Autism spectrum disorder update – Part three

| August 19, 2014 | 0 Comments

According to the United States (US) National Institutes of Health,1 autism spectrum disorders (ASD) represent “a range of developmental disorders characterised by impaired social interactions, problems with verbal and non-verbal communication, and repetitive behaviours or severely limited activities and interests”.

The Centres for Disease Control and Prevention (CDC)2 has presented revised figures for the estimated prevalence of ASD in the United States (US), causing many to declare a “crisis situation”.3

Spike in numbers causes controversy

Marking a 30% spike from the 1 in 88 children reported in 2012 to have ASD, the CDC now estimates that one in 68 children have one form or another of the disorder, with numbers still heavily skewed towards white boys. The CDC looked at records for 363 749 children who were eight years old in 2010.

The research methods employed by the CDC to monitor the prevalence of ASD have always met with criticism from the global ASD research community.4

In 2012, Eric Fombonne, professor of psychiatry at Oregon Health and Science University, said of that year’s CDC report on ASD figures:5 “Some [US] states [for example] use only medical records, others use both medical and educational records. If… all states include educational sources, the rates will go up, not because of an increased incidence but because the method will be more efficient.”

However, this year, in an interview with the Philadelphia Inquirer,6Walter Zahorodny, an epidemiologist and psychologist at Rutgers New Jersey Medical School, said that arguing over whether the increase in ASD diagnoses stems from growing awareness or reflects growing numbers of children with the disabling condition is a waste of time. “It’s a true increase, a change of great magnitude,” he observed.

Costs cause for concern

In 2012, Fombonne suggested that the CDC “follow large birth cohorts prospectively, as is being done in Norway. If you follow them over time, you can capture most kids with autism (sic) at a later age. But the costs would be prohibitive.”

Fombonne’s reference to cost is apposite. David Mandell, director of the Centre for Mental Health Policy and Services Research at the University of Pennsylvania Perelman School of Medicine,7 says that his recent research – published online in June 2014 in the journal JAMA Paediatrics8 – indicates that the lifetime cost of supporting just one person with ASD in the US can range from US$1.4 million to US$2.4 million, with factors as varied as lost wages (with reference to parents who must forsake jobs in favour of home-based care for ASD children), residential care and special education driving up expenses.

“We really need very different workplace policies that support the parents of children with disabilities,” said Mandell.

Is ASD an autoimmune disease?

Fombonne has argued for over 20 years for the urgent need to find “persuasive evidence” as to the causes of ASD.

Scientists sought such evidence at the ICare4Autism conference hosted at the end of June 2014 in New York City.9 Keynote speaker Dr Eric Hollander, reminded delegates that “ASD is incredibly unique to each individual and therefore it has been historically difficult to try to find what can lead to its development”.

Hollander has also been involved in studies using whipworms (Trichuris suis), a parasitic intestinal worm. Regular ingestion of the worms (subjects ate 2 500 eggs every two weeks for 12 weeks), reduced repetitive actions, known as ‘stimming’. The result indicates that ASD may be an autoimmune disease, says Hollander, occurring because a person doesn’t acquire enough microbes or parasites early in life to deal with, for example, elevated rates of internal inflammation. The worms may help the body build an immune response.

Maximise motor-based mimicry

Whilst it has been suggested that schools may consider temperature control in classrooms to aid those with ASD in the future, other studies have been presented to help teachers and parents right now.

At the University of California, Los Angeles (UCLA) health science faculty, a new study published in the June 2014 issue of Journal of the American Academy of Child and Adolescent Psychiatry10 has reaffirmed that technology can enhance the development of communication skills in minimally verbal ASD children.

The three-year study exposed 61 children between the ages of five and eight years to digital tablets programmed with audio clips that described pictures. The interaction led to a marked increase in spontaneous verbal and non-verbal communication from the children.

There are estimated to be 600 000 ASD children in the UK, where a new paper, published in Frontiers in Neuroscience, examined the pivotal importance of using motor-mirroring classroom techniques with ASD children.11

Researchers found that the most effective way of communication with non-verbal ASD children was through “motor behaviours, such as banging toys and copying gestures or facial expressions, picture exchange training and play-based approaches”.

Look at the big picture

Joe Long, researcher in residence at Scottish Autism and honorary research fellow in anthropology at the University of Aberdeen, is tired of endless research.12

Citing the recent ‘What should autism research focus upon?’ report produced by the Centre for Research in Autism and Education (CRAE), at the University of London,13 Long expressed frustration that “[the] majority of research funding and publications are focused on the biological and cognitive elements of autism spectrum disorders, while only a small proportion of research addresses autism services or societal issues”.

“The effectiveness of a new intervention or support strategy can rarely be shown in a clinical context. We need a holistic picture of someone’s life – the community, relationships, and support services in which small changes can deeply affect someone’s wellbeing.”

References:

1. See: http://www.nih.gov/.

2. See: http://www.cdc.gov/media/releases/2014/p0327-autism-spectrumdisorder. html.

3. See, for example: Macdonald, G. (2014) “Spike in autism-spectrum diagnoses called a ‘public health crisis’”. Available at: http://www.theglobeandmail.com/news/national/spike-in-autism-spectrumcalled- a-public-health-crisis/article17714662/.

4. See, for example: http://www.autismpolicyblog.com/ 2014_03_01_archive.html.

5. See, for example: http://sfari.org/news-and-opinion/q-a/2012/q-a-with-ericfombonne- are-autisms-rising-rates-real.

6. See: http://www.inquirer.com/.

7. See: http://www.med.upenn.edu/cmhpsr/faculty_mandell.html.

8. See: http://archpedi.jamanetwork.com/journal.aspx.

9. See: http://www.icare4autism.org/news/2014/07/dr-eric-hollander-makesan- impact-at-icare4autism-conference/.

10. See: http://www.jaacap.com/.

11. See: http://www.frontiersin.org/neuroscience.

12. See, for example: Long, J. (2014) “We need to research practical knowledge about autism – not just how it affects the brain”. Available at: http://www.theguardian.com/social-care-network/2014/jun/16/need-researchpractical- knowledge-autism.

13. See: Charman, T., Dinsmore, A. and Pellicano, E. (2014) “What should autism research focus upon? Community views and priorities from the United Kingdom”. Available at: http://aut.sagepub.com/content/early/ 2014/04/29/1362361314529627.full.

Category: Spring 2014

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