Immunization uptake in younger siblings of children with autism spectrum disorder

12 Oct

If one child has autism, the chance that a younger sibling will have autism is about 18.7%. (see the study Recurrence Risk for Autism Spectrum Disorders: A Baby Siblings Research Consortium Study and discussions here and elsewhere). Anecdotally, we hear a lot about families deciding to forgo or delay vaccines after having an autistic child. This raises a question and an opportunity for research: does delaying or stopping vaccines result in a lower risk of autism? Looking at younger siblings, one would have a population that both has a higher autism risk and a possibly higher percentage of use of alternate (including no) vaccine schedule.

A study has been published this week on this very topic: Immunization uptake in younger siblings of children with autism spectrum disorder. The answer? Immunization does not increase the risk of autism. But I get ahead of myself.

The authors divided the children into three groups

Immunization status was divided into three predefined categories: (a) Fully immunized: Children with four doses of DPTP (2, 4, 6, and 18 months) and the initial MMR dose at 12 months, (b) Partial/delayed immunizations: Children with any missing dose of DPTP or MMR at any age or a delay of 3 months or more for at least one of the doses of DPTP or MMR, and (c) Not immunized/declined: Children for whom all immunizations had been withheld as of 3 years of age.

In case you are wondering, yes, comparing groups (a) and (c) is a vaccinated/unvaccinated study design. [edit to add--see note below] (b) just gives more dimension to the study.

Yes, siblings of autistic children are vaccinated differently (on average) than younger siblings of non-autistic children:

MMR immunization uptake. The analysis revealed a significant group difference in MMR immunization status (Fisher’s exact test = 80.82, p < .001). Bearing in mind that the Public Health Agency of Canada recommends that children receive their initial MMR vaccine at 12 months (in contrast to the United States, where it is recommended at 12–15 months; Public Health Agency of Canada, 2006a; CDC, 2011), only 42 of the 98 (43%) younger sibs received the 12-month MMR vaccine ontime (i.e. by at least 15 months of age; see Figure 2); an additional 38 (39%) received the vaccine after 15 months of age, and 18 (18%) had not been immunized against MMR by the age of 3 years. In contrast, 88 of 98 (90%) probands received the MMR by 15 months, 9 (9.2%) were delayed, and only 1 had not been immunized by the age of 3 years. Similarly, 63 of 65 (97%) controls had completed their MMR immunization on time (i.e. only two were delayed, and none had parents who had fully declined).

Only 42% of younger siblings of autistics received the MMR ontime. 18% were not given the vaccine by age 3. Compare this to the control group, where 90% received the MMR by 15 months and 98% by age 3.

Differences were seen with the DPTP vaccine as well:

DPTP immunization uptake. A significant group difference was also found for DPTP immunization status (Fisher’s exact test = 38.95, p < .001), with just over half (55.1%) of the younger sibs having been immunized on time (31.6% were delayed, and 13.3% were not immunized by the age of 3 years; see Figure 3). The rates of DPTP uptake were higher for probands (86.7% immunized on time, 12.2% delayed, and 1% not immunized) and controls (90.8% immunized on time, 9.2% delayed, and none declined).

What did this do to autism risk for these un- and under-vaccinated younger siblings? Statistically nothing:

Of the 39 younger sibs who had completed their immunizations on time, 6 (15.7%) were diagnosed with ASD and 2 with speech-language delay (SLD). Of the 47 younger sibs for whom immunization as delayed, 15 (31.2%) received an ASD diagnosis and 2 had SLD. Of the 12 younger sibs who had not received any immunizations, 4 (33.3%) were diagnosed with ASD and 1 with SLD. Note that of those children who did not receive a diagnosis, 43.8% were fully immunized. The Fisher’s exact tests revealed no significant difference in the rates of diagnoses between immunized and nonimmunized groups for MMR (Fisher’s exact test = 5.46, p = .22), DPTP (Fisher’s exact test = 3.65, p = .44), or both (Fisher’s exact test = 4.13, p = .37), although small sample size renders these comparisons exploratory only.

And, by “statistically nothing”, I am not saying, “the calculated risk for vaccinated siblings are higher, but we can’t claim they are because the p values aren’t statistically significant”. No, I’m saying, “the calculated values are lower for vaccinated siblings.”

The authors found about 15.7% autism risk for baby siblings. Very close to the Baby Siblings study mentioned above which found 18.7% risk. The risk found for siblings with delayed vaccination was 31.2% and for unvaccinated was 33.3%. Again, these values are not statistically significant from the 15.7%.

So, when one does a vaccinated/unvaccinated study, one finds that autism risk (for familial autism) is not increased.

Since people will undoubtedly be looking for the conflicts of interests for the study authors, the COI statement is “The authors declare that there is no conflict of interest.” and their funding is “This research was funded by the Canadian Institutes of Health Research and Autism Speaks.”

Limitations include sample size and the fact that the authors relied upon parent recall for much of the data:

Parents of 22.2% (58/261) of the children provided a copy of their child’s immunization record or had it sent by their doctor; for the remaining 77.8%, status report was based on parent recall (note that this information was typically gathered at each visit, at 3- to 6-month intervals, to avoid recall bias). Due to the potential for recall bias (e.g. see Dorell et al., 2011, for bias in recall for the older children), we examined the influence of information source (card copy vs parent recall) on immunization status. No significant relationship was found for MMR (Fisher’s exact test = .38, p = .84), DPTP (Fisher’s exact test =1.71, p = .44), or “both” (Fisher’s exact test = 1.58, p = .48).

Here is the abstract:

Background: Parental concerns persist that immunization increases the risk of autism spectrum disorder, resulting in the potential for reduced uptake by parents of younger siblings of children with autism spectrum disorder (“younger sibs”).

Objective: To compare immunization uptake by parents for their younger child relative to their
older child with autism spectrum disorder (“proband”) and controls.

Design: Immunization status was obtained for 98 “younger sibs,” 98 “probands,” and 65 controls.

Results: A significant group difference emerged for overall immunization status (Fisher’s exact test = 62.70, p < .001). One or more immunizations in 59/98 younger sibs were delayed (47/98; 48%) or declined (12/98; 12.2%); immunizations were delayed in 16/98 probands (16.3%) and declined in only one. All controls were fully immunized, with only 6 (9.2%) delayed. Within the “younger sibs” group, 25/98 received an autism spectrum disorder diagnosis; 7 of whom (28%) were fully immunized. The rates of autism spectrum disorder diagnosis did not differ between immunized and nonimmunized younger sib groups, although small sample size limits interpretability of this result.

Conclusion: Parents who already have one child with autism spectrum disorder may delay or
decline immunization for their younger children, potentially placing them at increased risk of
preventable infectious diseases.

Edit to add: The authors have clarified that unvaccinated means not vaccinated with MMR or DPTP, not necessarily completely unvaccinated.

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38 Responses to “Immunization uptake in younger siblings of children with autism spectrum disorder”

  1. Science Mom October 12, 2012 at 04:08 #

    I will, of course, give this a thorough read but at its face is going to be very upsetting (and not rightfully so) for some people. I can only imagine the sophomoric critiques that will be forthcoming.

  2. Leonard Oestreicher October 12, 2012 at 15:01 #

    Then what is the cause of the second child being so often affected by ASD? As I discuss in my book, The Pied Pipers of Autism, it is most likely the influence of the first autistic child on the second newborn. Babies learn social behavior through interactions with the people surrounding them starting from birth. Motherese is a good example of such a back and forth interaction. If one of the principal people in their family (their older sibling) does not engage in such behavior, it is likely a powerful model for the second child to not learn social behavior as well.

    The other side of this question is the influence the newborn has on the child with ASD. I suspect in some cases the baby may open some doors to social communication to the child with ASD

    Someone needs to do a study on whether second siblings who are raised in families without any family members with ASD and the frequency of ASD in such a second sibling.

    Meanwhile I would suggest caution to parents. They need to watch the interactions between the siblings very carefully. If the baby is not showing joint attention by 6 months, then sadly enough, it may be best to separate the siblings until social behavior is well established in the baby.

    • Science Mom October 12, 2012 at 15:13 #

      Meanwhile I would suggest caution to parents. They need to watch the interactions between the siblings very carefully. If the baby is not showing joint attention by 6 months, then sadly enough, it may be best to separate the siblings until social behavior is well established in the baby.

      On what are you basing this Dr. Oestreicher? And what are your qualifications in the field of ASD research?

      Someone needs to do a study on whether second siblings who are raised in families without any family members with ASD and the frequency of ASD in such a second sibling.

      Oh hey now there’s a brilliant idea. Not only would there be a vanishingly small number of children in such a situation so as to make statistical power unattainable, but to create such a situation would be unethical beyond imagination.

      • Leonard Oestreicher October 13, 2012 at 10:35 #

        I am a family practitioner (a GP in England, I suppose) in Merced, CA and my biography is attached to my book, The Pied Pipers of Autism. In short, I became very interested in autism after my nephew and his brother both developed ASD. My research assistant and I have done a mountain of research on ASH that is reflected in the bibliography of the book.

        My hypothesis is very simple. The first year of life is the critical time for the acquisition of social behavior and language, two related but different skills. At birth and thereafter, babies and infants are genetically prepared to make connections and interact with the people around them. For a variety of genetic reasons, some are more inclined to make these critical social connections and some are less. The infants with less inclination are vulnerable to acquire ASD.

        The infants identify who to interact with by attending to eyes, faces, body movements, and language. In the last 20 years infants increasingly find these cues on the televisions, videos, talking toys, etc. that form a major part of their surroundings. Some infants are tricked and trapped by these sources of one-way communication and soon prefer these media to the social interactions of family members. Such infants are developing ASD.

        There can be no doubt this represents a radical change in the experience of infancy from our prior evolutionary history. For instance, previously during infancy eyes were always connected to living beings.

        The book goes into much more detail and talks about the evidence supporting this idea. I call this idea, the Integrated Theory of Autism.

        If this idea seems like the ‘Ice Box Mother’ theory to you, therefore deserving to be rejected out of hand, I suggest you read. the book before insulting the author.

      • Science Mom October 13, 2012 at 14:18 #

        I am a family practitioner (a GP in England, I suppose) in Merced, CA and my biography is attached to my book, The Pied Pipers of Autism. In short, I became very interested in autism after my nephew and his brother both developed ASD. My research assistant and I have done a mountain of research on ASH that is reflected in the bibliography of the book.

        So that would be a Google-U graduate with zero relevant education and actual ASD research. Having a “research assistant” doesn’t mean you are doing research Dr. Oestreicher.

        At birth and thereafter, babies and infants are genetically prepared to make connections and interact with the people around them. For a variety of genetic reasons, some are more inclined to make these critical social connections and some are less. The infants with less inclination are vulnerable to acquire ASD.

        Well your “hypothesis” falls apart on a couple of levels. First, infants don’t acquire an ASD, they are born with it and second, why should an interaction with an ASD sibling dominate interactions with everyone else around them?

        Some infants are tricked and trapped by these sources of one-way communication and soon prefer these media to the social interactions of family members. Such infants are developing ASD.

        Quite a contradiction there. Which is it? Television or an older ASD sibling? And the whole television-blaming thing…how original.

        The book goes into much more detail and talks about the evidence supporting this idea. I call this idea, the Integrated Theory of Autism.

        If this idea seems like the ‘Ice Box Mother’ theory to you, therefore deserving to be rejected out of hand, I suggest you read. the book before insulting the author.

        I don’t buy charlatans’ books. If you have anything of value to publish then I suggest you do it the way the rest of us have to; submit your “hypothesis” and “research” to peer-review and get it published. Then I will read it but that’s only a first step and of limited value without independent replication. Suggesting separating siblings without a single shred of evidence to do so is repugnant and I hope that even the most credulous parent would see you and your suggestion for what they really are.

        Oh and stop pimping your nauseating book; no one is buying what you are selling here.

      • Chris October 13, 2012 at 17:48 #

        Dr. Oestreicher, you now make me appreciate that our family doctor actually referred us to experts, like a speech pathologist and pediatric neurologist, when my oldest was not speaking at 26 months. At least he knows his limitations.

        You are a prime example of a medical doctor making statements outside of your specialty. You can now share the same shaded spot on the Venn diagram with Dr. Mark Geier and Dr. Andrew Wakefield.

      • Chris October 13, 2012 at 17:56 #

        AArgh… he was 27 months old when we were referred to specialists. I am blaming lack of getting coffee because of dealing with a blue screen of death on laptop.

    • Sullivan (Matt Carey) October 12, 2012 at 15:51 #

      Leonard Oestreicher,

      I don’t do this often, but I’m going to be blunt: your ideas are nonsense and your recommendation is irresponsible.

      The idea that autism is a learned behavior is just completely wrong. Instead of Bettleheim’s bad parents you focus on siblings.
      The idea that a family with a six month old should split up is irresponsible in the extreme.

      • Leonard Oestreicher October 14, 2012 at 19:48 #

        Not much a welcome here. Is this a 100% genetics only blog? Is anyone open to the idea that what happens to a baby in the first year of life might matter?
        You know there are problems with 100% genetic hypothesis; many reasons to think there is more to the story than everything stops with conception and genes alone determine whether your child will grow up with ASD.
        No wonder the general public is frustrated with academia. They look around more and more their children afflicted and disabled by ASD. The CDC reported a staggering 23% increase between 2006 and 2008 of children diagnosed with ASD. I have heard all the genetic apologists’ explanations about parents passing off their normal kids as having ASD and how people used to hide children with ASD in the basement. These arguments have the merest glimmer of plausibility and serve only to keep the 100% genetic hypothesis on life support. Those people who believe in the 100% genetic hypothesis must ask themselves how many children and families need to be afflicted by ASD before they admit to possibility something else may be going on, that genetics may not be the whole story.
        And to the point, how do 100% genetics people explain the 18% occurrence rate in the second child? I have heard some pretty tortured explanations. Maybe since I have not reached the exalted state of being academic myself, I am too much of simpleton to grasp what the high and mighty were saying. Maybe one of you, my betters, who are so against what I am saying, could explain this in a way that even someone like me could understand. Because the general public wants to understand why academia is so enamored with this fruitless 100% genetic theory.
        The problems with this hypothesis go on and on. The 100% genetics first arose in 1977 when a small study of 22 twin pairs showed a marked different in concordance between monozygotic and dizygotic twins for autism. This study done long ago is the strongest evidence for the 100% genetics hypothesis. The study was a game changer at the time. Since then there have been a variety of twin studies, larger studies with more sophisticated analysis and always they show room for environmental factors in the genesis of ASD. Then last year Hallmayer et al published a very well done study with 192 twin pairs from California. Their conclusions- environment factors account for 57% of the cause of ASD and autism while genetic factors are down to 38%. The same kind of studies that gave birth to the 100% genetic hypothesis are the ones now pointing researcher in a different way.
        Why are such similar studies giving such difference results? What could be the explanation for this change?
        Of course, I am not an academician, so I am not allowed to have ideas worth considering, at least in this blog. But just the same, my thought is we are bringing up our babies, infants, and children is a different world now than in 1977. If I may coin a word, the world surrounding our children is much more ‘autistagenic’ now than in 1977. Babies today are surrounded by devices that occupy their time and hold their interest but deny them the social interaction experiences they need to nurture their incipient social skills.

        There are many more problems with 100% genetic theory but enough said. And yes, knowing what we know today, it is time for academia and researchers to re-think what in the environment of these babies has changed in the last 30 years that might impact the acquisition of social behavior.
        Do not mistake me for as a supporter of the vaccine or mercury hypothesis. I think these ideas were born out of a general public desperately looking for answers for this pandemic and not finding much coming of academia that either explains or offers much hope. Just denial.
        Yes, I know the idea about TV watching being harmful in infancy is not my own. I assume you are referring to the landmark paper from 2006, “Does Television Cause Autism?” by Michael Waldman, Sean Nicholson, and Nodir Adilov. To me it is so sad so little research was generated in response to this very important study. Sadly enough, this paper was greeted by scorn and neglect. He was subjugated to a form of ostracism, really. I suppose this is what happens when your thoughts and findings are out of line with the thoughts of the social network you live in. I remember reading an article about this study and the commentator’s conclusion was simply “Make Dr. Waldman go away”. His courage inspires me.
        As far as my book, The Pied Pipers of Autism, goes it is your choice to look at it or not. It is available for downloading at Smashwords for free. It is best enjoyed by people open to new ideas.

      • Sullivan (Matt Carey) October 14, 2012 at 19:50 #

        Why not read the blog and find out for yourself? I (hint: your assumptions are incorrect.)

      • Lara Lohne October 14, 2012 at 21:13 #

        @Leonard Oestreicher You may wish to read about the advances in cause of ASD being reported at IMFAR and through the Autism Science Foundation in the past few years. There are several very good studies that have found genetic causes, over 300 genes have been found to influence ASD development. There is also very strong consensus from these researchers that there may very well be an environmental factor, and it is generally believed to be prenatal, the maternal environment, more then anything else.

        There have also been two studies done in the past 12 months one in the UK, one in the US (the latter actually being a revisited study from the 1980s on instance of autism [prior to it being a spectrum disorder] reviewing the diagnoses of the children used at the time and switching to use the ASD criteria from the DSMIV) and both of these studies have found a number of adults who now have been identified as having an ASD where before they were diagnosed as mentally retarded, mentally insane, or severely learning disabled. There are also many adults that were completely overlooked as children due to them seeming to be high functioning, but having the social confusion and repetitive behavior now known as the core of individuals with ASD. After the data from these studies is reviewed, they come to find that the number of adults now being diagnosed for the first time, or correctly diagnosed using the new criteria, are about 1 in 100, so not that far off from the numbers today.

        Why it is so much more prevalent now is due to better awareness, more detailed diagnostic criteria and also parenthood shifting from early to mid twenties to early to mid or even late thirties, allowing for far greater instances of genetic shift due to chromosomal duplication or deletion, or mutation. This isn’t really that hard to figure out, you just seem unwilling to even consider it.

      • Science Mom October 14, 2012 at 21:28 #

        Not much a welcome here. Is this a 100% genetics only blog? Is anyone open to the idea that what happens to a baby in the first year of life might matter?
        You know there are problems with 100% genetic hypothesis; many reasons to think there is more to the story than everything stops with conception and genes alone determine whether your child will grow up with ASD.

        Nice strawman you set up there to blather on for paragraphs about Dr. Oestreicher. You call yourself a researcher but don’t seem to know about studies regarding in utero enviroment and yes, de novo genetic mutations in the germ line (aka not heritable genes)?

        The CDC reported a staggering 23% increase between 2006 and 2008 of children diagnosed with ASD. I have heard all the genetic apologists’ explanations about parents passing off their normal kids as having ASD and how people used to hide children with ASD in the basement.

        In order to maintain your wonky hypothesis you deny the effect that greater awareness of parents and clinicians along with changes in educational accomodations and the migration away from institutionalising children with an ASD? No effect huh?

        If I may coin a word, the world surrounding our children is much more ‘autistagenic’ now than in 1977. Babies today are surrounded by devices that occupy their time and hold their interest but deny them the social interaction experiences they need to nurture their incipient social skills.

        Exactly how many children were in your intervention and control groups? What statistical tests did you apply? What were your other methods? How many children did you determine to have “avoided becoming autistic”? I trust this is written up in a journal somewhere?

        Do not mistake me for as a supporter of the vaccine or mercury hypothesis. I think these ideas were born out of a general public desperately looking for answers for this pandemic and not finding much coming of academia that either explains or offers much hope. Just denial.

        Not jumping on the vaccinesdidit bandwagon doesn’t endear you to me. Your suggestions are completely evidence-free, repugnant and would be terribly disruptive for a family and in all likelihood, cause more harm than good.

        Yes, I know the idea about TV watching being harmful in infancy is not my own. I assume you are referring to the landmark paper from 2006, “Does Television Cause Autism?” by Michael Waldman, Sean Nicholson, and Nodir Adilov. To me it is so sad so little research was generated in response to this very important study. Sadly enough, this paper was greeted by scorn and neglect.

        Landmark study? You do like to cherry-pick don’t you. Great ideas have been met with scorn, derision and scepticism. You know what the differences are between those ideas and yours? They were meticulously-designed experiments, transparent and independently-replicated and yours are arrogant, weak and have the potential to do great harm.

    • David N. Brown October 13, 2012 at 08:06 #

      Mr. Oestreicher,
      I’m not familiar with your work, but I think your idea has at least a measure of plausibility. It makes sense that autistic behavior could be “communicable” to some degree, in the same manner that more extreme mental abnormalities in one member of a household are known to lead to “shared psychosis”. Then there’s the strongest line of evidence that might be brought to bear, that whole cultures have accepted “autistic” behaviors as normal and even “proper”. (I have wondered if these examples aren’t a legacy of ASDs occurring in historic nobility.)

      You seem, however, to be taking these ideas to quite unnecessary extremes. I find the idea of separating an autistic child from a younger sibling especially troubling. Surely, this would cause a major disruption in the household routine, not to mention emotional distress for one or both siblings. It also must be considered that autistic children are frequently observed to show better social functioning with younger or older children than same-age peers. Thus, from what we know about autism, younger and older siblings with autism or autistic tendencies are likely to function better together than apart.

      David N. Brown
      Mesa, Arizona
      http://www.evilpossum.weebly.com
      http://www.autismandreligion.weebly.com

      • Leonard Oestreicher October 13, 2012 at 10:44 #

        I agree it could be quite disruptive to a household to separate siblings. It is quite against cultural norms to be sure. But if it protects the second sibling from ASD, then it is a step well worth taking. Once social behavior is well established in the second sibling, then the normal routine of the family could be re-established.

      • Sullivan (Matt Carey) October 13, 2012 at 15:54 #

        No one is going to try your unethical experiment because it is founded on a bad theory. Dividing a family would cause trauma to all involved, including the infant and the older ASD sibling.

        But it’s OK to rip a younger siig from a child because the older child is autistic? Blame to autistic for his younger sibling’s disability, remove his family members (the younger sibling plus much or all of the time from the adults caring for that sibling).

        Parents in the study above tried an experiment. They delayed or stopped vaccinating younger siblings based on the false idea that vaccines cause autism. It didn’t work out for them. They exposed their children to a greater risk of infectious disease. They get to rely on herd immunity to protect them. Parents following your idea would have no protection from the harmful effects.

  3. Lara Lohne October 12, 2012 at 17:43 #

    Leonard, your theory is no different from the original cold mother syndrome thoughts of how autism came to be. Autism is not behavioral, even though currently that is all we have to base diagnoses on, it is neurodevelopmental, differences in how the brain is constructed and wired, not a learned behavior. I am the mother of 6 children, 5 are neurotypical, my youngest has autism. The main difference between them is different biological father, and we believe that he also has an ASD, but can’t find anyone who is qualified to do adult assessments and will accept our state health coverage (so that’s fun). He also has two other children of his own by two different women and they, as far as we can tell, are neurotypical. His older son may exhibit ASD traits (he is very shy and socially awkward, but I don’t believe his mother would have him evaluated on her own.)

    In my family, my older brother, first born, has cerebral palsy, he has certain characteristics that are autistic like, but he doesn’t have autism. My older sister, born after him, nor any of his siblings that followed picked up any of his traits so the idea that a disorder that a person is born with, is taught by them to younger siblings is ridiculous, and to be frank slightly offensive. If older siblings can have that profound an effect on younger siblings, why don’t we go back to the days when parents were made to feel responsible and ashamed for causing their child’s autism? I mean, what woman wouldn’t want to be known as a ‘refrigerator mother?’ It’s such a flattering term after all.

    • Leonard Oestreicher October 13, 2012 at 11:10 #

      Thank you for commenting on my prior comment.

      Your comment brings to mind how difficult it is to separate the genetic from the environmental in any particular person. To my mind it is time we stopped playing this silly game anyway. Just about any trait or characteristic we choose to look at in humans behavior involves both genetics and environment and more exactly the interaction between the two.

      In my book, The Pied Pipers of Autism, I go into a lot of detail about how babies acquire binocular vision because it is so well studied and such apt model for acquisition for ASD.

      It is known babies are not born with binocular vision but acquire this very important skill over the first six month of life. As they acquire this skill there are actual physical change in the arrangement of the neurons in visual cortex that can be seen and studied. However, if one eye is blind, and the baby receives visual stimuli from only one eye, binocular vision will never be acquired even if vision returns to the blind eye.

      So the baby is genetically prepared to see in three dimension. The position of our eyes and capabilities of our brains have been designed through evolution to make this possible. However, it REQUIRES appropriate interaction with visual world around the baby at the RIGHT time for the skill to be actually acquired.

      Social communication is much the same. It requires some social interaction during infancy. If it does not develop in a infant, we are left with a child with ASD.

      The book goes into much more detail about this and what in contemporary life is interfering with the acquisition of social behavior in infants today

      • Lara Lohne October 13, 2012 at 18:20 #

        You are rejecting out of hand all those infants who are developing normally and then regress. This is actually considered a normal pattern in ASD children and has been attributed by Neurobiology researchers to be linked to over aggressive brain development in the very early months of life (as evidenced by a larger then average head circumference) and then an overactive pruning of neural pathways at the developmental stage when language would be progressing significantly.

        I am not dismissing your theories out of hand, but they are much too close to the idea of the refrigerator mother theory to be anything close to acceptable. You are also assuming that all children that develop ASD are children plopped in front of the TV all day. That is also not true in many cases. In my son’s case it is for sure not true. We didn’t even have a television until he was over 3 and had been diagnosed. We tried to encourage him to say words after he lost his initial language, but he didn’t even try. We thought he was being stubborn since we knew he could talk before. I got frustrated not being able to figure out what he wanted for a snack or to drink because he couldn’t even point. I started teaching him sign language well before we even thought about ASD as a possibility.

        Your theory is not unfounded and goes against all the results from neurobiology that are being found now. I’m not going to buy your book, your theory is implausible just on the surface, I’m not going to read more about it because it is implausible and there isn’t room in my intellect for junk science. My apologies if this offends you, but I grew up in a very large family, with developmentally delayed siblings as well as raised or am raising six children of my own. From your statements, my guess is you don’t have any children yourself and have no actual experience in how they develop.

  4. Big Morbillie Style October 12, 2012 at 20:16 #

    Thanks for finding and posting this so quickly, Sullivan. I’m glad to continue to accumulate studies that show no association between the number of vaccines and autism rather than just the MMR. Not that a mountain of studies of any size will make a difference to some.

  5. Shorty October 12, 2012 at 22:57 #

    Whatever happened to that troll who used to go from website to website saying there were no unimunized autistic children. Here we have unimunized autistic siblings of autistic children, do we not?

    • Andrew, but not that one October 12, 2012 at 23:34 #

      Last I saw him was here http://blisstree.com/look/jenny-mccarthy-anti-vaccination-queen-really-loves-botox-332/

    • Sullivan (Matt Carey) October 12, 2012 at 23:47 #

      I wondered the same thing. I couldn’t remember the gentelman’s name but someone reminded me.

      The study above isn’t the strongest, but the idea that here are kids who did not get vaccines and are autistic is an example. As many of us have pointed out again and again, there are people out there in parent groups discussing their unvaccinated autistic kids. It’s not like the paper above is breaking dramatic ground with demonstrating that unvaccinated kids have autism too.

      • Lara Lohne October 13, 2012 at 06:27 #

        While I can’t say strictly that my son was unvaccinated completely, as he did have his routine vaccines at 2, 4 and 6 months, but then not anymore until he was about 28 months, he was definitely different from my previous five children and I noticed that from the day he came home from the hospital. My son did not receive the birth hep b vaccine due to something having to do with him being jaundiced. I don’t recall the exact specifics as I was on some serious pain meds after my tubal the day after his birth. And he was stimming on lights, had sleep issues, certain textures of material would send him into fits of what appeared to be pain and we couldn’t figure it out at all. Of course when he was two and had lost all his words and regressed from the progress he had made, along with other little things that he had picked up from about age 14 months on, we began looking into what it could have been and everything pointed toward autism. At just over two and a half he was evaluated, found to be significantly developmentally delayed and was placed in Early Intervention, to begin special ed pre-school when he turned three, but before they would admit him, we needed to get his vaccinations current. Over the next five months, we worked on getting two years worth of vaccines that he had missed up to date so he could begin preschool on time. I know a lot of anti-vaccine people claim there are holes in my story, but not really, if my story is taken at face value for what it is. When you cherry pick tidbits out, sure there are going to be holes. That’s because you left out bits of it. This just is one more point on the ‘unvaccinated children develop autism too’ score board, because the anti-vaccine crowd doesn’t believe these studies exist. Now we have one more to show then they are not correct.

  6. lilady October 13, 2012 at 15:09 #

    No one is buying into your “theories” Oestreicher and no one is buying your book, either. What not run along now..instead of hawking your theories and your book.

    • Leonard Oestreicher October 15, 2012 at 16:42 #

      I can see I have gotten off on the wrong foot with this group. I apologize. I live in this small farm sun-drenched town in the middle of California doing the yin-yang (compassionate care- dispassionate analysis) of medical practice day after day, year after year. You see I do not get to talk about my passionate interest in ASD much here. I bumped into your blog and I thought well here is blog from full of well-informed intelligent people who share my interest in ASD. And I thought, England, the land of Fairness where even un-conventional ideas are given a fair hearing and where the eccentric is welcomed even admired. And then the topic, the second sibling with ASD, is one dear to my heart since my nephews are so affected. I thought I would just share my thoughts and see what happens. I now realize I was being rude and offensive. I might have walked into one of local Baptist churches here in Merced (the town is full of them) walked down to the pulpit some Sunday and started shouting ‘God is dead’. Alright, I’ll confess, I have some Aspe tendencies. I’m pretty good now with face-to-face one-on-one social communication but I get flummoxed by groups. Please excuse me.

      • Chris October 15, 2012 at 17:48 #

        This is now an American blog. The website name is kept to keep links to it from other areas viable.

        You really need to sit down and read more articles on this site, because you seem to not understand this blog. And develop a thicker skin and some actual evidence if you are proposing breaking up families as a way to prevent autism.

      • Sullivan (Matt Carey) October 15, 2012 at 18:19 #

        I will point out to you that passive-aggressive slams like this:

        ” You see I do not get to talk about my passionate interest in ASD much here. I bumped into your blog and I thought well here is blog from full of well-informed intelligent people who share my interest in ASD.”

        Are very transparent.

        Just because an idea is not accepted does not mean it wasn’t given a fair hearing. That is a common theme (voiced in a few different ways) by people whose ideas have been given a fair hearing but whose ideas have failed.

        One basic flaw with your idea is that infants do not learn socialization primarily from older siblings, unless that sibling is quite a bit older and is taking on parental support roles. Infants have most of their contact with adults–parents, daycare or other care-givers. The idea that older siblings would somehow teach an infant to be autistic is illogical just on that basis.

        Autism risk for younger siblings is higher if the time between pregnancies are shorter. I.e. if a mother has a child 12 months after the previous child, the risk is significantly higher than if the interval were 36 months. How, exactly, does a toddler affect the socialization of an infant in such a way as to confer greater risk of autism, in your model? Especially when autism is often subtle enough to be undetected at this toddler age?

        Also, you are referring to social communication. Autism also frequently comes with intellectual disability. I assume that neither of your nephews has ID as (a) certainly ID isn’t taught sibling-to-sibling and (b) how can you set a rather arbitrary schedule of 6 months for development of social skills for a child who is globally delayed?

        You see, it isn’t just because your idea presents irresponsible conclusions (which it does). It is that your model doesn’t work.

        The idea that a family should be split up is an extraordinary claim. Extraordinary claims require extraordinary evidence. Your argument is extraordinary, but in the wrong direction. And, no, that isn’t a passive aggressive slam. That is a clear statement that your argument lacks the support required to make any sort of claim, much less one as potentially damaging as splitting up a family.

        And, for what it is worth, I have roots in the Central Valley. Also the Sacramento Valley.

      • Science Mom October 15, 2012 at 19:54 #

        I see what you did there Dr. Oestreicher, you’re hubris is showing again and you can spare me the nationalistic passive-aggressive crap. You mistake “land of fairness” with gullible acceptance and libel laws which place an undue burden on anyone who deigns to speak out against pseudoscience. But that is changing and Americans are no less uncritically accepting of what you call “un-conventional ideas”.

        This is a blog about ASD issues, not a forum (although I speak only for myself) for the self-promotion of dodgy hypotheses that will go unchallenged. We are all passionate about ASD issues, we just don’t pass ourselves off as “researchers” in the field.

      • Leonard Oestreicher October 18, 2012 at 19:31 #

        Some great comments, this round.
        To Lara Lohne:
        That over 300 genes have been found to be related to ASD development is not good news for the 100% genetic hypothesis. What this means is the researchers are using very powerful techniques and huge databases to query out these associations. Thanks to the power of modern computers we are able to discern very weak genetic association. That there are at least 300 genes involved is astonishing but I think not surprising. The traits needed to diagnoses ASD are quite varied and probably touch on many areas of the brain and our genetic code. In fact, it is very difficult to draw a hard line between where ASD end and non ASD begins since there is a normal (in the statistical sense) distribution of these traits in the population.
        This argument about the whether the incidence of ASD is actually increasing is getting tedious. I guess you can always come up with a counter hypothesis to explain any set of historical observations. I thought the last set of CDC figures would settle the issue and the world of ASD research could move on and try to understand this epidemic of suffering, but no, always some counter argument. To me looking at the numbers it seems obvious more and more children have this condition, that it has gone from a rare condition to frighteningly common. And the public is frightened. Even in the few blogs entries here in this thread, you can hear people wondering who and where in the family did these awful genes come from that have separated my child from his family and other people in his world. In the end, at some point, the 100% Genetic school is going to have to let go of this idea. What evidence it will take to give up this idea is hard to say. I hope it is soon though. Like the vaccine story, it demonstrates, strongly felt thoughts and ideas are painful to let go.
        To Science Mom:
        My role in the ASD is not to run experiments but to put together a theory that better explains the literature out there and maybe will take the experimenter to a more fruitful place than the 100% Genetic hypothesis or the Vaccine-Did-it group. In other words, without a hypothesis in place it is hard to design a clean experiment to answer the question posed by the hypothesis.
        However, while there a marked paucity of such studies, there is one recent study that appeared in the peer-reviewed literature. If you will allow me to place an except directly from my book here–
        There is a more recent study that directly looks at the television viewing habits of infants and their subsequent development of ASD. It is a study from Bangkok, Thailand by Dr. W. Chonchaiya and her colleagues. That this study comes from Thailand serves as a reminder that ASD is a worldwide pandemic.
        The author compares three groups of about 50 children each. The children in the first group have ASD. The children in the second group have delayed language development but are socially normal. The third group, the control group, has children without any of these problems, normal typical kids.
        The author interviewed the parents about the infancy of their children. ASD begins in infancy so it is very good investigators are taking an interest in what happens during this critical time in life.
        The author questioned the parents about the age the child started watching television and how many hours a day the child watched television as an infant. The parents were also asked how many hours a day they had spent together with their infants.
        Is it a surprise the children who later developed ASD not only watched television the earliest but also watched for the most hours?
        The first principle a new parent learns is never disturb a sleeping or quiet baby. A baby needs so many hours of sleep, something like 16 hours a day. The rest of the day is either spent with company or by himself. If the baby is awake and quiet, he is generally not disturbed.
        So imagine a baby is exposed to television at 6 months of age and he likes it. He finds it soothing and interesting. He is quiet in the presence of the television, especially when a familiar video is playing. He pays attention to the television and like most adults he may find lounging in the presence of undemanding one-way communication quite pleasant. He may even fuss and become irritable when the television is turned off.
        In this situation the caregiver will naturally leave the television on more and more. And if the caretaker believes television and video watching are magically transforming their baby into a baby Einstein or Mozart, then why would the caregiver possibly turn the television off ?
        So you might expect the earlier the infant starts watching television, the more television he will end up watching. And it follows the more time he spends with television, the less time he will have to spend interacting with his caregivers.
        The time the infant is watching television is time lost from learning how to participate in an enduring social relationship. That time could have actually been used to engage in two-way communication with repeated episodes of joint attention between the caregiver and the infant. This time is a kind of isolation, in a way similar to the poor baby monkeys who could passively observe but did not get to participate in the social world around them.(Harry Harlow’s studies)
        The study showed that infants who later developed ASD, started watching television 6 months earlier, at 6 months of age, and ended up watching twice as much television per day compared to the control group of typically developing children. Not surprisingly, watching that much television left less time for actual social interactions with their caregivers. The children with ASD spent half as much time engaged in two-way communication with their caregivers as the children in the control group.
        While this is just one study, the implication is clear. A parent, who turns on the television in front of a six month baby with a tendency towards ASD, is heading down a slippery slope. They may very well end with a child with ASD, an event that could have easily been avoided.
        As a junior scientist and skeptic, I would say well the study needs to replicated and needs to be done in double blind fashion prospectively before the scientific community becomes convinced Dr. W. Chonchaiya’s study holds water. Dr. Chonchaiya is by the way an American trained researcher.
        Chonchaiya, Weerasak & Chandhita Pruksananonda. “Comparision of television viewing between children with autism spectrum disorder and controls” Acta Pædiatrica. 2011, 100. Pp 1033-1037.
        But I have said before, I am family practitioner. My patients come to me with situations in the present and ask me what to should they do. I have to recommendations based on the best current information I can find. So picture this situation. A young mother comes to my office. She has one autistic child. Despite knowing the risks of having a second child with ASD is 18%, she has chosen to have another baby, an act of great faith and hope, if you ask me. She is pregnant. She asks me, what should she do?
        Do I tell her it is all a genetic crap shoot? Do I tell her, I hope she has picked out a different father with a better genetic endowment this time around? Or do I tell her about Dr. Chonchaiya’s study? Do I share with her that it could be critical she follows the American Academy of Pediatrics recommendation to avoid all video exposure during the first two years of life?
        To Sullivan-
        I am wondering why you say and how you know where infants learn socialization. This is a very important question and to the best of my looking through the literature, I could find much on this topic. In a way it is not surprising. Infants and babies are hard to study. We know a lot is going on because all this brain re-modeling is happening presumably in response to the babies increasing awareness of its surroundings. The babies are hard to read since they do not have a big repertoire of actions at their command. The eyes thanks goodness gives us a window into the brain and show at least what the infant and baby is paying attention to. I do not want to short change the other people in the babies and infants environment but I do think siblings especially a sibling close in age attract a baby’s attention strongly. Twins are a special case of course, but you might say private language (not real language, of course, but a private vocal channel of communication) between twins is fairly common but it also appears when the siblings are separated by one year or less. It would be a good study to actually measure the relative attention babies and infants pay to the different cast members in their little worlds. My guess is caretakers and siblings would be both high on the list.
        Then you ask about the detection of ASH in babies and infants. This is an area of heightened attention and I am sure more literature will be available soon. The detection and treatment of ASD earlier in life seems to confer some advantage to the ultimate outcome. This is totally consistent with my hypothesis since treatment usually involved both a heavy dose of two way communication and the avoidance of one way communication. However if the cards are 100% in the genes, why would it make any difference? My hypothesis is the twisted and varying interaction between the genetic makeup and the surrounding world lead a baby to eventual ASD.
        My ideas on detection are simple. The parent needs to pay attention to whole baby of course but the eyes will tell the story. As the baby learns to control the actions of his eyes, the parents need to focus on where the eyes are looking. If they prefer objects to living faces, there could be a problem. The toy manufacturers have gone to great length to design toys to capture the baby’s interest. This is a real problem. I would say as a general rule, if you find you baby prefers a toy to interacting with you, the caretaker, then get rid of that toy. Later on when the infant is 6 months or so, continue to follow the infant’s eyes. You want to look for joint attention. At the first hint of problems (baby preferring tv or video watching to your company) get rid of the tv, video, etc. If you have difficulty separating your infant from TV, video, etc. then that is a big clue to the eventual development of ASD.
        This is a dynamic process and there is no sense taking chances. Your child will have other opportunities to become an Einstein or a Mozart later on after they have achieved adequate socialization.
        My nephews are both bright boys but so many children on the spectrum are. My feeling is children with ID are much more likely to have some more global impairment in brain function. These children are often found to have some form syndromic autism on a genetic basis. Quite a different group than the bright boys with Asperger’s we meet commonly. You are right, instead of saying 6 month age for the appearance of joint attention I should have said the developmental age of 6 month.
        Breaking up siblings for the first one or two years of life, is not a small decision. I recognize it is a startling idea quite outside the social norm today. But there is a serious risk. We know these children have a one out of five chance of developing ASD. No one can say this risk in 100% genetic or prenatal. An autistic sibling could be a big source of one way communication. If you believe, like I do, one way communication is big part of the environmental cause of ASD, it is painfully un-escapable, to come to my conclusion. At the first sign the baby has tendencies to ASD, the two should be largely separated until social communication is well established in the second child. Until the right study is done then there is no proof but like the mother with the second baby, we have to act now, on imperfect information. Weighing the risk of the separation of the siblings against the risk of having a second child with ASD, my vote goes to separation.

      • Sullivan (Matt Carey) October 18, 2012 at 20:28 #

        “That over 300 genes have been found to be related to ASD development is not good news for the 100% genetic hypothesis.”

        Do you really believe there is a viable 100% genetic hypothesis being discussed seriously? I believe it was Stella Chess in the 1970′s who showed that congenital rubella syndrome increased the risk of autism dramatically. Other exposures were dicussed in the 1990′s.

        That leaves aside the fact that “autism” is not a single entity so having multiple genes possibly involved says nothing like what you are claiming. If there are 1000 different syndromes behind autism as we know it, 300 genes is not a lot. Especially when you factor in multiple-hit risk, where it takes 2 or more genes to confer risk.

        But this is all just a little diversion from the fact that you don’t have a good argument.

        “Weighing the risk of the separation of the siblings against the risk of having a second child with ASD, my vote goes to separation.”

        We get that. It is a remarkably poor idea, even if your premise were valid. Which it isn’t.

        Thankfully facts aren’t up for a vote. But, even if they were, you would be rather lonely with your position.

        “Breaking up siblings for the first one or two years of life, is not a small decision. I recognize it is a startling idea quite outside the social norm today. ”

        That isn’t the problem here. The problem is that it is based on an incredibly bad idea of what causes autism.

        “I am wondering why you say and how you know where infants learn socialization.”

        Simple–who do they spend time with. It’s all in the discussion above. Tell me, how much socialization does a newborn learn from a 1 year old older sibling vs. a parent who is holding and playing with the child?

        “Despite knowing the risks of having a second child with ASD is 18%, she has chosen to have another baby, an act of great faith and hope, if you ask me. She is pregnant. She asks me, what should she do?”

        I know this will sound like it is a slam, but my advice to that mother would be to find a different doctor.

      • Lara Lohne October 18, 2012 at 21:08 #

        You are confusing correlation with causation. My autistic son actually hasn’t ever watched television. He watches movies now, but he didn’t actually sit and watch his first movie until he was over a year and a half. He preferred music and actually interacting with people. That changed gradually over the second year of his life. And as I’ve said, my son showed differences from my other children from birth, and my other children do not have ASD and they watched television when they were growing up, probably less then I did growing up, and they also played a lot outside also, but they watched a significantly higher amount of television then my autistic child.

        Your hypothesis is flawed, significantly. Studies have shown, an autistic individual will actually learn social interaction when they are put together with NT peers, they become more social, not less social. If a baby is added into the mix in a family with an older child with ASD, that older child, depending on the severity of their ASD, will show more social interaction because of that baby. Autism is not a learned behavior, it is determined by brain construction and that is determined prior to birth.

        Take your ideas elsewhere because they are greatly offensive to me, as the mother of an autistic boy. When you use words like ‘awful genes’ and ‘children being separated’ because of their autism, it shows how pathetically ignorant about autism you really are. You plainly see them as less then human and that they need to be kept separate from other people so they don’t spread autism? Do you even realize how ridiculous you sound saying that? Autism is not contagious, it isn’t a virus. My son is a joy, I love him and not in spite of his autism, but because of it.

        As to the latest CDC numbers, sure they are showing an increase in diagnoses of ASD since they started tracking it. You are completely ignoring the current generation of adults, not young adults but adults who are in their 40s, 50s and 60s and are just now being found to have ASDs. They didn’t catch it from someone, they had it all their life, because it is a life long condition, but they were overlooked or misdiagnosed when they were children because the diagnostic criteria of the day only caught those who were significantly affected by ASD. At the time, there was no ASD, it was Autism, or infantile schizophrenia. Learn your history because your hypothesis flies in the face of everything we have learned in the past several decades about autism, ASDs and learning disabilities.

  7. Shorty October 14, 2012 at 17:14 #

    The troll who slithers around the web saying there are no unvaccinated autistic children is called Tony Bateson and he has recently turned up elsewhere with his usual junk. He is impervious even to research which explicitly identifies such children.

  8. brian October 16, 2012 at 20:01 #

    Sullivan,

    Pushback from some commenters suggest that the “unvaccinated” children who developed ASD might have skipped only the MMR and DTP vaccines, but have received other vaccines. The authors wrote: “Not immunized/declined: Children for whom all immunizations had been withheld as of 3 years of age.” Does that mean, as I infer, that those children received NO vaccinations?

    Thanks.

    • Sullivan (Matt Carey) October 16, 2012 at 20:11 #

      brian,

      seems very clear to me that “all” means “all”, not just the two combination vaccines. But to be sure I’ve emailed the contact author with the question.

      • Science Mom October 16, 2012 at 20:14 #

        Thanks for doing that Sullivan. Could you let me know? I’m doing a critique of the paper and that would be an important piece of information. Thanks for asking that brian.

  9. Science Mom October 19, 2012 at 15:38 #

    Since Sullivan and Lara Lohne said it best, there is little I can add. Dr. Oestreicher, you are not a “junior scientist” and frankly a lousy, pompous physician. You don’t even know the difference between a theory and a hypothesis and you have no business being anywhere near autists and their families if you are going to characterise autists as having “awful genes” and “an epidemic of suffering”.

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