The Age of Autism: A new approach
Dr. Elizabeth Mumper, a pediatrician in Lynchburg, Va.,
is concerned that the increasing number of childhood vaccinations in the
1990s may have triggered a huge increase in autism and other
developmental disorders. This article looks at treatment strategies she
and others are trying based on that view.
Mumper has just been named top adviser on autism
treatment for Defeat Autism Now! (DAN!) and is medical director of their
physician training lecture series. Mumper graduated from the Medical
College of Virginia and completed her residency at the University of
This weekend, at a conference in Charlottesville, she and other doctors
and scientists who advocate this approach will outline their strategies
for treating autism as a biomedical disorder.
Mainstream medical and scientific groups say autism is primarily a
genetic disorder and there is no link between vaccines and autism or
other mental or physical problems.
Q. Give us a sense of your overall philosophy in
treating autistic children.
A. The basic premise of our treatment strategy is
to tailor our treatments to the unique constellation of the child's
problems, as determined by history, careful physical exam and
targeted laboratory evaluations. Certain treatments are helpful to
some children, but would not be expected to help other autistic
children with different problems.
Many autistic patients have significant gastrointestinal pathology,
which can be well characterized by endoscopy and pathology. Standard
treatments targeted at their esophagitis, gastritis or inflammatory
bowel disease often lead to improvements in self-abusive behaviors
such as head banging, which we believe are frequently signs of
physical pain in children who cannot communicate their distress.
Many patients who have major sleep problems begin sleeping through
the night when their erosive esophagitis is treated with classic
Many patients who had unexplained crying or sudden meltdowns become
calmer when their inflammatory bowel disease is treated with
standard anti-inflammatory medications.
Q. What about the neurological problems that are
clearly a central feature of autism?
A. Many autistic children demonstrate
abnormalities in methylation pathways. Methylation is the
biochemical process of adding a carbon (atom) and 3 hydrogens, and
is crucial for the formation of new DNA, the synthesis of
neurotransmitters and the creation of phospholipid cellular
Careful study of the individual child's cellular biochemistry can
lead to treatments with methylcobalamin and folinic acid, which have
been demonstrated to correct deficiencies in reduced glutathione,
which is the major intracellular anti-oxidant.
Glutathione also has vital roles in immune function, gut structure
and detoxification. Correcting this biochemistry makes the child
healthier and often improves language acquisition and socialization.
Q. You believe that part of what's going on here is
that some children have a genetic or metabolic deficiency in methylation
and glutathione pathways that make it harder to excrete heavy metals �
like the mercury that was used as a preservative in many childhood
vaccines through the 1990s. How does that figure in to your treatment
A. Many children in the autism spectrum have
problems with sulfation pathways and detoxification systems.
Therapeutic strategies aimed at enhancing the body's mechanisms for
eliminating environmental toxins are associated with a decrease in
so-called autistic behaviors in some children.
Our patients frequently have evidence of significant oxidative
stress, which can be treated effectively with relatively simple
therapies, such as vitamins A, C, and E and selenium.
Q. How many patients have you treated this way in
A. We estimate that there are about 800 patients
with neurodevelopmental disabilities in our practice who have been
treated with some combination of biomedical treatments. We try to
look for underlying medical problems that are amenable to treatment,
so that the child will be healthier and more attentive for (his or
her) educational and behavioral therapies. We believe strongly in
working as a team with educators and therapists.
Q. How well is this working, in your opinion?
A. There are some patients that we have not really
helped much, despite our best efforts. There are other patients
whose parents describe extraordinary improvements in language,
behavior and socialization. Sometimes it is as if a light bulb has
been turned on.
One of the most gratifying moments of my career was when a
6-year-old non-verbal girl said "Mama" for the first time several
months after we began working on correcting her biochemical
abnormalities. I will never forget the look on that mother's face
when she thanked me. Of course, I cannot prove she would not have
spontaneously said "Mama" in the absence of our interventions.
Another gratifying moment came when a 15-year-old boy, who had not
slept through the night for four years, began sleeping all night
within one week of having his erosive esophagitis identified by
endoscopy and treated with standard medications. He must have been
in agony. His mother had been chronically exhausted.
He is nonverbal, but just this morning typed to me on his Alpha
Smart (portable word processor) in complete sentences how much
better he has felt since he started coming to our practice.
Q. The counter-argument to this is that some
autistic children improve anyway; that their disorders might not have
been as severe as originally believed, or that behavioral treatments
going on at the same time really made the difference. How do you respond
A. We are very aware of the potential for bias in
detecting improvements � or the lack thereof � when parents or
healthcare providers are the only ones assessing the child.
We try to keep teachers, therapists and
second-degree relatives "blinded" to the fact that biomedical
interventions are being added. We ask the parents to record any
spontaneous comments that are made, and frequently get comments that
suggest significant improvements in language or behavior over
We also compare the developmental trajectory at
baseline and after biomedical interventions. For example, a child in
speech therapy may have made four months' worth of progress in 18
months prior to our interventions, then 10 months of progress in the
three months after our treatments, which suggests � but does not
prove � effectiveness.
This morning I saw a 3-year-old patient with
autism who started on methylcobalamin and folinic acid 12 weeks ago.
At baseline he had about 50 words. He added 100 new words the first
six weeks and 50 more words the next six weeks. That seems to be a
significant improvement over baseline and is documented with a
specific list of words recorded by his therapist.
There is a 140-question assessment tool we use to
evaluate the effects of our methylcobalamin and folinic acid
regimen. It utilizes data from observers blinded to the
intervention. The MIND Institute at the University of California at
Davis is carrying out a double-blind, placebo-controlled trial of
the protocol, which will utilize sophisticated psychological and
educational testing before and after.
I am working with some colleagues who are carrying
out multiple-blinded behavioral and educational assessments at
baseline and after biomedical interventions, such that each child
establishes his or her own developmental trajectory and changes can
be tracked by therapists unaware of the medical interventions.
Q. What do your fellow pediatricians think of all
A. Most of my pediatric colleagues have accepted
the conclusions of the IOM and honestly think the case is closed on
the issue of the vaccine-autism link. (An Institute of Medicine
panel concluded last year the epidemiology favors rejecting any link
between autism and the mercury in vaccines or the vaccines
I am concerned that some of my colleagues think I
have lost my mind.
Q. So, what are you basing your theories on?
A. My conclusions about the science implicating
vaccines came after reading over 50 books, including some very
technical ones about neuropsychopharmacology, biochemistry and
My interest in these subjects was piqued when I was asked to write a
book chapter about developmental pediatrics, which includes autism
and ADHD, and another chapter about allergy and immunology. Since
then, I have read hundreds of articles in peer-reviewed scientific
literature about those topics.
I have a paradigm in my mind where much of the science fits together
in ways that make the vaccine-autism link quite plausible � although
clearly not the only factor in autism.
My husband, Mike, is a psychiatrist. He has a
theory that pediatricians are, as a group, such nice people
committed to helping children that the thought that we may have
unintentionally harmed a generation of children is too painful to
28 April 2005