Autism's cause likely linked to environment, study says
By Sandy Kleffman
Contra Costa Times http://www.insidebayarea.com/health/ci_11411611
Posted: 01/08/2009 09:07:59 PM PST

It is time to focus on environmental causes for the rapid rise in
autism, a leading researcher said Thursday, after her study concluded
that such factors as earlier diagnosis and families moving to
California cannot fully explain a dramatic seven- to eightfold
increase in the state since the early 1990s.

"With no evidence of a leveling off, the possibility of a true
increase in incidence deserves serious consideration," states the
study, published in the January issue of the journal Epidemiology.

For years, experts have debated whether the autism increase is real.
Skeptics argue that it is a result of better diagnosis, a change in
definitions and the inclusion of children with milder forms of the
disorder.

Irva Hertz-Picciotto and her colleagues at the UC Davis M.I.N.D.
Institute and Department of Public Health Sciences set out to explore
such hypotheses.

They concluded that while those factors explain some of the increase,
they do not account for most of it.

The findings prompted Hertz-Picciotto, a leading autism researcher and
a professor of environmental and occupational health and epidemiology,
to urge policy makers to devote more research money to looking for an
environmental trigger.

"Right now, about 10 to 20 times more research dollars are spent on
studies of the genetic causes of autism than on environmental ones,"
she said. "We need to even out the funding."

Rick Rollens, the father of an autistic child and a co-founder of the
M.I.N.D. Institute, agreed.

"This is a definitive study that should once and for all put the
proverbial nail in the coffin of those who have been denying the
existence of an autism epidemic," he said.

"The sooner that people recognize the significance of this crisis, the
sooner we'll be on our way in trying to address the needs of the
children and families," Rollens said.

Autism is a developmental disorder marked by poor verbal and
communication skills, repetitive behaviors and an inability to form
social connections.

Once considered a rare disorder, it is now prevalent in industrialized
countries around the world.

The search for answers has taken on added urgency because children who
have autism often need expensive educational services and may require
a lifetime of care. As they reach adulthood and no longer have parents
who can care for them, the burden on taxpayers will escalate.

"Unless some really miraculous treatments come along, there are some
big financial questions ahead," Hertz-Picciotto said.

Her study found that the incidence of children diagnosed with autism
by age 6 in California has risen dramatically. Fewer than nine out of
10,000 children born in 1990 were diagnosed with the disorder. But for
those born in 2000, the rate had jumped to 44 per 10,000.

"The rise is still happening," Hertz-Picciotto said. "It's really
important to realize it's not leveling off and it's definitely not
declining."

To determine whether people moving to the state could explain this
increase, the researchers compared autism diagnoses with birth records
and excluded children who were not born in California. They concluded
that migration to the state has had little impact on the large
increase in autism.

They also looked at whether including people with milder forms of the
disorder could explain the increase.

In 1993-94, the standard definition of autism was broadened, enabling
more people to receive the diagnosis. But the study determined that
including milder cases accounted for less than one-tenth of the 600
percent to 700 percent increase in autism since 1990.

Diagnosing children at an earlier age, which could make it seem as if
more people have the disorder, also accounted for only a small portion
of the increase, the study found. That left most of it unexplained.

The study did not directly address another factor that could play a
role in the increase in diagnoses — greater public awareness. But if
that is a major cause, at some point the numbers should start leveling
off. Hertz-Picciotto notes that this is not happening.

She and her colleagues at the M.I.N.D. Institute are conducting two
large studies to explore whether some combination of environmental
factors may be triggering autism in genetically susceptible children.

"We're looking at the possible effects of metals, pesticides and
infectious agents on neurodevelopment," she said. "If we're going to
stop the rise in autism in California, we need to keep these studies
going and expand them to the extent possible."

Rollens, like many other parents of autistic children, also believes
vaccines should be investigated, although much of the medical
community disagrees.

"We've put way too much time and effort in trying to find the elusive
autism gene," Rollens said. "We've got a big problem here and we need
to be addressing it."

In addition to focusing on possible environmental causes,
Hertz-Picciotto urged her fellow scientists to continue focusing on
improving therapies and developing new ones.

"These children are now moving toward adulthood," she said, "and a
sizable percentage of them have not developed the life skills that
would allow them to live independently."

-- 
Jim Devine / "Segui il tuo corso, e lascia dir le genti." (Go your own
way and let people talk.) -- Karl, paraphrasing Dante.
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