Grandjean and Landrigan Propose a Global Prevention Strategy To Control the Pandemic of Developmental Neurotoxicity

In Neurobehavioural effects of developmental toxicity, published in the Lancet, Dr Philippe Grandjean MD and Philip J Landrigan MD, propose a global prevention strategy to address the impact of developmental neurotoxicants and the increasing numbers of children with developmental disabilities including autism, ADHD and intellectual disabilities. As the article abstract points out the authors had conducted an earlier systematic review and identified five industrial chemicals as developmental neurotoxicants with six additional developmental intoxicants identified since then:

Neurodevelopmental disabilities, including autism, attention-deficit hyperactivity disorder, dyslexia, and other cognitive impairments, affect millions of children worldwide, and some diagnoses seem to be increasing in frequency. Industrial chemicals that injure the developing brain are among the known causes for this rise in prevalence. In 2006, we did a systematic review and identified five industrial chemicals as developmental neurotoxicants: lead, methylmercury, polychlorinated biphenyls, arsenic, and toluene. Since 2006, epidemiological studies have documented six additional developmental neurotoxicants—manganese, fluoride, chlorpyrifos, dichlorodiphenyltrichloroethane, tetrachloroethylene, and the polybrominated diphenyl ethers. We postulate that even more neurotoxicants remain undiscovered. To control the pandemic of developmental neurotoxicity, we propose a global prevention strategy. Untested chemicals should not be presumed to be safe to brain development, and chemicals in existing use and all new chemicals must therefore be tested for developmental neurotoxicity. To coordinate these efforts and to accelerate translation of science into prevention, we propose the urgent formation of a new international clearinghouse.

In 2013 Landrigan, Lambertini and Birnbaum had proposed A Research Strategy to Discover the Environmental Causes of Autism and Neurodevelopmental Disabilities. Autism researchers in particular, and the agencies and institutions that fund them, do not seem to have taken seriously the obvious, yes I said obvious, need to explore environmental causes and triggers of autism and neurodevelopmental disabilities and instead appear to be continuing their obsessive need to find genetic elements that "might" be "associated with"  some subsets of autism disorders. The rigid adherence to a non evidence based belief that autism has to be caused by genetic influences, the "it's gotta be genetic" (Teresa Binstock, 1999) paradigm is almost cult like in its persistence in the face of its repeated failure, despite overwhelming funding of genetic based autism research, to find any specific genetic causes of most autism disorders. 

We must act now as Grandjean, Landrigan, Lambertini and Birnbaum have proposed and take seriously the harmful effects of neurotoxicants.  We must begin to develop a rational, serious global strategy to deal with their harmful impact on generations of children to come.  

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Autism Research Bias and the DSM-5 Autism Do-Over Exclusion of Those with Intellectual Disabilities

Why has the APA decided that the DSM-5 Autism Spectrum Disorder should eliminate or substantially reduce the numbers of persons with ASD who are intellectually disabled?   The removal from an ASD diagnosis of persons with ID will be accomplished by the express wording of Mandatory Criterion A of the DSM-5's New Autism Spectrum Disorder which requires "A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays.."  Where the numbers of persons with intellectual disability constitute the vast majority of persons with Autistic Disorder under the DSM-IV they will now be removed from the autism spectrum under the DSM-5 Autism Do-Over which will now define autism largely in terms of the current Asperger's definition of social communication and repetitive behavior deficits.  The DSM-5 Autism Spectrum Diosrder would be more accurately titled Aspergers Spectrum Disorder.  But why the substitution of Asperger's for Autism in the DSM-5 Autism Do-Over?

The answer may be found in the convenience of autism researchers, clinicians and pharmaceutical manufacturers.  It is easier to treat, and even research, high functioning autism and Aspergers than to deal with patients and subjects with classic, severe autism and intellectual disability.  Interviewed for an article in the Financial Times about the DSM-5's new autism spectrum diagnostic criteria Dr Craig Erickson, chief, Christian Sarkine Autism Treatment Center, Indiana University School of Medicine noted the presence of  a high functioning autism bias in autism research:

"The DSM-5 modifications will be great for drug development, as there will be greater standardization in clinical trials, said Dr Craig Erickson, chief, Christian Sarkine Autism Treatment Center, Indiana University School of Medicine. With hardened criteria, there will be better, clearer studies that are easier to interpret, he said. DSM-5 changes will be a positive for research as the improved diagnostic clarity would ensure proper enrollment criteria, Ring agreed.


Erickson noted that there is often a bias in clinical trials, where high-functioning patients are typically enrolled as they are more readily able to tolerate routine procedures such as blood tests part of clinical trials. Further, it is easier to make improvements in less-impaired children, Elliott said, noting the Phase II Kuvan in autism trial included children with IQs in the 50-60 range as well as Asberger patients.


To avoid a bias in developing treatments only for higher-functioning patients, it would be especially advantageous to target specific symptoms rather than a broad lump of ASD so that specific interventions can target symptoms for a particular severity, for example stereotypic motor movements, Elliott said."

I have commented several times about what I perceived as high functioning bias in autism research.  Dr. Erickson confirms my perception as Dr. Catherine Lord has done previously in  Social Policy Report, Autism Spectrum Disorders Diagnosis, Prevalence, and Services for Children and Families:

""However, research in ASD has tended to use overwhelmingly White, middle to upper middle class samples, and has often excluded children with multiple disabilities and/or severe to profound intellectual disabilities". [underlining added - HLD]

The APA has stated in its form letter reply to those who submitted concerns to them about the new Autism Spectrum Disorder criteria that the new definition is based on existing research:

"The [DSM-5 Autism Spectrum Disorder] proposal is based on years of accumulated clinical, epidemiological, and neuroscience research which was thoroughly examined by the members of the DSM-5 work group on Neurodevelopmental Disorders."


A problem with that explanation  is that the research on which the DSM-5 autism spectrum disorder is based is biased in favor of high functioning autistic and Asperger's subject participation.  The existing research as admitted by Dr. Lord and Dr. Erickson tends to exclude the severely challenged, intellectually disabled population.  The new DSM-5 reflects that research bias by expressly excluding the intellectually disabled from a DSM-5 era Autism Spectrum Disorder diagnosis.

The DSM-5 Autism Do-Over will exclude the intellectually disabled to make life easier for autism researchers, clinicians and pharmaceutical manufacturers.  There is no compelling reason to expressly exclude the intellectually disabled from the ASD except for the convenience of these groups.

There is no legitimate research basis for removing the intellectually disabled from an autism spectrum disorder diagnosis.  There is only bias ... bias against the intellectually disabled. 

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DSM5 Combining Autisms into One Autism Disorder: Why?

It is common place today to refer to autism(s), plural, rather than autism, singular.  So why is the DSM5 combing the autisms into one Autism Spectrum Disorder? It is common in both professional and parent based discussions of autism to encounter comments like "if you've met one person with autism, you've met one person with autism".  So why pretend that these persons with widely varying challenges and deficits represent one diagnostic grouping?

My son is severely autistic and profoundly "developmentally delayed".  He has nothing in common with the persons with high functioning autism and Aspergers who write books, conduct research, make representations to the Supreme Court of Canada to oppose the only recognized evidence based treatment for autistic children, run successful businesses, get married, have children and drive automobiles.  

These very successful high functioning "free ranging Aspergians" and autistic persons  have very little in common with the "vast majority" of persons with Autistic Disorder and intellectual disability.  How does combining such different and diverse conditions under one umbrella help any of those involved, particularly those who are most severely affected by autism disorders. 

Very little media or research attention is now paid to those severely affected by the current Autistic Disorder.  Under the DSM5's New Autism Spectrum Disorder those most severely affected will likely disappear from the public and professional  radar screens altogether.

Why combine such different conditions under one  diagnostic label?  How does this help any of those who will carry the new label?

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Autism in Russia: Pravda Misrepresents Asperger's as Autism

Like its mainstream media counterparts in the US and Canada the Russian news service Pravda is busy misrepresenting Asperger's as Autism.  In Autism: Life full of struggle and success there is mention of Asperger's as "an" autism disorder.  There is also acknowledgement of some of the challenges faced by persons with autism. But there is no mention of those who CDC Autism Expert Dr. Marshalyn Yeargin-Allsopp  described as the "vast majority" of those with actual Autistic Disorder diagnoses; those who have autism and intellectual disabilities. The article read as a whole, including the title,  portrays those persons with Asperger's, and persons "with some traits of autism and Asperger's" who have found employment with companies like Aspiritech as representative of persons with autism:

The son of the founder Moshe Vittsberga at some point had problems finding work due to Asperger Syndrome diagnosis. For this reason, the Aspiritech undertook to help people with autism.
 According to specialists, work with computers is well suited for autistic individuals. In addition, many high-end programmers are people with certain traits of autism or Asperger syndrome.

Among professions preferred for autistic individuals are accounting, librarianship, archival work and drawing, and art. Autistic individuals are good at archeology, paleontology, and museum work.
Some people with autism are good at jobs involving visual thinking - computer-aided design, architectural modeling, industrial design, etc.


For example, in 2008, a fellow of the Massachusetts Institute of Technology Wendy Jacob founded a studio where she worked with autistic individuals to create radically new art and design solutions in the field of interior design and the design of everyday objects specifically for people with autism spectrum disorders. This is the beginning of a niche market.


Autistic individuals are also good at work associated with fulfilling certain actions at certain times. Autistic individuals do not need a team and can work quite effectively in isolation.
However, work related to rapid processing of information in short-term working memory is not suitable for them. They should avoid such areas as history, political science, business, philology, or higher mathematics.

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