Objective: Autism spectrum disorders are considered to be among the most heritable mental disorders, a notion based on surprisingly sparse data from small clinical studies. Population-based studies of the heritability of other neuro-psychiatric disorders and comorbidities among them have also been sparse. The authors sought to address both of these issues. Method: Parents of all Swedish 9- and 12-year-old twin pairs born between 1992 and 2000 (N=10,895) were interviewed regarding autism spectrum disorders and associated conditions (response rate, 80%). Concordance rates and structural equation modeling were used for evaluating causes for familial aggregation and overlap between conditions. Results: Monozygotic twins had higher concordance rates than dizygotic twins for autism spectrum disorders, attention defcit hyperactivity disorder (ADHD), developmental coordination disorder, and tic disorder. Genetic effects accounted for 80% (95% CI=29-91) of the variation in liability for autism spectrum disorders, 79% (95% CI=61-88) for ADHD, 70% (95% CI=35-83) for developmental coordination disorder, and 56% (95% CI=37-68) for tic disorder. Among monozygotic co-twins of children with autism spectrum disorders, the probability of having a diagnosis of ADHD was 44%, compared with 15% for dizygotic co-twins. Differences in cross-disorder effects between monozygotic and dizygotic twins were observed for most other comorbidities, and substantial proportions of the genetic variance for autism spectrum disorders was shared with each of the other disorders. Conclusions: Different neuropsychiatric disorders seem to have a common genetic etiology, suggesting caution in the use of diagnostic entities and proband status in efforts to uncover genes predisposing to autism spectrum disorders.

The genetics of autism spectrum disorders and related neuropsychiatric disorders in childhood

Ongoing debate exists within the resting state fMRI literature over how intrinsic connectivity is altered in the autistic brain, with reports of general over-connectivity, under-connectivity, and/or a combination of both. Classifying autism using brain connectivity is complicated by the heterogeneous nature of the condition, allowing for the possibility of widely variable connectivity patterns amongst individuals with the disorder. Further differences in reported results may be attributable to the age and sex of participants included, designs of the resting state scan, and to the analysis technique used to evaluate the data. This review systematically examines the resting state fMRI autism literature to date and compares studies in an attempt to draw overall conclusions that are presently challenging. We also propose future direction for rs-fMRI use to categorize individuals with ASD, serve as a possible diagnostic tool, and best utilize data-sharing initiatives.

/pdf/resting-state-functional-connectivity-in-autism-spectrum-182mqghb8e.pdf

Resting-State Functional Connectivity in Autism Spectrum Disorders: A Review

Importance The prevalence of autism spectrum disorders (ASDs) has increased markedly in recent decades, which researchers have suggested could be caused in part by nonetiologic factors such as changes in diagnosis reporting practices. To our knowledge, no study has quantified the degree to which changes in reporting practices might explain this increase. Danish national health registries have undergone a change in diagnostic criteria in 1994 and the inclusion of outpatient contacts to health registries in 1995. Objective To quantify the effect of changes in reporting practices in Denmark on reported ASD prevalence. Design, Setting, and Participants We used a population-based birth cohort approach that includes information on all individuals with permanent residence in Denmark. We assessed all children born alive from January 1, 1980, through December 31, 1991, in Denmark (n = 677 915). The children were followed up from birth until ASD diagnosis, death, emigration, or the end of follow-up on December 31, 2011, whichever occurred first. The analysis uses a stratified Cox proportional hazards regression model with the changes in reporting practices modeled as time-dependent covariates. Exposures The change in diagnostic criteria in 1994 and the inclusion of outpatient diagnoses in 1995. Main Outcomes and Measures Autism spectrum disorders. Results For Danish children born during the study period, 33% (95% CI, 0%-70%) of the increase in reported ASD prevalence could be explained by the change in diagnostic criteria alone; 42% (95% CI, 14%-69%), by the inclusion of outpatient contacts alone; and 60% (95% CI, 33%-87%), by the change in diagnostic criteria and the inclusion of outpatient contacts. Conclusions and Relevance Changes in reporting practices can account for most (60%) of the increase in the observed prevalence of ASDs in children born from 1980 through 1991 in Denmark. Hence, the study supports the argument that the apparent increase in ASDs in recent years is in large part attributable to changes in reporting practices.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/1919642/poi140052.pdf

Explaining the Increase in the Prevalence of Autism Spectrum Disorders: The Proportion Attributable to Changes in Reporting Practices

The prevalence of Autism Spectrum Disorder (ASD) has increased dramatically in recent decades, supporting the claim of an autism epidemic. Systematic monitoring of ASD allows estimating prevalence and identifying potential sources of variation over time and geographical areas. At present, ASD prevalence estimates are available worldwide, coming either from surveillance systems using existing health and educational databases or from population studies specifically performed. In the present article, we present a review of the ASD prevalence estimates published since 2014. Data confirm a high variability in prevalence across the world, likely due to methodological differences in case detection, and the consistent increase of prevalence estimates within each geographical area.

https://www.mdpi.com/2076-3425/10/5/274/pdf

Epidemiology of Autism Spectrum Disorders: A Review of Worldwide Prevalence Estimates Since 2014

Fluorine is the world's 13th most abundant element and constitutes 0.08% of the Earth crust. It has the highest electronegativity of all elements. Fluoride is widely distributed in the environment, occurring in the air, soils, rocks, and water. Although fluoride is used industrially in a fluorine compound, the manufacture of ceramics, pesticides, aerosol propellants, refrigerants, glassware, and Teflon cookware, it is a generally unwanted byproduct of aluminium, fertilizer, and iron ore manufacture. The medicinal use of fluorides for the prevention of dental caries began in January 1945 when community water supplies in Grand Rapids, United States, were fluoridated to a level of 1 ppm as a dental caries prevention measure. However, water fluoridation remains a controversial public health measure. This paper reviews the human health effects of fluoride. The authors conclude that available evidence suggests that fluoride has a potential to cause major adverse human health problems, while having only a modest dental caries prevention effect. As part of efforts to reduce hazardous fluoride ingestion, the practice of artificial water fluoridation should be reconsidered globally, while industrial safety measures need to be tightened in order to reduce unethical discharge of fluoride compounds into the environment. Public health approaches for global dental caries reduction that do not involve systemic ingestion of fluoride are urgently needed.

https://downloads.hindawi.com/journals/tswj/2014/293019.pdf

Water fluoridation: a critical review of the physiological effects of ingested fluoride as a public health intervention.

Autism spectrum disorders (ASDs) are estimated to occur among about one percent of children in the United States. This estimate is in line with estimates from other industrialized countries. However, the identified prevalence of ASDs has increased significantly in a short time period based on data from multiple studies including the U.S. Centers for Disease Control and Prevention’s (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network. Whether increases in ASD prevalence are partly attributable to a true increase in the risk of developing ASD or solely to changes in community awareness and identification patterns is not known. It is clear that more children are identified with an ASD now than in the past and the impact on individuals, families, and communities is significant. However, disentangling the many potential reasons for ASD prevalence increases has been challenging. Understanding the relative contribution of multiple factors such as variation in study methods, changes in diagnostic and community identification, and potential changes in risk factors is an important priority for the ADDM Network and for CDC. This article summarizes the discussion from a workshop that was co-sponsored by CDC and Autism Speaks as a forum for sharing knowledge and opinions of a diverse range of stakeholders about changes in ASD prevalence. Panelists discussed recommendations for building on existing infrastructure and developing new initiatives to better understand ASD trends. The information, research, and opinions shared during this workshop add to the knowledge base about ASD prevalence in an effort to stimulate further work to understand the multiple reasons behind increasing ASD prevalence.

/pdf/evaluating-changes-in-the-prevalence-of-the-autism-spectrum-5538yn2mt7.pdf

Evaluating Changes in the Prevalence of the Autism Spectrum Disorders (ASDs).

In recent years, there has been increasing awareness about autism spectrum disorders (ASD) around the world, including in low and middle income countries. Unlike countries in Western Europe and North America where infrastructure and capacity are available to help meet some of the needs of individuals with ASD, little expertise or capacity exists in most of the developing world. In 2008 Autism Speaks launched the Global Autism Public Health (GAPH) Initiative to facilitate the development of systematic and sustainable solutions for enhancing global autism awareness, research, training and service delivery. In the last 3 years Autism Speaks has established collaboration with stakeholders from over 20 countries who are working alongside dedicated local and international stakeholders to effect change. In this article, the GAPH framework is described, along with a few brief case examples that illustrate how the framework for implementation of the model can occur. GAPH is still in its infancy but has the potential to have significant impact through inclusive collaboration with local and international stakeholders to develop effective and sustainable public health solutions for disseminating best practices and delivering tangible benefits to individuals with ASD and their families.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/aur.1236

A global public health strategy for autism spectrum disorders.

http://www.scielo.br/pdf/ramb/v57n1/v57n1a02.pdf

Autism in Brazil: perspectives from science and society

Autism Speaks Global Autism Public Health Initiative: Bridging gaps in autism awareness, research, and services around the world.

Objective
Research has demonstrated that early intervention for children with autism can lead to improvements in core symptoms and enhance cognition, adaptive functioning, and quality of life. Unfortunately, most children are diagnosed too late to fully benefit from these services. Even in regions where diagnosis of autism can reliably be made, families often face additional barriers in accessing quality services. This article describes case examples in which Autism Speaks’ Global Autism Public Health (GAPH) Initiative partnered with communities to facilitate a process of multi-stakeholder collaboration to better understand local autism priorities related to awareness activities, early diagnosis, and developing autism surveillance systems.

Method
This paper utilised a nested case study to demonstrate how GAPH employs multi-stakeholder collaboration, community-based participatory research (CBPR) and consensus building to enhance early identification in low-resource settings. Each of these processes influenced different phases of the projects.

Results
In the first example, Autism Speaks adopted a CBPR approach to understand and address barriers to help-seeking behaviour among the Korean community affected by autism in New York City. The second example describes an international effort to develop open-source screening and diagnostic tools for autism that can be delivered by non-specialists in low-resource settings. The last example describes efforts to facilitate the development of an autism registry in Ireland to inform health policy decisions.

Conclusions
Collectively, these examples outline approaches the GAPH initiative uses to support global communities in working to overcome challenges related to the needs of individuals with autism and their families.

The Role of Multi-Stakeholder Collaboration and Community Consensus Building in Improving Identification and Early Diagnosis of Autism in Low-Resource Settings

Michael Rosanoff

Papers

Evaluating Changes in the Prevalence of the Autism Spectrum Disorders (ASDs).

A global public health strategy for autism spectrum disorders.

Autism in Brazil: perspectives from science and society

Autism Speaks Global Autism Public Health Initiative: Bridging gaps in autism awareness, research, and services around the world.

The Role of Multi-Stakeholder Collaboration and Community Consensus Building in Improving Identification and Early Diagnosis of Autism in Low-Resource Settings