|[Letter BMJ Jan 2005--Autism diagnosis] Looking Out of Olmsted County bmj||18 January 2005|
In her “News Roundup”, (1) Ms. Janice Hopkins Tanne reports that according to a recent study from the Mayo Clinic: “Changes in the definition of autism, rather than use of the measles, mumps, and rubella vaccine (MMR vaccine), led to increased diagnosis of autism in the United States and probably in Europe”.
This sweeping conclusion was based on a review and analysis of available data for the period between 1976 and 1997 from relatively isolated Olmsted County, Minnesota.
According to the US census Bureau, the population of Olmsted County was 84,104 in 1970 and 124,277 in 2000 (2).
The authors identified 124 (one hundred and twenty four) children under 21 with autism, reviewed their charts and concluded that: “Most had not been diagnosed as having autism, but rather as having developmental delay, delayed speech and language development, attention deficit or hyperactivity disorder, and mental retardation”.
AUTISM; DEFINITION and DIAGNOSIS
In the United States, (3) the definition and diagnosis of autism have been based since 1994 on the clear criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV).
The diagnosis is usually made by trained physicians and reviewed by Special Education specialists in the different school districts, before services are provided.
Because of the cost involved and the shrinking Special Ed budgets, it is unlikely that services would be provided to anyone who does not clearly fit the criteria.
In 1994, there were 22,780 children diagnosed with autism and autistic spectral disorders (ASD) aged 6 to 21 in US schools according to the US Department of Education (DOE) reports to Congress. This number increased on average by 22% per year (18.28 - 26.48%/yr) to reach 140,972 in 2004. (3, 4)
According to the same sources, the number of children with autism aged 6 to 21 attending Minnesota schools increased from 296 in school year 1992-1993 to 4,116 in 2002-2003, a 1300% increase in 10 years. The number of such affected students reached 5,076 in school year 2003-2004, a 23% increase in a single year. (4)
In January 2004, HHS, CDC and AAP jointly issued an “Autism A.L.A.R.M.” warning that the prevalence of autism (autistic spectrum disorders) in the United States was 1 in 166 children. (5)
According to recently released figures by the California Department of Developmental Services (6, 7), a record 807 NEW cases of Type I autism (aged 3 years or older and not including children with other ASD) were admitted into the system in the Fourth Quarter of 2004. This is the largest number of new cases for any October to December period in 36 years. It is 16% higher than the Fourth Quarter of 2003 (676 new cases) and 468% more than the last 3 months of 1994 (142 new cases).
On average, California added 9 new children with type I autism DAILY to its system from October 1 to December 31, 2004.
To put all this into perspective, while there were apparently 124 children with autism in Olmsted County, MN in 21 years, according to the Mayo Clinic study, California will register the same number of new cases in the next two weeks.
In school year 2003-2004, there were 19,034 children with autism/ASD aged 6 to 21 in California and as mentioned earlier, 5,076 in Minnesota.(4) In 2003, the population of Minnesota was estimated at 5,059,375 (8) and that of California at 35,484,453 (9). The percentage of children with autism (ages 6 to 21) to the population was therefore 0.1 in MN and 0.05 in CA, a surprising and alarming finding indeed.
The team from the Mayo Clinic can not tell parents that autism represents a small change in definition, when these parents are facing children who convulse, scream and bang their heads all day, or who have severe bloody diarrhea or severe constipation for two weeks at a time, or who meltdown in the supermarket and at church or who freak out when the garage door opens or when the neighbor starts his lawn mower, or who can never be left alone for a minute … and who were born normal and will certainly need help for the rest of their lives.
One can only also imagine the outrage of school superintendents (who are responsible for the training and education of these children until they turn 21) or municipal and state legislators (who have to fund all the needed services), when informed that all the challenges they are facing now always existed but with a different name. The fact is that public authorities and school districts are overwhelmed by the recent rapid increase of their financial responsibilities.
MMR and AUTISM
According to the CDC, the UK DOH and other “experts”, no one knows what is really causing this recent epidemic of autism, whatever it is called and however it is defined, but one thing is absolutely certain: It is not caused by vaccines or thimerosal and certainly not by the MMR.
Obviously many parents who have seen their children literally disappear after receiving an MMR vaccination are convinced otherwise.
In hundreds of these children, a specific type of enterocolitis has been identified; Some have evidence of measles virus genomic RNA in the CSF, some in the gut wall and some in both sites.
Many affected children have specific patterns of urinary polypeptides, high serum measles and MMR antibody titers and elevated Myelin Basic Protein auto-antibody levels.
In fact, it will be safe to say that it is impossible to find ONE normal child who has evidence of both MMR antibody and Myelin Basic Protein auto-antibodies in his serum or his CSF or ONE child who regressed after MMR vaccination and who does not have at least one of the following: The typical enterocolitis of autism, a suggestive pattern of urinary polypeptides, elevated serum measles virus antibody, MMR antibody or Myelin Basic Protein auto-antibodies. (10)
Those who want to deny that MMR can precipitate autistic regression in genetically predisposed children will keep studying old clinic records in North-West London and Olmsted County, MN, look for evidence in spreadsheets in Denmark and produce epidemiological studies that will not stand up to scrutiny.
On the other hand, those who are searching for the truth, will use their time and talent to interview parents and examine children.
1. BMJ 2005;330:112 (15 January), doi:10.1136/bmj.330.7483. 112-d
3. Yazbak FE. Autism in the United States: A Perspective J .Am Phys Surg 2003; 8(4) 103-108 http://www.jpands.org/vol8no4/yazbak.pdf
7. SAR Volume 9, Number 6, Wednesday, January 12, 2005
10. A Black spot on a Good Journal
Competing interests: Grandfather of a boy with regressive autism, enterocolitis and evidence of measles virus genomic RNA in the gut wall