Those with Asperger syndrome are more likely to commit suicide

A study shows that those with Asperger syndrome have a higher risk of suicide. This is especially true if they are depressed.

Adults with the milder form of autism known as Asperger syndrome are much more likely to think about and attempt suicide than those in the general population, a new British study suggests.

The survey of 374 British adults with Asperger syndrome found that 66 percent reported having suicidal thoughts and 35 percent had planned or attempted suicide. Suicidal thoughts were much more common among those with a history of depression, the authors noted.

In comparison, rates of suicidal thoughts were 17 percent in the general population of U.K. adults and 59 percent of patients with psychosis, according to the study published June 24 in The Lancet Psychiatry.

Among adults with Asperger syndrome, those with depression were four times more likely to have suicidal thoughts and twice as likely to plan or attempt suicide, compared to those without depression, the investigators found.

The study also found that adults with more severe autism symptoms were more likely to plan or attempt suicide.

"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," study co-leader Dr. Sarah Cassidy, of the Autism Research Centre at Cambridge University, said in a journal news release.

And, study co-leader Simon Baron-Cohen, also of Cambridge, added, "Adults with Asperger syndrome often suffer with secondary depression due to social isolation, loneliness, social exclusion, lack of community services, under-achievement and unemployment."

However, Baron-Cohen believes that "their depression and risk of suicide are preventable with the appropriate support. 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," he said in the news release.

Two experts in the United States weren't surprised by the findings.

Dr. Melissa Nishawala is assistant professor at the Child Study Center at NYU Langone Medical Center in New York City. She said the new study supports "something we have known clinically for quite some time: bright, verbal individuals with autism spectrum disorder (ASD), commonly described as Asperger syndrome, have a much higher rate of depression, suicidal ideation and suicide attempts than peers who are not on the autism spectrum."

Nishawala agreed with Baron-Cohen that the finding "underscores the unmet need for increased support and resources for people with ASD at each developmental stage from childhood through adulthood."

Dr. Alexander Kolevzon, clinical director of the Seaver Autism Research Center at Mount Sinai Hospital, agreed. He said the study "will likely have an impact on patient care by raising clinical suspicion for suicidality [in patients with Asperger syndrome] and highlighting the need for treatment and close monitoring."

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Link found between autism and ADHD

Research shows that adults who have epilepsy are likely to have symptoms of autism as well.

Adults with epilepsy are more likely to have a greater number of characteristics of autism and Asperger syndrome, according to new research by the University of Bath, England.

The finding was discovered by Dr. SallyAnn Wakeford, a PhD student from the University's Department of Psychology, and revealed a previously unknown link between epileptic seizures and the signs of autism in adults.

Traits of autism, such as impaired communication and social interaction and restricted and repetitive interests, can be serious and go undetected for several years - creating a lasting impact on the lives of those who endure them.

The investigators found that epileptic seizures interfere with the neurological function that affects social functioning in the brain - causing the same characteristics that depict autism.

Dr Wakeford said:

"The social difficulties in epilepsy have been so far under-diagnosed and research has not uncovered any underlying theory to explain them. This new research links social difficulties to a deficit in somatic markers in the brain, explaining these characteristics in adults with epilepsy."

The researchers revealed that having elevated autistic traits was standard to all types of epilepsy, however, it was more evident for adults with Temporal Lobe Epilepsy (TLE).

The authors believe one reason may be because anti-epileptic medications are many times less effective for TLE. These drugs may cause an impact because they are significantly related to the severity of autistic characteristics. 

Dr. Wakeford and her colleagues conducted a comprehensive range of studies with participants who have epilepsy and found that all adults with epilepsy exhibited autism traits.

She explained:

"Epilepsy has a history of cultural stigma, however the more we understand about the psychological consequences of epilepsy the more we can remove the stigma and mystique of this condition. "These findings could mean that adults with epilepsy get access to better services, as there is a wider range of treatments available for those with autism condition."

The findings may lead to better treatment for people with epilepsy and autism. Dr. Wakeford suggested that although epilepsy has a cultural stigma, the more understood the physical outcomes of this condition are, the better chance there is to eliminate this stigma.

She concluded, "These findings could mean that adults with epilepsy get access to better services, as there is a wider range of treatments available for those with autism condition."

Margaret Rawnsley, research administration officer at Epilepsy Action, was pleased with the results of the study, saying: "We welcome any research that could further our understanding of epilepsy and ultimately improve the lives of those with the condition. This research has the potential to tell us more about the links between epilepsy and other conditions, such as autism spectrum disorders."

A study released earlier this year suggested a link between mothers who took the antiepileptic drug sodium valproate during pregnancy and an increased risk for autism in their children. Researchers found that neurodevelopmental issues were more prevalent in children whose mothers had epilepsy.

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Violence and Crime Doesn’t Fit in with Autism Diagnosis

An analysis of the school shooting in Connecticut discusses how tying violent crime to autism or Asbergers diagnosis is not accurate.

As investigators begin to piece together a profile of Connecticut school massacre gunman Adam Lanza, much is being speculated about his possible Asperger's Syndrome diagnosis. But to suggest a tie between autism and violent, sociopathic tendencies is to undermine the large body of research and progress that's been made in understanding the disorder, says autism expert and Executive Director of the Kinney Center for Autism Education and Support at Saint Joseph's University Michelle Rowe, Ph.D.

"We know that children and adults with autism are often misunderstood," she says. "Small talk is not especially easy. Those on the spectrum have trouble understanding sarcasm. They struggle to understand basic social rules -- how to take turns, how to make eye contact.

"We also know that people with autism are not sociopaths. There is no evidence or research that suggests a link between autism and planned violence."

Rowe points to critical differences in the brains of so-called "neuro-typicals" and those on the autism spectrum.

"The prefrontal cortex (the front part of the brain, just above the eyebrows, that most people know as the frontal lobe) helps "neuro-typicals" make sense of the world," she explains. "We make eye contact and assess facial expressions. This is the brain's way of helping us connect with people. Without that skill -- that ability -- wouldn't we all be misunderstood?"

It's a much different world for people living with autism than it was just 10 years ago, Rowe adds. Awareness is at an all-time high. Services are expanding and those on the autism spectrum are being mainstreamed in schools all across the country.

"We've come too far and we know too much to revert back to the days when people with disabilities were locked up out of fear," says Rowe. "We shouldn't fear autism-- not now-- not when we understand more than we ever have about it."

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Study: Schizophrenia and autism may be linked in families

Families with a history of schizophrenia or bipolar disorder are also more likely to have a child with autism, new research from Sweden and Israel suggests.

Researchers found that kids whose parents or siblings had been diagnosed with schizophrenia were almost three times more likely to have an autism spectrum disorder, including autism and Asperger syndrome.

The link was weaker for bipolar disorder, but still consistent, according to findings published this week in the Archives of General Psychiatry.

"Most people with a family history of one of these disorders actually get nothing - the vast majority in fact," said Dr. Patrick Sullivan, the study's lead author from the University of North Carolina at Chapel Hill.

Still, he told Reuters Health, "Maybe there is something that is more fundamental but common to both," such as certain changes in gene patterns that are passed from parents to children.

The number of autism diagnoses in the United States has been rising, and the Centers for Disease Control and Prevention now estimates one in 88 kids has an autism spectrum disorder. That's up from one in 150 a decade ago.

One of the questions in recent autism research has been how much genetics is involved in who gets the condition, versus the prenatal or early childhood environment.

Sullivan and his colleagues note that autism used to be considered the childhood version of schizophrenia, before researchers learned more about the two disorders. And some research has continued to suggest certain genetic changes are common in both conditions, as well as in bipolar disorder.

So for the new study, the researchers analyzed information from three separate databases, including two that tracked kids and families in Sweden and their medical diagnoses and a third that recorded data on all Israeli citizens entering the army draft, including sibling pairs.

All in all, Sullivan's team had data on more than 30,000 young people with autism.

The researchers found that in the Swedish studies, kids whose parent or sibling had been diagnosed with schizophrenia, according to family medical records, were 2.6 to 2.9 times more likely to have autism. The trend was the same for siblings of teens with schizophrenia in Israel.

When a parent had bipolar disorder, on the other hand, kids were 1.6 to 1.9 times more likely to have autism or another autism spectrum disorder.

"It's been questioned for many years, whether there's a relationship" between schizophrenia and autism, said Dr. Andrew Zimmerman, a neurologist from the Lurie Center for Autism at MassGeneral Hospital for Children in Lexington, Massachusetts.

"In fact, I think those of us that see a lot of patients with autism have seen this relationship in relatives for a long time," he added.

Sullivan said there are certain rare genetic mutations that seem to predispose people to both autism and schizophrenia.

And there could be other gene variations, he said, where differences in a person's environment in the womb or growing up could influence whether the same mutation ends up leading to schizophrenia, autism or nothing.

"Just because two things share a risk factor doesn't mean that they're the same thing," Sullivan added. "The needs of people with autism and schizophrenia, and the treatments that we know work for one or the other, don't overlap very well."

Zimmerman, who wasn't involved in the current research, told Reuters Health there are still many questions about how the conditions may be related.

The new study "is important because it makes us think," he said. "It doesn't tell us whether (autism and schizophrenia) are genetic or environmental - certainly both are still possible - but it makes us think there might be relationships between the two."

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Study: Small babies at higher risk of autism

Babies born small or prematurely go on to develop autism at higher rates, although the risk is still small, according to a new study from Finland.

The research is part of a global push to identify the culprits behind the developmental disorder and the recent uptick in its occurrence, which has had scientists scratching their heads for years.

"Previous reports of how birth weight or gestational age is associated with autism have not been consistent," Dr. Andre Sourander, a psychiatrist at Turku University, told Reuters Health by email.

"Because autism spectrum disorders are one of the major challenges in child mental health it is extremely important to get more understanding of its causes," Sourander said.

Autism spectrum disorders, which range from mild Asperger syndrome to severe mental retardation and social disability in childhood autism, are diagnosed in about one in 88 children in the U.S., according to the Centers for Disease Control and Prevention.

The new results, published in the Journal of Pediatrics, are based on almost two decades' worth of data from more than one million births in Finland.

As of 2005, the rate of autism in the Northern European country was 9 per 10,000 children in Finland, whereas Asperger was diagnosed in 14.5 children out of 10,000.

After accounting for the mother's age, smoking, number of previous births and other factors, Sourander's team found an increased risk of autism, but not Asperger syndrome, in preemies and babies that were very small at birth.

For instance, those who weighed less than 1,500 grams, or 3.3 pounds, at birth had three times the odds of developing autism.

However, because autism is relatively rare, most children who are born very small don't end up with autism, said Sourander.

No one is certain why some children develop autism spectrum disorders, but scientists assume it's caused by an interplay between genes and environment, such as infections or other medical problems during pregnancy.

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Young adults with autism lag in school and work

Young adults withautism are less likely to go to college or hold down a job than their peers with other types of disabilities, a new U.S. study finds.

Researchers found that more than one-third of young adults with an autism spectrum disorder had not gotten a job or gone into higher education since high school. And that number was much higher compared with young adults with learning disabilities or other impairments.

It's estimated that about one in 88 U.S. children has an autism spectrum disorder, or ASD.

That's up 78 percent from a decade ago — which health officials attribute to better diagnosis, as well as broader definitions of what constitutes an ASD.

ASDs are a group of developmental brain disorders that hinder a person's ability to communicate and interact socially — ranging from the severe cases of "classic" autism to the relatively mild form calledAsperger's syndrome.

But while rates of ASD diagnoses are shooting up, researchers have not known all that much about how kids with the disorders fare after high school.

So for the new study, researchers collected data on 680 young U.S. adults with an ASD, along with nearly 1,400 young people with learning disabilities, speech or language impairments or intellectual impairment.

All were between the ages of 19 and 23, and had been in special education programs when they were in school.

Overall, the study found, 35 percent of young adults with ASDs had not gone to school or held a job since high school.

That compared with only 7 percent of young adults with speech or language impairments, and 3 percent of those with learning disabilities. Even young people with intellectual impairments were faring better than the ASD group: one-quarter had not gone on to higher education or the workplace after high school.

The findings appear in the journal Pediatrics.

GAP STRIKING

It's not surprising that many young adults with ASDs would struggle, according to Paul T. Shattuck, the lead researcher on the study.

"But I wasn't prepared for the magnitude of the effect," said Shattuck, an assistant professor at Washington University in St. Louis. "The gap between them and young people with other disabilities was striking."

Another important finding, Shattuck said, was that low-income adults with ASDs were at substantial risk.

Among young adults from families making under $25,000 a year, 55 percent had not worked or started higher education since high school.

That compared with 18 percent of those from families who made more than $75,000 a year.

"That's a huge difference," Shattuck said. The reasons for the gap are not clear from the study, he noted — but it likely has something to do with access to services for people with ASDs.

Another reason, according to Shattuck, may be that higher-income families have more social connections, including people who could help their child find work or get into school.

The researchers estimate that in 2009, about 163,000 U.S. children with an ASD were living below the poverty line.

DOESN'T MAGICALLY DISAPPEAR

There are some services available to help families and kids with ASDs prepare for life as an adult. Shattuck said that special ed programs should include, "as part of the package," some type of transitioning plan for the post-high school years.

"That's the goal anyway," he said. "The reality is, not every kids gets that, and the quality of (the service) will vary from place to place."

There is definitely a need for more research into services for young adults with ASDs, according to Shattuck's team — particularly programs to help kids from low-income families.

The "popular image" associated with autism is the affected child, Shattuck noted.

"But autism doesn't magically disappear in adolescence," he said. "These kids grow up, and that's the age group we know the least about."

Women Who Smoke during Pregnancy are Likely to Have Child With High Functioning Autism

Women who smoke in pregnancy may be more likely to have a child with high-functioning autism, such as Asperger's Disorder, according to preliminary findings from a study by researchers involved in the U.S. autism surveillance program of the Centers for Disease Control and Prevention.

"It has long been known that autism is an umbrella term for a wide range of disorders that impair social and communication skills," says Amy Kalkbrenner, assistant professor in the University of Wisconsin-Milwaukee's Joseph J. Zilber School of Public Health, lead author of the study. "What we are seeing is that some disorders on the autism spectrum, more than others, may be influenced by a factor such as whether a mother smokes during pregnancy."

The study was published April 25 online by the journal Environmental Health Perspectives.

Smoking during pregnancy is still common in the U.S. despite its known harmful impacts on babies. Kalkbrenner found that 13 percent of mothers whose children were included in the study had smoked during pregnancy.

Kalkbrenner and colleagues' population-based study compared smoking data from birth certificates of thousands of children from 11 states to a database of children diagnosed with autism maintained by the CDC's Autism and Developmental Disabilities Monitoring Network (ADDMN). Of the 633,989 children, born in 1992, 1994, 1996 and 1998, 3,315 were identified as having an autism spectrum disorder at age 8.

"The study doesn't say for certain that smoking is a risk factor for autism," Kalkbrenner says. "But it does say that if there is an association, it's between smoking and certain types of autism," implicating the disorders on the autism spectrum that are less severe and allow children to function at a higher level. That connection, she adds, needs further study.

April is Autism Awareness Month, and several studies of possible links between environmental factors and autism are being published by Environmental Health Perspectives at the same time as Kalkbrenner's study. "The CDC recently released data indicating that 1 in 88 children has an autism spectrum disorder, making such environmental studies even more timely," says Kalkbrenner.

Because autism involves a broad spectrum of conditions and the interplay of genetics and environment is so complex, no one study can explain all the causes of autism, she adds. "The goal of this work is to help provide a piece of the puzzle. And in this we were successful."

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Impact of New Autism Diagnostic Criteria

Getting an autism diagnosis could be more difficult in 2013 when a revised diagnostic definition goes into effect. The proposed changes may affect the proportion of individuals who qualify for a diagnosis of autism spectrum disorder, according to a study by Yale Child Study Center researchers published in the April issue of the Journal of the American Academy of Child & Adolescent Psychiatry.

The proposed changes to the diagnostic definition will be published in the fifth edition of the American Psychiatric Association's (APA) "Diagnostic and Statistical Manual of Mental Disorders (DSM-5)."

"Given the potential implications of these findings for service eligibility, our findings offer important information for consideration by the task force finalizing DSM-5 diagnostic criteria," said Yale Child Study Center director Dr. Fred Volkmar, who conducted the study with colleagues Brian Reichow and James McPartland.

Volkmar and his team performed an analysis of symptoms observed in 933 individuals evaluated for autism in the field trial for DSM-4. They found that about 25 percent of those diagnosed with classic autism and 75 percent of those with Asperger's Syndrome or pervasive developmental disorder, not otherwise specified, would not meet the new criteria for autism. The study also suggests that higher-functioning individuals may be less likely to meet the new criteria than individuals with intellectual disabilities.

Volkmar cautioned that these findings reflect analyses of a single data set and that more information will be provided by upcoming field trials overseen by the APA. He stressed that it is critical to examine the impact of proposed criteria in both clinical and research settings.

"Use of such labels, particularly in the United States, can have important implications for service," he said. "Major changes in diagnosis also pose issues for comparing results across research studies."

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Mutations Linked to Autism Spectrum Disorders

Mutations in three new genes have been linked to autism, according to new studies including one with investigators at Mount Sinai School of Medicine. All three studies include lead investigators of the Autism Sequencing Consortium (ASC). The findings, in a trio of papers revealing new genetic targets in autism, are published in the April 4th online issue of the journal Nature. The studies provide new insights into important genetic changes and the many biological pathways that lead to autism spectrum disorders (ASD).

Gene mutations are glitches in DNA which can put you at risk for a particular disease. The genes with mutations identified in the studies -- CHD8, SNC2A, and KATNAL2 -- were discovered with a new state-of-the-art genomics technology known as exome sequencing, where all protein coding regions of the genome, called the exome, are analyzed. The researchers say that with further characterization of the genes and sequencing of genes in thousands of families, they will be able to develop novel therapeutics and preventive strategies for autism.

"We now have a good sense of the large number of genes involved in autism and have discovered about 10 percent of them," said Joseph Buxbaum, PhD, Director of the Seaver Autism Center and Professor of Psychiatry, Genetics and Genomic Sciences, and Neuroscience at Mount Sinai School of Medicine. "We need to study many more parents and their affected children if we are to uncover the genes important in ASD. As these genes are further characterized, this will lead to earlier diagnosis and novel drug development. This work is crucial for advancing autism treatment."

In the study, ASC researchers hypothesized that de novo mutations account for a substantial fraction of the risk for autism. De novo gene mutations are mutations that show up in affected children for the first time and result from mutations in the production of sperm or egg.

Founded by Dr. Buxbaum, the Autism Sequencing Consortium is an international group of autism genetics researchers that is working to identify additional genetic causes of autism through large-scale next-generation sequencing. The institutions involved in this study sequenced data from more than 500 families (both parents and the affected child), examining the protein-enriched areas of the genome.

"When the same mutations are found in multiple affected children and none are found in children without autism, we believe that we have identified mutations that collectively affect a higher proportion of individuals with autism," said Dr. Buxbaum. "Our studies revealed that the proteins encoded by the mutated genes interact with each other far more than expected, demonstrating significantly greater connectivity than would be expected."

Two other papers from groups participating in the Autism Sequencing Consortium are also featured in the same issue ofNature. Led by Matthew State, PhD, Yale School of Medicine, the first identified several highly disruptive mutations in genes associated with ASD. The results show that multiple variants on one gene identify risk factors for ASD. The second study led by Evan Eichler, PhD at the University of Washington discovered that certain mutations associated with ASD are mainly of paternal origin. Their findings also support previous research showing an increased risk of developing ASD in children of older fathers.

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Study Claims Two-Thirds of Kids With Autism Have Been Bullied

Nearly two-thirds of American children with autism have been bullied at some point in their lives, and these kids are bullied three times more often than their siblings without autism, a new survey finds.

Bullying occurs in every grade but is worst in grades five through eight, with 42 percent to 49 percent of autistic children in those grades bullied, according to the survey of nearly 1,200 parents of autistic children ages 6 to 15.

The Interactive Autism Network (IAN), a project of the Kennedy Krieger Institute, conducted the survey.

"These survey results show the urgent need to increase awareness, influence school policies and provide families and children with effective strategies for dealing with bullying," Paul Law, director of the IAN Project, said in an institute news release.

Children with autism, a developmental disorder, usually have delayed language development and difficulty with social interaction.

"Children with [autism] are already vulnerable. To experience teasing, taunts, ostracism or other forms of spite may make a child who was already struggling to cope become completely unable to function," Law said. "The issue is complex and we plan to carefully analyze the data and publish peer-reviewed findings that will serve to advance policy and care for individuals with [autism]."

Overall, 63 percent of kids with an autism spectrum disorder have been bullied at some time, the survey found.

Children with autism in public schools are bullied nearly 50 percent more often than those in private schools or special-education schools, the researchers found.

Types of bullying experienced by autistic children include: being teased, picked on or made fun of (73 percent); being ignored or left out of things on purpose (51 percent); being called bad names (47 percent); and being pushed, shoved, hit, slapped or kicked (30 percent).

Bullying is experienced by 57 percent of children with autism who want to interact with others but have difficulty making friends, compared with 25 percent of those who prefer to play alone and 34 percent of those who will play with others only if approached.

Fifty-two percent of the parents said their child had been taunted by other children in order to trigger a meltdown or aggressive outburst.

Kids with Asperger's syndrome, a high-functioning type of autism, were nearly twice as likely as children with another autism disorder to be bullied, perhaps because of different school placements, the researchers said.

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Learning to Drive With A.D.H.D.

The first time Jillian Serpa tried to learn to drive, the family car wound up straddling a creek next to her home in Ringwood, N.J.

Ms. Serpa, then 16, had gotten flustered trying to sort out a rapid string of directions from her father while preparing to back out of their driveway. “There was a lack of communication,” she said. “I stepped on the gas instead of the brake.”

On her second attempt to learn, Ms. Serpa recalled, she “totally freaked out” at a busy intersection. It was four years before she tried driving again. She has made great progress, but so far has still fallen short of her goal: Two weeks ago she knocked over a cone while parallel parking and failed the road test for the fourth time.

Learning to drive is hard and scary for many teenagers, and driving is far and away the most dangerous thing teenagers do. But the challenges are significantly greater for young people who, like Ms. Serpa, have attention problems.

A number of cognitive conditions can affect driving, and instructors report a recent increase in the number of teenagers with Asperger syndrome seeking licenses. But the largest group of challenged teenage drivers — and the mostly closely studied — appears to be those with attention deficit hyperactivity disorder. A 2007 study, by Russell A. Barkley of the Medical University of South Carolina and Daniel J. Cox of the University of Virginia Health System, concluded that young drivers with A.D.H.D. are two to four times as likely as those without the condition to have an accident — meaning that they are at a higher risk of wrecking the car than an adult who is legally drunk.

Researchers say that many teenagers with attention or other learning problems can become good drivers, but not easily or quickly, and that some will be better off not driving till they are older — or not at all.

The most obvious difficulty they face is inattention, the single leading cause of crashes among all drivers, said Bruce Simons-Morton, senior investigator at the National Institute for Child Health and Human Development in Bethesda, Md.

“When a driver takes his eyes off the road for two seconds or more, he’s doubled the risk of a crash,” he said.

Inexperienced drivers usually are distractible drivers. Dr. Simons-Morton cited a study on a closed course in which teenagers proved much more adept than adults at using cellphones while driving — and missed more stop signs.

The situation isn’t helped by how “noisy” cars have become, with cellphones, iPods and Bluetooth devices, said Lissa Robins Kapust, a social worker and coordinator of a driving program at Beth Israel Deaconess Medical Center in Boston. “Driving is so busy on the inside and the outside of the car — it’s the most complex thing we do.”

But A.D.H.D. involves more than distractibility. Its other major trait is impulsiveness, which is often linked to high levels of risk-taking, said Dr. Barkley.

“It’s a bad combination” for young drivers, he said. “They’re more prone to crashes because of inattention, but the reason their crashes are so much worse is because they’re so often speeding.” Many drivers with A.D.H.D. overestimate their skills behind the wheel, Dr. Barkley noted.

Far better, researchers say, to have the attitude that Ms. Serpa does — not minimizing the difficulties or being daunted by them. “I am persistent,” said Ms. Serpa, now 21. “I don’t quit. And if there are people who think I am struggling with driving, I will tell them the truth.”

Ms. Serpa heads back to the road test on Thursday, with “a whole new level of confidence” after more intensive practice — plus a new string of kabbalah beads and a lucky pendant.

Fortunately, researchers and special instructors are discovering more tangible ways to help teenagers like her. The first step: deciding whether a 16-year-old is ready to learn, or really needs to drive at all.

Dr. Simons-Morton thinks that almost any reason to put off starting lessons is a good one. “If I were the parent of an A.D.H.D. or other special-needs kid, my goal would be to delay licensing,” he said. “They mature, they accommodate to their deficits and they’re more likely to take medication.”

Some instructors believe that there’s no way to judge readiness until the child gets behind the wheel. “You can’t tell from a diagnosis or first impression — you have to drive with them a while,” said Thomas Kalina, a driving rehabilitation instructor at Bryn Mawr Rehab in Malvern, Pa.

Maturity also has to be considered. If a teenager with A.D.H.D. is showing consistent poor judgment or has earned only limited independence, he may not be ready. Behavioral problems can be a red flag, regardless of whether they have to do with driving.

“If your kid is that oppositional and defiant, she shouldn’t be driving,” said Dr. Patty Huang, a pediatrician at the Children’s Hospital of Philadelphia.

Even before the child reaches driving age, instructors recommend preparing by making sure the child can ride a bike, or by “narrating” a parent’s driving, both of which help raise the teenager’s awareness of what’s involved in maneuvering through space and traffic.

When a child with A.D.H.D. is ready for lessons, experts say the first stop is not the driving school — it’s the doctor’s office.

Most young drivers with A.D.H.D. should be taking medication, they say; many studies have found that stimulants that help focus attention, like Ritalin and Adderall, can reduce the risk of accidents. “Medication should not really be optional,” Dr. Barkley said. He recommends considering extended-release formulations that remain effective at night, when accidents are most common.

A doctor’s exam might also uncover hidden issues. When Ms. Serpa decided to try again at age 20, for instance, an eye exam turned up a visual processing problem that may have contributed to her earlier driving difficulties.

More than most other teenagers, those with A.D.H.D. benefit from professional instruction — in some cases, with a driving rehabilitation specialist. The field developed to meet the needs of stroke patients and the elderly, but instructors now see a growing number of special-needs teenagers.

All involved should be prepared for training to take as long as is necessary for the young driver to develop competence — which may be a long time. The instructor should coach parents as well, since they oversee the bulk of practicing.

As any parent knows, it’s easy for sessions to turn acrimonious. But learning happens more quickly in a positive atmosphere. “It’s important to remind parents to work on catching your teen doing the right thing,” said Gregory A. Fabiano, a professor ofpsychology at the University at Buffalo.

Most states require only 40 or 50 hours of road practice before a driver is eligible for a licensing exam. Researchers generally agree that all teenagers should have more practice, and for children with learning disabilities the amount should be much greater, even if it means keeping them in the learner permit stage longer than strictly necessary.

For parents anxious about safety during practice, installing a temporary passenger-side brake can cost less than repairing a significant dent. And experts say parents may find that a child learns better in a car with a manual transmission, which gives the attention less time to wander.

Special measures may be helpful even after a teenager with A.D.H.D. earns a license. Many experts recommend that parents adopt a ramped-up version of the graduated licensing common in most states. Dr. Barkley encourages parents to carry out a strict program of monitoring that is relaxed bit by bit. Sign a contract on safe driving practices. Set up a logbook that teenagers can use to record medication, sign cars in and out and list where they’re going and who with. Cellphones should be strictly forbidden. The household contract can be tougher than the law, he said: “Tell them that even if the state doesn’t take their license away, we’re going to.”

It isn’t easy, but with these techniques children with A.D.H.D. are learning to drive, and safely. Indeed, sometimes they are their own best instructors. When he was learning, Josh Nabours, 21, a student with A.D.H.D. in Phoenix, found that his mind wandered whenever he waited at a red light.

“If I’m not doing anything, my mind starts going five times as fast,” he said. His solution? Turning on the radio, which provides just enough engagement to keep him rooted in the present.

These days, Mr. Nabours drives himself to classes at a community college, and he has never been in an accident or received a ticket.

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Older parents more likely to have an autistic child: study

Children born to a parent over age 35 are at greater risk for developing an autism spectrum disorder -- but the risk is the same whether just one or both parents are older, according to a new study of Danish families.

"Parental age doesn't appear to be synergistic. That is having an older mom and an older dad doesn't increase risk more than having one or the other," said Marissa King, a professor at the Yale School of Management, who was not involved in the study.

"The data clearly demonstrate that older parents are more likely to have kids with autism, but it doesn't establish why that is the case," King told Reuters Health in an email.

The findings throw a monkey wrench into the idea that perhaps older sperm or eggs have more mutations that could increase the odds of having a child develop autism.

Erik Thorlund Parner at the University of Aarhus School of Public Health in Denmark said that if genetic problems arising from older sperm or eggs explain the results, then having both an older sperm and an older egg together should total up to an even higher risk of autism for the child.

Yet Parner, who led the study, and his colleagues did not find a higher risk of autism among kids with two older parents compared with just one.

The researchers collected information on more than 9,500 children in Denmark who had been diagnosed with an autism spectrum disorder.

These disorders range from mild Asperger's Syndrome to severe mental retardation and social disability.

In the new study, kids born to fathers in their late thirties had up to a 28 percent higher risk of being diagnosed with an autism spectrum disorder than kids born to dads under age 35. The increase in risk was not tied to the mother's age.

For kids born to dads over age 40, the risk for developing an autism spectrum disorder was 37 to 55 percent greater than for kids of dads under age 35, and the mother's age didn't seem to matter.

According to the Centers for Disease Control and Prevention, about 10 in 1,100 children have an autism spectrum disorder. A 55-percent increase in risk, for instance, would push that number up to about 15 out of every 1,100 children.

Similar to the findings on dads, children whose moms had them in their late 30s were 21 to 37 percent more likely to develop autism than kids with moms under age 35, and the dad's age did not change the numbers.

And just like with dads over age 40, kids born to moms over age 40 were 28 to 65 percent more likely to have autism than kids with moms under age 35, regardless of the age of their dad.

"The result was surprising in that there was no additive effect of maternal and paternal age," Parner said in an email to Reuters Health.

"We do not really have a qualified guess on the explanation to the non-additive effect," he said. "I don't believe that one can yet say anything conclusive about whether (having an) older parent is biologically related to autism."

Some earlier studies have also found that older parents are more likely to have a child with autism, but they have not had consistent results.

For example, one study found that having an older mother increases a child's risk of autism, but having an older father only increases the risk if the mom is under the age of 30 (see Reuters Health report of February 8, 2010).

Parner said he and his colleagues are planning on an even larger analysis of autism and parental age using data from Denmark, Finland, Israel, Norway, Sweden and Western Australia.

Read more: http://www.nlm.nih.gov/medlineplus/news/fullstory_121531.html