GPS-based technology & Autism Spectrum Disorders

3 05 2015

Please find a link to my new post that discusses the potential benefits of GPS-based technology to the safety & wellbeing of people with Autism Spectrum Disorders and their family caregivers. Feel free to comment and share.

To read the article click Here

Employment: The Autism Advantage

3 04 2015

It is estimated that Autism Spectrum Disorders (ASD) affect 1 in 68 children and 1 in 42 boy and that for unknown reasons ASD prevalence figures are growing. This year World Autism Awareness day theme is “Employment: the Autism Advantage”. Here is a short article I wrote for this important day . I hope that you’ll find it helpful and relevant.

What we know, and mostly don’t know about ASD in 2014

28 03 2014

Autism Awareness: April 2014


Autism Awareness Month arrives this year with a package of new, important research findings. Below I describe a few of these. The field is moving so rapidly that, by the end of April, there will likely be yet a new crop of findings—so this is, at best, a progress report for the beginning of Autism Awareness Month.

Today the Centers for Disease Control and Prevention (CDC) released new numbers on the prevalence of autism, based on the most recent results from their long running Autism and Developmental Disabilities Monitoring  (ADDM) network.  Looking at administrative data on 8-year-olds from 11 sites across the country, ADDM reported a prevalence of autism of 1 in 68 children in 2010 (based on children born in 2002), up from 1 in 88 in 2008 (based on children born in 2000).  There was considerable variation across the 11 sites: from 1 in 45 in New Jersey to 1 in 175 in Alabama. As in previous surveys, boys were almost 5 times more likely to have an autism label. The prevalence in boys was 1 in 42; in girls, 1 in 189.

One of the best things about the ADDM network is that it has provided surveillance using similar methods for over a decade. The prevalence of autism as estimated from administrative records has increased:  by 125 percent since 2002 and by 29 percent just between 2008 and 2010.  How much of this increase is “more detected” versus “more affected”? Is this increase a mark of better care, with more cases identified and treated, or is this a reflection of a continually growing public health care emergency due to more children affected? ADDM cannot answer these questions, but it does point to the need for a population-wide study, as currently planned by CDC and Autism Speaks in South Carolina. A previous total population study of all 7- to12-year-olds in a town in South Korea (more than 55,000 children) used standardized diagnostic instruments for children who screened positive and reported a prevalence of 1 in 38 children. Could that figure, which is in the range of the ADDM estimate of 1 In 45 for New Jersey, serve as a reasonable estimate for the actual prevalence once everyone with autism is detected? Perhaps the ADDM numbers will continue to rise, indicating better detection as awareness of the signs and symptoms increase.

Whatever the meaning of the new ADDM report, there is little doubt that more children and more adults on the autism spectrum will require more services. Ganz estimated the lifetime economic cost of autism to be $3.2 million per individual, back in 2006 when the prevalence was thought to be closer to 1 in 150.1 A new economic analysis looks at the cost, including education and indirect costs, based on three national data sets.2 The additional cost of having a child with autism was $17,081 per year in 2011. Only 18 percent of these costs were related to health care; half were attributed to school costs. Assuming 673,000 children ages 3 to 17 with a diagnosis of autism spectrum disorder, the total societal cost would be roughly $11.5 billion per year. Of course, with new estimates from the CDC about the increase in prevalence, these costs may need to be adjusted upward.

On the brain research front, a new report in the New England Journal of Medicine describes changes seen in the architecture of post-mortem brains in 10 of 11 children who had an autism diagnosis.3 Similar changes were found in  only 1 of 11 unaffected children. Dr. Eric Courchesne and his colleagues at the University of California, San Diego and Dr. Ed Lein and colleagues at the Allen Institute of Brain Science found patches of abnormal anatomy in parts of the brain associated with social and communication functions. Given that the pattern of cell layers in the cortex is laid down prenatally, these findings, if replicated, suggest that brain changes in autism are likely to have originated before birth, although the disorder is usually diagnosed behaviorally after age 4 years.

In 2014, the mystery of autism remains largely unsolved. We describe autism as a neurodevelopmental disorder, but even with the new report mentioned above, we do not know precisely how to define what the brain disorder is or when it occurs. We realize that as many as 30 percent of children with autism have spontaneous genetic mutations, but these large genetic changes have not yet been shown to cause the disorder, since other children with some of the same changes don’t have autism. We have treatments for autistic symptoms, helping many children to enter regular classrooms and ultimately function fully in society. But these behavioral treatments are expensive and intensive and often not available to children in need. Medical treatments have lagged behind.

All of this reminds us that for both children and adults with autism we need more science as well as more services. Indeed, the best way to better services will be through better science. As we understand what happens in the developing brain that renders a child unable to communicate or unable to engage the social world, we will be better able to provide earlier detection and better interventions. As we identify the many forms of autism, some more genetic, some more environmental, we can expect better tools for prevention and treatment. And as we understand better the evolution of autism in adults, we should be able to provide better care and offer better outcomes. Autism awareness reminds us of the vital importance of committing to both science and service for an increasing number of our fellow citizens.


1 Ganz ML. The lifetime distribution of the incremental societal costs of autism.  Arch Pediatr Adolesc Med. 2007 Apr;161(4):343-9.

2 Lavelle TA et al. Economic burden of childhood autism spectrum disorders.  Pediatrics. 2014 Mar;133(3):e520-9. doi: 10.1542/peds.2013-0763. Epub 2014 Feb 10.

3 Stoner R et al. Patches of disorganization in the neocortex of children with autism. N Engl J Med. 2014;370:1209-19. DOI:10.1056/NEJMoa1307491.

Brain Awareness Month – What do we know and don’t know about the brain

12 03 2014

Brain Awareness

By Thomas Insel

This is the time of March Madness, Daylight Savings Time, and what Emily Dickinson famously called the “month of expectation.” March is also Brain Awareness Month, an annual celebration with school visits, community lectures, and lab tours to introduce the public to the mind-blowing world of neuroscience. A list of Brain Awareness events can be found at , where you will also find that March 10 -16 is the peak for related public events around the world.

Since NIMH began focusing on mental disorders as brain disorders nearly two decades ago, educating people about the brain has been a priority for us. We often say that with the powerful tools of neuroscience, we can now use the brain to understand the mind, fulfilling the original vision that Freud had for a scientific psychology. But we have to remain humble about our understanding of the brain, because even our most powerful tools remain pretty blunt instruments for decoding the brain. In fact, we still do not know how to decipher the basic language of how the brain works.

A few numbers can help to define the challenge. The human brain is thought to have close to 86 billion neurons, each making on average about 10,000 connections. In contrast to most animals, our brains are largely made up of a heavily folded cortex, accounting for 80 percent of brain mass and about 100,000 miles of axons that provide the highways between neurons.1

How many different kinds of neurons are there in the brain? We really don’t know.  Unlike the heart or kidney, which have a small, defined set of cell types, we still do not have a taxonomy of neurons, and neuroscientists still argue whether specific types of neurons are unique to humans. But there is no disputing that neurons are only about 10 percent of the cells in the human brain. Most of our brain cells are glial cells, once thought to be mere support cells, but now understood as having a critical role in brain function. Glial cells in the human brain are markedly different from glial cells in other brains, suggesting that they may be important in the evolution of brain function. As one hint to their function, astrocytes, which are one form of glial cell, have been reported recently to “eat” synapses in the brain, providing a critical new mechanism for brain plasticity.2

How does the brain work? Again, we really don’t know. We have a very detailed understanding of how the heart pumps and the kidney filters, but how the brain encodes, stores, and retrieves information is still largely a mystery. We have known for over a century that most of the cortex is organized horizontally into six precise layers, and much of the cortex has vertical mini-columns, but how this matrix of horizontal and vertical structures computes information is not really clear.

Neuroscientists talk a lot about brain circuits. In fact, the word “circuit” is probably misleading. We do not know where most circuits begin and end. And unlike an electrical circuit, brain connections are heavily reciprocal and recursive, so that a direction of information flow can be inferred but sometimes not proven. We believe there are “emergent properties” of the brain that convert electrical signals into memories or dreams, but how this happens is still a mystery. Recent studies have shown that diffuse waves of synchronization across the brain may be critical for attention or learning, but we are just learning about these slow waves of activity, and whether they occur at the “speed of thought” is still debated.3

Of course, the spectacular images from MRI and PET scans have already given us maps for perception and fear and language and many other functions. As scanners have improved their resolution from 1.5T (tesla) to 3T to recent 7T magnets, and the protocols and analytic approaches have evolved, we now can map the cortical real estate associated with complex tasks like decision-making and face recognition. But these approaches, even with the best current technology, are still a 30,000-foot view of the action. Jay Giedd here at NIMH estimates that each gray matter voxel—the individual 3D pixels of 1 cubic mm that make up the scan—contains about 90,000 neurons, 400 meters of dendrites, and 4.5 million synapses. Each scan has over 650,000 voxels. And the actual measure is not neural activity per se but local blood flow, which changes slowly relative to the speed of thought.

In a sense, functional MRI (fMRI) is providing an image of something like the power grid of a city. fMRI slowly maps where and when different parts of the brain wake up, based on blood oxygen metabolism. By contrast, the street map of the brain is being mapped by the Human Connectome Project. Supported by the NIH Blueprint for Neuroscience Research , over 100 neuroscientists at ten sites in the United States and Europe are building something like a Google map for the human brain.  Scientists at Massachusetts General Hospital have created new MRI scanners with greatly enhanced resolution for looking at the geometric structure of the human brain.4 One remarkable claim from that work (still controversial) is that the fiber connections which heretofore looked like a bowl of spaghetti might actually have a relatively simple grid structure, allowing comparisons of connectomes between people. This kind of comparison is already underway at Washington University and the University of Minnesota where the Human Connectome Project  is obtaining the wiring diagrams of 1200 healthy adults, including 300 twin pairs. Thus far, data from the first 226 volunteers have been released on the Connectome website, with 10 gigabytes of data available for each subject. That’s right, this project is releasing the data as it becomes available to scientists everywhere—over 700 users are already mining the Connectome data to see how a Google map of the human brain might answer their questions.

Whether March for you means basketball, changing clocks, or expectations, I hope you will check out some of the Brain Awareness events. Brain science has become one of the most exciting frontiers of science. When I was a kid, the scientific frontier was “outer space.” Today it seems to be “inner space” that fascinates the boldest and brightest young minds (or should we say young brains). We are still at the beginning of what could be an era of brain exploration, with great promise for understanding more about how each of us thinks and dreams and loves, but perhaps even greater promise for helping people with mental disorders.


1 Lent R, Azevedo FA, Andrade-Moraes CH, Pinto AV. How many neurons do you have? Some dogmas of quantitative neuroscience under revision.  Eur J Neurosci. 2012 Jan;35(1):1-9. doi: 10.1111/j.1460-9568.2011.07923.x.

2 Chung WS et al. Astrocytes mediate synapse elimination through MEGF10 and MERTK pathways . Nature. 2013 Dec 19;504(7480):394-400. doi: 10.1038/nature12776. Epub 2013 Nov 24.

3 Salazar RF, Dotson NM, Bressler SL, Gray CM. Content-specific fronto-parietal synchronization during visual working memory Science 2012 Nov 23;338(6110):109-100. doi: 10.1126/science.1224000.

4 Wedeen VJ et al. The geometric structure of the brain fiber pathways .Science. 2012 Mar 30;335(6076):1628-34. doi: 10.1126/science. 1215280.

Brain enlargement as a potential biomarker for Autism

20 06 2013

Here is an interesting paper posted yesterday by the National Institute of Mental Health:

Biases in standardized norms used to compare data on head size weaken evidence for early excess brain growth in autism, say NIMH intramural researchers. Their analysis of existing and new data undermines the case that had been building for such early brain enlargement as a potential biomarker that might be used in making treatment decisions.

“Our results show that the most highly replicated aspects of early brain overgrowth in autism are not a feature of the disease, but instead arise through replicable biases in the population growth norms that have been used to define brain overgrowth in autism”.explained Armin Raznahan,

Raznahan and NIMH Child Psychiatry Branch colleagues reported their findings online May 23, 2013, in the journal Biological Psychiatry.


Although still a hypothesis, dramatic early brain overgrowth during the first year of life had become widely-viewed as a likely hallmark feature of autism, raising hopes that it might find application as a biomarker.

Most studies reporting such early brain overgrowth in autism have been based on head circumference as a proxy for brain size. Researchers have typically compared head circumference of children with autism to – as a control group – standardized charts of head circumference published by the Center for Disease Control (CDC), and World Health Organization (WHO).

Ten of 11 long-term studies of head circumference in autism had been published since the last time the topic had been systematically reviewed. Also, discrepancies had emerged between the norms used in autism studies and recent patterns of head growth emerging from several more recent large non-autism studies. Typically-developing young children’s heads seemed to be growing faster, so that they looked strikingly similar to the overgrowth – it turns out perhaps erroneously – ascribed to autism. This suggested that previous studies had been based on norms that underestimated typical early brain growth.

Suspecting that the norms might be skewed by various sources of bias, the NIMH researchers reexamined them in light of the updated data from 34 relevant studies. They integrated crosssectional and longitudinal head circumference data between birth and 18 months. They also included 330 head circumference measures from their own longitudinal study that followed 35 children with autism and 22 typically developing controls as they grew up, from birth to 18 years old.

Results of This study

“The most methodologically robust and bias-free sources of evidence are equivocal regarding the presence of abnormally accelerated early brain growth in autism” said Raznahan.

In the few studies that did find evidence of such early brain overgrowth, head circumference in children with autism showed a “subtle divergence” from that in controls during the second year of life, rather than in the first year.


Earlier studies overestimated early brain growth in children with autism because their head circumference data was compared to published norms that were wrong – based on studies that underestimated typical head circumference/brain growth.

Inconsistencies that turned up in the study suggest the possibility of a more subtle, lateremerging pattern of early brain overgrowth among only a subgroup of children with autism. Since some related disorders show brain undergrowth, the results are also consistent with the idea that extreme dysregulation of brain growth – as opposed to brain enlargement per se – may be more relevant to understanding autism spectrum disorders.

What’s Next

Use of head circumference as an index of brain size offers practical advantages over more sophisticated measures, such as structural magnetic resonance imaging, in longitudinal studies, provided that the methodological pitfalls can be minimized, say the researchers.

Future studies might compare evidence for extreme versus isolated overgrowth and possible links between aberrant brain size and genetic and environmental influences prior to, or just after, birth, they add.

“These findings have far-reaching implications for use of standardized growth norms extending well beyond autism to decision-making across medicine.” said Raznahan, who suggests that widely-used norms be reevaluated in light of the new evidence.


Compared to What? Early Brain Overgrowth in Autism and the Perils of Population Norms. Raznahan A, Wallace GL, Antezana L, Greenstein D, Lenroot R, Thurm A, Gozzi M, Spence S, Martin A, Swedo SE, Giedd JN. Biol Psychiatry. 2013 May 23. doi:pii: S0006-3223(13)00303- X. 10.1016/j.biopsych.2013.03.022. [Epub ahead of print] PMID:23706681

Changes in Prevalence of Parent-reported Autism Spectrum Disorder in School-aged U.S. Children: 2007 to 2011–2012

23 03 2013

The U.S. Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration released a report titled “Changes in Prevalence of Parent-reported Autism Spectrum Disorder in School-aged U.S. Children: 2007 to 2011–2012”. The report presents data on the prevalence of diagnosed autism spectrum disorder (ASD) as reported by parents of school-aged children ages 6–17 years in 2011–2012. Data was drawn from the 2007 and 2011–2012 National Survey of Children’s Health, which comprises independent, nationally representative telephone surveys of households with children.

Last year, the CDC’s Autism and Developmental Disabilities Monitoring Network estimated that 1 in 88 children had been identified with ASD. The CDC now estimates that in 2011–2012, about 1 in 50 school-aged children, or 2 percent of children ages 6–17 years have some form of the disorder. Since the average school bus holds 50–55 children, that means, statistically speaking, on average there is one child with parent-reported ASD on every school bus in America.

Click HERE for the full report.

Happy holidays!


Identifying Autism in Early Months

11 02 2013

Here is a 20 minutes lecture by Dr. Ami Klin,  an award-winning autism spectrum disorder researcher that is talking about autism and   new avenues for early diagnosis. I hope that you will find it interesting & helpful.

Dr. Ami Klin

Blood test for autism?

7 12 2012

As reported by, Boston Children’s Hospital researchers have developed a prototype blood test for autism, and preliminary results published Wednesday suggest it could one day be used to help diagnose the disorder when children are very young and respond best to treatment.

The blood test, which measures the activity of a panel of dozens of genes, was able in one group to predict with about 70 percent accuracy whether a child was at risk for autism or not. Outside researchers cautioned that the work has limitations and that the blood test needs much more study before it is clear whether it could be a useful tool for doctors and parents.

The new study represents one piece of a much larger effort to identify biological hallmarks of autism—whether genes or brain abnormalities detected on scans—that could speed diagnosis of a disorder that causes social problems and developmental delays and is now diagnosed in an estimated 1 in 88 children.

“It’s a very worthwhile area of investigation: the hypothesis that one might be able to classify patients based on blood is very worth testing,” said Dr. Daniel Geschwind, a professor of neurology and psychiatry at the University of California, Los Angeles School of Medicine who was not involved in the study. But he added, “it’s fairly clear that we have a long way to go.”

The urgency and need for better tests for autism is increasing as its prevalence grows, in large part because children’s brain are most easily molded early in life. Intervening sooner has a greater chance of having real and lasting improvements. But autism spectrum disorders are made up of a suite of behavioral and cognitive problems that have no easy biological litmus test, and the centers that specialize in diagnosis often have lengthy wait lists. The average age of diagnosis is after four, according to government data.

Dr. Isaac Kohane, a professor of health sciences and technology at Children’s Hospital, stumbled on this line of research by chance. More than a decade ago, a neighbor in Brookline asked Kohane, who is also a pediatrician, about one of her triplets. The child tended to play alone and just seemed a little different than the other two.

“I said, ‘I know what you’re thinking—you think this kid has autism,’ ” Kohane recalled. He reassured her that he didn’t think she had anything to worry about.

Later, when the child was diagnosed with autism, he was stunned, sorry, and motivated to learn more.

“It’s just shocking to be told afterward, ‘That kid you told me was fine has autism,’ ” said Kohane, who led the new study, published in the journal PLoS ONE. “I started reading up a lot on that. … This is an amazing problem. I had been unaware of frankly how little we know about this disease and how haphazard our diagnostic process is.”

That process is painfully familiar to Stephanie Sourwine, a single mother living in rural Alexandria Bay, N.Y.. Sourwine said she began noticing her son, Austin, regress when he was 2 years old. He was almost 3 by the time she got a diagnosis, and he is now 10 and non-verbal. Then, when she began to see developmental delays in his younger sister, Gabby, she again sought help. The diagnostic process took the better part of a year, until her daughter was 3, despite her experience with Austin.

“Gabby was kind of heartbreaking,” Sourwine said. “If I could have skipped all that wait, it would have been much better.”

Now, she worries that her youngest, 4-year-old Avery, is showing signs of similar symptoms. She called the doctor’s office, and was told that he was not taking any new patients; there was a two-year waiting list, despite her family history. Her best option would be to travel to medical centers many hours away.

A Southborough company, SynapDx, has licensed Kohane’s technology and is preparing to launch a large study of a blood test that will be informed by his laboratory’s research and its own studies, according to the company’s president, Stanley Lapidus.

“Behavioral therapy (for autism) is pretty good. But it has to be started earlier—the earlier, the better. Alas, the average age of diagnosis is four and a half, and the average age of parental suspicion is 19 months,” Lapidus said. “That gap is the tragedy here, and that gap doesn’t need to exist.”

Kohane said the test was not intended as a general screening tool, but as an aid that could help provide guidance when there was a suspicion of autism. He said it needed further study, and would not supplant behavioral testing.

Researchers not involved in the research had mixed opinions about the findings. The signal was identified by looking for differences in gene activity in the blood samples of 66 boys with autism and 33 boys without it. It was then tested on another sample, correctly predicting autism risk 70 percent of the time in boys, among samples taken from 104 children with autism and 82 without. But differences in how and when the various samples were collected could affect the results, Geschwind said. He also added that one possibility is that the study is not detecting the disorder, but a general signal that exists in the blood of families with autism—meaning it might flag people with autism but also siblings or parents without the disorder.

Andy Shih, senior vice president for scientific affairs at Autism Speaks, a science and advocacy organization, said that so far genetic studies have been limited, identifying mutations that contribute to about a fifth of the cases.

“Anything that will help us push over that threshold … would be welcome progress,” Shih said. “The caveat here is that it is a complex disorder; when you identify someone at risk … it doesn’t mean someone’s coming down with the disorder.”

This is truly exciting. What do you think?


Autism with Louis Theroux

20 11 2012

The amazing broadcaster, Louis Theroux, travels to America to introduce several families in which one or more children has Autism, and how the family deals with this. Visiting schools (such as DLC Warren in New Jersey, one of the most innovative autism schools of its kind) were the ratio student/teacher is 1 on 2, Louis looks how autism influences the kids and the problems it gives.

Theroux meets Joey, whose mother Carol is finding it increasingly hard to cope with some of the more challenging aspects of his disorder. In between the ever more explosive tantrums, Louis discovers a cheeky and charming 13-year-old, but there are tough decisions ahead about his future in the family home.

Nicky is 19. After making good progress at DLC Warren he is about to leave, but the prospect of change leads to increasing anxiety and erratic behaviour. Surrounded by a loving family who say they wouldn’t have him any other way, he shows Louis his novel Dragonula and invites him to share his first day at his new school.

Twenty-year-old Brian is severely autistic and his behaviour – setting fire to the house and attacking his mother – has led to the difficult decision of placing him in residential care. Louis meets a mother whose love for her son has been tested to its limits and finds out how the school is preparing him for an adult life.

Highly recommended!

To see the full episode click HERE

One Mind for Research

12 11 2012

Today I want to give you an opportunity to watch and hear a series of fascinating lectures and interviews that were conducted as part of the “One Mind for Research”, an extraordinary event took place in Boston last year. This event  brought together researchers, health advocates and politicians to mount a concerted challenge to solving what has been called the final frontier of medicine: the human brain.

Among other things you can find lectures by Steven E. Hyman, MD  “Imagining the Future: A 10-Year Plan for Neuroscience”; by Kevin Kit Parker, PhD that talked about Traumatic Brain Injury on the Battlefield; and by Husseini Manji, MD, that claims that “Serious Neuropsychiatric Diseases Can Be Tackled Through An Innovative, Accelerated, Collaborative Effort”. Furthermore, you can enjoy interesting interviews with Thomas Insel, MD, the Director of the National Institute of Mental Health (NIMH); Steven E. Hyman, MD from Harvard University and many other interesting researchers.