Overview of Autism, Prof. Fred Volkmar


Uploaded by YaleUniversity on 08.03.2010

Transcript:
Prof Volkmar: Let me say a little bit in terms of introduction
I'm going to start off the course,
the first half of the lecture, then Dr. Klin is going to take over.
And I want to acknowledge a couple of people,
most importantly the filming, which is not totally free.
It's being supported by several associates of the Child Study Center, which is fantastic.
We're also very grateful to our colleagues who are putting up with the hassle of creating
presentations that are going to potentially go on the web
There's information on
the web site which you can go to once we get everything up and running.
There will be reading and other kinds of materials on that web site.
We're supposed to always say what our conflicts of interests are
Both I and Dr. Klin have various federal grants and book royalties
I also edit the Journal of Autism.
We're filming this week as you heard, the logistics next week will be on the ground
floor conference room
one of the things I discovered, there's not a single adequate text.
I tried to write a textbook a few years ago for Cambridge University Press, which of course is a wonderful
book, it's paperback, it's part of a series,
it's eighty dollars for paperback book.
So if you want a relatively cheap book-
a less expensive book,
This one which just literally came out, is eighteen dollars on Amazon.
It's about this thick- it's fantastic.
We will have some things from the Handbook of Autism, which is more of a reference
book
We have about fifteen to twenty students in the course, we're going to talk about that,
we've talked a little bit about the
seminar and the field placement aspects already.
Today we're going to have a very selective introduction. This is an unusual course I think it probably
was the first one in the country on Autism,
and still is one of the few of its type.
I'm going to talk a little about diagnostic concepts,
history, epidemiology, neurobiology
Dr. Klin's going to talk about social development, psychological functioning
and about the Autism program here at Yale, Then we'll have some time for questions.
Now, if you go on the internet if you go to Wikipedia, which by the way, don't ever cite
in a paper,
at least when you give it to me, but it's a handy source of information. If you go to Wikipedia,
you will find a PDF file of the first paper on Autism by a man named Leo Kanner.
Leo Kanner was the first child psychiatrist in the country he wrote a paper
in 1943.
We're going to talk a lot more about that, and we'll have a chance to talk about Leo Kanner several times during the course.
One question is, did Autism exist before Leo Kanner? Well, nobody recognized it.
Certainly it must have existed. And in fact,
if you go back historically this is a picture of Victor
the wild boy in France
probably many so-called feral children, children
people thought were living with the animals,
probably were children who had Autism and who had been abandoned.
If you go back to read some of the reports of these so-called feral children,
they had many of the characteristics we see in children with autism today.
In the 1860's, a Great British psychiatrist, a man named Maudsley,
for the first time talked about children having what he called "insanity".
At that point in time, people who had no knowledge of the kinds of things we talk about in terms of mental
disorders today,
they talked about things like insanity.
People thought that children were somehow protected
because they were children
and in fact, he said, no no, I've seen children who are "insane".
This is interesting because it actually brings a thread through the work, which we'll come back to,
which is thinking that, is autism - what is it? Is it a developmental disorder?
Is it a mental illness, like schizophrenia?
What is it?
And we'll come back to that.
However the term "childhood psychosis", which was a more modern term for childhood insanity,
and childhood schizophrenia,
became synonymous- anybody who is very very disturbed but wasn't mentally retarded or
intellectually impaired
They'd say, "Oh, it's childhood psychosis, it's childhood schizophrenia".
This continued really in this country until 1980.
Leo Kanner was the first child psychiatrist, I mentioned, in the country,
He was actually a refugee from of Europe,
fled the nazis, was hired at Hopkins
to bridge the gap between pediatrics and psychiatry.
He reported his paper in 1943 on eleven children,
who he said had two things that were were essential.
One was autism,
living in your own world, being cut off from other people.
And he had very interesting, provocative and evocative ways of talking about this.
On the other side, he said the other thing that was essential was these were children had
trouble with change.
How many people actually
ever actually
seen a child or adult with autism?
Okay, so, a lot of you.
S,o you know what he's talking about in terms of change was
he was saying these were kids who would notice any little deviation from normal.
So the parents rearranged the house, the children would get very upset. Or if they took a different
route to school, the child
would get very upset. So we talked about this: literally insisting on things being the same way.
Also however as part of this, kind of the flip- side in a sense, in terms of an insistence of sameness,
he said, well another part of its resistance to change
he talked about some of the unusual behavior as we very commonly see
in younger and more classically autistic children,
body rocking, hand and finger flicking.
You say well how's that
resistance to change, how is that insistant on sameness?
He saw that as an attempt on the child's part
to maintain the sameness in the world. You follow that?
So it's a little tricky,
but in fact it's a whole package, this resistance
to change, the insistence on sameness thing.
It includes many unusual movements and mannerisms.
Dr. Klin's going to say a little more about that today, and we're going to talk a lot about it later on
when we talk some of the research
that when you think about it, it's very interesting, because he is saying,
these are kids who come into the world
and they don't connect with their parents and other people, like any other baby will starting from birth.
On the other hand, even though they're not living in the world of people,
they're very clued into the world of things, and we'll have a chance to see a little bit
about that later today
with Dr. Klin's talk.
He thought children were born with autism, he thought it was congenital.
We now know that about twenty percent of the time,
children with autism
seem to be
reasonably okay
and then they seem to either lose skills or they don't keep developing in the same way.
So it's not so clear that it's totally congenital, that being said,
almost always, by the time a child is three years of age the parents are worried. Ninety percent
of the time, parents are worried by the time the child is two.
About sixty percent of the time
parents are worried the child's first year of life.
And we'll have a whole talk when we'll talk about very young children with autism.
It's a very active area of research around here
Lastly, if you read his paper, Kanner talked about the work of a man who's here- literally
here - at Yale.
The building right next door, a man named Arnold Gesell who's running
what became the Child Study Center back then.
Gesell was interested in normal baby development.
Gesell was one of the people charting normal baby development and he said, you know
typical babies by six to eight weeks are starting to smile back to their parents.
And for those of you who, when you have children you will discover it's a wonderful occasion
because for the first time, you've been taking care of this little lump which just feeds and poops as far you can't tell,
and all of a sudden, you think, oh my God, there's a person there!
And it very characteristically happens around six weeks of age, and that's true.
And Kanner talked about that, he said kids with autism-
very different-
they don't seem to go through that same set of processes
And he was remarkably right about that. We'll talk more about that.
We now know that actually from the moment of birth, the typical baby
is more interested in the human face and voice
than anything else in the world.
I think it's very different in autism.
And here's a quote from Kanner, 1943, his paper,
He says, "The outstanding 'pathognomonic,' fundamental disorder
is in the children's inability to relate themselves in ordinary ways to people in situations
from the beginning of life...
There's this from the start an extreme autistic aloneness that, whenever possible,
disregards, ignores, shuts out anything that comes into the child from the outside."
And we'll have a chance to talk about that. That's most true of the youngest children.
As kids get older things change, and you'll have a chance to talk about that.
Now some of the things that Kanner talked about in his first paper...
it's a wonderful paper, but some things misled people. And these are couple of things
that exist out there to some extent as urban myths.
The first thing was, of the eleven children ten of the parents
either were in Who's Who of America or American Men and Women in Science.
Remarkably successful people.
Right? This led to the notion, especially in the 50's and 60's that you had a very bright parents
to have a child with autism.
This also led to a somewhat bad place, and some people said, Ah, it must be because he is so bright, they're not paying
enough attention to the child.
So people blamed the parents for the child's trouble.
In fact, if you think about it
Kanner was writing in the late nineteenth- he's seeing cases - in the late 1930's early
1940's.
This is how many decades before Al Gore invented the internet?
Remember that?
This was the time-
This is an old audience..
Dr. Klin: Exactly..
Dr. Volkmar: Yeah
I threatened Lisa that I was going to talk about Trotske and Emma Goldman today,
but she said, oh no, they'll never know about that.
Interestingly, back in the thirties and forties is no great
information resource right? Like the Internet is today.
How are you going to get to the one person- the only- child psychiatrist in the country, much less
the one person
interested in autism?
You're going to be well connected.
They're going to be somebody who's working in the university or college or are very academic
or in a very successful setting
where you can say to the dean of the medical school or president of the college or president of
the university, I've got a really unusual child,
is there anybody in the country
that's studying unusual children?
And the dean or the president would say
'Geez, I don't know, but I'll ask around.'
And we think that's the reason why there's this unusual bias
for getting very successful people.
You see children with autism everywhere. We've now come to appreciate this was a selection
bias.
Children are born into all social classes, I've seen children from every continent on the
globe, except for Antarctica,
with autism, I'm sure if there were penguins that were social, we'd see autistic penguins.
But you see it everywhere, and it looks remarkably the same.
Now what differs is how people respond to it. There's a lot of social, cultural things about
autism we can talk about terms of treatment.
But how it looks is really remarkably the same.
Kanner thought autism was not associated with medical conditions that led people in the fifties and
sixties to say, well
if you have a medical problem, you can't have autism.
I want to show a slide on this in a little bit.
Turns out about twenty percent of strictly diagnosed children with autism develop seizures.
Epilepsy.
Hard to imagine, right?
How can that not be a medical condition?
Well it took people a while because they had to follow children over time.
He thought children with autism- and I'm going to talk about this this next week-
had normal levels of cognitive ability. Now why did he think that?
Some things on IQ tests- puzzles- they were great!
Now the rest of the test?
Well, they didn't do so well.
But he said, Well if they did this well on the rest of the test
their IQ would be normal, which is true, but
-and the 'but' is, they don't.
They have unusual peaks
and valleys in terms of skills.
In classical autism, non-verbal skills often are preserved
where verbally mediated things can be really very very severely impaired.
I think we'll have a chance to talk about that.
And finally the schizophrenia business.
The word autism had first been used back in the early 1900's
to talk about some aspects of unusual thinking
and people's schizophrenia.
So people who thought things that really didn't make sense; they didn't communicate very well.
This confused people into thinking, well, autism is a kind of schizophrenia.
It took people about fifteen / twenty years to realize that that was not in fact true.
And this is a little summary of what happened over the years.
The most important thing to know is that in the seventies people in Great Britain started looking at children
with autism
and looking at children with schizophrenia, and said you know, this is not the same.
Kids with autism have trouble from very early in life.
Kids with schizophrenia, not only do they look different,
they hear voices, they look like adults with schizophrenia,
but they don't develop their troubles until much later.
The classical time to develop schizophrenia is young adulthood,
Sometimes you see adolescents,
very rarely do you see children. It's much less common than autism.
And when people then looked at family histories they discovered
no evidence of increased rates of schizophrenia in people with autism,
a lot of schizophrenia in the families of children with schizophrenia.
So people started making a distinction
by the time something called the diagnostic and statistical manual which is a very influential
psychiatric guidebook to diagnosis,
the third edition came out in 1980 and they included autism for the first time.
Until 1980 you couldn't make a diagnosis of autism
everybody was thought to have schizophrenia.
It was a horrible mess and muddle
because we couldn't interpret research, we didn't know who was being studied.
So there's a new category of disorder in DSM-III it has changed over time,
they have been through various editions.
This is a very short summary of the current edition DSM-IV.
This came out in in 1994, it's the fourth edition.
You have to have trouble in the social area in terms of language
and play and also these unusual behaviors.
It has a good balance of sensitivity and specificity it works very well,
it works will well around the world.
There was a lot of work that went into DSM-IV, Dr. Klin, who was then, I think,
probably a post-doc,
right?
After that. Even being a post-doc
we actually had a thousand cases, a hundred raters, twenty-some sites around the world.
It was like Ben Hur and the chariot races.
And it continues to be for the moment the - it's the current definition of
autism that's used
predominately in the United States but also very much around the world.
They're also - we'll have a chance to talk about this next week-
other approaches to definition: rating scales checklists,
and we will have a chance to talk about some of these.
And again these have their uses, their pros and their cons,
One of the problems is, what's the 'gold' standard?
How do you decide somebody really has autism?
We don't have a blood test,
we don't have any physiological things.
Turns out, the so-called 'gold' standard, you should get some really experienced clinicians together
and and say, Yeah, we think the kid's got autism.
And so it's a bit of a,
you know, dog chasing its tail in some respects.
We need better and different approaches, and you're going to hear about some of the work
a little bit today but more when we talk about infants,
trying to come up with better screening methods for finding autism in very young children.
I sometimes say, my wife is a pediatrician it's like somebody came in to her
with an eighteen month old and said, "I'm worried my child is deaf".
And she pulls out a fifteen item questionnaire. They'd say, "No, I don't want to fill out some paper and pencil thing,
I want a hearing test."
Well we don't have that for autism, but we- that's one of the things we're aiming for.
We would like something, you'll hear a little bit about it later today,
a lot more about it if you're in the course later on,
we're looking for better approaches that are more robust in terms of screening.
The reason that's important,
for many children, early intervention makes a big, big difference.
And again when we look into it, there's a lot of other categories that go along with autism,
these days, this may all change
when DSM-V comes out
We'll have a chance to talk a little bit about these; I'm going to say just a word about them very
briefly,
Dr. Asperger was working in 1944.
He reported a series of boys- he was working, by the way, in Austria,
so he was totally unaware of the Leo Kanner's work the year before, here in the States.
He wrote about boys who had horrible social troubles- they couldn't join groups,
but they had good cognitive and language skills. Unlike children with autism,
whose language is often delayed,
or very unusual or aberrant. They had motor problems; they had very unusual interests: the kid would know all the trains into
and out of Vienna
The 6:15 stops at Leipzig...
And the kid would have to take his parents to the train station to be sure the 6:15
got in on time.
And he made the point that these interests actually interfered with a child's learning.
And he mentioned there's often a positive family history
but these were kids whose fathers often were somewhat socially odd.
We'll have a chance to talk about this later on. I actually think Dr. Klin's going to show some drawings
to give some examples in a few minutes.
But Asperger's disorders get recognized as an autism variant- it's in that same category.
The difference is, these are kids with good
language. They don't have good communication; they know a lot of words and are often fixated on a topic,
but they can't necessarily carry on a conversation.
There's a lot of issues in terms of thinking about Asperger's.
Some of the things that Asperger said, the child talks before he walks, words are his lifeline.
He emphasized that it's different in autism,
although all the social deficits are there,
the language to some extent is also there.
It's interesting, and we'll talk about it in terms of implications for mechanisms and intervention.
When we looked at it in DSM-IV for this
big study,
in fact we've found some differences in Asperger's which was the reason it was included,
at least for the moment.
There's someone who is going to be on campus in a
few weeks, actually, who's screening the movie 'Adam'
which just came out, I think, just came out.
Which is about a young
person with Asperger's-
anyway, it just came out.
but there's going to be
the person who produced the movie is going to be here
on campus. We'll talk about that when it comes closer.
There are a small group of children who develop normally to three, five, six, seven, eight
years
and then develop something that looks like autism. This is very bad news unfortunately.
When you see this- most of these children are very very poorly-
people used to not believe parents
when they would say, "My child was perfectly normal."
Now with videotape we can go back
and look- you'll see children who were perfectly fine, and we may have a chance at some point during the course
when we talk about this,
to see some of these video tapes.
The child was perfectly normal and then kaboom- it's like someone pulls off
the light switch.
The child loses skills, often in multiple areas, comes to look very classically autistic,
and typically, unfortunately, don't get things back.
And finally, Rett's disorder. This was a man named Andreas Rett who was writing in 1966.
These were girls
who had very unusual movements of their hands. Has anyone here ever seen a patient with Rett's Syndrome?
Okay? Very odd hand movements,
they have breathing problems, they have movement problems, they have back troubles.
They are normal when they're first born and they seem to lose skills, they lose their hand movements,
and they become very very very intellectually impaired
Um,
Rett originally thought this was some kind of autism.
In fact, people agreed, it didn't really- except for the very beginning- look like
autism at all. These were very characteristic and very different things.
We put it in DSM-IV because we thought was sufficiently interesting and ought to be studied.
And subsequent to the time it got put in,
it has been found to be a single gene disorder. There's a very particular gene called
MECP2, which is a regulator gene which goes ka-phlooey in Rett's Syndrome.
And you can find boys with this, although it's very unusual, it's probably mostly lethal in boys.
And again, it's very interesting as an example of something that's relatively rare,
but very important because we can understand the genetic mechanism.
And finally,
there's a funny term, PDD-NOS: Pervasive Developmental Disorder - Not Otherwise Specified.
This means kids who have some features of autism but they don't meet the full definition.
"Close but no cigar autism."
Now this is a very large group of children- it's probably on the order of 100 to
150 kids.
But very poorly studied. You can imagine it's hard enough to get federal money to study autism,
think of how much harder it will be to get something that's not quite autism.
There are unlikely to be several sub-types of this,
but it's a very interesting area of work, and when you hear those ads on television about how common
autism is,
they really are talking about the autism spectrum and especially about PDD-NOS.
Let me say a very little bit about epidemiology.
There's a wonderful chapter, which we'll put on the web site for anyone who's interested,
by a man named Eric Fombonne,
from the Handbook of Autism,
He makes several important points, one is that various
- various things happen in terms of looking at epidemiology.
There are important implications of how big your study is, how small your study is,
Small studies find higher rates
probably because they do a better job of finding cases.
He also points out that there have been changes in definition over time,
also there's a problem which is that sometimes parents want the autism label to get services.
It's a ticket essentially. Remember Willy Wonka
and the Chocolate Factory? It's the golden ticket; it gets you a lot of services.
And so sometimes parents will push
to get the label
to get the services.
PDD very broadly defines probably about 1 in 150 children.
Autism is more like 1 in 800 to 1000. Still not uncommon,
but not as common as the broader PDD group.
And this just shows you- this is data from Frombonne's chapter that I actually graphed out.
This shows you the rates of autism over time starting with the first epidemiological study.
But you can see among other things, although things look like they're going up in terms of the rate,
were also changing the ways we diagnose autism.
So we're looking at a moving target.
And particularly DSM-IV and ICD-10, which are essentially exactly the same,
we specifically set out to have a system that worked well for more able, as well as for less
cognitively able people.
Which means we're going to pick up kids that
were there, they just weren't picked up before.
So it's not so clear that the rate has increased even though it looks like it has.
And furthermore you can do something called confidence intervals around all those same numbers,
and then you see that in fact there's a fair amount of agreement
overall in terms of
what people are saying in terms of rates.
So there's no question that more cases are being identified, but the question is, is there a real increase
and there are lots of issues in terms of changing definition, better diagnosis,
more awareness and its implication for services. A problem called diagnostics substitution.
I mentioned in neurobiology, early on
people didn't think there was much in terms of neurobiology, but as they follow children over
time it became clear two things:
one was high rates of seizures disorder, epilepsy,
pretty clearly a brain-based problem, right? Seizures.
The other thing was, as people started looking at the family members they became aware of a strong
genetic aspect to autism.
We're going to have a whole talk on that later in the course.
This is data actually from that
book that I mentioned before.
This is a sample from here in New Haven of I think several hundred people with autism.
This is a sample from Boston.
This is data time from a normative British sample, 5,000 I think,
normal, typically developing children, a normative sample.
this shows rates of developing seizures by age, so this
is first seizures,
rates per thousand,
and here's less than 3, 3 to 6, 7 to 10
obviously once you developed a seizure,
you're going to drop out of this,
it excludes children that have febrile seizures- if you only have seizures in relation to a fever-
so, this is really epilepsy.
And the normal sample you can see the highest rate is less than 3 years,
then it goes down, down, down,
by the time you get to be 14,
15, less than 1 in 1000.
Children with autism either in New Haven or in Boston, high rates across the board,
including a big group
early in life
but then another big group in adolescence. It's not at all uncommon to hear
a child with autism develop seizures
as an adolescent.
Someone your age who develops seizures, I can tell you, you'd literally be worked up the wazoo
because it's very uncommon.
Kids with autism, it's actually not at all uncommon.
This was very convincing to people thinking this was a brain-based disorder.
Medical conditions with autism, there have been a lot of speculations over the years about people
reporting cases of autism associate with X syndrome, Y syndrome, Z syndrome.
The strongest associations are with some disorder like fragile X and tuberous sclerosis,
which are strongly genetic disorders.
And I mentioned, with epilepsy.
The problem with many of the early case reports, is there's a bias in case reports.
Autism-
as a journal editor, I get a paper,
autism associated with down syndrome, 2 papers.
I might publish that, or I might not. In fact, I stopped publishing case reports
for just this reason. But, it's more interesting.
Somebody sends me a paper on autism not seen in 2 it down syndrome.
Hey. I'm not
going to publish that. It's not newsworthy.
So it's a problem, there's a bias for people to be swayed by these positive
reports of cases
so we have to do more,
larger epidemiologically-based studies, and when you do,
you find this.
So some of the things that people saw early on- people said, "Oh, there's an autism association
with Congenital Rubella.
Kids with Congenital Rubella are often blind or deaf, they're very impaired.
Interestingly, if you look at them over time, they look less and less autistic
over time.
Lots of interesting neurobiological findings,
we mentioned the seizure disorder,
high levels of the blood transmitter called serotonin
Serotonin is a transmitter in the brain that's also found in the stomach and in the platelets.
As a group, people with autism have high levels of serotonin.
We'll talk some about that when we talk about psychopharmacology.
Some of the medications actually work on serotonin.
People with autism are more likely to have unusual reflexes that persist.
There's some interesting reflexes that you see in babies that go away.
This one called, for example, a visual routing reflex
If I take my pencil
or my reflex hammer
and I make eye contact
and I go like this, the typical person looks at me like I'm crazy person.
A person with autism, not every time and not every person, but a fair number
[mouth sucking sound] ... will root.
It's like if you take a baby and do the same thing,
the baby will root. And the idea is that the baby is programmed to look for the breast.
Turns out that the hosts of these
funny little neurological signs
that you sometimes find in people with autism.
There's some work on changes in the brain, actually in terms of the brain structure.
Especially around some things called minicolumns the arrangement of the brain in columns, the cortex,
also something called mirror neurons.
You're going to hear about the fusiform gyrus and faces in just a second,
and there's a paper that just came out from us, which has yet to be replicated,
but it reports high rates of placental abnormalities.
This is a colleague of ours over at OB/GYN who asked us, Gee, do you have any placentas
of kids with autism? And they then did a study,
and there are the abnormalities of these unusual were called trophoblast inclusions,
the persistent kids with autism are more likely to be there
otherwise they're pretty much gone.
You also see them in kids with genetic syndromes, things like triple X syndrome or
XXY syndrome, where they've got one to many chromosomes.
So lots of areas, and we'll have a chance to talk about this, we have a whole talk by Kevin Pelphrey
on autism and the brain.
There's a lot of interest in terms of thinking about brain regions
and what the implications might be understanding the social aspects of autism.
And genetics.
If you look early on there was an impression of no genetics to autism but
obviously people with autism weren't so commonly reproducing at that time the outcome was poor. Many people
with autism ended up in institutional settings.
As people started to look, and the first study was by Rutter and Folstein in the
late seventies.
Identical twins versus fraternal - same sex fraternal twins-
identical twins are always going to be the same sex, right? Because they're identical-
---
The
fraternal twins could be brother sister.
They exclude those because there's a gender difference in autism and we haven't talked about
but will,
which is that girls, when they get autism tend to be much more severely affected.
Boys on the other hand are more likely to get autism,
which is something that's interesting thinking about the neurobiology.
If you look-
and this is all
the twin studies lumped together- again, we're going to have a whole talk on genetics-
about 60 percent of the time identical twins will have
pretty strictly diagnosed autism- if one kid has autism,
the other will.
If you start to expand your definition a bit,
you get to 90 percent- not 100 percent-
that's awfully high.
And here are the data on the fraternal twins, same sex.
So there clearly is a very strong genetic aspect.
The complexity as you'll hear, is that probably there are multiple genes involved
and people have speculated based on
mathematical models somewhere between 4 and
20, maybe even more.
The interesting thing, as you'll hear when Matt State comes to talk, is we're actually close to being able
to find some genes out there that have been identified.
Once we absolutely do have some genes it'll
be fantastic
because we can come up with animal models, we can understand how the genes are expressed in the brain.
Environmental causes in autism.
This is an area of tremendous interest, especially in the lay public and the media.
That's one of those places where there's a lot of smoke and not so much fire.
Interestingly enough
animal models have been attempted - it's difficult- most of the animal studies that have been done to date,
involve lesion studies.
Now whatever else is true, it's not as if somebody's coming along and lesioning the brain of children with autism.
And so it's a different kind of time course, it's a developmental thing, and as you'll hear,
when we talk about some of the things with babies,
there's good reason to think that one of the things that's so difficult about autism,
is that early lack of social interest then gets entrained in a lot of other aspects of development.
It has a lot of implications for learning.
Identification of genes clearly will help because we'll come up with much better models.
Immunizations and autism- we're actually having grand rounds in a couple weeks
with a man who's written a wonderful book called 'False Prophets'
on this whole topic immunizations and autism.
There's a tremendous amount of evidence that says immunizations do not cause autism.
Immunizations prevent illness.
Children who are not immunized
die from
preventable illness
but this- again, a tremendous amount of
misinformation out there.
People have looked at other things like heavy metals, mercury,
arsenic, lead,
drugs and other toxins. In fact, the data are pretty limited.
People also looked at cluster cases.
You know, Brook township, New Jersey.
It's a funny business- I had the experience a few years ago of having
someone from one of the papers in Hartford call me and ask me about the outbreak of autism
in Guilford, Connecticut.
And I laughed at the guy- he said, "Why are you laughing?"
And I said, "That's the town I tell anybody who's coming to Yale,
if they want to live in a good town with a good school district, you say 'oh, go live in Guilford.'"
So I was actually referring people
with autism to Guilford.
Um, right?
So it's a- it's a funny business. And again on balance the data for environmental causes
is not horribly strong.
There's a paper that will show up on the reading list by Wing and Potter
that summarizes all this.
Outcome research, very briefly, as time has gone on,
kids are doing better with early intervention- we're going to talk about outcome in, I think, about two weeks.
We have more people who are talking, people have higher levels of intellectual ability,
kids are now going to college. There's a whole set of books out there now
for kids going to college- I mention the Chapel Haven program
is for kids who are doing so well, they can
almost make it independently in college.
They just need another push
to help them get those life skills up to the point where they can actually
go and do it. Often the academic part isn't so challenging
it's the social and the unstructured part that is.
There are problems that do remain- it's difficult in terms of understanding a cure, you'll find a lot of people
that claim, "oh, my child was cured of autism."
Over the years, seeing thousands upon thousands of children
probably, I've seen five, that if I met the child I wouldn't necessarily know that they had autism.
But that's 5, out of over seven to ten thousand.
So I remember those.
That's not to say people don't do a
whole lot better,
but often there are some residual problems, which is not surprising- this is a very serious problem.
But again, and we'll talk about what 'normal' means and what a 'cure' is.
Treatment.
There's a very good report- we're going to talk about in two weeks on treating children with autism
from the National Research Council.
It looks at all the programs around the country that have empirical data to show they work.
There's about ten of these programs, they are wonderful programs,
they have some differences, but many things in common.
They all focus on structured intensive intervention, they have some things going for them in terms
of
working on the kinds of things, early intervention,
language, communication, joint attention.
We'll have a chance to talk about that.
They do make the point in this report
that not every child gets better.
Some kids, even despite the programs
don't do so well and we need to understand more about that.
But as a group, children are doing better and better and better.
We'll also have a chance later on, we'll talk about drug treatments.
Drug treatments don't cure autism but they can help with of some of the symptoms,
and sometimes that actually helps the child participate in the program