Monday, 01 December 2008 23:52
By Alan Mozes
MONDAY, Dec. 1 (Health Day News) -- Parents of autistic children are more likely to see their sons or daughter's special health needs go unmet, a new government report shows.
Data from the National Survey of Children With Special Health Care Needs also indicated that when compared with families that have kids with other special emotional or physical needs, parents caring for autistic children face a significantly greater financial burden -- given that many must cut back their work schedule or quit their jobs altogether to care for their autistic child.
"Families of kids with autism were impacted much more strongly by the condition than the other groups, across all indicators," said study author Michael D. Kogan, director of the office of data and program development with the Maternal and Child Health Bureau at the U.S. Health Resources and Services Administration, based in Rockville, Md.
Kogan and his colleagues publish the findings in the December issue of Pediatrics.
Recent National Institute of Health estimates suggest that as many as one in 166 children have some form of autism spectrum disorder (ASD) -- a constellation of conditions including autism, Asperger syndrome and pervasive developmental disorder. Children with ASD account for 5.6 percent of the larger pool of children coping with some type of special health-care need, the authors noted.
To get a handle on the real-world experience of caring for such kids, Kogan and his team analyzed 2005-2006 data concerning 2,088 children between the ages of 3 and 17 who were reported by their parents to have ASD.
In turn, the ASD group experience was compared with that of a second group of parents caring for another 9,534 children diagnosed with "other emotional, developmental or behavioral" problems. Both groups were also compared with a third pool of almost 27,000 children coping with a wide range of other special-care needs, running the gamut from allergies to cerebral palsy.
The research team found that the families of children with ASD were more likely to develop financial difficulties in the face of their child's medical expenses.
As well, ASD families were more likely than other special-needs families to have their child's health-care needs go unattended or delayed, while facing insufficiencies or obstacles in terms of getting the medical care they needed.
"There were no differences [across special-needs groups] in having a usual source of care or having a personal provider or nurse," Kogan noted. "But where the special problems show up for families with autistic children is when they get beyond the primary point of contact. Then there's a difficulty getting referrals, coordinating care, and dealing with unmet needs for family support services."
In terms of the particular financial hardship associated with caring for an ASD child, the researchers noted that 57 percent of such families had to reduce or stop working because of their child's needs. This compared with 36 percent and 17 percent, respectively, among parents in the second and third special-needs groups.
These parents were also found to be more likely than parents in the other groups to have spent 10 or more hours per week giving or arranging care for their child -- care which cost more than $1,000 out-of-pocket in the prior year.
Laura Bono -- former chair of the National Autism Association, and herself the mother of an autistic teenager -- said she was not surprised by the findings, and noted that the emotional and financial demands placed on parents of autistic children are "absolutely enormous and stressful."
"Of course, I don't want to minimize the responsibilities related to caring for children with any other special need," she said. "But the level of functionality among autistic children is different, and it means they need 24/7 support. Which is a huge burden -- in the financial area, the educational area, and the appropriate medical-needs area."
Bono -- who currently serves on the board of "Safe Minds," a nonprofit advocacy group in Durham, N.C., focused on childhood neuro-developmental disorders -- explained how thoroughly the needs of an autistic child can alter a family's routine.
"Even if an autistic child is well enough to go to school, schools are often only half a day or so, so many parents choose to stay home so someone is there," she noted. "And many insurance plans won't cover all the things an autistic child needs, because they view the situation as a developmental disorder, not a disease. So, you have to pay huge expenses out of pocket. Otherwise, you just can't get occupational therapy. You can't get speech therapy. You sometimes can't even get basic blood work at your pediatrician. It's a real struggle."
Last Updated on Wednesday, 03 December 2008 23:55
Tuesday, 04 November 2008 23:03
Source: BBC News
Increased rainfall, or something linked to it, may be connected to the development of autism, scientists say.
The theory is based on child health and weather records from three US states, but has been given an icy reception by UK experts.
The US study found autism rates were higher among children whose states experienced higher rainfall in their first three years.
The work appears in Archives of Pediatrics and Adolescent Medicine.
The rising rate of autism - up, by some measures, from one in 2,500 to one in 150 - has been attributed mainly to improvements in the way doctors are able to recognise the disorder.
However, scientists from Cornell University say this does not exclude a factor which may be independently increasing the number of children growing up with the condition.
They calculated average annual rainfall for California, Oregon and Washington State between 1987 and 1999, then looked at autism prevalence rates in the children growing up during this period.
They found that rates could be linked to that amount of precipitation in their state between these dates.
They added: "Autism prevalence was higher for birth cohorts that experienced relatively heavy precipitation when they were younger than three years."
The reason for the link, if it exists, might not be directly related to rainfall, although the scientists said it was possible that the process of rainfall might affect the chemicals to which children were exposed.
They also suggested that being forced to stay indoors for longer periods could affect development, perhaps by increased exposure to television, or to household chemicals, or even through a lack of vitamin D, produced by being out in sun.
However, they made it clear that none of these was more than a theory, and called for further research to see if the link was a real one.
Mark Lever, chief executive of The National Autistic Society said the latest theory would join a succession of others advanced about the condition and its origins.
He said: "In recent years autism has been linked to factors as varied as older aged fathers, early television viewing, vaccines, food allergies, heavy metal poisoning, and wireless technology, to name just a few.
"Some of these theories are little more than conjecture or have been discredited, others seem more promising and are in need of further study. As yet, however, very few have been substantiated by scientific research."
He said: "We don't yet understand what causes autism, although scientists do believe that genetic factors might play a part.
"People with autism and their families are naturally concerned to get the right information and there is a lot of confusion and concern over the conflicting theories put forward."
Dr Michael Fitzpatrick is a GP in London and author of the book 'Defeating Autism: A Damaging Delusion'.
He said: "The notion that autism is caused by higher rainfall is manifestly absurd.
"It is about time we recognised that autism has largely genetic causes and devoted our energies to providing the best possible education and care services for people with autism and their families."
Monday, 04 December 2006 08:00
Source: NIH News
Well Siblings Share Some of the Same Behavioral, Neural Features
The brain’s fear hub likely becomes abnormally small in the most severely socially impaired males with autism spectrum disorders (http://www.nimh.nih.gov/healthinformation/autismmenu.cfm), researchers funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH) and National Institute on Child Health and Human Development (NICHD) have discovered. Teens and young men who were slowest at distinguishing emotional from neutral expressions and gazed at eyes least — indicators of social impairment — had a smaller than normal amygdala, an almond-shaped danger-detector deep in the brain. The researchers also linked such amygdala shrinkage to impaired nonverbal social behavior in early childhood.
The new findings suggest that social fear in autism may initially trigger a hyperactive, abnormally enlarged amygdala, which eventually gives way to a toxic adaptation that kills amygdala cells and shrinks the structure, propose Richard Davidson, Ph.D., and colleagues at the University of Wisconsin, who report on their magnetic resonance imaging (MRI) study in the December 2006 Archives of General Psychiatry.*
In a related study, another research team led by Davidson found that well siblings of people with autism share some of the same differences in amygdala volume, and in the way they look at faces and activate social/emotional brain circuitry, particularly an area critical for face processing.
“Together, these results provide the first evidence linking objective measures of social impairment and amygdala structure and related brain function in autism,” explained Davidson. “Finding many of the same differences, albeit more moderate, in well siblings helps to confirm that autism is likely the most severe expression of a broad spectrum of genetically-influenced characteristics.”
While SOME people with minimal expression of these traits might be perceived as aloof or loners, those at the more severe end of the spectrum are unable to engage in give-and-take interactions and fail to develop age-appropriate peer relationships. Notably, they shy away from looking at eyes. Davidson’s research team had reported last year linked such eye-gazing with hyperactivation of their fear hub.** Yet different studies have found the amygdala in autism to be variously enlarged, shrunken or even normal in size.
Davidson, Kim Dalton and colleagues suspected that these seemingly inconsistent findings resulted from the wide variability of the autism spectrum, which masked amygdala changes — that a clearer picture would emerge if the length and severity of hypersensitivity to social interactions were factored in. They brought to bear eye-tracking and other measures of facial emotion processing in combination with MRI to find out if degree of non-verbal social impairment might predict amygdala volume in 49 males, aged 8-25, including 25 with autism spectrum disorders.
Those in the autism group who had a small amygdala were significantly slower at identifying happy, angry, or sad facial expressions and spent the least time looking at eyes relative to other facial regions. Autistic subjects with the smallest amygdalae took 40 percent longer than those with the largest fear hubs to recognize such emotional facial expressions, and those with the largest amygdalae spent about four times longer looking at eyes than those with the smallest. Eye fixation did not correlate with amygdala volume among 24 control subjects. The size of the amygdala increased early in autism group subjects with normal eye fixation, while it increased little in those with low eye fixation. Moreover, autism group subjects with small amygdalae had the most non-verbal social impairment as children.
The researchers suggest that the amygdala in autism fits a model in which a brain structure adapts to chronic stress — in this case, fear of people — by first becoming hyperactive, but over time succumbing to a process of toxic cell death and atrophy, as has been proposed occurs in the hippocampus for some forms of depression.*** Children with autism who are least hypersensitive to interaction with people would thus show slower amygdala shrinkage while those who were most hypersensitive would begin to show amygdala changes early in life. Such amygdala adaptations likely affect most people with autism by adulthood, according to the researchers. However, they caution that these changes do not explain all autistic behavior, but account for slightly more than half of the variability in nonverbal social impairment.
In the related study, published online in Biological Psychiatry, October 24, 2006,**** Davidson, Kim Dalton, Ph.D. and colleagues at the University of Wisconsin employed functional magnetic resonance imaging (fMRI) as well as many of the same measures used in the above study in 21 subjects with autism, 12 siblings and 19 healthy controls. Notably, they found that unaffected siblings of people with autism showed a similar pattern of smaller amygdalae, and decreased eye fixation as their autistic siblings when looking at faces.
However, while the autism group showed reduced activation of a face-processing area, the fusiform gyrus, on both sides of their brains while performing a face-processing task, the well siblings showed this difference only on the right side. This suggested an “intermediate pattern” — that the well siblings were using circuitry similar to healthy controls, but with some slight changes reminiscent of their autistic siblings, but not as pervasive.
Similarly, eye fixation time did not predict amygdala activation in the well siblings as it did in their autistic relatives. This suggested that looking at faces did not boost activation of emotion-related circuitry in the well siblings. Looking at eyes may not be a negative experience for them, again suggesting an intermediate pattern. Nonetheless, their amygdalae were about the same size as those in the autism group.
The findings of both studies, taken together, suggest that measures such as eye gazing time may prove useful in clarifying the relationship between genes, brain and behavior in the autism spectrum, say the researchers.
Also participating in the Archives of General Psychiatry study were: Kim Dalton, Ph.D., Tom Johnstone, Ph.D., Micah Long, Emelia McAuliff, Terrence Oakes, Ph.D., Andrew Alexander, Ph.D., University of Wisconsin.
Also participating in the Biological Psychiatry study were: Brendon Nacewicz, Andrew Alexander, Ph.D., University of Wisconsin.
The Archives study was also funded by NARSAD. The Biological Psychiatry study was also funded by NARSAD and NAAR.
The National Institute of Mental Health (NIMH) mission is to reduce the burden of mental and behavioral disorders through research on mind, brain, and behavior.More information is available at the NIMH website, http://www.nimh.nih.gov .
The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Web site at http://www.nichd.nih.gov/.
The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
* Nacewicz BM, Dalton KM, Johnstone T, Long MT, McAuliff EM, Oakes TR, Alexander AL, Davidson RJ. Amygdala volume and nonverbal social impairment in adolescent and adult males with autism. Arch Gen Psychiatry. 2006 Dec;63(12).
** Dalton KM, Nacewicz BM, Johnstone T, Schaefer HS, Gernsbacher MA, Goldsmith HH, Alexander AL, Davidson RJ. Gaze fixation and the neural circuitry of face processing in autism. Nat Neurosci. 2005 Apr;8(4):519-26. Epub 2005 Mar 6.
***McEwen BS. Mood disorders and allostatic load. Biol Psychiatry. 2003 Aug 1;54(3):200-7. Review.
****Dalton KM, Nacewicz BM, Alexander AL, Davidson RJ. Dalton KM, Nacewicz BM, Alexander AL, Davidson RJ. Gaze-Fixation, Brain Activation, and Amygdala Volume in Unaffected Siblings of Individuals with Autism. Biol Psychiatry. 2006 Oct 24; [Epub ahead of print]