Connections Between the Brain and Heart in Autism

Recently, two interesting research summary articles published online at Spectrum indicate that children and adults with autism display characteristic differences in heart rates, suggesting the autonomic nervous systems of their brains also function differently. In “Nerves that control heart rate may contribute to autism,” published February 19, 2019, Nicholette Zeliadt describes contrasts between heart rate changes in typical children and those with autism. [To read this article, please click here.]

Referencing “Developmental trajectories of autonomic functioning in autism from birth to early childhood,” published March 2019, in Biological Psychology, this Spectrum article explains research done at Brown University in the United States. [To read this research article, please click here.] Under the direction of Stephen Sheinkopf, associate professor of psychiatry and human behavior, researchers studied 118 children from ages one month to six years by measuring their heart and breathing rates. Of this group, 12 had autism, and the other 106 did not have autism. They were assessed every 6-12 months.

Normally, a person’s heart rate increases when inhaling and decreases when exhaling, a condition known as respiratory sinus arrhythmia (RSA). The autonomic nervous system controls these slight changes. These changes in breathing and heart rate are also linked to regulating emotions and paying attention to social cues, which are often impaired in autism.

The researchers found that all of the children showed similarly decreasing heart rate, which occurs over time with normal development. However, the children with autism were slower than their typical peers to develop the normal fluctuation of heart rate that occurs with breathing. Moreover, this phenomenon was most obvious after 18 months of age when behavioral symptoms of autism often emerge. By the age of 6, children with autism catch up with their typical peers in this trait (RSA) and demonstrate similar fluctuation of heart rate with breathing.

After observing the differences in heart rates and breathing between typical children and those with autism, researchers concluded, “RSA is a marker of functional status in autism rather than a cause of social deficits.” They suggest that the impairment of the autonomic nervous system occurs when autistic behaviors appear. Moreover, they note that children with autism have issues with physiological regulation––such as breathing and heart rate––that develop over time. Because this research only involved children who were exposed to drugs before birth, the researchers plan to study other groups of children to see if heart rate and breathing differences occur more widely.

In another recent Spectrum article, published May 17, 2019, and titled “Nerves that control heart rate may be offbeat in autistic adults,” Jessica Wright describes similar research involving adults. [To read this article, please click here.] She summarizes an article, “Reduced heart rate variability in adults with autism spectrum disorder,” published in Autism Research on April 10, 2019. [To read this research, please click here.]

Under the direction of Adam Guastella, professor of child and youth mental health at the University of Sydney in Australia, researchers examined resting heartbeats of 110 adults aged 16-41. Half of the participants had autism, and the other half included typical adults. All of the people in the study had no known heart conditions, and none of them were taking heart medications.

Usually, people’s resting heartbeat varies, showing flexibility and readiness to respond to environmental changes. However, researchers discovered that in adults with autism, the resting heart rate rarely varied. Moreover, those with autism had a higher baseline heart rate than the typical people. The lack of change in heart rate suggests issues with the autonomic nervous system responsible for reacting to social stimuli as well as heart rate and breathing. Researchers note that these results may explain issues with social skills common in autism as well as heart problems that can lead to early death in people with autism.

Of the participants in the study who had autism, half of them were taking medications, specifically antidepressants and antipsychotics. However, there was no difference in the heart rates between the adults with autism taking medications and those with autism who were not taking medications. Nonetheless, researchers indicate the need for further study to examine the impact of medications upon those with autism.

While both of these research studies indicate connections between heart rates, the autonomic nervous system, and autism that begin in infancy and continue through adulthood, more research clearly needs to be done. For example, what triggers at age 18 months may be responsible for the emergence of autistic behaviors? What is the connection between impairment of the autonomic nervous system and the apparent need for antidepressant and antipsychotic medications commonly prescribed for autism? What can be done to regulate heart rates so that adults with autism do not die young from heart conditions? Certainly, gaining knowledge regarding autism proves helpful, but more research must be done before we can hope to find a cure for autism.

“Jesus replied, ‘Love the Lord your God with all your heart and with all your soul and with all your mind.’” Matthew 22:37

One in Forty

An article published in the December 2018 issue of the journal Pediatrics indicates that the current rate of autism in the United States is 1 in 40 children. “The Prevalence of Parent-Reported Autism Spectrum Disorder Among U.S. Children” details research led by Michael D. Kogan, Ph.D. and his colleagues at the Office of Epidemiology and Research at the Health Resources and Services Administration’s Maternal and Child Health Bureau. [To read this article, please click here.] Their study analyzed parent survey data from the 2016 National Survey of Children’s Health and included 43,283 children 3-17 years old.

For this survey, parents were asked if a doctor and/or another health care provider had ever told them that their child had autism. The parents were also asked if their children currently had autism. Of the parents surveyed, 2.5% responded that their children had received an autism diagnosis from a medical professional and still had autism. This translates into approximately 1.5 million children in the United States with autism. In addition, the data showed that boys are 3.5 times more likely than girls to have autism.

In comparing this survey to other similar surveys regarding autism prevalence, the researchers noted that the National Health Interview Survey yielded similar statistics. The results of the Autism and Developmental Disabilities Monitoring Network (ADDM), which were reported in April of this year, showed a lower rate of autism: 1.7% of children with autism, or 1 in 59 children. Dr. Kogan’s team notes that the ADDM survey focused only on eight-year-old children in eleven communities in 2014, whereas their research covers a wider range of ages across the country in a more recent survey.

In addition to citing the increase in the rate of autism in the United States, the researchers emphasize that children with autism have greater health needs than typical children. Specifically, 83% of children with autism have at least one health condition, such as asthma, eczema, gastrointestinal issues, or seizures, accompanying autism. Furthermore, they found that children with autism are more likely than other children with behavioral, developmental, or emotional disorders to have seen a specialist and to have received mental health counseling, early intervention, and special education services.

However, finding proper care for children with autism proves difficult, the researchers discovered. The survey indicated that parents were 44% more likely to have difficulty getting mental health treatment for their children with autism. Moreover, children with autism are 46% less likely to receive needed mental health care. The researchers also found that 64% of the children with autism had received behavioral therapy in the past twelve months. In addition, 27% of the children with autism took medications for symptoms such as anxiety, irritability, and hyperactivity.

Aside from a lack of mental health care availability, the researchers also noted problems finding a “medical home” for each child with autism. They defined medical home as having five criteria, all of which must be met for the patient: a personal doctor or nurse, a usual place for sick care, no problems getting referrals, family-centered care, and effective care coordination. Their survey indicated that children with autism were 23% less likely to have a medical home, and 24% were less likely to have their care coordinated. Clearly, having professionals work together to improve the child’s physical and mental health is crucial in autism, but more coordination of services must be done.

As the researchers state, autism rates have been increasing over the past thirty to forty years. Other studies have demonstrated the significant rise in the number of children diagnosed with autism. Specifically, the rate of autism in the United States has gone from 1 in 5000 in 1975 to 1 in 2500 in 1985 to 1 in 500 in 1995 to 1 in 250 in 2001 to 1 in 166 in 2004 to 1 in 110 in 2009 to 1 in 88 in 2012. This new research now makes another leap to 1 in 40 in 2016. The researchers speculate that the increase is due to better and earlier diagnosis, broader diagnostic criteria for autism, greater parental awareness, and some increased risk factors, such as older parents.

The sudden increase in numbers of children with autism poses a financial hardship as well as difficulties noted in finding proper physical and mental health care. The researchers indicated that the cost of providing proper health care and non-health care for a child with autism is $17,081 greater per year than for a typical child. Moreover, the researchers cited data from 2011 indicating that the total societal cost of caring for children with autism in the United States was estimated to be $11.5 billion per year. Considering the number of children in the U.S. has doubled or tripled since then, the cost of caring for them would also significantly rise.

The researchers conclude their article as follows: “Because ASD [autism spectrum disorder] is a lifelong condition for most children, an important area of future research would be to study life course development and understand what factors influence health and well-being in young adulthood and beyond for these children.” Well, the good news is that they will probably have a lot of people with autism available to study, especially if the rates keep increasing dramatically. The bad news is that they will get no closer to finding the cause of autism if they continue to stick with the better diagnosis/greater awareness/increased diagnostic criteria reasoning. At what point will the medical profession declare we have a health care crisis as more and more children are diagnosed with autism, a lifelong condition?

Instead of just counting the number of children with autism and admitting they need better access to care, researchers need to figure out the true causes of autism. For example, what roles do environmental toxins, such as heavy metals, play in autism? Furthermore, instead of denying that vaccines cause autism, perhaps an unbiased reexamination of their effects upon children should be taken. One only need to see that the dramatic increase in autism follows the dramatic increase in the number of vaccines recommended by the CDC for children between birth and five years of age. In 1962, only three shots were recommended, but in 1983, ten shots were advised. The 2018 CDC Recommended Immunization Schedule now includes 38 shots.

The researchers who proclaim the new rate of autism is 1 in 40 American children never address the possibility that environmental toxins or the increased rate of vaccines may be related to autism. Until doctors and researchers are willing to consider all possible causes of autism and seek ways to make our children with autism healthier, we can anticipate that the autism rates will likely go higher. We can only hope and pray that our merciful God will save us and our children from this calamity, for He can heal what humans cannot.

“From six calamities He will rescue you; in seven no harm will touch you.” Job 5:19

Looking for Links in Autism

As if dealing with autism were not difficult enough, most children with autism also have at least two other medical conditions. A recent article, “Some conditions tend to accompany autism in pairs,” written by Hannah Furfaro and published online on the Spectrum website on September 12, 2018, describes research regarding this phenomenon. [To read this article, please click here.] This article summarizes research published on July 24, 2018, in the journal Academic Pediatrics under the title “Identifying Associations among Co-occurring Medical Conditions in Children with Autism Spectrum Disorders.”

Under the leadership of neurologist Ann Neumeyer, the medical director at the Lurie Center for Autism at MassGen Hospital for Children in Boston, this study examined data from a network of autism clinics between 2010 and 2016. The research focused upon 3335 children with autism: 2114 who were seventeen months to five years old and 1221 who were six to seventeen years old.

For this study, researchers identified twelve medical conditions that commonly affect people with autism. These conditions included anxiety, ADHD (attention deficit hyperactivity disorder), developmental delay, and seizures. In addition, issues related to eating and digestion often found in autism, such as feeding difficulties, pica (eating nonfood substances), and constipation, were also included. Rounding out the list were various conditions: eczema, hypotonia (low muscle tone), disruptive behavior, sleep difficulties, and speech issues.

As they examined the data, researchers looked for conditions that were often found together and calculated the prevalence of these pairs in the two age groups of children with autism. In the group of children under six years old, the most commonly linked conditions were speech issues and developmental delay, occurring in 18.54% of the children. Next, 16.46% of the children had both speech issues and sleep difficulties. The third most common pair of conditions was speech issues and feeding difficulties (9.74%), followed by speech issues and constipation in 8.09% of the children. Closely following at 7.99% was the pair of sleep difficulties and developmental delay, then speech and hyponia at 7.28%, and finally, sleep difficulties and constipation, with 6.24% of children affected by both conditions.

In the group of children with autism who were six to seventeen years old, some of the same pairs of conditions occurred, but other new ones also arose in this data. The most commonly observed pair was sleep difficulties and ADHD seen in 11.22% of the older children. In approximately one tenth of those children, speech issues and sleep difficulties (10.89%) and speech issues and ADHD (10.65%) were paired. In addition, 8.68% of these children had speech issues with developmental delay. Also, these children suffered from constipation: 6.39% of the children with speech issues had constipation, and 5.65% of the children with sleep problems had constipation. Finally, 5.16% of the children had both speech issues and hypotonia.

Obviously, the common denominator in many of these paired conditions is speech issues, which occur in the vast majority of these pairings. Dr. Neumeyer notes that speech issues are linked with other conditions because speech difficulties are common in autism. She also notes that the link between some conditions proves more obvious. For example, children who have oral motor issues may likely have problems with speech and feeding. By examining the linked conditions, researchers hope to discover possible genetic origins and potential treatments for these conditions.

Clearly, the overall prevalence of speech issues highlights the importance of speech therapy for children with autism. However, finding a speech therapist is not always easy, especially with the increasing numbers of children with autism, which often means being on waiting lists before speech therapy can begin. Speech therapists in school districts are often overwhelmed by ridiculously large caseloads of children and cannot always provide the individual therapy time needed to help children with autism.

Another issue repeatedly found in this research is the problem of sleep difficulties. Many children with autism struggle with sleeping, which impacts their families, as well. To keep their children with autism and insomnia safe, many parents stay awake with their children all night. For some children with autism, the supplement melatonin offers a natural way to increase drowsiness, helping them fall asleep and stay asleep so that everyone in the home can get a good night’s sleep.

In addition, doctors need to find the cause of constipation in children with autism so that they don’t have to suffer needlessly. Children with speech issues may not be able to communicate abdominal distress associated with constipation, and abdominal pain may be responsible for sleep problems linked to constipation. Since many children with autism also have food allergies and digestive issues, perhaps identifying and addressing these conditions could prevent constipation and any related issues.

Most importantly, this research demonstrates the wide range of medical conditions associated with autism. Parents must advocate to make sure their children get the best medical care possible, and doctors must recognize that these problems go beyond the scope of autism and need to be addressed. After these common conditions found in autism are diagnosed, proper treatment must begin to help children overcome issues that affect their health and well-being. Awareness of the links between autism and various conditions is just the beginning; seeking the true connections and finding ways to make children with autism happier and healthier should be the ultimate goal.

“Keep on asking, and you will receive what you ask for. Keep on seeking, and you will find. Keep on knocking, and the door will be opened to you.” Matthew 7:7