Et cetera

In autism study, it’s all about the eyes

Watching subjects watch a film, researchers gain insight into social perception by people with autism.

When Yale scientists wanted to find out what people with autism looked at, they turned for help to Elizabeth Taylor and Richard Burton. The investigators used brief clips from the 1966 movie Who’s Afraid of Virginia Woolf? and a baseball cap affixed with cameras to follow their subjects’ eye movements.

“It’s as if we can stand behind the eyes of a person with autism and see what they’re looking at. They are looking at very different things than the rest of us,” said Fred R. Volkmar, M.D., professor of child psychiatry, pediatrics and psychology, and principal investigator on the project.

Volkmar and colleagues reported the results of two similar experiments in the September issue of the Archives of General Psychiatry and in last June’s issue of The American Journal of Psychiatry. As subjects and controls watched the movie on a computer screen and reacted to emotional scenes, the researchers monitored what each viewer saw, using an infrared camera that captured eye movements. The camera was placed on the bill of a baseball cap worn by the subjects. Another miniature camera on the hat recorded images in each subject’s field of view.

The investigators found that the people with autism focused on individual features of the face, rather than the whole face. They looked at the mouth rather than the eyes, which contain many social clues. In fact, the control group looked at the eyes twice as often as did the group with autism. Those with autism also tended to focus on inanimate objects in the scenes they observed. The subjects with autism who fixated on mouths tended to have better social adjustment than those who concentrated on inanimate objects.

Volkmar said previous efforts to measure response to social stimuli tended to rely on still photographs. “That doesn’t tell us much about what happens in the real world,” he said, explaining the decision to use a movie. To eliminate distractions, the researchers looked for a movie depicting intense social interaction with a limited number of characters and few locations. “We didn’t want Rambo and Sylvester Stallone and Arnold Schwarzenegger chomping up scenery,” Volkmar said. “We were interested in a movie that focused on people and relationships.”

The experiments yielded clues as to what people with autism observe and the strategies they use to understand situations. They also suggested possible interventions, Volkmar said, such as new methods of screening for children at risk for autism.

Volkmar and another Yale scientist recently received $11 million in grants to pursue their studies. Two grants of $5 million each came from the Collaborative Programs of Excellence in Autism and the Studies to Advance Autism Research and Treatment Centers Program, under the auspices of the National Institutes of Health. Another $1 million grant came from the National Institute of Mental Health, for a study by Ami J. Klin, Ph.D., associate professor of child psychiatry.

—John Curtis

Although reducing accidents was not the project’s primary goal, the construction of new housing along New Haven’s Dixwell Avenue in the mid-1990s led to a lower incidence of accidents involving cars and pedestrians.

Busing and better housing are found to have an impact on pedestrian safety

Analyzing New Haven accident statistics during a seven-year period, a Yale team has found that interventions by city officials helped keep children safe, even though some of those measures never had pedestrian safety in mind.

The researchers found that between 1992 and 1999 the number of children hit by vehicles plummeted from 223 to 87. They attributed the decline to five policy moves instituted in those years, two of which weren’t intended to prevent accidents.

Research began when Thomas S. Renshaw, M.D., chief of pediatric orthopaedics, noticed that the city had an alarmingly high rate of pedestrian accidents involving children. With Jon C. Driscoll, M.D. ’95, Gregory A. Merrell, M.D., and Linda C. Degutis, Dr.P.H. ’94, an associate professor of surgery (emergency medicine) and public health, Renshaw approached city agencies. “They clearly were interested in doing something about the problem, and did have some things in the planning stages,” Degutis said.

After comparing the statistics of children involved in pedestrian accidents in 1992-93 to those for 1998-99, the team found that several factors that could have figured into the decline—population, the number of parks, and traffic speed and volume—hadn’t changed much between 1992 and 1999.

So what did change?

The city launched two separate campaigns in the 1990s to make the streets safer. One was a public service message that included mass mailings and billboards to promote safe driving. The second encouraged police officers to write more tickets to people driving recklessly. In 1999, police wrote 22 percent more tickets than they had the year before.

Also during this time, traffic safety became a regular part of the curriculum in the New Haven public schools. The schools also undertook a massive increase in busing—not for safety, but for integration. Bus ridership rose from 35 percent in 1992 to 73 percent in 1999, the study said. Moreover, more pupils were picked up at home instead of at a bus stop. The Yale team estimated that this lowered the number of accidents in two ways: children were crossing fewer streets and getting home later. “They’re on the bus instead of playing in the streets,” Renshaw said.

The city also started decentralizing its public housing in 1990. The largest high-rise development, Elm Haven on Dixwell Avenue, was torn down in 1999 “because of the crime and [because we’re] trying to provide decent, sanitary housing,” said Diane Jackson of the New Haven Housing Authority. “I don’t think we sat down and said, ‘We need to do this to take care of the statistics from accidents happening in the area.’”

Yet that’s exactly what happened. Five children were struck at an intersection adjacent to Elm Haven in 1992, more than on any other street in the city. In 1999 there were none.

“The decrease in injuries is an unintended positive consequence of these actions,” Degutis said. “We certainly can’t take credit for making the change, but are pleased that it has appeared to have an effect.”

The research was published in the May 2002 issue of The Journal of Bone and Joint Surgery.

—John Dillon

Et Cetera

A step against smallpox

Travels abroad led James L. Hadler, M.D., M.P.H. ’82, to seek inoculations against smallpox at least four times before 2003. His fifth vaccination in January landed him in full color on the pages of newspapers around the country. As head of smallpox preparedness planning for Connecticut and state epidemiologist at the Department of Public Health, Hadler became one of the first civilians to receive the vaccine under the Homeland Security Act.

Hadler’s vaccination was part of stage 1 of the program, in which up to 400,000 front-line health care providers may volunteer for inoculations. These vaccinations, Hadler said, would help set the stage for handling an emergency. “We will have a core of responders who are ready to roll. We will have experience with the vaccine. We will have people trained and experienced in administering the vaccine. We can initiate a response much more quickly than if we didn’t have this core of people,” Hadler said.

—John Curtis

New approach to ovarian cancer

The School of Medicine has joined in an international study of a new drug, phenoxodiol, that unblocks receptors needed to destroy ovarian cancer cells. Yale is the only U.S. institution participating in the Phase II clinical trial. “This is a completely new approach in the treatment of ovarian cancer,” said Gil Mor, M.D., Ph.D., assistant professor of obstetrics and gynecology, who is leading the study along with Thomas J. Rutherford, M.D., Ph.D., associate professor of gynecologic oncology. “We are finding that phenoxodiol is able to induce cell death in ovarian cancer cells that proved to be resistant to the effects of all other drugs, including those presently in use for the treatment of ovarian cancer.”

The Yale study will enroll about 40 women for 12-week treatment cycles. The drug is being tested by Yale for Marshall Edwards Inc., a subsidiary of Novogen Ltd.

—John Curtis


			Originally published in Yale Medicine, Spring 2003. Copyright © 2003 Yale University School of Medicine. All rights reserved.