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Kennedy Krieger Institute: Study Finds Fever May Lead to Improved Behavior in Children with Autism Spectrum Disorders
Can fever lessen symptoms of autism? A new study published in Pediatrics aimed to find out, inspired by anecdotes from parents and clinicians of behavioral improvements during fever in people with autism.
Reported improvements include increases in alertness, decreases in self-stimulatory behavior, and for some, more coherent language. The new study, funded by Cure Autism Now (CAN), marks the first attempt to systematically document such a “fever effect” in children with autism.
Primarily the work of Laura Curran, Ph.D., at the Johns Hopkins Bloomberg School of Public Health in Baltimore, MD, the study obtained parent responses to the “Aberrant Behavior Checklist” for 30 children with autism during a fever (100.4°F or higher), just after a fever, and when the child had been fever-free for seven days. Most children (83%) showed fewer aberrant behaviors during a fever. This was indicated by lower scores in at least one of the subcategories of the checklist, which includes irritability, hyperactivity, stereotypy, and inappropriate speech. Strikingly, a majority of the children (53%) showed more dramatic improvements, with lower scores in at least three subcategories. Unfortunately, all improvements were transient. The behavior scores during and after the fever also differed from scores obtained over a similar time course from age-, gender- and language skill-matched children with autism who did not have a fever; this suggests that the changes observed in the fever group were not due to day-to-day fluctuations in behavior sometimes seen in autism.
Because the reported improvements involved decreases in aberrant behaviors, the “fever effect” could be due to the lethargy that comes whenever one feels sick. Alternatively, fever might have a more specific effect on the nervous system, perhaps somehow changing the connections, or synapses, between neurons. This new study provided evidence for both possibilities.
“It gives hope that we might find causes and treatments for autism by studying synapses and how fever affects them,” said senior author of the study, Andrew Zimmerman, M.D., from the Kennedy Krieger Institute in Baltimore, MD.
To understand just how fever influences autistic behavior, future research will have to examine the behavior of sick children who do not develop a fever. If they do not show any improvements, then this would suggest a specific effect of fever beyond sickness-induced lethargy. In the meantime, the new study is significant because it advances the “fever effect” from anecdote to the realm of research, and it shows again how cooperation between parents, clinicians and scientists can yield important insights into the nature of autism.
Read a press release from the Kennedy Krieger Institute below.
Study Finds Fever may Lead to Improved Behavior in Children with Autism Spectrum Disorders
Kennedy Krieger Institute Research Confirms Parent and Physician
Reports that Children with Autism Spectrum Disorders Exhibit Fewer
Autistic-like Behaviors during Illness with Fever
BALTIMORE, Dec. 3 /PRNewswire-USNewswire/ — Over the past few decades,
parents and clinicians have observed that the behaviors of children with
autism spectrum disorders (ASD) tend to improve, sometimes rather
dramatically, during a fever. Longer concentration spans, increased
language production, improved eye contact and better overall relations with
adults and peers have all been reported. In a study published today in the
journal Pediatrics, researchers from the Kennedy Krieger Institute in
Baltimore, Maryland confirmed, for the first time, parent and clinician
reports that the behavior of children with ASD improves with fever. The
study evaluated children with ASD during and after an episode of fever and
found that fewer autistic-like behaviors were recorded for children with
fever compared to controls. Understanding how fever affects the behaviors
of children with ASD may provide insight into the causes of the disorder
and potential treatment opportunities.
In typically developing children, signals are constantly being sent
through pathways that connect the different regions of the brain and allow
them to communicate with one another. Research has shown that these
connections between brain regions are not made in children with autism,
which limits their ability to communicate and socialize. But, the rapid
behavioral changes observed with the onset of fever in children with ASD
suggest that the different regions of the brain are in fact capable of
connecting and communicating with one another, and that something about the
fever state triggers or speeds up the signaling between brain regions.
Understanding this “fever effect,” including why and how connections are
made between brain regions during a febrile (fever) state and not in an
afebrile (without fever) state in children with ASD may provide valuable
insight into the neurological basis of the disorder.
“Since autism spectrum disorders are behaviorally defined and
diagnosed, studying changes in behavior resulting from a wide range of
physiological changes is critical to increasing our understanding of this
complex group of disorders,” said Andrew Zimmerman, Director of Medical
Research at the Center for Autism and Related Disorders. at the Kennedy
Krieger Institute. “The results of this study are important because they
show us that the autistic brain is plastic, or capable of altering current
connections and forming new ones in response to different experiences or
Researchers evaluated 30 children with ASD, ages two to 18 years,
during and after an episode of fever (fever was defined as 100.4 degrees
F/38.0 degrees C or greater). Parents were asked to observe their child’s
actions and complete a standardized behavior questionnaire at three
different points: during fever; when the fever subsided and the child was
asymptomatic; and when the child was fever-free for seven days. These data
were compared to data collected from parents of 30 afebrile children with
ASD who made up the control group. Children in the control group were
matched to children in the fever group in terms of age, sex and language
skills. Results revealed fewer autistic-like behaviors for children with
fever compared to controls, with more than 80 percent of fever subjects
showing some behavioral improvements and approximately 30 percent
exhibiting dramatic improvements.
“Pilot research studies such as this provide clues about the underlying
metabolic changes in the brain that may prove to be targets for novel
autism therapies,” said Dr. Gary Goldstein, President and CEO of Kennedy
Krieger Institute. “These and other similar findings are shaping the future
direction of autism research.”
Further research involving a larger participant pool is needed to
better understand fever-specific effects in autism. In the future, Dr.
Zimmerman would like to collaborate with other research institutions to
study the underlying biologic mechanisms of fever-specific effects in
autism by conducting blood tests during and after fever and analyzing
immune measurements and hormonal changes in the blood. This research study
was the work of senior author Dr. Andrew Zimmerman of the Kennedy Krieger
Institute and the doctoral thesis of Laura Curran at Johns Hopkins
Bloomberg School of Public Health and the Kennedy Krieger Institute. The
study was funded by Cure Autism Now, which merged with the organization
Autism Speaks in 2007.
Pediatrics is an official peer-reviewed journal of the American Academy
of Pediatrics, publishing original research, clinical observations, and
special feature articles in the field of pediatrics. The journal has been
continuously published by the American Academy of Pediatrics since January
Autism spectrum disorders (ASD) is the nation’s fastest growing
developmental disorder, with current incidence rates estimated at 1 in 150
children. This year more children will be diagnosed with autism than AIDS,
diabetes and cancer combined, yet profound gaps remain in our understanding
of both the causes and cures of the disorder. Continued research and
education about developmental disruptions in individuals with ASD is
crucial, as early detection and intervention can lead to improved outcomes
in individuals with ASD.
About the Kennedy Krieger Institute
Internationally recognized for improving the lives of children and
adolescents with disorders and injuries of the brain and spinal cord, the
Kennedy Krieger Institute in Baltimore, MD serves more than 13,000
individuals each year through inpatient and outpatient clinics, home and
community services and school-based programs. Kennedy Krieger provides a
wide range of services for children with developmental concerns mild to
severe, and is home to a team of investigators who are contributing to the
understanding of how disorders develop while pioneering new interventions
and earlier diagnosis. For more information on Kennedy Krieger Institute,