Autism Talk Q & A

Last night I gave my Autism talk at Lewes Skeptics in the Pub. Someone tweeted the questions so I thought I’d write up what I said – plus extra bits – here on my blog, as promised. These are not complete, but I hope to add more in the future.

Are psychopathic tendencies linked to autistic diagnoses sociologically or clinically?

This question is related to my comments on the Aurora shooter and the more recent events at Sandy Hook – I stated in my talk that it really upsets me when people link Autism to violence. The key difference between autism and psychopathy that I see is that an Autistic person may not understand if they’ve upset someone where as a psychopath, on the whole, won’t care either way. Autism is not shorthand for psychopathy but they are very distinct things. For more information on my views on linking the Aurora shooter’s actions to his potential diagnoses (and therefore similar views on Sandy Hook), please check out this post (which ended up on the Pod Delusion podcast).

Distinctions between v low functioning and high functioning autistic are massive – do you think they will become separate diagnoses?

On the whole I’m not a fan of the descriptors ‘high-functioning’ and ‘low-functioning’, but they are common, shorthand qualifiers for how the general population describe the spectrum.

Without a diagnosis, you cannot get treatment. My main fear about the proposals of removing Asperger’s as a diagnosis and integrating those currently diagnosed as so within the Autism spectrum is that people will lose their support. I don’t believe there is good evidence at this juncture that Autism and Asperger’s are distinct diagnoses – as far as I can see they have a lot in common, with a core difference between the two being in terms of socialisation and language abilities.

My specific concern, since we cannot know until changes are implemented, is that people currently diagnosed with Asperger’s will be placed in classes with children who struggle more. Supporters of the changes argue that the broader definition will allow LEAs (Local Education Authorities) to provide more support, instead of less, in places where support for those with Asperger’s is not provided for. Of course, this remains to be seen.

ABA is time and money intensive – if speaking to policy makers, where would you suggest funds should go?

If we’re talking in a purely economical sense, I believe we can make a very successful argument for the provision of ABA at a young age – when I worked as an ABA tutor the cost for a year’s services – including consultants – was £30k per year. Let’s assume some rises and I would suggest a 3 years provision of services, for the sake of argument. If we’re talking about £100, 000 for 3 years and we assume that this intervention is as successful as possible then the argument is weighing £100k against a lifetime of intensive support – constant around the clock care and benefits. I believe there is simply no contest, especially when you factor in the pricelessness of someone’s quality of life.

I also believe that parents should be getting better support, especially when it comes to diagnosis – when parents find the diagnosis hard, they will turn to all avenues of support – evidence-based or not. 28% of people feel they received adequate advice on where to go to for information and support. That’s simply not good enough.

Vaccination – where can I find resources?

The course I have been on was by Coursera, led by Paul Offit. I believe this course will be offered again very soon and as soon as I am aware of a firm date I will let people know. I will write some post about vaccination in due course whilst addressing specific points that anti-vaccinators bring up when criticising immunisation. I recommend looking into how vaccines are made and how they were developed – not only is it fascinating, but it is only by addressing the ignorance behind the arguments that we can fight back against these myths and legends.

Are we in danger of pathologising extremities of the scope of human interactions?

That’s a really common criticism of the DSM and one I feel that does have some merit. However, this question, when contextualised in terms of Autism, is again due to a lack of knowledge about Autism. The idea of a spectrum does seem a nebulous concept, but what I take pains to explain is that although it is a spectrum, the criteria used to assess if a person appears on that spectrum is very specific. I hope to expand on this is a forthcoming blog post.

This question also brings up the idea that ‘we are all on the spectrum’ and while I champion the sentiment and intention behind the statement, I don’t believe it’s a particularly useful concept. People often use this to almost ‘normalise’ the idea of Autism in terms of helping people understand and celebrate differences between us but I also think it runs the risk of downplaying what is, more often than not, quite a debilitating disability.

I’ve heard that the Amish community do not vaccinate their children and they don’t have any Autism within their community – why is that?

I had heard about the idea the Amish don’t get Autism and it’s something that I haven’t fully looked into yet. However, based on the fact that Autism is not hindered by race, socioeconomic status or ethnicity, I find this very hard to believe and a very brief Google search leads me to believe it is in fact a myth. Interestingly, studies in Japan where they use a single vaccine and the fact that Autism is now increasingly being diagnosed before an MMR vaccine is given blow the idea that vaccination is the cause of Autism right out of the water.

 Neuroscience has been big growth area – any sneak previews of what is coming in terms of diagnoses?

 It was interesting to hear someone say they were surprised that we hadn’t cracked this yet, given we’re now into 2013. However, what should be noted is that we know far less about the brain than we do about other parts of the body. Neuroscience is a baby! We know what we do about it because of horrendous accidents and procedures like splitting brains – it’s not ethical to do too much poking around under the hood until there is something that needs treating and so we know so little about this organ with the consistency of tapioca. Sometimes I wish I could time travel to the future to discover what insights about the brain it holds.

 Unfortunately I am not a scientist (working on it!) and I can’t give any sneak previews in terms of that but an important point was made last night (not by me) regarding the influence of environment in addition to genetic predisposition. This should not be overlooked nor should it be used as a hook for blaming parenting skills or toxins, like mercury or immunisations, for the rising prevalence rates of Autism.

 Some investigation is underway into the link between low birth weight and Autism but I do believe that more work is required when it comes to the assortative mating and testosterone theories – I am not overly convinced, yet, of any explanatory explanation yet. At the moment we must focus on interventions focusing on the symptoms whilst science looks for answers on cause.

 This brings me to a point where I should make it clear that I do not advocate the idea of a cure of pre-screening foetuses for Autism – it’s a complicated and murky area full of shades of grey, but I truly believe a world without Autism would be a lesser one.