Controversies in autism

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Diagnoses of autism have become more frequent since the 1980s, which has led to various controversies about both the cause of autism and the nature of the diagnoses themselves. Whether autism has mainly a genetic or developmental cause, and the degree of coincidence between autism and intellectual disability, are all matters of current scientific controversy as well as inquiry. There is also more sociopolitical debate as to whether autism should be considered a disability on its own. [1]

Contents

Epidemiology

The current accepted prevalence of autism spectrum disorder (ASD) are around 1%, [2] although previous research has shown far lower rates of incidence. [3] ASD averages a 4.3:1 male-to-female ratio. The number of children on the autism spectrum has increased dramatically since the 1980s, at least partly due to changes in diagnostic practice; it is unclear whether prevalence has actually increased; [4] and as-yet-unidentified environmental risk factors cannot be ruled out. [5] The risk of autism is associated with several prenatal factors, including advanced parental age and diabetes in the mother during pregnancy. [6] ASD is associated with several genetic disorders [7] and epilepsy. [8]

Genetics

The role of genetic influence on ASD has been heavily researched over the past few years. ASD is considered to have polygenic traits since there is not a single risk factor, but multiple ones. [9]

Multiple twin and family studies have been conducted in order to observe any genetic influence in diagnosing ASD. The chance of both twins having ASD was significantly higher in identical twins than fraternal twins, concluding that ASD is heritable. [10] A reoccurring finding is that de novo (new mutation) copy number variants (CNVs) are a primary cause of ASD – they alter synaptic functions; germ line mutations can produce de novo CNVs. [11] These mutations can only be passed on to offspring; this explains the phenomenon that occurs when the child has symptoms of ASD, but the parents have no symptoms or history of ASD. De novo variants differ from person to person, i.e. one variant can cause ASD in one person, whereas another person would need multiple variants to cause the same disorder. [10] Loss of function variants occur in 16-18% of ASD diagnoses, which is nearly double the normal population. [9] These loss of function variants reduce function in the protein neurexin, which connects neurons at the synapse and is important for neurological development; deletion mutations of neurexin are also very common in people with autism, as well as other neurological disorders like schizophrenia, bipolar disorder, and ADHD. [12]

There is also controversy over the Nature vs. Nurture debate. According to family studies, genetic and environmental factors have an equal influence on risk of ASD. [10]

Bacteria

Gut microbiome has a relation to ASD. Excessive Clostridia spp. was found in children with ASD and gastrointestinal difficulties; Clostridia spp produces propionic acid, which is impaired or in excess in people with ASD. [13] Specifically, C. tetani and C. histolyticum are two species of this bacteria that affect people with ASD. C. tetani produces tetanus neurotoxin in the intestinal tract; C. histolyticum is a toxin producer that is abundant in people diagnosed with ASD. [14] Both of these could contribute to neurological symptoms.

Vaccines

A later-retracted article from The Lancet making false claims provoked concern about vaccines among parents. Its author was found to be on the payroll of litigants against vaccine manufacturers. [15]

The idea of a link between vaccines and autism was extensively investigated and shown to be false. [16] The scientific consensus is that there is no relationship, causal or otherwise, between vaccines and incidence of autism, [17] [18] [16] and vaccine ingredients do not cause autism. [19]

Nevertheless, the anti-vaccination movement continues to promote myths, conspiracy theories and misinformation linking the two. [20] A developing tactic appears to be the "promotion of irrelevant research [as] an active aggregation of several questionable or peripherally related research studies in an attempt to justify the science underlying a questionable claim." [21]

Intelligence

The percentage of autistic individuals who also meet criteria for intellectual disability has been reported as anywhere from 25% to 70%, a wide variation illustrating the difficulty of assessing autistic intelligence. [22] For pervasive developmental disorder not otherwise specified (PDD-NOS), the association with intellectual disability is much weaker. [23] The diagnosis of Asperger syndrome excludes clinically significant delays in mental or cognitive skills. [24]

A 2007 study suggested that Raven's Progressive Matrices (RPM), a test of abstract reasoning, may be a better indicator of intelligence for autistic children than the more commonly used Wechsler Intelligence Scale for Children (WISC). Researchers suspected that the WISC relied too heavily on language to be an accurate measure of intelligence for autistic individuals. Their study revealed that the neurotypical children scored similarly on both tests, but the autistic children fared far better on the RPM than on the WISC. The RPM measures abstract, general and fluid reasoning, an ability autistic individuals have been presumed to lack. [25] A 2008 study found a similar effect, but to a much lesser degree and only for individuals with IQs less than 85 on the Wechsler scales. [26]

Facilitated communication

Facilitated communication (FC) is a scientifically discredited technique [27] that attempts to facilitate communication by people with severe educational and communication disabilities. The facilitator holds or gently touches the disabled person's arm or hand during this process and attempts to help them move to type on a special keyboard. It was used by many hopeful parents of individuals with autism when it was first introduced during the early 1990s by Douglas Biklen, a professor at Syracuse University. [28]

There is widespread agreement within the scientific community and multiple disability advocacy organizations that FC is not a valid technique for authentically augmenting the communication skills of those with autism spectrum disorder. [29] Instead, research indicates that the facilitator is the source of the messages obtained through FC (involving ideomotor effect guidance of the arm of the patient by the facilitator). [30] [31] Thus, studies have consistently found that patients are unable to provide the correct response to even simple questions when the facilitator does not know the answers to the questions (e.g., showing the patient but not the facilitator an object). [32] In addition, numerous cases have been reported by investigators in which disabled persons were assumed by facilitators to be typing a coherent message while the patient's eyes were closed or while they were looking away from or showing no particular interest in the letter board. [33] Despite the evidence opposing FC, many continue to use and promote this technique. [29]

Note that facilitated communication is separate and different from a range of scientifically supported augmentative and alternative communication (AAC) devices and processes that facilitate communication for people with communication difficulties.

Advocacy initiatives

There are two major conceptualizations of autism within autism advocacy. Those who favour the pathology paradigm, which aligns with the medical model of disability, see autism as a disorder to be treated or cured. Those who favor the pathology paradigm argue that atypical behaviors of autistic individuals are detrimental and should therefore be reduced or eliminated through behavior modification therapies. Their advocacy efforts focus primarily on medical research to identify genetic and environmental risk factors in autism. Those who favour the neurodiversity paradigm, which aligns with the social model of disability, see autism as a naturally-occurring variation in the brain. Neurodiversity advocates argue that efforts to eliminate autism should not be compared, for example, to curing cancer, but instead to the antiquated notion of curing left-handedness. Their advocacy efforts focus primarily on acceptance, accommodation, and support for autistic people as "neuro-minorities" in society. [34] These two paradigms are not fully exclusive, and many people hold a combination of these viewpoints.[ citation needed ]

Pathology paradigm

The pathology paradigm is the traditional view of autism through a biomedical lens, in which it is seen as a disorder characterized by various impairments, mainly in communication and social interaction. [35] [36] Those taking this perspective believe that autism is generally a harmful dysfunction. [34] Ways of functioning which diverge from a typical brain are perceived as harmful and disordered and must therefore be treated or cured. [37] The atypical behaviors of autistic individuals are considered a detriment to social and professional success and should therefore be reduced or eliminated through therapy. [38] [39]

Advocates with this view include both a small but significant minority of autistic adults and large majority of parents of autistic children, but contain a higher percentage of parents when compared to those adopting the neurodiversity paradigm. [40] [ citation needed ] These advocates believe that medical research is necessary to address the rapid rise in autism diagnoses (sometimes referred to as the "autism epidemic"), [40] reduce suffering, and provide the best outcomes for autistic individuals. In addition to etiological research, other areas of focus may include biology, diagnosis, and treatment, including medication, behavioural and psychological interventions, and the treatment of co-existing medical conditions. [41]

Advocacy groups that focus primarily on medical research include Autism Speaks, the Autism Science Foundation, and its predecessor organizations, the Autism Coalition for Research and Education, the National Alliance for Autism Research, and Cure Autism Now, and the former Autism Research Institute.

Neurodiversity paradigm

The neurodiversity paradigm is a view of autism as a different way of being rather than as a disease or disorder that must be cured. [40] [42] Autistic people are considered to have neurocognitive differences [34] which give them distinct strengths and weaknesses, and are capable of succeeding when appropriately accommodated and supported. [40] [42] The belief is that efforts to eliminate autism should not be compared, for example, to curing cancer but instead to the antiquated notion of curing left-handedness. [43]

There is no leader of the neurodiversity movement and little academic research has been conducted on it as a social phenomenon. [34] As such, proponents of the neurodiversity paradigm have heterogenous beliefs, [34] but are consistent in the view that autism cannot be separated from an autistic person. [40] Advocacy efforts may include accommodations in schools and work environments, [44] lobbying for the inclusion of autistic people when making decisions that affect them, [45] and opposition to therapies that aim to make children "indistinguishable from their peers". [40]

Neurodiversity advocates are opposed to medical research for a cure, believing that it will lead to eugenics, and instead support research that helps autistic people thrive as they are. [40] For example, NeuroTribes author Steve Silberman noted a lack of research in regards to seizure-controlling drugs and autistic brains; that sensory differences in autistic people were unheard of until Temple Grandin spoke about her experiences; and that only a small percentage of research funding goes towards the needs of autistic adults. [42] [44] [46]

Advocacy groups that focus primarily on acceptance and accommodation include Autism Network International, Autism National Committee, Autistic Self Advocacy Network, and Autistic Women & Nonbinary Network.

Further reading

See also

Related Research Articles

<span class="mw-page-title-main">Asperger syndrome</span> Formerly recognized neurodevelopmental condition

Asperger syndrome (AS), also known as Asperger's syndrome or Asperger's, is a term formerly used to describe a neurodevelopmental condition characterized by significant difficulties in social interaction and nonverbal communication, along with restricted, repetitive patterns of behavior and interests. Asperger syndrome has been merged with other conditions into autism spectrum disorder (ASD) and is no longer considered a diagnosis. It was considered milder than other diagnoses which were merged into ASD due to relatively unimpaired spoken language and intelligence.

<span class="mw-page-title-main">Conditions comorbid to autism</span> Medical conditions more common in autistic people

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that begins in early childhood, persists throughout adulthood, and affects two crucial areas of development: social communication and restricted, repetitive patterns of behavior. There are many conditions comorbid to autism spectrum disorder, such as attention deficit hyperactivity disorder, anxiety disorders, and epilepsy.

<span class="mw-page-title-main">Neurodiversity</span> Non-pathological explanation of variations in mental functions

The neurodiversity paradigm is a framework for understanding human brain function that recognizes the diversity within sensory processing, motor abilities, social comfort, cognition, and focus as neurobiological differences. This diversity falls on a spectrum of neurocognitive function. The neurodiversity paradigm argues that diversity in human cognition is normal and that some conditions generally classified as disorders, such as autism, are differences and disabilities that are not necessarily pathological.

<span class="mw-page-title-main">Autism rights movement</span> Disability rights movement for autistic people

The autism rights movement, also known as the autistic acceptance movement, is a social movement allied with the disability rights movement. It emphasizes the neurodiversity paradigm, viewing autism as a set of naturally occurring variations in human cognition rather than as a disease to be cured or a disorder to be treated, diverging from the medical model of disability.

The following outline is provided as an overview of and topical guide to autism:

<span class="mw-page-title-main">Causes of autism</span> Proposed causes of autism

Many causes of autism, including environmental and genetic factors, have been recognized or proposed, but understanding of the theory of causation of autism is incomplete. Attempts have been made to incorporate the known genetic and environmental causes into a comprehensive causative framework. ASD is a neurodevelopmental disorder marked by impairments in communicative ability and social interaction, as well as restricted and repetitive behaviors, interests, or activities not suitable for the individual's developmental stage. The severity of symptoms and functional impairment vary between individuals.

<span class="mw-page-title-main">Autism therapies</span> Therapy aimed at autistic people

Autism therapies include a wide variety of therapies that help people with autism, or their families. Such methods of therapy seek to aid autistic people in dealing with difficulties and increase their functional independence.

The epidemiology of autism is the study of the incidence and distribution of autism spectrum disorders (ASD). A 2022 systematic review of global prevalence of autism spectrum disorders found a median prevalence of 1% in children in studies published from 2012 to 2021, with a trend of increasing prevalence over time. However, the study's 1% figure may reflect an underestimate of prevalence in low- and middle-income countries.

<span class="mw-page-title-main">Societal and cultural aspects of autism</span>

Societal and cultural aspects of autism or sociology of autism come into play with recognition of autism, approaches to its support services and therapies, and how autism affects the definition of personhood. The autistic community is divided primarily into two camps; the autism rights movement and the pathology paradigm. The pathology paradigm advocates for supporting research into therapies, treatments, and/or a cure to help minimize or remove autistic traits, seeing treatment as vital to help individuals with autism, while the neurodiversity movement believes autism should be seen as a different way of being and advocates against a cure and interventions that focus on normalization, seeing it as trying to exterminate autistic people and their individuality. Both are controversial in autism communities and advocacy which has led to significant infighting between these two camps. While the dominant paradigm is the pathology paradigm and is followed largely by autism research and scientific communities, the neurodiversity movement is highly popular among most autistic people, within autism advocacy, autism rights organizations, and related neurodiversity approaches have been rapidly growing and applied in the autism research field in the last few years.

<span class="mw-page-title-main">Classic autism</span> Former neurodevelopmental disorder now classified under autism spectrum disorder

Classic autism, also known as childhood autism, autistic disorder, (early) infantile autism, infantile psychosis, Kanner's autism, Kanner's syndrome, or (formerly) just autism, is a neurodevelopmental condition first described by Leo Kanner in 1943. It is characterized by atypical and impaired development in social interaction and communication as well as restricted, repetitive behaviors, activities, and interests. These symptoms first appear in early childhood and persist throughout life.

Autism, also called autism spectrum disorder (ASD), is a neurodevelopmental disorder characterized by symptoms of deficient reciprocal social communication and the presence of restricted, repetitive, and inflexible patterns of behavior. Autism generally affects a person's ability to understand and connect with others, as well as their adaptability to everyday situations, with its severity and support needs varying widely across the spectrum. For example, some are nonspeaking, while others have very proficient spoken language.

Autism spectrum disorders (ASDs) or autism spectrum conditions (ASCs) describe a range of conditions classified as neurodevelopmental disorders in the DSM-5, used by the American Psychiatric Association. As with many neurodivergent people and conditions, the popular image of autistic people and autism itself is often based on inaccurate media representations. Additionally, media about autism may promote pseudoscience such as vaccine denial or facilitated communication.

Diagnosis, treatment, and experiences of autism varies globally. Although the diagnosis of autism is rising in post-industrial nations, diagnosis rates are much lower in developing nations.

The history of autism spans over a century; autism has been subject to varying treatments, being pathologized or being viewed as a beneficial part of human neurodiversity. The understanding of autism has been shaped by cultural, scientific, and societal factors, and its perception and treatment change over time as scientific understanding of autism develops.

Sex and gender differences in autism exist regarding prevalence, presentation, and diagnosis.

Discrimination against autistic people involves any form of discrimination, persecution, or oppression against people who are autistic. Despite contention over its status as a disability, discrimination against autistic people is considered to be a form of ableism.

<span class="mw-page-title-main">Autistic masking</span> Suppression of autistic behaviors and compensation of social difficulties in autistic people

Autistic masking, also referred to as camouflaging or, more broadly, neurodivergent masking, is the conscious or subconscious suppression of autistic behaviors and compensation of difficulties in social interaction by autistic people with the goal of being perceived as neurotypical. Masking is a learned coping strategy that can be successful from the perspective of autistic people, but can also lead to adverse mental health outcomes.

<span class="mw-page-title-main">Double empathy problem</span> Psychological theory regarding individuals on the autism spectrum

The theory of the double empathy problem is a psychological and sociological theory first coined in 2012 by Damian Milton, an autistic autism researcher. This theory proposes that many of the difficulties autistic individuals face when socializing with non-autistic individuals are due, in part, to a lack of mutual understanding between the two groups, meaning that most autistic people struggle to understand and empathize with non-autistic people, whereas most non-autistic people also struggle to understand and empathize with autistic people. This lack of understanding may stem from bidirectional differences in communication style, social-cognitive characteristics, and experiences between autistic and non-autistic individuals, but not necessarily an inherent deficiency. Recent studies have shown that most autistic individuals are able to socialize, communicate effectively, empathize well, and display social reciprocity with most other autistic individuals. This theory and subsequent findings challenge the commonly held belief that the social skills of autistic individuals are inherently impaired, as well as the theory of "mind-blindness" proposed by prominent autism researcher Simon Baron-Cohen in the mid-1980s, which suggested that empathy and theory of mind are universally impaired in autistic individuals.

The diagnosis of autism is based on a person's reported and directly observed behavior. There are no known biomarkers for autism spectrum conditions that allow for a conclusive diagnosis.

There is currently no evidence of a cure for autism. The degree of symptoms can decrease, occasionally to the extent that people lose their diagnosis of autism; this occurs sometimes after intensive treatment and sometimes not. It is not known how often this outcome happens, with reported rates in unselected samples ranging from 3% to 25%. Although core difficulties tend to persist, symptoms often become less severe with age. Acquiring language before age six, having an IQ above 50, and having a marketable skill all predict better outcomes; independent living is unlikely in autistic people with higher support needs.

References

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