I have spent the last few weeks reading article after article on CNN.com about the tragedies and triumphs of families and individuals struggling with autism. I found myself reading provocative and emotional excerpts of stories from stars like Jenny McCarthy (whose child is autistic) and watching “YouTube “ footage of families with autism on the Oprah Winfrey show. After a few weeks, I found myself sitting at home talking to my wife saying, “What if I am wrong? What if these people are right?”

In response, I did what any good dork that made it through college, med school and residency would do. I sat down and read everything I could about autism and then I read some more. While reading I learned a great deal about autism, but I also was reminded of the sources of parental concern. These reasons can be extremely varied from believing that vaccines are unnatural and therefore unnecessary to political objections about the government forcing parents to vaccinate their children. The long list also includes lack of trust in groups like the CDC (Centers for Disease Control, which outlines vaccine recommendations but was also responsible for such atrocities as the Tuskegee experiments), mixed messages from medical professionals, historic concerns about doctors getting kick-backs for vaccination, perception of risk, arrogance on the part of physicians/pediatricians, and many more.

None of the major medical institutions have been able to explain the increase in diagnosis or the cause of autism. Autism is understood to be a group of genetic disorders with a likely environmental factor or factors that have not yet been identified. With no answer coming from the medical institutions parents who care about their children feel forced to search elsewhere for recommendations and insight. This has led to a lot of conjecture about possible causes of autism. The latest case before the Supreme Court will only lead to more parental confusion. The case involves a young child with a genetic disorder (mitochondrial disorder) who received 9 vaccines. The patient then had encephalitis (inflammation around the brain) which may have contributed to regression in development and symptoms of autism.

One of the main reasons parents struggle with vaccinating their children is that the rates and publicity of cases of autism and autistic spectrum disorders (ASD) are rising while the number of cases of diseases for which we vaccinate continue to decrease. In 2004 there were zero reported cases of diphtheria reported in the US. A recent outbreak of mumps in Iowa in 2006 drew some media attention, but there were few serious complications (one case of encephalitis, no linked spontaneous abortions). Recent estimates show that 1 in 150 children are diagnosed with ASD. 1 in 6 children will be diagnosed with developmental disorder and/or behavioral problem.

After all of my studying, I feel much more confident discussing vaccinations and letting parents know that there is no evidence of a link between autism and vaccinations. This is not meant to brush aside questions and concerns that parents have about either vaccinations or autism. As a pediatrician, I do not feel it is my job to keep parents from worrying. It is your job to worry; it is my job to help you figure out what to worry about. While hearing about children diagnosed with autism will always be more compelling than any statistics or report I could explain to parents, they are not the full story. The full story balances autism with the experiences of doctors like Dr. Jaffe, Dr. Dawson or Dr. Colley who during their residencies had children dying every week of H. Flu and Pneumococcal Meningitis. Fears about autism must be balanced with stories of children and families devastated by what are now preventable diseases like measles and mumps. As a practice, we will continue to follow the latest research into the causes of autism and will continue to recommend the current vaccine schedule.

Right now, the best evidence shows that early diagnosis of autism can have an amazing impact on patients’ and families’ lives. One of the earliest symptoms of autism are deficits in what is called Joint Attention. Joint Attention (JA) refers to the normal spontaneously occurring behavior whereby infants show enjoyment in sharing an object or event with another person by looking back and forth between the two. Later gestures and/or speech are used to engage another’s attention simply for the enjoyment of sharing the experience. JA begins with a joyous smile in response to a parent’s smile or talking. At around 8 months a child will learn to follow a parent’s gaze. At 12 months, children should be learning to “follow a point” (if a parent points at something interesting and says “look”, the child will look at the object and then look back at the parent). Not meeting these milestones is a red flag. Other early red flags include: poor eye contact, poor response to other’s voices (esp. one’s name being called), more interest in objects than people, decreased to-and-from babbling, lack of warm joyful reciprocating expressions. Other serious indications for further evaluation include no babbling or pointing by 12 months, no single words by 16 months, no 2-word phrases (not just repeating) by 24 months or loss of language or social skills at any age.

Please help us to continue to provide the best care possible to your families. Feel free to share any concerns or questions you have with us at any time.