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"Healing Autism: No Finer a Cause on the Planet" ________________________________________________________________

PUBLIC HEALTH

* Shortages Confound Vaccination Logistics

RESEARCH

* Food Supplements 'Improve' Learning Ability

FORENSICS

* Pinning Down The Rock Wrestler to Be Subpoenaed in Florida

Drowning Death

AWARENESS

* My Autistic Sons Count

Shortages Confound Vaccination Logistics

The hassle factor is high as physicians help patients play catch-up when vaccines, long on back order, arrive at their offices.

Washington -- Physicians are vaulting additional hurdles as they try to meet the goal of immunizing patients while contending with widespread vaccine shortages.

They must flag patients' charts, keep careful records and try to get patients to return for missed shots when vaccine becomes available.

Many find this to be a time-consuming and frustrating -- although vital -- task.

"It is complicated and difficult," said Julia McMillan, MD, professor of pediatrics at Johns Hopkins University in Baltimore. "Depending on the size of the practice, the resources of the practice and the computer-based record availability of the practice, the process can vary from simply telling a parent that they need to come back, and hoping that they do, to a very sophisticated sending out of postcards or making calls when vaccine becomes available."

"Clearly a lot of practitioners are having difficulties," said Keith Powell, MD, chair of the pediatrics department at Children's Hospital Center in Akron, Ohio. "And there are probably as many solutions as there are practices," he added.

The Centers for Disease Control and Prevention realizes that recalling patients is a big problem for physicians. "We know that very few physicians actually have a tracking system where they could easily do recalls," said Abigail Shefer, MD, a branch chief at the CDC's National Immunization Program.

A CDC survey of immunization program managers in everystate found that 75% have sent memos, educational materials and tracking forms to help physicians recall patients. "But what we don't know is how well they are being used by physicians," Dr. Shefer said.

Dr. Powell lamented the lack of a "nice little software program" to help track the children who are missing doses of any vaccines in short supply at the moment. Most physicians keep track of patients' needs manually, which means they compile many lists.

The CDC does weekly updates of its own list indicating the vaccines in short supply. As of mid-April, it listed vaccines to combat diphtheria, tetanus and pertussis; measles, mumps and rubella; varicella and pneumococcal infection.

One of the biggest physician worries is that patients won't return or parents won't bring their children back in when the vaccine is available. While no one seems certain just how effective reminder notices and calls are during the current shortages, the fear is that many patients may fall behind on immunizations, and diseases that were once on the way out may stage a return.

The CDC has offered recommendations intended to stretch existing vaccine supplies and minimize the risk of leaving children without any protection at all by prioritizing who receives the limited supplies on hand. For example, in February the agency recommended that physicians delay administering the varicella vaccine until a child is 18 to 24 months old. The vaccine is usually administered at 12 to 18 months.

If the vaccine's use must still be prioritized, those first in line should include health care workers, family contacts of immunocompromised people, adolescents, and adults and children infected with HIV.

Similarly, the CDC recommended delaying the fourth dose of the DTaP vaccine in order to ensure that sufficient supplies are available to give infants the first three doses.

This necessary delay in vaccination schedule should not cause a problem with the effectiveness of a series of vaccines, said Jane Seward, MD, MPH, acting chief of the CDC's Child Vaccine Preventable Diseases Branch.

Longer intervals between shots aren't a problem, she said, as the intervals are intended to be the minimal times between shots. "It never matters if you go longer. You never have to restart the series."

Patient education

Laurie Mortara, MD, an infectious diseases specialist in Long Beach, Calif., is troubled by the lack of public awareness of the vaccine shortage problem. "The first thing we need to do is to make the patient aware that there is a shortage," she said.

Shortages tend to vary by area of the country, and Dr. Mortara has experienced shortages of tetanus and influenza vaccines and, more recently, pneumococcal vaccine.

"We also need to make patients aware of when they are due for their next vaccination and, in the case of the tetanus vaccine, what kinds of injuries should prompt them to go to the emergency room for a tetanus shot," she said.

Recalling patients for vaccine when it becomes available is a serious problem, she said. "You have to maintain a list that is almost a calendar to indicate when people are due for their shots."

Patients are also not likely to return immediately if the only reason is for a shot, said Dr. Mortara. Instead they wait for their next office visit, a situation that makes her uncomfortable.

There could be some improvement in patients' return trips "if we could make the population understand the protective nature and importance of the vaccines," she said.

But the largest frustration for physicians, said Dr. Mortara, comes from not understanding why, "all of a sudden we're not able to routinely get all of the vaccines at a reasonable price. Now there seem to be back orders not only for vaccines but for many other drugs as well."

Timothy Tobolic, MD, is a member of a five-physician family practice near Grand Rapids, Mich., and, while he is keeping lists of patients who are missing shots, he questions the effectiveness. "Can we capture everybody? And if a limited amount of the vaccine becomes available, who do you call first?

"It's not an equitable or fun system to deal with," he said.

Both Dr. Tobolic and Dr. Mortara fault the supply system for their plight. Dr. Mortara suggested having some level of federal control to assure that people at high risk are able to receive needed vaccine.

"I think we are at the mercy of the manufacturers," said Dr. Tobolic. "Before, we had four or five manufacturers of a particular vaccine, and you could shop for price and there was availability." Now there are only one or two manufacturers for a vaccine.

Acknowledging that there are frustrations all around that are associated with the current shortages, Bruce Gellin, MD, executive director of the National Network for Immunization Information praised the efforts of primary care doctors. "The pediatricians and family physicians on the front line know how important it is for kids to be vaccinated."

He also recommended issuing recall notices. After all, he noted, automobile mechanics send reminders to get the oil changed and the vet sends reminders on the dog's shots. So why not reminders on tetanus shots?

* * *

Food Supplements 'Improve' Learning Ability

Food supplements may prompt enormous improvement in the educational abilities of children with learning difficulties, a study has found.

The study, examining the effect of fish and vegetable extracts on the concentration and learning levels of 120 six to 11-year-olds from 13 primary schools, is being run by Durham county council.

Researchers say it is already showing signs that food supplements bring enormous benefits for those with neuro-developmental disorders, such as dyslexia, dyspraxia, attention deficiency hyper-activity disorder and autistic spectrum disorder.

Half of the children are being given daily supplements, while the other half receive a placebo - neither group is aware of which they are taking. Each day, breathalysers measure the levels of fatty acids in the children's bodies.

Results so far have been marked. One child's reading skills have improved by the equivalent of four years after just 12 weeks of taking the supplements.

Analysis at the halfway stage of the study has shown remarkable advances among some children - believed to be taking the supplements - while others, expected to be taking the placebo, have not shown any real improvement.

Although the results will not be confirmed until the full study is completed and it is revealed which children are taking the placebo, Dr Madelaine Portwood, a senior educational psychologist at the county council, who is leading the trial, has described the findings so far as a "landmark".

She said: "The children's social skills seem to be improving because they are more confident. They are becoming more socially interactive and perhaps this increases the motivation to learn."

Dr Portwood said her 10-year-old son is taking the food supplements - which contain fish oil as a source of omega 3, evening primrose oil and vitamin A - and has shown a marked improvement.

"I wouldn't give them to him if I did not feel they did him any benefit," she said.

The study is being funded by the Dyslexia Research Trust in Oxford and the supplements are being provided by Equazen Nutraceuticals.

A spokesman for The Dyslexia Association said: "We are interested in all research which helps dyslexics. But we are keen not to raise people's expectations at a so-called "cure". We are also concerned that there should be proper research into the long-term effects and that such research is properly peer reviewed.

"We don't believe there will be a cure, or that one exists at the moment. So-called cures can help some people and not others, so that needs to be taken on board. The so-called brain foods, or supplements, are understood to show improvements in concentration, but it is teaching in the classroom which consistently works."

Results from the Durham study will be published in September.

* * *

Pinning Down The Rock Wrestler to Be Subpoenaed in Fla. Drowning Death

[In The Associated Press.]

Pro wrestling's The Rock will be subpoenaed by the defense for a teenager facing adult manslaughter charges in the drowning death of an autistic 5-year-old, attorney Ellis Rubin said today.

Rubin made the announcement just minutes after Circuit Judge Victor Tobin granted a state request to delay the trial's start while two court-appointed psychologists review the mental competency of Gorman Roberts, the 17-year-old Pompano Beach youth charged in the crime.

"This is not a wrestling defense, but it's a factor and needs to be examined," Rubin said while telling reporters that he planned to take testimony from The Rock, of World Wrestling Entertainment (formerly World Wrestling Federation) and Hollywood movie (The Scorpion King) fame.

Rubin claims the victim and two other children watched a wrestling program featuring The Rock two days before the drowning.

"Little boys imitate what they see on TV. If they hadn't been watching wrestling, none of this might have happened," Rubin said.

Roberts is accused of pushing Jordan Payne, 5, into a canal Feb. 10, then walking away laughing as the boy struggled to survive. He faces up to 30 years if convicted.

Shades of the Lionel Tate Case

Rubin claims his client has an IQ of 67, rendering him unable to understand that he waived his Miranda rights when questioned by police after the drowning.

Police say two other boys also were involved in the drowning: a 10-year-old charged with misdemeanor culpable negligence and a 9-year-old who has been granted immunity in exchange for his testimony.

Both boys told police they roughhoused with the victim on the canal bank. They and their police questioners repeatedly referred to wrestling moves when questioned after the 5-year-old was found drowned, Rubin said.

Last year, the Fort Lauderdale murder trial of teen Lionel Tate made headlines around the world when his attorney argued that the strapping 14-year-old killed his 6-year-old playmate accidentally, while practicing wrestling moves he had seen on World Wrestling Federation shows and videos. Tate went to prison for life.

Prosecutor Maria Schreiber seemed momentarily speechless reporters asked for reaction to another defense attorney bringing professional wrestling into another Broward case involving a juvenile charged as an adult in the death of a younger playmate.

"I'm surprised," she said. "But it's not really appropriate for me to comment."

Flanking Rubin at the news conference were Roberts, Roberts' mother Bobbie Sapp, and Carrie Mae Lovett, the wheelchair-bound guardian who raised Roberts since he was 5.

"I don't believe he was even there — and may the sweet Lord strike me if I'm wrong," a tearful Lovett said. "He's a good boy, always been a good boy."

Rubin, known for headline-grabbing defense strategies, refused to let Roberts speak. Copyright 2002 The Associated Press.

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My Autistic Sons Count

Is autism on the increase? More than two-thirds of teachers think so, according to a National Autistic Society survey. The number of ASD (autistic spectrum disorder) pupils is three times higher in primary than secondary schools. In special schools, one child in three has an autism-related condition.

It is still argued that there is no real rise in incidence, that more widespread diagnosis wholly accounts for the growing numbers. It's certainly true that diagnosis is now far more frequent and accurate. The "triad of impairments" - of imagination, communication and social interaction - all have to be present for diagnosis, but it is now recognised that the impairment can be subtle or slight.

When my older son George was a baby, I only knew about classic, Kanner's syndrome autism. I thought all autistic people were aloof, shunned touch, were locked in their own worlds. As George's behaviour became odder, autism crossed my mind, but I dismissed the idea. My playful, smiley, interactive child, who walked at nine months and talked and sang at me - how could he be autistic? George drew people like a magnet: how aloof was that? And later, when Sam, his younger brother, gave cause for concern, I was slow to recognise that he, too, had autism. Two in one family? I'd never heard of such a thing. Now, I know of dozens of families with two, and a few with three or more.

Could my boys have escaped diagnosis in the past? Possibly. George might have been seen as disturbed or suffering from "infantile schizophrenia", a largely mythical condition once often applied to autists. Sam is more profoundly affected; his endless spinning and flapping, his obsession with washing machines (indeed, with laundry in all its aspects) would have provided hefty clues. Neither boy is wholly socially isolated, but every single thing they do is different, eccentric. They don't have Kanner's syndrome, but they are both autistic through and through.

But diagnosis or not, George and Sam would have been noticed. In the state primary school I attended, we sat at our desks tootling London's Burning on our recorders in classes of 40. An autistic child would not have slipped undetected by the eagle eye of Miss Everden. So where were those children? Special schools were in their infancy. Some must have been "put away" in institutions, but it hardly accounts for one in 100 children, which is today's estimate.

Common sense suggests there is a real increase, as well as underdiagnosis.

Nearly every week I get a call about some friend-of-a-friend who's worried about their child. What could account for this trend? I don't have anything useful to add to the MMR debate; I don't think it affected George and Sam, but found myself unable to give it to Jake, my non-autistic four-year-old. To the public MMR is the prime suspect but there are other

theories: diet, pollution, allergies, ultrasound scanning... I just don't know. But I do believe there must be something.

Whatever the causes, the reality is that these children - who will turn into "these adults" - are woefully under-catered for. The government's policy on special needs is "inclusion in mainstream wherever possible". This assumes that those with special needs don't want to be stigmatised, enjoy feeling "normal", and want the same academic opportunities as everyone else. The premise is that children learn from each other; put an abnormal child with his peer group and some "normality" will rub off. But if an autistic child could learn normality this way he wouldn't be autistic. George and Sam wouldn't know a stigma if they tripped over one. They have not the smallest toe-hold in the com-petitive, interactive world of their peer group. They have no ambitions and they are indifferent to the opinion of teachers or pupils.

Some more able ASD children do benefit from the mainstream. I know one clever, obsessive boy who's doing so well that no one at his school knows there's anything "wrong". But I know far more cases where inclusion has been a disaster. Local authorities assess special needs placements in terms of

IQ: it's much more useful to see autism as a social handicap. I know of several able autistic children who are not at school at all because they have failed and been traumatised by the failure, but are refused special school places because of a high IQ.

Autistic people seldom contribute to society in the Blairite sense. They're not good value. Most need expensive care all their lives, because even those with high intelligence lack common sense and basic life skills. We should give up the hopeless struggle of trying to fit them into an approximation of normality. Instead, we should encourage the special interests and qualities of the autistic child to help them enjoy being what they are, and what they always will be. Having an autistic child will always be a challenge; it does not need to be a tragedy.

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Lenny Schafer, Editor@feat.org • CALENDAR EVENTS@feat.org Michelle Guppy

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