The Interdisciplinary Council on Developmental and Learning Disorders

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NEWSLETTER - Vol. I, No. II 3213 Midfield Road, Baltimore, Maryland 21208  Phone & Fax: (410) 486-1251  E-Mail: JO@ICDL.COM Stanley I. Greenspan, MD, Chair Serena Wieder, Ph. D., Associate Chair Jo Raphael, MSW, LCSW-C, Administrative Editor *** Leon Cytryn, MD, Biomedical Editor Deborah Flaschen, Parent Steering Committee Editor Barbara Kalmanson, Ph. D., Education Editor Lori Jeanne Peloquin, Ph. D. Regional Networks Editor *** SPECIAL FEATURE: Stanley I. Greenspan, MD: Clinical Insights The Newsletter of the Interdisciplinary Council on Developmental and Learning Disorders is written to provide regional updates and networking opportunities to professionals and parents working with young children with communication and relating challenges. We hope to provide information and support and welcome any feedback or contributions that you may have. Please address your comments to Jo Raphael, MSW, LCSW-C, Administrative Editor at: 3213 Midfield Road Baltimore, MD 21208, E-mail at JO@ICDL.COM, phone or fax at (410) 486-1251. Thank you. REGIONAL NETWORKS, Lori Jeanne Peloquin, Ph. D. Northern California What started out as a regional network for Northern California has turned into many smaller networks based on geography and interest areas. The first meetings attracted an unwieldy crowd (as reported by Barbara Kalmanson, Ph.D., Northern California Regional Facilitator in the Journal of Developmental and Learning Disorders Vol. 3). New groups continue to spring up all the time. A San Francisco, Marin County and East Bay multidisciplinary network of professionals has settled on a study group format, meeting every other month, alternating with an evening and weekend daytime meeting. To keep the group alive long-term, they decided that it would be best not to meet too often and to vary the time so as not to make too many demands on anyone’s schedule. Thus far, the original group is intact. They set out an agenda of topics for the year and various members of the group volunteered to prepare and lead the group discussions. Some of the discussions have looked at issues in diagnosis, principles of DIR® in practice, playgroups, using DIR® in school-based settings, and working with families. They have been considering organizing a local conference to cover some of these topics. In northern California there is much interest in how to incorporate DIR® in school settings and many school districts are requesting consultation and training. They are considering a membership fee to cover expenses for mailings and an administrative assistant’s time. Marin County has a wonderful parent organization called MATRIX which sponsors groups for parents of children with Autistic Spectrum Disorder or Multi-System Developmental Disorder. They maintain a resource library for parents and really appreciated the ICDL parents’ resource guide. Parents advocate for other parents and accompany them to IEP meetings. MATRIX sponsors speakers, educates families about available services and provides support to families just learning about their child’s special needs. This organization is entirely run by parents and applauded and supported by professionals in the area. The Sacramento area also has a working network including parents’ group that provides support and advocacy as well as a forum for discussing home and school based interventions. A multidisciplinary professional network also meets to support their development as DIR® therapists. This group is organized by Mary Beth Steinfeld, M.D. and Nicole Wiggins, M.S., C.C.C. Napa, Sonoma and Solano Counties have an active networking group called North Bay FEAT. They organize a newsletter, regularly sponsor speakers, advocate for families seeking services and run fundraisers to provide services and sustain the organization. Although they are primarily a parent organization, professionals in the community are encouraged to participate. Monterey and San Benito Counties have a parent/professional network that has been meeting monthly. They have few DIR® services in their area and support each other in learning more about how to create comprehensive interventions and practice floor time at home. This group is organized by Regina Marshall, Ph.D. and Donna Jackson, OTR. San Mateo County has an active network of educators who are trying to bring DIR® into the special early childhood programs. Tish Teaford, Ph.D., a school psychologist is organizing this effort. A parent network is also starting and planning to bring in consultants to assist them in their work with their children at home. Most striking in all the networks are the efforts of individuals to support others in their learning and of course the central importance of relationships in sustaining the group efforts. Barbara Kalmanson, Ph.D. Licensed Psychologist and Special Educator San Francisco and Kentfield, CA Phone: (415) 752-4705   EDUCATION, Barbara Kalmanson, Ph.D. CELEBRATE THE CHILDREN THE MODEL The Mt. Arlington "Celebrate the Children" program provides services for children with special needs using a developmental, individual, relationship-based approach (D.I.R.). This approach was developed by Dr. Stanley Greenspan and Dr. Serena Wieder and was originally used in one-to-one therapy sessions with children and their parents. The Celebrate the Children program has implemented these same strategies in a classroom environment with outstanding results. The main areas of focus in the program are language, socialization, play skills, abstract thought, critical thinking/problem solving, independence, sensory integration and regulation, motor planning and sequencing, and academics. The program was started in September of 1998 by Monica G. Osgood and Julie Frank, M.A.. It is located in the Decker School, a public school in Mt. Arlington, New Jersey, serving grades K-3. Being a new program, the staff had the luxury of creating their own curriculum with goals and objectives that reflect a developmental model. STRUCTURE AND ORGANIZATION The program includes a preschool disabilities classroom, a social skills/sensory room and mainstream support for children in grades K-3 and off-site preschools. Typical children are brought into the preschool classroom for peer modeling. The program operates 187 days a year. Full-time preschoolers attend 9-2. Part-time preschoolers attend 12-3. Mainstream students attend at various times. A six week summer camp is offered 9-2 and open to out-of-district students. The camp integrates typical and special needs children full time and focuses mainly on social skills. A behavioral consultant works in all areas of the program overseeing the behavioral, social and developmental aspects. A certified special education teacher works closely with the consultant on all levels in addition to running the preschool classroom. Staff trained by both the consultant and classroom teacher work as aides in the classroom and shadows in the mainstream as needed. Teachers in the mainstream classrooms are also trained and have close communication with all program staff. Speech and occupational therapists work in the classroom and pull students out for individual sessions only when necessary. A Psychologist, Learning Disabilities Consultant, Social Worker, Registered Nurse, and Technologies Specialists comprise a full Child Study Team. Visitors and volunteers often come into the program to learn about the approaches being used. Consultations and trainings with other programs and districts provide these approaches to a wider range of students. CLASS MAKE UP The preschool classroom is comprised of four full time and five part-time students who attend staggered sessions. There are an additional seven children in mainstream classrooms, on and off-site, who receive special services as needed. Ten students are from the Mt. Arlington school district and six are tuition students from other districts. The disabilities of the students include autism, PDD-NOS, MSDD, regulatory disorder, ODD, ADHD, expressive language delay, and mild physical disabilities. RATIO There is one full-time teacher and seven part-time staff members in the preschool classroom to nine students. Schedules are flexible which allows for a one-to-one ratio during specific activities. Volunteers increase the ratio on various days. Three of the mainstream students have aides, one part time and two full time. The mainstream classrooms have one teacher and one aide to approximately 18-25 students. The off-site mainstream preschools have smaller class sizes with higher ratios. INTEGRATION OF SERVICES Speech and occupational therapists work part time as staff in the preschool classroom. Some of the children in the program get pull-out speech, OT, and PT. All of the children in the program attend social skills groups and receive individualized social skills training as needed. Students in the mainstream receive academic support from the resource room teacher and behavioral and social support from the behavioral consultant. CURRICULUM The program curriculum was created by the behavioral consultant and classroom teacher based on a variety of approaches. However, the predominant component of the curriculum is the D.I.R. model (Greenspan/Wieder). Goals and objectives were put into the student’s IEP’s to reflect this model. Other models used in developing the curriculum and goals and objectives include: Cognitive behavioral therapy, specific social skills training, Visualizing and Verbalizing (Bell), Piaget’s theory of development (Thinking Goes to School- Wachs and Furth), Theory-of-mind training(Teaching Children with Autism to Mind Read-Howil, Baron-Cohen & Hadwin), and others. All sections of the curriculum, including academics, reflect the above models. Evaluation and Assessment When a child enters the program an extensive video tape and anecdotal assessment is administered. The assessment targets all areas of development and reflects our hierarchy of goals and objectives. A Functional Emotional Assessment Scale(FEAS) and Brigance Diagnostic Inventory of Early Development are also applied. The above assessments are repeated in January and June. Daily anecdotal comments, rating of specific goals, observation and videotaping monitor the ongoing progress of each child. From this information goals are assessed and adjusted accordingly. Each child has their own video tape diary from the day they enter the classroom until they leave the program. ACTIVITIES Although the day is broken up into specific activities, independence, abstract thinking, socialization and sustained interactions, language and motor planning are targeted at all times. Staff is trained in the D.I.R. approach and all interactions between staff and students reflect the principles of the approach. During circle time and group activities the group leader uses motivating activities to build on circles of communication, elicit abstract thinking, problem solving, initiations, and peer interactions and awareness. Activities such as individual Floor Time, play skills and free time are opportunities to build on the students, symbolic world, sequencing, problem solving, language and relatedness. One to three students work together with one to three staff members, depending on the student’s functioning levels and the skills being targeted, during these activities. Specific social skills and emotions training are targeted in small groups through highly motivating, experience-based activities. The staff works hard at creatively illustrating concepts in ways that are meaningful to the students. Students are taught through experience and encouraged to be aware of their peer’s experiences and how they differ from their own. Group activities such as OT group, Thinking Goes to School, and self expression are times to work on motor planning and sequencing, self awareness and showing off to peers. Critical thinking activities, creative drawing, and Visualizing and Verbalizing lend to improving the student’s creativity and abstract thinking skills. Independence is the only goal during independent seatwork teaching the students to be proud of independent task completion. Academics are targeted using a multi-element approach which includes experience-based activities. Time devoted to activities in the preschool classroom: Circle and social skills/emotions training (theory-of-mind, visualize and verbalize, etc.)…45 minutes/day, Floor Time (Greenspan/Wieder)…1.5-2 hours/day, Obstacle courses/motor planning…at least once a day, Creative drawing...15-20 minutes twice a week, Specific plays skills and games…45 minutes/week, Critical thinking…40 minutes/week, Thinking Goes to School…10 minutes/day, Self expression…10 minutes/day, OT group…20 minutes/week, Speech group…20 minutes/week, Gym and music…40 minutes/week, Academics…40 minutes/week, Independent seat work…15 minutes/day, Free play…varies. Mainstream students receive some of the above interventions as pull-out on a regularly scheduled basis. All mainstream support is individually structured to meet each child’s needs and to work on the tools needed to be successful in the mainstream. Many of the mainstream children receive extensive emotions/Theory-of Mind, social skills, abstract thinking and problem solving training. WORK WITH FAMILIES Parents of children in the program are encouraged to visit the classroom on a regular basis. Staff work with parents on child development and parent-child relations. Constant communication with parents through log books, phone calls, and conferences insures consistency between school and home. Siblings also visit the program and often attend the summer camp full time. Celebrate the Children provides weekly home programming to many families in North New Jersey. This individual therapy involves parents and siblings and reflects the above model. Parent training and support group lectures are contracted on an as-needed basis. FUNDING AND COSTS The Mt. Arlington program is state funded. In district students receives services paid for by the district. Out-of-district students pay a full-time tuition of $19,880 per year. Related services are additional. Costs for summer camp, home programming and consulting vary. CONCLUSION The staff at Celebrate the Children are eager to interact with other programs and individuals who use, or are interested in using, the D.I.R. approach in group situations. The success of the program has reinforced the need for more programs using this approach in our school systems. Celebrate the Children has also started several research projects within the program and is interested in collaborating with others on standardizing data collection protocols for D.I.R. interventions. For more information on Celebrate the Children please contact Monica Osgood at 973-948-7952 or monicao@interactive.net. THE PHILOSOPHY The child with autism spectrum disorders experiences the world differently than most people. They see, hear, feel and process information in unique ways. First, and foremost, this needs to be respected. Although we cannot empathize with this, we must try to understand the best we can through our observations and from what people with autism are able to tell us. We must share equally in their world while expecting them to conform to ours. Finally, while teaching the skills to survive in our world, interacting with these children in a natural, social manner facilitates natural, social skills from them. When working with these children it is imperative to make a personal connection with the individual before placing expectations on them. This can be done by showing the child that one is interested in their world. Taking part in activities that are reinforcing to the child is a good way to start. By letting them know that you respect them and can see the joy they find in their activities you will promote an environment where they can feel comfortable interacting. Forcing a child to interact before this relationship is built often leads to more withdrawn behavior. The goal with this type of approach is to elicit initiation on the part of the child. No-pressure, child-lead activities should dominate interactions until the child is consistently showing intent to initiate or continue activities. Once the child is seeking out interactions, target behaviors may be slowly introduced. This is most effective when using activities and materials that are reinforcing to the child. For example, if the child likes to be tickled, use this opportunity to begin requiring her to request "more" between tickles. If a child likes to spin the wheels of cars take a turn modeling driving the car on his tummy and then encourage him to reciprocate. Keeping the activities light and child-DIR®ected while respecting the unique characteristics of each individual allows the child to learn skills in ways that are meaningful to them. In addition, participating in these activities in a play setting rather than a discrete trial format will result in more natural, spontaneous generalization of skills taught. Although demands on the child may slowly be increased, respect for their world should never be put second to those demands. Continual enthusiasm for their interests builds a trusting relationship that allows for maximum learning. Many children with autism and related disorders are plagued with anxiety. This is due to their ultra sensitive neurological make-up which causes many environments to be overstimulating. For these children it is easier to tune out painfully stimulating situations, such as social interactions, than to have to deal with them. This results in self absorption and minimal, if any, observational learning. Instead, many of these children will engage in self stimulatory activities as a way of coping with their anxiety. In the most severe cases we are left with a child who appears to be very odd and completely separated from the world around him. By taking this anxiety into consideration, reducing the stress for the child also attributes to more accessibility to learn and better socialization. Celebrate the Children always respects the degree to which a child is able to cope with their environment. Through intervention anxiety is targeted and reduced before demands are placed on the child. When working with children who have autism it is important to remember that they are children first and have autism second. Therefore, it is imperative to understand the development of "typical" children. Not only for teaching skills that are characteristic of typical children, but also to recognize when your child's behavior is that of a typical child. Expecting children with autism to behave in an over-compliant manner is a common mistake in the field. Allowing these individuals to be silly children and taking joy in this with them creates a strong bond and trust that will encourage the child to feel more comfortable interacting in a natural manner. By treating these children as you would a typical child you model natural social behavior while teaching important skills. In summary, our philosophy is to celebrate the children for who they are. We don't try to change them into a different person. We let them know we respect and love who they are, but want to give them the tools to cope and survive in our society. There must be mutual respect. Relationships between all people, including our children, should be give and take from both sides. We let these children know we respect what is important to them, enjoy some of their world with them. When we do this we are delighted at what they give in return, how quickly they learn, how happy they (and we) are.... Monica G. Osgood 1997,1999   PARENT NETWORK, Deborah Flaschen The Parent Steering Committee of the ICDL Parent Network have been busy! We had a wonderful response to our panel presentation at the ICDL conference. The panel was entitled " Going In Circles: A View From The Floor", a parents’ perspective on raising a child with communication and developmental difficulties. Amy Jackson did a wonderful job as our moderator and helped the various participants describe their individual situations and description of their children. We talked about a full range of issues dealing with the realities of having a special child with special needs. Cindy Harrison talked about "Now, What Do I Do?". She very eloquently talked about the journey she is taking with her son and how that initial diagnosis felt. She discussed the pitfalls of labeling, gathering information and organizing a plan for your child in a community without ready resources and the importance of the parent as quarterback. Jill Kail described the actuality of living life "on the floor" over a period of many years and how that became a way of life for her and her family. She also addressed the needs of children as they matured through floor time. Deborah Flaschen talked about "What Hat Am I Wearing Today?" where she described what it is like to act as a therapist, doctor, case manager, teacher and parent. She addressed how to choose among the many options that compete for your time, your energy and your wallet. She also talked about factors that might lead you to explore nutritional or biomedical options. She then donned a hat with RPM on it-for Really Pushy Mom. Bob Naseef then talked about what happens when the "Big Breakthrough Never Comes". He is a father of a twenty year old autisitic young man and a psychologist. He very eloquently talked about facing autism, how and why a family may try different methods and philosophies of intervention including ABA. He talked about facing what one cannot fix; the challenge of the male psyche and, importantly, learning to enjoy one’s child – healing broken dreams. Mark Rosenbloom, a father and Director of the Unicorn Children’s Foundation, talked about the journey with his son who is apraxic and read us a very compelling letter written by his son to his new classmates. He talked about the importance of accepting children for who they are and embracing their differences and strengths. Jane Downey, a mother of six, (yes, six) talked about "Going on with Life As a Family" and describes the fierce mother tiger, facing the challenges as a couple and reactions of and reacting to siblings. Vicki Thompson talked about the importance of the parent "Taking Care Of Yourself". She reinforced that to be an effective advocate for your child you must first "heal yourself". She also talked about living in the present and how that impacts the family system and yourself personally. This was a very moving panel with about five hundred people in attendance. We hope to do another panel next year and to continue to share our experience and journeys with others. We hope to place a transcript of the panel on this website in the near future. The Parent Steering Committee also published "A Resource Guide-For Parents By Parents". This is a revised guide that is much more user friendly with a great deal of useful information. One exceptional additional is called "A Parent’s Roadmap" which was authored by Sue Resnick, with the help of several committee members, which helps navigate the road once a diagnosis is made. We plan to update it on an annual basis. You can view it on the website and purchase a hard copy in the publications window of this website. Another exciting project being done by one of our members is a new public awareness campaign called "First Signs" that will help inform and educate the community about children with communication and relating disorders. The Parent Steering Committee has also begun to form work groups to address issues such as parent to parent support, advocacy, education…Keep posted for more information in later editions of this newsletter.   BIOMEDICAL, Leon Cytryn, MD Highlights of the  2nd annual conference of the American Society for Gene Therapy June 9-13, 1999 Washington D.C. We have reported in the previous edition of this Newsletter about the importance of the so-called knockout mice for genetic research. Some of the readers questioned the relevance of animal research to human genetics. However, there are several compelling reasons for its crucial importance to the study of human genetic disorders. 1) Mice are mammals. 2) Mice share at least 75% of their genes with humans. 3) Knockout mice provide an opportunity to remove or to add an entire gene and thus directly test its function. I doubt if anybody would suggest replicating the feat with humans. It’s therefore no accident that knockout mice research figures so prominently in recent scientific literature. And so we begin this report with a study done on knockout mice with rich implications for future use in humans. Andrew Brooks and Howard Federroff (Rochester University School of Medicine) attempted to improve learning and memory in mice. Crucial to these functions is the nerve growth factor (NGF) in the hippocampus. The researchers tested the spatial memory of NGF deficient mice before and after gene therapy to increase the expression of this protein in the hippocampus. KO-mice that carried only one gene for NGF were released into a spatial performance chamber that consists of four compartments, one of which had a saccharin reward. To reach the reward, the mouse had to find its way through four partitions, each consisting of three doors. Only one of the doors in each partition was unlocked and the mouse had to remember which one in order to successfully complete the journey. Compared with their normal littermates, the KO-mice were vastly impaired on the task. The research team then injected doses of NGF directly into the hippocampus, using the herpes simplex virus as a carrying vehicle (vector). The control mice received herpes simplex virus injections carrying a placebo. After a few days recovery both group were tested in the aforementioned testing chamber. The results were striking. After NGF treatment the knockouts took on average 75 seconds to complete the task compared with 200 seconds before the injection. The effect however was short-lived and after 17 days their performance returned to pretreatment levels. Federroff told the audience that their research team is already working on ways to extend the expression of the gene without having to re-administer it. (Editor’s note: This pioneering study demonstrates that a gene tagged to a proper vector can be directly injected into a tissue and function properly. Of course, further efforts are needed to ensure longer, perhaps even lifelong genetic expression, resulting in sustained improved learning. However, a recent experience at The Pennsylvania Institute for Human Gene Therapy where an 18 year man with an inherited enzyme deficiency died 4 days after being injected with a genetically altered virus, may indicate that safe human gene therapy is still a while away). Sanjiv Sam Gambhir (UCLA) reported about ways of tracking the genes after they were delivered to living organisms without killing the recipient. Researchers would like to be able to follow where their vectors go, how long their genes are expressed, and how much protein is made inside of a living animal or human. Gambhir and associates have harnessed the PET (positron emission tomography) to monitor the expression of a gene in live mice. They injected a gene for dopamine receptor coupled with an adenovirus into the tail veins of mice. Two days later, the mice were injected with a radioactive compound that that binds to the dopamine receptor. The results were clear (and bright): The livers of the mice infected with the dopamine receptor lit up when examined using a special miniaturized PET apparatus constructed by the UCLA team. (Most therapeutic genes delivered by adenovirus vectors concentrate in the liver). Because the animals clear the radioactive compound from their bodies after a few hours, Gambhir and his associates simply reinject this compound prior to subsequent rounds of PET scanning (without having to reinject the gene). They also demonstrated that the PET images could be used to quantitate accurately the amount of protein produced. The UCLA team is looking forward to use such systems to monitor the efficacy of gene therapy in human patients, allowing investigators whether molecular biologists or physicians- to see exactly when and where their proteins are being produced. (Editors note: a related article in a recent edition of SCIENCE indicates that the interest in small animal imaging is growing by bounds and leaps. The main reason for this phenomenon is a tremendous advance in the techniques of human imaging which is beginning to illuminate molecular events within a cell, when genes are turned on or when a cancer cell turns malignant. Since these phenomena–like drugs-can be tested more easily in animals than in humans, the imaging research and industry are rushing to develop scanners able to be used for animals of all sizes. In the past researchers had to sacrifice an animal to check its gene expression, which only yielded a snapshot of the process. However, imaging gene expression in live animals will allow tracking the process over time and being able to correlate it with animal’s behavior and health. In addition, these new techniques should also advance drug development. Service R.F. (1999), Scanners get a fix on lab animals. Science, 286-5448: pages 2261-2263. Even in the aging brain some cells never grow up. Over the last few years Fred H. Gage (Salk Institute, La Jolla, CA.) and other researchers have demonstrated that in rats, mice, monkeys and men, neurons continue to be born even in mature organisms. The parent (stem) cells that produce these neurons reside in two brain regions in particular—the hippocampus, which controls learning and memory, and the sub ventricular zone, which in the embryo supplies neurons to the developing cortex. These stem cells divide and their offspring migrate to other brain regions, where they form neurons with established connections or become the supportive glial cells. Gage reported that these parent cells harnessed from either the hippocampus or the sub ventricular zone can respond to local growth-factor cues when transplanted to just about everywhere in the brain, generating healthy new neurons—even to the spinal cord, which is normally thought to be an area fairly resistant to self-repair. According to Gage you can put such parent cells in the eye, and they may even turn into something resembling a photoreceptor. His group has shown that by providing these progenitor cells with particular neurotrophic factors, they can begin to direct how the cells perform. Finally, Gage reported that mice raised in a stimulating environment had more new neurons in the hippocampus. Moreover, just letting them exercise produces the same effect. When mice jog four to six miles a day on their running wheels-an activity they engage in quite happily-the animals show a 60% increase in the number of neurons. Just to be on the safe side, Gage foresees a combination of exercise and gene therapy to allow the therapeutic neurons to proliferate and survive. (Editor’s note: this news should make the joggers and marathoners happy. However, just to be on the safe side, they should periodically interrupt the exercise and hit a book.) Highlights of the Conference of the American Society of Experimental Biology (FASEB) Washington DC April 17-21 1999. We all have memories that are indelibly etched in our minds, but it is still a mystery how are those memories are encoded within the billions of neurons we call a brain. Bill Greenough (University of Illinois at Urbana-Champaign) reported at the meeting that neurons in the brain form a vastly complex web of connections. Even a single brain cell can send out more than 10,000 thin extensions called dendrites that receive signals from other neurons. To learn and form memories, neurons must sense which of their neighbors have signaled them, and somehow alter the receiving dendrite so that it remembers being contacted. Until recently, most neuroscientists believed that neuronal memories were formed when an incoming signal jumped the synapse, triggering the receiving dendrite to transform a particular protein (by attaching a phosphate). Then, that transformed protein was shipped to the cell nucleus on a sort of an intracellular bus. Once in the nucleus it helped to turn on specific genes that shaped the future of the cell. Although this theory explained how neurons could learn from their neighbors, it seems that the cell was wasting a lot of energy. Since the dendrites are distant from the nucleus, the "intracellular shuttle" would have to make stops at all dendrites, to pick up their proteins. Greenough presented evidence that dendrites are "self-sufficient and have all the tools they need to make new proteins and all that is needed to change the synapse". The research team then focused on a protein called the Fragile X mental retardation protein (FMRP). When defective, this protein causes mental retardation. Greenogh and associates raised rats in a complex, stimulating environment and found that the animals have a dramatic increase in FMRP. On the other hand knockout mice, who lacked the gene to produce FMRP, had abnormal dendrites, which could not make the protein necessary for intercellular communication. (Editor’s note: These are all tantalizing clues to understanding memory formation and learning. It is to be hoped that they may in time help to understand the nature of memory and the exact role played by FMRP in the learning process). Catherine Spong and Douglas Brenneman (N.I.H.) and Ilana Gozes (Tel Aviv University) have reported on their discovery of a class of neuropeptides that prevent damage caused by alcohol in the developing fetal brain. Their findings could have implications for the treatment of a variety of neurodegenerative diseases. Fetal Alcohol Syndrome (FAS) affects 12,000 babies in the US every year. Stunted growth, reduced brain weight and mental deficiency characterize it. After genetic causes, maternal alcohol consumption is the most common cause of mental retardation, and often leads to miscarriage. FAS is associated with oxidative stress and an increase in the production of free radicals. The protein used in this research, vasoactive intestinal peptide (VIP) is found in the brain and is known to regulate early embryonic growth in mice. The action of its receptor is mediated by two neurotrophic factors. The team has extracted from them their active components known as SAL and NAP respectively. The researchers treated pregnant mice with NAP, SAL or both, 30 minutes before injecting them with alcohol. They chose the eighth day of embryogenesis when the embryo is most vulnerable to oxidative stress. They then waited ten days and measured the number of miscarriages, and the weight of the surviving fetuses. The treatment effect was quite dramatic. In mice treated with alcohol alone, 36% of the fetuses had miscarried compared to 4% for the untreated controls. Contrastly, in mice pre-treated with NAP or both NAP and SAL, the death rate dropped back to control level. Alcohol alone caused a reduction of brain and body weight in the surviving fetuses, but again, the NAP-SAL combination brought them back to control levels. The findings could have serious implications for the prevention of FAS and potentially, other conditions caused by oxidative stress. The fact that NAP is found in the human cortex, cerebellum and hippocampus-areas known to be important to learning and memory, means that it could also play a role in prevention of neurodegenerative diseases such as Alzheimer’s. For Brenneman, the most exciting of all is that these peptides are working at minute concentrations. "NAP is a thousand times more potent than any known nerve growth factor". (Editors note: It is to be hoped that these findings may provide a model for the role of different proteins in protecting against oxidative stress in various conditions spanning the entire lifespan, from conception to old age.) The next report dealt with cerebellar ataxia in mice caused by a spontaneous mutation that destroyed part of cerebellum-the brain region responsible for coordinating movement. In this condition and in some humans with Holmes disease, (a particular form of this disorder), the Purkinje cells that comprise the bulk of the cerebellar cortex are totally wiped out. Lazaros Triarhou and associates.( Indiana University School of Medicine), wondered whether introducing healthy neurons, taken from a healthy fetal cerebellum, would be able to establish residence and restore some of the lost motor function. They implanted the fetal cells on both sides of the brain into a region deep within the cerebellum where Purkinje cells would normally send their axonal projections to communicate with other neurons about balance, posture, and position. The procedure caused the animals’ motor abilities to improve. For example, diseased mice prior to treatment would fall off a rotating rod within a second or two. After implantation they were able to keep their balance for an average of 12 seconds-between five to six times as long. Although this was a significant improvement, it falls short of the performance of normal animals. When Triarhou dissected the brains of these animals, he found that not only did many of the transplanted neurons survive, but they also had migrated from the center of the cerebellum out to the cortex , the area that the Purkinje cells normally inhabit. In addition, these cells displayed receptors, which bind to glutamate, the excitatory neurotransmitter released by the neurons, which communicate with Purkinje cells. "So now we have the evidence-both cellular and behavioral-that the neurons in the cerebellar grafts function", stated Triarhou. He admitted that the recovery of motor function was nowhere near 100% in those treated animals. Perhaps that’s because the researchers only transplanted between 1,000 and 6,500 fetal cells, whereas the normal cerebellum contains more than 200,000. Finally, he wisely said: "we have to use great caution when we talk about jumping from mouse to human". (Editors note: For now, the results indicate that transplanted cells can survive and recolonize the disease-decimated cerebellum, and they suggest that the brain is a very flexible organ. The above study and all the other studies reported in this issue do not herald an immediate breakthrough in using such techniques in the clinic. Nevertheless, they represent very important steps in eventual application in human disorders).   CLINICAL INSIGHTS Stanley I. Greenspan, MD BRIDGING IDEAS and CLOSING CIRCLES One of the most important goals, once children are verbal, is to be able to help the children close every verbal or ideational circle. That is, when we follow their lead and build on what they’re talking about, either in pretend play, talking about school, or negotiating what’s for dinner. We say something and it’s often very hard, because of receptive processing problems (auditory processing) for the children to close the circle—to respond to what we say. Sometimes they might not fully understand what we’ve said because while they’ve got a good memory, they can’t quite piece together the components of our question, in terms of understanding in an abstract way, what we’re asking. At those times, the children might simply free-associate off to the side. We might say, "Why do you like eating apples better than broccoli?" and they might say, "Apples are green," which is a free association to apples, but doesn’t really compare apples and broccoli. Alternatively, they might have a good memory about apples and even remember the question, but they aren’t really abstracting that the question has a few elements: apples, broccoli, and comparing the two. Logic, or connecting the ideas together, is not just something they have a hard time expressing; they also have a hard time understanding the questions receptively. For that reason, it’s important to slow down and not answer the question for the child. Instead, help the child figure out the problem, perhaps by bringing out an apple and some broccoli or drawing a picture of them so that the child can see them and juxtapose them. Or, the parent can just repeat the question, "What makes one better than the other?" If the child says, "Apples are green," the parent or therapist can continue with, "How does that compare to broccoli? Isn’t broccoli green too?" "Oh yes, but I like apples!" "What is it about apples you like?" "I like the way they taste." "Well, how about broccoli?" "I don’t like the way it tastes." "Oh, well then, apples taste good and broccoli doesn’t." Now the child has used that discussion to actually abstract the true nature of the question, enabling him to build better bridges to figure out an answer. What we’ve done here is to help the child-not by thinking for him, giving him an answer or completing a sentence with the answer for him (saying, "You think apples are better than broccoli because…" or "You think it’s because they taste good?" and the child just has to say "yes."). We avoid spoon-feeding the child and closing the circle at the expense of the child’s actually doing some thinking. We get involved with the child in a more Socratic way, not falling into the trap of spoon-feeding or over-protecting the child by doing the thinking for him either with a sentence-completion prompt or a "modeling the answer" type of prompt or with a "yes" or "no" kind of answer. In other words, we don’t want to lead the witness. Some of the tactics we use and justify as modeling are only appropriate when children are learning to speak, form their words, and to use words. Prompting and modeling cannot teach a child to think because the act of copying what is seen or modeling something after what he sees teaches him to use his rote memory skills. It is OK to model and prompt at one level, when a child is just learning to form phrases and use words, but it is not a useful strategy, and can wind up in a person doing too much for a child, when he’s working on thinking. Parents and other caregivers need to do a lot in terms of getting in there and helping a child reason things out, but not over-script, over-prompt, and go into yes/no questions, etc. The other common area in helping children close their symbolic circles and in helping them learn to think, to form bridges between their ideas in such situations build on what the child is aying and build on thinking type interactions. Some of the things that get in the way of this are simply letting the child free-associate, or letting the child go on repeating facts in a rote manner while parents or other caregivers listen and try to figure out a meaning of what they’re saying, later attempting to summarize that. What often happens is that the child goes off and free-associates some more. An example might be of a child talking about school, perhaps naming children in his class in a more rote way, repeating names and not actually saying what he liked or didn’t like about one or another child, what he did with them, and why today was more fun than yesterday (or the reverse). In this instance, move in to try and create a logical dialogue where there’s purpose and meaning and the child has some emotional investment in sharing something logical, the caregiver should be patient and just listen, perhaps later saying, "Oh, gee, it sounds like you have a lot of nice kids in your class." The child might smile happily because it’s been a nice, supportive interaction, but no logic or thinking has taken place. On the other hand, if the parent were quicker and said, "Oh, you’re telling me the names of the kids at school, but who did you play with today and who did you have fun with?" and "Who do you like to play with the best?" Suddenly, the interaction moves from the descriptive to the purposeful, intentional, emotional, and meaningful. Sometimes, when the child is describing something, he’s saying that he’s interested in this area. Then we have to help the child who is not fully logical himself to create a logical dialogue about the area he’s identifying as being interesting, like children at school, by exploring an emotionally relevant theme within that larger topic area. Here, we have to move in a supportive, warm way, picking out something that might be meaningful or fun for the child, so he can talk about it in a more logical way. The two common errors when we’re closing circles is to move in too quickly and think for the child or to not move in enough and not challenge the child sufficiently. In both cases, the child doesn’t learn how to think. Helping a child close every symbolic circle is a hard task, but it becomes an expectation that the child soon resonates with because we’re helping the child become a thinker. As a child learns to think, closing every circle becomes easier and easier for him. UPCOMING EVENTS: CHICAGO ICDL The IICDLD has developed a web page: http://ezad.com/iicdld and can be reached via e-mail at IICDLD@ezad.com PHILADELPHIA AREA ICDL: Next meeting is scheduled for 6/30/00 from 9:30 AM to 11:30 AM in King of Prussia, PA. Contact person is Steve Glazier, (215) 782-3160. The Greater Boston–area ‘Greenspan Group’ This is a group of parents focused on utilizing Dr. Stanley Greenspan’s techniques. Sally Savelle is the group contact person. She talks with new parents to make sure that they understand the goals of the group, and then sends them the group’s Statement of Purpose, list of pertinent phone numbers, publications and several articles related to floortime and techniques to use. Sally can be reached through e-mail at Ssavelle@AOL.Com or by phone at (978) 287-4837. APRIL 28, 29, 30 & MAY 1, 2000 – THE INFANCY & EARLY CHILDHOOD TRAINING COURSE. Assessment, Diagnosis and Intervention for Developmental and Emotional Disorders. Autistic Spectrum Disorders, Regulatory Disorders Involving Attention, Learning, and Behavior Problems, Cognitive, Language, Motor, & Sensory Disturbances. Course to be taught by Stanley I. Greenspan, MD, and Serena Wieder, Ph. D. To be held at the Crystal City Marriott – Arlington, Virginia. For more information go to WWW.StanleyGreenspan.com or call (301) 320-6360. JUNE 3, 2000 – The Developmenteal Basis of the Psychotherapeutic Process With Adults, Adolescents and Older Children. Course to be taught by Stanley I. Greenspan, MD. To be held at the Crystal City Marriott – Arlington, Virginia. For more information go to WWW.StanleyGreenspan.com or call (301) 320-6360.