National Children's Study Examining Environmental Genetic Interaction Will Boost Autism Research Paradigm Shift

Autism is only one of the conditions that will be examined as part of the National Children's Study being conducted by the U.S. Department of Health and Human Services (including the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Environmental Health Sciences, of the National Institutes of Health and the Centers for Disease Control and Prevention), and the U.S. Environmental Protection Agency. But the massive study of the interaction of environmental genetic factors will undoubtedly push into motion the autism research paradigm shift called for over the past decade, a paradigm which breaks away from the simplistic "it's gotta be genetic" funding mandates that have restricted expansion of knowledge of environmental causes of autism and limited the ability to find treatments and cure for autism disorders.

Today it was announced that NCS centers at The University of North Carolina at Chapel Hill and the Mount Sinai School of Medicine in New York will begin recruiting volunteer Study participants this week. Over the course of the study the health of 100,000 children from diverse backgrounds and 105 locations across the US will be studied as they grow to adulthood.

Information gathered during the study will be analyzed periodically and released to the public. This will probably generate more research including research of the genetic-environmental factors and processes giving rise to autism disorders.

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Autism and Vaccines: New York Times Promotes Offit Book

The New York Times has a new promotional feature, Book Is Rallying Resistance to the Antivaccine Crusade pushing Dr. Paul Offit's, "Autism's False Prophets" book. The NYT describes Dr. Offit as "mild, funny and somewhat rumpled" so you know where they are going with this one. They focus on Dr. Offit's receipt of death threats and quote him in a self comparison to Jonas Salk.

The NYT also manages to bring the beautiful actress, and Jenny McCarthy debater, Amanda Peet into the story, complete with photo of her in very motherly looking attire. What they don't do is mention the Poling case which put a serious dent in the "vaccines don't cause autism" position. Nor do they mention Dr. Julie Gerberding's acknowledgement that in some cases vaccines may trigger "autism like symptoms". Nor do they mention Dr. Bernardine Healy's (former head of the NIH and American Red Cross) comments calling for more research of a possible vaccine-autism connection, the limitations on the epidemiological studies which are used in defense of the vaccines, the discouragement by health authorities of vaccine-autism studies or the fact that vaccines still contain mercury.

The NYT has taken a stance and it has a right to do so. But it might be more honest to place the article in the opinion or editorial sections of the paper. Or in the advertising pages.

Journalism used to be about objectivity and presenting a complete, balanced summary of all sides of public issues. And the New York Times used to be about journalism.


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Neurodiversity Hate Video Extremism

Much of the autism advocacy in the past 10-20 years has been led by parents seeking to treat and cure their own autistic children, either by ABA therapy or by seeking cures. Parent advocates have come under attack from some high functioning autistic persons who have formed a loose coalition of bloggers who oppose the right of other peoples' autistic children to be treated or cured for their autistic disorders.

Most of the Neurodiversity commentary has been civil. Some has been silly, snide and sarcastic. Now some extremist ND bloggers are confessing their hatred of parent autism advocates openly on the internet as shown in this Christschool video promoted on Autism Street.

It will be interesting to see if ASAN and Neurodiversity leaders like Ari Ne'eman, Dora Raymaker and Kristina Chew, and Change.org, distance themselves from this hate video. Chew and Ne'eman once complained about offensive imagery about autistics. Will they now drink deep from the well of hypocrisy and embrace this blatant hate video message?

In the video CS literally demonizes autism (parent) advocates seeking to cure their own children. This video constitutes hate propaganda, contrary to the United Nations Declaration of the Rights of the Child. The video is also a direct and offensive attack on the rights of parents to advocate for their children, and the rights of children as declared by the United Nations to have their parents advocate on their behalf.

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Autism and Environmental Factors - Valproate

In "Study finds epilepsy drug may increase chance of autistic children", reported in Future Medicine, a summary is provided of a UK study which found that children born to mothers who took the epilepsy drug valproate while pregnant were seven times more likely to develop autism than children born to mothers who took no epilepsy drug while pregnant. The risk was not found with other epilepsy drugs.

The article summarizes the study by RL Bromley, G Mawer, J Clayton-Smith and GA "Gus" Baker reported in "Autism Spectrum Disorders following in utero exposure to antileptic drugs. Neurology 71, 1923-1924 (2008). One of the study authors, Gus Baker, is quoted in the Future Medicine article:

"The potential risk for autism in this study was substantial for children whose mothers took valproate while pregnant, but more research needs to be done since these are early findings. However, women who take valproate while pregnant should be informed of the possible risks of autism and are encouraged to consult their doctor. Those who are taking valproate should not stop their treatment without talking to their doctor first."

The valproate study is one more indicator that autism research funding which has been so heavily weighted toward genetics research should be more evenly distributed to include more environmental research. It is also of interest to note that Dr. Bernardine Healy also emphasized the particular issue of pregnant women being given flu vaccines containing thimerosal and the fact that thimerosal passes the placenta.

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Autism Research Folly

"the NIH and NIMH are impeding progress in research about causes, diagnostics, and treatment in autism and similar syndromes.

By clinging to an oversimplified and outmoded model of autism (ie, it's gotta be genetic), the stubborn persistence of several research administrators in the NIH and NIMH means that funding for autism and autism-spectrum syndromes remains funneled into the hands of a small group of researchers who pledge (via NIH-grant contracts) to conduct their research in accord with the model wherein "it's gotta be genetic" (1).

This funding pattern imposes a serious limitation on research that ought be occurring, given the growing amount of new data which indicate that *more than* genetic-aspects need be considered.

The relationship between (a) the offically approved though outmoded paradigm and (b) subsequent funding patterns is worth re-stating:

The persistence of the NIH and the NIMH in focusing almost entirely upon a genetic-theory of autism means that a goodly amount of data continues to be ignored, shunted from view, and unfunded -- even as the primary genetics-model researchers are blessed with abundant funding despite decades of non-success (1). For instance, the data from Wakefield, Warren, Singh, Shattock, Oleske et cetera are important, as are patterns amidst parental anecdotes -- eg, gastrointestinal atypicalities, vaccination effects, extraodrinarily recurrent otitis et cetera.

However, as recent years have shown, despite the many new data and anecotes, the NIH and NIMH are resistant to change. The new data remain virtually ignored, the parents' anecdotes treated as if mere hearsay. Not surprisingly, in the face of this bureaucratic intransigence, the goal of changing and improving the NIH and NIMH in regard to autism funding will require increased effort."

Teresa Binstock, Researcher in Developmental and Behavioral Neuroanatomy, in IGNAZ SEMMELWEISS and AUTISM: when prevailing paradigms resist change, 1999

The Binstock article, referenced above, was a review of Jeanne Achterberg's book Woman as Healer and the sad story of Ignaz Semmelweiss who challenged medical orthodoxy of his time (1818-1865) by gathering data and arguing that peuperal (childbed) fever was caused by the unclean hands of those who delivered, or assisted, delivery of children. Hospital wards staffed by midwives had a 3% mortality rate due to fever while those staffed by medical students who often came straight from autopsy rooms to the maternity rooms, and either did not wash their hands, or wiped them on already bloody, dirty clothes, had a 10% rate.

The medical establishment of the time did not believe Semmelweiss and he was professionally punished by lowering his academic standing and restricting his hospital privileges. Ultimately he became depressed and committed to an asylum where he died of blood poisoning. Binstock noted similarities between the treatment afforded Semmelweis, his conclusions, and his data and what has happened today to the anecdotal evidence of parents and researchers who followed up on that anecdotal evidence.

Teresa Binstock's contention that research of a possible vaccine-autism conection has been discouraged by public authorities is in fact confirmed in the Institute of Medicine (IOM) Immunization Safety Review: Vaccines and Autism (2004) . In that document the public health authorities expressly discouraged research of vaccine-autism connections as shown at p. 152:

Biological Mechanisms Conclusions

In the absence of experimental or human evidence that vaccination (either the MMR vaccine or the preservative thimerosal) affects metabolic, developmental, immune, or other physiological or molecular mechanisms that are causally related to the development of autism, the committee concludes that the hypotheses generated to date are theoretical only.

SIGNIFICANCE ASSESSMENT

The committee concludes that because autism can be such a devastating disease, any speculation that links vaccines and autism means that this is a significant issue.

PUBLIC HEALTH RESPONSE RECOMMENDATIONS

The committee recommends a public health response that fully supports an array of vaccine safety activities. In addition the committee recommends that available funding for autism research be channeled to the most promising areas.

Policy Review

At this time, the committee does not recommend a policy review of the licensure of MMR vaccine or of the current schedule and recommendations for the administration of the MMR vaccine.

At this time, the committee does not recommend a policy review of the current schedule and recommendations for the administration of routine childhood vaccines based on hypotheses regarding thimerosal and autism.

Given the lack of direct evidence for a biological mechanism and the fact that all well-designed epidemiological studies provide evidence of no association between thimerosal and autism, the committee recommends that cost-benefit assessments regarding the use of thimerosal-containing versus thimerosal-free vaccines and other biological or pharmaceutical products, whether in the United States or other countries, should not include autism as a potential risk.

Apart from the express discouragement of funding of research of a possible vaccine autism connection it is interesting to note the first paragraph of the above quote. The highlighted portion states "In the absence of experimental or human evidence " that vaccines are causally related to autism any such hypothesis can be theoretical only. Having noted an absence of evidence the IOM then discouraged any research that might have produced such evidence. It is also becoming less certain that the epidemiological studies were as well designed as the IOM contended given the continued presence of thimerosal in vaccines, including some vaccines given to pregnant women.

In the last year the Poling case upset the IOM 2004 strategy. Government had to acknowledge that, at least in some subsets of children vaccines could trigger "autism like symptoms" :

if you're predisposed with the mitochondrial disorder, it can certainly set off some damage. Some of the symptoms can be symptoms that have characteristics of autism.

Dr. Julie Gerberding, Director, CDC, CNN Interview with Dr. Sanjay Gupta, March 29, 2008

As many have noted there is no intelligent distinction between autism and autism like symptoms. Autism is currently diagnosed by symptomatic behavior. In addition to Dr. Gerberding's reluctant acknowledgement of a vaccine-autism connection, Dr. Bernardine Healy, former director of the American Red Cross and the NIH, exposed limits of the epidemiological studes and expressed the need for further research of possible vaccine-autism connections in April 2008.

It is sheer folly to discourage research into possible environmental triggers or causes of autism. Not doing the research means that we might have missed out on possible treatments or preventative measures for autism. Teresa Binstock pointed out the folly of such a course of action in her 1999 comment. Now Irva Hertz-Picciotto, an author of the recent California study, has called for increased funding of research of possible environmental causes of autism.

It is time to move away from the "it's gotta be genetics" paradigm of autism research that Binstock described in 1999. It is time to move ahead with the autism research paradigm shift that the University of Minnesota called for in 2007, a paradigm based on the premise that autism is caused by a combination of environmental influence and genetic vulnerabilities.

It is time to end the "its gotta be genetics" autism research folly.

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Real Autism Advocacy - In Virginia Delegates Marshall and Poisson Push for Autism Health Insurance Coverage

In Here's why Virginia should mandate coverage for autism Delegates Rob Marshall (R-Manassas) and David Poisson (D-Sterling) argue for mandated health insurance coverage for autism by passage of H.B. 1588 in the Virginia General Assembly.



HB1588: Autism spectrum disorder; mandated health insurance coverage therefor was introduced in the Virginia General Assembly by Mr. Marshall on September 24, 2008 and requires health insurers, health care subscription plans, and health maintenance organizations to provide coverage for the diagnosis and treatment of autism spectrum disorder in individuals under age 21. Coverage is subject to an annual maximum benefit of $36,000. Anyone interested in following the progress of the bill can do so on the excellent Richmond Sunlight site.

Delegates Marshall and Poisson point out that, in addition to the gains for autistic children, early intervention in treating autism is an effective cost saving measure and that it alleviates the burden on on schools in their efforts to educate autistic children. The health insurance autism mandate is required to ensure that early intervention is provided to autistic children in Virginia. The legislation would provide for coverage of evidence-based, medically necessary care prescribed, provided or ordered by a physician or psychologist for a child under the age of 21.

Autistic children, and their families, in Virginia have two strong champions in Delegates Rob Marshall and David Poisson.

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Arkansas Parents Meet Governor To Advocate For Their Autistic Children

In Arkansas parents of autistic children met with Arkansas Governor Beebe on Friday to fight for their autistic children by asking the Governor to discuss possible legislation that would require insurance companies to cover Applied Behavioral Analysis. You won't see this story on the formerly progressive Change.org's "autism" page, operated as it is by Neurodiversity extremists Kristina Chew and Dora Raymaker, but you can find it, complete with video coverage, on line at Arkansas matters.com and at MSNBC.

ABA is the one evidence based intervention shown by decades of research to help autistic children make real gains and parents were in Little Rock fighting to obtain it for their children. But you would never know it by reading the Change.org Neurodiversity maskquerading as Autism page. At Change.org you will find attacks on Jerry Lewis for his disabilities advocacy over several decades but no mention of ABA or the good parents of Arkansas.

For that matter you wouldn't know anything about evidence backed ABA or the parents struggle in Arkansas by reading the Age of Autism either. That site devotes more coverage to the ACE Pathway Investigational Study of Dr. John Martin and Rev. BJ McKelvie then it does to parents' struggles to obtain evidence based ABA treatment for their children.

There are many people pretending to help autistic children. Some are actually doing so, like the parents who met the Governor in Little Rock, Arkansas. From Fredericton, New Brunswick, Canada, this autism dad salutes you. Keep up the good fight.

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Environmental Causes of Autism - It Is Time To Get The Research Done

The new UC Davis Mind Institute study indicating the likelihood of environmental factors in the dramatic increases in autism cases in California is a step forward in the still developing autism research paradigm shift that investigates autism disorders and their causes from the perspective that autism is caused by a combination of environmental influence and genetic vulnerabilities:

Autism research is poised for another paradigm shift, from an irreversible condition to a treatable disease. In the revolutionary paradigm, autism is not a rare disorder with a constant rate but frequent condition with a rising incidence. It is a combination of environmental influence and genetic vulnerabilities. It is both preventable and treatable, not by any one method but by a combination of behavioral and biomedical approaches. Autistic kids are not defective, they are sick but otherwise normal kids, and thus, recoverable. 

University of Minnesota, Press Release, July 2007

The move to a combined environmental-genetic research model seems to be long overdue. The vaccine-autism controversy may well have pushed public authorities away from possible environmental causes of autism generally but it is difficult to understand why anyone ever assumed that autism is entirely genetically determined. In a December 2007 interview piece published on TimesOnLine, Freedom of Expression, Professor Simon Baron-Cohen made the following salient observiation:

Studies of twins have established that it is not 100 per cent genetic, since even among identical twins, when one has autism, the likelihood of both twins having autism is only about 60 per cent. This means there must also be an environmental component, but what it is remains unknown. 

The vaccine-autism controversies have generated entrenched positions and ideologies on all sides of those controversies.  One of the unfortunate tendencies has been a tendency to berate and ridicule any mention of possible environmental causes of autism disorders. Another has been a focus on genetic research to the near exclusion of environmental factors.  That has begun to change, as called for in the University of Minnesota 2007 press release but the change is not as fast as it could be.  

The vaccines we give children still contain the mercury based preservative thimerosal, according to the FDA web site and children are exposed to a variety of toxic materials in toys and jewelry including mercury, lead, and arsenic.  If specific environmental factors are causing or contributing to autism, whether in isolation, or in concert, then preventative measures can be taken and research into curing autism can, and should,  incorporate those factors.

It is time to drop the rigid, ideological belief that autism is 100% genetic and get the environmental research done to help our children.

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Autism Rising - UC Davis Mind Institute Study Points To Environmental Factors

Although Classics Professor Kristina Chew, ASAN co-founder Dora Raymaker, and the once progressive Change.org have decreed that autism is most likely entirely genetic, with no environmental contributing factors, recent research says otherwise. The UC Davis MIND Institute has published a news release of a study indicating that the dramatic rise in California autism cases probably arises from environmental factors. The news release also calls for an autism research paradigm shift from simplistic focus on genetic causes of autism to an examination of both genetic and environmental factors. ... with the funding necessary to fully implement the shift. In fact UC Davis Mind Institute has already been a leader in this autism research paradigm shift with its CHARGE program, a major epidemiological study investigating environmental factors and gene-environment interactions in autism disorders.

January 7, 2009 (SACRAMENTO, Calif.) — A study by researchers at the UC Davis M.I.N.D. Institute has found that the seven- to eight-fold increase in the number children born in California with autism since 1990 cannot be explained by either changes in how the condition is diagnosed or counted — and the trend shows no sign of abating.

Published in the January 2009 issue of the journal Epidemiology, results from the study also suggest that research should shift from genetics to the host of chemicals and infectious microbes in the environment that are likely at the root of changes in the neurodevelopment of California’s children.

“It’s time to start looking for the environmental culprits responsible for the remarkable increase in the rate of autism in California,” said UC Davis M.I.N.D. Institute researcher Irva Hertz-Picciotto, a professor of environmental and occupational health and epidemiology and an internationally respected autism researcher. .... Hertz-Picciotto said that the study is a clarion call to researchers and policy makers who have focused attention and money on understanding the genetic components of autism. She said that the rise in cases of autism in California cannot be attributed to the state’s increasingly diverse population because the disorder affects ethnic groups at fairly similar rates.

...

“Right now, about 10 to 20 times more research dollars are spent on studies of the genetic causes of autism than on environmental ones. We need to even out the funding,” Hertz-Picciotto said.

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Change.org Opposes Human Rights of Autistic Children

A quick browse of the topics listed on the current front page of the Change.org web site paints a clear picture of a politically progressive organization; one that is supportive of human rights and the natural environment in which we all must live and exercise those rights. The web site shows compelling campaigns against the genocide in Darfur, for humanitarian relief in the Congo and Gaza, demanding an end to plastics killing marine life and arguing for increased health care spending. And yet, despite this generally strong commitment to human rights and the environment, Change.org has decided to oppose the human rights of autistic children, specifically the rights of autistic children, rights enjoyed by all children, to treatment and cure of their medical conditions, to become fully functioning members of society and to have their voices heard through their parents. This regressive, anti-human rights move by Change.org was implemented recently by hiring two bloggers, Kristina Chew and Dora Raymaker, who are leaders of an extremist movement which opposes these human rights of autistic children.

Human Rights of Autistic Children

The United Nations has pronounced on several occasions on the subject of the human rights of children. 2009 marks the 50th anniversary of the United Nations Declaration of the Rights of the Child Proclaimed by General Assembly resolution 1386(XIV) of 20 November 1959 but international bodies have long called for recognition and action to protect the human rights of children as indicated in the preamble to the 1959 declaration which references the 1924 Geneva Declaration of the Rights of the Child and the Universal Declaration of Human Rights as predecessor statements affirming the human rights of children. The preamble calls upon governments and others to recognize and act on the rights of children:

Whereas mankind owes to the child the best it has to give,

Now therefore,

The General Assembly

Proclaims this Declaration of the Rights of the Child to the end that he may have a happy childhood and enjoy for his own good and for the good of society the rights and freedoms herein set forth, and calls upon parents, upon men and women as individuals, and upon voluntary organizations, local authorities and national Governments to recognize these rights and strive for their observance by legislative and other measures progressively taken in accordance with the following principles

Principle 2

The child shall enjoy special protection, and shall be given opportunities and facilities, by law and by other means, to enable him to develop physically, mentally, morally, spiritually and socially in a healthy and normal manner and in conditions of freedom and dignity. In the enactment of laws for this purpose, the best interests of the child shall be the paramount consideration.

Principle 4

The child shall enjoy the benefits of social security. He shall be entitled to grow and develop in health; to this end, special care and protection shall be provided both to him and to his mother, including adequate pre-natal and post-natal care. The child shall have the right to adequate nutrition, housing, recreation and medical services.

Principle 5

The child who is physically, mentally or socially handicapped shall be given the special treatment, education and care required by his particular condition

The UN Declaration of the Rights of the Child calls not just upon governments but also upon all voluntary organizations, parents, men and women to respect the rights therein set out. Change.org and its bloggers are directed by the Declaration to recognize those principles. It is a direction with which they refuse to comply.

Change.org has endorsed the views of an organization and individuals, and given them a platform, who refuse to recognize a child's right to be given the opportunity to develop mentally and socially in a normal and healthy manner, as set out in principle 2, to grow and develop in health with adequate medical services as set out in principle 4. Change.org does not recognize the right of autistic children, as children with mental handicaps to be given the special treatment, care, and education required by their autistic condition as set out in principle 5.

Change.org, and its staff bloggers, Dora Raymaker and Kristina Chew, also refuse to recognize important elements of Principles 6 and 7, those elements which give primary responsibility for the care of autistic children to their parents, not to adult strangers who share some aspects of their autistic disorders but their parents, including parents seeking treatment for their own children and their medical conditions.

Change.org Refusal to Recognize UN Declared Human Rights of Autistic Children

It is not necessary to go to the voluminous writings of Kristina Chew, or ASAN which was cofounded by Dora Raymaker, to find evidence of Change.org's opposition to the human rights of autistic children. These two Change.org bloggers have wasted no time dumping their opinions on the internet via their new Change.org platform. Put simply, but accurately, these two bloggers do not recognize the right of autistic children to be treated for, and cured of, their autistic disorders.

Nor do they recognize that the responsibility for the best interests of these children rests with their parents .... not with strangers like Ms Chew or Ms Raymaker or their colleagues in ASAN. In particular they do not recognize the responsibility of parents to represent their childrens' best interests, when that representation seeks to obtain cures for their childrens' medical conditions, their neurological disorders, their autism disorders.

10 Autism Controversies

On December 31, 2008 Change.org published an article by Chew and Raymaker called 10 Autism Controversies. The article sets out the Chew/Raymaker/Neurodiversity position on various autism matters. The article is simplistic, unfair to the views of parents who do not share their views, and totally one sided.

It clearly states though the position of Change.org on the right of autistic children, more properly the lack of a right of autistic children, to treatment for, and cure of, their autism disorders:

2. Recovery from autism.

Autism is a lifelong disability that is most likely genetic in origin. Nonetheless, claims that children have been "cured" from autism and have lost their diagnosis have been reported and are often given excessive attention in the media. But focusing on recovery distracts from attending to the needs of autistic individuals in the here and now. Parents may put all their energy and resources into so-called "cures" for autism, instead of focusing on the individual in front of them, and on the educational needs of that individual. Recovery from autism is neither possible, nor desirable.

3. Support vs. cure.

The idea of "cure" is tied to the medical model of disability which holds that a person with a disability is "sick" and needs to be "cured;" some internal flaw has "caused" the disability. This is the perspective still taken by popular culture and many autism organizations.

In contrast, the socio-ecological model of disability holds that there are problems instead in the relationship between the disabled individual and their environment; disability is "caused" by a poor person-to-environment match. This perspective rejects the idea of "cure" as nonsensical (and in some ways offensive) as it does not view disability as a flaw that resides solely within an individual. Instead, this perspective asks, what needs to be done to bring the individual and their environment into better alignment?

What is not being expressly stated in the Change.org comments opposing cures, and research to find cures, for autism disorders, is that the criticisms are directed at the many parents who seek to cure their childrens' autism disorders, medical conditions defined by the Diagnostic Statistical Manual of the American Psychiatric Association. If governments, particularly the US federal government, are now discussing investmentng funds for research into the environmental causes of autism, and cures for autism, research that has heretofore been discouraged by public health authorities, it is because of the activism of parents. These parents in seeking cures for their childrens' autism disorders are fulfilling their responsibilities pursuant to the United Nations Declaration of the Rights of the Child. It is they whose views are dismissed with contempt and presumed omniscience by Change.org and their "autism" bloggers.

It is the parents who seek cures for their childrens' autistic disorders who recognize the human rights of their children. It is unfortunate that Change.org has embraced an ideological movement which rejects and refuses to recognize those rights.

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Public Discussion of Vaccine Issues

I encourage parents and members of the public interested in autism and vaccine safety issues to visit Age of Autism and read The Vaccine Hard Sell at Pediatrics. That comment includes a letter by Michael Wagnitz, a chemist with 27 years experience, and self described father of a "vaccine injured child", in which Mr Wagnitz challenges Pediatrics and Dr. Paul Offit for alleged misinformation regarding the use of neurotoxic metals in vaccines.

Pediatrics, the journal of the American Academy of Pediatrics, apparently refused to publish Mr. Wagnitz letter, despite his chemistry background, and despite the sourcing for the points made in his letter. The Age of Autism, to its credit did publish the Wagnitz letter.

Vaccination programs are an important part of public health strategies and have been very successful in reducing or eliminating serious illnesses, some of which have taken the lives of many children. Claims regarding vaccine injuries should not be made lightly. But neither should democratic discussion, particularly well informed, rational discussion of possible vaccine induced injuries, including possibly autism, be shut down.

If the research which Dr. Bernardine Healy has called for into possible vaccine connections to autism is not done, if public discussion of such connection is shut down, if dissenting voices like Mr. Wagnitz with his chemistry background are not heard, then the public concerns about vaccines and autism or brain injuries will continue to grow.

It may also be the case that some of the claims about vaccine induced autism and other brain injuries are true. Without proper research and public discussion we may end up missing out on opportunities to prevent neurological damage to children.

Let us do the research, let us have the discussion. Let us hear from parents, doctors, chemists anyone with information and a perspective to offer. That is the ONLY way confidence in the vaccine programs will be strengthened. And we may learn of ways to prevent autism disorders and neurological damage.

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Canada Still Awaits A National Autism Strategy

The following comment by Brian Rimpilainen, a friend and autism dad from Fredericton New Brunswick, was published in autism group networks and in the Telegraph-Journal. Brian is a dedicated autism advocate who has worked as a member of the Autism Society New Brunswick Board of Directors, the ASNB representative on the Autism Society Canada board and the Medicare for Autism organization. He has also been actively involved in direct citizen advocacy through local print media and internet media tools such as Facebook where Brian is the founder and administrator of the National Autism Strategy / ABA in Medicare NOW! group:

As 2008 comes to a close, I am reminded of former Fredericton MP Andy Scott's statement of June 5, 2007: "Mr. Speaker, it is regrettable that we have seen little action by the government toward implementing a national autism strategy ;

A year earlier Mr. Scott's private member's motion called for "evidence-based standards, innovative funding arrangements for diagnosis, treatment and research, and a national surveillance program."

I am the father of a son with Autism Spectrum Disorder (ASD). I watched hopefully as Liberal MP Shawn Murphy introduced a private member's bill, which would called for amendment of the Canada Health Act to provide coverage for autism treatments. The bill was defeated. The Liberals and the New Democrats both voted, by and large, in support of Bill C-304.

Autism is a serious neurological disorder that affects 1 in 150 Canadians. Persons with an ASD can display a wide range of intellectual, communication, behavioural and/or social deficits. While no known cure exists, a treatment that has been demonstrated in hundreds of studies to decrease the negative autism deficits, and in some cases virtually eliminate these deficits exists. Applied Behaviour Analysis (ABA) has been demonstrated to improve the abilities in all these areas and improve the quality of life of persons with autism.


Despite this, governments in Canada have an atrocious record in dealing with the autism crisis and in helping these vulnerable people.


I hope all MPs will carry the torch Mr. Scott has lit as we move into 2009.


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Has Thimerosal Actually Been Removed From Vaccines? If Not, Of What Value Are the Epidemiological Studies?

Are the epidemiological studies relied upon by public authorities to refute assertions that the mercury based vaccine preservative thimerosal is responsible for some or all autism cases reliable?

These studies tend to show that autism rates did not decline after removal of thimerosal from vaccines. This past year the epidemiological defense of vaccines took a hit with the Poling case and with assertions by Dr. Bernardine Healy, a former director of the American Red Cross and the US National Institutes of Health, that the necessary clinical research to refute such a connection had not been done, particularly into subsets of children who might be genetically vulnerable or prediposed to develop when autism triggered by mercury or other toxins? Dr. Healy stated in Fighting the Autism-Vaccine War, US News & World Report, April 10, 2008, that:

“vaccine experts tend to look at the population as a whole, not at individual patients. And population studies are not granular enough to detect individual metabolic, genetic, or immunological variation that might make some children under certain circumstances susceptible to neurological complications after vaccination.

She also stated, amongst other points, that:

thimerosal crosses the placenta, and pregnant women are advised to get flu shots, which often contain it.

I find that last statement very troubling. If the epidemiological studies are based on the premise that thimerosal has been removed from vaccines and in fact they have not then what is the probative value, if any, of the epidemiological studies? Particularly given the pregnancy context cited by Dr. Healy.

I am only a humble small town lawyer in Fredericton, New Brunswick, Canada but my concern is prompted in significant part by the information provided by a prominent and accomplished member of the US medical establishment. Other credible sources also lead me to the same concern about whether thimerosal has, or has not, been removed from vaccines as claimed in the public health authorities' refutations of vaccine-autism connections.

As of this posting the web site of the US Food and Drug Administration states: Over the past several years, because of an increasing awareness of the theoretical potential for neurotoxicity of even low levels of organomercurials and because of the increased number of thimerosal containing vaccines that had been added to the infant immunization schedule, concerns about the use of thimerosal in vaccines and other products have been raised. Indeed, because of these concerns, the Food and Drug Administration has worked with, and continues to work with, vaccine manufacturers to reduce or eliminate thimerosal from vaccines.

Thimerosal has been removed from or reduced to trace amounts in all vaccines routinely recommended for children 6 years of age and younger, with the exception of inactivated influenza vaccine (see Table 1). A preservative-free version of the inactivated influenza vaccine (contains trace amounts of thimerosal) is available in limited supply at this time for use in infants, children and pregnant women. Some vaccines such as Td, which is indicated for older children (≥ 7 years of age) and adults, are also now available in formulations that are free of thimerosal or contain only trace amounts. Vaccines with trace amounts of thimerosal contain 1 microgram or less of mercury per dose.

The above, current statements from the US FDA, raise several concerns for me:

1) Theoretical potential for neurotoxicity of even low levels of organomercurials

The use of the term "theoretical potential for neurotoxicity" tells me that potential toxcity of organomercurials has NOT been definitively ruled out by the FDA. I appreciate that the expression is used in an historical context to explain the decision to remove mercury based preservatives from vaccines but surely the FDA web site would have immediately stated after that comment that there was no longer even a theoretical potential if such were the case.

2) continues to work with, vaccine manufacturers to reduce or eliminate thimerosal from vaccines.

Again, this information is taken from the web site of the US FDA as it exists today. Why are they continuing to reduce or eliminate thimerosal from vaccines if the epidemiological studies were based on the premise that thimerosal had already been removed? I appreciate that some of the studies are from other countries but have those countries all completely removed thimerosal from vaccines? If so, why were those other countries able to completely remove thimerosal when the US can not?

In the United States a study by the California Department of Health released in February 2008 found that autism rates remained steady after the removal of thimerosal from vaccines. That study conclusion was qualified though by Dr. Robert Schechter, a health officer with the California health department and lead author on the report of the study as reported in the Lexington-Herald, February 5, 2008:

As for Haley's argument that some children still might be getting some mercury from vaccines, Schechter said that could be true. But he said the general removal of thimerosal from vaccines still should have caused autism rates to fall -- if mercury were the culprit in the disease. "I would not claim that children are getting no mercury from vaccines," Schechter said. "But the average exposure for the population has been substantially decreased over the past decade. If mercury from vaccinations was a primary cause of autism, you would expect rates to be dropping substantially."

Substantial decrease is not the same as total removal of mercury from vaccines. The California epidemiological study, at least, is not based on removal of mercury from vaccines.

3) Trace amounts

The FDA site, as quoted above, states that vaccines with trace amounts of thimerosal contain 1 microgram or less of mercury per dose. That certainly sounds like a very small amount and the implication appears to be that the amount is too small to have any effect. But the FDA also referred to the theoretical potential for neurotoxicity of even low levels of organomercurials.

It seems dubious to claim that epidemiological studies show no autism increase after removal of mercury-thimerosal if all elements of the material have not in fact been removed when the potential for neurotoxicity is recognized even in small amounts. Partcularly since the FDA, as stated above, considers vaccines with trace amounts to be vaccines with the mercury removed:

A preservative-free version of the inactivated influenza vaccine (contains trace amounts of thimerosal) is available in limited supply at this time for use in infants, children and pregnant women.

Why leave trace amounts in the vaccines to begin with? If trace amounts of thimerosal can still have a preservative effect on bacteria in the vaccines then why can't they also have a neurotoxic effect on children receiving the vaccines? And some of the flu vaccines, the ones not considered thimerosal free, contain more than trace amounts of thimerosal.

I am not a medical authority and do not pretend to be. Nor do I claim that vaccines or thimerosal cause autism. As some one who does earn his living by some degree of critical thinking and analysis I find the statements of public health authorities about epidemiological studies refuting a vaccine-autism link open to question.

Their own statements appear to contradict their claims that the studies refuting a vaccine-autism link are based on periods when thimerosal was removed from vaccines.

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Autism Rising in Marin County

From coast to coast, across North America, autism is rising. In the United States, from South Carolina facing the Atlantic Ocean to Marin County, California, facing the Pacific, autism is rising and schools are struggling to meet the challenge of educating autistic children.

In Tsunami' of autism cases crippling to Marin parents, schools Rob Porter of marinij.com (Marin Independent Journal) reports on the struggles of parents and schools in Marin County, California, trying to provide an education to autistic school children whose numbers in Marin County have doubled from 76 in 2001 to 152 in 2008. The article is balanced quoting sources who explain the dramatic increases in autism diagnoses on the basis of the 1994 DSM changes which lumped Aspgergers Disorder together with Autistic Disorder but also quotes Robert Herndon, executive director of the Medical Investigation of Neurodevelopmental Disorders (MIND) Institute at the University of California at Davis who doesn't buy the belief that the DSM changes are a complete answer and points out that we really don't know at thist time what is behind the increases:

"The reason it's such a controversial question is that if we say autism is primarily a genetic disease, then we shouldn't be getting more of it. Genes don't just change - something in the environment has to interact with them. Some people don't want to think there is anything bad in the environment, while some want to say the environment is terribly toxic and that explains it. The truth is that we really don't know about any of them. There is no smoking gun. "

The truth is also that research into possible environmental causes of autism has been discouraged until fairly recently. That has been changing though and in 2007 the University of Minnesota aptly described a new paradigm for autism research, an autism research paradigm shift based on the possible interaction of genetic and environmental factors:

Autism research is poised for another paradigm shift, from an irreversible condition to a treatable disease. In the revolutionary paradigm, autism is not a rare disorder with a constant rate but frequent condition with a rising incidence. It is a combination of environmental influence and genetic vulnerabilities. It is both preventable and treatable, not by any one method but by a combination of behavioral and biomedical approaches. Autistic kids are not defective, they are sick but otherwise normal kids, and thus, recoverable.

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Change.org Blows It BIG TIME Putting Neurodiversity Ideologues in Charge of Alleged Autism Blog

Change.org is a positive contribution to public life; in the United States and around the world.

One of its most unfortunate decisions made of late though was to start an alleged "Autism" blog site and then stack it with two blogger representatives of the anti-cure, anti-treatment Neurodiversity movement. One of the bloggers is Dora Raymaker a very high functioning person with an autism spectrum disorder and prominent member of ASAN and Dr. Kristina Chew, a parent of an autistic child, blogger, and professor of Greek and Latin classics. Both are adherents to the Neurodiversity Ideology which does not view autism spectrum disorders as medical conditions, opposes cures for autism, objects to autism distinctions based on functioning levels despite common sense and their use by expert autism researchers and medical professionals, declares not only that there is no cure for autism now but that there never can be such a cure and tries with every breath to discourage research into possible environmental causes of autism.

The latter effort is becoming ever more desperate as research now has begun on many fronts based a new paradigm of autism research one that works on the basis that there is an interaction between the genetic and the environmental causes of autism. Another jolt to the omniscience of the Neurodiversity movement came in 2008 with comments made by no less an authority than Dr. Bernardine Healy that necessary clinical research into possible environmental causes of autism has not been done and has in fact been discouraged for reasons of public policy, principally the potential impact on public vaccination programs.

The Neurodiversity movement has some parent adherents, of which Ms Chew is possibly the best known, but most parents are too sensible to subscribe to an ideology which dictates that efforts to cure their children of their neurological disorders are wrong and should not continue. The ND movement is offensive and a violation of the human rights of autistic children whose parents represent their interests not strangers with little in common. But the ND adherents serve a useful purpose for media outlets looking for a new angle and for pubic administrations that do not want to spend monies on treatment and research into autism cures.

The Change.org Neurodiversity blog has come out with guns blazing by listing 10 Autism Controversies and then putting a blatantly one sided Neurodiversity spin on all 10 of those controversies. To the full credit of Ms Raymaker and Dr. Chew they did not try to create any illusion of balance or objectivity. Every controversy is described and resolved from a Neurodiversity perspective.

What the two ND ideologues did not do was canvass ALL of the autism controversies particularly those created most directly by Neurodiversity ideologues like Ms Raymaker and Dr. Chew. What they did not do was discuss the controversy over the legal, moral or common sense basis on which these people tell OTHER people how they should raise, care for and protect THEIR autistic children.

The greatest autism controversy arises from the unmitigated gall, audacity and arrogance which sees ND ideologues tell parents of autistic children who can barely understand language or the world that they have no right to speak on their children's behalf. Instead Neurodiversity advocates assert that THEY , high functioning, highly articulate, strangers, with little in common with severely autistic children, should speak on behalf of those children in place of their actual parents. The fraud and hypocrisy arising from this incredible arrogance are part of a reprehensible misrepresentation taking place in world autism discussions. It is a fraud which seeks to deprive autistic children of the protection of their parents and violates their human rights.

Change.org has waded into the autism wars by appointing one party to those wars as the official Change.org blogging voices. In doing so Change.org has sided with an irrational movement which in fact seeks to prevent treatment and cure of autistic children and even prevent open, honest discussion of autism realities.

With this decision by Change.org the autism wars have just been taken to a new level of hostility and confrontation.

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Research to Practice: Making Real Changes in the Lives of People with Autism

The agenda that follows is taken from the Association for Behavior Analysis International® web site. The focus of the conference, as the conference title declares, is on making real changes for the benefit of people with autism. Anyone who shares that focus on making real changes for people with autism should give serious thought to attending this conference if time and circumstances permit. All the topics are of compelling interest. One that catches my eye in particular as my son, who will be 13 in February, grows up is the discussion by Peter F. Gerhardt, Ed.D., Organization for Autism Research entitled Applied Behavior Analysis and Adults with Autism: Applications to Promote Competence and Quality of Life.

If you are serious about helping people with autism make real changes in their lives this is the conference you should attend in 2009! Registration forms and information, including on-line registration, are available on the ABA International conference registration page.

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Research to Practice: Making Real Changes in the Lives of People with Autism

The 2009 Autism Conference program would not be possible without the dedicated contributions of the Program Committee.

2009 Autism Conference Program Committee

Agenda

The conference titles and speakers are listed below. Click on each to view the presentation abstract and speaker biography.

Friday, February 6

6:00 pm - 9:00 pm
Opening Reception: Poster Session 1, Exhibitors, Bookstore & Author Signing Fair

Saturday, February 7

8:00 am - 8:15 am
Opening Remarks and Introductions
William L. Heward, Ed.D., BCBA, The Ohio State University

8:15 am - 9:15 am
Fostering Independent Performance Skills in Young Children with Autism
Diane M. Sainato, Ph.D., The Ohio State University
Introduced by: William L. Heward, Ed.D., BCBA, The Ohio State University

9:15 am - 10:15 am
Improving Joint Attention and Reciprocal Language Skills in Children with Autism
Bridget A. Taylor, Psy.D., BCBA, Alpine Learning Group
Introduced by: Mary Jane Weiss, Ph.D., BCBA, Rutgers University

10:15 am - 10:45 am
Break

10:45 am - 11:45 am
Pivotal Response Intervention
Lynn Kern Koegel, Ph.D., and Robert L. Koegel, Ph.D., University of California, Santa Barbara
Introduced by: Linda A. LeBlanc, Ph.D., BCBA, Western Michigan University

11:45 am - 12:45 pm
Applied Behavior Analysis and Adults with Autism: Applications to Promote Competence and Quality of Life
Peter F. Gerhardt, Ed.D., Organization for Autism Research
Introduced by: Marianne L. Jackson, Ph.D., BCBA, California State University, Fresno

12:45 pm - 2:15 pm
Lunch Break

2:15 pm - 3:15 pm
Expert Panel/Question & Answer Session: Recent Developments in Behavioral Programming & Interventions
Panelists: Peter Gerhardt, Lynn Koegel, Robert Koegel, Diane Sainato, and Bridget Taylor
Moderator: Mary Jane Weiss, Ph.D., BCBA, Rutgers University

3:15 pm - 4:15 pm
Early Intensive Behavioral Intervention for Children with Autism: What Does Research Tell Us?
Adrienne M. Perry, Ph.D., C.Psych., BCBA, York University
Introduced by: James E. Carr, Ph.D., BCBA, Auburn University

4:15 pm - 4:45 pm
Break

4:45 pm - 5:45 pm
Defining, Designing & Delivering ABA School Programs for Students with Autism Spectrum Disorders

Suzanne Letso, M.A., BCBA, Connecticut Center for Child Development
Introduced by: David Celiberti, Ph.D., BCBA, Association for Science in Autism Treatment

5:45 pm - 6:00 pm
Overview of ABAI’s Autism and Parent-Professional Partnership Special Interest Groups
Mary Jane Weiss, Past-President, ABAI Autism SIG & David Celiberti, President, ABAI's Parent-Professional Partnership SIG

6:00pm - 8:00pm
Dinner

8:00 pm - 10:00 pm
Poster Session 2, Bookstore and Exhibitors

Sunday, February 8

8:00 am - 9:00 am
Now That We Know What to Do, How Do We Do It? Implementation Science and Applied Behavior Analysis
Samuel L. Odom, Ph.D., University of North Carolina
Introduced by: Jack Scott, Ph.D., BCBA, Florida Atlantic University

9:00 am - 10:00 am
Experimental Approaches to Behavioral Assessment
Brian A. Iwata, Ph.D., BCBA, University of Florida
Introduced by: Susan M. Wilczynski, Ph.D., BCBA, National Autism Center

10:00 am - 10:30 am
Break

10:30 am - 11:30 pm
Expert Panel/Question & Answer Session: Using Science to Guide Autism Treatment
Panelists: Brian Iwata, Suzanne Letso, Samuel Odom, Adrienne Perry, and Susan M. Wilczynski, Ph.D., BCBA, National Autism Center
Moderator: James E. Carr, Ph.D., BCBA, Auburn University

11:30 am - 12:30 pm
Expert Panel/Question & Answer Session: Current Status, Challenges, and Opportunities in Legislation of Behavior Analytic Autism Services: Observations and Recommendations from Professionals and Parent Advocates

Panelists: Mandana Davani, M.D., St. Johns Radiology Associates; Michael Dorsey, Ph.D., BCBA, Vinfen Corporation and Gordon College; Kim Lucker, Ph.D., BCBA, Behavior Management Consultants; Eric D. Prutsman, Esq., Prutsman & Associates; Judith Ursitti, Autism Speaks
Moderator: Jack Scott, Ph.D., BCBA, Florida Atlantic University

12:30 pm - 1:00 pm
Concluding Remarks

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Autism Rising in South Carolina

Source: S.C. State Department of Education, as Reported on The State

There are some who scoff at the notion that there is an actual autism epidemic. They ridicule the idea that the startling rise in autism diagnoses can be attributed to any real environmental cause. For those who refuse to see the autism elephant in the room the rise in autism diagnoses is attributable entirely to the expansion in the 1994 edition of the Diagnostic and Statistical Manual of the American Psychiatric Association, the DSM-IV, of the autism spectrum diagnoses from autistic disorder or classic autism to include Aspergers Disorder. But even that explanation does not explain the dramatic increase in the numbers in the last five years in South Carolina.

In South Carolina, as reported in Rising autism rates challenge schools on the State web site, the numbers of autism students counted by public schools has doubled since .... 2003 ... a period which begins 9 years AFTER the DSM-IV autism definition expansion. Even more troubling for the simplistic change in definition explanation for dramatic increases in autism in South Carolina is the fact that the doubling in autism cases counted in the public schools refers to a doubling of the classic autistic disorder diagnoses. It does not include Aspergers Disorders:
The number of students diagnosed with autism in South Carolina’s public schools has more than doubled in the past five years, creating more challenges in programming and staffing for education officials.

The state Department of Education counted 2,685 students in 2007, up from 1,283 students in 2003, with autism as their leading disorder. Official data for 2008 was not completed by mid-December, when school districts are required to update their totals .....

[Craig Stoxen, President,S.C.Autism Society], added that the state’s totals still are far less than the number of actual students with autism, or autism-related conditions. Because the state only counts the primary disorder, and because autism is just one of several disorders classified as an “autism spectrum disorder,” the level of incidence among students is underestimated, Stoxen said.

While some argue that there is no autism epidemic Education officials in South Carolina do not enjoy the luxury of hiding behind such an assumption. They are busy trying to provide the necessary supports to enable South Carolina students with autism disorders with real educations. In South Carolina schools autism is rising. Autism reality can not be ignored.

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Autism Treatment Drugs May Be On Your Local Pharmacy Shelves Right Now

The drugs to provide effective autism treatment may be sitting on the shelves of your local pharmacy right now. Linda Restifo is a University of Arizona professor of neurobiology and neurology and a researcher with the Arizona Research Laboratories. She is interviewed by Evan Pellegrino of Scripps Howard News Service and the interview is reported on NewsChief.com about her research on fruit flies. That research which may not sit well with Alaska Governor Sarah Palin but is done because of the similarities between some segments of fruit fly brains and human brains. As reported on NewsChief.com, Professor Restifo is currently conducting tests which she hopes may disclose existing drugs which could help treat autism:

"Restifo takes single mutated brain neurons from a fruit fly and tries to figure out what's wrong with them and, more importantly, what can be done to correct it.

And Restifo thinks there may be a drug to improve brain function in people with autism that's already been discovered and is waiting in the pharmacy.

She tests drugs that already have been approved by the Food and Drug Administration for a purpose other than improving brain function to see whether they also may correct mutated or curly neurons.

"It's entirely possible drugs to treat autism are already out there," she said.

And it's much faster to conduct research with drugs that already have been approved because they've already been proved safe, she said.

I don't know if Restifo's research will, or will not, discover any existing drugs that might treat autism but I admire her focus on treatment for autism and her can do attitude. The USA has long been a leader in real research to benefit persons with autism and it looks like that trend will continue with efforts like Professor Restifo's.

Once again, God Bless America.

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Inane Autism Quote of the Year Award for 2008 Goes to Dr. Laurent Mottron, Who Else?

The main thing is that nobody knows what it is. We know that a society decided to call it autism. So, autism is a definition currently. It is a DSMIV. It groups certain numbers of people who have in common, who share, atypicalities at the social level, at the communication level, and in the variety of interests. So they may be in some ways quite different, but they all share these peculiarities. Autism is currently included in psychiatric diseases. This is a sociological fact. It doesn’t mean that it is psychiatric. It means that it is incorporated in psychiatric books which list all the variations of typical development, for example.

- Dr. Laurent Mottron, High Functioning Autism Expert, Interviewed on CBC's Positively Autistic

Dr. Mottron has made many comments that seem inane to me. As the parent of an almost 13 year old boy with Autistic Disorder and profound developmental delays I am not impressed by Dr. Mottron's grasp of the realities faced by autistic persons with more severe deficits than those presented by his colleague, and mentor, Michelle Dawson. His comment above, from the onesided CBC presentation Positively Autistic is one of the good Doctor's most absurd.

I have read nothing in his pubished reports that disclose any contact between the good Dr. Mottron and the more severly afflicted autistic people who do not understand the world well enough to be left unattended by family or carers, who injure themselves and people who love them. Nor have I seen any evidence that Dr. Mottron gives a damn about the severely autistic as he churns out government funded research papers on high functioning autism, Aspergers and autistic savants while opposing government funding of evidence based ABA treatment for autistic children.

I can not pretend to respect Dr. Mottron. I do not respect his legal (Auton, assisting Michelle Dawson), political (appearance before the Canadian Senate) and media (Quirks and Quarks on CBC radio, Positively Autistic on CBC television and countless newspaper interviews) campaign that helps disavow the existence of severely autistic persons like my son or those who in fact live their lives in institutional care. I do not respect his opposition to government funding of ABA the only evidence based intervention substantiated as effective by serious autism experts including those who actually work with the severely autistic.

The above quote is the most absurd autism comment that I came across in 2008 and has earned the good Doctor Mottron the Inane Autism Quote of the Year Award for 2008. In this beauty of a quote the good Doctor, a psychiatrist, disavows a disorder category specified in the diagnostic manual of the American Psychiatric Association, a disorder which he references in his dozens of studies and articles on high functioning autism, Aspergers Disorder and autistic savants.

As the parent of a youth with Autistic Disorder who I love dearly, I concern myself with ensuring that he does not wonder off across traffic as he once did, or hurt himself or family members. I try to ensure that he learns and develops to the fullest extent possible. As an engaged autism advocate I fight for real autism awareness and I fight to overcome the drivel that Dr. Mottron spews in misrepresenting the serious challenges faced by many persons with Autistic Disorder.

No doubt Dr. Mottron will publish several more papers on autism intelligence, high functioning autism and autistic savants in 2009. And no doubt he will appear for several more media interviews in which he praises Michelle Dawson for what she has taught him about autism. But what will he mean by use of the term autism? Will he be referring to autistic disorder as defined by the DSM or will he be referring to what he now describes as "atypicalities at the social level"? Or will the good Doctor really know himself what he means?

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