Why has the incidence of autism increased? Do you think vaccines relate to this?
There really is not a good hypothesis right now to explain that increase. I think many parents have been concerned that vaccines may cause autism. At this point there is not any good evidence that shows vaccines result in autism. That does not mean that there could not be children where that happened, but you can not explain the increase in autism by vaccine rates because, in fact, they have not occurred at the same time. So, it is not that when the numbers started to increase in autism was the same time when kids started getting vaccines. What is coincidental is that the timing of when autism begins to be noticed in children tends to be the beginning of that second year of life, and there are some kids with autism who really seem to lose skills during that time, and we do not know why. That does occur in the same period when kids get vaccinated, but as far as we can tell it is not causal. It is not that one causes the other, it is just that they both happen at about the same time.
Do you ever see a child younger than 2 diagnosed with autism?
More and more we are seeing kids who are referred at early ages. That is one of the things we study here, which is how early we can make a diagnosis. Sometimes in 1-year-olds, they really do look and act autistic. By that, I mean they have the same social behaviors, they have odd interests, they have unusual movements, but there are also kids whose parents are concerned early on even though they do not look autistic. Some of them look more autistic as they get older, and some of them do not. One of the big scientific questions right now in the United States and Europe is what are the signs that really mean something in those little kids, and what are the signs that there is no need to worry. Most of the kids I have met where parents have been worried if they might have autism at very early ages are the siblings of kids who have autism, and there have been a number of times where parents have said, “I think this is autism again when I saw the child at first.” I could not see it, and then in fact, the parents were right. So, I think there is a lot to be learned about those earliest signs, and there are also a number of parents who have had other kids who will swear that their child really was quite normal in that first year of life, and I think we believe them, but we do not know how that becomes autism.
Do you have any idea what some of those early signs of autism are?
Yes. Probably one of the earliest signs is a child who seems to understand some language, but does not respond to his or her name. They just do not seem to understand when you are calling them that that is why you are making that sound. Also, kids with autism when they are young do not seem to respond as well to the idea of shared attention. So if I started looking off to the corner over here, you would probably start looking there too wondering why am I looking over there, and that is something that is much harder for kids with autism to do. That is something that typical babies can do usually in the beginning of the second year of life. Also, many kids with autism do not point to draw people’s attention to things. They do not point out things like a cow or a fire engine or the moon, and they do not take that social initiative even though they may go to their parents for help. Those are the predominant things that you look for, but I do think if families are worried it is really important for them to find someone who knows a lot about autism in very young kids and then work with them to try to figure out what you could be doing about it to get the child started on therapy.
Also, I think it is hard that kids at that age are so cute and so engaging, and people have this conception of autism as this horrible disorder that means you are totally aloof and are in a corner banging your head. When in reality, the little kids may be very happy and smile a lot and are just as cute as can be, but they do not participate in social interaction the same way.