Young children with common ear, nose, and throat (ENT) disorders may have an increased risk of autism or higher levels of detectable autistic symptoms, according to a study published online in the open-access journal BMJ Open. Early detection and treatment of ENT conditions can improve the quality of life in these children and potentially help shed light on some of the origins of autism, the researchers say.
The causes of autism may involve an interaction of genetic, environmental, and biological factors, and the origin of each autistic symptom may be different, the researchers note.
Previous research suggests that ENT conditions, such as ear infections, ‘glue ear’, and sleep breathing, may play a role in the development of autism. But much of this evidence is based on health records, which may have biased these findings, because parents of children with suspected autism may be more likely than other parents to seek medical help for their children, the researchers say.
To avoid this, researchers drew on participants in the 90s Longitudinal Study of Children, also known as the Avon Longitudinal Study of Parents and Children (ALSPAC). It has tracked the health of more than 14,000 children since birth and the health of their parents since the early 1990s.
The current study is based on extensive data for more than 10,000 young children who were closely monitored during their first 4 years.
Their mothers completed 3 questionnaires when their children were 18, 30, and 42 months old, designed to record the frequency of 9 different signs and symptoms related to ear, nose, and throat as well as hearing problems.
They also completed 3 questionnaires when their children were about 3, about 6, and about 9 years old. These were designed to identify speech coherence, social and communication problems, repetitive and abnormal behavior, and sociability, which are characteristics of autism. Autism diagnoses were confirmed from educational records and parental feedback, among other sources.
Adjustments were made for 10 potentially influential ‘environmental’ factors: early or late birth; sex; the number of the mother’s previous pregnancies resulting in live or stillbirth; Breast milk; postpartum depression; mother’s educational achievements; maternal smoking at 18 weeks of pregnancy; mother’s belief in her own agency; Infant exposure to environmental tobacco smoke at 15 months; Child’s attendance at creche/other daycare at 30 months of age.
In all, 177 children had a probable diagnosis of autism: 139 boys and 38 girls. Those with autism symptoms were defined as the 10% of the sample with the highest trait scores.
Mouth breathing, snoring, ear pulling or plucking, ear redness and pain, hearing worse when cold, and rarely hearing were all associated with higher scores on each of the 4 autism symptoms in general, and with diagnosis. Autism.
Purulent or sticky discharge from the ears was also associated with autism and poor coherent speech.
At the different ages tested, the strongest associations were observed especially when the child was 30 and 42 months old. Children with higher scores on autistic symptoms at 30 months had more ENT symptoms. Autism itself was significantly associated with all symptoms except symptoms of sleep apnea (obstructed breathing during sleep).
10 Factoring in environmental features made little difference to the results. For example, children with ear discharge were more than 3 times more likely to develop autism, while children with hearing loss during colds were more than twice as likely to develop it. And children who failed to respond to nearby sounds were six times more likely to develop autism at this age.
However, the researchers point out: ** “These ENT signs and symptoms are very common in childhood and the majority of children who experience them are not diagnosed with autism. For example, in a cohort of nearly 1700 children who snore at age 30 months, most (1660) were not diagnosed with autism. .”
The researchers acknowledge several limitations, including the loss of some children to subsequent follow-up, as is the case with any longitudinal study, and the lack of ethnic diversity among the participants’ children in the 90s, limiting the broad applicability of the findings.
What’s more, the children were not consistently tested to determine a diagnosis of autism; Instead, a strategy of evaluating the probability of diagnosis using different sources was used.
But they concluded that the associations they found “may be important because (1) these ear and breathing signs may be early signs of increased risk for autism, (2) they may inform the origins of autism, or (3) they may highlight . co-existing conditions that, if treated, can improve the quality of life of children with autism.”
They add: “This study adds to the evidence that, compared with the general population of the same age, early ear and upper respiratory symptoms are more common in individuals with later autism or extreme levels of autistic symptoms.”
But they warn: “It is not possible to determine whether these ENT conditions have a causal role in the development of autistic symptoms or are related to an unmeasured factor.
“One possibility, for example, may be the result of an increased prevalence of minor anatomical anomalies in individuals with autism, including anatomical differences in ear structure and/or position, such differences in ear morphology increase the risk of ENT conditions.”
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