Females with autism are different than males with autism in a lot of ways. This week, researchers used twins to examine the differences between males and females with autism in their brain structure and how it’s associated with autism traits, not a diagnosis. To do this, researchers in Sweden turned to twins. As it turns out, females have more of a diversity of differences in brain changes compared to boys, supporting the female protective effect. But how to females with autism feel? As them! A group in the UK interviewed over 20 women on the spectrum or their parents to find out what concerns them most and what they find most challenging. Listen to the podcast here.
Podcast: An update on females with autism, on the double
Happy President’s Day! This week’s podcast is focuses on a topic that has been on the mind of families affected by autism: autism and violence and victimization. The studies reinforce 1) the lack of an association between autism and criminality, 2) the association of an autism diagnosis with being the victim of abuse. This includes self report data, database analyses and assessment of people who cannot report their abuse. This sobering podcast was posted today because gun violence is an issue at the forefront of this president’s administration. While this podcast is not focused on gun violence, hopefully this data will reduce the misconceptions and stereotypes around autism and violence. Listen to the podcast here.
There is demonstrated genetic overlap between many neurodevelopment disorders including ASD, ADHD, and schizophrenia, and now there is data showing similarities in the structure and size of the brains in people with autism and those with ADHD. These differences depend on how severe social difficulties are, but the similarities are seen with ASD and ADHD, but not OCD. In addition, this week there are new depressing results from the Interactive Autism Network on unemployment and females with ASD. The results may not surprise you, but they will upset you. Listen to the podcast here.
Everyone knows the way to study infants with autism is through thorough testing of younger siblings of those with a diagnosis, who have a 15x greater chance of have a diagnosis themselves. Through these methods, new ways of identifying and predicting autism later on have been developed. On this week’s podcast: two very influential and recent papers on the study of motor issues in 6 month olds who go on to be diagnosed with autism, and those who don’t have an autism diagnosis but have signs and symptoms of ASD. Are motor issues related to an ASD diagnosis or ASD symptoms? And what about core symptoms of autism like language? Can early motor behaviors be used to predict who goes on to receive an autism diagnosis or has language problems? What should parents do? How should this influence an early intervention plan? Listen to the podcast here.
Twins with autism, where either one or both is diagnosed, is crucial to understand the role of genetics and the environment to both autism diagnoses and now, autism traits. In a study this week, researchers using data from the California Twins Study examined the genetic and environmental influences of brain development in multiple regions and measures. While estimates of genetic and environmental influences can only be modeled in twins, they can be experimentally tested in animal models. Researchers at the University of Washington investigate what causes the link between air pollution in humans and autism by studying diesel fuel exhaust in pregnant mice. Finally, across all of these disparate animal studies – does anything pull them together. Are these models all one-offs or do they have anything in common? It turns out disruption in normal brain activity is one thing that they have in common, and something that is at the common core of ASD neurobiology. Listen to the podcast here.
Even though many parents of kids with autism and autistic adults are using cannabis (THC and CBD) and cannabidiols (CBD only), these treatments are technically illegal. So how are pediatricians discussing these options with their patients when asked? A few pediatricians from states where it is legal for adults to obtain cannabis containing products weigh in on what they say, how they communicate, and what is ethical to explain in what circumstance. Also, new findings from an imperfect, but medically supervised, study on stem cell therapies in autism. Findings are interesting but should be judged with caution. Listen to the podcast here.
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. Listen to the podcast here.
PROBLEM/CONDITION: Autism spectrum disorder (ASD).
PERIOD COVERED: 2014.
DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence of autism spectrum disorder (ASD) among children aged 8 years whose parents or guardians reside within 11 ADDM sites in the United States (Arizona, Arkansas, Colorado, Georgia, Maryland, Minnesota, Missouri, New Jersey, North Carolina, Tennessee, and Wisconsin). ADDM surveillance is conducted in two phases. The first phase involves review and abstraction of comprehensive evaluations that were completed by professional service providers in the community. Staff completing record review and abstraction receive extensive training and supervision and are evaluated according to strict reliability standards to certify effective initial training, identify ongoing training needs, and ensure adherence to the prescribed methodology. Record review and abstraction occurs in a variety of data sources ranging from general pediatric health clinics to specialized programs serving children with developmental disabilities. In addition, most of the ADDM sites also review records for children who have received special education services in public schools. In the second phase of the study, all abstracted information is reviewed systematically by experienced clinicians to determine ASD case status. A child is considered to meet the surveillance case definition for ASD if he or she displays behaviors, as described on one or more comprehensive evaluations completed by community-based professional providers, consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for autistic disorder; pervasive developmental disorder-not otherwise specified (PDD-NOS, including atypical autism); or Asperger disorder. This report provides updated ASD prevalence estimates for children aged 8 years during the 2014 surveillance year, on the basis of DSM-IV-TR criteria, and describes characteristics of the population of children with ASD. In 2013, the American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which made considerable changes to ASD diagnostic criteria. The change in ASD diagnostic criteria might influence ADDM ASD prevalence estimates; therefore, most (85%) of the records used to determine prevalence estimates based on DSM-IV-TR criteria underwent additional review under a newly operationalized surveillance case definition for ASD consistent with the DSM-5 diagnostic criteria. Children meeting this new surveillance case definition could qualify on the basis of one or both of the following criteria, as documented in abstracted comprehensive evaluations: 1) behaviors consistent with the DSM-5 diagnostic features; and/or 2) an ASD diagnosis, whether based on DSM-IV-TR or DSM-5 diagnostic criteria. Stratified comparisons of the number of children meeting either of these two case definitions also are reported.
RESULTS: For 2014, the overall prevalence of ASD among the 11 ADDM sites was 16.8 per 1,000 (one in 59) children aged 8 years. Overall ASD prevalence estimates varied among sites, from 13.1-29.3 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and race/ethnicity. Males were four times more likely than females to be identified with ASD. Prevalence estimates were higher for non-Hispanic white (henceforth, white) children compared with non-Hispanic black (henceforth, black) children, and both groups were more likely to be identified with ASD compared with Hispanic children. Among the nine sites with sufficient data on intellectual ability, 31% of children with ASD were classified in the range of intellectual disability (intelligence quotient [IQ] <70), 25% were in the borderline range (IQ 71-85), and 44% had IQ scores in the average to above average range (i.e., IQ >85). The distribution of intellectual ability varied by sex and race/ethnicity. Although mention of developmental concerns by age 36 months was documented for 85% of children with ASD, only 42% had a comprehensive evaluation on record by age 36 months. The median age of earliest known ASD diagnosis was 52 months and did not differ significantly by sex or race/ethnicity. For the targeted comparison of DSM-IV-TR and DSM-5 results, the number and characteristics of children meeting the newly operationalized DSM-5 case definition for ASD were similar to those meeting the DSM-IV-TR case definition, with DSM-IV-TR case counts exceeding DSM-5 counts by less than 5% and approximately 86% overlap between the two case definitions (kappa = 0.85).
INTERPRETATION: Findings from the ADDM Network, on the basis of 2014 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD among children aged 8 years in multiple communities in the United States. The overall ASD prevalence estimate of 16.8 per 1,000 children aged 8 years in 2014 is higher than previously reported estimates from the ADDM Network. Because the ADDM sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States. Consistent with reports from previous ADDM surveillance years, findings from 2014 were marked by variation in ASD prevalence when stratified by geographic area, sex, and level of intellectual ability. Differences in prevalence estimates between black and white children have diminished in most sites, but remained notable for Hispanic children. For 2014, results from application of the DSM-IV-TR and DSM-5 case definitions were similar, overall and when stratified by sex, race/ethnicity, DSM-IV-TR diagnostic subtype, or level of intellectual ability.
PUBLIC HEALTH ACTION: Beginning with surveillance year 2016, the DSM-5 case definition will serve as the basis for ADDM estimates of ASD prevalence in future surveillance reports. Although the DSM-IV-TR case definition will eventually be phased out, it will be applied in a limited geographic area to offer additional data for comparison. Future analyses will examine trends in the continued use of DSM-IV-TR diagnoses, such as autistic disorder, PDD-NOS, and Asperger disorder in health and education records, documentation of symptoms consistent with DSM-5 terminology, and how these trends might influence estimates of ASD prevalence over time. The latest findings from the ADDM Network provide evidence that the prevalence of ASD is higher than previously reported estimates and continues to vary among certain racial/ethnic groups and communities. With prevalence of ASD ranging from 13.1 to 29.3 per 1,000 children aged 8 years in different communities throughout the United States, the need for behavioral, educational, residential, and occupational services remains high, as does the need for increased research on both genetic and nongenetic risk factors for ASD.