Birth & The Autism Epidemic - (Inc. Australian Study)

[BellyBelly]

Exclusive Interview with Michel Odent: The Autism Epidemic

Among the readers of Midwifery Today are mothers of autistic children. Many of them are seeking explanations about the current autism epidemic. Some are ready to transform themselves into amateur epidemiologists and to design their own surveys. Before supporting one of these surveys, Jan Tritten requested the point of view of Dr. Michel Odent, the founder of the Primal Health Research Centre in London, UK. Primal Health Research is a developing branch of epidemiology. It includes all studies exploring correlations between what happened during the "primal period" (fetal life, perinatal period, year following birth) and what will happen later on in life in terms of health, behavior and personality traits.

JT: Midwifery Today is considering supporting a survey of parents of autistic children to try to interpret what is leading to the current epidemic of autism (and autistic spectrum disorders). The intent of the survey is to consider possible risk factors such as prenatal pollution, exposure to ultrasounds during fetal life, obstetrical procedures during the perinatal period and vaccinations. Do you consider such a survey promising?

MO: I am skeptical about the value of such a retrospective study, which will reach too few families to accurately evaluate the risks of autism. Explore the primal health research database www.birthworks.org/primalhealth and select keywords such as "autism", "vaccination" and "ultrasound scans": You'll find dozens of huge published studies that address these issues. An accumulation of data suggests that the timing of the gene-environment interactions is different for autism than for schizophrenia. Several authoritative studies indicate the paramount importance of what happened at birth in the genesis of the autistic spectrum disorders.

Perinatal Period Risks. Among the recent large and authoritative studies of autism from a Primal Health Research perspective, the Australian one will convince anyone that the main risk factors occur in the perinatal period (Glasson, E.J., et al. 2004. Perinatal factors and the development of autism: a population study. Arch Gen Psychiatry 61(6): 618–27). The birth records of 465 subjects born in Western Australia between 1980 and 1995 and diagnosed with an autism spectrum disorder by 1999 were compared with those of 481 siblings and of 1313 controls. No differences in gestational age at birth (including the proportion of premature infants), weight for gestational age, head circumference or length were observed between cases and control subjects. Pre-eclampsia did not appear as a risk factor. These negative findings lend more importance to perinatal factors. Compared with their siblings, individuals with autism were more likely to have had induced births, to have experienced fetal distress and to have been born with low Apgar scores. Compared with control subjects, they were more likely to have been born after induction and by elective or emergency c-section.

The largest study ever published about the perinatal risk factors for autism was published in July 2002.(Hultman, C., P. Sparen and S. Cnattingius. 2002. Perinatal risk factors for infantile autism. Epidemiology 13: 417–23) The researchers had at their disposal the recorded data from the Swedish nationwide Birth Register regarding all Swedish children born during a period of 20 years (from 1974 until 1993). They also had at their disposal data regarding 408 children (321 boys and 87 girls) diagnosed as autistic after being discharged from a hospital from 1987 through 1994 (diagnosis according to ICD-9 code 299A). Five matched controls were selected for each case, resulting in a control sample of 2040 infants. The risk of autism was significantly associated with caesarean delivery and a 5-minute Apgar score below 7. Unfortunately the variable "labour induction" could not be taken into account, because it did not appear in the National Birth Register until 1991 (personal correspondence with one of the authors).

A recent report from Israel also found no prenatal differences between autistic children and controls, but the rates of birth complications were higher among the autistic population. In addition, we must consider data indicating that perinatal factors may play a lesser role in autism in "high-functioning" individuals compared with studies of autism associated with severe retardation, as well as data suggesting that anesthesia during labour is a risk factor for the development of dyskinesia among autistic children. Although the risk factors for autism seem to occur mostly in the perinatal period, we must keep in mind the association of autism with fetal valproate syndrome (a rare congenital disorder caused by exposure of the fetus to valproic acid during the first three months of pregnancy), thalidomide embryopathy (a syndrome related to in utero exposure to thalidomide) and Mobius sequence (disorder linked to first-trimester exposure to misoprostol).

Vaccinations. In regard to a link between autism and vaccinations, a study involving all children born in Denmark from January 1991 through December 1998 (more than half a million children) will convince anyone that the main negative effect of the MMR (measles, mumps, rubella vaccination) fuss has been to divert the attention (and probably money) from the study of risk factors that might explain the current autism epidemic.(Madsen, K.M. et al. 2002. A population-based study of measles, mumps, and rubella vaccination and autism. N Engl J Med 347(19): 1474–75) An accumulation of data suggests that the significant risk factors occur before the age at which babies receive MMR, which is usually given at 12 months or after.

The hypothesis that mercury associated with certain vaccines is a risk factor is not supported by a study involving all children born in Denmark from January 1990 until December 1996 (nearly half a million).(Hviid, A, et al. 2003. Association between thimerosal-containing vaccine and autism. JAMA 290(13): 1763–66) The risk of autism and other autistic-spectrum disorders was the same among children vaccinated with thimerosal-containing vaccine and children vaccinated with thimerosal-free vaccine.

Ultrasound Scans. Although prospective studies found effects of exposure to ultrasounds during fetal life on average birth weight and handedness, none of them found effects on intellectual performance and therefore (probably) on the risks of autism.

I think that many people express opinions, theories and hypotheses (that lead to small surveys) without being aware of huge valuable studies published in authoritative medical or scientific journals. These studies can be easily explored on the primal health research database (it is more time consuming to feed it!).

JT: Taking into account the studies already included in your database, can you imagine some fruitful avenues for research in the near future?

MO: We have many reasons to suspect a link between "autism epidemic" and "labour induction epidemic." The first reason is that in all studies that took into account independently the variable "labour induction," it appeared as a risk factor. Labour induction should be explicitly taken into consideration by epidemiologists, because it can be associated either with birth by the vaginal route (with or without intervention such as forceps), or with cesarean birth.

Another reason is that the epidemic of autism and the epidemic of induction seem to have developed side by side in Western countries and in China. Bai, from the Association of Rehabilitation for Children with Autism of Wuhan City, estimates that the number of children with autism is growing at an annual rate of 20 percent in that country, higher than the world average of 14 percent (http://news.xinhuanet.com/english/20...nt_1759576.htm). Let us recall that the rate of inductions is growing fast in China, since the Chinese are autonomous for synthesizing misoprostol.

A third reason is that the results of recent studies suggest that children with autistic disorder show alterations in their oxytocin system. The first clues came from a study of mid-day blood samples from 29 autistic and 30 age-matched normal children, all prepubertal.(Modahl, C., et al. Plasma oxytocin levels in autistic children. 1998. Biol Psychiatry (4): 270–77) The autistic group appeared to have significantly lower blood oxytocin levels than the normal group. Oxytocin increased with age in the normal but not in the autistic children. These results inspired an in-depth inquiry into the oxytocin system of autistic children.

In recent years oxytocin has been shown to appear in the brain in several forms. The nonapeptide oxytocin (OT) and the "C-terminal extended peptides" are described together as OT-X. The OT-X represent intermediates of oxytocin synthesis that accumulate due to an incomplete processing mechanism.

Twenty-eight male children, diagnosed with autistic disorder, were compared with 31 age-matched control children with no psychiatric disorders: A decrease in blood OT, an increase in OT-X and an increase in the ratio of OT-X/OT were seen in the autistic sample, compared with control subjects.(Green, L., et al. 2001. Oxytocin and autistic disorder: alterations in peptides forms. Biol Psychiatry 50 (8): 609–13) In other words autistic children show alterations in the oxytocin system: there are deficits in the synthesis of oxytocin.

We are learning that, among humans, the period surrounding birth is a period of dramatic reorganization of central oxytocin binding. Artificial induction of labour creates situations that undoubtedly interfere with the development and the reorganization of the oxytocin system in such a critical period. This fact alone is a reason for further epidemiological studies focusing on labour induction as a possible risk factor. It would be useful to know also how autistic children release oxytocin. Oxytocin is more effective when released rhythmically, in a succession of fast pulsations. Today it is possible to measure the rhythmicity "the pulsatility" of oxytocin release. In other words, the time has come to study autism as an "impaired capacity to love."

Editor's Note: Oxytocin is a hormone released by the posterior pituitary gland. Its mechanical effects, particularly its stimulating effects on uterine contractions during labour, have been known for a long time. Recently we learned that oxytocin also has important behavioral effects. Today we are in a position to summarize the results of dozens of studies by claiming that oxytocin is the typical hormone of love: Whichever facet of love one considers, oxytocin is involved.

[Kirsty77]

Very interesting........heres my 2 cents........LOL>>>>>>>>>

Of course a traumatic/difficult labour can cause a child to be born with a disability......for e.g cerebal palsy caused by lack of oxygen to the brain during a natural delivery. Any type of delivery has its risks. I work in the disability field, primarily and soley with adults with intellectual disabilities that they were born with or aquired as a child. I honestly didn't think that there was a 'autism epidemic' I think that its just been diagnosed alot more due to better trained docs and better research. I wonder how many people do have some form of autism or other disability that was never diagnosed.

[Trillian]

I discussed this with a MCHN once. I honestly think that some babies are just born with it through no fault of their own or due to anything their mother did during the pg or labour etc - they are just 'wired' differently. some aquire it and some is from it being heriditary. I agree with Kirsty, that I don't think it has become an epidemic, but rather what typically defines the nature of ASD's has become more structured and tested - meaning it isn't just a stab in the dark anymore with diagnosis.

I wonder how many people do have some form of autism or other disability that was never diagnosed.

This is mainly what the MCHN and I were talking about, that it isn't that autism has become the new trendy or latest fad in medical conditions, but there is a better chance of a diagnosis and that in cases where it runs in families, once a child is diagnosed with an ASD, then the actions of another much older family member are put into perspective.

ETA - I know what I've just said doesn't directly related to birth and autism, but it is interesting that the links have been made.

[BellyBelly]

Kirsty that theory has actually been challenged about cerebral palsy:

Cerebral Palsy linked to viral infection at birth
Medical Studies/Trials
Published: Monday, 9-Jan-2006

A new Australian study has found that exposure to certain viral infections shortly before and after birth, the perinatal period, is associated with cerebral palsy.

The findings support the theory that infections during this period can trigger brain damage and the development of cerebral palsy.

The study at the Adelaide Women's and Children's Hospital in Australia involved 443 children with cerebral palsy and 883 control babies.

All babies were born to white mothers between 1986 and 1999.

Within a few days of birth blood samples taken were used to test for the presence of a group of viruses including herpes viruses, known as neurotropic viruses, which can cross the placenta and infect the fetus.

Apparently exposure to viral infection was common in all newborn babies, especially in preterm babies, implying that infection before birth may also be linked to preterm delivery.

The team found that Herpes group B viruses were found more often in babies who were later diagnosed with cerebral palsy than in control babies.

The risk of cerebral palsy was in fact almost double with exposure to herpes group B viruses.

The authors say that despite some limitations, the study shows that perinatal exposure to neurotropic viruses is associated with preterm delivery and cerebral palsy.

They are apparently planning further studies in order to investigate the possible causes of this link.

The study is published online by the British Medical Journal.

[hannanat]

Hi,

Love you Kirsty but completely disagree with that argument that the rise in autism is due to better diagnostics. If that was the case where are all of the autistic adults? Sure there were some misdiagnosed as schizophrenic or retarded but we've gone from as 1 in 10,000 to 1 in around 160 (and thats being generous).

Any doctor or expert who dismisses out of hand a solid link between thimerisol and autism loses any credibility for me. The fact is the medical profession in general have no conclusive evidence on what causes autism - they need to be listening to the parents.

Would you know if you had a perfectly normal child, had them immunised and then lost them - not physically but in every other conceivable way within 48 hrs of the vaccination? I have said on here many times that I think there has to be a predisposition - and that may very well be what Kelly's article is talking about. But regressive autism is the autism that people are talking about - thats where you have a neurotypical child that loses their ability to communicate and loses interest in the world around them. Prenatal causes of mercury induced autism could be as simple as a mothers dental fillings or a high consumption of mercury rich fish.

Its my opinion that the autism spectrum is a hundred different illnesses with similar symptoms and slowly we will sort them out.

[Kirsty77]

Thats really interesting Kelly. We haven't had anything passed onto us regarding that study yet, but there is always constant research on the various disabilites slowly filtering through. Although most people diagnosed with cerebal palsy actually have no 'brain damage' IYKWIM I guess I mean they yes do have damage to the part that affects physical ability, but their brains are highly functioning.

Nat- With regards to where are all the adults with autism. Well most of them haven't been diagnosed and I think you'd find most of them are on pensions/disability pensions due to the fact that they've been diagnosed as just having an 'intellectual' disability as so many other adults were back in the day as research wasn't as great and they were just all pooled together.I run some residences where our clients are supported 24hr/day and most of them have some form of autism or aspergers. Our non=profit company sees so many that have autistic traits but have been diagnosed way back when with just an intellectual disability and when now we've had them reassessed they have found out that they do indeed have autism. Gotta agree Nat that I also believe that although people do have autistic traits I bet also that later on they'll be diagnosed differently due to different illnessess, factors etc.

I just wish there was so much more research into disability. Slowly we are getting there. And I wish there was more understanding for people with disabilities.

[BellyBelly]

OoOooh yeah I agree... where are they putting all the money??!!! It's hard to understand isn't it...

[Mumma2three]

I don't know much about autismn, and therefore cant' comment much, but I do remember on a current affair a while back (no, I don't watch it often...) and they had 5 children with severe autism. They changed the diet of all 5 and they improved out of sight. They went from not communicating, to different happy children. I am NOT saying this will fix autism, but I was absolutely amazed at the outcome, these kids were so so much better. Could some of the increases in autism be from the processed foods etc that are given to children, similar to allergies and obesity? The foods they cut out from memory were wheat, dairy and sugar. Was very hard to maintain the new diet, but I guess the families would think that a tiny sacrifice to have their children back. xoxoxo

[Juliette]

Re: The Cerebral Palsy study - As I understood that study Kelly, it was providing support to the idea of multiple causation of CP. I don't think they were suggesting that birth trauma is less positively associated with CP, but rather adding to our understanding that there are other variables affecting the brain and nervous system that are also significantly associated with CP. Most of the studies (due to ethical considerations) have to be designed using a non-experimental design, and as such cannot infer causation anyhow.

Re: Autism. I think that 'better' (or more enthusiastic) diagnostics definately play a part in the apparent increasing incidence of autism. Keep in mind that the DSM and ICD are diagnostic tools that were developed by committees of psychiatrists and medical practitioners to explain and justify what they see (common patterns of behaviour). We need to be careful when we talk about developmental and psychiatric diagnoses. It's not the same as diagnosing diabetes whereby there are clearly defined and accepted physiological markers that can be physically seen. The chance for misdiagnosis is much greater for psychological and developmental disorders than for any other medical conditions. There is also a lot of pressure on schools and parents to 'seek' diagnoses to 'explain' deviant behaviour (that is, behaviour that deviates from the norm). I have known paeditricians and GP's to use the term 'autism spectrum' in preference to ADHD, knowing that the child will only recieve financial support/funding with the former diagnosis. So in addition to a fairly complicated, ambigous diagnosic criteria there is a strong social & political incentive for making one diagnosis over another. This is not because the medical profession are being deliberately sneaky - they are just seeing the day to day reality of families who really need help, and they know what's needed in order to get it for them. I cannot register a person with ADHD with the government department I work for. I can (within certain stringent guidelines) accept an Autism Spectrum Disorder diagnosis.

Again, retrospective, non-experimentally designed studies are problematic. I think we're barking up the wrong tree seeking to understand diagnoses such as these. I think we should be focussing on the individuals who are stuggling in our society, asking them and their families what they need, and tailoring our responses to each person and their unique needs. Stigmatising labels are of no real use (aside from access to funding - but that is a systemic issue, not a medical concern).

In terms of where all the adults with ASD are, I work with many of them. They are also grossly over-represented in the criminal justice system unfortunately. Social norms and rules can be very confusing to the ASD adult - especially those who have not been accurately diagnosed, or who haven't had access to early intervention, and concrete guidance in negotiating the strange, sometimes very abstract world we live in!

[Juliette]

I also wanted to comment on the 'significant association' between c-section and autism. Childbirth is also significantly associated with c-sections (funnily enough!) - 1 in 4 in fact! It would take some pretty sophisticated and creative statistical analysis to separate out the many variables involved here. I have to say, I'm sceptical.

Also, assuming I was to accept that we could confidently make an association - statistically speaking, saying that there is a 'significant association' does not explain the direction of the association (what causes what). Which comes first? The autism or the intervention? Perhaps a fetus with ASD is more likely to experience failure to progress for one reason or another? Or... conversely, does the procedure itself create the conditions for the development of the disorder?

[Kirsty77]

Well said Jules!!