Remote Delivery of Allied and Behavioral Healthcare During COVID-19 for Children With Developmental Disabilities

Objective

Many children with autism spectrum disorder (ASD) and other developmental disabilities (DD) transitioned to telehealth services due to the COVID-19 pandemic. Our objectives were to describe reductions in allied and behavioral healthcare services and receipt of caregiver training to deliver services at home because of COVID-19 for children with ASD and other DD, and factors associated with worse response to remote delivery of services for children with ASD.

Method

Prior to the pandemic, children 2 to 5 years of age were enrolled in a multi-site case-control study and completed a developmental assessment. Caregivers completed questionnaires on child behavior problems and ASD symptoms. Children were classified as having ASD vs another DD based on standardized diagnostic measures. Subsequently, caregivers completed a survey during January to June 2021 to assess how COVID-19 affected children and families.

Results

Caregivers reported that most children with ASD and other DD had a decrease in service hours (50.0%-76.9% by service type) during the COVID-19 pandemic. Children with ASD were significantly more likely to experience reduced speech/language therapy than children with other DD. Receipt of caregiver training to deliver services at home ranged from 38.1% to 57.4% by service type. Among children with ASD, pre-pandemic problems with internalizing behaviors and social communication/interaction were associated with worse response to behavioral telehealth but no other common therapies.

Conclusion

Our study demonstrates the caregiver-reported impacts of COVID-19 on remote delivery of allied and behavioral healthcare services for children with ASD and other DD. Considerations for caregiver support and remote delivery of services are provided.

Economic impacts of the COVID-19 pandemic on families of children with autism and other developmental disabilities

Background

To control the spread of the coronavirus disease (COVID-19), many jurisdictions throughout the world enacted public health measures that had vast socio-economic implications. In emergency situations, families of children with developmental disabilities (DDs), including autism, may experience increased difficulty accessing therapies, economic hardship, and caregiver stress, with the potential to exacerbate autism symptoms. Yet, limited research exists on the economic impacts of the COVID-19 pandemic on families of children with autism or another DD compared to families of children from the general population.

Objectives

To assess impact of the COVID-19 pandemic related to parental employment and economic difficulties in families of children with autism, another DD, and in the general population, considering potential modification by socioeconomic disadvantage before the pandemic and levels of child behavioral and emotional problems.

Methods

The Study to Explore Early Development (SEED) is a multi-site, multi-phase, case-control study of young children with autism or another DD as compared to a population comparison group (POP). During January-July 2021, a COVID-19 Impact Assessment Questionnaire was sent to eligible participants (n=1,789) who had enrolled in SEED Phase 3 from September 2017-March 2020. Parents completed a questionnaire on impacts of the pandemic in 2020 and completed the Child Behavior Checklist (CBCL) to measure behavioral and emotional health of their child during this time. Multiple logistic regression models were built for employment reduction, increased remote work, difficulty paying bills, or fear of losing their home. Covariates include group status (autism, DD, POP), household income at enrollment, child's race and ethnicity, and binary CBCL Total Problems T-score (<60 vs. ≥60). Unadjusted and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated.

Results

The study included 274 children with autism, 368 children with another DD, and 385 POP children. The mean age of 6.1 years (standard deviation, 0.8) at the COVID-19 Impact Assessment did not differ between study groups. Parents of children with autism were less likely to transition to remote work (aOR [95% CI] = 0.6 [0.4, 1.0]) and more likely to report difficulty paying bills during the pandemic (1.8 [1.2, 2.9]) relative to parents of POP children. Lower income was associated with greater employment reduction, difficulty paying bills, and fear of losing their home, but inversely associated with transitioning to remote work. Parents of non-Hispanic (NH) Black children experienced greater employment reduction compared to parents of NH White children (1.9 [1.1, 3.0]). Parents from racial and ethnic minority groups were more likely to experience difficulty paying bills and fear losing their home, relative to NH White parents. Caregivers of children with CBCL scores in the clinical range were more likely to fear losing their home (2.1 [1.3, 3.4]).

Conclusion

These findings suggest that families of children with autism, families of lower socio-economic status, and families of racial and ethnic minority groups experienced fewer work flexibilities and greater financial distress during the pandemic. Future research can be used to assess if these impacts are sustained over time.

Health and Education Services During the COVID-19 Pandemic Among Young Children with Autism Spectrum Disorder and Other Developmental Disabilities

OBJECTIVE

Understanding how the COVID-19 pandemic affected children with disabilities is essential for future public health emergencies. We compared children with autism spectrum disorder (ASD) with those with another developmental disability (DD) and from the general population (POP) regarding (1) missed or delayed appointments for regular health/dental services, immunizations, and specialty services; (2) reasons for difficulty accessing care; and (3) use of remote learning and school supports.

METHOD

Caregivers of children previously enrolled in the Study to Explore Early Development, a case-control study of children with ASD implemented during 2017 to 2020, were recontacted during January-June 2021 to learn about services during March-December 2020. Children were classified as ASD, DD, or POP during the initial study and were aged 3.4 to 7.5 years when their caregivers were recontacted during the pandemic.

RESULTS

Over half of all children missed or delayed regular health/dental appointments (58.4%-65.2%). More children in the ASD versus DD and POP groups missed or delayed specialty services (75.7%, 58.3%, and 22.8%, respectively) and reported difficulties obtaining care of any type because of issues using telehealth and difficulty wearing a mask. During school closures, a smaller proportion of children with ASD versus another DD were offered live online classes (84.3% vs 91.1%), while a larger proportion had disrupted individualized education programs (50.0% vs 36.2%).

CONCLUSION

Minimizing service disruptions for all children and ensuring continuity of specialty care for children with ASD is essential for future public health emergencies. Children may need additional services to compensate for disruptions during the pandemic.

Differential Performance of Social Communication Questionnaire Items in African American/Black vs. White Children

Screening for autism spectrum disorder (ASD) is an essential early step in the identification process and inaccurate screening may lead to significant delays in the onset of treatment. Past research has highlighted discrepancies in the performance of ASD screening tools such as the Social Communication Questionnaire (SCQ) among certain racial and ethnic groups. The current study explored the functioning of the SCQ among African American/Black and White respondents based on item level performance on the measure. Differential Item Functioning (DIF) analyses showed that 16 (41%) items of the SCQ functioned differently for African American/Black respondents when compared to White respondents. Implications, such as the potential for delayed diagnosis and treatment, and the influence on downstream outcomes, are discussed.

Effect of Co-occurring Psychiatric Disorders on Treatment of Children with Autism Spectrum Disorder and Anxiety

Co-occurring psychiatric diagnoses are very common in individuals with ASD. Little is known about the effect that co-occurring psychiatric conditions may have on treatment response to CBT for children with ASD and anxiety. The present study examined the relationship between co-occurring psychiatric diagnoses and response to CBT for anxiety in ninety youth with ASD. Psychiatric complexity did not appear to differentially impact treatment response. A notable portion of youth with anxiety and externalizing disorders such as ADHD, no longer met criteria for those externalizing diagnoses following intervention. Results indicate that youth with ASD and anxiety present with complex psychiatric profiles and CBT for anxiety may positively affect co-occurring diagnoses. In addition, thorough and nuanced assessment of psychiatric symptoms in youth with ASD is needed to ensure the differentiation between diagnoses of anxiety and other co-occurring psychiatric symptoms.

A comparison of costs of two forms of educator professional development in Wyoming: Traditional conference vs. project ECHO

Educator professional development (PD) is essential for improving student outcomes (Guskey, 1986, 2002). However, logistical challenges with traditional in-person conferences can detract from the reach of educator PD (Corcoran, 1995; Johnston, 1994; Shaffer & McNinch, 1997; Stephens, 1991). Project ECHO is a model of PD that utilizes videoconferencing technology to provide training to educators in rural or underserved areas through didactic presentations and case-based learning (Arora et al., 2007; Root-Elledge et al., 2018) while eliminating some of the challenges faced by traditional conferences. However, cost comparisons between ECHO and various forms of PD have not previously been considered. The current study utilizes an in-depth cost comparison to examine PD delivered by ECHO relative to traditional conferences. Findings suggest that ECHO is more affordable for funders and attendees overall. ECHO for Education may, therefore, be a useful tool in delivering PD to educators in rural and remote communities.

Peak frequency of the sensorimotor mu rhythm varies with autism-spectrum traits

Autism spectrum disorder (ASD) is a neurodevelopmental syndrome characterized by impairments in social perception and communication. Growing evidence suggests that the relationship between deficits in social perception and ASD may extend into the neurotypical population. In electroencephalography (EEG), high autism-spectrum traits in both ASD and neurotypical samples are associated with changes to the mu rhythm, an alpha-band (8–12 Hz) oscillation measured over sensorimotor cortex which typically shows reductions in spectral power during both one’s own movements and observation of others’ actions. This mu suppression is thought to reflect integration of perceptual and motor representations for understanding of others’ mental states, which may be disrupted in individuals with autism-spectrum traits. However, because spectral power is usually quantified at the group level, it has limited usefulness for characterizing individual variation in the mu rhythm, particularly with respect to autism-spectrum traits. Instead, individual peak frequency may provide a better measure of mu rhythm variability across participants. Previous developmental studies have linked ASD to slowing of individual peak frequency in the alpha band, or peak alpha frequency (PAF), predominantly associated with selective attention. Yet individual variability in the peak mu frequency (PMF) remains largely unexplored, particularly with respect to autism-spectrum traits. Here we quantified peak frequency of occipitoparietal alpha and sensorimotor mu rhythms across neurotypical individuals as a function of autism-spectrum traits. High-density 128-channel EEG data were collected from 60 participants while they completed two tasks previously reported to reliably index the sensorimotor mu rhythm: motor execution (bimanual finger tapping) and action observation (viewing of whole-body human movements). We found that individual measurement in the peak oscillatory frequency of the mu rhythm was highly reliable within participants, was not driven by resting vs. task states, and showed good correlation across action execution and observation tasks. Within our neurotypical sample, higher autism-spectrum traits were associated with slowing of the PMF, as predicted. This effect was not likely explained by volume conduction of the occipitoparietal PAF associated with attention. Together, these data support individual peak oscillatory alpha-band frequency as a correlate of autism-spectrum traits, warranting further research with larger samples and clinical populations.

Challenges Faced by Rural Primary Care Providers When Caring for COPD Patients in the Western United States

RATIONALE

Rural chronic obstructive pulmonary disease (COPD) patients have worse outcomes and higher mortality compared with urban patients. Reasons for these disparities likely include challenges to delivery of care that have not been explored.

OBJECTIVE

To determine challenges faced by rural primary care providers when caring for COPD patients.

METHODS

Rural primary care providers in 7 primarily western states were asked about barriers they experienced when caring for COPD patients.

RESULTS

A total of 71 rural primary care medical providers completed the survey, of which 51% were physicians and 49% were advanced practice providers (APPs). A total of 61% used Global Initiative for Chronic Obstructive Lung Disease or American Thoracic Society/European Respiratory Society guidelines as an assessment and treatment resource. The presence of multiple chronic conditions and patient failure to recognize and report symptoms were the greatest barriers to diagnose COPD. A total of 89% of providers used spirometry to diagnose COPD, but only 62% were satisfied with access to spirometry. Despite recommendations, 41% of providers never test for alpha-1 antitrypsin deficiency. A total of 87% were comfortable with their ability to assess symptoms, but only 11% used a guideline-recommended assessment tool. Although most providers were satisfied with their ability to treat symptoms and exacerbations, only 66% were content with their ability to prevent exacerbations. Fewer providers were happy with their access to pulmonologists (55%) or pulmonary rehabilitation (37%). Subgroup analyses revealed differences based on provider type (APP versus physician) and location (Colorado and Kansas versus other states), but not on population or practice size.

CONCLUSIONS

Rural providers face significant challenges when caring for COPD patients that should be targeted in future interventions to improve COPD outcomes.

ECHO: A Model for Professional Development in Nursing Through Learning Networks

Health research is published at a breathtaking pace and quantity; however, even when research is systematically developed into best practices and/or clinical guidelines, it often is not implemented into practice. Project ECHO (Extension for Community Healthcare Outcomes) is an evidence-based professional development approach that can help nurses to stay current and apply new knowledge to practice. The purpose of this article is to describe ECHO as a model for professional development and capacity building through learning networks. This article describes the ECHO model, evidence supporting its use, the infrastructure needed to implement an ECHO network, and two nursing ECHO learning networks. [J Contin Educ Nurs. 2021;52(4):198-204.].

Body Matters in Emotion: Restricted Body Movement and Posture Affect Expression and Recognition of Status-Related Emotions

Embodiment theory suggests that we use our own body and experiences to simulate information from other people’s bodies and faces to understand their emotions. A natural consequence of embodied theory is that our own current position and state contributes to this emotional processing. Testing non-disabled individuals, we investigated whether restricted body posture and movement influenced the production and recognition of nonverbal, dynamic emotional displays in able-bodied participants. In Experiment 1, participants were randomly assigned to either unrestricted or wheelchair-restricted (sitting, torso restrained) groups and nonverbally expressed six emotions (disgust, happiness, anger, fear, embarrassment, and pride) while being videotaped. After producing each emotion, they rated their confidence regarding how effectively they communicated that emotion. Videotaped emotional displays were coded for face, body, and face + body use. Based on naïve coders’ scores, both unrestricted and wheelchair-restricted groups produced emotionally congruent face and body movements and both groups were equally confident in their communication effectiveness. Using videos from Experiment 1, Experiment 2 tested non-disabled participants’ ability to recognize emotions from unrestricted and wheelchair-restricted displays. Wheelchair-restricted displays showed an overall decline in recognition accuracy, but recognition was selectively impaired for the dominance-related emotions of disgust and anger. Consistent with embodied emotion theory, these results emphasize the importance of the body for emotion communication and have implications for social interactions between individuals with and without physical disabilities. Changes in nonverbal emotion signals from body restrictions may influence social interactions that rely on the communication of dominance-related social emotions.

Perceiving gaze from head and eye rotations: An integrative challenge for children and adults

Gaze is an emergent visual feature. A person's gaze direction is perceived not just based on the rotation of their eyes, but also their head. At least among adults, this integrative process appears to be flexible such that one feature can be weighted more heavily than the other depending on the circumstances. Yet it is unclear how this weighting might vary across individuals or across development. When children engage emergent gaze, do they prioritize cues from the head and eyes similarly to adults? Is the perception of gaze among individuals with autism spectrum disorder (ASD) emergent, or is it reliant on a single feature? Sixty adults (M = 29.86 years-of-age), thirty-seven typically developing children and adolescents (M = 9.3 years-of-age; range = 7-15), and eighteen children with ASD (M = 9.72 years-of-age; range = 7-15) viewed faces with leftward, rightward, or direct head rotations in conjunction with leftward or rightward pupil rotations, and then indicated whether the face was looking leftward or rightward. All individuals, across development and ASD status, used head rotation to infer gaze direction, albeit with some individual differences. However, the use of pupil rotation was heavily dependent on age. Finally, children with ASD used pupil rotation significantly less than typically developing (TD) children when inferring gaze direction, even after accounting for age. Our approach provides a novel framework for understanding individual and group differences in gaze as it is actually perceived-as an emergent feature. Furthermore, this study begins to address an important gap in ASD literature, taking the first look at emergent gaze perception in this population.

Training clinicians to deliver group CBT to manage anxiety in youth with ASD: Results of a multisite trial

OBJECTIVE

Few guidelines are available regarding optimal training models for practitioners delivering cognitive-behavioral therapy (CBT) for anxiety in youth with autism spectrum disorder (ASD). The present study systematically compared 3 instructional conditions for delivering the Facing Your Fears program (FYF) to children with ASD and anxiety.

METHOD

Thirty-four clinicians (Mage = 34 years; 94% women, 88% Caucasian) and an intent-to-treat sample of 91 children with ASD and anxiety (Mage = 11; 84% male 53% Caucasian) met eligibility criteria across 4 sites. A 3-group parallel design via a Latin square procedure was used to randomize 9 teams of clinicians to 1 of 3 training conditions: Manual, Workshop, Workshop-Plus. The effectiveness of instructional condition was assessed via implementation (CBT knowledge, treatment fidelity) and treatment outcomes (reductions in anxiety as measured by the Anxiety Disorders Interview Schedule-Parent (ADIS-P).

RESULTS

Clinicians in both Workshop conditions significantly increased CBT knowledge postworkshop, F(1, 18) = 19.8, p < .001. Excellent treatment fidelity was obtained across conditions (above 89%), although clinicians in the Workshop conditions obtained significantly higher fidelity ratings and delivered FYF with greater quality than the Manual condition. Children with ASD demonstrated significant reductions in anxiety symptoms for three of the four anxiety diagnoses, with no differences noted across instructional condition. Rates of improvement were lower than those obtained in a previous controlled trial.

CONCLUSIONS

Results suggest that although there may be some advantage to participating in a Workshop, clinicians in all conditions could deliver FYF with excellent fidelity and yield positive treatment outcomes. Lack of a no-treatment comparison group limits interpretation of findings. (PsycINFO Database Record

It's time for a change!: The appreciative inquiry/bootcamp translation to address disparities in the Latino community with autism spectrum disorders

OBJECTIVE

Autism spectrum disorder (ASD) is underidentified and misidentified in the Latino community, and numerous barriers limit this community's ability to access quality health care for ASD. Appreciative inquiry/boot camp translation (AI/BCT) is a novel method of community engagement that can be used within community-based participatory research partnerships. AI/BCT uses qualitative methods to uncover strategies that the community is already successfully using and develops actionable messages to increase the use of those strategies throughout the community. We describe this method and outline how it is likely to be more effective at reducing disparities related to ASDs in the Latino community than traditional methods.

CONCLUSION

AI/BCT is a promising method of community engagement that is responsive to cultural differences. It is a strength-based approach focused on increasing the use of strategies that already work within the community. Therefore, it has the potential to reduce health disparities in the Latino community who have loved ones with autism ASD much more rapidly than traditional methods of inquiry. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Screening for Autism with the SRS and SCQ: Variations across Demographic, Developmental and Behavioral Factors in Preschool Children

The Social Communication Questionnaire (SCQ) and the Social Responsiveness Scales (SRS) are commonly used screeners for autism spectrum disorder (ASD). Data from the Study to Explore Early Development were used to examine variations in the performance of these instruments by child characteristics and family demographics. For both instruments, specificity decreased as maternal education and family income decreased. Specificity was decreased with lower developmental functioning and higher behavior problems. This suggests that the false positive rates of the SRS and the SCQ are associated with child characteristics and family demographic factors. There is a need for ASD screeners that perform well across socioeconomic and child characteristics. Clinicians should be mindful of differential performance of these instruments in various groups of children.

Demographic and Operational Factors Predicting Study Completion in a Multisite Case-Control Study of Preschool Children

Participant attrition can limit inferences drawn from study results and inflate research costs. We examined factors associated with completion of the Study to Explore Early Development (2007-2011), a multiple-component, case-control study of risk factors for autism spectrum disorder in preschoolers, conducted in California, Colorado, Georgia, Maryland, North Carolina, and Pennsylvania. Participants (n = 3,769) were asked to complete phone interviews, questionnaires, an in-person evaluation, and biologic sampling. We examined whether participant demographic and administrative factors predicted completion using mixed-effects logistic regression models. Completion of individual key study components was generally 70% or higher. However, 58% of families completed all per-protocol data elements (defined a priori as key study components). Per-protocol completion differed according to mother's age, race, educational level, driving distance to clinic, number of contact attempts to enroll, and number of telephone numbers provided (all P < 0.05). Case status was not associated with completion, despite additional data collection for case-confirmation. Analysis of a subset that completed an early interview revealed no differences in completion by household factors of income, primary language spoken, number of adults, or number of children with chronic conditions. Differences in completion by race and education were notable and need to be carefully considered in developing future recruitment and completion strategies.

Influence of family demographic factors on social communication questionnaire scores

This study examined the effect of demographic factors on Social Communication Questionnaire (SCQ) scores in children aged 30-68 months. Diagnoses of ASD were made after a gold standard evaluation that included the Autism Diagnostic Observation Schedule (ADOS), and the Autism Diagnostic Interview Revised (ADI-R). The relationship of demographic variables to SCQ scores was compared in two source populations: (a) children recruited from clinical and educational sources serving children who have ASD or other developmental disorders (CE) and (b) children recruited from birth certificates to represent the general population (BC). The impact of the demographic variables-child sex, child age, maternal language, maternal ethnicity, maternal education, maternal race, and household income-on total SCQ score were studied to examine their impact on the SCQ's performance. Demographic factors predicting the SCQ total score were used to generate ROCs. Factors that had a significant influence on SCQ performance were identified by examining the area under the ROCs. Optimal SCQ cut-points were generated for significant factors using the Youden's Index. Overall male sex, lower household income, lower maternal education and Black race predicted higher SCQ scores. In this sample, the most common optimum value for the SCQ cut-point across the different sociodemographic groups was 11. Autism Res 2018, 11: 695-706. © 2018 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

Screeners are used to help identify children who are more likely to have ASD than their peers. Ideally screeners should be accurate for different groups of children and families. This study examined how well the Social Communication Questionnaire (SCQ) predicts ASD. We found that male sex, lower household income, lower maternal education and Black race were associated with higher SCQ scores. In this study an SCQ cut-point of 11 worked best across the different sociodemographic groups in our sample.

Use of Transition Resources by Primary Care Providers for Youth With Intellectual and Developmental Disabilities

Youth with intellectual and developmental disabilities (IDD) often experience difficulties with successful transition from pediatric to adult healthcare. A consultative Transition Clinic for youth with IDD was piloted as a quality improvement project, and assessed the engagement of primary care providers (PCPs) for transition planning after patients were seen in clinic. Although many PCPs found the clinic and resources useful, individual and systemic barriers often prohibited them from participating in transition planning for this patient population. These findings highlight systemic barriers that need to be addressed to ensure successful transition, as well as the need for a specialized Transition Clinic with involvement of specialists with expertise in IDD, such as Developmental-Behavioral Pediatrics, to assist throughout transition process.

Emotional Mimicry Beyond the Face?

Emotional mimicry—quick and spontaneous matching of another’s expressions—is a well-documented phenomenon that is associated with numerous social outcomes. Although the mechanisms underlying mimicry are not fully understood, there is growing awareness that it is more than a one-to-one motor matching of others’ expressions and may be the result of neural simulation. If true, it is possible that mimicry could extend to other parts of the body, even in the absence of visual information from that body part. Indeed, we found that passively viewing anger and fear expressions, without accompanying information from the body, voice or other channels, produced both facial mimicry and corresponding responses in arm muscles that make a fist or a defensive posture. This suggests that observers simulated observed expressions and that activity may have spilled over to other areas to create a body response.

Examining the Relationship Between Parental Anxiety and Treatment Response in Children and Adolescents with Autism Spectrum Disorder and Anxiety

In response to the high co-occurrence of anxiety symptoms in youth with autism spectrum disorder (ASD), several interventions have been developed for this population. In spite of promising findings, some youth with ASD respond only minimally to such interventions. To understand potential factors that may impact treatment response, the current study explores the role of parental anxiety in youth treatment outcome. Thirty-one youth with ASD, ages 7-18, and their parents participated in the study. Parents completed the State/Trait Anxiety Inventory pre- and post-treatment. Contrary to previous research, there was no correlation between parental anxiety and youth anxiety at baseline or post-treatment. However, parental trait anxiety significantly decreased from pre- to post-treatment for parents of treatment responders. The findings are consistent with previous research and suggest a youth-to-parent influence.

Don't Listen With Your Mouth Full: The Role of Facial Motor Action in Visual Speech Perception

Theories of speech perception agree that visual input enhances the understanding of speech but disagree on whether physically mimicking the speaker improves understanding. This study investigated whether facial motor mimicry facilitates visual speech perception by testing whether blocking facial motor action impairs speechreading performance. Thirty-five typically developing children (19 boys; 16 girls; M age = 7 years) completed the Revised Craig Lipreading Inventory under two conditions. While observing silent videos of 15 words being spoken, participants either held a tongue depressor horizontally with their teeth (blocking facial motor action) or squeezed a ball with one hand (allowing facial motor action). As hypothesized, blocking motor action resulted in fewer correctly understood words than that of the control task. The results suggest that facial mimicry or other methods of facial action support visual speech perception in children. Future studies on the impact of motor action on the typical and atypical development of speech perception are warranted.

Improving transportability of a cognitive-behavioral treatment intervention for anxiety in youth with autism spectrum disorders: results from a US-Canada collaboration

Anxiety disorders frequently co-occur in youth with autism spectrum disorders. In addition to developing efficacious treatments for anxiety in children with autism spectrum disorders, it is important to examine the transportability of these treatments to real-world settings. Study aims were to (a) train clinicians to deliver Facing Your Fears: Group Therapy for Managing Anxiety in Children with High-Functioning Autism Spectrum Disorders to fidelity and (b) examine feasibility of the program for novel settings. A secondary aim was to examine preliminary youth treatment outcome. Results indicated that clinicians obtained excellent fidelity following a workshop and ongoing consultation. Acceptability ratings indicated that Facing Your Fears Therapy was viewed favorably, and critiques were incorporated into program revisions. Meaningful reductions in anxiety were reported posttreatment for 53% of children. Results support the initial effectiveness and transportability of Facing Your Fears Therapy in new clinical settings.

Mimicry of Dynamic Emotional and Motor-Only Stimuli

Simple reciprocal matching behaviors, such as facial mimicry, appear fundamental to social development and interpersonal processes. Identifying mechanisms and moderators of these reactions to others' behaviors is thus important to understanding basic social–emotional functioning and specific clinical syndromes. This experiment extends early electromyographic (EMG) research (Berger & Hadley, 1975) to explore whether rapid, subtle mimicry involves a general motor-matching mechanism (e.g., the mirror neuron system) or if it is related solely to emotional processes. The EMG measured responses to short, dynamic videos of smiling, scowling, stuttering, and arm wrestling. Although mimicry of emotional stimuli was greater than to nonemotional stimuli, participants matched both nonemotional mouth movements and facial expressions of emotions. Mimicry of arm motions was not significant. Individuals' levels of mimicry of emotional and nonemotional were positively correlated. Findings suggest that both motor and affective processes are involved in producing rapid mimetic reactions to dynamic stimuli.

Diagnosing Autism in Individuals with Known Genetic Syndromes: Clinical Considerations and Implications for Intervention

Assessing symptoms of autism in persons with known genetic syndromes associated with intellectual and/or developmental disability is a complex clinical endeavor. We suggest that a developmental approach to evaluation is essential to reliably teasing apart global impairments from autism-specific symptomology. In this chapter, we discuss our assumptions about autism spectrum disorders, the process of conducting a family-focused, comprehensive evaluation with behaviorally complex children and some implications for intervention in persons with co-occurring autism and known genetic syndromes.

Validity of the Five Minute Speech Sample in families with infants from low-income backgrounds

Caregivers of 169 infants from low-income and multi-ethnic backgrounds completed the Five Minute Speech Sample (FMSS). Validity of the FMSS was supported by demonstrating significant associations among positive and negative affect dimensions of the FMSS and other indices of the caregiving environment.

More than mere mimicry? The influence of emotion on rapid facial reactions to faces

Within a second of seeing an emotional facial expression, people typically match that expression. These rapid facial reactions (RFRs), often termed mimicry, are implicated in emotional contagion, social perception, and embodied affect, yet ambiguity remains regarding the mechanism(s) involved. Two studies evaluated whether RFRs to faces are solely nonaffective motor responses or whether emotional processes are involved. Brow (corrugator, related to anger) and forehead (frontalis, related to fear) activity were recorded using facial electromyography (EMG) while undergraduates in two conditions (fear induction vs. neutral) viewed fear, anger, and neutral facial expressions. As predicted, fear induction increased fear expressions to angry faces within 1000 ms of exposure, demonstrating an emotional component of RFRs. This did not merely reflect increased fear from the induction, because responses to neutral faces were unaffected. Considering RFRs to be merely nonaffective automatic reactions is inaccurate. RFRs are not purely motor mimicry; emotion influences early facial responses to faces. The relevance of these data to emotional contagion, autism, and the mirror system-based perspectives on imitation is discussed.

Internet use and its relationship to lonelines

The association between Robert Weiss's bimodal theory of loneliness and Internet use was examined. The degree of social and emotional loneliness was assessed using the Social and Emotional Loneliness scale. This was compared with self-report measures of Internet use and the breadth of one's network of friends, both online and on a face-to-face basis. Low levels of social and emotional loneliness were both associated with high degrees of face-to-face networks of friends, while high levels of Internet use were associated with low levels of social loneliness and high levels of emotional loneliness. This supports recent research that has found that the Internet can decrease social well-being, even though it is often used as a communication tool.

Distinct structural requirements for the direct and indirect actions of the anaesthetic etomidate at GABA(A) receptors

1. The intravenous anaesthetic etomidate augments GABA-gated chloride currents (indirect action) and, at higher concentrations, evokes chloride currents in the absence of GABA (direct action). 2. In order to identify amino acid residues essential for these actions, site directed mutagenesis was performed on the beta3 subunit. 3. Mutation of an asparagine to a serine residue at position 290 dramatically reduced both etomidate-induced chloride currents and its ability to enhance [3H]flunitrazepam binding in HEK293 cells expressing alpha1beta3gamma2 recombinant GABA(A) receptors. 4. In contrast, the indirect effect of etomidate was retained, though its potency was reduced. 5. These findings indicate that there are distinct requirements for these dual actions of etomidate at GABA(A) receptors.

Stereoselective actions of halothane at GABA(A) receptors

Isoflurane anesthesia exhibits stereoselectivity, and a corresponding stereoselectivity ((+)->(-)-isomer) has been reported at GABA(A) receptors in vitro. The objective of the present study was to determine if the positive modulatory actions of halothane at GABA(A) receptors exhibited a similar stereoselectivity. Both (R)- and (S)-halothane ((+)- and (-)- isomers, respectively) enhanced [3H]flunitrazepam binding to brain membranes in a concentration dependent manner without a significant difference in either potency (EC50) or efficacy (Emax). While both (R)- and (S)-halothane enhanced [3H]muscimol binding, the potency of the (+)-isomer was slightly greater than the corresponding (-)-isomer (0.91 +/- 0.17 versus 1.45 +/- 0.04% atmospheres, respectively (P < 0.02)). Thus, subtle structural differences between inhalational anesthetics can have a significant impact on the degree of stereoselectivity at the receptor level and may provide insights for the development of more specific drugs.

Distinct loci mediate the direct and indirect actions of the anesthetic etomidate at GABA(A) receptors

Most general anesthetics produce two distinct actions at GABA(A) receptors. Thus, these drugs augment GABA-gated chloride currents (referred to as an indirect action) and, at higher concentrations, elicit chloride currents in the absence of GABA (referred to as a direct action). Because a beta subunit appears to be required for the direct action of intravenous anesthetics in recombinant GABA(A) receptors, site-directed mutagenesis of the beta3 subunit was performed to identify amino acid residues that are critical for this action. In HEK293 cells expressing a prototypical GABA(A) receptor composed of alpha1beta3gamma2 subunits, mutation of amino acid 290 from Asn to Ser dramatically reduced both etomidate-induced chloride currents and its ability to stimulate [3H]flunitrazepam binding. By contrast, the ability of etomidate to augment GABA-gated chloride currents and GABA-enhanced [3H]flunitrazepam binding was retained. The demonstration that the direct, but not the indirect, actions of etomidate are dependent on beta3(Asn290) indicates that the dual actions of this intravenous anesthetic at GABA(A) receptors are mediated via distinct loci.

Contribution of "diazepam-insensitive" GABAA receptors to the alcohol antagonist properties of Ro 15-4513 and related imidazobenzodiazepines

Both in vivo and in vitro studies have shown that Ro 15-4513 can antagonize many of the pharmacologic actions of ethanol. In contrast to many benzodiazepine receptor (BzR) ligands, Ro 15-4513 binds with high affinity to a novel GABAA receptor subtype, referred to as "diazepam-insensitive" (DI). This study examined the contribution of DI GABAA receptors to the modulation of ethanol-induced sleep time by Ro 15-4513 and related imidazobenzodiazepines [e.g., Ro 19-4603, Ro 16-6028, and ZG-63 (t-butyl-8-chloro-5,6-dihydro-5-methyl-6-oxo-imidazo[1,5,a] [1,4]benzodiazepine-3-carboxylate)] that possess high affinities for this GABAA receptor subtype. Ro 15-4513 (0.6-5 mg/kg) significantly reduced ethanol (3.5 g/kg, i.p.) sleep time in mice (p < 0.001, analysis of variance). This effect was not blocked by BzR antagonists ZK 93426 (5 mg/kg) and Ro 14-7437 (5 mg/kg), which possess low affinities for DI but bind with high affinities to other "diazepam-sensitive" (DS) GABAA receptor isoforms. Although Ro 19-4603 (2.5 mg/kg) also reduced ethanol sleep time (p < 0.01), this effect was attenuated by coadministration of ZK 93426 (2.5 mg/kg). Ro 16-6028 (2.5 mg/kg) prolonged (p < 0.01) ethanol sleep time. However, in the presence of either Ro 19-7437 (5 mg/kg) or ZK 93426 (2.5 mg/kg) ethanol-induced sleep time was reduced to values approaching those obtained with ethanol in the presence of Ro 15-4513. A low dose (2.5 mg/kg) of ZG-63 did not significantly affect alcohol sleep time. However, in the presence of ZK 93426, ZG-63 increased sleep time (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Different subunit requirements for volatile and nonvolatile anesthetics at gamma-aminobutyric acid type A receptors

The ability of volatile (halothane and isoflurane) and nonvolatile (alphaxalone and pentobarbital) general anesthetics to modulate radioligand binding to gamma-aminobutyric acid (GABA)A receptors was examined in an immortalized cell line (WSS-1) expressing rat alpha 1 and gamma 2 subunits. Volatile anesthetics enhance [3H]flunitrazepam binding to WSS-1 cells in a concentration-dependent manner, with potencies and efficacies comparable to those found with native GABAA receptors. Transfection of these cells with cDNAs encoding rat beta 2 or beta 3 subunits had a significant influence on anesthetic efficacy but not potency in this assay. Thus, transfection with the beta 2 subunit reduced the efficacy of both isoflurane and halothane, whereas transfection with the beta 3 subunit increased the efficacy of isoflurane but not halothane, compared with values obtained in WSS-1 cells. In contrast, alpha-xalone (an anesthetic steroid) had no effect, whereas at high concentrations pentobarbital (an anesthetic barbiturate) produced a modest inhibition of [3H]flunitrazepam binding to GABAA receptors in WSS-1 cells. Transfection of WSS-1 cells with cDNAs encoding either beta 2 or beta 3 subunits resulted in a concentration-dependent enhancement of [3H]flunitrazepam binding by these nonvolatile anesthetics. Moreover, pentobarbital was significantly more potent in enhancing [3H]flunitrazepam binding to WSS-1 cells transfected with the beta 2 subunit, compared with the beta 3 subunit. The difference in subunit requirements between volatile and nonvolatile anesthetics for enhancement of [3H]flunitrazepam binding indicates that these classes of agents affect GABAA receptor function at distinct loci. These studies also provide evidence that the beta subunit is required for these nonvolatile anesthetics to positively modulate GABAA receptors.

The potential for safer anaesthesia using stereoselective anaesthetics

The molecular mechanisms by which inhalational agents produce anaesthesia remains a subject of controversy, despite a history of clinical use spanning two centuries. The demonstration of a significant difference in the anaesthetic potencies of (+)- and (-)-isoflurane provides compelling evidence for the hypothesis that proteins, rather than lipids, are the primary sites of anaesthetic action. Moreover, the optically active isomers of volatile anaesthetics provide new tools to discriminate among putative molecular targets of anaesthesia. A difference in the anaesthetic potencies of (+)- and (-)-isoflurane, together with an apparent lack of stereoselectivity in their myocardial suppression, raises the possibility that an optically active volatile agent may have clinical advantages over currently available racemic mixtures.

Inhibition of [3H]isradipine binding to L-type calcium channels by the optical isomers of isoflurane. Lack of stereospecificity

BACKGROUND

The dose-dependent myocardial depression of volatile general anesthetics such as isoflurane has been linked to blockade of L-type Ca2+ channels. The effects of (+)- and (-)-isoflurane on the inhibition of [3H]isradipine binding to L-type Ca2+ channels in membranes prepared from mouse heart were examined. In addition, because there is a stereo-specific effect of these isomers on sleep time in mice, the potential contribution of L-type Ca2+ channels to isoflurane-induced sleep was assessed by determining whether a similar stereoselectivity would be manifested at these sites in cerebral cortical membranes.

METHODS

The effects of isoflurane stereoisomers on the binding of an L-type Ca2+ channel ligand ([3H]isradipine) were studied in cardiac and brain cortical membranes. Their potencies and effects on the Kd and Bmax of [3H]isradipine were measured.

RESULTS

Pharmacologically relevant concentrations of (+)- and (-)-isoflurane inhibited [3H]isradipine binding. The IC50 values for (+)-isoflurane were 0.48 +/- 0.02% and 0.40 +/- 0.01% in heart and brain membranes, respectively. The values for (-)-isoflurane were not significantly different from the respective values for the (+)-isomer. Saturation analysis demonstrated (+)- and (-)-isoflurane inhibited [3H]isradipine binding by significantly reducing Bmax and increasing Kd, but there were no significant differences between these isomers in either tissue.

CONCLUSIONS

The stereoisomers of isoflurane are equipotent as inhibitors of [3H]isradipine binding to L-type Ca2+ channels. This lack of stereoselectivity between (+)- and (-)-isoflurane indicates that the [3H]isradipine site on L-type Ca2+ channels in brain does not contribute to the differences in isoflurane-induced sleep time reported for these stereoisomers. Taken with a lack of stereoselectivity at L-type Ca2+ channels in heart, an optically resolved isomer of isoflurane may have clinical advantages compared to the current racemic mixture.

Volatile anesthetics bidirectionally and stereospecifically modulate ligand binding to GABA receptors

Pharmacologically relevant concentrations of volatile anesthetics can bidirectionally modulate radioligand binding to GABAA receptors. In mouse cerebral cortex, halothane (a prototypic volatile anesthetic) increased [3H]muscimol (a GABA receptor agonist) binding while inhibiting the binding of a GABA receptor antagonist ([3H]SR 95531). These bidirectional effects of inhalational anesthetics on ligand binding to GABA receptors are effected through changes in the Bmax with no significant alterations in the KD of these radioligands. Moreover, the concentration dependent, bidirectional modulation of radioligand binding to GABA receptors by volatile anesthetics exhibited stereoselectivity. Thus, (+)-isoflurane was about twice as potent as the (-)-enantiomer in enhancing [3H]muscimol binding and approximately 50% more potent as an inhibitor of [3H]SR 95531 binding, respectively. The demonstration of a bidirectional, stereospecific modulation of radioligand binding to GABA receptors by inhalational agents is consistent with the presence of specific recognition sites for inhalational anesthetics on the GABAA receptor complex.

Stereospecific actions of the inhalation anesthetic isoflurane at the GABAA receptor complex

The inhalation anesthetic isoflurane stereoselectively modulates ligand binding to the GABAA receptor complex. The (+)-isomer of isoflurane was more potent and efficacious than the (-)-isomer in enhancing [3H]flunitrazepam binding to benzodiazepine receptors. For example, concentration effect curves for Cl- enhancement of [3H]flunitrazepam binding were significantly different (P < 0.001) in the presence of (+)- and (-)-isoflurane (0.44 and 0.88 mM). At the higher anesthetic concentration, they potency of Cl- to increase [3H]flunitrazepam binding was increased 3.2- and 1.45-fold by (+)- and (-)-isoflurane, respectively (P < 0.05). Likewise, concentration-effect curves for (+) isoflurane-enhanced [3H]flunitrazepam binding were significantly different (P < 0.05-P < 0.001) from the (-)-isomer in the presence of 0-200 mM Cl-. Stereoselectivity was not observed with respect to the potencies of these enantiomers as inhibitors of [35S]t-butylbicyclophosphorothionate (TBPS) binding to sites within the Cl- ionophore. In this measure, the isomers had similar potencies (P > 0.05), although at higher concentrations (> 0.1 mM) (+)-isoflurane produced significantly more inhibition than (-)-isoflurane. While the absolute potency differences between isomers were modest (< or = 2-fold) and measure dependent, these effects were manifested at clinically relevant concentrations of isoflurane and are consistent with in vivo studies demonstrating (+)-isoflurane is a more effective anesthetic than the (-)-isomer. This is the first demonstration of an inhalation anesthetic producing a stereoselective perturbation of the GABAA receptor complex.

Site-specific acylation of GABA-gated Cl- channels: effects on 36Cl- uptake

Radioligand binding studies indicate that p-isothiocyanato-t-butylbicycloorthobenzoate (p-NCS-TBOB) specifically acylates GABA-gated chloride channels. Preincubation of synaptoneurosomes with p-NCS-TBOB followed by washing resulted in a concentration dependent (63-500 nM) inhibition of both muscimol-stimulated chloride uptake and [355]t-butylbicyclophosphorothionate (TBPS) binding. The extent of acylation (assessed by inhibition of [35S]TBPS binding) was highly correlated (r = 0.89; p less than 0.001) with the inhibition of muscimol-stimulated Cl- uptake. Neither basal Cl- uptake nor [3H]muscimol binding to GABAA receptors were affected by p-NCS-TBOB. Preincubation with the nonacylating 'cage' convulsant t-butylbicycloorthobenzoate (500 nM) followed by washing had no effect on either muscimol-stimulated Cl- uptake or [35S]TBPS binding. These findings indicate that p-NCS-TBOB interferes with the efficacy of muscimol promoted channel openings, but does not affect the recognition qualities of GABAA receptors. p-NCS-TBOB should prove useful in electrophysiological and biochemical studies examining the properties of GABA-gated Cl- channels.

Chlormethiazole: neurochemical actions at the gamma-aminobutyric acid receptor complex

Chlormethiazole has been extensively employed as a sedative/hypnotic and anticonvulsant for more than 25 years. While pharmacological and electrophysiological studies have implicated the GABAA receptor complex in these actions, neurochemical findings have not been consistent with this conclusion. We now present evidence that pharmacologically relevant concentrations of chlormethiazole perturb the GABAA receptor complex. Chlormethiazole was found to increase 36Cl- uptake into rat cortical synaptoneurosomes in a concentration-dependent (EC50 = 48 +/- 3 microM; Emax = 8.9 +/- 0.8 nmol Cl-/mg protein per 5 s), picrotoxin-sensitive fashion. Chlormethiazole was also found to inhibit the binding of the 'cage' convulsant [35S]t-butylbicyclophosphorothionate to rat cortical membranes (IC50 = 58.6 +/- 0.6 microM) through an increase in the apparent KD of this radioligand. Moreover, at these concentrations chlormethiazole did not affect pentobarbital-enhanced [3H]flunitrazepam binding, but inhibited [3H]flunitrazepam binding with a low potency (IC50 = 1.6 +/- 0.2 mM). These findings provide neurochemical evidence that pharmacologically relevant concentrations of chlormethiazole can perturb the GABAA receptor complex, and suggest that this compound acts at a distinct locus from other sedative/hypnotics such as barbiturates, benzodiazepines and GABAmimetics.

Ultraviolet irradiation selectively disrupts the gamma-aminobutyric acid/benzodiazepine receptor-linked chloride ionophore

The ability of UV light to affect radioligand binding and 36Cl-uptake at the gamma-aminobutyric acidA (GABAA) receptor-chloride channel complex was examined. Exposure to 302 nm UV light produced a rapid (t1/2 = 4 min) reduction in [35S]t-butylbicyclo-phosphorothionate binding (assayed in the presence of 200 mM chloride) to sites associated with the GABAA receptor-coupled chloride ionophore. Saturation analysis revealed that this effect could be attributed entirely to a decrease in the maximum number of binding sites. Exposure to UV irradiation at lower (254 nm) and higher (366 nm) wavelengths also inhibited [35S]t-butylbicy-clophosphorothionate binding, but the respective rates of inactivation were 8- and 27-fold slower, compared with 302 nm. Other anion-dependent interactions at the GABAA receptor complex were disrupted in a similar manner. In the absence of permeant anion, [3H]flunitrazepam binding to benzodiazepine receptors was unaffected by 302 nm UV irradiation, whereas chloride-enhanced [3H]flunitrazepam binding was inhibited markedly. In the presence of 250-500 mM chloride, [3H]methyl-6,7-dimethoxy-4-ethyl-beta-carboline-3-carboxylate binding to benzodiazepine receptors was also inhibited after UV exposure. Basal 36Cl- uptake into synaptoneurosomes was nearly doubled after 15 min of exposure to 302 nm light, whereas pentobarbital- and muscimol-stimulated 36Cl- uptake were reduced significantly. UV irradiation at 302 nm appears to disrupt selectively the anion-dependent functional interactions at the GABAA receptor complex. The apparent wavelength specificity suggests that the gating structure (channel) may contain tryptophan and/or tyrosine residues vital to the regulation of anion movement through the ionophore portion of this supramolecular receptor-ion channel complex.

Stereospecific reversal of nitrous oxide analgesia by naloxone

The opiate antagonist naloxone was found to block nitrous oxide analgesia in a stereospecific fashion. Using a modified hotplate test in mice, the (-)-enantiomer of naloxone (which has a KD of approximately 1 nM for opiate receptors) antagonized the analgesic actions of nitrous oxide in a dose-dependent (2.5-20 mg/kg) fashion. In contrast, the (+)-enantiomer (KD approximately 10,000 nM) had no effect on nitrous oxide analgesia at the highest dose tested (40 mg/kg). These data strongly suggest that nitrous oxide analgesia is mediated via opiate receptors and is consistent with the hypotheses that this effect occurs either through the release of endogenous opioids or by physical perturbation of the opiate receptors.

Modulation of the benzodiazepine/gamma-aminobutyric acid receptor chloride channel complex by inhalation anesthetics

Inhalation anesthetics, such as diethyl ether, halothane, and enflurane, increase 36Cl- uptake into rat cerebral cortical synaptoneurosomes in a concentration-dependent, picrotoxin-sensitive fashion. At concentrations consistent with those that stimulate 36Cl- uptake, inhalation anesthetics also inhibit the binding of t-[35S]butylbicyclophosphorothionate ([35S]TBPS) to well-washed cortical membranes. Scatchard analysis of [35S]TBPS binding indicates that these agents reduce the apparent affinity of this radioligand and have little effect on the Bmax. The ability of inhalation anesthetics to directly stimulate 36Cl- uptake and inhibit [35S]TBPS binding is a property shared by nonvolatile anesthetics. Nonetheless, there are differences between nonvolatile agents (such as barbiturates and alcohols) and inhalation anesthetics, because the former compounds augment muscimol (a GABAmimetic) stimulated 36Cl- uptake, whereas the latter group (such as ether and enflurane) inhibit this effect. These findings demonstrate that therapeutically relevant concentrations of inhalation anesthetics perturb the benzodiazepine/gamma-aminobutyric acid receptor chloride channel complex, and suggest this oligomeric protein may be a common mediator of some aspects of anesthetic action.

The imidazobenzodiazepine Ro 15-4513 antagonizes methoxyflurane anesthesia

Parenteral administration of the imidazobenzodiazepine Ro 15-4513 (a high affinity ligand of the benzodiazepine receptor with partial inverse agonist qualities) produced a dose dependent reduction in sleep time of mice exposed to the inhalation anesthetic, methoxyflurane. The reductions in methoxyflurane sleep time ranged from approximately 20% at 4 mg/kg to approximately 38% at 32 mg/kg of Ro 15-4513. Co-administration of the benzodiazepine receptor antagonist Ro 15-1788 (16 mg/kg) or the inverse agonists DMCM (5-20 mg/kg) and FG 7142 (22.5 mg/kg) blocks this effect which suggests that the reductions in methoxyflurane sleep time produced by Ro 15-4513 are mediated via occupation of benzodiazepine receptors. Moreover, neither DMCM (5-20 mg/kg) nor FG 7142 (22.5 mg/kg) reduced methoxyflurane sleep time which suggests this effect of Ro 15-4513 cannot be attributed solely to its partial inverse agonist properties. These observations support recent findings that inhalation anesthetics may produce their depressant effects via perturbation of the benzodiazepine/GABA receptor chloride channel complex, and suggest that Ro 15-4513 may serve as a prototype of agents capable of antagonizing the depressant effects of inhalation anesthetics such as methoxyflurane.

Control of extracellular ions in skate brain during osmotic disturbances

Regulation of brain water and osmolytes in osmotic disturbances has been studied in the little skate, Raja erinacea. Free-swimming fish were subjected to seawater plus 125 mM NaCl (hyperosmotic; these also received 10 ml/kg body wt im 4.19 M NaCl in elasmobranch Ringer) or to 50% seawater (hyposmotic). At a set time, fish were killed, and blood and brain (telencephalon and medulla) were analyzed. Brain water was divided into a Cl- and a non-Cl- space. Responses of water and osmolytes to osmotic disturbances were mutually consistent. In telencephalon, there was good regulation of Cl- space, based on Na+ and Cl- shifts in hypo- and hyperosmolality. This control was near perfect at 2- and 4-h hyperosmolality. Regulation of non-Cl- space was minimal at 24-h hyperosmolality, with small K+ uptake. In medulla, Cl- space and ions were unregulated, whereas non-Cl- space was partly controlled in hyposmolality in relation to amino acid loss. Thus in this elasmobranch, regulation of Cl- space and of Na+ and Cl- is effective in telencephalon but is nonexistent in medulla oblongata.

Sign language acquisition by a global aphasic

A left hemisphere-damaged, hemiplegic, and globally aphasic man was taught receptive and expressive language using Total Communication--a combination of standardized sign language and speech. After an initial period during which words (in sign) were learned slowly and with frequent lapses of memory, the subject's learning ability and memory improved dramatically. He has learned to communicate using increasingly complex, syntactically correct sentences, self-correcting his mistakes. He reads and understands simple sentences. These results suggest that it may be possible to restore communicative function even in those stroke victims who remain orally aphasic if a suitable means of expression can be found.

Impairment of platelet function by growth-hormone release-inhibiting hormone

Synthetic cyclic growth-hormone release-inhibiting hormone (G.H.-R.I.H.) impaired platelet aggregation in each of four healthy men given 6-hour infusions. The effects lasted over 24 hours in three of them. There was no consistent change in platelet-counts during the infusions, but 18 hours after the end of the infusions there was a slight but significant increase in platelet-count. There was no change in prothrombin-time, partial thromboplastin-time, fibrinogen titres, and fibrinogen-degradation products. Incubation of G.H.-R.I.H. with blood in vitro did not affect platelet aggregation. Similar impairment of platelet function has been reported by others in baboons given linear G.H.-R.I.H. Infusions in the four healthy men studied also produced abdominal pain, dizziness, and diarrhoea in three, as have been reported in patients similarly infused. Although other side-effects or impairment of platelet-counts or bleeding-tendencies have not been reported in patients infused for up to 72 hours, caution should be exercised when using G.H.-R.I.H. over extended periods until further data on its toxicity are available.