Autism Linked to Being Firstborn, Breech or Moms 35 and Older Giving Birth

Children who are firstborn or breech or whose mothers are 35 or older when giving birth are at significantly greater risk for developing an autism spectrum disorder, University of Utah School of Medicine researchers have reported in a new study with Utah children.

In the April 27, 2009, online issue of the journal Pediatrics, the researchers showed that women who give birth at 35 or older are 1.7 times more likely to have a child with an autism spectrum disorder (ASD), compared with women between the ages of 20-34. Children diagnosed with ASD also were nearly 1.8 times more likely to be the firstborn child, the researchers found.insert beginning span tag hereAlthough they didn't identify a causal relationship between breech births and autism, children diagnosed with the disorder were more than twice as likely to have been a breech presentation, meaning they were not born head first.

"The results of this study give us an opportunity to look more closely at these risk factors for children across the autism spectrum, and not only those diagnosed with autism," said first author Deborah A. Bilder, M.D., assistant professor of psychiatry. "This shows that further investigation of the influence of prenatal factors is warranted."

Autism is a complex brain disorder that impairs social, communicative, and behavioral development and often is characterized by extreme behavior.

Bilder and her colleagues in the U medical school's department of psychiatry and the Utah Department of Health examined the birth records of Utah children who had been identified as having an autism spectrum disorder in a 2002 epidemiological study by the U.S. Centers for Disease Control and Prevention (CDC). That study looked at 8-year-old children in Utah's three most populous counties--Salt Lake, Davis, and Utah--and used nationally accepted criteria for an ASD classification. The researchers compared birth records for children identified with an ASD with unaffected children born in those three counties in 1994. Of that group, 196 were identified with an ASD. Birth certificates were available for 132 of those children, and the researchers examined those records for possible prenatal, perinatal, and neonatal risk factors related to ASD.

Their investigation showed that the mother's age when giving birth (older than 34), breech presentation, and being firstborn were significant risk factors for the development of an ASD. The researchers also identified a small but significant relationship between the increased duration of education among mothers of those children.

Further investigation would be needed to understand how these three risk factors may relate to ASD. But a possible explanation for the correlation of firstborn children might be that parents are reluctant to have a second child if the first is diagnosed with ASD. A possible interpretation of increased risk associated with advanced maternal age is that changes in genes occurring over time may contribute to autism spectrum disorders. The association found between breech presentation and ASD most likely indicates a shared cause, such as neuromuscular dysfunction. The vast majority of children born breech, however, are healthy.

This study follows several from the University in recent years, which found that Utah has one of the highest autism spectrum disorder rates in the country (one in 133 Utah children has the disorder), helped indentify a gene that may predispose people to autism, and showed that Utah adults with autism have a better quality of life than those in other studies.

For the next step in their research, Bilder and her colleagues want to repeat this study, using a larger population of Utah 8-year-olds from subsequent birth years, to see if it replicates the results of the current study. They also may study the subset of children with breech presentation to determine whether they haven a genetic vulnerability that put them at increased risk for developing an autism spectrum disorder.

The study's other authors are Judith P. Zimmerman, Ph.D., research assistant professor of psychiatry; Judith Miller, Ph.D., associate professor of psychiatry; and William M. McMahon, M.D., chairman of the Department of Psychiatry.

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Lack of Food Variety Puts Kids with Autism at Risk for Poor Nutrition

The strong preference kids with autism have for certain foods places them at risk for nutritional deficiencies because their diets lack sufficient variety, according to research presented at this year's Pediatric Academic Societies meeting in Baltimore.

Researchers said screening children for the amount of variety of food in their diets may be a good clinical marker to predict which children might be at risk for nutrition problems. Kids with low food variety scores who are at risk could then be referred to dieticians or therapists to help them expand food choices and improve nutrition, said Michelle Zimmer, M.D., lead investigator and a pediatrician in the division of Developmental and Behavioral Pediatrics at Cincinnati Children's.insert beginning span tag hereThe study is one of two presented by Dr. Zimmer and colleagues this year at PAS that deal with autism, the second one showing that the red blood cells of children with autism have low levels of a fatty acid linked to cognitive function. This finding, the researchers report, warrants further research into how the low fatty acid levels may trigger biochemical changes in the brain linked to autism.

The team found that levels of docosahexanoic acid and total omega-3 fatty acids were significantly lower in the red blood cells of autistic children than in normally developing children. Omega-3 fatty acids are nutritionally important substances considered vital to the normal development of children.

Evidence of abnormal fatty acid metabolism in children with autism runs counter to at least one previous study that suggested no difference between normally developing and autistic children. The different results between studies may be explained by the current research focusing on an older group of children, Dr. Zimmer said.

"The fatty acid docosahexanoic is linked to other mental health issues, and this raises questions about whether there are functional issues in neural cells involving a deficiency of essential fatty acids," said Dr. Zimmer. "The main point of the study is we cannot rule that fatty acids are part of the story of what is going on with kids who have autism."

Dr. Zimmer said its possible older children with autism have had more time to use up their bodies' stores of omega-3 fatty acids and are unable to replenish those stores. The 21 children with autism in this study were between the ages of 3 and 18 years, as were the 20 age-matched normally developing children and 10 if their siblings who served as control subjects.

The research team is conducting a larger study with more children to verify its PAS findings. Dr. Zimmer said another study is also under design to give essential omega-3 fatty acids, such as docosahexanonic acid, to children with autism to see what impact it has on brain chemistry and/or the disorder.

Increasing foods rich in omega-3 fatty acids in the diets of autistic children has been suggested by some researchers as potentially beneficial, Dr. Zimmer said. Although doing so would not have a negative impact on the children, until studies are conducted it isn't known what affect, if any, it might have, she added. Also, given the findings of the previous study on the lack of food variety among kids with autism, augmenting their diets could be challenging.

Most of the 19 autistic children in the food study had much lower food variety scores in their diets than typically developing children. A majority of the children with autism also suffered from nutritional deficiencies. The researchers concluded children with autism and low food variety scores are at risk for mild and serious nutritional deficiencies.

Researchers participating in studies were from the division of Developmental and Behavioral Pediatrics and division of Neurology at Cincinnati Children's. Researchers from the department of Pathology at the University of Cincinnati participated in the study on food variety.

The PAS meeting is the largest international meeting focused on research in child health. It is sponsored by the American Academy of Pediatrics, the American Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association.

Cincinnati Children's Hospital Medical Center is one of America's top three children's hospitals for general pediatrics and is highly ranked for its expertise in digestive diseases, respiratory diseases, cancer, neonatal care, heart care and neurosurgery, according to the annual ranking of best children's hospitals by U.S. News & World Report. One of the three largest children's hospitals in the U.S., Cincinnati Children's is affiliated with the University of Cincinnati College of Medicine and is one of the top two recipients of pediatric research grants from the National Institutes of Health. For its achievements in transforming healthcare, Cincinnati Children's is one of six U.S. hospitals since 2002 to be awarded the American Hospital Association-McKesson Quest for Quality Prize (r) for leadership and innovation in quality, safety and commitment to patient care. The hospital is a national and international referral center for complex cases, so that children with the most difficult-to-treat diseases and conditions receive the most advanced care leading to better outcomes. Additional information can be found at www.cincinnatichildrens.org.

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Exercise Is Healthy Option for Kids With Developmental Disabilities

Newswise — Group exercise programs, treadmill training and horseback riding can be healthy choices for children with developmental disabilities. With these kinds of activities, children with disorders such as autism, mental retardation and cerebral palsy can improve their coordination and aerobic fitness.

The findings are encouraging, since studies show that children with developmental disabilities tend to be less fit than their peers. In many cases, the children lack the resources and community support that would encourage them to be more active, Johnson said.

Children and adults with disabilities "can ill afford to have a downturn in health and yet when told by their doctor to exercise or lose weight, they are rarely ‹ if ever ‹ given the resources or knowledge to do so," said James Rimmer, Ph.D., director of the National Center on Physical Activity and Disability.

However, "parents may be more likely to provide their children with opportunities for physical activity if the specific potential benefits for their children are proven," said Johnson, whose review appears in the January-February issue of the American Journal of Health Promotion.

Johnson analyzed 14 studies and three other evidence reviews to determine how youth with developmental disabilities might benefit from physical activity. The strongest evidence of benefits came from studies of group exercise, therapeutic horseback riding and treadmill workouts. Skiing and swimming programs might also be beneficial, but the evidence from those programs was not as strong, she concluded.

As other studies have suggested, however, the children all found "some level of enjoyment, satisfaction or physical benefit from the activities," Johnson said.

Only two studies reported any problems with the exercise programs, including one study of children with severe cerebral palsy where therapeutic horseback riding raised some heart rates above the healthy levels recommended for all children by the American Heart Association.

According to the Centers for Disease Control and Prevention, developmental disabilities affect nearly 17 percent of children un

American Journal of Health Promotion: Call (248) 682-0707 or visit www.healthpromotionjournal.com.

Johnson CC. The benefits of physical activity for youth with developmental disabilities: a systematic review. Am J Health Promo, 23(3), 2009.

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