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Donald Trump, Vaccines, Autism and Political Theater

Thursday's debate between the GOP candidates for president—otherwise education policy-free—did offer one moment of relevance for those interested in special education: a debate over whether vaccines cause autism. The Wall Street Journal captured the relevant conversation in this video clip, which included Ben Carson (a pediatric neurosurgeon,) Rand Paul (an eye surgeon and senator from Kentucky) and Donald Trump (a developer and jack-of-all-trades).

Jake Tapper, the debate moderator for CNN, asked Carson if Trump should stop asserting, as he has on several occasions, that vaccines cause autism. Carson responded that "there have been numerous studies, and they have not demonstrated that there is any correlation between vaccinations and autism" and that some vaccines that prevent "death or crippling" are very important. Others should be discretionary, he said.

Trump said "autism has become an epidemic" and that it's gotten "totally out of control." He believes that vaccines should be given on a different schedule. "I am totally in favor of vaccines. But I want smaller doses over a longer period of time," Trump said.

Paul also spoke in favor of vaccine spacing. "I'm also a little concerned about how they're bunched up. My kids had all of their vaccines, and even if the science doesn't say bunching them up is a problem, I ought to have the right to spread ... my vaccines out a little bit at the very least."

What We Know about Vaccines and Autism

There's a lot to pull out, there. First, vaccines do not cause autism. Not even receiving multiple vaccines at one time. And interestingly, the debate was held in California, which was ground zero for a debate on vaccines after a measles outbreak that started at Disneyland in Anaheim earlier this year. 

But without question, there has been an increase in the number of children who are currently classified under the Individuals with Disabilities Act as having autism. About 7.6 percent of students with disabilities are classified as having autism. To put that in perspective, children with learning disabilities, the largest category, make up about 40 percent of all students with disabilities. The next largest category, speech and language impairments, covers about 18 percent of students.

As a percentage of the entire student population, children and youth with autism have increased from 0.2 percent in 2000-01 to 0.9 in 2011-12, according the the Department of Education.

But what is behind those numbers? As I explained in a blog post earlier this year, scientists believe diagnostic substitution accounts for at least some of the increase in autism prevalence. Doctors are diagnosing as autism what might have been classified as intellectual disabilities in previous years. Doctors are also better at spotting autism behaviors that might have gone undiagnosed in the past.

The general scientific consensus  about the safety of vaccines is not likely to quell the debate in some quarters. But what's interesting to me is that the debate about causes is so rarely followed by a debate about what we can do to help people with autism and their families medically, educationally, and socially. 

"I think we've gotten quite fixated on the number," David Mandell, the associate director of the Center for Autism Research at The Children's Hospital of Philadelphia, told me in an interview earlier this year. "We just haven't done as good a job at making those other things as compelling." 

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