Definition of the Term and Background
In 2006, the CDC found that 1 in 110 children (90 in 10,000 eight-year-olds) had autism, up from 19 in every 10,000 six-year-olds in 1992 (Weintraub).
According to the American Psychological Association (APA), autism is a chronic, neurodevelopmental condition defined by difficulties in social interaction and communication (Publication Manual of the APA). It is also characterized by stereotyped or rigid behaviors. People with the condition often lack skills necessary for the “establishment and maintenance of a community”. The severity of autism is thought to occur on a spectrum therefore creating a range of so-called autism spectrum disorders (ASD). Individuals who are diagnosed with ASD have symptoms ranging from mild to severe. It is categorized by the American Psychiatric Association as a pervasive developmental disorder (PDD) since it has long-term effect on learning, language, mobility, and self-care. Regardless of intelligence level, cognitive skills are usually uneven in individuals with autism. Other features include hyperactivity, impulsiveness, short attention span, aggressiveness, and self-injurious behavior. In addition, individuals with autism usually have abnormalities of eating, sleeping, mood, and fear responses and have high thresholds for pain (Bagatell).
Although the exact cause of these disorders is unclear, it is thought to be the result of a disconnection within widespread brain circuits. Several regions of the brain showed significant abnormal connectivity between neurons among patients with autism spectrum disorder. Almost all these regions were related to social processing, and these regions showed common patterns of circuitry among these individuals. They included structures though to be crucial for emotional aspects of social processing, communication, and social processing of vision, touch, and muscle feeling. In addition to the presence of these patterns, the severity of the disease was also related to the amount of disconnection in these regions (Tallantyre).
While the trend in increasing cases of autism strengthened public fears that an epidemic was in the making, its prevalence has instead mostly been explained by a greater awareness for autism, wider diagnostic criteria for ASD, and diagnosis at younger ages. However, it is thought that there may be an environmental cause as well that contributed to the increase in autism diagnoses. It is thought that this environmental cause, combined with a genetic factor, contributes to the prevalence of the disorder. Many of the proposed environmental causes involve risk factors during pregnancy, such as infection and antidepressants (Weintraub).
Autism currently has no cure. However, it can be managed to ensure physical and psychological health. This primarily encompasses preventative medical care, which includes regular check-ups by a physician to monitor growth, vision, hearing, blood pressure, and immunizations. In addition, careful attention must be given to diet and nutritional needs as well as dental hygiene. In addition, early detection has allowed for treatment of many of the sleep, eating, and behavioral disorders that develop in individuals with ASD and which can cause additional physical issues. Another major part of treatment is the use of medication such as psychopharmacotherapeutic medications under the right criterion (Berkell Zager).
The Trend in Autism since 2000 (CDC)
History of Autism
Today, Autism is a clearly defined developmental disorder. However, its use began much earlier. The term was first introduced in the 20th century by Eugen Bleuler to describe children who had deficits in attention, perception and memory. Accounts of children with similar behavior along with a poor sense of imitation that interfered with establishing peer relationships had been documented for many generations. However, these earlier reports did little to clarify their origins, with tales of children raised by wolves. Instead, they were often confused with a decline into schizophrenia (Berkell Zager).
In 1943, Dr. Leo Kanner introduced the term early childhood autism. Through his study of eleven children, Kanner showed that the characteristics of autism were significantly different from schizophrenia. Although currents views of autism differ significantly from some of kanner’s early observations, many of the underlying point remain relevant. Kanner recognized social disorder as a primary sign of autism, portrayed through tendencies such as avoiding the gaze of others and a lack of recognition for the absence of a parent that are still recognized. He also showed that children with autism displayed their “extreme loneliness from the very beginning of life”, unlike those with schizophrenia who withdraw themselves from the world over time. He saw those with autism as living in “a world in which they have been total strangers from the beginning.” He pointed out insistence on ritual behavior, resistance to change, unusual language traits, and isolated play as other motifs commonly found among children with autism (Berkell Zager).
Despite creating the basis for autism used today, Kanner also drew some conclusions that are no longer supported by modern psychology. He perpetuated the idea of autistic children being latent geniuses, determining that they had “good cognitive potentialities”. This led to significant distress among parents of autistic children who viewed their inability to unlock this genius as a personal failure. The genius idea was unlike many other diagnosed childhood psychologic disorders of the time which used cognitive depression as a diagnostic criterion and has since been dismissed. In addition, Kanner concluded that children had no physical deformities or presentation. Recent research has instead concluded a higher incidence of other identifiable medical disorder such as epilepsy among children with autism.
Drawing on Kanner’s work, A behavioral approach to autism was developed in the 1960s, which aimed to use finding to teach children with autism a variety of skills. In addition, increased focus on the neurological basis of autism in the 1980s created a separate but related approach known as the Cognitive-Developmental approach. A combination of these approaches has drastically improved knowledge on autism, allowing for the degree of detail in diagnosing autism used today by psychologists (Berkell Zager).
Many physicians and parents of children afflicted with autism advocated for increased screening and special education programs throughout the 1980s and 1990s. In 1991, autism was officially recognized as a disability by the United States Government in the Individuals with Disabilities Education Act. This provided a major boost to the diagnosis and early treatment of autism, but also contributed to the autism epidemic of the 1990s (Baker).
Perspectives
Perhaps the biggest public controversy around autism is the debate over the role of vaccines in causing it. While scientific communities and global media have endlessly covered the topic since the concern was raised in the 1990s, the safety of vaccines and their role in causing autism remain a concern for many new and experienced parents alike. It is a controversy that isn’t only found in the United States, but instead varies from country to country. In addition, the controversy has been blamed for numerous outbreaks of preventable diseases in public areas around the United States (Baker).
In the United States, the majority of the vaccine and autism controversy involves the use of thimerosal, a mercury-based preservative, in vaccines. Thimerosal, which contains a form of mercury known as ethylmercury, was first introduced in World War I as a promising germicide. Early studies on thimerosal toxicity showed that animals could tolerate significant doses without any apparent injury. It came as a relief to a major problem afflicting child immunization in the early 1900s: bacterial contamination. Before the introduction of thimerosal, vaccines were drawn under unsanitary condition, leading to the contamination of entire batches of vaccines. The best example of this occurred in Columbia, South Carolina in 1916 when a contaminated batch of typhoid vaccine cause 68 severe reactions and 4 deaths. However, the introduction of thimerosal reduced concentrations by up to 10000 times, and by 1940 it was incorporated into a variety of common vaccines (Baker).
Its safety was first questioned during the 1970s, when many other pesticides and germicide were brought under investigation. Despite significant accumulations of thimerosal in the ecosystem, a formal review by the FDA in 1976 denied any legitimate concerns. In the mid-1990s, skin testing of thimerosal caused hypersensitivity in some people. The story eventually evolved to describing thimerosal as dangerous to infants, even at low doses. This was in part due to the extensively documented link between methylmercury and damage to the developing brain (Baker)
Efforts to improve autism awareness in the early 1990s led to a rise in autism diagnoses. However, the American medical system wasn’t equipped to handle the drastic increase in autism diagnoses. Many parents of newly diagnosed autistic children were confronted with long waiting times and inexperienced primary care doctors. Without access to proper resources, many parents turned to each other and the Internet, inspiring the development of an “alternative” community for autism research. British gastroenterologist Andrew Wakefield proposed a hypothesis in 1998 linking the increase in autism diagnoses with an environmental factor. He published a report correlating the development of autistic regression and receiving the measles-mumps-rubella (MMR) vaccine, creating a large controversy in Britain before spreading through the internet across the globe (Baker)
While many in Britain believed that the MMR vaccine was responsible for increased autism diagnoses, by the time the report had reached the United States, the concern instead shifted to the presence of thimerosal in vaccines. This was popularized by a group of parents of autistic children, which eventually led to a published study in Medical Hypotheses. In time, other groups of parents politicized the issue, creating the Safe Minds advocacy organization that shifted the focus of Congressman Burton to blaming thimerosal rather than the MMR vaccine (Baker).
Since then, many studies have been published discrediting a connection between thimerosal and autism. However, opponents of vaccines have cited previous examples of science being manipulated to promote social and political viewpoints. In addition, the introduction of personal injury lawyers has further served to legitimize the viewpoint of many vaccine opponents. Today, there is a large standing on both sides of the debate, and many parents of autistic children continue to support the thimerosal and autism connection (Baker).
An example of the political nature of the vaccine and autism debate (The Washington Post)
Relation to Politics of Health
Medicalization is the process by which human experiences are defined and treated as medical issues. Medicalization often involves the creation of a new diagnosis, but it can also involve the expansion of an existing diagnostic definition to include cases that were previously excluded. While many experiences that we associate with a diagnosis are universally accepted today, many other cases of medicalization have seen significant controversy. For example, homosexuality was once recognized by the American Psychological Association as a legitimate medical disorder (Conrad).
The release of the Diagnostic and Statistical Manual of Mental Disorders (DSM) Volume 5 in 2013 by the American Psychological Association saw the combination of multiple separate autism disorders into a single category of Autism Spectrum Disorder. This move was faced with significant criticism especially since it eliminated Asperger’s disorder, a widely applied diagnostic label. DSM-IV, the predecessor to DSM-5, described 2,2027 different symptom combinations, but DSM-5 narrowed this down to only 11 significantly different psychological conditions. Today, DSM-5 is notoriously broad in its definitions, and some interpretations have seen up to 1 in 11 children eligible under the definition for Autism Spectrum Disorder. In addition, many psychologists consider it to medicalize symptoms that lie within the normal range (Barker).
While the vagueness of the DSM-5 may seem inconsequential, with an increased medicalization of autism spectrum disorder comes an entire host of issues. Many parents with children on the autism spectrum disorder see the expansion of the scale as delegitimizing the severity of the condition. They emphasize the importance in differentiating between an abnormal child and a developmentally disabled child who may never get better on their own. In addition, many parents have used the diagnosis of autism spectrum disorder as a justification for their child’s behavioral issues, even if the symptoms weren’t correlated. Therefore, it not only absolves their child, but it also absolves the parents of responsibility for their actions. While not unique to autism, the over-medicalization of psychological disorders has posed a significant problem over the past few decades (Baker).
Works Cited
Bagatell, Nancy. “From Cure to Community: Transforming Notions of Autism.” Ethos, vol. 38, no. 1, 2010, pp. 33–55., doi:10.1111/j.1548-1352.2009.01080.x.
Baker, Jeffrey P. “Mercury, Vaccines, and Autism.” American Journal of Public Health, vol. 98, no. 2, 2008, pp. 244–253., doi:10.2105/ajph.2007.113159.
“Carson, Trump, Paul Debate Vaccines and Autism.” The Washington Post, www.washingtonpost.com/video/politics/carson-trump-paul-debate-vaccines-and-autism/2015/09/17/1f117b78-5d4c-11e5-8475-781cc9851652_video.html?utm_term=.3d78288ad8ec.
CDC. “Autism Spectrum Disorder (ASD).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 11 July 2016, www.cdc.gov/ncbddd/autism/data.html.
Conrad, Peter. “The Shifting Engines of Medicalization.” Journal of Health and Social Behavior, vol. 46, no. 1, 2005, pp. 3–14., doi:10.1177/002214650504600102.
Publication Manual of the American Psychological Association. American Psychological Assoc., 2017.
Tallantyre, E, and Neil P. Robertson. “Autism and Intellectual Disability.” Journal of Neurology, vol. 260, no. 3, 2013, pp. 936–939., doi:10.1007/s00415-013-6861-y.
Weintraub, Karen. “The Prevalence Puzzle: Autism Counts.” Nature, vol. 479, no. 7371, 2011, pp. 22–24., doi:10.1038/479022a.
Zager, Dianne Berkell. Autism: Identification, Education, and Treatment. Lawrence Erlbaum, 1999.
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