Guess what? The Amish vaccinate!

And they have autism.

In the spring of 2005, UPI reporter Dan Olmsted wrote that autism is rare among the Amish of Lancaster County, Pennsylvania. “Where are the autistic Amish?” he wrote. “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.”

Olmsted’s anecdotal evidence is cited ad nauseum as evidence that thimerosal causes autism. The case rests on twin assumptions: that the Amish don’t vaccinate, and that they don’t have autism. But Olmsted never visited the cryptically-named Clinic for Special Children in Strasburg, where doctors treat of children who exhibit autistic behavior. It’s not even necessary to visit the clinic. A simple phone call to a staff physician, such as the one I made recently, is enough to debunk “the Amish anomaly”, as Olmsted calls it.

“The idea that the Amish do not vaccinate their children is untrue,” says Dr. Kevin Strauss, MD, a pediatrician at the CSC. “We run a weekly vaccination clinic and it’s very busy.” He says Amish vaccinations rates are lower than the general population’s, but younger Amish are more likely to be vaccinated than older generations.

Strauss also sees plenty of Amish children showing symptoms of autism. “Autism isn’t a diagnosis - it’s a description of behavior. We see autistic behaviors along with seizure disorders or mental retardation or a genetic disorder, where the autism is part of a more complicated clinical spectrum.” Fragile X syndrome and Retts is also common among the clinic’s patients.

Strauss, along with Dr. D. Holmes Morton, MD, authored a study published in the New England Journal of Medicine which described a mysterious seizure disorder that resulted in mental retardation and autistic behavior in nine Amish children. The study was publish one year after Olmsted’s mythic voyage, so it would seem a story correction would be in order.

In an email exchange with AutismNewsBeat, Olmsted said he made several attempts to contact Dr. Morton, but Olmsted would not say if those attempts were made before or after his Age of Autism stories ran. Strauss said Olmsted never visited the clinic, and added “I don’t think he spent much time in Lancaster County.

Strauss said the clinic treats “syndromic autism”, where autism as part of a more complicated clinical spectrum that can include mental retardation, chromosomal abnormalities, unusual facial features, and short stature, as well as Fragile X syndrome. “We see quite a few Amish children with Fragile X,” he said.

Strauss says he doesn’t see “idiopathic autism” at the clinic, which he defines as children with average or above average IQs who display autistic behavior. “My personal experience is we don’t see a lot of Amish children with idiopathic autism. It doesn’t mean they don’t exist, only that we aren’t seeing them at the clinic.”

He says a child in the general population is more likely to have autism detected early and to receive a diagnosis than an Amish child. “Amish child may not be referred to an MD or psychologist because the child is managed in the community, where they have special teachers,” he says. “We know autism when we see it, but we don’t go actively into the Amish community and screen for ASD.”

Strauss adds that the Amish have a high prevalence of genetic risk factors and are protected from others. The low rate of idiopathic autism “might have more to do what genetic structure of population than lifestyle, environment or diet.”

So what’s up with Olmsted? Did a UPI reporter fabricate a story, then pass it off as true? Science blogger Prometheus offers three possible explanations:

Mr. Olmsted didn’t look all that carefully for autistic children, having already concluded that there wouldn’t be any.

Mr. Olmsted found autistic children, but didn’t count them - either because he either didn’t feel that they had real autism or because it conflicted with his forgone conclusion.

The Amish families - being somewhat suspicious of “outsiders” (not without good reason) - didn’t confide the details of their family medical issues with Mr. Olmsted.

I’m still waiting for Mr. Olmsted’s side of the story.