Tag Archives: ASD

Autism and Childhood Vaccinations: The Myth is Finally Debunked

In a number of previous blogs, I’ve discussed vaccine myths, in an attempt to bring you information about vaccines that is reliable, trustworthy, and medically accurate. I recently found this review of the myth that vaccines cause autism and wanted to share it with you. It’s a discussion between Robert Dachs, MD, FAAFP (Ellis Hospital Family Medicine Residency Program, Schenectady, New York), Andrea Darby-Stewart, MD (Scottsdale Healthcare, Scottsdale, Arizona), and Mark Graber, MD, FACEP (University of Iowa Carver College of Medicine, Iowa City, Iowa) and was published in the American Family Physician (2010 Sep 15;82(6):586-592).

Are childhood vaccinations associated with subsequent development of autism?

Bob: In 1998, a British gastroenterologist, Dr. Andrew Wakefield, published a report in the Lancet on eight children who developed symptoms of autism within one month of receiving the measles, mumps, and rubella (MMR) vaccine.1 Since then, the media, advocacy groups, and celebrities have promulgated the link between childhood vaccinations (particularly the MMR vaccine) and the development of autism. But, is it true?

This month’s article clearly outlines the epidemiologic and biologic studies that should reassure physicians and parents that there is no connection between childhood vaccinations and autism.2 For the family physician, the data in this article are impressive and can be used to counter most parental concerns.

What does this article say?

Bob: This article reviews the three most commonly proposed hypotheses for vaccine-induced development of autism:

  1. the MMR vaccine damages the intestinal lining, allowing the entrance of encephalopathic proteins;
  2. thimerosal induces central nervous system toxicity; and
  3. multiple vaccinations overwhelm and weaken the immune system.

This article looks at the genesis of each theory and the data that debunk them.2

In regard to the MMR vaccine, Dr. Wakefield noted lymphoid nodular hyperplasia on endoscopy in eight children with gastrointestinal symptoms and signs of autism within one month of receiving the MMR vaccine. He then postulated that this intestinal inflammation allowed nonpermeable peptides into the bloodstream, subsequently affecting brain development.1

There are many holes in this argument.

  • First, this was a self-referred cohort without a control group.
  • Second, in Great Britain, approximately 50,000 children one to two years of age receive the MMR vaccine each month; this is a time when autism typically presents, making this likely a coincidental association.
  • Third, the MMR vaccine has not been found to cause chronic intestinal inflammation.
  • Fourth, no toxic encephalopathic proteins traveling from the intestine to the brain have ever been identified. Instead, genes that code for endogenous proteins, which influence neuronal synapse function, have been identified in children with autism.3

Mark: The most glaring flaw in the argument connecting an MMR-induced intestinal hyperplasia and subsequent autism development is assigning cause and effect to a potential association. Association should not be confused with causation.

Without a control group in the original study by Dr. Wakefield, it is imprudent to even suggest that there is an association between the MMR vaccine and intestinal lymphoid hyperplasia. Large-scale studies are often needed to demonstrate whether an association is statistically present.

Bob: The authors of this month’s article reviewed 13 such large-scale studies that demonstrate no association between the MMR vaccine and autism.2 These are separated into three types of studies:

Ecologic (studies comparing vaccination rates with autism diagnosis). In California and the United Kingdom, the diagnosis of autism increased through the 1980s and 1990s, yet MMR vaccination rates remained stable during this time.4,5 In Quebec, Canada, autism rates increased despite a decrease in MMR vaccination.6

Retrospective observational (studies comparing vaccination status with autism diagnosis using national registries). The best study was one conducted in Denmark in which 440,655 children born between 1991 and 1998 who received the MMR vaccine were compared with 97,648 children born during the same years who were not given the MMR vaccine. There were no differences in autism rates between the two groups.7

Prospective observational (a long-term vaccination project allows researchers to prospectively record adverse events associated with the MMR vaccine). In Finland, 1.8 million children were prospectively followed after MMR vaccination, and no cases of vaccine-induced autism were recorded.8

Andrea: To further refine the concept of association and causation, there are times when an association does represent a cause and effect. A good example is smoking and lung cancer rates. Clearly, smoking is associated with increased lung cancer rates, and a randomized, placebo-controlled trial is not needed to prove this. The association between smoking and lung cancer meets all of the following criteria: strength and consistency of the scientific data; existence of a temporal relationship (between smoking history and lung cancer); existence of a biologic gradient (increased exposure results in increased risk); a scientifically plausible association; and experimental interventions that work (smoking cessation decreases cancer rates).9 However, in the case of MMR vaccine–induced autism, none of these criteria are present. The data, in fact, overwhelmingly support no association.

Bob: Let’s briefly look at the second hypothesis of thimerosal-induced neurotoxicity. Thimerosal is an antibacterial agent that has been used in multidose vaccine preparations for more than 50 years. It is 50 percent ethyl mercury by weight. However, mercury poisoning has a distinctly different presentation than autism. The CDC has also demonstrated that the mercury in vaccines has not resulted in any subtle signs or symptoms of mercury poisoning.10 The authors of this month’s article review seven large-scale studies—again, ecologic, retrospective, and prospective studies—all demonstrating no association between thimerosal and autism.2

Mark: And, by the way, live vaccines like MMR do not contain thimerosal.

Bob: The third and final theory suggests that the simultaneous administration of multiple vaccines overloads the immune system, triggering autism in a susceptible host. However, because of advances in protein chemistry and DNA technology, the immunologic load has decreased from more than 3,000 immunologic components in the seven available vaccines in 1980 to less than 200 in the 14 recommended vaccines today.2

Andrea: Two more points: (1) an infant’s immune system is capable of handling the thousands of antigens it is exposed to early in life; and (2) autism is not an autoimmune disease. Therefore, this theory has no credibility.

Should we believe this study?

Bob: This month’s article clearly provides the science and statistics to dispel the theory that childhood vaccinations induce autism.2 A Cochrane review came to the same conclusion in October 2005.11

Andrea: Large-scale studies, smaller studies, retrospective studies, prospective studies, and case-control studies (you name it) all come to the same conclusion: there is no connection between vaccines and autism. The only outlier is Dr. Wakefield’s study, which suggests this possible link.1

Mark: Lo and behold, 10 of the 13 authors of Dr. Wakefield’s Lancet article have since publicly retracted the interpretation they reported.12 The editor of the Lancet has acknowledged that, had they appreciated the full context of Dr. Wakefield’s study, “… publication would not have taken place the way that it did.”13 On further review, the Lancet also recently published an official retraction of Dr. Wakefield’s study (http://press.thelancet.com/wakefieldretraction.pdf).

What should the family physician do?

Bob: Get this month’s article. It’s an easy read. Keep it handy for when parents are apprehensive about immunizing their child.

Andrea: A national survey conducted in 2003 to 2004 indicated that more than one fourth of all U.S. parents were either unsure of vaccine safety or refused or delayed vaccination of their children because of safety concerns. However, the most important take-home point from that survey was that the parents who changed their minds and immunized their children did so because of information and assurance provided by their health care professional.14 Indeed, we do make a difference!

Mark: Understand the consequences if we just give in to fear and myths. In 2008, only three fourths of preschool children in the United Kingdom received two doses of the MMR vaccine. The result: measles infection rates have reached more than 1,000 cases per year, the highest since monitoring began in 1995.15

Main Points

There are no epidemiologic or biologic studies that support a connection between childhood vaccinations and autism.

EBM Points

An association does not confer causation.

Multiple criteria should be examined when considering if an association implies causation, including strength, consistency, specificity, temporality, dose-response relationship, plausibility, coherence, experimental evidence, and analogy.9

REFERENCES:

  1. Wakefield  AJ, Murch  SH, Anthony  A, et al.  Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children [retraction published in Lancet. 2010;375(9713):445].  Lancet.  1998;35(9103):637–641.
  2. Gerber  JS, Offit  PA.  Vaccines and autism: a tale of shifting hypotheses.  Clin Infect Dis.  2009;48(4):456–461.
  3. Sutcliffe  JS.  Genetics: insights into the pathogenesis of autism.  Science.  2008;321(5886):208–209.
  4. Dales  L, Hammer  SJ, Smith  NJ.  Time trends in autism and in MMR immunization coverage in California.  JAMA.  2001;285(9):1183–1185.
  5. Kaye  JA, del Mar Melero-Montes  M, Jick  H.  Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis.  BMJ.  2001;322(7284):460–463.
  6. Fombonne  E, Zakarian  R, Bennett  A, Meng  L, McLean-Heywood  D.  Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations.  Pediatrics.  2006;118(1):e139–e150.
  7. Madsen  KM, Hviid  A, Vestergaard  M, et al.  A population-based study of measles, mumps, and rubella vaccination and autism.  N Engl J Med.  2002;347(19):1477–1482.
  8. Peltola  H, Patja  A, Leinikki  P, Valle  M, Davidkin  I, Paunio  M.  No evidence for measles, mumps, and rubella vaccine–associated inflammatory bowel disease or autism in a 14-year prospective study.  Lancet.  1998;351(9112):1327–1328.
  9. Simon S. Children’s Mercy Hospitals and Clinics. Causation. http://www.childrens-mercy.org/stats/ask/causation.asp. Accessed January 8, 2010.
  10. Thompson  WW, Price  C, Goodson  B, et al.; Vaccine Safety Datalink Team.  Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years.  N Engl J Med.  2007;357(13):1281–1292.
  11. Demicheli  V, Jefferson  T, Rivetti  A, Price  D.  Vaccines for measles, mumps and rubella in children.  Cochrane Database Syst Rev.  2005;(4):CD004407.
  12. Murch  SH, Anthony  A, Cassen  DH, et al.  Retraction of an interpretation.  Lancet.  2004;363(9411):750.
  13. Horton  R.  The lessons of MMR.  Lancet.  2004;363(9411):747–749.
  14. Gust  DA, Darling  N, Kennedy  A, Schwartz  B.  Parents with doubts about vaccines and reasons why.  Pediatrics.  2008;122(4):718–725.
  15. Health Protection Agency. Measles figures soar. http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1227774034336?p=1204186170287. Accessed December 6, 2009.

For more information on EBM terms, see the EBM Toolkit here.

U.K. bans doctor who linked autism to MMR vaccine

In past blogs, I’ve exposed what I consider to be the unethical and unscrupulous actions of Dr. Andrew Wakefield and his so-called autism research. Here are just a few:

Wakefield’s now disproven 1998 study supposedly linked the vaccine for mumps, measles and rubella (MMR) to autism. Unfortunately, this led to a dramatic drop in vaccinations and a jump in measles cases around the world — causing who knows how many unnecessary childhood deaths.

Since then, at least 25 studies have found no link between the vaccine and autism.

And now, not only have the scientific methods of Wakefield been shown to be highly suspect, but so have his many financial conflicts. You can read more about these in a New York Times report.

Now, Britain’s top medical group has ruled that Wakefield can no longer practice in the U.K. Here are the details from an AP report:

The General Medical Council also found Dr. Andrew Wakefield guilty of “serious professional misconduct” as it struck him from the country’s medical register. The council was investigating HOW Wakefield and colleagues carried out their research, NOT the science behind it (the latter being long ago discredited).

When the research was published a dozen years ago, parents around the world abandoned the measles vaccine in droves, leading to a resurgence of the disease. Vaccination rates have never recovered and there are outbreaks of measles in the U.K. and the U.S. every year as a result.

In 1998, Wakefield and colleagues published a study alleging a link between autism and the vaccine for measles, mumps and rubella. Most of the study’s authors renounced its conclusions and it was retracted then by the journal, the Lancet, this last February.

Many other studies have been conducted since then and none have found a connection between autism and the vaccines. Wakefield moved to the U.S. several years ago and the ruling does not affect his right to practice medicine there or in other countries.

In 2005, Wakefield founded a nonprofit autism center in Austin, Texas, but quit earlier this year.

In January, Britain’s medical council ruled that Wakefield and two other doctors acted unethically and showed a “callous disregard” for the children in their study. The medical body said Wakefield took blood samples from children at his son’s birthday party, paying them 5 pounds (today worth $7.20) each and later joked about the incident.

In a statement then, Wakefield said the medical council’s investigation was an effort to “discredit and silence” him to “shield the government from exposure on the (measles) vaccine scandal.”

In Monday’s ruling, the medical council said Wakefield abused his position as a doctor and “brought the medical profession into disrepute.”

But, worse than this, who knows how many childhood deaths now rest at his doorstep?

Low immunization rates linked to epidemic spread of whooping cough

Barb, my wife, reported to me that friends who are expecting a baby very soon, have informed those who may be visiting or caring for the baby, including grandparents, be immunized against whooping cough (pertussis). Barb asked me, “Is that reasonable?”

“Absolutely,” I replied. I believe it is the parents’ responsibility to provide a bubble of protection around their newborn. The hospital requires nurses and doctors who care for babies to have a variety of immunizations. And, it’s past time for parents to do the same (for themselves and care providers).

We doctors certainly do the same thing each flu season. Since babies cannot get the flu shot until they are 6 months old, the only protection they have is for their care givers to be immunized. The same with whooping cough.

Anyway, now we have another pertussis scare due to unimmunized children. The Los Angeles Times reports, “Public health officials say California’s lackluster immunization rates could be a factor in the epidemic spread of whooping cough.” Unfortunately, more than one small baby has died in this epidemic. The horrible thing is that these deaths were preventable.

At present, “California is one of only 11 states that does not require middle school students to receive a booster shot against whooping cough.”

As a result, “just 43.7% of California adolescents had the vaccine for whooping cough, known as Tdap, in 2008, according to the CDC.”

What’s more, the “state is the only one in the nation to report such a dramatic surge in pertussis.”

Notably, “efforts to require the whooping cough shot in adolescents have stalled in the California Legislature in recent years because of the budget crisis.”

Meanwhile, “public health officials” continue to “worry that some parents may decline vaccination because they believe that vaccines cause autism.”

Of course, readers of this blog understand that there is absolutely NO evidence of any association between any immunization and autism or autism spectrum disorders.

Should Kids take Fish Oil Supplements?

All the talk about the benefits of omega-3s has parents asking whether CHILDREN should take fish oil supplements. Omega-3s are important for neurodevelopment … and they’re now showing up in many prenatal vitamins, infant formulas, and foods. Fish oil supplements for kids are often promoted as improving visual acuity, brain function, or intelligence.

But, according to the experts at the Natural Medicines Comprehensive Database, “there’s no proof that omega-3 supplements make kids ‘smarter’…or have any cognitive benefit in most kids.”

In fact, according to the NMCD, “… many of these claims will be removed … due to pressure from the feds.”

The NCMD recommends this to physicians and healthcare professionals who care for kids:

  • Tell parents that most kids don’t need fish oil supplements.
  • Instead, suggest that kids eat about 4 oz/week of fatty fish … such as canned light tuna, salmon burgers, etc. This provides about 250 mg/day of eicosapentaenoic acid (EPA) plus docosahexaenoic acid (DHA).
  • Supplements may be worth a try for kids who don’t get enough omega-3s from diet … especially those with behavioral or psychiatric disorders as preliminary evidence suggests fish oil MIGHT benefit kids with ADHD symptoms … autism … depression … or those at high risk for psychosis.
  • Reassure parents that most fish oil supplements don’t contain mercury or harmful levels of PCBs. To be safe, suggest a “USP Verified” or “ConsumerLab” product.
  • Tell parents NOT to use cod liver oil, as it has too much vitamin A.
  • Tell parents NOT to use flaxseed, as it doesn’t contain the same omega-3s as fish oil.

Court once again rejects theory that vaccines cause autism

A federal court has determined that the theory that thimerosal-containing vaccines cause autism is “scientifically unsupportable,” and that the families of children diagnosed with the condition are not entitled to compensation. Three special masters in the U.S. Court of Federal Claims determined that the three families represented in the suit didn’t prove a link between the vaccines and autism. The three released more than 600 pages of findings after reviewing these test cases.

Hopefully, this court ruling will put to rest the persisting delusion that some have that vaccines are associated with autism. Whether it’s the MMR vaccine or the vaccine preservative, thiomersol, there is no compelling reason to believe that either are causing the increasing numbers of kids with autism or autism spectrum disorders (ASD).

The New York Times reported, “In a further blow to the antivaccine movement, three judges ruled Friday in three separate cases that thimerosal, a preservative containing mercury, does not cause autism.”

The rulings “are the second step in the Omnibus Autism Proceeding begun in 2002 in the United States Court of Federal Claims,” which “combines the cases of 5,000 families with autistic children seeking compensation from the federal vaccine injury fund.”

The fund pays “families of children hurt by vaccines,” but it “has never accepted that vaccines cause autism.”

The Los Angeles Times reported, “The cases that three judges, called special masters, chose to rule on as test cases were considered among the strongest, so the outlook appears grim for others making the same claim.”

Special Master Denise K. Vowell wrote that “petitioners propose effects from mercury in [vaccines] that do not resemble mercury’s known effects in the brain, either behaviorally or at the cellular level.”

Although Special Master George Hastings was sympathetic with one of the families and believed they brought their claim in good faith, he found “the opinions provided by the petitioners’ experts in this case, advising the … family that there is a causal connection between thimerosal-containing vaccines and Jordan’s autism, have been quite wrong.”

“The cases had been divided into three theories about a vaccine-autism relationship for the court to consider,” the AP reported. The court previously “rejected a theory that thimerasol can cause autism when combined with the measles-mumps-rubella vaccine,” and “a theory that certain vaccines alone cause autism.”

Although, Friday’s “ruling doesn’t necessarily mean an end to the dispute … with appeals to other courts available,” hopefully this will allow physicians, researchers, parents, and child activists to work together to find the real cause(s) of autism, and quit chasing our tails over a theory that no longer holds water or credibility.

You can read some of my blogs on autism here:

Though unproven, 1 in 4 parents believes vaccines cause autism

The New York Times, in Vital Signs, reports that one in four parents “think some vaccines cause autism in healthy children, and nearly one in eight have refused at least one recommended vaccine,” according to a study published online March 1 in the journal Pediatrics.

The USA covered the story with this article:

Most parents continue to follow the advice of their children’s doctors, according to a study based on a survey of 1,552 parents. Extensive research has found no connection between autism and vaccines.

“Nine out of 10 parents believe that vaccination is a good way to prevent diseases for their children,” said lead author Dr. Gary Freed of the University of Michigan. “Luckily their concerns don’t outweigh their decision to get vaccines so their children can be protected from life-threatening illnesses.”

In 2008, unvaccinated school-age children contributed to measles outbreaks in California, Illinois, Washington, Arizona and New York, said Dr. Melinda Wharton of the U.S. Centers for Disease Control and Prevention. Thirteen percent of the 140 who got sick that year were hospitalized.

“It’s fortunate that everybody recovered,” Wharton said, noting that measles can be deadly. “If we don’t vaccinate, these diseases will come back.”

Fear of a vaccine-autism connection stems from a flawed and speculative 1998 study that recently was retracted by a British medical journal. The retraction came after a council that regulates Britain’s doctors ruled the study’s author acted dishonestly and unethically.

The new study is based on a University of Michigan survey of parents a year ago, long before the retraction of the 1998 study. However, much has been written about research that has failed to find a link between vaccines and autism. Mainstream advocacy groups like Autism Speaks strongly encourage parents to vaccinate their children.

“Now that it’s been shown to be an outright fraud, maybe it will convince more parents that this should not be a concern,” said Freed, whose study appears in the April issue of Pediatrics, released Monday.

Some doctors are taking a tough stand, asking vaccine-refusing parents to find other doctors and calling such parents “selfish.”

A statement from a group practice near Philadelphia outlines its doctors’ adamant support for government recommended vaccines and their belief that “vaccines do not cause autism or other developmental disabilities.”

“Furthermore, by not vaccinating your child you are taking selfish advantage of thousands of other who do vaccinate their children … We feel such an attitude to be self-centered and unacceptable,” the statement says, urging those who “absolutely refuse” vaccines to find another physician.

“We call it the manifesto,” said Dr. Bradley Dyer of All Star Pediatrics in Lionville, Pa.

Dozens of doctors have asked to distribute the statement, Dyer said, and only a handful of parents have taken their children elsewhere.

“Parents have said, ‘Thank you for saying that. We feel much better about it,'” Dyer said.

The new study is based on an online survey of parents with children 17 and younger. It used a sample from a randomly selected pool of nationally representative participants. Households were given Internet access if they didn’t already have it to make sure families of all incomes were included. Vaccines weren’t mentioned in the survey invitation and vaccine questions were among others on unrelated topics.

Twenty-five% of the parents said they agreed “some vaccines cause autism in healthy children.” Among mothers, 29% agreed with that statement; among fathers, it was 17%.

Nearly 12% of the parents said they’d refused a vaccine for their children that a doctor recommended. Of those, 56% said they’d refused the relatively new vaccine against human papillomavirus, or HPV, which can cause cervical cancer. Others refused vaccines against meningococcal disease (32%), chickenpox (32%) and measles-mumps-rubella (18%).

Parents who refused the HPV vaccine, recommended for girls since 2006, cited various reasons.

Parents who refused the MMR vaccine, the shot most feared for its spurious autism link, said they’d read or heard about problems with it or felt its risks were too great.

The findings will help doctors craft better ways to talk with parents, said Dr. Gary S. Marshall of the University of Louisville School of Medicine and author of a vaccine handbook for doctors.

“For our children’s sake, we have to think like scientists,” said Marshall, who was not involved in the new study. “We need to do a better job presenting the data so parents understand how scientists have reached this conclusion that vaccines don’t cause autism.”

U.S. study clears measles vaccine of autism link
Does the MMR vaccine cause autism? A redux
Special court rules against families who claim vaccines caused autism
Vaccine Myth #1: Vaccines Cause Autism
You can read some of my blogs on autism here:

Parents Often Miss Subtle Autism Signs

Action Points
Explain to interested parents that autism may progress more slowly and subtly than previously thought.
Note that parents often miss regressive symptoms of autism in their children.
The symptoms of autism tend to emerge in children after six months of age, with a loss of social and communications skills that is more common and more subtle than previously thought, according to a new study that questions previous assumptions about the progression of the condition.
At six months, children with autism spectrum disorder demonstrated behavior similar to other children, gazing at faces, sharing smiles, and vocalizing with similar frequency, researchers reported online in the Journal of the American Academy of Child & Adolescent Psychiatry.
However, autistic children displayed fewer of these behaviors as as they got older, and from six months to 18 months the loss of social communication and skills typically became clear.
While doctors typically caught early signs of autism, the declines were more subtle than previously suggested and most parents (83%) did not report regression in the social behaviors and skills.
“These findings lead us to two major conclusions,” Sally Ozonoff, PhD, of University of California Davis Health System in Sacramento, and colleagues wrote.
“First, the behavioral symptoms of autism spectrum disorder appear to emerge over time, beginning in the second half of the first year of life and continuing to develop for several years.
“Second, our most widely used and recommended practice for gathering information about symptom onset, parent-provided developmental history, does not provide a valid assessment of the slow decline in social communication that can be observed prospectively.”
Autism is thought to emerge in two ways: an early onset pattern and a regressive pattern.
A majority of autistic children are thought to experience the early onset pattern, showing clear signs of the disease in the second year of life but in some cases showing signs before the first birthday.
Those with the regressive pattern are thought to develop normally for the first year of life, then begin losing communications and social skills.
However, most previous studies have been retrospective in design, and some children don’t appear to fit either of the typical patterns, bringing into question the validity of this two-pronged model of onset.
More recently, a third category has been suggested, in which children develop normally and then seem to hit a developmental plateau, but not regress.
In an accompanying editorial, Tony Charman, PhD, of the Institute of Education in London, wrote that the design of the new study heralds a new wave of descriptive developmental studies of autism, or features of autism, in infants and toddlers.
“Previously, the only source of information we had about infancy and toddlerhood of children with autism was retrospective reports from parents at the age of diagnosis (often years after the onset),” he wrote.
“Parental report of early history and development still is an important component of the autism diagnostic evaluation. However, the retrospective parental informant biases, particularly through the lens of autism, might lead both to over- and underestimation of atypical features.”
Ozonoff and colleagues conducted a long-term prospective study that compared 25 high-risk infants later diagnosed with an autism spectrum disorder with 25 gender-matched, low-risk children later determined to have typical development.
The children were recruited for the study at University of California Davis and University of California Los Angeles. The high-risk children were identified based on having a sibling who had already developed autism.
The children were evaluated at 6, 12, 18, 24 and 36 months of age for frequencies of gaze to faces, social smiles, and directed vocalizations, which were were coded from video and rated by examiners.
“The results of the current prospective study suggest that the traditionally defined categories of early onset and regressive autism do not portray accurately how symptoms emerge, nor does the newer-onset category involving a developmental plateau,” the authors wrote.
They found that specific social communicative behaviors clearly decreased, rather than failing to progress, as previously thought, with losses especially dramatic between 6 and 18 months.
They concluded that this suggests onset of autism spectrum disorder, marked by loss of social communication behaviors, occurs much more often than has been recognized using parent report methods.
However, rather than the rapid and marked losses typically reported, they saw relatively subtle and gradual declines, which were often preceded by earlier parental concerns and often followed by failures to progress in other areas.
“We urge professionals to refer to intervention any infant or toddler who displays a sustained reduction in social responsivity over time,” they wrote.
“Given the gradual course of symptom emergence and the paucity of diagnostic tools for infants and toddlers with suspected autism, the diagnostic process can be quite protracted and intervention may be needlessly delayed.”

The symptoms of autism tend to emerge in children after six months of age, with a loss of social and communications skills. However, according to a new study, these changes may be both more common and more subtle than previously thought. Here are the details from an article in MedPage Today:

At six months, children with autism spectrum disorder (ASD) demonstrated behavior similar to other children, gazing at faces, sharing smiles, and vocalizing with similar frequency, researchers reported online in the Journal of the American Academy of Child & Adolescent Psychiatry.

However, autistic children displayed fewer of these behaviors as as they got older, and from six months to 18 months the loss of social communication and skills typically became clear.

While doctors typically caught early signs of autism, the declines were more subtle than previously suggested and most parents (83%) did not report regression in the social behaviors and skills.

These findings have lead the researchers to two major conclusions:

  • First, the behavioral symptoms of autism spectrum disorder appear to emerge over time, beginning in the second half of the first year of life and continuing to develop for several years.
  • Second, our most widely used and recommended practice for gathering information about symptom onset, parent-provided developmental history, does not provide a valid assessment of the slow decline in social communication that can be observed prospectively.

The bottom line is this: autism may progress more slowly and subtly than previously thought and parents often miss regressive symptoms of autism in their children.

MedPate Today explains:

Autism is thought to emerge in two ways: an early onset pattern and a regressive pattern.

A majority of autistic children are thought to experience the early onset pattern, showing clear signs of the disease in the second year of life but in some cases showing signs before the first birthday.

Those with the regressive pattern are thought to develop normally for the first year of life, then begin losing communications and social skills.

However, most previous studies have been retrospective in design, and some children don’t appear to fit either of the typical patterns, bringing into question the validity of this two-pronged model of onset.

More recently, a third category has been suggested, in which children develop normally and then seem to hit a developmental plateau, but not regress.

What does this mean for doctors and parents? First of all, early diagnosis of autism and ASD is incredibly beneficial. Simply put, it leads to early treatment which is enormously helpful to the child and the family.

Therefore, more than ever, parents and physicians who care for young children will have to carefully address developmental and social milestones in each child at each visit. If there are ANY concerns in the eyes of the parent or the physician, a careful evaluation (a second opinion) by a specialist in child behavior and development would be indicated. And, the earlier, the better.

You can read some of my blogs on autism here:

Reader wants more proof on vaccine safety

A reader recently wrote: Hi Dr Walt I am having trouble finding a peer review or non drug company funded study proving that vaccines work out of the 2,427 (studies) you link to. Can you please identify one good one of these studies that proves they work for all the readers to read. Thanks.

More Information: Continue reading

Special court rules against families who claim vaccines caused autism

According to an AP report today, a special court has ruled rather dramatically against three sets of parents with autistic children, saying that vaccines are absolutely not to blame for their children’s neurological disorder (autism). The judges in the cases said the evidence was overwhelmingly contrary to the parent’s claims — and their ruling backs years of science and mountains of evidence from around the world that found no risk for either the MMR vaccine or the vaccine preservative, thimerosal, having any role in autism or ASD.

More Information: Continue reading

Vaccine Myth #1: Vaccines Cause Autism

Tuesday, in my weekly interview with Mark Elfstrand on WMBI in Chicago, a woman called to inquire about the risk of autism from vaccinations.

It reminded me of a chapter from my book, God’s Design for the Highly Healthy Child, in which I discuss a number of myths about vaccinations. This week, I’ll start a multipart series on a dozen or more of these common myths and misperceptions. Continue reading