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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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The 2018 Year in Review: A spectrum within a spectrum

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There were a number of exciting advances in scientific understanding autism in 2018.  These include things that we know to be true, and know to be not true.  Researchers made progress in identifying subgroups of ASD, defining biological markers, and developing  interventions. There were also research that demonstrates that while autism is a spectrum itself, it is also part of a bigger spectrum of neurodevelopmental disorders from anxiety to ADHD to OCD.  Therefore, the approaches to these other conditions may be applicable to ASD. In addition, there may be more similarities than differences in the biological features of these conditions.

This is just a sampling of the exciting research presented on this year’s Year in Review.  You can also read the full summary, complete with references, HERE.

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Nobody puts babies in a corner

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Nobody can dispute that research to better understand autistic adolescents and adults is lacking.  However, scientists continue to make important scientific discoveries in infants and toddlers with autism.  These infants and toddlers eventually become adolescents and adults, so identifying critical periods of brain development that influences behavior, what to say to parents and when, and how to  engage the entire community to better serve infants and toddlers is still needed.  This week is an update on the activities of the Baby Siblings Research Consortium (BSRC), including a paper that ties in activity of different brain regions at 1 year olds, to stereotyped behaviors and insistence on sameness in 2 year olds.  The research of the BSRC is directly applicable to families affected by autism at all ages.

 

https://www.ncbi.nlm.nih.gov/pubmed/30446435

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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