1. Autism: Relevance to immunizations Meghan Cole Brenda Curenton Ashley Donaldson Auburn University of Montgomery

2. What is Autism? Autism, also known as Autism Spectrum Disorder, is a disorder of brain development categorized by difficulties in social interaction, verbal and nonverbal communication, and repetitive behaviors (Autism Speaks, Incorporated 2013).

3.  Social Skills  Communication Skills  Behavioral Skills Currently there are no known laboratory tests to diagnose autism. How is Autism Diagnosed?

4. Treatment Methods No cure exists. Treatment involves: level of function by autistic symptoms Therapy involves:  Educational  Family Counseling  Behavioral modification  Communication  Medications

5. Because many of the causes of autism remain unknown by the medical community and concerned parents, there is some question if immunizations in children can cause this disorder. The case study involves an expectant mother already dealing with one child who has been diagnosed with autism. The mother has a strong belief that immunizations caused the first child’s autism. The mother requested a pediatric nurse to verbalize her opinion on the matter. The information to be identified by this case study is whether or not vaccinations can be linked to the cause of autism ??? Causes of Autism ???

6. Patient or Situation Focused Question Meta-analyses and systematic reviews Evidence-based reviews Random control trials Case-control studies Case series Case reports Textbook, review articles, expert opinions, and laboratory research The purpose and goal of this query are to determine the link between the development of autism and immunizations in children. The focused question is: “What is the highest level of evidence to determine if immunizations can cause autism in young children?”

7. Targeted Resources In order to find the highest level of evidence based information related to the focused question the EBP team explored in Cochrane Library, PubMed, and Google Scholar. The word search within the databases is shown in the following (see Table 1). SEARCH WORDS CORRESPONDING TO PPARRE ALTERNATIVE WORDS OR SYNONYMS Autism Development disorder, socially impaired, impaired communication, risk factors of autism Immunizations Vaccines, vaccinations, childhood vaccines ChildrenGirls and boys ages birth to 6 MercuryThimerosal Table 1 PPARRE Word Search

8. To be thorough in the research the EBP team used the PPAARE process in developing the focused question. The acronym mapped the course for the development.  Problem-autism linked to immunizations.  Population-young children.  Action-gaining knowledge to determine whether or not vaccines are actually linked to autism.  Alternative-in this case there is no alternative.  Results-educate the mother on the link between vaccines and autism so that the mother can make an informed decision about immunizing and decreasing the mother’s fear and anxiety.  Evidence- that will be gained with the completion of our research. The following demonstrates this process (see table 2). PPAARE

9. Table 2 PPAARE Question for Case Study Focused Query Question ProblemPPAARE ComponentCase Example Patient Children Action Gain knowledge whether autism is linked to vaccinations Alternative Patient Results Educate the mother with information about immunizations so she can make an informed decision and reduce mother’s anxiety and fear Level of EvidenceHighest level

10. Relevance of Evidence In order to ensure the EBP team stays on track with the research, a “Relevance of Evidence” table was used. This table is multifunctional  Keeps data/visited sites listed  Reveals relevance of the articles found

11. Evidence Appraisal To establish trustworthiness of two relevant studies:  A quantitative study was used from authors E. Fombonne, R. Zakarian, A. Bennett, L. Meng, and D. McLean-Heywood written in 2006.  A qualitative study was conducted from authors S. Hilton, K. Hunt, M. Petticrew written in 2007. After conducting the analysis using this systematic process, both studies were found to be trustworthy. The qualitative study was the most beneficial for the EBP team to use to prove the trustworthiness of the project

12. Course of Action The course of action the Evidence Based Practice (EBP) team plans to implement includes:  Share with the mother the study conducted for the highest level of evidence found to determine if immunizations can cause autism in young children.  Educate the mother on the outcome of the study.  The outcome can be measured by following up with mother to see if her concerns have been relieved.  Allowing the child to be immunized would demonstrate a positive outcome from the knowledge gained and shared with the mother from this study that there is no link between immunizations and autism.

13. Conclusion In conclusion, this study was an effective use of the EBP team’s efforts:  Searched for the highest level of evidence to determine if immunizations can cause autism in young children.  Found no evidence that immunizations can cause autism.  Shared this information with the concerned mother  Put to rest mother’s fear of immunizing her younger child.  The team completed a post- education evaluation  Determined that the mother’s anxieties were relieved  Mother allow her child to receive the MMR vaccine.

14. References Autism Speaks Incorporated. (2013). What is Autism? Retrieved from http://www.autismspeaks.org/what-autism Demicheli, V., Riveter, A., Deadline, M.G., & Di Pietrantonj, C. (2012). Vaccines for measles, mumps and rubella in children. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004407.pub3/abstract Fombonne, E., Zakarian, R., Bennett, A., Meng, L., & McLean-Heywood, D. (2006). Pervasive developmental disorders in Montreal, Quebec, Canada: Prevalence and links with immunizations. Pediatrics, 118 (1), 139-150. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16818529 Health Council of the Netherlands. (2007). MMR vaccination and autism: no indication for a association. Retrieved from http://www.gezondheidsraad.nl/sites/default/files/200704EMMR.pdf Hilton, S., Hunt, K., & Petticrew, M. (2007). MMR: Marginalized, misrepresented and reject? Autism: A focus group study. Archives of Disease in Childhood, 92(4), 322-327. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17376937 Mayo Clinic. (2012). Autism. Retrieved from http://www.mayoclinic.com/health/autism/DS00348