Having autism as an adult

This article explains the difficulties of autism after high school and entering the adult world.

Melanie Tyner-Wilson is facing one of her toughest battles yet. She wants nothing more than to help her son Jay Tyner-Wilson, who is a person with autism, land his first real job.

Public school provided opportunities for Jay to gain volunteer vocational experience. There, he discovered he enjoyed working with animals -- and school offered a repetitive, structured and routine environment. But Jay is 21 years old now and aged out of the school system in May.

"The challenge is now finding a job," says his mother. "That's the golden ticket that I'm trying to figure out."

Jay did not qualify for an official high school diploma, so the path to college or career is a tricky one. Melanie laments that many people with disabilities end up living in poverty unless they have families and other resources that can save and plan for them. With an ever-increasing number of students on the autism spectrum coming through the school pipeline, questions abound as to what they can do to build a life for themselves beyond school.

A new study at the University of Kentucky College of Education helps frame the conversation around this transition. The National Institute of Mental Health (NIMH) has awarded a $693,000 grant to College of Education Professor Lisa Ruble and a cross-disciplinary team of co-investigators at UK and Indiana University-Purdue University Indianapolis.

"This funding will allow us to find ways to help reduce or eliminate the disconnect from needed services that often occurs when students with Autism Spectrum Disorder (ASD) complete school," Ruble says.

Melanie says her son is a person with multiple skills that would be of value to an employer, but who would need additional support.

"The powerful thing about this study is that it brings national attention to it beyond just some parent like me saying 'oh dear, my poor child,'" she says. "It is exciting because when something gets researched, it gets attention and it counts. It formalizes things and forces people to begin to pay more attention in this area. We have all kinds of people like my son Jay in the far reaches of this state and we need to figure out how we are going to meet their needs and give them a quality of life."

The study will further the research team's previous work with an intervention called the "Collaborative Model for Promoting Competence and Success" (COMPASS) for young children with ASD. COMPASS is a parent-teacher consultation model that has been shown to empower teachers, families, and above all, students, by improving educational outcomes.

While the work with COMPASS has been successful for young students, it will need to be adapted, based on stakeholder input, for students nearing adulthood and preparing to complete high school. Once adopted, it will be tested in a randomized controlled study of 32 participants. Additional variables to help understand factors that explain optimal and poor outcomes will be obtained.

Jay has been receiving services at the UK College of Education ever since he was a pre-school student at the college's Early Childhood Lab. He participates in services offered through the college's CASPER center such as social skills training and small group programs. Through the years, Jay has had the opportunity to interact with many of the college's faculty and students.

"UK is conducting research and training all these people who are going into careers to help those with autism," Ruble says. "It is uplifting because I know every student who goes through these programs helps raise the state and nation's capacity to provide services to children and adults with ASD. We need to continue to keep doing better."

Melanie is involved with the Autism Society of the Bluegrass, which is a caregiver support and advocacy group. She has had an opportunity to meet many individuals on the autism continuum. These individuals have a wide range of abilities -- some attend college, but many struggle to find employment.

"While many on the continuum have achieved postsecondary education and/or employment, there continues to be a significant number that struggle," she says. "The challenge is how we are going to plan and get what we need for these individuals."

For now, Jay is putting in lots of volunteer hours in pursuit of "the good life."

"I'm doing the same thing any parent would want for their child," his mother says. "We want to make sure our children are okay after we are gone. With Jay, it's a more involved, complicated plan. I think it's possible. I have got to figure out as a parent how to do it.

"It's been really humbling to be on this journey with my son, and it's probably the hardest thing I have ever done in life. It's also an honor because he's just an amazing person and has taught me so much as a parent."

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Suicide risk increased by sleep disorder presence

This article discusses the association seen between presence of a sleep disorder in older adults and increased suicide risk.

Sleep quality influences suicide risks for older adults, according to a research undertaken by scientists from Stanford University School of Medicine. Rebecca Bernert, the study’s author, says this is a highly treatable condition. Bernert, PhD, is the director of the Suicide Prevention Research Laboratory at Stanford. The fact that sleep disorder increases suicide risks for older adults comes after a complex research.

Another research carried earlier this year involvedblood analysis to determine suicide risks.

“Suicide is the outcome of multiple, often interacting biological, psychological and social risk factors,” Bernert said. “Disturbed sleep stands apart as a risk factor and warning sign in that it may be undone, which highlights its importance as a screening tool and potential treatment target in suicide prevention.

To reach the conclusion, the team of scientists from Stanford looked at data from 14.456 adults over 65 years old. Out of this group, they chose 400 individuals who had similar sleeping patterns to 20 people who committed suicide. Scientists followed the sleeping behavior over a 10 years period. In the end, researchers concluded that older people with sleeping disorders have a suicide risk 1.4 times higher than their counterparts with high sleep quality.

The comparison between the two groups was done by looking at a series of data obtained through interviews. The questions addressed topics such as depression signs, and mental and physical functioning. Even after taking out the depression variable, the lack of quality sleep remained an important factor determining an increased risk of committing suicide.

Suicide is associated with stigma, so people suffering suicidal thoughts or attempts have troubles talking about the issue. However, if a disturbed sleeping pattern accounts for such a high influence in determining suicide, there is a ray of hope. If trouble sleeping is not a stigmatized disorder, focusing on improving the older adults’ sleep quality might reduce the suicide rates.

The subjects involved in the study were mostly white males. A group of twenty suicide victims is surely not enough to draw the definitive conclusion that sleep disorder increases suicide risks, but is a start. Further research involving data from cases involving women and minority groups may shed additional light on the issue.

People who are at risk of committing suicide should ask for help by calling the National Suicide Prevention Lifeline (1-800-273-TALK).

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Lack of sleep is a health issue for adults

This article discusses how lack of sleep is a huge issue for adults, and what those who aren't getting enough sleep should to do fix it.

America is full of sleepy people.

Adults should get between seven and nine hours of sleep each night, but most average between five and six, according to Shari Newman, clinical manager of sleep services at Spartanburg Regional Healthcare System

“We are sleepier today than we have ever been before,” Newman said. “Sleepy is an epidemic.”

When we are sleepy, we don't exercise as we should. We eat too much thinking it will give us energy to get through the day and we drink coffee and other caffeine-heavy drinks because we need that added boost, which only causes us to have trouble sleeping at night. The problems reoccur the next day.

“Sleepiness is adding to the obesity problem,” said Newman, seated in a room at North Grove Medical Center in Spartanburg. The room resembles a small hotel room instead of a typical doctor's office exam room. A tidy bed with white sheets sits against one wall. A TV sits in one corner. A bathroom, complete with a shower, is connected.

Newman said as many as 3,000 people stay in one of these 12 rooms each year. They come in around 8:30 p.m., go to sleep and leave the next morning around 6:30 a.m. While they sleep, doctors analyze their sleep patterns, studying brain waves and any breathing irregularities. There are 88 types of sleep disorders, Newman said.

The average adult spends a third of his life sleeping, according to the National Sleep Foundation. If you're 75 years old, that means you have slept for 25 years. How we sleep and how often we sleep affects the other two-thirds of our life, studies say.

Not only can sleepiness lead to obesity, studies have found other relationships between the quantity and quality of one's sleep and health problems. Blood pressure usually falls during the sleep cycle, however, interrupted sleep can adversely affect this normal decline, leading to hypertension and cardiovascular problems. Research has also shown that insufficient sleep impairs the body's ability to use insulin, which can lead to the onset of diabetes, according to the National Sleep Foundation. If you're sleepy, you can have a negative mood and behavior, decreased productivity, and safety issues in the home, on the job and on the road. A recent study by the American Academy of Pediatrics found that children who do not adhere to a regular bedtime are more likely to exhibit behavior problems during the day.

“We know sleepy folks really are at risk,” Newman said. “You have to plan for good sleep and make sleep the priority it needs to be.”

She adds that you should be able to lie down and go to sleep within 10 minutes and wake up without needing an alarm clock.

“If that's not happening, why? What is going on with your sleep?”

If you have trouble falling asleep at night, consider these tips provided by Spartanburg Regional Sleep Services:

* Lie down when you feel sleepy. If you don't fall asleep within 30 minutes, don't keep looking at the clock. Get up and go to another area where it's nice and quiet and relaxing. When you feel sleepy again, go back to bed. If you keep tossing and turning, you get anxious and frustrated and it's not going to happen.

* Go to sleep and get up at the same time everyday, even on weekends. “A lot of us try to catch up on sleep over the weekends. But sleep is not money, you can't save it up or put it in a bank. You have got to do it everyday.”

* Do not have caffeine within six hours of bedtime. Caffeine is a drug and it takes longer to clear from your system than a lot of people realize.

* Add exercise to your daily schedule. Exercise can deepen your sleep

• Insulate your room against sound and light
• Keep your room temperature moderate. Exceedingly warm or cold temperatures can disturb sleep. Generally, we sleep better when it's cooler.
• Consider eating a light, caffeine-free snack before bedtime. Both hunger and excessive fullness can disturb sleep.
• Avoid excessive liquids in the evening so you don't have to go to the bathroom in the middle of the night.
• Don't smoke tobacco.
• Avoid alcohol, especially in the evening. Alcohol may help you fall asleep more easily, your sleep will be disturbed later by the alcohol.
• Keep work materials such as computers and television out of the bedroom.

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Brain Development Determines ADHD Recovery

Studies show that around 50% of children with ADHD grow out of the condition while the rest become adults with ADHD. This article claims that the pattern of a child's brain development could determine if a child grows out of their ADHD or not.

Some people grow out of their childhood attention-deficit/hyperactivity disorder (ADHD) and some don't. In fact, around 50% of individuals diagnosed as children continue to suffer from ADHD as adults.

Researchers are trying to understand the reasons why, and relatedly, whether there are any differences that distinguish the two groups. Gender, ethnicity, socioeconomic class, and symptom severity have already been ruled out as potentials. So, perhaps there is a distinguishing variable in the brain? Dr. Philip Shaw at the National Human Genome Research Institute and his colleagues conducted a study to find out.

They already knew from prior work that cortical structure is thinner in adults with ADHD, particularly in regions of the brain that play important roles in cognitive functioning and attention. However, that work was cross-sectional, meaning it was conducted at a single point in time, so any changes over time weren't captured. Thus, they focused on those same regions in this study, but conducted a longitudinal study so they could link trajectories of symptoms with trajectories of brain development, particularly the structure of cortical regions that control attention.

They recruited 92 children with ADHD, with a mean age of 11, who underwent repeated structural imaging scans and clinical assessments over the years, including as adults at a mean age of 24 years. For comparison, they also scanned 184 volunteers without ADHD.

They found that ADHD continued into adulthood in 37 (40%) of the participants diagnosed with childhood ADHD, and these individuals showed increased rates of thinning. In contrast, the cortical thickness of individuals who achieved remission of their ADHD developed toward the normal range.

"We find that differences in patterns of brain growth are linked with differences in the adult outcome of childhood ADHD. Differences in these regions -- specifically a thinner cortex -- are found in childhood ADHD," Shaw further explained. "However, for the group whose ADHD improved with age, these differences tend to resolve and by adulthood, these regions did not differ significantly from individuals who never had ADHD. By contrast, for the group with persistent ADHD, childhood differences persisted in the 'attention' regions of the brain."

These findings seem to suggest that the trajectory of cortex development differentiates people who recover from childhood ADHD from people whose disorder continues into adulthood.

"The development of the cortex seems to be a critical factor influencing the recovery from childhood ADHD. However, there is much that we do not understand about this relationship," commented Dr. John Krystal, Editor of Biological Psychiatry. "Cortical thinning may be related to the pruning of connections in the brain, in this case, connections with the prefrontal cortex. The current data would seem to suggest that excessive trimming of connections is a risk factor for the persistence of ADHD into adulthood. But we do not yet understand which connections are being trimmed, why these connections disappear, and how this loss of connections contributes to ADHD symptoms."

More work will be necessary to answer these questions, but Shaw concludes that "understanding how differences in brain development are tied to the course of ADHD is the first step in developing tools to help us predict the outcome of childhood ADHD."

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Concussion symptoms the same for teens and adults

A study claims that concussions symptoms are at the same level of severity for teenagers and young adults.

Whether injured athletes are teens or young adults does not affect the severity of their concussion symptoms, according to a new study. However, differences may still exist in the concussion's aftermath, the researchers say.

Some previous research has raised concerns that high school-age athletes may suffer more severe symptoms after a concussion than college-age athletes, but this study found no evidence of that.

Related symptoms include headache, dizziness, nausea, fatigue, irritability, sleeping difficulties and problems with memory and concentration.

Vanderbilt University School of Medicine researchers compared concussion symptoms in 92 athletes aged 13 to 16 with those of 92 athletes aged 18 to 22. Both groups had 56 percent females and 44 percent males.

No significant differences occurred between the two groups in the number, duration or severity of concussion symptoms, according to the study published online Sept. 24 in the Journal of Neurosurgery: Pediatrics.

Some age-related differences may occur after sports-related concussion, the researchers said. They noted that previous research from the Vanderbilt Sports Concussion Center concluded that age-related differences exist in neurocognitive testing after sports-related concussion.

In evaluating sports-related concussion, it's important to separate different ways of assessing outcomes, study co-author Dr. Scott Zuckerman said in a journal news release. These methods include assessing symptoms, neurocognitive testing, balance problems, school performance and others.

"It appears that symptoms may not be a prominent driver when assessing outcomes of younger versus older athletes. We hope that our study can add insight into the evaluation of youth athletes after sports-related concussion," Zuckerman said in the news release.

The author of an accompanying editorial, Dr. Ann-Christine Duhaime, noted that definitions of concussion are not uniform, its diagnosis is not standardized and it's extremely difficult to match all variable factors in a study of sports-related concussion in different age groups.

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Young adults with autism struggle with jobs and independent living

This article discusses how adults with autism may struggle in independent living situations and in their job search.

For young adults with autism spectrum disorders (ASDs), making the transition from school to the first rites of independent adult life, including a first job and a home away from home, can be particularly challenging.

Two newly published studies show precisely how stark the situation is for finding success in employment and independent living among young adults on the autism spectrum, compared to their peers with other types of disabilities. The researchers emphasize the need to strengthen services to help adolescents and young adults and their families with transition planning.

"Roughly 50,000 youth with autism will turn 18 years old this year," said Dr. Paul T. Shattuck, an associate professor in the A.J. Drexel Autism Institute and Drexel University School of Public Health, who co-authored both studies. "So many of these young people have the potential to work and participate in their communities. Supporting this potential will benefit everyone -- the person with autism, the family, employers and society."

Employment Outlook: Just Over Half with ASDs Had Ever Worked for Pay

In the Journal of the American Academy of Child & Adolescent Psychiatry, Shattuck's team reports that young adults with autism spectrum disorders have worse employment outcomes in the first few years after high school than do peers who have other types of disabilities.

"Not only was the employment rate low for young people with ASDs when compared with young adults with other disabilities, but pay for jobs -- if they got them -- was significantly lower compared to young adults with other types of disabilities," said Anne M. Roux, senior research coordinator at the A.J. Drexel Autism Institute, who led the employment study as a member of Shattuck's research team while both were at Washington University in St. Louis.

They report that just over half (53.4 percent) of the young adults on the autism spectrum they surveyed had ever worked for pay outside the home within the first eight years after leaving high school. Only about one in five (20.9 percent) young adults with ASDs worked full-time at a current or most-recent job. Average pay was $8.10 per hour.

Employment rates, full-time employment status and average pay were substantially higher for young adults with other disabilities, including learning disabilities, emotional disturbance and speech/language impairment, compared to young adults with ASDs. The employment gap widened even farther when adjusted for differences in functional skills and conversational ability.

"The news is mixed," Roux said. "This study highlights the particular difficulty that youth with autism are having during the transition into adulthood, especially youth from poorer households who are more likely to be disengaged from the services needed to secure and maintain a job.

"At the same time, half of young adults with an ASD did become employed, including youth with more challenging levels of impairment. This finding gives us hope for what might be possible with more effective preparation for employment, transition practices and workplace supports."

In an independent editorial in the same journal issue, Dr. Patricia Howlin of King's College London and the University of Sydney, wrote, "if young adults with autism miss out on this rite of passage, they risk transition into a world of social exclusion, financial hardship and significantly decreased quality of life. On the positive side, there is evidence that specialized, supported employment programs can be very helpful in assisting young people into work and in improving quality of life and even cognitive performance."

Residential Status: Young Adults with ASD Less Likely to Live Independently

In another study published this week in the journal Autism, members of Shattuck's research team report that young adults on the autism spectrum are less likely to have ever lived independently after high school, than adults with other disabilities.

"This paper suggests that the years following high school are markedly different for young adults with ASDs compared to other disability categories," said Kristy A. Anderson, a doctoral student at the University of Wisconsin-Madison, who led the residential status study. "Notably, young adults on the autism spectrum have higher rates of coresidency in the parental home."

Young adults on the autism spectrum were less likely to have ever lived independently since leaving high school, compared to their peers with other disabilities. More young adults with autism lived with their parents or guardians, and for longer periods of time, than did individuals with emotional disturbance, learning disability or intellectual disability. They also had the highest rates of living in a supervised living arrangement.

Young adults with an ASD also experienced the highest rates of postsecondary residential continuity (79.1 percent).

"They are residing in the parental home at higher rates and longer time periods relative to peers with other disabilities, warranting family-based services in the years following high school exit," Anderson said.

Despite the concurrent study on employment, the researchers found no association between having held a paying job and residential outcomes among young adults on the autism spectrum.

Long-Term Research Targets the Autism Services Cliff for Adolescents

The analyses of employment and residential status were both products of Shattuck's widely recognized research program examining outcomes and service use among adolescents and young adults on the autism spectrum. The needs of this age group are largely under-represented in research, even as many individuals diagnosed in childhood face a decline in available social services after they age out of the educational system.

The project involves long-term follow-up study on the outcomes of a large, nationally representative sample of young adults (National Longitudinal Transition Study). All of the participants were initially enrolled while receiving special education services in school; they or their parents completed regular follow-up surveys for up to 10 years after the student had completed high school.

"Many families tell us it's like driving off a cliff when their child with autism exits high school because there just aren't many options once they enter adulthood," Shattuck said. "Our work highlights the enormous challenges facing this vulnerable population and their families. Experimenting with innovative solutions that can help these youth is a top priority at the A.J. Drexel Autism Institute."

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Adults with ADHD

This article discusses the problems adults with ADHD face, and treatment options.

Do you remember when you used to stare out of the window in the classroom in elementary school and watch the butterfly dance on the flower? And that fly that landed on your desk was always a little more entertaining than the teacher? Or when students in the hallway outside the classroom always distracted you just when the teacher called on you? How your desk was always filled with crumpled papers and books always falling out onto the floor? When you knew the answer you blurted it out in excitement and the teacher would always remind you to raise your hand first? Sometimes people used big words to describe you like "impulsive," but you thought you just faster at reacting than everybody else was. That seemed like a good thing. It was a little hard to get along with some children, and you frequently did not get picked for teams because you weren't able to kick or throw the ball as well as the other kids.

Perhaps you were among that 10 percent of the children in school who had attention deficit hyperactivity disorder but, in your case, it was not recognized. People often said that you were just lazy and immature. It seemed as if they were probably right since you struggled with school work ever since you started school. It sure didn't help your self-esteem either because you knew you were somehow different from the other kids and sometimes you got teased. Maybe you compensated for the ADHD by working harder and being intelligent enough to overcome some of your limitations.

But that is all behind you now and you are an adult. Adults grow out of things like that. Or do they? Unfortunately, approximately 50 percent of the children who had ADHD as children continue to have some of the symptoms even into adulthood. It is important to understand that this disorder does not involve an actual deficit in attention but a problem with "attention regulation” or keeping your attention on what is most important at the time. As an adult it is may be referred to as ADD because there are few symptoms of hyperactivity. Problems of attention, concentration, organization and impulsivity are more common. Hyperactivity symptoms may look more like restlessness, getting bored easily and trying to do too many things at once. Daily routine tasks such as being on time, starting and finishing a  project, remembering things, paying attention when someone talks and staying focused on a job are just some of the common challenges that you can continue to experience. Adults may find that they have trouble keeping a job, managing finances and maintaining relationships. Self-esteem can suffer as ADHD adults struggle with things that come naturally to others.

The causes for ADHD are unclear. It seems to have a neurological basis involving the chemical messengers in the brain known  as neurotransmitters. The cerebral cortex of the brain is also believed to play a role in the areas of  "executive functioning” such as planning, problem solving, and impulse control. A genetics seems likely since parents who are ADHD are much more likely to have children with the disorder.

Making a diagnosis of ADD requires more than identifying a cluster of symptoms. Anyone can experience some of these symptoms at times. They must be of sufficient intensity, duration and frequency that they interfere with important life functions. The diagnosis can be determined by a qualified physician or psychologist after an extensive interview, psychological and cognitive testing, and gathering information from collateral sources. It is not uncommon for ADHD adults to also have other conditions such as anxiety, depression, or substance abuse ... confounding the task of making an accurate diagnosis.

Treatment for ADHD adults generally involves use of some type of medication to achieve some balance in brain neurotransmitters. Education and counseling is also recommended as an adjunct to medication to help individuals learn to manage those the most troubling characteristics of the disorder and to teach them strategies to manage problems with attention, distraction, social skills, organization, budgeting and planning. With treatment adults with this disorder can lead successful lives and develop the skills to manage work, relationships and life in general.

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Childhood ADHD Lasts Into Adulthood

A study that followed children with ADHD into adulthood shows their ADHD symptoms lasted in adulthood and are associated with other psychiatric issues.

The first large, population-based study to follow children with attention-deficit hyperactivity disorder into adulthood shows that ADHD often doesn't go away and that children with ADHD are more likely to have other psychiatric disorders as adults. They also appear more likely to commit suicide and to be incarcerated as adults. The findings appear in the March 4 online issue ofPediatrics.

"Only 37.5 percent of the children we contacted as adults were free of these really worrisome outcomes," says lead investigator William Barbaresi, M.D., of Boston Children's Hospital, who started the study when he was at Mayo. "That's a sobering statistic that speaks to the need to greatly improve the long-term treatment of children with ADHD and provide a mechanism for treating them as adults."

The study is unique because it followed a large group of ADHD patients from childhood to adulthood, says Slavica Katusic, M.D., an epidemiologist and Mayo Clinic's lead researcher on the study.

ADHD is the most common neuro-developmental disorder of childhood, affecting about 7 percent of all children and three times as many boys as girls. Most prior follow-up studies of ADHD have been small and focused on the severe end of the spectrum -- such as boys referred to pediatric psychiatric treatment facilities -- rather than a cross-section of the ADHD population.

The study followed all children in Rochester who were born between 1976 and 1982, were still in Rochester at age 5 and whose families allowed access to their medical records. That amounted to 5,718 children, including 367 diagnosed with ADHD. Of this group, 232 participated in the follow-up study. About three-quarters received ADHD treatment as children.

At follow-up, the researchers found:

*29 percent of children with ADHD still had ADHD as adults.

*57 percent of children with ADHD had at least one other psychiatric disorder as adults, as compared with 35 percent of those studied who didn't have childhood ADHD. The most common were substance abuse/dependence, antisocial personality disorder, hypomanic episodes, generalized anxiety and major depression.

*Of the children who still had ADHD as adults, 81 percent had at least one other psychiatric disorder, as compared with 47 percent of those who no longer had ADHD and 35 percent of those without childhood ADHD.

*Seven of the 367 children with ADHD (1.9 percent) had died by the time the study began, three of them from suicide. Of the 4,946 children without ADHD whose outcomes could be ascertained, 37 children had died, five by suicide.

*Ten adults who had childhood ADHD (2.7 percent) were incarcerated when the study started.

"We suffer from the misconception that ADHD is just an annoying childhood disorder that's overtreated," Dr. Barbaresi says. "This couldn't be further from the truth. We need to have a chronic disease approach to ADHD as we do for diabetes. The system of care has to be designed for the long haul."

Dr. Barbaresi thinks the study findings may underestimate the bad outcomes of childhood ADHD. Most of those studied were white and middle class, with good educations and access to health care.

"One can argue that this is potentially a best-case scenario," Dr. Barbaresi says. "Outcomes could be worse in socioeconomically challenged populations."

He advises parents of children with ADHD to ensure that their children are in high-quality treatment -- and remain in treatment as they enter adolescence. Children also should be assessed for learning disabilities and monitored for conditions associated with ADHD, including substance use, depression and anxiety.

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Study: Autistic Adults Report Shortcomings in Their Health Care

A study discusses how autistic adults report having worse health outcomes than non-autistic adults.

Researchers at Oregon Health & Science University (OHSU) have found that adults with autism, who represent about 1 percent of the adult population in the United States, report significantly worse health care experiences than their non-autistic counterparts.

"Like other adults, adults on the autism spectrum need to use health care services to prevent and treat illness. As a primary care provider, I know that our health care system is not always set up to offer high-quality care to adults on the spectrum; however, I was saddened to see how large the disparities were. We really need to find better ways to serve them," said Christina Nicolaidis, M.D., M.P.H., principal investigator and associate professor of medicine (general internal medicine and geriatrics) at OHSU.

The study, published in the Journal of General Internal Medicine, was conducted by the Academic Autistic Spectrum Partnership in Research and Education (AASPIRE), an academic-community partnership where academic investigators, autistic adults and other community members work together throughout the project.

Nicolaidis and colleagues surveyed 209 autistic adults and 228 non-autistic adults through a secure registration system for online studies. Autistic adults reported greater unmet health care needs, higher use of the emergency department, and lower rates of preventive services such as Pap smears. They also reported poorer satisfaction with provider communication and lower comfort in navigating the health care system or managing their health.

"While I am discouraged by the findings, I am also encouraged by the direct involvement of the autistic community in all parts of this project. In order to ensure research that is truly useful to autistic adults, it is critical to involve us directly in the process," noted Dora Raymaker, AASPIRE's community co-director.

The study also has important implications related to changes in the newly released Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which combined Autistic Disorder, Asperger's Disorder, and Pervasive Developmental Disorder Not Otherwise Specified into one new category of Autism Spectrum Disorder. There has been considerable controversy over the new criteria, with some studies predicting a significant reduction in the number of people who will meet criteria, especially among those with Asperger's disorder or without intellectual disabilities.

"The existence of health care disparities in our sample, most of whom had diagnoses of Asperger's and/or high educational attainment, highlights the possible negative consequences of stricter criteria. Not having a diagnosis may deprive patients and their providers of insights, strategies, and accommodations to improve health care experiences," explained Nicolaidis.

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Epilepsy Care for Adults Needs Improvement

This article discusses epilepsy care in adults and how the standard of care needs to be improved.

Only about half the U.S. adults with active epilepsy see a specialist for their condition, the CDC reported Friday.

In 2010 about 1% of those 18 or older reported a diagnosis of epilepsy coupled with recent seizures or with medication to control attacks – so-called "active" epilepsy, agency researchers reported in the Nov. 16 issue ofMorbidity and Mortality Weekly Report.

Another 0.8% had been diagnosed with the condition but reported they had not had a seizure in the previous year and were not taking medication – defined as "inactive" epilepsy.

But in both groups, the proportion that reported recent consultation with a specialist was low – 53.4% and 6.9%, respectively.

Combined, just 33.4% of those with any history of epilepsy had visited a neurologist or epilepsy specialist in the previous year, the CDC analysis showed.

The findings are based on data from the 2010 National Health Interview Survey, an annual cross-sectional survey of the civilian, non-institutionalized U.S. population. Statistical software applied to the survey respondents generates population estimates, the agency noted.

Based on the 27,139 adults surveyed, the researchers estimated that there are 4.1 million adults in the U.S. who have been diagnosed with the condition, including 2.3 million with active and 1.7 million with inactive disease.

While they appeared to make limited use of specialty care, they were more likely to visit a generalist physician than the non-epileptic population, the agency found.

Specifically, 86.4% of adults with active epilepsy and 76.6% of those with any form of the condition had visited a generalist in the previous 12 months, compared with 66.1% of those without epilepsy.

The agency also found that the prevalence of the condition did not vary by age, sex, or education, but those with a history of epilepsy were more likely to be white or black or to live in families at the lowest income level.

For example, among those living in families with annual incomes of $34,999 or less, 3.1% reported a history of epilepsy and 1.9% had active disease.

The agency cautioned that the estimates are based on self-reported data and could be subject to reporting bias. In addition, reported cases are not classified by seizure type, severity, or etiology and some other forms of seizure might have been misclassified, inflating the prevalence estimates.

The findings form a baseline, the agency noted, from which a Healthy People 2020 objective can be developed.

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Study Suggests Men Diagnosed With ADHD as Children Had Worse Outcomes as Adults

A study looks at occupational, educational, social and economic outcomes for men who were diagnosed with ADHD as a child.

Men who were diagnosed as children with attention-deficit/hyperactivity disorder (ADHD) appeared to have significantly worse educational, occupational, economic and social outcomes in a 33-year, follow-up study that compared them with men without childhood ADHD, according to a report published Online First by Archives of General Psychiatry, a JAMA Network publication.

ADHD has an estimated worldwide prevalence of 5 percent, so the long-term outcome of children with ADHD is a major concern, according to the study background.

Rachel G. Klein, Ph.D., of the Child Study Center at NYU Langone Medical Center in New York, and colleagues report the adult outcome (follow-up at average age of 41 years) of boys who were diagnosed as having ADHD at an average age of 8 years. The study included 135 white men with ADHD in childhood, free of conduct disorder (probands), and a comparison group of 136 men without childhood ADHD.

"On average, probands had 2½ fewer years of schooling than comparison participants … 31.1 percent did not complete high school (vs. 4.4 percent of comparison participants) and hardly any (3.7 percent) had higher degrees (whereas 29.4 percent of comparison participants did). Similarly, probands had significantly lower occupational attainment levels," the authors note. "Given the probands' worse educational and occupational attainment, their relatively poorer socioeconomic status at [follow-up at average age of 41 years] is to be expected. Although significantly fewer probands than comparison participants were employed, most were holding jobs (83.7 percent). However, the disparity of $40,000 between the median annual salary of employed probands and comparisons is striking."

In further comparisons of the two groups, the men who were diagnosed with ADHD in childhood also had more divorces (currently divorced, 9.6 percent vs. 2.9 percent, and ever been divorced 31.1 percent vs. 11.8 percent); and higher rates of ongoing ADHD (22.2 percent vs. 5.1 percent, the authors suspect the comparison participants' ADHD symptoms might have emerged during adulthood), antisocial personality disorder (ASPD, 16.3 percent vs. 0 percent) and substance use disorders (SUDs, 14.1 percent vs. 5.1 percent), according to the results.

During their lifetime, the men who were diagnosed with ADHD in childhood (the so-called probands) also had significantly more ASPD and SUDs but not mood or anxiety disorders and more psychiatric hospitalizations and incarcerations than comparison participants. And relative to the comparison group, psychiatric disorders with onsets at 21 years of age or older were not significantly elevated in the probands, the study results indicate.

The authors note the design of their study precludes generalizing the results to women and all ethnic and social groups because the probands were white men of average intelligence who were referred to a clinic because of combined-type ADHD.

"The multiple disadvantages predicted by childhood ADHD well into adulthood began in adolescence, without increased onsets of new disorders after 20 years of age. Findings highlight the importance of extended monitoring and treatment of children with ADHD," the study concludes.

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Teenagers Fare Worse After Concussion Than Children or Adults

Teenagers and children are not little adults. Its a basic premise of all pediatric medicine. If a teen or child is hurt, see a pediatric specialist. JR

Teenagers who suffer a concussion are more sensitive than adults or children to its aftereffects, Canadian researchers report.

Concussions can affect short-term memory in adolescents, which is essential for reading and calculating, and those effects can last for six months or longer, the study authors found.

"Contrary to the belief by some parents and coaches that children can play through a concussion because their brains are more resilient, we find that children are more vulnerable to the effects of a brain injury than adults," said lead researcher Dave Ellemberg, a neuropsychologist at the University of Montreal.

And, teenagers suffer greater symptoms than either children or adults, he added.

"It's not that surprising," Ellemberg noted. "We know the adolescent's brain, more specifically the areas affected by the concussion, the frontal lobe areas of the brain, are growing in spurts and when something is developing rapidly it is even more fragile to injury."

The report was published Feb. 28 in the journal Brain Injury.

To come to its conclusions, Ellemberg's team worked with 96 male athletes who had suffered a concussion three to nine months before testing. The athletes were divided into three groups: adults (30), kids aged 9 to 12 (32) and teens aged 13 to 16 (34). These athletes were then compared with similar people who had not had a concussion.

All of the study participants were given neuropsychological tests used by the U.S. National Hockey League. The researchers then compared the results of those tests with the results of electrophysical evaluations that measured working memory, attention and inhibition while participants worked on a computer. Electrophysical tests are considered more sensitive than neuropsychological screens, the study authors noted.

The researchers found all the athletes who suffered concussions had results on their electrophysical evaluations that indicated injurious effects, compared with similar people who had not had a concussion.

Among teens, there were also problems with short-term working memory that lasted six months to a year, they noted.

"We find that most concussions are similarly severe, whether or not there is loss of consciousness," Ellemberg said.

Immediate symptoms after an injury are not a way to know how a child is doing, he said. "You, typically, have to wait for a couple of days, or even weeks, after the injury to see the symptoms," Ellemberg explained. "Concussions are severe, and do have consequences. We need to have a systematic system to evaluate these children."

After a suspected concussion, the child or teen should be seen by a medical professional who can assess the patient and make a plan for when the child can go back to playing, he said.

"We can't be afraid to have our kids play sports. We know that it's good for the child's physical health and mental health," Ellemberg stressed. "So, we want to encourage sports, but we want to make sure that we do it in a safe way."

Teams need to have an adult trained in what to do if a child has a concussion. In addition, an effort should be made to eliminate violence and situations that can lead to concussions, Ellemberg added.

Commenting on the study, Gillian Hotz, director of the concussion program at the University of Miami Miller School of Medicine, said that "kids have developing brains, so issues may not show up until a year later when they are stressed to do more frontal lobe activities."

Concussions are preventable, she said, and there needs to be education about concussion directed to parents, coaches and children. "Of course, wearing helmets properly is important," Hotz noted, adding that more communities are taking a proactive approach to dealing with concussions.

For example, high school athletes in Miami are given tests of mental functioning before they can play. These give professionals a baseline with which to compare their symptoms after a concussion to see if there are changes, she explained.

These and other measure can make a difference in identifying and treating concussions, Hotz said.

Read more: http://www.nlm.nih.gov/medlineplus/news/fullstory_122391.html

Surprisingly High Number of Adults With Severe Learning Disabilities Also Have Autism, UK Research Shows

New UK research on autism in adults has shown that adults with a more severe learning disability have a greater likelihood of having autism. This group, mostly living in private households, was previously 'invisible' in estimates of autism.

Dr Terry Brugha, Professor of Psychiatry at the University of Leicester, led research on behalf of the University for the reportEstimating the Prevalence of Autism Spectrum Conditions in Adults: Extending the 2007 Adult Psychiatric Morbidity Survey, which has just been published by the NHS Information Centre.

The report involved a survey of adults from learning disability registers in Leicestershire, Lambeth and Sheffield between August 2010 and April 2011.

The new report presents findings from a new study based on a sample of people with learning disabilities living in private households and communal care establishments. The findings are combined with information from the Adult Psychiatric Morbidity Survey (APMS) 2007, previously published by the NHS Information Centre, which included research on autism also led by Dr Brugha.

Dr Brugha, also a consultant psychiatrist working in the NHS with the Leicestershire Partnership NHS Trust, said: "We were surprised by how many adults with moderate to profound learning disability had autism because previous estimates pointed to lower rates in this group. Because they form a very small part of the adult population, when we added these new findings to the rate we had previously found in adults living in private households, and able to take part in our national survey in 2007, the overall percentage of adults in England with autism did not increase significantly over our 2007 estimate of 1%."

"Our finding that about 60% of men with profound learning disabilities and 43% of women with profound learning disabilities have autism has never been shown previously. It may also seem surprising how many live at home with parents or carers who provide 24 hour care and shoulder a considerable burden: 42% of men and 29% of women with severe learning disabilities living with family members and in other private households have autism. Taken together with the 2007 survey findings this means that most adults with autism live in private households, and before these two surveys they remained largely invisible."

Dr Brugha added "This new information will be of particular importance for those who plan and provide services to support those with learning disabilities. In March 2010, the Government published a national strategy for autism and guidance for the condition, with the view to improving the quality of services provided to adults with autism in England. Such improvements can only be achieved if the number of people with recognised and unrecognised autism is quantified. The strategy gave special emphasis to the need to train staff who have responsibility for identifying people with autism and their care. It will be vital to repeat such studies in future years in order to make sure that the national strategy is working effectively."

Read more: http://www.sciencedaily.com/releases/2012/01/120131092844