Autism why the increase

Welcome to my world. I am a developmental and behavioral pediatrician who has specialized, over the last 30 years, in caring for, diagnosing, and helping literally thousands of children and adolescents with ASD. Andrew Solomon no relation to me , in his wonderful, profound, and essential book Far From the Tree, discusses the difference between illness and identity.

While each of these experiences [of disability] can isolate those who are affected, together they compose an aggregate of millions whose struggles connect them profoundly. We must embrace our differences. Of embracing differences. My answer might surprise you, as it did me. Since autism has increased fold! As the brand-new graph below from Autism Speaks shows, the dramatic and disturbing rise has continued, tripling over the last 15 years. When I speak to audiences about the importance of intensive, early intervention for children with autism, this question—Why the huge increase in autism?

In the last decade, research has found several pieces to this puzzling question but there are still missing pieces. First, autism is increasing because we are diagnosing milder forms. This is reflected in the term autism spectrum disorders because it includes such a broad spectrum of children that we, in the medical profession, never would have included before. Then we included children with some language but with serious problems socializing whose special interests—cars, trains, wheels, Toy Story, LEGOs, YouTube—took them out of social interaction.

Second, there is a hunt on. Our society has become sensitized. The media is making mothers hyper-aware that their children might have symptoms of autism. Symptoms typically last from weeks in children, with some reporting symptoms that persist for many months. Second, children are increasingly recognized as vectors who can bring infection into the house , potentially transmitting infection to vulnerable household members.

Finally, we have all seen the mayhem that results when one child in the classroom becomes infected with COVID and the other students get sent home to quarantine — across the U. We now have an extraordinarily effective vaccine with more than 90 percent efficacy at preventing symptomatic infection. Vaccinating children will boost our countrywide vaccination rate which is trailing many countries after an early start.

Nevertheless, there are still many questions and concerns that parents have as the vaccine gets rolled out. I will address six of them here. Even though this is a relatively new vaccine, the technology is not new. By now it has been more than a year and a half since the Pfizer trials began in March , and more than 7 billion doses have already been administered globally, including in This is not how mRNA works.

DNA is present in the cell's nucleus. The mRNA only stays in the outside cytoplasm , gets destroyed and never enters the inner sanctum of the nucleus. Furthermore, for the mRNA to be ever integrated into DNA, it requires a special enzyme called reverse transcriptase which humans don't have. Pieces of spike proteins get displayed on the outside of our cells and our body makes protective antibodies that then protects us handily against the future real virus if it were ever to enter our or our children's bodies.

Unlike medications that are taken daily or periodically and can build up over time, the mRNA in the Pfizer vaccine is evanescent.

It literally is just the messenger that is what the "m" in mRNA stands for and the messenger quickly disappears. Our cells break down and destroy the mRNA within a few days after receiving the instructions to make the virus spike proteins. The presence of these fragments of the virus note this is not "live" virus prompts our immune system to generate protective antibodies to the real thing. Our bodies break down mRNA all the time in normal cellular processes — this is nothing new.

What the transience of the delivery system means is that most of the effects of the mRNA vaccines are expected to be more immediate sore arm, redness at the site, fever, chills etc. A severe allergic response has been reported to occur in some generally within the first 15 minutes, is very rare, and everyone gets observed for that as part of standard vaccine administration. Even with the very uncommon complication of myocarditis inflammation of the heart muscle and pericarditis inflammation of the lining of the heart seen primarily in young men under the age of 30 following mRNA vaccines, these typically happen within days to 2 weeks and many return to work or school in days.

In the year history of pediatric and adult vaccines , dangerous complications happen in the first two months.

There have been millions of adolescents as young as 12 years and thousands in the initial trial of children aged who have already received the vaccine and are well beyond the two-month period of observation. There is no biological reason to believe that younger children will have a different long-term side effect profile compared to adolescents or adults. Although the Pfizer trial in children aged was relatively small, it was big enough to give us statistical confidence in assessing safety and efficacy outcomes.

Scientists spend a lot of time determining the right sample size of a study during the design phase. On one hand, you want to conduct the study efficiently so that resources are used in a cost-effective way and that you get a timely answer, especially in a fast-moving pandemic.

On the other hand, you want to make sure you have enough sample size so that you can answer the question confidently as to whether the intervention works and whether there are adverse effects. The more profound the effect size of the intervention in this case the vaccine , the fewer the numbers of children needed in the trials.

Statistics help investigators determine whether the results seen would have appeared by chance or not. In this case, the effect was real and impressive.

Over 3, children around the world have received the vaccines through the trials alone with no serious side effects detected. The first press release reported that the immune response in children aged was similar at one-third the vaccine dose to the response in the comparator group aged years old. Extrapolating clinical efficacy results from immune response measurements " immunobridging " study would already have been acceptable if this was the only data.

This is a standard trial design for many pediatric vaccines. Vaccines are first tested in the lab, followed by animals then adults. Only when deemed safe in adults and various regulatory bodies have signed off, do the pediatric vaccine trials commence. Because children's immune systems and bodies are in a constant state of development, the vaccines must be right-sized.

Investigators typically conduct "age de-escalation" studies in various age groups. The lowest dose is first tried so see if that is effective, then the dose is increased gradually as needed. Immune response is the easiest, safest and most efficient way to test the efficacy of pediatric vaccines.

This is a typical size and design of a childhood vaccine seeking regulatory approval. There is no reason to think that the clinical efficacy would be any different in children vs. Although this was primarily designed as an "immunobridging" study, the initial immunologic response data was followed by real clinical outcomes in this population. Reporting on the outcomes of 2, children in the randomized controlled trial, the vaccine was Myocarditis inflammation of the heart muscle and pericarditis inflammation of the lining of the heart have been associated with receipt of the mRNA vaccines , particularly among male adolescents and young adults, typically within a few days after receiving the second dose.

But this is very rare. For every million vaccine recipients, you would expect 41 cases in males, and 4 cases in females aged years-old. The risk in older age groups is substantially lower. It is important to recognize that the risk of myocarditis associated with COVID is substantially higher.

Patients present with new chest pain, shortness of breath, or palpitations after receiving an mRNA vaccine more common after the second dose. But outcomes are good if associated with the vaccine. Most respond well to treatment and resolve symptoms within a week. There have been no deaths associated with vaccine-associated myocarditis. The risk of myocarditis is likely related to vaccine dose, so the fact that one-third the dose of the vaccine will be used in the year-olds is expected to correspond to a lower risk of myocarditis.

At the lower dose given to younger kids, there has been a lower incidence of adverse effects reported compared to older children and adults who received the full dose. In addition, baseline rates of myocarditis not associated with vaccination are much lower in children ages years than in older children, so the same may hold true for vaccine-associated myocarditis cases. This is because myocarditis is associated with sex hormones particularly testosterone that surge during puberty.

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