"It is very possible that PATERNAL AGE is the major predictor of(non-familial) autism." Harry Fisch, M.D., author "The Male Biological Clock". Sperm DNA mutates and autism, schizophrenia bipolar etc. results. What is the connection with autoimmune disorders? Having Type 1 diabetes, SLE,etc. in the family, also if mother had older father. NW Cryobank will not accept a sperm donor past 35th BD to minimize genetic abnormalities.VACCINATIONS also cause autism.

Friday, May 28, 2010

Men’s Biological Clock

Naked Fatherhood
Parenting for Smart DadsCategory
Select Category Balanced Parenting The Recent Fathers’ Club (
Men’s Biological Clock
by justin on May 24, 2010

There were rumours a while back that Hugh Hefner, the octogenarian founder of the Playboy empire was planning to father a child with Holly Madison (53 years his junior), the alpha female of his three live-in girlfriends. Of course that was before the jam hit the fan and all three moved out of the mansion.

But, apropos the baby – why not? Charlie Chaplin and Picasso both fathered children well into their 70s, with no ill-effects. There are even anecdotal reports in the medical press of men in their 90s becoming fathers. Everyone knows that we men can just carry on having children until very late in life, (although it’s possible that having kids just makes you feel 100 hundred years old).

Photo by: judepics
But is it all true? It seems that medical evidence is mounting that men are not immune from the ticking of the biological clock (although we often battle to hear it quite as loudly as our partners).

The first part of the problem lies with the decline in fertility of men as they age. Testosterone levels fall over time which not only makes it harder for men to hold their tummies in at the beach, but also affects sexual performance. There is also a decline in sperm count and sperm quality which means that it takes men over 45 significantly longer to produce a pregnancy than men under 25 – up to 5 times longer according to some research.

Still, it was thought that even with a decline in fertility, any genetic issues with the pregnancy or resulting child lay with the mother. This was because while a woman is born with her full quota of eggs, men manufacture sperm continually without even having to think about it, so conception between an older couple might be the meeting of a forty-year-old egg with a three-month-old sperm (the time taken to manufacture mature spermatozoa).

However, it now seems that there’s also a deterioration in the quality of the genetic material that each sperm carries. This is first seen in an increase in the number of miscarriages – three times greater where fathers are older than 35 compared to those younger than 25. The incidence of pre-eclampsia also rises with increasing paternal age.

This deterioration of genetic material is thought to arise from a number of causes. The cells which divide to produce sperm cells replicate around 23 times per year starting from puberty, so by the time a man hits 50, those cells have divided about 800 times, increasing the risk of errors.

With age, the frequency of sporadic single-gene mutations also increases four to five times for a person over 45. On top of that, the enzymes that repair faulty DNA decrease in efficiency as one gets older.

All of which means an increase in a list of medical problems now totalling about 20.

A study of data from a huge Israeli health database showed that, for example, schizophrenia is twice as likely to occur in the children of men over forty as in those in their twenties. Men over fifty lead to a three-time increase in risk.

A further study on the same database showed that autism too is six times more frequent where fathers are over forty than those under 30.

An earlier study by Dr Harry Fisch (author of the book The Male Biological Clock) concluded that parents over 40 have a six-times higher risk of having a child affected by Down Syndrome than where both are under 35. And where a woman over forty has a child affected by Down Syndrome, the genetic blame is now thought to lie 50% with the father.

And the list goes on, with various studies linking advanced paternal age to disorders such as dwarfism, progeria (an extremely rare accelerated aging disease), skeletal disorders, congenital heart defects, certain types of cancer and even reduced scores in nonverbal IQ tests.

All of which helps explain why the cutoff age for sperm donors in The States is set at 40. So that’s another paying hobby limited to the youth – smacks of ageism, doesn’t it?

And yet more and more couples are leaving it later to have children for any number of reasons. Many want to feel like they’ve experienced something of a life and a career before the little tyrants arrive. Some prefer to wait until they’re in a more financially stable phase of their lives before committing. Maybe its just that there are more frogs to kiss nowadays in search of princes. Or even that the kiss-per-frog ratio has risen.

And really, what’s the downside? You may be more likely to spend time in casualty with a back problem from flinging your toddler around and there’s the danger of injuring yourself by tripping over your Zimmer frame when playing cricket with the young ‘uns.

Having kids later probably means that you’re going to have a bit less energy for them, but then again, that depends on how well you’ve looked after yourself in getting to where you are. Also, a decrease in the time available to spend with children can be offset to a certain degree by an increase in the quality of the time spent.

Many parents are finding that they’re having children later without even planning it that way – life often gets in the way of our plans. Then when one’s finally ready to make this life-altering commitment it takes a little while to get everything ready to even start trying (especially when you discover that the whole house has to be remodelled before you can even start).

And then it doesn’t just happen right away, and where there are miscarriages, recovery, both physical and emotional, takes time before you can start again.

All of which means an upswing in the number of parents who battle to remember where they left the children a few minutes before.

Then again, children of older parents should be more independent when they grow up, if only because they’re used to being able to easily outpace their pursuers.

From a selfish point of view, having kids later means that you’ll have someone around who is able to intuitively figure out how to use the new DVD player that has been standing unused because you can’t work out what the instruction manual is trying to tell you.

Also, you don’t resent the loss of your social life to the same degree as those that have their children while they are young (the parents, not the children) – you’re giving up a whole lot less when your idea of a good time is staying in with a good book and listening to Smooth Classics.

And when you’re lucky enough to have your mid-life crisis with small children you’re much less likely to embarrass yourself by running off and buying a convertible or any motorcycle that comes with tassles hanging from the handlebars.

The bottom line? Don’t leave it too late. While it is physiologically possible for a man to produce heirs at a very late stage of life, the risks do rise along the way.

And Hef? I think that at his age, he’s just perfected the art of saying ‘Yes Dear’ without really listening to what anyone is actually saying.

Share and Enjoy:

Tags: fathers, old dads, senior fathers


Wednesday, May 26, 2010

From: NY Alliance for Vaccination Choice

From: NY Alliance for Vaccination Choice

Dear All,

The NY Senate Health Committee just moved this bill along and we need to stop it in the Assembly and in the rest of the legislature. Please see below for details. Please ACT today, your call, email and visit COUNTS! ~Lisa, NYAVC

A bill to require meningitis vaccine for 7th graders and ALL college students is gaining momentum in Albany!

Bill S7156 passed the Senate Health Committee and is due for a floor vote.

Bill A10313 will be voted on the Assembly Health Committee any given Tuesday.

We have to FLOOD The Assembly & Senate with calls and e-mails. They must vote `no' on Bill S7156 and A10313


This bill is only steps away from LAW. We need to stop it. Our lawmakers will listen to these reasons:

* There is NO meningitis health `emergency'. Why the extreme measure?
* Less that .005% of the entire US contracts the disease yearly.
* Mandatory shots cost MILLION$$$. NY is $9.2B in debt. Financial pain is everywhere. We're increasing our burden?
* There is nothing stopping people from getting the shot right now.
* The vaccine does not address all strains.
* The vaccine can contain mercury-filled thimerosal

CALL THIS LIST of Assembly Health Committee Members

Find their e-mails at


All phones numbers begin with 1-518-455- ####

Richard N. Gottfried, Chair, 4941
Jim Bacalles , 5791
Jonathan L. Bing , 4794
Kevin A. Cahill , 4436
Robert Castelli, 5397
James D. Conte , 5732
Steven Cymbrowitz , 5214
Jeffrey Dinowitz , 5965
Sandy Galef , 5348
Aileen M. Gunther , 5355
Andrew Hevesi , 4926
Rhoda Jacobs , 5385
Charles D. Lavine , 5456
William B. Magnarelli, 4826
Nettie Mayersohn , 4404
David G. McDonough , 4633
Joel M. Miller , 5725
Amy Paulin , 5585
Crystal D. Peoples , 5005
Jack Quinn , 4462
Naomi Rivera , 5844
Linda B. Rosenthal , 5802
Robin Schimminger , 4767
Lou Tobacco , 4495
Darryl C. Towns , 5821



May 26, 2010
Meet Dr. Andrew Wakefield at The American Rally for Personal Choice Today
From The American Rally for Personal Choice:

Join us TODAY in Chicago to show our support for vaccination choice and parental consent. Please join us live and meet Dr. Andrew Wakefield, or you can participate via satellite, or with balloons to represent all those who cannot attend but want to have their family counted.

Wednesday, May 26, 2010
3:00 - 5:00 pm
Grant Park, Downtown Chicago
Complete details here

Attend a Satellite Rally

Sign the petition in support of the Chicago Principles and Calls for Immediate Action.

Continue reading "Meet Dr. Andrew Wakefield at The American Rally for Personal Choice Today" »

Share on Facebook • Digg This!

Autism Professor Needs Help


Autism Professor Needs Help

Professor Gene Stubbs of the University of Oregon needs help with his study about vitamin D and autism. He is testing the theory that a mother with one child with autism will not have another if the mother takes vitamin D during her pregnancy. Women no longer need to come to the University of Oregon but can participate at a distance. Professor Stubbs writes:

"Can anyone assist us in recruiting mothers who already have children with autism and the mother is pregnant again before her third trimester? We are giving the mothers 5000 IU D3/day. So far every mother who has delivered has delivered within 1 week or on the date of expected delivery, and the babies are well within normal birth weights. They have not progressed far enough in age for us to screen for autism, but so far, the babies are interactive, have eye contact, are vocal etc..

However, we need more research families to participate. We have recruited other doctors to help us recruit and we have recruited doctors on the Vitamin D Council sites to help us recruit. We still need more families to participate to make our results significant. The families no longer have to come to our site to participate. If you know of any families who potentially might be eligible for our research, please give them my research assistant's phone number, 503-351-9255."

Thank you,

John Cannell, MD

The Vitamin D Council

1241 Johnson Ave., #134

San Luis Obispo, CA 93401


Tuesday, May 25, 2010

Geographic distribution of autism in California: a retrospective birth cohort analysis.

Autism Res. 2010 Feb;3(1):19-29.

Geographic distribution of autism in California: a retrospective birth cohort analysis.
Van Meter KC, Christiansen LE, Delwiche LD, Azari R, Carpenter TE, Hertz-Picciotto I.

Department of Public Health Sciences, School of Medicine, and Medical Investigations of Neurodevelopmental Disorders Institute, University of California-Davis, One Shields Avenue, Davis, CA 95616, USA.

Prenatal environmental exposures are among the risk factors being explored for associations with autism. We applied a new procedure combining multiple scan cluster detection tests to identify geographically defined areas of increased autism incidence. This procedure can serve as a first hypothesis-generating step aimed at localized environmental exposures, but would not be useful for assessing widely distributed exposures, such as household products, nor for exposures from nonpoint sources, such as traffic. Geocoded mothers' residences on 2,453,717 California birth records, 1996-2000, were analyzed including 9,900 autism cases recorded in the California Department of Developmental Services (DDS) database through February 2006 which were matched to their corresponding birth records. We analyzed each of the 21 DDS Regional Center (RC) catchment areas separately because of the wide variation in diagnostic practices. Ten clusters of increased autism risk were identified in eight RC regions, and one Potential Cluster in each of two other RC regions.After determination of clusters, multiple mixed Poisson regression models were fit to assess differences in known demographic autism risk factors between the births within and outside areas of elevated autism incidence, independent of case status.Adjusted for other covariates, the majority of areas of autism clustering were characterized by high parental education, e.g. relative risks >4 for college-graduate vs. nonhigh-school graduate parents. This geographic association possibly occurs because RCs do not actively conduct case finding and parents with lower education are, for various reasons, less likely to successfully seek services.


Saturday, May 22, 2010

Dear All,

On Monday May 24th 2010 the GMC will convene to announce whether Andrew Wakefield is to be struck off. In light of the improprieties of the Legal Services Commission and GMC, it is hoped that the panel in Wakefield's case will be discharged pending a full inquiry.

We will gather to support Andrew Wakefield at 8:00am in 30 Rockefeller Center on Monday, May 24, 2010 in front of the NBC Studios on 49th St. Between 5th and 6th Ave. Andre w Wakefield will be interviewed by Matt Lauer and immediately following Andrew Wakefield will join our gathering outside the studio. Urgent attendance is requested and bring signs supporting Andrew Wakefield. PLEASE SEND TO ALL YOUR EMAIL LISTS!!

In 1998 Andrew Wakefield and 12 colleagues published a case series paper in the Lancet, describing bowel disease in twelve children diagnosed with autism spectrum disorders, a cautious article say the findings based on a study of 12 children did not prove for certain that there was an association between MMR-cited as the cause by the parent and the syndrome, but that further research should be carried out.

The significance of these finding has been overshadowed by a concerted systematic effort to discredit the work. This effort and an intense desire to subvert the inquiry into the issues of vaccine safety and legal redress for vaccine damage, has culminated in the longest running and most expensive fitness to pra ctice case ever to come before the GMC.

Thank you to all!!!

NY Alliance for Vaccination Choice (NYAVC)

Friday, May 14, 2010

Volume 47, Number 2, May 2010 Social Demographic Change and Autism

Volume 47, Number 2, May 2010 Social Demographic Change and Autism
Journal Information

Volume 47, Number 2, May 2010
E-ISSN: 1533-7790 Print ISSN: 0070-3370

DOI: 10.1353/dem.0.0101

Social Demographic Change and Autism
Kayuet Liu
Noam Zerubavel
Peter Bearman

Demography, Volume 47, Number 2, May 2010, pp. 327-343 (Article)
DOI: 10.1353/dem.0.0101
HTML Version | PDF Version (616k)
Subject Headings:

■Autism -- Genetic aspects.

Parental age at child's birth—which has increased for U.S. children in the 1992-2000 birth cohorts—is strongly associated with an increased risk of autism. By turning a social demographic lens on the historical patterning of concordance among twin pairs, we identify a central mechanism for this association: de novo mutations, which are deletions, insertions, and duplications of DNA in the germ cells that are not present in the parents' DNA. Along the way, we show that a demographic eye on the rising prevalence of autism leads to three major discoveries. First, the estimated heritability of autism has been dramatically overstated. Second, heritability estimates can change over remarkably short periods of time because of increases in germ cell mutations. Third, social demographic change can yield genetic changes that, at the

Labels: , ,

Monday, May 10, 2010

Cancer vaccine programme suspended after 4 girls die

Cancer vaccine programme suspended after 4 girls die
Vineeta Pandey / DNAThursday, April 8, 2010 0:39 IST Email

New Delhi: The Indian Council of Medical Research (ICMR) has told Andhra Pradesh and Gujarat to immediately suspend the cervical cancer control vaccination programme for girls. The programme is part of a two-year study to look into the utility of a vaccine in public health programmes and acceptability of Gardasil, the human papillomavirus (HPV) vaccine made by Merck. Gardasil, available in medical stores across the country, is marketed in India by MSD Pharmaceuticals Pvt Ltd.

You may also want to see
Henna dye associated with high leukaemia rates in UAE women
Removing kidney of elderly patients with localised kidney cancer does not prolong their lives
Soon, an early warning test for breast cancer
Skin cancer-treating prescription drug could boost effects of HIV vaccines
Popular diabetes drug may help treat cancer
The programme was marred by controversy after four deaths and complications among 120 girls were reported after vaccination. The girls complained of stomach disorders, epilepsy, headaches and early menarche. Women activists fear the vaccine may impact the mental health of girls who have shown no signs of distress so far.

Health ministry sources said the vaccination programme is being conducted by Gardasil, jointly with PATH, a Seattle-based NGO, ICMR and the two state governments. About 32,000 girls, aged 10-14, were to be tested in the study.

ICMR chief Dr VM Katoch clarified ICMR was only a technical partner, with an advisory role, in the project. But Katoch said they were checking out who was at fault.

Questioning the study, CPM leader Brinda Karat said: “How has the government embarked on the study of giving three injections to the girls when it is also planning a massive multi-centric dose determination study to see if two doses will suffice?”

For a drug to be administered to children, Karat said, it has to go through stages of clinical trial, including phase 3 adult clinical trials. With Gardasil, only one trial has been carried out with a small sample of 110 girls, which has followed up with them for a month after completion of vaccination and that too only to look at the immune response post-vaccination, Karat said. The vaccine has also been approved for adult women aged 27, Karat said, without any trials on them.

Karat also alleged scientific logic and ethical guidelines have been violated at each step during drug and vaccine trials.


Australian Flu vaccination ban goes national after fever, convulsions in children

Australian Flu vaccination ban goes national after fever, convulsions in children

submitted by Drew Kaplan on May 5, 2010 – 7:24 pm

In Australia Doctors are being advised to stop giving the flu vaccine to children.
Seasonal flu vaccinations across Australia for children under five have been suspended after 23 children in Western Australia were admitted to hospital with convulsions following their injections. One child, aged 1, remains in a coma in a Perth hospital. Commonwealth chief health officer Professor Jim Bishop yesterday announced the suspension while authorities urgently review data from around the country. WA’s chief public health officer Tarun Weeramanthri has defended the response time in closing down the state’s juvenile flu vaccine program amid revelations that children were presenting with convulsions more than two weeks ago.

Rogue batch may be to blame
National warning to GPs
Perth mum: ‘I was petrified’

WA free vaccine program suspended

More than 60 children around the state may have had adverse reactions to the vaccine, including fevers, vomiting and febrile convulsions – a type of fit brought on by a high fever.

One child remains in a critical condition in hospital after being given the vaccine. Dr Weeramanthri said he had few details on the child’s condition but they were “seriously ill”.

He said a national process set by the Therapeutic Goods Administration had been observed in responding to the reactions. Under the process the best clinical information was collected from as many doctors as possible and an assessment made on the “totality of that”.

“We take all reports very seriously and we believe we’ve acted in a very timely fashion,” Dr Weeramanthri said.

“We’ve been monitoring the situation, we’ve been talking to clinicians and we’ve acted as soon as we can.”

He said that since this year’s vaccine program started a month ago, 23 children under the age of 10 had presented to Princess Margaret Hospital with convulsions related to vaccinations they had received less than 12 hours before.

Another 40 convulsion cases had been detected in the past month in children at other metropolitan hospitals and in Bunbury. Doctors are now working to determine how many of those children received the flu vaccine.

Aside from the convulsions, affected children were suffering fever and vomiting within 12 hours of their flu shots.

A teleconference today with state, territory and TGA officials confirmed the picture in other states would not be available for “a few days”.

Dr Weeramanthri said the TGA was assessing the geographical spread of symptoms across Australia, and directly testing batches of vaccine for any impurity.

Rogue batch may be to blame

Health authorities are also working to determine if the entire Fluvax drug, or just batches, have caused the symptoms, and whether an alternative vaccine should be used.

University of Western Australia school of Paediatrics and Child Health Associate Professor Peter Richmond said that only Fluvax – produced by Australia’s biggest biopharmaceutical company CSL – was being used to vaccinate children in WA.

Dr Richmond said researchers were trying to determine whether it was the entire vaccine, or just batches, that had caused the problems which today prompted Australia’s chief medical officer to tell doctors to stop giving the vaccine to children.

He said the side effects had been largely limited to children under the age of five and he would not recommend that anybody in other groups – including elderly people – cancel their flu shots.

“This is not a long-term safety issue with vaccines,” Dr Richmond told

He recommended parents of young children who had received only the first of the required two vaccination doses hold off on the second dose for now.

This was despite the fact children who had no side effects from their first dose were unlikely to receive complications from their second.

Dr Richmond said the first dose provided partial protection against the flu anyway.

He said researchers were examining whether an alternative drug to Fluvax could be used for the second dose – generally scheduled for four weeks after the first.

Researchers were also trying to determine if the problem with Fluvax was temporary only – and whether the drug could still be used in coming weeks for the second dose.

He stressed that the vast majority of children receiving Fluvax had suffered no complications.

National warning to GPs

Commonwealth chief medical officer Jim Bishop issued a national warning to GPs not to use the vaccine followed a decision last night by the WA government to suspend the free vaccination program for children under five over concerns it was causing high fevers and convulsions.

“We suggest doctors and health professionals vaccinating children don’t use the seasonal flu vaccine for the moment, until we can get the Therapeutic Goods Administration (TGA) to investigate this in more detail,” Professor Bishop told ABC TV.

He said the concerns stemmed from a significant rise in the number of children developing a fever after receiving the vaccine.

“We need more information about what’s happened in WA, but also what we can now find out from all the other states from their experience,” Professor Bishop said.

“If this has been brought up as a possible side-effect of this drug, then we ought to at least suspend its use until we know more.”

In light of the seasonal flu shot suspension, Professor Bishop suggested children get vaccinated against swine flu instead, because that could be a health risk this winter too.

He said there did not appear to be any side effects from the swine flu vaccine Panvax.

“It is safe to have the swine flu vaccine,” Professor Bishop said.

“The TGA’s assessment of clinical trials and the advice of its expert committees is that Panvax is a safe, effective vaccine for prevention of the H1N1 influenza.

“It is expected that the dominant flu this winter season will be swine flu and the specific Panvax vaccine is available free for all Australians.”

‘I was petrified’

Perth mother of two Bea Flint said her 11-month-old boy Avery had a seizure after receiving the first dose of the two-dose flu vaccination on Saturday.

Mrs Flint said that after the 9am vaccination she noticed Avery had a minor temperature about 2pm. She treated him with Panadol and by Avery’s 7pm bedtime he seemed “OK”.

However, at 7.45pm, Avery started whimpering and moaning.

When Mrs Flint got to his cot the baby had vomited and was lying on his side having a seizure.

“In the car driving to the hospital he was just whimpering,” she said.

“He couldn’t cry – his head was hanging down in the car seat and he couldn’t move.

“I was petrified – it was one of the worst experiences of my life.”

By the time Avery arrived at St John of God Hospital in Murdoch, he was burning up with a fever of 39.5 degrees.

The doctor who treated Avery told Mrs Flint her baby was the fifth child with similar symptoms admitted to the hospital that day.

WA vaccine program suspended

Health Minister Kim Hames last night advised of the state-wide suspension as a precautionary measure.

He said the suspension came after a significant rise in the number of children who had developed a high temperature after receiving the vaccine.

He said some children had gone into febrile convulsions, a fit caused by a high fever, following the vaccinations.

Dr Hames said it was unclear if the fevers were related to the influenza vaccination but the precautionary measure was the most responsible course of action.

Fevers in most instances are treatable.

“People should give Paracetamol according to the instructions and tepid sponging to keep the temperature down.” Dr Hames said.

“On rare occasions children can have a convulsion as the result of the high temperature and sometimes that can be prolonged, which can be a risk to the child.”

He said parents should not take children under the age of five to be vaccinated against influenza until further notice

Labels: ,

Wednesday, May 05, 2010

Older Parents and Autism

From Medscape Pediatrics > Best Evidence Interviews in Pediatrics
Best Evidence Interview: Older Parents and Autism -- Questions on the Rise in Autism Continue
Expert Interview With Judith K. Grether, PhD
Carol Peckham

Posted: 05/04/2010

Information from Industry
Featuring New Content at the Pain Institute InfoSite Stay abreast of the latest topics in chronic pain assessment and management
Connect now The Best Evidence Study
Risk of Autism and Increasing Maternal and Paternal Age in a Large North American Population

Grether JK, Anderson MC, Croen LA, Smith D, Windham GC
Am J Epidemiol. 2009;170:1118-1126

This study was selected as the subject of this interview because of its high ranking in Medscape Best Evidence, which uses the McMaster Online Rating of Evidence System. Of a possible top score of 7, clinicians who used this system ranked this study as 5 for relevance and 7 for newsworthiness.


About the Interviewee
Judith Grether, PhD, is Senior Epidemiologist in the Environmental Health Investigations Branch, California Department of Health Services. Dr. Grether is a perinatal epidemiologist who has had the opportunity over many years, within the California Department of Public Health, to conduct research studies on the prevalence of and risk factors for developmental disabilities, primarily cerebral palsy and autism spectrum disorders. She has recently retired and is now working to complete some analyses and manuscripts.

Medscape: Your study, "Risk of Autism and Increasing Maternal and Paternal Age in a Large North American Population," was highly ranked by pediatric clinicians. Could you just give a brief description of it and its significance?

Judith Grether, PhD: Our study was the largest that has yet been conducted -- and, I would guess, is probably the largest that will be conducted -- to specifically address the question of whether the risk for autism in offspring increases with the advancing age of the mother and/or the father. With our very large study, we were also able to obtain statistically precise estimates of how much of an increase in risk there is as parents get older. A number of prior studies have looked at the question of a parental age effect; to my knowledge, none have reported a decreasing risk as parents get older, but some have found an increased risk only for advancing maternal age and others only for advancing paternal age. A couple of studies have pretty dramatic estimates of the amount of that increased risk -- particularly one from Israel that found only father's age to be important. From a scientific perspective, to get clues to what may underlie any increase in risk for autism associated with older parents, it is important to answer the question: is it both age of the father and the mother, or is it only mothers or only fathers? There are some tricky statistical issues here and it is very helpful to have a large database like we had, in which the subjects are not self-selected for the study.

Medscape: Where did you get your data from?

Dr. Grether: We analyzed data from the California Department of Developmental Services (DDS), which is a statewide service system in California for people with developmental disabilities. It is a well-established, well-known program that has been around since, I believe, the late 1970s. Children and adults with autism, mental retardation, cerebral palsy, epilepsy, and related conditions are eligible to receive services if they meet diagnostic and severity criteria. It is an entitlement program, so there are no income or citizenship criteria. The program has a database that, I believe, has used the same data collection instrument since 1987 to document eligibility for services.

With the appropriate approvals from DDS and our institutional review board (IRB), we were able to obtain a data file that contained eligibility diagnoses for children born in 1989-2002. We then linked the DDS data to the statewide birth certificate files, again with IRB approval and strict requirements to maintain the confidentiality of the data, to obtain demographic data, such as parental age, [that had been] recorded before there was any concern that a child might have a developmental disability. The DDS data are assembled for administrative purposes, so the database has definite limits for research studies, especially with regard to diagnostic details and potential underlying causal factors. However, DDS data are extremely valuable for looking at broad-stroke time trends and demographic patterns. And so, it is really very useful for some types of studies.

After we had excluded multiple births and subjects with missing data, we were able to analyze the demographic characteristics of more than 20,000 singleton children born to California residents who were receiving DDS services for autism and compare them to the remaining 7.5 million singleton children born to California residents during those same 14 years.

Medscape: Did these children in your dataset have classic autism or were they part of the autism spectrum?

Dr. Grether: Well, that is part of the complexity here. According to DDS eligibility guidelines, a child is supposed to have autistic disorder or have mental retardation with sufficient severity to meet the criteria to be getting services. In reality, partly because the diagnosis of autism is based on behavioral criteria, the distinction between autistic disorder and other spectrum conditions can be rather "soft." We know through experience that there are some children receiving DDS services for autism who may not, in some clinicians' eyes, meet the full DSM-IV [Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition] criteria for autistic disorder. However, these are clearly not typically functioning children; they need services and there may be nowhere else to send them. So, sometimes the eligibility criteria likely get interpreted a bit leniently. None of this, I think, is particularly relevant to our concerns in this study. It has restricted some other analyses, but is not so relevant here.

Some unknown proportion of children enrolled with DDS are probably somewhere else on the spectrum, and there also children receiving services from DDS who have autism but whose eligibility diagnosis is mental retardation. We have no way of teasing this apart unless we actually go into the hard copy records, which we have done for some other studies, but not for this one, given the very large size of this study. The bottom line is that we can't make any claims about autistic disorder vs other spectrum disorders, so we have to be careful here, especially when looking at time trends.

Medscape: Would the fact that children are entering the system who actually don't meet the strict autism criteria be responsible for the increase observed over the past decades?

Dr. Grether: Clearly, there has been a huge increase in children with autism coming into the DDS system, and as epidemiologists, we have spent a lot of time trying to figure how much of that increase is likely attributable to children with other spectrum disorders coming into the system, and how much is likely due to other factors, such as more awareness or that there are now treatments for eligible children. We know all of those things go on, and also that diagnostic criteria have changed over time. The basic question is, from an etiologic standpoint, how much of the increase may be real, in the sense that something new is going on that was not there before and that contributes to some children having autism.

Medscape: So, you can't tell what percentage of the increase might be due to this broader diagnosis.

Dr. Grether: No, to really get a good handle on that, you would have to do a study in which you go into a community, you try to find every child who may be anywhere on the spectrum, and you give all of them the gold standard diagnostic evaluation. That is a very expensive and time-consuming kind of study.

Medscape: I suppose if you saw autism leveling off now, it would be some indication that a fairly significant percentage might be due to broader diagnostic or socioeconomic factors.

Dr. Grether: If the eligibility criteria for programs like the DDS included anybody anywhere on the spectrum, then you would expect there would be an influx of new kids coming in who meet the broader diagnostic criteria. The numbers would go up accordingly and then level off after that if nothing else was changing to lead to bigger numbers. Obviously, we cannot go backward in time and reconstruct such a scenario, so we have to live with uncertainty.

Medscape: Are there any other factors that you could hypothesize might be going into the increase in autism?

Dr. Grether: Many environmental factors have been raised as possibilities, because obviously, many things have changed in our environment. The difficulty is that most of the things that we worry about -- water and air contamination, plastic hardeners in the sports water bottles, etc. -- are very hard to study in a rigorous way. It is a huge methodological challenge and, fortunately for all of us, some talented scientists are trying to do these studies. Some years ago, after trying to tease out how-much-is-real-and-how-much-isn't kind of question, some of us got to the point of saying, you know, folks, we are never going to have the occurrence data to really figure this out in a satisfying way. Let's stop devoting some much of our precious time and energy to this question, and let's try to figure out what is going on in our environment that could be relevant here. Even if all these new environmental exposures and other changes in our environment are not contributing to autism, per se, we need to know more about them because autism is only one of many pediatric disorders that could be linked to environmental factors. Let's do our best to design studies to really try to narrow in on some of it. It is a huge challenge.

Medscape: What about genetic factors?

Dr. Grether: Genetic studies are going on, and talented researchers are finding more and more genetic factors that may contribute. But from everything we know about the human condition, environmental factors are likely to also play a role.

Medscape: To get back to your study, older parenting has been increasing, so might this also contribute to the increase in autism?

Dr. Grether: Yes, the typical age of parents has been going up somewhat. We have done an estimate, not yet published, in which we basically took the demographic profile of the statewide population in 1989 and applied it to the statewide population in 2002. This standardized the 2002 population for the demographic profile in 1989, permitting us to estimate how much of the increase in DDS-reported autism was either reduced or exacerbated by changing demographic patterns. It was somewhat reduced, but not by a lot. Overall, the changing demographics of the population, including increasing age at parenthood, seems to explain some small part of the increase we see. In a recent paper, colleagues at UC [University of California]-Davis used DDS data and came up with an estimate that 4.6% of the increase in DDS-reported autism from 1990-1999 may be attributable to changing parental age patterns. That's a very modest portion. Clearly, the fact that parents are typically somewhat older than they used to be is not the main explanation behind the increase in autism that we are seeing.[1]

Medscape: What was the significance of your results on older parenting and autism?

Dr. Grether: Our results were certainly consistent with what other people are reporting using California data and also with other studies conducted elsewhere in the world. Both mother's and father's age matter, there is both a maternal and a paternal age effect, and in our study, the maternal age effect is somewhat stronger. However, the increase in risk for autism in offspring born to older parents is pretty modest and probably not useful as a guide in personal decision-making. The real benefit of our study and similar ones is that we now have a scientific clue that may help point us toward underlying biological factors that contribute to the risk for autism in some children. We needed to pin down whether advancing parental age really matters or if it is just some kind of statistical artifact. We can now have confidence that there is a modest parental age effect for both mothers and fathers (at least in the US population). Our task now is to try to figure out why the risk of having a child with autism is greater for older parents.

Medscape: Can you give us some background on why parental age may affect the risk for autism?

Dr. Grether: There are 2 sets of factors, they are not mutually exclusive, and both may well be important. One set of factors involves biological changes that occur as men and women get older and that can affect the outcome of the pregnancy. Down syndrome would be an example of an outcome we know is sometimes related to maternal age. For women, as they get older, the hormonal balance of the womb changes in some ways, and older women are more likely to have infertility. There has been speculation that the hormonal changes that contribute to infertility, or the treatments for infertility, may increase the risk for autism, but we don't have very good data yet. As a woman ages, she will have an increased cumulative exposure to chemicals and toxins in her environment that may affect the neurodevelopment of the fetus. Again, there are not very much data there, but it makes good biological sense to conduct research on environmental factors to which the mother is exposed before or during pregnancy that may affect fetal neurodevelopment.

Medscape: How is male reproduction affected by aging that might influence the risk for autism?

Dr. Grether: Unlike eggs, which were formed during fetal development of the mother, the process of sperm creation and maturation is ongoing, and it is now recognized that as men get older, typically there are more new mutations that occur in the sperm, that are developing. Again, it could be related in some ways to cumulative toxic exposures as men get older. Several studies have demonstrated that, in families lacking a history of schizophrenia, there is an association between older age of fathers (but not mothers) and risk of having a child with schizophrenia, presumably due to more de novo mutations in sperm. These studies of young-adult schizophrenia provide a model that may be relevant to autism, but the studies needed to clarify this for autism have not yet been reported.

The data we and others report showing both a maternal and a paternal age effect for autism could indicate that genetic mutations to the sperm contribute to the risk for autism in the children, but clearly that is not the whole picture because we also see a maternal age effect. That is one reason why we are so interested in studying hormonal factors in the mother during or before pregnancy that may contribute to autism risk.

Medscape: Are there reasons, other than biology, why this risk exists in older parents?

Dr. Grether: There is another possibility here, another possible explanation that could also explain the parental age effect. Over and above whatever reproductive biological changes happen as people age, people who are predisposed to have an autistic child may be more likely to start having children later in life, for a variety of reasons. They may be going to college, pursuing more intensive careers, and putting off childbearing until later. We can speculate about these reasons, but we don't yet have studies on this and, unfortunately, we don't have relevant data from our study.

There is also speculation in the research literature that, to the extent there is a tendency for people to have children with a partner who is similar to themselves ("like marries like"), there may be a pattern for people with a genetic predisposition for autism to form a relationship with a partner who has a similar genetic predisposition. By waiting until later in life to have a family, perhaps there is more opportunity to find a partner with similar underlying genetics, thereby increasing the genetic risk in the child.

As I said, this is speculation at this point. The studies simply have not yet been done. The "takeaway" message here is that we now have some good hypotheses around which to conduct further studies that will help in disentangling the mix of genetic and environmental factors that contribute to autism.

Medscape: Did you find any greater association with autism and any ethnicity or race in older parents?

Dr. Grether: No, not with the increasing parental age. It was really very, very similar across racial ethnic groups, which is really interesting.

Medscape: What about socioeconomic groups?

Dr. Grether: We found an association with one SES [socioeconomic status] measure (private insurance payment for the delivery vs other sources of payment, primarily government programs for low income people) but not with another (educational level attained by the mother or father), so our findings must be considered to be inconclusive with regard to socioeconomic status.

Medscape: Haven't there been some studies indicating that higher economic groups are more prone to autism than lower?

Dr. Grether: Yes, but that is really a different question. Let me try to restate it, as this can be a real mind-twister. In our parental age study, we were trying to look at how much an increase in the age of parents is related to the risk for autism in a child. We were not looking at the baseline risk. So when I say that we did not see a difference in the increase in risk associated with age of parents for well-educated parents compared with less well-educated parents, what I am talking about is the increase associated with the parents being older. At any given age, well-educated parents are more likely to have children with autism than less well-educated parents (and we don't know why this is so), but the amount that the risk increases with increasing age of parents is the same for both groups. Their baseline risk may be different, but the rate of increase in risk represented by the upward slopes of the lines are parallel to each other.

Medscape: Are there any other factors that might affect the risk of having a child with autism among older vs younger parents?

Dr. Grether: One finding that we have, which most other studies have not examined, is that both the maternal and paternal age effect is stronger among first-born children than among later-born children. For first-born children, both for mothers and fathers, that slope with increasing parental age is steeper than for later-born children. So, if it is the first time a parent is having a child, the risk of that child having autism is greater than for a child of a parent of comparable age who already has children.

The explanation for this pattern may be that parents starting their families later in life have a pre-existing risk and so we would see this pattern more strongly among first-born children. It certainly should not matter if it is the first-born child for that older father or the fifth-born, since the sperm at that older age would still be going through the same genetic changes.

Medscape: Does the higher risk in first-born children hold up with women as well as men?

Dr. Grether: Yes, the maternal age effect is stronger in first-born than in later-born children. For a woman has had prior children, prior pregnancies may change the in utero environment in ways that affect her fetus differently than is typical for a women of the same age having her first child. Or perhaps the effect of toxic exposures from the environment is different, depending on the reproductive history of a woman giving birth for the first time compared with one who has given birth before.

My guess is that when we have the answers to all the questions raised by our study and others that have addressed the question of a parental age effect, we will see that both delayed childbearing and age-related biological changes contribute to the higher risk for older parents. But until the research is conducted, we won't know. A recent letter to the editor in the American Journal of Public Health by some colleagues basically said, and I fully agree, that studies, including ours, have consistently established a parental age effect. Now it is time to move on and figure out why.[2]

Medscape: Do you see prenatal screening anytime in the future?

Dr. Grether: No. I don't think we are close to having prenatal screening. In the meantime, as a society, we need to work through the deep ethical issues involved. Our current best understanding is that autism spectrum disorders are at one end of a human continuum, raising complex questions about the kind of society we want to fashion as science changes and the possibilities for medical interventions increase.

Medscape: Just as an aside, our news group covered the Lancet article that retracted the study associating autism with vaccinations. Do you have any thoughts on this and the problem of convincing fearful parents to immunize their children?

Dr. Grether: It has always surprised me how many people confuse the various concerns that have been raised regarding childhood immunizations and risk for autism. The Lancet retraction focused on the MMR [measles, mumps, and rubella] vaccination and the allegations by a team of researchers in Great Britain about MMR playing a role in autism in some children. The MMR-autism connection has now been demonstrated to have been based on very shoddy, perhaps even falsified, evidence. There is no scientific basis that I am aware of for being concerned about MMR and autism. Another issue about vaccines is the thimerosal preservative that was included in multidose vials of some other childhood vaccines (thimerosal was not in the MMR vaccine). Here there have been many studies and no credible study has found a link between thimerosal exposure through vaccines and autism. In the United States, thimerosal exposure from vaccines is no longer an issue, except perhaps through some flu shots. The other concern that I have heard voiced is that the recommended childhood vaccine schedule now includes so many vaccines and that children are thereby being exposed to more antigens than previously. Although there are now more vaccines recommended for children, the total antigen exposure from today's vaccines is considerably less than in earlier years because of advances in vaccine composition. And compared to the sheer volume and diversity of antigens in a typical environment, the antigen dose received in vaccines is minor. While it is understandable that parents, and perhaps some clinicians, have raised the alarm about vaccines, I am not aware of any credible evidence to support these concerns.

Medscape: To conclude, and I think you really answered this already, do your results have any implications for personal decision-making or clinical practice?

Dr. Grether: You know, I wish they did, but I really don't think that they do at this point. The increase in risk that comes with older parents is really quite modest and we don't know what is behind it. I think the main benefit of our study and other similar ones is to alert us to an important etiologic clue, and it is now time to find out what is going on.



Top Autism Sites Health Blogs -  Blog Catalog Blog Directory StumbleUpon Toolbar Stumble It! blog directory PageRank Button Add to Technorati Favorites Health Blogs
Directory of Health Blogs Blogarama - The Blog Directory