Prenatal SSRI Use and Offspring With Autism Spectrum Disorder or Developmental Delay

Harrington, Rebecca A.; Lee, Li Ching; Crum, Rosa M.; Zimmerman, Andrew W.; Hertz‐Picciotto, Irva

doi:10.1542/peds.2013-3406

Cited by 164 publications

(172 citation statements)

References 42 publications

Supporting

Mentioning

163

Contrasting

Order By: Relevance

“…Some environmental factors may also contribute to the female protective effect [23]. Inuterine exposure to SSRIs [34] and steroids including progesterone and testosterone [35] are associated with greater autism likelihood amongst male children than female. Some evidence suggests higher maternal age at conception may increase likelihood of autism amongst males, but not females [36].…”

Section: Female Protective Effectmentioning

confidence: 99%

Protective Effect or Missed Diagnosis? Females with Autism Spectrum Disorder

Hull

Mandy

2017

Future Neurol.

View full text Add to dashboard Cite

Autism Spectrum Disorder (ASD) has historically been diagnosed more frequently in males than females. One explanation for this is the 'female protective effect': that there is something inherent in being female that makes girls and women less susceptible to ASD.Another possibility is that ASD is under-diagnosed in girls and women, due to the existence of a 'female autism phenotype', which is not well captured by current, male-biased diagnostic criteria. To evaluate the 'female protective effect' and 'female autism phenotype' hypotheses, this narrative review describes recent developments exploring the genetic underpinning and behavioural expression of ASD in females. We then look at ways to better identify females with ASD who may be missed under the current diagnostic criteria. KeywordsAutism, Autism Spectrum Disorders, Gender Differences, Sex Differences, Genetics, Diagnosis, Person-Environment Fit IntroductionAutism Spectrum Disorder (ASD) is a group of neurodevelopmental conditions characterised by deficits in social communication and reciprocity, and by restricted and repetitive interests and behaviours 1 . ASD is the current term used to integrate the previously separate diagnostic categories of autistic disorder, Asperger's disorder, childhood disintegrative disorder and pervasive developmental disorder -not otherwise specified (aka 'atypical autism' [2]). ASD is a lifelong condition that is present from birth. Although adult diagnosis is possible, symptoms must be reported as present from early developmental stages in order for the 1 In line with preferences from a majority of the autism community [1], we use identity-first language (e.g. 'autistic person') to refer to individuals with an ASD throughout this paper, while recognising that others might prefer person-first language (e.g. 'person with autism'). Gender differences in diagnosisASD affects approximately one to two per cent of the population [3,4], and is much more likely to be diagnosed in males than in females. Gender ratios in diagnosis vary depending on the country, cohort, and characteristics of those included, but average ratios are reported at around four males for every one female [3][4][5]. However, when looking at those individuals with intellectual disability, the male-to-female ratio narrows significantly to around two-toone [6]. In addition, population-based studies, which screen all participants in order to identify cases regardless of whether they have already been diagnosed by local services, suggest that the male-to-female ratio is closer to 3:1 [7,8]. This is in contrast to the average of around 4-5:1 generally reported in studies based on clinically-diagnosed cases [9]. The fact that a lower proportion of females are found in clinical samples than in community-based, epidemiological samples suggests that there is a bias against autistic girls and women coming to clinical attention. This bias may have existed from the very first conceptions of ASD; only 3 of 11 children in Kanner's original cases were female, and no gi...

show abstract

Section: Female Protective Effectmentioning

confidence: 99%

Protective Effect or Missed Diagnosis? Females with Autism Spectrum Disorder

Hull

Mandy

2017

Future Neurol.

View full text Add to dashboard Cite

show abstract

“…High serum levels of PCB's in banked second trimester maternal samples associated with an increased risk of autism (particularly so for PCB138/158 and PCB153 ) [107]. Prenatal use in the first trimester associated with autism development in boys [120]. Fluoxetine has also been shown to alleviate serious and pervasive repetitive behaviours in the clinic in later life [121] Psychoactive compounds are also environmental pollutants and mixtures can be found, at low concentrations, in drinking water.…”

Section: Polychlorinated Biphenyls (Pcb)mentioning

confidence: 99%

Autism genes are selectively targeted by environmental pollutants including pesticides, heavy metals, bisphenol A, phthalates and many others in food, cosmetics or household products

Carter

Blizard

2016

Neurochemistry International

View full text Add to dashboard Cite

“…The current data do not, on the whole, suggest that SSRI/ SNRIs are related to negative long-term neurobehavioral effects; children exposed to antidepressants have not consistently been found to differ on cognitive, motor, or behavioral outcomes relative to nonexposed controls. [67][68][69] Recently, some investigations have found an association between autism and prenatal antidepressant exposure, 70,71 while other large-scale studies have failed to detect such a connection. 72,73 Further research into this correlation is needed.…”

Section: Antidepressantsmentioning

confidence: 99%

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Misri

Abizadeh

Sanders

et al. 2015

Journal of Women's Health

113

View full text Add to dashboard Cite

Perinatal generalized anxiety disorder (GAD) has a high prevalence of 8.5%-10.5% during pregnancy and 4.4%-10.8% postpartum. Despite its attendant dysfunction in the patient, this potentially debilitating mental health condition is often underdiagnosed. This overview will provide guidance for clinicians in making timely diagnosis and managing symptoms appropriately. A significant barrier to the diagnosis of GAD in the perinatal population is difficulty in distinguishing normal versus pathological worry. Because a perinatal-specific screening tool for GAD is nonexistent, early identification, diagnosis and treatment is often compromised. The resultant maternal dysfunction can potentially impact mother-infant bonding and influence neurodevelopmental outcomes in the children. Comorbid occurrence of GAD and major depressive disorder changes the illness course and its treatment outcome. Psychoeducation is a key component in overcoming denial/stigma and facilitating successful intervention. Treatment strategies are contingent upon illness severity. Cognitive behavior therapy (CBT), relaxation, and mindfulness therapy are indicated for mild GAD. Moderate/severe illness requires pharmacotherapy and CBT, individually or in combination. No psychotropic medications are approved by the FDA or Health Canada in pregnancy or the postpartum; off-label pharmacological treatment is instituted only if the benefit of therapy outweighs its risk. SSRIs/SNRIs are the first-line treatment for anxiety disorders due to data supporting their efficacy and overall favorable side effect profile. Benzodiazepines are an option for short-term treatment. While research on atypical antipsychotics is evolving, some can be considered for severe manifestations where the response to antidepressants or benzodiazepines has been insufficient. A case example will illustrate the onset, clinical course, and treatment strategies of GAD through pregnancy and the postpartum.

show abstract

Prenatal SSRI Use and Offspring With Autism Spectrum Disorder or Developmental Delay

Cited by 164 publications

References 42 publications

Protective Effect or Missed Diagnosis? Females with Autism Spectrum Disorder

Protective Effect or Missed Diagnosis? Females with Autism Spectrum Disorder

Autism genes are selectively targeted by environmental pollutants including pesticides, heavy metals, bisphenol A, phthalates and many others in food, cosmetics or household products

Perinatal Generalized Anxiety Disorder: Assessment and Treatment

Contact Info

Product

Resources

About