Eric Fombonne, M.D.
M.I.N.D. Institute Distinguished Lecturer Series: December 14, 2005
Eric Fombonne, M.D., is professor of psychiatry and head of the Division of Child Psychiatry at McGill University. He also directs the Department of Psychiatry at the Montreal Children’s Hospital and serves as the Canada Research Chair in Child Psychiatry. Since his 2001 appointment at McGill, he has consolidated the Autism Spectrum Disorder program in Montreal and now heads a research program directed at evaluating environmental risk factors, immunological factors and genes in autism and a training program in autism research. His research focuses on epidemiological investigations of child psychiatric disorders and the risk factors associated with them, with a particular focus on the epidemiology of autism. He has also been involved in family and adoption studies of autism, molecular genetic studies of autism and depression, and long-term outcome studies of child and adolescent depression. In addition to serving on the advisory boards and as an ad hoc reviewer for several scientific journals, Dr. Fombonne was associate editor of the Journal of Autism and Developmental Disorders from 1994 to 2003. He has over 130 scientific publications in peer-reviewed journals and 25 book chapters. Fombonne is a member of the scientific, advisory and membership committees of several professional organizations. He is a permanent member of an NIMH study section and was recently appointed to a special NIH advisory board for autism research programs funded as part of its CPEA and STAART programs.
Autism and Immunizations: The epidemiological tale (4 pm)
Concerns have been raised about the role of immunization as a risk factor for autism. The measles-mumpsrubella vaccine (MMR) has been postulated to induce a new form of regressive autism with enterocolitis. Thimerosal, a mercury-based compound used to stabilize vaccines, has also been hypothesized to induce autism in infants and toddlers. Both hypotheses have been linked with increasing prevalence rates of autism spectrum disorders, suggesting that an epidemic of autism has occurred. Epidemiological data on rates of autism and other pervasive developmental disorders will be reviewed, with special reference to competing interpretations of time trends. The MMR and thimerosal hypotheses have been evaluated with cohort, case-control and ecological studies that will be summarized. The evidence accumulated in recent years currently favors the rejection of both hypotheses. Attention will also be paid to biological, public health and non-scientific issues which have influenced this debate.
Autism: Have Child Immunizations Created an Epidemic? (6 pm)
Epidemiology is the scientific study of the occurrence of disease in human populations. Basic principles of epidemiological research designs (cohort, case-control, prevalence, ecological studies) and analysis (risk and confounding factors) will first be introduced. Autism prevalence studies have shown upward trends in rates in the last 20 years. The best current prevalence estimate for all autism spectrum disorders combined is 0.6%. Possible interpretations for the higher prevalence figures will be discussed. In particular, two separate hypotheses have focused on child immunization schedules as potential explanations for the increased rates of autism. The MMR (measles-mumps-rubella) hypothesis has been evaluated in several studies that have failed to demonstrate an increased in the risk of autism following exposure to MMR. The thimerosal hypothesis has linked the total cumulative exposure to ethylmercury up to age 2 and an increased risk of autism. Yet, epidemiological studies have failed to demonstrate such an association. Current results will be discussed in the context of concerns by parents of autistic children on the causes and treatment of autism, and also of more general public health issues.