Controversies in autism: Difference between revisions

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There is considerable disagreement over the exact nature of autism, however it is generally considered to be a neurodevelopmental condition which manifests itself in markedly abnormal social interaction, communication ability, patterns of interests, and patterns of behavior. It encompasses a wide range of atypical conditions, none of which is well understood. Although there are common and specific physical conditions co-morbid to, perhaps arguably exacerbating the severity of some people's autism spectrum disorder, not all people diagnosed with autism spectrum disorders experience these.

The diagnostic criteria for autism differs from that of Asperger's ^[1]. The diagnostic process in either case is usually assessed through psychiatric and cognitive evaluation methods with IQ score indicating particular patterns of abilities (common to those with autism and generally infrequent in the non-autistic population) and to distinguish autism from psychiatric conditions. In the case of classical autism this assessment usually also involves an interview of carers and the client or, where interview is not possible, observation of the client. In the case of adults suspected of having classical autism, carers, where their report would be deemed feasible and reliable, would usually be interviewed about the person's early infancy. By contrast, as Asperger's Syndrome is often not diagnosed until mid childhood and even into adulthood, interview about early infancy may not be necessary to a diagnosis.

The cause(s) of autism and the spectrum of pervasive developmental disorders (PDDs) are as yet either unknown or unclear in all cases, as are the prognoses, or best treatment options. There is, however, widespread agreement that early diagnosis and intervention can often make a significant difference for the long-term prospects of a person with autism because the human mind and nervous system are more plastic at a younger age; therefore, research for possible therapies and treatments is often focused toward children who have been diagnosed early with a spectrum disorder. However, there is controversy that this emphasis on the problems facing children has resulted in limited research and treatment options for adults with autism.

Much of today's medical and autism fund-raising communities considers autism to be essentially incurable, or at least to have life-long effects. By contrast, those in the autism rights movement and their allies do not consider autism to be a disorder, but, rather, a different way of perceiving and behaving and believe that at least some of the difficulties encountered by people with autism may result from prejudice and lack of accommodation from society.

The usefulness and accuracy of autism as a diagnosis

The 1994 DSM-IV criteria for the diagnosis of autism are the result of several revisions, and consequently the psychiatric community is divided as to whether the condition should be ordered by severity along a spectrum or categorised into multiple distinct disorders that have similar symptoms. This division is exacerbated by the wide range of co-morbid conditions effecting a significant proportion of those with autism spectrum disorders. Research and clinical experience suggests however, that while autism can appear to manifest as a psychiatric disorder, psychiatric co-morbidities aside, its underlying causes are largely neurological.

A diagnosis of autism is complicated by the fact that there is no definitive test for autism due to the significant variance of symptoms among people with autistic traits, as well as a lack of knowledge about the etiology of the condition. Whilst a majority of those with Asperger syndrome may be highly functional cognitively but lack 'social' skills, a majority of those with so-called "profound autism" may be non-verbal and deficient in elementary skills. Some autistic people are considered mentally retarded, having low IQs (Intelligence Quotients). Others have been ultimately found to have average or above average intelligence. To complicate this some with high IQs have had severe functioning challenges whilst some with low IQs (under 70) have had significant skills and a minority of people with autism have narrow, but exceptional autistic savantabilities.

Treatment strategies and choices are based on definitions of what is perceived as needing to be changed. Different treatment approaches have had widely divergent outcomes for different individuals. As a result, some parents claim their children recovered with only behavioral approaches, some credit biomedical intervention as the best method for improvement, others claim success with interventions for sensory-perceptual disorders or augmented communication technique (or combinations). Others report little or no progress after trying many different approaches. Occasionally, parents claim their autistic children have simply "grown out of it."

There are also those (primarily those on the autistic spectrum themselves) who reject the premise that autism is necessarily a disorder that should be cured. In their view, a diagnosis can sometimes result from a judgment of non-conformity that is followed by efforts to correct what are essentially personality traits.

Asperger's Syndrome and autism

Currently, Asperger's syndrome is classified as a separate diagnosis from autism in the DSM-IV, but it is still considered an autism spectrum disorder. The primary distinction between the definitions of autism and Asperger's Syndrome in the DSM-IV is that autism involves a significant speech delay by the age 3-4^[2] and is less common in those with Asperger's. Some people believe autism and Asperger's syndrome should not be given separate labels in the DSM-IV because they believe that differences in language acquisition are not significant enough to separate the disorders or that autism and Asperger's have few definitive differences^{[citation needed]}. It is also unclear whether a child with high-functioning autism who learns to speak should have their diagnosis changed to that of Asperger's Syndrome, though it should be noted that late speech does occur in a minority of neurotypical children and, in itself, need not be indicative of autism in a child with Asperger's Syndrome who goes on to develop good functional language.

'Autistic' vs. 'Has autism'

Some people diagnosed on the autism spectrum have a preference for the word autistic to be used as both an adjective and a noun; they dislike the politically correct person-first terminology. Autistic author, Donna Williams has written about this as a division between culturalists who see autism in cultural terms and curists who see autism as a condition requiring cure^[3]. Those who define themselves as moderates prefer to think of treatment and management of extreme functioning issues in autism rather than seeing everything as either culture or cure.

Some persons with Asperger's syndrome prefer to be called Aspergerian or aspie. Others with Asperger's Syndrome prefer to refer to themselves collectively as autistics, preferring to see themselves as part of one collective spectrum rather than having a condition different or separable from autism in general.

Person-first terminology is preferred by many with medical conditions, such as AIDS or epilepsy, where it may serve to remove some of the stigma of these illnesses. Many in the autistic community, including some persons who are considered to be severely autistic or low-functioning, feel that to use person-first language conveys the impression that autism is another such disease, something that can and should be cured^[4]. These autistics feel that autism is an integral part of their identity, that the person and the autism cannot be separated. Some even go so far as to propose that the removal of autism is akin to proposing death for them.

Cure oriented parents of autistic children, by contrast, contend that the autism of those they live with is an illness, that autism is not part of the person, and should be removed or cured. A more moderate group is open to treatment for co-morbid issues effecting people with autism whilst not seeing this as necessarily seeking to cure autism proper.

Person-first terminology remains the preferred form in most clinical literature about autism.

Epidemiology of autism

There is uncertainty and controversy over whether the incidence of autism is actually increasing or if there simply is an increase in the number of reported cases and better diagnosis. Some argue^{[citation needed]} that if the incidence is rising, then environmental factors play a greater role; if it is simply being reported more often, genetics deserves more attention. One theory, particularly associated with Simon Baron-Cohen, suggests that increased social mobility and assortative mating may lead to the genetic amplification of autistic traits.

Anecdotal reports from school districts and physicians lend support to the impression that the incidence is rising, and some studies appear to support this as well. Some believe the incidence has risen markedly in the last few years, from about one in 5000 to estimates ranging between one in 400 or even as high as one in 166, which may indicate a major societal problem. In the United States, Centers for Disease Control (CDC) have vacillated between the latter two figures. In January of 2004 the CDC sent out an autism alarm to all pediatricians stating that they believed that 1 in 166 children had an autism spectrum disorder and as common as one in six now suffered from a neurodevelopmental or behavioral disorder. (Others have quoted these figures as high as 1 in 40 for autism and one in three for the neurodevelopmental or behavioral disorders.)

Among the factors cited likely to cause increased reporting are the broadening definition of autism, which began most markedly with revised classifications in DSM-III-R in 1987 and the greater availability of services for autistic individuals creating an incentive to be inclusive in the diagnosis. Secondly, the last few decades have seen a greater awareness of autistic traits among pediatricians and other medical specialists. It is surmised that the types of children diagnosed as infants prior to the 1970s as retarded, emotionally disturbed or psychotic are now diagnosed as autistic or having PDD^[5]. Today Childhood Schizophrenia is distinguished from autism by later age of onset and the presence or absence of persistent hallucinations, between 1800-1938, Autism was believed to be related to childhood schizophrenia^[6].

Genetics and autism

There is evidence that autism has a genetic component^[7], and ongoing research focuses on finding the biomarkers that determine autistic phenotypes. One, as yet unproven theory is that there may be genes which contribute to a vulnerability to environmental triggers or have another role in the etiology of autism.

There is a trend in research towards viewing genetics as an underlying factor. However, whilst some parents of those with autism are progressively also being diagnosed on the autism spectrum, at least some autistic children have apparently neurotypical parents. This suggests that genetics are either not a necessary cause or that they don't play a part in all cases of ASD. The spectrum of autistic disorders is notable for its significant gender disparity, with the incidence of autism in males greatly exceeding the incidence in females. Whilst this could argue against a genetic theory, it has also been argued that male brains may be more vulnerable during early development^[8]. Conversely, some studies have suggested that testosterone potentiates the toxic effects of mercury, and this has also been cited by some interest groups to account for the gender difference along non-genetic lines^[9].

Scientists have recently (July 2005) shown that variations in the gene for protein kinase C beta 1 (PRKCB1), a protein with an important role in brain function, are strongly associated with autism^[10]. This find may suggest some answers to a number of previous, but unexplained, observations about autism and provides the potential for a mechanistic explanation for some of the characteristics of the condition.

Implications of genetic testing

If and when genetic testing for autism becomes available, it is anticipated that many women pregnant with an autistic child will decide to abort the pregnancy. There is such a precedent from Down's Syndrome^[11]. Seeing autism from a cultural perspective, Autism rights advocates have argued this will be akin to genocide^[12] and, furthermore, that the impact of such an event on the human species as a whole could be very significant, arguing that common pro-life rhetoric about the potential for geniuses to be aborted might be more persuasive if people such as Albert Einstein and Isaac Newton were, as some have claimed, autistic^[13].

Vaccines and autism

In the late 1990s, controversial hypothesis arose that linked childhood vaccinations to autism. The claim was that the mercury used in vaccinations causes regressive autism.

Thiomersal

MMR triple vaccine

Intelligence and autism

The 1991 publication of the autobiography Nobody Nowhere by autistic author Donna Williams challenged the existing stereotype of Classical autism being synonymous with mental retardation^[14]. In the early 1990s, autism was still largely synonymous with the concept of 'low functioning' and and controversy soon ensued, heightened by the progressive publication of other autobiographical works. This progressively lead to a realisation that so called 'high functioning', presumably highly intelligent people with autism may have been more common than once imagined. This coincided with a greater interest in Hans Asperger's publications about Asperger's Syndrome which were only translated into English by Lorna Wing in 1981 and became popularised by her in 1992^[15].

The term 'mentally retarded' is based on IQ testing, which has its own set of controversies and detractors. Whilst a majority of children diagnosed autistic before the increased incidence of 'high-functioning' autism and the recognition of Asperger's syndrome may have been assessed with low IQ scores associated with presumed mental retardation, this correlation is questionable when applied to those across the entire diversity of the autism spectrum.

As those with normal or high intelligence are less likely to be diagnosed with autism, the average IQ of the autistic community as a whole may not be able to be reliably determined. Furthermore, anecdotal accounts of autistic children whose IQ scores have increased dozens of points over a relatively short period of time are not uncommon. Some of these cases, however, may arguably not correspond to an increase in actual intelligence, however; perhaps, as with neurotypical children, children with autism may simply get better at taking IQ tests (the so-called practice effect).

Characteristics observed by some studies as being associated with gifted children at least appear to be analogous to those of autistic children:

Some studies suggest that gifted children are more than twice as introverted as their peers.^[16]
Gifted children have been characterized as having obsessive interests, preferring to play alone, and enjoying solitude. They are also said to have prodigious memories and show intense reactions to noise, pain and frustration.^[17]
According to some reports, gifted children have a higher-than-average propensity to allergies^[18]

These findings have led to speculation that high intelligence and autism are related. Autistic author Temple Grandin speculates that genius itself "may be an abnormality."^[19]

An alternative view is that autism and intelligence are unrelated; all levels of intelligence have been observed in those with autism. According to this view, those with autism and low intelligence would be more likely to be recognized and diagnosed, and those with normal to high intelligence might be better able to articulate their experiences (either verbally or through writing) and would be labeled as high-functioning regardless of their other neurological deficits.

Prognosis for autistic children

Children who are diagnosed with autism face a great range of outcomes. Some have appeared to 'outgrow' much of the extremity of their autism spontaneously by mid childhood. Others have appeared to become significantly less autistic after one or a range of different mainstream and non-mainstream interventions. Many become mainstreamed and achieve employment skills and some level of independent living after years of hard work and intensive training and others remain in special education and later move into residential care facilities. Some develop slowly, but never lose their diagnoses. Some may appear less autistic during childhood and report becoming "more autistic" or 'regressing' in adulthood. Some, for any variety of reasons, may fail to develop many more skills than they had in infancy.

While some people see early intervention as crucial for autism, the prognosis is also less certain the younger the child is meaning its may be impossible to clearly attribute improvement to the intervention itself. An idiosyncratic development path may also be confused with a more severe disorder, and the child may 'catch up' on his/her own. Those with a range of untreated co-morbid conditions may be presumed more 'severely autistic' and either dramatically change once these are addressed or fail to progress if they are overlooked as part and parcel of 'untreatable autism'. Research indicates that the human mind and nervous system remains plastic for longer than originally thought, and people with autism, like those with learning disabilities, have been known to cognitively develop throughout their lives.

There is broad consensus in the medical community to the effect that autistic behaviors can be improved through training and through medical or educational interventions, though there is apparently no consensus on treatment regimes and objectives.

For a discussion of prognosis of persons with AS, see that article's section.

Disorder vs. neurodiversity models

There is some controversy about which model of autism is correct: the model that autism is a disorder that creates suffering or the model that autism is a natural, even healthy, variation in neurological hardwiring.

The model that says autism is a healthy variation in neurological hardwiring is sometimes called the neurodiversity or anti-cure perspective and is the basis of the autism rights movement. Jim Sinclair, a proponent of this model, argues that autism colors every aspect of an autistic person's existence and that to cure an autistic person of autism is equivalent to replacing the autistic person with a different neurotypical person^[20]. Groups like Aspies for Freedom, the Autistic Self Advocacy Network and Autism Network International advocate the anti-cure perspective.

The disorder model, on the other hand, sees autism as something that creates significant suffering and advocates a cure for autism. Lenny Schafer, a proponent of the disorder model of autism, argues that a cure for autism will free autistic children from suffering from the disabilities of autism and will give them what it takes to obtain happiness^[21]. Organizations like Cure Autism Now and Autism Research Institute advocate and research treatments and a potential cure for autism. Autism therapies exist to alleviate aspects of autism that the therapies' proponents argue create suffering.

In an article titled Culture versus Condition autistic author Donna Williams espoused a third, more moderate, direction^[22]. In her work, The Jumbled Jigsaw^[23], Williams espoused the treatment of co-morbidities is seen not as treating autism, as such, but as but as reducing unnecessary developmental and functioning burdens on the person with autism. According to her work these co-morbidities may include genetic or metabolically founded psychiatric mood, anxiety and compulsive disorders as well as gut, immune or metabolic disorders or severe sensory perceptual or motor planning deficits.

References

^ http://web.syr.edu/~rjkopp/data/dsm_criteria.html
^ http://www.comeunity.com/disability/speech/guidelines.html
^ http://www.donnawilliams.net/culturevscondition.0.html?&no_cache=1&sword_list[]=culture&sword_list[]=cure
^ http://web.syr.edu/~jisincla/person_first.htm
^ http://www.upi.com/Consumer_Health_Daily/Reports/2006/10/09/the_age_of_autism_many_many_more/4170/print_view/
^ http://serendip.brynmawr.edu/biology/b103/f00/web1/obaray.html
^ http://www.reuters.com/article/scienceNews/idUSN1623067120070219
^ http://www.sciam.com/article.cfm?articleID=00018E9D-879D-1D06-8E49809EC588EEDF
^ http://www.lewrockwell.com/miller/miller14.html
^ http://www.news-medical.net/?id=11761
^ http://en.wikipedia.org/wiki/Down_syndrome
^ http://en.wikipedia.org/wiki/Eugenics
^ http://en.wikipedia.org/wiki/People_speculated_to_have_been_autistic
^ http://www.geocities.com/connectingthedots_2002/autismandmr.html
^ http://en.wikipedia.org/wiki/Asperger_syndrome
^ www.a-gifted-child.com
^ www.jewishworldreview.com
^ www.sengifted.org
^ www.onlineparadigm.com
^ Sinclair, Jim. "Don't Mourn for Us." 1993. http://ani.autistics.org/dont_mourn.html. Page accessed: 22 January 2007.
^ Schafer, Lenny. "Commentary: Somewhere over the Spectrum, Part 3." Schafer Autism Report. 12 January 2005 http://lists.envirolink.org/pipermail/sareport/Week-of-Mon-20050110/000350.html Page accessed: 22 January 2007.
^ http://www.donnawilliams.net/culturevscondition.0.html?&no_cache=1&sword_list[]=culture&sword_list[]=cure
^ http://www.donnawilliams.net/jumbledjigsaw.0.html

[1] ttp://web.syr.edu/~rjkopp/data/dsm_criteria.html

[2] ttp://www.comeunity.com/disability/speech/guidelines.html

[3] ttp://www.donnawilliams.net/culturevscondition.0.html?&no_cache=1&sword_list[]=culture&sword_list[]=cure

[4] ttp://web.syr.edu/~jisincla/person_first.htm

[5] ttp://www.upi.com/Consumer_Health_Daily/Reports/2006/10/09/the_age_of_autism_many_many_more/4170/print_view/

[6] ttp://serendip.brynmawr.edu/biology/b103/f00/web1/obaray.html

[7] ttp://www.reuters.com/article/scienceNews/idUSN1623067120070219

[8] ttp://www.sciam.com/article.cfm?articleID=00018E9D-879D-1D06-8E49809EC588EEDF

[9] ttp://www.lewrockwell.com/miller/miller14.html

[10] ttp://www.news-medical.net/?id=11761

[11] ttp://en.wikipedia.org/wiki/Down_syndrome

[12] ttp://en.wikipedia.org/wiki/Eugenics

[13] ttp://en.wikipedia.org/wiki/People_speculated_to_have_been_autistic

[14] ttp://www.geocities.com/connectingthedots_2002/autismandmr.html

[15] ttp://en.wikipedia.org/wiki/Asperger_syndrome

[16] www.a-gifted-child.com

[17] www.jewishworldreview.com

[18] www.sengifted.org

[19] www.onlineparadigm.com

[20] Sinclair, Jim. "Don't Mourn for Us." 1993. http://ani.autistics.org/dont_mourn.html. Page accessed: 22 January 2007.

[21] Schafer, Lenny. "Commentary: Somewhere over the Spectrum, Part 3." Schafer Autism Report. 12 January 2005 http://lists.envirolink.org/pipermail/sareport/Week-of-Mon-20050110/000350.html Page accessed: 22 January 2007.

[22] ttp://www.donnawilliams.net/culturevscondition.0.html?&no_cache=1&sword_list[]=culture&sword_list[]=cure

[23] ttp://www.donnawilliams.net/jumbledjigsaw.0.html

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@@ Line 57: / Line 57: @@
 In the late [[1990s]],  controversial hypothesis arose that linked childhood vaccinations to autism. The claim was that the mercury used in vaccinations causes regressive autism.
-===Thimerosal===
+===Thiomersal===
-{{main|Thimerosal controversy}}
+{{main|Thiomersal controversy}}
 === MMR triple vaccine ===