The changes, detected in white matter of the infants’  brains, were widespread and would likely have a profound effect on brain development, said Annette Estes, PhD, research associate professor of speech and hearing sciences at the UW and a co-author of the study.

The findings also suggest that autism does not develop suddenly but involves a long process that begins early in life, Estes said.

A tensor diffusion image showing the white matter tracts of the brain

Individuals with autism typically have difficulty with social interaction, interpersonal communication and may engage in repetitive behaviors. Symptoms can range from mild to severely disabling.

The U.S. Centers for Disease Control and Prevention estimates that 1 in 110 U.S. children is affected by the disorder. The condition is usually detected in the second year of life after a seemingly normal infancy.

Although the cause of autism is unknown, recent research suggests that abnormalities in the brain’s white matter are involved.

White matter: the brain’s wiring

White matter is made up of bundles of millions of nerve fibers that create the “wiring” through which nerve cells communicate with each other. These nerve fibers are sheathed in a fatty insulating material, called myelin, that gives these areas of the brain a whitish appearance.

It is thought that abnormalities in white matter not only disrupt communication within the brain but also impair normal brain development, Estes said.

In the study, the UW researchers, working with collaborators from across the country, studied the brains 92 infants with a technique called diffusion tensor imaging that allowed them to track the development of the infants’ white matter,

The infants all came from families that already had one child with autism, which meant the infants were at high-risk of developing the condition as well.

Each infant had diffusion tensor imaging study at six months followed by a behavioral assessment at the age of two. Most also had follow-up scans at at one and two years of age.

The  researchers found that at the age of two, 28, or 30 percent, of the children had symptoms of autism while 64, or 70 percent, did not.

Comparing the brain imaging studies of the two groups revealed significant differences in the development of 12 of the brain’s 15 major white matter tracts.

That so many white matter tracks are involved suggests that at this stage autism is a “a whole-brain phenomenon not isolated to any particular brain region at this early stage of development,” said said Dr. Stephen R. Dager, M.D., UW professor of radiology and principal investigator of the University of Washington team.

The study’s findings are preliminary and diffusion tensor imaging is not ready to be used to diagnose autism in infants, Estes said, but the technique should help researchers better understand the cause of the condition and hopefully develop better interventions.

Autism and childrearing

In the past, it was commonly held that autism was the result of the failure on the part of parents to be sufficiently nurturing to their infants,  but the findings of this study suggest autism involves abnormal brain development that begins very early in life, Estes said.

Many parents wrongly blame themselves when their child develops autism, Estes said, but these findings indicate they “did nothing wrong” to cause the condition.

Future research will include looking at changes in the white matter development in infants younger than six months of age and tracking those changes as children age, Estes said.

The study, published online by the American Journal of Psychiatry, was the result of a collaboration with the Infant Brain Imaging Study (IBIS) Network funded by the National Institutes of Health and headquartered at the University of North Carolina at Chapel Hill.

Dr. Joseph Piven, professor of psychiatry at University of North Carolina at Chapel Hill and director of UNC’s Carolina Institute for Developmental Disabilities, was the senior author of the study.

Other institutions that took part in the study include the University of Utah, Washington University in St. Louis, McGill University, Children’s Hospital of Philadelphia and the University of Alberta.

To learn more:

• Visit the Infant Brain Imaging Study (IBIS) website: www.ibisnetwork.org

• UW Autism Center’s IBIS page.

• Seattle Children’s Autism Center.

Temple Grandin, who was diagnosed with autism as a child but went on to obtain a Ph.D. in animal science, is noted for her work exploring the similarities between autistic consciousness and the thought processes of animals — research that has led to improvements in livestock handling to reduce animal stress.

Grandin’s research on pictorial thinking shared by animals and autistics alike has resulted in more than 400 scientific and lay publications, 6 books, and numerous awards.

In 2010, TIME Magazine listed Grandin as one of the 100 Most Influential People in the World.

Improving Animal Welfare

When:

Wednesday, November 30, 2011

4:00 – 5:45 PM

Where

Hogness Auditorium (A-420), Health Sciences Center, UW

Event is free and open to the public. A personal book signing will follow the lecture.

Time: Study: Autistic Children Have More Brain Cells

PET scan by Jens Langner

There’s growing evidence that the brains of autistic children are very different from the brains of other youngsters.

Now a new study that found an excess of brain cells in children with autism comes closer to pinpointing the origins of the condition: in utero versus in toddlerhood.

In research reported in the Journal of the American Medical Association (JAMA), scientists at the University of California, San Diego, found that autistic children have about 67% more nerve cells in a part of the brain known as the prefrontal cortex than children without autism.

The prefrontal cortex is involved in processing social skills, communication, cognitive functions and language — all areas in which autistic children often show abnormal development (Alice Park, 11/9).

The Atlantic: A Conservative Icon Upholds The Affordable Health Care Act

Photo: Franz Jantzen

Just in time for Thursday’s Supreme Court conference, the Affordable Care Act … was upheld Tuesday in an opinion by one of America’s most feared conservative judges — Judge Laurence Silberman of the District of Columbia Court of Appeals, a jurist so gruff he is rumored to make some lawyers cry just by agreeing with them.

Silberman is also a conservative icon — Ronald Reagan appointee, friend and sometime mentor to Clarence Thomas, co-chair of the Iraq Intelligence Committee, winner of the Presidential Medal of Freedom, Second Amendment hard-liner. … the opinion removes one reason why the Supreme Court might have wanted to delay responding to the government’s petition for review of Eleventh Circuit’s decision striking down the act.

But the D.C. Circuit’s decision reminds us that, if a majority of this conservative Court does decide to scuttle the ACA, it will almost certainly have to scuttle or vitiate that century of precedent — the legal basis upon which regulation of the national economy depends (Garrett Epps, 11/9).

Mother Jones: Why Mississippi’s Personhood Measure Failed

Mississippi voters overwhelmingly rejected a ballot measure that would have granted full rights to a fertilized egg on Tuesday, with 58 percent of the state voting against the amendment.

Activists on both sides of the battle were watching the state as a test case for other state-level initiatives that would outlaw all forms of abortion. Perhaps it’s worth looking, then, at why it didn’t pass in one of the most conservative states in the country.

The primary reason for the measure’s failure was overreach. In recent weeks, opponents of the measure made the case to the public that it wasn’t really just about abortion, but could also have far-reaching impacts on birth control, in vitro fertilization, and a doctor’s ability to provide care for pregnant women (Kate Sheppard, 11/9).

American Medical News: Jumping To A Nonclinical Career

For all kinds of reasons, some new — like opportunities in the health information technology industry — and some old — like burnout — occasionally physicians decide to leave clinical practice.

But how can doctors tell the difference between needing a vacation from clinical work or a permanent break from it? And how do those who don’t have a plan B identify a fulfilling second career? Career coaches and former physicians, who are sometimes one and the same, say there is no limit to the new careers physicians can take on.

But they also advise careful planning before making the leap. The transition to a new career isn’t always quick (Emily Berry, 11/7).

The Atlantic: Do Nonprofit Hospitals Make Too Much Money?

For years, nonprofit hospitals have shied away from quantifying the amount of charitable care they provide communities. Hospital officials argue that it’s almost impossible to put a dollar value on charity and that doing so would take valuable time and resources away from actually serving the needy.The charity question is significant because nonprofit hospitals get major tax breaks. Also, because of loopholes in state laws, nonprofit hospitals are often permitted to make huge profits. …

Recent economic downturns, however, have shined a detective’s spotlight on the amount of charity care hospitals provide. … The thinking goes: if nonprofit hospitals are making money and unwilling to prove how much charity care they provide, why do they deserve nonprofit tax breaks?  (Matt Stroud, 11/9).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Photo: Willi Heidelbach

Autism treatment advocates have won one legislative battle after another since 2007, most recently in California, which sent a bill to the governor this month mandating that insurers cover the disorder.

Now more than half the states have such requirements, but that success could be in jeopardy as federal officials set new national standards for health coverage.

Insurers and employers argue that the laws increase health costs because treatment is often expensive and lasts years.

But the advocates have prevailed by using federal data showing a growing number of children with the disorder, compelling stories about middle-class families struggling to afford treatment and testimony from celebrity parents of children with autism, including former pro football stars Dan Marino and Doug Flutie.

However, a provision in the 2010 health overhaul law gives the federal government authority to define “benefits” that will be offered on the health insurance exchanges, or marketplaces, to individuals and small businesses starting in 2014.

If states mandate a benefit, but it isn’t on the federal list, the states would be responsible for the cost of the coverage.

As a result, autism benefits and dozens of other state-required benefits, covering services and conditions such as infertility, acupuncture and chiropractic care, could be at risk.

By the end of September, the Institute of Medicine is scheduled to recommend criteria the Department of Health and Human Services should use in determining the essential benefits package. HHS is expected to announce its decision by the end of the year.

“We do think states will be under enormous pressure to repeal benefits” not deemed essential, said Stephen Finan, senior director of policy for the American Cancer Society’s Cancer Action Network. The society is concerned that the benefits package will not include all the cancer screenings that it has recommended.

“It will be a new day,” said Amanda Austin, a lobbyist for the National Federation of Independent Business, which typically fights new insurance mandates because the costs will lead to higher premiums.

HHS faces a difficult balancing act: The more comprehensive the benefits package, the more it would cost insurers and their customers. Taxpayers would pay more, too, because the law provides government subsidies to help millions of people afford coverage.

Tens Of Thousands Of Dollars In Services

Most of the state laws covering autism require insurers to pay for behavioral analysis as well as physical and occupational therapy. These services can cost tens of thousands of dollars a year, although many states put dollar limits on coverage.

Autism encompasses many disorders ranging from mild to severe that can affect a child’s behavior and ability to communicate.

Applied behavioral analysis typically involves one-on-one counseling to teach children how to behave or act in different situations. Although parents and many clinicians consider it the most effective therapy for children with autism, the results are mixed in peer-reviewed research.

Insurers typically oppose state benefit mandates, saying they reduce their ability to control costs. In addition, they argue that autism is a development disorder that is best addressed by the educational system, not the medical system.

Parents worry the essential-benefits provision could reopen the debate over covering treatment for autism and spark another showdown with insurers.

“Fear runs through my mind,” said Ann Rounseville of Newton, Mass., whose son Luke, 4, has been able to get speech, occupational and behavioral therapy because of the insurance benefit that started this year.

“Without this coverage he would not be getting any of the extra therapy he needs,” said Rounseville, estimating the Massachusetts law has saved her family more than $10,000 since May.

Stuart Spielman, a lobbyist for Autism Speaks, the New York-based group that has led the push for coverage laws, said he’s confident HHS will include autism because the federal law lists behavioral health treatment in its broad outline of what should be considered essential. The law also spells out the need for emergency services, hospitalization, maternity care, prescription drugs and prevention.

It’s unclear how HHS will decide what to deem an essential benefit. The agency could declare a broad list of categories of treatments and services essential and leave the specifics to the states.

At the state level, autism treatment advocates have argued that the problem is too big – and too expensive for families – not to be covered by insurers. They also say providing treatment to young children can save money in the long run by reducing the later need for institutionalized care.

The state mandate laws typically only affect about half of people with health coverage because they do not apply to self-insured employers, typically large companies.

1 In 110 Children Affected

According to the federal Centers for Disease Control and Prevention, 1 in 110 American children have been diagnosed with Autism Spectrum Disorder, including 1 in 70 boys.

A Harvard University study in 2006 found that on average the annual care for a person with autism runs about $29,000 for medical costs and $38,000 for non-medical costs such as special education, camps and child care.

“The mandates have been a way for states to be doing something on a major issue without money coming out of the state treasury,” said Jack Pitney, professor of American politics at Claremont McKenna College in California. “It’s a cost borne by insurance companies who are not an object of a great deal of public affection.”

Insurers argue that the cost of autism coverage gets passed on to all their customers through higher premiums. The Council for Affordable Health Insurance, an insurer-backed group, estimates  that autism mandates boost premiums from 1 percent to 3 percent.

Highmark, Pennsylvania’s largest private health insurer, says the autism mandate enacted in the state in 2009 increased premiums from 0.6 to 1 percent. Overall, the cost of employer-paid insurance for family coverage last year was $13,770, according to a Kaiser Family Foundation study. (Kaiser Health News is an editorially independent part of the foundation.)

Autism advocates point to lower estimates. They say data from the agency overseeing health benefits for South Carolina state employees shows that autism coverage added just 44 cents per member per month.

Richard Cauchi, program director of the health program of the National Conference of State Legislatures, said HHS has not yet said how it will determine the cost to states of keeping certain mandates. States may be required to pay the insurer or the enrollee.

Cauchi was surprised 16 states approved a variety of new mandates in 2011 given the uncertainty about future costs. Four of the states imposed autism benefits: Arkansas, Rhode Island, Virginia and West Virginia.

Until 2007, only Indiana required insurers to cover autism treatment. Today, 26 states do, not including California, where Gov. Jerry Brown (D) has not yet said if he will sign the bill, and New York, where a bill awaits the signature of Gov. Andrew Cuomo (D).

Autism advocates and other patient groups continue to press for more benefits laws. By 2014, Cauchi said, “There could certainly be a number of mismatches between what’s considered essential and what states have on their books.”

Wilson Cristancho of Miami hopes the autism treatment Florida requires remains part of his insurance. Before the law took effect in 2009, he said he piled up nearly $30,000 in debt for his son’s medical bills. The intensive therapy now paid for by his insurer has helped his son, Marc Anthony, 9, communicate and improve his hand-eye coordination.

“The mandate has had a huge impact on me and my family,” Cristancho said. “We don’t want to see it go away.”

PHOTO: Willi Heidelbach

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.