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California suspends Mark Geier’s medical license

10 Aug

California is the fifth state to suspend the medical license of a Maryland physician who chemically castrates disabled children. Mark Geier, who operates ASD Centers, is still licensed in six other states: Hawaii, Florida, Missouri, New Jersey, Kentucky and Illinois.

The St. Louis Post-Dispatch reports that Illinois has scheduled a preliminary hearing on Geier’s license for Aug. 22. The story hints that the Missouri Healing Arts Board may be investigating Geier as well:

A doctor who is disciplined in another state is also subject to discipline in Missouri and Illinois. A spokesman for the Missouri healing arts board would not confirm an investigation of Geier, whose license is active.

Mark Geier and his son, David, reportedly received a standing ovation from anti-vaccine activists at May’s cult-like AutismOne conference. But few in the movement have publicly defended their actions.

Four other states have suspended or revoked Geier’s privileges since April 27, when his home state of Maryland took action against him. Washington followed on May 26, then Virginia on June 9. On June 29, Indiana issued an emergency 90-day suspension, citing the Maryland action.

The Association of Autism Diagnosis With Socioeconomic Status

4 Aug

The CDC’ autism prevalence estimates are probably the most quoted values. Not too long ago, the estimate was 1 in 166. Then 1 in 150. About a year ago, the estimate was revised to 1 in 100.

But, these numbers are estimates. And, more importantly, these estimates spam a wide range. Autism prevalence estimates vary by state and by ethnicity.

The state with the highest prevalence estimate is New Jersey. A team in New Jersey has analyzed the most recent data for the relationship on factors such as race/ethnicity and household income.

What did they find? Kids from high income families are twice as likely to get an autism designation as kids from less affluent areas.

The prevalence estimate in wealthy areas? 17 per 1000. Or 1 in 59.

Here is the abstract:

Background: In 2007 the Centers for Disease Control and Prevention (CDC) reported a higher prevalence of autism spectrum disorder (ASD) in New Jersey, one of the wealthiest states in the United States, than in other surveillance regions. Objective: To examine the association of socioeconomic status (SES) with ASD prevalence. Methods: Information on eight-year-olds with ASD from four counties was abstracted from school and medical records. US Census 2000 provided population and median household income data. Results: 586 children with ASD were identified: autism prevalence was 10.2/1000, higher in boys than girls (16 vs. 4/1000); higher in white and Asian non-Hispanics than in black non-Hispanics and Hispanics (12.5, 14.0, 9.0, and 8.5/1000, respectively); and higher (17.2/1000 (95% CI 14.0-21.1)) in tracts with median income >US$90,000 than in tracts with median income ?US$30,000 (7.1 (95% CI 5.7-8.9)). Number of professional evaluations was higher, and age at diagnosis younger, in higher income tracts (p < .001), but both measures spanned a wide overlapping range in all SES levels. In multivariable models race/ethnicity did not predict ASD, but the prevalence ratio was 2.2 (95% CI 1.5-3.1) when comparing highest with lowest income tracts. Conclusions: In the US state of New Jersey, ASD prevalence is higher in wealthier census tracts, perhaps due to differential access to pediatric and developmental services.

Listeners prefer the laughs of children with autism to those of typically developing children.

4 Aug

When you see a paper with a title like that, you have to read the abstract. OK, I have to. I didn’t expect this to be profound. It is interesting, though. Right up the the last ( and in my opinion unfortunate) sentence.

The purpose of this study was to investigate the impact of laugh sounds produced by 8- to 10-year-old children with and without autism on naïve listeners, and to evaluate if listeners could distinguish between the laughs of the two groups. Results showed that listeners rated the laughs of children with autism more positively than the laughs of typically developing children, and that they were slightly above chance levels at judging which group produced the laugh. A subset of participants who reported listening for “uncontrolled” or “longer” laughs were significantly better at discriminating between the laughs of the two groups. Our results suggest that the laughs of children with autism have the potential to promote the formation of relationships.

Senate HELP Committee to discuss Combating Autism Reauthorization Act September 7

2 Aug

Slated for committee discussion: the Combating Autism Reauthorization Act: Executive Session – S. 958, the Children’s Hospital GME Support Reauthorization Act of 2011, S. 1094, the Combating Autism Reauthorization Act

10am Eastern time, and it looks like the hearing will be live web-cast.

Here is the agenda:

• S. 958, the Children’s Hospital GME Support Reauthorization Act of 2011

• S. 1094, the Combating Autism Reauthorization Act

• Any Nominations Cleared for Action

The Combating Autism Act is set to sunset September 30th.

Congress delays hearing on autism bill

2 Aug

The Santa Monica Dispatch is reporting that committee hearings on the Combating Autism Reauthorization Act have been pushed off to September:

e U.S. Senate Health, Education, Labor and Pensions (HELP) Committee has just announced that it is postponing a meeting on the Combating Autism Reauthorization Act (CARA) until September 7. The meeting had been scheduled for this Wednesday August 3, but Congress is apparently so exhausted by its represensible behavior during the debt ceiling debate that it’s giving itself a five-week recess. With pay.

http://www.santamonicadispatch.com/2011/08/congress-delays-hearing-in-autism-bill/

The Combating Autism Act reinstated the Interagency Autism Coordinating Committee (IACC) which creates a strategic plan for autism research in the US. More importantly, the CAA authorizes congress to appropriate money for autism specific research.

The CAA is set to end (sunset) on September 30. This leaves very little time from committee hearing to any potential vote by the legislature.

Ancestry of pink disease (infantile acrodynia) identified as a risk factor for autism spectrum disorders

30 Jul

One of the arguments for the mercury-causes-autism hypothesis is that there are subgroups more susceptible to harm from mercury exposures. It is argued that pink disease gives an example for such a susceptibility group.

Pink disease was a reaction to a teething powder which contained mercury. About 1 in 500 children exposed to the powder reacted with pink disease. Two points are important to keep in mind. First, the levels of mercury exposure from the powder were far greater than from vaccines. Second, the exposures were not the same for all children. Some parents would use more teething powder at a time. Some might use it for longer times. This makes it impossible to claim a susceptibility group as the children who showed signs of pink disease could very likely be the ones who had higher levels of mercury exposure.

In a paper just released, a team of researchers interviewed people who had a history of pink disease. Since that teething powder has been gone for decades, these individuals are now old enough to be grandparents.

This is, at best, a very strange paper. Consider these questions:

1) why aren’t they reporting a high autism prevalence in the people who had very high mercury exposures and who showed signs of pink disease? If there is a genetic susceptibility, why isn’t it seen in those with the greatest exposures?

2) why isn’t there a report of high autism prevalence in the children, just the grandchildren? My guess is that the response from some will be that the grandchildren received higher doses of mercury in vaccines than did their parents. Which again would beg the question of where is the high rate of autism in those exposed to the teething powders, especially those who developed pink disease.

The conclusions of this paper have some major logical hurdles to overcome, to say the least. And this is even before the methods are addressed. For example, this all hinges on reports by the grandparents. Not on an actual prevalence measure of the decendents.

If is already well established that the rise in mercury exposures from childhood vaccines was not the cause of the rise in autism prevalence estimates. It has always been clear that autism is not similar to mercury poisoning symptoms. The mercury hypothesis has been harmful, both to public health and the autism communities The time for papers which pose intriguing questions on this subject has past. Studies with weak methods and poor logic are irresponsible in today’s world.

Here is the pubmed link:
Ancestry of pink disease (infantile acrodynia) identified as a risk factor for autism spectrum disorders.

Here is the abstract:

Pink disease (infantile acrodynia) was especially prevalent in the first half of the 20th century. Primarily attributed to exposure to mercury (Hg) commonly found in teething powders, the condition was developed by approximately 1 in 500 exposed children. The differential risk factor was identified as an idiosyncratic sensitivity to Hg. Autism spectrum disorders (ASD) have also been postulated to be produced by Hg. Analogous to the pink disease experience, Hg exposure is widespread yet only a fraction of exposed children develop an ASD, suggesting sensitivity to Hg may also be present in children with an ASD. The objective of this study was to test the hypothesis that individuals with a known hypersensitivity to Hg (pink disease survivors) may be more likely to have descendants with an ASD. Five hundred and twenty-two participants who had previously been diagnosed with pink disease completed a survey on the health outcomes of their descendants. The prevalence rates of ASD and a variety of other clinical conditions diagnosed in childhood (attention deficit hyperactivity disorder, epilepsy, Fragile X syndrome, and Down syndrome) were compared to well-established general population prevalence rates. The results showed the prevalence rate of ASD among the grandchildren of pink disease survivors (1 in 22) to be significantly higher than the comparable general population prevalence rate (1 in 160). The results support the hypothesis that Hg sensitivity may be a heritable/genetic risk factor for ASD.

Lack of association between autism and four heavy metal regulatory genes

30 Jul

One question that has been discussed for some time is the hypothesized role of mercury as a potential cause of autism. The basic idea is that administrative prevalences of autism went up coincident with increases in mercury exposure from vaccines. Plus, it was asserted that autism symptoms are similar to the symptoms of mercury poisoning (they aren’t).

Part of the mercury model held that there could be a genetic susceptibility to mercury in a subset of children.

Researchers at Vanderbilt University have explored the question by testing autistics for genes involved in how the body processes mercury. They did not find any link between the four genes they screened and autism.

Of course one could argue that some other gene or genes are important. One would then need to explain why mercury exposure from vaccines does not increase the risk of autism.

The paper:
Lack of association between autism and four heavy metal regulatory genes.

Here’s the abstract.

Neurotoxicology. 2011 Jul 20. [Epub ahead of print]
Lack of association between autism and four heavy metal regulatory genes.
Owens SE, Summar ML, Ryckman KK, Haines JL, Reiss S, Summar SR, Aschner M.
Source
Department of Pediatric Toxicology, Vanderbilt University School of Medicine, Nashville, TN, USA.
Abstract
Autism is a common neurodevelopmental disorder with genetic and environmental components. Though unproven, genetic susceptibility to high mercury (Hg) body burden has been suggested as an autism risk factor in a subset of children. We hypothesized that exposure to “safe” Hg levels could be implicated in the etiology of autism if genetic susceptibility altered Hg’s metabolism or intracellular compartmentalization. Genetic sequences of four genes implicated in the transport and response to Hg were screened for variation and association with autism. LAT1 and DMT1 function in Hg transport, and Hg exposure induces MTF1 and MT1a. We identified and characterized 74 variants in MT1a, DMT1, LAT1 and MTF1. Polymorphisms identified through screening 48 unrelated individuals from the general and autistic populations were evaluated for differences in allele frequencies using Fisher’s exact test. Three variants with suggestive p-values <0.1 and four variants with significant p-values <0.05 were followed-up with TaqMan genotyping in a larger cohort of 204 patients and 323 control samples. The pedigree disequilibrium test was used to examine linkage and association. Analysis failed to show association with autism for any variant evaluated in both the initial screening set and the expanded cohort, suggesting that variations in the ability of the four genes studied to process and transport Hg may not play a significant role in the etiology of autism.

Percutaneous endoscopic gastrostomy and gastro-oesophageal reflux in neurologically impaired children

29 Jul

A large amount of what goes into a doctor’s decision making process is based on the communication between doctor and patient. How can you tell if someone has heartburn if you don’t understand the ways that person is communicating? Or, to put it more generally, how does the medical system appropriately serve those with difficulty communicating or with sensory issues?

This recent paper, Percutaneous endoscopic gastrostomy and gastro-oesophageal reflux in neurologically impaired children (full paper online), while not specific to autism, shows that with a lot of extra work, one can get valuable diagnostic information.

Here is the abstract:

Abstract

AIM:To investigate the effects of percutaneous endoscopic gastrostomy (PEG) feeding on gastro-oesophageal reflux (GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance (pH/MII).

METHODS: Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement.

METHODS: Prior to PEG placement (pre-PEG) a total of 183 GOR episodes were detected, 156 (85.2%) were non-acidic. After PEG placement (post-PEG) a total of 355 episodes were detected, 182 (51.3%) were non-acidic. The total number of distal acid reflux events statistically significantly increased post-PEG placement (pre-PEG total 27, post-PEG total 173, P = 0.028) and the mean distal pH decreased by 1.1 units. The distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25 (0-2), post-PEG 2.95 (0-40)]. Average proximal pH was lower post-PEG but the within subject difference was not statistically significant (P = 0.058). Median number of non-acid GOR, average reflux height, total acid clearance time and total bolus clearance time were all lower pre-PEG, but not statistically significant.

CONCLUSION: PEG placement increases GOR episodes in neurologically impaired children.

It is a small study. They place feeding tubes in the children and measure acid events (GOR). The feeding tubes increase the number of acid events.

Gastrointestinal disease has been a major topic within the autism communities for some time. While most of the discussion tends to focus upon whether this is highly prevalent and whether this is somehow linked to autism causation, much less time has been focused upon the actual diagnosis and treatment. Doctors will need extra time and effort in order to make the diagnoses and treat individuals where communication is limited.

Mark Geier: under scrutiny in more states

29 Jul

In Home Autism doctor here under scrutiny, The St. Louis Post Dispatch discusses investigations ongoing in Illinois:

A autism doctor who operates clinics in St. Peters and Springfield, Ill., has been suspended in two states for alleged mistreatment of children.

Dr. Mark Geier has been accused of misdiagnosing children with early puberty and treating them with high doses of Lupron, a drug used to suppress the hormone testosterone.

A hearing will be held on August 22nd to consider Dr. Geier’s license in the state of Illinois.

The Post Dispatch notes that Dr. Geier’s hypotheses and methods are far from generally accepted:

Dr. John Constantino, a psychiatry professor and leading autism researcher at Washington University, said Geier “understands the tools of science but has applied them in questionable ways” to justify specific treatments.

“There is currently no scientific evidence to support the clinical use of Lupron to treat autism in anything other than carefully conducted research trials,” Constantino said.

Autism News Beat in Castration doctor’s license now suspended in four states notes:

Dr. Mark Geier, the Maryland physician who chemically castrates disabled children, is still licensed to practice medicine in seven states, down from eleven. Four states have suspended or revoked his privileges since April 27, when his home state took action against him. Washington followed on May 26, then Virginia on June 9. On June 29, Indiana issued an emergency 90-day suspension, citing the Maryland action.

Onset patterns in autism: correspondence between home video and parent report

27 Jul

Regression is a major topic in autism. Children who lose abilities at a very young age. In Onset patterns in autism: correspondence between home video and parent report, Sally Ozonoff, Ph.D. and a team of researchers at the U.C. Davis MIND Institute looked at the developmental trajectories of children, autistic and non autistic. They reviewed home videos of the children to map those trajectories. They monitored social communication as a function of time.

What they found was even more complex than expected. Instead of finding that some children show low levels of social communication from very early in life. A second group has early high levels of social communication, followed by significant decreases over time (regression). But, there was a third group: a group which was more typical in development followed by not regression, but a plateau in progress in social communication.

The numbers of children in the study are small (53 autistic children), making it unlikely to get a precise idea of what fraction of the children follow each trajectory. According to the IMFAR abstract for this study:

Bayesian Information Criteria were used to select the number of trajectories that best fit the data. There was strong support from coded home video for 3 onset trajectories. The first “early onset” trajectory (n = 20) displayed low rates of social-communication behavior at all ages. The second “regression” trajectory (n = 20) displayed high levels of social-communication behavior early in life and significantly declined over time. The third “plateau” trajectory (n = 12) was similar to the typical children early in life but did not progress as expected. There was no support for a mixed (early signs + regression) trajectory.

Here is the abstract for the published paper:

OBJECTIVE:
The onset of autism is usually conceptualized as occurring in one of two patterns, early onset or regressive. This study examined the number and shape of trajectories of symptom onset evident in coded home movies of children with autism and examined their correspondence with parent report of onset.

METHOD:
Four social-communicative behaviors were coded from the home video of children with autism (n = 52) or typical development (n = 23). All home videos from 6 through 24 months of age were coded (3199 segments). Latent class modeling was used to characterize trajectories and determine the optimal number needed to describe the coded home video. These trajectories were then compared with parent reports of onset patterns, as defined by the Autism Diagnostic Interview-Revised.

RESULTS:
A three-trajectory model best fit the data from the participants with autism. One trajectory displayed low levels of social-communication across time. A second trajectory displayed high levels of social-communication early in life, followed by a significant decrease over time. A third trajectory displayed initial levels of behavior that were similar to the typically developing group but little progress in social-communication with age. There was poor correspondence between home video-based trajectories and parent report of onset.

CONCLUSIONS:
More than two onset categories may be needed to describe the ways in which symptoms emerge in children with autism. There is low agreement between parent report and home video, suggesting that methods for improving parent report of early development must be developed.

The last statement in the results is obviously intriguing. “There was poor correspondence between home video-based trajectories and parent report of onset.”

Here is the segment of the IMFAR abstract:

There was poor correspondence between parent report and home video classifications (kappa = .11, p = .30). Only 9 of 20 participants whose home video displayed clear evidence of a major decline in social-communication behavior were reported to have had a regression by parents. Only 8 of 20 participants with evidence of early delays in social-communication on video were reported to demonstrate an early onset pattern by parents. Of the 10 whose parents described a plateau, only 3 had home video consistent with this pattern.

So, none of the three groups were able to correctly recall the trajectory. Not the parents of kids who regressed. Not the parents of kids who plateaued. Not the parents of kids who had early onset autism.

As parents we’d like to see ourselves as the experts of our children. And, frankly, we are. No one else knows them like we do. But that doesn’t make us infallible.

The study was presented at IMFAR and Shannon Rosa wrote about it for The Thinking Person’s Guide to Autism.

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