“Biological therapies need definitive randomized controlled clinical trials”:
Reading between the lines for autism research
A recent editorial in the prestigious journal Science potentially offers a boon to research into autism spectrum disorder (ASD), specifically that looking to study the gut microbiota in relation to ASD. Penned by the commissioner of the U.S. Food and Drug Administration (FDA) and the director of the Center for Biologics Evaluation and Research at the FDA, the article focuses on the research gaps in science citing an example of how the use of fecal microbial transfer (FMT) therapy is being applied to ASD. FMT involves transferring bacteria from one person to another. Authors mention how initial results on the use of FMT in ASD are promising but, despite the enthusiasm, further, more controlled trials are needed to substantiate initial claims and counter any placebo effects. Coincidentally, at the same time of publication, a new meta-analysis of existing controlled trials of FMT for ASD independently concluded that there are benefits to be had with such an intervention and the important requirement for further study.
[Note from J. Rodakis: It’s notable that the both the FDA commissioner and head of CBER took the time to pen an article about a single treatment (FMT) for a single condition (ASD). Believe FDA is offering two coded messages here:
1) We would prefer clinicians stop (making money by) offering single patient IND for FMT
2) We will work (bend over backwards) to help any company that wants to conduct large scale, commercial FMT trials for ASD]
What do students with ASD think about school?
“Participants felt that, following autism disclosure, teachers viewed them narrowly through an autism lens.” That was one of the findings reported in a study of ten people aged 15-35 years and diagnosed with ASD discussing their secondary school experiences. US researchers delved into various aspects of school and the effects it had on their participant group, particularly their sense of identity. They highlighted how participants viewed their identity as individuals and how aspects of their autistic identity may actually have helped them in parts of their learning experience. More study is needed on how attitudes at school, and other places, can impact the educational experiences of youth and adults with ASD. That ASD forms only one part of a person is an important message transmitted in this study, such that educators and fellow students learn to see beyond the diagnostic label and recognize and nurture the skills and talents of the individual.
ICD-11 ASD: Moving away from a unitary ‘autism’ diagnosis and including a ‘regressive autism’ coding
The various innovations included in the ICD-11 diagnostic description of ASD are laid bare in a new paper from researchers in the Netherlands and UK. Focused on the psychological perspective, authors highlight how ICD-11 ASD has moved to align itself with other diagnostic manuals such as the DSM-5, including taking further steps away from a unitary diagnosis of ASD to one that takes into account the presence of intellectual (learning) disability, verbal communication skills and recognition of whether or not regression was a part of the onset of ASD symptoms. At the heart of the new ICD-11 ASD diagnostic descriptions is the idea of heterogeneity in presented symptoms, coupled with an important understanding of various overlap (boundaries) with other symptoms/conditions. While it will take time for the new ICD guidance to filter through assessment practices, the new direction offered will undoubtedly provide many talking points. Not least because the new diagnostic sub-codings based on intellectual and language abilities, provide an ideal template to further characterize increasingly popular terms such as ‘profound autism’ as well as offering autism research and practice a more nuanced approach to defining and studying the condition.
Full-text: https://icd.who.int/browse11/l-m/en#/ http%253a%252f%252fid.who.int%252ficd%252fentity%252f437815624
Focus on siblings quality of life: caring for the next generation of carers
Researchers from Italy recently turned their attention to an important topic: the quality of life of siblings of people with ASD. Looking at the available research literature, they sought to answer important questions about what effect having an autistic sibling might have on their quality of life and how such a measurement was made. Their findings highlight the need to make greater efforts for siblings in relation to findings of decreased psychological wellbeing and high levels of anxiety and stress affecting their quality of life. The theme of being ‘undervalued’ was also underscored in the review. Such studies are of vital importance. Not least Especially because many siblings will eventually become guardians of their autistic brothers and/or sisters. The importance of ‘caring for the (future) carers’ both enables siblings to live their lives to their full potential as well as preparing them for their important future role.
MAR autism: where we’re at and more autoantibodies added
Maternal-Autoantibody-Related (MAR) autism describes a potential new autism subtype thought to originate when autoantibodies from the pregnant mother react to fetal brain proteins. While still under research, the theory could explain a sub-type mechanism to ASD. A new expert review from researchers in New York provides an up-to-date overview of MAR autism, suggesting up to 1 in 5 cases of ASD may be related to MAR autism and detailing the various autoantibodies that show a connection. An independent study at the same time also revealed a number of additional antibodies that might also be further added to enhance the diagnostic concept of MAR autism.
[Note J. Rodakis: Maternal Autoantibody autism was discovered by N of One Scientific Advisor Dr. Judy Van de Water of UC Davis MIND Institute. N of One has an ongoing, multi-year study with Dr. Van de Water exploring the role of auto- antibodies in children in ASD.]
ABA intervention for childhood ASD meta-analyzed
A review of comprehensive ABA (Applied Behavior Analysis) interventions for children with ASD has concluded that there are potentially some positive effects associated with improved intellectual functioning and adaptive behavior to be had from such an intervention. Drawing on findings from 11 studies, including over 600 participants, researchers from Germany analyzed data relating to multiple outcomes covering behavior and also parental stress. Alongside they also noted language abilities and age may affect the usefulness of intervention and its intensity. But not everything was rosy. Aside from noting the generally poor methodological quality of the studies included for review, researchers also pointed to little or no effect in relation to symptom severity and parental stress following intervention. Further, more controlled studies are proposed by the authors.
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