About a third of toddlers diagnosed with an early autism diagnosis do not subsequently meet the diagnostic criteria
“These findings suggest that an ASD [autism spectrum disorder] diagnosis in a child younger than 3 years may not persist, and child-specific factors may be associated with persistence.” So said new results out of Boston Children’s Hospital in Massachusetts (USA) looking at the developmental trajectories of some 200 children who were diagnosed with autism aged 1-3 years. The children underwent a thorough diagnostic workup at 5-7 years of age, revealing that 37% did not continue to meet the diagnostic thresholds for ASD. Researchers reported that those with lower adaptive skills covering things like communication issues and requiring self-care help were more likely to show persisting autism. Sex differences were also noted as per the observation that two-thirds of girls vs. a third of boys were categorized as non-persisters. Of note, although most children were receiving behavioral interventions, the study did not find any significant relationship between the intensity of such intervention and whether autism persisted or not. Further research is required on the hows-and-whys of autism non-persistence, including looking at the biological factors potentially correlated with differing developmental trajectories. Recognition that autism may not be lifelong for everyone is an important addition to the vast heterogeneity of the label. Diagnostic instability also seemingly extends to what might happen to symptoms during later stages of life too according to other recent independent research.
Considering dietary intervention for autism: real-world data adds to top-tier scientific evidence
Parental ratings of various dietary interventions used to manage certain aspects of ASD seem to concur with the available top-tier scientific evidence on such diets according to new research from Arizona State University, USA. Drawing on data from over 800 parents and guardians who were asked about the benefits, harms and effects on symptoms of some 13 dietary interventions potentially useful for managing autistic and related symptoms, researchers reported various important trends. Not least was that use of the gluten free/casein-free seemed to be associated with ratings of an ‘overall symptom improvement’ for many people following such diets. Such findings mimics other real-world data-collecting studies with participant numbers in the thousands, that have for example, concentrated on the effects of a gluten-free diet. Caution is however required when interpreting such results, because they were not based on a clinical trial. But neither can such findings be ignored, providing as they do, an impetus for further studies on a possible role for diet for some children and adults with autism and a window on what parents/guardians perceive as useful for furthering their child’s development.
Full-text: https://www.mdpi.com/2075-4426/13/10/1448
Abstract: https://pubmed.ncbi.nlm.nih.gov/37584768
Bumetanide for childhood autism falls at the final research hurdle
Clinical research findings on use of the loop diuretic bumetanide for pediatric autism showed no significant differences compared with placebo on various behavioral endpoints according to the results of two gold-standard trials. A cross-European collaboration of researchers published their findings following previous hints that bumetanide might be effective in reducing specific symptoms of ASD. The SIGN 1 and SIGN 2 studies cumulatively included over 200 participants with autism, pitting an oral solution of bumetanide against a placebo solution (dummy medicines without notable biological effects). Despite key baseline characteristics being similar across the active vs. placebo groups, no significant differences in behaviors were found after 26 weeks of study. Indeed researchers commented on how notable the placebo effect was in their trials. Another important detail from the trials was the rate of treatment emergent adverse events (TEAEs) associated with bumetanide use being much more frequent than with the placebo used. Because bumetanide is a diuretic, hypokalemia (reduced potassium levels) is always a potential worry and indeed, was listed as an important side-effect alongside things like thirst. The authors still suggest that the class of medicine that bumetanide belongs to - Na-K-Cl cotransporter 1 (NKCC1) chloride importer inhibitor - may still have some merit for further investigation for some autism phenotypes despite their important methodologically sound findings.
DSM-5 autism support levels: how do clinicians decide what level and what do their decisions potentially mean for profound autism?
One of the important additions to the DSM-5 diagnostic criteria for ASD was the introduction of support levels for the core symptoms of social affect and restricted, repetitive behaviors (RRB) via scoring of symptom severity (levels 1-3). Despite their inclusion, relatively little research has been done on how clinicians determined ASD level. A recent US study offers an important insight based on findings for over 130 children following diagnostic assessment. As expected, those with greater autistic symptoms were more likely to require more intensive support (level 3 support denoting a requirement for substantial support). Also too, decisions on intellectual and adaptive functioning also fed into the varying need for support and what support level was decided by clinicians. Cumulatively, greater autistic symptoms and a focus on intellectual and/or adaptive functioning also fit well with the recent US CDC designation of ‘profound autism’ currently utilizing criteria including “nonverbal, were minimally verbal, or had an intelligence quotient <50” as its basis, with perhaps a requirement for further standardized description.
Cochrane does… Pharmacological intervention for irritability, aggression, and self-injury in autism
A new Cochrane Review - a renowned resource that conducts evidence-based reviews on specific topics - has concluded that several atypical antipsychotic medicines “probably” reduce irritability when presented by people with ASD, and some medicines for attention-deficit hyperactivity disorder (ADHD) “may reduce irritability slightly” at least in the short-term. Researchers from Australia and the UK conducted the research review based on data from over 100 studies including over 7000 participants. They concluded that irritability and, to some degree, self-injury seemed to show important reductions when taking atypical antipsychotic medicines compared to placebo. The other side of their analysis examined the rate of adverse effects potentially associated with medicines used to affect irritability. This also unearthed potentially important issues such as fatigue, dizziness and tremor associated with medicine use, but the authors rated the general quality of such side-effects evidence as uncertain or very uncertain depending on the class of medicine used. What the current evidence seems to show is that pharmacotherapy for issues like irritability and self-injury is available and can work for some people, recognizing certain important caveats. As would be expected, regular medicines management and health monitoring should always follow the introduction of such intervention options.
And finally…
The US NIH BICCN brain cell project publishes (and it’s relevant to autism and beyond)
The US National Institutes of Health (NIH) project called BICCN (Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative - Cell Census Network) has recently released a whole slew of publications aiming to map the various cells of the human and non-human primate brain. One of the headline-grabbing findings from the initiative related to how inflammation can and does affect gene activity in the cerebellum, something that may have particular relevance for labels like autism and schizophrenia given the suggested links between early life inflammation and the elevated risk of developing those conditions. There’s lots more to do in this area. But as the tools and technology available are becoming less expensive and more widespread, expect to see a lot more of this kind of work accompanying related areas such as the impact of maternal immune activation (MIA) on offspring behavior and development.
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