Improvements in autism symptoms vary kid by kid

NEW YORK (Reuters Health) - A new study suggests that social and communication skills in some kids with autism may improve over time with therapy, but other kids will continue having problems functioning as they get older.

Not surprisingly, kids who had milder symptoms when they were first diagnosed tended to be doing better a few years later than those who started out with more severe autism.

But among close to 7,000 children followed by researchers, there was also a group of so-called "bloomers" who started out with lots of communication and social problems but made fast gains during their elementary-school years.

"There's a wide variety of children with different kinds of symptoms that fall within this (autism) umbrella," said Christine Fountain, the lead author of the study and an autism researcher at Columbia University in New York. "We were interested in how these symptoms play out over time."

The new findings, published Monday in Pediatrics, come just a few days after the Centers for Disease Control and Prevention released new data suggesting that one in 88 kids in the United States now has an autism spectrum disorder, which includes less-debilitating conditions such as Asperger's syndrome (see Reuters story of March 29, 2012).

Using data from California centers responsible for testing and treating kids with autism, Fountain and her colleagues tracked kids ages two to 14 who'd had at least four evaluations. During those approximately annual evaluations, staff recorded kids' symptoms of social and communication difficulties as well as their repetitive behaviors.

The researchers found that especially when it came to social and communication scores, most kids improved over time -- though some much faster than others.

White kids, and those whose parents were more educated, tended to have less severe autism symptoms during treatment. They were also more likely to be among the 10 percent or so of kids deemed bloomers, whose symptoms improved dramatically between ages three and 12.

Kids who had other intellectual disabilities along with autism weren't likely to have very large improvements.

"The conclusion is, if you have mental retardation as a co-occurring condition with autism, your prognosis is worse," said Johnny Matson, who studies autism spectrum disorders and intellectual disabilities at Louisiana State University in Baton Rouge.

That's not new, he said -- previous studies have shown that kids with autism and a normal IQ improve more from intensive therapy than those who have both autism and intellectual disabilities.

Unlike social and communication skills, repetitive behaviors didn't tend to improve or worsen much over time among the majority of kids in the study.

MOST KIDS WILL IMPROVE

The gaps in improvement based on parents' race and education are probably about access to good-quality treatment, according to Matson. The good news is, "those gaps are narrowing very rapidly," he told Reuters Health, because of laws requiring insurance companies to cover intensive treatment for all autistic kids.

Matson, who wasn't involved in the new study, had some doubts about the specific "symptom trajectories" the researchers used to separate kids, and said a lot of autism assessments aren't done correctly to begin with -- which makes interpreting changes over time difficult.

"I think all (kids with autism) are going to improve, it's just a matter of how much they're going to improve," Matson added. "I don't believe you can cure autism. Having said that, you can make it a lot better," especially if kids with autism continue to get therapy as they get older.

Still, another autism specialist not involved in the research said the different patterns in improvement -- or lack thereof -- jibe with his own experience.

"We deal with this problem every day, and we sense that there are different patterns or trajectories... in the kids as they develop," said Dr. Andrew Zimmerman, from the Lurie Center for Autism at Massachusetts General Hospital for Kids in Lexington.

"For some kids, you work very hard and you do a lot of therapy and nothing happens or very little, and then some kids seem to do really well," Zimmerman told Reuters Health.

Fountain said the findings suggest that providing equal access to the best autism treatment for minority and less well-off kids will be important going forward. Some states including California provide services to all kids with autism regardless of their ability to pay, she added, but others don't.

Kids' specific conditions and symptoms may play a role in their long-term improvement, but the treatment they get at certain points in development is also likely to be important, she added.

She and Matson said that parents of children with autism should be persistent in making sure their kids get the help they need, but agreed they can also be optimistic.

"There is a bit of a hopeful note in that we did find that most children get at least a little better over time," Fountain told Reuters Health.

Zimmerman agreed, adding that the idea of some kids being bloomers is especially exciting.

"There's a lot of hope here," he said.

SOURCE: http://bit.ly/cxXOG Pediatrics, April 2, 2012.

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CORRECTION: Formula-fed babies don't always overeat: study

[Corrects spelling of researcher Gary Beauchamp's last name in paragraphs 3 and 12 of story posted Mar 30, 2012 as 20120330elin005.]

NEW YORK (Reuters Health) - Babies given extra amino acids in their formula ate less and felt sated sooner than with regular cow's-milk formula, in a new study whose results challenge the idea that bottle-feeding diminishes a baby's ability to regulate its own food intake.

When the amino acid glutamate was added to a typical cow's milk formula, researchers found that babies drank significantly less of it and showed no signs of being hungry. Human breast milk has naturally high levels of glutamate, a building-block of proteins, but cow's milk, which is used to make most infant formulas, has less of it.

"What food is fed may be at least as important as how it is fed," said Gary Beauchamp, director of the Monell Chemical Senses Center in Philadelphia, who worked on the study.

Formula-feeding infants has been linked to faster weight gain in the babies' first year, which puts them at greater risk of obesity later in life. Adding glutamate to regular infant formula might shorten feeding time, Beauchamp told Reuters Health.

"The gold standard you want to mimic is consumption at the same rate as human milk," he said.

Thirty parents and their infants participated in the research, which is published in the American Journal of Clinical Nutrition.

The babies, who were less than four months old, were bottle-fed two consecutive formula meals a day in a laboratory setting over three days.

Infants drank one of three formulas during each first meal: regular cow's milk formula; cow's milk formula with added glutamate; or so-called hydrolyzed formula, which contains broken-down or predigested milk protein. Hydrolyzed formulas, which also have high glutamate levels, are typically given to babies who have bad reactions to whole protein.

Researchers allowed the infants to drink formula at the first meal until they indicated they were full. When the infants showed they were hungry again, they were given a second feeding of cow's milk formula.

Parents fed their baby at their customary pace, starting and ending only when the baby signaled hunger or satisfaction with cues such as sucking on hands or turning away from the bottle. They were unaware of what type of formula their baby was getting.

During the first meal, the infants drank significantly less hydrolyzed formula and cow's milk formula with added glutamate compared to when they got regular cow's milk formula, leading researchers to conclude that even on formula, babies may know to stop eating when they're full.

"Since the parents feeding the infants did not know what formula they were feeding, the infants must have been able to control the amounts that they consumed," Beauchamp explained in an email.

The time between the first and second feedings did not differ markedly depending on which formula a baby was given at the first meal. The infants who first got hydrolyzed or added-glutamate formulas also did not make up for drinking less at the earlier meal by having extra formula at the next one.

That showed infants were just as satisfied after the two high-amino-acid formulas despite drinking less, said Beauchamp.

The study was funded by the National Institutes of Health and Ajinomoto Inc, a maker of amino acids, but neither was involved in the research or the written report, the authors note.

Beauchamp's team concludes from the infants' behavior that glutamate may trigger a signal in the body that tells babies they have eaten enough.

"Extra glutamate seems to control the baby's appetite," said Dr. Ian Holzman, a neonatologist at Mount Sinai School of Medicine in New York, who was not involved in the study.

Although human milk remains best for babies, Holzman explained, some babies have to be fed formula for various medical or social reasons.

In those cases, the study suggests adding glutamate to infant formula could make it "closer to breast milk," he told Reuters Health.

"We should try to make formula as good as it can be," he added.

SOURCE: http://bit.ly/GYfQVL American Journal of Clinical Nutrition, April 2012.

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Suicide rates rising among Canadian girls

NEW YORK (Reuters Health) - A new study finds suicide rates for female teens and preteens in Canada rose over the past few decades while the overall number of kids who took their own lives was dropping.

Researchers with Canada's public health agency also noted a change in the youngsters' favored methods of suicide - from guns or poisons, to suffocation by strangulation -- though they can't explain either pattern.

"Our message is that all suicide is a tragedy and the trend is very disturbing," said the study's lead author, Robin Skinner, an epidemiologist with the Public Health Agency of Canada in Ottawa.

Overall, suicide is the second leading cause of death for Canadians between 10 and 19 years old, after accidental injuries.

Skinner told Reuters Health that they saw a slight improvement in the suicide rates for all Canadians in that age group between 1980 and 2008. Whereas 6.2 of every 100,000 young Canadians killed themselves in 1980, the rate fell to 5.2 per 100,000 in 2008.

In general, there was about a 1 percent annual decline over nearly three decades.

But, Skinner said, they wanted to look deeper.

When they did, the group found there was no significant change in suicide rates for boys 10 to 14 years old. In 2008, 1.6 per 100,000 committed suicide.

However, the rate of suicide among boys between ages 15 and 19 fell considerably. In 1980, 19 per 100,000 boys in that age group took their own lives compared to 12.1 per 100,000 in 2008.

Though girls had much lower suicide rates than boys, they trended in the opposite direction.

In 1980, 0.6 per 100,000 girls between ages 10 and 14 committed suicide. That number increased to 0.9 per 100,000 in 2008.

Among girls 15 to 19 years old, the suicide rate rose from 3.7 per 100,000 in 1980 to 6.2 per 100,000 in 2008.

The study did not examine why the rates for girls increased over the 28-year period, or why that of boys dropped.

But the researchers do point out a fairly steady rise among both boys and girls in deaths by suffocation, along with a fall in deaths by poisoning or firearms.

In 1980, 140 young Canadians used a firearm to kill themselves, 60 used poison and 74 used a form of suffocation. In 2008, those numbers were 22, 20 and 177, respectively.

Previous research has found that young people perceive hanging to be a "clean, quick and painless method" of suicide, according to the authors.

In addition, they write, a so-called "choking game" has grown in popularity among kids and teens during the study period. It involves either strangling the throat or applying pressure to the chest to achieve euphoria from oxygen deprivation.

"The 'game' can turn deadly if the participant being choked is physiologically susceptible or if the pressure is not released quickly enough after the loss of consciousness. Deaths resulting from the 'choking game' have the potential to be misclassified as suicides, especially when the "game" is played alone," Skinner's team writes in the Canadian Medical Association Journal.

He told Reuters Health, however, that although suicides -- especially non-violent deaths -- can sometimes be misclassified, past studies have shown suicide rates are still reliable.

A commentary by Dr. Laurence Kirmayer, of the Department of Psychiatry at McGill University in Montreal that accompanies the study suggests the increase in suicides among girls might be explained by the more lethal methods young Canadians are using to attempt suicide.

"Girls tended to use poisoning not gunshots; hanging is potentially more lethal than poisoning, partly because people often use sublethal doses of pills or other substances," Kirmayer told Reuters Health in an email.

The increasing popularity of suffocation by hanging is a trend Canada shares with the U.S., and might be explained by laws meant to keep guns away from children speculated one expert who was not involved in the study.

"It's very possible that young people who die by suicide in the U.S. are increasingly selecting hanging/suffocation as a method-specific substitution for firearms," wrote Jeff Bridge, of the Research Institute at Nationwide Children's Hospital in Columbus, Ohio, in an email.

But, Bridge, who's looked at suicide trends among U.S. youths, told Reuters Health that unlike Canada, the youth suicide rate in the U.S. has been much more volatile.

According to the National Institute of Mental Health, there were 0.9 per 100,000 suicides among Americans between the ages of 10 and 14 in 2007. That number was 6.9 per 100,000 for kids between the ages of 15 and 19 years old.

Kirmayer says "access to mental health care and reducing stigma may play a role" in preventing suicides. He adds, "Antidepressants may be part of that" but they are more suitable for severe and persistent depression "and may not be as effective (or appropriate) for some of the more acute, episodic, impulsive, crisis-based suicides seen among young people."

According to Bridge, the main message is that suicides are preventable deaths.

"We need to take an aggressive public health approach to suicide prevention in all young people and focus on approaches that prevent suicidal behavior before it ever occurs," he said.

SOURCE: http://bit.ly/HdqVhu and http://bit.ly/Hj1ugM Canadian Medical Association Journal, online April 2.

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Female skiers likelier to injure non-dominant knee

NEW YORK (Reuters Health) - Women skiers are more likely than men to injure a knee while skiing, and a new study shows they are about twice as likely to have that injury occur to their non-dominant leg, often the left one.

The study did not go so far as to explain these inequalities, but Dr. Robert Johnson, a sports medicine physician at the University of Vermont College of Medicine said it could be caused "by a whole herd of issues."

"Anatomy, strength patterns, muscle patterns, wider pelvis...it all adds up. It's not just one factor," said Johnson, who was not involved in the research.

Earlier studies have shown that women are twice as likely as men to hurt a knee during downhill ski crashes, and three times as likely to tear the knee's anterior cruciate ligament, or ACL.

Gerhard Ruedl, lead author of the new study and a researcher at the University of Innsbruck in Austria, said he was interested in looking at whether women's knee troubles had to do with leg dominance.

The dominant leg is the one that a person prefers to kick with.

Ruedl and his colleagues collected information from close to 200 recreational skiers who had torn their ACL while skiing in Austria.

Men were just about equally likely to have injured their left knee as their right, although 87 percent of them were right-leg dominant.

Most women, 91 percent, were also right-leg dominant, but twice as many injured their left ACL as their right.

Skiing ability and physical fitness did not appear to influence the injury locations, leading the authors to conclude that the sex of the skier was responsible for the differences.

Ruedl said women have greater body asymmetry than men with regard to strength and proprioception, the sense of how the body -- in this case, the knee -- is positioned.

"Studies show that strength and proprioception is greater in the dominant compared to the non-dominant leg," Ruedl told Reuters Health by email.

This could perhaps make women more vulnerable to the strain that is put on the non-dominant knee as a skier turns.

"During a carving turn the greatest pressure is on the inside edge of the downhill (outside) ski," he said. "Our results showed that most skiers injured their ACL during a right turn where the left leg (= mostly the non-dominant leg) is the outside leg."

Ruedl and his colleagues note in their study, published in the American Journal of Sports Medicine, that four out of every 10,000 visits to a ski resort result in an ACL tear.

He recommends that to prevent injuries skiers should do strength and balance training on their non-dominant leg to reduce differences between the legs.

Johnson said he's skeptical that strength training could reduce ACL injuries for female skiers, and there have been no studies showing that working on the muscles of one leg could prevent it from being injured in a downhill wipeout.

"It makes sense that the stronger you are the less likely you are to be injured, but who has the highest incidence of ACL tears? It's ski racers," Johnson told Reuters Health.

"When you've got a two-meter lever on your leg, I'm skeptical anything will make a difference," he added.

Ruedl also said that skiers should get their bindings professionally adjusted each year and not ski faster than their skill level.

SOURCE: http://bit.ly/H5DVr8 American Journal of Sports Medicine, online March 16, 2012.

U.S. gives nod to Eli Lilly's brain plaque test

WASHINGTON (Reuters) - U.S. regulators gave the nod to an imaging test from Eli Lilly and Co. that can for the first time help doctors detect brain plaque tied to Alzheimer's disease, the company said.

The U.S. Food and Drug Administration approved the radioactive dye, called Amyvid, to help doctors rule out whether patients have Alzheimer's, the most common form of dementia, Lilly announced late on Friday.

The dye binds to clumps of a toxic protein called beta amyloid that accumulates in the brains of patients with Alzheimer's. Doctors can then see the plaque light up on a positron emission tomography, or PET, scan.

Patients with Alzheimer's always have some brain plaque, so its absence in the test would tell doctors to look for other causes of mental decline, such as depression or medications, Lilly has said.

But Lilly, which plans to sell the drug through its unit Avid Radiopharmaceuticals Inc, said the test should not be used to diagnose Alzheimer's, since brain plaque can also be tied to other neurologic conditions and may occur naturally in older people with normal mental states.

An FDA advisory panel recommended against approving the dye last year, saying doctors might have trouble interpreting scans of the plaque, and the FDA rejected Amyvid last March.

Since then, Eli Lilly said it has worked to identify better ways of training doctors to use the test.

Dr. Daniel Skovronsky, CEO of Avid, said one in five patients who are diagnosed with Alzheimer's turn out not to have the disease after an autopsy.

"The approval of Amyvid offers physicians a tool that, in conjunction with other diagnostic evaluations, can provide information to help physicians evaluate their patients," he said in the company's statement from Friday.

There is currently no cure for Alzheimer's, a mind-robbing disease that affects more than 35 million people worldwide and gets worse with age.

But an early hint that something is wrong might improve the success of drugs meant to prevent or delay disease progression, researchers believe.

Avid has been in the lead in the race for imaging agents for Alzheimer's, which are estimated to have a potential global market anywhere from $1 billion to $5 billion.

General Electric Co and Bayer AG are developing rival products.

Lilly, as well as Pfizer Inc, are the farthest along in developing experimental medicines to treat Alzheimer's. Lilly expects to release final data for its contender, solanezumab, as soon as this summer.

Combined vaccine not tied to seizures in older kids

NEW YORK (Reuters Health) - Although the combined vaccine against measles, mumps and chickenpox comes with a small risk of fever-related seizures in toddlers, a new study suggests that's not true in older children.

The measles-mumps-rubella-varicella (MMRV) vaccine has been available in the U.S. since 2005. It combines the traditional MMR vaccine with the anti-chickenpox shot so young children can undergo fewer jabs.

But after its release, the MMRV vaccine was found to carry a small risk of fever-related seizures in one- to two-year-olds -- the age at which the first dose of the vaccine is given.

Fever-related, or "febrile," seizures are short-lived, lasting about a minute or two.

Though the seizures are "very scary" for parents, "they are not dangerous, and they do not lead to later epilepsy or seizure disorders," lead researcher Dr. Nicola Klein, co-director of the Kaiser Permanente Vaccine Study Center in Oakland, California, told Reuters Health in an email.

Experts now recommend that parents opt for either the MMRV or separate MMR and varicella shots for their toddlers. The separate shots seem to cut the odds of a fever-related seizure.

But that has still left questions about the second MMRV vaccine, which is given between the ages of four and six.

In the new study, researchers found no evidence that the vaccine significantly raised the risk of fever-related seizures in those older children.

The findings, reported in the journal Pediatrics, are based on medical records for nearly 87,000 four- to six-year-olds who received the MMRV shot between 2006 and 2008. Another 67,000-plus received the MMR and varicella vaccines separately, on the same day, between 2000 and 2008.

One child had a fever-related seizure seven to 10 days after getting the MMRV vaccine -- the time frame in which one- to two-year-olds appear to be at risk. No seizures were recorded in kids who had the MMR and varicella shots separately.

The findings suggest the vaccine carries no particular risk of the seizures in older kids. Fever-related seizures are fairly common in children; according to the National Institutes of Health, about one in every 25 kids will have at least one fever-related seizure -- though they most often affect toddlers.

So it's not surprising that the MMRV shot has been linked to seizures in toddlers, but not in older kids, according to Klein's team.

Even in toddlers, the risk is small, said Klein.

"It is more common for a child to have a febrile seizure caused by a cold than by an immunization," she said.

In a 2010 study, Klein's team found that compared with one- to two-year-olds who got separate MMR and varicella jabs, those given the combined vaccine had twice the rate of fever-related seizures seven to 10 days later.

That translated to one additional seizure for every 2,300 doses of the MMRV shot given to one-year-olds instead of the separate vaccines.

Klein said that parents should talk with their pediatrician about the pros and cons of the MMRV vaccine versus giving toddlers the MMR and varicella vaccines separately.

The vaccine is not the only one that's associated with fever-related seizures in very young children. A recent study found a small risk among babies getting the combined vaccine against diphtheria, tetanus, whooping cough (pertussis), polio and Haemophilus influenzae type 2 -- known collectively as DTap-IPV-Hib (see Reuters Health story of February 21, 2012).

But again, experts stressed that the risk was "very small" and the vaccine was not linked to future seizure disorders.

Klein and some of her co-researchers on the study have received past research funding from vaccine makers, including Merck, which makes the ProQuad MMRV vaccine.

SOURCE: http://bit.ly/HzT6vz Pediatrics, online April 2, 2012.

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Blueberries and apples tied to lower diabetes risk

NEW YORK (Reuters Health) - Eating more blueberries, apples and pears may be linked to lower risk of diabetes, according to a new U.S. study.

These fruits are loaded with flavonoids, a natural compound present in certain fruits, vegetables and grains, which some research has tentatively tied to heath benefits such as a lower risk of heart disease or cancer.

"People who ate a higher amount of blueberries or apples, they tended to have a low risk of type 2 diabetes," said An Pan, a research fellow at the Harvard School of Public Health who worked on the study.

The findings show an association, he added, but don't prove the fruits, themselves, prevent diabetes.

The new work, published in the American Journal of Clinical Nutrition, parallels a study published in the same journal last year associating flavonoid-rich fruits with a reduced risk of high blood pressure.

According to the American Diabetes Association, approximately 26 million Americans have the disease. It's caused by a defect in the body's ability to produce or use insulin, a hormone that converts glucose in the blood into energy.

Type 2 diabetes can usually be controlled with exercise and diet changes and without insulin.

For the new U.S. National Institutes of Health-funded study, researchers tracked the dietary patterns of approximately 200,000 men and women for up to 24 years.

The participants, who were enrolled in three large ongoing studies of American health professionals, filled out regular questionnaires about how frequently they consumed certain foods and beverages of a standard portion size.

None had diabetes at the outset, but about 12,600 of the participants were diagnosed during the research period.

The lightest blueberry eaters in the study reported getting less than one serving (half a cup) of the fruit per month, while the biggest blueberry consumers had two or more servings per week.

Pan's team found that blueberry-lovers had a 23 percent lower risk of developing type 2 diabetes compared with those who ate no blueberries. People who ate five or more apples a week also had a 23 percent lower risk compared with those who didn't eat apples.

The researchers suggested that certain flavonoids especially high in those fruits might be behind their possibly beneficial effect on diabetes risk.

"We found consistent results across the three (study groups) that apples and blueberries are beneficial for type 2 diabetes," Pan told Reuters Health.

That was after taking into account other risk factors, such as body weight, cigarette smoking and a family history of diabetes.

These results jibe with an earlier Finnish report related to consumption of berries and apples and diabetes risk.

But these previous studies were much smaller in scope, Pan noted.

He and his colleagues reported no financial conflicts of interest.

While fruit sugar raises blood glucose levels rapidly, other substances in fruit such as fibers and pectin may have diabetes-related benefits, said Dr. Loren Greene, a professor of medicine at New York University who was not involved in the study.

"It argues very nicely for the consumption of whole fruits rather than fruit juices," she told Reuters Health, citing recent evidence that fruit juices may increase the risk of diabetes.

SOURCE: http://bit.ly/w4PAt8 American Journal of Clinical Nutrition, online February 22, 2012.

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