What I Wish Everyone Knew About Autism
Recently I received an alert from the American Academy of Pediatrics reporting the latest statistics from the CDC on the incidence of autism in America. Essentially, the prevalence of autism spectrum disorders (ASD) has increased 30% increase over rates reported in 2012, according to data released today by the Centers for Disease Control and Prevention (CDC).
I did not make a comment immediately because I wanted this alarming update to sink in. The prevalence of Autism Spectrum Disorder is rising in epidemic proportions; now 1 in 68 children in America have ASD. This is no surprise. Everyone these days seems to know at least one family who has a child diagnosed with autism.
It wasn’t always like this. While some authorities claim that the new numbers merely reflect better screening, that argument should not detract from the harsh reality. There is something more fundamental that is being missed in the way we deal with autism. This epidemic will continue to grow unless we in the medical field are willing to be courageous and change our current mindset.
1. The answer is blowing in the wind (not the genes).
If we are going to change this alarming trend, research will have to make a major shift away from 20th century reductionist thinking that persists in focusing solely on the genetics of autism. This flies in the face of the facts. You cannot have a genetic epidemic!
When I began my career as a pediatrician 25 years ago, Autism was diagnosed at a rate of 1:2,500 children. Better screening simply cannot account for such rises in these numbers. And our population is not expanding fast enough to account for the statistical probabilities of a purely genetic cause for autism.
Logic dictates that if it’s not genetic, we are obligated to examine the environmental factors affecting our children’s development. Yet, the majority of research institutions in the United States continue to dismiss environmental causes except in the most cursory ways. What’s more, despite the fact that autism and ADHD combined are now far more prevalent than heart disease or cancer, they are allotted only a tiny percentage of research funding.
How can we expect to find answers to what is going on with our children if we continue to look in all the wrong places for clues? It's time for parents to demand that research funding reflects the current reality of this disorder.
2. Wake up, pediatricians!
Pediatricians are caught in a bind, using outdated perspectives that are biased in favor of genetics-based research and against environmental factors. Without a significant paradigm shift, they will continue to run assembly line practices that ignore the subtle early signs that indicate a child may be at risk for environmental damage that can lead to autism.
Current screening tools look for children with signs of autism but do not look for environmentally at-risk children. I ran a busy pediatric practice of 14,000 patients for over 20 years, and my subspecialty training in developmental pediatrics provided an opportunity to track subtle imbalances in children at early ages. The way a baby sucks, soothes, coos, cries, bonds, sleeps, and transitions in the first few weeks and months of life are crucial clues that inform early health care decisions in a sensitive infant.
Physical manifestations such as eczema, constipation, or low tone become important factors in guiding recommendations for early interventions. A history of IVF pregnancy, number of prenatal ultrasounds, antibiotic use during pregnancy, pitocin exposure, C-section associated antibiotic and anesthesia exposures and the absence of mother’s good bacteria or colostrum are factors that must be considered in sum when trying to identify children at higher risk for environmental damage later in childhood.
This is a real opportunity to change the course of a child’s life at the age when the brain’s plasticity is maximally ripe to reshape itself. Pediatricians have good hearts, but they are simply not trained to look for these clues. Much to my frustration, we continue to apply 20th century medicine for a 21st century problem and lose precious time waiting until “it’s broken before it needs fixing.” It’s time for parents to demand that pediatricians wake up and take off their blinders.
3. Listen to your parents.
Why is it that I hear the same story again and again from parents? A mother will complain that she tried to tell her pediatrician that something was wrong with her child only to hear statements like, "Oh he’s just stubborn," or "He’ll grow out of it," or "Let’s wait another few months." These are red flags, too! What arrogance to assume we doctors know more about a child’s subtle rhythms than those who are with their child 24/7!
In reality, it's the parents who hold the key to stopping this epidemic. Twenty-first century medicine must break old paternalistic habits and become collaborative medicine if it's going to work. It is imperative that we as clinicians and researchers utilize the invaluable wisdom of parents. This begins by taking the time to listen.
4. One size does not fit all: Autism is a symptom, not a single disease.
Treating symptoms is the 20th century approach. It fails to define the subtle subtypes of autism and only leads to more confusion for parents. This is why some children respond to one biomedical and behavioral intervention while others do not. Parents and clinicians alike must not fall sway to the old idea that “one size fits all.”
The seriousness of this epidemic calls for a comprehensive individualized medical approach that examines the complex balance and rhythms of mind-body functions and customizes recommendations for at-risk children. That includes considering different dietary choices for different children, adapting vaccine schedules to the readiness of the child, weighing carefully when to treat a fever, avoiding unnecessary antibiotic use, supporting specific nutritional needs, choosing which technology exposures are potentially harmful, and identifying which parenting styles will be optimal for a particular child to thrive. These are not easy decisions. They take time and a better training.
5. Living outside the box: It’s not easy stepping outside the conventional assembly line way of thinking.
Twenty-first century parents are better informed than at any time in our history. Indeed it has been their courage to look for answers outside conventional approaches that challenge our old ideas. But can you blame them? Such courageous parents deserve the support of caring clinicians during this crisis rather than being made to feel alienated by the medical establishment. That means that pediatricians and early intervention therapists must be better informed and willing to consider all the options open to families.
Stepping outside the box has its risks for any practitioner. This will not happen without the support of cutting-edge research that encourages a more holistic understanding of our connection to this planet. This epidemic calls for innovative public policies that demand new ways of thinking to meet what must be now considered a major public health crisis.
6. Hear the Canary Kids sing. (If autism is a symptom, then we must ask, What is it a symptom of?)
Last night I attended a fundraiser for The Canary Kids Project, the brainchild of Beth Lambert, whose heroic work in raising consciousness about the current autism epidemic is beginning to gain some momentum. One in 68 children in America is a canary in the coal mine of our society, and they are crying out to us to take a closer look at our relationship to the environment in which we are raising them.
Like Beth, I truly believe that we have the power to “stop autism in its tracks.” If I hadn't seen it myself I wouldn’t believe it. But to do this, our children need the right medicine, and the only way they are going to find that is if we learn to listen more mindfully and demand that our scientific community change their old perspectives.
There is no time left for 20th century thinking. Our 21st century children cannot wait.