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Children with autism whose social and communications skills regress around age 3 tend to have more severe autism than children who show signs of the neurodevelopmental disorder at younger ages, new research finds.

Autism spectrum disorders are marked by delays or disruptions in social, language and communications skills, and restricted or repetitive behaviors or interests. Increasingly, doctors are coming to understand that there are several subtypes of the disorder, explained senior study author Dr. Paul Law, director of the Interactive Autism Network at Kennedy Krieger Institute in Baltimore.

In the study, researchers used data from 2,720 parents of children aged 3 to 17 years who had been diagnosed with an autism spectrum disorder. Children were placed in one of three groups, depending on how and when their autism symptoms started:
Regressive, in which children seemed to be developing generally normally or close to normally, but then experienced a sharp decline in skills before age 3. About 44 percent of the children were in this group.
Plateau, or the 17 percent of children who were not delayed or only mildly delayed until about age 2, at which point they gradually or abruptly stop developing.
No loss/no plateau, sometimes called early onset autism, in which subtle signs of autism show up at relatively younger ages, but children don’t regress or plateau. About 39 percent of the children fell into this category.

The researchers found some notable differences between the groups. In children who regressed or plateaued, parents said they first became concerned about their child’s development at about 17 months, compared to about 15 months for children who did not plateau or regress.

Children who regressed said their first word at about 14 months, compared to 20 months for children who plateaued and 21 months for those with no loss/no plateau autism.

Another difference: Children who regressed took longer to potty train — about 52 months, compared to about 48 months for other children with autism.

Over time, children who regressed tended to end up with more severe autism. They were at the greatest risk for not attaining conversational speech, and were more likely than the other groups to need educational support, such as a classroom aide. The more marked the regression, the more severe the autism later on, according to the study.

Autism with regression is much debated among researchers, with some estimates putting the prevalence at one-third to one-half of children with the disorder, with others saying as few as 15 percent of children experience regression.

Study author Luther Kalb, a researcher at the Center for Autism and Related Disorders at the Kennedy Krieger Institute, said some of the discrepancy may be definitions of regression — some consider autism regression to be only children who had no symptoms of autism prior to the decline in previously acquired skills, while others allow for some delays prior to losing skills.

In the study, about 35 percent of parents had concerns about their child’s development before their child began losing skills.

The study was published online April 20 in the Journal of Autism and Developmental Disorders.

“There are still discussions within the science community about how exactly to define regression,” added Andy Shih, vice president of scientific affairs for Autism Speaks. “This study certainly adds to the body of evidence that suggests there is a differentiation between different types of autism development progression and outcomes for the individual.”

Parents whose child has experienced regression should take heart, Law said, and remember that the statistics show trends, not how an individual child will do. “A lot of children with regression did well,” Law said. “There is a lot of individual variation. This is by no means a very dire sentence.”

Among the first signs of autism typically noticed by parents are lack of eye contact or social smiles, speech delays, restricted interests, hand waving or flapping, or generally not engaging with others in the ways other children do, Kalb said.

If parents notice any losses in a child’s vocabulary or social skills, or the child seems to have stopped progressing, they should have the child evaluated by a pediatrician right away, all of the experts stressed.

“What we do know is that the earlier we identify children who may be at risk for autism and provide early intervention, the better the prognosis and the more likely you are to have better outcomes,” Shih said.

SOURCES: Luther Kalb, MPH, researcher, Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore; Paul Law, M.D., director, Interactive Autism Network, Kennedy Krieger Institute, Baltimore; Andy Shih, Ph.D., vice president, scientific affairs, Autism Speaks, New York City;

Patients with type 2 diabetes who can’t control their blood glucose levels with the drug metformin alone do better after adding injections of the drug liraglutide compared to oral doses of another drug called sitagliptin, researchers report.

In the study, Dr. Richard E. Pratley, of the University of Vermont College of Medicine in Burlington, and his colleagues randomly assigned patients whose blood glucose wasn’t sufficiently controlled by metformin (Glucophage) to receive 26 weeks of treatment with liraglutide (Victoza) by injection or sitagliptin (Januvia) by mouth.

The researchers found that the patients did better on liraglutide, although between 21 percent and 27 percent of patients reported nausea, compared to 5 percent of those on sitagliptin, according to the report published in the April 24 issue of The Lancet.

Liraglutide “was well-tolerated with minimum risk of hypoglycemia. These findings support the use of liraglutide as an effective agent to add to metformin,” they wrote in a news release from the journal.

In a commentary accompanying the study, Dr. Andre J. Scheen and Dr. Regis P. Radermecker of the University of Liege in Belgium noted that patients may think it’s easier to take one sitagliptin pill a day compared to daily injections of liraglutide. And liraglutide, they added, is more expensive, but it has improved benefits in terms of blood glucose control and weight reduction.

New research suggests that cocaine overdose deaths in New York City go up with the temperature: They’re more likely when the average weekly temperature goes past 75 degrees Fahrenheit.

The findings, published online March 3 in the journal Addiction, are based on death statistics in the city from 1990 through 2006.

The increase in accidental overdose deaths during warmer temperatures appears to be because cocaine raises body temperature and makes it harder for the cardiovascular system to cool the body, according to background information from the journal’s publisher. When using cocaine, people also tend to be less apt to comprehend that they’re hot and need to do something to cool off.

The research clarifies earlier findings that had linked cocaine overdose deaths to much higher temperatures — those over about 88 degrees Fahrenheit.

The study estimated that the number of cocaine overdose deaths in New York City would rise by at least two a week when the average temperature is higher than 75 degrees, compared with an average of 75 degrees or lower.

What to do? Air conditioning and special health alerts could help in urban areas where cocaine use is high, the study suggested.

SOURCE: Wiley-Blackwell

Sports are the most common cause of shoulder dislocation, and young males have the highest risk of suffering this type of injury, a new study shows.

Researchers studied 8,940 shoulder dislocations treated at 100 hospital emergency rooms across the United States from 2002 to 2006 and found that the overall incidence rate was 23.9 shoulder dislocations per 100,000 person years (the number of years times the number of members of a population affected by a certain condition).

The study author also found that: 71.8 percent of shoulder dislocations occurred in men; 46.8 percent were in patients aged 15 to 29; 48.3 percent occurred during sports or recreation; and 37 percent of all sports-related injuries occurred while playing football or basketball.

The majority of dislocations were caused by a fall. Of those falls, 47.7 percent occurred at home and 33.6 percent occurred at sports or recreation sites. Among women, those aged 80 to 90 had higher shoulder dislocation rates, mostly because of falls at home.

“We were not too surprised to find the high number of young males dislocating their shoulders during athletic activity. However, the rate of shoulder dislocations among elderly women was higher than we had previously assumed,” study co-author Dr. Brett Owens, an orthopedic surgeon at Keller Army Hospital in West Point, N.Y., and an associate professor at the Uniformed Services University of the Health Sciences, said in a news release.

The study appears in the March issue of The Journal of Bone and Joint Surgery.

Symptoms of shoulder dislocation include pain, swelling, numbness, weakness and bruising. A shoulder dislocation can tear ligaments or tendons in the shoulder and may cause nerve damage.

SOURCE: The Journal of Bone and Joint Surgery

Kapidex (dexlansoprazole) has been given the new name Dexilant — so approved by the U.S. Food and Drug Administration — to avoid confusion with other drugs that have similar names.

There is no problem with Kapidex itself and, other than the name switch, nothing else will be changed about the drug, the FDA said. It’s a proton pump inhibitor, used to treat heartburn and other conditions caused by excess stomach acid.

In a news release, the FDA cited pharmacy errors in dispensing Kapidex, approved in January 2009, citing confusion with the drugs Casodex and Kadian. All three drugs have widely different uses; Casodex is prescribed for prostate cancer and Kadian to treat pain.

The newly named heartburn drug will begin appearing on store shelves in late April, the FDA said. It’s manufactured by Takeda Pharmaceuticals North America.

A hand-held device that delivers a magnetic pulse to the head may offer relief for some migraine sufferers, researchers report.

The findings, which apply to migraine sufferers who experience “aura,” expand on previous research by using a device that could work at home instead of only at the doctor’s office.

It’s unclear, however, how expensive the treatment will be and how it should be administered for optimal effectiveness. And some patients didn’t seem to benefit from the treatment.

At stake are patients who suffer from migraine with aura, meaning they experience visual disruptions, tingling, numbness and weakness before a headache begins.

The device uses single-pulse transcranial magnetic stimulation, which is thought to prevent aura by disrupting the brain’s electrical system.

In the new study, Richard B. Lipton, of the Albert Einstein College of Medicine in New York City, and colleagues randomly assigned 201 patients to take home a fake stimulation device or a real one.

Those who used the real device had less pain and recurring headaches and were less likely to need medication. Of 164 patients who treated at least one attack with the real or fake stimulation devices, 39 percent of those who used the real device reported no pain after two hours compared to 22 percent of those who used the fake device.

The researchers also report that the real stimulation device didn’t make symptoms worse or cause serious side effects.

In an accompanying commentary, Hans-Christoph Diener, of University Hospital Essen in Germany, wrote that the research suggests the technology “could be a major step forward in the treatment of migraine with aura, particularly in patients in whom presently available drug treatment is ineffective, poorly tolerated, or contraindicated.”

The study was published online in advance of print publication in the April edition of The Lancet Neurology.

SOURCE: The Lancet Neurology

Women who take diabetes drugs known as thiazolidinediones, which include Avandia and Actos, are at a greater risk of bone fractures, a new study finds.

Women who took a thiazolidinedione drug for a year were 50 percent more likely to suffer a bone fracture than patients who didn’t take the drug, the researchers found. Women older than 65 were most vulnerable, with a 70 percent higher risk.

“Older women are already at a higher risk of osteoporosis and osteoporosis-related fractures, which might explain why they appeared to be the most affected,” study senior author Dr. L. Keoki Williams, of the Center for Health Services Research at Henry Ford Hospital, said in a news release.

Thiazolidinedione drugs — which include pioglitazone (Actos) and rosiglitazone (Avandia) — help people with type 2 diabetes better control their blood sugar levels. The drugs work by lowering resistance to insulin and cutting the amount of glucose made by the liver.

But doctors have worried in recent years about reports linking the drugs to bone loss and higher risk of fractures.

The researchers studied 4,511 patients who filled at least one prescription for a thiazolidinedione between 2000 and 2007 at Henry Ford Hospital. Men were not found to be at higher risk of fracture in this study group, the study authors noted in the news release, although other recent research has suggested such a link.

The findings are published in the February issue of the Journal of Clinical Endocrinology & Metabolism.

The drugs “may put some patients at increased risk for other health issues, and I encourage patients to talk with their physician about other suitable options,” Williams added.

People who think they’re protecting their lungs by smoking pipes or cigars instead of cigarettes are kidding themselves, a new study shows.

“Inhalation of tobacco smoke by any means is deleterious,” said Dr. R. Graham Barr, assistant professor of medicine and epidemiology at Columbia University Medical Center and lead author of a report in the Feb. 16 issue of Annals of Internal Medicine.

The cancer-causing danger of any kind of smoking has been well-publicized by the American Cancer Society and the U.S. National Cancer Institute, among others. But some smokers believe cigars or pipes can lessen respiratory danger because they think the smoke isn’t inhaled, Barr said.

To test that notion, he and his colleagues looked at the effects of cigar or pipe smoking in more than 3,500 adults ages 48 to 90 who were participants in a study of heart disease. Of these, nine of every 100 said they had smoked a pipe at some time and 11 of every 100 said they had smoked cigars.

To determine whether smoke was inhaled, the researchers measured blood levels of cotinine, a byproduct of metabolized nicotine.

Among pipe or cigar users, they found cotinine levels lower than those produced by cigarette smoking but nevertheless significant.

“For pipe smoking, it was 20 percent compared to cigarette smoking, and for cigars it was 10 percent,” Barr said. “Less, but still quite considerable.”

The effect of smoking on breathing ability was measured by spirometry, a lung function test in which people blow into a tube to determine the maximum amount of air they can move in one second.

Pipe or cigar smokers had more than twice the incidence of airway obstruction than nonsmokers, and the degree of obstruction increased with the amount of smoking, the researchers found.

The study was done because there has been a noticeable shift away from cigarettes to pipes and cigars, partly because of health warnings, partly because of heavy taxes on cigarettes, Barr said.

“There haven’t been good data in the United States from a large study showing that first, people who smoke cigars and pipes inhale the smoke and second, that on a long-term basis they have damage to their lungs,” he said.

The study results show clearly that cigar and pipe smokers are exposed to toxins and run the risk of developing chronic obstructive pulmonary disease (COPD), a progressive destruction of airways than can be crippling. Emphysema and chronic obstructive bronchitis are the two major forms of COPD, which is a leading cause of death among U.S. adults.

“Physicians should consider pipe and cigar smoking a risk factor for chronic obstructive pulmonary disease and counsel their patients to quit,” Barr said.

“There is a public perception that this is a safer habit,” said Dr. Neil Schachter, professor of medicine and community medicine at Mount Sinai Medical Center in New York City. Tobacco companies have promoted that perception, he said.

“Cigarette companies realize there is a decreasing demand for cigarettes and have tried to push tobacco products in different ways,” Schachter said. “They have been able to promote this image that smoking cigars and pipes is safer than smoking cigarettes. This article goes a long way toward showing this is not true.”

Smokers don’t often pursue medical advice about smoking, he said. “It is something patients don’t go to doctors to ask about,” Schachter said.”‘What should I smoke’? The answer is, ‘Nothing’.”

SOURCES: R. Graham Barr, M.D., Dr.P.H., Florence Irving assistant professor of medicine and epidemiology, Columbia University Medical Center, New York City; Neil Schachter, M.D., professor, medicine and community medicine, Mount Sinai Medical Center, New York City

People with high-functioning autism or Asperger’s syndrome were better able to “catch” social cues after inhaling the hormone oxytocin, new research shows.

Oxytocin,which is produced in abundance when a mother is breast-feeding her baby, is known as the “bonding” hormone.

Although there are many kinks to be worked out, experts feel the strategy holds promise to treat one of the core symptoms of autism spectrum disorder.

“When you start thinking of a hormone that can actually encourage pro-social behavior, you’re talking about potentially significant changes in quality of life,” said Clara Lajonchere, a vice president of clinical programs at the advocacy group Autism Speaks and a clinical assistant professor at the Keck School of Medicine, University of Southern California.

“In the absence of intellectual deficits, the areas where they have the greatest struggle is around social communication and social connectedness,” she continued. “These people can’t interpret other people’s perceptions, they can’t read social cues, they don’t make eye contact.”

While there are drugs for the secondary symptoms of autism, such as irritability and aggression, doctors have nothing yet for the core symptoms in the areas of language, social interaction and intellectual deficits.

Prior studies have shown a strong effect of oxytocin on people with autism, as well as on people who are not on the autism disorders spectrum. One study found that autistic people seem to have a lower sensitivity to oxytocin than people without the disorder.

“There’s no doubt that oxytocin has a big effect on social interactions in anyone. It’s almost like a designer drug, a drug which has a selective effect on a behavior in the normal range,” said Keith Young, vice chairman of research in psychiatry and behavioral science at the Texas A&M Health Science Center College of Medicine in Temple and the neuroimaging and genetics core leader at the VA Center of Excellence for Research on Returning War Veterans at the Central Texas Veterans Health Care System.

The new study, led by Angela Sirigu at the Center for Cognitive Neuroscience in Lyon, France, was published in this week’s issue of Proceedings of the National Academy of Sciences. It involved 13 adults, most of them men, aged 17 to 39. All had high-functioning autism or Asperger’s syndrome.

Participants performed different tasks — either after inhaling oxytocin or without using the hormone.

When observed playing a virtual ball game, individuals who had inhaled oxytocin were able to interact better with their virtual partners compared to untreated participants.

Also, after inhaling oxytocin, participants showed more alertness to socially important visual cues in pictures of human faces.

There were, however, wide variations in individual responses, the team noted.

“It’s not clear whether this would be effective at all in children or in young adults who had intellectual problems,” warned Young.

The long-term effects of the hormone are also uncertain.

“I really want to encourage clinical trials in this area because of its potential significance, but we have to be very careful in terms of safety data,” Lajonchere said. “Safety data is really critical.”

Also, scientists would need to come up with a different method of delivery, Young said.

“The nasal [inhaled] drugs only work for a few minutes. Potentially it would be very difficult to be using this drug once an hour or something. It doesn’t make a whole lot of sense,” he pointed out. “But it does point the way to the possibility of raising oxytocin levels with other kinds of compounds to increase oxytocin levels more generally over a longer period of time. I don’t know whether this is a realistic therapy as we have it now but, potentially, in the future it could really help these people whose primary autistic symptoms are having to do with reduction in social activity.”

SOURCES: Clara Lajonchere, Ph.D., vice president, clinical programs, Autism Speaks, and clinical assistant professor, Keck School of Medicine, University of Southern California; Keith Young, Ph.D., vice chairman, research in psychiatry and behavioral science, Texas A&M Health Science Center College of Medicine, Temple, and neuroimaging and genetics core leader, VA Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Health Care System