Gathering the Evidence: ASD, New Findings, and Public Policy

By James Jeffrey Bradstreet
Issue 115, November - December 2002

Adapted from written supplement to oral testimony before the Government Reform Committee, US House of Representatives, June 19, 2002.

Autism is not a single entity, nor does it have simplistic genetic or epidemiological characteristics; rather, it represents a broad spectrum of clinical disorders that share behavioral and delayed-development features. Autism and its related entities are characterized by delayed neurodevelopment, lack or inappropriate use of language, stereotypical repetitive behaviors, and social withdrawal.

My colleagues and I at the International Child Development Resource Center (ICDRC) have been involved in describing and/or treating this disorder from its biological roots, as opposed to the genetic and psychiatric perspectives. We have medically evaluated and treated over 1,500 children with autism-related disorders. Therefore, our insights contribute primarily to an understanding of the immunology and toxicology of this condition.

In July 2001, I presented the ICDRC data on mercury burden and autoimmunity to the Institute of Medicine (IOM).1 There is a fundamental flaw in the analysis process of vaccine safety. The IOM has undertaken the process of drawing conclusions regarding separate pieces of the actual vaccine schedule when they are, in fact, an integrated event in an individual child's life.

I presented 221 children with autism spectrum disorders (ASD) who showed significantly (500 percent, on average) greater mercury burden when compared to neurologically normal controls. The study was based on routine heavy metal provocation challenge testing similar to that published in Environmental Health Perspectives in 2001.2 I did not try to infer a direct tie to thimerosal. Rather, it was apparent that some possible foundational problem in the metabolism of heavy metals was present in the autistic population. This observation could represent a significant predisposing factor in their vulnerability to mercury when used as a preservative--a point the IOM did not mention. It is also consistent with research regarding sulfur depletion in the presence of persistent viral infections. The literature is replete with references in the case of HIV.3 Rosemary Waring has found marked renal loss of sulfur in autism.4

Of most concern to me in the IOM's treatment of the mercury problems was the almost complete absence of regard for the compounding effect of thimerosal on pre-existing mercury levels. The National Health and Nutrition Examination Survey study from the CDC had already established that perhaps one in ten children is born to a mother with elevated mercury burden.5

Prevalence of ASD
The number of children with autism appears to be greater than previously suspected. Recent hearings of the Congressional Reform Committee revealed a broad consensus that autism spectrum disorders now represent an epidemic of neurodevelopmental problems for our youth. Various recent studies place the prevalence at 57 to 67 per 10,000 children, although older literature places the prevalence at 10 in 10,000 (1 in 1,000).6 However, this figure underestimates the problem for males. Boys suffer from autism at a 4-to-10-fold greater frequency than girls. So the actual problem for male children in this country is more accurately represented as 100 in 10,000 (1 in 100), or greater.

The 1997 US Census disability data reported that 2.4 percent of children ages five and under suffer from developmental delays; clearly many of these are ASD-related issues. Data from California further reveal that the rate of growth of ASD is doubling every four years.7 According to the CDC, 1 in 149 US children have autism.8 (That is the statistic for Brick, New Jersey, but the CDC implies it is consistent with the likely general statistics.) If the current epidemiology of autism is correct, it will affect approximately 1 percent of boys under 18, or an estimated current total of 364,540, as well as approximately 60,000 girls. This is considerably less than the figure of one million reported in Time Magazine's cover story (May 6, 2002), but probably far more accurate.

Economic Impact
While no precise studies have attempted to look at the cost of correcting the biological problems associated with ASD, at least one report from England places the custodial costs of ASD in the range of $3 to 4 million per child per lifetime, with a societal cost that would likely be three times the individual cost. The cost of education, medical care, and therapies for behavioral and physical symptoms is staggering. Many of our families report having paid $50,000 per year to care for their child. The Individuals with Disabilities Education Act (IDEA) allows up to $35,000 a year for education of children with autism.