Six Developmental Trajectories Characterize Children With Autism

The goal of this study was to describe the typical longitudinal developmental trajectories of social and communication functioning in children with autism and to determine the correlates of these trajectories

Medical school gift restriction policies and physician prescribing of newly marketed psychotropic medications: difference-in-differences analysis

Objective: To examine the effect of attending a medical school with an active policy on restricting gifts from representatives of pharmaceutical and device industries on subsequent prescribing behavior. Design: Difference-in-differences approach. Setting: 14 US medical schools with an active gift restriction policy in place by 2004. Participants: Prescribing patterns in 2008 and 2009 of physicians attending one of the schools compared with physicians graduating from the same schools before the implementation of the policy, as well as a set of contemporary matched controls. Main outcome measure: Probability that a physician would prescribe a newly marketed medication over existing alternatives of three psychotropic classes: lisdexamfetamine among stimulants, paliperidone among antipsychotics, and desvenlafaxine among antidepressants. None of these medications represented radical breakthroughs in their respective classes. Results: For two of the three medications examined, attending a medical school with an active gift restriction policy was associated with reduced prescribing of the newly marketed drug. Physicians who attended a medical school with an active conflict of interest policy were less likely to prescribe lisdexamfetamine over older stimulants (adjusted odds ratio 0.44, 95% confidence interval 0.22 to 0.88; P=0.02) and paliperidone over older antipsychotics (0.25, 0.07 to 0.85; P=0.03). A significant effect was not observed for desvenlafaxine (1.54, 0.79 to 3.03; P=0.20). Among cohorts of students who had a longer exposure to the policy or were exposed to more stringent policies, prescribing rates were further reduced. Conclusion: Exposure to a gift restriction policy during medical school was associated with reduced prescribing of two out of three newly introduced psychotropic medications

Spatial clusters of autism births and diagnoses point to contextual drivers of increased prevalence

Autism prevalence has risen dramatically over the past two decades in California. Although often suggested to have been crucial to the rise of autism, environmental and social contextual drivers of diagnosis have not been extensively examined. Identifying the spatial patterning of autism cases at birth and at diagnosis can help clarify which contextual drivers are affecting autism's rising prevalence. Children with autism not co-morbid with mental retardation served by the California Department of Developmental Services during the period 1992–2005 were matched to California's Birth Master Files. We search for spatial clusters of autism at time of birth and at time of diagnosis using a spatial scan approach that controls for key individual-level risk factors. We then test whether indicators of neighborhood-level diagnostic resources are associated with the diagnostic clusters and assess the extent of clustering by autism symptom severity through a multivariate scan. Finally, we test whether children who move into neighborhoods with higher levels of resources are more likely to receive an autism diagnosis relative to those who do not move with regard to resources. Significant birth and diagnostic clusters of autism are observed independent of key individual-level risk factors. While the clusters overlap, there is a strong positive association between the diagnostic clusters and neighborhood-level diagnostic resources. In addition, children with autism who are higher functioning are more likely to be diagnosed within a cluster than children with autism who are lower functioning. Most importantly, children who move into a neighborhood with more diagnostic resources than their previous residence are more likely to subsequently receive an autism diagnosis than children whose neighborhood resources do not change. We identify birth and diagnostic clusters of autism in California that are independent of individual-level autism risk factors. Our findings implicate a causal relationship between neighborhood-level diagnostic resources and spatial patterns of autism incidence but do not rule out the possibility that environmental toxicants have also contributed to autism risk

The Population Level Impacts of Differential Fertility Behavior of Parents of Children with Autism

Drawing on population level data of exceptional quality (including detailed diagnostic information on the autism status of sibling pairs of over 3 million different mothers), this study confirms that stoppage is the average fertility response to a child born with autism, thereby reducing observed concordance in sibling pairs and leading to potentially biased estimation of genetic contributions to autism etiology. Using a counterfactual framework and applying matching techniques we show, however, that this average effect is composed of very different responses to suspicion of autism depending on birth cohort, the character of the disorder (severe versus less severe), the gender of the child, poverty status, and parental education. This study also sheds light on when parents suspect autism. We find that parents’ fertility behavior changes relative to matched controls very early after the birth of a child who will later be diagnosed with autism

Can Sibling Sex Ratios Be Used as a Valid Test for the Prenatal Androgen Hypothesis of Autism Spectrum Disorders?

Sibling sex ratios have been applied as an indirect test of a hypothesized association between prenatal testosterone levels and risk for autism, a developmental disorder disproportionately affecting males. Differences in sibling sex ratios between those with and without autism would provide evidence of a shared risk factor for autism and offspring sex. Conclusions related to prenatal testosterone, however, require additional assumptions. Here, we used directed acyclic graphs (DAGs) to clarify the elements required for a valid test of the hypothesis that sibling sex ratios differ between children with and without autism. We then conducted such a test using a large, population-based sample of children

Patterned remittances enhance women’s health-related autonomy

The consequences for women “left behind” by virtue of temporary male migration are known to be mixed. On one hand, concomitant changes in fertility, female labor force participation, and social norms are often associated with increased independence for women. On the other hand, women left behind can be vulnerable to increased dependency on members of their husbands’ family, or face limited access to social institutions. These shifts in women’s capacity for decision-making can have important implications for their health and well-being. Focusing on the state of Kerala in southern India, we examine the conditions under which the remittances that migrants send home have an impact on the health of women left behind. Specifically, we assess the extent to which the timing of remittance sending can support women’s autonomy, and hence improve their autonomous healthcare decision-making and mobility to health facilities. We use evidence from migrant households in Kerala, a region deeply engrained in the world labor migration system for over five decades. Analysis is conducted with representative household survey data from the 2016 wave of the Kerala Migration Study (KMS), and paired with in-depth qualitative interviews with women in Kerala whose husbands and other family members have migrated to the Gulf. We show that the positive effect of remittances on women’s autonomy manifests primarily through the timing of remittance receipt, not the amount of money remitted. Those who receive regular remittances experience more gains in autonomy, as compared to those receiving remittances at irregular intervals, net of amount remitted. This finding challenges the usual emphasis on remittance volume as the driving factor of social and behavioral change in sending communities. Analytical efforts should be refocused on the social-interactional component of remittance sending, and how these interactions can impact women’s health and autonomy

Cohort effects explain the increase in autism diagnosis among children born from 1992 to 2003 in California

The incidence and prevalence of autism have dramatically increased over the last 20 years. Decomposition of autism incidence rates into age, period and cohort effects disentangle underlying domains of causal factors linked to time trends. We estimate an age-period-cohort effect model for autism diagnostic incidence overall and by level of functioning

Wake transition in the flow around two circular cylinders in staggered arrangements

Accepted versio