 |
Published: Jan. 25, 2007 at 5:12 PM
By DAN OLMSTED
UPI Senior Editor
WASHINGTON, Jan. 25 (UPI) -- "You're going to hate my book," Roy Richard Grinker
told me a few weeks ago when I met him at George Washington University.
Actually, I don't hate "Unstrange Minds: Remapping the World of Autism," his
newly published, beautifully written look at autism through the lens of history
and culture.
I just disagree with it.
Grinker -- an anthropology professor and father of a teenage daughter, Isabel,
who has autism -- sees a genetic brain-based disorder that, contrary to
widespread belief, has not truly increased.
Rather, he says, it's just better-recognized. Plus, the categories have expanded
to include a "spectrum" of related disorders including the milder Asperger's.
"Maybe we are finally diagnosing and counting autism correctly," he writes.
Grinker, who mentions my reporting in the book, marshals an impressive body of
research to support his contention. Time magazine gave it a full-page review and
found his argument "persuasive." Regardless of one's point of view, it's good to
have the case against an "autism epidemic" spelled out as clearly and
convincingly as possible.
That said, I do suspect autism has exploded in ways that are not satisfactorily
explained by Grinker's argument -- and, therefore, that some new "environmental
insult" interacting with genetic susceptibility is behind the rise. My basis for
that is not solely the ten-fold increase in diagnoses in the past two decades;
it goes back much further.
Read the first words of the first scientific paper written about autism in 1943
by Leo Kanner, the Johns Hopkins University child psychiatrist who introduced
the disorder to the world:
"Since 1938, there have come to our attention a number of children whose
condition differs so markedly and uniquely from anything reported so far, that
each case merits -- and, I hope, will eventually receive -- a detailed
consideration of its fascinating peculiarities."
Years later, he called it "a behavior pattern not known to me or anyone else
theretofore."
Does that sound like something that's been around for ages at the same
prevalence? Not to me. What gives Kanner's comments heft is that he had just
written the first comprehensive tome on child psychiatry ever published in the
United States -- aptly titled "Child Psychiatry."
Of the 11 initial cases documented by Kanner, four of the fathers (accounting
for more than one-third of the cases) were psychiatrists. Grinker calls this
referral bias -- in other words, if you're a psychiatrist and you notice
something wrong with your own child, you're much likelier to avail yourself of
the services of an acknowledged leader in the field like Leo Kanner.
But, to my mind, that raises another question about the "no epidemic" argument.
Here's a thought experiment:
When the study came out in 1943, the oldest child was 11 or 12, born in 1931.
The study was published in a journal (The Nervous Child) aimed at psychiatrists.
Yet as far as I can tell from his many follow-up accounts, Kanner never heard
from a psychiatrist (or anyone else) with a child born before 1931 -- in other
words, with kids as young as 13 when the study appeared.
If four psychiatrists brought their children to Kanner before the disorder even
had a name, why was there dead silence afterward from psychiatrists with
autistic teenagers?
This rather humble experiment, along with taking Kanner at his word, suggests to
me that 1930 really was a bright line -- before-and-after the age of autism. If
my facts or reasoning are flawed, please let me know. Until then, I'll continue
to suspect that something new set off the disorder -- and, ultimately, an autism
epidemic.
Grinker makes one inadvertent error worth mentioning. Among Kanner's original
cases was a child called Richard M.; Grinker says Richard, "like many of the
others ... showed signs of normal cognitive development -- or at least this is
what the parents retrospectively argued -- until he was about two. Then, as his
mother wrote to Kanner, 'It seems that he has gone backward mentally gradually
for the last two years.'"
Grinker misreads Kanner. Richard regressed at about one year old, not two.
Picky? Well, consider this comment about Richard in the original study:
"Following smallpox vaccination at 12 months, he had an attack of diarrhea and
fever, from which he recovered in somewhat less than a week," Kanner wrote.
To me, that's a possible clue -- a vaccine reaction -- and it made me go over
the timing very carefully. If you've discounted that idea, it's easier to make a
math error and conclude that Richard, like "many of the others," proves the
point about regression at age 2.
As the epidemiologists say, "Assume nothing. Let the evidence speak for itself."
When Grinker visits the only school for autistic children in New Delhi, he finds
more evidence of referral bias: 10 of 10 fathers and four of 10 mothers were
college-educated, and half the men had advanced degrees. That confirms what he's
already concluded: "People of higher socioeconomic status tend to avail
themselves of medical interventions more often than people of lower
socioeconomic status."
"I interviewed only one child there who had received a diagnosis of Asperger's
Disorder, and -- big surprise -- his mother was a chemist with a Ph.D. from
Harvard ... "
Grinker's not surprised because advanced education fits his hypothesis. He
notices the Ph.D.; I notice it was in chemistry. In earlier columns I pointed to
a couple of overlooked, thoroughly mainstream autism studies from the 1970s that
found a "startling" chemical connection via parents' professions. And chemists
stood out -- that's not my bias, that's what the experts saw when they looked at
their data.
I've proposed that several of Kanner's first 11 highly educated fathers might
also suggest an unrecognized chemical connection: plant pathologist (Ph.D.),
forestry professor (Ph.D. and Richard's father), mining engineer (college
degree), chemist-lawyer (J.D.).
Even those first four psychiatrists -- M.D.'s all -- might signal not solely
referral bias but professionals who had availed themselves of new medical
interventions or medicines with "markedly and uniquely" tragic consequences.
That, too, could be a chemical connection.
So that's why I just disagree with "Unstrange Minds." As Grinker says of those
who believe there is an autism epidemic, "I sympathize with these opinions, but
I think they are wrong."
E-mail: dolmsted@upi.com
|
|