ADHD in Children Slideshow
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Saturday, July 18, 2009
NYT article: Research on Autism and Girls
This article in the New York Times speaks about how autism is often thought of as a boys’ affliction."Boys are three or four times as likely as girls to have classic autism (autism with mental retardation, which is now often referred to as cognitive impairment). The sex ratio is even more imbalanced for diagnoses that include normal intelligence along with the features of autism — social and communication impairments and restricted interests; this is called Asperger’s syndrome (when there is no speech delay) or high-functioning autism or, more generally, being “on the autistic spectrum.” Among kids in this category, referral rates are in the range of 10 boys for every girl.
Girls are often "culled" from autism research as they are too few in number to use in statistical analysis. This article reviews some new attempts to refocus the research on girls and their different presentation of the disorder. The article may be found here:
http://www.nytimes.com/2007/08/05/magazine/05autism-t.html?scp=6&sq=autism&st=cse
and is also referenced at the bottom of the page.
Girls are often "culled" from autism research as they are too few in number to use in statistical analysis. This article reviews some new attempts to refocus the research on girls and their different presentation of the disorder. The article may be found here:
http://www.nytimes.com/2007/08/05/magazine/05autism-t.html?scp=6&sq=autism&st=cse
and is also referenced at the bottom of the page.
Friday, July 17, 2009
Hyperbaric Oxygen for Autism - answers and questions
Taken from:
http://www.theness.com/neurologica
Hyperbaric Oxygen for Autism
Published by Steven Novella, MD
A new study looks at the effectiveness of hyperbaric oxygen therapy in autism. The study is the first double-blind placebo controlled study of such therapy in autism and found a significant improvement in those children in the treatment group.
However, the treatment is very controversial and remains so, even after this study.
Hyperbaric oxygen therapy involves placing patients in a chamber with pressure increased above atmospheric pressure with an enriched oxygen content. It has many legitimate medical applications, such as treating certain kinds of infection, but also has become popular among some as an unscientific treatment. It is offered by practitioners and chambers are even sometimes purchased by private individuals for their own family’s use.
The problem, of course, is that some claims for hyperbaric oxygen go way past the evidence, or exist in the utter absence of evidence. This includes autism - there are no compelling studies showing any benefit from hyperbaric oxygen therapy in autism. The few studies that do exist are uncontrolled, which means they are mostly worthless.
This current study is at least a double-blind controlled trial. But it still has significant weaknesses. The primary weakness, in my opinion, is that the parents of the children being studied were allowed in the chamber with their children. The two groups in the study either received 24% oxygen in 1.3 atmospheres, or 21% oxygen in 1.03 atmospheres. It’s probable that many of the parents knew if they were getting increased pressure or not, and this therefore could have unblinded the study.
Tight blinding is critical for these type of studies because the assessment of the effect on the autistic children is highly subjective. For example, the assessment includes how much eye contact the children make.
The study is also on the small side, with 62 children total. However, the clinical effects were very robust.
Some have pointed out that the study leader, Daniel Rossignol, has a potential conflict of interest in that he offers hyperbaric oxygen therapy in his practice. He therefore stands to gain personally if its effectiveness is proven. While such conflicts are important to expose, I think they are trumped by a well-enough controlled study. The whole point of a well-designed study is to eliminate the effects of bias. But given that this study was poorly blinded, and bias was present, it certainly diminishes its impact.
Everyone agrees, even Rossignol, that this study will not end the controversy over hyperbaric oxygen in autism. It needs to be replicated. This is generically true of any new treatment - the first few smallish studies are never enough to establish its effectiveness. The strength of clinical trials rests primarily in replication. Only when various researchers with different biases come to the same conclusion from well-designed studies can we confidently come to a conclusion. The history of medicine is littered with treatments that initially seemed promising but just did not pan out.
Another weakness of the study is that it was short term, only four weeks. It therefore did not test if the effect of hyperbaric treatment survives much beyond the treatment itself. Even if the effect in this study is real, it may represent only a temporary symptomatic benefit - not altering the course of autism itself. Therefore longer followup studies are needed as well.
It is not impossible that hyperbaric oxygen may have some benefit in some children with autism. Although there is no established mechanism at this time, and proposed mechanisms (like the notion that hyperbaric O2 decreases inflammation) are largely speculative. But a physiological effect is not implausible. The treatment is also fairly safe. Therefore it is reasonable to study it further.
The biggest risk of the treatment now is that it is expensive - costing 150-900 dollars per treatment or 14-17 thousand dollars for a chamber. It also diverts energy and emotions away from possibly more productive treatments.
Because of this, this is one treatment where I think high quality research may have an actual impact. If it works, of course, than more people can benefit from it. If high quality studies show it does not work I think there are families who will save themselves from the expense of an ineffective treatment. It will likely not go away completely, but would be significantly marginalized.
But one thing is clear - any future studies should be very tightly controlled, or they will be counterproductive.
http://www.theness.com/neurologica
Hyperbaric Oxygen for Autism
Published by Steven Novella, MD
A new study looks at the effectiveness of hyperbaric oxygen therapy in autism. The study is the first double-blind placebo controlled study of such therapy in autism and found a significant improvement in those children in the treatment group.
However, the treatment is very controversial and remains so, even after this study.
Hyperbaric oxygen therapy involves placing patients in a chamber with pressure increased above atmospheric pressure with an enriched oxygen content. It has many legitimate medical applications, such as treating certain kinds of infection, but also has become popular among some as an unscientific treatment. It is offered by practitioners and chambers are even sometimes purchased by private individuals for their own family’s use.
The problem, of course, is that some claims for hyperbaric oxygen go way past the evidence, or exist in the utter absence of evidence. This includes autism - there are no compelling studies showing any benefit from hyperbaric oxygen therapy in autism. The few studies that do exist are uncontrolled, which means they are mostly worthless.
This current study is at least a double-blind controlled trial. But it still has significant weaknesses. The primary weakness, in my opinion, is that the parents of the children being studied were allowed in the chamber with their children. The two groups in the study either received 24% oxygen in 1.3 atmospheres, or 21% oxygen in 1.03 atmospheres. It’s probable that many of the parents knew if they were getting increased pressure or not, and this therefore could have unblinded the study.
Tight blinding is critical for these type of studies because the assessment of the effect on the autistic children is highly subjective. For example, the assessment includes how much eye contact the children make.
The study is also on the small side, with 62 children total. However, the clinical effects were very robust.
Some have pointed out that the study leader, Daniel Rossignol, has a potential conflict of interest in that he offers hyperbaric oxygen therapy in his practice. He therefore stands to gain personally if its effectiveness is proven. While such conflicts are important to expose, I think they are trumped by a well-enough controlled study. The whole point of a well-designed study is to eliminate the effects of bias. But given that this study was poorly blinded, and bias was present, it certainly diminishes its impact.
Everyone agrees, even Rossignol, that this study will not end the controversy over hyperbaric oxygen in autism. It needs to be replicated. This is generically true of any new treatment - the first few smallish studies are never enough to establish its effectiveness. The strength of clinical trials rests primarily in replication. Only when various researchers with different biases come to the same conclusion from well-designed studies can we confidently come to a conclusion. The history of medicine is littered with treatments that initially seemed promising but just did not pan out.
Another weakness of the study is that it was short term, only four weeks. It therefore did not test if the effect of hyperbaric treatment survives much beyond the treatment itself. Even if the effect in this study is real, it may represent only a temporary symptomatic benefit - not altering the course of autism itself. Therefore longer followup studies are needed as well.
It is not impossible that hyperbaric oxygen may have some benefit in some children with autism. Although there is no established mechanism at this time, and proposed mechanisms (like the notion that hyperbaric O2 decreases inflammation) are largely speculative. But a physiological effect is not implausible. The treatment is also fairly safe. Therefore it is reasonable to study it further.
The biggest risk of the treatment now is that it is expensive - costing 150-900 dollars per treatment or 14-17 thousand dollars for a chamber. It also diverts energy and emotions away from possibly more productive treatments.
Because of this, this is one treatment where I think high quality research may have an actual impact. If it works, of course, than more people can benefit from it. If high quality studies show it does not work I think there are families who will save themselves from the expense of an ineffective treatment. It will likely not go away completely, but would be significantly marginalized.
But one thing is clear - any future studies should be very tightly controlled, or they will be counterproductive.
A List of Government Resources
Organizations
Association for Science in Autism Treatment
P.O. Box 188
Crosswicks, NJ 08515-0188
info@asatonline.org
http://www.asatonline.org
Autism National Committee (AUTCOM)
P.O. Box 429
Forest Knolls, CA 94933
http://www.autcom.org
Autism Network International (ANI)
P.O. Box 35448
Syracuse, NY 13235-5448
jisincla@syr.edu
http://www.ani.ac
Autism Research Institute (ARI)
4182 Adams Avenue
San Diego, CA 92116
director@autism.com
http://www.autismresearchinstitute.com
Tel: 619-281-7165
Fax: 619-563-6840
Autism Society of America
7910 Woodmont Ave.
Suite 300
Bethesda, MD 20814-3067
http://www.autism-society.org
Tel: 301-657-0881 800-3AUTISM (328-8476)
Fax: 301-657-0869
MAAP Services for Autism, Asperger Syndrome, and PDD
P.O. Box 524
Crown Point, IN 46308
info@maapservices.org
http://www.maapservices.org
Tel: 219-662-1311
Fax: 219-662-0638
Autism Speaks, Inc.
2 Park Avenue
11th Floor
New York, NY 10016
contactus@autismspeaks.org
http://www.autismspeaks.org
Tel: 212-252-8584 California: 310-230-3568
Fax: 212-252-8676
National Dissemination Center for Children with Disabilities
U.S. Dept. of Education, Office of Special Education Programs
P.O. Box 1492
Washington, DC 20013-1492
nichcy@aed.org
http://www.nichcy.org
Tel: 800-695-0285
Fax: 202-884-8441
National Institute of Child Health and Human Development (NICHD)
National Institutes of Health, DHHS
31 Center Drive, Rm. 2A32 MSC 2425
Bethesda, MD 20892-2425
http://www.nichd.nih.gov
Tel: 301-496-5133
Fax: 301-496-7101
National Institute on Deafness and Other Communication Disorders Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
nidcdinfo@nidcd.nih.gov
http://www.nidcd.nih.gov
Tel: 800-241-1044 800-241-1055 (TTD/TTY)
National Institute of Mental Health (NIMH)
National Institutes of Health, DHHS
6001 Executive Blvd. Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
nimhinfo@nih.gov
http://www.nimh.nih.gov
Tel: 301-443-4513/866-415-8051 301-443-8431 (TTY)
Fax: 301-443-4279
Association for Science in Autism Treatment
P.O. Box 188
Crosswicks, NJ 08515-0188
info@asatonline.org
http://www.asatonline.org
Autism National Committee (AUTCOM)
P.O. Box 429
Forest Knolls, CA 94933
http://www.autcom.org
Autism Network International (ANI)
P.O. Box 35448
Syracuse, NY 13235-5448
jisincla@syr.edu
http://www.ani.ac
Autism Research Institute (ARI)
4182 Adams Avenue
San Diego, CA 92116
director@autism.com
http://www.autismresearchinstitute.com
Tel: 619-281-7165
Fax: 619-563-6840
Autism Society of America
7910 Woodmont Ave.
Suite 300
Bethesda, MD 20814-3067
http://www.autism-society.org
Tel: 301-657-0881 800-3AUTISM (328-8476)
Fax: 301-657-0869
MAAP Services for Autism, Asperger Syndrome, and PDD
P.O. Box 524
Crown Point, IN 46308
info@maapservices.org
http://www.maapservices.org
Tel: 219-662-1311
Fax: 219-662-0638
Autism Speaks, Inc.
2 Park Avenue
11th Floor
New York, NY 10016
contactus@autismspeaks.org
http://www.autismspeaks.org
Tel: 212-252-8584 California: 310-230-3568
Fax: 212-252-8676
National Dissemination Center for Children with Disabilities
U.S. Dept. of Education, Office of Special Education Programs
P.O. Box 1492
Washington, DC 20013-1492
nichcy@aed.org
http://www.nichcy.org
Tel: 800-695-0285
Fax: 202-884-8441
National Institute of Child Health and Human Development (NICHD)
National Institutes of Health, DHHS
31 Center Drive, Rm. 2A32 MSC 2425
Bethesda, MD 20892-2425
http://www.nichd.nih.gov
Tel: 301-496-5133
Fax: 301-496-7101
National Institute on Deafness and Other Communication Disorders Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892-3456
nidcdinfo@nidcd.nih.gov
http://www.nidcd.nih.gov
Tel: 800-241-1044 800-241-1055 (TTD/TTY)
National Institute of Mental Health (NIMH)
National Institutes of Health, DHHS
6001 Executive Blvd. Rm. 8184, MSC 9663
Bethesda, MD 20892-9663
nimhinfo@nih.gov
http://www.nimh.nih.gov
Tel: 301-443-4513/866-415-8051 301-443-8431 (TTY)
Fax: 301-443-4279
Autism Vancouver Introduction
Autism Vancouver is a blog to help you stay informed of the latest diagnostic and treatment issues in the field of autism. We will focus on science based practice here in the lower mainland including Vancouver, Burnaby, coquitlam, New Westminster and areas nearby. We will discuss therapy and counselling for children, therapy and counselling for adolescents and therapy and counselling for adults. Dr. Roche is a proponent of scientifically supported medicine and psychological interventions for autism, asperger's, adhd and related social-cognitive disorders. The blog is moderated by Dr. Jim Roche, a Registered Psychologist and Registered Family Therapist in British Columbia. He is a behavioural and cognitive behavioural therapist as well as a certified teacher of special education. He provides consultation and training to school districts throughout British Columbia. He has offices in Burnaby, coquitlam and Vancouver and provides disgnostic, counselling, therapy and behavioural intervention services to children, adolescents and adults with autism, Asperger's and ADHD.
Dr. Roche's professional web site can be found at http://www.relatedminds.com or at http://www.socialcognitivetherapy.com
Dr. Roche's professional web site can be found at http://www.relatedminds.com or at http://www.socialcognitivetherapy.com
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