PURPOSE OF REVIEW:The American Academy of Pediatrics recommends exclusive breastfeeding for the first 6 months of an infant#$#apos;s life, with continuation of breastfeeding for at least a year or as mutually desired by mother and child. A robust body of research literature documenting the short-term medical, developmental, and emotional benefits of breastfeeding for infants and toddlers supports this position. This article reviews the neurodevelopmental benefits of breastfeeding as it relates to preschool and school-age children, with particular emphasis on cognitive development, attention-deficit/hyperactivity disorder, and autism spectrum disorder.

RECENT FINDINGS:The majority of research studies examining breastfeeding and long-term neurodevelopmental outcomes suggest that children who breastfeed for longer than 6 months have better cognitive outcomes, lower risk of developing attention-deficit/hyperactivity disorder, and lower risk of being diagnosed with autism spectrum disorder.

SUMMARY:Pediatricians play a critical role in educating and counseling families about infant nutrition and feeding. Along with the many positive short-term medical effects that breastfeeding confers, physicians should be aware of the growing body of research suggesting that there are also significant long-term neurodevelopmental benefits of breastfeeding.

BACKGROUND:A significant number of children diagnosed with autism spectrum disorder suffer a loss of previously-acquired skills, suggesting neurodegeneration or a type of progressive encephalopathy with an etiological basis occurring after birth. The purpose of this study is to investigate the effectof the age at which children got their first Measles-Mumps-Rubella (MMR) vaccine on autism incidence. This is a reanalysis of the data set, obtained from the U.S. Centers for Disease Control and Protection (CDC), used for the Destefano et al. 2004 publication on the timing of the first MMR vaccine and autism diagnoses.

METHODS:The author embarked on the present study to evaluate whether a relationship exists between child age when the first MMR vaccine was administered among cases diagnosed with autism and controls born between 1986 through 1993 among school children in metropolitan Atlanta. The Pearson's chi-squared method was used to assess relative risks of receiving an autism diagnosis within the total cohort as well as among different race and gender categories.

RESULTS:When comparing cases and controls receiving their first MMR vaccine before and after 36 months of age, there was a statistically significant increase in autism cases specifically among African American males who received the first MMR prior to 36 months of age. Relative risks for males in general and African American males were 1.69 (p=0.0138) and 3.36 (p=0.0019), respectively. Additionally, African American males showed an odds ratio of 1.73 (p=0.0200) for autism cases in children receiving their first MMR vaccine prior to 24 months of age versus 24 months of age and thereafter.

CONCLUSIONS:The present study provides new epidemiologic evidence showing that African American males receiving the MMR vaccine prior to 24 months of age or 36 months of age are more likely to receive an autism diagnosis.

OBJECTIVE: To find out an effective therapy for severe child autism. METHODS: Sixty-nine autism children were divided into a JIN's 3-needling group (n=35) and a behavior intervention group (n=34). The JIN's needling group was treated with JIN's 3-needling therapy, including Four-shen needling, Zhi-three needling and Nao-three needling, etc. with point group of the head selected as main points; and the behavior intervention group with professional behavior intervention comprehensive therapy in a special training school for autism children. Childhood autism rating scale (CARS) was used for evaluation of therapeutic effects. RESULTS: After 2 therapeutic courses (240 sessions), the markedly effective rate was 97.1% in the JIN's 3-needling group and 64.7% in the behavior intervention group; there was asignificant difference the therapeutic effect between the two groups (P<0.01); after the first course (first 120 session) and the second course (later 120 sessions), there was a very significant difference between the two groups (P<0.001); and there were significant differences before and after treatment in the courses in the two groups (P<0.01). CONCLUSION: Both the JIN's 3-needling therapy and the behavior intervention therapy have better therapeutic effects on severe child autism, but the therapeutic effect of JIN's 3-needling is much better.

OBJECTIVE: To find out an effective therapy for severe child autism. METHODS: Sixty-nine autism children were divided into a JIN's 3-needling group (n=35) and a behavior intervention group (n=34). The JIN's needling group was treated with JIN's 3-needling therapy, including Four-shen needling, Zhi-three needling and Nao-three needling, etc. with point group of the head selected as main points; and the behavior intervention group with professional behavior intervention comprehensive therapy in a special training school for autism children. Childhood autism rating scale (CARS) was used for evaluation of therapeutic effects. RESULTS: After 2 therapeutic courses (240 sessions), the markedly effective rate was 97.1% in the JIN's 3-needling group and 64.7% in the behavior intervention group; there was asignificant difference the therapeutic effect between the two groups (P<0.01); after the first course (first 120 session) and the second course (later 120 sessions), there was a very significant difference between the two groups (P<0.001); and there were significant differences before and after treatment in the courses in the two groups (P<0.01). CONCLUSION: Both the JIN's 3-needling therapy and the behavior intervention therapy have better therapeutic effects on severe child autism, but the therapeutic effect of JIN's 3-needling is much better.

OBJECTIVE: To observe the therapeutic effect of acupuncture ("Jin's Sanzhen") treatment for autism patients with different severity. METHODS: A total of 202 autism children were divided into treatment group (n=118) and control group (n=84) according to their parents' will. Autism children in the treatment group were treated with "Jin's Sanzhen" therapy [for example, Niesanzhen: the point 2 cun superior to the ear tip, and those at the same level 1 cun apart on the left and right sides; Naosanzhen: Naohu (GV 17), bilateral Naokong (GB 19), etc.], while those of control group accepted special training: behavior education (cognition, speech, communication ability, life self-care ability, etc.) and sensory integration training. The treatment was given to the patients in both groups once per day, six times a week for 4 months. RESULTS: Of the 78 and 58 severe patients in the treatment and control groups, 63 (80.8%) and4 (6.9%) experienced marked improvement, 9 (11.5%) and 33 (56.9%) experienced improvement, 6 (7.7%) and 21 (36.2%) failed, with the effective rates being 92.3% and 63.8% respectively. Of the 118 and 84 patients in the treatment and control groups, after the treatment, the no symptoms, mild, moderate and severe cases were 12 (10.2%) and 3 (3.6%), 56 (47.5%) and 25 (29.8%), 45 (38.1%) and 23 (27.4%), 5 (4.2%) and 33 (39.3%), respectively. The total score of Childhood Autism Rating Scale of treatment group was significantly lower than that of control group after the treatment in severe cases (P<0.01), showing a better therapeutic effect of the treatment group. CONCLUSION: "Jin's Sanzhen" therapy has a better therapeutic effect for improving the autism patients symptoms at different severity.

OBJECTIVE: To observe the therapeutic effect of acupuncture ("Jin's Sanzhen") treatment for autism patients with different severity. METHODS: A total of 202 autism children were divided into treatment group (n=118) and control group (n=84) according to their parents' will. Autism children in the treatment group were treated with "Jin's Sanzhen" therapy [for example, Niesanzhen: the point 2 cun superior to the ear tip, and those at the same level 1 cun apart on the left and right sides; Naosanzhen: Naohu (GV 17), bilateral Naokong (GB 19), etc.], while those of control group accepted special training: behavior education (cognition, speech, communication ability, life self-care ability, etc.) and sensory integration training. The treatment was given to the patients in both groups once per day, six times a week for 4 months. RESULTS: Of the 78 and 58 severe patients in the treatment and control groups, 63 (80.8%) and4 (6.9%) experienced marked improvement, 9 (11.5%) and 33 (56.9%) experienced improvement, 6 (7.7%) and 21 (36.2%) failed, with the effective rates being 92.3% and 63.8% respectively. Of the 118 and 84 patients in the treatment and control groups, after the treatment, the no symptoms, mild, moderate and severe cases were 12 (10.2%) and 3 (3.6%), 56 (47.5%) and 25 (29.8%), 45 (38.1%) and 23 (27.4%), 5 (4.2%) and 33 (39.3%), respectively. The total score of Childhood Autism Rating Scale of treatment group was significantly lower than that of control group after the treatment in severe cases (P<0.01), showing a better therapeutic effect of the treatment group. CONCLUSION: "Jin's Sanzhen" therapy has a better therapeutic effect for improving the autism patients symptoms at different severity.

STATEMENT OF PURPOSE: Indirect markers are consistent with greater oxidative stress in autism. They include greater free-radical production, impaired energetics and cholinergics, and higher excitotoxic markers. Brain and gut, both abnormal in autism, are particularly sensitive to oxidative injury. Higher red-cell lipid peroxides and urinary isoprostanes in autism signify greater oxidative damage to biomolecules. A preliminary study found accelerated lipofuscin deposition--consistent with oxidative injury to autistic brain in cortical areas serving language and communication. Double-blind, placebo-controlled trials of potent antioxidants--vitamin C or carnosine--significantly improved autistic behavior. Benefits from these and other nutritional interventions may be due to reduction of oxidative stress. Understanding the role of oxidative stress may help illuminate the pathophysiology of autism, its environmental and genetic influences, new treatments, and prevention. OBJECTIVES: Upon completion of this article, participants should be able to: 1. Be aware of laboratory and clinical evidence of greater oxidative stress in autism. 2. Understand how gut, brain, nutritional, and toxic status in autism are consistent with greater oxidative stress. 3. Describe how anti-oxidant nutrients are used in the contemporary treatment of autism.

OBJECTIVE: Determine the effect of a moderate dose multivitamin/mineral supplement on children with autistic spectrum disorder. DESIGN: Randomized, double-blind, placebo-controlled 3-month study. SUBJECTS: Twenty (20) children with autistic spectrum disorder, ages 3-8 years. RESULTS: A Global Impressions parental questionnaire found that the supplement group reported statistically significant improvements in sleep and gastrointestinal problems compared to the placebo group. An evaluation of vitamin B(6) levels prior to the study found that the autistic children had substantially elevated levels of B6 compared to a control group of typical children (75% higher, p < 0.0000001). Vitamin C levels were measured at the end of the study, and the placebo group had levels that were significantly below average for typical children, whereas the supplement group had near-average levels. DISCUSSION: The finding of high vitamin B(6) levels is consistent with recent reports of low levels of pyridoxal-5-phosphate and low activity of pyridoxal kinase (i.e., pyridoxal is only poorly converted to pyridoxal-5-phosphate, the enzymatically active form). This may explain the functional need for high-dose vitamin B(6) supplementation in many children and adults with autism.

Autism is commonly associated with sensory and self-regulatory disturbances. This article presents a randomized controlled study evaluating the effect of a 5-month intervention directed toward improving sensory impairment, digestion, and sleep in 46 children with autism < age 6. The intervention, Qigong Sensory Training (QST), is a qigong massage intervention based in Chinese medicine. It is two-pronged: Trainers work with children directly 20 times over 5 months, and parents give the massage daily to their children. Improvement was evaluated in two settings--preschool and home--by teachers (blind to group) and parents. Teacher evaluations showed that treated children had significant classroom improvement of social and language skills and reduction in autistic behavior compared with wait-list control participants. These findings were confirmed by parent data, indicating that the gains had generalized across contexts. A model and supporting data for understanding and treating sensory and self-regulation problems in autism is presented.

BACKGROUND AND OBJECTIVES: Autism is a neurodevelopmental disorder that manifests in delays in social interaction, language used in social communication, and symbolic or imaginative play, with an onset prior to age 3 years. Language therapy (LT) for children with autism is the main form of rehabilitation, because it emphasizes its major presenting symptom (i.e., language impairment). Scalp acupuncture (scalp AP) is a modality based on the physiologic function of different brain areas, where different scalp zones are stimulated with needles so as to stimulate the reflexively related nervous tissue. This study aimed to evaluate the role of scalp AP as a complementary modality to LT in rehabilitation of children with autism. SUBJECTS AND DESIGN: The study involved 20 children (divided into 2 equal groups: A and B), diagnosed as autistic according to DSM IV classification. Their ages ranged between 4 and 7 years old. All subjects underwent LT twice weekly, aiming at stimulation of cognitive and verbal abilities. Group B only was subjected to scalp AP sessions--twice weekly--as a rehabilitation complementary tool during the 9-month period of the study. The acupoints used were: Du 20, 26, GV17; three temple needles; and Yamamoto's New Scalp Acupuncture cerebrum and aphasia points (acupuncture needles 0.3 x 30 mm). A language test was performed before and after therapy to monitor cognition and expression (an Arabic test was included). RESULTS: Both groups, whose mean age range was 5.5 years+/-1.22 years, showed a significant improvement in cognitive and expressive language skills pre- and post-therapy, which was highly significant among group B children treated with scalp AP (attention 2.8+/-0.8 in group A versus 3.5+/-0.8 in group B; receptive semantics were 7+/-3.8 in group A versus 9.4+/-3.1 in group B). Expressive semantics significantly improved in both groups. CONCLUSIONS: Scalp AP is a safe complementary modality when combined with LT and has a significantly positive effect on language development in children with autism.

BACKGROUND AND OBJECTIVES: Autism is a neurodevelopmental disorder that manifests in delays in social interaction, language used in social communication, and symbolic or imaginative play, with an onset prior to age 3 years. Language therapy (LT) for children with autism is the main form of rehabilitation, because it emphasizes its major presenting symptom (i.e., language impairment). Scalp acupuncture (scalp AP) is a modality based on the physiologic function of different brain areas, where different scalp zones are stimulated with needles so as to stimulate the reflexively related nervous tissue. This study aimed to evaluate the role of scalp AP as a complementary modality to LT in rehabilitation of children with autism. SUBJECTS AND DESIGN: The study involved 20 children (divided into 2 equal groups: A and B), diagnosed as autistic according to DSM IV classification. Their ages ranged between 4 and 7 years old. All subjects underwent LT twice weekly, aiming at stimulation of cognitive and verbal abilities. Group B only was subjected to scalp AP sessions--twice weekly--as a rehabilitation complementary tool during the 9-month period of the study. The acupoints used were: Du 20, 26, GV17; three temple needles; and Yamamoto's New Scalp Acupuncture cerebrum and aphasia points (acupuncture needles 0.3 x 30 mm). A language test was performed before and after therapy to monitor cognition and expression (an Arabic test was included). RESULTS: Both groups, whose mean age range was 5.5 years+/-1.22 years, showed a significant improvement in cognitive and expressive language skills pre- and post-therapy, which was highly significant among group B children treated with scalp AP (attention 2.8+/-0.8 in group A versus 3.5+/-0.8 in group B; receptive semantics were 7+/-3.8 in group A versus 9.4+/-3.1 in group B). Expressive semantics significantly improved in both groups. CONCLUSIONS: Scalp AP is a safe complementary modality when combined with LT and has a significantly positive effect on language development in children with autism.

The purpose of this study was to examine the effect of background music and song texts to teach emotional understanding to children with autism. Participants were 12 students (mean age 11.5 years) with a primary diagnosis of autism who were attending schools in Japan. Each participant was taught four emotions to decode and encode: happiness, sadness, anger, and fear by the counterbalanced treatment-order. The treatment consisted of the four conditions: (a) no contact control (NCC)--no purposeful teaching of the selected emotion, (b) contact control (CC)--teaching the selected emotion using verbal instructions alone, (c) background music (BM)--teaching the selected emotion by verbal instructions with background music representing the emotion, and singing songs (SS)--teaching the selected emotion by singing specially composed songs about the emotion. Participants were given a pretest and a posttest and received 8 individual sessions between these tests. The results indicated that all participants improved significantly in their understanding of the four selected emotions. Background music was significantly more effective than the other three conditions in improving participants' emotional understanding. The findings suggest that background music can be an effective tool to increase emotional understanding in children with autism, which is crucial to their social interactions.

BACKGROUND: Recently, hyperbaric oxygen therapy (HBOT) has increased in popularity as a treatment for autism. Numerous studies document oxidative stress and inflammation in individuals with autism; both of these conditions have demonstrated improvement with HBOT, along with enhancement of neurological function and cognitive performance. In this study, children with autism were treated with HBOT at atmospheric pressures and oxygen concentrations in current use for this condition. Changes in markers of oxidative stress and inflammation were measured. The children were evaluated to determine clinical effects and safety. METHODS: Eighteen children with autism, ages 3-16 years, underwent 40 hyperbaric sessions of 45 minutes duration each at either 1.5 atmospheres (atm) and 100% oxygen, or at 1.3 atm and 24% oxygen. Measurements of C-reactive protein (CRP) and markers of oxidative stress, including plasma oxidized glutathione (GSSG), were assessed by fasting blood draws collected before and after the 40 treatments. Changes in clinical symptoms, as rated by parents, were also assessed. The children were closely monitored for potential adverse effects. RESULTS: At the endpoint of 40 hyperbaric sessions, neither group demonstrated statistically significant changes in mean plasma GSSG levels, indicating intracellular oxidative stress appears unaffected by either regimen. A trend towards improvement in mean CRP was present in both groups; the largest improvements were observed in children with initially higher elevations in CRP. When all 18 children were pooled, a significant improvement in CRP was found (p = 0.021). Pre- and post-parental observations indicated statistically significant improvements in both groups, including motivation, speech, and cognitive awareness (p<0.05). No major adverse events were observed. CONCLUSION: In this prospective pilot study of children with autism, HBOT at a maximum pressure of 1.5 atm with up to 100% oxygen was safe and well tolerated. HBOT did not appreciably worsen oxidative stress and significantly decreased inflammation as measured by CRP levels. Parental observations support anecdotal accounts of improvement in several domains of autism. However, since this was an open-label study, definitive statements regarding the efficacy of HBOT for the treatment of individuals with autism must await results from double-blind, controlled trials. TRIAL REGISTRATION: clinicaltrials.gov NCT00324909.

The purpose of this study was to investigate the effects of improvisational music therapy on joint attention behaviors in pre-school children with autism. It was a randomized controlled study employing a single subject comparison design in two different conditions, improvisational music therapy and play sessions with toys, and using standardized tools and DVD analysis of sessions to evaluate behavioral changes in children with autism. The overall results indicated that improvisational music therapy was more effective at facilitating joint attention behaviors and non-verbal social communication skills in children than play. Session analysis showed significantly more and lengthier events of eye contact and turn-taking in improvisational music therapy than play sessions. The implications of these findings are discussed further.