WASHINGTON, Jan. 25 (UPI) -- "You're going to hate my book," Roy Richard Grinker told me a few weeks ago when I met him at George Washington University. Actually, I don't hate "Unstrange Minds: Remapping the World of Autism," his newly published, beautifully written look at autism through the lens of history and culture.
I just disagree with it.
Grinker -- an anthropology professor and father of a teenage daughter, Isabel, who has autism -- sees a genetic brain-based disorder that, contrary to widespread belief, has not truly increased.
Rather, he says, it's just better-recognized. Plus, the categories have expanded to include a "spectrum" of related disorders including the milder Asperger's. "Maybe we are finally diagnosing and counting autism correctly," he writes.
Grinker, who mentions my reporting in the book, marshals an impressive body of research to support his contention. Time magazine gave it a full-page review and found his argument "persuasive." Regardless of one's point of view, it's good to have the case against an "autism epidemic" spelled out as clearly and convincingly as possible.
That said, I do suspect autism has exploded in ways that are not satisfactorily explained by Grinker's argument -- and, therefore, that some new "environmental insult" interacting with genetic susceptibility is behind the rise. My basis for that is not solely the ten-fold increase in diagnoses in the past two decades; it goes back much further.
Read the first words of the first scientific paper written about autism in 1943 by Leo Kanner, the Johns Hopkins University child psychiatrist who introduced the disorder to the world:
"Since 1938, there have come to our attention a number of children whose condition differs so markedly and uniquely from anything reported so far, that each case merits -- and, I hope, will eventually receive -- a detailed consideration of its fascinating peculiarities."
Years later, he called it "a behavior pattern not known to me or anyone else theretofore."
Does that sound like something that's been around for ages at the same prevalence? Not to me. What gives Kanner's comments heft is that he had just written the first comprehensive tome on child psychiatry ever published in the United States -- aptly titled "Child Psychiatry."
Of the 11 initial cases documented by Kanner, four of the fathers (accounting for more than one-third of the cases) were psychiatrists. Grinker calls this referral bias -- in other words, if you're a psychiatrist and you notice something wrong with your own child, you're much likelier to avail yourself of the services of an acknowledged leader in the field like Leo Kanner.
But, to my mind, that raises another question about the "no epidemic" argument. Here's a thought experiment:
When the study came out in 1943, the oldest child was 11 or 12, born in 1931. The study was published in a journal (The Nervous Child) aimed at psychiatrists. Yet as far as I can tell from his many follow-up accounts, Kanner never heard from a psychiatrist (or anyone else) with a child born before 1931 -- in other words, with kids as young as 13 when the study appeared.
If four psychiatrists brought their children to Kanner before the disorder even had a name, why was there dead silence afterward from psychiatrists with autistic teenagers?
This rather humble experiment, along with taking Kanner at his word, suggests to me that 1930 really was a bright line -- before-and-after the age of autism. If my facts or reasoning are flawed, please let me know. Until then, I'll continue to suspect that something new set off the disorder -- and, ultimately, an autism epidemic.
Grinker makes one inadvertent error worth mentioning. Among Kanner's original cases was a child called Richard M.; Grinker says Richard, "like many of the others ... showed signs of normal cognitive development -- or at least this is what the parents retrospectively argued -- until he was about two. Then, as his mother wrote to Kanner, 'It seems that he has gone backward mentally gradually for the last two years.'"
Grinker misreads Kanner. Richard regressed at about one year old, not two.
Picky? Well, consider this comment about Richard in the original study: "Following smallpox vaccination at 12 months, he had an attack of diarrhea and fever, from which he recovered in somewhat less than a week," Kanner wrote.
To me, that's a possible clue -- a vaccine reaction -- and it made me go over the timing very carefully. If you've discounted that idea, it's easier to make a math error and conclude that Richard, like "many of the others," proves the point about regression at age 2.
As the epidemiologists say, "Assume nothing. Let the evidence speak for itself."
When Grinker visits the only school for autistic children in New Delhi, he finds more evidence of referral bias: 10 of 10 fathers and four of 10 mothers were college-educated, and half the men had advanced degrees. That confirms what he's already concluded: "People of higher socioeconomic status tend to avail themselves of medical interventions more often than people of lower socioeconomic status."
"I interviewed only one child there who had received a diagnosis of Asperger's Disorder, and -- big surprise -- his mother was a chemist with a Ph.D. from Harvard ... "
Grinker's not surprised because advanced education fits his hypothesis. He notices the Ph.D.; I notice it was in chemistry. In earlier columns I pointed to a couple of overlooked, thoroughly mainstream autism studies from the 1970s that found a "startling" chemical connection via parents' professions. And chemists stood out -- that's not my bias, that's what the experts saw when they looked at their data.
I've proposed that several of Kanner's first 11 highly educated fathers might also suggest an unrecognized chemical connection: plant pathologist (Ph.D.), forestry professor (Ph.D. and Richard's father), mining engineer (college degree), chemist-lawyer (J.D.).
Even those first four psychiatrists -- M.D.'s all -- might signal not solely referral bias but professionals who had availed themselves of new medical interventions or medicines with "markedly and uniquely" tragic consequences. That, too, could be a chemical connection.
So that's why I just disagree with "Unstrange Minds." As Grinker says of those who believe there is an autism epidemic, "I sympathize with these opinions, but I think they are wrong."
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