New Zealand Autism Spectrum Disorder Guideline - Ministry of Health

Part 2: Support for individuals, families and carers
herd immunity. However, the proportion of
children in New Zealand who complete all their
immunisations is not high enough to protect
vulnerable members of the community who
have not received immunisation, for whatever
reason.
Parents have been particularly anxious about
MMR vaccine (Measles, Mumps and Rubella).
This vaccine is given at the age of 15 months in
New Zealand.
In 1997, a group of workers studying
gastrointestinal symptoms in children
announced (at a press conference before
publication of their work 151 ) that they had found
a link between the development of autistic
symptomatology and the prior administration of
Measles, Mumps and Rubella (MMR) vaccine. A
number of large and well-conducted studies of
whole populations have demonstrated that this
claim has no basis in fact. The lead worker has
subsequently been disciplined by the General
Medical Council in the United Kingdom and
has been shown to have had a financial conflict
of interest. Expert international review panels
(such as, in the United States, the Institute of
Medicine of the National Academy of Sciences),
have examined all the evidence and concluded
that there is no causal relationship between
either thiomersal or MMR vaccine and autism 152-
154
. A recent study from Japan, where MMR
vaccine was withdrawn for reasons unrelated to
the autism controversy, demonstrated that the
incidence of ASD continued to rise in a cohort of
children, none of whom received MMR 155 .
Infection with measles, mumps and rubella can
cause significant problems in some children.
All these viruses can cause encephalitis and
permanent disability. This is very rare as a
consequence of infection with the mumps virus
and rubella virus, but devastating when it
occurs.
support the hypothesis that the vaccine plays
any role in causing ASD (Recommendation 2.3.11).
2.3.d Nutrition
Full discussion of the nutritional issues in
children with ASD is outside the scope of the
New Zealand ASD Guideline.
Some children who have ASD restrict their
intake of food by refusing foods on the basis of
smell, taste, texture and colour. Such children
may be very sensitive to small changes in the
food offered, such as changing a brand of, for
example, bread. Children may also restrict their
intake on the basis of how the food is offered,
for example refusing to eat if the food is not
presented on a particular plate, or if certain
foods are touching on the plate rather than
separated. Often these self-restrictions result in
the child taking a very limited range of foods,
resulting in concerns that the child’s intake of
essential nutrients (especially vitamins and trace
elements) is inadequate.
In this situation, the child’s nutritional state
should be assessed by their general practitioner,
paediatrician or a dietitian. Dietary supplements
may be recommended. It is acknowledged
that access to dietitians who have paediatric
experience is limited.
Some parents choose to place their child on diets
that eliminate certain proteins (especially gluten
or casein or both). Parents should ensure that
children on these diets also receive adequate
intake of vitamins and trace elements, especially
where the child also self-restricts that range of
foods taken.
Resources for parents can provide some
guidance on this issue 156-158 .
2.3.e Health promotion
Part 2
The evidence strongly indicates that all children
should therefore be immunised according to
the New Zealand schedule. Parents should be
reassured that there is no scientific evidence to
The health and physical well-being of society
in general is frequently targeted by national
campaigns on smoking, obesity, driving, alcohol
and drug abuse, sexual health and safety,
New Zealand Autism Spectrum Disorder Guideline 77