A Review of Discover’s Autism: it’s not just in the head
“Autism: it’s not just in the head” contain reference to real science and some careful and respectable theoretical statements. It also includes errors of fact, a lack of a skeptical perspective, and defense of credulity.
In the April 2007 edition of “Discover”, Jill Neimark presents a thesis that autoimmune and gastrointestinal issues cause the differences in the brain in children with autism. Anecdotes and interviews from doctors and parents who theorize such a connection are given in support of this view.
Review of Graphics
The author offers picture of a distended stomach of a child with autism, and claims that such are comment with children with autism. A claim not supported by well designed research.
The author offers a graphic of Texas comparing the counties with the highest toxicity and the rates of autism. Seemingly these are special education data, of assignment to the autism service category and not recordings of actual cases.
The author offers us two samples of handwriting of a home-schooled autistic child taken a month apart, before and after a child started treatment with antifungal medication. However, the author does not offer us multiple samples let alone a month’s worth of samples. We have no idea of the conditions at the time of these writing, whether the child was hurrying to get the former done in time for a favorite show or activity. These factors would be good to know.
Review of Article
In the article begins with a quote from a mother of two autistic children. I relates to her suicidal thoughts upon learning that her second child also met criteria for autism. The anecdotes of suicidal thoughts of mothers of autistic children has recently been popular making several appearances in documentaries or written work where the mothers advocated a vaccine etiology of autism or a specific treatment modality.
The author writes “and a 2003 report by the Center for Disease Control suggests that as many as one in every 166 children is now on the autism spectrum, while another one in six suffers from a neurodevelopmental delay.”
However the 1 in 6 statistic includes autism as well as other disorder. Furthermore, these disorders include thing like Attention Deficit Hyperactivity Disorder, which are not delays, but disorders or differences. Moreover, 1 in 6, corresponds to 16%. This is the percentage, equal to or below one standard deviation from the mean in a normalized curve. In terms of a given measure such as adaptive behavior or academic achievement, I should (based on the statistics) expect that 1 in 6 children to be at least 1 standard deviation below the average. The confusion here is similar to the confusion that leads to shocked outcries, when it is revealed that ½ of the population perform below average on an IQ test.
Further, it is worth mentioning that many of the advocates of alternative treatments in autism or the vaccine etiology of autism are inconsistent as to whom this 1 in 6 applies to. It can range from describing brain disorders to asthma and food allergies depending on the source.
Another doctor, Martha Herbert states “In spite of so many years of assumptions that a brain disorder like this is not treatable, we’re helping kids get better. So, it can’t just be genetic, prenatal, hardwired, and hopeless”.
It should be asked here for what studies show that any biomedical treatment improves the quality of life for children meeting criteria for autism. At the moment there are no studies that indicate this, perhaps in the future this will change, but it seems that Dr. Herbert’s statement has moved ahead of the data.
In addition, more than one disorder that is genetic and pre-natal offer problems or complications that can be treated, outgrown, or overcome via medical treatment or education. The examples are too numerous to name. What is more, no one who has an even rudimentary familiarity with autism research in the last 20 years would call autism “hopeless”. This is a caricature or straw man fallacy, of those who advocate a theory of idiopathic or genetic etiology of autism.
Dr. Herbert goes on to state “On very striking piece of evidence that many of us have noticed is that when autistic children go in for certain diagnostic tests and are told ot to eat or drink anything ahead of time parents often report that their child’s symptoms improve – until they start eating again after the procedure.”
This statement is reminiscent of one by Dr. Krigsman, who advocates a biomedical treatment approach to autism and a gastrological etiology theory. The endoscopies he performs requires only clear liquid be drunk for a period before hand, so as to offer better vision during the procedure. He mentions that on such a clear liquid diet, the parents claim the child’s behavior improves. Such a diet is devoid of gluten or casein and is somewhat similar the gluten free and casein free diet that Dr. Krigsman advocates. It is notable that this diet did not show improvement in the only controlled study of the subject thus far (Elder et al. 2006). Moreover the majority of parents in the previous study couldn’t tell if their child was on the control diet or the GF/CF diet. Perhaps there are parallels to Hoover & Millch (1994) who found that after giving children artificial sweetener and telling parents it was sugar, the parents rated the children’s behavior significantly worse than controls.
The author mentions an emotional reaction reading the original 11 case studies by Dr. Kanner, the first person to organize autism under a given name. The author finds evidence of autoimmune and gastrointestinal problems within the original case studies. However, this is unfortunate as not every child in those case studies had either sort of problem. This seems like an example of shoe-horning or confirmation bias.
Furthermore, the correlation that struck many more professionals at that time was that many of the children had highly educated parents. This helped give birth to the cold-mother etiology of autism theory, which was propped up, for at least a generation by the lack of organized and consistent biological findings.
At another point Dr. Herbert say’s “I can’t think of it as coincidence anymore that so many autistic kids have a history of food or airborne allergies”. However, these findings are demonstrated within the research. Many typically developing children have a history of environmental allergies as well. Dr. Herbert needs to demonstrate that these occur more frequently in children meeting criteria for autism for this point to stand.
The author states that a ‘Copernican-scale” shift in under way in the world in autism. The author then goes on to site improvement of several children via chelation. The author may indeed by right. However, one may hope that if so, this theory like the theory of a heliocentric universe, will be propped up by excellent proof rather then the anecdotal proofs any faith healer of witch doctor could likewise provide.
The author later cites Dr. Jill James work tracking 8 nchidlren who were treated with folinic acid, trimethylglycine, and methyl-B12. Dr. James found that an increase in markers for methylation and glutathione production within the children. Which is good news, because the researchers theorize that autistic behavior may be related to oxidative stress which might be eliminated by treatment with the above named factor. Unfortunately one of those treatments has been assessed and found to not produce statistically significant results (Deprey et al., 2006). Perhaps these factor in combination will produce notable effect. We will have to see.
A particularly disturbing statement by the author summarizing a statement by Dr. Herbert is: “In other words treat now before the gavel of science strikes a final judgment which might be decades away”. And then the author gives examples of parents ding just that. It seems that the author has assumed what the science will eventually say. This looks like faith based reasoning, not actual logic or science. But, even if the author actually means that at the moment we don’t know what the science will say, but certain treatments anecdotally looks promising so they should be tried, is still poor logic. Some of these treatment are expensive and or dangerous. And even the lowest risk treatment that costs very little money such as the GF/CF diet still takes time and effort on the part of child, the parents, and sometimes that other siblings and grandparents. And diet based intervention are by definition restrictive and can be alienating.
Also, the author points out a anecdote from a mother who’s child broke out in welts after the child was no longer provided with milk. The mother states that is seems that the child was going through a detoxification reaction. The mother seems to have persevered and stuck to the restriction whereas other mothers might have stopped withholding milk or looked for allergens in whatever alternatives where being provided, such as soy milk. This reaction seems similar to what is called a “healing crisis” or “Herxheimer reaction” in alternative medical circles.
Late in the article the author refers to Dr. Yasko’s work concerning polyphorisms and methylation. The author states that Dr. Yasko “seems immune to controversy”, which is a very interesting statement to a skeptic. The author quotes Dr. Yasko (on her decision to focus on treatment rather the scientific publication) as saying “I was on those cliffs you see in the movies and you’re going to jump. You don’t know if there is water below, or enough momentum to get to the other side, but you just jump.” One rather hopes there is enough momentum or at least deep water and that no child will be hurt by Dr. Yasko’s decision to jump off the cliff.
The final statement of the article says “If we can crack the puzzle of autism and be clear about how we did it, that may have huge implications for other chronic environmentally triggered systematic illness. Autism may be a much-needed wake-up call to us all”.
It seems that the author will end as several others have done, will a canary in the coal mine simile.
This article does offer some service in that it explains certain basic research and provides quotes from certain players in the field. Howver, there are factual problems, a reliance on anecdote, and lack of a skeptical voice. Autism may not just be in the head, but if certain treatments are to be used, then research offered must show that "effective biomed treatments" are not just in the advocates' heads.
Hoover, D. W., Milich, R. (1994). Effects of sugar ingestion expectancies on mother-child interactions. Journal of Abnormal Psychology. 22(4), 501-15.
Elder, J, H., Shankar, M, Shuster, J., Theriaque, D., Burns, S., Lindsay Sherrill. (2006). The Gluten-Free, Casein-Free Diet In Autism: Results of A Preliminary Double Blind Clinical Trial. Journal of Autism and Developmental Disorders. 36(3), 413-420.
Deprey LJ, et al "Double-Blind, Placebo-Controlled, Cross-Over Trial of Subcutaneous Methylcobalamin in Autism: Preliminary Results" AACAP 2006; 33:F47.