00:01
I’d like to spend a
little bit of time just
briefly explaining the
vaccine-autism connection.
00:07
There is none.
00:08
There is no connection
between vaccine and autism.
00:11
This has been studied so carefully.
00:14
This arose largely because a British
physician, Andrew Wakefield,
took advantage of a connection
between vaccines and autism
that is purely time-based.
00:26
Think about this carefully.
00:28
If a child is going to present with autism
as an inability to play with other children,
that will probably show up when
a child is put into a situation
where there are other
children more often.
00:39
An example would be daycare.
00:41
Many children in the United States
start daycare around a year of age.
00:46
That’s also when they
get their MMR vaccine.
00:49
Likewise, many children will start more
social interactions when they enter school.
00:56
And it may be, especially,
for the milder cases,
that these children are picked up when
they start school around the age of 6.
01:03
That’s also when they receive
a second of the MMR vaccine.
01:08
So this temporal connection
lead a doctor in England to think that
there would be a great way to market
a new vaccine and make
some cash on the side
by creating belief that vaccines
are associated with autism.
01:22
Therefore, he created a fraudulent
paper, which connected these two things.
01:27
And his goal was to create a
vaccine that would be autism free.
01:32
Since then, this paper has been debunked.
01:35
He lost his license in England.
01:37
So it’s been well-known that
this is no longer a connection.
01:42
But, if you imagine, if autism
happens in 1 in 110 people
and there is a myth out there that
vaccines are connected to autism,
people will start to
come forward and say,
“Yes, my child was diagnosed with autism
right after they got the vaccine.”
And this persisted through
work of some celebrities.
02:00
And this connection has been hard to debunk
resulting in remarkable outbreaks
of very severe disease
that wouldn’t need to happen if it
weren’t for low vaccinations rates.
02:14
So we need to do our best to
contraindicate and contradict
the belief out there that
vaccines and autism is connected.
02:23
We should not even entertain the thought
that there is a connection here.
02:29
So let’s go back to autism.
02:31
There are some comorbidities
that can present
as a result of autism and other problems.
02:38
And you should be aware that
these things can go together
because we may treat
such patients differently.
02:44
Patients with autism may or may
not have intellectual disability.
02:48
But it’s more common
among autistic patients.
02:51
Likewise, they may have language disorders,
anxiety, depression, obsessive
compulsive disorder,
symptoms of attention deficit disorder or
attention deficit hyperactivity disorder.
03:03
They may have self-injurious
behavior or aggressive behavior.
03:07
They may develop seizures
more often or tic disorders.
03:10
They also may develop food selectivity and
that can cause all kinds of problems.
03:16
I once had a patient who
would only eat peanut butter
who presented with
vitamin deficiencies.
03:21
We have to think very creatively
about how to address these issues.
03:25
Also, they may have sleep difficulties
or difficulties with sleep,
which result in making
their therapy harder.
03:33
So if we suspect autism, how
do we make the diagnosis?
I would encourage people to refer
patients to an autism specialist.
03:42
These children really require expert care
in terms of not only their evaluation
but setting up a
regimen of therapy.
03:50
There is genetic testing
available for children with
other sequelae such as
fragile X or other problems.
03:56
And generally, an EEG is
completely unhelpful,
unless there are seizures
present in which case
you can identify a potential
seizure disorder.
04:06
Treatment of autism can
be very challenging.
04:10
And families can get very frustrated.
04:12
We have to have a lot of
patience with these families
because their lives are very
difficult and challenged.
04:18
And they love their children and
they want the best for them.
04:20
So we should try and help them
find the best opportunities.
04:24
Generally, earlier special
programs yield better results.
04:28
So the sooner you can make this
diagnosis and intervene positively,
the better the outcomes.
04:34
One study which I think was
absolutely fascinating
showed that for children who are
in a standardized school,
training the peers of that child
to learn to integrate that child into
the play was even more effective
than training parents for how
to get that chid to act better.
04:54
So it’s important in a child who’s
having a difficult school situation
to work with the school and even identify
some potential peers for that child
who can learn to interact better with
that chid and that can go a long way
for it’s integrating that child into the
social structure of the school setting.
05:12
Additionally, there are some adjuvant
medications that may be helpful.
05:17
SSRIs may help for mood or anxiety issues
and stimulants may be helpful
for attention deficit
or attention deficit
hyperactivity disorder.
05:28
Family therapy maybe key.
05:30
It’s important not only to
get therapy for the child,
but for the parents who struggle and
may suffer significant depression
as a result of having to deal with a
child who is so difficult to manage.
05:43
The majority of patients
have life-long symptoms.
05:47
Setting up a system for them
to continue to work with them
throughout their life is
critically important.
05:53
So that’s my review of autism in children.
05:56
Thanks for your attention.