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

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.

Enrichment + Protection = Healthy Development

Monday, April 8th, 2013

Such is a key take-home message from the Early Childhood Summit 2013: Innovation and Opportunity - held in Boston on Friday, April 5th as part of the ongoing celebration of the 100th anniversary of the Boston Children’s Museum.

This meeting brought together leaders from pediatrics, developmental science, public health, the non-profit sector, and top business leaders in the Boston region. The focus was on sharing new ideas about the challenges that some kids and families face, along with possible creative solutions to ensure that kids have early experiences that serve as a platform for healthy and adaptive development. And the idea of thinking about “enrichment” and “protection” as critical components of a child’s rearing environment particularly resonated with me.

This idea was offered by Jack P. Shonkoff, MD, who is the Director of the Center on the Developing Child at Harvard University. As discussed by Dr. Shonkoff, “enrichment” refers to all the good things parents should be doing in the early years to promote social, emotional, and cognitive development. These are the fundamental building blocks of parenting, including spending lots of time talking to babies and toddlers, being emotionally responsive and engaged, and promoting and supporting curiosity and play. But Dr. Shonkoff emphasized – using the platform of neuroscience research – how critical it is that babies and toddlers also be protected from the toxic effects of excessive stress. Overexposure to harsh rearing environments – including those characterized by overt discord, anger, hostility, and criticism – can take a psychological toll in the early years which can have lasting effects due to the neurodevelopmental sensitivity to extreme stress. Even babies and toddlers can show stress responses that get turned on too much – and don’t shut down quick enough – which predicts a host of problems down the road, both in terms of cognitive and social functioning as well as physical health.

Jack P. Shonkoff, MD, Harvard University

By integrating the concepts of enrichment and protection, we have a framework that simultaneously emphasizes both the good things that parents should be doing lots of, and the bad things that parents shouldn’t do much at all. For those of us who study kids – and in particular track kids from infancy through adulthood – we keep seeing more and more evidence that those early years matter greatly in terms of influencing brain development at a critical period of life. Putting effort into enrichment and providing protection against toxic stress is indeed an equation that predicts healthy development (physical and psychological) from the early years all the way into adulthood.

Photo of Jack P. Shonkoff, MD, addressing the Early Childhood Summit 2013: Innovation and Opportunity meeting (April 5, 2013, Boston, MA) courtesy of Gus Freedman

Is ADHD On The Rise – Or Just Overdiagnosed?

Monday, April 1st, 2013

The latest numbers on the rate of ADHD are extraordinary. The New York Times has reported data collected from the Centers for Disease Control and Prevention which suggest that 11% of youth (between 4 and 17 years of age) have been diagnosed with ADHD at some point in their lifetime. 

This is troubling – primarily because the data come from phone surveys of parents. This means that parents are receiving this diagnosis at unprecedented rates – not that kids are being properly diagnosed with ADHD at higher rates than before. It is too easy for kids to get labeled ADHD and not go through the comprehensive screening that should take place as administered by a multidisciplinary team of professionals.

It’s becoming clear that ADHD is being used as a label to try to provide a quick handle on behavior that may – or even may not – be somewhat troublesome. ADHD involves much more than not sitting still and not paying attention. All kids exhibit “ADHD” like behaviors now and then. It’s a difficult condition to diagnose because it is based on increased frequencies of a number of behaviors across a number of contexts (home and school) for a sustained period of time which cause impairment for the child. Without a detailed diagnostic process, it can be too easy to misread normative behaviors as symptoms of ADHD.

Part of the increase comes from diagnoses of older kids including those in high school. Diagnostic criteria are beginning to reflect the thinking that symptoms can develop later in childhood and even in the teen years (and not just the early years). That said, it can also become another convenient label for a kid who is not doing well in school. At the other end of the spectrum, diagnosing preschoolers can raise related issues in terms of figuring out which kids are really showing early signs and which kids are just being kids.

There are a number of problems with overdiagnosis. Kids typically get treated with drugs that are not appropriate for them. They get labeled rather than receive the kind of attention that they deserve (for example, to improve their engagement in the classroom). And some kids get diagnosed simply because they are in very large classrooms which promote inattention and not sitting still.

The less obvious issue is that the cursory diagnosing that may be going on is also a disservice to kids who do suffer from ADHD. They should be getting full assessments and comprehensive treatment plans that find optimal combinations of psychosocial intervention and, when necessary, well monitored use of drug therapy. Tossing around labels and drugs as a diagnostic and treatment strategy is not going to give them the help they need, especially since we know that ADHD can persist into adulthood and cause much in the way of academic and social impairment.

The bottom line? If you are a parent, and you (or someone else) suspects that your child might have ADHD, try to seek out an assessment from a multidisciplinary team that has the requisite experience to know how to sort out normative behaviors and issues from clinically meaningful ADHD. You might need to network with other parents, your pediatrician, and educators to locate a provider. But it will be worth your time and effort to make sure your child isn’t misdiagnosed as having ADHD – or not given the proper assessment and treatment plan if they do show the clinically meaningful symptoms of ADHD.

ADHD image via Shutterstock.com

Why Aren’t Treatments For Preschoolers With ADHD Effective?

Thursday, March 28th, 2013

A paper published in the Journal of the American Academy of Child and Adolescent Psychiatry came to two major conclusions based on a 6-year study of 207 preschoolers with ADHD: 

Most of them – 89% – continued to meet criteria for ADHD 6 years later

Drug treatments were not effective in lowering the risk for ADHD 6 years later

What should we make of these data?

First, the continuity of symptoms across 6 years suggests that there may be some precision in diagnosis ADHD at a young age (if clinical guidelines are followed very carefully).

Second, while that observation suggests that intervention may be important, the lack of benefits of drug treatment raise some questions. Maybe it’s hard to achieve compliance with this type of medication routine in very young kids. Maybe medications in very young kids don’t act the same way as when they are used with older kids.

But it may also be that we need to amp up the intensity of psychosocial intervention as well. For many kids, this is not a first-line strategy – and it should be.

Bottom line, the medication regimens currently in practice for preschoolers with ADHD don’t seem to be helping much. Given the continuity of symptoms shown in this study, I would argue that more intensive study of the potential benefits of behavioral intervention would be especially important – and perhaps more so than trying out other types of medication strategies.

A Bunch Of Capsules via Shutterstock.com