When Unreasonable Intuition Takes The Initiative

"We've launched a massive testing and research effort that's going to involved hundreds of scientists from around the world."

"By September, we will know what has caused the autism epidemic and we'll be able to eliminate those exposures."

"Our food system, our water, our air, different ways of parenting, all the kind of changes that may have triggered this epidemic."

"We are going to look at vaccines, but we are going to look at everything. Everything is on the table."

Robert F. Kennedy Jr., U.S. Secretary of Health and Human Services 

 

"It would be a great disservice to our families if, despite plentiful and robust evidence to the contrary, the administration announces vaccines cause autism, declares the case closed and stops funding critically needed autism research that is providing valuable information about the true causes." 

Alison Singer, president, Autism Science Foundation 

"There's got to be something artificial out there that's doing this."

"If you can come up with that answer where you stop taking something, you stop eating something, or maybe it's a shot, but something is causing it."

U.S. President Donald Trump

A former top federal vaccine official spoke on the danger of Robert F. Kennedy Jr. giving “false hope” to people as the Health and Human Services secretary recently promised to identify the “cause” of autism by September.  Rolling Stone

 

Autism is a complex human condition, a spectrum of disorders inhibiting language and communication, affecting behaviour, that has been studied by scientists for decades. Autism, it is generally held, is caused by genetics and environmental factors even prior to birth; parents for example, conceiving children past reproduction prime; exposure to chemicals during pregnancy -- each contributing to the condition.  Crucial questions abound without answers. Which genes are involved, and how environmental exposure can influence the condition.

 

The Autism Society's response to the stated certainty of these deep scientific biological mysteries suddenly being revealed in several months' time is as skeptical as the premise deserves to be regarded: "We are deeply concerned by the lack of transparency around this effort -- who is leading it, what methods are being used and whether it will meet established scientific standards", stated Christopher Banks, president and chief executive of the organization. 

What do the experts, the scientific community, the parents of children with autism, and the specialized charitable organizations formed to represent their interests know, after all? Surely all it takes is an individual with an ingrained sense of entitlement and a belief in his own intuition fortified by theories outside the scientific realm of medicine, fuelled by suspicion of vaccines meant to save lives which a segment of the population prefers to believe threatens lives -- to arrive at an answer.

 

One that might conclude with a public announcement that repeats that old hyperbolic message of smug "I told  you so!" It is an investigative query of a conclusion searching for validation. Even health officials nominated by Donald Trump as advisers note that the deadline for conclusive resolution of the mystery is overblown rhetoric in which there can be little confidence. The reference of September is a reflection of the research process reaching finalization, and certainly not the analysis and conclusion finalization. 

A multi-million-dollar research program meant to examine the spike in autism diagnoses is underway but yet still in its early stages under the auspices of the National Institutes of Health. Over $300 million has been spent annually in the funding of autism research. Studies examining the roles of genetics and environmental influences have been factored into the study along with the manner in which the condition is diagnosed.

 

Given Mr. Kennedy's previous statements certifying his belief in the role of vaccines in producing autism, and other health theories he subscribes to beyond the pale of real science, medical researchers have sound reason to be concerned that the statements by this man have the purpose of legitimizing the debunked claims of vaccines causing autism, reflecting Mr. Kennedy 'sstanding by the claims for years past.

 

In his confirmation hearings for the post of Secretary of Health, he would not disavow those claims. Worse, under his leadership, David Geier, a discredited researcher and robust proponent of a connection between autism and immunization was hired to conduct a government study on their purported connection. Mr. Kennedy latterly gave short shrift to research that denies a causal link.  

 President Trump is right behind his Secretary of Health, fully in support of his intuitive theory, urging Kennedy and his research team to investigate autism's causes. The mass layoffs under this administration at the Centers of Disease Control which will have a deleterious impact on health research for the nation, did not extend to the autism program at the gutted agency.

 

"It's like saying 'by September we are going to know the cause of cancer'."

"Autism is every bit as complicated as cancer, and that's how it needs to be addressed."

Peter Hotez, pediatrician, author, Vaccines Did Not Cause Rachel's Autism

"It has become clear that truth and transparency are not desired by the Secretary, but rather he wishes subservient confirmation of his misinformation and lies."

"There’s no scientific evidence ruling out genetics [as a cause of autism]."

"There is data that had been published that say that genetics may contribute to autism. There are, obviously, data that… suggest that perhaps environmental factors may. But one has to be incredibly careful, incredibly careful about making associations between environmental factors and autism."

"Autism is an incredibly complicated issue. So, we have the issue of diagnosis bias. We don’t know how many of those cases are true, how much of this is true growth of autism, how much of this is just that we now have diagnostic criteria and we diagnose it more often."

Dr. Peter Marks, former head of the Food and Drug Administration’s Center for Biologics Evaluation and Research

The CDC’s headquarters in Atlanta, Ga, USA. Photograph: MIguel Martinez/AP

Clarifying C-Sections Connecting With Autism

"Our study does not provide irrefutable proof that C-sections cause psychiatric disorders. Association is not causation."
"However, we believe that the study provides information that may help parents [and] doctors to make informed decisions about how they want their births to be."
"C-section is often recommended by obstetricians if the mother has diseases such as diabetes, hypertension, etc. Some of the diseases might already have an effect on a child’s brain development when he or she is still in the womb. [A combination of factors may contribute to the risk, so] it would therefore be wrong to demonize C-sections. C-sections should continue to be used when medically necessary." 
"Researchers should continue [to] investigate what are the underlying causes of the observed associations." 
Tianyang Zhang, researcher, Karolinska Institute, Sweden, study lead author

"Public health concerns have been raised because access to medically indicated cesarean delivery may be difficult in low-resource settings and unnecessary cesarean deliveries may be performed in high-resource setting."
Research team, study, published in JAMA Network Open

It’s important to understand why there may be a link between cesareans and some disorders, especially as C-section rates have risen in recent years, say the researchers.  (Loic Venance/Getty Images)

"The impact of this is not going to be great because the increase is still pretty low."
"It’s not very dramatic. It’s statistically significant but from the population standpoint, the risk is not huge. And it absolutely does not prove that cesarean section is causing autism or ADHD."
"The risk factors that lead to a C-section may also be risk factors that lead to autism or ADHD."
Dr. Pankhuree Vandana, pediatric psychiatrist, Nationwide Children’s Hospital, Columbus, Ohio

"This study is certainly interesting and begs further prospective research be undertaken to try and answer the question of whether delivery by caesarean section increases the burden of mental health issues in children."
"Before undergoing any treatment, particularly elective treatment, it is important that doctors make patients aware of the options they have and their potential risks and benefits."
"Ultimately, this study does not answer this question, but merely comes up with the correct recommendation that 'further research is required'."
University of Queensland obstetrics researcher Gino Pecoraro

The link might be due to other factors such as the mother’s age or weight. Christian Bowen

A research team involving scientists from the Karolinska Institute in Sweden along with a number of Australian researchers undertook to examine 60 studies incorporating a total of 20.6 million births, finding that children delivered by caesarean section are a third likelier to develop autism than children born normally through the birth canal. The analysis also found that those children delivered by C-section were as well a sixth more likely to develop ADHD (attention deficit hyperactive disorder). The results of the study saw publication in JAMA Network Open.

As far as experts in the field are concerned, it remains  unclear why risks associated with C-sections appear to be so elevated, irrespective of whether the C-section was planned or undertaken as a result of a medical emergency. However, there is a possibility that factors such as a mother being older, or a baby at risk of premature birth could conceivably impact with such consequences and may also explain the higher risk of developmental disorders

Scientists also throw in the possibility that post-birth exposure to antibiotics could play a part as well. Professor Jeffrey Keelan, deputy director of the women and infants research foundation, University of Western Australia, found the study "interesting and well-performed", but failed to sufficiently adjust for a host of factors that could explicate the additional risk -- while other scientists felt the findings to be "significantly flawed", in that some of the studies included in the analysis reflected extremely high autism rates.

It is estimated that in the United Kingdom alone, around one percent of the population could be on the autism spectrum, reflecting the fact that Britain hosts some of the highest rates of births by caesarean section in Western Europe, with 26.2 percent delivery by C-section currently, in comparison to 19.7 percent performed in 2000. Experts link the rise in C-sections to the increasing age of mothers-to-be, along with the rise of obesity levels.

"The need for a caesarean is often caused by problems that could influence brain function, such as a poorly functioning placenta. It is highly unlikely the caesarean delivery itself is causal in these mental health conditions, from our current understanding of brain physiology and the effects of a caesarean."
"Women should not be alarmed by the need for a caesarean, which is often performed to reduce risk to their baby."
Dr. Andrew Shennan, professor of obstetrics, King's College London

"A number of underlying factors ... were not accounted for [in the study]. Therefore the findings of this paper do not show that caesarean birth leads to autism and ADHD."
"Women who have a caesarean birth should be reassured that it is a safe procedure. In many cases, a caesarean birth can be a life-saving intervention."
Dr. Pat O'Brien, consultant obstetrician, spokesman, Royal College of Obstetricians and Gynaecologists

Kids delivered by c-section are a third more likely to develop autism, a study has found     Credit: Getty - Contributor

"We know, for example, that caesarean sections are more common for pregnant women who are obese and older, and who have a history of immune conditions such as asthma."
"All of these factors have also been linked with an increased chance of having a child with autism, and it is entirely possible – and some would argue, probable – that it is more likely these factors underlie the relationship between caesarean section and neurodevelopmental disorders."
Dr. Andrew Whitehouse, Bennett Chair of Autism, University of Western Australia

That Problematical Autism Explosion

"The pretend epidemic of autism is related to the inclusion of people less and less different from non-autistics."
"This means that, across all disciplines, the people with or without autism who are being included in studies are increasingly similar. If this trend holds, the objective difference between those with autism and the general population will disappear in less then ten years."
"The definition of autism may get too blurry to be meaningful -- trivializing the condition -- because we are increasingly applying the diagnosis to people whose differences from the general population are less pronounced."
"[There is no gold standard, no biological marker such as a blood test] to tell you this one is autistic, this one is not. People tried all possible solutions, but with the constant enlargement of the criteria."
"Fifty years ago, one sign of autism was a lack of apparent interest in others. Nowadays it's simply having fewer friends than others. Twenty years ago you would ask for a complete absence of facial expression. Now it's less facial expression, fewer friends, less reciprocity -- it's become more and more fuzzy."
"You could not be ADHD and autistic before 2013. Now you can. This is justified in some cases where people have both presentations. But it also authorizes to label as autistic pure ADHD people."
"The cliche that you will see everywhere is, 'oh, you have more autism because they are better recognized', which is absolutely wrong."
"It's not that they are better recognized. [It's that people with less profound deviations from] normal [are being diagnosed with autism]."
Dr.Laurent Mottron, professor of psychiatry, Universite de Montreal

"Panicked parents falsely assumed the rapid increase in rates was due to vaccination — not realizing it was First described in the 1940s a decade later severe autism instead a consequence of looser definitions and assessments."   Getty Images

First identified as a condition in the 1940s, a decade later it was assumed that severe autism affected five to ten children for every 10,000 in any population. That estimate rose to one child in 59 by the year 2014 -- according to figures released by the U.S. Centers for Disease Control and Prevention. By any standards of measurement that represents an enormous spike. The mystery is, what could account for it? Are children in those numbers really legitimately to be classified in the autism range? What could possibly be causing what certainly appears on the surface to look suspiciously like an epidemic?

Ah, of course, that would be inoculations. Those same inoculations against diseases that once swept a deadly swath of destruction through the global community. And still do, in some backward areas of the world, now trying to 'catch up' by fast-tracking inoculations for children, led by the UN's WHO. And then the backlash, the uninformed but persuasive opinions with no basis in medical science whatever promulgated on social media by celebrities, that autism is caused by inoculations. And so many convinced this to be true, aided by a since-discredited scientific paper, that measles and other once-rare diseases have returned.

The anti-vaxxers have a huge, faithful following. Medical science, dismayed but forgiving to a fault, expresses the opinion that these 'misguided' parents who withhold vaccine inoculations from their children simply need to be educated; that their fears for the well-being of the children have led them down the confused garden path of inviting disease rather than spurning its onset. A newly-published study looks at the prevalence of autism diagnoses and has arrived at a not very surprising conclusion; the condition is being over-prescribed, partly thanks to the latest edition of the Diagnostic and Statistical Manual of Mental Disorders.

Published in JAMA Psychiatry, Dr. Mottron and his colleagues involved in the research project identified the explosion in diagnoses of autism as having resulted from the broadening of the "autism" definition to the extent that differences between those diagnosed with autism and the balance of the population are seen to be diminishing. The research reviewed eleven meta-analyses -- studies of studies -- published from 1966 to 2019 comparing individuals with autism and those in the population considered to be autism-free.

The magnitude of the differences observed between those with autism and those without was of particular interest to the researchers, in how the "effect size" changed over the period studied. Close to 23,000 people diagnosed with autism in total were included in the study. Traits assessed including "emotion recognition", recognizing emotions in other people, and brain size, in recognition that people with autism tend to have a slightly larger brain volume, along with other traits that were assessed, seeing shrinkage in measurable differentiation by 45 to 80 percent.

Too many people with mild and dubious symptoms not very different from people without true autism are being diagnosed with autism, invalidating study results, concluded Dr. Mottron. This is a situation whereby any child or adult exhibiting symptoms barely resembling autism now is being diagnosed with autism. The result overwhelms specialty clinics and related services to the extent that true autistics are being denied the assistance they require. Diagnostic criteria have been loosened unhelpfully.

In the opinion of some experts, the over-diagnoses began in 1994 as a result of the American Psychiatric Association releasing the fourth edition of its Diagnostic and Statistical Manual of Mental Disorders, considered the officially sanctioned encyclopedia of mental illness. Merging Asperger syndrome with autism increases three-fold the rate of autism diagnoses, according to Dr. Frances of Duke University. Even more critical, classic autism and Asperger's were collapsed into a "spectrum" making misdiagnoses even more common, in the current (fifth) edition of the manual, DSM-5.

"Probably the biggest mistake we made in DSM-IV was including Asperger's, a much milder form of autistic disorder with unclear boundaries to normal diversity, eccentricity and giftedness."
"Careless diagnosis, often related to requirements for extra school services, resulted in a fake epidemic -- a 50-fold increase in the past 25 years."
"Panicked parents falsely assumed the rapid increase in rates was due to vaccination -- not realizing it was instead a consequence of looser definitions and assessments. This has led to measles epidemics all over the world."
"[Over-diagnosis is also harmful for parents and children] stigmatizing them, causing needless worry and reducing expectations."
Dr. Allen Frances, emeritus professor of psychiatry, Duke University, chair, task force DSM-IV

Autism Diagnoses in Girls

"Many parents of girls with autism spectrum disorders (ASD) report spending much of the early years on an emotional rollercoaster. On the one hand, they are excited and celebrate their daughter’s developmental milestones, yet, they become increasingly concerned and anxious over puzzling behaviours."
"Parents are faced with barriers from medical doctors and psychologists to explain these sometimes severe and unusual behaviours. “I have been told by my own physician that ‘there is nothing wrong with your daughter’, and you start believing it is all in your own head” (Walker, 2012).
Obtaining an ASD diagnosis for a female can be very challenging with scant research and available answers from professionals."
"Autism was first reported by Leo Kanner in 1943 and since that time there has been thousands of journal articles and wide-spread international attention. Yet, there is a paucity of scholarly research focused on females with ASD. Although there is some recent discussion regarding the exact ratio of males to females, the most widely reported male-to-female ratio for ASD is 4:1 (Halladay, 2014). Dr. Hans Asperger originally reported in his seminal research on a milder form of autism (1944) that:

In the autistic individual the male pattern is exaggerated to the extreme… It could be that autistic traits in the female only become evident after puberty. We just don’t know. (Frith, 1991, pg. 85)."

Dr Lori Ernsperger, PhD, BCBA-D, US expert on Autism Spectrum Disorder in girls and women.

Images by artist Rosanna Rosetti

Autism has long been considered to be an emotional dysfunction affecting boys, seldom girls. There were scientific studies attesting to the conclusion that boys overwhelmingly presented with autism as opposed to girls, at a four-to-one ratio. But now new research has developed to the point where a re-think of the assumption is required with the realization that it does not reflect reality. Girls too are assailed with Autism disorders, but their symptoms tend to be far more subtle and quite unalike those experienced by boys, hence the lag in understanding that the theory has little substance.

Autism represents a spectrum of characteristics that are as different in every individual, just as individuals are themselves unique in character development traits and personalities. It is a complex neurobiological condition. And diagnosis has been reliant on assessments of behaviours. No brain scans or blood tests can diagnose the presence of autism. And since boys have a tendency to exhibit obvious symptoms of atypical behaviour, they are easier to diagnose, leaving the impression that they monopolize the autism spectrum disorder.

Boys typically like being among others similar to themselves and boys tend to be noisy and active, curious and often given to stretching the boundaries of age-permissive, curiosity-driven activities. So when a boy withdraws from that type of typical interaction, preferring to be off on his own, fascinated with his own version of curiosity-driven, but solo action as opposed to group activities, alarm bells ring. Boys are simply easier to categorize in their actions.

When girls behave in a withdrawn manner, preferring to be on their own, reading, playing with their possessions, behaving in a  elf-contained manner in preference to joining other girls doing similar things together, it was typically viewed as ordinary behaviour for certain types of girls. Which is not to say that both boys and girls exhibiting extreme symptoms of disorder are not more readily identified and as such are both diagnosed in equal numbers.

It is girls who display less obvious mannerisms of unsociability and difficulty in responding normally who go undiagnosed and as such, untreated.

Girls on the less extreme of the spectrum of behaviours tend to be overlooked. While girls who exhibit similar behaviours to boys when both are at the extreme end of the spectrum, are diagnosed at rates equal to boys. Parents are often informed that despite their concern over their daughters' behaviours that appear out-of-the-ordinary, using the typical yardstick of expectations, their daughters cannot possibly be on the spectrum.

Instead, these girls who are obsessively neat, or withdrawn because they appear shy and their characterizing manners are to be quiet and focused on dolls or books, these behaviours are still considered to reflect normal behaviour for girls, as being typically female. Doctors instead tend to diagnose such girls with attention deficit hyperactive disorder (ADHD), or alternately obsessive compulsive disorder, because they have become so accustomed to recognizing male symptoms of autism.

So when these incorrect diagnoses occur, there is no move toward appropriate early childhood intervention whereas with a correct diagnosis what follows is a spectrum of social and educational support ranging from educational accommodation, to special social services reaching out to give aid. In response to the new reality, however, doctors are now designing different types of services appropriate to meet the needs of girls whose parents have been demanding recognition of their daughters' aid requirements to offset their autism.

New guidebooks informing how to react throughout puberty and helping girls to establish social relationships have resulted from new diagnostic tools identifying the presence of autism spectrum now being increasingly diagnosed in girls.

The general consensus is that females with ASD exhibit:

• Increased social imitation skills,
• A desire to interact directly with others,
• A tendency to be shy or passive,
• Better imagination,
• Better linguistic abilities developmentally, and
• Interests that focus on animals or people.

 (Lai, Lombardo, Auyeung, Chakrabarti, & Baron-Cohen, 2014).

Images by artist Rosanna Rosetti