April 2, is World Autism Awareness Day and the whole month of April is Autism Awareness Month. In the past five or six years there has been this huge upswing in interest in autism and autism spectrum disorders like Asperger’s Syndrome. I’ve worked in the field of mental health for more decades that I’d care to mention, and over the years I’ve seen fads come and fads go–fads in treatment and fads in diagnosis. Back in the late-70s there was an absolute epidemic of agoraphobia (fear of public places). It was so pervasive amongst my clients that it seemed to be catching; every time I would go into the Altamonte Mall or a big Albertson’s grocery store I’d start to feel edgy. Then, a decade ago adult ADD was all the rage, and for a while about every third client I was seeing was telling me that they had ADD, or their spouse had told them they had ADD (attention deficit disorder). More recently, about every third client who shows up in my office says they were diagnosed Bipolar Disorder–some of these folks really are but many just have slightly greater than normal mood swings or are Cyclothymic. Sadly, adult ADD and bipolar are disorders largely promulgated and exploited by Big Pharma–the insidious pharmaceutical industry.
As defined today, autism is an incredibly broad and complex disorder with multiple causes. Its genotype is quite broad–many different chromosomal markers, but it’s phenotype (description) has been narrowed to deficits in communication and socialization. Right off-hand I can’t see any benefit in the pharmaceutical industry pushing its awareness. As best I can tell, most of the interest seems to be coming from the parents of autistic children and aggressively marketed awareness organizations. One statistic that no one seems to have a hold on, or a solid explanation for, is that autism seems to be increasing in recent years; currently, one child in 50 is diagnosed with an autism spectrum disorder–that is a significant revision from the old figure of 1/88.
One reasonable explanation for the increase is because of greater awareness. In other words autism is simply being recognized and more accurately diagnosed than in the past. All of us went to school with a few strange kids–poorly socialized kids who just didn’t seem to fit in, kids who marched to the beat of a different drum–fifty years ago they were labeled “weird” or in an earlier era “eccentric”–but today they are given a diagnosis of Asperger’s Syndrome. As I recall, Forrest Gump had an IQ of 75 and he referred to himself as “retarded”–but that’s not a PC term today and so today he’d likely be called “cognitively challenged” or perhaps even Asperger’s. In other words autism does not have the sting of certain other words–yet. Another explanation as to why autism is being diagnosed so frequently (now largely discredited), is that autism is burgeoning because of certain early childhood vaccinations like the MMP vaccine (measles, mumps & rubella). This notion was pushed on Oprah-like talk shows, and in the media by celebs and health cranks.
For the past four years I’ve gone to a symposium on autism sponsored jointly by the University of North Florida in Jacksonville, Nemours and Wolfson Children’s Hospital. It’s a top-drawer event. Every year they fly in at least two of the leading experts in the field to speak. This year’s presenter’s were Dr. Daniel Geschwind, from UCLA and Dr. John Constantino from Washington Univ. in St. Louis, and this year’s focus was genetics and neurological perspectives on autism. They spoke about their research, and I suspect that some of what they related was over the head of many in the audience. They are used to addressing doctors and doctoral students. Our audience was about 200 educators, parents, counselors and various healthcare providers. This year the focus was on diagnosis and causality, but other years it’s been more about treatment interventions.
In a nutshell, autism is characterized by: (1) significant deficits in verbal communication. (2) Failure to develop and maintain peer relationships and deficits in social skills or in the ability to engage others in social reciprocity–studies show that autistic kids can’t read facial expressions, etc. (3) stereotyped motor or behavior patterns and restricted, fixated interests–some are savants and brilliant in one area, and (4) the symptoms are apparent in early childhood.
My treatment team worked with three autistic kids back in the late-60s in my first job with the Illinois Dept of Mental Health. All were very seriously impaired. The saddest case was an adorable 8-year old girl who was completely uncommunicative. She spent all of her time lying on a bed playing with her private parts–today that would be a red-flag for abuse but at the time there was less awareness of child sexual abuse. One delightful young black kid was obsessed with movies and could tell you who won the Oscar’s each year. You could ask him what the best picture was in 1938. He’d get a far-off look in his eye and then tell you what picture won, who the director was and the stars, etc. The other boy had the classic pronoun reversals of severe autism. When he said “I” he meant you and when he said “you” he meant himself. If he said, “would you like a cookie?” That meant he wanted a cookie. Both he and the movie savant were very shy. They had been mainstreamed in school for a year or two and I suspect were victims of peer cruelty.
When I think about these kids I feel some sadness that we viewed them as behavior problems that needed to be fixed, instead of appreciating who they were as people and then loving them as best we could. At least the young movie-savant got a lot of positive strokes. He decided I was “Dirty Harry” and that was sort of a compliment being associated with Clint Eastwood. He would see me coming down the hall and say “Uh oh, it’s Dirty Harry” and then head the other way. I wonder how he’s doing today. I’d like to see him again–see if he still would recognize me as Dirty Harry, and I wish I could say that he turned out to be a famous movie critic–but probably not.