All About Autism – PediaCast 107

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  • MMR and Autism
  • Autism and Fever
  • What Causes Autism?

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Announcer 1: Bandwidth of PediaCast is provided by Nationwide Children's Hospital. For every child. For every reason.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from Birdhouse Studios, here is your host, Dr. Mike!

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00:45

Dr. Mike Patrick: Hello everyone and welcome to PediaCast. This is Dr. Mike, coming to you from Birdhouse Studio. I'd like to welcome everyone to the show and I do believe that we have our audio technical difficulties under control. Those of you who listened to the last couple of episodes, we had some issues, if you were listening over speakers, you probably didn't notice it, but if you were listening to the show with headphones on, there was a little warble in there and it had to do with the coding and turning it into an MP3 and there are just some technical issues that I overlooked. We should be OK with the show, I think we have everything ironed out, we'll see. But I think we're good. It is Episode 107 of the PediaCast program this is Friday, February 8th 2008 and we're calling this one Autism, Autism, Autism. That's all we're going to talk about. Now, we're not going to cover every nook and cranny of the entire spectrum, as it were, of this disorder. We're just going to talk about a couple of news stories that are out there right now with regard to autism.

02:01

And then answer a listener question or two regarding autism spectrum disorder. So that's all coming up. I have a question, I want to know if doctors 20 to 30 years ago had a deal with this sort of thing that I'm about to describe? I mean, seriously. If you have an old, retired doctor in the family, I'd like to know, ask them. It just seems to me, more and more, that there are kids who refuse to have exams or tests, or procedures done, with the parents doing very little to help out. For instance, kids covering their mouth when you need to do a throat swab and clamping their jaws tight and actually refusing, absolutely refusing, except by force for you to do the throat culture, or kids who literally fight the nurses when it's time for a shot or flat out refusing a blood drawn and running the other way.

03:00
Now, I'm not talking about two and three year olds here. OK, you expect that kind of thing out of two and three year olds, really. I'm talking about the 200 pound teenager acting like a two or three year old and it just seems to me like this is more and more of an issue. I had a 200 pound, 12 year old, yes 12 OK, they have other issues that are very pressing, but a 200 pound 12 year old trying to do a throat culture. My nurse is attempting to help me hold her arms down, mom's doing pretty much nothing, the girl jumps off the table, knocks my nurse to the ground and has my nurse pinned to the ground and won't get up off of her. [Sigh] Boy, I don't know. This flu season's been a crazy one, let me tell you. All right, so what are we going to talk about today? Well as I mentioned, it's all about autism.

04:00
The MMR vaccine is in the news again with regard to autism and the latest research, what's showing, we're going to talk about that. Also, autism and fever and then we're going to discuss a little bit about the cause of autism. Is it a shot, is it environmental, is it genetic and who's to say? So we're going to talk about that a little bit. Don't forget, if there's an issue that you'd like us to discuss on this program, all you have to do is go to Pediacast.org, click on the contact link and shoot me an e-mail, or you can e-mail me directly at pediacast@gmail.com. If you go that route, make sure you include your name and where you're from so we can include that in the program. You can also call the Skype line at 347-404-KIDS, which is 5437 and leave a message that way. I have a backlog of Skype messages and I'm going to work on them this weekend so hopefully, next week's shows, we will include some Skype calls for you.
05:01

OK. Don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your doctor and arrange a face to face interview and hands on physical examination. Also, your use of this audio program is subject to the PediaCast Terms of UseAagreement, which you can find at pediacast.org. With that in mind, we will be back with News Parents Can Use, right after this.

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06:03

Our 'News Parents can Use' is brought to you in conjunction with news partner Medical News Today, the largest independent health and medical news website. You can visit them online at Medicalnewstoday.com.

There is no evidence of a link between the MMR or Measles, Mumps, Rubella vaccine and autism, according to a new independent virus study, the most comprehensive ever undertaken. The new report comes ten years after the original lancet article by Dr. Wakefield called on to question the safety of the MMR vaccine. The joint report by Guy's Hospital, the British Health Protection Agency and Manchester University looked for the measles virus and antibody levels in children. It linked very careful assessment and diagnosis of a child's condition with expert analysis of blood samples, carried out by laboratories, recognized as world leading by the World Health Organization.

06:56

The study found that there was no difference between the results from autistic and non-autistic children. Welcoming the study published in the archive of Diseases of Childhood, Director of Immunization at the British Department of Health, Professor David Salisbury said, "It's natural for parents to worry about the health and well-being of their children, and I hope that this study will reassure them that there is no evidence linking the MMR vaccine to autism." Dr. David Brown from the Health Protection Agency who worked on the study added, "The study found no evidence linking MMR to autistic spectrum disorder and the paper adds to the overwhelming body of evidence around the world, supporting the use of MMR. Public confidence in the MMR vaccine continues to remain high as the numbers of those receiving their first dose has stayed stable. However, it is also important to remember, that children should complete their full course of MMR vaccine for optimum protection. This virus study reached the same conclusion, as a number of large epidemia logical studies. Studies found that the rate of autism on children who have not had the MMR vaccine is the same as those who have."

08:05

OK, that's the official story, but it doesn't exactly tell you what the researchers looked for here. It's kind of nebulous, you know what I'm saying, they just say, "Well, it is sure that there wasn't a connection." But they don't tell you what they did. So, I'm not sure it really gives parents more confidence because they're just telling you that there was no connection. So never fear, here, I did the leg work, and here's the DOH study, basically they looked at 100 autistic kids. They looked at 52 kids with learning difficulties but who did not actually have autism and then they looked at 90 kids who were developing normally. And then all of these kids had received at least one MMR vaccine in the past and then they took blood samples from all of the kids. And looked at the antibody levels for MMR or the presence of measles virus still in the child's body.

09:04
There is no evidence of virus still in any of the children's bodies, regardless of what group they were in, and the antibody levels were the same in all three groups. OK, now I know why they didn't include the specifics in the official article. I mean, give me a break. This does not tell me anything that gives me confidence that the MMR is not associated with autism. I'm going to call them on this because parents want a reassurance that the MMR is not related to autism. So this is a study that looked at 250 kids, in the scheme of things, it's a very, very small sample size. And basically, what they're doing here is they're saying, "If the MMR, the basis behind this, if the MMR,  if the antibodies that are made because of the MMR vaccine, somehow attack the brain, you think that there's going to happen if there's more measles' antibodies in kids with autism. [Sigh]

10:15

But the problem with that is, let's say that's true, these kids are kids who've had autism for a long time. No one has suggested that the antibody levels against measles is going to stay high. What's more interesting to know or what would tell you that is this an issue, is what were the antibody levels when the child first went from having sort of normal development to autism and if at that point the measles antibody titers took a spike high, they were higher, then that might suggest that measles antibodies were involved. But just because the antibody levels are normal years later, does not mean that those antibody levels didn't do something.

11:06

And the other issue is, let's say that those antibody levels are normal, but what if a child is more susceptible to those antibodies doing something in the child's brain. So, to me, the fact that the antibody levels are the same in autistic kids versus not autistic kids years down the road, that doesn't tell me anything. That doesn't tell me that the MMR is not related to autism. And the fact that there's no evidence of any measles virus still in their body, no one has suggested that that's what was causing autism either. So, to my looking at this, this is really not a very good study. Don't get me wrong, I mean, I don't believe personally, that there is a connection between MMR and autism. But when you parade around studies like this and you put them out as proof that there is no connection, it's a shame, and it puts scientists in the same boat as those who use bad studies and faulty conclusions to show that there is a link and in my opinion, that's a bad boat to be in.

12:15
If you're going to tell parents that there's this great new study that proves there is no link between MMR and autism, it better be a damn good study. Anything else is just irresponsible. [Sigh]

All right. One more thing in the news regarding autism and would do the official story and then I'll give you my thoughts on this one as well.

Providing some interesting and possibly hopeful findings for parents of children with autism. A recent study shows that a fever may temporarily improve social skills in kids with autism. It's research that might eventually lead to a deeper understanding of this increasingly diagnosed condition. For decades, both parents and doctors have reported that some of the behaviors of kids with autism seem to improve for a few days when they came down with a fever.

13:01

So researchers set out to find out what effect, if any, fever might have on kids with autism spectrum disorder, so often referred to collectively as autism. The researchers analyzed the behavior of 30 children ages two to 18 with autism, during and after a fever of 100.4 degrees Fahrenheit or more. Then they compared these behaviors with those of 30 kids with autism who did not have a fever.

According to the study, supported by the Cure Autism Now Foundation, kids with a current or recent fever show temporary improvements in use of language, irritability, hyperactivity and other behaviors. But the researchers point out that more studies are needed to find out whether these changes are direct biological consequences of fever and how exactly fever might affect the brain in autism.

13:51
More common in boys than girls, autism spectrum disorders can affect the way a child behaves, thinks, communicates and interacts with others. Some kids have only mild symptoms, where as others are more severe. Subtle symptoms are often present before a child's first birthday, sometimes even on early infancy. But often go unnoticed until the symptoms are more obvious to parents, usually when a child is between 15 and 36 months old. Calling autism an urgent public health issue, the Centers for Disease Control and Prevention reported in early 2007 that about one in a hundred and fifty children in the United States is diagnosed with the developmental disorder, a higher rate than health officials had previously thought.

Although it might seem that more kids have autism today, it's unclear whether the increase numbers mean that the disorder is actually on the rise. Why?

Well for one, a broader definition of autism can be applied to more children who show varying degrees of symptoms plus health professionals have become more aware of the condition which has led to more diagnosis. Though there's no cure for autism, getting help early on is crucial to helping kids cope with the disorder, learn and to communicate. That's why the American Academy of Pediatrics recently began on urging doctors to routinely screen all children for red flags of autism at 18 and 24 months of age.

15:06

Parents of a child with autism are often desperate to get help and understandably so. Although this latest study does show some positive brief effects of fever in kids with autism. If you have a child with an autism spectrum disorder, it's crucial that you never try a home cure by creating your own fever inducing remedies. No kidding.

That could do far more harm than good. Much more research is needed in the why, how and whether fever can affect autistic behaviors and whether this knowledge might translate into the development of more effective treatments. Always talk to your doctor before starting any kind of treatment plan to make sure it's safe and appropriate for your child.

I think we should definitely file this report on the shelf of interesting tidbits. I do have one big issue of this study. They looked at two groups of autistic kids, right?

15:56

One group with fever and one group without. But since autism varies so much, it's really a group of disorders, how do you know that two groups were really equal to begin with. Wouldn't it be better to compare the same kids against themselves? Evaluate their baseline function and behaviors when they don't have a fever and then evaluate them again during and just after a febrile illness then evaluate them a third time maybe a few weeks after the fever, just to show that they've returned back to their baseline and hadn't had recent improvements for some other reason.

Then again, what do I know? Just a primary care doctor and a podcast host. [Laughs]

Let's take a quick break and then we're going to get to a question that Emma from Pittsburgh wrote in regarding autism and we'll talk about that in detail, right after this break.

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17:13

OK, this is from Emma in Pittsburgh. She said, "I just wanted to thank you for your show number 14 reviewing autism and vaccines. Well I believe vaccines are an important part of public health. I wanted to learn more about the debate, I listened to your podcast with Dr. Sears and his vaccine book, but the older podcast was much more thorough. I had a bit of a harsh moment at the store the other day, when a father with an autistic boy of about five, who was with him, came up to me and asked if I immunized my baby because his son's autism was caused by the vaccines. I was dumbstruck. I feel empathy for his son so I kept my mouth shut and just walked away. Thank you for sighting the studies which compared vaccinated and non-vaccinated children and for explaining mercury. Good stuff. Now I have a couple of more questions, why do more males get autism? Maybe the tough as yet, what does cause autism? Is it genetics, is it environmental factors and is that a lack of knowing that causes parents to grasp at straws. This is from Emma.

18:12

OK, Emma. So, a dad with an autistic child approaches you out of the blue and warns you to avoid vaccines because they caused his kids autism. [Laughs] That is just craziness! Clearly, this father's desperate, and it sounds to me like he really believes that vaccines are what caused his son's autism and he doesn't want others to go through the same hell that he's experienced. And I think in the end, this sort of desperation really illustrates the medical communities, just other failure, to educate parents on the vaccine-autism issue. I do feel sorry for this dad, really, I do. But I wonder how he'd feel if he knew that you followed his advice and you're child ended up paralyzed from polio.

18:59

Would that be enough to make him reconsider the stance? [Sigh] All right. We do need to do a better job of discovering and explaining the origins of autism, because, I think Emma, that you hit the nail on the head, parents are grasping at straws to understand and unfortunately, we have allowed vaccines to become escape goat. So, what does cause autism? First she has why are more boys affected, we don't know. We don't know why more boys are affected but knowing this fact certainly does point to a strong genetic component. If it were purely environmental you would expect to do affect boys and girls equal numbers. So does definitely the fact that more boys are affected leads you to believe that at least some genetic component to the disorder? Also the fact that it runs in families, also does, there are lot of identical twins who were both autistic and so can these are all things sort of point toward genetics as being, at least, a factor in autism.

20:01
So what does cause it? Remember, this is a group of disorders that fall under one umbrella, the autism spectrum disorder, which we've talked about before. So this is going to be more than one cause, this isn't a single disease process, so it's complicated.

Research is ongoing but it's likely, the autism in the end is the result of a variety of factors. Some of the possibilities, as we've mentioned, genetic, infectious, neurologic, metabolic, immunologic and environmental. These are all possibilities so can be something that's passed on, or pre-disposition, it could be from some infectious agent that we don't know about, either in when babies are inside of mom or shortly after birth. That could be a contributing factor to obviously something in the neurological system. Metabolic is the way the body makes energy and there all sorts of errors and problems that could go wrong there that are very difficult to diagnose.

21:02

And the immune system and the environment are kind of newer ideas in the last ten years or so and the role that they play in the development of autism; we're going to talk a little bit more about that. It's likely that in the end, there is a combination of factors that play a role. So just one theory sort of goes like this, first you have to have a genetic pre-disposition to this sort of thing happening. And then, there's some infectious or environmental insult that happens in utero, or shortly after birth which leads to an immunological event. So you have an infectious agent or an environmental agent that's inside the baby's body, the baby's body makes antibodies against this thing and then the antibodies not only attack this thing, whatever it is, but also attack the central nervous system, so they attack the brain and then that's what causes the autism.

22:02

Because the body, sort of like an auto immune sort of disorder, this is sort of where the research is heading with this right now. And then the question becomes, could something in the immunizations be that environmental factor. Could the immunizations be what stimulates the antibodies and then attack the brain? And this is what the first article that we talked about the news section was getting at. Could it be that the measles antibodies attack the brain and then would you expect the antibodies to be of a higher level. Not necessarily. As we mentioned, if you're genetically predispositioned to having those antibodies attack your brain because of some other factor, maybe something on the surface of the brain is different so those antibodies are able to attack it where as in other kids, the antibodies are the same antibodies but they don't attack because something is different in the brain.

23:01

That could be happening and that study doesn't tell you that at all. But the thing that makes me think that it's not the immunizations is that there have been, we've talked about this before, too. Very large sample size study that looks at kids who've had the MMR and groups of kids who've not had the MMR and the rate of autism in those two groups is the same. You'd expect, if the MMR were significantly involved in the creation of autism, that there will be far less autism in large groups of unimmunized kids and it's not true. The unimmunized kids have the same autism rate as groups of immunized kids. And that to me is the best studies to look at in terms of is the MMR, rather the vaccines involved in this process. If you're interested in the role of the immune system in autism and don't mind waiting through a bit of science, there's an excellent article from the May 2006 edition of the Journal of Leukocyte Biology, yes there is such a thing, called the Immune Response in Autism: A New Frontier for Autism research.

24:15

And it provides a nice introduction to the topic and the direction of this research to the immune system is currently taking and we'll put a link to that in the show notes for you. I would like to take this opportunity to once more state that there is a serious undertaking using the scientific method in the medical community to get at the cause of autism, we want to understand it better. We want to prevent it and we want to be able to treat it to the greatest extent possible. There's no conspiracy to hide anything and if well done studies using the scientific method in large sample sizes so that you can statistically significant results, if that points to immunizations as the cause, do you really think that such a thing could be hidden from the public.

25:04

No. There will be outcry from the four corners of the earth. The truth is there's had not been any well done studies that show there to be a link at all. I get the occasional bad review on ITunes saying that I'm too opinionated I bash so called alternative medicine and the ideas and practices of alternative medicine. At the heart of it, I'm a scientist and we live in a world governed by certain physical rules and laws, and the way we've come to learn about these rules and laws is through the scientific method. It's how we understand such things as gravity and motion and the theory of relativity it's how we put men on the moon it's how we curb polio, and diphtheria and small pox, it's how we're preventing and successfully treating more cancers than ever before, and it's how one day we'll better understand and prevent and treat autism.

25:57

One of those iTunes reviews I'm talking about said this, this is quote from an iTunes review, "Dr. Mike is not used to addressing a very progressive community. If you do listen to this podcast, you'll realize there are other view points out there and they are not all alternative or uneducated just because they are not the norm." Look folks, this is not about alternative versus mainstream. Science is about getting at the truth. Sure there's other viewpoints but you have to prove your point using the scientific method to get my attention. Show me the world isn't flat and I'm in your camp.  Let's face it, viewpoints without evidence, that's the essence of alternative medicine. Prove your point and over time it will become the norm. But if you cling the unproven viewpoints in the face of evidence to the contrary, people are going to think you're uneducated, expect it. Don't complain about it when that happens. Am I wrong?

26:56

[Sigh] All right. Let's go ahead and take a break and we'll wrap up the show and wrap up the week right after this.

[Music]

27:32

As always, thanks go out to Nationwide Children's Hospital for providing the bandwidth for our show. Also, Medical News Today for helping us out with the news department and Vlad over Vladstudio.com for helping us with the artwork on the website and in the feed and of course as always, thanks to you the listener for tuning in, listening, contributing to the show, asking questions really taking an active part in the show. I really do appreciate that. Coming up in the next couple of weeks, I'm hoping to have a scheduled time when we will get together for a PediaCast live program. It will be a call-in type show over at TalkShoe so I'm currently getting that together. So stay tuned for information about that. I think it'd be fun, it'd be something different than this show, so would not be included on this feed, it would just be PediaCast live over on TalkShoe, an occasional scheduled show when we can interact with the audience in a call-in style radio show. I think that'd be fun so we should have some information on that coming up.

28:35

Pediascribe, the blogging arm of this podcast. What do you get when you cross American Idol's Randy Jackson with type II diabetes and a public service announcement? [Laughs] You get a blog post, of course and Karen talks about why her critical health numbers, may be the only normal thing about her, so I'm not going to say anything more, you just got to check out the blog and there'll be link on the show notes for you for that. So I hope everyone has a great weekend and we'd be back with a couple of more shows next week. We'll see you on the other side. Till next time, this is Dr. Mike saying, "Stay safe, stay healthy and stay involved with your kids…. So long everybody.

[Music]

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