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In This Issue of JAMA
April 21, 2015


Author Affiliations

Copyright 2015 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA. 2015;313(15):1491-1493. doi:10.1001/jama.2014.11693
Child Health

Edited by Jody W. Zylke, MD


Disruptive behaviors such as tantrums, noncompliance, aggression, and self-injury are common among children with autism spectrum disorder (ASD). In a randomized trial involving 180 children aged 3 to 7 years who had ASD and disruptive behavioral problems, Bearss and colleagues found that parent training—providing specific techniques to manage disruptive behaviors and reinforce positive behaviors—was more effective than parent education—information about autism but not behavior management strategies—in reducing parents’ reports of disruptive behaviors.


Continuing Medical Education

Extensive research has found no link between the measles-mumps-rubella (MMR) vaccine and autism spectrum disorders (ASD); however, beliefs that the MMR vaccine causes autism persist. In an analysis of administrative claims data from 95 227 children with older siblings and continuous health plan enrollment from birth to at least age 5 years, Jain and colleagues found that receipt of the MMR vaccine was not associated with an increased risk of ASD whether or not older siblings had ASD. In an Editorial, King discusses several studies assessing risk factors for ASD and the importance of support for ASD-affected families.


Author Video Interview

Autoantibodies to insulin are among the first to appear in children who develop type 1 diabetes. In a randomized trial that enrolled 25 children who tested negative for insulin autoantibodies and who were genetically susceptible to type 1 diabetes, Bonifacio and colleagues found that daily administration of oral insulin (67.5 mg/d), compared with placebo, resulted in an immune response to insulin without hypoglycemia. In an Editorial, Skyler discusses immune regulation for prevention of type 1 diabetes.


Author Audio Interview

Wiskott-Aldrich syndrome—a rare primary immunodeficiency syndrome caused by loss-of-function mutations in the WAS gene—is associated with severe thrombocytopenia, eczema, and opportunistic infections. Hacein-Bey Abina and colleagues report outcomes following gene-corrected autologous hematopoietic stem cell transplantation in 7 patients with severe Wiskott-Aldrich syndrome. In an Editorial, Malech and Ochs discuss progress toward clinically beneficial gene therapy.


Clinical Review & Education

An article in JAMA Pediatrics reported that orphaned Romanian infants who were removed from institutional-care settings and placed in high-quality foster care had more normative white matter development at age 8 years than their peers who were randomly chosen to remain in the institution. In this From The JAMA Network article, Boyce discusses implications of findings from the Bucharest Early Intervention Project.

A 15-year-old girl had increasing right shin pain of 4 weeks’ duration that began when she started to play competitive basketball. Focal tenderness was present along the distal mid shaft of the tibia anteriorly. A single-leg hop elicited severe pain. Radiographs were obtained. What would you do next?

This Medical Letter on Drugs and Therapeutics article provides summary information regarding the MiniMed 530G insulin pump, which, when used in combination with a continuous glucose monitoring sensor, can stop delivery of insulin when interstitial glucose reaches a prespecified low level. In 2 clinical trials (one with 247 adolescents and adults; the other, 95 adults and children) use of the sensor-augmented insulin pump with the threshold-suspend feature was associated with reduced frequency of nocturnal hypoglycemic events.