Although symptoms of attention deficit/hyperactivity (ADHD) can last into adulthood, typically they decline as a child gets older. But a new study indicates that the stressful transition from elementary school to middle school complicates this pattern and may even disrupt it. The study, which analyzed data from the NIMH-funded Multimodal Treatment Study of ADHD (MTA), was published in the Journal of Clinical Child and Adolescent Psychology.

Research has shown that ADHD symptoms, especially hyperactivity and impulsivity, tend to decline during a child’s adolescent years, although these symptoms do not necessarily disappear. Also, studies have indicated that simplifying and structuring a child’s environment and routine can impact ADHD symptoms. But when children enter middle school, their environment and routine change dramatically —they have multiple classes with multiple teachers; more homework, planning and organizational demands; and become more responsible for their own success.

Joshua M. Langberg, Ph.D., and Jeffery Epstein, Ph.D., of the University of Cincinnati and Cincinnati Children’s Hospital Center, and colleagues analyzed data from 258 children in the MTA study who completed elementary school and went on to middle school while enrolled in the study. Using reports from the children’s parents and teachers, the researchers found that while ADHD symptoms lessened as the children aged, the transition to middle school interrupted this trend. Parents reported greater disruption in symptoms than teachers, likely because the impact of the transition may have been more evident at home, according to the researchers.

The researchers also found that children taking medication for their ADHD symptoms fared no better than those not taking medication during the transition. Langberg and colleagues suggest that while medication is highly effective in treating ADHD symptoms, it is unlikely to help a child develop the specific skills needed to succeed in middle school, such as time management, organization, planning, and study skills.

For comparison, Langberg and colleagues tracked the experience of a control group of children without ADHD, who transitioned into the same schools at the same time as the children enrolled in the MTA study. They found that the children without ADHD were less likely to experience the same level of distress or difficulty as the children with ADHD, as they entered middle school, according to parent and teacher ratings.

The study provides the first research data to support the assertion that the environmental changes associated with the transition to middle school can worsen a child’s ADHD symptoms or disrupt the typical pattern of decline.

U.S.D.E. Announces $2.4 Million in Grants to Improve Special Education Teacher Training Programs

The U.S. Department of Education today announced the award of $2.4 million in grants to 20 institutions in 15 states to help train highly qualified teachers of students with high incidence disabilities, such as learning disabilities, emotional disturbance and mental retardation.

The awards, made under the Special Education Preservice Training Improvement Grants Program, are meant to improve the quality of special education teacher preparation programs and ensure that graduates meet the highly qualified teacher requirements of the Individuals with Disabilities Education Act (IDEA).

"We consistently hear from state, local and higher education officials that personnel preparation programs for special education teachers should be restructured or redesigned for graduates of these programs to meet the highly qualified teacher requirements in IDEA," said U.S. Secretary of Education Margaret Spellings.

The grants announced today cover the first year of what's expected to be five-year projects overseen by the Education Department's Office of Special Education Programs.
During that first year, the grant recipients will begin upgrading their teacher preparation programs with research-proven strategies designed to improve outcomes for children with high incidence disabilities.

They will also coordinate their efforts with the National Center to Enhance the Professional Development of School Personnel by using the center's Web-based training modules.
In addition, the money is to be used to:

Address the specialized needs of children with high incidence disabilities from diverse cultural and language backgrounds, including those with limited English proficiency.
Provide extended clinical learning opportunities, field experiences and mentoring opportunities in local schools.
Use field-based training opportunities in high-poverty communities and in schools not making adequate yearly progress under the No Child Left Behind Act.

Following is a list of the grant recipients. For more information, see http://www.ed.gov/programs/osepprep/index.html.

U.S. Department of Education
Office of Special Education Programs
Special Education Preservice Training Improvement Grants
CFDA No. 84.325T - (State, city, institution, project director, grant amount)

AL—Birmingham—University of Alabama-Birmingham, Renitta Goldman, $100,000.
CA—Chico—California State University, Chico, Teresa Davis, $146,661.
CA—Los Angeles—Loyola Marymount University, Teresa Jimenez, $122,265.
CO—Greeley—University of Northern Colorado, Harvey Rude, $99,932.
FL—Orlando—University of Central Florida, Mary Little, $110,744.
GA—Valdosta—Valdosta State University, Karla Hull, $142,875.
ID—Boise—Boise State University, Keith Allred, $149,990.
IL—Joliet—University of St. Francis, Srimani Chakravarthi, $100,832.
KS—Lawrence—University of Kansas Center for Research, Sean Smith, $117,904.
ME—Gorham—University of Southern Maine, Catherine Fallona, $127,543.
MD—College Park—University of Maryland, Phillip Burke, $113,176.
NC—Greensboro—North Carolina A&T University, Cathy Kea, $100,000.
NV—Las Vegas—University of Nevada, Kristin Sayeski, $149,253.
OH—Dayton—Wright State University, Catherine Keener, $100,000.
OH—New Concord—Muskingum College, Linda Morrow, $111,718.
TX—Odessa—University of Texas of the Permian Basin, Karen Smith, $139,102.
VA—Fairfax—George Mason University, Kelley Regan, $136,635.
VA—Harrisonburg—James Madison University, Cheryl Beverly, $119,759.
VA—Radford—Radford University, Elizabeth Altieri, $149,958.
VA—Richmond—Virginia Commonwealth University, Colleen Thoma, $109,810.

Total—$2,448,157.

Federal Report Shows Reading, Math Scores Up For 4th and 8th graders; Increases Seen in Teen Birth, Low Birth Weight

The nation’s fourth and eighth graders scored higher in reading and mathematics than they did during their last national assessment, according to the federal government’s latest annual statistical report on the well-being of the nation’s children. Not all the report’s findings were positive; there also were increases in the adolescent birth rate and the proportion of infants born at low birthweight.

These and other findings are described in America’s Children in Brief: Key National Indicators of Well-Being, 2008. The report is compiled by the Federal Interagency Forum on Child and Family Statistics, a working group of Federal agencies that collect, analyze, and report data on issues related to children and families, with partners in private research organizations. It serves as a report card on the status of the nation’s children and youth, presenting statistics compiled by a number of federal agencies in one convenient reference.

"In 2007, scores of fourth and eighth graders were higher in mathematics than in all previous assessments and higher in reading than in 2005," said Valena Plisko, associate commissioner of the National Center for Education Statistics, a part of the U.S. Department of Education.

This year’s report also saw an increase in low birthweight infants (less than 5 pounds 8 ounces). Low birthweight infants are at increased risk for infant death and such lifelong disabilities as blindness, deafness and cerebral palsy.

"This trend reflects an increase in the number of infants born prematurely, the largest category of low birthweight infants," said Duane Alexander, M.D., director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health. Although not all the reasons for the increase are known, infertility therapies, delayed childbearing and an increase in multiple births may be contributing factors.

The birth rate among adolescent girls ages 15 to 17 also increased, from 21 live births for every 1,000 girls in 2005, to 22 per 1,000 in 2006. This was the first increase in the past 15 years.

"It is critical that we continue monitoring this trend carefully," said Edward J. Sondik, PhD, director of the National Center for Health Statistics in the Centers for Disease Control and Prevention. "Compared with other teens their age, teen mothers are less likely to finish high school or to graduate from college. Infants born to teen mothers are more likely to be of low birthweight."

Among the favorable changes in the report were a decline in childhood deaths from injuries and a decrease in the percentage of eighth graders who smoked daily.
These and other findings on the nation’s children and youth are described in the report’s content areas:

Demographic Background
http://www.nichd.nih.gov/news/releases/june112008_childstats.cfm#DemographicBackground
Family and Social Environment
http://www.nichd.nih.gov/news/releases/june112008_childstats.cfm#FamilyandSocialEnvironment
Economic Circumstances
http://www.nichd.nih.gov/news/releases/june112008_childstats.cfm#EconomicCircumstances

Health Care
http://www.nichd.nih.gov/news/releases/june112008_childstats.cfm#HealthCare

Physical Environment and Safety
http://www.nichd.nih.gov/news/releases/june112008_childstats.cfm#PhysicalEnvironmentandSafety

Education http://www.nichd.nih.gov/news/releases/june112008_childstats.cfm#

Education Health
http://www.nichd.nih.gov/news/releases/june112008_childstats.cfm#Health

The Forum’s Web site at http://childstats.gov contains all data updates and detailed statistical information accompanying this year’s America’s Children in Brief report. As in previous years, not all statistics are collected on an annual basis and some data in the Brief may be unchanged from last year’s report.

Members of the public may access the report on-line at http://childstats.gov. Alternatively, members of the public also may obtain printed copies from the Health Resources and Services Administration, Information Center, P.O. Box 2910, Merrifield, VA 22116, by calling 1-888-Ask-HRSA (1-888-275-4772), or by e-mailing ask@hrsa.gov.

The Forum alternates publishing a detailed report, America’s Children: Key National Indicators of Well-Being, with a summary version that highlights selected indicators. This year, the Forum is publishing America’s Children in Brief; it will publish the more detailed report in 2009.

The data tables and figures for all the indicators in this year’s brief are available at http://childstats.gov.

The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s Web site at http://www.nichd.nih.gov/.

U.S. Department of Education Reports New Reading First Data From States Shows Impressive Gains in Reading Proficiency for Students with Disabilities

U.S. Secretary of Education Margaret Spellings today announced new data from the states showing impressive gains for Reading First students. The achievement data submitted by state education agencies (SEAs) and compiled and analyzed by the Education Department's contractor, American Institutes for Research, showed improvement in nearly every grade and subgroup, including English language learners and students with disabilities.

Under No Child Left Behind, State educational agencies have received over $6 billion in Reading First grants. President Bush's proposed budget for FY 2009 includes $1 billion for Reading First. Last week, the House Appropriations Subcommittee for Labor, Health and Human Services and Education stripped funding for this important program from their 2009 funding bill.

"Reading First has done so much to crack the code on how to get kids to read," said Secretary Spellings. "It would be tragic to cut the nation's only reading program when so many policymakers and teachers know it's working to increase achievement."

Reading First builds on a solid foundation of scientifically based research and provides struggling students in the nation's highest need schools with the necessary resources to make significant progress in reading achievement. The new state data shows this emphasis on scientific research into reading is making a difference for all students:

In Grade 1, 44 of 50 SEAs reported increases in the percentage of students proficient in reading comprehension. Of these, 31 SEAs increased by five percentage points or more.
In Grade 2, 39 of 52 SEAs reported improvement. Of these, 19 SEAs increased by five percentage points or more.
In Grade 3, 27 of 35 SEAs reported improvement. Of these, 15 SEAs increased by five percentage points or more.

Thanks to Reading First, schools and teachers finally have the technical knowledge and the practical training to ensure every child, including English language learners and students with disabilities, gets the help he or she needs to excel in reading. Again, the state data demonstrates substantial improvements for these students with special needs:

English Language Learners:

In Grade 1, 28 of 37 SEAs reported increases in the percentage of students proficient in reading comprehension. Of these, 25 SEAs increased by five percentage points or more.
In Grade 2, 25 of 37 SEAs reported improvement in reading comprehension. Of these, 19 SEAs increased by five percentage points or more.
In Grade 3, 17 of 25 SEAs reported improvement. Of these, 12 SEAs increased by five percentage points or more.

Students with Disabilities:

In Grade 1, 34 of 44 SEAs reported increases in the percentage of students proficient in reading comprehension. Of these, 28 SEAs increased by five percentage points or more.
In Grade 2, 30 of 48 SEAs reported improvement. Of these, 20 SEAs increased by five percentage points or more.
In Grade 3, 25 of 32 SEAs reported improvement. Of these, 15 SEAs increased by five percentage points or more.

Reading First funds professional development, scientifically based instructional programs, materials, and strategies, valid and reliable screening, diagnostic and ongoing classroom assessments, and statewide accountability and leadership structures. Reading First is designed to help needy students in grades K-3, while Early Reading First helps preschool age children.

In April of this year, an IES Reading First Interim Impact Study did not find significant gains in comprehension by students in Reading First schools; however, that study measured Reading First schools against other schools in Reading First districts—schools that may have implemented the same reforms. A final report is expected in late 2008. The Reading First Advisory Committee, a group of experts who advise the Secretary on the Reading First program, convenes today to discuss questions they have about the IES study.

For more information on the state data, please visit: http://www.ed.gov/programs/readingfirst/performance.html

For a fact sheet on Reading First, visit : http://www.ed.gov/nclb/methods/reading/readingfirst.html

For more information about Reading First, please visit : http://www.ed.gov/programs/readingfirst/index.html

$4.37 Million in Grants Awarded for Training Highly Qualified Personnel in Special Education

The U.S. Department of Education today announced the award of $4.37 million in grants to universities in 14 states to help train doctoral, post-doctoral and other graduate students to work with children with disabilities. Under the Preparation of Leadership Program, the grants will help children with disabilities by training doctoral and post-doctoral students in early intervention, special education or related services. Some money will also be used to prepare master's degree students for special education administration and supervision. "We hope to build a corps of highly qualified personnel to help children with disabilities reach their academic potential," said U.S. Secretary of Education Margaret Spellings. "Research has consistently suggested that there is a persistent need for additional special education and related services personnel who have been trained at the doctoral and post-doctoral levels. These experts can play a critical role in improving the quality of services for children with disabilities and their families."

To read more, click here:
http://www.ed.gov/news/pressreleases/2008/07/07012008b.html

Tune-Deaf People May Hear a Sour Note Unconsciously

Findings Could Help Scientists Study Consciousness

People with tune deafness aren’t able to tell when a musician accidentally strikes the wrong note in a song, but their brains know the difference. Researchers from the National Institute on Deafness and Other Communication Disorders (NIDCD), part of the National Institutes of Health, have found that people with tune deafness, an auditory processing disorder in which a person with normal hearing has trouble distinguishing notes in a melody, are able to detect a wrong note unconsciously. The study is published in the June 11, 2008, issue of the online journal PLoS ONE.

Because tune deafness is a commonly occurring phenomenon that is largely inherited, the study of this disorder could enable scientists to use the tools of genetic research to better understand the differences between conscious and unconscious thought.

Neuroscientists have long been baffled by what separates the state of consciousness from unconsciousness. Other sensory disorders have been identified in which the brain perceives a stimulus outside of conscious awareness. However, because these disorders are typically caused by damage to the brain, there is an inconsistency in data from one patient to the next and researchers have difficulty finding a sufficient number of volunteer patients for clinical trials.

“The prevalence of tune deafness is surprisingly high—perhaps as much as 2 percent of the population is tune deaf—and it exists in an otherwise normal, uninjured brain,” said James F. Battey, Jr., M.D., Ph.D., director of the NIDCD. “These factors, combined with the fact that tune deafness is largely genetic in origin, now raises the possibility of using tune deafness as a new way to study consciousness.”

A person who is tune deaf is unable to perceive pitch, reproduce melodies, or identify deviations in a melody. According to geneticist Dennis Drayna, Ph.D., one of the study authors, not only is music not enjoyable for people with tune deafness, many of them don’t fully understand what music is. “For severely affected tune-deaf people, Yankee Doodle is no different than traffic noise in Manhattan. It’s fairly meaningless to them,” he said.

Dr. Drayna worked closely with neuroimaging scientist Allen Braun, M.D., and others in NIDCD’s Division of Intramural Research to randomly screen 1,218 individuals using an online version of the Distorted Tunes Test. The Distorted Tunes Test is a standardized survey that tests a person’s ability to identify whether or not a short melody is played correctly. (The online version, which was created by Dr. Drayna, can be found on the NIDCD Web site: www.nidcd.nih.gov/tunetest/.) The researchers then selected those volunteers who scored in the bottom 10 percent, screened them for hearing loss and other factors, and arrived at seven subjects with severe tune deafness who were otherwise medically normal and were willing to take part in the study. Ten healthy control subjects who performed normally on the Distorted Tunes Test also took part in the study.

Dr. Braun, Joseph McArdle, Ph.D., and others then used electroencephalography (EEG), a brain imaging technique that places electrodes around a person’s head and measures the electrical impulses of millions of neurons in the brain, to study these subjects further. The researchers measured the volunteers’ responses as they listened to an altered version of the Distorted Tunes Test in which the incorrect melodies had a single wrong note at the end. Volunteers listened to 102 familiar melodies, roughly half of which were correct, and half of which contained the errant last note. The researchers then sifted through the EEG data to isolate the brain’s response to a specific stimulus—in this case, the right or wrong note.

Of principal interest were two signals that brains normally generate when they are presented with a stimulus that doesn’t match what the brain expects to hear, such as the wrong note in a song. The first, the mismatch negativity (MMN), is a large negative signal that occurs roughly 200 milliseconds after the unexpected stimulus is heard; the second signal, the P300, is a large positive signal occurring roughly 300 milliseconds after the unexpected stimulus.

Because tune-deaf people consistently don’t recognize when a wrong note is played or sung, the researchers hypothesized that their brains would not generate the MMN or P300 signals, and as expected, this was true for the MMN signal. However, in the case of the P300 signal, tune-deaf volunteers were processing the wrong note in the same way as the normal participants, even though they weren’t consciously aware of the deviation. Other brain signals demonstrated that correct notes were being processed equally well for both tune-deaf and normal volunteers.

As for how a brain can register a wrong note without the person being aware of it, the researchers explain that the MMN and P300 signals are generated in different parts of the brain. The MMN is generated near the primary auditory cortex, in the brain’s temporal lobe, while the P300 is generated in the frontoparietal cortex, downstream from the auditory cortex. Normal brains process sounds in a series, with the frontal and parietal cortices receiving signals that have already been processed in the auditory cortex. In someone with tune deafness, however, the direct route for processing the wrong note may be disrupted, and signals are possibly being routed to the two regions through parallel pathways independent of each other. In this way, information about a wrong note may not be reaching the auditory cortex at all, while information reaching the frontoparietal cortex is not consciously perceived.

The researchers hope to conduct studies to better pinpoint the locations from which the MMN and P300 signals originate in the brain. In addition, the researchers will continue to pursue genetic studies on the causes of tune deafness which, if found, could help them and others grapple with the very puzzling notion of consciousness at the cellular and molecular level.

NIDCD supports and conducts research and research training on the normal and disordered processes of hearing, balance, smell, taste, voice, speech and language and provides health information, based upon scientific discovery, to the public. For more information about NIDCD programs, see the Web site at www.nidcd.nih.gov.

U.S. Department of Education Offers Effective Early Childhood Language and Literacy Practices

The U.S. Department of Education's "Doing What Works" Web site recently added a feature that will empower educators and administrators with research-based strategies to help boost their early childhood language and literacy practices. This new feature brings online the recommendations outlined in five research reports previously released by the Department's Institute of Education Sciences (IES) on early childhood education.

The "Doing What Works" site, http://dww.ed.gov, offers a user-friendly interface to quickly locate teaching practices that have been found effective by IES, the Department's research arm, and similar organizations. In addition, it cites examples of possible ways, although not necessarily the only ways, teachers and designers of teaching materials may use this research to help students reach their academic potential.

"If we want every student reading on grade level by 2014, we must make sure that educators have access to information about best practices in early childhood literacy," said U.S. Secretary of Education Margaret Spellings. "By sharing effective teaching practices, the Doing What Works website helps improve classroom instruction and give all children the chance to achieve their potential."

The content on Early Childhood Language and Literacy focuses on two recommended practice areas: develop phonological awareness skills; and utilize interactive and dialogic reading practices to improve language and literacy skills.

Content on the site is organized into three areas:

Learn what works - to help understand the research base behind the practices.
See how it works - providing examples of schools and classrooms engaged in those practices, including engaging videos.
Do what works - enabling users to gain access to examples of tools and templates in order to improve their practices.

Similar resources, in areas such as school restructuring and mathematics instruction, will added to the site in the near future.

The Department's Office of Planning, Evaluation & Policy Development leads the "Doing What Works" site. Other offices and programs within the Department also assist in the initiative.

U.S. Secretary of Education Announces Public Meetings to Discuss New Regulations for No Child Left Behind

U.S. Secretary of Education Margaret Spellings recently announced in the Federal Register a series of upcoming public meetings being held around the country to discuss the proposed changes to regulations for No Child Left Behind. The meetings will seek comments from the public on the proposed regulations at the following dates, times and locations:

Wednesday, May 14, 2008
Hilton Boston Back Bay Hotel
40 Dalton Street
Boston, Mass. 02115
Time: 9 a.m. - noon and 2 - 5 p.m. EDT
Meeting Room: Fenway Room
Thursday, May 15, 2008
Georgia Perimeter College, Dunwoody Campus
2101 Womack Road
Dunwoody, Ga. 30338
Time: 9 a.m. - noon and 2 - 5 p.m. EDT
Meeting Room: Auditorium, C1100, North Campus
Monday, May 19, 2008
Sheraton Kansas City Sports Complex Hotel
9103 East 39th Street
Kansas City, MO. 64133
Time: 9 a.m. - noon and 2 - 5 p.m. EDT
Meeting Room: Royal Ballroom
Thursday, May 22, 2008
W Hotel
1112 4th Avenue
Seattle, WA 98101
Time: 9 a.m. - noon and 2 - 5 p.m. EDT
Meeting Room: Great Room 1

According to the U.S. Department of Education, "the purpose of these proposed regulations is to build on the advancements states have made in accountability and assessment systems under No Child Left Behind in the past six years, while incorporating key feedback from the field into a more clear vision of what it takes to educate each and every student. Issuing regulations that strengthen Title I implementation will help bring about higher-quality assessments and stronger accountability for results, as well as provide parents with the information they need to make informed decisions about public school choice and Supplemental Educational Services." A copy of the proposed regulations (NPRM) is available at http://www.ed.gov/policy/elsec/reg/proposal/index.html.

The Department is accepting public comments on the NPRM through June 23, 2008. Comments must be submitted in writing to the Department in accordance with the instructions in the NPRM. We look forward to receiving your comments on these proposed regulations to ensure that they accomplish our intended objectives.

Individuals who wish to present comments during a public meeting should register at Special.Events@ed.gov, at least one week before the public meeting. Any meeting time that remains after the Web site registrations are processed will be made available on the day of the meeting. Individuals who have not registered on the Web site and who wish to present comments should do so at the on-site registration desk on the day of the meeting. We will process Web-site and on-site registrations on a first-come, first-served basis.

NIH REVEALS FACTORS THAT INFLUENCE PREMATURE INFANT SURVIVAL, DISABILITY

Based on observations of more than 4,000 infants, researchers in a National Institute of Health (NIH) newborn research network have identified several factors that influence an extremely low birth weight infant's chances for survival and disability. The findings offer new information to physicians and families considering the most appropriate treatment options for this category of infants.

Every day, physicians and new parents must struggle with the type of care to provide to extremely low birth weight infants, the smallest, most frail category of preterm infants. These infants are born in the 22nd through the 25th week of pregnancy -- far earlier than the 40 weeks of a full term pregnancy. Many die soon after birth, despite the best attempts to save them, including the most sophisticated newborn intensive care available. Some survive and reach adulthood, relatively unaffected. The rest will experience some degree of life long disability, ranging from minor hearing loss to blindness, to cerebral palsy, to profound intellectual disability.

The study authors referred to the issue of providing intensive care for extremely low birth weight infants. For example, physicians and family members may be reluctant to expose an infant to painful life support procedures if the infant is unlikely to survive. In such cases, they may opt for "comfort care," which provides for an infant's basic needs, but foregoes painful medical procedures. In deciding the kind of care to provide, specialists at intensive care facilities traditionally have relied heavily on an infant's gestational age -- the week of pregnancy a premature infant is born. Gestational age is known to play a large role in the infant's survival. For this reason, in many facilities, intensive care is likely to be routinely given to infants born in the 25th week of pregnancy, whereas infants born in the 22nd week may be more likely to receive comfort care.

The study authors noted, however, that it is often difficult to assess gestational age. Moreover, an estimate that is inaccurate by only a week could result in an infant receiving care that was not appropriate for his or her individual case. To identify other factors that influenced survival and disability risk, the study authors observed more than 4,000 extremely low birth weight infants in their network.

The researchers published their findings in the April 17 "New England Journal of Medicine". In addition to gestational age, factors influencing survival and risk of disability consisted of: whether the baby is male or female (sex); birthweight; whether the baby was a single baby, or one of two or more infants born; and whether the baby's mother was given medication during pregnancy to prompt the development of the baby's lungs. Known as antenatal steroids, these drugs are typically given to women in premature labor, or who are at known risk for giving birth prematurely.

Physicians and parents may access an online tool that generates statistics, based on the factors the researchers listed in their article, at <http://www.nichd.nih.gov/about/org/cdbpm/pp/prog_epbo/>. By specifying the baby's sex, weight, and information related to each of the variables listed above, physicians and family members can generate composite statistics on infant outcomes, based on the experiences of extremely low birthweight infants in the NICHD Neonatal Research Network study. The Web tool is not a substitute for a physician's careful assessment, but physicians and families may find the statistics it generates useful when considering the most appropriate care to provide an infant.

"Every individual is different, and no single tool can precisely predict a given baby's chances of survival or disability," said Duane Alexander, M.D., director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH Institute that supports the Neonatal Research Network. "However, the researchers' findings, and the tool they developed, provide important information that physicians and family members can consult to help them make the most informed treatment decisions possible."

Additional funding for the study was provided by NIH's National Center for Research Resources.

The study involved only infants born at level III neonatal intensive care facilities. For this reason, the study findings may not apply to infants born at level I and level II facilities.

Level III facilities are the most advanced of neonatal care facilities. They offer the highly specialized medical care that extremely low birth weight infants need to survive. Most extremely low birth weight infants are born in level III facilities, as it is routine practice to rush women likely to give birth prematurely to level III facilities. However, in some cases, a woman may give birth before she can be brought to a level III facility. These infants are typically cared for at level I and II facilities until they are stable enough to transport to a level III facility.

To conduct their analysis, researchers in the NICHD Neonatal Research Network observed 4,446 infants born at 22-25 weeks' gestational age at hospitals around the United States, explained the NICHD co-author of the study, Rosemary Higgins, M.D., the program scientist for the NICHD Neonatal Research Network. Dr. Higgins explained that extremely low birthweight infants (those weighing less than 1,000 grams, or 2.2 pounds) make up about 1 percent of babies born in the United States each year, or roughly 40,000 babies a year.

Using standardized measures of mental development, vision, and hearing, the researchers assessed the health status of surviving infants when the infants were from 18 to 22 months corrected age -- the age they would have been, had they been born full term. Dr. Higgins said that 49 percent of the infants in the study had died, 21 percent lived and did not have a disability, while the remainder experienced some degree of disability.

After conducting mathematical analyses of all the infants' cases, the researchers determined that infants were more likely to survive -- and more likely to survive without disability -- if they were of older gestational age, their mothers had been given corticosteroids, if they were female, were single born rather than part of a multiple birth, and been of a higher birthweight.

"Many neonatal intensive care units base treatment decisions mainly on gestational age," said Dr. Higgins. "We found that it's much more accurate if the assessment is based on the combination of 5 factors, rather than just on gestational age."

Dr. Higgins added that it is often difficult to accurately estimate gestational age, and a preterm infant may be as much as a week or two younger, or older, than believed.

She noted that the researchers found that race appeared to play no role in subsequent survival or chances of disability.

She stressed that the study data could not be used to predict with certainty the outcome of individual cases.

"A lot of medicine is a judgment call," Dr. Higgins said. "We provided our data in the hope that it would be helpful for making the best judgments for a particular situation."

A video interview with Dr. Higgins in which she provides additional information about the study and the online tool is available at <http://www.nichd.nih.gov/news/resources/links/neonatal/>.

The National Institutes of Health (NIH) -- The Nation's Medical Research Agency -- is comprised of 27 Institutes and Centers and is a component of the U. S. Department of Health and Human Services. It is the primary Federal agency for conducting and supporting basic, clinical, and translational medical research, and investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit <www.nih.gov>.

U.S. Government Concedes First Vaccine-Autism Case

The U.S. Department of Health and Human Services, the federal agency that oversees the U.S. Food and Drug Administration (FDA) and the U.S. Centers for Disease Control and Prevention (CDC), recently conceded the first vaccine-autism case.

The unprecedented concession was filed on November 9, and sealed to protect the plaintiff's identify. It was obtained through individuals unrelated to the case. It was one of the first three cases chosen that alleged Thimerosal in childhood vaccines significantly contributed to a child developing autism.

The claim, one of 4,900 autism cases currently pending in Federal "Vaccine Court," was conceded by US Assistant Attorney General Peter Keisler and other Justice Department officials, on behalf of the Department of Health and Human Services, the "defendant" in all Vaccine Court cases.

The child's claim against the government -- that mercury-containing vaccines were the cause of her autism -- was supposed to be one of three "test cases" for the thimerosal-autism theory currently under consideration by a three-member panel of Special Masters, the presiding justices in Federal Claims Court.

Gene for Brain Networks Tied to Autism

A gene that helps the brain make connections may underlie a significant number of autism cases, researchers in the United States reported on Tuesday. Disruptions in the gene, called contactin 4, stop the gene from working properly and appear to stop the brain from making proper networks, the researchers reported in the Journal of Medical Genetics. These disruptions, in which the child has either three copies of the gene or just one copy when two copies is normal, could account for up to 2.5 percent of autism cases, said Dr. Eli Hatchwell of Stony Brook University Medical Center in New York, who led the study. "That is a significant number," said Hatchwell. "Generally the mistake that people make is they are looking for one unifying cause for autism, and there is no such thing and there never will be," Hatchwell said in a telephone interview. He said his finding adds to the list of potential tests for autism, and perhaps treatments for a range of conditions known as autism spectrum disorders.

To read the entire article, CLICK HERE

Study Shows Variety of Approaches Help Children Overcome Auditory Processing and Language Problems

For children who struggle to learn language, the choice between various interventions may matter less than the intensity and format of the intervention, a new study sponsored by the National Institute on Deafness and Other Communication Disorders (NIDCD) suggests. The study, led by Ronald B. Gillam, Ph.D., of Utah State University is online in the February 2008 Journal of Speech, Language, and Hearing Research. NIDCD is one of the National Institutes of Health.

The study compared four intervention strategies in children who have unusual difficulty understanding and using language, and found that all four methods resulted in significant, long-term improvements in the children’s language abilities. The aim of the study was to assess whether children who used commercially available language software program Fast ForWord-Language had greater improvement in language skills than children using other methods. This program was specifically designed to improve auditory processing deficits which may underlie some language impairments. Children who have auditory processing deficits can jumble the order of sounds that are heard in close sequence. Researchers believe that this deficit can interfere with vocabulary and grammar development.

“These results show that any of a number of intensive educational approaches can make a tremendous difference for children whose language and auditory processing skills are lagging,” says NIDCD director James F. Battey, Jr., M.D., Ph.D. “Even play with peers seemed to support the improvements the children in this study made.”

“We had a very positive outcome,” says Dr. Gillam. “Our results tell us that a variety of intensive interventions that we can provide kids will improve auditory processing and language learning.”

While most children are chattering easily by the time they are toddlers, about 7 percent struggle to speak, read and understand language despite having adequate hearing, intelligence and motor skills. Children with language impairment have trouble learning language or expressing their thoughts through language. They often have difficulty learning new vocabulary words or sentence structures, comprehending what’s said to them, holding conversations, or telling stories. These children tend to perform poorly on measures of auditory processing and standardized tests of language development. Many of these children are hindered academically throughout their formal education, explains Dr. Gillam.

To address auditory processing problems, a different group of language researchers developed the computer software package called Fast ForWord-Language several years ago. The program uses slow and exaggerated speech to improve a child’s ability to process spoken language. As children advance through the program, subsequent language exercises use gradually faster and less exaggerated speech.

Dr. Gillam’s team designed a study that would compare Fast ForWord-Language to three other interventions. He and colleagues at the University of Kansas, the University of Texas at Austin and the University of Texas at Dallas enrolled 216 children in the trial. All were between ages 6 and 9 and had been diagnosed with language impairment.

The children, from Northeast Kansas, Central Texas or North Texas, were randomly assigned to receive one of four possible interventions. In addition to Fast ForWord-Language, the trial included another computer-assisted language intervention, an individual language intervention with a speech-language pathologist, and a nonlanguage academic enrichment intervention that focused only on math, science and geography.

The other computer-assisted language intervention, which used Earobics and Laureate Learning Systems software, differed from Fast ForWord-Language in not using slow or exaggerated speech. Groups of children worked on the computer intervention exercises at their own pace wearing headphones and supervised by a speech-language pathologist.

Children assigned to the individual language intervention worked one-on-one with a speech-language pathologist for the duration of the trial. In their sessions, the children read picture books that contained a variety of age-appropriate vocabulary words.

In the academic enrichment intervention, children worked on educational computer games designed to teach math, science and geography. This intervention was delivered in the same way as the language-focused computer interventions. It served as a comparison group against which the researchers could measure the results of the language interventions.

All of the interventions were delivered in an intensive, six-week, summer program that also included day camp activities such as arts and crafts, outdoor games, board games and snack time. The children attended the program five days per week for three and a half hours per day. They practiced their assigned interventions for an hour and forty minutes each day. The children took a standard language test—the Comprehensive Test of Spoken Language— and completed a variety of auditory processing measures at the beginning and end of the program as well as three and six months afterward. The children in all four groups demonstrated statistically significant improvement on the auditory processing measures and the language measures immediately after their six-week program.

The children showed even greater improvement when their language skills were tested again six months later. Even a subgroup of children with very poor auditory processing skills made improvements on the auditory processing tasks and the language measures. About 74 percent of children in the Fast ForWord-Language group made large improvements on the language measures. Sixty-three percent of children in the computer-assisted language intervention group made large improvements. Of those who worked with a speech-language pathologist, 80 percent made large gains, and in the general academic enrichment group, almost 69 percent made large gains. These gains are much larger than the improvements that have been reported in long-term studies of children who have received language therapy in public school settings.

The researchers were surprised that such a large percentage of the children who worked on the math, science and geography computer games improved their auditory processing and language skills. They speculate that all the children may have benefited from the opportunities to listen carefully, to decide on an appropriate response based on what they heard, and to practice language skills with each other. The recreation and play time built into each day of the six-week program gave the children the chance to form friendships with peers who were functioning at similar language levels.

The intensive delivery of the interventions—500 minutes per week—may also have benefited kids in every intervention group. In comparison, school systems typically offer speech-language pathology services to students with language impairment for 30 minutes twice per week.

“I urge speech-language pathologists to engage children with auditory processing problems and language impairments in activities in which they have to listen carefully, attend closely and respond quickly, and to do it in an intense manner,” says Dr. Gillam. “And clinicians should provide children with ample opportunity to converse, socialize and interact with kids at their same developmental level.”

The language intervention trial was also supported by a grant from the National Institute of Child Health and Human Development (NICHD) to the Kansas Mental Retardation and Developmental Disabilities Research Center at the University of Kansas. NICHD is also part of the National Institutes of Health.

The NIDCD supports and conducts research and research training on the normal and disordered processes of hearing, balance, smell, taste, voice, speech and language and provides health information, based upon scientific discovery, to the public. For more information about NIDCD programs, see the Web site at www.nidcd.nih.gov.

THIN BONES SEEN IN BOYS WITH AUTISM AND AUTISM SPECTRUM DISORDER

Results of an study by researchers from the National Institutes of Health and Cincinnati Children's Hospital Medical Center suggest that dairy-free diets and unconventional food preferences could put boys with autism and autism spectrum disorder (ASD) at higher than normal risk for thinner, less dense bones when compared to a group of boys the same age who do not have autism. The study was published online in the "Journal of Autism and Developmental Disorders".

The researchers believe that boys with autism and ASD are at risk for poor bone development for a number of reasons. These factors are lack of exercise, a reluctance to eat a varied diet, lack of vitamin D, digestive problems, and diets that exclude casein, a protein found in milk and milk products. Dairy products provide a significant source of calcium and vitamin D. Casein-free diets are a controversial treatment thought by some to lessen the symptoms of autism.

Funding for the study was provided by the NIH's National Institute of Child Health and Human Development and National Center for Research Resources. The research team that conducted the study was led by Mary L. Hediger, Ph.D., a biological anthropologist in NICHD's Division of Epidemiology, Statistics and Prevention Research.

"Our results suggest that children with autism and autism spectrum disorder may be at risk for calcium and vitamin D deficiencies," Dr. Hediger said. "Parents of these children may wish to include a dietitian in their children's health care team, to ensure that they receive a balanced diet."

Dr. Hediger stressed that the current study results need to be confirmed by larger studies. Until definitive information is available, however, it would be prudent for parents of children with autism and ASD to include a dietitian in their care, particularly if the children's diets do not include dairy products or they are not otherwise eating a balanced diet, she said.

Because girls are much less likely to have autism or ASD than are boys, the researchers were unable to enroll a sufficient number of girls within the short time frame of the study to allow them to draw firm conclusions. Dr. Hediger added that if a girl with autism or ASD is not eating diary products or eating a balanced diet, it would be prudent for a dietitian to be included in her health care team.

Autism is a complex brain disorder involving communication and social difficulties as well as repetitive behavior or narrow interests. Autism is often grouped with similar disorders, which are often referred to collectively as autism spectrum disorders. The underlying causes of autism and ASD are unclear. There is no cure for the disorders and treatments are limited.

When the boys were enrolled in the study, the researchers asked the boys' parents if the boys were taking over-the-counter or prescription medications, were taking any vitamin or mineral supplements, or were on a restricted diet.

During the study, researchers X-rayed the hands of 75 boys between the ages of 4 and 8 years old who had been diagnosed with autism or ASD. The researchers then measured the thickness of the bone located between the knuckle of the index finger and the wrist and compared its development to a standardized reference based on a group of boys without autism.

Dr. Hediger said that the research team measured cortical bone thickness. She added that this procedure was done as a substitute for a conventional bone scan, which measures bone density. Bone density is an indication of bones' mineral content. Less dense bones may indicate a risk of bone fracture.

The researchers used the measure of bone thickness because many of the boys were unable to remain still long enough for the conventional scan, which requires individuals to lie immobile for an extended period of time. To successfully complete the bone scan, many of the boys would have required sedation -- a step the researchers were reluctant to take for an early study.

The hand X-ray, Dr. Hediger explained, offers an approximate indication of bone density. She added, however, that because the researchers were unable to use a conventional bone scan, the results of the current study should be confirmed by additional studies using conventional bone scans.

The investigators found that the bones of the boys with autism were growing longer but were not thickening at a normal rate. During normal bone development, material from inside the bone is transferred to the outside of the bone, increasing thickness, while at the same time, the bones are also growing longer.

At 5 or 6 years of age, the bones of the autistic boys were significantly thinner than the bones of boys without autism and the difference in bone thickness became even greater at ages 7 and 8.

The bone thinning was particularly notable because the boys with autism and ASD were heavier than average and would therefore be expected to have thicker bones.

The researchers do not know for certain why the boys had thinner than normal bones. A possible explanation is lack of calcium and vitamin D in their diets. Dr. Hediger explained that a deficiency of these important nutrients in the boys' diets could result from a variety of causes. Many children with autism, she said, have aversions to certain foods. Some will insist on eating the same foods nearly every day, to the exclusion of other foods. So while they may consume enough calories to meet their needs -- or even more calories than they need -- they may lack certain nutrients, like calcium and vitamin D.

Other children with autism may have digestive problems which interfere with the absorption of nutrients. Moreover, many children with autism remain indoors because they require supervision during outdoor activity. Lack of exercise hinders proper bone development, she said. Similarly, if children remain indoors and are not exposed to sunlight, they may not make enough vitamin D, which is needed to process calcium into bones.

The boys in the study who were on a casein-free diet had the thinnest bones. In fact, the 9 boys who were on a casein-free diet had bones that were 20 percent thinner than normal for children their age. Boys who were not on a casein-free diet showed a 10 percent decrease in bone thickness when compared to boys with normal bone development.

The study authors wrote that bone development of children on casein-free diets should be monitored very carefully. They noted that studies of casein-free diets had not proven the diets to be effective in treating the symptoms of autism or ASD.

Only 9 boys on casein-free diets were available to participate in the study, Dr. Hediger said. When conducting a scientific study, it's easier to obtain statistically valid results by studying a larger number of individuals than with a smaller number of individuals. However, the dramatic difference in the boys' bone thickness when they were either on a casein-free diet or an unrestricted diet and when compared to normally developing bones strongly suggest that the bone thinning the researchers observed was statistically valid.

The researchers recommended that larger studies be conducted to confirm their results.

Until those studies can be conducted, Dr. Hediger offered the following advice: "Our study shows that it couldn't hurt -- and would probably help -- if parents of children with autism or autism spectrum disorder consulted with a dietitian during their children's routine medical care to make sure that their diets are balanced."

General information about autism and ASD is available from the NICHD's Web site, at <http://www.nichd.nih.gov/publications/pubs/autism/overview/index.cfm>.

National Institutes of Health Develops Down Syndrome Research Plan

The National Institutes of Health has developed a research plan to advance understanding of Down syndrome and speed development of new treatments for the condition, the most frequent genetic cause of mild to moderate mental retardation and associated medical problems. The plan sets research goals for the next 10 years that build upon earlier research advances fostered by the NIH.

"Through the years, the NIH research effort has led to increased understanding of Down syndrome," said Elias Zerhouni, M.D., director of the National Institutes of Health. "We are now poised to capitalize on these advances and improve the health of people with Down syndrome."

Down syndrome occurs in 1 out of every 800 births in the United States. Down syndrome most frequently results from an extra copy of chromosome 21 in the body's cells. In most cases, this extra chromosome comes from the mother. In some cases, forms of Down syndrome can result from just having an extra portion of chromosome 21. The chance of giving birth to a baby with Down syndrome increases as women age.

Infants with Down syndrome have certain characteristic physical features, such as short stature, distinctive facial features and are more likely to have health conditions like hearing loss, heart malformations, hypertension, digestive problems, and vision disorders. Although Down syndrome is the most common cause of mild to moderate intellectual disability, the condition occasionally is severe. People with Down syndrome are also much more likely to die from infections if left untreated.

The NIH's National Institute of Child Health and Human Development convened a working group of NIH scientists. Through a public comment process, the scientists listened to comments and suggestions from families of individuals with Down Syndrome, as well as from Down Syndrome research advocacy organizations. The NIH scientists then developed the research plan in collaboration with researchers in the national scientific community.
Among the research objectives identified as priorities over the next 10 years is the need for greater access to laboratory animals with the characteristics of Down syndrome.

The plan cites the need for increased research on the medical, cognitive, and behavioral conditions that occur in people with Down syndrome. These conditions include leukemia, heart disease, sleep apnea, seizure disorders, stomach disorders and mental health problems.

The working group also identified the need to study whether aging has a greater impact on mental processes in people with Down syndrome than in people who do not have Down syndrome. As adults, individuals with Down syndrome age prematurely and may experience dementia, memory loss or impaired judgment similar to that experienced by Alzheimer's disease patients.

The plan summarizes current research efforts by the various NIH institutes studying Down syndrome.

The National Institute of Child and Human Development (NICHD) has supported Down syndrome research since the institute was established in the 1960s. NICHD scientists have bred mice that help researchers study the intellectual disability and dementia that occurs in Down syndrome. The NICHD is currently studying specific genes and gene groups that may play a role in developing Down syndrome. Researchers are also studying the role that the age of the mother's egg plays in developing the disorder.

An NICHD-sponsored study is examining whether individuals with an additional complete copy of chromosome 21 differ as they age from people with only a portion of the extra chromosome. Another long-term study will examine the prevalence of dementia in adults with Down syndrome and whether certain medications, like hormone replacement therapy, slow the aging process in Down syndrome.

Other NICHD-supported projects include devising a weight loss program for adults with developmental disabilities, and a computer program to help children with Down syndrome learn.

The National Heart, Lung, and Blood Institute (NHLBI) is supporting studies of the genes that contribute to heart malformations found in Down syndrome patients. The NHLBI also is supporting investigations of the causes and potential treatments for obstructive sleep apnea, a disorder in which throat tissue blocks the airway during sleep, temporarily shutting off air to the lungs. Obstructive sleep apnea is common in Down syndrome children.

Children with Down syndrome are 10 to 15 times more likely than other children to develop leukemia. The National Cancer Institute is investigating various types of leukemia that affect children with Down syndrome.

Other NIH institutes continue to investigate additional aspects of Down syndrome. The National Institute on Aging is conducting research on ways to treat Alzheimer's disease in people with Down syndrome.

The National Institute of Allergy and Infectious Diseases is studying the significance of two genes recently found in a region of chromosome 21. These genes are involved in the development of the immune response against disease.

The National Institute of Mental Health is investigating rates and possible treatments for mental disorders found with Down syndrome. These include autism, obsessive-compulsive disorder, depression, and psychosis.

The National Institute of Neurological Disorders and Stroke (NINDS) is investigating how the brain is affected by Down syndrome. The intellectual disability seen in people with Down syndrome is caused when neurons die or do not function properly. One NINDS study is investigating the potential role of a specific gene called APP, for amyloid precursor protein. It is thought that disruption of the APP gene may kill neurons by interfering with a growth factor needed for neurons to survive. APP is believed to be related to Alzheimer's disease and may play a role in Down syndrome.

The research plan on Down syndrome "is intended to provide the NIH, and its member Institutes and Centers, with guidelines for prioritizing and coordinating future research related to Down syndrome," wrote the members of the NIH Down syndrome working group in the report.

The working group is moving forward to implement plan objectives. The plan's short- term objectives are expected to be accomplished within the next three years.

The report is available on the NICHD Web site at: http://www.nichd.nih.gov/publications/pubs/upload/NIH_Downsyndrome_plan.pdf

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit: www.nih.gov.

Scientists Can Predict Psychotic Illness in up to 80 Percent of High-Risk Youth

The National Institute of Mental Health reported today that youth who are going to develop psychosis can be identified before their illness becomes full-blown 35 percent of the time if they meet widely accepted criteria for risk, but that figure rises to 65 to 80 percent if they have certain combinations of risk factors, the largest study of its kind has shown. Knowing what these combinations are can help scientists predict who is likely to develop the illnesses within two to three years with the same accuracy that other kinds of risk factors can predict major medical diseases, such as diabetes.

Plans for studies to confirm the results, a necessary step before the findings can be considered for use with patients in health-care settings, are underway.

The research was conducted in youth with a median age of 16 and was funded primarily by the National Institute of Mental Health (NIMH), part of the National Institutes of Health. Results were published in the January 7, 2008, issue of the Archives of General Psychiatry by lead researchers Tyrone D. Cannon, Ph.D., of the University of California Los Angeles, and Robert Heinssen, Ph.D., of NIMH, with colleagues from seven other research facilities.

The combinations of factors that predicted psychosis included:

deteriorating social functioning (for example, spending increasing amounts of time alone in one's room, doing nothing)
a family history of psychosis combined with recent decline in ability to function (such as a drop in grades not explained by other factors or an unexplained withdrawal from extracurricular school activities)
increase in unusual thoughts (such as thinking that strangers' conversations are about oneself)
increase in suspicion/paranoia (such as suspicion of being followed)
past or current drug abuse

"When teens have a dive in grades or drop out of the school band, and it happens against a backdrop of family history of schizophrenia and recent troubling changes in perception — like hearing nondistinct buzzing or crackling sounds, or seeing fleeting images that disappear with a second glance — more often than not it indicates that psychosis is fairly imminent," Cannon said.

If participants had an unrealistic belief that they were being followed, for example, but could be shown that their troubling thoughts were unfounded, the researchers considered them as having a risk factor, but not yet psychosis. But if the participants' sense of being followed became unshakable, despite evidence to the contrary, or became disabling, the researchers considered them as having crossed a threshold to psychosis.

Research shows that intervention during the early stages of psychosis improves outcomes, but it is not yet clear if even earlier intervention, before a psychotic illness develops, is effective.

"Having this more accurate ability to measure who's likely to develop psychosis will be a great asset. Identifying young people in need of intervention is crucial, but the results of this research can help us do more than that. It can eventually help us determine the most effective time to intervene," said NIMH Director Thomas R. Insel, M.D.

Researchers from the facilities that conducted the study used similar criteria and techniques to evaluate 291 high-risk youth, about three times as many as had been evaluated in any previous study of this kind. In addition to being smaller, earlier studies had used different criteria and measuring techniques from one another, which clouded the picture and resulted in only moderate accuracy in predicting psychotic illness.

In this study, a total of 35 percent of participants with at least one risk factor developed a psychotic illness within the 30-month study timeframe. However, when researchers broke the data down further, they found that the youth who had two or three additional risk factors developed psychosis at a rate of 68 to 80 percent, depending on which risk factors were combined.

A separate group of 134 healthy people with no known risk factors for psychosis served as a control group, for comparison. None of them developed a psychotic illness.

Researchers also found that the youth who progressed to a psychotic disorder tended to do so relatively quickly. Twenty-two percent developed psychosis within the first year of follow-up, an additional 11 percent by the end of the second year, and 3 percent more by two-and-a-half years (adding up to the total percentage of people — 35 percent — who developed psychosis in this study).

"The message here is that once we identify people as being high risk, we have a very good chance of knowing whether or not they're likely to develop a serious mental disorder like schizophrenia and that, if they do, it will happen fairly quickly. That's such a critical window of opportunity for getting them the help they need," said Heinssen.

The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior. More information is available at the NIMH website: http://www.nimh.nih.gov/.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Reference:
Cannon TD, Cadenhead K, Cornblatt B, Woods SW, Addington J, Walker E, Seidman LJ, Perkins D, Tsuang M, McGlashan T, Heinssen R. Prediction of Psychosis in High Risk Youth: A Multi-Site Longitudinal Study in North America. Archives of General Psychiatry. January 7, 2008.

NIH Announces New Spanish Language Website on Neurological Disorders

Free, accurate information on many neurological disorders is now available on a new Spanish language website from the National Institutes of Health (NIH). The website is available at: www.espanol.ninds.nih.gov

Health information featured on the new website includes publications on epilepsy, autism, as well as many other neurological disorders. The publications can be downloaded or ordered free of charge. The website also provides information on clinical studies, links to non-profit organizations that offer information and assistance on neurological disorders, and a contact form where people can submit questions on topics related to health and biomedical research.

Providing health information to the nation’s Spanish-speaking population is an important part of the NIH's outreach efforts, which support its mission to reduce the burden of neurological disease. According to the 2000 United States Census, 28.1 million people in the U.S. who are age 5 or older speak Spanish in their homes.

For more information about NIH and its programs, visit: www.nih.gov

Fever May Be Significant Clue to Autism Research and Treatment

Fever can temporarily unlock autism's grip on children, a finding that could shed light on the roots of the condition and perhaps provide clues for treatment, researchers reported on Monday. It appears that fever restores nerve cell communications in regions of the autistic brain, restoring a child's ability to interact and socialize during the fever, the study said.

"The results of this study are important because they show us that the autistic brain is plastic, or capable of altering current connections and forming new ones in response to different experiences or conditions," said Dr. Andrew Zimmerman, a pediatric neurologist at Baltimore's Kennedy Krieger Institute, who was one of the study authors.

The study, published in the journal Pediatrics, was based on 30 children with autism aged 2 to 18 who were observed during and after a fever of at least 100.4 degrees Fahrenheit. More than 80 percent of those with fever showed some improvements in behavior during it and 30 percent had dramatic improvements, the researchers said.

To read more about the study: CLICK HERE

Statement by the USDOE on the 2006 Progress in International Reading Literacy Study (PIRLS) Results

The National Center for Education Statistics (NCES) today released the 2006 Progress in International Reading Literacy Study (PIRLS). This assessment, focusing on students' reading comprehension and literacy, was administered to a random sampling of approximately 5,000 4th graders from across the United States. The results were then compared to students in more than 45 countries and subnational systems (e.g., Canadian provinces). The last PIRLS assessment was administered in 2001.

Following the release of the 2006 PIRLS results, U.S. Secretary of Education Margaret Spellings today made the following statement:

The results of this report indicate that our strong commitment to academic excellence is more important than ever.

Although our nation's 4th graders rank above the international average in reading performance on the PIRLS assessment, the U.S. score has not changed measurably from 2001. While we're seeing progress under No Child Left Behind, we can do better. If we want to sustain America's position as an economic power and innovative leader, our students must master the fundamentals.
PIRLS is just one piece of data we use to determine how our students compare with their international peers. U.S. educators and policymakers rely on other assessments, such as the National Assessment for Educational Progress (NAEP), to advise on student performance at multiple levels. In fact, I'm encouraged by recent NAEP results on 4th and 8th grade reading and math, particularly given the sample size tested in which approximately 700,000 students participated, as opposed to 5,000 U.S. students assessed under PIRLS.

Clearly, as the world becomes flatter, it's becoming more competitive. We need to do better than simply keep pace.

New Web Page Helps Users Identify Evidence-Based Programs

The Substance Abuse and Mental Health Services Administration has developed a new Web page to assist the public in identifying evidence-based programs and practices that can prevent and/or treat mental and substance use disorders. Debuting online today, A Guide to Evidence-Based Practices on the Web at www.samhsa.gov/ebpWebguide features 37 Web sites that contain information about specific evidence-based interventions or provide comprehensive reviews of research findings.

The Web Guide – a component of SAMHSA’s Science and Service Initiative - can be used by stakeholders throughout the behavioral health field to promote awareness of current intervention research and to increase the availability and implementation of evidence-based practices.

Users can browse the listings in the Web Guide by content area, age group, or treatment setting. Each listing includes the name of the organization sponsoring the Web site, a hyperlink to the actual Web site, a statement of the site’s purpose and intended audience(s), and key features, such as sources of evidence and review processes and information on resources needed to implement the evidence-based practices properly.

For more information, visit A Guide to Evidence-Based Practices (EBP) on the Web at www.samhsa.gov/ebpWebguide .

Brain Matures a Few Years Late in ADHD, But Follows Normal Pattern

In youth with attention deficit hyperactivity disorder (ADHD), the brain matures in a normal pattern but is delayed three years in some regions, on average, compared to youth without the disorder, an imaging study by researchers at the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH) has revealed. The delay in ADHD was most prominent in regions at the front of the brain’s outer mantle (cortex), important for the ability to control thinking, attention and planning. Otherwise, both groups showed a similar back-to-front wave of brain maturation with different areas peaking in thickness at different times (see movie).

“Finding a normal pattern of cortex maturation, albeit delayed, in children with ADHD should be reassuring to families and could help to explain why many youth eventually seem to grow out of the disorder,” explained Philip Shaw, M.D., NIMH Child Psychiatry Branch, who led research team.

Previous brain imaging studies failed to detect the developmental lag because they focused on the size of the relatively large lobes of the brain. The sharp differences emerged only after a new image analysis technique allowed the researchers to pinpoint the thickening and thinning of thousands of cortex sites in hundreds of children and teens, with and without the disorder.

“If you’re just looking at the lobes, you have only four measures instead of 40,000,” explained Shaw. “You don’t pick up the focal, regional changes where this delay is most marked.”

Among 223 youth with ADHD, half of 40,000 cortex sites attained peak thickness at an average age of 10.5, compared to age 7.5 in a matched group of youth without the disorder.

Shaw, Judith Rapoport, M.D., of the NIMH Child Psychiatry Branch, Alan Evans, M.D., of McGill University, and colleagues report on their magnetic resonance imaging (MRI) study during the week of November 12, 2007, in the online edition of the Proceedings of the National Academy of Sciences.

The researchers scanned most of the 446 participants – ranging from preschoolers to young adults – at least twice at about three-year intervals. They focused on the age when cortex thickening during childhood gives way to thinning following puberty, as unused neural connections are pruned for optimal efficiency during the teen years.

In both ADHD and control groups, sensory processing and motor control areas at the back and top of the brain peaked in thickness earlier in childhood, while the frontal cortex areas responsible for higher-order executive control functions peaked later, during the teen years. These frontal areas support the ability to suppress inappropriate actions and thoughts, focus attention, remember things from moment to moment, work for reward, and control movement – functions often disturbed in people with ADHD.

Circuitry in the frontal and temporal (at the side of the brain) areas that integrate information from the sensory areas with the higher-order functions showed the greatest maturational delay in youth with ADHD. For example, one of the last areas to mature, the middle of the prefrontal cortex, lagged five years in those with the disorder.

The motor cortex emerged as the only area that matured faster than normal in the youth with ADHD, in contrast to the late-maturing frontal cortex areas that direct it. This mismatch might account for the restlessness and fidgety symptoms common among those with the disorder, the researchers suggested.

They also noted that the delayed pattern of maturation observed in ADHD is the opposite of that seen in other developmental brain disorders like autism, in which the volume of brain structures peak at a much earlier-than-normal age.

The findings support the theory that ADHD results from a delay in cortex maturation. In future studies, the researchers hope to find genetic underpinnings of the delay and ways of boosting processes of recovery from the disorder.

“Brain imaging is still not ready for use as a diagnostic tool in ADHD,” noted Shaw. “Although the delay in cortex development was marked, it could only be detected when a very large number of children with the disorder were included. It is not yet possible to detect such delay from the brain scans of just one individual. The diagnosis of ADHD remains clinical, based on taking a history from the child, the family and teachers.”

Also participating in the research were: Kristen Eskstrand, Wendy Sharp, Jonathan Blumenthal, Dede Greenstein, Liv Clasen, and Jay Giedd, M.D., NIMH.

Maturation of the brain, as reflected in the age at which a cortex area attains peak thickness, in ADHD (above) and normal development (below). Lighter areas are thinner, darker areas thicker. Light blue in the ADHD sequence corresponds to the same thickness as light purple in the normal development sequence. The darkest areas in the lower part of the brain, which are not associated with ADHD, had either already peaked in thickness by the start of the study, or, for statistical reasons, were not amenable to defining an age of peak cortex thickness. (see movie)

Pediatricians Urge Autism Screening

The country's leading pediatricians group is making its strongest push yet to have all children screened for autism twice by age 2, warning of symptoms such as babies who don't babble at 9 months and 1-year-olds who don't point to toys.

The advice is meant to help both parents and doctors spot autism sooner. There is no cure for the disorder, but experts say that early therapy can lessen its severity.

Symptoms to watch for and the call for early screening come in two new reports. They are being released by the American Academy of Pediatrics on Monday at its annual meeting in San Francisco and will appear in the November issue of the journal Pediatrics and on the group's Web site: http://www.aap.org/.
To read the entire article, visit: http://www.aap.org/advocacy/releases/oct07autism.htm

New York Loses Supreme Court Appeal

Supreme Court Splits on NY Special Ed Case, Leaving City Schools to Pay Private Tuition

On Monday, October 1, the Court heard Oral argument in New York Bd of Ed v. Tom F.

On Wednesday, October 10, the United States Supreme Court issued a decision in this case. Justice Kennedy, recused himself. The justices split 4-4, leaving intact a lower court's ruling in favor of former Viacom and MTV executive Tom Freston. Lower courts had ruled in favor of Freston against New York City's board of education, saying the city must pay for educating learning-disabled students in private schools, even when they don't first give the public school system a chance.

New York City's legal department said the decision detracts from schools' abilities to work with parents for the best possible educational outcomes for children with disabilities. Since the decision is not a precedent which would guide all U.S. public school districts, "we are hopeful that the Supreme Court will resolve this important issue in the near future," the city legal department said in a statement.

The favorable decision on behalf of the parents and child stands for families who live in the Second Circuit - Connecticut, New York, and Vermont. However, the failure of the Supreme Court to issue a definitive ruling on this issue means that the case has no precedential value beyond the 2nd Circuit. The decision is, in essence, a nullity, i.e., the case never went beyond the 2nd Circuit.

You can read the decision in Tom F. at:

http://www.wrightslaw.com/law/caselaw/ussupct.nyc.tomf.pdf

To read more about this landmark decision, visit:

Supreme Court Weighs Special Education Law

Does IDEA provide for public tuition reimbursement for private school when a child has not previously received special education from a public school?

The Supreme Court began its 2007 term by hearing arguments in a case that could affect the six million children who receive special education in the United States.

At issue is the nation's cornerstone special education law, the Individuals with Disabilities Education Act (IDEA). IDEA mandates public school systems to ensure a Free Appropriate Public Education (FAPE) for special-needs children in their district.

In some cases, that means that if a public school does not have an adequate special education program for a student, the district will pay for that student to attend a private school that does.

The case before the Court, School Board of New York City vs. Tom F., asks whether taxpayers should pay to send a child with a disability to a private school if that child has not first tried a special education program offered by a public school.

The Individuals with Disabilities Act (IDEA) guarantees students with disabilities a "free appropriate public education." Tom Freston enrolled his son Gilbert in a private school for students with special needs, because the New York City school district was unable to establish an adequate "individualized education program." The school district reimbursed Freston for the private school tuition. After two years the school district offered to place Gilbert in another public school, but Freston chose to keep his son in private school and again sought tuition reimbursement from the district.

A U.S. district court ruled that the school district was not required by the IDEA to reimburse Freston, because Gilbert had never been enrolled in public school.

The case before the Court, School Board of New York City vs. Tom F., asks whether taxpayers should pay to send a disabled child to a private school if that child has not first tried a special education program offered by a public school.

The question before the Court is: Does the Individuals with Disabilities Act provide for public tuition reimbursement for private school when a child has not previously received special education from a public school?

To read more about this case, School Board of New York City vs. Tom F, visit:
http://www.pbs.org/newshour/extra/features/july-dec07/scotus_10-08.html

AHRQ and FDA to Collaborate in Largest Study Ever of Possible Heart Risks With ADHD Medications

Two U.S. Department of Health and Human Services agencies will collaborate in the most comprehensive study to date of prescription medications used to treat attention deficit hyperactivity disorder (ADHD) and the potential for increased risk of heart attack, stroke or other cardiovascular problems.

Researchers supported by the Agency for Healthcare Research and Quality and the U.S. Food and Drug Administration will examine the clinical data of about 500,000 children and adults who have taken medications used to treat ADHD, to determine whether those drugs increase cardiovascular risks.

Because medications used to treat ADHD can increase heart rate and blood pressure, there are concerns about the drugs' potential to increase cardiac risks. It is also thought these risks may be different for adults and children, but more evidence is needed about the long-term effects of using ADHD medications.

The planned analysis follows an FDA-sponsored preliminary study that compiled information from large health care databases on prescription drug use, inpatient care, outpatient treatment, and health outcomes, including death. Based on that effort, researchers identified people who took ADHD drugs during a seven-year period ending in 2005. AHRQ, which sponsors research on clinical effectiveness and safety, will team with FDA to complete the analysis of the data.

"This study highlights one of AHRQ's most important missions: to collect and analyze, scientific evidence that will help patients, policymakers, and clinicians make the best possible decisions," said AHRQ Director Carolyn M. Clancy, M.D. "This partnership with the FDA is a great way to move closer to answering important clinical questions that affect children and adults who have ADHD."

"Case reports have described adverse cardiovascular events in adult and pediatric patients with certain underlying risk factors who receive drug treatment for ADHD, but it is unknown whether or not these events are causally related to treatment," said Gerald Dal Pan, M.D., director of FDA's Office of Surveillance and Epidemiology. "The goal of this study is to develop better information on this question."

The study will be coordinated by Vanderbilt University researchers on contract through AHRQ's Effective Health Care program. Data analysis will be performed by researchers at Vanderbilt, Kaiser Permanente of California, the HMO Research Network and i3 Drug Safety, as well as from FDA and AHRQ. The analysis will include all drugs currently marketed for treating ADHD. The study will analyze the risks of all the drugs as a whole, and risks of the drugs grouped by class.

The analysis will take about two years to complete. Results are expected to be important not only to patients, their families and health care providers, but also to government insurance programs. Medicaid, Medicare, and the State Children's Health Insurance Program provide reimbursement for drugs prescribed for ADHD. This information could also be used to inform product labeling, which is used by health care providers when making treatment decisions.

ADHD is a behavioral disorder that, in many patients, causes hyperactivity, and may have a significant impact on school performance and social functioning. According to the National Institute of Mental Health, ADHD affects approximately 3 percent to 5 percent of school-age children and about 4 percent of adults.

Use of ADHD drugs has increased in recent years among children and adults. A recent AHRQ analysis of medication expenditures found three ADHD drugs—Concerta, Strattera, and Adderall—ranked among the top five drugs prescribed for children ages 17 years and younger. About $1.3 billion was spent on those drugs in 2004, the study estimated. Adult use is also believed to be increasing.

In May 2006, based on a review of anecdotal reports of heart attack, stroke and sudden death among patients taking usual doses of ADHD medications, the FDA asked drug manufacturers to revise product labeling to reflect concerns about possible adverse events. Drug manufacturers have created patient Medication Guides for individual products to help patients understand risks.

FDA and AHRQ recommend that individuals using or being considered for treatment with ADHD drug products work with their physician or other health care professional to develop a treatment plan that includes a careful health history and evaluation of current health status, particularly for cardiovascular and psychiatric problems, including assessment for a family history of such problems.

For more information:
National Institute of Mental Health—ADHD page
www.nimh.nih.gov/healthinformation/adhdmenu.cfm

FDA News—ADHD Medications and Cardiovascular, Psychiatric Adverse Events
www.fda.gov/bbs/topics/NEWS/2007/NEW01568.html

AHRQ's Effective Health Care Program
www.effectivehealthcare.ahrq.gov

Study Links Attention Problems to Early TV Viewing

Watching television more than two hours a day early in life can lead to attention problems later in adolescence, according to a study released on Tuesday. The roughly 40 percent increase in attention problems among heavy TV viewers was observed in both boys and girls, and was independent of whether a diagnosis of attention deficit/hyperactivity disorder was made prior to adolescence. "Those who watched more than two hours, and particularly those who watched more than three hours, of television per day during childhood had above-average symptoms of attention problems in adolescence," Carl Landhuis of the University of Otago in Dunedin wrote in his report, published in the journal Pediatrics. To read the entire article, visit http://www.sciam.com/article.cfm?alias=study-links-attention-pro&chanId=sa003&modsrc=reuters

Research on Neurofeedback Indicates Success with Some Children with ADHD

Training the brains of children with attention-deficit hyperactivity disorder (ADHD) using a technique called neurofeedback can improve their behavior and reduce hyperactivity and impulsivity, according to a team of Swiss and German researchers. But the strategy doesn't work for every child and shouldn't be thought of as a replacement for drug treatment, Dr. Renate Drechsler of the University of Zurich, the study's lead author, told Reuters Health."Impaired control of attention is a core problem in ADHD," Drechsler explained via e-mail. "Neurofeedback is aimed at learning how to regulate cortical activation in order to induce better attentional control, and thereby improve a main symptom directly."

To read the entire article on how neurofeedback can help children with ADHD, visit: http://uk.reuters.com/article/healthNews/idUKFLE26802220070822

Children Who Complete Intensive Early Childhood Program Show Gains in Adulthood

Greater College Attendance, Lower Crime and Depression

By the time they reached adulthood, graduates of an intensive early childhood education program for poor children showed higher educational attainment, lower rates of serious crime and incarceration, and lower rates of depressive symptoms than did non-participants in the program, reported researchers in a study funded in part by the National Institutes of Health.

The Child-Parent Centers (CPC) program in the Chicago Public School System provided intensive instruction in reading and math from pre-kindergarten through third grade, combined with frequent educational field trips. The children’s parents received job skills training, parenting skills training, educational classes and social services. They also volunteered in their children’s classrooms, assisted with field trips and attended parenting support groups. The CPC program is distinct from the federally funded Head Start program.

“These results strongly suggest that comprehensive early education programs can have benefits well into adult life,” said Duane Alexander, Director of the National Institute of Child Health and Human Development, the NIH institute that funded the study. “A comparatively small investment early in life is associated with gains in education, economic standing, mental health, and other areas.”

The research team that conducted the study was led by University of Minnesota investigators Dr. Arthur J. Reynolds, professor at the Institute of Child Development, and Dr. Judy A. Temple, professor at the Humphrey Institute and Department of Applied Economics. The researchers followed the children from ages 3 or 4 through age 24 to assess the possible benefits of the CPC program in terms of the children’s educational achievement, need for remedial education, involvement with the child welfare and foster care system, economic status, involvement with the criminal justice system, health status and mental health. The study appears in the August Archives of Pediatrics & Adolescent Medicine.

Dr. Reynolds and his coauthors followed a group of 1,539 low-income children in the Child-Parent Center (CPC) program, administered by the Chicago Public Schools in Chicago, Illinois. Roughly 1,000 children in the study were enrolled in the CPC program at ages 3 or 4 and 500 were enrolled in the comparison group, which was made up of children in alternative early childhood education programs. Children in the CPC group were matched to children in the comparison group of similar age and background. The study began following the children in 1985 and 1986. Families moved into and out of the area during the time the study took place, so not all children completed all components of the CPC program. The children in the study were 93 percent African American and 7 percent Hispanic.

Because the study did not assign children randomly to the two groups, it cannot conclusively prove that the CPC program caused the gains observed in its graduates. However, the study results strongly suggest that the program produced lasting benefits — even for children who completed only part of the program. By age 24, for example, children who participated only in the preschool program had lower rates of depression, lower rates of violent crime and incarceration, were more likely to attend 4 year colleges and were more likely to have health insurance than children who did not participate in the preschool program. However, graduates of both the preschool and school age components of the CPC program were more likely to attend college and to be employed full time, and less likely to receive public assistance or to have a disability than those who participated in other programs. Children who participated in only the school age component of the CPC program also showed benefits in adult life. By age 24, these children had lower rates of disability and were less likely to receive public assistance.

“Children who were enrolled in the CPC program were generally more socially engaged and educationally adept,” said Dr. Reynolds. “These benefits appear to be derived from early gains made in the CPC program on school readiness, achievement, and parental involvement in the children’s schooling.”

Established in 1967, the CPC program is currently federally funded through Title I of the No Child Left Behind Act and is still operating in Chicago. The program is implemented by certified teachers, has a low child-to-teacher ratio, and provides intensive parent involvement. Its curriculum includes structured field trips and class activities that emphasize oral and written communication, said Dr. Reynolds. The program also fosters early literacy through conventional classroom activities, in addition to story book reading and language games that help children recognize letters and understand the sounds for which they stand.

In addition to parenting classes, the CPC program offers high school equivalency classes, career development skills workshops, and other professional training.
“The program is an outreach to the parents as well,” said Dr. Reynolds. “In order to lift families out of poverty, attention is directed to the whole family.”

He noted that past research has shown that completing more schooling is linked with earning a higher income, a decreased involvement in criminal activity and even a decrease in rates of depression.

“Children who participated in this program had a greater recognition that more schooling is the way out of poverty,” he said. “The study is the first to show that large-scale established programs run by schools can have enduring effects into adulthood across a range of outcomes.”

Improvement Following ADHD Treatment Sustained in Most Children

But Linked Problems Persist Into Adolescence — Major Follow-up Study

Most children treated in a variety of ways for attention deficit hyperactivity disorder (ADHD) showed sustained improvement after three years in a major follow-up study funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH). Yet increased risk for behavioral problems, including delinquency and substance use, remained higher than normal.

The study followed-up children who had participated in the Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (MTA).

Initial advantages of medication management alone or in combination with behavioral treatment over purely behavioral or routine community care waned in the years after 14 months of controlled treatment ended. However, Peter Jensen, M.D., Columbia University, and colleagues emphasized that “it would be incorrect to conclude from these results that treatment makes no difference or is not worth pursuing.”

Their report is among four on the outcome of the MTA study published in the August, 2007 Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).
“We were struck by the remarkable

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Age-Related Decline of ADHD Symptoms Disrupted by Middle School