Personal views: MMR, autism, and Adam
Authors: David Goldberg
Journal: BMJ (2000)

Adam was born in January 1990. His early development was uneventful though slow by comparison with that of his older sister. At 15 months, when Adam received his measles, mumps, and rubella (MMR) vaccine, he was beginning to articulate two word utterances. After 18 months, however, Adam began to show signs which gave my wife and me cause for concern. He became distant, disinterested, and inattentive, and he started to flap his arms and twirl. Our concerns, which had initially been greeted by some friends and professionals as those of neurotic parents were confirmed by experts at the time of Adam's second birthday. Our son was autistic and the regression experienced during his second year was characteristic of the condition. The cause, we were told, was likely to be genetic though environmental factors could not be excluded.


One reaction which we, and other parents in similar circumstances, had was to search for a possible cause. Had there been an infection during the pregnancy, an encephalitic element to Adam's chickenpox, anoxia during birth, lead in our water supply (this was checked), any family history of learning difficulties, or a metabolic disturbance? An explanation might help us to decide whether or not to have another child but, more importantly, if we found the cause, perhaps, just perhaps, Adam could receive some existing, or yet to be developed, treatment which would reverse his cognitive and social deterioration. We wondered if the MMR vaccine had something to do with Adam's condition, but, following endless reflection, we concluded that Adam's first year of development, before the vaccine, had not been entirely normal. 


They sense that not enough is known about the cause of autism



Adam is now 9 and, for the past four years, has been at an excellent residential school for autistic children. When, in 1998, Andrew Wakefield and his colleagues hypothesised that there could be an association between MMR and autism, it was entirely understandable to us why many, though not all, parents of autistic children became either partly or totally convinced that this was the answer. While there was a spectrum of opinion among the parents of children at Adam's school, two distinct camps emerged—those of us who thought there was no evidence to indicate that the vaccine was unsafe and those who believed it may well have caused their child's autism.

The health departments' stance—based on wide ranging non-governmental expert opinion that the vaccine is safe—was dismissed by many whose view was, “Well they would say that, wouldn't they?” Because of my NHS and public health affiliations, I was tarred with the establishment brush for not joining the Wakefield bandwagon. Three investigations have since been unable to demonstrate any link between MMR and autism.

What impact these findings will have on the many parents of autistic children in the United Kingdom who, presently, are seeking legal advice, remains to be seen. Whatever the outcome, it would be a gross insult to the intelligence of these parents if their collective view was explained as an emotional response to media hyperbole. They sense that not enough is known about the cause of autism and too little is being done to develop effective pharmacological and behavioural therapies.

They also believe that autism, which accounts for a considerable proportion of the state's education and social care budgets, is becoming more prevalent. Indeed, recent reports confirm that the prevalence of cases known to local authorities is increasing. Because the current epidemiological surveillance and study of autism at a national level is so poor, it is unknown whether this observation is due to increased awareness and recognition or a true increase in new cases.

A major step in the right direction would be the establishment of a nationwide epidemiological register of children who have been diagnosed as having a disorder which lies within the spectrum of autism. The register would hold a range of data including those relating to familial, social, obstetric, neonatal, immunisation, developmental, and general health and disease variables. In time, information about longer term child development in the context of specific treatment and education (or lack of) could be obtained.

These data would help to determine, for example, if autism is becoming more prevalent, which environmental exposures (if any) might increase the risk of children having autism and the extent and type of inequities which exist in the provision of care and education for autistic children. Identifying and classifying children, eligible for entry on to such a register, would present difficulties, but parents, including ourselves, would gain assurance from the knowledge that serious measures were being taken to further understand this challenging condition.