By Warren King

Seattle Times medical reporter
http://seattletimes.nwsource.com/html/localnews/2003692973_autism04m.html

A hormone that helps women give birth and breast-feed has shown promise in relieving some symptoms of autism, scientists reported Thursday at an international conference convened this week in Seattle.

Oxytocin, which naturally stimulates uterine contractions and milk secretion, has helped some autistic adults reduce repetitive behavior, such as rocking, and improved their ability to identify emotions, such as anger and happiness, and relate to people better.

"There are still a lot of questions, such as how to administer it daily," said Evodokia Anagnostou, of Mount Sinai Medical Center, New York. "But this is probably a promising avenue to pursue."

Anagnostou is one of more than 900 researchers, parents and activists who are gathering through Saturday at the Sheraton Hotel downtown for the sixth International Meeting for Autism Research. The meeting is not open to the public.

"People from around the world are here to share information and ideas," said Geraldine Dawson, co-chair of the conference and director of the University of Washington Autism Center. "It will contribute to the research in autism for people with autism."

For example, in the oxytocin study, which was relatively small with 23 subjects, the scientists found that both injections and nasal sprays of the hormone relieved symptoms for several weeks much better than in patients who received placebos.

Using magnetic resonance imaging, Anagnostou and her colleagues also have found that oxytocin improved regions of the brain that are affected by autism. Autism is a permanent brain disorder, usually diagnosed after age 3, that can seriously impair social and communication skills and limit people's interests and activities. It manifests itself in a spectrum of ways, from mild to severe, and experts now estimate 1 in 150 people in the U.S. have the disorder.

Most scientists don't believe there is a single cause of autism. But they have identified abnormalities in several brain regions, and some genetic defects are believed related to the disorder. Conventional drug treatment usually targets problems such as hyperactivity and aggressive behavior.

Recently, much research has focused on early diagnosis and early treatment to help socialization and language skills. Scientists don't believe symptoms can be detected before 6 months of age. But a decade ago, Dawson conducted research showing that autistic children as young as 1 exhibit little eye contact with others, and subsequent research has found other such early clues.

At the conference Thursday, Dawson and Sally Rogers of the University of California, Davis, showed videos of toddlers who steadily improved through daily sessions of parent-child play that stimulated socialization and language. Before the sessions, the children played silently and alone in a room with parents. Afterward, they laughed, looked parents in the eye and used words to identify toys and express wishes.

"Intervention during the onset period may slow or minimize the progression," Rogers said.

In other research, Eric Fombonne, of Montreal Children's Hospital, said in a news conference that samples of blood, hair and toenails taken from 71 newly diagnosed children and their mothers showed levels of mercury no different from children who didn't have autism.

Fombonne conceded the samples gave only a snapshot in time, but he said the findings support studies cited by the Centers for Disease Control and Prevention saying there is no link between mercury in vaccine preservatives and autism. Many parents and some scientists believe there is a link.

http://www.sciencedaily.com/releases/2007/04/070403112757.htm

 Each individual with autism accrues about $3.2 million in costs to society over his or her lifetime, with lost productivity and adult care being the most expensive components, according to a report in the April issue of Archives of Pediatrics & Adolescent Medicine, a theme issue on autism spectrum disorders.

Autism costs society more than $35 billion in direct and indirect expenses each year, according to background information in the article. Relatively little is known about when these costs occur across the lifetime of an individual with autism.

Michael L. Ganz, M.S., Ph.D., Abt Associates Inc., Lexington, Mass., and Harvard School of Public Health, Boston, used data from the medical literature and from national surveys to estimate the direct medical and non-medical costs of autism, including prescription medications, adult care, special education and behavioral therapies. Approximate indirect costs, including lost productivity of both individuals with autism and their parents, were calculated by projecting average earnings and benefits at each age, adjusted for the fact that some autistic individuals can work in supported environments. Only costs directly linked to autism, and no medical or non-medical costs that would be incurred by individuals with or without autism, were included.

These costs were projected across the lifetime of a hypothetical group of individuals born in 2000 and diagnosed with autism in 2003. Costs estimates were broken down into age groups at five-year intervals, with the youngest group age 3 to 7 years and the oldest age 63 to 66 years.

"Direct medical costs are quite high for the first five years of life (average of around $35,000), start to decline substantially by age 8 years (around $6,000) and continue to decline through the end of life to around $1,000," Dr. Ganz writes. "Direct non-medical costs vary around $10,000 to approximately $16,000 during the first 20 years of life, peak in the 23- to 27-year age range (around $27,500) and then steadily decline to the end of life to around $8,000 in the last age group. Indirect costs also display a similar pattern, decreasing from around $43,000 in early life, peaking at ages 23 to 27 years (around $52,000) and declining through the end of life to $0."

Over an individual's life, lost productivity and other indirect costs make up 59.3 percent of total autism-related costs. Direct medical costs comprise 9.7 percent of total costs; the largest medical cost, behavioral therapy, accounts for 6.5 percent of total costs. Non-medical direct costs such as child care and home modifications comprise 31 percent of total lifetime costs.

Because these costs are incurred by different segments of society at different points in an autistic patient's life, a detailed understanding of these expenses could help planners, policymakers and families make decisions about autism care and treatment, Dr. Ganz notes. "Although autism is typically thought of as a disorder of childhood, its costs can be felt well into adulthood," he concludes. "These results may imply that physicians and other care professionals should consider recommending that parents of children with autism seek financial counseling to help plan for the transition into adulthood."

Note: This story has been adapted from a news release issued by JAMA and Archives Journals.

SAN FRANCISCO, April 6 (UPI) -- Scientists are proposing ways to take some of the hypothesizing -- and hyping -- out of autism treatments.

One team has devised a classification tool for sorting out autistic traits and improving forecasts of how young patients will fare over time.

If the model holds up under further scrutiny, it may crack open a window into the future for doctors trying to gauge a child's response to a particular treatment for the range of neurodevelopmental disorders that fall on the autism spectrum. These can vary in severity from barely noticeable to disabling.

Simply put, rather than compartmentalizing the varying autistic disorders, as current methods are wont to do, the proposed technique provides a broader view of the total span as the oftentimes overlapping symptoms arise, append and alter over time.

The study of 91 autistic children, most of them boys of preschool or elementary-school age, underscored the wide range of features and their combinations that can characterize autism, researchers said in the journal Pediatrics.

Some children have severe disability but high intelligence, others are mildly impaired but profoundly mentally retarded, with most falling somewhere in between, they said.

Among their key findings, the investigators from The Children's Hospital of Philadelphia noted youngsters in the normal range of intelligence -- an IQ of 70 or higher -- naturally improve with age, a pattern also observed in attention deficit/hyperactivity disorder.

Once confirmed, the model can serve as a benchmark for evaluating the effectiveness of various treatments for autism -- and for exposing any exaggerated claims taking credit for time's healing touch.

Another group attempting to undermine the bedeviling unpredictability of autism treatments has gone a step further. The researchers have developed and tested a method for foretelling a child's response to a specific therapy, they reported in the Journal of Consulting and Clinical Psychology.

With even the most rigorously scrutinized behavioral interventions producing widely varying results, many families find themselves in the quandary of having to try out numerous offerings before arriving at the one that's best suited for their child.

Such laborious miss-and-hit efforts cost precious time, said Laura Schreibman, professor of psychology and director of the Autism Research Program at the University of California, San Diego. Her technique, she said, may help doctors to nail it the first time.

Schreibman and her colleagues drew up a profile that enabled them to correctly pair up the right child with the right treatment, in this case a technique they developed called Pivotal Response Training.

Characteristics of children expected to do well with the therapy include:

-- a moderate to high interest in toys,

-- tolerance of another person in close proximity, and

-- fewer repetitive behaviors, such as flapping or rocking, and more verbal expression, such as squeaking or other nonsensical sounds, than shown by those for whom PRT is not a good match.

The authors urged further research to construct similar crystal balls for all other behavioral therapies.

As more kids are designated autistic, fewer are called learning disabled or retarded.

Steve Liss for TIME

Epidemic is a powerful word. It generates bold headlines, congressional hearings, research dollars and dramatic, high-stakes hunts for culprits. It's a word that has lately been attached to autism. How else to account for the fact that a disorder that before 1990 was reported to affect just 4.7 out of every 10,000 American children now strikes 60 per 10,000, according to many estimates--the equivalent of 1 in 166 kids?

But what if there is no epidemic? What if the apparent explosion in autism numbers is simply the unforeseen result of shifting definitions, policy changes and increased awareness among parents, educators and doctors? That's what George Washington University anthropologist Roy Richard Grinker persuasively argues in a new book sure to generate controversy. In Unstrange Minds: Remapping the World of Autism, Grinker uses the lens of anthropology to show how shifting cultural conditions change the way medical scientists do their work and how we perceive mental health.

In addition to rising awareness of autism, Grinker points to these factors:

BROADER DEFINITIONS Each successive edition of the Diagnostic and Statistical Manual of Mental Disorders--the bible of mental health--has revised the criteria for identifying autism in ways that tend to include more people. Two conditions on the milder end of the autistic spectrum--Asperger's syndrome and the awkwardly named PDD-NOS (pervasive developmental disorder, not otherwise specified)--were added to the DSM in 1994 and 1987, respectively. Grinker and others say 50% to 75% of the increase in diagnoses is coming in these milder categories.

SCHOOL POLICY U.S. schools are required to report data on kids who receive special-education services, but autism wasn't added as a category until the 1991-92 school year. No wonder the numbers exploded--from 22,445 receiving services for autism in 1995 to 140,254 in 2004. Grinker points out that "traumatic brain injury" also became one of the 13 reportable categories in 1992, and it had a similar spike.

MORE HELP, LESS STIGMA As services have become more available for kids with autism, more parents are seeking a diagnosis they would have shunned 30 years ago, when psychiatrists still blamed autism on chilly "refrigerator" mothers. Doctors are also more willing to apply the diagnosis to help a patient. "I'll call a kid a zebra if it will get him the educational services I think he needs," National Institute of Mental Health psychiatrist Judith Rapoport told Grinker.

FINANCIAL INCENTIVES In some states, parents of children with autism can apply for Medicaid even if they are not near the poverty line. A diagnosis of mental retardation doesn't always offer this advantage.

RELABELING For all the reasons above, many kids previously given other diagnoses are now called autistic. University of Wisconsin researcher Paul Shattuck has found that the number of kids getting special-ed services for retardation and learning disabilities declined in 47 states between 1994 and 2003, just as those getting help for autism was rising. In 44 states, the drop exceeded the rise in autism.

As convincing as Grinker's analysis seems, arguments about the apparent epidemic will probably continue. It's simply impossible to accurately reconstruct the past incidence of the disorder, given how radically definitions have changed. Those who believe the increase is real often focus on the mysterious paucity of autistic adults. With their conspicuous symptoms like hand flapping and little or no language, "I think we would be recognizing them in institutions," says Dr. Robert Hendren, executive director of the M.I.N.D. Institute at the University of California, Davis.

Grinker's answer is that autistic adults are out there but wearing other labels. "Where are all the adults with fetal alcohol syndrome?" he asks. No one over 40 has the condition, thought to affect up to 1 in 500 kids today, because it was not recognized until the mid-'70s. "But no one would say alcoholism among pregnant women just started," says Grinker.

Grinker, whose 15-year-old daughter is autistic, concedes that there's something reassuring about the idea of an epidemic: "Thinking about any disorder as an epidemic is easier than thinking about it in terms of multiple causes, shifting definitions and a scientific reality we are only just beginning to understand." Besides, if a disease suddenly spikes, it seems more plausible that the increase could be reversed--if only we could find the mysterious environmental trigger. With autism, though, that hopeful scenario seems just too simple.

Public health officials say that medical reasons for the requirement imposed by the state legislature have received scant attention.

Contrary to popular belief that chickenpox is a mild illness, Reed and other health officials say, it is impossible for doctors to predict who will suffer serious complications, the risk of which increases with age. The most dreaded includes necrotizing fasciitis, the so-called "flesh-eating bacteria," which can be fatal.

"Every doctor who has seen a case of this hopes never to see one again," said physician Deborah Wexler, executive director of the Immunization Action Coalition, a nonprofit Minnesota group that provides informational materials about vaccines to doctors and works with federal Centers for Disease Control and Prevention.

"People who don't vaccinate their children are putting them at risk, as well as kids who can't be vaccinated" because they have cancer or other medical problems, Wexler said. "This is about protecting yourself and protecting your community."

Once accepted without question as a parental responsibility, immunization has lost its urgency. Most parents have never seen or heard of children who went blind from measles, deaf from mumps or suffered overwhelming infection from other childhood diseases such as haemophilus influenza.

Some of the skepticism about the need to vaccinate is attributable to what many health officials say are persistent unsubstantiated myths about childhood vaccines that circulate on the Internet: that dangers of vaccines outweigh their benefits, cause autism and other serious ailments or encourage promiscuity. Much of the controversy has swirled around mercury, once used as a preservative for the vaccine against measles, mumps and rubella known as MMR.

In 19 states, lawmakers have made it easier in recent years for parents to opt out of vaccinations based on a "personal belief exemption" that in some states may be obtained simply by signing a waiver. (In the District of Columbia, Maryland and Virginia, exemptions are permitted for religious or medical reasons, such as a severe allergy to a vaccine component.)

"The MMR controversy did a lot of damage and made people scared of vaccines," Wexler said.

A study by public health researchers from Johns Hopkins, published in the Journal of the American Medical Association in October, found that states that permitted personal belief exemptions had significantly higher rates of pertussis infection than those that did not allow them.