"The PIT Experience": A Young Adult with Autism Spectrum Disorder's Opinion of how a Wellness Program Changed her Life.

Piece it Together (PIT) is a comprehensive wellness program designed for transitional age youth with Autism Spectrum Disorder and mild neurodevelopmental disabilities that focuses on exercise, nutrition, socialization, and stress-reduction. The PIT Summer Program is a 6-week program, consisting of 90-min classes, twice a week. Each class incorporates 45-min of exercise and health and wellness lessons in goal setting, nutrition, bones and muscle anatomy, and stress management. The PIT program has successfully brought together a unique group to build friendships and make healthier lifestyle choices. One female participant has felt positively impacted and many of her in-class achievements have translated to greater success in work and school environments. She describes the impacts of the PIT program in this letter.

Translating benefits of exercise on depression for youth with autism spectrum disorder and neurodevelopmental disorders.

Young adults with Autism Spectrum Disorder (ASD) are at increased risk of poor health and depressive symptoms due to difficulty with communication, limited interests, sensory deficits, and sedentary lifestyles. The Piece It Together program was developed to provide socialization and wellness goals for teens and young adults with ASD and other mild neurocognitive deficits. The curriculum includes strength and endurance training, nutrition education, and stress reduction techniques to promote healthy lifestyle choices. Twelve participants, aged 15-27, attended 90-minute classes at the MUSC Wellness Center twice a week for six weeks and were encouraged to increase their activity level every day. The Patient Health Questionnaire (PHQ-9) was administered to each participant at the first and last class. Results showed significantly decreased PHQ-9 depression scores at the end of the program, from mild (7.69) to minimal depression (3.42) (p=0.000063). Overall, the activities completed in the Piece It Together program successfully unified this group to promote healthy lifestyle choices and resulted in improved mood.

Use of the Spot Vision Screener for patients with developmental disability.

PURPOSE: To determine whether the Spot Vision Screener effectively detects amblyopia risk factors (ARFs) in patients with developmental disability using the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). METHODS: Children with developmental disability presenting for complete pediatric ophthalmologic examination were prospectively enrolled between June 2012 and March 2016. The following data were analyzed: presence of ARFs according to the AAPOS guidelines, refraction, eye alignment, and other ocular pathology. RESULTS: A total of 100 children (average age, 5.7 years; range, 2.2- 9.2 years) were included. The prevalence of ARFs in this cohort was 38%. The sensitivity of the Spot Vision Screener in detecting amblyopia risk factors was 84%; the specificity, 62%. The positive predictive value was 58%; the negative predictive value, 86%. CONCLUSIONS: In our study cohort the Spot Vision Screener provided good sensitivity and adequate specificity for a screening examination. Automated screeners may be useful in screening children with developmental disability.

Detecting High Hyperopia: The Plus Lens Test and the Spot Vision Screener.

PURPOSE: To evaluate the usefulness of the Plus Lens (Goodlite Company, Elgin, IL) test and the Spot Vision Screener (Welch Allyn, Skaneateles Falls, NY) in detecting high hyperopia in a pediatric population. METHODS: Between June and August 2015, patients were screened with the Spot Vision Screener and the Plus Lens test prior to a scheduled pediatric ophthalmology visit. The following data were analyzed: demographic data, Plus Lens result, Spot Vision Screener result, cycloplegic refraction, and examination findings. Sensitivity/specificity and positive/negative predictive values were calculated for the Plus Lens test and Spot Vision Screener in detecting hyperopia as determined by the "gold-standard" cycloplegic refraction. RESULTS: A total of 109 children (average age: 82 months) were included. Compared to the ophthalmologist's cycloplegic refraction, the Spot Vision Screener sensitivity for +3.50 diopters (D) hyperopia was 31.25% and the specificity was 100%. The Plus Lens sensitivity for +3.50 D hyperopia was 43.75% and the specificity was 89.25%. Spot Vision Screener sensitivity increased with higher degrees of hyperopia. CONCLUSIONS: In this preliminary study, the Plus Lens test and the Spot Vision Screener demonstrated moderate sensitivity with good specificity in detecting high hyperopia. [J Pediatr Ophthalmol Strabismus. 2017;54(3):163-167.].

Biologic effects of stress and bonding in mother-infant pairs.

OBJECTIVE: Maternal stress in humans influences behavior of children and can be assessed using biological markers. Mothers and their one-month-old infants were recruited from an existing study to examine baseline maternal serum oxytocin and hypothalamic-pituitary-adrenal axis response to infant blood heel stick stress as measured by salivary cortisol in the dyads. Objectives were to explore (1) relationships between mother and infant cortisol levels, (2) gender differences in infant biologic cortisol response, and (3) the association of cortisol levels in the dyads and maternal oxytocin levels METHODS: Forty-two mother-infant dyads provided biologic samples and self-report data. Maternal oxytocin samples were obtained. Initial salivary cortisol was assessed in both the mother and infant, followed by a heel stick blood draw. Twenty minutes later, salivary cortisol was collected again from dyads. RESULTS: Self-report measures were negative for depression and risk for childhood neglect. Although oxytocin and baseline cortisol in the infants was higher in mothers that did some breast-feeding, there was no statistically significant difference (p = 0.2 and p = 0.1, respectively). Analyses showed (a) higher baseline cortisol in mothers was related to higher baseline cortisol in infants (p ≤ 0.0001), (b) following the stressor, female infants had a larger positive change in cortisol, after adjusting for baseline cortisol (p = 0.045), and (c) there was no relationship between dyad cortisol levels and maternal oxytocin. CONCLUSIONS: Maternal and infant biologic stress measures are related. Female infants have a larger hypothalamic-pituitary-adrenal response to a blood draw stressor as measured by salivary cortisol than male infants.

Prospective Evaluation of Photoscreeners in the Pseudophakic Eyes of Children.

PURPOSE: To compare refractive data of Plusoptix AO9 (Plusoptix, Inc., Atlanta, GA) and Spot (Welch Allyn, Skaneateles Falls, NY) photoscreeners with retinoscopy in pseudophakic eyes of children. METHODS: In this prospective study, patients underwent testing with the Plusoptix and Spot photoscreeners prior to their examination by a pediatric ophthalmologist masked to the results of both photoscreeners. Data including testability and estimated refractions were entered into a Research Electronic Data Capture database for statistical analysis. For bilateral pseudophakia, one randomly selected eye was included in the analysis. RESULTS: Forty-four eyes were included, with a mean age of 7.4 ± 4.8 years. Refraction was estimated in all eyes using retinoscopy, but a refractive estimate was obtained in only 11.3% (5 of 44) of eyes using the Plusoptix binocularly and 63.6% (28 of 44) of eyes using the Spot. Compared to retinoscopy, the Plusoptix showed a mean difference of -0.80, 0.10, and -0.75 diopters (D) for sphere, cylinder, and spherical equivalent, respectively (P > .05). Comparable values for the Spot were 0.18, -0.26, and 0.05 D, respectively (P > .05). Compared to retinoscopy, the Plusoptix showed a mean absolute difference of 1.30, 0.80, and 1.25 D for sphere, cylinder, and spherical equivalent, respectively (P > .05). Similar values for the Spot were 1.38, 0.88, and 0.97 D, respectively (P > .05). CONCLUSIONS: Refraction was estimated in a higher number of pseudophakic eyes of children using the Spot as compared to the Plusoptix. The Spot may be useful to evaluate myopic shift in pseudophakic eyes of children. [J Pediatr Ophthalmol Strabismus. 2016;53(3):146-149.].

Detection of strabismus by the Spot Vision Screener.

BACKGROUND: The Spot Vision Screener, a new automated screener designed for use in schools and pediatric offices, refers children for strabismus based on the device's measurement of "gaze." We sought to evaluate its ability to detect manifest strabismus of ≥8(Δ) in primary position, which criteria is specified by the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus for detection of amblyopia risk factors by automated vision screeners. METHODS: In this prospective study, new and returning patients seen in the pediatric ophthalmology clinic underwent screening with the Spot Vision Screener (version 1.1.51) prior to a complete examination by a pediatric ophthalmologist. A Research Electronic Data Capture database was created for results of Spot referral status and examination. Patients who were referred by the Spot for gaze were included as test positives. Patients found to have constant strabismus of ≥8(Δ) in primary position by the physician were considered referral positive. RESULTS: A total of 444 children (average age, 72 months; range, 11-221 months) were included. Of these, 93 (20.9%) met the referral-positive threshold for strabismus criteria on examination by the pediatric ophthalmologist. The sensitivity of the Spot to detect AAPOS-threshold strabismus was 77.17%; the specificity, 93.73%. Positive predictive value was 76.34%; negative predictive value, 94.0%. CONCLUSIONS: The Spot demonstrates good sensitivity and excellent specificity for detecting AAPOS-threshold strabismus.

Evaluation of the Spot Vision Screener in young children in Costa Rica.

BACKGROUND: The Spot Vision Screener has demonstrated good sensitivity and specificity in the pediatric ophthalmology clinic setting. We sought to evaluate the updated Spot (version 2.0.16) in a general pediatric population through a collaboration of the Storm Eye Institute of the Medical University of South Carolina, the Clinica Dr Clorito Picado, and National Children's Hospital of Costa Rica. We compared results of screening with the Spot and pediatric ophthalmologic examination and determined sensitivity and specificity of the Spot in detecting amblyogenic risk factors (ARFs) according to the 2013 AAPOS Vision Screening Committee guidelines for automated vision screeners. METHODS: Children were screened with the Spot followed by a pediatric ophthalmologic examination. Cycloplegic refraction and motility findings were analyzed by age group to determine ARFs. RESULTS: A total of 219 subjects, averaging 60 months of age (range, 20-119 mo) were included. The prevalence of ARFs in our population was 12.3% (27/219). The most common risk factor was astigmatism, with a prevalence of 8.7% (19/219). The Spot referred 43 children (19.6%). Sensitivity of the Spot was 92.6%; specificity, 90.6%. The positive predictive value was 58.1%; the negative predictive value, 98.9%. CONCLUSIONS: The Spot demonstrated good sensitivity and specificity in detecting amblyopia risk factors in this general pediatric population.

Combining automated vision screening with on-site examinations in 23 schools: ReFocus on Children Program 2012 to 2013.

PURPOSE: The Association for the Blind and Visually Impaired (ABVI) began the ReFocus on Children Program to assist school nurses in providing vision screening for at-risk children in the Charleston County School District in South Carolina. METHODS: In 2012 to 2013, 2,750 low-income school children ages 3 to 5 years were screened using the Plusoptix Vision screener (Atlanta, GA). Further examinations were performed on 419 (56%) children referred and glasses prescribed and provided for 192 children (positive predictive value 46%). In 2013, teacher feedback questionnaires were sent to the 23 schools. RESULTS: Teacher feedback questionnaires had a 49% response rate. Of teachers responding to the questionnaire, 70% reported the children liked wearing their glasses. Teachers provided observations of positive impact, including improved academic performance. CONCLUSIONS: Nurses appreciated that the entire process was efficient and completed in school, simplifying care and follow-up. The authors encourage partnerships between schools, nonprofit agencies, and healthcare providers to improve screening and access to comprehensive vision care for young children.

Pilot Study and Review: Physiological Differences in BDNF, a Potential Biomarker in Males and Females with Autistic Disorder.

AIMS: There is a need for more biologic research in autistic disorder (AD) to determine if biomarkers exist that would be useful for correlating to symptom severity and/or clinical improvement during treatment. Given the fact that AD is 4 times more common in males than females, gender differences in physiological biomarkers may be present. One potential biomarker that has begun to be studied is brain-derived neurotropic factor (BDNF), a peptide involved in the regulation of neuronal cell survival, differentiation, and plasticity, and possessing an ability to influence neurotransmitter systems by modulating gene expression. This pilot study examined whether serum BDNF differed according to gender in children with AD and whether differences were associated with a behavioral phenotype or severity of illness. STUDY DESIGN: Data for this investigation were collected during the participants' baseline visit of an intervention study. Participants were males (n=29) and females (n=7), aged 5 to 12 years diagnosed with AD. Baseline serum BDNF concentration was determined for comparison to clinical ratings using an autism severity measure and the Pervasive Developmental Disorder-Behavior Inventory (PDD-BI). RESULTS: BDNF serum concentrations were higher in females (p<0.049). The baseline BDNF value corresponded significantly to hyperactivity in females (p<0.0002) but not in males. BDNF did not correlate with severity of disease in either gender. CONCLUSION: Although this is a small study, a better understanding of the central role of BDNF may provide insight into the pathophysiology of the disease and elucidate why gender differences exist in prevalence and behavioral phenotype of AD.

Growth failure associated with early neglect: pilot comparison of neglected US children and international adoptees.

The long-lasting impact of different neglectful environments on growth in children is not well studied. Three groups of children, 3-10 years old, were recruited (n=60): previously institutionalized international adoptees living in stable home environments for at least 2 years (IA; n=15), children with a history of neglect born in the USA (USN; n=17), and controls (n=28). Children underwent physical examination, anthropometry, and collection of serum for growth parameters. Mean height standard deviation scores (SDS) were different (p<0.05). Age-adjusted head circumference (HC) was significantly smaller (p<0.05) in IAs. Insulin growth factor (IGF-1), a marker of growth hormone action, was higher in US neglected children. IGF-1 adjusted for age and weight SDS were different (p<0.05) between control and US neglect groups. The degree of growth failure in height and HC in IAs was more severe than neglected US children. These findings may reflect differences between the impact of chronic and intermittent deprivation on the growth hormone system.

The effectiveness of the Spot Vision Screener in detecting amblyopia risk factors.

PURPOSE: To evaluate the updated Spot Vision Screener (PediaVision, Welch Allyn, Skaneateles Falls, NY) in detecting amblyopia risk factors using 2013 guidelines of American Association for Pediatric Ophthalmology and Strabismus (AAPOS). METHODS: In this prospective study, patients seen from June 2012 to November 2013 were tested with the Spot prior to examination by a pediatric ophthalmologist who was masked to test results. The following data were analyzed: age, subject testability, examination findings, and systemic and ocular pathology. Children were divided into three age groups to determine gold standard results according to the AAPOS guidelines. RESULTS: A total of 444 children (average age, 72 months) were included. Compared to the ophthalmologist's examination, the Spot sensitivity was 87.7% and the specificity was 75.9% in detecting amblyopia risk factors. Sensitivity did not differ significantly between age groups, although the positive predictive value improved in the older age groups. CONCLUSIONS: In our study cohort, the Spot provided good specificity and sensitivity in detecting amblyopia risk factors according 2013 AAPOS criteria, with minor improvements with updated versions.

Photoscreeners in the pediatric eye office: compared testability and refractions on high-risk children.

PURPOSE: To compare refractive data and testability of Spot (PediaVision) and Plusoptix A09 (Plusoptix, Inc) photoscreeners and to compare each device with traditional cycloplegic retinoscopy. DESIGN: Prospective, interventional case series. METHODS: After informed consent, patients underwent testing with the Spot and Plusoptix photoscreeners before their examination by a pediatric ophthalmologist masked to the results. Data including testability and estimated refractions were entered into a Research Electronic Data Capture database for statistical analysis. RESULTS: A total of 265 children were enrolled (mean age, 6.0 ± 3.4 years). Both devices produced a computer printout result in 250 (94.3%) of the patients. The Spot photoscreener provided a refractive estimate in all computer printouts, whereas the Plusoptix, used binocularly, provided a refractive estimate in 75.2% (188/250) of the printouts. Compared with cycloplegic retinoscopy, both devices underestimated hyperopia or overestimated myopia (-1.35 diopters [D] and -0.64 D, Spot and Plusoptix, respectively) and overestimated astigmatism (0.36 D and 0.32 D, Spot and Plusoptix, respectively). The intraclass correlation coefficient for spherical equivalents indicated good agreement between cycloplegic retinoscopy and Spot (0.806) and excellent agreement between cycloplegic retinoscopy and Plusoptix (0.898). CONCLUSIONS: The Spot photoscreener provided refractive data on a greater percentage of children. The photorefractors correlated with cycloplegic retinoscopy refractive findings for sphere and spherical equivalents, but underestimated hyperopia or overestimated myopia and overestimated astigmatism. The binocular refractions of Plusoptix agreed more closely with the refractions of our pediatric ophthalmologists.