Environmental Links to the Rise in Autism

1. Environmental Links to the Rise in Autism ShailajaGawali & Erica DeNicola Ithaca College Dr. SrijanaBajracharya HPEG 52500 Critical Perspectives 14 November 2012

2. What is Autism? • Autism Spectrum • Diagnosis • Characteristics • The Rise in ASDs • Why Should we Care? • Costs of ASD BREAK • Contributing Factors • Non-environmental • Environmental • Research • Funding • Debate • Take-Home Message • Prevention (If time allows) Overview

3. What do you know about Autism? In groups, create a bulleted list of things you know about Autism, and the challenges people with Autism face

4. What is Autism? • General term used for Autism Spectrum Disorders (ASD) • “Spectrum disorders” • Affect people in different ways (mild to severe) Communication, social, behavioral challenges

5. DSM-IV-TR (Diagnostics and Statistics Manual, Fourth Ed. Text Revision, 2000) Pervasive Developmental Disorders “…characterized by severe deficits and pervasive impairment in multiple areas of development…[including] impairment in reciprocal social interaction, impairment in communication, and presence of stereotyped behavior, interests, and activities” (pp. 40). Includes: Autistic Disorder, Rett’s Disorder, Childhood Disintegrative Disorder, Asperger’s Disorder,& Pervasive Developmental Disorder Not Otherwise Specified (NOS)

7. Two Stages: • Developmental Screening • Well-child checkups • ASD Screening • Comprehensive Diagnostic Evaluation • DSM-IV-TR • Professional Evaluation Diagnosis

8. Red Flags • No big smiles or other warm, joyful expressions by six months or thereafter • No back-and-forth sharing of sounds, smiles or other facial expressions by nine months • No babbling by 12 months • No back-and-forth gestures such as pointing, showing, reaching or waving by 12 months • No words by 16 months • No meaningful, two-word phrases (not including imitating or repeating) by 24 months • Any loss of speech, babbling or social skills at any age

9. http://www.youtube.com/watch?v=vGKCtp9Gaxc (1:20)

10. Simulation Directions: • Turn over test and begin working when instructed • Begin with your green flag raised • As you start feeling anxious, frustrated, or stressed out, raise your yellow flag • When you are overwhelmed, raise your red flag **Continue working on your test the whole time**

11. What is the current prevalence of Autism in America?

12. 1 in 88 children According to estimates from CDC's Autism and Developmental Disabilities Monitoring (ADDM) Network in the U.S. is on the ASD spectrum

13. 5 times more common in boys 1 in 252 girls are diagnosed with an ASD 1 in 54 boys are diagnosed with an ASD ASDs occur in all racial groups, regions, SES groups

14. How is prevalence determined?

16. The Rise in Autism

17. In 5 yearsit would affect 1 in 50 children 80,000 children per year will be diagnosed with autism. • There will be at least one child with autism in every classroom in America If this rate continues?

18. Why Should We Care?

19. Each new pediatric diagnosis of autism carries with it specific implications for: Family Community National socioeconomic systems

20. The Co$t of Autism • The average per-pupil expenditure for educating a child with autism estimated to be nearly three times the expenditure for a typical regular education • Need for long-term half-way houses, adult employment for the disabled • The cost of autism over the lifespan is 3.2 million dollars per person • $60 billion annual cost • In 10 years, the annual cost will be $200-400 billion

21. The Cost to the Individual& Families • Cognitive, social, behavioral impairment • 40% of children with Autism do not speak • Only 56% of students with autism finish high school • Families are often unable to pay for basic speech and occupational therapies • Wandering-related deaths • Need for life-long assistance or care • Long-term half-way houses

22. Affect on families http://www.youtube.com/watch?v=8jrqpn60d4A&feature=related (2:20) http://www.youtube.com/watch?v=Iu7C5clA4q0(1:00)

23. No Cure for Autism • Research shows that early intervention treatment services can greatly improve a child’s development • Therapies and behavioral interventions are designed to remedy specific symptoms

24. 5-minuteBreak 

25. Why are ASDs increasing?

26. Non-environmental risk factors • Change in the diagnostic criteria • Earlier diagnosis • Older parental age (especially older fathers) • Comorbidities • Down syndrome, fragile X syndrome, tuberous sclerosis, and other genetic and chromosomal disorders

28. Twin StudiesUsed to help determine extent genetics play in personality, disorders, diseases, etc. • Identical Twins • If one identical twin has autism, other twin is 36-95% more likely to also develop autism • Evidence for genetic link

29. Fraternal Twins • If one fraternal twin has autism, other twin is 0-31%more likely to also develop autism • More affected than general population • 2-18% chance of second child with ASD • Shared embryonic environment plays an important role

30. Role of Genetics

31. Role of Environment

32. Video http://www.youtube.com/watch?v=hH44Q2lSX6A (1:35) http://www.teachersdomain.org/resource/envh10.health.autism/ (3:30)

33. Environmental Factors • Environmental Chemicals • Pesticides • Heavy Metals • Lack of Vitamin D and Folic Acid during prenatal period • Premature birth

34. Autism as an Interaction

35. Current Funding

36. For Comparison, the National Institutes of Health spent the following on research in 2011: • $ 169 million on Autism • Affects 45, 454 US babies each year. • $ 79 million on Cystic Fibrosis • Affects 1,081 US babies each year. • $ 228 million on Pediatric AIDS • Affects 13,333 US babies each year. • $ 170 million on Pediatric cancer • affects 800 US babies each year. Federal Funding is not proportional to Autism's Impact.

37. All of these are important, but given the long-term human and cost impacts and autism's rapid rate of growth, autism research is grossly underfunded.

38. According to the NAA(National Autism Association) • Genetic studies are the most common type of study in the medical literature concerning ASD • more studies (1,576) than other areas of study combined • 190publications examined environmental toxicant exposures in ASD • 170 (89%) found an association

39. Congratulations!You are now all wealthy philanthropists donating financial assistance for the ASD crisis

40. Debate! Timing Rules • 5 minutes for formulating opening statement • 2 minutes to state your argument • 5 minutes to create rebuttal • 2 minutes to present rebuttal • 1 minute to prepare closing statements • 2 minutes to present closing statements

41. Debate Topic Side 1 Side 2 Money is better spent on helping those with Autism & their families Money is better spent on research for environmental factors

42. Take-Home Message As health educators, it is our job to: • Educate people about risk factors, prevention, and management of Autism • Advocate for funding and collaborate with researchers to determine the cause of increased Autism rates • Promote and protect health

43. No drugs during pregnancy (unless doctor prescribes) • No alcohol while pregnant • Immunization against German measles (rubella) before pregnancy • Act quickly whenever there is a concern about a child development • Taking prenatal vitamins containing folic acid and/or eating a dietrich in folic acid during the months before and after conception Prevention

44. Prevention • No “Mom shots” • Breastfeeding • Eat organic • Limit cow milk (casein) • Avoid gluten • Don’t overuse antibiotics • Limit pesticide exposure • Limit preservative intake