Schafer Autism Report, July 11, 2003

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Evan has autism. He very rarely talks to me or my family using words. Instead, he uses pictures and sign language. One of my friends can communicate with Evan in sign language and knows what to do if Evan hands her a picture of a snack that he wants to eat. He loves anything crunchy-potato chips are his favorite. My friend has been around him enough that she understands him almost as well as I do.

My name is Sarah Peralta. I am nine years old and go to Maria Hastings Elementary School in Lexington, MA. I would like you to meet my brother, Evan, who is eight. He goes to a special school and three afternoons a week a home trainer (a special teacher) comes to our house to work with him. Sometimes we all play together and I help her teach Evan. Sarah and Evan Sometimes it is hard having a brother with autism. He can be really annoying, like the time he wanted to feed a friend’s goldfish and dumped the entire container into the tank-Evan didn’t understand that goldfish only need a little food at a time. But at other times it is kind of nice. For example, when you yell at him for stealing your pillow, he doesn’t yell back. Instead he laughs, because he thinks it is a game. Evan has a great laugh that we all love to hear. + Story continues at: http://infobrix.yellowbrix.com/pages/infobrix/Story.nsp?story_id=40000652&ID

Difficulties that children with autism have in pointing and showing objects to other people may emerge from earlier problems with simple face-to-face interaction, according to new research sponsored by the ESRC.

Findings from a two-year study led by Dr Susan Leekam, of the Department of Psychology, University of Durham, could be important for understanding the early language and communication problems found in these children.

Dr Leekam said: “We have known for a long time that children with autism have special difficulties with pointing and showing objects to other people. Until recently, however, many researchers believed that this problem was due to the child’s lack of awareness that people’s thoughts and reactions were directed towards objects and events in the world around them.

“Our new research suggests a different interpretation - that the failure to point and show things to others may emerge from much simpler beginnings of face-to-face interaction. These findings indicate that the problems may start even earlier in development than previously recognised.”

The study involved examining in close detail the face-to-face contacts of 20 pre-school children with autism and 20 developmentally delayed comparison children as they played games with an adult. The two groups were matched for mental age.

A computer-based digital video analysis system was used to measure the use of voice and touch by an adult when playing with the child and instances of pointing and showing by the child itself. The technique enabled the researchers to examine in detail whether certain types of attention-seeking, such as touch or gaining the child’s eye gaze, were more effective.

As expected from previous studies, researchers found that children with autism had more difficulty with pointing and showing than developmentally delayed children. The researchers also found that the adult was more likely to use both voice and touch as attention-seeking devices for the children with autism than the children without autism.

Their most important finding however was that the children’s difficulty in responding to face-to-face interaction was strongly related to the problem with pointing and showing. Children who did no pointing or showing objects to the adult were those most impaired in face-to-face interaction.

Those who did some pointing and showing were less weak at face-to-face activity. This relationship was found regardless of the actions of the adult or whether children had either high or low ability levels.

Dr Leekam said, “What is striking is that the relationship between response to face-to-face interaction and pointing and showing ability was significant only for children diagnosed with autism and not for children with developmental delays.

“This finding has implications for early intervention. Many parents are aware of difficulties long before a diagnosis of autism is made. By gaining greater understanding of these very early problems we hope that ways can be found to target them before other difficulties emerge.”

HealthDayNews - Early problems with simple face-to-face interaction may be responsible for the difficulties autistic children have in pointing and showing objects to other people, says new British research.

The results of the two-year study from the University of Durham could provide better understanding of the early language and communication problems found in children with autism.

“We have known for a long time that children with autism have special difficulties with pointing and showing objects to other people. Until recently, however, many researchers believed that this problem was due to the child’s lack of awareness that people’s thoughts and reactions were directed towards objects and events in the world around them,” lead author Dr. Susan Leekam says in a statement.

“Our new research suggests a different interpretation -- that the failure to point and show things to others may emerge from much simpler beginnings of face-to-face interaction. These findings indicate that the problems may start even earlier in development than previously recognized,” Leekam says.

The study included 20 pre-school children with autism and 20 developmentally delayed children in a comparison group. The two groups were matched for mental age.

The use of voice and touch by adults playing with the children was measured by a computer-based digital video analysis system. The system also measured the use of pointing and showing by the children.

Using this method, the researchers were able to examine in detail the effectiveness of touch or gaining a child’s eye gaze and other methods of attention-seeking used by the adults.

The researchers found an autistic child’s difficulty in responding to face-to-face interaction was strongly related to the problem of pointing and showing. Autistic children who did no pointing or showing objects to the adults were those most impaired in face-to-face interaction.

Dense Linkage Disequilibrium Mapping in the 15q11-q13 Maternal Expression Domain Yields Evidence For Association In Autism.

Nurmi EL, Amin T, Olson LM, Jacobs MM, McCauley JL, Lam AY, Organ EL, Folstein SE, Haines JL, Sutcliffe JS. [1] 1Department of Molecular Physiology and Biophysics, Program in Human Genetics, Vanderbilt University, Nashville, TN, USA [2] 2Center for Molecular Neuroscience, Vanderbilt University, Nashville, TN, USA.

Autism [MIM 209850] is a neurodevelopmental disorder exhibiting a complex genetic etiology with clinical and locus heterogeneity.

Chromosome 15q11-q13 has been proposed to harbor a gene for autism susceptibility based on (1) maternal-specific chromosomal duplications seen in autism and (2) positive evidence for linkage disequilibrium (LD) at 15q markers in chromosomally normal autism families.

To investigate and localize a potential susceptibility variant, we developed a dense single nucleotide polymorphism (SNP) map of the maternal expression domain in proximal 15q.

We analyzed 29 SNPs spanning the two known imprinted, maternally expressed genes in the interval (UBE3A and ATP10C) and putative imprinting control regions.

With a marker coverage of 1/10 kb in coding regions and 1/15 kb in large 5’ introns, this map was employed to thoroughly dissect LD in autism families.

Two SNPs within ATP10C demonstrated evidence for preferential allelic transmission to affected offspring.

The signal detected at these SNPs was stronger in singleton families, and an adjacent SNP demonstrated transmission distortion in this subset.

All SNPs showing allelic association lie within islands of sequence homology between human and mouse genomes that may be part of an ancestral haplotype containing a functional susceptibility allele.

The region was further explored for recombination hot spots and haplotype blocks to evaluate haplotype transmission.

One haplotype within ATP10C displayed suggestive evidence for preferential transmission.

Interpretation of these data will require replication across data sets, evaluation of potential functional effects of associated alleles, and a thorough assessment of haplotype transmission within ATP10C and neighboring genes.

Nevertheless, these findings are consistent with the presence of an autism susceptibility locus in 15q11-q13.Molecular Psychiatry (2003) 8, 624-634. doi:10.1038/sj.mp.4001283

Neural Systems For Compensation And Persistence: Young Adult Outcome Of Childhood Reading Disability.

Shaywitz SE, Shaywitz BA, Fulbright RK, Skudlarski P, Mencl WE, Constable RT, Pugh KR, Holahan JM, Marchione KE, Fletcher JM, Lyon GR, Gore JC. Department of Pediatrics (SES, BAS, WEM, KRP, JMH, KEM), Yale University School of Medicine, New Haven, Connecticut, USA

This study examined whether and how two groups of young adults who were poor readers as children (a relatively compensated group and a group with persistent reading difficulties) differed from non-impaired readers and if there were any factors distinguishing the compensated from persistently poor readers that might account for their different outcomes. Using functional magnetic resonance imaging, we studied three groups of young adults, ages 18.5-22.5 years, as they read pseudo-words and real words: 1) persistently poor readers (PPR; n = 24); 2) accuracy improved (compensated) readers (AIR; n = 19); and 3) non-impaired readers (NI, n = 27).

Compensated readers, who are accurate but not fluent, demonstrate a relative under-activation in posterior neural systems for reading located in left parietotemporal and occipitotemporal regions. Persistently poor readers, who are both not fluent and less accurate, activate posterior reading systems but engage them differently from non-impaired readers, appearing to rely more on memory-based rather than analytic word identification strategies. These findings of divergent neural outcomes as young adults are both new and unexpected and suggest a neural basis for reading outcomes of compensation and persistence in adults with childhood dyslexia.

Bar-Haim Y, Marshall PJ, Fox NA, Schorr EA, Gordon-Salant S. Department of Psychology (YB-H), Tel-Aviv University, Ramat Aviv, Tel-Aviv, Israel

Individual differences in auditory processing have been associated with social withdrawal, introversion, and other forms of dysfunction in social engagement. The goal of this study was to investigate the characteristics of an electrophysiologic response that is seen to index early cortical auditory processing (mismatch negativity, MMN) among socially withdrawn and more sociable control children. Auditory event-related potentials to standard and deviant tone stimuli were computed for 23 socially withdrawn children and 22 control subjects.

We calculated MMN difference waveforms for frontal, central, and parietal electrode sites. Socially withdrawn children had smaller MMN amplitude and longer MMN latencies compared with more sociable control children. The findings point to the involvement of individual differences in early cortical auditory processing in childhood social withdrawal. Reduced MMN amplitude and delayed latency may index a component of social withdrawal seen in socially withdrawn children and in depressed and schizophrenic patients.

The existence of a secondary MMN generator in the frontal cortex may provide a link between the hypothesized frontal lobe involvement in childhood social withdrawal, schizophrenia, and depression and the MMN reductions seen in these conditions.

Camp Lejeune, N.C. AP - A Marine helicopter pilot who refused on religious grounds to receive an anthrax vaccination was dismissed from the Corps on Tuesday and ordered to serve seven months in prison.

1st Lt. Erick Enz pleaded guilty during a court-martial to disobeying the order of a superior. He faced a maximum punishment of five years confinement, forfeiture of all pay and allowances and dismissal from service.

Enz could serve as little as 30 days based on a pretrial agreement, The Daily News of Jacksonville reported.

Enz, a father of five and Bible study group leader, said he prayed for guidance before researching the potential adverse affects of the vaccination and refusing inoculation.

Military Judge Col. Steven Day ruled earlier that Enz’s objection on religious grounds would not be allowed as evidence.

Department of Defense officials contend that the vaccination is safe, as do military doctors.

A September 2002 U.S. General Accounting Office survey of 1,253 soldiers who received the anthrax vaccination found that 84 percent suffered minor reactions. At least 24 percent had major multiple “systemic” reactions, the latter more than 100 times higher than the estimate of the manufacturer.

“The people who refuse this are not the dummies or the troublemakers,” said Lt. Col. John Richardson, a retired Air Force pilot who has criticized the vaccine. “I get two to three unsolicited calls or e-mails a week sometimes as many as five a day from kids who are sick. Someone has to stand up and do the right thing.”

[What does this debate have to do with autism? In addition to the attempt to limit awards in malpractice suits, it also serves as a Trojan horse for the pharmaceutical industry’s agenda -- giving them the same protections and limits against lawsuits it gives to doctors. It contains the same language in part, of the vaccine protections paragraphs slipped into the Homeland Security legislation (and then later excised). The opinions expressed belong to the author and not necessarily by the Schafer Autism Report. By Michael Kinsley in the Washington Post.] http://www.washingtonpost.com/wp-dyn/articles/A40915-2003Jul10.html

The American Medical Association (AMA) propaganda for medical malpractice reform is almost enough to turn you against it. Senate Democrats killed a reform bill on Wednesday, giving Republicans an issue in next year’s election. The core of the bill was a $250,000 limit on how much injured patients can collect for pain and suffering. The AMA describes this as “enabling patients to receive up to $250,000” for pain and suffering. According to the AMA, the leading purpose of the bill was “ensuring patients receive 100 percent compensation for their economic losses.” This is a non-problem of particular lack of concern to the AMA, whose entire interest in this issue is reducing malpractice payments. The AMA refers to the bill as the Patients First Act of 2003, an Orwellian conceit that could equally well be used by the other side of the debate: the trial lawyers.

The malpractice debate is a war of anecdotes. Both sides want you to feel that life could go awry at any moment. Reading the contradictory literature simultaneously leaves you with a why-get-out-of-bed feeling that if it’s not one thing, it’s another. If you are hit by a car on a country road and rushed to the hospital with a head injury, you will probably die, because the high cost of malpractice insurance has driven every brain surgeon in the region to retire to the golf course. And if there happens to be a doctor who is still in business, he will probably be so incompetent that he absent-mindedly implants a golf ball in your left frontal lobe. We are all imperiled, but especially at risk are cute little girls, who, judging from the anecdotes, are victims of both medical malpractice and medical malpractice insurance way out of proportion to their share of the population.

One subject you don’t see many anecdotes about is “frivolous lawsuits,” although this is a major theme of malpractice reform crusaders. There’s a reason: Even unworthy lawsuits usually don’t look frivolous up close. A quadriplegic who wins $20 million in what critics call the “lawsuit lottery” is still a quadriplegic. He is still a quadriplegic even if others in the same situation get little or nothing. He is still a quadriplegic even if the doctor he sued did nothing in particular wrong. If you had the choice in advance, would you agree to become a quadriplegic for $20 million? Suffer severe pain in your right leg for the rest of your life for $350,000? Very few winners of what the critics call the lawsuit lottery actually win enough to make it a deal they would take voluntarily.

So the direct effect of restricting the size of malpractice judgments would be to increase injustice, not to reduce it. Nevertheless, limits on malpractice lawsuits are a good idea that Democrats are wrong, and possibly foolish, to oppose. The current arrangement delivers justice at random, in widely varying amounts or not at all, depending on whether you’re feeling litigious, how good your lawyer is or what a judge or a juror had for breakfast that day. It is less a matter of injustice than of more justice than we can afford.

What is wrong with a $250,000 cap on payments for pain and suffering? Why should one person get $5 million, another $500,000 and yet another nothing at all for essentially the same injury? The fact that $250,000 can’t begin to compensate for the pain and suffering a patient may have endured can demonstrate that $250,000 isn’t enough money, or it can demonstrate that money’s ability to compensate for non-monetary losses is inherently limited.

One of the major Democratic presidential contenders, Sen. John Edwards, made a fortune as a trial lawyer. In a profile of Edwards last year, Nicholas Lemann of the New Yorker suggested that economic-justice-by-lawsuit might be a replacement for the economic-justice-by-legislation that the Democrats no longer have the power or inclination to fight for. Lemann also pointed out the flaw in this kind of justice: It is transactional, based on particular episodes, rather than on fate in general. If you’ve been screwed out of $1,000 by a credit-card company or screwed out of the use of your elbow by an incompetent doctor, litigation can help you. If you’ve been screwed by life itself, there is no one to sue.

Edwards was perceived as the Democratic front-runner a few months ago, but his campaign seems to be going nowhere. And the Republicans forced a vote on malpractice reform this week, even though they knew they’d lose, because they wanted to force every Democratic senator to take a stand. (All the Democrats opposed the reform.) So it looks as if justice-by-litigation, like justice-by-legislation, has become a better issue for the Republicans than the Democrats. In both areas, Republicans seem to have found the sweet spot between “no” and “yes,” where “yes and no” can seem like a philosophical advance rather than a contradiction in terms.

It is a society with an odd sense of justice that awards millions of dollars to every 25th victim of what may or may not have been a botched operation but doesn’t guarantee basic health care to anyone. But it is a political party with an odd sense of justice that makes a big issue of the former and basically ignores the latter. Republicans are right about malpractice reform. They may not realize quite how right they are.

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