Monday, May 05, 2008

Autism Causation - Back to Bettelheim?

A recent study of mental illnesses amongst parents of autistic children provides some ominous echos of Bruno Bettelheim. The study, “Parental psychiatric disorders associated with autism spectrum disorders in the offspring,” appears in the May 5, 2008, issue of the journal Pediatrics. The authors gathered data from Swedish medical and hospital registers of children with autism diagnoses before 10 years of age and matched with a control population. Parent diagnoses were based on an inpatient hospital diagnostic evaluation and included schizophrenia, other nonaffective psychoses, affective disorders, neurotic and personality disorders and other nonpsychotic disorders, alcohol and drug addiction and abuse, and autism.

The study found that "for both parents, schizophrenia was associated with autism. For other disorders, such as depression and nonpsychotic personality disorders, the positive association between psychiatric disorders and childhood autism was found only for maternal disorders, not for paternal disorders."

The authors concluded that the study results results "support the hypothesis that there is a familial predisposition, perhaps genetic, that presents differently in the parent than in the child and probably requires a constellation of other genetic or environmental factors for expression."

The authors of the study themselves note a number of study design limitations but it should be interesting to see the reaction to the authors' conclusions. In pointing to a connection between autism and parental mental issues, particularly the association between autism and maternal depression and nonpsychotic personality disorders, the authors appear to be retracing the steps taken by Bruno Bettelheim whose "refrigerator mothers" theories of autism causality caused so much harm to families with autistic children. Hopefully this study and the conclusions arising therefrom, will be given as much rigorous study and discussion as others pointing to possible causes of autism.

15 comments:

Lisa Jo Rudy said...

Hey, Harold - was surprised by your response to this study.

So far as I can tell, the conclusions don't suggest that "when parents have a mental illness they act in ways that create autism in their children!"

In fact, ALL it seems to say is "mental illness in parents is associated with autism in children."

There could be many, many reasons for this, since parents and children share many things - including genetics, location, culture, stresses, etc. etc.

I'm not reading this as blame-related study at all... And what's more, since it's the first of its kind, it isn't even replicated.

Lisa (autism.about.com)

Autism Reality NB said...

Hello lisa jo

I respectfully disagree.

While you suggest a list of OTHER reasons which might be involved the authors expressly describe a correlation between a variety of mental illnesses of the parents and autism in their children. They differentiate between illnesses which impact both parents and those which impact the mother - For other disorders, such as depression and nonpsychotic personality disorders, the positive association between psychiatric disorders and childhood autism was found only for maternal disorders, not for paternal disorders."

The maternal disorders listed - depression and personality disorders - clearly and expressly imply that the personality of mothers is a factor associated with their childrenès autism.

Autism Reality NB said...

lisa jo

As a follow up to my last comment - the following post is from a blog called PsychCentral.com and a post titled "A Link Between Parents’ Mental Health and Autism" by John M. Grohol, Psy.D. Dr. Grohol states in respect of this study that:

"Knowing whether autism might be more prevalent in families with a history of psychiatric problems could better inform future prevention efforts. Whether the link is passed via the environment (e.g., THROUGH THE FAMILY CHILD-REARING ENVIRONMENT) or through genetics, or a combination of the two."

note: I converted the above all caps from lower case for emphasis -HLD

Anonymous said...

Nailed it there. The shrinks make their return with this ugly piece of "research". Lisa Jo, you better be ready for more shrinks coming out of the woordwork to pull their old theories out. They worked before and can work again, if the propaganda is forced down people's throats.

Ari said...

What's more likely to me is that the parents themselves are autistic or on the broader autism phenotype. Autism has been mistaken for schizophrenia and frequently comes with a number of co-morbid conditions that are or are mistaken for mental illness. That could account for part or all of this study's conclusions. I'd be curious as to your thoughts on that perspective, Harold, despite our significant disagreements in other sectors.

Autism Reality NB said...

ari

It is possible. But not well studied or proven.

Anonymous said...

Ari,

Yeah, so the asian and african women in Sweeden were autistic but no men were? Come on now. The study goes in so many directions that it is really not suitable to use for drawing any broad conclusions, other than immigrants in Sweeden with dark skin have it rough.

Ari said...

True - but it deserves further study, particularly as it is a reasonable possible implication from the data collected in this one. Furthermore, I'd point out other studies that have noted that autistics are very often born to parents who are in categorization-heavy fields. At the very least, I'd categorize that as a promising avenue of further research.

Anonymous said...

"Furthermore, I'd point out other studies that have noted that autistics are very often born to parents who are in categorization-heavy fields."

You mean scientists, researchers, doctors, lawyers. Your're correct on that for sure. Analytical capability is not autism mistaken for schizophrenia, or autism "lite" or anything like that though, unless you want to call every professor in the world autistic. Autism could be analytical ability gone haywire though.

Autism Reality NB said...

Ari

I am supportive of any well designed,properly conducted, study which provides reliable information about any aspect of autism.

Harold

Translating Project said...

Hi Harold, I just read the study. A couple of comments. The authors never stated that schizophrenia, depression, etc caused autism. Actually, the main hypothesis of the authors was that increased psychiatric diagnoses in the parents could reflect higher rates of services utilization, thus leading to higher rates of diagnoses in the children (not only autism). "We hypothesized that having a psychiatric condition
might influence parents to have their child evaluated for
psychiatric conditions and consequently result in increased
diagnosis of autism". They also consider that there is a possibility of a predisposition, genetic, or otherwise, in some families. But...

The second issue is that the data speak to a minuscule portion of autism cases. For example, maternal schizophrenia, which was one of the significant findings, was found in 0.6% of the parents with kids with autism and 0.2% on the mothers of typically developing kids. This means 99.4% of kids with autism did not have mothers with schizophrenia. Thus the possible familial/genetic predisposition, if real, would explain only less than 1% of autism cases. I think the press may be overstating these findings.

Finally, the authors mentioned depression and personality disorders in the mothers because those were the disorders that showed up as significant. They did not pick, or select these disorders specifically to make a point. They examined all recorded disorders and reported only those who provided statistically significant differences.

Cheers, N.

PS, These authors are mostly epidemiologists at departments of epidemiology. There were not traditional psychiatrists or psychologists ('shrinks').

Anonymous said...

That review should be posted all over, especially Age of Autism. Yeah, one could say the press overstated a bit.

OneSick said...

Hi,

Good post. I think you are right that this study could potentially be very harmful to parents of children with Autism. I seems to me that the greater potential for harm lies in the press and the hype surrounding this study. I read a lot of the press first, and that had the term "refrigerator mother" resounding in my head much louder than the actual study did.

However I do think the study has several fundamental flaws which need to be explored. These are probably due to the flawed logic inherent in sending an epidemilologist to do a psychologist's job.

-One Sick Mother

OneSick said...

You may find this interesting:

http://onesickmother.typepad.com/my_weblog/autism-and-schizophrenia-.html

-One Sick Mother.

Maya M said...

This maternal factor makes me think that, after all, there may be something in the theory about maternal antibodies.
We'll wait and see.
I agree with you that this may exhume the refrigerator mother theory.
Ooph. Anyway, I know a number of people for whom this theory has never been dead.