Publications - Autism Spectrum Disorders

How A Hospital And A School District Teamed Up To Help Kids In Emotional Crisis, by Rhitu Chatterjee, NPR, Jun 11 2021.

“The concerning rise in mental health issues noticed by school administrators mirrors national trends. Roughly 1 in 5 U.S. children meet criteria for a mental health disorder, and the rate of suicide attempts among youth has risen over the past decade, according to the U.S. Centers for Disease Control and Prevention.  Around the country, most kids who have mental health issues don't get treatment. There's a shortage of providers who work with children and it can take months to get an appointment.  "The wait times on an average to see a mental health specialist on an emergency basis is somewhere between two to three months, and for regular basis is up to 12 months, which is an unacceptable wait time," says Dr. Ujjwal Ramtekkar, a child and adolescent psychiatrist at Nationwide Children's Hospital. ”

MMR vaccine does not cause autism, another study confirms, by Dr. Edith Bracho-Sanchez, CNN, Mar 4 2019.

“The measles, mumps, and rubella vaccine does not increase the risk of autism and does not trigger autism in children who are at risk, according to a new study of over 650,000 children. ”

Even with insurance, getting mental health treatment is a struggle in Mass., study says, by Liz Kowalczyk, Boston Globe, Dec 11 2018.

“Massachusetts residents who need health care are colliding with a hard reality: Having medical insurance doesn’t guarantee you can get treatment, particularly for psychiatric problems. More than half of adults who sought mental health or addiction treatment in recent months had difficulty getting that care, according to a survey of 2,201 residents by the Blue Cross Blue Shield of Massachusetts Foundation in Boston...The obstacle wasn’t a lack of insurance; the vast majority of patients were insured. Rather, the problem was that providers either did not accept their insurance or their practices were closed to new patients. ”

Younger siblings of kids with autism and ADHD have higher risk of these disorders, by Lisa Rapaport, Reuters, Dec 11 2018.

“Children who have an older brother or sister with autism or attention deficit hyperactivity disorder (ADHD) may be more likely to develop these conditions than kids who don’t have an older sibling with these neurological problems, a new study suggests. When an older sibling had autism, younger kids were more than 30 times more likely to be diagnosed with autism and three times more likely to be diagnosed with ADHD than children whose siblings didn’t have these disorders, researchers report in JAMA Pediatrics. ”

States may now broaden mental health treatment under Medicaid, by Michael Nedelman, CNN, Nov 13 2018.

“The Centers for Medicare and Medicaid Services may now allow for states to pursue Medicaid reimbursements for short-term inpatient treatment in mental health facilities despite a decades-old exclusion, Health and Human Services Secretary Alex Azar announced Tuesday. In a letter to state Medicaid directors, CMS detailed a new Medicaid waiver opportunity through which states may bypass longstanding reimbursement restrictions on inpatient psychiatric treatment, which apply to mental health facilities with more than 16 beds. Azar said the original policy has posed a "significant barrier" to people getting the treatments they need. ”

Study: Most Psychoactive Drugs Taken During Pregnancy Do Not Increase Risk of Autism, by Rick Nauert, PhD, Psych Central, Nov 1 2018.

“New research finds that a mother’s use of antidepressants and antipsychotic drugs while pregnant does not place the baby at risk for autism. But the rates of autism were higher among children of mothers with worse general health before pregnancy, suggesting that the mother’s health plays a more critical role in a child’s development than the medications she takes. ”

Autism Can Mask the Warning Signs of Suicide, by Cheryl Platzman Weinstock and Spectrum, The Atlantic, Aug 10 2018.

“Studies over the past few years hint that suicidal ideation is more common in people with autism than in the general population, but the estimates vary so widely that some experts say they are meaningless. Still, there is some evidence that autistic people are especially vulnerable to suicide: One 2015 study that mined Sweden’s large National Patient Register found that they are 10 times as likely to die by suicide as those in the general population. (Women with autism are particularly at risk, even though men are more so in the general population.) Even when signs of suicidality are apparent, clinicians may dismiss them...Clinicians may wrongly assume that people on the spectrum don’t have complicated emotions, or they may discount their outbursts, says Paul Lipkin, the director of the Interactive Autism Network at the Kennedy Krieger Institute in Baltimore, Maryland. ”

Autistic children prone to food, skin and respiratory allergies, by HANNAH FURFARO , Spectrum, Jul 26 2018.

“Autistic children prone to food, skin and respiratory allergies   Food allergies are more than twice as common among autistic children as they are among their typical peers, according to a new study1. Boys with autism are also more likely than typical boys to have respiratory or skin allergies, the study suggests. The findings jibe with a large body of research linking autism to an abnormal immune response. For example, women with autoimmune and immune conditions such as lupus and rheumatoid arthritis are more likely than women without these conditions to have an autistic child. But few studies have directly probed the connection between autism and allergies. The new work, based on survey responses from the parents of nearly 200,000 children, is the first large study to find an association. “It is one of the first to identify a connection suggesting there may be something related to autism that we may not have looked at before — and that food may play a crucial role,” says Linda Snetselaar, professor of epidemiology at the University of Iowa in Iowa City. However, the research does not suggest that autism causes food allergies, she says. Some researchers caution against drawing strong conclusions from survey data from parents, who may not be relying on professional diagnoses. “It is not necessarily what you would call 100 percent reliable as opposed to, say, a clinical panel where they do the full allergy testing,” says Brian Lee, associate professor of epidemiology and biostatistics at Drexel University in Philadelphia, who was not involved in the work. Lee says the study is “still pretty important” as a clue to a relationship between autism and allergies. Taste test: The researchers examined responses from parents who completed the National Health Interview Survey from 1997 to 2016. The survey is a federally sponsored study of health among children and adults in the United States. Parents of 199,520 children aged 3 to 17 years answered questions about whether their child had experienced a food, skin or respiratory allergy in the past year. Of these children, 1,868 (1,478 boys and 390 girls) have autism. Of the autistic children, 11.25 percent have a food allergy, compared with 4.25 percent of the typical children. And about 19 percent have a respiratory allergy, compared with 12 percent of their typical peers. About 17 percent of children with autism have eczema or some type of skin allergy, compared with roughly 10 percent of typical children. The boys in the study accounted for the differences in skin and respiratory allergies. The researchers did not find an association between autism and these allergies in girls, perhaps because the study contained relatively few autistic girls, Lee says. Though the findings hint at a relationship between allergies and autism, they do not suggest allergies increase autism risk or vice versa. “It’s very important not to focus on causality but rather to see this as a path toward additional research in the future,” Snetselaar says. The work appeared in June in JAMA Pediatrics. One possibility is that allergies and autism share common roots: “For example, some kind of common genetics that underlies both the immune irregularities at birth and the neurodevelopmental, behavioral disorder,” says Lisa Croen, director of the Autism Research Program at Kaiser Permanente, a managed healthcare provider based in California. Croen was not involved in the study. The study has other limitations, such as relying on parents’ memories of their children’s allergies, which may be inaccurate. And some of the difference in allergy diagnoses may be due to the fact that autistic children are likely to see doctors more often than typical children do. REFERENCES: Xu G. et al. JAMA Pediatr. 1, e180279 (2018) Full text ”

Skepticism surrounds autism drug given ‘fast track’ for approval, by HANNAH FURFARO , Spectrum, Jul 25 2018.

“Skepticism surrounds autism drug given ‘fast track’ for approval For more than a decade, pediatrician Peter Halas has overseen the treatment of a young autistic woman, Mary Anne, who consistently resisted his attempts to examine her. Mary Anne’s parents have brought her to his New Jersey clinic at least once a year since she was 10, but at each visit, she would push him away and say just one word: “No.” (Halas did not disclose Mary Anne’s last name, to protect her privacy.) Halas prescribed Mary Anne anxiety medication, he says, but her mood and behaviors did not improve. So, when Yamo Pharmaceuticals, a small biotechnology company based in New York City, asked Halas to lead a study on its candidate autism drug, he jumped at the opportunity. “This patient, who had been my patient for a long time and was severely autistic, immediately came to mind,” Halas says. Halas convinced Mary Anne’s parents to enroll her as one of the study’s eight participants. Shortly after Mary Anne, then 24, began taking the drug, Halas says he witnessed a transformation. “Within a week she became more comfortable, happier, and started to speak more,” he says. “The second week, she was starting to use sentences, asking questions and making eye contact.” She began to blow kisses to her family members, recalling minute details about nursery school teachers from 20 years earlier, and even attended a rock concert. And she allowed Halas to examine her. As in the young woman’s case, results from the study — and a subsequent 41-person trial — hint that the drug, L1-79, improves social behaviors in adolescents and young adults with autism, according to J. Thomas Megerian, chief medical officer at Yamo. The company has yet to publish its results or post them on Clinicaltrials.gov — a federal repository of clinical trial results — so they are difficult to confirm, however. Despite the dearth of data, in May the U.S. Food and Drug Administration (FDA) granted the drug ‘fast track’ status, according to Megerian. (FDA officials declined to confirm this, citing agency rules.) Fast-track status is not an endorsement of a drug’s potential: A candidate drug can gain fast-track status if it has the potential to fulfill an unmet need for a serious medical condition; the agency can grant this status at any point during a drug’s review. The drug’s makers can also meet frequently with FDA officials about their study design. Many scientists say they are surprised by the FDA’s decision because of the lack of published data on the drug’s effectiveness. “[The decision] blows me away,” says Joseph Coyle, director of McLean Hospital’s Laboratory for Psychiatric and Molecular Neuroscience in Belmont, Massachusetts. The drug affects several distinct neuronal systems, he says, “most of which have nothing to do with autism.” Guerilla pharmacology: Yamo’s candidate is chemically similar to an approved cancer drug, Demser, whose mechanism is well understood. It inhibits an enzyme called tyrosine hydroxylase, which is critical for the production of chemical messengers called catecholamines. This category includes the chemical messengers dopamine, norepinephrine and epinephrine; abnormal dopamine signaling has been linked to autism in several ways. Demser is used to treat tumors that release high levels of catecholamines. Yamo’s drug mixes Demser with a mirror image of its chemical structure — and the participants in both of Yamo’s studies took it at much lower doses than Demser’s typical dose, according to the company’s officials. The Yamo drug would be expected to act similarly to Demser, although no animal studies exist to support that idea. “We just treated patients; we didn’t do a lot of the kind of antecedent work that might be done in terms of investigating mechanisms,” says John Rothman, Yamo’s chief scientific advisor. The process was “a little bit of guerilla pharmacology,” he says, because Yamo operated on a shoestring budget in its early days. Broad claims: It’s unclear how blocking signaling by dopamine or other catecholamines would improve social behavior in people with autism — the claim the company makes in the white paper it made available to Spectrum. In its description of the drug’s proposed mechanism, Yamo “was not only selective, but it was also to the point of being less than scholarly,” says George Anderson, senior research scientist at the Yale Child Study Center. “To think this is in any way improving a fundamental alteration of systems in autism is, I think, misguided.” In Yamo’s phase II clinical trial, launched in 2016, 31 young men with autism, aged 13 to 21 years, took the drug for 28 days; another 10 took a placebo. “Nobody thought this was going to show anything,” says Megerian. But to his surprise, he says, most participants taking the drug improved on several scales that assess social behavior. Parents of children in the trials have given video testimonials that the company shared with the FDA about the drug’s benefits. In one video, a mother tells a story about her teenage son, who sometimes bangs his head on walls and head-butts his brothers. While taking the drug, she says, her son went for weeks without hurting himself; his sleep improved and he accepted his parents’ affection. However, poignant anecdotes are no replacement for well-designed clinical trials, scientists note. Given the lack of published data, they are concerned about raising families’ hopes of a treatment. “Parents are desperate for treatment for their kids,” Coyle says. “I can tell you, in terms of the autism community, there are a number of unfortunately fringe, charismatic people offering treatments that have no biomedical validity.” Yamo officials say they intend to enroll 250 people with autism in a second phase II trial in early 2019. ”

Communication Issues Among Kids With Autism May Lead to Self-Harm, by Rick Nauert PhD, Psych Central, May 2 2018.

“A new study discovers communication problems among children can lead to depression and increase the risk of self-harm and suicidal intent during adolescence...The review comes in response to new findings that teen suicidality is under-recognized among children with ASD. Until now, community-based studies on suicidal thoughts and behaviors among children with symptoms of ASD have been limited...'Our study suggests that children who have difficulties with social communication are at higher risk for suicidal ideation and behavior in late adolescence,' said Dr. Iryna Culpin, senior research associate in the Bristol Medical School (PHS). 'Depressive symptoms in early adolescence partially explain this association.' ”

The Struggles of Women Who Mask Their Autism, by Francine Russo, The Atlantic, Feb 24 2018.

“Over the past few years, scientists have discovered that, like Jennifer, many women on the spectrum “camouflage” the signs of their autism. This masking may explain at least in part why three to four times as many boys as girls are diagnosed with the condition. It might also account for why girls diagnosed young tend to show severe traits, and highly intelligent girls are often diagnosed late...'Camouflaging is often about a desperate and sometimes subconscious survival battle,' says Kajsa Igelström, an assistant professor of neuroscience at Linköping University in Sweden. 'And this is an important point, I think—that camouflaging often develops as a natural adaptation strategy to navigate reality,' she says. 'For many women, it’s not until they get properly diagnosed, recognized, and accepted that they can fully map out who they are.' ”

Male Hormones May Alter Autism-Related Genes in Utero, by Traci Pedersen, Reuters, Feb 11 2018.

“A new French study may shed more light on why autism spectrum disorder (ASD) affects males around four times more than females. The researchers found that exposure to androgens (male hormones) during early fetal brain development alters certain genes linked to autism...Male fetuses produce androgens during critical stages of brain development when cells are dividing and developing into neurons. The study found that androgens increase the spread of cells and prevent them from death, which could predispose boys to ASD by contributing to the excessive brain growth that occurs in people with ASD during the first years of life. ”

Many Young Adults With Autism Also Have Mental Health Issues, by Tara Haelle , NPR, Oct 1 2017.

“Young adults on the autism spectrum are more likely to also have been diagnosed with a psychiatric condition, such as depression, anxiety and attention deficit hyperactivity disorder (ADHD) than are typically developing people or those with other developmental disabilities, a study finds. And managing those multiple conditions can make the transition to young adulthood especially difficult. ”

Increased risk of fatal injury comes with an autism diagnosis, by Madeline Kennedy, Reuters, Apr 7 2017.

“Young people with autism are about three times more likely than the general population to experience deadly injuries like choking or drowning, according to a U.S. study. Parents and caregivers need to be aware of this increased risk and do what they can to reduce the chances of preventable injuries, for example by helping children with autism to learn to swim as early as possible, the study team writes in American Journal of Public Health...People with autism died significantly younger than the general population, at a mean age of 36 years old, compared to 72 in the general population. Among injury deaths specifically, autistic people died at a mean age of 29, while the mean age among those without autism was 55. ”

Autism: Why Act Early?, CDC, Apr 3 2017.

“If you’re concerned about your child’s development, don’t wait. You know your child best. Use a developmental milestones checklist, talk with your child’s doctor, and call your local early intervention program. ”