Questionnaire May Help Predict Autism at 1 Year

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By Amanda Gardner

THURSDAY, April 28, 2011 ( — A quick and simple questionnaire given to parents during a regular checkup in a pediatrician’s office may help detect autism in children as young as 1 year old, a new study suggests.

The 24-item questionnaire, which assesses a child’s ability to communicate with eye contact, sounds, and gestures, may steer infants who show early signs of autism spectrum disorders (ASDs) into appropriate treatment at earlier ages, the researchers say.

Identifying language and developmental delays in babies may also help scientists uncover the underlying neurological processes of autism, paving the way for more effective treatments, says Karen Pierce, Ph.D., the lead author of the study.

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“Most of the studies on autism are on adolescents and adults,” says Pierce, an assistant professor of neuroscience at the University of California San Diego (UCSD), in La Jolla. “Some [are] on children, but very few people have the ability to study autism in babies, because we can’t diagnose it until 3 or 4 years. How in the world are we going to discover the causes if we’re studying brains that have had a lifetime of living with autism, and [have] a host of compensatory mechanisms?”

The average age of ASD diagnosis is around 5 years old, though most of those children show signs of developmental problems before age 3, according to the Centers for Disease Control and Prevention. There are no biomarkers to indicate that a child has autism, so clinicians have to rely on behavioral clues, making diagnosis tricky. And even when a child is accurately diagnosed early, he or she often doesn’t start treatment until some time after the diagnosis.

The questionnaire used in the study is a simple checklist that asks parents to say whether their baby displays certain types of communication “often,” “sometimes,” or “not yet.” It takes just five minutes to fill out and can be scored on the spot.

The checklist does not zero in specifically on autism but “will tell you something is wrong,” Pierce says. That could be the early signs of autism or another type of language or developmental delay.

Next page: More than 10,000 children screened

In the study, which appears in the Journal of Pediatrics, 137 pediatricians in the San Diego area screened more than 10,000 children who were undergoing their one-year checkup. Of those, 184 were determined to be below the appropriate levels of development for their age, and were referred to UCSD’s Autism Center of Excellence for further evaluation.

Doctors examined them every six months until they were 3 years old. So far, 32 children have been definitely or provisionally diagnosed with an autism spectrum disorder, 56 with a learning disorder, and nine with another disorder.

Based on these findings, the researchers estimate that 20% of children flagged by the checklist at 12 months will go on to develop autism and 55% will develop a learning or developmental disorder. Twenty-five percent will get a false-positive result, they say, giving the questionnaire a high accuracy rate of 75%.

Five children in this study sample who were initially diagnosed with ASD were later determined not to have an autism disorder. And, as hoped, the children who were assigned a diagnosis of autism or a learning or developmental delay started treatment at an average age of 19 months.

In theory, earlier treatment might influence how connections between neurons are being made in the brain, greatly influencing a child’s emotional and social development, Pierce says.

But that remains an open question, says Keith A. Young, PhD, vice chairman for research in the department of psychiatry and behavioral science at the Texas A&M Health Science Center College of Medicine, in Temple.

“At this point in time, there are no validated treatments at that young of an age,” Young says. “There are various treatments that have been tested in older kids, but do they work in younger kids? How do we need to adapt them? All of that stuff needs to be done before we go out and say, ‘OK, there needs to be screening.'”


A teen with autism who has a thing for vacuums recently had a dream come true: a vacuum salesperson gave a demo at his birthday party, then told him the vacuum was his to keep, and it moved the room to tears. The story’s winning hearts around the country, and has special meaning for parents like me who have children with special needs.

Dylan Johnson has loved vacuum cleaners since he was two years old, reports WTVR. Kirby vacuums, in particular. As his 14th birthday approached, his mom, Jodie Green, emailed the Kirby Company. “I am reaching out to you in hopes for an answer to an unusual request for my son who is autistic,” she wrote. “He has always been obsessed with vacuum cleaners. His favorite is the Kirby. He spends hours every day watching videos on his tablet about different Kirbys. When he isn’t watching videos about them, he is talking about them. I really would LOVE to get a demo done for him for his birthday. In fact, I am even getting him a cake made that looks like a Kirby vacuum. I am writing to you in hopes that you can get me in touch with a way to get him this demo.”

What happened next is web history: Kirby sent salesperson Al Archie to do a vacuum demonstration at Dylan’s party. “He knew more about the Kirby that I did,” said Archie, who’s been selling Kirbys for 25 years. “I have never experienced anything like that.”

Oh, but I have, along with parents of kids with autism and other special needs. My 12-year-old, Max, has cerebral palsy. He has cognitive differences as a result of his condition, and over the years he’s had various obsessions including the color purple, car washes, spaghetti, and currently, fire trucks. Max could easily show anyone all the parts of a fire engine, and also does an impressive imitation of a siren. For Max’s recent birthday party, a local fire truck showed up at our house and escorted him to his party.

So, yes, I know what it’s like to want to satisfy the interests of a child with a disability. For any parent, it’s part of your general job description: Make your child happy. But like Dylan’s mom, I also know that it takes a village—including firefighters and vacuum salespeople.

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Introducing Julia: Sesame Street's New Character With Autism


For years, Sesame Street has educated children not only about academics, but also important life lessons. This week was no exception when they unveiled their newest character: Julia.

In a statement to ABC News, the Sesame Street Workshop described Julia as a “preschool girl with autism who does things a little differently when playing with her friends, the lovable Elmo, Abby Cadabby, and Grover.”

Julia joins her pals in a series of online storybooks, videos and interactive games— all part of Sesame Street’s campaign called Sesame Street and Autism: See Amazing in All Children, an initiative to fight the stigma surrounding the disorder.

“Children with autism are five times more likely to get bullied,” Jeanette Betancourt, Ed.D., senior vice president of social impact for Sesame Street, explained to People. “And with one in 68 children having autism, that’s a lot of bullying. Our goal is to bring forth what all children share in common, not their differences.”

RELATED: How My Son’s Autism Changed Everything

The U.S. Centers for Disease Control and Prevention (CDC) reports diagnoses have been on a steady rise over the past decade, which may be due to better reporting. Yet, according to the Sesame Street website: “While the diagnosis is common, public understanding of autism is not.”

That’s where characters like Julia have a lot to teach both children and parents.

For example, in one of the online story books, Elmo says to his friend Abby: “Elmo’s daddy told Elmo that Julia has autism. So she does things a little differently.” While maintaining a tone of acceptance and compassion, Elmo explains that at times he talks to Julia using fewer words and says the same thing a few times.

“This is what makes our project so unique,” Betancourt told People. “When we explain from a child’s point of view that there are certain behaviors, such as slapping their hands or making noises, to express excitement or unhappiness, it helps younger children to understand how to interact with their autistic peers. It makes children more comfortable and therefore more inclusive.”

RELATED: How ADHD is Different in Boys and Girls

But Sesame Street’s initiative isn’t limited to awareness-raising stories. They also offer a free app with routine cards to make day-to-day life easier for families with autistic children along with resources for care providers and helpful organizations they can turn to. Plus, the educational efforts of the campaign may even help parents realize their child is living with autism, and consequently take steps to help improve his or her quality of life.

To top it off, the campaign created a video called “The Amazing Song” which features Elmo, Abby Cadabby, and a group of autistic children. This heartwarming campaign gives hope that future generations of children will respect rather than bring down each other for their differences.

“We are trying to spread the story about the theory behind this whole thing: love and acceptance,” Betancourt explained. “Everyone is touched by autism, and by creating Julia, Sesame is bringing children together.”

RELATED: How My Son’s Autism Changed Everything

A 24

This summer, Women’s Running magazine made headlines for their decision to feature plus-sized model Erica Jean Schenk on their August cover. The magazine is once again proving that runners aren’t a one-size-fits-all group by making Kiley Lyall, a 24-year-old runner with autism, their January/February cover star.

As a two-time marathoner who raises money for her local hospital and the Make-a-Wish Foundation, Lyall’s entry stood out from more than 4,000 submissions in the magazine’s annual Cover Runner Contest. She’s now the first runner with autism to appear on the cover of a national fitness magazine.

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Lyall’s mother Kathleen urged her daughter to enter the contest, telling People that she hoped her daughter’s entry would inspire others to take up running. “Kiley’s been running for many years now, and people on the outside keep telling her how inspirational she is, and how she motivates them to want to run with all the struggles she goes through,” she said. “One of my friends said this would be a really cool thing to enter because Kiley makes them want to run. But we never thought anything would come of it.”

In her submission, Lyall, who along with moderate autism lives with epilepsy and cerebral palsy, said that running has made a huge impact on her life. “[It’s] literally helped my brain become healthier,” she said to Women’s Running. “My autism doesn’t take over my days anymore…when I run it relieves so much stress on my brain, allowing me to function much better through most days!”

Along with her cover, Lyall will receive a new running wardrobe and entries to three Rock ‘n’ Roll Marathon races in 2016. Congratulations, Lyall, for being an inspiration to runners everywhere!

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Polycystic Ovarian Syndrome in Mom Linked to Autism Risk in Child

TUESDAY, Dec. 8, 2015 (HealthDay News) — Children of mothers with polycystic ovarian syndrome (PCOS) may have an increased risk for autism, new research from Sweden suggests.

This study is the first to find such a link, the researchers said. And, they added, the findings support the theory that exposure to sex hormones early in life may play an important role in a child’s risk of autism.

PCOS is a disorder in which a hormonal imbalance can cause changes in the menstrual cycle, ovarian cysts, trouble getting pregnant and other health problems. It affects 5 percent to 15 percent of women of childbearing age, the study authors said.

“We found that a maternal diagnosis of PCOS increased the risk of autism spectrum disorder in the offspring by 59 percent,” lead researcher Kyriaki Kosidou, of the department of public health sciences at the Karolinska Institute in Stockholm, said in an institute news release.

However, the study only shows an association between PCOS and autism in offspring. It wasn’t designed to prove a cause-and-effect relationship.

The investigators identified about 24,000 children with an autism spectrum disorder born in Sweden between 1984 and 2007. The researchers then compared them to 200,000 children without the developmental disorder.

“The risk [of autism] was further increased among mothers with both PCOS and obesity, a condition common to PCOS that is related to more severely increased androgens,” Kosidou explained.

Androgens are sex hormones responsible for the development of male characteristics. These hormones also play a role in the development of the brain and central nervous system, the researchers said. Women with PCOS have higher levels of androgens, even during pregnancy, according to background information in the news release.

The study was published online Dec. 8 in the journal Molecular Psychiatry.

“It is too early to make specific recommendations to clinicians in terms of care for pregnant women with PCOS, though increased awareness of this relationship might facilitate earlier detection of [autism] in children whose mothers have been diagnosed with PCOS,” study senior author Renee Gardner, of the department of public health sciences at the Karolinska Institute, said in the news release.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about autism.

Does Too Much Folic Acid in Pregnancy Increase Autism Risk?

By Dennis ThompsonHealthDay Reporter

WEDNESDAY, May 11, 2016 (HealthDay News) — Pregnant women are encouraged to get plenty of folic acid in their diet or through vitamin supplements, to protect their babies against birth defects of the brain and spinal cord.

But a new study suggests that excessive amounts of folate (vitamin B9) and vitamin B12 in a mother’s body might increase a baby’s risk of developing an autism spectrum disorder.

“The new research question before us is to understand the optimal dose,” said co-researcher Daniele Fallin. She is a professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“Some [folate] is a good thing. It does appear the levels in the body could get too high, and that would be a bad thing,” she said.

“Supplementation is indeed an important thing,” Fallin added. “We would not want anyone to interpret from this that they should stop taking vitamin supplements if they are intending to get pregnant or if they are pregnant.”

In the study, mothers who had very high blood levels of folate at delivery were twice as likely to have a child with autism compared to mothers with normal folate levels.

Researchers also found that mothers with excessive B12 levels were three times as likely to have a child with autism.

The risk was greatest among mothers who had excess levels of both folate and B12—their risk was over 17 times that of a mother with normal levels of both nutrients, the investigators reported. However, the study only found an association and could not prove that high levels caused an increased risk of autism.

The study findings are scheduled for presentation Friday at the International Meeting for Autism Research in Baltimore.

Folate is found naturally in fruits and vegetables, while the synthetic version, folic acid, is used to fortify cereals and breads in the United States, and in vitamin supplements.

However, expecting mothers shouldn’t toss away their supplements, the researchers stressed.

The study also found that women who took folate and B12 supplements three to five times a week were less likely overall to have a child with autism, particularly when they’re taken during the first and second trimesters, Fallin said.

The March of Dimes, the American College of Obstetricians and Gynecologists and other medical associations recommend that pregnant women consume folic acid to prevent neural tube defects, which happen in about 3,000 pregnancies each year in the United States. Spina bifida is the most common of this type of birth defect.

And recent studies have also indicated that folate and vitamin B12 might protect a developing fetus against future autism, Fallin said.

To investigate this effect, Fallin and her colleagues analyzed data from almost 1,400 mother-child pairs in the Boston Birth Cohort, a predominantly low-income minority population.

The mothers were recruited at the time of their children’s birth between 1998 and 2013, and followed for several years. The study included a check of the mothers’ blood folate levels within three days of delivery.

The researchers found that one in 10 of the women had what is considered an excess amount of folate, while 6 percent had an excess amount of vitamin B12.

“We saw those women who had extremely high, much higher than the recommended amount, of folate or vitamin B12 were more likely to have children who later had a diagnosis of autism,” Fallin said.

Fallin and her colleagues could not say from their data why certain women had excessive levels of folate or B12 in their systems around the time of delivery, although many said they took vitamin supplements during their pregnancy.

It could be that some women are genetically predisposed to high levels of folate and B12 in their bodies, or they might be getting too much of the nutrient through diet or supplements, she said.

Women should talk with their obstetrician about their diet and supplements, and how those might be affecting their blood levels of folate and B12, Fallin said.

Dr. Paul Wang, senior vice president of medical research for Autism Speaks, agreed that “it’s just too early to say” what this study means, particularly because it hasn’t yet appeared in a peer-reviewed medical journal.

“We need to see the full study,” Wang said. “We need to look at all of the data they have.”

Wang noted that the study does show a protective benefit against autism for folic acid and vitamin B12 in women taking supplements three to five times a week.

“What we’ve always believed to be true remains true, that supplements decrease the risk of autism,” Wang said. “The bottom line still is that taking the recommended vitamins is overall decreasing your child’s risk.”

More information

For more on folic acid, visit the March of Dimes.

Despite Being Banned, Lingering PCB Chemicals Still Linked to Autism

TUESDAY, Aug. 23, 2016 (HealthDay News) — Children exposed to relatively high levels of PCBs in the womb may have an increased risk of developing autism, a new study suggests.

PCBs, or polychlorinated biphenyls, are man-made chemicals once used in a wide range of products, from electrical appliances to fluorescent lighting.

Use of these chemicals was banned in the 1970s because of concerns about their health effects. But since they do not easily break down, PCBs still linger in the environment—and in people.

In the new study, researchers found that when pregnant women had relatively high levels of certain PCBs in their blood, their children were about 80 percent more likely to be diagnosed with autism versus other kids.

Those children also had a roughly twofold higher risk of intellectual disabilities unrelated to autism, the researchers said.

The findings don’t prove that PCBs directly raise those risks, however.

“Autism is a complex condition with many different causes, and those causes vary among individuals,” said Kristen Lyall, lead researcher on the study.

Experts believe that for children to develop autism, they have to have a genetic susceptibility and be exposed to certain environmental factors during critical periods of early brain development.

Researchers are still trying to figure out what those environmental factors are. But some suspects include prenatal exposure to poor nutrition, certain infections, heavy air pollution and pesticides, according to the non-profit Autism Speaks.

The new findings suggest that PCBs could be another one of the “puzzle pieces,” said Lyall, an assistant professor at Drexel University’s A.J. Drexel Autism Institute, in Philadelphia.

The study, published Aug. 23 in Environmental Health Perspectives, included more than 1,100 children born in Southern California between 2000 and 2003.

Overall, 545 kids had been diagnosed with an autism spectrum disorder; another 181 had an intellectual disability, but not autism. The rest—418 in all—had neither diagnosis.

The children’s mothers had all been enrolled in a prenatal screening program, enabling the researchers to analyze blood samples taken during each woman’s second trimester.

It turned out that a mother’s levels of two particular PCBs — ones used as lubricants, coolants and insulators—were linked to her child’s risk of developing autism, the study authors said.

Women whose PCB levels were in the top 25 percent were roughly 80 percent more likely to have a child with autism, versus women in the bottom 25 percent, the researchers reported.

Lyall’s team tried to dig for other explanations. They factored in the mothers’ ages, races and weights, for instance. But PCB levels were still linked to autism risk, the investigators found.

It is, however, difficult to point the finger at any one chemical, Lyall said.

In daily life, people aren’t exposed to chemicals in isolation, she noted. Her team plans to study whether mixtures of different chemicals are related to autism risk, as well.

What’s clear, though, is that many studies have tied PCBs to ill health effects.

“We’ve known that these chemicals can have effects on the immune system and the endocrine [hormonal] system,” said Dr. Daniel Coury, medical director of Autism Speaks’ Autism Treatment Network.

“What’s concerning,” he said, “is that they are pretty ubiquitous.”

Decades after they were banned, PCBs persist in the air, soil and water. People are still exposed through food—particularly fish, meat and dairy products—and breathing PCB-contaminated air, according to the U.S. Centers for Disease Control and Prevention.

Old electrical appliances and fluorescent lighting can be sources, too.

Coury stressed that although the new study was “well done,” it does not prove that PCBs contribute to autism.

“We’d like to see if the findings can be replicated in other groups,” he said. “Do you see this same association in Nebraska? Or in France?”

It’s also important to keep the findings in perspective, Coury and Lyall said.

An 80 percent increase sounds scary. But that’s the relative increase comparing children with the highest prenatal PCB exposure against those with the lowest, Lyall pointed out.

The CDC estimates that about 1.5 percent of U.S. children have an autism spectrum disorder, Coury noted. “It’s a low risk to begin with,” he said. “So even with an 80 percent increase, it’s still low.”

Plus, the CDC says, recent studies have shown that Americans’ PCB levels are declining.

For now, Lyall said, pregnant women can take steps to reduce their PCB exposure. Trimming the fat from meat, avoiding fish from PCB-contaminated waters, and getting rid of old appliances are a few ways.

Many U.S. states have advisory systems that warn people about PCB-contaminated fish and wildlife, according to the CDC.

More information

The U.S. National Institute of Environmental Health Sciences has more on environmental factors and autism.

7 Things Autistic People Want You to Know

Like many autistic people, I have complicated feelings about Autism Awareness Month, which rolls around every April. According to the Autism Society, the initiative was created “to promote awareness, inclusion and self-determination for all, and assure that each person with [Autism Spectrum Disorder] is provided the opportunity to achieve the highest possible quality of life.”

On paper, these efforts sound wonderful. If there had been more widespread awareness of what autism really is and who can be on the spectrum when I was growing up in the ’80s and ’90s, I probably would not have spent 27 years trying to figure out what was “wrong” with me before finally receiving my diagnosis. I might even have been able to receive the kind of support and accommodations that could have helped me develop healthier coping mechanisms for managing my social, sensory, and processing concerns than the ones I came up with on my own when I was flailing in the dark for all of those years.

Not all of the awareness that comes with this month’s campaigns genuinely helps autistic people, though. Well-meaning but hurtful “awareness”-raising stunts, mostly staged by people who aren’t autistic, rarely bring much attention to the actual concerns and needs of our community. Fundraising and publicity for organizations that are usually run by people who aren’t autistic and like to portray us as tragic, family-ruining burdens dehumanize us and perpetuate the idea that autism is something that must be eradicated, not something that should be supported and accepted.

This is why many autistic people have come to dread April—and why we’d like to see an Autism Acceptance Month instead. That said, true acceptance still requires a degree of awareness about who autistic people truly are and what we want from non-autistic—or, as we call you, “allistic”—society. So, in that spirit, here’s a few of the things that we’d really like you to be aware of this month—and every month going forward.

We’re not all white men

Some autism awareness campaigns want you to “Light It Up Blue” because they say that autism disproportionately affects boys, but the fact that white heterosexual cisgender boys are more likely to be diagnosed with autism doesn’t mean that they’re more likely to be autistic. There are autistic people of every color, creed, and class. Recent studies suggest that we might be more likely to be transgender than the allistic population.

The stereotype that autism is primarily a white male thing negatively affects everything from the way the rest of us are treated in society to what kind of care we receive to the age at which we’re diagnosed—and whether we are able to receive a proper diagnosis at all. Which, in turn, perpetuates the idea that autism is for white boys.

RELATED: Introducing Julia: Sesame Street’s New Character With Autism

We don’t need to be cured

Being autistic in a world that isn’t built for people like us comes with all sorts of pain and challenges, but why do so many people automatically assume that it’s the autism that needs fixing? Many of us on the spectrum believe that the money and energy that’s funneled into searching for a cure would be better spent on acceptance, supports, and services to help autistic people with everything from personal care to employment issues.

Surviving and thriving as our autistic selves is far more appealing—not to mention more practical—than chasing a magic pill that would fundamentally change who we are, forcing us into harmful treatments geared toward making us look more “normal,” or pursuing prenatal testing that could prevent the next generation of people like us from being born at all.

RELATED: Do Vaccines Really Cause Autism?

Calling someone “high functioning” isn’t helpful

Every autistic person has a unique combination of skills and needs and if you’re new to autism, you might think that it’s beneficial to describe those differences in terms of how well we do or don’t “function.”

When I first started writing about autism, I thought that I had to describe myself in terms of function, because I had to acknowledge that I faced fewer challenges than people with more severe issues. But a helpful fellow autistic called me out on my language and pointed out that I was both unfairly dismissing and hurting other people on the spectrum and ignoring my own fluctuating needs with that terminology.

As noted autistic neurodiversity advocate Laura Tisoncik put it: “The difference between high functioning autism and low functioning is that high functioning means your deficits are ignored, and low functioning means your assets are ignored.”

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“Terms such as ‘high-’ or ‘low-functioning’ and ‘mental age’ may be convenient clinically, but they interfere with accurate perceptions of abilities and disabilities,” Shannon Des Roches Rosa, who has an autistic son, wrote last year. “I would prefer that scientists choose terms that focus on meeting the needs of autistic people, such as ‘low-’ and ‘high-support,’ instead of those more judgmental words.”

We don’t lack empathy

There’s no scientific evidence that proves this hurtful stereotype. In fact, research suggests just the opposite. One theory even suggests that some of us are dealing with an overabundance of empathy—feeling too much.

Autistic people can struggle to process and express empathy, but so do allistic people. That’s very different from not being able to feel anything for our fellow human beings. The real empathy issue when it comes to autism is that other people don’t always have a lot of it for us.

Not all of us can talk, but we all have something to say

Depending on your source, perhaps 20-30% of autistic people are estimated to be nonverbal. But talking is only one way to communicate. Some of us type. Some of us use sign language and/or AAC (Augmentative and Alternative Communication). Even behavior is a form of communication. So the problem isn’t that autism can’t “speak,” it’s that the rest of you need to learn how to listen to us.

We work hard to be a part of your world. And we’re exhausted

From social interactions to managing sensory issues and everything in between, participating in an allistic world on allistic people’s terms requires constant vigilance and effort on our parts. Autistic writer and pastor Lamar Hardwick compares this ongoing herculean task to starring in an elaborate theatrical production run by an unskilled crew:

“Every day I step onto the stage, the sound and lighting are so bad that it is borderline obnoxious and at times just painful to listen to and look at. The lights are often too bright or too dim. The spotlight is never in the right place, the house lighting is terrible and all of that impacts with my depth perception and facial recognition. Sometimes that’s why I have trouble recognizing people I’ve already met. This means that I visually experience things quite differently than you do. It’s actually a lot of work, and sometimes it’s overwhelming, so I don’t just look tired, I am tired.”

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If you’ve met one person with autism, you’ve met one person with autism

Also, if you’ve read one article by an autistic person, you’ve read one article from one autistic perspective. For every person who agrees with this list, there are far more who will have their own points they’d prefer to make. The only thing that all autistic people have in common is that we’re all human beings who deserve to be treated like human beings.

So if you’re really interested in knowing more about us and what we want you to know, learn from as many of us as possible. Understand that while parents and experts might have valuable insights, their voices and expertise are no substitute for the lived experiences of autistic people. Check out the #ActuallyAutistic hashtag on Twitter. Support organizations run by actually autistic people like the Autistic Self Advocacy Network and the Autism Women’s Network. Seek out work and interviews by autistic people, especially autistic people of color, queer autistic people and more multiply marginalized autistic people and open your mind to the spectrum of experiences, beliefs, and issues that exist in the autism community.

Fever During Pregnancy May Raise Baby’s Autism Risk

Running a fever during pregnancy—particularly during the second trimester—is linked to an increased risk of autism in children, according to a new study. Treating fevers with acetaminophen (best known as Tylenol) may be somewhat protective, say the authors, although they stress that more research is needed in this area.

has previously been tied to prenatal exposure to a wide range of infections, researchers at Columbia University wrote in the journal Molecular Psychiatry. Because fever is such a common response to infections and illness, they wanted to see whether high temperatures during pregnancy—and attempts to lower those temperatures with medication—seemed to play a role in a child’s likelihood of being diagnosed years later. 

So the researchers studied nearly 100,000 mothers and their children born between 1999 and 2009 in Norway. About 16% of the women reported having at least one fever during their pregnancies, a rate that’s similar to estimates in the United States. Between ages 3 and 7, the children were screened for autism spectrum disorder, and 583 were diagnosed.

After adjusting for factors such as maternal age, status, and previous pregnancies, the researchers found that children whose mothers reported fever at any time during pregnancy had a 34% increased risk of developing autism compared to those whose moms reported no fevers. Much of that increased risk seemed to originate in the second trimester: Kids whose moms had fevers during this period had a 40% increased risk of autism, compared to those whose moms didn’t.

When women reported only one or two fever episodes after 12 weeks, their children’s increased risk for autism was only about 30%. But with three or more fever episodes, it jumped to more than 300%.

That may sound scary to mothers-to-be. But first author Mady Hornig, MD, associate professor of epidemiology at Columbia University’s Center for Infection and Immunity, says it’s important to remember that the overall risk is still very low. Even among mothers who had three or more fevers after the 12-week mark, only 5 out of 308 children (or about 1 in 62) developed autism. That’s compared to 376 out of the 65,502 children whose moms never had fever, or about 1 in 178.

Doctors don’t know why, exactly, a mother’s fever might boost her child’s autism risk. But Dr. Hornig points out that the second trimester is a time of key brain development; it’s also a time when the mother’s immune system is somewhat “turned down,” so her body won’t reject the growing fetus. Together, she says, these factors could make her offspring more vulnerable to developmental disruption.

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Because the study was observational, it was unable to prove a cause-and-effect relationship between prenatal fever exposure and the development of autism. As a follow-up, the researchers are now analyzing blood samples from mothers and babies to determine what types of infections—or what types of immune responses from the mother—may be associated with greater risks than others. 

“If we can figure that out, we can think more about how to prevent those specific infections during pregnancy,” Dr. Hornig says. But it’s equally important, she adds, to know how to treat fever in pregnant women when it does occur.

The study did find that children whose mothers took acetaminophen to lower fevers during their pregnancies had a slightly lower risk of autism than those who had fevers but didn’t take anything. But the difference between groups was much smaller than the researchers expected.

“We were surprised there was not a more robust effect,” says Dr. Hornig. “At this point it’s hard to tell whether it really has a meaningful effect at all.”

The researchers wanted to know if taking ibuprofen would have protective effects, as well, but not enough women in the sample used the drug during pregnancy to make any meaningful conclusions. (None of the moms who took ibuprofen had children who developed autism, but Dr. Hornig says this finding should be interpreted with “extreme caution.”)

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While acetaminophen and ibuprofen both reduce fever, only ibuprofen has anti-inflammatory properties—which could potentially offer additional safeguards against the risks associated with fever and infection, the authors say. But some studies have suggested a link between ibuprofen and miscarriages, and doctors don’t usually recommend the drug to pregnant patients.

Dr. Hornig says that it’s important to weigh the pros and cons of any medication considered during pregnancy—including acetaminophen—and she stresses that the new study doesn’t change current recommendations for how moms-to-be should manage pain or fever. (If you’re unsure of what’s safe, she says, ask your obstetrician.)

But she does say women can take simple precautions to reduce their risk of developing infections that can trigger a fever—like , for example. “I think that being healthy, washing your hands, and avoiding contact with sick individuals are all fairly easy to do,” she says, “and it’s a good idea for this and a lot of other reasons.”

The U.S. Centers for Disease Control and Prevention recommend that pregnant women get a flu shot in any trimester to protect themselves and their newborns from the flu (protective antibodies can be passed from mom to baby).