NJ - Rise in number of children diagnosed with autism makes parents wary

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New Jersey

http://www.nj.com/news/index.ssf/2008/07/rise_in_number_of_children_dia.html

Rise in number of children diagnosed with autism makes parents wary

Posted by afriedma July 20, 2008 10:54AM

" De-li-lah, " she coos in a singsong voice, holding the 4-month-old baby close to

her face. As she did with her other kids, she hopes to elicit a smile, a laugh

or a gurgle of recognition.

It's a time-honored mother's gesture -- but one that now comes with a twist:

This time, Devlin is also checking for autism.

Every generation of parents has a worry unique to its era. In the '40s, the

specter of polio made mothers frantic about any trip to the neighborhood

swimming pool. The '80s brought the sense that every child risked abduction, his

photo ending up on the side of a milk carton.

For today's parents, that fear is autism.

" In my office, that's the big elephant in the room. They'll ask about something

else, but what they're really asking is, 'He doesn't have autism, does he?' It

is the question for this generation, " said Ari Brown, a Texas pediatrician and

spokeswoman for the American Academy of Pediatrics.

With autism spectrum disorders now diagnosed in 1 out of 150 children nationally

and 1 in 94 in New Jersey, rare is the parent who isn't aware of autism. And

with that awareness can come a new wariness of vaccines, which a vocal minority

of autism activists blame for the jump in cases. Pediatricians report seeing

more parents question, delay or even shun altogether the traditional round of

childhood immunizations.

Such worries never crossed the mind of Devlin, of Denville, with her first two

children, now 19 and 13. Autism arrived on her radar screen for the next two

kids, now 9 and 3. With Delilah, born 11 weeks prematurely, that concern is

front and center.

" I never did that with my older kids, " she says of her new habit of checking for

eye contact from Delilah. " But now I'm looking specifically for autism. "

Pediatricians say this worry has its benefits: Parents are more aware of crucial

child-development milestones and as a result, they are quicker to pick up on

lags. That may mean some cases of autism -- maddeningly difficult to catch in

the youngest toddlers -- are diagnosed earlier.

" If you have a child who doesn't talk, I think in other generations they

would've said, 'Oh, he's a late bloomer.' It wasn't a big deal, " said Jean

Wick, another Denville mother of five. " Now it's definitely a fear for this age

of parent. "

However, it can make some parents see autism behind every bush.

" Thirteen years ago, parents wouldn't be able to answer the question, 'How does

your child play?' " Brown said of her early years in practice. " Now you hear, 'Oh

my God, my child lines up his trains. Does he have autism?' There are these

extreme parents who think every little thing is autism. I have to say to them,

'Sometimes kids can be quirky.' "

SINGLING OUT A 'SYMPTOM'

Autism spectrum disorders are developmental disabilities marked by an impairment

of social interaction combined with communication problems and restricted or

repetitive behaviors and interests. The spectrum encompasses a wide variety of

thinking and learning abilities, from gifted to severely challenged. While its

prevalence has soared in recent years, experts are unsure whether more cases are

occurring or simply more cases are being diagnosed.

Some parents will single out one small trait or habit of their children as a

" symptom " of an autism spectrum disorder, said Segarra, president of the

New Jersey chapter of the American Academy of Pediatrics, who practices in North

Brunswick.

When a parent voices concern that a child plays with only one toy, for instance,

Segarra will ask a checklist of questions about the child's social interaction.

This helps the parent see the big picture.

Some parents accept their pediatrician's reassurances. Others don't -- leading

to more referrals to specialists.

" New Jersey has the most pediatric neurologists per capita, and even then, we're

booking a year in advance, " said Janice Prontnicki, a neurodevelopmental

pediatrician at Children's Specialized Hospital, Mountainside.

She sees that looming dread of autism when she diagnoses a significant

developmental delay that stems from some other cause. " When I say, 'It's

definitely not autism,' you can see how relieved they are, " she said.

" A lot of referrals we make are so parents can hear another person, a

neurologist, say the kid's okay, " said Carol Calabrese, with Skylands Pediatrics

in Sparta. She finds that parents who needn't worry about autism are still

concerned about it, while the parents who really should be concerned aren't.

In fact, parents are downright eager to have their children evaluated for autism

if there is the slightest delay in developmental milestones, said Aradhana

Rajkumar, of Pediatric Care in Parsippany.

SUSPECTING VACCINES

Apprehension about autism shows up most dramatically with the issue of child

immunizations, which some parents view as a culprit in the recent rise in

autism.

A major study released last year in the New England Journal of Medicine shows no

association between long-term neurological and psychological problems and early

exposure to thimerasol -- which contains mercury -- in shots. (Use of thimerasol

in routine vaccines was stopped in 2001.)

However, that has not reassured everyone.

A poll of parents of autistic children showed 54 percent believe autism is

caused by vaccination shots, according to Harvey , director of Child

Neurology and Development Medicine at Goryeb Children's Hospital in town.

At a recent talk before a group of family physicians, he called that finding

worrisome and " astounding. "

Pediatricians report more parents are either delaying shots, asking they be

spaced out or refusing them altogether.

" They don't listen to me. They don't believe a word I say, " said Naomi

Grobstein, a pediatrician with the Family Health Center of Montclair. " They say,

'He's not ready!' or 'He's too young!' "

She reminds parents of the lethal risk posed by diseases like measles,

diphtheria and tetanus.

" It's easy to believe these shots aren't necessary, because we don't see these

diseases anymore, " she said. " I ask them, 'What if your child is the one who

spreads measles around?' "

She reports more parents indicate they plan to seek a religious exemption from

the state law requiring immunizations to enroll in public school. Medical

exemptions require a doctor's note; religious exemptions simply require a parent

to state the shots conflict with the student's " bona fide religious tenets or

practices. "

Statewide, more parents sought a medical exemption than a religious one until

the 2006-07 school year, when the numbers suddenly switched. By the next school

year, religious exemptions outnumbered medical ones, 2,105 to 645, according to

figures provided by the New Jersey Department of Health and Senior Services.

(All told, however, both categories account for less than 1 percent of

students.)

Complicating the picture are celebrities who either blame or suspect vaccines,

such as actress McCarthy and radio talk show host Don Imus. Doctors

complain they get an unquestioning ride in the media.

" It infuriates me to no end, " said pediatrician Calabrese. Her practice has a

satellite office in Pennsylvania, where she sees more parents who home-school

their children. More of them feel free to refuse or postpone shots because their

children don't attend public school.

Some of these fears come with the territory for parents. Others may be generated

by the information age, said Campagnolo, past president of the New Jersey

Association of Family Physicians.

" I feel parents today are generally more worried about things than they ever

were, " she said.

Wick, the mother of five children ages 1 to 11, said she has worried about

immunizations, but decided to get her kids vaccinated. " I can see that there are

people who just panic, " she said. " But maybe that's something in the culture,

that we just want to control everything. "

It's important to address that anxiety, said Brown, the Texas pediatrician who

is also author of " Baby 411, " an advice book. " If there is something that is

keeping you up at night with worry, then you need to go to the pediatrician to

check it out, " she said. " That peace of mind is worth the co-pay. "

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