Thursday, 19 December 2013

Autism in the Somali population in Minneapolis

I see that the report from Amy Hewitt and colleagues* (open-access) providing results from The Minneapolis Somali Autism Spectrum Disorder Prevalence Project has been published and has started to generate some media interest (see here).
Gondereshe @ Warya @ Wikipedia 

The long-and-short if it was that based on some concerns that children of Somali origin seemed to be over-represented when it came to a diagnosis of an autism spectrum condition, otherwise known as 'otismo' among some in the Somali community, the research wheels were set in motion in the City of Minneapolis to see if there were indeed disparities in the numbers of children presenting with autism. The project was "expanded" above and beyond just asking about prevalence of autism in Somali children vs. non-Somali children to importantly include other questions; not least: "Were children with ASD and of Somali descent more likely to have intellectual disability than children with ASD who were not of Somali descent?" I was particularly interested in the intellectual disability (ID) issue in light of other research suggesting that there may indeed be an over-representation of ID alongside autism in migrant children from countries of the African continent or with a low 'human development index' (see here and more recently here).

Without trying to simply plagiarise the Hewitt report, there are a few key findings worthy of comment.

  • Bearing in mind how researchers collected information about autism - screening and reviewing health records - from a total population numbering above 12,000 7-9 year olds in 2010, the autism prevalence rate in Minneapolis was estimated to be 1 in 48 children. This figure covered all children irrespective of any ethnicity differences.
  • Specifically looking at children of Somali origin, 31 children out of a total of 1007 children were judged to be on the autism spectrum equating to a prevalence of 1 in 32 children. Nearly half of the Somali children identified as being on the autism spectrum were done so via inspection of a combination of school and health records (48%).
  • Within the range of other ethnic groupings examined, 120 out of a total of 4,336 white children were also judged to be on the autism spectrum, making a prevalence estimate of 1 in 36 children.
  • Just as important, all the Somali children with autism were reported to have some degree of ID (this being ascertained as an IQ level below 70).
  • The average age at diagnosis for Somali children was 5.3 years, exceeding all other ethnic groups and above the overall mean age at diagnosis of 4.9 years.

There's not too much more to add to those factoids aside from the need for quite a bit more research into this area given the data indicating that almost 1 child in every classroom aged between 7-9 years old will potentially present as being on the autism spectrum. The fact that Somali children, and indeed white children, presented with prevalence estimates of autism above that of other ethnic groups potentially offers some clues as to where research might next head in terms of genetics, epigenetics and even environmental differences tied into such categorisations. I've speculated before about the possibility of something like a vitamin D link** given the differences in sun exposure between Somalia and the City of Minneapolis, but I dare say the whole thing is going to be a lot more complicated than just this one potential precipitating factor.

It's also interesting to note that the Hewitt report includes some mention of 'interventions' for autism, and quite prominently, the use of 'dietary and nutritional interventions'. Although the authors are right to be wary and sceptical of the effectiveness of any 'universal' intervention for autism (sorry the autisms), it got me wondering whether this was given such prominence specifically because of the chatter about such an intervention including the horror that is a GFCF diet, or whether there may be some differences in the effectiveness of such interventions with an ethnic slant? I might add I'm not talking about 'eating right for your blood type' or anything like that but there is always the example of ethnicity and lactose intolerance and its potential link to cases of autism for example. Food for thought anyway.

Whatever your interpretation of the Hewitt report, there are important practical lessons to be learned in terms of screening, diagnosis and the provision of services for those children diagnosed with autism whether of Somali origin or any other ethnic group. And once again, parents of children with autism were a primary driving force behind getting this research done and bringing it into the public arena...

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* Hewitt A, Gulaid A, Hamre K, Esler A, Punyko J, Reichle J. & Reiff M. (2013). Minneapolis Somali autism spectrum disorder prevalence project: Community report 2013. Minneapolis, MN: University of Minnesota,  Institute on Community Integration, Research and Training Center on Community Living

** Fernell E. et al. Serum levels of 25-hydroxyvitamin D in mothers of Swedish and of Somali origin who have children with and without autism. Acta Paediatr. 2010 May;99(5):743-7. 

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ResearchBlogging.org Fernell E, Barnevik-Olsson M, Bågenholm G, Gillberg C, Gustafsson S, & Sääf M (2010). Serum levels of 25-hydroxyvitamin D in mothers of Swedish and of Somali origin who have children with and without autism. Acta paediatrica (Oslo, Norway : 1992), 99 (5), 743-7 PMID: 20219032