Autistic young men and women are more affected by psychiatric conditions and have an increased risk of being hospitalized as a result of their mental illness compared with non-autistic people. Autistic women are particularly vulnerable. This is shown by researchers from Karolinska Institutet in a study published in JAMA Psychiatry.   

Autistic people have an increased risk of suffering from mental illness. Current data indicates that autistic women are more vulnerable than autistic men, but few studies have been able to establish that there are sex differences.   

Researchers from Karolinska Institutet have now conducted a register-based cohort study with more than 1.3 million people in Sweden who were followed from the age of 16 to 24 between 2001 and 2013. Just over 20,000 of these individuals were diagnosed with autism.   

The researchers found that by age 25, 77 out of 100 autistic women, compared with 62 out of 100 autistic men, had received at least one psychiatric diagnosis.  

“We saw an increased risk of eleven different psychiatric conditions, including depression, anxiety disorders, self-harm and difficulty sleeping,” says Miriam Martini, a doctoral student in psychiatric epidemiology at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet and first author of the study. 

  

Something that Miriam Martini finds particularly worrying is that 32 out of 100 autistic women had been hospitalized as a result of their mental illness, compared with 19 out of 100 autistic men. For non-autistic people, the corresponding figure was less than five out of 100.    

The study focuses on young adults who are at a crucial time in their life when many mental health problems increase, while the transition to adulthood often means poorer access to care, says Miriam Martini.    

“Healthcare for young adults needs to be expanded, especially for autistic women, so that mental illness can be detected in time to avoid worsening of symptoms resulting in hospitalization,” says Miriam Martini.   

The reason why autistic women are more affected by mental illness than autistic men is not clear, but in the study, the researchers point to several possible factors. Previous research has shown that autistic women to a greater extent use compensatory behaviours to camouflage their autism, which may be due to the fact that women generally tend to adapt to the expectations of those around them. This delays diagnosis and the provision of assistance, which can negatively affect their mental health.   

Another possible explanation may be that it could be difficult to detect autism in women using diagnostic criteria.    

“It may be that autism manifests differently in women than in men, which means that women are not detected using today’s diagnostic criteria. This is something we need to do more research on,” says Miriam Martini.   

The study was funded by MQ Mental Health Research. Some of the study authors have received compensation from industrial companies outside the scope of the current study.    

The Autism Diagnostic Observation Schedule (ADOS) did not change the diagnosis in 90% of cases; study findings could reduce wait times for diagnosis and care

Trained developmental-behavioral pediatricians can generally diagnose autism spectrum disorder (ASD) in young children without the need for additional Autism Diagnostic Observation Schedule (ADOS) testing, finds a prospective multicenter study. The study, conducted through the Developmental Behavioral Pediatrics Research Network (DBPNet) and led by Boston Children’s Hospital, was published October 17 in the journal JAMA Pediatrics.

The ADOS was originally developed as a research tool. Through semi-structured observations, specially trained evaluators assess children’s communication skills, social interaction, and imaginative use of materials.

“The ADOS was never designed to be used in the clinic,” says William Barbaresi, MD, the study’s principal investigator and chief of the Division of Developmental Medicine at Boston Children’s. “But currently, ADOS testing is often required for young children to receive an ASD diagnosis that is accepted by early intervention agencies, schools, and insurers. This study shows that in the majority of cases, young children may be able to have a diagnostic evaluation for ASD by a developmental-behavioral pediatrician without using the ADOS.”

ADOS administration is time consuming, adds additional cost to the diagnostic process, and  there are not enough people trained to administer it. “The requirement for ADOS testing has become a barrier to timely diagnosis and initiation of treatment,” Barbaresi says. “Young children can wait months or even years for an assessment, making it difficult for them to access intensive early intervention services when they are most effective — ideally starting at around 24 months of age.”

The study involved 349 children aged 18 months to 5 years who were evaluated at nine academic pediatric centers. Developmental-behavioral pediatricians (DBPs) first made a diagnosis based on their clinical assessment. A specially trained clinician then administered the ADOS, the results of which were shared with the DBP, who then could revise their diagnosis.

In 90 percent of cases, the diagnosis including the ADOS was consistent with the original clinical diagnoses. Consistency was most likely when the clinician felt highly certain of their original diagnosis.

“Overall, this study is good news,” says Barbaresi. “We believe it has the potential to change current practice by reducing wait times for diagnostic evaluations so that children can receive early, intensive treatment for ASD.” The other participating centers were the Children’s Hospital of Philadelphia, Children’s Hospital Colorado, University of Arkansas for Medical Sciences, University of California-Davis, Children’s Hospital Los Angeles, Hospital of St. John of God (Linz, Austria), Rainbow Babies and Children’s Hospital (Cleveland, Ohio); and the Children’s Hospital at Montefiore (Bronx, NY).

New autism diagnoses tend to be clustered within specific NHS service regions, suggesting that where individual life may influence whether they receive an autism diagnosis and access to special education needs support.

The latest findings, from researchers from the University of Cambridge in collaboration with researchers from the London School of Economics and Political Science and Newcastle University, are published today in the Lancet Child & Adolescent Health.

After analysing all new autism cases across England using NHS health service boundaries for possible hotspots, some areas stand out. For example, 45.5% of the NHS Rotherham catchment area had higher-than-average new autism diagnoses clusters. For NHS Heywood, this amounted to 38.8% of its catchment area and 36.9% for NHS Liverpool, pointing at a possible health service effect towards who receives an autism diagnosis.

The research team used four years’ worth of data from the Summer School Census, which collected data from individuals aged 1-18 in state-funded schools in England. Of the 32 million pupils studied, more than 102,000 new autism diagnoses were identified between 2014 and 2017.

After adjusting for age and sex, the researchers found that one in 234 children was given a new autism diagnosis during those four years. New diagnoses tend to happen when children are transitioning to a new school, whether that is into the nursery (1-3 years), primary school (4-6), or secondary school (10-12 years).

Particular communities appeared to have different rates, varying by ethnicity and deprivation. 

Lead researchers Dr Andres Roman-Urrestarazu from the Department of Psychiatry and Cambridge Public Health at the University of Cambridge said: “Autism diagnoses are more common among Black students and other minority ethnic groups. Why this is the case is not clear, and so we need to explore the role played by social factors such as ethnicity and area deprivation as well as the nature of local services.”

The likelihood of receiving an autism diagnosis more than tripled among girls depending on their ethnicity and social and financial situation compared to white girls without financial disadvantages who speak English as their first language.

In contrast, boys’ likelihood of receiving an autism diagnosis increased more than five-fold depending on their ethnicity and social and financial situation compared to white boys without financial disadvantages who speak English as their first language.

Boys and young men are already more likely to receive autism diagnoses, but the social determinants that could affect a diagnosis remain an open question.

Dr Robin van Kessel, co-lead researcher from the Department of Health Policy at the London School of Economics and Political Science said: “These new findings show how social determinants interact and can combine to increase the likelihood of an autism diagnosis significantly. As a result, individuals from a minority ethnic background experiencing economic hardship may be significantly more likely to receive an autism diagnosis than their peers.”

Professor Carol Brayne from Cambridge Public Health said: “There are clear inequalities in an individual’s likelihood of receiving an autism diagnosis, whether they are socioeconomic factors, ethnicity or even which NHS region or local authority someone lives in.”

Crisann Black wanted more inclusive spaces for people with special needs, like her 4-year-old son Zeus and started Club Zeus, a once-a-month dance party, for those with special needs or disabilities

Scientists at Oregon Health & Science University have identified a long-sought gene-encoded protein that enables the brain to communicate a broad range of signals across gaps between neurons, known as synapses.

The discovery published today in the journal Nature.

Known as synaptotagmin-3, or SYT3, the protein helps to replenish the supply of chemical neurotransmitters that carry signals between neurons.

“When brain cells are active, they release neurotransmitters to communicate with their neighbors,” said senior author Skyler Jackman, Ph.D., assistant scientist in the OHSU Vollum Institute. “If a cell is very active it can exhaust its supply of neurotransmitters, which can cause a breakdown of communication and brain disfunction.

“It turns out that cells have a boost mode that replenishes their supply of neurotransmitters, but until now, we didn’t know the molecule that was responsible. We found that SYT3 is directly responsible for that neurotransmitter boost,” he said. “This gives us new insight about how brains can break down and fail to process information properly.”

Researchers generated “knock-out” mice that did not have the SYT3 gene. They found that those mice lacked the more robust level of synaptic transmission, compared with control mice that had the gene.

Notably, mutations of the SYT3 gene have been implicated in human cases of epilepsy and autism spectrum disorder. The research published today suggests the possibility of developing gene therapies or pharmaceutical approaches targeting SYT3, Jackman said.

“Imbalances in neurotransmitter release are the underlying causes for many neurological disorders,” said lead author Dennis Weingarten, Ph.D., a postdoctoral researcher in the Jackman lab. In the future, he said, “understanding these molecular switches — such as SYT3 — is a crucial step for us to combat these diseases.”

Jackman’s lab specializes in the study of synaptic transmission. The human brain contains hundreds of trillions of synapses. Discovering the molecules that endow these specialized structures with their unique properties is essential for understanding brain function and neurological disorders. 

“Synaptic transmission is fundamental for sensing our surroundings, making decisions and nearly every other feature of our inner world,” Jackman said.