Siblings of autistic kids also at risk

Siblings of kids with autism have a higher risk of being diagnosed with the disorder than previously believed, suggests a new study.

The analysis of more than 600 three-year-olds with an older autistic sibling found that almost one in five of them had an autism spectrum disorder, which includes Asperger's syndrome and similar conditions.

That suggests paediatricians need to keep an extra eye on those siblings, even as toddlers – because early interventions with therapy and extra support might help keep their symptoms to a minimum, researchers said.

"We know that the brain at young ages is more amenable to change," said study author Wendy Stone, of the University of Washington Autism Centre in Seattle.

Autism rates show no sign of decrease

"When children are showing signs of autism even before the diagnosis is official, we need to start thinking about how can we help parents within the course of their everyday activities to promote their child's social and emotional development," she said. The findings, she said, also show that autism rates probably aren't going to decrease anytime soon.

Previous studies estimated that between 3 and 14% of autistic kids' younger siblings also had the condition.

Stone and her colleagues had the advantage of a large data set of kids with autism and their siblings, including 664 sibling infants seen at 12 different institutions. They recruited the young siblings to the study when most were younger than six months old, before they showed any symptoms.

Boy siblings more likely to have autism

Around their third birthday, doctors tested each of those kids for signs of autism.

At that point, 132 of the siblings, or close to 20%, had developed an autism spectrum disorder, the researchers report in Pediatrics.

Kids who had multiple older autistic siblings were twice as likely to be diagnosed with autism as those with only one sibling with autism. As has been shown before, boy siblings were also about three times more likely than girls to have autism.

Researchers have long known that genes play a role in predisposing kids to autism, but it's clear that "genetics is not the whole story," Stone said – and there are still many unanswered questions about what causes the condition.

Guiding parents’ decision making

Keely Cheslack-Postava, an autism researcher from Columbia University in New York, said that the rate of autism in siblings may be higher now because the definition of who has an autism spectrum disorder has widened to include more kids.

Still, she said, “the one-in-five number for an individual family is somewhat limited in terms of exactly what this information means," she said.

Stone and her colleagues said that it's important that parents of an autistic child have access to genetic counselling if they're thinking of having another kid – but added that it's hard for doctors to evaluate each family's individual risk of having another autistic child.

What this does puts a much better estimate of risk in the hands of parents and clinicians, so hopefully that will help guide their decision-making more effectively, said Zachary Warren. He's the head of the Treatment and Research Institute for Autism Spectrum Disorders at the Vanderbilt Kennedy Centre in Nashville, Tennessee – one place where kids were recruited for the study.

More research needed into early intervention

Cheslack-Postava, who like Warren did not work on the new report, agreed with the authors that one of the key messages to come from the findings is the importance of early intervention for at-risk siblings.

"The most important public health implication of this higher observed recurrence risk is probably for awareness and attention to development in those children, in order to facilitate intervention as early as possible for children who could benefit from it," she said by email.

Researchers agreed that more work needs to be done to figure out what kinds of interventions might be most helpful for kids with the first signs of autism.

The research network is funded by Autism Speaks, an organisation that promotes awareness of autism and funds research into prevention and treatments.

(Reuters Health, August 2011)

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Asperger's syndrome

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