Autism:Relevance to immunizations

Meghan Cole

Brenda Curenton

Ashley Donaldson

Auburn University of Montgomery

What is Autism?

Autism, also known as Autism Spectrum Disorder, is a disorder of brain development categorized by difficulties in social interaction, verbal and nonverbal communication, and repetitive behaviors (Autism Speaks, Incorporated 2013).

Social Skills Communication Skills Behavioral Skills

Currently there are no known laboratory tests to diagnose autism.

How is Autism Diagnosed?

Treatment Methods No cure exists.Treatment involves:

level of function

by

autistic symptoms

Therapy involves: Educational Family Counseling Behavioral modification Communication Medications

Because many of the causes of autism remain unknown by the medical community and concerned parents, there is some question if immunizations in children can cause this disorder.

The case study involves an expectant mother already dealing with one child who has been diagnosed with autism. The mother has a strong belief that immunizations caused the first child’s autism. The mother requested a pediatric nurse to verbalize her opinion on the matter.

The information to be identified by this case study is whether or not vaccinations can be linked to the cause of autism

??? Causes of Autism ???

Patient or Situation Focused Question

Meta-analyses and systematic

reviews

Evidence-based reviews

Random control trials

Case-control studiesCase series

Case reports

Textbook, review articles, expert opinions, and laboratory research

The purpose and goal of this query are to determine the link between the development of autism and immunizations in children.

The focused question is:

“What is the highest level of evidence to determine if immunizations can cause autism in young children?”

Targeted ResourcesIn order to find the highest level of evidence based information related to

the focused question the EBP team explored in Cochrane Library, PubMed, and Google Scholar.

The word search within the databases is shown in the following (see Table 1).

SEARCH WORDS CORRESPONDING TO PPARRE

ALTERNATIVE WORDS OR SYNONYMS

Autism Development disorder, socially impaired, impaired communication, risk factors of autism

Immunizations Vaccines, vaccinations, childhood vaccines

Children Girls and boys ages birth to 6Mercury Thimerosal

Table 1 PPARRE Word Search

To be thorough in the research the EBP team used the PPAARE process in developing the focused question. The acronym mapped the course for the development.

Problem-autism linked to immunizations. Population-young children. Action-gaining knowledge to determine whether or not vaccines are

actually linked to autism. Alternative-in this case there is no alternative. Results-educate the mother on the link between vaccines and autism so that

the mother can make an informed decision about immunizing and decreasing the mother’s fear and anxiety.

Evidence- that will be gained with the completion of our research.

The following demonstrates this process (see table 2).

PPAARE

Table 2 PPAARE Question for Case Study Focused Query Question

Problem PPAARE Component Case Example

Patient Children

Action Gain knowledge whether autism is linked to vaccinations

Alternative  

Patient Results Educate the mother with information about immunizations so she can make an informed decision and reduce mother’s anxiety and fear

Level of Evidence Highest level

Relevance of Evidence

In order to ensure the EBP team stays on track with the research, a “Relevance of Evidence” table was used.

This table is multifunctional

Keeps data/visited sites listed Reveals relevance of the articles found

Evidence Appraisal

To establish trustworthiness of two relevant studies:

A quantitative study was used from authors E. Fombonne, R. Zakarian, A. Bennett, L. Meng, and D. McLean-Heywood written in 2006.

A qualitative study was conducted from authors S. Hilton, K. Hunt, M. Petticrew written in 2007.

After conducting the analysis using this systematic process, both studies were found to be trustworthy. The qualitative study was the most beneficial for the EBP team to use to prove the trustworthiness of the project

Course of ActionThe course of action the Evidence Based Practice (EBP) team plans to implement includes:

Share with the mother the study conducted for the highest level of evidence found to determine if immunizations can cause autism in young children.

Educate the mother on the outcome of the study.

The outcome can be measured by following up with mother to see if her concerns have been relieved.

Allowing the child to be immunized would demonstrate a positive outcome from the knowledge gained and shared with the mother from this study that there is no link between immunizations and autism.

Conclusion

In conclusion, this study was an effective use of the EBP team’s efforts:

Searched for the highest level of evidence to determine if immunizations can cause autism in young children.

Found no evidence that immunizations can cause autism.

Shared this information with the concerned mother Put to rest mother’s fear of immunizing her younger

child. The team completed a post- education evaluation Determined that the mother’s anxieties were relieved Mother allow her child to receive the MMR vaccine.

ReferencesAutism Speaks Incorporated. (2013). What is Autism? Retrieved from http://www.autismspeaks.org/what-autism

Demicheli, V., Riveter, A., Deadline, M.G., &  Di Pietrantonj, C. (2012). Vaccines for measles, mumps and rubella in

children. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004407.pub3/abstract 

Fombonne, E., Zakarian, R., Bennett, A., Meng, L., & McLean-Heywood, D. (2006). Pervasive developmental disorders in

Montreal, Quebec, Canada: Prevalence and links with immunizations. Pediatrics, 118 (1), 139-150. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/16818529

Health Council of the Netherlands. (2007). MMR vaccination and autism: no indication for a

association. Retrieved from http://www.gezondheidsraad.nl/sites/default/files/200704EMMR.pdf

Hilton, S., Hunt, K., & Petticrew, M. (2007). MMR: Marginalized, misrepresented and reject? Autism: A focus group study.

Archives of Disease in Childhood, 92(4), 322-327. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17376937

Mayo Clinic. (2012). Autism. Retrieved from http://www.mayoclinic.com/health/autism/DS00348