Our study does not support a causal association between early exposure to mercury from thimerosal-containing vaccines and immune globulins and deficits in neuropsychological functioning at the age of 7 to 10 years.

WHAT'S KNOWN ON THIS SUBJECT:Most previous research has not revealed an increased risk of autism associated with receipt of thimerosal-containing vaccines. Evidence is limited, however, on the timing of vaccination, especially prenatal exposure, and associations with different subtypes of autism. WHAT THIS STUDY ADDS:This study revealed no increased risk of ASD associated with receipt of thimerosal-containing vaccines. No increased risk was found for subtypes of ASD, including ASD with regression, and prenatal exposure was not associated with a risk of ASD. abstract OBJECTIVE: Exposure to thimerosal, a mercury-containing preservative that is used in vaccines and immunoglobulin preparations, has been hypothesized to be associated with increased risk of autism spectrum disorder (ASD). This study was designed to examine relationships between prenatal and infant ethylmercury exposure from thimerosalcontaining vaccines and/or immunoglobulin preparations and ASD and 2 ASD subcategories: autistic disorder (AD) and ASD with regression. METHODS:A case-control study was conducted in 3 managed care organizations (MCOs) of 256 children with ASD and 752 controls matched by birth year, gender, and MCO. ASD diagnoses were validated through standardized in-person evaluations. Exposure to thimerosal in vaccines and immunoglobulin preparations was determined from electronic immunization registries, medical charts, and parent interviews. Information on potential confounding factors was obtained from the interviews and medical charts. We used conditional logistic regression to assess associations between ASD, AD, and ASD with regression and exposure to ethylmercury during prenatal, birth-to-1 month, birthto-7-month, and birth-to-20-month periods. RESULTS:There were no findings of increased risk for any of the 3 ASD outcomes. The adjusted odds ratios (95% confidence intervals) for ASD associated with a 2-SD increase in ethylmercury exposure were 1.12 (0.83-1.51) for prenatal exposure, 0.88 (0.62-1.26) for exposure from birth to 1 month, 0.60 (0.36 -0.99) for exposure from birth to 7 months, and 0.60 (0.32-0.97) for exposure from birth to 20 months.

There is a widespread belief that high-quality early care and education can improve children's school readiness. However, debate continues about the essential elements of a high-quality experience, about whether quality means the same things across different types of care settings, about how to measure quality, and about the level of quality that might make a meaningful difference in outcomes for children. Are the aspects of the child care environment that researchers measure the ones that are most strongly related to children's development? This article argues that the ways in which researchers currently measure early care environments are flawed and that the conclusions drawn about the relationship between these measures and outcomes for children are frequently incorrect or overstated. The article addresses four questions: How is the quality of the child care environment commonly defined and measured? Do the most commonly used measures capture the child's experience? Do they work well across all settings? Are researchers drawing the correct conclusions from studies that relate the child care environment to child outcomes? Finally, the article discusses some possible directions for future research.

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