristics include socioeconomics, access to green spaces, single-parent households, and the presence of early childhood education centres.

The index encompasses education, health and environment, and social and economic resources. Higher scores are linked to better childhood health. Of the three domains, the scores for education and social and economic resources were most strongly related to ADHD symptoms.

The analysis showed the Child Opportunity Index scores at birth were a strong predictor for ADHD symptoms in adolescence in autistic children but not in the other groups. Calub noted that the finding was unexpected.

“These results are quite concerning,” Calub said. “Those with both autism and ADHD are already more likely to have additional challenges—behaviorally, cognitively, emotionally, and socially. Being born in a low-income neighbourhood puts them at an even greater disadvantage. This adds to the evidence that more resources are needed for underserved areas and specifically for those who have conditions like autism.”

The need for a larger, more diverse sample

Calub pointed out that more research is needed to determine if the obtained results are conclusive.

apply to a larger group.

“It will be important for future studies to be larger and more diverse. This will help us learn whether neighbourhood conditions might also influence ADHD symptoms in other groups, such as youth without autism, or in Black, Asian, and Native American individuals, who were underrepresented in our sample,” Caleb added.

These findings also provide insights on how to target preventive strategies to reduce the risk of increased ADHD symptoms, as noted by Schweitzer, who was also a co-author on the study.

“ADHD is highly prevalent in the general population and is common in autistic youth. If we can find ways to increase resources in these neighborhoods, we have the potential to improve academic, social, mental, and physical health outcomes, particularly for autistic youth, and also decrease long-term economic costs,” Schweitzer explained.

Calub and Schweizer assert the study’s findings should motivate policymakers to allocate more resources for underserved communities. Furthermore, they suggest that incorporating the Child Opportunity Index and other neighborhood metrics could yield fresh insights for future studies to guide policy.