MMR: marginalised, misrepresented and rejected? Autism: a focus group study
Open accessAbstract
OBJECTIVE: To explore how the measles, mumps, and rubella (MMR) vaccine controversy impacted on the lives of parents caring for children with autism. DESIGN: Qualitative focus group study. SETTING: United Kingdom. PATIENTS: A purposively selected sample of 38 parents took part in 10 focus group discussions between March 2003 and May 2005. RESULTS: Many parents felt that the MMR vaccine could be too potent for children who are susceptible to developing autism. Of the parents whose children received the MMR vaccine, many felt guilty that they may have caused or contributed to their child's autism. Some parents felt frustrated by health professionals' lack of understanding of the negative impact the MMR controversy has had on them. Some parents were anxious about subsequent MMR decision-making for their children. CONCLUSIONS: The controversy has had a negative impact on some parents of children with autism. This has implications for health professionals, who need to be particularly aware of the issues these parents face in future MMR decision-making for their affected child and younger siblings. It is anticipated that these findings will raise awareness among health professionals of the difficulties faced by such parents. More generally, there is a need to promote a greater awareness of the important role health visitors can play in parental decision-making and for research examining whether health professionals feel they receive sufficient training in communication skills. It is also essential that the latest scientific research findings are disseminated quickly to these parents and to those health professionals advising parents on matters of vaccine safety.
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Written from the paper’s full text.
TL;DR
This UK focus group study of 38 parents of children with autism found that the MMR controversy caused uncertainty, self-blame, anger at health professionals, and anxiety about later vaccination decisions. Many parents remained unconvinced by evidence against a link and some withheld or delayed subsequent MMR doses.
Key findings
- Of 38 parents, 28 felt it was possible that vaccines had contributed to their child’s autism, while 10 were adamant that MMR had played no role.
- Many parents whose children had received MMR felt guilty that they may have caused or contributed to their child’s autism; parents also described anger and frustration at health professionals’ lack of understanding or dismissal of their concerns.
- The controversy made subsequent MMR decision-making anxious: parents who thought MMR may have played a role were more likely to withhold the second dose, and siblings’ vaccination was often delayed until parents were satisfied the child showed no signs of autism, described as an “agonizing decision” and “Russian roulette.”
- A few parents said a health visitor had advised them not to have their autistic child immunised with the second dose; the group interpreted this as inconsistent care.
Methods
- Qualitative focus group study in the UK: 10 focus groups with 38 parents (34 mothers, four fathers) of children with autism under 14 years old (mean age 7 years), recruited purposively for maximum variation via autism and carer support groups. Two pilot groups ran in March 2003 and eight further groups between April and May 2005.
- Topic guide covered experiences of diagnosis, living with a child with autism, feelings about childhood immunisation and vaccine decision-making, and thoughts on the MMR controversy and its impact.
- Groups were recorded, transcribed, checked against recordings, imported into NVivo 2.0, and thematically coded using the constant comparative method, with attention to deviant or contradictory cases and group dynamics.
Limitations
- The paper states that the sample was selected and findings may not be generalisable, a common criticism of qualitative research; it also notes that more vocal parents may have opted into the groups.
- The paper argues the high level of agreement between parents, despite purposive diversity, suggests the findings are robust.
- Evident from the text: recruitment through autism/carer support groups and focus group discussion may limit representativeness and introduce group or social-desirability effects; accounts of vaccination and autism onset are retrospective.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
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Cites
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Claims the paper makes
0 of 20 cited sources checked · 0 supported · 0 flagged
- Findingown data§ Results
The MMR controversy contributed to considerable uncertainty among the parents in the focus groups about the causes of autism.
“A prominent theme of the discussions was that the MMR controversy had contributed to considerable uncertainty among the parents about the causes of autism.”
Quote in the paperSubstantial claim - Findingown data§ Results
Some parents whose children received the MMR vaccine blamed themselves or felt guilty that they may have caused or contributed to their child's autism.
“Of the parents whose children received the MMR vaccine, many felt guilty that they may have caused or contributed to their child's autism.”
- Also stated in: § Results · plain
“As a consequence, some parents blamed themselves for having unwittingly sanctioned an intervention that they now believed, with hindsight, may have contributed to their child's condition.”
Quote in the paperNot a substantial claim - Also stated in: § Results · plain
- Findingown data§ Results
Other parents highlighted differences between their children with autism and other children in the family.
“Other parents highlighted differences between their children with autism and other children in the family (see Box 1).”
Quote in the paperNot a substantial claim - Findingown data§ Results
Some parents felt frustrated by health professionals' lack of understanding of the negative impact the MMR controversy has had on them.
“Some parents felt frustrated by health professionals' lack of understanding of the negative impact the MMR controversy has had on them.”
Quote in the paperNot a substantial claim - Findingown data§ Results
It was common for parents to speak about their autistic children having had recurrent bouts of infection and having been repeatedly prescribed antibiotics.
“It was common, for example, for parents to speak about their autistic children having had recurrent bouts of infection, and having been repeatedly being prescribed antibiotics.”
Quote in the paperNot a substantial claim
- Findingown data§ Results
Some parents were anxious about subsequent MMR decision-making for their children.
“Some parents were anxious about subsequent MMR decision‐making for their children.”
Quote in the paperNot a substantial claim - Findingown data§ Results
Of the parents who had either refused their child with autism the second dose MMR or had refused to take their other children for MMR vaccination, most mentioned that they had experienced unwelcome pressure.
“Indeed, of the parents who had either refused their child with autism the second dose MMR or had refused to take their other children for MMR vaccination, most mentioned that they had experienced unwelcome pressure.”
Quote in the paperNot a substantial claim - Findingown data§ Results
Even parents who stated that their child's autism was entirely genetic in origin felt affected by the uncertainty about the causes of autism heightened by the controversy.
“Even parents who stated that their child's autism was entirely genetic in origin felt affected by the uncertainty about the causes of autism which were heightened by the controversy.”
Quote in the paperNot a substantial claim - Findingown data§ Results
Some parents believed they had seen a significant change in their child's health or personality post-vaccination, which they gave as a reason for believing vaccines had played a causal role in their child's autism.
“The second reason given for believing vaccines had played a causal role in their child's autism was that some parents believed that they had seen a significant change in their child's health or personality post‐vaccination.”
Quote in the paperNot a substantial claim - Findingown data§ Results
Parents often spoke angrily about how the MMR controversy had impacted on their lives.
“Parents often spoke angrily about how the MMR controversy had impacted on their lives.”
Quote in the paperNot a substantial claim - Findingown data§ Results
Parents who considered that MMR had played a role in their child's autism were more likely to withhold the second dose MMR, believing it might worsen their child's autism.
“Parents who considered that MMR had played a role in their child's autism were more likely to withhold the second dose MMR, believing it might worsen their child's autism.”
Quote in the paperSubstantial claim - Findingown data§ Discussion
Uncertainty about the origins of their child's autism was common among parents.
“Uncertainty about the origins of their child's autism was common, and the sense of self‐blame that some parents felt because of their decision to vaccinate was unmistakable.”
Quote in the paperNot a substantial claim - Findingown data§ Results
There were a few instances where parents said that their health visitor had advised them not to have their autistic child immunised with the second dose MMR.
“However, there were a few instances where parents said that their health visitor had advised them not to have their autistic child immunised with the second dose MMR.”
Quote in the paperNot a substantial claim - Findingown data§ Results
It was common for parents to describe how the controversy had made them anxious about subsequent MMR decision-making.
“It was common for parents to describe how the controversy had made them anxious about subsequent MMR decision‐making.”
Quote in the paperSubstantial claim - Findingown data§ Discussion
The sense of self-blame that some parents felt because of their decision to vaccinate was unmistakable.
“Uncertainty about the origins of their child's autism was common, and the sense of self‐blame that some parents felt because of their decision to vaccinate was unmistakable.”
Quote in the paperNot a substantial claim - Findingreasoning§ Discussion
Some parents opted not to immunise rather than risk exacerbating their child's condition.
“Some opted not to immunise rather than risk exacerbating their child's condition.”
Quote in the paperNot a substantial claim - Findingcitation§ Discussion
Consistent with Raithatha et al, parents in this study took health professionals' apparent uncertainty and lack of knowledge about autism into consideration when making future decisions about vaccine risk.
“Consistent with the findings of Raithatha et al,25, parents in this study took health professionals' apparent uncertainty and lack of knowledge about autism into consideration when making future decisions about vaccine risk.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Raithatha et al,25
Not checked in the free run.
- Findingcitation§ Discussion
Like many parents in the general population, this group of parents often delayed MMR vaccination until their other children were showing no signs of autism.
“Like many parents in the general population,42 this group of parents often delayed MMR vaccination until their other children were showing no signs of autism.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42]
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- Interpretationown data§ Conclusions
The MMR controversy has had a negative impact on some parents of children with autism.
“The controversy has had a negative impact on some parents of children with autism.”
Quote in the paperSubstantial claim - Premisecitation§ Conclusions
There is a notable absence of scientific research reporting the views of parents caring for children with autism.
“Despite this growing evidence base on parental views of decision‐making about MMR,22,23,24 there is a notable absence of scientific research reporting the views of one crucial group of parents, namely those caring for children with autism.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [22]
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- Study design and conductown data§ Results
The sample included 38 parents (34 mothers and four fathers) with 36 sons and four daughters diagnosed with autism (mean age 7 years).
“The sample included 38 parents (34 mothers and four fathers) with 36 sons and four daughters diagnosed with autism (mean age 7 years).”
Quote in the paperNot a substantial claim- Rests on an assumption: The children's autism diagnoses, as reported by parents, are accurate.
- Study design and conductown data§ Results
Parents' descriptions of their child's autism ranged in severity from children who had no communication, few social skills and were totally dependent on others for basic care and safety, to children who were reasonably independent, often at the higher-functioning end of the autistic spectrum.
“Parents' descriptions of their child's autism ranged in severity from children who had no communication, few social skills and were totally dependent on others for basic care and safety, to children who were reasonably independent. These were often at the higher‐functioning end of the autistic spectrum, with Asperger's syndrome.”
Quote in the paperNot a substantial claim- Rests on an assumption: The children's autism diagnoses, as reported by parents, are accurate.
- Interpretationreasoning§ Conclusion
Parents caring for children with autism may find it difficult to weigh up the risks and benefits of subsequent vaccination for their children, including children affected and unaffected by autism.
“In particular, health professionals should be aware that these parents may find it difficult to weigh up the risks and benefits of subsequent vaccination for their children – including children affected, and unaffected, by autism.”
Quote in the paperSubstantial claim - Interpretationown data§ Conclusion
This research has highlighted the considerable negative impact that the MMR controversy had had on this group of vulnerable parents.
“This research has highlighted the considerable negative impact that the MMR controversy had had on this group of vulnerable parents.”
Quote in the paperSubstantial claim
- May combine two claims. 22
- Classified as probably not a substantial claim. 20
- The quote only partly states this claim. 1
May combine two claims.
Findingown data§ ResultsWhile 10 parents were adamant that the MMR vaccine had not played any role in their child's autism, 28 parents felt it was possible that the vaccines had been a contributory factor.
“While 10 parents were adamant that the MMR vaccine had not played any role in their child's autism, 28 parents felt it was possible that the vaccines been a contributory factor.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.
Findingown data§ ResultsMany parents believed that the MMR vaccine could be too potent for a sub-group of children susceptible to developing autism, who have inherently weak or sensitive immune systems unable to cope with vaccination.
“Many parents felt that the MMR vaccine could be too potent for children who are susceptible to developing autism.”
- Also stated in: § Results · hedged
“In all groups parents spoke about the possibility that there may be a sub‐group of autistic children who have inherently “weak” or “sensitive” immune systems which are unable to cope with vaccination.”
Quote in the paperNot a substantial claim- Also stated in: § Results · hedged
May combine two claims.
Findingown data§ ResultsSome parents believed they had ignored early warning signs that their child was not healthy and had then sanctioned a vaccine that may have caused autism, which placed a significant burden of guilt upon them.
“Another important theme which arose spontaneously in all the groups was that some parents believed that they had ignored early warning signs that their child was not healthy, and had then sanctioned a vaccine that may have caused autism. This placed a significant burden of guilt upon them.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown data§ DiscussionAlthough parents seemed well-informed and aware that the body of scientific evidence overwhelmingly supports the safety of the MMR vaccine, many remained unconvinced.
“Although parents seemed well‐informed and were aware that the body of scientific evidence overwhelmingly supports the safety of the MMR vaccine, many remained unconvinced.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ ResultsMany parents decided to let subsequent siblings have the vaccine, but often delayed it until they were happy that their child was showing no sign of autism.
“Although many parents did decide to let subsequent siblings have the vaccine, it was often delayed until they were happy that their child was showing no sign of autism.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ ResultsThe 10 parents who did not believe that MMR played any role in their child's autism believed autism to be a genetic disorder, and either stated a family history of autism or recalled early signs of autism in their children pre-vaccination.
“The 10 parents who did not believe that the MMR vaccine had played any role in their child's autism believed autism to be a genetic disorder, and either stated that there was a family history of autism or recalled the early signs of autism in their children pre‐vaccination.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown data§ ResultsParents commonly spoke of feeling frustrated and annoyed at health professionals' lack of appreciation of their difficult situation, and some felt their concerns were dismissed or ignored by them.
“Parents commonly spoke of feeling frustrated and annoyed at health professionals' lack of appreciation of their difficult situation and some felt their concerns were dismissed or ignored by them.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ ResultsThe key reason parents gave for anger towards health professionals was that they thought health visitors and general practitioners tended to underestimate the devastating impact of autism, were dismissive of their concerns about MMR safety, and seemed to have an inflexible approach.
“When parents were encouraged to explain further why they felt angry towards health professionals, the key reason they gave was that parents thought that health visitors and general practitioners tended to underestimate the devastating impact of autism, were dismissive of their concerns about the safety of MMR vaccination and seemed to have an “inflexible approach””
Quote in the paperSubstantial claimMay combine two claims.
Findingown data§ DiscussionMany parents displayed frustration and anger at health professionals for failing to give them better advice for their children, for failing to recognise how damaging and undermining the debate surrounding the safety of the MMR vaccine has been, and for underestimating the impact of autism.
“Many parents displayed frustration and anger at health professionals for failing to give them better advice for their children, for failing to recognise how damaging and undermining the debate surrounding the safety of the MMR vaccine has been, and for underestimating the impact of autism.”
Quote in the paperNot a substantial claimMay combine two claims.
Premisecitation§ ConclusionsVaccine uptake dropped following widespread media coverage of the MMR vaccine controversy, despite government and public health officials acting quickly to reassure parents that the MMR vaccine was not associated with autism.
“Despite government and public health officials acting quickly to reassure parents that the MMR vaccine was not associated with autism, vaccine uptake dropped following the widespread media coverage of the MMR vaccine controversy (see: http://www.hpa.org.uk/infections/topics_az/vaccination/071102_MMRpreferable.htm).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites http://www.hpa.org.uk/infections/topics_az/vaccination/071102_MMRpreferable.htm
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Study design and conductnone given§ MethodsParents with a range of different MMR vaccine decision-making outcomes for their children were included in order to select the most diverse sample.
“We also included parents with a range of different MMR vaccine decision‐making outcomes for their children in order to select the most diverse sample (table 1).”
Quote in the paperSubstantial claimMay combine two claims.
Premisecitation§ ConclusionsTo date, the stories of parents of children with autism have been represented by journalists or through a few books in which parents offer their personal accounts.
“To date their stories have been represented by journalists27,28 or through a few books in which parents offer their personal accounts.29,30,31,32”
Quote in the paperSubstantial claim0 of 6 sources checked- cites [27]
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Study design and conductown data§ MethodsInformed consent was obtained before commencing group discussions.
“Before commencing group discussions, informed consent was obtained and after completing the session any travel expenses and childcare costs were reimbursed.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Premisecitation§ ConclusionsIn February 1998, a paper was published postulating a link between the MMR vaccine, bowel disease and autism.
“In February 1998, a paper was published postulating a link between the MMR vaccine, bowel disease and autism.5”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5]
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Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitation§ MethodsThe sample used purposive (maximum variation) sampling methods to ensure that the broadest possible range of experiences was included.
“The sample used purposive (maximum variation) sampling methods to ensure that the broadest possible range of experiences was included.37”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37]
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Study design and conductnone given§ MethodsAll group discussions were recorded with respondents' permission and transcribed in full.
“All groups were recorded with the respondents' permission and transcribed in full.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitation§ MethodsParticular attention was paid to deviant or contradictory cases and to group dynamics.
“Particular attention was paid to deviant or contradictory cases39 and to the group dynamics.40”
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- cites [40]
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Premisecitation§ ResultsThere may be as many as 15 times more males than females affected with high-functioning autism and twice as many males as females affected with lower-functioning autism.
“it has been suggested that there may be as many as 15 times more males than females affected with high‐functioning autism and twice as many males as females affected with lower‐functioning autism.41”
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Premisecitation§ ResultsAutism spectrum disorders affect approximately 60 in every 10 000 children under 8 years of age in the UK.
“According to the MRC's review of autism research, autism spectrum disorders affect approximately 60 in every 10 000 children under 8 years of age in the UK26”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [26]
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Study design and conductnone given§ MethodsTranscripts were checked against the recordings.
“The transcripts were checked against the recordings and imported into NVivo 2.0 (QSR International, Cardigan UK), a qualitative software programme, to facilitate systematic comparisons across the large amounts of data.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
Study design and conductcitation§ MethodsData were thematically coded following the constant comparative method, with each transcript repeatedly re-examined and cross-compared to identify common themes and explore parents' underlying reasoning.
“Data were thematically coded. Following the principle of the constant comparative method,38 each transcript was repeatedly re‐examined and cross‐compared to identify common themes and explore parents' underlying reasoning.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [38]
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Interpretationcitation§ ResultsThe gender distribution of children in this study reflects the greater prevalence of autism among boys.
“The gender distribution of children in this study therefore reflects the greater prevalence of autism among boys.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitation§ MethodsThe final sample included parents with children with autism under 14 years old (mean age 7 years), whose autism had been diagnosed after the publication of Wakefield's paper and covered a range of severity.
“The final sample included parents with children with autism under 14 years old (mean age 7 years), whose autism had been diagnosed after the publication of Wakefield's paper5 and covered a range of severity.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [5]
Not checked in the free run.
- Rests on an assumption: The children's autism diagnoses, as reported by parents, are accurate.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone given§ MethodsEthical approval for the study was obtained from the Faculties of Law, Financial Studies and Social Sciences Ethics Committee at the University of Glasgow.
“Ethical approval for the study was obtained from the Faculties of Law, Financial Studies and Social Sciences Ethics Committee at the University of Glasgow.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductreasoning§ MethodsIn order to ensure anonymity, groups are described only by broad regional terms, parents are identified by number, and names and ages of parents and children have been omitted.
“In order to ensure anonymity for the parents and their families, the groups are described only by broad regional terms, parents are identified by a number, and the names and ages of parents and children have been omitted.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationreasoning§ ConclusionThe MMR controversy has caused uncertainty and anxiety for these parents.
“The uncertainty and anxiety the MMR controversy has caused for these parents adds weight to the MRC's recommendations in 2001 for a comprehensive research strategy towards autism in order to confirm or refute the existence of a range of possible causal triggers for the condition.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown data§ DiscussionThe MMR controversy represented a period of continuing uncertainty about the safety of vaccines for children with, or predisposed to, autism, and this impacted on some parents' later immunisation decision-making.
“The MMR controversy represented a period of continuing uncertainty about the safety of vaccines for children with, or predisposed to autism, and this impacted on some parents' later immunisation decision‐making.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Study design and conductnone given§ DiscussionIt is possible that the more vocal parents opted into the groups and this should be borne in mind.
“Nevertheless, it is possible that the more vocal parents opted into the groups and this should be borne in mind.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Interpretationown data§ ConclusionSome of these parents may feel in part responsible for having sanctioned an intervention that they believe may have contributed to their child's autism.
“Health professionals also need to be sensitive to the fact that some of these parents may feel in part responsible for having sanctioned an intervention that they believe may have contributed to their child's autism.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationreasoning§ DiscussionThe study represents a selected sample of participants and the findings may not be generalisable.
“The main criticism which may be levelled is that it represents a selected sample of participants and the findings may not be generalisable, a common criticism of qualitative research.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.
Premisenone given§ ConclusionThe suggestion that MMR vaccination may be a cause of autism received widespread publicity, although subsequent scientific research has failed to support a link.
“The suggestion that MMR vaccination may be a cause received widespread publicity, although subsequent scientific research has failed to support a link.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
Interpretationreasoning§ ConclusionThese parents, perhaps more than most, face a particularly difficult decision when trying to decide whether vaccination is in their child's best interests.
“In general, these parents, perhaps more than most, face a particularly difficult decision when trying to decide whether vaccination is in their child's best interests.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown data§ DiscussionA notable feature of these focus group discussions was the high level of agreement between parents even though the sample was selected to be as diverse as possible, which suggests that the findings are robust.
“Moreover, a notable feature of these focus group discussions was the high level of agreement between parents even though the sample was selected to be as diverse as possible, which suggests that the findings are robust.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).
Premisenone given§ DiscussionThe body of scientific evidence overwhelmingly supports the safety of the MMR vaccine.
“Although parents seemed well‐informed and were aware that the body of scientific evidence overwhelmingly supports the safety of the MMR vaccine, many remained unconvinced.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The children's autism diagnoses, as reported by parents, are accurate.
“The sample included 38 parents (34 mothers and four fathers) with 36 sons and four daughters diagnosed with autism (mean age 7 years).”
“Parents' descriptions of their child's autism ranged in severity from children who had no communication, few social skills and were totally dependent on others for basic care and safety, to children who were reasonably independent.”
The paper relies on this without support.
To our knowledge, this exploratory study is the only research to date which has investigated how the MMR controversy has impacted on the lives of parents caring for children with autism.
“Despite this considerable ongoing research effort, to our knowledge this exploratory study is the only research to date which has investigated how the MMR controversy has impacted on the lives of parents caring for children with autism.”
The paper relies on this without support.
To date no research has explored these issues with parents of children with autism.
“Although there have been a number of studies which have examined the challenges parents face in weighing the risks and benefits of MMR vaccination, to date no research has explored these issues with parents of children with autism.”
The paper relies on this without support.
This is the first research study to consider the impact the MMR controversy has had on parents of children with autism.
“This is the first research study to consider the impact the MMR controversy has had on parents of children with autism.”
The paper relies on this without support.
Little is known about how health visitors view their role in childhood immunisation and guidance on how they communicate advice to parents, particularly those with concerns, is not well defined.
“Although health visitors play a pivotal role in promoting childhood immunisation, little is known about how health visitors view their role in childhood immunisation and guidance on how they communicate advice to parents, particularly those with concerns, is not well defined.”
The paper relies on this without support.
Health visitors play a pivotal role in promoting childhood immunisation.
“Although health visitors play a pivotal role in promoting childhood immunisation, little is known about how health visitors view their role in childhood immunisation and guidance on how they communicate advice to parents, particularly those with concerns, is not well defined.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Excessive and unjustified media coverage of Wakefield 1998 led to a significant decrease in MMR-vaccine coverage and re-emergence of measles in the UK.
“At that time (1998) an excessive and unjustified media coverage of this small study had disastrous consequences (Flaherty 2011; Hilton 2007; Offit 2003; Smith 2008), such as distrust of public health vaccination programmes, suspicion about vaccine safety, with a consequential significant decrease in MMR-vaccine coverage and re-emergence of measles in the UK.”
From Vaccines for measles, mumps and rubella in children (2012) · cites this paper as Hilton 2007
The paper’s Conclusions state that MMR uptake dropped following widespread media coverage of the controversy, and that subsequent research did not support Wakefield’s proposed link between MMR and autism. They do not quantify the drop, characterize the coverage as excessive, or say that it caused measles to re-emerge in the UK. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Cites
1 retracted
Wakefield, A., Murch, S., Anthony, A., Linnell, J., Casson, D., Malik, M., Berelowitz, M., Dhillon, A., Thomson, M., Harvey, P., et al. (1998) · The Lancet · doi:10.1016/s0140-6736(97)11096-0 · Cited by 3,006 · see citing works
RetractedQualitative research in health care: Analysing qualitative data
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The methodology of Focus Groups: the importance of interaction between research participants
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Focus Groups in Social Research
Bloor, M., Frankland, J., Thomas, M., & Robson, K. (2001) · SAGE Publications Ltd eBooks · doi:10.4135/9781849209175 · Cited by 2,174 · see citing works
Developing Focus Group Research
Barbour, R. S., & Kitzinger, J. V. (1999) · SAGE Publications Ltd eBooks · doi:10.4135/9781849208857 · Cited by 1,603 · see citing works
Reluctance to vaccinate: Omission bias and ambiguity
Ritov, I., & Baron, J. (1990) · Journal of Behavioral Decision Making · doi:10.1002/bdm.3960030404 · Cited by 854 · see citing works
Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association
Taylor, B., Miller, E., Farrington, C., Petropoulos, M.-C., Favot-Mayaud, I., Li, J., & Waight, P. A. (1999) · The Lancet · doi:10.1016/s0140-6736(99)01239-8 · Cited by 753 · see citing works
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Flagged first, then by citations
Cited by
Sorted by citations
Vaccines for measles, mumps and rubella in children
Demicheli, V., Rivetti, A., Debalini, M. G., & Di Pietrantonj, C. (2012) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004407.pub3 · Cited by 372 · see citing works
- Authors
- Hilton, S., Hunt, K., & Petticrew, M.
- Affiliations
- MRC/CSO Social and Public Health Sciences Unit (GB)
- Corresponding author
- Hilton, S.
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 2007-03-21
- Volume
- 92
- Issue
- 4
- Pages
- 322-327
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- PMC
- PMC2083659
- OpenAlex
- W2169616575
- Cited by
- 31
- References
- 36
- Citations by year
- 2023: 1 · 2021: 2 · 2020: 2 · 2017: 3 · 2016: 1 · 2015: 2 · 2014: 1 · 2013: 3 · 2012: 5
- FWCI
- 2.95
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Disease in Childhood (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Ethics and Legal Issues in Pediatric Healthcare
- Social Sciences › Sociology and Political Science › Risk Perception and Management
- Keywords
- autism spectrum disorder, parental experiences, vaccine safety, parental guilt, health professional communication, health visitors, parental decision-making, vaccine hesitancy
- MeSH terms
- Adolescent, Attitude to Health, Autistic Disorder, Child, Female, United Kingdom, Guilt, Humans, Male, Parents, Physician-Patient Relations, Vaccination, Focus Groups, Measles-Mumps-Rubella Vaccine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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