Autism

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If you've met one person with autism, you've met one person with autism.
—Dr. Stephen Shore

Autism, also known as autism spectrum disorder, is an inborn, lifelong developmental disability that impacts language, communication and socialization (among other things). It is often referred to as a "spectrum" because different autistic people may experience different traits in different ways. Common traits include:

  • Developmental delays
  • Repetitive self-calming behavior, known as "stimming"
  • Need for routine
  • Difficulty discerning what others are thinking (not to be confused with lack of caring)
  • Over- or under-sensitive senses (sight, hearing, etc.)
  • Difficulty understanding and managing emotions
  • Executive dysfunction
  • Intense passions, called "special interests"
  • Difficulty recognizing faces (similar to prosopagnosiaWikipedia's W.svg)
  • Sincerity

Because every autistic person is unique, it's typical for each person to different amounts of each trait, and not every autistic person may have every trait associated with autism.

Autism is considered to be a subset disorder under the heading of Pervasive Developmental Disorders, which also includes Asperger Syndrome, Rett Syndrome, Childhood Disintegrative Disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS). Under the DSM-5 all previously distinct autistic disorders are now classified and diagnosed as Autism Spectrum Disorder, and Rett Syndrome and CDD (which are very different, and in the case of the former scientists have determined it is an X chromosome abnormality) have been reclassified as distinct disorders.

Testing for autism can be difficult, since there are no distinct markers. People may be diagnosed through personal interviews and questionnaires, and sometimes by qualitative observation by a team of caregivers and professionals. Getting a diagnosis can be harder for women and girls, and for people of color, as research on autism has historically been focused on white males, [1][2][3][4] (although it should be noted that all people with autism face prejudice and discrimination). [5] Research also continues to be heavily focused on infants and children, making it harder for adults to seek diagnosis or support. [6]

Since 1944, when Austrian psychologist Hans Asperger published his first paper about what he called "autistic psychopathy", the psychiatric community has become increasingly aware that people with autism-like symptoms are not "psychopaths", as they were once, and are sometimes still, labeled. We also now know that autism is a spectrum of traits and disabilities with varying levels of severity. Depending on the amount of woo involved, the fact that people who present unusual but not extremely dysfunctional behavior can be diagnosed with autism (and suffer the consequences)[7] can be used as rational criticism of modern clinical psychology, or as fodder for crank theories about autism being a higher level of evolution.

Causes and Controversy[edit]

There has been a marked increase in the number of diagnosed cases of autism in recent years, but the true incidence and possible cause has been hotly debated. Some think the rise in reported cases may be simply due to more awareness and understanding, coupled perhaps with defining it more broadly to include the whole autistic spectrum.[8][9] There is some evidence that autism may be genetic in nature.

It has been recently shown that the deletion of a section of chromosome 17 results in a 14-fold increase in the chance of having schizophrenia or being on the autism spectrum. David H. Ledbetter, a genetics professor at Emory University stated "Not all people with autism, a developmental delay or schizophrenia have this deletion, but all people who have the chromosome change will develop some form of the disorders, whether it's mild or strong enough for a diagnosis"[10].

People have proposed all kind of causes for autism. People have claimed that autism is linked to heavy metal exposure,[11] a so-called "insanity virus" called human endogenous retrovirus W or HERV-W or the Herpes Simplex virus,[12] maternal fever during pregnancy,[13] and more. So many causes have been proposed that the autistic community has produced numerous parodies detailing "causes" of autism.[14][15]

The vegan and animal rights activist group PETA has launched a scare campaign claiming that the ingestion of dairy products from cow's milk causes autism. There is no scientific basis for this belief.[16]

Some people are concerned that looking for a genetic cause of autism could lead to potentially autistic fetuses being selectively aborted.[citation needed]

Hans Asperger was also very closely tied to Nazis.[17]

Vaccine hysteria[edit]

See the main article on this topic: Vaccine hysteria § Autism

In the 1990s and the 2000s, vaccine hysteria linking childhood vaccinations to autism broke on both sides of the Atlantic. In the UK, it was fueled by Andrew Wakefield's fraudulent study claiming the MMR vaccine caused autism.[18][19] In the US, the focus was on thimerosal, a preservative used in some "dead" vaccines. Both hypotheses have been thoroughly discredited by the medical community worldwide, yet some people still hold on to this idea.

Many autistic individuals[20] point out, with appreciable validity, that even if vaccines caused autism, advising against vaccination sends a message that autistic people would be better off dead of horrible and easily preventable diseases and therefore argue that anti-vaccine campaigning should be prosecuted as a hate crime. One example is that Karen McCarron felt guilty over "giving" her daughter Katie autism by vaccinating her and then trying to atone for it with a "mercy killing".[21] This[22] phenomenon[23] is neither unique[24] nor isolated[25] to autism.

The Autism omnibus trial settled the case.

Antidepressant hysteria[edit]

Antidepressants do considerable good in the pregnant mothers that benefit from their effects, and these benefits translate to the child directly. Being depressed and/or not eating and/or inflicting self-harm and/or spiking your stress hormones from anxiety - those things harm the developing child immensely.[26] However, some sources find that giving autistic people antidepressants does not only not help them, it may cause them harm, although it was noted that "We can't recommend SSRIs as treatments for children, or adults, with autism at this time. However, decisions about the use of SSRIs for co-occurring obsessive-compulsive disorder, aggression, anxiety or depression in individuals with autism should be made on a case by case basis.", and it is possible that in some cases autistic individuals, particularly with co-occuring conditions, may benefit from these drugs. [27] [28]


In a nutshell[edit]

Pseudoscientific treatment[edit]

If I use anti-virus on my computer will it get autism?
—shittyaskscience[29]

Because all the stigma and fearmongering about autism, parents of autistic children may feel desperate and hopeless.[30][31] This makes them prime targets for the pseudoscience and alternative medicine communities. These individuals primarily prey on the parents of autistic children and make a fortune peddling false cures and therapies, including chelation therapy and lupron therapy. As with most alternative therapy, the results and effectiveness are not scientifically verified. Some therapies such as chelation and specialized diets can in fact be harmful.

Why?[edit]

People who are told by the "establishment" that there is no hope are prime for manipulation. Parents of autistic children are in just such a category. Some parents end up desperate, helpless and clueless about how to help their children. They may then fall victim to the people who use them as a vehicle to push an anti-vaccination agenda.[32]

Autism itself carries several things with it that make it more susceptible to cranks and quacks. Autism usually doesn't manifest itself in detectable symptoms until after the first year of life. This means many parents believe their child was totally "normal" and then, at around one year of age, suddenly changed. While this sometimes (but rarely) happens, the perception is real. The subtlety of this is lost on most people who search for the "cause" of what went wrong, and instead of looking at the beginning of development, they look for things that occurred right around the time of diagnosis. There are plenty of things that happen around the first year of life, and this leads many people to make the jump from correlation to causation.

Also, specialists have become better at diagnosing subtler cases of autism (including in girls and people of color) and the focus on diagnosis is stronger;[33][34] at the same time, the growth of industries such as information technology has drawn many slightly autistic couples into close proximity: "Guys who might never have had a prayer of finding a kindred spirit suddenly discover that she's hacking Perl scripts in the next cubicle."[35] The former has led to an increase in the number of children diagnosed with autism, while the latter has led, possibly, to an increase in the number of actually autistic children.

All of this combines to lead people to believe there is an increasing "epidemic" of autism and that it's being caused by an external environmental toxin that the children are exposed to around their first year. None of this is true; our understanding of what autism is and how it emerges is increasing exponentially. Autism tends to run in families and is most likely strongly or completely based in genetics.

False therapies and cures[edit]

Major players[edit]

Actual treatments[edit]

Autistic people may benefit from therapies to help them live healthier and happier lives. The National Autistic Society recommends the SPELL and TEACCH approaches to help autistic people.[37] Counselling may also help with co-occurring mental health problems like anxiety or depression. Because every autistic person has different needs, different people benefit from different therapies.

Some autistic people have difficulty speaking, and may be taught to use augmentative and alternative communication (AAC) to help with communication. This can include Picture Exchange Communication Systems (PECS), sign language, and use of tablets or computers for typing.

Some autistic people may benefit from medication. Pharmacotherapy with antipsychotics is well-documented to be effective[38]; risperidone (Risperdal) and aripiprazole (Abilify) are approved by the FDA for autism. Patients treated with either show reduced irritability, aggression and other asocial behaviours. Some autistic people benefit from over-the-counter melatonin as a sleep aid,[39] and medication for anxiety or depression if they have it.

Applied Behavior Analysis[edit]

Applied behavior analysis (ABA) is a controversial therapy involving rewards and punishments to influence a person's behavior. It is the most common therapy recommended for autistic children.

Proponents of ABA argue that it has a solid evidence base.[40] Use of ABA-based therapies early in life has been conclusively linked to improved language skills, social behaviour and academic performance in autistic children.[41][42][43] There have been success stories of children who were greatly helped by ABA therapists.

Critics of ABA, mostly in the Autism rights movement, have voiced concerns that it may be emotionally damaging, especially if done badly. More extreme forms of ABA, like using electric shocks as punishment and withholding food, are obviously abusive. Other cases are murkier. One study suggests that exposure to ABA significantly increases a child's risk of developing PTSD,[44] a concern that some autistic people parents have been voicing as individuals.[45][46] Other researchers have called into question the strength of the evidence base.[47] Some people advocate a shift away from compliance-based therapy, and towards support with issues like emotion regulation.[48][49]


Savant Skills[edit]

People with savant skillsWikipedia's W.svg (known pejoratively as "idiot savant") describes a person who has exceptional ability in one specialised field with accompanying reduced ability in others. They are often characterised by an inability to relate with other people except in the field of their ability.[citation needed] Only about half of all savants are actually autistic; the savant who inspired Rain ManWikipedia's W.svg, unlike the character, had an entirely unrelated disorder called FG syndromeWikipedia's W.svg.

Common savant skills include mental arithmetic, music, chess, memory (often photographic or eidetic) of what to other people is trivia, and art. Although this is a rare occurrence, the impressive abilities of the individuals are often widely reported. Why they excel in a specific field is unknown, though some have speculated that they may find some comfort by focusing their attention and energies on that field.[citation needed]

Despite the fact that many savants appear in the media, researchers estimate that only around 1 in 10 autistic people have savant skills.[50]

See also[edit]

External links[edit]

References[edit]

  1. Autism in women 'significantly under-diagnosed'
  2. https://www.npr.org/sections/health-shots/2017/07/31/539123377/social-camouflage-may-lead-to-underdiagnosis-of-autism-in-girls 'Social Camouflage' May Lead To Underdiagnosis Of Autism In Girls]
  3. Children of Color and Autism: Too Little, Too Late
  4. ASAN Statement on 2018 CDC Prevalence Data
  5. http://a4.org.au/node/972
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4940003/
  7. On the Diagnosis and Misdiagnosis of Autism Spectrum Disorder
  8. The CDC just announced one in 59 children are autistic. Here’s why that’s not evidence of an epidemic.
  9. ASAN Statement on 2018 CDC Prevalence Data
  10. MSN - Study: Chromosome Change Points to Autism
  11. NIH - Baby teeth link autism and heavy metals, NIH study suggests
  12. [1]
  13. Fever During Pregnancy Tied to Autism in Study
  14. "Things That Cause Autism" (satire)
  15. This Just In ... Being Alive Linked to Autism
  16. Emily Willingham, PETA: Milk Linked To Scary Autism And Vegan Is Your Only Hope, Forbes, May 28, 2014
  17. Sheffer, Edith (March 31, 2018). "The Nazi History behind "Asperger"". https://www.nytimes.com/2018/03/31/opinion/sunday/nazi-history-asperger.html. 
  18. Retracted autism study an 'elaborate fraud,' British journal finds
  19. The Vaccine-Autism Myth Started 20 Years Ago. Here's Why It Still Endures Today
  20. http://www.disabilityandrepresentation.com/ableism-in-the-anti-vaccination-movement-a-qualitative-content-analysis-of-the-great-mothers-facebook-page/
  21. http://www.notdeadyet.org/katie-mccarron
  22. http://www.raggededgemagazine.com/0902/0902ft2.html
  23. http://www.notdeadyet.org/why-we-shouldnt-blame-the-murders-of-disabled-kids-on-lousy-services
  24. http://www.notdeadyet.org/look-for-annie-abuse
  25. http://www.raggededgemagazine.com/0302/0302ft7.html
  26. http://theincidentaleconomist.com/wordpress/the-panic-du-jour-antidepressants-and-autism/
  27. https://www.livescience.com/8457-study-antidepressants-autistic-children.html
  28. https://www.scientificamerican.com/article/autisms-drug-problem/
  29. https://www.reddit.com/r/shittyaskscience/comments/35p34d/if_i_use_antivirus_on_my_computer_will_it_get/
  30. The Dangers of Snake-Oil Treatments for Autism
  31. Why are we still treating autism like an epidemic?
  32. http://www.independent.co.uk/news/world/americas/us-politics/donald-trump-autism-anti-vaccination-vaxxer-myth-injection-health-campaigners-a7580941.html
  33. The CDC just announced one in 59 children are autistic. Here’s why that’s not evidence of an epidemic.
  34. ASAN Statement on 2018 CDC Prevalence Data
  35. http://www.wired.com/wired/archive/9.12/aspergers_pr.html
  36. http://bigthink.com/neurobonkers/blowing-the-whistle-on-institutionalised-child-abuse-in-the-uk
  37. Strategies and Approaches
  38. Antipsychotics in the treatment of autism. David J. Posey, Kimberly A. Stigler, Craig A. Erickson, and Christopher J. McDougle, 2008
  39. Raising Children: Melatonin
  40. Myers, S.M.; Johnson, C.P.; Council on Children with Disabilities (2007). Management of children with autism spectrum disorders. Pediatrics.
  41. Cohen H, Amerine-Dickens M, Smith T. Early intensive behavioral treatment: replication of the UCLA model in a community setting. J Dev Behav Pediatr.2006;27(2 suppl) :S145– S155
  42. Eikeseth S, Smith T, Jahr E, Eldevik S. Intensive behavioral treatment at school for 4- to 7-year-old children with autism: a 1-year comparison controlled study. Behav Modif.2002;26 :49– 68
  43. Lovaas OI. Behavioral treatment and normal educational and intellectual functioning in young autistic children. J Consult Clin Psychol.1987;55 :3– 9
  44. Evidence of increased PTSD symptoms in autistics exposed to applied behavior analysis
  45. "ABA" by Maxfield Sparrow
  46. Thinking Person's Guide to Autism: Quiet Hands
  47. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009260.pub3/full
  48. Thinking Person's Guide to Autism: The Cost of Compliance Is Unreasonable
  49. Compliance is not the goal: Letting go of control and rethinking support for autistic individuals (TED talk by Amy Laurent)
  50. Research: Autistic Savants