Mysteries and Complications

You wonder what he thinks. The little boy who flaps his arms and bangs his head. Who bristles at the touch of wool and covers his ears when balloons go "pop!" The boy who doesn't respond to his name and will never say "I love you." What does he think of the world outside? The busy world of childhood vaccines, celebrity fund-raising and genetic research. The cauldron of medicine, media, politics and the law. What does he think of autism?

For that matter, what are we to think? Passions about autism are running higher than ever, and for good reason. Autism spectrum disorders affect one in 150 kids from all walks of life, according to the Centers for Disease Control and Prevention, a tenfold jump in just the past decade. As the numbers grow, public awareness increases and the fervor surrounding each new development intensifies.

Earlier this month, after the federal government said vaccines aggravated an underlying disorder that led to autism-like symptoms in 9-year-old Hannah Poling, the longstanding controversy over the role of childhood vaccines flared anew on network newscasts, the Internet and talk radio. The culture of autism is hitting prime time, too. Next week HBO will air "Autism: The Musical," a documentary about five children with autism who perform in their own show. A week later, Sundance Channel will broadcast "Autism Every Day," a film laying out the challenges faced by families. April 2 marks the first World Autism Awareness Day, a global effort voted into existence by the U.N. General Assembly. Less than two weeks after that, Jon Stewart will host an autism fund-raiser at New York's Beacon Theater, to be aired live on Comedy Central. Among the glittery lineup: Tina Fey, Stephen Colbert and Conan O'Brien.

Despite its high profile, however, autism is one of the most complicated neurological disorders known. Some of the people on "the spectrum" attend college; others never speak an intelligible word. Its complexity, in fact, is what has fueled the ongoing vaccine debate and caused divisions within the "autism community." Unlike most conditions that attract popular and celebrity support—breast cancer, AIDS—autism is almost a complete mystery, with no known cause. The vacuum created by this lack of knowledge has been filled with the theories, worries and frustrations of desperate parents. It's hard not to want something, or somebody, to blame. But now, as the spotlight glares again, it's time to separate fact from fear, to strive for perspective and clarity over emotion, to define the true scope of the disorder.

For decades, researchers have been trying to pinpoint a cause for autism. In the 1950s, clinicians blamed "refrigerator mothers" and their cold, uncaring parenting. More recently, the furor has swirled largely around childhood vaccines. In 1998, a controversial British study, later retracted by most of its authors, suggested a possible link between autism and the MMR vaccine, which contained live viruses. Not long after, a debate over the effects of thimerosal, a mercury-based preservative used in other vaccines, began to build.  Starting in 2001, thimerosal was removed from almost every childhood inoculation (some flu shots still contain it), and the weight of scientific evidence has found no connection between autism and the preservative. Today, scientists believe that genes (the disorder runs in families) and environmental factors, which could be anything from pesticides to antibodies in a mother's womb, both play a role. But some parents continue to believe their children were injured by modern medicine. Sen. John McCain lent his voice to their cause recently when he said "there's strong evidence" that autism is connected to "a preservative in vaccines." That, and this month's ruling in the Poling case—which was one of thousands yet to be decided by a federal "vaccine court"—have given new fodder to the debate. In a CNN "quick vote" conducted after the news broke, 58 percent of respondents said they believe there's a connection between childhood vaccines and autism.

But the court case wasn't that simple. It turned out that Hannah had a rare mitochondrial disorder. Rather than support the thimerosal hypothesis, the decision endorses a whole other field of research into the causes of autism. It's possible, scientists say, that a challenge to the immune system—be it an infection, a vaccine or some other trigger—could stress already fragile cells and exacerbate the problem. Scientists want to know how many children with autism have mitochondrial disorders. And would it be possible to identify those who might be vulnerable to vaccines? "This case is a call to action to continue to understand this very complex disorder," says Geraldine Dawson of the advocacy group Autism Speaks.