Saturday, 25 June 2016

HBOT and autism systematically reviewed

"Current evidence indicates that HBOT [Hyperbaric Oxygen Therapy] is not an effective treatment for children and youth with autism."

That was the conclusion reached by Cynthia Goldfarb and colleagues [1] following their "systematic review of the literature evaluating the clinical impact of HBOT on behavior and development in ASD [autism spectrum disorder]." Drawing on guidance from the American Academy of Neurology and their "Classification of Recommendations", authors looked at the collected peer-reviewed literature "focusing on clinical outcomes of HBOT in ASD." They determined that the research literature as it currently stands (a review based on 5 articles) does not support HBOT as an intervention option for children and young people diagnosed with an ASD.

I appreciate that for some people this will be slightly disappointing news. As per the multitude of other interventions put forward to improve quality of life or ameliorate the more disabling aspects of autism, there are nearly always reports of 'positive changes' [2] and such over-arching reviews say little about how individuals might be impacted by such intervention. Indeed, in a post a few years back on the topic of HBOT and autism (see here) I was cautiously optimistic about this approach; not least because alongside descriptions of positive changes, side-effects seemed to be few and far between when it came to HBOT ('first, do no harm' and all that).

Without trying to second-guess the findings from Goldfarb et al and without coming across as being a supporter of HBOT, I do think it's worthwhile reiterating a few points. The recent review was only based on data from 5 studies. Most of those studies were quite small scale (in terms of participant numbers) and carried out under slightly different conditions in terms of pressures used. The authors rightly make use of the term 'current evidence' as balancing their findings in these respects. Indeed, quite a few of the research 'issues' potentially involved in the study of HBOT have been covered in the review by Dan Rossignol and colleagues [3]. Among other things they suggested that the frequency of HBOT sessions might be an important factor and also: "certain subgroups of children with ASD [respond] differently to HBOT." Autisms people, autisms; and bearing in mind that inflammation seems to be a key target when it comes to the use of HBOT in this context (well, C-reactive protein (CRP) anyway).

The message however, based on the currently available evidence, is that HBOT is probably not blanket indicated for all autism...

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[1] Goldfarb C. et al. Hyperbaric oxygen therapy for the treatment of children and youth with Autism Spectrum Disorders: An evidence-based systematic review. Research in Autism Spectrum Disorders. 2016; 29-30: 1-7.

[2] Rossignol DA. et al. The effects of hyperbaric oxygen therapy on oxidative stress, inflammation, and symptoms in children with autism: an open-label pilot study. BMC Pediatr. 2007 Nov 16;7:36.

[3] Rossignol DA. et al. Hyperbaric oxygen treatment in autism spectrum disorders. Medical Gas Research. 2012;2:16. doi:10.1186/2045-9912-2-16.

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ResearchBlogging.org Goldfarb, C., Genore, L., Hunt, C., Flanagan, J., Handley-Derry, M., Jethwa, A., Jones-Stokreef, N., Kirkpatrick, S., Richards, A., Rojnica, L., Schwartz, C., Shawn, D., Superina-Bell, D., Young, E., & Anagnostou, E. (2016). Hyperbaric oxygen therapy for the treatment of children and youth with Autism Spectrum Disorders: An evidence-based systematic review Research in Autism Spectrum Disorders, 29-30, 1-7 DOI: 10.1016/j.rasd.2016.05.004

Friday, 24 June 2016

Is autism underdiagnosed in prisoners? Probably not...


The UK media today is awash with the result of 'that referendum'.

Life however goes on here at Questioning Answers and today the recent opinion piece by Sarah Ashworth [1] talking about autism being 'underdiagnosed' in the prison population provides the starting material for today's post.

Being careful not to generalise nor also 'excusing' the often important reasons why people end up in prison, I'm particularly interested in this area of discussion given what is increasingly being recognised with regards to the levels of attention-deficit hyperactivity disorder (ADHD) in the prison population (see here). So it was that I wanted to talk about the peer-reviewed literature with autism in mind too.

OK, let's start from the beginning and how the currently available data has generally concluded that "people with ASD [autism spectrum disorder] do not seem to be disproportionately over-represented in the CJS [Criminal Justice System]." [2] Indeed, when I've previously covered this topic (see here), on the occasions that people on the autism spectrum have had contact with the CJS, most times this was as a result of spontaneous crimes over pre-meditated ones [3] and detainment sentences were diverted in all cases (at least in the Cheely cohort). What this tells us is that, no, not every prisoner has autism (or ADHD) - not even close - and that a diagnosis of autism can sometimes be seen in legal terms as a mitigating factor [4]; a point recently noted in a "very sad case with a sad background narrative."

But, and it is an important point, the focus on the Ashworth opinion piece on autism being underdiagnosed in the prison population refers to the fact that formal diagnosis before entering the CJS may not be the whole story. Indeed, I will draw your attention to the paper by Louise Robinson and colleagues [5] who started from the point of: "concerns that individuals with autism spectrum disorders (ASDs) are over-represented but not recognised in prison populations" in their attempt to looking at possible screening of prisoners for autism. The results? Well, let's just say that their 'screening tool for ASDs' in prisoners needed more work but on the basis of their findings "rather than routinely screen for ASDs in prison, staff should be encouraged to raise concerns about individuals struggling to cope in prison." Make of that what you will, although prison and probation staff can sometimes be surprisingly good at picking up those in potential need of further referral.

Moving on, or rather going back to the idea that a diagnosis of ADHD might be over-represented among the prison population, are those findings from Ylva Ginsberg and colleagues [6]. They observed that among the longer-term inmates where ADHD was identified (~40%), an ASD might also be comorbid in about a quarter of these cases. This is perhaps not an entirely unexpected finding given what is known about autism and ADHD comorbidity (see here) and *could* be interpreted in the context of autism underdiagnosis in prisoners just reflecting that ADHD is also underdiagnosed. Without moving 'blame' from label to label, there is quite a strong emerging research base suggesting that a heightened risk of going to prison as one possible [7] long-term adverse outcome following a diagnosis of ADHD is worthy of a lot more investigation particularly when it comes to trying to mitigate any enhanced risk (see here).

What can we conclude about the question of 'autism underdiagnosis in prisoners'? On the basis of the research base so far, yes, it can happen, because not every case of autism is 'picked up' during infancy and individual reports of such undiagnosed persons coming into contact with the CJS are still apparent. But I'm not so sure about the extent to which underdiagnosis of autism in prisoners occurs [8] and indeed, whether we would necessarily expect large numbers of  prisoners to present on the autism spectrum. I say this on the basis that people on the autism spectrum are far more likely to be the victims rather than perpetrators of crime and although some facets of autism might show some possible connections to certain types of unwanted behaviour (see here), generally speaking, one would expect more law abiding citizens on the autism spectrum than less.

Oh, and before you pull the old 'empathy' card in relation to offending behaviour on this one, we also need to get away from the view that a universal lack of empathy is somehow characterstic of all autism...

The photo included with this post by the way, will contain some familiar faces to most people here in Blighty particular with the EU referendum in mind. For those who might not know, one chap is a comedian and the other a politician... both have, on occasion, had audiences in stitches...

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[1] Ashworth S. Autism is underdiagnosed in prisoners. BMJ. 2016 Jun 2;353:i3028.

[2] King C. & Murphy GH. A Systematic Review of People with Autism Spectrum Disorder and the Criminal Justice System. J Autism Dev Disord. 2014; 44: 2717-2733.

[3] Cheely CA. et al. The prevalence of youth with autism spectrum disorders in the criminal justice system. J Autism Dev Disord. 2012 Sep;42(9):1856-62.

[4] Berryessa CM. Brief Report: Judicial Attitudes Regarding the Sentencing of Offenders with High Functioning Autism. J Autism Dev Disord. 2016 Apr 22.

[5] Robinson L. et al. Evaluation of a Screening Instrument for Autism Spectrum Disorders in Prisoners. PLoS ONE. 2012;7(5):e36078.

[6] Ginsberg Y. et al. Attention Deficit Hyperactivity Disorder (ADHD) among longer-term prison inmates is a prevalent, persistent and disabling disorder. BMC Psychiatry. 2010;10:112.

[7] Smith E. et al. Preschool hyperactivity specifically elevates long-term mental health risks more strongly in males than females: a prospective longitudinal study through to young adulthood. Eur Child Adolesc Psychiatry. 2016 Jun 13.

[8] Underwood L. et al. Autism spectrum disorder traits among prisoners. Advances in Autism. 2016; 2:

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ResearchBlogging.org Ashworth S (2016). Autism is underdiagnosed in prisoners. BMJ (Clinical research ed.), 353 PMID: 27255544

Thursday, 23 June 2016

ADHD symptoms improved with allergic rhinitis treatment

The findings reported by Ming-Tao Yang and colleagues [1] make for some brief blogging fodder today and the idea that: "Higher ADHD [attention-deficit hyperactivity disorder] scores in children with AR [allergic rhinitis] compared with healthy controls decreased significantly with AR treatment." Said AR treatment consisted of "nonpharmacologic intervention, oral antihistamines, and topical steroids."

I know furrowed brows and eye-rolling might be the response of some people to this work but consider however the [peer-reviewed] data already published on how the presentation of allergy or atopic disease might go well beyond just somatic presentation (see here for example). Given also that Yang et al are based in Taiwan, it is useful to mention how 'big data' from Taiwan has been instrumental in pushing the relationship between immune function and behavioural outcomes (see here).

This time around researchers looked at a small-ish participant group diagnosed with AR; evaluating both their physical AR symptoms and also symptoms scores according to ADHD criteria. After treatment for their AR, their AR symptoms improved (not unexpectedly) but alongside changes to their ADHD scores were noted too. Indeed: "Significant predictors for the improvement of ADHD scores included age, AR drugs, AR subtypes, and multiple atopic diseases." The authors make quite a forthright assertion from their data: "For children with AR and borderline ADHD symptoms, who do not meet full ADHD diagnostic criteria, we recommend initially treating their AR and monitoring improvement of ADHD symptoms."

Just before anyone assumes that I'm pushing oral antihistamines for ADHD, I'm not. Accepting that there are still some research gaps in how ADHD is managed pharmacologically (see here) I do however think that there could be a further research study or two to do on this topic; not least including a placebo element to it. If you need a template for how this might play out, well, there is some mention in the related autism research literature about allergy symptoms potentially affecting autistic symptoms (see here). The case report included in that previous blog post was from Harumi Jyonouchi [2] and went a little further in terms of how AR was treated, but the idea that behaviour could be impacted by such intervention is there and perhaps further stretches the whole 'immune function is related to behaviour' hypothesis.

And yes, autism and ADHD may share a lot more than perhaps previously recognised (see here).

To close, it's news here in Blighty but I'm not so sure elsewhere, but the question 'should I stay or should I go?' will be resolved one way or another today regarding the UK's membership of the European Union. Depending on your point of view, you'll be happy/sad to know we will still be able to take part in Eurovision and the EUROs no matter what...

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[1] Yang MT. et al. Attention-deficit/hyperactivity disorder-related symptoms improved with allergic rhinitis treatment in children. Am J Rhinol Allergy. 2016 May;30(3):209-14.

[2] Jyonouchi H. Marked improvement of neuropsychiatric symptoms following control of allergy symptoms with the use of humanized murine anti-IgE antibody (omalizumab) in 2 patients with severely limited expressive language. Allergy, Asthma & Clinical Immunology. 2015; 11: 38.

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ResearchBlogging.org Yang MT, Chen CC, Lee WT, Liang JS, Fu WM, & Yang YH (2016). Attention-deficit/hyperactivity disorder-related symptoms improved with allergic rhinitis treatment in children. American journal of rhinology & allergy, 30 (3), 209-14 PMID: 27216352

Wednesday, 22 June 2016

Still 'nothing good comes from exposure to lead'

Consider this short-ish entry a sort of extension of other discussions on this blog on the topic of lead (Pb) (see here). As per the blog title, the systematic review published by Maryam Daneshparvar and colleagues [1] (open-access available here) adds to the quite voluminous peer-reviewed literature indicating that lead exposure, particularly during infancy and childhood, seems to be associated with nothing but adverse outcomes in terms of development and behaviour.

Surveying the research literature "on the role of lead exposure in children with ADHD‏ [attention-deficit hyperactivity disorder‏symptoms" up to May 2014 - including some sources that I've not come across before e.g. IRAN Medex - the authors eventually boiled down the current research landscape to 18 articles "selected and entered into the data synthesis." It appears that some important guidance was followed when it came to study selection and interpretation and, all in all, some 12,000 participants were included in the selected research literature included for analysis.

Results: well as perhaps expected, nothing good seems to come from lead exposure. The authors reported that even at quite small concentrations in blood (blood lead levels, BLLs below 10µg/dL), lead is potentially linked to the presentation of ADHD in one form or another. In 16 of the 18 studies included in their analysis: "a significant association was found between ‎BLL and one of the types of ADHD.‎"

What's more to say on this topic? Well, as the authors note, the vast majority of the studies analysed included only one measure of BLL so one perhaps has to be a little cautious about the 'snapshot' nature of the data included. They also make some comment on how the symptoms of ADHD were a focus over and above a 'diagnosis' so that could also be considered a methodological weakness.

That all being said, and knowing what we know about 'lead being a strong poison' I'm yet again convinced that keeping kids in particular away from sources of possible lead contamination is of vital importance. I say that not just from the point of view of risk of ADHD-type behaviours or any other label (see here), but simply because nothing good comes from exposure to the stuff. When also we talk about lead exposure, we might also be inclined to note that ambient levels of the stuff might also show some interesting correlations too [2] (yes, correlation is not the same as causation).

Finally, in amongst all the doom and gloom about lead exposure and developing brains, there may also be a ray of hope...

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[1] Daneshparvar M. et al. The Role of Lead Exposure on Attention-Deficit/ Hyperactivity Disorder ‎in Children: A Systematic Review. Iran J Psychiatry. 2016 Jan;11(1):1-14.

[2] Dickerson AS. et al. Autism spectrum disorder prevalence and associations with air concentrations of lead, mercury, and arsenic. Environ Monit Assess. 2016 Jul;188(7):407.

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ResearchBlogging.org Daneshparvar M, Mostafavi SA, Zare Jeddi M, Yunesian M, Mesdaghinia A, Mahvi AH, & Akhondzadeh S (2016). The Role of Lead Exposure on Attention-Deficit/ Hyperactivity Disorder ‎in Children: A Systematic Review. Iranian journal of psychiatry, 11 (1), 1-14 PMID: 27252763

Tuesday, 21 June 2016

'Self-treatment' with helminths and autism?

At the end of 2013 there was some media interest in the presentation of interim data at the 2013 Annual Meeting of the American College of Neuropsychopharmacology from a couple of studies being run by Prof. Eric Hollander.
It's life Jim but not as we know it... @ CDC

The abstracts for the studies 'Trichuris Suis Ova (TSO) as an Immune-inflammatory Treatment for Repetitive Behaviors in ASD' and 'Hyperthermia and the Improvement of ASD Symptoms' can be found here (look under abstracts T177 and T231).

Whilst the media headlines citing 'worms and hot baths' as potential intervention approaches for autism generated quite a nice soundbite and are probably enough for most people to click on the story to read more, I personally did not think they did justice to how potentially important these areas might be to at least some cases of autism. Indeed hot baths as a way of mimicking fever took me back to the article by Curran and colleagues [1] who "documented behavior change among children with autism spectrum disorders during fever."

Sweeping generalisations about hot baths, fever and autism aside, today I'm discussing the paper by Liu and colleagues [2] who, following a review of "the practices and experiences of individuals 'self-treating' with helminths through the eyes of their physicians" reported that over half of those 'self-treating' had a diagnosis of autism. Helminths by the way, are parasitic worms, and whilst some are rather unpleasant in terms of their detrimental effects to health, others have been used in a more therapeutic capacity. Insofar as the idea of 'self-treatment', well, let's just say that this may not be unusual...

Liu et al describe how: "Five physicians monitoring more than 700 self-treating patients were interviewed" and how: "These observations point toward potential starting points for clinical trials, and provide further support for the importance of such trials and for concerted efforts aimed at probing the potential of helminths, and perhaps other biologicals, for therapeutic use." Although one has to be slightly cautious about this type of 'clinical experiences' methodology ('the plural of anecdote is not data' and all that) adopted in the study, it was interesting to note that: "Physicians reported that the majority of patients with autism and inflammation-associated co-morbidities responded favourably to therapy with either of the two most popular organisms currently used by self-treaters, Hymenolepis diminuta and Trichuris suis." We are also importantly told that about 1% of paediatric patients using H. diminuta "experienced severe gastrointestinal pains" suggesting that any future studies should also be observant for side-effects.

I am still in two minds about this area of study and the 'palatability' of the proposed intervention. I note the full trial by Hollander and colleagues looking at the use of Trichuris Suis Ova in the context of autism has kinda fallen off the radar a little bit judging by the status of the trial entry in ClinicalTrials.gov at the time of writing. Aside from that proposed trial and some other speculations about the use of helminthic therapy potentially applied to autism [3] there is little else in the peer-reviewed research literature on this topic in terms of effects or some further details about any proposed mode of action. With my speculating hat on, one could perhaps see the logic around helminthic therapy with regards to the suggested augmentation of an abnormal immune response thought to involve the Th1/Th2 response (see here [4] for more details about this). With autism in mind, certainly there has been some research chatter about this immunological balancing act being potential important for some [5].

I'm sure also that some readers who've encountered this post are either (a) thinking WTF (apologies for my bad language) or (b) potentially thinking about how unethical this study and intervention sounds. Worms after all, are not generally regarded as a great therapy for anything, particularly when people are talking about eradication of such parasites rather than supplementing with them (see here). I'm certainly not going to stand up and suggest helminthic therapy is the be-all-and-end-all for autism intervention by any means even in the context of inflammatory process being potentially involved in many behaviourally-defined conditions [6]

The thing is though, that our prejudice against all parasites is similar to our prejudice against all bacteria. Not all parasitic worms are the same, just as not all bacteria are the same (he says drinking from his probiotic yoghurt). Indeed, helminthic therapy has found a place in medicine, particularly when it comes to various conditions with an immune system element to them as exemplified by papers such as this one [7]. The review article by Wammes and colleagues [8] kinda summarises the mixed feelings that science has about such intervention and how "a paradox exists between efforts to deworm populations with helminth-associated morbidities, and initiatives to test helminthic therapy on patients with hyperinflammatory diseases". If I remember correctly, I think Dr Michael Mosley also had something to say about swallowing parasites...

Added also to the words of caution about proposed side-effects from helminthic therapy, I will draw your attention to the paper by Bager and colleagues [9] who reported that "gastrointestinal reactions" were quite significantly elevated during the early days of quite a long administration period (every 21 days for 168 days) of pig whipworm in their particular trial and cohort. With all that science now knows about gastrointestinal (GI) issues in relation to autism, one probably doesn't want to compound any existing problems in that particular area of comorbidity.

Palatability aside, there is however more science to do in this area including looking further at potential mechanisms [10] and specifically, how swallowing worm eggs might one day be replaced by swallowing pills with a similar mode of biological action...

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[1] Curran LK. et al. Behaviors associated with fever in children with autism spectrum disorders. Pediatrics. 2007 Dec;120(6):e1386-92.

[2] Liu J. et al. Practices and outcomes of self-treatment with helminths based on physicians' observations. J Helminthol. 2016 May 31:1-11.

[3] Siniscalco D. & Antonucci N. Possible use of Trichuris suis ova in autism spectrum disorders therapy. Med Hypotheses. 2013 Jul;81(1):1-4.

[4] Kidd P. Th1/Th2 balance: the hypothesis, its limitations, and implications for health and disease. Altern Med Rev. 2003 Aug;8(3):223-46.

[5] Gupta S. et al. Th1- and Th2-like cytokines in CD4+ and CD8+ T cells in autism. J Neuroimmunol. 1998 May 1;85(1):106-9.

[6] Friedrich MJ. Research on Psychiatric Disorders Targets Inflammation. JAMA. 2014. July 23.

[7] Elliott DE. & Weinstock JV. Helminthic therapy: using worms to treat immune-mediated disease. Adv Exp Med Biol. 2009;666:157-66.

[8] Wammes LJ. et al. Helminth therapy or elimination: epidemiological, immunological, and clinical considerations. Lancet Infect Dis. 2014 Jun 26. pii: S1473-3099(14)70771-6.

[9] Bager P. et al. Symptoms after ingestion of pig whipworm Trichuris suis eggs in a randomized placebo-controlled double-blind clinical trial. PLoS One. 2011;6(8):e22346.

[10] Chhabra S. et al. Kv1.3 channel-blocking immunomodulatory peptides from parasitic worms: implications for autoimmune diseases. FASEB J. 2014 Jun 2. pii: fj.14-251967

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ResearchBlogging.org Liu J, Morey RA, Wilson JK, & Parker W (2016). Practices and outcomes of self-treatment with helminths based on physicians' observations. Journal of helminthology, 1-11 PMID: 27240605

Monday, 20 June 2016

Lactobacillus reuteri rescuing [mouse] social behaviours: relevance to autism?

Continuing a recent 'probiotic theme' on this blog I've decided to talk a little about the study results reported by Shelly Buffington and colleagues [1] on how a "single species of gut bacteria can reverse autism-related social behavior in mice." I say 'talk about' but my conversations on this topic should be viewed in light of what others have also said about this study (see here for example) including the lead author (see here).

To summarise the findings: authors started from the idea that maternal obesity during pregnancy might have some implications for offspring in terms of their risk of "neurodevelopmental disorders including autism spectrum disorder (ASD)." It's something that has been covered before on this blog (see here) including the idea that inflammation or response to inflammation in-utero might be an important part of any risk mechanism (see here).

Conversations then progressed towards the possibility that the gut microbiome might play a role in that elevated risk of offspring autism following pregnancy obesity. To test this theory out, researchers fed female mice a high fat or 'normal diet' for 8 weeks, paired them for mating and gave all their offspring a regular diet. They studied social behaviour of offspring mice and observed that "MHFD [maternal high-fat diet] offspring had impaired sociability and showed no preference for social novelty."

To examine whether those mouse social behaviours were linked to the gut microbiome, researchers looked at the "bacterial composition and community structure in the feces" of offspring mice to ascertain any differences. They did find differences; indeed in one write-up of the study the authors note: "We found a clear difference in the microbiota of the two maternal diet groups." Could such bacterial differences account for the social differences noted between the groups? Quite possibly as Buffington et al reported that "co-housing one MRD [maternal regular diet] with three MHFD offspring was sufficient to rescue both the social behaviors and microbiota phylogenetic profile of MHFD offspring." Further, researchers transplanted the faecal microbiota from the MRD and MHFD offspring into germ-free mice providing "causal evidence that an imbalanced microbial ecology in the mice born to mothers on a high-fat diet is responsible for their social deficits."

Then came a big question: what was it about the maternal high-fat diet offspring microbiome that might be 'responsible' for the social issues observed? The answer or at least one answer: "L. reuteri [Lactobacillus reuteri] was the most drastically reduced (>9-fold) in the MHFD microbiota population, compared to the MRD microbiota." Subsequent addition of L. reuteri to the drinking water of MHFD offspring was instigated and: "Remarkably, treatment with L. reuteri significantly improved sociability and preference for social novelty in MHFD offspring."

As if all that wasn't enough researchers also looked at the old gut-brain axis and subsequently noted that: "L. reuteri treatment restores oxytocin levels, VTA [ventral tegmental area] plasticity and social behaviors." Oxytocin has something of an interesting possible connection to [some] autism (see here).

And rest.

As you can perhaps appreciate, this piece of research is fairly comprehensive both in terms of the methodologies used and also the findings in relation to maternal pregnancy obesity, offspring social behaviour, gut microbiome and the gut-brain axis. Certainly quite compelling evidence for some kind of effect including the concept of foetal programming allied to the idea of possible intervention.

Of course you'd be right to question whether the processes described in this mouse model would necessarily map on to the human experience and indeed the very heterogeneous autism spectrum characterised by [variable] issues with social affect for example. Similar questioning is asked of all animal studies trying to model the complexities of autism (see here). But added to other research where mouse modelling of autism 'deficits' has been to some degree 'changed' as the result of the addition of a particular bacterial species (see here) there is some reason for potential excitement. More so when one considers other research on the gut microbiome in relation to specific preparations potentially modifying the risk of 'neurospychiatric disorder' (see here) for example, and potentially affecting mood and/or behaviour (see here). Don't even get me started on toddler temperament being linked to the inner workings of the gut (see here) minus any hype.

But just before sales of Lactobacillus reuteri increase markedly there is further research to be done. Not least is the translation of elements of the Buffington research into studies of humans. Set within the idea that mapping exactly what kinds of wee beasties are residing in the gut is now fairly commonplace and has already stretched into autism research (see here) I would have thought that looking for the presence or absence of L. reuteri in certain groups (and sub-groups) on the autism spectrum and beyond should be fairly easy to do. If and when issues are found with this particular species, supplementing could be indicated bearing in mind some of the potential effects [2] noted already on this bacterium might already show indication in some cases of autism (see here). One might also see a way to look at this and other bacteria in conjunction with levels of oxytocin and possibly other important compounds too as part of that gut-brain axis. Given also that the Buffington study was a study of offspring of obese mice in terms of their sociability, does this also mean that kids born to overweight or obese mums are less likely to have age-appropriate social skills outside of any talk of autism?

There is still a research journey to be travelled in this area of investigation and, I might add, potentially linking various areas together including the idea that not all fats in a high-fat diet are necessarily the one and the same (see here)...

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[1] Buffington SA. et al. Microbial Reconstitution Reverses Maternal Diet Induced Social and Synaptic Deficits in Offspring. Cell.2016; 165: 1762-1775.

[2] Coccolrullo P. et al. Lactobacillus reuteri (DSM 17938) in Infants with Functional Chronic Constipation: A Double-Blind, Randomized, Placebo-Controlled Study. J Peds. 2010; 157: 598-602.

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ResearchBlogging.org Buffington, S., Di Prisco, G., Auchtung, T., Ajami, N., Petrosino, J., & Costa-Mattioli, M. (2016). Microbial Reconstitution Reverses Maternal Diet-Induced Social and Synaptic Deficits in Offspring Cell, 165 (7), 1762-1775 DOI: 10.1016/j.cell.2016.06.001

Sunday, 19 June 2016

Estimated autism prevalence in Northern Ireland: 2.3% for 2015-2016

I'm blogging on a Sunday again but for a very good reason: The prevalence of autism (including Asperger’s Syndrome) in school age children in Northern Ireland 2016. The main report is here and includes that quite important graphic accompanying this post.

The press release summarises the important points including the observation that "including Asperger syndrome" the estimated prevalence of autism among school-aged children in Northern Ireland (NI) "has increased by 1.1 percentage points from 1.2% in 2008/09 to 2.3% in 2015/16." Indeed, the estimated autism prevalence rate for boys in 2015-2016 is approaching 4%.

When looking at autism rates across the (school) year groups, we are told that: "Prevalence across all school years was higher during 2015/16 compared with 2008/09." Further: "Looking at Years 1 – 4 (5 – 8 year olds) in 2015/16 there is a steady rise in the prevalence rate of autism. These Year Groups also had the largest percentage increase in the numbers between 2008/09 and 2015/16. This indicates that most identification of autism is occurring when children are aged between 5 and 8 years old."

The question of urban vs. rural rates of autism also showed some interesting trends: "[a] decrease in the
year on year growth of the number of children identified with autism in the rural population
from 13% in 2010/11 to 4% in 2015/16. In comparison the urban autistic population has
increased at an average of 11% each year over the same time period."

What's missing from this data? Well, I'd like to have seen something written about the various comorbidities that seem to be over-represented when a diagnosis of autism is made such as learning disability and the rising star that is attention-deficit hyperactivity disorder (ADHD). The data also says relatively little about how many children are still waiting to be diagnosed in NI as per some media reports on "thousands". I would also suggest that other parts of the UK could learn from NI in terms of data on their [estimated] autism prevalence rates in similar populations.

The bottom line: [estimated] autism prevalence rates are still increasing in many parts of the world for whatever reason. We can argue all day about the factors pertinent to the increase and whether the old 'better awareness' explanation really cuts the mustard these days. The reality however is that more money, support and services need to be pumped into the various educational and health care systems so that potentials can be reached and inequalities are minimised.