Meer suïcidale gedachten bij personen met stoornis van Asperger

Asperger's Syndrome Linked to Suicidal Thoughts

Laird Harrison

July 03, 2014

Adults with Asperger's syndrome are 9 times more likely to experience suicidal thoughts compared with those in the general population, a new study shows.

"Our findings confirm anecdotal reports that adults with Asperger syndrome have a significantly higher risk of suicide in comparison to other clinical groups, and that depression is a key risk factor in this," said Sarah Cassidy, PhD, of the Autism Research Centre at Cambridge University, the United Kingdom, in a media release.

The study was published online June 25 in the Lancet Psychiatry.

The study surveyed 374 individuals (256 men and 118 women) diagnosed with Asperger's syndrome as adults between 2004 and 2013 at the Cambridge Lifetime Asperger Syndrome Service clinic.

The researchers defined Aspberger's syndrome as "a subgroup on the autism spectrum, showing core symptoms in the absence of language delay or intellectual disability."

(The American Psychiatric Association formerly used the term "Asperger's disorder," but in 2013 it folded this diagnosis into the broader category of "autism spectrum disorder.")

The study showed that 66% of adults with Asperger's syndrome have suicidal ideation. Previous studies have shown that 17% of the general population and 59% of those with psychosis have such thoughts, the researchers said.

In addition, the new study showed that 35% of adults with Asperger's syndrome had planned or had attempted suicide during their lifetime.

Suicidal thoughts and behaviors were significantly more common in adults with Asperger's syndrome who had a history of depression.

Among adults with Asperger's syndrome, those with depression were 4 times more likely to experience suicidal thoughts and were twice as likely to plan or attempt suicide, compared with individuals with Asperger's syndrome but who did not have history of depression.

A second risk factor for suicide plans or attempts was a higher level of autistic traits.

Adults with Asperger's syndrome often suffer from secondary depression, owing to social isolation, loneliness, social exclusion, lack of community services, underachievement, and unemployment, the researchers said.

But they added that appropriate support can alleviate this depression and reduce the risk for suicide.

"This study should be a wake-up call for the urgent need for high-quality services, to prevent the tragic waste of even a single life," said coauthor Simon Baron-Cohen, PhD, also of the Autism Research Centre.

The study was funded by the Three Guineas Trust, the Baily Thomas Foundation, the Medical Research Council, NIHR-CLAHRCEoE, Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), and the Autism Research Trust. The authors have disclosed no relevant financial relationships.

Lancet Psychiatry. Published online June 25, 2014. Full text

Mindfulness en CGT verminderen angst en depressie bij volwassenen met ASS

Mindfulness, CBT Cut Anxiety, Depression in Adult Autism

Pam Harrison

May 27, 2014

ATLANTA ― Mindfulness-based stress reduction (MBSR) therapy as well as cognitive-behavioral therapy (CBT) are both effective in reducing comorbid anxiety and depression in adults with autism spectrum disorder (ASD), Dutch investigators report.

Investigators at the Center for Developmental Disorders, Dimence Institute of Mental Health, Deventer, the Netherlands, observed significant reductions in both anxiety and depression in adults with ASD who underwent treatment with either MBSR techniques or CBT. Both approaches were modified to match the capabilities of adults with ASD.

"ASD in adults is an emerging field of interest [but] most research has focused on treating the presumed core symptoms of ASD as outcome measures," lead investigator Bram Sizoo, MD, PhD, told Medscape Medical News.

"This is regrettable because anxiety and depressive symptoms are known to be prevalent in adults with ASD and can be treated provided the treatment methods used take into consideration the way people with ASD understand and process information."

The study was presented here at the 13th Annual International Meeting for Autism Research (IMFAR).

Ready for Use

For the study, the Dutch group randomly assigned 90 adults with ASD in equal numbers to the MBSR program, to CBT, or to treatment as usual.

Mindfulness has been defined as paying attention to experiences in the present moment in a nonjudgmental way.

It is thought that by teaching people to accept thoughts and feelings as they appear, "avoidance strategies can be countered effectively, which reduces ruminative thinking and consequently also anxiety and negative mood," Dr. Sizoo explained.

To adapt the mindfulness protocol for adults with ASD, researchers removed as many cognitive elements as possible and made the text clear and unambiguous.

The CBT protocol was also modified so that it was very structured and tailored to a pace that people with ASD can generally handle.

However, Dr. Sizoo pointed out, "the relation between event, emotion, thought, and action is generally perceived as 'very logical' by people with ASD, and this, in fact, leads to a better recognition and labeling of their own emotions."

Indeed, both protocols are used routinely for adults with ASD in the Netherlands, he added.

Participants completed 13 sessions of the randomly assigned training protocol, each session lasting 1.5 hours in total.

Anxiety and depression scores were measured using the Hospital Anxiety and Depression Scale (HADS) at baseline and again after participants had completed the 13-week course and again at 3 months' follow-up.

Table. Average HADS Scores at Baseline After Completion of the 13-Week Course and at 3 Months' Follow-up*

	Anxiety†		Depression‡
	MBSR (n = 20)	CBT (n = 10)	MBSR (n = 20)	CBT (n = 10)
Baseline	11.3 (3.46)	14.0 (1.7)	8.7 (4.18)	8.7 (4.62)
Completion (13 weeks)	9.2 (3.11)	11.2 (4.16)	6.9 (5.00)	6.0 (4.50)
Follow-up (3 months)	8.8 (3.33)	10.3 (3.80)	5.8 (4.15)	6.2 (5.56)
* The treatment-as-usual group has not yet been analyzed. †Anxiety: significant reduction in anxiety score (F=14.39, P = .000, effect size =.34), no interaction with treatment type. ‡Depression: significant reduction in depression score (F=14.14, p=.000, effect size = .35), no interaction with treatment type.

As Dr. Sizoo noted, both modified protocols are ready for use in any center that provides services for adults with ASD.

In the Netherlands, however, training is recommended for facilitators who carry out the MBSR protocol.

For both modalities, facilitators also require a thorough understanding of ASD to ensure that adults are able to grasp and follow what is being said during each protocol.

"In most cases, the MBSR exercises were clear and easy to carry out, and we noticed that patients very quickly adapted mindfulness techniques for use in their daily lives to reduce stress," Dr. Sizoo observed.

"Unfortunately, the protocols are as yet only available in Dutch."

Clinically Important, Timely

Asked to comment on the study, Stefan Hofmann, PhD, director, social anxiety program, Boston University, in Massachusetts, told Medscape Medical News that the authors report "very promising results."

"ASD is a difficult-to-treat condition that is associated with many emotional and behavioral problems, including depression and anxiety, and few treatments are available for patients suffering from this debilitating disorder."

Inasmuch as CBT is an established treatment for many psychiatric disorders and MBSR is showing considerable promise as an alternative treatment, studying these 2 treatments in adult ASD is "clinically important and timely," Dr. Hofmann added.

"The study demonstrated that it is possible to modify and tailor both treatment approaches to this particular population," he said. "[And although] it was not possible to examine whether both treatments are equally effective, both interventions led to significant reductions in anxiety and depression."

Dr. Hofmann felt that there is a need for future studies with larger samples to examine not only whether MBSR and CBT are equally effective but whether there are any patient characteristics that might predict a better response to one or the other treatment or whether combining CBT and MBSR would be more effective than either as monotherapy.

Dr. Sizoo and Dr. Hofmann report no relevant financial relationships.

13th Annual International Meeting for Autism Research (IMFAR). Abstract 135.004. Presented May 16, 2014. 

Medscape Medical News © 2014  WebMD, LLC 

Send comments and news tips to news@medscape.net.

Cite this article: Mindfulness, CBT Cut Anxiety, Depression in Adult Autism. Medscape. May 27, 2014.

Autisme door mitochondriale dysfunctie?

Mitochondrial Dysfunction Evident in Some Patients With Autism Spectrum Disorder

By Will Boggs MD

April 15, 2014

NEW YORK (Reuters Health) - A significant proportion of patients with autism spectrum disorder (ASD) has evidence of mitochondrial dysfunction on magnetic resonance studies, in a study that one expert called "fascinating."

"We now have compelling evidence for the common presence of metabolic dysfunction in the brains of persons with ASD," Dr. Bradley S. Peterson from Columbia University Medical Center, New York told Reuters Health. "This provides vitally important information about the mechanisms of disease and clues for the development of new interventions in this very common, life-long, and highly debilitating illness."

Although mitochondrial disease is an established cause of syndromic autism, it remains unknown whether mitochondrial dysfunction is present in the brains of individuals with ASD and whether it plays a role in the core cognitive and behavioral symptoms of ASD.

Dr. Peterson and colleagues acquired proton magnetic resonance spectroscopic (MRS) imaging data to assess in vivo evidence of mitochondrial dysfunction in the brains of 75 adults and children with ASD and 96 typically developing controls matched by age and sex.

They used the presence of lactate doublets as an indication of mitochondrial dysfunction.

Lactate doublets were present in significantly more individuals with ASD (13%) than in typically developing controls (1%; p=0.001), they reported April 9th online in JAMA Psychiatry.

The presence of lactate doublets in the ASD group increased with age and was significantly more common in adults (20%) than in children (6%). Their location varied across individuals, but they seemed to aggregate preferentially within the cingulate gyrus.

Lactate doublets did not correlate with sex, ASD subtype, intellectual ability, Autism Diagnostic Observation Schedule total score or subscores, or the presence of comorbid neurological or psychiatric diagnoses.

"Regardless of its cause, our finding suggests that the inclusion of adults is important for understanding the complex role of mitochondrial dysfunction in ASD," the researchers say.

"Our strong evidence for the common presence of mitochondrial dysfunction in persons with ASD suggests that patients should undergo clinical evaluation for the presence of mitochondrial disease," Dr. Peterson said.

"Novel treatments for known mitochondrial diseases are under development and showing promise," Dr. Peterson said. "These might one day prove helpful in the treatment of mitochondrial dysfunction in persons who have ASD."

Dr. Richard E. Frye from the University of Arkansas for Medical Sciences in Little Rock recently reviewed mitochondrial dysfunction in ASD. He told Reuters Health, "It is not uncommon for children with autism to have mitochondrial disease, a disorder that has many potential treatments. Diagnosing mitochondrial disease in children with autism can lead to appropriate treatments that may substantially improve the child's life."

"This supports the notion that we should be screening children with autism for mitochondrial disease, especially if they have symptoms that are commonly reported in children with autism and mitochondrial disease, including seizures, gastrointestinal problems, gross motor delays, and regression," Dr. Frye said.

"More research is needed into this subgroup of children with autism so that we can provide appropriate treatment," Dr. Frye concluded.

Dr. Agustin Legido from Drexel University College of Medicine in Philadelphia recently reviewed mitochondrial dysfunction in autism. He told Reuters Health by email, "Every patient with autism should have an easy, nonaggressive evaluation of the mitochondrial respiratory chain."

"This should not be interpreted as the answer to autism," Dr. Legido cautioned. "It addresses another piece of the big and complex puzzle of the cause of autism."

Dr. Legido added, "The cause of autism is complicated. Mostly, the prenatal cases are due to genetic abnormalities involved in brain development. Acquired post-natal cases are due to damage of brain structures involved in brain functions of language, behavior and socialization (e.g. west syndrome or infantile spasms, tuberous sclerosis, etc.). The question is: what is the role of mitochondria and particularly of mitochondria genes and nuclear genes regulating mitochondria function? The fact of finding signs of abnormal mitochondria function is the tip of the iceberg."

Dr. Derrick Fraser MacFabe directs the Kilee Patchell-Evans Autism Research group at University of Western Ontario in London, Ontario, Canada. He told Reuters Health by email, "This initial study may lead to more careful studies/metabolic controls pointing to environmentally induced mitochondrial function from many environmental agents( PCPs, metals, organophosphates, inflammation-induced oxidative stress), but particularly (what we have proposed) from short chain fatty acids from an abnormal gut microbiome (i.e., history of early antibiotics/hospitalization/and/or altered host immune system)."

He continued, "This fascinating study points to autism as a systemic metabolic disease as opposed to a primary brain disorder, and to future metabolic biomarkers . . . or treatments (i.e., augmenters of mitochondrial function - e.g., carnitine, coenzyme Q10), and risk factors (gut dysbiosis, antibiotics, hospitalization) in at least a subset of patients."

SOURCE: http://bit.ly/1gxmLRM

JAMA Psychiatry 2014.

 

Reuters Health Information © 2014 

Cite this article: Mitochondrial Dysfunction Evident in Some Patients With Autism Spectrum Disorder. Medscape. Apr 14, 2014.

Mogelijk verband tussen blootstelling aan SSRIs tijdens zwangerschap en ASS

Prenatal SSRI Use May Be Linked to Autism Spectrum Disorder
Laurie Barclay, MDApril 14, 2014

Prenatal use of selective serotonin reuptake inhibitors (SSRIs) appears to be a risk factor for autism spectrum disorders (ASDs) and other developmental delays (DDs) in young children, but underlying maternal depression may be a confounder, according to findings of a population-based case-control study published online April 14 in Pediatrics.

"Serotonin is critical in early brain development, creating concerns regarding prenatal exposure to factors influencing serotonin levels, like [SSRIs]," write Rebecca A. Harrington, PhD, MPH, from the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and colleagues. "Prenatal SSRI use was recently associated with autism; however, its association with other developmental delays is unclear."

Therefore, the investigators analyzed the possible associations between prenatal SSRI use and the likelihood of ASDs and other DDs in the offspring in a group of 966 mother–child pairs. The pairs were enrolled in the Childhood Autism Risks from Genetics and the Environment (CHARGE) Study. Of those, 492 children had ASD, 154 had DD, and 320 had typical development (TD), according to standardized measures. The investigators interviewed the biological mothers regarding prenatal SSRI use, maternal mental health history, and sociodemographic factors.

Boys With ASD More Likely to Have Prenatal SSRI Exposure

Although children with TD had the lowest prevalence of prenatal SSRI exposure (3.4%), it was not statistically significantly different from the prevalence seen in children with ASD (5.9%) or DD (5.2%).

However, when the team analyzed boys separately, they found that boys with ASD were nearly 3 times as likely to have prenatal SSRI exposure compared with boys with TD (adjusted odds ratio [OR], 2.91; 95% confidence interval [CI], 1.07 - 7.93). This finding in boys with ASD was even more pronounced with first-trimester SSRI exposure (OR, 3.22; 95% CI, 1.17 - 8.84).

Boys with DD also had increased prenatal SSRI exposure compared with boys with TD (OR, 3.39; 95% CI, 0.98 - 11.75), but this only reached statistical significance in the second and third trimester (second trimester: OR, 4.41; 95% CI, 1.01 - 19.17; third trimester: OR, 4.98; 95% CI, 1.20 - 20.62). Among mothers with a history of anxiety or mood disorder, findings were similar but not statistically significant.

The authors note that the relatively small number of girls in the study precluded them as a separate subgroup (eg, just 17.5% of the children with ASD).

"This population-based case-control study in young children provides evidence that prenatal SSRI use may be a risk factor for autism and other developmental delays," the study authors write. "However, underlying depression and its genetic underpinnings may be a confounder."

Limitations of this study include difficulty in isolating SSRIs' effects from those of their indications for use, reliance on self-report with potential recall bias, lack of data on SSRI dosage precluding dose-response analyses, and a relatively small sample of DD children.

"In boys, prenatal exposure to SSRIs may increase susceptibility to ASD or DD," the authors conclude. "Larger samples are needed to replicate DD results. Because maternal depression itself carries risks for the fetus, the benefits of prenatal SSRI use should be carefully weighed against potential harms."

This research was supported by US National Institute on Environmental Health Sciences, the MIND Institute, and Autism Speaks. Funded by the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online April 14, 2014.

Neurotoxines mede debet aan autisme en ADHD

Neurotoxische chemicaliën zijn mede oorzaak van de stijgende prevalentie van neurologische ontwikkelingsstoornissen als autisme, ADHD en dyslexie. Philippe Grandjean en Philip Landrigan van Harvard School of Public Health in Boston en de Icahn School of Medicine at Mount Sinai in New York concluderen dat in een overzicht van de bestaande onderzoeksliteratuur in The Lancet Neurology.

Op de lijst met chemicaliën waarvan bekend is dat ze een negatieve invloed hebben op de ontwikkeling van het menselijk brein staan momenteel 214 stoffen. Die komen voor in alledaagse producten als kleding, meubels en speelgoed. Grandjean en Landrigan noemen onder meer het oplosmiddel tetrachloorethyleen dat ze in verband brengen met hyperactiviteit, mangaan dat de ontwikkeling van cognitieve en motorische vaardigheden afremt, en bepaalde pesticiden die ook de cognitieve ontwikkeling vertragen.

Volgens beide onderzoekers blijft nu een pandemie van neurotoxische ontwikkelingsschade onopgemerkt. Van het merendeel van de chemicaliën waarmee mensen dagelijks te maken hebben, is bovendien onbekend wat de neurotoxische effecten zijn op foetus en kind. Vaststaat in ieder geval dat een kleine dosis al schade kan toebrengen aan de hersenen van (ongeboren) baby’s en kinderen.
Grandjean en Landrigan stellen daarom voor om te komen tot een internationale preventiestrategie en een internationaal agentschap dat producenten verplicht te laten zien welke risico’s verbonden zijn aan nieuwe chemicaliën. Dat voorstel komt niet voor het eerst, in 2006 deden ze ook al een poging.

Henk Maassen

www.thelancet.com/neurology http://www.ncbi.nlm.nih.gov/pubmed/24556010

Heeft oxytocine ook effect op beperkte patronen van belangstelling?

Volgende bericht van het IMFAR congres geeft aan dat oxytocine bij personen ook effect zou hebben op hun beperkte patronen van belangstelling:

Foliumzuur aan het begin van de zwangerschap verkleint kans op autisme bij het kind

Surén et al concluderen op basis van een grootschalig onderzoek (n=85.000) onder zwangere vrouwen dat gebruik van foliumzuur vanaf 4 weken voor de conceptie tot 8 weken na de conceptie samenhing met een lagere kans dat er bij het kind later een autismespectrumstoornis gediagnosticeerd werd.

Surén P, Roth C, Bresnahan M, et al; JAMA. 2013;309:570-577

 

Patricia van Wijngaarden: ‘Vrouwelijk autisme is wat minder bizar’

Ontwikkelingsstoornissen vaak gemist bij meisjes

Een meisje dat veel kwebbelt of gek is van paarden. Niks raars aan. Of toch? Psychiater Patricia van Wijngaarden komt in de verslavingszorg geregeld vrouwen tegen bij wie in de jeugd de diagnose ADHD of autisme is gemist. Ze pleit voor een vrouwelijke vertaling van de criteria.

Lieke de Kwant. Medich Contact 2012, 49; 2770-2773

Hoe ouder de vader, hoe meer genetische mutaties

Hoe ouder de vader, hoe meer genetische mutaties hij aan zijn kinderen overdraagt. Hierdoor neemt het risico op afwijkingen zoals schizofrenie en autisme wellicht toe. Dit blijkt uit genetisch onderzoek bij IJslandse families. Augustine Kong e.a. publiceren erover in Nature.

 

De onderzoekers brachten het genoom in beeld van 219 mensen die samen 78 verwante trio’s (zoals vader-moeder-kind) vormden. De onderzoekers waren geïnteresseerd in SNP’s (single nucleotide polymorfism-mutaties) op de autosomale chromosomen. De leeftijd van de vaders lag op één geval na tussen de 18 en 40.

Het aantal SNP’s neemt toe met de leeftijd van de vader, en verdubbelt naar schatting in 16,5 jaar. Oudere moeders geven ook meer mutaties door dan jongere, maar het aantal mutaties dat zij doorgeven is veel lager (voor vaders gemiddeld 55, voor moeders 14). Als de leeftijden van beide ouders in een multipel regressiemodel worden gestopt, blijkt alleen de leeftijd van vader significant gerelateerd aan meer mutaties bij het kind. Dit neemt overigens niet weg dat oudere moeders vaker chromosomale afwijkingen aan hun kinderen overdragen, zoals downsyndroom.

De onderzoekers denken dat hun bevindingen een verklaring kunnen vormen voor de relatie tussen een hoge leeftijd van de vader en een groter risico op schizofrenie en autistische stoornissen bij hun kinderen.

Sophie Broersen (medisch contact, aug 2012)

Minder ASS diagnoses door de DSM-5

In de JAACAP wordt beweerd dat er door de voorgestelde DSM-5 criteria voor autisme veel minder mensen in aanmerking zullen komen voor een diagnose autismespectrumstoornis (ASS). 

Een resultaten van een onderzoek van de Yale University wijzen erop dat 40% van degenen bij wie op grond van de huidige DSM-IV criteria een ASS werd gediagnosticeerd hun diagnose door toepassing van de DSM-5 criteria zouden kunnen verliezen en daarmee geen aanspraak meer zouden kunnen maken op voorzieningen in de zorg. 

Lees meer ...

JAACAP. 2012;51:368-382, 348-349; 344-346. Abstract, Editorial, Commentary

Autisme prevalentie 78% omhoog in VS

Het Center for Disease Control in de Verenigde Staten maakt in Morbidity and Mortality Weekly van 30 maart 2012 bekend dat het aantal kinderen dat een autismespectrumstoornis (ASS) diagnose 23% is toegenomen sinds het laatste rapport van 2009, en zelfs 78% is gestegen ten opzichte van 2002. De redenen zijn onduidelijk, maar het is onwaarschijnlijk dat dit uitsluitend toe te schrijven is aan verbeterde diagnostiek en toegenomen alertheid op ASS.
Lees hieronder het volledige bericht.


March 29, 2012 — The prevalence of autism spectrum disorders (ASDs) has increased by 78% since 2002, a new report from the Centers for Disease Control and Prevention (CDC) shows. However, the exact reason for this increase is unclear.
Overall, the report's data, derived from the Autism and Developmental Disabilities Monitoring (ADDM) surveillance network, show that in 2008, 1 in 88 children aged 8 years — 1 in 54 boys and 1 in 252 girls — had an ASD diagnosis by age 8, a significant jump from the current estimate of 1 in 110.
This marks an estimated 23% increase since the last report in 2009 and a 78% increase since 2002. According to the CDC, some of this increase can be attributed to the way children with ASD are identified, diagnosed, and served in their communities, although exactly how much is due to these factors is unknown.
"These data confirm that the estimated prevalence of ASDS identified in the ADDM network surveillance populations continues to increase. The extent to which these increases reflect better case ascertainment as a result of increases in awareness and access to services or true increases in prevalence of ASD symptoms is not known," the report authors write.
The study is published in the March 30 issue of the CDC publication Morbidity and Mortality Weekly Report.
"To understand more, we need to keep accelerating our research into risk factors and causes of autism spectrum disorders," Coleen Boyle, PhD, MSHyg, director of CDC's National Center on Birth Defects and Developmental Disabilities, said in a statement.
The study also shows that more children are being diagnosed by age 3, an increase from 12% for children born in 1994 to 18% for children born in 2000.
"Unfortunately, 40% of the children in this study aren't getting a diagnosis until after age 4. We are working hard to change that," said Dr. Boyle.
Released today, the findings are based on data from the ADDM network, an active surveillance system that estimates the prevalence of ASDs of 8-year-old children at 14 sites in the United States.
The network focuses on 8-year-olds because a baseline CDC study revealed that this is the peak age of identified prevalence.
The report provides updated ASD prevalence estimates from the 2008 surveillance year. In addition to prevalence estimates, it describes the characteristics of children with ASDs and compares 2008 surveillance-year findings with those from the 2002 and 2006 surveillance years.
For 2008, the overall estimated prevalence was 11.3 per 1,000 among children aged 8 years. The investigators report that there was wide variation in overall ASD prevalence across the 14 surveillance sites; prevalence ranged from 1 in 210 children in Alabama to 1 in 47 children in Utah.
Further, there was wide variation in prevalence estimates by sex and race and ethnic group. Boys were 5 times more likely than girls to have an ASD diagnosis. The largest increases were among Hispanic and black children.
"One thing the data tells us with certainty — there are many children and families who need help. We must continue to track autism spectrum disorders because this is the information communities need to guide improvements in services to help children," CDC Director Thomas Frieden, MD, MPH, said in a statement.
MMWR. 2012;61:1-24.

Babyhersenen verraden risico op autisme

De hersenen van kinderen die later een vorm van autisme ontwikkelen, reageren anders dan de hersenen van kinderen die deze aandoening niet krijgen. Dat blijkt uit een onderzoek gepubliceerd in Current Biology waarin de hersenrespons van baby’s werd gemeten terwijl iemand hen aanstaarde of juist wegkeek.

beeld: Thinkstock

Mayada Elsabbagh en collega’s testten de hersenrespons van 104 kinderen: 54 met een verhoogd risico op autisme vanwege een broer of zus met de ziekte en 50 zonder autisme in de familie. Toen zij tussen de 6 en 10 maanden oud waren, werd hun hersenrespons gemeten terwijl er al dan niet een blik op hen was gericht.

Toen de kinderen 3 jaar oud waren, bekeken de onderzoekers of sprake was van een vorm van autisme. Deze diagnose kan gewoonlijk niet vóór de 2-jarige leeftijd worden gesteld, omdat bij jongere kinderen de typische gedragingen die wijzen op autisme onvoldoende duidelijk zijn. Uit de analyse bleek dat een karakteristieke hersenrespons op de blikken gerelateerd is aan het vóórkomen van een autistische stoornis op 3-jarige leeftijd.

Het was echter niet zo dat alle kinderen met de karakteristieke respons uiteindelijk autisme ontwikkelden. Ook vertoonden niet alle kinderen waarbij later autisme werd vastgesteld de respons.

Nadere bestudering van de hersenprocessen die het gevolg zijn van het aanstaren, kunnen mogelijk meer inzicht geven in de ontwikkelingsstoornissen die uiteindelijk leiden tot autisme, stellen Elsabbagh e.a.

Twan van Venrooij

Medisch Contact 2012, 5, 278

Current Biology 2012, doi: 10.1016/j.cub.2011.12.056

Autistisch kind door gebruik van antidepressiva tijdens de zwangerschap?

Het gebruik van selectieve serotonineheropnameremmers (SSRI’s) tijdens de zwangerschap geeft een twee keer zo groot risico op een kind met een autism spectrum disorder (ASD). Dat schrijven Lisa Croen e.a. in Archives of General Psychiatry.

Croen e.a. voerden een casecontrolstudie uit met 298 kinderen met ASD en 1507 willekeurig geselecteerde kinderen. Bij 20 kinderen (6,7%) met ASD bleek de moeder tijdens de zwangerschap antidepressiva gebruikt te hebben. Uit de controlegroep hadden 50 kinderen (3,3%) een moeder die tijdens de zwangerschap antidepressiva had gebruikt. Na correctie voor mogelijke andere risicofactoren als het geboortegewicht, geslacht en etniciteit, bleek een kind met ASD een twee keer zo hoge kans te hebben dat zijn moeder tijdens de zwangerschap antidepressiva gebruikte.

Om uit te sluiten dat het verband niet het gevolg is van de onderliggende ziekte waar de moeder de antidepressiva voor krijgt, onderzochten Croen e.a. ook of er een verband was tussen moeders met psychiatrische afwijkingen in de voorgeschiedenis en een kind met ASD. Dit was niet het geval. Hoewel het verband tussen SSRI’s bij de moeder en ASD bij het kind statistisch significant was, wijzen de auteurs erop dat hun studiegroepen aan de kleine kant waren en dat er meer onderzoek nodig is om de relatie definitief te bevestigen.


Wanneer de antidepressiva opgesplitst werden in verschillende groepen bleek het verband tussen het gebruik van antidepressiva door de moeder en ASD bij het kind alleen statistisch significant te zijn voor de SSRI’s. Het grootste risico lijkt te liggen bij SSRI-gebruik in het eerste trimester van de zwangerschap. Wanneer er slechts naar SSRI-gebruik in deze periode werd gekeken, bleek het risico op een kind met ASD drie keer zo hoog te zijn.


Arch Gen Psychiatry 2011 doi: 10.1001/arch gen psychiatry.2011.73:

Relatie tussen ASS en interval tussen zwangerschappen

Een kort inter-pregnancy-interval verhoogd de kans op autisme.

In januari publiceerde Cheslack-Postova et al van de Columbia University in New York, resultaten van een retrospectief cohort onderzoek naar de relatie tussen de periode tussen eenling zwangerschappen en het voorkomen van autisme. Als er minder dan 12 maanden tussen twee zwangerschappen zat, nam het risico op autisme spectrum stoornissen met een factor 3 toe. Dit relatieve risico nam af naarmate het inter pregnancy interval (IPI) groter was. De auteur wijst erop in Medschape Medical News dat deze data roepen om longitudinaal vervolgonderzoek. Als deze associatie tussen IPI en autisme wordt gerepliceerd, zou dit kunnen leiden tot een verhoogde alertheid op ASS problematiek bij consultatiebureaus.

20 februari 2010, Bram Sizoo

Pediatrics. 2011 Feb;127(2):246-53. Epub 2011 Jan 10.

Closely spaced pregnancies are associated with increased odds of autism in california sibling births.

Cheslack-Postava K, Liu K, Bearman PS.

MSPH, 420 W 118th St, Mail Code 3355, New York, NY 10027. kc2497@columbia.edu.

Abstract

OBJECTIVE: To determine whether the interpregnancy interval (IPI) is associated with the risk of autism in subsequent births.

METHODS: Pairs of first- and second-born singleton full siblings were identified from all California births that occurred from 1992 to 2002 using birth records, and autism diagnoses were identified by using linked records of the California Department of Developmental Services. IPI was calculated as the time interval between birth dates minus the gestational age of the second sibling. In the primary analysis, logistic regression models were used to determine whether odds of autism in second-born children varied according to IPI. To address potential confounding by unmeasured family-level factors, a case-sibling control analysis determined whether affected sibling (first versus second) varied with IPI.

RESULTS: An inverse association between IPI and odds of autism among 662 730 second-born children was observed. In particular, IPIs of <12, 12 to 23, and 24 to 35 months were associated with odds ratios (95% confidence intervals) for autism of 3.39 (3.00-3.82), 1.86 (1.65-2.10), and 1.26 (1.10-1.45) relative to IPIs of ≥36 months. The association was not mediated by preterm birth or low birth weight and persisted across categories of sociodemographic characteristics, with some attenuation in the oldest and youngest parents. Second-born children were at increased risk of autism relative to their firstborn siblings only in pairs with short IPIs.

CONCLUSIONS: These results suggest that children born after shorter intervals between pregnancies are at increased risk of developing autism; the highest risk was associated with pregnancies spaced <1 year apart.

PMID: 21220394 [PubMed - in process]

Wakefield’s article linking MMR vaccine and autism was fraudulent

Het omstreden onderzoek van Wakefield uit 1998 over het verband tussen vaccinaties en autisme was al in diskrediet geraakt wegens foutieve conclusies. Het wetenschappelijk tijdschrift dat het resultaat destijds publiceerde heeft het artikel in 2004 ingetrokken en de wetenschapper kreeg wegens de fouten een tuchtmaatregel opgelegd. Maar nu pas blijkt dat hij ook bewust gefraudeerd heeft.

De spraakmakende en zeer omstreden studie uit 1998 legde een verband tussen de vaccinatie van kinderen tegen mazelen, bof en rode hond en het ontwikkelen van autisme. Wetenschappers haalden de resultaten onderuit maar de alarmerende conclusie was voor veel ouders reden vaccinatie te weigeren. Dat leidde onder meer in Engeland tot gevaarlijke situaties voor de volksgezondheid.

In 2004 trok The Lancet, het wetenschappelijk tijdschrift dat de resultaten van de studie publiceerde, in. De conclusies bleken niet te deugen. Duidelijk werd ook dat de leider van het onderzoek, dr Andrew Wakefield, verzwegen had dat het onderzoek was betaald door de Legal Aid Board, een organisatie die zich specialiseerde in het indienen van schadeclaims als gevolg van medische fouten. Wakefield zlef bleef echter achter de resultaten staan.

Nu is door onderzoek van een Britse journalist duidelijk geworden dat Wakefield heeft geknoeid met de onderzoeksgegevens. 

Wakefield claimde dat bij acht van de twaalf onderzochte kinderen aanwijzingen voor autisme ontdekt werden kort na de vaccinatie. Naar nu blijkt waren in vijf gevallen die aanwijzingen al bekend voordat de vaccinatie plaatsvond. Wakefield heeft dat doelbewust verzwegen. 

bron: British Medical Journal: Wakefield’s article linking MMR vaccine and autism was fraudulent

Behandeling met SSRIs zinvol bij Autisme?

Dit jaar is er in de Cochrane Library een systematische review verschenen over
de effecten van farmacotherapie met SSRIs bij kinderen en volwassenen met ASS.
De onderstaande presentatie vat deze review samen.



Bottomline:
Er is geen evidentie voor positieve effecten bij kinderen (5 onderzoeken).
In de 2 onderzoeken betreffende volwassenen met een ASS werden significante verbeteringen gevonden
m.b.t. de "clinical global impression" (fluvoxamine and fluoxetine), obsessieve-compulsieve symptomen (fluvoxamine), angst(fluoxetine) en agressie (fluvoxamine).

Lees het hele artikel...

Risperidon vermindert prikkelbaarheid bij volwassenen met autisme

Deze presentatie geeft een samenvatting van het artikel "A Double-blind, Placebo-Controlled Study
of Risperidone in Adults With Autistic Disorder and Other Pervasive Developmental Disorders" van McDougle et al. (1998) in de Archives of General Psychiatry.



Bottomline:
Risperidone is bij volwassenen met een ASS effectiever dan een placebo als korte termijn behandeling van autistische symptomen (cgi, prikkelbaarheid, repetitief gedrag).

Lees het hele artikel ...