Autism Reality

Autism Rising in Nevada



The results of a decade-long study conducted by UNLV professors John P. Tuman and Sheniz Moonie found autism is on the rise in Nevada’s schools.

UNLV professors John Tuman and Sheniz Moonie have completed a decade long study on increasing autism rates in Nevada schools – from .27 per 1,000 in 1995 to 2.37 per 1,000 in 2004. This rate of increase is hard to explain away by any rationalization.

Professor Tuman notes that some autism cases are diagnosed as early as 24 months with signs noted as early as 15 months. In my sons case he was diagnosed 9 years ago at age 24 months and we noticed signs much earlier than 15 months although we did not think of, or even know about, autism at that time. He simply was not showing ordinary development milestones like giggling in response to peek a boo or responding in any noticeable way to attention. He did not use any typical baby words and barely spoke until long past 2 years of age – although he did use one word at an early age that stuck in my mind. While lying on the tile floor of a shopping mall, with his face pressed against the cool tile floor, Conor looked at the circular metal ring which formed the circumference of a drain pipe cover in the floor and said “circle”. That reference to a geometric shape was the only word I heard him speak for a few years until we started using ABA to teach him words beginning with – apple.


Study: Autism rising
Professor shares findings

By Natalie Lombardo

UNLV political science professor and lead investigator of a study on the prevalence of autism in Nevada, John P. Tuman, spoke Wednesday about a nearly tenfold increase of the disorder in state schools.

Tuman was accompanied by his co-investigator Sheniz Moonie, a UNLV School of Public Health assistant professor, epidemiologist and biostatistician, speaking to a small group at the Carlson Education Building. Tuman said that 15 out of the 17 school districts in Nevada have experienced an increased prevalence of Autism Spectrum Disorder.

Counties such as Clark, Lander and Churchill had prevalence of one in 322, one in 224 and one in 250 in 2004. Esmeralda County is the only district in Nevada that reported zero prevalence from 1994 to 2004. “I do not think this statistic is unusual because Esmeralda enrolls fewer than 80 students,” Tuman said, pointing out that the larger the district the more prevalence of autism.

He said the average prevalence of autism increased in Nevada from .27 per 1,000 in 1995 to 2.37 per 1,000 in 2004. He added that the average prevalence of learning disabilities have increased from 84 per 1,000 in 1995 to 92.4 per 1,000 in 2004, which is the largest increase in the state.

In 1943, about a dozen children were observed with having an extreme social disability. Their inability to interact with others was characterized as “autism” by a psychiatrist, Dr. Leo Kanner.

Since Kanner discovered this disorder, research and knowledge of autism has come a long way.

Today, autism is not only characterized by children who have difficulties communicating in a social scene, but also by unresponsiveness, slow development, sometimes being mute, attachment to routines, impaired speech and temperamental behavior.

Having a child with autism, Tuman is extremely passionate about his studies, noticeable through during his lecture.

He also looked at resources and funding for more research and dealing with the disorder correctly in schools.

“Funding has a positive and statistically significant help in detecting children with autism,” he said. More funding would allow school districts to have the tools needed to detect students with autism and give them the special needs and attention required of autistic children.

Tuman said that although the average age of diagnosis for autism is 24 months, there have been cases where autism signs were noticed as early as 15 months.

He said differences in social and economic characteristics of school districts influence the identification of ASD, providing statistics to the audience.

Tuman and Moonie collected data about the prevalence of ASD from the Nevada State Department of Education. The data included statistics on disorders such as mental retardation, learning disabilities and speech and language impairment. The data received was from each school district in the state.

http://www.unlvrebelyell.com/article.php?ID=10788

May 14, 2007 Posted by | autism awareness, autism disorder, autism prevalence, diagnosis, John Tuman, Nevada, Sheniz Moonie | Leave a comment

Combating Autism Act Spurs Autism Research

The following article from the Psychiatric Times gives a good, digestible, overview of some of the autism studies currently being conducted even as the Combating Autism Act spurs more research.


New Act by Congress Gives Boost to Autism Research
By Arline Kaplan

February 2007, Vol. XXIV, No. 2

The passage and signing in December of the Combating Autism Act (S. 843), which authorizes $945 million over 5 years for research, screening, intervention, and education on autism spectrum disorders (ASD) and developmental disabilities, has been hailed by the advocacy group Cure Autism Now (CAN) as a “federal declaration of war on the epidemic of autism,” a disorder that affects 1 in 166 children. 1 Yet, some battles are already under way at NIMH’s Intramural Research Program, with patient recruitment proceeding for 3 major autism studies.

In a press statement, Jonathan Shestack, father of an autistic child and cofounder of CAN, a large private funding organization for autism research, said S. 843 (now Public Law 109-416) “creates a congressionally mandated road map for a federal assault on autism, including requirements for strategic planning, budget transparency, congressional oversight, and a substantial role for parents of children with autism in the federal decision-making process.”

Key provisions of the law, subject to the availability of appropriations, call for the following:

* Expanded research on ASD, including basic and clinical research in such fields as pathology, developmental neurobiology, genetics, pharmacology, nutrition, immunology, neurobehavioral development, and toxicology.
* The CDC to increase and update its efforts to monitor autism incidence and prevalence around the country and to support the establishment of regional Centers of Excellence in the epidemiology of ASDs and other developmental disabilities.
* Development of a curriculum for continuing education to assist in recognizing the need for valid and reliable screening tools and in using those tools.
* Early screening of individuals at higher risk for ASD and other developmental disabilities.
* Congressional oversight of the Autism Centers of Excellence.
* Expansion and reauthorization of the Interagency Autism Coordinating Committee, composed of relevant government officials, experts, families of those with ASD, and at least one individual who has ASD.

Autism trials

The NIMH studies on the NIH campus in Bethesda, Md, are the first products of a new, integrated focus on autism. One study, “Clinical and Immunological Investigations of Sub-types of Autism,” seeks to learn more about autism and its subtypes. “It is actually two studies in one,” said Susan Swedo, MD, chief of NIMH’s Pediatrics and Developmental Neuropsychiatry Branch.

The first is a study of regressive versus nonregressive autism to determine whether there is an immune or other systemic trigger of children’s neurologic regression, she said. It involves 50 children with idiopathic autism and regression, 50 children with idiopathic autism and no history of regression, 25 children with Rett syndrome, and 50 healthy children. The age range of all 4 groups is between 12 months and 48 months at first visit.

The second component to the study, Swedo said, is part of the Autism Phenome Project, a pilot investigation being conducted in collaboration with David Amaral, PhD, Beneto Foundation Professor and director of research at the M.I.N.D. Institute at the University of California, Davis. Between the 2 sites, the pilot phase of the phenome study involves 50 to 100 children with autism, 50 children with developmental delays, and 50 to 100 children without disorders. The purpose is to identify clinically meaningful subtypes of autism, which could lead to better understanding of the etiology and pathophysiology of the disorder.

Increasingly, researchers are considering that autism may be multiple disorders. The regressive subtype is well characterized, Swedo said, although there is some debate about how common it is. The reports vary from indicating that as few as 10% to as many as 40% of children with autism have a pattern of regression.

With regressive autism, Swedo explained, you have a history of the child developing typically until age 12 to 18 months with appropriate development of language and social skills and then the child loses words and social skills and begins to look indistinguishable from children who have had autistic symptoms from birth or early on.“Some investigators have found that the regressive subtype actually has a worse prognosis,” she said.

To explain the regression, Swedo said that the research team’s working hypothesis is that there are environmental triggers or perhaps genetic aberrations that are expressed at this particular point in the child’s development. One possibility based on Swedo’s work with obsessive-compulsive disorder and the pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections subgroup is that regressive autism develops following a viral or bacterial infection that triggers an autoimmune response and neuropsychiatric symptoms.

The phenome study includes questions related to a child’s exposure to environmental toxins and household products; neuroimaging (structural MRI); and biomarkers; as well as very careful behavioral, neurologic (eg, via electroencephalograms administered while the child sleeps in the hospital overnight), and physical assessments. “The children will be monitored every 6 months to a year until they are age 5, and then intermittently after that time” to examine the validity of their diagnosis and how their symptom course evolves over time, Swedo added.

Minocycline study

In another small-scale intramural study, Treatment of Childhood Regressive Autism With Minocycline: An Anti-Inflammatory Agent Active Within the CNS, NIMH researchers are examining the use of the antibiotic minocycline (Dynacin, Minocin, Myrac) in children aged 3 to 12 years with regressive autism.

“We are using minocycline, a tetracycline derivative, not for its effectiveness as an antibiotic but rather for its ability to modulate the immune system,” Swedo said. “It has fairly specific effects on NF-kappa B and therefore inhibits the initiation of the cascade that leads to inflammation. Published data from the Johns Hopkins group [2,3] demonstrate that brains of individuals with autism have evidence of chronic neuroinflammation. We hope that by stopping that process, the children will be able to recover some of their skills. We are conducting an open-label trial in 10 children and are accepting referrals. If the results are encouraging, we will do a placebo-controlled trial in a larger cohort of subjects.”

Asked about other pharmacologic approaches being investigated at NIMH, Swedo responded, “We have a few in [the] pipeline, but it is premature to talk about them. Eric Hollander, MD, has been doing some work with oxytocin, reported at the American College of Neuropsychopharmacology’s annual meeting.”

Hollander, chairman of psychiatry at the Mt Sinai School of Medicine in New York and director of the Seaver and New York Autism Center of Exellence, and Jennifer Bartz, PhD, found that pitocin (synthetic oxytocin), administered intravenously or nasally, may have significant positive effects in adults with autism. Oxytocin, a hormone that is best known for activity during birth and lactation, is also a brain neurotransmitter involved in social recognition and bonding.

Chelation therapy

The third NIMH study, “Mercury Chelation to Treat Autism,” seeks to address whether chelation therapy can be helpful for autism. The chelation study is a placebo-controlled trial that involves use of meso-2,3-dimercaptosuccinic acid (DMSA, succimer), an orally adminstered chelating agent that binds to all metals including mercury and lead but also to some beneficial metals, such as zinc and iron, according to Swedo. DMSA is commonly used to treat autism, with some surveys estimating that 1 in 12 children with autism has undergone chelation, although it has never been tested in a controlled study and there is no proof that it helps children with the disorder. Support for its use is based on single-case reports of benefits of chelation with DMSA.

Children aged 4 to 10 years in whom autism, Asperger disorder, or pervasive child developmental disorders have been diagnosed; who weigh at least 33 lb; who have detectable, but not toxic, levels of mercury or lead in the blood; and who have not previously received chelation therapy may be eligible for this study.

“The chelation study is based on the hypothesis that mercury toxicity is responsible for at least some cases of autism,” Swedo said. She explained that extensive controversy surrounds the issue of mercury toxicity in autism. The Institute of Medicine (IOM) conducted a comprehensive study of the question of whether thimerosal, an ethylmercury-based compound used previously in the United States as a vaccine preservative for routine childhood immunizations, contributed to the apparent increase in the prevalence of ASDs. 4 The IOM panel concluded that there was no evidence for an association, but the report has been dismissed by some parents who report “toxic mercury levels” among their affected children and who have observed benefits of open-label DMSA administration.

To answer the question in a controlled fashion, the NIMH will enroll about 120 children in the chelation study, with half randomized to placebo and half to DMSA. The trial will last for 6 months, and researchers are enrolling participants now. “We would love to receive referrals,” Swedo said, adding that psychiatrists can find out more by going to http://www.clinicaltrials.gov or by contacting Lorraine Lougee, LCSW, research coordinator. Lougee’s e-mail address is LougeeL@intra.nimh.nih.gov.

Incidence and prevalence

Because of recurrent questions about whether autism is increasing, Swedo was asked about incidence and prevalence. “We have absolutely no data on incidence,” she said. “We can say the disorder appears to be more prevalent now than it has been reported in the past. However, there was a major change in diagnostic criteria and case-finding methods, so it is unclear [whether] it represents a true change in rates of affected individuals. . . . The CDC is conducting several studies currently to address that question.”

There is increasing agreement on what true autism is, using the Autism Diagnostic Observational Schedule, a semistructured observational scale developed to assess social interaction, communication, and play in persons suspected of having autism, and the Autism Diagnostic Interview, Swedo said.

“Those 2 give you nice, reliable cutoffs where you can say a child has autism, is on the autism spectrum, or is developing typically. Including children on the autism spectrum will increase apparent prevalence rates,” Swedo said. “The figure of 1 in 166 children having autism was recently confirmed in a CDC study that reviewed school records and confirmed the diagnosis from medical records. But the study included all children with an ASD as having ‘autism’—this included not only severely affected individuals with full-blown autism but also those with a pervasive developmental disorder not otherwise specified and those with Asperger disorder, a condition [that] is not as impairing.”

“In order to determine the true prevalence of autism and to know whether there is an ‘epidemic’ as some have asserted,” Swedo continued, “we need to have better data about the current prevalence of autism and related disorders and then compare those data with comparable data from previous studies. The CDC is conducting surveillance studies at a number of US sites, and the NIH is sponsoring longitudinal investigations here and abroad to address those questions.”

References

1. Centers for Disease Control and Prevention. How common are autism spectrum disorders (ASD)? Available at: http://www.cdc.gov/ncbddd/autism/asd_common.htm. Accessed January 5, 2007.
2. Pardo CA, Vargas DL, Zimmerman AW. Immunity, neuroglia and neuroinflammation in autism. Int Rev Psychiatry. 2005;17:485-495.
3. Vargas DL, Nascimbene C, Krishnan C, et al. Neuroglial activation and neuroinflammation in the brain of patients with autism [published correction appears in Ann Neurol. 2005;57:304]. Ann Neurol. 2005;57:67-81.
4. Board on Health Promotion and Disease Prevention, Institute of Medicine. Immunization Safety Review: Vaccines and Autism (2004). Available at: http://www.nap.edu/books/030909237X/html/1.html. Accessed January 5, 2007.

http://www.psychiatrictimes.com/showArticle.jhtml?articleId=197002523&pgno=1

February 27, 2007 Posted by | Asperger Disorder, autism disorder, chelation, Combating Autism Act, diagnosis, mercury, minocycline, neuroinflammation, oxytocin, PDD-NOS, prevalence, Psychiatric Times, thimerosal | Leave a comment