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Autism study prompts fears over mystery environmental factor
By Lorraine Fraser, Medical Correspondent
(Filed: 18/05/2003)
 

The number of children suffering from autism has doubled in California in the past four years, according to a new study which has fuelled worldwide concerns that an environmental factor may be making them susceptible to the condition.

British doctors have reacted with alarm to the research, and the findings will be seized on by campaigners who believe that the triple MMR vaccine is causing bowel disease and autism in children. Such claims have consistently been denied by the Department of Health.

The latest study, by health authorities in California, shows that autism cases there have leapt by an "unprecedented" 97 per cent over the past four years, with 10,000 new cases emerging between December 1998 and December 2002.

The findings are particularly significant because California has had a rigorous system of diagnosing autism cases. In Britain, claims that autism levels are also on the increase have been countered by arguments that this simply reflects a greater willingness among doctors to diagnose the condition.

In their findings published last week, Californian health officials said that autism cases had increased six-fold over the past 15 years. They added that even this "dramatic" rise might be an underestimate and the trend appears to be accelerating.

Some doctors fear a smiliar pattern is happening in Britain, but that it is going undetected becauser the lack of a central register of autism cases and standard criteria for diagnosis make it difficult to analyse trends. It is estimated that some 500,000 people in Britain have some characteristics of autism: of these, around 100,000 have serious difficulties, including learning problems.

One study of GP records in the UK conducted by James Kaye, a specialist from Boston University, found that diagnoses of autism increased seven-fold between 1988 and 1999. The researchers ruled out any link with MMR, however.

Dr Andrew Wakefield, the British gastroenterologist who sparked controversy by suggesting in a scientific paper that the MMR jab - which contains live measles, mumps and rubella virus - could be linked with autism and bowel disease, said that the figures from California were "terrifying".

He said: "The diagnostic criteria for autism have been the same there since 1994, so the idea that this rise in autism is due to better diagnosis is redundant, as is the claim that this is a purely genetic disease." The Californian report gives no information on what might be responsible for the sharp rise in autism cases in the state, where the MMR triple vaccine, was introduced in the early 1980s.

While not suggesting causes, the Californian research is the most thorough attempt by any community to analyse autism trends. The data suggests that the condition, once considered extremely rare, is already as common as childhood cancer in California: if the trend continues it will be as common as epilepsy by 2006.

"We are the canary in the coal mine - the warning for others," said Rick Rollens, the secretary of the Autism Society of America. "The system in California is unique in that it requires a professional diagnosis of autism, so we can really keep track of what is going on. The rate of increase is unbelievable. When you look at the real numbers, you are looking at about 2,700 cases statewide in 1987: by the end of 1998 there were over 10,000 cases, and by 2002 it was over 20,000 cases.

"California is now adding on average 11 new children a day, seven days of the week, to this diagnosis. The department has just released an update on the first quarter of 2003 and they added another 832 children over those 85 days."

Autism is a life-long disorder, affecting four times as many boys as girls, in which the sufferer's ability to communicate and interact socially is severely impaired. Although autism was largely unknown 20 years ago, the Department of Health in and medical authorities in the USA deny any link with vaccinations or the three-in-one measles, mumps and rubella jab. They say that claims of a link to MMR have undermined parents' confidence in immunisation and put children at risk.

Some specialists argue that the increase is merely a reflection of doctors' increased preparedness to diagnose autism. Dr Lorna Wing, an adviser to the National Autistic Society, said: "Whether there is a genuine rise in incidence remains an open question."

However, an investigation by Robert Byrd, an epidemiologist at the MIND Institute at the University of California, has concluded that the rise is real. A spokesman for the Department of Developmental Services, which is based in Sacramento, also said last night that improved awareness among parents and professionals could not explain the jump in cases.

As well as the sharp increase in numbers, the analysis shows that children are being diagnosed with autism younger than ever before. In 1987, only 15 percent of autism sufferers in the state were aged five to nine: by 2002, some 37 per cent were in this age group. The study also found that far fewer cases now show serious mental retardation, raising the possibility that a new type of autism is becoming apparent.

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