FW: New Model May Better Predict Outcomes for Children with Autism and Autistic Spectrum Disorders

[Guest guest]

http://www.emaxhealth.com/50/5286.html

New

Model May Better Predict Outcomes for Children with Autism and Autistic

Spectrum Disorders

By: Children's Hospital

of Philadelphia on Mar 31 2006 17:13:21

Autism related disorders

A new classification tool may allow healthcare

professionals treating children with autism and autism-related disorders to

more systematically sort out the combination of traits in the condition, and

to better predict how children may improve over time. If the model holds up

to further study, it may also allow researchers to gauge the effectiveness of

different autism treatments.

Developmental pediatrician Coplan, M.D., reports

on a study of 91 children he saw between 1997 and 2002 at the Regional Autism

Center of The Children's Hospital

of Philadelphia. Most

patients were pre-schoolers or of elementary school age, and predominantly

boys. The study appears in the July 2005 issue of Pediatrics.

The children in the study had autistic spectrum

disorders (ASD), a group of neurodevelopmental disorders of impaired social

communication. Those disorders include classic autism, pervasive

developmental disorder and Asperger's syndrome. Dr. Coplan studied the

relationship among three variables: the severity of the disorder (called

atypicality), general intelligence (measured as IQ or developmental quotient)

and time.

" These disorders are dynamic and change over

time, " says Dr. Coplan. " Although they are traditionally classified

into mutually exclusive diagnostic boxes, they tend to blend into each other,

and this model provides a way to look continuously at autistic spectrum

disorders, as the symptoms occur and develop along the autistic spectrum, and

as the symptoms change over time. "

Some

children have severe autistic symptoms but high intelligence; others have

mild symptoms and mental retardation, or combinations in between, he added.

In explaining the model to parents, he sometimes draws an analogy to weight

and height. Just as each individual can have a different combination of

weight and stature, someone can have an individual combination of

intelligence and degree of autism.

One

central finding of the study, said Dr. Coplan, is that children in the normal

range of intelligence (an IQ of 70 or above) show significant improvement in

their ASD symptoms over time. " We can offer the hopeful message to

parents that many children with autistic spectrum disorders will improve

as part of the natural course of the condition, " he said. This finding

reinforced impressions by Dr. Coplan and many previous researchers about

clinical outcomes for children with autistic spectrum disorders.

Dr.

Coplan cautions that although the model has predictive value for clinical

outcomes when looking at average outcomes for groups of children, it will not

necessarily predict a course for each individual patient. Rather it would

provide a " roadmap " on which to plot a child's progress over time.

The

model still must be confirmed in larger studies of populations of children

with autistic spectrum disorders, not just in a sample from one clinic,

according to Dr. Coplan.

If

larger studies validate the model, he adds, it may become a benchmark to help

researchers evaluate the effectiveness of particular autistic spectrum disorders

treatments. " Many currently popular therapies

may be capitalizing on the natural history of ASD, and claiming such

improvement on their own behalf, " he writes in the paper. If patients

improved more than would be anticipated from the model's outline of the

natural course of ASD alone, that might provide evidence for a treatment's

success.

Additionally,

the model might shed light into causes of autistic spectrum disorders,

as yet unknown. Children with ASD from different causes may follow different

developmental paths, " says Dr. Coplan, and studying those patterns may

help researchers to better identify causes for the diseases.

Dr.

Coplan has since left Children's Hospital to establish a private practice,

Neurodevelopmental Pediatrics of the Main Line, in Rosemont,

Pa. Dr. Coplan's co-author was Abbas F.

Jawad, Ph.D., of the Division of Biostatistics and Epidemiology of The

Children's Hospital

of Philadelphia, and

the University of Pennsylvania School of Medicine. The Regional Autism

Center at Children's

Hospital houses a large interdisciplinary program for the diagnosis and

treatment of children with ASD.

[Guest guest]

I'd view this initiative with a healthy dose of cynicism and skepticism. Any

tool that can be

use to predict treatment effectiveness across a heterogeneous group can also be

used as a

mechanism for rationing expensive services especially when resources are

limited. I

seriously doubt that treatment effectiveness can be predicted at this point

because the

relevant subsets have not even been defined let alone the effects of various

treatments

(and combinations of treatments) on each of the relevant subsets.

This statement is a strong signal here - " We can offer the hopeful message to

parents that

many children with autistic spectrum disorders will improve as part of the

natural course

of the condition,... " This is a recommendation that can be used to defend a

standard of

care (i.e. no care) and to bolster insurance company claims that various

biomedical

treatments are not necessary and therefore, not covered expenses. And here

again, " Many

currently popular therapies may be capitalizing on the natural history of ASD,

and claiming

such improvement on their own behalf. "

Since when did the prevailing beliefs about autism coming from mainstream

medicine

switch from being a condition that was " lifelong and incurable " to one that will

" improve as

a natural course of the condition " ? Where's that study - I must have missed

it! This does

not sit right at all.

Perhaps we should consider the source -- The Children's Hospital of

Philadelphia,

and the University of Pennsylvania School of Medicine.

Vicky

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> New Model May Better Predict Outcomes for Children with Autism and Autistic

> Spectrum Disorders

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> GlsYWRlbHBoaWE= & page=1> Children's Hospital of Philadelphia on Mar 31 2006

> 17:13:21

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> Autism related disorders

>

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> A new classification tool may allow healthcare professionals treating

> children with autism and autism-related disorders to more systematically

> sort out the combination of traits in the condition, and to better predict

> how children may improve over time. If the model holds up to further study,

> it may also allow researchers to gauge the effectiveness of different autism

> treatments.

>

> Developmental pediatrician Coplan, M.D., reports on a study of 91

> children he saw between 1997 and 2002 at the Regional Autism Center of The

> Children's Hospital of Philadelphia. Most patients were pre-schoolers or of

> elementary school age, and predominantly boys. The study appears in the July

> 2005 issue of Pediatrics.

>

> The children in the study had autistic spectrum disorders (ASD), a group of

> neurodevelopmental disorders of impaired social communication. Those

> disorders include classic autism, pervasive developmental disorder and

> Asperger's syndrome. Dr. Coplan studied the relationship among three

> variables: the severity of the disorder (called atypicality), general

> intelligence (measured as IQ or developmental quotient) and time.

>

> " These disorders are dynamic and change over time, " says Dr. Coplan.

> " Although they are traditionally classified into mutually exclusive

> diagnostic boxes, they tend to blend into each other, and this model

> provides a way to look continuously at autistic spectrum disorders, as the

> symptoms occur and develop along the autistic spectrum, and as the symptoms

> change over time. "

>

> Some children have severe autistic symptoms but high intelligence; others

> have mild symptoms and mental retardation, or combinations in between, he

> added. In explaining the model to parents, he sometimes draws an analogy to

> weight and height. Just as each individual can have a different combination

> of weight and stature, someone can have an individual combination of

> intelligence and degree of autism.

>

> One central finding of the study, said Dr. Coplan, is that children in the

> normal range of intelligence (an IQ of 70 or above) show significant

> improvement in their ASD symptoms over time. " We can offer the hopeful

> message to parents that many children with autistic spectrum disorders will

> improve as part of the natural course of the condition, " he said. This

> finding reinforced impressions by Dr. Coplan and many previous researchers

> about clinical outcomes for children with autistic spectrum disorders.

>

> Dr. Coplan cautions that although the model has predictive value for

> clinical outcomes when looking at average outcomes for groups of children,

> it will not necessarily predict a course for each individual patient. Rather

> it would provide a " roadmap " on which to plot a child's progress over time.

>

> The model still must be confirmed in larger studies of populations of

> children with autistic spectrum disorders, not just in a sample from one

> clinic, according to Dr. Coplan.

>

> If larger studies validate the model, he adds, it may become a benchmark to

> help researchers evaluate the effectiveness of particular autistic spectrum

> disorders treatments. " Many currently popular therapies may be capitalizing

> on the natural history of ASD, and claiming such improvement on their own

> behalf, " he writes in the paper. If patients improved more than would be

> anticipated from the model's outline of the natural course of ASD alone,

> that might provide evidence for a treatment's success.

>

> Additionally, the model might shed light into causes of autistic spectrum

> disorders, as yet unknown. Children with ASD from different causes may

> follow different developmental paths, " says Dr. Coplan, and studying those

> patterns may help researchers to better identify causes for the diseases.

>

> Dr. Coplan has since left Children's Hospital to establish a private

> practice, Neurodevelopmental Pediatrics of the Main Line, in Rosemont, Pa.

> Dr. Coplan's co-author was Abbas F. Jawad, Ph.D., of the Division of

> Biostatistics and Epidemiology of The Children's Hospital of Philadelphia,

> and the University of Pennsylvania School of Medicine. The Regional Autism

> Center at Children's Hospital houses a large interdisciplinary program for

> the diagnosis and treatment of children with ASD.

>