A recent article in the journal Pediatrics tries to offer parents of autistic children some information to answer these simple questions: “What will my child’s life be like as an adult? What are the chances for college and future employment” One of the effects of the recent heightened awareness about autism spectrum disorder (ASD) among physicians and parents is that many more cases are being diagnosed, especially milder ones. What happens to these children when they grow up? What are their chances for living a normal adult life?
The authors, from Washington University in St. Louis and Vanderbilt University in Nashville, used a standardized survey of 680 patients with ASD and their parents from 2007-2008. The design was simple. The authors looked at two useful markers of advancement in adult life — postsecondary education and employment. For comparison, they also looked at children who had been diagnosed with learning disabilities or speech impairments.
The results showed that, six years after leaving high school, 35% of children with ASD had attended college and 55% had held a paid job of some sort. But fully half of the children in the first two years after high school had no engagement at all with either education (college, junior college, or technical school) or employment. In this regard they fared worse than children carrying the diagnosis of speech and language impairment or learning disability. Poor children with ASD had the worse outcomes.
What can we learn from this? First, as usual, we need more information. Children with ASD are a very diverse group, ranging from mild to severe difficulties. We can’t lump them all together. Compared with the past, children with ASD receive more and better services. Yet it is clear we need to look at useful and effective ways to launch them into adult life.
I’ve written before about whooping cough, or pertussis, and its vaccine. It’s a potentially deadly illness for infants. There’s been quite a large epidemic of whooping cough over the past few months in California. In fact, it’s shaping up to be the largest epidemic in fifty years. Five infants have died as a result.
We have a vaccine for it, although it’s not an ideal one. For one thing, it can’t be given to the youngest of infants, those at most risk of dying from the disease. For another, the protection the vaccine gives wanes with age, requiring booster shots. The upshot is that those receiving the vaccine are getting it as much (or more) to protect others than to protect themselves. That raises the key question of to what extent it is our civic duty to get the vaccine, and give it to our children, to protect those very small, vulnerable infants who can’t get it yet. Freedom of choice collides with the public welfare.
Dr. Bill Schaffner, a distinguished infectious disease expert at Vanderbilt University, recently weighed on on the question of compulsory vaccination in this context. He writes:
“But here’s a reason [for refusing vaccine] that really makes me cringe — our society puts more value on personal choice than on protecting our fellow citizens. “Mandates” has become a dirty word. We don’t like mandating anything in this country. No, we’re not going to mandate and take away personal choice. But what choice did those five infants have? Does our thirst for individual freedom absolve us of our responsibility to protect them?”
There is precedent from the past for compelling people to do things for public health reasons. Old quarantine laws are one example. Of course making a sick person stay at home does not force them to get a particular treatment, such as a vaccination. There is a parallel, however, with tuberculosis treatment. There have been instances when courts have confined a person with active TB and forced them to receive treatment for it. Although this treated the person, the reason for the compulsory treatment was that it protected the community.
As a trained infectious disease specialist myself, I have do doubt that the vaccine, although not ideal, works. You will find people who disagree with that statement. What interests me the most on the issue is the question of civil rights: to what extent does the state have the right to compel its citizens to do something to protect the health of others? The answer, I think, is — it depends.