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PUBLIC HEALTH

Editorials, Commentaries & Letters

* Autism and MMR: Open Up The Debate

* Vaccines Expert Warns Studies Are Useless

* HEALTH: Vaccinations and Autism: A Link?

* LA Times Editorial: Autism's Rising Threat

MEDIA ALERT!

* Burton Calls for Criminal Penalties for Govt. Officials Who May Have

"Covered-Up" Dangers of Mercury in Vaccines - TV REPORT

LETTERS in the NY Times

RESEARCH

* Abnormal Asymmetry In Language Association Cortex In Autism

Readers' Posts

PUBLIC HEALTH

Autism and MMR: Open Up The Debate

Autism in children under eight has increased tenfold since 1988. A new study claims this is due not to better diagnosis but to unknown factors. We must establish whether MMR is one of them

Last week, researchers at the University of California opened a Pandora’s box that British officials have been trying to keep the lid on for years. The team claims that the dramatic increase in the number of children with autism in the state — the numbers have tripled in the past 15 years — is a genuine increase that is caused by some unknown factor, not by greater awareness of the disease. If this is true, it is dynamite. Doctors and officials in America and Britain have long tried to explain away the increases in autism by claiming that we just had not diagnosed the disease properly before.

It remains to be seen how people react to the new research, but there is no question that it has finally opened up the debate. Dr Robert Byrd, who led the California team, said that it was now important to investigate possible causes of autism, including vaccinations such as the triple mumps, measles and rubella (MMR): “A large number of our families believed vaccines were to blame. Until we can definitively answer that question it seems the research in autism is stuck.”

Will this finally make British officials take autism seriously? Although the Medical Research Council says that the disease now affects one in 166 British children under the age of eight — a tenfold increase since 1988 — the Government has been strangely reluctant to investigate this crippling brain disorder that often leaves children unable to speak, rocking compulsively and unable to form normal social relationships. This is because the Department of Health is terrified of undermining confidence in its vaccination programme. But its dogmatic approach has already lowered confidence in the very vaccines it wants to protect.

Scientists who have dared to suggest that autism and MMR are linked have been treated as heretics — the Prime Minister has accused them of “scare-mongering”.

So far, so medieval. But the Inquisition isn’t working. The more the Government insists that MMR and other vaccines are safe, the more alarm there seems to be.

More than a thousand families are going to court next year claiming that their children have been damaged by the MMR vaccine. Cases are pending from a further 100 who claim that their children have been damaged by the vaccine for diphtheria, pertussis, tetanus (DTP). Vaccination rates for MMR have fallen so low that the Department of Health is predicting a measles epidemic. An ICM poll in July said that only 55 per cent of adults have confidence in the MMR vaccine and that 76 per cent would support an inquiry into whether it is linked to autism.

Scares are created when people sense that they are not being told the whole truth. “Pretty much the first lesson you learn in medical school,” says Dr Richard Nicholson, editor of the Bulletin of Medical Ethics, “is never to use the words ‘never’ or ‘always’. There is no absolute certainty in medicine. The Government is being dishonest by saying MMR is totally safe.”

David Thrower, whose son Oliver deteriorated into autism after receiving first a measles/rubella jab and then the MMR, says: “The Department of Health suspends common sense. The main objective of the department seems to be to preserve public confidence, rather than investigate suspected adverse consequences. People are scared to strike a match in case the whole thing explodes.”

No one has proved a link conclusively between autism and vaccines, but there is a small but growing body of research that raises serious questions. What is strange is the Government’s refusal to take this research seriously.

The first scientist to raise the alarm was Dr Andrew Wakefield, a consultant gastroenterologist at the Royal Free Hospital in London, who published his findings in The Lancet in 1998. He had noticed a huge increase in cases of inflammatory bowel disease since the 1970s and closer examination showed that many of his patients were infected with the measles virus. Astounded by the findings, he investigated and concluded that the measles virus alone was not causing the illness — it was the presence of the mumps virus that made the disease possible. His later research suggested that many children developed autism shortly after receiving the MMR vaccine and that 24 in 25 autistic children he examined had traces of the measles virus in their gut.

The Department of Health went to great lengths to rubbish Dr Wakefield ’s research, and officials have insisted that no other study has replicated his work. But in June, Dr Arthur Krigsman, from the New York University School of Medicine, told a US congressional committee that in 90 per cent of his autistic patients he had found a pattern of inflammatory bowel disease identical to that found by Dr Wakefield.

Earlier this year Professor John O’Leary and colleagues in Dublin found the vaccine strain of measles virus in the gut of 12 vaccinated children who had both bowel disease and autism. In August, Professor Vijendra Singh at Utah State University found that autism might be linked to an antibody response to MMR.

Some researchers have suggested that autism may be a new form of mercury poisoning. Studies have found high rates of autism in places where exposure to mercury is high, such as Brick Township in the US and some Japanese cities. Mercury is a neurotoxin that is used as a preservative in some vaccines.

In the US, large payments are being made to children damaged by thiomersal, the mercury preservative used in the US (though not the UK) version of the MMR vaccine. More than $1 billion has been paid out under the National Vaccine Injury Compensation Programme, established in 1986 by US drug companies and the Government.

Around 12 of the 18 vaccine doses that the average American child receives before the age of two contain mercury. Petitioners claim that this adds up to almost 30 times the level considered safe for an adult. In 2000, a study by the American Centres for Disease Control and Prevention suggested that three-month-old babies exposed to 63 micrograms of mercury were

two-and-a- half times more likely to develop autism.

Mercury is not used in MMR in Britain, but it is present in some other vaccines. Dr Richard Halvorsen, a London GP, believes that “there is potential for interaction between medical interventions — mercury and MMR may somehow be co-factors in triggering autism. At the moment there is no other sensible explanation for the massive increase in autism.”

Last year the Department of Health asked UK vaccine manufacturers to stop using mercury “where feasible”, but a spokesman said it had set no timetable and will not be monitoring the manufacturers’ response.

Health officials generally seem more interested in discrediting scientists than in investigating whether health is really at risk. Some of the studies cited by the Government in its contention that MMR is safe simply look at the old case notes from the children with autism. They do not examine patients. Most of the research does not compare children who have had MMR with those who have not, nor does it compare children before and after MMR vaccination.

Responding to criticism from the Government’s Public Health Service Laboratory last month, Professor Singh said: “If they enter their same old data in the statistical equation they will continue to find the same old answer, ie, there is no possibility of a connection between MMR and autistic regression. I do not wish to show disrespect towards them, but please do me a favour and ask them what new research they have done to discredit my research. The answer will be none.”

Some of the other studies cited by government have been linked to vaccine manufacturers. A Finnish study which claimed to prove that there was no link between MMR and autism was paid for by Merck, the US vaccine manufacturer. Last month, the Department of Health announced that it had given £300,000 to fund a study that would attempt to copy Dr Wakefield’s research. Campaigners have since discovered that one of the lead members of the team, Dr Phil Minor, is retained by Glaxo-SmithKline, Britain’s biggest MMR manufacturer. Dr Minor was also a member of the Medical Research Council ’s review body into autism which concluded last year that there was “no evidence” to support a link. A third of the members of the UK Committee on Safety of Medicines, which has advised that the triple MMR is safe, have declared personal or non-personal links with drug companies that make the vaccine.

Dr Richard Nicholson, of the Bulletin of Medical Ethics, says that the Government prefers scientists who have already made up their minds. “If you’ ve got people funded by government who for years have been shouting from the rooftops to anybody who will listen that there is no link between MMR and autism, how much credence do you give the results? Why does the Government think it is worth spending money on this kind of research unless it wants it for propaganda purposes?” Lord Clement-Jones, Liberal Democrat spokesman in the House of Lords and vice-chair of the All-Party Parliamentary Group on Autism, feels similarly frustrated. “The argument has got extremely theological,” he says, “and has gone well beyond the point where people are discussing the facts.”

The Government has had a long time to get to grips with these issues and to prevent the slide into emotion. In the mid-1990s, two men raised their own concerns privately with the Department of Health about MMR in the hope that the Department would investigate and prevent a health scare. One was Dr Andrew Wakefield, who was subsequently rubbished by government and accused of being a selfpublicist.

The other was Richard Barr, a partner in one of the law firms that is co-ordinating the claims of more than a thousand families who believe their children have developed autism as a result of receiving MMR.

“In 1996,” says Barr in a recent letter to The Lancet, “I became so concerned about what seemed to be happening that I wrote to the chairman of the Committee on Safety of Medicines offering to make available the medical records and other information about children who had apparently been affected by the vaccine. My offer was put to the Government on three occasions but was turned down.” It is not clear why the Department of Health was so reluctant to investigate. But under pressure, officials eventually made a small concession. They agreed to send questionnaires to Barr’s list of parents about their children’s symptoms, although it is not clear how they expected this to shed any new light on the matter.

Richard Barr again: “The Department of Health, without referring to us or our clients, set up a working party to look at the families’ questionnaires, and questionnaires they later sent to the treating family physicians. They now use the resulting report as part of the evidence to support the assertion that the MMR vaccine and autism are not linked. They describe it as involving a detailed assessment of more than 100 children’s records referred to them by solicitors, yet the report itself states that it took into account only evidence derived from the parental and medical questionnaires. The report’s conclusion is that it is impossible to prove or refute the suggested associations between MMR vaccine and autism, pervasive development disorder, or inflammatory bowel disease because of the nature of the information used.”

The Department of Health’s intransigence on MMR, and its apparent nonchalance about links with drug companies, is not only undermining confidence in the MMR vaccine but leading some parents and doctors to question the whole childhood vaccination programme.

“We need to take stock,” says London GP Dr Richard Halvorsen. “We’re introducing more and more vaccines earlier, and that concerns me. When do we get to the stage where we could be giving too many? I believe that any medical intervention has the potential for side- effects in some people. We have to be pretty damn sure that we are doing more good than harm.”

Grandparents who had only one jab in childhood — against smallpox — are amazed that their grandchildren are routinely receiving 22 vaccine doses before they are old enough to start school. British babies now receive six vaccine doses in one go at the age of eight weeks, including DTP. Britain has had the most aggressive DTP programme in Europe since 1990, when the programme was accelerated to reduce “drop-out” rates. At the same time GPs were given extra money if they managed to achieve 70 per cent or 90 per cent vaccination coverage. With this incentive, the proportion of GPs reaching the highest coverage level went from 60 per cent to 90 per cent in two years.

Britain’s childhood vaccination programme is clearly convenient and profitable for both drug companies and GPs. But is it sensible? Allison Edwards does not think so. Her son Jonathan was born a week and a half early but still had his first set of injections at eight weeks because “they don’t count for early births, they just start at week one. I asked questions and was made to feel like a troublemaker. The health visitor was push, push, push. Nothing checked — no questions about possible contraindications — they just went straight in there with the needle. I think his little body couldn’ t take it.”

Jonathan Edwards, now 5, is diagnosed as autistic, with a mental age of 12 months.

The astonishing thing about many of the parents who believe their children have been affected by vaccines is how moderate they are. Most seem bewildered by the Government’s lack of interest, rather than bitter. Most support the overall vaccination programme. David Thrower again: “We must protect children from communicable diseases. But we need to screen out a small percentage of children from the immunisation programme to protect its credibility for the future.”

This measured approach is in stark contrast to the Government’s tactics. Fear of MMR has led many parents to travel around the country to pay for single doses. The Government has responded by restricting imports of the single doses, which is further reducing the number of vaccinated children. Parents are taking matters into their own hands and are trying to assess the relative risks of vaccination for themselves. If vaccination rates fall too much farther, a new generation of children could be in danger from serious diseases, such as measles.

Something must be done before next October, when the MMR cases will come before the High Court.

“If the legal judgment goes against the vaccine manufacturers,” says Dr Richard Halvorsen, “I fear the public confidence in the whole immunisation policy may come crashing down.”

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Vaccines Expert Warns Studies Are Useless

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Most safety studies on childhood vaccines have not been conducted thoroughly enough to tell whether the jabs cause side effects, a leading authority on vaccine research has warned.

Dr Thomas Jefferson, who has been funded to investigate vaccine safety by the European Commission, said that the issue was the "Cinderella" of public health research and that Government officials had failed to make it a high priority.

Dr Jefferson is the head of the vaccine division of the Cochrane Collaboration, an organisation of scientists that aims to make accurate information about the effects of treatments available worldwide and promotes high standards in research.

He is also a board member of the European Programme for Improved Vaccine Safety Surveillance, set up by the commission.

He said: "There is some good research, but it is overwhelmed by the bad. The public has been let down because the proper studies have not been done."

His outspoken and unprecedented comments will anger public health officials in Britain and elsewhere, who fear that any discussion will undermine parents' confidence in national vaccination programmes.

Officials at the Department of Health are already alarmed by the number of parents shunning the triple measles, mumps and rubella jab (MMR) after claims that it is linked with autism and bowel disease.

Although Dr Jefferson emphasised that there was no evidence to suggest that any vaccine now in use was dangerous, he said that there was a "dearth" of sound studies on the risks and benefits.

As a result, the information available on the safety of vaccines that are routinely given to babies and toddlers was "simply inadequate".

Dr Jefferson also disclosed plans for a Europe-wide electronic register of children's vaccine exposure that would allow scientists to investigate the risks and benefits of inoculations using data on thousands of participants. Pilot schemes will start soon in Sweden and Finland.

"We need such a system urgently," he said. "Governments are reluctant to accept this but in my view they owe it to future generations to back this idea."

He was especially concerned, he said, because future vaccination programmes were likely to involve giving children "five, six, even seven vaccines all at once".

A vaccine designed to protect children against measles, mumps, rubella and chickenpox in one shot is already under development.

"For people like me, it is becoming more and more difficult to tease out what problems may be due to an individual vaccine," said Dr Jefferson.

"It is almost becoming impossible to do this. We have to think very carefully about how we will monitor these vaccines.

"We have a responsibility to these children - they are our future. It is no use having a situation where someone suggests a possible harm and everyone runs around frantically trying to find bits of evidence. What is required is good-quality information that has been systematically collated and assessed."

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HEALTH: Vaccinations and Autism: A Link?

Enjoying greater public trust, U.S. agency officials have been able to calm most fears about the MMR vaccine, despite rapid increases in the incidence of autism in recent decades. This public confidence has kept U.S. vaccination rates high and prevented outbreaks of the targeted diseases.

The Centers for Disease Control and Prevention recently reported that autism or its less-severe variants were found in one out of every 150 children in Brick Township, N.J.-a rate several times higher than had been expected. In California, where the state government has sponsored new studies of the trend, the autism rate grew almost three-fold between 1987 and 1998, after accounting for other factors, such as better data-gathering, according to an October 17 report issued by the state-funded M.I.N.D. Institute at the University of California at Davis.

Many researchers believe that autism and its less-severe strains are likely caused by several factors, including genetic flaws and chemicals in the environment. Perhaps one-third of autism cases are diagnosed when a child is about 18 months old, which is when nearly all children get their MMR shots. Support groups for parents of autistic children provide numerous videos of pleasant, attentive children who, they say, lapsed into fevers and autism immediately after getting the shots.

U.S. officials have taken some steps to deal with public worries about the MMR vaccine. In 2000 and 2001, the Food and Drug Administration quietly ended use of Thimerasol, a mercury-based preservative in many children's vaccines. Some activists-joined by Rep. Dan Burton, R-Ind., who publicized the issue by holding hearings of the House Government Reform Committee after his grandson's lapse into autism-say that Thimerasol may have increased the autism rates.

Officials at the CDC are about to start gathering additional statistics, in the hope of finding patterns that might reveal biological or environmental factors that increase the incidence of autism. CDC and FDA officials are also studying a new measles vaccine that would be inhaled.

But activists charge that federal scientists have been slow to repeat clinical studies performed by academics in the U.K. and Ireland, and by a Florida-based doctor, that showed portions of the MMR vaccine in the bowels or nervous systems of autistic children. "It is pretty appalling," said Rick Rollins, father of an autistic child, who lobbied California's Legislature to fund the M.I.N.D. Institute. Because the CDC is focused on the use of shots to prevent deadly disease, Rollins said, it cannot be trusted to investigate their role in autism. "It is like asking the tobacco companies to sponsor and pay for research into the link between lung cancer and smoking," said Rollins, who lives near Sacramento, Calif.

Rep. Dave Weldon, R-Fla., complained that government scientists "remind me of ostriches.... There has been group denial within the scientific community." However, both Rollins and Weldon say that new appointees, including Julie L. Gerberding, director of the CDC, are sympathetic to their case and are likely to promote the needed research.

The CDC is preparing to launch a study attempting to replicate the U.K. clinical findings, said Diane Simpson, senior medical policy adviser for the national immunization program at the CDC. The result will be available in a few years, she said. In the meantime, the MMR should still be used, Simpson said, citing a study by the Institute of Medicine, which is part of the National Academy of Sciences, a nonprofit group of scientists in academia and business. The IOM study, released in April 2001, found that statistical studies are not detailed enough to reveal any link between the MMR and autism, but that further studies should be conducted. Without evidence of a link, the study concluded, the MMR should continue to be used to prevent the spread of disease.

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LA Times Editorial: Autism's Rising Threat

Federal officials have long required doctors to report cases of many kinds of infectious diseases. However, the government has never required similar tracking of patients afflicted by chronic diseases such as asthma and autism -- lifelong disorders thought to be caused by a dance between people's genes and their exposure to particular substances in their diet or environment.

Washington's neglect of chronic-disease monitoring may have been a tragic mistake. A study released by UC Davis researchers last week showed a dramatic tripling of autism rates in California in the last decade and a half. The increase cannot be explained away merely by statistical glitches. For example, the researchers have ruled out the possibility that today's doctors are diagnosing anomalies that their predecessors missed.

The new study of autism -- a severe brain disorder that often leaves its victims unable to speak or form long-term social relationships -- should prompt Congress to develop an effective and comprehensive way to track the outbreak of chronic diseases.

The good news is that California legislators have been ahead nationally in recognizing the danger that chronic diseases present. They, in fact, commissioned the UC Davis report. But California's initiative does little to help people in other states, most of which have no chronic-disease monitoring systems.

Moreover, even California's autism reporting system is flawed. It does not, for example, require doctors in all state agencies, from the Department of Education to the Department of Developmental Disabilities, to use a uniform standard for diagnosing autism.

Creating a national chronic-disease database won't be easy. Epidemiologists will have to be careful to protect patients' privacy by using record-keeping safeguards, like computer encryption. And consumer privacy groups that have reflexively opposed any new reporting systems should accept that improved disease-rate monitoring will require patients to give scientists some limited access to their medical records.

What's clear is that continued indifference will be deadly. Political leaders have to give epidemiologists the money and moral support they need to overturn all the rocks in their search for answers to rising autism rates.

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Burton Calls for Criminal Penalties for Govt. Officials Who May Have

"Covered-Up" Dangers of Mercury in Vaccines - TV REPORT

Video of the broadcast at WFAA Dallas/FtWorth TV today at WFAA's site via Real Player

[Thanks to Mary McDonald.]

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LETTERS in the NY Times

On the Trail of Childhood Autism

Rise in Autism

To the Editor:

As the authors of the study discussed in your Oct. 20 editorial "A Mysterious Upsurge in Autism," we appreciate that you pointed out that our study did not rule out the possibility that the upsurge was caused by a rise in the number of parents who sought assessments of their children.

We would also like to emphasize the implications of the study. The results show that the accuracy of diagnosis at the centers we studied is quite high and has not changed over time. Therefore, current estimates of the rates of autism are correct, and autism is a larger public health problem than previously recognized.

Greater resources than had been anticipated will be necessary not only for research into the "mysterious upsurge" but also to provide services for the larger number of afflicted people. Robert Byrd, M.D. Marian Sigman Sacramento, Oct. 22, 2002

[Brief commentary: So far, "The rise in autism numbers could be from more parents seeking assessments of their children" (and "That's just relevant for California, not for here") are the two main specious counter-arguments standing to defend the status quo and its minimizing of autism and its causes. So now, thanks to this MIND report, we know more certainly that the rise in autism is not due to sudden improvements in diagnosing by doctors. Instead, we are told that it is better screening by more aware parents that's at the core of today's autism surge. But this variant of the Hidden Hordes Conjecture is silly on its face and ought to be dispatched. It is impossible for hard-core autism to go unnoticed. The disabilities are just too profound. To suggest that parents in any great numbers could have a not-high functioning autistic child during the 80's and not know something is very wrong and not seek help is ridiculous. It's time to stop giving these air-head conjectures undue weight. –Lenny Schafer.]

To the Editor: Re "A Mysterious Upsurge in Autism" (editorial, Oct.

20): As the parent of a 7-year-old autistic girl, I have suffered for several years through consultations with members of the medical profession who dismissed the perceived increase in childhood autism as a statistical glitch. Certainly, it is bittersweet news to read the report from California that confirms what most parents of autistic children have long suspected: that the autism epidemic is real and that medical doctors have no idea how to halt its spread.

In this light, I cannot settle for your conclusion that it "could take years of study to unravel the widening mystery of autism." Is it not also appropriate to address an urgent need for well-financed and more widely available early intervention programs? And as our kids grow up, will they be able to count on services that will help them live more independent lives? Michael E. Staub Princeton, N.J., Oct. 20, 2002

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To the Editor: Two related factors deserve investigation as possible contributors to the rise in childhood autism (front page, Oct. 18): the increased survival of extremely preterm infants and steroid drugs given to prevent or treat the lung disorders of prematurity. Extremely preterm birth is now known to interfere with normal brain development. Recent research also shows that steroids are toxic to the developing brain.

As the mother of a prematurely born child with autism, and as a participant in research on the outcomes of prematurity, I have been struck by the number of preterm and steroid-exposed children who are found to have autism disorders. Steroid drugs were never properly investigated for safety and efficacy in children before being given to tens of thousands of preterm infants, beginning in the late 1980's.

By conservative estimates, steroids given to fetuses and newborns produce 2,500 extra cases of cerebral palsy and neurodevelopmental impairment in the United States each year. Could autism be part of this picture? Helen Harrison Berkeley, Calif., Oct. 20, 2002

To the Editor: "A Mysterious Upsurge in Autism" (editorial, Oct. 20) notes that while we have more information about autism in California, "nobody knows for sure what the nationwide trends are." Today, chronic diseases, including autism, cancer, asthma, Parkinson's, Alzheimer's and diabetes, strike more than a third of our population and cost our citizens and our country more than $325 billion a year. By 2020, these costs will climb to almost $1 trillion, and these diseases will afflict more than 130 million Americans. If we want to reverse these trends, we must develop a way to track these diseases and monitor the environmental factors that may contribute to them. That is why I introduced the Nationwide Health Tracking Act of 2002, which would establish a uniform system for tracking chronic diseases and potential environmental links. Now is the perfect time to pass this legislation and address this worrisome gap in our public health infrastructure. Hillary Rodham Clinton U.S. Senator from New York Washington, Oct. 21, 2002

To the Editor: Re "Increase in Autism Baffles Scientists" (front page, Oct. 18): Twenty-one years ago, when I was pregnant with my third child, my obstetrician offered me a sonogram for no reason other than to have it done. A radiologist friend had wondered what the long-term effect of sonograms would be on developing fetuses because sonograms generate heat. I heeded his comment and refused suggestions to get one when none were medically required. In light of the increase in diagnosed autism, I am wondering how many of the children with diagnosed autism were exposed to sonograms in utero and if so, when during pregnancy? Of these, how many were exposed one time? Two times? Three times? Four or more times? Nancy Suniewick Kensington, Md., Oct. 19, 2002

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RESEARCH

Abnormal Asymmetry In Language Association Cortex In Autism

Martha R.

Herbert, MD, PhD 1 *, Gordon J.

Harris, PhD 2, Kristen T.

Adrien, BA 1, David A.

Ziegler, BS 1, Nikos Makris, MD, PhD 1, Dave N.

Kennedy, PhD 1, Nicholas T.

Lange, PhD 3, Chris F.

Chabris, PhD 2, Anna Bakardjiev, MD 5, James Hodgson, PhD 6, Masanori Takeoka, MD 7, Helen Tager-Flusberg, PhD 4, Verne S.

Caviness Jr., MD 1 1Center for Morphometric Analysis, Massachusetts General Hospital, Boston 2Radiology Computer Aided Diagnostics Laboratory, Massachusetts General Hospital, Boston 3McLean Hospital Brain Imaging Center, Belmont 4Boston University School of Medicine, Boston, MA 5Children's Hospital, Oakland, CA 6Pennington School, Pennington, NJ 7Keio University School of Medicine, Tokyo, Japan

email: Martha R.Herbert (mherbert1@partners.org) *Correspondence to Martha R. Herbert, Center for Morphometric Analysis, Massachusetts General Hospital, CNY-149, Room 6012, Boston, MA 02114

setDOI("ADOI=10.1002/ana.10349")

Funded by: Cure Autism Now Foundation; Grant Number: NS02126, NS20489

Armenise Foundation Fund Fairway Trust; Grant Number: NS34189, DA09467,

NS27950, P01-DC03610 NICHD/NIDCD funded Collaborative Programs of

Excellence in Autism; Grant Number: MH57180, NS37483

Abstract

Autism is a neurodevelopmental disorder affecting cognitive, language, and social functioning.

Although language and social communication abnormalities are characteristic, prior structural imaging studies have not examined language-related cortex in autistic and control subjects.

Subjects included 16 boys with autism (aged 7-11 years), with nonverbal IQ greater than 80, and 15 age- and handedness-matched controls.

Magnetic resonance brain images were segmented into gray and white matter; cerebral cortex was parcellated into 48 gyral-based divisions per hemisphere.

Asymmetry was assessed a priori in language-related inferior lateral frontal and posterior superior temporal regions and assessed post hoc in all regions to determine specificity of asymmetry abnormalities.

Boys with autism had significant asymmetry reversal in frontal language-related cortex: 27% larger on the right in autism and 17% larger on the left in controls.

Only one additional region had significant asymmetry differences on post hoc analysis: posterior temporal fusiform gyrus (more left-sided in autism), whereas adjacent fusiform gyrus and temporooccipital inferior temporal gyrus both approached significance (more right-sided in autism).

These inferior temporal regions are involved in visual face processing.

In boys with autism, language and social/face processing-related regions displayed abnormal asymmetry.

These structural abnormalities may relate to language and social disturbances observed in autism.

Received: 4 February 2002; Revised: 29 May 2002; Accepted: 29 June 2002

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Readers' Posts

Any one have any good sleep remedys for 9 year old autistic boy who only averages 4.5 hours a night? thanks, Marlene mommom55@webtv.net

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Where can I find information about state and federal financial assistance (e.g., Medi-Cal) for a 2-1/2 year old grandson recently diagnosed with autism? We live in Orange County, CA. Who can I call for help? Papagrswld@aol.com

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I have an 18 year old with Autism. She has such bladder control, she will hold her urine all day until she goes to bed. If too overloaded, she'll just go. Almost refuses to use the toilet, but will sit on it for 15 to 20 minutes to no avail. Bowel training, the same. Non verbal, low functionong, but knows what we want. Rewards do not help. Suggestions? John Muldrew muldrew1@msn.com

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