Schafer Autism Report June 17, 2003

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The Centers for Disease Control and Prevention (CDC) is co-hosting a unique Public Health Grand Rounds satellite telecast on autism. The program, entitled “Autism Among Us: Rising Concerns and the Public Health Response” will air on Friday, June 20, 2003, at 2:00-3:00 pm Eastern Time.

Part of the public health response to autism is early identification, which leads to early intervention and a much better prognosis for children who are diagnosed with an autism spectrum disorder (ASD). To do this, public health professionals must be aware of the signs of autism and be able to connect children and their families with community resources.

“If you work with children and their parents, you can’t afford to miss this program, because you can’t afford to miss autism. The earlier we in pubic health can find it and the more effectively we can educate, refer, and support, the more we can reduce the grave burden of this growing problem.” - Hugh Tilson, MD, DrPH Registration allows you to suggest questions for the expert panel and also enables the program planners to assess the impact of this program, which is the basis for continued funding. Public Health Grand Rounds is an innovative broadcast and Webcast series offered at no cost to

section is offered so that we may continuously improve the Grand Rounds series. Your feedback is valuable and has been the cornerstone of these programs.

For more information and the opportunity to view past programs, visit our Website at: http://www.PublicHealthGrandRounds.unc.edu If you need assistance, please call us at 919.843.9261 or email GrandRounds@sph.unc.edu. Thank you for your continued support, Donna E. Davis, MPH Grand Rounds Project Director

[Brief commentary: Here’s an opportunity for the autism community to be heard. Even if you cannot participate, you can register and respond to survey questions that will require in the input of the parent community. I encourage everyone to let our voices be heard on behalf of our children. -LS.]

The Senate version of the Individuals with Disabilities Education Act was introduced on Thursday, June 12, 2003. You can read a five-page summary of Senate Bill 1248 from National Association of Protection and Advocacy

Meetings will be scheduled at 20-Minute Intervals, from 10:00 am -- noon, and 1 PM - 6 PM on these days: Monday, June 16, 2003 Tuesday, June 17, 2003 - RALLY DAY! Wednesday, June 18, 2003 Thursday, June 19, 2003 Meetings will be in the HELP Committee Conference room, 428 Dirksen Senate Office Building.

To schedule a meeting, please contact Aaron Bishop at 202-224-6770. Please request a specific date and time, and provide the number of people attending, group/organization name, and contact information (email address and phone number) for the person who is scheduling the meeting.

You may also contact Aaron by e-mail at idea_feedback@labor.senate.gov In the subject line of your email, type: “Aaron - IDEA Feedback Meeting.” He will confirm the meeting via email/phone.

The Committee encourages groups with similar interests to schedule meetings together, if possible. Meeting times will be scheduled on a first-come/first-serve basis, and the 20-minute time limit will be strictly enforced.

The Committee will also receive responses to the bill via email at: idea_feedback@labor.senate.gov or by fax at 202-228-0929.

Emailed and faxed responses should be sent to the attention of and titled “Annie and Connie - IDEA Reauthorization Feedback.”

Please note that this email address and fax number will only be available from Thursday, June 12, 2003 through Friday, June 20, 2003.

Learn about the IDEA Rally: http://www.wrightslaw.com/news/2003/idea.rally.htm Your Role If you are the parent of a child with a disability, you represent your child’s interests. You need to stay informed about changes to the law that may affect your child. If you are a teacher or special education service provider, the reauthorized law is likely to affect you and your job. We encourage you to read the Summary of IDEA Senate Bill by NAPAS - this document will help you identify the strengths and weaknesses of the bill. Please share your concerns with the Senators - they seem to be open to feedback from parents. Please distribute this Alert: http://www.wrightslaw.com/nltr/03/al.0616.htm

1. Personal stories are important. Explain how your child, or a child for whom you advocate, will be hurt by the proposed changes. 2. Explain what you like or do not like about the proposed bill. Why do you think part of this bill may harm children or lead to increased costs to society if children with disabilities don’t get the education they need to “prepare them for employment and independent living” (§1400(d) Purposes of IDEA

statute) 3. Keep your letter short. Focus on one or two key points. 4. Offer to follow-up with a phone call or visit. 5. Send your letter by fax or email.

The HELP Committee will receive responses to the bill via email at idea_feedback@labor.senate.gov or by fax at 202-228-0929. Emailed and faxed responses should be sent to the attention of and titled “Annie and Connie - IDEA Reauthorization Feedback.”

IDEA Reauthorization News As the IDEA Reauthorization process unfolds, you need news, progress reports, and other important information. Bookmark the IDEA Reauthorization News page http://www.wrightslaw.com/news/idea2002.htm To learn more about the issues, including reports, surveys and recommendations about how the law may be changed, please visit the IDEA Resources page.

Subscription & Contact Info The Special Ed Advocate is a free online newsletter about special education legal and advocacy issues, cases, and tactics and strategies. Subscribers receive “alerts” about new cases, events, and special offers on Wrightslaw books.

Free Newsletter - Contact Info Pete and Pam Wright Wrightslaw & The Special Ed Advocate P. O. Box 1008 Deltaville, VA 23043 Website: http://www.wrightslaw.com Email: newsletter@wrightslaw.com

Hall of Fame Teacher’s San Jose Domain - Teacher’s Success Rewarded Instructor departs from conventional wisdom by integrating regular, special education students

It is a world of primary colors and exclamation points, of crayons spilling out of their boxes, of fat puzzle pieces that might fit together if you work at them long enough.

This is Larry Statler’s scattered domain. And within its ordered disorder, the 55-year-old San Jose teacher has developed a unique system. At every table and counter and bookshelf, special education students learn side by side with their general-education peers.

The program -- which Statler has named Discovery -- does not entirely conform to the accepted wisdom of special education. But in terms of student behavior and growth, everyone agrees that it works.

It has brought the Santa Teresa Elementary teacher numerous awards, including induction later this month into the exclusive National Teachers Hall of Fame. Nationally, only five teachers a year gain entry into the Emporia, Kan., center.

“Mr. Statler has pretty high standards for his kids -- he demands a lot of them,” Ken Rains said. Rains’ daughter, Kimberly, was a special education student under Statler 20 years ago. Today, she volunteers as an aide in his classroom.

“It’s been just a great experience.” Statler calls his approach to teaching the “shining star theory,” which he applies to all students. “If you have high expectations, they’re going to reach for them.” Discovery -- with students from kindergarten through second grade dispersed in one large space -- places the children in small groups, based partly on their constantly changing levels of ability. Each grade has its own teacher, and several aides and volunteers are there to assist. Statler oversees the entire process.

Parents can choose whether to send their children to Statler’s program or a more traditional classroom that segregates the special education students from their general education peers. Discovery has gained much renown throughout the Oak Grove school district, and it’s popular among parents of both types of students.

“I like that they go at their own pace,” says parent and weekly volunteer Debbie Martinez. Her son Jared is in the first grade. “Also, I like that he’s exposed to others. Some kids might make fun, or get scared of them. But Jared sees them as just another person.” The most difficult and challenging students in the district -- including those who suffer from retardation, autism and speech and hearing difficulties -- come to Statler’s program. Although it’s a popular theory in education that autistic students should not be exposed to distractions, the Discovery program places them smack in the middle of Discovery’s controlled chaos.

Unconventional “Some of it flies in the face of what a lot of experts recommend,” Statler says. But he believes the special education students “learn more from the modeling of their peers and classmates.” Statler constantly circulates among the pods of teachers and students. He is soft-spoken and genial, but no pushover. When he spots a student doing nothing in particular, he firmly shepherds him to a table with a puzzle.

Later, he likens his job to that of an orchestra director. “We call it `the hum.’ As soon as someone is out of tune, I can hear it.” `A-B-Sea’ The special education students are included in every activity, including a popular, annual collaboration with the Children’s Musical Theater of San Jose. This year, the class -- which had studied oceanography all year, transforming one entire adjoining room into a mock-sea -- took part in a show called “A-B-Sea.” The effect of all this on the students is evident in the class. Students work busily, side by side, with a minimum of fuss. On this June day, one group is writing a story.

He happens to have a mostly pink, almost-new eraser. He looks at it for a moment, knowing full well that at the end of the school year, almost-new erasers do not exactly fall out of the sky or jump from the A-B-Sea.

He hands it over without a word; then he trustingly turns back to his own work as she erases.

“This is the best learning experience I ever had,” says Kim Makin, 20, a college student who returns to volunteer when she has free time. “I made some of the best friends I ever had here. Everyone was so nurturing.” One reason the room is so jam-packed with stuff is that Statler is an inveterate grant-application-writer. “I spend part of my Christmas and spring and summer vacations writing grants,” he said. “We’re always looking for ways to obtain funding.” That’s how the Hall of Fame nomination came about. “We nominate each other for awards -- really, mostly to see if we can get funds for the program.

“But holy mackerel, when you actually get one, it’s kind of shocking.” The hall has honored 60 teachers since its start in 1992, including Jaime Escalante, the Los Angeles math teacher profiled in the movie “Stand and Deliver.” Induction brings $3,000 in cash and materials, and a $1,000 scholarship for a district student who plans to pursue an education degree.

Statler seems not quite sure what to make of the honor. “To be alongside Jaime Escalante,” he says. He shakes his head at the thought; then adds, “I feel very lucky.” His co-workers and students seem to feel equally lucky. Amid the colors and confusion of the classroom, they create their happy hum. Above them hangs a large banner. If they look up -- and sometimes they do -- they can read it any time. It says, “Children Like Flowers Bloom At Different Times.” And if you step back and look at the bobbing colors and gentle motion, the figures could remind you of one whole fertile garden.

Parent Autism Research Funding Group Commits Nearly $5 million National Alliance for Autism Research’s 2003 Awards Include 35 Pilot Studies & 15 Fellowships and Training Programs

The National Alliance for Autism Research (NAAR) has recently committed nearly $5 million to fund 50 research grants and fellowships in the U.S., Canada and Europe focusing on a wide range of disciplines, including the neurosciences, language and communication, behavioral sciences, genetics and epidemiology.

The NAAR Board of Trustees approved this year’s funding commitment following the seventh annual meeting of the organization’s Scientific Advisory Board. NAAR’s 2003 research commitment totals $4.92 million and will fund 35 pilot studies, 13 pre- and post-doctoral fellowships and two training programs.

“This year, we received a total of 170 requests for funding, which represents an 75% increase in the amount of total requests we received compared to last year,” said Andy Shih, Ph.D., director of Research and Programs at NAAR. “It is encouraging to see that the scientific community is recognizing NAAR as a resourceful partner for the development of world class autism research projects.”

NAAR-funded pilot studies and fellowships have proven to be a sound investment. To date, research initially funded by NAAR has made a dramatic impact on the autism research landscape in North America and Europe and has been leveraged to attract more than $37 million in autism research awards by the National Institutes of Health and other governmental sources.

NAAR’s 2003 research commitment represents an increase of approximately $800,000 over last year’s commitment. NAAR funds autism research projects based on the recommendations of its prestigious Scientific Advisory Board and its Lay Review Committee.

NAAR has been able to again increase its funding commitment to autism research due to the remarkable support of its donors and the amazing success of its Walk F.A.R. for NAAR autism research walkathons and the dedicated volunteers who bring these events to life.

“We are thrilled to announce our 2003 research awards and are grateful to the ever-growing number of supporters who dedicate their talents and resources to our organization,” said NAAR President Prisca Chen Marvin. “We remain committed to accelerating the pace of research and elevating the caliber of the science, as it represents the best hope for our loved ones and for future generations.”

Including the 2003 research awards, NAAR has now committed $14.9 million to directly fund 169 research grants and fellowships worldwide - more than any other non-governmental organization in the U.S.

Brandeis University (Waltham, MA) Regulation of Cortical Synaptogenesis by Basal Forebrain Cholinergic Neurons.

The Institute of Psychiatry at King’s College (London, England) Speech & Language Impairments and Autism Spectrum Disorders: A Twin Study of the Links Two-year award - $119,083 Patrick Bolton, Ph.D.

The Institute of Psychiatry at King’s College (London, England) Event Related Potential & Behavioral Investigations of Face Processing in Individuals with Tuberous Sclerosis and Autism Two-year award - $113,011 Kenneth Campbell, Ph.D.

Children’s Hospital Research Foundation (Cincinnati, OH) Genetic Control of Mammalian Amygdalar Development Two-year award - $120,000 Alice Carter, Ph.D.

University of Massachusetts (Boston, MA) Maternal Sensitivity, Joint Attention and Gains in Language Acquisition in Toddlers Diagnosed with Autism Two-year award - $103,096 Manuel Casanova, M.D.

Medical College of Georgia (Augusta, GA) Macroscopic Correlates of Minicolumnar Abnormalities in Autism Two-year award - $120,000 Susan Christian, Ph.D.

University of Chicago (Chicago, IL) Identifying Small Chromosomal Rearrangements in Autism Using Microarrays Two-year award - $118,845 Antonio Convit, M.D.

New York University School of Medicine (New York, NY) Social Cognition and Brain Volumes in Asperger Syndrome Two-year award - $112,900 Thomas Cook, Ph.D.

Rutgers University (Piscataway, NJ) Placental Metabolism & Fatty Acid Homeostasis in Fetal Imprinting of Autism and Autism Spectrum Disorders Two-year award - $120,000 Michael Cuccaro, Ph.D.

Duke University Medical Center (Durham, NC) Retrospective Association Analysis of Children with Idiopathic Autism Spectrum Disorders Treated with Fluoxetine Two-year award - $109,703 Mirella Dapretto, Ph.D.

University of California at Los Angeles (Los Angeles, CA) Language & Prosody in Autism: Evidence from fMRI Two-year award - $120,000 Michelle Dunn, Ph.D.

Albert Einstein College of Medicine (Bronx, NY) Understanding Cortical Auditory Processing Abnormalities in Children with Autism Two-year award - $119,912 Michelle Dunn, Ph.D.

Albert Einstein College of Medicine (Bronx, NY) Mapping Lexical Organization in Children with Autism Two-year award - $119,912 Nicole Gage, Ph.D.

University of California at Irvine (Irvine, CA) MEG Investigations of Cortical Auditory Processing in Children with Autism Two-year award - $109,788 H. Hill Goldsmith, Ph.D.

University of Wisconsin at Madison (Madison, WI) A Birth Register-based Twin Study of Autism Spectrum Disorders Two-year award - $118,910 Eli Hatchwell, Ph.D.

Cold Spring Harbor Laboratory (Cold Spring Harbor, NY) Genomic Copy Number Variation in Autism One-year award - $60,000 Karl Herrup, Ph.D.

Case Western Reserve University (Cleveland, OH) The Engrailed-2 Mutant as a Model of the Neuropathology of Autism Two-year award - $120,000 Laura Hewitson, Ph.D.

University of Pittsburgh (Pittsburgh, PA) Autism in Primates: Genetics vs Environment Two-year award - $118,825 Jana Iverson, Ph.D.

Johns Hopkins School of Medicine (Baltimore, MD) Genetic Mutations Associated with Autism in Unexplored Regions of FOXP2 One-year award - $56,063 James Millonig, Ph.D.

University of Medicine & Dentistry of New Jersey/Robert Wood Johnson Medical School (Piscataway, NJ) Studying Mouse Cerebellar Development as a Tool to Identify Autism Susceptibility Genes Two-year award - $120,000 Sherie Novotny, M.D.

Mt. Sinai School of Medicine (New York, NY) Galantamine vs Placebo in Childhood & Adolescent Autism Two-year award - $118,526 Payam Rezaie, Ph.D.

The Open University (Milton Keynes, England) Assessment of the Glial Response Within the Cerebral Cortex in Autism Two-year award - $119,973 Timothy Roberts, Ph.D.

University of Toronto (Toronto, Ontario) MEG Correlates of Linguistic Processing at and Below the Word Level in Autism Two-year award - $119,918 Peter Scheiffele, Ph.D.

Columbia University (New York, NY) Frequency & Functional Characterization of Neuroligin Mutations Two-year award - $119,998 Stephen Sheinkopf, Ph.D.

Brown Medical School (Providence, RI) Vagal Tone & Social Behaviors in Children with Autistic Disorder Two-year award - $116,952 Elise Temple, Ph.D.

Cornell University (Ithaca, NY) Neural Mechanisms Underlying “Theory of Mind”: fMRI Studies of Normally Developing and Autistic Children Two-year award - $112,916 Poul Thorsen, M.D., Ph.D.

NANEA at Department of Epidemiology and Social Medicine/Aarhus University (Denmark) Exposure to Pharmaceuticals in Pregnancy & Development of Autistic Disorder Two-year award - $118,454 Jochen Triesch, Ph.D.

University of California at San Diego (La Jolla, CA) The MESA Project: Modeling the Emergence of Shared Attention Two-year award - $120,000 Michael Ullman, Ph.D.

Georgetown University (Washington, DC) Neurocognitive Correlates of Language in Autism Two-year award - $118,575 John Welsh, Ph.D.

Autism: Electrical Synapses, Neuronal Synchrony & Cognition Two-year award - $101,639 Justin Williams, M.B.B.S., MSc University of Aberdeen (Aberdeen,

England) Functional Neuroimaging Studies of Action, Facial and Object-directed Imitation Two-year award - $119,977 Peter Zandi, Ph.D.

Johns Hopkins School of Public Health (Baltimore, MD) Maternal-fetal Incompatibility and Autism Risk One-year award - $59,998 Xiaoxi Zhuang, Ph.D.

University of Chicago (Chicago, IL) Behavioral Effects of Hyper- and Hypo-Serotonergic Function in Transgenic Mouse Models Two-year award - $120,000 Lonnie Zwaigenbaum, M.D.

McMaster University (Hamilton, Ontario) Investigating the Emergence of Familial Traits in Autism Two-year award - $120,000 Mentor-Based Fellowships & Autism Training Programs - $991,000 Pre-Doctoral Fellowships Centre for Molecular Medicine & Therapeutics, Vancouver, British Columbia

GABA-ergic Genes in Autism University of Massachusetts, Boston, MA Mentor: Alice Carter, Ph.D.

Fellow: Megan Sullivan Multiphoton Investigation of Sensory Encoding in the Mammalian Cerebellum Post-Doctoral Fellowships Cambridge

Quantitative Neuroanatomical Training: New Methods to Reveal Structural Changes in the Cortex of Individuals with Autism The Institute of Psychiatry at King’s College, London (England) Mentor: Francesca Happe, Ph.D.

A Language Processing View of Pragmatic Impairments in Autism Spectrum Disorders University of Medicine & Dentistry of New Jersey/Robert Wood

Regulation of the Purkinje Cell, Dendritic Growth, Spine Formation and Synaptogenesis Vanderbilt University, Nashville, TN Mentor: Wendy Stone, Ph.D.

Developing a Downward Extension of the STAT Autism Training Programs NAAR is collaborating with the Canadian Institute of Neurosciences, Mental Health and Addiction to co-sponsor a pair of six-year, interdisciplinary autism training programs, known as the “Training Programs in Autism

as a co-sponsor of this unique program - the first of its kind in Canada to focus on autism.

More than 1,500 families are planning to bring legal action against manufacturers of the MMR vaccine, despite the High Court ruling last week that ordered two mothers to give their children the jab. A class action against GlaxoSmithKline, the largest manufacturer of the vaccine, Aventis Pasteur and Merck and Co. is being prepared by solicitors acting for parents who believe their children were harmed by the immunisation.

The prospects for civil action appear not to have been dented by the controversial High Court ruling last Friday, which resulted in two mothers being ordered to let their girls have the MMR jab. Their fathers want them to have the immunisation.

One of the mothers said another freedom had been ‘eroded’ after Mr Justice Sumner decided to go against her and another mother’s wishes. In a statement released yesterday, the mother said: ‘It’s outrageous that in a free society a judge could make such a decision.

‘This ruling makes it possible for officials to take my child and inject her with MMR jabs against my beliefs and my will - against the will of her mother, who lives with her, cares for her and looks after her. And for what?’ During the High Court hearing, Mr Justice Sumner said he was aware that the civil trial was pending next April, and added that his ruling should not be seen as a general approval of immunisation: ‘It does not mean that, at another hearing, a different decision might not be reached.’ The parents, many of them supported by legal aid, claim that, before their children were vaccinated, they were developing normally, but after the injections suffered health problems, including autism and bowel disorders.

‘Curious Incident of the Dog in the Night-Time’: The Remains of the Dog Math and Physics? A Cinch. People? Incomprehensible. By Michiko Kakutani

This new book (fiction) has a 15-year old with Asperger’s/autism as the narrator.

Christopher’s book seemingly has a nice tidy ending, as he would have wished -- horrified as he is of indeterminacy. But this tidiness is an illusion, as the gulf between Christopher and his parents, between Christopher and the rest of us, remains immense and mysterious. And that gulf is ultimately the source of this novel’s haunting impact. Christopher Boone is an unsolved mystery -- but he is certainly one of the strangest and most convincing characters in recent fiction.

Christopher’s mind is logical and literal in the extreme; early on he suggests that metaphor is a form of lying, pointing out that very few people actually have skeletons in their closets or apples in their eyes. “When I try and make a picture of the phrase in my head it just confuses me because imagining an apple in someone’s eye doesn’t have anything to do with liking someone a lot and it makes you forget what the person was talking about.” Christopher’s inability to tell lies is one of the many reasons he has difficulty engaging in, or understanding, normal social intercourse. And his distaste for falsehood is one reason he doesn’t like novels, except for murder mysteries, which are essentially puzzles, Sherlock Holmes being his literary hero -- though he has problems with Arthur Conan Doyle, Holmes’s creator, who became involved with spiritualism later in life. Christopher’s mind is purely scientific.

Fifteen-year-old Christopher Boone of Swindon, England, seems, at first glance, an unpromising narrator for a novel -- a curious hybrid of reliable and unreliable. By his own admission he doesn’t like fiction. He is incapable of lying, of understanding metaphor or jokes. He’s also incapable of reading any but the most basic of human facial expressions. “Usually people look at you when they’re talking to you. I know that they’re working out what I’m thinking, but I can’t tell what they’re thinking. It is like being in a room with a one-way mirror in a spy film.” His own range of emotional response is so limited he makes the repressed butler in Kazuo Ishiguro’s “Remains of the Day” -- a novel that this one resembles in its elegant economy of means -- seem like Zorba the Greek.

Haddon manages to bring us deep inside Christopher’s mind and situates us comfortably within his limited, severely logical point of view, to the extent that we begin to question the common sense and the erratic emotionalism of the normal citizens who surround him, as well as our own intuitions and habits of perception.

If all this sounds somewhat grim and clinical, it’s not. Christopher’s skewed perspective and fierce logic make him a superb straight man, if not necessarily a stellar detective. In the course of interrogating one of his neighbors, while waiting impatiently for her to cut the chitchat, he

observes: “Mrs. Alexander was doing what is called chatting, where people say things to each other which aren’t questions and answers and aren’t connected. . . . I tried to do chatting by saying, ‘My age is 15 years and 3 months and 3 days.’ “ His inability to interpret basic social cues results in great moments of deadpan comedy, with strangers as well as with his patient, long-suffering father.

Midway through the book, Christopher’s quest for the dog’s murderer becomes a search for his mother, who his father has told him is dead. His solo journey from Swindon to London is, for him, a terrifying leap into the unknown, as suspenseful and harrowing as anything in Conan Doyle. He literally sees everything around him and is unable to edit the onslaught of sensory data in a new environment. And he is afraid of strangers and ill equipped to ask for their help.

One of the subtle ironies of the book, given the evolution of the murder mystery detective toward the tough guys of Hammett and Chandler, is that young Christopher is ultimately far more hard-boiled than any gumshoe in previous detective fiction; unlike Sam Spade or Nick Charles, he has no sentimental streak, no underground reservoir of emotional identification with other human beings -- although he is fond of dogs.

The book’s jacket copy identifies him as an autistic savant, but Christopher tells us all we need to know about his condition without reference to medical terminology -- just as well, since the term “autism” encompasses a variety of symptoms and behavioral problems that are still baffling behavioral scientists. The American Psychiatric Association definition includes “problems with social interaction, verbal and nonverbal communication and a restrictive repertoire of activities and interests.” The problems of autism are related to how the brain processes, organizes and retrieves information; Christopher compares his own brain to a computer that is easily overloaded by multitasking. He has a photographic memory and is capable of working out complicated factoring problems in his head but is so overwhelmed by unfamiliar visual or verbal stimuli that sometimes he shuts down, holding his hands over his eyes or his ears while he groans or screams. He abhors physical contact, new environments and the colors yellow and brown.

The difference between literature and its imitations might be defined in any number of ways, but let’s be reckless, even elitist, and propose that a literary novel requires new reading skills and teaches them within its pages, while a conventional novel -- whether it is about lawyers or professors or smart single girls -- depends on our ingrained habits of reading and perception, and ultimately confirms them as adequate to our understanding of the world around us. Mark Haddon’s stark, funny and original first novel, “The Curious Incident of the Dog in the Night-Time,” is presented as a detective story. But it eschews most of the furnishings of high-literary enterprise as well as the conventions of genre, disorienting and reorienting the reader to devastating effect.

When Christopher discovers his neighbor’s poodle dead, skewered on a pitchfork, he sets out to solve the mystery and to write a true account of his detective work. In so doing he inadvertently stumbles upon the messy, illogical, emotionally complicated secrets of his parents and their neighbors. And even as he is finally forced to come to some limited accommodation of this knowledge, he makes a kind of plausible case for his own, ostensibly crippled worldview. Perhaps the greatest mystery here is whether Christopher is capable of change -- a question that goes to the heart of certain deeply held convictions about character.

It seems quite simple, but I have found in my practice not many parents are aware they can request a “titer” to be drawn on their children to determine if immunity is present. This is a blood test. If immunity is present, then there is no need to receive the vaccination.

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DISCLAIMER: All information, data, and material contained, presented, or provided here is for general information purposes only and is not to be construed as reflecting the knowledge or opinions of the publisher, and is not to be construed or intended as providing medical or legal advice. The decision whether or not to vaccinate is an important and complex issue and should be made by you, and you alone, in consultation with your health care provider.