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A synthesis of theoretical perspectives of autism

The explosion of autism research since the end of the twentieth century has provided a multiplicity of theories proposing explanations for one or more of the characteristics of autism. Some theories are based on sound scientific research others are based on individual reports and recall. Currently no one theoretical perspective has been able to account for the spectrum of characteristics observed in autism. This discussion seeks to synthesis the information provided in the Analysis and Evaluation of the Theoretical Perspectives of Autism artefact ?????? by examining how this wealth of information has impacted developments in autism, exploring the interconnectedness of these theories and looking at the current thinking regarding these perspectives. The absence of sound scientific research linked to many theories has, from the onset, been responsible for damaging misconceptions. The earliest theories had a psychoanalytical perspective and suggested that lack of stimulation from parents led to the development of autism. This resulted in the institutionalisation of many children and left parents believing their behaviours were responsible for their childs autism. In his book, The Empty Fortress: Infantile Autism and the Birth of the Self, Bettleheim noted some similarities between behaviours of individuals in prisoner of war camps and individuals with autism. This led to the idea that child abuse and neglect may be a component in the cause of autism. Again the implications of this claim will have been far reaching and injurious to many families. Despite these theories being disproved after Bettleheims death in 1990, and the suggestion by Powell in 1999 that differences in the behaviour of parents with autistic children was a product of having an autistic child rather than a cause, this perspective is still advocated by some professionals and families. Another seemingly misleading group of theories, this time coming from an environmental perspective, is the implication of both the MMR vaccine and the use of thimerosal in vaccines in increasing autism risk. These theories, although never proved conclusively, resulted in many parents not having their children vaccinated against childhood diseases. The consequences of this are being dramatically demonstrated in Wales where, since November 2012, there have been 903 reported cases of measles. This outbreak is being attributed to parents not having their children vaccinated against measles, mumps and rubella due to the autism scare. Research has since confirmed there is no link between these vaccinations and autism. However, there is some speculation that this research may be driven by the companies that produce the vaccines and raises the question of a conflict of interest. The effect of temporal concurrence should be considered as a factor in the emergence of these theories. Many childhood vaccines are administered when the infant is also most susceptible to developing autistic behaviours. More recent theories from within and across differing perspectives appear to interconnect and substantiate one another. In 1996 Frith suggested the cognitive perspective of impaired

executive functioning was caused by frontal lobe damage present at birth. This would appear to corroborate the environmental theories of in utero insult leading to a higher risk of autism. Adding credence to this are scientific advances that have enabled brain hemisphere development to be monitored in the foetus by the use of ultrasound and detecting brain abnormalities. A further link exists between the two cognitive theories of extreme male brain and weak central coherence. The imbalance in the development of the brain hemispheres is cited as the cause for the extreme male brain characteristics seen in autism. If characteristics of systematising and lack of empathy can be attributed to an overdevelopment of the right brain hemisphere then it could be suggested that the underdevelopment of the left brain hemisphere would account for the language impairments seen in autism. In addition it might be inferred that the variability of language makes it inaccessible to an over developed right hemisphere that deals with systems and routines further compounding language impairments. As the left hemisphere is also responsible for our ability to see the bigger picture a connection can be seen between the theories of extreme male brain and weak central coherence. In 2005 Ramachandran et al suggested that broken motor neurons prevented individuals with autism from understanding or recognising the actions of others which would support Cohen- Barons cognitive theory of mind blindness. Some theories, such as the increase in candida producing higher frequencies of autism, have led to dead ends whereas research data from other theories have acted as catalysts for further research and the development on more precise theories. In the 1990s studies by Ritvo and Rutter made strong links to a genetic factor being implicated in the development of autism. Since 2000 this research has focused more closely on molecular genetics and specific chromosomal abnormalities. As a result a number of chromosomes and copy number variations have been linked to one or a cluster of autistic behaviours but also acknowledges that the presence of these chromosomal factors does not always result in autism. The vast increase in environmental theories has developed concurrently with molecular genetic theories again with different theories offering explanations for some but not all characteristics seen on the autistic spectrum. Opioid excess is thought to affect cognitive and behavioural function whereas deprivation of oxygen at birth can lead to symptoms including difficulties tackling complex tasks. Current opinion recognises the importance of multiple genetic and molecular genetic, factors in the causation of autism and the likelihood that these are triggered by prenatal or perinatal environmental factors. As many prenatal or perinatal environmental theories are based on individual or small sample size there is a need for longitudinal studies to look at these factors in a more controlled way. However, this multi causal explanation accounts for the enormous variation in the development of, and characteristics observed in, autism. A number of researchers believe that now is the right time to use and combine the evidence from these various theoretical perspectives to identify indicators of increased autism risk

and in doing so allow diagnosis and intervention to occur at an earlier stage in the childs development offering a higher chance of an improved outcome.

The purpose served by the varying perspectives of autism theories vary. Environmental theories such as opioid excess suggest the possibility of a cure or prevention, cognitive theories such as mind blindness offers an explanation of the core characteristics autism and methodologies that can be employed to work with these individuals. Whatever our role in the field of autism it is vital that we keep an open mind regarding all theoretical perspectives ranging from both scientifically validated theories to those based on personal accounts. It is important to consider the effect or temporal co-occurrence and remain mindful that co-existence is not necessary an indicator of cause. It is widely accepted that there are multiple causes of autism accounted for by a range of theoretical perspectives and consequently there will be a range of interventions that can be employed to support people on the autistic spectrum.

Rate of de novo mutations and the importance of fathers age to disease risk

Augustine Kong et al. Nature 488,471475 (23 August 2012) doi:10.1038/nature11396 Received 28 February 2012 Accepted 04 July 2012 Published online 22 August 2012

http://autism.about.com/od/whatisautism/p/autismcauses.htm http://www.autismspeaks.org/science/science-news/birth-complications-and-autism

Brain abnormalities seen in ASD due to genetics and exposure to environmental risks in utero Quote p 7 Herbet et al Move toward in utero factors combined with genetic predisposition resulting in altered brain development Away from bad parenting Need for longitudinal studies to look at environmental factors on autism environment component suggested by multifactorial manifestation of autsim Effects Toxins in brain from opioid excess is worsened by testosterone explain higher freq of ASD in males. Multifactoral nature of ASD means more than one cause and so more than one course of action imp to remain open minded about theories until scientifically Gupta S., Aggarwal

and Heads C. Dysregulated immune system in children with autism. Beneficial effects of intravenous immune globulin on autistic characteristics. J Autism Develop Dis 26:439-452, 1996.proved otherwise

Shaw W, (1999) Role for certain yeast and bacteria byproducts discovered by organic acid testing in the etiology of a wide variety of human diseases. Bulletin of The Great Plains Laboratory. Overland park, KS 66204 (913) 341-8949.

Nature Reviews Genetics 9, 341-355 (May 2008) | doi:10.1038/nrg2346

Advances in autism genetics: on the threshold of a new neurobiology


Brett S. Abrahams & Daniel H. Geschwind