How autism affects its victims?
The following sentences describe a few ways that Asperger's Syndrome affects families in order to provide an idea of the different ways in which it can affect families, but it is by no means a complete description. Family members, especially parents, can be exhausted from taking care of the child with Asperger's Syndrome because of the child's special needs. Because of the time the parents spend with the child with Asperger's Syndrome, siblings might feel neglected. Family members might feel embarrassed by the child's behavior in public. The child might have special skills, such as an amazing ability to do mathematical calculations in one's head or remembering the dialogue of a movie word-for-word after one viewing, which could prompt feelings of pride in the child from the parents. Paying for different therapies that might help can cause financial stress for the family. This short list illustrates that Asperger's Syndrome can affect families in physical, emotional, and financial ways.
^^^ All the above examples are ableist, presumably taken from a source such as Autism Speaks which uses such propaganda against autism in order to increase it's profits. Autism does not destroy families as this answer suggests, for many families it makes no difference or a positive difference.
Seriously, all the examples above seem to be negative - ableist tripe!
What gender is more likely to get autism?
Autism affects more boys than girls. The ratio of boys to girls with autism is about 4:1. The National Autistic Society's site (link below) explains more about the different level of occurrence in males and females.
For the most severe cases of autism, the ratio of autism in boys and girls is nearly 1:1. This has led to speculation by some of the most noted experts in the field that girls with autism have a few symptoms that differ from boys and thus are underdiagnosed. (The original description of autism was based on case studies of males, and the underlying reason for some of the behaviors might manifest differently in males and females.) For example, instead of acting aggressive, they might withdraw and be viewed as very shy and passive. Also, their obsession-like special interests (such as animals) cause less concern. So, even though they might have a great many behaviors identified with autism, girls with autism might not come to the notice of parents or educators because of those few behaviors where they differ from males might mean that no concern is triggered despite matching most of the characteristics.
I don't agree with above poster regarding girls being under-diagnosed and reasons why. There are not a "few symptoms" that lead to a diagnosis of autism, like there are for other medical maladies. Basically, a very well trained person must observe the child, speak to the parents and review anecdotal reports regarding the child's behavior. Then and only then can the trained individual say that the child (may) have some degree of autism. There is no absolute test, and anyone that says there is, is not a true trained professional. When making a diagnosis, there is a list of target behaviors, about 20 or so. If the child exhibits a high degree of these behaviors, (like 12 or 15 out of 20) then it's pretty safe to say that the child fits somewhere on the autism spectrum. Every child is different and acts out in different degrees. That is why I question the answer above. AGGRESSIVENESS in and of itself is not necessarily a sign of autism. However, combined with 10 other target behaviors, it may well fit the autism profile. Same with OCD or ADHD. Alone, these behaviors don't really tell you the whole story. However, combined with 10 or 12 other target behaviors, then you might be talking autism. AND, boysand girls would be evaluated on the same scale, looking for the same target behaviors that would suggest autism in the first place! I hope this helps clear things up a bit for some folks. I've been working with adults and children with autism for 30+ years and it is a very complicated, misunderstood disorder....<<>> The female differs from the male in her enhanced ability to rid her body of environmental foreign toxins such as fluorine, chloride, and bromine compounds. These compounds, found in paints, cleaners, plastics, fire retardants in new clothing, bedding, towels, coatings to keep oils and greases from leaching (microwave popcorn bags, carpet coatings), etc, are absorbed by the infant and stay there from 5 to 8 years. This also accounts for the fact that the first child is at a greater risk of having autism, because he/she is the one with the new crib, BFR (brominated fire retardant) treated mattress, freshly painted or cleaned room and carpet, new toys, etc. This is why products such as "Scotchgard" and "Stainmaster" have disappeared, and Biphenol A (BPA) is under fire. see: AutismApocalypse.com
What are the symptoms of Asperger's in kids?
Asperger's Syndrome (AS) has many characteristics in common with autism and is thus viewed as a variant of it. It is a neurological condition. If a person has an IQ under 70, it is typically labeled as autism. If a person has average or above average IQ, it is typically labeled as AS. Asperger's Syndrome is also known as high-functioning autism, although there is some disagreement about whether they truly are the same. Some people describe AS as a mild version of autism, but actually it is just as severe. (The conditions are similar but have differences, and both autism and AS can range from mild to severe.) One difference is that the people with Asperger's Syndrome have better language abilities and typically have higher intelligence; thus, they might be more able to compensate to function in society.
Here is a list of some of the possible signs or symptoms in those who have AS (many of which are also common to autism), compiled from several sources. No person with AS has all these traits, and they do not have them at the same levels. Some traits are opposites, but stem from the same underlying issue. Although neuro-typical people (ones without an autism spectrum disorder) might experience some of these characteristics, the problems are usually tenfold to a hundredfold worse for the person with AS or autism. These characteristics are based on observation of males with AS; it is thought that females could exhibit AS in different ways because they might react to the same difficulty in a different manner. In adults, some of these traits only occur in specific situations or when under stress. Compensating for some traits and learning ways to do some things can be accomplished with explicit instructions. Some of these characteristics usually occur only in children because adults have learned to compensate through trial and error or observation of other people. Some of these characteristics are comparisons to the development of neuro-typical children.
Social interactions
- seems content when left alone
- does not understand social cues and thus might act inappropriately, appearing rude, uncaring, and tactless
- might be able to function in one-to-one interactions but not with multiple people
- has strong sense of loyalty; very loyal to friends
- has strong sense of social justice; tends to defend others and causes
- achieves social success by intellectual analysis rather than intuition
- often has a sense of humor as an adult that is not frequently understood by others, often a very dry sense of humor
- might or might not desire friendships; most seem to desire friendships but the stress involved makes them decide it is not worth it
Child development:
- does not play turn-taking games
- is more likely to play by him- or herself, or next to other children, than with them
- uses adult's hand as a tool
- does not interact socially with same age group; indifference to peer contacts; difficulties interacting with peers
Verbal communication
- rarely initiates communication; might speak only when discussing favorite subjects (special interests)
- when trying to participate in conversations, it might seem odd or awkward; does not know how to keep a conversation going
- understands and uses words literally, resulting in misinterpretations; might not understand idiomatic expressions and metaphors; might not pick up double meanings; might not understand subtle satire and irony; might not understand when exaggeration is being used; is often the last person to understand the point of a joke
- discusses objects and facts, not feelings
- might sound overly formal or excessively technical; pedantic; includes too much detail
- is more comfortable writing than speaking; more comfortable in situations where body language is not an issue, such as in the dark or back-to-back
Child development:
- fails to imitate actions or sounds
- might have echolalia - repeats or echoes words and phrases just heard
- might have delayed language acquisition; might have precocious language acquisition
Nonverbal communication
- eye contact is limited/fleeting, staring, or otherwise seems atypical; might make appropriate eye contact when talking but look away when listening or processing an answer; more likely to look at mouth than eyes
- has atypical body language; does not accurately express intents, thoughts, and feelings via nonverbal language
- might not use gestures; gestures might seem stilted or clumsy; gestures might be exaggerated
Child development:
- has a deficit in joint attention; does not point at object to share interest and does not realize that gaze should be directed where other person is pointing
Relating to surroundings (including change)
- is upset by or resists changes; inflexible; desires predictability; should be warned about changes to environment and routines
- develops rigid routines; prefers to know rules for all situations; seemingly simple activities that are not part of the routine, such as going out to eat, can be extraordinarily stressful
- might be reluctant to enter unknown places or visit friends' homes because of not knowing the "rules" for that place
- has a tendency to collect objects or information / facts
- tends to notice patterns; tends to notice license plates numbers; often notices details that other people do not
- might refuse to eat foods that are touching other foods on the plate
Child development:
- play is repetitive
Responses to sensory stimuli
- usually has sensory integration disorder - unusual perception of sensory input, sensory processing abnormalities
- might be oversensitive to sound, hearing sounds most people do not or panicking at certain sounds, or undersensitive to sound, appearing deaf at times
- might be oversensitive to sight, preferring dimly lit rooms or certain colors, or undersensitive to sight, desiring lots of colors and interested in flashing lights
- might be oversensitive or undersensitive to taste, preferring either extra spicy or very bland foods, or preferring sourness such as lemon slices
- might be oversensitive or undersensitive to touch; might become very stressed by light touches, but less stressed by firm ones; might feel calmer in Temple Grandin's "hugging machine"
- might be oversensitive or undersensitive to smell
- might be under or oversensitive to balance (vestibular stimulation); might frequently twirl or might easily become dizzy
- might have proprioceptive dysfunction - insufficient processing of information from muscles and joints so is unaware of where body is in space; might hit, kick, or bang head against objects intentionally to gain awareness of where one's body parts are in space; might watch one's feet or hands to be aware of where they are
- might prefer to wear the same clothing day after day (because of how it feels, as well as preferring the same routines)
- might prefer to sleep under many blankets for the pressure of the weight or similarly to wear heavy clothes for the comforting pressure
- might be oversensitive or undersensitive to pain
- is often very inactive or very active
Child development:
- plays with light and reflections
- flicks fingers before eyes
Motor clumsiness
- has a lack of coordination in physical activities; cannot synchronize leg and arm movement; might be described as clumsy or accident-prone
- might have problems with both fine and gross motor control; might have fine motor control but not gross motor control or vice versa
Child development:
- is behind age group performance on neurodevelopmental examination
Special interests
- are all-absorbing, narrow interests done to the exclusion of other activities, done with repetitive adherence, or done with more rote than meaning (as a child)
- often include a fascination with facts or numbers, science, or something related to transportation
- often involve a couple lifelong primary special interests; might include short-term, but very intense, secondary special interests; might acquire more primary interests over time so adults might have 4 or more
- are calming and reduce stress (as opposed to an obsession), but might give appearance of obsessive-compulsive disorder
Thinking and memory
- has excellent long-term memory for facts and routines; often have an excellent memory for dialogue
- might have difficulty with short-term memory
- is logical and detail-oriented; easily able to identify errors
- can focus on tasks intensely; persistent; difficulty leaving tasks unfinished
- often has poor imagination as a young child; might have extraordinary imaginative abilities as a teenager and adult
Brain differences
- the amygdala (the brain's social and emotional control center) is enlarged during early childhood and then shrinks; resulting in an amygdala that appears the same as the amygdala in children who were subjected to physical abuse, sexual abuse, or neglect; a person with a "damaged" amygdala might sense danger when there is none
- researchers believe that children with autism related disorders suffer chronic stress from fear of people that results in the atypical development of the amygdala
Child development:
- larger than normal head circumference is common
Other characteristics
- often only minimally affected by peer pressure, so does what is comfortable for him or her; or, tries to fit in by doing anything peers suggest without realizing peers' true intentions
- has an aversion to being interrupted; compulsion for completion
- is often very spiritual, but not necessarily religious
- is a perfectionist
- has an impaired fight or flight response - possibly because fight or flight is already activate in almost all situations; often does not recognize dangerous situations
- has difficulty making friends; often might misinterpret kindness as friendship; might never form long-term intimate relationships due to lack of social skills and ability; might invent imaginary friends, worlds, or scenarios due to social difficulties
- unusual attachment to objects; is attached to one particular object; might be preoccupied with parts of objects
- might be especially sensitive to mind-affecting medicines, such as anti-anxiety and anti-depressant ones; might have atypical side effects from medicines, such as codeine causing insomnia
- might have nicknames such as "little professor" and "encyclopedia" (more often male) or "little philosopher" (more often female)
- the combination of misunderstandings due to taking words literally, possessiveness and intense loyalty to perceived friends, and socially odd or inappropriate behavior can make others feel as if they might be being stalked
- often has family members with a smaller number of these traits or learning disabilities; has a genetic factor to autism related disorders which is probably then triggered by environmental factors
Other conditions that might occur with Asperger's Syndrome
- might suffer anxiety disorder and panic attacks due to effects of Asperger's
- might suffer depression and have suicidal tendencies due to effects of Asperger's
- might suffer post-traumatic stress disorder due to victimization which is due to effects of Asperger's
- might have prosopagnosia (face blindness) - difficulty with facial recognition
- might have learning disabilities
- might have dyspraxia, also known as sensory integration disorder (difficulty planning and performing complex movements such as drawing, writing, buttoning, or other fine motor skill tasks)
- might have sleep problems
- might have dietary intolerances, such as gluten, casein, or lactose intolerance; greater risk of immune system disorders related to digestion, such as Crohn's disease or celiac disease; food allergies
- might not process B6 vitamins efficiently; a study on children with autism showed that they seem to benefit from what are normally toxic doses of B6, but this is not something to try at home
- might have chronic diarrhea or chronic constipation for years
- other co-existing conditions include attention deficit hyperactivity disorder (ADHD), bipolar disorder, obsessive-compulsive disorder (OCD), oppositional defiance disorder (ODD), antisocial personality disorder (APD or ASPD), and Tourette's Syndrome (TS) and other tic disorders
- has a slightly greater incidence of epilepsy
- has a greater incidence of tuberous sclerosis (benign tumors in the brain and other vital organs)
- has 10 times greater incidence of savantism, often in the form of mental calculation or fast computer programming skills
Sources include, among others:
No, you cannot get rid of your autism.
If you're Autistic then your brain is autistic - it effects every single aspect of who you are, it is who you are as a person and that cannot be changed. You are born Autistic and continue to be Autistic throughout your entire life, which is absolutely fine. There is nothing wrong with being Autistic.
Autism is from birth, although autism-like symptoms can occur as a result of brain injury and illness etc. It is likely that autism is the result primarily of environmental factors triggering genetics that would not normally cause a problem to result in ASD, or autism spectrum disorder.
Vaccines have been suspected to cause autism for a while, but the evidence for them causing autism is weak.
The actual cause of autism is not yet known, although we do know that some drugs can cause autism when exposed to unborn babies in utero.
One example of this is the anti-convulsant sodium valproate, which is still commonly prescribed to women of childbearing age. Class action lawsuits in various countries (including the UK and USA) are currently underway.
How do you get autism spectrum disorder?
There are a lot of different speculations about why people get autism. Some researchers have theorized that autism is caused by heavy metal buildup in the body, but other evidence has shown that theory to be somewhat shaky and possibly untrue. Other evidence suggests that autism is primarily a genetic disorder. This theory seems to be gaining popularity, and so far no studies have been able to disprove this theory. In fact, there have been several reported cases of parents being diagnosed with asperger's syndrome (a more mild form of autism) after their children have received the same diagnoses.
Well said above and additionally, there is an environmental factor that triggers the genetic predisposition that basically kicks the autism into gear. What the trigger is remains unknown and has been speculated it varies from individual to individual.
How do you care for a person with autism?
If your spouse is Autistic you should learn what you can about the condition and help to provide an environment that does not cause them distress. (Usually sensory-related, such as noise or bright/flickering lights) Above all, when your Autistic spouse gets upset, back off and let them "recharge" for a while. Listen and observe. Other than that, the same things apply to Autistic people as anyone else: food, clothing, shelter, love (or at least companionship) and enough sunlight to synthesize their vitamin D. There is no reason why people on the Spectrum can not have successful marriages and careers if they have people who love them and believe in their abilities and talents... but it takes two to make a relationship work and Autism does not excuse anyone from being an equal participant, it just may change the nature of that participation.
How would you handle an Autistic child who was having a tantrum?
Bare in mind that there is a difference between tantrum and meltdown.
A tantrum is where a child is attention seeking and acting out to get something they want. A meltdown is an uncontrollable emotional response to stress and/or stimulation, often this causes temporary drop in function so the child is unable to communicate and may be more sensitive to stimulation, and for a few days following they may be more severely effected by their autism.
Your twin has autism will your baby have autism too?
Yes. However, it is more likely that the second child will not have an autism spectrum disorder than that the child will have one.
There is a genetic component to autism spectrum disorders. The chance of having a second child with autism or Asperger's Syndrome is greater than the usual chance of having a child with an autism spectrum disorder. If the next child does have it, it could be a milder or more severe case than that of the first child.
According to one study, if one child in the family has autism, the chance that another will also have autism is 10%. In that study, the chance that an identical twin has autism when the other does is 82%. Other studies give results ranging from a 5% chance of a second child with autism to a 15% chance. However, if there are two children in the family who have autism, the chance of a third child with autism increases greatly to about 30%. (One study indicates that the chance of a third child with autism is 50% if the child is male.)
How do you know if your child has Asperger's Syndrome?
A person with Aspergers' Syndrome will not talk much, not be very brave or courageous, he'll be normally nervous, sometimes talk back, and not be very reasonable in minor cases.
In major cases, they're basically vegetables, they have zero concern or respect for anyone they don't like, they like to think that they know everything, they bully, and normally gang up on someone without Aspergers' or someone with a minor case.
A:I am an adult with Asperger's and since being diagnosed I can now tell if others have the condition. I believe that there will be many people like myself who never knew about Asperger's itself let alone know that they have the condition. Asperger's covers a wide range of 'symptoms' 'difficulties' and 'oddities'. Adults with Asperger's generally don't like working in teams unless their role in the team is clearly defined and it is one where they feel confident. Sometimes an adult with Aspergers will repeat themselves in conversations, answer questions inappropriately. Social interaction is difficult because non verbal communication is often not understood. Although the diagnostic criteria and other professionals talk about 'special interests' many people with Asperger's dont in fact have these. However they may go through a period of time having obsessions about certain things. I will describe some of my own personal difficulties, visual spacial, often getting lost, not understanding if people are being serious or joking, unable to multi task (I am a female), very few friendships, easily upset with things like plans changing, people being late,
Why do autistic children rock back and forth?
In what way? surely there is no harm in Rocking chairs, literal (Hobby Horses), and use of playground equipment with a to-and-fro motion.
Yes it can and it also can mean a side effect of a medicaton that is making the child very antzieHave you ever felt like your skin is crawling. Well kids head banging are feeling very neverious.Drugs, abuse, sexual abuse etc. I have ADHD and yes I have felt like banging my head against the wall, rocking etc. Usually I have eatten to much sugar or chocolate protein etc before going tobed.
Are there support groups for people with Asperger's Syndrome?
Yes. There are online and local support groups. There are support groups for individuals with Asperger's Syndrome and for the families of individuals with AS.
If you go to the OAASIS website listed in the "Related Links" section, it has information on support groups.
Did Albert Einstein have autism?
Albert Einstein died before autism and Asperger's Syndrome were recognized as conditions, so the possibility that he had Asperger's Syndrome is speculation. Einstein had difficulties with social skills, which is one characteristic of Asperger's Syndrome, but that alone would not be enough to diagnose Asperger's Syndrome. He had some other characteristics of Asperger's Syndrome, but also some characteristics not commonly found in people with severe Asperger's Syndrome, so if he did have Asperger's Syndrome, it was probably a milder form.
Woody Allen, Tony Benn, Bob Dylan, Joseph Erber, Bobby Fischer, Bill Gates, Genie, Crispin Glover, Al Gore, Jeff Greenfield, David Helfgott, Michael Jackson, Garrison Keillor, Kevin Mitnick, John Motson, John Nash, Keith Olbermann, Michael Palin, Keanu Reeves, Oliver Sacks, James Taylor,albert Einstein
???? different person???
i just, what to say i looked up un some websites about autism... it said bill gates is probably not autistic.
What part of the brain does autism affect?
Well, the brain differences are actually what affects ADHD ;). The primary area affected in ADHD individuals (according to numerous recent brain imaging studies) is the prefrontal cortex. The volume (size) is smaller in ADHD children; this size can catch up (though slower) with peers and is a sign of disappearance of the disorder (meaning the brain developed fully and the adult with not have ADHD); if development doesn't catch up (the prefrontal cortex remains small) the adult will continue to exhibit ADHD.
Prefrontal cortex is the hub for deliberate thoughts and actions--it's where your motor cortex (your conscious control of muscles) is centered, along with functions such as attention, planning, working memory, set-shifting, etc.. Explains a lot of ADHD, huh?
How many people are autistic in America?
The CDC puts Autism diagnosis at 1 in 68, however it is impossible to say how many Autistic people exist in the US. Many people are not diagnosed or may not even realize that they're Autistic, furthermore certain groups are under-diagnosed - for example girls are less likely to be diagnosed than boys, and African-Americans are less likely to seek diagnosis for a number of reasons.
The current scientific information says that although they are yet to find the cause of Autism, it may be hereditary. This is due to the increased rate in familys, with someone affected by Autism, having another Autistic family member. It is also incredably common in identical twins for both to have Autism rather then just one. Scientists are currently trying to find what gene, if in fact it is a gene, that is causing Autism.
Have you got autistic spectrum disorder?
Yes i do have autism
I'm on the spectrumI have very mild Asperger's syndrome. Why are you asking a general "you" this question?mys sister has autism and dispratsia and attachment and sensory issues and aspergers and i have trates every1 here autistic dont understand how much people try to make your lives happy and then the slightest thing wrong you think that they dont love you because they do and even if the dont show it Y WOULD THEY HATE YOU people hate people the same every single one of you atre unique in your own ways
No, there is actually strong evidence against this idea. The MMR vaccine is not linked to autism.
Much of the original controversy was caused by a paper published by Andrew Wakefield (t the time he was a physician) in The Lancet - the prestigious British medical journal. After the publication of Wakefield's paper, other researchers were unable to reproduce Wakefield's findings or confirm his hypothesis of an association between the MMR vaccine and autism, or autism and gastrointestinal disease. After a British Journalist uncovered and published undisclosed financial conflict of interest information (Wakefield was getting money from people suing the vaccine company claiming the vaccine caused autism in their children), the British Governing Medical Council (GMC) - the governing body for physicians in Britain - opened an investigation against Wakefield and two former colleagues. Most of his co-authors withdrew their support for the study's interpretations
On 28 January 2010, a five-member statutory tribunal of the GMC found three dozen charges proved, including four counts of dishonesty and 12 counts involving the abuse of developmentally challenged children. The panel ruled that Wakefield had "failed in his duties as a responsible consultant", acted both against the interests of his patients, and "dishonestly and irresponsibly" in his published research.
Wakefield's study that was used to link MMR to autism was retracted by The Lancet and was subsequently labeled an "elaborate fraud" in an investigation published by the British medical journal BMJ. The investigation concluded the study's author, Dr. Andrew Wakefield, misrepresented or altered the medical histories of all 12 of the patients whose cases formed the basis of the 1998 study -- and that there was "no doubt" Wakefield was responsible.
Three months following The Lancet's retraction, Wakefield was struck off the UK medical register, with a statement identifying deliberate falsification in the research published in The Lancet and was barred from practicing medicine in the UK.
Wakefield's utter failure to conduct valid research does not disprove any possible links between vaccines and autism, but it is pretty obvious his "study" suggesting a possible link between the MMR vaccine and autism was worthless.
How could you diagnose someone for autism?
It comes down to a simple urine test. The chemical bufotenin makes up most of the autistic individual and is easy to detect. If it is not found within the urine, then the person must have some other obscure disorder.
How do you get autistic kids to take pills?
Many autistic children have difficulties withthe feeling of swallowing food let alone pills. I would get any meds that I could prescribed in a liquid form and as for the rest I would just crush them and mix with something you are fairly certain they will eat or drink all of.
Would a person with Munchausen by proxy simulate Asperger's Syndrome in a child?
Before pediatricians and psychiatrists were familiar with Asperger's Syndrome, some of them thought the parents who said there was something wrong with their children were exaggerating, delusional, over-protective, and, in some cases, abusive parents with Munchausen by proxy. (For mention of parents being thought to have Munchausen by proxy because their children had AS, see the links below.)
I do not know of Munchausen by proxy cases where the parent or guardian attempted to make the child appear to have Asperger's Syndrome, but this does not mean it has not happened. There are other conditions that would be easier to fake by giving the child medicines or chemicals, since some of the social skills impairments (lack of eye contact, avoidance of social contact) would be harder to replicate with drugs. However, many medical professionals' unfamiliarity with Asperger's Syndrome diagnoses could make it an attractive option for Munchausen by proxy, since the professionals might not have been exposed to it previously. Asperger's Syndrome also has the advantage of not being able to be diagnosed with laboratory tests. However, using Asperger's Syndrome means the parent might need to engage in lengthy descriptions of AS before receiving the desired sympathy and attention from others. Unfortunately, I cannot give you a definitive answer on whether the condition of Asperger's has been the goal of an abusive parent via Munchausen by proxy.
Can people with a mild case of autism have kids?
I think that this story about a couple with Autism will provide a lot of insight regarding relationships between individuals who have autism...
"Living and Loving With Autism - A Very Special Love Story"
Here's the link: http://autismbeacon.com/topics/article/living_loving_with_autism_a_very_special_love_story/sexuality
To learn more about this topic, there are many additional resources and articles to be found under the category "Sexuality and Relationships" on AutismBeacon.com
http://autismbeacon.com/topics/articles/sexuality
No one knows for sure what causes autism, but there's a good chance that it's linked to early-childhood vaccines. Many parents of autistic kids say their kids were normal and changed after vaccinations.