MRC Autism Forward Look and Review 1.0 Aim and background 1.1 The rationale for the Forward Look and Review The rationale was partly to revisit the MRC’s previous Autism Initiative (see Annex 1). However, it was also considered timely to take a forward look at research priorities and opportunities in the autism spectrum disorders (ASDs). It was hoped that by taking a realistic forward look at the tractable questions that future research might address, that this would be of value in updating the public on recent progress in autism research. A major part of the Forward Look was a workshop held on 15 January 2009 at the Melia Whitehouse Hotel in London. (more details of this workshop are at Annexes 2 and 3). The report of the Forward Look was subsequently postponed while the MRC-led a major review of mental health on behalf of all public funders of mental health research in the UK. The Autism Forward Look informed that report (and vice versa) and Autism Speaks contributed (as did many other stakeholders) to the Review of Mental Health Research which has been published on the MRC web site at www.mrc.ac.uk/mentalhealthresearch 1.2 Features of autism Whilst it is well known that autism involves impaired social communication, language impairment and repetitive, stereotyped interests, it is still unknown as to whether this constellation of impairments is inherent in a cohesive syndrome (usually called Autism Spectrum Disorder or ASD) or whether it is an artifact of 1 diagnostic practice. There is association with intellectual impairment (albeit within a wide IQ range) and with epilepsy in about a quarter to a third of cases (with onset typically in late adolescence). Like many neurodevelopmental conditions, for example, ADHD and dyslexia, autism is characterized by a marked male preponderance (circa 3 or 4 to 1). While some autistic individuals achieve considerable independence and autonomy, many remained severely handicapped and have virtually no contact with the outside world. It is rare for autistics to make love relationships, to marry and have children. The worst outcomes are for those who have not gained spoken language by 5 years of age and have a low IQ. Psychologically, autism has been described as an impaired ‘theory of mind’ skills (in essence autistic subjects can not see situations from any other perspective than their own. This is preceded by earlier impairment in imitation and joint attention (the process by which one alerts another to a stimulus via nonverbal means, such as gazing or pointing). There is also a lack of central coherence (the ability to see the ‘big picture’ and the ability to plan). Unlike other mental health problems, there is usually only a very limited response to attempts at psychological and behavioural therapy. Other features of autism that have emerged from research include: 1

Association in scientific terms infers a cause but it is not proof . For example, the association could be ‘secondary’ that is that autism itself is the cause of the observed effect, not the other way round.

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the fact that it is partly heritable and that this is at least partly due to an increased rate of Copy Number Variations2. that there is no localized brain abnormality although sophisticated brain imaging techniques combined with psychological experiments in autistic individuals do suggest that there is some impairment across ‘brain systems’. raised serum serotonin levels in about one third of cases of autism although there is no therapeutic response to attempts to regulate this 2.0 General points raised and conclusions from Forward Look 2.1 MRC strategy and portfolio (overview) Autism has been an MRC priority for research since 2001. At that time there was concern about the higher prevalence of autism than had been previously recognised and there were public concerns about a possible relationship to immunisation and bowel disorders. This led to the MRC review of Autism “Epidemiology and Causes”. Since then, autism research has focused much more on the aetiology and risk for autism and research has become more enmeshed in the neurobiology of complex brain disorders. It was agreed that was the correct approach. Except for the Autism Initiative, MRC does not ear-mark funds for autism and researchers can submit in response mode to all of MRC schemes. MRC strategy is to encourage ASD researchers to link with expertise in conjoint disciplines and 3 work with partners such as Autism Speaks to encourage the development of competitive proposals. However the number of applications submitted remains low despite evident strengths in this area. With the relatively small number of active autism researchers in the UK, it is impossible for the UK to address every question in autism research. However when viewed in the context of the whole MRC portfolio of mental health research, autism research seemed to be doing well and better than other neurodevelopmental disorders. Out of a total MRC research spend of £579m in 2007/08, the financial commitment to autism research had been £2.26m. This had increased by £0.56 m on the previous year. The total value of the 18 major autism grants awarded between 2000 and 2007) was £8.9m*. Just over 1 in 5 applications submitted were awarded – which was not dissimilar to the award rate for all grant applications. The research funded by MRC naturally had mostly long-term relevance to policy and practice in that the MRC mostly supported well-designed studies to understand the biological basis of autism. It was stressed by those attending the Forward Look workshop that this remained an important goal. The reason for this is that we know already that the developing brain is altered in autism and we have some knowledge about how, but we do know what causes these changes. Given that one stimulus for the increase in autism funding by the MRC was the controversy provoked by the studies published by Andrew Wakefield, it was interesting to note that none of the current projects funded by MRC dealt with the issue of immunizations and autism. This remains a contentious issue in the UK for 2

Copy number variations are microscopic changes in the DNA sequence that can be found within genes. They can be inherited or arise spontaneously by mutation . It is thought that possessing certain CNVs in a chromosome could put the developing child at risk of being on the autism spectrum. 3 In the UK, the UK-arm of Autism Speaks has become a new charity; ‘Autistica’.

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some parents but had become a much bigger issue in the United States where there were calls for more funding to address the parental concern that has its origin in the Wakefield publications. Academic scientific interest had waned in this area in the UK and the very few proposals submitted to MRC in this field had all been declined. MRC agreed to work with any applicants in terms of a study coming forward in this field in recognition of the remaining public concern about this issue. Delegates at the Forward Look workshop were struck by the fact that the MRC receives few grant applications for autism studies. Given the rapid developments in the field of animal models and neuroscience, it was considered worthwhile to see how the MRC could encourage more neuroscientists to study autism and apply for grants for research relevant to autism. The MRC had achieved a lot in terms of encouraging collaboration within autism researchers but there was still further work to be done in engaging those in conjoint neurobiological disciplines. Delegates agreed that there was a need to reach out and bring new scientists into the field either through studentships or perhaps junior fellowships. This could also be of value in studying other mental health conditions and learning and intellectual disabilities. It was noted that this might be an issue for the general field of mental health research that was likely to be addressed in the mental health research review. In respect of comparisons with the US and Canada, the majority of the funded projects in North America focused on animal models, immunology and geneenvironment interaction. Computational biology was also a burgeoning field (e.g. pathway-based genetic studies). In the UK, distinctive strengths were apparent in population-based studies and genetics. 2.2. The need for large resources and shared infrastructure From the autism researchers' perspective, large shared resources were needed to tackle the challenges of the heterogeneity among individuals with ASD and because assembling large cohorts of autistic subjects was particularly challenging. There are a number of registries and cohorts in existence that could be explored further, for example, the IAN Project at Kennedy Krieger Institute that is funded by Autism Speaks and the US NIH’s National Database for Autism Research. 4 Registries focused on severe mental illness were being considered in the UK and having a resource based on NHS contact with the general population was particularly attractive in overcoming ascertainment bias. Improving the availability of human brain tissue for research, such as through the UKCRC (MRCled) Brain Banking Initiative should also advance research progress. Projects such as the Autism Genome Project, the Infant Sibling Network, and the Autism Tissue Bank are also potentially valuable assets in moving the field forward. An interesting suggestion was the notion of a brain image repository so that the rich wealth of information coming from such studies could be pooled. There might also be an opportunity to attract leaders in brain imaging at the most advanced

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Since the workshop that formed the cornerstone of this Forward Look, the MRC has completed a review of mental health. It was recommended that the UK could take a strong international lead in developing a registry of well phenotyped individuals along with biological data so that aspects such as the effects s of environmental risk factors and comorbidity could be untangled by using the power of large numbers

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imaging centres in the world to join the effort to move the investigations of autism forward. It was suggested that funders might explore whether data collection and storage could be centralized. Autism Speaks also suggested exploring the possibility of networking researchers within the field through online resources and allowing the dissemination of findings through science community websites. 2.3. Interventions and treatment There was particular interest in the early intervention work presented at the Forward Look workshop. Apart from the obvious benefit in controlling the most deleterious effects of symptoms before they develop, developmental disorders such as autism exhibit initial symptoms that can be compounded by atypical interactions with the environment and other people. The mother-child interaction in the first year of life was considered crucial especially as there is on average over 1,000 hours of face-to-face social interaction in the first year. Intervention programmes were being developed for young children who had already been diagnosed, but interest and excitement was generated around the feasibility of devising interventions for babies at-risk, or those that show early warning signs. Complementary research to the UK-based early intervention work was ongoing in the US, funded by NIH. During the Forward Look there was some debate over whether ‘curing’ autism was a very ambitious aim, even in the medium-term (next 5-10 years). Some argued that it was more realistic and reachable to develop better interventions to improve the quality of life of those affected by autism within the next five years or less. Already we have the knowledge to identify those at highest risk and predict at just two months old, half of those going to develop autistic deficits. All the evidence pointed to better outcomes being achieved when the intervention is early, in particular, before symptoms developed. Therefore preventive strategies probably had more to offer at the moment rather then curative approaches, although this would be controversial viewpoint for some.

2.4 Genetics and the interaction with the environment The MRC, together with Autism Speaks, had funded the first international molecular genetics studies of autism, and UK researchers such as Professors Monaco and Plomin continue to be regarded as world leaders in the field. Autism genetics should remain a priority given these existing strengths. Regarding the huge international effort to find ‘risk genes’ particularly through the Autism Genome Project, two factors had been instrumental to this goal. One was the ever improving genetic technology and the other was the recruitment of large numbers of subjects. There now existed an opportunity for statistical analysis using large computers to analyse the huge amount of genetic information to allow segmental analysis of genotype against phenotype, imaging data, natural history and outcomes of intervention. This would require recruitment of basic science leaders in bioinformatics to work together with clinical experts in autism. Clearly the Autism Genome Project was a paradigm example of a successful international coalition. Despite the advances in genetics, autism clearly came about because of the interaction of genes with environmental triggers. Research progress was limited by the relative paucity of knowledge about the role of environmental risk factors and how to combine them with genetics into a single paradigm that explained

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how the two interacted to cause the problems associated with the autism spectrum. Research into the role of environmental risk factors did not figure significantly in the UK (other than one or two notable exceptions). There was no doubt that genetics had seized upon a raft of coincident opportunities, but the challenge remained for the research community to bring the environmental component into line with the advances in genetics and to start the complex process of unpicking the pathways that lead specifically to autism from within the plethora of neurobiological mechanisms. The emerging knowledge from genetics about the gene products involved, ought to provide new insights into both the aetiology and the links between autism and a range of disabilities. 2.5 Interdisciplinary research Clearly all areas of mental health research were dependent on interdisciplinary research. The Forward Look recognised that interaction among different disciplines should be encouraged at all levels, including the design of fellowships. Also important is collaboration between basic scientists and clinicians. Such collaboration is not only necessary for the translation of basic science findings into clinical practice, but also for the fertile opportunity for discovery that clinical practice provides. Scientists studying ASD on a macro level should be encouraged to talk with those studying ASD at a molecular level. Interdisciplinary collaboration should be encouraged through interdisciplinary workshops organized around a specific topic, through initiatives that focus on interdisciplinary studies, and through grant application mechanisms that solicit interdisciplinary proposals. It was noted that neuroscience and developmental biology continued to be UK strengths but the ‘cross-talk’ between these fields and autism research needed to be facilitated. This was a criticism that could be levelled at all mental research however. 2.6 Building the capacity of autism research to deliver innovation Given the number and young age of the scientists now attending the International Meeting for Autism Research (around a 1000 and up three fold approximately over five years), there is clearly an increasing number of young people entering the field from all over the world. However, increasing innovation was key and the funders needed to consider how best to encourage both young and established researchers to acquire a broad experience in different methods and environments given the demanding nature of the challenges of studying autism. 2.7 Working with stakeholders It is increasingly appreciated that a strong collaborative relationship between academia, non-profits, and for-profits organizations is essential for rapid drug discovery and dissemination. Such relationships might be facilitated through sponsored forums and other methods for enhancing communication between academia and industry (conferences) as well as co-funding of projects. Delegates at the Forward Look workshop also emphasised that to date, most drug studies in autism have focused on psychopharmacologic agents which do not target the core deficits of autism. Therefore, autism could be of interest to companies targeting the cognitive deficits of dementia that may be closer to those underpinning autism.

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Other key stakeholders in autism research in particular include the public and users (most often concerned parents). It should be important for researchers to involve community stakeholder representatives during the experimental design process and in considering what the optimum outcomes should be from a putative intervention (i.e a real-world outcome like getting a job and not just improvement on a clinical rating scale). One recommendation from the Forward Look was to encourage researchers to hold focus group meetings for stakeholders to provide their perspective on the value, prioritization, design, and implementation of research. MRC remained committed to increasing public and professional autism awareness in the UK and when the opportunity arose, to join in campaigns with mental health charities and parent organisations to reduce stigma. 2.8 International perspective and collaborative opportunities There were a number of areas where North American and UK scientists could collaborate. This was already in progress in the area of genetic and environmental risk factors and the development of behavioural/psychosocial treatments that will be of immediate benefit to individuals with ASD. A future area where Autism Speaks and MRC agreed to work together was on the need to disseminate ethical and empirically-validated methods for screening, diagnosis and treatment to the community, when such tools became available. The translation of genetic findings into screening and diagnostic assessments will be a logical and exciting next step for the Autism Genome Project. It was important to emphasise however that gene-based diagnostics were some way off – maybe 3 or more years. That which was currently being marketed was of little value. Translational work such as the development of novel assays for drug discovery and testing of drugs in animals and humans was another area that would benefit from encouragement and where the UK could contribute. 2.9 Future areas for research A long list of vogue questions for researchers was drawn up reflecting the wideranging discussion at the Forward Look and the complexity and breadth of the field. These included: exploring further collaborative comparative international epidemiological research to exploit genetic and environmental differences and more exploration of intersections among various approaches and disciplines should be encouraged. For example, correlation of data from genetic, environmental and neuroimaging studies. whether developmental perturbations (such as CNV, chromosomal anomalies or minor congenital anomalies) had an effect •

exploiting the knowledge from genetics •

exploring the feasibility of translational research by utilization of recent discoveries of biochemical pathways affected by autism risk genes to identify target molecules for drug discovery identification of preclinical biomarkers of risk for ASD

exploring the physiological and neurophysiological mechanisms underlying cognitive building on the UK strengths in cognitive psychology

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intervention research where there was limited work in the UK and particular how to intervene to ameliorate the symptoms of autism, for example, improving parent-child communication •

understanding the diversity of the autism spectrum. As in the US, UK researchers should be encouraged to investigate the causes and treatments of medical co morbidities associated with autism, e.g. epilepsy, sleep difficulties, mental health problems such as ADHD, anxiety and depression

•

stronger collaboration between BASIS partners in the UK with the US Baby Sibs Research Consortium and identification of other European partners was encouraged.

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whether there was some physical hazard in utero or in early infancy that increased risk for autism

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as in the US, UK researchers could be encouraged to investigate the causes and treatments of medical comorbidities associated with autism, e.g. epilepsy, sleep difficulties, mental health problems.

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there remains a need to conduct more research on individuals with ASD and learning difficulties (LD). MRC could look to show leadership in this area to encourage UK researchers to explore methodologies that are appropriate for this group.

•

lastly and not least, there remains a need to conduct more research on individuals with ASD and learning difficulties. MRC could look to show leadership in this area to encourage UK researchers to explore methodologies that are appropriate for this group.

3.0 Summary It was generally agreed that autism research was a burgeoning field worldwide. The research underway in the UK was mostly of an international standard and autism was a relative MRC portfolio strength. It was important for the public to be aware of the complex scientific challenges in addressing a disorder with a constellation of different problems. Immediate hope of a cure was unrealistic but there was genuine hope of advance in the area of early intervention to improve the outcome of those affected. Alongside pragmatic approaches to deal with symptoms, fundamental discovery research into autism should remain a priority recognising that the ‘pay-off’ was long-term (maybe more than 10 years). However, progress might be speeded up by sharing resources and engaging experts in other disciplines. Understanding the diversity of the autism spectrum was a key objective. In summary, the main areas for research priority fell roughly into three categories: • Intervention research • The role of Environmental risk factors • The role of comorbidity and particularly individuals with learning difficulties In terms of infrastructure for research, the need for investment in bio repositories, including the support of the newly established Brain Bank in the UK, was strongly encouraged

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Annex 1 Previous Autism Initiative and subsequent developments 1. Previous Autism Initiative •

The Autism Initiative was initiated in 2001/2 and funded with £2.75m Government & Scottish Executive monies, topped up to £3.1m by MRC.

•

Researchers were encouraged to submit research proposals to the MRC, and in doing so were asked: o

how the proposals would advance our understanding and treatment of ASDs

o

how the study would encourage the participation of non-academic users, such as people with autism and their carers

•

A Steering Group (Chair Carol Dezateux) was set up and awarded 6 proposals. The previous Autism Steering Group agreed that there was an excellent mix of studies spanning epidemiology, brain imaging, cognitive phenotyping, non-verbal communication, Asperger’s in adults, and a psychosocial/educational intervention study. It was noted however that no work had been funded in relation to the GI hypothesis – either observational or interventional - which was unfortunate given that this was an area of unmet need and of high priority to parents of autistic individuals.

•

MRC also hosted four research workshops through 2002/3, in the areas of i) gut and the developing child, ii) brain and mind, iii) autism in populations; and iv) interventions in autism

2. Developments since last autism initiative •

Autism is a burgeoning field. The main activities have been the establishment in 2003 of a High Risk Baby Siblings Research Consortium, the continued funding by MRC and Autism Speaks of the Autism Genome project, MRC funding of the AIMS consortium and the growth in autism research at the MRC Social genetic and Developmental Psychiatry Centre.

•

MRC has also made 2 significant awards since the previous autism initiative to Professor Francesca Happe and Professor Simon Baron-Cohen.

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The influential charity Autism Speaks has entered into an informal collaboration with MRC.

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Annex 2 Foreword Look workshop The Foreword Look workshop was also attended by other autism researchers supported by the MRC and a range of invited experts and stakeholders in autism in the UK. The MRC was particularly pleased to welcome.Geraldine Dawson, Ph.D, Chief Science Officer, Autism Speaks and Professor Gary Goldstein from Rutgers university. Autism Speaks had become important partners in MRC funding activities in autism. In addition to presentations, the workshop briefly reviewed achievements in autism over the last five years and scoped areas for future development. presenters provided background on how their MRC-funded research had been successful in progressing knowledge in autism research and were ask to speculate about future directions in autism research. Some of their presentations are attached with this report. MRC strategy in autism Professor Christopher Kennard (Professor of Neurology at the University of Oxford and Chair of the Forward Look) briefly described the MRC Autism Research Initiative. This initiative was set up by the MRC in the light of the £2.5 million given by the English Department of Health, and the subsequent £250,000 from the Chief Scientist’s Office of the Scottish Executive, to take forward the research recommendations of the MRC Review on Autism: Epidemiology and Causes (2001). Autism Speaks strategy Professor Geraldine Dawson gave an overview of Autism Speaks strategy. Key goals included the the discovery of genetic and environmental risk factors and their interaction translation of biological findings into clinically useful tools for early detection, personalized medical approaches, and novel treatment discovery the development of behavioural/psychosocial and biomedical treatments that will be of immediate benefit to individuals with ASD dissemination of empirically-validated methods for screening, diagnosis and treatment to the community Autism Speaks have purblind a strategic plan for booth the USA and UK-based chariest and these can be seen at Scientific Presenters The agenda is at Annex 3. Professor Tony Charman spoke about the SNAP study looking at individual differences and outcomes for people with autism. The aim of this study is to comprehensively characterise the cognitive and behavioural phenotype of a large sample (N=100) of adolescents with autism spectrum disorders. The aim was to test predictions regarding cognitive and behavioural subtypes that might inform future neuroimaging and genetic studies.

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Professor Charman highlighted the need for large collaborative samples because even in a cohort if a 100, subgroups are difficult to identify in such a complex spectrum. There was a need to embed cognitive, clinical, and genetic and neuroscience studies in the same cohorts to maximise payoff, to study developmental trajectories and develop interventions around learning and learning environments. Professor Jean Golding outlined research to assess whether signs and symptoms related to common health problems in childhood were associated with ASD. The study was based on the Avon Longitudinal Study of Parents and Children (ALSPAC; n=14000) started in early pregnancy. Data collected on the child during the first years of life included signs and symptoms of the infant/child. The result indicated that the only common sign or symptom associated with ASD in the ALSPASC cohort was related to middle ear disease Professor Declan Murphy reported on the U.K. A.I.M.S. (Autism Imaging Multicentre Study) network. This was set up in 2004 as the first autism research network in the UK, made up of the Universities of Oxford (Professor Anthony Bailey) and Cambridge (Professor Simon Baron-Cohen), and the Institute of Psychiatry. The AIMS project was investigating brain anatomy in autism in order to try and answer important questions put forward by individuals with autism spectrum disorders (ASD) such as "is my brain different from other peoples brains?" and "is that related to some of the things I do?". Profesor Murphy was also interested in using fMRI to explore functional specialisation for human vocalisation, in particular: non-speech, environmental, positive (laugh) and negative (cry) sounds. Professor Dermot Bowler spoke about his current research interests, focused on memory in people from the high-functioning end of the autism spectrum. As Professor Bowler explained thjat when we remember things that have happened to us, we often have an experience of travelling back in time to re-experience the place and time of the remembered event. To do this, we need to be able to bind together particular aspects of our surroundings into a memory of the unique combination of aspects that make up the episode. Existing research has shown that people with autism spectrum disorder (ASD) appear to find it harder to engage in such binding suggesting they have atypically functioning part of the brain responsible, the hippocampus. Professor Bowler suggested that this ultimately needed to be tested by brain scanning studies, but before that he was planning research to provide more evidence about the functioning of memory in people with ASD and how this related both to their autistic behaviour and their everyday memory capacities. Professor Francesca Happe and Professor Patrick Bolton spoke about their own research and that ongoing at SGDP, This included exploring the coherence of triad traits in a community-based twin study (TEDs) and investigating various chromosome 15 abnormalities associated with autism spectrum disorder Professor Happe argued for the need to measure each triad dimension, not just global ASD rating and to refine measures for atypical autism and to explore single-deficit cases. She felt that this did not ‘threaten’ the value of the ASD concept. Professor Bolton outlined some of the genetic studies. For example, in tuberous sclerosis there is a strong association with autism spectrum disorder, but marked variability in expression. His felt that this was a unique ‘model’ for testing neurobiological theories of ASD. Various chromosome 15 abnormalities

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had been shown to be associated with autism spectrum disorder, including duplication of C15q11-13 and copy number variations (e.g. 16p; 22q), He also highlighted the high & significantly elevated rates of co morbid disorders with autism, such as hyperkinesias, anxiety, affective disorder, and epilepsy Professor Mark Johnson spoke about his research into babies at risk for autism. He argues that research into early onset can get at causal factors. AS symptoms may be compounded during development, the possibility of early intervention was very attratavctive but might be an area to focus on in the sdhort-term rather than a cure. His research had shown that at 2 months half of those identified as being at risk go onto to develop symptoms. Professor Simon Baron-Cohen had been testing if foetal testosterone, measured in amniotic fluid obtained via amniocentesis, is associated with later psychological and neural development postnatally. He presented data that he argued showed that foetal testosterone is inversely associated with social development, language development, and empathy; and that foetal testosterone is postively associated with systemizing and a number of autistic traits. Professor Jonathan Green spoke about the ongoing PACT trial. First large RCT of an early psychosocial treatment in autism. It was a 3 site 2 arms RCT of PACT/TAU against TAU taking place in Manchester, Newcastle, London. He saw the goals for research in his area to include an integrated and sophisticated trials programme addressing change through development (a clinical protocol for sequenced interventions through development that go further than support by intervening in core developmental processes). Other important topics for autism research included understanding the nature of gene brain interaction and understanding diversity in the autism spectrum. He noted that research on the role of the gut had been neglected. Professor Tony Monaco outlined the work of the Autism Genome project. The curgent work included chromosome 2 and 7 fine mapping studies, genome-wide association study and CNV analysis. The future directions included the translation of CNV findings to the NHS and population-based cohort studies. The rationale was that the role of rare CNVs of large effect in autism susceptibility had potential benefits for genetic counselling, early intervention for sibs and increased parental/family understanding for the reason for the disorder affecting them. They were also considering using ALSPAC to determine whether polymorphisms identified by AGP also influence communication abilities within the normal range.

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Annex 3 Autism Forward Look and Review: January 15th: Melia Whitehouse, Albany Street, Regents Park London, London, NW1 3UP Agenda 09.00 09.30 09.40 09.40 10.00 10.20 10.40 look 10.40

Registration and coffee Welcome – Professor Chris Kennard (Chair of MRC Neuroscience and Mental Health Board) Session 1 – Strategy, international context and forward Look Professor Sir Michael Rutter: Autism research; an overview. tbd Professor Geri Dawson, Autism Speaks’ strategic plan for science Session 2 – Outputs from previous autism initiative and forward Prof T Charman

11.00

Professor J Golding

11.20

Coffee

11.40 12.00 12.20 12.40 13.00 14.00 Look 14.00 14.20 14.40 15.00 15.30

Professor Declan Murphy Professor D Bowler Professor J Green Discussion Lunch Session 3 – Developments since last autism initiative and forward Professor Mark Johnson Professor Simon Baron-Cohen Professor Patrick Bolton Tea Professor Tony Monaco; “Genetics of Autism: Progress and Future Prospects"

15.50 Professor Adrian Bird 16.10 Session 4 – Forward look General discussion 17.00

Close of meeting

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