Autism

Posted on Autism

Survey heightens concern about pandemic’s impact on education of autistic students

Helen M. Genova, PhD


Dr. Genova is associate director of the Center for Autism Research at Kessler Foundation. CREDIT Kessler Foundation

Kessler Foundation scientists conducted an online survey of parents of school-aged children to compare the effects of pandemic-related school closures on autistic vs neurotypical students. Their findings indicate that children on the autism spectrum are at greater risk for negative educational outcomes.

The article, “Effects of school closures resulting from COVID-19 in autistic and neurotypical children,” (doi: 10.3389/feduc.2021761485) was published open access on November 23, 2021, by Frontiers in Education. This open access article is available at:https://www.frontiersin.org/articles/10.3389/feduc.2021.761485/full The authors are Helen Genova, PhD, Aditi Arora, PhD, and Amanda Botticello, PhD, MPH, of Kessler Foundation.

Using the COVID-19 Adolescent Symptom and Psychological Questionnaire, survey data were collected from May 2020 to August 2020 from parents/guardians of school-aged children – autistic and neurotypical – aged 4 to 15 years. Final sample was N=250, including respondents with neurotypical children (65%), and those with autistic children (35%).

The survey revealed differences in the psychological impact of the pandemic on neurotypical and autistic children, as reported by their parents. Overall, parents of autistic children were more likely to report negative effects of the pandemic. For neurotypical children, being isolated from friends was the most negative experience; for autistic children, disruption of their routine schedule was the most negative.

While neurotypical children turned to virtual experiences to connect socially, autistic children were less likely to participate in virtual experiences. This finding has implications for the shift to online delivery of education, medical treatment, and therapy precipitated by the pandemic. “Children on the autism spectrum may benefit less from virtual services,” noted Dr. Genova. “While remote delivery of educational and therapy services may be a convenient way for schools and facilities to remain open when in-person attendance carries risks, the long-term negative effects for children on the autism spectrum may be significant. To help them continue to achieve their educational goals, autistic children may need alternative ways to keep pace with their peers.”

The study also revealed that parents of children on the autism spectrum had specific concerns related to their children’s diagnosis. “Addressing these concerns is important for the mental health of parents and children,” added Dr. Genova, “since stress levels of caregivers can influence stress levels of autistic children.”

Funding: None

Posted on Autism

Stanford Medicine study shows differences between brains of girls, boys with autism

Happy children playing head over heels on green grass in spring park




Brain organization differs between boys and girls with autism, according to a new study from the Stanford University School of Medicine. 
 
The differences, identified by analyzing hundreds of brain scans with artificial intelligence techniques, were unique to autism and not found in typically developing boys and girls. The research helps explain why autism symptoms differ between the sexes and may pave the way for better diagnostics for girls, according to the scientists.


 
Autism is a developmental disorder with a spectrum of severity. Affected children have social and communication deficits, show restricted interests and display repetitive behaviors. The original description of autism, published in 1943 by Leo Kanner, MD, was biased toward male patients. The disorder is diagnosed in four times as many boys as girls, and most autism research has focused on males. 
 
“When a condition is described in a biased way, the diagnostic methods are biased,” said the study’s lead author, Kaustubh Supekar, PhD, a clinical assistant professor of psychiatry and behavioral sciences. “This study suggests we need to think differently.”


 
The study was published online Feb. 15 in The British Journal of Psychiatry. 
 
“We detected significant differences between the brains of boys and girls with autism, and obtained individualized predictions of clinical symptoms in girls,” said the study’s senior author, Vinod Menon, PhD, a professor of psychiatry and behavioral sciences and the Rachael L. and Walter F. Nichols, MD, Professor. “We know that camouflaging of symptoms is a major challenge in the diagnosis of autism in girls, resulting in diagnostic and treatment delays.” 
 
Girls with autism generally have fewer overt repetitive behaviors than boys, which may contribute to diagnostic delays, the researchers said. 
 
“Knowing that males and females don’t present the same way, both behaviorally and neurologically, is very compelling,” said Lawrence Fung, MD, PhD, assistant professor of psychiatry and behavioral sciences, who was not an author of the study. 
 
Fung treats people with autism at Stanford Children’s Health, including girls and women with delayed diagnoses. Many autism treatments work best during the preschool years when the brain’s motor and language centers are developing, he noted.
 
“If the treatments can be done at the right time, it makes a big, big difference: For instance, children on the autismspectrum receiving early language intervention will have a better chance of developing language like everyone else and won’t have to keep playing catch-up as they grow up,” Fung said. “If a child cannot articulate themselves well, they fall behind in many different areas. The consequences are really serious if they are not getting diagnoses early.”
 
New statistical methods unlock differences
 
The study analyzed functional magnetic resonance imaging brain scans from 773 children with autism — 637 boys and 136 girls. Amassing enough data to include a sizeable number of girls in the study was challenging, Supekar said, noting that the small number of girls historically included in autism research has been a barrier to learning more about them. The research team relied on data collected at Stanford and on public databases containing brain scans from research sites around the world. 
 
The preponderance of boys in the brain-scan databases also set up a mathematical challenge: Standard statistical methods used to find differences between groups require that the groups be roughly equal in size. These methods, which underlie machine-learning techniques in which algorithms can be trained to find patterns in very large and complex datasets, can’t accommodate a real-world situation in which one group is four times as large as the other. 
 
“When I tried to identify differences [with traditional methods], the algorithm would tell me every brain is a male with autism,” Supekar said. “It was over-learning and not distinguishing between males and females with autism.”
 
Supekar discussed the problem with Tengyu Ma, PhD, assistant professor of computer science and of statistics at Stanford and a co-author on the study. Ma had recently developed a method that could reliably compare complex datasets, such as brain scans, from different-sized groups. The new technique provided the breakthrough the scientists needed. 
 
“We happened to be lucky that this new statistical approach was developed at Stanford,” Supekar said.
 
What differed?
 
Using 678 of the brain scans from children with autism, the researchers developed an algorithm that could distinguish between boys and girls with 86% accuracy. When they verified the algorithm on the remaining 95 brain scans from children with autism, it maintained the same accuracy at distinguishing boys from girls.
 
The scientists also tested the algorithm on 976 brain scans from typically developing boys and girls. The algorithm could not distinguish among them, confirming that the sex differences the scientists found were unique to autism.
 
Among children with autism, girls had different patterns of connectivity than boys did in several brain centers, including motor, language and visuospatial attention systems. Differences in a group of motor areas — including the primary motor cortex, supplementary motor area, parietal and lateral occipital cortex, and middle and superior temporal gyri — were the largest between sexes. Among girls with autism, the differences in motor centers were linked to the severity of their motor symptoms, meaning girls whose brain patterns were most similar to boys with autism tended to have the most pronounced motor symptoms.
 
The researchers also identified language areas that differed between boys and girls with autism, and noted that prior studies have identified greater language impairments in boys. 
 
“When you see that there are differences in regions of the brain that are related to clinical symptoms of autism, this seems more real,” Supekar said.
 
Taken together, the findings should be used to guide future efforts to improve diagnosis and treatment for girls, the researchers said.
 
“Our research advances use of artificial intelligence-based techniques for precision psychiatry in autism,” Menon said.
 
“We may need to have different tests for females compared with males. The artificial intelligence algorithms we developed may help to improve diagnosis of autism in girls,” Supekar said. At the treatment level, interventions for girls could be initiated earlier, he added.
 
The study’s other Stanford Medicine co-authors are scientific data analyst Carlo de los Angeles; senior research scientist Srikanth Ryali, PhD; and graduate student Kaidi Cao. Co-authors include members of Stanford’s Maternal and Child Health Research Institute, Stanford Bio-X, the Stanford Wu Tsai Neurosciences Institute and the Stanford Wu Tsai Human Performance Alliance, and the Stanford Institute for Human-Centered Artificial Intelligence.
Posted on Autism

Study performs cost analysis of popular autism interventions

Female protective effect: Yale researchers find clues to sex differences in autism


Working in schools as an occupational therapist and board-certified behavior analyst, Gretchen Scheibel would often see students, parents and educators at crisis points. Though youths receiving special education services would take part in interventions intended to help them reach their ideal educational outcomes, some students showed little to no progress, or they may have engaged in severe or dangerous behaviors. That sometimes led to students being removed from their neighborhood schools and parents taking legal action against school districts. Over a 15-year period, Scheibel worked in schools and with parents in seven states across the country, often seeing firsthand how special education interventions were tried with little thought to how much they cost in terms of money, time and student outcomes.

“I had an opportunity to see what was happening on the ground in a lot of different school districts. When kids are at a crisis point, it wasn’t one incident that led to them being sent out of a school or a classroom,” said Scheibel, now a doctoral candidate in special education at the University of Kansas. “It was a long history where they weren’t receiving interventions that could help them. I came to KU to get my Ph.D. to think about that more.”

The questions of how much special education interventions cost and whether they work led to a study co-written by Scheibel and published in the journal Exceptional Children that conducted an economic evaluation of two commonly used interventions for students with autism spectrum disorder. The results showed implementing interventions with emerging evidence or those shown to be ineffective or harmful can consume curriculum and professional development funds, as well as valuable teacher and student time, without a strong promise of positive outcomes.

Scheibel and co-authors Thomas Zane, director of KU’s online behavior analysis program, and Kathleen Zimmerman, assistant professor of special education, selected two interventions called DIRFloortime and Rapid Prompting Method, classified in research literature as emerging and limited in evidence, respectively. Scheibel said the goal of the study was not to advocate for or against any specific intervention but to conduct an economic evaluation on two that are popular, even if controversial, to provide a different way to think about interventions.

The researchers conducted a cost analysis of the two interventions, using an approach known as “the ingredients method.” They analyzed all the ingredients it would take to implement the interventions in a school, including the cost of teachers’ time, training and material costs, and the potential cost of compensatory services if a parent pursues legal action due to lack of appropriate intervention. They calculated the cost for DIRFloortime to be $9,976 for the first year and Rapid Prompting Methods’ first-year cost to be $32,159.

However, Scheibel cautioned against taking those estimates literally.

“When you’re talking about value and dollar costs in this sense, a school district doesn’t necessarily need to have $32,000 cash on hand to implement the intervention. It’s more of a way to view all the resources that will be used when the intervention is implemented on the same scale.”

The authors argue the more important factor is to give districts an idea of what an intervention will cost and what its potential benefits and harms to the student, school and family are before a decision is made on whether to adopt it. This information is also beneficial with interventions that are already commonly used in schools such as the two analyzed in the study. Furthermore, they said that such economic evaluations of special education interventions should be included in research studies. This information can be helpful in the initial research stages when researchers are determining whether an intervention works, what population it could benefit and also in the synthesis stage, when individual intervention studies are looked at collectively to determine if they are likely to be effective in schools.

“We are arguing that we should be including cost analysis in research, especially in the synthesis phase. That will allow the teachers and educators receiving the information to make a more contextualized, informed decision,” Scheibel said.

Posted on Autism

Study reveals high rate of possible undiagnosed autism in people who died by suicide

New genetic clues on multiple sclerosis risk
New genetic clues on multiple sclerosis risk


A new study has revealed that a significant number of people who died by suicide were likely autistic, but undiagnosed, highlighting the urgent need for earlier diagnosis and tailored support for suicide prevention. 

A team of researchers, led by Dr Sarah Cassidy from the University of Nottingham and Professor Simon Baron-Cohen from the Autism Research Centre at the University of Cambridge, are the first to examine evidence of autism and autistic traits in those who died by suicide in England. They analysed Coroners’ inquest records of 372 people who died by suicide and also interviewed family members of those who died. The research is published today in the British Journal of Psychiatry.

The researchers found that 10% of those who died by suicide had evidence of elevated autistic traits, indicating likely undiagnosed autism. This is 11 times higher than the rate of autism in the UK. The research team worked with Coroners’ offices in two regions of England to identify the records. 

The team first examined the coroners’ inquests for each death by suicide for signs of elevated autistic traits indicating possible undiagnosed autism, or a definite diagnosis of autism. Evidence of autism was then checked by an independent researcher to make sure that these decisions were reliable. The researchers then spoke to 29 of the families, to gather further evidence to corroborate the elevated autistic traits in those who died. After speaking with the families, the researchers found evidence of elevated autistic traits in more people who died by suicide (41%), which is 19 times higher than the rate of autism in the UK.

Previous research by the same group has shown that up to 66% of autistic adults have thought about taking their own life, and 35% have attempted suicide. Around 1% of people in the UK are autistic, yet up to 15% of people hospitalised after attempting suicide have a diagnosis of autism. Previous research has also found that both diagnosed autistic people and those with elevated autistic traits are more vulnerable to mental health problems, suicidal thoughts and behaviours. The new research goes beyond this by examining Coroner’s records related to people who have ended their own life. 

Autism is a lifelong developmental condition diagnosed on the basis of difficulties in social and communication skills and in adapting to unexpected change, alongside heightened sensory sensitivity, unusually deep interests in specific topics, and a preference for predictability. There are many barriers to obtaining an autism diagnosis, including limited availability of diagnostic services, leading to long waiting lists. Even post-diagnosis, there are insufficient support services for autistic people. 

Dr Sarah Cassidy commented: “Many adults in the UK find it very difficult to obtain an autism diagnosis and appropriate support post-diagnosis. Our study shows that undiagnosed autistic people could be at increased risk of dying by suicide. It is urgent that access to an autism diagnosis and appropriate support post diagnosis is improved. This is the top autism community priority for suicide prevention, and needs to be addressed immediately by commissioners of services and policy makers.”

Professor Simon Baron-Cohen added: “Even a single suicide is a terrible tragedy for the person and a traumatic loss for their families and friends. Suicide rates are unacceptably high in autistic people and suicide prevention has to be the number one goal to reduce the worrying increased mortality in autistic people. Autistic people on average die 20 years earlier than non-autistic people, and two big causes of this are suicide and epilepsy. We published the preliminary data on elevated suicide rates back in 2014 as a wake-up call to governments, and yet nothing has been done.” 

Currently evidence of an autism diagnosis or elevated autistic traits are not usually included in Coroners’ inquests in England. This study highlights the need for Coroners to begin to systematically gather evidence of autism and autistic traits in inquests, to help prevent future deaths. There is also an urgent need to work with the autism community to co-design suicide prevention services. 

Posted on Autism

Nine Positive Autistic Traits (that you may not already know!)

9 Positive Autistic Traits (that you may not already know!) | Patrons Choice - YouTube


There are character traits that are not usually seen as common behaviours of people with autism. In this video, we’ll discuss 9 autistic traits that are actually positive character traits and are very common in autistic adults. Some autistic traits are often misunderstood but you will see from this video that they can be an asset in autistic adults.