Study: Link between preterm birth and autism

A study indicates that premature infants could be at an increased risk of developing autism.

According to a new study, very premature infants may have an increased risk of being diagnosed with autism by age 4, although the research questions just how high the odds are.

The Australian study, published online Jan. 21 in Pediatrics, found that just under 2 percent of tiny preemies were later diagnosed with autism between 2 and 4 years of age.

That prevalence, the researchers say, is lower than what's been seen in past studies -- where figures have ranged from roughly 4 percent to 13 percent.

They also said there are reasons to trust the reliability of their findings. This study is one of the few to directly evaluate children, rather than using parent questionnaires, said lead researcher Margo Pritchard, a professor of neonatal nursing at Australian Catholic University, in South Brisbane.

"What we found is that being born very preterm is a risk factor, which is consistent with previous studies," Pritchard said. "But when diagnostic rigor is applied, using direct assessment, the rate of autism is lower than reported in other studies."

However, Dr. Paul Wang, senior vice president of medical research for the nonprofit organization Autism Speaks, said it's not clear what to make of the lower prevalence.

Studies differ in their methods, and some have followed children for longer periods -- to age 8 and beyond -- so it's hard to know which estimates are closer to the truth, Wang said.

Instead, he saw the new findings as further support for the overall picture. "Prematurity and low birth weight are risk factors for autism," Wang said.

He also stressed, however, that there is no single contributing factor to autism spectrum disorder -- a developmental disorder thought to affect one in 68 children in the United States, according to the U.S. Centers for Disease Control and Prevention.

Autism is complex, Wang said, and the mix of causes varies from one child to the next. But in general, experts believe it starts with a genetic vulnerability, in combination with certain environmental exposures at a critical point in development -- particularly in the womb.

Researchers are still trying to understand the environmental influences, Wang said.

According to Autism Speaks, studies have implicated a number of factors other than preterm birth. Those include older age of the parents at conception, as well as prenatal exposure to certain infections, air pollution or particular medications -- such as the anti-seizure drug valproic acid (Depakote).

For the new study, Pritchard's team assessed 169 young children born before the 29th week of pregnancy. They were screened at ages 2 and 4 years for possible signs of autism -- such as language delays, or a lack of interest in other children.

Overall, 13 percent of the children screened "positive" and underwent further evaluation. In the end, just under 2 percent were diagnosed with autism.

Still, Wang pointed out, nearly all of the children who screened positive but did not get a formal diagnosis did have significant problems -- with communication, imaginative play or repetitive behavior, for example.

And since very preterm babies are at risk of various developmental problems, it can be hard to definitively diagnose autism at a young age, Wang said.

Pritchard agreed that it's challenging to pinpoint autism in those children. But, she added, "gold standard" assessments such as the Autism Diagnostic Observation Schedule -- which was used in this study -- can help identify the disorder at an early age.

Whatever the true prevalence of autism is among preemies, it's important that these children have routine developmental screenings, Wang and Pritchard said.

"These children all need to be followed closely and screened," Wang said. That way, any impairments -- physical, mental or social -- can be caught early and addressed.

"Identifying early differences in development can help to link children with effective intervention practices," Pritchard agreed.

"The take-home message," she added, "is to take advantage of developmental monitoring and keep children born very preterm on these programs through childhood."

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Pregnancy intervals might affect autism in children

A study shows that the intervals at which mothers space their children may influence the child's risk of autism.

The amount of time between a woman's pregnancies may matter when it comes to the possible risk of her children developing autism, new research suggests.

"Children conceived in less than two years after the birth of their older sibling or greater than six years have [about] a two- to threefold increased risk of being diagnosed with autism," said study researcher Lisa Croen, director of the autism research program at Kaiser Permanente division of research, in Oakland, Calif.

Croen said that previous studies have shown an increased risk associated with very short pregnancy intervals, and a higher risk with longer than usual intervals. "We are finding the same thing. I think now there is a growing body of evidence that is pointing in the same direction," she said.

She cautioned, however, that "this is not causal. These kinds of studies can't prove cause, this is association."

And at least one neonatologist reiterated that the study only found an association between pregnancy intervals and possible autism, and much more research is needed into the topic.

Croen said the findings lend support to the current recommendation by the World Health Organization to wait at least two years after a child is born before attempting the next pregnancy.

The research was released online Sept. 14 and will be published in the October print issue of the journal Pediatrics.

One in 68 U.S. children has an autism spectrum disorder, according to the U.S. Centers for Disease Control and Prevention. Boys are more likely than girls to be diagnosed with autism, the CDC reports. Genetic and environmental factors may play a role in the condition, which involves problems with communication and socialization.

The new study included medical record reviews of about 45,000 second-born children, delivered between 2000 and 2009 in Kaiser Permanente Northern California hospitals.

The researchers looked at codes that encompass a diagnosis of any condition under the umbrella of autism spectrum disorder (ASD), which can range from mild to severe. The study team also looked at interpregnancy intervals, defined as the time from the first birth to conception of the second child.

Most older siblings of the 45,000 second-born children did not have a diagnosis of ASD, but 878 did. The researchers first analyzed the group without an older sibling with ASD.

For these children, the risk of autism was 1.5 to three times higher for intervals less than 24 months and 72 months or longer, when compared with an interval of 36 to 47 months. Intervals of less than six months appeared to carry the highest risk, the study found.

The researchers did a secondary analysis of those whose older siblings had ASD and found the same pattern -- that short or long intervals increased the risk of an ASD diagnosis.

The researchers don't know how to explain the association with certainty, according to Croen. One possible explanation is that mothers with short intervals between a pregnancy may have depleted levels of folic acid. "Folic acid is a critical nutrient in terms of healthy brain development," she said.

Dr. David Mendez, a neonatologist at Nicklaus Children's Hospital in Miami, said many researchers have looked at the pregnancy gap and investigated the effects of long ones versus shorter ones. Some have linked short intervals to psychiatric disorders, such as schizophrenia, he added.

However, Mendez said, "more specific studies need to be done before anyone can say anything definitive."

Pregnancy interval is one of many factors that may affect a child's health and upbringing. However, he suggested that avoiding short intervals between pregnancy may make it easier for parents to cope.

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Genes may be linked to autism and higher intelligence

What causes autism? A study claims that genes that may indicate an increased autism risk may also indicate a person has higher intelligence.JR

Genes believed to increase the risk of autism may also be linked with higher intelligence, a new study suggests.

Researchers analyzed the DNA of nearly 10,000 people in Scotland and also tested their thinking abilities. On average, those who had genes associated with autism scored slightly higher on the thinking (cognitive) tests.

Having autism-linked genes doesn't mean that people will develop the disorder, the researchers noted.

Similar evidence of an association between autism-linked genes and intelligence was found in previous testing of 921 teens in Australia, according to the study published March 10 in the journal Molecular Psychiatry.

"Our findings show that genetic variation which increases risk for autism is associated with better cognitive ability in non-autistic individuals," said study leader Toni-Kim Clarke, of the University of Edinburgh in Scotland.

"As we begin to understand how genetic variants associated with autism impact brain function, we may begin to further understand the nature of autistic intelligence," Clarke said in a university news release.

Another researcher went further. "This study suggests genes for autism may actually confer, on average, a small intellectual advantage in those who carry them, provided they are not affected by autism," Nick Martin, head of the Genetic Epidemiology Laboratory at the Queensland Institute for Medical Research in Australia, said in the news release.

While 70 percent of people with autism have intellectual disabilities, some people with the disorder have higher-than-average nonverbal intelligence, the study authors noted.

The study only revealed an association, and not a cause-and-effect link, between autism-related genes and intelligence.

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Study: Children in institutions have a higher risk of autism

Children placed in institutions have a higher risk of developing autism according to a new study.

A recent study published in the February 2015 issue of the Journal of the American Academy of Child and Adolescent Psychiatry demonstrates that children who were abandoned to institutional care have an increased risk for behaviors similar to those seen in children with autism, including impaired social communication. When these children were moved into child-centered foster family care at a young age, their social behaviors improved.

As part of the Bucharest Early Intervention Project, 136 children abandoned at birth and raised in institutions in Bucharest, Romania were randomly assigned to either continued care as usual in the institution, or high quality foster care created and maintained by the investigators. The children averaged 23 months of age at the time of randomization.

At 10 years of age, 117 children were assessed. Each child's primary caregiver filled out the Social Communication Questionnaire (SCQ), which assesses for symptoms associated with autism, including social communication skills. Children with concern for possible autism were then referred for a full neurodevelopmental evaluation to determine whether they met the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for autism.

Five children with a history of institutional care (three in the institutional care as usual group and two in the foster care group) met the DSM diagnostic criteria for autism spectrum disorder. In a comparison group of 100 age-matched, never-institutionalized children living in Bucharest, Romania, no child met criteria for autism spectrum disorder. Based on SCQ scores, children in the foster care group were identified as having more typical social behaviors compared to children in the institutional care as usual group.

These findings suggest that children with a history of institutional care are at increased risk for behaviors associated with autism, including social communication difficulties. These behaviors improved with an early intervention of quality foster care.

The authors strongly emphasize that in the vast majority of autism cases in the general population, children are raised in caring families, and psychosocial deprivation plays no role. "Although the institutionalized children with autism resemble children with autism in the general population, the origins of their symptoms are very different," says Charles A. Nelson PhD of Boston Children's Hospital and Harvard Medical School, who is senior author on the paper. "We believe that both groups suffer deprivation, but of different types: In institutionalized children, the deprivation comes from their environment, while in the general population, the autism itself causes a kind of deprivation, making it harder for children to perceive and understand social cues."

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Study: Association between autism risk and a mother's birth place

A study claims that there is an association between a child's autism risk and where his or her mother was born.

A mother's birthplace may affect her children's risk of developing an autism spectrum disorder, according to new research.

Children of foreign-born black, Central and South American, Filipino and Vietnamese mothers were more likely to have an autism spectrum disorder (ASD) compared to children born to white mothers who were born in the United States, the study found.

"The rates [of ASDs] in the African immigrants was the highest," said lead researcher Dr. Beate Ritz, chair of epidemiology at the Fielding School of Public Health at the University of California, Los Angeles.

The study also found that U.S.-born African American and Hispanic mothers, as well as foreign-born black and Central/South American mothers, were more likely to have children with a type of autism that included severe emotional outbursts and expressive language impairment, compared to U.S.-born white mothers.

The study is published in the July print issue of Pediatrics.

Although this study found an association between a mother's birthplace or race and the development of an autism spectrum disorder, the study doesn't show that these factors cause autism.

Autism spectrum disorders describe a range of developmental disabilities that can cause social, communication and behavioral difficulties. About 1 in 68 U.S. children have an autism spectrum disorder, the U.S. Centers for Disease Control and Prevention (CDC) estimates.

The exact cause of autism is unknown, but a number of risk factors have been found, including genetic risk factors, being born to older parents and having a sibling with the disorder, according to the CDC.

Previous studies have found autism spectrum disorders are most common among white children, Ritz noted.

In her study, Ritz wanted to look at the influence of the mother's race, ethnicity and birthplace. She and her colleagues reviewed the records of 7,540 children with autism who were born in Los Angeles County during the years 1998 to 2009 and given an autism diagnosis at ages 3 to 5 years. The researchers adjusted for other factors such as maternal age and education.

Compared to white children of U.S.-born mothers, the risk of autism was 76 percent higher for children of foreign-born black mothers, she said.

Mothers born in Vietnam, the Philippines, Central and South America also were at higher risk of having a baby with autism.

The researchers also found a small subgroup of 806 children who had both an autism spectrum disorder and mental retardation. For this group, having a foreign-born mother further increased the risk of the disorder. In fact, the risk was doubled for children born to foreign-born black mothers or those from the Philippines or Vietnam compared to U.S.-born white mothers, the study reported.

Additionally, for a specific type of the disorder that included severe emotional outbursts and impaired expressive language, U.S.-born Hispanic and black mothers, and foreign-born black and Central/South American mothers were more likely to have a child with this type of autism than U.S.-born white mothers.

The study wasn't designed to tease out the reasons behind this association, but Ritz has some theories. She believes that it's possible that "a child is more likely to develop an ASD if the mother emigrated from a country which had political unrest or wars in the recent past."

Even if those events were 20 or 30 years ago, it could still have an effect, she said. The mother giving birth may have witnessed atrocities of war or other trauma as a child, perhaps programming her to react to stress in a certain way. These mothers may react to stress in a certain way when pregnant, and that could affect the baby's ''brain wiring," she speculated.

As for whether these mothers can obtain ideal care and a prompt diagnosis for an autism spectrum disorder, Ritz cannot say, as it was outside the scope of the study. However, the average age at diagnosis for all the youngsters in this study was in the child's third year, according to the study.

"It's an interesting study to have done. It's a first step to begin to try in a more detailed fashion to identify other causes of autism," said Dr. Trevor Resnick, chief of neurology at Miami Children's Hospital. Resnick was not involved in the research, but reviewed the study's findings.

Pinning down the cause of autism spectrum disorders is complex, he said. Experts know genetic, metabolic and structural factors affect risk. "We know there is not one cause, there are multiple causes," he said.

There may even be multiple causes within one child, Resnick noted.

What the new study seems to identify is the risk of autism in different ethnic groups, he said. But the common factor is the immigrant status, not the ethnicity itself, he noted.

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Study claims early repetitive behaviors may indicate autism risk

A study claims that early repetitive behaviors may indicate that a child is at risk for autism.

There may be a simple way to help spot signs of autism early on in siblings of children with the disorder, new research suggests.

The study, which included 184 children at high risk of autism, found that those who developed the disorder typically started showing some "red flags" as early as 12 months of age.

Specifically, they had an unusually high rate of repetitive behaviors, such as flapping their hands or arms, rocking back and forth, or focusing obsessively on one toy.

Some amount of repetitive behavior is normal for babies, said lead researcher Jason Wolff, an assistant professor of psychiatry at the University of North Carolina at Chapel Hill.

"But in typically developing children, that usually peaks around the age of 6 months," said Wolff, who is scheduled to present his findings on Saturday at the International Meeting for Autism Research, in Atlanta.

"In children who go on to develop autism, repetitive behavior is still highly prevalent, or even increasing, at the age of 12 months," Wolff said.

Wolff said an advantage of looking at repetitive behaviors is that parents can report on them with a simple "pen-and-pencil measure." And it's possible that such a tool could be used to screen for autism in average-risk children, too, he added.

More research is needed before repetitive behavior can be used as part of an early screening tool, according to Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen Children's Medical Center of New York, in New Hyde Park, N.Y.

"This is a promising observation, but it needs refinement before it can be turned into something clinically useful," said Adesman, who was not involved in the study.

Wolff agreed. For one, he said, his team wants to fine-tune the way repetitive behavior is measured. And any screening tool would have to not only reliably catch autism, but also have a low risk of "false positives."

"But this study is a good start," Wolff said.

The precise causes of autism are not clear, but genes are involved. When a child has autism, his or her siblings are at high risk themselves -- with a roughly 20 percent chance of developing the disorder, Wolff noted.

And there's a "great need" for ways to spot those children early, he said. In general, Wolff noted, the earlier that speech and behavioral therapies for autism can be started, the better children do in the long run.

But until now, researchers haven't looked at whether repetitive behavior can serve as an early red flag.

"At one time, people thought repetitive behavior didn't really show up until preschool," Wolff said. But recent research, including the current study, has shown that to be untrue.

For the study, Wolff's team followed 59 children at average risk of autism and 184 who were at high risk because an older sibling had the disorder. When the children were 12 and 24 months old, their parents completed a standard questionnaire on repetitive behaviors.

Overall, 42 of the high-risk children were diagnosed with autism at age 2. And those children had shown many more repetitive behaviors at the age of 12 months -- an average of four to eight different types, Wolff said, versus one or two for kids without an autism diagnosis.

Still, that's an average difference between two groups, Adesman pointed out. The trick, he said, is to turn that into an assessment that can reliably spot the individual kids who will develop autism.

"There's a risk you could identify too many kids, and give some of them services that they don't need," Adesman said.

He agreed, though, on the need for early screening tools, and said this study points to one potential way.

Researchers are looking into other ways, too. In a separate study reported at the meeting, a team at Boston Children's Hospital used electroencephalograms (EEGs) to gauge brain activity in 208 babies and toddlers. They found that the readings, taken with electrodes on the scalp, were able to distinguish high-risk youngsters from children at average risk of autism.

And in some cases, the EEG readings were able to separate children who went on to develop autism from those who didn't.

Because findings from both studies were presented at a meeting and not yet published in a peer-reviewed journal, the results should be considered preliminary.

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Autism risk may be influenced by parental obesity

A study looked into how autism risk in a child may be influenced by parental obesity and found that paternal obesity is a greater risk factor than maternal obesity.

Several studies have looked at possible links between maternal obesity during pregnancy and the risk of developmental disorders in the child. However, paternal obesity could be a greater risk factor than maternal obesity, according to a new study from the Norwegian Institute of Public Health.

As the first researcher to study the role of paternal obesity in autism, Dr. Pål Surén emphasises that this is still a theory and requires much more research before scientists can discuss possible causal relationships.

"We have a long way to go. We must study genetic factors in the relationship between obesity and autism, as well as environmental factors associated with switching the genes on or off -- so-called epigenetic factors," he explains.

Surén and his fellow researchers used data from the Norwegian Mother and Child Cohort Study (MoBa). The researchers studied questionnaire data from over 90,000 Norwegian children at three, five and seven years of age. The mothers had answered detailed questions about their own mental and physical health, and about their children. The fathers completed a questionnaire about their mental and physical health while their partner was pregnant. The researchers also collected data from the Norwegian Patient Registry and from studies of children who were referred for evaluation and treatment of possible autism or Asperger's syndrome. By the end of the follow-up period, the children were aged 4 to 13 years.

Surprising findings

419 children, approximately 0.45 per cent of the sample, had an autism spectrum diagnosis (ASD). This is slightly lower than in the general population (0.8 per cent) because it is difficult to diagnose autism among the youngest children.

In the sample, 22 per cent of the mothers and 43 per cent of the fathers were overweight, with a body mass index (BMI) of between 25 and 30. Approximately 10 per cent of mothers and fathers were obese, with a BMI of 30 or more.

The researchers found that maternal obesity had little association with the development of autism in the child. However, they found a doubled risk for development of autism and Asperger's syndrome in the child if the father was obese, compared with a normal weight father.

"We were very surprised by these findings because we expected that maternal obesity would be the main risk factor for the development of ASD. It means that we have had too much focus on the mother and too little on the father. This probably reflects the fact that we have given greater focus to conditions in pregnancy, such as the growth environment for the fetus in the womb than both environmental and genetic factors before conception," says Surén.

The researchers adjusted for variables that may also be associated with the development of autism in the child. In addition to adjusting for maternal obesity, they considered education, age, smoking, mental disorders, hormone therapy before pregnancy, use of folic acid, maternal diabetes , pre-eclampsia and the baby's weight at birth.

Risk genes

Surén believes that the finding about paternal obesity is sound. The researchers found that the risk remained unchanged when adjusted for sociodemographic and lifestyle factors.

"Our findings therefore suggest that there may be a genetic link between obesity in the father and the development of ASD in the child," says Surén.

He points out that genetic mutation may play a role in the development of both extreme obesity and autism. Researchers have shown, for example, that if a section of chromosome 16 is missing this can lead to morbid obesity or developmental disorders in children. Mutations may be a basis for the development of a number of complex syndromes and diseases.

Another explanation may lie in epigenetics. Epigenetic changes do not mean that the gene is altered, but that the gene is activated or inactivated as a result of environmental conditions. Switching a gene on or off at the wrong time and place can lead to adverse consequences for the individual and the epigenetic changes can be passed on to the next generation.

"We still know very little about how epigenetic changes in germ cells are affected by obesity or other environmental factors but animal experiments have shown that obese males have offspring with altered gene expression in early growth regulation," says Surén.

Further research

Researchers are still in the early stages of studying possible links between obesity in the father and the development of ASD in the child. The first study was recently published in the Pediatrics journal. The research paper is included in Surén's doctoral thesis and it was written with a large group of researchers from university and hospital environments in Norway, England and the USA.

"We have begun to sequence all genes to find mutations and we must do more epigenetic analysis. If there is a correlation between obesity and ASD, this is a risk factor where the incidence is increasing in the population. Further research is therefore of great importance to public health," says Surén.

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Study: Maternal infections increase child's autism risk

A study found that a pregnant woman with a bacterial infections diagnosed in the hospital had a higher risk of the child being diagnosed with autism.

Hospital-diagnosed maternal bacterial infections during pregnancy were associated with an increased risk of autism spectrum disorders in children, according to a Kaiser Permanente study published Dec. 23 in the Journal of Autism and Developmental Disorders.

The research contributes new evidence to a body of scientific literature on the role of infection in autism risk and points to areas for further examination.

The study included 407 children with autism and 2,075 matched children who did not have autism. The study included infants born between January 1995 and June 1999 who remained members of the Kaiser Permanente health plan for at least two years following birth.

"Though infections in pregnant women are fairly common, in this study most were not associated with an increased risk of autism," said Lisa A. Croen, PhD, research scientist with the Kaiser Permanente Division of Research and senior author of the study. "Only bacterial infections diagnosed in the hospital were associated with an increased risk."

"Infections diagnosed in a hospital setting were more common among mothers of children who developed an ASD compared with mothers of children who did not develop an ASD," Croen further explained.

Women with bacterial infections diagnosed during a hospitalization (including of the genitals, urinary tract and amniotic fluid) had a 58 percent greater risk of having a child with an ASD. While not very common in any of the mothers studied (1.5 percent of mothers of a child with ASD vs. 0.5 percent of mothers of a child without ASD), infections diagnosed during a hospitalization in the second trimester were associated with children having more than a three-fold increased risk of developing ASD.

"Infections diagnosed in an inpatient setting may represent more severe infections, and these were associated with increased risk of ASD," said Ousseny Zerbo, PhD, research fellow with the Kaiser Permanente Division of Research and the study's lead author.

While the mechanism for how maternal infections may influence autism risk has not been firmly established, Zerbo said animal tests have shown that immune-system responses to infections during pregnancy may influence the neurological development of the fetus.

"Our findings indicate that although most infections during pregnancy were not associated with autism in the child, there appears to be some increased risk for autism," Zerbo said. "It would be prudent for pregnant women to contact their doctor if they suspect an infection."

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Autism not related to mother's antidepressant use

A large study has shown that a mother's antidepressant use while pregnant is not linked to her child having autism.

Despite some concerns to the contrary, children whose moms used antidepressants during pregnancy do not appear to be at increased risk of autism, a large new Danish study suggests.

The results, published Dec. 19 in the New England Journal of Medicine, offer some reassurance, experts said.

There have been some hints that antidepressants called selective serotonin reuptake inhibitors (SSRIs) could be linked to autism. SSRIs are the "first-line" drug against depression, and include medications such as fluoxetine (Prozac), sertraline (Zoloft), citalopram (Celexa) and paroxetine (Paxil).

In one recent U.S. study, mothers' SSRI use during pregnancy was tied to a twofold increase in the odds that her child would have autism. A Swedish study saw a similar pattern, though the risk linked to the drugs was smaller.

But both studies included only small numbers of children who had autism and were exposed to antidepressants in the womb.

The new study is "the largest to date" to look at the issue, using records for more than 600,000 children born in Denmark, said lead researcher Anders Hviid, of the Statens Serum Institute in Copenhagen.

And overall, his team found, there was no clear link between SSRI use during pregnancy and children's autism risk.

Hviid cautioned that the finding is still based on a small number of children who had autism and prenatal exposure to an SSRI -- 52, to be exact. The researchers noted that it's not possible to rule out a small increase in autism risk.

But, Hviid said, "at this point, I do not think this potential association should feature prominently when evaluating the risks and benefits of SSRI use in pregnancy."

Commenting on the findings, Christina Chambers, director of the Center for the Promotion of Maternal Health and Infant Development at the University of California, San Diego, stated, "I think this study is reassuring."

One "important" point, Chambers added, is that the researchers factored in mothers' mental health diagnoses -- which ranged from depression to eating disorders to schizophrenia.

"How much of the risk is related to the medication, and how much is related to the underlying condition?" Chambers said. "It's hard to tease out."

In theory, she noted, depression or other mental health disorders could contribute to autism risk because those moms may be more likely to make unhealthy lifestyle choices, such as smoking or drinking.

In this study, Hviid's team did initially see a slightly increased risk of autism among children whose mothers used SSRIs during pregnancy. But once the researchers factored in the psychiatric disorders themselves, that statistical link fell away.

On top of that, there was a slight increase in autism risk among children whose mothers had used an SSRI in the two years before pregnancy, but not during pregnancy.

Hviid said that all suggests it's the underlying conditions, rather than the drugs, that are associated with a small autism risk -- though the reasons, he added, are unknown.

The study, which was funded by the Danish government, is based on records from Denmark's national system of health databases. Of nearly 627,000 children born between 1996 and 2005, just under 3,900 were later diagnosed with autism.

Among those children, 52 were born to mothers who filled an SSRI prescription during pregnancy. There were just over 6,000 other children whose mothers used the antidepressants during pregnancy but did not develop autism.

Both Hviid and Chambers said the findings do not prove that SSRIs carry no autism risk. And a connection is biologically plausible, Hviid said.

No one knows what causes autism, which affects an estimated one in 88 children. But it involves a disruption in fetal brain development. It's thought that serotonin -- the chemical that SSRIs target -- contributes to early brain development, and in animals, altered serotonin levels can affect brain function and behavior.

"It's still worthwhile to continue to study this," Chambers said.

But, she added, based on the human studies so far, "if there is any increased risk of autism, it appears small."

And for any one woman, Chambers said, that possible risk would have to be balanced against the risks of leaving major depression untreated.

"For some women, the optimal situation may be to take an SSRI, even if there is an association [with autism]," Chambers said.

Hviid agreed, saying that's a decision that has to be left up to women and their health care provider.

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Lack of eye contact in the first month of life may indicate autism

A study claims that certain signs of autism may be seen as early as the first month of life. Specifically, lack of eye contact at that age may indicate autism in a young child.

The first signs of autism may be visible as early as the first month of a child's life, according to a study published Wednesday in the scientific journal Nature.

"These are the earliest signs of autism ever observed," says lead study author Warren Jones.

Researchers at the Marcus Autism Center in Atlanta followed 110 children from birth to age 3, at which point a diagnosis of autism was ascertained. Fifty-nine babies were considered "high risk" for developing an autism spectrum disorder (ASD) because they had siblings with autism; 51 were considered "low risk" because they did not have first, second or third-degree relatives with ASD.

Data was collected at 2, 3, 4 ,5, 6, 9, 12, 15 and 24 months of age. Each time, the children watched videos showing actresses playing the role of a caregiver. "Every baby watched the same videos, and then we could measure what was different about the responses of infants later diagnosed with autism versus infants who were typically-developing," Jones says.

Lack of eye contact is one of the red flags when it comes to autism - a group of neurodevelopmental disorders that can cause significant social, communication and behavioral challenges.

Jones, who is the director of research at Marcus Autism Center and assistant professor in the Department of Pediatrics at Emory University School of Medicine, says he really expected the children later diagnosed with autism would have diminished eye contact from birth. Instead, he and his colleagues measures how much time each baby was looking at the eyes of the caregiver in the video.

"Basically from birth, (all) babies will look more at the eye part of faces," says Jones. But at about 4 to 6 weeks, he says the attention to eyes decreases, then in typical babies picks up again at 2 months. Jones found, "in the first 6 months of life we're seeing a decline in the amount of looking at other people's eyes in children who later are diagnosed with autism."

The research suggests that a baby's initial eye contact ability may be an almost a reflex-like behavior, but then there may be a second phase of development that depends on different brain and gene systems which lead to social interaction, Jones says. That's where a typically developing child's development may differ from a child with autism.

The study authors conclude that "the observation of this decline in eye fixation - rather than outright absence - offers a promising opportunity for early intervention."

This is not something parents are going to see by just holding their baby, Jones points out.  This type of eye-tracking requires sophisticated technology that can track even the slightest movement of the eye.

"It's a very interesting study with intriguing results. " says Wendy Stone, a longtime autism researcher and director of the Research in Early Autism Detection & Intervention (READI) lab at the University of Washington. But, she adds, "many researchers in this field have not seen behaviors under 6 months to be predictive of later diagnosis."

She also cautions that babies looking at videos of their mothers are not the same as the actual stimuli created by a mom interacting with her baby. "Are these babies less interested in eyes because mouths are more interesting to look at and more attractive because there's more movements? To me that's one of the big questions," says Stone.

Dr. Max Wiznitzer, a pediatric neurologist and autism specialist at the Rainbow and Babies Children's Hospital in Cleveland, Ohio, says this new study is a continuation of previous work in babies. He says this research makes sense to him. "There's a decrease in the amount of attention to eyes as an early marker of social behavior (think of it as a primitive level of socialization)." Wiznitzer suggests the failure to establish these early social skills has ramifications later as "social behavior shifts into more sophisticated patterns."

If this research bears out, then maybe at some point a pediatric practice could track eye movements as one way to diagnose a child with autism, says Stone. "But we're really, really far away from that."

Wiznitzer says this may explain why the autism symptoms may be more apparent at 18 to 24 months, "even though 'subclinical' onset was months earlier." He also suggests these study results may offer another explanation why the measles, mumps and rubella vaccine, which isn't administered until a baby is at least 12 months old, cannot be blamed for causing autism.

Everyone agrees this research needs to be replicated in bigger studies with more children, Wiznitzer says. "The authors are correct that a replication study using a larger number (of children) is necessary. Before that time, I would not devote extensive resources towards assessing eye attention in infants or designing major intervention programs."

Jones says, "what we really want to do is create growth charts for social behavior, just like we have growth charts for charting a child's height and weight." He says these those are the kind of tools that pediatricians need and parents are looking for.

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Mothers with lupus more likely to have child with autism

A study claims that children of mothers who have lupus are more likely to have autism spectrum disorders.

According to research presented this week at the American College of Rheumatology Annual Meeting in San Diego, children born to mothers with lupus may be at twice the risk of autism spectrum disorders than those born to mothers without the disease.

Systemic lupus erythematosus, also called SLE or lupus, is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system, and/or other organs of the body. The most common symptoms include skin rashes and arthritis, often accompanied by fatigue and fever. Lupus occurs mostly in women, typically developing in individuals in their twenties and thirties -- prime child-bearing age.

Recent experimental studies suggest exposure to a mother's antibodies and cytokines while in the womb are important risk factors for autism spectrum disorders (commonly called ASD). Interestingly, women with lupus display autoantibodies and cytokines, which -- when studied in animals -- have been shown to alter fetal brain development and induce behavioural irregularities in offspring.

Despite these studies, no studies have specifically assessed the risk of ASD in children of women with lupus, and researchers recently aimed to determine if children born to these mothers might have an increased risk of ASD when compared to children born to mothers without lupus.

"A handful of small studies suggest an increased risk of learning disabilities in children born to women with lupus. However, no study has specifically assessed the risk of ASD in offspring of mothers with lupus, explains Evelyne Vinet, MD, FRCPC; assistant professor, Department of Rheumatology; McGill University Health Centre, Montreal; and lead investigator in the study. "We undertook this study because women with lupus often ask: 'Will my disease affect the future health of my children?' By providing evidence to answer this relevant question, our study will help clinicians to appropriately counsel women with lupus who are planning a pregnancy."

The Offspring of Systemic Lupus Erythematosus mothers Registry ( OSLER) is a large, Canadian, population-based cohort which includes all women who have had one or more hospitalizations for childbirth after lupus diagnosis as identified through health care databases between the years of 1989 and 2009. Using OSLER, Dr. Vinet's team compared 719 children born to 509 mothers with lupus to 8,493 children born to 5,824 randomly-selected women without the disease.

The average age of mothers in the study was just over 30 years, and the average time of follow up for the children in the study was just over nine years. Dr. Vinet's team matched each mother with lupus to at least four women without the disease, based on their age and the year they delivered their children. The researchers also took into consideration each mother's demographics, sex and birth order of the children delivered, and obstetrical complications.

Dr. Vinet's team discovered that children born to mothers with lupus had more ASD diagnoses compared to the children born to mothers without the disease (1.4 percent vs. 0.6 percent, respectively). Additionally, the researchers found that children born to mothers with lupus might be diagnosed with ASD earlier in life -- with an average of 3.8 years at the time of diagnosis (compared to 5.7 years in children born to mothers without lupus).

Finally, Dr. Vinet's team looked at whether medications taken during pregnancy potentially played a role in ASD diagnosis in this study. They looked at a smaller group of 1,925 children, whose mothers had public drug coverage, and found exposures to medications during pregnancy were rare. In fact, in the 18 ASD cases observed in offspring of lupus mothers with public drug coverage, none of the children were exposed to antimalarials, antidepressants, or immunosuppressants during pregnancy. And, only one child born to a mother with lupus and another born to a mother without the disease were exposed to corticosteroids and anticonvulsants, respectively.

"The findings from this study suggest that, although the absolute risk is relatively small, when compared to children from the general population, children born to women with lupus have a two-fold increased risk of autism spectrum disorders," says Dr. Vinet. "Hopefully, this study will prompt further research on the potential role of lupus-related autoantibodies, such as N-methyl-D-aspartate receptor antibodies, in ASD. In the meantime, women with lupus who are contemplating a pregnancy should discuss with their physician to ideally plan the pregnancy at a time of low disease activity and review the safety of their medications."

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Risk of autism for full and half siblings

This study looks at how much of a higher risk fill and half siblings of children with autism have for developing the disease themselves.

A Danish study of siblings suggests the recurrence risks for autism spectrum disorders (ASDs) varied from 4.5 percent to 10.5 percent depending on the birth years, which is higher than the ASD risk of 1.18 percent in the overall Danish population, according to a study published by JAMA Pediatrics, a JAMA Network publication.

ASDs are neurodevelopmental disorders that are characterized by difficulties in social interaction and communication and also include repetitive behavior and narrow interests. Childhood autism (CA) accounts for about 30 percent of all ASD cases and the prevalence of ASDs has increased during the last two decades, according to the study background.

Therese K. Grønborg, M.Sc., of Aarhus University, Denmark, and colleagues conducted a population-based study in Denmark of all children (about 1.5 million) born between 1980 and 2004. They identified a maternal sibling group derived from mothers with at least two children and a paternal sibling group derived from fathers with at least two children.

"To date, this is the first population-based study to examine the recurrence risk for autism spectrum disorders (ASDs), including time trends, and the first study to consider the ASDs recurrence risk for full- and half-siblings," the authors note in the study.

The study results suggest an almost seven-fold increase in ASDs risk if an older sibling had an ASD diagnosis compared with no ASD diagnoses in older siblings. In children with the same mother, the adjusted relative recurrence risk of 7.5 in full siblings was significantly higher than the risk of 2.4 in half siblings. In children with the same father, the adjusted relative recurrence risk was 7.4 in full siblings and significant, but no statistically significant increased risk was observed among paternal half siblings, the results also indicate.

"The difference in the recurrence risk between full and half siblings supports the role of genetics in ASDs, while the significant recurrence risk in maternal half-siblings may support the role of factors associated with pregnancy and the maternal intrauterine environment in ASDs," the study concludes.

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Risk of autism linked to induced labor

This article discusses a study that claims women who have induced labor are more likely to have an autistic child.

A new study finds that pregnant women who have their labor started or sped up artificially are slightly more likely to have autistic children.

The increased autism risk likely stems from an underlying problem with the pregnancy, rather than any of the methods used to jump-start labor, says lead author Simon Gregory of the Duke Institute of Molecular Physiology.

It's possible that "infants destined to develop autism are less likely to send out the correct biochemical signals for normal progression of labor," says Tara Wenger, a pediatric genetics fellow at the Children's Hospital of Philadelphia, who wasn't involved in the new study, published in JAMA Pediatrics.

Pregnancy complications increase the risk of many developmental disorders, says Michael Rosanoff, associate director for public health research and scientific review at Autism Speaks, an advocacy group.

And a growing number of studies now link autism to a variety of things that can compromise the health of a pregnancy, says Rosanoff, who wasn't involved in the study, funded by the Environmental Protection Agency. Researchers are increasingly looking at prenatal risk factors for autism, because this period plays a key role in brain development. Science has ruled out vaccines as a cause of autism, he says.

But studies have found that children are at higher risk for autism if they are born early or very small; if they are in medical distress during delivery; if they have older mothers or fathers; or if they are born less than a year after an older sibling. Autism risk also goes up if a mother has diabetes or high blood pressure; is obese; is exposed to significant air pollution during pregnancy; had low levels of folic acid; takes medications such as an anti-seizure drug called valproic acid; or makes antibodies toxic to the fetal brain.

Gregory notes that his findings are still preliminary and that women shouldn't resist a doctor's recommendation about jump-starting labor out of fear of autism.

Inducing labor can often reduce the risk of stillbirth, such as when a pregnancy lasts more than a week or so beyond the usual 40 weeks, says co-author Chad Grotegut, a Duke maternal-fetal medicine specialist. Augmenting labor, which may be done when natural labor stalls, can reduce the risk of maternal or fetal infections or post-partum hemorrhage.

And while the link between autism and jump-starting labor is consistent with smaller, earlier studies, the research doesn't prove that labor induction or augmentation actually causes autism, Gregory says.

In the new study, researchers analyzed the records of 625,042 North Carolina births, which were linked to school records that noted any diagnosis of autism.

Those records didn't specify where children fell on the autism spectrum, the study says.

Doctors can induce or speed up labor in several ways, such as by applying a hormone gel to the cervix or giving women intravenous oxytocin, an artificial version of a natural hormone involved in labor, Gregory says.

Women whose labor was induced were 13% more likely to have an autistic child, compared to women whose labor wasn't induced. Women whose labor was sped up were 16% more likely to have a child later diagnosed with autism, the study found. Those whose labor was both induced and augmented were 27% more likely to have an autistic child.

In comparison, the risk of autism went up 23% when the mother had diabetes, and 25% when the fetus was in distress, the study says.

There was no increase in autism risk among women who had C-sections, Gregory says.

He says scientists should look more closely at labor induction with oxytocin. Oxytocin, sometimes called the "love hormone," plays a key role in social behavior and reasoning.

Gregory and other researchers are investigating oxytocin to treat some of the symptoms of autism.

About one in 88 American children have an autism diagnosis, according to the Centers for Disease Control and Prevention.

Rather than one disease, autism is now regarded as a collection of conditions with similar traits but different causes, Rosanoff says. People on the autism spectrum are extremely diverse. Some are non-verbal and profoundly disabled; others have successful careers, particularly in science and technology, describing themselves as different, rather than disabled.

"Autism is so heterogeneous," Rosanoff says. "We're never going to get to the one cause."

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