What We Know About Autism: Separating the Science From the Scandal

Shortly after pulling a controversial documentary linking autism and common childhood vaccinations from the Tribeca Film Festival, Robert De Niro issued a statement explaining that festival organizers and members of the scientific community “do not believe it contributes to or furthers the discussion I had hoped for.” Instead, his decision has sparked a conversation that has recirculated discredited theories, leaving even the most informed among us feeling slightly confused.

As it happens, there is no proven link between vaccines and autism spectrum disorders, which are characterized by difficulties with social interaction, verbal and nonverbal communication, and repetitive behaviors. The theory’s origins lie in a study of 12 children published in 1998 in the British medical journal The Lancet. The article blamed the measles, mumps, and rubella (MMR) vaccine typically given to babies between 12 and 15 months for the eventual onset of behavioral problems among the children. It was retracted in 2010, and Andrew Wakefield, the doctor who led the research, has since been stripped of his medical license.

“It’s positively clear there is no relationship between the vaccine and autism,” says Eric Hollander, MD, director of the Autism and Obsessive Compulsive Spectrum Program and a professor of psychiatry and behavioral sciences at Albert Einstein College of Medicine and Montefiore Medical Center in New York. According to the CDC, one in 68 American children—one in 42 boys and one in 189 girls—is on the autism spectrum. The disorder is 10 times as prevalent as it was 40 years ago (though as a society we’re more informed about early signs, which means that higher detection rates are likely behind the surge).

Autism presents itself in many forms—from cases that would have once been characterized as severe intellectual impairment to those of individuals with high intelligence and good verbal skills who aren’t diagnosed until mid-life. The common thinking today is that its causes are a mix of genetic and environmental factors, which might include air pollution, gestational illnesses such as diabetes, and parental age. “There has been some data supporting advanced age of parents, but there’s also a theory that people with autistic traits can be awkward and marry later in life, so what we’re actually seeing is it being passed down genetically,” says Andrea Roberts, PhD, a research associate at Harvard’s T.H. Chan School of Public Health. She finds the gestational diabetes hypothesis more solid. “Obesity causes inflammation, which can have negative effects on the development of the fetal brain,” she says. “It’s plausible in terms of explaining autism’s increased prevalence—we used to be a lot thinner.”

In addition to identifying environmental triggers, scientists are still working to uncover the hundreds, or possibly thousands, of genetic mutations (there are more than 200 known genes linked to autism at present).

There is no FDA-approved treatment for the core autism symptoms. For now, says Dr. Hollander, researchers’ best bet is to focus on the 30 to 40 percent of cases that have a known genetic underpinning, and to attempt to create medical treatments to match genes. “It’s more of a personalized approach,” he says. “Every case is a unique interplay of several gene variations and environmental factors. This way of thinking doesn’t offer an easy solution.”

The most effective course of action is a combination of early detection (if a baby doesn’t point things out or smile at other people by his first birthday, it could indicate the condition) and intervention therapies aimed at helping young children build neural pathways, such as floor time and intense face-to-face interaction with a caregiver. “Late infancy is a major period of brain development,” says Rebecca Landa, PhD, director of the Center for Autism and Related Disorders at the Kennedy Krieger Institute in Baltimore. “We’re not curing autism, but we can help children make sense of the world around them.”

No matter how patient and informed parents are, the meltdowns, anxiety, and difficulty expressing emotions that often accompany autism can be painful to cope with. Other experimental treatments gaining favor include transcranial magnetic stimulation, oxytocin (a hormone associated with social bonding that can be administered nasally), vitamin B12 injections (to improve brain function), and even cannabis (which has been shown to help those who suffer seizures).

“When I was starting out, we thought it was going to be easy,” says Dr. Hollander, who has been studying autism for more than 25 years. “We thought: We’re going to find a gene and develop a drug treatment that targets it. It has proven to be far more complex. I completely understand the urge to hang it all on one simple cause and blame vaccinations.”

 

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