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February 14, 2022

Higher Risk of Mortality for Individuals Diagnosed With Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder Demands a Public Health Prevention Strategy

Author Affiliations
  • 1Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond
  • 2Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
JAMA Pediatr. 2022;176(4):e216398. doi:10.1001/jamapediatrics.2021.6398

In this issue of JAMA Pediatrics, Catalá-López et al1 report the findings of a systematic review and meta-analysis assessing the risk of mortality among persons with autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) and their first-degree relatives. The takeaway message is not subtle or nuanced, but clear, direct, and sobering—individuals with ASD or ADHD frequently die of preventable natural causes (eg, cardiac events) and unnatural causes (eg, unintentional injury, suicide). As such, this knowledge demands widespread recognition and the implementation of systematic screening and preventive approaches. Higher mortality rates have been documented in the field of ASD for longer than they have in the field of ADHD, owing to the well-established higher risks for drowning, pedestrian-auto crashes, suicide, seizure disorders, and other medical conditions associated with ASD that can lead to a shorter life expectancy.

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    1 Comment for this article
    Improved Sleep-Breathing Hygiene in Early Childhood: implications for better impulse control longer lifespan and healthspan
    Kevin Boyd, DDS(Peds),MSc (Nutrition) | Lurie Children's Hospital-Chicago; Depts. Dentistry (Clin. Instructor) and Sleep Medicine (Consultant); University of Pennsylvania Museum of Anthropology (Visiting Scholar)
    Recently published data from separate trials within The Dunedin Study Cohort(New Zealand) indicate that children with poor sleep hygiene were at risk for neuropsych. problems in later life(https://publications.aap.org/pediatrics/article-abstract/123/4/1171/71377/Sleep-Problems-in-Childhood-Predict?redirectedFrom=PDF);

    and, in an adjacent trial, children with better self-control behaviors when compared to other others before the age of 10-12 years old, aged more slowly when compared to kids who did not have good self-control(https://www.pnas.org/content/118/3/e2010211118).

    Furthermore, in another adjacent Dunedin trial it was concluded that kids with ASD actually aged more rapidly than did other age-matched kids without Dx:ASD (file:///Users/kevinboyd/Downloads/Trosman-Cognitive%20and%20Behavioral%20Consequences%20of%20Sleep%20Disordered%20Breathing%20in%20Children.pdf).

    I think these trends
    are interesting in light of what is now well understood about how many young kids with poor sleep and associated narrow jaws and compromised naso-respiratory competence, tend to have improved sleep, breathing and QOL after they have their little narrow palates expanded with a simple orthodontic expander (several references upon demand). Our team will soon be publishing data to support our hypothesis which posits: maxillary (palatal) expansion prior to the age of 72 months old in children with DX: maxillary transverse deficiency and co-morbid sleep disordered breathing traits, will show mitigation of both conditions; and some children even show improved neuropsychological behaviors coincidental to palatal expansion.