When it comes to autism, few questions spark as much debate as how best to support autistic people with the greatest needs.

This prompted The Lancet medical journal to commission a group of international experts to propose a new category of “profound autism”.

This category describes autistic people who have little or no language (spoken, written, signed or via a communication device), who have an IQ of less than 50, and who require 24-hour supervision and support.

It would only apply to children aged eight and over, when their cognitive and communication abilities are considered more stable.

In our new study, we considered how the category could impact autism assessments. We found 24% of autistic children met, or were at risk of meeting, the criteria for profound autism.

Why the debate?

The category is intended to help governments and service providers plan and deliver supports, so autistic people with the highest needs aren’t overlooked. It also aims to re-balance their under-representation in mainstream autism research.

This new category may be helpful for advocating for a greater level of support, research and evidence for this group.

But some have raised concerns that autistic people who don’t fit into this category could be perceived as less in need and excluded from services and funding supports.

Others argue the category doesn’t sufficiently emphasise autistic people’s strengths and capabilities, and places too much emphasis on the challenges that are experienced.

What did we do?

We conducted the first Australian study to examine how the “profound autism” category might apply to children attending publicly funded diagnostic services for developmental conditions.

Drawing on the Australian Child Neurodevelopment Registry, we examined data from 513 autistic children assessed between 2019 and 2024. We asked:

• how many children met the criteria for profound autism?
• were there behavioural features that set this group apart?

Because we focused on children at the time of diagnosis, most (91%) were aged under eight years. We described these children as being “at risk of profound autism”.

What did we find?

Around 24% of autistic children in our study met, or were at risk of meeting, the criteria for profound autism. This is similar to the proportion of children internationally.

Almost half (49.6%) showed behaviours that were a safety risk, such as attempting to run away from carers, compared with one-third (31.2%) of other autistic children.

These challenges weren’t limited to children who met criteria for profound autism. Around one in five autistic children (22.5%) engaged in self-injury, and more than one-third (38.2%) showed aggression toward others.

So, while the category identified many children with very high needs, other children who didn’t meet these criteria also had significant needs.

Importantly, we found the definition of “profound autism” doesn’t always line up with the official diagnostic levels which determine the level of support and NDIS funding children receive.

In our study, 8% of children at risk of profound autism were classified as level 2, rather than level 3 (the highest level of support). Meanwhile, 17% of children classified as level 3 did not meet criteria for profound autism.

Our concern

We looked at children when they first received an autism diagnosis. Children were aged 18 months to 16 years, with more than 90% under the age of eight years.

This aligns with our earlier research, showing the average age of diagnosis in public settings is 6.6 years.

From a practical perspective, our biggest concern about the profound autism category is the age threshold of eight years.

Because most children are already assessed before age eight, introducing this category into assessment services would mean many families would need repeat assessments, placing additional strain on already stretched developmental services.

Second, modifications will be needed if this criteria is going to be used to inform funding decisions as it didn’t map perfectly onto level 3 support criteria.

On balance, however, our results suggest the profound autism category may provide a clear, measurable way to describe the needs of autistic people with the highest support requirements.

Every autistic child has individual strengths and needs. The term “profound autism” would need to be promoted with inclusive and supportive language, so as to not replace or diminish individual needs, but to help clinicians tailor supports and obtain additional resources when needed.

Including the category in future clinical guidelines, such as the national guideline for the assessment and diagnosis of autism, could help ensure governments, disability services and clinicians plan and deliver supports.

What can you do in the meantime?

If you’re concerned your child requires substantial support, here are some practical steps you can take to ensure their needs are recognised and addressed:

Explain your concerns

Not all clinicians have experience working with children with high support needs. Be as clear as possible about behaviours that affect your child’s safety or daily life, including self-injury, aggression or attempts to run away. These details, while difficult to share, help give a clearer picture of your child’s support needs.

It can also be a challenge to find and access clinicians with appropriate expertise. Another potential benefit of having a defined category is that it can better help families navigate care.

Ask about support for the whole family

Our studies show that many caregivers want more support for themselves but don’t always ask. Talk with clinicians about supports for yourself as well, including respite, or family support groups.

Reach out

Coming together with other carers and families can reduce your own isolation and normalise many of the unique challenges you face. Connecting with like-minded people can provide a supportive, empathetic and empowering community.

Plan for safety

For children with high support needs, prioritise safety planning with your child’s care team. This can include strategies to reduce risks, as well as planning how best to support your child’s interactions with health, education and disability services over time.

Kelsie Boulton, Senior Research Fellow in Child Neurodevelopment, Brain and Mind Centre, University of Sydney; Marie Antoinette Hodge, Clinical Lecturer, University of Sydney, and Rebecca Sutherland, Lecturer & Speech Pathologist, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Walk down the health aisle of any supermarket and you’ll see shelves lined with brightly packaged vitamin and mineral supplements designed for children.

These products promise to support immunity, boost brain development and promote healthy growth – leading many parents to believe they’re a necessary addition to their child’s diet.

For parents of fussy eaters in particular, supplements may feel like a quick and reassuring solution. But are they actually needed?

The nutrients children really need

It’s true that children require a broad range of vitamins and minerals – such as vitamins A, B, C, D, E, and K, along with folate, calcium, iodine, iron and zinc – for healthy development. These nutrients play essential roles in brain and nerve development, vision, bone strength, immune function, metabolism and maintaining a healthy weight.

However, for most healthy children, these nutrients can and should come from food – not from supplements.

Even children with selective eating habits typically receive adequate nutrition from everyday foods, many of which are fortified. Common staples such as breakfast cereals, milk and bread are often enriched with key nutrients such as B vitamins, iron, calcium and iodine.

What the science says about supplements

Although many children’s supplements claim to support immunity, growth, or overall wellbeing, there is little robust scientific evidence that they improve health outcomes or prevent illness in otherwise healthy children.

Leading health bodies advise that children who consume a varied diet do not need additional supplementation.

Research consistently shows that getting vitamins and minerals through whole foods is superior to taking them in supplement form. Foods provide these nutrients along with fibre, enzymes, and bioactive compounds, such as phytochemicals and healthy fats, which enhance absorption, metabolism and overall efficacy in ways isolated supplements cannot replicate.

Potential risks and unintended consequences

Parents should also be aware that supplements are not risk-free.

Fat-soluble vitamins – such as A, D, E and K – can accumulate in the body if consumed in excess. If they reach toxic levels, they can cause cause health issues. In the case of A and B vitamins, these issues can be severe and even cause death.

High doses of other water-soluble vitamins, such as vitamin C, may not be dangerous, but can cause side effects like diarrhoea or interfere with the absorption of other nutrients.

Many children’s supplements are flavoured or sweetened to make them more appealing. While this might make them easier to administer, it also introduces added sugars and artificial ingredients into children’s diets – potentially undermining healthy eating habits.

There is also a psychological dimension to consider. Routinely giving children supplements in response to normal eating behaviours, such as fussiness or selective food preferences, may inadvertently teach them that pills are a substitute for a nutritious diet, rather than a temporary aid.

So, what should parents do?

The most reliable way to provide children with essential vitamins and minerals is through a varied and balanced diet. This means including dairy, meat, poultry, fish, wholegrains, nuts, seeds, legumes, and a colourful array of fruits and vegetables.

If you’re regularly negotiating with a pint-sized dictator over a single pea, rest assured you’re far from alone. Research shows nearly half of children go through a phase of picky eating – a behaviour rooted in our evolutionary past.

Early humans developed an aversion to unfamiliar or bitter foods as a survival mechanism to avoid potential toxins. At the same time, they learned to seek out and store energy-rich, palatable foods to survive periods of scarcity.

So, how can parents gently encourage toddlers to embrace healthier, more colourful food options?

• Mix things up. Blend less nutritious beige or white foods with healthier ingredients. For example, add cannellini beans and cauliflower into mashed potatoes to boost nutrient content without sacrificing familiarity.
• Make healthy swaps. Gradually replace white bread, pasta and rice with wholegrain versions. Start by mixing brown rice into a serving of white rice to ease the transition.
• Use familiarity to your advantage. Pair new, colourful foods with familiar favourites. Offer fruit dipped in yoghurt or add a vibrant red or green sauce to pasta, making new flavours less intimidating.

By taking these small, strategic steps, parents can support their child’s nutrition and help them develop a positive relationship with food – no matter how selective their tastes may be.

That said, there are cases where supplementation may be appropriate – such as children with diagnosed nutritional deficiencies, specific medical conditions, or highly restricted diets.

In these instances, parents should seek advice from a qualified health professional, such as a GP or paediatric dietitian. Warning signs may include symptoms such as persistent constipation or signs of impaired growth.

But for most children, vitamin supplements aren’t necessary – they may be doing more harm than good.

Nick Fuller is the author of Healthy Parents, Healthy Kids – Six Steps to Total Family Wellness. His free, practical recipe ideas for a nutritious, varied diet can be found at feedingfussykids.com.

Nick Fuller, Clinical Trials Director, Department of Endocrinology, RPA Hospital, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Globally, the rates of common sexually transmissible infections (STIs) are increasing among people aged over 50. In some cases, rates are rising faster than among younger people.

Recent data from the United States Centers for Disease Control and Prevention shows that, among people aged 55 and older, rates of gonorrhoea and chlamydia, two of the most common STIs, more than doubled between 2012 and 2022.

Australian STI surveillance data has reflected similar trends. Between 2013 and 2022, there was a steady increase in diagnoses of chlamydia, gonorrhoea and syphilis among people aged 40 and older. For example, there were 5,883 notifications of chlamydia in Australians 40 plus in 2013, compared with 10,263 in 2022.

A 2020 study of Australian women also showed that, between 2000 and 2018, there was a sharper increase in STI diagnoses among women aged 55–74 than among younger women.

While the overall rate of common STIs is highest among young adults, the significant increase in STI diagnoses among midlife and older adults suggests we need to pay more attention to sexual health across the life course.

Why are STI rates rising among older adults?

STI rates are increasing globally for all age groups, and an increase among midlife and older people is in line with this trend.

However, increases of STIs among older people are likely due to a combination of changing sex and relationship practices and hidden sexual health needs among this group.

The “boomer” generation came of age in the 60s and 70s. They are the generation of free love and their attitude to sex, even as they age, is quite different to that of generations before them.

Given the median age of divorce in Australia is now over 43, and the internet has ushered in new opportunities for post-separation dating, it’s not surprising that midlife and older adults are exploring new sexual practices or finding multiple sexual partners.

It’s also possible midlife and older people have not had exposure to sexual health education in school or do not relate to current safe sex messages, which tend to be directed toward young people. Condoms may therefore seem unnecessary for people who aren’t trying to avoid pregnancy. Older people may also lack confidence negotiating safe sex or accessing STI screening.

Hidden sexual health needs

In contemporary life, the sex lives of older adults are largely invisible. Ageing and older bodies are often associated with loss of power and desirability, reflected in the stereotype of older people as asexual and in derogatory jokes about older people having sex.

With some exceptions, we see few positive representations of older sexual bodies in film or television.

Older people’s sexuality is also largely invisible in public policy. In a review of Australian policy relating to sexual and reproductive health, researchers found midlife and older adults were rarely mentioned.

Sexual health policy generally targets groups with the highest STI rates, which excludes most older people. As midlife and older adults are beyond childbearing years, they also do not feature in reproductive health policy. This means there is a general absence of any policy related to sex or sexual health among midlife or older adults.

Added to this, sexual health policy tends to be focused on risk rather than sexual wellbeing. Sexual wellbeing, including freedom and capacity to pursue pleasurable sexual experiences, is strongly associated with overall health and quality of life for adults of all ages. Including sexual wellbeing as a policy priority would enable a focus on safe and respectful sex and relationships across the adult life course.

Without this priority, we have limited knowledge about what supports sexual wellbeing as people age and limited funding for initiatives to engage with midlife or older adults on these issues.

How can we support sexual health and wellbeing for older adults?

Most STIs are easily treatable. Serious complications can occur, however, when STIs are undiagnosed and untreated over a long period. Untreated STIs can also be passed on to others.

Late diagnosis is not uncommon as some STIs can have no symptoms and many people don’t routinely screen for STIs. Older, heterosexual adults are, in general, less likely than other groups to seek regular STI screening.

For midlife or older adults, STIs may also be diagnosed late because some doctors do not initiate testing due to concerns they will cause offence or because they assume STI risk among older people is negligible.

Many doctors are reluctant to discuss sexual health with their older patients unless the patient explicitly raises the topic. However, older people can be embarrassed or feel awkward raising matters of sex.

Resources for health-care providers and patients to facilitate conversations about sexual health and STI screening with older patients would be a good first step.

To address rising rates of STIs among midlife and older adults, we also need to ensure sexual health promotion is targeted toward these age groups and improve accessibility of clinical services.

More broadly, it’s important to consider ways to ensure sexual wellbeing is prioritised in policy and practice related to midlife and older adulthood.

A comprehensive approach to older people’s sexual health, that explicitly places value on the significance of sex and intimacy in people’s lives, will enhance our ability to more effectively respond to sexual health and STI prevention across the life course.

Jennifer Power, Associate Professor and Principal Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe University

This article is republished from The Conversation under a Creative Commons license. Read the original article.