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AUTISM FIRST STEPS
AUTISM DAILY NEWSLETTER
Wednesday December 12, 2001
INDEX:
* Fighting the cruelty and
prejudices that place so many obstacles in the
way of the disabled
* Recognizing Psychosis in Nonverbal Patients With Developmental
Disabilities
* CAUCUS for Autism Meeting
* IMMEDIATE CALL FOR ACTION FROM THE INTERNATIONAL HYPERBARIC
MEDICAL ASSOCIATION!
* "Status of Education Integration, State by State"
******************************
Fighting the cruelty and
prejudices that place so many
obstacles in the way of the disabled
Independence for the
disabled: The Independent Christmas appeal
By Paul
Vallely and Cahal Milmo 11 December 2001
Emma at school in London
Leading
article: Give generously to help change attitudes
How
to donate
It was dark outside. But Emma's eyes were not on the cold night air at the
pleasant townhouse she shares with her mother and father in the north London
borough of Camden. Instead, as she sat in her special, wheeled dining-chair,
her eyes were transfixed by the TV screen on which a favoured video, The
Wrong Trousers, was replaying for the umpteenth time. She did not blink.As
she watched, she hungrily devoured her favourite meal, spaghetti with tomato
sauce covered in what she calls "Parma and cheese". After eating she
shifted across to the computer and loaded a succession of computer games before
fairly swiftly announcing, in a one-word demand, that she wanted her mother to
help her upstairs to play pool.The snooker table dominates her little bedroom.
She plays on it for two or three hours a night; her obsession with it has
brought enormous improvements in her co-ordination and motor-skills. Leaning on
the table she has even learnt to take some steps unaided.Emma was a premature
baby who, at birth 10 years ago, weighed 1lb 6oz. As the months and years went
by her parents realised her birth complications had not just produced some
paralysis to her left arm and leg but also an effect on her brain, producing
some of the impacts of epilepsy, cerebral palsy, autism and sensory maturation
difficulties.Despite all that, or perhaps because of it, Emma, a pretty little
girl with her hair in pink-banded bunches, is a happy child. But 3,000 miles
away there was a different story.That same night in a two-room, windowless, mud-brick
hut in the dusty West African provincial town of Bobo-Dioulasso , in Burkina
Faso, another little girl was telling her tale. Coulibaly is disabled too. She
lost her leg in an accident with a rifle when she was two. But there was a
melancholy about her.Coulibaly, her hair combed into dreadlock plaits above her
long, thin face and expressive eyes, was showing off in the communal courtyard
in front of the bedroom she shared with her mother, brother and sister.
Supporting herself on her crutch, she was playing her favourite game,
hopscotch, and was, she said, hoping that for tea her mother would have been
able to afford her favourite food, canned tuna. Girls this age – Coulibaly is
13, and Emma nearly 11 – are keen on "favourite" things.Emma will
almost certainly never meet Coulibaly. They live in worlds separated by a vast
chasm of wealth and expectation. It is a gap as wide as the geographical
distance that disjoins them. Yet across that great divide is a bond that ties
together the way the two girls experience life. For though one lives in
grinding poverty in the remote sub-Saharan savannah and the other in the
relative affluence of the Western world, what the girls have in common
dominates both their lives.But the pair defy stereotypes. "Sometime people
think I feel sad because I look at the other children jumping and cycling, but
I don't," Emma says through her mother. "I really like to see other
children jumping and running about and being silly. It makes me
laugh."Coulibaly says: "I'm not allowed sport lessons. They gave me a
dispensation even though I want to take part. It's a pity because I would like
to be in a running race. I can't think of many good things about being
handicapped."In part it is the physical rigour of Coulibaly's existence
that gets her down. Once she could rise at 7am to get to school. But the
neighbourhood taxi broke down, and there is no money to fix it. Now she has to
get up at 5.30am and to reach the Lycée Provinciale she laboriously walks the
three-mile journey along the ochre roads of Burkina Faso, using a crutch to
support her body in place of her shattered right leg. "Sometimes I'm late
for my lessons," she says. "That makes me cry."It makes her
mother, Bernadette, 44, weep too, with frustration at the necessity of her daughter's
daily slog. Life for a handicapped child in the world's third poorest country,
she adds, is "cruel, pitilessly cruel". The cruelty is not merely
physical. Some of her school fellows are nasty, she says. "They call me
One Foot and say I'm bad. I wouldn't want to be in a different school with all
handicapped children. But here I do get mocked and teased."That phenomenon
may be more indirect in the West but it's still there. "It's not the lack
of wheelchair ramps which is the real problem for children like Emma,"
says her mother, Christina "It's the attitude of other people, the
teachers and education specialists who discriminate against her, and the
secondary schools who ask almost as a condition of admission, 'Does your child
do this? Can she do that?'"Then there are those members of the public who
arrogate to themselves the right to make scathing comments in supermarkets
about the 'bad behaviour' of children with disabilities or utter loud asides
like, 'Fancy bringing a child like that to a restaurant like this'. It's an
indignity. Emma has a right to belong. And yet we have to fight for everything
she needs."There is still, almost everywhere, an aura of shame that
lingers around disability, and which finds an echo in the distaste and
hostility with which the able-bodied world greets those with physical and
learning difficulties. Again the starkest manifestation are in the Third World.
There is a widespread belief there, as in many parts of Africa, that a disabled
child is the result of a spell by a witch. "For me, having a handicapped
child is not something to be ashamed of," Bernadette says. "But they
tell me I am cursed."The reaction is more subtle in the West but, here
too, there is the same desire to shun those with a disability. "There are
those who treat you as if you were contagious," says Emma's mother,
Christina. "The relatives who say, 'It's not from our side of the family'
or the friends who ask whether it might be something you did or took during
pregnancy."Coulibaly and Emma have something else in common. Both have
been helped by the two small charities that The Independent has chosen
to be the recipients of money raised from readers in our Christmas Appeal this
year.In Burkina Faso, Coulibaly and her mother have been supported by Action on
Disability and Development (Add). The charity also runs a co-operative that
repairs hand-driven tricycles, and trains disabled women in skills to avoid
them being driven to prostitution in the Aids-riven country.Add also works with
landmine victims in Cambodia, where one in 250 of the population is disabled.
It helps a co-operative of blind women farmers in Uganda who have been expelled
from the individual communities for being "cursed by witches". It has
set up income-generation projects in Lesotho, Mali and Bangla-desh. It presses
for disabled people to be included in mainstream decision-making in Zambia,
Ghana, Sudan and Zimbabwe and works with disabled self-help groups in India.In
Britain, Emma and her family have benefited from services provided by Kids,
including a home-learning pro- gramme and developmental play nurseries which,
step-by-step, teach children with physical and learning difficulties and skills
other children pick up instinctively by observation.Kids also offers respite
care by sending skilled workers into the home–- Emma has a helper in
developmental play 10 hours a week – and runs an educational advice service to
help parents lobby local education authorities for their rights. It runs
support groups for the siblings of disabled children as well as family support
services and a forum for disabled children, some of Britain's most
under-consulted people, to air their own views on their care.Over the weeks, The
Independent will publish daily accounts of the detailed work Add and Kids
do. What will emerge is an in-depth look at a society, at home and abroad,
whose attitudes and prejudices are far greater obstacles than anything which
can be overcome with a wheelchair ramp.Christina says: "One of the great
myths about disability is that children with these problems are incapable of
improvement. They are just written off." She was 38 when Emma was born and
the intervening years have produced a remarkable change in her. "Early on,
I suppose, you want your child to be perfect, to redeem your own imperfections.
In a world that values people for being beautiful, clever, rich, good talkers
it is quite a learning curve to realise we should value none of these things
when it comes to considering the worth of a human being."You realise
people have to be allowed just to be. I wouldn't say, 'I wouldn't have
her any other way', because her disabilities create difficulties for her. But
she is a source of never-ending pride and joy. I've realised our daughter
doesn't have to go to Oxford for us to love her."Her husband, David, says
quietly: "I don't think I was aware you ever had these negative
feelings." Christina says: "I felt it was shameful and toxic and kept
it to myself. But Emma has handed me a purpose and grounded me. I don't have
any existential questions any more. And I have discovered skills and strengths
I never dreamt I had." Also from the This Britain section.
How
telling horror stories helps parents to cope
http://news.independent.co.uk/uk/this_britain/story.jsp?story=109443
******************************
Recognizing
Psychosis in Nonverbal Patients With Developmental Disabilities
by
Ruth Ryan, M.D.
Psychiatric Times December 2001 Vol. XVIII Issue 12
People with developmental disabilities (e.g., mental retardation, autism) are
vulnerable to the same psychiatric conditions as the general population
(Szymanski et al., 1990). Fortunately, for the most part, DSM-IV criteria can
be adapted easily to permit accurate diagnosis (Aman, 1991; Ryan, 1994b).
However, these individuals may exhibit some unusual behaviors that seem
indicative of psychosis yet are actually almost never reflective of psychosis.
In addition, even when indications of psychosis are present, epidemiological
issues, such as comorbid conditions, may lead to a different final diagnosis
than otherwise would be expected.
Symptoms and Indicators
In patients who do not communicate verbally, there are many cues that can lead
a psychiatrist to recognition of psychosis. The following list was compiled
from observing patients with psychosis who were able to communicate verbally.
After observations, patients later explained the psychosis content. This
information is valuable in that the results might be extrapolated as possible
indicators in people who do not use verbal communication.
*Patient stares to the side, nods and gestures as though listening to a
conversation others do not hear. It is important to note that some people have
been trained to do this or have learned to do this to occupy themselves
("self-talk"). If the patient seems to be in complete control of this
activity or is using this activity for self-soothing purposes, the presence of
true psychosis is less likely.
*Patient seems to be shadow boxing with unseen others (unless, as in above, the
patient is in total control of the activity or doing so for soothing purposes).
*Patient brushes unseen material off themselves. Conditions that could produce
paresthesias are more common in individuals with developmental disabilities
than is psychosis and should be considered first.
*Patient wears multiple layers of clothing. It is important to note that some
people do this to self-treat sensory integration deficits. In addition, some
people learn this as a coping skill in some congregate facilities, as a way to
keep one's possessions.
*Patient covers eyes or ears as though shutting out stimuli, with the caveat
that this can be an expression of anxiety or physical pain.
*Patient places unusual wrappings (e.g., feminine hygiene products) around
their ankles, sleeve ends, ears or collars, also keeping in mind this could be
an expression of anxiety or physical pain.
*Patient glares with an out-of-context, angry or intensely fearful expression
at strangers or previously liked others.
*Patient wraps bandannas or extra scarves around the head and ears when this is
not congruent with the weather or the rest of the person's clothing.
*Patient wears costumes that are associated with a false role (e.g., wearing
full firefighter gear when the patient is not a firefighter); caveat: the
person may be expressing a wish rather than a false belief.
*Patient inspects food and beverages with new and out-of-context intensity.
*Patient grimaces or winces as though smelling or tasting something foul.
Similarly, there are symptoms that are just as important to recognize which are
almost never indications of psychosis. They include the following:
--Volitional self-talk.
--Vocal tics. Tourette's syndrome and other tic disorders are much more common
in individuals with developmental disabilities than in the general population.
When someone is making nonsensical noises, this possibility should be
considered.
--Phenomena that are modeled directly from other people.
--Phenomena that the person can start and stop at will.
--Phenomena thought to be purely taught by circumstance or program.
(Consultation with a behavior specialist and completion of a functional
analysis [this refers to the process used by modern behaviorists, not a listing
of the person's skills] can make this distinction.)
--Displays of aggression, agitation, shouting or self-injury.
--Epidemiology Considerations
Between 70% and 85% of people with developmental disabilities referred for
psychiatric consultation have one or more untreated, undertreated or
undiagnosed medical problems influencing their behavior (Ryan and Sunada, 1997;
Sundheim et al., 1998). Many of these conditions can produce delirium, which
may include psychosis (Ryan et al., 1998). Therefore, it is essential to
conduct a thorough search for secondary medical conditions that contribute to
or possibly cause the apparent psychosis (Szymanski et al., 1990).
Between 60% and 100% (depending on sample) of individuals with developmental
disabilities have experienced trauma, usually repeated incidents of abuse
(Sobsey, 1994). Since many symptoms that resemble psychosis are actually
dissociative phenomena, careful evaluation for posttraumatic stress disorder and
other sequelae of trauma should be considered.
Due the nature of their disabilities, patients commonly develop habits that
could lead to suspicious behaviors. For instance, some people were given
medications hidden in their foods; this may cause them to inspect food with
extreme intensity. Others touch themselves in unusual ways or look at people
with suspicion or anger in relation to flashbacks. Careful assessment of the
rest of the patient's symptoms should assist with the diagnostic distinctions.
Mood disorders with psychotic features are more common in people with
developmental disabilities than are conditions in the schizophrenia spectrum
(Szymanski and Crocker, 1989). Support staff and/or family members may not be
attuned to monitor symptoms such as sleep problems, appetite problems and other
neurovegetative signs of mood disorders; and the examiner will need to probe
very carefully to establish these criteria.
Individuals with pervasive developmental disorders and autism often have
sensory integration deficits that can produce a variety of physical
discomforts. Some people self-manage these discomforts with unusual gestures,
postures or withdrawal. Evaluation of sensory integration status by an
occupational therapist can help avoid misattribution of these symptoms to
psychosis (Sundheim et al., 1998).
When updated criteria are used, it appears that schizophrenia spectrum
conditions are as rare in this population as in any other. Thus, even if the
presence of psychosis is established, schizophrenia may still be the least
likely diagnosis. By observing problems with initiation, gating deficits and
affect inconsistent with content, clinicians can clarify the diagnosis and the
long-term treatment plan. Specific clinical questions might include ascertaining
if the person has a hard time getting started in preferred familiar activities,
if the person appears to have more confusion and psychosis in preferred
stimulating situations, or if the person seems to laugh at things that are
frightening or gruesome. Individuals with schizophrenia tend to have more
symptoms of psychosis in situations that are stimulating, even if it is
something the person likes. If the symptoms resembling psychosis occur more
often in low stimulation situations or in association with reminders of
previous trauma, dissociation may be the more accurate diagnosis (Ryan, 1994a).
Olfactory or gustatory hallucinations are much more common in certain forms of
epilepsy and posttraumatic stress disorder than in schizophrenia spectrum conditions
(Neppe and Tucker, 1988; Ryan, 1994b). One man, for example, was known to
repeatedly wrinkle his nose and look at others as though smelling flatus. It
was eventually discovered that he had complex partial seizures with a temporal
lobe focus and ictal violence. Treatment of the epilepsy produced a remission
of ictal violence as well as a remission of this frequently seen gesture.
Certain physical gestures can be easily mistaken for psychosis. A person who
bats out with their hands as though something were there might be experiencing
visual hallucinations; in my clinical experience, however, the last several
times this was a symptom, the cause turned out to be uncorrected myopia.
Similarly, individuals who wave fingers in front of their eyes or bang their
heads are more likely to have headaches or depression than psychosis.
Of course, it is reasonable to attempt to interview all individuals, even those
who do not use speech. Many understand more than they can express and can give
very helpful answers via gestures, nods, drawings and non-speech vocalizations
(Ryan, 2001; Stavrakaki and Klein, 1986; Trumble, 1993).
Conclusion
Gathering observational data from the patient and from those who know the
patient very well (i.e., family, caregivers and so on), as well as from
videotaping and spending unstructured time with the patient, is essential to
correctly identifying psychosis in nonverbal patients with developmental
disabilities (Ryan, 2001; Szymanski, 1977). All observational data should be
augmented with a complete database regarding family history and all physical
signs and symptoms. The environmental context of a symptom of possible
psychosis is essential in understanding its significance and meaning, if any.
The time spent in these initial assessments is richly repaid in better quality
of life and clinical outcomes for the patient. If, despite all attempts to
gather complete data, the clinical outcome is not favorable, restarting the
process with particular attention to unstructured observation may be helpful.
Guides and other reading material (Table) are also helpful to the psychiatrist
encountering such patients.
Dr. Ryan works full time with people with developmental disabilities, is
clinical assistant professor of psychiatry at University of Colorado Health
Sciences Center, and directs a non-profit research and education foundation.
******************************
CAUCUS for Autism Meeting
Date: Tuesday, December 18, 2001
Time: 7:00PM - 9:00PM EST (GMT-05:00)
Topic of this meeting is HOW TO SURVIVE THE HOLIDAYS!
Meetings held at the Upper Main Line YMCA, 1416 Berwyn-Paoli
Road, Berwyn, PA call 610-647-YMCA or www.UMLY.org for
directions.
******************************
IMMEDIATE
CALL FOR ACTION FROM THE INTERNATIONAL HYPERBARIC MEDICAL ASSOCIATION!
CALL YOUR MEMBER OF CONGRESS AND U.S. SENATORS
TELL THEM TO COSPONSOR H.R. 3351 and H.R. 3360 OR S. 1707 and S. 1745
TODAY!!
CALL THE WASHINGTON D.C. SWITCHBOARD AT (202) 225-3121
Ask for your Congress Member and when you reach their office, ask for
the Healthcare L.A.
We Need to Preserve Our Nation's Hyperbaric Medicine
Treatment Funding!!!
Dear Friends of Hyperbaric Medicine:
December 7, 2001
The Centers for Medicare and Medicaid Services (CMS) has published a
new administrative rule that lists reduced reimbursement rates for a
number of medical treatments. Changes affecting Hyperbaric Oxygen
Therapy are among the more than 60 pages of code listings. These
changes would pay the full rate for the first unit treatment and only
½ price for subsequent unit. This is a 33% cut for a standard
Hyperbaric treatment!
If this rule is allowed to stand, it would
hurt to our cause.
State Medicaid boards and many insurance companies would adopt this
lower reimbursement rate as the standard. Especially now, when we are
poised to win the battle and have treatment for many conditions
covered by insurance, including chronic neurological injuries, this
reimbursement standard should not go into effect! Even though
reimbursement would be approved, it would be too low to allow for
treatment with proper medical supervision within the heath care system
guidelines. This would seriously limit the availability of care.
We are not in this fight alone. Right now, the American
Hospital Association, the American Medical Association, and many
others are calling for a delay in this new administrative ruling.
Timing is crucial because Congress is wrapping up its legislative
business within a matter of days. Current plans include adding this
legislation to the economic stimulus package or an omnibus
appropriations bill. Unless it is stopped, this new reimbursement
rule becomes effective January 1, 2002.
When you call, you should give your name,
address and phone
number. Only call your own Members of Congress and State Senators!
It does not do any good to call Members who do not represent you in
Congress. You should also e-mail your respective members, since the
Capitol in Washington is not receiving regular mail due to the Anthrax
threat. The House of Representatives can be accessed at www.house.gov
and the Senate at www.senate.gov. Follow the prompt to contact your
specific Member. A fax number may also be available on your Member's
web site.
The IHMA plans to fax an endorsement letter
from the House and
Senate sponsors of the legislation (Representative Bilirakis for H.R.
3351 and Senator Jeffords for S. 1707) for the physician payment
portion. Representative Deal (H.R. 3360) and Senator Blanch Lincoln
(S. 1745) are receiving a letter on the hospital/outpatient payments.
I strongly encourage the other groups involved with Hyperbaric
Medicine to send letters also. Individual clinics should call their
own Members in the House and Senate, and encourage their patients to
do the same.
For further information about this
legislation, organization
representatives can call Rod Veasey in Nathan Deal's office at (202)
226-5281, Fax (202) 225-8272, or Robbie Kumar in Mr. Bilirakis' Office
at (202) 225-2658, Fax (202) 225 4085.
Paul G. Harch, M.D.
Pres International Hyperbaric Medical Association
******************************
"Status of Education Integration, State by
State"
Information Bulletin #20 - Integration of Children with
"Orthopedic Impairments"
One measure of your State's commitment to integrate people with disabilities
into the community is how well integrated are our children with disabilities.
The U.S. Department of Education reports annually to Congress on the
implementation of the Individuals with Disabilities Education Act. The appendix
of this report is full of data, state-by-state and disability-by-disability. Of
particular interest is the federal category "Orthopedic Impairments,"
i.e., those children whose primary (or exclusive) disability is
"orthopedics." Below is a state by state breakdown of the percentage
of children, who are classified with only "orthopedic impairments,"
who are integrated in their schools and educational programs for 80 percent or
more of the school day. Children who are not integrated in this category are in
segregated educational programs.
STATE % of children with orthopedic impairments integrated
into regular classes for 80% or more of the school day.
Alabama 52% of children are integrated.
Alaska 50% of children are integrated.
Arizona 43% of children are integrated.
Arkansas 37% of children are integrated.
California 28% of children are integrated.
Colorado 76% of children are integrated.
Connecticut 75% of children are integrated.
Delaware 25% of children are integrated.
D. C. Not reported.
Florida 43% of children are integrated.
Georgia 34% of children are integrated.
Hawaii 49% of children are integrated.
Idaho 58% of children are integrated.
Illinois 32% of children are integrated.
Indiana 72% of children are integrated.
Iowa 57% of children are integrated.
Kansas 68% of children are integrated.
Kentucky 43% of children are integrated.
Louisiana 30% of children are integrated.
Maine 58% of children are integrated.
Maryland 39% of children are integrated.
Massachusetts 65% of children are integrated.
Michigan 63% of children are integrated.
Minnesota 69% of children are integrated.
Mississippi 14% of children are integrated.
Missouri 35% of children are integrated.
Montana 63% of children are integrated
.Nebraska 55 % of children are integrated.
Nevada 50% of children are integrated.
New Hampshire 40% of children are integrated.
New Jersey 45% of children are integrated.
New Mexico 41% of children are integrated.
New York 60% of children are integrated.
North Carolina 58% of children are integrated
.North Dakota 65% of children are integrated.
Ohio 50% of children are integrated.
Oklahoma 67% of children are integrated.
Oregon 57% of children are integrated.
Pennsylvania 18% of children are integrated.
Rhode Island 35% of children are integrated.
South Carolina 22% of children are integrated.
South Dakota 70% of children are integrated.
Tennessee 32% of children are integrated.
Texas 18% of children are integrated.
Utah 32% of children are integrated.
Vermont 87% of children are integrated.
Virginia 50% of children are integrated.
Washington 52% of children are integrated.
West Virginia 62% of children are integrated
.Wisconsin 42% of children are integrated.
Wyoming 64% of children are integrated.
US 47% of children are integrated.
This data and other IDEA data can be found at www.ed.gov/offices/OSERS/OSEP/Products/OSEP2000ANLRPT/PDF.
The Disability Odyssey, Steve Gold <SteveGoldADA@cs.com>
******************************
Cherie Blair takes personal interest in
mother's MMR claim
By Sarah Womack, Political Correspondent
(Filed: 11/12/2001)
CHERIE BLAIR has expressed a personal interest in a mother's legal fight for
compensation for a son she believes was brain damaged by the MMR
vaccination.Mrs Blair's response to emails sent to her by Julie Loch from Wales
has raised speculation about whether Leo Blair, now 18 months old, has received
the combined measles, mumps and rubella vaccination.A Downing Street spokesman
refused to comment, saying the Prime Minister's children were entitled to
"complete privacy in medical matters".But a doctor at the centre of
the MMR row said the Blairs should be open about what medical route they had
chosen. Peter Mansfield, a Lincolnshire GP who offers single dose injections,
said: "If you expect to be some kind of role model, it is important to be
transparent."It is prudent to be beyond reproach. I do not know what the
Blairs' situation is." Mrs Blair thanked Mrs Loch for keeping her
informed, and said she would be "happy to receive further information".The
Department of Health retains faith in MMR, insisting that parents have no need
for concern. MMR is recommended for children at 13 months and for
four-year-olds.But with fears mounting that the vaccine could be linked to
autism in young children, an increasing number of parents are having children
vaccinated privately with separate jabs at a cost of almost £200.A report by
the Medical Research Council has concluded that the possibility of MMR causing
autism in susceptible children cannot
be ruled out on current evidence.Mrs Loch said her youngest son began to
"regress developmentally and behaviourally" when he was two years
old.He is now autistic, with chronic bowel damage which was affecting his
gastrointestinal tract. She said "countless medics" had refused to
accept that her son was vaccine damaged. However, her son was among eight cases
that had been selected to represented a group litigation case against the
vaccine manufacturers. Pat Troop, the Government's deputy chief medical
officer, said she had been advised that the single jabs were not safe.Dr
Mansfield was charged by the General Medical Council's disciplinary body with
putting patients at risk and failing to conform to the recommendation of the
Chief Medical Officer. The charges were subsequently dropped.He said: "The
MMR vaccine should not be administered in one dose. When three live viruses are
forced alongside each other into the body, they may mutate with devastating
consequences."
9
December 2001: Studies fail to disprove autism link to MMR jab
9
December 2001: Anti-MMR doctor is forced out
1
December 2001: Medical chief says MMR jabs 'too low'
7
August 2001: MP backs doctor in row over single dose MMR
MMR
vaccine - Department of Health
MMR:
the facts - Immunisation.org.
http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2001/12/11/nmmr11.xml
******************************
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