Research, Early Signs and Treatment
4. THERE IS NO KNOWN SCIENTIFIC LINK BETWEEN VACCINES AND AUTISM
There's been widespread controversy about a possible connection between vaccines and the soaring autism rates. Some parents of children whose autistic symptoms first appeared shortly after their measles-mumps-rubella (MMR) immunization are convinced the shot was the cause, but repeated studies have failed to find scientific evidence. Although one small, heavily publicized British study published in 1998 suggested a link, 10 of the 13 authors publicly retracted the findings in March 2004, saying they were unreliable. The study, lead by Dr. Andrew Wakefield, only studied a small sample of 12 kids, eight of whom were diagnosed with autism. By early 2010, the same British journal, The Lancet, that published his findings retracted his study and in January 2011, the British Medical Journal publicly denounced Dr. Wakefield's research as "fraudulent." The British Medical Journal announced that Dr. Wakefield had "falsified data" and tampered with his research results to give the MMR vaccine bad publicity. At the time of his study, Dr. Wakefield had been involved in a lawsuit against the manufacturers of the MMR vaccine and would have gained money if he'd won, making his research an obvious conflict of interest.
Because the MMR vaccine is routinely given at 12 to 15 months -- when the first symptoms of autism often become noticeable -- the apparent association is a coincidence, says Parents adviser Neal Halsey, M.D., director of the Institute for Vaccine Safety at Johns Hopkins University, in Baltimore. Up to 40 percent of children with autism typically experience regression at 12 to 18 months; they start developing normally but then suddenly lose communication and social skills.
The possibility that mercury poisoning might cause autism is also a concern. Since the 1930s, a preservative called thimerosal, which contains small amounts of mercury, had been used in some childhood vaccines (not MMR). Although mercury is known to be harmful to the brains of infants and young children, most vaccine experts say the amounts used in the preservative were too tiny to cause neurological damage. Nevertheless, manufacturers voluntarily began removing thimerosal in 1999, and by the end of 2001, none of the routine vaccines given in early childhood contained the preservative. The preservative is now used only in flu shots and some vaccines given to adults and adolescents.
5. LARGE HEAD SIZE IS A RED FLAG
Recent findings published in the Journal of the American Medical Association suggest that the brains of children with autism develop differently from an early age. Researchers discovered that most infants who were later diagnosed with autism had small head circumferences at birth but had heads -- and brains -- much larger than normal by 6 to 14 months. "Some of them went all the way up to the 90th percentile in just a few months," says study coauthor Natacha Akshoomoff, Ph.D., an assistant professor of psychiatry at the University of California, San Diego. Those who ended up with the most severe form of autism were found to have the most dramatic acceleration of brain growth during infancy.
Pediatricians don't always measure head circumference at well-baby visits, so it's wise to request it. However, don't panic if your baby's head size is above the norm. Some babies just have big heads. "Rapid head growth is not a way to diagnose autism," Dr. Akshoomoff points out, "but it means that a child should be watched closely to be sure that she meets speech and behavioral milestones."
6. EARLY TREATMENT IS CRUCIAL
There is no known cure for autism, but intensive therapy helps a child learn a wide range of skills -- from making eye contact to hugging to having a conversation. And the sooner a child begins, the better. A panel of experts convened by the National Academy of Sciences in 2001 recommended that children should have 25 hours of therapy per week as soon as autism is suspected. Because children with autism have very different behaviors and abilities, the most effective approach takes into account a child's unique challenges and encourages healthy development through play, rather than just trying to change specific symptoms. "Intervention can take many forms, from going to a regular preschool to a parent's working with her child over the course of a normal day to direct therapies from well-trained teachers and professionals -- all depending on the child," Dr. Lord says.
Thanks to early intervention, some children -- like Nancy Wiseman's daughter, Sarah -- make remarkable progress. "At the very least, we're able to lessen the severity of symptoms," says Dr. Lord, who chaired the expert panel. "The latest studies show that almost 80 percent of kids with autism now have some speech by age 9, whereas only 50 percent of these kids were talking 20 years ago." And though past research suggests that most autistic children have below-average cognitive abilities, a recent study found that early treatment raised children's IQ scores by about 20 points, to almost normal levels. Those who started therapy as toddlers were also more likely to attend regular kindergarten.
One of the biggest remaining challenges is the shortage of trained therapists and spots in special-education programs and schools for children with autism. To address this problem, the federal government recently announced a ten-year plan to provide adequate services.
While there's still much about autism that remains a mystery, research scientists are making new discoveries every day. In fact, they say, it may be possible to cure autism one day -- perhaps through gene therapy even before a child is born. But for now, early diagnosis and therapy offer the best hope. "There's no doubt that today's generation of autistic kids will be better off than previous generations, because they're getting help sooner," Dr. Wetherby says.
Copyright © 2004. Reprinted with permission from the July 2004 issue of Parents magazine. Reviewed and updated 2013.