Tracking cancer: Victor Velculescu (shown here), a physician and researcher

at Johns Hopkins University, has developed a new way to use DNA sequencing to track the subtle


DNA changes could help doctors see if stray cancer cells remain after treatment

MIT Technology Review, February 18, 2010, by Nora Schultz  —  Tracking tiny amounts of a patient’s unique cancer DNA could provide a new way of detecting small tumors or stray cancer cells that linger after treatment. Researchers from Johns Hopkins University and Life Technologies Corporation, a biotechnology tools company, used fast and cheap sequencing methods to spot genetic alterations in breast and bowel cancers in individual patients. Once found, the researchers used stretches of rearranged DNA to construct personalized biomarkers that allow them to detect even faint traces of tumor DNA.

As our understanding of cancer grows, scientists are beginning to view it as a chronic disease that is very difficult to eliminate entirely. Technologies like this one could provide ways to track it and keep it in check. The technique exploits a well-known tendency of tumors to sport scrambled chromosomes. Such swapping around of big chunks of DNA may in fact be one of the key events contributing to cells becoming cancerous in the first place.

Existing biomarkers are mostly protein-based and available for only some types of cancers. An example is the PSA protein that indicates prostate cancer. But because these proteins aren’t always unique to cancer cells, they aren’t very sensitive. “Our genetic markers work because they are extremely different” from the DNA in healthy cells, says Victor Velculescu, who led the research. “We could easily find one piece of cancer DNA among 400,000 normal ones.” The research was published today in the journal Science Translational Medicine.

While scientists have long known that cancer cells tend to harbor scrambled DNA, using this information to track the progression of cancer, or the effectiveness of treatment, has been a challenge. That’s because the precise nature of the genetic change is different in each patient, making these markers hard to find. The notable exceptions are several types of blood cancers that always display the same type of DNA rearrangement.

To tackle solid tumors with unpredictable genetic changes, Velculescu’s team turned to new sequencing technologies that have brought sequencing costs down tremendously over the past few years. Cheap sequencing meant the scientists could search the entire genome for signs of cancer. They used technology from Applied Biosystems, part of Life Technologies, to sequence the genomes of four bowel and two breast cancer genomes along with the genomes of four patients’ healthy tissue.

Applied Biosystems approach works by chopping the genome up into 200 million pieces that are each about 1,500 DNA base pairs long, and then sequencing just the 25 base pairs at the edges of these pieces, yielding pairs of mated tags. By comparing the sequences of these DNA ends against a healthy reference genome as well as between the patients’ normal and tumor genomes, the researchers could spot rearrangements between chunks of DNA. Velculescu’s team found about nine regions of swapped DNA in each tumor, providing unique biomarkers for each patient’s tumors.

The researchers then tracked the level of abnormal DNA as one of the colon cancer patients underwent different types of treatment. After surgery, chemotherapy, and surgical removal of metastases from the liver, the level of cancer-specific DNA in his blood dropped from 37 percent to 0.3 percent. This showed that some cancer cells still remained in the liver, indicating a need to remain vigilant and consider further treatment.

The research is an “exciting step down the road toward personalized cancer medicine,” says Peter Johnson at the University of Southampton and Cancer Research UK’s chief clinician. “The detection of DNA changes, unique to individual cancers, has proved to be a powerful tool in guiding the treatment of leukemia. If this can be done for other types of cancer like bowel, breast, and prostate, it will help us to bring new treatments to patients better and faster than ever.”

Velculescu says the biggest caveat to a wide clinical use of the technique is the cost. While the price of sequencing has dropped dramatically, the analysis costs around $5,000 per genome. In an editorial accompanying the paper, Ludmila Prokunina-Olsson and Stephen Chanock of the National Cancer Institute, in Bethesda, MD, point out that researchers will need to sequence a number of cancer genomes before the approach can be put into clinical practice. For example, scientists need to assess how reliably these DNA rearrangements can be detected, whether certain types of rearrangements are most useful in tracking cancer, and whether certain parts of the genome tend to harbor these changes. In addition, researchers need to show that detecting latent cancer DNA can help tailor treatment, improving a patient’s long-term health.

Clot buster: High-intensity focused ultrasound in conjunction with magnetic resonance imaging, pictured here, has the potential to pinpoint the location of a stroke-causing blood clot and break it up with sound waves.      Credit: InSightec



New technology being tested could provide a noninvasive approach to treating stroke


MIT Technology Review, February 18, 2010, by Lauren Gravitz  —  An ultrasound device designed to produce highly focused sound waves might one day be used to break up stroke-causing blood clots in the brain without surgery or drugs. So far, the system has only been tested on clots in test tubes and animals, but researchers aim to start human tests by the end of 2011.

Thilo Hoelscher, a neurologist at the University of California at San Diego, is attacking the clots with a device developed by Israeli ultrasound technology company InSightec. The device surrounds the head with an array of transducers that can focus ultrasound beams on a single spot in the brain without damaging the skull.

The technology is already being tested in patients to remove diseased brain tissue, but treating stroke will require a more delicate hand. Hoelscher and colleagues will need to prove that the device can break up a clot without damaging nearby brain tissue.

Strokes are the most common cause of long-term disability in the United States, and the third most common cause of death. Typically, they occur when a blood clot blocks an artery and prevents blood from flowing to the brain. The longer the clot remains, the more brain tissue dies, and the lower a person’s chance for survival. “Anything you can do that’s going to safely restore blood flow more quickly could have a lot of potential for societal, medical, and economic impact,” says Evan Unger, a radiologist at the University of Arizona who is not involved in the research.

Today, only two proven methods are in use to bust clots. A drug called tissue plasminogen activator (tPA) dissolves clots, but it can only be given to certain patients, and it usually must be administered within three hours of the stroke itself. Alternatively, some clots can be physically retrieved through a blood vessel, but few hospitals practice this technique. Overall, perhaps fewer than 10 percent of all patients are candidates for either of these interventions.

InSightec’s high-intensity focused ultrasound (HIFU) device is a bit like a helmet, lined with more than 1,000 ultrasound transducers. Each can be focused individually to send a beam into the brain of the person wearing the helmet. The focused beams converge on a spot only four millimeters wide, accurate enough to hit an artery-blocking clot and dissolve it in under a minute. “Outside this focus, the ultrasound energy is completely negligible,” Hoelscher says.

In studies in rabbits, Hoelscher and colleagues have shown that the InSightec system can break up clots in the brain without harming healthy tissue. Beyond animal studies, the researchers have shown that HIFU can focus on and break up blood clots in skulls of human cadavers–the sound waves are undeterred by bone, a tricky substance that absorbs energy and can alter a beam’s path.

“I’m enthusiastic, but cautiously enthusiastic,” says Robert Siegel, an ultrasound specialist and cardiologist at Cedars-Sinai Medical Center in Los Angeles. “In theory it should be doable, but the hurdles are large.” And, he notes, some major questions remain unanswered.

The first question is how radiologists will be able to pinpoint the clot’s exact location to precisely focus the beams. Researchers at the University of Virginia in Charlottesville are working to combine HIFU with magnetic resonance angiography to precisely locate blockages.

The second question is one of safety. “Heating the brain is not a good thing,” Siegel says. “Generally, we cool the brain to protect it. If you’re only using ultrasound, you’re relying on heat. And if you put heat into the skull, it can’t get out, and [it] could instead amplify.”

Hoelscher agrees, saying that his lab at UCSD is now looking into all of the related mechanisms. “We have to understand the skull bone, what it does with the ultrasound, how the ultrasound breaks up the blood clot, what happens with the tissue,” he says.

To make the technique even safer, Hoelscher is also looking to combine HIFU with another ultrasound method, one that works in conjunction with an intravenous contrast agent called Definity developed by the University of Arizona’s Unger. Typically used to increase contrast in heart sonograms, Definity consists of millions of tiny microbubbles that magnify sound waves. “They have the potential to function as little bombshells in the vicinity of a blood clot,” Hoelscher says. If microbubbles can amplify the effects of HIFU, he says, it may be possible to use less energy to break up clots, decreasing potential for brain tissue damage.

Aging cells: Reprogramming skin cells from patients with a premature aging disease appears to lengthen telomeres (green), repetitive DNA sequences that cap chromosomes (blue). Telomere length is a measure of cellular “aging” and determines how many times a cell can divide.    Credit: Suneet Agarwa

Cells from people with premature aging disease get “younger” with the help of stem cell technology

MIT Technology Review, February 18, 2010, by Emily Singer  —  Reverting skin cells from people with a premature aging disease back to a more embryonic state appears to overcome the molecular defect in these cells. People with the disease have abnormally short telomeres, a repetitive stretch of DNA that caps chromosomes and shrinks with every cell division, even in healthy people.

Researchers from Children’s Hospital Boston found that reprogramming the skin cells, using induced pluripotent stem cell technology, lengthened the telomeres in the cells. The reprogramming process activated the telomerase enzyme, which is responsible for maintaining telomeres. The research was published today in the online version of the journal Nature.

The research adds to previous findings suggesting that enhancing activity of the telomerase enzyme might benefit patients with premature aging disorders. The study also provides a new tool for studying telomerase, an enzyme of great interest to scientists working on both aging and cancer. The shortening of telomeres over a lifetime is thought to be tied to aging. And abnormal activation of telomerase in cancer cells allows them to proliferate uncontrollably. While scientists already knew that reprogramming could lengthen telomeres in cells from healthy people, it was unclear if the same could happen in cells with defective telomerase.

Telomerase is most active in stem cells, allowing these cells to maintain their telomere length and divide indefinitely. The telomeres of differentiated cells, such as skin cells, shorten with every cell division, limiting their lifespan. (The discovery of the enzyme in the 1980s was awarded the Nobel Prize in Physiology or Medicine last year.)

People with a premature aging disease called dyskeratosis congenita often have genetic defects in one of the three components of telomerase, producing a range of abnormalities, including in the skin, blood, and gastrointestinal tract. The deadliest defect is an inability to replenish the various types of blood cells, leading to early death from infection or bleeding. “We know that cells from these patients grow very poorly in culture compared to normal cells,” says Inderjeet Dokal, a physician at Barts and The London School of Medicine and Dentistry, in London, who identified the first genes underlying the disease but was not involved in the new research. The disease, which is quite rare, has become of broader interest thanks to a growing focus on the science of telomeres and their role in aging.

In the new study, Suneet Agarwal, a physician and researcher at Children’s Hospital, and collaborators took skin cells from three patients with the disease and genetically engineered the cells to express a set of genes that triggers reprogramming, reverting the cells to an embryonic state. They were surprised to find that the reprogrammed cells grew and divided, their telomeres lengthening with subsequent divisions.

“They show that they can make the cells young,” says Lorenz Studer, a physician and scientist at Memorial Sloan-Kettering Cancer Center, in New York, who was not involved in the research. The defect in the telomerase enzyme “seems to be repressed or overridden during reprogramming, which probably explains why patients do reasonably well in the early stages of life,” he says. “Patients still have same mutation whether in the [skin cell] or iPS cell, but the mutation only manifests itself in the differentiated cell.”

The researchers found that reprogramming appeared to activate a specific component of the telomerase enzyme, a discovery that they hope to use to develop new treatments for this and other telomerase-related diseases. Agarwal hopes to search for drugs that boost the enzyme.

“This disease is an ideal case for the clinical application of telomere-rejuvenated adult stem cells or iPS cell therapies, because the primary defect of telomerase deficiency does not need to be corrected if telomerase function can be temporarily stimulated enough to elongate telomeres,” wrote Kathleen Collins, a biologist at the University of California, Berkeley, in an e-mail. “This work shows that the iPS state does exactly that.”

The findings are an early example of the potential of induced pluripotent cell reprogramming, a technology first developed in 2007 as a tool for studying human disease. The technique, in which genetic engineering or chemicals are used to activate genes normally expressed in embryonic cells, allows scientists to create stem cells from patients with different diseases. The hope is that differentiating these cells into the cell type affected by the disease will allow researchers to study the molecular mechanisms that cause it.

Studer points out that the new research could shed light on how the age or telomere status of a cell might affect how it manifests a particular disease. For example, it’s not yet clear whether cells derived from patients with an age-related disease, such as Parkinson’s or Alzheimer’s, will show signs of the disease soon after reprogramming, or if the cells must age–cycling through a number of cell divisions–to more accurately reflect age-related ailments.

Age of mother affects child’s autism risk: study  –  A hormone thought to encourage bonding between mothers and their babies may foster social behavior in some adults with autism, French researchers said on Monday.

They found patients who inhaled the hormone oxytocin paid more attention to expressions when looking at pictures of faces and were more likely to understand social cues in a game simulation, the researchers said in the journal Proceedings of the National Academy of Sciences.

Angela Sirigu of the Center of Cognitive Neuroscience in Lyon, who led the study, said the hormone has a therapeutic potential in adults as well as in children with autism.

“For instance, if oxytocin is administered early when the diagnosis is made, we can perhaps change very early the impaired social development of autistic patients,” Sirigu said in an email.

Sirigu said the study focused on oxytocin because it was known to help breast-feeding mothers bond with their infants and because earlier research has shown that some children with autism have low levels of the hormone.

People with Asperger’s syndrome and other autism spectrum disorders often have problems with social interaction.

Sirigu said oxytocin could help autism patients who have normal intellectual functions and fairly good language abilities because it improves eye contact.

“Eye contact can be considered the first step of social approach,” Sirigu said. But people with autism often avoid looking at others.

“In our study we show that oxytocin enhances eye contact because patients spent more time looking at the eyes,” she said.

She said the hormone also improves the ability of people with autism to understand how other people respond to them, and they can learn the appropriate response to others’ behavior.

In their study, Sirigu and colleagues had 13 people with high-functioning autism spectrum disorders inhale oxytocin before taking part in two experiments.

The participants, 11 men and two women, had no medication two weeks before the study, which included a control group of an equal number of healthy men and women.

The researchers watched the patients’ responses during a virtual ball tossing game to measure behavioral changes.

In a separate experiment, Sirigu’s team measured how patients responded to facial expression when shown pictures of human faces.

Read more about spray to help autism…………..

By Rob Stein
Washington Post Staff Writer
Tuesday, February 17, 2010

A nasal spray containing a hormone that is known to make women more maternal and men less shy apparently can help those with autism make eye contact and interact better with others, according to a provocative study released Monday.

The study, involving 13 adults with either a high-functioning form of autism or Asperger syndrome, a mild form of the disorder, found that when the subjects inhaled the hormone oxytocin, they scored significantly better on a test that involved recognizing faces and performed much better in a game that involved tossing a ball with others.

Although more research is needed to confirm and explore the findings, the results are the latest in a growing body of evidence indicating that the hormone could lead to ways to help people with the often devastating brain disorder function better.

“This is the first study that looked at whether oxytocin has an effect on social behavior, which is a major deficit in autism,” said Angela Sirigu, who directs the National Center for Scientific Research in France and led the study, published online by the Proceedings of the National Academy of Sciences. “It looks like it could be very helpful.”

Researchers who were not involved in the study praised the work, saying the findings were promising and could lead to the first effective treatment for the central problems affecting people with autism.

“I think it’s going to be a very exciting finding for a lot of people,” said Alex Martin, chief of cognitive neuropsychology at the National Institute of Mental Health.

Because oxytocin does not last long in the body and produces its effects for a relatively brief period, some experts said the findings were more likely to encourage drug companies to develop alternative substances that had the same benefits.

“This paper suggests that’s worth doing,” said Thomas R. Insel, director of the institute. “It adds another brick in the wall that suggests there may be an opportunity to develop treatment for one of the core symptoms of autism. That’s been the brass ring.”

But Sirigu was among those who said the finding should encourage more research on the potential benefits of oxytocin itself, especially for children. Administering the hormone soon after a child’s autism is diagnosed might help him or her develop more normally, she said.

“It’s possible it can become a cure, if it’s given early when the problems are detected in the little kids,” Sirigu said. “We can change the way these patients interact with people from childhood.”

Because previous research has indicated that some people with autism might have abnormally low levels of oxytocin, conducting tests to identify those people and administering them the hormone might help as well, said Karen Parker, an assistant professor of psychiatry at Stanford University School of Medicine.

“If you can find someone who appears to have deficits in oxytocin biology, giving them what you might argue would be replacement oxytocin may be helpful,” Parker said.

Autism is a baffling disorder that can cause a variety of symptoms, including speech and learning problems and profound, disabling difficulties understanding emotions and social cues when interacting with people. The number of children found to have autism has been increasing for reasons that remain mysterious.

Oxytocin is produced naturally in the bodies of humans and animals. It plays a key role in social interaction, promoting maternal behavior and monogamy in animals. The hormone also heightens social sensitivity, social awareness, generosity and trust in people.

Previous U.S. studies found that people with autism who received the hormone intravenously were less likely to engage in repetitive behavior that is another hallmark of autism and were more likely to be able to identify emotions in voices. Another study being published in the journal Biological Psychiatry found that 16 autistic males in Australia ages 12 to 19 who received the hormone through a nasal spray were better able to recognize other people’s facial expressions.

“All the data seem to suggest that manipulating the oxytocin system has a powerful effect on the core symptoms of autism,” said Eric Hollander, director of the compulsive, impulsive and autism spectrum disorders program at the Montefiore Medical Center in New York.

While cautioning that more research is needed on children and additional patients to make sure oxytocin is safe and effective, advocates for families with children with autism welcomed the findings. Oxytocin has been in use for several years as an “alternative” therapy for autism.

“Many families are using it with success and reporting improvement,” said Wendy Fournier, president of the National Autism Association. “Getting double-blind clinical studies like this one published helps to bring credibility to parental reports.”

“We need to be mindful of the fact that the majority of human studies of oxytocin have been conducted using adults, including this study, and only one paper has included individuals between the ages of 12 and 18. We have to be careful about the safety and efficacy of oxytocin on pediatric populations,” said Clara Lajonchere, vice president of clinical programs for Autism Speaks.

Website of WebMD




For caregivers, understanding autism symptoms is key to coping with them.

By R. Morgan Griffin

Reviewed by Brunilda Nazario, MD

One of the most difficult aspects of being a caregiver for someone with autism – whether a child or an adult – is the inability to understand what it’s really like for him. Autism is a condition that can be isolating for the person who has it, and autism symptoms are tough to understand from the outside.

“I like to think of autism as a different way of being,” says Stephen Shore, PhD, who was diagnosed with autism at age 2. “It’s a nonstandard way of perceiving and interpreting the environment.”

Every person with autism is different, and there is no single autistic perspective. But experts and people who have the condition say that there are some issues that are shared by many on the autistic spectrum. What are they? WebMD asked doctors, caregivers, and people with autism what it’s like to live with the condition.

2 Keys to Understanding Autism Symptoms

According to experts, the first key to understanding autism is to recognize that it profoundly alters how a person perceives the world.

“You could think of a person with autism as having an imbalanced set of senses,” says Shore, who is an assistant professor in the School of Education at Adelphi University in Garden City, N.Y. “Some senses may be turned up too high and some turned down too low. As a result, the data that comes in tends to be distorted, and it’s very hard to perceive a person’s environment accurately.”

People who don’t have autism — sometimes called “neurotypicals” — are naturally good at filtering out what doesn’t matter. Their senses work in unison to focus on what’s relevant. “When an average person walks into a roomful of people, he notices who they are and what they are doing, and figures out how he fits in,” says Geraldine Dawson, PhD, chief science officer for the education and advocacy group Autism Speaks.

“But when a person with autism walks into the room, he notices things that aren’t as relevant – the sound coming from outside the window, a pattern in the carpet, a flickering light bulb,” Dawson tells WebMD. “He’s missing out on the relevant details that would help him understand the situation. So for him, the world is a lot more confusing.”

The second key is to understand that people with autism are desperately trying to make sense of this chaos. Experts see many autism symptoms that are difficult for others to understand as attempts to communicate or to assert control over a baffling and disorderly universe.

“Most of the time, these behaviors are really an attempt to convey something,” says Dawson. “As a caregiver, the important thing is to recognize that and try to figure out what it is.”

What Do Autism Symptoms Mean?

What are some aspects of life that are difficult for people on the autistic spectrum?

Sound. Intense sensitivity to sound is a common autism symptom. 

Loud noises may be painful. The din of a city street or a mall can be too much. When overwhelmed, people on the autistic spectrum may cover their ears to try to block out the noise. They may also start up self-soothing behaviors such as rocking or shaking their hands. Some people with autism also have central auditory processing disorder (CAPD), a condition that makes it difficult for them to perceive subtle differences in sound and language.

Touch. Just like sound, physical sensations can be exaggerated and overwhelming to people with autism. Feelings that most people barely register — the sensation of clothing on the body, a breeze — can be unpleasant. 

Janice McGreevy, of Browns Mills, NJ, has an 8-year-old son with autism. Since age 1, his haircuts have been a terrible ordeal, but only recently could he explain why. “He told me that the individual hairs, when they touch his skin, feel like needles,” she says.

Communication. Difficulty communicating is a common autism symptom – one of the early signs of the condition is a delay in speech. But this doesn’t indicate a lack of intelligence. Instead, many children with autism simply can’t discern how language works. That can be terribly difficult and isolating. 

“I remember a lot of frustration when I was nonverbal as a child and couldn’t communicate my needs,” says Shore, who did not speak until he was 4. Although some people with autism never learn to speak, most do. But even in those who master language, communication – real understanding – can still be a problem. “One of the hardest things for many people with autism is expressing or even recognizing how they feel,” says Dawson. “They’re often really out of touch with their internal states and feelings.” That’s why some who are very bright — with awe-inspiring vocabularies — may still retreat when overwhelmed, engaging in autism symptoms such as repetitive behaviors instead of explaining what’s bothering them. They’re simply unable to articulate it, even internally.

 Socialization. People with autism are sometimes pegged as loners who want to keep to themselves. But Shore disagrees.

“There’s this myth that people with autism don’t want to socialize,” says Shore. “The problem is that they don’t know how to socialize.” The unspoken rules of social behavior – things that most other people pick up and use unconsciously – may remain mysteries to people with autism. The result is that socializing, both as a child and an adult, is difficult and frustrating. It can lead to a lot of anxiety.

Some people with autism are forthright to a fault, says Adam Berman, a 22-year-old from Potomac, MD, who was diagnosed with autism at 18 months. “A kid with autism might walk up to a woman and just tell her she’s ugly,” Berman tells WebMD. “We sometimes tell the truth too much.”

On the other hand, Berman says that there’s an implicit advantage for parents from this particular autism symptom. “I see a lot if [neurotypical] kids who can sweet talk their way out of anything,” Berman says. “But kids with autism are terrible liars. I can’t lie my way out of a paper bag.”

Common Autism Coping Mechanisms

People with autism may use some of these behaviors to try to impose order on their world:

“Stimming.” Short for self-stimulatory behaviors, this includes all sorts of things: flapping hands, echoing phrases, making noises, and walking in circles. Sometimes, these autism symptoms can be self-injurious, like head banging.

To outsiders, these may seem some of the strangest autism symptoms. But Dawson points out that they’re really not so different from all sorts of habits that lots of people have – biting fingernails, fidgeting, or bouncing a knee. People with autism might have more severe versions of these behaviors.

Many with autism characterize stimming as pleasurable; for some, stimming is a way of coping with a stressful or overwhelming situation. It can also help them concentrate. McGreevy says that her son’s particular habit is to rub the back of his neck – even to the point where it’s raw or bleeding – especially when he’s reading. “I think it somehow helps him focus on the book instead of the 15 other things that are going on around him,” she says.

Compulsive organization. Caregivers are sometimes confused, and awed, by the obsessions and compulsions that people with autism exhibit. “As soon as my son gets home from school — within 15 minutes — he’ll have a hundred toy dinosaurs lined up in a single file in his room,” says McGreevy. “It’s so bizarre and it still astounds me.”

A seemingly compulsive need to organize and arrange objects is a pretty common autism symptom. “We like order,” says Berman. “Some kids arrange items by size, some by the same sequence of colors. They do it the exact same way, day in and day out.” That organization can extend to how they break up their days. People with autism may rigidly adhere to a schedule. If it’s disrupted, they can become distraught.

For a caregiver, accommodating these needs can be difficult. A very minor alteration – a single book put upside down on the shelf, a cabinet door left open, an unexpected day off from school — can trigger panic. But to people with autism, the disruption might feel like much more than it would to you. Seeing that single upside down book might make them feel as if the entire bookcase had been ransacked and its contents scattered.

It’s difficult to say exactly what motivates these obsessions and compulsions. But Shore believes that these autism symptoms are a reaction against the disorder they perceive in the world. “I think it’s another attempt to bring order and sense to an environment that seems chaotic,” says Shore.

Intellectual obsessions. This is another common autism symptom: an exhaustive and staggering knowledge of a particular subject. To outsiders, these interests can seem baffling. And when communication is so difficult already, it can be frustrating when all your loved one wants to talk about are baseball stats or the nuances of the side arms of different Star Wars characters.

Again, it’s important to understand that these obsessions might serve a function. In a confusing world, a specific interest — over which the person with autism has total mastery — can be like an anchor, grounding him. And while these autism symptoms may sometimes be frustrating for a caregiver, they also have a benefit: They offer a way in.

“If you have a child with autism who’s obsessed with SpongeBob, then you had better learn a lot about SpongeBob too,” says Berman, “because that’s how you can talk to him.”

Shore agrees. “I think the best thing for a caregiver is to find out what a child’s interests are and to start interacting through those interests,” says Shore.

How? McGreevy gives one example. When her son gets overwhelmed by a situation, she talks to him about his favorite subjects, animals and dinosaurs. Her effort to connect with him on one of those topics — on his own terms — can really help calm him down.

Autism Caregiving: Treatment Helps

Caregiving for a loved one with autism can be tremendously difficult. But happily, treatment can often make a difference.

“The good thing is that people with autism can learn many of the things that they don’t know intuitively,” says Shore. “It just requires direct instruction.” Skills that neurotypical children learn unconsciously – such as evaluating a social situation or reading a person’s behavior – can be taught, step-by-step.

There are many different approaches to instructing children with autism, including the Applied Behavior Analysis (ABA), the Miller Method, and the Floortime method. Shore says that there is no single best approach. As a caregiver, the key is to be flexible, to try different approaches, and see what works best with your child.

The Importance of the Autism Caregiver

Caregivers also need to understand how important they are. Both Berman and Shore give a lot of credit to their parents for their tenacity and dedication. In the early 1960s, experts told Shore’s parents that their son’s autism symptoms were so severe that his case was hopeless and he needed to be institutionalized. But his parents defied the experts and kept fighting, and they were right.

McGreevy is a passionate advocate for her son too. While she tries to accommodate his autism symptoms and keep a home environment in which he feels safe, she’s also working constantly to expand his horizons. “I think because of his condition, my son would be fine being stagnant,” she tells WebMD. “If he’s going to experience new things and grow and take the next step, I need to push him.”

For a caregiver, empathy is key. Just forcing a person with autism into the “real world” won’t work. Instead, the first step is to try to understand his perspective a little better.

“As a parent or caregiver, you need to go into the world of the person with autism first,” says Shore. “Then you can start guiding that person out.”