Federal Circuit Rules No Link between Autism and Vaccine

From The Blog of Legal Times:

The U.S. Court of Appeals for the Federal Circuit has just upheld lower court findings that reject a causal connection between childhood vaccines and the onset of autism.

The ruling came in Cedillo v. Secretary of Health and Human Services, which was the first of a series of test cases heard by special masters for the U.S. Court of Federal Claims in 2007. The claims court picked several such cases to test different theories of causation advanced in the roughly 5,000 cases alleging a link to autism filed under the National Childhood Vaccine Injury Act of 1986.

Read more on The BLT.

Murder or an Accident? The Brain Knows

Tim Wogan reports on the Science web site about some research investigating the role of the right temporoparietal junction (RTPJ) in forming judgments about others’ intentions and actions.  The research has special implications for those with Asperger’s or on the autism spectrum:

…. social neuroscientist Liane Young of the Massachusetts Institute of Technology in Cambridge and colleagues decided to turn off the right temporoparietal junction and see whether people would make different judgments of others’ actions. They achieved this using transcranial magnetic stimulation (TMS), a technology that uses a tightly focused magnetic field to temporarily disable individual regions of the brain.

The researchers aimed the device either at the RTPJ or at a nearby region of the brain not thought to be involved in cognitive processing. Subjects between the ages of 18 and 30 read stories containing a series of hypothetical scenarios on a computer screen. In some, person A accidentally killed person B; in others, person A intended to kill person B but failed. Subjects were asked to rate from one to seven how excusable they found person A’s conduct from “not at all” to “completely.” The subjects considered some scenarios with their temporoparietal junction turned off and other scenarios with the area functioning as normal.

In both cases, volunteers judged unsuccessful attempts at murder to be more egregious than cases of accidental killing. However, subjects were significantly more forgiving of attempted murder when their right temporoparietal junctions were knocked out by TMS than when they were functioning normally, the team reports online today in the Proceedings of the National Academy of Sciences. The findings imply that activity in the region is required for us to properly judge another person’s motives, say the researchers.

Can oxytocin help social skills in individuals with autism?

Two studies out this month and next suggest that oxytocin inhalation may be of benefit.   Here are the abstracts:

 Andari E, Duhamel JR, Zalla T, Herbrecht E, Leboyer M, Sirigu A: Promoting social behavior with oxytocin in high-functioning autism spectrum disorders. Proc Natl Acad Sci U S A. 2010 Mar 2;107(9):4389-94.

Social adaptation requires specific cognitive and emotional competences. Individuals with high-functioning autism or with Asperger syndrome cannot understand or engage in social situations despite preserved intellectual abilities. Recently, it has been suggested that oxytocin, a hormone known to promote mother-infant bonds, may be implicated in the social deficit of autism. We investigated the behavioral effects of oxytocin in 13 subjects with autism. In a simulated ball game where participants interacted with fictitious partners, we found that after oxytocin inhalation, patients exhibited stronger interactions with the most socially cooperative partner and reported enhanced feelings of trust and preference. Also, during free viewing of pictures of faces, oxytocin selectively increased patients’ gazing time on the socially informative region of the face, namely the eyes. Thus, under oxytocin, patients respond more strongly to others and exhibit more appropriate social behavior and affect, suggesting a therapeutic potential of oxytocin through its action on a core dimension of autism.

Guastella AJ, Einfeld SL, Gray KM, Rinehart NJ, Tonge BJ, Lambert TJ, Hickie IB: Intranasal oxytocin improves emotion recognition for youth with autism spectrum disorders. Biol Psychiatry. 2010 Apr 1;67(7):692-4.

BACKGROUND: A diagnostic hallmark of autism spectrum disorders is a qualitative impairment in social communication and interaction. Deficits in the ability to recognize the emotions of others are believed to contribute to this. There is currently no effective treatment for these problems. METHODS: In a double-blind, randomized, placebo-controlled, crossover design, we administered oxytocin nasal spray (18 or 24 IU) or a placebo to 16 male youth aged 12 to 19 who were diagnosed with Autistic or Asperger’s Disorder. Participants then completed the Reading the Mind in the Eyes Task, a widely used and reliable test of emotion recognition. RESULTS: In comparison with placebo, oxytocin administration improved performance on the Reading the Mind in the Eyes Task. This effect was also shown when analysis was restricted to the younger participants aged 12 to 15 who received the lower dose. CONCLUSIONS: This study provides the first evidence that oxytocin nasal spray improves emotion recognition in young people diagnosed with autism spectrum disorders. Findings suggest the potential of earlier intervention and further evaluation of oxytocin nasal spray as a treatment to improve social communication and interaction in young people with autism spectrum disorders. Copyright 2010 Society of Biological Psychiatry.

This is not the first time that oxytocin has been suggested as a possible treatment for autism-related social skills deficits. The first suggestion was in 1992, and there have been almost 100 articles and reports since then discussing the possibility. While the results are encouraging, I do not mention the studies here as a suggestion that parents run out and start this treatment for their children. But if you’d like to know more or perhaps participate in clinical trials, see the federal government’s site for studies that are recruiting participants.

Will DSM-5 Contain Or Worsen The “Epidemic” Of Autism?

Allen Frances, M.D. has been an outspoken critic of the DSM-5 process and draft proposal.   In Psychology Today, he blogs about the proposed changes to Autism Spectrum Disorder, a topic I have blogged about here and here.   Dr. Frances writes, in part:

There has been an "epidemic" of autism in the last fifteen years. This used to be a very rare condition diagnosed less than once in every two thousand kids. Now it is diagnosed once in a hundred. We will elsewhere take up the foolish theory that this was cause by vaccination. Here we will trace the real causes.

People change slowly, if at all. In contrast, fads in psychiatric diagnosis can come and go in a fast and furious fashion. The autism fad resulted from changes in DSM4 (published in 1994) interacting with a strong societal push.

There were two DSM4 contributions:1) the inclusion of a surprisingly popular new diagnosis, Asperger’s Disorder; and, 2) much less importantly, editorial revisions meant only to clarify the criteria for Autistic Disorder, but which may have inadvertently lowered the threshold for its diagnosis.

[...]

The DSM5 proposal is highly controversial both within the professional community and among the advocacy groups- with strong supporters and equally strong critics and probably about an equal weight of argument on both sides. When it comes to labelling, the heat of the argument is often a direct reflection that there are no clear right answers. The major point is to ensure that DSM5 not provoke a further misleading "epidemic" of autism. The criteria set should retain and enhance items that will reduce the risk of false positive diagnosis. Proposed changes and alternative wordings need careful field testing in nonspecialist settings to determine their likely future impact on rates. Even small wording changes can have a profound impact on who is, and who is not, diagnosed.

Ultimately, there will not ever be a clear right verdict on the DSM5 proposal to unify autistic disorders within one rubric. The scientific evidence is not overwhelming either way and is subject to different plausible interpretations. The stigma question cuts both ways. The services issues will have to be dealt with whether there is one diagnosis or two.

Read more of his commentary here.

Bus safety: school aide accused of beating up student

WSB-TV in Georgia has a story on their web site today about how a surveillance camera on a special education school bus in Fulton County enabled school authorities to determine that a bus aide had grabbed an autistic 10-year old and put him in a head-lock.  The aide subsequently told the student’s mother that she had intervened after the child had allegedly been involved in an altercation with another student on the special education bus.

"Restraining does not come by restraining someone by the face," said the child’s mother.

"Protocols are in place and they were not followed. Immediately upon learning about this situation from the parent we launched an investigation. Based on our findings, we made the decision to terminate the bus employees and file criminal charges," Fulton County School official Allison Toller said in a statement to Channel 2 Action News.

The aide faces battery charges.

Read more

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