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    The role of vitamin D and Omega-3 long chain polyunsaturated fatty acids in children with Autism Spectrum Disorder : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nutritional Science, Massey University, Albany, New Zealand
    (Massey University, 2018) Mazahery, Hajar
    Background: The efficacy of vitamin D and omega-3 long chain polyunsaturated fatty acid (omega-3 LCPUFA), each individually, in Autism Spectrum Disorder (ASD) has been tested in a few trials and the results are inconclusive. Furthermore, several observational studies have observed low vitamin D and omega-3 LCPUFA status in populations with ASD. Children with ASD are susceptible to nutritional issues and poor diet quality due to sensory, behavioural and gastrointestinal issues associated with the condition, though no information regarding these children’s nutritional status is available in New Zealand. Also, no validated nutritional quality assessment tools are available for this population. Aim and Objectives: The overall aim of this study was to investigate the role of vitamin D (VID), omega-3 LCPUFA (OM), or both (VIDOM) in ASD in children through systematically reviewing literature and conducting an intervention trial with these nutrients. The primary objective was to investigate the efficacy of vitamin D, omega-3 LCPUFA, both on core symptoms and sensory issues after correcting major nutritional deficiencies and secondary objectives were to investigate the efficacy of intervention on irritability and hyperactivity, to study dietary adequacy/nutritional status of children with ASD, and to validate a dietary Index of Children’s Eating (DICE) questionnaire against 4-day estimated food record (4DFR). Methods/Design: New Zealand children with ASD (age 2.5-8.0 years) participated in a 12-month randomised, double-blind, placebo-controlled, 2x2 factorial trial. Prior to trial entry, children’s dietary adequacy and nutritional status were assessed by 4DFR, DICE questionnaire (designed based on New Zealand Ministry of Health Food and Nutrition guidelines), and nutritional biomarkers (25(OH)D, red blood cell fatty acids, iron, calcium, albumin, vitamin B12, and folate). Data regarding dietary supplement use and special/exclusion diet, demographics and anthropometrics (height and weight) were also collected. Children then were randomly assigned to one of four treatment groups; daily 2000IU vitamin D3, 722 mg docosahexaenoic acid (DHA), both supplements, or placebo, and behaviours were assessed. Core symptoms were assessed using Social Responsiveness Scale (SRS), sensory issues using Sensory Processing Measure (SPM), problem behaviours including irritability and hyperactivity using Aberrant Behaviour Checklist (ABC). Outcome measures were analysed pre- and post-intervention. Pair-wise mixed effects longitudinal models were used for data analysis. Results: 309 families registered their interest in the study, of whom 190 families were either excluded or not enrolled. The children of remaining families (n=119) were screened for nutritional deficiencies and high serum 25(OH)D concentrations, of whom two children were excluded. Overall, 62% (73/117) of children completed the trial (placebo 16, VID 19, OM 23, VIDOM 15). The mean serum 25(OH)D concentrations (nmol/L) increased in the VID (27±14, P<0.001) and VIDOM (36±17, P<0.001) groups and changed slightly in the OM (1.1±14, P>0.05) and placebo (8.9±23, P>0.05) groups. The median omega-3 index (%) increased in the OM [4.4 (3.3, 5.9), P<0.001] and VIDOM [4.0 (2.0, 6.0), P<0.001] groups and decreased in the VID [-0.2 (-1.0, 0.1)] and placebo [-0.5 (-0.9, -0.1), P>0.05] groups. Compared to placebo, a greater improvement in multiple outcomes in the intervention groups was observed: SRS-social awareness for OM (0.4±2.9 vs. -1.4±2.3, P=0.03) and VIDOM (0.4±2.9 vs. -1.7±3.5, P=0.03); SRS-social communicative functioning for VIDOM (-5.6±10 vs. -16±24, P=0.07); SRS-total for OM (-5.8±12 vs. -17±18, P=0.08); SPM-taste and smell for VIDOM (-0.3±1.7 vs. -2.5±4.3, P=0.06), SPM-balance and motion for OM (-0.1±4.7 vs. -2.6±4.3, P=0.09), ABC-irritability for VID (0.8±6.1 vs. -4.0±4.9 P=0.01) and OM (0.8±6.1 vs. -5.0±5.0, P=0.001); and ABC-hyperactivity for VID (-0.8±5.6 vs. -5.2±6.3, P=0.047). Out of 86 children whose food records were available, approximately 50% (39/86) reported taking dietary supplements and 15% (13/86) were on a special/exclusion diet. A large proportion of children had dietary intake for vitamin D below the Adequate Intake (AI, 96%), protein below the Average Macronutrient Distribution Range (AMDR, 65%), and iodine below the Estimated Average Requirement (EAR, 54%). Dietary intake of fibre (43%) and vitamin E (37%) was also below the AI by at least one third of children. All or most children exceeded the recommendations for sodium (100%), total saturated fat (80%) and sugar (52%). There was a significant and positive correlation (r=0.7; P<0.001) and good agreement (ĸ=0.6) between total scores from DICE (64±16) and 4DFR (58±11). Participants in the highest tertile of DICE had higher intakes of magnesium (P=0.02), vitamin A (P=0.03) and fibre (P=0.06). Conclusions: Vitamin D and omega-3 LCPUFA, each individually or together, improved some behavioural symptoms of ASD. However, large attrition rates and resultant loss of statistical power preclude definitive conclusion and warrant further trials. Also, the baseline assessment of nutrition confirms nutritional issues and poor diet quality in children with ASD. Given the importance of nutrition in growth and development and in the management of ASD, screening of the nutritional status of children with ASD for nutrient adequacy to reduce under- or over-consumption of nutrients is recommended. DICE is a valid tool for the assessment of diet quality in children with ASD living in New Zealand.
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    The imperfection of healing : crafting lyric poetry from personal family challenge : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Creative Writing at Massey University, Manawatū, New Zealand
    (Massey University, 2018) Gartrell, Brett David
    How can lyric poetry be used to communicate a father’s changing perceptions and emotional growth in caring for a child with autism? In writing about family health issues, we face many challenges as poets. Given the very particular nature of any given health situation, such as autism, we face the challenge of lifting the purely personal into one with broader significance. And given the entanglement of such experience with the trajectory of the circumstances, we face the challenge of engaging with that narrative without allowing it to subsume the impulses and pleasures of the lyric. The key questions that I wish to investigate are, firstly, how can we write autobiographical lyric poetry from these intensely personal family events while evading polemic or tragedy-based narratives that lack the nuance of the experience? Secondly, how can we create the emotional distance from the circumstances that inspired the poems to incorporate important narrative elements within the lyric, which elevates experience and perception? Finally, how can we create a narrative sequence from individual lyrical poems, in particular the trajectory of the narrative journey of the parent learning to deal with the challenges of a child’s health problems, be they mental or physical? I would contend that, especially for these works, the boundary between narrative and lyric elements is often blurred. This thesis is comprised of two parts: a critical essay (30%) and my own creative work, a manuscript of original poetry (70%). I am interested in several ways that poets create two sorts of distance. One I am calling an "emotional distance” in that they use various techniques to forestall sentimentality or conversely, the development of anger narratives that lack nuance. The other is what I am calling “aesthetic distance” in the sense that they use other formal strategies to depart from a narrow investment in the circumstances of the poems in order to link them to broader issues of significance, a form of moving from the particular to the universal. April Salzano’s collection Turn Left Before Morning will be discussed as an example of poems that lack emotional distance, leaving the narrator portrayed as a victim. I will then discuss in detail how aspects of emotional and aesthetic distance are successfully manipulated by three other poets within the their poems and collections: Anne Kennedy’s Sing-song, Siobhan Harvey’s Cloudboy and Jessica Le Bas’ Walking to Africa. I contend that for these poems that are based in autobiographical narratives, the emotional heart of the poems must remain consistent to the struggle of parenting a special needs child. However, while the lyric should gain prominence in individual poems, a narrative sequence and a coherent tone across poems can be developed within the overall collection. The challenge has been to bring these techniques into my own work, which comprises the creative portion—and not only to balance detail with lyrical impulse but also accomplish a nuanced portrait of my son. While I prefer to reject the tragedy based narrative, I have tried to portray the some of the nuance of parenting a special needs child. The aim was to create a unified collection of autobiographical lyric poetry that communicates the unique angle of vision of this father of an autistic child.
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    A play ground : supporting interactions of children with autism through music therapy groups in a special education classroom : an exegesis presented in partial fulfillment of the requirements for the degree of Masters of Music Therapy, New Zealand School of Music, Wellington, Aotearoa, New Zealand
    (Massey University, 2013) Sanders O'Connor, Kathleen T
    Children with autism face significant obstacles to social interaction and learning. This qualitative, exploratory study of student music therapy practice in a special education Unit, focused on supporting interactions of children with autism through music therapy groups integrated into the school programme. Clinical work took place over ten months, and the research employed secondary analysis of three data sources: clinical records, notes from supervision and staff meetings, and a reflective research journal. Two complementary forms of music therapy groups, on the same day and with the same children, were developed: an established morning structured music therapy group, and at the end of the day, a free form music therapy group more like a typical playground. Findings suggest that the work of adults to engage the children, music play which attended to sensory sensitivities, promoting calm, giving new experiences and giving structured interaction opportunities contributed to an increase in the children’s interactive behaviors in music therapy groups. When adults provided a free play community experience, the children showed an increase in initiating interactions and more expressive communications. Eliciting emotional responsivity and giving patterned interactive experiences, through both improvisation and familiar music, seemed to build bridges with the children’s communications and support motivation to interact.
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    The 'exclusion' of autism : how does music therapy aid the psychological, social and educational difficulties confronted by children with autism in a special education setting? : a thesis presented in partial fulfilment of the requirements for the degree of Master of Music Therapy at Massey University, Wellington, New Zealand
    (Massey University, 2006) Travaglia, Rebecca Anne
    This research project explores how music therapy can provide opportunities for inclusion and exclusion for children with autism. It draws attention to the various psychological, social and education difficulties faced by children with autism regarding social inclusion and social exclusion. The project also considers current attitudes towards social exclusion documented within the fields of special education and child welfare and rights. The research was conducted using a qualitative and naturalistic enquiry approach. The therapeutic method was client centred. Case material is presented for three children with autism who attended individual music therapy sessions once a week for a period of five weeks. Characteristic narratives of each music therapy session are included in the body of the text. From these, the researcher highlighted moments of inclusion and exclusion observed in the music therapy sessions for each child. These were collaborated and presented in classification tables designed by the researcher from her observations. Music therapy sessions reveal evidence of opportunities for both social interaction and social isolation for three children with autism. Moments were categorised as Inclusion Moments and Exclusion Moments. Inclusion Moments were grouped under four headings: Client Initiated Moments, VerbalNocal Communication Moments, Engaged In Music Non Verbal Moments and Therapist Supported Inclusion. Exclusion Moments were grouped under four headings: Inappropriate Social Behaviours, Purposeful Removal from Musical and Social Interaction, Withdrawal and Therapist Supported Exclusion. Techniques to support inclusion included listening, playing, improvising, singing and movement, adapting the level of attention demanded from the child. Exclusion could be supported by allowing the child to withdrawal from verbal interaction and providing them with a safe and non-demanding environment. This research project concludes that there are patterns of inclusion and exclusion in music therapy sessions and suggests that exclusion does play a role in music therapy for children with autism. The researcher highlights the difficulty for therapists to find a position that satisfies the child 's right to social inclusion, while still respecting the child 's lack of a need for social connectedness.