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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Younger siblings of children with autism show abnormal development

Research shows that younger siblings of children with autism show abnormal development and behavior early.

Younger siblings of children with autism may show signs of abnormal development or behavior as early as 1 year of age, according to a new study.

The findings suggest that parents and doctors should keep close watch for such symptoms at an early age among younger siblings of children with autism so problems can be addressed sooner, the researchers said.

The new study included nearly 300 infant siblings of children with autism and 116 infant siblings of children without the disorder. The children's development was assessed at 6 months, 12 months, 18 months, 24 months and 36 months of age.

Researchers found problems in nearly half of the siblings of children with autism, with 17 percent developing autism and 28 percent having delays in other areas of development or behavior.

Among that 28 percent, abnormalities in social, communication, thinking or movement development were apparent by the time they were 1 year old. The most common types of problems were extreme shyness with strangers, lower levels of eye contact and delayed pointing, according to the study, which was published online recently in the Journal of the American Academy of Child and Adolescent Psychiatry.

"This research should give parents and clinicians hope that clinical symptoms of atypical development can be picked up earlier, so that we can, perhaps, reduce some of the difficulties that these families often face by intervening earlier," study author Sally Ozonoff, a professor of psychiatry and behavioral sciences at the MIND Institute at the University of California, Davis, said in a university news release.

"Good clinical practice suggests that when children are showing atypical development they and their families should be provided with information about the child's difficulties, clinical reports when practical and referrals to local service providers," Ozonoff said.

Treatment will vary depending on the child and family, she added.

"The intervention approaches need to be chosen based on each child's profile of strengths and weaknesses and each family's goals and priorities," Ozonoff said.

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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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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: Half Siblings show Genetic Clues to Autism

When a child has autism, siblings are also at risk for the disorder. New research from Washington University School of Medicine in St. Louis shows that the genetic reach of the disorder often extends to half siblings as well.

On the surface, the finding may not be surprising -- half siblings share about 25 percent of their genes. But the discovery is giving scientists new clues to how autism is inherited.

The study is published online in the journal Molecular Psychiatry.

According to principal investigator John N. Constantino, MD, the new research adds to recent evidence that even though autism is far more common in males, females still can inherit and pass along genetic risk for autism.

"We found that autism risk for half siblings is about half of what it is for full siblings," he says. "Most of the half siblings we studied had the same mothers. Given that half of the risk of transmission was lost and half was preserved among those maternal half siblings, mothers and fathers appear to be transmitting risk equally in families in which autism recurs."

Constantino, the Blanche F. Ittleson Professor of Psychiatry and Pediatrics and director of the William Greenleaf Eliot Division of Child and Adolescent Psychiatry at Washington University and psychiatrist-in-chief at St. Louis Children's Hospital, says the findings also suggest that in many families, the transmission of autism is the result of the effects of many genes -- not just one -- with each contributing a small proportion of risk.

Prior estimates of the extent to which autism is influenced by genetic factors are derived from studies of identical and fraternal twins where one, or both, are affected by the disorder. Since identical twins share 100 percent of their genes, and fraternal twins share 50 percent, inherited conditions tend to be twice as common in an identical twin pair compared to a fraternal twin pair. But twin studies of autism are too small to give precise estimates about how the disorder is inherited.

"The largest studies have included less than 300 clinically affected twin pairs," Constantino says. "And they include girls, boys and mixed twin pairs, which complicates the testing of models of inheritance in autism because the disorder is much more common in boys than girls."

Other studies have focused on siblings of children with autism, looking at how much more common autism recurrence is in siblings than the general population. But to derive more information on genetic structure from their family studies, Constantino's group looked at autism recurrence in half siblings and compared it to that in full siblings.

The researchers studied over 5,000 families in which there was a child with autism and at least one additional sibling -- the families were enrolled in a national volunteer, Internet-based family registry for autism, the Interactive Autism Network (IAN). Among those families, 619 included at least one maternal half-sibling. The researchers focused on maternal half-siblings rather than paternal half siblings because these children were more likely to live full-time with their biological mothers and to share the same environmental influences between the time they were born and the age of two, the time at which the onset of autistic syndromes occur. They compared autism recurrence among the 619 maternal half siblings to the rate among 4,832 full siblings.

In an attempt to replicate their findings, the researchers also looked at a group of local St. Louis families in which maternal half siblings also were known to have been raised in the same household.

After analyzing both sets of families, the researchers found that 10 percent to 11 percent of full siblings had been diagnosed with autism, compared to 5 percent to 7 percent of half siblings.

"If transmission of autism risk was occurring equally from unaffected mothers and fathers, you would predict that maternal half siblings' risk of autism would be about half of what we saw in full siblings," Constantino says. "And that's exactly what we found."

Current statistics from the U.S. Centers for Disease Control and Prevention estimate that about one in 110 children in the United States is somewhere on the autism spectrum. Constantino says that according to the new findings, more than 60 percent of those cases of autism are likely to be inherited on the basis of genetic variations inherited from unaffected mothers and fathers.

"In 15 to 20 percent of children with autism, it appears that genetic problems aren't inherited, rather that genes become altered in sperm cells, egg cells or in the developing embryo," he says. "The recent discovery of these kinds of abnormalities have raised questions about the interpretation of twin studies and the extent to which autism is inherited. The current study, however, supports inheritance as a central cause for a majority of autistic syndromes and encourages a new focus on the mechanisms by which genetic susceptibility to autism can be silenced in some individuals, especially females who typically exhibit symptoms of autism at only one third of the rate seen in males."

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The 'Secret' Perks Of Being A Middle Child

Stereotypes about middle children are hardly flattering. They're often described as confused underachievers, overshadowed by older and younger siblings, and overlooked by their parents.

But in The Secret Power of Middle ChildrenCatherine Salmon and Katrin Schumann argue that many middle-borns have hidden strengths and are agents of change in business, politics and science.

Salmon and Schumann join NPR's Rebecca Roberts to discuss the perks of being a middle child.