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Here’s what you won’t hear about that new JAMA study on Twitter

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A couple of weeks ago, a group in Australia published a study that investigated the efficacy of a “preemptive” intervention. That is, what happens if you provide support to parents to improve social communication, interaction and skills in infants before a diagnosis can be made? The results have a lot of meaningful implications of what interventions are possible at this age, how they can be delivered, and what it means to NOT receive an autism diagnosis but still show challenges. But the Twitter hive didn’t perceive it that way. This week I explain what the study did and didn’t do, and how it can help people across the spectrum.

Open access here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453361/

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From being high to being aggressive

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There are many many potential factors that influence a diagnosis of ASD that have been underexplored, and recreational drugs are one of them. Of course it would never explain all the cases of ASD, not one singular thing does, but does cannabis consumption during pregnancy lead to an increased probability of having a child with ASD? As it turns out, yes, a small increase, meaning it isn’t the only thing causing ASD but: JUST SAY NO if you are pregnant. On the other end of the spectrum is aggression, a completely horrible feature of some people with ASD. About 30% of people who are aggressive and have an ASD diagnosis are not responsive to any medications or therapies, which is horrifying. Researchers in Canada and Brazil have studied the brains of this group, with what is called “refractory aggression” to try to get to the mechanism.

https://pubmed.ncbi.nlm.nih.gov/32778828/

https://pubmed.ncbi.nlm.nih.gov/32762791/

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Autistic Adults Advise and Advance Research

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Have you ever heard of an initiative called “Autistic Adults and other Stakeholders Engaged Together”? If you have, you know their goal is to ensure that autistic perspectives are included in future scientific research. They recently published an article that summarized the research that autistic people feel is critical, and what is missing, and what needs to be done. They concluded most of the research done so far is applicable to males without intellectual disability. That needs to change. Speaking of adults, how many adults are autistic? Is it 5 million? Maybe, maybe not, but it is still unclear even after a recent publication. Listen to hear more.

To learn more about AASET click here

https://www.ncbi.nlm.nih.gov/pubmed/32390461

https://link.springer.com/content/pdf/10.1007/s10803-020-04494-4.pdf

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CBT and ADDM – two acronyms in the autism news

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Two studies missed last year (sorry) but are of importance to the autism community include a modified version of Cognitive Behavioral Therapy to treat anxiety, which was adapted and updated for people with ASD.  It also works better than traditional CBT, which is good news for  the 80% of people with ASD that also suffer from anxiety.  Also, in recognition of MLK day today, the CDC released information last year that shows that 1/4 of those that they counted in their prevalence numbers were missed by schools or other health care providers.  Unfortunately, those who were black or hispanic were more likely to be those that were missed but still met criteria.  This just shows that educators have to do better in helping those with ASD from all racial and ethnic backgrounds.

https://www.ncbi.nlm.nih.gov/pubmed/31868321

https://www.ncbi.nlm.nih.gov/pubmed/31755906

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The AAP Empowers Pediatricians to Help Kids with ASDs

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Thank you to the American Academy of Pediatrics for publishing an updated guide for their 67,000 members about identification, evaluation and management of children on the autism spectrum.  Pediatricians have a lot of things going on every day and could use a primer, or a condensed guide, on what the basic level of care should be for kids and families affected by ASD.  Here, thanks to Drs. Susan Hyman, Susan Levy and Scott Myers, from the council of the AAP on children with disabilities, they have one.  This podcast will summarize the main points of what the guidance document says.  Please download it and share it by clicking here:  https://pediatrics.aappublications.org/content/pediatrics/early/2019/12/15/peds.2019-3447.full.pdf 

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The Pros of Prozac and the Placebo Effect

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Two of the largest randomized control trials of Prozac as an intervention for restrictive and repetitive behaviors were published recently.  They both coincidentally found no effect on the core features of autism, nor clinician rated improvement.  What they did find is a big placebo effect.  That is the behaviors of the participants changed even if they thought they might be getting the medication, but were actually getting an empty pill.  This is a big problem in research in studying medications across mental health.  So why is Prozac so popular?  And when it comes to some features of autism, is the placebo effect so bad?

https://www.ncbi.nlm.nih.gov/pubmed/31638682 

https://www.ncbi.nlm.nih.gov/pubmed/31267292

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The extra benefit of caregiver mediated interventions

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This week, a new systematic review published by researchers at Virginia Polytechnic Institute looked at the existing evidence around caregiver (parent) mediated interventions and not child outcome, but family relationships and dynamics. While it isn’t the focus on the intervention, what effect does allowing parents to be involved and empowered on their child’s support on the wider family?  The answer is, it does help, although not all interventions are the same.  Also, a new video tool from collaborators at Washington University and the UC Davis MIND Institute to help parents identify early signs and symptoms in their own children was validated, which is exciting but more work needs to be done.

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If you can make it there, you can make it anywhere: preparing early interventions for the community

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This week two groups of heroes of autism research published studies that may not be the type of major breakthrough that the media reports on, but they are more important to families:  These studies help translate what works in the research clinic into the community.  Specifically, is it even possible, how, and what do families need to know when they receive an intervention that has yet to be “field tested”.  This is a whole field of research called implementation science, and it deals with how scientists and community services implement what is learned in research settings into real world settings.

https://www.ncbi.nlm.nih.gov/pubmed/31206690 

https://www.ncbi.nlm.nih.gov/pubmed/31241851

 

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Guys, we all need exercise

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People with autism are less likely to be physically active and more likely to be sedentary.    A number of studies have looked into different physical activities, both group based and individually, on improvements in health as well as core features of autism, and most have had positive results.  New animal model research demonstrates a benefit of exercise using the maternal immune activation model of ASD, pruning back the excess of connections and cell fibers.  As people with autism also have too many connections in the brain, this may have a direct therapeutic benefit.  But besides all the scientific conjecture, we all need more exercise, physical activity interventions seem to only help, not hurt, people across the spectrum, and should be used to complement, not replace existing therapies.

 

 

https://www.ncbi.nlm.nih.gov/pubmed/29693781

 

https://www.ncbi.nlm.nih.gov/pubmed/31102193

 

https://link.springer.com/article/10.1007%2Fs10803-019-04050-9

 

https://www.cell.com/cell-reports/retrieve/pii/S2211124719306266?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2211124719306266%3Fshowall%3Dtrue

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How do parents choose different interventions?

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Parents have choices of dozens of different autism interventions, available in private and public settings.  A new study explores factors which influence parents decisions on different interventions, how they are similar to each other and different.  They include cognitive ability of their kids with ASD and economic resources.  Parents in the US may have similarities in how they obtain interventions, but they are also similar in how they identify autism signs in their preschool kids, and these similarities are seen across the world.  In a new study of over 19,000 preschoolers with autism, some similarities are seen in parent reported symptoms of ASD across 24 different countries.  This is pretty remarkable given societal, geographical, and cultural issues.  But it’s not all harmony and unity – there were lots of differences between parents and teachers which can have enormous impact on how autism is diagnosed worldwide.

https://www.ncbi.nlm.nih.gov/pubmed/30990248

https://www.ncbi.nlm.nih.gov/pubmed/30995081