1 in 20 school-aged children diagnosed with ASD in Northern Ireland
The Department of Health in Northern Ireland (NI) continues to produce annual data on the estimated prevalence of ASD in school-aged children. The figures for 2022- 2023 were released in May and identify 1 in 20 (5%) children with ASD currently in the NI school system. As reported in media outlets, this figure represents the highest on record and continues the relentless increase detailed in previous reports from the Department of Health, even despite subtle changes in the recording procedures implemented in 2019/2020. The stark figure of 5% overlaps with the increasingly desperate need for suitable educational facilities for children with ASD. The true prevalence figure is likely to be even higher given the number of children who are still awaiting referral and assessment as backlogs increase at a seemingly rapid pace. Various other details are included in the current NI report, where the rate of ASD in boys reached over 7% (compared with 2.7% in girls) and 4 in 5 children with ASD have a statement of educational need denoting the requirement for educational support. Although tired explanations of ‘better awareness’ continue to be used to account for the huge increase, the time has come for more detailed analysis on why so many children are being diagnosed and to better plan for their care and support during childhood and beyond.
[Note from J. Rodakis: Believe the extraordinary prevalence figures in Northern Ireland, (1:20 Children/ 1:14 boys) merit a deep investigation. Are there societal, demographic issues behind this, or could there be something more environmental. We at N of One believe a concerted, large-scale multi-disciplinary investigation needs to be initiated quickly.]
Screen for ASD when ADHD is diagnosed
A retrospective chart review of over one hundred children diagnosed with attention deficit hyperactivity disorder (ADHD) revealed that about a quarter also subsequently met diagnostic criteria for autism spectrum disorder (ASD) too. Researchers from South Korea examined the medical records of participating children with an average age of 8 years looking both at the prevalence of ASD and characteristics of those with a dual diagnosis compared with those having ADHD alone. Their findings tally with other work pinning the presence of ASD in already diagnosed kids with ADHD to around 20-25%. There are some obvious implications for such findings in terms of their contributing to the rising autism (estimated) prevalence figures and ideas about cross-label behavioral presentations. Such findings may also support the suggestion of ADHD being a potential ‘prodromal diagnosis’ onwards to later clinically-significant ASD presentation for some. Something even more relevant in light of other recent research observing a fluctuating course of childhood ADHD in around a third of participants.
“Transient symptoms of autism spectrum disorder”
“This case report highlights that, in rare cases, it is possible for a child's early presentation of ASD symptoms to be transient.” So concluded a recent case report providing detailed developmental and diagnostic data on a young child whose autistic symptoms “resolved” over a 4 month period. Having been participating in an autism research study, detailed developmental and behavioral information was garnered about the young boy leading to an eventual diagnosis of ASD (based on DSM-5 criteria). At follow-up however, there was a notable difference in developmental exam scores and clinical impressions exemplified by a “remarkable improvement in social behavior and decline in ASD symptoms”. Such case reports are unusual but not entirely novel. They highlight how ongoing monitoring and reevaluations should be considered more widely in the context of ASD. They also provide further evidence that within the massive heterogeneity of ASD, not all cases should be universally defined as ‘lifelong’ whether as a feature of maturational changes or due to other influences including the effects of intervention.
Full-text: https://pubmed.ncbi.nlm.nih.gov/31632036/
Exercise, nutrition and sleep: comprehensive support for improving the core symptoms of autism?
Exercise, nutrition and sleep all represent modifiable variables that, independently at least, can have a real effect on the presentation of ASD according to a new review paper from researchers in Japan. Examining some of the evidence around each area, authors highlighted some important data reflecting how different changes to each ‘pillar’ can positively affect core symptoms and quality of life. Exercise and sleep interventions have a particularly strong connection to the presentation of ASD as evidenced by the use of specific strategies such as melatonin for sleep issues. Nutritional aspects are a continual feature following, for example, important studies describing various deficiencies related to vitamins C and D in particular, as being over-represented in cases of ASD, leading to a surge in cases of rickets and scurvy (historical diseases). Mention of gluten and casein-free diets for ASD continue a long history of discussions. What such reviews offer are a comprehensive roadmap to potentially improving quality of life; importantly linking physical health with developmental and mental health.
Time to look at the possible biological correlates of suicidal behaviors in autism?
Suicidal behaviors, including early death by suicide, are unfortunately over- represented alongside a diagnosis of ASD. Efforts continue to identify the psychosocial risk factors linked to such devastating behaviors. New research from Italy examined another potentially important area: a possible role for biology linked to such extreme behaviors. Based on biological data from a small group of adults diagnosed with ASD, several compounds in blood were identified as possibly relevant to reported suicidality including those associated with immune system functioning (inflammation) and methylation pathways. Importantly too, levels of the aromatic amino acid tryptophan, the starting material for the neurotransmitter serotonin, were lower in those reporting suicidality. This represents very preliminary work and so caution is required. Further studies are however implied, including whether any potential biological findings of suicidality may involve functions linked to the metabolism of lithium, the archetypal anti-suicidal agent under certain clinical circumstances.
Full-text: https://www.mdpi.com/2227-9059/11/6/1600
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