San Francisco Chronicle, 14/05/2003

Autism cases in California nearly doubled over the past four years to more than 20,000 - a phenomenon whose cause may be difficult to pinpoint because it is not related to population increases or the way the disorder is diagnosed, a state study said on May 13.

The study, conducted by the California Department of Developmental Services, tracked the number of autism cases referred to 21 regional centers where patients and their families receive government-funded services. 

The report showed that the agency's caseload increased by 97 per cent - from 10,360 in December 1998 to 20,337 four years later. 

Once a rare disorder, autism was now more prevalent than childhood cancer, diabetes and Down syndrome, said the study's author, Dr Ron Huff, senior psychologist at the department and lead author of both reports.The spectacular rate of increase for autism dwarfed rises of 35 per cent to 49 per cent for new cases of mental retardation, cerebral palsy and epilepsy in California, said Dr Huff.  "We are convinced that this is for real. It has to be taken seriously." 

He added: "We were hoping and praying it would go down. But it's accelerating slightly. Everything we see now says we might as well assume that it will continue. It would be risky not to assume that." 

Dr Huff's study was a follow-up to an earlier report ordered by California lawmakers which had shown a 273 per cent rise in autism cases statewide between 1987 to 1998. 

"All through the 1970s to the mid-1980s, we were looking at a couple of hundred (autistic) kids each year," Dr Huff said. "Over the next decade, we were looking at thousands of new cases each year. Parents were reporting anecdotally that there were a lot more of these kids out there that anyone believed." 

A parallel study, funded by the state and conducted at UCLA Neuropsychiatric Institute, showed that the dramatic increases in California's autism caseload were not due to changes in population or reporting criteria. 

"The study has proven two very clear things: the validity of the diagnosis has not changed and the kids are not moving to California for the services," said this study's author, Dr Marian Sigman. "That still leaves us with the puzzle of why are we getting this increase in numbers of cases." 

Preliminary results of a study commissioned by the Department of Developmental Services had found high levels of a naturally occurring protein in the blood of newborns who later developed autism, said Dr Huff said, adding that that study's conclusions were due in about three years.

However, despite a broader awareness of autism and increasing research in recent years, the DDS report said that scientists had not yet pinpointed a cause for the disorder. A once-dominant theory, now discounted, that placed blame on cold and distant mothers for causing autism has given way to a more thorough investigation of the potential genetic and environmental factors which may increase a child's vulnerability to the condition. 

"We know that it's a very complicated genetic disorder, but it's also probably true that genes are not the entire answer," said Dr David Amaral, research director of the MIND Institute, an arm of the University of California, Davis devoted to studying neurodevelopmental disorders, including autism. "It's most likely a combination of genetic susceptibility and an environmental disorder." 

DDS researchers are looking at range of environmental toxins which could make children more vulnerable, including PCBs, pesticides, and heavy metals such as mercury and lead. They are also exploring the debated theory that childhood vaccines may be at the root of the problem. 

While at least one large study has discounted the connection between autism and the triple MMR (measles, mumps and rubella) vaccine, Huff pointed to other research indicating that the mercury contained in thimerosal, used as preservative for many vaccines, had caused neurological problems in animals. 

Advocacy groups and many parents have pressed for a closer examination of the autism/vaccine connection. Rick Rollens, who helped to found the MIND Institute, said his 12-year-old autistic son, Russell, was a normal baby until he suffered a violent reaction to a series of vaccines he received when he was seven months old. 

"Getting researchers to look at vaccines has been like attacking the sacred cow," said Rollens. "We're dealing with a paradox of all the good vaccines do to control and often eliminate infectious disease, but may also add a burden to kids who may be genetically susceptible to autism." 

The DDS has released guidelines to promote effective treatment of autism throughout the Calfiornia. "We have to look for ways to reduce stress on families and make access to services more palatable," said Dr Huff. 

He added: "California is absolutely not special. In fact, we're middle of the road in terms of our rates." 

When the rising rates were first noticed, some experts speculated that it might be because parents were more apt to seek help for their children, and that those previously given a general diagnosis like mental retardation were now being identified as autistic. 

The latest report puts that hypothesis largely to rest, according to Dr Amaral, "This is one more strong piece of evidence that the increase is real," he said. "I don't think we have to wait around necessarily for more scientific confirmation." 

The implications of the rising numbers were profound, said Dr Amaral. "These numbers are frightening," he said. "This is something that is devastating to families and devastating to children who have a lifelong disability. But it will be devastating to the state of California, too. If you think about it, there are now 20,000 kids in the system, and each of them will eventually get $2 million worth of services. Just do the maths." 

The public schools provide most of the services autistic children receive, although autistic children are also eligible for programmes and support from the Department of Developmental Services. 

The state of California has undertaken several efforts to gain a clearer handle on the extent of the problem and to develop better therapies. Last year, the legislature added $17 million to the budget to cope with the increasing numbers now being served at the network of centres around the state.