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By DAN OLMSTED   |   April 29, 2005 at 12:05 AM

BALTIMORE, April 29 (UPI) — They were born within four months of each other, Fritz V. in June of 1933 and Donald T. that September. Fritz was born in Austria, Donald in Mississippi, but they had a surprising amount in common.

Unfortunately.

When Donald was taken by his beleaguered parents to Johns Hopkins University in 1938, he acted like no 5-year-old that famed child psychiatrist Leo Kanner had ever seen.

“He learned my name,” Kanner recounted decades later, “but he would never see me if he met me because he would never look up enough and had enough eye contact to recognize faces. … Also, while he spoke, it was not for communication, and if in order to satisfy his needs some communication was needed, he would not be able to distinguish between ‘I’ and ‘you,’ rather echoing religiously some of the things that he was interested in.

“For instance, if he wanted his milk, he remembered constantly that his mother always asked him, ‘Donnie, do you want your milk?’ And his way of asking for milk was ‘Donnie, do you want your milk?’ Well, this was only a part of some of his peculiar behavior.”

Yet, strangely, by age 2 1/2 he could name the presidents and vice presidents of the United States backwards and forwards and recite the 25 questions of the Presbyterian catechism.

Fritz made an equally vivid impression on Hans Asperger, the pediatrician who first saw him in 1939 at age 6 in Vienna. Asperger described him as “a highly unusual boy who shows a very severe impairment in social integration. … His gaze was strikingly odd. It was generally directed into the void.”

In school, “He quickly became aggressive and lashed out with anything he could get hold of (once with a hammer). … Because of his totally uninhibited behavior, his schooling failed on the first day. … Another strange phenomenon in this boy was the occurrence of certain stereotypic movements and habits.”

As with Donald, “The content of his speech was completely different from what one would expect of a normal child,” Asperger said of Fritz. “Only rarely was what he said in answer to a question.”

Weird, but he started speaking at 10 months and soon “talked like an adult.”

Donald T. and Fritz V. — their last names were never given — have endured in medical literature because they are firsts. Donald was the first to confront Kanner with the behaviors that he later named “autism.” Fritz was the first case study of what came to be known as Asperger’s Disorder. Both conditions are now classed in the official U.S. guide to mental problems as Pervasive Developmental Disorders, and are also called Autism Spectrum Disorders.

Autism derives from the Greek word for self, “autos,” as in autobiography.

Most experts think the disorders are related, with autism the severe manifestation; Asperger’s is sometimes referred to as “autism lite” or “a dash of autism” and is differentiated by a lack of delay in language development.

Kanner’s study of Donald and 10 other children was titled “Autistic Disturbances of Affective Contact,” and was published in the journal “Nervous Child” in 1943. Asperger called his study of Fritz and three other children “‘Autistic Psychopathy’ in Childhood;” it was published in the “Archiv fur Psychiatrie und Nervenkrankheiten” in 1944.

Kanner described autism’s defining features as “extreme aloneness and a desire for the preservation of sameness.”

“The children seemed to live in a static world in which they could not seem to tolerate any kind of change introduced by anybody but themselves,” Kanner said in a 1972 speech, “and even that didn’t occur very often.”

“The autist is only himself,” Asperger wrote, “and is not an active member of a greater organism which he is influenced by and which he influences constantly.”

Kanner and Asperger did not collaborate on their studies. Nor did either predict the deluge that would follow: In the United States, a reasonable estimate is 30 or 40 children out of every 10,000 are diagnosed with autism, and another 30 or 40 are diagnosed with other Pervasive Developmental Disorders, including Asperger’s.

This leads to a simple but significant question: Was it coincidence the first few cases of these strikingly similar disorders were identified at the same time, by the same term, in children born the same decade, by doctors thousands of miles apart?

Or, is it a clue to when and where autism started — and why?

The question reflects a huge, and hugely important, debate. If autistic children always existed in the same percentages but just were not formally classified until the 1940s, that would suggest better diagnosis, not a troubling increase in the number of autistic children.

If, however, autism had a clear beginning in the fairly recent past (a past so recent that Fritz and Donald could both be alive today at age 71), then the issue is very different. That would suggest something new caused those first autism and Asperger’s cases in the early 1930s; something caused them to increase, and something is still causing them today.

This ongoing series will look for answers by tracking the natural history of autism around the world — a road less traveled than one might think. For example, Asperger’s study was not translated into English until 1994 — a half-century later — and still is not easily available. Actually reading Asperger’s account of Fritz V. makes you realize the severity of his disorder and its similarity to classical autism.

“The reader of Asperger’s first paper cannot fail to be impressed by the close similarities to Kanner’s case descriptions and the relatively few differences,” wrote British psychiatrist Lorna Wing in the 1994 anthology “Autism and Asperger Syndrome,” which includes the first English translation. Translator Uta Frith noted, “By a remarkable coincidence, Asperger and Kanner independently described exactly the same type of disturbed child to whom nobody had paid much attention before and both used the label autistic.”

Both said autistic children were impossible to miss.

“Once one has properly diagnosed an autistic individual one can spot such children instantly,” Asperger said.

“It is a unique syndrome,” Kanner said, “and almost photographically not identical, but similar.”

Kanner was clear he never saw an autistic child until he met Donald T. in 1938 — 17 years after he got his medical degree in Berlin, on his way to becoming one of the world’s leading psychiatrists, to whom the toughest cases were often referred “all the way to the great Hopkins,” as he jokingly put it.

In fact, his landmark 1943 paper begins, “Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits — and, I hope, will eventually receive — a detailed consideration of its fascinating peculiarities.”

Markedly, uniquely different: The great psychiatrist at the great Hopkins was convinced he was seeing something new.

Next, a look at the oldest of Kanner’s patients, the one whose birth might mark the start of the age of autism. Her name was Virginia S.

By DAN OLMSTED   |   April 28, 2005 at 2:43 PM

WASHINGTON, April 28 (UPI) — Part 2 of 2. 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 Virginia.

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 medications.

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 membranes.

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 plan?

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 your practice?

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 to that?

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 baseline.

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 this?

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 themselves.)

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 immunology.

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 face.

By DAN OLMSTED   |   April 28, 2005 at 2:41 PM

WASHINGTON, April 28 (UPI) — Part 1 of 2. Dr. Elizabeth Mumper is an unlikely contrarian. Mumper is a pediatrician in the southern Virginia city of Lynchburg, best known as the home of the Rev. Jerry Falwell’s Liberty Baptist University.

She graduated from the Medical College of Virginia and completed her residency at the University of Virginia.

About a decade ago, Mumper said, she began noticing a change for the worse in the overall health of the children she was seeing, including a startling rise in cases of autism. Ultimately, Mumper came to suspect the increasing number of childhood vaccinations in the 1990s — and particularly the mercury-based preservative called thimerosal in many of those vaccines — was a big reason.

The federal government recommended phasing out thimerosal in childhood vaccines in 1999 as a precautionary measure, but health officials said the epidemiological evidence favored rejection of thimerosal, or any vaccine link, as a culprit.

Last week, Mumper was named top adviser on autism treatment for Defeat Autism Now! and is medical director of their physician training lecture series.

This weekend, she and several like-minded colleagues will outline their approach at a conference in Charlottesville, Va.

This first of two articles is the transcript of a United Press International interview with Mumper.

Q. What got you going on this line of thinking? As you know, mainstream medical groups, including the American Association of Pediatrics, have firmly rejected the idea that vaccines played any role in autism or other disorders. They also say that continuing to push this idea is dangerous — not to mention a waste of money — because parents might stop vaccinating their children. Many also believe there is no real increase in these disorders, just more diagnoses.

A. In the mid-1990s, I had a general intuitive sense, as a clinician who’s walked into rooms with thousands of patients at this point, that children were sicker.

When I asked myself what I was seeing, I realized I was seeing more development problems; I was seeing more stuttering; I was seeing more speech and language issues; I was seeing more autism; I was seeing lots more ADHD (Attention Deficit Hyperactivity Disorder); I was seeing more asthma, more eczema — all those sort of auto-immune allergic conditions.

I started having more diabetic patients. In this very small practice — I’ve only got 1,700 patients — I’ve got four insulin-dependent diabetics, and they’re younger, diagnosed as young as 16 months old. The incidence of diabetes used to be something like one in 2,000 kids 15 years ago.

So, for me as a clinician, we shouldn’t get hung up on questions like, “Is this really autism?” or “Is it Asperger’s (a milder variation)?” or have we broadened the definition and included more neurologically damaged kids? The question should be: What has happened to 1 in 6 children in America that both the CDC and the American Academy of Pediatrics acknowledge have a neurodevelopmental disability?

That, to me, is the question.

Q. And that’s more than it used to be?

A. Oh, yes. In Virginia, it’s a 66-fold increase in ADHD since 1985. So, even if you say, “OK, maybe we’re overdiagnosing half the cases, because the drug reps are visiting us all and pushing more meds, and we’re writing out prescriptions for kids when they don’t really have a problem” — I could throw out half my ADHD cases and I’ve still got a huge increase that begs for an explanation.

Autism has increased 11-fold in Virginia since 1985. If you independently look at things like peanut allergies and asthma, those numbers are going up, too.

Now, how much of that is vaccine related, how much of that is environmental toxins or other factors? It quickly gets very, very, very muddy, but when you’ve got bench (laboratory) science that’s looking at the mechanism of thimerosal toxicity and that for many, many years has documented all the horrible things mercury does to your immune system and your nervous system; and when you’ve got all these things that theoretically could be caused by a culprit like thimerosal; and the levels of thimerosal (in vaccines), the levels of Ritalin, the levels of autism, the levels of ADHD all follow the same curve in time, how can you not look at that in a compelling way?

Q. The Institute of Medicine, the Centers for Disease Control and Prevention, the Food and Drug Aministration and others say they have looked at it, and that the epidemiology basically refutes it. The IOM said autism research funding should now go to “promising” areas.

A. But when you look at the Danish study, which they use a lot to refute the thimerosal-autism connection, it’s not analagous to the United States.

Danish children only received six doses of thimerosal-containing vaccines in the first year of life vs. 12 doses in the United States. The Danish study purported to show an increase in autism after thimerosal was removed in 1992, but the diagnostic criteria changed and they added in outpatient cases of autism, whereas previously they only counted inpatients with autism.

Secondly, epidemiology uses too blunt a tool to look for the connection in the first place. Clearly, thimerosal didn’t make every kid (who was vaccinated) autistic, so when epidemiology does not look at genetic predispositions, you are not going to be able to tease out those subsets and make meaningful conclusions about them.

Epidemiology missed the folate connection to neural tube defects, but clinical science established the link.

Q. This is the deficit in pregnant women that can cause spina bifida (an opening in the back around the spinal cord)?

A. Right. So, why does epidemiology trump clinical science and bench science? That’s the thing that I don’t understand. Also, the epidemiology studies have to be designed to answer the question they’re asked to answer. If the studies are designed one way, and then you go back 10 years later and try to use those studies to answer a question about thimerosal or mercury toxicity or MMR (the measles-mumps-rubella vaccine), or whatever, you can’t expect to find answers to questions it wasn’t designed for in the first place.

Epidemiology is a tool for public health, and clearly it has a place in making these decisions, but I don’t think it should have trump power over all the rest. It’s very frustrating to believe that clinical observations and individual case histories have something valuable to teach, and to be told “that’s all anecdotal” and we don’t see these kids when we look at large populations.

Well, come to my office, they’re here every day. It’s the most puzzling thing I’ve ever tried to wrap my mind around.

—

Next: Treatment strategies that Mumper and others have begun using

By DAN OLMSTED   |   April 19, 2005 at 9:41 AM

LEOLA, Pa., April 19 (UPI) — Part 2 of 2. Three-year old Julia is napping when I arrive at the spare, neat, cheerful house on Musser School Road near the town of Leola in Lancaster County.

She is the reason I have driven through the budding countryside on this perfect spring day, but I really do not need to meet her.

In the last column, I wrote about trying to find autistic Amish people here in the heart of Pennsylvania Dutch country, and noted there should be dozens of them — if autism occurs at the same prevalence as the rest of the United States.

So far, there is evidence of only three, all of them children, the oldest age 9 or 10. Julia is one of them. I found out about her through a pediatrician in Richmond, Va., Dr. Mary Megson. I had been asking around for quite some time about autism and the Amish, and she provided the first direct link.

Megson said she would give my name to this child’s mother, who could call if she chose. A few days later the phone rang. It was Stacey-jean Inion, an Amish-Mennonite woman. She, her husband Brent and their four children live simply, but they do drive a vehicle and have a telephone. After a few pleasantries, I told her about my trying to find autistic Amish.

Here is what she said, verbatim:

“Unfortunately our autistic daughter — who’s doing very well, she’s been diagnosed with very, very severe autism — is adopted from China, and so she would have had all her vaccines in China before we got her, and then she had most of her vaccines given to her in the United States before we got her.

“So we’re probably not the pure case you’re looking for.”

Maybe not, but it was stunning that Julia Inion, the first autistic Amish person I could find, turned out to be adopted — from another country, no less. It also was surprising that Stacey-jean launched unbidden into vaccines, because the Amish have a religious exemption from vaccination and presumably would not have given it much thought.

She said a minority of Amish families do, in fact, vaccinate their children these days, partly at the urging of public health officials.

“Almost every Amish family I know has had somebody from the health department knock on our door and try to convince us to get vaccines for our children,” she said. “The younger Amish more and more are getting vaccines. It’s a minority of children who vaccinate, but that is changing now.”

Did she know of any other autistic Amish? Two more children, she said.

“One of them, we’re very certain it was a vaccine reaction, even though the government would not agree with that.”

Federal health officials have said there is no association between vaccinations and autism or learning disabilities.

“The other one I’m not sure if this child was vaccinated or not,” she added.

During my visit to their home, I asked Stacey-jean to explain why she attributed the first case to vaccines.

“There’s one family that we know, their daughter had a vaccine reaction and is now autistic. She was walking and functioning and a happy bright child, and 24 hours after she had her vaccine, her legs went limp and she had a typical high-pitched scream. They called the doctor and the doctor said it was fine — a lot of high-pitched screaming goes along with it.

“She completely quit speaking,” Stacey-jean said. “She completely quit making eye contact with people. She went in her own world.”

This happened, Stacey-jean said, at “something like 15 months.” The child is now about 8.

For similar reasons, Julia Inion’s Chinese background is intriguing. China, India and Indonesia are among countries moving quickly to mass-vaccination programs. In some vaccines, they use a mercury-based preservative called thimerosal that keeps multiple-dose vials from becoming contaminated by repeated needle sticks.

Thimerosal was phased out of U.S. vaccines starting in 1999, after health officials became concerned about the amount of mercury infants and children were receiving. The officials said they simply were erring on the side of caution, and that all evidence favors rejection of any link between Autism Spectrum Disorders and thimerosal, or vaccines themselves.

Julia’s vaccinations in China — all given in one day at about age 15 months — may well have contained thimerosal; the United States had stopped using it by the time she was born, but other countries with millions to vaccinate had not.

Stacey-jean said photographs of Julia taken in China before she was vaccinated showed a smiling alert child looking squarely at the camera. Her original adoptive family in the United States, overwhelmed trying to cope with an autistic child, gave Julia up for re-adoption. The Inions took her in knowing her diagnosis of severe autism.

I tried hard — and am still trying — to find people who know about other autistic Amish. Of the local health and social service agency personnel in Lancaster, some said they dealt with Amish people with disabilities, such as mental retardation, but none recalled seeing an autistic Amish.

Still, I could be trapped in a feedback loop: The Amish I am likeliest to know about — because they have the most contact with the outside world — also are likeliest to adopt a special-needs child such as Julia from outside the community, and likeliest to have their children vaccinated.

Another qualifier: The Inions are converts to the Amish-Mennonite religion (Brent is an Asian-American). They simply might not know about any number of autistic Amish sheltered quietly with their families for decades.

It also is possible the isolated Amish gene pool might confer some kind of immunity to autism — which might be a useful topic for research.

Whatever the case, Stacey-jean thinks the autistic Amish are nowhere to be found.

“It is so much more rare among our people,” she said. “My husband just said last week that so far we’ve never met a family that lives a healthy lifestyle and does not vaccinate their children that has an autistic child. We haven’t come across one yet.”

“Everywhere I go (outside the Amish community) I find children who are autistic, just because I have an autistic daughter — in the grocery store, in the park, wherever I go. In the Amish community, I simply don’t find that.”

—

UPI researcher Kyle Pearson contributed to this article.

By DAN OLMSTED   |   April 19, 2005 at 7:56 AM

LANCASTER, Pa., April 18 (UPI) — Part 1 of 2. Where are the autistic Amish? Here in Lancaster County, heart of Pennsylvania Dutch country, there should be well over 100 with some form of the disorder.

I have come here to find them, but so far my mission has failed, and the very few I have identified raise some very interesting questions about some widely held views on autism.

The mainstream scientific consensus says autism is a complex genetic disorder, one that has been around for millennia at roughly the same prevalence. That prevalence is now considered to be 1 in every 166 children born in the United States.

Applying that model to Lancaster County, there ought to be 130 Amish men, women and children here with Autism Spectrum Disorder.

Well over 100, in rough terms.

Typically, half would harbor milder variants such as Asperger’s Disorder or the catch-all Pervasive Development Disorder, Not Otherwise Specified — PDD-NOS for short.

So let’s drop those from our calculation, even though “mild” is a relative term when it comes to autism.

That means upwards of 50 Amish people of all ages should be living in Lancaster County with full-syndrome autism, the “classic autism” first described in 1943 by child psychiatrist Leo Kanner at Johns Hopkins University. The full-syndrome disorder is hard to miss, characterized by “markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activities and interests,” according to the Diagnostic and Statistical Manual of Mental Disorders.

Why bother looking for them among the Amish? Because they could hold clues to the cause of autism.

The first half-dozen articles in this ongoing series on the roots and rise of autism examined the initial studies and early accounts of the disorder, first identified by Kanner among 11 U.S. children born starting in 1931.

Kanner wrote that his 1938 encounter with a child from Mississippi, identified as Donald T., “made me aware of a behavior pattern not known to me or anyone else theretofore.” Kanner literally wrote the book on “Child Psychiatry,” published in 1934.

If Kanner was correct — if autism was new and increasingly prevalent — something must have happened in the 1930s to trigger those first autistic cases. Genetic disorders do not begin suddenly or increase dramatically in prevalence in a short period of time.

That is why it is worth looking for autistic Amish — to test reasoning against reality. Largely cut off for hundreds of years from American culture and scientific progress, the Amish might have had less exposure to some new factor triggering autism in the rest of population.

Surprising, but no one seems to have looked.

Of course, the Amish world is insular by nature; finding a small subset of Amish is a challenge by definition. Many Amish, particularly Old Order, ride horse-and-buggies, eschew electricity, do not attend public school, will not pose for pictures and do not chat casually with the “English,” as they warily call the non-Amish.

Still, some Amish today interact with the outside world in many ways. Some drive, use phones, see doctors and send out Christmas cards with family photos. They all still refer to themselves as “Plain,” but the definition of that word varies quite a bit.

So far, from sources inside and outside the Amish community, I have identified three Amish residents of Lancaster County who apparently have full-syndrome autism, all of them children.

A local woman told me there is one classroom with about 30 “special-needs” Amish children. In that classroom, there is one autistic Amish child.

Another autistic Amish child does not go to school.

The third is that woman’s pre-school-age daughter.

If there were more, she said, she would know it.

What I learned about those children is the subject of the next column.