Update on Autism Spectrum Disorders on Nashville Medical News

Update on Autism Spectrum Disorders

By: KELLY PRICE

April is National Autism Awareness Month

A new report by the Centers for Disease Control and Prevention (CDC) shows, statistically, one in every 110 children in the United States is affected by autism spectrum disorders (ASD). This number, which is based on 2006 study results, is up from the 1:150 prevalence rate from findings just four years prior to that. Autism continues to be 4.5 times more common in boys than in girls.

Changes in diagnostic practice may account for a portion of the increase but do not completely explain the rise in the prevalence of autism. Nor do these changes account for other factors, including environmental ones, which are likely to play a role in the growth of autism in America.

The top Autism Research findings for 2009, an annual list of the 10 most significant research achievements to have impacted autism research during the previous year, has been released by Autism Speaks, the world’s largest autism science and advocacy organization (www.autismspeaks.org/press/top_10_research_achievements_2009.php). Each study advanced understanding of ASD in some important way.

Stone to Leave TRIAD Program

Cook Accepts Position

Wendy Stone, PhD, founding director of TRIAD, the Treatment and Research Institute for Autism Spectrum Disorders at the Vanderbilt Kennedy Center, will leave Vanderbilt this month to assume the position of director of the University of Washington’s Autism Center.

Ed Cook, MD, will assume the position of director of Autism Research at Vanderbilt University and the Vanderbilt Kennedy Center for Research on Human Development beginning Aug. 1, 2010.

Elisabeth Dykens, director of Vanderbilt Kennedy Center, said, “Wendy’s caring for children with autism and their families has motivated her many extraordinary achievements. TRIAD, which she created, has grown into an outstanding array of assessment and educational services for children and families. With her leadership, excellent training programs have been developed for parents and for educators and health professionals.

“Finally, she has conducted groundbreaking research in the early diagnosis of autism spectrum disorders, as well as promoting research collaboration at Vanderbilt from the genetics of autism to interventions. We appreciate all that she has accomplished at Vanderbilt and in working with the autism community locally and in Tennessee, and her national leadership in promoting evidence-based practices. We will miss her greatly but wish her well on this next chapter in her career.”

Cook will be appointed as a tenured professor of psychiatry in the Division of Child and Adolescent Psychiatry in the Department of Psychiatry and will hold secondary appointments in the Departments of Pediatrics and Pharmacology.

Currently he is director of the Autism and Genetics Program at the University of Illinois in Chicago, where he is a tenured professor of psychiatry.

Cook’s work has been in molecular genetics and neurochemistry of autism, ADHD, and obsessive-compulsive disorder.

The 10 research achievements include:

Converging studies using different research methodologies yielded data that 1 percent of children in the United States is affected by ASD.
Early intervention for toddlers has shown to be effective at improving cognition, language and adaptive behavior.
The first successful genome-wide association studies for autism have enabled a better understanding of genetic risk factors.
Studies of genetic copy number variations revealed a new biological pathway, known as the “ubiquitin pathway,” in the pathology of autism.
Combined therapies, including medication and parent training, were shown to be more effective in reducing serious behavioral problems than medications alone.
In a mouse model of autism, genetic findings showed mice carrying a mutation in a gene linked to autism displayed some features of the disorder.
One study showed a link between mitochondrial dysfunction, fever and autistic regression.
Another study showed that, contrary to earlier belief, individuals with autism can acquire spoken language after age five.
While other causes are associated with language learning difficulties, the loss of language skills has been found to be specific to children with ASD.
Studies from a large database in Denmark added another link between autism and the immune system.

Zachary E. Warren, PhD, director of Parent Support and Education Programs for Vanderbilt Kennedy Center’s Treatment and Research Institute for Autism Spectrum Disorders (TRIAD), pointed out the new report from the CDC suggests a level of confidence in the statistic that 1:70 boys meets the criteria for a diagnosis of ASD.

“There is no good answer in terms of why this number is so large,” he said. “Even though the terms of the diagnosis are changing, the numbers are telling us that this will be a big deal for service systems and a potential public health crisis.”

Warren is enthused about results from the early toddler intervention studies, showing that babies as young as 18 months evidenced a large increase of improving IQ and language with earlier intervention.

“This shows we can apply models to younger children and may see improvements, which might make more of an impact when the child is identified with ASD at an earlier age. This links to work that is already going on at Vanderbilt to identify a toddler treatment network across the state,” he said.

Warren also pointed to the work being done by Quentin Humberd, MD, a past president of the Tennessee Chapter of the American Academy of Pediatrics. Humberd is using a program developed in conjunction with TRIAD — Screening Tools and Referral Training-Evaluation and Diagnosis (START ED) — to help practicing pediatricians accurately assess children suspected of having ASD as early as possible in the context of traditional community practice settings. A growing body of research indicates that children who receive autism-specialized intervention services at young ages show significant gains in cognitive and adaptive functioning and may be more likely to achieve fully integrated classroom placements at school age.

Warren pointed out, “In the absence of the ability to provide children with developmental concerns with appropriate intervention service without a diagnosis of ASD … and in the face of lengthy waits for traditional specialized diagnostic evaluations during the presumed critical window of neurobehavioral plasticity … the potential impact of ASD-specific diagnostic training programs is promising.”

The Kennedy Center has received federal stimulus funds as part of the American Recovery and Reinvestment Act in the form of a two-year Challenge Grant from the National Institutes of Health to compare stress management techniques in parents raising children with disabilities. The Parent Stress Intervention Project is investigating the effectiveness of two different approaches to lowering stress in these overtaxed parents. Over the next two years, the project will work with 400 parents, fathers included, who will be randomly assigned to either Adapted Mindfulness Practice or to a Positive Parent Support Model for six weekly sessions and three booster sessions.

Parenting a child with a disability can cause high levels of stress, often identified by sadness or distress upon discovery of a child’s disability, interacting with multiple professionals, expense, restricted social activities, isolation, lack of support, and guilt about not doing enough.

Warren said interesting work is being done with infant siblings of children with ASD to identify risk factors earlier and earlier. Studies of these “Baby Sibs” may provide clues to diagnosis at younger ages since there is evidence that the risk of ASD may be as high as 20 percent for first-degree siblings, as opposed to closer to 1 percent in the general population.

“We are continuing work on intervention paradigms and we even have a team of engineers who are helping us design systems and new platforms that will help in intervention.”

Warren pointed out The Lancet magazine has formally retracted a 1998 article suggesting an association between autism and the childhood MMR vaccination (measles-mumps-rubella) that lead to increased speculation about a connection between ASD and vaccines. “It would be great if there were a simple thing to blame for this disorder,” he said, “but it is much, much more complex.”