Tag: family

“Could My Child Have Autism?”

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Ten Signs of Possible Autism-Related Delays in 6- to 12-Month-Old Children

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Though autism is often not diagnosed until the age of three, some children begin to show signs of developmental delay before they turn a year old. While not all infants and toddlers with delays will develop autism spectrum disorders (ASD), experts point to early detection of these signs as key to capitalizing on early diagnosis and intervention, which is believed to improve developmental outcomes.

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According to Dr. Rebecca Landa, director of the Center for Autism and Related Disorders at the Kennedy Krieger Institute in Baltimore, Md., parents need to be empowered to identify the warning signs of ASD and other communication delays. “We want to encourage parents to become good observers of their children’s development so that they can see the earliest indicators of delays in a baby’s communication, social and motor skills,” says Dr. Landa, who also cautions that some children who develop ASD don’t show signs until after the second birthday or regress after appearing to develop typically.

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For the past decade, Dr. Landa has followed infant siblings of children with autism to identify red flags of the disorder in their earliest form. Her research has shown that diagnosis is possible in some children as young as 14 months and sparked the development of early intervention models that have been shown to improve outcomes for toddlers showing signs of ASD as young as one and two years old. Dr. Landa recommends that as parents play with their infant (6 – 12 months), they look for the following signs that have been linked to later diagnosis of ASD or other communication disorders: 1. Rarely smiles when approached by caregivers2. Rarely tries to imitate sounds and movements others make, such as smiling and laughing, during simple social exchanges3. Delayed or infrequent babbling4. Does not respond to his or her name with increasing consistency from 6 – 12 months 5. Does not gesture to communicate by 10 months6. Poor eye contact7. Seeks your attention infrequently8. Repeatedly stiffens arms, hands, legs or displays unusual body movements such as rotating the hands on the wrists, uncommon postures or other repetitive behaviors9. Does not reach up toward you when you reach to pick him or her up10. Delays in motor development, including delayed rolling over, pushing up and crawling

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“If parents suspect something is wrong with their child’s development, or that their child is losing skills, they should talk to their pediatrician or another developmental expert,” says Dr. Landa. “Don’t adopt a ‘wait and see’ perspective. We want to identify delays early in development so that intervention can begin when children’s brains are more malleable and still developing their circuitry.”

About the Kennedy Krieger Institute Internationally recognized for improving the lives of children and adolescents with disorders and injuries of the brain and spinal cord, the Kennedy Krieger Institute in Baltimore, MD serves more than 16,000 individuals each year through inpatient and outpatient clinics, home and community services and school-based programs. Kennedy Krieger provides a wide range of services for children with developmental concerns mild to severe, and is home to a team of investigators who are contributing to the understanding of how disorders develop while pioneering new interventions and earlier diagnosis. For more information on Kennedy Krieger Institute, visit: www.kennedykrieger.org.

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Abnormal Eye Movements

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Relatives of Individuals With Autism Tend to Display Abnormal Eye Movements

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Abnormal eye movements and other sensorimotor and neurobehavioral impairments appear common in unaffected family members of individuals with autism, according to a report in the August issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

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“Autism is a highly heritable neurodevelopmental disorder with considerable genetic and phenotypic heterogeneity,” the authors write as background information in the article. “Its core behavioral features include social and communication impairments, behavioral inflexibility and executive dysfunction.” Several sensorimotor features have also been shown to be abnormal in some patients with autism. Common impairments include deficits in saccades, or rapid eye movements that shift between objects in the field of vision, and smooth-pursuit eye movements, in which the gaze is stabilized on a slowly moving object.

Matthew W. Mosconi, Ph.D., and colleagues at the University of Illinois at Chicago conducted eye movement testing and other assessments of neurobehavioral function in 57 first-degree relatives of individuals with autism. Their results were compared with those of 40 individuals who were the same age, sex and had the same IQ but did not have a family member with the condition.

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When compared with controls, family members of individuals with autism tended to perform more slowly and less accurately on eye movement tasks, including those assessing saccades and smooth-pursuit eye movements. “The present findings document that first-degree relatives of individuals with autism demonstrate a unique pattern of oculomotor impairments similar to that previously reported in independent samples of individuals with autism, suggesting that these alterations within sensorimotor and cognitive brain circuitry may be familial traits,” the authors write.

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“Family members also demonstrated executive dysfunction on neuropsychological tests, communication abnormalities and increased rates of obsessive and compulsive behaviors, but these were independent from one another and from oculomotor impairments,” they continue.

The abnormalities were associated with several brain pathways—including the cerebellar, frontotemporal, striatal and prefrontal circuits—that have been linked to autism, some of which are important for language skills, motor control and executive function, or the control and regulation of behavior. The results suggest that these potentially familial deficits could be “useful for studies of neurophysiological and genetic mechanisms in autism,” the authors conclude. “Further work is needed by way of replication of our findings, quantitative evaluation of the familiality of these traits in family trios and efforts to demonstrate association of oculomotor and other phenotypes with genetic mechanisms.”(Arch Gen Psychiatry. 2010;67[8]:830-840. Available pre-embargo to the media at http://www.jamamedia.org.)

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Editor’s Note: This study was supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Program of Excellence in Autism, a grant from the National Institute of Mental Health Autism Center of Excellence, the National Alliance for Autism Research and an Autism Speaks fellowship. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Protecting kids from risky drinking

Alcoholism: Clinical & Experimental Research

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Many parents permit their adolescent children to drink alcohol, believing this helps teach them responsible use and avoids the appeal of ‘forbidden fruit’. In research studies, greater parental permissibility for alcohol has been linked to earlier and heavier drinking in adolescence. However, it is not clear whether parents allowing adolescents to drink is itself to blame, or if this kind of permissibility is simply a marker for other factors (relating to the family, parents or child) that increase the risk of problem alcohol use among adolescents. For example, parents’ own heavy drinking, family sociodemographics, and adolescents’ friends’ use of alcohol can all affect the likelihood of alcohol misuse among adolescents, and each of these risk factors might also be underlying causes of parents allowing drinking. In a new report published in the journal Alcoholism: Clinical & Experimental Research, researchers from Pennsylvania State University have used intergenerational data from a contemporary UK study to examine whether parents allowing adolescents to drink is itself associated with risky drinking in adolescence, beyond other such risk factors.

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The Millennium Cohort Study (MCS) has collected data from over eleven thousand parents and children from infancy through to 14 years, using regular interviews. Children were asked questions about their alcohol use when they were aged 11 and 14 years; the data showed that by age 14, half had drunk more than a few sips of alcohol, around 10% had drunk heavily, and 3% had drunk heavily at least 3 times in the past year. Seven percent had made a rapid transition to heavy drinking, defined as escalating to having at least five drinks at a time, within a year of having their first drink.  

Parents of 14-year olds were asked if they permitted their child to use alcohol, with about 16% of parents indicating that they did allow this. Using a series of statistical analyses, the researchers found that these teenagers faced an elevated risk of heavy alcohol use at age 14, even after accounting for a large host of other risk factors measured earlier when children were age 11. Specifically, children who were permitted to drink alcohol had over twice the odds of engaging in heavy or frequent heavy drinking by age 14, and almost double the risk of a rapid transition to heavy drinking, than those whose parents did not permit alcohol use.

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These findings do not support the idea that allowing children to drink alcohol inoculates them against alcohol misuse, and will help to target prevention and screening efforts to reduce underage drinking. However, the researchers note that because adolescent heavy drinking and parental permissiveness about alcohol were measured at the same point in the survey (at around age 14), the findings represent an association rather than cause and effect; further research will be needed to establish whether parental permissiveness leads to adolescent heavy drinking, or whether adolescent drinking over time leads parents to become more permissive.

Parents Allowing Drinking is Associated with Adolescents’ Heavy Alcohol Use. J. Staff, J. Maggs (pages xxx).

ACER-19-4039.R1

First Large-Scale Study of Universal Screening for Autism Raises Critical Questions about Accuracy, Equity

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Researchers urge continued screening for all toddlers, while recommending changes to M-CHAT screening method to improve accuracy, address disparities

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Newswise — Philadelphia, September 27, 2019 –

In the first large, real-world study of universal screening for autism spectrum disorder (ASD) in toddlers, researchers at Children’s Hospital of Philadelphia (CHOP) have found that the most widely used and researched screening tool is less accurate than shown in previous studies conducted in research laboratory settings. The new study also revealed significant disparities in detecting early autism symptoms in minority, urban and low-income children. The findings were published online today in the journal Pediatrics.

The American Academy of Pediatrics (AAP) recommends screening all toddlers for ASD at their 18- and 24-month primary care check-ups using the Modified Checklist for Autism in Toddlers with Follow-Up (M-CHAT/F), a two-stage parent survey to determine whether a child may have autism, with the follow-up designed to eliminate false positives. However, most studies to evaluate the accuracy of the M-CHAT/F have been conducted in research settings rather than in real-world clinical settings. Therefore, very little was known about screening in the recommended primary care setting, nor about longer-term outcomes for children who screened negative on the M-CHAT/F. The CHOP study is the first to look at outcomes of truly universal screening in a real-world primary care setting.

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“As part of a large pediatric network implementing universal screening, we found ourselves in a unique position to find answers to critical questions about the accuracy of the M-CHAT, and to determine how many children are missed by early, universal screening,” said lead author Whitney Guthrie, PhD, a clinical psychologist specializing in early diagnosis at CHOP’s Center for Autism Research. “Early intervention has been shown to improve outcomes, potentially into adulthood. We know that early and accurate screening and diagnosis is the crucial first step in helping children access those effective, autism-specific therapies.”

The CHOP research team studied the electronic health records (EHR) of 25,999 patients screened in primary care using the M-CHAT/F between the ages of 16 and 26 months, and systematically followed these children until 4 through 8 years of age using the EHR. Ninety-one percent of these children were screened using the M-CHAT/F, meaning that nearly universal screening of all children in primary care was achieved.

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The study showed that the M-CHAT/F detected only about 40% of children who went on to be diagnosed with ASD. However, children who screened positive were diagnosed seven months earlier than those who screened negative, suggesting that early screening may facilitate early intervention. Overall, 2.2% of children in the study were ultimately diagnosed with ASD, which is consistent with the Centers for Disease Control and Prevention (CDC) estimates nationally.

“Although our findings reveal significant shortcomings in current screening tools, we want to be clear that we are not recommending that pediatricians stop universal screening,” said Guthrie. “Instead, clinicians should continue to screen using the M-CHAT/F, while being aware that this screening tool does miss some children with ASD. Any clinical or parental concerns should be taken seriously, and warrant continued surveillance even if a child screens negative on the M-CHAT/F. And of course, a screen positive on the M-CHAT/F warrants referral so that children with ASD can be diagnosed and receive early intervention.

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“Pediatricians should also be aware of disparities in screening practices and results in children of color and from low-income backgrounds.”

The CHOP study found that the 9% of children who did not receive screening at 18 or 24 months were disproportionately from racial minority groups; from non-English speaking households; and from households with lower median income and who receive Medicaid. When screening was administered, these same children were more likely to receive a false positive result. The M-CHAT was also less accurate in girls than in boys.

“Persistent racial and economic disparities in autism screening and diagnosis are a cause for great concern, and are consistent with previous research showing that black and Hispanic children tend to be diagnosed years later than white children,” said co-author Kate Wallis, MD, MPH, a developmental pediatrician and researcher at CHOP’s PolicyLab who is also studying disparities in referrals for autism services. “This study revealed important limitations and provides us with new knowledge that we can use to make critical improvements to autism screening tools and screening processes, so pediatricians can properly detect and support more children with autism and reduce disparities in diagnosis and care.”

Guthrie et al, “Accuracy of Autism Screening in a Large Pediatric Network.” Pediatrics, online 27 September 2019. DOI: 10.1542/peds.2019-0925.

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About Children’s Hospital of Philadelphia: Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and pioneering major research initiatives, Children’s Hospital has fostered many discoveries that have benefited children worldwide.  Its pediatric research program is among the largest in the country.  In addition, its unique family-centered care and public service programs have brought the 564-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu