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January 2009 Archive

Date:	1/30/2009
Title:	Study Suggests Preemie, Autism Link - 1 in 5 Toddlers Showed Autism Signs in New Study
Author:	By Salynn Boyles — January 29, 2009
Publication:	WebMD Health News
Article:	There is growing evidence linking very premature birth to a dramatic increase in autism risk, but more study is needed to confirm the association. Last spring, researchers from Harvard Medical School and McGill University reported that one in four very low birth weight preemies showed early signs of autistic behavior when evaluated before age 2 in a study involving 91 children. Now a much larger study shows that one in five toddlers born more than three months early showed early signs of autism spectrum disorder, regardless of their weight at birth. Toddlers with established motor, visual, hearing, and mental handicaps were more likely to show early signs suggesting a high risk for autism, compared to children without these problems. The studies don’t prove that extreme prematurity is directly linked to autism because the children who participated were too young to have a confirmed diagnosis, lead author Ken C. K. Kuban, MD, of the Boston University School of Medicine tells WebMD. "We should know more in a few years if we are able to follow these children," he says. Early Birth and Autism The study included close to 1,000 children born at least three months early between 2002 and 2004, enrolled in a larger trial. When the children reached age 2, they were tested for early signs of autism spectrum disorder using a widely used screening tool known as the Modified Checklist for Autism in Toddlers (M—CHAT). When the M—CHAT is used to screen children during routine pediatric visits, about 5% test positive, Kuban says. By comparison, 21% of the very premature children in the study had positive M—CHAT scores. Slightly more than one in four (26%) had birth—related health issues, including cerebral palsy (11%), visual impairments (3%), and hearing impairments (2%). The risk of having a positive M—CHAT increased 23—fold among children unable to sit or stand by themselves, eightfold among children with visual and hearing impairments, and 13—fold among children with severe mental impairment. Nearly half of the children with cerebral palsy and two—thirds of the children with visual or hearing problems tested positive on the M—CHAT screen. "Children who had these impairments were more likely to be M—CHAT positive, but that didn’t mean they were necessarily at higher risk for autism," Kuban says. "The message to pediatricians is that they need to be cautious in interpreting the results of this screening test in children with these handicaps." Healthier Preemies Scored Better When these children were excluded from the analysis, 10% of 2—year—olds without these disabilities still tested positive. The study appears in the January issue of the Journal of Pediatrics. "Children who had no motor, hearing, visual, or cognitive impairments still had double the risk of being M—CHAT positive," Kuban says. March of Dimes Medical Director Alan Fleischman, MD, tells WebMD that it is clear that very premature children —— those born more than two months early, weighing 3 pounds or less —— are at high risk for a wide range of birth—related developmental problems. But it is not clear that those problems include autism spectrum disorder, he says. "If a baby’s brain has been hurt by the consequences of extreme prematurity, it isn’t surprising that they display these symptoms, but I’m not sure it is helpful to label it autism," he says. "Certainly, these babies need to be evaluated closely. That is an important message."

Date:	1/29/2009
Title:	Why Virginia Should Help Children with Autism
Author:	By Del. Robert G. Marshall (R-13) and Del. David E. Poisson (D-32)
Publication:	Wednesday, January 28, 2009
Article:	Why should insurers cover the cost of treating children with autism? First, there is real hope. The U.S. Surgeon General has reported that early treatment can spare an autistic child from lifelong dependency as wards of the state. Second, a recent study in Pediatrics, published by the American Academy of Pediatrics, found that children with autism are significantly more likely to have problems accessing health care. These children are more likely to live in families that report financial problems, need additional income for the child’s medical care and pay more out-of-pocket for the child’s care. Parents of more than half of children with autism reduce or stop work altogether to care for their child. Roughly one of every 150 Virginia children has autism. Studies suggest that boys are more likely than girls to develop autism and receive the diagnosis three to five times more frequently. Current estimates are that one out of 94 boys is diagnosed with autism. As the surgeon general notes, with early intervention, a sizable minority of children diagnosed with autism are able to achieve normal social and intellectual functioning. These children can be mainstreamed into regular classrooms and may be indistinguishable from peers. Even children who make less dramatic progress benefit from early intervention, showing gains in language, fewer inappropriate behaviors and less overall costs to taxpayers. Under Virginia law, public schools must provide a free appropriate education to children with disabling conditions. However, that mandate is complicated by the absence of private health insurance to treat the core symptoms of autism. The school system, charged principally with the education of children with and without disabilities, cannot bear the full burden of attending to the health needs of children with autism. Unless private insurers do their fair share, the needs of these children will not be met and the stresses on their families will not diminish. To help children and families and the communities in which they live, we have introduced H.B. 1588 to require insurance coverage for the treatment of autism. The bill covers proven, evidence-based, medically necessary care prescribed, provided or ordered by a physician or psychologist for a child under the age of 21. Coverage is subject to an inflation-adjusted annual maximum benefit of $36,000 and will complement rather than supplant school services. H.B. 1588 is similar to laws enacted in Louisiana and Pennsylvania, two of the eight states that have enacted legislation ensuring coverage of children with autism. The Louisiana Legislative Fiscal Office estimated the total premium cost of autism coverage in that state as ranging from $1.12 to $3.87 per policy per month, while an independent panel report in Pennsylvania found a marginal premium increase cost of approximately $1 per insurance plan member per month attributable to the autism benefit. H.B. 1588 will likewise have a similarly modest impact on premiums. The General Assembly’s Joint Legislative Audit and Review Commission concluded that the financial impact of covering autism treatment is within the range of existing Virginia health insurance mandates. While the cost of autism treatment may be calculated with reasonable accuracy, no calculus fully measures the toll autism takes on children and families. Balancing medical, social and financial considerations, the Joint Legislative Audit and Review Commission concluded that health insurance coverage of autism treatment is necessary. Even in these difficult economic times, the pertinent question to ask is not whether we can afford to provide appropriate interventions to Virginia children with autism, but is instead whether we can afford not to. The lives and futures of affected Virginia families depend upon passage of H.B. 1588. Delegate Marshall was first elected to the Virginia House in 1992. He serves on the House Finance, Science and Technology, and Counties, Cities and Towns Committees. Delegate Poisson was first elected to the Virginia House in 2005. He serves on the House Counties, Cities and Towns and Militia, Police and Public Safety Committees. Their bill, H.B. 1588, is scheduled to be heard in a House Commerce and Labor Subcommittee Feb. 3.

Date:	1/28/2009
Title:	Helping Autistic Adults To Grow
Author:	By Janice Neumann — Special to the Tribune January 28, 2009
Publication:	Chicago Tribune
Article:	Until six months ago, helping prepare dinner or taking out the garbage were monumental challenges for Joey Rosenbloom, who would become overwhelmed and frustrated by simple tasks. But things changed for the bright, friendly 21-year-old after he enrolled in a program at Elim Christian Services in Palos Heights for adults with autism that nurtures social, leisure and vocational skills. Elim launched the adult program in August, four years after creating a school for autistic children. The Christian ministry has taught students with special needs for more than 50 years. Rosenbloom, who lives with his family in South Barrington, and the two other adults in the program have flourished under the direction of an instructor who has experience working with autistic children and a background in organizational communication. "I see him becoming more independent, reaching out and doing things on his own," said Sharon Rosenbloom, Joey’s mother. Autism is a developmental disability that affects about 1 in 150 births, according to the Centers for Disease Control and Prevention. Symptoms vary but can include a lack of speech, repetitive use of words or mannerisms, and little or no eye contact. People with autism are often concrete thinkers and visually oriented. The adult program meets weekdays from 8:30 a.m. to 2:30 p.m. in a classroom with bright wall schedules that outline activities with pictures and objects. The students gather around several large tables to talk and complete assignments. On a typical recent morning, Mark Boys, the teacher, instructed each student on saying good morning through pictures and patient coaxing. The students then gathered around tables to stock bags with school supplies for underprivileged students in Chicago. The students already were looking forward to their afternoon trip to Starbucks, with Boys coaching them on how to order drinks. On other afternoons, the class goes to a grocery store or a recreation center, or spends time emptying trash, cleaning a car or stocking vending machines. "The hope is really to create independence with this type of work," said Boys, who added that the goal is for them to "reach their God-given potential." Such programs are scarce in Illinois, though the state has a number of day programs for adults with developmental disabilities that include adults with autism. Easter Seals in Chicago has a program for adults with autism, as does Little Friends Inc. of Naperville. Though Elim wants to expand the program, funding has proved a challenge. The state Division of Developmental Disabilities allots roughly $11,500 per year for such programs, according to Bob Marsh, Elim’s vice president of ministry resources. The school is trying to raise money from grants, individuals and churches. "Funds for adults with disabilities in Illinois is a systemic issue," said Marsh.

Date:	1/23/2009
Title:	Families Demand Coverage For Autism Care
Author:	Heather May
Publication:	Salt Lake City Tribune 01/22/2009 03:44:28 PM MST
Article:	Saying autism should be treated like other childhood illnesses such as cancer and diabetes, two lawmakers and 30 community supporters promoted a bill Thursday that would require insurance companies to cover up to $50,000 a year in autism therapy. "We realize it’s an uphill battle in getting it passed," said chief sponsor Sen. Howard Stephenson, R—Draper. "We believe it is a barbaric society in which health insurance covers Viagra for older people and yet will not cover autism treatment for younger children." Stephenson has opposed insurance mandates in the past, including for birth control and fertility treatments, but said he considered those measures less—important "nice—to—haves." Bill drafters have not yet calculated how much the mandate would cost Utahns who pay private insurance premiums. But supporters said states with similar mandates have found premiums rise on average up to $1.25 per policy holder per year. It would also cost the state and local governments an undetermined amount, because government employees’ insurance plan would be part of the mandate. However, Medicaid and CHIP would not be included in the mandate because it’s not seen as politically feasible. Nor would self—insured companies, which have policies governed by federal rules. Those exceptions leave one—third of Utahns eligible for coverage, said Kelly Atkinson, executive director of the Utah Health Insurance Association. The association hasn’t taken a stand against the bill, but Atkinson said Thursday that mandates will increase insurance costs on small businesses at the same time the governor is pushing for mandate—free policies to make them more affordable. "It isn’t that we don’t have sympathy for this, we do," he said. "When [House Speaker David Clark] is looking for ways to make insurance more affordable for his target population, small businesses, this is going in the wrong direction." Dubbed "Clay’s Law" for a third—grader who "recovered" from autism after therapy, the bill would mandate coverage for a variety of treatments, including occupational and speech therapies, drugs and psychological care. It directs the state insurance office to determine deductibles, duration and amount limits for those therapies. But for "early intensive behavior therapy," the bill explicitly mandates up to $50,000 per year for children up to age 9. The coverage amount would drop to $25,000 a year for such treatment for children ages 9 to 17. Behavior therapy that is considered effective provides one—on—one treatment for up to 40 hours a week at home, reinforcing communication and appropriate social behavior and discouraging negative behaviors. Studies have found up to 40 percent of higher functioning autistic children who receive at least two years will eventually be indistinguishable from their peers. Another 40 percent improve but still need help and about 10 percent won’t improve. The insurance industry questions those claims of success. Most parents cannot afford the $50,000 a year in private therapy. And while the state provides early intervention services to disabled children, it’s not as intense. Brittany Recalde couldn’t afford the 40 hours a week needed for her daughter, Mira, and said Thursday she will have "tremendous guilt" for the rest of her life. While the 4—year—old now plays with toys, is social and shows imagination, she also displays rigid, repetitive behaviors common to autism and throws herself on the ground and bangs her head on the floor. Recalde said she expects her daughter will eventually attend a mainstream classroom, but doesn’t believe she will turn out like Clay Whiffen, who is no longer considered to be on the autism spectrum. "Those children should no longer be ignored by the health insurance industry," she said. "If given a chance, these children can recover." Julien Smith, a neuropsychologist who treats patients with autism, said Utah’s pediatric community endorses the bill. She noted that treating children will save some of the $3.2 million it is estimated to cost to care for an autistic person over his or her life. She said autism is a life—long diagnosis but its symptoms can be ameliorated with treatment. Geri Vohn believes her son will "recover," but has little faith in the public school system, which is where Kaleb is left if the bill doesn’t pass. The 4—year—old can’t talk or eat with utensils. He has been making progress —— he no longer spits and bites — with behavior therapy through a state—funded autism preschool. But that therapy ends after this year. "You find out [behavior therapy] will help, but nobody can afford it," she said. "It’s heartbreaking."

Date:	1/22/2009
Title:	Autistic Traits ’Spread Widely’
Author:	BBC News
Publication:	BBC News, Wednesday, 21 January 2009
Article:	Many children have mild autistic "symptoms" without ever having enough problems to attract specialist attention, say UK researchers. The Institute of Child Health team says diagnosed children have severe versions of character traits probably shared by millions of others. The 8,000 child study found even these mild traits could impair development. Boys - who make up the bulk of autism diagnoses - were most likely to be affected, the US journal study found. Scientists have understood for some time that the "autistic spectrum" covers a wide range of children with differing levels of problems, from relatively mild cases to severely disabling problems. However, a relatively small number of children - approximately 116 per 10,000 - are said to have an autistic disorder. The UK research, published in the Journal of the American Academy of Child and Adolescent Psychiatry provides further evidence that the same traits do not begin and end there, but continue at into the whole population of children, just at a level which does not lead parents to seek medical help. Seeing autism as a "distinct illness" was probably wrong, they said. Even at this mild level, however, these characteristics - particularly problems communicating with peers and teachers - can be a disadvantage. The findings confirmed that IQ was not an issue - the traits could be present regardless of levels of intelligence. However, it cast some light on the differential in the numbers of boys and girls diagnosed with autism. Girls with autistic traits appeared to be able to compensate for social communication problems if they had sufficient "verbal IQ" - a natural ability to use language well. However, even boys with high "verbal IQ" seemed less able to overcome their communication problems. Education Awareness Professor David Skuse, one of the researchers involved, said the results did not downplay the genuine impact of more severe autism. However, he added: "What this does suggest is that drawing a dividing line between those with autism and the rest of the population involves taking an arbitrary decision." "Clinicians and those involved in education need to aware that there are children who do not have autism but who nevertheless have somewhat elevated levels of autistic traits - our research suggests that these children are at slightly greater risk of developing behavioural and emotional problems." In an accompanying editorial, Professor John Constantino, from Washington University, said that the idea that autism represented the "severe end" of a natural distribution of abilities could help scientists looking for the genetics underlying the condition, or for ways to treat it. It could also help the development of children who were affected, but not to the level of an autism diagnosis. He wrote: "The approach of teachers and family members to such children can vary dramatically on the basis of the perceived origins of the behaviour, and recognition of the contribution of subthreshold autistic impairments can result in far more appropriate and supportive responses than typically occur when antisocial motives are presumed."

Date:	1/21/2009
Title:	Autism Said To Be Among Top Medical Priorities for Obama
Author:	Nancy Shute
Publication:
Article:	Autism tops Barack Obama’s medical to-do list, according to the new president’s website. Whitehouse.gov launched at 12:01 pm yesterday, even before the new president had taken his oath of office on the Capitol’s West Front. Autism is the only disorder or disease mentioned explicitly in Obama’s 24-point agenda. Heart disease and cancer don’t get the call. Neither does diabetes, or other chronic diseases. But there are four hefty bullet points addressing autism. Obama called for: 1. Increased funding for research, treatment, screenings, public awareness and support services for autism spectrum disorders. 2. "Life-long services" for people with autism spectrum disorders, as children and as adults. Many parents struggle to find and pay for screening and treatments for their children, but there is even less coverage and capacity for adults with autism-based impairments 3. More funding for the 2006 Combating Autism Act, as well as improving state and federal autism programs. 4. Universal screening for all infants for autism disorders, as well as re-screening for all 2-year-olds. This is the biggie; children are currently screened only if parents or pediatricians voice a concern, so too many children aren’t diagnosed until they enter elementary school. The earlier treatment starts, the more effective it is, and a national screening program would help reduce the number of kids falling through the cracks. It would also be a huge undertaking, at a time when both government and privately insured health care is foundering. That second bullet point would be a huge help for families who are struggling to provide care. In a recent survey, 52 percent of parents of children with autism said their family finances were drained by treatment and care, compared to 13 percent of typical families. The 2006 Combating Autism act promised almost $1 billion over five years for autism research and development, but Congress hadn’t appropriated $200 million per year, even before the economy hit the skids. The Obama manifesto gives a big fat hint that for autism, at least, the hard times cited in the new president’s inaugural address won’t mean big cuts in funding. Still, universal screening for autism will be a huge challenge. There’s no blood test that can be used to diagnose autism, as there is for hereditary diseases like galactosemia and sickle cell, which are screened for using a heel stick while a newborn is still in the hospital. With autism, parents and doctors instead need to observe a child and look for delays in language, social interactions, and gross motor skills. The Centers for Disease Control and Prevention recommends that pediatricians screen children during well-baby visits at 9 months, 18 months, and 24 or 30 months. (Here’s the CDC’s page on screening for autism.) But many doctors don’t get around to doing those screens, and until very recently the recommended tests weren’t sensitive enough to pick up mild autism spectrum disorders. Early screening for autism is a terrific idea. Making it happen will be a tall order, even for the can-do Obama team.

Date:	1/21/2009
Title:	No. Virgina Lawmakers Endorse Autism Insurance
Author:	By Amanda Ladden—Stirling
Publication:	Capital News Service WEDNESDAY, JANUARY 21 2009
Article:	Cassandra Oldham, a Leesburg resident and mother of three, has two sons diagnosed with regressive autism. Because she cannot afford therapy for both, she said, she finds herself having to choose which one to provide for. "Do I help the one that needs it the most, or do I help the one that will go the furthest? These are questions no parent should ask themselves — not in Virginia," Oldham said. In Virginia, health insurance companies are allowed to exclude coverage for autism and therapies, such as applied behavior analysis. Applied behavior analysis is endorsed by the American Academy of Pediatrics, the Virginia chapter of the American Academy of Pediatrics and the U.S. Surgeon General. A proposed bill in the House of Delegates would allow more than 7,000 children in Virginia access to medically necessary, evidence-based autism services up to age 21 with an annual cap of $36,000. Del. Bob Marshall, (R-Manassas), said it would cost the equivalent of only one cup of Starbucks coffee a month to cover children with autism. "If our entrepreneurs can’t figure out how to find ... one Starbucks cup of coffee a month, nothing is going save them. No amounts of bailouts are going to save them," Marshall said. Opponents of the bill argue that lawmakers should focus on making health insurance affordable for more people instead of mandating expensive treatments for a smaller group. "While mandated health insurance benefits may make things more comprehensive, they also make it more expensive," said Keith Cheatham, vice president of government affairs for the Virginia Chamber of Commerce. Sen. Chap Petersen (D-Fairfax) disagrees. "I know all the arguments against [the bill], but the bottom line is this is one of those issues that makes sense to do ... for Virginia families," Petersen said. Judith Ursitti, the regional director of state advocacy relations for Autism Speaks, wants her child and other families of children with autism to be treated the same way children with chronic health conditions are treated. "This is not a disorder caused by a refrigerator mother; this is a disorder that can be treated. Our kids have potential," Ursitti said. "We have hope for them and we are just asking for a seat at the table for our children." Arizona, Florida, Illinois, Indiana, Louisiana, Pennsylvania, South Carolina and Texas are among the states that already have comprehensive autism insurance coverage. Del. Tim Hugo (R-Centreville) chaired the Mandated Benefits Commission, which recommended passage of the autism coverage bill. He joined hundreds of parents at a Jan. 16 rally in support of the bill. "I was deeply stirred by the testimonies of parents across the state during the commission hearings," Hugo said. "I refuse to allow any child to be ’shackled by autism,’ like one parent testified before me. As a parent of four, I will not deny any child the opportunity of the fullest life -- or any parent the chance of treatment for their child."

Date:	1/20/2009
Title:	Trying Anything and Everything for Autism
Author:	By JANE E. BRODY
Publication:	Published: January 19, 2009
Article:	Rochelle and Ian Yankwitt were thrilled when their son, Casey, was born seven years ago, 19 months after the birth of their daughter. But their delight was short—lived. At 7 months, this otherwise happy infant failed to respond to his name or any attempt to engage him with words, his mother recalled in an interview. "I thought he was deaf," Ms. Yankwitt said, but tests showed nothing wrong with his hearing. Instead, at 14 months, Casey received a diagnosis of autism. His parents, both lawyers, wasted no time in setting up early intervention treatments — speech and occupational therapy and special education — as provided by New York State for developmentally disabled children. Ms. Yankwitt, who described Casey as "pretty seriously affected," left her job to coordinate his endless rounds of treatment. If not for speech therapy five or more days a week for six years, Ms. Yankwitt is convinced Casey would not have the limited language skills he now has, which enable him to speak in short sentences, make his needs known and share things that excite him. But, she added, "there is no mistaking Casey for a normal child. He is in constant motion, flaps his arms, is easily frustrated and makes strange noises." Ms. Yankwitt read many books and articles by parents claiming that this, that or the other treatment had cured their child’s autism, all anecdotal and based on theories and therapies unproved by scientific study. "I spent six years hoping that the next thing around the corner would be the one for Casey," she said. So far, nothing has made a substantial difference in Casey’s behavior. Still, Ms. Yankwitt said, guided by a pediatrician who specializes in holistic care of children with neurodevelopmental disorders, through trial and error some of the suggested remedies have produced apparent improvements. The Yankwitts’ many attempts to help their son and, in turn, help themselves are typical of the endless ups and downs faced by families of children with autism, for which there is no documented cure. A Variable Disorder According to Laura Schreibman, a psychologist who is the director of the Autism Research Program at the University of California, San Diego, and the author of "The Science and Fiction of Autism" (Harvard University Press, 2005), if anything definitive can be said of the popular therapies for autism, it is that treatments have to be individualized. What works to reduce symptoms in one child may or may not help another. It is also true that autism is highly variable, with periodic improvements and regressions, and most children receive several therapies at once. So it is difficult to say what makes things better or worse at a given time, Dr. Schreibman said in an interview. This means that parents like the Yankwitts try one thing after another, often keeping careful records of the latest regimen and its seeming effects on their child’s behavior. "Parents are afraid of missing what might be effective, so they try everything," Dr. Schreibman said. Alternative Therapy Initially the Yankwitts sought only mainstream therapy for Casey — "we were very afraid of all the alternative treatments," Ms. Yankwitt said — but a regression he suffered between ages 2 and 3 prompted them to branch out. Their tests of alternative methods began with a dairy—free diet. "Thirty—six hours later he was like a different kid," Ms. Yankwitt said. "He made eye contact for the first time. It was as if a layer of smog had peeled off him." That was followed by another dietary change: a gluten—free diet, with less obvious results, then "a specific carbohydrate diet to eliminate yeast in his digestive tract," Ms. Yankwitt said. "These diets are very challenging," she said. "We carried food for him everywhere he went." Next came supplements, introduced one at a time, with daily notes of how Casey reacted to each. In addition to theanine to aid sleep, Casey now takes garlic capsules, calcium, coenzyme Q—10, L—carnitine, taurine, zinc, magnesium, molybdenum, selenium and Nystatin (for yeast), as well as two psychotropic drugs: a mood stabilizer and an antidepressant. He also uses a glutathione cream that is supposed to detoxify his body, a B—12 cream, an intestinal complex to help with digestion, fish oils, curcumin and milk thistle. At the doctor’s suggestion, Casey underwent a full round of chelation therapy to remove heavy metals from his body that might be damaging his brain, "but it didn’t seem to make a difference in what he was, and so we stopped," Ms. Yankwitt said. What she thinks has helped is hyperbaric oxygen therapy purported to reduce inflammation in the brain, which coincided with a significant improvement in Casey’s language skills. But, Ms. Yankwitt conceded, "We don’t know what would have happened if we had done nothing. "The most difficult thing for me is constantly hoping something will fix this and being given reason to hope by people you trust," she added. In "Defeating Autism: A Damaging Delusion" (Routledge, 2009), Dr. Michael Fitzpatrick, a general practitioner in London whose son is autistic, likened the alternative medicine approach to a return to "medicine’s dark ages." Every biomedical intervention, he wrote, "is supported by anecdotes and personal testimonies: it is understandable that parents want to share their experience that their child has made progress, and it is equally understandable that other parents are impressed by success stories." Dr. Fitzpatrick continued, "When parents have invested money, time, energy and, above all, hope into a particular treatment, it is natural to seek to attribute any improvement to that treatment." But, he added, anecdotal examples and wishful thinking are not science. A Behavioral Approach The one approach that has been scientifically validated to help, though by no means cure, autistic children is behavioral intervention that mimics the way normal children learn, Dr. Schreibman said. For example, if the child wants to play with a toy car, the therapist holds it and prompts the child to say "car." If the child makes the "c" sound, he is given the car to play with. The next session may require him to say "car." In this way, a behavioral repertoire can be built gradually and systematically to develop behaviors like communication, engagement, social interactions and play skills, Dr. Schreibman said. "Parents need to learn how to do it," she said. "It’s a lot of work and it takes a lot of time — maybe 30 to 40 hours a week for a 7—year—old — and the results are not instant, but it does work. But the earlier in a child’s life it is started, the more effective it is likely to be." With the increase in awareness of autism and improvements in diagnosis, more children today can get an early start on effective therapy rather than wasting valuable time, effort and money on remedies that lack a scientific basis and proof of effectiveness.

Date:	1/03/2009
Title:	UW Researcher Finds Link Between Age, Birth Order and Autism
Author:	By Susanne Rust
Publication:	Journal Sentinel — Posted: Jan. 3, 2009
Article:	In the largest study of its kind, researchers have shown that the risk of autism increases for firstborn children and children of older parents. The risk of a firstborn with an autism spectrum disorder triples after a mother turns 35 and a father reaches 40. Although the study was not designed to uncover the cause of the disorder, the findings suggest avenues of research to explore, including the role of environmental toxins. "Is this pure genetics? Or a toxic phenomenon?" said Darold Treffert, former president of the Wisconsin Medical Society, a psychiatrist at St. Agnes Hospital in Fond du Lac and an expert in savant syndrome. Treffert was not involved in the study. "I think we’re bombarded with all sorts of stuff. And we know from experiences such as thalidomide that there are specific times during development of specific risks with specific chemicals. The problem is there is just so much out there." Thalidomide was a drug taken by pregnant women in the 1950s and 1960s that caused severe birth defects in their children. The autism study, led by University of Wisconsin—Madison epidemiologist Maureen Durkin, looked at more than 1,200 cases of autism, or 50% more than any previous study. The research team looked at more than 300,000 U.S. births. The team found a 20% increase in the risk of autism with each 10—year increase in the parents’ ages. Also, they found a couple’s fourth child has half the risk of the first, regardless of the parents’ ages. Although debate exists about the prevalence of autism in the U.S. population and whether it is on the rise, the Centers for Disease Control and Prevention says the disorder appears in one in 150 births and is increasing. Regardless of its prevalence, Durkin and Treffert say, the link between age and the risk of autism is not surprising. They pointed to several developmental disorders, including Down syndrome, for which risk rises as the parents’ age increases. Treffert said, "This a trend that I’m concerned about: The increase in developmental disorders in general and the rise in premature births," which are related to autism. Durkin said the study shows there probably is an ideal window in which to have children — when parents are not too young or too old. But regardless of age, she said, the chances are still very low. "For the individual family, this study is not going to have a big impact," because the chances are so low for any one individual, said James Crow, a retired professor of genetics at UW. But the study will shape public health statistics, he said. Possible causes Durkin said her research will hopefully lead to other studies designed to uncover the causes of the disorder. She said the observations that parental age and birth order are involved bring to mind several likely causes. For instance, she said, factors that might influence the disorder in the children of older parents include age—related genetic and chromosomal damage, environmental toxins and the effects of infertility treatment. Crow thinks the genetic hypotheses can be ruled out because the kinds of genetic problems that occur with age are not the same for men and women. So, if autism were caused by an age—related genetic mutation, then the study would show that it is only the age of the father that causes the disorder. That’s because men produce sperm throughout their lives, while a woman’s eggs are developed before she is born. And if the disease were caused by chromosomal damage, as occurs in older women’s eggs, then the risk would be dependent on only the mother’s age. Crow said the other two possibilities are more likely. As for what is occurring in firstborn children, he said the most likely explanation is just a statistical artifact caused by "stoppage." Parents whose first child is autistic generally do not continue to have other children. The correlation seen with firstborn children is simply a result of parents not having more children, Crow said. Although Durkin didn’t test for this, she believes it’s unlikely because most parents do not know their child is autistic until the child is 2 or 3 years old. She said many couples have had, or already are pregnant with, their second child when they realize that their first is autistic. Other theories include the firstborn’s exposure to toxins. The chemicals a woman has acquired over her lifetime are either released directly into the fetus or passed through her breast milk as she nurses. The firstborn soaks up more of those stored chemicals. Another theory is the hygiene hypothesis, which suggests that firstborn children are exposed to fewer infections from other children early in childhood. Because of this delay, they may be more likely to develop autoimmune responses that affect brain development. Although some parents consider vaccines a possible cause of autism, they were not mentioned in the paper. Numerous other studies have shown no link between vaccines and autism. Before any cause can be discovered, Treffert said, doctors must refine their definition of autism. Some types of autism are apparent at birth, while other cases don’t appear until a child is 3 or 4. There may be different causes for these kinds of autism, he said. "While I’m all for community acceptance and education, if we keep expanding the definition, we’re never going to find the cause," he said.