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Ageing in autism

6 May

A new paper highlights the issue with geriatric populations in autism.

At present, one of the major challenges is that the majority of the currently older individuals with ASD has not received a formal diagnosis of ASD, and this would be dif?cult to establish using the currently recommended diagnostic assessments, because for many of them, neurodevelopmental history would be hard to obtain. The diagnosis of ASD in children involves both the parents and the child contributing…

You see, nobody working the field of geriatric psychology has any doubt that there is a large population of autistic people within the geriatric population:

Many adult and older subjects with ASD remain undiagnosed and thus are largely unknown to specialist services. [M]any have survived childhood and adulthood by either being fully supported by their family or holding jobs in
protected environment, enabling them to function ‘normally’, and thus escaping the ASD diagnosis. In support for this are the three recent case reports on diagnosing older people with ASD indicating that the standard clinical screenings used in childhood had to be modi?ed and adapted for ?rst?time diagnosis of ASD in older individuals.

As also published recently, it is becoming clearer that there is in fact, no ‘autism epidemic’ and that, in point of fact, research shows:

…nearly one percent of Britons older than 16 years have autism, a rate that is similar to that seen in children. Younger people were no more likely to be affected than older ones, however, which would have been expected if the condition were truly on the increase.

So what can we take from this? Being who I am and having the interests I have I take two main things:

1) Vaccines haven’t caused an epidemic of autism because an epidemic of autism does not in fact exist.

2) There is a large amount of undiagnosed adults with autism who need our help now. They are in community homes (group homes I believe they are referred to as in the US) or living with very elderly relatives. The majority are in situations where their autism is not recognised and not diagnosed. How do we help them?

The University of Newcastle held a Workshop Meeting ‘to reach a consensus on he need for new initiatives in this area.’ and came away with the following points:

1 Prevalence rates of older people with ASD (a prerequisite for planning service needs and placements)
2 Determine life expectancy, behavioural changes and cognitive changes with ageing in ASD
3 Data regarding health problems common in ASD, clinical assessments and treatment of seriously medically ill and frail older individuals with ASD
4 Information whether and how the characteristic clinical symptomatology of ASD change with age
5 Problems diagnosing older individuals with ASD not known to services and development of diagnostic tools for this purpose
6 Diagnosing cognitive impairment and dealing with challenging behaviour in nursing homes
7 Increasing need for advocacy and mental capacity assessments
8 Need to identify services, support and resources for older people with ASD
9 Design of adequate environment for older individuals with ASD
10 Neuroimaging studies in older individuals with ASD
11 Biobanking facilities (cerebrospinal fluid, blood/blood derivates and brain donations) and facilitating research

We should all be aware of the needs of elderly autistic people and try and find a way to help I think. How we should do this is vital. The first step must be the recognition that the idea of an autism epidemic marginalises them.

Do we have to wait for someone to be injured to call a practice unsafe?

5 May

Mark Geier has had his license to practice medicine suspended in his home state of Maryland. The Chicago Tribune (which has discussed Mark Geier and his “lupron protocol”) has a story discussing this: Trib Update: Md. suspends autism doctor’s license.

These paragraphs stood out when I read them:

In some cases, the board found that Geier diagnosed the children with precocious puberty and prescribed Lupron and other hormone-disrupting drugs without examining them or conducting proper tests. Some of these children were within the normal age range for puberty, so they couldn’t have qualified for such a diagnosis, the board found.

Geier, who is not allowed to practice in Maryland while the case is pending, declined comment, instead referring questions to an attorney. The attorney, Joseph A. Schwartz III, said that at the root of the complaint was a “bona fide dispute over therapy” rather than a case of a doctor who is an immediate threat to patients.

“If you read the (complaint), you say, ‘Holy God, this is awful.’ But if it were so awful they should have an injured child, and they don’t. I would hope that the board would step back and say, ‘Maybe there’s a lot of controversy and he’s not in the mainstream.’ But let’s test these allegations in a fair hearing. It’s just like shadow-boxing with allegations that sound awful but when you delve into the facts of them you say, ‘What’s the big deal here?’” Schwartz said.

“But if it were so awful they should have an injured child”

Do we really have to wait for someone to be injured? Clearly, the answer is no. “An immediate threat” is different from “has already caused harm”.

Let’s address this question: “What’s the big deal here?” Let’s address it in short, easily digested statements, centering around the fact that this is a breach of ethics, not a question of treatment modalities.

Here are a few “big deals” which come to mind readily:

1) diagnosing children with a condition they do not have (precocious puberty)
2) not performing the follow through to see if children have brain tumors, which would be possible if the diagnosis were real.
3) doing (1) to justify a very serious medication for the disabled children
4) allowing an untrained/unlicensed person to perform examinations

Mr. Geier is very lucky that no one was injured. His original methodology included giving

Here is the paragraph on “use” for Lupron:

LUPRON DEPOT?PED® (leuprolide acetate for depot suspension) 7.5 mg, 11.25 mg and 15 mg are prescribed for the treatment of children with central precocious puberty (CPP). Doctors may diagnose children with CPP when signs of sexual maturity begin to develop in girls under the age of 8 or boys under the age of 9. Doctors will also perform tests to rule out possible causes of CPP that would require different treatment (e.g., tumors).

One issue that came up was Mr. Geier’s lack of followup testing. Having diagnosed precocious puberty, he should have ordered tests to rule out brain tumors. These were not performed. This makes one question: did he actually believe the diagnoses himself or was he just negligent in calling for the brain scans?

Something caught my eye that I hadn’t seen before. Notice the pediatric dosage: 7.5, 11.25 and 15 mg. This is the same dosage that the Geiers note in their patent application: US20070254314A1: Methods of treating autism and autism spectrum disorders.

Check the dosages given to some children:

On Nov. 24, 2004, Child X was given a single shot of LUPRON DEPOT® (leuprolide acetate, Takeda Pharmaceutical Company Limited, Osaka, Japan) in the amount of 22.5 mg.

On Apr. 2, 2005, Child Y was given a single shot of LUPRON DEPOT® (leuprolide acetate, Takeda Pharmaceutical Company Limited, Osaka, Japan) in the amount of 22.5 mg.

Perhaps the pediatric doses were larger back then. I’d be very interested to know, as these children were given dosages above the maximum listed values.

In an interesting side note in this story. Mark Geier’s son, David, was appointed to a position on the Maryland state’s autism commission as a “diagnostician”. Apparently his position is being reviewed and he has been asked to resign:

Gov. Martin O’Malley appointed David Geier in 2009 to the state’s Commission on Autism as a “diagnostician,” a decision state officials are now reviewing. David Paulson, a spokesman for the state health department, said David Geier declined Wednesday to resign from the position.

Maryland Board of Phyicians: Mark Geier “endangers autistic children and exploits their parents”

4 May

Dr. Mark Geier is well known in the world of alternative medicine and autism. He, together with his son David, work a medical practice and publish papers. They are long-standing proponents of the vaccine-causation hypothesis, presenting pseudo-epidemiological studies as support. Dr. Geier has worked as a witness in the vaccine court, has has a long history of criticism for his work there.

One of the stranger notions Dr. Geier has put forth involves testosterone. In their model of autism, testosterone binds with mercury in the brain and makes it difficult to remove through chelation. For many, many reasons, this was just plain wrong. Based on their mistaken hypothesis, the Geiers have promoted a treatment for autism based on reducing testosterone in autistic children. In short, they put children on an injected drug: Lupron.

This idea has met with much criticism. Probably no one has studied the Geier’s and their actions more closely than Kathleen Seidel on her blog at Neurodiversity.com. Five years ago and more she exposed the “Lupron Protocol” in a sixteen partseries called

Significant Misrepresentations: Mark Geier, David Geier & the Evolution of the Lupron Protocol.

Well, it isn’t just one of the best bloggers saying it anymore. The Maryland Board of Physicians has investigated Dr. Geier and Dr. Geier has now had his license suspended.

Here is part of the Order for Summary Suspension:

The Respondent misdiagnosed autistic children with precocious puberty and other genetic abnormalities and treated them with potent hormonal therapy (“Lupron Therapy” or “Lupron Protocol”), and in some instances, chelation therapy, both of which have a substantial risk of both short-term and long-term adverse side effects. The Respondent’s treatment exposed the children to needless risk of harm.

The introduction goes on.

The Respondent, in addition to being a physician, is certified as a genetic counselor. His assessment and treatment of autistic children, as described herein, however, far exceeds his qualifications and expertise. The extensive and expensive batteries of laboratory studies the Respondent initially orders, many of which he orders to be repeated on a monthly basis, are outside the standard of quality care for a work-up for an autistic patient or to determine the underlying cause of autism. The Respondent failed to conduct adequate physical examinations of any of the patients and in several instances, began his Lupron Protocol based merely on a telephone consultation with the child’s parent and the results of selected laboratory tests he ordered. The Respondent’s omission of a comprehensive physical examination constitutes a danger because his treatment is based on a diagnosis that requires documentation of sexual development beyond that expected for the age of the child. Moreover, his treatment may constitute more of a risk to a child with an underlying medical condition.
The Respondent failed to provide adequate informed consent to the parents of the autistic children he treated. In one (1) instance, he misrepresented that his treatment protocol had been approved by a federally approved IRB.
There are no evidence-based studies to support either the Respondent’s Lupron Protocol or his administration of chelation therapy to autistic children; he relies in large part on his own studies which have been wholly discredited by the Institute of Medicine and denounced by the American Academy of Pediatrics. The Respondent’s treatment of autistic children with his Lupron Protocol and chelation therapy is not limited to Maryland. Indeed, in a recent article in the Chicago Tribune, the Respondent stated his intent to open clinics all over the United States, H[w]e plan to open everywhere. I am going to treat as many as I can.

The introduction ends with this paragraph:

The Respondent endangers autistic children and exploits their parents by administering to the children a treatment protocol that has a known substantial risk of serious harm and which is neither consistent with evidence-based medicine nor generally accepted in the relevant scientific community.

Pretty much sums it up. There are numerous counts and details listed in the full document. Below I’ll highlight some specific statements.

Patient A, a child whose mother stated aggression was not a problem, was reported as having aggression and self-injurious behaviors:

Notwithstanding Patient A’s mother’s report that aggression was not a problem with Patient A, the Respondent noted in the “Precious (sic) Puberty Evaluation” section of the form that Patient A, “bites and punches others; hits head with hands.”

As with many (if not all of the children) listed in the order, the diagnosis of precocious puberty was not considered valid:

45. The Respondent misdiagnosed Patient A with premature puberty. Significantly, Patient A did not meet the age criteria for premature puberty.
46. In addition, the results of Patient A’s laboratory studies do not support the Respondent’s diagnosis. The Respondent reported that Patient A’s testosterone metabolites were “significantly increased;” however, the results of Patient A’s luteinizing hormone (“LH”) were only marginally elevated, and his free testosterone and DHEA were within range for a ten (10) year old male.

One question that is often raised with alternative medical practitioners is the validity of their diagnoses. Quite often this involves diagnoses of “heavy metal toxicity” using non-standard tests. In the case of the Geier’s, there is also the validity of diagnoses of “precocious puberty”. There are standards for age, and for tests which should be performed. Reading the order, it is clear that age requirements were often ignored. Bone density tests were often not performed:

The Respondent failed to assess Patient B’s bone age, assess the child’s growth velocity or order a GnRH test to confirm the presumptive diagnosis of precocious puberty.

Also, the signs of precocious puberty could be due to a brain tumor. Yet brain scans were not performed. This from Patient E:

In addition, the Respondent failed to assess Patient E’s skeletal maturation by ordering an x-ray of her left wrist and he failed to order a scan of her brain in order to rule out a tumor.

Another question that often comes up with the Geier practice is what role David Geier plays. David Geier holds only a bachelor’s degree. He is not a physician. Patient C appears to have been examined by David Geier, with Dr. Mark Geier absent:

Patient C’s mother returned to the Respondent’s office on May 19, 2008 because of the worsening of Patient C’s aggressive behaviors. According to her complaint, the Respondent was not present during this office visit, She saw only his unlicensed son.

And, yet, the child was given “comprehensive” abdominal and thyroid ultrasounds at the visit:

The note of the visit indicates that “comprehensive” abdominal and thyroid ultrasounds were performed. Patient C’s physical appearance is described as suggesting “advancement from his chronological age” and that he appeared to be “potentially significantly physically aggressive to himself and/or others.”

and something akin to a diagnosis was rendered:

A portion of the “Psychological Examination” section of the note states, “It is apparent based upon examination of the DSM-IV criteria that [Patient Crs present symptoms are compatible with a diagnosis of pervasive developmental delay – not otherwise specific (sic).”

One problem with research performed by the Geier’s is the lack of an appropriate IRB–institutional review board. Dr. Geier placed himself, his wife and his son on the IRB. Not noted in the Order is the timing of the IRB. If memory serves correctly, there is evidence that the IRB was put into place after research began.

An IRB must consist of at least five (5) members. The ICI IRB’s members include the Respondent, his son and the Respondent’s wife. The ICI IRB is inconsistent with the requirement that a member should not have a conflict of interest in the research project.

The Order includes discussion that “The Respondent [Mark Geier] Misrepresented His Credentials”. When the investigative board interviewed him, here is how Dr. Geier described himself:

On November 6, 2007, in furtherance of the Board’s investigation, Board staff interviewed the Respondent. During the interview, the Respondent stated that he was a board-certified geneticist and a board-certified epidemiologist. The Respondent stated that he had been board-certified in epidemiology in 2007.

However, “board certified” and “geneticist” seem to be incorrect:

As to being a board-certified epidemiologist, this appears to be inaccurate:

166. By letter dated March 29, 2011, the Respondent, through counsel, submitted to the Board a “Fellowship Certificate” from the American College of Epidemiology (“ACE”). The ACE is a professional association whose policy on admission is “inclusiveness.” An ACE fellow is not required to have a degree in epidemiology, a degree in a “related field” is sufficient.
167. The Respondent knew, or reasonably should have known, that he was not board-certified in epidemiology.

As to being a “geneticist”, Dr. Geier is a “genetic counselor”, a different creature:

168. By letter dated March 29, 2011, the Respondent, through counsel, also submitted to the Board a certificate issued by the American Board of Medical Genetics on September 15, 1987 certifying the Respondent as a Genetic Counselor.
169. The term “genetic counselor” is not synonymous with “geneticist.” A geneticist, or medical geneticist, is a physician who evaluates a patient for genetic conditions, which may include performing a physical examination and ordering tests. A genetic counselor is an individual with a masters degree who helps to educate the patient and provides an assessment of the risk of the condition recur in the family.
170. The Respondent knew, or reasonably should have known, that he was not a board-certified geneticist.

Geneticist/genetic counselor and whether he is board certified in epidemiology or not are interesting but minor questions compared to the board findings of misconduct in treating disabled children. So it comes as no surprise that it is ordered:

Based on the foregoing, it is this 27th day of April , 2011, by a majority of the quorum of the Board:
ORDERED that pursuant to the authority vested by Md. State Gov’t Code Ann., § 1 0-226( c)(2), the Respondent’s license to practice medicine in the State of Maryland be and is hereby SUMMARILY SUSPENDED;

Mr. Mark Geier is at present unable to practice medicine in his home state of Maryland.

kathleen Seidel has already blogged this: Maryland Medical Board Suspends Dr. Mark Geier’s License

UK Research places huge question mark over the autism ‘epidemic’

3 May

Just a quick couple of quotes as I’m in a rush.

Researchers found nearly one percent of Britons older than 16 years have autism, a rate that is similar to that seen in children. Younger people were no more likely to be affected than older ones, however, which would have been expected if the condition were truly on the increase.

Source.

And this – same source.

Fears that the condition is becoming more and more common in children have launched both researchers and parents on a fierce search for the underlying reasons.

So far those efforts haven’t paid off, however, and the much-reported claim that childhood vaccines could be the culprit has been widely discredited.

…

“None of them had been diagnosed (previously) with autism,” he said. “I think for me the issue is that people have been ignoring autism in adulthood and only focusing on children.”

Sullivan to attend IMFAR

27 Apr

I have written in the past that I will be attending IMFAR, the International Meeting For Autism Research. I will be supported by a stakeholder travel grant from the Autism Science Foundation, for which I am very grateful. What I haven’t mentioned before is that I was planning to attend IMFAR even before applying for the stakeholder grant. I’ve been planning on attending since I submitted an abstract.

That abstract was briefly, and mistakenly, posted online so I chose that time to acknowledge my identity. As it turns out the abstracts are still under embargo and, as such, I have pulled the remainder of this article. I will repost once the embargo is lifted.

Dr. Ricardo Dolmetsch on Autism Spectrum Disorder Research and Stem Cell Possibilities

25 Apr

Dr. Ricardo Dolmetsch is a professor at Stanford University. He is one of the keynote speakers for the IMFAR conference. Recently, Tom Insel, director of the National Institute of Mental Health interviewed Prof. Dolmetsch on his work. The video is up on the NIMH website, and I embeded it here.

I’m sure when many people read “stem cell possibilities” they are going to wonder if this is about stem cell therapy. No, there is no stem cell therapy for autism at present. What Prof. Dolmetsch is doing is taking skin cells and converting them into brain cells. He can then compare brain cells from autistic and non-autistic individuals and look for differences.

The idea is very interesting. If this method really does represent the brain cells in the individual, it would give some indication of the operation of those cells. What it probably won’t do, I suspect, is give an indication of long range connectivity or size of individual structures (e.g. corpus callosum, amygdala, etc.).

As you will hear (or read), Prof. Dolmetsch started working on autism after one of his children was diagnosed.

Here is the transcript:

Transcript

Announcer: NIH Radio… from Bethesda.

Announcer: Recently, Dr. Ricardo Dolmetsch, an associate professor of neurobiology at Stanford, spoke with National Institute of Mental Health Director Dr. Thomas Insel. Devoted to Autism Spectrum Disorder research, Dr. Dolmetsch and his colleagues have generated stem cells from children with autism allowing them to study how the brain develops in children with ASD.

Dr. Thomas Insel: I thought a good place to begin the conversation was to ask you about your interest in autism and how that happened. You’re someone who trained in calcium channels… worked on very basic problems in molecular biology and now you’re interested in autism…

Dr. Ricardo Dolmetsch: Right, when I first got to Stanford I was interested in a very basic question.. and um.. you know for a few years we worked on that and that was really exciting but it was very arcane. And then about I guess four and a half years ago, our son was diagnosed with autism. And so this really changed my…the direction of my lab. Actually, what really happened was that my wife and I got together and we thought a little bit about what we could do and we came up with a bunch of projects and one of the ideas was that we were going to just change all of our efforts and that’s how we started working on autism.

Dr. Thomas Insel: I know what you’re working on now has to do with induced pluripotent stem cells. And that’s a bit magical for many people… the idea that you can create a stem cell from skin or from some other differentiated cell. Can you explain what that is and how you think that will be helpful for studying autism?

Dr. Ricardo Dolmetsch: Our whole idea of development is that development is sort of a directional arrow. It’s kind of like spilling water. You can spill water but you can’t unspill water. And we sort of thought development went to the same way. You start out with an egg and you end up with a human- you don’t go backwards. But it turns out that that’s not quite true. So, this pioneering Japanese group led by Dr. Yamanaka developed this system that allows you to take for example skin cell or blood cell and convert it into a stem cell. And the way you do this is you introduce these four proteins that do something mysterious that nobody completely understands and it changes the cell and makes it into a stem cell. And that stem cell has the capacity to make every cell in your body including brain cells.

Dr. Thomas Insel: So you can make brain cells from the skin or blood cells of a child with autism.

Dr. Ricardo Dolmetsch: Exactly, so what this allows you to do then is you can then take.. for the very first time… you can make these tissues that you wouldn’t be able to access normally. So, so you can take the skin cells of a child with autism and you can make stem cells from those skin cells and then you can take those stem cells and you can differenciate them to generate basically little pieces of brain. And then you can analyze the development of those cells as well as their function once they’re mature and so this gives you insights that you wouldn’t have any other way.

Dr. Thomas Insel: So, when you do this in autism how do those brain cells that you derieve from skin differ in children with autism versus kids who don’t have autism.

Dr. Ricardo Dolmetsch: Well, this is something we’re still working on, right and I think we’re still at the very beginning. I think that the short answer is that we have so far only looked at a couple classes of autism and in those classes of autism we have learned something about how development is changing. So for example in one case we know that these kids are making too many cells that produce dopamine and norepinephrine. Dopamine and norepinephrine are these really important neurotransmitters that are important for motivation, attention and pleasure and for some reason these children are making too many of them and they’re turning on the pathways that generate these neurotransmitters in the wrong cells. And so, that…. I mean just knowing that gives you a target- gives you something to target therapeutically.

Dr. Thomas Insel: Is there some way in which having the stem cells the way you describe is going to help us to develop new therapeutics?

Dr. Ricardo Dolmetsch: Oh absolutely. So, so…. this is the thing, right? We need to understand what is going wrong. And things are going wrong at multiple levels. So, so… we know for example.. so the first sort of level of understanding is we have to figure out what the genes are. We’ve started to identify many of the genes. The next level of understanding is we have to understand how those genes are actually changing the function and development of the cells and that is what we are working on-what we have developed. Now, once you know what is wrong with the cells you can then look for ways to reverse that.

Dr. Thomas Insel: I can’t help but ask the question.. how you done this with your own son? Have you taken skin cells and created stem cells from him?

Dr. Ricardo Dolmetsch: We have. And we have sequences genome as well as ours. And you know, I mean, it’s um… it’s a difficult project to have in your own lab. Um… in a way.. you really want to know. And in a way you really wish.. you really hope that what you find is not too terrible. But absolutely, this is one of the motivations- not the only motivation. I think one of the things I’ve discovered in working on autism I’ve met many families – it’s been that it motivates you in a way that… you know… is difficult to explain and in a way I never would have expected when I was being trained as a very basic scientist.

Controlled Evaluation of the Effects of Hyperbaric Oxygen Therapy on the Behavior of 16 Children with Autism Spectrum Disorders

21 Apr

Hyperbaric oxygen treatment (HBOT) has become a big topic in the world of CAM (complementary and alternative medicine) and autism. An upcoming parent convention with a focus on CAM is even sponsored by an HBOT company. A few papers have come out, without much clear evidence of benefit.

A recent paper looks again at HBOT. This paper has a few limitations. Amongst these: there were only 16 participants and, well, I consider papers by Thoughtful House and by Andrew Wakefield in particular to be somewhat problematic.

Here is the abstract:

Controlled evaluation of the effects of hyperbaric oxygen therapy on the behavior of 16 children with autism spectrum disorders.

Jepson B, Granpeesheh D, Tarbox J, Olive ML, Stott C, Braud S, Yoo JH, Wakefield A, Allen MS.

Thoughtful House Center for Children, Austin, TX, USA.
Abstract

Hyperbaric oxygen therapy (HBOT) has been used to treat individuals with autism. However, few studies of its effectiveness have been completed. The current study examined the effects of 40 HBOT sessions at 24% oxygen at 1.3 ATA on 11 topographies of directly observed behavior. Five replications of multiple baselines were completed across a total of 16 participants with autism spectrum disorders. No consistent effects were observed across any group or within any individual participant, demonstrating that HBOT was not an effective treatment for the participants in this study. This study represents the first relatively large-scale controlled study evaluating the effects of HBOT at the level of the individual participant, on a wide array of behaviors.

One problem with HBOT studies in the past is the attempt to use a placebo like therapy. It seems to this observer at least that it would be quite easy to distinguish placebo vs. real HBOT. The current study avoids that. They took data during a baseline period, during the HBOT therapy weeks and a post-HBOT period. They found that there was no benefit.

These findings diverge considerably from those of Rossignol et al. (2009). The current study controls for the potential ‘‘washing out’’ of the effect when group data are averaged (as must be done in a between-groups design) by carefully measuring potential changes in 11 topographies of behavior over time across 16 individuals. If there was a subgroup for which HBOT was effective, it seems likely that at least one such child would have participated in the current study. The lack of an effect for any participant in the current study makes the existence of such a subgroup seem implausible.

The paper concludes:

News programs and community blogs report that many families of children with autism are using HBOT therapy. The cost of such treatment may range up to $150 per hour. Families report using anywhere from 40 to 120 h of HBOT. These hours are in lieu of other therapies such as applied behavior analysis, speech therapy, and occupational therapy and do not include travel time to the medical center where the therapy is provided. Some families purchase the chambers in order to provide therapy in their home. A number of websites focus on renting ($1,395 per month) and selling ($8,495–27,995) chambers to families. Given the financial and time-investment required for HBOT and the conflicting study outcomes to date, we cannot recommend HBOT as a treatment for autism until such time as more conclusive favorable results are demonstrated.

This is consistent with a previous study which included one of the above authors, Randomized trial of hyperbaric oxygen therapy for children with autism, which concluded:

This study found HBOT to have no significant beneficial effect on ASD symptoms. The experimental design of the current study is of a higher rigor than those employed in previous studies which have suggested that HBOT is effective. Further, the dependent measures included were far more comprehensive than those included in previous studies; therefore it is unlikely that an effect was present which was not detected. Based upon the findings of the current study, HBOT delivered at 24% oxygen at 1.3 atmospheric is not recommended for the treatment of ASD symptoms.

Do’C over at the AutismStreet blog has followed the HBOT research pretty closely. Here is his list of articles skeptical about HBOT.

My own view:
HBOT is expensive, time consuming, not effective for treating autism and will continue to be promoted heavily to parents looking for a way to help their children. There is something profoundly wrong with the world of CAM and autism if they don’t move away from therapies like HBOT.

Preliminary program for IMFAR

20 Apr

IMFAR, the International Meeting For Autism Research will be held next month (May 12-14). The full scientific program is not up yet (with all the details about who is talking and when), but the preliminary program is online. You can see what sessions are focusing on and see who the keynote speakers are.

Here are some sessions which caught my eye:

Characterizing Cognition in Nonverbal Individuals with Autism: Innocation Assessment and Treatment (an invited symposium–i.e. the conference felt this was an important topic and specifically invited speakers to present their research)

Sex Differences and Females with Autism Spectrum Disorders

Interventions: Behavioral CAM and Psychopharmacology Treatments

In addition, a number of sessions have full or partial focus on adults:

Adults with Autism Spectrum Disorders: Challenges for Epidemiological and Outcome Research (another invited symposium)

Epidemiology: ASD Prevalence, Trends, and Adults with ASD

a poster session on Adults with Autism

Structural and Functional Brain Imaging in Older Children, Adolescents and Adults with ASD

If you missed it, let me draw your attention: there is a session that includes CAM–Complementary and Alternative Medicine

93% of US parents trust vaccinations

19 Apr

“Celebrities have no expertise in childhood immunizations or infectious disease,” Freed said. “There is a danger in the media of putting up celebrities as experts on any topic for which they have an opinion, and giving them a platform to share their opinions that is presented as equal to true experts.”

In the first survey, published in the May issue of Pediatrics, researchers used data from a 2009 nationally representative sample of about 1,550 parents of children aged 17 and younger.

About 76 percent of parents said they trusted their child’s doctor “a lot,” 22 percent said they had “some” trust, while only 2 percent said they didn’t trust the doctor.

Parents also trusted other health-care providers and government vaccine experts, but not as much as doctors.

Two percent of parents said they trusted celebrities “a lot,” 24 percent said they trusted celebrities somewhat for vaccine information, and 74 percent said they trusted celebrities “not at all.” Women and Hispanics were more likely to trust celebrities.

A second survey by researchers from the U.S. Centers for Disease Control and Prevention published in the same journal used 2009 survey data from parents of children under the age of 6.

Nearly 75 percent of parents reported their youngest child had received all of the recommended vaccines; another 19 percent said their child would receive the vaccines.

About 79 percent of parents were either confident or very confident in vaccine safety, and about 80 percent said they thought vaccines were important for a child’s health.

But parents still have their concerns. About 22 percent somewhat or strongly agreed that they were concerned about “too many vaccines potentially damaging a child’s immune system,” according to the study.

When asked how many shots parents were comfortable with their child receiving in a single doctor’s visit, 42 percent said one to two; 34 percent said three to four; and 23 percent said “whatever the doctor recommends.”

The authors suggest that pediatricians listen to parents’ concerns and direct them to appropriate resources for information.

“It’s encouraging that in this survey the overwhelming majority said they will get all of their immunizations. That’s a wonderful thing,” said Dr. David Kimberlin, a professor of pediatrics at University of Alabama at Birmingham and a member of the American Academy of Pediatrics Committee on Infectious Diseases. “The noise out there that seems to question vaccine safety is increasingly being discounted and being discounted in a very public way.”

Source.

A Systematic Review of Secretin for Children With Autism Spectrum Disorders

15 Apr

The journal Pediatrics has a series of articles out recently on autism therapies. All are review articles: discussions of previous papers rather than new research. One topic that was covered was secretin. I don’t hear much about secretin now, but it was a big event in the 1990’s. Last I checked (which was some time ago) many alternative medical practitioners in the Defeat Autism Now group still were prescribing it. The Autism Research Institute’s webpage still has a prominent link to “The Use of Secretin in Autism: Some Preliminary Answers “, an article from 1998.

A number of studies have been performed on the use of secretin, including randomized control trials (RCT). There is enough data that the authors of this review were able to make a rather definitive statment: not only is there no evidence of having an imact.

CONTEXT: As many as 1 in every 110 children in the United States has an autism spectrum disorder (ASD). Secretin is 1 of many medical treatments studied for treating the symptoms of ASDs, but there is currently no consensus regarding which interventions are most effective.
OBJECTIVE: To systematically review evidence regarding the use of secretin in children with ASDs who are aged 12 years and younger. METHODS: We searched the Medline, PsycINFO, and ERIC (Education Resources Information Center) databases from 2000 to May 2010 and reference lists of included articles. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of-evidence ratings on the basis of predetermined criteria.
RESULTS: Evidence from 7 randomized controlled trials supports a lack of effectiveness of secretin for the treatment of ASD symptoms including language and communication impairment, symptom severity, and cognitive and social skill deficits. No studies have resulted in significantly greater improvements in measures of language, cognition, or autistic symptoms when compared with placebo; study authors who reported improvement over time did so equally for both the intervention and placebo groups.
CONCLUSIONS: Secretin has been studied extensively in multiple randomized controlled trials, and there is clear evidence that it lacks benefit. The studies of secretin included in this review uniformly point to a lack of significant impact of secretin in the treatment of ASD symptoms. Given the high strength of evidence for a lack of effectiveness, secretin as a treatment approach for ASDs warrants no further study.

Here is the conclusion of the paper:

Previous studies have demonstrated that secretin is not effective for improving language, cognition, behavior, communication, autism symptom severity, or socialization skills. The strength of evidence for this lack of effectiveness is high. With 7 randomized controlled trials with fair- to good quality scores and 1 case series that contributes to this evidence base, future studies are unlikely to change the estimate of effect for this treatment. Further studies of secretin in children with ASDs are not warranted.

This is pretty strong: “Further studies of secretin in children with ASDs are not warranted”

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