This webcast discusses current concepts in the assessment, treatment andresearch of autism, and features BJ Casey, PhD, who is the Director of theSackler Institute and Neuroscience Graduate Program at NewYork-PresbyterianHospital/Weill Cornell Medical Center, and the Sackler Professor ofDevelopmental Psychobiology at Weill Cornell Medical College; and BradleyS. Peterson, MD, the Chief of Child Psychiatry Services atNewYork-Presbyterian/Columbia University Medical Center, who is also theDirector of Child and Adolescent Psychiatry, Director of MRI Research, andthe Susanne Crosby Murphy Professor of Pediatric Neuropsychiatry atColumbia University College of Physicians & Surgeons and the New York StatePsychiatric Institute.

One very important realization is that the optimal assessment and treatmentof a child with autism requires a multidisciplinary approach. In manyplaces it is at present a sole clinician who spends time with the child andoffers a diagnosis. But, as Dr. Peterson pointed out, "you need people frommultiple disciplines, including either a child psychiatrist, a pediatricneurologist, or a developmental pediatrician, to do a very thorough andstandardized assessment of the child's social interactions, repetitivebehaviors, and unusual interests, for instance. You also need a verycareful developmental history of the child, and need a psychologist whowill assess cognitive functioning. A thorough review of medical andneurological issues needs to be conducted, as well as an assessment ofproblem behaviors. Frequently, speech and language evaluations need to beperformed, as do social work assessments, in order to get these childrenthe intensive services they need." A multidisciplinary assessment service,called the Developmental Neuropsychiatry Service, is located at ColumbiaUniversity Medical Center.

"Many people suggest that the earlier you intervene the better," Dr. Caseynoted. "Unfortunately, it is difficult to reliably diagnose autism in thefirst or even second year of life, and I am very concerned with the messagethis sends to parents who as a result may feel that they didn't intervenesoon enough." Families, Dr. Casey added, have had an enormous impact onlobbying for the government to fund more research in autism. "Unless weunderstand how the typical child's brain develops and how that developmentgoes awry in these neurodevelopmental disorders, we will be hard-pressed tofind the underlying etiology and the interventions needed to help thispopulation."

Dr. Casey's work at Weill Cornell Medical College attempts to identifytypes of interventions that are helpful to improve core aspects of thedisorder. As an example, a computer program is being developed that mayhelp children with autism address their reluctance to engage in eyecontact, which is so important for reading other people's emotions. Thecomputer screen shows a face with targets that appear in the eyes, but alsoat other places on the screen, such as in the mouth or off the faceentirely. "If there is a way to get individuals to look at eyes morethrough these activities, then that is a type of early intervention. Thecombination of these eye-tracking paradigms that can be done in the firstfew months of life -- and downloaded to home computers, or be web-based --and genetic testing may lead to a change in the way we treat thisdisorder." Dr. Casey also discussed research using knockout and knock-inmouse models. Genes that are fundamental to learning are identified andtheir impact on learning is assessed. Colleagues Barbara Hempstead andFrancis Lee are developing mouse models for neurotrophin, important in thedevelopment of the brain and for communication among the brain's regions.

Dr. Peterson stressed that treatment, like assessment, also demands amultidisciplinary team approach. For example, a pediatric neurologist maybe needed to address the seizure disorders that develop in as many as 40percent of children with autism. Problem behaviors like aggression towardsothers or themselves require consultation with behavioral and childpsychologists. Gastroenterologists need to be available since many of thesechildren suffer from gastrointestinal discomfort. "Nonverbal children havea great deal of difficulty communicating their physical discomforts, sohaving a good medical team to look for such things as ear and respiratoryinfections is very important," Dr. Peterson said. Occupational and physicaltherapists are needed to address gross motor coordination and hypotonicmusculature. Child psychiatrists must work to reduce the frequentobsessive-compulsive symptoms seen in this population, which can be verydistressing to both the patient and those in his or her environment.

It is now known that there are multiple genetic causes for autism and thattherefore there are multiple autisms. Dr. Peterson noted that large-scalegenetic studies are underway looking at how these genetic and possibleenvironmental causes of autism exert their effects on the brain. To thatend, Dr. Peterson heads state-of-the-art brain imaging studies, in whichregions of the autistic brain are mapped and compared to normallydeveloping children. "What are the functional consequences, and whatprecisely are the abnormalities in how the brain is wired up? We can nowimage that, and we can even look at chemical concentrations of keyneurotransmitters in children with autism to understand how those may playa role."

Dr. Peterson, in discussing the future of autism research, said, "My mostardent wish is that we gain a better understanding of the various causes ofautism and of the neurobiological mechanisms by which those causes exerttheir effects on brain structure, function and behavior, because only whenwe understand those pathways will we really identify targeted treatmentsthat make rational sense."

The future of autism research is underway right now at NewYork-PresbyterianHospital and its academic medicine partners Columbia and Cornell. Thoseinterested in learning the latest developments in the assessment andtreatment of autism, as well as ground-breaking research in this disorder,should view this webcast featuring two of the innovators in the field.

Learn more about the latest in autism by visiting: OR-Live

VNR: Autism

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