A behavioral update by Rayyan Anwer, MD FAAP

The recent CDC report from March of 2023 on the rates of Autism must alert the whole country to the astronomical rise of childhood developmental changes and challenges.

Per the report, the prevalence of Autism has increased from 1 in 150 in 2020 to 1 in 44 in 2018.

Two years later, data from 2020 showed a prevalence of 1 in 36, and this data does not even encompass the true effect of the COVID years. (https://www.cdc.gov/mmwr/volumes/72/ss/ss7202a1.htm?s_cid=ss7202a1_w)

On the ground now, we are seeing a much higher prevalence rate.Research has shown us that the causes of Autism are multifactorial. This means that it is a combination of genetic factors and environmental factors. To help us understand what that means, let us use the example of some cancers that might run in families and how carcinogens (substances or exposures that increase the risk of cancer) can drastically increase the risk of that particular individual in the family getting cancer.

It is important to understand that Austim being a vast spectrum in itself, is part of a larger spectrum called “Neurodivergence.” This umbrella term refers to brain development or function that does not necessarily follow the normative path of brain development or function. Examples of these brain types include ADHD, Dyslexia, OCD, Tic disorders, Sensory Processing Disorders, Anxiety, and other learning disorders. These disorders are not mutually exclusive and frequently coexist. Often these brain types can be highly gifted in certain areas while having significant challenges in others. It is important not to stigmatize these brain types, as they are all part of the beautiful tapestry of human brain diversity.  Each brain is unique, and getting the right therapy and help for these individuals’ unique challenges is extremely necessary. It is interesting to note that the prevalence of ADHD far outnumbers the prevalence of Autism. Most forms of Autism also have ADHD, but not necessarily the other way around. Additionally, we see a significant rise in ADHD with “sprinkles” of Autistic features.

Although much more research is needed to assess risk factors for Autism during pregnancy, we do have mounting research on what can cause significant derangements in healthy brain development early on.

I like to use the term neuro-damaging vs neuro-protective. (if we use the cancer analogy: like carcinogens and anti-oxidants)

Babies learn by watching faces and lips and by touching and feeling.Amongst other factors, quality human interaction is very neuro-protective, but there is more detail to it. Modeling positive and appropriately graded responses to babies’ expressions is key, according to a study that analyzed EEG patterns in infants based on caregiver interactions (Swingler et al., 2017). Other significant neuro-protective exposures include building routines, especially around protecting sleep, a healthy diet (minimizing regular consumption of sugar-sweetened foods and highly processed foods and prioritizing foods rich in nutrients and omega-3 fatty acids), age-appropriate time in nature or outdoor activities, and age-appropriate sport or exercise routines.

The major neuro-damaging factors (aside from outright negligence and abuse) can be summarized into hyperstimulation, addiction, and derangements in sleep. Screen time may be the most significant neuro-damaging factor that combines hyperstimulation, addiction, and derangements in sleep.  We know that this leads to challenges in emotional regulation (the ability to regulate emotional responses to change or the lack of it), challenges in modulating and learning social interaction, mindfulness, empathy, and executive function (the ability to analyze, process and organize behavior, or “stop and think before doing”).  These are key features of ADHD and in most forms of Autism.

Adding to the list of studies associated with the matter is a new study published in JAMA this year (Radesky et al., 2023), showing a significant link between the frequent use of mobile devices for calming young children and its adverse effects on learning emotion-regulation.

In my view, this continues to cement the idea that using screen time to distract a child during a stressful situation subverts their ability to process stress and, with caregiver support, learn to mitigate that stress healthily.

Poor development in emotional regulation, in combination with other factors like poor development in social interactions, is an extensive setup for depressive symptoms and mood dysregulation later on.

This segways to another startling report by the CDC on teen mental health that calls for urgent action: “Record high levels of violence, sadness, and suicide risk in our teens,” especially in teen girls at a rate double that of teen boys.

Per the CDC, in 2021, 57% of teen girls felt persistently sad or hopeless, up from 36% in 2011.

The article mentions other very troubling statistics that are too hard for me to present in this article, but I urge every parent to review it. (https://www.cdc.gov/media/releases/2023/p0213-yrbs.html)

My intention in these updates is not to present all doom and gloom but rather an urgent call to action in spreading awareness and advocating for our youth.

Citations:

https://www.cdc.gov/mmwr/volumes/72/ss/ss7202a1.htm?s_cid=ss7202a1_w

https://www.cdc.gov/media/releases/2023/p0213-yrbs.html

Swingler MM, Perry NB, Calkins SD, Bell MA. Maternal behavior predicts infant neurophysiological and behavioral attention processes in the first year. Dev Psychol. 2017 Jan;53(1):13-27. Doi: 10.1037/dev0000187. Epub 2016 Aug 8. PMID: 27505693; PMCID: PMC5191916.

Radesky JS, Kaciroti N, Weeks HM, Schaller A, Miller AL. Longitudinal Associations Between Use of Mobile Devices for Calming and Emotional Reactivity and Executive Functioning in Children Aged 3 to 5 Years. JAMA Pediatr. 2023 Jan 1;177(1):62-70. doi: 10.1001/jamapediatrics.2022.4793. PMID: 36508199; PMCID: PMC9857453.