Autism, Intellectual Disability & Environment: Children of Immigrants in Sweden At Greater Risk of Developing Autism with Intellectual Disability


Swedish Flag by Matti Mattila 

A major Swedish study offers uncomfortable news to the DSM-5 team trying to pretend there is no relationship between autism and the intellectual disability which affects the vast majority of those with classic Autistic Disorder. It will also be disconcerting  to those who devoutly believe that autism is 100% genetic. The study finds that children born of immigrants to Sweden had an increased risk of developing autism with intellectual disability. The study authors also conclude that autism is governed by environmental as well as genetic factors:

A major register study from the Swedish medical university Karolinska Institutet shows that children born to certain groups of immigrants in Sweden had an increased risk of developing autism with intellectual disability. The study includes all children in Stockholm County from 2001 to 2007, and brings the question of the heredity of autism to the fore.

"This is an intriguing discovery, in which we can see strong links between a certain kind of autism and the time of the mother's immigration to Sweden," says principal investigator Cecilia Magnusson, Associate Professor of epidemiology at Karolinska Institutet. "The study is important, as it shows that autism isn't governed only by genetic causes but by environmental factors too."

The study, which is published in the scientific periodical The British Journal of Psychiatry shows that children of immigrant parents, particularly from countries of low human development, are disproportionately likely to develop autism with intellectual disability, a connection that appears to be related to the timing of migration rather than complications in childbirth. Children, whose mothers migrated just before or during pregnancy, ran the highest risk of all.

"At this juncture we can but speculate about the causes, but our assumption is that environmental factors impacting on the developing fetus, such as stress, new dietary habits or infections, could lead to the development of autism with intellectual disability," says Dr Magnusson.

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A Real Hero: Australian Cameraman Glenn Edwards Dives Into Creek and Saves Autistic Boy


Autism news is seldom this good.  Australian Nine Network cameraman Glenn Edwards dived into a swollen creek and saved an autistic boy, missing for 16 hours, from a swollen Creek. The story at CabooltureNews  quotes Mr. Edwards extensively and is very uplifting.

Well done Mr. Edwards.  Very well done!

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Lisa Jo Rudy Does A Bettelheim, Demeans ABA Parents While Pushing Her New Autism Book


Lisa Jo Rudy and I seldom, if ever, agreed on autism issues while she was the host of the About Autism web page. Lisa Jo has a high functioning autistic son and leans towards a Neurodiversity perspective on most autistm issues while my son is severely autistic and I have NEVER been accused of buying into Neurodiversity ideology. I did, at one time,  actually praise Lisa Jo Rudy though for her courteous approach to me and others with whom she disagreed on autism issues:
"About.com Autism by Lisa Jo Rudy is a corporate blog written by a parent who shares a neurodiversity perspective but tries honestly to present all sides of autism issues objectively and with impeccable courtesy."

Now that Lisa is no longer the host of the About.com Autism page though she appears to be taking a new approach to discussing autism issues. She has done a  Full Bettleheim in order to promote her new book "Get Out, Explore, and Have Fun: How Families of Children With Autism or Asperger Syndrome Can Get the Most Out of Community Activities."

In promoting her new autism book Lisa Jo demeans parents who employ evidence based ABA therapy to help their autistic children by actually stating that their resort to ABA therapy for their children is more about dumping their kids with the therapists and freeing themselves up to go shopping than in helping their autistic children. In a Wicked Local Cape Cod article linked by Autism Speaks "In the News" section the following segment appears:

“Rudy said although the most common form of autism therapy is Applied Behavior Analysis (ABA) she opted for another method.“The ABA recommendation is for 40 hours a week and it’s more about handing your child over to a therapist while you go to the grocery store,” she said. 

Rudy discovered the Greenspan Floortime Approach, developed by the late Stanley Greenspan, which focuses on parent and child interaction.”

Bettleheim's refrigerator mom's theory essentially blamed lack of parent child interaction for causing children to become autistic.  The theory was in fact a fantasy with no evidence in support but it was widely accepted by the psychiatric/psychological professionals for many years and caused great harm to both autistic children and their parents.  Although Bettleheim's fantasies have long been discredited it appears Lisa Jo is still reading his books when she suggests that parents seek ABA therapy not because it is the most evidence based effective intervention for autism but because, according to Lisa, it frees the parents up to go shopping.  Lisa of course prefers the 
Greenspan Floortime Approach because, according to her, it focuses on parent child interaction.

How Lisa Jo knows anything about ABA as someone who didn't "opt for" ABA for her child has always puzzled me.  What is most interesting though, apart from her new willingness to demean ABA oriented autism parents while promoting her book is her failure to mention the different evidence bases for the effectiveness of the two approaches as autism interventions.

Many credible authorities have recommended ABA as the most evidence based effective intervention for autistic children including the office of the US Surgeon General and the Association for Science in Autism Treatment.  The American Pediatric Association issued the following statements about ABA and Floortime therapies in December 2007 noting the abundant evidence over several decades in support of ABA as an autism intervention and the scarcity of quality evidence in support of Floortime and similar relationship/developmental models:

ABA

Applied behavior analysis (ABA) is the process of applying interventions that are based on the principles of learning derived from experimental psychology research to systematically change behavior and to demonstrate that the interventions used are responsible for the observable improvement in behavior. ABA methods are used to increase and maintain desirable adaptive behaviors, reduce interfering maladaptive behaviors or narrow the conditions under which they occur, teach new skills, and generalize behaviors to new environments or situations.

The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–4

Floortime

"Relationship-focused early intervention models include Greenspan and Wieder's developmental, individual-difference, relationship-based (DIR) model,55 Gutstein and Sheely's relationship-development intervention (RDI),56 and the responsive-teaching (RT) curriculum developed by Mahoney et al.57,58 The DIR approach focuses on (1) “floor-time” play sessions and other strategies that are purported to enhance relationships and emotional and social interactions to facilitate emotional and cognitive growth and development and (2) therapies to remediate “biologically based processing capacities,” such as auditory processing and language, motor planning and sequencing, sensory modulation, and visual-spatial processing. Published evidence of the efficacy of the DIR model is limited to an unblinded review of case records (with significant methodologic flaws, including inadequate documentation of the intervention, comparison to a suboptimal control group, and lack of documentation of treatment integrity and how outcomes were assessed by informal procedures55) and a descriptive follow-up study of a small subset (8%) of the original group of patients.59"

American Academy of Pediatrics, Management of Children with Autism Spectrum Disorders, Published online October, 29, 2007, Reaffirmed by the APA, September 2010.  

Lisa Jo Rudy has chosen to depart from a previously courteous, objective approach to discussing autism issues, unfortunately for autistic children whose parents abandon ABA efforts based on Ms Rudy's personal prejudices.  Most parents demeaned by such comments will not take them too seriously because the Bettelheim cold mother's fantasy has been widely exposed as nonsense (outside of France anyway).  The autistic children  of parents who look to Ms. Rudy for guidance though may not be as fortunate.

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Volkmar Says Many Intellectually Disabled May Be Excluded from DSM-5 Autism Spectrum Disorder Diagnosis


When I first pointed out that the DSM-5 New Autism Disorder would exclude intellectually disabled I was ignored by most, insulted and mocked by others.  Some were annoyed. When Catherine Lord confessed that the intellectually disabled were the real target for exclusion very few mentioned the exclusion of the intellectually disabled from the DSM-5 autism definition.  Certainly not the New York Times and other prominent Mainstream Media institutions that have wrung their hands over the possible exclusion of the very high functioning Autism ruling class.  

When Fred Volkmar, who kick started the current uproar over the possible exclusion of some with high functioning autism and Aspergers, mentioned in a Yale Daily News interview the possible DSM-5 exclusion of many of the intellectually disabled it did not merit any response from the MSM:

"In its next manual on mental disorders, the American Psychiatric Association plans to issue a single set of diagnostic criteria that will merge the four types of disorders on the autism spectrum, which include autism and Asperger syndrome. Although no current patient will be affected by the new rules, research by Yale Child Study Center Director Fred Volkmar suggests that the revision may disqualify a large number of intellectually disabled patients from receiving a diagnosis of autism spectrum disorder in the future."  [Underlining added for emphasis - HLD]

The autism spectrum is not just a spectrum. It is a caste system with the intellectually disabled occupying the lowest rung unworthy of concern or comment from the mainstream media or feel good, autism is beautiful, Neurodiversity variety autism advocates.

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Intellectual Disability and the DSM-5 Autism Do-Over: Catherine Lord Then (2003) and Now (2013)


Catherine Lord, and her highly influential views about autism and intellectual disability seem to have changed a bit since the 2003 article published below and the DSM-5 Autism Do-Over which will be published in 2013.  For those who quibble over the reference to 2013 as being "now" they should know that Dr. Lord and the DSM-5 subcommittee have no intention of changing any of the wording of the DSM-5 Autism Do-Over which will take effect in 2013. For the intellectually disabled  the future is now, they are no longer part of the autism spectrum. 

As Dr. Lord has already confessed, the DSM-5 committee of which she is a member has already targeted the intellectually disabled for exclusion  from the DSM-5's New Autism Spectrum Disorder. That confession is also confirmed by the exclusion language in mandatory criterion A of the DSM-5 which excludes an autism diagnosis where the social communication deficits are accounted for by general developmental delay. The writing is on the DSM-5's purple wall.

If there is any change at all in the wording of the DSM-5 Autism Do-Over it will be at the higher functioning end and will favor inclusion of more persons who are least affected by an "autism" disorder.  Persons with high functioning autism and Aspergers have powerful allies in the major mainstream media institutions; allies like Amy Harmon of the New York Times.  For the MSM and Hollywood autism is Aspergers. 

The intellectually disabled who comprise the vast majority of those with DSM-IV Autistic Disorder are never mentioned in those highly influential circles and the recent firestorm over exclusion from the DSM-5. The uproar is over the possible exclusion of the highest functioning persons with an ASD, persons who can work in rock bands, run successful businesses, graduate from university, cavort with New York media and New Jersey and Washington political figures and committees.

Dr. Catherine Lord and her DSM-5 committee will continue with their plans to separate intellectual disability completely from the autism spectrum as though there were no connection between the two.  But Dr. Lord did not always see the intellectually disabled as a lower caste to be excluded from the autism spectrum rooming house as illustrated in this 2003 journal article abstract:

Evidence for Latent Classes of IQ in Young Children With Autism Spectrum Disorder


Jeffrey Munson, Geraldine Dawson, Lindsey Sterling, Theodore Beauchaine, Andrew Zhou, Elizabeth Koehler, Catherine Lord, Sally Rogers, Marian Sigmand, Annette Estese, and Robert Abbotte

Autism is currently viewed as a spectrum condition that includes strikingly different severity levels; IQ is consistently described as one of the primary aspects of the heterogeneity in autism. To investigate the possibility of more than one distinct subtype of autism based on IQ, both latent class analysis and taxometrics methods were used to classify Mullen IQs in a sample of 456 children with autism spectrum disorder. We found evidence for multiple IQ-based subgroups using both methods. Groups differed in level of intellectual functioning and patterns of verbal versus nonverbal ability. Results support the notion of distinct subtypes of autism that differ in severity of intellectual ability, patterns of cognitive strengths and weaknesses, and severity of autism symptoms.


In 2003 Dr. Catherine Lord (and Dr. Geraldine Dawson of Autism Speaks) saw the intellectual ability patterns as a significant basis for distinguishing subtypes of autism that differ in severity.  Apparently her views have changed ... dramatically ... since then.  To the great detriment of the vast majority of those with Autistic Disorder and intellectual disabilities.

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Conor Turns 16 And Enjoys Some Birthday Cake Therapy



Conor turned 16 today.  No autism issues.  Just lots of fun. No swimming with dolphins therapy or riding horse back across Mongolia.  Conor has enjoyed some Birthday Cake Therapy though and has requested Pizza Therapy for supper.  The one rule we follow on Conor's birthday is to spoil him rotten.  

Bad Parent Syndrome?

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What Does Autism Awareness Mean As The Great DSM-5 Autism Do-Over Approaches?


What exactly is Autism Awareness and what does it accomplish?

Can anyone, Autism Speaks, or any other autism organization, say with a straight face that they are promoting autism awareness when the official criteria for determining what autism is, or is not, changes every 15-20 years?  Can anyone say what autism is when the vast majority (CDC expert Dr. Marshalynn Yeargin-Allsopp) of those with autistic disorder, those with intellectual disabilities, are rendered a minority, albeit a large minority at 41-44% (CDC surveys) , with the publication of the DSM-IV and when that large minority are removed from the autism "spectrum" entirely with the publication of the DSM-5?

Can anyone pretend to be talking about the same autism when some are talking about severely impaired and challenged children and adults who lack any significant communication skills, suffer epileptic seizures and engage in dangerous Self Injurious Behavior while others, especially mainstream media like the NYT,  bemoan the challenges faced by very shy high functioning persons who function well in rock bands, businesses and quasi-governmental organizations but heaven forbid find, not unlike much of humanity, that personal intimacy with a person to whom one is attracted can be an awkward, learning experience during adolescence?

Can anyone stand up in good faith in this day and age and say that autism is an entirely genetic disorder when in fact not all identical twins both have autism when one does? Or when researchers find multitudes of genetic bases for autism but no single genetic characteristic of autism? Even after the overwhelming majority of autism research dollars have been funneled for years into a bottomless pit of genetic autism research?

And how about the French psychoanalysts who in 2011-2012 are promoting nonsensical, non evidence based, non reality based autism causation theories, including the "refrigerator mothers" theory of autism causation,  a dangerous harmful work of fiction that never did have an evidence basis? And they have the unmitigated audacity to sue Sophie Robert for exposing their incompetent, archaic nonsense to the world?


Unfortunately the gross autism incompetence of many in the French psychoanalytic profession is about the only thing that remains clear in the world of autism awareness. The very definition of autism has now become contentious. The impact of new diagnostic definitions on epidemiological based autism research can only be imagined but, if past is prologue, will not be helpful in increasing our knowledge of autism causes. 


I do not mean to discourage anyone from engaging in raising autism awareness.  But in this time of the great DSM-5 Autism Do-Over please be clear about what you mean when you say ... autism. 

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