Autism Causation - Back to Bettelheim?

A recent study of mental illnesses amongst parents of autistic children provides some ominous echos of Bruno Bettelheim. The study, “Parental psychiatric disorders associated with autism spectrum disorders in the offspring,” appears in the May 5, 2008, issue of the journal Pediatrics. The authors gathered data from Swedish medical and hospital registers of children with autism diagnoses before 10 years of age and matched with a control population. Parent diagnoses were based on an inpatient hospital diagnostic evaluation and included schizophrenia, other nonaffective psychoses, affective disorders, neurotic and personality disorders and other nonpsychotic disorders, alcohol and drug addiction and abuse, and autism.

The study found that "for both parents, schizophrenia was associated with autism. For other disorders, such as depression and nonpsychotic personality disorders, the positive association between psychiatric disorders and childhood autism was found only for maternal disorders, not for paternal disorders."

The authors concluded that the study results results ^"support the hypothesis that there is a familial predisposition, perhaps genetic, that presents differently in the parent than in the child and probably requires a constellation of other genetic or environmental factors for expression."

The authors of the study themselves note a number of study design limitations but it should be interesting to see the reaction to the authors' conclusions. In pointing to a connection between autism and parental mental issues, particularly the association between autism and maternal depression and nonpsychotic personality disorders, the authors appear to be retracing the steps taken by Bruno Bettelheim whose "refrigerator mothers" theories of autism causality caused so much harm to families with autistic children. Hopefully this study and the conclusions arising therefrom, will be given as much rigorous study and discussion as others pointing to possible causes of autism.

autism

Read more »

No Real Autism Increase? Any Evidence To Back That Up?

The latest bandwagon to roll across the autism terrain is the argument, already presented by some as fact, that the stunning increases in estimated rates of autism are due entirely to expanded definitions of autism and the availability of special education monies for those with an autism label. On the latter point it is argued that doctors are more inclined today to diagnose autism because an autism label will trigger special education resources in the United States.

I am willing to accept, without substantial evidence, that the changes to the DSM-IV, in 1994, would have had a significant impact on the numbers of autism diagnoses, particularly in the first few years after the 1994 changes. The mere expansion of diagnostic criteria certainly seems on its face to logically indicate that more people would be caught by the diagnosis. And as an active participant in autism discussions, and advocate for my son who has a classic Autism Disorder diagnosis, I have argued that there are many high functioning autistic persons purporting to speak on behalf of "autistics' who bear little resemblance in their intellectual and communication skills to my son.

The incentive to diagnose autism argument might also have merit to some extent although I am not sure how much of a factor this would be in the increases. There would also be strong reasons why doctors and parents want not want to place an inaccurate label on their children or patients. An erroneous diagnosis could result in inappropriate treatment.

But where is the evidence that the massive increases in recent years is due solely to these perceptual or social factors rather than to actual increases? Many of the diagnostic changes took place in 1994. I have been an active autism advocate since 1999. At that time, 5 years after the 1994 DSM changes, the prevailing figure was 1 in 500 persons on the "autism spectrum". Soon it changed to 1 in 250. Just 2-3 years ago the figure was lowered to 1 in 166 and only in the last year to 1 in 150 - in the United States as a whole. In New Jersey the estimated rate is 1 in 98 and in the United Kingdom 1 in 100.

Do the 1994 changes account for a stunning rise in estimated autism diagnoses from 1 in 500 to 1 in 150 in the US as a whole, 1 in 100 in the UK and 1 in 98 in the State of New Jersey? These are very large increases. Where is the evidence that such increases are entirely attributable to the 1994 diagnostic changes? And why are there current geographic discrepancies.

Furthermore what about the unified theory of autism? Genetics has long been known to play a very large role in autism causality. But there are also theories which look to both genetic and environmental factors of autism causality. If the environment plays a role, in some cases at least, in triggering autism, is it safe to assume that the stunning increases of recent years are entirely attributable to the 1994 diagnostic criteria changes?

Where is the evidence?

Read more »