One of the articles comes from the DSM-V neurodevelopment disorders workgroup:
One focus of discussion:
1) Possible modification of ADHD criteria to allow for co-morbidity of autism and ADHD (currently excluded). The ADHD & Disruptive Behavior Disorders Work Group has agreed to consider this possibility.Some questions they are addressing in the realm of the proposed Autism Spectrum Disorder (ASD):
1) How to describe the “spectrum” of disorders now known as ASD (e.g., how many domains will define the disorder);There is a great opposition to this new spectrum among many psychiatrists, in part because Asperger's Syndrome gets lumped in there (see item 5), which is not accurate in terms of brain chemistry and function. Asperger's is not the same as "high-functioning autism" according to the psychiatrists I have talked with about this issue.
2) What is the specificity of repetitive behaviors in ASD and how might they be better defined;
3) Whether Childhood Disintegrative Disorder (CDD) is a unique and separate disorder, and if so, what are its defining characteristics;
4) Whether autism is a life-long diagnosis or whether it is possible to recover/remit to the point where the diagnosis is no longer applicable;
5) Whether Asperger’s disorder is the same as “high-functioning autism”;
6) How the DSM-V can alert clinicians to common medical comorbidities (including genetic disorders, epilepsy/EEG abnormalities and sleep, or GI problems) and potential biomarkers;
7) How to include consideration of severity and impairment in diagnosis (currently defined as “qualitative impairments”) and how to integrate these with the overall structure of DSM-V; and
8) How/where to discuss cultural influences on diagnosis (e.g., Korean use of reactive attachment disorder rather than ASD to avoid family stigmatization).
Interestingly, despite the fall in vaccine rates as a result of Dr. Wakefield's "study," the autism rate continues to rise. This is also despite the fact that vaccine makers in 2001 largely eliminated thimerosal from routinely administered childhood vaccines (thimerosal was blamed for autism, and still is by some) - the study below is from 2002 to 2006 - a huge increase in 4 years.
Rising Autism Rates Still Pose a Mystery
Mike Mitka JAMA. 2010;303(7):602.
A new study suggests that the prevalence of autism spectrum disorders (ASDs) has surged in recent years, but questions remain as to whether the rise reflects an actual increase in the number of individuals with the condition, changing definitions of diagnosis or awareness, or a combination of such factors.
The study, released in December by the US Centers for Disease Control and Prevention (CDC), found that 1 8-year-old in 110 was classified in 2006 as having an ASD vs 1 in 153 estimated in 2002 (http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5810a1.htm). The study was a systematic retrospective review of evaluation records from 11 sites participating in the Autism and Developmental Disabilities Monitoring Network. It compared results with those from its 2002 analysis, which involved 10 of the same sites; for these sites, prevalence increased 57% from 2002 to 2006 (http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5601a2.htm). The researchers selected 8 years of age as a reasonable index age for monitoring peak prevalence.
Alarmingly, the number is 1 in 70 for boys but only 1 in 315 for girls who are identified with an ASD. Certainly a part of this increase is in greater concern of parents who then take their kids in to doctors, who then may give a diagnosis just to cover their asses.
On the other hand, I think there is a HUGE nutritional and environmental element that is still largely overlooked. This review article looks at nutritional strategies (among all the others) and finds them lacking. Other studies (here, here, here - this last one suggests a severe deficiency of omega-3 fats in autistic children) have found omega-3 fats to show immense promise in treating autism. The gluten-free diet, which is quite popular, has had mixed results (good - bad).
Finally, there is more evidence that the "trust hormone," oxytocin, may be a viable treatment for autism.
'Trust Hormone' May Improve Autism
A dose of the "trust hormone" oxytocin may help bring some autistic people out of their shell. Patients with the condition usually have a hard time interacting with others, but when they inhaled oxytocin in a new study, they began looking at people in the eye and recognizing social concepts like fairness in a computer game. Although the results are preliminary, the work could lead to drugs to treat a variety of social disorders, including schizophrenia and anxiety, says expert Evdokia Anagnostou, a child neurologist at the Bloorview Research Institute in Toronto, Canada.
Oxytocin appears to function as a sort of "social glue" for many mammals. Mice and monkeys release the hormone when they groom and mate, for example, and humans given a dose of oxytocin are more likely to offer a total stranger money, even if they don't get anything in return. Autistic people have less oxytocin circulating in their blood than those without the disorder, so neuroscientist Angela Sirigu of the Centre de Neuroscience Cognitive in Lyon, France, wondered whether ramping up the hormone would make them more socially adept.
Sirigu's team asked 13 adults with Asperger's Syndrome--a form of high-functioning autism--to play a computer game of toss. On the "field" were four boxes, indicating three players and the participant. To throw the ball to another player, the participant touched a given box. The computerized players were sometimes friendly, meaning they threw the ball to other players, and sometimes bullies, meaning that they kept the ball to themselves. The volunteers received either a placebo or a nasal spray of oxytocin on one day and then swapped formulations a week later. That way, the researchers could observe how the same individual performed with and without the hormone boost.
The oxytocin made a difference. Without the hormone boost, volunteers tended to play equally with the good guy and the bully, indicating their difficulty in grasping important social concepts like fairness and empathy. With the hormone, they tended to avoid playing with the bully.
In a second experiment, the researchers asked the volunteers to look at a series of faces on a computer monitor. Like many with autism, the subjects tended to fixate on the chin and mouth and rapidly shifted their gaze, indicating agitation. But when given oxytocin, they began looking at the person's eyes, a sign of social ease, the team reports online this week in the Proceedings of the National Academy of Sciences.
Anagnostou agrees that autism patients who take oxytocin and then play the game appear to be learning how to interact with people. "There is, in fact, some form of social learning that is happening," she says. But because this study only looked at the effect of oxytocin after a single dose, she adds, it's not clear if hormone boosters will continue working for the long term.
In terms of therapeutic applications, Sirigu says that studies have shown that addressing autism early can sometimes help curb the condition. So administering a hormone like oxytocin during childhood may be a powerful weapon in fighting autism, she says.
Anagnostou and her colleagues are currently administering oxytocin to Asperger's patients every day for 6 weeks. But even if her study yields similar results, she says, it will still take years for researchers and doctors to figure out potential side effects and proper dosage levels for the hormone.
No comments:
Post a Comment