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Autism Clues: Seeing Inside The Brain

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SEATTLE (Ivanhoe Newswire) - More than two million Americans have autism and studies suggest prevalence rates increase 10 to 17 percent each year. Researchers are getting closer to understanding this mysterious disorder by looking side the brain.

It will affect one in every 88 children, but autism has no known cause and no cure.

Researchers at the University of Washington are looking for answers. They are using special glasses to measure a toddler's eye contact.

"It records what I'm seeing, so I can see whether a child is looking at my eyes or my mouth," Wendy Stone, PhD, Clinical Psychologist, UW Medicine, told Ivanhoe.

Scientists are also looking at brain chemistry using MRI.

"Kids with autism have about 10 percent bigger brains than other kids," Stephen R. Dager, MD, Professor of Radiology, UW Medicine, told Ivanhoe.

Doctors found between ages 3 and 10, children with autism and those with developmental delays had significantly less of an important brain chemical. However, by age 10, the autism group had normal levels, but the kids with delays were still low.

Scientists believe this study shows development isn't fixed in autism.

"We also found that, in many ways, children bloomed and grew and became really interesting and wonderful people," Annette Estes, PhD, Director, UW Autism Center, Susan & Richard Fade Endowed Chair, Research Associate Professor of Speech and Hearing Sciences, University of Washington, told Ivanhoe.

These new insights are bringing doctors another step closer to understanding a complex disorder.

Researchers are now studying three month old babies who have siblings with autism. They want to determine if very early alterations in brain cell signaling may precede early clinical symptoms of autism.

RESEARCH SUMMARY

BACKGROUND: Autism and autism spectrum disorder are both general terms for a group of complex disorders of brain development. These disorders are characterized by difficulties in verbal and nonverbal communication, social interaction, and repetitive behaviors. Autism begins during early brain development, but symptoms and signs usually cannot be seen until the child is two or three. About 1 and 88 children in the U.S. will develop some form of autism and it is about five times more common in boys than girls. Studies show that 1 in 252 girls and 1 in 54 boys in the U.S. are diagnosed with autism. (Source:    http://www.autismspeaks.org/what-autism)

CAUSES: What causes autism?  Not long ago, the answer to this question would have been "we have no idea."  Researchers are now delivering the answers.  First, we now know that there is no one cause of autism.  Over the last five years, researchers have found a number of rare gene changes, or mutations, associated with autism.  However, most cases of autism appear to be caused by a combination of autism risk genes and environmental factors that influence early brain development.  (Source: http://www.autismspeaks.org/what-autism)

NEW TECHNOLOGY: Between ages three and ten, autistic children exhibit distinct brain chemical changes that differ them from children with developmental delays and those with typical development, according to a study at the University of Washington. "In autism, we found a pattern of early chemical alterations at the cellular level that over time resolved – a pattern similar to what others have seen with people who have had a closed head injury and then got better," Dr. Stephen R. Dager was quoted as saying. "The brain developmental abnormalities we observed in the children with autism are dynamic, not static. These early chemical alterations may hold clues as to specific processes at play in the disorder and, even more exciting, these changes may hold clues to reversing these processes."  In the study, researchers compared brain chemistry among three groups of children: those with autism spectrum disorder, those with a diagnosis of developmental delay, and those considered typically developing.  They used MRI to measure tissue-based chemicals in three age groups: three to four years old, six to seven years, and nine to ten years. An important finding concerned changes in gray matter N-acetylaspartate concentration in scans of the three to four year-olds, concentrations were low in both the autism spectrum disorder and developmentally delayed groups. By nine to ten years, N-acetylaspartate levels in the children with autism spectrum disorder had caught up to the levels of the typically developing group, while low levels of N-acetylaspartate persisted in the developmentally delayed group. (Source: http://www.washington.edu/news/2013/08/01/brain-chemistry-changes-in-children-with-autism-offer-clues-to-earlier-detection-and-intervention/

INTERVIEW

Wendy Stone, PhD, Clinical Psychologist, UW Medicine, talks about new research in autism.

We've been doing a lot of autism stories over the years and the numbers keep getting closer and closer together.  It used to be 1 in 110, now it's 1 in 88 and that's only on an average.  Does that worry you?  

Dr. Stone: When I came into the field in 1980, the numbers were 3 or 4 out of 10,000.  So, it is a remarkable change.  I mean, it is alarming that the prevalence is so high; the numbers are so high right now.  There are many possible reasons for the increased numbers, but I don't think we really have a definitive explanation at this time.  

Do you think it's just because it's being diagnosed now?  

Dr. Stone:  We certainly do have better recognition now.  There is more awareness about autism, and if you have a label for something, then it is easier to find it. On the other hand, having been in the field for so long, there appear to be more children who actually meet the diagnostic criteria than there used to be.  

I've heard about low birth weight, the age of the father is something that's kind of coming into it now, right?  I thought that was interesting because all problems are always blamed on the mom.  

Dr. Stone: Yes, we know that genetic factors contribute to autism, and it seems fair to look for risk factors in fathers as well as mothers. Scientists are also looking into more environmental causes of autism.  The prenatal environment could be one type of environmental cause, but we are looking at different kinds of possible environmental factors. For example, we know that there are lots of neurotoxins that we encounter every day in minute amounts through breathing, touching, smelling, and drinking. So the question now is, is there something present in the environment that may be contributing to the increased numbers.

Does that always have to go with pollution or could it be?

Dr. Stone: No, I don't think it's necessarily the kind of pollution that we think about, air pollution or smog. I think it's more about the combinations of the chemicals that are used in things like foam cushions, or other materials that we encounter daily. Singularly they may not be present at toxic levels, but we don't know whether they have a cumulative effect. There are some studies that are exploring that now. 

We hear a lot about how early intervention is just so important, and we've witnessed where you see a child that had early intervention and by the time they are six, you can't tell that they had autism. Is that because it's early intervention? Is it because you have parents who are so diligent and this is something that can be kind of reversed?  

Dr. Stone: Yes, children who receive autism-specialized intervention at young ages can show really dramatic improvements and sometimes no longer meet the diagnostic criteria for autism.  It's hard to know how much is due to the intervention as opposed to the natural course of development for a given child.  It's tricky to figure this out because most children who receive an early diagnosis, do get some sort of intervention.  So, we don't really have a comparison of diagnosed children who don't receive any intervention. But we do know that with specialized intervention, and by specialized I mean interventions that focus on the core social-communicative impairments of autism, you can see really great improvement in important behaviors like social interaction, imitation, communication, and play. For some children, we don't just need to teach them how to communicate, but first need to teach them that there is a process of communication with others that can help them get their needs and desires met. There are some very focused interventions and some very broad-based interventions that suggest that the early core behavioral deficits of autism are malleable, which is very encouraging.

Can some children be cured?

Dr. Stone: So, "cure" is an interesting word because autism is a brain-based disorder.  It's a complex neurobiological disorder.  And so what exactly does cure mean?  If it means that your symptoms improve to the extent that you no longer meet diagnostic criteria for autism, then yes, that can happen for some children. If it means that your brain processes information in exactly the same way as others, then maybe not.  But different wiring may not matter if you're able to compensate for your areas of weakness. And we all have areas of strength and weakness, whether or not we have autism.

How early can you diagnose someone?  

Dr. Stone: There are different ways to think about this.  There are certainly some children who come into the clinic or the lab who are 14 or 15 months old and you have strong suspicions.  There is replicated research that the diagnosis can be made as young as 24 months.  There is emerging research that it can be made reliably at about 18 months, and by reliably I mean that the diagnosis is fairly stable over time, and that individual diagnosticians agree when they are blind to each other's opinions.

How early can you see the signs?

Dr. Stone: How low can we go? That is one of the key questions to answer in early identification research. We are working really hard to find early signs, knowing that early intervention is so effective for so many children.  So we have started looking for signs of autism in babies.  We know that younger siblings of children with autism are at elevated risk for eventually getting a diagnosis.  So, when we study these younger siblings, we can actually watch their behavior and monitor it from birth, to find the earliest signs.  Right now, in terms of the behavioral signs of autism, there is pretty good evidence that some early signs begin to appear in the first year of life. But it is very difficult to make a definitive diagnosis that young.

And so tell me about these glasses.  What can you do with these glasses to also be able to tell? 

Dr. Stone: We are very interested in how infants and toddlers process their visual world - what kinds of things they are looking at and which are particularly salient to them. For young children at risk for autism, we wanted to find a way to measure where they are looking during social interactions. So we have been trying out a specific type of eyeglasses that has a video camera embedded in the frame. When we wear the glasses, the camera records whether the child is looking at our face, and, more importantly, whether the child is looking at our eyes or our mouth. This type of differentiation is very hard to make from the traditional camcorders that are wall-mounted and stationary. There is an exciting new field called computational behavioral science that can use mathematical models and computational approaches for helping us understand social behavior by analyzing the data from these eyeglasses.

Are there things I could do even when my child's born just to decrease the chance, or help him along socially even if he has autism?

Dr. Stone: Well, as human beings we are pretty strongly wired to provide social stimulation to our babies, just as babies seem to be biologically driven to attend to human faces. Babies learn within a social context, and there is a natural rhythm that develops when babies and caregivers are interacting. If you are concerned that your baby is not responsive or interactive, then it is really important that you speak to your primary health care provider about it. 

FOR MORE INFORMATION, PLEASE CONTACT:

Annette Estes, Ph.D.
Director, UW Autism Center
Susan & Richard Fade Endowed Chair
Research Associate Professor of Speech and Hearing Sciences
University of Washington
206-543-1051
estesa@uw.edu

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