One of the topics that comes up over and over online is “The Amish don’t vaccinate” and “the Amish don’t have autism”. Both statements are incorrect. The Amish have no religious prohibition against vaccination and they do have autism.
The question of autism amongst the Amish has been studied and is being presented at the IMFAR autism conference this week. The paper, Prevalence Rates of Autism Spectrum Disorders Among the Old Order Amish, demonstrates a preliminary prevalence of 1 in 271 as the prevalence of autism amongst Amish children in two Amish communities: Holmes County, Ohio and Elkhart-Lagrange County, Indiana.
J. L. Robinson , Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL
L. Nations , Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL
N. Suslowitz , Center for Human Genetics Research, Vanderbilt University, Nashville, TN
M. L. Cuccaro , Human Genetics, University of Miami School of Medicine, Miami, FL
J. Haines , Center for Human Genetics Research, Vanderbilt University, Nashville, TN
M. Pericak-Vance , Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL
Background:
The prevalence rate of Autism Spectrum Disorders (ASD) appears to be steadily increasing. The latest report from the Center for Disease Control estimates the rate of ASD is 1 in 91 children (Kogan, 2009), up from 1 in 150 in 2007. Understanding the seeming changes in ASD prevalence require careful exploration of genetic and environmental factors. A method that has proven useful in dissecting the etiology of complex diseases is the study of isolated populations. One population isolate that has been studied extensively is the Amish, with well over 250 genetic studies. Expanding studies of autism to the Amish may provide important information about etiology. A crucial first step in this process is a feasibility study to determine ASD prevalence rates in this population.
Objectives:
This study presents preliminary data on the estimated prevalence of ASD among the Amish in two Amish dominant counties as part of a larger epidemiological study. All children between ages 3 to 21 in those counties will be screened for the presence of an ASD.
Methods:
Screening occurred in two of the largest Amish communities in the United States. Trained clinicians ascertained door to door using a published Amish Directory as a guide. Families were approached and asked to participate in a brief interview regarding their children. Two primary screening instruments were used: the Social Communication Questionnaire (SCQ) and the DSM-IV-TR Checklist (a tool created by the authors). A Vaccination History and a brief family history including questions specific to the ASD phenotype were also taken. Children screening positive on either the SCQ or DSM-IV-TR Checklist were seen for a more comprehensive clinical evaluation by two licensed psychologists. This evaluation included the Autism Diagnostic Observational Schedule (ADOS) and Autism Diagnostic Interview (ADI).
Results:
From September 2008 to October 2009, 1899 Amish children were screened in the two Amish communities. A total of 25 children screened positive for ASD on either the SCQ or the DSM-IV-TR checklist. A total of 14 screened positive for ASD on both screeners. Of those 25 children, 14 were evaluated and seven children were confirmed as having a diagnosis of ASD using the ADI and/or ADOS, and clinical judgment. Interestingly, four of the seven only met ASD criteria on the ADOS but not the ADI. Three of the four who were not diagnosed by the ADI only missed criteria on the Behavioral Domain, which may be attributable to the reporting style of Amish caregivers.
Conclusions:
Preliminary data have identified the presence of ASD in the Amish community at a rate of approximately 1 in 271 children using standard ASD screening and diagnostic tools although some modifications may be in order. Further studies are underway to address the cultural norms and customs that may be playing a role in the reporting style of caregivers, as observed by the ADI. Accurate determination of the ASD phenotype in the Amish is a first step in the design of genetic studies of ASD in this population.
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I didn't see any adjustment for maternal age - maternal age is a well known factor in autism and average maternal age has been steadily increasing in most of the US as women put off kids to have careers. There are probably not many women in Amish society putting off kids for a career, so this is a big factor.
Now, the comparison of prevalence can not be done without
1-appropiate genetic testing in Amish children vs non-Amish children
2-Appropiate consideration of autism with mental retardation and autism without mental retardation in Amish children vs non-Amish children
3-prevalence of epilepsy and autism in Amish vs non-Amish children
4-Concomitant medical problems in autistic amish children vs non-amish children
5-Appropiate clinical studies of comparison between autistic amish children vs non-amish children to detect if the autism diagnosis is related to mental retardation genetically linked or a metabolically genetically linked condition whose behavioral manifestation has been diagnosed with ASD.
6-regression in autistic amish children (age, character, kind- in skills, in language) vs regression in autistic non-amish children
7- Autism since birth or autism with regression in amish autistic children?
8- Plateau in development or regressive/since birth autism?
9- Adverse reactions to vaccines in amish-liver enzymes, renal status, immune status?
The cause for autism , based upon responses of more than 500 children with autism has been confirmed to be gross malnutrition.
The dietary changes of around 1960 have caused many children to be provided diets that are deficient in at least 60 or more critical brain nutrients. The Amish are far more likely to be consuming diets that existed before these changes were made and thus would not be expected to incur the increased incidence of autism as seen in the rest of the population.
the increased incidence of autism is entirely accounted for by both increased screening and expanded diagnostic criteria. The time was, if a child was verbal, he or she was by definition not autistic.