This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders.
Improved Autism Detection Methods came with a Hefty Price Tag by Dustin Belden
Have you ever heard the adage that life is all about timing? The romantic attachments you cross paths with when you’re ready, the jobs that are open and available for hire when you’re looking, and the information that’s available when you’re open to influence, all happen in the moment. In some regards, timing is everything, and what happens in the moment, can shape your future self forever. In the case of the autism/vaccination link, the same thing can be said – Timing is Everything.
By now, it seems as if everyone has at least been exposed to the Autism/Vaccine calamity. The topic poked its ugly head out of the ground in 1998 when Andrew Wakefield published a report about the link between autism and the MMR vaccine. The British Medical Journal, which is the journal in which Wakefield disseminated his results, has concluded that the study was an absolute fraud, that the children showed developmental disabilities before the vaccine, and that Mr. Wakefield received over a half million dollars from attorneys hoping to use his report for a class action lawsuit. Connections to the origin of autism have been haphazardly thrown around by John McCain, Jenny McCarthy, and Donald Trump but the science has been consistent. After millions of dollars spent in due diligence of calming the public, multiple health panics due to the choice not to vaccinate, years of media confusion, and countless unfortunate aftereffects, scientific researchers have found that there is NO link between vaccines and autism. Regardless of this exhausting fact, the conspiracy theories still haven’t completely abandoned ship. So instead of providing more evidence that might not be accepted, I think it’s important to take a look at how we got here.
Compared to how long autism has been present in humans, the history of understanding autism is actually a relatively short one. Several evolutionary theories attempt to explain why autism has been passed along through history as a polygenic trait, including explanations of imbalanced genomic imprinting, parentally selected fitness indicators, and polyvagal development. The most recent neurological evidence that shows autism beginning in the early fetal stages seems to implicate that the etiology of autism may be a combination of each evolutionary theory. Polyvagal theory may have the most applied merit, since it relies on developmental areas that can be more easily observed. But while we now know a significant amount about the development of autism, this wasn’t always the case.
In the early 1900’s, what we now call autism, psychiatrists considered a range of neuropsychological disorders. Around 1911, a Swiss psychiatrist, Eugen Bleuler, first coined the term autism, which he used to describe a group of schizophrenic symptoms. Later in America, psychiatrist Leo Kanner applied a description of autism after 11 children that he studied, who possessed some of the symptoms of what we know exist in autism. Still, he and psychiatrists through the 1960’s continued to lump autism together with childhood schizophrenia. It wasn’t until the 1970’s that we understood that autism was caused from biological differences in brain development, and the 1980’s that objective criteria for diagnosing autism was developed. At this time autism was definitively given its own classification, clearly separate from childhood schizophrenia. In 1994, the American Psychological Association, through its diagnostic manual, the DSM-IV, added Aspergers to the Autism Spectrum, and it wasn’t until 2000 that the United States Center for Disease Control (CDC) began tracking the rates of autism.
A brief chart summarizing the evolution of autism definitions and descriptions
Pre-1900’s – Autistic children lumped in with mentally retarded or the insane: There was a story recorded in a book, The Wild Boy of Aveyron, of a boy that people said he grew up with wolves because he couldn’t communicate with humans; in fact he had human parents.
1911 – The term autism first used by Swiss Psychiatrist
1943 – Leo Kanner publishes “Autistic Disturbance of Affective Contact” describing 11 socially isolated children who share an obsessive desire for sameness.
1950s – 1960s Autism widely regarded as a form of childhood schizophrenia. Psychoanalysts also blame emotionally cold mothering.
1970s – Autism understood as a biological disorder of brain development.
1980 – DSM-III distinguishes autism from childhood schizophrenia.
1987 – DSM-III-R lays out a checklist of criteria for diagnosing autism.
1994-2000 – DSM-IV and DSM-IV-TR expand definition of autism and include Asperger syndrome. CDC keeps track of autism rates.
2013 – DSM-5 folds all subcategories into one umbrella diagnosis of autism spectrum disorder (ASD). It is defined by two categories: impaired social communication and/or interaction and restricted and/or repetitive behaviors.
A short look through this chart and you can see that only in the last few decades did behavioral professionals truly understand how to classify autism. It would make sense that more and more people would be diagnosed with this disorder as the diagnostic information spread. It takes a while for information to get around… or at least it used to. The DSM-IV, which was created in the early 1990’s, was becoming popular aound the same time as something that completely revolutionized the spread of information: the Internet.
The internet was developed earlier, but private companies (ISP’s) were not allowed direct connection until the mid-1990’s. Social media wasn’t invented yet. The general public only had access to what behavioral scientists had to say if they had the money to go and see them. Now, healthcare has expanded access to behavioral experts, referrals and emails about diagnoses are given over email every day, social media sites like Facebook and TUMBLr push information to average citizens about every topic imaginable. People don’t have to wonder what is wrong with their child, they have all the means they need to figure it out. In fact, information about Autism has evolved so much that people are screening their children at ages much younger than before.
The title of this blog mentions that all of this progress came with a hefty price tag. Well, by being able to identify autism at the earliest ages in our human history, we also bump into the ages in which vaccines are required. Though the research over the last two decades is solid and consistent that there is no connection with thimerosal and autism, it’s been difficult for the public to digest how dynamically things have changed. The erroneously flawed and now retracted research of Andrew Wakefield didn’t help either. Nevertheless, some anti-vaxxers try to make claims on other vaccines besides MMR, for example, stating that there is correlative evidence that the Hep B vaccine causes autism. Well, the Hep B vaccine was added to the list of recommended vaccines in 1995, just as the internet was rolling out, so of course correlations will exist as millions of additional people are learning of autism. Some anti-vaxxers claim that there is correlative evidence that the Hep A vaccine causes autism. The Hep A vaccine was added to the list of recommended vaccines in 2000, just as the internet was still young and gaining millions of users per year. The CDC also began recording autism rates for the first time, so with a young internet, it is natural for a population growth curve to look like autism rates were increasing from the beginning.
The truth is, we truly can’t know for sure whether autism has increased, because it was never diagnosed before like it is now. Information about it was never even able to spread like it is now. All we can look at is the evidence that we have, and the evidence states that better diagnostic criteria, more healthcare options, and the internet, has helped people live with autism like never before. The evidence is also clear, that there is NO link between vaccines and autism.