Friday, September 23, 2016

CAR Researcher Dreams of a Better Night's Sleep for Children With Autism, Their Families

Children and adolescents need a healthy sleep pattern to fully develop and to perform their best during the day, but – as many reading this know all to well- sleep difficulties plague as many as  50%-80% of children with autism spectrum disorder (ASD)- and by default, their parents! And the consequences overflow to nearly every aspect of waking life.

Research has shown that children and adolescents with ASD who sleep poorly are more likely to engage in problematic daytime behaviors than children who get enough sleep, and that sleep disturbance is connected to anxiety, heightened sensory responses, aggression and poorer health outcomes in kids with ASD.

CAR researcher and developmental pediatrician Amanda Bennet, MD, MPH, empathized with the parents she’d see in her office, whose children’s sleep troubles were taking a difficult toll on the family over extended periods of time. With support from the Autism Speaks Autism Treatment Network, Dr. Bennett and her team set out to conduct the first large-scale study to look at the prevalence of sleep problems and patterns of sleep medication use in children with ASD patients and their families.

The team collected data from more than 1500 children and their parents, and it revealed a significant “disconnect” between parents and clinicians. Parents reported sleep problems in 71% of the children, but clinicians only diagnosed 30% of the children with a sleep disorder, indicating that parents’ concerns about sleep may not be reflected in the information gathered during a clinical visit.

Of the 30% of children who were diagnosed with a sleep disorder by a doctor, a little less than half (46%) were prescribed at least one medication to support better sleep; but these children who took sleep medications had more troublesome behaviors during the day and poorer quality of life overall.

Given this evidence that sleep concerns are both common and associated with problematic daytime symptoms, it is important that primary care providers be vigilant to sleep concerns voiced by parents,” the researchers wrote in the study.  However, there are barriers to this discussion on both sides of the exam table. Parents may think that sleep problems are “just a part of autism” or might be focused on other “daytime” behavioral concerns that could be the result of poor sleep. On the other side, health care providers may not have received training to implement behavioral sleep interventions for children with ASD, and given a lack of other options, turn to recommending medication when faced with parent’s concerns over a challenging sleep problem.

The causes of sleep difficulties in children with ASD are often complex. They may be related to health conditions like epilepsy or gastroesophageal reflux, which are fairly common in children with ASD; or it may be that challenges unique to autism, like difficulty with transitions or with understanding parent expectations regarding sleep, exacerbate problems with sleep hygiene or pediatric insomnia. Although some children require medications for treatment, a behavioral intervention might be more appropriate for others.   

While the study findings will come as no surprise to families living through this first-hand, Bennett and her colleagues see this study as a starting point for improving support for families and improving screening tools and training for clinicians.

In the meantime, some factors that have been shown to improve quality of sleep include calming bedtime routines and relaxing bedtime environments. Sleep medications can have their benefits, but establishing a nightly routine can ease the anxiety and stress of sleep disturbances. Parents learning sleep education can also help their child develop nighttime routines that ease the difficulties of sleep. Visit the CAR Autism Roadmap ™ for more information and tips on improving sleep for children with ASD.

Thursday, September 22, 2016

CHOP, Drexel Join National Consortium Studying Baby Teeth for Clues to Environmental, Chemical Risks Associated With Autism

CAR's Director, Bob Schultz, PhD, will be the
site leader for 10-site study that will
look at 
the baby teeth of children to learn
exposure to certain chemicals in

the womb is linked to a higher risk for
autism spectrum disorder (ASD)

Two Philadelphia research centers are among 10 centers studying baby teeth of high-risk children to learn about risk factors in the womb

CAR is among 10 research centers nationwide contributing to a study that will use new technology to explore what baby teeth can reveal about children’s exposure to chemicals in the womb, and whether prenatal exposures can contribute to a child’s risk of developing autism spectrum disorder (ASD)-- estimated to affect one in 68 children in the US.
In this national consortium, the researchers will examine the chemical composition of lost baby teeth from infants who go on to develop autism, looking for trace amounts of chemicals that could affect genetic and brain functioning. This study will be the first large-scale effort to determine whether prenatal exposure to specific chemicals plays a role in putting a child at risk for autism. The study will involve infants with older siblings who were diagnosed with ASD, because these “baby sibs” have a 20-fold greater risk of developing autism than children in the general population.
Researchers suspect that one way chemical exposures might affect brain development is by interfering with normal gene function, so examining the interaction among these three factors is extremely important, and has been a limitation of autism research until very recently.
“By joining our existing baby siblings research program with this national consortium, we will be able to establish the largest sample of high-risk children to ever be evaluated for environmental exposures and gene and environment interactions,” said Robert Schultz, PhD, the lead investigator for the CHOP site and director of CAR. The study will have a grand total of 1,713 baby sibling participants and will be led by Drexel University. “This is a monumental endeavor that would not be possible without pooling efforts and collaborating with colleagues across the nation, including colleagues at the A.J. Drexel Autism Institute, with whom we have worked closely since we founded CAR in 2008.”
Chemicals being examined in the study include organochlorine pesticides—like DDT—and polychlorinated biphenyls (PCBs)—formerly used as an insulator for electrical materials. Although banned in the 1970s, these chemicals remain in the environment and human exposure continues. The study will also consider phthalates, a chemical used to make plastics more flexible.
The consortium hopes the study’s findings will advance the understanding of the underlying mechanisms of autism, a crucial and notoriously complex question. Once these mechanisms are better understood, more targeted and effective prevention and treatment strategies can be developed.
“This study represents the best of cutting-edge research, as it focuses on the earliest stages of brain development, the interaction between different potential causes, and involves a large scale collaboration involving thousands of participants,” said Schultz. "This large sample size is critical for a deep understanding of autism, because it is inherently heterogeneous in its causes and clinical manifestations. In order to see patterns emerge, we need to be able to research a very large group of people. This kind of research is what will ultimately help us to discover autism’s causes and develop more effective treatment and prevention strategies.”
For at least the next two years, co-investigators at 10 institutions will be funded as a part of the Environmental Influences on Child Health Outcomes (ECHO) Initiative--a $157 million NIH program devoted to understanding how early exposure to environmental factors influences the health of children and adolescents.The collaborative team is composed of some of the world’s foremost autism experts across 10 institutions, with Drexel University as the lead Center:
• Manish Arora, PhD, Icahn School of Medicine at Mount Sinai
• Kelly Botterton, MD, Washington University in St. Louis
• Lisa Croen, PhD, Kaiser Permanente Division of Research
• Stephen Dager, MD, and Wendy Stone, PhD, University of Washington
• M. Danielle Fallin, PhD and Heather Volk, PhD, Johns Hopkins University
• Rebecca Landa, PhD, Kennedy Krieger Institute
• Daniel Messinger, PhD, University of Miami
• Craig Newschaffer, PhD, A.J. Drexel Autism Institute of Drexel University
• Joseph Piven, MD, and Heather Cody Hazlett, PhD, University of North Carolina at Chapel Hill
• Rebecca Schmidt, PhD, and Sally Ozonoff, PhD, University of California, Davis
• Robert Schultz, PhD, Children’s Hospital of Philadelphia and University of Pennsylvania
Learn more about this new study in the CHOP press release and the Drexel blog post.