Friday, August 31st, 2012
This month two ideas about the causes of autism have been put into the spotlight. One idea that has been given some play is that spontaneous mutations – primarily tied to paternal age – are a major etiological factor that may in fact be a primary reason for the increase in autism over the last few decades. A different idea has also been in the spotlight – that there are fundamental problems in the immune system which start in the womb which may be responsible for as many as 1 in 3 cases of autism.
While there is some science to back these claims, their juxtaposition highlights the complexity and confusion of trying to make sense of where we are at in terms of understanding the causes of autism. Over the decades, there have been many grand theories, all of which have needed to be tempered to some degree (and in many cases, to a large degree). What this is may boil down to is that we may never have a universal theory about the cause of autism. Rather, through the lens of history, we may always be wrestling to figure out the degree to which one of two possibilities holds the most traction:
1) It may be that autism is in fact many different disorders which share common features. This is the case, for example, with different types of cancer – while all cancers have some commonality in terms of pathology, they may in fact be thought of as very different diseases, with different causes and potential treatments.
2) It may be that autism is in principle a multifactorial disorder, meaning that there are a number of factors that operate in conjunction to contribute to risk for autism. In this model, there can be a number of genetic loci and environmental influences, all of which add some additional risk for autism.
Of course, these two models are not new – they’ve been around for a long time. And they are not necessarily mutually exclusive. But I am reminded of them each time a new study is released. We typically don’t read much about the bigger picture of autism as the merits of the particular theory and method get discussed. As you continue to follow research in autism, I suggest that you, in your mind, temper the large claims that may come with new avenues of research, until the day comes that we have not only strong evidence supporting it but also translation into effective treatments. Despite all the scientific talent aimed at understanding autism these days, it remains a puzzling disorder or group of disorders. While it would be amazing to have a universal theory that becomes proven and leads to either prevention or eradication, the reality is that slow and steady approaches that fit findings into the bigger puzzle probably offer the most realistic hope for the many ways we will need to understand autism.