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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

 

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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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The good and evil sides of technology use by autistics

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This year’s Day of Learning included two presentations on the use of technology among people with autism.  As it turns out, technology can be great.  In fact, a new study using Google Glass shows promise in improving socialization.  On the other hand, sometimes technology can have a downside.  People with autism spend more time than typical peers on their iPads, iPhones and other devices.  What could be wrong with that?  Well, problematic internet use is linked to autistic traits and to suicidality.  This link is NOT a clear line and obviously causes of suicide are multifactorial.  However, new data demonstrate that obsessive internet use is not making things better for people with ASD.

 

https://www.ncbi.nlm.nih.gov/pubmed/30934756

https://www.ncbi.nlm.nih.gov/pubmed/30908423

https://www.ncbi.nlm.nih.gov/pubmed/30907929

 

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Can IGF-1 treat autism symptoms? A clinical trial aims to find out

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A full transcript of this podcast episode can be read on the ASF blog here.

Researchers at Mount Sinai led by Alex Kolevzon are running a clinical trial of the compound insulin-like growth factor 1 (IGF-1) for children with idiopathic autism. Dr. Kolevzon’s team previously demonstrated the safety and feasibility of IGF-1 in treating Phelan-McDermid syndrome, a single-gene form of autism. Particularly, the IGF-1 treatment improved symptoms of social impairment and repetitive behaviors, which are core symptoms of autism. Expanding their investigation into idiopathic autism, the researchers are working hard to make sure families can comfortably and knowledgeably participate in the clinical trial. Mahir Rahman spoke with Dr. Kolevzon about the study and where it hopes to go. Interested in joining the study? Go here to learn more.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326443/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450831/

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Tristram Smith, 1961-2018

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Two weeks ago, the autism research community lost a pioneer, mentor and advocate for the autism community.  This podcast only highlights a portion of the enormous contribution he made to autism research and the impact his research had on families with ASD.  Also, two people that know him best, one of his current mentees, Suzannah Iadarola and his wife, Jennifer Katz, reflect on his dedication and commitment to families of all ages.  He will be missed.

 

Some of his more recent papers are here, although just a recent sampling of everything he contributed:

https://www.ncbi.nlm.nih.gov/pubmed/30101320

https://www.ncbi.nlm.nih.gov/pubmed/30009626

https://www.ncbi.nlm.nih.gov/pubmed/29458258