Autism Vox

No Single Explanation for Autism?

by Kristina Chew, PhD on November 22nd, 2006

The stated purpose of Lidia Wasowicz’s multi-part Ped Med series has been to “[keep] an eye on autism, [take] a backward glance at its history and surrounding controversies, [face] facts revealed by research and [look] forward to treatment enhancements and expansions.” Many of the articles have been more specifically focused on the topic of mercury and vaccines, and whether these might be connected to what causes autism. The Ped Med series has accordingly tended to refer to public health figures from the Centers for Disease Control and Prevention and also from the National Institute of Mental Health. Wasowicz has also often noted the crucial role that parent advocates have played in advancing and funding research on autism (especially in regard to a cure for autism) and in championing new and novel methods of educating and treating autistic children. Again, despite the Ped Med series’ stated focus on “surrounding controversies” and “treatment enhancements and expansions,” Wasowicz has tended to focus on the mercury/vaccine issue. The “parent advocates” cited have more than once been administrators from Cure Autism Now, such as the organization’s executive director, Peter Bell.

Wasowicz notes this focus in the first paragraph of her November 22nd article, Ped Med: Autism Picture still incomplete:

Right or wrong, the comparatively minuscule minority convinced mercury [sic] in medicines lies at the root of autism’s ascent has something the American healthcare behemoth does not: a cause.

In this rather heavily alliterative opening sentence (note the repetition of “c” and “m” as well as the repeated vowel sound of “autism’s ascent”), Wasowicz catches the determined fervor that is characteristic of the anti-vaccine advocates she cites (including Barbara Loe Fisher, president of the National Vaccine Information Center). By honing in on mercury/vaccines as the main or even sole cause of autism, advocates like Fisher and Bell of CAN are then able to postulate certain treatments or even “cures” for autism, as Bell says:

“We need to understand the biological basis of autism. We need to understand what it is we’re dealing with. We know what it is from a behavioral perspective, but we really don’t have a very good sense of what is happening at a molecular and cellular level…….

“Second, we need to find the children,” he continued. “We need to get the early identification models working. We need to identify biomarkers that can spot these kids as early as possible so that we can put them into interventions earlier on and get the best outcomes.”

Wasowicz has consistently noted the continued controversy that surrounds the theory that mercury and/or vaccines are the cause of autism—-are the one, the sole and single, cause of autism. And perhaps it is more than time to “give up on a single explanation for autism,” on finding a single cause for autism, as Francesca Happé, Angelica Ronald, and Robert Plomin argue in Nature Neuroscience (September 25, 2006, vol. 9, no. 10):

Research on ASD at the behavioral, cognitive and genetic levels has proceeded on the assumption that the three impairments that define autism must be explained together.

Happé et al. consider whether the behavioral features of autism are “integral or fractionable.” They note that

1. “autistic-like traits can be measured in the general population”;
2. there are “modest-to-low correlations between autistic-like behavioral traits in the three core areas” of social, communicative and rigid/repetititive traits;
3. within the researchers’ “large population-based sample, a considerable number of children showed isolated difficulties in only one area of the autistic triad”;
4. “studies of the development of children with autism suggest different developmental trajectories for different parts of the triad” of impairments in the three core areas.

Referring to the Twins Early Development Study, Happé et al. further suggest that this “behavioral or phenotypic separability of the triad of autistic-like traits” is “mirrored at the genetic level”–that separate genes contribute to social impairment, difficulties in communication, and rigid/repetitive behavior. And when the researchers turn to cognitive accounts of autism, they note that, while these have “traditionally aimed to explain all three key features of autism,” that the attempt to pinpoint a monolithic, “single cognitive account for the three core features of autism” is to be abandoned, and “good accounts” sought instead for each feature.

Abandoning the search for a single cause of autism has implications in:

• evaluating the “severity” of autism;
• seeking “genes ‘for autism’ as a whole”;
• understanding the “heterogeneity in ASD”—the extent to which autism is seen as a spectrum;
• acknowledging that an individual may have an “isolated” impairment” in one of the core features of autism while not meeting the “diagnostic criteria” for autism or any other condition, and still have “difficulties of comparable severity to those with autism”;
• acknowledging that there is no one “single ‘cure’ or intervention” for autism.

Wasowicz’s Ped Med article quotes Dr. Julie Geberding, Director of the CDC, as saying that “‘we don’t have a complete picture of the scope of the problem’” and Dr. Thomas Insel, Director of the NIMH, as admitting our current uncertainty even in defining autism: “‘Should it be around language? Should it be around neuropsychological function? Should it be around time of onset? There’s just a whole series of questions that we need to begin to define answers to much more precisely.’” Dr. Insel compares autism to polio, saying that our knowledge of and response to autism is comparable to where these were in regard to polio in the mid-1950s; he moves from referring to treatments like the iron lung to the development of a vaccine for polio.

But this seems too simple a comparison, to speak of autism spectrum disorders and all the varieties of being autistic—the “heterogeneity” of ASD—as so similar to the case of polio, for which specific treatments (the iron lung, a vaccine) exist. Not only is the “autism picture still incomplete”; so is our understanding of autism and of the neurological difference of autistic persons yet very limited. Perhaps what we understand as autism is but a two-dimensional image compared to the three- (or four-, or more-) dimensioned reality of what it is to be autistic—-and, in order to see all the dimensions of the autism spectrum, we need indeed to “give up on a single explanation for autism.”

And just as there is not one cause of autism, no one explanation for autism, so there is more than one kind of parent autism advocate, too.

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POSTED IN: Autism Organizations, Diagnosis, Environment, Genetics, Health, Medicine, Neuroscience, Psychology, Science, Treatment, Vaccines