Without question, anxiety is a real and serious problem for many people on the autism spectrum. We hear this from parents, teachers and doctors, as well as from adolescents and adults with autism spectrum disorder (ASD). This disabling anxiety can take the form of one or more disorders, including panic disorder and phobias.
A recent review of scientific studies on autism and anxiety revealed that we have no clear gauge of how commonly anxiety disorders overlap with autism. A few small, relatively short-term studies have produced starkly different results: from 11 percent to 84 percent. (For comparison, the prevalence of anxiety disorders among the general population is about 18 percent.) A reliable estimate will require a study that tracks many more individuals with autism over longer periods of time and that considers the distinctive way that anxiety oftentimes expresses itself in those affected by ASD.
Fortunately, Autism Speaks is funding the Autism Treatment Network, which collects systematic data on a wide range of medical conditions, including anxiety disorders, in children with ASD. This data will help us better understand the proportion of people with ASD who are suffering from anxiety symptoms.
Meanwhile preliminary studies have provided insights. They suggest, for example, that adolescents with autism may be particularly prone to anxiety disorders, while younger children on the spectrum may not differ at all from the average population. Some studies likewise suggest that high-functioning individuals on the spectrum experience higher rates of anxiety disorders than do lower-functioning individuals. Still we must emphasize that these results are preliminary. We don’t know nearly as much as we should about how anxiety disorders affect those with autism.
A recent review of studies found that behavioral interventions can help many children and adolescents with autism who also struggle with anxiety. Along these lines, some studies suggest that cognitive behavioral therapy can be particularly helpful for high-functioning adolescents and adults with autism and anxiety. We will explore behavioral interventions further in a future “Got Questions?” blog. My own expertise is in the medical treatment of anxiety in persons with ASD.
Currently, we have no medications approved by the Food and Drug Administration (FDA) expressly for the treatment of anxiety in children, adolescents or adults with autism. Some classes of drugs commonly prescribed for treating anxiety disorders in the general population likewise help some of those on the autism spectrum. These include the selective serotonin reuptake inhibitors (SSRIs) such as Prozac. For those with autism, anxiety drugs are best used in combination with behavioral interventions. Among high-functioning individuals, they may be particularly effective when combined with cognitive behavioral therapy.
However, some doctors report that anti-anxiety medications seem to be less effective overall in people with autism spectrum disorder than they are in the general population. This observation needs to be verified with controlled research. It suggests the possibility that the biological root of anxiety in those with autism may differ from the “norm” and, as a result, may respond best to different treatments.
At Autism Speaks, we are actively supporting research into anxiety disorders and other medical conditions frequently associated with autism. This includes both basic research on the underlying biology of autism and the safe development of drugs that can relieve disabling symptoms and improve quality of life.
If you are considering anti-anxiety medication for a child with autism, our recently published Medication Decision Aid can help you work with your child’s physician to sort through the pros and cons in the context of your values and goals for your child. You can learn more about the medication tool kit and download a free copy, here.
Got more questions? Send them to GotQuestions@autismspeaks.org. And bring them to our next webchat with Autism Speaks Chief Science Officer Geri Dawson, Ph.D., and Autism Speaks assistant vice president and head of medical research Joe Horrigan, M.D. More information on their monthly webchats here.
This week’s ‘Got Questions?’ answer comes from Rob Ring, PhD, Autism Speaks vice president of Translational Research, and Joe Horrigan, MD, Autism Speaks assistant vice president, head of medical research.
To bring readers up to speed, the above question stems from two reports: In July, a group of California researchers reported a modest increase in the risk that a child would develop autism if his or her mother took selective serotonin uptake inhibitors (SSRIs) during pregnancy. The results were based on a very small sample of children exposed to antidepressants during the time their mothers were pregnant—just 20 children with autism compared to 50 without autism. This past month, another team of scientists reported that rats fed SSRIs as newborn pups exhibited abnormalities in brain development.
Given the great hunger for information about what causes autism, both studies made headlines. Unfortunately, the media stories may have served to alarm without putting these early and inconclusive scientific findings into perspective.
First and foremost, research with animals and investigations looking at a small number of cases are both important for guiding larger, more informative studies. But in and of themselves, these two particular studies don’t come close to reaching the bar at which scientific evidence is reliable enough to warrant a change in behavior. We feel this is particularly true of important medical decisions such as the need to treat depression, which can be a serious and life-threatening illness.
Take, for instance, the small number of children in the California study. This small “sample size” increases the likelihood that the results were due to chance or other unrelated factors. In other words, they may not represent real differences in risk. It is very common in science for such preliminary findings to vanish when researchers repeat the analysis with a larger, more “statistically significant” number of cases.
In addition, among women taking SSRIs, there may be other, hidden factors responsible for raising autism risk among their future children. For example, we know that anxiety is common among persons with an autism spectrum disorder (ASD). In fact, many of those who learn, as adults, that they have an ASD do so when they seek treatment for anxiety and/or related depression. A common type of medicine prescribed in these instances is SSRIs. We also know that ASDs tend to run in families. So it may be that family genetics—not SSRIs—produced the above-mentioned finding of a modest increase in the prevalence of autism among children whose mothers took these antidepressants during pregnancy.
And the rat study? While it’s useful for guiding the focus of further research, we simply can’t extrapolate results from rats to humans.
Finally, we worry about the consequences of women going off antidepressants when they truly need these medications. Certainly if a woman is pregnant or trying to become pregnant, she should discuss all her medicines with her physician—so that with guidance she can weigh the risks and benefits of continuing or discontinuing one or more of them. Certainly, a woman’s untreated depression can itself pose a danger to her pregnancy or newborn child. The bottom line: If you have concerns regarding your medications during pregnancy, discuss them with your physician, who can help you make the best decision for you and your family.
We hope that we’ve lent some helpful perspective to this issue. Please keep your questions coming (GotQuestions@autismspeaks.org).
This week a reporter from Bloomberg News asked me to comment on new research showing how stimulating certain brain cells can spur autism-like symptoms–and how calming these same cells can restore normal behavior. The reporter quoted me as calling the research “revolutionary.” It’s true—for a number of reasons.
We need to study brain activity to better understand and treat social behavior disturbances such as those associated with autism. Researchers do this by seeing what happens when they change what’s happening in the brain. But until now they’ve had only crude methods such as administering chemicals that target many parts of the brain.
To better understand normal and altered brain activity, we need to pinpoint exactly where something is going wrong. It helps to think of brain cells and their connections as microcircuits. Following this analogy, researchers need to be able to test specific microcircuits within the brain.
With this in mind, Karl Deisseroth and his colleagues at Stanford University used genetic engineering to create mice that produce brain chemicals that are activated by light. When activated, these chemicals excite surrounding brain cells. The researchers then used tiny pulses of laser light to produce activity in specific parts of the brain—right down to the level of a few brain cells, or a specific brain circuit.
Using this approach, the researchers found that when they stimulated certain cells in the prefrontal cortex—a part of the brain involved in social behavior—the mice stopped socializing with each other. At the same time, the mice’s brain waves took on a pattern seen in many persons with autism. Then, the researchers used a different light that dampened the activity and calmed the overexcited cells. In response, the mice started socializing again and the autism-like brain waves began to disappear.
The idea here isn’t to control behavior or implant fiber optics in anyone’s brain! What Karl has developed is a way to help us see exactly where something might be going wrong inside a brain and decipher exactly what is happening there.
Importantly this kind of approach may allow us to use lab animals to test new medicines that can help “rebalance” certain brain circuits to ease autism symptoms–and do so with fewer or no side effects.
This is the kind of pioneering research that wins the Nobel Prize. Even more important, we at Autism Speaks want to be supporting research along this promising path toward greater understanding of autism, its prevention and its treatment.
Translational research in autism converts complex scientific discoveries into real life benefits for those living with autism spectrum disorders (ASDs). Earlier this year, I had the privilege of organizing and moderating a translational research symposium we called “Autism Spectrum Disorders: From Genes to Targets to Treatments” at the New York Academy of Sciences. The symposium was made possible through funding from Autism Speaks. Indeed, sponsorship of meetings like this is an essential part of Autism Speaks’ commitment to advancing innovative autism research.
The New York Academy symposium brought together respected experts working on translational autism research from the proverbial bench to the bedside. The day was filled with stimulating scientific discussion that helped those of us involved in this research to align our research priorities.
In this week’s “Science in the City” podcast from the New York Academy (click the image below to access the podcast), you can listen in as two of the symposium’s speakers offer a behind-the-scenes look at the new technologies and treatments that could redefine how we understand autism. Eric Hollander, of the Albert Einstein College of Medicine, talks about using oxytocin, a brain chemical that fosters social bonding, as a potentially treatment for aspects of autism. And Timothy Roberts, of the Children’s Hospital of Philadelphia, discusses his use of brain imaging to identify early markers of autism—such as a tell-tale delay in how a child responds to voices and other sounds.
For more information about the translational research Autism Speaks funds, please visit our Grant Search portal, where you can learn more about specific studies on technology development, biomedical interventions, and more.
We’d love your feedback. So please leave a comment and respond to our polldaddy question of the day below the podcast link. Thanks.
Click the image to hear the podcast.