AUTISM (ASD) IS NOT A SINGLE SYNDROME
There is much controversy over, and millions if not billions of dollars are being spent on an attempt to find a cause for autism or as it is now called: Autism Spectrum Disorder (ASD).
Researchers are desperate to understand the aetiology of the condition so that that an appropriate ‘cure’ can be developed.
However ASD is not an easily definable condition but rather a set of behaviours, which are gathered together under an umbrella. Even then there remains controversy as to what properly fits under the umbrella. The last official definition under the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM 5), has Social Communication
Disorder (SCD) as a separate category removing perhaps 20% of children who suffer from this disorder, which was previously included under autism in DSM 4. This can leave them without access to services available under a diagnosis of ASD but not available under a diagnosis of SCD. But DSM 5 then goes on to include a measurement of SCD to establish the severity level
of a person diagnosed with ASD. So if we cannot agree even to such an apparently simple question as to who has ASD and the role of SCD in the diagnosis it is unlikely that we will find a single cause or even to establish a simple diagnostic test.
Even if a cause of autism could be found it would require a very early screening mechanism and an effective early therapy to exclude the development of the challenging behaviours, and social isolation which are dominant features of ASD. Although there is important ongoing research into both areas no early diagnostic test and no early treatment protocol has yet been proven.
Research continues in the following non exhaustive list of possible causes: genetics; mirror neuron disorder; absence of a Theory of Mind or Theory of Own Mind; an insufficient decay of neurons causing a neuronal surplus in the infant brain; sensory overload; movement disorder
in utero; encephalitis in utero; birth trauma leading to lack of brain oxygenation; gastro-intestinal disease; vaccination; maternal prenatal medication; environmental problems – including air pollution and food additives; food engineering; high maternal age at conception; high paternal age at conception; and many more . There is evidence for all of these causes and others not listed here or not yet imagined but the multiplicity of possible reasons for autism would lead one to believe that there is no one cause for the condition.
It is a well known saying that: “if you have seen one child with autism you have seen one child with autism”; that all children with autism are different from each other. Which brings me back to my earlier statement that autism is not a condition or syndrome but rather a set of behaviours. What, you may legitimately ask, is the cause of this set of behaviours.
Children with cognitive difficulties or delays will be placed by their caring adults or by their peers under pressure to perform or act in the same way as their neuro-typical peer group. In response they frequently adopt avoidance behaviours including having a tantrum, stiffening the body, averting the gaze, running away to a safe place and over or under social behaviour.
Or they may adopt self-delighting behaviours such as rocking, spinning, hand flapping, and other ‘stimming’ activities, which provide the child with the greatest feedback for the least amount of effort.
These avoidance or repetitive behaviours are not the primary impediment, which may be a reflection of one or more of the aetiologies outlined above; but are secondary impediments – behaviours adopted to avoid or escape external pressures. The child adopts them as a diversionary mechanism or to provide simple and undemanding pleasures in a surrounding world, which is hard to comprehend.
So Autism or ASD is not a simple to understand single syndrome. Rather autistic behaviour is a reaction to an underlying condition, and comes in many forms or severities. In DSM5 the child without speech and with severe cognitive delay is bundled together with the high performing young adult who cannot find his or her independent route through life.
In my next post I will turn to the mechanism of the adoption of autistic behaviours and later, how these behaviours can be slowly ameliorated.