Boys with Autism, Related Disorders, Have High Levels of Growth Hormones

Boys with autism and autism spectrum disorder had higher levels of hormones involved with growth in comparison to boys who do not have autism, reported researchers from the National Institutes of Health, the Centers for Disease Control and Prevention, the Cincinnati Children’s Hospital and the University Of Cincinnati College Of Medicine.

The researchers believe that the higher hormone levels might explain the greater head circumference seen in many children with autism. Earlier studies had reported that many children with autism have very rapid head growth in early life, leading to a proportionately larger head circumference than children who do not have autism.

The researchers found that, in addition to a larger head circumference, the boys with autism and autism spectrum disorder who took part in the current study were heavier than boys without these conditions.

“The study authors have uncovered a promising new lead in the quest to understand autism,” said Duane Alexander, M.D., Director of the National Institute of Child Health and Human Development, the NIH institute that funded the study. “Future research will determine whether the higher hormone levels the researchers observed are related to abnormal head growth as well as to other features of autism.”

Autism is a complex developmental disorder that includes problems with social interaction and communication. The term autism spectrum disorder (ASD) refers to individuals who have a less severe form of autism.

The study was published on line in Clinical Endocrinology.

The researchers compared the height, weight, head circumference and levels of growth-related hormones to growth and maturation in 71 boys with autism and with ASD to a group of 59 boys who did not have these conditions.

The investigators found that the boys with autism had higher levels of two hormones that directly regulate growth (insulin-like growth factors 1 and 2). These growth-related hormones stimulate cellular growth. The researchers did not measure the boys’ levels of human growth hormone, which for technical reasons is difficult to evaluate.

The boys with autism also had higher levels of other hormones related to growth, such as insulin-like growth factor binding protein and growth hormone binding protein.

In addition to greater head circumference, the boys with autism and those with autism spectrum disorders weighed more and had a higher body mass index (BMI). BMI is a ratio of a person’s weight and height. A higher BMI often indicates that a person is overweight or obese. The boys’ higher BMI may be related to their higher hormone levels, said the study’s principal investigator, NICHD’s James L. Mills, M.D., a senior investigator in the Division of Epidemiology, Statistics and Prevention Research’s Epidemiology Branch. Dr. Mills and his coworkers also found that there was no difference in height between the two groups of boys.

The levels of growth-related hormones were significantly higher in the boys with autism even after the researchers compensated for the fact that higher levels of these hormones would be expected in children with a greater BMI.

“The higher growth-related hormone levels are not a result of the boys with autism simply being heavier,” said Dr. Mills.

While it has long been noted that many children with autism have a larger head circumference than other children, few studies have investigated whether these children are also taller and heavier, Dr. Mills added.

Researchers analyzed medical records and blood samples from 71 boys diagnosed with autism and ASD who were patients at Cincinnati Children’s Hospital Medical Center from March 2002 to February 2004. The researchers compared the information on the boys with autism and autism spectrum disorders to other boys treated for other conditions at the hospital and who do not have autism. Children with conditions that may have affected their growth — such as being born severely premature, long-term illness, or the genetic condition Fragile X were not included in the study. Girls are much less likely to develop autism than are boys, and the researchers were unable to recruit a sufficient number of girls with autism to participate in the study.

Dr. Mills explained that the bone age of the boys with autism — the bone development assessed by taking X-rays and comparing the size and shape of the bones to similarly-aged children — were not more advanced in the group of boys with autism. For this reason, Dr. Mills and his coworkers ruled out the possibility that they were merely maturing more rapidly than were the other boys.

Dr. Mills said that future studies could investigate whether the higher levels of growth hormones seen in children with autism could be directly related to the development of the condition itself.

The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s Web site at http://www.nichd.nih.gov/.

The National Institutes of Health (NIH) — The Nation's Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Study links autism with growth hormones, big heads

Boys with autism and related disorders had higher levels of growth hormones than other boys, which may explain why children with the condition often have larger heads, researchers reported on Friday.

Boys with autism and autism spectrum disorders were also heavier than boys without these conditions, the teams at the National Institutes of Health, the Centers for Disease Control and Prevention and the Cincinnati Children's Hospital reported.

Other studies had already shown that children with autism have very rapid head growth in early life.

"The study authors have uncovered a promising new lead in the quest to understand autism," said Dr. Duane Alexander, Director of the National Institute of Child Health and Human Development.

"Future research will determine whether the higher hormone levels the researchers observed are related to abnormal head growth as well as to other features of autism," Alexander said in a statement.

No one knows what causes autism, a complex developmental disorder that includes problems with social interaction and communication.

Symptoms range from mild awkwardness seen in Asperger's syndrome, to severe disability and mental retardation. A recent CDC survey found that 1 in every 150 U.S. children has autism or an autism spectrum disorder, a less severe condition related to autism, such as Asperger's.

Writing in the journal Clinical Endocrinology, Dr. James Mills of the NICHD and colleagues said they compared the height, weight, head circumference and levels of growth-related hormones to growth and maturation in 71 boys with autism to a group of 59 healthy boys.

The boys with autism had higher levels of two hormones that directly regulate growth -- insulin-like growth factor-1 and IGF-2. The boys also had higher levels of hormones that indirectly affect growth.

The researchers did not measure the boys' levels of human growth hormone, which for technical reasons is difficult to evaluate.

The boys with autism and those with autism spectrum disorders had a greater head circumference on average, weighed more and had a higher body mass index than the other boys, although there was no difference in height between the two groups of boys.

Girls are much less likely to develop autism than boys, and the researchers were unable to recruit enough girls with autism to participate in the study.

Several genes have been linked with autism, but environmental factors may also play a role, experts say.

UCLA Imaging Study Provides Clues About Inability To Imitate And Empathize In Autistic Children

New imaging research at UCLA shows that impairments in autistic children's ability to imitate and empathize can be linked to dysfunction in the brain's mirror-neuron system.

In research presented at the annual International Meeting for Autism Research in Seattle, UCLA scientists demonstrated a clear link between a child's inability to imitate expressions on the faces of other people and a lack of activity in the mirror-neuron system (MNS).

Mirror neurons fire when an individual performs an action with a goal in mind. They also fire when one watches another individual perform that same action. Neuroscientists believe this "mirroring" is the neural mechanism by which the actions, intentions and emotions of other people can be automatically understood.

Individuals with autism can't rely on this system to read the minds of other people. Symptoms of autism include varying levels of difficulty with social interaction, including verbal and nonverbal communication, imitation, and empathy. These findings bolster the growing body of evidence that points to a breakdown of the MNS as the mechanism behind these symptoms.

"These results support the notion that a dysfunctional mirror-neuron system may underlie the impairments in imitation and in empathizing with other people's emotions typically seen in autism," said Mirella Dapretto, associate professor of psychiatry and biobehavioral sciences at the Semel Institute for Neuroscience and Human Behavior at UCLA and the David Geffen School of Medicine at UCLA. Dapretto and Stephany Cox, a research assistant in Dapretto's lab, are the lead authors of the study. "Together with other recent data, our results provide further support for a mirror-neuron theory of autism."

To measure mirror-neuron activity, the research used functional magnetic resonance imaging (fMRI) in 12 high-functioning children with autism as they viewed and imitated faces depicting several emotional expressions, such as anger, fear, happiness or sadness. Prior to the fMRI experiment, the children's imitative behavior was measured using scores from the Autism Diagnostic Interview (ADI-Revised), an instrument widely used to assess symptoms of autism. Children's empathic behavior was assessed using a child-modified version of the Interpersonal Reactivity Index (IRI), a previously validated scale that assesses four distinct facets of empathy.

The researchers found that, as expected, the level of brain activity in "mirroring" areas was related to the children's tendency to spontaneously imitate others, as well as to empathize with them. Specifically, significant negative correlations were found between symptom severity on the imitation items of the ADI-R and activity in the mirror area located in the brain's right inferior frontal gyrus. Additionally, significant positive correlations were observed between children's total scores on the empathy scale and activity within this mirror area and two other key regions in the brain involved in emotional understanding and empathy, the insula and amygdala.

"Simply put," said Cox, "the more the children tended to spontaneously imitate social behaviors or to empathize with the plight of others, the more brain activity we saw in the frontal component of the mirror-neuron system in the right inferior frontal gyrus. Conversely, the greater their impairments in these domains, the less activity we saw in this mirroring brain region.

"Importantly, these results indicate that abnormalities in the mirror-neuron system may negatively affect imitative behavior," she said. "In turn, this may lead to a cascade of negative consequences for the development of key aspects of social cognition and behavior in children with autism."

Top of the class: Santa Rosa student overcomes autism to graduate with honors

By CLARISSA MARTINEZ SANTA ROSA — Danny Canales is a role model.

Diagnosed as autistic at 2, Danny grew up during a time when autism was not well known in the Rio Grande Valley, his mother, Janie Canales-Cabrera said.

But with guidance from his family and members of the education community, Danny graduated — with honors and among the top 10 in his class — from Santa Rosa High School on Friday night. “It’s a lot of feelings at one time,” Danny said. But graduation didn’t come without overcoming struggles.

Danny, 19, began an Early Childhood Intervention Program when he was 3 years old.
“At the time he was severely autistic,” Canales-Cabrera said. “Children with autism, they live in their own little world, they build a world around them.”

Instead of separating Danny, Canales-Cabrera worked with his teachers and speech therapist to try to help Danny learn how to cope in a regular classroom. “He spent two years in kindergarten in the hopes that his social skills would improve,” Canales-Cabrera said.

By first grade, Danny was in the classroom, without any academic assistance but with behavioral modification. “Basically, every year I would speak to teachers and explain what to expect from him,” Canales-Cabrera said.

While in high school, Danny was involved in the high school band, 4-H and student council.
It was his interest in extra-curricular activities that surprised his mother. “Autistic children do not become cheerleaders,” Canales-Cabrera said. “Danny made it to All-American Cheerleaders.”

But Canales-Cabrera said she had to explain to coaches, teachers and even cheerleading judges about Danny’s autism so they could understand his behavior.

She compared it to building a bridge between his world and the rest of society.
“That bridge may break down a couple of times, but you go back and rebuild,” Canales-Cabrera said. “And in the end there is success.”

A success she was told couldn’t be reached.

When Danny was first diagnosed, a doctor recommended that he be institutionalized.

“I made up my mind that day that I would never give up,” Canales-Cabrera said. “I guess I have to thank that doctor for telling me that, because I did totally the opposite.”

Danny’s sister, Kassandra, a junior in high school, said her brother is a role model who carries his enthusiasm for school with him every day. “He actually likes coming to school,” Kassandra said. “He’s always doing something.”

Kassandra is often involved in the same activities as her brother.

“It makes life so much easier,” Canales-Cabrera said.

But Kassandra said Danny has his own interests, like his love of the Weather Channel and architectural design. “It’s just that I’m a very creative person,” Danny said about enjoying architecture. Danny has been accepted to Texas A&M University in Corpus Christi, something that the family is addressing both financially and logistically.

“His autism is never going to go away, but yet he appears normal that society has forgotten,” she said. “My biggest goal is for people to understand that autism is not a disability unless you make it so.”

“I have hope someone will read Daniel’s story, and have faith that this can happen,” Canales-Cabrera said, trying to hold back tears. “Because we went through a lot.”

When asked by his mother if he had a message to other autistic children, Danny spoke about hope and persistence.

“There’s hope,” Danny said. “No matter how dark the tunnel is, there is always going to be some sort of a light.”

Boy dies during autism treatment

By Karen Kane and Virginia Linn, Pittsburgh Post-Gazette

A 5-year-old autistic boy died Tuesday in a Butler County doctor's office while undergoing an increasingly popular though controversial medical treatment touted by some as a cure for the lifelong neurological and developmental disorder.

Abubakar Tariq Nadama died while receiving chelation therapy, an intravenous injection of a synthetic amino acid that latches onto heavy metals and is then passed in the urine.

State police at Butler are investigating Nadama's death, which occurred at about 10:50 a.m. Tuesday in the office of Dr. Roy Eugene Kerry in Portersville.

Authorities said Kerry's office reported that the child was receiving an IV treatment for lead poisoning when he went into cardiac arrest.

The boy was being treated with EDTA, or ethylene diamine tetraacetic acid, which has been approved by the Food and Drug Administration for use only after blood tests confirm acute heavy-metal poisoning.

Exposure to heavy metals, especially mercury, has been linked by some researchers as a contributing cause to autism. Removing those metals, they believe, can improve a child's condition. The theory is a matter of dispute among scientists and within the autism community.

A family friend said the boy and his mother, Marwa, who are from England, moved here in the spring, specifically to receive chelation therapy, and were living in Monroeville.

In the autism community, the use of chelation as a way to detoxify environmental contaminants in children has exploded since 2000 as more and more families have reported miraculous improvements and even cures. But skeptics in the community say they fear the procedure is at best risky and possibly lethal.

"It was just a matter of time before something like this would happen," said Howard Carpenter, executive director of the Advisory Board on Autism-Related Disorders.

"Parents of children with autism are desperate. Some are willing to try anything," he said.

"I can't sit there and endorse it as a viable treatment. It's not something published in peer review journals and studies," said Dr. Gary Swanson, a child psychiatrist at Allegheny General Hospital who works with autism patients. "It's probably a quack kind of medicine."

If the child's death is tied to chelation therapy, it would be the first associated with the procedure since the 1950s, said Dr. Ralph Miranda of Greensburg. Miranda is the former president of the American College for Advancement in Medicine, a group that sets clinical practice and education standards for chelation and other, similar therapies.

Chelation can be administered through pills, skin creams or other transdermal methods, nasal sprays, sauna baths and intravenously. Miranda said it is unusual to give a young child IV treatments unless he has an extremely high level of heavy metals.

He said although EDTA is a "very safe drug" he usually administers an oral form of chelation drugs to children to remove toxins because pills are safer. It does, however, take longer to remove the toxins with the pills.

"There are people out there suggesting using the IV to get faster results. I'm not," he said.

Marwa Nadama said yesterday she did not want to comment except to say that she is not blaming chelation for her son's death, at least not at this point.

"Let's wait until we have the results of the autopsy," she said.

An autopsy conducted yesterday on the child's body by the Allegheny County coroner's office was inconclusive. Results on the cause and manner of death are pending additional testing which could take up to five months to complete, authorities said.

Kerry, who is a board-certified physician and surgeon, advertises himself as an ear, nose and throat specialist, dealing with allergies and environmental medicine. He operates out of offices in Greenville and Portersville under the name Advanced Integrative Medicine Center Inc. Kerry did not return calls to his offices yesterday.

Doctors affiliated with the National Institutes of Mental Health and American Academy of Pediatrics do not endorse the use of chelation therapy to remove heavy metals for autism. Such drugs used in the process can cause liver and kidney damage and other problems.

Cindy Waeltermann, director of the Pittsburgh-based national advocacy group AutismLink, issued a statement to members yesterday warning that caution needs to be used as parents seek help for their autistic children.

"Please, before you try any new therapies, we urge you to research the physician, the methods, and the safety. Some of these therapies are quite dangerous. We're not telling you what to do, we're just urging you to use caution. We all do what we think is best for our children, and sometimes we are desperate. While we've heard stories of chelation success, it is definitely a dangerous process," Waelterman wrote.

She said parents on her group's online forum have referred to Kerry as a known practitioner of chelation therapy.

News of the death soared across the autism community yesterday, alarming proponents and foes of the treatment.

"It's just terrible. My heart is just dying for the family," said J.B. Handley of San Francisco, who helped found Generation Rescue, an international advocacy program for the use of biomedical treatments that include chelation therapy to help autistic children.

He claims his son Jamison, now 3, has dramatically improved since undergoing chelation therapy to remove mercury, the metal most associated with autism because of its presence in some childhood vaccines. He and his wife launched their international group in May.

He said that, in 2000, perhaps a dozen autistic children were treated with chelation therapy. This year, it's more than 10,000.