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Autism highest among Minneapolis' Somali and white children, U study finds

REUTERS/Eric Miller
“This report is reassuring in the finding that autism rates in the Somali community are not greater than expected,” wrote Dr. Steve Miles, a U of M professor of medicine and bioethics.

The prevalence of autism spectrum disorder is the same among Somali and white children living in Minneapolis, but Somali children tend to develop a more severe form of the developmental disorder, according to a new report released Monday by University of Minnesota researchers.

The study's data revealed that 1 in 32 Somali and 1 in 36 white children aged 7 to 9 were identified with autism in 2010 — numbers that are statistically indistinguishable, according to the researchers.

Both Somali and white children in Minneapolis were, however, more likely to have been identified with autism than their non-Somali black or Hispanic peers. The data showed that the prevalence of autism was 1 in 62 among the city’s black children and 1 in 80 among its Hispanic children in 2010.

Overall, 1 in 48 Minneapolis children were identified with autism in 2010. That number is fairly close to the national parent-reported prevalence of 1 in 50 that was reported in March 2013 by the Centers for Disease Control and Prevention (CDC). But it is much higher than the CDC's more official 1 in 88 estimate, which is based on 2008 data from 14 communities across the United States. (That estimate is expected to be updated in 2014.)

The data for the U of M study was collected from the school and medical records of more than 5,000 Minneapolis children. Clinicians reviewed each child’s records for behavioral descriptions or other information consistent with autism to determine if the child had the disorder. Although it has obvious limitations, this method of identifying and tracking children with autism or other development disabilities has long been used by the CDC.

The 'why' is unknown

The authors of the study stress that although the data they collected revealed racial and ethnic differences in the prevalence of autism among Minneapolis’ children, it did not provide an explanation for why those differences exist.

umn.edu
Amy S. Hewitt

“We just don’t know,” said Amy Hewitt, the study’s lead author and a senior research associate at the U of M’s Institute on Community Integration, in a phone interview with MinnPost. “That’s the answer. And we need to know why. That’s for future research.”

Another unexplained — and surprising — finding was that every Somali child with autism in the study had an intellectual disability (defined as an IQ score less than 70), compared to one-third of all the children with autism in the study.

“It’s definitely a very interesting finding, a very important finding,” said Hewitt. “It definitely tells us that autism spectrum disorder looks differently in kids from the Somali community, and we have to find out why and how that is.”

Somali parents in Minneapolis have long expressed concerns that their children were experiencing a high rate of autism. In 2009, the Minnesota Department of Health found that Somali three- and four-year-olds were two to seven times more likely to be receiving services for autism within the Minneapolis school system than were other children. That finding was the impetus behind the current study and report.

“This is taking a huge toll on our community,” said Dr. Edward Ehlinger, state health commissioner, in a phone interview shortly after the U of M study was released on Monday. “We will be advocating with the CDC and [the National Institutes of Health] to do more studies.”

Ehlinger expressed particular concern with the report’s finding that the average age of diagnosis for Minneapolis’ children with autism was five. Research has shown that children can be reliably diagnosed at age two. Nationally, the average age of diagnosis is three, according to the CDC.

“We need to do a better job at early identification,” Ehlinger said. “The earlier you get [a child] into intervention, the more impact the intervention will have.”

‘Reassuring’ but ‘misleading’

“This report is reassuring in the finding that autism rates in the Somali community are not greater than expected,” wrote Dr. Steve Miles, a U of M professor of medicine and bioethics, in an e-mail response to a request from MinnPost for his comments on the report's findings. He was not involved in the study, although he has advocated for research on autism in the Somali community.

The study also shows, Miles added, “that the Somali community, which is disadvantaged with regard to health care, does merit continued public health and clinical attention.”

Miles believes, however, that the report’s data on the prevalence of autism among Minneapolis' different ethnic groups is misleading.

“The correct number to use is not the prevalence but the confidence intervals, which reflects the precision of the numbers,” he pointed out. “All the confidence intervals overlap — there is no difference between the populations.”

Miles also found the intellectual disability part of the report “deficient.” “The failure to give confidence intervals or statistical tests on the intellectual disability on page 12 [of the report] is a terrible error,” he wrote, “and is probably gravely misleading. Furthermore, none of this data is properly corrected for socioeconomic status.”

Other research has found a strong correlation between poverty and intellectual disability, he pointed out.

The U of M study was funded by the CDC, the National Institutes of Health and the advocacy group Autism Speaks. You can read it in full here.

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Comments (5)

average age of diagnoses

About five years ago, a preliminary state report showed the prevalence of ASDs about three year old Somalis was more than twice greater than among other three year olds, but that the prevalence for 8 yr olds in the two groups was about the same. This suggested better health screening for Somali children under 3. But this report says the average age of diagnoses for Somalis is five. Can someone explain this?

Autism epidemic

It's hard to understand why Amy Hewitt, the lead researcher on this study, only described it as "very interesting" that all the Somali children also have an intellectual disability. With an autism of one in 32 among Somali children, that is extremely frightening.

Steve Miles found the autism statistics "reassuring" but then called results "misleading."

Incredibly, no one can tell us why this is happening either to children in general in Minnesota or to the Somali community in particular. Those of us who attended the meeting of Somali parents and health officials in 2008 when the rate among the Somali children was one in 28 expected that after FIVE YEARS OF STUDY, experts could have done more than just adjust the rate to one in 32.

What should really concern people is the fact that no one is saying that this is just better diagnosing of a condition that's always been around, as they do every time the U.S. autism rate makes another increase. No one is saying that Somali adults have a one in 32 rate of autism. Something is dramatically impacting the health of these children, just as in children everywhere in MN. Imagine the future when this disabled generation ages out of school and is dependent on the taxpayers for their support and care. Then Minnesotans will really be able to say, in the words of Edward Ehlinger, 'This is taking a huge toll on our community.'

Anne Dachel, Media editor: Age of Autism

for 2 decades they have no answers

We already know autism is an epidemic--has been for years. Who really cares about studies that find 1 in 36 or 1 in 37 children has autism? We know the numbers are horrible and yet health officials are still just sharpening their pencils. They're more affected or less affected. So what? They still affected with autism--a man-made disease that is only getting worse. If 1 in 36 children wer diagnosed today with being deaf, would health officials still be contemplating their navels?
Autism is man-made. Autism is medical and needs to be treated medically. Autism is a neurodevelopmental and metabolic disorder affecting every organ in the body.
Health officials and many doctors are in denial or truly hiding the truth.
Maurine Meleck SC
grandmother to 1 in 31(vaccine injured)

Plausible cause - Tylenol

There is a plausible explanation for the rates of autism in the Somali community. We now have a well done cohort study showing that prolonged prenatal use of acetaminophen is associated with severe neurodevelopmental outcomes (autism phenotypes) in 3 year olds. It is not that great a leap to think that infant exposure to acetaminophen could also be related. In the US, newborn males are often given 5-7 doses of acetaminophen with the circumcision procedure. Most Somali males would be circumcised, as would more midwestern white than black or hispanic boys. Newborns have been shown to have difficulties metabolizing acetaminophen and it may be converted to it's neurotoxic metabolite NAPQI. NAPQI has been shown to deplete glutathione and to destroy cerebellar Purkinje cells in animals. These are all common findings in autism.

http://www.ncbi.nlm.nih.gov/pubmed/24163279

http://www.ehjournal.net/content/pdf/1476-069X-12-41.pdf

http://www.ncbi.nlm.nih.gov/pubmed/22111857

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534986/pdf/nihms428627.pdf

Plausible cause - Tylenol

There is a plausible explanation for the rates of autism in the Somali community. We now have a well done cohort study showing that prolonged prenatal use of acetaminophen is associated with severe neurodevelopmental outcomes (autism phenotypes) in 3 year olds (1). It is not that great a leap to think that infant exposure to acetaminophen could also be related. In the US, pain management guidelines from the American Academy of Pediatrics suggest that newborn males be given 5-7 doses of acetaminophen with the circumcision procedure (2). Most Somali males would be circumcised, as would more white than black or hispanic boys. Newborns have been shown to have difficulties metabolizing acetaminophen and it may be converted to it's neurotoxic metabolite NAPQI. NAPQI has been shown to deplete glutathione and to destroy cerebellar Purkinje cells in animals (3,4). These are all common findings in autism.

(1) Brandlistuen RE, Ystrom E, Nulman I, Koren G, Nordeng H.Prenatal paracetamol exposure and child neurodevelopment: a sibling-controlled cohort study.nt J Epidemiol. 2013 Oct 2

(2) Bauer AZ, Kriebel D. Prenatal and perinatal analgesic exposure and autism: an ecological link.Environ Health. 2013 May 9;12:41.

(3). Allegaert K, van den Anker J.Pharmacokinetics and pharmacodynamics of intravenous acetaminophen in neonates
Expert Rev Clin Pharmacol. 2011 Nov;4(6):713-8

(4) Shannon L. Dean, Jessica F. Knutson, Desiree L. Krebs-Kraft, and Margaret M.McCarthy Prostaglandin E2 is an endogenous modulator of cerebellar development and complex behavior during a sensitive postnatal period Eur J Neurosci. 2012 April ; 35(8): 1218–1229

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3534986/pdf/nihms428627.pdf