Girls With Autism May Need Different Treatments Than Boys

By Serena Gordon
HealthDay Reporter

WEDNESDAY, May 1 (HealthDay News) -- With four to five times more males affected by autism spectrum disorders than females, much less is known about girls with autism.

Fortunately, more research is beginning to focus on autism in girls, said Geraldine Dawson, chief science officer of Autism Speaks, with two such studies set to be presented Saturday at the International Meeting for Autism Research in San Sebastian, Spain.

"Autism affects boys much more frequently than girls. But, we may be missing some girls. The diagnostic criteria were developed using symptoms in boys, and symptoms in girls and boys may be different," Dawson explained.

"Because of this difference in incidence, researchers may end up with a small number of girls in studies," she said, adding that differences in symptoms or reactions to treatments may lead to the girls' data being excluded from studies. But, it's just those differences that may really need to be researched, to make sure girls are being diagnosed and treated correctly.

"Other neuropsychiatric disorders have already made the discovery that symptoms can be different in girls and may require different treatments for girls," said Dawson, who is also a research professor in the department of psychiatry at the University of North Carolina, Chapel Hill. One such example is attention-deficit/hyperactivity disorder. Girls tend to be less hyperactive than boys, and may instead appear as if they're daydreaming.

In the latest autism research, the first study compared visual scanning patterns in boys and girls with autism spectrum disorders. Scanning patterns were also collected for typically developing children.

"We used eye-tracking technology while the participants in these studies watched videotapes of social scenes that presented naturalistic stimuli," said study co-author Ami Klin, director of the Marcus Autism Center, in Atlanta.

The study, which was led by Klin's student, Jennifer Moriuchi, included 116 school-aged children with autism spectrum disorders. Eighty-one were boys and 35 were girls. The children with autism had varying degrees of social disability. The study also included 36 typically developing children.

"On a surface level, it appears that boys and girls with autism appear to spend equal time learning from the eyes. They did look less than other children," Klin said. But, when the researchers correlated the youngsters' eye tracking with their level of disability, a much different picture emerged.

"In boys, the more they looked at the eyes, the less socially disabled they are. In girls, the more they looked at the eyes, the more disabled they are," said Klin, chief of the division of autism and related disorders at Emory University School of Medicine and Children's Healthcare of Atlanta.

"What the study is suggesting is that we should not automatically assume that boys and girls learn about the world in the same way," Klin said, adding, "we have to take gender as a mediating factor."

Dawson said "the study found that there are differences in the way girls and boys look at the eyes, so there may be differences in the way autism is manifested in girls than in boys." She noted that an important criterion right now for diagnosing autism is a lack of eye contact and using the eyes for social cues.

The second study looked at the genetics involved in autism, and potential differences in boys and girls. Yale University researchers analyzed samples from 2,326 families. Included in those samples were those of 2,017 boys and 309 girls with an autism spectrum disorder.

The Yale team found differences between the boys' and girls' genetic samples.

"The fact that autism does affect boys so much more frequently has been staring us in the face for decades. There's been a hypothesis that there's something in the extra X chromosome that girls have that may be protective," Dawson explained. "The idea is that if you have this protective mechanism in place you may need more risk factors to overwhelm that protective effect and cause autism, and that's exactly what they found."

"To develop autism in a girl requires more genetic mutations," Dawson said. The type of mutations they found are called "de novo" mutations, she added. This means that the genetic change occurs in the sperm or the egg. It isn't a gene that's passed down from the parents. These mutations can occur randomly, or they can be caused by an environmental trigger.

Because these studies are being presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

Copyright © 2013 HealthDay. All rights reserved. SOURCES: Geraldine Dawson, Ph.D., chief science officer, Autism Speaks, and research professor, department of psychiatry, University of North Carolina, Chapel Hill; Ami Klin, Ph.D., director, Marcus Autism Center, and professor and chief, division of autism and related disorders, Emory University School of Medicine and Children's Healthcare of Atlanta; May 4, 2013, presentations, International Meeting for Autism Research, San Sebastian, Spain

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Gene Studies Could Point to New Alzheimer's Treatments

THURSDAY, April 25 (HealthDay News) -- Insight into genes that play a key role in disrupting immune system pathways in the brains of people with Alzheimer's disease could offer a potential target for new drugs against the disease, two new studies show.

"Defining the precise steps of the inflammatory response crucial to causing Alzheimer's disease has been elusive. We are pleased to discover these novel insights into that process," Bin Zhang, lead author of one of the studies and an associate professor of genetics and genomic sciences at the Icahn School of Medicine at Mount Sinai in New York City, said in a school news release.

In the study, Zhang's team analyzed brain tissue samples from deceased Alzheimer's patients, as well as healthy people who had died. By measuring the activity level of thousands of genes in these tissue samples, the team identified which gene networks are disrupted in diseased brains.

Specifically, their analysis pinpointed the important role of a gene expressed in immune cells called microglia, which clean up debris and destroy pathogens in the brain.

This gene, called TYROBP, is overactive in the brains of Alzheimer's patients and plays a major role in disrupting the activity of many other genes that control microglia activation, according to the study, which was published April 25 in the journal Cell.

"As a next step, we will evaluate drugs that impact [this] pathway as potential therapies for the disease," Zhang said. "This discovery enables us to design more specific compounds that target these key steps precisely, in contrast to existing anti-inflammatory drugs that may be less ideal for hitting this target."

Another study, published online April 25 in the journal Neuron, may have uncovered another genetic clue to Alzheimer's disease.

Researchers looked at brain samples from deceased Alzheimer's patients and found that higher activity of a gene called CD33 in microglia was linked to higher levels of the beta-amyloid protein plaques that have long been associated with Alzheimer's disease.

In their experiments with mice, switching off CD33 activity seemed to help microglia sweep away the plaques.

"Our findings suggest that pharmaceutical inactivation of CD33 represents a potentially powerful new therapy for the treatment and prevention of Alzheimer's disease, and perhaps other neurodegenerative disorders," senior study author Rudolph Tanzi, of Massachusetts General Hospital and Harvard Medical School in Boston, said in a journal news release.

Another expert said the findings from both studies may help advance research.

"We have known for a long time that Alzheimer's disease is characterized by the presence of excessive inflammation in the brain," said Philippe Marambaud, an investigator at the Litwin-Zucker Research Center for the Study of Alzheimer's Disease at the Feinstein Institute for Medical Research in Manhasset, N.Y.

"The role of this inflammatory response in the pathogenic mechanisms of the disease, however, remains unclear," he said. "These two studies ... provide concordant evidence that the immune cells microglia actively participate in this disease process."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCES: Philippe Marambaud, Ph.D., investigator, Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, N.Y.; Cell, news release, April 25, 2013; Neuron,news release, April 25, 2013; Icahn School of Medicine at Mount Sinai, New York City, news release, April 25, 2013

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Best Glaucoma Treatments Still a Puzzle, Task Force Reports

By Maureen Salamon

HealthDay Reporter

MONDAY, Feb. 18 (HealthDay News) -- Drugs and surgery can lower the hallmark inner-eye pressure characteristic of glaucoma -- the second-leading cause of blindness in the United States. But research still hasn't identified the best ways to prevent significant vision loss and improve patient satisfaction, according to a prominent government medical group.

The U.S. Preventive Services Task Force (USPSTF) reviewed dozens of studies and collective reviews on open-angle glaucoma, which accounts for about 90 percent of all cases, concluding there's inadequate evidence to directly compare the effectiveness of medical, surgical or laser treatments.

The task force, comprised of 16 independent experts in prevention and evidence-based medicine, also said it couldn't determine whether glaucoma screening for adults without previous vision problems prevents blindness or enhances long-term health.

"We know that treatments are effective, but we don't know enough to say treatment A is definitely better than treatment B," said task force co-vice chair Dr. Albert Siu, director of geriatric research, education and the clinical center at James J. Peters VA Medical Center in the Bronx, N.Y. "What we do know is that these treatments are effective in reducing the development and progression in small losses of [peripheral vision]. What isn't clear is how this translates into reducing vision problems or vision quality of life."

The task force report is published Feb. 19 in Annals of Internal Medicine.

Open-angle glaucoma affects about 2.5 million Americans, primarily seniors, older blacks and those with a family history, the task force said. Often symptomless, the condition is diagnosed with a combination of tests that show degenerative changes in the optic nerve head and a loss of peripheral vision.

Complicating diagnosis, however, is the fact that many people with open-angle glaucoma don't suffer from characteristically increased pressure in the inner eye (called intraocular pressure), and not all with elevated pressure go on to develop glaucoma. The condition develops over years and has a highly variable course, with some people never progressing to visual problems.

The dozens of collective reviews and studies on glaucoma treatments analyzed by the USPSTF reported mixed results. Some evidence suggested surgical treatment was slightly more effective than drugs at decreasing intraocular pressure and protecting against worsening peripheral vision loss. Treatment side effects -- such as eye redness from topical medications -- were common, and surgery can raise the risk of adverse effects such as cataracts, infections and bleeding.

One expert not associated with the study gave his reaction.

"We could say for sure there are interventions for lowering intraocular pressure . . . but that had better be true. We didn't need this study to tell us that lowering intraocular pressure tends to slow the progression of disease," said Dr. Louis Pasquale, co-director of the glaucoma center at Massachusetts Eye and Ear Infirmary, in Boston. "What this study is saying is there are many ways of lowering eye pressure and we don't know which one is best for minimizing visual disability and maximizing patient happiness while they're being treated for glaucoma."

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Side Effects of Prostate Cancer Treatments Similar in Long Run: Study

By Carina Storrs

HealthDay Reporter

WEDNESDAY, Jan. 30 (HealthDay News) -- For men with prostate cancer who are trying to decide between surgery or radiation therapy, new research shows that declines in sexual, urinary and bowel function do differ with each treatment in the short-term, but those declines tend to even out in the long run.

The study included more than 1,600 men treated for early stage prostate cancer. Researchers asked them about their urinary, sexual and bowel health following either surgery to remove the prostate or radiation therapy.

Although the rates of health decline in these areas differed at two and five years after treatment, men reported similar declines regardless of their treatment after 15 years.

While men who underwent surgery experienced higher rates of urinary incontinence and erectile dysfunction two and five years later, men who received radiation therapy had higher rates of bowel urgency, or feeling like they had to pass stool but not being able to do so.

The study was published in the Jan. 31 issue of the New England Journal of Medicine.

"Our hope was that measuring patient-reported outcomes at a 15-year time point would provide patients and their physicians with a realistic picture of the prostate cancer survivorship experience," said study author Dr. Matthew Resnick, an instructor of urologic surgery at Vanderbilt University Medical Center in Nashville, Tenn.

Urinary, sexual and bowel problems are among the most common side effects of treatment for prostate cancer, Resnick added. Declines are probably due to a combination of the treatment and aging in general, and the side effects even out after 15 years.

However, the shorter-term differences could be enough to steer some men toward one treatment or the other.

"There isn't a one-size-fits-all approach. Different men feel differently about the possibility of benefits and risks of treatment," Resnick said. For example, men who were already experiencing urinary incontinence might want to choose a treatment like radiation therapy because it was associated with lower rates of urinary problems in the short-term.

Surgery to remove the entire prostate, called radical prostatectomy, and radiation therapy are both recommended treatments for low- and medium-risk prostate cancer, according to the National Comprehensive Cancer Network guidelines.

However, these guidelines state that, for men with low-risk prostate cancer, watchful waiting -- closely monitoring the disease and treating it only if it changes -- is the best option.

It remains to be seen how men who opt for watchful waiting will fare in terms of their urinary, sexual and bowel health, especially in the long-term, Resnick noted.

Previous research has found doing watchful waiting for one year after diagnosis was associated with lower rates of urinary incontinence and sexual dysfunction, but higher rates of urinary blockage seven years later, compared to men who were treated immediately.

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Non-Drug ADHD Treatments Don't Pan Out in Study

WEDNESDAY, Jan. 30 (HealthDay News) -- Many parents pursue costly and time-consuming treatments to help their children with attention-deficit/hyperactivity disorder. Now, a new study finds little evidence that non-drug interventions reduce key symptoms of ADHD.

A multinational team of experts identified no positive effects from psychological treatments including mind exercises (cognitive training), neurofeedback and behavioral training (positive reinforcement). And the researchers discovered only small benefits associated with dietary treatments: supplementation with omega-3 and omega-6 free fatty acids, and elimination of artificial food coloring.

Still, parents shouldn't be discouraged, said study co-author Dr. Emily Simonoff.

"I think our findings allow a much more informed discussion than did previous work because we've been able to demonstrate that what we once thought worked is more limited and more questionable," said Simonoff, a professor of child and adolescent psychiatry at King's College London.

Simonoff thinks the study conclusions need to be interpreted in the context of a child's particular situation.

"I think people need to talk with their child's clinician," she said. "Evidence is never a substitute for having a discussion about your own child and what is right for your child and your family."

ADHD diagnoses are on the rise. Between 1997 and 2007, diagnoses among U.S. children and teens increased between 3 percent and 6 percent a year, according to the U.S. Centers for Disease Control and Prevention. According to the American Psychiatric Association, between 3 percent and 7 percent of U.S. children have the condition, which makes it hard to focus in school and to sustain friendships. Currently, a combination of medication and behavior therapy is the recommended treatment, according to the CDC.

The new review, an analysis of 54 studies by the European ADHD Guidelines Group, compared "blinded" and "unblinded" ratings for several dietary and psychological treatments. "Blinded" raters are unaware of the treatment used, while "unblinded" judges know of the therapy. It is thought that blinded ratings eliminate bias.

The study, published online Jan. 30 in the American Journal of Psychiatry, found that treatments were rated more effective in the unblinded tests, which appears to invalidate the conclusions.

Even after learning of the study findings, some people might say it can't hurt to try a particular therapy. But Simonoff warned of potential negative side effects.

"Adverse effects are often associated with pharmacological therapies, but other interventions can have them as well," she said. "For example, does a highly selective diet limit the way a child can play and socialize, making them feel different from their friends? And for parents, if a child doesn't improve under these therapies, does it affect how the parents feel about themselves?"

Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Steven and Alexandra Cohen Children's Medical Center of New York in New Hyde Park, agreed: "The danger in saying it won't hurt [to use non-drug therapies] is, where do you draw the line and what's the rationale?"

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Racial Disparities Still Seen in Use of Breast Cancer Treatments

Title: Racial Disparities Still Seen in Use of Breast Cancer Treatments
Category: Health News
Created: 12/5/2012 10:35:00 AM
Last Editorial Review: 12/5/2012 12:00:00 AM

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