-
More clusters of children developing autism after MMR shot
- Jun 29, 2008 at 6:54 PM
- By
- Comments (11) Total Views (82) Everyone can see this journal post.
Pediatrician from Scotland finally paying attention.
Evidence of a possible link between the MMR vaccination and autism came from the finding of children from villages, within two miles of each other in Scotland, being diagnosed with autism after MMR inoculation.1The three children from different families in Ayrshire were given MMR vaccine at the same health center within four months of each other. Child Neuro-Psychologist, Ken Aitken, said that the cluster of cases in Ayrshire indicated the need for further research before the MMR vaccine can be declared safe beyond doubt.
"More children are being diagnosed with autism and clusters like these are deeply worrying", he said. "There is strong circumstantial evidence to point to the MMR as the reason, but there has to be much more coordinated research to look into this issue in detail. Research so far hasn't been adequate to address the questions that are being raised about the possible links and there have been a lot of queries about the validity of the conclusions which were drawn."
In the 1980s, one in 2500 children in Britain and America were diagnosed as autistic. Latest figures compiled by researchers revealed a dramatic leap - to one in 146.
The MMR immunisation was introduced in the UK in 1988 with the first dose aimed at children of 12-15 months, a the second dose at 3-5 years. It is designed to protect against measles, mumps and rubella (German Measles) and works by stimulating the immune system to produce antibodies against the viruses without causing harm. It was so well received by both parents and doctors that over 90 per cent of children were being immunised by 1992.
Most children received the vaccine with no obvious serious side-effects, but some became seriously ill within a few weeks. These children began behaving strangely, stopped talking and became socially withdrawn, staring into space for hours on end. Many developed a raging thirst, bizarre eating habits, multiple food allergies, hyperactivity and sleep problems. This was usually accompanied by abdominal pain, bloating and bowel disturbances. Some children became incontinent of urine or feces. Their development deteriorated. Thousands of children now fall into this category of abnormal development only after receiving the vaccine.
Professor John O'Leary, Director of Pathology at the Coombe Women's Hospital in Dublin, told the US Congress in April, 2000, that he had produced compelling evidence of an association between autism and the MMR vaccine. Professor O'Leary found the measles virus in the guts of 24 out of 25 children who had developed autism, after an apparently previously healthy infancy.
His research supported the findings of Andrew Wakefield, of the Royal Free Hospital, London, who claimed there was an etiological implication between persistent measles virus infection or measles vaccination and inflammatory bowel disease (IBD), mainly on the basis of epidemiological and immunohistochemical findings. Dr. Wakefield identified "autistic enterocolitis", an inflammation of the gut in 150 autistic children who became autistic after receiving the vaccine.
Dr. Aitken, based at Edinburgh University, said, "The substantial increase in cases in the US began about three years after MMR vaccine was introduced and the same thing happened three years after MMR was introduced in Britain. There has been a national increase throughout Britain and I find it very surprising that the change is so tightly linked in time with when triple vaccine was introduced."
On February 28, 1998, Wakefield reported in The Lancet a possible connection among inflammatory bowel disease, autism, and viral infection associated with measles, mumps, and rubella (MMR) vaccination. The damage from autism is thought to be provoked by an allergic reaction initiated by the body's reaction to the vaccine. This auto-immune response may also reduce levels of the dipeptidyl peptidase (DPP)-IV enzyme, thereby connecting vaccines to the opioid theory of autism.
Andrew Wakefield did his first colonoscopy on an autistic child, because the anguished mother begged him to find the reason why her son had such terrible gastrointestinal problems. Finding some very specific pathology, Dr. Wakefield proceeded to investigate 11 more autistic children, again finding similar pathology in all children. These children had lost acquired skills, including communication, after a period of apparent normality.
Among eight of the children, the onset of behavioral problems had been linked, either by the parents or the child's physician, with MMR vaccination Five had an early adverse reaction to immunization (rash, fever, delirium, and seizures in 3). The average interval from exposure to first behavioral symptom was 6.3 days (range: 1-14 days).
Among the remaining 4 children, one received monovalent measles vaccine at 15 months, after which his development slowed. A striking deterioration then occurred in his behavior at age 4.5 years, the day after he received an MMR vaccine. A second child received the MMR vaccine at 16 months, developing at 18 months a combination of recurrent, antibiotic resistant, otitis media, along with his first behavioral symptoms (lack of interest in siblings and lack of play). A third child received an MMR at 15 months, experienced recurrent "viral pneumonia" for the next 8 weeks, and developed behavioral symptoms 4 weeks after the MMR ( loss of speech development and deterioration in language skills). The fourth child developed self- injurious behavior 2 month after the MMR.
Urinary methylmalonic acid excretion was significantly raised in all children tested (8 of the 12). Ten of the twelve children showed lymphoid nodular hyperplasia of the terminal ileum on endoscopy. The eleventh child had prominent luteal lymph nodes and the ileum was not reached in the twelfth (who had an ulcer in the rectum along with chronic colitis).
Wakefield, concluded that a subset of autistic people may suffer brain inflammation resulting from infections that began in their intestines after they were inoculated with the measles-mumps-rubella (MMR) vaccine. Theoretically, this condition could occur after naturally-acquired infection as well. The pro-vaccine community would argue, if this is true, that vaccination still reduces the incidence of disease by reducing the number of infections.
Wakefield's studies received enormous press attention in the United Kingdom. The immediate result of Dr.Wakefield's paper was a vitriolic attack from every front. A flood of opposing articles appeared in the same issue of The Lancet, and systematic criticism, nearing persecution, of Dr. Wakefield began, and is still going on. Rates of vaccination against measles fell to about 85 percent last year. Epidemiologists have been predicting a measles epidemic to result. Ireland reported an outbreak of 300 measles cases as of summer, 2000, compared to only 30for all of 1999. Two of the new cases were infants who had to be hospitalized with pneumonia complications.
Distraught parents of affected children have become even more confused, because no one has been able to prove conclusively to them yet, that an MMR vaccine-Autism connection does not really exist.
We know from data reported before the availability of MMR vaccine, that a subset of autistic children suddenly regressed at age 15 months, long before the measles vaccine became available.There have been no safety follow-up studies looking beyond four weeks post vaccination, and many studies quoted, have been partially funded by vaccine manufacturers, with obvious commercial interests.
No serious researcher has looked at a large sample - three to nine months post MMR vaccination, when auto-immune diseases usually would occur. When some parents in England became vocal, the pro-vaccine authorities in the UK reacted forcefully, to protect the MMR vaccination program. The single measles, mumps and rubella vaccines effectively became unavailable, and every effort was made to prove Dr. Wakefield wrong.
Despite the above, Britain's National Health Service's Chief Medical Officer, Sir Kenneth Calman, felt confident enough to say, "I have concluded there is no link between MMR immunisation and autism." Questioned in Parliament in 1997 on the possible link between MMR and autism, then health minister Tessa Jowell reassured Parliament that: "No vaccine is issued in the United Kingdom unless it passes the highest standards for quality, and parents should have confidence that the vaccines that are provided are both safe and efficacious."
In 1999, two studies appeared that the Department of Health claimed "reinforce the conclusion that there is no link" between MMR and autism. The first, by the Committee on the Safety of Medicines, involved examining questionnaires sent to the parents who had suspected MMR as a cause for their child's autism - 1200 questionnaires were distributed and 126 examined in detail. The study concluded: "It is impossible to prove or refute the suggested associations between MMR vaccine and autism" - hardly convincing reassurance.
The second study cited by the DOH looked at one area - north London - and found an alarming increase in autism there. The incidence was running steadily at between four and eight of the children born there each year between 1978 and 1985. Then came a dramatic increase to just under 50 of the children born in 1992 - the last year studied by Professor Brent Taylor and colleagues at University College London. Curiously, however, they concluded: "Our analyses do not support a causal association between MMR vaccine and autism."
The Taylor study was funded by The Medicines Control Agency and The Public Health Laboratory Service and was published in The Lancet, June 1999. Taylor, et al. stated that the age of diagnosis was the same before and after the introduction of the MMR vaccine, and used this finding to conclude that the MMR vaccine did not have a causative role in autism. Dr. Taylor stated: "For age at first parental concern, no significant temporal clustering was seen for cases of core autism and atypical autism, with the exception of a single interval within six months of MMR vaccine associated with a peak in reported age of parental concern at 18 months." Taylor, et al. Could not explain the increase in autism noted in 1992, the last year for which they examined data.
To others, Taylor's failure to explain the massive increase in autism only added fuel to the controversy. Children who were born in the mid-1980s in Britain and the 1970s in the United Sates were the first to receive the MMR vaccine. In California the incidence of autism was running at 150-200 a year until 1980, when it dramatically rose to reach nearly 600 in 1990.
While Taylor argued that MMR cannot contribute to autism, and Wakefield argued that it might, both studies may be correct. What Taylor may have missed is the susceptible child argument. He limits himself to the more typical, reductionistic, one variable theory of disease. In this theory, one agent causes a disease. All individuals exposed to this agent have equal probability of developing the disease.
A more accurate theory of disease posits susceptible individuals who succumb to the disease after multiple contributory insults. Wakefield worked backwards from children who definitely had autism with gastrointestinal symptoms. Taylor worked forward from all children receiving the MMR vaccine. While various authors question his sampling effort and point out potential bias in how he selected his subjects, the much more important problem lies in Taylor's type of study posing no help for the question of whether susceptible children could be more likely to develop autism after MMR vaccine.
We have only begun to speculate about who is susceptible to autism. We know the risk is higher if one or more family members have the condition. But what are the promoting agents that make autism more likely? Not all children with autistic siblings develop autism. The genetic penetration is not 100%. Non-genetic factors must play a role. Could vaccines be one of these promoting agents? Wakefield suggested yes, and Taylor's study did not really address that question.
Some other investigators have not been able to reproduce Wakefield's findings [M.A. Azfal and colleagues]. They could not detect measles viruses in the bowel, brain, or any other tissue of the patients in Wakefield's series.2
Subjectively, we cannot deny that many parents report developmental deterioration following MMR vaccination. Neurological sequelae following MMR are also widely reported. Dozens of heart-rending, anecdotal accounts link permanent neurological disability or death to vaccine use. One of the leading sites in the anti-immunization field is the National Vaccine Information Centre (NVIC).
Other studies besides Wakefield's have suggested a link between autism and vaccination. H.H.Fudenberg reported that the first symptoms of autism among 15 of 20 children developed within a week of vaccination. S.Gupta commented on the striking association between MMR vaccination and the onset of behavioral symptoms in all the children he investigated for regressive autism.
The MMR vaccine is all live virus. Disintegrative psychosis is recognized as a sequela of measles encephalitis. Viral encephalitis can give rise to autistic disorders, particularly when it occur early in life.
A genetic association for autism is represented by a null allele of the complement C4B gene located in the class III region of the major histocompatibility complex. The C4B-gene is also crucial for protection against viruses. Affected individuals may not handle certain viruses appropriately - even the attenuated ones used in vaccines. In an addendum to the paper, Wakefield, et al. noted that their sample size had increased to 40 children by Jan 28,1998, with 39 of those showing similar findings. The C4b null allele is present on chromosome 6.3
These studies support our view that MMR vaccine may trigger a cascade of events leading to autism in genetically susceptible children, and not affect children who lack susceptibility. Unfortunately, vaccination among public health and medical practitioners has become almost sacred. Questioning the wisdom of vaccination for certain children is seen as professional heresy. Nevertheless, the possibility cannot be ignored.
Could killed (rather than live virus) MMR accomplish the same task? Should measles be administered separately from mumps? We know that the combination of chicken pox and measles dramatically increases the risk for subacute sclerosing panencephalitis. Perhaps other mixed viral infections are also clinically significant.
More important is the science we must use to explore this. Simple correlation analysis and comparison studies will not suffice. If autism is indeed linked to the MMR vaccine in genetically susceptible individuals, unless these individuals are selected from the larger pool, the statistical significance will cancel out in these studies.
Medical research also suffers from a failure to consider interactions and synergy in the disease process. Simple epidemiology will not suffice either, since we are not even sure what the potential genetic defect is in autism - or if autism is one syndrome or many.
The United States' Center for Disease Control (CDC) believes that the current scientific evidence does not support the hypothesis that MMR, or any combination of vaccines, cause the development of autism, including regressive forms of autism.4 CDC argues that the apparent link between MMR and autism is purely coincidental, based upon the fact that the MMR vaccine is usually given between the ages of 12 and 18 months, which is also the most common age at which autism is diagnosed. One could say, "go figure!", or pursue more sophisticated studies.
An extensive study of the evidence was recently conducted in the United Kingdom. The British Committee on Safety of Medicines convened a "Working Party on MMR Vaccine" to conduct a systematic review of reports of autism, gastrointestinal disease, and similar disorders after receipt of MMR or measles/rubella vaccine. The National Childhood Encephalopathy Study (NCES) was examined to see if there was any link between measles vaccine and neurological events.
The CDC noted that no researchers in England had found any indication that measles vaccine contributed to the development of long-term neurological damage, including educational and behavioral deficits (Miller et al. 1997). A more recent epidemiological study also found no association between MMR vaccine and autism (Taylor et al. 1999). This study compared rates of autism between children who received the MMR vaccine and children who did not. The results found no difference in rates of autism between the two groups. On the other hand, such large scale population studies, would not necessarily be expected to identify a small difference in autistic rates, which, as parents argue, is crucial to those affected.
The CDC agreed with an expert committee from the UK Medical Research Council (MRC) who reviewed Wakefield's research and concluded that no link had been demonstrated between MMR vaccine and inflammatory bowel disease in autism.
Wakefield's study was criticized for:
- Using too few cases to make any generalizations about the causes of autism; only 12 children were included in the study. The cases were selected by researchers and may not be representative of many cases of autism.
- There were inadequate groups of control children. As a result, it is difficult to determine whether the bowel changes were similar to changes in normal children, or to determine if the rate of vaccination in autistic children was higher than in the general population.
- The study did not identify the time period during which the cases were identified.
- In at least 4 of the 12 cases, behavioral problems appeared before the onset of symptoms of bowel disease; that is, the effect preceded the proposed cause. It is thus proposed unlikely, therefore, that bowel disease or the MMR vaccine triggered the autism.
The CDC argues against any scientific research or data indicating benefit to separating the MMR vaccine into its individual components. CDC argued that splitting the MMR vaccine into three separate doses could be harmful because it would expose children unnecessarily to potentially serious diseases. If the rubella vaccine were delayed, 4 million children would be susceptible to rubella for an additional six to 12 months. This would potentially allow otherwise preventable cases of congenital rubella syndrome (CRS) to occur. Infection of pregnant woman with "wild" rubella virus is one of the few known causes of autism. Thus, by preventing infection of pregnant women, rubella vaccine also prevents autism, asserts CDC.
CDC argues that, due to the general safety of vaccines, and the rarity of serious vaccine adverse events [Ed: although, see information from the US government contained in a Database of Vaccine Injury: The Vaccine Adverse Event Reporting System (VAERS)], it is extremely difficult to study whether a subgroup (e.g., family members) are actually at increased risk compared with the general population.
The one exception, they acknowledge, is an increased risk of neurologic events -primarily febrile seizures - after vaccination with DTP vaccine and measles-containing vaccines (MCV). The risk increases if any of these have previously occurred in immediate family members. Considering the rare occurrence of these events after DTP and MCV vaccination, the generally benign outcome of febrile convulsions, and the risk of pertussis and measles to unvaccinated people and the general population, the Advisory Committee on Immunization Practices concluded that a history of convulsions in siblings or parents should not be a contraindication to pertussis or measles vaccination.
Special care in the prevention of post-vaccination fever could be warranted in children with a family history of seizures, they admit. For instance, oral polio vaccine (OPV) is contraindicated when there is a family member with immune-deficiency, since OPV can spread to family contacts.
CDC argues for evidence of the benefits of childhood immunization, including record, or near record, low rates of vaccine preventable diseases in the United States. Last year, for example, there were fewer than 100 reported cases of measles - and no deaths - in the US, compared with 27,786 cases and 64 deaths in 1990.
Kawashima, et al.5reported that measles virus could be present in the intestines of patients with Crohn's disease. Responding to Wakefield's data on "autistic enterocolitis (see above), the authors set out to determine if the virus found in Crohn's disease, ulcerative colitis, and autistic enterocolitis came from wild strains of measles or from vaccine strains.
To do this, they found measles RNA from peripheral blood mononuclear leukocytes (PBML) in eight patients with Crohn's disease, three patients with ulcerative colitis, and nine children with autistic enterocolitis. They used healthy children and patients with subacute sclerosing pan-encephalitis and human immunodeficiency virus 1 as controls (eight patients).
RNA was purified from PBML, followed by reverse transcription. The resulting cDNAs were subjected to nested PCR for detection of specific regions of the hemaglutinin (H) and fusion (F) gene regions. Positive samples were sequenced directly, in nucleotides 8393-8676 (H region) or 5325-5465 (from noncoding F to coding F region).
One of eight patients with Crohn disease, one of three patients with ulcerative colitis, and three of nine children with autism, were positive. Controls were all negative. The sequences obtained from the patients with Crohn's disease shared the characteristics with wild-strain virus. The sequences obtained from the patients with ulcerative colitis and children with autism were consistent with being vaccine strains. The results were concordant with the exposure history of the patients. Persistence of measles virus was confirmed in PBML in some patients with chronic intestinal inflammation.
References- Nugent E. Experts call for new research over linked Scot autism cases. Scottish Daily Mail, Wednesday, June 14, 2000.
- Azfal MA, et al. The Lancet. Vol 351. February 28, 1998 pp. 611-12.
- H. H. Fudenberg, NeuroImmuno Therapeutics Research Foundation, Classic Infantile Onset Autism is an Autoimmune Disease, accessed May 20, 1998.
- MMR Vaccine and Autism. National Immunization Program: Leading the Way to Healthy Lives. Centers for Disease Control and Prevention (CDC).
- Kawashima H, Mori T, Kashiwagi Y, Takekuma K, Hoshika A, Wakefield A. Detection and sequencing of measles virus from peripheral mononuclear cells from patients with inflammatory bowel disease and autism. Dig Dis Sci 2000 Apr;45(4):723-9.
Tags: aspergers, autism, children, developmental delays, immune system, innoculations, mmr, pdd, pediatricians., scotland, vaccines
Comments:
Early autism detection strongly recommended  |
www.chinaview.cn  2007-10-30 11:13:34 |   Print |
The American Academy of Pediatricians recommends that early detection of autism can improve a child's chances for effective treatment. The new reports say that children with suspected autism should begin treatment even before a formal diagnosis. Because autism can be difficult to diagnose, the American Academy of Pediatrics has listed new guidelines for what subtle behavioral signs pediatricians should be on the lookout for. They say not babbling by nine months and not pointing to toys by one year can be symptoms. Other warning signs include a four month old not smiling at the sound of a parents' voice, language or social skills disappearing and failure to make eye contact. But, not every child who displays these signs has autism. "Sometimes their muscle tone is very low, so if they don't roll over early enough, if they have fine motor skills problems, they don't clap their hands. If they're extremely quiet or have stomach problems," explained Marguerite Colston, spokeswoman for the Autism Society of America. "Just as a parent, I can tell you that if a child doesn't make eye contact, if they don't play games by 12 months of age with their parents like patty-cake and that sort of thing, then you really should see your pediatrician and ask to see a neurologist or a developmental pediatrician." To help guide parents as to what autism is (and is not), the nonprofit group autismspeaks has also just put out a website that has dozens of video clips of autistic children, contrasted with children of the same age with normal behavior. Recommended treatment for autism should include at least 25 hours a week of both behavioral and speech therapy. |
Early Signs of Autism
Question of the Week
By Vincent Iannelli, M.D., About.com
Updated: March 30, 2007
About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD
See More About:
A. If your baby otherwise seems to be growing and developing normally, then that is probably not a sign of autism. Among other normal developmental milestones that you would expect at this age include that your baby smiles, is usually comforted or soothed when she is picked up, follows objects past the midline of her face, make 'ooo' and 'aah' type cooing noises, and maybe has begin laughing. You should definitely discuss it with your Pediatrician if you don't think your baby's behavior is normal though.
The symptoms you describe could also be seen in infants with high muscle tone, especially if her muscles usually seem extra stiff. This is something that you should also discuss with your Pediatrician, but it isn't really related to autism at all.
Among the early signs and symptoms that parents and Pediatricians look for to alert them that a child needs further evaluation for autism include:
- not smiling by six months of age
- not babbling, pointing or using other gestures by 12 months
- not using single words by age 16 months
- not using two word phrases by 24 months
- having a regression in development, with any loss of language or social skills
Keep in mind that autism usually isn't diagnosed until about age 3, although some experts believe that some children begin to show subtle signs as early as six months of age.
There is also an autism study that showed that some children with autism had abnormal brain growth. Specifically, they had a smaller than average head size at birth (at the 25th percentile), but then had a period of rapid head growth during which their head size moved up to the 84th percentile by age 6-14 months. But rapid head growth is not a sign in all kids with autism.
In general, if you are concerned about your child's development, especially if you think that they might have autism, you should talk to your Pediatrician and consider a more formal developmental evaluation.
And keep in mind that when a child arches her back a lot, it can be a sign of gastroesophageal reflux (Sandifer Syndrome), although you would usually expect other symptoms, like spitting up and being fussy.
Getting An Evaluation
One of the frustrating things that occurs when parents think something is wrong with their child's development is that they may be told 'not to worry' or that they 'should just wait.' Experts think that it is better for parents to trust their instincts and get their child evaluated if they think that they aren't developing normally. This guide from First Signs is a good resource for parents trying to share their concerns with their Pediatrician.Your local early childhood development program may also be able to do an evaluation if you are concerned about your child's development.
Pediatric Resources
More Pediatric Resources
This is from the Mayo Clinics website.
Autism
ARTICLE SECTIONS
Symptoms
Children with autism generally have problems in three crucial areas of development — social interaction, language and behavior. But because the symptoms of autism vary greatly, two children with the same diagnosis may act quite differently and have strikingly different skills. In most cases, though, the most severe autism is marked by a complete inability to communicate or interact with other people.
Many children show signs of autism in early infancy. Other children may develop normally for the first few months or years of life but then suddenly become withdrawn, aggressive or lose language skills they've already acquired. Though each child with autism is likely to have a unique pattern of behavior, these characteristics are common signs of the disorder:
Social skills
- Fails to respond to his or her name
- Has poor eye contact
- Appears not to hear you at times
- Resists cuddling and holding
- Appears unaware of others' feelings
- Seems to prefer playing alone — retreats into his or her "own world"
Language
- Starts talking later than other children
- Loses previously acquired ability to say words or sentences
- Does not make eye contact when making requests
- Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
- Can't start a conversation or keep one going
- May repeat words or phrases verbatim, but doesn't understand how to use them
Behavior
- Performs repetitive movements, such as rocking, spinning or hand-flapping
- Develops specific routines or rituals
- Becomes disturbed at the slightest change in routines or rituals
- Moves constantly
- May be fascinated by parts of an object, such as the spinning wheels of a toy car
- May be unusually sensitive to light, sound and touch and yet oblivious to pain
Young children with autism also have a hard time sharing experiences with others. When read to, for example, they're unlikely to point at pictures in the book. This early-developing social skill is crucial to later language and social development.
As they mature, some children with autism become more engaged with others and show less marked disturbances in behavior. Some, usually those with the least severe problems, eventually may lead normal or near-normal lives. Others, however, continue to have great difficulty with language or social skills, and the adolescent years can mean a worsening of behavior problems.
The majority of children with autism are slow to acquire new knowledge or skills and some have signs of lower than normal intelligence. Other children with autism have normal to high intelligence. These children learn quickly yet have trouble communicating, applying what they know in everyday life and adjusting in social situations. An extremely small number of children with autism are "autistic savants" and have exceptional skills in a specific area, such as art, math or music.
Reprints and permissions
This is directly from the National Institute of Neurological Disorders.
Autism Fact Sheet
Autism
Information Page
| Publications |
Clinical Trials
News
Research literature
NINDS is part of the
National Institutes of
Health
Download Adobe Reader
See a list of all NINDS Disorders
Get Web page suited for printing
Email this to a friend or colleague
Request free mailed brochure
Autismo
Table of Contents (click to jump to sections)
What is autism?What are some common signs of autism?
How is autism diagnosed?
What causes autism?
What role does inheritance play?
Do symptoms of autism change over time?
How is autism treated?
What research is being done?
Where can I get more information?
Autism (sometimes called “classical autism”) is the most common condition in a group of developmental disorders known as the autism spectrum disorders (ASDs). Autism is characterized by impaired social interaction, problems with verbal and nonverbal communication, and unusual, repetitive, or severely limited activities and interests. Other ASDs include Asperger syndrome, Rett syndrome, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (usually referred to as PDD-NOS). Experts estimate that three to six children out of every 1,000 will have autism. Males are four times more likely to have autism than females.
What are some common signs of autism?
There are three distinctive behaviors that characterize autism. Autistic children have difficulties with social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive interests. These behaviors can range in impact from mild to disabling.
The hallmark feature of autism is impaired social interaction. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement.
Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other people’s faces for clues about appropriate behavior. They lack empathy.
Many children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging. They also tend to start speaking later than other children and may refer to themselves by name instead of “I” or “me.” Children with autism don’t know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.
Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms such as a resistance to being cuddled or hugged.
Children with autism appear to have a higher than normal risk for certain co-existing conditions, including fragile X syndrome (which causes mental retardation), tuberous sclerosis (in which tumors grow on the brain), epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. For reasons that are still unclear, about 20 to 30 percent of children with autism develop epilepsy by the time they reach adulthood. While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which are not found in autism.
Autism varies widely in its severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps. Doctors rely on a core group of behaviors to alert them to the possibility of a diagnosis of autism. These behaviors are:
- impaired ability to make friends with peers
- impaired ability to initiate or sustain a conversation with others
- absence or impairment of imaginative and social play
- stereotyped, repetitive, or unusual use of language
- restricted patterns of interest that are abnormal in intensity or focus
- preoccupation with certain objects or subjects
- inflexible adherence to specific routines or rituals
Doctors will often use a questionnaire or other screening instrument to gather information about a child’s development and behavior. Some screening instruments rely solely on parent observations; others rely on a combination of parent and doctor observations. If screening instruments indicate the possibility of autism, doctors will ask for a more comprehensive evaluation.
Autism is a complex disorder. A comprehensive evaluation requires a multidisciplinary team including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with ASDs. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for autism, children with delayed speech development should also have their hearing tested. After a thorough evaluation, the team usually meets with parents to explain the results of the evaluation and present the diagnosis.
Children with some symptoms of autism, but not enough to be diagnosed with classical autism, are often diagnosed with PDD-NOS. Children with autistic behaviors but well-developed language skills are often diagnosed with Asperger syndrome. Children who develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviors may be diagnosed with childhood disintegrative disorder. Girls with autistic symptoms may be suffering from Rett syndrome, a sex-linked genetic disorder characterized by social withdrawal, regressed language skills, and hand wringing.
Scientists aren’t certain what causes autism, but it’s likely that both genetics and environment play a role. Researchers have identified a number of genes associated with the disorder. Studies of people with autism have found irregularities in several regions of the brain. Other studies suggest that people with autism have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that autism could result from the disruption of normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how neurons communicate with each other. While these findings are intriguing, they are preliminary and require further study. The theory that parental practices are responsible for autism has now been disproved.
What role does inheritance play?
Recent studies strongly suggest that some people have a genetic predisposition to autism. In families with one autistic child, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population. Researchers are looking for clues about which genes contribute to this increased susceptibility. In some cases, parents and other relatives of an autistic child show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as manic depression, occur more frequently than average in the families of people with autism.
Do symptoms of autism change over time?
For many children, autism symptoms improve with treatment and with age. Some children with autism grow up to lead normal or near-normal lives. Children whose language skills regress early in life, usually before the age of 3, appear to be at risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with autism may become depressed or experience behavioral problems. Parents of these children should be ready to adjust treatment for their child as needed.
There is no cure for autism. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism: impaired social interaction, problems with verbal and nonverbal communication, and obsessive or repetitive routines and interests. Most professionals agree that the earlier the intervention, the better.
- Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills. Family counseling for the parents and siblings of children with autism often helps families cope with the particular challenges of living with an autistic child.
- Medications: Doctors often prescribe an antidepressant medication to handle symptoms of anxiety, depression, or obsessive-compulsive disorder. Anti-psychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity.
- Other therapies: There are a number of controversial therapies or interventions available for autistic children, but few, if any, are supported by scientific studies. Parents should use caution before adopting any of these treatments.
The National Institute of Neurological Disorders and Stroke (NINDS) is one of the federal government’s leading supporters of biomedical research on brain and nervous system disorders. The NINDS conducts research in its laboratories at the National Institutes of Health in Bethesda, Maryland , and also awards grants to support research at universities and other facilities.
As part of the Children’s Health Act of 2000, the NINDS and three sister institutes have formed the NIH Autism Coordinating Committee to expand, intensify, and coordinate NIH’s autism research. Eight dedicated research centers across the country have been established as “Centers of Excellence in Autism Research” to bring together researchers and the resources they need. The Centers are conducting basic and clinical research, including investigations into causes, diagnosis, early detection, prevention, and treatment, such as the studies highlighted below:
- investigators are using animal models to study how the neurotransmitter serotonin establishes connections between neurons in hopes of discovering why these connections are impaired in autism
- researchers are testing a computer-assisted program that would help autistic children interpret facial expressions
- a brain imaging study is investigating areas of the brain that are active during obsessive/repetitive behaviors in adults and very young children with autism
- other imaging studies are searching for brain abnormalities that could cause impaired social communication in children with autism
- clinical studies are testing the effectiveness of a program that combines parent training and medication to reduce the disruptive behavior of children with autism and other ASDs
Where can I get more information?
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute's Brain Resources and Information Network (BRAIN) at:
BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov
Information also is available from the following organizations:
| Association for Science in Autism Treatment P.O. Box 188 Crosswicks, NJ 08515-0188 info@asatonline.org http://www.asatonline.org Tel: 781-397-8943 Fax: 781-397-8887 | Autism National Committee (AUTCOM) P.O. Box 429 Forest Knolls, CA 94933 http://www.autcom.org |
| Autism Network International (ANI) P.O. Box 35448 Syracuse, NY 13235-5448 jisincla@mailbox.syr.edu http://ani.autistics.org | Autism Research Institute (ARI) 4182 Adams Avenue San Diego, CA 92116 director@autism.com http://www.autismresearchinstitute.com Tel: 619-281-7165 Fax: 619-563-6840 |
| Autism Society of America 7910 Woodmont Ave. Suite 300 Bethesda, MD 20814-3067 http://www.autism-society.org Tel: 301-657-0881 800-3AUTISM (328-8476) Fax: 301-657-0869 | MAAP Services for Autism, Asperger's, and PDD P.O. Box 524 Crown Point, IN 46308 info@maapservices.org http://www.maapservices.org Tel: 219-662-1311 Fax: 219-662-0638 |
| Autism Speaks, Inc. 2 Park Avenue 11th Floor New York, NY 10016 contactus@autismspeaks.org http://www.autismspeaks.org Tel: 212-252-8584 California: 310-230-3568 Fax: 212-252-8676 | National Dissemination Center for Children with Disabilities U.S. Dept. of Education, Office of Special Education Programs P.O. Box 1492 Washington, DC 20013-1492 nichcy@aed.org http://www.nichcy.org Tel: 800-695-0285 Fax: 202-884-8441 |
| National Institute of Child Health and Human Development (NICHD) National Institutes of Health, DHHS 31 Center Drive, Rm. 2A32 MSC 2425 Bethesda, MD 20892-2425 http://www.nichd.nih.gov Tel: 301-496-5133 Fax: 301-496-7101 | National Institute on Deafness and Other Communication Disorders Information Clearinghouse 1 Communication Avenue Bethesda, MD 20892-3456 nidcdinfo@nidcd.nih.gov http://www.nidcd.nih.gov Tel: 800-241-1044 800-241-1055 (TTD/TTY) |
| National Institute of Mental Health (NIMH) National Institutes of Health, DHHS 6001 Executive Blvd. Rm. 8184, MSC 9663 Bethesda, MD 20892-9663 nimhinfo@nih.gov http://www.nimh.nih.gov Tel: 301-443-4513/866-615-NIMH (-6464) 301-443-8431 (TTY) Fax: 301-443-4279 |
"Autism Fact Sheet," NINDS. Publication date April 2006.
NIH Publication No. 06-1877
Back to Autism Information Page
See a list of all NINDS Disorders
Prepared by:
Office of Communications and Public Liaison
National Institute of Neurological Disorders and Stroke
National Institutes of Health
Bethesda, MD 20892
NINDS health-related material is provided for information purposes only and does not necessarily represent endorsement by or an official position of the National Institute of Neurological Disorders and Stroke or any other Federal agency. Advice on the treatment or care of an individual patient should be obtained through consultation with a physician who has examined that patient or is familiar with that patient's medical history.
All NINDS-prepared information is in the public domain and may be freely copied. Credit to the NINDS or the NIH is appreciated.
Last updated April 11, 2008
Already a member? Click here to log in
