Ansa Zakriya

IRI/10h/3
11/19/19
Interview format
Interviewer: Ansa Zakriya
Interviewee: Dr. Paul Lipkin
Kennedy Krieger Institute MD
Director of Medical Informatics and the Interactive Autism Network at Kennedy Krieger Institute
Interviewer: Whatever you say in bold
Interviewee: Whatever they say
Interviewed on 11/18/19

Interviewer: Hello this is Ansa Zakriya

Interviewee: Hi

Thank you for this opportunity for the interview

Sure

Um so I was looking at your different publications and one of them was explaining how

Autism is not fully genetic could you expand on that and what other possibilities are

there?

Um ya um uh let me see Im wondering where you read that um so um um ah um we can we can

attribute a ah ah sizeable portion of Autism from genetic but that doesn't explain um all of the

um causes um at this point in time um but clearly genes govern brain growth and development

and a bunch of other things as well um um ah there are um mitochondria in our cells which

affect um brain growth and development um there are neuroreceptors um um as well um and

sometimes eh well this can affect um all those particular um organs systems in the brain, there

are probably other things that can influence them as so uh there is a large category of people

under environmental but that often requires clarification cause its uh not necessarily

environmental in the way that um the way the public sees it um um uh um

Ya
(Same vocal mannerisms of interviewee are implied)

The prenatal or intra uterus environment so that entire world that the fetus is growing and

developing in, the external environment that occurs after birth and that has to do with the

physical world we live in and also a little bit of the social world we live in and all those things

may also impact brain growth and development which can result in some of the things we call

autism so as an example there is this suggestion that there are auto immune problems in the

mother that might affect the fetus and that would be something that occurs intrauterin, within the

uterus, during fetal development we know that infections, maternal infections while pregnant

may affect fetal development after birth certainly young children can be affected by infections

and by brain trauma and then there are some of the more common perceptions of environment

one about the air we breath or the water we drink and that's actually in that category there are

some suggestions that there might be some contributions to autism but it's really fairly loose,

there isn’t a real firm connection with that then people always bring up the social environment a

child grows up in we know there are consequences to adverse childhood experiences and

socioeconomic problems as well could affect brain development however the issue with autism

is a little looser. The important concept around autism is that the symptoms are ties to brain

growth and brain development and anything that can affect that can result in symptoms.

Genetics is still the easiest to identify through testing at this point and it remains quite high but it

doesn't present all.

So you mentioned earlier that there are receptors that can cause autism in the brain

(right) ​, so I am currently looking into GABA and glutamate and how an imbalance in

those two could lead to different genetic causes of Autism, so i'm mainly looking into

GABA and how it affects anxiety but do you have any idea because I haven't been able to

find how it can specifically affect the brain?

Honestly that isn't one of my strengths in terms of my depth of knowledge there are

neuroscience people who would be able to give you a little more thought on that

Alright thank you, so i know according to the website that you diagnose Autism correct?

Yes

So I have watched multiple videos on how they diagnose it and one of them was eye

contact so do you know why autism patients don't have as much eye contact as per say

another person?

That's an excellent and very important question, The way I see of it is that eye contact is one

component of communicative interaction with other people, so we speak in many different ways

we communicate in many different ways, but we really use many hand gestures and body

movements and eye contact as well and so the eye contact is one really price of the

developmental problems a child might have with interpersonal connections why children with

autism have this problem is still far from known people are recognizing that that may be one of

the earliest ways to recognize it

I was wondering if autism could be developed over time for example a child may not be

born with it but over time are they able to develop it or is it just that you can only be born

with it

Most people think of it as developmental, that implies that someone is born with it but it

develops over time so it does become apparent until brain growth has reached a point of

development of communication to show how gene mutations and receptors play a critical role.

There are a small number of cases such as retts syndrome that we understand at this point, we

know its a gene abnormalities and the symptoms don't show until the child is a year or older and

that's because the gene does not affect brain growth or neurotransmitter until after a year of

age.
Oh that's interesting, I was also looking at another one of the articles that was listed

under the kennedy kriger website and it was explaining how you are able to screen

different autistic brains to see how they could have language disorders, I didn't really

understand how they are able to do that.

So there are other investigators here who are looking at brains from MRIs of individuals with

Autism and they are looking at how different parts of the brain are used for different controls

such as language or motor control and they are identifying certain patterns, I don't know enough

about that.

So overall what are major symptoms you look for when diagnosing Autism and what is

the difference between diagnosing a younger child versus an adult.

Those are two good questions, most of the time we like to identify symptoms when they are

younger, and those patients usually have a wider array of symptoms that they show, usually the

first signs that become apparent are delay in language use and so that usually comes between

18 and 30 months of age. We will notice some other symptoms that patients didn't notice such

as eye contact. The younger children have more classic symptoms of autism. As you know now

there is a very wide definition of autism, so there are some people that get diagnosed with it at a

later age such as preschool, usually they have milder problems. They usually arise from

expectations of social interactions.

I remember earlier you recognized how earlier in the uterus the environment could affect

how the child is developed so does that mean that there is an increased chance of twins

having autism

Yes exactly, and it probably has to do more with genetics than environment but there are some

twin studies that are consistent. Identical, or monozygotic twins, then there is a higher chance of

the other to have autism. The twins have given a lot of insight on genetics.
Currently im looking into a certain gene, I know this isn't your specific research, but it's

the GABRB3 gene that affects GABA, so when im reading about these genes are they

explaining the neurotransmitter or are the encoding the receptors and how do I

differentiate them?

Ya that's not really what I know

Ya I understand, Thank you for this opportunity

Did you find someone to advise you

I emailed the emails you sent but they didn't respond so should I email them

They are notorious for not responding we actually have a neuroscientist who is a pleasure to

work with he knows a lot about what your asking Johnathan Pevaser see if he is available you

can mention my name if you would like to

Alright thank you so much that was very helpful

Thank you

Have a nice day

You too bye bye

I learned that I need to look more into twin case studies because they have helped further te

Autism research overall and they mainly show genetic causes. Additionally I learned that my

field pertains to neuroscience, therefore moving forward I will try and contact neuroscientists

instead. The interview was shaky and awkward to start but once we started getting in the flow I
was able to ask questions comfortably and he seemed to open up more as the interview went

on. For my next interview I will definitely try to contact a neuroscientist as well and I will try to

make more questions because I realized I ran out of them during the interview. The difficult part

of the process was finding questions that I could ask him because during the interview I realized

the questions I made he wouldn't be able to answer them. The easy part of the interview was

ending it and getting it schedules because he has an assistant that quickly reached out to me

with specific dates an times.