...which is apparently "ruining the English language."

Not half so much as the bloody spelling. I don't know why we put up with, I really don't.

What we need is a visionary leader.

We need tough legislation. And a mascot. How about the Langwage Bare...he goes from school to school teaching the children to not learn spelling.

Wouldn't that be the langwij ber?

Yabbut, that looks too much like Lager Beer...and you know how those kids are. ;)

I have the book and am now digesting it. er so to speak.

:lol:

I have now reached the point in the book where this is done for the MMR studies. It gives valid reasons why Taylor 1999 is flawed, and Madsen 2002. Then it goes (footnotes are in parens):

I like the book because it is footnoted beautifully. So far it makes a persuasive case on many things. I am particularly convinced of Clod's earlier point that there is a genetic basis that is aggravated by some other condition. "Oh yeah now I get it"

I was originally skeptical that the book addressed the majority of the studies, but in fact all but one of the MMR studies I mentioned are footnotes 12-26.

However, this is far from a "systematic debunking". And (35) is not a peer-reviewed article, and references PDD, not autism. And two of the footnotes (31 and 32) are actually the same reference. So, we have 15 footnotes referencing studies which find no MMR-autism link, and 7 footnotes that criticize the studies. So I would say he has listed strong criticisms of 2 studies, and given one unpersuasive sentence vaguely dismissing the other 15.

(I would not use the term "debunking" at all in the context of scientific investigation. It's a highly biased and imprecise word.)

So we don't know yet - to really know, what I'd need is the text of the cites. Was there someone willing to retrieve studies for us?

I believe that was Mercenary.

How many could you do Merc? We have here roughly 15-20 cites... I'm particularly interested in BMJ 2001 Jul;323(7305):163-4 and N Engl J Med. 2003 Mar 6;348(10):951-4

Isn't Merc on vacation at the moment?

I think Pie has access to some medical studies, but I don't know if it's all of them.

This is really the crux of everything. If it has a cause--and it obviously does--the CDC has an obligation to be looking for it. They are steadfastly not looking for it, at the moment. Some might surmise this is because they know what they will find.

I was discussing this with my mom the other day, and her take on it was, "Why won't they just admit there were mistakes made and move on? Hiding something only makes it worse in the long run." What I had to explain to her is the very real financial side of it--not from the pharmaceutical companies' perspective, from the government's. Current law says that anyone damaged by a vaccine is entitled to compensation. This fund was set up from the very beginning, because they always knew there would be a very small number of people who would have complications from these shots they were mandating--anything from triggering recognized genetic conditions (as opposed to triggering autism, which is not recognized in this fashion yet) to a staph infection at the injection site spreading and causing significant damage.

The minute they acknowledge that vaccines can exacerbate autism, nevermind trigger it, they are opening themselves to quite literally billions of dollars in litigation.

Here is what is going to happen: the outcry will slowly but surely grow until, just like with thimerosal, another few Congressmen have themselves autistic grandchildren. And then Congress will pass a law requiring the CDC to moderate the vaccination schedule, regardless of what the CDC says its studies have found. The CDC will shrug and comply, insisting all the way that there is no link. Autism rates will go down, research will be able to grow without the political baggage because the decision's already been made, and in another 30 years they will be comfortable saying perhaps there was a link after all. By that point we will know so much more about treatment and recovery, and the current autistic population will have aged so much that they will not be on the hook for nearly as much money anymore.

Meanwhile the news over here is that they are considering making MMR vaccine a requirement for registering with a school.

Really really a requirement, or just a "requirement" like it is over here, where every school official will tell you it is definitely a legal requirement, except that's a total lie and you can file an exemption form and no one can do anything about it?

Still at the discussion stage, but they're looking at making it a legal requirement for kids to be vaccinated before starting school, and for schools to have to check before admitting a child.

http://news.bbc.co.uk/1/hi/wales/8080681.stm

Just got back from a 7's tourny. I will hook you up in the am from work.

Cheers

Awesome!

Is this as much as a rarity as it seems? A well-informed internet discussion...

Pie sent them along, I just have to delve into them yet. I will have other requests...

No problem. It might be better if you send your requests to me via PM. Considering how much this thread deteriorated and became the focus of much conflict I have avoided reading it since attempting a neutral position.

It's cool, Merc. It got better after Tiki left.

Why don't you say what you really feel, huh?

:D

I fully agree with you

N Engl J Med. 2003 Mar 6;348(10):951-4

Fever in the Neonate and Young Child

Is this the one you wanted? Many of these are too long to post here due to the 1000 charater limit.

Autism
James Robert Brasic, MD, MPH, Research Associate, Division of Nuclear Medicine, Russell H Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine


Updated: Sep 10, 2008

Introduction
Background
Autism is a condition that manifests in early childhood and is characterized by qualitative abnormalities in social interactions, marked aberrant communication skills, and restricted repetitive and stereotyped behaviors.

Most individuals with autism also manifest mental retardation, typically moderate mental retardation with intelligence quotients (IQs) of 35-50 (approximate numbers). Although often difficult to evaluate with intelligence tests, three fourths of children with autism function in the mentally retarded range. Generally, the lower the IQ, the greater the likelihood of autism. However, the low functioning level hinders assessment for key characteristics of autism in individuals with profound mental retardation and IQs below approximately 20. Thus, diagnostic instruments for autism may give spurious results in children with profound mental retardation.

The diagnosis of autism in a child with profound mental retardation requires an experienced clinician. This article addresses the problems of individuals with mental retardation. For information concerning individuals with autism spectrum disorders and related conditions without mental retardation, please see Pervasive Developmental Disorder: Asperger Syndrome.

Seizure disorders are common in individuals with autism. Movement abnormalities are a prominent feature in a subset of individuals. Motion anomalies have been reported at birth in some individuals. Motion analysis may provide evidence of autism in early infancy before other manifestations occur. Although autistic disorder was initially reported in children of high social class, subsequent research has established that autistic disorder equally afflicts all social classes.

The motion anomalies demonstrated by children with autism are often highly characteristic. Children with autism who exhibit motion anomalies often stand out as odd in crowds because of the motions. An example of a motion typical in autism occurs when the child places a hand with fingers separately outstretched before the eyes and rapidly moves the hand back and forth. This action is described as self-stimulation because it produces a visual sensation of movement. Many of the motions of children with autism appear to be attempts to provide sensory input to themselves in a barren environment. Through special education, children may learn not to perform movements. The movements may then be exhibited at times of particular stress or excitement.

Although the etiology is unknown, hypotheses include genetic abnormalities; obstetric complications; exposure to toxic agents; and prenatal, perinatal, and postnatal infections. Maternal rubella is associated with significantly higher rates of autism and other conditions in children. Additionally, tuberous sclerosis is associated with autism as a comorbid disorder. On the other hand, anecdotal reports that autism may be linked with vaccinations for measles, mumps, and rubella have not been confirmed. Approximately 10% of children with a pervasive developmental disorder exhibit a known medical condition.

Effective treatment of associated behavioral problems includes intensive behavioral, educational, and psychological components. Interventions initiated at the time of diagnosis increase the likelihood of a favorable outcome. Regular screening of infants and toddlers for symptoms and signs of autistic disorder is crucial because it allows for early referral of patients for further evaluation and treatment.

Although psychoanalytic approaches to treatment of children with autism were common in the mid-20th century, these approaches were not found to be effective and are no longer used. The initial clinical descriptions of autism suggested that cold, rejecting parents ("refrigerator mothers") caused autism in offspring; however, careful study of children with autism and their parents has disproved this hypothesis. Autism is not caused by a lack of warmth and affection in parents. Autism is not due to any emotional or psychological deficits in the parents. Blaming parents for the development of autism in their children is inappropriate.

A major problem in the public health of children with autism and other pervasive developmental disorders is the inconsistent diagnosis of autism. Criteria for the diagnosis of autism are included in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR[TM]) and the International Classification of Diseases, Ninth Revision, Clinical Modification, Fourth Edition.1,2 Although the criteria for autism and other pervasive developmental disorders differ between the DSM-IV-TR(TM) and the ICD-9-CM, they are both widely accepted and are used around the world by clinicians and researchers.

A discussion of the differences in the criteria for autism and related conditions in the DSM-IV-TR(TM) and the ICD-9-CM and other nomenclatures is beyond the scope of this article. The key point for pediatricians and other clinicians is that the criteria for autism and related conditions in the DSM-IV-TR(TM) and the ICD-9-CM are presented in an outline form without a discussion of the terms used.

The DSM-IV-TR(TM) and the ICD-9-CM are poor textbooks of child development and child psychopathology; they do not fully describe the concepts incorporated in the criteria for autism and related conditions. Therefore, an inexperienced clinician is likely to incorrectly apply the criteria for autism and related conditions in the DSM-IV-TR(TM) and the ICD-9-CM.

Several instruments have been developed to diagnose autism and other pervasive developmental disorders. To administer tools for the diagnosis of autism and related conditions in a reliable and valid manner, extensive training and experience is needed. Therefore, unless they have vast experience with children with autism and understand the concepts implicit in the diagnostic criteria and rating scales, pediatricians and other clinicians are advised to refer patients with possible autism to experienced clinicians for definitive diagnostic evaluations. One goal of this article is to convey fundamental concepts related to autism and related conditions. Readers of this article must obtain considerable additional training before they can reliably and validly apply diagnostic criteria and rating tools.

Pharmacotherapy is ineffective in treating the core deficits of autism but may be effective in treating associated behavioral problems and comorbid disorders. The possible benefits from pharmacotherapy must be balanced against the likely adverse effects on a case-by-case basis.


Pathophysiology
Neuroanatomic and neuroimaging studies reveal abnormalities of cellular configurations in several regions of the brain, including the frontal and temporal lobes and the cerebellum. Enlargements of the amygdala and the hippocampus are common in childhood. Findings vary in each person. Hughes (2007) has observed the presence of underconnectivity in the brains of children with autism and related conditions.3 This finding provides a basis for further investigation of autism and other pervasive developmental disorders.

Abnormalities in affiliative behaviors of other species, which are associated with dysfunction of serotonin and the neuropeptides, oxytocin, and vasopressin, suggest that there may be a neurophysiological dysfunction involving one or more of these substances in autism in humans.

Elevations of whole blood serotonin occur in one third of patients. Increased levels are also reported in the parents and siblings of patients. Individuals with autistic disorder and their mothers show elevated levels of C-terminally directed beta-endorphin protein immunoreactivity. The basis and importance of these findings is unknown. Test findings suggest that low-functioning children with autism may have impairment in the metabolism of phenolic amines. Therefore, symptoms of autistic disorder are possibly aggravated by the consumption of dairy products, chocolates, corn, sugar, apples, and bananas; however, no large population studies have confirmed this.

Many individuals with autism and related conditions experienced untoward events in the prenatal and neonatal periods and during delivery. The possible role of obstetric complications in the pathogenesis of autism and related conditions is unclear. Brasic and Holland (2006, 2007) and Brasic and colleagues (2003) have reviewed the literature on autism and obstetric complications.4,5,6 In particular Roberts and colleagues (2007) and Samson (2007) have reported an association between exposure to dicofol and endosulfan, organochlorine pesticides, in the first trimester of pregnancy in the Central Valley of California and the subsequent development of autism spectrum disorders in the child.7,8 Potential mothers can wisely be advised to avoid exposure to organochlorine pesticides.

Some children developed autism after immunizations, including inoculations for measles, mumps, and rubella. However, several population studies have demonstrated no association between childhood immunization and the development of autism and related conditions.9 Thompson and colleagues (2007) detected no causal association between exposure to vaccines that contain thimerosal and neuropsychological deficits at age 7-10 years.10 Parents can administer the recommended childhood immunizations without fear of causing autism and related conditions.11

Many other hypotheses, such as the consumption of folic acid in pregnancy, have been proposed as possible causes of autism. None has been established as a definite etiology of autism.

Frequency
United States
Autistic disorder and related conditions affect up to 10-20 individuals per 10,000 population. Estimates of the prevalence of autism suggest that as many as 400,000 individuals in the United States have autism and related conditions. Autism spectrum disorder is one of the most common childhood developmental disabilities. Current epidemiological studies are needed to identify the incidence, prevalence, and distribution of autistic disorder in the United States.

Epidemiological studies of relatively uncommon conditions such as autism spectrum disorders are expensive. A suitable strategy is the performance of multiple screenings on a population, each time identifying more likely subjects for detailed investigation. For example, a checklist such as the Autism Screening Checklist can be distributed to all parents and guardians of a target population. The Autism Screening Checklist identifies those children with characteristics of autism spectrum disorders. It differentiates children with autism spectrum disorders from children with schizophrenia and other psychoses. The higher the score on the Autism Screening Checklist (see Media file 1 for a printable version), the more likely the presence of autism spectrum disorders.


International
Autistic disorder and related conditions affect up to 10-15 people per 10,000 population. Studies in Japan report much higher rates.12 Japanese investigators suggest that these findings reflect the careful evaluations performed by Japanese clinicians. Some studies suggest that infectious diseases that are prevalent in parts of Japan may account for higher rates of autistic disorder. Epidemiologic studies are needed to assess the current incidence, prevalence, and distribution of autistic disorder throughout the world. These studies may help focus on causality.

Mortality/Morbidity
The long-term outcome for individuals with autistic disorder is directly proportional to the IQ of individuals. In other words, individuals with autistic disorder and intellectual limitations have poorer outcomes. Individuals with autistic disorder and profound mental retardation may require constant care in a residential treatment facility.

Race
Japanese studies often indicate the more common occurrence of autism in Japan than in other countries.12 The high rates of autism reported in many Japanese studies may reflect higher incidence and prevalence in Japan. Alternatively, because Japanese clinicians are highly skilled to diagnose autism, they may identify cases that are overlooked in other countries. Some studies suggest that some cases of autism in Japan result from GI infections and other infections due to the ingestion of seafood and other aquatic sources of food characteristic of Japan.

Sex
The male-to-female ratio is 3-4:1.
Autistic disorder is most common in boys who have the 46,XY karyotype (ie, the karyotype of healthy normal boys). In some studies, fragile X is reported in approximately one tenth of males with autistic disorder.13,14,15,16,17,18
Age
Autistic disorder manifests in early childhood. Using contemporary criteria, the absence of abnormalities in the first 30 months of life rules out autistic disorder. For information about individuals with later onset of symptoms consistent with autistic disorder, see Pervasive Developmental Disorder: Childhood Disintegration Disorder, Pervasive Developmental Disorder: Rett Syndrome, Pervasive Developmental Disorder: Asperger Syndrome, and Pervasive Developmental Disorder (not otherwise specified).
Many parents report normal development in their child until age 2 years before noticing the deficits in social and communicative skills.
Individuals with autism spectrum disorder and unspecified pervasive developmental disorder typically benefit from behaviorally oriented therapeutic programs developed specifically for people with autistic disorder. Therefore, children who manifest symptoms of autistic disorder, other pervasive developmental disorders, and other autism spectrum disorders are likely to benefit from the highly specialized intensive intervention programs designed for children with these disorders.
Because optimal results occur when intensive interventions are administered early in childhood, autistic children should be placed in specialized programs as soon as the diagnosis is entertained. Delays in placement of a young child in a specialized program for children with autistic disorder may reduce the effectiveness of those interventions. Parents, pediatricians, other health care providers, and educators are advised to seek the assistance of people who are familiar with early intervention programs for children with autistic disorder. The Autism Society of America can help parents obtain appropriate referrals for optimal interventions.
Clinical
History
Environmental exposures: Roberts and colleagues (2007) and Samson (2007) have reported that women in the Central Valley of California who were exposed to endosulfan and dicofol, organochlorine pesticides, during the first trimester of pregnancy were more likely to have children with autism spectrum disorders.7,8 Thus, obstetricians and other health workers can wisely advise women who are likely to become pregnant to avoid contact with pesticides and other environmental contaminants.
Protodeclarative pointing
Protodeclarative pointing is the use of the index finger to indicate an item of interest to another person. Toddlers typically learn to use protodeclarative pointing to communicate their concern for an object to others.
The absence of protodeclarative pointing is predictive of the later diagnosis of autism. The presence of protodeclarative pointing can be assessed by interview of the parent or caregiver. As a screening question, Baron-Cohen and colleagues (1992, 1996) have demonstrated that the absence of a positive response to an inquiry about protodeclarative pointing is predictive of the later diagnosis of autism.19,20 Screening questions include "Does your child ever use his or her index finger to point, to indicate interest in something?" The absence of a positive response to this question suggests the need for a specialized assessment for possible pervasive developmental disorder.
Environmental stimuli
Parents report unusual responses to environmental stimuli, including excessive reaction or an unexpected lack of reaction to sensory input.
Sounds, such as vacuum cleaners or motorcycles, may elicit incessant screaming from a child with autistic disorder. Playing a radio, phonograph, or television at a loud level may appear to produce auditory stimulation of a painful magnitude. Sometimes parents must rearrange the family routine so that the child is absent during noisy housekeeping activities.
Children with autistic disorder may also display exaggerated responses or rage to everyday sensory stimuli, such as bright lights or touching.

Social interactions
Separation from parents may elicit a lack of appropriate eye contact and other symptoms that are typically seen in individuals with autism. Media files 5-6 illustrate the apparent indifference of a boy with autistic disorder to the departure and return of his father and his brother.
An absence of typical responses to pain and physical injury may also be noted. Rather than crying and running to a parent when cut or bruised, the child may display no change in behavior. Sometimes, parents do not realize that a child with autistic disorder is hurt until they observe the lesion. Parents frequently report that they need to ask the child if something is wrong when a change in the child's mood occurs. When injured, a child may not run to the parent to seek help. The parent may need to examine the surface of the child's body to detect the injury.
Difficulties in social interactions are common. Children may have problems making friends and understanding the social intentions of other children. Instead, they may show attachments to objects not normally predicted to be child oriented. Although children with autistic disorder may want to have friendships with other children, their actions may actually drive away other children.
Communication: Speech abnormalities are common. They take the form of language delays and deviations. Pronominal reversals are common, including saying "you" instead of "I."
Play
Baron-Cohen and colleagues (1992, 1996) have demonstrated that the absence of symbolic play in infants and toddlers is highly predictive of the later diagnosis of autism.19,20 Therefore, screening for the presence of symbolic play is a key component of the routine assessment of well babies. The absence of normal pretend play indicates the need for referral of specialized developmental assessment for autism and other developmental disabilities.
Odd play may take the form of interest in parts of objects instead of functional uses of the whole object. For example, a child with autistic disorder may enjoy repeatedly spinning a wheel of a car instead of moving the entire car on the ground in a functional manner. The nonfunctional play of a boy with autism is illustrated in Media files 4-6.
Children with autistic disorder may enjoy repeatedly lining up or dropping objects from a particular height.
Children may be fascinated with items that are not typical toys, such as pieces of string. Media file 5 illustrates the fascination of a boy with autism with a string of yarn. They may enjoy hoarding rubber bands, paper clips, and pieces of paper. They may spend hours watching traffic lights, fans, and running water.
Some parents report that they must lock the bathroom door to prevent a child from flushing the toilet all day long.
Response to febrile illnesses
Children with autistic disorder may show a decrease in their odd behaviors during a febrile illness. Parents may report that when their autistic child has a fever, the child's behavior appears to be improved. Parents may say, "When he is suddenly an angel, I know that he has an ear infection." Some behavioral abnormalities that plague the parents when their autistic child is well, such as self-injurious behaviors, aggression toward others, property destruction, temper tantrums, and hyperactivity, may diminish and resolve temporarily during a febrile illness. Children who typically display uncontrollable behavior at school and at home may seem more manageable and obedient.
This inhibition of negative behaviors may occur with various febrile illnesses, including ear infections, upper respiratory tract infections, and childhood illnesses. The recovery of the child from the febrile illness may be accompanied by an abrupt return of the child's usual problem behaviors

Physical
Screening well babies for signs predictive of autistic disorder is important. Baron-Cohen and colleagues (1992, 1996) observed that abnormalities in gaze monitoring, protodeclarative pointing, and pretend play noted in toddlers during well child visits in the United Kingdom was useful in predicting the later diagnosis of autistic disorder.19,20 Baron-Cohen and colleagues (1992, 1996) developed the Checklist for Autism in Toddlers (CHAT) to screen newborns and toddlers to rule out autism.19,20

CHAT screening
Although the CHAT has been reported to identify infants and toddlers in Britain who develop autism, the reliability and the validity of the CHAT have not been confirmed by other investigators with other populations. In particular, an item on the CHAT about pretending to pour tea from a toy teapot into a toy teacup is not likely to be meaningful to minority North American children because the cultural connotations may not be relevant to children outside the United Kingdom. However, a tea party with toy teacups and a toy teapot involves symbolic play. Because children with autism spectrum disorders may be unable to engage in symbolic play as other children, an item to assess the ability to participate in a tea party is useful in cultures in which a tea party is widely understood. The possible cultural biases of the CHAT limit its usefulness outside the United Kingdom. For this reason, direct application of the full CHAT is not recommended. Additionally, the specificity and sensitivity of the CHAT remain to beascertained in various cultures.
The items of the CHAT that are highly correlated with the diagnosis of autistic disorder are recommended. This discussion is limited to those items. Instead of asking the child to pretend to pour tea from a toy teapot into a toy teacup, the child is asked to pretend to drive a miniature car. Driving a car is important to minority North American children, whereas pouring tea is not. Although pretending to drive a car is not tantamount to pretending to pour tea, it is a good screen for minority North American children. The failure of a minority North American child to pretend to drive a miniature car constitutes a definite deficit in pretend play. Other make-believe play may be substituted based on cultural relevance. A child who does not respond appropriately to a pretend activity compared to most other children of the same culture merits referral for a specialized assessment to rule out autism and other developmental disabilities.
The assessment of normal gaze monitoring, suggested by Baron-Cohen and colleagues (1992, 1996), is composed of the following steps: The clinician calls the child's name, points to a toy on the other side of the room, and says, "Oh look! There's a [name a toy]!"19,20 If the child looks across the room to look at the item indicated by the clinician, then a joint attention is established, indicating normal gaze monitoring. The absence of a normal response merits referral for specialized assessment to rule out autism and other developmental disabilities.
Baron-Cohen and colleagues (1992, 1996) have established a protocol to assess for the presence of protodeclarative pointing in the evaluation of well babies as follows: "Say to the child, 'Where's the light?' or 'Show me the light.' Does the child point with his or her index finger at the light?"19,20 If the child does not respond appropriately to the light, the procedure may be repeated with a teddy bear or any other unreachable object. The child must look up at the clinician's face at the time of pointing to establish a normal response for this item. Absence of the expected response merits specialized clinical evaluation to rule out autism and other developmental disorders.
Unlike many other children with mental retardation, children with autistic disorder are typically physically normal in appearance, without dysmorphic features. Thus, among children with developmental disorders, children with autistic disorder and other pervasive developmental disorders may be remarkable for their pulchritude. For this reason children with autistic disorder and other pervasive developmental disorders may be vulnerable to sexual and physical abuse. Since children with autistic disorder and other pervasive developmental disorders may be unable to report abuse to authorities, parents and guardians must examine their children for evidence of abuse especially when behavioral changes are present.
Body movement
Some children with autistic disorder display choreoathetotic movements that resemble the movements seen in Sydenham chorea and other movement disorders. Stereotypies (patterned repetitive movements, postures, and utterances) constitute a common finding in many individuals with autistic disorder.
Common abnormal motor movements that occur in children with autism include hand flapping, a motion in which the upper extremity is rapidly raised and lowered using a flaccid wrist so that the hands flap like flags in the wind.
Hand flapping typically occurs when the child is happy or excited. Hand flapping may occur in combination with movement of the entire body, such as bouncing (ie, jumping up and down) and rotating (ie, constantly spinning around a vertical axis in the midline of the body).
Children with autistic disorder also often display motor tics and are unable to remain still. Because children with autistic disorder are often mentally retarded and nonverbal, expressing subjective experiences associated with the movement is often impossible for them. Because the verbalization of the subjective desire to be in motion is necessary for the diagnosis of akathisia, akathisia cannot be diagnosed in individuals without the ability to express those subjective experiences in words. The high activity level and apparent lack of ability to remain still, resembling akathisia, has been termed pseudoakathisia when the individual cannot verbally express a sensation of inner restlessness and an urge to move.
Head features
The head circumference is increased in a subgroup of children with autistic disorder without known comorbid conditions. Increased head circumference is more common in boys and is associated with poor adaptive behavior. The increase in head circumference becomes pronounced in the first few years of life. The head circumference may then return to normal in adolescence.
Aberrant palmar creases and other dermatoglyphic anomalies are more common in children with autistic disorder.
Rating procedures
Patients with autistic disorder merit a careful assessment of movements (see Body movement).
The caregiver and clinicians may be asked to look for any motions in the mouth, face, hands, or feet of the patient and, if so, may be asked to describe them and how they bother the patient. The patient may be asked to sit on the chair with legs slightly apart, feet flat on the floor, and hands hanging supported between the legs or hanging over the knees. The patient may be asked to open his or her mouth and then twice to stick out the tongue. If the subject does not perform the requested action, the examiner then repeatedly performs the actions in the direct view of the subject to demonstrate the desired actions. For additional information about the rating of movement disorders, please see Tardive Dyskinesia.
The patient may be asked to sit, stand, and lie on a sheet on the floor for 2 minutes in each position. The patient is asked to remain motionless in each posture. In each position, the patient is asked, "Do you have a sensation of inner restlessness?" and "Do you have the urge to move?" These questions require an appropriate developmental level for a useful response. Therefore, most children with autism cannot respond appropriately. In the absence of a clear verbal response, the subjective items are not rated. Nevertheless, the objective behavior of the child can be observed and rated. For additional information about the rating of movement disorders, please see Tardive Dyskinesia.
Because the verbalization of inner restlessness and an urge to move are required for the diagnosis of akathisia, the observation of the movements typical of akathisia in an individual who does not verbalize the subjective experience of akathisia merits the diagnosis of pseudoakathisia or probable objective akathisia. For additional information about the rating of movement disorders, please see Tardive Dyskinesia.

Assessing stereotypies
Movements observed in individuals with autistic disorder are frequently classified as stereotypies (eg, purposeless, repetitive, patterned motions, postures, and sounds). Stereotypies are divided into the following 3 topological classes:
Oro-facial (eg, tongue, mouth, and facial movements; smelling; sniffing; and other sounds)
Extremity (eg, hand, finger, toe, leg)
Head and trunk (eg, rolling, tilting, or banging of the head; rocking the body)
Stereotypies occur in nonautistic infants and children with mental retardation. Regularly assessing stereotypies is a valuable practice because stereotypies may bother other people and interfere with performance at school, work, and home. Routine assessment of stereotypies before, during, and after treatment is valuable in determining the effects of interventions.
Stereotypies are assessed for clinical purposes through regular use of the Timed Stereotypies Rating Scale. For this procedure, the occurrence of stereotypies is noted during 30-second intervals over a 10-minute duration. For additional information about the rating of stereotypies, please see Tardive Dyskinesia.
Self-injurious behaviors
A particularly serious form of stereotypy is self-injurious behavior. Self-injury may take the form of skin picking; self-biting; head punching and slapping; head-to-object and body-to-object banging; body punching and slapping; poking the eye, the anus, and other body parts; lip chewing; removal of hair and nails; and teeth banging.
Self-injury can result in morbidity and mortality. For example, eye poking and head banging may cause retinal detachments resulting in blindness. Although only a minority of the population of children with autism manifest self-injury, they constitute some of the most challenging patients in developmental pediatrics.
Clinical examples
A 6-year-old boy with autistic disorder who is treated with 75 mg clomipramine (Anafranil) by mouth daily at bedtime exhibits nonstop stereotypies. He frequently peers out of the corner of his eye, tilting his head. He often twiddles his fingers, moving an action figure in a nonfunctional manner. He occasionally grimaces. He repeatedly touches the slits of the blinds at the corner of the window. He rubs his fingers on the blinds, the cabinet drawer, and the chair. At 8:30 pm he rocks briefly and utters indeterminable vocalizations. He may be falling asleep.
A 7-year-old boy with autistic disorder took daily vitamins and no other medications at the time of assessment. The examiner repeated movements of the telephone receiver and tapping on the telephone receiver initially exhibited by the subject. The examiner repeated the subject's actions several times in an attempt to elicit repetition of the movement by the subject. Instead, the subject does not acknowledge the presence of the examiner. The subject spins by rotating on a central vertical axis in his body. He exhibits nonfunctional play with the telephone. He displays frequent finger wiggling and the other hand stereotypies. He frequently vocalizes indecipherable sounds and rocks briefly (see Media file 4).
The examiner may attempt to establish a sequence of taking turns hitting a plate with a block. The examiner says, "My turn," and then taps the plate. The examiner gives the block to the subject and says, "Your turn." The subject may be physically assisted in the activity if the desired response does not occur. The following is a clinical example: A 7-year-old boy with autistic disorder took daily vitamins and no other medications at the time of assessment. The examiner attempted to elicit turn-taking by hitting the plate with a block. The child repeatedly jumps and rotates. He exhibits nonfunctional play with the telephone. He tilts his head and peers out of the corner of his eye. He is interested in the feel of the stick. He exhibits quick hand movements with small toys (see Media file 5).

Causes
Decades ago, researchers conjectured that infantile autism resulted from rejection of the infant by cold parents ("refrigerator mothers") who were blamed for the occurrence of the social deviations of their young children. Careful family studies have disproved the hypothesis that the development of autistic disorder in children is due to faulty parenting. Communicating repeatedly to the parents of the autistic child that they are not responsible is important. For additional information for parents and people with autism and related conditions, please visit the Autism Society of America.

The causes of autistic disorder are unknown. Hypotheses include obstetric complications, infection, genetics, and toxic exposures.


Obstetric complications are associated with an increased risk of autistic disorder. Whether obstetric complications caused autistic disorder or whether autism and obstetric complications resulted from another problem is unclear.
An infectious basis for autistic disorder in some individuals is suggested by the large number of children with autistic disorder born to women who were infected in the rubella epidemic. This finding supports the hypothesis that this infection triggers a vulnerability to develop autistic disorder in the fetus.
A genetic contribution to the development of autism has been hypothesized.
Multiple family studies have suggested genetic components to many cases of autism. For example, many studies have demonstrated that some asymptomatic first-degree relatives of some probands with autism have abnormalities in serotonin and other chemicals similar to the probands with autism. However, a particular individual with autistic disorder may not exhibit familial traits seen in populations.
Finding genetic bases for autism is a promising research goal. However, the clinical usefulness of the assessment of families of individuals with autism has not been established.
Toxic exposures have been hypothesized to cause autism.
Exposures to toxins, chemicals, poisons, and other substances have been hypothesized to cause autism. Although anecdotal case reports suggest that exposures to toxins and other substances may play a role in isolated cases of autistic disorder, a causative role for toxins in the development of autism in general has not been demonstrated. Local regions may have toxic exposures that exert a geographical influence. For example, the high incidence of autism in portions of Japan has been hypothesized to be due to a toxic effect of fish. Although toxins may play a role in the development of isolated cases of autism in Japan, toxins have not been proved to be causative of autism in Japan in general. Another possible explanation for the high rates of autism in Japan is the excellent training of Japanese clinicians. Low rates of autism in countries outside Japan may reflect the limited abilities of clinicians to make the diagnosis of autism.
In particular, the development of autism after immunization to measles, mumps, and rubella led to the hypothesis that autism was caused by immunization. Careful research has not demonstrated an association between immunization for measles, mumps, and rubella and the subsequent development of autism and related conditions in the general population. General immunization for measles, mumps, and rubella is recommended. Immunization for the general population is highly recommended. The rate of autism in children who receive immunizations does not appear to be increased.

Differential Diagnoses
Acanthocytosis
Down Syndrome

Anxiety Disorder: Obsessive-Compulsive Disorder
Eating Disorder: Pica

Anxiety Disorder: Trichotillomania
Fragile X Syndrome

Biotin Deficiency
Gaucher Disease

Child Abuse & Neglect: Dissociative Identity Disorder
Hearing Impairment

Child Abuse & Neglect: Failure to Thrive
Human Immunodeficiency Virus Infection

Child Abuse & Neglect: Physical Abuse
Hypomelanosis of Ito

Child Abuse & Neglect: Psychosocial Dwarfism
Learning Disorder: Reading

Child Abuse & Neglect: Reactive Attachment Disorder
Toxicity, Lead

Cognitive Deficits
Tuberous Sclerosis

Cornelia De Lange Syndrome

Cri-du-chat Syndrome


Other Problems to Be Considered
44,XXX karyotype
47 chromosomes
(7;20) balanced chromosomal translocation
Angelman syndrome
Deletion 1p35
Duplication of bands 15q11-13
Extra bisatellite marker chromosome
Habit disorder
Hydrocephalus, infantile
Interstitial deletion of (17)(p11.2)
Inv Dup (15)(pter->q13)
Language disorder: mixed
Language disorder: phonology
Language disorder: receptive
Language disorder: stuttering
Long Y chromosome
Minamata disease
Moebius syndrome
Nonketotic hyperglycinemia (NKH)
Partial 6p trisomy
Seizures
Seizures, frontal lobe
Spasms, infantile
Tourette disorder
Trisomy 22

This continues through the "how to" do the work up.

It is really long.

Let me know what you are looking for and maybe I can isolate it for you.

I would suggest, with the greatest of respect, that posting that amount of an article online may broach some copyright rules. I don't know for sure; but I'd advise caution.

Good point.

Maybe that should be removed and perhaps handled via PM for whomever wants THAT specific info. The last thing we need is any more......issues.

Huge surprise there...

Bumped. I finally got around to looking at the studies

BMJ 2001 Jul;323(7305):163-4
and
N Engl J Med. 2003 Mar 6;348(10):951-4

and it appears Pie has sent me the original studies, and not the criticism of them. Pie, what I have is BMJ edition 322, not 323, and NEJM 347, not 348.

I read the studies, or at least what I could understand of them without 300-level courses in statistics. In the NEJM study, roughly of 80% of about 500,000 children in Denmark were MMR-vaccinated, and roughly 80% of autism cases in the same group of children were of MMR-vaccinated children. (IOW, 20% of autism cases were in non-vaccinated children.)

It will be interesting to see how this is criticized.

No one ever claimed that the MMR is the sole and exclusive trigger of autism. It's not just about the MMR, it's about the aggressiveness of the entire schedule, and the way vaccinations are intended to work. Even vaccine opponents aren't sure why the MMR seems to have a higher risk than other vaccines.

It is, in short, all about the adjuvants. The immune response is an extremely complex biological process, but in layman's terms, it's somewhat like this: the immune system works in stages. The first antibody response is supposed to be from IgA antibodies, which live almost exclusively in the lungs and digestive tract. This is how most diseases enter the body. The IgA antibodies are the ones that organize the overall response to the pathogen, and call in the IgE antibodies (which are what give you a typical allergic response of itchy eyes, sneezing, etc.) to do the dirty work of fighting the pathogen. They also are the ones that best "remember" the pathogen for the future, so that the body has immunity.

When you inject the pathogen directly into the bloodstream, you completely bypass this IgA part of the immune system (and that is one reason why blood-borne diseases are usually so much more devastating than airborne.) This is an acknowledged drawback of injected vaccines, and it is precisely why they include an adjuvant with the injection, usually the heavy metal aluminum. An adjuvant is a substance which, for an unknown reason, hyperstimulates the IgE response. We can't get the IgAs to remember the pathogen, since we've excluded them from the process, so instead we just throw the IgEs into overdrive, significantly overproduce antibodies to fight the pathogen, and that way plenty are left over after the disease is defeated. But these antibodies die off over time, and this is why injections don't provide lifelong immunity while getting the actual disease does, and why we need booster shots after a few years.

Is it really so hard to imagine that artificially stimulating the IgE antibodies would lead them to be more likely to mistake harmless substances (like, say, peanut proteins) as pathogens, thus creating an allergy to peanuts? It's not just about the MMR, and it's not just about autism. All autoimmune disorders are sharply on the rise, because we are screwing with our immune system and forcing it to work in ways it isn't designed to. The only reason the autism advocates are the only ones screaming is because having a kid with a severe peanut allergy just isn't that big a deal (I know, I have a stepson with one.) All the lesser diseases, while they might be lifestyle-altering, still leave you with your kid intact. But they are all a reflection of the problem--asthma, allergies, autism, ADHD, celiac disease, type 1 diabetes, rheumatoid arthritis...

Incidentally, it's quite possible to administer vaccines in an airborne fashion, breathing them in through a mask. When they do this, no adjuvant is needed, and indeed, that's how they do vaccinations in Africa, because they have to re-use all their medical equipment down there, and re-using needles in an AIDS-ridden population is a big no-no. Guess who doesn't have an autism epidemic like we do? Of course, detractors will say that's because African doctors are too stupid to recognize autism when they see it, and African parents are too stupid to know whether their child knows how to talk or not.

I don't think most people think African parents are too stupid. Possibly not educated enough to pick the symptoms, and most likely not wealthy enough to seek help anyway.

It's not hard to imagine, no.

Yes, very cute HM. There are studies to back it up, but that shit's just not available for free on the internet, sorry. If you're interested, it's not hard to find books on the subject.

As I alluded, it does not take an education to determine that your child is or is not speaking, or is or is not smacking themselves in the face all day long. The symptoms are subtle at the age of 2-3. They are not subtle at ages 4, 5, 6, or all the rest of the years of their lives as this disease continues to affect them.

A lot of African people who live a tribal life would believe their child was possessed if they exhibited those types of symptoms. That is my point when I suggest that education is part of the issue. Sure they'd know something wasn't right, but they'd have a whole different way of thinking about what was wrong with their child than you or I might.

eta: The same goes for any other culture which still lives a tribal way of life.

Right. And they would hold exorcism ceremonies, or have whatever methods of treatment they thought might be successful--the point being that they would recognize the disease and know who had it and who didn't. And outsiders could tabulate how many "possessed" children there were in a group of people, and know what they were really counting. And in the end, they have done all this, and determined that the rate of autism in Africa is vastly lower than in America, both in areas where they vaccinate (through breathing treatments) and areas where they don't.

The whole thing is much more complicated, but that is a good synopsis of how it works with the immune response.

My point was that not all detractors of the theory you're presenting necessarily assume people from Africa are stupid.

This is a better synopsis of how the immune system works if anyone is really interested in understanding it better. It is quite complicated but efficient. The human body is amazing...

http://en.wikibooks.org/wiki/Human_P...inst_Infection

I don't think in re: Africa the issue is one of education or health awareness, but more the question of where children rank, culturally. We're pretty children-centric, all overpopulation aware and trying to get the infant mortality rate down more than it already is.

Not my area of limited-enough-to-bullshit awareness, but I read Dancing Skeltons once. What I got was: the poor health of developing children was due largely to the fact that their nutrition was considered after that of others.

Flip the coin around: if children should be seen and not heard, would a child not developing verbal skills be noticed?

Yes, we can throw guesses out all day long as to why the results of a study that none of you have read might or might not have cultural flaws that our own educated and trained scientists are unable to compensate for.

Or, we can take the simplest route: the government has already admitted, twice, that in certain cases, vaccines and the MMR in particular can and did trigger certain types of autism in certain children. With 5,000+ identical cases waiting in line on the docket behind those two, and hundreds of thousands waiting in the wings, they had every motivation in the world not to set that precedent unless they absolutely had to, unless the evidence presented to them (which took years to present, by the way, it wasn't just a casual conversation on a message board) was so undeniable there was just no way around it.

The main consensus of scientific opinion on this subject is shifting, as science always does, and it is moving towards my side, not yours.

It would appear in the case of Hannah Poling that the government has "admitted" (by settling out of court) that thimerosal was responsible. That's not your position.

The NY Times Poling story: http://www.nytimes.com/2008/03/08/us/08vaccine.html

Do you have a link to the government admitting it was thimerosal specifically?

Actually, no one knows if she was predisposed with a mitochondrial disorder, or if she developed it, along with autism, after receiving 5 vaccines against 9 antigens in one day because she had fallen behind the mandated schedule due to illness.

Uh well no actually... there's no full published record of the court's proceedings as far as I can tell, but that was the father's position and largely the position of the 5,000 cases that Clod mentions. Mercury is damaging to mitochondria.

Poling was in this group. Now here's all you need to know about the "omnibus autism courts" set up for the 5,000 claims:

http://www.washingtonpost.com/wp-dyn...0901344_2.html

Bold mine. Despite this fact, the 5,000 cases have been dismissed via the Omnibus after the special masters found no evidence in three test cases (Poling was not one of the test cases).

There is no such thing as "settling out of court" in this case. It is not a civil suit, it is a specially-commissioned body that rules for or against compensation to the victim. They ruled in favor of compensation to cover her medical expenses.

And in the Bailey Banks case, his vaccines did not contain thimerosal.


What's more, the Bailey Banks legal proceedings also reference two previous rulings that I had never even heard of:

I don't know about the Hannah Poling records, but the full court proceedings in the Bailey Banks case are included in the link I posted.

I think what he means is that the CDC conceded the biological plausibility of the Poling's [expert's] claims without an an evidentiary hearing.

link

Links regarding vaccinations and their effect on the autoimmune system (and demyelination) here.

(The site is drcarley.com. She was an MD, and speaks out specifically against Vaccines. Alot of folks dismiss her as a quack, and she has had her license taken away because of her stance on these issues, but I want to point out that what she is saying in these articles on her website are the same things that are being said in these court cases that have been sourced in this thread. I wanted to post that up front, before anyone tries to dismiss her findings simply because of her politics.)

There are videos of her on youtube that are particularly informative, and clod's explanation of how vaccines bypass the inital IgA stage of the immune system is a paraphrase of Dr. Carley's explanation.

I also want to point out this:
http://www.torontosun.com/news/canad...7/8560781.html
and
in Czech and in Czech and in Czech

as well as

http://www.youtube.com/watch?v=wg-52mHIjhs

Now the CDC has recommended over half the Americal population get the H1N1 flu shot.

The flu shot they are recommending is three injections. The first totally wipes out your immune system, so that you feel great (because your body isn't fighting anything any more). The second shot bypasses your normal immune system function and gives you whatever disease they want you to have, and the third shot turns your immunesystem back on. Either you'll die immediately (within 3 days) or your body will exhaust itself fighting off the disease, and most of the people will die anyway. (That's Dr. Carley.)

Now we're hearing about the possibility of mandatory H1N1 vaccinations? I don't think so.

No offense OC, but when you're trying to garner credibility for your cause, referencing people who claim that the majority of people who receive the H1N1 vaccine are going to die... it doesn't really help.

I mean, come on. Is the flu shot a bad idea? Yes, I absolutely think so. Is it going to outright kill the majority, or even a significant percentage of the people who get it? No way.

Mitochondrial dysfunction, impaired oxidative-reduction activity, degeneration, and death in human neuronal and fetal cells induced by low-level exposure to thimerosal and other metal compounds

Interesting. But:

1. They were In Vitro studies.

2. And I agree with the conclusions, "Future studies need to be conducted to evaluate additional mechanisms underlying Thimerosal-induced cellular damage and assess potential co-exposures to other compounds that may increase or decrease Thimerosal-mediated toxicity." This is a single study.

3. I am glad to see someone taking a closer look at the science of it all.

I thought thimerosal was ruled out.

You better call the authors and tell them... boy, are they gonna feel pretty stupid...