Autism, Services, and Co-morbidity: Insights from Kansas. PART I

Title: Characteristics of children with autism spectrum disorders who received services through community mental health centers.
Authors: Stephanie A. Bryson, Susan K. Corrigan, Thomas P. Mcdonald, and Cheryl Holmes
Source: Autism 2008 12: 65-82. (January).

Note: Co-morbidity refers to the presence of two conditions simultaneously. For example, depression has high co-morbidity with anxiety, since often people with depression also have anxiety. In research, we use the term to refer to the presence of two separate diagnoses simultaneously.

NOTE 2: This is such an interesting paper that I decided to break it into at least two review posts.

This is a basic epidemiological study from the University of Kansas that gives us some interesting data about co-morbid psychiatric disorders in children with ASDs. What services and diagnoses are obtained by children with autism, Asperger’s, PDD NOS and other childhood developmental disorders? In order to answer this question the authors examined community mental health records of 26 community centers in Kansas, through the use of a new electronic health record system that allows for the sharing of medical information between the different health centers(the great importance of such system and its possible implications for privacy violations is a very interesting topic, but a better match for a different blog). The researchers compared children who in 2004 received a diagnosis of Autism with children who received a diagnosis of a different ASD (PDD-NOS, Asperger’s). The two groups were then compared in a number of demographic factors, service use, and co-morbid diagnoses. The first amazing finding: Using very conservative estimates of autism rates (5.5 in 1000 CDC), the authors found that the Kansas community mental health system served less than 3% of children with Autism in the State and less than 15% of children experiencing other types of ASD. What happened to the 97+% of children with autism who did not receive services through the community mental health system? The authors indicated that it is possible that most children with autism in Kansas receive adequate services through the school or other State systems, so they have no need to seek services through the community mental health system. It is also possible that these children receive services privately (private ABA, therapists, evaluations, etc). Finally, a number of these children may simply not be receiving services at all. Unfortunately, the data in this paper do not help us clarify these issues. The data only tell us that less than 3% of children with autism received services through the community mental health system in the State. Is the community mental health system simply underutilized by parents of children with ASDs? Or is it simply that this system does not meet the needs of children with ASDs so that essential services are actually obtained somewhere else?

Autism, Monkeys, and Maternal Antibodies

Title: Stereotypies and hyperactivity in rhesus monkeys exposed to IgG from mothers of children with autism
Authors: Loren A. Martin, Paul Ashwood, Daniel Braunschweig, Maricel Cabanlit, Judy Van de Water and David G. Amaral
Source: In press. Journal Brain, Behavior, and Immunity

You can find a more complete description and review of this paper based on the press coverage here. Thus, I’ll limit this to a micro summary and a few related thoughts. The researchers wanted to experimentally test the hypothesis that exposure to maternal neuronal antibodies (IgG) during the PREnatal period could be one of the causes of at least some variants of Autism. To test this hypothesis the researchers exposed 4 prenatal rhesus monkeys with IgG taken from human mothers who had multiple children with ASD. They also exposed 5 prenatal monkeys with IgG taken from human mothers who did not have any children with Autism. Once the monkeys were born, these two groups were also compared to monkeys that had not been exposed to any antibodies. The researchers found that the monkeys that had been exposed to the antibodies of human mothers of children with autism engaged in much higher levels of unique whole-body stereotypic behaviors and less social contact with familiar peers, than did the monkeys exposed to IgG of mothers of typically developing kids or monkeys not exposed to any antibodies. Furthermore, these stereotypic behaviors increased when the monkeys were exposed to novel environments or peers. As I understand how controversial this paper will be for some people, I want to say that the authors are very clear and explicit in stating that this is NOT an animal model of autism. That is, they did not intent to say that they were able to “cause” autism in these monkeys via exposure to IgG. Instead, their data presents some evidence that exposure to IgG before birth leads to unique patterns of stereotypic behaviors, similar to those observed in some children with ASD. This is a very small preliminary study, but the results are fascinating in that it will guide future research to explore exposure to IgG as a potential cause (one of many) of ASD.

School Principals and Autism.

Title: Principals’ Attitudes Regarding Inclusion of Children with Autism in Pennsylvania Public Schools
Authors: Judy L. Horrocks, George White, & Laura Roberts
Source: Journal of Autism and Developmental Disorders, In press.

A very interesting study that will be published in the next issue of the Journal of Autism and Developmental Disorders. The authors wanted to examine the attitudes of school principals in Pennsylvania regarding the mainstream inclusion of children with autism. The researchers surveyed 571 school principals. The principals were provided with descriptions of 5 children with different levels of social and academic strengths and deficits, and asked for placement recommendations for these children (the descriptions did not explicitly stated that the kids had autism). Based on the Principals' responses, the authors identified two domains used by principals to determine placements: Social Detachment and Academic Skills. Then the researchers examined what characteristics of the principals that predicted how they used the two domains to make placement decisions. Here is the most interesting result: Principals with 1) formal training in special education and 2) from elementary schools (as compared to middle and high school) were more likely to recommend higher placement for children with high level of Social Detachment (various deficits in social functioning). First, it is clear that formal training in special education of Principals have an effect in their placement decisions, possibly by helping them more accurately understand the capacities and limitations of these students (Although this assumes that the higher placement decision was the best decision for these kids). It is interesting also to see the School Level effect. Why are principals at the middle and high school level more hesitant to recommend mainstream inclusion? Is it an understanding of changing social pressures and the belief that these children will be “protected” by keeping them in a self contained classroom?

NOTE: Principals are not usually involved in placement decisions, so the purpose of this study was to examine "attitudes" towards placement. The assumption is that the decisions these Principals made to the sample descriptions may reflect their general beliefs about placement, which in turn could affect how decisions are made at the school level (by those truly in charge of making such decisions).