US study shows 10-fold increase in autism over the past 20 years
BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7380.71 (Published 11 January 2003) Cite this as: BMJ 2003;326:71All rapid responses
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Dear Sir:
Our organization, The Autism Autoimmunity Project is currently
tracking the US Department of Education figures on autism since they first
started them in 1991/1992. They used the same criterion since then to the
present in recording autistic school children from ages 6-21 and the
increase nationwide has skyrocketed. These figures can be looked at on our
web site under Research at http://www.autismautoimmunityproject.org/.
In the July 8, 2000 edition of The Lancet, I wrote a letter that was
published in the Correspondence section under "The MMR Question". I
mentioned some of the figures both in the US and in the UK. The Centers
for Disease Control (CDC) had a chance to check the immune blood panels of
the children they examined in the Brick, NJ study but didn't. I made note
of that in my letter. Our son has gastrointestinal problems as well as
tested for elevated measles antibody titers by two immunologists. Also he
tested positive for myelin basic protein antibodies. He was normal at
birth and then regressed into autism. No one seems to want to replicate
this clinical science because of the controversy regarding the MMR vaccine
and autism. This science should be looked into.
Recently, the National Institutes of Child Development and Health
(NICHD) funded a porn arousal study at Northwestern University for the
amount of $147,000.00. The NICHD won't fund any independent research
linking the MMR vaccine to autism but consider porn arousal studies to be
science. They spend millions of dollars to look for an elusive gene in
autism but nothing on clinical research regarding the immune and
gastrointestinal dysfunctions involving children with autism. To date our
organization has funded independent research in the amount of $120,000.00
for such researchers as Dr. Andrew Wakefield, Dr. Vijendra Singh and Dr.
James Oleske. More needs to be done.
Raymond Gallup, Founder
Autism Autoimmunity Project
Lake Hiawatha, NJ 07034
Competing interests:
None declared
Competing interests: No competing interests
The basic fact, which is beyond dispute, is that there has been a
massive increase in the number of cases diagnosed as autistic. However,
the reasons for that are varied, and alternatives to an "epidemic" have
been suggested.
Firstly, it is suggested that the increase in figures must be
normalised against the increase in population growth, particularly in
California, which is where the most notable published data has emerged.
Yet if population growth is the major determinant, then it should also
reveal a similar and remarkable increase in other developmental
handicapping conditions, which would be as newsworthy. The proponents of
this argument have failed to produce evidence of this, and have produced
no statistics correlating autism well with population growth, which surely
would strengthen their case beyond all doubt.
Secondly, it is suggested that the increase in figures are due to a
widening of the diagnostic criteria. While it is certain that the
diagnostic criteria have widened considerably since Kanner's orginal work,
they would appear to have become relatively stable and consistent during
during the last ten years. However, the secondary implication of this
argument must be that there is as large a percentage of the population
beyond school age since the 1990 (as a baseline) who exhibit the same
range of features in the same proportion.
Proper experimental procedure would suggest that age ranked surveys
of the adult population be carried out to determine if the same proportion
of the population show autistic spectrum disorders, and in roughly the
same proportions (mild to severe). as the junior population; if the
condition changes with age, and becomes less severe, one would simply
expect the same distribution patterns for different age groups, but either
shifted or skewed in a regular (and mathematically consistent) manner.
Also, where are the children undiagnosed earlier, and how did they
cope without invention? It is possible that adults with aspergers have
developed varied strategies for coping, and their condition may have
lessened as these strategie became more automatic, and that such adults
were diagnosed differently, but an aged ranked survey would using today's
diagnostic instruments would help to clarify this. But it is also
probably, that without suitable support mechanisms, that a significant
proportion of these children, if classified under the ESN category in use
then, would have ended in Special Needs Schools, or special Hospital
units, like those with other handicapping conditions, or of milder,
dropped out of the school system, and to as large a degree (adjusting for
population increase) as those currently identified in the present
"epidemic". It is remarkable that if a comparable large population of
children exhibiting a similar cluster of symptoms existed that no one
noticed it.
Lastly, not enough attention has been given to peer group dynamics
and identification, acceptance or rejection of the unusual child. Do
children notice the "oddity" of their peers on the autistic continuum?
Studies of peer group dyamics regarding children diagnosed with ADHD have
shown that their peers easily mark them out as different (Landau and
Milich 1988), often, although not always, with a degree of rejection.
Clearly any survey would have to be stratified and random, and would be
dependend upon the vagaries of memory, but if the same identification
applies to children on the autistic spectrum, one would expect, as a rule
of thumb, for it to apply to adults recalling any "odd" peers in their
school days. However, the small scale surveys I have carried out on a
percentage basis, while by no means representative enough, do nonetheless
call into question the idea that the same proportion of children were on
the continuum.
I would feel happier with this report by Scott Gottlieb if children
and adults had actually been assessed, rather than basically reviewing old
data and diagnostic notes.
Competing interests:
child with autism
Competing interests: No competing interests
Increasing numbers of parents do not run around looking for
intensive, highly expensive exhausting home based treatments or special
school accomodations if their children do have have very considerable
problems. School staff do not leave in droves just because a perception
has shifted. Both of these groups have different reasons for wanting the
same thing. They both want to be able to reach the child. Staff who say
they will be leaving teaching include the increasing difficult behaviours
of the children as one of the major reasons. Reception staff just last
week reported on the increasing numbers of children arriving at school
with communication problems.
The controversy and association with DPT, Mercury and MMR has grown
since it became obvious first to parents, then to teachers, that vast
numbers of children are no longer reachable and this has reached public
consciousness in relation to vaccines because vast numbers of parents have
seen a change in their children following their triple vaccine. Not little
changes, not little things that can be made into big things by a shift in
perception - but major change to their child's communicative development
and often to their behaviour and to their health.
Parents and teachers are responding to the extreme behaviours of the
children in front of them - to the problems stariung them in the face and
demanding vastly different ways of relating to and educating. If the
children do not present with increasing autistic problems, attentional
deficits, bowel problems, asthma etc, following triple vaccines, and the
Government statistics tell them that there is no increase in such
conditions - why on earth would these groups rush to the media to make it
up?
Parents and teachers want `normal` children, academically and
socially. Parents of today are better educated and better informed about
education, health and child development than ever before.The last thing
the vast majority of parents and teachers would want to do is create a
storm in a teacup if their children were all OK.
Competing interests:
None declared
Competing interests: No competing interests
Increased awareness of autism, whether by doctors or parents, is
indeed better, hardly surprising because the condition has dramatically
increased at least ten fold as the latest Atlanta study has confirmed.
Mounting cases of acquired or late onset autism have contributed to
the increase of autistic spectrum disorders (ASD) , over classic autism,
the latter more often present at birth.
Environmental factors such as the effect of synergistic action
between the three combined live virus components of MMR vaccine on gut and
neurological immune processes , cannot be so confidently dismissed by
epidemiological population studies of medical database records , as ASD is
a disorder with no single phenotype, rather than a disease with a root
cause and outcome.
Age of diagnosis varies enormously, more so in the early to mid
nineties, when most GP's, then unfamiliar with autism were first faced
with it. This was compounded by uncertainty , when in some cases, a
previously normal child patient lost skills , speech and communication
.These puzzling symptoms often led to investigations into "glue ear",
hearing tests and grommet insertion, before autism was eventually
diagnosed after exhausting alternatives, two or three years later.
Boys outnumber girls 4:1 and often have immune dysregulation. An
autoimmune component, triggered by environmental factors, in those with
perhaps a genetic susceptibility and a family history of autoimmune
disease, merits urgent publicly funded investigation.However the only
treatment and clinical studies of these children so far undertaken, rely
on private funding alone,and have been boorishly dismissed as bad science
and refused government grants, due to the negative polarisation of
political, vaccination and economic issues.
Against this background, one thing is for sure, doctors will become
more expert in diagnosing autism as numbers continue to increase without
government support and funding for clinical investigation and treatment.
Competing interests:
None declared
Competing interests: No competing interests
There has been some speculation, especially by the American Centers
for Disease Control and Prevention and other public health agencies, that
the increase in population of those diagnoses with the most severe form of
autism is the result of increased awareness by the public. The less severe
forms of autism are not a factor in the most recent prevalence studies.
Parents, as well as the diagnosticians, are now more familiar with the
symptoms because of the vaccine controversy and as a result, more children
make the roster of disability agencies and public schools. Thus, they
have become more visible.
However, severe autism is unlike a tick or a stutter, which might go
unnoticed by a parent who might not keep up the lay press or medical
journals. Severe autism presents such profound behavioral disorders it is
just as unlikely to have gone unnoticed 10 years ago, as it is unlikely
now.
The message behind this "spin" is that since there is only the
perception of increased autism prevalence because of all the purported
awareness, there is no real increase. It would follow then that there is
no need to spend additional research resources on the matter. Problem
solved. This speculation is so weak; there is not even much anecdotal
evidence to support it. This did not restrain the CDC from invoking it as
a conclusion to the Atlanta study, however.
Kudos belong to the BMJ for avoiding the duplicity of repeating it in
their reportage.
Competing interests:
Author has a child with autism
Competing interests: No competing interests
In 1993 as a paediatric junior doctor I met my first autistic child.
I had to get literature from the library to find out what it was. By the
late 1990s as a consultant giving diagnoses to parents, I found that they
too had to read up about autism to know what it was. Now if I tell a
parent "I think your child has autism", the most common reply is "I
suspected it myself." The likelihood of diagnosis has increased due to
this greater level of recognition.
Could the media campaign against MMR itself be responsible for the
increased public awareness of autism?
Competing interests:
None declared
Competing interests: No competing interests
Is the hormone 1,25-D exacerbating ASD?
I was fascinated to see Richard Miles' mention of immune disorders
as being possibly associated with Autism.
We have focused our research on the most serious of those disorders,
Sarcoidosis, which is now known to have both an hereditary component and an
infectious component. We are noticing that the children of Sarcoidosis
patients seem to be diagnosed with ADHD or ASD at a relatively high rate.
Since we know there is a genetic component leading to the sarcoid immune
hyper-sensitivity, we, too, have wondered whether these diagnoses of their children
might indicate an association with some form of hypersensitivity
immune reaction.
Let me suggest an alternative hypothesis to the MMR-Mercury theory. What
if there had been something added to U.S. kids' diets in the last 20 years
— something that hypersensitized the immune system — allowing the MMR vaccines
to cause a chronic immune reaction, one which leads to the ongoing cognitive and
behavioral problems...
We use a simple test to detect immune hyper-activity. 8ml of
serum is drawn and sent for assay of the
1,25-dihydroxyvitamin-D (1,25-D) and 25-hydroxyvitamin-D (25-D) levels at
any of the U.S. labs (e.g.). We
then calculate the D-Ratio as outlined in reference 1.
A D-Ratio above 1.3 (the normal mean) indicates extra-renal
production of 1,25-D, typical of a hyper-activated immune system.
We have described the inflammatory biochemistry by which 1,25-D (a
secosteroid hormone) hyper-activates the immune system. We can't get the
darn thing published ("too specialized") but you can find a
simplified outline on Clinmed.
1,25-D acts directly on the brain and a number of other
organs, including the thyroid and parathyroid. It stimulates the
differentiation of Monocytes and Macrophages within the inflamed tissue. Its
effects on the brain are profound, ranging from irritability,
hyperactivity and loss of memory to alternating loss and
enhancement of cognitive ability.
Vitamin D has been extensively added to the U.S. food chain in the last
30 years, and the body synthesizes both 25-D and 1,25-D from it. Sarcoidosis
patients are told to avoid it. But here in the U.S.A., avoidance has
become a very difficult task. It is added to milk, milk products, breakfast
cereal, health bars, diet foods, root beer, and even orange juice (e.g.).
It is
a component of most multi-vitamin preparations.
Now I am not suggesting that all ASD
kids have a predisposition to sarcoidosis. But maybe they have a lesser
immune anomaly, one which is being activated by the excess dietary Vitamin D
to cause a vigorous immune reaction upon vaccination. One that, like
sarcoidosis, can be sustained by a combination of the injected viral material and excessive
levels of the D metabolites.
Except for our own data2, there is virtually no information on the level of 1,25-D,
and whether it has changed subsequent to the increased supplementation of
our diet during the last few decades.
Does anyone have any data on this hormone in Autism? We would urge the
use of this assay whenever one is trying to diagnose a patient of any age,
and we would be happy to help with any data interpretation issues.
References:
1. Marshall TG, Marshall FE: Remission in Sarcoidosis. clinmed 2002 Aug
22; 2002080004 [Full Text]
2. Marshall TG, Marshall FE: Vitamin D may be Harmful in Rheumatic
Disease. BMJ Rapid Response 13 Jan 2003 [Full Text]
Competing interests:
None declared
Competing interests: No competing interests