Foreword: Environmental Chemical Exposures and Autism Spectrum Disorders: A Review of the...
Transcript of Foreword: Environmental Chemical Exposures and Autism Spectrum Disorders: A Review of the...
Environmental Chemical Exposures and AutismSpectrum Disorders: A Review of the EpidemiologicalEvidenceAmy E. Kalkbrenner, PhD, MPH, Rebecca J. Schmidt, MS, PhD,Annie C. Penlesky, MPH
Environmental Contributors to Autism:The Pediatrician’s RoleLeonardo Trasande, MD, MPP
Curr Probl PediatrAdolesc Health Care, November 2014
Foreword: Environmental Chemical Exposures andAutism Spectrum Disorders: A Review of the
Epidemiological Evidence
Autism spectrum disorders exact a tremendous
toll emotionally, physically, socially, and econom-
ically. In the United States, on average, for children
with autism spectrum disorders compared to
children without autism spectrum disorders, health
care costs were $3020 higher and aggregate non-
health care costs were $14,061 higher, including
$8610 higher school costs.1 In a statistical model
assuming a prevalence of concomitant intellectual
disability of 40%, the national cost of supporting
children with autism spectrum disorders in the
United States was found to be $61 billion per year,
while the national cost of supporting adults with
autism spectrum disorders in the United States
was found to be $175 billion per year.2
Given the enormous personal, family, and soci-
etal costs, early intervention and prevention of
autism spectrum disorders are very important.
The American Academy of Pediatrics recom-
mends that all children be screened for devel-
opmental delays and disabilities during regular
well-child doctor visits at 9 months, 18 months,
and 24 or 30 months.3 Also, the American Acad-
emy of Pediatrics recommends that children be
screened specifically for autism spectrum disor-
ders at 18 and 24 months.4 A toolkit designed to
assist clinicians in the recognition, diagnosis, and
management of children with autism spectrum
disorders is available at www.aap.org/autism.
More than 70 tools are included.
The Federal government also is making a
coordinated effort to encourage healthy child
development, universal developmental and
behavioral screening for children, and provision
of support for patients’ families and providers.
The Birth to 5: Watch Me Thrive campaign is
available at hhs.gov/WatchMeThrive.
With regard to prevention, there is evidence that
folic acid supplementation during the pericon-
ception period is associated with a decreased
risk for autism spectrum disorders.5–7 This evi-
dence provides yet another justification for the
recommendation that all women of childbearing
age should follow the U.S. Public Health Service
recommendation to take folic acid.8 The American
Academy of Pediatrics has endorsed the U.S.
Public Health Service recommendation that all
women capable of becoming pregnant consume
275
400 mg of folic acid daily to prevent neural tube
defects, particularly for adolescent, sexually active
women who do not plan to use effective contra-
ception or abstain from sexual intercourse.9,10
Clinicians should advise patients that prevention
of autism spectrum disorders may be yet another
benefit of folic acid supplementation.
References1. Lavelle TA, Weinstein MC, Newhouse JP, Munir K, Kuhlthau
KA, Prosser LA. Economic burden of childhood autismspectrum disorders. Pediatrics 2014;133(3):e520–9.
2. Buescher AVS, Cidav Z, Knapp M, Mandell DS. Costs ofautism spectrum disorders in the United Kingdom and theUnited States. J Am Med Assoc Pediatr 2014. http://dx.doi.org/10.1001/jamapediatrics.2014.210:[Published online].
3. Council on Children With Disabilities, Section on Develop-mental Behavioral Pediatrics, Bright Futures Steering Com-mittee and Medical Home Initiatives for Children With SpecialNeeds Project Advisory Committee. Identifying infants andyoung children with developmental disorders in the medicalhome: an algorithm for developmental surveillance and screen-ing. Pediatrics 2006;118(1):405–20.
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4. Johnson CP, Myers SM, American Academy of PediatricsCouncil on Children with Disabilities. Identification andevaluation of children with autism spectrum disorder. Pedia-trics 2007;120(5):1183–215.
5. Schmidt RJ, Hansen RL, Hartiala J, et al. Prenatal vitamins,one-carbon metabolism gene variants, and risk for autism.Epidemiology 2011;22:476–85.
6. Schmidt RJ, Tancredi DJ, Ozonoff S, et al. Maternal peri-conceptional folic acid intake and risk of autism spectrumdisorders and developmental delay in the CHARGE (Child-hood Autism Risks from Genetics and Environment) case–control study. Am J Clin Nutr 2012;96:80–9.
7. Suren P, Roth C, Bresnahan M, et al. Association betweenmaternal use of folic acid supplements and risk of autismspectrum disorders in children. J AmMed Assoc 2013;309:570–7.
8. Centers for Disease Control. Recommendations for the use of folicacid to reduce the number of cases of spina bifida and other neuraltube defects. Morb Mortal Wkly Rep 1992;41:[No. RR-14].
9. American Academy of Pediatrics. Folic acid for the preventionof neural tube defects. Pediatrics 1999;104:325–7.
10. Klein JD, American Academy of Pediatrics Committee onAdolescence. Adolescent pregnancy: current trends and issues.Pediatrics 2005;116:281–6.
Ruth Ann Etzel, MD, PhD
Editor
Curr Probl PediatrAdolesc Health Care, November 2014