Infant screen media and child development: A prospective community study.

The current study examined longitudinal associations between early screen media exposure (assessed at 6, 12, and 24 months) and the child's motor and language/communication development at the ages of 24 and 36 months. We also aimed to study whether these associations varied by socioeconomic status (SES). Participants were 179 parent-infant dyads, recruited from well-baby clinic services during routine visits. Child development measures included standardized measures of developmental milestones as assessed by professionals and referral data to child developmental centers. Both measures were retrieved from the official health maintenance organization records by an expert in child development. Results indicated that screen exposure at 6 and 12 months was associated with a higher risk for language/communication deficits at 36 months in children with moderate or high SES but not in children with low SES. Our findings are consistent with existing literature demonstrating cross-sectional and longitudinal associations between early screen exposure and language development deficits. Given that media use practices and motivations vary among families from different backgrounds, further investigation of the interaction between SES and screen exposure is needed.

Maternal Thyroid Anomalies and Attention-Deficit Hyperactivity Disorder in Progeny.

Previous epidemiologic investigations suggested that maternal thyroid anomalies are a possible causal factor in attention-deficit hyperactivity disorder (ADHD) in progeny, yet clinical trials indicated that levothyroxine treatment was ineffective in preventing neurodevelopmental impairments. We used an Israeli cohort of 385,542 singleton births from 1999-2012 to explore the interrelated roles of maternal thyroid conditions, laboratory gestational thyroid hormone measurements, use of thyroid medications, and offspring ADHD. Analyses were performed using Cox proportional hazards models. Results indicated that maternal hypothyroidism diagnosis was associated with an elevated progeny ADHD hazard (adjusted hazard ratio = 1.14, 95% confidence interval = 1.10, 1.18). However, this association was unmitigated by gestational use of levothyroxine and was unexplained by maternal gestational thyroid hormone levels. Associations with gestational thyrotropin values and hypothyroxinemia were also observed but were robust only in mothers without other records indicative of a thyroid problem. Results indicated that maternal thyroid hypofunction was associated with progeny ADHD but possibly not due to a direct causal relationship. Instead, maternal thyroid hypofunction may serve as a proxy indicator for other factors that affect neurodevelopment through thyroid hormone independent pathways, which are thus unaffected by pharmaceutical treatments for thyroid hypofunction. Factors known to disrupt thyroid functioning should be examined for their independent ADHD-related effects.

Associations of Maternal Androgen-Related Conditions With Risk of Autism Spectrum Disorder in Progeny and Mediation by Cardiovascular, Metabolic, and Fertility Factors.

Fetal exposure to elevated androgens is thought to contribute to autism spectrum disorder (ASD) risk. However, data rely heavily on in utero androgens measurements, which also reflect fetal secretions. Thus, in utero hyperandrogenemia might indicate adverse autism-related neurogenesis that has already occurred affecting fetal androgen homeostasis, rather than being a cause of the disorder. Associations between maternal androgen-related conditions and ASD could more directly implicate androgens' etiological role. We examined the association between maternal hyperandrogenemia-related conditions, focusing primarily on polycystic ovarian syndrome (PCOS), and progeny ASD, in an Israeli cohort of 437,222 children born in 1999-2013. Odds ratios and 95% confidence intervals were estimated using generalized estimating equations. Multiple mediation analyses using natural effect models were conducted to evaluate combined mediation of the PCOS effect by androgen-related cardiovascular, metabolic, and fertility factors. Results indicated that children of mothers with PCOS had higher ASD odds compared with children of mothers without PCOS (odds ratio = 1.42, 95% confidence interval: 1.24,1.64), and this effect was only partly mediated by the factors considered. Elevated odds were also observed for other hyperandrogenemia-related conditions. Findings provide support for direct involvement of maternal hyperandrogenemia in ASD etiology. Alternatively, findings might reflect shared genetic and/or environmental factors independently affecting maternal androgen homeostasis and fetal neurodevelopment.

Diagnosis despite clinical ambiguity: physicians' perspectives on the rise in Autism Spectrum disorder incidence.

BACKGROUND: To provide insight on physicians' perspectives concerning recent changes in the incidence and diagnostic process of Autism Spectrum Disorder (ASD) compared to other mental and neurodevelopmental disorders. METHOD: A questionnaire was sent to 191 specialists in child neurology and child development, and 200 child psychiatrists in Israel. Information was collected on professional background, as well as on physicians' opinions concerning the accuracy and rate of ASD diagnosis compared to that of cerebral palsy (CP), mental illness, and Attention Deficit Hyperactivity Disorder (ADHD). For each closed-ended question, a global chi-square test for categorical variables was performed. RESULTS: 115 (60.2%) of specialists in child neurology and development, and 59 (29.5%) of child psychiatrists responded. Most physicians (67.2%) indicated that there was a moderate/significant increase in the incidence of ASD, which was higher than similar responses provided for CP (2.9%, p < 0.01) and mental illnesses (14.4%, p < 0.01), and similar to responses provided for ADHD (70.1%, p = 0.56). 52.8% of physicians believed that in more than 10% of clinical assessments, an ASD diagnosis was given despite an inconclusive evaluation (CP: 8.6%, p < 0.01; mental illnesses: 25.8%, p = 0.03; ADHD: 68.4%, p = 0.03). CONCLUSION: The clinicians perceive both ASD and ADHD as over-diagnosed disorders. The shared symptomology between ASD and other disorders, coupled with heightened awareness and public de-stigmatization of ASD and with the availability of ASD-specific services that are not accessible to children diagnosed with other conditions, might lead clinicians to over-diagnose ASD. It is advisable to adopt an approach in which eligibility for treatments is conditional on function, rather than solely on a diagnosis. The medical community should strive for accurate diagnoses and a continuous review of diagnostic criteria.

Maternal Thyroid Disorders and Risk of Autism Spectrum Disorder in Progeny.

BACKGROUND: Maternal thyroid dysfunction is suspected of causing adverse neurodevelopmental effects, but current evidence is inconclusive. Epidemiologic investigations generally suggest an association between maternal thyroid dysfunction and neurodevelopment impairments in progeny, but clinical trials of thyroid treatment during pregnancy reported null effects. To better understand these discrepant findings, we evaluated the association between maternal thyroid conditions and autism spectrum disorder (ASD), including examining the role of gestational thyroid-related hormone concentrations and thyroid medications use. METHODS: Analyses considered 437,222 singleton live births occurring in a large Israeli health fund in 1999-2013, followed through 2016. Thyroid conditions and ASD cases were identified through International Classification of Diseases-9 codes with subsequent validation through review of medical records. Laboratory gestational thyroid hormone measurements were also considered. RESULTS: Children of mothers who ever experienced hypothyroidism had a higher risk of ASD compared with children of mothers without hypothyroidism (adjusted odds ratio [aOR] = 1.26, 95% confidence interval [CI] = 1.12, 1.42). The association with hyperthyroidism was less consistent, but elevated in main analyses (aOR = 1.42, 95% CI = 1.04, 1.94). These associations were not explained by maternal gestational thyroid hormones levels nor mitigated by gestational use of thyroid medications. CONCLUSIONS: Results indicate that maternal thyroid conditions are associated with increased ASD risk in progeny, but suggestively not due to direct effects of thyroid hormones. Instead, factors that influence maternal thyroid function could have etiologic roles in ASD through pathways independent of maternal gestational thyroid hormones and thus be unaffected by medication treatment. Factors known to disrupt thyroid function should be examined for possible involvement in ASD etiology.

Postnatal steroid therapy is associated with autism spectrum disorder in children and adolescents of very low birth weight infants.

BACKGROUND: This study evaluates the association between major neonatal morbidities and autism spectrum disorder (ASD) in children and adolescents born of very low birth weight (VLBW). METHODS: Historical cohort study using the Israel national VLBW infant database linked with the Maccabi Healthcare Services (MHS) medical records. The study cohort comprised 4963 VLBW subjects born from 1999 to 2012, >1 year of age. Multivariable logistic regression analyses were used to assess factors associated with ASD. RESULTS: The diagnosis of ASD was confirmed in 113 children (2.3%). Infants with major neonatal morbidities had higher rates of ASD; however, in the multivariable analyses these were not significantly associated with ASD: severe intraventricular hemorrhage (OR 1.21 [95% CI 0.60-2.45]), post-hemorrhagic hydrocephalus (OR 1.77 [0.73-4.29]), periventricular leukomalacia (OR 1.02 [0.42-2.51]), severe retinopathy of prematurity (OR 1.91 [0.995-3.67]), and bronchopulmonary dysplasia (OR 1.44 [0.84-2.45]). Postnatal steroid therapy when included separately was associated with an OR of 1.97 [1.18-3.29] for ASD. This association remained significant when postnatal steroid therapy was included with each of the neonatal morbidities (ORs ranging from 1.91 to 2.11). CONCLUSIONS: This study suggests a significant association between postnatal steroid therapy and ASD in VLBW infants. This possible association should be considered in future studies evaluating potential risk factors for ASD in preterm infants.

Congenital Abnormalities of the Male Reproductive System and Risk of Autism Spectrum Disorders.

Androgens have an extensive influence on brain development in regions of the brain that are relevant for autism spectrum disorder (ASD), yet their etiological involvement remains unclear. Hypospadias (abnormal positioning of the urethral opening) and cryptorchidism (undescended testes) are 2 relatively common male birth defects that are strongly associated with prenatal androgen deficiencies. Having either disorder is a proxy indicator of atypical gestational androgen exposure, yet the association between these disorders and autism has not been extensively studied. We analyzed male singleton live births (n = 224,598) occurring from January 1, 1999, through December 31, 2013, in a large Israeli health-care organization. Boys with autism, cryptorchidism, and hypospadias were identified via International Classification of Diseases, Ninth Revision, codes, with further verification of autism case status by review of medical records. In multivariable-adjusted analyses, the odds ratio for ASD among boys with either condition was 1.62 (95% confidence interval (CI): 1.44, 1.82). The odds ratio for boys with cryptorchidism only was 1.55 (95% CI: 1.34, 1.78), and that for boys with hypospadias only was 1.65 (95% CI: 1.38, 1.98). ASD risk was not elevated among unaffected brothers of hypospadias or cryptorchidism cases, despite familial aggregation of all 3 conditions, providing some indication for the possibility of pregnancy-specific risk factors driving the observed associations. Results suggest that in-utero hypoandrogenicity could play a role in ASD etiology.

Challenges in defining the rates of ADHD diagnosis and treatment: trends over the last decade.

BACKGROUND: There is a global trend of large increases in the prevalence and incidence of Attention Deficit Hyperactivity Disorder (ADHD). This study aimed to address potential causes of these major changes. METHODS: The authors used a large cohort to analyze data employing patients' electronic medical records, with physicians' diagnosis of ADHD, including records of medication purchases. RESULTS: The prevalence of ADHD diagnoses rose twofold from 6.8% to 14.4% between 2005 and 2014 (p < 0.001), while the ratio of males to females with ADHD decreased from 2.94 in 2005 to 1.86 in 2014 (p < 0.001). The incidence increased, peaking in 2011 before declining in 2014. ADHD medication usage by children and adolescents was 3.57% in 2005 and 8.51% by 2014 (p < 0.001). CONCLUSIONS: We report a dramatic increase in the rate of ADHD diagnoses. One of the leading factors to which we attribute this increase is the physicians' and parents' changed attitude towards diagnosing attention/hyperactivity problems, with more parents appear to consider ADHD diagnosis and treatment as a means to improve their child's academic achievements, commonly with the aid of medications. This change in attitude may also be associated with the dramatic increase in female ADHD diagnosis prevalence.

Late diagnosis of autism spectrum disorder-Journey, parents' concerns, and sex influences.

Despite increasing awareness for diagnosing autism spectrum disorder (ASD) and initiating treatments early in life, many children and adolescents continue to be diagnosed at a relatively older age. Focusing on children who first received an ASD diagnosis at age six or older, this study aimed to describe the symptoms that parents reported when ASD was diagnosed, follow the patients' clinical trajectory prior to receiving the diagnosis, and describe differences in symptoms and prior diagnoses between males and females cases. We included 258 children (205 males and 53 females) who were first diagnosed with autism at age 6-18 in 2017-2018. We retrieved demographic information, neurologic and developmental symptoms, diagnoses, and medications dispensing history from the children's electronic medical charts. The data indicated that prior diagnoses of language delays and attention deficit hyperactivity disorder were common among children with a late ASD diagnosis. Two thirds of the children were prescribed one or more medications to treat psychosocial and behavioral conditions before receiving a late ASD diagnosis. Difficulties in social relationships with peers were the leading reported symptoms by parents at the time of ASD diagnosis. Across these different domains, some differences were found between males and females, including a somewhat higher cognitive level in males, who were also more likely to present aggressive behavior.

Primary School Children's Self-Reports of Attention Deficit Hyperactivity Disorder-Related Symptoms and Their Associations With Subjective and Objective Measures of Attention Deficit Hyperactivity Disorder.

BACKGROUND: The diagnosis of Attention deficit hyperactivity disorder (ADHD) is primarily dependent on parents' and teachers' reports, while children's own perspectives on their difficulties and strengths are often overlooked. GOAL: To further increase our insight into children's ability to reliably report about their ADHD-related symptoms, the current study examined the associations between children's self-reports, parents' and teachers' reports, and standardized continuous performance test (CPT) data. We also examined whether the addition of children's perceptions of ADHD-symptoms to parents' and teachers' reports would be reflected by objective and standardized data. METHODS: The study included 190 children with ADHD, aged 7-10 years, who were referred to a pediatric neurologic clinic. A retrospective analysis was conducted using records of a clinical database. Obtained data included children's self-reports of their attention level and ADHD-related symptoms, parent, and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and CPT scores. RESULTS: Children's self-evaluations of their functioning were globally associated with their teachers' and parents' evaluations, but not uniquely. Children's self-reports of ADHD symptoms were not uniquely linked to a specific CPT impairment index, but to a general likelihood of having an impaired CPT. The CPT performance successfully distinguished between the group of children who defined themselves as inattentive and those who did not. CONCLUSION: Primary school children with ADHD are able to identify their limitations and needs difficulties and that their perspectives should inform clinical practice and research. The clinical and ethical imperative of taking children's perspectives into account during ADHD diagnosis and treatment is highlighted.

Maternal mobile phone use during mother-child interactions interferes with the process of establishing joint attention.

Parental mobile device use while parenting has been associated with reduced parental responsiveness and increased negative affect among children. However, it remains unclear whether it can interfere with the process of acquiring social communication skills. Thus, this study sought to experimentally examine whether maternal mobile phone use while interacting with the child has an immediate effect on the frequency of mothers' and infants' joint attention (JA) behaviors, the likelihood that these behaviors will lead to JA episodes, and the duration of established JA episodes. Participants were a community sample of 114 (Mage = 11.36 months; 50% male) Israeli typically developing infants, in which most mothers were highly educated and living in two-parent families. Mother-infant dyads completed a modified still-face paradigm and were randomly assigned to one of three experimental conditions during the still-face phase: (a) mobile phone disruptions, (b) social disruptions, and (c) undisrupted play. Mother-infant interactions were coded for frequency of JA behaviors and duration of JA episodes. In dyads assigned to the mobile phone disruptions condition, infants produced more JA initiations, mothers were less likely to contingently respond to infant initiations, JA behaviors were less likely to result in established JA, and JA episodes were shorter compared to dyads in the two control conditions and the baseline free play phase. Findings suggest that maternal mobile phone use during face-to-face interactions with the infant can disrupt the process of establishing JA in ongoing mother-child interactions. Possible implications from this line of work for family digital media use are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

[Developmental outcome of fetal macrocephaly and associated syndromes].

Macrocephaly is defined as an enlargement of the head circumference above the 98th percentile or greater than two standard deviations above the mean normalized for age and gender. The diagnosis of enlarged head circumference can be made by ultrasound, during pregnancy. This condition may be caused by enlargement of any of the head's compartments. When resulting from excessive brain tissue, the condition is defined as megalencephaly. Macrocephaly can be associated with many genetic disorders. Emphasis is placed on its outcome. Although the literature concerning macrocephaly and its neurodevelopmental features is vast, there is no general consensus concerning its outcome. Several studies claim macrocephaly is usually a benign, familial condition without any clinical significance, while others claim an association between macrocephaly and learning and attention difficulties, visuo-motor problems and expressive and receptive deficits. Based on these reports, concerning macrocephaly identified in utero, doctors find it difficult to assess prognosis and provide clear guidelines for parents.

Age-Specific Time Trends in Incidence Rates of Autism Spectrum Disorder Following Adaptation of DSM-5 and Other ASD-Related Regulatory Changes in Israel.

We analyzed data on 879,029 children born in 1999-2017 from a large Israeli health fund to evaluate time-trends in incidence of autism spectrum disorder (ASD). This included examining possible effects associated with the adaptation of the DSM-5 criteria for ASD, and the implementation of regulatory changes affecting eligibility for ASD-related stipends and services. ASD cases were ascertained based on electronic medical records review, with complete verification of ASD case status. Results indicated a substantial increase in ASD incidence rate (IR) over time that was overall not appreciably affected by the above changes. Cumulative incidence through age 8 rose from 0.46% (boys: 0.73; girls: 0.18) in 2007 to 1.30% (boys: 2.12; girls: 0.45) in 2018. Age-specific analyzes indicated that the largest increase in IR occurred in toddlers and preschool children, with a more modest increase at older age groups. Results suggest that the rise in early diagnosed ASD does not stem from a downward shift in the distribution of ages at first diagnosis, but rather from early detection of cases not previously diagnosed. Findings highlight the need to expand research aimed at identifying exogenous factors that may underlie the rise in incidence, and to evaluate factors that may contribute to late diagnosis of some cases. Autism Res 2020, 13: 1893-1901. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: In an analysis of nearly 900,000 Israeli children born in 1999-2017, we found that the incidence of autism spectrum disorder (ASD) increased significantly over time, especially among toddlers and preschool children but also at older age groups. We additionally observed that changes affecting diagnostic criteria for ASD and eligibility for ASD-related services did not appreciably affect these trends. Results highlight the need to continue research aimed at identifying factors causing this increase and reasons contributing to late diagnosis of some cases.

An amphiphilic, PK/PBAN analog is a selective pheromonotropic antagonist that penetrates the cuticle of a heliothine insect.

A linear pyrokinin (PK)/pheromone biosynthesis activating neuropeptide (PBAN) antagonist lead (RYF[dF]PRLa) was structurally modified to impart amphiphilic properties to enhance its ability to transmigrate the hydrophobic cuticle of noctuid moth species and yet retain aqueous solubility in the hemolymph to reach target PK/PBAN receptors within the internal insect environment. The resulting novel PK/PBAN analog, Hex-Suc-A[dF]PRLa (PPK-AA), was synthesized and evaluated as an antagonist in a pheromonotropic assay in Heliothis peltigera against 4 natural PK/PBAN peptide elicitors (PBAN; pheromonotropin, PT; myotropin, MT; leucopyrokinin, LPK) and in a melanotropic assay in Spodoptera littoralis against 3 natural PK/PBAN peptide elicitors (PBAN, PT, LPK). The analog proved to be a potent and efficacious inhibitor of sex pheromone biosynthesis elicited by PBAN (84% at 100 pmol) and PT (54% at 100 pmol), but not by MT and LPK. PPK-AA is a selective pure antagonist (i.e., does not exhibit any agonistic activity) as it failed to inhibit melanization elicited by any of the natural PK/PBAN peptides. The analog was shown to transmigrate isolated cuticle dissected from adult female Heliothis virescens moths to a high extent of 25-30% (130-150 pmol), representing physiologically significant quantities. PPK-AA represents a significant addition to the arsenal of tools available to arthropod endocrinologists studying the endogenous mechanisms of PK/PBAN regulated processes, and a prototype for the development of environmentally friendly pest management agents capable of disrupting the critical process of reproduction.

Biostable beta-amino acid PK/PBAN analogs: agonist and antagonist properties.

The pyrokinin/pheromone biosynthesis activating neuropeptide (PK/PBAN) family plays a significant role in a multifunctional array of important physiological processes in insects. PK/PBAN analogs incorporating beta-amino acids were synthesized and evaluated in a pheromonotropic assay in Heliothis peltigera, a melanotropic assay in Spodoptera littoralis, a pupariation assay in Neobellieria bullata, and a hindgut contractile assay in Leucophaea maderae. Two analogs (PK-betaA-1 and PK-betaA-4) demonstrate greatly enhanced resistance to the peptidases neprilysin and angiotensin converting enzyme that are shown to degrade the natural peptides. Despite the changes to the PK core, analog PK-betaA-4 represents a biostable, non-selective agonist in all four bioassays, essentially matching the potency of a natural PK in pupariation assay. Analog PK-betaA-2 is a potent agonist in the melanotropic assay, demonstrating full efficacy at 1pmol. In some cases, the structural changes imparted to the analogs modify the physiological responses. Analog PK-betaA-3 is a non-selective agonist in all four bioassays. The analog PK-betaA-1 shows greater selectivity than parent PK peptides; it is virtually inactive in the pupariation assay and represents a biostable antagonist in the pheromonotropic and melanotropic assays, without the significant agonism of the parent hexapeptide. These analogs provide new, and in some cases, biostable tools to endocrinologists studying similarities and differences in the mechanisms of the variety of PK/PBAN mediated physiological processes. They also may provide leads in the development of PK/PBAN-based, insect-specific pest management agents.

Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children.

Attention deficit hyperactivity disorder (ADHD), one of the most prevalent childhood disorders today, is generally more likely to be diagnosed and treated in boys than in girls. However, gender differences in ADHD are currently poorly understood, partly because previous research included only a limited proportion of girls and relied mainly on subjective measures of ADHD, which are highly vulnerable to reporter's bias. To further examine gender differences in ADHD and to address some of the shortcomings of previous studies, this study examined gender differences in subjective and objective measures of ADHD among clinic-referred children with ADHD. Participants were 204 children aged 6-17 years-old with ADHD (129 boys, 75 girls). A retrospective analysis was conducted using records of a clinical database. Obtained data included parent and teacher forms of the Conners ADHD rating scales, Child Behavior Checklist (CBCL), Teacher's Report Form (TRF), and child's continuous performance test (CPT) scores. Results showed that according to parents' and teachers' reports of ADHD-related symptoms (Conners ADHD rating scales), girls had more inattention problems than boys, but no differences were identified in the level of hyperactivity and impulsivity symptoms. CPT data, however, revealed higher impulsivity among boys. We did not find gender differences in the level of distractibility during CPT performance. Specifically, the effects of distractors type (visual environmental stimuli, auditory stimuli, or a combination of them) and distractors load (one or two distracting stimuli at a time) on CPT performance did not differ between boys and girls with ADHD. These findings suggest that gender effects on ADHD symptoms may differ between subjective and objective measures. Understanding gender differences in ADHD may lead to improved identification of girls with the disorder, helping to reduce the gender gap in diagnosis and treatment.

Screen Media and Autism Spectrum Disorder: A Systematic Literature Review.

OBJECTIVE: Previous studies suggest that psychiatric disorders are associated with problematic use of screen media. This article systematically reviews the literature on the associations between screen media and autism spectrum disorder (ASD). The review uses the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHOD: Electronic databases were searched from inception to April 2018, using the term "ASD/autism" along with one of the following terms: "screen time"/"media"/"computer"/"phone"/"television"/"video game." RESULTS: A total of 16 studies met the inclusion criteria. The studies support the view that children and adolescents with ASD are exposed to more screen time than their typically developing peers or other clinical groups and that the exposure starts at a younger age. The content and context of screen use (e.g., with parents vs alone) may affect the behaviors associated with media exposure. Correlates and long-term consequences of early screen exposure (before the age of 3 years) remain largely unexamined. CONCLUSION: The current review provides important information about how ASD is associated with screen use and exposure. Future longitudinal research should examine the impact of early screen exposure on child development while accounting for potential moderating environmental factors (e.g., socioeconomic status, parent-child relationship). This will help determine whether-and if so, how much-exposure is detrimental and allow appropriate recommendations and interventions related to screen time among children with ASD.

High dose folic acid during pregnancy and the risk of autism; The birth order bias: A nested case-control study.

OBJECTIVE: To examine whether there is an association between the cumulative dose of folic acid (FA) purchased by mothers, and risk of autistic spectrum disorders (ASD) in their progeny. METHODS: We identified 2009 singletons who received an ASD diagnosis from a cohort of 480,526 children born in a large health organization in Israel from 2000 through 2013. ASD patients were individually matched to ASD-free children (n = 19,886). Median cumulative daily doses of supplemented FA during the 12-month period prior to the end of pregnancy (from dispensing records) were compared using conditional logistic regression models. RESULTS: Children with ASD were more likely to be first-born, and birth-order was significantly associated with FA use. In multivariable analysis, there were no statistically significant differences in the cumulative dose of FA between the groups. CONCLUSION: Birth order effects need to be accounted for in analyses aiming to decipher the associations between gestational FA use and developmental outcomes.

Deviations from Typical Developmental Trajectories Detectable at 9 Months of Age in Low Risk Children Later Diagnosed with Autism Spectrum Disorder.

This study was designed to track the developmental trajectory, during the first 24 months of life, of 335 low-risk infants later diagnosed with Autism Spectrum Disorder and identify early deviations observed in routine Well Care checkups. We compared their achievements to typically developing children and to children later diagnosed with non-autistic developmental impairments. The results show that in the first 6 months, the children with autism showed normal acquisition of milestones, whereas by 9 months of age they began to fail the language/communication, as well as motor items when compared to typical and delayed non-autistic children. Regular check-up visits may be useful in detecting early failure in achieving milestones, leading to earlier referral for further evaluation and treatment.

The role of cellular phone usage by parents in the increase in ASD occurrence: A hypothetical framework.

Over the last few decades there has been a significant worldwide increase in the diagnosis of autism spectrum disorder (ASD), the causes of which are unknown. The biggest environmental change over this decade has been the massive introduction of cellphones. Eye contact is fundamental for infants' development, and parent-infant eye contact is impaired when parents are pre occupied by cellphones. We speculate that children with a pre-existing vulnerability to autism may be adversely affected by this pattern of parental behavior. As a first step toward exploring our hypothesis, we wished to document the extent of cellular phone usage by parents during their child's diagnostic developmental assessment. We speculated that, if under these stressful circumstances of awaiting their child's crucial assessment the parent is not fully engaged with his/her child, then in real daily activities this phenomenon is likely much more pronounced. Of 111 developmental sessions, 73 parents (66%) engaged their phone during the assessment, between 1 and 20 times. Of 62 observations in the waiting room, 52 (83.9%) parents used their phone, 1-19 times. Nine parents (17.3%) used their phone for 10-50% of the time and 16 (30.8%) for more than 50% of the time in the waiting room. In our analysis, the rate of language/motor delays was twice more common among children of cell phone users than among non users (p = 0.04) as an initial support of our hypothesis. Parents' focus and full attention toward their cellphones can adversely affect the development of joint attention in infants and may contribute to the development of autistic features among a vulnerable subgroup of infants. While more research is needed to prove causation, it would be reasonable to advise parents to decrease to minimum the usage of cellphones when interacting with their young children.