Tag Archives: Journal of Child Psychology and Psychiatry.

Journal of American Medical Association study: Folic acid may reduce autism risk

12 Feb

Moi has written several blog posts about autism. In University of Connecticut study: Some children with autism may be ‘cured’ with intense early therapy:

In order for children with autism to reach their full potential there must be early diagnosis and treatment.

Autism Speaks reports about a University of Connecticut study in the post, Study Confirms “Optimal Outcomes”:

Some children diagnosed with autism in early childhood reach “optimal outcomes” with levels of function similar to their typical peers. The findings appear today in the Journal of Child Psychology and Psychiatry.

Although the diagnosis of autism is not usually lost over time, the findings suggest that there is a very wide range of possible outcomes,” says Thomas Insel, M.D., director of the National Institutes of Mental Health (NIMH). “For an individual child, the outcome may be knowable only with time and after some years of intervention.”

This week’s report is the first in a series of autism studies on optimal outcomes, sponsored by the NIMH. They follow up on earlier reports that a small group of children appear to “lose” their autism diagnosis over time. Some experts have questioned the accuracy of these children’s initial diagnoses. Others argued that simply being able to function in a mainstream classroom doesn’t mean that these children don’t quietly struggle with autism-related disabilities. http://www.autismspeaks.org/science/science-news/study-confirms-%E2%80%9Coptimal-outcomes%E2%80%9D

https://drwilda.com/2013/01/19/university-of-connecticut-study-some-children-with-autism-may-be-cured-with-intense-early-therapy/

The Journal of the American Medical Association (JAMA) is reporting in a new study that folic acid use during pregnancy may reduce autism risk.

Steven Reinberg, Health Day Reporter for WebMD reports in Folic Acid in Pregnancy May Lower Autism Risk:

A new study suggests that women who start taking folic acid supplements either before or early in their pregnancy may reduce their child’s risk of developing autism.

“The study does not prove that folic acid supplements can prevent childhood autism. But it does provide an indication that folic acid might be preventive,” said study lead author Dr. Pal Suren, from the division of epidemiology at the Norwegian Institute of Public Health in Oslo.

“The findings also provide a rationale for further investigations of possible causes, as well as investigations of whether folic acid is associated with a reduced risk of other brain disorders in children,” he said.

Taking folic acid supplements during pregnancy is already known to prevent birth defects such as spina bifida, which affects the spine, and anencephaly, which causes part of the brain to be missing.

Alycia Halladay, senior director of environmental and clinical sciences at Autism Speaks, said that “parents always wonder what they can do to reduce the risk [of autism], and this [folic acid] is a very inexpensive item that mothers can do both before pregnancy and very early in their pregnancy.”

As to why folic acid may be beneficial, Halladay speculated that the nutrient might blunt a genetic risk for autism or boost other processes during pregnancy that are protective.

Another expert, Dr. Roberto Tuchman, director of the Autism and Neurodevelopment Program at Miami Children’s Hospital’s Dan Marino Center, said, “This study suggests that in some kids autism spectrum disorders may be preventable. As a clinician who works with autism spectrum disorders it is exciting that we can look at potentially preventable factors in autism. This is really encouraging.”

Still, Tuchman cautioned that the study findings are very preliminary, and it isn’t possible to tell which autism spectrum disorders, if any, folic acid may prevent. http://www.webmd.com/brain/autism/news/20130212/folic-acid-in-pregnancy-may-lower-autism-risk

Citation:

February 13, 2013, Vol 309, No. 6 >

Original Contribution | February 13, 2013

Association Between Maternal Use of Folic Acid Supplements and Risk of Autism Spectrum Disorders in Children FREE

Pål Surén, MD, MPH; Christine Roth, MSc; Michaeline Bresnahan, PhD; Margaretha Haugen, PhD; Mady Hornig, MD; Deborah Hirtz, MD; Kari Kveim Lie, MD; W. Ian Lipkin, MD; Per Magnus, MD, PhD; Ted Reichborn-Kjennerud, MD, PhD; Synnve Schjølberg, MSc; George Davey Smith, MD, DSc; Anne-Siri Øyen, PhD; Ezra Susser, MD, DrPH; Camilla Stoltenberg, MD, PhD

JAMA. 2013;309(6):570-577. doi:10.1001/jama.2012.155925.

Text Size: A A A

Article

Figures

Tables

References

Importance  Prenatal folic acid supplements reduce the risk of neural tube defects in children, but it has not been determined whether they protect against other neurodevelopmental disorders.

Objective  To examine the association between maternal use of prenatal folic acid supplements and subsequent risk of autism spectrum disorders (ASDs) (autistic disorder, Asperger syndrome, pervasive developmental disorder–not otherwise specified [PDD-NOS]) in children.

Design, Setting, and Patients  The study sample of 85 176 children was derived from the population-based, prospective Norwegian Mother and Child Cohort Study (MoBa). The children were born in 2002-2008; by the end of follow-up on March 31, 2012, the age range was 3.3 through 10.2 years (mean, 6.4 years). The exposure of primary interest was use of folic acid from 4 weeks before to 8 weeks after the start of pregnancy, defined as the first day of the last menstrual period before conception. Relative risks of ASDs were estimated by odds ratios (ORs) with 95% CIs in a logistic regression analysis. Analyses were adjusted for maternal education level, year of birth, and parity.

Main Outcome Measure  Specialist-confirmed diagnosis of ASDs.

Results  At the end of follow-up, 270 children in the study sample had been diagnosed with ASDs: 114 with autistic disorder, 56 with Asperger syndrome, and 100 with PDD-NOS. In children whose mothers took folic acid, 0.10% (64/61 042) had autistic disorder, compared with 0.21% (50/24 134) in those unexposed to folic acid. The adjusted OR for autistic disorder in children of folic acid users was 0.61 (95% CI, 0.41-0.90). No association was found with Asperger syndrome or PDD-NOS, but power was limited. Similar analyses for prenatal fish oil supplements showed no such association with autistic disorder, even though fish oil use was associated with the same maternal characteristics as folic acid use.

Conclusions and Relevance  Use of prenatal folic acid supplements around the time of conception was associated with a lower risk of autistic disorder in the MoBa cohort. Although these findings cannot establish causality, they do support prenatal folic acid supplementation. http://jama.jamanetwork.com/article.aspx?articleid=1570279

One of the implications of this study is the necessity that women receive adequate prenatal care and women really should have pre-pregnancy counseling and care.

United Health Foundation reports Prenatal Care (1990 – 2011): Percentage of pregnant women receiving adequate prenatal care, as defined by Kessner Index:

Prenatal care is a critical component of health care for pregnant women and a key step towards having a healthy pregnancy and baby. Early prenatal care is especially important because many important developments take place during the first trimester, screenings can identify babies or mothers at risk for complications and health care providers can educate and prepare mothers for pregnancy.  Women who receive prenatal care have consistently shown better outcomes than those who did not receive prenatal care[1]. Mothers who do not receive any prenatal care are three times more likely to deliver a low birth weight baby than mothers who received prenatal care, and infant mortality is five times higher[2].  Early prenatal care also allows health care providers to identify and address health conditions and behaviors that may reduce the likelihood of a healthy birth, such as smoking and drug and alcohol abuse.                                           http://www.americashealthrankings.org/All/PrenatalCare/2012

Given this recent study it is imperative that ALL women receive prenatal care particularly poor and those women at risk of difficult pregnancies.

Related:

Autism and children of color                                                https://drwilda.com/tag/children-of-color-with-autism/

Archives of Pediatrics and Adolescent Medicine study: Kids with autism more likely to be bullied                                   https://drwilda.com/2012/09/06/archives-of-pediatrics-and-adolescent-medicine-study-kids-with-autism-more-likely-to-be-bullied/

Father’s age may be linked to Autism and Schizophrenia https://drwilda.com/2012/08/26/fathers-age-may-be-linked-to-autism-and-schizophrenia/

Chelation treatment for autism might be harmful  https://drwilda.com/2012/12/02/chelation-treatment-for-autism-might-be-harmful/

Where information leads to Hope. ©                 Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©                             http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©                                                http://drwildareviews.wordpress.com/

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University of Connecticut study: Some children with autism may be ‘cured’ with intense early therapy

19 Jan

In Autism and children of color, moi said:

The number of children with autism appears to be growing. The Centers for Disease Control and Prevention provides statistics on the number of children with autism in the section Data and Statistics:

Prevalence

  • It is estimated that between 1 in 80 and 1 in 240 with an average of 1 in 110 children in the United States have an ASD. [Read article

  • ASDs are reported to occur in all racial, ethnic, and socioeconomic groups, yet are on average 4 to 5 times more likely to occur in boys than in girls.  However, we need more information on some less studied populations and regions around the world. [Read article]

  • Studies in Asia, Europe, and North America have identified individuals with an ASD with an approximate prevalence of 0.6% to over 1%. A recent study in South Korea reported a prevalence of 2.6%. [Data table Adobe PDF file]

  • Approximately 13% of children have a developmental disability, ranging from mild disabilities such as speech and language impairments to serious developmental disabilities, such as intellectual disabilities, cerebral palsy, and autism.  [Read articleExternal Web Site Icon]

Learn more about prevalence of ASDs »

Learn more about the ADDM Project »

Learn more about the MADDSP Project »

On this Page

http://www.cdc.gov/ncbddd/autism/data.html

In order for children with autism to reach their full potential there must be early diagnosis and treatment. https://drwilda.com/2012/03/27/autism-and-children-of-color/

Autism Speaks reports about a University of Connecticut study in the post, Study Confirms “Optimal Outcomes”:

Some children diagnosed with autism in early childhood reach “optimal outcomes” with levels of function similar to their typical peers. The findings appear today in the Journal of Child Psychology and Psychiatry.

“Although the diagnosis of autism is not usually lost over time, the findings suggest that there is a very wide range of possible outcomes,” says Thomas Insel, M.D., director of the National Institutes of Mental Health (NIMH). “For an individual child, the outcome may be knowable only with time and after some years of intervention.”

This week’s report is the first in a series of autism studies on optimal outcomes, sponsored by the NIMH. They follow up on earlier reports that a small group of children appear to “lose” their autism diagnosis over time. Some experts have questioned the accuracy of these children’s initial diagnoses. Others argued that simply being able to function in a mainstream classroom doesn’t mean that these children don’t quietly struggle with autism-related disabilities. http://www.autismspeaks.org/science/science-news/study-confirms-%E2%80%9Coptimal-outcomes%E2%80%9D

Here is the University of Connecticut press release:

Researchers Find Possibility of Change in Children Previously Diagnosed with Autism

January 17, 2013

UConn psychology professor Deborah Fein is the lead author of an article just published in the Journal of Child Psychology and Psychiatry which indicates that some children who are accurately diagnosed with autism in early childhood may lose the symptoms as they grow older.

The article, “Optimal Outcome in Individuals with a History of Autism,” appears in the February 2013 issue of the publication. Co-authors include Professor Marianne Barton, director of clinical training and director of the Psychological Services Clinic in UConn’s Department of Psychology.

Autism Spectrum Disorder and autism are both general terms for a group of complex disorders of brain development. These disorders are characterized, in varying degrees, by difficulties in social interaction and verbal and nonverbal communication, and repetitive behaviors. Statistics from the U.S. Centers for Disease Control and Prevention identify around 1 in 88 American children as being on the autism spectrum.

Fein, UConn Board of Trustees Distinguished Professor of Psychology, has been a leader in autism research since she first worked with children with the disability in the early 1970s. She says the findings in the current study are important, but like much research, raise other questions that are as yet unanswered.

We want to find out what percentage of children are capable of a favorable outcome, what type of behavioral intervention is necessary, what is it in a child’s brain that allows change to take place,” she says. “One thing we do know is that in virtually every case of a child who loses the symptoms of this disorder, the outcome is due to years of unwavering dedication and hard work by parents, teachers, and the children themselves.”

Study methodology

The study, supported by the National Institutes of Health, consisted of carefully documenting a prior diagnosis of autism in a small group of school-age children and young adults with no current symptoms of the disorder who were functioning on a par with their mainstream peers. These 34 children were considered the Optimal Outcome group. This group was then compared with two other cohorts consisting of 44 children with high-functioning autism and 34 children with typical development.

This report is the first in a series that will probe more deeply into the nature of the change in the status of the Optimal Outcome children. Having at one time been diagnosed with Autism Spectrum Disorder, these young people now appear equal to typically developing peers. The study team is continuing to analyze data on changes in brain function in these children, and attempting to determine whether they have subtle residual social deficits.

Also under review is the type of interventions these children received, and to what extent that intervention is predictive of a successful transition.

Although the diagnosis of autism is not usually lost over time, the findings suggest that there is a very wide range of possible outcomes,” says Dr. Thomas R. Insel, director of the National Institute of Mental Health. “For an individual child, the outcome may be knowable only with time and after some years of intervention. Subsequent reports from this study should tell us more about the nature of autism, and the role of therapy and other factors in the long-term outcomes for these children.”

Prior studies have examined the possibility of a loss of diagnosis, but questions remained regarding the accuracy of the initial diagnosis and whether children who ultimately appeared similar to their mainstream peers initially had a relatively mild form of autism.

In Fein’s study, early diagnostic reports by clinicians with expertise in autism diagnosis were reviewed by the investigators. As a second step to ensure accuracy, a diagnostic expert without knowledge of the child’s current status reviewed reports in which the earlier diagnosis had been deleted.

The results suggested that children in the Optimal Outcome group had milder social deficits than the high functioning autism group in early childhood, but had other symptoms, related to communication and repetitive behavior, that were as severe as the latter group.

In addition, to be included in the Optimal Outcome group, children had to be in regular education classrooms with no special education services aimed at autism, and not show any signs of problems with language, face recognition, communication, and social interaction.

Ongoing research

While the current study cannot provide information on what percentage of children diagnosed with Autism Spectrum Disorder might eventually lose the symptoms, investigators have collected a variety of information on the children, including structural and functional brain imaging data, psychiatric outcomes, and information on the therapies the children received.

Analysis of that data, which will be reported in subsequent papers, may shed light on questions such as whether the changes in diagnosis resulted from a normalizing of brain function, or if these children’s brains were able to compensate for autism-related difficulties.

According to Fein, “All children with Autism Spectrum Disorder are capable of making progress with intensive therapy, but with our current state of knowledge, most do not achieve the kind of optimal outcome that we are studying. Our hope is that further research will help us better understand the mechanisms of change so that each child can have the best possible life.”

Citation:

Optimal outcome in individuals with a history of autism

  1. Deborah Fein1,6,
  2. Marianne Barton1,
  3. Inge-Marie Eigsti1,
  4. Elizabeth Kelley2,
  5. Letitia Naigles1,
  6. Robert T. Schultz3,
  7. Michael Stevens4,
  8. Molly Helt1,
  9. Alyssa Orinstein1,
  10. Michael Rosenthal5,
  11. Eva Troyb1,
  12. Katherine Tyson1

Article first published online: 16 JAN 2013

DOI: 10.1111/jcpp.12037

© 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.

Journal of Child Psychology and Psychiatry

Volume 54, Issue 2, pages 195–205, February 2013

http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12037/full

The National Institute of Neurological Disorders and Stroke has an autism fact sheet

A diagnosis of autism can be heartbreaking for families and many cling to any shred of hope that there might be a treatment or a cure. Families have to be careful about the treatments and therapies they seek for their children.

Related:

Father’s age may be linked to Autism and Schizophrenia https://drwilda.com/2012/08/26/fathers-age-may-be-linked-to-autism-and-schizophrenia/

Autism and children of color                                                https://drwilda.com/tag/autism-not-diagnosed-as-early-in-minority-children/

Archives of Pediatrics and Adolescent Medicine study: Kids with autism more likely to be bullied                                   https://drwilda.com/2012/09/06/archives-of-pediatrics-and-adolescent-medicine-study-kids-with-autism-more-likely-to-be-bullied/

Chelation treatment for autism might be harmful               https://drwilda.com/2012/12/02/chelation-treatment-for-autism-might-be-harmful/

Where information leads to Hope. ©                 Dr. Wilda.com

Dr. Wilda says this about that ©

Blogs by Dr. Wilda:

COMMENTS FROM AN OLD FART©                           http://drwildaoldfart.wordpress.com/

Dr. Wilda Reviews ©                                                 http://drwildareviews.wordpress.com/

Dr. Wilda ©                                                                                       https://drwilda.com/