SCHAFER AUTISM REPORT "Healing Autism:

No Finer a Cause on the Planet"

The Autism Calendar, November 2002 Update is out!

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PUBLIC HEALTH

* Increase in Autism Troubling: Houston Chronicle Front Page

* No Evidence Of Autism Epidemic in Australia

* Dismay as Triple Jab Cleared Of Autism Link

* Notes on the Denmark MMR-Autism Study

RESEARCH

* Autism Linked To Brain Growth

AWARENESS

* Facing Asperger's: Often-Misdiagnosed Syndrome Creates Special

Challenges For Youngsters

PUBLIC HEALTH

Increase in Autism Troubling: Houston Chronicle Front Page

Some parents link illness to vaccines, but doctors unsure

Beaumont residents Mark and Darla Williford can tell you exactly when their infant daughter stopped making eye contact, learning new words and smiling for the camera.

It was shortly after her first birthday, on the day in November 1995 that Laura received four vaccines. That night, she had a fever and was agitated, common side-effects of vaccination. But the next six months were anything but typical: the girl acted strangely, flipping lights on and off, for example, and she would scream and laugh for no reason.

"It looked like she was going insane," said her dad.

In March 1999, Laura was diagnosed with autism, a devastating neurological disorder marked by jerky, repetitive movements, a lack of language skills and social withdrawal. A month after the diagnosis, Mark Williford found a report about a possible link between autism and childhood vaccines that contained a mercury-based preservative. His daughter's vaccines contained the preservative, called thimerosal; her symptoms matched those of mercury poisoning.

"I remember reading the symptoms and a cold chill went up my spine," Williford recalled. "I said, `This is what's causing it.' "

In Texas and around the world, more and more people are becoming convinced that autism can be caused by the vaccines supposed to protect them. The U.S. Food and Drug Administration and Centers for Disease Control and Prevention say there's no evidence to support the hypothesis, but thousands of parents have joined a worldwide legal campaign to hold pharmaceutical companies liable for injecting infants with a known toxin.

It might sound like ambulance-chasing lawyers and blame-happy parents except for one thing: Autism's exploding these days and no one knows why.

The explosion, a tripling over the last decade, suggests an environmental component that could be explained by increased mercury exposure associated with a rapid increase in vaccinations during the 1990s. The mercury has now been removed from most vaccines, but concern over a possible link to autism has led to congressional hearings, multimillion-dollar studies, and clusters of class-action lawsuits that one of the lawyers says "could be the biggest thing to come down the litigation pipeline ever."

There also have been declining immunization rates in some countries, raising fears among public health leaders that the allegations could undermine a vaccine program considered one of the great medical breakthroughs of the past century. Some scientists acknowledge that this fear threatens to stifle open inquiry into whether the concerns are legitimate.

For the most part, however, doctors seem confident that the allegations aren't legitimate.

"Vaccines have been tested every which way and no link to autism has ever come up," said Dr. Jane Siegel, a pediatrics professor at the University of Texas Southwestern Medical Center in Dallas, who has served on national advisory committees on vaccines. "They're safe."

Still, scientists are at a loss to explain the dramatic increase in the incidence of autism, which was not described until the 1940s and then was attributed to cold "refrigerator" mothers. That theory has been debunked and researchers are zeroing in on genetic causes, but the disorder is still poorly understood. There is no cure, though a new intensive therapeutic program is helping some children.

Once thought to occur in 1 of every 10,000 children, autism today is estimated to afflict 1 in 500. A California study last month that found a three-fold increase from 1987 to 1998 said the hike couldn't be explained away by statistical anomalies or different definitions or growing public awareness, but the study could offer no explanation. The increase in Texas was more than twice as large as in California.

There are two ways vaccines are alleged to play a role. One is that certain vaccines -- the measles, mumps and rubella (MMR) shot has attracted the most attention -- may themselves cause autism or other problems in a small percentage of sensitive people. A study in the New England Journal of Medicine, published Thursday, found no evidence to support the MMR theory, the latest in a series of such findings involving that vaccine.

The other theory involves thimerosal, which until recently was used in many vaccines to guard against contamination when pediatricians jab the same vial repeatedly to vaccinate one child after another. The amount of mercury in each shot was slight, but advocates of this theory say a dangerous amount could accumulate because the number of required vaccinations has mushroomed since the late 1980s as researchers have figured out how to prevent more infectious diseases -- a typical child now gets 32 doses of 12 vaccines by the age of 6; a 2-month-old may get five shots during one visit to the doctor's office.

Critics wonder if all that mercury was more than those little bodies could handle, whether the result is autism or some other crippling neurological disorder.

"It's outrageous to think that injecting a child with all that toxicity is an acceptable risk," said Bernard Rimland, director of the Autism Research Institute in San Diego. "It's also outrageous that despite such compelling evidence of harm, the medical community would subject children to it."

In 1999, the FDA concluded that infant children who receive the recommended series of immunizations are receiving more mercury than is considered safe by the U.S. Environmental Protection Agency and asked vaccine manufacturers to voluntarily phase out their use of thimerosal. The conclusion was later echoed by the CDC, pediatric organizations and a blue-ribbon panel of experts that reviewed all the existing studies on thimerosal and autism.

The manufacturers now say they're producing thimerosal-free vaccines, and a Texas Department of Health representative said the agency is confident of this. Believers in the mercury theory, however, are skeptical about whether all the old stuff is off the shelves.

For instance, it took an intense effort by Williford to get the Beaumont Health Department to replace its supply last year. The department finally agreed in August 2001, following six months of Williford's making requests, talking to his state representatives and appearing at City Council meetings.

For his and other families, the struggle was to understand what was happening. After her son was diagnosed with mild pervasive developmental disorder at age 2 1/2, autism a couple of years later, and then "severe autism," Spring resident Gina Shaw traveled to California in 2000 for a Defeat Autism Now conference.

There, she heard a speaker present new information suggesting a link between thimerosal and autism. Coming on the heels of a test that had revealed high levels of metals in her son's blood, the theory seemed persuasive.

Tears began running down Shaw's cheeks as she listened to the speaker. She grew angry that government agencies allowed the use of vaccines containing thimerosal. "I was mad as hell," she said, "because they did this to my baby."

Shaw and her husband, Darwin, can barely look at early photographs of Brett. They show a laughing child with twinkling blue eyes.

But in photos taken after his second birthday, Brett is stonefaced. He could barely sit still long enough to be photographed.

Now 10, Brett mumbles a few random words such as "bye" and "eat." He can follow simple instructions but doesn't understand everyday conversations between his parents and his 12-year-old sister, Brianna. He takes special-education classes and functions at a 2-year-old's level.

Unable even to write his name, Brett lives largely in a world of his own, entertaining himself with simple computer games or playing alone in a closet or tent.

The Shaws estimate that they've spent $50,000 on their child's care. (The Willifords have spent $60,000.) In January, the Shaws filed a complaint with the U.S. Court of Federal Claims in Washington, D.C., under the National Vaccine Injury Compensation Program, which compensates people injured by routine vaccinations. The complaint was handled by Hitt, Patterson & Sell in Houston, one of four Texas firms leading the litigation onslaught.

Two other firms are also based in Houston -- Gallagher, Lewis, Downey & Kim and Williams & Bailey -- and one is a Dallas firm, Waters & Kraus.

The firms are part of two legal coalitions that estimate they have about 4,000 clients between them. The first lawsuit in a state civil court, filed by Waters & Kraus, concerns a Plano boy who had a growing vocabulary at 20 months, then lost all his language skills, was diagnosed with autism and found to have high levels of mercury exposure. The lawsuit is in Brazoria County, where one of the defendants, Dow Chemical Co., has a drug manufacturing plant.

Attorney Jeff Sell believes in the cases as a litigator and father. His 8-year-old twins have autism.

Sell cannot file a complaint through the Vaccine Court because those must be filed within three years of the onset of symptoms, and it was five years before he made a connection. But because the Vaccine Court strictly limits damages, the potential for bigger money is in civil courts anyway.

"With as many as 200,000 possible cases of developmental disorders that could be tied to vaccines, this could turn out to be one of the biggest mass tort cases ever in the United States," said Michael Williams, chairman of the Mercury Vaccine Alliance, which already has filed seven class-action lawsuits around the country. "But we won't know for two or three years."

Complicating the plaintiffs' case is that the children could have been exposed to mercury from other sources, such as fish or dental fillings. Even if science ultimately finds a link between mercury and autism, it might not be clear whether the culprit was the vaccines or exposure from the mother's fillings or consumption of fish while the child was in the womb.

At the moment, of course, the biggest threat to the lawsuits' success is the lack of science backing them, say legal observers. Scientists acknowledge that mercury is a potent neurotoxin known to damage the brains, nervous systems and immune systems of unborn children, but beyond that little is certain.

For one thing, although autism sometimes can be detectable as early as 6 months, it more often appears to hit later, at 1 1/2 to 2 years, and after the child had appeared to be developed normally. Those skeptical of a vaccine link say it is just a coincidence that symptoms appear at the same time the MMR vaccine is given.

For another, there have been few well-designed studies looking into the mercury allegation. The blue-ribbon panel of experts assembled to look into the matter called the idea that thimerosal poses a significant threat to the developing brain "biologically plausible" but said none of the existing studies had been designed well enough to produce evidence of a link.

Both sides in the debates have seized on the panel's report.

(The evidence is much better that the MMR vaccine doesn't cause autism, said the head of the panel. The New England Journal of Medicine study published Thursday tracked 500,000 Danish children born between 1991 and 1998 and found no statistical difference in autism between those who received the MMR vaccine and those who didn't. The vaccine has never contained thimerosal.) Typical of the contentiousness surrounding the issue was a July 2000 congressional hearing convened by U.S. Rep. Dan Burton, R-Ind., whose autistic grandson seemed healthy and talkative until getting a series of vaccinations at one time. Rep. Henry Waxman, D-Calif., complained that the hearing was unfairly stacked with parents and experts alleging a connection between vaccination and autism, and the only thing committee members could agree on was the need for further study of the issue.

"The fact is, there just hasn't been much done in this area," said Irva Hertz-Picciotto, a professor of maternal and child health at the University of California-Davis School of Medicine, recently awarded a federally funded center to study the issue. "We don't know much about the epidemiology of autism, let alone whether mercury could foster it."

This much is known about autism: There's a genetic susceptibility -- the risk increases for younger siblings of autistic children -- that scientists think involves 10 to 20 genes. But the environment also can play a role: It was more common in babies born to mothers who took thalidomide or had rubella during pregnancy. New studies will look at the interaction between genes and environment.

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One theory is that some autistic children lack a protein called metallothionein, which the body needs to excrete toxic metals, such as mercury, before they damage the brain and gut. In one study of 503 children with autism or other pervasive developmental delays, all but four were missing the protein. But the theory is considered speculative at this point.

The problem with the few studies that have been done is that they're retrospective, not prospective -- they ask parents to recall the vaccine shots and onset of autism, a method considered unreliable. The new studies will track babies receiving vaccines to determine who develops autism and who doesn't; and will analyze blood, urine and hair samples of different population groups (those with autism, those developing normally and those diagnosed as retarded but not autistic) for environmental agents and genetic information.

Over it all looms the vaccine program -- a savior to some, a sacred cow to others. Those who worry about the effect of the allegations say society is vulnerable because people don't know what it was like before vaccines, when diseases such as diptheria and polio claimed thousands of lives a year.

Others, like Baylor College of Medicine vaccine researcher Bonnie Dunbar, worry that the program's special status is interfering with the scientific process. After adverse reactions to the hepatitis B vaccine by family members and co-workers convinced her to research the theory that in some people the immune system attacks itself rather than the vaccine's viral material, drug companies denied her access to materials and the government turned down her requests for grant money.

"No one wants to hear anything bad about vaccines," said Dunbar, a professor of molecular and cellular biology who has spent most of her career developing vaccines. "Health institutes' and pharmaceutical companies' lack of support for research into adverse reactions to some vaccines is appalling."

* * *

No Evidence Of Autism Epidemic in Australia

There was insufficient evidence to say whether Australia was experiencing an increase in autism despite concern about a worldwide "epidemic of autism", a Sydney researcher said.

Dr Katrina Williams of the Children's Hospital at Westmead and Sydney University said, based on NSW figures, at least 3.5 children in every 10,000 were newly diagnosed with autism in the year 2000.

This compared to a 4-in-10,000 incidence rate for all children known to have autism in the 1960s and 70s, she said.

Dr Williams will be a speaker at the World Autism Congress that opens in Melbourne on Sunday.

She said at least 222 NSW children up to the age of 15 were newly reported as having classical autism in 2000.

"We had 150 children aged 0-5, and that gives us an incidence of 3.5 per 10,000 newly recognised children with autistic disorder in the year 2000,"

she said.

"That's very similar to the earliest reported prevalence figures for autistic disorder."

However, she said there was still insufficient evidence to reach any conclusions about whether more Australian children were being diagnosed with autism.

Meanwhile Dutch research published in the New England Journal of Medicine has further weakened the controversial link between autism and the measles, mumps and rubella (MMR) vaccination.

The Danish team looked children born from 1991 and 1998 and concluded it was coincidental that the symptoms of autism appeared around the time children were vaccinated.

Dr Williams said a large study of the roles played by genetic and environmental factors in the development of autism was needed.

"The study should look at risk factors for autism so we can try and put environmental factors like MMR and diet into the context of genetic predisposition and other factors like adverse perinatal exposure," she said.

West Australian researcher Emma Glasson said research she conducted for the University of WA into autistic siblings added weight to evidence that autism was related to genetic factors.

Ms Glasson found children diagnosed with autism were more likely to have experienced a difficult birth and caesarean section delivery than those without autism.

She also found siblings of autistic children were more likely to experience difficult births than brothers and sisters of non-autistic children.

"It shows that kids who get autism are different before birth so whatever's causing autism is more likely to be before they're born, and what you think of as genetics," she said.

"The fact that my siblings had increased complications is good support for that."

A recent Californian study of 648 children found the incidence of autism had nearly tripled between 1987 and 1998.

* * *

Dismay as Triple Jab Cleared Of Autism Link

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Parents of autistic children have dismissed new research which claims to prove there is no link between autism and the MMR vaccine.

A new study looked at the records of 537,303 children born in Denmark between January 1991 and December 1998 of whom 440,303 had been given the jab.

The research, published yesterday in the New England Journal of Medicine, found that 316 children had been diagnosed with an autistic disorder and 422 with other autistic-spectrum disorders.

The researchers, led by Kreesten Madsen from the Danish Epidemiology Science Centre, found the relative risks of developing an autistic disorder were similar for those who had been given the MMR jab and those who had not.

But Julie Loch, 37, who believes her six-year-old son Oliver's autism was caused by MMR, said the latest research proved nothing.

Traces of the MMR vaccine Oliver received have been found in his gut and Mrs Loch, from Marshfield, near Cardiff, believes this proves the link with his autism.

She said, "Epidemiological studies have limited use and what the Governments of the world ought to be doing is looking at the children that appear to have been damaged by the vaccine and finding out what has caused their difficulties.

"There are just too many parents who have had normal children and seen them regress within weeks who are all telling exactly the same story.

"With Oliver it was a gradual and insidious process.

"I've got a friend with a ten-year-old son with autism.

"With her little boy it is a genetic thing - he didn't develop normally - whereas with Oliver she could clearly see there was normal development and because she knew about autism she could see the features emerging."

The researchers also found no link between the development of an autistic disorder and the child's age at the time of vaccination or the date when they had the MMR jab.

The study authors concluded, "This study provides strong evidence against the hypothesis that MMR vaccination causes autism."

The suggestion of a link between MMR and autism was sparked by Dr Andrew Wakefield in a study published in 1998.

However, since then numerous studies have said there is no evidence that the jab causes children to develop autism.

The deafblind charity Sense yesterday welcomed the new research.

Joff McGill, head of voluntary services, said, "Now we have a comprehensive study showing that children who have the MMR vaccination are no more likely to develop autism than those who don't.

"The consequences of measles, mumps and rubella can be devastating. The MMR vaccine has been a huge success in reducing the numbers of people affected by these diseases.

"This latest research should re-assure parents that MMR remains the best way of protecting their children."

* * *

Notes on the Denmark MMR-Autism Study

by Sallie Bernard of Safe Minds

(11/5/02)

Positives

· The CDC and public health authorities are investing dollars and efforts into autism research. These efforts should be applauded, and expanded!

· Shows steep rise in autism rates from 1980s to 1990s (from <2.0 to

>10.0 per 10,000). Increases are being reported in other countries,

>again

suggesting environmental influences at work, as the recent landmark MIND Institute epidemiology of California study did.

· Supports thimerosal hypothesis?? (This assumes that we are able to obtain the information which was requested from the Congressional Research Office on the level of thimerosal exposure in the Danish population during the time period 1986-1998.)

· Acknowledges that previous attempts to refute MMR-autism hypothesis were too poorly designed to reach definitive conclusions. (p.1477, 2nd paragraph on right)

· Has identified a rich database of information (i.e., Danish

registries) on which additional studies of autism can be based.

Cautions

· Lower incidence of Danish autism group vs rates reported in US and UK limit applicability to other countries. [see table at end of document for statistics]

o Same diagnostic criteria developed by CDC used in Brick, Atlanta, and Denmark, so lower incidence not a factor of variation in diagnosis.

o Means other environmental factors, rates of factors, or combination of factors may be at work in Denmark vs US or UK.

o It is possible that MMR increases the rate of autism only when acting in conjunction with another environmental factor, such as mercury. If that factor’s prevalence is not controlled for among the study groups (vaccinated vs unvaccinated), it would obscure the role of MMR as a causative factor in the study.

· Only psychiatric records were accessed, not medical records, so there were no data on gastrointestinal symptoms and no taking of CSF or GI samples to detect presence or absence of measles virus. Cannot tell if measles persistence is impacting a subgroup of children, if any. Measles persistence may be increasing the severity of autism, even if it is not causing an increase in the number of cases.

· There was no attempt to differentiate between regressive and early-onset forms of autism. Since the regressive form comprises a minority of cases – 10%-20% - the power to detect whether there was a difference in regressive autism prevalence between MMR vaccinated and non-vaccinated is lacking in this study.

o The assertion that a relative risk of autism of less than one rules out the possibility that there are important subgroups is false.

· Although overall well designed, there appear to be some methodological problems with the study which need further elucidation from the investigators and raise questions about its conclusions of being the “definitive” MMR-Autism study.

o The study covered 8 birth cohorts, but two of these, those born in 1997 and 1998, were only 1 or 2 years old when the data records were obtained. These age groups are too young in most cases to be diagnosed with autism or to be immunized with the MMR. This might have been fine if the impact applied equally to both vaccinated and unvaccinated groups. However, fully half (50.6%) of the unvaccinated group fell into these two younger birth cohorts, vs. just a fourth (27.7%) of the vaccinated group. This issue involves approximately 32% of the sample.

o Children who were in fact vaccinated were assigned to the unvaccinated group if they were diagnosed with autism before they received the MMR. The reassigned cases comprise 10% of the unvaccinated autism cases (13 out of 130). This commingling blurs the distinction between vaccinated and unvaccinated. It is not clear what effect this would have on the results.

o A number of the measures used to arrive at the conclusion that autism and autism disorders were not associated with MMR vaccination are irrelevant. Age of vaccination with MMR, time interval between receipt of MMR and diagnosis of autism, and year of MMR vaccination do not help elucidate the hypothesized relationship between receipt of MMR and development of measles-related symptoms and regressive autism. The child’s age at time of diagnosis is arbitrary and can vary for many reasons, among them differences in severity of illness, access to care, and clinician skill and preference. Thus these measures cannot be used to refute the presence of a temporal relationship between MMR and onset of symptoms of measles-related illness and regressive autism.

As the authors point out on page 1481, they had no information on the presence or absence of a family history of autism, which could explain the study’s negative findings only if families with a history of autism avoided MMR vaccination. It should be noted that in 1993, there was a widely reported news story in Denmark about a parent with autistic twins who asserted that their autism was caused by the MMR vaccine. It is entirely possible that parents with either (a) a family history of autism or (b) an infant or toddler with emerging symptoms of autism, would avoid vaccination at a higher rate than other parents. This would inflate the unvaccinated group with children of families predisposed to autism.

Reported Rate of Autism from Recent US, UK, and Denmark Studies

Study

Study Group Rate per 10,000

Denmark MMR-Autism Study, 2002

Broader autism (738 cases ¸ 537,303)

among 1-8/9 year olds comprising study sample 13.7

Classic autism (316 cases ¸ 537,303)

among 1-8/9 year olds comprising study sample 5.9

Other PDD 7.9 per 10,000 (422 cases ¸ 537,303)

among 1-8/9 year olds comprising study sample 7.9

Classic autism among 5-9 year olds in 2000 (data not sho >10.0

Broader autism among 8 year olds in study sample 29.9

Classic autism among 8 year olds in study sample 7.7

Other PDD among 8 year olds in study sample 22.2

Chakrabarti and Fombonne UK Study, 2001

Broader autism among 2-6 year olds in UK 63

Classic autism among 2-6 year olds in UK 17

Other PDDs among 2-6 year olds in UK 46

Brick Township, NJ, by CDC, 2000

Broader autism among 3-10 year olds in 1998 61

Classic autism among 3-10 year olds in 1998 31

Other PDDs among 3-10 year olds in 1998 30

Broader autism among 6-10 year olds in 1998 67

Classic autism among 6-10 year olds in 1998 40

Other PDDs among 6-10 year olds in 1998 27

Metro Atlanta, by CDC, 2001

Classic autism among 3-10 year olds in 1996 34

* * *

RESEARCH

Autism Linked To Brain Growth

1,00.html <- - address ends here.

Autistic children have abnormally fast brain growth that begins a few months after birth, according to research that offers the first hope for early detection of the disorder.

The causes of autism have so far been unknown, but US specialist Eric Courchesne will tell the World Autism Congress in Melbourne today he has discovered that by the time an autistic child is about four, the size of their brain is equal to that of a normal 12-year-old.

While the trigger for this growth remains unknown, the discovery means that the size of a baby's skull could be an early warning sign of autism, Professor Courchesne said.

Using magnetic resonance imaging, Professor Courchesne and his team found excessive brain growth in autistic children.

After examining their medical records they found that children who later become autistic have normal brain size at birth.

However, at between four and 12 months, the brain grows too quickly, resulting in an abnormally large brain.

"Some time shortly after birth something is going terribly wrong and causing the brain to grow especially rapidly," Professor Courchesne told The Australian yesterday.

"By the time an autistic child is about 12 months, their brain is about as large as a normal two or three year old. By the time they're two or three, their brain has reached maximum size -- a size that is typically reached by normally developed children six to eight years later.

"So essentially they're compressing into a brief span of one to two years the amount of brain growth that normally takes roughly six to 12 years."

Normally, the brain develops slowly, and as a child learns, the brain's neurons adapt their shape and function to the information they receive.

But in an autistic child the brain grows without the guidance of experience.

"It is making circuits that aren't necessarily the most flexible and adaptive circuits for behaviour, and this is what is going wrong with autism," Professor Courchesne said.

The next step will be to identify what triggers this abnormal growth, said Professor Courchesne, of the department of Neurosciences at the University of California, and director of the Centre for Autism Research at the Children's Hospital Research Centre in California.

Professor Courchesne was part of the team that discovered in 1988 that autism was caused by a brain abnormality and was not, as some believed, a result of bad parenting.

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AWARENESS

Facing Asperger's: Often-Misdiagnosed Syndrome Creates Special Challenges For Youngsters

Brian Braudis' passion for baseball covers all bases. He sits entranced for hours, designing stadiums with intricate plans for the shops, entrances and dugouts. He grabs his glove and pitches to imaginary players. In conversation, Brian always reverts to the World Series, good games and accomplished players.

"It's kind of hard to stop," said Brian, 10, of Chelmsford, flanked in his room by his favorite baseball bat, caps and cards. "I still don't know who wants to talk about baseball and who doesn't."

One of the hallmarks of Brian's condition, Asperger Syndrome, is an inability to read social cues, such as body language, that hint someone's grown tired of a particular subject.

About one in 500 Americans have some form of Asperger Syndrome, a neurobiological disorder that often is described as autism without mental retardation, according to the National Institute of Child Health and Mental Development. Symptoms can include difficulties with social interaction and communication; repetitive, odd interests or behavior patterns; and extreme sensitivity to physical sensations.

Although it's difficult to differentiate AS from high-functioning autism, children with AS are more likely than autistic kids to desire social connection.

"It's a myth that they don't want to be with others," said Dania Jekel, executive director of the Asperger's Association of New England, based in Newton. "They tend to be excluded because they don't know quite how to do it. They don't know what's appropriate to say and not say. We see a lot of depression in these kids because they're lonely."

"I have trouble in groups," said Brian, who fidgeted with a toy horse to stay focused while he spoke. "There's another kid who collects baseball cards and I've asked him to trade cards with me."

Many AS kids also experience unusual responses to stimulation and the environment, said Dr. Michael D. Powers, author of the new book "Asperger Syndrome & Your Child: A Parent's Guide" (HarperResource, $24.95). Fireworks and school bells or a slight bump in the cafeteria line can be excruciating. Some AS kids seek rigidity, experiencing "meltdowns" or extreme tantrums when faced with minor changes in routine.

"It's also difficult for these kids to (infer) other people's perspectives and express emotions," said Debbie, a MetroWest mother of a 17-year-old girl with AS. "If she received a gift when she was younger and didn't like it, she would get up and throw it in the garbage can" in front of the gift giver. "You can't say, `Honey, you should know better,' because they often don't get it."

More awareness among doctors, educators and parents and better diagnostic methods have translated into an increase in AS diagnoses in the past few years.

"I'm getting 15 to 30 calls and e-mails a day, and most of them are related to children," Jekel said. "When I first started the association 10 years ago, the youngest child diagnosed was 3 or 4. Now they're 18 months old because people are noticing symptoms and traits much earlier."

Yet similar symptoms can occur in people with other psychological and developmental disorders.

"There have been people who have been misdiagnosed before they've been identified as having AS," said Powers. "Some kids might have seemed like they had obsessive-compulsive disorder or attention deficit disorder but then the person actually has Asperger's."

Although there is no cure for AS, psychiatric counseling can help those with the condition to become aware of their actions and better function within society.

But parents have to be advocates for their children, Powers said. AS kids tend to excel in hands-on settings, so parents should discuss the condition with their child's school officials and create an individual education plan that emphasizes projects over essays. Parents can ask that the school notify their child before starting a fire drill.

"You have to be prepared when you walk into meetings," said Brian's mom, Judy Steiner. "I keep all these binders with reports and correspondence. When you walk in with binders, they won't even try to snow you."

Telling family and friends also can help AS kids adjust.

"Self-acceptance and family acceptance is a huge part of healing," said Dr. Sally Ozonoff, co-author of "A Parent's Guide to Asperger Syndrome and High-Functioning Autism: How to Meet the Challenges and Help Your Child Thrive" (Guilford, $35). "Thanksgiving's not a good time to do it but you can bring it up another time," when a relative notices a peculiar trait.

AS kids must decide whether to tell their peers.

"I don't normally tell people I have AS," Brian said. "I don't want to explain it because I don't really understand it."

Powers said despite their difficulties, most of these children can thrive as adults.

"I tell parents that if an adult with Asperger Syndrome is not gainfully employed, somebody messed up," he said. "It all comes down to finding the right job to fit the right person. One of my patients was fabulous with numbers and the best job he ever worked at was with a rental car company, checking if charges had been applied correctly. He worked by himself and worked within his needs."

"These kids really have a passion and conviction about something early on, so in terms of finding a career or niche in life, we know where to go," Ozonoff said. "They know what lights their fire before many other kids, even college students."

Janet, a Cambridge resident, has a 19-year-old daughter with AS who attends a small, out-of-state women's college. Her daughter always has liked sea creatures and plans to draw on that in the future, she said.

"She's doing so well that she hates being considered anything other than a normal kid," Janet said. "The small college is good for her. There's not too much social stuff going on. She can study marine biology and be successful. She'll be an incredible researcher."

Brian said he wants to be a baseball player when he grows up. His mother said he'll more likely work as a statistician or sports analyst if he can continue to learn to adapt to the world around him.

"You can't change children with AS. You can only help them adapt," Steiner said. "It's challenging, but I wouldn't change who Brian is. He is very much a joy.

"(AS) has you redefining what's important in life. We can learn a lot from AS kids."

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