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Weekend House Call

Aired September 7, 2003 - 08:30   ET


DR. SANJAY GUPTA, MEDICAL CORRESPONDENT: Good morning. I'm Dr. Sanjay Gupta. Welcome to CNN's WEEKEND HOUSE CALL. Well, autism is a true medical mystery. Doctors don't know what causes it and there is no cure. More and more children are being diagnosed with the disorder. Some estimates say one out of every 250 children born. Now, autism is a brain development disorder it can range from moderate to severe and can cause children to have poor social skills, unusual styles of communication, and repetitive behaviors.


GUPTA: 13-year-old Russell Rollens is autistic. The struggle his family goes through -- immense.

RICK ROLLENS, FATHER: It's a living hell for my son who suffers terribly from this disorder. It's a living hell for all of our family members and everyone who knows and loves Russell.

GUPTA: The Rollens family are far from alone, in fact, government figures show a huge increase in autism from 5,000 cases identified in 1992 to almost 98,000, last year. Is this an epidemic?

DR. MARSHALYN YEARGIN-ALLSOPP, CENTERS FOR DISEASE CONTROL: I don't think that we can say that there is an epidemic of autism. We can say the rates of autism are higher now than they were 10 years ago. This means that professionals, parents, everyone will see more children with autism and we can say today that autism is not a rare condition.

GUPTA: Maybe it's on the rise because in the past cases simply went undiagnosed. Another factor? Children with even mild symptoms of autism are being included in the count, whereas they weren't before, and states weren't required to report autism until the early '90s. And yet, despite a lot of research, the causes of autism remain unknown.

What does seem clear is that childhood vaccinations are not to blame. A new data study based on 30 years of research suggests immunizations in young children are safe.

DR. MARK BATSHAW, CHILDREN'S NATL. MED. CTR.: It is known that autism is increasing and everyone wants to know why and certainly it was not inappropriate to consider immunization as a cause, but it's been considered now and ruled out. GUPTA: Scientists agree genetics likely play a role, but with advances in research and early diagnosis, the future of an autistic child may not be as bleak as in the past.

MELISSA KATZ, AUTISM PREVENTION CTR.: Research has shown that the earlier you get these kids into therapy and get them communicating then they don't have as many behavior problems as they get a little older.

UNIDENTIFIED FEMALE: Oh, you do like that bear.


GUPTA: Now, one of the most interesting stories we've done in a while. Children with classic autism are usually diagnosed at the age of 3, but experts say that earlier intervention can give kids a better shot at a normal life.

Now, here's what you should look for: At 12 months the child does not gesture or babble. At 16 months no single words spoken. By two years of age no two words are spoken together.

You should be concern if your child begins to develop language and then stops abruptly, doesn't respond to his or her name, but has normal hearing. Doesn't point to things to direct a parent's attention or avoids eye contact and cuddling.

Now, as we said, there's no known cause of autism. We're going to talk about childhood immunizations and environmental factors, that comes up a lot. We'll also look at some new research on the brain and what it tells us. But, most importantly we want to hear from you, we want to answer your questions. Call us at 1-800-807-2620 or e-mail us at It is a complicated topic and therefore we've asked an expert to join us, Dr. David Holmes joins us from Kansas City, this morning. He's the chairman of the Autism Society of America.

Good morning, sir, thank you very much for joining us.


GUPTA: You won't be surprised to hear we've had an overwhelming response to this topic, so many e-mails have been coming in, so many phone callers, as well, standing by. So, I want to get straight to our first question.

Pedro from California asks, "If I suspect my 3-year-old daughter is autistic, what sort of specialized doctor to I take her to? Her present pediatric doctor says that there is nothing wrong with her even thought she did not start to speak until age two, and only speaks in two or three word phrases when she does speak. She is still not potty trained. Where do I seek answers?"

Now, this might be a, sort of, common question, Dr. Holmes. You know, a lot of concerns there, but how do you, sort of, comfort a parent and also direct them in the -- in to the right people?

HOLMES: Well, obviously, the major challenge that we have today is we're expecting that every doctor, physician is going to have the answers to every problem of human kind and even a well trained pediatrician may be not aware of the subtleties of autism. And so, if I were a parent and I had concerns that my child was having autism or has autism I would ask for a second opinion, and specifically ask for someone in the area who might have expertise in the diagnosis of autism. If they have difficulties finding one, I would suggest they contact 1-800-3-autism. 1-800-3-autism which is the Autism Society of America and they'll be able to guide them to an expert in their area.

GUPTA: Well, that's good advice and we'll certainly try and remind people of that once more, as well, before the end of the show.

Another e-mail question, now. David from California writes, "My 6-year-old son, David, was diagnosed with sever autism about three years ago. At is last assessment; he was rated at approximately 12 months old mentally. For some, this seems discouraging, but for my family, David seems to have made significant progress. Now, it seems that early detection and intervention has been very beneficial to my son. He was diagnosed at age 2-and-a-half." The question is, "Have there been any advances towards diagnosing children at an even earlier age?"

We mentioned already, Dr. Homes, about three seems to be the average for the age of diagnosis. How early are kids being diagnosed with autism?

HOLMES: Well, for those of us who have been in the field for many, many years, we have the capacity -- clinical capacity to identify autism as early as -- more recently we've identified a child at eight months. The reason why we're talking 30 months to 36 months or 40 months, for the diagnosis of autism -- or the accurate diagnosis of autism, is because that's when all of the symptoms fully evolve. And to be frank, that's a little late. We want to make certain that we diagnose the children sooner than later, and as I tell parents, I said, if we make a mistake, if the child is not really going to be developing autism -- what's the downside? The down side is that your child will be smarter and brighter because the treatments really are of natural kinds of good parenting, early on.

GUPTA: OK and we certainly are going to talk a lot more about those treatments. We want to talk about some of the causes, that's something a lot of people are interested in. Question is: Is there a link between childhood immunizations and autism? We're going to get into that. May parents believe there is, despite several contradicting studies. When we come back, we'll ask Dr. Homes for the latest on that debate.

We'll also answer your questions; we want to hear from you. Call us 1-800-807-2620 or e-mail us at HOUSE We'll be right back.

(COMMERCIAL BREAK) GUPTA: Autism affects more boys than girls. There are over a million Americans with autistic disorders and males account for more than 80 percent of that number.

This is WEEKEND HOUSE CALL and we're talking about autism. Please call us with your questions at 1-800-807-2620 or e-mail us at

Now, while we're getting your phone calls lined up, let's go ahead and check our "Health Quiz" for today.

In the first few months of life, does the brain of an autistic child shrink or grow? We'll have that answer in 30 seconds. Stay with us.


GUPTA: Checking our "Health Quiz" now, we asked: "In the first few months of life, does the brain of an autistic child shrink or grow?"

The answer, it grows. Researchers at University of California, San Diego, found that while children with autism have smaller heads at birth than normal children, accelerated growth within the first few months of life result in a far larger than normal brain size in 90 percent of autistic children.


ERIC COURCHESNE, NEUROSCIENTIST: The infants that showed the most rapid rate of growth turned out to be those who later had the more severe form of autism.


GUPTA: So, why would autism be influenced by brain size?


COURCHESNE: We think that it must be something about brain structure that's being put together incorrectly, too rapidly that leads to a more impaired outcome.


GUPTA: All right. This is WEEKEND HOUSE CALL. We're talking about autism. Many parents of autistic children think increases in the number of recommended childhood vaccines are to blame for the apparent autism surge, but a new study based on 30 years of data seems to rule out that link. Dr. David Holmes is joining us. He's the chairman of the Autism Society of America.

Doctor, we have a lot of questions about that topic, I'm sure you've had a lot of questions. Let's go ahead and get to an e-mail.

Paul in New Jersey, he's asking about the vaccine link. He writes, "Have there been any studies done that show some direct or indirect link to the combined immunizations (two or more vaccines in one shot) that children are required to get, and autism?"

Now, that's a big issue for lots of parents of autistic children. Does this new study completely rule out vaccine as a cause, Dr. Holmes?

HOLMES: I think what we have to be careful about some of the studies that have taken place regarding the culpability of vaccinations and autism. Let me state without equivocation, however, that the vaccination program is a critical program for our nation and for the health of our children and future generations. That said, we're very cautious. We have a lot of information coming from mothers and fathers who seem to think that there's a correlation between the vaccinations and the MMR vaccinations, specifically, and the onset of autism in their particular child. So, although current studies are suggesting no culpability of vaccinations, we still want to be cautious and continue to investigate to see if there may be a small number of youngsters that are culpable in receiving this vaccination.

That said, there are certain things that families can do to mitigate the potential downside of vaccinations and one thing is to request of their pediatricians that the MMR vaccination be given without thimersol as the fixative, which is a mercury-based fixative. Those vaccinations are available, today, and we also suggest that families not have the child vaccinated if the immune system is challenged by a cold or any other kind of childhood illness and wait until the child is healthy before the vaccinations occur.

GUPTA: And, that's good advice and worth repeating again. So, for parents out there, you're saying go ahead and get the vaccines, but not if your child is sick, wait until your child is healthy and also ask for the mercury-free -- mercury derivative-free vaccine, is that right?

HOLMES: That is correct.

GUPTA: Get let's get to a caller, now. Callers are standing by. Kim from Vermont, excuse me, welcome to HOUSE CALL.

KIM, VERMONT: Thank you.

GUPTA: What's your question?

KIM: My question is, as the mother of two of autistic boys, is there any link -- I was given tributline during both pregnancies to prevent labor and I've read that that's not to be used. Is there any link to the use of tributline as in autism?

GUPTA: And, Dr. Holmes, again -- you know, lots of questions about this sort of thing. This is a medication, obviously, given during labor. Have they found links between medications given to the mother and autistic children later in life?

HOLMES: We have not seen any correlation, again, I don't think there's been good, controlled studies to determine if there's any correlation, but we are concerned about any kind of environmental influence, toxins, and otherwise that may influence developing fetuses. So, it's a cautionary statement.

GUPTA: OK. An e-mail, sort-of along the same topic, now. Diana from Indiana is concerned about other factors possibly being the cause. She writes, "I have a 4-year-old son who is currently being evaluated for autism. Are any researchers currently studying whether or not environmental factors such as diet, pollutants, etc...have contributed to the huge increase we have seen in autism in the past few years?"

And, Dr. Holmes, you -- we've already talked a little about this increase, but a lot of people are very concerned about this increase. There does seem to be a increase a surge, as Diane puts it, in the number of cases. Environmental, pollutants, diet -- do you think any of those things are the -- are to blame.

HOLMES: The answer is probably all. We are looking, now, if fact, there's a center that was recently established in the state of New Jersey to investigate environmental or industrial toxins and impact on the surge of the numbers of children being diagnosed with autism throughout the nation. And, from that we've seen some initial studies that are very promising suggesting that there are certain forms of plastics that may have impact on the developing fetus. We're also finding that hormones potentially hormones that are used to enhance the meat production and milk production might also have an influence on developing fetuses, but it makes sense to think that environmental issues, especially in today's day and age when industrial toxins -- industrial chemicals are being produced every day and every moment, that these would be culpable agents in the surge of autism in our society.

GUPTA: I got to tell you, Dr. Holmes, that sounds pretty scary when you say it like that. There are a lot of things that could possibly be affecting unborn fetuses. Is that a fair bottom line?

HOLMES: Well, you know, for example, a recent study identified the new car smell and a component of the new car smell as being -- having neurotoxic effects on developing mice fetuses. And, you know, we all sit in our new cars and we're just inhaling this wonderful smell, when in reality there might be a component of that, that if we are pregnant and carrying a unborn child that there might be an impact there. And I don't want to create a scare, but this is some initial research that is suggesting environmental toxins may have an impact on developing fetuses and autism.

GUPTA: OK, and we're going to get into that, a little bit more.

Let's invite Paul from Maine to go ahead and jump in this, as well.

Paul, welcome to HOUSE CALL.


GUPTA: Hello, sir, do you have a question? PAUL: Yes, I was wondering is there any research going to see if there's a genetic link for autism?

GUPTA: And, Dr. Holmes, you know, one thing worth pointing out again, 80 percent, about, of the people who have autism are boys as opposed to girls. What about that genetic link?

HOLMES: Well, are looking at the genetic link and when you see four times as many children being boys than girls it makes sense to think about maybe there's some kind of sex-linked component to autism. A recent study by Simon Baron-Cohen in the U.K., suggests that there potentially is a more maleness associated with the symptoms of autism and that study has created quite a stir and it was recently published in "NewsWeek" and I think that's going to be the foundation for a lot of debate in the months to come.

GUPTA: So being a boy and having a new car can both be risk factors, potentially.

HOLMES: Well, I hope people don't want boys and buy used cars now, I don't want to give that impression.

GUPTA: Right, well we're going to talk a little bit more about that. We've been talking a lot about kids, but the question is, -- well, what can adults with autism do? Are there any therapies or services available to them? This is a huge topic, as well, and does every autistic person have a savant skill, like Dustin Hoffman's character in the movie "Rain Man?" We'll have the answer to that, as well, when WEEKEND HOUSE CALL continues.




GUPTA: Welcome back to WEEKEND HOUSE CALL. We've been learning a lot this morning, taking questions about autism. Dr. David Holmes is joining us, as well. He's chair of the Autism Society of America.

And, you've really been teaching me a lot this morning, doctor.

HOLMES: Thank you.

GUPTA: A lot of questions coming in, no surprise, there. We'll go straight to an e-mail, first.

Travis from Illinois has a really good question, really practical question. He asks, "With so many more cases of autism being discovered, is there any assistance (financial or educational) available when autistic children become adults?"

HOLMES: Well, that's a -- I think, a national disgrace, to be quite frank. There's crisis in services for early identification and early treatment of these children because we have a lack of services and there's also a crisis during the school age years because we don't have adequately-trained teachers to effectively mitigate the symptoms of autism, but during the adult years it's as if the lights are turned off. The federal government has a very limited amount of dollar available for adults that have autism and the reason why it's a national disgrace is because these individuals brought to the adult years, now are all of a sudden dropped off of the face of the earth and they have the potential for being wonderful, productive members of adult society in this country. And, so we need have legislation, and we need have federal initiatives to insure that these very vulnerable of American citizens have some services throughout their lifespan, because autism is a lifespan disorder.

GUPTA: Important to point that out. And more questions along those lines, as well. Kelly, now, from Charlotte, North Carolina.

Welcome to HOUSE CALL, Kelly.


GUPTA: Good morning.

KELLY: The question is, we have a two and a half-year-old with autism. And we've been -- from the statistics and research, we've seen that ABA is the most effective, aggressive program that we can start for our daughter, now. The cost, though, can range from $40 to $60,000 per year and my husband and I are just wondering what type of funding, if any, is applicable when wanting to start our small children with such a program?

GUPTA: Yeah, and I think I can hear your two and a half-year-old in the background there, as well. Were you able to hear that question, doctor?

HOLMES: I sure was, and ABA, to be quite frank is probably one of the few treatments that we have science to support its effectiveness and that's what makes it such a valuable asset and such a -- in many cases, a rare opportunity for these youngsters. We know that early in intensive treatment means, oftentimes, ABA treatment. The challenge, of course, is finding agencies that can do it and do it properly, but more importantly as this mother has informed us, it's finding the resources -- the dollars to support these types of services. It can be very, very costly. The federal government has, under IDEA, which is the Individuals with Disabilities Education Act, monies available for infant and toddler services. That means from birth to 3 years of age. The challenge is making certain that you get adequate dollars to support the numbers of hours that are necessary to have this early and intensive treatment.

GUPTA: This is really important stuff, here, and we want to make sure you and at home can get this information a little bit more concretely. So, when we come back, grab a pencil -- we'll give you information on where to get federally-funded help for your autistic child. Stay with us. We'll have that in a moment.


GUPTA: All right. There's some important information there, on the screen for you -- a phone number and a Web site. We'll try to get some of that information for you at home, if you're trying to get more information about autism.

One of the things we mentioned a little bit earlier, one of the things that autism is commonly associated with is a savant behavior, some sort of unique skill in an area. Dr. Holmes has been joining us from Kansas City. He's a chair of the Autism Society.

Is that an unfair sort of characterization, that people with autism have a savant skill of some sort?

HOLMES: Well, before I answer that question, let me first -- one proviso, I'm not the chair of the Autism Society, I'm of the chair of the panel of processional advisers, our chair, Lee Grossman is a very important figure in the Autism Society.


HOLMES: Now, let's talk about the savant capacity. Many times when a youngster has savant capacity, of course the public at large says, well, that must be wonderful. How wonderful to have a child with savant capacities. Well that's not -- that's not the rule in autism. Very few people have savant capacities and when they do it's not necessarily wonderful. It means that these children have some gifts, but they're -- these gifts are at the expense of just activities and daily you living, and so we've done research to try to see if we can take a savant skill and then make it more usable in day- to-day living, and when we do that, the savant skill goes -- actually is mitigated and other skills come up. So, if you over-select on something and over-select on it with -- at the expense of everything else, and you can do it extremely well, but we want to see more well rounded youngsters that have autism, as opposed to savants, that have autism.

GUPTA: OK, Dr. David Holmes, very good advice. Thank you for getting up with us this morning...

HOLMES: My pleasure.

GUPTA: ..on WEEKEND HOUSE CALL and that is all of the time we have for today. Make sure you join us next weekend when we look at the newest birth control options on the market. That's next Saturday at 8:30 Eastern.

Remember, this is the place for the answers to all of your medical questions. Thanks for watching. I'm Dr. Sanjay Gupta. "CNN Sunday Morning" continues, now.


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