Autism risk factors: moving from epidemiology to translational epidemiology

James C. Harris, MD (1940-2021)

Sadly, Dr. James C. Harris passed away at his home in April 2021, peacefully and in the presence of his loving wife Catherine DeAngelis, MD, shortly after he was diagnosed with pancreatic cancer. He was born in Birmingham, Alabama, and received his medical degree in 1966 from the George Washington University School of Medicine in Washington, DC. This followed a year of internship at the Children's Hospital of Los Angeles in California and a residency in Pediatrics at Strong Memorial Hospital University of Rochester in New York State. He came to Johns Hopkins as a Senior Assistant Resident in Pediatrics in 1972, and it is then that Hopkins became his professional home, which he never left. He proceeded to complete his general psychiatry residency and child and adolescent psychiatry fellowship at Johns Hopkins as well. Dr. Harris was Professor of Psychiatry and Behavioral Sciences, and of Pediatrics, former Director of Child and Adolescent Psychiatry, founding director of the Developmental Neuropsychiatry Program at Hopkins and the Kennedy Krieger Institute, and a beloved mentor to so many of today's leaders in child and adolescent psychiatry. Jim was indeed a distinguished clinician, educator, scholar, investigator, and advocate; he was also my training director, mentor, and friend.

Quality of Life of Caregivers of Autistic Children and Adolescents Visiting Health Facilities in Lucknow City, Uttar Pradesh, India: A Cross-sectional Study

Background:

The lifelong responsibility of the autistic children along with the lack of knowledge, lack of treatment, and if treatment is available, it is unaffordable leads to deterioration of quality of life of the parents in several domains.

Objectives:

The objective is to study the quality of life of principal caregivers of autistic children and adolescents visiting health facilities in Lucknow city.

Materials and Methods:

The sample included 90 principal caregivers (aged < 60 years) of autistic children and adolescents aged 3–19 years and diagnosed with autism, attending government and private health facilities providing treatment for autism in Lucknow, Uttar Pradesh, India.

Results:

The quality of life of principal caregivers was found to be influenced most in the physical health domain (with least score). The predictors of quality of life of principal caregivers were type of family and knowledge regarding child's problem.

Conclusion and Recommendations:

Thus, there is an immense need of increasing awareness through information, education, and communication materials, mass media, and discussions regarding autism.

Sociodemographic differences in parental satisfaction with an autism spectrum disorder diagnosis

BACKGROUND

The diagnostic process for autism spectrum disorder (ASD) can be difficult for families. Growing evidence suggests that the diagnostic process may vary as a function of sociodemographic factors, such as socioeconomic status. The purpose of this study was to extend findings related to families' experiences obtaining a diagnosis and accessing services for their young child with ASD.

METHOD

A mixed methods approach was used in this study, in which 46 families with children with ASD participated. A chi-square analysis compared ratings of parental satisfaction with the diagnostic process and current services between sociodemographic groups, and this was supplemented by thematic analysis of relevant open-ended questions.

RESULTS

Results indicated that satisfaction ratings varied significantly by maternal education and family income levels. Ratings of satisfaction with the child's paediatrician also differed by family income. Major themes from the open-ended questions are discussed.

CONCLUSIONS

Results support assessing satisfaction and barriers in families seeking healthcare and school-based services to facilitate access to services.

Autism spectrum disorders in children of parents with inflammatory bowel disease - a nationwide cohort study in Denmark

PURPOSE

Inflammatory bowel disease (IBD) and autism spectrum disorders (ASD) may share genetic and environmental risk factors. We examined whether parental IBD is associated with an increased risk of ASD in offspring.

METHODS

We conducted a registry-based nationwide cohort study including children born alive in Denmark from January 1, 1994 to December 31, 2009, with follow-up throughout 2010. IBD in parents and ASD in offspring were identified using inpatient and outpatient hospital diagnoses. We computed risk of ASD and crude and adjusted incidence rate ratios (aIRRs) with 95% confidence intervals (CI) using Cox proportional-hazards regression. We evaluated the risk of ASD according to maternal and paternal IBD, and separately for maternal and paternal Crohn's disease (CD) and ulcerative colitis (UC). Children with parents free of IBD were the comparison cohort.

RESULTS

We identified 1,005,330 children during the study period. Among them, 11,888 (1.2%) had a parent with IBD and 8,087 (0.8%) had a diagnosis of ASD during up to 17 years of follow-up. The 10-year risks of ASD were 0.7% among children of parents with IBD and 0.9% among children of parents without IBD. The aIRR for ASD among children with parental IBD was 0.8 (95% CI: 0.6-1.0), and results were similar regardless of parent of IBD origin or whether a parent had CD or UC. The estimates were similar for different ASD subtypes.

CONCLUSION

We found no evidence of an increased risk of ASD among children born to parents with IBD.