Study: Signs of autism may show up as early as first month

— The first signs of autism may be visible as early as the first month of a child’s life, according to a study published Wednesday in the scientific journal Nature.

“These are the earliest signs of autism ever observed,” says lead study author Warren Jones.

Researchers at the Marcus Autism Center in Atlanta followed 110 children from birth to age 3, at which point a diagnosis of autism was ascertained.

Fifty-nine babies were considered “high risk” for developing an autism spectrum disorder (ASD) because they had siblings with autism; 51 were considered “low risk” because they did not have first, second or third-degree relatives with ASD.

Data was collected at 2, 3, 4 ,5, 6, 9, 12, 15 and 24 months of age. Each time, the children watched videos showing actresses playing the role of a caregiver. “Every baby watched the same videos, and then we could measure what was different about the responses of infants later diagnosed with autism versus infants who were typically-developing,” Jones says.

Lack of eye contact is one of the red flags when it comes to autism — a group of neurodevelopmental disorders that can cause significant social, communication and behavioral challenges.

Jones, who is the director of research at Marcus Autism Center and assistant professor in the Department of Pediatrics at Emory University School of Medicine, says he really expected the children later diagnosed with autism would have diminished eye contact from birth. Instead, he and his colleagues measures how much time each baby was looking at the eyes of the caregiver in the video.

“Basically from birth, (all) babies will look more at the eye part of faces,” says Jones. But at about 4 to 6 weeks, he says the attention to eyes decreases, then in typical babies picks up again at 2 months. Jones found, “in the first 6 months of life we’re seeing a decline in the amount of looking at other people’s eyes in children who later are diagnosed with autism.”

The research suggests that a baby’s initial eye contact ability may be an almost a reflex-like behavior, but then there may be a second phase of development that depends on different brain and gene systems which lead to social interaction, Jones says. That’s where a typically developing child’s development may differ from a child with autism.

The study authors conclude that “the observation of this decline in eye fixation — rather than outright absence — offers a promising opportunity for early intervention.”

This is not something parents are going to see by just holding their baby, Jones points out. This type of eye-tracking requires sophisticated technology that can track even the slightest movement of the eye.

“It’s a very interesting study with intriguing results. ” says Wendy Stone, a longtime autism researcher and director of the Research in Early Autism Detection & Intervention (READI) lab at the University of Washington. But, she adds, “many researchers in this field have not seen behaviors under 6 months to be predictive of later diagnosis.”

She also cautions that babies looking at videos of their mothers are not the same as the actual stimuli created by a mom interacting with her baby. “Are these babies less interested in eyes because mouths are more interesting to look at and more attractive because there’s more movements? To me that’s one of the big questions,” says Stone.

Dr. Max Wiznitzer, a pediatric neurologist and autism specialist at the Rainbow and Babies Children’s Hospital in Cleveland, Ohio, says this new study is a continuation of previous work in babies. He says this research makes sense to him. “There’s a decrease in the amount of attention to eyes as an early marker of social behavior (think of it as a primitive level of socialization).” Wiznitzer suggests the failure to establish these early social skills has ramifications later as “social behavior shifts into more sophisticated patterns.”

If this research bears out, then maybe at some point a pediatric practice could track eye movements as one way to diagnose a child with autism, says Stone. “But we’re really, really far away from that.”

Wiznitzer says this may explain why the autism symptoms may be more apparent at 18 to 24 months, “even though ‘subclinical’ onset was months earlier.” He also suggests these study results may offer another explanation why the measles, mumps and rubella vaccine, which isn’t administered until a baby is at least 12 months old, cannot be blamed for causing autism.

Everyone agrees this research needs to be replicated in bigger studies with more children, Wiznitzer says. “The authors are correct that a replication study using a larger number (of children) is necessary. Before that time, I would not devote extensive resources towards assessing eye attention in infants or designing major intervention programs.”

Jones says, “what we really want to do is create growth charts for social behavior, just like we have growth charts for charting a child’s height and weight.” He says these those are the kind of tools that pediatricians need and parents are looking for.

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Should I be concerned about new virus?

— When the head of the World Health Organization says a new virus is her “greatest concern right now,” people worldwide may wonder whether they should be concerned.

This new coronavirus, which experts recently named MERS-CoV or Middle East respiratory syndrome coronavirus, first surfaced in Saudi Arabia in March 2012.

It’s in the same family of viruses as SARS (severe acute respiratory syndrome – coronavirus) as well as the common cold — but the new virus is not SARS.

“There’s not the same level of concern as there was in Hong Kong or Toronto during the SARS epidemic,” says Dr. Mark Denison, a professor of pediatrics and longtime coronavirus researcher at Vanderbilt University.

Unlike SARS which sickened more than 8,000 people in 2003 and killed 773 worldwide, this new coronavirus does not spread easily between humans — at least not yet.

It’s too early to tell whether MERS-CoV is going to spread or just burn out, so it’s essential that health officials stay vigilant, Denison says. “What’s important is continued reporting of active cases which allows for better surveillance.”

Should I be concerned about MERS-CoV?

So far only 49 cases of MERS have been reported, including 27 deaths. Most of those were older men with other health problems. And most contracted the virus in the Middle East: Saudi Arabia, United Arab Emirates, Jordan, Qatar.

Cases have been reported in three European countries (United Kingdom, Germany, France) and Tunisia. But those cases had either traveled from the Middle East or in a few instances were infected through close contact with someone who recently returned from one of the above countries.

As of now, if you haven’t been to the Arabian Peninsula, your chance of a MERS infection is probably considerably less than 1%, or even zero, as all the cases have been linked to that region, says WHO spokesman Gregory Hartl.

What researchers don’t know is how many people may have had mild symptoms and never were reported. The more information scientists have, the more can be done to try to combat the disease.

I recently returned from the Middle East. What signs should I look for?

If you’ve traveled to the countries above and have cold-like symptoms which are getting worse, and you’re having increasing difficulty breathing and a fever, you may want to see a doctor. It’s important to tell your physician where you have been, so you can be tested for regular flu and other illnesses that can cause these symptoms as well as MERS-CoV.

The WHO describes the common symptoms as acute, serious respiratory illness with fever, cough, shortness of breath and breathing difficulties. According to Hartl, the real worry is that patients will develop pneumonia — most, although not all, of the cases have. Many have also had gastrointestinal problems including diarrhea.

What should I avoid?

The original source of the infection is still a mystery, so health officials cannot tell you what to avoid to prevent getting this coronavirus.

Researchers haven’t identified any animal that may be carrying the virus. Early on in the SARS outbreak, an animal called the civet cat was implicated — maybe unfairly, because bats were later implicated too.

It’s not known how the virus spreads between humans, be it droplets in the air from coughing or sneezing or touching contaminated surfaces, but WHO isn’t ruling out contact with surfaces as a possible mechanism of transmission.

It’s also not known how long the virus can live outside the body. The SARS virus was shown to live as long as four days. Other viruses, such as HIV, lose their ability to be infectious within hours.

How can I help my family?

While there’s no cure for MERS-CoV, there are things you can do to protect your loved ones — the same measures you would take to prevent spreading the flu or other viruses.

If you’ve recently returned from Middle East and aren’t feeling well, stay home and avoid contact with babies and people who may already be sick. Cover your mouth when you cough or sneeze (tissue, sleeve or elbow, not your hands) and wash your hands frequently.

There currently is no vaccine or treatment for MERS-CoV.

A lot has been learned about new coronaviruses over the past 10 years by studying the SARS virus because the National Institutes of Health have continued to support research on it, Denison says, adding that he’s hopeful that knowledge could be “potentially applied towards vaccines,” if MERS-CoV develops into a pandemic.

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