In Utero Exposure to Acetaminophen

In The Politics of Autism, I discuss various ideas about what causes the condition. Here is just a partial list of correlates, risk factors, and possible causes that have been the subject of serious studies:

• Pesticides;
• Air pollution and proximity to freeways;
• Maternal thyroid issues;
• Autoimmune disorders;
• Induced labor;
• Preterm birth;
• Fever;  
• Birth by cesarean section;
• Anesthesia during cesarean sections;
• Maternal and paternal obesity;
• Maternal diabetes;
• Maternal and paternal age;
• Maternal post-traumatic stress disorder;
• Smoking during pregnancy;
• Antidepressant use during pregnancy;
• Polycystic ovary syndrome;
• Infant opioid withdrawal;
• Zinc deficiency;
• Processed foods;
• Maternal occupational exposure to solvents;
• Estrogen in the womb;
• Morning sickness;
• Sulfate deficiency;
• Congenital heart disease;
• Insufficient placental allopregnanolone.

Yuelong Ji and colleagues have an article at JAMA Psychiatry titled "Association of Cord Plasma Biomarkers of In Utero Acetaminophen Exposure With Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Childhood"

Question What is the association between cord plasma biomarkers of in utero acetaminophen exposure and risk of childhood attention-deficit/hyperactivity disorder and autism spectrum disorder?

Findings In this cohort study of 996 mother-infant dyads from the Boston Birth Cohort, cord plasma biomarkers of fetal exposure to acetaminophen were associated with significantly increased risk of childhood attention-deficit/hyperactivity disorder and autism spectrum disorder.

Meaning These findings suggest in utero exposure to acetaminophen is associated with increased risk of attention-deficit/hyperactivity disorder and autism spectrum disorder in children and warrant additional investigations.

Driver License Bill in New York State

In The Politics of Autism, I discuss interactions between police and autistic people.  Sometimes they occur on the road.  A number of ASD people drive cars.

Josh Navarro at WROC-TV Rochester:

A new bill in New York state would allow people with Autism Spectrum Disorder to obtain a special driver’s license. Supporters say it would help law enforcement on routine stops, but the bill does raise concerns among advocates.

Assembly Bill A08711, establishes a system for people on the Autism spectrum to receive special driver’s licenses. It was introduced by Assemblymember Nader Sayegh of Yonkers. It is a way for law enforcement and first responders to immediately know a person has autism and react appropriately towards them.

Facebook Algorithms Screw Up

In The Politics of Autism, I look at the discredited notion that vaccines cause autism.  Twitter, Facebook, and other social media platforms have helped spread this dangerous myth.

Blake Montgomery at The Daily Beast:

Facebook promised to institute a stricter policy on anti-vaccination misinformation in ads back in February, a policy it expanded sitewide in March. That crackdown, however, appears to be penalizing some legitimate healthcare providers while letting some anti-vaccine conspiracies slide, even as the United States faces its largest outbreak of diseases preventable by vaccines in decades.

This month, the Idaho Department of Health and Welfare, the state’s official health department, bought 14 ads to promote a statewide program providing free pediatric vaccinations. Facebook removed all of them.

During the same time period, Children’s Health Defense, an anti-vaccine nonprofit founded and chaired by the nation’s most prominent vaccine conspiracy theorist, Robert F. Kennedy Jr., successfully placed more than 10 ads stoking unfounded fear about vaccines and other medical conspiracy theories.

...

The Minnesota Hospital Association, which lobbies the Minnesota legislature on behalf of the state’s hospitals, buys Facebook ads to fight vaccine disinformation and promote conversations with healthcare providers about vaccines. Over the last two months, Facebook has removed dozens of their ads. Facebook flags the group’s advertisements referencing vaccines far more often than any of its other ad campaigns, which cover medical issues like mental illness, addiction, and vaping-related illnesses.

...
Archived ads in Facebook’s Ad Library reveal an unpredictable approach to moderation. The social network blocked one Minnesota Hospitals ad that read, “MYTH: Vaccines will infect me with the disease I am trying to prevent” but allowed another with similar text: “MYTH: Vaccines cause autism.” Both led to the same webpage, which advised visitors to talk to their doctors about vaccinations.

Data on Wandering

The Politics of Autism discusses the problem of wandering, which has been the topic of legislation.

Tara Haelle at MDEdge:

Nearly half of all children with autism spectrum disorder wander off from safe supervision at some point in their childhood or adolescence, reported Paul Lipkin, MD, at the annual meeting of the American Academy of Pediatrics.
...
“Drowning is overwhelmingly the main cause of death in children with autism,” he said, sharing the data from National Autism Association, which relied on parent report and media reports. In that data, 71% of deaths from autistic children who wandered from 2011-2016 were drowning, and of those deaths, 76% of the drownings occurred in a natural body of water or drainage water. At a distant second, 18% of deaths were traffic accidents. The remaining causes were being hit by a train (4%), hypothermia or hyperthermia (3%), falling (1%) or other trauma (3%) (J Autism Dev Disord. 2019 Mar 5. doi: 10.1007/s10803-019-03961-x).

Academic research has found similar statistics to those from the National Autism Association. In one study, 53% of autistic youth who attempted to run off succeeded and were missing long enough to cause safety concerns (Pediatrics. 2012 Nov;130[5]:870-7). Among these youth – representing about a quarter of all families surveyed in the study – the police were called in 31% of cases. In addition, 65% had a “close call” with a traffic injury and 24% had a close call with drowning.

The children wandered off in various settings, including home; another’s home; a store or other public place; or school, daycare or camp. A 2019 study found that 70% of parents reported their children wandering off from home at least once in the past 2 years (J Autism Dev Disorders. 2019 Mar 5; doi: 10.1107/s10803-019-03961-x).

Underemployment

In The Politics of Autism, I discuss the employment of adults with autism and other developmental disabilities. Many posts have discussed programs to provide them with training and experience.  

Denise Brodey at Forbes:

The days of employing people with Intellectual/Developmental Disabilities (I/DD) as a charitable act are slowly coming to an end. Why slowly? I won’t sugar coat it: Often the problem is institutionalized discrimination. “Systemically, public resources fund service hours rather than outcomes and are often neither sufficient nor flexible enough to allow collaboration and blending of employment funding streams, according to The Arc. They offer a list of best practices, opportunities and policy changes that could remedy this issue in the future. In general, the goal is for more people with I/DD to benefit from early guidance and job counseling. Students should leave high school with opportunities to pursue post-secondary education and/or with an appropriate job or an action plan for finding one, according to Arc experts. The Arc has hundreds of offices throughout the country. If you are struggling with this issue, their resources may be helpful.

Microsoft and Hiring Practices

In The Politics of Autism, I discuss the employment of adults with autism and other developmental disabilities. Many posts have discussed programs to provide them with training and experience.  

Maitane Sardon at WSJ:

“We realized candidates with autism don’t get through the initial phone screen because they may have yes or no answers or they may not elaborate on other skills,” says Neil Barnett, director of inclusive hiring at the Redmond, Wash.-based company. So in 2015 Microsoft decided to launch an autism hiring program that included adapting its hiring process to the specific needs of people with the condition.

The changes include allowing candidates with autism to apply via a special email and skip the initial phone screening. The company also gives such candidates a chance to do a practice interview and get feedback from recruiters before doing the official one. And finally, Microsoft allows them to code using their own laptops instead of doing it on a whiteboard in front of recruiters and other candidates, which people with autism have said makes them feel very nervous.
...
Since the launch of the autism hiring program, Mr. Barnett says some of the procedures—such as allowing candidates to code on their own laptops—have been adapted by hiring managers in other parts of the company and outside Microsoft too, thanks to Autism @ Work, a coalition Microsoft co-founded with SAP SE, Ernst & Young and JP Morgan Chase & Co. to help other employers put similar programs in place.

Microsoft has hired over 100 employees with autism across different teams through its program. They hold various positions including software engineer, data scientist, content writer and finance-team member.

Mark Zuckerberg Meets Bill Posey

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism.  Twitter, Facebook, and other social media platforms have helped spread this dangerous myth.

Rep. Bill Posey (R-Florida) is perhaps the leading antivaxxer in Congress. Aaron Mak at Slate:

Slate found more than two dozen posts on Posey’s congressional, public figure, and campaign pages promoting vaccine skepticism and misinformation. In fact, Posey’s official page shared a post while the hearing was still in session that applauded him for challenging Zuckerberg and pushed the theory about the Vaccine Injury Trust Fund. In other cases, Posey has shared links to websites that falsely establish a relationship between autism and vaccines, such as Age of Autism and Truth in Media, and pages for anti-vax organizations such as the Children’s Health Defense and Texans for Vaccine Choice.* The congressman also posted a link to a petition pressing Congress to hold hearings on “CDC Fraudulent Pediatric Vaccine Research” and shared news that Robert De Niro had defended the screening of an anti-vax documentary at the Tribeca Film Festival with a caption that further pushes the Vaccine Injury Trust Fund conspiracy theory. (Posey did not post that De Niro eventually decided to pull the documentary from the festival.) He advertised the documentary in another post. Posey also, at times, shares YouTube links to speeches he’s given on vaccines in Congress, and pictures featuring antivax figures with hashtags like #TheTruthAboutVaccines.

On Wednesday, Mark Zuckerberg testified before the House Financial Services Committee. Posey was there.

Michael Nuñez at Forbes:

One revealing moment came from an outspoken anti-vaccination supporter, Congressman Bill Posey (R-FL), who wanted assurance Facebook would “support users’ fair and open discussions and communications related to the risk as well as the benefits of vaccinations.”

“We do care deeply about giving people a voice and freedom of expression,” Zuckerberg said. “At the same time, we also hear consistently from our community that people want us to stop the spread of misinformation. So we try to focus on misinformation that has the potential to lead to physical or imminent harm, and that can include misleading health advice.”

Facebook has tried to tackle the spread of misinformation by lowering its value in News Feed and making it easier for users to report false posts. Independent third-party fact-checking organization review them—if they determine a story is false, it will be flagged as disputed and there will be a link to a corresponding article explaining why. But Facebook fact-checkers have described the process like “playing a doomed game of a wack-a-mole.” These various approaches have been widely criticized for not doing enough to stomp out the spread of false information across the platform.
...
Zuckerberg, who told Congressman that his “understanding of the scientific consensus” is that people should get their vaccines, said Facebook won’t stop its users from posting information that’s wrong.

“If someone wants to post anti-vaccination content, or if they want to join a group where people are discussing that content, we don’t prevent them from doing that. But we don’t go out of our way to make sure our group recommendation systems try to encourage people to join those groups.”

Daivergent

In The Politics of Autism, I discuss the employment of adults with autism and other developmental disabilities. Many posts have discussed programs to provide them with training and experience.  

Ellen Rosen at NYT:

Byran Dai was 24 when he promised his mother, who passed away less than two months later, that he would look out for his younger brother Brandon, who is autistic. Brandon, 15 at the time, was receiving special education and social services, but Mr. Dai knew that by 22, his brother would phase out of the services and education provided by the state.

“In the autism community, we call that ‘falling off the cliff,’” Mr. Dai said. “It’s what a lot of families are worried about.”

Like so many entrepreneurs inspired by personal experience, Mr. Dai’s concern for his brother ultimately became the genesis for a new business. In 2018, Mr. Dai co-founded Daivergent, a start-up that is connecting tech companies with a pool of candidates on the autism spectrum. The company already has 20 corporate clients and has helped 75 people find work. There are about 1,100 candidates in the Daivergent pool.

The employment rate for individuals on the spectrum — even for those who have finished college — is extremely low. Statistics vary, but according to Anne Roux, a research scientist at the A.J. Drexel Autism Institute at Drexel University, about 50 percent of those on the autism spectrum have had at least one job since high school, but often that job is a low-paying part-time position. For those with greater impairment, she added, only 14 percent have employment in the community in which they live.

Warning Letter on CBD Claims

In The Politics of Autism, I write:

The conventional wisdom is that any kind of treatment is likely to be less effective as the child gets older, so parents of autistic children usually believe that they are working against the clock. They will not be satisfied with the ambiguities surrounding ABA, nor will they want to wait for some future research finding that might slightly increase its effectiveness. They want results now. Because there are no scientifically-validated drugs for the core symptoms of autism, they look outside the boundaries of mainstream medicine and FDA approval. Studies have found that anywhere from 28 to 54 percent of autistic children receive “complementary and alternative medicine” (CAM), and these numbers probably understate CAM usage

These approaches sometimes include cannibis products.

A Tuesday release from the FDA:

Today, the U.S. Food and Drug Administration and the Federal Trade Commission posted a joint warning letter to Rooted Apothecary LLC, of Naples, Florida, for illegally selling unapproved products containing cannabidiol (CBD) online with unsubstantiated claims that the products treat teething pain and ear aches in infants, autism, attention-deficit/hyperactivity disorder (ADHD), as well as Parkinson’s and Alzheimer’s disease, among other conditions or diseases.

“Cannabis and cannabis-derived compounds are subject to the same laws and requirements as FDA-regulated products that contain any other substance. We are working to protect Americans from companies marketing products with unsubstantiated claims that they prevent, diagnose, treat, or cure a number of diseases or conditions. This is especially concerning when companies are peddling unproven CBD products for use in vulnerable populations like infants and children,” said Acting FDA Commissioner Ned Sharpless, M.D. “We’ve sent numerous warning letters that focus on matters of significant public health concern to CBD companies, and these actions should send a message to the broader market about complying with FDA requirements. As we examine potential regulatory pathways for the lawful marketing of cannabis products, protecting and promoting public health through sound, science-based decision-making remains our top priority. We appreciate the FTC joining us on these and other actions to protect consumers from fraudulent CBD products.”

As described in the warning letter issued to Rooted Apothecary, the company used product webpages, through its online store and social media websites, to make unfounded claims about its CBD products, and some of the products were also unlawfully marketed as dietary supplements. The agency has determined that CBD products cannot be marketed as dietary supplements.

Examples of the unsupported claims made by the company include:

• “Instead of synthetic chemical[s] that can have safety concerns, this blend uses the best of nature to help calm the inflammation and pain of teething, while also promoting sleepiness for your little one.”
• “No matter what age, ear aches are a terrible, no good way to live each day! Our main priority was safety, effectiveness . . . as we formulated this for the entire family including our precious little ones. When the pain is bad, this roller goes to work for soothing pain, inflammation, and to battle against the bacterial/viral critters to blame.”
• “Increasing evidence suggests that CBD oil is a powerful option for pain . . . anxiety . . . and autism . . . It seems like an attractive and safe option for children.”
• “CBD oil may have neuroprotective properties and may protect against neurological conditions, such as Parkinson’s and Alzheimer’s disease.”
• “[P]ossible uses for CBD include helping with skin problems such as acne, autism, ADHD, and even cancer. It’s often used in conjunction with traditional treatments to provide extra help. Children can use high amounts of CBD safely and without any risk.

Michigan Bill on Communication Impediment Designation

In The Politics of Autism, I write:

[M]any police departments have trained officers and other first responders how to spot signs of autism and respond accordingly. Some organizations have also published identification cards that ASD adults can carry in order to defuse potential conflicts. Virginia provides for an autism designation on driver licenses and other state-issued identification cards. Once again, however, the dilemma of difference comes into play. One autistic Virginian worries: “Great, so if I get into an accident, who’s the cop going to believe, the guy with the autistic label or the guy without it?” Clinical psychologist Michael Oberschneider is concerned about the understanding level of first responders: “I think many people still think of Rain Man or, more recently, the Sandy Hook Shooter, when they think of autism even though very few people on the autistic spectrum are savants or are homicidal and dangerous.”

Lauren Gibbons at MLive:

When Xavier DeGroat got pulled over for going over the speed limit in Lansing five years ago, it wasn’t long before the flashing lights of the police car and the interaction with law enforcement gave him severe sensory overload anxiety.

DeGroat, the founder and CEO of the Xavier DeGroat Autism Foundation, has autism, and he said the stress of the situation made it difficult for him to communicate with the officer or provide required documentation in a timely manner.

“The police did not know, the police would not imagine just by looking at me,” he said.

DeGroat’s experience helped inspire bills passed unanimously in the Michigan Senate last week that would let drivers with autism or hearing loss voluntarily disclose a “communication impediment designation” to the Secretary of State when obtaining a driver’s license or registering their vehicle.

State Senator Tom Barrett, who sponsored the bills, explained them:

Senate Bill 278 would require the secretary of state to allow a vehicle owner who is on the autism spectrum, is deaf or has hearing loss to choose to put a “Communication Impediment” designation on their vehicle registration. This voluntary designation would be visible to law enforcement when reviewing a vehicle’s registration through the Law Enforcement Information Network — signaling to the officer that the owner has autism or a hearing issue.

SB 279 would also allow the same eligible applicants to add the designation to their enhanced driver license or enhanced state ID card application.

The bills were part of ideas highlighted at a recent “Policing Autism” event attended by Barrett and hosted by the Xavier DeGroat Autism Foundation and Lansing area local enforcement leaders at the Anderson House Office Building in Lansing.

Another Correlate: Insufficient Placental Allopregnanolone

In The Politics of Autism, I discuss various ideas about what causes the condition. Here is just a partial list of correlates, risk factors, and possible causes that have been the subject of serious studies:

• Pesticides;
• Air pollution and proximity to freeways;
• Maternal thyroid issues;
• Autoimmune disorders;
• Induced labor;
• Preterm birth;
• Fever;  
• Birth by cesarean section;
• Anesthesia during cesarean sections;
• Maternal and paternal obesity;
• Maternal diabetes;
• Maternal and paternal age;
• Maternal post-traumatic stress disorder;
• Smoking during pregnancy;
• Antidepressant use during pregnancy;
• Polycystic ovary syndrome;
• Infant opioid withdrawal;
• Zinc deficiency;
• Processed foods;
• Maternal occupational exposure to solvents;
• Estrogen in the womb;
• Morning sickness;
• Sulfate deficiency;
• Congenital heart disease

A release form Children's National Hospital:

A study in experimental models suggests that allopregnanolone, one of many hormones produced by the placenta during pregnancy, is so essential to normal fetal brain development that when provision of that hormone decreases or stops abruptly—as occurs with premature birth—offspring are more likely to develop autism-like behaviors. A Children's National Hospital research team reports the findings Oct. 20, 2019, at the Neuroscience 2019 annual meeting.

"To our knowledge, no other research team has studied how placental allopregnanolone (ALLO) contributes to brain development and long-term behaviors," says Claire-Marie Vacher, Ph.D., lead author. "Our study finds that targeted loss of ALLO in the womb leads to long-term structural alterations of the cerebellum—a brain region that is essential for motor coordination, balance and social cognition—and increases the risk of developing autism," Vacher says.

According to the Centers for Disease Control and Prevention, about 1 in 10 infants is born preterm, before 37 weeks gestation; and 1 in 59 children has autism spectrum disorder.

In addition to presenting the abstract, on Monday, Oct. 21, Anna Penn, M.D., Ph.D., the abstract's senior author, will discuss the research with reporters during a Neuroscience 2019 news conference. This Children's National abstract is among 14,000 abstracts submitted for the meeting, the world's largest source of emerging news about brain science and health.

ALLO production by the placenta rises in the second trimester of pregnancy, and levels of the neurosteroid peak as fetuses approach full term.

To investigate what happens when ALLO supplies are disrupted, a research team led by Children's National created a novel transgenic preclinical model in which they deleted a gene essential in ALLO synthesis. When production of ALLO in the placentas of these experimental models declines, offspring had permanent neurodevelopmental changes in a sex- and region-specific manner.

"From a structural perspective, the most pronounced cerebellar abnormalities appeared in the cerebellum's white matter," Vacher adds. "We found increased thickness of the myelin, a lipid-rich insulating layer that protects nerve fibers. From a behavioral perspective, male offspring whose ALLO supply was abruptly reduced exhibited increased repetitive behavior and sociability deficits—two hallmarks in humans who have autism spectrum disorder."

On a positive note, providing a single ALLO injection during pregnancy was enough to avert both the cerebellar abnormalities and the aberrant social behaviors in experimental models.

The research team is now launching a new area of research focus they call "neuroplacentology" to better understand the role of placenta function on fetal and newborn brain development.

"Our team's data provide exciting new evidence that underscores the importance of placental hormones on shaping and programming the developing fetal brain," Vacher notes.

Collett Quits

In The Politics of Autism, I write about special education and the Individuals with Disabilities Education Act.

Evie Blad at Education Week:

The U.S. Department of Education's top official in charge of special education services is leaving his post, Secretary Betsy DeVos announced Wednesday.

Johnny Collett, assistant secretary for the office of special education and rehabilitative services, has served in the Trump administration for nearly two years. Mark Schultz, who has been commissioner of the rehabilitation services administration, will take on Collett's duties, an Education Department spokesperson said. The position requires Senate confirmation.

The office for special education and rehabilitation services oversees programs and policies that support people with disabilities, including transitions to adulthood.

Collett, who is respected in the special education community, previously served as special education director for Kentucky and as the director of special education outcomes for the Council of Chief State School Officers. He also served on the board of the National Association of State Directors of Special Education.

Michelle Diament at Disability Scoop:

 Angela Morabito, an Education Department spokeswoman, said Collett is leaving Washington to spend more time with his family.

Sharpton Cancels Antivax Event

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing disease to spread. 

Azeen Ghorayshi at Buzzfeed:

An event hosted by Rev. Al Sharpton's civil rights organization and poised to raise dangerous anti-vaccine viewpoints in Harlem this weekend was canceled by the group on Tuesday, after physicians and public health officials argued that the event was harmful and targeted the African American community.

"We said both sides must be heard — we haven’t taken a position yet," Sharpton said, asked about the National Action Network's decision to host the event in the first place. Sharpton clarified that he was not hosting the event and was not even sure whether he'd attend.

 The free event, which was planned to be hosted by NAN's chapter in Harlem, was slated to come just one month after New York City declared an end to its largest measles outbreak in nearly 30 years. 

Orac:

To summarize, Curtis Cost was slated to be one of the attendees. He’s the author of a book called Vaccines Are Dangerous: Vaccines Are Dangerous: A Warning to the Global Community and a blog called—you guessed it—Vaccines Are Dangerous. (Subtlety would not appear to be one of Mr. Cost’s virtues.)

The interesting thing about Curtis Cost is that he was an antivaxer back when Andrew Wakefield’s antivax grift was just a greedy gleam in his eye as he listened to barrister seeking to sue vaccine manufacturers for “vaccine-induced autism” who was offering him hundreds of thousands of pounds to produce “research” to help him do that. No, seriously. Cost was spouting the “toxins gambit” long before I ever coined the term and before Wakefield ever became a household name for his antivaccine activities.

Vaccine Excemption Uptick

In The Politics of Autism, I analyze the discredited notion that vaccines cause autism. This bogus idea can hurt people by allowing disease to spread. 

From CDC:

 For the 2018–19 school year, coverage was 94.7% for 2 doses of measles, mumps, and rubella vaccine (MMR) and 94.9% for the state-required number of doses of diphtheria and tetanus toxoids and acellular pertussis vaccine, and 94.8% for varicella vaccine. Although the exemption rate slightly increased to 2.5%, most states could achieve the recommended ≥95% MMR coverage if undervaccinated children without an exemption were completely vaccinated.