AIM-ing High

Many forms of treatment exist that can potentially help improve some social and behavioral deficits for children with autism. However, it is often difficult for autism service providers to determine how successful a treatment is for a specific child.

“Every child is different, so it’s important to know what types of treatment do and do not work for each child, based on their specific needs,” said Dr. Stephen Kanne, executive director of the Thompson Center. “If a certain behavior therapy or medication is working, it’s important for the care provider to know so they can continue the treatment. However, if a therapy isn’t working, it’s equally important to know, so that the care provider can change what they are doing to better suit the needs of the child.”

In order to measure how effective autism treatments are in addressing core autism symptoms, Kanne, along with Dr. Micah Mazurek, formerly on faculty at the Thompson Center and now a professor at the University of Virginia, have developed the Autism Impact Measure (AIM). AIM allows service providers

a picture of Dr. Stephen Kanne, executive director of the Thompson Center. — Dr. Stephen Kanne, executive director of the Thompson Center.

to accurately measure the progress, or lack of progress, their patients and clients are experiencing in terms of improving core autism symptoms.

AIM is a parent-report measure, meaning that parents can fill out questionnaires throughout their child’s treatment. AIM has been shown to measure the progress, or lack of progress, in many of the most common types of treatment, including all three major categories of autism treatment: medication-based treatment, behavior therapy-based treatment, and curriculum-based treatment.

“Part of what is valuable about AIM is that it measures both the frequency and the impact of specific autism symptoms.” Kanne said. “While we want to know if the child’s autism symptoms are improving, it is also important for care providers to know which symptoms are most affecting that child’s functioning, so the care provider can be much more effective in providing targeted treatment.”

As a culmination of their major National Institutes of Health grant to study the value and effectiveness of AIM, Kanne and Mazurek conducted a final study which found that the AIM measure could accurately indicate whether a patient’s core autism symptoms were improving, declining or maintaining the status quo based on the treatment they were receiving.

“Showing that AIM truly measures what we think it does is really important for autism treatment moving forward,” Kanne said. “We can now start spreading this measure to autism care providers around the country so they can begin using it to measure the progress of their patients. Ultimately, we hope this will lead to better autism care for everyone.”

Picking Up the Picky Eaters

A common symptom for many children with autism is food aversion, commonly known as picky eating. This type of extreme picky eating can lead to an unbalanced and unhealthy diet if a child refuses to eat foods such as fruits, vegetables and proteins.

In order to help children with food aversion improve their diet and increase the number of foods they will eat, Thompson Center occupational therapist Brittney Stevenson has developed the Picky Eaters program for patients of the Thompson Center. While the program has existed and had success for several years, Stevenson is now conducting research into exactly how effective the program is at introducing new foods to diets of children with autism.

“Often due to sensory sensitivities or the need for rigid patterns, many children with autism have difficulty adopting new foods to their diet, whether due to their temperature, texture or appearance,” Stevenson said. “Some children come into the program eating as few as 7 or 8 different foods, so it’s really important to introduce healthy options into their diet.”

The Picky Eaters program is designed for preschool-aged children and focuses on structured play activities with food. The program runs from 6-8 weeks and meets once a week at the Thompson Center, though there is an important home component to the program as well.

“The main strategy is to familiarize the children with the look, feel and taste of different foods, primarily vegetables and fruits,” Stevenson said. “Once they get comfortable with how a food feels and are convinced it won’t hurt them, they start to become more willing to eat that food more regularly.”

For her study, Stevenson followed 11 children as they completed the program, tracking how many different foods they would eat before the program and then how many they would eat a few months after the program.

She found that children who participated in the program increased the number of foods they would eat from an average of 17 foods before the program to 25 foods after the program, which is an increase of nearly 50 percent. Stevenson hopes these positive and promising results will continue as she hopes to expand the program.

“Increasing a child’s diet, even by 8 different foods, can have a really positive impact on their health and the stress levels of their families,” Stevenson said. “It can be easier to go out to eat when you know there will be something on the menu that your child will eat, especially if it is a healthier option.”

Stevenson plans to continue studying the effectiveness of the Picky Eaters program in order to ensure she is providing the highest level of service to Thompson Center patients. She also hopes to present the data at the national occupational therapy conference next spring to share her successful methods with other occupational therapists from around the country.

Researcher Spotlight: Dr. Kerri Nowell

Dr. Kerri Nowell’s experiences with disability began early in her life. Growing up as one of six children, Nowell’s younger brother was born with a hearing impairment. Nowell credits these early experiences with helping develop her passion for working with children with disabilities.

A picture of Kerri Nowell — Kerri Nowell is an assistant professor of health psychology at the Thompson Center.

After growing up in Oman and moving to the United States to attend college, Dr. Nowell spent years working in schools as a school psychologist before pursuing her doctorate in school psychology. Those years of work with autism created an interest, and a later a passion, in Dr. Nowell for researching developmental disorders and how they affect children.

Now that she is on faculty at the Thompson Center, Dr. Nowell splits her time between her clinical work, where she assesses and diagnoses children with autism and other neurodevelopmental disorders, and her research.

Dr. Nowell currently is exploring three different research areas: behavioral phenotyping, demographic factors and autism, and young adults with autism and their co-occurring symptoms. Phenotyping involves using multiple sources of information to describe specific characteristics of a child with autism. Dr. Nowell says this could help determine what types of treatments work best for which kids.

“While it is certainly true that every child with autism is different, there is evidence suggesting that we may be able to identify subgroups of children based on shared characteristics,” Nowell said. “If we can accurately categorize these symptoms and identify which category a specific child might tend to lean toward, we may be more easily identify the most effective types of treatment for each specific child, rather than having to try many different things before finding what works.”

Dr. Nowell also is exploring different demographic factors and how they affect autism and autism diagnosis. She is specifically interested in gender differences in autism and how those differences might affect diagnosis and treatment for girls with autism.

“Because autism seems to affect boys much more often than girls, several of our existing diagnostic tools focus on male behaviors that perhaps girls with autism don’t exhibit,” Nowell said. “However, there might be more gender-specific behaviors that girls exhibit that are associated with autism that we miss because we are used to looking for behaviors that boys are more likely to show. It is important to identify these female behaviors that may be linked to autism in order to ensure that girls aren’t going undiagnosed.”

Other demographic factors Nowell is exploring include how minority and low-income families access treatment for autism and as well as how what kinds of treatment decisions are made by low-income families and whether those decisions differ from families with higher incomes.
Finally, Dr. Nowell is working to identify and study additional health issues that may affect young adults who also have autism, such as catatonia, anxiety and depression. She currently is the principal investigator on a grant from the Sears Foundation to study the reliability of a catatonia scale developed by Dr. Judith Miles, a long-time Thompson Center researcher.

While Dr. Nowell’s research interests are broad, her work is targeted toward the same goal: to discover the best ways to identify, care for and support people and families with autism.

A SPARK of Hope

SPARK is a large, online, national research initiative working to bring together a community of individuals with autism and their families. The primary goal of SPARK is to identify the hundreds of genes suspected to be contributing to autism and understand their biological mechanisms.

SPARK also seeks to connect this community of individuals and families to research opportunities that advance the understanding of autism. The Thompson Center is one of 25 sites around the country selected to help recruit participants.

What has SPARK accomplished so far?

an infographic with information about SPARK — Graphic courtesy of SPARK.

What’s New with SPARK?

Recruiting participants for autism studies can be extremely expensive and time consuming. In order to hasten our understanding of autism, SPARK has created a new Research Match program, which helps to introduce the 114,000-plus SPARK participants to new research opportunities offered by scientists from around the country.

This process will make it easier for researchers to connect with potential participants, allowing researchers to focus their time and effort on their science, rather than recruitment. The SPARK Research Match program can support many kinds of studies, including in-clinic studies, online surveys, and other types of studies such as remote participation, focus groups and infant sibling studies.

For more information about this program, contact Amanda Shocklee at the Thompson Center, shockleea@missouri.edu or 573-884-6092. To register for SPARK visit www.SPARKforAutism.org/MUTC.

2018 INSAR In Review

This spring, Thompson Center autism experts joined hundreds of the leading international autism research experts in Rotterdam, Netherlands at the 2018 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. Research is continuing to increase focusing on adults and teens with autism, including their

a picture of four women at the INSAR conference — Members of the Thompson Center research core connect with SPARK representatives at the 2018 INSAR conference.

quality of life, mental health, diagnostic tests and differences in sensory processing. Further, research into the genetics involved with autism and co-occurring conditions was often discussed. Specifically, it was announced that the number of genes with strong ties to autism has increased to 99, up from 65 last year. Also, the search for autism biomarkers has increased in recent years.

“The complexity and heterogeneity, or diversity, of autism is being taken into account more broadly,” says David Beversdorf, professor of radiology, neurology and psychology at the Thompson Center and the University of Missouri. “This lends emphasis to the need to consider heterogeneity when evaluating the salience of potential biomarkers.”

The scope of autism research was another theme of the conference and how researchers should view the scale of their work.

“Some of the biggest takeaways for me were related to how we think about the scope of autism research,” said Dr. Karen O’Connor, an assistant research professor at the Thompson Center. “In her keynote, Dr. Geraldine Dawson shared that we need to shift our research paradigm from ‘diagnose and treat’ to instead ‘predict and promote.’ I also very much enjoyed the strand focused on females with autism and hearing about the research examining the perspectives of adults with autism related to social camouflaging.”

Ultimately, INSAR proved once again to be invaluable as a means of connecting autism researchers and experts, allowing the brightest minds in the field to meet and began innovative collaborations.

“INSAR allowed me connect with some of the leading experts in the field,” said Dr. Nancy Cheak-Zamora, an associate professor of health sciences at the Thompson Center and University of Missouri. “I was able to attend a grant writers’ luncheon to meet different funding sources. It was a great opportunity to share my grant ideas and I received excellent feedback as well as connections to other funders. Also, conversations during the poster sessions and between meetings was wonderful. I made several researchers with whom I am now working on a collaboration.”

In total, the Thompson Center sent 10 staff, students and faculty members to INSAR, and presented 12 posters and research projects at the conference.

Link Found between Neurotransmitter Imbalance, Brain Connectivity and Language Processing in Individuals with Autism

One in 59 children in the United States lives with a form of autism spectrum disorder, according to the Centers for Disease Control and Prevention. The signs of autism begin in early childhood and can affect individuals differently. However, many with autism share similar symptoms, including difficulties with social communication. Researchers from the University of Missouri School of Medicine and MU Thompson Center for Autism and Neurodevelopmental Disorders identified a link between a neurotransmitter imbalance and brain connectivity between regions of the brain that play a role in social communication and language. The study found two tests that could lead to more precise medical treatments.

A “First Class” First Class

Within a few days of beginning an internship at the Thompson Center as a part of her undergraduate degree, Brittany Schmitz knew without a doubt that she wanted to be a behavior analyst.

“I just loved being able to use effective interventions to make a meaningful impact on the individuals we work with, as well as their caregivers,” Schmitz said. “Seeing the changes and growth in the individuals we work with blesses me every single day. Every milestone achieved, no matter how big or small, is something that we celebrate.”

Fast forward just a few years and Schmitz is now a member of the first graduating class from the Applied Behavior Analysis (ABA) master’s degree program at the University of Missouri.

The program, which began two years ago thanks to financial support from the Thompson Foundation, trains students in evidence-based, science-driven behavior analysis techniques in order to help individuals with a variety of developmental and behavioral disorders, including autism.

Not only do students in the ABA program receive classroom instruction, but they also receive valuable experience working directly with patients at the Thompson Center under the supervision of some of the leading behavior analysis experts in the country.

“I feel like the program really improved my confidence in my clinical skills,” Schmitz said. “It is one thing to understand the concepts and principles on paper, but totally different to apply them to real life situations involving real individuals whom you are there to help. The courses provided me with the knowledge I needed and the practicum provided me with a supportive environment and supervisors to navigate challenging clinical situations.”

The first graduating class included four members, all of whom graduated on schedule and are either already employed or are being aggressively recruited by employers from around the country. As the ABA program begins its third year, it continues to grow. The newest incoming class is double the size of the first class.

“Prospective students have seen the success of, and received good feedback from, our current students, which will help shape our program to meet the needs of future students,” said Dr. Casey Clay, an assistant professor of health psychology who runs the ABA program at Mizzou. “Because we have prepared strong behavior analysts in this first class, the University of Missouri and the Thompson Center now have connections to these students as they go on to be leaders in their careers.”

The graduating students, and their teachers, are confident that they are now well prepared to provide the best possible services to people with autism and other developmental disorders not just here in Missouri, but around the country as well.

“I believe this first class will be excellent,” Clay said. “They have received cutting-edge and top-of-the-field training that will set them apart. They are already working and making improvements to the standard of care of individuals with autism and developmental disabilities in the state of Missouri.”

Now that she has graduated, Schmitz accepted a full-time behavior analyst position at the Thompson Center. She will be able to continue her passion right where it began.

“I am extremely excited and honored to be offered this position at the Thompson Center,” Schmitz said. “I am able to wake up in the morning and actually look forward to going to work. It changed my life in more ways than I am able to describe.”

April is Safety Awareness Month!

April is Safety Awareness Month! Kids with special needs, including autism, often require additional steps to make sure they remain safe.

Check out some of these resources for keeping you and your child with autism safe!

Kid’s Safety Primer

Water Safety

Bullying Prevention Tip Sheet

How to Prevent Wandering

Gun Safety

Car Seat Recommendations

My child might have autism. What do I do?

By: Kristen Sohl, associate professor of clinical child health and director of ECHO Autism University of Missouri Health Care

If you think your child could have autism, you might be unsure about what to do next. You’ve noticed the warning signs: repetitive behavior like hand-flapping and rocking back and forth, limited eye contact and speech, even failure to respond to their own name. You want to get your child the diagnosis and care they need, but there’s a problem: the nearest autism care center is hundreds of miles away, and if you manage to make the trip, you might face a wait list that is months or sometimes even years long.

Faculty Spotlight — Dr. Jennifer Sykes

Dr. Jennifer Sykes has always known that she had a passion for parenting dynamics and helping parents understand their children’s behaviors. Growing up in a large extended family, Sykes was able to see how different parenting skills and tactics played out among her siblings, cousins and other relatives.

“My mother would always tell me stories about her experiences growing up and our large extended family,” Sykes said. “I always was intrigued by the differences in parenting and family practices and how they appeared to impact individuals across their lifespan. It really motivated me to learn more about family dynamics and which parenting behaviors encouraged better outcomes for children.”

To pursue this path, Sykes earned her undergraduate degree in psychology from Spelman College in Atlanta followed by a master’s degree at Fayetteville State University. Sykes then made her way to Columbia where she earned her doctorate in counseling psychology at the University of Missouri.

Sykes first got her feet wet performing assessments and diagnostic evaluations as a part of her doctoral work with Thompson Center faculty Dr. Connie Brooks and Dr. Andy Knoop at the University of Missouri Assessment and Consultation Clinic (ACC). Her dissertation research and internship experiences focused on identifying parenting challenges and supporting parents’ efforts to improve their children behaviors and emotional functioning. After finishing her degree Sykes accepted a postdoctoral fellowship at the Thompson Center.

“I always knew I wanted to work with children and parents, but my experience working at the ACC lead to me falling in love with diagnostic work and my time at the Thompson Center solidified by interest in autism spectrum disorders,” Sykes said.

Following her fellowship, Sykes spent a year and a half performing autism assessments and individual counseling with individuals with developmental disabilities at the Southeast Missouri State University Autism Center. In late 2017, Sykes accepted a position back at the Thompson Center on faculty as an assistant clinical professor of health psychology in the MU School of Health Professions. In this role, Sykes performs five diagnostic evaluations week, diagnosing patients with autism and other neurodevelopmental disorders.

Sykes says the amazing opportunities and resources available for Thompson Center patient families are what drew her back to Columbia. Sykes and her husband now have two children, three-year-old and five-month-old girls, which she says makes her work all the more important to her.

“Now that I have children of my own, it makes this work all the more visceral,” Sykes said. “It really feeds my desire to build additional supports for families even above and beyond what the Thompson Center already offers.”

Sykes hopes to develop additional resources and support programs for families with questions of autism, even before they receive diagnoses.

“So much misinformation about ASD currently exists out there that parents often come in with misconceptions about their children’s behaviors,” Sykes said. “If we can help build resources full of good, reliable information for families, it will help relieve a lot of the stress parents often feel before, during and following the ASD diagnostic process.”

With Dr. Sykes on the case, the present and future of parental and family support at the Thompson Center has never been stronger.