July 9, 2008

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Autism

Vaccinations and Autism: One Pediatrician's Perspective

Medical Author:David Perlstein, MD, FAAP
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR

One doctor's perspective on vaccines and autismWhen I was asked to write a Doctor's View about the Hannah Poling ruling, I hesitated initially, and then determined that it was one of my responsibilities as a pediatrician to give my opinions of the decision. Briefly, this is in response to the recent case in which the federal government ruled that Hannah Poling, a nine year old girl, was entitled to receive compensation from a federal vaccine injury fund after developing neurological delays, including signs and symptoms of autism, following administration of a number of vaccines in 2000. This decision added fire to the Blog-O-Sphere where it was seen as both a victory for anti-vaccine groups and as the Government's admission that vaccines are the cause of the increase in the incidence of Autism Spectrum Disorders. On March 6, 2008, after the Poling ruling, Dr. Julie Gerberding, Director of the Centers for Disease Control and Prevention, in response to a question about the government's ruling stated:

"Let me be very clear that government has made absolutely no statement about indicating that vaccines are a cause of autism. And that is a complete mischaracterization of the findings of the case and a complete mischaracterization of any of the science that we have at our disposal today."

First of all, as a general pediatrician working in the Bronx, and as a parent of children with medical and developmental problems, I can wholly appreciate the visceral nature of dealing with a child who is not "normal". I also want to be clear that, although I do not have child with autism, I recognize the challenges and emotional stress that is involved in raising a child with autistic features. I would like to personally praise Hannah's parents and especially her father Dr. Jon Poling, who has been adamant about his support of immunizing children against infectious diseases.

Read more of Dr. Perlstein's perspective »

Autism Overview

Autism is a complex disorder of the central nervous system that has the following 3 defining core features:

  • Problems with social interactions

  • Impaired verbal and nonverbal communication

  • A pattern of repetitive behavior with narrow, restricted interests 
A number of other associated symptoms frequently coexist with autism. Most people with autism have problems using language, forming relationships, and appropriately interpreting and responding to the external world around them.

Autism is a behaviorally defined neurodevelopmental disorder that begins in early childhood. Although the diagnosis of autism may not be made until a child reaches preschool or school age, the signs and symptoms of autism may be apparent by the time the child is aged 12-18 months, and the behavioral characteristics of autism are almost always evident by the time the child is aged 3 years. Language delay in the preschool years (younger than 5 years) is typically the presenting problem for more severely affected children with autism. Higher functioning children with autism are generally identified with behavioral problems when they are aged approximately 4-5 years or with social problems later in childhood. Autism persists throughout the person's lifetime, although many people are able to learn to control and modify their behavior to some extent.

Autism is classified by the American Psychiatric Association as one of a group of disorders known as the pervasive development disorders (PDD). In addition to autistic disorder, the pervasive developmental disorders include Asperger syndrome, childhood disintegrative disorder, Rett disorder, and pervasive developmental disorder not otherwise specified (PDD NOS).

  • All of these disorders are characterized by varying degrees of problems with communication, social interaction, and atypical, repetitive behaviors. This group of disorders is sometimes called the autism spectrum disorders (ASDs). 

  • There is a wide range of symptoms, severity, and other manifestations of these disorders. The expression of autism spectrum disorders varies widely from person to person. A child with significant impairment in all 3 of the core functioning areas (socialization, communication, and atypical, repetitive behaviors) may have autism, while a child with similar problems but without delays in language development may have Asperger syndrome. 

  • Some people are affected fairly mildly; many of these individuals learn to live independent lives. Others are more severely affected and require lifelong care and supervision.
Autism is a common developmental disorder.
  • About 1 in every 1000 people in the United States has autism, and the number of children diagnosed with autism spectrum disorders appears to be increasing. Although there is a concern that the actual number of children with autism spectrum disorders is increasing, several factors, such as improvements in diagnostic methods and the view of autism spectrum disorders as being on a continuum, can account for the increase.

  • As many as 1.5 million people in this country may have some form of autism.

  • Autism affects all races, ethnic groups, and socioeconomic levels.

  • Boys are 3-4 times more likely than girls to have autism.
There is no cure for autism. There is good news, however.
  • A generation ago, most children with autism were institutionalized. This is no longer the case and most children live with their families.

  • Our improving understanding of autism has shown that, regardless of the severity of the condition, appropriate treatment and education can eventually help many children with autism to be integrated into their community.

  • Early diagnosis is essential for implementing appropriate treatment and education at an early age, when they can do the most good.



Next: Autism Causes »


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