Pay No Attention to the Man Behind the Curtain…

June 19, 2012

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Guest blogger & TACA Physician Advisory Member:  Dr. Cindy Schneider

You remember it…the scene in The Wizard of Oz where Dorothy returns with the ruby red slippers and requests an audience with the Wizard, only to find that he isn’t a wizard at all, he’s a short pudgy fraud bellowing “Pay no attention to the man behind the curtain.”

I had flashbacks of that scene when I read a recent study “Differences in White Matter Fiber Tract Development Present from 6 to 24 Months in Infants with Autism”, published in this month’s issue of the American Journal of Psychiatry. [1] It’s an important and informative paper, but not for the reasons you might think. The investigators in this study followed 92 infant siblings of children with autism from 6 to 24 months of age.  The development of white matter fiber tracts was assessed with an MRI technique known as diffusion tensor imaging.  All children underwent imaging studies at 6 months and psychological testing at 24 months.  Most had diffusion tensor imaging again at 12 or 24 months of age.  At 24 months, 28 of the infants met the diagnostic criteria for an autism spectrum disorder.  I majored in biology, not math, but I’m pretty sure that 28 out of 92 children developing autism is not the recurrence rate I’ve heard thrown around.

In the 1990’s, when my son and daughter were diagnosed with autism, we were told that the risk of a younger sibling developing autism when one child in the family was diagnosed was 5-9%.  At the time, having two children in one family was almost unheard of—an anomaly that baffled the physicians and psychologists who diagnosed them.  More recently, the recurrence rate of 20% has been reported.[2]

Again, my math is weak, but I’m getting 30.4% when I divide 28 by 92.  White matter changes are important.  The entire paper is important.  But let’s talk about the man behind the curtain, shall we?  Over 30% of the younger siblings of children with autism developed an autism spectrum disorder by 24 months of age.  This finding is staggering.

There was no discussion whatsoever about this finding.  Did any more develop autism by 36 months, the age cut-off for diagnosis?  How many will develop ADD, dyslexia, learning disabilities, seizures, or multiple food allergies?  We will probably never know.

I mean no disrespect to the authors.  We need more autism research of all kinds, including prospective neuroimaging studies like this one.  I am only hoping that there is more data to be reported in future papers.  Did they measure cytokines and other markers of inflammation?  Did they record the frequency of ear infections and gastrointestinal symptoms, family history of autoimmune diseases and cancer, or details about the rates of vaccination in children who did develop autism versus those who did not?  Have any of the authors done diffusion tensor imaging in children who have recovered from autism?  I should probably just click my heels three times and go home.

Cindy Schneider, MD

Medical Director

Center for Autism Research and Education


[1] Wolff JJ, Hongbin G, Guido F, Elison J, Styner M, Gouttard S, Botteron KN, Dager SR, Dawson G, Estes AM, Evans AC, Hazlett HC, Kostopoulos P, McKinstry RC, Paterson SJ, Schultz RT, Zwaigenbaum L, and Piven J.  Differences in white matter fiber tract developmentpresent from 6 to 24 months ininfants with autism.  Am J Psychiatry 2012; 169:589-600.

[2] Kogan MD, Blumberg SJ, Schieve LA, Boyle CA, Perrin JM, Ghandour RM, Singh GK, Strickland BB, Trevathan E, Can Dyck PC.  Prevalence of parent-reported diagnosis of autism spectrum disorder amoung children in the US. 2007.  Pediatrics 2009’ 124”1396-1403.