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Linking risk factors and outcomes in autism spectrum disorder: is there evidence for resilience?

BMJ 2020; 368 doi: (Published 28 January 2020) Cite this as: BMJ 2020;368:l6880

Rapid Response:

More resilience or lower toxic exposure?

Dear Editor

The paper by Mayada Elsabbagh [1] displays many of the same problems as the paper by Zwaigenbaum and Penner [2] back in May 2018. On that occasion I wrote [3]:

"I have read this review with interest but disquiet ... There is perhaps little point in talking about a global prevalence of autism, which Zwaigenbaum and Penner place according to literature at between 1 and 1.5% if autism is rising dynamically in many parts of the world including the United Kingdom - as I have been recently detailing in the columns of BMJ on-line ... For instance, recent data from Northern Ireland showed an overall prevalence in schools there of 2.9%, having risen from 1.2% nine years ago, but there are also big disparities between economic classes and town and country, while in Belfast the rate was 4.7% ... Unfortunately, as Zwaigenbaum and Penner point out diagnosis is characteristically delayed so the true rates are likely much higher..."

It should be noted that by May 2019 the Northern Ireland school's autism rate had risen to 3.3% and Belfast's 5.6% while 58% of these were at Stage 5 (the highest measure of disability) [4], and such are the dynamics behind these figures that they will almost certain be higher again this year. My own supposition is that the data for Northern Ireland while necessarily incomplete (because diagnosis takes time) are nevertheless more complete than the rest of the United Kingdom where demand for autism services continue to spin out of control, as I have documented copiously in these columns [5,6]. The causes of such an unviable population change can scarcely be genetic.

Citing a paper by Gaugler [7], Elsabbagh reports [1]: "While estimates vary, there is general agreement that heritability is greater than 50%,... with first degree relatives having a higher risk for developing autism relative to the general population" but to talk about "liability" as in the Gaugler paper or "susceptibility" as in in many autism gene papers is quite different from determination or causation, and it makes no sense when once we were talking about 0.2% of the population or even 0.02% [6] and now we are talking about 3.3% and rising. It also makes no sense when people who share genes also often share environmental exposures: yes, indeed, they might have been more "resilient" if they had not been hit by this or that environmental factor which did not exist in the past, in a different place or just randomly. Recently, I was interested to encounter the PhD thesis of Toby Rogers. Rogers states [8]:

"Autism cost the U.S. $268 billion (1.5% of GDP) in 2015; if autism continues to increase at its current rate, autism will cost the U.S. over $1 trillion (3.6% of GDP) in 2025 (as a point of comparison, U.S. Defense Department spending is 3.1% of GDP). Over the last decade, several groups of leading epidemiologists, doctors, and public health experts have published consensus statements declaring that toxicants in the environment are contributing to the rising prevalence of neurodevelopmental disorders including autism. Beyond the consensus statements, a range of independent researchers have identified many additional factors that appear to increase autism risk..."

Looking at just the vaccine programme most infants will now have received in the United Kingdom by birth seasonal flu vaccine and a four in one vaccine Polio+DTaP [9]. Before 6 months they will have as well [11]:

8 weeks:
6-in-1 vaccine (Polio, DTaP, HiB, Hep B)
RV (rotavirus) vaccine
MenB vaccine

12 weeks:
6-in-1 vaccine – 2nd dose
PCV (pneumococcal) vaccine (13 strain)
RV (rotavirus) vaccine – 2nd dose

16 weeks:
6-in-1 vaccine – 3rd dose
MenB vaccine – 2nd dose

This may be a little less than in recent years but apart from excoriating Andrew Wakefield [12] it is not clear what machinery the MHRA have for detecting and assessing the neurological fall out of all this exposure [13-16].

It would be idle to give the impression that we are dealing with anything historically normal or sustainable, nor can we any longer afford the dogma of vaccine safety.

[1] Mayada Elsabbagh, 'Linking risk factors and outcomes in autism spectrum disorder: is there evidence for resilience?',
BMJ 2020; 368 doi: (Published 28 January 2020)

[2] Zwaigenbaum L, Penner M, 'Autism spectrum disorder: advances in diagnosis and evaluation', BMJ 2018; 361 doi: (Published 21 May 2018)

[3] John Stone, 'Re: Autism spectrum disorder: advances in diagnosis and evaluation' 21 may 2018,

[4] Ian Waugh, The Prevalence of Autism (including Asperger Syndrome) in School Age Children in Northern Ireland 2019', Information Analysis, Directorate May 2019,

[5] Responses to Wise, 'Social care: pressure mounts for urgent and radical reform',

[6] John Stone, 'Response to David Oliver I (The Indisputable Rise in Autism), 28 August 2018,

[7] Gaugler T, Klei L, Sanders SJ, et al. 'Most genetic risk for autism resides with common variation', Nat Genet2014;46:881-5. doi:10.1038/ng.3039 pmid:25038753

[8] Toby M Rogers, 'The Political Economy of Autism', University of Sydney, October 2018,




[12] Philip T Brian, June Raine, Ian Hudson, 'MHRA response to BMJ Editor’s Choice – ‘A tale of two vaccines’, 10 October 2018,

[13] [Peter Doshi, 'Pandemrix vaccine: why was the public not told of early warning signs?',
BMJ 2018; 362 doi: (Published 20 September 2018)

[14] Responses to Doshi, 'Pandemrix vaccine: why was the public not told of early warning signs?',

[15] Fiona Godlee, 'A tale of two vaccines', BMJ 2018; 363 doi: (Published 04 October 2018)

[16] Responses to Godlee, 'A tale of two vaccines',

Competing interests:, an on-line daily journal, concerns itself with the potential environmental sources for the proliferation of autism, neurological impairment, immune dysfunction and chronic disease. I receive no payment as UK Editor

31 January 2020
John Stone
UK Editor
London N22