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A deeper dive into racial disparities in ASD diagnosis

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The racial and ethnic disparities in the diagnosis of ASD has always been unacceptable, but it’s been hard to figure out. This week, researchers published their findings from a close look at 500 African American families with ASD to understand what the barriers were to a timely diagnosis. The results are not surprising, but they are also alarming. Some of these families may benefit from telehealth in the future. Telehealth is not perfect, but it turning out to be helpful. For example, it may be beneficial in treating insomnia in people with ASD. Delivering cognitive behavioral therapy online resulted in improvements in sleep in adolescents with ASD. It isn’t a panacea, but it seems to be more helpful than people gave it credit for before the pandemic.

https://pubmed.ncbi.nlm.nih.gov/32839243/

https://pubmed.ncbi.nlm.nih.gov/32838539/

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Pandemic Problems? ASD Researchers are Listening

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You have spoken, and scientists have listened, to surveys that have asked how you are doing, what your family needs, what is working and what has not worked. Telehealth gets mixed reviews, and kids are suffering from everything from anxiety to OCD. Other results of these surveys are covered in this week’s ASF podcast. Please continue to answer these requests for feedback, because the future of autism interventions, assessments and services depends on them.

https://pubmed.ncbi.nlm.nih.gov/32515992/

https://pubmed.ncbi.nlm.nih.gov/32503172/

https://pubmed.ncbi.nlm.nih.gov/32445682/

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“ASADHD” – where does ASD and ADHD join together, and go their separate ways?

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One the surface, symptoms of ADHD and ASD may seem very similar.  However, they come from very different places.  The genetic and behavioral makeup may be on the same spectrum across the two disorders, but they are actually farther apart than you might think.  Dr. Meghan Miller from UC Davis MIND Institute who studies both ADHD and ASD and people with ADHD and ASD explains what those differences and similarities are, how to make the right diagnosis, and what’s on the horizon for treatments for ADHD in people with ASD.

 

https://www.ncbi.nlm.nih.gov/pubmed/31974800

https://www.ncbi.nlm.nih.gov/pubmed/30535156

https://www.ncbi.nlm.nih.gov/pubmed/30658861

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News new families can use, thank you to the BSRC

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This week an important study was released that provides information that parents can use – particularly parents with a child with autism and another on the way or who is an infant.  This of course comes from the Baby Siblings Research Consortium and makes particular observations about families with 2 or more affected children vs 1 affected child.  They have different rates of autism outcomes and trajectories of behaviors that parents and doctors should be aware of.  In addition a new meta analysis of vitamin supplementation shows that while moderate doses of vitamins may not be harmful, they may not also be helpful.  In other words, talk to your doctor about a nutritional plan and assessment, and save your money for things that are known to work.

https://www.ncbi.nlm.nih.gov/pubmed/31589284

https://www.ncbi.nlm.nih.gov/pubmed/31586029

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Do the rules apply in school?

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This week is focused on what happens in schools, including classification, service receipt and new interventions.  How an educational classification translates to a clinical diagnosis, how and what factors are important in receiving services, what teachers think about repetitive behaviors and finally, a new intervention that can be delivered by therapists in school or mental health settings.  They all have real-life consequences for kids who are receiving services in school.

 

https://www.ncbi.nlm.nih.gov/pubmed/30892948

https://www.ncbi.nlm.nih.gov/pubmed/30848681

https://www.ncbi.nlm.nih.gov/pubmed/30889547

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2727134

 

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Understanding the hard to research

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What do Princess Kate and Amy Schumer have in common, and what does it have to do with autism?  The answer:  Hyperemesis Gravidum.  It’s linked to autism, but not strongly, but it does show more evidence of significant overlap between many neuropsychiatric issues and disorders.

More importantly though, those with low verbal ability and low cognitive function are harder to study than most people with autism.  Two new research studies documented what they had to do to make studies in this population possible, and how this group was different from those with average IQ and some words.  One looked at brain structure, and the other was a treatment for minimally verbal girls with autism.

The HG study:  https://www.ncbi.nlm.nih.gov/pubmed/30594672

The minimally verbal girls study https://www.ncbi.nlm.nih.gov/pubmed/30607780 

The imaging study:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307191/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6307191/

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Super siblings!

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This podcast is dedicated to siblings of people with autism who are typically developing.  They play an important and beneficial role in development of socialization of those with ASD.  But sadly, they also have issues of their own, such as a high rate of issues like anxiety and depression.  Those siblings may be genetic carries of a specific mutation and not have an autism diagnosis, but have increased risk for schizophrenia and cognitive disability.  Finally, just because they are considered “typically developing” doesn’t mean they don’t have challenges with adaptive behavior.  However, they have a very special relationship with their brothers and sisters, and the world needs these strong advocates for the community.

 

https://www.ncbi.nlm.nih.gov/pubmed/30280363

https://www.ncbi.nlm.nih.gov/pubmed/30248583

https://onlinelibrary.wiley.com/doi/full/10.1111/jcpp.12985

https://www.nature.com/articles/s41436-018-0266-3.pdf

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Quality vs. Quantity in an autism diagnosis

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In the fight to ensure everyone with autism is detected and diagnosed as early as possible, community providers are sometimes pushed to the limit in what they can do.  They have a huge caseload and there are long waitlists.  So how accurate are autism diagnoses given by these providers with little time and little resources for training?  As it turns out, they are just okay.  Approximately 23% of those diagnosed by community providers were not diagnosed using standardized and validated autism tools.  How can we weigh this potential over and mis-diagnosis with the potential for missing individuals with autism and depriving them of interventions and services?  That’s a topic for another discussion.  However, one question on the cause of autism was addressed and a theory debunked:  autism is not caused by caesarean section deliveries altering the microbiome, and then leading to ASD.  The microbiome may be involved, but not because of method of delivery and use of antibiotic medications.

https://www.ncbi.nlm.nih.gov/pubmed/30270970

https://www.ncbi.nlm.nih.gov/pubmed/30273187

 

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What is autism? It’s changing.

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This week, the Autism and Developmental Disabilities Network, or ADDM, was used to look at the changes across time in co-occuring conditions in people with autism, like ADHD, depression, anxiety, language delay and other developmental delay.  They found the frequency of 8 year olds with autism with these co occurring conditions is increasing.  So is the percent of people with autism with intellectual disability.  The data continues to show that in many people, what was autism 20 years ago, is not the same autism seen today.  While depression and anxiety have already been established as co occurring issues, things like hoarding are just starting to be examined.   These results suggest that co-occurring conditions may be one of the features of autism that can separate people into different groups, to improve intervention and treatment opportunities.

https://www.ncbi.nlm.nih.gov/pubmed/30227350

https://www.ncbi.nlm.nih.gov/pubmed/30178724

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Autism diagnosed in school age, and does early intervention make a difference?

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Thanks to a Facebook follower, this week’s podcast highlights a new systematic review on Early Intense Behavioral Intervention. This systematic review, however, is not different from one published 5 years ago, because the nature of early interventions have changed so much that they no longer fit into the same criteria. While the rankings are disappointing, the findings do not reflect the ways in which newer interventions are being selected, delivered and studied. Also, we always hear about early diagnosis helping with early intervention. But what about kids who are not diagnosed until they reach school age? They have a different profile of ASD and may be a different subgroup of autism altogether.

https://www.ncbi.nlm.nih.gov/pubmed/29742275

https://www.ncbi.nlm.nih.gov/pubmed/29852752