The A.J. Drexel Autism Institute at Drexel University has received a grant of $3.6 million from an anonymous donor to launch four major initiatives of its Life Course Outcomes research program, focused on understanding and improving quality of life issues for people on the autism spectrum at all ages. This program is led by Autism Institute professor Paul Shattuck, PhD, a nationally recognized expert on these issues.

“Finding ways for people on the autism spectrum to pursue fulfilling lives as full members of the community is vitally important work,” said Drexel University President John A. Fry. “Thanks to this incredibly generous gift, Drexel can help Dr. Shattuck expand his pioneering work in this area and further the A.J. Drexel Autism Institute’s critical mission.”

Four major research initiatives being advanced by the Life Course Outcomes Program include:

1. Indicators Initiative, assessing community and national indicators of services and outcomes
2. Promising Practices Initiative, examining innovative approaches to service provision and policies
3. Research Leadership Initiative, expanding the field of useful research by training additional scholars
4. Long-Term Knowledge Initiative, doing studies that discover how life unfolds over a long period of time for people on the autism spectrum and their families.

The Autism Institute leadership is actively pursuing additional partnerships for these key initiatives.

“About 500,000 adolescents on the autism spectrum will enter adulthood in the next decade,” said Shattuck, an associate professor at the A.J. Drexel Autism Institute with a secondary appointment in Drexel’s School of Public Health. “We believe people on the autism spectrum are valuable members of our communities. They have roles to play, dreams to achieve and contributions to make. We see an urgent need for research aimed directly at understanding what strategies, beyond clinical interventions, promote positive outcomes and prevent negative ones – both for people on the autism spectrum and the families and communities they are part of.”

Shattuck joined Drexel in 2013 and is one of only a handful of scholars in the world whose work is wholly devoted to answering these kinds of questions. The A.J. Drexel Autism Institute was established in 2012 as the nation’s first autism research center based on a public health science approach.

Drexel’s Life Course Outcomes Program addresses questions about quality of life across the entire lifespan. Are children getting diagnosed and entering services at an early age? What’s holding back more adults on the spectrum from attending college or becoming gainfully employed? What kinds of services do people receive compared to what they need? What’s working and what’s not?

The program’s aims address the needs and challenges recognized by many adults on the autism spectrum as well as by parents of children with autism who anticipate the so-called “services cliff” that occurs when young adults on the spectrum age out of supports that are available to children and adolescents.

Sonia Voynow, a psychotherapist and parent of a teenager with ASD, who leads support groups for parents and grandparents of children on the spectrum, noted “a sense of terror” among parents such as herself when anticipating their kids’ future. “We know that our children are capable of so much when they have the right supports,” Voynow said. “But we don’t know where to find these resources, or if they even exist, particularly as our kids reach adulthood. Drexel’s Autism Institute, by using a systematic and organized approach to focus on what works for these kids, is filling a huge, and growing, need.”

“No approach to autism from a public health perspective could be comprehensive without considering the experiences of individuals and communities across the entire lifespan,” said Craig Newschaffer, PhD, director of the A.J. Drexel Autism Institute and a professor in Drexel’s School of Public Health. “We are grateful to our anonymous donor whose generosity will help Drexel lead the way on research with a lifespan perspective. Dr. Shattuck will answer essential questions for individuals on the spectrum, their families and our communities.”

As the Life Course Outcomes program grows, Shattuck and colleagues at Drexel envision – as described in a recent JAMA Pediatrics editorial – an approach that is centered on innovation and investment. Their aims include learning from innovations already underway in communities; measuring systematically and repeatedly to quantify societal impacts over time; planning large, long-term life-course studies for autism; and increasing the number of scholars pursuing this line of work.

“Ultimately, we need to know if the billions spent to move the needle on life outcomes like employment, health, community contribution, and social participation are having a measurable impact,” said Shattuck. “This gift positions the A.J. Drexel Autism Institute to lead the way in figuring out how to strengthen the connection between efforts and outcomes so we know what’s working for whom.”

For More Information

To learn more about research at the A.J. Drexel Autism Institute, see the special report in Drexel University’s research magazine, EXEL: Exploring the Spectrum.

To learn more about the A.J. Drexel Autism Institute, visit the institute’s website or follow on Facebook or Twitter.

– See more at: http://drexel.edu/now/archive/2014/September/Autism-Life-Course-Research/

A new study from researchers at Drexel University adds evidence that using common antidepressant medications during pregnancy may contribute to a higher risk of autism spectrum disorders (ASD) in children, although this risk is still very small.

Results from past studies of prenatal use of selective serotonin reuptake inhibitors (SSRIs) and ASD risk have not been consistent. An ongoing challenge in this line of research is trying to tease apart potential effects of the medication on risk from the effects associated with the condition for which the medication was prescribed (most commonly depression). Based on past studies, both SSRIs and genetic factors associated with depression are likely associated with greater risk of ASD.

This new study, published online ahead of print last month in the Journal of Autism and Developmental Disorders, suggests that under-reporting of maternal depression, if not properly considered in analyses, may influence results of studies trying to address this question.

In the study, the Drexel team analyzed large population based registers of nearly 750,000 births in Denmark from 1997 through 2006. They found that about 1.5 percent of children born to women who had taken an SSRI during pregnancy were diagnosed with ASD, compared to about 0.7 percent of children born to an otherwise similar group of women not taking the medication.

“We found a two-fold increased risk for ASD associated with in utero exposure to SSRIs compared to the unexposed reference group” said lead author Nicole Gidaya, PhD. “More importantly, in our analysis we accounted for under-reporting of maternal depression in the register. This suggests that under-reporting of the confounder, maternal depression, may be a limitation in approaches previously used in the other studies.”

Gidaya, who performed this study while a doctoral student in the Drexel University School of Public Health, noted that “if the increased ASD risk we saw here is real, it is important to realize that the number of ASD cases that could be prevented by reducing SSRI exposure in pregnancy still represents only a small fraction of overall cases of ASD.”

The researchers further advised caution in interpreting the results in practice. Because of the challenges of distinguishing effects of medications from those of the condition indicating their use, more research in larger study populations will be needed to confirm the findings. In addition, the decision whether or not to use an SSRI in pregnancy is a complex one; pregnant women and their doctors need to consider women’s physical and mental health needs as well as other pregnancy-associated risks, including risks associated with untreated depression both during and after pregnancy.

However, the research team believes that the greater value of this finding is to direct further attention on understanding the mechanisms by which in utero SSRI exposure might influence the developing brain. Serotonin is a neurotransmitter whose use by the brain is altered during depression and modified by SSRI use, and has been shown to play an important role in brain development.

The authors of the current study point out that there is still a need for more population studies of possible associations between maternal SSRI use and autism, in light of the limitations of the present study and the conflicting results within the field’s previous studies of the question. They say future studies should use a large population sample where there is good quality data about exposure to medication, mental health diagnoses as well as ASD diagnoses.

“As we complete research in our attempts to understand autism’s causes we continue to realize that there are likely many genetic and non-genetic contributors,” said Craig Newschaffer, PhD, director of the A.J. Drexel Autism Institute and professor in Drexel’s School of Public Health, and the study’s senior author. “We must begin trying to map these multiple risk factors on to common pathways, so that these pathways can be a focus in our effort to prevent the impairment associated with ASD.  Pathways involving the brain’s serotonin system are still one viable candidate.”

Gidaya performed this research with the support of funding from Drexel’s Office of International Programs which allowed her to travel to Denmark.

– See more at: http://drexel.edu/now/archive/2014/June/Antidepressants-Autism-Risk/

Older parents are more likely to have a child who develops an autism spectrum disorder (ASD) than are younger parents. A recent study from researchers from the Drexel University School of Public Health in Philadelphia and Karolinska Institute in Sweden provides more insight into how the risk associated with parental age varies between mothers’ and fathers’ ages, and found that the risk of having a child with both ASD and intellectual disability is larger for older parents.

In the study, published in the February 2014 issue of the International Journal of Epidemiology, researchers report that fathers’ and mothers advancing ages have different impacts on their child’s risk. The rise in ASD risk with parental age was greater for older mothers as compared to older fathers.

“The open question at hand really is, what biological mechanisms underlie these age effects?” said Brian K. Lee, PhD, an assistant professor in the Drexel University School of Public Health and research fellow of the A.J. Drexel Autism Institute, and senior author of the study.  The observed differences in risk based on mothers’ and fathers’ ages point to a need to continue investigating underlying mechanisms of ASD that may be influenced by a mother’s age, Lee said, even though much recent discussion has focused on fathers’ and even grandfathers’ ages.

The risk of having a child with ASD had a more complicated relationship to age in women than in men – whose risk of fathering a child with ASD increased linearly with age across their lifespan. Among women giving birth before the age of 30, the risk of ASD in the child showed no association with age — it was simply very low. But for babies born to mothers aged 30 and older, the chance of developing ASD rose rapidly with the mother’s age.

Lee noted that the non-linear maternal age effect that is relatively stronger than the paternal age effect on ASD risk has been observed in previous studies, but has not received much attention.

Multiple mechanisms could be in play to account for the different patterns of risk, including environmental risk factors occurring in women after age 30. Factors such as complications in pregnancy could also underlie the effect of mothers’ ages on a child’s ASD risk but not a paternal age effect. The linear, steady increase in risk associated with fathers’ ages is consistent with the hypothesis of increased genomic alterations over the father’s lifespan that can increase risk of ASD, Lee said.

In this study, Lee and colleagues analyzed a large population registry sample of 417,303 children born in Sweden between 1984 and 2003, adjusted for numerous possible factors that could vary with parental age and also influence risk, such as family income and each parent’s psychiatric history.  The study also used a particularly comprehensive case-finding approach, to identify more ASD cases than other studies might, based on all pathways to care in a socialized health system.

A goal was to study these parental age effects in more detail by looking at possible differing risks of ASD with and without intellectual disability – one of the most serious comorbid diagnoses with ASD, with a significant impact on functional status in life. This was the first population-based study with an ASD sample large enough to study ASD risk in populations of children with and without intellectual disability.

“When considering risk factors, we can’t necessarily lump all ASD cases together, even though they fall under a broad umbrella of autism,” Lee said. “We need to keep an open mind in case intellectual disability might be a marker of a different underlying mechanism.”

The finding that ASD with intellectual disability had a stronger association with older parents, compared to ASD without intellectual disability, supports continued investigation of possible different mechanisms.

Lee noted that, although age effects are important indicators of risk at the population level that could eventually help researchers identify preventable causes of disability, they aren’t very significant for a couple’s family planning because the overall risk remains low. “The absolute risk of having a child with ASD is still approximately 1 in 100 in the overall sample, and less than 2 in 100 even for mothers up to age 45.”

– See more at: http://drexel.edu/now/archive/2014/April/Autism-Risk-Older-Parents/