For one North Texas family, that resilience is embodied in their little boy, Gabriel “Thor” Munoz. Not because life has been easy, but because from the very beginning, he has faced it with a strength that is impossible to ignore.

The Origin Story: The Birth of a Superhero

It regularly takes 40 weeks for a baby to be born, but not for a superhero. For Thor, it only took 24 weeks and three days, weighing just one pound and seven ounces. His parents, Michael and Mary Munoz, stood by Thor’s side while he spent his first six months fighting, and winning, every battle his tiny body faced.

Thor encountered one of his hardest battles at just a few weeks old when he was diagnosed with necrotizing enterocolitis (NEC), a serious gastrointestinal condition typically seen in premature infants. NEC left Thor with only a 2% chance of surviving corrective surgery. Despite the daunting odds, Michael and Mary chose to take the risk, clinging to that small window of hope for their son’s future.

On the day of the surgery, Cook Children’s surgeon Marty Knott, DO, Ph.D., arrived wearing a surgical cap covered in superheroes, including the well-known god of thunder, Thor. As soon as Michael and Mary saw the cap, they took it as a sign that their little boy was in the right hands.

Three years later, Dr. Knott and Thor’s family reunited to reflect on the profound bond they formed during those vulnerable early days. To honor Thor's journey, Dr. Knott presented the family with the surgical cap he wore during the life-saving procedure, a symbolic reminder that their child not only carries a superhero’s name, but he is also the true hero of his own story.

The Discovery: A Different Kind of Superpower

Arriving into the world prematurely wasn’t the only challenge Thor and his family would endure. As he kept growing, his family noticed irregular behaviors that concerned them, such as totally refusing solid foods and banging his head against hard surfaces. These behaviors disrupted his health and made it difficult for him to communicate with the world around him.

Seeking answers, his parents pushed for a medical evaluation. At just three years old, Thor was officially diagnosed with autism. For his family, this wasn't just a label; it was the key to unlocking the specialized help he needed.

His mother, Mary, said acting fast made all the difference. "To me, the earlier you diagnose, the more help you can get and the better the outcome," she said.

The Adaptation Process: A Superhero in Training

When Thor arrived at Cook Children’s, his symptoms were so complex that other applied behavior analysis (ABA) clinics had previously refused to treat him. However, the team at Child Study Center accepted the challenge, using ABA techniques to address his severe behavioral hurdles. Duy D. Le, MS, BCBA, Manager of Applied Behavior Analysis, explained that the program is designed to build essential life skills: "ABA therapy techniques can help decrease problem behavior, and increase desirable behavior, including tolerance of hygiene tasks... and expand the number of foods a child is willing to eat,” Le said. By breaking down these daunting tasks into small, rewarding steps, ABA therapy provided Thor with a structured roadmap to navigate a world that often felt overwhelming.

The specialized training focused on replacing Thor’s most difficult struggles with functional communication. Cheyenne Matson, the Lead Program Specialist for the Behavior Disorders Clinic at Child Study Center, who worked directly with Thor, noted that the program was visibly effective when Thor was given a way to be heard.

"When Thor started treatment, we introduced the Picture Exchange Communication System (PECS) to teach Thor a functional form of communication rather than banging his head," Matson explained. As Thor learned to use images to express his needs, his head-banging diminished. This clinical expertise allowed Thor to move past his most severe symptoms, turning high-intensity struggles into a series of manageable victories.

Thor’s progress is now evidenced by milestones that once seemed out of reach. He has successfully transitioned to eating solid foods, adding six new foods to his diet, and his self-injurious behavior dropped to 0% by the end of his treatment. His parents note that while the journey is ongoing, the resilience he displays at Cook Children’s is truly heroic as he continues to bridge the gap between his inner world and the community around him.

The Power Source: Love and Braveness

Although Thor has proven to be a resilient child, he is a superhero with a unique source of power: the unwavering devotion of his loving parents. While Michael and Mary faced a maze of obstacles, they refused to let the search for answers exhaust their hope.

“You just have to keep fighting for what you know your kid needs,” Mary said. “There are people out there who truly care and want to help for the right reasons.”

Thor’s parents now hope to raise awareness and advocate not only for children diagnosed with ASD, but also for the caregivers walking a similar path in search of the right treatment for their children.

Related Stories:

• Compassionate Connections: Community Health Worker Joins New Neighborhood Health Center
• Mental Health & Medication: Overcoming Stigmas
• Raising Joy Podcast: Raising a Child With Autism With Bianka Soria-Olmos, D.O.

Being a pediatrician, Dr. Bianka Soria-Olmos knows how to identify the signs of autism spectrum disorder (ASD) in her patients. When her own son was diagnosed, she learned the very personal challenges that come along with being a parent of a child with ASD. On this episode of Raising Joy, we talk to Dr. Soria-Olmos about how the diagnosis and how it has impacted her work as a doctor and as a mom.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Autism spectrum disorder (ASD) is a life-long neurodevelopmental disability characterized by communication and social skills deficits, in addition to restrictive and repetitive behavior. Recently, the Centers for Disease Control and Prevention updated their estimates, which now show that one out of every 36 children in the US has ASD. If your own family has not been directly impacted by ASD, chances are you know someone who has.

Autism impacts many different areas of an individual’s life, and Cook Children’s Child Study Center offers medical, psychological, behavioral, speech, and academic services to help address the unique needs of each individual child with ASD.

Perhaps the most fundamental skill affected by ASD is a child’s ability to communicate. Less than half of children with ASD will develop fluent speech by age 8, and approximately ¼ will remain nonverbal, relying on an alternative form of communication to interact with others.

Regardless of how your child speaks, you can help bolster their ability to communicate by focusing on four critical areas of language development.

What is CLEaR Speech?

Research on language development has identified four critical areas of communication that may require systematic intervention: Conversing, Labeling, Echoing, and Requesting (CLEaR). You can help your child develop CLEaR speech by practicing each of these language domains during their everyday play. For example, suppose your child enjoys playing with a toy train:

Conversing: Can they say the name of the toy when it is described? Ask your child to fill-in-the-blank using a description of a toy that they are not currently playing with. For example, say, “Choo, choo goes the ….”

Labeling: Can they say the name of the toy when it is present? Ask your child to say the name of the toy they are holding. For example, give the train to your child and ask, “What is that?”

Echoing: Can they say the name of the toy when you name it? Ask your child to repeat the name of a toy that they are not currently playing with. For example, say “Say, ‘Train.’”

Requesting: Can they say the name of the toy when it is absent? Ask your child to say the name of the toy they want to play with. For example, hide the train from your child and ask, “What do you want?”

Note that you have asked the child to say the word train four different times. It is the different contexts that make each word unique. Many children with ASD have some ability to label or echo, but struggle with conversing and requesting. Others may only speak when requesting preferred items. The goal of CLEaR speech is to help the child understand the different contexts in which a word can be used, and to gradually develop their language abilities in each area through a process called abstraction.

Abstracting CLEaR Speech

^[1] Mario is not a real child, but an amalgamation of different patients treated in Autism Services.

To demonstrate the process of abstraction, let me introduce you to Mario^[1], a 4-year-old boy receiving early intensive behavioral intervention through Child Study Center’s Autism Services department. Mario’s parents noticed his lack of eye contact early on, and had trouble engaging him when he was an infant. 

As a toddler, Mario did not respond to sounds (e.g., he did not look up when called by name), and his parents suspected hearing loss. They were surprised when he received an ASD diagnosis at age 3. Though Mario sporadically repeats phrases from his favorite TV shows, he lacks the ability to express his basic wants and needs. He may lead mom to the refrigerator when he is hungry, but often resorts to tantrums until his parents can guess what he wants. Mario’s parents use CLEaR speech to help him learn to request his favorite things. 

They begin by letting Mario choose what he is going to talk about, by simply allowing him to select a toy or snack. Whenever his interest shifts, they will direct his speech toward the new activity. Throughout his play, Mario’s parents alter the different environmental configurations that support Mario’s CLEaR speech. Mario picks up his toy car and rolls it down a ramp. His parents use the following sequence to help strengthen Mario’s ability to request by purposefully changing the non-critical details of requesting across each step:

CLEaR: After the car goes down the ramp, Mom picks it up. She shows it to Mario (labeling), and says, “Drive the car” (echoing), “Drive the …” (conversing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

LER: After the car goes down the ramp, Dad picks it up. He shows it to Mario (labeling), and says, “Car.” (Echoing). When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again. 

CLR: After the car goes down the ramp, Mom picks it up. She shows it to Mario (labeling), and says, “Drive the …” (conversing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

CER: After the car goes down the ramp, Mom picks it up and hides it. She says, “Vroom, vroom goes the car” (echoing), “Drive the …” (conversing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

LR: After the car goes down the ramp, Dad picks it up. He shows it to Mario (labeling). When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

ER: After the car goes down the ramp, Mom picks it up and hides it. She says, “Car.’” (Echoing). When Mario requests, “Car,” she enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

CR: After the car goes down the ramp, Dad picks it up and hides it. He says, “Drive the …” (conversing). When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

R: After the car goes down the ramp, Dad picks it up and hides it. When Mario requests, “Car,” he enthusiastically repeats, “Car!” and hands it back to Mario so he can put it down the ramp again.

The order of the steps is less important than the variation of supports across steps. Children with ASD may rely heavily on a particular aspect of their environment, like the presence of the toy. We can use that feature to help support their language development, while also helping the child become more responsive to changes in their environment. 

The presence of the toy is necessary for labeling, but it shouldn’t also be necessary for requesting. It may take repeated practice with one step before your child is ready to move onto the next. Similar abstractions can be arranged to strengthen conversing, labeling, and echoing skills. While language development comes naturally for many children, others require targeted intervention. If you have questions about your child’s language development or concerns that your child may have ASD, speak with your pediatrician and contact Early Childhood Intervention or your local public school to find out what services are available to your family.

April is Autism Awareness Month and our experts are answering questions about Autism Spectrum Disorder (ASD). From signs to treatment, Bianka Soria-Olmos, M.D. and Lee Mason, Ph.D. share what parents need to know about ASD. Dr. Soria-Olmos is a pediatrician at Cook Children’s office in Haslet and Dr. Mason is an Applied Behavior Analyst at the Child Study Center, which is part of Cook Children’s Health Care System.

What is ASD (Autism Spectrum Disorder)?

Autism, or ASD, is a neurodevelopmental condition that may include difficulties with social skills, behaviors of repetitive nature and difficulties with verbal and nonverbal communication. It’s estimated that 1 in 54 children are affected by autism in the United States. ASD is a complex disorder that presents with varying symptoms ranging from mild to severe. There is no single cause, and at this time, both genetic and environmental factors are thought to contribute. More importantly, no reliable studies to date have shown a link between ASD and vaccines.

What are the signs of ASD?

Signs of autism can vary depending on the child. The key to early diagnosis is a partnership between the parent and the child’s doctor. Parents should discuss any developmental concerns with their pediatrician. In some cases, concerns may arise after standard developmental screening, which occurs at each well-child visit. A standard autism screening should occur between 18-24 months of age.

Some early signs include:

• Delays in development like babbling or cooing
• Lack of social smile by 6 months of age
• No pointing or waving by 12-14 months of age
• No single words by 15 months of age

Having a pediatrician recognize these signs is one of the reasons it’s important to keep your child up to date with well-child visits. The visits typically include questionnaires about development and this is an opportunity to identify any of these delays early.

Some children may have delays only in one area and no other difficulties. Standard screening tools exist to help your doctor identify other problems, which may indicate autism as a possible diagnosis.

One of the most widely used screening tools is MCHAT-R (Modified Checklist for Autism in Toddlers, Revise). This checklist is a series of 20 yes/no questions. The scoring of this screening tool gives a low, medium or high risk for ASD. All children with medium/high-risk results should have appropriate follow up which may include referral to a developmental pediatrician or a trained psychologist for formal ASD testing.

What if the MCHAT-R screening is negative, but I still have concerns?

A detailed history regarding the concerns also may lead to a referral for further testing even if the screening is negative. The reason for this is because ASD has such a wide presentation of symptoms it may eventually be diagnosed when symptoms are more subtle.

Since every child with autism is different, the treatment recommendations will vary for every child depending on the difficulties they are having. The current evidence supports the following effective treatments for autism: ABA (Applied Behavior Analysis), speech therapy, occupational therapy and treatment of any other co-existing condition of course.

What happens after my child receives an ASD diagnosis?

Half a century of research has convincingly shown that early intensive behavioral intervention, along with other applications of behavior analysis, is the treatment of choice for individuals with ASD. Behavior analysis is a science that studies how the environment affects behavior, and how behavior changes over time. The goal of ABA is to change behavior in ways that are meaningful to the patient and their family. For families of children with ASD, this often means increasing communication and social skills, while reducing behavior that interferes with learning.

Just as every person with autism is different, every ABA intervention is individualized to meet the patient’s needs, cultural norms, and family values. Comprehensive intervention is typically recommended, and may consist of up to 40 hours of ABA per week. In addition to addressing communication and social skill deficits, early intensive behavioral intervention can help with feeding problems, toileting, elopement (running away), tantrums, and other challenging behavior.

Research suggests that children with ASD who receive comprehensive ABA treatment show large developmental gains, and a reduced need for special services later in life. Less-intensive ABA treatments may be appropriate for older individuals. These programs typically focus on specific skills like developing relationships or obtaining employment.

Despite the broad variety of treatment goals, all ABA interventions rely on reinforcement-based approaches to develop lasting behavior change. Working in collaboration with other professionals has advanced the treatment options for individuals with ASD. Speech and occupational therapies that incorporate evidence-based practices (e.g., augmentative communication systems) while avoiding unproven approaches (e.g., sensory integration) can be highly effective.

A final note from the experts

We know being a parent can be stressful whether you are a first-time parent or not. Often worries and questions can arise when a child starts missing developmental milestones. Rest assured that science is on your side, and advances in screening, diagnostics, and treatment are helping us understand more about autism every single day. We know early diagnosis leads to early intervention, which has been shown to improve behavior, skills and language development. Early intervention helps with the outcomes of children diagnosed with autism. It’s important to bring up any concerns to your child’s primary care doctor as soon as you have any worries or concerns.

To help raise awareness of this rare genetic cause of neurodevelopmental disease, M. Scott Perry, M.D., medical director of neurology and director of the Genetic Epilepsy Clinic at Cook Children’s, shares basic information about the disorder and exciting advancements towards treatment for this rare disease.

What do SCN2A-related disorders look like? 

Children with genetic variants in SCN2A can develop early onset epilepsy with various levels of severity. SCN2A was first discovered as a cause of benign familial neonatal infantile seizures (BFNIS), a syndrome that often occurs in multiple family members. These children can develop seizures as newborns or infants, but can develop normally with good seizure control.

Later, SCN2A was discovered as a cause of infantile spasms and other early onset severe epilepsies of childhood, the so-called early infantile epileptic encephalopathies. The gene has also been linked to Ohtahara Syndrome, Dravet Syndrome, Migrating Partial Epilepsy of Infancy and West Syndrome amongst others. In addition, SCN2A variants are a major cause of intellectual disability, schizophrenia, and autism which may occur without associated epilepsy. A variety of other medical conditions may be present in people with SCN2A-related disorders, including sleep problems, cerebral palsy, and movement disorders to name a few.

What is the cause of SCN2A-related disorders? 

SCN2A is a gene which makes a sodium channel found primarily in the nerve cells that generate electricity. Two issues can occur with SCN2A. The first is a change in the gene which causes a gain of function – a change that allows too much sodium to enter the nerve cell and thus increases electricity – often presenting with epilepsy as a main symptom.

For others, SCN2A variants cause a loss of function – a change that decreases sodium entering the nerve cell and thus decreases electricity – more often presenting with autism and intellectual disabilities. Many mutations in SCN2A are de novo, meaning they occur spontaneously and were not inherited from the parents. This is often the case in more severe disease presentations. There are instances where SCN2A may be inherited from a parent and this is more commonly seen in benign presentations such as BFNIS.

How are SCN2A mutations diagnosed? 

Often, genetic testing can diagnose SCN2A mutations. The Behind The Seizure program provides free testing for children in the U.S. under the age of 8 years.

Magnetic resonance imaging (MRI) scans are often normal and electroencephalogram (EEG) findings may vary.

Is there a treatment for SCN2A-related disorders? 

While there is not yet a cure for SCN2A-related disorders, a significant amount of research is leading to exciting new therapies. Certain traditional sodium channel seizure drugs (for example, phenytoin, lamotrigine) have demonstrated more favorable responses for seizure control in select patients (often gain of function), while in others, sodium channel drugs may aggravate seizures.

New drugs are being developed that specifically target the abnormal channel produced by SCN2A. These treatments may provide more precise control of the channel without disrupting the function of other sodium channels like many traditional sodium channel seizure drugs. This may result in better seizure control with less side effects.

Potentially most exciting is the development of genetic approaches to therapy, treatments that don’t just treat symptoms, but aim to correct the genetic abnormality. Antisense oligonucleotides (ASO) are small pieces of genetic material that can be given to help increase or decrease production of SCN2A. This approach has been used in other genetic conditions (spinal muscular atrophy and Dravet syndrome) with success and represents a promising therapy for SCN2A disorders as well. This is just one of several genetic approaches to therapy on the horizon.

Where can you find more information about SCN2A disorders?

For more information about SCN2A and SCN2A Awareness Day, visit www.scn2a.org. The SCN2A Foundation serves as an excellent resource for information about SCN2A related disorders and helps connect a community of people living with these rare conditions. The site provides updates on SCN2A research as well.

Augmentative and alternative communication (AAC) allows non-verbal children and adults the opportunity to learn how to communicate through a speech generating device (SGD). The device, similar in shape and size to a tablet, can be mounted to a wheelchair or desk, and tracks the movement of their eyes to choose preset pictures, words and phrases, depending on skill level.

Many children who are non-verbal experience frustration and behavioral issues due to the inability to express themselves to others. AAC focused therapy has the ability relieve the tremendous frustration that often accompanies lack of communication. Therapy sessions often include games to help patients learn how to utilize their full field of vision and learn how operate the device independently.

“If you’ve had any experience not being able to communicate, even for a short-term, it’s very frustrating when people don’t understand you,” Speech/Language Pathologist at Cook Children’s Rehab Center Carol Edley said. “We’re trying to get them to be independent, intentional communicators, and not be placed in the role of a responder.”

Eleven-year-old Willy struggled with speech his entire life until his mother, Carla Cowdrey, learned about AAC therapy, and knew Willy would thrive with the opportunity to finally speak.

“I really had a feeling Willy could communicate, and this was the way he was going to do it,” Carla said. “And it turns out, it worked.”

Willy has learned numerous words such as go, play, help, mom and recently said “she look”, referring to Carol on the computer monitor, during a telemedicine visit. His word choices are described as a one to two-step process, depending on his choice, and his mom is hopeful for longer phrases in the future.

More recently, Willy has begun using short phrases to ask questions.

“When you start having the child demonstrate what they are thinking, in a manner where they are understood, for lack of a better term, it just makes the family happy,” Carol said. “All of a sudden this child is something more than they thought he or she could be.”

For Marisa Sanchez, AAC therapy has allowed her to hear her daughter Isabella’s first words at six years old, including the word every mother wants to hear: mom.

“Going into this journey six years ago, and not being able to have your six-year-old communicate with you, it’s hard,” Marisa said. “Hearing Isabella say mom for the first time is something I’ll never forget.”

Isabella knew four words on her device in February 2020, and now has access to 28 words to grow her vocabulary.

“We’ve increased the number of buttons presented to give her more language to choose from,” Isabella’s speech language pathologist Theresa Jones said. “She’s recently started using words like “papa”, “go… home”, “go”, “put” and “stop”. This is in addition of her using [the word] mom. Dad got to see her use “papa” for the first time via FaceTime since we only allow one parent with a patient at a time due to COVID-19.”

Edley estimates 30% to 50% of the eye gaze therapy patients have moved to telemedicine in the wake of COVID-19. The change in therapy delivery has given families the opportunity to learn how to adapt when glitches and other life moments occur.

“For the kids, it can be difficult to shift eye gaze from their device to the computer screen that may have a book or some other language activity. But that is life and they would have had to learn to shift attention in busier environments to talk.”

Although COVID-19 has shifted routines and therapies, the Cook Children’s speech pathology team has still been able to work with the AAC SGD vendor to supply the devices for patients and families to continue working on speech at home.

“Excitedly, we gave out a rental device with eye gaze yesterday. She hasn’t had the chance to practice these last two to three months,” Carol said. “It was exciting to see the little girl's reaction. With her, her mother and I have found low tech ways to train her eye gaze. The real thing is so much better.”

AAC eye gaze therapy has given parents hope, and their children, like Isabella and Willy, a voice.

Historically recognized as Autism Awareness Month, April 2020, like everything else, has been overshadowed by COVID-19.

It’s important to recognize that children with autism are adapting to new daily routines just like the rest of us, but for some, new routines can be hard to establish.

For example, the Centers for Disease Control and Prevention have recently recommended the use of cloth face coverings in public settings, like grocery stores and pharmacies.

For kids who don’t like wearing shoes or other tight fitting clothing, parents may be wondering how in the world they can get them to wear a face mask?!

Research on applied behavior analysis points to two solutions to adapting to new routines: pairing and shaping.

Pairing is a method introducing unfamiliar objects, like a face mask, to children with autism. To appropriately pair the new item, we deliver it to the child along with positive reinforcers like tickles and hugs.

Prior to asking the child to wear the mask, we simply want them to become more familiar with it. We can do this by giving them a mask followed by praise or high fives. Don’t be afraid to be silly with it either! Try making goofy faces with your child and using the mask to play peek-a-boo. Once the child is comfortable in the presence of the mask, we use shaping to get them to wear it.

The goal of shaping is to reinforce each small step towards wearing the mask. With pairing, we simply want the child to enjoy holding the mask. Now we may provide the same rewards for (a) bringing the mask toward their face, (b) touching the mask to the face, (c) allowing us to pulling back the elastic, and (d) fitting the elastic over the head.

It sounds easy, but each step may require several trials, and it’s important not to move ahead too fast. As we continue to celebrate this year’s Autism Awareness Month, let’s remember that we’re not the only ones who are adjusting to a new way of life.

Regardless of statistics, research or science, some parents will never change their minds.

But for the vaccine-hesitant parents who are truly trying to make the most informed decision for their child, let’s take a look at some of the most commonly asked questions and concerns we read on social.

The responses to these questions are based on extensive research conducted by the Cook Children’s Vaccine Clinical Guideline teams, comprised of primary care and specialists in their field. The team cited 99 different sources during their research and their work was approved by the Cook Children’s Medical Center’s Clinical Excellence Committee.

We hope this helps to answer some of your questions.

1. Do vaccines work?

Immunizations are considered to be one of the greatest accomplishments of modern medicine. Compared to pre-vaccine statistics, we’ve seen a reduction in the number of cases of measles by 99.9%, mumps by 95.9%, pertussis by 92.2% and rubella by 99.9%.

This is important because many vaccine-preventable diseases require high vaccination rates to maintain community immunity. For most of the vaccines that are currently available, there must be a population immunization rate for at least 90% to ensure consistent community immunity and some diseases that are highly contagious, such as pertussis or measles, require population immunization rates of at least 95%.

The maintenance of community immunity protects people who received the vaccine but were unable to generate a lasting immune response to the illness, as well as those individuals who are too young to receive a vaccine or have medical reasons that prevent them from receiving a vaccine.

2. Do vaccines cause autism?

This is a most difficult subject to approach because some parents make the direct link to their child’s autism to the vaccines they received.

Because MMR is one of the vaccines that is given to children between 12-18 months and signs of developmental conditions such as autism develop around the same time, it’s easy to see why families would perceive a cause and effect relationship between the two.

This argument was strengthened when Andrew Wakefield published an article in The Lancet in 1998 that claimed a link between the MMR vaccine and autism. Since his initial article was published, investigations have found that Wakefield’s study was flawed by research misconduct, conflicts of interest and lies. This ultimately led the Lancet to retract his original article. In 2010, Wakefield was barred from practicing medicine in Britain.

Dozens of studies have been conducted to look for any possible link between vaccines and autism and these studies continue to confirm no link exists, and that vaccines are safe and effective.

3. If children receive too many vaccines, can it overload their system?

While the number of vaccines that children are given has increased over time, children are actually being exposed to fewer antigens than they had been previously – thanks in large part to the increased purity of the pertussis vaccine.

Some parents may have concerns that vaccines can overwhelm a child’s immune system, but this simply isn’t true. When a child is born, they leave a relatively sterile environment and within hours their GI tract becomes heavily colonized with bacteria. They begin to produce what’s called a specific secretory IgA against these bacteria within the first weeks of life. A 2002 study, published in Pediatrics, states that an infant has a theoretical capacity for up to 10,000 vaccines at any one time.

Multiple studies have been done that show vaccines do not cause an increased risk of infection for children. One study even found that children who received vaccines had a lower rate of infections from vaccine-related and unrelated pathogens. There is also no evidence to support the idea that vaccines lead to increased risk of SIDS. Research has found that vaccines significantly reduced the risk of SIDS.

Children with severe immunodeficiencies who receive live viral vaccines may be at risk for developing an infection or disseminated disease. The biggest concern would be children with T-cell immune deficiencies receiving live virus vaccines. Fortunately these immune deficiencies are usually diagnosed around 6-8 months well before the first live virus vaccines are scheduled (12 months). 

With all that being said, many children with immunodeficiencies can receive vaccines safely, such as certain children with HIV or certain children with malignancies.

4. Is it really hygiene and better nutrition that caused disease reduction and not vaccines?

Statements like this are commonly found in anti-vaccination literature and it implies that vaccines are ineffective and unnecessary. While better hygiene and nutrition have certainly helped to improve the health of our population, it ignores the dramatic effects of vaccination.

If hygiene and nutrition were responsible for disease reduction, you would expect all disease incidence to decrease at around the same time, but this is not what we have seen. Instead, we have seen a recurrent pattern of disease reduction shortly after a vaccine against that disease has become available.

For example, while there was yearly variation in rates of measles, it wasn’t until a vaccine was released and widely distributed in 1963 that we saw a permanent drop in measles cases. Another example is Haemophilus influenza type b, which remained prevalent until the early 1990s when a vaccine that could be used in infants was developed.

Another way of debunking this myth can be to look at individual countries who saw a decrease in their immunization rates. Great Britain saw a dramatic drop in their immunization rates for pertussis in 1974, which was followed by a pertussis epidemic with more than 100,000 cases and 36 deaths by 1978.

In Japan, a drop in pertussis vaccine rates around that time from 70% to below 40% resulted in an increase of pertussis cases from 393 in 1974, to 13,000 in 1979.

5. If your child is vaccinated, why do you care if my child isn’t?

The increasing prevalence of vaccination acts to prevent the circulation of an infectious organism within the community provides benefit to everyone, even those who aren’t vaccinated. This is referred to as community immunity. Community immunity is an important means of protecting the elderly, the young and those with medical conditions that prevent them from receiving vaccines.

For most of the vaccines that are currently available, there must be a population immunization rate of at least 90% to ensure consistent community immunity and some diseases that are highly contagious, such as pertussis or measles, require population immunizations rates of at least 95%.

The maintenance of community immunity is important to protect those individuals who received the vaccine but were unable to generate a lasting immune response to the illness, as well as those individuals who are too young to receive a vaccine or have medical reasons that prevent them from receiving a vaccine.

More on This Topic:

• Vaccines for Your Children: 9 Facts Parents Need To Know
• Vaccines and Immunizations
• Information for Parents
• Immunization Collaboration of Tarrant County
• Childhood Vaccine Assessment Tool (CDC)
• American Cancer Society and HPV
• Centers for Disease Control and Prevention
• Vaccinate Your Family
• Voices for Vaccines
• Allied Vaccine Group
• Texas Department of State Health Services

This would be stressful for any mom, but Alexa's son has high-functioning autism. She was worried about who would be sitting next to him on the flight and would they be tolerable of her son. 

The story had such a happy ending because of a wonderful man named Ben Pedrazza, who even messaged Alexa with a photo of the two of them on the flight. 

"He did ask if we were there yet several times but he was a great travel buddy," he wrote. 

Isn't that awesome?

With this story in the news, I thought it would give us a chance to talk about autism. I often get asked about it in my office. Some parents want to know if their child should be tested or how they would know if their child has autism. So let's take a look at what pediatricians look for as far as the signs and symptoms of autism spectrum disorder.

Not one single test can diagnose autism. This is not surprising given the complexities of the neurodevelopmental condition, some of those we do not understand fully. What is known is that the earlier it is diagnosed the earlier interventions can be started and the outcomes tend to be more positive.

So what do you look for? What are the signs?

The real answer is it can vary depending on the child, key to early diagnosis requires a partnership between the parent and the child’s doctor. Any concerns a parent has about development should be looked into further. In other cases, concerns may arise after standard developmental screening which occur at each well-child visit. Standard autism screening should occur between 18-24 months of age.

Autism, or ASD (Autism Spectrum Disorder), is a neurodevelopmental condition that may include difficulties with social skills, behaviors of repetitive nature and difficulties with verbal and nonverbal communication. It’s estimated that 1 in 59 children are affected by autism in the United States today. ASD is a complex disorder that presents with varying degree symptoms ranging from mild to severe. There is no single cause, and at this time both genetic and environmental factors are thought to contribute. More importantly no reliable studies to date have shown a link between ASD and vaccines.

Some early signs include:

• Delays in development like delayed babbling or cooing
• Lack of social smile by age 6 months
• No pointing or waving by age 12-14 months
• No single words by age 15 months

Having a pediatrician recognize these signs is one of the reasons it’s important to keep your child up to date with well-child visits. The visits typically include questionnaires about development and this is an opportunity to identify any of these delays early.

Some children may have delays only in one area and no other difficulties. Standard screening tools exist to help your doctor identify other problems which may indicate autism as a possible diagnosis.

One of the most widely used screening tools is MCHAT-R (Modified Checklist for Autism in Toddlers, Revise). This checklist is a series of 20 yes/no questions. The scoring of this screening tool gives a low, medium or high risk for ASD. All children with medium/high risk results should have appropriate follow up which may include referral to a developmental pediatrician or a trained psychologist for formal ASD testing.

What if the screening is negative, but the parent has concerns?

A detailed history regarding the concerns also may lead to referral for further testing even if the screening is negative. The reason for this is because ASD has such a wide presentation of symptoms it may eventually be diagnosed when symptoms are more subtle.

Since every child with autism is different, the treatment recommendations will vary for every child depending on the difficulties they are having. The current evidence supports the following effective treatments for autism: ABA (Applied Behavior Analysis), speech therapy, occupational therapy and treatment of any other co-existing condition of course.

We know early diagnosis leads to early intervention, which has been shown to improve behavior, skills and language development. Early intervention helps with the outcomes of children diagnosed with autism. It’s important to bring up any concerns to your child’s primary care provider as soon as you have any worries or concerns.

An early diagnosis may also start you on an incredible journey with a child as interesting and amazing as Landon.

For more on this Topic:

• Autism
• Cook Children's Child Study Center
• New Self-Defense Class Empowers Teens with Intellectual Disabilities to be a 'Hard Target'
• The Autism Spectrum: A Pediatrician's Explanation
• Avery's Journey: An Autism Spectrum Disorder
• Autism Spectrum Disorder: The Need to Wander or Elope
• Julia Brings 'Sunny Days' to Kids with Autism
• Living with Autism
• What Is Autism?

It may sound like a melee, but this is part of a unique program that launched last fall at the Jane Justin School at Cook Children’s Child Study Center. The program began as a R.A.D. self-defense course and has since evolved into a curriculum called ‘Hard Target.’ The 12-hour class teaches self-defense to students with developmental and learning disabilities in the Center’s Upper School.

On this morning, four female students are participating in a drill. The scenario includes being attacked at an ATM and sadly, because of their disabilities, it’s a situation they’re more likely to find themselves in than the average person.

“We know that individuals with developmental disabilities are three to five times more likely to become victims of bullying, assault and sexual assault,” said Joyce Elizabeth Mauk, M.D., CEO and medical director of the Child Study Center.

According to a recent investigative series by NPR called ‘Abused and Betrayed’, the rate of sexual assault among people with intellectual disabilities may be even higher. Reporter Joseph Shapiro said in his report that unpublished data from the U.S. Justice Department shows people with intellectual disabilities are sexually assaulted at seven times the rate of people without disabilities. His series calls the issue an “epidemic.”

The concern surrounding these statistics sparked an idea with the Child Study Center’s team. What if they taught students how to defend themselves, especially during the transitional years when students are preparing to go out into the world to seek employment and possibly even live on their own? Dr. Mauk and her team contacted Security Services at Cook Children’s, which already provided self-defense courses to employees. Together they developed a curriculum specifically tailored to the needs the school’s students, aged 13 to 22.

“The most important thing we want these students to learn is how to protect themselves,” said Brennan McCullars, ‘Hard Target’ instructor and security services trainer at Cook Children’s. “These are people who are much more vulnerable to predators than the majority of the population. They are often trusting of others. They don’t always know what behaviors are inappropriate, so we have to work on that.”

One of the girls in McCullars’ class is 18-year-old Elizabeth. She’s a soft-spoken junior at the Child Study Center’s school where she also interns as a teacher’s aide. She’s small in stature and supportive of her classmates, cheering them on as they move through the course. When it’s her turn to approach the “ATM” – a punching pad leaned against the wall – Elizabeth transforms. There’s no reservation in her voice as she belts out ‘’NO!” and blocks incoming hits. She throws eight punches before sprinting away from her “attacker.”

When asked what she thought of the course, Elizabeth said she feels more confident now.

“In self-defense class, they taught us how to use our voice and how to use our hands and our feet (against an attacker),” said Elizabeth. “It has eased my concerns because I know I can protect myself when my brothers and my support system are not around.”

For Elizabeth’s father, Lonnie Ramon, these new skills are just one more tool in her toolbox. He and his wife believe Elizabeth will be able to live and work independently. He says he feels better about her future knowing she’s had to think through what should be unthinkable situations.

“It’s a crazy world nowadays. You see too many weird and crazy things on TV. People take advantage of others and I’m afraid of that,” said Ramon. “But that’s part of this self-defense course. It’s helping her think about how to get herself out of situations, God forbid they ever arise.”

Along with the four females, a group of eight male students are also going through ‘Hard Target.’ All of the students who complete the class will have a chance to take a refresher course next school year.

“We are excited to offer this one-of-a-kind curriculum,” said Tracie Mann, Ph.D., LBA, the headmaster of the school. “The ‘Hard Target’ program demonstrates our unwavering commitment to preparing our students for the future, both academically and in life.”

Kevin & Avonte’s Law will give $2 million annually until 2022 for grants to local law enforcement and nonprofit agencies. The money can be used to provide parents and caregivers the opportunity to voluntarily apply non-invasive tracking technology attached to their children to help locate them if they have wandered away from home.

Nearly half of children with Autism Spectrum Disorder (ASD) older than 4 years of age are reported to wander, or elope, from home.

The American Academy of Pediatrics (AAP) states that of those children, “one-quarter of families report at least one episode that placed their child at risk for drowning, and two-thirds report risk for traffic-related accidents.” Accidents are the most common cause of death for children, youths and adults with ASD.

“I am pleased to see bipartisan support for individuals with autism and other developmental disabilities and am encouraged by this legislation,” said Matt Robison, LMSW, director of the Cook Children’s Child Study Center . “Given the large number of individuals with autism who may elope or wander from home or school, having resources available in the community to help keep them safe is critically important. Having a community that is both equipped to deal with and aware of the potential safety risks for this vulnerable population goes a long way in ensuring their safe return home.”

Kevin and Avonte’s Law is named in honor of two boys with autism who died after wandering. The grants from the law will facilitate training and emergency protocols for school personnel, supply first responders with additional information and resources, and make locating technology programs available for people who may wander from safety.

“Impulsiveness is present in at least half of individuals with ASD, who also may not understand or attend to environmental danger,” according to the AAP. “People with ASD may leave a situation that they find stressful when overstimulated, anxious, confused or afraid. They may become upset at times of transition or commotion, or in new or unfamiliar settings and try to leave.”

Another issue is that an intense interest in water may cause someone with ASD to seek it out, causing an increased risk for drowning.

“Elopement is a common and dangerous behavior seen in about half of children with autism,” said Joyce Mauk, M.D., a neurodevelopmental pediatrician at Cook Children’s and CEO/medical director of the Cook Children’s Developmental Pediatrics and Child Study Center. “It occurs more commonly in children with more severe developmental delays. When this happens it’s of great concern because children can face dangers of drowning or traffic injury when they run away.”

Dr. Mauk says children with ASD most frequently run away from the home, but can escape their caregivers in various community settings. Dr. Mauk says she has seen teen-aged patients run away and cross several busy urban intersections before finally being found. But even when someone tries to help, it may not guarantee safety for the children who have eloped.

“Because children with autism may have poor communication skills, they may not give reliable parental contact information when they are found,” Dr. Mauk said.

Dr. Mauk recommends the following for parents to safe-guard their children with ASD:

• Use a medic alert bracelet or tag for children who are known to elope.
• Look into GPS trackers that can be worn attached to shoes.
• In cases where this is a severe problem of the child bolting from his or her parents, the child may even need to be contained in large strollers when the family is out.
• At home closed and locked doors are helpful.

But in the end, Dr. Mauk stresses that nothing beats close care-giver supervision.

Other Resources:

Cook Children’s Developmental Pediatrics and the Child Study Center

National Autism Association website

Family Wandering Emergency Plan

AAP: Anticipatory guidance for children with autism should address wandering

Released earlier this year, the survey looked at more than 3,500 school-aged kids with either ASD, intellectual disability and or developmental delay; and found that children on the autism spectrum disorder were more prone to wander, or elope, from home. Of the parents surveyed, more than 26 percent had eloped in the previous year.

The number of kids who stray from the safety of their homes increases even more dramatically when you look at kids as young as 4 years old and up.

“Elopement is a common and dangerous behavior seen in about half of children with autism,” said Joyce Mauk, M.D., a Cook Children’s pediatrician/CEO and medical director of the Child Study. “It occurs more commonly in children with more severe developmental delays. When this happens it’s of great concern because children can face dangers of drowning or traffic injury when they run away.”

Dr. Mauk says children with ASD most frequently run away from the home, but can escape their caregivers in various community settings. Dr. Mauk says she has seen teen-aged patients run away and cross several busy urban intersections before finally being found. But even when someone tries to help, it may not guarantee safety for the children who have eloped.

“Because children with autism may have poor communication skills, they may not give reliable parental contact information when they are found,” Dr. Mauk said.

Dr. Mauk recommends the following for parents to safe-guard their children with ASD:

• Use a medic alert bracelet or tag for children who are known to elope.
• Look into GPS trackers that can be worn attached to shoes.
• In cases where this is a severe problem of the child bolting from his or her parents, the child may even need to be contained in large strollers when the family is out.
• At home closed and locked doors are helpful.

But in the end, Dr. Mauk stresses that nothing beats close care-giver supervision.

Joyce Mauk, M.D., CEO and medical director of the Child Study Center, believes the increase in more kids being diagnosed is because examiners are now more aware of the autism spectrum than ever before because of the attention autism has gotten in recent years.

So what exactly is the spectrum?

Dr. Mauk, who is a Cook Children’s pediatrician and board certified in pediatrics and neurodevelopmental pediatrics, says that most human characteristics aren’t spread evenly across the public.

She compares it to the ability to draw. A few people are excellent. Some are natural artists. The majority of us do Ok and some of us have no skill at all.

Dr. Mauk says that’s also the way to look at the autism spectrum, and some other disorders as having a range or continuum. Children are generally diagnosed with an autism spectrum disorder in the preschool years. Those at the severe end of the spectrum are diagnosed at an earlier age and those at the milder end are diagnosed later. Dr. Mauk says this is because the severe end is associated with more severe developmental delays such intellectual disability or mental retardation.

More severe problem behaviors (self-injury, aggression) are likely to be nonverbal and more likely to have a known genetic cause (etiology).

At the milder end are children whose cognitive abilities are in the normal range and have less significant problem behaviors (rhythmic, repetitive movement, or stereotypies, and rigid behaviors).

“An experienced clinician will make the determination of degree of severity,” Dr. Mauk said. “There is no specific test that will alone determine the diagnosis or the level of severity. In the past children at the milder end of the spectrum would not have been diagnosed with autism. They may have had a diagnosis of Asperger Disorder or a language disorder with atypical features. In general those on the mild end have a better prognosis and will need less lifetime supports.”

Click here to learn more about your child’s development and what you should do.

Previous articles related to this topic:

Why are more U.S. kids being diagnosed with autism than ever before?

Julia brings 'Sunny Days' to kids with autism

But the research may simply be a matter of parents being more mindful of autism than they were previously.

“What is telling is that the overall prevalence of developmental disabilities hasn’t increased,” said Joyce Mauk, M.D., CEO and medical director of the Child Study Center. “Some of this is diagnostic substitution. Many more children with language disorders and some unusual features of behavior are now being diagnosed with autism.”

Dr. Mauk, who is board certified in pediatrics and neurodevelopmental pediatrics, said examiners are more likely to diagnose children with more subtle or mild symptoms of the autism spectrum than ever before because of the attention autism has gotten in recent years.

The Centers for Disease Control and Prevention and National Center for Health Statistics stated reported that 1 in 45 children were diagnosed with autism in 2014, a leap of nearly 80 percent from 2011 to 2013 (1 in 68 children were diagnosed during that time period).

“The survey changed from 2013 to 2014 and the categories for autism were more inclusive in the most recent study,” said Lena Zettler, director of Psychology at Cook Children’s. “They included other developmental delays. The incidence isn’t necessarily changing, but awareness is.”

Both Dr. Mauk and Zettler agree that the focus should remain on the science we know.

Autism is more common if there other family members who are on the spectrum. Higher incidence in autism can occur if:

• The father is older
• Pregnancies are less than two years apart
• Preemies are at a higher risk for developmental delays (including, but not limited to the autism spectrum)

The survey found that the majority of children diagnosed were boys than girls, with a 75 to 25 ratio. Fifty-nine percent were identified as non-Hispanic White.

Another key factor that some point to is the fact that more than 67 percent of the children who were diagnosed had at least one parent with more than a high school education, which could mean they are more likely to be aware and educated of the symptoms of autism, making for quicker identification.

“There is of course a lot we still don’t know about the underlying factors that cause autism, but I think the fact that people are becoming more aware is a great start,” Zettler said. “It makes for quicker diagnosis and care for the child.”

We know these familiar names from Sesame Street like they are family members. Maybe, because they all had a hand in raising most of us.

But now a new character has brought excitement from families of children with disabilities and health care professionals alike.

Julia is an orange-haired girl with autism, who is a friend of Elmo’s. The new character will help children get a glimpse of the life of a child with autism and explain why she gets upset over loud noises or memorizes the words to so many songs.

“I think this is really great,” said Barbi Beard-Wolfe, the Parents as Partners coordinator at Cook Children’s. “Introducing Julia to kids at an early age teaches children different approaches to ways of life, interaction with others and that people with disabilities are more alike than different. People who have autism or other challenges have value and can have a meaningful life like typically developing people.”

Beard-Wolfe believes by including Julia as a character, Sesame Street is teaching children how to have social interaction with others and hopefully prevent stereotypes.

“Hopefully, by kids growing up with this character, they will think a child with autism or another disability is OK instead of weird and they will learn to enjoy and see the value in their differences.”

Beard-Wolfe has a child with Down syndrome and is happy that kids may learn "more alike than different approach.”

Denise Coover , a clinical social worker with the Psychology department at Cook Children’s, believes Sesame Street may help not only children, but adults learn more about children who have been diagnosed with a Autism Spectrum Disorder.

“Sesame Street has done a spectacular job celebrating children who have this diagnosis as special, unique and wanting the same things as children who are developing in a typical manner. I read that Sesame Street chose Julia to be a girl, rather than a boy to bring to light that although the disorder occurs more frequently in boys, girls can also have the disorder,” Coover said. “Showing other children how to have empathy and to recognize that children on the spectrum see the world in the most amazing way. They will teach you to find joy in things in ways you would have never imagined. One of my favorite things about children on the spectrum is that they really are present in the moment, not in the past and not in the future – they live right in the here and now. “

Coover believes Sesame Street could help children to recognize all the unique and fun experiences they will have when they befriend a child on the spectrum, as well as offer insight into hand flapping and other behaviors that may be difficult for children to decipher and note that we all have things we do that make us stand out.

Some children jump when excited, some run in circles and some flap their hands. Who is to say that there is one acceptable way of showing excitement? Sesame Street offers different videos to watch, including an e-book. Coover says it would be beneficial to view for children in many settings, like day cares, mother day out programs, preschools, etc. It also offers support to parents on interacting with other parents who have children with an autism diagnosis, as some parents are uncertain about how to support another parent.

“A unique offering is the view of the sibling who happens to have a family member who has autism,” Coover said. “It offers a perspective that I think is sometimes overlooked. Siblings play such an important role in any family, but when a child is diagnosed with Autism, the sibling is put into a position that can feel very lonely and full of adult responsibilities and worry. Sesame Street has offered normalization to a sibling experience that is both encouraging and supportive.”

*Images courtesy of Sesame Workshop

No.

So why are we discussing this issue again?

Because Donald Trump linked vaccinations to autism in last night's debate between Republican presidential candidates.

“Autism has become an epidemic, 25 years ago, 35 years ago, you look at the statistics, it’s not even close,” he said. “It has gotten totally out of control.”

He went on to say he had evidence of a relationship between autism and vaccinations.

I wish I had a voice in the debate last night, I would have been less political and more factual.

What can’t be debated are the facts on this issue: Multiple studies done by different people in different places have shown consistent results that vaccines do not cause autism.

There have been multiple theories proposed over time as to why vaccines might be a cause of autism. In my checkups and vaccine discussions, I generally address the issue of vaccine safety by answering three questions:

No. 1 - What does basic science say?

No. 2- Do studies of groups of children (vaccinated vs unvaccinated) show a problem?

No. 3 - What do you do with your own kids?

Basic Science

The basic science and scientific community has overwhelmingly supported the use of vaccines in children over time. Take a look at any major medical organization and they support vaccination. The overwhelming majority of pediatricians support vaccines according to the Centers for Disease Control schedule. Just so you don't think you’re in the minority, the overwhelming majority of patients have their child vaccinated according to the same schedule.

Over time, various concerns about vaccines have been brought up. Basically the way it happens is like this … someone comes up with a theory as to why vaccines might be a cause of autism. The scientific community starts to complete studies to determine if it could be a concern. Over and over, the theories have been disproven. Here are three specific examples of this pattern.

Population Studies

I believe that research has shown, through basic science, that vaccines are safe. But, there are studies that have looked at the problem from a different perspective.

In an example from 2010, two researchers from the University of Louisville, Dr. Michael Smith and Dr. Charles Woods, studied a group of over 1000 children to determine if delayed vaccination or on-time vaccination affected developmental outcomes. The study was published in Pediatrics (the journal of the American Academy of Pediatrics) in June 2010.⁵ The study compared children who were vaccinated “on-time” (received vaccinations within one month of the recommended schedule) with children who were not on-time.

The testing looked at multiple different tests, which included outcomes for speech, intelligence, memory and behavior control (among a few others). Results showed that children who were vaccinated on-time showed improved scores in intelligence and naming questions, all other testing showed equivalent scores. If delayed vaccines protected against autism or other developmental problems you would expect those vaccinated on time to show deficiencies in many of the areas tested.

Another study done in Australia, released in June 2014 looked at multiple combined studies totaling 1.2 million children. The findings were overwhelming supportive and showed no link to autism for any of the following: vaccination and autism, vaccination and autism spectrum disorders, and autism and MMR/thimerosal/mercury.

These are just two examples of many studies that have shown vaccines to be safe and not a cause of autism, even when looking at large studies of populations over time.

My Personal Practice

The science tells us that antigen load (and load on the immune system has actually decreased) and population studies have shown that children vaccinated on time do not have developmental problems.

But the real point I like to discuss with my families is this: I vaccinate my kids on time. Each of my children has been vaccinated on time without hesitation. I am confident that by doing so I have not harmed them in any way and I will continue to vaccinate them with all available vaccines according to the CDC schedule.

I am willing to have an open and honest discussion with any family about their choice to vaccinate, their choice to vaccinate on an alternative schedule, or any other issue surrounding vaccination but I do feel strongly that vaccines are safe and that I am not putting any child at risk by vaccinating and vaccinating on time.

In summary, I have studied this issue extensively and have seen no study that convinces me that vaccines are the cause of autism or any other concern. I consider them to be the most important thing that I do to prevent disease in my patients and will continue to vaccinate my children and my patients with confidence.

Vaccines work. Vaccines are safe. Donald Trump shouldn’t change your mind.

“It’s wonderful day. I thought I would never be a mom,” Kristy said. “Mother’s Day is not something I take for granted. I’m grateful to my mother and grandmother, who taught me to be a mother . I love it.”

But when you consider each child has his or her own special needs, life can be amazingly hectic and difficult. And what’s the biggest challenge for the mom of nine?

“Probably laundry,” she jokes. “Would that sound crazy if that was my answer? I think more than anything, it’s working to meet each kid’s individual needs where they are at that particular moment. And then looking ahead, some of the kids aren’t as independent as they should be when they hit that magical 18 mark. Some are not ready to go out into the world yet. Some days that’s the scariest thing for me.”

Kristy’s story began as it continues now with her husband John. They loved kids then as much as they do now, but they couldn’t have any of their own.

John was a foster care agent. He was 26 at the time and Kristy was 22 when they met Luke and Josh, 7 and 2 respectively. Then two years later, they met Kathryn and Daniel, a brother and sister who were 6 and 4 then.

“After we got them, we kind of thought we were done,” Kristy said. “We weren’t sure though and we kept our certification to get more kids placed with us. Then two years later we met a set of precious little twins – Juliana and Josiah, then 4, who were half of a sibling group with Paul and Caleb, then 7 and 5. They were in an emergency situation. Their life would be pretty demanding. We thought we could add four and we already had four, so eight sounded about right.”

But what sealed the deal was when Juliana said to John, “All my friends have a daddy. I don’t have one. Will you be my daddy?”

Maybe some could still say no, but not the Goodnights. Their hearts are too big and their skills at taking care of kids with special needs too strong. All of their eight adopted children have medical and/or behavioral needs.

The Goodnights take their children from their home in Corsicana to Cook Children’s to be treated at the medical center. Kristy jokes her kids have many “ists” – endocrinologists, neurologists, psychologists …

“We have all of our specialty care through Cook Children’s,” Kristy said. “We really appreciate the cohesiveness of care. The specialties share information with each other. One doctor sees what the other doctor has done. There’s a great consistency of care. The other thing we like is we see the same doctor every time in their specific specialty and that’s not always true with other places. And we see a slew of doctors for everything from cerebral palsy to autism to emotional issues. We see doctors for behavioral issues, intellectual issues, growth issues – a wide variety of stuff. We are at Cook Children’s on a regular basis.”

Of course with the number of kids and the challenges that each bring, Kristy admits that she sometimes wonders if she’s the best person to care for them.

“There’s always days where I think I’m not doing the best I can and I think surely I can be a better mother,” she said. “I look around and the laundry is not done and the house is a mess. And then I remember the alternative. Without us, they wouldn’t have a family at all.”

Kristy chuckles. “And then I realize, I’m better than nothing.”

Needless to say, John says his wife is selling herself way short.

“She keeps everybody grounded, including me,” he said. “He keeps me focused on what’s important and not letting things bother us that might get in the way of that fact that we’re all in this together. She’s the most loving person that I know and you can tell she wears her emotions on her sleeves. You can look at her and know our kids are extremely important to her.”

And with that kind of love, why stop at eight, right? The Goodnights realized they’d experienced so much as parents, except what it was like to raise a newborn.

Kristy and John looked at other countries, but nothing came to fruition. Then they found a story on a new spin on in vitro fertilization – adopting an embryo. The embryo had been frozen for 10 years and was made available to the Goodnights. They only knew the age of race of the parents, but nothing else. They made the decision to take the baby without knowing anything more. They were used to facing challenges and they would be up for one more challenge.

So far, the newest member of the family, Jude, has been healthy. But he's still a toddler in a house with eight other children. Kristy says that’s OK because one more person only adds to what makes the Goodnight household special.

“The love. I love having a family. There’s just so much love in this house,” Kristy said. “There’s always someone laughing. It’s so much fun. I never expected that and the way the other kids care for the baby. It’s just tied everybody together in the ends. We have sweet kids with big hearts and that’s given us the ability to love everything we’ve gone through.”

Over the following months, Isaiah began to show the classic signs of Autism: regression of previously acquired skills, repetitive drumming, hand stemming, staring into space for brief periods of time and desiring less social interaction. At the age of 3, Isaiah transferred from Early Childhood Services (ECI) to public school; it was there the Hensons were informed of the possibility of autism. By the age of 4 years old, Isaiah received an “official diagnosis.”

“Though I saw all the signs of autism, I did not desire the label of ‘autism,’” Lotoya said. “The onset shock was overwhelming. It was difficult at times to mask my emotional state. I would take tearful breaks, relying heavily on the foundation of my faith. When telling others about the diagnosis, tears began to flow before my thoughts could gather their full explanation. This is where I believe that the cycle of grief began.”

Lotoya did not grieve because she didn’t love and accept her son as he was, but because she knew that she had to face a new reality. Things would never be “normal;” the symptoms would not go away with short-term, “intensive therapy.”

“This now would be a possible life-long journey and the son I dreamed of would be different with limited, ‘normal’ moments in time,” Lotoya said. “I went into survival mode by focusing on the only thing that I had control over: the ability to learn, share, develop, grow and strategize to ensure that our son received the best care available. I let myself grieve through acquiring knowledge. I lived in a fog of hope.”

Other members in Lotoya’s family had autism. She said that experience helped her appreciate that not every person with autism is alike.

 “The one significant thing that I have learned is that not all people with autism are the same,” Lotoya said. “Some kids are nonverbal with limited behavioral concerns, while others are highly verbal and creative, but have difficulty with sensory and other needs. The statement is true: ‘If you’ve seen one person with autism, you’ve seen only one.’ "

Isaiah is 5 years old today. Lotoya said his smile is special because of a dimple in his cheek that “lights up a room.” Isaiah loves to give long hugs, kisses on the check, and a good tickle.

“Anyone who meets him is consumed with the joy on his face and the twinkle in his eye,” Lotoya said. “The stress melts away when he meets me at the door after coming home from a long day at work.” Right now, in addition to public school, Isaiah attends Easter Seals North Texas Autism Treatment Program four days a week.

Lotoya also credits Cook Children’s, and specifically Deborah Vert, D.O., for helping her through some of the tougher times while raising Isaiah. The medical center gave her an avenue to share her experience and ideas, and to help better serve families through the Family Advisory Committee and the Autism Patient Safety Committee.

“Cook Children’s has helped our family by providing specialized therapists who are compassionate toward the needs of both the child and caregiver,” Latoya said. “They were very patient, accepting of my endless questions, suggestions and various training that I would acquire over the years. Isaiah’s plan of care was always individualized to his skillset and needs. Adaption and flexibility were at the core, and exemplified quality care.”

Currently, Lotoya helps families by sharing her experiences, assisting with the navigation of services (applied behavior analysis, occupational therapy, speech, etc.), providing encouragement and sharing resources and training material.

“This gave me a sense of purpose and a way to turn ‘lemons into lemonade’ and see the blessing in what others see as pain,” she said.

By providing guidance for strategic planning, parents get a sense of power and hope, instead of helplessness. Lotoya encouraged that all parents should ACT: Assess the situation; Call someone if life seems to become emotionally overwhelming; Take the lead as the coach of your child’s care team through acquiring knowledge.

Looking at life through the lens of autism has reminded Lotoya what life is really about.

“I was so career minded that I missed out on the essence of life itself,” she said. “I have learned how simple life really is. My mind had to be re-conditioned to not always be in control. I now strive to be selfless on a day-to-day basis; though I have not yet arrived.”

What is autism?

Autism is a disorder where a person has difficulty with communicating and interacting with others. There are many forms of autism that can vary from mild to severe.

There are 3 major categories of symptoms in autism:

Social interaction-Children show difficulty interpreting other’s emotions or difficulty in making appropriate eye contact.

Communication-Speech is often delayed or non-existent. In addition there are limited other attempts to try and communicate with others (lack of hand signals, expressions, etc).

Limited interests-Children show very specific interests and lack of interest in other activities.

So, that is the definition…here’s my practical look at how the diagnosis of autism usually evolves.

Up to 12 months-There are very few suspicions of autism prior to the first year of life. Occasionally, a family will pick up on a lack of eye contact or limited verbalization but this is uncommon.

12-15 months-Families and doctors will begin to notice that a child is not progressing in their speech development appropriately. Speech therapy referrals can be made at this time to begin appropriate therapy and to monitor development more closely.

15-18 months-Speech development will continue to lag behind and the other abnormal behaviors will continue to become more obvious. Many diagnoses can be made during this time, especially in severe cases.

What do I look for in a diagnosis of autism?

The main symptoms I look for when consulting with a family about autism is a “lack of joint attention.” An example of joint attention is when a child is playing with a toy they enjoy, they will occasionally bring it over to you and engage you in play with them. Another example is when an adult points to a plane in the sky and the child looks in the direction of the point. When I have a family with a concern about autism, I present both of these examples to the family. If the child does show these behaviors, autism is very unlikely and parents can be reassured. If they do not, further investigation and a possible referral to a developmental pediatrician could be in order.