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Monday, July 23, 2018

“Covert” Neurofeedback Tunes-up the Social Brain in ASD

From NIMH
The National Institute of Mental Health

July 17, 2018

Playing game boosts brain circuit connectivity – and maybe sociability.

Young people with autism spectrum disorder (ASD) thought they were just playing a picture puzzle game while undergoing functional magnetic resonance imaging (fMRI) scanning. In fact, the game was rigged – by their own brain activity.


The more participants spontaneously activated social brain circuitry known to be under-connected in ASD, the more pieces of a puzzle filled-in to reveal the picture. Since the game was controlled by circuit activity, the participants were unknowingly tuning-up their own brains.

Resting state scans following the sessions revealed increased communications between two key networks of the social brain that typically don’t talk with each other enough in ASD. What’s more, participants’ parents noted improvements in their children’s social behavior linked to this boost in circuit connectivity.

“Rather than specifying explicit tasks, the game provided positive reinforcement for spontaneously achieved desired states of circuit activity,” explained Alex Martin, Ph.D., chief of NIMH’s Section on Cognitive Neuropsychology.

“Such implicit training resulted in significant long-term connectivity increases in the suspect circuits that were correlated with improvements in behavior. This proof-of-principle suggests that covert neurofeedback may have potential as an intervention in ASD – and perhaps in other disorders of circuit under-connectivity.”

However promising, the researchers note that results of this small exploratory study would have to be confirmed in larger samples, and the approach would need to be adapted to a more accessible and cost-effective form of neuroimaging before it might become a practical treatment alternative.

The NIMH researchers and others had earlier linked such resting state under-connectivity in social brain circuits with symptom severity and a worsening course of symptoms in ASD. So the researchers wondered whether training to boost such connectivity might improve social behavior.

Conducting fMRI scans while the brain is at rest predict how well brain networks communicate with each other when performing behaviors. In this case, the networks in question are normally activated during social behaviors.

However, training on explicit social behavior tasks only serves to re-activate dysfunctional circuit patterns underlying the social deficits seen in the disorder.

Enter post-doctoral fellow Michal Ramot, Ph.D.

She devised a training scheme based on open-ended, implicit, non-social tasks. The researchers told participants in the scanner – 17 young adult males with ASD and 10 without ASD – to do whatever might fill-in pieces of a picture puzzle on a computer screen. Participants were promised monetary rewards and bonuses for completing the puzzles.

Unbeknownst to the participants, a computer running the game was programmed to fill-in pieces of the picture whenever the scanner detected increased chatter between the two social brain networks that are under-communicative in ASD. The more participants spontaneously activated the targeted social brain circuitry, the more pieces of the picture appeared.

“Showing faces or other social stimuli would only activate networks wired in a sub-optimal way, so we found a way to bypass this,” explained Ramot. “We show pictures that are completely unrelated to social behavior that we thought participants would like, while still being relatively abstract – such as mechanical things or board games. Participants never really reach the ‘true’ strategy, because there is no explicit strategy for getting these networks to co-activate. That’s why the scanner is useful. When we do neurofeedback, we go directly to the networks.”

Resting state scans taken immediately following each of the four training sessions revealed increased functional connectivity between the two targeted brain regions in most participants with ASD.

Participants without ASD did not show a significant change in functional connectivity between the targeted networks. Parents of participants with ASD noted improvements in their children’s social behavior that correlated with the increased connectivity.

While falling short of an overall statistically significant change in sociability, the researchers demonstrated that change in the behaviorally-relevant networks correlated with a change in behavior.

These findings led the researchers to become interested in understanding how long the observed changes in connectivity would last. To find out, they had participants come back between 5 and 56 weeks following the main training session for a single shorter training session.

Brain scans taken at this session indicated that that the changes in circuit connectivity seen following the main training were mostly preserved even over the longest time period.

In the future, instead of fMRI, which is expensive, clinicians might be able to use more readily-available and cost-effective EEG technology to develop a more practical application of covert neurofeedback, said Martin. But more research is needed.

“Researchers would first have to determine what EEG signals reflect the same activation of the social brain circuit networks corresponding to the fMRI signals,” he added.

Reference

Update on ‘Brady’s Room’: Orleans Parish School District and Charter School Working on Arrangements for High-Needs Student

From The Lens

By Marta Jewson
July 18, 2018


A month before Brady, a 14-year-old with Down syndrome and autism, is supposed to start school, his mother doesn’t know what sort of classroom he’ll be in or who his teacher will be.

But she knows more than she did a month ago, when it wasn’t clear whether his new charter school would accommodate her request that Brady work with a teacher one-on-one, away from students that can make him anxious.

New Orleans met Brady a few weeks ago. He bounced from school to school until his mother found a special room, built specially for another student with a budgeted $130,000, at the old McDonogh 35 building in Treme.


Brady LeFleur plays an educational game in a special-needs classroom
at the old McDonogh 35 Senior High School facility.

Brady is now too old for his current school, and the school district plans to gut the old McDonogh 35 building. So earlier this year his mom was on the hunt for a high school, like many other families navigating charter schools in New Orleans — except that Brady needs a lot more help than most students.

The day The Lens published its story, LaFleur got a call from staffers at Morris Jeff Community School and the Orleans Parish school district. They told her Brady will be enrolled at Morris Jeff as a ninth-grader, but he’ll attend class at the new McDonogh 35 facility.

“He’ll be using a room at McDonogh 35 as a Morris Jeff student,” LaFleur said. “I haven’t seen where they’re going to put him yet. I just know they are using the school.”

It’s a bit of a puzzling arrangement, she said, because she wanted him to attend McDonogh 35 all along. But she is happy he’ll be able to use special education space there.

Brady was assigned to Morris Jeff through the city’s centralized enrollment lottery. LaFleur contacted the school as soon as he was assigned there so she could make sure they could accommodate her son’s needs.

When our story ran in late June, they still hadn’t ironed out Brady’s arrangements.

Related (Part I)

Federal law requires that school districts educate all students who walk through their doors, regardless of their special education needs. The district — in New Orleans, sometimes a charter school is its own district — is required to provide a free and appropriate education to each student and ensure the student has the support he needs to progress in the curriculum.

The details of how that will be done are laid out in an individualized education plan, or an IEP. It’s a contract between the student’s family and the school.

They can be complicated documents, Brady’s for example, includes a behavior plan that dictates how often he needs attention and how to watch him when he’s near other students.

In traditional school districts, the central office is responsible for placing special education students at schools and ensuring they receive the proper services. Depending on the student’s needs, that could range from having a special education teacher on staff to placing the student on a campus designed for a specific disability.

In New Orleans, nearly all traditional schools have been replaced by independent charter schools after Hurricane Katrina. So those responsibilities are divided between dozens of independent charter organizations. Most charter schools in New Orleans can’t turn any student away. But they don’t have the backing of a centralized bureaucracy.

Starting this spring, when LaFleur learned McDonogh 35 wouldn’t accept ninth graders for the following school year, she began touring high schools. She asked the district for advice on which school to pick.

School district staff suggested Morris Jeff because it’s expanding to a second building, Joseph S. Clark High School. But Brady needs to be on the first floor for safety reasons, and the school is leasing only the upper floors at Clark.

Last week, Morris Jeff Principal Patricia Perkins confirmed the Orleans Parish School Board has arranged space for one of her students at McDonogh 35.

“We are using space there for one of our students that we could not accommodate on the first floor at Clark,” Perkins said. Schools generally can’t discuss individual students due to privacy.

She said she expects to get an agreement in writing from the district soon.

Orleans Parish School Board spokeswoman Dominique Ellis would not confirm the arrangement.

“At this time there has been no decision on whether or not any other school will be in the McDonogh 35 building next year, but one could be forthcoming in the next several weeks,” she wrote in an email.

There are still a lot of things to coordinate, LaFleur said.

She wonders about small things, like where will Brady will eat lunch, whether the food will be brought over from Morris Jeff and if the school’s schedule will align with McDonogh 35.

And she wonders about big things, like what room he’ll be in, who his teacher will be and what day he’ll start.

LaFleur said Morris Jeff school leaders know it’s better for Brady to be closer to the entrance of the school. His anxiety could make it difficult to get him down a long hallway crowded with students. That’s one thing she likes about the new McDonogh 35: Its special education hallway is near the front of the building.

Morris Jeff starts August 6 but McDonogh 35 doesn’t start until August 17. LaFleur doesn’t know which day Brady will begin school.

She said Brady made a lot of progress in the space at the old McDonogh 35 because he had such a great teacher.

He’s had a new teacher every year, but she hopes Brady can keep his current one. That would’ve been easy if Brady had been allowed to enroll at McDonogh 35 as a ninth-grader, she said, because the teacher is employed by the parish.

LaFleur said Brady’s individualized education plan team will meet before the end of July. That should provide more clarity on what his freshman year will look like.

Marta Jewson covers education in New Orleans for The Lens. She began her reporting career covering charter schools for The Lens and helped found the hyper-local news site Mid-City Messenger. Jewson returned to New Orleans in the fall of 2014 after covering education for the St. Cloud Times in Minnesota. She graduated from the University of Wisconsin-Madison with majors in journalism and social welfare and a concentration in educational policy studies.

Sunday, July 22, 2018

Helping At-Risk Students Address Adverse Experiences is Critical

From Education Dive

By Roger Riddell
July 20, 2018


Dive Brief
  • Butler University College of Education Assistant Professor Lori Desautels writes for Edutopia on the need for educators to properly address students' adverse childhood experiences due to the impact they can have on brain development, behavior and a variety of other educational and life outcomes.
  • With students spending around 1,000 years in school annually, faculty and staff members have an opportunity to build positive relationships and offer support to troubled youth, with the quality and quantity of those relationships correlating with their potential impact, she writes.
  • To create resiliency "touch points" — interactions with trusted individuals who offer these supports — Desautels recommends that schools become adversity- and trauma-informed, target interventions to transitional grade years in particular, plan the interactions without scripting them and develop a metric for their effectiveness.

Dive Insight

As Indiana principals Amber Schroering and Chris Renner noted during a session last week at the 2018 National Principals Conference in Chicago, students bring more baggage to school than the supplies they're carrying on their backs.

Their identities, in-school and online relationships, home lives, abuse, what just happened on the bus, hormones, academic standing and a lack of resources are all part of the additional weight they carry.

And, the prevalence of that baggage can vary from district to district. Low-income, inner-city or rural schools and districts will likely see more of it than, say, a more affluent suburban community.

To some extent, schools and districts have already been tried to address these concerns with more social-emotional learning programs, mental health resources and holistic, restorative approaches to discipline.

In many cases, adverse childhood experiences are at the root of disciplinary issues, so addressing them appropriately can change the trajectory of a student's life. But doing so requires administrators to put effective and substantial training opportunities in place so educators know how to help students identify and work through these problems.

At last week's National Association of Elementary School Principals' conference, retired principal and former National AfterSchool Association CEP Paul Young stressed that it's important to involve after-school providers in addressing these challenges as well.

It will never be an easy process, but it's a worthwhile endeavor for every student whose future is positively impacted by the additional attention, understanding and belief in their abilities.

How Disgraced Anti-Vaxxer Andrew Wakefield Was Embraced by Trump's America

From The Guardian (U.S. Edition)

By Sarah Boseley
July 18, 2018

Twenty years after his discredited paper linked autism to the MMR jab, the doctor – who was struck off the medical register in the U.K. – has become a leading light in the U.S. and frighteningly influential worldwide.


Andrew Wakefield and his then-wife Carmel in 2007, flanked by supporters
ahead of an appearance before the GMC. Photo: Daniel Berehulak/Getty

There cannot be many doctors as thoroughly discredited and ostracised as Andrew Wakefield has been in the U.K. who are subsequently seen smiling at the inauguration ball of a U.S. president and later discovered to be dating the Australian model Elle Macpherson.

But there he is. Wa
kefield was all but drummed out of Britain. The gastroenterologist lost his job, had his scientific paper linking the MMR vaccine and autism retracted by medical journal the Lancet and, in 2010, was struck off the medical register. He disappeared to the U.S. and it was assumed he had gone to ground, having lost all credibility.

He was a spent force, even though his name was often in the air as the anti-MMR views he seeded around the world led to many parents shunning the vaccine and outbreaks of measles wherever anyone had heard Wakefield’s creed.

It was known he was in Texas with those who shared his views on vaccines and conspiracy. But he was not a public figure. Until Donald Trump was elected President of the United States.

Under an anti-establishment presidency, the anti-vaccine crusader, whose views appear to have become all the more entrenched by his drubbing at the hands of eminent scientists around the world, is back in the limelight and his new visibility could give his arguments even more currency.

At one of President Trump’s inaugural balls in January last year, he was quoted as contemplating the overthrow of the (pro-vaccine) U.S. medical establishment in words that brought to mind Trump himself. “What we need now is a huge shakeup at the Centers for Disease Control and Prevention (CDC) – a huge shakeup. We need that to change dramatically.”

Andrew Wakefield in May 2010, addressing the American Rally for
Personal Rights in Chicago. Photograph: Charles Rex Arbogast/AP

That same month, vaccine sceptic Robert F. Kennedy, Jr. announced that he would be heading up a new federal panel on vaccine safety convened by Trump. It didn’t happen, but the possibility sent shivers through the medical world.

This week, it became clear that Wakefield has been accepted by celebrity-smitten U.S. society. Separated from Carmel, the wife who was staunchly at his side throughout the U.K. debacle, he is now dating Elle Macpherson, a supermodel with her own nutrition brand. He was photographed this week kissing her on an organic farm in Miami.

In fact, Wakefield never did run and hide. From the very beginning, he had supporters who hailed him as a hero victimised by the medical establishment in the U.K. which, they believed, was in hock to big pharma. The perpetual cry of the anti-vaxxers is that you can’t trust the drug industry – which is only interested in profits and not people – to tell you the truth.

If Wakefield ever had the normal uncertainties of a scientist embarking on research, wondering what their investigations will prove, that must have been pulverised by the avalanche of criticism over the Lancet study. He and those around him now believe there is a massive conspiracy to force vaccines upon our children, driven and funded by the wealthy pharmaceutical companies and those who take their shilling.

Disgraced anti-vaxxeWakefield aims to advance his agenda in Texas election.

It is 20 years since the crucial paper was published by the Lancet, one of the world’s best-respected medical journals, in February, 1998. Even at the press conference to launch the paper, the dean of the Royal Free hospital in London where Wakefield worked was trying to dampen down any speculation about the implications.

The paper featured just eight children – a case series, not a trial. But it purported to find a connection between the measles, mumps and rubella vaccine (MMR), gut problems and autism in children. Little was known about the causes of autism. The paper was dynamite.

Parents recalled that their autistic children had been developing normally until they had the MMR – in fact, it is at about that age that the symptoms often first show themselves, regardless of immunisation.

A still from 2016 film Vaxxed.

Wakefield could have taken the medical establishment’s criticism on the chin, accepted that he might be wrong and continued with a promising career. But he refused to back down. In March, the Medical Research Council, which had been quickly tasked by the government with finding out whether there could possibly be a problem with MMR, said there was no evidence.

Wakefield battled on, offering scientific papers by himself and collaborators to try to prove the thesis. Their arguments were dismissed. In 2001, he left his job at the Royal Free. In 2004, allegations were published in the Sunday Times that Wakefield had been funded by the Legal Aid Board while looking for evidence for parents of autistic children suing vaccine manufacturers for compensation.

In 2010, he was struck off the medical register and forbidden from practising – the ultimate disgrace for a doctor.

By then, he was in New York, reviling the British establishment and insisting he was right. The General Medical Council’s decision was predictable, he told me by phone.

“It seemed to me that they had come to this decision a long time ago, long before the evidence was fairly heard. This is the way the system deals with dissent. You isolate, discredit and provide an example to other doctors and scientists not to get involved in this kind of thing. That is examining questions of vaccine safety,” he said.

There are plenty of vaccine sceptics in the US and, as everywhere, parents of autistic children looking for answers. Wakefield went to Texas, working with autism-related charities and businesses. In 2005, while still a registered medical practitioner, he became director of the Thoughtful House Center for Children, an autism treatment and education centre in Austin (now known as Johnson Center for Child Health and Development), but resigned after losing his licence.

He then founded the Strategic Autism Initiative the same year, and ran it with Polly Tommey, a British mother with an autistic son, who has been a major collaborator and ally. Wakefield also founded the Autism Media Channel in Austin, which makes videos asserting a link between autism and the MMR vaccine.

Its most famous film was Vaxxed, directed by Wakefield, which was put forward to premiere at the 2016 Tribeca film festival by Robert De Niro, the father of an autistic child. It alleges a cover-up of the alleged link between MMR and autism by the CDC – the institute Wakefield said needed a shake-up at the Trump inaugural ball. After the furore that broke out and discussions with scientists, De Niro eventually withdrew the film.

Many worried parents in the US and Europe continue to shun the MMR vaccine, fearful that it could precipitate autism in their child in spite of all the reassurances of the World Health Organization and public health authorities around the world.

An outbreak of measles in Minnesota in the spring of last year was caused by doubts about the MMR vaccine in the local American-Somali community, who had seen the incidence of autism rise. Wakefield had been a visitor to the community six or seven years earlier, talking to them about the risk of autism.

Wakefield at work in Vaxxed.

Worldwide last year, measles cases soared in Europe, according to the WHO. There was a four-fold increase during 2017 with large outbreaks in one in four countries. Festivalgoers were urged to get the jab, after infection rates in England tripled in a year.

“Over 20,000 cases of measles, and 35 lives lost in 2017 alone, are a tragedy we simply cannot accept,” said Dr. Zsuzsanna Jakab, the WHO regional director for Europe, at the time. Romania, Italy and the Ukraine were worst hit.

Loss of confidence in the MMR vaccine, which is very effective, was blamed. There are ambitions to wipe out measles from the planet, but that will not be possible while confidence in the immunisation programmes is undermined.

Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance says vaccination in developed countries has never fully recovered since Wakefield’s initial claims, and that “the anti-vaccination campaigners he continues to spearhead” are “endangering the health of children across the world”.

The internet and social media have spread vaccine doubts and conspiracy theories around the world. Wakefield has said so himself. Social media has provided an alternative to the “failings of mainstream media”, he has said – another phrase that could have come from a tweet by the US president himself.

“In this country, it’s become so polarised now … No one knows quite what to believe,” Wakefield said. “So, people are turning increasingly to social media.”

The scientific establishment has its work cut out. Wakefield and his supporters insist mainstream science is wrong and will not be persuaded otherwise. The conspiracy theories of the anti-vax movement are all over the internet. The apparent acceptance of Wakefield into the upper echelons of American society can only boost them further.

Saturday, July 21, 2018

How to Meet Autistic People Halfway

From The New York Times

By Vikram K. Jaswal and Nameera Akhtar
July 13, 2018

Children in a third grade class that integrates children with autism with
general education students, at Academy of Talented Scholars in Brooklyn.
Credit: Joshua Bright for The New York Times

One of the most widely held beliefs about autistic people — that they are not interested in other people — is almost certainly wrong. Our understanding of autism has changed quite a bit over the past century, but this particular belief has been remarkably persistent.

Seventy-five years ago, the first published account of autism described its subjects as “happiest when left alone” and “impervious to people.”

Even now, a National Institutes of Health fact sheet suggests that autistic people are “indifferent to social engagement,” and the Centers for Disease Control and Prevention claims that some “might not be interested in other people at all.”

There is no question that autistic people can seem as though they are not interested in others. They may not make eye contact or they may repeat lines from movies that don’t seem relevant in the moment. They may flap their hands or rock their bodies in ways that other people find off-putting.

But, just because someone appears socially uninterested does not mean that he or she is.

As we point out in a paper published last month in Behavioral and Brain Sciences, many autistic people say they are very interested in, and in some cases desperate for, social connection. They experience loneliness, say they want friends and even prefer two-player games to one-player games.

As the autistic author Naoki Higashida writes, “I can’t believe that anyone born as a human being really wants to be left all on their own, not really,” adding, “The truth is, we’d love to be with other people.”

So, why do autistic people act in ways that make it appear they want to be left alone?

Autism is a neurological condition that affects how people perceive, think and move. Autistic people say that some of their apparently unsociable behaviors result from these neurological characteristics. Paradoxically, they may behave in these ways when they are trying to engage with other people.

Take eye contact. Some autistic people say they find sustained eye contact uncomfortable or even painful. Others report that it’s hard to concentrate on what someone is saying while simultaneously looking at them. In other words, not looking someone in the eye may indicate that an autistic person is trying very hard to participate in the conversation at hand. Unfortunately, this attempt to engage often gets interpreted as a lack of interest.

Or consider another common autistic behavior: echolalia. People who say the same thing over and over again can appear socially disengaged, but this does not mean that they are. Sometimes autistic people repeat phrases as a way of connecting at a deep level.

For example, one autistic boy repeated, “Chicken Little thought the sky was falling, but the sky is not falling” when his mother was despondent over the death of a friend.

Wrongly assuming that someone is not socially motivated can have devastating consequences. Being sociable is widely considered to be a fundamental part of being human. The presumption that autistic people are not sociable effectively dehumanizes them.

If you assume a person is not interested in interacting with you, then you probably won’t exert much effort to interact in the first place. This can lead to a situation where neither person wants to interact with the other. Or you might insist that he or she interact in the ways you expect socially interested people to interact.

Some popular autism interventions recommend that parents and teachers attempt to train autistic children to make eye contact or to stop repeating themselves or flapping their hands. The problem with this is that the neurological makeup of an autistic person may make it difficult or impossible for him or her to do so.

Insisting that autistic people behave in ways that they are unable to can lead to feelings of learned helplessness, self-defeating thoughts and behaviors and, eventually, social withdrawal.

As an autistic participant in one study explained: “I have been endlessly criticized about how different I looked, criticized about all kinds of tiny differences in my behavior. There’s a point where you say, ‘To hell with it, it’s impossible to please you people.’”

The danger of being assumed to be socially uninterested is especially acute for the roughly one-third of autistic people who do not use spoken language reliably. Like other autistic people, they behave in ways that get misinterpreted, and they may not be able to correct the record.

For all of us, whether we are socially motivated at any given time depends on much more than our innate predisposition for sociability. It also depends on how we’ve been treated in the past; our ability to tune out distracting sights, sounds, smells, thoughts and feelings; and the attitudes and behaviors of potential social partners.

Autistic people have been making the case for decades that they are interested in other people, and that they do not intend their unusual behaviors to indicate otherwise. So when someone does not make eye contact or repeats something you just said, be open to the possibility that it is just his or her way of trying to connect with you.

Improving the social lives of autistic people will require putting aside assumptions about how social interest is expressed and recognizing that it can be shown in unexpected ways.

Vikram K. Jaswal is an associate professor of psychology at the University of Virginia. Nameera Akhtar is a professor of psychology at the University of California, Santa Cruz.

Study Links Frequent Gadget Use to Increased ADHD Symptoms in Teens

From The Verge
via TNW - The New Web

By Bryan Clark
July 18, 2018


It’s no secret that the number of hours teens spend on electronic devices has some impact on their well-being. What scientists disagree on, however, is just how much.

The latest study, published in the Journal of the American Medical Association, has linked Attention Deficit/Hyperactivity Disorder Symptoms to teens who frequently use electronic devices.


Out of 2,586 high school students studied over a two-year period, those who consumed multiple types of digital media were twice as likely to report strong ADHD-like symptoms as their peers.

The more they consumed digital media, the more prevalent the symptoms — impulse control, inability to focus, and lack of patience.

Researchers, however, stopped well short of saying digital media consumption caused the ADHD symptoms, presenting a sort of chicken and egg problem. Are screens the cause of ADHD-like behavior, or is ADHD leading kids to distracting devices, like smartphones?


Students exhibiting significant ADHD symptoms were eliminated from the study in an attempt to answer this question.

And while the answer is still unclear, there does appear to be some evidence pointing to screens compounding the effects of ADHD, or causing similar behaviors in those who weren’t previously believed to be affected by it.

Of the 2,586 15 and 16 year olds, 495 reported infrequently consuming digital media. This group had a 4.6 percent chance in exhibiting ADHD-like symptoms after the two-year test period.


For those that regularly used half of the 14 listed digital media types, the number nearly doubled, to 9.5 percent. Those who used all 14 displayed the highest instances of ADHD-like behavior, at 10.5 percent.

The study itself wasn’t without its limitations. Most notably, it relied on self-reported surveys, which, historically speaking, has never been an entirely accurate way to collect data. Some respondents may keep better track of screen usage than their peers, and others may be embarrassed to admit anything perceived as a mental health issue.

As for the researchers, they didn’t press to find possible causes of the increased symptoms. Theories range from phone notifications limiting kids’ ability to concentrate, to instant stimulation just a few clicks away, both of which lend themselves to always-on gratification.

Friday, July 20, 2018

Study Ties Autism to Maternal High Blood Pressure, Diabetes

From Spectrum News

By Nicholette Zeliadt
July 18, 2018

Children born to women who had diabetes or high blood pressure while pregnant are at an increased risk of autism, two new studies suggest (1,2).

Cuff links: No one knows why high blood pressure during pregnancy
is associated with elevated autism risk.

Autism has previously been linked to type 2 diabetes and to gestational diabetes — a temporary condition in which a woman develops diabetes during the course of her pregnancy.

One of the new studies confirms these risks and extends the link to type 1, or juvenile, diabetes, the most severe form of the condition. Children born to women with this form have about twice the risk of autism as those born to women who do not have any form of diabetes.


The findings appeared 3 July in JAMA.

They suggest that children born to women with diabetes should be monitored closely for autism, says lead investigator Anny Xiang, director of biostatistics research at Kaiser Permanente Southern California in Pasadena.

In the other study, published in June in JAMA Psychiatry, researchers reviewed 61 reports on the link between developmental conditions and types of high blood pressure, including preeclampsia, a pregnancy complication involving high blood pressure.

Overall, the new work suggests that children whose mothers had preeclampsia have a 50 percent higher risk of autism than controls do. Previous studies have not consistently linked autism to preeclampsia, but the new findings solidify the connection.

“There seems to be some pretty solid evidence that hypertensive disorders in pregnancy are associated with autism,” says Diana Schendel, professor of public health and epidemiology at Aarhus University in Denmark, who was not involved in either study.

Still, the increase in risk from either maternal condition is small. For example, the blood pressure study suggests that only about 1.5 percent of children born to women with preeclampsia have autism, compared with about 1 percent of children in the general population.

And neither study provides insights into the mechanisms underlying the links. It is possible that genetics underlies the associations, Schendel says.

Severity Sign

Xiang and her colleagues analyzed the medical records of 419,425 children born in Kaiser Permanente hospitals in southern California from 1995 to 2012. Of those, 621 children were born to women with type 1 diabetes.

Among the 5,827 children later diagnosed with autism, 19 have mothers with type 1 diabetes. The researchers estimate that children born to women with type 1 diabetes have more than double the average risk of autism.

Type 2 diabetes boosts the risk by about 45 percent, and gestational diabetes before the 27th week of pregnancy by 30 percent. (Gestational diabetes later in pregnancy has no effect on autism risk.)

Xiang’s team controlled for potentially confounding variables, including the child’s birth year and sex, as well as maternal age, education, income, race and history of chronic health conditions.

The finding that type 1 diabetes carries a greater risk of autism than other forms suggests that the severity of the condition may influence risk, Xiang says.

The three forms of diabetes have distinct causes, but all of them result in high blood sugar. Xiang says she would like to explore whether blood sugar levels independently track with autism risk.

Pressure Readings

In the other study, researchers analyzed 61 studies linking maternal high blood pressure to autism, attention deficit hyperactivity disorder (ADHD) and other developmental conditions; 20 focused on autism and 10 on ADHD.

They pooled the results from the 11 most rigorous autism studies and found that women with any form of high blood pressure during pregnancy have 35 percent increased odds of having a child with autism. Of the six studies focused on preeclampsia, all but one show an increase in autism risk.

High blood pressure during pregnancy also increases the risk of ADHD by 29 percent.

“I was excited to see the meta-analysis and see that they have autism and ADHD in here together,” says Renee Gardner, assistant professor of public health sciences at the Karolinska Institutet in Stockholm, Sweden, who was not involved in either study. The two conditions often occur together and share some risk factors.

Most studies did not control for maternal obesity — which commonly accompanies high blood pressure and diabetes — Gardner says. Maternal obesity is linked to autism, but may simply be a marker of genetic risk.

What’s more, many of the blood pressure studies used in the analysis fail to account for key confounds, such as family history of psychiatric conditions, says lead investigator Ali Khashan, senior lecturer in epidemiology and public health at the University College Cork in Ireland.

Khashan and his colleagues are analyzing data on high blood pressure during pregnancy from a large group of women; they plan to control for a family history of psychiatric diagnoses, among other variables.

References
  1. Xiang A.H. et al. JAMA 320, 89-91 (2018) PubMed
  2. Maher G.M. et al. JAMA Psychiatry Epub ahead of print (2018) PubMed