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Here’s what you won’t hear about that new JAMA study on Twitter

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A couple of weeks ago, a group in Australia published a study that investigated the efficacy of a “preemptive” intervention. That is, what happens if you provide support to parents to improve social communication, interaction and skills in infants before a diagnosis can be made? The results have a lot of meaningful implications of what interventions are possible at this age, how they can be delivered, and what it means to NOT receive an autism diagnosis but still show challenges. But the Twitter hive didn’t perceive it that way. This week I explain what the study did and didn’t do, and how it can help people across the spectrum.

Open access here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8453361/

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Sex differences: It’s not about the diagnostic measurements.

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A fresh take on an existing topic: why there are more boys diagnosed with ASD than girls. Even from a few months old, girls are different than boys, and they show subtle differences in toddlerhood. But at the time of diagnosis, they score the same on standardized instruments of ASD used to categorize someone as having ASD or not. This means it isn’t about the measures. It could be cultural factors, it could be a protective effect, but there needs to be a better understanding of these differences across the lifespan to help everyone with ASD, especially females.

https://www.cell.com/current-biology/retrieve/pii/S096098222030419X?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS096098222030419X%3Fshowall%3Dtrue

https://doi.org/10.1007/s10803-020-04526-z

https://doi.org/10.1111/jcpp.13242

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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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Autism symptoms in girls with anorexia

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This week summarizes some new studies looking at autism traits and autism diagnosis in girls with anorexia nervosa.  While the two disorders may seem different on the outset, they do share some behavioral features.  Unfortunately, most studies look at autism in those with anorexia, not the other way around.  However, what is known is that there is not only higher levels of ASD traits in girls with anorexia, about 10% of girls with anorexia also have an autism diagnosis.  This number can only be trusted if you look at both standardized observation instruments AND parental report.  Studies determining the rates of eating disorders in autism are desperately needed for better treatment of symptoms.

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Managing real life autism situations.

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Compared to researchers, community clinicians don’t have time for the same rigorous training on the standard autism diagnostic instrument called the ADOS, so can they still do it as well?  Or does this group not have the resources they need to use it properly?  Also, because psychiatric hospitals don’t see as many people with autism as they used to, a group of child psychiatrists got together and wrote guidelines for what to do if a child with autism showed up at the general inpatient ward.  These are things that face families in the real word, and we thought you should hear about new science around them.