Autism NICE guidance

Autism: The management and support of children and young people on the autism spectrum (CG170).  This clinical guideline offers evidence-based advice on the care and management of children and young people with autism.

Press release:  http://www.nice.org.uk/newsroom/news/TailorManagementAutismChildrenYoungPeopleIndividualNeeds.jsp

Guideline:  http://guidance.nice.org.uk/CG170

Is road traffic pollution really a cause of autism?

“Severe air pollution ‘can double risk of having autistic child’,” reports The Times.  This frightening headline was based on a US case controlled study published in the journal Environmental Health Perspectives into the exposure to environmental pollutants of mothers with children diagnosed with autism spectrum disorder (ASD).

The study compared women in the highest 20% pollution exposure category with those in the lowest 20% of pollution levels. It found exposure to diesel, lead, manganese, mercury, methylene chloride and an overall measure of metals were all significantly associated with a higher risk of ASD.  However, due to its study design this research cannot, and does not, prove that higher air pollution around the time of childbirth causes or increases the risk of a child developing ASD.  The causes of ASD are not firmly established and it is likely this research has not accounted for other factors that could be influencing risk. However, it does suggest a potential link that warrants further investigation.

Neither the Daily Mail nor the Daily Mirror’s coverage discussed the limitations of the research although The Times’ coverage included points from ‘other scientists’ outlining some of the study’s limitations.

Behind the Headlines Story
http://www.nhs.uk/news/2013/06June/Pages/Is-road-traffic-pollution-really-a-cause-of-autism.aspx

 

Original Research http://ehp.niehs.nih.gov/1206187/

 

Evidence Updates: Autism / Self harm

NHS Evidence has published two Evidence Updates which aim to inform health and social care professionals about new evidence that reinforces or may be a consideration in a future update to a NICE clinical guideline; they are not intended to replace current guidance or provide formal practice recommendations:

–  Autism diagnosis in children and young people . A summary of selected new evidence relevant to NICE clinical guideline 128 ‘Autism – recognition, referral and diagnosis of children and young people on the autism spectrum 2011 Evidence update 40.

–  Self-harm: longer term management . A summary of selected new evidence relevant to NICE clinical guideline 133 ‘Self-harm: longer term management’ (2011) Evidence update 39.

https://www.evidence.nhs.uk/about-evidence-services/bulletins-and-alerts/evidence-updates/evidence-updates-by-date

Abnormal growth rate in womb linked to autism

‘Babies that are abnormally heavy or underweight are at 62% greater risk’ of developing autism, reports the Daily Mail. The news is based on a large study of Swedish children with and without autism spectrum disorder (ASD).  The study case control study of youth in Stockholm was published in the American Journal of Psychiatry.

Researchers examined whether there were any differences between the children in terms of how quickly they grew while in the womb (foetal growth) and the length of the pregnancy.  They found that babies with unusually low and unusually high levels of foetal growth had an increased risk of ASD.  This large study does suggest a possible association between foetal growth and ASD, but it does not prove a direct cause and effect.  This study does raise interesting questions about how development in the womb could affect a child’s risk of ASD.

The study was covered by the Daily Mail, whose reporting was arguably not as clear as it could have been. While the main findings of the study were reported accurately, there was no discussion about the limitations of the study.  The reporting focuses on birth weight whilst the original research focuses on foetal growth.

Full Behind the Headlines Article:
http://www.nhs.uk/news/2013/05May/Pages/Abnormal-growth-rate-in-womb-linked-to-autism.aspx

Original Article in American Journal of Psychiatry
http://ajp.psychiatryonline.org/article.aspx?articleid=1674558

Final response to the events at Winterbourne View Hospital

The Department of Health has published ‘Transforming care: A national response to Winterbourne View Hospital’. The report sets out the governments final response to the events at Winterbourne View hospital. It sets out a programme of action to transform services for people with learning disabilities or autism and mental health conditions or behaviours described as challenging. A number of supporting documents have been published alongside the report.

https://www.gov.uk/government/publications/winterbourne-view-hospital-department-of-health-review-and-response

Older dads ‘more likely’ to have autistic grandkids

“Having an older grandfather ‘raises autism risk'” the Daily Telegraph reports, saying that older fathers are much more likely to go on to have grandchildren with autism.  The association between fathers’ ages and the likelihood of their children having autism has been seen before. This news comes from a study suggesting that the link may go back another generation.  This association was particularly clear for men who had children after the age of 50.  The researchers speculate that the association seen in the study may be caused by mutations in men’s sperm cells that develop as they grow older.

This case controlled study was carried out by researchers from Sweden, UK, US and Australia and published in JAMA Psychiatry.  As a case-control study, this research can only describe associations between age and autism risks two generations later. It cannot tell us conclusively that one causes the other, and can only speculate as to possible causes underlying the association.  A single cause for autism, such as genetics, is unlikely with several interacting risk factors having been proposed.

The research was covered appropriately in the media, with both BBC News and The Daily Telegraph pointing out that the results do not mean that older people should be discouraged from having children. The chances of a child being born with autism are quite small, despite more alarming figures of a 67-79% relative increase.

Behind the headline http://www.nhs.uk/news/2013/03March/Pages/Older-dads-more-likely-to-have-autistic-grandkids.aspx

Original article: http://archpsyc.jamanetwork.com/article.aspx?articleid=1666654

Five ‘mental disorders’ may have genetic links

Sky News reports that, “five of the most common psychiatric disorders are genetically linked.” This news is based on a landmark study that examined the genetic sequences of more than 50,000 people. Some of these people had one of five common long-term conditions the researchers called ‘psychiatric disorders.’ These were: autism, attention deficit hyperactivity disorder, clinical depression, bipolar disorder and schizophrenia.

The study was carried out by researchers from the Cross-Disorder Group of the Psychiatric Genomics Consortium, and published in the peer-reviewed journal The Lancet.  This useful and well-conducted study provides an invaluable insight into the possible genetic factors linked to these common mental health disorders.

Researchers found variations in four genetic regions were associated with these disorders when they looked at the DNA of people who had been diagnosed with one of the mental or behavioural conditions.  Some of these genetic variations affect how calcium moves through the brain. These findings have given rise to speculation about the possibility of new treatments being developed for these conditions.

However, reports that genetic testing could be used to predict or diagnose mental illnesses are probably wide of the mark. The researchers have stated that the effects of the genetic variations are small, and that on their own the variations would not be useful for predicting or diagnosing these conditions.  It is also simplistic to regard mental health conditions or behavioural problems as being purely genetic. There is a wide range of rigorous evidence that shows that environmental factors are also involved.

Behind the Headlines page: http://www.nhs.uk/news/2013/February/Pages/Five-mental-disorders-genetic-links.aspx

Original Article: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)62129-1/fulltext

Is it possible for children to ‘grow out’ of autism?

“Children can ‘grow out of’ autism, psychologists say, challenging the established view that autism is a permanent, incurable condition,” The Independent has reported.

 The story is based on a study that documented a group of individuals with an early history of diagnosed autism.  These individuals no longer met the criteria for this diagnosis in later life and seemed to function normally.  The study compared the functioning of this group with a group consisting of people with high functioning autism (often referred to as Asperger syndrome) and a second group of people who were developing or had developed “normally”.  This observational study was carried out by researchers in Canada and the USA and was published in the peer-reviewed Journal of Child Psychology and Psychiatry.

 The study found that people in the first group, who had lost the autism diagnosis, showed language, face recognition, communication and social interaction skills no different from the “normal” group and had no remaining autistic symptoms.  However, whether they genuinely “grow out” of autism is uncertain. It is possible that some of these children were misdiagnosed initially, or that intensive therapy helped this group ‘mask’ their underlying condition.

 While this study suggests that there may be individual cases where symptoms of autism can be overcome, it does not provide any evidence about the most effective way this can be done.  As the authors say, more research is needed to explain their findings and to explore how children with autism can be best helped to develop their potential.

 http://www.nhs.uk/news/2013/01January/Pages/Can-children-grow-out-of-autism.aspx

Asperger’s not in DSM-5 mental health manual

‘Asperger’s syndrome dropped from psychiatrists’ handbook’, is the headline in The Guardian. The news is based on a press release from the American Psychiatric Association (APA) announcing the approval by their Board of Trustees of a revised fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).  The DSM is essentially designed to be a ‘user manual to diagnose mental illness’ – providing US psychiatrists with clear definitions of what pattern of symptoms correspond to specific conditions.

One (amongst many) of the controversial decisions taken by the panel, made up of over 1,500 mental health experts, involved in drawing up the new draft guidelines, is to remove Asperger’s syndrome as a separate diagnosis and replace it within the term ‘autism spectrum disorder’.  In the terminology of the DSM-5 – Asperger’s syndrome would be seen as being at the ‘upper end’ of the autistic spectrum disorder (ASD). That means people with this type of ASD would normally have unaffected intelligence and language development, but would have milder symptoms affecting social interaction, behaviour and language comprehension.

Despite the media hype, the revised classifications in DSM-5 will have limited impact on individuals who receive mental health care in the UK, at least in the short-term.  Psychiatrists in the UK tend to use the World Health Organisation’s International Classification of Diseases (ICD) system to diagnose mental health conditions, rather than DSM, which is used in the US.  Also, the term ‘autistic spectrum disorder’ (and the concepts underpinning it) have been widely used in the UK for many years. However, in the long-term, it is difficult to predict the potential impact the DSM-5 will have on the future diagnosis and treatment of m

http://www.nhs.uk/news/2012/12December/Pages/Aspergers-dropped-from-mental-health-manual-DSM-5.aspx

‘Autism gene discovered’ by researchers

“Genetic mutation discovered in people with autism,” The Daily Telegraph reports.  The newspaper goes on to say that this mutation “cuts communication between brain cells to about one-tenth of normal levels” and offers “a likely explanation” for the cognitive and behavioural difficulties experienced by people with autism.  This headline is loosely based on recent research published in the ‘Journal of Neuroscience’ into the impact of a previously discovered genetic mutation on the ability of brain cells to transmit signals.

The researchers described the detailed molecular processes that occur between brain cells when the level of a specific protein is changed.  Previous research had discovered that mutations to the gene that controls this protein occurred in people with some types of autism. The authors found that varying the level of this protein affected other proteins responsible for communication between the rats’ brain cells.  The research did not, however, examine the impact of this disrupted communication in people with autism, and should not be interpreted as offering “a likely explanation for their cognitive and behavioural difficulties” as reported by the Telegraph.  In addition, many experts think that autism may arise as the result of a combination of factors – not just genetics.

While the Telegraph appropriately pointed out that a treatment based on this research is years away, their coverage of the study is flawed. To start with, this research did not discover a genetic mutation in people with autism. That link had been previously established. The Telegraph’s coverage also fails to mention that the study was conducted in rats, and further misguides readers by picturing a scan of a human brain.

 http://www.nhs.uk/news/2012/11November/Pages/Autism-gene-discovered-by-researchers.aspx