On the etiology & proposed treatment of Autism

There are many hypotheses regarding the “cause” of autism, very much a 21st century phenomenon, at least in our categorization & recognition. Many of these are speculations based on temporal correlations with potential environmental exposures including agricultural & industrial pollutants, and vaccinations. The apparent parallel between the reported incidence of autism and many of these implicated potential “causes” cannot be clearly attributed to causation; recall that all those who confuse correlation with causation eventually die. The most honest assessment of these correlations is that the reported incidence of autism has been increasing over time, in parallel with many other time-dependent phenomena. One plausible explanation might be growing awareness of and expansion of the diagnosis of autism in parallel with unrelated developments in time. Individuals labeled as “autistic” today were merely regarded as “odd” or “socially awkward” in past years.

The reported incidence of autism correlates strongly with the rise of reality TV shows and the cost of house ownership; can we infer a causal relationship?

Families with autistic children are often in desperate search for answers, both to guide the search for potential treatments, and to resolve questions around assumed culpability for the condition of their child.

I know it sounds ludicrous, but I’ve had parents ask me if their child was born autistic because they had sex during the pregnancy, or because they waited too long to have a child due to career goals, or due to particular food choices during the pregnancy. Parents often cling to what they feel are plausible explanations such as glyphosate in their produce or 5G cellphone signal exposure or vaccination, all of which which can be demonstrated to correlate over time with the reported incidence of autism. Many purported “cures” are offered that assume cause, such as “vaccine detoxification” regimens.

One important issue that requires our attention is: should we regard autism as a disease? There are two issues here. One involves concerns from within the autistic community of being labeled as “diseased.” In the sense of statistical norms, autism is not “normal;” but does this mean it is “abnormal” in the sense of being a disease that needs to be “cured”? A growing movement urges us to “embrace neurodiversity;”

to recognize that the great variety of individuals labeled “autistic” may certainly be atypical of the population at large, but are not necessarily “abnormal” in the sense commonly ascribed to that term. The real problem might be our expectation that everyone “fits in” with the demands of normative society, much as much of “ADHD” has to do with our expectation that children might be “normally” adapted to spend most of their day in passive attention in the classroom. Our task might be to adapt as a society to the reality of “neurodiversity” rather than to attempt to “fix” those labeled as atypical. Without a particular autistic individual, we wouldn’t currently have a U.S. space program or self-driving electric cars (I’ll leave it to you to determine if those are Good Things, but they are what they are). My mentor in medical school was an autistic genius (not a recognized diagnosis in the day, he was merely regarded as “odd” while respected for his outstanding intellect); he was responsible for the problem-oriented record, the S.O.A.P. note, and the first electronic medical record system, P.R.O.M.I.S., with a set of skills and behaviors that set him apart as clearly atypical; but his struggles to be perceived as “human” resulted in his being one of the most warmly human physicians I’ve known.

Interlinked with this is the question of whether autism (as a single phenomenon or a collection of superficially related phenomena) represents dynamically-maintained disease amenable to treatment. We know that not all the “conditions” we’re presented with are; we cannot “cure” an amputation, as a distant example. If autism is a phenomenon not amenable to cure, it’s rather an act of violence to subject the autistic individual to our expectation that they might be “cured,” to become “normal”.

Therapies have arisen that rely on chelating agents to remove neurotoxic metals (Mercury, Aluminum) presumed to be causative of autism, which are highly questionable, as the potential role of these in causation is speculative and has not been established.