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December 15, 2010

In Research

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Kids with autism build creativity skills with Legos

Medical Center researchers have tapped a toy box staple to help children with autism learn the building blocks of creativity. By building Lego structures in new and unique ways, children with autism spectrum disorders (ASD) learned to use creativity, an important skill that they had seen as very challenging prior to the study.

Many children with autism spectrum disorders can become frustrated and uncomfortable when asked to break out of repetitive activities and create something new. Using Applied Behavior Analysis, the science of figuring out how to target and systematically change a specific behavior, the study’s researchers succeeded in teaching all six children in the study to play with Legos in a more creative way. The findings have been published in the Journal of Applied Behavioral Analysis.

The children, who had wanted to create the same 24-block Lego structure over and over again at the start of the study, began venturing out of their comfort zones to create new structures with different color patterns.

By the end of the study, all six participants succeeded in making changes to every Lego structure they worked on. Participants were between the ages of 6 and 10 and five of the six had moderate problems with restricted or sameness behavior, according to an assessment that each participant’s parent or teacher completed.

As each child began building with 24 Legos, the instructor praised the child with a “good job” from time to time, to get baseline data and decide whether the child seemed inclined to change the color pattern or structure of the Legos.

During a series of sessions in the next several months, an instructor asked a child to build something new at the beginning of each session. Instructors modeled the task for children who did not understand what they were being asked to complete. If a child succeeded, he or she was rewarded with a small prize.

In the next phase, the instructor asked the children to build something new with wooden blocks, rather than the plastic Lego blocks, to see whether they could apply their new skills to a slightly different situation. Then the instructor gave the children Legos again, but this time they didn’t receive teaching sessions and were rewarded only with a “good job” and not a small prize. The instructor wanted to see whether the children would still experiment with the Legos. In the last phase, the children were once again rewarded for varying their Lego structures.

A few months later, researchers followed up with the children and found that they were all still able to create new structures in varying colors or shapes.

“The study’s findings could pave the way for new studies testing interventions that attempt to improve a wide variety of social skills and behaviors among people with ASD,” says Deborah Napolitano, the study’s principal investigator and an assistant professor of pediatrics. “With positive reinforcement and teaching sessions, such tasks as engaging in novel conversations, posing new questions, and creating new ways to play could be within reach for children with ASD.”


glass of beerRaise a glass to ‘Notch’

Many studies support the assertion that moderate drinking is beneficial when it comes to cardiovascular health. Now, Medical Center scientists have discovered that a well-known molecule, called Notch, may be behind alcohol’s protective effects. The finding could help scientists create a new treatment for heart disease that mimics the beneficial influence of modest alcohol consumption.

In the study, published in Arteriosclerosis, Thrombosis and Vascular Biology, scientists found that alcohol at moderate levels of consumption—generally considered one to three drinks per day—inhibits Notch and subsequently prevents the buildup of smooth muscle cells in blood vessels, which contributes to narrowing of the arteries and can lead to a heart attack or stroke.

In trying to uncover the molecular players involved when it comes to alcohol and improved cardiovascular health, Redmond and her team focused on Notch because research has shown it influences the growth, migration, or death of vascular smooth muscle cells. In blood vessels, the growth and movement of smooth muscle cells plays a key role in the development of atherosclerosis, the hardening and narrowing of arteries, and in restenosis, the re-narrowing of arteries after they have been treated to remove buildups of plaque: Both are risk factors for heart attack and stroke.

The team studied the effects of moderate amounts of alcohol in human coronary artery smooth muscle cells and in the carotid arteries of mice. In both scenarios, regular, limited amounts of alcohol decreased Notch, which in turn decreased the production and growth of smooth muscle cells, leaving vessels open and relatively free of blockages or build-up—a desirable state for a healthy heart.

“Now that we’ve identified Notch as a cell signaling pathway regulated by alcohol, we’re going to delve deeper into the nuts and bolts of the process to try to find out exactly how alcohol inhibits Notch in smooth muscle cells,” says David Morrow, an instructor in the Department of Surgery and first author of the study.

Eileen Redmond, an associate professor of surgery, was lead author of the study. Coauthors include John Cullen and Weimin Liu from the Medical Center and Paul Cahill at the Vascular Health Research Center, Dublin City University, Ireland. The study was funded by grants from the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health and the American Heart Association.


Prescriptions for teens and young adults on the rise

Prescription rates for controlled medications, or drugs the Drug Enforcement Administration deems as having the potential for abuse, have nearly doubled for teens and young adults in the past 14 years, according to a recent Medical Center study published in Pediatrics. Overall, a controlled medication was prescribed for young adults at approximately one out of every six visits and by adolescents one out of every nine encounters.

“Physicians must balance the need to treat patients’ symptoms while remaining aware of the possibility that prescription medications can be misused or shared with others. At times, it can be a delicate balance between treating a problem and inadvertently causing one,” says Robert Fortuna, principal investigator of the study and an assistant professor of pediatrics and internal medicine.

The study found that between 1994 and 2007, prescription rates for controlled medications nearly doubled from 8.3 to 16.1 percent among young adults and rose from 6.4 to 11.2 percent in adolescents. This increase was observed for both males and females and across multiple settings—ambulatory offices, emergency departments, and for injury-related and non-injury–related visits.

Controlled medications were often prescribed for common conditions, such as headaches and back pain. While the study did not examine the appropriateness of prescriptions, researchers suggested that physicians take responsibility for monitoring patients receiving controlled medications to ensure that the treatment is effective and that the medications are being used appropriately.

Researchers partly attributed the rising trend in prescriptions for narcotics among young adults to evolving state and federal regulations increasing advocacy for pain management. For example, prescriptions for narcotics rose after 2001, when the Joint Commission on Accreditation of Healthcare Organizations launched an initiative to monitor and treat pain as a fifth vital sign (along with temperature, pulse, respiration, and blood pressure).

Sedative medications were increasingly prescribed to young adults and adolescents.  Researchers tied the rise to a heightened awareness of insomnia and anxiety, the availability of new pharmaceuticals, and widespread direct-to-consumer marketing.

The study found adolescents were also increasingly prescribed stimulant medications. While reports between 2002 and 2008 showed that the overall misuse of stimulant medications like Ritalin has decreased, a recent study found that poison centers are increasingly receiving calls from those who have intentionally misused stimulants, which could mean that the smaller numbers of those misusing stimulants are doing so more intensively. Further, stimulant medications are increasingly being shared with those who have not been prescribed the medication.

“Physicians need to have open discussions with patients about the risks and benefits of using controlled medications, including the potential for misuse and diversion,” Fortuna says.


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