POINT/COUNTERPOINT: AUTISM

It began, as so many things do, with me being a dick.

Mike is related to a person who has become a champion of the vaccine-autism link, and when I discovered this I sent an email along the lines of "I mock this and hope you have fun chatting about this at family gatherings." What followed was a very interesting back-and-forth. I consider the vaccine-autism theory to be roughly on par with the 9-11 Was an Inside Job theory in the intellectual hierarchy.

Before I go into any details, let's be emphatic about two things up front to avoid wild accusations at the end: Mike was not arguing in favor of the vaccine-autism link and I was not arguing that autism is made up or nonexistent. Are we clear on that? Great.

What Mike argued is that a steady rise in cases of autism is cause for concern. While the vaccine link appears to have no empirical support (but plenty of Hollywood celebrity support!) there is a non-trivial increase in children with autism in the last decade and it requires an explanation. The existence of substantial statistical noise – which was my counter-argument and which I will describe momentarily – does not negate the potential existence of an underlying trend.
buy lipitor online www.parkviewortho.com/wp-content/languages/new/prescription/lipitor.html no prescription

My response was lengthy but centered around what I feel is a key semantic point: it's inaccurate, until solid evidence can be provided, to say that autism is on the rise. The diagnosis of autism is what is on the rise. I believe that the rise in diagnoses is as likely to be attributable to the following two factors as to a legitimate increase in the occurence of autism.

First, autism is relatively new in the context of medical issues. It hasn't been on the radar screen of the general public or the non-specialist medical community for more than a decade or two.

online pharmacy strattera no prescription

I doubt that many people had even heard the term prior to the mid-1990s. So I believe that one valid hypothesis is that doctors and parents, spurred by successful public awareness campaigns, now diagnose cases that would not have been diagnosed in 1970. To prove that autism is on the rise, someone needs to convince us that the kids diagnosed autistic today are not the same kids who were called "slow" or "learning disabled" or "retarded" prior to 1980.

online pharmacy zovirax no prescription

Second, the downside of increased public awareness of the disease is the inevitable hypochondria and hysteria that set in with panicky parents. After 10001 Oprah segments about autism, some parents become convinced that their child has this new, fashionable disease and, seeking to fulfill their own martyr complex, shop around for a doctor who will agree. You may think this is a poor argument, but anecdotally I am convinced that it is some part of the increase. It exists. To what extent, I cannot say. But there are parents out there who operate like this. The hysteria can also affect well-intentioned school psychologists or medical professionals who practically fall all over themselves in a rush to diagnose autistic every child who stacks up his toys or fails to make eye contact for a few minutes. As prior experience with social panics about psychological illnesses (ADHD, depression, etc) has shown us, over-reaction leading to over-diagnosing is a legitimate concern.

Of course the "marketing" of a new medical problem often involves our friends in the pharmaceutical industry; drug companies are pushing autism diagnoses just like they pushed depression and ADHD. They've been pushing the idea of an "autism spectrum", i.e., not really autism but close enough that we can start prescribing drugs for it. Like doctors were encouraged to throw fistfulls of pills at people with even the mildest depression symptoms, they are now being encouraged to stick the autism label on any child whose behavior even hints at behavior outside of a narrowly-defined idea of normality. There is a widespread public perception that drug companies wouldn't get involved because autism treatments are non-pharmaceutical. That is false. More than 50% of children diagnosed autistic are put on antipsychotics, an incredibly powerful and expensive class of drugs, despite the fact that no medical evidence proves that drug treatments work.

If something really is causing more children to develop autism, I certainly hope that we discover what it is quickly. I have no doubts at all about the seriousness of the problem. Autism, depression, ADHD, and other mental illnesses are real and they are serious. However, the subjective nature of psychological disorders means that over-diagnosis is very easy. So before we get all twisted up about a rise in autism I think we should make sure that we are dealing with a rise in autism rather than a rise in diagnosing it.

What do you think? I'm afraid that I didn't do justice to the other person's argument here, but let's be clear about the fact that I consider it an entirely reasonable one.
buy strattera online www.parkviewortho.com/wp-content/languages/new/prescription/strattera.html no prescription

Given the amount of environmental contaminants and chemicals that end up in our bodies these days it is in no way inconceivable that something is causing autism and causing more of it than ever before.

17 thoughts on “POINT/COUNTERPOINT: AUTISM”

  • Hey – I think this is a really good summary. I had an additional data point – we also we a similar increase in autism diagnosis in Sweden and Denmark, places with homogenous populations, better access to better healthcare, and no mecury-based supplements in their vaccines. That data point exists as early as 1999. (In fact, this cross-country comparison is what lead me to disregard the thimerosal stuff before better evidence to disregard it came along.) Now Swedish and Danish cultural norms are different than ours – it would be odd for us to show the same expansion of the autism spectrum at the same time…

    But yes, I'd be curious as to what your readers think – many of them are educators especially, so probably have to deal with the related stuff quite a bit. As you acknowledge my points, I totally acknowledge that the American waves of hysteria supplemented by purchasing power often can compound otherwise dealable problems. Anti-psychotics are a really tough medication for an adult to take – it shocks me that it gets mass prescribed, especially when something more like cognitive training is much more effective….

  • I think you've misdiagnosed parents as having martyr's complexes regarding their children; it is more likely that parents are lazy. Instead of taking the serious time and effort that children require to turn from their natural state (which is downright Randian in it's me-first!ianism) into functioning human beings capable of realizing that they're not the only people on Earth. Unfortunately, many parents feel the same way about themselves, and since they could not possibly be responsible for their child's misbehavior, it has to be something else. Autism has become the new ADHD.

    I was a social worker, and can unequivocally state that no more than ten percent of my kids had bonafide ADHD; the rest were problematic, and drugs calmed them down. It was easier than teaching them. Autism is serving the same function now. "That's the reason my kid's fucked up! It isn't me; it's the disease. I've been a great parent. They're just afflicted!" It's pathetic. Parenting is a job; these diagnoses (and drugs) frequently provide a way out of doing it and doing a good job with it.

    What's also unfortunate is that, like ADHD or depression, those who are genuinely suffering from it will be lumped in with all of the jackasses who are not but who cannot be held responsible for their (or their children's) behavior.

  • These 'martyr complexes' we've posited aren't even a willing self-sacrifice; in fact, it can be far more pernicious and venturing into territory of self-interest. As an (anecdotal!) example, the parents of my middle school special ed teacher wife's students have often fought for their kids to get into special ed programs, which started with them having their kids diagnosed with 'high-functioning autism' or 'high-functioning ADHD', whatever those possibly illegitimate terms mean. The parents know that if their kid is labeled 'Special Ed' then they can get extra time on tests, more one-on-one time with teachers, and other nuggets of advantage UNTIL THEY GRADUATE FROM HIGH SCHOOL! Basically it seems like the kids are not getting good grades in school, parents getting frustrated, kids too lazy to do their homework on time, Hey I've Got An Idea, Maybe Little Jimmy Is Mildly (ADHD/Autistic), He Can Get Extra Help On The District's Dollar!

    No district will ever deny that a child is special ed because of crippling fear of lawsuits.

    I've visited her classes many times and sometimes it's shocking how poor of work ethic some of these 'special ed' kids have in class. I've tried to help a kid who I liked a lot write the simplest possible 5-paragraph essay on the branches of government in the Constitution. His teacher gave him a handout with all the information he needed to include in the essay (he just had to organize the ideas, which was already holding his hand), and I sat with him for an entire class period trying to get him to formulate the thesis sentence of this essay. (Which was provided to him also.) In the end, we didn't get more than half a sentence written. As a result of this experience I took up drinking. The kid is a great basketball player though, and beat me handily at 13.

  • Hi, new.

    I was diagnosed with Asperger's Syndrome at age fourteen…ish, memory is fuzzy, in an odd little space just after autism and related disorders had hit mainstream awareness hard and just before things got genuinely silly. My particular set of difficulties is almost purely social: I am manifestly bright and express it in a way the average person can understand, and I do my work (eventually, but I blame the procrastination on my dad), but I just don't get social interaction. Consequently I was given the "high-functioning" label, because while I was a freak and social outcast literally incapable of reading facial expressions or even the grossest of body language and with little to no sense of personal boundaries hey, at least I could do my schoolwork. That's what really counts, right?

    There were attempts to label me ADHD which I did not accept because that would mean they'd try to drug me and I was not having with that.

    One of the things that's made me genuinely sad about the glut of diagnoses and snake oil cures on the market is that when I was diagnosed, I remember feeling mainly an incredible relief. I mean, there was a reason now. This thing, this not-knowing and confusion that had me thinking for a while that I was just plain wrong in some deep and essential way had a name. It was no longer my fault, and no one had the right to scream at me for getting things wrong. Now they had to sit down and help me.

    I suspect poster Sam is correct in that much of what we are seeing is laziness and a sort of unconscious trend-hopping as parents invested in their child as an ideal rather than as an individual grow tired of their eccentricities and look for an easy answer and an easy fix. Except, as many keep trying to point out to them, there is no cure. There are "treatments," which if they involve drugs are IMHO useless and if they don't amount to nothing more than careful and systemic socializing. You can teach a spectrum kid to put on a mask of normalcy, but we won't ever be normal (and why would we want to be? Social skills are important, but not so important that I would sacrifice my unique perspective on the world to master them). I can only imagine how damaging the process is to a kid who is not genuinely wired funny but only a bit weird, as kids sometimes are. To be diagnosed with autism or Asperger's is to be told, essentially, that there really is something just wrong with you, and that's not something anyone should have to hear unless they already kinda suspected.

  • 1) It is certainly true that Autism is increasingly diagnosed. To evaluate whether this is statistical noise or trend requires either assumptions or data that we don't have.

    2) Promoting an solution (e.g., drugs) always seems to work if it helps people deny accountability or relieves them of other burdens of treatment.

    3) I have no data to support this, and only became a father in the last 10 years. But I don't remember allergies being as prevalent or as pernicious as they appear to be today. In my son's class of 14, 3 of them have peanut allergies. The school's a "nut-free school", of necessity. Did kids when I was growing up just die of this, earlier? Did we blame histamenic reactions on something else? My point: If there is a real increase in the rates of autism, then I wonder if there's a common cause for the peanut allergies.

    4) There was an article in Scientific American a few years ago, about links between childhood trauma (esp. abuse) and Autism spectrum disorders—something to do with failure to develop the amygdala. If that's true, and if autism is on the rise, that might suggest an explanation other than vaccines.

    5) I think human variability is easy to underestimate. As we find more labels to define, more behaviors to characterize, and more "solutions" to sell, it certainly makes it look like more of us are freaks.

  • One of the things that gets overlooked constantly here is the fact that autism seems to cluster. Simon Baron-Cohen first started discussing this a decade ago, and there certainly seems to be anecdotal information at least supporting the hypothesis. And these clusters, unsurprisingly, seem to be found most heavily in areas where you've got high-achieving, quantitative jobs–computer and university towns, for example. Check out this old article from Wired (http://www.wired.com/wired/archive/9.12/aspergers_pr.html) about the eruption of autism in Silicon Valley, and other IT centers. Other clusters (such as the recent Somali cluser in Minneapolis, which apparently was relatd to a Viatmin D deficiency, maybe) appear to be much more random in their cocurrence. So you have a rise in autism in places where you generally have an affluent, highly-educated community.

    And j is correct–I was on the school board in a town in new Jersey for several years, and Special Ed was the things that caused us the most heartburn. Any sort of ADD label gets you special ed dispensation these days–parents would actually compete on this. Amazing. No wonder everyone wants their kid to be autistic (reflecting a deep inability to understand how debilitating the extreme forms of this disorder can be)–you get great talking points.

  • I saw a sign addressing this very issue in the exam room at my kids' (ages 10 and 11) pediatrician's office last week. Apparently everyone has heard of this "link" except me. The gist of the sign was that there is ABSOLUTELY NO SCIENTIFIC EVIDENCE OR INDIVIDUAL CASES linking vaccines and autism. They made the same point Ed made about the rise in diagnoses correlating to renaming conditions formerly labeled mental retardation, learning disabled, slow learner, etc. as autism. I tend to agree just intuitively, but I'm not a doctor or a scientist, so I have nothing to base my agreement on except (perhaps naiive) trust in the AMA.

  • As someone whose degree is in psychology, and who got it relatively recently, the thing that explains this most easily that gets overlooked a lot is that the rise in autism diagnoses starts almost immediately after the changes in diagnostic criteria of autism spectrum disorders with the publication of the DSM IV in 1994. In the DSM IV the criteria for diagnosing someone as autistic was greatly broadened, with the hope that more people would then be able to get help and recognition for real disorders. I suppose the psychologists working on it at the time greatly underestimated the lengths people would go to to convince themselves that their children were special too. Oops.

    To be fair, as someone has pointed out here, there is a recognized "spectrum" of autism-like disorders. The main problem is that we're saying that based on symptoms, not root causes. Aspergers and similar autism spectrum disorders are classified as such because they look kinda like autism in the clients, but we have no clue if they are caused by anything remotely similar or if the correct treatment (if there is one) is similar for any of the disorders in the spectrum.

  • Ed's Sister says:

    I just wanted to point out that John is 7 now, and when he was a baby receiving his vaccines, the chemical in question (thimerosal) had already been removed from 99.9% of vaccines. So, to argue this cause/effect about children under the age of 7 or 8 is sort of a moot point.
    I believe the spectrum quality of an autism diagnosis is where a lot of the overdiagnoses lie, as you have pointed out Ed, and I think it takes away from those who really need the help when doctors are so quick to label children. I know of a child who was placed on the autism spectrum because he did not like getting his clothes wet. I believe this is going too far.
    Finally, I wanted to say that whenever this discussion comes up among moms, as these things are want to do, I have always argued that the anti-vaccine crowd has the luxury of being so for two reasons. First, they never lived through a time when people were actually getting – and dying from – the diseases that are all but eliminated today. The risk of a worldwide rubella or measles outbreak without vaccines far outweighs the very questionable link to autism with them. Second, your kid doesn't get sick because my kid is vaccinated. Do some web searching on vaccine-free communities in Europe and some of the diseases their children are getting, and you'll see what I mean.

  • This is a really interesting and complicated topic and one that is quite frequently discussed in "Mom circles." I will just add 3 quick comments.

    First, I have no statistical or medical evidence to support this, but I think dbsmall may be on to something with the allergy hypothesis. There is some anectdoctal evidence to support this as well. Friends of ours have a child with relatively severe ADHD and were able to improve his condition drastically by eliminating Red Dye 40 in his diet. This was one individual with a specific sensitivity, but given the amount of products that this is in, it suggests greater research should be given. I also know of several cases where children with autism were helped susbstantially by changes in their diet, such as eliminating gluten. To draw generalized conclusions based on these examples would be just as faulty as the vaccine link, however I see many of these as "No regret" policies. We make every attempt to minimize exposure to artificial dyes and ingredients, as well as HFCS and hydrogenated oils. This means we eat very little processed food. This isn't because I am 100% certain there is a connection to these specific disorders but because there are several other reasons to do it, and no down side. When it comes to vaccines though, the potential cost is far too great for me not to immunize my children.

    Second, I completely agree with Ed's sister and am always surprised at how little weight is given to my "free rider," lack of social responsibility argument. But my father had polio as a child and has spent most of his life in severe pain as a result, so perhaps I am more fearful of a world without immunizations.

    Finally, statistically this is a nightmare. So many things have occured simultaneously in the last 30 years, it will be very difficult to control for so many intervening variables. In the next 20 years we will probably see a variety of things linked and unlinked to the range of conditions that fall under the autism spectrum, and each will probably be accompanied by similar public reactions.

  • As a (non clinical) psychologist I have to agree that this is a great debate here that captures a lot of the complexities involved. Unfortunately people are messy messy creatures, and I would be amazed if these things didn't come out more or less continuously in a spectrum. The problem comes when you get a nexus of things that regular people do that just look like autism-ish symptoms (as people above have noticed) a diagnostic regime that tries to put hard and fast binary labels on kids (you are officially autistic, or not autiistic, there isn't any space for mostly neurotypic, but with a few autistic quirks thrown in), and parents who are highly motivated to have diagnoses for their kids – perhaps because they are lazy or are seeking any advantage for little junior they can get, but I suspect perhaps even more so to remove any sense of guilt they might feel over why their kid isn't perfect. Parents tend to see their kid as heavily reflecting on them, and they hate the idea of being a bad parent, so can be looking for relief in a diagnosis as much for themselves as for the kid.

  • I'm one of Ed's loyal educator readers, but I don't have much to add to this. I work in a very small school (under 200 students) and don't have any students with autism in my classes (I have one with Aspberger's). I haven't had any run-ins with students who seem to be over-diagnosed for cognitive issues (can't say the same for "emotional disability," which I know really exists and is valid but in my school seems to be shorthand for "asshole you can't expel no matter what because he has this label, despite being a perfectly intelligent individual who bullies other children constantly"). Students who I know to be medicated for ADD/ADHD–let's just say that I've seen most of them on days when they "forgot" their meds, and I feel the diagnoses are accurate.

    Like I said, I can't say I've personally seen parents pushing for a label for a student who seems cognitively normal. I *will* say that I meet a lot of parents of developmentally-disabled students who INSIST that junior will be taking his 70 IQ straight to Harvard, thankyouverymuch, and suggesting that he doesn't need to be in college prep literature is just WRONG. o_O

    Cameron's mother is the autism consultant at one of the large public school districts nearby, so he might have more straight dope. I am exceedingly dubious of the vaccination hypothesis.

  • Good discussion going here. My personal experience revolves around helping with a summer camp my son was attending. I was the new guy so I was given the task of taking all the boys on meds to the nurses tent every morning before breakfast. Gathering this pack of "Tiggers" and getting them there was indeed a feat. Made me smile watching the unbridled energy.
    Made me very sad watching them zombie out while picking at their food. I don't know much about these drugs or why these children were taking them, but they are fast acting and powerful.

  • Pat, maybe it was the food.

    On the subject, I'm someone who is very likely on the Asperger's portion of the spectrum. What caused it? Was it environmental or genetic or my parents' fault? I really don't know. But I remember not feeling like I thought I should have felt about social interactions for my entire life. Finally having a name for it made it better, even without an official diagnosis, since I realized that people like me–even if I rarely want anything to do with them, either–exist. Back in the school system of the 70s and 80s, I was okay with the academics but had social issues. It made me the weird kid, not the picked-on kid (though I was that on occasion, plus I was the bully at times, too–like most children, I believe.)

    I think some of the rise is increased awareness, some of it is that people don't send their "different" children away any more, some of it is people keeping track better, and some of it is probably caused by something. But whatever it is, I just hope those who need treatment (and I don't consider myself to be among them, though I benefitted greatly from a greater understanding about my state) get it. I also hope that causes are found, but I doubt that there will be a simple cause for something that manifests itself in something as complex as people's brains.

    I have three sons, one of whom is a lot like I am. But I'm probably wrong, since I tend to miss those things. My ex seems to think so about both of those things.

  • Great discussion, and very respectful of various viewpoints.

    My son was recently diagnosed with autism. I don't know where he falls in the spectrum, but his two primary issues seem to be toilet training and speech delay. Ben is otherwise a pretty happy kid with some "quirks." He is five now, and we started noticing some issues from age three. He does go into meltdowns sometimes, and we do not always know the trigger. It does not seem to follow a tantrum pattern, although I try not to close out that possibility that he is just having one.

    I am not sure what to make of the diagnostic increase. I will say that we did not seek this diagnosis, and what we started out with was seeking out why we saw a developmental delay in our son, and how we could best help him. That is all. I have no doubt about the possibility of abuse, but please understand I don't want my kid to be "special." I just want him to have a good life. If I had a cure on hand for whatever is in him that causes this, I would use it.

    I appreciated the discussion here, and I appreciate the way Ed wrote about what he is seeing with autism diagnosis. I cannot speak for all parents dealing with autism, only myself.

    One other thing. I am currently working as a service coordinator working with people dealing with developmental disabilities, and I realize that in my case, I am too close to the issues and made a horrible mistake in taking this job. I see other autism cases and become upset thinking of the possible outcomes for my son. I hate what I do, and think I am hurting my own care for my son. I am currently job searching in this terrible economy and I hope to make a change as quickly as I can.

  • Andrew,

    Let me be very clear here: GET THE HELL AWAY FROM THAT JOB!

    Taking care of a special needs person requires a break from it. Your job doesn't provide that. So get away as fast as you can. Choose your own child, please. He needs you. Martyrdom isn't worth it. It's okay to not help everyone. Really. Honestly. The feeling that you are a shit for abandoning the others will pass. But your son will still need you.

    You can go back to working there at some other time, but now is not that time. Or you can never go back, since you'll find it too hard. I honor what you do in your job, but you need to remember to honor yourself and your child too. Helping that one person can be your job, while the thing you do for money can be your escape. Trust me, you'll need it.

  • I have two children with Autism, and was glad to see this post.
    The Anti-Vacc crowd does so much more harm than good.

    I think that the increase in diagnosis is tied to an increase in awareness, as well as a slight relaxing of diagnostic criteria.

    I take slight issue with a previous comment stating that "No district will ever deny that a child is special ed because of crippling fear of lawsuits."
    We have to fight so hard to get services for our children, because schools would like to spend that money elsewhere.

    My son Isaac is 9 years old. He has a vocabulary of about 40 words, isn't toilet trained, and understands very little of what goes on around him. He represents the extreme end of the "Autism Spectrum", yet for years we had to fight school districts to get him appropriate services.
    I ended up becoming a parent advocate, helping parents access the services their children needed because children were being deniedthe special ed services.

    Just sayin.

Comments are closed.