Messy children make better learners

Attention, parents: The messier your child gets while playing with food in the high chair, the more he or she is learning.

Researchers at the University of Iowa studied how 16-month-old children learn words for nonsolid objects, from oatmeal to glue. Previous research has shown that toddlers learn more readily about solid objects because they can easily identify them due to their unchanging size and shape. But oozy, gooey, runny stuff? Not so much.

New research shows that changes if you put toddlers in a setting they know well. In those instances, word learning increases, because children at that age are “used to seeing nonsolid things in this context, when they’re eating,” says Larissa Samuelson, associate professor in psychology at the UI who has worked for years on how children learn to associate words with objects. “And, if you expose them to these things when they’re in a highchair, they do better. They’re familiar with the setting and that helps them remember and use what they already know about nonsolids.”

In a paper published in the journal Developmental Science, Samuelson and her team at the UI tested their idea by exposing 16-month-olds to 14 nonsolid objects, mostly food and drinks such as applesauce, pudding, juice, and soup. They presented the items and gave them made-up words, such as “dax” or “kiv.” A minute later, they asked the children to identify the same food in different sizes or shapes. The task required the youngsters to go beyond relying simply on shape and size and to explore what the substances were made of to make the correct identification and word choice.

Not surprisingly, many children gleefully dove into this task by poking, prodding, touching, feeling, eating—and yes, throwing—the nonsolids in order to understand what they were and make the correct association with the hypothetical names. The toddlers who interacted the most with the foods—parents, interpret as you want—were more likely to correctly identify them by their texture and name them, the study determined. For example, imagine you were a 16-month-old gazing at a cup of milk and a cup of glue. How would you tell the difference by simply looking?

“It’s the material that makes many nonsolids,” Samuelson notes, “and how children name them.”

The setting matters, too, it seems. Children in a high chair were more apt to identify and name the food than those in other venues, such as seated at a table, the researchers found.

“It turns out that being in a high chair makes it more likely you’ll get messy, because kids know they can get messy there,” says Samuelson, the senior author on the paper.

The authors say the exercise shows how children’s behavior, environment (or setting), and exploration help them acquire an early vocabulary—learning that is linked to better later cognitive development and functioning.

“It may look like your child is playing in the high chair, throwing things on the ground, and they may be doing that, but they are getting information out of (those actions),” Samuelson contends. “And, it turns out, they can use that information later. That’s what the high chair did. Playing with these foods there actually helped these children in the lab, and they learned the names better.”

“It’s not about words you know, but words you’re going to learn,” Samuelson adds.

A single spray of oxytocin improves brain function in children with autism

A single dose of the hormone oxytocin, delivered via nasal spray, has been shown to enhance brain activity while processing social information in children with autism spectrum disorders, Yale School of Medicine researchers report in a new study published in the Dec. 2 issue of Proceedings of the National Academy of Sciences.

“This is the first study to evaluate the impact of oxytocin on brain function in children with autism spectrum disorders,” said first author Ilanit Gordon, a Yale Child Study Center adjunct assistant professor, whose colleagues on the study included senior author Kevin Pelphrey, the Harris Professor in the Child Study Center, and director of the Center for Translational Developmental Neuroscience at Yale.

Gordon, Pelphrey, and their colleagues conducted a double-blind, placebo-controlled study of 17 children and adolescents with autism spectrum disorders. The participants, between the ages of 8 and 16.5, were randomly given either oxytocin spray or a placebo nasal spray during a task involving social judgments. Oxytocin is naturally occurring hormone produced in the brain and throughout the body.

“We found that brain centers associated with reward and emotion recognition responded more during social tasks when children received oxytocin instead of the placebo,” said Gordon. “Oxytocin temporarily normalized brain regions responsible for the social deficits seen in children with autism.”

Gordon said oxytocin facilitated social attunement, a process that makes the brain regions involved in social behavior and social cognition activate more for social stimuli (such as faces) and activate less for non-social stimuli (such as cars).

“Our results are particularly important considering the urgent need for treatments to target social dysfunction in autism spectrum disorders,” Gordon added.

Brain Connectivity Study Reveals Striking Differences Between Men and Women

A new brain connectivity study from Penn Medicine published today in the Proceedings of National Academy of Sciences found striking differences in the neural wiring of men and women that’s lending credence to some commonly-held beliefs about their behavior.

In one of the largest studies looking at the “connectomes” of the sexes, Ragini Verma, PhD, an associate professor in the department of Radiology at the Perelman School of Medicine at the University of Pennsylvania, and colleagues found greater neural connectivity from front to back and within one hemisphere in males, suggesting their brains are structured to facilitate connectivity between perception and coordinated action. In contrast, in females, the wiring goes between the left and right hemispheres, suggesting that they facilitate communication between the analytical and intuition.

“These maps show us a stark difference—and complementarity—in the architecture of the human brain that helps provide a potential neural basis as to why men excel at certain tasks, and women at others,” said Verma.

For instance, on average, men are more likely better at learning and performing a single task at hand, like cycling or navigating directions, whereas women have superior memory and social cognition skills, making them more equipped for multitasking and creating solutions that work for a group. They have a mentalistic approach, so to speak.

Past studies have shown sex differences in the brain, but the neural wiring connecting regions across the whole brain that have been tied to such cognitive skills has never been fully shown in a large population.

In the study, Verma and colleagues, including co-authors Ruben C. Gur, PhD, a professor of psychology in the department of Psychiatry, and Raquel E. Gur, MD, PhD, professor of Psychiatry, Neurology and Radiology, investigated the gender-specific differences in brain connectivity during the course of development in 949 individuals (521 females and 428 males) aged 8 to 22 years using diffusion tensor imaging (DTI). DTI is water-based imaging technique that can trace and highlight the fiber  pathways connecting the different regions of the brain, laying the foundation for a structural connectome or network of the whole brain.

This sample of youths was studied as part of the Philadelphia Neurodevelopmental Cohort, a National Institute of Mental Health-funded collaboration between the University of Pennsylvania Brain Behavior Laboratory and the Center for Applied Genomics at the Children’s Hospital of Philadelphia. 

The brain is a roadmap of neural pathways linking many networks that help us process information and react accordingly, with behavior controlled by several of these sub-networks working in conjunction. 

In the study, the researchers found that females displayed greater connectivity in the supratentorial region, which contains the cerebrum, the largest part of the brain, between the left and right hemispheres. Males, on the other hand, displayed greater connectivity within each hemisphere. 

By contrast, the opposite prevailed in the cerebellum, the part of the brain that plays a major role in motor control, where males displayed greater inter-hemispheric connectivity and females displayed greater intra-hemispheric connectivity. 

These connections likely give men an efficient system for coordinated action, where the cerebellum and cortex participate in bridging between perceptual experiences in the back of the brain, and action, in the front of the brain, according to the authors. The female connections likely facilitate integration of the analytic and sequential processing modes of the left hemisphere with the spatial, intuitive information processing modes of the right side.

The authors observed only a few gender differences in the connectivity in children younger than 13 years, but the differences were more pronounced in adolescents aged 14 to 17 years and young adults older than 17.

The findings were also consistent with a Penn behavior study, of which this imaging study was a subset of, that demonstrated pronounced sexual differences.  Females outperformed males on attention, word and face memory, and social cognition tests. Males performed better on spatial processing and sensorimotor speed. Those differences were most pronounced in the 12 to 14 age range.

“It’s quite striking how complementary the brains of women and men really are,” said Dr. Ruben Gur.  “Detailed connectome maps of the brain will not only help us better understand the differences between how men and women think, but it will also give us more insight into the roots of neurological disorders, which are often sex related.”

Next steps are to quantify how an individual’s neural connections are different from the population; identify which neural connections are gender specific and common in both; and to see if findings from functional magnetic resonance imaging (fMRI) studies fall in line with the connectome data.

Memories Are ‘Geotagged’ With Spatial Information

Using a video game in which people navigate through a virtual town delivering objects to specific locations, a team of neuroscientists from the University of Pennsylvania and Freiburg University has discovered how brain cells that encode spatial information form “geotags” for specific memories and are activated immediately before those memories are recalled.

Their work shows how spatial information is incorporated into memories and why remembering an experience can quickly bring to mind other events that happened in the same place.

"These findings provide the first direct neural evidence for the idea that the human memory system tags memories with information about where and when they were formed and that the act of recall involves the reinstatement of these tags," said Michael Kahana, professor of psychology in Penn’s School of Arts and Sciences.

The study was led by Kahana and professor Andreas Schulze-Bonhage of Freiberg. Jonathan F. Miller, Alec Solway, Max Merkow and Sean M. Polyn, all members of Kahana’s lab, and Markus Neufang, Armin Brandt, Michael Trippel, Irina Mader and Stefan Hefft, all members of Schulze-Bonhage’s lab, contributed to the study. They also collaborated with Drexel University’s Joshua Jacobs.

Their study was published in the journal Science.

Kahana and his colleagues have long conducted research with epilepsy patients who have electrodes implanted in their brains as part of their treatment. The electrodes directly capture electrical activity from throughout the brain while the patients participate in experiments from their hospital beds.

As with earlier spatial memory experiments conducted by Kahana’s group, this study involved playing a simple video game on a bedside computer. The game in this experiment involved making deliveries to stores in a virtual city. The participants were first given a period where they were allowed to freely explore the city and learn the stores’ locations. When the game began, participants were only instructed where their next stop was, without being told what they were delivering. After they reached their destination, the game would reveal the item that had been delivered, and then give the participant their next stop.

After 13 deliveries, the screen went blank and participants were asked to remember and name as many of the items they had delivered in the order they came to mind.

This allowed the researchers to correlate the neural activation associated with the formation of spatial memories (the locations of the stores) and the recall of episodic memories: (the list of items that had been delivered).

“A challenge in studying memory in naturalistic settings is that we cannot create a realistic experience where the experimenter retains control over and can measure every aspect of what the participant does and sees. Virtual reality solves that problem,” Kahana said. “Having these patients play our games allows us to record every action they take in the game and to measure the responses of neurons both during spatial navigation and then later during verbal recall.”

By asking participants to recall the items they delivered instead of the stores they visited, the researchers could test whether their spatial memory systems were being activated even when episodic memories were being accessed. The map-like nature of the neurons associated with spatial memory made this comparison possible.

"During navigation, neurons in the hippocampus and neighboring regions can often represent the patient’s virtual location within the town, kind of like a brain GPS device," Kahana said. "These so-called ‘place cells’ are perhaps the most striking example of a neuron that encodes an abstract cognitive representation."

Using the brain recordings generated while the participants navigated the city, the researchers were able to develop a neural map that corresponded to the city’s layout. As participants passed by a particular store, the researchers correlated their spatial memory of that location with the pattern of place cell activation recorded. To avoid confounding the episodic memories of the items delivered with the spatial memory of a store’s location, the researchers excluded trips that were directly to or from that store when placing it on the neural map.

With maps of place cell activations in hand, the researchers were able to cross- reference each participant’s spatial memories as they accessed their episodic memories of the delivered items. The researchers found that the neurons associated with a particular region of the map activated immediately before a participant named the item that was delivered to a store in that region.

“This means that if we were given just the place cell activations of a participant,” Kahana said, “we could predict, with better than chance accuracy, the item he or she was recalling. And while we cannot distinguish whether these spatial memories are actually helping the participants access their episodic memories or are just coming along for the ride, we’re seeing that this place cell activation plays a role in the memory retrieval processes.”

Earlier neuroscience research in both human and animal cognition had suggested the hippocampus has two distinct roles: the role of cartographer, tracking

location information for spatial memory, and the role of scribe, recording events for episodic memory. This experiment provides further evidence that these roles are intertwined.

“Our finding that spontaneous recall of a memory activates its neural geotag suggests that spatial and episodic memory functions of the hippocampus are intimately related and may reflect a common functional architecture,” Kahana said.

Eat crow if you think I’m a bird-brain

Scientists have long suspected that corvids – the family of birds including ravens, crows and magpies – are highly intelligent. Now, Tübingen neurobiologists Lena Veit und Professor Andreas Nieder have demonstrated how the brains of crows produce intelligent behavior when the birds have to make strategic decisions. Their results are published in the latest edition of Nature Communications.

Crows are no bird-brains. Behavioral biologists have even called them “feathered primates” because the birds make and use tools, are able to remember large numbers of feeding sites, and plan their social behavior according to what other members of their group do. This high level of intelligence might seem surprising because birds’ brains are constructed in a fundamentally different way from those of mammals, including primates – which are usually used to investigate these behaviors.

The Tübingen researchers are the first to investigate the brain physiology of crows’ intelligent behavior. They trained crows to carry out memory tests on a computer. The crows were shown an image and had to remember it. Shortly afterwards, they had to select one of two test images on a touchscreen with their beaks based on a switching behavioral rules. One of the test images was identical to the first image, the other different. Sometimes the rule of the game was to select the same image, and sometimes it was to select the different one. The crows were able to carry out both tasks and to switch between them as appropriate. That demonstrates a high level of concentration and mental flexibility which few animal species can manage – and which is an effort even for humans.

The crows were quickly able to carry out these tasks even when given new sets of images. The researchers observed neuronal activity in the nidopallium caudolaterale, a brain region associated with the highest levels of cognition in birds. One group of nerve cells responded exclusively when the crows had to choose the same image – while another group of cells always responded when they were operating on the “different image” rule. By observing this cell activity, the researchers were often able to predict which rule the crow was following even before it made its choice.

The study published in Nature Communications provides valuable insights into the parallel evolution of intelligent behavior. “Many functions are realized differently in birds because a long evolutionary history separates us from these direct descendants of the dinosaurs,” says Lena Veit. “This means that bird brains can show us an alternative solution out of how intelligent behavior is produced with a different anatomy.” Crows and primates have different brains, but the cells regulating decision-making are very similar. They represent a general principle which has re-emerged throughout the history of evolution. “Just as we can draw valid conclusions on aerodynamics from a comparison of the very differently constructed wings of birds and bats, here we are able to draw conclusions about how the brain works by investigating the functional similarities and differences of the relevant brain areas in avian and mammalian brains,” says Professor Andreas Nieder.

Speech recovery after stroke

With right-handed people, it is positioned in the left side of the brain; left-handed people have it (usually) in the right side: the location of speech production has been known for quite some time. But it is not that simple, states psychologist Gesa Hartwigsen, Professor at Kiel University. In her current scientific publication, published in the magazine Proceedings of the National Academy of Science of the USA (PNAS), she investigates which areas in the brain really are in charge of speech, and how these interact. Her findings are supposed to help patients who have speech production problems or aphasia following a stroke.

Comprehending & Speaking

Gesa Hartwigsen and her team started by analysing speech production. They let healthy right-handed test persons listen to words, which they should then repeat. “These were pseudo words such as `beudo`. In German, they don’t have any associated meaning. Therefore, when hearing and repeating these words, no areas of the brain that had a connection to the meaning of what had been heard were activated”, said Hartwigsen.

The psychologist applies a combination of non-invasive methods (fMRI– functional magnetic resonance imaging and TMS – transcranial magnetic stimulation) to deduce what happens in the brain during the test. “We thus proved that the left hemisphere, as expected, was activated during speech production, while the right hemisphere did not actively contribute to language function”, explains Hartwigsen. This is the regular functionality within a healthy brain. From these results as well as others, scientists had up to now deduced that the right hemisphere did not contribute to speech production in the healthy system and was therefore suppressed.

Interfering & Measuring

With a second test, the Kiel University scientists simulated a dysfunction in the brain comparable to a stroke. A magnetic coil transmits a current pulse that interrupts the function of the area responsible for producing speech (Broca’s Area) in the left hemisphere. This completely harmless method influences the speech production of the volunteers for about 30 to 45 minutes. “During this period, the ability to listen and repeat was tested again. While we observed a suppressed activity in the left hemisphere during repeating, with some test persons taking longer to repeat the pseudo words, we also found unexpected activities in the right hemisphere”, reports Hartwigsen.

The right hemisphere showed increased activity during pseudo word repetition. The more the activity in the right Borca’s Area increased, the faster the volunteers were able to solve their speech tests. The right hemisphere also increased its facilitatory influence on the right hemisphere, a finding that was not observed prior to the TMS-induced lesion. “This reaction lends further support to the notion that the right hemisphere area reacts to the dysfunction of the left hemisphere and tries to compensate for the lesion.” Does the right hemisphere have a supporting influence and does it play an active role in speech production? So far, the common opinion was that it does not.

Result & Outlook

The findings of Gesa Hartwigsen and her team show an interaction of both hemispheres during speech repetition. When the left hemisphere is suppressed for example by a stroke, the right hemisphere could actively facilitate speech production. “By stimulating the right hemisphere, it could be possible to support speech recovery”, speculates the scientist. Here, timing would be very important. “Right after a stroke, we could support the right hemisphere. But when the remaining areas of the left hemisphere are ready to do their work again, it might be more helpful if the right hemisphere was suppressed. During this phase, we could stimulate the left hemisphere instead. The correct timing can therefore be crucial for recovery of speech after a stroke.”

In collaboration with the Department of Neurology at Kiel University, a stroke specialist from Leipzig and doctoral students of Medicine and Psychology, Gesa Hartwigsen has started a follow-up study on the recent publication. “We would like to find out more about the collaboration of the hemispheres and the right timing in helping stroke patients to recover”, says Hartwigsen. Her field of research is fairly new within the cognitive neuroscience. Nevertheless, she is positive that it will offer practical help in the form of concrete therapies within the next ten to fifteen years.

Shedding new light on learning disorders

A Michigan State University researcher has discovered the first anatomical evidence that the brains of children with a nonverbal learning disability – long considered a “pseudo” diagnosis – may develop differently than the brains of other children.

The finding, published in Child Neuropsychology, could ultimately help educators and clinicians better distinguish between – and treat – children with a nonverbal learning disability, or NLVD, and those with Asperger’s, or high functioning autism, which is often confused with NLVD.

“Children with nonverbal learning disabilities and Asperger’s can look very similar, but they can have very different reasons for why they behave the way they do,” said Jodene Fine, assistant professor of school psychology in MSU’s College of Education.

Understanding the biological differences in children with learning and behavioral challenges could help lead to more appropriate intervention strategies.

Children with nonverbal learning disability tend to have normal language skills but below average math skills and difficulty solving visual puzzles. Because many of these kids also show difficulty understanding social cues, some experts have argued that NVLD is related to high functioning autism – which this latest study suggests may not be so.

Fine and Kayla Musielak, an MSU doctoral student in school psychology, studied about 150 children ages 8 to 18. Using MRI scans of the participants’ brains, the researchers found that the children diagnosed with NVLD had smaller spleniums than children with other learning disorders such as Asperger’s and ADHD, and children who had no learning disorders.

The splenium is part of the corpus callosum, a thick band of fibers in the brain that connects the left and right hemispheres and facilitates communication between the two sides. Interestingly, this posterior part of the corpus callosum serves the areas of the brain related to visual and spatial functioning.

In a second part of the study, the participants’ brain activity was analyzed after they were shown videos in an MRI that portrayed both positive and negative examples of social interaction. (A typical example of a positive event was a child opening a desired birthday present with friend; a negative event included a child being teased by other children.)

The researchers found that the brains of children with nonverbal learning disability responded differently to the social interactions than the brains of children with high functioning autism, or HFA, suggesting the neural pathways that underlie those behaviors may be different.

“So what we have is evidence of a structural difference in the brains of children with NLVD and HFA, as well as evidence of a functional difference in the way their brains behave when they are presented with stimuli,” Fine said.

While more research is needed to better understand how nonverbal learning disability fits into the family of learning disorders, Fine said her findings present “an interesting piece of the puzzle.”

“I would say at this point we still don’t have enough evidence to say NVLD is a distinct diagnosis, but I do think our research supports the idea that it might be,” she said.

People with highly superior powers of recall also vulnerable to false memories

People who can accurately remember details of their daily lives going back decades are as susceptible as everyone else to forming fake memories, UC Irvine psychologists and neurobiologists have found.

In a series of tests to determine how false information can manipulate memory formation, the researchers discovered that subjects with highly superior autobiographical memory logged scores similar to those of a control group of subjects with average memory.

“Finding susceptibility to false memories even in people with very strong memory could be important for dissemination to people who are not memory experts. For example, it could help communicate how widespread our basic susceptibility to memory distortions is,” said Lawrence Patihis, a graduate student in psychology & social behavior at UC Irvine. “This dissemination could help prevent false memories in the legal and clinical psychology fields, where contamination of memory has had particularly important consequences in the past.”

Patihis works in the research group of world-renowned psychologist Elizabeth Loftus, who pioneered the study of false memories and their implications.

Persons with highly superior autobiographical memory (HSAM, also known as hyperthymesia) – which was first identified in 2006 by scientists at UC Irvine’s Center for the Neurobiology of Learning & Memory – have the astounding ability to remember even trivial details from their distant past. This includes recalling daily activities of their life since mid-childhood with almost 100 percent accuracy.

The lead researcher on the study, Patihis believes it’s the first effort to test malleable reconstructive memory in HSAM individuals.

Working with neurobiology & behavior graduate student Aurora LePort, Patihis asked 20 people with superior memory and 38 people with average memory to do word association exercises, recall details of photographs depicting a crime, and discuss their recollections of video footage of the United Flight 93 crash on 9/11. (Such footage does not exist.) These tasks incorporated misinformation in an attempt to manipulate what the subjects thought they had remembered.

“While they really do have super-autobiographical memory, it can be as malleable as anybody else’s, depending on whether misinformation was introduced and how it was processed,” Patihis said. “It’s a fascinating paradox. In the absence of misinformation, they have what appears to be almost perfect, detailed autobiographical memory, but they are vulnerable to distortions, as anyone else is.”

He noted that there are still many mysteries about people with highly superior autobiographical memory that need further investigation. LePort, for instance, is studying forgetting curves (which involve how many autobiographical details people can remember from one day ago, one week ago, one month ago, etc., and how the number of details decreases over time) in both HSAM and control participants and will employ functional MRI to better understand the phenomenon.

“What I love about the study is how it communicates something that memory distortion researchers have suspected for some time: that perhaps no one is immune to memory distortion,” Patihis said. “It will probably make some nonexperts realize, finally, that if even memory prodigies are susceptible, then they probably are too. This teachable moment is almost as important as the scientific merit of the study. It could help educate people – including those who deal with memory evidence, such as clinical psychologists and legal professionals – about false memories.”

The study appears this week in the early online version of Proceedings of the National Academy of Sciences.

iPads help late-speaking children with autism develop language

The iPad you use to check email, watch episodes of Mad Men and play Words with Friends may hold the key to enabling children with autism spectrum disorders to express themselves through speech. New research indicates that children with autism who are minimally verbal can learn to speak later than previously thought, and iPads are playing an increasing role in making that happen, according to Ann Kaiser, a researcher at Vanderbilt Peabody College of education and human development.

In a study funded by Autism Speaks, Kaiser found that using speech-generating devices to encourage children ages 5 to 8 to develop speaking skills resulted in the subjects developing considerably more spoken words compared to other interventions. All of the children in the study learned new spoken words and several learned to produce short sentences as they moved through the training.

“For some parents, it was the first time they’d been able to converse with their children,” said Kaiser, Susan W. Gray Professor of Education and Human Development. “With the onset of iPads, that kind of communication may become possible for greater numbers of children with autism and their families.”

Augmentative and alternative communication devices—which employ symbols, gestures, pictures and speech output—have been used for decades by people who have difficulty speaking. Now, with the availability of apps that emulate those devices, the iPad offers a more accessible, cheaper and more user-friendly way to help minimally verbal children with autism to communicate. And, the iPad is far less stigmatizing for young people with autism who rely on them for communicating with fellow students, teachers and friends.

The reason speech-generating devices like the iPad are effective in promoting language development is simple. “When we say a word it sounds a little different every time, and words blend together and take on slightly different acoustic characteristics in different contexts,” Kaiser explained. “Every time the iPad says a word, it sounds exactly the same, which is important for children with autism, who generally need things to be as consistent as possible.”

As many as a third of children with autism have mastery of only a few words by the time they are school age. Previously, researchers thought that if children with autism had not begun to speak by age 5 or 6, they were unlikely to acquire spoken language. But Kaiser is encouraged by study results and believes that her iPad studies may help change that notion.

Building on findings from this research, Kaiser has begun a new five-year long study supported by the National Institutes of Health’s Autism Centers of Excellence with colleagues at UCLA, University of Rochester, and Cornell Weill Medical School. She and a team of researchers and therapists at the four sites are using iPads in two contrasting interventions (direct-teaching and naturalistic-teaching) to evaluate the effectiveness of the two communication interventions for children who have autism and use minimal spoken language.

In the direct-teaching approach, children are taught prerequisite skills for communication (such as matching objects, motor imitation and verbal imitation) and basic communication skills (such as requesting objects) in a massed trial format. For example, an adult partner may present five to 10 consecutive opportunities for a child to use the iPad to request preferred objects. During these opportunities, the child is prompted to use the iPad to request and may receive physical assistance if he cannot use the iPad independently.

In the naturalistic-teaching approach, the adult models the use of the iPad during play and conversation. She also teaches turn-taking, use of gestures to communicate, play with objects and social attention to partners during the play. She provides a limited number of prompts to use the iPad to make choices, to comment or make new requests.

In both approaches, children touch the symbols on the screen, listen to the device repeat the words, and sometimes say the words themselves. They are encouraged to use both words and the iPad to communicate, and the adult therapist uses both modes of communication throughout the instructional sessions.

Results from the Autism Speaks study will be available in Spring 2014; the NIH study will continue through Spring 2017; and more information can be found at Kidtalk.org.