Although ASD varies significantly in character and severity, it occurs in all ethnic and socioeconomic groups and affects every age group. Experts estimate that three to six children out of every 1,000 will have ASD. Males are four times more likely to have ASD than females.

H2 What are some common signs of autism?

How is autism diagnosed?

What causes autism?

What role does inheritance play?

Do symptoms of autism change over time?

How is autism treated?

What research is being done?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:

BRAIN
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424

http://www.ninds.nih.gov

Information also is available from the following organizations:

Source: National Institute of Neurological Disorders and Stroke – http://www.ninds.nih.gov/disorders/autism/detail_autism.htm

Differences in infant mortality rates among industrialized nations may reflect disparities in the health status of women before and during pregnancy, as well as the quality and accessibility of primary care for pregnant women and infants. However, some of these differences may be due, in part, to the international variation in the definition, reporting, and measurement of infant mortality.

In 2005, the U.S. infant mortality rate was more than twice that of seven other industrialized countries, including Singapore, Hong Kong, Sweden, Japan, Finland, Norway, and the Czech Republic. Singapore had the lowest rate (2.1 per 1,000), followed by Hong Kong and Sweden (2.4 per 1,000).

Source: U.S. Department of Health and Human Services – http://mchb.hrsa.gov/chusa08/hstat/hsi/pages/207iim.html

Investigations determined that an estimated 905,000 children were victims of abuse or neglect in 2006, equaling a victimization rate of 12.1 per 1,000 children in the population. Neglect was the most common type of maltreatment (experienced by 64.1 percent of victims), followed by physical abuse (16.0 percent).

Other types of abuse included sexual abuse, psychological maltreatment, medical neglect, and categories of abuse based on specific State laws and policies. Some children suffered multiple types of maltreatment.

Victimization rates were highest among young children. In 2006, the rate of victimization among children under 1 year of age was 24.4 per 1,000 children of the same age; the rate declined steadily as age increased (data not shown). Younger children were more likely than older children to be victims of neglect, while older children were more likely to be physically or sexually abused. Almost 80 percent of perpetrators of abuse or neglect were parents of the victim.

Remaining types of perpetrators included other relatives (6.7 percent), unmarried partners of parents (3.8 percent), and professionals such as daycare workers and residential facility staff (0.9 percent). Foster parents accounted for 0.4 percent of perpetrators, while friends and neighbors accounted for 0.5 percent.

Source: U.S. Department of Health and Human Services – http://mchb.hrsa.gov/chusa08/hstat/hsc/pages/213an.html

Non-Hispanic White children and non-Hispanic children of multiple races were most likely to be reported in excellent or very good health (91.0 and 87.9 percent, respectively), followed by non-Hispanic children of other races (85.3 percent). Hispanic children were least likely to be reported in excellent or very good health (68.4 percent). Slightly more than 80 percent of non-Hispanic Black children were reported in excellent or very good health.

Parents were also asked to rate the condition of their child’s teeth as excellent, very good, good, fair, or poor. Overall, the parents of 70.7 percent of children aged 1-17 reported that their child’s teeth were in excellent or very good condition (the question was not asked of children under 1 year of age).

The child’s oral health status also varied with race and ethnicity. More than 80 percent of non-Hispanic White children and 76.9 percent of non-Hispanic children of multiple races were reported to have excellent or very good oral health, compared to 62.5 percent of non-Hispanic Black children and 49.3 percent of Hispanic children.

Source: U.S. Department of Health and Human Services – http://mchb.hrsa.gov/chusa08/hstat/hsc/pages/208hs.html

The infant mortality rate began a substantial decline in the late 19th and early 20th century. Some factors in this early decline included economic growth, improved nutrition, new sanitary measures, and advances in knowledge about infant care. More recent advances in knowledge that contributed to a continued decline included the approval of synthetic surfactants and the recommendation that infants be placed on their backs to sleep. However, the decades-long decline in infant mortality began to level off in 2000, and the rate has remained relatively steady in the years since.

In 2006, the mortality rate among non-Hispanic Black infants was 13.8 deaths per 1,000 live births. This is two and one-half times the rate among non-Hispanic White and Hispanic infants (5.6 and 5.5 per 1,000, respectively). Although the infant mortality rates among both non-Hispanic Whites and non-Hispanic Blacks have declined over the last century, the disparity between the two races remains largely unchanged.

The Maternal and Child Health Block Grant and MCHB’s Healthy Start program provide health and support services to pregnant women and infants with the goal of improving children’s health outcomes and reducing infant and child mortality.

Source: U.S. Department of Health and Human Services – http://mchb.hrsa.gov/chusa08/hstat/hsi/pages/206im.html

Overall, the parents of 84.4 percent of children reported their children to be in excellent or very good health in 2007, but that percentage was lower for older children. The health and well-being of these children, and that of the entire Nation, depends on preventive services, such as prenatal care and immunization, as well as the promotion of healthy life choices. These measures help ensure that children are born healthy and maintain good health as they grow up.

Good health begins even before birth. Timely prenatal care is an important preventive strategy that can help protect the health of both mother and child. Entry into prenatal care during the first trimester has been increasing, reaching 83.2 percent of pregnant women in 2005 (this is according to data from areas using the “unrevised” birth certificate—for more information, please see page 65). A small proportion of women (3.6 percent) did not receive prenatal care until the third trimester, or did not receive any at all. This was more common among non-Hispanic Black and Hispanic women, as well as those who were younger, unmarried, and less educated.

Several other indicators of maternal health are included in Child Health USA. For instance, data are presented on maternal age, which can affect the health of both infant and mother. In 2006, births to women aged 15-19 years increased for the first time in 15 years to 41.9 births per 1,000 females in this age group; this is still significantly lower than the most recent peak (61.8 per 1,000 in 1991). The average age at first birth among women in the United States was 25.0 years.

A number of family and neighborhood factors can also affect the health and well-being of children and the larger community. In 2007, 71.0 percent of women with children under 18 years of age were in the labor force (either employed or looking for work). Mothers with children under 6 years of age were less likely to be in the labor force (63.3 percent). In 2005, 60 percent of children under 6 years of age required care from someone other than a parent at least once a week. The 2007 National Survey of Children’s Health measured a number of neighborhood amenities available to children: 46.7 percent of children were reported to have all four of the listed amenities (sidewalks or walking paths, a park or playground, a community or recreation center, and a library or bookmobile), while 4.5 percent of children had none of those neighborhood amenities. Additionally, 28.6 percent of children were reported to live in neighborhoods with at least one of three specific indicators of poor neighborhood conditions, such as litter, vandalism, or dilapidated housing.

Child Health USA also provides information regarding the health of infants and young children. Healthy birth weight is an important indicator of infant health, and emerging evidence indicates that birth weight may affect children into adulthood. Children born very low birth weight are significantly more likely to die in the first year of life than children of healthy birth weight, and those who survive are at particularly high risk for health complications. In 2006, 8.3 percent of infants were born low birth weight (less than 2,500 grams, or 5 pounds 8 ounces). Although the number of multiple births, which are more likely to result in low birth weight, are on the rise, the low birth weight rate among singletons is rising as well. Very low birth weight (less than 1,500 grams, or 3 pounds 4 ounces) represented 1.5 percent of live births in 2006. Although maternal and infant mortality rates have dropped dramatically in the last century, the United States still has one of the highest rates of infant death in the industrialized world (6.7 deaths per 1,000 live births).

Breastfeeding can support the health of infants and mothers, and rates have increased steadily since the beginning of the last decade. In 2007, 75.5 percent of children through age 5 had been breastfed for some period of time. Although recommended by the American Academy of Pediatrics, only 12.4 percent of children were breastfed exclusively (without supplemental food or liquids) for the first 6 months of life.

Vaccination is a preventive health measure that protects children into adulthood. Vaccines are available for a number of public health threats, including measles, mumps, rubella (German measles), polio, diphtheria, tetanus, pertussis (whooping cough), and H. Influenzae type b (a meningitis bacterium). In 2006, 80.5 percent of children aged 19-35 months had received this recommended series of vaccines; 76.9 percent of children received the recommended series plus the varicella (chicken pox) vaccine.

Physical activity is another important protective factor in lifelong health, with habits that can be formed early in childhood. Results from the 2007 Youth Risk Behavior Surveillance System indicate that 34.7 percent of high school students met the levels of physical activity recommended at the time, and 24.9 percent of students did not participate in 1 hour or more of physical activity in the past week.

Mental health is another important health issue among children. In 2005-2006, the parents of 11.2 percent of girls aged 4-17 years and 17.6 percent of boys in that age group had talked to a health care provider or school staff about emotional or behavioral difficulties. Overall, 4.2 percent of girls and 6.4 percent of boys received treatment for these difficulties (not including children who received medication only).

The period of adolescence brings age-specific health issues that need to be monitored and addressed. In 2007, 47.8 percent of high school students reported ever having had sexual intercourse. Although sexual activity increased with grade level, condom use decreased: among 9th grade students, 20.1 percent were sexually active, two-thirds of whom used condoms, while 52.6 percent of 12th grade students were sexually active, half of whom used condoms.

With sexual activity comes the risk of sexually transmitted infections (STIs). Adolescents (aged 15-19) and young adults (aged 20-24 years) are at much higher risk of contracting STIs than are older adults. Chlamydia continues to be one of the most common STIs among adolescents and young adults, with rates of 1,674 and 1,796 per 100,000, respectively, in 2006. Gonorrhea followed in prevalence with overall rates of 459 and 528 per 100,000 among adolescents and young adults, respectively. Cases of genital human papillomavirus (HPV) are not currently tracked by the Centers for Disease Control and Prevention, but it is believed to be the most common STI in the United States. It is estimated that 24.5 percent of females aged 14-19 years and 44.8 percent of females aged 20-24 years had an HPV infection in 2003-2004.

Violence also threatens the health of adolescents. The 2007 Youth Risk Behavior Surveillance indicates that 18.0 percent of high school students had carried a weapon at some point during the month preceding the survey. Males were about four times as likely as females to carry a weapon (28.5 versus 7.5 percent), with non-Hispanic White males being the most likely to do so (30.3 percent). The survey also showed that 12.4 percent of students had been in a fight on school property in the past year; this was most common among non-Hispanic Black males (20.0 percent).

With regard to substance use, 9.5 percent of adolescents aged 12-17 years reported using illicit drugs in the past month. Rates were highest among children aged 16-17 years (16.0 percent). Alcohol was the most commonly used drug among adolescents, with 15.9 percent reporting past month use.

The health status and health services utilization indicators reported in Child Health USA can help policymakers and public health officials better understand current trends in pediatric health and wellness and determine what programs might be needed to further improve the public’s health. These indicators can also help identify positive health outcomes which may allow public health professionals to draw upon the experiences of programs that have achieved success. The health of our children and adolescents relies on effective public health efforts that include providing access to knowledge, skills, and tools; providing drug-free alternative activities; identifying risk factors and linking people to appropriate services; building community supports; and supporting approaches that promote policy change, as needed. Such preventive efforts and health promotion activities are vital to the continued improvement of the health and well-being of America’s children and families.

Source: U.S. Department of Health and Human Services

http://mchb.hrsa.gov/chusa08/more/introduction.html

But this logic is faulty; you might as well say that eating bread causes car crashes, since most drivers who crash their cars had probably eaten bread within the past 24 hours.

If you consider that most SIDS deaths occur during the age range when 3 shots of DTaP are given, you would expect DTaP shots to precede a fair number of SIDS deaths simply by chance. In fact, when a number of well-controlled studies were conducted during the 1980s, the investigators found, nearly unanimously, that the number of SIDS deaths temporally associated with DTP vaccination was within the range expected to occur by chance. In other words, the SIDS deaths would have occurred even if no vaccinations had been given.

In several of the studies, children who had recently gotten a DTaP shot were less likely to get SIDS. The Institute of Medicine reported that “all controlled studies that have compared immunized versus nonimmunized children have found either no association . . . or a decreased risk . . . of SIDS among immunized children” and concluded that “the evidence does not indicate a causal relation between [DTaP] vaccine and SIDS.”

Source: Centers for Disease Control and Prevention (CDC) – http://www.cdc.gov/vaccines/vac-gen/6mishome.htm

A healthcare provider has a responsibility to listen to and to try to understand a patient’s or parent’s concerns, fears, and beliefs about vaccination and to take them into consideration when offering vaccines. These efforts will not only help to strengthen the bond of trust between provider and patient but will also help each provider decide which, if any, perspectives might be most effective in encouraging patients to accept vaccination.

Six common misconceptions about vaccination that are often cited by concerned parents as reasons to question the wisdom of vaccinating their children. If providers can respond with accurate vaccination and immunization information and reassure parents on these specific issues, parents will be better able to discern inaccuracies they receive from other sources. The goal is be sure patients and parents have accurate information with which to make an informed decision.

1. Diseases had already begun to disappear before vaccines were introduced, because of better hygiene and sanitation.

Statements like this are very common in anti-vaccine literature, the intent apparently being to suggest that vaccines are not needed. Improved socioeconomic conditions have undoubtedly had an indirect impact on disease. Better nutrition, not to mention the development of antibiotics and other treatments, have increased survival rates among the sick; less crowded living conditions have reduced disease transmission; and lower birth rates have decreased the number of susceptible household contacts. But looking at the actual incidence of disease over the years can leave little doubt of the significant direct impact vaccines have had, even in modern times. Here, for example, is a graph showing the reported incidence of measles from 1950 to the present.

There were periodic peaks and valleys throughout the years, but the real, permanent drop in case of measles in the U.S. coincided with the licensure and wide use of measles vaccine beginning in 1963. Graphs for most other vaccine-preventable diseases show a similar pattern. Are we expected to believe that better sanitation caused incidence of each disease to drop, just at the time a vaccine for that disease was introduced?

*The incidence rate of hepatitis B has not dropped so dramatically yet because the infants we began vaccinating in 1991 will not be at high risk for the disease until they are at least teenagers. We therefore expect about a 15 year lag between the start of universal infant vaccination and a significant drop in disease incidence.

Hib vaccine is another good example, because Hib disease was prevalent until just a few years ago, when conjugate vaccines that can be used for infants were finally developed. (The polysaccharide vaccine previously available could not be used for infants, in whom most cases of the disease were occurring.) Since sanitation is not better now than it was in 1990, it is hard to attribute the virtual disappearance of Haemophilus influenzae disease in children in recent years (from an estimated 20,000 cases a year to 1,419 cases in 1993, and dropping) to anything other than the vaccine.

Varicella can also be used to illustrate the point, since modern sanitation has obviously not prevented nearly 4 million cases each year in the United States. If diseases were disappearing, we should expect varicella to be disappearing along with the rest of them. But nearly all children in the United States get the disease today, just as they did 20 years ago or 80 years ago. Based on experience with the varicella vaccine in studies before licensure, we can expect the incidence of varicella to drop significantly now that a vaccine has been licensed for the United States. Active surveillance in a number of countries and cities demonstrate a 76-86% decrease in varicella cases from 1995-2001.

Finally, we can look at the experiences of several developed countries after they let their immunization levels drop. Three countries – Great Britain, Sweden, and Japan – cut back the use of pertussis vaccine because of fear about the vaccine. The effect was dramatic and immediate. In Great Britain, a drop in pertussis vaccination in 1974 was followed by an epidemic of more than 100,000 cases of pertussis and 36 deaths by 1978. In Japan, around the same time, a drop in vaccination rates from 70% to 20%-40% led to a jump in pertussis from 393 cases and no deaths in 1974 to 13,000 cases and 41 deaths in 1979. In Sweden, the annual incidence rate of pertussis per 100,000 children 0-6 years of age increased from 700 cases in 1981 to 3,200 in 1985. It seems clear from these experiences that not only would diseases not be disappearing without vaccines, but if we were to stop vaccinating, they would come back.

Of more immediate interest is the major epidemic of diphtheria which occurred in the former Soviet Union from 1989 to 1994, where low primary immunization rates for children and the lack of booster vaccinations for adults have resulted in an increase from 839 cases in 1989 to nearly 50,000 cases and 1,700 deaths in 1994. There have already been at least 20 imported cases in Europe and two cases in U.S. citizens working in the former Soviet Union.

1. The majority of people who get disease have been vaccinated.

This is another argument frequently found in anti-vaccine literature – the implication being that this proves vaccines are not effective. In fact it is true that in an outbreak those who have been vaccinated often outnumber those who have not – even with vaccines such as measles, which we know to be about 98% effective when used as recommended.

This is explained by two factors. No vaccine is 100% effective. Most routine childhood vaccines are effective for 85% to 95% of recipients. For reasons related to the individual, some will not develop immunity. The second fact is that in a country such as the United States the people who have been vaccinated vastly outnumber those who have not. Here’s a hypothetical example of how these two factors work together.

In a high school of 1,000 students, none has ever had measles. All but 5 of the students have had two doses of measles vaccine, and so are fully immunized. The entire student body is exposed to measles, and every susceptible student becomes infected. The 5 unvaccinated students will be infected, of course. But of the 995 who have been vaccinated, we would expect several not to respond to the vaccine. The efficacy rate for two doses of measles vaccine can be higher than 99%. In this class, 7 students do not respond, and they, too, become infected. Therefore 7 of 12, or about 58%, of the cases occur in students who have been fully vaccinated.

As you can see, this doesn’t prove the vaccine didn’t work – only that most of the children in the class had been vaccinated, so those who were vaccinated and did not respond outnumbered those who had not been vaccinated. Looking at it another way, 100% of the children who had not been vaccinated got measles, compared with less than 1% of those who had been vaccinated. Measles vaccine protected most of the class; if nobody in the class had been vaccinated, there would probably have been 1,000 cases of measles.

1. There are “hot lots” of vaccine that have been associated with more adverse events and deaths than others. Parents should find the numbers of these lots and not allow their children to receive vaccines from them.

This misconception got considerable publicity recently when vaccine safety was the subject of a television news program. First of all, the concept of a “hot lot” of vaccine as it is used in this context is wrong. It is based on the presumption that the more reports to VAERS^** a vaccine lot is associated with, the more dangerous the vaccine in that lot; and that by consulting a list of the number of reports per lot, a parent can identify vaccine lots to avoid.

This is misleading for two reasons:

1. A report made to VAERS does not mean that the vaccine, or other vaccines from the same group or lot caused the event. VAERS is a national system for reporting health problems that happen around the same time of the vaccination. Only some of the reported health conditions are side effects related to vaccines. A certain number of VAERS reports of serious illnesses or death do occur by chance alone among persons who have been recently vaccinated.

2. VAERS reports have many limitations since they often lack important information, such as laboratory results, used to establish a true association with the vaccine. For all serious and other clinically significant events (life-threatening events, hospitalization, permanent disability, death), follow-up with the health care provider and/or the parent or vaccinated individual is conducted in an attempt to collect supplemental information on the reports. Because of the limitations of this type of reporting system, causality is difficult to determine. Regardless of the cause, VAERS is interested in hearing about any health concerns that happen around the time of vaccination. In summary, scientists are not able to identify a problem with a vaccine lot based on VAERS reports alone without scientific analysis of other factors and data.

Vaccine lots are not the same. The sizes of vaccine lots might vary from several hundred thousand doses to several million, and some are in distribution much longer than others. Naturally a larger lot or one that is in distribution longer will be associated with more adverse events, simply by chance. Also, more coincidental deaths are associated with vaccines given in infancy than later in childhood, since the background death rates for children are highest during the first year of life. So knowing that lot A has been associated with x number of adverse events while lot B has been associated with y number would not necessarily say anything about the relative safety of the two lots, even if the vaccine did cause the events.

Reviewing published lists of “hot lots” will not help parents identify the best or worst vaccines for their children. If the number and type of VAERS reports for a particular vaccine lot suggested that it was associated with more serious adverse events or deaths than are expected by chance, the Food and Drug Administration (FDA) has the legal authority to immediately recall that lot. To date, no vaccine lot in the modern era has been found to be unsafe on the basis of VAERS reports.

All vaccine manufacturing facilities and vaccine products are licensed by the FDA. In addition, every vaccine lot is safety-tested by the manufacturer. The results of these tests are reviewed by FDA, who may repeat some of these tests as an additional protective measure. FDA also inspects vaccine-manufacturing facilities regularly to ensure adherence to manufacturing procedures and product-testing regulations, and reviews the weekly VAERS reports for each lot searching for unusual patterns. FDA would recall a lot of vaccine at the first sign of problems. There is no benefit to either the FDA or the manufacturer in allowing unsafe vaccine to remain on the market. The American public would not tolerate vaccines if they did not have to conform to the most rigorous safety standards. The mere fact is that a vaccine lot still in distribution says that the FDA considers it safe.

1. Vaccines cause many harmful side effects, illnesses, and even death – not to mention possible long-term effects we don’t even know about.

Vaccines are actually very safe, despite implications to the contrary in many anti-vaccine publications (which sometimes contain the number of reports received by VAERS, and allow the reader to infer that all of them represent genuine vaccine side-effects). Most vaccine adverse events are minor and temporary, such as a sore arm or mild fever. These can often be controlled by taking acetaminophen before or after vaccination. More serious adverse events occur rarely (on the order of one per thousands to one per millions of doses), and some are so rare that risk cannot be accurately assessed. As for vaccines causing death, again so few deaths can plausibly be attributed to vaccines that it is hard to assess the risk statistically. Of all deaths reported to VAERS between 1990 and 1992, only one is believed to be even possibly associated with a vaccine. Each death reported to VAERS is thoroughly examined to ensure that it is not related to a new vaccine-related problem, but little or no evidence suggests that vaccines have contributed to any of the reported deaths. The Institute of Medicine in its 1994 report states that the risk of death from vaccines is “extraordinarily low.”

Source: Centers for Disease Control (CDC) – http://www.cdc.gov/vaccines/vac-gen/6mishome.htm

Immunization is one of the most important things a parent can do to protect their children’s health. Today we can protect children from 14 serious diseases. Failure to vaccinate may mean putting children at risk for serious diseases.

Vaccine Descriptions:

• HepB: protects against hepatitis
• DTaP: a combined vaccine that protects against diphtheria, tetanus, and pertussis (whooping cough)
• Hib: protects against Haemophilus influenzae Type b
• PCV: protects against pneumococcal disease
• Polio: protects against polio, the vaccine is also known as IPV
• RV: protects against infections caused by the Rotavirus
• Influenza: protects against influenza (flu)
• MMR: protects against measles, mumps, and rubella (German measles)
• Varicella: protects against varicella, also known as chickenpox
• HepA: protects against hepatitis A

Growth charts are not intended to be used as a sole diagnostic instrument. Instead, growth charts are tools that contribute to forming an overall clinical impression for the child being measured.

Chart: Length by Age for Infant Girls

Chart: Weight by Age for Infant Girls

Source: CDC – http://www.cdc.gov/GROWTHcharts/