Tag Archives: CDC

The word AUTISM written in vintage letterpress type

Top post of 2017- why the increase in autism?

You’ve heard and read much about autism recently. The top new TV drama this season , The Good Doctor, has a major character with autism (although the actor himself is not).

This illustrates the interest in autism spectrum disorders, and the controversy. We are not certain of the cause, and wonder why the condition is diagnosed more frequently.

Perhaps that explains why this was the most viewed post on this blog in 2017.

Light it up blue-autism speaks

 

 

 

Like other physicians and families of people with autism, I puzzle over the increased number of children and adults diagnosed with autism. Most of us have theories about why we now believe 1 in 68 children have autism spectrum disorders.

People point out that “when they were children” they never knew of anyone with autism. There are those who are absolutely convinced that the increased numbers of autism followed the introduction of the measles-mumps-rubella vaccine, MMR. Others implicate genetics, environmental toxins, diet, and intrauterine brain trauma.

I found an article that offers a sound, well thought out and expressed explanation. It contains several points that I have identified and some I had not.

The article was published in Spectrum whose commitment is “to provide accurate and objective coverage of autism research.” Spectrum is funded by the Simons Foundation Autism Research Initiative. Senior News Writer Jessica Wright, Ph.D. in biological sciences from Stanford University, wrote the report. (Scientific American also published the article by permission.)

In the article, Dr.Wright concludes,

“The bulk of the increase (in autism rates) stems from a growing awareness of autism and changes to the condition’s diagnostic criteria.”

First , let’s consider some terminology. Prevalence is an estimate of how common a disease or condition is in a particular population of people at any given time.

So the prevalence of autism in children would be

the number of children identified as autistic at any given time

divided by  the total number of children alive at that time .

The currently accepted rate of autism is 1 in 68 children, or 1.4 %.

So  autism prevalence depends on children being correctly identified as autistic. At any given time, some autistic children may not be identified, and some may be  incorrectly identified.

We do not have any totally objective tests available for autism yet. There is no blood test, scan, culture, imaging study, DNA test, or  monitor to definitely conclude that autism is or is not present.

 

 

 

 

The definition of and criteria for autism have changed substantially since “infantile autism” was first identified by Leo Kanner over 70 years ago. Since 1980, the diagnosis is based on applying the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In the most recent version, DSM-5, released in 2013, autism, Asperger syndrome, and pervasive developmental disorder, formerly separate, are now a single diagnosis.

Autism Spectrum Disorder is characterized by

  • Persistent deficits in social communication and social interaction across multiple contexts
  • Restricted, repetitive patterns of behavior, interests, or activities
  • Symptoms must be present in the early developmental period (But may not yet be fully expressed or may be modified by learned behavior in later life)
  • Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
  • These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

At this link you may read the full detailed criteria from DSM-5

Diagnostic Criteria for 299.00 Autism Spectrum Disorder

 

When the diagnostic criteria for other diseases change, the prevalence also changes. Examples include diabetes, high cholesterol, high blood pressure, migraine, obesity, depression , even some cancers. So autism is not unique in this regard.

The currently accepted rate of autism, 1 in 68, comes from the Autism and Developmental Disabilities Monitoring Network, established by the CDC in 2000. Children are identified by reviewing health and school records of 8 year olds in selected counties. So possibly some children get missed, and some assigned incorrectly.

 

 

 

 

 

 

 

 

 

Another major milestone in autism awareness occurred in 1991 when the U.S. Department of Education ruled that autistic children qualify for special education services.

 

Parents of children with developmental and intellectual disabilities  have an incentive to secure accurate diagnosis, to qualify their child for services they otherwise might not  have access to.

 

 

Since 2006, the American Academy of Pediatrics recommends routine screening of all children for autism at 18 and 24 months old. Many physicians, psychologists, and therapists believe early intervention improves these children’s chances to do well intellectually and socially.

If we could go back and review records of children 10, 20, or 30 years ago, and apply current diagnostic criteria, would we find less autism than we do today? Perhaps. But such records would likely reflect the understanding of autism at the time, so might still fail to recognize autism, even when present by today’s standards.

The apparent increased number of children with autism seems alarming-some call it an epidemic. It may represent our increased awareness, recognition, and knowledge about this disorder. And while this increase should raise concern, it can lead to increased research, treatment options, and more effective care for autistic persons.

Here is a link to the original article

Autism Rates in the United States Explained

 

 

 

How The Good Doctor became such a hit

“Highmore’s ( actor who plays an autistic surgical resident ) restrained yet not emotionless portrayal has also resonated within the autism community. Shore (the producer) has heard from multiple people who have found the series inspiring, including one mother who told him that her son, who is on the spectrum and has struggled with depression, agreed to resume therapy after watching the first episode.”

 

 

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The word AUTISM written in vintage letterpress type

Are too many children autistic?

Like other physicians and families of people with autism, I puzzle over the increased number of children and adults diagnosed with autism. And most all of us have theories about why we now believe 1 in 68 children have autism spectrum disorders.

People point out that “when they were children” they never knew of anyone with autism.There are those who are absolutely convinced that the increased numbers of autism followed the introduction of the measles-mumps-rubella vaccine, MMR. Others implicate genetics, environmental toxins, diet, and intrauterine brain trauma.

I found an article that  offers a sound, well thought out and expressed explanation. It contains several points that I have identified and some I had not.

The article was published in Spectrum whose commitment is “to provide accurate and objective coverage of autism research.” Spectrum is funded by the Simons Foundation Autism Research Initiative. Senior News Writer Jessica Wright, Ph.D. in biological sciences from Stanford University, wrote the report. (Scientific American also published the article by permission.)

In the article, Dr.Wright concludes,

“The bulk of the increase (in autism rates) stems from a growing awareness of autism and changes to the condition’s diagnostic criteria.”

First , let’s consider some terminology. Prevalence is an estimate of how common a disease or condition is in a particular population of people at any given time.

So the prevalence of autism in children would be

the number of children identified as autistic at any given time

divided by  the total number of children alive at that time .

The currently accepted rate of autism is 1 in 68 children, or 1.4 %.

So  autism prevalence depends on children being correctly identified as autistic. At any given time, some autistic children may not be identified, and some may be  incorrectly identified.

We do not have any totally objective tests available for autism yet. There is no blood test, scan, culture, imaging study, DNA test, or  monitor to definitely conclude that autism is or is not present.

The definition of and criteria for autism have changed substantially since “infantile autism” was first identified by Leo Kanner over 70 years ago. Since 1980, the diagnosis is based on applying the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In the most recent version, DSM-5, released in 2013, autism, Asperger syndrome, and pervasive developmental disorder, formerly separate, are now a single diagnosis.

Simply explained, Autism Spectrum Disorder is characterized by

  • Persistent deficits in social communication and social interaction across multiple contexts
  • Restricted, repetitive patterns of behavior, interests, or activities
  • Symptoms must be present in the early developmental period (But may not yet be fully expressed or may be modified by learned behavior in later life)
  • Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
  • These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.

Here is the full detailed criteria from DSM-5

Diagnostic Criteria for 299.00 Autism Spectrum Disorder

 

When the diagnostic criteria for other diseases we diagnose and manage changed, the prevalence also changed. Examples include diabetes, high cholesterol, high blood pressure, migraine, obesity, depression , even some cancers. So autism is not unique in this regard.

The currently accepted rate of autism, 1 in 68, comes from the Autism and Developmental Disabilities Monitoring Network, established by the CDC in 2000. Children are identified through reviewing health and school records of 8 year olds in selected counties. So possibly some children get missed, and some assigned incorrectly.

Another major milestone in autism awareness occurred in 1991 when the U.S. Department of Education ruled that autistic children qualify for special education services. This ruling encouraged parents of children with developmental and intellectual disabilities to secure accurate diagnosis, to qualify for services they otherwise might not  have access to.

Since 2006, the American Academy of Pediatrics recommends routine screening of all children for autism at 18 and 24 months old. Many physicians, psychologists, and therapists believe early intervention improves these children’s chances to do well intellectually and socially.

If we could go back and review records of children 10, 20, or 30 years ago, and apply current diagnostic criteria, would we find less autism than we do today? Perhaps. But such records would likely reflect the understanding of autism at the time, so might still fail to recognize autism, even when present by today’s standards.

The apparent increased number of children with autism seems alarming-some call it an epidemic. It may represent our increased awareness, recognition, and knowledge about this disorder. And while this increase should raise concern, it can lead to increased research, treatment options, and more effective care for autistic persons.

Here is a link to the original article

Autism Rates in the United States Explained

 

The story of autism isn’t just about statistics, theories, and criteria; it is about the  children and adults with autism, and their families. Here are just two of many stories of how autism plays out in real life.

We Are Autism, Too. Don’t Forget About Us.

“My boy, with his classic autism, the kind that used to be the only face of autism half a century ago, is the one who does not belong now.”

Looking Into the Future for a Child With Autism

“As my son’s limitations became clearer, I found it harder every year to write a vision statement for his I.E.P. Then he showed us how.”

 

And in this  previous post  I share my personal experience with autism.

Why I have a different way of seeing autism

The word "Read" written in black paint on a colorful watercolor washed background.

Reconsidering vaccination- a book review

In 1961,  my mother and I went to my school on a Sunday afternoon to receive the newly released oral polio vaccine. She along with other parents eagerly sought a way to prevent a dreaded disease that had the potential to cripple or even kill their children.

In medical school I learned about diphtheria, a painful throat infection due to a bacteria, Corynebacterium diphtheriae. . Once a common cause of severe illness and death, a vaccine had rendered it rare. I saw no cases of diphtheria in medical school, nor have I since.

As a young physician I welcomed the introduction of the H.Flu vaccine (Haemophilus influenzae bacteria, not the virus) in 1985. At that time, any infant or toddler with a fever was a potential victim  of  meningitis due to H.Flu, which could be deadly or leave the child with neurological damage.

Similarly, the Hepatitis B vaccine made healthcare a less risky occupation; Hepatitis B is a blood borne infection contracted from contact with infected blood.

VACCINE-PREVENTABLE DISEASES

FROM THE CDC, UPDATED JANUARY 2016– follow link for detail

 

 

 

 

 

So, I was  first surprised, then puzzled, then alarmed , now resigned to the number of parents who reject vaccination for their children, and   adults who decline immunizations for themselves. Some people now fear the vaccines more than the diseases they prevent and we physicians must consider this to help people stay well instead of treating them when sick.

I was intrigued when I heard of a book, by a physician,that seems to promote a compromise-

The Vaccine-Friendly Plan

 

The Vaccine-Friendly Plan is published by Ballantine Books,  2016

 

 

The Vaccine-Friendly Plan by Paul Thomas, M.D., a pediatrician  and Jennifer Margulis, Ph.D.a science journalist.

It is based on his pediatric practice, Integrative Pediatrics,  as well as their extensively noted references. The book’s subtitle summarizes the contents accurately-

“Dr. Paul’s Safe and Effective Approach to Immunity and Health- from Pregnancy through your Child’s Teen Years.”

The book discusses pregnancy, infant and  child care in general, not just vaccination, although that is a major emphasis.There is a chapter about pregnancy and for each stage of child development through adolescence.

The first chapter discusses a popular health topic now- toxins. (As an aside, I don’t know when we started calling poisons  “toxins”) . This should grab your attention-

“Toxins, Toxins, Toxins: Raising Healthy Children in a Poisoned World”.

Anything can be “toxic” if misused, overused,or abused  but they concentrate on these toxins in particular- acetaminophen, aluminum, aspartame, fluoride, methanol, mercury, and what they call endocrine disruptors(this includes pesticides).  They state “environmental toxins are likely contributing to the autism epidemic” as well as other neurodevelopmental and mental disorders in children.  They base their conclusion on an extensive list of review articles from the medical and scientific that support their view (obviously) and also from Dr. Paul’s medical practice of 11,000 children who he calls “among the healthiest in the world.” While I suspect  families who are already health conscious tend to select a physician who is health oriented, this claim sounds impressive.

I agree with some of the advice the authors offer. For example this advice for pregnancy is hard to argue with-

  • Eat a whole foods, organic, non-GMO diet 
  • Skip the soda
  • Drink filtered water
  • Minimize stress
  • Get treatment for addiction
  • Join a support group

But in addition, they recommend declining all vaccinations during pregnancy, certainly not mainstream medicine advice.

 

A later chapter also offers sound advice:

“ The Best Ways to Support your Child’s Immune System” 

  • Breast feed
  • Enjoy cuddling
  • Laugh a lot
  • Relax often
  • Rock your body
  • Stay hydrated
  • Eat a variety of foods
  • Maintain social connection
  • Read
  • Get Dirty
  • Be cautious but not afraid
  • Choose vaccines based on real science, your family’s needs and common sense
  • Sleep enough
  • Trust your children
  • Trust yourself

 

He offers an interesting list  Ten Questions to Ask When Looking for a Pediatrician (which I assume would apply if you use a family physician for your child’s care).

As a physician, I have never liked the idea of being “interviewed” by a potential patient; I  want a relationship with patients, not a job. But I think pediatricians routinely offer “get acquainted” visits so you may find it helpful. Some of the questions seem more appropriate to explore  in a long term relationship with a physician, not quick answers in a short visit, like “What would you like me to know in order to keep my family healthy?”

An appendix compares the CDC immunization schedule of 1983 to the current 2016 version, illustrating  many more vaccines and doses are now recommended.

Of course the list is longer since several new vaccines have been developed in the past 30 years and the CDC recommends those considered necessary for the public health. Most areas of medical care have changed dramatically in the past 30 years, we have a lot more of everything-drugs, procedures, etc- so this should not be a surprise.

vaccines

CDC Immunization Schedule– follow link for detail

 

 

Also in the appendix is Dr. Paul’s Vaccine Plan at a Glance, which is a much abbreviated version of the CDC recommendations. The plan is offered free at his web site drpaulapproved.com by signing up to receive his newsletter. (There is also a “store” on the web site offering an assortment of vitamins, minerals, probiotics and melatonin.)

The authors describe themselves as “pro-vaccine”, have received vaccines themselves and vaccinated their children. But they also believe that physicians and parents should have a choice and make informed decisions about immunization and other procedures. 

Universal vaccination is recommended , but there are individual circumstances where the routine schedule might need to be altered due to a child’s particular medical circumstance, but not for some vague concern that vaccination might not b e “safe”. Neither is infectious disease.

If  you are a parent who has  rejected vaccination for your children,  please read this book soon.

Also, read another review of this book by  Vincent Iannelli, MD is a pediatrician and Fellow of the American Academy of Pediatrics.

 

 

 

 

Sonia Shah, a science journalist, also wrote about vaccination in her book

Pandemic – Tracking contagions from cholera, to Ebola, and beyond

Read my review at this link Pandemic- a book review

 

Pandemic by Sonia Shah

 

Previous posts about vaccination on this blog include

Vaccination prevents disease – Part 1 and Part 2

 

Explore the Category “books, literature, writing” for more book reviews.

And please follow this blog for more articles to

inform, instruct, and inspire you to explore the

HEART of HEALTH.      

a stethoscope, a red heart and a heart ekg tracing

exploring the HEART of HEALTH

6 smart facts about antibiotics

6 smart facts about antibiotic use

We’ve already looked at how antibiotic resistance develops and why it’s important. Now let’s consider 6 more important facts about using antibiotics appropriately.

Antibiotics save lives.

“The discovery of penicillin in 1928 by Alexander Fleming was one of the greatest scientific achievements of the 20th century. It’s hard to imagine a world before the development of what many consider to be miracle drugs; however, just 90 years ago antibiotics weren’t available” (quote from the CDC website)

Prior to the discovery of penicillin, infectious diseases frequently caused death, probably the most common cause prior to the mid-20th century.  Now they have been surpassed by heart disease, cancer and trauma. We are less likely to contract and die from an infectious disease because of immunization, improved hygiene, sanitation, safe food and water, improved nutrition, and antibiotics. Unfortunately, in some parts of the world, and in any place devastated by war or a natural disaster, infectious diseases are still a major menace.

please wash your hands

common sight now in public restrooms

Antibiotics are used to treat infections caused by bacteria.

In a broad sense, the word antibiotic could refer to any drug that kills or stops germs, or in other words, organisms that cause disease. But we usually reserve it to refer to bacteria type organisms. There are many families of bacteria; two of the most common are the Streptococci, or Strep and the Staphylococci, or Staph (pronounced staff). There are different drugs that work on other infections caused by viruses, fungus, and parasites.

MRSA bacteria

MRSA- a staph bacteria photo from Public Health Image Library

Ear infections may or may not need treatment with an antibiotic.

Ten years ago we thought all ear infections must be treated with antibiotics. Now we know that some resolve spontaneously, so antibiotic prescribing is not automatic. In some circumstances, they are still recommended

  • Infants less than 6 months old
  • Toddlers under 2 years old with both ears infected
  • A ruptured ear drum (perforated tympanic membrane) with pus draining

In other cases, it is safe to wait 2-3 days before giving an antibiotic if symptoms have not resolved.

A sore throat usually gets better without an antibiotic.

Unless it is due to an infection with the Streptococcus bacteria, “Strep throat”. Greater than 90% of sore throats are caused by viruses, including those which cause colds and influenza. Mono, the “kissing disease”, (infectious mononucleosis) is also caused by a virus called Epstein-Barr. None of these are treatable with antibiotics, although influenza symptoms can be lessened with an anti-viral drug.

Strep throat is usually treated with penicillin but symptoms may not get better any faster than without. The goal in using an antibiotic is to prevent rheumatic fever, a complication of strep which is now rare in the United States.

Chart showing that the following illnesses are usually caused by viruses and don’t need antibiotic treatment: colds/runny nose, bronchitis/chest cold (in otherwise healthy adults), flu, sore throat (except strep), and fluid in the middle ear (otitis media with effusion). Chart also shows that the following illnesses are usually caused by bacteria and do need antibiotic treatment: whooping cough, strep throat, and urinary tract infection.

illness chart provided by the CDC

 The color of mucus, pus, or drainage does not determine the need for an antibiotic.

Some infections may cause characteristic colors or odors, but that alone is not used to diagnose or treat bacteria. If there is pus or other drainage, a sample may be collected and sent to a lab for a culture- attempting to grow any bacteria present. Sometimes this is misleading, since our bodies harbor lots of bacteria normally.

Like all drugs, antibiotics have potential risks.

You may think of antibiotics as safe, harmless drugs with no potential for serious effects.  Usually antibiotics are well tolerated and safe. But serious side effects are possible and dangerous, though rare.

Here are some of the potential serious risks of popular frequently used antibiotics

  • Penicillin- anemia (loss of red blood cells), injury to kidneys and nerves
  • Cephalexin- seizures, liver problems leading to yellow jaundice
  • Sulfa- increased sensitivity to sunlight, inflammation of the pancreas
  • Azithromycin (Z-Pak) irregular heart rhythm, injury to liver and pancreas
  • Ciprofloxacin- seizures, depression, rupture of tendons

In the last post of this series I’ll talk about when to use an antibiotic and when not to. In the meantime, you can explore further here.