Scientific evidence indicates that there is no correlation between autism and vaccines though millions of dollars, which might otherwise have gone to funding important research, have been spent investigating this notion. Andrew Wakefield and 12 colleagues published a study in The Lancet tentatively suggesting a link. However, it was discovered that Wakefield was paid over $100,000 by a group of lawyers and parents seeking to sue vaccine manufacturers for damages caused by the MMR injection prior to conducting his research. Additionally, participants were deliberately rather than randomly selected for the study. It is likely they were chosen to suggest a link because they had autism and gastrointestinal difficulties. This link has not been supported by subsequent scientific investigation. Madsen and colleagues (2002) conducted a large scale study in Denmark in which over half a million children born between 1991 and 1998 were studied. Nearly 100,000 were not vaccinated with the MMR vaccine. The prevalence of autism in this group was compared to that observed in the over 400,000 children who did receive the MMR vaccine. If the vaccine was related to autism a difference in prevalence would be apparent, however, prevalence was identical across the groups. This study provides overwhelming evidence against the hypothesis that MMR vaccination causes autism. The CDC, the American Academy of Pediatrics, the National Academy of Sciences Institute of Medicine, the World Health Organization, and the UK’s Medical Research Council have all concluded that there is no evidence that the MMR vaccine is related to autism.

The person who supervises the implementation of an ABA program should be a “behavior analyst.” There is a Behavior Analyst Certification Board® (BACB®) and the criteria for becoming a Board Certified Behavior Analyst® or BCBA® are listed at www.bacb.com. In brief, a professional would need a Master’s or PhD in a human service discipline such as psychology, education, or special education and they should have a number of graduate courses specifically in behavior analysis. Another necessary qualification is substantial relevant supervised experience in working with persons with autism. Beyond that, a BCBA or BCABA must remain abreast of developments in the field by obtaining a minimum of 36 hours of continuing education across every 3 years. MRC-NECC employs approximately 66 Board Certified Behavior Analysts.

Most children with autism make substantial progress and gain valuable skills and independence when education and treatment based on ABA are applied.  Though ABA has been shown to be effective, many of the aspects of applying the principles of behavior analysis in the treatment of autism have not been investigated thoroughly. For example, how many hours per week are necessary to produce a change is not known. Additionally, some skills are very difficult to teach and the best instructional strategies are not known. It is, however, quite likely that the proficiency of the providers of service, both direct care therapists or teachers and their supervisors will play a significant role in the progress that any child makes.

Applied Behavior Analysis or ABA is the application of the empirically validated principles of behavior to build skills through directed instruction.  ABA also seeks to treat problem behaviors by determining their function and arranging for intervention that teaches functional alternatives. ABA is an approach to analyzing each individual’s skill deficits and problem behaviors. Each child brings with them a distinct set of skills and deficits. No single treatment package can be used for all children and ABA is a method for examining the needs of each individual. Specific instruction can then be tailored to a child’s unique situation.  ABA, for the treatment of autism, is the application of the principles of learning to 1) build skills and 2) treat problem behavior. It works because each person’s behavior is assessed to determine what skills they have not mastered and what types of problem behavior interfere with learning and social functioning. The assessment is then used to identify goals and progress evaluation methods.

The most effective treatments for autism are evidence-based, education-based treatments that help to increase communication, social, academic, and self-care skills.  The most consistently effective treatments for individuals with autism are those based on an understanding of how children learn, such as Applied Behavior Analysis.  MRC-NECC uses an ABA-based approach to education and treatment.  Individualized goals are established for each child and the child’s progress on each goal is regularly monitored and reported to the family.

There are no definitive diagnostic tests for autism. The soundest means of determining diagnosis is a thorough review of the child’s developmental history and observation of their behavior in structured and unstructured situations. The diagnostic tools most often turned to by pediatricians, who are the front line of noting developmental problems, are the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD). When a pediatrician suspects autism or another developmental disorder, they should refer the child’s family to a specialist in childhood development. When a child is referred to a specialist for formal testing, a caregiver interview instrument is often the first diagnostic tool used. Two tools require clinicians to receive competency-based training to implement them. One is the Autism Diagnostic Interview (ADI), developed by a panel of autism experts headed by Catherine Lord in 1994, and the other is the Diagnostic Interview for Social and Communication Disorders (DISCO), developed by Lorna Wing and colleagues in the UK. A structured observation of the child should also be conducted and the currently accepted gold standard for this is the Autism Diagnostic Observation Schedule (ADOS). Clinicians are also required to pass competency-based training to administer this tool.

No. There are a variety of disorders that are related to limited speech development but any child that is not talking by the age of 3 should have a developmental assessment immediately. Most children are babbling before they reach their first birthday and use single words to communicate by 18 months. Any child that does not display these behaviors or who has and subsequently loses a communicative or social skill should be screened for an autism spectrum disorder as soon as possible.

Though the presentation of symptoms with autism can vary quite a bit, there are specific behaviors necessary for diagnosing it. Impairment in reciprocal social interaction must be present. We often envision a child with autism as avoiding eye contact or perhaps as using people as they would inanimate objects. Communicative deficits also must be present for an ASD to be diagnosed. There are well-documented specific problems in communication such as incorrect usage of pronouns, but the range of impairment in this area is great and can include the absence of any functional communication skill. Repetitive behaviors and/or marked adherence to specific routines also must be present for an ASD to be diagnosed. Stereotypic behavior is quite prevalent in persons with autism and recent research indicates that though these repetitive behaviors occur during typical development, they tend to persist in children with autism beyond the developmental stages at which they are usually replaced by more functional behavior. Symbolic play deficits have also been noted to be common in children with autism.

The original estimates of the prevalence of autism indicated that it occurred in around 2 per 10,000 people. However, recent estimates place the prevalence as high as or higher than 1 in 59 children in the United States for all autism spectrum disorders combined according to The Centers for Disease Control and Prevention (CDC).  The prevalence of autism in the UAE is assumed to be similar to the U.S., although there is not yet a comprehensive prevalence analysis.  It is likely that the increased prevalence of autism in the U.S. is due to increased awareness of the disorder by the community as well as by physicians and other service providers as well as better diagnostic tools that more accurately cover the entire autism spectrum. There is some evidence that intellectual disabilities diagnoses are being given as a primary diagnosis less often than in the past. The increased prevalence of autism coincides with this decrease. However, a true increase in the prevalence of autism across time is certainly possible.

Genetic inheritance is involved in the development of autism spectrum disorders (ASD). Genetic factors likely interact with environmental variables to result in the expression of autism. Neurobiological research indicates that autism is likely the result of genetically determined abnormalities in brain development. This abnormal brain development may start before the child is born. It has been difficult for genetics researchers to locate a specific  chromosome(s) involved in autism but recent studies have identified several genetic mechanisms that each lead to autism.