4 New Things We’ve Learned About Autism Spectrum Disorder In The Last 2 Years

Friday, April 19th, 2013

As part of Autism Awareness Month, I’ve been reflecting on some of the new things we have learned about Autism Spectrum Disorder (ASD) over the past few years. Four findings stand out for me: 

It’s Not Just DNA: The landmark twin study published in 2011 suggests that while genes are important, environmental factors that increase likelihood of ASD are a key etiological influence as well. This finding is a critical one as it is the first twin study to show such a strong environmental effect after controlling for the role of genetics. It gives new impetus to examining a range of environmental influences in addition to searching for genes that increase risk for ASD.

Recovery From ASD Is Possible: While it’s been a controversial topic in the scientific literature, a recent study provides solid evidence that some kids can “outgrow” ASD. What we still don’t know is why that is the case. But this paper does stand out as important documentation that the phenomena of recovery is real.

Psychosocial Interventions Can Change Brain Functioning: While complete recovery from ASD is still rare, the positive effects of early intervention are not. New research published in 2012 provides dramatic evidence that some interventions – such as the Early Start Denver Model – may not just improve behavior, but also “normalize” brain functioning in response to social stimuli. This is a dramatic result because it demonstrates there is ‘plasticity’ in the brain that can be shaped by intensive intervention. It shows that we should give more weight to supporting psychosocial interventions, in part because they can effect biological development.

ASD Is More Common Than Ever: A recent paper reported that 1 in 50 kids have ASD. While it is difficult to generate a premise statistical estimate of the frequency of ASD,  it is clear that each new attempt reports that the frequency is higher than previously reported. This trend may, of course, reverse with the publication of the new DSM 5 criteria for ASD. That said, the newest estimates bring attention to how common ASD is in the population – and how many kids need appropriate diagnosis and intervention.

Human Brain Research via Shutterstock.com

Can a Child “Outgrow” Autism?

Thursday, April 18th, 2013

As April is Autism Awareness Month, I am taking on some of the most frequently asked questions about Autism Spectrum Disorder (ASD). “Can A Child ‘Outgrow’ Autism?” is one of the basic ones. A new study released earlier this year suggests that the answer is … yes.

To get to this answer, the study took on two core issues that need to be resolved:

• Did the youth really have ASD? (Or put another way –  were they misdiagnosed initially?)
• Did the youth fully recover? (Or put another way – did they lose all of their symptoms, or just enough to lose the diagnosis?)

This study was able to address these issues by combining the clinical resources of a number of institutions, and by using a longitudinal design that tracked kids over time. Via comparisons with two other groups of kids (one with current ASD, another without ASD) - along with rich clinical and developmental histories –  they were able to document complete recovery in 34 cases. By complete recovery, they answered the above questions as follows:

• The youth had documented ASD earlier in life using current diagnostic criteria.
• The youth lost all of their symptoms over time (not just some of them).

The question the study has not answered yet is what factors contributed to the complete recovery of these 34 cases. It is anticipated that a future publication will examine this.

While complete recovery is a goal for many parents, right now it is not the typical outcome for the majority of kids with ASD. That said, great strides are being made with intervention – especially early intervention. Getting kids diagnosed early and using that as a platform for early intervention will always lead to improvement in functioning over time, even if complete recovery is not achieved.

Autism Diagnosis via woaiss / Shutterstock.com

5 Things Every Pregnant Woman Should Know (Though Your Doctor Won’t Tell You)

Wednesday, April 17th, 2013

Jennifer Margulis, Ph.D., an award-winning journalist and a Schuster Institute Fellow at Brandeis University, has just released a new book called The Business of Baby. In it she takes on a number of controversial issues facing those who are thinking of becoming pregnant, are pregnant, or are new parents. Here she offers a guest blog post with her take on 5 key things that every pregnant woman should know. 

1. Prenatal vitamins can make you sick: Not all prenatal vitamins are created equal. Some “natural” brands, whether over-the-counter or prescribed by a doctor, contain harmful additives, including petroleum-based dyes like Red 40. The nausea you’ve attributed to pregnancy hormones may actually be from the vitamins you’ve been told to take.

2. Ultrasounds are not medically recommended: Though some doctors do them at every visit, routine ultrasounds are not recommended by the American College of Obstetricians and Gynecologists for normal pregnancies. There is no evidence that ultrasounds improve pregnancy outcomes but there is an increasing body of evidence that prolonged exposure to ultrasound can cause harm.

3. How much weight you gain is not as important as what you eat: Every woman gains weight differently but all pregnant women need nutritious, fresh, high quality food. The fat your body stores during pregnancy is there for a reason: to give you reserves for breastfeeding after the baby is born. It’s much more important to eat high quality protein, healthy fats, fresh vegetables and fruits, whole grains, and unprocessed foods than to worry about the amount of weight you’re gaining. Doctors actually look down on nutrition as irrelevant and unimportant, says Michael Klaper, M.D., director of the Institute of Nutrition Education and Research in Manhattan Beach, California. “There’s an inherent contempt for nutrition built into Western medicine,” Klaper explains. “Nutrition is a sissy sport among physicians.”

4. You can avoid gestational diabetes and anemia: With a healthy whole food based diet and enough exercise, most women can avoid common pregnancy problems. According to Stuart Fischbein, M.D., a Los Angeles based obstetricians with 30 years experience, the key is to eat proactively, avoiding processed sugar and doing enough exercise (to prevent gestational diabetes) and eating iron-rich foods (like eggs, red meat, and green leafy vegetables) along with foods high in vitamin C to help your body absorb the iron (to prevent anemia).

5. Your doctor believes birth is an illness: Growing a human being inside your body may be the most magical, spiritual, awe-inspiring time of your life, but your obstetrician has been taught to look for worse case scenarios and view your pregnancy as an accident waiting to happen. If you want a care provider who shares your wonder and a gentle birth, pick a well-trained midwife over a doctor.

Boston Marathon Explosions: Be In Control of What Your Child Will Hear and See

Monday, April 15th, 2013

The news of the explosions at the Boston Marathon once again necessitates that parents take control of what their kids will hear and see. Here are a few key points to keep in mind.

Be aware that coverage (TV and online) of these explosions – and the coverage will be continuous and extensive – will have some graphic footage. There are recordings of when the explosions happened. There are images of injured people on stretchers. You will see the aftermath which can be disturbing.  It will be on TV. It will be online. Keep this in mind in terms of what your kids will see. Kids of any age will find this disturbing. It’s a good idea to monitor your kids now so you can be in control of what they see – and be on the ready to switch off quickly if there are things they shouldn’t see.

In addition to footage, remember that interviews will contain graphic talk. People will be describing what they saw and heard. Many will be distressed. The talk may be graphic and reference fatalities. Online, you will read quotes by witnesses. Again, you might want to actively screen this information.

While shielding your kids from footage and conversation that is upsetting, it’s also important that you be the source of information for them. You can explain things in the best way possible without deviating from being honest. Keep your descriptions short and factual (“Yes something bad happened. Some people were hurt.”) without going into much expansion. Allow your kids to ask you questions and answer exactly what they are asking. For example, if they ask if anyone died, you can simply answer “Yes” and see if they ask anything else. Try to be calm and in control even though these catastrophes rattle all of us. Even though we can’t assure our kids that we can keep them safe every second of the day, we do want them to feel safe with us and have some sense of control.

Finally, be aware that your kids may have questions for awhile, as this tragedy will undoubtedly be in the news for some time. Keep the lines of communication open and be ready to have frequent and short conversations about it – kids may have a question here or there and they are only looking for an immediate answer to it. You can rely on your knowledge about your kid’s personality, but do bear in mind that kids typically don’t want the level of detail that we adults would pursue.

And of course do what you do best – hug your kids. That will speak volumes.

Mom Soothing Child via Shutterstock.com

Is TV Viewing The Unhealthiest Screen Time For Kids?

Tuesday, April 9th, 2013

A new study published in Pediatrics suggests that it may be, at least when it comes to risk for obesity. 

WHAT DID THE STUDY DO?

91 teens (45 girls) around 14 years of age responded multiple times a day – via an electronic diary – to questions about what they were doing, over a 1-week period. Included were questions about a variety of screen time activities (for example, TV, video games, computer) and how much attention they were paying to each activity. Electronic diaries are an excellent method for getting kids to report on what they are doing in “real time” – it’s quick and easy for them to do and studies have shown that they provide reliable data using this method. The kids also had their height and weight measured by the research team in order to calculate their body mass index (BMI) – which is one metric used to measure risk for obesity.

WHAT DID THE STUDY FIND?

The overall findings were intriguing. First, the raw amount of screen time reported by the kids was not associated with their BMI. The statistical association of interest involved TV, but again it wasn’t about how much TV the kids were watching. Rather, it was how engaged the kids were when watching TV that was associated with BMI – the more a kid reported that they were paying the MOST attention to TV (versus all other activities), the higher their BMI.

WHAT DOES THE STUDY MEAN?

There are limitations to the study design that need to be addressed. The most prominent is that each teen was only observed during the 1-week period (this was a “cross-sectional” study).  Finding statistical associations in a cross-sectional design limits what we conclude because we can’t tease apart what leads to what.  It could be that kids with the highest BMI levels were the most likely to become engaged in TV viewing. It could be that TV viewing was one of the causative factors for their increased BMI levels. The point is that with these kinds of data we can’t distinguish between those interpretations. And of course we don’t have data on younger kids from this study, so technically there are no inferences to be made on non-teens.

WHAT SPECULATIONS CAME OUT OF THE STUDY?

Noting the limitation discussed above, researchers use cross-sectional data to generate and support hypotheses to be tested in future studies. The interesting idea that comes out of this paper is the speculation on the specific health risks associated with TV viewing versus other forms of screen time. One deserves particular mention. They note the potential impact of commercials promoting unhealthy foods – which may be particularly influential for kids who are highly engaged watchers. What’s interesting here is the idea that it’s not just about screen time, and it’s not just about TV – it’s about the specific risk of being a highly engaged TV viewer that seems to be linked with BMI. But future work will need to measure all these things and evaluate them longitudinally.

WHAT’S THE TAKE-HOME MESSAGE HERE?

Clearly this paper is the beginning, and not the end, of the story. The story, however, may be quite informative for parents if future studies replicate and expand the finding – and particularly if longitudinal studies provide clearer evidence of the directionality of the findings and support for the hypothesized mechanisms. Starting with younger samples of kids and tracking them across time will help determine if engaged TV viewing is especially linked with increases in BMI. But right now the interesting idea for parents to think about – at all ages – the potential downside of when kids get too attached to passive activities. This study suggests that TV may be the worst culprit for multiple reasons. But the bigger picture is that we are probably moving away from talking about screen time per se – many kids are increasing rather than decreasing screen time – and shifting toward a focus on unhealthy habits and unhealthy content that may be linked with specific types of screen time.

So … right now keep on eye on when your kid seems most likely to pair eating with screen time, and see if you can discourage that link. And see for yourself at home if it seems to happen more when they are especially glued to the tube.

Remote Control and Salty Snack via Shutterstock.com