Rare instances of individuals with autism supporting or engaging in terrorism

* Abbreviations: ASD — : autism spectrum disorder AA — : African American Significant racial inequities exist in access to services for youth with autism spectrum disorder (ASD). Multiracial children are diagnosed with ASD later than their white counterparts, report difficulty accessing treatment services, and ultimately experience worse health outcomes. Empirical data on the mechanisms of inequities are generally lacking, although traditional contributors (structural racism, prejudice, education, income) are certainly at play. In this month’s issue of Pediatrics , Constantino et al1 found that among a large cohort of African American (AA) children, there was on average a 3-year delay between first parental developmental concern and ASD diagnosis. Moreover, nearly half of parents reported visiting multiple providers before receiving an ASD diagnosis, and 31.3% stated lack of available professionals contributed to this delay. Given the pervasive history of racism and exclusion that exists across the United States, particularly in medical care and research, we first applaud the overall goal of Constantino’s work to increase representation of AA children in ASD research. Next, we want to leverage this opportunity as a call to action for the field of ASD services. Specifically, how can these data be used to … Address correspondence to Sarabeth Broder-Fingert, MD, MPH, Department of Pediatrics, Boston Medical Center, 801 Albany St, Boston, MA 02118. E-mail: sarabeth.broder-fingert{at}bmc.org

Evidence supporting the association between breastfeeding patterns and autism is inconsistent. This study examined sociodemographic and birth factors related to breastfeeding duration and subsequent autism spectrum disorder (autism) diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, compared to a neurotypically developing cohort, based on electronic health records. Demographics, feeding preferences, and breastfeeding duration as reported by parents during routine baby wellness visits were analyzed for a cohort of 11,766 (1.9%) children with autism spectrum disorder diagnosis and a random subsample of 12,000 (2.03%) neurotypically developing children. Autism spectrum disorder diagnosis was based on a national autism registry and assigned after electronic health records were completed. Preterm, very low birth weight, multiple births, and complex medical comorbidities were excluded. Infants subsequently diagnosed with autism were breastfed for an average of 5.0 months, 1.5 months shorter than neurotypically developing. Fewer autism spectrum disorder infants were exclusively breastfed in the first year of life. Two-way analysis of variance indicated a significant effect of socioeconomic status and autism spectrum disorder on breastfeeding duration, and a significant interaction of socioeconomic status with autism spectrum disorder. Shorter breastfeeding duration among infants with subsequent autism spectrum disorder was confirmed, calling for closer monitoring for autism traits in infants with breastfeeding difficulties. These challenges were independent of birth parameters; however, they were influenced by socioeconomic factors.Lay AbstractThis study found that infants later diagnosed with autism were breastfed for a shorter duration than their typically developing peers, with differences influenced by socioeconomic status. These findings highlight the importance of monitoring breastfeeding challenges as a potential early indicator of autism, particularly in families of mid-range socioeconomic status.

The administration requirements of the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised, widely used in high-income countries, make them less feasible for diagnosis of autism spectrum disorder in low- and middle-income countries. The flexible administration requirements of the Childhood Autism Rating Scale have resulted in its use in both high-income countries and low- and middle-income countries. This study examines the agreement between assessments using the Childhood Autism Rating Scale with those using the Autism Diagnostic Observation Schedule or Autism Diagnostic Observation Schedule, Second Edition and Autism Diagnostic Interview-Revised in Jamaica. Children aged 2-8 years (n = 149) diagnosed with autism by an experienced clinician using the Childhood Autism Rating Scale were re-evaluated using the Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised. The proportion diagnosed with autism spectrum disorder using the Autism Diagnostic Observation Schedule, Autism Diagnostic Observation Schedule, Second Edition, and Autism Diagnostic Interview-Revised was determined and mean domain scores compared using analysis of variance (ANOVA). The mean age was 64.4 (standard deviation = 21.6) months; the male:female ratio was 6:1. The diagnostic agreement of the Childhood Autism Rating Scale with the Autism Diagnostic Observation Schedule and Autism Diagnostic Observation Schedule, Second Edition was 100.0% and 98.0%, respectively. Agreement with the Autism Diagnostic Interview-Revised was 94.6%. Domain scores were highest for children with more severe symptoms (p < 0.01). Despite a high level of agreement of the Childhood Autism Rating Scale with the Autism Diagnostic Observation Schedule, Autism Diagnostic Observation Schedule, Second Edition, and Autism Diagnostic Interview-Revised, the Childhood Autism Rating Scale should be evaluated further with a broader range of autism spectrum disorder symptomatology, and by clinicians with varying experience before recommendation for use in low- and middle-income countries.

This appears to be the first meta-analysis study which has incorporated articles on the percentage of people with a Diagnostic and Statistical Manual of Mental Disorders-Forth Edition (DSM-IV) autism spectrum disorder (ASD) diagnosis receiving a Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5) ASD diagnosis and articles on the percentage of people with a Diagnostic and Statistical Manual of Mental Disorders-Forth Edition-Text Revision (DSM-IV-TR) ASD diagnosis receiving a DSM-5 ASD diagnosis. Our meta-analysis measured the percentage of people with an ASD diagnosis from the DSM-IV or DSM-IV-TR obtaining an ASD diagnosis from the DSM-5. All 24 studies identified indicated a reduction in the number of people with a DSM-IV or DSM-IV-TR ASD diagnosis being eligible for a DSM-5 ASD diagnosis, a 35 and 37 % reduction respectfully. Our meta-analysis also showed that those with a DSM-IV-TR or DSM-IV diagnosis of PDD-NOS were the least likely to qualify for a DSM-5 ASD diagnosis at 26 and 47 % followed by 55 and 19 %, respectfully of people with Asperger syndrome, and 80 and 87 %, respectfully of people with an autism diagnosis.

BackgroundLong-term consequences of comorbid autism spectrum disorder (ASD) in individuals with anorexia nervosa (AN) are inadequately investigated.MethodsIn the 1980s, 51 adolescent-onset AN cases (AN group) and 51 matched controls (COMP group) were recruited from the community. They have been examined on five occasions. The four last assessments included the Morgan-Russell Outcome Assessment Schedule (MROAS) to assess eating disorder outcomes (weight, dieting, menstruation), and related problems including psychiatric, psychosexual and socioeconomic state. In the present study, at age 44, when 30 years had elapsed, MROAS data were compared with previous results. At age 16, 21, 24 and 32 years, all individuals had been assessed regarding ASD. At the 30-year follow-up, the impact of the ASD on the MROAS data was analysed.ResultsIn the AN group, all core anorectic symptoms (weight, dieting, menstruation) were on a par with the COMP group at the 30-year follow-up, but the positive outcomes were limited to those who had never had an ASD diagnosis. Psychiatric state was significantly worse in the AN group, particularly in the subgroup who had an ASD diagnosis assigned. The AN group—again particularly those with ASD—had a more negative attitude to sexual matters than the COMP group. The AN group had worse outcomes than the COMP group for ‘personal contacts’, ‘social contacts,’ and ‘employment record’ at the 30-year follow-up and the outcomes were worse the more often an ASD diagnosis had been assigned.LimitationsRare data collection points throughout 30 years (only 5 assessments). ASD was assessed in the first four studies but was not assessed again at the 30-year follow-up.ConclusionsMental health, psychosexual, and socioeconomic status were compromised up to 30 years after AN onset. Coexisting ASD contributed to the poor outcome. Core anorectic symptoms had “normalised” three decades after AN onset.Plain English summarySome individuals with anorexia nervosa (AN) also suffer from autism. In this study we have investigated outcome of AN 30 years after the onset of AN and whether the presence of autism affects the outcome. Since the 1980s we have followed 51 individuals with teenage-onset AN and 51 healthy controls. They have been examined on five occasions, and an instrument that measures symptoms of AN (weight, dieting, body image), psychiatric symptoms, ability to work, and relationships with partner, family, and friends has been used to assess outcome. Autism was assessed in the first four studies. Symptoms of AN had normalised at 30-year follow-up, but only among those without autism. Psychiatric symptoms, ability to work, and relationships were issues that persisted after 30 years in the AN group, and those who had both autism and a history of AN had even more pronounced problems in these areas. The AN group had a more negative attitude to sexual matters than the control group, the outcome was worse the more often an autism diagnosis had been assigned.ConclusionsMental health, psychosexual, and socioeconomic status are affected up to 30 years after AN onset, particularly among those with autism.

The current study was a case-control, focused on the presence of environmental exposures during pregnancy in mothers of children diagnosed with autism spectrum disorder (ASD) and children who were not. Exposures investigated included: acetaminophen/paracetamol use, air pollution, fever, smoking, parental age, maternal diabetes, prenatal vitamin use, workplace exposures, recreational drug use, seafood consumption, obesity, and maternal thyroid issues. Two-hundred and fifteen mothers of children (107 with ASD and 108 without ASD) aged 0-10 years participated in a telephone survey regarding prenatal exposures followed by a chart review. Data were analyzed with a series of univariate tests and a multivariate logistic regression. Univariate analyses showed correlation for the presence of siblings with ASD, presence of family members with ASD, maternal use of medications and maternal smoking during pregnancy; and child's gestational age at the start of prenatal vitamins with a diagnosis of ASD. Multivariate logistic regression analysis demonstrated an association with the use of medications (although specific medications could not be delineated due to small sample size), smoking, and gestational age at the start of prenatal vitamins. These preliminary results suggest that certain prenatal exposures (medication use, smoking, and gestational age at the start of prenatal vitamins) may be associated with a later diagnosis of ASD. Future research should be conducted with larger sample sizes and control for potentially confounding factors. Working towards an understanding of factors that come together to create or prevent a diagnosis of autism will be helpful for families, physicians, and allocating government resources.

This study was performed to determine (a) the age at which autism spectrum disorder (ASD) is first diagnosed in Ugandan children receiving mental health services, (b) whether age at diagnosis varies by sex and clinical presentation, and (c) the average age of ASD diagnosis in children manifesting comorbid conditions. A retrospective chart review was performed and demographic as well as clinical data were collected from children with ASD diagnoses who attended two mental health clinics in Uganda between 2014 and 2019. Descriptive statistics such as percentages, means, and standard deviations were used to summarize the data. Independent t-test was also performed to determine differences in the mean age of diagnosis between males and females. Two hundred and thirty-seven (156 males, 81 females) children with ASD were identified. The average age of ASD diagnosis was (6.9 ± 4.0) years. A statistically significant difference in age of ASD diagnosis was found between males and females (t=-2.106, p=0.036), such that on average females received a diagnosis at least 1 year later than males. Of the 237 participants, 53.6% were identified with ASD only, 16.0% had ASD and ADHD, 10.5% were diagnosed with ASD and epilepsy, and 7.2% had a diagnosis of complex ASD. The results confirm delays in access to ASD diagnosis and suggest that females are more likely to receive a ASD diagnosis later than males within the Ugandan context. ASD awareness should be intensified to improve public or professional knowledge about ASD to enhance early identification in Uganda.

Autism spectrum disorder (ASD) can be diagnosed as early as 18 months of age. However, the average age at diagnosis in the United States is over 2 years later. A lot has been written about the many barriers families face when seeking a diagnosis for their child. One area of research that has received no attention is whether separation between a child's biological parents affects the age at which a child is diagnosed with ASD. This study was conducted among 561 children who were receiving an ASD diagnosis for the first time. On average, these children were 5 years of age. The study took place in an urban, outpatient specialty autism clinic in the United States. Biological parents self-reported their relationship status during the evaluation. This was categorized as either "together" (married or living together but not married) or "not together" (separated, divorced, or never married). At the time of diagnosis, most children's biological parents were together (69%). We found children of parents who were together were diagnosed 1.4 years earlier than those who were not together. These findings have important implications for providing support to families that separate early in a child's life, with the goal of reducing the age at ASD evaluation among single parents and those who have been separated from their child's other biological parent. Providing support to these families is important since earlier age at diagnosis leads to earlier intervention, which can improve long-term outcomes for the child, family, and community as a whole.

An association between maternal smoking in pregnancy and autism may be biologically plausible, but the evidence to date is inconsistent. We aimed to investigate the causal relationship between maternal smoking during pregnancy and offspring autism using conventional analysis and causal inference methods. In the Avon Longitudinal Study of Parents and Children we investigated the association of maternal smoking during pregnancy (exposure) with offspring autism spectrum disorder (ASD) or possible ASD diagnosis (n = 11,946) and high scores on four autism-related traits (outcomes) (n = 7402–9152). Maternal smoking was self-reported and also measured using an epigenetic score (n = 866–964). Partner’s smoking was used as a negative control for intrauterine exposure (n = 6616–10,995). Mendelian randomisation (n = 1002–2037) was carried out using a genetic variant at the CHRNA3 locus in maternal DNA as a proxy for heaviness of smoking. In observational analysis, we observed an association between smoking during pregnancy and impairments in social communication [OR = 1.56, 95% CI = 1.29, 1.87] and repetitive behaviours, but multivariable adjustment suggested evidence for confounding. There was weaker evidence of such association for the other traits or a diagnosis of autism. The magnitude of association for partner’s smoking with impairments in social communication was similar [OR = 1.56, 95% CI = 1.30, 1.87] suggesting potential for shared confounding. There was weak evidence for an association of the epigenetic score or genetic variation at CHRNA3 with ASD or any of the autism-related traits. In conclusion, using several analytic methods, we did not find enough evidence to support a causal association between maternal smoking during pregnancy and offspring autism or related traits.

Purpose Several clinical studies have shown correlations between certain physiological measurements and an autism spectrum disorder (ASD) diagnosis. Such findings, however, have generally not resulted in tangible progress towards practical translation. In fact, most studies have been retrospective in nature and compare biomarker profiles in children with an ASD diagnosis to those who are typically developing. A clinically meaningful test, however, requires an ASD diagnostic center to distinguish children from those with a developmental disorder pre-diagnosis. Methods This paper presents, for the first time, a double-blind case/control trial design in which metabolic profiles, collected at two developmental pediatric clinics, were collected from children on a diagnostic waitlist for the purpose of developing a blood-based test for ASD. Besides obtaining blood samples, the children underwent gold-standard clinical evaluations, including the Autism Diagnostic Observation Schedule (ADOS), Mullens Scale of Early Learning (MSEL), and Vineland Adaptive Behavior Scale (VABS). The analysis, together with a complete medical history and physical exam, allowed to confirm or rule-out suspected ASD using DSM-V criteria. The study was based on a cohort of 140 children between the ages 18-60 months, that were referred to a developmental pediatrician because of concerns in their development. Results 114 of these children received an ASD diagnosis, while 26 were diagnosed with non-ASD related developmental delays. Based on the measured metabolites, artificial intelligence-based classification algorithms allowed for an over 80% accuracy in predicting whether a sample came from a child diagnosed with ASD or not. Conclusion While these results need to be replicated in a larger study, especially involving more children with non-ASD related developmental delays, this is the first work using physiological measurements, coupled with AI, to support ASD diagnoses in a clinically relevant setting.

The abnormal brain functional connectivity (FC) of patients with mental diseases is closely linked to the transition features among brain states. However, the current research on state transition will produce certain division deviations in the measurement method of state division, and also ignore the transition features among multiple states that contain more abundant information for analyzing brain diseases. To investigate the potential of the proposed method based on coarse-grained similarity measurement to solve the problem of state division, and consider the transition features among multiple states to analyze the FC abnormalities of autism spectrum disorder (ASD) patients. We used resting-state functional magnetic resonance imaging to examine 45 ASD and 47 healthy controls (HC). The FC between brain regions was calculated by the sliding window and correlation algorithm, and a novel coarse-grained similarity measure method was used to cluster the FC networks into five states, and then extract the features both of the state itself and the transition features among multiple states for analysis and diagnosis. (1) The state as divided by the coarse-grained measurement method improves the diagnostic performance of individuals with ASD compared with previous methods. (2) The transition features among multiple states can provide complementary information to the features of the state itself in the ASD analysis and diagnosis. (3) ASD individuals have different brain state transitions than HC. Specifically, the abnormalities in intra- and inter-network connectivity of ASD patients mainly occur in the default mode network, the visual network, and the cerebellum. Such results demonstrate that our approach with new measurements and new features is effective and promising in brain state analysis and ASD diagnosis.

To describe retention of an autism spectrum disorder (ASD) diagnosis from preschool to adolescence and the most common co-occurring diagnoses among children with ASD in preschool and adolescence. A second objective was to identify co-occurring diagnoses more likely to emerge between preschool and adolescence among children with ASD vs. another developmental or mental health diagnosis in preschool. Children completed a case-control study when they were between 2 and 5 years of age. Caregivers reported their child's diagnoses of ASD and attention deficit hyperactivity disorder (ADHD), any developmental delay (DD), epilepsy/seizure disorder, obsessive-compulsive disorder, sensory integration disorder, and speech/language disorder when the child was preschool age and, separately, during adolescence. Any anxiety and depression/mood disorder, intellectual disability (ID), and learning disability (LD) were considered only in adolescence. 85.5% of preschool children retained their ASD diagnosis in adolescence. DD, sensory integration disorder, and speech-language disorder co-occurred in over 20% of preschool age children with ASD. These same conditions, along with anxiety disorders, ADHD, ID, and LD, co-occurred in over 20% of adolescents with ASD. Significantly more children with ASD vs. another developmental or mental health diagnosis in preschool gained diagnoses of ADHD, DD, sensory integration disorder, and speech-language disorder by adolescence. ASD is a highly stable diagnosis and co-occurring conditions are common. The prevalence of co-occurring diagnoses may depend on age, with some persisting from preschool to adolescence and others emerging over time. Health and education providers can use these findings to inform precision monitoring and treatment planning.

Autism in DSM-5

In recent years, many studies indicate that children with an autism spectrum disorder (ASD) diagnosis have brain pathology suggestive of ongoing neuroinflammation or encephalitis in different regions of their brains. Evidence of neuroinflammation or encephalitis in ASD includes: microglial and astrocytic activation, a unique and elevated proinflammatory profile of cytokines, and aberrant expression of nuclear factor kappa-light-chain-enhancer of activated B cells. A conservative estimate based on the research suggests that at least 69% of individuals with an ASD diagnosis have microglial activation or neuroinflammation. Encephalitis, which is defined as inflammation of the brain, is medical diagnosis code G04.90 in the International Classification of Disease, 10th revision; however, children with an ASD diagnosis are not generally assessed for a possible medical diagnosis of encephalitis. This is unfortunate because if a child with ASD has neuroinflammation, then treating the underlying brain inflammation could lead to improved outcomes. The purpose of this review of the literature is to examine the evidence of neuroinflammation/encephalitis in those with an ASD diagnosis and to address how a medical diagnosis of encephalitis, when appropriate, could benefit these children by driving more immediate and targeted treatments.

Our objective was to evaluate pathways between initial concerns of parents regarding atypical development of their children and autism spectrum disorder (ASD) diagnosis in Turkey. The study included 199 children aged 18–97 months and diagnosed with ASD. The fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were used along with information obtained from parents and direct observation of the child. The Childhood Autism Rating Scale (CARS) was used as a diagnostic tool. A 45-minute semi-structured interview was conducted with parents to evaluate the time until their child was diagnosed with ASD. A period longer than 1 year (mean: 13.69 ± 10.80 months) had passed from the first concern of parents until their children were diagnosed with ASD. Further, 53.8% of parents consulted a healthcare professional a few months after their initial concern and 46.2% did not for a longer time (9.34 ± 8.36 months). Maternal education level, socioeconomic status, and higher Autism Behavior Checklist (ABC) relating subscale scores predicted an earlier age for a diagnosis of ASD, while higher ABC language subscale scores predicted ASD diagnosis at older ages. Based on our results, it appears that factors such as spoken language and socioeconomic level may be related to significant delays in ASD diagnoses in Turkey.