A study which used data from the National Emergency Department Sample database which consists of information from over 28 million emergency department visits at 961 hospitals, showed that "[p]eripubertal boys with autism spectrum disorder have lower bone mineral density than typically developed controls." (Ann M. Neumeyer, Julia A. O'Rourke and Madhusmita Misra, "Brief Report: Bone Fractures in Children and Adults with Autism Spectrum Disorders," Journal of Autism and Developmental Disorders, 45, No. 3 (March 2015): 881-887, doi: 10.1007/s10803-014-2228-1). Both male and female children and adults with autism had a significantly increased risk of hip fractures Furthermore, adult women with autism had a higher risk of forearm and spine fractures compared to controls. The study further discusses that hip fractures in particular often require surgery and can cause life-long disability and individuals with autism may have more difficulty adhering to treatment including rehabilitation. In addition, individuals with autism may not understand risk and be more prone to accidents. Interestingly, another study showed peripubertal boys with autism on gluten- and casein- free diets have even lower bone mineral density, Ann M. Neumeyer, Amy Gates, Christine Ferrone, Hang Lee and Madhusmita Misra, "Bone Density in Peripubertal Boys with Autism Spectrum Disorders," Journal of Autism and Developmental Disorders, 43, No. 7 (July 2013): 1623-1629, doi: 1007/s10803-012-1709-3). What is concerning is that a recent study involving 68,730 individuals, demonstrated a significantly increased risk of hip and nontraumatic major osteoporotic fractures in individuals on psychiatric medications, including selective serotonin reuptake inhibitors, antipsychotics and benzodiazepines, (James M. Bolton, Suzanne N. Morin, Sumit R. Majumdar, "Associations of Mental Disorders and Related Medication Use with Risk for Major Osteoporotic Fractures, JAMA Psychiatry, published online (April 19, 2017): doi: 10.1001/jamapsychiatry.2017.0449). All these types of medications are commonly prescribed in individuals with autism spectrum disorders, which may further increase the risk for fractures in this population which is already at an increased risk.
ADHD, Medications and Adult Height
Individuals with autism commonly have ADHD symptoms. A recent study involving 519 children taking stimulants and 289 without stimulants were followed into adulthood. (James M. Swanson, L. Eugene Arnold, Brooke S. G. Molina, Margaret H. Sibley, Lily T. Hechtman, Stephen P. Hinshaw, Howard B. Abikoff et al., "Young Adult Outcomes in the Follow-up of the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder: Symptom Persistence, Source Discrepancy and Height Suppression," Journal of Child Psychiatry and Psychology, (March 10, 2017): doi: 10.1111/jcpp.12684). Long term use of stimulant medication was associated with a reduction in adult height, yet no reduction in ADHD symptoms.
Probiotics, Mood and Autism
A new literature analysis showed that probiotics improved depression, cognition, anxiety and even social anxiety although there needs to be more reasearch done including more placebo controlled trials, (Caroline J. K. Wallace and Milev Roumen, "The Effects of Probiotics on Depressive Symptoms in Humans: A Systemic Review," Annals of General Psychiatry (2017) 16, No.14 doi: 10.1186/s12991-017-0138-2). Changes in the mircobiology of the gut may have profound effects.
Ten studies were analysed for depression, seven for anxiety and three for cognition. Depression and anxiety can manifest as increased health dangerous behaviors in individuals with autism. One study in the analysis found a reduction in anger-hostility scores on a standaridzed outcome measure. Individuals with autism often have problems coping with emotions including anger. One placebo controlled study discussed in the analysis showed "reduced overall cognitive reactivity to depression, in particular aggressive and ruminative thoughts." Ruminative thoughts are common in individuals with autism spectrum disorders. Unlike medications, probiotics have not shown to have side effects.
Supreme Court Unanimously Overturns Gorsuch's Discriminatory Ruling
Two days ago, the US Supreme Court stated in a unanimous decision that education for children with special needs has to go beyond, what Neil Gorsuch ruled, which was "merely... more than de minimus" progress.
Children who do not have special needs have to take rigorous standardized exams. If they perform poorly, even if there is merely more than minimal progress than the year before, teachers and schools will be blamed. Many schools have closed due to students performing poorly on these exams. Making merely more than minimal progress does not apply to children without disabilities. If it did, standardized exams and even much of the cirriculum would be unnecessary.
Applying a lower standard for educational progress for neurotypical children than individuals, who through no choice of their own need additional services, clearly is discriminatory. The United States Supreme Court made the right decision.
ADHD, iron and ferritin
Individuals with autism often display symptoms of ADHD. A recent literature analysis of ten studies involving 2,191 subjects and 1,196 cases of ADHD (Wang, Y., Huang L., Qu., and Mu, D., "Iron Status in Attention-Deficit/Hyperactivity Disorder: A Systemic Review and Meta-analysis," PLoS One, 12(1), e0169145, doi: 10.1371/journal.pone.0169145) showed that individuals with ADHD have lower levels of seurm ferritin. Ferritin is a protein inside cells which stores iron and a low level can detect an iron deficiency early on. Although this deserves further study, it may make sense to check a ferritin level when someone has ADHD symptoms and consider iron supplementation which is both safe and inexpensive. *