Pediatric Academic Societies (PAS)
On May 2 several Autism Treatment Network (ATN) physicians made presentations at the Annual Meeting of the Pediatric Academic Societies (PAS), held in Toronto, Canada. The PAS is comprised of four pediatric organizations — the American Pediatric Society, the Society for Pediatric Research, the Academic Pediatric Association, and the American Academy of Pediatrics — who co-sponsor the PAS Annual Meeting. Members include more than 6100 pediatricians and other health care providers involved in research, academic and clinical pursuits.
Daniel Coury, M.D., ATN medical director, moderated a two-hour symposium titled Autism Spectrum Disorders Research – From Bench to Bedside. This panel discussion consisted of four presentations about recent developments across some important areas of autism research and medicine, followed by a short question and answer session.
Panelist Clara Lajonchere, Ph.D., Autism Speaks' vice president for clinical programs, presented on “Findings in Autism Genetics: the Autism Genetic Resource Exchange”. Dr. Lajonchere, reviewed recent findings in autism genetics and their implications for translational research. She emphasized that was that it is critical to take the continuing advances in our understanding of autism genetics to foster further research that will translate this understanding into real world clinical practice.
James Perrin, M.D, then addressed the subject of “Developing Research and Improvement networks – What are we Doing, What Have we Learned, What have we Achieved?” Dr. Perrin, director of the ATN's Clinical Coordinating Center, spoke about their collaborative network approach to autism care. He described the history of the ATN and the rationale behind it, showing how many medical problems among children with autism have been under-diagnosed, and how certain behaviors have been interpreted as inherent to autism spectrum disorders (ASD) rather than arising from other medical conditions. He reviewed the ATN's goals and some recent progress, including expanding the ATN's research agenda, enabled through a grant from the Health Resources and Services Administration, to establish the Autism Intervention Research Network on Physical Health (AIR-P), and cited several research studies now underway and treatment guidelines currently being piloted. He concluded by outlining the broad vision of the ATN: “Every child with ASD will live within 100 miles of a program that can provide comprehensive, coordinated, multidisciplinary, ongoing care; care that will benefit from best practices and the latest research findings, and the ATN will serve as the leading network for providing medical training, leadership, and education both in the U.S. and internationally.”
Jeffery Brosco, M.D., Ph.D., spoke about “The Boundaries of Family Centered Care for Autism: Ethical Challenges in Diagnosis, Treatment and Communication.” Dr. Brosco is professor of Developmental Pediatrics at the University of Miami Leonard M. Miller School of Medicine and the associate director of their Leadership Education in Neurodevelopmental and Related Disabilities (LEND) program. While not an ATN clinician, Dr. Brosco's substantial expertise in autism and other developmental disorders and recent research into social history and public policy trends in health care for persons with developmental disabilities provided him with a unique and important perspective in the context of this panel. He provided a historical context to family-centered care and suggested a pragmatic approach to situations when a family's choices conflict with best available evidence. In Dr. Brosco's view, "Clinicians have a dual obligation: to follow evidence-based practice and to share decision-making with families.”
Susan Swedo, M.D., chief of the Pediatrics and Developmental Neuropsychiatry Branch, National Institutes of Mental Health, and a member of both the ATN External Advisory Group and Scientific Review Committee, presented “Medical Comorbidities: Implications for Care.”Dr. Swedo described common medical comorbidities associated with ASD including EEG abnormalities and sleep problems, and explored their implications for patient care.
PAS Poster Sessions
The PAS Annual Meeting also hosted special poster sessions on ASD. ATN clinicians reported on the latest findings from the ATN Registry, which collects data on children and teens with ASD who are being treated through ATN clinics. This special session, focused on 10 posters, offered ATN clinicians ample time to present information and answer questions.
The poster sessions, and their lead authors, included:
• Sleep is Associated with Behavior in Children with ASD: An ATN Study – Suzanne Goldman, Ph.D. (Vanderbilt University)
• GI Symptoms in ASD: An ATN Study – Kent Williams, M.D. (Vanderbilt University)
• Use of Psychotropic Medications in ASD: An ATN Study – Daniel Coury, M.D. (Nationwide Children's Hospital)
• Use of Complementary and Alternative Medicine in ASD: An ATN Study – Daniel Coury, M.D.
When asked about the significance of these abstracts, Dr. Coury responded, “These abstracts represent the first major analyses from the ATN Registry since its expansion in 2008. They add to our understanding of some of the medical comorbidities of ASD as well as some of the more common treatments these children and adolescents are receiving. They also give us an idea of the kind of questions that this Registry can help answer as we work to establish better treatments for children and adolescents with ASD.”
Digestive Diseases Week
Digestive Diseases Week (DDW) is billed as “the world's largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy and gastrointestinal surgery.” Sponsored by the American Association for the Study of Liver Diseases, the American Gastroenterological Association, the American Society for Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract, this high profile educational forum drew approximately 16,000 gastrointestinal (GI) clinicians from around the world to New Orleans, La.
Kent Williams, M.D., ATN pediatric gastroenterologist and assistant professor of Pediatrics at the Vanderbilt University School of Medicine, presented a paper on Clinical Features Associated with GI Symptoms in ASD: An ATN Study. This presentation provided a unique opportunity for the ATN to increase awareness among thousands of GI clinicians, researchers, and educators about findings derived from the ATN Registry that show that GI complaints are associated with age, behavioral abnormalities, sleep disturbances and overall decreased health-related quality of life. Dr. Williams cited findings based on an analysis of GI data from 1185 children in the ATN Registry.
According to Dr. Williams, “These revealed that 45 percent of parents reported gastrointestinal dysfunction in children with an ASD, with constipation, abdominal pain, diarrhea, nausea and bloating being the most common complaints. Analysis of data collected at the time of enrollment into the registry indicates that gastrointestinal complaints occur more often in older children with ASD and are associated with abnormal behaviors, sleep dysfunction and overall decreased quality of life.”
The study concluded that further investigation is needed to clarify these associations and whether treatment of GI disorders improves behavioral and cognitive function, sleep and quality of life in children with ASDs.