The New Frontier of Autism Research & Factors We Need to Consider | Dr. Karen Parker & Jim Kwik

So according to data from the World Health Organization, roughly 1 in 100 children worldwide has autism. According to the CDC, that number is approximately 1 in 36 in the US.

The average age of an autism diagnosis in the US is 4 years of age, and it's actually even higher in areas that are impoverished or lack medical specialists.

There are many potential There are many contributors for autism, including environmental and genetic factors. However, there is still very little information about the specifics.

It's a very poorly understood disorder.

And this might start to change slowly now that neuroscientists at Stanford University have proposed a new theory for a key driving force of autism.

We went and looked in spinal fluid to see if there were any molecules that might be different between people with autism What are some of the big obstacles that you're currently facing in autism research? Having a lab-based diagnostic test for autism would be fantastic.

What are the traditional early interventions or treatments currently for autism?

You know, we have a couple different options. So one is—

Welcome back, Kwik Brains. I am your host and your brain coach, Jim Kwik. Today we will be discussing the research behind autism and its potential contributors. Dr. Karen Parker directs the Social Neurosciences Research Program at Stanford University, which seeks to advance understanding of the biological basis of social functioning. She has committed her life to understanding and finding solutions to the challenges faced by children with autism and learning differences. In doing so, she's bringing hope to many. Welcome to the show, Dr. Parker.

Thank you. It's a pleasure to be here.

So this is a question or a topic, I would say, a subject matter That comes up in our community pretty frequently. People know in our community I take a very strength-based approach to be able to serve and support people of all ages and stages in life, and that our differences could be really a superpower. But what is autism and how is autism currently diagnosed?

So autism is what we would call like a spectrum condition. And, you know, if we think about it from a neurodiversity lens, there's a range of strengths and challenges associated with autism. And so autistic traits are sort of continuously distributed across the general human population. And if we think about the sort of tail end of the distribution where people can face challenges, autism is diagnosed. So the American Psychiatric Association has something called the DSM, which is the Diagnostic Statistical Manual of Mental Disorders, and it's in the 5th version now. And there are 2 main behavioral criteria by which clinicians diagnose autism, which is persistent social interaction challenges and the presence of restricted repetitive behaviors. And so the diagnosis for autism, unlike many other medical conditions, is purely behavioral. So we don't have a lab-based diagnostic test for autism. So you have to go into a trained specialist who uses those DSM criteria to make a diagnosis.

Okay, so currently there's not a lab-based diagnostic test, but there are behavioral considerations. And so is there an early age or a range that you start to—

Yeah, so autism can be reliably diagnosed by an expert clinician by about 2 years of age. And then I think if there's features that are more pronounced, you can get an earlier diagnosis. But one of the issues in the US is that because these specialists are needed and there's not enough of them, there's very long clinic wait times that could be a year and a half in some instances. And so even though we can reliably diagnose autism with these behavioral criteria, the average age of an autism diagnosis in the US is 4 years of age, and it's actually even higher in areas that are impoverished or lack medical And so most of the data say that if you want to intervene, you need to do it as early as possible. And so we're missing some of these critical brain development windows by having this delayed diagnosis.

I want to remind everyone who's listening that Dr. Parker, the show is not intended to diagnose or treat. This is, you talk to your qualified health practitioner. What are the traditional early interventions or treatments for currently for autism?

So currently what we have is there's, there's basically a couple, you know, we have a couple different options. So one is that there are behavioral therapies that are used to manage symptoms. So basically behavioral management therapies try to reinforce wanted behaviors and reduce unwanted behaviors. And many of them are based on applied behavioral analysis. And so that's one option that we have. And then the other option in terms of medications, there are no medications that treat these core behavioral features of autism. So right now the FDA is what approves medications and there are only 2 medications approved for the treatment of autism, which are antipsychotics, risperidone and aripiprazole. And they cause a lot of side effects like weight gain, sedation, and tremors. And they only target sort of secondary features like irritability, but they don't improve social abilities or they don't reduce restricted repetitive behaviors.

Okay, and I wanna dive into your research over at Stanford University.

Yeah.

What is the current understanding of causes before we go into your research? I find that there's very little information on the contributing factors for autism? Is there, is there a traditional understanding of it currently?

Yeah, I mean, so one thing about autism, there's a saying that if you've seen one person with autism, you've seen one person with autism. So it's what we would call the behavioral features are really variable. And so there's been a lot of work on the genetic causes of autism. And so there's been a bunch of what we would call autism susceptibility genes that have been identified that can contribute to autism. But if you have— and it's a pretty heritable disorder, meaning that it can kind of be in families. But even if you have identical twins, if it was 100% genetic, you would see that both identical twins would always have autism, and that's not the case. And so, although many— often they both do have autism. So there are some environmental factors that we don't understand very well at present. So it's a very poorly understood disorder.

So you lead a team of researchers at Stanford University and have recently proposed a new theory that could potentially change the way we decipher the contributing factors or causes of autism. Maybe we could elaborate on that.

Yeah, sure. So I started my career studying 2 molecules that are called vasopressin and oxytocin, and they're related molecules. So they're both what we call 9 amino acids, and they only differ by 2 amino acids. So like evolutionarily, they're very related, and they in every single animal ever studied are related to social behavior. And so I was doing work in animal models and thinking about how these molecules regulate social behavior in a lot of different species, including in people. And so then I got really interested in asking the question, well, if autism is characterized by one of the core features is social challenges, What if there's some dysregulation in these neuropeptides, or what if they're low? And so we could think about measuring them in people with autism. And so what we did was we've measured it in 2 different fluids. And so autism, as Jim, you know, is considered a brain disorder. And so most of the time people had been looking in blood samples because it's actually a lot easier to get blood than the fluid that I was most interested in, which is called cerebral spinal fluid, and that's what bathes the brain and the spinal column. And so if you're interested in sort of like a readout of the brain, you wanna look at the biochemistry that's closest to the organ of interest. And I was interested in spinal fluid because there's also neurological conditions where you can see biomarkers of disorders like Alzheimer's or multiple sclerosis. And a biomarker is simply something that can be measured that's associated with a condition or a disease state. Right? So I could give you an example. Like, if you think somebody has diabetes, you might measure their blood sugar. And so what we did was we went and looked in spinal fluid to see if there were any molecules that might be different between people with autism and people who didn't have autism.

I think a lot of listeners have heard of oxytocin, but maybe we could elaborate a little bit, make it a little bit more vivid in terms of oxytocin, vasopressin. What, with those molecules, how does that manifest in Maybe like social behaviors or—

What's really interesting is both oxytocin and vasopressin have roles in the body that were historically known for many decades. So oxytocin's involved in uterine contractions during labor, and then also in lactation. And then vasopressin has roles that really have nothing to do with social behavior, like measuring or sort of regulating blood pressure, regulating water balance in the body. And so oxytocin was first implicated in regulating maternal behavior. And then it was studied subsequently in bonding behavior between mates in prairie voles, for example. And what was interesting is that vasopressin was then, because it was related to oxytocin, it was also studied in the brain and work that was, I think, actually, so then oxytocin got all the love, I'll say. And what was interesting is there was some work done in voles in the early to mid-1990s showing that vasopressin was involved in male social behavior. And so why I got really interested in this was that autism is a male-biased disorder. So you, for every 1 female, you have about 4 males that are diagnosed with autism.

Wow.

And, and so when I went in to do this work, I had actually done my dissertation work on the role of vasopressin in male social behavior in a little species called a meadow vole. And so I was really interested in looking at these molecules in the context of autism, but was particularly interested in thinking about vasopressin's role and could it have been dysregulated given that, you know, males seem to be more susceptible to autism than females are. And so what we did was then we went and measured vasopressin and oxytocin in spinal fluid. And what we were able to show was that in particularly males with autism, they had much lower vasopressin levels in spinal fluid compared to children that didn't have autism, and that boys that had the greatest social symptom severity, they had the lowest vasopressin levels in spinal fluid. And so then that led to us wanting to give vasopressin to see if we could boost social abilities in kids with autism. And then a few years ago, we published a paper showing that if you give vasopressin intranasally, you could improve social abilities in kids with autism, which was really exciting because this was one of the first demonstrations of a medication that could have, you know, that could treat core features in autism or, you know, improve symptoms in autism.

Yeah, vasopressin, oxytocin. Are there any other hormones or any other factors that could help us understand the contributors to autism better, or those are the primary. Are you tired of constantly feeling overwhelmed by your never-ending to-do list? Do you struggle to find enough hours in the day to accomplish everything you need? But what if I told you there's a solution that can help you take back control of your time, your focus, your productivity? I'd like to introduce you to Kwik Productivity. This 10-day course is designed to provide you the proven strategies you need to get more done in less time without burning out. So if you're ready to learn to get the most out of your time, your tasks, and your life, then don't wait any longer. Click the link below to learn more and secure your spot and your access right now.

Well, I think there's lots of people working in very different, you know, And I think the thing is, is that there's, you know, there's been lots of medications that people have tried and then there's been failures. And I think one of the questions is, you know, were the drugs, did the medications fail in clinical trials because we don't have subgroups of people with autism, right?

Mm-hmm.

So like we might wanna think about autism as there might be different kinds of autism that we don't, we haven't been able to create like biologically defined groups of individuals. And so this is called like personalized or precision medicine, right? And so if you think about, you know, if we think about oncology, you know, there's all these very specific precision treatments for different kinds of cancers now that are based on the biology, right? And so if we're thinking about different kinds, potentially different kinds of autism, you know, we don't know yet if vasopressin can, You know, everyone can benefit from vasopressin, or there will be a subset of individuals who benefit, and then there will be other medications that come along that might be helpful to different groups of people.

What are some of the— I'm curious also in terms of what inspired you on this track, but what are your hopes that come from your dedicated research for you and your team? And what are some of the big obstacles that you're currently facing in autism research?

My goals, like, I always feel like, you know, dream big, right? Like, do the— you want the rocket to give you the moonshot, right? And so, like, I think that having a lab-based diagnostic test for autism would be fantastic, right? Because you wouldn't, you know, you wouldn't have these long wait times. We actually showed a few years ago that in babies, before they would've ever showed symptoms, that they already, kids that go on to get an autism diagnosis many months to years later, already have low vasopressin levels in spinal fluid. within the first couple months of age. And so what would be really interesting is if there was a way to create a lab-based diagnostic test, particularly for kids that might be at familial risk for autism, right? So if you have one kid with autism, you're at greater risk of having another kid with autism. So having a laboratory-based diagnostic test, but also then potentially having a medication that can treat core features and— We've just completed the largest single-site medication trial to date for autism. So it's a repeat trial. It's called a Phase 2B trial. We did the work at Stanford and we have over 100 kids that enrolled in our trial. And the idea that we're testing is, can we replicate the pilot vasopressin trial in this larger population of children to see if we can again show that we could improve social abilities? With the idea being that if we see this in this larger trial, that then maybe vasopressin could be a medication that could benefit any child with autism. And then in terms of the challenges, you know, I think one that faces all research is that the riskiest research, the ideas that could be groundbreaking, are often not funded. So a lot of traditional funding agencies are very risk-averse. They want you to have done the research before you submit the grant. And so one thing I'll tell you about me and a lot of my colleagues, I think the most important work I've ever done has been funded by philanthropists who believed in my ideas. And it gives you very flexible funding to be able to sort of chase these, you know, moonshots. So I think that's one thing. The other thing is that a lot of the animal models simply are not good enough. And so we have a lot of medications. that are developed in animals that fail in clinical trials. And this isn't the case just for autism, it's for any brain disorder. So, you know, about 93% of medications that are effective in animal models fail in human clinical trials, and 50% of those failures can be attributed to poor animal model selection. So that's one problem. And then another problem is that a lot of the time basic scientists who have access to the cutting-edge scientific insights and clinicians who have access to the patients work in these, what I would call disciplinary silos. So building bridges between people at universities is really critical. And one thing that I love about Stanford is it's on a single campus. And so it's really easy for basic scientists and clinicians to work together. And I think that's why there's so much innovation here. And we also have like world leaders in engineering, bioengineering. And so what you see is this nexus of clinicians, neuroscientists, and engineers all working together towards some of these solutions.

So if people want to get more, go deeper and find out more details about your research, or maybe even potentially even support those endeavors, where can they go?

Well, certainly they can come to my lab website, which I think, you know, you can provide, and people are obviously free to email me. I try to answer every email.

Wow.

Yeah. Um, well, also because my work has been funded by taxpayer dollars and I really feel like, you know, there's a lot of people that are out there looking for solutions. And, you know, our current trial has closed, so we've had a lot of people wanting to enroll in it. Um, but my, my hope is that if this is a positive trial, that there will be lots of opportunities to participate in subsequent trials, you know, where everybody could, you know, potentially benefit from Vasopressin.

Okay. So we'll put that contact information, website, email, um, in the show notes as we always do at, uh, jimkwik.com. Really appreciate your, your time, your research. Um, you touched on this kind of already, but what do you see as the future of autism research?

It's multifactorial. So I think on one hand, I have a colleague, Lawrence Fung, at Stanford who is doing absolutely wonderful work in the neurodiversity space. And he's taking a strength-based approach to autism. And he's even set up job programs, you know, between Stanford, and then, you know, companies to make sure that people with autism, that their strengths can be celebrated and that they can enter the workforce in specific programs. And then I think on the other, you know, the other piece for people that are suffering and that they want treatments, that we will actually have treatments that can improve the symptom management for, you know, autism, for some of these challenges.

Are you hopeful yourself?

I hope so. I mean, you know, you dedicate your life to something, and I love what I do. And, you know, I'm the mother of 3 children, and I really feel like, as a parent myself, you know, you want every single child to be able to reach their full potential. And so, you know, when you're a researcher and you're working in a specific space and you think that you have insights that, you know, could provide benefit, it's a real driving factor. It gets you up in the morning, and it makes you really want to get the work done each day.

We really appreciate the work that you're doing. I know this is a topic that comes up often, you know, in our community, and I'm glad we could shed some light. I want to thank everybody for tuning into this conversation with Dr. Karen Parker. We're talking about cutting-edge autism research happening at Stanford University. Her team's work exploring the role of various molecules and hormones in autism causes is truly groundbreaking. And to our listeners, I encourage you to stay curious about research like Dr. Parker's that continues to evolve our understanding of autism and other possible neurological conditions. I sincerely thank you, Dr. Parker, for joining us and inspiring us with your brilliant mind.

Thank you so much. It was a pleasure to be here.

Wonderful. Thank you, everybody, for tuning in. As always, don't forget to subscribe. If you want to share this, With a family member or friend. I think we all know somebody who could probably benefit from this knowledge, and that's why we do what we do. You know, our show has been 400 episodes roughly to people who could really benefit from it. And so make sure you don't forget to subscribe to our 1.5 million YouTube community online. Leave a comment on whatever platform you're listening To this. If you want to post this and tag us on social media and let us know your thoughts, please do so. And as always, this is your host and your brain coach, Jim Kwik. Until our next episode, be limitless.