Just a quickie to point you to an update about the “doctor” who started all the craziness about the SUPPOSED link between the MMR vaccine and autism.(My friend Esther runs the site — a smart cookie and a doctor to boot — look around her site a little bit, too):
Remember, there are no guarantees when it comes to weighing the healthcare options for your family. But the more informed you are, the better prepared you will be to balance the pros and cons. For my money, vaccines are an easy bet.
In an interesting development in the ongoing saga of the alleged link between vaccines and autism, the medical journal The Lancet is retracting the original study that proposed the idea that the MMR vaccine could cause the disorder.
If you’ve been a BabyShrink reader for awhile, you know my stand on vaccines: They’ve saved millions of lives. It’s just like any medical advance: There’s a cost-benefit ratio to consider. And when you’re talking about saving the number of lives that vaccines have saved, SIGN ME UP.
In terms of the supposed autism/vaccine link, I’ve always been skeptical. I want to know more about possible environmental and genetic causes, but I believe the reams of research done that show NO CAUSATION by vaccines. And I’m still wondering about the issue of autism recognition, diagnosis, and the increase of cases: Clinically, I see a lot of pressure to diagnose autism, and much greater willingness to give the diagnosis. If you’re interested in more, here are a couple of links:
Hi Dr. Heather,
I came across your website when doing a search for signs of autism in infants. Our 3-month-old doesn’t look at us very much, doesn’t track objects across the midline well, and doesn’t often respond to our voice. He stares at the wall or just beyond us pretty much anytime we hold him in our lap looking up at us. He is very calm and mellow, and only cries when he is tired or hungry. He would sit in his bouncer or swing all day if we let him. We also have a 3-year-old very active boy with sensory processing problems so I know our baby doesn’t get as much attention as i would like to give him. We know he is way too young for any of these signs to be a definitive answer, but I am having a hard time finding information on what we can do preventatively as we observe him over time. There is a program in our city, but other than that, everything I find is geared towards 18 months to 2 years, since that is the time that it is easier to see more clear signs. Can you help?
I’m so glad you are aware of this crucial aspect of your baby’s cognitive development. I think most parents would be happy to have a “mellow and easy” baby who would happily sit in his bouncer all day. But you recognize that he might not be reaching out to you for the important “give and take” and communication that he needs to trigger important aspects of his development. He needs to engage with you and play “Baby Games” in order to solidify his relationship with you, which forms the foundation of his cognitive growth. What to do?
I understand that you want to be as proactive as possible, given your experience with your older son. And while there is a possibility that your baby may suffer some similar developmental issues, it’s also quite possible that everything you describe is well within the norm for typical development. First of all, try not to over-worry, but maintain the watchful engagement that led you to research your concerns. Your baby can pick up your fears and anxieties, and this can push him to be even more distant. There is some interesting psychological discussion and observation going on about this very basic “give and take” in the parent/infant interaction, and in the ability of a baby to pick up on his parents’ feelings. When a very anxious parent reaches out to a baby in a way that seems desperate or demanding, the infant can sometimes seem to feel pressured, and retreat even more. So, as with many aspects of parenting, containing and managing your own feelings is Job One.
That said, there are many things that ALL parents can — and should — be doing to maximize this incredibly important time in a baby’s development:
Carefully watch your baby’s sleep/wake/activity schedule for clues as to when he is most likely to be responsive to parent interaction. Sometimes he’ll be fussy, or seem overstimulated by your efforts. Other times he may be more receptive. Often, these receptive times are shortly after waking from a nap and having a feed. But you are your baby’s best expert; try to figure out when he’s most approachable.
Then, make a conscious effort to play “Baby Games” during these times of approachability. Try to match his energy level and catch his gaze. Follow his lead; if he coos and looks away, try to respond in kind. You want to reinforce any efforts on his part, even brief eye contact that might be just 1 or 2 seconds long. Each baby is different; perhaps your baby is more auditory and responds well to your cooing back, other babies might be better reinforced by a brief touch to the face or hand, or from a big returned smile. Experiment, and see which response generates another round of interaction from your baby.
Don’t give up if your baby continues to avert his gaze. Take a deep breath if you start to worry, and try to be as available as you can for “Baby Games”. Give him time and keep trying.
Jennifer, I have a 3-month old too. Although she does engage in periodic eye contact, coos and smiles, she is much more reserved than her siblings were at this stage. At first I also worried about her relative lack of eye contact and her willingness to hang out in her crib for long periods of time. I can’t help but think that the noise and chaos of our busy household causes her to be a bit more protective in her interactions; there’s a lot for a little baby to absorb in this household! But her Daddy and I have been engaged in the exactly these exercises with our little one, and I can see the difference in just a couple of weeks of consciously trying to engage with her.
Dr. T. Berry Brazelton has some excellent suggestions for engaging a baby who might have sensory issues or sensitivities. Use your parents’ detective skills to determine WHICH senses your baby tolerates — and DOESN’T tolerate — very easily. Use this information to “fine tune” your interactions with him. For instance, our baby seems to respond longer to us, and with more smiles, when I’m quiet. Responding both with my facial expressions AND my voice seems to be too much for her, and she turns away. But if I keep focused on giving her a big returned smile, maintain eye contact, and maybe even stroke her hand or her cheek, she’s much more likely to stay engaged in our “Baby Game” than if I coo or talk back to her. Eventually, she’ll develop the ability to tolerate my voice as well. But until then, I’ll hold back a bit. Experiment with using different modes of communication with your baby and maximize what works.
I also double-checked on the expected timeframe of infant response to parents’ voices, and most authorities agree that this isn’t regularly observed in most infants until 4 months. Our baby is 14 weeks, and only in the past few days has she started responding to our voices on a somewhat-regular basis.
Now, I’m not able to evaluate your little one, but there are many things you can do to maximize this important aspect to your son’s development. Over time, you can judge his progress and if you’re not satisfied, have him evaluated by the program you mentioned in your city. If they’re not yet able to enroll him due to his young age, perhaps their specialists can take a quick look at your son and make some further suggestions to you. I’m a firm believer in erring on the side of having a child evaluated early, not only for reassurance of an expert opinion, but for the often very helpful recommendations that the specialists can give you, even if there’s nothing really atypical with your child.
And I can’t stress this enough: At 3 months of age, you should be aiming for interactions measured in SECONDS, not minutes. Feel good if you generate a few “rounds” of interaction between you and your baby at this age. Over time, you’ll both want to stretch these interactions to last longer and become more complex. But at 3 months of age, your baby is still very young and new to the world of interaction. A 3-month-old is only recently “hatched” — our psychological term for the opening of awareness that marks the end of the “squirrelly newborn” phase. So manage your expectations accordingly.
Jennifer, thanks for the opportunity to write about this extremely important topic. I hope you’ll write back to update us on your progress!
Mom of Four, Parenting Expert
There’s a lot of confusion out there about illness, the flu, vaccines, medications, and autism. This poor Mom is terrified that her son may have contracted Autism from a bout of Swine Flu. Here’s her email to me:
Dear Dr. Heather,
Please help. I saw your article on autism, and I am very intrigued and impressed by your knowledge and insight.
I don’t know what to do. I have two beautiful, 91/2 month old identical twin boys who were always very social, smiley, interactive, looking directly into the face, etc. The one I am most concerned about would turn his head and smile at his brother in their crib, smile at everybody, I would play the ‘up’ game with him and he would gaze into my eyes, smile, and giggle… and they both almost always responded by looking when I said their names.
Then one of them got sick with Swine Flu on August 6th. His brother got sick on August 8th. I will never forgive myself as the last time I remember him (the baby who got sick on the 8th) acting distinctly like himself was the 6th when I went to pick up his sick brother at daycare… he looked right up into my eyes, threw up his arms, smiled, and said ‘Mommmmm’…. And I barely paid attention to him, I rushed to his sick brother… I should’ve thrown my arms around him and hugged him and praised him…. I have such guilt and keep worrying/wondering what if that is the last time he ever does that?
They were both put on Tamiflu due to being high-risk (they have asthma symptoms). The baby I am most concerned about didn’t get as high a fever, but the virus infected his eye, and we think he also got a bacterial infection, so he got eye-drops and Amoxycillin as well. He was miserable and cranky for days. I know he can hear (by testing by loud noises, etc.) and he doesn’t have an ear infection, as he’s seen a doctor.
Now he is not himself. I first noticed this as he got better. He is not responding when I say his name, hardly ever. If he does he just looks for a second. He will make eye contact, but only for a second or two. He looks away when I try to play the ‘up’ game with him. He is still babbling, but not as much. He did this weird whisper-babbling this morning and smacked his lips. He is still playing with his toys, but is also playing with non-toy objects like straps and blinds.
The doctor has an ear test set up for him, but I have to wait two weeks just for a call to make the appointment.
Can a virus or antibiotics trigger autism? Does a flu ever attack the ears, eyes, or brain which might cause sudden symptoms? What are the other possibilities might be going on if he doesn’t have an ear infection? This is a very, very abrupt change.
What tests should I push for to find out what is wrong as soon as possible? What are the possibilities?
So far his brother is acting normally, but I am terrified as I’m worried about it affecting both twins eventually.
Please, I would love a response. We have (mega-large HMO) and it is hard to get tests/things done. I am eagerly awaiting your response and guidance.
Very, very sincerely,
Obviously, this mom is in a state of desperation, so I responded immediately:
Dear Concerned Mom,
Of course I cannot evaluate your son myself and as such, I can only provide some educational information for you. But I did want to respond right away because you sound so very upset and worried.
First of all, please know that autism is thought most likely to be a genetically-related developmental issue, and I have seen no convincing information that it can be caused by a simple flu or other virus in a child, nor by antibiotics or antivirals. Additionally, the timeframe you mention of the abrupt changes in your son do not sound like the onset of autism. After all, it’s been barely 2 weeks since the onset of his flu symptoms.
A (temporary) step backwards in response to illness
However, it is VERY common to see temporary developmental regression in response to illness. This means that your child can take several steps BACKWARD developmentally — in response to illness and/or stress — and then “bounce back” days or weeks later. It’s all part of the normal developmental process,which is full of starts, stops, and reversals — the old “one step forward, two steps back” thing. Young children don’t understand that the course of illness is temporary; that they will get better. They simply know they feel lousy. They are not up to showing off all their “best” developmental skills. They commonly regress to earlier stages of development, temporarily, until they feel better. And often times, symptoms of illness can linger for WEEKS in children — especially for something as yucky as a flu. If he is showing regression in response to illness, the regression itself can linger for weeks as well, past the time that he gets better. This may vary from child to child and from illness to illness, so his brother may be fine (at least this time).
Personalities vary in response to illness and stress
I don’t know about your husband, but when mine gets sick, he just wants everyone to GO AWAY. (is this a guy thing?) He’s crabby and won’t talk to me and is just a completely different personality than when he’s feeling well. Everyone is different, and your boys also will have different responses to stress and illness. The point is that there are very reasonable possible explanations as to why your son is acting so differently than his usual self, for this relatively short timeframe.
It’s important that you respond in a positive and supportive way, and not convey to him that you’re so worried. He’s able to pick up your anxieties, and internalize the message that “something must be wrong with him”. He needs reassurance that he WILL get better, and WILL feel better, but for now he still feels lousy and needs to be babied — and that’s OK.
As I said, however, I cannot evaluate your child from afar, so it’s important you get your doctors’ advice, as it sounds like you are doing. But since you have to wait for appointments, I would take this time to hang out with your boys in a relaxed way, giving them the chance to fully recover.
Please let us know how you’re all doing in a few weeks’ time.
Following up on yesterday’s post is an interesting new finding from the University of North Carolina, where researchers are confirming more evidence for an actual structural brain difference in babies with Autism.
Please excuse the “science geek” in me, but this stuff is really important for us to understand. It will help us to better diagnose and help even very young children with Autism-related difficulties, and it will help us to screen out those who SEEM to have Autism, but don’t (see yesterday’s post).
For my non-science-geek, non-shrink parent readers, this is the bottom line here: It’s important to really be watching the quality of your baby’s social development. Your baby’s glances, smiles, gestures and babbles in his first year of life tell you a TON about whether he’s developing normally. The article highlights the importance of “Joint Attention”, which is what your baby does to attract and sustain your attention, in order to share something interesting with you. If he likes doggies, when he sees one, he’ll try to get your attention so that YOU can see the doggie — and get excited by it — too. He’ll want to share his interests with you, even if he doesn’t yet have the words to tell you about them. By the end of his first year, you should see him doing this more and more. Children with Autism have trouble with this — and now we have more information as to why.
If you’re interested in more, check out the summary article here.
And as always, post a comment with your questions or thoughts, if you’d like.
I’ve written before about the confusion and difficulty around the diagnosis of Autism in young children (before the age of 3).
My regular readers know that I’m a strong proponent of Early Intervention screening, and also of early intervention therapy services. This means having your local Child Development center see your child BEFORE the age of three, should you have any concerns about her development, social interaction, or communication skills.
But you also know that I am loathe to jump on the autism-hysteria bandwagon. I worry that there are many other problems that are being missed because we’re jumping to the Autism diagnosis too quickly. Issues of sensory, cognitive, medical, environmental, or even genetic problems can be missed when a diagnosis is made too quickly. Also, the range of child development is so wide, that what can SEEM abnormal may not be. And I blame my field; many of us are so concerned about the number of developmentally delayed children out there, and so few of us are adequately trained to truly evaluate for Autism in the early years, that too may children are mistakenly diagnosed as Autistic. And then their REAL problems go undetected — and untreated.
If I had a million bucks (or ten) I’d start a training foundation centered on the intensive training of Early Intervention clinicians in the detection and treatment of Autism-related conditions — and other problems that might SEEM like Autism, but are NOT. We need a nation-wide (heck, world-wide) training initiative so that psychologists, pediatricians, speech and language therapists, occupational therapists, special instruction teachers — indeed the whole range of Early Intervention professionals — can get the advanced training we all need in this very specialized area.
In the meantime, you can read this very interesting article at Time.com summarizing some of the newest research on signs of Autism in the very young infant. It also helps to explain why this is truly a very difficult disorder to diagnose in the early years. And if you missed it, there’s also a link to a popular post of mine on the diagnosis of Autism.
*Please note: This post was updated by Dr. Heather on 11/22/2010 .
Autism diagnoses are skyrocketing, but is the incidence of autism really increasing? Are there really more autistic kids out there than there were before?
We don’t know for sure, but one major contribution seems to be the increasing recognition of developmental problems in children by professionals like me. In other words, is it possible that the increase in autism is simply an increase in our diagnosis of the disorder?
The single most frequent referral question I get, as a BabyShrink, is: “Is this child autistic?” Often, I see a two-year-old who is head-banging, language delayed, or performing repetitive behaviors. He may already have a speech therapist or other specialist who worries about autism. Or his parents may have seen Jenny McCarthy on Oprah, and say, “my kid does that!”
The New Autism?
When I went to grad school in the 1990s, we learned that Autism was a rare, severe, and life-long disorder of communication and social relatedness. These kids exhibited the most obvious signs of the disorder:
Near complete retreat from communication with others
Hand-flapping and other odd self-stimulatory behaviors
Severe developmental delays and behavioral outbursts
These kids really could not be taught in any regular school setting; They needed support and help in daily living for a lifetime. But as time went on, clinicians started to see less severe forms of these symptoms; we got better at recognizing them in their more subtle forms. As more behavioral health-care professionals were trained, we had more “eyes” looking for the problem. Parent advocacy and special education laws increased pressure on the school systems to widen the array of services for kids with less severe symptoms. Soon, I had parents and teachers asking me to diagnose autism or a related disorder so the child would qualify for intensive, expensive help that was only available under the autism spectrum range of diagnoses.
The pressure is tremendous; here is a child who has communication and other developmental delays. His parents have few resources. The school will only pay if there is an autism diagnosis. Many clinicians admit that they rationalize labeling the child “autistic” if it helps them get the services they need.
Digging Deeper: When Autism Diagnoses Are Misguided
So, back to the typical 2-year-old head-banger referral. A toddler I saw recently already had a new speech and language therapist, and an occupational therapist. They were concerned about his lack of progress in therapy. He had “lost speech”, meaning he no longer used the words he once did. One psychologist had already labeled him “autistic”, after spending just 60 minutes with him….in an office, not the child’s home, where he is most comfortable and most himself. I found a shy little boy who needed a lot of reassurance from his parents with me, a stranger, in his home. But he was outgoing and comfortable with his siblings and cousins on the playground. Later I found a buried note in the records about ear infections and asked about it. Fast-forward two months; after an ear/nose/throat and audiology consult, the child had ear tubes placed to drain the accumulated fluid behind his eardrums. He immediately began speaking meaningful words and his head-banging decreased by 90%; Nobody is worried anymore about him; he is progressing beautifully and is on track to start preschool at age 3.
That child had painful, unremitting ear infections that interfered with his hearing and language development, and caused him to bang his head in an effort to deal with the pain; His “lost speech” was a result of his shyness with the new speech therapist, and his hearing difficulty. He never truly “lost” any speech; he just was too shy to use his words with a new stranger, the speech therapist! And he was diagnosed with autism, and that diagnosis is “counted” in the statistics of the increasing “epidemic”.
I’m not arguing with the possibility that the actual incidence of autism is increasing. But I am not 100% convinced that that is taking place. And I’m worried about the panic and alarm caused unnecessarily to parents.
I am worried that there are several other distinct disorders being thrown together inappropriately with autism. Children with these disorders deserve to have them studied and understood uniquely, and not just lumped together with other disorders. In particular, there is a large group of children with sensory and motor problems; for example, a baby born with difficulty in tracking her vision. She cannot control her eyes properly so she cannot make eye contact with her parents. She does not learn to communicate well because she cannot make her eyes look where she wants them to go. Her parents think she does not “want” to look at them to communicate. These days, when clinicians hear that a baby does not make eye contact, they immediately think “autism”. But in this case, it is primarily a visual problem – one that, if corrected, will completely eliminate all her delays and symptoms.
Check out the following illustration I found online…(if anyone knows the source, please email me! I have been trying to locate the author but cannot find any information.)
Figure 2. At the age of four months this baby girl turned her head away when an adult tried to interact with her. This was interpreted as a sign of infantile autism. Since two of the older three siblings had esotropia, the infant was referred for an examination. She had normal looking eyes, a refractive error of +1.0 I both eyes and no accommodation to accommodative targets. Therefore +4.0 lenses were placed in front of her eyes to give her a clear image on the retinas. The effect was immediate, the baby looked surprised and a few seconds later showed a normal social smile for the first time.
One thing that health-care professionals seem to agree on is the fact that “Autism” is really a general term for many different disorders, each with different causes and outcomes. We need to work harder at understanding all of the unique disorders that are now being lumped together under one umbrella.
A Word About Vaccines
People are desperate to find a cause for autism. Childhood vaccines protect children from some of the most horrible, deadly, disfiguring, dangerous illnesses that routinely used to kill thousands. Are there dangers with vaccines? Of course. As for all medical treatments, you must weigh the potential risks with the potential benefits. But this problem has been studied extensively by gold-ribbon teams worldwide. Their findings? Vaccines do not cause autism. Not even the older vaccines with thimerosol, a type of mercury. Mercury poisoning by itself does not cause autism either. My kids have all their vaccinations. I have relatives who are survivors of diphtheria, polio and other horrendous illnesses. They don’t want me to lose sight of the misery (and death) that these illnesses inflict. And honestly, when other families choose not to immunize their children, they put the safety of others at risk; especially babies who are too young to have their full complement of vaccines, and other children and adults with compromised immune function. Please do not be misguided by the misinformation out there on vaccines. If you have any questions, please review them carefully with your pediatrician, who will probably agree with what I am saying.
True Autism Symptoms
Now, what does make me worry about autism in a child? Here are the main things I look for when evaluating a baby or toddler. (Remember: each child needs to be seen and thoroughly evaluated in person, preferably in your home, by an experienced professional.) These are some things that should trigger an evaluation, often to simultaneously include the evaluation of developmental psychology, vision, hearing, genetics, neurology, and occupational therapy/physical therapy specialists.
* No eye contact after four-to-five months of age;
* Inability to comprehend any language by 12 months (comprehension of language is far more important than spoken language or speech);
* Lack of gesturing (including pointing) by 18 months;
* Not turning to parents for emotional support/reassurance;
* Exclusively preferring objects to people at any age;
* Lack of imaginative play (make-believe/pretend games) by 18-24 months
There are many other possible, “lesser” symptoms, such as lining up objects compulsively, not responding to the child’s name being called, frequent tantrums, making “strange” sounds, and the apparent “loss” of speech. Often, these symptoms are problems, but are better explained by other diagnoses, such as the visual/motor example above, family stresses and problems, or even complex genetic disorders. And sometimes, these “problems” are simply normal expressions of toddlerhood!
So the bottom line is this: if there are any concerns, get an evaluation for your child sooner, rather than later, since time is of the essence. But make sure you get a comprehensive, thorough evaluation that takes all of the above into account. And if someone does use the word “autism”, don’t panic. These days the word means many different things to many different professionals, and often, the symptoms can be completely ameliorated by the right therapy.
Do you have stories to share about the diagnosis of your child’s developmental delays? Please share!