AAAP Today

Dear Reader:

Fourth line from bottom of BACKGROUND paragraph should read:

"Thus, in the search for non-genetic factors (genetic factors are considered the main predictors of autism risk), antidepressant treatment during pregnancy was examined as a possible environmental factor influencing autism risk."

My apologies for the error.

Lirio Sobrevinas-Covey

Does Antidepressant Use During Pregnancy Increase The Risk Of Autism In Offspring?

By Lirio Sobrevinas-Covey, Ph.D.

​Recent findings:

1. From a recent population based large sample in Sweden (1):

§ Yes, antidepressant use during pregnancy increased the risk of ASD in children.

§ The risk occurred in ASD offspring without intellectual disability.

§ No increased risk was found in offspring with ASD with intellectual disability.

2. From an ongoing population-registered base in Quebec (2):

§ Yes, the risk for ASD was higher in offspring of mothers who used SSRIs (selective serotonin reuptake inhibitors​)​ during the second or third trimester of pregnancy.

§ The risk persisted after controlling for the effect of maternal depression.

COMMENT: A causal interpretation, that is, that antidepressant use causes autism in offspring cannot be inferred from these early data. Further, the risk that antidepressant use influenced the autism is estimated at less than 1%. The finding that the phenomenon was observed primarily in ASD offspring without intellectual disability suggests that the risk affects ASD persons previously

​diagnosed ​
as having Asperger’s syndrome. A possible implication is that a certain portion of cases of ASD could be prevented if antidepressants were not used during pregnancy.

BACKGROUND: A history of depression, one of the more prevalent psychiatric conditions, has been considered a possible risk factor for autism. Depression is a condition that is responsive to medication treatment (in addition to behavioral therapy). SSRIs (selective serotonergic reuptake inhibitor drugs), because of their demonstrated efficacy and safety, are a widely used treatment for depression. Serotonin has been shown to play a critical role in fetal brain development, thus, concerns have been raised regarding the manipulation of serotonin levels, a neurotransmitter which crosses the placental barrier, when taken by pregnant mothers. Thus, in the search for non-genetic factors (considered the main predictors of autism risk), antidepressant treatment during pregnancy was examined as a possible environmental factor influencing autism risk.

Of interest, the use of antidepressants during pregnancy has increased in the last several decades, parallel in some way to the rise in the incidence of autism in those years. The clinical dilemma therefore is whether to treat depression or not during pregnancy with SSRIs (or any other antidepressant). Existing research is limited. The mechanisms underlying the observed associations are unclear. Because depression during pregnancy by itself has been found to increase the risk for autism, non-pharmacological measures treatments should be considered. Understanding prenatal factors such as medication of mothers’ conditions during pregnancy could identify modifiable targets for preventing the incidence of ASD.

1. Dheeraj R, Lee BK, Dalman C, et al, British Medical Journal, 2013, Apr 19; 346

2. Boukhris T, Sheehy O, Mottron L, Bérard A, JAMA Pediatr. 2015 Dec 14:1-8.

Excerpts from “I Am Not Broken”
By : Eric Garcia
National Journal, 9 Dec 2015

PSY­CHI­AT­RIST EU­GEN BLEULER first used the word “aut­ism” in 1910; he viewed it as a symp­tom of schizo­phrenia.

Thirty-three years later, a child psy­chi­at­rist at Johns Hop­kins Uni­versity Hos­pit­al named LEO KANNER in­tro­duced his work on early in­fant­ile aut­ism. His first ma­jor study on the sub­ject was based on ob­ser­va­tions of 11 chil­dren—eight of them verbal and three of them what he called “mute.” He found that all the chil­dren had strong in­tel­lec­tu­al ca­pa­city and “ex­cel­lent rote memory,” which en­abled them to mem­or­ize things like a French lul­laby, Psalm 23, or an in­dex page of an en­cyc­lo­pe­dia.

But he also noted that when they formed sen­tences, these sen­tences were par­roted re­pe­ti­tions of pre­vi­ously heard word com­bin­a­tions. Loud noises and mov­ing ob­jects, he found, caused the chil­dren great dis­tress. In ad­di­tion, he noted that “the child’s be­ha­vi­or is gov­erned by an anxiously ob­sess­ive de­sire for same­ness.”

Around the same time, an­oth­er doc­for—HANS ASPERGER was conduct­ing his own work across the At­lantic in Vi­enna, on what he called “aut­ist­ic psy­cho­pathy.” In a 1944 study, As­per­ger no­ticed pat­terns in the boys he ob­served, in­clud­ing “a lack of em­pathy, little abil­ity to form friend­ships, one-sided con­ver­sa­tion, in­tense ab­sorp­tion in a spe­cial in­terest, and clumsy move­ments.”

As­per­ger saw “aut­ist­ic psy­cho­pathy” as something that oc­curred across a wide vari­ety of people. By con­trast, ac­cord­ing to Steve Sil­ber­man, au­thor of Neur­o­tribes: The Leg­acy of Aut­ism and the Fu­ture of Neurodi­versity, Kan­ner saw aut­ism as a very rare form of child psy­chos­is and “framed his pa­tients as a strictly defined and mono­lith­ic group, to the point of be­ing will­ing to over­look sig­ni­fic­ant dif­fer­ences between them.”

Dur­ing the last leg of World War II, a school As­per­ger had opened for chil­dren with “aut­ist­ic psy­cho­pathy” was bombed, des­troy­ing much of his re­search. As­per­ger con­tin­ued work­ing after the war and lived un­til 1980, but much of his writ­ing went un­trans­lated from its ori­gin­al Ger­man.

Then, in 1981, LORNA WING, a doc­tor work­ing in the United King­dom and the moth­er of a daugh­ter with aut­ism, used As­per­ger’s 1944 study—which “had nev­er been trans­lated in­to Eng­lish,” ac­cord­ing to Sil­ber­man—as the basis for her own study, “As­per­ger Syn­drome: A Clin­ic­al Ac­count.” Wing’s work was in­stru­ment­al in shap­ing dis­cus­sions about the aut­ism spec­trum.

Here in the United States, the Amer­ic­an Psy­chi­at­ric As­so­ci­ation did not have sep­ar­ate cri­ter­ia for dia­gnos­ing “in­fant­ile aut­ism” in the Dia­gnost­ic and Stat­ist­ic­al Manu­al of Men­tal Dis­orders un­til 1980; and it wasn’t un­til 1987, that there was an ex­pan­ded dia­gnos­is for “aut­ist­ic dis­order.”