Category: Uncategorized

  • The Age of Autism: Goshen

    By DAN OLMSTED   |   May 23, 2005 at 5:26 PM

    WASHINGTON, May 23 (UPI) — Our search for Amish people with autism is now departing Lancaster County, Pa., and heading for the Midwest, where a significant percentage of the nation’s 80,000 Amish can be found.

    Lancaster County — home to 22,000 Amish and the heart of the Pennsylvania Dutch Country — was our first stop. We found evidence of only three or four Amish children with Austism Spectrum Disorders in Lancaster County; there should be dozens based on the 1-in-166 prevalence among “the English,” as the Amish call the rest of us. We’re still looking in Lancaster, but widening the search at the same time.

    Nationwide, there are 80,820 Old Order Amish according to the almanac. By the time you include Amish-Mennonites and allied believers that number easily passes 100,000, but we’re staying on the conservative side in every sense to avoid inflating expectations.

    Dividing those Old Order Amish by the autism rate yields nearly 500 nationwide who should have Autism Spectrum Disorders — that is, if autism is primarily a genetic disorder that has always existed but is just now being better identified.

    Let’s cut that number in half, to represent only the full-syndrome autism cases that are impossible to miss and don’t shade into any other diagnosis. And let’s lower that number to an even 100, in case autism now affects children and adolescents in much higher numbers than their elders — in case it has become virtually epidemic among them, in other words. (Remember, the Amish have large families; 10 children is not rare and autism shouldn’t be, either.)

    Next stop: the Amish community around Goshen, Ind. According to the local Web site amishcountry.org, “While they may wait longer, or try alternative treatments, Amish families may use the services of doctors and modern hospitals when necessary.”

    So we called a medical practice we were referred to in Middlebury, heart of the Amish community in northern Indiana, and asked about Amish people with autism. The conversation with a staff member went exactly like this:

    “There are no doctors here today. They’re all in a meeting. I’ll give them this message.”

    Pause.

    “You know, I’ve been here for five years and I don’t think I’ve seen one autistic Amish come in here. … “

    “Would you have, do you think, if there were any? I mean, do you guys treat Amish folks?”

    “Oh we do, yes, quite a few.”

    “So, that’s kind of interesting, huh?”

    “Yeah, but you know that doesn’t mean that … Yeah, that is, I never thought of that before. This is very interesting.”

    We seem to be starting off on the same foot in Goshen that we ended on in Lancaster, where the Amish do see doctors, but the doctors say they don’t see autism.

    “You’ll find all the other stuff, but we don’t find the autism,” said a Lancaster doctor who has treated thousands of Amish for nearly 25 years. “We would have seen it. It’s not something they would hide. They’re not like that.”

    Calling doctors who treat Amish patients in the heart of Amish country is the sort of unscientific, anecdotal approach that drives the autism experts absolutely buggy, to use an irresistible word — though not buggy enough to look for themselves, apparently. We’re told that recently, parents of autistic children met at a fairly high level with congressional and White House representatives and mentioned the Amish issue.

    “It’s intriguing, but of course it’s not a scientific study,” a government official pointed out.

  • The Age of Autism: Mercury ascending

    By DAN OLMSTED   |   May 17, 2005 at 1:57 PM

    WASHINGTON, May 17 (UPI) — A year ago, the prestigious Institute of Medicine slammed the door on the idea that mercury in vaccines bore any relation to autism.

    “The overwhelming evidence from several well-designed studies indicates that childhood vaccines are not associated with autism,” the chairman of the IOM panel, Harvard scientist Marie McCormick, told reporters last May 18.

    The panel went further: It took the unusual step of urging that research money go instead to more “promising” areas. You can’t slam a door much harder than that.

    But 12 months later, that door seems slightly ajar. One big doorstop is the new 441-page book by David Kirby called “Evidence of Harm,” a compelling portrayal of parents and scientists who have pushed the vaccines-autism theory. They contend that a mercury-based preservative called thimerosal, in an increasing number of vaccinations, triggered an autism epidemic in the 1990s.

    Thimerosal was phased out of U.S. childhood vaccines beginning in 1999.

    One memorable vignette in Kirby’s book is a meeting between several of those advocates and Dr. Julie Gerberding, who had been director of the Centers for Disease Control and Prevention less than two years.

    Last May 12, a week before the IOM report, Gerberding flew in from Atlanta to meet them — at her request — in the Rayburn House Office Building on Capitol Hill. Rep. Dave Weldon, R-Fla., a medical doctor who is a persistent critic of thimerosal and the CDC’s handling of the issue, also was present.

    Taking turns, the parents and scientists methodically laid out their case.

    Mady Hornig of Columbia University described how mice with an autoimmune genetic predisposition develop autistic-like behaviors after being injected with thimerosal-containing vaccines.

    “Hornig played the videos for Gerberding, who suddenly appeared stunned,” Kirby recounts in his book. “She brought her hands to her face in disbelief.

    “Dave Weldon had a similar reaction. He stopped Hornig in the middle of her ghastly presentation. ‘Wait a minute,’ he said. ‘Am I to understand you correctly? You injected these mice with the same amount of mercury, relatively speaking, that infants receive in vaccines, and you saw these kinds of mutilatory behaviors? You saw this mouse eat through the cranium of his cellmate?’

    “‘Yes,’ she replied calmly.”

    The Institute of Medicine saw the same presentation before issuing its report but rejected it as unconvincing.

    Gerberding was polite but noncommital, Kirby writes. As she left, she said, “I am not afraid of controversy, and I am determined to follow the science.”

    Call it coincidence, but it’s striking how much less dismissive of thimerosal concerns the CDC is these days, compared with the Institute of Medicine and others.

    The National Network for Immunization Information, for instance, launched a pre-emptive broadside against “Evidence of Harm.” That group represents the mainstream medical establishment, including the American Academy of Pediatrics, the American Nurses Association and the American Academy of Family Physicians. Their members, it should be noted, were among those who administered the vaccines in question on the recommendation of the CDC.

    “Warning: Controversial vaccine book,” the NNII statement was headlined. “Reporter David Kirby has recently written a book … purporting that there is a link between thimerosal and autism and other developmental disorders.”

    That’s a bit of an overstatement, considering the first two sentences of Kirby’s book: “Does mercury in vaccines cause autism in children? Anyone hoping to find proof that it does in the pages that follow is advised to put this book down now.”

    The NNII asserted that “extensive evidence shows no link between vaccines and neurodevelopmental disorders, including autism. This evidence is based on well-established scientific studies.

    “Continued attempts to link vaccines and autism run the risk of diverting attention away from efforts to understand the cause or causes of autism,” the group said.

    The CDC also issued a release on Kirby’s book. Its thrust was different — that the book is a “look back” to a time when thimerosal was in childhood vaccines.

    “Given the historical nature of the book, it is important to emphasize that today, with the exception of some flu vaccines, none of the vaccines used in the U.S. to protect preschool children against 12 infectious diseases contain thimerosal as a preservative.

    “As the IOM concluded in a recent report, the vast majority of studies, which have involved hundreds of thousands of children in a number of countries, have failed to find any association between exposure to thimerosal in vaccines and autism; that is, they have failed to find any evidence of harm,” the CDC said.

    It’s worth noting the contrasts in the statement. The doctors and nurses group says “extensive evidence shows no link.” Dr. McCormick at the Institute of Medicine says “overwhelming evidence” shows no link.

    But the CDC, which unlike such groups has ongoing access to the actual data, merely states that studies so far “have failed to find any association.”

    “CDC continues to support research related to autism,” the statement said, “including studies designed to examine the possible causal association between autism and other possible environmental causes, including thimerosal-containing vaccines. … Research in these areas is ongoing.”

    Ongoing research that includes thimerosal as a possible cause of autism? Supported by the CDC?

    Put simply, the CDC isn’t ruling out anything — contrary to the Institute of Medicine’s declaration that more research on thimerosal is a waste of money, contrary to the medical establishment’s pronouncement that continuing to look could cause harm.

    Consider Gerberding’s comments April 28, 2004, at a House subcommittee hearing: “We don’t have the evidence to show that the thimerosal preservative is a risk, but you know we have an open mind about that.”

    Apparently the Institute of Medicine’s findings three weeks later didn’t completely reassure her, because this February — almost a year after the IOM report — she said the same thing in an interview with NBC.

    “Right now, the scientific evidence doesn’t provide any framework for concluding that thimerosal or immunizations in any way affect autism,” she said. “But we have to have an open mind about that.”

    An open mind, not a closed door. Ongoing research, not ending research. That’s quite a difference. Experts who are certain thimerosal didn’t cause the autism epidemic may want to have a word with Dr. Gerberding.

  • The Age of Autism: Witness

    By DAN OLMSTED   |   May 10, 2005 at 10:14 AM

    LEBANON, Pa., May 10 (UPI) — Frank Noonan is a family doctor in Lancaster County. When I met him for lunch last Saturday, he was still in golfing togs from his weekly game — “Saturdays are my ‘I can breathe’ day,” he says. Even so, he stayed after our meal to meet a cancer patient who phoned him at the restaurant.

    He’s energetic, friendly, straightforward — the kind of doctor people want.

    People such as the Amish. As a family practitioner, Noonan sees patients of all ages. He combines traditional and alternative medicine in an “integrative” blend to suit the individual. The Amish like that approach — they prefer to see just one doctor for all their care, and their first resort is herbs and supplements, not prescriptions and pills. For one thing, most don’t have insurance.

    Based on movies like “Witness” and the image of the Amish in horse-and-buggies, many people — myself included — assume they have virtually no contact with such outside influences as modern medicine.

    Not so.

    Noonan has been a doctor in Lancaster County nearly 25 years and about a third of his patients are Amish, making his Amish practice one of the area’s largest. He has seen “thousands and thousands” of the county’s 22,000 Amish residents and others who live nearby.

    I found him through an Amish-Mennonite mother of an autistic child adopted from China. She told me she has seen almost no autism among the Amish, but that I should talk to Noonan because he has treated so many Amish for so long.

    Based on my reporting so far, there is evidence of only three or possibly four Amish with autism in Lancaster County, where there should be dozens at the 1-in-166 prevalence in society at large. One of them is the adopted Chinese child. Another was described as having “a clear vaccine reaction” at 15 months, after which she became autistic. I have not met that child and can’t vouch for that description.

    When I called Noonan three weeks ago, he seemed surprised by my question about Amish autism but agreed to think about it, check around and tell me what he found. At lunch, Noonan said he hesitated to offer an opinion when I first called because it had never occurred to him.

    But now, he said, he realized something.

    “I have not seen autism with the Amish,” Noonan told me. “And I say that having seen a ton of Amish patients. I may be able to think in all those years of maybe one case of (Amish) autism I’ve had.”

    “I’ve checked with some of my colleagues,” he added, “and they all tell me it’s very, very sporadic that we’ll see a case of autism among the Amish.”

    From 2000 to 2003, Noonan also saw patients at the Wellness Center, which is operated by the Amish and Mennonites. About 90 percent of those patients are Amish, Noonan said, and he saw thousands of them. But still he saw no autism.

    “Absolutely none, in the almost three years I was there. We would have seen it. It’s not something they would hide. They’re not like that.”

    Noonan said he sees “a fair amount of mental retardation among the Amish.” A significant percentage of people with autism have mental retardation as well as severe speech and hearing problems. Wouldn’t they show up on the radar of those who track and treat such issues?

    And wouldn’t autistic Amish see Noonan for the same inevitable illnesses and injuries that bring the rest of their family to him?

    I tried various ways to find gaps in Noonan’s account. Perhaps autistic Amish children were seeing pediatricians or specialists as opposed to family doctors …

    “The Amish don’t go to specialists like we do,” he responded. “The Amish go to family docs for all their pediatric care. So at least in Lancaster County, where I practice, almost all pediatrics among the Amish is done by family docs.”

    “You’ll find all the other stuff, but we don’t find the autism,” Noonan said. “We’re right in the heart of Amish country and seeing none. And that’s just the way it is.”

    In my last column, I said this interview was a tipping point between absence-of-evidence (not finding many autistic Amish) and evidence-of-absence (finding there might not be many).

    The case is still open, but does anyone disagree that Dr. Noonan makes a compelling witness?

  • The Age of Autism: Absence of evidence

    By DAN OLMSTED   |   May 9, 2005 at 3:37 PM

    LEBANON, Pa., May 9 (UPI) — After several weeks of looking, the prevalence of autism among the central Pennsylvania Amish still appears remarkably low, and the few cases I have found suggest an ominous pattern.

    In two columns last month I asked, “Where are the autistic Amish?”

    My search encompassed Lancaster County, heart of Pennsylvania Dutch country, and I obtained a tentative answer. After inquiring widely, these three cases emerged:

    –a girl, age 3, adopted from China by an Amish-Mennonite family;

    –a girl of about 8, described by the mother of the first child as a clear vaccine reaction at 15 months (a very small percentage of Amish do vaccinate their children), and

    –a boy of about 10.

    Since then, I have become aware of possibly one more case in Lancaster County and a total of five more nationwide — which will be the subject of a future column.

    Meanwhile, there is the question of prevalence. There is no reason to be particularly interested in autism among the Amish — unless it occurs much less frequently than normal. If it did, it would suggest either genetic immunity — which is unlikely, because at least a handful of Amish are in fact autistic — or lower exposure to something that, combined with genetic susceptibility, triggers autism.

    In my view, the latter is more likely.

    About 22,000 Amish live in Lancaster County, where they first put down roots almost 300 years ago after fleeing religious persecution in Germany. At the current rate of autism among the “English,” as they call the rest of us, several dozen of them should be identifiably autistic.

    My first Lancaster contacts basically fell into the “absence of evidence” category, which is intriguing, but establishes nothing. The well-known scientific axiom is, “absence of evidence is not evidence of absence.”

    In the absence-of-evidence category:

    –“I’ve been an advocate for the past five years in Lancaster and I have yet to come across a case where an Amish family is struggling for services,” said Jim Bouder of the Lancaster County Autism Support Group. “I haven’t seen any.”

    –“There are a lot of other kids who have autism, but we haven’t seen that in the Amish because they’re not referring them,” said Stu Symons, director of mental retardation and early intervention services for Lancaster County Mental Health/Mental Retardation, a public agency. “There’s a lot of birth defects and other disabilities (among the Amish), but we haven’t seen, necessarily, autism.”

    –“That’s one of our head-scratchers,” said another local person who works with autistic children.

    The Amish-Mennonite mother with whom I spoke, Stacey-jean Inion of Leola, said the view from inside looking out is no different.

    “Everywhere I go (outside the Amish community) I find children who are autistic, just because I have an autistic daughter — in the grocery store, in the park, wherever I go,” Inion said. “In the Amish community, I simply don’t find that.”

    Though all this seemed intriguing, it did not constitute proof of anything. Because of the insular and unusual nature of the Amish community, everyone outside might just be missing the necessary evidence.

    Among the dozens of e-mail messages I read after publishing the previous articles, several made exactly that point.

    “I do not know of any Amish or Mennonite children with autism,” said one doctor in a neighboring county, “but it would be difficult to assess this because these families rarely come to medical care for that type of problem, nor do they use Early Intervention or IU (Intermediate Unit) services. Thus, the incidence of autism in that population is unknown.”

    One message board posting even suggested because there apparently have been no studies of Amish people with autism, they must be there.

    “Proof? Evidence? Where is it written other than a newspaper article or forum message? A search for ‘amish autism’ on ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search&DB;=pubmed only comes up with a ‘No items found’ message. You would think that anything that significant would actually be published.”

    You would think.

    This past weekend, I traveled back to Pennsylvania and met with a person who gave me the best insights yet into autism in the Amish community here. What he had to say was the tipping point between absence-of-evidence and evidence-of-absence.

    That will be the focus of the next column.

  • The Age of Autism: Letter from Ibiza

    By DAN OLMSTED   |   May 6, 2005 at 12:05 AM

    WASHINGTON, May 6 (UPI) — As part of United Press International’s ongoing series on the roots and rise of autism, we invited readers to interact with us via e-mail. As a result, we have received loads of insightful, informative, sometimes critical comment; we printed a selection in a previous column and will make it a regular feature of the series.

    One letter we found particularly interesting is from Alan G. Carter, who describes himself as a high-functioning autistic person.

    We do not presume Mr. Carter speaks for anyone but himself, but his comments are worth sharing. We hope this encourages other people on the “autism spectrum” to share their views as well.

    Mr. Carter’s name is used with his permission.

    I know you’ve attracted some negative responses from some within the autistic community, but I think the questions you are asking could lead somewhere useful because you really do seem to be keen to begin at the beginning.

    So if I may, I’d like to offer a perspective from the point of view of a “high functioning” autistic person who is sympathetic to your approach, and who has spent many years pondering these issues in commercial contexts – before withdrawing a few years ago because conditions had got so bad it had become impossible to achieve anything useful and seriously health threatening to try. I think this will suggest a very different approach to the medical conceptualization that you have primarily been exposed to.

    First off, I do not regard myself as disabled in any way. I’m very much aware of the cognitive differences between myself and the majority — I’ve been coping with them for as long as I can remember – and I see no evidence of disability on my part at all. I shall speak plainly about how things look from my point of view in what follows. I think this is only fair, since some others are so forward as to call me a disease, and assert that I must be “cured” — i.e. exterminated — and expect to be applauded for this.

    If you look into the matter, I think you’ll find that what I’m about to say is echoed in psychoanalytical theory, the various spiritual traditions, the Deming approach to industrial quality which produced such spectacular results in post WWII Japan, and even in the writings of Ayn Rand. One book that I’d particularly suggest you look at is a small volume of management theory called “Narcissistic Process and Corporate Decay,” by Prof. Howard S. Schwartz, New York University Press. Personally I don’t agree with the mechanisms Prof. Schwartz proposes are in play, but the social phenomena he describes are certainly real.

    I’m a software engineer, and I’m very good at it. Typically, problems start when there is a clearly stated objective that I must work towards along with others who are not “on the spectrum.”

    I look at the task in a holistic way, where no step is any more important than any other, since we must execute them all to complete the task. There are always areas of risk and ambiguity which we presently possess no proceduralized method for dealing with. These areas of difficulty can however be “herded” – much as I imagine you, as a professional writer, “herd” the pieces of your own product together.

    There’s an abstract “space” in which you shuffle your paragraphs and sentences around, as you simultaneously develop and express your conclusions. That’s what I’m doing now as I write to you, and I imagine that to be able to write a whole article which hangs together in its parts and also as a whole, you must do something similar. (Has it occurred to you that to do your job, you may very well be “on the spectrum” yourself, whether or not your abilities and awareness have thus far been categorized and discounted with a “diagnosis”?)

    So before I start, I must contemplate the whole task, running backwards and forwards in my mind until a derisked and viable course is apparent.

    If I do not do this, I’m just stumbling around in the dark. I must then implement my creatively produced plan in a pedantic and rule following way, if I am to preserve the assurances the first, contemplative stage yielded. (The bits where a mathematician might say “in any case” and really mean “in all possible cases” rather than “if we ignore the issues”.)

    In contrast, my colleagues do not see that many steps ahead – or are not interested in doing so. Instead they are more concerned with acting out their “fitting in” with whatever random and ill-thought-out approach happens to emerge from a kind of chimpanzee jabbering session. This behaviour appears to be encouraged in schools, and is known as “taking turns and making points.” The play-acting seems to be more important than the content of the “points” that are made.

    So often we hear that the problem with ADHD children is that they “blurt” – no one every mentions that their swiftly produced answers are usually correct. To the teacher, maintaining the singsong matters more than the stated purpose of asking the question, but these highly intelligent children are responding sincerely and effectively to the stated purpose. For this they are labelled mentally retarded. Similarly the wretched glancing from side to side as my colleagues change their nonsense in mid-sentence, depending on the threatening grimaces of others, indicates the lack of rigour and sincerity in their speech.

    I can do creativity, and I can follow the letter as well as the spirit of rules. All too often, I find that my colleagues do not even attempt to do either.

    There’s an element of asinine uniformity in my colleagues’ behaviour – even in the phrases used to celebrate it. “Taking turns and making points.” “Looking professional and playing roles.” “Being very clever and playing games.” “La di da di da and da di da.”

    There’s a stage when they “all-agree” a blatantly doomed approach. I point out the logical inconsistencies in their plan, but I find that they don’t have sufficient attention spans to think ahead more than a couple of steps. Instead of making an effort to follow, they commence unpleasant jeering, subject-changing avoidance behaviors. Sometimes, they announce that I am mentally weak, that I “just don’t get it,” and am unable to keep up with their cleverness. They seem to believe that it is I, not they, who is deficient in attention span. Worse, this deeply habituated evasiveness prevents them from ever learning from their mistakes. Hence the high proportion of software projects which run vastly over budget if they are ever implemented at all.

    Then they start play-acting the implementation stage. Here, the objective also seems to be closely aligned with what happens in schools.

    The idea is not to get a result, but to fudge, pass the buck, do or say anything that will pacify an unthinking “teacher” figure who is looking for a shallow outward “seeming” of work, without actually doing any work. When I question them, they all seem to harbour a belief that anyone who approaches the job with a sincere intent to complete it is an imbecile. They certainly don’t look forward to the natural high that comes from seeing a beautiful system working as intended.

    A typical phrase used at this time is, “Oh just put something and get on”. Now what on earth is the point of “getting on” when one knows one has already taken a wrong turn – even done so deliberately? There is no point unless the intent is to at all times (until the project is canceled as a failure) maintain a sham of work that is visible from a distance (even if no-one is looking) rather than getting a result.

    I know that I often find the noise of randomly shouted falsehoods, incessant subject changing, attempted bullying and so on to be very, very difficult to cope with. Add the hideous flicker of florescent lights, the perpetually ringing telephones in the open plan offices and the constant need to be on the lookout for insincere sneakiness, and the workplace can be a very unpleasant and overwhelming place to be.

    It is certainly no fit environment for anyone to do productive work – but actually productive work is not the point. I often find myself “stimming” – rubbing my hands rhythmically backwards and forwards over my scalp, focussing on the regularity and groundedness of the feeling, to drown out the insincere insanity around me and giving myself some emotional support. I am not surprised that others find themselves banging their heads against the wall.

    The situation is getting much, much worse with every year that passes.

    This is the context in which the demonization of those who “fail to comply” with society going down the plughole is occurring. Do you believe that the 20th century would have known no totalitarianism if just a few people with names like Hitler, Stalin and McCarthy had not been born? Or that to make a Belsen guard it is necessary to do any more than take Jo Public out of the supermarket and stuff her into an SS uniform?

    There’s plenty of evidence that many of us “on the spectrum” have great abilities in any subject found in nature – except the “ability” to self-delude and behave in this nihilistic, herdlike way. The only thing we “fail” to do is deny reality for “social” reasons.

    Many of us express our profound emotional distress in extreme ways because we are profoundly emotionally distressed by the madness and bullying to which we are subjected. How easy it is to assert that we have no emotions because we do not parade false affect, and have nothing to be distressed about because the world is almost at the point of total perfection. In fact, I believe the developed world is nearing the point of total collapse.

    The modern affliction of adrenaline addiction offers a model of what I think is going on. These days some people have lots of leisure time, and some of them spend too much time doing exciting sports. They actually get hooked on raised adrenaline levels, and when their adrenaline level drops, withdrawal drives them to do dangerous things to raise it again.

    They are not aware that they are seeing things in a distorted way, and that parachuting off buildings is something they would not normally choose to do.

    To my mind, it’s possible that most people are vulnerable to a (likely neurochemical) form of madness which can be induced by joining in with group behaviors in a manner similar to adrenaline addiction, but with

    boredom as the behavioral extreme where they should not spend too much time. For various different reasons those of us “on the spectrum” are immune to this. We therefore retain the human normal faculties which are

    everybody’s birthright, experience great distress from what we see going on with our clear vision, and yet we are categorized, demonized and persecuted by the herd, particularly at times of maximal insanity.

    The disease of the herd comes and goes in waves, improving after a period of maximal delusion has caused an economic collapse and war, then steadily worsening during the reconstruction … until the next collapse.

    Because machines now do so much of the work, the population of the developed world has been freed up to make this the deepest trough in history.

    We are already deeply into the next Dark Age, but thanks to the machines most people haven’t noticed yet. The slightest deviation from regularized herd madness is now quite intolerable, bureaucrats, teachers, and medical staff are the most ritualized and so bored and so herdlike people of all, and this is the context in which the epidemic of autism, Asperger’s and ADHD diagnosis is occurring.

    Even so, I am optimistic. This has been going on for a long time — probably thousands of years, since we first invented division of labor and the first humans to go gaga fell into their group hypnotic disease state. I reckon we retain some awareness of this in our legends of the “Fall.” Certainly something caused us to lose all our history and culture prior to around 6000 years ago. Perhaps the way out is through a time of maximal madness, when the insanity will become evident to even the most blinkered, even as they physically collapse from the stress of it all. Perhaps, as Dante described in “The Inferno,” the road out of Hell is found in the deepest and most terrible part of it.

    A full description of this viewpoint, as criticized and improved by many others who can see it too, is online at: reciprocality.org/thirdage.

    Perhaps we who are “on the spectrum” are like miners’ canaries, and you’d better get out of the mine now – because the canaries have fallen off their perches.

    Yours sincerely,

    Alan G. Carter

    Ibiza, Spain

  • The Age of Autism: Mercury in the air

    By DAN OLMSTED   |   May 5, 2005 at 12:05 AM

    WASHINGTON, May 5 (UPI) — A new study has found a possible link between higher mercury emissions and higher rates of autism.

    The study, accepted for publication in the peer-reviewed journal Health and Place, looked for an association in Texas between rates of autism, special education services and levels of mercury released into the environment.

    “There was a significant increase,” according to the study. “On average, for each 1,000 pounds of environmentally released mercury, there was a 43 percent increase in the rate of special education services and a 61 percent increase in the rate of autism.”

    The Bush administration is announcing a new proposal to control mercury emissions that has already stirred controversy.

    The study’s lead author, Raymond F. Palmer, an associate professor at the University of Texas Health Science Center in San Antonio, cautioned the findings are limited, but added they should prompt more research. The following is a transcript of an interview United Press International conducted with last March:

    Q. Will you describe the study in layman’s terms?

    A. I think it’s the first study to look at total legal amounts of released mercury from different sources of industry, and it’s a relationship between that and developmental disorders and special education rates at the general population level.

    Q. Also, autism has really not been looked at as part of this picture of mercury in the environment.

    A. Right, it’s the first one to look at autism in relationship with it. Now this is only an associational study, and there are some limits to this study, but it’s a good starting point to look at this issue — a first jumping-off point where you could say there’s an association here.

    There’s a hypothesis that mercury is associated with autism. This just supports that general hypothesis, but it in no way confirms it — the findings that higher emissions of mercury are related to higher rates of autism.

    Q. When you say there’s a hypothesis, are you referring to thimerosal (the ethyl mercury preservative that was used in childhood vaccines through the 1990s)?

    A. Right. And that’s mercury. That’s just another form of mercury.

    Q. Now what critics would say is that there is no evidence that ethyl mercury in vaccines can do that kind of damage. Whereas environmental mercury is a different kind entirely and has known toxic effects on humans.

    A. That gap is starting to close because there are some studies starting to show that ethyl (mercury in thimerosal) is as toxic.

    I think what the critics would say is this (study) is an ecological association, it’s cross-sectional, meaning it’s at a point in time. And then being ecological, you cannot infer anything at the individual level. So anybody who really wants to rip into this can.

    But if you have a hunch about a relationship as serious as this and you go investigating it and (find an association) at this level, it gives you confidence to move on to the next level.

    Q. What would the next level be?

    A. You’d want maybe to look at the association over time. We have some data on that, too, and that’s our next step. We’re working on that paper right now — levels of mercury related with a change in autism over time, not just the prevalence rate at one specific point.

    Q. I understand you’ve also looked for an association between mercury emissions and autism at the national level?

    A. That’s an unpublished manuscript. But the data that I have at the states level, the 50 states, is consistent with the same idea. States that are reporting the highest levels of mercury emissions also have the highest rates of developmental disorders including autism. I’m still trying to get that one published.

    Q. New mercury-emissions standards are being announced by the Bush administration. Some people say they don’t go far enough. Does your study have implications for this issue?

    A. I would say that it does suggest that further study has to be done. Nobody really knows the long-term effects of low-dose mercury exposure. I would think this is a serious enough issue that we would want politicians to look at it, given that the substance is such a toxic element.

    Q. I understand that in doing your study you came across a possible correlation between autism rates and an old mercury mine?

    A. We were also mapping this relationship in counties of Texas, and we identified the counties with the highest levels of autism and the highest mercury rates.

    One county that stood out, Brewster County, didn’t have very much mercury reported to the TRI (Toxic Release Inventory Program of the Environmental Protection Agency). But it did have high autism rates.

    So we were wondering about that and found that they had historically been one of the top mercury mines in the nation.

    Q. How could an old mercury mine have any effect on autism rates?

    A. (Perhaps because) it just stays in the environment forever. We don’t know.

    The other thing about the study, the criticism, is that we’re just inferring exposure because of the release (of mercury emissions). So again it’s hard to say that there’s individual-level exposure. We’re talking about potential for exposure.

    I think it’s an important study to lend support to further investigation. Why not? Why not investigate it more? What do we have to lose?

    Q. Does that apply to the mercury in vaccines as well? The Institute of Medicine has rejected that idea and said research money should be spent in more promising areas.

    A. I think if you look at everything in (terms of) total toxic load, thimerosal could just be another source. If you have it in your environment, and you’re also getting it in, say, you’re mother’s diet, and fish, and also through your immunization schedule, that’s just one source. And the environmentally released mercury is also just one source.

    Q. Could other heavy metals be playing a role here?

    A. There are some studies showing that other pollutants could potentiate the action of mercury. Like aluminum, like PCBs, pesticides. The point is, we’re at this stage of investigation where nobody really knows.

  • The Age of Autism: Backward

    By DAN OLMSTED   |   May 4, 2005 at 12:05 AM

    WASHINGTON, May 4 (UPI) — When Leo Kanner first identified autism as a unique developmental disorder in 1943, he was certain it was present from birth.

    “This is not, as in schizophrenic children or adults, a departure from an initially present relationship,” Kanner wrote. “It is not a ‘withdrawal’ from formerly existing participation. There is from the start an extreme autistic aloneness.”

    Almost 30 years later, in a 1972 speech, Kanner was of the same mind: “I didn’t find that withdrawal was a proper term because you withdrew from something where you were before. These children had never been there.”

    Not emphatic enough for you? Kanner declared these children were “pure-culture examples” — as in a closely observed petri dish — “of inborn autistic disturbances.”

    Certain is not a synonym for correct, however, and now there are signs Kanner was wrong — or at least not totally persuasive — about that. Re-evaluating his 11 case studies of children born from 1931 to 1938, there is ample reason to wonder whether some of them developed autism after a period of normal development.

    Take Richard M., born in November 1937.

    “I can’t be sure just when he stopped the imitation of word sounds,” his mother wrote when he was almost 3. “It seems that he has gone backward mentally gradually for the last two years.”

    Or Elaine C., born in February 1932.

    “She took feedings well, stood up at 7 months and walked at less than a year. She could say four words at the end of her first year, but made no progress in linguistic development for the following four years.”

    Four words at the end of the first year is about right for normally developing babies. No words for the next four years, obviously, is not.

    Both Elaine and Richard were “there” before age 1, it seems, then went backward — they withdrew, to use the word Kanner would not.

    The term for that is regression, and today children who at first develop normally but become autistic by 36 months are diagnosed with regressive autism. Yet few associate that sequence with any of Kanner’s original cases, because he was so definite their autism was present from birth.

    What difference would it make if Kanner used too broad a brush to paint every single case as innate? It would make a lot of difference, by raising the possibility that some factor triggered autism in these children after they were born, not before.

    Earlier articles in this series tracked the natural history of autism. We looked at whether autism has always existed at a steady prevalence or, instead, began decisively among children born in the 1930s.

    We found the “steady state” theory hard to reconcile with the relatively few cases of autistic-style behavior reported before then; we calculated that at today’s rate there should have been 369,000 hard-to-miss full-syndrome autistics alive in the United States in 1930. Where were they?

    We also pointed to a striking link among the first 10 parents — they had college educations and many had advanced degrees — but we concluded this link weakened when the first 100 parents were analyzed.

    Implication: It is plausible some new factor triggered autism in those college-educated families in the 1930s, and by the 1940s it was spreading to a broader range of families.

    If some of Kanner’s original cases were not autistic-from-birth but regressive — acquired autism syndrome, in effect — that would fit with a “new trigger” theory.

    Kanner was brilliantly right in identifying autism — which, by the way, he described as “a behavior pattern not known to me or anyone else theretofore.” Kanner literally wrote the book on child psychiatry: “Child Psychiatry,” published in 1934.

    Like anyone studying a puzzling new phenomenon, however — consider some of the misbegotten theories about AIDS — not all of Kanner’s observations or inferences have proven absolutely correct.

    For instance, Kanner wrote that in the whole group of parents, “there are very few really warmhearted fathers and mothers. For the most part, the parents, grandparents and collaterals are persons strongly preoccupied with abstractions of a scientific, literary or artistic nature, and limited in genuine interest in people.”

    Kanner wondered whether “this fact” caused their children’s autism, but his hypothesis it was present from birth gave him pause.

    “The question arises whether or to what extent this fact has contributed to the condition of the children. The children’s aloneness from the beginning of life makes it difficult to attribute the whole picture exclusively to the type of early parental relations with our patients.”

    Hey — so does this fact: Quite a few of those parents did not fit that cold unfeeling stereotype. Kanner individually described several: “a patient, even-tempered man … a well-educated, kindly woman … energetic and outgoing, fond of people and children.” Another mother told him, “The thing that upsets me most is that I can’t reach my baby.” How unfeeling is that?

    Kanner’s gift for observation undercut his generalization, which since has been proven to have nothing to do with the risk of having an autistic child.

    Trying to make sense of those first cases, we did the modern thing: We got a second opinion. We asked a pediatrician who has worked with dozens of autistic children and their families to read Kanner’s original study. These were her main points:

    –“I don’t think he makes the case that they all were totally autistic from birth,” she said. By the same token, given the limitations of the data reported in the case histories, we cannot be absolutely certain any were instances of regressive autism.

    –Ironic, some of the children seem to have the milder Asperger’s Disorder rather than classic “Kanner autism,” which has come to signify the most severe cases.

    –A number of these children had physical problems that should not be overlooked as possible clues to their developmental disorder. Those problems centered on food, digestion and illnesses that could suggest allergic reactions or a weakened immune system, the pediatrician pointed out.

    –Donald T., the first patient Kanner saw in 1938, never had a normal appetite. “Eating has always been a problem with him,” the father wrote. “Seeing children eating candy and ice cream has never been a temptation to him.”

    –“Following smallpox vaccination at 12 months,” Richard M. “had an attack of diarrhea and fever from which he recovered in somewhat less than a week.” This is the child whose mother recalled him going “backward” about that age.

    –Barbara K. “nursed very poorly and was put on bottle after about a week. She quit taking any kind of nourishment at 3 months. She was tube-fed five times daily up to 1 year of age.” Her eating eventually became normal.

    –Herbert B. “vomited all food from birth through the third month,” after which feeding progressed satisfactorily.

    –John F.’s father said, “The main thing that worries me is the difficulty feeding. That is the essential thing, and second is the slowness in development. During the first days of life he did not take the breast satisfactorily. … There is a long story of trying to get food down. We have tried everything under the sun.”

    Kanner noted that John had “frequent hospitalizations because of the feeding problem. No physical disorder was ever found, except the anterior fontanelle did not close until he was two-and-a-half. He suffered from repeated colds and otitis media (ear infections).”

    What could these symptoms mean? Perhaps nothing, because babies tend to have all sorts of upsets, but the pediatrician said such illnesses and digestive ailments might increase a child’s vulnerability to toxins by making them harder to eliminate.

    In the reverse, they could signal if something was causing the child’s autism, then it was disrupting their entire system.

    It obviously is impossible to tell, but consider this: Today, the children diagnosed with the regressive kind of autism are usually the ones with the food allergies, digestive problems and long-running infections that suggest an immune system under siege and out of whack.

    That is the kind of autism that now predominates. At first, autism at birth was much more frequent, but now regressive cases are several times more common, according to Bernard Rimland, a pioneer autism researcher.

    Perhaps something did happen to some of Kanner’s children after they were born in the 1930s — and perhaps whatever that was is still happening.

  • The Age of Autism: Feedback Loop

    By DAN OLMSTED   |   May 3, 2005 at 12:05 AM

    WASHINGTON, May 3 (UPI) — One of the great things about being a journalist in this day and age is how easy it is to interact with readers in a meaningful way.

    In olden times, say 1980, there was the telephone, the letter to the editor, the occasional community forum, sometimes the angry subscriber at the front desk who made you think about slipping out the back, but that is nothing like the immediacy and depth the Internet and e-mail provide.

    This new world was brought home when I began this series about autism. My purpose is to trace what scientists call its “natural history” — where autism first appeared, how it spread, whether it changed and what all of that might signify.

    I invited feedback — “comment, criticism and suggestions” — and I got tons of it. One reader took me to task for describing the behavior of autistic children as “bizarre,” and clearly she is right. There is enough stigma based on difference in this society that adding to it is a bad thing. The point was autistic children behave in characteristic ways that makes them hard to miss, and that is what should have been said.

    This reader also objected to my use of the word “ominous” in discussing the spread of autism to a wider segment of society in the 1940s. I disagree with her about that, because hard-core autism is awful, period. The rise of autism in the United States needs to be faced and fixed.

    Most of the feedback — some quite lengthy — addressed the three questions at the heart of the issue:

    –When did autism start, or was it always with us, and is it increasing?

    –Why was it first diagnosed in the 1930s among children of an elite group in U.S. society — college-educated professionals?

    –Is autism something children simply inherit, or is there an outside factor, and if so, what?

    Those are the questions raised in the first three articles, and we will explore them in depth going forward, but I am turning over the remainder of this column to readers’ comments, edited only for length. These interactions make me more cautious, more curious, and, if nothing else, more considerate — and no, they do not make me want to sneak out the back door.


    I think you have been badly informed about the nature of autism. I am sorry to be so blunt, but your articles reveal a serious lack of perspective of how autism plays itself out in families and in the lives of individuals.

    As for why autism seems more prevalent today, one reason is: an autistic child born in the last 30 years is bound to be more frequently assaulted by noise and irritations like florescent lighting that can be inescapable; they are more likely to be exposed to overstimulating routines like being taken to day care at 7 a.m. 5 days a week. These things force more autistic coping behaviors to the fore and make the children seem more autistic.

    The autism epidemic is a bogus construct that is kept alive by parents who love to whine and dramatize the pathos of their lives while demanding money from their governments. One might take note that the vast majority of these people are Caucasian and middle- to upper-class. Many of them are angry that their carefully planned-out lives have been disrupted by an autistic child or two and they are perfectly willing to exploit their children to get attention. I find it very disturbing to observe them in action.

    I hope you will look carefully at what they are saying and that you will not write anything that will add fuel to the autism epidemic hysteria.


    Autism is ancient. Look at Newton for example. Look at how Archimedes died — now that’s about as autistic as you can get. Putting concerns with geometry above concerns about the social order, he died when he reprimanded a Roman soldier for stepping on his circles in the sand.

    Forget the recent assignment of the label autism, and look at the older myths. For severe regressive autism there was the changeling, a child that suddenly lost speech, the village idiot; for high-functioning autism/Asperger’s there was the eccentric genius, the asocial village blacksmith unmarried because he was unable to notice the advances of women.

    Forget the words, look for the traits in history. The only advance in the term autism is understanding that Einstein and the village idiot had something in common. One condition covers both extremes.


    I am the parent of a 15-year-old girl diagnosed with autism when she was 3. I have always been baffled about the community of experts who would maintain that autism has always been with us. They claim that they are just now so smart, that they are finally beginning to notice it. To the question, “Where are all these old autistics?” we are told that they were institutionalized.

    I was brought up in the ’50s. I went to a parochial school with 50 children to a classroom. I remember seeing children with Down syndrome and I remember seeing children with epilepsy. I never saw anyone with autistic symptoms. I remember no stories about children who were “sent away” to institutions.

    I have never read anything in old literature where a character was described, such that he or she might have been diagnosed as autistic. People love to say that Einstein was autistic or had autistic traits. I don’t buy it.

    How many of the children diagnosed will marry? How many will have a satisfactory social life? How many will get a college or high school education? How many will have a successful career?

    Talk to parents of children my daughter’s age. We diagnosed our children. We educated the doctors. They told us not to worry. They told us children develop at different rates. We knew there was something terribly wrong.

    I have no idea what causes autism. Perhaps there is a strong genetic link. Until we investigate the clues right in front of our noses, we will not unlock the mystery of this disorder. We must recognize that it is here now, and it wasn’t here before.


    I have been following with interest and frustration the recent media coverage of the so-called autism epidemic. Your approach to the issue — the origins of autism — is a little different, and I have enjoyed reading your pieces.

    In your second installment, “Educated Guesses,” you wonder about the conceivable risk factors for autism among the college-educated men and women of the 1920s and early 1930s — specifically, the highly educated group of parents of Leo Kanner’s first autism subjects. I’d like to speculate a little.

    At the same time, social and economic changes were making life harder for autistic people. There was less room for a reclusive scholar, a quiet farmer, an artisan of few words, or a secluded poet, for example. These Kanner parents were living during the rise of urban living, mass production on assembly lines, and the standardization of mandatory public education. All these forces combined to give heightened importance to the “social drive,” fitting in, getting along, and teamwork. It is no surprise to me that somebody decided to pathologize autism in the early 20th century.

    The decade of the 1920s may have been the age of jazz, the age of sports, and the age of Prohibition, but I don’t think it was the age of autism. I think it is unlikely that some genetic mutation suddenly occurred then. I think that social and economic conditions are the cause of the autism “epidemic.”

    But I’m just speculating.


    It always amazes me how something that is so obvious to those of us who are genuinely knowledgeable about autism can utterly escape those that have a passing interest … like reporters.

    Here is the most plausible explanation for the profile of the first families to endure the horrors of autism: The mercury-based preservative thimerosal was first introduced into vaccines in the 1930s. Kanner identified the first cases of autism in 1938, a condition he called so unique, nothing like it had ever been seen before.

    The families most likely to fully vaccinate their children at the earliest possible age were those who were well-educated (especially in the medical profession) and had the means to obtain comprehensive medical care for their children.

    Even Bruno Bettelheim, the autism-treatment pioneer (though now fully discredited for his theories) observed that the mothers of autistic children were especially dutiful in noting and acting upon all medical information they were given (however misguided).

    To suggest that common genes somehow spawned the current autism epidemic is remarkably ignorant. Any ninth-grade biology student will tell you that genetics alone can’t create epidemics … they don’t mutate that fast. The children of these highly educated and well-meaning parents were the first victims of what later came to be the mercury-poisoning of 1.5 million children in the U.S. alone.

    Please, before you go espousing your own speculative and uneducated theories, get the scientific facts on thimerosal.


    One possible theory not mentioned is that the parents of the autistic children described by Kanner might themselves have been somewhere on the autistic spectrum but went unrecognized because they were farther along in their development than the children Kanner was studying. Most autistic individuals develop fluent speech over their lifespan. Autistic wiring confers many intellectual advantages, often in the area of analytical thinking.

    Autistic people have been around for centuries; Kanner was just one of the first to describe autism in the clinical literature of modern psychology, and he just happened to be working within the first couple of decades of large-scale entry of women into higher education.

    Check out the life of Henry Cavendish (he discovered hydrogen, and was lucky enough to be the richest man in England); Oliver Heaviside (you wouldn’t have your cell phone without him); Nikola Tesla (inventor of wireless, Marconi stole his thunder); Blind Tom Wiggins (piano-playing phenom of the 19th century, son of uneducated slaves).

    Lastly, I urge you to reconsider your use of words like “bizarre” and “ominous” in describing autism and people on the autistic spectrum; they are sensationalistic and insulting! With all the growing awareness of autism these days, and the hysteria that has grown around its increased recognition, autistic citizens are being increasingly bombarded by this sort of florid verbiage.

    “Autism” is not a “thing”; rather, “autistic” is a kind of people who should be discussed with respect.


    I was in the room at a conference in Baltimore when a leading geneticist from Hopkins stood up from the audience to add that there was nothing in genetics that could possibly explain the epidemiological history of autism.

    The question of why the frequency of incidents of neurological damage (not only autism but also narrower learning disabilities like dyslexia, or disabling conditions like Tourette’s) is growing faster than genetics can explain is one that is universally relevant. It is not just the parents of autistic children who will pay for this damage.

    This epidemic will be paid for by anyone who pays taxes as departments of education and ultimately disability and rehabilitation become legally required to care for people who struggle to learn and care for themselves. It will be paid for by anyone living in an economy where a significant percentage of men are unable to do work requiring more than elementary education.

    Moreover, while these challenged children are now objects of sympathetic interest, they may soon enough be seen as canaries in the coal mine. What will the numbers of affected people be in 10 years? Finding the environmental piece of the puzzle is an issue for everyone, not just those of us who are already caring for a disabled child.

    As the saying now goes, genetic diseases do not present as epidemics. It is deeply mysterious to me, therefore, that there is not more open, public discussion of the possible suspects, and vigorous research to rule them out.

  • The Age of Autism: Educated Guesses

    By DAN OLMSTED   |   May 2, 2005 at 12:05 AM

    WASHINGTON, May 2 (UPI) — There was something similarly strange about the children who caught Leo Kanner’s attention starting in 1938. He called their behavior “autistic.”

    There also was something strangely similar about the families they came from.

    “There is one other very interesting common denominator in the backgrounds of these children. They all come of highly intelligent families,” child psychiatrist Kanner wrote at the end of his historic study of 11 children, published in 1943.

    He ticked off the fathers’ occupations: four psychiatrists, one “brilliant lawyer,” one chemist and law school graduate, one plant pathologist, one professor of forestry, one ad copywriter with a law degree, one mining engineer and one businessman.

    “All but three of the families,” Kanner wrote, “are represented either in ‘Who’s Who in America’ or in ‘American Men of Science,’ or both.”

    Among the first 100 cases Kanner saw, he reported they “almost invariably came from intelligent and sophisticated stock.” Of the 100 fathers, 96 were high school grads and, of those, 74 were college grads — almost twice today’s percentage. They included:

    –31 businessmen

    –12 engineers

    –11 physicians

    –10 lawyers

    –8 tradesmen

    –5 chemists

    –5 military officers

    –3 with a Ph.D. in science

    –2 with a Ph.D. in the humanities.

    Why this amazing “intellect effect” in the parents of children whose only common traits were language delay and deficit, “extreme aloneness” and “a desire for the preservation of sameness?” Kanner said those traits were present from birth: “These children had never been there.”

    The topic is not much discussed these days, as researchers hunt genetic causes and debate whether autism rose tenfold during the 1990s. Yet, the effect was so striking — and, it turns out, so short-lived — that surely it is a clue to the roots and rise of autism, the subject of this ongoing series.

    “It is not easy to evaluate the fact that all of our patients have come of highly intelligent parents,” Kanner acknowledged.

    Theories:

    –Brilliant people (read: brainiacs who were a little weird to start with) hook up with other brilliant people and produce autistic (read: very weird) children. Verdict: unproven, unable to explain more than a fraction of children now affected.

    –So-called refrigerator moms and dads, who obsess over their careers and their academic abstractions, coldly ignoring their child’s development. Verdict: a damaging and discredited idea.

    –Parents with the most education and money were most likely to bring their children to a specialist like Kanner. Verdict: plausible.

    –Autism started in this stratum of society. Verdict: plausible.

    Let’s discuss the two open verdicts.

    Four of those first 11 fathers were psychiatrists, likely to realize early on that something was clinically wrong with their children — and likely to know about Kanner, a renowned psychiatrist at The Johns Hopkins University in Baltimore.

    Interesting, though, one of the first autistic children appears to have been identified, not by her psychiatrist father, but by a doctor at the institution where she lived. Kanner disapprovingly remarked she had been “dumped in a state school for the feebleminded.” This suggests, counter-intuitively, her father’s medical career might be a risk factor for autism, not the reason she was referred to Kanner.

    Regardless, the whole approach feels dubious and has a whiff of paternalism — only the really top-drawer crowd would notice their child had a bizarre problem and get to the right doctor. It also is significant that Kanner, a brilliant observer, did not dismiss the “intellect effect” that way, but continued to puzzle over it.

    Another correlation, less noticed, involves the mothers: nine of the first 10 also graduated from college, including a writer, a physician, a psychologist and a history teacher.

    The 1940 U.S. Census reported just 3.8 percent of all women over 25 had completed four years of college. Yet, 90 percent of these mothers graduated from college? That is at least as startling as the fathers’ attainments.

    Looked at this way, what really connects these first families, including the husbands and wives, is more precise and less bizarre than an “intellect effect.”

    It is a college education, particularly the remarkable fact of the women’s degrees.

    This education effect does a better job of reconciling Kanner’s view — that autism was “very rare” and differed “markedly and uniquely from anything reported so far” — with the much higher current autism rate of 30 to 40 children out of every 10,000. It does so by defining the parents of these early autistic children by what they did (going to college) instead of who they were (brainiacs).

    It does, however, raise an unpleasant prospect: Some outside factor, unique to that remarkably homogenous group at that time, could have triggered autism in their children — and then spread.

    There are some early signs of exactly that spread: The one pair of parents without college educations constitute the 11th of Kanner’s original 11 families.

    Their son, Charles, was born in 1938; the other 10 children were born earlier in the decade. Kanner described the father as “a high school graduate and a clothing merchant … a self-made, gentle, calm and placid person.” His mother, whose education also stopped with high school, “has a successful business record, theatrical booking office in New York, (and is) of remarkable equanimity.” (Say good night, weirdo-brainiac-refrigerator-mom theories.)

    Look again at the list above of Kanner’s 100 fathers, a list that incorporates the super-educated dads from the original study. Starting with Charles’ parents, college and whatever it might imply no longer was the common thread.

    Ten out of 10 of the original fathers were college graduates, followed by 64 of the next 90 — still impressive, but a much lower percentage, no longer connecting all the families. Four did not even graduate from high school and eight were described as tradesmen.

    There was not one businessman among the first 10 fathers, but there were 31 in the next 90. There were four physicians in the first 10, but just seven more in the next 90.

    Demographics are always tricky to decipher, and it is easy to make too much of too little, but at some point all sorts of families began having autistic kids, and that ominous pattern may well be visible in the first 100 cases.

    What were the conceivable risk factors for autism among the college-educated men and women of the 1920s and early 1930s and did they spread? We will pursue that in future columns.

    Next: Clues from Kanner’s kids.

  • The Age of Autism: ‘Absolutely different’

    By DAN OLMSTED   |   April 29, 2005 at 12:05 AM

    WASHINGTON, April 29 (UPI) — Her name was Virginia.

    “Virginia S., born Sept. 13, 1931, has resided at a state training school for the feebleminded since 1936, with the exception of one month in 1938, when she was paroled to a school for the deaf for ‘educational opportunity.’”

    So wrote Leo Kanner, world-renowned child psychiatrist at The Johns Hopkins University in Baltimore. He went on to point out Virginia was neither feebleminded nor deaf. She was autistic.

    Virginia was, in fact, the oldest of the 11 children in Kanner’s 1943 paper, “Autistic Disturbances of Affective Contact,” which first named “autism” as a distinct and devastating disorder. Kanner said autistic children differed “markedly and uniquely” from anyone ever described. They were “something new.”

    Virginia — no last name or home state was given — was referred to Kanner after Dr. Esther Richards saw her several times at the training school.

    “Virginia stands out from other children,” Richards wrote Kanner, “because she is absolutely different from any of the others.” She did not talk. She did not play with other children. She did picture puzzles by the hour. “All findings seem to be in the nature of a congenital abnormality which looks as if it were more of a personality abnormality than an organic defect.”

    In 1955 Kanner revisited his first 42 cases. The oldest autistic person at that point was 24 — born in 1931 and presumably Virginia S.

    Across the Atlantic, something remarkably similar was happening almost simultaneously.

    A Viennese pediatrician named Hans Asperger also was identifying children he called autistic, though in a slightly milder form that came to be known as Asperger’s Disorder. Of his four case studies, only one, Fritz V., is given a birth year: 1933. Two of the other children also appear to have been born in the 1930s, given their age when Asperger met them.

    The fourth, Hellmuth L., was first seen “six years ago, at age 11,” Asperger wrote in his 1944 paper. That means he was born around 1927, but Hellmuth is interesting for another reason: His case study appears to be the only one described by Kanner or Asperger whose autism clearly was due to organic causes.

    “He had severe asphyxia (lack of oxygen) at birth and was resuscitated at length. Soon after birth he had convulsions. … In Hellmuth’s case there were clear indications that his autism was due to brain injury at birth.”

    Many autistic children are characterized as looking angelic. Hellmuth was “grotesque,” Asperger said, perhaps because of his brain damage.

    Asperger drew a “preliminary conclusion” that some organic problems create symptoms “closely similar to the picture presented by ‘autistic personality disorder’ of constitutional origin.” That has been proven correct.

    So, the only case study, by either Kanner or Asperger, of an autistic child clearly born before 1931, had a different cause: brain damage.

    Here is the question: How many people born before 1931 fit the profile, not of Hellmuth but Virginia — nothing apparently wrong with them except this bizarre and baffling set of behaviors?

    That might sound arcane, but it is crucial: When and where classic “Kanner autism” began is key to tracking its roots and rise. That is the focus of this series.

    Some experts on autism say many such people have been documented before the 1930s. One of the most-cited instances of apparent autism — some say the first — was Victor, the Wild Boy of Aveyron, who was discovered living in the woods in France in the late 1700s — and who is profiled at feralchildren.com.

    “There can be no doubt that Victor was autistic and fitted into Kanner’s syndrome,” wrote British psychiatrist Lorna Wing.

    Other early possibilities were outlined in an intriguing e-mail message I received after the last article, from longtime autism researcher, Dr. Darold A. Treffert.

    “You raise the question whether Kanner and Asperger were seeing a ‘new disorder,’ or were they simply very keen observers who, for the first time, provided a classic description of an until-then-unrecognized but existing disorder? I think the latter,” Treffert wrote.

    “In fact I think autistic disorder was part of Dr. J. Langdon Down’s original 10 cases of what he called (regrettably) ‘idiot savant,’ now known as savant syndrome. The movie ‘Rain Man’ made autistic savants household terms.”

    Treffert is past president of the Wisconsin Medical Society and a psychiatrist at St. Agnes Hospital in Fond du Lac. He wrote the book “Extraordinary People: Understanding the Savant Syndrome.” He directed me to a Web site about the phenomenon: savantsyndrome.com. There, his discussion of Down’s cases reveals striking similarities to modern autism.

    Down, best-known for having described Down syndrome, gave a lecture in 1887 to the London Medical Society, in which he described 10 patients as having remarkable gifts — far too remarkable to consider them retarded — but also “living in a world of their own.” One boy “(referred) to himself in the third person,” “lost speech,” “self-contained and self-absorbed, caring not to be entertained other than (in) his own dream-land, and automatic and rhythmical movements.”

    “Those descriptions are so applicable to what we now call Autistic Disorder. … Autism is not a new disorder,” the summary concluded.

    Nor is it increasing, according to what might be called the “steady state” theory of the autism universe. It was always thus, just not diagnosed. Those who believe instead in the “big bang” — an initial explosion of autism in the 1930s that has been expanding ever since — argue that scattered cases before then actually make their point.

    The pre-1930s cases were few and far between, goes this argument, and might have resulted from organic triggers such as Hellmuth L.’s brain damage or congenital defects such as Fragile X Syndrome, which causes a small percentage of today’s autism cases.

    Or, even measles might be responsible. There is an early account of a child who, after getting measles, changed markedly and developed repetitive speech and other autistic behaviors. Measles is a known culprit in other cases. Some women who contract German measles while pregnant give birth to children with Congenital Rubella Syndrome and a significant percentage of those children are autistic.

    When Wing said, “the history of autistic disorders stretches far back into the mists of time, long before Kanner’s and Asperger’s insights,” it is unclear how well we can see through those mists. More pertinent, perhaps, would be knowing the number of Americans with autism who were alive on Sept. 12, 1931, the day before Virginia S. was born.

    Today’s autism rate is 30 to 40 out of every 10,000 children, according to several studies, including one in 2003 by the Centers for Disease Control and Prevention. Applying that rate to the U.S. population of 123 million in 1931 would mean at least 369,000 people were autistic.

    That is an awful lot of people, but it is the number resulting from the steady state theory of autism. Cut that number by one or two orders of magnitude, just for the sake of argument, and you face the same issue.

    Of course, in 1931 none of those people would have been diagnosed with “autistic disorder,” but would not some percentage of those 369,000 — the infants, children, teens and adults of 1931 — ultimately have been called autistic instead of deaf, or feebleminded, or schizophrenic, or whatever they were originally labeled?

    Like Virginia, they already stood out because they were “absolutely different from any of the others,” and by 1943 Leo Kanner had defined their disorder and given it a name.

    Something doesn’t add up.