Study: Girls diagnosed with autism later than boys are

A study shows that girls are diagnosed with autism later than boys are.

Current statistics on autism spectrum disorder (ASD) show that boys are nearly five times more likely than girls to have autism. Now a new study proves that in addition to being diagnosed less, girls are also diagnosed at a later age than boys.

The study, conducted by the Kennedy Krieger Institute in in Baltimore, Maryland, analyzed data from the Institute’s Interactive Autism Network (IAN), an online information registry of nearly 50,000 people affected by autism and their families.  Researchers took into account the age that both boys and girls were diagnosed with autism for 9,932 children, and Social Responsiveness Scale data from 5,103 children, which identifies the presence and severity of social impairment.

Results showed that girls with a type of autism called pervasive developmental disorder (PDD)— which is characterized by delays in the development of socialization and communication skills— were diagnosed at an average age of 4 years old, compared to 3.8 years old in boys. In addition to PPD diagnosis, researchers found that Asperger’s syndrome diagnoses also happened later for girls – at 7.6 years old compared to 7.1 years of age for boys.

“The later diagnosis of girls appears to be tied to their areas of delay being less apparent, showing up more as shyness and quietness rather than the more unusual behaviors seen in boys, ” Dr. Paul Lipkin, study author and director of the Interactive Autism Network at Kennedy Krieger told FoxNews.com.

Lipkin said findings suggest that when it comes to social cognition, or the ability to interpret social cues, girls struggle more than boys, while boys have more difficulty with more obvious symptoms like severe mannerisms and repetitive behaviors.

“At the present time, autism screeners are not designed to look at boys and girls differently. This and other studies suggest that such may be needed, particularly around social skill development,” Lipkin said. “So parents, pediatric clinicians, therapists, educators now should give careful consideration to girls who are having difficulties in social situations and assist these girls early.”

Researchers noted an increase in the number of girls diagnosed with autism from 2010-2013 compared to the statistic measured four years earlier. Lipkin said he thinks the reason for the rise might be better public awareness and screening methods.

“We need to look at large groups of girls with autism and better understand their developmental pathways, in order to find the best means for their early identification and to find the best treatments for the challenges they experience,” he said. “One can no longer assume that boys and girls with autism are alike.”

Lipkin said he hopes the findings help change the way autism is diagnosed, and that further research will determine whether less recognizable symptoms in girls are not only leading to later diagnosis, but also under-identification of the condition.

“We need to find the best ways to identify those at both ends of the spectrum, those with severe problems and those with milder problems in social development,” he said. “The quiet girl with social difficulties may have an ASD and may benefit from special treatments aimed at these delays in social development.”

Read more here

Do girl's lacrosse players need helmets

This article discusses the need for helmets in lacrosse, especially girls lacrosse which is perceived to he less of a contact sport than boy's lacrosse.

Lacrosse is one of the fastest-growing high school sports in the country. It also has one of the hottest debates regarding its rules — specifically, whether girls who play should be required to wear helmets, as boys are.

Boys lacrosse is a physical sport with heavy doses of contact. Girls lacrosse is regarded as more of a skill sport, with less contact. Players in the girls game are required to wear protective eyewear and mouth guards, but not helmets.

A study recently published in The American Journal of Sports Medicine looked at the types of injuries high school lacrosse players suffer. The study, conducted by researchers from the Center of Injury Research and Policy at Nationwide's Children Hospital and the Colorado School of Public Health, evaluated injuries players suffered from 2008-12. The research found that the most common injury, at 38 percent, were sprains and strains, followed by concussions at more than 22 percent.

Dawn Comstock, a professor at the Colorado School of Public Health and one of the researchers, said the most surprising discovery was how players got concussions.

"In boys, nearly 75 percent of all of the concussions were due to athlete-athlete contact," Comstock said. "Not surprising, since boys lacrosse is a full contact sport. But girls, over 60 percent of the concussions resulted when a girl was struck in the head by a ball or the stick."

Even though girls lacrosse is regarded as a noncontact sport, researchers found that almost 25 percent of concussions came from athlete-to-athlete contact. About 63 percent of the concussions resulted from being hit in the head by a ball or a stick.

According to rules from U.S. Lacrosse, which the National Federation of State High School Associations endorses, girls may wear soft headgear but not hard helmets. Only goalies can wear helmets. Field players wear protective eyewear and mouth guards.

Denver East High School coach Mallory Cleveland would like to see helmets mandated in girls lacrosse. Cleveland played one year of lacrosse without goggles before they were required.

"At that time it was kind of a pain and people didn't like them and there was some lash out," Cleveland said. "But I would say now that it's just a part of the sport, it's something that's a given and everyone is used to them and wears them now. Helmets will definitely be the same thing once they are implemented."

Cleveland said a handful of players on the Denver East varsity and lower-level teams suffered concussions this past school year.

In June, the Florida High School Athletics Association announced that in 2015 all girls lacrosse players will be required to wear helmets.

Comstock said helmets can't eliminate concussions but can help minimize head injuries. When two players run into each other, often the head of one of the players snaps back. This results in brain sloshing, when the brain moves around inside the skull, and can result in a concussion. Comstock said a helmet can help protect against the direct transfer of force when a player gets hit in the head.

Some players and coaches worry that adding helmets will change their game. Cherry Creek assistant coach Ashley Thompson said girls lacrosse is about finesse and technical skills, not physical play. If helmets are required, she's afraid the cost might turn away interested players. Thompson added that coaches are more aware about concussions than in the past.

Denver East senior-to-be Shelby Parks said she would be upset if helmets are required to play girls lacrosse. She said she's never had a concussion and has seen only one player get a concussion during a game. Implementing helmets would make the players more aggressive, she said.

"When you're wearing a helmet or you see someone wearing a helmet, it means they're protected and anything goes," Parks said. "Lacrosse can get aggressive, but the refs are there for a reason and people shouldn't get hit in the head, because that's not a part of the game."

Read more here

Girls suffer worse concussions than boys do

A study looked into how gender affects concussion and showed that girls suffer worse concussions than boys do.

Girls who suffer a concussion may have more severe symptoms that last longer compared to boys, according to new research that builds on other studies finding gender differences.

"There have been several studies suggesting there are differences between boys and girls as far as [concussion] symptom reporting and the duration of symptoms," said Dr. Shayne Fehr, a pediatric sports medicine specialist at Children's Hospital of Wisconsin.

In his new study, Fehr also found those differences. He tracked 549 patients, including 235 girls, who sought treatment at a pediatric concussion clinic.

Compared to the boys, the girls reported more severe symptoms and took nearly 22 more days to recover, said Fehr, also an assistant professor of pediatric orthopedics at the Medical College of Wisconsin.

He was due to present the findings this week at the annual meeting of the American Medical Society for Sports Medicine, held in New Orleans. Studies presented at medical meetings are typically viewed as preliminary until published in a peer-reviewed journal.

A concussion is any brain injury that disturbs normal functioning. Concussions are typically caused by a jolt or blow to the head, often in collision sports such as hockey or football, according to the American Academy of Pediatrics (AAP).

In recent years, experts have advised coaches, players and parents that athletes should not return to play until they are seen by a doctor if a concussion is suspected.

In the new study, Fehr tracked patients aged 10 to 18, all treated between early 2010 and mid-2012. Each patient reported on their symptoms, how severe they were and how long it took from the time of the injury until they were symptom-free.

In addition to reporting more severe symptoms, girls took an average of 56 days to be symptom-free. In comparison, the boys took 34 days. Overall, the time to recovery was 44 days when boys and girls were pooled.

That duration of symptoms, Fehr said, is much longer than what people commonly think. "Commonly you hear that seven to 10 days [for recovery] is average," he said.

Fehr did not find age to be linked with severity of symptoms. Most of the injuries -- 76 percent -- were sports-related, with football accounting for 22 percent of the concussions.

The top five reported symptoms were headache, trouble concentrating, sensitivity to light, sensitivity to sound and dizziness. Boys and girls, in general, reported the same types of symptoms, Fehr said, but the girls reported more severity and for a longer time period.

"This confirms what has been reported before," said Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital, who reviewed the findings.

While he said the 44-day recovery seems lengthy, he added that it probably reflects the boys and girls studied. They all went to a concussion clinic, so their injuries may have been more severe.

What's not known, Fehr said, is why the differences exist and whether they are related to more reporting of symptoms right after the injury by girls or if girls are truly more significantly affected.

"I wouldn't treat girls any differently than boys,'' he said.

For both genders, it's important to be seen by a doctor and not return to play prematurely, which can be dangerous or even fatal, according to the AAP. Anyone with a history of concussion is at higher risk for another injury.

Read more here

Increase in autism diagnosis rates since 2000

The CDC has found a steady increase in autism diagnosis rates since 2000. Reasons for this are unknown, but may be due to increased awareness.

Autism rates in children have continued their steady rise, surging 30 percent in two years, according to the latest data released Thursday by the Centers for Disease Control and Prevention. While 1 in 88 children were estimated to have autism in 2008, public health officials now estimate that 1 in 68 children are on the autism spectrum.

Those statistics are based on the 2010 medical records of 8-year-olds living in 11 communities throughout the United States that are part of the CDC’s autism surveillance network. When the CDC started its surveillance of these communities back in 2000, the incidence of autism was 1 in 150 children.

CDC officials couldn’t offer specific reasons for the rise beyond increased awareness of the condition among doctors, teachers, and parents. “It may be that we’re getting better at identifying autism,” said Coleen Boyle, director of the CDC’s National Center on Birth Defects and Developmental Disabilities, during a press briefing. “We do feel like some of this has to do with how children are identified, diagnosed, and served in their communities.”

Autism advocacy groups noted that the increasing prevalence underscores the need for research funding to identify the causes of autism. “To be perfectly frank, it’s an incomplete picture right now,” said Robert Ring, chief science officer at Autism Speaks, a research advocacy organization in New York City. “All the pieces of the puzzle aren’t in place.”

Certain trends have remained constant during the decade that the CDC has been collecting data. Autism remains five times more common in boys — affecting 1 in 42 compared with 1 in 189 girls — and white children are more likely to be diagnosed than black or Hispanic children, though the prevalence in those minority groups has risen at a faster rate than for whites.

About half of children with autism in 2010 had average or above-average intelligence, compared with a third in 2002.

“We now recognize that autism is a spectrum,” said Marshalyn Yeargin-Allsopp, chief of the CDC’s developmental disabilities branch. “Our understanding has evolved to the point that we understand that there are children with higher IQs who may not have been receiving services in the past.”

The CDC provided grants to 11 states across the country — including Arizona, Arkansas, Maryland, and Wisconsin — based on their ability to survey medical and school records for pediatric autism diagnoses. Massachusetts is not one of the sites providing data to the federal government.

Autism rates varied widely among the 11 areas under CDC surveillance. In Alabama, only 1 in 175 children had autism in 2010 compared with 1 in 45 children in New Jersey.

That difference could reflect varying access to expensive autism assessments and therapies among states. New Jersey mandated in 2010 that insurance companies must cover $36,000 per year in behavioral programs and other autism therapies for any person under age 21 who is diagnosed with the disorder. Alabama didn’t pass a coverage mandate until 2012. A Massachusetts coverage law took effect in 2011, and more than 30 other states instituted such laws as well.

Some children with behavioral or intellectual disabilities other than autism may receive the diagnosis from their doctors in order to qualify them for coverage for treatments that could benefit them too, said Dr. Sarah Spence, codirector of Boston Children Hospital’s Autism Spectrum Center. “Kids may get labeled with autism disorder because that’s the best way for them to get services, but I don’t think this overdiagnosis is a huge piece of the rising incidence.”

More likely, doctors have become more attuned to early signs of autism in toddlers and preschoolers, such as failure to make eye contact, smile, or express emotional attachments to their caregivers. The American Academy of Pediatrics recommends that health care providers conduct autism screening tests at every well-child visit.

“Doctors are getting better at doing these screenings,” Spence said, “to the point where every once in a while, I can happily tell parents that their child’s language delay isn’t autism.”

Despite this increased awareness, the average age at which a child is diagnosed hasn’t budged much; most children aren’t diagnosed until after 4 years of age, according to the CDC, two years after signs of the disorder usually start to appear.

“Research suggests that the earlier we intervene with treatment, the greater the probability that children will realize their full potential,” Ring said.

In an effort to get children diagnosed earlier, the US Department of Health and Human Services revealed an educational campaign on Thursday to make parents, teachers, and health care providers even more aware of early autism signs. Parents are advised to look for certain expected milestones in their child’s development, such as developing a fear of strangers, responding to other people’s emotions, and looking in the mirror by age 6 to 9 months.

One problem, however, that still remains unaddressed is the lack of behavioral specialists to assess and treat the growing population of children displaying signs of autism.

“The wait lists in Boston for assessment and treatment are too long,” Spence said, “and that’s unacceptable because every month counts when it comes to starting therapy.”

Read more here

Girls naturally more protected from autism development

This article explains why boys are four times more likely to develop autism and explains why girls may be naturally more protected from developing autism.

It takes more mutations to trigger autism in women than in men, which may explain why men are four times more likely to have the disorder, according to a study published 26 February in the American Journal of Human Genetics.

The study found that women with autism or developmental delay tend to have more large disruptions in their genomes than do men with the disorder. Inherited mutations are also more likely to be passed down from unaffected mothers than from fathers.

Together, the results suggest that women are resistant to mutations that contribute to autism.

"This strongly argues that females are protected from autism and developmental delay and require more mutational load, or more mutational hits that are severe, in order to push them over the threshold," says lead researcher Evan Eichler, professor of genome sciences at the University of Washington in Seattle. "Males on the other hand are kind of the canary in the mineshaft, so to speak, and they are much less robust."

The findings bolster those from previous studies, but don't explain what confers protection against autism in women. The fact that autism is difficult to diagnose in girls may mean that studies enroll only those girls who are severely affected and who may therefore have the most mutations, researchers note.

"The authors are geneticists, and the genetics is terrific," says David Skuse, professor of behavioral and brain sciences at University College London, who was not involved in the study. "But the questions about ascertainment are not addressed adequately."

Genetic burden:

The new study draws from the Simons Simplex Collection (SSC), a database of families that have one child with autism and unaffected parents and siblings. (This project is funded by the Simons Foundation, SFARI.org's parent organization.) In a 2011 study, researchers found that girls with autism in the SSC tend to have more large duplications or deletions of regions of the genome, called copy number variants (CNVs), than do boys with the disorder, although this disparity does not reach statistical significance2.

For the new study, Eichler and his colleagues cataloged the number of CNVs in 109 girls and 653 boys with autism from the SSC. They found that females are twice as likely as males to carry CNVs that are at least 400 kilobases long. (The larger the CNV, the more likely it is to disrupt important genes.)

When the researchers analyzed only CNVs that encompass risk genes for neurodevelopmental disorders, they found that females with autism are three times as likely as males with the disorder to carry CNVs that encompass these genes.

Females with autism also carry slightly more rare mutations that change a single DNA nucleotide than the men do. These are the "nastiest of nasty mutations," says Eichler, because they interfere with the protein's function.

The researchers saw a similar but smaller effect for CNVs in a larger group of 9,206 males and 6,379 females referred for genetic testing: 75 percent of this group turned out to have developmental delay, intellectual disability or autism.

Women in this group are 1.28 times more likely than men to carry large CNVs that include risk factors for these disorders.

Many autism-linked mutations arise spontaneously, or de novo, and about 80 percent of these come from the father.

Eichler and his colleagues found that women are far more likely than men to transmit the inherited mutations that confer autism risk.

Of the 27 large CNVs the researchers identified in the SSC group, 70 percent, or 19, were inherited from the mother. Mothers had similarly passed down about 57 percent of the 3,561 CNVs detected in the neurodevelopmental group.

Eichler intends to extend this work in a bigger study to assess whether certain mutations are more likely than others to be inherited.

"I think it's really critical to identify these inherited components," he says. "We know they're there, but we need to really focus on identifying the specific genes so we can advise [parents] a little more about recurrence."

However, it's unclear whether this gender bias is the result of genetics or reflects differences in diagnosis or the way females manifest symptoms of the disorder. Girls with autism tend to actively compensate for their symptoms in ways that boys don't, which may account for the discrepancy, says Skuse.

As a result, the females enrolled in studies may tend to be severely affected and carry multiple mutations. "There is some suggestion that higher-functioning females are out there in the general population, but they're not being referred," he says.

The study also does not address why women with autism transmit more mutations, or how they are protected from autism.

"We need to ask what it is about brain development that makes it such that females are protected -- because ultimately that is what we want know," says Aravinda Chakravarti, director of the Center for Complex Disease Genomics at the Johns Hopkins University School of Medicine in Baltimore. "We need to re-create that developmental environment."

The most obvious explanation for autism's gender bias is that because men have only one X chromosome, they are hypersensitive to mutations in this chromosome. In line with this theory, several autism-linked genes are located on the X chromosome. However, most of the mutations that show a gender bias in the new study are not on the X chromosome, suggesting that other factors must be involved.

This article has been modified from the original. An earlier version incorrectly stated that 80 percent of the genetic risk factors for autism arise spontaneously. The exact contribution of spontaneous genetic variants to autism is not known.

Read more here

DNA may explain why more boys are affected by autism than girls

A study that looks at genetics and DNA to determine why more boys are affected by autism than girls are.

A new DNA study begins to explain why girls are less likely than boys to have an autism spectrum disorder.

It turns out that girls tend not to develop autism when only mild genetic abnormalities exist, the researchers said. But when they are diagnosed with the disorder, they are more likely to have more extreme genetic mutations than boys who show the same symptoms.

"Girls tolerate neurodevelopmental mutations more than boys do. This is really what the study shows," said study author Sebastien Jacquemont, an assistant professor of genetic medicine at the University Hospital of Lausanne, in Switzerland.

"To push a girl over the threshold for autism or any of these neurodevelopmental disorders, it takes more of these mutations," Jacquemont added. "It's about resilience to genetic insult."

The dilemma is that the researchers don't really know why this is so. "It's more of an observation at a molecular level," Jacquemont noted.

In the study, the Swiss researchers collaborated with scientists from the University of Washington School of Medicine to analyze about 16,000 DNA samples and sequencing data sets from people with neurodevelopmental disorders, including autism spectrum disorders.

The investigators also analyzed genetic data from almost 800 families affected by autism for the study, which was released online Feb. 27 in the American Journal of Human Genetics.

The researchers analyzed copy-number variants (CNVs), which are individual variations in the number of copies of a particular gene. They also looked at single-nucleotide variants (SNVs), which are DNA sequence variations affecting a single nucleotide. Nucleotides are the basic building blocks of DNA.

The study found that females diagnosed with any neurodevelopmental disorder, including attention-deficit/hyperactivity disorder and intellectual disability, had more harmful CNVs than males who were diagnosed with the same disorder. Females with autism also had more harmful SNVs than males with the condition.

"There's a well-known disparity when it comes to developmental disorders between boys and girls, and it's been puzzling," Jacquemont said. "And there have been quite a bit of papers trying to investigate this bias that we've seen in the clinic."

The study authors pointed out that autism affects four boys for every one girl. The ratio increases to seven-to-one when looking at high-functioning autism cases.

It's an interesting study, said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven & Alexandra Cohen Children's Medical Center of New York.

"It's not an easy study to read, but certainly the take-away suggests it tries to lend further support to the assumption that the ratio of males to females [who have autism] is affected by genetic vulnerabilities -- that it has a genetic underpinning," Adesman said.

What do the findings mean for parents and patients?

Adesman said there are no immediate benefits, but the knowledge can help direct future research.

"This isn't going to lead to a breakthrough in treatment, but from a clinical standpoint it may help researchers and academics understand why it is that developmental disorders seem to be more common in boys than girls," he noted.

The new research also reinforces that genetic differences -- or vulnerabilities -- aren't limited to sex chromosomes, Adesman added.

"The presumption has been, 'Well gee, boys have a Y chromosome and girls don't, so are there problems with the Y chromosome that explain it?'" Adesman noted.

"The bottom line is that there are a lot of different genetic abnormalities and atypicalities that result in developmental disorders in children and adults," Adesman explained. "Women seem to be a little more resilient in terms of being able to have minor abnormalities without having a developmental problem."

Jacquemont agreed that the team's discovery opens the door for new avenues of study.

The findings provide ideas "for deciphering the issue further," said Jacquemont. "One study that might be helpful would be trying to understand what are the symptoms that appear a lot faster in males than females. There are a lot of alleys that could be explored."

Read more here

Study claims concussions are common in middle school-aged girls playing soccer

A recent study claims that girls who are middle school-aged and play soccer commonly have concussions.

Girls who play soccer in middle school are vulnerable to concussions, new research shows.

And despite medical advice to the contrary, many play through their injury, increasing the risk of a second concussion, the study found.

Although awareness has increased about sports concussions, little research has been done on middle school athletes, especially girls, noted study co-author Dr. Melissa Schiff, a professor of epidemiology at the University of Washington School of Public Health in Seattle.

In the study, which evaluated 351 soccer players between the ages of 11 and 14, Schiff and her colleagues found 59 concussions. A concussion is defined as a traumatic injury to the brain after a blow, shaking or spinning. In the study, the girls' symptoms included headache, dizziness, drowsiness and concentration problems.

That rate of injuries, Schiff said, is higher than what has been reported at either high school or college level of women's soccer.

Heading the ball was to blame for about 30 percent of the injuries. This involves hitting the ball with your forehead to redirect the ball in play. More than half of the concussions were from contact with another player.

Experts recommend those who have a concussion be evaluated by a doctor or other health care professional trained in the injury, but Schiff found that ''56 percent were never evaluated." Experts also advise that players not return to practice or games until symptoms disappear, but 58 percent of the players in the study continued to play even with symptoms persisting, she said.

The study was published online Jan. 20 in the journal JAMA Pediatrics.

Awareness about the dangers of concussions has increased, Schiff said, beginning with the National Football League's attention to the problem. Research about the problem has slowly increased to encompass college-level, high school, and now middle school players, she said.

In this study, the researchers randomly selected 33 of 72 elite teams from four youth soccer clubs in the Puget Sound region of Washington state. The study continued from 2008 to 2012. Players reported injuries and symptoms.

With so many injuries blamed on heading the ball, should it be banned?

Schiff thinks that is unrealistic. "It's part of the soccer sport," she said. However, it was found to result in concussion 23 times more often in a game than in practice. One suggestion, she said, is to teach middle school athletes heading in practice but tell them not to do it in games until they are older. The researchers speculate that younger players' less mature brains and weaker neck muscles, along with poorer heading technique, may contribute to the number of concussions.

The new study ''calls attention to the high incidence of concussion in this age group," said Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Miami Children's Hospital.

The number of injuries blamed on heading the ball, 30 percent, is not surprising, he said. "I see it all the time," Kuluz explained. Often, he noted, a heading injury occurs along with colliding with another player.

Kuluz advises young athletes who have had a concussion to avoid heading the ball.

Parents need to pay attention to their child during and after soccer, he suggested. "In the event of an injury, pay attention to symptoms," Kuluz said. He added that if a concussion is suspected, a young athlete must be evaluated by a doctor or trainer who has experience with concussions.

"Soccer can be done safely," he said, but parents and coaches need to be aware of concussion symptoms and obtain good medical evaluation and care.

Read more here