Runninghead:The History of Vaccines and Autism

The History of Vaccines and Autism; Waiting on a Public Paradigm Shift

Lindsay A. Birchall
University of Calgary

Advanced History, Theory and Practice of Psychology EDPS 635

Dr. John Mueller
August 14th, 2014

Autism and Vaccines

The autism vaccine controversy (AVC) has been a contentious topic since The Lancet
publication of Wakefield et al.s (1998) research, entitled Ileal-lymphoid-nodular hyperplasia,
non-specific colitis, and pervasive developmental disorder in children. Wakefield et al., (1998)
drew causal relationships between gastrointestinal problems, the Measles Mumps Rubella (MMR)
vaccine and Autism Spectrum Disorder (ASD) in children. With rising rates in the prevalence of
ASDs in the 1990s Wakefeield et al.s (1998) research sparked and permanently embedded public
fears of vaccines. Several implications arose, such as reduced immunization rates, outbreaks of
infectious diseases, millions of dollars spent on scientific research to disprove Wakefields et al.
conclusions, public mistrust in health care systems, class action lawsuits, and biomedical
interventions, all as a result of one flawed study (Wakefield, et al., 1998).
A multitude of research has since refuted Wakefield at al.s (1998) findings. On January
28th, 2010, his study was full retracted by The Lancet on grounds that he had acted dishonestly
and irresponsibly in doing his research (Gorski, 2010). However, the stage was already set, and
the retraction was too late. Media attention given to the research and the forthcoming internet in
1990s, together not only created a public frenzy surrounding vaccines at the time, but contributed
to the ongoing AVC.
Before examining Wakefiled et al.s (1998) research, it is imperative to have some
historical knowledge of the development of vaccines and their widespread use in Canada.
Following that, we will discuss the era in which Wakefield at al.s (1998) research was published
and factors that may have contributed to the development of the AVC controversy. Lastly, we will
consider implications for school psychologists, and those working with children with ASD.
History of Vaccines in Canada

Vaccines are commonly known as a medical marvel of the 20th century, increasing our
lifespan by 20-30 years (cdc.gov). Vaccines prevent, supress, and can even eradicate infectious and
deadly diseases. When a sufficient proportion of the population is vaccinated, herd immunity
(also termed community immunity) results (cdc.gov). In theory, herd immunity assumes the
greater the proportion of individuals who are resistant, the smaller the probability that a
susceptible individual will come in to contact with an infectious individual, therefore disrupting
the spread of contagious diseases (cdc.gov). This offers protection for those who cannot be
vaccinated (e.g. infants, immunocompromised individuals, the elderly) (cdc.gov). A critical drop in
heard immunity can leave the door open for viruses to spread. With the current rates of
international travel, the spread of infectious diseases is a serious and legitimate concern (e.g.
current Ebola outbreak in West Africa) (who.int). On the other hand, a strong and lengthy herd
immunity, with the absence of large outbreaks, can lead to eradication of diseases in some
populations.
In 1798, Edward Jenner, an English physician, demonstrated that human inoculation with
cowpox vaccines could protect against small pox (CPHA.ca). Because Jenner brought forth the
first inclination of hope that diseases could be eradicated using vaccines; he is now referred to as
The Father of Immunology and is said to have saved more lives than the work of any other
human (Riedel, 2005). During Jenners time, 60% of the British population caught smallpox and
20% of the population died of it (Riedel, 2005). In 1885, Dr. Alexander Stewart, of Ontario,
founded the first Canadian small pox vaccine and vaccine farm, where his cattle provided a
dependable small pox vaccine for 31 years (CPHA.ca). Shortly after, in 1907, immunization for
small pox began in Ontario schools. Before the benefit of mass immunization, generations of
Canadians lived with the threat of a range of debilitating diseases that frequently swept through
their communities (CPHA.ca).

1918 yielded the first Canadian pertussis (whooping cough) vaccine. During this time
public health activities were largely uncoordinated and focused mainly on responses to infectious
disease outbreaks alone (Diphtheria, tuberculosis, Spanish Influenza). Spanish influenza was
responsible for killing approximately 50, 000 Canadians and diphtheria was one of the most
common deaths in children 1 to 5 years of age in the early 19th century (CPHA.ca). The 1940,
1950s and 1960s were periods of major contrast. Routine immunizations for pertussis began in
1943, followed by the measles vaccine in 1963. Prior to immunization, measles occurred at an
estimated rate of 300-400, 000 cases per year (immunize.ca). In 1962, the polio vaccine was
approved; and by 1968 no cases of polio were reported in Canada. 1969 brought forth the rubella
vaccine, decreasing the number of cases by 60, 000 per year (CPHA.ca). In 1983 the MMR
vaccine was introduced to all infants, reducing cases of rubella from 5,300 per year in 1971 to 30
cases per year by 1994 (CPHA.ca).
In the 1990s Canada was officially certified as polio free, and was acknowledged
worldwide for their efforts in the eradication of this disease (who.int). In 1997 the two-dose MMR
vaccine was introduced, with children receiving one dose at 12 months and second dose at 18
months. 1999 then brought Canada the chicken pox vaccine, 2005 the Meningococcal vaccine and
2006 the HPV vaccine. Lastly, the rotavirus vaccine the shingles vaccines were approved by 2008.
In Alberta, infants and children currently receive 14 vaccines, and adolescents receive 2,
preventing 16 infectious diseases (PHAC-aspc.gc.ca). With the last case of small pox reported in
the 1970s, small pox was considered to be eradicated in North America, and the vaccine was
formally removed from the Canadian vaccine schedule in 1972 (CPHA.ca; health.gov). A decade
ago, the World Health Organization (WHO) recommended the removal of polio vaccine from
scheduled in North America because the last reported occurrence was in 1994. But, because
vaccine scares have since reduced Canadas herd immunity numbers and the probability of an

outbreak is real, the WHO withdrew their recommendation and polio continue to be on the vaccine
scheudle (who.int; cdc.gov).
Wakefield et al.s 1998 Research
The vast majority of scientific research never gains much attention beyond a small
community of interested professionals. But in 1998, the prestigious British medical journal The
Lancet published Wakelfield et al.s article which continues to garner attention 15 years later. Even
after being repudiated by most of those involved in its publication and officially retracted by the
publishing journal, the AVC created by Wakefield et al.s (1998) research lives on (Kolodziejski,
2014)
Andrew Wakefield was a former British gastroenterologist and researcher. In his 1998
research, titled Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive
developmental disorder in children, Wakefield examined twelve children with gastrointestinal
issues, 8 of whom he then reported demonstrated developmental regression despite previous
normal progress. However, the articles wide recognition is not due to this finding. Rather, it has
received significant attention, because Wakefield asserted there was a regression in the childrens
development after they had received the MMR vaccine (Kolodziejski, 2014). Specifically, he
believed that the MMR vaccine caused inflammation of the intestines, which resulted in harmful
proteins released into the blood stream, eventually damaging the brain and causing the child to
develop ASD (Kolodziejski, 2014). Although Wakefield initially denied the articles direct link of
the MMR to ASD, many people still interpret his article as establishing the scientific grounds for
such a conclusion, and now controversy (Poland & Jacobsen, 2011; Rope, 2010; Ropeik, 2011;
Woolcock & Hawkes, 2006).
In Kolodzieskis (2014) analysis of Wakefields original publication she attributes the
misleading nature of Wakelfields findings to careful hedgingand passive voice that hid a

strategic ambiguity of meaning, using language such as if and might or speculate and
extrapolate (p. 166). Through passive-voice construction, Wakefield avoided making any
explicit claims himself but still inserted the idea of a link between the MMR vaccine and autism
(Kolodzieski, 2014, p.167).
After publication of the article Wakefield conducted several interviews, which solidified
his stance on his research intentions and conclusions. In one such interview he states, measles
mumps and rubella given together may be too much for the immune system of some children to
handle; clearly for the vast majority it is protective. We must emphasize that it is just a small
cohort of children, we dont know how large, who have appeared to have developed the
syndrome (PBS.org). Later, Wakefield associated a commonly used vaccine preservative,
thiomersal, as a possible agent of neurological contamination in children with ASD, because it
contained mercury.
After publication of the article, several other researchers attempted to replicate
Wakefields results, to no avail (Madsen et al, 2002; Black, Kaye & Jick, 2002). Throughout the
turn of the century Wakefields fraudulent behaviour was slowly uncovered. A 2004 investigation
by Sunday Times reporter Brian Deer, identified undisclosed financial conflicts of interest on
Wakefield's part (McKee, 2004), resulting in most of his co-authors withdrawing their support for
the study's interpretations (McKee, 2004). The British General Medical Council (GMC) conducted
an inquiry into allegations of misconduct against Wakefield. The investigation centered on Brian
Deer's numerous findings, including that children with autism were subjected to unnecessary
invasive medical procedures such as colonoscopies and lumbar punctures (Ferriman, 2004).
Although Wakefield had 12 coauthors, the British General Medical Council proved that Wakefield
authored the paper alone. His research was also conducted without the necessary ethical approvals
from the institutional review board.

On January 28th, 2010, The Lancet fully retracted Wakefields 1998 article, noting that
elements of the manuscript had been falsified A five-member statutory tribunal of the GMC found
grounds for three dozen charges, including four counts of dishonesty and 12 counts involving the
abuse of developmentally challenged children (Deer, 2011c). The panel ruled that Wakefield had
"failed in his duties as a responsible consultant", and acted both, against the interests of his
patients and, "dishonestly and irresponsibly" in his published research (James & Boseley, 2010).
Wakefield was barred from practicing medicine in the UK and struck off the Medical Register in
May 2010. The GMC verdict stated Wakefield demonstrated deliberate falsification in his
research (Boseley, 2010). Since, there has been several follow up articles further discrediting
Wakefields work, including information that Wakefield had planned to launch a venture on the
back of an MMR vaccination scare that would profit from new medical procedures and "litigation
driven testing" (Deer, 2011a). Another report from the whistleblower, Brain Deer (2011b),
revealed original raw data indicating that the children who participated in Wakefields original
research actually did not have inflammatory bowel disease (Geboes, 2011).
Setting the Stage- Contributing Factors in the Development of AVC
Historically, what set the stage for Wakefield et al.s (1998) research to have such an
ongoing impact on how the public perceives vaccines? First, it is imperative to examine the era in
which his research was released. Rising prevalence rates and the developing conceptualization of
ASD likely contributed to the publics interpretation of Wakefield at al.s (1998) conclusions
History of Diagnostic Conceptualization and Prevalence of ASD. The increase in the
prevalence of ASD, most often documented to occur in the 1990s and certainly after 1999, is one
of the main contributing factors in the maintenance of the AVC. Debates on the issue of increasing
prevalence have been dichotomized to indicate that increases in prevalence may be explained by
changes in identification patterns or by a true increase in symptoms among children born in more

recent times (Rice, 2011). By monitoring ASDs over time, we can nd out whether the prevalence
of autism is increasing, decreasing, or staying the same (cdc.gov). Importantly, we know that
changes in conceptualization and diagnostic criteria of any disorder have significant impacts on
prevalence rates (Rice, 2011). When diagnostic systems are consistent, prevalence rates are more
reliable. Overall, the diagnostic history of ASD is historically complex and convoluted. Several
shifts have occurred over the past 50 years within comorbidity and dimensional aspects of the
diagnosis. Historically approaches to diagnosis tend to swing from emphasizing overarching
groups (lumping) to focusing on potentially distinct subgroups (splitting) (Volkmar & McPartland,
2014).
In the early 19th century, before the discovery of symptomology patterns we now know as
ASD, it is presumed that people did exist with the syndrome. Detailed descriptions of such people
have been found; such as Victor, a boy found in the forest, who had grown up without any human
contact (Wolf, 2004). However, it wasnt until 1943 that autism was formally conceptualized as a
disorder by Leo Kanner. In his paper, Autistic Disturbances of Affective Contact, he documented
a collection of symptoms based on his observations of 11 children, which he named Early Infantile
Autism. Kanner believed the word autism best represented these children because it meant
escape from reality and he saw these children to be cut off from the world of people (Kanner,
1943; Volkmar & McPartland, 2014, p.198). Kanner documented symptoms such as selfstimulatory behaviours, difficulty dealing with change or insistence on sameness, echolalia,
idiosyncratic language and over engagement in the non-social world (Kanner, 1943; Volkmar &
McPartland, 2014). In some aspects Kanners conceptualization of autism was contradictory and
was often confused with schizophrenia, in which autistic thinking has been described for some
years (Volkmar & McPartland, 2014). Prevalence rates at that time are unknown, but believe to be
around 1 in every 10,000 children (autism-resources.com).

Kanners discovery propelled the interest in autism as a disorder of child psychopathology.

From Kanners work came an early movement that attributed ASD to parental psychopathology,
contributing to the earliest manifestations of childhood psychosis or schizophrenia (Volkmar &
McPartland, 2014; Cappron, 1953; Bettleheim, 1967). During this time a Freudian
conceptualisation of autism also emerged, which asserted that children who fail to form parental
bonds fail to progress. Parents of such children were called refrigerator parents, assumed to be
cold and unloving (Holaday, 2012). At this time prevalence rates for autism were consistently
thought to be 1 in every 10, 000 children (Rutter, 2005).
Studies of clinical phenomenology by Kolvin (1972) and Rutter (1972) began to
differentiate childhood schizophrenia from autism in terms of onset, clinical features, and family
history (Volkmar & McParland, 2014). In 1978, Rutter developed a diagnostic approach that
markedly influenced the Diagnostic and Statistical Manual (DSM)-III (APA, 1980) 2 years later.
He identified symptomology guidelines such as early onset, marked social problems, language
difculties or absence of speech and unusual behaviors and rigidities that could not be attributed to
intellectual delays (Rutter, 1978).
The DSM-III (APA, 1980), officially recognized Kanners original work by adding a new
classification of disorders, labelled Pervasive Developmental Disorders (PDD). Two categories of
ASD were described: Residual Autism and Early Infantile Autism, differentiated by age of onset
(Volkvar & McPartland, 2014). The largest complaint about the DSM-III (APA, 1980) criteria is
that the overall approach was monothetic (every criterion had to be met) and therefore lacked
exibility, (Volkmar & McPartland, 2014, p. 199). Seven years later the DSM-III-R (APA, 1987)
was developed. Autistic disorder replaced Early Infantile Autism, a specific number of observable
criteria needed were included and three domains of dysfunction were identified: qualitative
impairment in reciprocal social interaction and in communication, as well as restricted interests.

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Between 1980 and 1990 prevalence rates of children diagnosed with ASD increased from
approximately from1 in every 2500 children to 1 in 1000 (Rutter, 2005).
Between 1992 and 1998 prevalence rates continued to rise, from approximately 1 in every
1000 children to 1 in 150 (cdc.gov). Conceptualization of ASD continued, resulting in many
revisions for the DSM-IV (APA, 1994), which finally included a more evidence based consensus
of symptoms in comparison to previous conceptualizations of ASD (Volkmar & McPartland,
2014). However, a major issue of the DSM-IV was balancing the sensitivity and specificity of the
diagnostic approach while maintaining a exible and developmentally oriented denition of the
condition (Volkmar & McPartland, 2014). Important to measures of prevalence, the DSM-IV
included other conditions below the umbrella of PDD: Aspergers disorder (Szatmari 1991), Retts
disorder (Gillberg 1994, Rutter 1994) and rare condition variously termed disintegrative psychosis,
Hellers syndrome, or childhood disintegrative disorder (Volkmar, 1992). PDD-NOS (not
otherwise specified) also became a common diagnosis for children that fit some criteria, but not all
(Volkmar et al., 1994). The DSM-IV and DSM-IV-TR (APA, 1994; 2004) criteria was also
criticized for reduced diagnostic stability before age three (Lord 1996). Positively, the criteria
provided in DSM-IV were highly effective in supporting the development of standardized
assessment methods and in facilitating research, with scientic publications on autism increasing
dramatically from 1994 to 2012 (Volkmar & McPartland, 2014, p. 203). Between 2000 and 2008,
the prevalence of ASDs had increased dramatically, from 1 in every 110 children to 1 in 68
(cdc.gov).
The DSM-V (APA, 2013) published further revisions and even more drastic changes to the
diagnostic criteria of ASD. Specifically, the previous categories under PDD were now merged into
a single class of ASD. And a related disorder, social communication disorder, was added. This
lumping will have a significant effect on current and future prevalence rates of ASD in the future

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(Volkmar & McPartland, 2014). At present, prevalence rates are documented to be approximately
1 in every 68 children; 1 in 42 boys and 1 in every 189 girls (cdc.gov; autismcanada.org.).
So, what can we conclude from the evolution of the ASD diagnostic criteria over the past
50 years? Simply, the conceptualization of ASD is a work in progress. And, prevalence rates are
significantly impacted by changes in diagnostic criteria (cdc.gov). Other factors that may be
contributing to the rising prevalence rates should also be considered, such as better diagnostic
measures, earlier detection, better trained diagnosticians, increased literature on ASD, broader
diagnostic criteria, addition (i.e. Retts) and removal of disorders (e.g. childhood schizophrenia)
within ASD and availability of effective interventions (cdc.gov). Because the AVC hinges on the
assumption of rising prevalence rates, we need to carefully consider how increased prevalence
may contribute to the publics perception of vaccines causing autism.
Age of Onset Public Interpretation of Causation or Coincidence? A second
contributing factor in the development of the AVC is the common belief that age of symptom onset
coordinates with the timing of the childs MMR vaccine. In Canada, since 1963, the MMR vaccine
has consistently been given to children, in 1 or two stages, between the ages of 12 and 18 months.
Because ASD symptoms often become apparent around 15-18 months of age, it is understandable
that parents may associate the timing of the MMR vaccine to the cause of their childs ASD
symptoms. Further contributing to this is the public belief that there may two types of ASD onset,
as first identified in the DSM-III (APA, 1980), one at birth, and one after a period of typical
development. The 18 month mark is also when pertinent and discernible developmental milestones
typically occur (e.g. saying words, pointing, demonstrating joint attention, following one step
directions). In the case of ASD, parents may observing the lack of these milestones as a result of
the MMR vaccine, even though ASD may have been present from birth.

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The Media. So, why did Wakefield at al.s (1998) article have such vast repercussions for
the public? One clear facilitator in the AVC was the media. Movies such as the The Boy Who
Could Fly, released in 1986 and Rainman, released in 1988, sparked public interest in ASD,
giving the public a type of framework to reference Wakefield at al.s (1998) research. Television
and newspaper coverage of Wakefield et al.s (1998) discovery was incessant, captivating and
suggestive, to say the least. In combination with the internet as common household facilitator of
information in 1995 (Windows, 1995 and Google, 1998), the media was a significant enabler and
driving force behind the AVC, providing more information, and misinformation while infusing
public fears that the MMR vaccine may cause autism.
Social Media & Celebrity Endorsement. Social media can be defined as internet sites
where people interact freely, sharing and discussing information about each other and their lives,
(Curtis, 2013). The implications that social media had, and has, on the AVC is insurmountable.
With the addition of social media such as My Space in 2003, Facebook and Podcasting in 2004,
YouTube in 2005 and Twitter in 2006, information and propaganda surrounding ASD flourished.
Blogs, Facebook forums and videos can be found at the simple click of a button, all with the
potential to communicate destructive information to parents.
Large media based organizations such as Generation Rescue (GenerationRescue.org),
created by JB and Lisa Handley in 2005, have supported Wakefield et al.s (1998) research. The
websites claims that vaccines may be a cause of ASD are unethical to say the least. Unsuspecting
consumers are easily pulled in by Generation Rescues easily accessible information, and multiple
celebrity endorsements. Unfortunately, much of the information parents are consuming does not
have any scientific evidence base, such as autism is preventable and reversible
(generationrescue.org). The most well-known of Generation Rescues celebrity endorsements is
Jenny McCarthy. Her establishment of the Mommy Warriors movement has grown with the

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backing of Wakefield at al.s (1998) research, in combination with the commendation of

biomedical interventions as a path to recovery.
As one blogger has said the internet is certainly an unfortunate equalizer in that it
provides a platform for any and all (PBS.org). In short, ideas fight for attention. Tactlessly, the
internet can breed public skepticism of evidence based information and scientific establishments.
We see a new battle ground where conspiracy theories develop and linger (e.g. FDA Fraud: New
Studies Prove Vaccines Cause Autism) (conspiracyplanet.com). Once information hits the internet,
it is there to stay, making it difficult to counteract myths or undue conspiracy type damage. It is
quite frightening to consider that people may be more likely to believe something they have seen
on You Tube, then information they receive from the CDC (PBS.org). Unfortunately, inaccurate,
misleading and destructive information comes with the territory. One questions how Wakefields
(1998) research would have impacted society had the internet not played a role in embellishing his
ideas?
Historic Implications of Wakefields research
Reduction in Immunization Rates & Outbreaks of infectious diseases. Immediate and
dramatic decline in the rates of vaccinations for young children resulted from Wakefield at al.s
(1998) publication. This phenomenon occurred in many countries, with the most drastic
immunization reductions in Europe. By 2002, MMR immunization rates in the United Kingdom
dropped below 85%, with some areas, such as Ireland, dropping to a staggering 70%, falling under
the minimum percentage for a community to maintain heard immunity (Fitzpatrick, 2004;
Mascarelli, 2011). In the U.S. and Canada MMR vaccination rates were overall higher,
(approximately 85-90%), but the CDC continues to find pockets of communities where
vaccinations rates are lower than 85% (e.g. Lethbridge, Alberta 61%, Ashland Oregon 71%).

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Importantly, data shows that outbreaks of infectious diseases have notoriously occurred in
areas where heard immunity is low (Greby, Wooten, Knighton, Avey, & Stokley, 2012; Lynfield,
2011; Storrs, 2012). Consequently, in 2000, a measles outbreak occurred in Ireland, causing over
100 non-immunized infants to be hospitalized and 3 deaths. In Canada, we also see evidence of
epidemics, such as the measles outbreak that occurred in Edmonton and Calgary in 2014 where 21
cases were confirmed, including 9 infants (Edmonton journal.com). In 2011, Quebec experienced
the largest outbreak of measles in the Americas since 2002. The outbreak began with unvaccinated
individuals acquiring the disease on their trip to France, a country with high measles incidence. A
mass vaccination campaign was immediately implemented; however, the outbreak still resulted in
776 confirmed cases. 79% of individuals who contracted the measles were unvaccinated, sadly
including 29 infants who were too young for their MMR vaccine (msss.gouv.qc.ca). More recently,
in Vancouvers Fraser Valley, where vaccination rates are known to be low, a measles outbreak
occurred in March, 2014, where a total number of 228 cases were reported.
In a recent survey, it was determined that 1 out of 4 parents still believe vaccines cause
autism (Freed, Clark, Butchart, Singer, & Davis, 2010). With the reduction of vaccinations, there
are broad and grave implications for reduced herd immunity. Diseases once nearly eliminated
through successful vaccination programs have been reappearing (cdc.gov).
Removal of Thiomersal from Vaccines - Public Health Reactions. A second result of
Wakefield et al.s research was a public health decision to remove thiomersal from vaccines.
Thiomersal is a mercury-containing compound that has been used to prevent bacterial and fungal
growth in some vaccines since the 1930s (WHO.int). Following Wakefields research, it was
recommended that thiomersal be removed from many childhood vaccines to eliminate any
potential risk (NCIRS.edu). Although there was no empirical evidence supporting this
recommendation, multiple countries immediately removed thiomersal from their vaccines in 1999

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(e.g. USA, Canada, UK) (NCIRS.edu). Unfortunately, this action had adverse effects on public
opinions of vaccines and only perpetuated fears of possible harm. Simply stated, why would you
take something out unless there was a problem?
After thiomersal was removed, research was conducted to investigate possible adverse
effects of the compound. At present the WHO, and many other institutions, such as the CDC and
the Global Advisory Committee on Vaccine Safety, have established that there is currently no
evidence of mercury toxicity in infants, children, or adults exposed to thiomersal in vaccines
(WHO.int). But, the damage has already been done, creating distrust in public health care.
Distrust in the Public Health Systems. The reaction of the government to Wakefields
research, in combination with many other factors (e.g. the medias perpetuation of public fears,
social media supports, the creation of organizations and private agencies set up to protect
individuals from the adverse effects of vaccines) has contributed to parental distrust in the public
health care system. Almost any government health care website now includes extensive
information on how vaccines are not related to autism (e.g. Alberta Health, Health Canada). We
are in a new era of medicine, impacted by the internet and the media, where people do not just
take their doctors word.
In The Vaccine War, a documentary that aired on Frontline (PBS.com) several interviews
with parents were included, examining their opinion of vaccines. Specifically, it was asked if they
felt a public responsibility to immunize their child. To this question, most parents asserted that
vaccinations are a personal choice and it was their responsibility to protect their child from the
possible adverse effects of vaccines, particularly contracting ASD. Parents believed their
childrens heath was a private affair, and not a public responsibility. Several other parental
arguments were brought forth on The Vaccine War (PBS.org) such as, it is healthy for children to
get sick, epidemics are rare, if I had to choose between autism and the chicken pox, Ill take

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the chicken pox, when was the last case of polio? and if the vaccines work, who am I putting
at risk?.
The medical profession believes that parents are declining vaccination because they do not
truly understand the reality or severity of contracting a deadly disease such as polio. In short,
parents have become complacent. Historically, those born in the first half of the century would
have experienced first-hand how deadly something like small pox or tuberculosis can be (e.g. lost
loved ones, saw their friends lose their ability to speak or walk). One would assume those images
are frozen in their minds. For those individuals, vaccines are an easy sell. But, without those real
life experiences, vaccines may be regarded as more of a risk.
Evidence, Vaccines and the Pseudo hypothesis. The MMR Hypothesis. Wakefields
1998 research initially sparked the hypothesis that the MMR vaccine caused ASD. Particularly, he
believed that the MMR triple shot (i.e. three vaccines at once), triggered symptoms of autism in
some individuals, predominantly those with gastro intestinal issues. As this hypotheses gained
steam, researchers were forced to look at evidence that may disprove his conclusions.
Denmark was one of the first countries to take on such an endeavour, particularly because
of its unique opportunity to conduct epidemiological research. Specifically, Denmark collects
epidemiological data on each and every citizen in their country, throughout their lifetime. A
population based study was conducted on data representing half a million children, born between
1991 and 1998. The researchers examined the rates of ASD between groups that had been
vaccinated and those that had not, during that time. Later published in the New England Journal of
Medicine in 2002, A Population Based Study of Measles, Mumps and Rubella Vaccinations and
Autism found no association between the ages at the time of the MMR vaccination, the time since
the MMR vaccination, or the date of the vaccination and the development of autistic disorder in

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children (Madsen et. al, 2002). They concluded that their study provides strong evidence against
the hypothesis that MMR vaccination causes autism (Madsen, et. al, 2002).
To further refute the connection between ASD and the MMR vaccine, data from 300,000
residents of Yokohama were used to examine the prevalence rates of ASD pre and post 1993, when
Japan removed the MMR vaccine entirely. What they found not only refuted Wakefields claim
that the MMR is linked to ASD, it also showed that prevalence rates of ASD in Japan actually rose
after the removal of the MMR vaccine (Honda, Shimizu & Rutter, 2002). This evidence was
congruent with other countries reports of rise in prevalence around that time. Additional research,
from other countries began flood in, contradicting Wakefield et al.s (1998) conclusions. Sweden
(Gilberg & Heijbel, 1998), Finland (Peltola et. al, 1998) and Britain (Taylor et al., 1999, Medicines
Commission Agency, 1999) all published results maintaining the same conclusion: the MMR
vaccine was not associated with the onset of ASD.
Mercury. The second assumption that was drawn from Wakefields research was that the
thiomersal in vaccines may be the foundation for developing ASD. Although Wakefield et al.
(1998) did not explicitly state this in his research this assumption was a later bi product of the
removal of thiomersal in 1999. Denmark, again, had a good base for this research. In their country,
the only vaccine containing thiomersal was the pertussis vaccine between 1970 and 1992.
Denmark researchers compared 956 children, from 1971-2000, who received vaccines containing
thiomersal before 1992, to those that received the newer vaccines after 1992 (Madsen et. al, 2003).
They found that there was no correlation between thiomersal-containing vaccines and autism from
1971 to 2000 (Madsen et al., 2003). Confirming the evidence found in the Yokohama study, the
Denmark research also found a rise in prevalence rates after 1992, in the absence of thiomersal
(Madsen, et. a, 2003). Boldly they concluded that their data did not suggest a cause-and-effect
relation between thiomersal-containing vaccines and autism (Madsen et al., 2003).

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In a California study similar evidence was collected, supporting Japan and Denmarks
research; their data showed no decrease in rates of ASD after the removal of thiomersal, rather ,
they documented a steady increase in prevalence of ASDs after 1999 (Schechter & Grether,
2008). Additional research in the USA (Stehr-Green, Tull, Stellfeld, Mortenson & Simpson, 2003),
Argentina (Pichichero, Gentile & Giglio, 2008) and Canada (MacDonald & Pickering, 2007) also
concluded that thiomersal was not related to autism. Furthermore, in 2004, a broad examination of
the evidence by the National Research Council and a review of 14 published studies (Parker,
Schwartz and Pickering, 2004) concluded the same.
The Pseudo hypothesis? Moving the goal post. So, we have evidence to disprove the
association of the MMR to ASDs and we have evidence to disprove the association of thiomersal
as well. Is that enough? Not for pseudo-science. Pseudo-science occurs when one non-evidence
based hypothesis is declared and then disproven, another arises, similar to how the MMR and
thiomersal hypothesis were brought forth. Other hypothesis associated to the AVC include vaccine
schedules themselves, the total number of vaccines given and the ages at which vaccines are given.
Bench Science has also been suggested; examining changes in immune and neurological
function based on individual predispositions to vaccine reactions (facebook.com). Parental
vaccinations have also been hypothesized as a cause of ASD (facebook.com).
On and on we go. Sadly, the world has spent billions of dollars investigating hypotheses
associating ASD to vaccines. In retrospect, time and money disproving these hypotheses would
have been better spent investigating treatments for children with ASDs. But, this opportunity has
been lost.
Class Action Law Suits. While researchers were investigating the MMR and thiomersal
hypothesis, a group of American parents with children diagnosed with ASD undertook a class
action lawsuit. They claimed the government was responsible for their children contracting ASD

19

through immunizations. In 2007, three cases were brought to the Omnibus Autism Proceeding (i.e.
federal vaccine court). Their cases were dismissed due to a lack of scientific or legal merit, based
on a strong evidential base denying the link between ASD and vaccines (Cedillo, 2009). Legal
efforts in the UK, Italy and Japan resulted in similar dismissals (VRAN.org).
Biomedical Interventions. A parent of a child diagnosed ASD will desperately do
anything to make them better. This is fertile ground for the blandishments of proponents of
these implausible and unproven therapies (Gorski, 2008, p.11). Biomedical interventions are a
direct product of Wakefield et al.s (1998) research and can be found on multiple ASD websites
(autism.canada.org.; autism.net.; treatingautism.co.uk.). And, at conferences around the world you
can find medical doctors endorsing these treatments (e.g. the University of Calgary hosted an ASD
conference that included a day of biomedical workshops in 2007). The biomedical movement
proclaims that after implementing changes like diet, and/or supplementing deficient vitamins and
minerals, parents often remark on improved language, eye contact, social engagement and their
child's ability to learn (autism.net). Unfortunately, these treatments are neither scientifically
based nor have convincing evidence in the form of well-designed clinical trials to support their
efficacy in ameliorating delays observed in autistic children (Gorski, 2008, p.12).
Although the GI association has been disproven, in Finland (Peltola et. al, 1998), and the
UK (Frombonne & Chakrabarti, 2001; Taylor, Miller, Lingam, Andrews, Simmons & Stowe,
2002), among other studies, biomedical interventions still hold solid roots in Wakefield et al.s
original hypothesis. Historically, in 1994, Bernard Rimland and his Defeat Autism Now! (DAN!)
movement, was the first to organizationally acknowledge biomedical treatments for children with
ASDs. Although this was before Wakefields research was published, Wakefields claim of
gastrointestinal difficulties, and his association of thiomersal to ASD, fueled DAN! in 1998,
increasing DAN! conference attendance 100 fold by 2000 (autismcanada.org). DAN! emphasised

20

detoxification as a means to treat children with ASD, based on the premise that toxic metals,
from thiomersal caused autism (autismcanada.org).
Chelation. A main assertion of the biomedical movement, and DAN!, was the use of
Chelation for children with ASD (healinghearts.org). Chelation is a legitimate intervention for
individuals with heavy metal (mercury) poisoning and comes in many forms, such as creams or
pills. There is no evidence base for the use of Chelation in children diagnosed with ASD. From
personal experience, Chelation techniques can make children with ASD child very sick, because
they do not have mercury poisoning. And, ethically chelation can be physically harmful.
Gluten Free Casein Free Diet (GFCF). Between 2002 and 2004, information began being
published linking wheat and casein to gastrointestinal difficulties in children with ASD, piggy
backing off the Wakefield et al.s research (1998) (Milward et al., 2004; Horvath, 2002). Some
websites even endorse the GFCF diet as a cure for ASD (collectiveevolution.com;
generationrescue.ca). This is sure is supported by theoretical evidence that eating gluten leads to
high levels of protein by-products, called gluteomorphines, and these by-products affect behaviour
like an illicit drug would (autismcanada.org). In children with ASD gluteomorphines are claimed
to reduce their desire for social interaction, block pain messages, and increase confusion
(autismcanada.org). If gluten is taken out of the diet, the idea is that this will reduce the level of
gluteomorphines, and behaviour and learning will improve as a result (autismcanada.org).
However, in a review of current evidence, the effectiveness of GFCF diet for children with
ASD has been highly inconclusive (Dosman, Adams, Qudel, Vogels, Turner and Vohra in 2013).
Dosman et al. (2013) concluded that caution should be used when trying to decide whether to try
a GFCF diet for a child who already has nutritional deficiency, growth problems, or restricted diet
due to difficulty accepting new foods (Dosman et. al, 2013).

21

Others?! The GFCF diet and Chelation are just the tip of the iceberg with regards to
Biomedical Interventions. Other common interventions include a plethora of supplements
(digestive enzymes, prebiotics, probiotics), testing for a number of possible medical disorders (e.g.

immunodeficiency, allergies, intestinal inflammation) Hyperbaric Oxygen therapy, B12 shots, and
so on and so forth (GenerationRescue.org). These interventions have little to no evidence base in
their effectiveness for children with ASD, and may do more harm than good.
Implications for School Psychologists
So, where do school psychologists fit in all of this? Unfortunately, our profession limits our
interactions with families. We may never encounter the AVC topic working in schools. But, those
that may choose to work in specialized agencies with children with ASD will. How do we take all
of this information and apply it to assessment and interventions. We know the history, the evidence
and the present day implications surrounding the AVC, but how does this translate into every day
work with families, professionals and students diagnosed with ASD?
Our largest role in this controversy may be in the area of interventions. As psychologists
we are mandated to provide evidence based recommendations, so the use of biomedical strategies
are unlikely. In order to provide comprehensive assessments and treatment plans we require as
much information about a student as we can access, which obliges open communication with
families and teachers. If we are too aberrant in our opinions we stand to close off communications,
with the possibility of parents and teachers not disclosing pertinent information (e.g. child may be
receiving supplements that affect his mood or attention). If we encourage treatments that are not
evidence based, we discredit our profession. Furthermore, where does our responsibility lie with
respect to harmful interventions, such as Chelation? Can staff ethically implement biomedical
interventions in the classroom? Are parents focused on curing their child rather than teaching

22

their child? And, how are all of these factors impacting our intervention plans? Is there a line in the
sand that we cannot ethically cross?
Obviously, as the writer, I am unsure of all the implications the AVC may have on our role
as school psychologists. In my 10 years experience working with children with ASD and their
families, I can caution that one should expect to encounter inquiries and strong opinions (positive
and negative) with respect to the AVC. As school psychologists, not only should we be familiar
with the evidence and history surrounding ASD and vaccines, but we should be well versed in the
countless alternative treatments available to parents and real world implications of those
treatments. We should try and put ourselves in a parents shoes, who would do anything to
improve their childs symptoms. At the end of the day, we may never have a solid and predictable
place in the AVC, other than to communicate the evidence in a non-judgemental way, if the
opportunity presents itself.
Conclusions
Wakefields association of ASD to vaccines left catastrophic implications. Parents are left
to navigate convoluted waters of information when deciding on what best treatments to choose for
their child. The public health system is scorn with parental fears that vaccines may cause more
harm than good. And, although the evidence has consistently refuted Wakefields claims of
vaccines as a cause of ASD, the public support of this evidence has yet to occur; a paradigm shift
that may never transpire. What if Wakefields research was published before the existence of the
internet? Would it have gained so many supporters? Likely not. Historically, the stage was set for
the AVC launch, gain and maintain ground, developing into somewhat of a conspiracy theory. As
school psychologists we are likely to encounter professionals and parents that believe vaccines do
cause ASD. Now that you know the history, what will you do?

23

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