Defining Autism

Host: What is autism from a neurological point of view, and why would you be involved, because you see psychiatrist talking about autism and not too many pediatrics neurologists, can you explain that a little bit? Steven Pavlakis: Well, autism is -- first of all, I think there is a huge overlap between psychiatry and neurology, and when we are talking about disease of the brain, both specialties can deal with it. I think psychiatrists are more used to using a lot of medications that have psychiatric implication, such as patients that have schizophrenia and severe depression, neurologists tend not to do that. But I think there is an overlap between child psychiatrists and child neurologists, in terms of treatment, and also research in autism. Host: If you were asked to explain simply, what would you define a classical autistic kid to be? Steven Pavlakis: Well, let's define autism and then let's speak about why, if anyone knows, it maybe increasing or not. Autism usually has to have three major criteria. One is, you have a language impairment. Two is, you have less personal skills. Three, you tend to do repetitive things. Those are the major three criteria that one has to meet to have autism or Pervasive Developmental Disorder, so called PDD. I think there are a few key facts to know. One is that you can't, in the year 2006 and 2007, diagnose autism under age four, four-and-a-half. We do often do it, but we do it for educational purposes. If a child meets those criteria at two, we say the child for educational purposes has autism or PDD. Many of those children though will change, ad by the time they are four, may not have it. So you really can't be certain until a child is four-and-a-half. All we can say is the child has those criteria at a younger age and may have it. Host: If you saw a baby four months old that wasn't making eye contact and no smile, does that mean the kid is autistic? Steven Pavlakis: No, in fact, at four months you really can't say. You might say that the child maybe at higher risk than another baby, but you cannot say. Host: So you would call that a red flag? Steven Pavlakis: You would call that a red flat, a risk factor, but not autism. Host: Okay. When the kid is 18 months old and not really speaking and not wanting to be hugged, and kissed, and loved, like every kid, does that mean the kid is autistic? Steven Pavlakis: No, it doesn't at 18 months, although the child may have features that are consistent with autism, and that child would be at a higher risk for having it. In fact, we generally in a child of 18 months would probably educationally treat that child as if that child did have autism, but we can't really diagnose until a child is older. In that, we sometime see patients like this that do very well. So one can't say it really is the end. Host: If there was some concern, is there any risk that you know that vaccines play a role in autism? Steven Pavlakis: Well, autism seems to be caused by something that happens intrauterine at large, is a major factor for causing autism. Host: But the routine immunizations that we give kids? Steven Pavlakis: There are probably other risk factors that add on to the expression of the problem. Right now, there is no evidence whatsoever that vaccinations are a risk factor for the development of autism, there really isn't. It's just that some patients develop autism at 18 months, and that's when people get vaccinations, but other than that, there is no statistical evidence that there is an association. Host: In Denmark, in 1992, they took the mercury out of all their vaccines and you figured the autistic rate would have gone down, and it didn't go down. That might be an indicator that maybe the concerns about mercury in vaccines which virtually have been free from most of the vaccines weren't really a cause, is that true? Steven Pavlakis: That's correct. There is really no evidence that mercury is a risk factor for autism. Host: I believe in 1998, there was a doctor in England who said, oh, based on 18, 20 patients, MMR must be the cause, because it seemed to be increasing, when we started getting measles, mumps and rubella, is there any truth to that? Steven Pavlakis: No, when people look at it statistically, there is no increased incidence of patients that have had MMR, that developed autism versus ones that have not. In fact, when one doesn't give MMRs, you have higher chance of measles than if one remembers when we used to have measles, the risk of having a very bad brain involvement with measles, with the development of severe mental retardations, is 1 in 1,000 once you get measles, which is very scary, and people my age used to get measles. So each time we got it, it was 1 in a 1,000 chance that we were going to become very impaired. So right now there is absolutely no evidence that vaccinations are a risk factor for autism, and there is great evidence that having these diseases can be very severe. So if one weighs the no clear risk versus the risk of the disease, it's a no-brainer that one should have their immunizations. Host: Is there any treatment you could offer a parent, young age, to prevent autism? Steven Pavlakis: Right now there isn't. Our treatments for autism are basically to make certain its not something underlying genetic, which usually, there are not a whole lot of test to do. We look to make sure the patient doesn't have associated epilepsy, and we give educational intervention.