The Age of Autism: Witness

LEBANON, Pa., May 10 (UPI) -- Frank Noonan is a family doctor in Lancaster County. When I met him for lunch last Saturday, he was still in golfing togs from his weekly game -- "Saturdays are my 'I can breathe' day," he says. Even so, he stayed after our meal to meet a cancer patient who phoned him at the restaurant.

He's energetic, friendly, straightforward -- the kind of doctor people want.

People such as the Amish. As a family practitioner, Noonan sees patients of all ages. He combines traditional and alternative medicine in an "integrative" blend to suit the individual. The Amish like that approach -- they prefer to see just one doctor for all their care, and their first resort is herbs and supplements, not prescriptions and pills. For one thing, most don't have insurance.

Based on movies like "Witness" and the image of the Amish in horse-and-buggies, many people -- myself included -- assume they have virtually no contact with such outside influences as modern medicine.

Not so.

Noonan has been a doctor in Lancaster County nearly 25 years and about a third of his patients are Amish, making his Amish practice one of the area's largest. He has seen "thousands and thousands" of the county's 22,000 Amish residents and others who live nearby.

I found him through an Amish-Mennonite mother of an autistic child adopted from China. She told me she has seen almost no autism among the Amish, but that I should talk to Noonan because he has treated so many Amish for so long.

Based on my reporting so far, there is evidence of only three or possibly four Amish with autism in Lancaster County, where there should be dozens at the 1-in-166 prevalence in society at large. One of them is the adopted Chinese child. Another was described as having "a clear vaccine reaction" at 15 months, after which she became autistic. I have not met that child and can't vouch for that description.

When I called Noonan three weeks ago, he seemed surprised by my question about Amish autism but agreed to think about it, check around and tell me what he found. At lunch, Noonan said he hesitated to offer an opinion when I first called because it had never occurred to him.

But now, he said, he realized something.

"I have not seen autism with the Amish," Noonan told me. "And I say that having seen a ton of Amish patients. I may be able to think in all those years of maybe one case of (Amish) autism I've had."

"I've checked with some of my colleagues," he added, "and they all tell me it's very, very sporadic that we'll see a case of autism among the Amish."

From 2000 to 2003, Noonan also saw patients at the Wellness Center, which is operated by the Amish and Mennonites. About 90 percent of those patients are Amish, Noonan said, and he saw thousands of them. But still he saw no autism.

"Absolutely none, in the almost three years I was there. We would have seen it. It's not something they would hide. They're not like that."

Noonan said he sees "a fair amount of mental retardation among the Amish." A significant percentage of people with autism have mental retardation as well as severe speech and hearing problems. Wouldn't they show up on the radar of those who track and treat such issues?

And wouldn't autistic Amish see Noonan for the same inevitable illnesses and injuries that bring the rest of their family to him?

I tried various ways to find gaps in Noonan's account. Perhaps autistic Amish children were seeing pediatricians or specialists as opposed to family doctors ...

"The Amish don't go to specialists like we do," he responded. "The Amish go to family docs for all their pediatric care. So at least in Lancaster County, where I practice, almost all pediatrics among the Amish is done by family docs."

"You'll find all the other stuff, but we don't find the autism," Noonan said. "We're right in the heart of Amish country and seeing none. And that's just the way it is."

In my last column, I said this interview was a tipping point between absence-of-evidence (not finding many autistic Amish) and evidence-of-absence (finding there might not be many).

The case is still open, but does anyone disagree that Dr. Noonan makes a compelling witness?

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(Researcher Kyle Pearson contributed to this story.)

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This series on the roots and rise of autism aims to be interactive with readers and will take note of comments, criticism and suggestions. e-mail: dolmsted@upi.com