Tuesday, 6 September 2011

The inflammatory consequences of caring?

Another quickie post (yeah right!) this one based on a study which just entered my Twitter radar. Published in the journal Psychoneuroendocrinology, Brian Lovell and colleagues* from Northumbria University based here in the bracing North-East of England ask whether there might be any psychosocial, endocrine or immune consequences as a result of caring for a child with autism or ADHD. Their answer: yes but not necessarily as straight-forward as you might expect.

Lovell and colleagues compared 56 caregivers of children with autism or ADHD and 22 control parents on various psychometric measures of stress, social support, etc. Patterns of cortisol, a hormone released in response to stress were measured at various points throughout two weekdays, I assume to capture daily life when kids need to be woken, taken to school, brought home, catered for, bathed and put to bed (and all the things in-between). The proinflammatory markers of interleukin-6 (IL-6) and C-reactive protein (CRP) were also measured. IL-6 in particular has some history with autism.

The results. Caregivers of children with autism or ADHD reported more stress than controls. Nothing particularly novel there in light of other similar findings. Caregivers of children with autism or ADHD also reported less social support. No Nobel prize there either. When it came to cortisol levels though, no significant difference between the groups was found. So being a young or middle-aged parent of a child with autism or ADHD is physiologically about as stressful as raising any child according to this study. This might make some sense given that raising children, whether with autism or ADHD or not, delivers stress, period. Searching the literature however, other studies have reported differences in maternal cortisol levels associated with caring for an adolescent or adult with autism, indeed with many disabilties. Does this mean that parental stress increases as a child gets older? Or as parents age they are more likely to show the effects of stress? Who knows.

Looking also at measures of CRP, there was some reported difference in levels of this inflammatory marker between the groups; greater CRP levels in parents of children with autism or ADHD and more frequent episodes of physical ill-health.

There are two ways you can take a study like this. Perhaps the more negative way is the implication that raising children with autism or ADHD is such a stressful thing to do that parents are doomed to a life of a greater risk of inflammatory-based diseases. The other way of looking at the study and its results is to say yes, parents might be more susceptible to problems caused by a 'disinhibition of the inflammatory response', but to question whether this is because of raising a child with autism or ADHD, or something that was always present either coincidentally or potentially tied into some of the inflammatory findings comorbid to autism?

OK this is a relatively small study in terms of participants and requires larger replication before we get too ahead of ourselves. The CRP findings however are interesting, and as per the Medline Plus link here, potentially tie into lots of things including those related to the bowel and other connective tissue disorders. The elevated risk of some of these conditions associated with parents of children with autism has been discussed previously in the literature. I was also drawn to this article which suggests that rather than just being a marker for inflammation, CRP could [speculatively] also have the capacity to 'protect' against certain autoimmune diseases. I can't say more than that really.

As per the mantra of this blog in terms of fostering a welcoming society with appropriate support and opportunities for people with autism, papers like this one also suggest that society should be doing a little more for parents of children/adults with autism also. Within the multitude of guidance for autism, for identifying autism, for 'managing' autism, for enabling people with autism, how much guidance do we offer that the physical and psychological health of parents should also be catered for?

* Lovell B et al. The psychosocial, endocrine and immune consequences of caring for a child with autism or ADHD. Psychoneuroendocrinology. September 2011