Autism and autistic spectrum disorders are serious, relatively common, and laden with questions and controversies. Dr. Daniel Coury has edited this Pediatric Annals issue full of terrific articles that summarize the major aspects of this field, which is important to all who treat children.
Much attention is now focused on this topic. Just in the few days prior to the writing of this column, Newsweek ran a cover story relaying the fact that 80% of autism cases occur in males, and the New York Times ran an article on an important new study from Denmark that found thimerosal is not a cause of autism.
Even though it is clear that genetic factors are involved in the etiology of autism, an autism-specific gene has not been identified. At the rapid pace of current research, achieving the goal of such identification may be closer at hand. Concerning therapy.
the paper by Drs. Butter and Mulick on page 677 details the principles of early intensive behavioral intervention (EIBI). Although expensive and very labor-intensive, EIBI has shown that many autistic children can be treated relatively successfully if begun early enough.
An aspect of autism that is critical to pediatricians is that it is not caused by immunizations. This is extremely important to convey to parents. The evidence is compelling, including the genetic data and the outstanding epidemiologic studies from Scandinavia. In 2002, Danish epidemiologists reported that the rates of autism and autistic spectrum disorder in children who had been vaccinated with MMR probably were a bit lower and were definately no higher than those of non- vaccinated children.1 This finding rules out MMR as causal for autism. A more recent study from the same group showed that the complete removal of thimerosal from vaccinations in 1992 in Denmark was not associated with a decrease in the rate of autism, indicating that it was not associated with autism.2
The importance of appropriate immunization of children is highlighted yet again by the recent reports of resurgent measles cases in Ireland in 2000 (1,407 cases, three deaths), the United Kingdom in 2002 (about 150 cases), the Netherlands in 1999 to 2000 (3,292 cases, three deaths), and most recently the Marshall Islands (a US protectorate) with more than 212 cases in 2003. In these areas, measles vaccine acceptance rates had declined sharply, usually because of misplaced safety concerns.
Because of an acute shortage of autism-related stamps, I have elected to include several immunizationrelated stamps here, to emphasize the lack of a relationship between autism and immunization. These include the blue stamp from Mauritius portraying protection against six childhood infections. The two Nicaraguan stamps show immunization orally and by injection, respectively, while the Egyptian stamps shows a worried-appearing infant with both oral vaccine and a needle coming toward him simultaneously.
1. Madsen KM, Hviid A, Vestergaard M. A population-based study of measles, mumps, and rubella vaccination and autism. W Engl J Med. 2002;347(19):1477-82.
2. Madsen KM, Lauritsen MB, Pedersen CB, et al. Thimerosal and the occurrence of autism: negative ecological evidence from Danish population-based data. Pediatrics. 2003; 112(3): 604-606.