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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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Environmental factors: the forgotten stepchild of autism spectrum disorders

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When people hear the word “heritability” in mathematical estimates, they automatically think “just genetics”.  That isn’t true, and this week epidemiologist Brian Lee from Drexel talks us through his SpectrumNews viewpoint about what heritability actually is and why there is room for environment.  Also this week, twin studies, which have traditionally used the word heritability to distinguish genetic vs. environmental interactions, are studied in a new light.  This one shows that severity and differences of autism across the spectrum in identical twins are caused by environmental differences – not just genetics.

https://www.ncbi.nlm.nih.gov/pubmed/31853901

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Keep on Screening for ASD

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This week, a little longer #ASFpodcast on a topic that deserves a little extra attention:  screening for ASD.  Some media click-bait driven headlines have made it seem like screening for autism is a waste of time for parents, doctors and care providers.  That’s FAKE NEWS!   We talk to Whitney Guthrie from CHOP and Diana Robins from Drexel about recent studies that cast doubt on common screening tools, why doctors may not be administering them the same way all the time and how that makes a difference, the importance of screening and data that shows that it does help toddlers with ASD maximize their full potential.

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Genes, environment and heritability: why does it matter?

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This week a 5 country collaboration including the largest number of people EVER revealed 80% of the causes of autism are heritable. This is incredibly important to understand autism and move forward with research that matters to families.  What it did not do was calculate the role of gene x environment interactions which seems to be the forgotten stepchild of autism research.  This week’s #ASFpodcast explains why it is important to understand the heritability while at the same time study the combined effects of genetic and environmental factors.

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2737582?guestAccessKey=d82b0145-f179-48bd-91bb-f77865732c3c&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=071719 

 

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This study is s**t

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You may have heard on the internet that a new “radical” treatment leads to a “50% reduction” in autism symptoms.  This radical treatment is fecal transplants, which is taking the bacteria from the feces from one person and putting them in another person.  This is a still experimental treatment, and while the microbiome should be researched more in regards to its relationship to autism, there might be a less invasive way to alter the microbiome which could stand up to the rigor of a well designed trial.  Also this week, new prevalence data on 4 year olds across multiple years.  Did it change across time, and is it different from 8 year olds, and why is this difference important?

https://www.ncbi.nlm.nih.gov/pubmed/30967657

https://www.ncbi.nlm.nih.gov/pubmed/30973853

 

 

 

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DSM5 – where are we now?

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Don’t be fooled, not all the studies on this week’s podcast focus on the DSM5.  But the first one, a review of a meta analysis and review of the dozens of publications that have emerged in the past 5 years around the DSM5 leads us off.  There are some people that weren’t captured by either DSM5 or Social Communication Disorder that need a diagnosis, and that should be the focus of future research.  A new topic of diagnosis is also explored by a large collaboration is addressed:  diagnosis in cousins.  They do show a higher probability of an autism diagnosis, but not as high as first degree siblings.  Finally, a new tool called JAKE in monitoring  treatment effectiveness is presented.  This could be used not just in the clinic but at home.  It includes monitoring of biological and behavioral features, and might be the next big thing in outcomes for treatment studies.

 

https://www.ncbi.nlm.nih.gov/pubmed/30852784

https://www.ncbi.nlm.nih.gov/pubmed/30851399

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6402449/

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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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What the Tooth Fairy knows about autism

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A new study uses baby teeth, which are formed in pregnancy and emerge at about 6 months to a year, to understand the dynamics of metals in people with autism.  Not just the levels, but the cycles of zinc and copper, which goes up and down normally with regular biological processes.  This could be the start to many more studies which use baby teeth to understand prenatal and early neonatal exposures in people with autism.  Also, the largest study published so far on food allergies confirmed a higher than normal presence of food, respiratory and skin allergies in people with autism.  Are allergies part of autism?  Probably not, but there seem to be a subgroup of people with immune issues that warrant specific treatments for those allergies.

 

https://www.ncbi.nlm.nih.gov/pubmed/29854952

 

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2683952

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Why the Environmental Protection Agency is important for autism

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The Environmental Protection Agency has a big job to do – keep our air and water clean.  They do so, in part, with air monitors placed across the United States which allow researchers to keep tabs on what is going on in our air.  This week, a study from Dr. Amy Kalkbrenner at UWM and colleagues replicated that certain types of air pollution increased risk of autism, as well as increased symptoms of severity of autism in those with a diagnosis.   These pollutants come from cars, but also coal burning power plants.  This new research calls for more action, not less, by the crucial staff and infrastructure of the EPA and policy to help support them do it.  #standwithEPA

https://ehp.niehs.nih.gov/ehp1867/

 

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What is the real prevalence of ASD?

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Unfortunately this podcast does not really provide an answer, but does highlight data published over the holidays which shows in another dataset, that the prevalence of autism seems to be leveling out, rather than continue to increase as it has done for the past several decades.  It isn’t the final word and clearly there may be exceptions, but now two national datasets have shown no further increase in autism prevalence in the last few years of looking.  Is it 1:68 as reported in one study or 1:39 in another?  Is it somewhere in between?  Still to early to say, but white boys seem to be the most likely to get a diagnosis no matter where you look.  Also, folic acid proves to show an effect on the probability of not just an autism diagnosis, but autism symptoms.  This is especially important for women taking anti epileptic medications for seizures and bipolar depression.  Welcome to 2018!

Here are links to the articles.  Some of them are open access!

https://www.ncbi.nlm.nih.gov/pubmed/29297068

https://www.cdc.gov/nchs/data/databriefs/db291.pdf

https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2667432

https://www.ncbi.nlm.nih.gov/pubmed/29279889