Magazine article Psychotherapy Networker

Clinician's Digest

Magazine article Psychotherapy Networker

Clinician's Digest

Article excerpt

Clinician's Digest By Garry Cooper

Autism and Vaccines

In mid-February, the growing number of parents of autistic children who insist the condition is triggered by thimerosal, a mercury-laced preservative in vaccines, were dealt a setback when a federal court ruled firmly that, "The evidence . . . has fallen far short of demonstrating such a link [between vaccines and autism]." Rather than settling things, the ruling further enflamed the controversy over whether childhood autism is actually increasing, and if it is, why?

About 1 in 150 American children are now thought to have autism or related conditions such as Asperger's disorder, Rett's disorder, or childhood disintegrative disorder. For the last decade, however, some researchers have contended that there's been no increase in incidence, but rather an increase in diagnosed cases resulting from an expansion of identified disorders on the autistic spectrum, a broadened definition of the symptoms, and better surveillance (see Clinician's Digest, January/ February 2006).

Despite the court's ruling, many parents point out that the time frame of the increased use of thimerosal-infused vaccines roughly paralleled the rise in autism diagnoses. If there's no danger in thimerosal, they ask, why did the government urge manufacturers to discontinue its use in 1999? Today, although the use of thimerosal has been eliminated from some vaccines, it's still prevalent in most flu shots, and both the Centers for Disease Control and the American Association of Pediatricians have greatly expanded annual flu shot recommendations. "One flu shot alone can expose a child to a dangerous amount of mercury," says Northwestern University psychologist Alexandra Solomon, whose interest in autism was triggered when her son Brian was diagnosed with Asperger's.

Those who insist there's an increase in autism believe that the recent discovery of genetic susceptibilities supports their case. They wonder whether even trace amounts of thimerosal, other vaccine ingredients, and environmental toxins like the mercury present in fish and coal plant emissions could trigger the disorder for a subset of children. None of the large-scale studies that found no thimerosal-autism link examined the preservative's possible effects on children who might have had a genetic susceptibility.

All this is relatively moot if there's been no increase in the actual incidence of autism. But now a report, led by an epidemiologist from the Department of Public Health Sciences at the University of California, Davis, suggests the increase may be real. Writing in the January journal Epidemiology, Irva Hertz-Picciotto reports that changing diagnostic criteria and surveillance patterns account for only about one-third of the 600 percent increase in California cases.

So, with only the conflicting claims about the dangers of thimerosal and other vaccine ingredients to guide them, should parents vaccinate their children? Some doctors have begun to inquire into the family history of autism or other autoimmune diseases before advising about whether to vaccinate, but in most instances, the correct decision remains far from clear. But it seems more and more likely that there's an actual increase. "Continuing to argue about whether there really are more kids with autism only diverts attention from the more important issue of determining what's causing the increase," says Solomon.

Self-Injuring Adolescents on the Rise

Years ago, adolescents who deliberately injured themselves were usually considered to be in danger of suicide or in the throes of serious pathology. But today, an estimated 14 to 17 percent of adolescents deliberately cut, bite, pinch, burn, or abrade themselves, and while such behavior is always a cause for concern, it's no longer necessarily a cause for alarm. Even the behavior's designation has changed, from self-mutilation to the less frightening non-suicidal self-injury (NSSI). …

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