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Ask Dr. Bob
 

This article originally appeared in the July 7, 2008 issue of the St. Louis Post-Dispatch.

Until doctors find a cure for the 1 in 150 children living with an Autism Spectrum Disorder, parents will continue to search for solutions and answers.

In the meantime, Developmental Pediatrician Rolanda Maxim, MD, would like to provide one answer to a well-publicized dispute: There is no scientific evidence linking childhood vaccines with autism. Period.

Childhood vaccines are important because they protect not only your child, but the children around him or her as well. In the past, they’ve helped eliminate diseases such as measles, but as fewer children become immunized, diseases that once were eradicated are starting to resurface.

The Centers for Disease Control and Prevention have reported 64 cases of measles so far in 2008, and of those 64 cases, only one person had records of being immunized. The disease, which can cause severe neurological disorders in children, spreads through homes, childcare centers, schools, hospitals, and doctors’ offices.

“This is a public health concern,” says Dr. Maxim, medical director of the Program for Autism Spectrum Disorders, in the Knights of Columbus Developmental Center at SSM Cardinal Glennon Children’s Medical Center. “These viruses can cause severe delays in development, including regression in language, and cognitive and motor function.”

Physicians believe that autism, which affects language development and behavior, is most likely a genetic disorder. Dr. Maxim said that triggers in the environment may be responsible for causing autism in children with a genetic predisposition to the condition, but this trigger most likely occurs before a child is born.

Some parents suspect that thimerosal, a mercury compound used as a preservative in certain vaccines, triggers autism sometime after the age of 1 (MMR – measles, mumps and rubella – vaccines do not contain thimerosal). Even though there is no scientific link, thimerosal has been removed or reduced to trace amounts for all immunizations given to children age 6 or younger. Since then, the prevalence of autism among children has actually gone up.

Dr. Maxim said the correlation between the age children are vaccinated – between 1 and 3 – and the age of onset for autism – between 12 and 24 months – leads parents to link the two. But in this case, correlation does not imply causation, she says, and there are increased health risks for a child who is not immunized.

“This is a public health danger,” Dr. Maxim said. “While there is no proof that vaccines can cause autism, there is proof that not giving vaccines can cause devastating brain diseases. The risks far outweigh the benefits.”

Alternative Medicine
When medicine can not offer a cure for a disease, it’s not uncommon for parents of patients to seek alternative therapies, such as special diets, hormones, vitamins or other types of treatments.

Unfortunately, most of these therapies are without benefit, and some can even be harmful to children, including chelation, a process of ridding the body of metals such as mercury.
 Alternative therapies can also create a financial burden on families, because they are not covered by insurance.

 “If you are using alternative medicine for your child, make sure to tell his or her physician,” Dr. Maxim cautions. “Parents should always consult with their child’s doctor and a nutritionist about any kind of special treatment or eating plan, to ensure he or she is getting a healthy diet and that the treatment is not having any negative side effects.”

One study showed that 92 percent of parents had used alternative medicine therapies for their children with autism spectrum disorders, but many such therapies have been unevaluated. Growing online communities make it easier for parents of children with autism to support each other, but it also encourages sharing of alternative treatments that have not been proven to help.

“The Internet is a blessing and a curse,” Dr. Maxim said. “I tell parents that it is good to do your homework and be informed, but stick with credible sites, such as the Centers for Disease Control and Prevention (www.cdc.gov), American Academy of Pediatrics (www.aap.org) and Food and Drug Administration (www.fda.gov).”

Physicians are a family’s greatest tool, because they have years of training and experience to help parents decide what course of treatment is best for each child. So far, behavioral management, speech and language therapy, and early educational intervention have proven to be the most effective treatments for children with autism.

“Parents should ultimately make the decisions about how best to treat their child, but it is the physician’s job to give information, so parents can make the best choices possible,” Dr. Maxim said.

Dr. Bob Wilmott is Chief of Pediatrics at SSM Cardinal Glennon Children’s Medical Center and is a Professor of Pediatric Medicine at Saint Louis University School of Medicine. If you have a question about your child’s health for Dr. Wilmott, go to the “Ask Dr. Bob” section of the Cardinal Glennon Web site at www.cardinalglennon.com.

7/14/2008