Student Spotlight — Meet Landon Kirlin

Growing up in Bolivar, Mo., Landon Kirlin has had experience with people with mental health and special needs for all his life. Being raised with family members, friends and classmates with special needs, he has known he wanted work in the field for a long time. However, Kirlin has had a longer journey than some to arrive as a master’s student at the Thompson Center.

Kirlin first attended the University of Missouri as an undergraduate student, earning degrees in psychology and sociology. After graduating, he first learned about the Thompson Center when he began working in a mental health support position locally for individuals with special needs.

“One of the men I worked with and supported had a position working at the Thompson Center,” Kirlin said. “I recognized even then the amazing work being done at the Thompson Center and the support and environment they fostered for my client and so many others.”

Kirlin’s journey then took him to Springfield, Mo., where he was introduced to Applied Behavior Analysis (ABA). In a position as a behavior technician, Kirlin learned more about both ABA and autism as he performed early intervention work for children on the spectrum.

“ABA really seemed to strike a chord for me,” Kirlin said. “I grew to appreciate the clarity it provides, how goal oriented and data driven it is. And most importantly how effective it can be in helping teach important skills and behaviors and how it can give families a sense of direction moving forward.”

For Kirlin, this work with ABA and with people with autism motivated him to expand his education and expertise of the practice. In 2018, Kirlin enrolled in the ABA master’s degree program at the University of Missouri College of Education and the Thompson Center. As a part of his studies, Kirlin will gain on-the-job training by working directly with people with autism at the Thompson Center.

“The opportunity to work and learn directly with patients was a huge draw for me to come to Mizzou and to the Thompson Center,” Kirlin said. “Having already had experiences with the Thompson Center and with Mizzou, I already knew it was an amazing place, so the choice was obvious and easy.”

Kirlin is on track to graduate with his master’s degree in the spring of 2020. Upon graduation, he hopes to continue his career in ABA by working on skill acquisition with older teenagers and adults with autism.

“ABA can be really effective in teaching social skills and reducing problem behaviors, so I look forward to using this knowledge to help others,” Kirlin said. “I enjoy this work so much because you really get back even more than you give. I come home each day and know that I’ve helped someone. It is a really great feeling.”

Kirlin also has a passion for music and hopes to incorporate that into his work in the future, sharing music and developing music-based programs for his patients. It’s this drive to learn and help patients that has earned Kirlin the second annual Davis Family Scholarship at the Thompson Center.

The Davis Family Scholarship provides annual support to a student at Mizzou who is currently training at the Thompson Center and pursuing a degree in an autism-related field. The selection process and criteria for awarding the scholarship is based on the recipient’s potential career impact on individuals and families with Autism Spectrum Disorder in the area(s) of advocacy; diagnosis and identification; research; and/or treatment and intervention. Criteria that Kirlin surpasses at every turn.

“I am so grateful for this scholarship,” Kirlin said. “I want to thank the Davises for this amazing opportunity and the support for my studies. I plan on paying it forward to my patients in the future.”

A future that is undoubtedly bright for Kirlin and his patients.

Through Their Eyes

Diagnosing children with autism as early and as efficiently as possible has always been a great challenge for autism providers and for families. Despite, or perhaps because of, the increased awareness of autism, waitlists for diagnostic evaluations by trained clinicians can last for months or even years at autism centers across the country.

To help improve autism diagnostic efficiency and reduce wait times for families desperate for answers, researchers at the Thompson Center are working to test a newly developed autism screening test that could help identify children as having a high risk for autism quickly and cheaply.

“We are always looking for better, faster and easier ways to identify children who may be on the autism spectrum,” said Dr. Stephen Kanne, Thompson Center executive director and lead investigator for the new study. “If we can find ways to identify children who may be at risk as soon as possible, we can get them evaluated by an expert and into treatment at a much earlier age, which improves potential outcomes greatly.”

Funded by a newly awarded $900,000 grant from the Simons Foundation Autism Research Initiative (SFARI), the Thompson Center will serve as the lead site for a three-year multi-site study to determine the effectiveness of an autism screener which operates by tracking the eyes and viewing patterns of children. The other sites include Stanford University and the University of Virginia.

The screening test, called AutismEYES, was first developed by Autism Speaks Chief Science Officer Tom Frazier and measures a child’s viewing patterns when shown videos of people communicating socially. While viewing the videos, the children’s eyes are monitored using motion tracking technology. The researchers believe that they might be able to determine autism risk based on which parts of the video scenes the children choose to focus on.

For example, when watching a scene of two people having a conversation at a restaurant, a typically developing child would most likely be drawn to the faces of the two people, paying attention to what they are saying and how they are acting. On the other hand, a child with autism may be more likely to ignore the faces on the screen and instead focus on items in the periphery, such as a clock on the wall or the food on the table.

“This screener can quickly and easily measure eye gaze without a complicated process, making it intriguing to autism diagnosticians as a simpler way to identify children with a risk for autism,” Kanne said. “Children identified by this screener would still need an expert evaluation, but this screener, if proven effective, could help fast-track those kids to receive the evaluation and treatment they need.”

To study AutismEYES, Kanne and the team of Thompson Center researchers, including Thompson Center clinician and researcher Dr. Kerri Nowell, will spend three years evaluating children who have already been diagnosed with autism. If these tests show a consistent pattern in how children with autism view the videos, potential exists for further longitudinal studies that would include typically developing children in order to measure the differences in viewing patterns. Ultimately, the researchers hope that AutismEYES proves to be a quick, inexpensive and effective way to identify children on the spectrum.

“This is a test that could easily be taught to people with minimal training,” Kanne said. “While it takes years of training and education to become an expert autism diagnostician, just a few hours could be spent training someone in a physician’s office or a school district to implement a test like this. While this screener doesn’t replace a clinical diagnosis by a trained professional, it can help identify at-risk children and fast-track them to receive a professional diagnosis. Finding ways to reduce barriers and improve access for all children is one of our primary missions as autism researchers and advocates, so we are hopeful tests like these can be further developed and implemented around the country.”

Searching for Footprints

A “golden goose” of the autism research world is finding a screening test that can accurately and efficiently identify autism risk in patients early in life so that they can receive treatment and resources as soon as possible. Clarifi ASD, developed by Quadrant Biosciences, might be a test that could help identify children with autism early.

In order to determine if Clarifi ASD can accurately predict autism risk, the Thompson Center is serving as a recruitment site to identify patients willing to help test the effectiveness of the new screener.

“How this test could potentially fit into the clinical picture for autism diagnosis currently is unclear,” said Dr. David Beversdorf, a researcher at the Thompson Center and co-investigator for the Thompson Center site along with Dr. Kristin Sohl. “By helping recruit participants among our patient base, we can further study whether Clarifi ASD could play a role in helping identify children with autism early and easily.”

Clarifi ASD examines patient saliva samples to determine if RNA patterns believed to be associated with autism are present. RNA works with DNA inside cells, using the genetic information provided by DNA to direct cells on how to function. By studying RNA patterns in saliva, the test developers at Quadrant Sciences believe they can predict if patients are at risk for autism.

“This test is different from a genetic test using DNA, because instead of looking for specific genes that cause autism, this test looks for signs that autism might exist based on specific RNA patterns,” Beversdorf said. “RNA patterns are like a looking for footprints. While the role of the RNA in the cause autism is not yet clear, it can potentially indicate that autism exists, like a footprint in the sand.”

The Thompson Center researchers say that by studying RNA patterns of enough people with and without autism, they hope to determine if this is indeed an effective way to determine autism risk.

By participating in this study, the Thompson Center is yet again leading the charge in searching for the best ways to diagnose and treat autism and other neurodevelopmental disorders. This study is ongoing and participants are needed. If you are interested in participating, contact Kathy Hirst at 573-882-5643 or hirstka@health.missouri.edu.

Romancing the Spectrum

Aging from adolescence into young adulthood brings many changes. Everyone experiences physical and emotional changes brought on by puberty, such as an increased interest in pursuing romantic relationships with peers. However, it often is unclear how neurodevelopmental disorders such as autism effect how these changes manifest themselves socially.

In a newly published study, researchers from the University of Missouri and Thompson Center found a high level of interest in romantic relationships by young adults with autism. However, they also found that these same young adults lacked the knowledge of how to pursue such relationships, often leaving them feeling isolated socially.

“The myth that people with autism are uninterested in romantic relationships has been debunked for a while, but we were still surprised by the level of interest in relationships the young adults within our study had,” said Dr. Nancy Cheak-Zamora, an associate professor within the department of health sciences in the MU School of Health Professions and a researcher at the Thompson Center. “The vast majority of people who we interviewed said they were definitely interested in romantic relationships, but that they had no idea how to initiate or be in a relationship.”

For her study, Cheak-Zamora held one-on-one interviews with 27 young adults with autism, 20 men and seven women. While neurotypical adolescents are acutely aware of their own romantic interest as they progress through high school, Cheak-Zamora’s research shows that young adults with autism may not reach this same level of romantic awareness until they are older, often after they have finished high school.

“Neurotypical adolescents likely use high school as a time to learn and experiment with being in romantic relationships,” Cheak-Zamora said. “This is valuable developmental time when people are in close proximity to their peers, giving them opportunities to learn how to pursue romantic relationships. These social skills can then be further honed as they continue to mature.

“If it is true that young adults with autism experience romantic relationship interests later than their typically developing peers, then they may miss out on important opportunities to experiment with and learn about relationship development. Once young adults are ready to pursue relationships, they may be out of school and have less contact with peers who have reciprocal interest.”

Cheak-Zamora says these findings illustrate the need for resources about romantic relationships for young adults with autism.

Cheak-Zamora says educational resources could be as simple as “relationship cheat sheets” or one-pagers with simple information such as: “How to ask a person on a date.” Within the healthcare setting, she says doctors should be talking to young adults with ASD about relationship interests and knowledge as well as having health discussions. She also says there is potential to create workshops or training classes designed especially for people with autism to help teach these skills. This study was published in the Archives of Sexual Behavior.

A Fair Affair

Over the years, one of the primary reasons that the Thompson Center has excelled in producing field-advancing, nationally recognized research is our access to experts in dozens of fields across the University of Missouri campus. This access, along with a tradition of fostering an atmosphere of collaboration across disciplines, has made the Thompson Center of a model of interdisciplinary work at Mizzou.

To continue this trend, the Thompson Center hosted its first annual Research Fair this summer to introduce students and junior faculty from Mizzou to the wide range of research and collaborative opportunities at the Center.

“We really wanted to reach out to campus, specifically to students and newer faculty at Mizzou who may not have been fully aware of all the amazing research we are doing here at the Thompson Center,” said Dr. Stephen Kanne, executive director and researcher at the Thompson Center. “We have had enjoyed partnerships with some of the amazing people in all areas of campus, such as engineering, health professions and veterinary medicine, which has led to some really revolutionary work. We want to continue to foster those partnerships and identify new collaborations which can help us advance the field of autism research even further.”

The fair featured short presentations by several Thompson Center researchers on their ongoing research into autism and other neurodevelopmental disorders, as well as provided networking opportunities for Thompson Center researchers and prospective research student and faculty partners.

“It was a great way to showcase the breadth of research occurring at the Thompson Center,” said Dr. Brad Ferguson, an assistant research professor in the MU School of Health Professions, MU School of Medicine and Thompson Center. “Connecting with researchers, clinicians, students, self-advocates, and community members has already resulted in new relationships. This was an excellent way to provide updates to the community on what kinds of research we’re engaged in, to receive feedback from the community, and to help people get involved in autism research at MU.”

“I was impressed with the diversity of disciplines, experience, and organizations that attended the research fair,” said Dr. Kim Bodner, a Thompson Center researcher and assistant clinical professor in the MU School of Health Professions. “I believe that collaboration among multiple fields is vital to advance research, especially research on adults and elderly with ASD. I was able to connect with providers and researchers at Harry S. Truman memorial Veterans’ Hospital, graduate students at University of Missouri, and made connections with members of the community and faculty that share my passion for supporting adults with ASD. I’m very much looking forward to collaborating in the future.”

“The research fair was a great success,” said Dr. Casey Clay, a Thompson Center researcher and an assistant professor in the MU College of Education. “It was incredible to be a part of new or younger faculty who have exciting lines of research. The breadth of the research presented was amazing. From gastrointestinal symptoms in autism to virtual reality behavior training.”

With the first research fair counted as a resounding success, Thompson Center leaders look forward to hosting future events to further grow the connection between the Center and campus experts. And they look forward even more to the groundbreaking discoveries that will surely continue to result from these partnerships.

From Acne to Autism

Improving social communication skill and ability is one of the primary hopes for autism treatment providers. Progress can be achieved with behavioral treatment such as Applied Behavior Analysis. However, improving social communication using pharmaceuticals has, to this point, had limited results, depending on the specific drug and the specific patient.

Now, Thompson Center researchers are performing a clinical trial on a drug they hope may prove effective in improving social communication among a specific group of people with autism for which other drugs may not previously have been effective.

Dr. David Beversdorf, a professor of radiology and neurology at Mizzou and a researcher at the Thompson Center, is leading a team testing the drug minocycline on children with autism. Minocycline has been on the market for years, used primarily as a drug for clearing up acne. However, Craig Erickson, a professor at the University of Cincinnati, recently found minocycline effective in improving social communication among children with Fragile X syndrome.

“Fragile X is a genetic condition that causes a range of developmental issues, often very similar to autism,” Beversdorf said. “Our hope is that minocycline can function similarly in certain groups of people with autism.”

Biomarkers relating to autism symptoms, including social communication problems, have been found by monitoring brain wave patterns through EEG, or electroencephalogram tests. These tests use electrodes placed on the scalp to study brain wave patterns. Through Erickson’s study with Fragile X, it has been determined that minocycline can help improve these social communication associated brain wave patterns. The Thompson Center researchers hope that minocycline can have a similar positive effect on these same brain wave patterns in patients with autism.

“If minocycline can help improve these EEG markers that are associated with social communication, we hope that means it could be a potentially effective treatment method for some patients with autism,” Beversdorf said. “We have a lot of research left to do on minocycline, but we are excited about taking this promising first step with this clinical trial.”

The clinical trial is currently recruiting participants with autism. If you are interested in participating, contact the Thompson Center research core at (573) 303-8405 or tcresearch@missouri.edu.

Problem behaviors linked with gastrointestinal issues in children with autism

Story contributor: Brian Consiglio, MU News Bureau

Many children and adolescents with autism often exhibit problem behaviors, such as aggression, as well as experience gastrointestinal (GI) issues, especially constipation. In a new study published in Frontiers in

This is a photo of researcher Bradley Ferguson. — Bradley Ferguson, PhD, researches autism at the Bond Life Sciences Center.

Psychiatry, researchers from the University of Missouri have now found that these common problem behaviors may be closely linked.

Dr. Bradley Ferguson, assistant research professor in the MU School of Health Professions, MU School of Medicine, and the Thompson Center for Autism and Neurodevelopmental Disorders, examined records from 340 children and adolescents with autism who are patients at the Thompson Center. Ferguson found that 65% of the patients examined experienced constipation, nearly half experienced stomach pain, nearly 30% experienced diarrhea, and 23% experienced nausea. Furthermore, some of these GI symptoms were associated with different behaviors, such as anxiety and aggression.

“We are starting to better understand how GI issues coincide with problem behaviors in ASD,” Ferguson said. “For example, we found that individuals with autism and co-occurring nausea were about 11% more likely to display aggressive behaviors. Therefore, addressing the nausea might help alleviate the aggressive behaviors which will ultimately increase the quality of life for the patient as well as their family.”

Ferguson and his colleagues also found that the relationship between problem behaviors and GI symptoms differed between young children and older children with autism. Aggressive behavior in younger children, aged 2-5, was associated with upper GI tract issues such as nausea and stomach pains. Older children and adolescents, aged 6-18, often experienced greater anxiety and were more likely to experience lower GI tract issues such as constipation and diarrhea.

Ferguson says that because autism can affect an individual’s social skills, speech, and nonverbal communication, it can be difficult for those with autism to effectively communicate their health challenges, such as GI discomfort.

“These findings further highlight the importance of treating GI issues in autism,” Ferguson said. “Many children and adolescents with autism are often unable to verbally communicate their discomfort, which can lead to problem behavior as a means of communicating that their stomach hurts. Understanding how these GI issues can lead to problem behaviors, or vice versa, can help shape future treatments for individuals with ASD.”

This study is the latest in this line of research for Ferguson examining the links between ASD, problem behaviors and GI distress. Previously, Ferguson measured the stress responses of children with autism to brief environmental stressors and found that children who had a higher, or more dysregulated stress response also tended to experience more GI problems, especially constipation.

Ferguson is currently working on a clinical trial with other Thompson Center researchers, including the principal investigator, Dr. David Beversdorf. The researchers are studying whether a common blood pressure drug, propranolol, may have positive effects on language and sociability by reducing stress levels in children and young adults with autism. Ferguson said that they are also monitoring GI symptoms in the patients enrolled in the trial.

“We are hopeful that propranolol will prove to be a valuable treatment option for some children with ASD to help reduce their stress levels which will hopefully lead to better language and social abilities,” Ferguson said. “If this is the case, reducing these stress levels could potentially help reduce some GI problems as well, as it is possible that these GI problems are linked to increased stress and anxiety.”

The propranolol clinical trial is currently ongoing. Researchers hope to have initial results by fall of 2020. Other Thompson Center research team members involved in the trial include Samantha Hunter, Katie Bellesheim, Kathy Hirst, Amy Underwood, Cory Riecken, Nicole Takahashi, and Bridget Lolli.

Researcher Spotlight: Dr. Nancy Cheak-Zamora

Who: Dr. Nancy Cheak-Zamora, an associate professor in the Department of Health Sciences at the University of Missouri School of Health Professions.

Bio: Dr. Cheak-Zamora grew up in Smithville, Texas and earned her bachelor’s degree in psychology and a master’s degree in health psychology from Texas State University. She then pursued a doctorate in public health at Saint Louis University. She served as an Applied Behavior Analysis therapist in college and managed the Metro St. Louis HIV Health Service Planning Council prior joining the Department of Health Sciences at Mizzou in 2009. She has been performing research with the Thompson Center since shortly after starting at Mizzou in 2009.

What are your research Interests?

“My training is in public health with an emphasis in policy analysis. My work focuses on the evaluation and promotion of optimal health care service for children and youth with special health care needs to improve health, independence and quality of life. In the immediate future, my work is focused implementing the Health-Related Independence (HRI) measure, that my team and I created, into clinical practice and utilization as an outcome measure in intervention projects.”

How did you first get involved with autism research?

“I assisted several families as an ABA therapist while in college and graduate school. I am still friends with these families and have loved watching their children grow into adults.”

What is one thing do you hope to discover or understand better by the end of your career?

“How to work with people with autism and all people with special health care needs to understand their life goals and work with them to develop programs to help achieve those goals.”

What motivates you to work so hard in this field?

“I love the families that I work with and the individuals on the spectrum that work with me. I fundamentally believe everyone should be able to set and work toward life goals and a disability or special need should not get in the way of that.”

2019 INSAR in Review

This spring, Thompson Center autism experts and researchers joined thousands of international autism research experts in Montreal, Canada at the 2019 International Society for Autism Research (INSAR) annual meeting. Every year, INSAR brings together the world’s leading autism researchers to present their latest findings and to exchange ideas.

At the conference, several key themes developed from the numerous sessions, research poster presentations and panels, including important findings on suicide and self-injury among populations with autism; discoveries regarding genetics that extend beyond high-confidence risk genes, including potential connections between sleep problems and genetics in autism; and general discussions about improving healthcare for people with autism.

“I found the presentations and discussions related to comorbid mental health conditions in autism particularly useful,” said Dr. Rose O’Donnell, a psychologist and researcher at the Thompson Center. “Some of the researchers suggest that within the ASD population there is a significant risk for suicidal thoughts, even at a frighteningly young age. This has prompted some discussion around our current diagnostic and screening methods. It was also impactful to hear from many individuals with ASD and their perspectives on this current research.”

The Thompson Center was well represented at INSAR, with 12 TC researchers in attendance, presenting 13 different research posters covering a wide range of topics and disciplines. These topics include how to increase clinical capacity for autism care among rural and underserved communities, differences in symptoms among the sexes in adolescents with autism, and psychophysiological biomarkers of stress as predictors of behavioral issues.

“I was amazed by the breadth and depth of the topics discussed at this year’s INSAR,” said Dr. Stephen Kanne, Thompson Center executive director. “It really illustrates how much the field of autism research is maturing. INSAR is starting to deal with issues and problems beyond basic research, including access to care, health insurance, and how can we get better at increasing access. It’s great how discussions among researchers are moving into areas that impact the field in general. INSAR is always a great forum for our researchers and clinicians. Staying in touch with the state-of-the-art work in the field is vital for us to continue to search as leaders.”

“I think the thing that struck me most about INSAR was how many of the challenges we face here, with early identification and access to evidence-based interventions that are effective for those with autism, are similar to those faced by countries around the world,” said Kim Selders, a research and training specialist at the Thompson Center. “It was inspiring to see so many professionals from so many different disciplines and from so many different countries dedicating their careers to supporting individuals with autism. It was especially interesting to see the innovative research being done to find solutions for these challenges, most notably in very under-resourced areas, such as using technology community health workers to access families in need of services.”

Next year’s INSAR conference moves a little closer to home, reappearing in the U.S. after a few years abroad. Thompson Center researchers are already working on new projects they plan to present at the internationally renowned conference in 2020.

Finding Your Stroke

When Ben Loeb spoke with his long-time friend and fellow tennis coach from Springfield, Mo. about his friend’s son’s autism, Loeb was aware of the disorder. But he wasn’t prepared for learning about the impact it had on his friend’s family and the challenges created by raising a son with severe autism.

“It really stuck with me,” Loeb said. “To hear about everything families endure and overcome when living with autism, the challenges they face on

A picture of Ben Loeb — Ben Loeb supports the Tiger OT Swim program at the Thompson Center and MU School of Health Professions.

a daily basis, it served as a motivation for me to seek out ways that I could help in some small way.”

Loeb has always been a huge proponent of sports and activities. He’s served as the tennis coach at Rock Bridge High School in Columbia since 1994, winning four straight boys state titles and five straight girls state championships dating back to 2014. When looking for ways to support families with autism, the first thing that stuck out to him was the Tiger OT swim program, offered by the University of Missouri School of Health Professions and Thompson Center occupational therapists.

The Tiger OT swim program primarily serves children with autism and focuses on water safety as well as teaching children on the autism spectrum to enjoy swimming. Drowning is the leading cause of accidental death for children with autism, so the program focuses on teaching children how to remain safe, as well as how to save themselves if they were to fall into a pool or other body of water.

“We want kids with ASD to do typical things in typical places with everyone else,” said Dr. Lee Ann Lowery, a Thompson Center occupational therapist and Tiger OT swim program organizer. “We see many benefits in addition to learning to swim. Many of our kids begin to use more spontaneous language. They also develop confidence. It’s the best feeling to see a child accomplish new goals in the water.”

a picture of a child learning to swim with an instructor — Tiger OT Swim instructors teach a child with autism how to swim.

Loeb realized that this program combined two of his interests: supporting families with autism and fun sporting activities.

“Teaching kids how to swim and be safe as well as giving them a lifelong sport and activity that they can enjoy with their friends and family, that’s what really interested me,” Loeb said. “Swimming is also something many of these kids can go on to participate in with competitions as well as healthy exercise. It’s just a great program all around.”

Loeb’s passion for the program led to him deciding to generously support the program financially. This support helps the program hire lifeguards and rent access to the Mizzou Rec pool for lessons.

a picture of a child learning to swim with two instructors — Tiger OT Swim instructors teach a child with autism how to swim.

“We offer our program free to our families,” Lowery said. “Support from donors like Mr. Loeb is what makes it possible for us to offer this service for free. We are so thankful for his ongoing support. He surely is making a difference in the lives of our patients and their families.”

Ben Loeb, along with his two sisters (Kathy and Nancy), funded the University of Missouri Al and Joan Loeb Endowed Fund at the College of Veterinary Medicine, which supports research into degenerative eye diseases. Ben also supports the Richard Loeb Memorial Scholarship Fund, which is a scholarship for students studying personal financial planning. He is also a member of the Mizzou Athletics Tiger Scholarship Fund.