Controversies in autism

Diagnoses of autism have become more frequent since the 1980s, which has led to various controversies about both the cause of autism and the nature of the diagnoses themselves. Whether autism has mainly a genetic or developmental cause, and the degree of coincidence between autism and intellectual disability, are all matters of current scientific controversy as well as inquiry. There is also more sociopolitical debate as to whether autism should be considered a disability on its own.<ref>Template:Cite journal</ref>

Epidemiology

{{#invoke:Labelled list hatnote|labelledList|Main article|Main articles|Main page|Main pages}}

The current accepted prevalence of autism spectrum disorder (ASD) are around 1%,<ref>Template:Cite journal</ref> although previous research has shown far lower rates of incidence.<ref name="Newschaffer">Template:Cite journal</ref> ASD averages a 4.3:1 male-to-female ratio. The number of children diagnosed with the autism spectrum has increased dramatically since the 1980s, at least partly due to changes in diagnostic practice; it is unclear whether prevalence has actually increased;<ref name="Newschaffer" /> and as-yet-unidentified environmental risk factors cannot be ruled out.<ref name=Rutter>Template:Cite journal</ref> The risk of autism is associated with several prenatal factors, including advanced parental age and diabetes in the mother during pregnancy.<ref name=Gardener>Template:Cite journal</ref> ASD is associated with several genetic disorders<ref name=Zafeiriou>Template:Cite journal</ref> and epilepsy.<ref name=Levisohn>Template:Cite journal</ref>

Genetics

Template:Further The role of genetic influence on ASD has been heavily researched over the past few years. ASD is considered to have polygenic traits since there is not a single risk factor, but multiple ones.<ref name=":12">Template:Cite journal</ref>

Multiple twin and family studies have been conducted in order to observe any genetic influence in diagnosing ASD. The chance of both twins having ASD was significantly higher in identical twins than fraternal twins, concluding that ASD is heritable.<ref name=":02">Template:Cite journal</ref> A reoccurring finding is that de novo (new mutation) copy number variants (CNVs) are a primary cause of ASD – they alter synaptic functions; germ line mutations can produce de novo CNVs.<ref>Template:Cite journal</ref> These mutations can only be passed on to offspring; this explains the phenomenon that occurs when the child has symptoms of ASD, but the parents have no symptoms or history of ASD. De novo variants differ from person to person, i.e. one variant can cause ASD in one person, whereas another person would need multiple variants to cause the same disorder.<ref name=":02" /> Loss of function variants occur in 16-18% of ASD diagnoses, which is nearly double the normal population.<ref name=":12" /> These loss of function variants reduce function in the protein neurexin, which connects neurons at the synapse and is important for neurological development; deletion mutations of neurexin are also very common in people with autism, as well as other neurological disorders like schizophrenia, bipolar disorder, and ADHD.<ref>Template:Cite journal</ref>

There is also controversy over the Nature vs. Nurture debate. According to family studies, genetic and environmental factors have an equal influence on risk of ASD.<ref name=":02" />

Bacteria

Gut microbiome has a relation to ASD. Excessive Clostridia spp. was found in children with ASD and gastrointestinal difficulties; Clostridia spp produces propionic acid, which is impaired or in excess in people with ASD.<ref>Template:Cite journal</ref> Specifically, C. tetani and C. histolyticum are two species of this bacteria that affect people with ASD. C. tetani produces tetanus neurotoxin in the intestinal tract; C. histolyticum is a toxin producer that is abundant in people diagnosed with ASD.<ref name="pmid28503135">Template:Cite journal</ref> Both of these could contribute to neurological symptoms.

Vaccines

{{#invoke:Labelled list hatnote|labelledList|Main article|Main articles|Main page|Main pages}} A later-retracted article from The Lancet making false claims provoked concern about vaccines among parents. Its author was found to be on the payroll of litigants against vaccine manufacturers.<ref name="retraction">Template:Cite journal

• Template:Cite news</ref>

The idea of a link between vaccines and autism was extensively investigated and shown to be false.<ref name = vaccines>Template:Cite journal</ref> The scientific consensus is that there is no relationship, causal or otherwise, between vaccines and incidence of autism,<ref name="BH">Template:Cite journal</ref><ref>Template:Cite news</ref><ref name = vaccines/> and vaccine ingredients do not cause autism.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Nevertheless, the anti-vaccination movement continues to promote myths, conspiracy theories and misinformation linking the two.<ref>Template:Cite magazine</ref> A developing tactic appears to be the "promotion of irrelevant research [as] an active aggregation of several questionable or peripherally related research studies in an attempt to justify the science underlying a questionable claim."<ref>Template:Cite journal</ref>

Intelligence

The percentage of autistic individuals who also meet criteria for intellectual disability has been reported as anywhere from 25% to 70%, a wide variation illustrating the difficulty of assessing autistic intelligence.<ref>Template:Cite book</ref> For pervasive developmental disorder not otherwise specified (PDD-NOS), the association with intellectual disability is much weaker.<ref name="Chakrabarti">Template:Cite journal</ref> The diagnosis of Asperger syndrome excludes clinically significant delays in mental or cognitive skills.<ref>Template:Cite book</ref>

A 2007 study suggested that Raven's Progressive Matrices (RPM), a test of abstract reasoning, may be a better indicator of intelligence for autistic children than the more commonly used Wechsler Intelligence Scale for Children (WISC). Researchers suspected that the WISC relied too heavily on language to be an accurate measure of intelligence for autistic individuals. Their study revealed that the neurotypical children scored similarly on both tests, but the autistic children fared far better on the RPM than on the WISC. The RPM measures abstract, general and fluid reasoning, an ability autistic individuals have been presumed to lack.<ref>Template:Cite journal

• Template:Cite press release</ref> A 2008 study found a similar effect, but to a much lesser degree and only for individuals with IQs less than 85 on the Wechsler scales.<ref>Template:Cite journal</ref>

Facilitated communication

Template:Further Facilitated communication (FC) is a scientifically discredited technique<ref name="Autism Wars">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> that attempts to facilitate communication by people with severe educational and communication disabilities. The facilitator holds or gently touches the disabled person's arm or hand during this process and attempts to help them move to type on a special keyboard. It was used by many hopeful parents of individuals with autism when it was first introduced during the early 1990s by Douglas Biklen, a professor at Syracuse University.<ref name=":1">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

There is widespread agreement within the scientific community and multiple disability advocacy organizations that FC is not a valid technique for authentically augmenting the communication skills of those with autism spectrum disorder.<ref name="Review 2018">Template:Cite journal</ref> Instead, research indicates that the facilitator is the source of the messages obtained through FC (involving ideomotor effect guidance of the arm of the patient by the facilitator).<ref name="Why debunked autism treatment fads persist">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="Ganz/Katsiyannis/Morin">Template:Cite journal</ref> Thus, studies have consistently found that patients are unable to provide the correct response to even simple questions when the facilitator does not know the answers to the questions (e.g., showing the patient but not the facilitator an object).<ref name="An experimental analysis of facilitated communication">Template:Cite journal</ref> In addition, numerous cases have been reported by investigators in which disabled persons were assumed by facilitators to be typing a coherent message while the patient's eyes were closed or while they were looking away from or showing no particular interest in the letter board.<ref name="Making contact with a helping hand">Template:Cite news</ref> Despite the evidence opposing FC, many continue to use and promote this technique.<ref name="Review 2018" />

Note that facilitated communication is separate and different from a range of scientifically supported augmentative and alternative communication (AAC) devices and processes that facilitate communication for people with communication difficulties.

Advocacy initiatives

Template:Discrimination sidebarTemplate:Outdated There are two major conceptualizations of autism within autism advocacy. Those who favour the pathology paradigm, which aligns with the medical model of disability, see autism as a disorder to be treated or cured. Those who favor the pathology paradigm argue that atypical behaviors of autistic individuals are detrimental and should therefore be reduced or eliminated through behavior modification therapies. Their advocacy efforts focus primarily on medical research to identify genetic and environmental risk factors in autism. Those who favour the neurodiversity paradigm, which aligns with the social model of disability, see autism as a naturally-occurring variation in the brain. Neurodiversity advocates argue that efforts to eliminate autism should not be compared, for example, to curing cancer, but instead to the antiquated notion of curing left-handedness. Their advocacy efforts focus primarily on acceptance, accommodation, and support for autistic people as "neuro-minorities" in society.<ref name="Bloomsbury">Template:Cite book</ref> These two paradigms are not fully exclusive, and many people hold a combination of these viewpoints.Template:Citation needed

Pathology paradigm

The pathology paradigm is the traditional view of autism through a biomedical lens, in which it is seen as a disorder characterized by various impairments, mainly in communication and social interaction.<ref>Template:Cite journal</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Those taking this perspective believe that autism is generally a harmful dysfunction.<ref name="Bloomsbury" /> Ways of functioning which diverge from a typical brain are perceived as harmful and disordered and must therefore be treated or cured.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The atypical behaviors of autistic individuals are considered a detriment to social and professional success and should therefore be reduced or eliminated through therapy.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Advocates with this view include both a small but significant minority of autistic adults and large majority of parents of autistic children, but contain a higher percentage of parents when compared to those adopting the neurodiversity paradigm.<ref name="Solomon">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>Template:Citation needed These advocates believe that medical research is necessary to address the rapid rise in autism diagnoses (sometimes referred to as the "autism epidemic"),<ref name="Solomon" /> reduce suffering, and provide the best outcomes for autistic individuals. In addition to etiological research, other areas of focus may include biology, diagnosis, and treatment, including medication, behavioural and psychological interventions, and the treatment of co-existing medical conditions.<ref name="Dawson">Template:Cite journal</ref>

Advocacy groups that focus primarily on medical research include Autism Speaks, the Autism Science Foundation, and its predecessor organizations, the Autism Coalition for Research and Education, the National Alliance for Autism Research, and Cure Autism Now, and the former Autism Research Institute.

Neurodiversity paradigm

The neurodiversity paradigm is a view of autism as a different way of being rather than as a disease or disorder that must be cured.<ref name="Solomon" /><ref name="Different">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Autistic people are considered to have neurocognitive differences<ref name="Bloomsbury" /> which give them distinct strengths and weaknesses, and are capable of succeeding when appropriately accommodated and supported.<ref name="Solomon" /><ref name="Different" /> The belief is that efforts to eliminate autism should not be compared, for example, to curing cancer but instead to the antiquated notion of curing left-handedness.<ref>Template:Cite news</ref>

There is no leader of the neurodiversity movement and little academic research has been conducted on it as a social phenomenon.<ref name="Bloomsbury" /> As such, proponents of the neurodiversity paradigm have heterogenous beliefs,<ref name="Bloomsbury" /> but are consistent in the view that autism cannot be separated from an autistic person.<ref name="Solomon" /> Advocacy efforts may include accommodations in schools and work environments,<ref name="Future">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> lobbying for the inclusion of autistic people when making decisions that affect them,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> and opposition to therapies that aim to make children "indistinguishable from their peers".<ref name="Solomon" />

Neurodiversity advocates are opposed to medical research for a cure, believing that it will lead to eugenics, and instead support research that helps autistic people thrive as they are.<ref name="Solomon" /> For example, NeuroTribes author Steve Silberman noted a lack of research in regards to seizure-controlling drugs and autistic brains; that sensory differences in autistic people were unheard of until Temple Grandin spoke about her experiences; and that only a small percentage of research funding goes towards the needs of autistic adults.<ref name="Different" /><ref name="Future" /><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Advocacy groups that focus primarily on acceptance and accommodation include Autism Network International, Autism National Committee, Autistic Self Advocacy Network, and Autistic Women & Nonbinary Network.

Further reading

• Decoteau, C. L., & Daniel, M. (2020). Scientific Hegemony and the Field of Autism. American Sociological Review.

See also

• Neurodiversity
• Employment of autistic people