The
information in this column is intended for informational
purposes only, and does not constitute medical advice or
recommendations by the author. Please consult with your
physician before making any lifestyle or medication changes, or if you
have any other concerns regarding your health.
EARLY
CHILDHOOD SCREENING
PREDICTS LATER BEHAVIORAL PROBLEMS
Significant
emotional or behavioral problems are often not detected until affected
children
begin school. Moreover,
even in
moderately severe cases, children with emotional and behavioral
problems may
not receive appropriate screening and intervention until they have been
in
school for several years. Researchers
from the University
of Connecticut
and the University
of Massachusetts
have just published the results of an interesting study, in the journal
Pediatrics, in which they screened
children for behavioral and psychological problems at a very early age,
and
then followed them as they subsequently entered elementary school.
A
total of 1,004
socio-economically and ethnically diverse children were evaluated in
this
study. The
children’s parents completed
a standardized Brief Infant-Toddler Social and Emotional Assessment
survey when
their children were between 12 and 36 months of age (the average age of
the
children participating in this research study was 24 months). These children were again
evaluated once they
entered elementary school, at an average age of 6 years. Both parents and the
children’s teachers
participated in this latter evaluation of social and behavioral
problems in
this large group of children.
Among
those
infants and toddlers with evidence of social, developmental and
emotional
problems detected upon their initial evaluation, 49% were reported,
when these
children subsequently began elementary school, to have significant
behavioral
and social difficulties in class, based upon their teachers’
evaluations. The
initial Brief Infant-Toddler Social and
Emotional Assessment and Evaluation survey also predicted which babies
and
toddlers would later develop significant criteria for psychiatric
disorders. Among
those infants and
toddlers who had evidence of developmental or behavioral difficulties
on their
initial survey, more than two-thirds (68%) were found to meet the
criteria
listed for specific psychiatric disorders after reaching elementary
school.
As
a disclaimer,
I will mention that the disciplines of Psychiatry and Psychology are
rather unique
among the clinical sciences in that it is very difficult (if not
impossible) to
obtain completely objective research data in clinical research studies
such as
this one. Human
behavior is extremely
complex, variable, and unpredictable.
Thus, unlike research studies that randomize different
groups of
patients to receive different medical therapies, or studies that
involve
laboratory experiments, clinical psychiatric and psychological research
studies
cannot completely control all of the experimental factors that might
skew
either the resulting data, or, for that matter, its interpretation. Therefore, I generally do
not include such
studies in my column. In
this case,
however, I chose to include this particular study, because I believe
that it
may be helpful for some parents (and teachers) to know about its
findings.
While
I absolutely
do not advocate performing routine psychiatric testing on children who
do not
have any evidence of significant behavioral or psychiatric problems,
the
results of this study suggest that it may be possible to pick up
evidence of
significant behavioral or/and psychological problems in the majority of
“at
risk” children long before they begin their school years. While not every child with
“abnormal” scores
on the Infant-Toddler evaluation survey ultimately experienced
psychiatric
illnesses by the time they reached elementary school, in this study,
more than
two-thirds of such children were, in fact, subsequently diagnosed with
a
psychiatric disorder after starting elementary school.
Perhaps,
if
identified during late infancy or while still a toddler, children who
are at
high risk of developing significant emotional or psychiatric illnesses
might be
able to undergo more intensive early screening and, if appropriate,
begin
therapy before they start attending school. If effective therapy is
available prior to
beginning elementary school for any significant emotional or
psychiatric
illnesses that are identified early, then these children might have a
much more
positive and successful experience at school in their later years.
PSYCHIATRIC
DISORDERS
AMONG PARENTS OF AUTISTIC CHILDREN
The incidence of
autism in the United States
has been, inexplicably and dramatically, rising in recent years. According to the Autism
Society of America,
autism is currently diagnosed in 1 of every 150 children born, and
approximately 1.5 million people in the US
are thought to have an autistic
disorder. Currently,
the care of
autistic patients is thought to cost around $90 billion per year, and
some
experts predict that this cost will rise to $200 billion dollars, or
more,
within the next 10 years. There
is also
evidence, from the London School of Economics, that the early diagnosis
and
treatment of autism can reduce the lifetime cost of caring for such
patients by
as much as two-thirds (in most cases, the difficulties in communication
and
social interactions that are the hallmarks of autism can usually be
detected
within the first 3 years of life).
There
is a great
deal of debate about the potential causes of autistic disorders. Recent studies have shown
that at least some
cases of autism do appear to be linked to specific gene mutations,
suggesting
that some cases of autism are very likely a result of inheritance. There has also been a
tremendous controversy
regarding autism and its link, if any, with childhood vaccinations (and
the
mumps, measles and rubella, or MMR, vaccine, in particular). However, multiple rigorous
clinical research
studies have, so far, failed to find any link between the development
of autism
and vaccinations. In
most cases, autism
is diagnosed during the same age range as when children are beginning
to
receive their immunizations, and many public health experts have
suggested that
this factor is the most likely explanation for the apparent onset of
the
symptoms of autism following vaccinations.
A
new Swedish
study, also just published in the journal Pediatrics,
takes a look at the incidence of psychiatric illnesses in the parents
of
children who have been diagnosed with an autistic disorder. As is the case in most of
Scandinavia, and in
much of Europe,
essentially the entire
population has access to universal healthcare provided by the federal
government and its contractors. It
is
for this reason that huge numbers of patients can be followed in
clinical
research studies in such countries, as a wide range of clinical data is
routinely entered into central public health databases, even in
countries with
relatively small populations.
This
particular
study was the result of collaboration between researchers from Sweden’s famed
Karolinska Institute, the University
of North Carolina
at Chapel Hill, and the Mount Sinai School of Medicine here in New York.
Using the Swedish
Medical Birth Register and
the Swedish Multi-Generation Register, and other centralized public
health
databases, the researchers identified 1,227 children born between 1977
and 2003
who were subsequently treated for an autistic disorder.
For comparison purposes, more than 30,000
other children born during the same interval, but without any history
of
autism, were also included in this research study.
The researchers were then able to further
assess this public health data to determine the incidence of treatment
for
psychiatric disorders among the parents of both groups of children born
between
1977 and 2003 (editorializing for a moment here, and needless to say,
conducting a study like this is never likely to be approved here in the
United
States).
In
this study,
the incidence of mental health disorders among the parents of autistic
children
was found to be significantly greater than what was observed among the
parents
of the much larger “control” group of parents of non-autistic children. Specifically,
schizophrenia was found to be
more common in both mothers and fathers of autistic children, while
depression
and personality disorders were found to be more common among mothers of
autistic kids, only.
While
the results
of this study, as with previous studies, suggests that at least some
cases of
autism might be inherited (and might be associated with other
psychiatric
disorders that are also thought to be heritable), one must be very
careful in
drawing conclusions from this data.
Certainly, caring for a child with autism, or other
serious mental or
physical illnesses, is a tremendously taxing and stressful undertaking. I can easily imagine that
parents who are
faced with, potentially, the lifelong care of a severely disabled child
could
rather easily succumb to the stresses of such demands by developing
emotional
or psychiatric illnesses themselves.
Unfortunately,
this study, which was based solely on confidential public health
records in Sweden,
cannot
tell us very much about the details of mental illness among parents of
autistic
children. Also, as
I have already
mentioned, virtually all clinical studies involving psychiatric testing
and
evaluation are associated with a significant likelihood of subjectivity
and
bias, due to the inherent complexity of assessing human behavior and
personality. All of
these disclaimers
aside, this study still suggests that at least some significant
percentage of
autism cases may be linked to specific genetic factors which, in turn,
may also
be associated with other psychiatric illnesses within families. The recent identification
of specific gene
mutations associated with at least some cases of autism also suggest
that many
(but not all) cases of autism are likely to be the result, at least in
part, of
specific and potentially heritable genetic factors.
SOCIAL
& PSYCHIATRIC
PROFILES OF YOUNG ADULTS BORN PREMATURELY
As
neonatal
intensive care units have become increasingly sophisticated in caring
for
extremely premature babies, more and more of these tiny infants are
surviving
into adulthood. There
have been numerous
clinical research studies published about this group of patients, with
some
studies finding a significant increase in the incidence of lifelong
physical
and mental health difficulties among those who were very premature at
birth. As is often
the case with public
health research, there have also been quite a few studies published
that have suggested
that most people who were born prematurely do just fine if they survive
into
adulthood.
A
new Dutch study
in the Journal of Pediatrics, which
was part of a larger ongoing study of children and adults born
prematurely,
evaluated 656 healthy adolescents who were born very prematurely, and
compared
them with their same-age peers with respect to general lifestyle,
risk-taking
behaviors, the presence of psychiatric disorders, and social
interactions.
Interestingly,
both the teenage boys and teenage girls who had been born prematurely
were less likely to smoke than
their peers
who had been born after a full-term pregnancy.
The teenage boys born prematurely were also less likely to
drink alcohol
than their full-term counterparts, while the adolescent girls who were
born
prematurely consumed alcohol as often as the girls who were born at
full-term. Lifetime
illicit drug use was
also significantly less common among the teens (boys and girls) who
were born
prematurely, when compared to their full-term birth peers. With the notable exception
of using public
transportation without paying the fare… the adolescents born
prematurely were
far less likely to be involved in criminal activity than the kids who
born at
full-term. Although
the boys born
prematurely appeared to experience greater difficulty in establishing
relationships than their full-term peers, on the whole, the incidence
of
psychiatric disorders did not differ significantly between the two
groups of
adolescent boys and girls.
Healthy
adolescents
who were born “very pre-term,” or at a “very low birth-weight,” like
those who were
included in this study, represent a very select subgroup of young
adults who have
managed to grow and thrive, and to achieve excellent overall health,
despite severe
prematurity at birth. In
this particular
subgroup of young adults born very prematurely, risk-taking behavior
appeared
to be less common than was observed in the general population. At the same time,
increased difficulties with
initiating new relationships appeared to be more common among the teens
who
were born prematurely, especially among the boys.
While the explanations for these differences
in social behavior between the two groups of teens is not unclear, they
are
nonetheless intriguing and worthy of further study.
Disclaimer:
As always, my advice to readers is to seek the advice of your physician
before making any significant changes in
medications, diet, or level of physical activity.
