title: Autism with ophthalmologic malformations: the plot thickens.
abstract: OBJECTIVE
  To review the association of autism spectrum disorder (ASD) in individuals manifesting thalidomide embryopathy and Möbius sequence and compare them with three new studies in which ASD was also associated with ocular and systemic malformations: (1) a Swedish study of individuals with CHARGE association (Coloboma, Heart, choanal Atresia, developmental or growth Retardation, Genital anomaly, and Ear involvement); (2) a Swedish study of Goldenhar syndrome; and (3) Brazilian Möbius syndrome (sequence) study.
  
  
  METHODS
  In the Swedish CHARGE study, 31 patients met the inclusion criteria (3+ or 4 of the common characteristics of the CHARGE syndrome). The same team of investigators also evaluated 20 Swedish patients with Goldenhar syndrome. In the Brazilian Möbius study, 28 children with a diagnosis of Möbius sequence were studied; some children had a history of exposure during their mother's pregnancy to the abortifacient drug misoprostol in an unsuccessful abortion attempt.
  
  
  RESULTS
  In the CHARGE study, five patients had the more severe autism disorder and five had autistic-like condition. In the Goldenhar study, two had autism disorder and one had autistic-like condition. In the Brazilian Möbius study, the systemic findings of the misoprostol-exposed and misoprostol-unexposed patients were almost undistinguishable, and ASD was present in both groups (autism disorder in five and autistic-like condition in three).
  
  
  CONCLUSIONS
  Autism spectrum disorder has been reported in two conditions with known early pregnancy exposure to the teratogenic agents thalidomide and misoprostol. In the Brazilian Möbius study, autism also occurred in both the misoprostol-exposed and misoprostol-unexposed groups. Autism also was present in patients with both CHARGE association and Goldenhar syndrome.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of Illinois, Chicago, Illinois, USA.
authors.forename: Marilyn T
authors.initials: MT
authors.lastname: Miller
authors.forename: Kerstin
authors.initials: K
authors.lastname: Strömland
authors.forename: Liana
authors.initials: L
authors.lastname: Ventura
authors.forename: Maria
authors.initials: M
authors.lastname: Johansson
authors.forename: Jose M
authors.initials: JM
authors.lastname: Bandim
authors.forename: Christopher
authors.initials: C
authors.lastname: Gillberg
mesh_terms: D000014:Abnormalities, Drug-Induced; D000015:Abnormalities, Multiple; D000293:Adolescent; D001321:Autistic Disorder / Q000150:complications* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D005124:Eye Abnormalities / Q000150:complications*; D005260:Female; D006053:Goldenhar Syndrome / Q000150:complications; D006801:Humans; D008297:Male; D016595:Misoprostol / Q000009:adverse effects; D020331:Mobius Syndrome / Q000139:chemically induced / Q000150:complications; D012720:Severity of Illness Index; D013723:Teratogens; D013792:Thalidomide / Q000009:adverse effects
chemical_list: D013723:Teratogens; D016595:Misoprostol; D013792:Thalidomide