Late last year, a study from tissue researchers at NYU showed angiogenesis in brains of people with autism spectrum disorder (ASD).   Angiogenesis is the creation of new blood vessels in the brain which normally stops around age 2.  Because of the study of post-mortem brain tissue, researchers were able to find evidence that in people with ASD, the development of blood vessels in the brain is in flux and changing across the lifespan.  Dr. Ephraim Azmitia, the lead author of the study that was able to complete this investigation because of the Autism BrainNet, explains the research here.


Dr. Ephrain Azmitia from NYU

Q:  Dr. Azmitia, please explain what you found.

A:  In 2014 we first discovered that brain blood vessels in the brains of people with ASD, but not those not diagnosed with ASD, showed continuous angiogenesis. We have spent all our time focused on this observation and have now published a full-length paper in Journal of Autism and Development Disorders entitled Persistent Angiogenesis in the Autism Brain. We found that splitting angiogenesis (not sprouting angiogenesis) is found in every area of the brain from ASD donors  that we examined; cortex from auditory and face recognition areas, general temporal association cortical areas, midbrain, pons and cerebellum. The angiogenesis continued even in brains from donors over the age of 28 while it was only lightly seen in very young brains (< 2 years) of typically developing donors.

Q: Why is this important?  

A:  First, our findings demonstrated that autism affects the whole brain, not just one localized region. While certain brain regions have been targeted based on behavioral studies, the whole brain should be considered.

Second, it appears blood vessels in the brain are involved in ASD. Splitting angiogenesis occurs when blood vessels are reorganizing, usually to supply more active neurons and glial cells with additional oxygen and nutrients. This implies that brains cells of autistic patients may be more active and dynamic than those without autism. It is possible splitting angiogenesis keeps cells richly supplied with blood so they retain their highly interactive condition, and fail to form more stable connections needed for mature complex functions such as language and social behaviors.

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Marker of angiogenesis is elevated in brains of people with autism, but not after 2 years of age in people not diagnosed with ASD.

Q:  Will this lead to new interventions?

A:  Therapies and drugs are widely available to control dividing vascular cells, such as seen in tumor growth. Unfortunately, most of these drugs are targeted for spouting angiogenesis, which is the form of vascular growth seen in tumor formation. Future research on regulating this type of angiogenesis is needed which then needs to be studied to determine if it helps ease symptoms.

Q:  How can I contribute to this type of research?

A:  Scientific research like this is not possible without the ability to study the brains of people with autism.  To register, go to www.takesbrains.org.

By Alycia Halladay, PhD, Chief Science Officer
and the Scientific Advisory Board of the Autism Science Foundation

2015 was an unprecedented year for autism research with many significant advances that will improve the lives of people with autism. Just last week, for example, the CDC reported a 5-month decrease in the age that children are first being evaluated for autism, which means families are learning the signs, acting earlier, and, hopefully, starting early intervention services earlier. In 2015, we changed the way we think about females with autism, gained a better understanding of the underlying genetic causes of autism, and made important progress in both behavioral and medical interventions.  Here’s a summary of some of the year’s most significant findings.

Researchers are expanding their attention beyond boys with autism, to the girls and women.

More males are diagnosed with autism than females. This means fewer girls and women participate in research, some scientific conclusions only apply to males, and, in some cases, females are not even studied because of the assumption it is a “male” disorder. This has disadvantaged understanding of females with autism. Luckily, 2015 was a year that science challenged the assumptions that autism is a male disorder.

The journals and news outlets are catching on to the special need to look at females with autism. A special issue of Molecular Autism was published that included many groundbreaking studies on females with autism, including studies involved in early behavior, genetics, and brain structure. A special issue in the journal Autism invited submissions this year, to be published in 2016 or 2017. Also, Spectrum News compiled a summary of what is known about females with autism, from basic science to specific challenges seen in girls and women with ASD. It includes science reports and essays written by women on the spectrum.

So, what did scientific research reveal in 2015? First, the brains of girls with autism are different than boys with autism, specifically regions relating to language function and the way that different regions of the brain connect to each other1,2. Differences in the size of the corpus callosum are seen even before a diagnosis3, and researchers believe they may help explain why symptoms are different in boys and girls.

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Differences in size of different regions of the brain in boys and girls with and without autism.

The corpus callosum consists of neural fibers that connect the left and right sides of the brain. Very early signs of autism may also be different in boys and girls4, but they are subtle and young boys and girls with autism may be more similar than different.5,6 Findings from the study of the molecular signatures in the brains of males and females with autism are hard to interpret because of the number of female brains with autism to study.7 The sex bias in autism diagnosis is also reflected in a scarcity of biological samples, including brain tissue, from females with ASD. If you are a woman with autism, or the parent of a girl with autism, please consider registering for the Autism BrainNet. It’s easy, and registrants receive regular updates on why this resource is so important.

But it’s not only the girls with autism bringing attention to research in sex differences, it’s the whole family. For example, families in which there is more than one person diagnosed or a female diagnosed tend to show higher levels of autism symptoms both in the affected person and in siblings8,9 and girls with autism show more genetic mutations10. These findings together suggest a protective factor in females which protects against the same symptom presentation as boys.

IMG_1876 (3)

Undiagnosed sisters play an important role in understanding autism.

Therefore, researchers have started expanding the scope of research from just the individual affected with autism to all family members, so that susceptibility and protective mechanisms from certain symptoms may be uncovered.10,11Earlier this year, the Autism Science Foundation launched a new initiative based on the study of unaffected females called the Autism Sisters Project. You can learn more at www.autismsciencefoundation.org.

It’s not just about an autism diagnosis

One of the questions that has plagued clinicians who make an autism diagnosis is the degree to which the symptoms may change over time, both in the short term and the long term. Two separate studies followed infants with a high probability of a later diagnosis and showed that if a diagnosis was given to a toddler at 18 months, that diagnosis stuck later on in life.12,13 However, that doesn’t mean that the threshold for a diagnosis is always met this early, as a proportion of children were diagnosed at 3 years but not earlier.12,13   Those that received a diagnosis later still showed some of the core features of ASD, but tended to have higher language ability and lower severity of autism symptoms before age 3.   There were also distinct patterns across time in each of the groups, reinforcing the variability in presentation of symptoms as well as providing data on how symptoms develop over time in each subset. These findings have enormous clinical importance, as primary care doctors need to continue to monitor children who show early signs and symptoms but do not meet all the criteria of a diagnosis.13,14

Dr. Peter Szatmari

Peter Szatmari, MD, led a study following children with autism  from ages 2 through 6.

However, while a diagnosis is stable, this does not necessarily mean that delays or impairments stay the same forever. Canadian researchers followed children with autism from age 2 to age 6 and tracked their cognitive ability and their ability to function in daily life (called adaptive behavior). They found that how children started didn’t necessarily predict how they fared later on, as most children with intellectual disability at age 2 didn’t have the same cognitive impairments at age 6.15 While adaptive behavior was more stable, 20% showed improvements in the years after the initial diagnosis.15 These findings show that autism changes and sometimes improves. Further these results underscore that in addition to monitoring autism symptomatology, there is a need to address how children with autism function overall.

Due to lack of funding, researchers studying infants who have a high likelihood of an autism diagnosis tend to stop their studies when the participants are 3 years old. However, a few projects were able to follow families through school age, and the findings may likely alter the way people think about autism. For example, in one long-term study at University of California, Davis, children with and without an autism diagnosis by age 3 were evaluated until they turned 11. The researchers looked beyond ASD and found a higher rate of ADHD symptoms, especially in the girls.16 ADHD and autism often occur together, so while they are different disorders, they may be two diverging roads from the same highway.

Better understanding of underlying genetic causes, and new information on epigenetic mechanisms

In 2015, rapid progress in the genetics of ASD continued. As has been the case in recent years, the lion’s share of progress in identifying specific genes has come through the study of so called germ-line de novo mutations. These are newly occurring changes in DNA that are only in the parent’s sperm or egg cell, are passed on and present in every cell in the child’s body, but are not detectable in the parent’s blood. A new study this year of germ-line de novo mutation bringing together new and previously published data from over 5500 families identified a total 65 genes with strong evidence for a role in ASD risk.10 This study replicated findings girls carry a greater genetic burden than boys, confirming prior findings17 that de novo mutations play an important role even in children with high IQ, and once again highlighted the importance of synaptic function and chromatin modification (discussed later) for the biology of ASD that was reported last year.18 These investigators also found, interestingly, that large copy number variations (CNVs), such as 16p11.2, are very likely to carry many risk genes each with modest risk, rather than one single “smoking gun”.

These findings contribute to the global picture of the genetic underpinnings of autism, which have become much more clear in the past few years. Several papers have shown that variations that are common in the population play an important role in ASD,19,20 in fact carrying most of the risk. This is called “common variation”. Common variation accounts for most of the genetic risk for autism in the entire human population, however, the vast majority of individuals do not have symptoms.  It is thought that most people with autism have multiple common variations which increase risk for autism. On the other hand, rare de novo mutations that can affect just one nucleotide of a key autism gene can also play major contributory role.21 In addition to germ line de novo mutations and common risk alleles which are heritable, a recent study from Boston22 highlighted the contribution to ASD of an additional type of mutation, called somatic mosaicism. These are new mutations that occur in the affected individual but sometime after fertilization of the egg. This is most commonly seen in cancer. In order to see the mutation, scientists need to study the organ of interest, in this case, the brain. This was the first time somatic mutations were identified in brain tissue of individuals with


Difference between somatic and germline mutations

autism. There may be even more of these somatic mutations in the brain, and knowing about them may not just inform geneticists about the underlying neurobiology, but shed light on what factors might increase the risk for such mutations to occur. 22 These findings highlight the importance of brain tissue in studying risk factors for ASD.

But the genetic influence of ASD is not just limited to the sequence of the A’s and C’s and G’s in the code of the DNA or the structure of chromosomes. A growing body of literature is demonstrating that the epigenetic code, or the code that influences how genes are turned on and off, may be just as important. As environmental factors target epigenetic markers in the DNA, this is part of the missing link in understanding gene/environment interactions in ASD.


As important as DNA sequence, epigenetic markers affect ASD risk.

One of the reasons geneticists don’t understand epigenetics is that there was no “Human Epigenome Project” to mirror the 2003 Human Genome Project. This is surprising considering doctors are sure that the epigenome contributes to different disorders and diseases, such as diabetes, cancer, and syndromes with a high prevalence of autism like Angelman’s Syndrome and Prader-Willi.23 This year was important for epigenetics research, because a group of researchers published a map of 111 epigenetic markers on the genome from over 183 types of cells, all data has been made publically available for other researchers to study.24 This advance will definitely increase the pace and productivity of science around the role of epigenetics and autism.

In 2012, a gene called CHD8 was reported to increase autism risk.25,26 CHD8 affects chromatin remodeling, or how the DNA is kept tightly wound, which in turn has a major effect on when and where genes are expressed (turned on and off). If CHD8 is disrupted, then DNA does not express itself properly. This year, geneticists looked at what this gene did, and found that it regulated the expression of many other known autism risk genes during fetal development.27. This information makes CHD8 a more interesting gene to understand the bigger picture of brain development in autism. Scientists agree that in the next phase of genetic research, discovery of new genes is going to be matched with figuring out what they do, and how they work together.


CHD8, involved in chromatin remodeling, is a genetic point of convergence for ASD risk

Another mechanism involved in epigenetics is methylation. This is the attachment of methyl groups to different parts of the DNA sequence that turns off gene expression. In a high-risk siblings study, fathers of a child with ASD showed methylation patterns in sperm that were similar to that seen in the cerebellum of people with autism.28 This suggests that this altered methylation may contribute to autism risk.

Other evidence of gene/environment interactions comes from studies on copy number variations, which are the duplication of or the deletion of parts of a chromosome that can result in the disruption of a gene or genes. Copy number variations contribute to ASD risk, but why they are more often seen in people with autism is still understudied. By looking at environmental factors, researchers have discovered that maternal infection, a risk factor for autism, interacts with the occurrence of these copy number variations to increase ASD symptoms. 29 This finding is a direct demonstration of how environmental factors can increase risk through genetic mechanisms.

Single genes, multiple solutions.

In addition to the more recent discoveries of de novo mutations identified in “typical” autism cases described above, there is a long history of studies of so-called syndromic forms of autism. As more data is accumulated, the distinctions between these groups is becoming less clear, but in general, those genes associated with ASD as well as other characteristic physical features have been considered syndromic, including the Fragile X protein causing Fragile X, or Shank gene causing Phelan-McDermid Syndrome. These are also sometimes described as “single gene” causes of ASD because it appears that a damaging mutation in one of these is sufficient on its own to lead to ASD. As research identifies more of the rare mutations discussed earlier21 the number of these syndromic forms will increase. In the big picture, syndromic/single gene forms of autism account for a relatively small proportion of all ASD cases, however, what they tell us about these syndromic forms can lead to discoveries that impact all forms of autism.

Charles Bluebonnets 2008 (2)

People with Phelan-McDermid Syndrome are often also diagnosed with autism.

In fact, a recent analysis of the shank gene, known to cause Phelan- McDermid Syndrome, shows that mutations of different types of the shank gene are seen across the spectrum of individuals with autism: both those with high IQ and lower IQ and everything in between.30 In other words, this gene doesn’t just show up in those with a certain phenotype, and in fact, one type of mutation shows up in about 2% of individuals with ASD.30 So therapies that were developed for Phelan- McDermid Syndrome may be helpful in treating different types of autism.

Understanding the role of these genes in pathology also helps in understanding the course and symptoms of the disorder. For example, using brain tissue of people with autism, with or without a specific mutation in chromosome 15, neuropathologists showed that there were fewer and smaller neurons in the auditory brainstem–the part of the brain crucial for hearing and distinguishing sounds.31 These cellular deficits are more severe in those with mutation, but the fact that they are present in both groups suggests that there is a common mechanism between auditory problems, pointing to common solutions. In other areas of the brain, scientists see specific persistent and profound decreases in cell size in areas of the amygdala and hippocampus, both involved in emotion, in those with the mutation. 32 These neurobiological differences contribute the phenotype of people with this genetic marker, like lower IQ and high rates of epilepsy. These findings were made possible through postmortem brain tissue donated to the Autism BrainNet.


To register with the Autism BrainNet, go to http://www.takesbrains.org

Postmortem brain tissue is also leading to new targets of treatment. Last year a study reinforced the importance of a type of immune cell in the brain, called microglia, in autism neurobiology.33 This year, a study found that a regulator of microglia activity, the mGLUr5 receptor, less active in brain tissue of people with autism.34 This receptor is also known to be a key target in Fragile X syndrome, and together, this data advances the idea that microglia may help control the shape the shape and size of neurons.   When microglia are overactive, this process goes awry and leads to disorders of synaptic plasticity, like autism. This discovery has already led to more research on the role of the microglia in cellular processes with hopes that it will be a feasible treatment target.

New genes that significantly contribute to autism are being discovered. Families are using the power of social media like Facebook to
find each other, and what was once an interesting finding on a gene array is turning into a syndrome. For example, earlier this year mc1407fe29c9610756a92704a12efe6deutations in a gene called DYRK1a, a gene where too many copies is associated with Down Syndrome, showed that not enough of this gene is associated with a very specific form of autism: those with low intellectual functioning, early seizures, and stereotyped behavior.35 A number of research and advocacy groups have now banded together to improve research in autism where there is a known genetic cause: http://www.gdaac.org.

The big question is whether genetic forms of autism have a hope of being treated. A few years ago, a completely revolutionary study showed that replacing the deficient gene involved in Rett Syndrome reversed the symptoms in a mouse model. 36 This year, the disorder that is produced by too much of this gene, MeCP2, was reversed using targeted gene technologies. 37  Similar modifications of activity of UBE3A, in the area of chromosome 15 associated with autism, have been shown in animal models.38 While it is way too early for clinical trials in humans, the reversal of the behavioral and cellular phenotype in individuals with Rett Syndrome and Dup15 opens the door to targeted gene interventions being available for multiple causes of ASD, even long after the behavioral features present.

New discoveries in treatment: it’s about what you should be doing, and what you shouldn’t be doing.

Many years ago, the first randomized clinical trials on early interventions were conducted. The results of those projects on some early markers of behavior at or around age of diagnosis were published. They were mostly positive, but none of these interventions were shown to improve the core symptoms of autism. Earlier this year, researchers at the University of Washington reported that by 6 years of age, children who had participated in an intervention called the Early Start Denver Model (ESDM) not only maintained the gains attained through this intervention, but continued to improvements in the core symptoms of autism39.   So in terms of what families should be doing, early interventions continue to be filed in the “do” category.

There were some interesting findings relating to pharmacological interventions for autism. The hormone oxytocin, otherwise known as the “love hormone,” had previously been shown to benefit individuals with ASD when administered in clinical settings via an intravenous (IV) drip. An IV drip is not really feasible in most real world settings, so researchers studied whether or not a nasal spray of oxytocin would work as well. As it turns out, it did. There were some improvements in some of the social behaviors of autism, but the effects were mild.40 Even so, this therapy is worth following up in additional studies where other interventions are controlled for as well.

Just as important to finding things that help is scientific data on things that don’t. For example, many parents of children with autism turn to dietary interventions like the gluten free casein free (GFCF) diet. Some children with (and without) autism have gluten sensitivities and in these cases, the diet is a good idea. But other parents just don’t know where else to turn and this diet has received enough anecdotal acclaim that they are willing to give it a try. But in many cases there is a large placebo effect, meaning, parents expect or want an effect so much that they unknowingly exaggerate improvement. Very few rigorous research studies have investigated the effects on autism behavior controlling for this placebo effect, until this year. Using a study design that allowed for children to eat either gluten and casein containing or free foods without either them or their caregivers knowing what was in them, the clinicians didn’t see any improvement in autism behaviors41. This casts doubt on the utility of the GFCF diet for treatment of autism symptoms, although, if monitored by a dietician, the diet does not seem to be harmful.

The world of behavioral interventions was turned on its ear earlier this year with a study challenging one of the most common procedures of applied behavioral analysis: repetition. In repetition, a stimulus is presented over and over again to facilitate learning. However, researchers studying repetition in autism found that too much repetition may actually impair the ability of people with high functioning autism to be flexible.42 The implications are clear: when it comes to repetition in some people with autism: maximize with moderation.

Bridging the gap from people in the clinic to people in the community.

Understanding of the early signs and symptoms of autism in the clinic has significantly advanced practice in the pediatrician’s office.43 This year, the same group of researchers that provided the data to enforce early screening for all children with autism challenged primary care providers to look even more closely and take even more action for those with a suspected diagnosis.44 In addition, in the face of the U.S. Preventive Services Task Force (USPSTF) ambiguity on the importance of universal screening for autism, this group continued to urge autism-specific tools to identify autism at 18 and 24 months.44 Finally, they urged culturally- appropriate interventions that involve all family members.


Amanda Gulsrud, PhD, from UCLA, works with a child with autism

As mentioned earlier, a number of rigorous studies examining the effectiveness of parent – mediated early interventions have reinforced the benefits of interventions targeting social, emotional, behavioral domains for the potential prevention of ASD symptoms. While improvements in overall behavior in children and parenting are seen, the effect on specific autism symptoms is unclear.45 On the other hand, reducing behavioral problems in those with autism is a huge concern of parents, and the largest randomized behavioral intervention study on behavioral issues in autism to date  compared  parent-training to parent education was published in 2015. There were improvements in these behavioral problems in both groups, but parent training was clearly superior.   After 6 months of treatment, children in the parent-training group showed a 48 percent improvement on parent ratings of disruptive behavior compared to a 32 percent decline for parent education, and 70% of those in the parent-training group saw an overall positive response by a clinician. 46  The data is encouraging, but data on standardized, objective measures of outcome showed modest improvements in behavior. This study reinforces the value of parent-training models to improve outcomes, and other research in the past year has focused on the right ways to train parents. This means making sure parents are getting the support and feedback they need and delivering the interventions the way they were designed. 47 This is clearly important, as the ultimate goal of developing a behavioral intervention is to make sure that it can be shared with children in a variety of settings under a variety of circumstances, not just those in a university clinic. Also important is the level that these parent-driven interventions produce improvements that make a difference clinically, not just in a statistical analysis.

Another important component of understanding what interventions will work for individuals with autism is knowledge about some of the behavioral characteristics that match well with different types of interventions. These are called moderators of outcome. In addition to IQ at start of intervention, now clinicians know that vocabulary and ability to intentionally communicate during toddler years can predict later outcome. 48 These moderators should now be incorporated into personalized decisions made about what type of interventions will lead to the best chance of improvements in different people, and will better inform treatment decisions. Teaching children with autism as a way to exchange knowledge may not always be effective, those children with autism without cognitive impairment still don’t always grasp the intentions of teaching.49   This calls for alternative methods of learning and teaching in those with autism.

mandatesAll the science is great, but what about getting the services paid for? As it turns out, getting insurance mandates in place doesn’t solve all of the challenges around making sure families receive appropriate care. As researchers at the University of Pennsylvania revealed, forcing insurance companies to pay for services increases the demand, and supply was already at capacity before, creating new problems. The efforts of insurance mandates is an important and crucial first step to providing much needed services for families, but should be followed up by incentives to increase the workforce and infrastructure.50

This is a just a sampling of some of the 2015 research that has made an impact on the science of autism. Science can be incremental, it can be slow, but each year there is progress–studies that changes the way scientists think or how the community manages autism. headshotPlease add your thoughts by commenting below or sending an email to ahalladay@autismsciencefoundation.org. See you in 2016!



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NEW YORK, NY (December 10, 2015) – The Autism Science Foundation today hailed new Centers for Disease Control and Prevention (CDC) findings of an improvement in the age of initial diagnosis of autism. Citing new data from its pilot Early Autism and Developmental Disabilities Monitoring Network (ADDM) study, the CDC reported a five-month decrease in the age of first comprehensive developmental evaluation for autism in a cohort of 4 year-old preschool children with autism. On average, these children born in 2006 had an average age of diagnosis of 2 years, 3 months, compared to children born in 2002 who had an average age of diagnosis of 2 years 8 months.

“The decrease in age of first evaluation for concerns is an important improvement because we know that the earlier children are identified and the sooner they begin early intervention services, the better their long term outcome,” said Dr. Alycia Halladay, chief science officer of the Autism Science Foundation.  “By continuing to study children’s development between age 4 and 8, we can gain actionable information that can inform how school districts and other service-providers can best help children during this critical developmental period.”

The prevalence of 4 year-olds was 30% less than seen in 8 year-olds, which is not an entirely new finding. Earlier this year, the High Risk Baby Siblings Research Consortium reported that while a diagnosis at 18 months is stable, some children do not meet criteria for a diagnosis until 3 years.  Children with a lower IQ were more likely to receive an early diagnosis, confirming earlier findings that children with more behavioral symptoms are more likely to be picked up earlier.

Screen Shot 2015-12-10 at 11.46.09 AMSaid Autism Science Foundation President Alison Singer, who participated in a CDC teleconference about
the new findings: “What’s five months in the scheme of things? It’s huge. That’s five months a mother or father doesn’t have to spend questioning their toddler’s development and behavior — or questioning whether they should be doing more to help him. That’s five fewer months of painful uncertainty. For a parent, five months can be an eternity.”

Added Singer, “We’ve gained five months, which is wonderful news. Now let’s be greedy and try to gain 12 months, 18 months, for all children. We need to keep chipping away at the delay and disparity in diagnosis. We’re making important and measurable progress, but, working together, we can do even more.”

Halladay noted:  “While this is great news, there is still progress to be made with regards to racial and ethnic variation in age of diagnosis.   At 4 years of age, there was no difference in diagnosis rates between African American and Caucasian children.  However, African American children still experience a delay in the age of first developmental evaluation.”

The overall prevalence of autism in the cohort of 4 years-olds was reported to be 13.4 per 1000 (1 in 75). This is the first time prevalence numbers have been reported for 4 year-old children. For the past 15 years, the ADDM network has reported autism prevalence in 8 year-old children. The new CDC data are not the widely cited “1 in x” prevalence data; those data, which measure the change in prevalence among 8 year-old children, are reported every two years and are next expected in the spring of 2016.

The same methodology was used to measure prevalence in 4 year-old children and in 8 year-old children: examination of school and health records. Preschool records were examined in 5 sites, a subset of the 12 ADDM sites.

Today’s report was published in the Journal of Developmental and Behavioral Pediatrics.

About The Autism Science Foundation

The Autism Science Foundation (ASF) is a 501(c)(3) public charity. Its mission is to support autism research by providing funding to scientists and organizations conducting autism research. ASF also provides information about autism to the general public and serves to increase awareness of autism spectrum disorders and the needs of individuals and families affected by autism. To learn more about the Autism Science Foundation or to make a donation, visit www.autismsciencefoundation.org.


Contact:                Rubenstein Communications, Inc.

Adam Pockriss – apockriss@rubenstein.com/212.843.8286

A study published today in Neuron  examines brain tissue of people diagnosed with autism to better understand the symptoms of autism, and when mutations in the DNA occurred. In other words, did the genetic mutation originate from the parents DNA, or did it happen sometime after the egg and the sperm formed an embryo?   Knowing when they occurred helps in understanding how autism can be passed on, how standard blood tests for autism should be used, and how often genetic mutations occur in brain tissue.


Alissa D’Gama, from Boston Children’s Hospital and Harvard University, was first author on the study

To illustrate the importance of different mutations, here is a primer.   Most human genetic diseases are the result of inherited DNA mutations, in other words, those that are present in one of the parents. There is one big exception to this: cancer. But other genetic diseases, like sickle cell disease and cystic fibrosis, result from inherited DNA. Maybe the parent doesn’t have the same exact mutation, but a geneticist can trace the mutation to one of the parents. Because the mutation came from the parent, the mutation is present when the sperm and egg join and the embryo is formed. These mutations end up in all the tissues of the affected individual: blood, saliva, organs. So you can look at any of these tissues and still see the mutation. A doctor doesn’t need the organ of interest to study them.  They are inherited.

In contrast to an “inherited” mutation, is a “heritable” mutation. For example, there is more evidence to show that de novo mutations are important in autism diagnosis. You’ve heard word de novo or “of new”, meaning, they end up in the offspring but can’t be seen in either parent.  These mutations may be in the sperm and the egg or the cells that come before the sperm and egg, called the germline, but they aren’t in the blood or spit or cells of the parents. In other words, to a geneticist without sperm or eggs to study, they are de novo. These sorts of heritable mutations are in all cells, including blood, saliva, skin cells, and organs.   More and more, scientists are showing that in autism, these de novo mutations result in psychiatric issues like autism spectrum disorders.   Scientists know more about these mutations in the last 5 years than they ever did, and how they cause problems in the genetic code.  These are germline mutations.

But what scientists don’t know a lot about is the role of somatic mutations in neurodevelopmental disorders. These are mutations that happen AFTER the embryo started forming, and they affect a certain organ of interest. Because they are not in every cell in the body,  they are called somatic mutations. Only a subset of cells, or a specific organ, shows the mutation. This is the sort of mutation you see in cancer., and a biopsy is needed to see them.  A doctor would need the specific organ to find it.  This is the sort of mutation that occurs as cells constantly divide through your lifetime. If you think about how many times your cells turn over, it’s inevitable that a mutation is going to happen somewhere at sometime. They can be common and not harmful. However, sometimes, for example in cancer, they are harmful.


Adapted from the National Cancer Institute and the American Society of Clinical Oncology

If you are lost right now, you are not alone.  This is pretty advanced genetics to most people.  See the image to the right to graphically explain the difference between somatic and germline

Scientists have the resources to study germline mutations and de novo mutations in blood or saliva. But until recently, it has not been possible to study somatic mutations. How would you know if autism is the result of a somatic mutation? You’d have to study the brains of people with ASD. And that’s what a group at Boston Children’s Hospital did recently and just published their findings. While somatic mutations in autism are rare, they do exist.  Alissa D’Gama, the first author, explains why the project is important:

“Identifying a few cases with somatic mutations shows us that such mutations can occur in ASD and that somatic mutations may be another genetic mechanism that contributes to ASD risk. Understanding that some mutations can occur late in development and only be present in the brain has important implications for clinical genetic testing, as studying the blood will miss the somatic mutations present only in brain.”

So how does this impact people with autism? 1. Scientists now know that there are genetic mutations in the brain that are specific to tITBhe brain, and not found in other tissues; and 2.   These somatic mutations may be responsible for the neuropathology of autism spectrum disorders.   The word “may” is used because there is still so much researchers do not know, but could know, if there were more brains of people with autism to study.   This type of analysis was only possible through the accrued collection of dozens of brains of people with autism. Please consider registering for the Autism BrainNet at www.takesbrains.org. It is not binding like a consent, and when you register, you will continue to receive important updates like this.


ASF Undergraduate Summer Research Grantee Dylan Ritter in the lab of  Dr.Dindot at Texas A&M

I first came in contact with Dr. Dindot at Texas A&M University in the late fall of 2013 when I was a college freshman. I had seen an article published that highlighted his success in creating a mouse model used to mimic the effects of a specific kind of autism spectrum disorder, Duplication 15q Syndrome (Dup 15q). For most people reading that, the article would stand merely as an informative story about some researcher in Texas. For me, that article had a totally different context.


My youngest brother, Travis, was diagnosed with Dup15q at the age of two when I myself was only four years old. For as long as I could remember, I had a younger brother that needed help brushing his teeth, could never speak to me, and somehow enjoyed the credits of a movie more than the movie itself. I never questioned it, but I was certainly aware that our family was different from a lot of others. Meeting other families that had children with Dup15q helped me realize this condition extended beyond my five-person family, and that there was research being performed to find therapeutic options and genetic factors behind this condition.

When talking with Dr. Dindot about his research, he surprised me by ensuring me that I would be on the workbench with my own projects doing real research. And that’s exactly how the summer of 2014 was spent. I learned so much about the condition, the laboratory environment, and all of the hard work being done to find answers. I decided that I would like to return to the lab to continue research in the summer of 2015, after my sophomore year. With most of the logistics figured out from the previous summer, I was able to speak with Dr. Dindot more about what was going on in the lab rather than figuring out where his lab was on campus. In discussions about my research, he proposed that I apply for a fellowship through the Autism Science Foundation, since they were eager to support the work of undergraduate researchers interested in autism. On March 9th, I was informed that I had been selected as one of five undergraduates to receive funding for my research. It was such an exciting feeling knowing that I had been chosen by a committee as someone they believe will succeed in research. With that extra motivation, I prepared myself for the summer ahead.

I had a variety of projects going on during my time, but that main one was the classification of one of the mouse models Dr. Dindot had designed. It was set up so that excess gene expression would mimic the effects of the extra chromosomal information present in Dup15q. However, there is a unique system in which a drug could be administered in order to suppress this extra expression. The theory behind it all was that if a mouse had normal gene expression, it should have a normal phenotype without the manifestations of Dup15q. By the end of the project, it was shown that after only three days of this treatment, the excess gene expression was reduced more than 60%, showing a major change between overexpression mice and wild-type mice.

Though this was just the beginning of the project, the hope is that these mice with slightly adjusted drug treatments may eventually reach gene expression comparable with wild-type mice. From there, it is possible to perform further analysis on these mice to see if there are any phenotypic changes that occur when the gene levels change in the mouse. With the amount of progress research has made in the past 20 or 30 years, there’s no way of even being able to guess where autism research will be in the next 20 or 30 years. All I can say is that I have been extremely humbled and honored to have the opportunity to represent the Autism Science Foundation, Texas A&M, and Ole Miss by doing what I love.

A summary of the recent evidence, by Thomas Frazier, PhD and Stelios Georgiades, PhD.


Stelios Georgiades, PhD

Some family members of people with ASD often share many autism traits, but don’t have or show the number or severity of symptoms needed to be diagnosed. A recent study using the Interactive Autism Network looked at some features of autism in over 5500 individuals, some with multiple siblings with autism, some only one sibling. They wanted to determine if number of siblings with autism or sex of the sibling with autism influenced how these symptoms presented, if at all.

What did the researchers do?

Frazier_Thomas_724336 headshot

Thomas Frazier, PhD

When a family enrolls in the Interactive Autism Network not only do they enter in information about the person diagnosed with autism, they also fill out a form called the Social Responsiveness Scale on all family members. This is a quantitative measure of autism traits. Instead of saying autism: yes-or-no, the scale gives a number that corresponds to the presentation of features. It is used in people with autism, but has also been used to study features of autism of those without a diagnosis. Some people have higher levels than others but most people score around the middle.   The higher the number, the more features of autism that person exhibits. In this study, the analysis consisted of 5515 brothers and sisters, 2858 with ASD and 2657 without ASD. They looked at how autism symptoms occur in male-only ASD-affected families vs. female-only affected families or in families with single vs. multiple cases of ASD. They also looked at the siblings of ASD children who did not have the condition but who had language delay or speech patterns usually seen in children with ASD. The sex of the siblings was also taken into account in the analysis.

What did the researchers find?

The research found that

  • the non-ASD brothers and sisters (siblings) of children with ASD were more likely to show higher levels of symptoms if they were many members of their family with ASD,
  • the non-ASD boys in these families were more likely to have a higher number of symptoms, as were boys with language delay or speech patterns usually seen in children with ASD,
  • the children with ASD in families with several members with ASD had lower levels of symptoms than did the ASD children if they were the only child in the family with the condition, and
  • the likelihood of having more than one child with ASD in a family was higher if that family had female members with ASD, and
  • it is likely that girls need a much greater number of the genes related to ASD to produce the symptoms needed to warrant a diagnosis of ASD.

 What does this mean?

Both the sex and the number of children with ASD in a family strongly influence the risk of their non-ASD siblings having a high number of autism symptoms.  This again, links genetics to the causes of autism. These preliminary data suggest that siblings from certain families may have a higher likelihood of having children with ASD, but it is too early to base any family planning decisions on this data. It also emphasizes that girls have a higher genetic load, and that girls may be in some way, protected against some symptoms of autism.



Frazier TWYoungstrom EAHardan AYGeorgiades SConstantino JNEng C. (2015)  Quantitative autism patterns recapitulate differential mechanisms of genetic transmission in single and multiple incidence families.  Molecular Autism, 6:58.  Full text here:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623917/

A new study published this month in the Journal of Developmental and Behavioral Pediatrics confirms current belief that many children with Autism also have Apraxia of Speech.

Cheryl Tierney, MD, MPH of Penn State University, Susan Meyes, PhD and others investigated the efficacy of the Checklist for Autism Spectrum Disorder (CASD), a screening tool developed to determine if children should undergo complete diagnostic testing for autism (1). The researchers found that the screening tool does effectively indicate which children are at risk for autism, but they also came to another interesting conclusion (2).

Intervention approaches for autism and apraxia address different features of communication, therefore, it is important for clinicians to be aware that kids with autism may have undiagnosed apraxia of speech as well.

Intervention approaches for autism and apraxia address different features of communication, therefore, it is important for clinicians to be aware that kids with autism may have undiagnosed apraxia of speech as well.

Autism spectrum disorders are diagnosed by neuropsychologists and developmental-behavioral pediatricians. Language impairments present in autism are partially characterized by difficulties with taking the perspective of another person, with  non-literal language and with appropriately maintaining a topic (3).

Apraxia of Speech, however, is typically diagnosed by a speech-language pathologist, and is characterized by difficulty coordinating volitional motor movements required for clear and intelligible speech.

While autism and apraxia clearly have different features, a child with autism who has profound language delays such that he or she is minimally verbal or non-verbal may have undiagnosed childhood apraxia of speech, masked by his or her language deficits.

The study concluded that “autism and apraxia are highly comorbid. Thus, it is important to monitor all children diagnosed with apraxia for signs of autism and all children diagnosed with autism for signs of apraxia. This will help identify children as early as possible and allow them access to services appropriate to their needs.”

In evaluating children with autism, speech-language pathologists should rule out apraxia of speech. In requesting services or evaluations for their children, parents should also consider the intelligibility of any language the child may produce.

This post was authored by Stephanie Millman-Dorsch, ASF’s Community Relations Manager. Stephanie is a Master’s of Science Candidate in Communicative Sciences and Disorders at NYU, expecting to graduate this December.

NB: Dr. Mayes, who co-authored the study, is the primary developer of the CASD

(1) CASD: Mayes, S. (2015). Checklist for Autism Spectrum Discorder (CASD). Retrieved October 23, 2015.

(2) Tierney, C., Mayes, S., Lohs, S. R., Black, A., Gisin, E., & Veglia, M. (2015). How Valid Is the Checklist for Autism Spectrum Disorder When a Child Has Apraxia of Speech?. Journal of Developmental & Behavioral Pediatrics36(8), 569-574.

(3) DSM-5: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

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