Pediatrician: What Parents Should Know About Autism

Recent news that a couple was compensated by the government for their daughter's autism-like symptoms after a series of routine vaccinations raises concern among parents about the developmental disorder. Pediatrician Dr. Marilyn Corder, talks about the couple's case, and what parents need to know.

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MICHEL MARTIN, host:

It's time for our weekly visit with the Mocha Moms. We go to them every week for their comments and savvy parenting advice. Today, we have an extended Mocha Moms. In a few minutes, we're going to get the Mocha take on the parenting of multiples. As you probably heard, more and more moms are having twins and even higher order multiples, so we want to get the special Mocha take on how to preserve your health and sanity. That's in just a few minutes.

But first, we want to talk about vaccines. For years, parents and advocates have insisted that there is a link between routine childhood vaccinations and the apparently rising incidents of autism. Federal officials insist that no such link has been proven. But the debate has been re-opened recently because the government agreed to compensate a Georgia family whose nine-year-old daughter developed autism-like symptoms after a series of shots although officials continue to deny that vaccines cause the disorder. Here to help us understand all of this Dr. Marilyn Corder. She's a pediatrician and associate professor of pediatrics and George Washington and Howard Universities. She's visited with us before to help us sort out these issues and she's here with us again. Dr. Corder, thanks so much for stopping in.

Dr. MARILYN CORDER (Pediatrician and Associate Professor, George Washington and Howard Universities): Thank you for having me.

MARTIN: First of all, what is autism?

Dr. CORDER: Autism is a diagnosis that is a delay, a significant and progressive delay in neurological functioning, cognitive functioning and social skills. So in one sentence, it is a youngster who appears to be in his own world and not able to socialize, not able to understand. Often, they're not communicating except very limited with head nods, banging, grunting...

MARTIN: And of course there are people who would have seen the movie "Rain Man" years ago that had kind of one person sort of take on how this disorder can be experienced. And of course, there's always a continuum with anything like this of functioning. But why is it that some parents and advocates believe that childhood vaccines are the cause of this?

Dr. CORDER: Well you know, we've been over this many times in my area of pediatrics. And one of the things that we do very early is vaccinate. Because of course we know if we don't we'd have many deaths, pandemics, and endemics of everything from ptosis to polio, etc. So it's life saving measures is the reason that we vaccinate. The reason that I feel strongly that parents are attributing vaccinations to autism is because during the time that we vaccinate is also during the time when that young person is achieving the milestones such as speech, such as walking, such as communication. And coincidentally, we're doing vaccinations. So it's like, ah ha, this is why this youngster is not doing that because he would have done it, but guess what? He got vaccinated.

MARTIN: You remain convinced along with federal officials that no scientific link has been proven.

Dr. CORDER: Absolutely. As a geneticist, I feel also that there are things underlying that we are still becoming aware of as medicine advances, and there are markers. In individual cases that we have found, turns out that those children most of the time will have had a marker of some type that we stem back and say, ah, that's the autism cause and etiology versus vaccines.

MARTIN: Well, the parents also acknowledge that in the case that we're talking about, nine-year-old Hannah Poling, that she had an underlying disorder. As I understand it, it was a mitochondrial disorder.

Dr. CORDER: Yes.

MARTIN: OK. But the government agreed to compensate them from a special fund set up to compensate people who had been injured by vaccines for a reason. So is it possible that vaccines did worsen her condition?

Dr. CORDER: First of all, what I would say and my take on this would be that the condition was there. Mitochondrial disorder is not what vaccinations give you. That was already underlying. The presentation of mitochondrial disorder is usual around 18 months to two years old simply because, as I stated before, that's when the communication skills. But it's something that's progressive, and it reverses. What happens, you have a child who can do things, motor skills and visual and eye contact, and then they reverse back because of the deterioration that's going on in the brain matter.

So I see where the child had a high fever. And anyone knows, once you have a high fever, you can even have seizure, no matter what causes the high fever. She's had recent and recurring ear infections. And the other factor in the formula is she had catch-up vaccinations. Now if I were to say, personally as a pediatrician, I'd space out the vaccines even more. I would have said, let's do three and then come back and do two more two weeks later. But it's still permitted to go ahead and do the catch-up, and the CDC still says it's safe. But that fever that she was screaming about, you know screaming with high fevers in irritability 48 hours later. I think that if anything, the fever itself may have caused a little more acceleration, but not have caused the mitochondrial disorder, which was there already.

MARTIN: And also, just to clarify a certain point, that thermasol, which is a mercury-based vaccine preservative, has already been removed from vaccinations given to children. Is it present in any other vaccinations?

Dr. CORDER: As a matter of fact, it has been eliminated and these preservatives that used to be there have been removed, and to the point of they've been fully studied. So we don't see that. But as I said, and this interesting, we're seeing an increase in autism over the past decade. And there's genetic underlying conditions. And I just think that that's something, if we worked, as we make a lot of noise about autism, we need to talk about the studies that are now being done where they're beginning to identify markers, and go back and study the parents and how they learn and some of the environment. Some of the things in the environment that can also aggravate from the time the woman conceived all the way to baby's birth. And then from there how that child is progressing.

MARTIN: I know for you this is a settled issue, and what I'm hearing is that for most of your colleagues it's a settled issue. But, you know, most of us - you know every parent as a new parent at some point, and you see stories like this and you're concerned, what should you do?

Dr. CORDER: As a pediatrician my advice would be, talk to the parents. The parents need to be very clear and speak to their pediatrician. You want to know, it's very important, how the child is progressing prior to that immunization. That's so key. There's something called a Denver Developmental, that you're going to ask questions. And no matter what the parents say, you want to document as you're asking and seeing that child roll over, seeing that child walk, seeing that child transfer an object form left hand to right hand. Some of things that would tell you, no matter how old the child is chronologically, to tell you what's going on in the brain.

MARTIN: It is a terrible feeling though, it would have to be, to be a parent to feel that you're doing everything that you're supposed to do and everything the law requires, and you're still having a negative outcome. It must be an awful feeling.

Dr. CORDER: Well you know, one thing about fever, you need to respect fever. You know, years ago before we had all these vaccines, that fever, that temperature rise over a course of hours can insult a child's brain. There's even something called febrile seizures, which is basically a fever due to a seizure. Well, once you have a fever, sometimes that will begin to bring about whatever things are there, be it ongoing seizures. The stage was already set in the brain, mitochondrial disorders, and host of other disorders that, wow, came about after that fever incident. So that's something very important to parents to know. Have you thermometer. Know how to take a temperature. But don't hesitate to take care of the fever.

MARTIN: Respect the fever.

Dr. CORDER: Absolutely.

MARTIN: That's the take away for today. Dr. Marilyn Corder is a pediatrician in Maryland. She's also an associate professor of pediatrics at George Washington and Howard Universities. She was kind enough to join us here in our studio in Washington. Dr. Corder, thank you so much.

Dr. CORDER: Thank you.

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Case Stokes Debate About Autism, Vaccines

The case of 9-year-old Hannah Poling may now affect the fate of a program that was created to compensate families whose children suffer rare injuries that are definitively linked to vaccines.

As part of a ruling that is supposed to be confidential, lawyers for the Department of Health and Human Services agreed to pay an as-yet undetermined amount from the federal vaccine injury compensation program to the Poling family.

Hannah had been developing normally until she received a series of shots when she was a year-and-a-half old. After that she began to regress and developed autistic-like symptoms.

At a news conference on the steps of the federal courthouse in Atlanta on Thursday, John Gilmore of the group Autism United said the case validates his position that vaccines can be dangerous for children.

"For the first time the court has conceded in a case that vaccines can indeed cause autism," Gilmore said.

But federal officials say that's not what they've done. Further testing determined Hannah had an underlying disorder in her cells — a mitochondrial disease. That can cause symptoms similar to autism. And in its ruling, the government said it was possible that the vaccines Hannah received may have exacerbated that disorder.

Charles Mohan, CEO of the United Mitochondrial Disease Foundation, says he finds the government's concession in the case reasonable.

"It could have been the vaccine that exacerbated that particular underlying mitochondrial disease," Mohan said, "or in a lot of cases it's the onset of a virus, an infection, a flu, that might have the same impact."

But at the same time, says Mohan, there is no scientific evidence to suggest that vaccines themselves can cause either mitochondrial disorders or autism.

That point was stressed by federal public health officials Thursday.

Julie Gerberding, who heads the Centers for Disease Control and Prevention, said, "The government has made absolutely no statement indicating that vaccines are a cause of autism."

"That is a complete mischaracterization of the findings of the case and a complete mischaracterization of any of the science that we have at our disposal today."

But that remains a hard sell to parents of autistic children, such as Becky Estepp of Poway, Calif. She says the reaction her son Eric had to a hepatitis B vaccine in 1998 was immediate and severe. And the symptoms went far beyond a myriad of physical problems, she said.

"At the same time, his speech wasn't developing as much any longer," Estepp said, "and he kind withdrew from our world and turned into himself."

Symptoms like those led Estepp and other autism activists to search for a vaccine-autism link. Many think that link may be the preservative thimerosal, a mercury derivative no longer used in most vaccines.

Now Estepp represents one of nearly 5,000 families of children with autism who have filed for damages from the federal Vaccine Injury Compensation Program.

That's nearly twice as many families as the program has compensated since its inception two decades ago. And most of those awards were for well-documented side effects that occur in a small number of cases, things like getting polio from the oral polio vaccine.

Paying claims to all those children with autism would quickly bankrupt the program, which is funded by a 75-cents-per-dose excise tax levied on all childhood vaccines.

"There's no question this is the biggest challenge to the vaccine compensation system it's ever seen," said Rep. Henry Waxman (D-CA), who wrote the law that created the vaccine compensation system in 1988.

Waxman says the program is threatened, no matter what happens. If the families of autistic children win compensation, there won't be enough money to pay all their bills. But if compensation is denied those families, Waxman says, they will probably go to court instead.

And that, Waxman says, could scare off manufacturers from staying in the vaccine business.

Vaccine manufacturers won't say they have considered that. But they voice another worry: that if the vaccine program awards money to families for autism, other parents might be afraid to vaccinate their children.

Thomas Netzer of the drug and vaccine maker Merck said that, in turn, could hurt efforts to control dangerous diseases.

"In fact, there'd be a real risk, I believe, that diseases that have been controlled in the United States, which used to cause very high morbidity and mortality — and thousands of deaths every year — could once again become common in the United States," Netzer said.

"That would not be a good outcome."

With the government's concession in the Poling case, a formal hearing won't be held in Georgia. But nine other test cases are being heard by the vaccine injury compensation program — testing various theories that either vaccines alone, thimerosal alone, or a combination of the two, could cause autism.

It could be a year before all those cases are decided.