DNA disorder linked to autism (ASD) social communication disorder (SCD), social phobia, behavioral problems, ADHD, and anxiety disorder

human DNA
Behavioral profile of DNA disorder reveals ties to autism

by Rachel Nuwer, 26 May 2015 *excerpted
SFARI.org  (Simons Foundation Autism Research Initiative)
News and Opinion articles on SFARI.org are editorially independent of the Simons Foundation.

People who carry an extra copy of a chunk of chromosome 7 have a wide range of symptoms, from social phobia to speech impediments, according to the first systematic look at the psychology and behavior of people with 7q11.23 duplication syndrome1. About one-third of these individuals show signs of autism, the study revealed. The findings, published 21 April in the American Journal of Medical Genetics, support the notion that genes within this surplus swath of DNA, called ‘Dup7,’ may contribute to autism symptoms.

Deletions of the same region cause Williams syndrome, a developmental disorder characterized by intellectual disability and extreme friendliness.

The researchers found that most of these individuals have intelligence quotients between 74 and 93. Half of them have social phobia, an extreme fear of meeting new people and of being in large groups; about 80 percent have speech problems.

Behavioral problems are also common, the researchers reported. About one-quarter of the participants show disruptive behaviors such as disobedience, and 35 percent have attention deficit hyperactivity disorder (ADHD). One-third of children between the ages of 4 and 17 scored above the cutoff for possible autism on the Social Communication Questionnaire, a screening test for the disorder, but most did not have an official diagnosis. A 2011 study found a strong link between autism and 7q11.23 duplication, but no study had estimated the rate at which the disorders may co-occur2.

“This study has many strengths,” says John Carey, professor of pediatrics at the University of Utah, and editor-in-chief of the journal that published the work. “The only shortcoming of this otherwise incredibly thorough paper is that the authors could have investigated the occurrence of autism spectrum disorder with 7q11.23 duplication syndrome in more detail by performing a comprehensive assessment.”

The study highlights some interesting differences between people carrying too many copies of the 7q11.23 region and those with too few. Whereas children with 7q11.23 duplication have social phobia, those with Williams syndrome tend to be exceedingly outgoing. ADHD is more common in children with Williams syndrome, but speech problems are far more prevalent among children with 7q11.23 duplication.

The research provides support for the genetics-first approach to autism research, in which individuals are included in studies based on their genetic profile as opposed to their symptoms. With this approach, “specific genes may be shown to be associated with specific characteristics, and that information may point to specific genetic pathways that are associated with characteristics of autism spectrum disorder,” Mervis says.

The findings are also likely to help doctors, families, teachers and therapists better understand what it means to have a 7q11.23 duplication, says Mervis.

“Many of these children who are selectively mute or have an anxiety disorder have been labeled rude, disruptive or disrespectful by their schools because they won’t respond to teachers,” she says. “But it’s not that they don’t want to cooperate — they can’t.”

References:
1. Mervis C.B. et al. Am. J. Med. Genet. A. Epub ahead of print (2015) PubMed
2. Sanders S.J. et al. Neuron 70, 863-885 (2011) PubMed

*Link to full article

Seminar: San Mateo County Psychiatry Residency Training Program

Childhood Disorders in the Real Worlds of Courtrooms and Classrooms

June 23, 2015  3:45-5:00 pm

Training opportunities at The Children’s Psychological Health Center, Inc. in San Francisco

Presenter: Gilbert Kliman, M.D.

By the end of this presentation a resident will be able to describe how

1) developmental and etiologic knowledge of child psychiatry can be applied in civil litigation testimony

2) psychotherapeutic techniques with disturbed preschool age children can be applied intensively and in an evidence based way in a real life setting such as a special education classroom

Hosted by: Raziya S. Wang, MD
Director, Psychiatry Residency Training Program
San Mateo County Behavioral Health and Recovery Services
222 West 39th Avenue, San Mateo, CA, 94403
650-573-2539 voicemail
650-573-2527 fax
http://www.smhealth.org/psychres

ACP Newsletter – Excerpts from Gilbert Kliman, MD’s presentation

American College of Psychoanalysts — 2014 Fall Newsletter

Summary of Presentations at the ACP conjoint conference, in Paris on May 23-24, 2014, with the University of Paris 7-Diderot (Centre pour Psychanalyse, Medecine, & Societe), and A2IP (Association Internationale Interactions de la Psychanalyse) by David R. Edelstein, MD

Excerpts from Dr. Edelstein’s summary of Gilbert Kliman, MD’s presentation of Reflective Network Therapy and subsequent discussion:

It was impressive that this deep interpretive work could be done in 15 minute sessions on the classroom floor and could be so thoroughly integrated with the rest of the child’s interactive environment…One could observe in the video clips, in a way that was profoundly moving to the entire audience, the way that the child could develop mental representations and mirror the therapist’s ability to present such representations.

Gil postulates that the reflective network environment strengthens weakened neural networks between limbic and motor systems…Gil emphasized that there was a profound biological process occurring as the child took in, metaphorically, the ‘scaffolding’ of the mental representations provided by the therapist.

Gil and his colleagues have worked with more than 1700 children, 40% of whom had Autism Spectrum Disorder, and has slowly built and evolved an increasingly fuller understanding of this disorder and its treatment by using psychoanalytic techniques in the context of orchestrating and harnessing small social networks for the advantage of the individual child as well as the group. Gil described, eloquently, how he had undertaken the treatment of autistic children without using medication and how he views it as a hazardous experiment to turn quickly to medicating children.

Gil described, using extensive and very moving video clips, his treatment of a young boy with high level autism who had few words, was preoccupied with train schedules, was aggressive, repeatedly wore the same clothing, often howled and screamed, could not tolerate noise, could not allow himself to be touched, spoke in the low guttural voice characteristic of what had previously been labeled Asperger’s Syndrome, and was clumsy. Gil had sessions four times weekly, 15 minutes per session, with the child within the child’s school classroom. The Reflective Network Therapy aims for a synergistic combination of education with psychotherapy.

The child’s play is central in the construction of the sessions and during the sessions other children might interact with the child and with the therapist. The therapist begins the session by being attuned to the child and tactfully verbalizing his or her reflections about the child’s feelings and behavior, particularly the therapist’s thoughts about what the child is doing and thinking in the here and now of the classroom.  In this way, the child’s resistances to education, refusal of affection, and inhibited or inappropriate enjoyment of socialization can be spoken about and often interpreted on the spot.  Following the session, the child and the therapist both brief the teachers on the treatment. The parents are seen weekly by the teacher, being offered a 45 minute private guidance session, and monthly by the therapist. The teachers and the therapist also meet regularly to share observations. …

The network reflects about the child in predictable ways and the intersubjective reflections organize and semantically encode each participant’s theory of the child’s mind. Classroom peers are a vibrant part of this network and everything happens in the real-life space of the classroom. The sessions focus strongly on attunement and are often filled with entangled and metaphoric interactions with the children. Interpretations, often deep, are made on the spot. The rejection that children experience from their peers is spoken of directly, allowing little time interval between the painful wounds of rejection and interpretation. Every child in the classroom interacts actively with the school and the therapeutic network and each child receives daily feedback and has hundreds of sessions. This environment is the opposite of the secluded Kleinian approach.

Children experience a linear increase in IQ with this treatment, going up one standard deviation with twice weekly treatment and two standard deviations with four times per week treatment. Gil also finds that this treatment can be done for 1/6th the cost of behavioral analysis and is much more effective.

Gil noted that something unexpected and very growth-promoting happens when the network is initiated; strong affection can be brought out in these children. Gil conceived of the therapist as holding mental representations and sharing them with the child to ‘scaffold’ them and to help the child to mentalize psychological content. One could observe in the video clips, in a way that was profoundly moving to the entire audience, the way that the child could develop mental representations and mirror the therapist’s ability to present such representations. Gil was literally on the floor with the child and his engagement and caring was evident, and was felt by the child, and this served as an important support for the attunement on which the development of mental representations was based.

In no other method does the child’s treatment take place exclusively within the learning and play activities of his special and regular education classroom groups. There is no pull-out therapy. Parents are often present in the classroom and behavioral aides are hardly ever used.

Discussion:

Discussant Dr. Drina Candillis felt that Gil’s emphasis on a group framework is essential. Drina noted the importance of sharing psychoanalytic ideas with people who are not psychoanalysts and felt that Gil had done this effectively. Drina felt that the French approach focuses too much on symptoms as reflective of parental suffering and focuses too much on parental issues and that Gil’s work shows that this may not lead to an accurate understanding of the child.

Discussant Dr. Gisèle Apter stated: In France these [ASD] children attend one half day of school, then have group meetings, then parent meetings, then therapy. The therapy is much less frequent than four times weekly and the children do not do as well.  Gisèle views the 15 minute session as a way for the therapist to stay engaged and to keep the child engaged and felt that longer sessions might be overwhelming for both the therapist and the child. Gisèle also commented that maintaining neutrality and giving medication are mistaken approaches and she strongly supported Gil’s efforts to be creative and inventive with technique.

Gil responded that suspicion of assessment with autistic children is often quite strong and may lead to resistance to studying the outcomes of treatment. Gil emphasized the importance of using extra-analytic outcome measures for scientific purposes as this can provide strong data. Psychoanalytic data, for example on defenses, may not be as useful and extra-analytic data can help our profession to achieve a better public image. Gil then pointed out that children often feel tranquilized by being thought about and that their pain at feeling isolated can be expressed in their howling. Gil emphasized that we can overcome genetic tendencies, gene expressions, through the use of Reflective Network Therapy.

Jerry Blackman commented that Gil’s technique ‘used interpretations upwards’ similar to Lowenstein’s technique, and was able to translate the child’s thinking into a less primitive form and to push verbalization, keeping children from retreating. Jerry also wondered if one might use conflict theory, with the concept of erotization in masturbation, and if one could view Gil’s patient as having sublimated. Gil responded that many meta-psychological theories are called out by his method and that he has greatly expanded his own “psychoanalytic IQ” by doing Reflective Network Theory.

Sophie de Mijolla-Mellor commented that the developments in Gil’s patient were not, in her view, sublimation but one could think of the child beginning to learn as the start of sublimation. She would use the term ‘symbolization’ rather than ‘sublimation.’ She quoted a French theory that the mother is the “bearer of language,” meaning that the mother names emotions and gives names to the roles and levels of interaction within the family. Sophie noted that, if that is not done, the child may have difficulty.

Gil responded that there have been studies which show that events which are discussed with the mother and the father are more readily recalled than those that are not, indicating that the “self” is built upon dialogue. Gil stated that he has produced workbooks on people’s roles in the child’s history so that children can know where they fit in; this helps children break free of repetition compulsions following multiple placements. Gil felt that the analyst is the “bearer of memory” and that this concept can be applied on a public health basis.

Drew Clemens described how Erna Furman at the Hannah Perkins program in Cleveland started a high school course on parenting and used Anna Freud’s developmental lines to study children in therapeutic schools. Henri commented that we need more parenting programs in schools.

Gil responded that he has observed IQ increasing more in his patients if the father is present in guidance sessions.

Harold Blum raised a question about the development of memory in these patients.

Gil commented that issues of infantile amnesia and the start of the ability to recover memories are later issues in the trajectory of development than developing mentalization and that little is known about this. Gil pointed out that the brains of autistic children may differ from those of normal children and that their genetics may differ. For example autistic children have been shown to often have a P10 gene that is linked with higher rates of cancer; the study of autistic children therefore has strong public health implications.

Web-Based Screening: Early Identification of High Risk Children

Evidence-based Early Detection of Developmental-behavioral Problems in Primary Care

What to Expect and How to Do It

Frances Page Glascoe, PhD, J Pediatr Health Care. 2015;29(1):46-53.

PEDS Online offers developmental-behavioral/mental health and autism screens with automated scoring, report writing, and a mineable database. Problematic screening results were found in more than 1 out of 5 children, and rates of screening test failures increased with children’s ages. Children screened outside the well-child visit schedule were more likely to have screening test failures. Personnel at 22 of the 79 clinics were either interviewed or observed in person to identify implementation strategies. Clinics, even those serving families with limited education or lack of facility with English, found a variety of ways to make use of online screening services.

Introduction
The American Academy of Pediatrics (AAP) and the National Association of Pediatric Nurse Practitioners (NAPNAP) have created a number of policy and position statements regarding early detection of developmental-behavioral difficulties, autism spectrum disorders, mental health problems, and motor impairments (American Academy of Pediatrics, 2006, American Academy of Pediatrics, 2009, American Academy of Pediatrics Task Force on Mental Health, 2010, High, 2008, Myers and Johnson, 2007, National Association of Pediatric Nurse Practitioners, 2009, National Association, 2011, National, 2013a, National, 2013b, Noritz and Murphy, 2013). The rationale, thoroughly grounded in evidence, is that early detection leads to early intervention, and through early intervention, children’s outcomes and families’ well-being are vastly improved (Anderson et al., 2003, Campbell et al., 2002, Farran, 2005, Muennig et al., 2009, Reynolds et al., 2011, Reynolds et al., 2011, Schweinhart et al., 2005).

In the United States, one in six children have developmental-behavioral problems, including deficits or disorders in language, motor, or pre-academic/academic skills; deficits in intelligence; mental health/behavioral/social-emotional problems; or autism spectrum disorders (Baio, 2008, Boyle et al., 2011). One in four to one in five children have either mild delays or psychosocial risk factors predictive of future difficulties (e.g., housing instability, parental depression, limited parental education, poverty, and parenting behaviors that fail to promote children’s language and academic skills). Psychosocial risk factors are strong predictors of present and future developmental and mental health problems (Simon, Pastor, Avila, & Blumberg, 2013). The majority of these children who are not treated in early childhood experience school failure, drop out before completing high school, are less likely to be employed as adults, are more likely to become teen parents, incur high health care costs, and engage in criminal behavior (Simon et al., 2013, Stevens, 2006). If the problems are identified and treated early through services such as Head Start, parent training, or the Individuals with Disabilities Education Act, outcomes are vastly improved. Research on cost savings to society show that for every $1 spent on early intervention, taxpayers save up to $17 (Anderson et al., 2003, Campbell et al., 2002, Farran, 2005, Muennig et al., 2009, Reynolds et al., 2011, Reynolds et al., 2011, Schweinhart et al., 2005).

Accurate early detection depends on validated, standardized screening measures.

Read full article.

Wall Street Journal — Preschool Therapy Benefits

PJ-AR442_WORKFA_G_20090908160626The Wall Street Journal discusses therapy for preschool children: “Advocates say that mental-health help in preschools is an efficient way to help small children learn lifelong social and emotional skills they need…A growing body of research shows that the programs are benefiting entire classrooms of children by reducing behavior problems and supporting overburdened teachers.”

Read the full article.

Treatment for Special Needs Preschoolers in Santa Rosa

There is now fully inclusive education for disturbed preschoolers in Santa Rosa.  A mental health team works right in a private preschool where typical preschoolers help socialize and educate their developmentally and psychiatrically challenged peers.  Autistic, developmentally atypical, traumatized and many other types of preschool disorders can be helped without any bureaucratic delays. Highly qualified psychiatrist is in charge of the treatment program and highly qualified educators run the preschool education process synergistically with the treatment.

full page ad for Santa Rosa RNT service

 

 

Volunteers needed: Preschool Service for Disturbed Children

Innovative preschool in Santa Rosa , CA (Kiwi Preschool and Day Care) for typical children is accepting special needs children. They receive therapy in the classroom.  The children often need help with energetic aggression-reducing activities.  Psychology or education students welcome and will receive lots of supervision from Board Certified Child psychiatrist, psychoanalyst and senior educators. Call Gilbert Kliman MD at 415 706 7010.

Surprising finding about a unique treatment of autism spectrum disorder

Medicalxpress.com July 2014

Breakthrough using unique therapy for children with autism spectrum disorders

Researchers have reported a surprising finding about a unique treatment of autism spectrum disorder: a large and reliable IQ rise. Almost every treated child, regardless of diagnosis, showed significant increases in IQ, along with improved social interaction, more positive behavior, and improved communication skills. These were the 2014 findings of a 49-year-long, multi-site study reported on at the American Psychoanalytic Association in Chicago. Investigators were led by Gilbert Kliman, M.D. of The Children’s Psychological Health Center in Santa Rosa and San Francisco.

“The treatment, called Reflective Network Therapy, (RNT) focuses on one child at a time,” said Dr. Kliman, “as it harnesses small social networks in the classroom, composed of parents, teachers, an in-classroom therapist and peers. It provides intensive interpersonal exercises within the child’s own preschool class on hundreds of occasions during the course of a school year.” Videos of treatments were used to illustrate results during the Chicago meeting.

“The method costs about one sixth that of the most commonly used treatment,” said Dr. Kliman, “and could save public special education systems, parents and insurers millions of dollars for every ten children receiving the treatment. Unlike most approaches to serious early childhood disorders, RNT has a how-to-do-it manual, training videos, and some very long-term follow-ups. It is easily replicated and ready for widespread use in public and private special education settings.”

Studies showed significant IQ increases following Reflective Network Therapy

The work included treatment of 1700 of disturbed preschoolers. Among them were 680 preschoolers on the autism spectrum. All were treated right in their own classrooms with this well-tested therapy. Videotapes of sessions studied for a school year show observable clinical progress among most of the children. Third-party researchers in eight programs administered IQ tests to 79 of the children, including 31 who were on the autism spectrum, at the beginning of treatment and again a year later. All but one of the 79 twice-tested children showed IQ gains, with an average gain of 24 points. Some of the highest gains were among the 31 autism spectrum patients. The data have been subjected to comparisons with other methods, as well as to controlled studies. The outcomes were of high statistical significance.

Dr. Kliman, the method’s principal author, presented this data on Reflective Network Therapy’s multi-site program in June at the American Psychoanalytic Association meeting in Chicago. He was awarded a prize for leadership in treatment of autistic and other preschoolers in May by the Parisian Psychoanalytic Society and the American College of Psychoanalysts. Dr. Alexandra Harrison presented findings at the World Association of Infant Mental Health in Edinburgh

Autism and related developmental disorders are increasing. This treatment gives powerful help to these children, their families, and the budgets of their schools, says Bay Area special education administrator Jay Parnes. It is being praised in professional publications about autism and education.

gilbert-kliman-mdParticipants in providing I.Q. outcome data included Arthur Zelman of the Center for Preventive Psychiatry, N.Y.; Alexandra Harrison MD, of Harvard Dept. of Psychiatry; Nancy Blieden Ph.D. of the Michigan Psychoanalytic Institute; Sandy Ansari, Educational Therapist of the San Diego Psychological Center; Catherine Henderson Ph.D. and staff at Wellspring Family Services of Seattle; Linda Hirshfeld M.A. of the Ann Martin Center in Piedmont, CA; and Alicia Mallo M.D. of Buenos Aires, Argentina.

The Children’s Psychological Health Center, Inc. in San Francisco and Santa Rosa provides training in the use of RNT therapy in public and private preschool classrooms around the world and is planning its own therapeutic preschool in Santa Rosa, California.