If you have any kids heading back to school this summer, you may be worrying about their health – both in the classroom and on the soccer or football field. Matthew Birkle, MD, an Urgent Care Physician at TriHealth Priority Care, shares a few tips for keeping your child healthy and safe during the next several months.
In the Classroom
Tip #1: Wash Your Hands and Don’t Share Drinks
The most common illnesses that go around, like persistent coughing, congestion, sore throat, or mononucleosis, are spread through the respiratory tract. “Wash your hands before you touch your face or eat, and don’t share your drinks, which is the number one thing for teenagers,” Dr. Birkle points out.
Tip #2: Stay Home and See Your Doctor
“Certainly, if you feel like your child is ill, contact your family doctor,” Dr. Birkle explains. Common symptoms that would warrant keeping your child home and scheduling an appointment with your doctor include:
· Cough (persistent)
On the Field Safety
Tip #1: Stay Hydrated
If your child participates in school-affiliated sports, they need to stay hydrated – especially during the late summer and early fall months. The amount of water your child should drink depends on their size and sweat rate, but it’s important to drink plenty of water throughout the day in order to avoid an episode of dehydration later.
Avoid drinks containing caffeine, such as tea or soft drinks or “energy drinks,” because they cause the body to release water. · Learn more about dehydration in our Health Library.
Tip #2: Watch for Repetitive Concussions
“If any head injury occurs, immediately evaluate the player for concussion with your coach or athletic trainer and see a sports medicine specialist if they have any concerns,” Dr. Birkle says. “Repetitive concussions, especially in football, need to be avoided. Soccer and football are also common activities involving head injuries.”
Signs and symptoms of a concussion include:
· Changes in mood
· Difficulty concentrating
· Feeling groggy
· Getting headaches
· Losing balance
· Vision problems
· Slower reaction times
Every parent should be aware of Lindsay’s law, a new Ohio law for 2017. Lindsay’s law addresses the need to be aware of the risk factors for Sudden Cardiac Death in young athletes.
A recent study published in the European Journal of Pain found elevated levels of childhood adversity (CA) in female patients with fibromyalgia (FM) and chronic widespread pain (CWP).1 The impact of CA on reports of pain severity was most pronounced in women who developed the symptoms of post-traumatic stress disorder (PTSD).
“Results of this study suggest that the impact of childhood adversity (ie, whether such events have led to the development of PTSD symptoms), rather than the mere presence of such adversity, is of crucial importance in FM/CWP patients,” said Eline Coppens, MS, psychologist-psychotherapist at The Leuven Centre for Algology & Pain Management, University Hospitals Leuven, Belgium, and corresponding study investigator, in an email interview with Psychiatry Advisor.
The prevalence of childhood adversities was investigated in 3 groups of female patients — 154 patients with either FM or CWP, 83 patients with functional dyspepsia (FD), and 53 patients with achalasia. Coppens and colleagues recruited study participants from a tertiary care center for chronic pain at the University Hospitals Leuven, Belgium, between 2011 and 2014. In the FM/CWP group, the investigators also analyzed the association between childhood adversities, PTSD, and pain severity. CA, PTSD symptoms, and pain severity were assessed using self-report questionnaires.
Ms Coppens emphasized that “CA has been associated with increased vulnerability to medical symptoms in adulthood.”2
In the present study, “we found elevated levels of CA in FM/CWP patients (prevalence around 50%) compared to both healthy controls and patients with a chronic organic disease,” said Ms Coppens. She added, “In FM/CWP, we found no direct relationship between CA and pain severity. However, PTSD mediated the relationship between CA and pain severity in FM/CWP and FM/CWP patients were about 6 times more likely to report PTSD.”
At least one type of CA was reported in 49% of patients with FM/CWP, 39.7% of patients with FD, and 23.4% of patients with achalasia (P <.01). Sexual abuse, emotional abuse, and emotional neglect were more frequently reported by patients with FM/CWP than patients with achalasia. PTSD was associated with higher pain intensity in patients with FM/CWP.
“These results suggest that screening for PTSD symptoms should be an essential part of the assessment process in patients suffering from FM/CWP, so that patients can be referred for evidence-based treatment to mental health care specialists when appropriate,”3,4 emphasized Ms Coppens. She added that “semi-structured interviews such as the MINI [Mini International Neuropsychiatric Interview,5 or well-validated self-report questionnaires such as PTSD-ZIL,6 may be used for this purpose.”
“In the context of multidisciplinary treatment of FM/CWP, psychotherapeutic strategies need to focus on treatment of PTSD symptoms and on the possible impact of these symptoms on pain severity,” she concluded.
The Centre for Pain Research at NUI Galway is currently recruiting people with chronic pain (pain that has lasted for 3 months or more) to take part in a trial of the ‘Pain Course’, a free online pain self-management programme. The study offers adults living with chronic pain the opportunity to avail of this eight-week Cognitive-Behavioural Therapy course, in the comfort of their own home.
The ‘Pain Course’ was developed by a team of experts at MacQuarie University in Sydney, Australia. The Centre for Pain Research at NUI Galway, in collaboration with the research team at MacQuarie University, is conducting a research trial of the ‘Pain Course’ with adults who experience chronic pain and live in Ireland.
As many people with chronic pain are unable to access specialist pain management services, this course provides people with a programme that teaches them about and how to manage chronic pain, with clinician telephone support, in their own home.
Living with chronic pain is very challenging and people affected by it can also struggle with anxiety and depression for very understandable reasons. Chronic pain can significantly disrupt a person’s life. The ‘Pain Course’ provides good information and teaches practical skills such as Thought Challenging, Activity Pacing, and Controlled Breathing, to help manage the impact of pain on a person’s day-to-day activities, feelings of well-being and overall quality of life.
A pilot study that examined the acceptability of the ‘Pain Course’ among a small group of adults with chronic pain in Ireland found that most participants reported a high level of satisfaction with the course. Increased understanding of their pain condition and Thought Challenging were identified as being particularly helpful features of the course. All participants found the programme to be worthwhile and would recommend it to others. Feedback was predominantly positive: “I have learned the basics about chronic pain.” “Having this information and using the skills delivered in the course, I find that I think about everything in a different way now.” “The course showed me that I am not alone.”
Catherine Navin, a clinical psychologist at NUI Galway who coordinates the study, said: “Over 1,000 Australians have completed the Pain Course with very encouraging results and we are hopeful that adults with chronic pain in Ireland will similarly benefit from this treatment.”
The study will take place over the coming months. General Practitioners, physiotherapists and psychologists are also encouraged to refer suitable people with chronic pain to the study.
Participants can register at: www.nuigalway.ie/centre-for- pain-research/current-studies
There are endless ways to get crafty with low-carb dinners—veggie-crust pizzas, riced cauliflower, zucchini noodles, you name it. But while these substitutes can be great hacks if you eat low carb or are just looking for lower-carb options, creative often translates to complicated. And I don’t know about you, but most of time time, I just can’t be bothered.
I learned this about myself after I tried making cauliflower tater tots one evening in college. They turned out to be a delicious and healthy way to indulge a craving without throwing me off my healthy eating game, but there’s a reason I’ve only made them one time—the effort. And while sometimes I’m willing to put the work, most of the time, it’s not worth it to me.
The good news? Not all low-carb dinners have to keep you in the kitchen for hours (with a mile-high stack of dishes, to boot). These seven recipes each have less than 20 grams of carbs each, and not one of them requires you to hollow out a squash or throw a head of broccoli into a food processor. (And trust me, my bar to consider something “easy” is pretty high.)
Just to be clear, carbohydrates aren’t bad for you. Actually, your body needs them. But if you’re looking for low-carb options for whatever reason, whether you’re trying a new low-carb eating plan, or you just want to introduce more variety into your meals, these have you covered. And, as a bonus, each one has at least the R.D.-recommended 15 grams of protein to keep you going strong.
A new study has found something remarkable: the activation of a particular type of immune cell in the brain can, on its own, lead to obesity in mice. This striking result provides the strongest demonstration yet that brain inflammation may be a cause, rather than a consequence, of obesity. It also provides promising leads for new anti-obesity therapies.
The evidence linking brain inflammation to obesity has been building for some time. Consistent overeating causes stress and damage to cells in the body and brain. This damage results in a response from the immune system that has a wide range of effects. Some of these effects help to reduce the problems caused by overeating, but others seem to make things worse. For example, in the hypothalamus—the part of the brain that controls, among other things, eating and activity—inflammation causes problems such as leptin resistance that interfere with the regulation of body weight.
Leptin is a hormone that is released by fat cells and provides the brain with information about the amount of energy stored as body fat. Normally, neurons in the hypothalamus that are sensitive to leptin will use this information to regulate eating and activity as needed to maintain body fat within some desired range.
In obesity, however, these neurons become insensitive to leptin. As a result, they no longer trigger the decrease in hunger and increase in energy expenditure that are necessary to lose excess weight. This is why the vast majority of attempts by obese people to lose weight fail—inflammation causes the brain to fight against it every step of the way.
So brain inflammation clearly plays an important role in sustaining obesity. But could it also be one of the primary causes of obesity in the first place? The onset of brain inflammation coincides with the other changes that take place in the body and brain as a result of overeating and weight gain. But whether brain inflammation actually causes the development of obesity is not yet clear. The results of the new study, however, demonstrate that the activation of a particular type of brain immune cell, microglia, initiates a cascade of events that do indeed lead directly to obesity.
Manipulating microglia in mice
In the study, researchers at the University of California, San Francisco and the University of Washington performed experiments on mice. They found that altering the activity of microglia in the hypothalamus allowed them to control the body weight of the mice independent of diet. The researchers began by testing the effects of reducing either the number of microglia or their level of activity. They found that both manipulations cut the weight gain that resulted from putting the mice on high-fat diet in half.
They then tested the effects of increasing the activity of microglia. They found that this manipulation caused obesity even in mice that were on a normal diet. This latter result is particularly surprising. The fact that obesity can be induced through microglia—rather than directly through neurons themselves—is an indication of how strongly the brain’s supporting cells can exert control over its primary functions.
So artificial brain inflammation can cause obesity in mice. Of course, that doesn’t mean that natural, diet-induced brain inflammation doescause obesity in humans. But these new results suggest that this idea is worth taking seriously, particularly given that fact that potential solutions to the obesity crisis are in short supply.
This new study alone has already identified several possible targets for anti-obesity drugs. Intriguingly, one of the same drugs that was used in the study to decrease activity in microglia is also being tested in human cancer trials, so initial indications of its effects on body weight should be available soon. But either way, a deeper understanding of the role of brain inflammation will help to clarify the causes of obesity. And hopefully prompt ideas about how it can be avoided in the first place.
Loud noises and bright lights terrified her, school gave her meltdowns. For years Dawn-joy Leong didn’t know why, until she found out she had Asperger’s Syndrome, she tells On the Red Dot.
She had always known that she was different from her friends and relatives, but couldn’t figure out why.
It was only 10 years ago, when she was 42 and her struggle neared breaking point, that she discovered that she was on the autism spectrum – and it all made perfect sense, as people with the disorder sometimes face difficulties communicating and interacting with others.
Unlike autistic children who are diagnosed early and if need be, attend special needs schools, Dr Leong attended a regular school which turned out to be daunting – at times, even traumatic.
Dr Leong is extra sensitive to sound and light, common among people with autism spectrum disorder. “School gave me endless meltdowns. I spent all my energies in school coping with the lights and the sounds.
“Classroom sounds were excruciating because the children dragged their chairs and desks were moved around,” she recalled.
‘I COULD HEAR CHICKENS SCREAMING’
The sensory overload also resulted in her having frequent meltdowns at public places such as wet markets.
“I grew up at a time where the wet markets allowed the fresh slaughter of chickens. I could hear the chickens screaming and the water boiling.
“For a regular person, it was probably nothing, part of the background noise. But in my head, it was like an orchestra, very loud,” recounted Dr Leong, now 52.
That hypersensitivity to sounds, lights and textures meant that she was susceptible to nausea and vomiting.
I would start to get headaches. It felt as if there were knives stabbing through my ears, going in this way, coming out the other way.
Her young sister Ms Althea Leong remembers the frequent meltdowns in school, and how Dr Leong would cry, scream and refuse to listen to the teachers’ instructions.
In her report card, her teachers frequently remarked that “Dawn was argumentative, too talkative and too rude. She has to learn to smile more, to be more friendly, to mix around more”, Ms Leong recalled.
It was a relief, she said, when her older sister found out about her condition in 2007 – somewhat by accident.
Dr Leong had decided to seek psychiatric help after dealing with the stress of studying abroad, living on her own, and coping with her father’s death, which had left her feeling suicidal.
‘I’M NOT BAD, I’M NOT EVIL’
Dr Leong said that it took three sessions before they diagnosed her with Asperger’s syndrome, a condition on the autism spectrum.
“He (the doctor) said ‘actually, you’re not going out of your mind, you’re not a bad person. You have Asperger’s syndrome’.
“It was a wonderful feeling. I am not bad, I am not ill, I am not evil – I am just autistic. It gave me an explanation for why I would react in certain circumstances, my social confusion and especially the sensory difficulties. Why would I have a breakdown at the wet market?” she said.
Watch: How Lucy, her assistance dog, helps her cope (3:00)
Contrary to what many think, autism is a wide spectrum and Dr Leong is not an anomaly: As many as 1 in 150 adults have it.
The programme On the Red Dot (Fridays, 9.30pm on Mediacorp Channel 5) profiles special needs individuals like Dr Leong, focusing on how they cope with their condition and how the community tries to help them.
Autism in adults is harder to diagnose as it may be more difficult to assess their childhood development. Autism spectrum disorders are diagnosed by obtaining detailed developmental history from these patients’ parents, through observation of their behaviours and also psychological assessments.
For Dr Leong, she’s grateful for some of the help that she received in her earlier years, despite her oddball ways.
For example, she had applied to a music programme at the University of Hong Kong after failing her A-Level examinations. The university offered her a probation placement on the condition that she re-take and pass her A-Level examinations.
Some of the professors, on seeing her potential, even helped her to prepare, and she was subsequently admitted. “I was still the odd kid but in a music programme, I think every kid is odd,” she said.
‘RESPECT US AS HUMAN BEINGS’
Since her diagnosis in 2007, Dr Leong has focused on portraying autism through art and music.
She has a Master of Philosophy degree in music composition from the University of Hong Kong and a PhD in autism and art at the University of New South Wales in Sydney.
Autistic people like myself, we just hope for respect as human beings and an understanding of our culture.
Nurse Siti Zulaiha Md Erfan, who has worked with autistic adults, said that society is generally more receptive to autism in children and the elderly than in adults.
In the support groups that she attends, the 37-year-old said, the adults with autism look up to Dr Leong and her works. Madam Siti’s own 10-year-old child is autistic, and she is worried about whether society will accept him when he’s an adult.
“When people see a young adult (with autism) talking to themselves or flapping their arms, people will think that these people are crazy, and no help will be given.
“I’m not really worried about him taking care of himself. I’m more worried about how society is going to accept him,” she said.
Sometimes, you may think treating ankylosing spondylitis (AS) seems more trouble than it’s worth. And we understand. But at the same time, forgoing treatment can mean the difference between living a healthy, productive life and feeling left in the dark. Here are seven things that could happen if you bypass treatment.
1. You might end up with a deformed spine
AS mainly affects the spine. With repeated attacks of inflammation, your spine starts to lose its flexibility. As the disease progresses, moving your spine gets increasingly difficult. The less you move your spine, the stiffer it can get.
In the most severe cases, chronic inflammation causes the formation of extra bone between your vertebrae. In time, the vertebrae can become fused together. Once that happens, your ability to move is severely restricted.
Think about all the everyday tasks that require bending, stretching, or twisting. As for posture, curvature of your spine can leave you permanently stooped over. Fully straightening your spine is no longer possible.
AS medications are designed to control inflammation. Physical therapy can help keep your spine flexible. Following a complete treatment plan can help keep your spine flexible so you can avoid or delay this complication of AS.
Beyond this point, there are few options. A type of surgery called osteotomy might be able to straighten and support your spine. It’s a procedure in which a surgeon has to cut through your spine. For that reason, it’s considered high risk and is rarely used.
2. Multiple joints and ligaments can become damaged
AS is chronic and progressive. Over time, it can fuse your spine and sacroiliac (SI) joints, which are in your hips.
For 10 percent of people with AS, inflammation of their jaw becomes a problem. It’s potentially debilitating because it makes it hard to open your mouth enough to eat. This could lead to malnutrition and weight loss.
About one-third of people with AS develop problems with their hips and shoulders. Some may have damage to their knees.
Inflammation can also occur where ligaments attach to bone. This can affect your back, chest, SI joints, and pelvic bones. It can also create problems for your heels (Achilles tendonitis).
These issues can cause chronic pain, swelling, and tenderness, and keep you from getting a good night’s sleep. They can interfere with everything from bending to the inability to turn your head while driving. Mobility becomes a growing problem.
Untreated spine problems can have a serious impact on your quality of life.
Treatment for AS can help prevent permanent joint damage and fusion. Once you have severe damage to your hips or knees, your options are limited. You may need surgery to replace your damaged hip or knee with a prosthetic one.
3. You can develop osteoporosis
Another potential complication of AS is osteoporosis. This is a condition in which your bones become weak and brittle. It puts all your bones at risk of fracture, even without a fall or hard bump. This is particularly worrisome when it involves your spine.
With osteoporosis, you may have to curb some of your favorite activities. Regular visits with your rheumatologist will help identify osteoporosis as a problem early on. There are a number of effective treatments to help strengthen your bones and lower your risk of fracture.
4. You might have problems with your eyes
Inflammation can also cause problems with your eyes. Anterior uveitis (or iritis) is a condition in which the front of your eye gets red and swollen. It’s more than a cosmetic problem. It can also cause blurry or cloudy vision, eye pain, and light sensitivity (photophobia).
Unchecked, anterior uveitis can lead to partial or complete loss of vision.
Sticking to your treatment regimen and having regular visits with your doctor will help catch anterior uveitis before your eye suffers permanent damage. Prompt treatment from an eye specialist, or ophthalmologist, can help protect your vision.
5. You’re at higher risk of cardiovascular disease
Because AS is a chronic inflammatory autoimmune disease, it increases your risk of cardiovascular disease. Cardiovascular disease includes:
high blood pressure
irregular heartbeat (atrial fibrillation)
plaque in your arteries (atherosclerosis)
You can lower your risk of cardiovascular disease by adhering to AS therapy. This should include a balanced diet, regular exercise, and not smoking.
Because you’re at higher risk, it’s a good idea to see your doctor regularly. The sooner you catch the warning signs of cardiovascular disease, the sooner you can start potentially lifesaving treatment.
6. Chronic inflammation can result in diminished lung capacity
Chronic inflammation can prompt new bone growth and scar tissue where your ribs and breastbone meet. Just as it does to your spine, it can cause bones in your chest to fuse.
That makes it very hard for your chest to fully expand when you breathe. Chest compression can cause pain that worsens when you take a deep breath. Not being able to breathe easily strains even the simplest activity.
You can lower your chances of this complication by taking medications to control inflammation. A physical therapist can also help you perform deep breathing exercises to expand your ribcage.
7. There’s a potential for permanent disability
Any of the complications listed previously can leave you with permanent disabilities. Having just one can lead to:
inability to participate in your favorite physical activities
decreased ability to work
loss of independence
lower quality of life
The goal of AS treatment is to slow disease progression and prevent the types of complications that can lead to permanent disability. A rheumatologist experienced in treating AS can help devise a treatment plan based on your particular needs and preferences.
The only thing harder than losing weight is keeping it off. There are the ongoing adjustments to make sure you stay on course, the bad days that make you want to throw in the towel (and raid the cookie jar), not to mention the never-ending temptations. (So. Many. Temptations.) And, unfortunately, there’s no one-size-fits-all strategy that will help you stay at your goal weight once you get there.
But by learning the inside scoop from women who’ve been there (and are still there), you can take their winning weight-loss strategies for a spin to see if they’re a fit for you too—or just use them as a source of inspiration to find your own.
“I stick to the 80/20 diet as closely as possible. That means 80 percent of my meals are made up of veggies, lean protein, healthy fats, and whole grains. The other 20 percent of my meals are more lax. I’ll eat the things I crave, like a burger at Shake Shack (my favorite), bagels, and pizza once a month—that’s it. The 80 percent of my healthy meals are planned in advance, and I use meal prep to make it happen. If you let yourself decide in the moment (like when it’s 2 p.m. and you realize you forgot to eat lunch), then your decisions are likely to be unhealthy. If you plan in advance, there’s less room for getting off track. These strategies have been so effective for me because they fit nicely into my lifestyle. Over time, I’ve realized that there’s no one-size-fits-all way to create a healthy lifestyle. I found what works best for me, and I stuck with it instead of getting distracted with other health trends.” —Talia Koren
“I think the hardest part is staying motivated with my fitness regimen—either I get bored, or my body gets used to my workouts and I stop seeing results, which makes me feel like quitting. To keep myself from falling into that trap, I always mix things up with my fitness. Yes, I still believe that strength training is key for weight loss for women, but there are other ways to work out too that are (way) more fun.
“Currently, I’m on a dance kick! I take fun classes at Dogpatch Dance and Yoga in San Francisco, which has heels classes, Caribbean-style dancehall classes, tap classes to Beyonce, and even classes that have super-sexy choreography. Sometimes, I’ll take four classes back-to-back and not even think about it until I check my FitBit and it says I’ve burned almost 1,600 calories. I also do yoga, which is on demand, when I need a rest but still want to move my body. When I combine fun fitness experiences with my traditional strength training I never fall into a rut and my body keeps progressing—and best of all, I keep the weight off.
“This journey can be so difficult when you’re going it alone. I make sure that I have multiple tribes of people to help keep me accountable. Each month, a group of women and I check in with our daily workouts and meals via a tracking app—it’s nice to see everyone’s posts, and we always motivate and encourage each other. I also keep in touch with a group of women on Instagram. Although we’ve never met in person, we always like and comment on each other’s posts and DM each other for motivation. Additionally, a group of people I take dance classes with participate in private FB chats to stay connected. The camaraderie and accountability ensure that I don’t let my excuses keep me from staying on track with my fitness and nutrition.” —Allison Tibbs (Dance your way fit with High-Intensity Dance Cardio, the first-ever socanomics DVD!)
I Move More Throughout The Day—Not Just At The Gym
“My exercise isn’t limited to structured workouts. I take two 15-minute walks daily during my breaks at work, and I also make it a goal to hit 10,000 steps a day on my FitBit. When it comes to nutrition, I truly believe that all food can be purposeful and enjoyed in moderation; you need to eat to fuel your body properly, but sometimes you also need food that nourishes the soul. I’m less likely to overeat if I honor my hunger cues and cravings.
“I track and monitor my progress through a variety of methods, including the scale, body-fat tests, progress pictures, and measurements. Instead of focusing on the day-to-day fluctuations, I look for trends over time. This helps hold me accountable and lets me know when I need to make adjustments to my eating or training. At the gym, I stick with mostly compound lifts. The more lean muscle mass I add to my body, the more calories my body burns at rest. I also make sure to consume enough protein and calories overall to maintain my muscle mass. Hydration is everything. When I drink at least 100 ounces of water a day, I stay fuller longer, have better skin, and am less bloated.” —Ellen Yin
I Allow Myself Cheat Meals
“I think one of the most important parts of maintaining the weight loss is staying consistent while also leaving room to have some fun. At the time that I lost the weight, I was doing consistent eating challenges that were pretty strict. Sometimes that meant no alcohol and no eating out (unless I knew how the restaurant cooked the food and if they served proper portions). However, being strict all the time isn’t sustainable. So, to maintain that weight loss and strike a balance between consistency and fun, I settled on allowing myself two cheat meals a week. This means that every Sunday I still prep all my lunches for the week, but I leave myself open to go out and enjoy a burger at some point if I’d like. Having this split of being mostly healthy, but still allowing myself to eat things outside of that seems to be the perfect balance for maintenance.” —Megan Bauer
Children whose moms have any type of fever during pregnancy may have slightly increased odds of developing an autism spectrum disorder, a new study suggests.
The large study found that one episode of fever in the second trimester might increase the risk for autism by 40 percent. Several bouts of fever after the twelfth week of pregnancy could raise the risk threefold, researchers reported.
“Fever is a response to a wide range of infections, and it is common during pregnancy,” said lead researcher Dr. Mady Hornig. She’s an associate professor of epidemiology at Columbia University’s Mailman School of Public Health in New York City.
But she pointed out, “The absolute risk is low. The vast majority of women who get an infection with fever, even flu, are not going to end up having a child with autism.”
Hornig also cautioned this study cannot prove that a fever during pregnancy causes autism, only that there appears to be an association.
The researchers also cannot tell what it is about fever that might have this effect. Hornig speculated that it might involve the body’s reaction to a fever-causing infection that also has an effect on fetal brain development.
“There is something in the mother’s immune response that may increase the risk for the infant,” Hornig said. “But it’s not in every mother. We don’t think this is a pathway for autism. We don’t think it’s the only way autism is triggered in children.”
Surprisingly, the researchers didn’t see much reduction in the fever-associated risk when women took acetaminophen (Tylenol), Hornig said. “We anticipated that we would have seen more of an effect,” she said.
Thomas Frazier, the chief science officer of Autism Speaks, said, “Unfortunately, the study is not able to determine exactly what is driving this relationship — the fever itself, any maternal infection, or specific types of infections.”
For the study, Hornig and colleagues collected data on nearly 100,000 children born in Norway between 1999 and 2009.
Among these kids, nearly 600 were diagnosed with autism spectrum disorder.
Mothers of almost 16,000 children reported having one or more fevers during pregnancy. That rate — 16 percent — is similar to the rate of fevers reported by pregnant women in the United States, Hornig said.
The researchers found that the risk for autism was increased 34 percent when mothers reported fever at any time during pregnancy.
Breaking it down by trimester of pregnancy, the rate of autism increased 34 percent when a mother had a fever in the first trimester, and by 40 percent for a fever in the second trimester. By the third trimester, a fever in the mother was tied to a 15 percent higher risk of autism, the study found.
The risk increased with the number of bouts of fever. The risk was 1.3 times higher with one or two fevers after the twelfth week of pregnancy. And, for women who had three or more fevers after the first trimester, the risk of autism was more than three times higher, the researchers reported.
In addition, women who took acetaminophen for fever in the second trimester only slightly reduced the odds their child would have autism, the researchers found.
Among mothers who took ibuprofen (Advil), however, no cases of autism were reported. However, the researchers couldn’t tell whether the drug reduced the risk for autism, because only a few women took ibuprofen for fever, Hornig said.
Reacting to the study, Dr. Trevor Resnick, a pediatric neurologist at Nicklaus Children’s Hospital in Miami, said that these findings are not something that’s unexpected.
“Autism is an abnormal brain function. Abnormal brain development can be caused by many things including genes and certain diseases that affect the brain,” Resnick said.
If there is an injury to the brain during its development, it can also predispose a child to autism, he said.
“But it doesn’t have to be autism, it could be epilepsy, or a brain malformation, depending on which virus it is and how it affects brain development. So it’s no stretch of the imagination to say that there may be a virus that affects brain development and results in autism,” Resnick said.
It isn’t clear, however, if it’s the fever that’s predisposing the baby to autism or the cause of the fever or the body’s immune response to the infection, Resnick said.
“Women should not be freaked out,” he said. “Some women may be unlucky enough to get the wrong virus at the wrong time, and they are at risk. Predominantly, women who get viruses have babies that are fine,” Resnick said.
A machine-learning algorithm has analysed brain scans of 6-month-old children and predicted with near-certainty whether they will show signs of autism when they reach the age of 2. The finding means we may soon be able to intervene before symptoms appear, although whether that would be desirable is a controversial issue.
“We have been trying to identify autism as early as possible, most importantly before the actual behavioural symptoms of autism appear,” says team member Robert Emerson of the University of North Carolina at Chapel Hill.
Previous work has identified that bundles of nerve fibres in the brain develop differently in infants with older siblings with autism from how they do in infants without this familial risk factor. The changes in these white matter tracts in the brain are visible at 6 months.
For the new study, Emerson and his team did fMRI brain scans of 59 sleeping infants, all of whom were aged 6 months and had older siblings with autism, which means they are more likely to develop autism themselves.
Connecting the dots
The scans collected data from 230 brain regions, showing the 26,335 connections between them. When the team followed-up with the children at the age of 2, 11 had been diagnosed with an autism-like condition. The team used the brain scans from when the babies were 6 months old and behavioural data from when the children were 2 years old to train a machine-learning program to identify any brain connectivity patterns that might be linked to later signs of autism, such as repetitive behaviour, difficulties with language, or problems relating socially to others.
After the training, the program used only the patterns from the 6-month-old brains to predict which of the children would show signs of autism at 2 years old. It correctly identified nine of the 11 who had been diagnosed at that age.
“The study confirms that autism has a biological basis, manifest in the brain before behavioural symptoms appear, and that autism is not due to environmental effects that occur after 6 months, for example, vaccinations,” says Uta Frith of University College London. “This still needs pointing out.”
The goal is to use such a classifier system to identify infants likely to develop autism at an early age. “That is the idea,” says Emerson. “What we desperately need to do is replicate the study first.”
The ability to predict who will develop behaviours linked to autism raises the prospect of giving training to parents so they can reduce the impact of some less-positive aspects of autism. Emily Jones of Birkbeck, University of London, and her colleagues have studied early interventions in which parents enhance their own responses to an infant’s social communication cues and behaviours. “We have shown that those kinds of interventions can help in reducing symptoms long term, both behaviourally and also in the brain,” says Jones.
About 20 per cent of children with a high familial risk of autism go on to be diagnosed with the condition, but only around 1.5 per cent of the general population have autism. If Emerson’s system can provide a way to predict which high-risk infants might benefit from early interventions, the challenge will be to extend the technique to work for children with a lower likelihood of developing autism.
“Even if the classification works well on the present data set, we don’t know how well it would work with a completely new set,” says Frith, who warns that the machine learning algorithms could lead to false positives.
The idea of intervening before behavioural characteristics appear is a controversial one. Many people consider autism to be a fundamental part of their personality, and although some autistic people have substantial difficulty communicating or forming relationships, some people with autism value traits such as abilities to concentrate, pay attention to detail or see things from a novel perspective. It’s hard to know whether early intervention could disrupt these.
In theory, machine-learning algorithms may be able to identify not just children who are likely to develop autism, but those who are likely to have particular problems, such as difficulties with language. If so, then early intervention therapies could be targeted to those who would benefit from help fostering those specific skills. “That probably could remove some of the controversy,” says Jones.