A... what?

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In years past, the most over-diagnosed psychiatric condition have, in turn, been depression, ADHD, and bipolar syndrome.  These days it seems that everyone is talking about Asperger's and Autism.  I'm sure that if you are reading this blog you have enough experience online to read comments by posters claiming Aspergers, and seen the web-based surveys that purport to tell you where you fall on a scale from Autism to Aspergers to "neurotypical" (i.e. the rest of us).  As I was looking at the potential list of topics to cover in today's blog, my son, studying Forensic Psychology in college, leaned over my shoulder and said "Considering how many people claim to have Asperger's Syndrome as an excuse for being a total jackass - why don't you cover that!"

I have probably lost some readers right there - but believe me - I am not denigrating those with *legitimate* diagnoses of Asperger's syndrome. Instead - I want to make a point about self-diagnosis, which will come a bit later.  Way back when I was a Sunday School teacher, I had a 4 year old student that would only play by himself in the corner, he would not socialize, spoke very little and would fight if forced to leave his comfortable spot.  He was extremely smart, we could tell that from story time, but he did not socialize well.  He had Aspergers - and that was the first I had heard of it.  Fourteen years later, he graduated near the top of his high-school class, played in various musical groups, acted in plays and musicals, and was essentially socially well-adjusted - or at least compensated very well.

And the latter point is very important.

Autism and Asperger's are part of a spectrum of disorders characterized by a very poor connection with the outside world.  Autism is quite frequently co-diagnosed with hearing disorders - not deafness, but instead a hyper sensitivity to certain sounds.  Asperger's and Autism are well defined psychologically, but poorly defined neurologically.  In other words, it is hard to point to any one malfunctioning brain area.

This leads to misunderstanding, misdiagnoses, and misuse of the term.

Both Asperger's and Autism have characteristics that show up in scans of brain activity - low activity in the frontal areas, and high activity in occipital and parietal areas - in other words - a lot of sensory activity, but much less "executive function."  The exact cause is unknown, but theories regarding insufficient connectivity or hypoactivity abound.  There are a few things we do and do not know about the disorders.

Autism and Aspergers are part of a spectrum - at one end are highly impaired persons that do not interact at all with their surroundings - particularly not with other people.  At the other end is normal social functioning.  The actual description of this scale is "Autism Spectrum Disorder."  There can be individuals with ASD that are very bright, very high functioning in society. The only way we know a person might even have ASD is that they don't understand or even detect normal social cues. 

Again, there are many popular online web sites and emails that purport to tell you where you fall in the ASD spectrum on the basis of answers to a few (typically <50) questions.  SELF-DIAGNOSIS is DANGEROUS!   Not to mention notoriously inaccurate.  The professional neuropsychological exam that I have seen consists of over 300 questions, several story problems, an interval with a clinical psychologist, and extensive observation of social behavior.  Anything less is not a professional diagnosis.  Any self-diagnosis is likely to be even less accurate - hence my son's comment in the first paragraph. (Disclaimer he is studying Abnormal Psychology with a minor in Criminal Justice - he knows whereof he speaks!).

We now know that Autism and Aspergers are not linked to childhood vaccinations.  The study that reported the link has been proven to be a fraud.  The professor stood to profit massively from the resulting backlash against vaccines, and he "cooked the books" with regard to the data analysis.

There are plenty of celebrities that still like to trot out the Autism/vaccine link, saying "Just because that study was disproven doesn't mean it isn't true."

Yes it does. 

There was *ONE* study which linked the mercury-containing preservative "thimerosal" with Autism. For the statistics, the author "cherry-picked" 12 subjects out of a base of over 300.  Even looking at only 1/25th of a population of persons with autism, the statistics could *barely* register any cause-and-effect thing over random chance. We now know that even that data was inaccurate, even fraudulent (http://www.bmj.com/content/342/bmj.c7452).  The study was disproved, the journal in which it was published has retracted the finding and censured the author - but does that mean the data says otherwise?

Yes, the data says otherwise.  An article by Stehr-Green, Tull, Stellfeld, Mortenson, and Simpson: "Autism and thimerosal-containing vaccines: Lack of consistent evidence for an association," appeared in the American Journal of Preventive Medicine, Volume 25, Issue 2, August 2003, Pages 101-106. (DOI: 10.1016/S0749-3797(03)00113-2) (http://www.sciencedirect.com/science/article/pii/S0749379703001132) This study shows that the rise in Autism diagnoses predates the rise in mercury content of vaccines in California, and is parallel in Sweden and Denmark, countries with negligible Thimerosal/mercury exposure.

The link between Autism and vaccines has been disproved.   Before believing any celebrity that says otherwise - ask yourself first whether, since even supposedly credentialled science can be false, do you really trust an uncredentialled musician, actor, politician - or even writer - to practice medicine without a license?

So - how to incorporate Autism or Aspergers as a plot device?

It would be very difficult to write a primary character with ASD - we just don't know the neurological basis for the disease.  On the other hand, we know that patients with ASD need extra parental care and different social encounters - it would be a perfect plot device to include an Autistic or Asperger's relative to explain a protagonists busy - even hectic - life and strained social relationships.

Above all - do NOT perpetuate the Autism and vaccines myth.

Don't make me come after you!

Until next time...