Center for Autism Developmental Disabilities Research and Epidemiology

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Center for Autism Developmental Disabilities
Research and Epidemiology
Funded by Centers for Disease Control and
Prevention (CDC)
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Childrens Health Act of 2000The efforts of
parent advocates and national legislature

• Established Centers of Excellence for Autism
  Epidemiology (CDC/CADDRE)
• California North Carolina
• Colorado Pennsylvania
• Maryland/Delaware
• 6th site is in Atlanta

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CA CADDRE Goals
Track Autism Spectrum Disorders (ASD) in
California Conduct research studies in
California and with other CADDRE centers Build a
resource and improve knowledge about ASD in
California
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Special Education
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California Department of Developmental
Services 633 increase in ASD Clients
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Kaiser Permanente Northern CaliforniaPrevalence
per 1,000 2-18 year olds
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Possible Explanations for Observed Increase

• Changes in diagnostic criteria
• Improvements in case recognition
• Increased awareness of service delivery system
• True increase in incidence

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Surveillance

• CA CADDRE conducted autism surveillance as
  part of the national CDC ADDM/CADDRE network to
  establish standardized prevalence rates and track
  trends over time

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Multi-source surveillance
Single source surveillance
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Multi-source Case Definition

• Birth residence in 6 county SF Bay Area (80,000
  births/year) validated by vital records
• Born in 1994 or 1996
• Identified through records of multiple
• sources
• ASD diagnosed before 9th birthday, then confirmed
  by chart review
• Expert review to resolve suspect diagnoses

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Ascertainment Sources

• Dept. of Developmental Services/Regional Centers
  (DDS/RC)
• Kaiser Permanente
• Hospital child development and PDD clinics
• Community clinics and assessment centers
• Private physicians/specialists
• NOT able to access school records due to FERPA

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Multi-source Surveillance

• Completed review of hundreds of charts at
  multiple sources
• Completed expert review of abstracted info
• Finalizing analyses
• Results to be released by Fall 2007

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ADDM Results

• The average finding of 6.6 and 6.7 per 1,000
  eight-year-olds translates to approximately one
  in 150 children in these communities.
• This is consistent with the upper end of
  prevalence estimates from previously published
  studies, with some of the communities having an
  estimate higher than those previously reported in
  U.S. studies.

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Surveillance

• Monitoring Early Childhood Autism (MECA)

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MECA Overview
One year planning grant to develop methods to
track the number of children less than 4 yrs of
age with an ASD in Santa Clara County Includes
strategies for increasing community and public
health awareness of ASDs and improving early and
consistent identification of ASDs
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Research
Neonatal Antibodies to Infectious Agents and
Risk of ASD
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Background

• Limited evidence indicates that infectious
  exposure during pregnancy may be etiologically
  important in schizophrenia and other psychiatric
  disorders.
• Exposure to infectious agents during pregnancy
  has been hypothesized to contribute to ASD, but
  studies with biologic assays are lacking.
• IgG antibodies in newborns are obtained
  transplacentally and are markers for maternal
  exposure to viruses and other infectious agents.
  
• IgM and IgA antibodies in newborns are produced
  by the fetus and correlate with active perinatal
  infection.

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Methods

• Used 1994 multi-source ASD surveillance cases
• Randomly sampled controls from birth certificate
  files
• Obtained newborn blood spots
• Measured levels of antibodies to several
  infectious agents

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Conclusions

• No evidence that exposure of mother to specific
  viruses or other infections during pregnancy or
  at delivery are major causes of autism in a CA
  population.
• Some evidence that Toxo IgG and total IgG are
  lower at birth in children with ASD than in
  control children from the same population.
• Possible explanations for lower levels of Toxo
  and total IgG antibodies include lower maternal
  exposure, maternal immune dysfunction, or lower
  transplacental transfer.

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Research
Investigating Air Pollutants in Relation to
Autism in the San Francisco Bay
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Background

• ASD has a strong genetic component, but
  environmental factors may also play a role in
  cause
• USEPA has modeled concentrations of hazardous air
  pollutants (HAPs) nationwide
• Goal Link CA CADDRE autism surveillance data to
  HAPs data in San Francisco Bay Area to look for
  possible environmental influences

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Methods

• Identified 341 potential case records
• Selected 2 controls/case from livebirths, matched
  by gender and month
• Abstracted birth address from birth certificate
• Geo-coded addresses to assign census tract
• Linked to HAPs data by census tract

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HAPs Background

• No monitoring data available on low-level,
  chronic exposures to air toxics
• EPA model estimates annual average concentrations
  for each census tract in the U.S.
• Based on Emissions from
• point sources (e.g. a power plant, dry cleaners
  and gas stations)
• mobile sources (e.g. cars, locomotives, boats,
  lawn and garden equipment)
• Factors in meteorological data, decay rates, and
  deposition

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Conclusions

• More cases likely to be born in areas with
  higher estimated metals concentration
• Cases also more likely to be born in areas with
  higher chlorinated solvent concentrations
• Diesel particulate matter may also be associated
  with case status, but less prior plausibility
• Further research is necessary to address study
  limitations and confirm findings

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Research
Childhood Autism Perinatal Study (CHAPS)
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CHAPS

• Case-Control Study
• Children born in Kaiser Permanente 1995-1999
• At least 2 years of health plan membership
  following birth
• 420 with ASD, 2100 controls
• Examining prenatal, perinatal, neonatal factors
• Maternal and child medical record review,
  electronic databases

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CHAPS Publications

• Maternal autoimmune and allergic diseases
• Psoriasis, allergy, and asthma around the time of
  pregnancy more common in mothers of children with
  ASD
• Neonatal jaundice
• Not more common in children with ASD
• Congenital anomalies
• More common in children with ASD
• Maternal and Paternal Age
• Risk of ASD increased for children with older
  parents
• Postnatal infection
• Not more common in children with ASD

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CADDRE Outreach and Education
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Parent Handbook

• New printing available on March 01
• English
• Spanish
• Vietnamese
• Chinese

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CADDRE Brochure and Autism Cards
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Bay Area Pocket Guide
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Study to Explore Early Development (SEED)
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Research and Clinical Medicine Collaboration

• Kaiser Permanente (KP), Division of Research
• KP Autism Spectrum Disorders Center, Santa Teresa
• Department of Developmental Services (DDS)
• Regional Center of the East Bay
• San Andreas Regional Center
  
• California Department of Health Services,
  Environmental Health Investigations Branch

Painting by a child with ASD
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Study Introduction

• SEED is the largest collaborative scientific
  study to date of risks and causes of autism.
• 2,700 children and their parents.
• Six areas across the county California,
  Colorado, Georgia, Maryland, North Carolina,
  Pennsylvania.

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Research Questions

• Physical and behavioral characteristics
• Infection and immune function
• Reproductive and hormonal features
• Gastrointestinal features
• Sociodemographics
• Genetics

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California Enrollment

• 2 to 5 year olds
• English and Spanish speaking
• 150 children with ASD (Case)
• 150 neurodevelopmentally impaired controls (NIC
  cohort)
• 150 general population controls ascertained from
  California live birth records. (Subcohort)

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Case / NIC Identification

• Kaiser Permanente of Northern California
• Department of Developmental Services/Regional
  Centers (DDS/RC)
• RCEB
• SARC

Regional Centers provide services without regard
to citizenship or financial status
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Study Area

• Alameda and Santa Clara Counties
• Birth residence and current residence
• Well established and integrated system of
  diagnostic and support services for children at
  risk for developmental disabilities

Study Area is 31 Hispanic, 30 White
non-hispanic, 23 Asian, 8 Black
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Data Collection

• Child development evaluation
• Child dysmorphology exam
• Biological samples buccal cells, venous blood,
  hair
• Medical record abstraction
• Primary caregiver telephone interview
• Primary caregiver self administered questionnaires

Data collection will be scheduled according to
what works best for families
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Study Values

• Data collection with the interest of families and
  children in mind
• Flexibility with scheduling
• Staff has extensive experience with
  developmentally disabled children (interviewers,
  recruiters, clinical assessors, phlebotomists)

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Clinic Visits

• KP Santa Teresa ASD Center in San Jose
• ASD families 1 day
• NIC families ½ day
• Control families ½ day

Kaiser Santa Teresa
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Family Compensation

• Participants will be compensated at a rate of
  30.00/hour
• Rate from focus groups in California and Georgia
• Each study component has estimated time
  completion associated
• 200.00 for subcohort/NIC group
• 310 for case group
• Travel expenses are reimbursed

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Study Timeline
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For more information.

• Call California CADDRE / SEED phone message line
• [phone]
• Lisa Croen, PhD, Principal Investigator
• (510)-891-3463
• For Community Advisory Board, Call Lori Copan,
  Community Participation Coordinator
• (510)-620-3631

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Community Advisory Board (CAB)

• CAB members include parents with child
  affected by autism or developmental delay,
  clinicians and community providers
• Provide advice on working with families and
  ensuring their participation
• Help develop and disseminate EO materials,
  consent forms and other documents
• Represent CADDRE at public events, meetings
• Act as a liaison between CADDRE and the agency
  or community each member represents
• We are currently recruiting CAB members