Action For Autism

Voices for Vaccines reply to CBS

Yesterday I referred to Age of Autism, the self styled “Daily Web Newspaper of the Autism Epidemic.” It has an editor, Dan Olmsted, who believes that

Autism was triggered by the commercialization of ethyl mercury in vaccines and fungicides in the 1930s.

There is a legal editor, Kent Heckenlively, who is in favour of pro vaccine doctors,

those guilty of the enormous crime of harming our children being consigned to hell-fire and damnation.

Then there is the managing editor, Kim Stagliano, who may need to consult her legal editor after her latest scoop. Someone at CBS leaked a fax from Voices for Vaccines that Age of Autism published under Ms Stagliano’s byline with the headline,

Vaccine Industry Group Calls on Couric and Attkisson for CBS Retraction

Vaccine Industry Group? That suggests an organization that speaks for and is funded by the vaccine industry. However, according to their website

The most important goal of Voices For Vaccines is to provide clear, accessible, science-based information about vaccines and vaccine-preventable diseases.  Our leadership consists of scientists and concerned individuals who are totally committed to supporting continued efforts to eradicate vaccine-preventable diseases.  We accept no funding from governments or vaccine companies.

Voices for Vaccines works in partnership with a number of organizations like Every Child by 2 and the American Academy of Pediatrics. There are no drug company representatives on its steering committee. There is only one staff member and their office is provided by a not for profit organization, The Task Force for Child Survival and Development. Vaccine Industry Group? Hardly.

Here is the letter that was sent. I have redacted all contact information, though it published unredacted on the AoA website.

Voices For Vaccines objects to the defamatory allegations made by the CBS Evening News on Friday, July 25, against the American Academy of Pediatrics, Every Child By Two, and the Vaccine Education Center at the Children’s Hospital of Philadelphia, with our colleague Dr Paul Offit singled out for baseless criticism.

This strikes me as a reasonable and reasoned response to a terrible piece of journalism. Ms Stagliano does not comment on the substance of the letter. But the headline and the accompanying graphic suggest that this is a story about Big Pharma trying to gag the media to prevent unpleasant truths about their conflicts of interest being published.

Graphic from Age of Autism

The truth is somewhat different. As my fellow bloggers Orac, Kev and Autism Newsbeat have already pointed out, the reporter on this case, Sharyl Attkisson, provided no new information. Every fact in her story is a matter of public record. And many of those facts are mangled. Take for example Dr Offit’s academic research chair financed by $1.5 million from Merck. Actually it is a $2 million chair and his institution provide the rest of the endowment. Endowment means that Dr Offit is free to spend the money as he sees fit. Merck, by writing the cheque, have given him more independence not less.

Ms Attkisson is running true to form though. Orac reminds us that he had reason to take her to task for anti vaccine crankery last year as well. Reading her articles it is almost as if she has a direct line to the anti-vaccine fanatics. She repeats their favourite line of attack against Dr Offit, that he once said that an infant’s immune system was robust enough to tolerate a theoretical dose of 10,000 vaccines at once.  Dr Offit was not suggesting that we do this. He was merely using this to point out that the current vaccine schedule was well within safety levels. Nevertheless it is routinely trotted out to paint him as a monster.

Maybe she does have a direct line. Somebody leaked that fax to AoA and she was one of the recipients. Perhaps CBS should investigate their “investigative correspondent.” And if they find that her ties to a particular faction make her less than credible as a journalist I am sure that Kim and Kent and Dan will welcome her with open arms to the “Daily Web Newspaper of the Autism Epidemic.” 

This is not to say that journalists  should not be committed. But if you believe in something you should use all of your journalistic skills to make the best possible case. In contrast this is more like allowing personal prejudice to dull your professionalism and produce lazy, shoddy propaganda that appeals to nobody except the converted.

Perhaps Ms Attkisson should examine the career of the late Charles Wheeler to learn how to combine committment with integrity in what should be a noble profession.

SEE ALSO

Autism News Beat 

August 1st, 2008 Posted by Mike | autism epidemic, journalism, science, vaccines | 8 comments

Green Our Vaccines - update

The Green Our Vaccines Rally in Washington went off as expected. According to journalist and Vaccine author, Arthur Allen there were around 1500 in attendance. This news channel said there were hundreds but I watched the whole march go past on a traffic cam and estimated no more than 2000 so I will go with Arthur’s figure. Do the numbers matter? I think so.  The autism-vaccine connection has been espoused for at least 10 years now. There are around 5000 cases in the Autism Omnibus Proceeedings. Over half of these were filed in a single year (2003) and since then numbers have dropped steadily.

Table of petitions filed is taken from The National Vaccine Injury Compensation Program Statistics Reports

This shows that there was a very brief flurry in which thousands of parents signed up to the view that their child’s autism was vaccine related followed by a sharp decline. I find this table interesting for two reasons.

First, if either the increasing burden of vaccines themselves or the increasing burden of ethyl mercury in the thiomersal containing vaccines (TCVs) was behind the increase in autism prevalence that was recorded throughout the 1990s it is not apparent in the number of petitions filed for compensation. Whatever the reason for the increase in prevalence parents at the time did not connect their child’s autism to vaccines.

Second, once the idea of an autism epidemic was mooted and vaccine damage was posited as a possible cause, lots of autism parents looked back and said, “Maybe.” And a significant few said, “Definitely,” and took action. Hence the bulge in the statistics for vaccine damage claims.

At the same time scientists carried out studies and found no connection between vaccines and autism. Consequently very few additional parents have jumped onto the vaccine-autism bandwagon. So we have a highly motivated group of parents, brought together by  circumstances at a given moment in time, who now feel marginalized. They are convinced that they are right and equally convinced that they are victims of a conspiracy to deny them justice.

This is why the numbers are significant. A growing campaign, fuelled by new recruits would have attracted a far bigger crowd than the one seen in Washington this Wednesday. What we saw instead was a rump of increasingly embattled activists who sustain each other via a shared mythology. The more they are challenged the closer they cling together.  They comfort themselves with the thought that science is on their side. But in reality they can only maintain their world view by their denial of science. 

June 6th, 2008 Posted by Mike | Autism, Quackery, autism epidemic, parents, science | 3 comments

David Kirby on Autism in Scotland

Autism in Scotland

Scotland has a population of just over 5 million people. In 2004 The Scottish Executive published the Audit of Services for Autistic People Statistical Report. This was the result of a questionnaire sent out to all local authority/National Health Service partnerships. Two areas, Borders and Western Isles failed to respond and were excluded from the subsequent ananlysis of results. As a consequence the Audit deals with a total  population of approximately 4.9 million people.

The Audit found 3412 children and young people under 18 with a diagnosis of an autistic spectrum disorder. The Audit could only find 645 adults with a diagnosis of an autistic spectrum disorder. This finding has been taken as further proof of a putative autism epidemic by journalist David Kirby writing for The Age of Autism. Unfortunately for Kirby, he obviously has not read the report in question. Instead he offers

Many thanks to Clifford Miller for furnishing the Scottish audit data.

Miller also furnished this graph which Kirby faithfully reproduces.

A misleading source 

It looks like a figure taken from the Audit. But this figure is not in the PDF version that Miller links to. Nor is it in the word.doc that I have read. The clue is in those weasel words at the top of the figure, “Data Source.” Yes, Miller invented the figure based upon data gleaned from the audit. This would matter less if it was an accurate representation of the data source. But it is not. If we start at the bottom with “Average age of diagnosis of autism - approx three,” Average age of diagnosis is nowhere mentioned in the Audit. Furthermore, the Audit only contains data on people aged 3 years and older. So is Miller claiming that everyone in Scotland was diagnosed around their third birthday? How does he explain Howlin and Moore [1997] who found a mean age of 5.69 years for diagnosis in Scotland?

Miller’s second innovation is to give us four age groups: those born up to 1954, and those born in 15 year birth cohorts: 1955 - 1970, 1971 - 1986, 1987 - 2002. These are not the age groups in the data source. The Audit does not refer to date of birth. It refers to adults over 50, adults aged 25 to 49, adults aged 18 to 24 and children aged 3 to 18. As 18 is the legal age of majority in Scotland I am going to assume they mean “up to but not including 18″ when they refer to children. Of the birth dates you can derive from these ages: up to 1954, 1955 -1979, 1980 - 1986, 1987 - 2001, only the over 50s group matches. 

Miller is also dishonest when he compares adults to children in the same graph. Data for children is derived from the responses of 13 NHS boards. Only 10 NHS boards provided adult data. Those missing are

Ayrshire and Arran -  population  376,000

Forth Valley - population               300,000

Greater Glasgow - population    1,200,000.

So the figures for adults are based on a population of approximately 3 million rather 5 mllion. They exclude Glasgow, the most densely populated urban area in Scotland. None of this matters to Miller. He believes there is a world epidemic of autism in children, a pandemic that is caused by “vaccines.” He does not specify which vaccines, or which components or how they might be acting to cause his pandemic. He argues that if there is no pandemic there ought to be 500,000 autistic adults requiring 24/7 care in the UK. This is plain silly. Never mind that we are talking about a spectrum of need, where most autistic adults do not require 24/7 care. If Miller were right there ought to be 133,500 autistic children requiring 24/7 care in the UK. Some do require constant care but most clearly do not.

A tenfold error

So much for Kirby’s source. What does Kirby make of this material? It turns out that he makes a complete pig’s ear of it.

Let’s look at the numbers. There are approximately 34,000 young people with autism in Scotland, born during the 16 years from 1987-2002. That is an average of 2,125 cases per birth cohort. But among older people, born during the 31 years between 1955 and 1986, there are only about 600 reported cases, or just over 19 cases a year.

If the rate of autism in Scotland had remained unchanged between 1955 and today, then there are many, many uncounted adults going without support, services, or even much recognition.
In fact, at 2,125 cases on average per year, there should be 65,875 people with autism in Scotland between the ages of 22 and 53 years alone. But only 600 have signed up for any help at all, in a country with universal healthcare, no less.

Which begs a few questions: Where are the other 65,275 people in that age group with autism? Why have 109 out of every 110 adults with autism never sought, nor received, any special attention for their particular needs? Why have they not been counted? And why is there no national outrage over the neglect of so many thousands of fellow citizens going without services that they need?

In a country the size of Maine, with a population much smaller than New York City, it seems that the government would be able to locate and help these people.
Unless, of course, some of them are not there.

These figures are hogwash. Kirby may be able to use a calculator but he cannot read a graph. The figure is 3,400 not 34,000.  Incredibly this post has been up for over a week now and nobody seems to have spotted such an egregious error, neither managing editor Kim Stagliano, nor editor Dan Olmsted and certainly not Kirby himself. And none of his  supporters has posted a correction in the comments section, not even Barbara Fishkin who commented,

David

Thank you for this. Such piercing information. We won’t know what to do with our kids with autism as they age because THERE IS NO PRECEDENT. There never were kids afflicted like this before, in these numbers. We had better start preparing to make life work for our kids as they get older! Barbara

No there never were kids like this in these numbers before because these numbers are wrong! Over on Barbara’s website I read that:

Barbara Fischkin has taught students how to read and write journalism, creative nonfiction and fiction in the university classroom and for the country’s most respected writers’ organizations and institutes.  Her innovative method for teaching writing across the curriculum simulates the atmosphere of a newsroom and utilizes the techniques of the fiction writing workshop, while emphasizing the crucial difference between fact and fiction.

Hm … yes, that crucial difference between fact and fiction.

FOOTNOTE:

Kirby has published the same article on the Huffington Post. There are a few minor changes - a different title and no acknowledgements for Clifford Miller. I suppose that if you write for a rag like Age of Autism, sponsored by Generation Rescue linking to someone like Miller gives you credibility with the mercury malicia. But it is best to be more discreet if you want to be taken seriously as a journalist writing for a genuine internet newspaper. Oh and one other thing, if you want to be taken seriously it is best to take your readers seriously. Which may be why Kirby corrected the 34,000 figure in his HuffPo version below, but could not be bothered for his AoA readers.

EDIT: Kirby originally posted near identical versions of his post on AoA and HuffPo, both containing the egregious error. Thanks to Matt for providing the link. When people make corrections to published blogs they usual draw attention to it themselves as I am doing now. I thought journalists were supposed to have professional standards that placed them above the citizen blogger in the informational hierarchy. Apparently not.

Let’s look at the numbers. There are approximately 3,400 young people with autism in Scotland, born during the 16 years from 1987-2002. That is an average of 212 cases per birth cohort. But among older people, born during the 31 years between 1955 and 1986, there are only about 600 reported cases, or just over 19 cases a year. Click here to Download file

If the rate of autism in Scotland had remained unchanged between 1955 and today, then there are many, many uncounted adults going without support, services, or even much recognition.

In fact, at 212 cases on average per year, there should be nearly 6,600 people with autism in Scotland between the ages of 22 and 53 years alone. But only 600 have signed up for any help at all, in a country with universal healthcare, no less.

Which begs a few questions: Where are the other 6,000 people in that age group with autism? Why have 1 out of every 11 adults with autism never sought, nor received, any special attention for their particular needs? Why have they not been counted? And why is there no national outrage over the neglect of so many thousands of fellow citizens going without services that they need?

Taken at face value these are reasonable questions to ask. Whether it is reasonable to ask them of a data source compiled by civil servants from existing records is another matter. I will be much more interested in the questions and the answers that will arise from the recently announced Audit of Adults with Autism. Real data, fit for purpose is an all too rare occurrence in debates about autism.

May 11th, 2008 Posted by Mike | adults, autism epidemic, journalism, vaccines | 24 comments

When Friends Fall Out

A few weeks ago in my post on Rett Reversal and Neurodiversity I wrote

Now that there is a real possibility of a cure for Rett Syndrome some time in the future, will it undermine the movement for autism acceptance and encourage those whose aim is normalization? Some will certainly see it that way. But in the short to medium term I predict that it will increase the tension between organizations like Autism Speaks that are funding research into genetic causes for autism and those like NAA and Safe Minds who think they already know the cause and the cure and are only interested in research that confirms their prejudices. 

Well, it has happened. J. B. Handley, the driving force behind Generation Rescue and Put Children First, is circulating a letter entitled Bernie versus Bryna: The Trouble with Autism Speaks 

Bernie refers to Bernard Rimland, the recently deceased founder of the Autism Research Institute [ARI] and Defeat Autism Now! [DAN] Rimland has done more than anyone to promote the idea that autism can be treated with alternative therapies like megadoses of vitamns, special diets and chelation for heavy metal poisoning. Bryna refers to Bryna Siegel who wrote The World of the Autistic Child and is very much in the autism mainstream.  Handley is upset because Autism Speaks is sponsoring a conference hosted by Jump Start in San Francisco this Friday [March 9th] at which Siegel is the keynote speaker. This is why.

Bryna Siegel diagnosed my son. My son was the first client of “JumpStart” when it was still a part of UCSF and just in its infancy. Bryna Siegel told us that the GFCF diet was a “placebo for parents.” She has testified in court for vaccine manufacturers to ward of Thimerosal lawsuits (something she does not disclose to you while telling you the vaccine-autism link has been disproven.) She thinks the Danish studies thoroughly refute the Thimerosal-autism hypothesis. She told us our son had no “theory of mind” and that he’d probably never talk.

A parent who attends this workshop and asks a question about biomedical treatment will be told by an “expert” that biomedical treatment does not work. I should know, that’s what she said to me and my wife.

And, that’s my point about Autism Speaks: way too much Bryna and not enough Bernie.

Handley believes that there is an autism epidemic caused by mercury in vaccines. He believes in special diets, supplements and chelation therapy. He is using them to try and cure his son. He is mad at Autism Speaks founders Bob and Suzanne Wright because they have not publicly embraced and endorsed DAN and ARI. He finds this particularly galling because their autistic grandson is being treated by a DAN practitioner.  

But that is not the whole story. The Autism Society of America [ASA] and ARI announced a research partnership in October last year. But Rimland died shortly afterwards and there is little evidence on either organization’s website of progress in this area. At the same time Autism Speaks has been making real headway. Its video, Autism Every Day, received widespread coverage, including a showing at the Sun Dance Festival and was heavily promoted among politicians in the run up to approval for the Combatting Autism Act. Autism Speaks marked the anniversary of its successful merger with the National Association for Autism Research [NAAR] in February by finalising a merger with Cure Autism Now. [CAN] Autism Speaks was quick to announce its role (courtesy of CAN) in the recent widely publicized report of the Autism Genome Project. Autism Speaks has also established itself in the UK and in Canada. While its US website still affirms its commitment to

funding global biomedical research into the causes, prevention, treatments, and cure for autism.

the UK website has a much more inclusive statement that avoids mentioning cures. 

Autism Speaks is a registered charity that raises funds to accelerate biomedical research to determine and understand the causes and biological basis of autism spectrum disorders; and through that understanding to discover and promote new ways of improving the quality of life for all those affected.

This is part of an inevitable process of accommodation. Autism Speaks has an ambition

to become a worldwide organisation by developing communication, organisational and fundraising models that encourage funders, researchers and those affected by autism to work collaboratively across geographies to ensure that the needs and priorities of each are met.

Collaboration means compromise. Working in the mainstream means that you adapt to the consensus. In the UK the consensus is more congenial to autism acceptance than it is in the USA.  So Autism Speaks has adapted. Some advocates for neurodiversity remain deeply suspicious. I tend towards a cautious and watchful acceptance of their good faith, in the UK at least. Handley, on the other hand, is outraged because he suspects that Autism Speaks are going to drop their support for biomedical interventions to cure autism and accept that autism is more genetic than environmental. These are his complaints against Autism Speaks.

1.      You do not mention DAN! or biomedical treatment on your website, and you have no link to DAN! or ARI or any of the groups on our side of the fence.
2.      When you eulogized Bernie Rimland on your website, which would cause him to roll-over in his grave I am certain, you did not even mention biomedical treatment or recovered children, this is a glaring, glaring omission that speaks volumes about the mindset of the people running your organization.
3.      Your scientific advisory board is populated with some of our world’s worst enemies, including some who have stated on the record that there is no autism epidemic. And, your research choices support this. (The only environmental research you can claim to have sponsored deals with prenatal insults with the notable – and commendable – exception of Richard Deth).
4.      When I met with AS in the Fall, I asked a simple question: “Are you sending anyone from your organization to the DAN! Conference?” After some silence and stumbles, everyone turned to Andy Shih and his answer was basically “No.” The only person in the room more annoyed with this answer than myself was Katie Wright.
5.      None of the research ideas presented to you by Laura and Lyn have received further study or consideration, as far as I know.
6.      Kevin Barry, our former President, was hired by Autism Speaks. On his first day of employment, Mark Roithmayr informed Kevin that he was only there “as a favor to Katie” [ the mother of Bob and Suzanne Wright's autistic grandson]
7.      You succeeded in completing alienating Deirdre and Don Imus, our community’s most important public advocates.
8.      The clarification by Alison Singer regarding her unambiguous statement to the Wall Street Journal only further clarified how far Autism Speaks is from the environmental camp. I’m pretty sure we are soon going to see funding to try to unravel the “genetic epidemic” we are experiencing.

I will not go into all these points right now. I expect other Autism Hub bloggers will have something to say about this. Handley ends by giving the email addresses of some  Autism Speaks luminaries for you to complain to. If they have managed to annoy Handley so much I suggest that congratulations and encouragement to do more of the same are in order.

Mark Roithmayr: mroithmayr@autismspeaks.org

Bob Wright: Bob.Wright@nbcuni.com

Suzanne Wright: suzanne.wright@nbcuni.com
With extreme annoyance and frustration,

JB Handley

It could be, JB, that you might be wrong. Just something to think about.

March 6th, 2007 Posted by Mike | Autism, DAN!, autism acceptance, autism epidemic, vaccines | 20 comments

Vaccines and autism: a thoughtful debate 1

I have just started watching the video of the debate between David Kirby and Arthur Allen on the subject of autism and vaccines. Kirby wrote a book, Evidence of Harm: Mercury in Vaccines and the Autism Epidemic: A Medical Controversy which starts from the premise that the rapid growth in recorded cases of autism in the USA that began in the early 1990s represented a real growth in numbers and could not be explaind by increased awareness, better diagnostic procedures or a change in the criteria. There had to be an environmental trigger. At the same time changes in the mandatory vaccination programme for children in the USA  increased exposure to thimerosal, a preservative that contains ethyl mercury.  

Did the thimerosal cause an autism epidemic? Kirby believes it did. Allen once thought it was a credible hypothesis. But in the course of researching his book, Vaccine, the Controversial Story of Medicine’s Greatest Lifesaver, Allen changed his mind.  Allen has also begun to question whether there has been an epidemic or not. See his review of Roy Grinker’s book, Unstrange Minds, Remapping the World of Autism. 

I was looking forward to the debate. But within minutes I was hitting the pause button and diving into my archive of autism related papers. Kirby began, quite rightly, with a discussion of epidemiology. But his version seemed at odds with what I thought I knew. Still, this was an important debate. Kirby must have checked his facts beforehand. So I went to check mine.

Kirby’s Fact 1.

In the 1980s autism prevalence in the USA was between 1 and 2 in 10,000

If anyone has a reference to an epidemiological study for this extremely low figure I would love to have it.  When Lorna Wing surveyed the major epidemiological studies carried out between 1966 and 1992 she referred to two studies in Utah (Ritvo et al 1989) and North Dakota (Burd et al 1987) that found rates of 4 and 3.3 in 10,000 respectively for DSM III autism which use very similar criteria to Kanner’s criteria. She also mentioned a study by Treffert which found a prevalence of 3 in 10,000 in 1970 in Wisconsin. When I considered Wing’s survey in an earlier post  I remarked upon the robust nature of the figures. Researchers who combined consistent epidemiological methods with Kanner’s diagnostic criteria found rates of between 4 and 5 in 10,000.

Kirby’s Fact 2.

In the late 1990s autism prevalence in the USA was 20 in 10,000

Kirby offers no citations for this figure. Probably the most well founded study in the USA in the 1990s was by Yeargin-Allsopp et al in Atlanta in 1996 which found a rate of 34 in 10,000 in 3-10 year olds. It was reprinted in JAMA in 2003. In the same edition Fombonne considers this an underestimate and thinks the 5 to 8 year olds in the study provide a more reliable estimate of 41 - 45 in 10,000. (JAMA 2003 Volume 289 Issue 1.)For comparison Wing and Gould found a rate of 20 in 10,000 in the Camberwell study in 1979. This study confined itself to children with learning dificulties in special schools and never looked at children in mainstream classes where most autistic children are found today.

Kirby’s Fact 3.

By 2000 autism prevalence in the USA was 40 in 10,000

Again there is no citation. And autism prevalence in whom? What is the age cohort?

Kirby’s Fact 4.

By 2004 autism prevalence in the USA was 60 in 10,000

We do have a lot of epidemiology for this figure.It is supported by the Medical Research Council in the UK and the Centers for Disease Control in the USA. But it is usually taken to mean that we have now reached a reasonably accurate estimate of prevalence figures for the entire autistic spectrum across the entire population. Kirby sems to be using these figures to suggest a year on year increase in incidence which is not the same as prevalence. Generation Rescue made a similar mistake last year which I commented on.

When you are dealing with statistics it is important not to get incidence and prevalence muddled up. Incidence refers to the number of new cases in a population over a period of time. Prevalence refers to the total number of cases in a given population at a specific time.

Kirby’s Fact 5.

By 2004 th USA figure of 60 in 10,000 was the same as in the UK. But the USA had 40 in 10,000 with autstic disorder and only 20 in 10,000 with other ASDs. In Britain the figures are reversed: 20 in 10,000 with Autistic disorder and 40 in 10,000 with other ASDs.

Kirby’s explanation is simple. Here in the UK we only ever had half the thimerosal in our vaccines compared to our American cousins. So we only got half the autistic disorder. OK. Thimerosal causes autistic disorder. There is a linear relationship. Double the thimerosal and you double the autistic disorder. So what causes PDD-NOS and Asperger Syndrome? Why should they be twice as prevalent in the UK as in the USA? Is that environmental or genetic? Perhaps we Brits are naturally more high functioning than the Yanks
By this time I was beginning to get a little bit sceptical about Kirby’s figures. He actually did mention a source for his 40 in 10,000 with autistic disorder, Brick Township. I remember that one; 40 in 10,000 for autistic disorder is correct. But the figure in Brick Township for other ASDs was not 20 in 10,000. it was 27 in 10,000. 67 in 10,000! That is a lot of autism, except for one fact. It was a very small sample; 60 children aged 3 to 10. The authors acknowledge the problems in generalizing from their data.

As mentioned earlier, the major limitation of this study was an inability to ascertain higher functioning individuals who were not in any special education class in public schools or had not been seen by participating clinicians. Consequently, because of these case-finding limitations, the results from Brick Township must be considered a minimal prevalence for autism. Categorical distinctions between autistic disorder and the other ASD were probably limited because the ADOS-G has been found to over estimate autistic disorder relative to PDD-NOS. Also, because clinical assessments could not be conducted for 17 children and the diagnosis had to be based on records alone, the reliability and validity of the diagnosis for those children is limited. Discrimination between PDD-NOS and autistic disorder also may have been influenced for these cases given that over 56% of the children who participated in the clinical assessment were determined to have autistic disorder in comparison to only 27% of the children assessed by record review only. Finally, the prevalence rates for autism obtained in this study must be generalized with caution since the community was selected for study because of a suspicion of increased numbers of children with the disorder. Studies of larger populations, such as one that included surrounding communities, may yield different findings.

They may indeed.

Kirby’s Fact 6

Denmark removed all its thimerosal way back in 1992 and it has a rate of only 8 in 10,000.

Yes, except that according to this study autism rates went up in Denmark after they removed the thimerosal. Actually the base rates for autism in this study were so low it is ridiculous, less than 1 in a 1000 throughout the seventies and eighties. That is less than Brask found in 1972 in Denmark for Kanner’s autism. (4.3 in 10,000) A more recent study suggests the real rate for ASDs in Denmark is closer to the 34 in 10, 000 that Yeargin-Allsopp found in Atlanta in 1996. the authors conclude:

We found that the estimated prevalences of the PDDs studied were probably underestimated. Furthermore, the increasing prevalence and incidence rates during the 1990s may well be explained by changes in the registration procedures and more awareness of the disorders, although a true increase in the incidence cannot be ruled out.

So much for Denmark then. I cannot say that  I am looking forward to the rest of this debate if this is the standard of evidence employed by Kirby. But I will resist the temptation to fast forward to Arthur Allen. I will do my blogging duty. Speaking of Arthur Allen, he has written about the debate on his blog and is open to comments. Kirby, despite boasting that whenever he writes on the Huffington Post he goes straight to number one, has yet to share his thoughts on the debate with a wider audience.

 STOP PRESS Kirby has made the slides  from his presentation available on his website. I wont be downloading them just yet. I don’t want to spoil the ending.

to be continued …

EDIT

… or not. Kev has blogged the debate here and here. So has Joseph, BC and D0′C. And Diva has set it to music.

January 21st, 2007 Posted by Mike | Autism, Autism epidemiology, autism epidemic, vaccines | 24 comments

Biomedical interventions in autism - a reply

The Winter 2006 edition of Communication, the quarterly magazine of the National Autistic Society contains an opinion piece, “Biomedical Interventions in Autism” by Lorene Amet. Unless otherwise indicated all quotes are from Amet’s article.

She claims that,

“A previously rare childhood developmental condition seems to have become common in ten years! This does not seem to be a matter of changing definitions, ascertainment bias, or case-finding methods. What this may tell us is that the role of environmental factors in autism is greater than previously envisaged.”

But according to a National Autistic Society leaflet, (NAS 1997)

“The best estimates of the total prevalence of autistic spectrum disorders are those based on the Camberwell and Gothenburg studies, because these focused on the whole spectrum and not just specific sub-groups.”

The Camberwell study (Wing and Gould 1979) found a prevalence of 20 in 10000 for autistic spectrum disorders amongst children with IQ less than 70. The Gothenburg study (Ehlers and Gillberg 1993) found a prevalence of 71 in 10000 for autistic spectrum disorders among school children with an IQ greater than 70. These studies were published in 1979 and 1993 respectively. So, when every newspaper and magazine report seems to include the obligatory statistic that, “1 child in 166 is now affected by autism,” we should remember that back in 1993 some of the leading autism experts in Europe were arguing that 1 in 110 children were affected then. One of their most trenchant critics, Eric Fombonne (1997) carried out his own epidemiological studies (Chakrabarti and Fombonne 2001, 2005)) which went a long way to confirming Wing and Gillberg’s position.

I fail to see the point of Amet’s remark “the explosion of autism diagnosis throughout the developed world continues to throw an uncomfortable light on the traditionalists within the autism community,” when, in fact, the explosion only serves to confirm what the traditionalists established during the 1990s, that when autism is understood as a broad spectrum disorder it is more prevalent than was suggested by previous studies that focused on the narrow portion of that spectrum first described by Kanner (1943).

Whether there has also been an increase in actual numbers alongside the increase in diagnosis is unknown. Fombonne (2003) argues that the few incidence studies we have are inadequate to the task. He also points to the extreme weakness of the evidence in support of a new environmental influence that might explain any secular incidence in autism in recent years. Amet is equally tentative about possible causes.

“32 reports … suggest that it [heavy metal toxicity] could be implicated.” There is a “possible association with autism” for “diet and food sensitivity; profound vitamin, minerals and fatty acid deficiencies; some abnormalities in purine levels and essential amino acid levels; as well as some cases with hormonal or cholesterol metabolism abnormalities.”

The one study she cites goes to show how tentative those links are. The Vargas paper (2005) is inaccurately reported as a study of “11 post-mortem brain tissues of children with autism.” These ‘children’ ranged in age from 5 to 44 years. If there is active neuroinflammation in subjects born in the 1960s it is unlikely that a recent, epidemic inducing toxin is responsible. And, far from proposing a “key pathological role in autism” as suggested by Amet, senior author, Carlos A. Pardo-Villamizar cautiously points out in a press release (Science Blog 2004) that, “it is not yet clear whether [the immune activation] is destructive or beneficial or both.” On the question of treatments he says that “much more research would be needed to establish the validity of this approach.”

Amet is not so tentative about possible treatments. Apparently, ‘could be’ and “possible association” provide sufficient proof to justify the treatment protocol on offer at her Edinburgh clinic. She agrees “that there is at present insufficient published evidence for the efficacy of the biomedical approach beyond anecdotal reports.” In plain English that means that there is no published evidence apart from anecdotal reports.

Amet believes it would be unethical to carry out proper research before experimenting on children because,

“the biomedical treatments that some feel have been shown to lead to recoveries are complex, comprised of several inter-dependent parameters, and carried out over a long period of time, usually for a minimum of two years.”

So studies on mice, monkeys and in vitro are good enough to suggest treatments but those treatments cannot be subject to clinical trials. This is quackery pure and simple. Amet argues that,

“It is only through thorough examination and biomedical testing that the individual child’s symptoms can be understood and treatments tailored accordingly.”

Autism is presently only diagnosable on the basis of observable behaviours. Amet would like to be able to diagnose on the basis of biomedical indicators. But here she suggests that it is already possible to match autistic symptoms to biological markers.

Once these biomedical problems are identified they will be treated with dietary and pharmaceutical interventions that will also cure the autistic symptoms. Biomedical interventions are often used in conjunction with applied behavioural analysis on the premise that the child needs to be re-educated in what it is to be normal while they are being recovered from their autism.

Quite aside from the arrogance that presumes such knowledge of the biochemical predictors of behaviour and competence to manipulate them successfully, there is the complete denial of any autonomy for the child in determining who they are. The child is a tabula rasa with no opportunity for influencing the outcome of their own development and education.

While every child is different,

“children with autism have a set of characteristic clinical complaints. And these are very well-substantiated in the current peer-reviewed medical and scientific literature.”

It would help if Amet could provide a list of these “characteristic clinical complaints” and some reference to the relevant literature. In contrast to Amet’s claim it is my understanding that the clinical picture in autism is heterogeneous. Common clinical characteristics have so far proved elusive. I remember David Amaral of the MIND Institute at UC Davis, speaking at the International Autism Conference held by the NAS in London 2005 showing a slide that said,

“Autism is an enormously heterogeneous disorder. It is likely to have a variety of etiologies and ultimately to be considered distinct variants or phenotypes of the same disorder (Autism type A, Autism type B etc.)

To date, research on autism has been too fragmentary to allow determination of the biomedical and behavioural characteristics that define different phenotypes of autism spectrum disorder.”(Amaral 2005)

Amet also claims that,

“The biomedical approach to autism is currently endorsed by over 500 medical doctors, throughout the world in a total of 23 countries. What these practitioners advocate is that autism is treatable. They uphold the principle that children with autism not only have the right, like any other children, to full medical investigation, but that the investigation must be comprehensive.”

Amet is wrong and she knows it. The five hundred medical doctors do not exist. She is referring to the DAN list of registered practitioners who have agreed to the DAN protocol for treating autism. Amet know that not all of these practitioners are medical doctors because she, a research scientist, is on the list. So is Ken Aitken, a psychologist and associate of Amet’s in the Autism Treatment Trust. Neither is qualified to call themselves an MD. The DAN list also includes naturopaths, homeopaths and other ‘alternative’ therapists.

Many of the DAN practitioners are medical doctors. But that is no guarantee of quality. Last year Abubakar Tariq Nadama died while being given chelation therapy. He was referred to Dr Kerry by DAN practitioner Dr Usman who recommended treatment with disodium EDTA with a dose of 50mg per kilo when the recommended dose is 40mg per kilo. Usman referred Abubakar to Kerry because “He apparently has a very high aluminum and has not been responding to other types of therapies and therefore she is recommending EDTA, which we do on a routine basis with adults.” Abubakar was five years old and autistic. His mother took him to America because she was persuaded that autism is treatable by the biomedical interventions championed by Amet.

At the time much was made of the fact that Kerry was not a DAN doctor. He is now. After he killed Abubakar, Kerry was admitted to a DAN conference, completed an eight hour intensive training programme and joined the “500 medical doctors, throughout the world” whom Amet looks to for endorsement.

Those “500 medical doctors, throughout the world” also include a Dr. Schwartz in California who is not allowed to examine boys without a chaperone because of previous misdemeanours. The Medical Board of California (2006) is currently trying to permanently revoke his licence to practise medicine after he persistently broke their injunction not to examine boys without a chaperone.

He chose to get round this problem by inventing a novel way to “uphold the principle that children with autism not only have the right, like any other children, to full medical investigation, but that the investigation must be comprehensive.” He interviews their mothers instead. And, without ever seeing the boys, orders a series of tests and prescribes treatments for them.

This is the company that Amet keeps. These are a few of the medical doctors who endorse her biomedical approach to autism. I am surprised that the NAS would publish an article that is so weak on logic, so riddled with factual errors and, above all, so ethically compromised. It is no more than a thinly veiled advertisement for her clinic, a commercial for autism treatments that are not supported by the literature rather than a serious discussion of that literature.

References

Amaral, D. (2005) A Multidisiciplinary Biomedical Approach to Autism Research: The Autism Phenome Project. Presentation to the NAS International Conference September 2005
http://www.nas.org.uk/content/1/c4/78/67/Friday_DavidAmaral6.pdf
(accessed 1/12/2006)

Amet, L. (2006)Biomedical interventions in autism. Communication 40:4 pp 10-11

Chakrabarti, S. Fombonne, E. (2001) Pervasive Developmental Disorders in Preschool Children. JAMA, June 27, 2001 - 285:24 pp 3093-3099

Chakrabarti, S. Fombonne, E. (2005) Pervasive Developmental Disorders in Preschool Children: Confirmation of High Prevalence Am J Psychiatry 2005; 162 pp 1133–1141

Ehlers, S. & Gillberg, C. (1993): The Epidemiology of Asperger syndrome. A total population study. Journal of Child Psychology and Psychiatry, 34:8 pp 1327-1350

Fombonne, E. (1997) Prevalence of autism spectrum disorder in the UK. Autism 1:2 pp 227-229

Kanner, L (1943) Autistic Disturbances of Affective Contact. Nervous Child 1943; 2: pp 217-250.

Medical Board of California (2006) Accusation and petition to revoke probation
http://publicdocs.medbd.ca.gov/pdl/Image.aspx
(accessed 1/12/2006)

NAS (1997) How many people have autistic spectrum disorders? NAS Factsheet
http://www.nas.org.uk/nas/jsp/polopoly.jsp?d=299&a=3527
(accessed 1/12/2006)

Science Blog (2004) Brain Inflammation found in autism.
http://scienceblog.com/community/older/2004/520044596shtml
(accessed 27/11/2006)

Wing L, Gould J. (1979)Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. J Autism Dev Disord. 1979: pp11-29

December 3rd, 2006 Posted by Mike | Autism, Autism epidemiology, Quackery in Autism, autism epidemic | 9 comments

An Open Letter to the Autism Treatment Center of America

This letter has been mailed to correspondence@option.org and posted here.
I have just read your press release announcing Raun Kaufman’s appointment as Director of Autism Treatment Center of America. I fully endorse the sentiments expressed by Kevin Leitch in his Open Letter to Raun Kaufman. I too am appalled to see that you are exploiting the deaths of Katie McCarron and Ryan Davies to promote your organization. This is in direct contradiction of the wishes of Katie’s family. Katie’s grandfather, Mike McCarron has paid eloquent tribute to Katie’s memory on Kristina Chew’s Autism Vox that contains these words.

“I can assure you that no one will describe her murder as “understandable” or devalue her in anyway without my personal challenge to them and the organizations they represent.”

Please read it in full and you will learn that Katie was a vibrant, happy girl who was much loved and loving in return. Her life was full of hope and not the hopelessness that you suggest.

Omissions and Inaccuracies

I was also concerned by the factual omissions and inaccuracies in the press release. Most glaring was the failure to correctly identify Ryan Davies as having Fragile X Syndrome. Or are you suggesting that SonRise can also repair abnormalities on the X chromosome?

The prevalence figure of 1 in 10,000 that you cite has no basis in fact. The landmark epidemiological study in the UK established a prevalence of 4.5 in 10,000. (Lotter 1966) When Lorna Wing (Wing and Gould 1979) discovered that autism was not a narrow disorder but was in fact a broad spectrum this raised the prevalence to 20 in 10,000. At this time most cases of autism were thought to be associated with mental retardation. The introduction by Wing (1981)of the work of Hans Asperger to the English speaking world reversed that. By identifying and including autistic people with average and above average IQ the prevalence rates do indeed approach 1 in 100.

The press release initially uses “autism” to refer to

“children [who] will never speak, attend a typical school, make friends, or even learn to dress themselves. Raun K. Kaufman tells parents something very different. He offers hope, help, and a concrete blueprint to reach “unreachable” children.”

It goes on to say that,

“According to the National Autistic Society, it is estimated that over half a million people have autism in the UK, with more than 2 million people affected by the disorder.”

It later refers to autism as one of many autism spectrum disorders.

“Autism treatment specialist Raun K. Kaufman is currently on a 10-city free public lecture tour across the UK and Ireland this September entitled: Breakthrough Strategies for Autism Spectrum Disorders. The specific strategies he will address have been shown to have an immediate impact on children with Autism, PDD, Asperger’s Syndrome, and other related developmental challenges.”

Anyone unacquainted with the facts or the way that the terminology has changed over the years could be forgiven for taking this to mean that there are now 500,000 “unreachable” people with autism alongside all the others on the spectrum and presume that they make up the “more than 2 million people affected by the disorder.”

According to the NAS there are an estimated 528,500 people, both adults and children, on the autistic spectrum in the UK. But this figure encompasses the entire spectrum: Autism, Aspergers, PDD-NOS etc. It includes over 400,000 people with average or above intelligence. With proper support in childhood this group will require less support during adult life and many if not most will be completely independent. There are only around 23,000 people with the severest forms of autism described by Kanner and measured by Lotter and an estimated 93,000 with other spectrum disorders who will probably require some level of support throughout their lives. The 2 million refers to their immediate families, who are indeed affected by a triad of impairments, if we define that triad as impairments in the health, education and welfare services available to autistic people and their families.

Misinformation and Misunderstanding

Compared to the unethical exploitation of these two children’s murders it may seem unduly pedantic to go on to question the accuracy of the information. But misinformation leads to misunderstanding. It is this lack of understanding that fosters feelings of helplessness and hopelessness in parents. Your publicity material strongly suggests that autism is a hopeless condition unless people turn to you in order to

“learn how to help their children, for the first time, to begin to cross the bridge from their world to ours.”

By talking up the hopelessness of autism in this way you are no better than the snake oil merchants who tout biomedical cures for autism on the back of a spurious autism epidemic. And what of the parents who come away from your “free public lecture tour” convinced by your message of hopelessness but unable to afford your package of hope or persuade a charitable foundation to fund it for their child? Who will bear the ultimate responsibility if any of them follow in the footsteps of Karen McCarron or Alison Davies?

REFERENCES:

Lotter, V. (1966). Epidemiology of autistic conditions in young children: I. Prevalence. Social Psychiatry, 1, 124-137.

Wing, L. (1981) Asperger Syndrome; a clinical account. Psychological Medecine. 1981 Feb;11(1):115-29.

Wing, L. & Gould, J. (1979): Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. Journal of Autism & Developmental Disorders, 9, pp. 11-29.

September 30th, 2006 Posted by Mike | Autism, autism epidemic | 7 comments

Beyond Our Ken

Ken Aitken is a clinical psychologist who co-authored a text book on autism. (Trevarthen et al. 1996). The book acknowledges that rubella in pregnant women is a cause of autism but notes that, “greater awareness of the disorder and widespread inoculation have virtually eradicated rubella as a significant cause of autism.” (page 91)

Five years later Aitken appeared as an expert witness before an enquiry into the safety of MMR vaccine called by the Scottish parliament. But instead of supporting a vaccine that had helped to eliminate “a significant cause of autism” he supported the connection between the MMR vaccine and autism. He specifically rejected the suggestion that mercury might be to blame in the UK because, compared to the USA, there are negligible amounts of mercury in our vaccines. (Aitken 2001)

So, when Aitken addressed the Treating Autism Conference in Edinburgh, held on 14 - 15 October 2005 I was surprised to see a slide attacking mercury in his presentation. (Aitken 2005) Has the amount of mercury in our vaccines suddenly increased? Is Aitken a mercury convert because the case against MMR has collapsed? Or was he playing to the gallery because he knew that his audience was sympathetic to the mercury hypothesis?

Whatever the reason, his present position is in marked contrast to the views expressed in his book. Then he argued that, “It now seems certain that the brains of person’s who became autistic in their early childhood already had microscopic faults in their development in early intra-uterine life, probably expressed among cells of the early embryo, in the first month.” (page 80)

Now he argues that
There is a dramatic increase in autism that is caused by new forms of autism that occur in normally developing children who regress after an environmental insult in early childhood.
Regressive autism now dwarfs other forms of autism.

Is there an increase in numbers?
More and more people are being diagnosed. But as early as 1979 the Camberwell Study suggested that autism was far more prevalent than people had previously thought. It found rates around 20 in 10000 in children with learning difficulties. (Wing and Gould 1979). This is identical to the prevalence rate in California that is cited as evidence for an “autism epidemic” In the 1990s.

“The cumulative prevalence of autism in California increased from 7.5 per 10,000 for the sample 1983-85 birth cohort to 20.2 per 10,000 for the 1993-95 birth cohort, an increase of 269 percent.” (CDDC 2003)

Scotland is the one part of the United Kingdom where there is a system in place for recording all known cases of autism. Aitken acknowledges that if we accept official estimates of a prevalence rate of 60 in 10000 only 44% of cases are diagnosed. (PHIS 2001) So what is going on? A diagnostic rate of 26 in 10000 in Scotland is evidence of under diagnosis. A diagnostic rate of 20 in 10000 in California is evidence of an epidemic.

Is there an increase in regressive autism?

Aitken believes that cases of regressive autism have “grown to dwarf those with more ‘typical’ presentations.” Published research shows that the proportion of cases of regressive autism have not changed. (Taylor, Miller, Lingam, Andrews, Simmons & Stowe 2002. (page 394))
Aitken knows this because he cites the same paper as evidence of a link between bowel problems and regressive autism.

“…bowel problems were reported more frequently in children with regression than in those without, 31 of 118 (26%) and 49 of 351 (14%) respectively (P = 0.002).”

Though it would have been more honest to quote the whole paragraph:

“Although neither bowel problems nor regression was related to MMR vaccination, bowel problems were reported more frequently in children with regression than in those without, 31 of 118 (26%) and 49 of 351(14%), respectively (P = 0.002). This relationship between bowel problems and regression did not significantly vary by type of bowel problem (P = 0.35). For the 31 children with both bowel symptoms and regression, there was also no association with MMR vaccination (P = 0.20) and no association with year of birth (1.01, 0.92 to 1.11; P = 0.79).”
Taylor, Miller, Lingam, Andrews, Simmons & Stowe 2002. (page 395)

Much of the evidence for regression comes from parental reports. And it is not always clear whether they are reporting regression or failure to meet expected milestones. It is also necessary to exercise caution when dealing with parental evidence. Aitken knows this. It is in the same study by Taylor et al.

“ A review of each record showed that in 13 children the history given by the parents had changed after the extensive publicity about MMR vaccine and autism. Before the publicity the parents often reported concerns early in their child’s life, usually before their first birthday; the current history for the same children recorded symptoms as developing only after MMR vaccination, in some cases shortly after.”
(Taylor, Miller, Lingam, Andrews, Simmons & Stowe 2002. page 395)

So, Aitken has taken research that contradicts his previous position on the connection between MMR, bowel problems and regressive autism and selectively quoted from it to support his view that there is a connection between bowel problems and regressive autism, while ignoring the authors’ qualifying remarks about the reliability of parental memories concerning regression. There’s more. Aitken misrepresents a pilot study for a screening checklist as if it were an authoritative measure of autism incidence among 18 month old children. (Baird G, Charman T, Baron-Cohen S, Swettenham J, Wheelwright S, Drew A 2000)

This study successfully predicted autism in 10 subjects out of 16,235 children but failed to identify a further 40 autistic children. Finding 6 in 10000 out of an actual incidence of 30 in 10000 in a particular birth cohort does not prove that the other children are victims of regression. This was a just pilot study for a screening test, not a full scale case finding exercise using the latest diagnostic techniques. Aitken uses it to support his thesis that regressive autism dwarfs traditional autism. What utter nonsense!

These are just a few of the problems I have with Aitken’s presentation. Another feature of his theory is that if there is a new form of autism there has to be a really low rate of autism in populations born prior to the alleged autism epidemic. Aitken uses these sources as proof.

Burd and colleagues in North Dakota estimated 3.26 per 10,000 in those born between1967 and 1983 (Burd, Fisher & Kerbeshian 1987; Burd, Kerbeshian, Klug &McCulloch 2000). In Sweden, Nylander and Gillberg (2001) found a prevalence rate of 2.7 per 10,000, screening previously undiagnosed adult psychiatric outpatients.

The problem is that Burd (1987) was using DSM III criteria that were highly restrictive compared to the present DSM IV(R) criteria. There is an interesting discussion about diagnostic criteria, autism epidemics and the perils of comparing prevalence rates over time that Aitken ought to read (Medscape 2005)

The second study by Burd et al. was actually a follow up to assess the methodology used in the original study and using the same methodology the authors found another autistic individual whom they had missed in 1987. This was not a study to assess the prevalence of autism in North Dakota in 2000.

The study by Nylander and Gillberg (2001) actually found

“at least 19 patients in this population (1.4%) had a definite ASD. Seventeen of the ASD patients had been previously diagnosed with other psychiatric disorders, most frequently schizophrenia (n=5). Of patients attending a treatment centre for severe psychiatric disabilities (n=499), 3.2% had an ASD.”

So where did Aitken find his figure of 2.7 per 10,000? Perhaps he reads the British Medical Journal. Mark Blaxhill, a board member of Safe Minds, the acronym for the snappily named Sensible Action For Ending Mercury-Induced Neurological Disorders. Blaxhill wrote to the BMJ citing these same three references as proof that there was no “hidden horde” of previously undiagnosed adults.(Blaxhill 2002) Has Aitken read any of the studies he cites or does he just accept the citations given to him by the “mercury moms” and their supporters?

REFERENCES

Aitken 2001 http://www.show.scot.nhs.uk/mmrexpertgroup/Aitken-rep.htm

Aitken 2005 http://www.actagainstautism.org.uk/presentations/14th/aitken.pdf

Baird G, Charman T, Baron-Cohen S, Swettenham J, Wheelwright S, Drew A (2000) A screening instrument for autism at 18 months of age: a 6-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 2000 Jun, 39(6):694-702

Blaxhill 2002) Letter to the editor. British Medical Journal Volume 324 2 February 2002 page 296

Burd L. Fisher W. Kerbeshian J. (1987) A prevalence study of pervasive developmental disorders in North Dakota. Journal of American Academy of Child and Adolescent Psychiatry, 1987, Vol. 26(5), pp. 700-703

Burd L, Kerbeshian J, Klug MG, McCulloch K. (2000) A prevalence methodology for mental illness and developmental disorders in rural and frontier settings. Int J Circumpolar Health. 2000 Jan;59(1):74-86.

CDDC (2003) AUTISTIC SPECTRUM DISORDERS Changes In The California Caseload An Update: 1999 Through 2002
http://www.dds.ca.gov/autism/pdf/AutismReport2003.pdf

Medscape 2005 http://www.medscape.com/viewarticle/508429

MRC (2001) http://www.mrc.ac.uk/pdf-autism-report.pdf

Nylander L. Gillberg C. (2001) Screening for autism spectrum disorders in adult psychiatric out-patients: a preliminary report. Acta Psychiatrica Scandinavica, 2001, June, Vol. 103 (6), pp. 428-434

PHIS (2001) Autistic Spectrum Disorders Needs Assessment Report
http://www.phis.org.uk/pdf.pl?file=publications/Autistic%20Spectrum%20Disorders.pdf

Taylor, Miller, Lingam, Andrews, Simmons & Stowe (2002) Measles, mumps, and rubella vaccination and bowel problems or developmental regression in children with autism: population study British Medical Journal, 2002, Vol. 324, pp. 393-396

Trevarthen, C., Jacqueline Robarts, J., Despina Papoudi, D. and Aitken, K. (1998) Children with Autism Diagnosis and Intervention to Meet Their Needs. Jessica Kingsley Publishers London.

Wing, L. & Gould, J. (1979). Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. Journal of Autism & Developmental Disorders, 9, pp. 11-29.

December 22nd, 2005 Posted by Mike | MMR, autism epidemic, mercury, vaccines | 3 comments