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Lordy Lordy it’s One in Forty

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This week’s headlines were focused on the new prevalence numbers of 1:40.  They were not calculated using the same method as the 1:59 number, so should not be  compared.  In addition to looking at just prevalence, this survey identified a major problem for families, which is unmet mental health needs.  Those with autism have higher unmet mental health needs than those with  ADHD, anxiety or depression.  Again, there is something unique about an autism diagnosis which poses a challenge to accessing care.  In addition, a new summary paper outlined what needs to be done to better study  regression in autism.  The rate may be higher than you think if a new definition of regression is used.

 

https://www.ncbi.nlm.nih.gov/pubmed/30478241

https://www.ncbi.nlm.nih.gov/pubmed/30475449

 

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Scientists know in their gut how the GI symptoms are linked to autism

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People with autism have higher levels of GI problems then people without a diagnosis, and the microbiome is associated with GI function, so is the microbiome linked to autism?  Some studies say yes, but this week studies in China look at non-caucasian people eating different diet.  Do the differences still hold?  Also, while GI  symptoms have been studied in relation to core autism features, they have not yet been linked to psychiatric issues like anxiety, ADHD, and aggression.  Until now.  This week’s podcast features three new studies looking GI issues and the causes of those issues, in kids with autism.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6204460/

https://www.ncbi.nlm.nih.gov/pubmed/30394313

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6143520/

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The average age of diagnosis depends on where, when, and how you ask

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While autism can be diagnosed reliably by 2 years of age, some people with autism don’t receive a formal diagnosis until much later.  Why not?  Racial and ethnic disparities as well as access to care issues are known factors.  This week, data from Denmark suggested that the diagnostic criteria has played a large role in prevalence in people with autism since 1980.  Many people who have autism may have been missed until they were older.  It suggests that older prevalence estimates were missing a proportion of autistic adolescents and adults.  Take away access and diagnostic barriers to a diagnosis, some kids followed from months of age in the baby siblings research consortium don’t receive a diagnosis at age 2, but do at age 5.  They always had autism, but their symptoms were sub-threshold for a formal diagnosis until age 5.

 

https://www.ncbi.nlm.nih.gov/pubmed/30398592 

https://www.ncbi.nlm.nih.gov/pubmed/30392626

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From cells to anxiety

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Thanks to brain tissue research, scientists now know how cells in the amygdala form, connect, and how this changes with age.  But does that explain behavioral or neurological features in autism?  Last week, Dr. Inna Fishman from SDSU examined connections in and out of the amygdala in children and adolescents in autism, in a different study but the same age range as when cellular changes in the amygdala are seen.  Strikingly, the brain connections to regions outside the amygdala follow a similar pattern at a similar time, which may explain functioning, autism severity and anxiety in adolescents with autism.   Also this week, while autism is a spectrum, it’s on a spectrum with other neurodevelopmental disorders like ADHD.  Just like in autism, there are individuals who are not diagnosed with ADHD until adulthood.  But these adults show signs of autism as children.  This is similar to autism, where symptoms are there but may not manifest until later in life.

 

https://www.ncbi.nlm.nih.gov/pubmed/30274651

https://www.ncbi.nlm.nih.gov/pubmed/30338854

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The waterbed around your brain (and its role in sleep)

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This week we have a very special guest:  Dr. Mark Shen from University of North Carolina at Chapel Hill, who has been leading the field in understanding the role that the fluid around the brain in autism.  This week he expands his research to show that this increase in extra – axial (around the brain) fluid is not limited to those with a family history of autism, and is seen both before and after a diagnosis.  This has implications for early detection of ASD, but more interesting, it may help explain why some people with autism have so many sleep issues.

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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

Click to access 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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A conversation with Clare Harrop about autism in boys and girls

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Recently, Clare Harrop from University of North Carolina at Chapel Hill published two papers which help explain the differences between boys and girls with autism, at least in kids and toddlers.  She graciously agreed to talk with us about these findings and what it means for better identification and diagnosis of girls with ASD, and where future research is needed.  Thank you to Dr. Harrop for this insight and for your work in this area!

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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