News: Confirmed — Autistic kids have poorer sleep quality
BMJ Group Media Centre News Release | London, UK | September 30, 2013 — Autistic children sleep duration is shorter and they are more prone to frequent waking at night. Poor quality sleep may affect daytime learning and behaviour, say the authors.
Children with autistic spectrum disorders have poorer sleep quality than their peers right up to their teens, reveals research published online in the Archives of Disease in Childhood.
Total sleep duration is shorter and punctuated by more frequent waking at night, the research shows. Poor quality sleep may affect daytime learning and behaviour, say the authors.
Disrupted sleep patterns have been linked to autism before, but the quality of the evidence accumulated to date has often been compromised by small sample size, lack of agreed definitions, and poor comparability of study participants.
The authors of this study instead base their findings on long term data derived from the Avon Longitudinal Study of Parents and Children (ALSPAC), which has been tracking the health and development of more than 14,000 children born in 1991-2 in South West England.
All the parents were quizzed about their children’s sleeping patterns when their kids were 6, 18, 30, 42, 69, 81, 115 and 140 months old, including when their children routinely went to bed and woke up on week days, and how much time they spent sleeping during the daytime.
The researchers also took account of other key information, including the results of validated questionnaires on social and communication skills (SCDC) and intelligence (WISC-III) when the children were 7 years old.
Eighty six of the children had been diagnosed with autistic spectrum disorders by the time they were 11 years old. Thirty had classic autism; 15 had atypical autism; and 23 had Asperger’s syndrome.
The final analysis was based on 39 children with autistic spectrum disorders and 7043 typical children for whom complete data across all time points were available.
This showed that before the age of 30 months, there was no major difference in sleeping patterns between the two groups of children. But from 30 months onwards, children with autistic spectrum disorders tended to sleep less in total, with the greatest discrepancy (43 minutes) persisting up to 140 months of age.
Although the gap in total sleep narrowed after this point, autistic children still slept around 20 fewer minutes each day than their typical peers by the time they reached their teens.
These differences remained even after taking account of influential factors, such as prematurity, low birthweight, maternal education, and social class.
These differences were wholly due to the length of night-time sleep, which was shortened by frequent bouts of wakefulness.
From the age of 30 months onwards, children with autistic spectrum disorders were significantly more likely to wake three or more times a night than their typical peers, a difference that became even more noticeable the older the children became.
By the time the children were 81 months old, more than one in 10 of those with autistic spectrum disorders were waking three or more times a night compared with just 0.5% of their peers.
An increasing body of data also suggests that production of the sleep hormone melatonin may be impaired in some children with autistic spectrum disorders, which may explain disturbed sleep patterns, suggest the authors.
But it’s unclear just what impact this shortened sleep pattern may have, they acknowledge. But they point out that other researchers have suggested that sleep loss may have impact on neuronal development.
“If this hypothesis of cumulative sleep reduction resulting in neuronal loss is confirmed, then clinically [children with autism] might gain from even a small consistent increase in total sleep time,” they write.
News: Obamacare and the I/DD Community
The Autistic Self Advocacy Network has written a policy brief on the impact that Obamacare will have on our community. The brief titled “The Affordable Care Act and the I/DD Community, An Overview of the Law and Advocacy Priorities Going Forward” was written by Ari Ne’eman. The 17 page report discusses the impact of the Affordable Care Act on the disability community and needs not yet met.
|Source:||ASAN Policy Brief: What Impact will the Affordable Care Act have on People with I/DD?
News: Is this the meaning of ‘Goodwill’?
Petition by The Autistic Self Advocacy Network
From Change.org — Goodwill Industries pays thousands of workers with disabilities less than minimum wage by exploiting a provision in the Fair Labor Standards Act left over from the 1930s. Sec 14 (c) allows corporations to pay people with disabilities a subminimum wage. According to Labor Department records, Goodwill pays some of its disabled workers as low as 22, 38 and 41 cents per hour. This is wrong: disabled workers at Goodwill deserve to be paid a living wage.
It’s not well known that Goodwill is a multibillion-dollar company whose executives make six-figure salaries. They don’t need to pay disabled people subminimum wages when salaries for the CEOs Goodwill franchises across America total more than $30 million.
For more infor or to sign this petition goto
Change.org: Goodwill Industries International: Pay Disabled Workers a Real Wage
News: Air Pollution Exposure May Cause Autism
Boston, MA, June 18, 2013 — Women in the U.S. exposed to high levels of air pollution while pregnant were up to twice as likely to have a child with autism as women who lived in areas with low pollution, according to a new study from Harvard School of Public Health (HSPH). It is the first large national study to examine links between autism and air pollution across the U.S.
“Our findings raise concerns since, depending on the pollutant, 20% to 60% of the women in our study lived in areas where risk of autism was elevated,” said lead author Andrea Roberts, research associate in the HSPH Department of Social and Behavioral Sciences.
The study appeared online June 18, 2013 in Environmental Health Perspectives.
Exposure to diesel particulates, lead, manganese, mercury, methylene chloride and other pollutants are known to affect brain function and to affect the developing baby. Two previous studies found associations between exposure to air pollution during pregnancy and autism in children, but those studies looked at data in just three locations in the U.S.
The researchers examined data from Nurses’ Health Study II, a long-term study based at Brigham and Women’s Hospital involving 116,430 nurses that began in 1989. Among that group, the authors studied 325 women who had a child with autism and 22,000 women who had a child without the disorder. They looked at associations between autism and levels of pollutants at the time and place of birth. They used air pollution data from the U.S. Environmental Protection Agency to estimate women’s exposure to pollutants while pregnant. They also adjusted for the influence of factors such as income, education, and smoking during pregnancy.
The results showed that women who lived in the 20% of locations with the highest levels of diesel particulates or mercury in the air were twice as likely to have a child with autism as those who lived in the 20% of areas with the lowest levels.
Other types of air pollution—lead, manganese, methylene chloride, and combined metal exposure—were associated with higher autism risk as well. Women who lived in the 20% of locations with the highest levels of these pollutants were about 50% more likely to have a child with autism than those who lived in the 20% of areas with the lowest concentrations.
Most pollutants were associated with autism more strongly in boys than girls. However, since there were few girls with autism in the study, the authors said this finding should be examined further.
Senior author Marc Weisskopf, associate professor of environmental and occupational epidemiology at HSPH, said, “Our results suggest that new studies should begin the process of measuring metals and other pollutants in the blood of pregnant women or newborn children to provide stronger evidence that specific pollutants increase risk of autism. A better understanding of this can help to develop interventions to reduce pregnant women’s exposure to these pollutants.”
Other HSPH authors included Alberto Ascherio, professor of epidemiology and nutrition; Kristen Lyall, visiting scientist in the Department of Nutrition; Jaime Hart, instructor in the Department of Environmental Health; Francine Laden, Mark Winkler and Catherine Winkler Associate Professor of Epidemiology in the Department of Epidemiology; Allan Just, research fellow in the Department of Environmental Health; and Jennifer Bobb, research fellow in the Department of Biostatistics.
Support for the study came from DOD W81XWH-08-1-0499, USAMRMC A-14917, NIH T32MH073124-08, P60AR047782 and R01ES017017-04. The Nurses’ Health Study II is funded in part by NIH CA50385.
For more information: Todd Datz, 617.432.8413, tdatz @ hsph.harvard.edu
Reference: Roberts, Andrea L.; Lyall, Kristen; Hart, Jaime E.; Laden, Francine; Just, Allan C.; Bobb, Jennifer F.; Koenen, Karestan C.; Ascherio, Alberto; and Weisskopf, Marc G. | Perinatal Air Pollutant Exposures and Autism Spectrum Disorder in the Children of Nurses’ Health Study II Participants | Environmental Health Perspectives | online June 18, 2013 @ http://ehp.niehs.nih.gov/1206187/.
|Links:||Environmental Health Perspectives: Press Release
Environmental Health Perspectives: Journal Article
News: Use of Anti-Epileptic Drug (Valproate) During Pregnancy Associated With Increased Risk of Autism•June 12, 2013 • Leave a Comment
News: Use of Anti-Epileptic Drug During Pregnancy Associated With Increased Risk of Autism
CHICAGO, April 24, 2013 – Maternal use of valproate (a drug used for the treatment of epilepsy and other neuropsychological disorders) during pregnancy was associated with a significantly increased risk of autism in offspring, according to a study in the April 24 issue of JAMA. The authors caution that these findings must be balanced against the treatment benefits for women who require valproate for epilepsy control.
“Anti-epileptic drug exposure during pregnancy has been associated with an increased risk for congenital malformations and delayed cognitive development in the offspring, but little is known about the risk of other serious neuropsychiatric disorders,” according to background information in the article.
Jakob Christensen, Ph.D., of Aarhus University Hospital, Aarhus, Denmark, and colleagues evaluated the association between maternal use of valproate during pregnancy and the risk of autism spectrum disorder and childhood autism in offspring. The population-based study included all children born alive in Denmark from 1996 to 2006. National registers were used to identify children exposed to valproate during pregnancy and diagnosed with autism spectrum disorders (childhood autism [autistic disorder], Asperger syndrome, atypical autism, and other or unspecified pervasive developmental disorders). Data were analyzed and adjusted for potential confounders (factors that can influence outcomes) such as maternal age at conception, paternal age at conception, parental psychiatric history, gestational age, birth weight, sex, congenital malformations, and parity. Children were followed up from birth until the day of autism spectrum disorder diagnosis, death, emigration, or December 31, 2010, whichever came first.
The analysis included 655,615 children born from 1996 through 2006. The average age of the children at end of follow-up was 8.8 years. During the study period, 5,437 children were diagnosed with autism spectrum disorder, including 2,067 with childhood autism. The researchers identified 2,644 children exposed to antiepileptic drugs during pregnancy, including 508 exposed to valproate. The authors found that use of valproate during pregnancy was associated with an absolute risk of 4.42 percent for autism spectrum disorder and an absolute risk of 2.50 percent for childhood autism.
“In this population-based cohort study, children of women who used valproate during pregnancy had a higher risk of autism spectrum disorder and childhood autism compared with children of women who did not use valproate. Their risks were also higher than those for children of women who were previous users of valproate but who stopped before their pregnancy,” the researchers write.
“Because autism spectrum disorders are serious conditions with lifelong implications for affected children and their families, even a moderate increase in risk may have major health importance. Still, the absolute risk of autism spectrum disorder was less than 5 percent, which is important to take into account when counseling women about the use of valproate in pregnancy.”
|Links:||JAMA: Press Release
JAMA: Journal Article
The Four Kingdoms of Autism
By Thomas Insel, Director of the National Institute of Mental Health (NIMH) , February 26, 2013
Every once in a while I come across a posting that I think is great and I find informative.
But some of the confusion has less to do with the heterogeneity of the syndrome and more to do with which door you knock on to get help. People with autism are likely to be viewed differently by pediatricians, child neurologists, child psychiatrists, developmental psychologists, behavior therapists, special education experts, occupational therapists, speech and language therapists, and any of the other range of providers. Like the blind men and the elephant, different providers can offer completely different perspectives on the problem and the treatment. And many self-advocates with autism dismiss the concepts of problem and treatment. They seek acceptance for what they call their “neurodiversity,’’ rejecting the goals of prevention and cure. Is it any wonder families are confused?
In the spirit of mapping the autism landscape and finding some common ground, I suggest four perspectives that currently separate the communities interested in the autism spectrum. The language, assumptions, literature, and societies that have grown up around each of these perspectives are so distinct, they have begun to represent different countries or kingdoms. Each has its own truths. And each too often fails to understand or even recognize that their truths may not apply to all kingdoms.
Autism was first described as a developmental disorder by Leo Kanner, a child psychiatrist, in 1943. In the 70 years since, research on autism has largely focused on autism as an illness. The illness kingdom is largely populated by clinicians, researchers, parents, and some people with autism. They view autism as a brain disorder in which the language of medicine applies, with a focus on improving diagnosis and interventions, and cure as the ultimate goal. Medical theories about the cause of autism have evolved from “refrigerator mothers” (a term coined by psychoanalysts to suggest that autism could be due to a lack of maternal warmth) to complex genetics. In this kingdom, just as in cancer and heart disease, the search continues for biomarkers to assist in diagnosis and molecular targets for drug treatments. In contrast to those who view autism as a disability, focusing on improved services and supports, the illness kingdom focuses on biomedical approaches to reduce the need for services and supports
Self-advocates with autism, like self-advocates in the deafness community, have replaced the medical model of illness with the language of diversity and identity. They, along with many in the educational and disability communities, view autism as a difference in need of accommodation, not a disorder in need of cure. The identity kingdom was founded by young adults with a past or current autism spectrum diagnosis who can live independently but who face a range of challenges in what they describe as the “neurotypical” world. Rather than seeking to become “neurotypical,” they advocate for acceptance or inclusion (“nothing about us without us”) as well as recognition that autistic thinking may yield innovative solutions. Some self-advocates interpret genetics research as eugenics, see causal explanations as irrelevant, and view treatment as coercive conformity. As with many other disability communities, their focus is on community supports, educational and occupational services, and civil rights.
One of the more heated arguments surrounding autism has been on the purported role of vaccine injury as a cause. This kingdom was founded by parents who report marked regression after the 18-month vaccination series, when their previously interactive, communicative toddler withdraws and stops speaking. While epidemiological studies do not support a link between vaccination and autism, those convinced that autism is an injury argue that population studies may obscure a link in rare individual cases. In contrast to the self-advocate quest for identity, many of these children are severely disabled by the core symptoms of autism and by immune dysfunction, gastrointestinal symptoms, and seizures. Many of these parents, feeling that mainstream science and medicine have failed them, have turned to alternative treatments based on detoxification, diet, or oxidative stress. But their guiding assumption is that autism has been caused by injury. This kingdom advocates for prevention, recognizing that identifying the cause is the most direct path to stopping the soaring prevalence of autism.
Just as scientists have studied blindness to understand the visual system, scientists in the kingdom of insight assume that the study of people with social and communication deficits is a remarkable opportunity to understand the social brain. This kingdom belongs to social neuroscientists, using tools from cognitive science, neuroimaging, and neuroanatomy. Their goal is to map brain pathways for social information such as face recognition or theory of mind. For scientists in the insight kingdom, studies of social behavior in animals or mapping the brain’s wiring diagram (the connectome) are critically important for gaining insight about the social brain even when these studies do not reveal a cause or a cure for autism.
These four kingdoms may not capture the entire universe of the autism spectrum, but they describe largely non-overlapping perspectives that now divide the world of autism. Not surprisingly, professional societies, social networks, and publications have emerged to fortify each kingdom, which may serve to limit interactions and constructive exchange of ideas between their communities. That explains the confusion of social neuroscientists when they see their work criticized by parents from the injury kingdom as useless or the bewilderment of geneticists who are criticized by self-advocates as trying to eliminate people with autism by searching for a prenatal diagnostic that could be used to abort the next generation.
Who has the right answer? In autism in 2013, as for what Caryn James saw for Africa, there is no single answer. At different times and for different people, each of these kingdoms has something to offer. We need better diagnostics and treatments; we need better services, especially for adults; we need a strategy for prevention; and we need a deeper understanding of the social brain. As long as each kingdom stays behind its own walls, there is little hope for progress overall.
A better way forward will be to find some common ground where the entire community can work together. One such area is the need for better services. Clinicians, self-advocates, parents, scientists, and educators should be able to embrace a goal of ensuring that every person on the spectrum, irrespective of wealth, geography, or ethnicity, receives the best treatments and services. We are unconscionably far from this goal now as families move from one state to another to find services for their child. The challenge only becomes more complex when children with autism become adults with autism. There are over 1 million parents of Americans with autism—nearly all worried about how their offspring will be cared for if he or she outlives them.
Fifty years ago, President Kennedy, chiding the nation for its neglect of those with mental illness and developmental disabilities, said, “This neglect must end, if our nation is to live up to its own standards of compassion and dignity and achieve the maximum use of its manpower.” Fifty years from now we don’t want to look back at this period and wonder why we stayed so long behind these kingdoms’ respective bastions, empowering conflict rather than cooperation. Instead, by focusing now on both short term needs and long term solutions we need a collective commitment to science and service to improve the world for both children and adults on the spectrum.
1James, C. (2007, April 29). Hollywood Finds Its Disorder Du Jour. The New York Times.
|Links:||Thomas Insel, NIMH Biography|