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Monday, May 25, 2020

Another Correlate: Aunts and Uncles on the Father's Side

In The Politics of Autism, I discuss various ideas about what causes the conditionHere is just a partial list of correlatesrisk factors, and possible causes that have been the subject of serious studies:

A release from NIH:
Roughly 3 to 5% of children with an aunt or uncle with autism spectrum disorder (ASD) can also be expected to have ASD, compared to about 1.5% of children in the general population, according to a study funded by the National Institutes of Health. Researchers also found that a child whose mother has a sibling with ASD is not significantly more likely to be affected by ASD, compared to a child whose father has a sibling with ASD.
The findings call into question the female protective effect, a theory that females have a lower rate of ASD than males because they have greater tolerance of ASD risk factors.
The results, derived from records of nearly 850,000 Swedish children and their families, appear in Biological Psychiatry. The study was conducted by John N. Constantino, M.D., at Washington University in St. Louis, and colleagues in the United States and Sweden.
“The results offer important new information for counseling people who have a sibling with ASD,” said Alice Kau, Ph.D., of the Intellectual and Developmental Disabilities Branch of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which funded the study. “The findings also suggest that the greater prevalence of ASD in males is likely not due to a female protective effect.”
Additional NIH funding was provided by the National Institute of Mental Health.
ASD is a complex neurological and developmental disorder that begins early in life and affects how a person interacts with others, communicates, and learns. Previous studies have found that roughly 3 times more males than females have ASD. Reasons for the difference are unknown.
One possible explanation is that females have a built-in resistance to the genetic factors leading to autism. With such a female protective effect, the theory holds that many women could carry such risk factors and be unaffected, but could transmit them to their sons, who lack the protective effect and may develop ASD.
In the current study, researchers analyzed data from Swedish national registers of births and family relationships. The children were born from 2003 to 2012. Roughly 13,000 children were diagnosed with ASD, about 1.5% of the total. Offspring of mothers with one or more siblings with ASD were about three times more likely than children in the general population to have ASD. Children of fathers with one or more siblings with ASD were twice as likely as children in the general population to have ASD, a rate that did not differ significantly than that of children whose mothers have a sibling with ASD.
According to the study authors, the results provide the first population-wide estimate of ASD risk to children of parents who have a sibling with ASD.
This finding challenges the existence of a female protective effect, Dr. Constantino explained, because if such an effect existed, the children of mothers with a sibling with ASD could be expected to have up to a 30% higher risk of ASD. Similarly, the researchers found no statistically significant increase in ASD risk for children whose uncles have ASD, compared to children whose aunts have the condition.
Reference
Bai, D et al. Inherited risk for autism through maternal and paternal lineage. Biological Psychiatry. 2020.

Sunday, May 24, 2020

Autistic People Need Additional Support During COVID-19

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. Those challenges get far more intense during disasters.  And coronavirus is proving to be the biggest disaster of all. 

Adrien A Eshraghi and colleagues have an article at Lancet Psychiatry titled "COVID-19: Overcoming the Challenges Faced by Individuals with Autism and their Families."
While the infection rate of coronavirus disease 2019 (COVID-19) rises exponentially around the globe, individuals with autism spectrum disorder are being identified as part of a group at higher risk for complications from COVID-19.1
Furthermore, autism spectrum disorder is often accompanied by anxiety, dyspraxia, learning disabilities, epilepsy, fragile X syndrome, Down syndrome, and immune system alterations. Individuals with autism can also have different types of behavioral challenges including deficits in social communication, attention-deficit hyperactivity disorder, irritability, and aggression. Such common comorbidities can present additional challenges for individuals to cope with during the COVID-19 pandemic, making it more difficult to receive needed therapies, practice physical distancing, and adjust to disrupted daily routines. We assert that individuals with autism are an important group who might require additional support during the COVID-19 outbreak and future public health emergencies.
1. Chow N Fleming-Dutra K Gierke R et al. Preliminary estimates of the prevalence of selected underlying health conditions among patients with Coronavirus disease 2019—United States, February 12–March 28, 2020.MMWR Morb Mortal Wkly Rep. 2020; 69: 382-386 View in Article  PubMedCrossrefGoogle Scholar
The authors might also have noted problems such as depression.

Saturday, May 23, 2020

Law and Neurodiversity

In The Politics of Autism, I discuss the neurodiversity movement.    I also note that we ought to have more comparative studies of autism politics and policy.

I read this book in manuscript.  It is a terrific and much-needed contribution to the field.

From the University of British Columbia Press:
Law and Neurodiversity: Youth with Autism and the Juvenile Justice Systems in Canada and the United States
By Dana Lee Baker, Laurie A. Drapela, and Whitney Littlefield


As social perceptions of diversity become more nuanced, awareness of the prevalence of autism has grown. But how do we accommodate natural human neurodiversity within the juvenile justice system? And what are the consequences for young people?
Law and Neurodiversity offers invaluable guidance on how autism research can inform and improve juvenile justice policies in Canada and the United States. Both countries rely on decentralized systems of governance to craft and implement law and policy, but their treatment of detained youth with autism differs substantively. This perceptive book examines the history of institutionalization, the evolution of disability rights, and advances in juvenile justice that explicitly incorporate considerations of neurological difference into court practice. In Canada, the diversion of delinquent autistic youth away from formal processing has fostered community-based strategies for them under state authority in its place. US policies rely more heavily on formal responses, often employing detention in juvenile custody facilities. These differing approaches profoundly affect how crucial services such as education are delivered to youth on the autism spectrum.
Building on a rigorous exploration of how assessment tools, rehabilitation programs, and community re-entry plans differ between the two countries, Law and Neurodiversity offers a much-needed comparative analysis of autism and juvenile justice policies on both sides of the forty-ninth parallel.

Scholars and students of socio-legal studies, criminology, and disability studies will find this book essential reading, as will policy analysts and policymakers in juvenile justice and frontline workers working with autistic youth in the justice system.

Friday, May 22, 2020

Infections in Illinois Developmental Centers

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. Those challenges get far more intense during disasters.  And coronavirus is proving to be the biggest disaster of all. 

 Jennifer Smith Richards and Jodi S. Cohen at Pro Publica Illinois:
While much of the attention related to COVID-19’s impact on vulnerable populations has focused on deaths at nursing homes, infection rates are remarkably high in another kind of residential setting: state-operated centers for adults with cognitive or behavioral disabilities.
As of Thursday, more than 1 in 5 people living in these developmental centers had tested positive for the novel coronavirus, state data shows. That’s more than double the infection rate seen in nursing homes and other long-term care facilities, where confirmed cases account for about 7% of residents, according to the Illinois Department of Public Health.
Of about 1,650 people who live in the seven developmental centers, which are scattered throughout the state, at least 355 have tested positive, or 21.5%. Eight residents have died, as have four workers.

Thursday, May 21, 2020

Antivaxxer Wins GOP Senate Nomination in Oregon

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Unfortunately, Republican politicians are increasingly joining up with the anti-vaxxers.

Mike Baker at NYT:
Republicans in Oregon have selected a Senate candidate who promotes the QAnon conspiracy theory, the latest sign that conservatives are increasingly willing to embrace a movement built on a baseless series of plotlines about President Trump battling a shadowy globalist cabal.

Jo Rae Perkins was carrying about 50 percent of the vote in Oregon’s primary as of Wednesday afternoon, vanquishing three other Republican candidates to become the party’s nominee for the seat currently held by Senator Jeff Merkley, a Democrat. While the incumbent is considered a strong favorite, and Ms. Perkins’s embrace of fringe ideas could alienate mainstream voters, she has the backing of party leaders for a seat Republicans held as recently as 2009.

Ms. Perkins said in an interview that the vote in Tuesday’s election was “monumental” as she saw QAnon supporters around the state and the country back her campaign.
...
Ms. Perkins expressed wariness about the medical leaders advising the president and said she would not get any vaccine that would be developed in response to the coronavirus.
“I don’t know what they are pumping me full of,” Ms. Perkins said. “I don’t want that crap.”
From her webpage:

Image

Wednesday, May 20, 2020

Trump Campaign Cites Antivax Group

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.  There is an unfortunate connection between the antivax movement and group opposing public health measures and promoting quack cures for COVID-19.
As Judd Legum points out at Popular Information, the AAPS is a fringe group:
The AAPS has also repeatedly pushed discredited theories about the dangers of vaccines. Asked earlier this year if vaccines cause autism, Orient said "the definitive research has not been done." But the "overwhelming scientific consensus is that vaccines do not cause autism."
After a 2015 measles outbreak at Disneyland in Florida, the AAPS "issued a news release opposing mandatory vaccination and raising questions about vaccine safety." The release "makes a link between autism and the measles vaccine." The group's work was condemned by public health officials.

The Trump campaign is now citing the AAPS as an authoritative source during a deadly pandemic. Life may only return to normal with the widespread adoption of a vaccine.
Readers of this blog may remember that Tom Price, Trump's HHS secretary who later resigned in disgrace,  also belonged to this fringe group.  So did Senator Rand Paul.

Tuesday, May 19, 2020

Fighting to Save a Program for Autistic Students

In The Politics of Autism, I discuss the growing number of college students on the spectrum.

Danielle Leigh at WABC-TV:
A community college on Long Island planning to cut two programs designed to help students with Autism Spectrum Disorder is facing new pressure to reverse course following a report by 7 On Your Side Investigates.
On Friday, students, parents, and program coordinators described the ASPIRES and ACHILLES Programs at Nassau Community College in Garden City as life-changing for the individuals they serve.

"It's helped me branch out more socially. I used to be very reserved and I used to avoid talking with people and I feel like I've improved in that a whole lot," said Lucas Librie, a liberal arts student. "I went to a different college before Nassau and I did terribly."
New York State Senator Monica Martinez, D-Brentwood, a school administrator and member of the state Education Committee, responded to the news by writing Nassau Community College imploring them to change course.
"I strongly urge the reconsideration of the cancellation of the ASPIRES program," read the letter to NCC Interim Vice President of Academic Affairs Valerie Collins. "I have been reached out by dozens of individuals whose lives have improved through participation in the ASPIRES program."

Monday, May 18, 2020

More on the Antivax/Antilockdown Connection

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Jonathan Oosting, Ted Roelofs at Bridge:
Anti-vaccination activists — already warring against government mandates — have emerged as key players in the battle against Michigan Gov. Gretchen Whitmer’s stay-at-home order designed to slow the spread of the deadly coronavirus.
Several organizers with Michigan United for Liberty, the group that hosted an April 30 protest at the Michigan Capitol and is planning another Thursday, have deep ties to the “anti-vaxx” and “medical freedom” movement, according to a review of online activity and public records by Bridge Magazine.

Some have used social media to promote conspiracy theories about the pandemic and to discourage the kind of widespread testing, contact tracing and vaccine development that medical experts say is critical to defeating the virus and reopening the economy.
Robert Mackey at The Intercept:
THE PRESIDENT OF the United States voiced his support on Saturday for a protest against New York state’s public health orders that was backed by an anti-government militia and anti-vaccine activists who called for the execution of Dr. Anthony Fauci, the nation’s senior immunologist.
The “Re-Open NY” rally on Thursday in Commack, New York was organized by a group of Trump supporters who call themselves the Setauket Patriots, but also endorsed by anti-vaccination activists and the Long Island branch of the Oath Keepers, a national organization of current and former law enforcement officers and military veterans who think they are defending the nation from a range of imaginary threats posed by the federal government.
Amid a sea of American flags and Trump banners, several of the signs waved by the protesters referenced conspiracy theories promoted by radical anti-vaccine activists that demonize Fauci and the philanthropist Bill Gates.

Sunday, May 17, 2020

Interventions and Health Outcomes

The Politics of Autism discusses health care, and explains that autism services can be complicated, creating difficulties for autistic people and their families. 

Teal W Benevides and colleagues have an article in Autism titled "Interventions to Address Health Outcomes among Autistic Adults: A Systematic Review."  The lay abstract:
Autistic adults have more health problems than their same-aged peers. Yet little research has been conducted that focuses on addressing these health problems. In order to guide future research, it is important to know what intervention studies have been done to improve health outcomes among autistic adults. The project team and student assistants read studies that were published between 2007 and 2018 in the online research database, PubMed. We looked for studies published in English, which were peer-reviewed and included (1) an intervention, (2) an outcome that was related to health, and (3) a study group that included autistic adults. We did not include studies that had outcomes about employment (unless there was a health outcome), studies about caregivers or caregiving, or expert opinions about interventions. Of 778 reviewed articles, 19 studies met all of the criteria above. Within these studies, two approaches were found to have emerging evidence for their use in autistic adults: cognitive behavioral interventions and mindfulness-based approaches for improved mental health outcomes. The remaining intervention approaches did not have enough articles to support their use. Many of the outcomes were about reduced symptoms of co-occurring mental health diagnoses (e.g. reduced anxiety, depression). Most of the participants in these studies were male and did not have intellectual disability. Most study participants were adults younger than 40. There are not many intervention studies that address health outcomes among autistic adults. More research is needed on interventions which are desired by the adult autism community and address preferred health outcomes such as increased quality of life or well-being.

Saturday, May 16, 2020

Autism in The Washington Post

In The Politics of Autism, I discuss coverage of autism in the mass media.

Noa Lewin & Nameera Akhtar have an article in Disability and Society titled "Neurodiversity and Deficit Perspectives in The Washington Post’s Coverage of Autism."
Abstract

Media representations can perpetuate stereotypes about marginalized groups. Autism is often portrayed as a series of deficits needing correction. Many autistic self-advocates argue, however, that their neurological characteristics represent natural genetic variation—neurodiversity—and that they are not in need of a “cure.” The current study examined articles about autism on The Washington Post website from January 2007 through December 2016. It was hypothesized that articles would contain more elements of the neurodiversity perspective over time. Each article was coded for its overall valence, four measures of neurodiversity, and four deficit measures. Mean valence and mean composite neurodiversity scores significantly increased over time, while the mean composite deficit score significantly decreased over time. While the data suggest positive trends towards the neurodiversity perspective, they also reveal that some aspects of the deficit view of autism did not change over this time period in this news outlet.
Points of interest

Autism is often portrayed as entirely negative, but it has been argued that autism represents a form of diversity (neurodiversity) that should be recognized and respected.

The current study examined how autism was portrayed in an influential US newspaper (The Washington Post) from 2007 to 2016.

Later articles about autism were more likely to use words like neurodiversity, more likely to highlight strengths of autistic people, and more frequently described accommodations for autistic people. They also focused less on identifying causes of autism but continued to use negative terms and very few articles contained the perspectives of autistic individuals themselves.

Although some progress seems to have been made in the portrayal of autism, there is still room for improvement.

Friday, May 15, 2020

Autism, College, and COVID

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. Those challenges get far more intense during disasters.  And coronavirus is proving to be the biggest disaster of all.  Providing education is proving to be very difficult.

Madeline St. Amour at Inside Higher Ed:
"Neurodiversity is a paradigm that acknowledges and accepts different ways of thinking and acting. It’s a diversity and inclusion perspective applied to autism, ADHD, learning disabilities and other invisible disabilities," said Solvegi Shmulsky, a professor and director of the Center for Neurodiversity at Landmark College, a Vermont institution that specializes in serving students with learning disabilities. ​"For my students, autism, ADHD or dyslexia is often part of who they are, and they say they want to be accepted, not fixed."
When her students went online, they worried they would lose the support they needed, Shmulsky said. Since the switch, many of her students have reported activation -- or executive function -- issues.
"If you’re in your house, you don’t have the structure from your peers," she said. "And not everyone’s home is the kind of place that is going to be conducive for them to work on their studies."
Another issue she's heard about is how difficult it can be to understand complex concepts on a video call. It's harder for faculty to tell when students are having trouble in a virtual setting, as well.
This can all be upsetting emotionally, she said. Students who are neurodivergent learned how to deal with difficulties, like how they best study and how to advocate for themselves. Now all of their strategies have been shaken up. ​

Thursday, May 14, 2020

The Growing Strength of the Antivaxxers

 In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing diseases to spread  And among those diseases could be COVID-19.

Neil F. Johnson and colleagues have an article at Nature titled "The online competition between pro- and anti-vaccination views."
Distrust in scientific expertise1,2,3,4,5,6,7,8,9,10,11,12,13,14 is dangerous. Opposition to vaccination with a future vaccine against SARS-CoV-2, the causal agent of COVID-19, for example, could amplify outbreaks2,3,4, as happened for measles in 20195,6. Homemade remedies7,8 and falsehoods are being shared widely on the Internet, as well as dismissals of expert advice9,10,11. There is a lack of understanding about how this distrust evolves at the system level13,14. Here we provide a map of the contention surrounding vaccines that has emerged from the global pool of around three billion Facebook users. Its core reveals a multi-sided landscape of unprecedented intricacy that involves nearly 100 million individuals partitioned into highly dynamic, interconnected clusters across cities, countries, continents and languages. Although smaller in overall size, anti-vaccination clusters manage to become highly entangled with undecided clusters in the main online network, whereas pro-vaccination clusters are more peripheral. Our theoretical framework reproduces the recent explosive growth in anti-vaccination views, and predicts that these views will dominate in a decade. Insights provided by this framework can inform new policies and approaches to interrupt this shift to negative views. Our results challenge the conventional thinking about undecided individuals in issues of contention surrounding health, shed light on other issues of contention such as climate change11, and highlight the key role of network cluster dynamics in multi-species ecologies15.
Kevin Roose at NYT:
I’ve been following the anti-vaccine community on and off for years, watching its members operate in private Facebook groups and Instagram accounts, and have found that they are much more organized and strategic than many of their critics believe. They are savvy media manipulators, effective communicators and experienced at exploiting the weaknesses of social media platforms. (Just one example: Shortly after Facebook and YouTube began taking down copies of “Plandemic” for violating their rules, I saw people in anti-vaccine groups editing it in subtle ways to evade the platforms’ automated enforcement software and reposting it.)

In short, the anti-vaxxers have been practicing for this. And I’m worried that they will be unusually effective in sowing doubts about a Covid-19 vaccine for several reasons.
  • First, fast-track approval of a COVID-19 vaccine might generate real concerns  that the antivaxxers could transmute into paranoid fantasies.
  • Second, Bill Gates will be involved, and they are already spinning conspiracy theories about him.
  • Third, airlines, schools and other organizations may require proof of vaccination, triggering an anti-mandate frenzy.

Tuesday, May 12, 2020

Masking Requirements

In The Politics of Autism, I discuss the day-to-day challenges facing autistic people and their families. Those challenges get far more intense during disasters.  And coronavirus is proving to be the biggest disaster of all.

At The Washington Post,  Shannon Des Roches Rosa explains why masking requirements may be a big problem for people on the spectrum.
Autistic people have varied individual experiences, preferences and needs, so although some kids can’t tolerate a mask, others are just fine with it. But before requiring them to put one on, consider the factors that may make masks intolerable or inadvisable for an autistic person:
  • Anxiety: A mask doesn’t block breathing, but it does change the feeling of one’s airflow. For some autistic people, this can feel like suffocation.
  • Sensory: My son can’t stand having anything covering his face. Some kids can’t bear the feeling of mask elastics pulling on their ears. One enterprising mom fixed the latter issue by sewing buttons on her son’s favorite hat and pulling the elastics around those instead.
  • Visibility: If your child wears glasses, masks may fog them up. There are fixes, such as tucking a tissue between the mask and the bridge of your nose or changing your breathing pattern, but these solutions may not work for people with sensory issues or developmental disabilities.
  • Smell: I nearly passed out from my own mask-confined coffee breath. Autistic people can be extra sensitive to smell, so be sure your child brushes their teeth before trying on a mask.
  • Epilepsy: A significant percentage of autistic children have seizure disorders. Not being able to see an epileptic child’s face can be a safety risk if they have distinctive pre-seizure facial expressions. Masks with clear sections over the mouth, developed to aid deaf people, may be an option.

Monday, May 11, 2020

Adult Prevalence: 1 in 45

In The Politics of Autism, I discuss the uncertainty surrounding estimates of autism prevalence

Patricia M. Dietz, Charles E. Rose, Dedria McArthur & Matthew Maenner have an article at The Journal of Autism and Developmental Disorders titled "National and State Estimates of Adults with Autism Spectrum Disorder."  The abstract:

U.S. national and state population-based estimates of adults living with autism spectrum disorder (ASD) are nonexistent due to the lack of existing surveillance systems funded to address this need. Therefore, we estimated national and state prevalence of adults 18–84 years living with ASD using simulation in conjunction with Bayesian hierarchal models. In 2017, we estimated that approximately 2.21% (95% simulation interval (SI) 1.95%, 2.45%) or 5,437,988 U.S. adults aged 18 and older have ASD, with state prevalence ranging from 1.97% (95% SI 1.55%, 2.45%) in Louisiana to 2.42% (95% SI 1.93%, 2.99%) in Massachusetts. Prevalence and case estimates of adults living with ASD (diagnosed and undiagnosed) can help states estimate the need for diagnosing and providing services to those unidentified.
From the article:
To date, an empirical study of adult ASD prevalence in the U.S. has not been accomplished, perhaps because any single approach to ascertain adult ASD has challenges. There are no psychometrically validated tests of ASD for adults, which leads to uncertainty for studies using tests designed for children, such as the Autism Diagnostic Observation Schedule. In addition, mixed methods are likely needed in order to reach populations living independently and in group settings. A subset of persons might only be identified through the review of service records of those being served in group settings. Individuals with ASD who live independently may be disinclined to participate in a survey if recruited via phone or in person. Adults with ASD may be more difficult to recruit because they may not be enrolled in services or may not receive services in a wide variety of settings (e.g., schools, health care providers, community based entities) resulting in challenges to comprehensive  recruitment efforts. Once a validated tool to identify adults with ASD is created, a study could incorporate information from public school classifications or publicly-funded programs that serve individuals with ASD and population-based telephone or community surveys of adults with adjustments to address greater non-response among adults with ASD. 
Overall, we estimated that 1 in 45 adults (95% SI, 41, 51), ages 18–84 years, are living with ASD. While these numbers are estimates, they do provide a place for states to think about available services for adults with ASD. We used the most current data available for all states to estimate the ASD prevalence among adults. This analysis may motivate some states to explore state-based data sources that may be more informative than data available for all states, and refine the estimates based on their existing local data.

Sunday, May 10, 2020

Knowledge and Stigma: China and the US

In the preface to The Politics of Autism, I note that we need more comparative studies of autism


ASD in China differs considerably from ASD in the West in terms of prevalence estimates, education opportunities and life outcomes of autistic people. The lack of ASD awareness could be a key factor underlying these disparities. We asked 1127 U.S. citizens and 1254 Chinese citizens about their autism knowledge using the Autism Stigma and Knowledge Questionnaire (ASK-Q).The results indicated profoundly different public views about ASD in China compared to the U.S. Specifically, only 57%-65% of the Chinese citizens demonstrated adequate ASD knowledge compared to 86%-91% in the U.S. citizens. Fourteen percent of the U.S. citizens were shown to hold stigma beliefs towards ASD; in comparison, 38% of the Chinese citizens indicated ASD stigma. The Chinese citizens displayed misconceptions about ASD related to symptoms, causes, and possible long-term outcomes. In China but not in the U.S., male citizens and citizens with lower social economic status were more likely to have misconceptions about ASD than others were. The findings of this research can help increase public awareness about ASD and create a more inclusive environment for autistic people in China.
From the article:
Both Chinese and U.S. citizens responded poorly to item 8. Many of them believed medication can alleviate ASD core symptoms (44%, 39%), despite the fact that so
far there is no Food and Drug Administration (FDA)- approved medication to treat ASD core symptoms
. The only drugs approved by the FDA for ASD are antipsychotics for alleviating autism-related irritability and aggression, rather than the core symptoms (LeClerc & Easley, 2015). In China, previous surveys of parents of autistic children indicate that some parents hold strong beliefs of promising pharmaceutical treatment in near future and thus feel no current targeted behavioral intervention is needed (Hu et al., 2015). Our findings suggest broad public misunderstanding of pharmaceutical treatment for ASD in China as well as in the United States.
  • Hu, X., Zheng, Q., & Xu, S. (2015). The dilemma and coping strategies of family education for children with ASD in China. Journal of Modern Special Education, 22, 18–24
  • LeClerc, S., & Easley, D. (2015). Pharmacological therapies for autism spectrum disorder: A review. Pharmacy and Therapeutics, 40(6), 389–397.

Saturday, May 9, 2020

Genetics Matters More Than Environment

In The Politics of Autism, I discuss various ideas about what causes the condition. Many posts have discussed the potential correlatesrisk factors, and possible causes that have been the subject of serious studies:

Mark J. Taylor and colleagues have an article at  JAMA Psychiatry titled "Etiology of Autism Spectrum Disorders and Autistic Traits Over Time." The abstract:
Key Points
Question Has association between genetic factors and autism spectrum disorders (ASDs) changed over time?

Findings In this study, data were available from 2 twin cohorts, one born between 1982 and 2008 (n = 22 678 pairs) and the other between 1992 and 2008 (n = 15 279 pairs). Genetic factors were associated with ASD and autistic traits and the relative importance of these factors was consistent over time, whereas environmental factors played a smaller role.

Meaning Environmental factors associated with ASD have not increased in importance over time and are unlikely to explain the apparent increase in the prevalence of ASD.

Abstract
Importance The frequency with which autism spectrum disorders (ASDs) are diagnosed has shown a marked increase in recent years. One suggestion is that this is partly because of secular changes in the environment, yet to our knowledge this hypothesis lacks evidence.

Objective To assess whether the relative importance of genetic and environmental associations with ASD and autistic traits has changed over a 16-year and 26-year period.

Design, Setting, and Participants A twin design was used to assess whether the heritability of ASD and autistic traits has changed over time. Data from 2 nationwide Swedish twin cohorts was used: the Swedish Twin Registry (STR; participants born between January 1982 and December 2008) and the Child and Adolescent Twin Study in Sweden (CATSS; participants born between January 1992 and December 2008). Autism spectrum disorder diagnoses were identified for twins in the STR, with follow-up to 2013. Questionnaires assigned screening diagnoses of ASD to CATSS participants and assessed autistic traits. Analyses were performed from September 1, 2018, to March 31, 2019.

Exposures Each sample was divided into several birth cohorts covering 1982 to 1991 (for the STR only), 1992-1995, 1996-1999, 2000-2003, and 2004-2008.

Outcomes We assessed whether the genetric and environment variance underlying autistic traits changed across birth cohorts and examined whether the relative contribution of genetics and environment to liability for autism changed across birth cohorts.

Results Data were available for 22 678 twin pairs (5922 female same-sex pairs [26.1%], 5563 male same-sex pairs [24.5%], and 11193 opposite-sex pairs [49.4%]) in the STR and 15 280 pairs (4880 female same-sex pairs [31.9%], 5092 male same-sex pairs [33.3%], and 5308 opposite-sex pairs [34.7%]) in CATSS. The heritability of ASD diagnoses in the STR ranged from 0.88 (95% CI, 0.74-0.96) to 0.97 (95% CI, 0.89-0.99). The heritability of screening diagnoses in CATSS varied from 0.75 (95% CI, 0.58-0.87) to 0.93 (95% CI, 0.84-0.98). Autistic traits showed a modest variance increase over time that was associated with increases in genetic and environmental variance, with the total variance increasing from 0.95 (95% CI, 0.92-0.98) to 1.17 (95% CI, 1.13-1.21) over time.

Conclusions and Relevance Weak evidence was found for changes in the genetic and environmental factors underlying ASD and autistic traits over time. Genetic factors played a consistently larger role than environmental factors. Environmental factors are thus unlikely to explain the increase in the prevalence of ASD.
A release from the University of Texas at Austin:
A mother's use of antidepressants during pregnancy does not appear to increase her child's risk for autism, according to a new meta-analysis by Jeffrey Newport, M.D., published in The American Journal of Psychiatry.
Newport is director of the Women's Reproductive Mental Health program at UT Health Austin's Mulva Clinic for the Neurosciences and a professor of psychiatry at Dell Medical School at The University of Texas at Austin.
He examined 14 studies, many of which identified a connection between prenatal antidepressant use and autism. However, Newport says that research failed to account for ascertainment bias, which occurs when one group of patients or subjects is tested more frequently than others.
In the analysis, Newport found the root of bias is limited access to health care among ethnic minority and immigrant mothers.
"In these studies, immigrant and Latina mothers consistently had both lower rates of antidepressant treatment and lower rates of autism diagnosis in their children," Newport said. "This is not surprising, as these minority groups are known to have poorer access to health care, including treatment for depression and careful diagnostic assessment of concerning behaviors in a child."
Newport discovered that family-based studies eliminated the bias problem by comparing children with antidepressant exposure or autism diagnosis with their siblings who did not have antidepressant exposure or autism. With the ethnic bias eliminated, the family-based studies revealed no association between prenatal antidepressant use and autism.
"This should remind us that although insurance databases and national registries have the advantage of huge numbers of participants, their data is not collected to answer research questions, but to manage business and clinical concerns," Newport said. "Thankfully, the results of this meta-analysis show that with thoughtful study designs, researchers can overcome the biases often encountered when using such databases."