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Thursday, 25 April 2013

Autism - a public health issue that deserves more than a societal autistic reaction.

CIHR recently reviewed many aspects of autism, a condition with more questions than answers, more puzzles than solutions. Why isn’t autism on the public health radar?  Why as a society do we show a lack of interest, avoid conversation and lack empathy?  - typical autistic symptoms. 

Despite 70 years of interest, it remains unclear whether the perceived increase in autism is related to actual increases in the disorder, or better diagnosis.  Certainly the condition has been the focus of growing public and scientific scrutiny, and the focus of many bogus claims.   Most notably the MMR allegations on which innumerable money has been spent and time wasted debunking. As measles ravages the UK where the antivaccination scam may have had one of its greatest impacts, innocent children are suffering consequences unrelated to the issue of autism  There have been allegations of association with increased radiofrequency exposure and with multiple chemical exposures.  More time has been spent on what it isn’t caused by than getting a better determination of what are the root causes (genetics is one). 

As such, the synthesis material available at Understanding autism CIHR  is a welcomed update on what deserves attention from public health professionals. 

While the site focuses on CIHR funded researches, the link to Cochrane reviews on group therapy, music therapy, extensive behavioural intervention and newer pharmacological approaches is reviewed.

Put in context, the US estimate of adequately caring for a child with autism is pegged at about $70,000.  Various provinces have funding allocations for children, some provinces the funding is more easily identified  such as BC (22K), Manitoba (20K), PEI (20 hrs/wk @13.18/hr ~ 14K).  The remaining provinces have much more complex funding models and rules.  An older parliamentary review from 2006 is still available for all provinces/territories at Parlimentary review

The match between funding and needs is subject to an Ontario audit currently Ontario audit  with no expected date of completion other than inclusion in the 2013 Auditor General’s report for the province.
At the heart of autism treatment controversy is the use of EIBI (Early Intensive Behaviour Intervention).  Referenced on the CIHR site is a Cochrane review, worth evaluating if you can access the paper Cochrane EIBI review  .  Only one randomized trial and four clinical trials were included in the review.  The RCT being one of a total of 28 children, each of the four clinical trials similarly with 41-44 children.  While few of the clinical studies demonstrated significant effects independently, combined in an additive metaanalysis there were reported benefits.  However, the metaanalysis excluded the RCT which had consistently demonstrated lower effect values in most measures. The Cochrane review does not justify its rationale for excluding the gold standard methodology and must be the only time Cochrane essentially excluded an RCT in favour of weaker methodologies.  (Cochrane notoriously dismissing methodologies other than RCT in its clinical reviews).

Now remember, this study forms the foundation on which we are spending hundreds of millions of dollars in Canada each year.

For such a profound and deeply distressing condition for families, our rudimentary knowledge and need for quality information should attract high quality epidemiological research and review.  

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