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According to a report published Wednesday in the New York Times, proposed changes to the definition for the new DSM edition, slated to be published next year, would exclude Aspergers and PDDNOS and consolidate autism diagnoses under a narrower category of autism. The person would have to show three deficits in social interaction and communication and two repetitive behaviors, a stricter set of criteria.
Many autism experts support the proposed changes, saying they will make it far easier to diagnose autism.
It may be possible to detect autism at a much earlier age than previously thought, according to an international team of researchers. A study published in Current Biology identified differences in infants' brainwaves from as early as six months. Behavioural symptoms of autism typically develop between a child's first and second birthdays. Autism charities said identifying the disorder at an earlier stage could help with treatment. It is thought that one in every 100 children has an autism spectrum disorder in the UK. It affects more boys than girls. While there is no "cure", education and behavioural programmes can help.
One of the researchers, Prof Mark Johnson from Birkbeck College, University of London, told the BBC: "The prevailing view is that if we are able to intervene before the onset of full symptoms, such as a training programme, at least in some cases we can maybe alleviate full symptoms." His team looked for the earliest signs of autism in 104 children aged between six and 10 months. Half were known to be at risk of the disorder because they had on older sibling who had been diagnosed with autism. The rest were low risk.
Older children with autism can show a lack of eye contact, so the babies were shown pictures of people's faces that switched between looking at or away from the baby. Sensors attached to the scalp looked for differences in brain activity. In low-risk babies, or high-risk babies that did not develop autism, there was a large difference in the brainwaves when looking at each type of image. There was a much smaller difference in the brainwaves of babies who developed autism.
'Very effective'
Previously the CDC estimated autism's prevalence at about an average of 1 in 110 U.S. children. The new estimate suggests autism is more common than previously thought - about 25 percent more common - and may affect more than one million children and teens in the U.S. "One thing the data tells us with certainty - there are many children and families who need help," CDC Director Dr. Thomas Frieden said in a written statement. "We must continue to track autism spectrum disorders because this is the information communities need to guide improvements in services to help children." For the CDC's study, researchers looked at autism prevalence estimates from 14 areas in the country. Since every state is not included, the CDC warned the rate "should not be generalized to the United States as a whole." But the data do show that autism diagnoses continue to increase. It's published in the March 29 issue of Morbidity and Mortality Weekly Report.
Boys are still about five times more likely to be diagnosed with autism in the U.S. than girls, according to the CDC report. It estimated one in 54 boys have autism, while one in 252 girls do. The number of children identified with ASDs ranged from 1 in 210 children in Alabama to 1 in 47 children in Utah. The largest increases were among Hispanic and black children. Some of this increase may be due to the way children are identified, diagnosed and served in their communities, although exactly how much is due to these factors is unknown, the CDC said.
Study results from the 2008 surveillance year show more than 11 out of 1,000 8-year-old kids have been identified as having an ASD, about a 23 percent increase since the last CDC report in 2009. Some of this increase is due to the way children are identified, diagnosed and served in their communities, although exactly how much is due to these factors is unknown. "To understand more, we need to keep accelerating our research into risk factors and causes of autism spectrum disorders," said Dr. Coleen Boyle, director of CDC's National Center on Birth Defects and Developmental Disabilities.
The study also shows more children are being diagnosed by age 3, an increase from 12 percent for children born in 1994 to 18 percent for children born in 2000. "Unfortunately, 40 percent of the children in this study aren't getting a diagnosis until after age 4," said Boyle. "We are working hard to change that." The CDC has a "Learn the Signs. Act Early" campaign that provides checklists for parents of developmental milestones. If a child does not reach these milestones, a parent should check with their child's doctor. "This information paints a picture of the magnitude of the condition across our country and helps us understand how communities identify children with autism," Health and Human Services Secretary Kathleen Sebelius, said in the CDC statement. "That is why HHS and our entire administration has been working hard to improve the lives of people living with autism spectrum disorders and their families by improving research, support, and services."
For 2012, the National Institutes of Health invested $169 million in autism research to improve screening and diagnosis, develop effective services and resources for families, identify potential risk factors in the environment that may cause the disorder, and for testing potential treatments.
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For autism campaigners, it is one of the most serious health scandals of our times. How for decades France turned its back on the latest scientific thinking, and treated autism as a form of psychosis. How, as a result, tens of thousands of children were misdiagnosed - or not diagnosed at all - and consigned to lives of misery.
And how, to this day, in its approach to autism, the French medical establishment continues to believe in the powers of psychiatry and psychoanalysis - long after the rest of the world has switched to alternative methods of treatment. "It is an out-and-out disgrace," according to Daniel Fasquelle, a member of parliament who campaigns on the issue. "Every day I am contacted by parents with the same story - how their child's autism was not detected in time, so they never had the treatment that they needed. "Thousands of children could have been saved. They do it everywhere else. Why not here? It is France's shame."
The row over autism in France has festered unreported for years. But recently it has become public. Independent associations have been created, lobbying for a move away from psychoanalysis and psychiatry, and over to the "behaviourist" treatments that prevail elsewhere. In early March, these groups scored an important victory - with a ruling from the health ministry that calls into question the use of psychoanalysis as a treatment for autism.
But the psychoanalysts are not taking it lying down. From their point of view, behaviourism is a form of superficial social conditioning that does not address root causes - and they resent the way they have been typecast as the villains of the piece, when their aims are as sincere as those of their opponents. "One thing that never pays in the field of autism is triumphalism," said Lauriane Brunessaux, a child psychiatrist. "Autism is far too complex, and we understand it so badly. "Today it is the behaviourists who are being triumphalist."
The behaviourist approach to autism was developed in the 1970s and 80s in the US and Canada, and it is now the norm in most of the world. Under the so-called ABA method (Applied Behavioural Analysis), autism is treated as primarily an educational - rather than a medical - problem. With a set of rewards (which can be granted or withheld) - and with plenty of individual attention - children can learn to function in society, and be much less of a burden on their families. "If you diagnose early, and then give the right treatment between the ages of two and seven, 70% of autistic children can acquire functional language skills. Here in France, we are way off that figure," says Fasquelle. "And the same pattern continues later in life. In the UK, there are 17 times more university students with autism than in France. It is unacceptable."
More BBC News - France's autism treatment 'shame'
Jacob Barnett was diagnosed with Asperger's Syndrome, a form of borderline autism when he was about three when his parents noticed it was difficult for him to make eye contact with them, show emotion and interact with other people, The Indianapolis Star reported. What he did do was work with numbers either on paper, a dry erase board or in his head working pi out to 200 digits for fun.
Jacob's parents noticed when they took him to the planetarium he loved looking at the stars and planets, but as his interest in cosmology grew so did his boredom in school. The Barnetts had a number of clinical evaluations done on "Jake" as he was known and decided to heed the last one made by clinical neurophysiologist Carl S. Hale. "He needs work at an instructional level, which currently is a post college graduate level in mathematics, i.e., a post master's degree. In essence, his math skills are at the level found in someone who is working on a doctorate in math, physics, astronomy and astrophysics."
So, off Jake went to Indiana University-Purdue University Indianapolis driven to class by his mom or dad. His professor sees great things for Jake. "We have told him that after this semester -- enough of the book work. You are here to do some science," said IUPUI physics Professor John Ross, who vows to help find some grant funding to support Jake and his work.
Mom Kristine, who says she is still not sure if this is work or play on his part, sent a video of Jake proposing a "new expanded theory of relativity" to astrophysics Professor Scott Tremaine at Princeton University. "The theory that he's working on involves several of the toughest problems in astrophysics and theoretical physics, Tremaine said. "Anyone who solves these will be in line for a Nobel Prize."
Read more: Autistic physics genius, 12, in college - UPI.com
Researchers with the U.S. National Institute of Mental Health and the Pfizer pharmaceutical company tested the drug called GRN-529 in mice that normally display autistic-like activities - in particular, social isolation and repetitive behaviors. NIMH co-investigator Jill Silverman says that after being injected with the experimental compound, the mice reduced two of their repetitive behaviors - obsessive grooming and jumping - and the normally asocial rodents engaged more with other mice. Researchers say the experimental compound dampens the activity of the brain chemical glutamate by modifying one of its chemical receptors. That could target a number of autistic behaviors linked to a defect in connections between brain cells or neurons.
But they don't know for sure. Silverman says the biochemical mechanism of GRN-529 is not completely understood, though she's not surprised that adjusting the biological activity of glutamate, which helps stimulate neurons throughout the brain, might reverse some of autism's core symptoms. "It's crucially involved in every connection in the brain, basically," said Silverman. "So, modulating its effects by acting at one receptor seems to be a very promising target."
Robert Ring was involved in the GRN-529 study at Pfizer and is now vice president of translational research with Autism Speaks, an non-profit scientific funding and advocacy group. Ring says the possibility of a drug that could treat the symptoms of autism, even if it's not a cure, could improve the quality of life for autistic individuals by making behavioral interventions more effective. "Individuals living with autism don't just encounter struggles with the core symptoms that have been defined for autism," said Ring. "But they have a whole host of associated psychiatric and neurological syptoms that also reduce the quality of life for them. And any agent that has the potential to reduce these may bring significant benefit to this population."
The experimental compound is currently in clinical trials for individuals with a disorder called fragile x syndrome, which is caused by a single mutated gene. Fragile x is the most commonly inherited form of intellectual impairment, often with autistic symptoms. Because the mice are born with the autistism-like tendencies, researchers know that GRN-529 might not work in children with autism. But then again, it might. An article on GRN-529 in mice is published in Science Translational Medicine.
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The Perromat family has three beautiful boys: Lucas, Philip and Thomas. Philip is the middle child. By the time he was a toddler, Kim and Carlos Perromat had already suspected that Philip's failure to make eye contact and his unwillingness to speak were caused by more than just slow development. So they were not really surprised when he was diagnosed with autism. Carlos says he tried to learn everything he could about the disorder. He believes he wasted a lot of valuable time trying to find the right treatment program for his child. "It's not a question of lack of information. It's a question of too much. It's impossible to sift through," he said.
Kim and Carlos have been taught to use applied behavior techniques to help Philip identify what he wants. At first, it was just one word, and even though Philip knew the word for the toy he wanted, he wouldn't say it until he realized it was the only way his parents would give it to him. The genetic link to autism may be prevalent in more than one male member of the Perromat family. Carlos believes that he and his father, and now perhaps his oldest son Lucas, also have signs of a high-functioning type of autism called Asperger's Syndrome. The youngest boy, Thomas, has shown no symptoms.
Katie Divelbiss of the Center for Autism and Related Disorders says parents should find a way to communicate with their autistic child as soon as possible. Teach them how to communicate," said Divelbiss. "That could be using pictures, that could be teaching them how to use hand signs, that could be a one word or a 'ugh' - one utterance."
For decades, autism was categorized incorrectly as a form of childhood schizophrenia, and in recent years as a diverse spectrum of developmental brain disorders. Doctor Susan Hyman of the American Academy of Pediatrics says the definitions of autism are changing because the difference between disorders on that spectrum can be hard to distinguish. "It's better to think of it as a single spectrum or a singular category with different degrees of intensity and different other factors that impact how significant the diagnosis is," said Hyman.
Professor Roy Richard Grinker is a recognized authority on autism whose own daughter was diagnosed with the disorder in 1994. Back then, Grinker says, there was little awareness or understanding of autism in the United States. That has changed, he says. "I don't know that the treatments for autism today are that much different than the treatments for autism back in 1994 or 1995, except for this: Society understands autism. Society gets it. Autism is no longer invisible," said Grinker. The National Institute of Mental Health, which is part of the National Institutes of Health, has a complete guide for parents who want to know more about autism, A Parents Guide to Autism Spectrum Disorder.
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Autism is nearly unknown in the Amish Community. I wonder why? Could it be vaccines, GMO crops and HFCS?
Naw!
The revisions come in the first major rewrite in nearly 20 years of the diagnostic guide used by the nation's psychiatrists. Changes were approved Saturday. Full details of all the revisions will come next May when the American Psychiatric Association's new diagnostic manual is published, but the impact will be huge, affecting millions of children and adults worldwide. The manual also is important for the insurance industry in deciding what treatment to pay for, and it helps schools decide how to allot special education.
This diagnostic guide "defines what constellations of symptoms" doctors recognize as mental disorders, said Dr. Mark Olfson, a Columbia University psychiatry professor. More important, he said, it "shapes who will receive what treatment. Even seemingly subtle changes to the criteria can have substantial effects on patterns of care." Olfson was not involved in the revision process. The changes were approved Saturday in suburban Washington, D.C., by the psychiatric association's board of trustees.
The aim is not to expand the number of people diagnosed with mental illness, but to ensure that affected children and adults are more accurately diagnosed so they can get the most appropriate treatment, said Dr. David Kupfer. He chaired the task force in charge of revising the manual and is a psychiatry professor at the University of Pittsburgh.
One of the most hotly argued changes was how to define the various ranges of autism. Some advocates opposed the idea of dropping the specific diagnosis for Asperger's disorder. People with that disorder often have high intelligence and vast knowledge on narrow subjects but lack social skills. Some who have the condition embrace their quirkiness and vow to continue to use the label.
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I think stronger criteria for the diagnosis of autusm is a good thing. I feel that "Autism" has become the newest PC catchall for everything that is wrong with children these days.
According to a report published Wednesday in the New York Times, proposed changes to the definition for the new DSM edition, slated to be published next year, would exclude Aspergers and PDDNOS and consolidate autism diagnoses under a narrower category of autism. The person would have to show three deficits in social interaction and communication and two repetitive behaviors, a stricter set of criteria.
Many autism experts support the proposed changes, saying they will make it far easier to diagnose autism.
New Autism Definition Could Exclude Many - ABC News
Autism is the new ADD
But a Comprehensive Autism Care Demonstration that began a slow rollout in late October will still leave retirees and reserve component families facing heavy out-of-pocket costs to provide children with intensive ABA therapy that has become a standard of care, say advocates for families. Defense Health Agency (DHA) officials say the demonstration, which is to run through December 2018 and is open to any military child diagnosed with autism, will be a platform for evaluating ABA therapy, a series of behavior interventions, to learn which ones benefit autism patients the most.
Army Maj. Gen. Richard W. Thomas, chief medical officer and director of healthcare operations for DHA, calls ABA therapy is an “emerging science.” Just as military has done for trauma care and other facets of health care delivery, Thomas sees the autism demonstration resulting in “new, innovative solutions to these patients” and discovery of best practices that are safe and effective. He called the improved autism coverage a “very robust and generous benefit. We can’t find anything comparable to it on the outside…We have the most broad-based, generous benefit for patients with these diagnoses.”
Kayleigh Norton, Applied Behavior Analysis therapist, reviews numbers with the six-year-old son of a servicemember at Joint Base Charleston, S.C.
A key feature of the demonstration removes an annual cap of $36,000 on Tricare family coverage of ABA therapy costs. This will allow more children to receive comprehensive treatment levels, typically 25 to 40 hours of therapy per week. The old cap limited treatments to 12 hours a week. “Families will finally have coverage of prescribed level of care. This is a very important development,” said Karen Driscoll, associate director for military relations at Autism Speaks, the nation’s largest funder of autism research and advocacy. Driscoll is married to a retired Marine and their oldest son has autism.
ABA therapy uses environmental modifications to produce socially significant changes in behavior of autistic children. It is endorsed by the U.S. Surgeon General and the American Academy of Pediatrics and is “the standard of care in the treatment of autism today,” Driscoll said. For the demonstration, DHA combined three autism treatment programs into one, ending separate programs for active duty families, non-active duty families and an interim plan under court order that required Tricare to offer ABA therapy as part of its basic benefit. Good riddance to an “administrative nightmare,” said one DHA official.
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