The international journal Autism is launching a new podcast series, “Autism Matters.” Hosted by University of London psychologist Laura Crane, PhD, the series aims to showcase the latest research published in the journal in accessible language with an emphasis on real world relevance. The intended audience is a broad one–from academics and journalists to individuals with autism and their families.
Last month, a group of California researchers reported an increased risk of autism among babies whose mothers took a certain catergory of antidepressant medications–selective serotonin reuptake inhibitors (SSRIs)—during the first trimester of pregnancy. You may know these drugs by such brand names as Prozac, Effexor, Paxil, and Celexa.
So what do these results mean for pregnant women? First, caution is needed before rushing to judgment. The study was relatively small, and the increase in the risk of autism was modest. So more study is clearly needed to confirm the link and clarify how great a risk, if any, is associated with a mother using this type of antidepressant during pregnancy.
Further caution is needed because the effects of a mother’s anxiety and depression during pregnancy and early infancy are well known. In fact, it’s not clear whether the autism risk associated with taking antidepressants during pregnancy is, in fact, related to the women’s depression rather than the drugs themselves.
For these reason, many doctors have argued that the benefits of SSRIs outweigh concerns about risks that SSRI exposure may pose to a fetus or infant during pregnancy and nursing. Clearly, more research is needed.
Beyond SSRIs, researchers have looked at several other medications to see if their use during pregnancy increases the risk that a baby will go on to develop autism. Among the most thoroughly researched is the anti-seizure medication valproic acid (U.S. brand name Depakote). Studies show that, as a group, children whose mothers take valproic acid during their first trimester of pregnancy are more likely to develop an autism spectrum disorder (ASD) than are children who are not exposed.
Autism Speaks has supported research into how valproic acid might contribute to the development of ASDs. Through the study of donated brain tissue, for example, we have learned that individuals with autism share some “neuropathologies,” or altered brain features, with those who were exposed to valproic acid before birth. In addition, several studies show that exposure to valproic acid during critical periods of brain development can produce autism-like behaviors in animal models.
So the good news is that our research has deepened understanding about how valproic acid during pregnancy can contribute to the development of ASDs. The bad news is that it can be quite dangerous for women with epilepsy to stop taking this medication during pregnancy—owing to their increased risk of seizures. As a result, such decisions should be made carefully with a physician can discuss alternative drugs.
Findings are still emerging with other medications given during pregnancy. For instance, relatively small studies (such as this one) suggest an increased risk for ASD in babies whose mothers were given the medication terbutaline to stop premature labor. Another small study suggested increased risk of autism related to women taking high doses of the anti-ulcer drug misoprostol early in pregnancy. (This drug is also used to induce labor later in pregnancy.) But in many cases, such preliminary research has yet to move past the “interesting” stage to reach enough certainty to change medical practices.
Other, larger studies hint at an increased risk of autism in the babies of women who take certain broad classes of medications such as antipsychotics or mood stabilizers during pregnancy. Still the question remains: Is the autism risk due to the medications or to the underlying medical conditions that the drugs are being used to treat?
Beyond medications, studies have revealed a number of other pregnancy complications and events that appear to contribute to the risk that a baby will go on to develop autism. These include the pregnant mother’s exposure to toxic chemicals, infections such as flu, and her diet and nutrition at the time of conception as well as during pregnancy.
Autism Speaks continues to fund a number of important studies looking at autism risk factors during pregnancy. If you have at least one child already diagnosed with an ASD, find out more about participating in the EARLI study (link at left) before or at the start of your next pregnancy. Or consider enrolling your child and family in the CHARGE study, which looks at risk factors before, during, and after your child’s birth.
We will be continuing to update you on the science as it emerges. If you have any concerns about the medications you are taking during pregnancy, please discuss them with your doctor. For more resources, we also recommend the Organization of Teratology Information Specialists.
Autism’s recurrence within families is of tremendous interest to both researchers and families, and our “High Risk Baby Siblings Research Consortium” continues to study this and other important questions regarding the risks, causes, prevention, and early treatment of autism.
We support this research consortium in collaboration with the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). In 2003, Alice Kau, of NICHD, and our own VP of Scientific Affairs Andy Shih organized the consortium. I joined with a leadership role in 2005. Since then, the group has grown to include 25 leading autism researchers across 21 medical centers in the United States, Canada, Israel, and the United Kingdom.
They all share the goal of studying the earliest symptoms of autism spectrum disorders (ASDs). They are able to do so because of the generous participation of families with infants and at least one older child on the autism spectrum. These families are so important to research because of the relatively high likelihood that autism will recur among younger siblings.
By following the development of these young children, our consortium researchers are able to do much more than give us more accurate information on recurrence rates. For example, they are making exciting progress in increasing understanding of how and when autism signs and symptoms first appear. This includes insights into the pattern we call “regression,” which involves a loss of skills in an infant or toddler who appeared to be developing normally. As a group, the consortium has published a number of articles to help guide pediatricians and other primary care doctors in how to approach children and families already affected by autism. Their research into early signs and symptoms, for example, has helped clinicians diagnose and provide treatment as early as 12 months of age.
Several of the Baby Sibling Consortium researchers also participate in another important Autism Speaks group, the Toddler Treatment Network. It has a deeper focus on early signs and symptoms, particularly as they relate to developing earlier interventions that may actually prevent the development of some or all autism symptoms.
Families with recurrent autism are crucially needed to help our researchers identify the genes and other influences that increase the risk that children will develop autism. By allowing our researchers to track progress beginning in pregnancy, for example, families provide insights into such risk factors as parental age at conception, and maternal infection and nutrition during pregnancy.
Our researchers are also tracking brain development and identifying so-called biomarkers (such as distinctive brainwave patterns) for earlier and more accurate diagnosis. And, yes, this research can also help us look at whether certain patterns of vaccination make any difference in the risk of autism among children genetically predisposed to the disorder.
Taken together, a better understanding of early signs and symptoms has led to earlier, better accurate diagnoses of ASD along with important knowledge of what causes autism. This research is not possible without the group working together, and without the valuable support of the National Institutes of Health, and most importantly, the families who donate their valuable time to this research.
Interested in learning more—and perhaps participating in the research? Please check out our list of Baby Sibling Research Consortium researchers and contact one in your area.
This summer brought the completion of the first round of Dennis Weatherstone Pre-Doctoral Fellowships, funded by the Stavros Niarchos Foundation in memory of Sir Dennis Weatherstone, the former chair and CEO of J.P. Morgan, to encourage promising young scientists to chose autism research as their career.
In this blog post, Meaghan Parlade, the first Weatherstone grad to complete her fellowship, reflects on her experience and the program’s importance to future autism research.
The life of a pre-doctoral student can be intense and taxing, to say the least. However, the training and experiences I have garnered during the past (dare I say it?) seven years have been invaluable in positioning me to achieve my ultimate goal: to further the scientific understanding of autism in a way that improves the lives of affected children and families. Families affected by autism are some of the most steadfast, passionate, and deeply devoted people I have ever encountered. No doubt, they will continue to inspire my work.
Looking back at my training, one experience stands out above the rest as the most formidable in shaping my development as a clinician and scientist: The Dennis Weatherstone Predoctoral Fellowship awarded by Autism Speaks. I am honored to be the first to complete the program.
With the support of Autism Speaks and in collaboration with my graduate advisor Jana Iverson, PhD, at the University of Pittsburgh, I have been investigating the development of communication skills in infants who have an older sibling on the autism spectrum. These skills include gestures, smiles, eye contact and sounds.
In conducting this research, our hope is to identify behavioral indicators of autism at a much earlier point than is currently possible. This, we further hope, will allow earlier diagnosis and treatment and lead to improved outcomes. In addition, by studying the development of social difficulties during infancy, we hope to improve our understanding of social communication difficulties in older children on the spectrum—and, in turn, hasten the development of tailored interventions.
Fellowships such as mine are highly coveted by my classmates because the financial support allows us to focus intensely on our research instead of taking on such time-consuming jobs such as teaching and working in faculty labs. The Weatherstone Fellowship allowed me to devote the majority of the past two years to my scientific research, clinical goals, and professional development. It also allowed me to meet regularly with other Weatherstone fellows and their advisors (all of whom are leading scientists in autism research) and to participate in national autism scientific meetings—opportunities that will enable me to develop future collaborations.
Finally, I believe this experience played an instrumental role in helping me secure a predoctoral internship in clinical psychology, the final step in my training to become a child psychologist and practice independently in clinical and research positions. Starting Sept. 1st, I will begin my internship at the Mailman Center for Child Development at the University of Miami’s Miller School of Medicine—as the program’s first autism intern.
As I look forward to this new exciting step in my career, I continue to reflect on my experience as a Weatherstone fellow. I appreciate how it has helped prepare me for a career dedicated to excellence in both research endeavors and clinical work, ultimately allowing me to better serve the unique needs of children and families affected by autism.
Back by popular demand: The “Got Questions?” feature of the Autism Speaks Science blog. Today’s answer comes from…
I can remember starting college and how anxious I felt facing the new and challenging environment. I had to meet such a range of new people, deal with academic pressures, organise my day and get to appointments on time, manage my finances (I still struggle!) and generally look after myself. Such an upheaval tests any young person—all the more so for a young adult on the autism spectrum.
So what can help? First, remember that US and international legislation supports the right to a college education for individuals with disabilities. Educational institutions are required under the Individuals with Disabilities Education Act and the Americans with Disabilities Act to provide services for students with an autism spectrum disorder (ASD). The college are required to make all reasonable adjustments to accommodate the needs of students on the autism spectrum and to avoid discrimination based on their disability. (See Ralph Savarese’s blog post on Oberlin’s acceptance of his son, DJ, possibly the first nonspeaking student with autism to live in a US college dorm and be accepted to such a highly selective US college.)
In addition, there are many steps that parents can take to help their son or daughter have a rewarding college experience. Transition planning is key. I encourage you to work with your child’s high-school and college advisors to draw up a transition plan that extends from before the freshman year to post-graduation. Consider such issues as the appropriateness of a college’s location, available facilities and course content. It helps to visit the college, meet with at least some of the teaching staff and tour classrooms and dorms with an eye for how well they accommodate your student’s needs.
As part of the transition plan, work closely with the college’s disability services. Of course, this requires that your son or daughter discloses his or her ASD and, if necessary, provides the necessary documentation of disability and needs. Armed with this information, the disability office can organize an assessment of need and provide learning supports. These can include both psychological and behavioral services, assistive technologies (e.g. a recording device for a lecture) and academic aids such as note-takers and extra time in exams. It is important to have assessments of need conducted early so that learning supports are in place when the student starts coursework. Then, once a year, ensure that college staff review the effectiveness of the support program.
Having a social mentor can be particularly useful. Autism Speaks’ college program–Autism Speaks U–promotes awareness and advocacy for students with ASD and may be one source of social mentoring during college. Sometimes just a friendly ear is needed, particularly at times of increased pressure (e.g. first week of college and exams).
Before the start of classes, see if you can get an advanced class schedule. Consider the timing and distance between classes—again from the point of view of the demands placed on your student.
Finally at least a year before your son or daughter graduates, begin planning an “exit strategy” in consultation with the school’s careers office and other college staff familiar with your now-adult child.
With the right planning and support, college can be a great environment for young adults on the autism spectrum. I hope your son or daughter has as much fun as I did.
Here are some additional resources:
1. The Autism Speaks’ Transition Toolkit, particularly the section on Post-Secondary Educational Opportunities.
2. The TEACCH Autism Program of the University of North Carolina-Chapel Hill.
3. Preparing Students with Autism for College, and Preparing Colleges for Students with Autism, Hurewitz and Berger (2008).
4. Supporting More Able Students on the Autism Spectrum: College and Beyond Journal of Autism and Developmental Disorders VanBergeijk, Klin and Volkmar (2008).
5. The [UK] National Autism Society’s Guidelines for Student Mentors.
Got more Questions? Please email us at firstname.lastname@example.org.
Autism Speaks’ Alycia Halladay, Ph.D., will be live online this afternoon (4 pm EDT, 1 pm PDT) to answer your questions on the just released study showing a high risk of autism among the younger siblings of children on the spectrum. Dr. Halladay organized and continues to help lead the High-Risk Baby Siblings Research Consortium that conducted the research and which continues to study the factors that predispose some families to autism recurrence. Please join us and bring your questions. Meanwhile, please see our news item and a special commentary from Autism Speaks’ Chief Science Officer Geri Dawson, Ph.D.
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To read the entire transcript from this chat, please visit here.