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Age 6 may represent key turning point in autism

Autism trait severity decreases from age 3 to 6 in most autistic children, but that progress then stalls for nearly three-quarters of them, according to a new long-term study.

The findings suggest that age 6 — when elementary school usually begins — is a key turning point for autistic children, when families, clinics, schools and communities can provide extra support.

“We can think about making sure these turning points turn out positively instead of negatively for kids,” says lead investigator Stelios Georgiades, associate professor of psychiatry and behavioral neurosciences at McMaster University in Hamilton, Canada.

The results jibe with a 2020 study showing that autism traits are not stable in young children with autism. But they run counter to the long-standing idea that these traits don’t typically ease with time.

“Most children with autism do show some improvement, in contrast with a lot of the literature,” says David Amaral, professor of medical psychiatry at the University of California, Davis, who led the 2020 study but was not involved in the new work. “Change in the severity of symptoms over time is more likely than ever thought before.”

Turning point:

Georgiades and his colleagues analyzed data from 187 children with autism enrolled in the Pathways in ASD study, a long-term project tracking the development of autistic children. They measured autism trait severity when the children were diagnosed — at 41 months of age, on average — and again at about ages 4, 6 and 10.

The children fell into two groups based on how their traits changed over that period.

About 73 percent of the children showed a slight decrease in trait severity up to age 6, and no further change past that point. The remaining 27 percent showed a more marked decline at first and continued to decrease after that, albeit at a slower rate.

The children in the continuously improving group started out with slightly less severe traits than children in the other group and performed marginally better on tests of cognition, language and daily-living skills.

“They didn’t start off all that different from children in the other group, but the discrepancies between the groups increased over time,” Georgiades says. “What that tells me is that at diagnosis, we may have a window of opportunity to ensure that all children develop in a positive way, and that family, clinical and community services should help make sure that improvement doesn’t stop or plateau or regress.”

The study is the first to reveal this specific turning point, Georgiades and his colleagues say. The work was published in March in the Journal of Autism and Developmental Disorders.

“I think their idea of turning points is really important — as someone who tries to do trajectory analysis myself, I look forward to trying to figure out how to find them with our own studies,” says Cathy Lord, professor of psychiatry at the University of California, Los Angeles.

Uncertain causes:

The reasons for the turning point remain uncertain, other experts note.

“We know that the social environment of school can be a challenge for many young children with autism,” says Tony Charman, professor of clinical child psychology at King’s College London in the United Kingdom. “But from the work presented, which has no school-based data about the cohort, it is hard to draw any definitive conclusions about whether school entry itself — and if so, what factors — are contributing to the change in trajectory.”

Brain development might also help to account for the turning point. It differs between autistic children whose traits wane over time and those whose traits do not, according to a 2020 brain imaging study by Amaral and his colleagues.

About 85 percent of the children in the new study are boys, so it’s unclear whether the turning point also applies to autistic girls, Amaral says. But his team’s previous work suggests that the severity of girls’ traits decreases more over time than that of boys’ traits.

“There is the question of whether or not this decrease in the severity of symptoms we see in girls is real, or whether they are better able to mask or hide their symptoms,” says Einat Waizbard-Bartov‬, a graduate student in Amaral’s lab who was not involved in the new work. “There are many different types of mental-health costs from such camouflaging or compensation, such as anxiety, depression and burnout, so that is something we want to be mindful of.”

Georgiades and his colleagues have launched a new initiative, the Pediatric Autism Research Cohort project, to analyze how clinical services and other forms of support might alter the developmental trajectories of autistic children, he says. “We also plan to regularly share our research data with families, who can share it with clinical teams and school teams and community teams to have conversations of how to adapt and refine care going forward.”

The post Age 6 may represent key turning point in autism appeared first on Spectrum | Autism Research News.

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Others Involved in Your Health Care or Payment for our Care:

Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
6. Uses and Disclosures of Protected Health Information Based upon Your Written Authorization Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose your protected health information for the reasons covered by your written authorization. Please understand that we are unable to take back any disclosures already made with your authorization.
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Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights
1. You have the right to inspect and copy your protected health information
This means you may inspect and obtain a copy of protected health information about you for so long as we maintain the protected health information. You may obtain your medical record that contains medical and billing records and any other records that we use for making decisions about you. As permitted by federal or state law, we may charge you a reasonable copy fee for a copy of your records.
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This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or health care operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

We are not required to agree to a restriction that you may request. If we agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your health provider.

You may request a restriction by making your request in writing to our Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
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We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer.
4. Your may have right to amend your protected health information
This means you may request an amendment of protected health information about you in a designated record set for so long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending your medical record.
5. You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you if you authorized us to make the disclosure, to family members or friends involved in your care, or for notification purposes, for national security or intelligence, to law enforcement (as provided in the privacy rule) or correctional facilities, as part of a limited data set disclosure. The right to receive this information is subject to certain exceptions, restrictions and limitations.
6. You have the right to obtain a paper copy of this notice from us
upon request, even if you have agreed to accept this notice electronically.
D. COMPLAINTS
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint

You may contact our Privacy Officer at (704) 824-7800 for further information about the complaint process.

This notice was published and becomes effective on August l, 2011.