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 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.
Read more here
What are the standards of care for managing neurologic problems and spasticity in cerebral palsy? What is the data? Its more than baclofen...
Systematic Review of Interventions fo Cerebral Palsy - AACPDM
I wrote this article a few years ago. Dr. Rotenberg
Guidance regarding temporary absence for children with disabilities - from the Texas educational code.
Custom sequencing test for my patients with autism
Exciting news..I just developed a custom made genetic sequencing test for autism.
Sadly, there are so many kids who have not been tested.
The AAN has issued updated recommendations for treating first seizure in adults. Adults still need an EEG and brain imaging. JR
Adults presenting with an unprovoked first seizure should be informed that the chance for a recurrent seizure is greatest within the first 2 years after a first seizure (21%–45%) (Level A).
Clinicians should also advise such patients that clinical factors associated with an increased risk of seizure recurrence include a prior brain insult such as a stroke or trauma (Level A), an EEG with epileptiform abnormalities (Level A), a significant brain-imaging abnormality (Level B), or a nocturnal seizure (Level B).
Clinicians should advise patients that, although immediate AED therapy, as compared with delay of treatment pending a second seizure, is likely to reduce the risk of a seizure recurrence in the 2 years subsequent to a first seizure (Level B), it may not improve QOL (Level C).
Clinicians should advise patients that over the longer term (>3 years), immediate AED treatment is unlikely to improve the prognosis for sustained seizure remission (Level B).
Patients should be advised that their risk for AED AEs ranges from 7% to 31% (Level B) and that these AEs are predominantly mild and reversible.
Full text here
From a neurology perspective it makes sense that idiopathic dypraxia, DCD has either a cerebellar or perhaps cortical localization.
Why do people ask the question if its neurologic or not? What else is it? Renal? Dermatologic?
The borderland between dyspraxia and mild ataxia is subjective. ..I think. JR
Dyspraxia or developmental coordination disorder? Unravelling the enigmaJ
John Gibbs, Jeanette Appleton, and Richard Appleton
Author information ► Article notes ► Copyright and License information ►
Dyspraxia has been defined as “a breakdown of praxis [action]” and “the inability to utilise voluntary motor abilities effectively in all aspects of life from play to structured skilled tasks” (Chu S and Milloy NR cited in Bowens and Smith).1 An alternative, psychology‐based definition is “motor difficulties caused by perceptual problems, especially visual‐motor and kinaesthetic motor difficulties”.2 Within the medical and scientific communities dyspraxia is generally considered to mean an impairment of, or difficulties with, the organisation, planning and execution of physical movement with a developmental rather than acquired origin. Most individuals with dyspraxia manifest a combination of both ideational or planning dyspraxia and ideomotor or executive dyspraxia; ideational or planning dyspraxia affects the planning and coordination, and ideomotor or executive dyspraxia affects the fluency and speed of motor activities.
Box 1 Neurological disorders initially diagnosed as “DCD/dyspraxia”Peripheral neuromuscular conditions
Central nervous system conditions
Mixed peripheral and central nervous system conditions
Dr. Rotenberg and Staff add articles and news of interest here. Our goal is for this page to be an educational resource for families and patients.
Serving The Greater Houston and Central Texas Area.
-- Katy Bellaire Kingwood The Woodlands Sugar Land Pearland Rosenberg Cypress Beaumont Galveston College Station Seguin Sealy Victoria Beaumont