Autism is a tragic, debilitating disorder that impacts families and individuals throughout a lifetime. It is also a disorder surrounded by controversy, a fact that few know better than Dr. Laura Schreibman, a Distinguished Professor of Psychology and director of the Autism Research Center at UCSD. Schreibman recently wrote a book addressing this controversy, called “The Science and Fiction of Autism.” As part of the Grey Matters lecture series at the Natural History Museum, she gave a lecture on the same topic.
“This is a field that has just been loaded with controversies and arguments, some of which are quite intense,” said Schreibman. The reason for these controversies, explained Schreibman, is that so little is known about autism. This lack of information leaves a void that tends to fill with speculation and conjecture. Parents, faced with this emotionally wrenching disorder and no clear answers, often grasp at theories and treatments that lack solid scientific evidence.
What exactly is autism? It was first described by Dr. Leo Kanner in 1943 and is characterized by three key features, which often develop before the age of 3. The first is severe and pervasive deficits in social attachment and behavior. According to Schreibman, “This is the nut of autism: these children are not social. They typically do not like to be held, or to be cuddled. They don’t seek out affection.” The second trait is severe deficits in verbal and nonverbal communication. Fully half of autistic children never learn to speak, and many fail to use any sort of hand gesture, like pointing. Third, autism is often accompanied by stereotyped and repetitive behaviors, such as rocking, head-bobbing, and arm-flapping. In addition, 75 to 80 percent of people with autism also have severe mental retardation.
That much is agreed upon. The controversies arise regarding the cause of autism. Said Schreibman, “A lack of critical evaluation of ideas has led us down some tragically wrong paths.” The first theory explaining autism was posited by Kanner and was based on the psychodynamic theory of child development. Kanner’s theory placed the blame on the parents, particularly the mothers, for not providing autistic children with enough affection, thereby driving them to withdraw from the outside world. Kanner coined the phrase “refrigerator mothers” to describe these alleged unaffectionate mothers.
This theory held for a long time and caused much pain for the parents of these autistic children but was largely discredited when a biological and genetic basis for autism was demonstrated. Autism “” and syndromes related to autism “” runs in families, and when one identical twin has it, there is a 60 to 90 percent chance the other twin also does. Furthermore, detailed neurological studies have found differences in the brains of autistic children, particularly in the cerebellum, which are present at birth, and therefore could not have been caused by neglectful parents. However, scientists don’t know if these differences in the brain are a cause or a result of autism, or just a coincidence. It is clear that autism has an organic cause, not a learned cause. Unfortunately, this cause is still a mystery.
A more recent theory that gained a lot of popularity is that the measles, mumps, rubella vaccine causes autism, in particular the mercury preservative used in the vaccine. However, according to Schreibman, “To this date, as far as I know, and I’ve been through the literature, there is no substantiated, replicated, scientific evidence that vaccines cause autism.” Schreibman recognizes that many people don’t agree with her position, but argues that the facts are the facts. Many large, well-respected medical organizations, including the American Pediatric Association and the American Medical Association, agree that there is insufficient evidence to support the claim that vaccines cause autism.
The reported incidence of autism has risen from 45 out of every 10,000 people in the 1960s to one out of every 150 people today. That may seem like a huge increase, leading some people to worry that autism is a rising epidemic. However, Schreibman suggests that other factors account for this increase, including increased awareness among doctors and the general public and a broader variety of diagnostic criteria falling under the label of autism. Said Schreibman, “If there is, in fact, a real increase in the incidence of the disorder, it’s likely a small increase, there are a lot of other factors involved.”
Schreibman concluded the talk by addressing potential therapies. There are mixed data suggesting that megavitamin regimens and various other drug regimens may help alleviate some of the minor behaviors associated with autism but not the core symptoms. However, other treatments, such as the hormone secretin, and casein- and gluten-free diets, have not been shown to provide any benefit.
Schreibman described several additional treatments as completely useless and a waste of time and money. These bogus treatments include facilitated communication, psychodynamic therapies, options therapy and holding therapy. In addition, animal therapy, in which autistic children are exposed to different types of animals, maybe be a positive experience for the children, explained Schreibman, but will not improve their symptoms.
According to Schreibman, the only methods scientifically proven to help autism are those based on the behavioral model, which is based on reducing specific problematic behaviors and increasing specific skills. She was careful to point out that the behavioral method is not a cure and that it only improves the symptoms. With early intervention, behavioral treatment can improve the social skills to a point where the autism is undetectable, but there is currently no cure for the disorder.
Even though the controversies sometimes lead to very heated and emotional arguments, in the end, said Schreibman, “Controversies can be our friends, because they can serve as a driving energy to move the field along.” As long as people are working to either prove or disprove a new cause or treatment, they contribute knowledge to the field, providing some concrete answers to help fill in the void of the unknown.