Autism

What is it? Why now?

Autism has been in the news a lot lately, and the news is scary. Who do we

believe? Who are the experts? What’s in the water?

The American Psychiatric Association defines autism as a disorder of human

relatedness. It is a persistent impairment in reciprocal social interactions

and communication, sometimes accompanied by motoric stereotypies or

idiosyncratic interests. These impairments must be present since early childhood and demonstrate impairment in all domains of life: home, school, and in the community.

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The word autism was first used by Dr. Leo Kanner of Johns Hopkins University

in 1943; he described “an innate inability to form the usual, biologically

provided contact with people.” He observed profound deficits in social

interaction, abnormal communication, and repetitive behaviors or an

insistence on sameness, which may look like obsessional rigidity. Using this

initial definition, neurological and psychiatric researchers have agreed on the

following definition as stated in the Diagnostic and Statistical Manual of

Mental Disorders, 5th Ed.:

1. Persistent deficits in social communication and social interaction

across multiple contexts as manifested by deficits in socio-emotional

reciprocity, nonverbal communication, and in developing, maintaining,

and understanding relationships.

2. Restricted, repetitive patterns of behavior, interests or activities. This

may manifest as idiosyncratic language or bizarre activities, echolalia,

obsessional insistence on sameness, or hyperesthesia to textures or

foods.

3. Though deficits in language or cognitive ability are used to specify

subtypes of autism, unlike in Dr. Kanner’s original definition, they are no

longer required to make the diagnosis.

4. The diagnosis also requires specification of the level of impairment.

This newest of definitions has increased the size of the diagnostic net, and so

this accounts to a large degree in the recent increase in the diagnosis of

autism from 5.5 per 100,000 in 1980 to the current 3400 to 3800 per 100000

(3.4% to 3.8%) of children and adolescents in 2025 per epidemiologic data.

Additionally, context and comorbidities matter. Many of the symptoms

attributed to autism may be seen with other disorders such as anxieties,

selective mutism, OCD, social pragmatic communication disorder, and

intellectual disabilities.

There is some degree of selection bias during educational testing, as a

diagnosis of autism is likely to justify more intense educational services.

There have also been influencers and celebrities on social media who have

assumed the diagnosis of autism as a badge of courage, though many times it

is more likely to be a personality disorder. Personality disorders such as

schizoid or avoidant personality disorders are mistaken for autism. Dr.

Kanner’s autism looks more Raymond Babbitt in the 1988 movie Rain Man or

Temple Grandin, PhD, the zoologist who was beautifully described by

neurologist Dr. Oliver Sacks as “an anthropologist on Mars.” She describes

learning about human relationships as if studying an unknown animal

species.

Unfortunately, there are no blood tests or brain scans which can clinch a

diagnosis of autism. If using strict diagnostic criteria, there are increasing

numbers of socially impaired people who seek treatment and services, so it

begs the question as to what is causing so many people to have autism.

Current theories include advanced parental age, maternal obesity,

gestational diabetes, maternal infection, exposure to certain medications

during pregnancy, air pollution, preterm birth, and delivery complications,

basically that can cause neurological insult to a developing brain. We should

certainly be mindful of what goes into our food and limit toxic environmental

exposures. .....And by the way, contrary to RFK Jr’s assertion about Tylenol,

there is no slam dunk evidence; the assertion is unnecessarily alarmist.

JAMA: April 9, 2024

2024;331;(14):1205-1214. doi:10.1001/jama.2024.3172

On a note of hope and resilience, former Fox News foreign correspondent

from 2010 to 2021 Leland Vittert has just released his autobiography on how

he overcame autism to become a journalist, “Born Lucky: A Dedicated Father,

a Grateful Son, and My Journey with Autism”.