Autism News & Resources

Gap in Autism Care

Autism Spectrum Disorders News | 18 June 2013

A study from investigators at MassGeneral Hospital for Children found that African-American or Hispanic children diagnosed with autism were significantly less likely than white children to have received subspecialty care or procedures related to conditions that often accompany autism spectrum disorders. While previous studies have documented that minority children with autism tend to be diagnosed at a later age than white children, this report—published online in Pediatrics—is the first to describe disparities in the use of specialty services in gastroenterology, psychiatry or psychology.

“We think there are probably many reasons for these differences,” said Sarabeth Broder-Fingert, an HMS clinical fellow in pediatrics at the Center for Child and Adolescent Health Research and Policy at Massachusetts General Hospital. “Many autism-related medical symptoms—including gastrointestinal issues like constipation and neuropsychiatric issues such as anxiety or sleep disorders—are not well understood, so doctors may not realize children are having those symptoms.”

The research team reviewed records for more than 3,600 patients ages 2 to 21 with a diagnosis of autism who received care at Mass General or its affiliated health centers from 2000 through 2010. Data on each clinical visit was analyzed, with particular attention to specialty care in gastroenterology, psychiatry and psychology and to procedures including endoscopy, ultrasound, EEG, brain imaging and sleep studies. Among the patients identified, 81 percent were white, 5 percent were African-American and 7 percent, Hispanic.

The analysis revealed that minority children were significantly less likely to have received either subspecialty care or procedures, with some of the most significant differences in gastroenterology services, which were accessed by almost 14 percent of white children but only 9 percent of African-American children and 10 percent of Hispanic children. Minority children were less likely to have received an endoscopy or colonoscopy, and Hispanic children were much less likely to have had sleep studies or other neurological or neuropsychiatric tests.

“We know that many children with autism have gastrointestinal or sleep issues, and if those problems are not being diagnosed or treated, they can lead to additional behavior difficulties that can inhibit development,” said Broder-Fingert, lead author of the report. “Combining the challenges of accessing specialty services for any child with autism, regardless of race or ethnicity, with the recognized difficulties minority communities have accessing medical care in general can lead to these major disparities in the use of services. 

“It’s going to be important to see whether these differences in service use lead to differences in medical and behavioral outcomes, and we need to understand more about why this is happening,” she added. “We hope this work can help doctors be aware of these disparities and be sure to look out for patients—especially minority patients—who might need specialty services, and that we can help parents of children with autism be aware that these conditions may occur in their children and ask their doctors for assistance.”

The study was supported by grants from the Nancy Lurie Marks Family Foundation and Autism Speaks.

Nearly One-Third of Children With Autism Also Have ADHD

Autism Spectrum Disorders News | 06 June 2013

In a study of the co-occurrence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in early school-age children (four to eight years old), researchers at the Kennedy Krieger Institute found that nearly one-third of children with ASD also have clinically significant ADHD symptoms.

Published in Autism: The International Journal and Practice (Epub ahead of print), the study also found that children with both ASD and ADHD are significantly more impaired on measures of cognitive, social and adaptive functioning compared to children with ASD only.

Distinct from existing research, the current study offers novel insights because most of the children entered the study as infants or toddlers, well before ADHD is typically diagnosed. Previous studies on the co-occurrence of ASD and ADHD are based on patients seeking care from clinics, making them biased towards having more multi-faceted or severe impairments. By recruiting patients as infants or toddlers, the likelihood of bias in the current study is significantly reduced.

"We are increasingly seeing that these two disorders co-occur and a greater understanding of how they relate to each other could ultimately improve outcomes and quality of life for this subset of children," says Dr. Rebecca Landa, senior study author and director of the Center for Autism and Related Disorders at Kennedy Krieger. "The recent change to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to remove the prohibition of a dual diagnosis of autism and ADHD is an important step forward."

Participants in this prospective, longitudinal child development study included 162 children. Researchers divided the children into ASD and Non-ASD groups. The groups were further categorized by ADHD classification according to parent-reported symptoms of ADHD on the Hyperactivity and Attention Problems subscales of the Behavioral Assessment System for Children-Second Edition, a standard assessment specifically designed to identify the core symptoms of ADHD.

Results revealed that, out of 63 children with ASD in the study, 18 (29%) were rated by their parents as having clinically significant symptoms of ADHD. Importantly, the age range for children in the study (four to eight) represented a younger and narrower sample than has been previously reported in published literature. "We focused on young school-aged children because the earlier we can identify this subset of children, the earlier we can design specialized interventions," says Dr. Landa. "Tailored interventions may improve their outcomes, which tend to be significantly worse than those of peers with autism only."

Researchers also found that early school-age children with co-occurrence of ASD and ADHD were significantly more impaired than children with only ASD on measures of cognitive and social functioning, as well as in the ability to function in everyday situations. They were also more likely to have significant cognitive delays (61 versus 25 percent) and display more severe autism mannerisms, like stereotypic and repetitive behaviors. The study findings suggest that children with the combined presence of ADHD and ASD may need different treatment methods or intensities than those with ASD only in order to achieve better outcomes.

Dr. Landa and her team recognize that this research supports the need for future prospective, longitudinal studies of attention, social, communication and cognitive functioning from the time that the first red flags of ASD are identified. Such research will lead to important insights about the relative timing of onset and stability of disruption to attention mechanisms and barriers to successful functioning in children with co-occurring ASD and ADHD.

In addition to Dr. Landa, the other study author was Patricia Rao, PhD, of Kennedy Krieger Institute.

Enrichment Therapy Effective Among Children With Autism, UCI Study Finds

Autism Spectrum Disorders News | 22 May 2013

Children with autism showed significant improvement after six months of simple sensory exercises at home using everyday items such as scents, spoons and sponges, according to UC Irvine neurobiologists.

They found that a treatment known as environmental enrichment led to notable gains in male subjects between the ages of 3 and 12. Results appear online in Behavioral Neuroscience.

Study co-authors Cynthia Woo and Michael Leon randomly assigned 28 boys to one of two groups, balanced for age and autism severity. For half a year, all subjects participated in standard autism therapies, but those in one group also had daily sensory enrichment exercises.

Parents of these children were given a kit containing household products to increase environmental stimulation, including essential-oil fragrances such as apple, lavender, lemon and vanilla. The boys smelled four of these scents a day and listened to classical music each evening.

In addition, the parents conducted twice-daily sessions of four to seven exercises with their children involving different combinations of sensory stimuli – touch, temperature, sight and movement among them. Each session took 15 to 30 minutes to complete.

After six months of therapy, 42 percent of the children in the enrichment group showed significant improvement in behaviors commonly affected by autism – such as relating to people, having typical emotional responses and listening – compared with 7 percent in the standard-care group.

They also scored higher in cognitive function, whereas average scores for the boys in the standard-care group decreased. Moreover, 69 percent of parents in the enrichment group reported improvement, compared with 31 percent of parents in the standard-care group.

“Because parents can give their child sensory enrichment using items typically available in their home, this therapy provides a low-cost option for enhancing their child’s progress,” said Woo, an assistant project scientist in neurobiology & behavior.

Exposing children to enriched sensory experiences builds upon previous research in other laboratories in which animals exposed to such environments had a great reduction in the behavioral and cognitive symptoms associated with a wide range of neurological disorders, including those resembling autism.

The researchers noted that most current therapies for autism must be started at a very young age to be successful, while the average age in this study was 6.6.

“We believe that sensory enrichment can be an effective therapy for the treatment of autism, particularly among children past the toddler stage,” said Leon, a professor of neurobiology & behavior affiliated with UC Irvine’s Center for Autism Research & Treatment.

“At the same time, we need to know whether we can optimize the treatment, whether there are subgroups of children for whom it’s more effective, whether the therapy works for older or younger children, and whether it can be effective on its own.”

He and Woo are now conducting a second, larger randomized clinical trial that includes girls.

“We’ve observed case studies in which the sensory enrichment therapy was used without any other therapy, and those children were clearly responsive to it,” Leon added. “We hope this new treatment will benefit children with autism, their parents and society as a whole.”

UC Irvine’s Institute for Clinical & Translational Science, the Nancy Lurie Marks Family Foundation, Eyal and Yael Aronoff, the Samueli Foundation and the William & Nancy Thompson Family Foundation provided support for the study.

Leon is one of several dozen UC Irvine researchers contributing knowledge to the autism puzzle from distinct areas of study, ranging from gene function to cell biology to brain function and behavior. They are working together under the auspices of the university’s Center for Autism Research and Treatment to discover effective drug therapies for the neurological disorder. The center was established last December with a gift from Bill and Nancy Thompson.

Small Number of Autism Cases Linked to Depression Medications

Autism Spectrum Disorders News | 19 May 2013

In utero exposure to depression medications may increase the risk of autism spectrum disorders in less than 1 percent of cases, researchers in Sweden say.

First author Dheeraj Rai, a clinical lecturer at the Department of Public Health Sciences at Karolinska Institutet in Stockholm, and colleagues at the University of Bristol; Avon and Wiltshire Partnership Mental Health NHS Trust in Bristol, England; and Drexel University School of Public Health on Philadelphia said the study involved 4,429 cases of autism spectrum disorder -- 1,828 with and 2,601 without intellectual disability and 43,277 age and sex matched controls.

The study involved 1,679 cases of autism spectrum disorder and 16,845 controls with data on maternal anti-depressant use.

The study, published in the British Medical Journal, said parental depression and other characteristics were recorded in administrative registers before the birth of the child. Maternal anti-depressant use, recorded at the first antenatal interview, was available for children born from 1995 onwards.

A history of maternal -- but not paternal -- depression was associated with an increased risk of autism spectrum disorders in offspring, the study said. In the subsample with available data on drugs, this association was confined to women reporting anti-depressant use during pregnancy irrespective of whether selective serotonin reuptake inhibitors or non-selective monoamine reuptake inhibitors were reported, the study said.

"Whether this association is causal or reflects the risk of autism with severe depression during pregnancy requires further research," the study authors wrote in the study. "However, assuming causality, anti-depressant use during pregnancy is unlikely to have contributed significantly towards the dramatic increase in observed prevalence of autism spectrum disorders as it explained less than 1 percent of cases."

Children with Autism See Movement Quicker- A Clue to Underlying Cause of the Disorder

Autism Spectrum Disorders News | 14 May 2013

Children with autism see simple movement twice as quickly as other children their age, and this hypersensitivity to motion may provide clues to a fundamental cause of the developmental disorder, according to a new study.

Such heightened sensory perception in autism may help explain why some people with the disorder are painfully sensitive to noise and bright lights. It also may be linked to some of the complex social and behavioral deficits associated with autism, says Duje Tadin, one of the lead authors on the study and an assistant professor of brain and cognitive sciences at the University of Rochester.

"We think of autism as a social disorder because children with this condition often struggle with social interactions, but what we sometimes neglect is that almost everything we know about the world comes from our senses. Abnormalities in how a person sees or hears can have a profound effect on social communication."

Although previous studies have found that people with autism possess enhanced visual abilities with static images, this is the first research to discover a heightened perception of motion, the authors write. The findings were reported in the Journal of Neuroscience on May 8 by Tadin, co-lead author Jennifer Foss-Feig, a postdoctoral fellow at the Child Study Center at Yale University, and colleagues at Vanderbilt University.

In the study, 20 children with autism and 26 typically developing children, ages 8 to 17, looked at brief video clips of moving black and white bars and simply indicated which direction the bars were heading, right or left. Each time a participant made the correct direction choice, the next video clip became slightly shorter and thus a little more difficult. When they made a mistake, the next video became a bit longer and thus easier to see. In this way, the researchers were able to measure how quickly children with autism can perceive motion.

"This dramatically enhanced ability to perceive motion is a hint that the brains of individuals with autism keep responding more and more as intensity increases. Although this could be considered advantageous, in most circumstances if the neural response doesn't stop at the right level it could lead to sensory overload," explains Foss-Feig.

Such hypersensitive perception is the neural signature for a brain that is unable to dampen its response to sensory information, note the authors. This same increase in neural "excitability" is also found in epilepsy, which is strongly linked to autism. In fact, as many as one third of individuals with autism also have epilepsy. Normally, the brain puts the brakes on its responses to sound, taste, touch, and other stimuli when they become too intense.

What's important about this dampening ability is that it's a ubiquitous mechanism controlling how humans perceive the world. "If the processing of our vision, hearing, and other sensory systems is abnormal in some way, it will have a cascading effect on other brain functions," says Carissa Cascio, assistant professor of psychiatry at Vanderbilt University, in whose lab the study was conducted. "You may be able to see better, but at some point the brain really is over responding. A strong response to high intensity stimuli in autism could be one reason for withdrawal."

The research builds on earlier findings that people with autism process visual stimuli differently. For example, previous studies have shown that individuals with autism are better able to perceive basic patterns, are able to see simple line images more quickly, and are more focused on details than individuals without the condition. By contrast, in more complex tasks, like facial recognition, these enhancements become impairments. Likewise, autism is associated with deficits in perceiving motion patterns more complex than the simple moving bars used in this study, such as detecting walking and other biological movements.

Kimberly Schauder, a research assistant at Vanderbilt University, is also an author on the paper. The research was supported by grants from the National Institutes of Health.

Autism Risk Can be Spotted at Birth

Autism Spectrum Disorders News | 30 April 2013

Researchers at the Yale School of Medicine have figured out how to measure an infant’s risk of developing autism by looking for abnormalities in his/her placenta at birth, allowing for earlier diagnosis and treatment for the developmental disorder. The findings are reported in the April 25 online issue of Biological Psychiatry.

One out of 50 children are diagnosed with an autism spectrum disorder in the United States each year, according to the Centers for Disease Control and Prevention (CDC), but the diagnosis is usually made when these children are 3 to 4 years of age or older. By then the best opportunities for intervention have been lost because the brain is most responsive to treatment in the first year of life.

Senior author Dr. Harvey Kliman, research scientist in the Department of Obstetrics, Gynecology & Reproductive Sciences at the Yale School of Medicine, and research collaborators at the MIND Institute at the University of California, Davis, have found that abnormal placental folds and abnormal cell growths called trophoblast inclusions are key markers to identify newborns who are at risk for autism.

Kliman and his team examined 117 placentas from infants of at-risk families, those with one or more previous children with autism. These families were participating in a study called Markers of Autism Risk in Babies – Learning Early Signs. Kliman compared these at-risk placentas to 100 control placentas collected by the UC Davis researchers from the same geographic area.

The at-risk placentas had as many as 15 trophoblast inclusions, while none of the control placentas had more than two trophoblast inclusions. Kliman said a placenta with four or more trophoblast inclusions conservatively predicts an infant with a 96.7% probability of being at risk for autism.

Currently, the best early marker of autism risk is family history. Couples with a child with autism are nine times more likely to have another child with autism. Kliman said that when these at-risk families have subsequent children they could employ early intervention strategies to improve outcomes. “Regrettably couples without known genetic susceptibility must rely on identification of early signs or indicators that may not overtly manifest until the child’s second or third year of life,” said Kliman.

“I hope that diagnosing the risk of developing autism by examining the placenta at birth will become routine, and that the children who are shown to have increased numbers of trophoblast inclusions will have early interventions and an improved quality of life as a result of this test,” Kliman added.

Other authors on the study include Kaitlin Anderson, Kristin Milano, and Saier Ye of Yale University; and Cheryl Walker, Daniel Tancredi, Isaac Pessah, and Irva Hertz-Picciotto of UC Davis.

Autism and Video Games

Autism Spectrum Disorders News | 29 April 2013

Children and teens with autism spectrum disorder (ASD) use screen-based media, such as television and video games, more often than their typically developing peers and are more likely to develop problematic video game habits, a University of Missouri researcher found.

“Many parents and clinicians have noticed that children with ASD are fascinated with technology, and the results of our recent studies certainly support this idea,” said Micah Mazurek, an assistant professor of health psychology and a clinical child psychologist at MU. “We found that children with ASD spent much more time playing video games than typically developing children, and they are much more likely to develop problematic or addictive patterns of video game play.”

Mazurek studied screen-based media use among 202 children and adolescents with ASD and 179 typically developing siblings. Compared to typically developing children, those with ASD spent more time playing video games and less time on social media, such as Facebook. Children with ASD also spent more time watching TV and playing video games than participating in pro-social or physical activities. Conversely, typically developing children spent more time on non-screen activities than on TV or video games.

In another study of 169 boys with ASD, problematic video game use was associated with oppositional behaviors, such as refusing to follow directions or engaging in arguments. Mazurek says carefully controlled research is needed to examine these issues in the future.

“Because these studies were cross-sectional, it is not clear if there is a causal relationship between video game use and problem behaviors,” Mazurek said. “Children with ASD may be attracted to video games because they can be rewarding, visually engaging and do not require face-to-face communication or social interaction. Parents need to be aware that, although video games are especially reinforcing for children with ASD, children with ASD may have problems disengaging from these games.”

Even though Mazurek cautions that too much screen time could be detrimental for children with ASD, she says tapping into what children with ASD enjoy about video games could help researchers and clinicians develop therapies using the technology.

“Using screen-based technologies, communication and social skills could be taught and reinforced right away,” Mazurek said. “However, more research is needed to determine whether the skills children with ASD might learn in virtual reality environments would translate into actual social interactions.”

The study, “Television, Video Game and Social Media Use among Children with ASD and Typically Developing Siblings,” will be published in an upcoming issue of the Journal of Autism and Developmental Disorders. “Video Game Use and Problem Behaviors in Boys with Autism Spectrum Disorders,” was published in Research in Autism Spectrum Disorders. Mazurek also authored an article for The Scientist Magazine about the benefits and possible negative consequences of using screen-based technologies in interventions for children with autism.

New Study: Drug Could Improve Working Memory of People with Autism

Autism Spectrum Disorders News | 23 April 2013

People with an Autism Spectrum Disorder (ASD) often have trouble communicating and interacting with others because they process language, facial expressions and social cues differently. Previously, researchers found that propranolol, a drug commonly used to treat high blood pressure, anxiety and panic, could improve the language abilities and social functioning of people with an ASD. Now, University of Missouri investigators say the prescription drug also could help improve the working memory abilities of individuals with autism.

Working memory represents individuals’ ability to hold and manipulate a small amount of information for a short period; it allows people to remember directions, complete puzzles and follow conversations. Neurologist David Beversdorf and research neuropsychologist Shawn Christ found that propranolol improves the working memory performance of people with an ASD.

“Seeing a tiger might signal a fight or flight response. Nowadays, a stressor such as taking an exam could generate the same response, which is not helpful,” said Beversdorf, an associate professor in the Departments of Radiology and Neurology in the MU School of Medicine. “Propranolol works by calming those nervous responses, which is why some people benefit from taking the drug to reduce anxiety.”

Propranolol increased working memory performance in a sample of 14 young adult patients of the MU Thompson Center for Autism and Neurodevelopmental Disorders but had little to no effect on a group of 13 study participants who do not have autism. The researchers do not recommend that doctors prescribe propranolol solely to improve working memory in individuals with an ASD, but patients who already take the prescription drug might benefit.

“People with an Autism Spectrum Disorder who are already being prescribed propranolol for a different reason, such as anxiety, might also see an improvement in working memory,” said Christ, an associate professor in the Department of Psychological Sciences in the MU College of Arts and Science.

Future research will incorporate clinical trials to assess further the relationship between cognitive and behavioral functioning and connectivity among various regions of the brain.

The study, “Noradrenergic Moderation of Working Memory Impairments in Adults with Autism Spectrum Disorder,” was published in the Journal of the International Neuropsychological Society. Kimberly Bodner, a psychological sciences doctoral student at MU, and Sanjida Saklayen from the Ohio State University College of Medicine co-authored the study.

CWRU Scientists Find New Way to Detect Autism

Autism Spectrum Disorders News | 22 April 2013

Neuroscientists from Case Western Reserve University School of Medicine and the University of Toronto have developed an efficient and reliable method of analyzing brain activity to detect autism in children. Their findings appear in the online journal PLOS ONE.

The researchers recorded and analyzed dynamic patterns of brain activity with magnetoencephalography (MEG) to determine the brain’s functional connectivity—that is, its communication from one region to another. MEG measures magnetic fields generated by electrical currents in neurons of the brain.

Roberto Fernández Galán, an assistant professor of neurosciences at Case Western Reserve and an electrophysiologist seasoned in theoretical physics, led the research team that detected autism spectrum disorder (ASD) with 94 percent accuracy. The new analytic method offers an efficient, quantitative way of confirming a clinical diagnosis of autism.

“We asked the question, ‘Can you distinguish an autistic brain from a non-autistic brain simply by looking at the patterns of neural activity?’ and indeed, you can,” Galán said. “This discovery opens the door to quantitative tools that complement the existing diagnostic tools for autism based on behavioral tests.”

In a study of 19 children—nine with ASD—141 sensors tracked the activity of each child’s cortex. The sensors recorded how different regions interacted with each other while at rest, and compared the brain’s interactions of the control group to those with ASD. Researchers found significantly stronger connections between rear and frontal areas of the brain in the ASD group; there was an asymmetrical flow of information to the frontal region, but not vice versa.

The new insight into the directionality of the connections may help identify anatomical abnormalities in ASD brains. Most current measures of functional connectivity do not indicate the interactions’ directionality.

“It is not just who is connected to whom, but rather who is driving whom,” Galán said.

Their approach also allows them to measure background noise, or the spontaneous input driving the brain’s activity while at rest. A spatial map of these inputs demonstrated there was more complexity and structure in the control group than the ASD group, which had less variety and intricacy. This feature offered better discrimination between the two groups, providing an even stronger measure of criteria than functional connectivity alone, with 94 percent accuracy.

Case Western Reserve’s Office of Technology Transfer has filed a provisional patent application for the analysis’s algorithm, which investigates the brain’s activity at rest. Galán and colleagues hope to collaborate with others in the autism field with emphasis on translational and clinical research. Galán’s collaborators and co-authors of this study are University of Toronto’s associate researcher Luis García Domínguez and professor José Luis Pérez Velázquez.

Older Fathers More Likely to Have Autistic Grandchildren

Autism Spectrum Disorders News | 12 April 2013

Men who have children when they are older are more likely to have grandchildren with autism, according to a study which shows for the first time that risk factors for autism may build up over generations.

Men who had a daughter when they were 50 or older were 1.79 times more likely to have a grandchild with autism than men between 20 and 24, and with sons the likelihood was 1.67 times.Avi Reichenberg of the Institute of Psychiatry at King's College London, who co-led the study, said the work showed for the first time "that your father's and grandfather's lifestyle choices can affect you."

"This doesn't mean that you shouldn't have children if your father was old when he had you, because whilst the risk is increased, it is still small," he said.

Autism disorders, caused by a combination of genetic and environmental factors, can range from severe mental retardation with a profound inability to communicate, to relatively mild symptoms combined with some high levels of function such as those seen in people with Asperger's syndrome.

Among core features of the disorders are poor communication skills and difficulties with social engagement. In the United States, an estimated 1 in 88 children have autism, while in Europe the rate is thought to be about in 100.

Research published in August last year showing that a father's age when a baby is conceived is the single largest factor in the risk of passing on new gene mutations may help explain why childhood autism rates are rising.

The study published on Wednesday in the Journal of the American Medical Association used Swedish national registers and analyzed data from 5,936 people with autism and 30,923 healthy controls born in Sweden since 1932.

The researchers from Britain, Sweden and Australia factored in each person's maternal and paternal grandfathers' age of reproduction and details of any psychiatric diagnosis.

"We know from previous studies that older paternal age is a risk factor for autism," said Emma Frans from the Karolinska Institute in Sweden, who co-led the research with Reichenberg.

"This study goes beyond that and suggests that older grand-paternal age is also a risk factor for autism, suggesting that risk factors for autism can build up through generations," she said.

The researchers said that while the mechanism behind the link to older fathers and grandfathers is not clear, it may be explained by mutations occurring in sperm cells over time.

While most genetic mutations do not result in a child developing autism, the researchers said their findings suggest some 'silent' mutations pass on through healthy children and may influence the risk of future generations developing autism.

They also said genetic risk could accumulate over generations, or could interact with other risk factors, until it reaches a particular threshold and prompts autism in a child.