bmj.com Rapid Responses for Hopkins Tanne, 330 (7483) 112

Rapid Responses to:

NEWS ROUNDUP:
Janice Hopkins Tanne
Increase in autism due to change in definition, not MMR vaccine
BMJ 2005; 330: 112-d [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Increase in autism: Joav Merick, Meir Lotan, and Eli Carmeli (14 January 2005)

Dubious Diagnostic Disconnect: Lenny Schafer (14 January 2005)

Re: Increase in autism - have I missed something: John Stone (14 January 2005)

This could be a real increase...: James M. Howard (14 January 2005)

20 years ago, my children look autistic too: Kathy Blanco (14 January 2005)

Autism rise misrepresented: Caroline M Gulian (15 January 2005)

Re: Re: Increase in autism - have I missed something: Aasa H. Reidak (16 January 2005)

Re: Increase in autism due to change in definition, not MMR vaccine: Raymond Gallup (16 January 2005)

Re: Autism rise misrepresented: Aasa H. Reidak (16 January 2005)

Looking Out of Olmsted County: F. Edward Yazbak (18 January 2005)

My goodness - someone else feels as I do!: Jamie S Robertson (18 January 2005)

Re: My goodness - someone else feels as I do!: John P Heptonstall (19 January 2005)

Re: My goodness - someone else feels as I do!: Elizabeth A. Birt (19 January 2005)

Misdirection! or What's the Issue?: Kathleen (Katie) M. Hill (19 January 2005)

Re: Misdirection! or What's the Issue?: Maria Acosta (20 January 2005)

Re: Looking Out of Olmsted County: Camille C Clark (20 January 2005)

Almost Five Years Ago: F. Edward Yazbak (21 January 2005)

Re: Looking Out of Olmsted County: Lenny Schafer (21 January 2005)

Re: Looking Out of Olmsted County: Raymond Gallup (21 January 2005)

Vaccinate the vaccinators: Alan D Rees (22 January 2005)

Re: Re: Looking Out of Olmsted County: Camille C C Clark (22 January 2005)

The Autism Epidemic-Recognize It or Pay for the Consequences of It: Raymond Gallup (22 January 2005)

Historic autistic geniuses: John Stone (23 January 2005)

The problem is lack of institutional memory.: Hilary Butler (23 January 2005)

Re: The problem is lack of institutional memory.: Lisa C Blakemore-Brown (24 January 2005)

Re: The Autism Epidemic-Recognize It or Pay for the Consequences of It: Raymond Gallup (24 January 2005)

Re: Re: The problem is lack of institutional memory.: Alan Challoner MA (Phil) MChS (25 January 2005)

Re: Vaccinate the vaccinators: L. Travis Haws (25 January 2005)

Re: Re: The problem is lack of institutional memory.: Camille C Clark (25 January 2005)

Re: Re: Vaccinate the vaccinators: Alan Challoner MA (Phil) MChS (25 January 2005)

A previously unreported study by Smeeth et al: John Stone (26 January 2005)

Re: Re: My goodness - someone else feels as I do!: Jamie Robertson (26 January 2005)

Re: Re: Re: Vaccinate the vaccinators: L. Travis Haws (27 January 2005)

Science, or brass neck?: John Stone (27 January 2005)

Re: A previously unreported study by Smeeth et al: Peter J Flegg (28 January 2005)

Re: Re: Re: My goodness - someone else feels as I do!: Peter J Flegg (28 January 2005)

Re: Re: Re: Re: Vaccinate the vaccinators: Peter J Flegg (28 January 2005)

Re: Science, or brass neck?: Hilary Butler (28 January 2005)

Re: Re: Re: Vaccinate the vaccinators: John Stone (28 January 2005)

Imbalance in autism studies? Yeah, probably, but...: Jamie S Robertson (29 January 2005)

Re: Peter Flegg on a previously unreported study by Smeeth et al: John Stone (29 January 2005)

Re: Re: Re: Re: Re: Vaccinate the vaccinators: L. Travis Haws (29 January 2005)

Re: Re: Re: Re: My goodness - someone else feels as I do!: Camille C Clark (29 January 2005)

Re: Re: Re: Re: My goodness - someone else feels as I do!: Alan Challoner MA (Phil) MChS (29 January 2005)

Re: Re: Re: Re: My goodness - someone else feels as I do! (Peter Flegg): John Stone (29 January 2005)

Re: Imbalance in autism studies? Yeah, probably, but...: John Stone (29 January 2005)

Re: Imbalance in autism studies? Yeah, probably, but...: John Stone (31 January 2005)

Swedish doctor prosecuted for refusal to hand over patient data: Raymond Gallup (31 January 2005)

Re: Imbalance in autism studies? Yeah, probably, but...: Tony Floyd (31 January 2005)

Different, but united, views: Jamie S Robertson (31 January 2005)

Epidemiology and manipulation: Jamie S Robertson (31 January 2005)

Re: Re: Re: Re: Re: My goodness - someone else feels as I do!: Lisa C Blakemore-Brown (31 January 2005)

Re: Re: Re: Re: Re: My goodness - someone else feels as I do! (John Stone): Peter J Flegg (31 January 2005)

Re: Different, but united, views: John Stone (31 January 2005)

Re: Re: Different, but united, views: John Stone (1 February 2005)

Re: Different, but united, views: Peter J Flegg (1 February 2005)

Response to Peter Flegg: John Stone (1 February 2005)

A question for Peter Flegg.: Hilary Butler (1 February 2005)

Re: "...we should collaborate on a weekly column (where?)": Lenny Schafer (1 February 2005)

Re: Re: Re: Re: Re: Re: My goodness - someone else feels as I do! (John Stone): John P. Heptonstall (1 February 2005)

Re: Re: Re: Re: Re: Re: My goodness - someone else feels as I do! (John Stone): Jayne LM Donegan (1 February 2005)

Random challenges...: Jamie S Robertson (1 February 2005)

We have a right as parents to know.: Christina England (2 February 2005)

The life sentence versus the death sentence: John Stone (2 February 2005)

Enoch Powell found the same problems: Alan Challoner MA (Phil) MChS (2 February 2005)

Re: Re: Re: Re: Re: Re: Re: My goodness - someone else feels as I do! (John Stone): Peter Flegg (3 February 2005)

Re: Re: Re: Re: Re: Re: Re: My goodness - someone else feels as I do! (John Stone): Joan Campbell (3 February 2005)

Re: Re: Different, but united, views--and properties of Helium and Lead: L. Travis Haws (3 February 2005)

Re: Re: Different, but united, views: John Stone (3 February 2005)

Anti Vaccine?: Christina England (3 February 2005)

Re: Re: Re: Different, but united, views--and properties of Helium and Lead: Peter Flegg (4 February 2005)

The emperor has no clothes: John Stone (4 February 2005)

Response to Donegan: Peter Flegg (4 February 2005)

Re: Re: Re: Re: Re: Re: Re: Re: My goodness - someone else feels as I do! (John Stone): John P. Heptonstall (4 February 2005)

How accurate are the statistics anyway?: Hilary Butler (4 February 2005)

Re: Response to Donegan: Jayne LM Donegan (4 February 2005)

Re: Re: Re: Re: Different, but united, views--and properties of Helium and Lead: L. Travis Haws (5 February 2005)

Obscured sight, when removing speck, perhaps?: Hilary Butler (5 February 2005)

Nutrition, infection and immunity.: Hilary Butler (5 February 2005)

Dr David Salisbury caught out but nevertheless bats on: Mark Struthers (5 February 2005)

Response to Flegg: Michael D Innis (5 February 2005)

Shifting the costs: John Stone (5 February 2005)

Confusion, truth and in which corner are you sitting?: Alan Challoner MA (Phil) MChS (5 February 2005)

Mumps and Rubella????: Christina England (6 February 2005)

Re: Mumps and Rubella????: Alan Challoner MA (Phil) MChS (7 February 2005)

The Finnish experience - a new study co-authored by Peltola: John Stone (7 February 2005)

Nine a Day: F. Edward Yazbak (8 February 2005)

Response: Peter Flegg (8 February 2005)

Re: The Finnish experience - a new study co-authored by Peltola: Hilary Butler (8 February 2005)

Re: Dr. Flegg - just a wee point....: Jamie S Robertson (8 February 2005)

Re: re Mumps and Rubella??: Christina England (9 February 2005)

Re: Response: L. Travis Haws (9 February 2005)

In response to Peter Flegg.: Hilary Butler (9 February 2005)

Re: Re: Dr. Flegg - just a wee point....: Peter J Flegg (9 February 2005)

Re: Re: Mumps and Rubella????: Mark Struthers (9 February 2005)

Peter Flegg's ' Response': John Stone (9 February 2005)

Ah, the joys of public health promotion...: Jamie S Robertson (9 February 2005)

Re: In response to Peter Flegg.: Mark Struthers (9 February 2005)

Hilary Butler (Re: In response to Peter Flegg): Peter Flegg (10 February 2005)

Re: Re: re Mumps and Rubella??: Peter Flegg (10 February 2005)

Re: Re: In response to Peter Flegg.: John Stone (10 February 2005)

Re Dr Flegg's wee point to Jamie Robertson.: Hilary Butler (10 February 2005)

Re: Re: Re: Mumps and Rubella????: Alan Challoner MA (Phil) MChS (10 February 2005)

Re: Response: John P Heptonstall (10 February 2005)

Re: Peter Flegg's ' Response': Peter Flegg (11 February 2005)

Re: Re: Response: Peter Flegg (11 February 2005)

The Infant Mortality Rate: An Index of a Nation�s Health: F. Edward Yazbak (11 February 2005)

My view may be simplistic but realistic.: Christina England (11 February 2005)

Re: Response to Dr Flegg and the pro-vaccine lobby: Mark Struthers (11 February 2005)

Why?: John Stone (18 February 2005)

Re: Re: Re: Response: John P. Heptonstall (19 February 2005)

Re: The Infant Mortality Rate: An Index of a Nation�s Health - Vaccination NOT the Holy Grail of Public Health Policy: John Stone (20 February 2005)

Question for Flegg: john lucas (21 February 2005)

Re: Question for Flegg: Jamie S Robertson (21 February 2005)

Pretest before you vaccinate, plausible way out of this mess: Kathy Blanco (22 February 2005)

Sudan 1 versus Thimerosal/Thiomersal: Lisa C Blakemore-Brown (22 February 2005)

Re: Re: Question for Flegg: Hilary Butler (22 February 2005)

Re: Re: Question for Flegg: j lucas (22 February 2005)

Talking turkey about smallpox...: Stevie M Gamble (22 February 2005)

Re: Intramuscular, not intravenous: Theo H Fenton (23 February 2005)

Re: Sudan 1 versus Thimerosal/Thiomersal: Dr John Rumbold (23 February 2005)

Re: Re: Intramuscular, not intravenous: C Johnson (24 February 2005)

Re: Re: Intramuscular, not intravenous: Lisa C Blakemore-Brown (24 February 2005)

Re: Question for Flegg: Peter Flegg (24 February 2005)

Re: Re: Re: Intramuscular, not intravenous: Christina England (27 February 2005)

Re: Re: Re: Intramuscular, not intravenous: Dr John Rumbold (27 February 2005)

Re: Re: Re: Re: Intramuscular, not intravenous: Christina England (28 February 2005)

Further to Peter Flegg and the TB ref.: Hilary Butler (28 February 2005)

Re: Re: Re: Re: Intramuscular, not intravenous: Aasa H. Reidak (28 February 2005)

Re: Intramuscular, not intravenous: C Johnson (28 February 2005)

Vaccination Statistics: Barry L Parnas (1 March 2005)

Re: Re: Re: Re: Intramuscular, not intravenous: Tony Floyd (2 March 2005)

Re: Re: Re: Re: Intramuscular, not intravenous: john e lucas (2 March 2005)

Re: Re: Re: Re: Re: Intramuscular, not intravenous: Dr John Rumbold (2 March 2005)

Re: Vaccination Statistics: Mark Struthers (2 March 2005)

Dr Rumbold and "conspiracy theories": John Stone (2 March 2005)

Re: Vaccination Statistics: John Stone (2 March 2005)

Re: Re: Re: Re: Re: Intramuscular, not intravenous: John Stone (3 March 2005)

Re: Dr Rumbold and "conspiracy theories": Dr John Rumbold (3 March 2005)

Re: Re: Re: Re: Re: Re: Intramuscular, not intravenous: Christina England (3 March 2005)

Re: Re: Re: Re: Re: Intramuscular, not intravenous: Dr John Rumbold (3 March 2005)

In reply to Tony Floyd.: Hilary Butler (3 March 2005)

Mark Struthers: Hilary Butler (3 March 2005)

Re: Further to Peter Flegg and the TB ref.: Peter Flegg (3 March 2005)

Re: Re: Re: Re: Re: Re: Intramuscular, not intravenous: Alan Challoner MA (Phil) MChS (4 March 2005)

Re: In reply to Tony Floyd.: Tony Floyd (4 March 2005)

Re: Re: Re: Re: Re: Re: Intramuscular, not intravenous: Dr John Rumbold (5 March 2005)

Re: Re: In reply to Tony Floyd.: John Stone (5 March 2005)

Tony Floyd's response.: Hilary Butler (5 March 2005)

Re: Re: Dr Rumbold and "conspiracy theories": John Stone (5 March 2005)

Re: Intramuscular, not intravenous: Theo H Fenton (5 March 2005)

Reply to Flegg: what is 8 years experience worth without autonomous critique?: Alexander H Russell (5 March 2005)

Re: Intramuscular, not intravenous: Dr Viera Scheibner (5 March 2005)

Re: Re: Re: Dr Rumbold and "conspiracy theories": Dr John Rumbold (5 March 2005)

Re: Tony Floyd's response.: Dr John Rumbold (5 March 2005)

Re: Re: Re: In reply to Tony Floyd.: Tony Floyd (5 March 2005)

A reply to Dr Rumbold in regard to the Japan study: John Stone (5 March 2005)

Dish of the Day: Red Herrings stuffed with Thiomersal - guaranteed 49.5% Mercury.: Lisa C Blakemore-Brown (5 March 2005)

John Rumbold and Japan.: Hilary Butler (5 March 2005)

The benefits of experience - Peter Flegg: Hilary Butler (5 March 2005)

Re: Re: Further to Peter Flegg and the TB ref.: Hilary Butler (5 March 2005)

Re: Re: In reply to Tony Floyd.: John P. Heptonstall (5 March 2005)

Re: Re: Re: Re: Re: Re: Re: Intramuscular, not intravenous: Aasa H. Reidak (5 March 2005)

Re: Hilary Butler: Jamie S Robertson (7 March 2005)

Re: Re: Re: In reply to Tony Floyd.: Tony Floyd (7 March 2005)

MMR and Japan: a commentary by Wakefield and Stott: John Stone (7 March 2005)

Re: Re: Intramuscular, not intravenous: Graeme Johnston (7 March 2005)

Re: Re: Re: Re: Dr Rumbold and "conspiracy theories": John P. Heptonstall (7 March 2005)

A Response to Dr Fenton: Alan Challoner MA (Phil) MChS (7 March 2005)

Re: Re: Re: Re: Re: Dr Rumbold and "conspiracy theories": Dr John Rumbold (7 March 2005)

Re: Re: Re: Further to Peter Flegg and the TB ref.: Peter Flegg (9 March 2005)

Tony Floyd makes some valid points.: Hilary Butler (9 March 2005)

Re: It wasn't just the references: Theo H Fenton (9 March 2005)

Re: Re: It wasn't just the references: Alan Challoner MA (Phil) MChS (10 March 2005)

Peter Flegg answer on TB: Hilary Butler (10 March 2005)

Danish study on Autism: Donna Arnold (10 March 2005)

Re: MMR and Japan: a commentary by Wakefield and Stott: Dr Viera Scheibner (15 March 2005)

Re: Re: MMR and Japan: a commentary by Wakefield and Stott: Alan Challoner MA (Phil) MChS (16 March 2005)

Increase in Autism Prevalence Not Due to Diagnosis Shift: Donna M Arnold (13 April 2005)

Increase in autism 14 January 2005

Joav Merick,
Medical director
Division for Mental Retardation, POBox 1260, IL-91012 Jerusalem, Israel,
Meir Lotan, and Eli Carmeli
Send response to journal:
Re: Increase in autism

EDITOR---This letter in response to the news that the increase in autism is due to a change in definition and not MMR vaccine (1).
Surveys conducted in the 1960s and 1970s examined the prevalence of autism as defined by Kanner (2), which today is looked upon as a narrow definition. Autism prevalence studies published before 1985 showed prevalence rates of 4 to 5 per 10,000 children for the broader autism spectrum and about 2 per 10,000 for the classic autism definition (3).
In the United Kingdom in 1979 Lorna Wing and Judith Gould (4) studied the prevalence in the Camberwell area of London and found a prevalence of 5 per 10,000 for those with an IQ under 70 and 15 per 10,000 with impairment of social interaction, communication and imagination or a total prevalence of 20 per 10,000. In Japan (5) a survey of children under 18 years showed that 2.33 per 10,000 had early infantile autism (2). The average prevalence rates of autistic children born between 1968 and 1974 was 4.96 per 10,000 children with boys to girl ratio of 9:1. A Swedish study from Gothenburg (6) of children born during 1962-76 found in 1980 that 2.0 per 10,000 had infantile autism.
Since 1985 there has been reported higher rates of autism from several countries, partly as a result of a broader definition and partly as a true increase in the number of cases (7). A study from the United Kingdom in 2001 (8) reported a prevalence rate of 16.8 per 10,000 children for autistic disorder and 62.6 per 10,000 for the entire autistic spectrum disorders. In Sweden a study of Asperger syndrome found a prevalence of 36 per 10,000 for Asperger and 35 per 10,000 for social impairment or a total prevalence of 71 per 10,000 for suspected and possible cases (9).
Studies in the United States have also found higher prevalence rates in recent years. One study from 1998 in Brick Township, New Jersey found 40 per 10,000 three to ten year old children for autistic disorder and 67 per 10,000 children for the entire autism spectrum (10). Data from California can show the dramatic increase in autism prevalence (11): In 1970 the prevalence rate for autism was 4 per 10,000, in 1997 it was 31 per 10,000 and in 2002 it was 31.2 per 10,000. The last published study was from five counties in Atlanta, Georgia (3) with a prevalence rate of 34 per 10,000 children aged 3-10 years.
AUTISM IN ISRAEL
To our knowledge there has only been one study of the incidence of autism in Israel, which was conducted in the north region for children born between 1989-93 in the Haifa area (12). This study was conducted through three service providers, where children with autism would have been registered and 26 children were found (21 males and five females), which resulted in an incidence rate of 10 per 10,000. Again as in other studies the male to female ratio was 4.2 male:1 female. The age at initial assessment and diagnosis was 32 months. There has not been any studies on the prevalence of the entire autistic spectrum disorders to date.
There is data on the total amount of children and adolescents treated by ALUT (Israel Society for Autistic Children) with 361 in 1993, 422 in 1995, 591 in 1998 and 641 in 1999(13), so here an increase can also be observed.
CONCLUSION
In recent years there has been a lot of concern about the possible increase in the prevalence of autistic spectrum disorders (14). Studies have shown an increase, but during these last twenty years the diagnostic criteria and definition have also changed, so many factors are at play, but it is evident that there has been an increase.
We therefore agree with the latest news (1) that the increase in autism is due to a change in the definition and not the use of the measles, mumps and rubella (MMR) vaccine, as found by the researchers at the Mayo Clinic in Rochester, Minnesota.
AFFILIATION
Joav Merrick, MD, DMSc is professor of child health and human development, director of the National Institute of Child Health and Human Development and the medical director of the Division for Mental Retardation, Ministry of Social Affairs, Jerusalem, Israel. E-mail: jmerrick@internet-zahav.net. Website: www.nichd-israel.com
Meir Lotan, MScPT, is a physiotherapist working at the Zvi Quittman Residential Center, The Millie Shime Campus, Elwyn Jerusalem with special interest in physiotherapy aspects on intellectual disability, Snoezelen and physical activity for children and adults with intellectual disability. He lectures on assistive technology at Department of Physical Therapy, Haifa University and Ben Gurion Univeristy. E-mail: ml_pt_rs@netvision.net.il
Eli Carmeli, BPT, PhD, is currently a Senior Lecturer of Gerontology and Anatomy and the chairman of the Department of Physical Therapy Department, Stanley Steyer School of Health Professions, Sackler Faculty of Medicne, Tel Aviv University. E-mail: elie@post.tau.ac.il Website: http://www2.tau.ac.il/Person/medicine/HealthSchool/researcher.asp?id=agfhfiffl
REFERENCES
1. Tanne JH. Increase in autism due to change in definition, not MMR vaccine. BMJ 2005;330:112-d.
2. Kanner L. Autistic disturbances of affectice contact. Nervous Child 1943;2:217-50.
3. Yeargin-Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, Murphy C. Prevalence of autism in a US Metropolitamn area. JAMA 2003;289(1):49-55.
4. Wing L, Gould J. Severe impairments of social interaction and associated abnormalities in children: Epidemiology and classification. J Autism Dev Disord 1979;9(1):11-29.
5. Hoshino Y, Kumashiro H, Yashima Y, Tachibana R, Watanabe M. The epidemiological study of autism in Fukushima-ken. Folia Psychiatr Neurol Jpn 1982;36(2):115-24.
6. Gillberg C. Infantile autism and other childhood psychoses in a Swedish urban region. Epidemiological aspects. J Child Psychol Psychiatry 1984;25(1):35-43.
7. Fombonne E. The prevalence of autism. JAMA 2003;289(1):87-9.
8. Chakrabarti S, Fombonne E. Pervasive developmental disorders in preschool children. JAMA 2001;285:3093-9.
9. Ehlers S, Gillberg C. The epidemiology of Asperger syndrome. A total population study. J Child Psychol Psychiatry 1993;34(8):1327-50.
10. Bertrand J, Mars A, Boyle C, Bove F, Yeargin-Allsopp M, Decoufle P. Prevalence of autism in a United States population. Pediatrics 2001;108:1155-61.
11. California Dept Dev Services. Autistic spectrum disorders. Changes in the California caseload. An update: 1999 through 2002. Sacramento, CA: California Health and Human Services, 2003 (www.dds.ca.gov)
12. Davidovitch M, Holtzman G, Tirosh E. Autism in the Haifa area. An epidemiological perspective. Irs Med Ass J 2001;3:188-9.
13. Ben-Arieh A, Tzionit Y, Beenstock-Rivlin Z, eds. The state of the child in Israel. A statistical abstract 2000. Jerusalem: Isr Nat Council Child, 2001.
14. Hyman SL, Rodier PM, Davidson P. Pervasive developmental disorders in young children. JAMA 2001;285(24):3141-2.
Competing interests: None declared

Dubious Diagnostic Disconnect 14 January 2005

Lenny Schafer,
Publisher
9629 Old Placerville Road, Sacramento, CA 94827
Send response to journal:
Re: Dubious Diagnostic Disconnect

First, the quoted figure of "36000 children" who cases were examined is in error, the correct number being 3,000. 36,000 children with developmental disorders in one county might have raised the eyebrows of even our somnolent public health department by now. But even without such errors, the findings are fantastic enough. This appears to be yet another �cooked� study undertaken by pediatricians with a questionable agenda. If there is no real dramatic increase in autism, then there is nothing really to be alarmed about, especial over possible iatrogenic factors like toxic vaccines at the source. Problem solved, we can all go home. But the disorders of only 124 out of 3,000 children were correctly identified? If the diagnostic skills of their own specialty doctors have only a 4% accuracy rate on this one disorder alone, in one county alone, Minnesota has a public health emergency on their hands, one should think.
How many children in Minnesota are suffering from potentially dangerous medical treatments for illnesses they don�t have, and the ones they do have being neglected, due to such amazingly poor diagnostic skills? One wonders what the malpractice insurance rates are going to look like there after the news of this story gets around. It appears that the researchers didn�t just cook their paper a little; they let the cake burn to a crisp. Anything that looks too bad to be true probably isn�t true.
Competing interests: A child with autism

Re: Increase in autism - have I missed something 14 January 2005

John Stone,
none
London N22
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Re: Re: Increase in autism - have I missed something

I am completely confused. Are Mer(r)ick et al saying there has been an increase, or are they saying there has not been an increase? Are they saying this is what they think or they saying that the sources that they cite establish it as a scientific fact (whichever it is)? What predisposes them to believe (if this is what they believe) that autism is static in incidence? If they believe that there has been an increase after all what predisposes them to believe that MMR is not implicated?
There are, of course, various investigatory methods for establishing whether their children may have suffered environmental or vaccine damage if they are interested.
Competing interests: Parent of an autistic child

This could be a real increase... 14 January 2005

James M. Howard,
independent biologist
Fayetteville, Arkansas, U.S.A.
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Re: This could be a real increase...

Some years ago, the increase in breast cancer was believed to result from increased surveillance. This has since been replaced by acceptance of a real, biological increase in breast cancer. This is currently the state of the debate regarding an "increase" in autism.
I think increased maternal testosterone may produce autism, among other disorders. I also think the "secular trend," the increase in size and earlier puberty in children actually is an increase in the percentage of individuals of higher testosterone within our populations with time. As they increase in time, so do their characteristics and associated phenomena. So, an increased number of mothers of higher testosterone should produce an increase in the numbers of offspring with autism, and other disorders. This is why I think the "increase" in autism is real and may eventually be accepted in the same manner as the increase in breast cancer.
(Some suggest the secular trend is due to increased nutrition. I suggest increased calories do not cause the trend but simply accelerate it. That is, increased nutrition increases reproductive rates and "appears" to cause the trend.)
Competing interests: None declared

20 years ago, my children look autistic too 14 January 2005

Kathy Blanco,
Mother
97006
Send response to journal:
Re: 20 years ago, my children look autistic too

About 20 years ago, I walked into the Stanford Autism Clinic to receive the most devastating news of my life, AUTISM. I didn't even know what the word meant, but it didn't take me long to know, it would completely change my life. If I were to take my same child in today, and have him diagnosed by BRYNA SIEGAL, who set forth the criterian of DSM3r for most of the major colleges, universities and qualified researchers, she would have said the same thing, as she said then, AUTISM. She further diagnosed my infant in my lap as having some kind of developmental suggestion of autism. I thank her for that. Because of that reality bite, I was able to put my daughter into early intervention, which my son didn't have, and today she is extremely high functioning. BUT STILL AUTISTIC.
The point I am making is, I don't see these journals, and these authors having any forms of judgement, that ASD as they call it, is a crisis of untold proportions! I still think 1/166 children according to NIH is an epidemic no matter how you slice it, and beyond that 1/6 children having forms of developmental, psychological and mental problems in our nation, a crisis-even though we don't put it under the umbrella of autism.
All these arguments of underconnectivity, and brain not maturing, etc etc, is all worth our time and efforts, but we must ask how can regression happen in a child who seemed to develop milestones, and then lose them? For the children who seemed to not develop at all into a cogent normal child, the same questions need to be asked, just backing them up to what happened in utero. In my mind, their are many ways to destroy neurons and pathways, beyond a vaccine, it has to be a combination of factors, immune and metabolic genetics and what kind of exposures these parents have had and oxidative stress in it's many forms...
What is more damning, is that these people refuse to look at the biological aspects of autism, the etiological environmental agents causing autism, beyond the MMR, such as mercury toxicity in mothers and birthing process known to cause autism in monkeys via immediate cord clamping, and the other aspects of autism such as poor immune quality, metabolic quality and autoimmune HLA propensity. Had they done their homework, we wouldn't be here worrying about definitions, but worrying why so many of these children are being damaged, knowingly, or unknowingly. My bet is knowingly.
Most of the time, parents who have children with autism don't need to be reinforced that they are making up what they saw in reality or that they are refridgerator parents and can't accept reality, and test with impunity in their children, such as autistic enterocolitis, an immune process of autoimmunity due to molecular mimicry, or a systemic persistent infection in the CNS and gut that came out of "thin air", or an infection that is known to cause demylination, such as lyme (which is in my estimation the first cause of autism). My son had a clear vaccine reaction, with high pitch screaming, febrile convulsions etc. What these people also fail to tell parents is that when the child is vaccine reacting, they are reacing to and with and for fever suppression medicines, known to further exasterbate the situation but recommended while vaccine reacting, with the viruses in vaccines, pulling the infection deeper into the immune system and ruining the fever response and immune quality of the child. I wish, I wish for the day, that these people would take their dunce caps off, and see reality, see, and feel our children for who they really, really, are...systemically ill.
Fiddle dee, these people are fiddling with the definitions, while children are suffering. If you want parents on your boat, you best find a way to listen to them, and see their tests that show their children are sick. Instead, we want to know if we diagnosed the child right? I almost don't care about the diagnosis, as much as how sick my child is?
Competing interests: Parent of two children with autism, vaccine induced, environmental induced, predisposed by autoimmunity in the family

Autism rise misrepresented 15 January 2005

Caroline M Gulian,
N/A
183 Suburban Avenue, 11729
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Re: Autism rise misrepresented

In response to your article that the rise of autism is directly related to awareness, I need to point out that, while it is true that certain conditions were once not recognized as autism, even profound autism (which has always been recognized as autism) has increased dramatically. In the four-year span December 1998 to December 2002, for instance, there was a 97 percent increase in just strictly-defined autism cases in California (DSM III and DSM IV autism, excluding children with other PDDs such as Asperger�s Syndrome). I remain neutral as to whether the vaccines contribute to this factor, although it is important to clarify this. The link between vaccines and autism cannot be completely disregarded as there are a very small percentage (less than 1%) of children who are at risk for developing negative reactions to vaccines because of inability to process thimerosal.
In summary, because of the chain of events started since vaccines were mandated, it simply cannot be ruled out until a definate cause is "ruled-in". Parents should not be discouraged from having their children vaccinated, but their decisions should be made after knowing the facts, and knowing that like many other medical procedures, there are risks involved.
Competing interests: None declared

Re: Re: Increase in autism - have I missed something 16 January 2005

Aasa H. Reidak,
elementary teacher
Toronto M5B 2H9
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Re: Re: Re: Increase in autism - have I missed something

I cannot help but wonder whether William Barbaresi might not have noticed a greater increase in the incidence of autism, had he continued to look at more recent years, beyond 1997. In the 1990's, there was a significant increase in the number of vaccines added to the childhood vaccination schedule in the States.It would also be interesting to know what the incidence of other forms of ASD/PDD, ADHD, and other related neurological disorders were for the years studied.
Although I live in Canada, my youngest son, who was born in 1994, did not receive his diagnosis of ASD/PDD until 1999. An older brother of his did not receive his Asperger's diagnosis until a few years later in 2001. With vaccines, some adverse effects may take time to become apparent and it may take years to get a diagnosis.
The California Department of Developmental Services (DDS), has just experienced the largest number of new intake cases of children with professionally diagnosed full syndrome autism during the 2004 Fourth Quarter reporting period in its 36-year history. They added a record 807 children (October-December) with full syndrome autism, not including any children with any other autism spectrum disorder (such as PDD-NOS, Asperger's etc.). In the 2003 Fourth Quarter, they had 676 intakes with autism. In the Fourth Quarter of 1994, they had 142 intakes with autism. They certainly don't believe that the increase could be due to better diagnosing.
For an interesting look at what may be going on in the States with regards to vaccines and the politics at play, one can tune in to Autism One Radio at http://autismone.org/radio/ . In the archive, there is a segment where Teri Small interviews Doctors Mark and David Geier. It is well worth a listen and contains reference to the part testosterone, along with thimerosal may play in the development of neurological disorders.
Competing interests: Have children diagnosed with neurological disorders

Re: Increase in autism due to change in definition, not MMR vaccine 16 January 2005

Raymond Gallup,
Founder of The Autism Autoimmunity Project
Lake Hiawatha, NJ 07034, USA
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Re: Re: Increase in autism due to change in definition, not MMR vaccine

I have not seen any clinical science done to explain why children with autism have tested positive for myelin basic protein antibodies, have elevated measles antibody titers or measles in the gut. At the same time this is not found in normal children.
Where is the clinical science to explain this other than what Dr. Andrew Wakefield and Dr. Vijendra Singh have found? I see computer based number studies to disprove a MMR vaccine link to autism but where is the clinical science to explain measles in the gut, elevated measles antibody titers and myelin basic protein antibodies? It is nice to have computer based number studies but where is the clinical science?
As far as an increase in autism due to a change in definition, then where are all these kids coming from? We never had autism in our family and when our son was born he was normal. He regressed into autism after receiving the MMR vaccine and we have the videotapes that show his speech was progressing and after the MMR, he lost his capabilities to speak. I have talked to hundreds of other families that saw the same thing.
If there is no autism epidemic then maybe we can insist there was no tsunami, only better earthquake detection.
While Janice Hopkins Tanne says Autism epidemic. What Autism epidemic?
I say Tsunami. What Tsunami? It would be the very same analogy. Think about it!
Whole generations of children are being written off by the medical community as non-entities. Even worse they are being denied and deprived of proper medical treatment. All because the medical community wants to deny an MMR vaccine link to autism.
Shameful!!!
Competing interests: Founder of The Autism Autoimmunity Project and father to Eric Gallup, who was born normal and regressed into autism after receiving the MMR vaccine

Re: Autism rise misrepresented 16 January 2005

Aasa H. Reidak,
elementary teacher
Toronto M5B 2H9
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Re: Re: Autism rise misrepresented

I do not know where Caroline Gulian got the information that there is a "very small percentage (less than 1%) of children who are at risk for developing negative reactions to vaccines because of inability to process thimerosal". From most of what I have read and heard over the past year, beginning in large part last February during the February 9th, 2004 Institute of Medicine's Vaccine Safety and Autism Review, the picture has become clearer in my mind that vaccine ingredients may indeed play a part in the development of neurological disorders, as may other sources of heavy metal neurotoxicants (including maternal dental amalgams) and other factors, such as testosterone levels, diet, and use of antibiotics etc. From what I can make sense of, it seems that there are at least several/perhaps many factors which can contribute towards children developing atypically neurologically but the addition of neurotoxicants to vaccines certainly does not help!
I found Janice Hopkins Tanne's article "Increase in autism due to change in definition, not MMR vaccine" downright confusing. Towards the end of the article, she was comparing the effects of vaccines which did or did not contain thimerosal in Minnesota and Denmark. How did she get from discussing autism and MMR to thimerosal? Supposedly, there is no thimerosal in MMR vaccines.
Despite all of this, the US CDC has issued an alarm that 1 out of 6 American children have a neurological disorder. I am truly surprised that more folks are not at least somewhat upset by this revelation. The CDC has also found that either 1 out of 5 or 6 (heard conflicting numbers here)women of child-bearing age have too much mercury in their systems and this may impact on their fetuses.
In any case, here in Canada too, we have a whopping number of children with various disorders and their numbers are also not decreasing.
Even though our government agencies seem to be busy burying their heads in the sand, there are folks who are ready and willing to stand up and try and corret this problem. Have a listen to Autism One Radio at http://www.autismone.org/radio/ .
Competing interests: Have children diagnosed with neurological disorders

Looking Out of Olmsted County 18 January 2005

F. Edward Yazbak,
Pediatrician, Director
T L Autism Research, Falmouth, Massachusetts 02540 USA
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Re: Looking Out of Olmsted County

In her �News Roundup�, (1) Ms. Janice Hopkins Tanne reports that according to a recent study from the Mayo Clinic: �Changes in the definition of autism, rather than use of the measles, mumps, and rubella vaccine (MMR vaccine), led to increased diagnosis of autism in the United States and probably in Europe�.
This sweeping conclusion was based on a review and analysis of available data for the period between 1976 and 1997 from relatively isolated Olmsted County, Minnesota.
According to the US census Bureau, the population of Olmsted County was 84,104 in 1970 and 124,277 in 2000 (2).
The authors identified 124 (one hundred and twenty four) children under 21 with autism, reviewed their charts and concluded that: �Most had not been diagnosed as having autism, but rather as having developmental delay, delayed speech and language development, attention deficit or hyperactivity disorder, and mental retardation�.
AUTISM; DEFINITION and DIAGNOSIS
In the United States, (3) the definition and diagnosis of autism have been based since 1994 on the clear criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV).
The diagnosis is usually made by trained physicians and reviewed by Special Education specialists in the different school districts, before services are provided.
Because of the cost involved and the shrinking Special Ed budgets, it is unlikely that services would be provided to anyone who does not clearly fit the criteria.
In 1994, there were 22,780 children diagnosed with autism and autistic spectral disorders (ASD) aged 6 to 21 in US schools according to the US Department of Education (DOE) reports to Congress. This number increased on average by 22% per year (18.28 - 26.48%/yr) to reach 140,972 in 2004. (3, 4)
According to the same sources, the number of children with autism aged 6 to 21 attending Minnesota schools increased from 296 in school year 1992-1993 to 4,116 in 2002-2003, a 1300% increase in 10 years. The number of such affected students reached 5,076 in school year 2003-2004, a 23% increase in a single year. (4)
In January 2004, HHS, CDC and AAP jointly issued an �Autism A.L.A.R.M.� warning that the prevalence of autism (autistic spectrum disorders) in the United States was 1 in 166 children. (5)
According to recently released figures by the California Department of Developmental Services (6, 7), a record 807 NEW cases of Type I autism (aged 3 years or older and not including children with other ASD) were admitted into the system in the Fourth Quarter of 2004. This is the largest number of new cases for any October to December period in 36 years. It is 16% higher than the Fourth Quarter of 2003 (676 new cases) and 468% more than the last 3 months of 1994 (142 new cases).
On average, California added 9 new children with type I autism DAILY to its system from October 1 to December 31, 2004.
To put all this into perspective, while there were apparently 124 children with autism in Olmsted County, MN in 21 years, according to the Mayo Clinic study, California will register the same number of new cases in the next two weeks.
In school year 2003-2004, there were 19,034 children with autism/ASD aged 6 to 21 in California and as mentioned earlier, 5,076 in Minnesota.(4) In 2003, the population of Minnesota was estimated at 5,059,375 (8) and that of California at 35,484,453 (9). The percentage of children with autism (ages 6 to 21) to the population was therefore 0.1 in MN and 0.05 in CA, a surprising and alarming finding indeed.
The team from the Mayo Clinic can not tell parents that autism represents a small change in definition, when these parents are facing children who convulse, scream and bang their heads all day, or who have severe bloody diarrhea or severe constipation for two weeks at a time, or who meltdown in the supermarket and at church or who freak out when the garage door opens or when the neighbor starts his lawn mower, or who can never be left alone for a minute � and who were born normal and will certainly need help for the rest of their lives.
One can only also imagine the outrage of school superintendents (who are responsible for the training and education of these children until they turn 21) or municipal and state legislators (who have to fund all the needed services), when informed that all the challenges they are facing now always existed but with a different name. The fact is that public authorities and school districts are overwhelmed by the recent rapid increase of their financial responsibilities.
MMR and AUTISM
According to the CDC, the UK DOH and other �experts�, no one knows what is really causing this recent epidemic of autism, whatever it is called and however it is defined, but one thing is absolutely certain: It is not caused by vaccines or thimerosal and certainly not by the MMR.
Obviously many parents who have seen their children literally disappear after receiving an MMR vaccination are convinced otherwise.
In hundreds of these children, a specific type of enterocolitis has been identified; Some have evidence of measles virus genomic RNA in the CSF, some in the gut wall and some in both sites.
Many affected children have specific patterns of urinary polypeptides, high serum measles and MMR antibody titers and elevated Myelin Basic Protein auto-antibody levels.
In fact, it will be safe to say that it is impossible to find ONE normal child who has evidence of both MMR antibody and Myelin Basic Protein auto-antibodies in his serum or his CSF or ONE child who regressed after MMR vaccination and who does not have at least one of the following: The typical enterocolitis of autism, a suggestive pattern of urinary polypeptides, elevated serum measles virus antibody, MMR antibody or Myelin Basic Protein auto-antibodies. (10)
Those who want to deny that MMR can precipitate autistic regression in genetically predisposed children will keep studying old clinic records in North-West London and Olmsted County, MN, look for evidence in spreadsheets in Denmark and produce epidemiological studies that will not stand up to scrutiny.
On the other hand, those who are searching for the truth, will use their time and talent to interview parents and examine children.
References
1. BMJ 2005;330:112 (15 January), doi:10.1136/bmj.330.7483. 112-d
2. http://recenter.tamu.edu/data/popcd/pc27109.htm
3. Yazbak FE. Autism in the United States: A Perspective J .Am Phys Surg 2003; 8(4) 103-108 http://www.jpands.org/vol8no4/yazbak.pdf
4. http://www.ideadata.org/tables27th/ar_aa3.htm
5.http://www.ewg.org/reports_content/autism/pdf/AutismAlarm.pdf
6. http://www.dds.cahwnet.gov/autism/autism_main.cfm
7. SAR Volume 9, Number 6, Wednesday, January 12, 2005
8. http://quickfacts.census.gov/qfd/states/27000.html
9. http://quickfacts.census.gov/qfd/states/06000.html
10. A Black spot on a Good Journal
http://bmj.bmjjournals.com/cgi/eletters/329/7477/1293#90879
Competing interests: Grandfather of a boy with regressive autism, enterocolitis and evidence of measles virus genomic RNA in the gut wall

My goodness - someone else feels as I do! 18 January 2005

Jamie S Robertson,
Intercalating Medical Student (Immunology)
University of Glasgow, G12
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Re: My goodness - someone else feels as I do!

"...children with autism have tested positive for myelin basic protein antibodies, have elevated measles antibody titers or measles in the gut. At the same time this is not found in normal children... where is the clinical science to support this?"
Y'know, about a year ago I followed the threads of responses on this topic, and was asking the very same question. No-one, it seems, is able to come up with any sort of answer....
Competing interests: None declared

Re: My goodness - someone else feels as I do! 19 January 2005

John P Heptonstall,
Director of the Morley Acupuncture Clinic
Leeds LS27 8EG
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Re: Re: My goodness - someone else feels as I do!

Sir
I think Jamie should read Vijendra Singh's research, perhaps contact him in the States; he will no doubt be able to explain to Jamie the basic science behind that statement.
Regards
John H.
Competing interests: None declared

Re: My goodness - someone else feels as I do! 19 January 2005

Elizabeth A. Birt,
self employed
60091
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Re: Re: My goodness - someone else feels as I do!

As the parent of a child diagnosed by three independent physicians as having autistic enterocolitis I am troubled that anyone doubts that there is not only an autism pandemic but that individuals who are looking for evidence of severe immune system dysfunction, gastrointestinal disease and neuro- immune dysfunction can't seem to "find it". I am trained as an attorney but I have no problem finding these articles. I point you to two of recent interest that relate directly to my son's condition: Neuroglial activation and neuroinflammation in the brain of patients with autism, Annals of Neurology, 2005; and Spontaneous Mucosal Lymphocyte Cytokine Profiles in Children with Autism and Gastrointestinal Symptoms: Mucosal Immune Activation and Reduced Counter Regulatory Interleukin- 10.
My child was treated at the Royal Free in Dec of 1999 since that time he has been diagnosed with MRNA in his terminal ileum and cerebral spinal fluid. He just had a grand mal seizure the day before his 11th birthday and his bowel disease has progressed to the point he is in constant pain. This weekend he will be admitted to Childrens Memorial Hospital in Chicago for an endoscopy/colonoscopy and a surgeon will be on call in case a gastric tube is necessary. I suggest that everyone in this debate who can't find the evidence isn't really looking for it.
Competing interests: Founder,Medical Interventions for Autism; Founder SAFEMINDS; former Staff Attorney, Committee on Government Refore; parent of 11 year old diagnosed with autistic enterocolitis

Misdirection! or What's the Issue? 19 January 2005

Kathleen (Katie) M. Hill,
Welfare Recipient
Home, Hamilton, ON Canada L8L 2P2
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Re: Misdirection! or What's the Issue?

I think that this article misses the point entirely!
Children, as young as babies have immature/undeveloped (weak) immune systems. Children of today have immune systems which are being assaulted from a diversity of toxic, biological (chemical and microbial -- air, water and soil) sources, that frequently did not exist 1/2C or 1/4C ago. And those environmental toxins that did exist were at a greatly reduced concentration (over-all) from today. For various reasons, a child's immune system may be tipped into an inability to cope with i.e. protect against being overwhelmed by whatever harm is next coming at it (both prior to and in consequence of - MMR).
Vaccinations work by assaulting the immune system. Why are we placing our childrens' health at risk by assaulting our childrens' precious, delicate immune systems - 3x over (MMR) - when a single dose would function as required in the promotion of health? Answer -- private, for- profit driven that is now combined with and within public, financial efficiency!
Why would anyone place a mercury base (thimerasol) in a vaccine to provide to anyone -- let alone our children and our elders? Why do we call it thimerasol instead of mercury? Could it be for the same reason that retailers and manufacturers state - Ritalin - rather than amphetamine/ speed? Answer - public, financial efficiency that is private for-profit- driven!
How about we go back to vaccinating our children (under the age of 6), which includes our babies and toddlers, with a single dose vaccine, regardless of how inefficient this is in time, effort and finances AND see what happens? How about we don't discuss the pros and cons of experimenting on our children in the name of health promoting efficiency, by allowing known toxins to be force-fed to our children under the mask of a potential good for our children! Masking what? Masking whom?
And oh yeah! Who paid for this study and in what manner(s) was it paid? I think that it is time that all research investors and their investments were made known as a given in any research experiment. e.x. List of Investors/Investments -- akin to Purpose, Methodology and Results.
Competing interests: Lack a profit motive.

Re: Misdirection! or What's the Issue? 20 January 2005

Maria Acosta,
Biologist; Private consultant
Lorraine, QC J6Z 3Z1
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Re: Re: Misdirection! or What's the Issue?

I do agree with Ms Hill�s comments: children born today have to face many more pollutants/toxins than those born 100 years ago and even 30 years ago. A child born today starts conception with some strikes: both parents are intoxicated/contaminated and they pass those toxins to the newly conceived child. During his/her nine months of intrauterine development also faces toxic challenges; then the child is brought into a more toxic world. This is a fact for every child born today and the parents, particularly the mother, can only control so much. Control we can, but that is another topic.
There is another important point she brings up: �Why do we call it thimerasol instead of mercury?� In reality thimerosal is benzoic acid with mercury (C9H9HgNaO2S), also called thiomersal or, even more clearly: sodium ethylmercurithiosalicylate. Thimerosal is metabolized by the body into thiosalicylate and ethylmercury. �Thio� means that you find a sulfur molecule. Thiosalicylate is a salicylate. A point to remember is that benzoic acid and salicylate are used interchangeably.
For those parents, like me, who wondered where their child sensibility to salicylates and benzoates came from, thimerosal is the most probable answer.
Many children suffering from autism are also suffering from ADHD and dyslexia. They won the largest lotto ticket price: autism, ADHD and dyslexia. Some other children, like my daughter, won a smaller price: ADD and dyslexia.
You are right Ms Hill, thimerosal should be called what it is: a salicylate with mercury, a more than double edge sword.
With the exception of Professor Boyd Haley, to my knowledge no one has looked into the toxicity of the thiosalicylate part of thimerosal. His team found it to be not �as toxic on enzymes� as ethylmercury. As he pointed out, it does not mean that for some individuals it will not be toxic. Further study is needed. Until today, nobody is looking into it. Not even at the FAUS (Feingold Association of the US) anyone was aware of thimerosal being a salicylate. Another pharmaceutical best kept secret!
Competing interests: Mother of salicylate sensitive child

Re: Looking Out of Olmsted County 20 January 2005

Camille C Clark,
student
95616
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Re: Re: Looking Out of Olmsted County

Dr. Yazbak apparently hasn't read the latest quarterly report from the California Department of Developmental Services (1) as he makes the assumption that was made by Rick Rollens, a board of directors member of the University of California Davis, Medical Investigation of Neurodevelopmental Disorders institute (UC Davis MIND institute) (2) in a letter published in the online newsletter, "The Schafer Autism Report". That assumption is that the 807 new cases added to the rolls of the California DDS who are tallied as clients with "autism" are all toddlers. In fact, only 159 of them were 3, 4 or 5 years old when the data were collected.
If I may re-emphasize, in 3 months time, in the whole State of California 159 new clients were added to the DDS rolls who were aged 3 to 5. They also added 131 youths 14 to 17 years old, 202 young ones 10 to 13 years