Fever?
There are moments—always out of the blue and fleeting—that my 10 1/2 year old son Charlie speaks with total lucidity, complete clarity of pronunciation, and in almost a full sentence (Charlie usually speaks in phrases of one to three words, with rather blurry articulation, and his words do not always fit the situation). Sometimes this happens when he really, really, really, really wants something so much; sometimes this happens when he is very angry. A few times this seeming flash of focused speech and cognition has occurred at a surprising moment, when Charlie is ill and, more specifically, when he has a fever. Other parents have noted the same to me, anecdotally.
The December 2007 volume of Pediatrics contains what its authors note is, to their knowledge, “the first to investigate behavioral changes associated with fever in children with ASD.”30 children (aged 2–18 years) with autism spectrum disorders were studied during and after an episode of fever” by Laura K. Curran, et al.. The children were identified via the billing database (AS-400) of the Kennedy Krieger Institute (Baltimore, MD); the Delaware Autism Program, a statewide public education program for autistic children with ASDs, and the Autism Society of America, Chapter of East Tennessee; 53% of these children had a diagnosis of autistic disorder; 32% had diagnoses of PDD-NOS, “high-functioning autism,” or Asperger Syndrome; and 15% “listed diagnoses for which it was difficult to determine the extent of impairment (ASDs or PDDs). In the control group were 30 children matched in terms of age, gender, and language skills. Data was collected in the following manner:
Fever was defined as a body temperature of [equal or greater than] 38.0°C (100.4°F). Parents were provided with FeverScan (Digi-Temp, Glenview, IL) liquid crystal thermometer strips for use on the forehead…………………..
Once a fever was recorded, parents were asked to observe their child’s behaviors carefully during the subsequent 24 hours and then to complete the first study questionnaire (time 1; described in “Questionnaire”). After time 1, parents were directed to mark when the fever had disappeared and the parent determined that the child was feeling better. Parents were asked to observe the child during the next 24 hours and then to complete the second copy of the study questionnaire at time 2. After time 2, parents were instructed to continue to monitor the child’s temperature until 7 days without fever had accrued. At that point, parents were asked to complete the third and final copy of the questionnaire, based on the child’s behaviors during a 24-hour observation period (time 3). This third time point effectively served as a “fever-free” measurement; data were collected when the child was unaffected by fever.
The study questionnaire mentioned was a slightly modified version of the Aberrant Behavior Checklist (ABC), which is a 58-item, third-party informant scale that “solicits information about behavior severity using a 4-point scale”; the scales in include irritability (15 items), lethargy (16 items), hyperactivity (16 items), stereotypy (7 items), and inappropriate speech (4 items).
The researchers concluded that there were “fewer aberrant behaviors during fever on the ABC domains of irritability, hyperactivity, stereotypy, and inappropriate speech” among febrile patients; any effects were transient and lethargy (not surprisingly, due to the patients being ill increased. These results in autistic children are indicative of interactions between “systemic immune responses and neurobiological mechanisms of cortical and neuronal function.” Five explanations are offered:
- neurobiological effects of selected proinflammatoryand/or anti-inflammatory cytokines, which have been found to be increased in cerebrospinal fluid (in the absence of fever) and postmortem brain tissue of individuals with autism and may be generated during different phases of responses to fever
- modification of neuronal and synaptic function secondary to variations in body temperature that influence neural conduction velocities or synaptic transmission
- modification of dynamic neural networks as a result of changes in cellular signal transduction and gene transcription that regulate synapse formation and function
- increased production of other stress-related proteins, such as heat-shock proteins, during fever that might modify energy consumption and mitochondrial activity
- stimulation of the hypothalamic-pituitary-adrenal axis leading to modifications of neurotransmitter production and interaction.
The researches suggest that a large observational study might involve comparisons between febrile illnesses (eg, viral versus bacterial infections), and whether (this seems of particular interest to me) there are similar behavioral improvements associated with fever in other population groups.
The study also noted that “anecdotal reports suggest that effects that are stimulated by fever are not evoked by high ambient heat associated with a sauna, hot summer weather, or physical activity” and we have indeed noted greater focus and clearer speech—more of a seeming ability to pull together his thinking and speaking and communicating—-in my son after sustained (and aerobic) physical activity.
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POSTED IN: Health, Neuroscience, Science
33 opinions for Fever?
passionlessDrone
Dec 3, 2007 at 9:50 am
If I’ve learned anything from cruising sites like this, it is that annectodal evidence is worthless, and the plura of annectode is not data. Whats more, I’d make a million dollar bet that if this study were to evaluate something like, say parental observations of reactions to a vaccine, HBOT, or chelation, it would be immediately branded as junk science. This article, for some reason, has just the science tag applied. Go figure.
Where was the placebo fever? Why was not attempt made to blind the parents as to whether the child actually had a fever or not? One has to wonder if the editors at Pediatrics have bothered to read Interverbal’s analysis of why single case design studies are inherently flawed and cannot achieve the levels of certainty real science requires.
I’ve been told countless times, including on this board, that coincidences do happen, and the only way to be sure of a cause and effect, or even an association, is by the golden standard of science, the double blind, placebo controlled study. I’m not saying that Kristina, or these other parents don’t think they noticed something when their child had a fever; just that we cannot use their inherently biased observations to come to any useful conclusions other than someone said something.
Of course, I’ve noticed exactly the same thing with our son on several occassions.
Take care!
- pD
Regan
Dec 3, 2007 at 10:27 am
“…Once a fever was recorded, parents were asked to observe their child’s behaviors carefully during the subsequent 24 hours and then to complete the first study questionnaire (time 1; described in “Questionnaire”). After time 1, parents were directed to mark when the fever had disappeared and the parent determined that the child was feeling better…”
I am not a statistician like Joseph or a physician like Orac, so this is just a layperson’s observation.
My impression is that this study might have benefited from double blinding or better control on the observations taken–i.e., just have people take continuing data on behavior categories and measure daily with a coded, rather than temperature rated thermometer, and then do the analysis. Include that control with NT kids. Include measures on environmental variables, such as our own behavior, because when kids are sick, we behave differently and usually alter level of demand, etc. The survey system as stated seems to be a problem because even if the fever is not explicitly stated, it is hard to believe that a parent wouldn’t put 2+2 together, esp. since some of the study participants stated a prior belief of improvements corresponding with fever.
I see that they noted such limitations, so until that study is done with increased controls, I am not necessarily compelled by this paper.
I’m being conservative because I have unskeptically (and sometimes eagerly) looked for the often reported improvements to come with fever in Eleanor when she runs a temperature. Except for being more tired and having less focus, which makes sense when one is sick, I have yet to see better speech or improved cognition. (Perhaps she’s an exception to the group statistics.)
Kristina Chew, PhD
Dec 3, 2007 at 10:34 am
The authors of the study acknowledged the limitations of their work. Passionless Drone, as the full study is now accessible from the Pediatrics website, some of your questions may be answered upon further reading. The authors are aware that, since parents collected the data via questionnaires, bias is very possible.
Generally when Charlie has a fever (which does not happen too much—he’s a very healthy kid) my main focus is to get him better.
Autismville
Dec 3, 2007 at 11:13 am
Jack never, ever runs a fever … (knock on wood…)
Cliff
Dec 3, 2007 at 11:59 am
I have to admit, I’m not really sure about this one. It’s an interesting prospect, but is just anecdotal, and probably not useful. Though, of interest, how would you placebo a fever?
If clear thinking ever came to me during a fever, I clearly missed it. Maybe the “fever clarity” is a stress-caused push that creates that clarity, and nothing more. It’s interesting, though, so I’ll look for anything more substantiative, but for now I’m doubtful.
Cliff
Ron Lovejoy
Dec 3, 2007 at 12:50 pm
Oh great.
The next thing we will see are quacks advocating “fever therapy” and pointing to the article in _Pediatrics_: “See? There’s scienciness* to back this up!”
* sort of like “truthiness”
Kristina Chew, PhD
Dec 3, 2007 at 1:06 pm
Saunas were mentioned in the Pediatrics article—hopefully it won’t give more impetus to this type of “therapy”.
anon_two
Dec 3, 2007 at 2:26 pm
Were the majority of the parents in the study those of the alt. biomed cure persuasion, I wonder? I’m sure I’m simply being cynical and curmudgeonly, but IF SO, THEN perhaps said parents were more embracing of acceptance while kids were sick … and the change in their perceptions/behaviour altered the experience in how they viewed their child, and in turn, how their child may have responded to them.
theasman
Dec 3, 2007 at 3:49 pm
Mudbaths anyone? they are hot no?
Once this goes mainstream , people without chew’s good sense and ethics will start promoting indian sweatlodges as cures to “sweat out the autism like a fever”
Not that I am saying a sweatlodge cannot be beneficial even for autistic kids. as I told a few people more than once I think sunlight and fresh air and physical activity is *beneficial* for ASD Children. (and NTs too). Environment does make a difference. But the kid is still on the spectrum.
Kristina Chew, PhD
Dec 3, 2007 at 3:54 pm
Not sure but a question to keep asking—especially as this is one of the NIMH’s clinical trials—-on mercury chelation to treat autism.
VAB
Dec 3, 2007 at 4:01 pm
Lord have mercy, this is already showing up in my local paper with the headline “Fever Loosens Autism’s Grip,” an complete with all sorts of specious conclusions about connections between neurons. I bet 5 mg of Valium would also cause parents to evaluate their children’s behavior more highly too. (I suppose I should keep quiet or someone will be publishing a study on that next.)
theasman
Dec 3, 2007 at 4:03 pm
But the problem with the mercury religious crowd, is if it doesnt show what they want they will cry cover up. And if there a measureable difference for the better they will claim they were right about the vaccines. Nevermind it doesnt necessarily follow logically.
the CDC is honorable and forthright only when the results fit a pre existing theory their theory . Science? NOT!
Mekei
Dec 3, 2007 at 4:04 pm
I’m sorry but this fever story isn’t cutting it with me.
I feel like donkey poo when I run a fever. I’m never quite myself when I’m sick and I don’t have the energy to do the things I would do if I was 100% (laundry, cleaning, jogging, etc). Why would my son be any different when he is sick and running a fever? Good gracious people. Make our kids sick with a low-grade fever to keep them serene?
I LMAO when I read this today. Interesting maybe, but not really *science,* is it?
Kristina Chew, PhD
Dec 3, 2007 at 4:04 pm
I’ve already seen a story with a qualification: Fever can temporarily unlock autism’s grip. Better not mention too many other potential treatments…….
acrimomominous
Dec 3, 2007 at 5:06 pm
There’s already a tendency among the DANasite quack fans to **make** their children sick (munchhausen’s by proxy???) and rejoice over it. “oh, look, he’s vomiting! that’s a good sign! it’s a Herxheimer’s reaction!” I can just see Lyn Redwood trying to get her child ill so he can stay feverish 24 hours a day for the rest of his life. Maybe a trip to Africa so the kid can acquire malaria would be a nice all natural alternative therapy? Sure it would shorten his life, but there’s no use to living a life as an empty shell anyway, right?
memphismommy
Dec 3, 2007 at 6:39 pm
Empty Shell? I am so moved I must write to you and somehow explain how the word appalled is quite the understatement. Lord knows we all understand and share your pain; but this website is not a place for your personal cynicism. It is not a place to “attack’ the real problem; this monster of a thing that what we are all furius about. We do not even know to whom to be angry with.
There is someone home in my beautiful son’s eyes. There is no emptiness. He has a soul I can see and feel and yes..touch..! And He does touch back. I love him for who he is..not for who he is not. He lives in a peaceful world..I do not. Neither do you. He has no fear..he does not know he will someday die..he has been spared the things we fear the most; along with the good come with the bad.
Every baby step is momentous is our home.
THEY JUST NEED US MORE.
I hurt with you and for you, but please have respect for the other parents who enjoy, share, educate and grieve along with you on this webite. I am truly worried about someone who would write such a cold statement.
***Please come to Memphis to St. Jude’s Hospital and meet these little children. It will help you as it does me. God Bless You Truly.
KK
Channon
Dec 3, 2007 at 6:41 pm
I’ve noticed better eye contact and responsiveness when my child is relaxed to the point of going to sleep. Having a fever makes me feel somewhat like this. Mekie has a point.
KimJ
Dec 3, 2007 at 7:18 pm
I agree they should have some kind of blind study. Perhaps comparing NT’s with fever and autistics with fever in a hospital or clinic setting. Fevers usually don’t present emergencies requiring hospital stays so I don’t know how you could actually study otherwise healthy autistics that happen to get sick with fever.
I know my son “acts NT” when he has a fever. I don’t like it because it’s so alarming.
When I get a fever, I go nutso. I get weepy, confused and bed bound.
Regan
Dec 3, 2007 at 8:41 pm
I agree with KimJ that a clinic setting might be the most controllable, although you would have to have a pretty healthy baseline starting out in the clinic setting because of the change from normal settings and routine. One other reason that I am not crazy about the study is that the baseline was pretty short, and so was the time of the entire study. Even though the group was comparable, there are multitudes of potential differences, and I think that change within subject for this are more significant, noting the oft-commented on difference of autism as a spectrum without so far identified single cause or single condition, even given if the initial hypothesis has ground. The subtleties of the statistic I leave to those with the training.
Anyway, there are alot of headlines that have trickled away and some that seem to endure. I don’t know which way this one is going to go. I also have the concern that this would motivate people to “seek fevers”, although I expect that the researchers goal was a more specific medical treatment.
Kristina Chew, PhD
Dec 3, 2007 at 9:01 pm
I see the study as not pointing toward a therapy—-inducing fever does not sound like anything I’d want to try and when I have a fever all I want to do is lie in bed or on the couch (this is not to say the day’s activities allow this…….)—–but pointing toward maybe something about the neurology of some autistic children. The researchers kept noting that it was also hard to tell whether some of the changes in behavior were simply from the children being (as they were) sick…..
I’ll hazard a correlation: Interesting timing to bring out a study about fever and getting sick in this time season of colds and coughs (my students bringing in boxes of Kleenex testifies somewhat to do this).
“Empty shell”: I think “acrimomominous” was referring to someone else saying that autistic children are “empty shells,” or rather become “empty shells” after they who were once normal become autistic —– my son (he’s sneaking glances at me as he hangs on the living room floor with his favorite stuff around him, after a good dinner) is most definitely very full of love and life!
Emily
Dec 4, 2007 at 12:47 am
Could it just be that with the fever, there’s more inward focus and less outward awareness of inputs, allowing for greater clarity of expression? I’m trying to think of how I feel with a fever. You’re lying there, feeling like crap, and how aware are you of the sensory inputs you’re usually noticing? If it’s less, that might allow for better streamlining from within.
It makes me think of how our son first said his first understandable sentence and first carried on a (brief) reasonably linear conversation, when he was four. The OT had wrapped him up VERY tightly in a spandex swing–he was no bigger than a throw pillow, he was wrapped so tightly–and suddenly, these sensical, comprehensible sentences started emerging. And on another occasion, the doctor had to papoose-board him to sew up an eyebrown wound, and again…he was coherent all of a sudden, saying things that made sense to our adult ears. Could a fever have the same effect, as you’re wrapped up in your blankets, your parent caring for you, the world locked out for now?
Or…maybe it’s just nonsense, like so much else. It’s just one study, just one hint, just another road to travel on either to a cul-de-sac or to something potentially useful.
acrimomominous
Dec 4, 2007 at 5:50 am
The “empty shell” reference was inspired by some autism advocates who have described their children this way. My autism spectrum child has never been an empty shell. Neither would I experiment with drugs or vitamins on my kid to make her less autistic.
I wonder how much of the change in the children was totally in the heads of the parents who were paying more attention to the child since he’s sick. Are they seeing things that they might have seen anyway had their child not been moving in one orbit and them in another? I don’t know. My child never changed during a fever, except to be more sleepy maybe. Given what we know about the hard wiring of the autistic brain, it is possible that cytokines that produce fever could cause a change in the way the neurons work together, perhaps, but it wouldn’t be permanent. Do these kids who change to “less autistic” during fever pick up skills that they maintain when the fever goes away?
theasman
Dec 4, 2007 at 8:42 am
I know why this works this fever thing.
Remember about that study about autism that stated it is all about over functioning? functioning at a higher level. overloading the brain. Well with a fever you are not functioning at peak performance hence the overload eases up.
autismdaddy
Dec 4, 2007 at 11:56 am
The paper’s conclusion seems to be that more study is required. That seems like good science to me.
HCN
Dec 4, 2007 at 3:12 pm
Our son had a seizure disorder (he seems to have grown out of it, now they just manifest as migraine headaches). Fevers and illness (like being dehydrated with a gastrointestinal bug) tend to cause seizures (full blown Grand Mal convulsions). During his younger years we made sure he did NOT get a fever.
The bathtub with the handshower and only slightly warm water helps when the prescribed amount of tylonol is insufficient.
anon_two
Dec 4, 2007 at 4:09 pm
http://pediatrics.aappublications.org/cgi/content/full/120/6/e1386
__”This study has limitations. Although subgroup comparisons suggest some specificity of the fever effect, the study did not include a comparison group of children with nonfebrile illnesses. Our measures of behavior were based solely on parent reports; these data are subject to information biases. Because symptom data were collected prospectively, however, recall bias, a major source of information bias, was likely limited.”
“Future studies may benefit from including independent raters (eg, teachers) or using videos to limit subjective misclassification of changes in behavior. Selection bias is also possible because a small fraction of eligible families from recruitment sources participated. Just more than half of families in the final analysis sample reported a priori that they thought that fever affected their children’s behaviors, and this proportion may be higher than that of the general population of parents of children with ASDs, yet among families who experienced fever during the study period, behavior change documented prospectively was similar in those with and without the previous belief that fever affected behavior.”
“It is interesting to recognize that many parents did not predict behavior changes with fever. There are multiple possible explanations for this finding. Parents may be focused on the illness, not behaviors, during a febrile episode. Although some parents may be aware of their children’s behaviors, some may not observe subtle changes. Subtle changes, if present, may not be picked up by the ABC items.”
“Alternatively, a fever-associated behavioral response may be heterogeneous or limited to particular population subgroups. It is also not clear whether we captured the true “window” for fever-associated behavior changes. The collection of data during different time windows could have demonstrated other changes. Regarding the observed decrease in aberrant speech during fever, it is uncertain how much is attributable to illness-related features such as trouble swallowing or a decrease in spontaneous speech. Although the thermometer offers a good means to measure fever, there is a challenge in measuring illness, perhaps especially in lower functioning children who are less able to communicate about their illnesses.__
Kristina Chew, PhD
Dec 4, 2007 at 4:21 pm
Amazing the headlines that are getting spun out of this study: Autistic Kids Are Less Autistic When Sick.
This and Last’s Weeks Top Posts
Dec 16, 2007 at 5:10 am
[…] Fever?The December 2007 volume of Pediatrics contains what its authors note is, to their knowledge, “the first to investigate behavioral changes associated with fever in children with ASD.” […]
daedalus2u
Jan 1, 2008 at 8:02 pm
I have now posted my analysis of the fever paper.
Kristina Chew, PhD
Jan 3, 2008 at 12:07 am
Here is daedalus2u’s post, entitled Stranger than you can imagine: Resolution of ASD symptoms with fever. Is it real, and if so, what does it mean?—I am still working my way through his analysis.
Time to Sleep (Because the TV Says So)
Mar 9, 2008 at 1:19 pm
[…] thing I had last week and passed the better part of Saturday in slumberland on the couch. He had a fever and a gurgling cough, and seemed the better for his long nap. He woke around 6.30pm and we asked […]
Rebranding Autism and David Kirby’s Rhetoric
May 29, 2008 at 1:33 am
[…] temporary improvement was documented in the December, 2007 issue of Pediatrics in a study titled, “Fever May Briefly Alleviate Autism Symptoms.” The authors reported that, out of 30 ASD children observed before and after a 100.4 degree […]
Nick
Jul 21, 2008 at 5:18 am
Scepticism is perfectly natural in those whose children aren’t affected.
But the study was undertaken in response to years of anecdotal observations by parents who noticed dramatic improvements in their ASD children.
It’s merely a formalisation to serve as a springboard from which to launch further research.
I’m an Aspie and now 46. Ever since I first noticed the dramatic change in myself with a cold/flu (at about 20 y/o), I’ve been curious (to say the least) about the cause.
Asked my GP about it on several occasions over the years - to no avail.
Question the sceptics have to ask themselves is just why so many parents would make up such a thing.
I certainly know I’m not making it up.
I’ve been combing the web for clues for years - and was delighted to find that I’m not unique in this experience.
Fever is a tiny price to pay for the relief from symptoms I get.
The post-febrile return to Aspiness from the neurotypical interlude is a VERY difficult time.
One is plunged back into the darkness and disorientation of Asperger’s.
It leaves you in no doubt as to the objective difficulty of life with Asperger’s - to the extent that one is overwhelmed with a sense of near-pointlessness in attempting to lead a meaningful and rewarding life with AS.
Nobody is defined by their affliction.
Those who believe that their AS defines their personality, only do so because they don’t experience life without the affliction … and understandably therefore, don’t perceive it as an affliction.
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