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This Month in Archives of Pediatrics and Adolescent Medicine
April 2007

This Month in Archives of Pediatrics & Adolescent Medicine

Arch Pediatr Adolesc Med. 2007;161(4):322. doi:10.1001/archpedi.161.4.322

The Lifetime Distribution of the Incremental Societal Costs of Autism

Little is known about the societal costs of autism at different points in the life cycle. This study used cross-sectional data from different age groups to estimate the direct medical, direct nonmedical, and the indirect (lost productivity) costs associated with autism. The lifetime incremental societal cost of autism is $3.2 million per affected person, approximately $35 billion dollars for an entire birth cohort. Direct medical costs are highest in the first 5 years of life, while direct nonmedical and indirect costs peak around 25 years of age. Direct medical care costs account for less than 10% of the total expenditures; lost productivity and adult care make up the largest components of the costs.

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Early Social-Communicative and Cognitive Development of Younger Siblings of Children With Autism Spectrum Disorders

While twin and family studies support a strong genetic basis for autism, little is known about the possible range of phenotypic findings in siblings of children with autism spectrum disorders (ASDs). Stone and colleagues compared younger siblings of children with ASD with the siblings of normally developing children. At 12 to 24 months of age, siblings of children with ASD had lower mean cognitive scores and had fewer social-communicative behaviors. While the majority of children of siblings with ASD had few or no signs of autism symptomatology, more than one third had scores on some measures that were in the at-risk range. The weaker performance found for children in the ASD sibling group may represent early-emerging features of the broader autism phenotype.

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Prenatal and Perinatal Risk Factors for Autism: A Review and Integration of Findings

This systematic review found a number of important risk factors for autism. The relative risk of autism associated with advanced paternal age was 1.6 to 5.8, with 1 study reporting a 2-fold increase in risk of autism spectrum disorder (ASD) for every 10-year increase in paternal age. The risk associated with advanced maternal age ranged from 1.5 to 3.4. Being small for gestational age and prematurity were found in some studies to significantly increase the risk of ASD. Hypoxia-related obstetrical complications and fetal hypoxia may increase the risk of autism.

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A Prospective Study of Response to Name in Infants at Risk for Autism

Early identification of autism offers the possibility of early intervention, which holds promise for improving the outcomes of children with autism. This study investigated the tendency to respond to one's name in infants at risk of autism spectrum disorder compared with those with no known increased risk. At 6 months of age, 80% of infants not at risk, but only 64% of at-risk infants, responded on the first or second call of their name. At 12 months, all control infants, but 86% of at-risk infants, responded to 1 or 2 calls of their name. Only 50% of the at-risk infants responded appropriately at both 6 and 12 months of age. The sensitivity of response to the calling of one’s name at 2 months for any developmental delay at 24 months was 39%, with a specificity of 94%. Children who fail to respond to their name at 12 months warrant further developmental evaluation.

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