The autoimmune hypothesis is yet another autism hypothesis that is advanced primarily by parents, because it offers more hope than a neurological etiology. A lot of people hold strongly to the hope that autism is just a set of symptoms that are triggered by something tangible and readily treatable like a nutritional deficiency or a food allergy, rather than a permanent difference in brain structure. The available evidence points very clearly in one direction - genetics.
It also bears repeating that what we call "severe autism" is really "some amount of autism comorbid with very low IQ". Autism is routinely overdiagnosed in preference to a more accurate diagnosis of intellectual disability because parents prefer it, again because it offers more hope, largely due to the popular trope of the autistic savant.
Parents of severely disabled children naturally hold out for any source of hope and I don't judge them for that in any way, but we can't let that get in the way of the science that really is their child's best hope. There is no evidence for the hygiene hypothesis.
Do you have any basis for saying the autoimmune hypothesis is "advanced primarily by parents?"
I ask because I have a son with autism, and I have met leading immunologists in famous medical schools who subscribe to this hypothesis. That doesn't make the hypothesis right, but it is taken far more seriously than your comment would imply.
Second, "severe autism is really some amount of autism with very low IQ" part is also wrong in my opinion. Autism can be so severe that it makes IQ irrelevant (even in cases where it can be demonstrated to be high). The analogy here is with other mental illnesses like schizophrenia - when it is severe enough, it masks every other trait of that person, including IQ. That does not mean "severe schizophrenia is really some amount of schizophrenia combined with very low IQ". There are many severely autistic individuals who also demonstrate high IQ in specific areas (but still cannot lead anything close to a normal life), directly contradicting your statement.
I expect a little more thoughtfulness on a top comment in HN.
The basis for my comment on the autoimmune is relatively poorly documented, because by definition it happened outside of academic literature. A bit of intelligent Googling will turn up a great deal of lay discussion that substantially pre-dates the earliest peer-reviewed publications on the subject. It is clear from perusing the relevant discussion forums that there are a great many parents who are advocating the autoimmune hypothesis; While this of course has no bearing on the validity of the theory itself, it is highly pertinent when considering the theory's prominence in the mainstream media.
As regards autism and IQ, your analogy to schizophrenia is completely inaccurate. Someone with high IQ can develop strategies to ameliorate essentially every aspect of their autistic symptoms - learning social and communication skills, structuring their life to deal with overstimulation, participating in behavioural therapy to minimise repetitive and autostimulative behaviours etc. Schizophrenics are by definition unaware that their delusional beliefs are delusional, whereas any intelligent autistic can be made aware of their social deficits and behavioural quirks and can learn to adapt around them.
As you said, some autistic people have high IQ in some areas but are still unable to live a normal life, but this is because their cognitive problems render them unable to overcome their autism symptoms. A specific cognitive impairment is still a cognitive impairment - strong arms do not nullify paraplegia.
While it may be the case that there are some individuals that have high IQ but severe levels of impairment, they are very much outliers. There is no generally-accepted classification for the severity of autism symptoms, but it is worth noting that those systems which simply use IQ are not obviously less useful than more complex schemes; IQ correlates as strongly with functional impairment as any other factor.
> Schizophrenics are by definition unaware that their delusional beliefs are delusional
delusions are not necessary for a schizophrenia diagnosis
also, during periods of convalescence, on hallucinations: "they may learn to ignore them, or treat them as benign accompaniments of everyday living" --http://www.schizophrenia.com/family/delusions.html
I don't think it's an entailment of schizophrenia that the sufferer is unaware that their beliefs are delusional. Even with that awareness, a schizophrenic idea can be very compelling. Even people who don't suffer from schizophrenia can get irrational ideas that interfere with their life despite decent self-awareness about these ideas.
While schizophrenia can have many very strong symptoms and is obviously not 'psychogenic' (e.g. in a Freudian sense), schizophrenics can and do learn skills to help them feel better and pass better and intelligence is an asset there.
I will agree that autism seems MUCH vaguer than schizophrenia as a diagnostic category, but that is also true of most other psychological disorders...
You said: Someone with high IQ can develop strategies to ameliorate essentially every aspect of their autistic symptoms - learning social and communication skills, structuring their life to deal with overstimulation, participating in behavioural therapy to minimise repetitive and autostimulative behaviours etc. <End quote>
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There are severely depressed people with very high IQ and they are fully intellectually aware of their depression, they try hard to compensate for it, doing all the types of things you mention in the context of autism. Tragically, for at least some of them, nothing seems to work.
My point is that it is more complicated than what you are asserting.
I have Aspergers, and I feel the same way that Autism might be incurable for those who already have it. This research may help future generations, but I'm not hopeful that it will help me.
I am probably going to get downvoted for being realistic about it, but if you don't have autism you really don't know what its like. I wouldn't wish this on my worst enemy, and I would do anything for a possible cure, but I can't allow myself to be filled with a false hope that someday I can live a normal life.
Normal is after all a common average and in that is overated by the masses. Remember if 99% of the human population was a psycopath then what would normal be then.
If your saying normal people have a smoother life then I'll admit I'm starting to become jelous, but if i lived on a island alone with no communications then in that I guess everybody would have a smoother life alot of the time :).
I read jdietrich's comment about "severe autism is really...is really overdiagnosed..." not as "is always" (which you seem to have chosen to interpret it as) but "is more often", which doesn't contradict your "autism can be...that it makes" response: I seriously doubt that jdietrich is claiming that no such people exist, and thereby the fact that "there are many severely autistic individuals" doesn't show the statement to be false.
Of course, it may be false, but so could anything people say, even when backed up by "sources"; however, I really do feel the need to point out that it isn't false only because there are exceptions, as the word "overdiagnosed" only implies "more often than is warranted" and doesn't in any way leave out the possibility that it is sometimes correct, or even that there aren't "many" cases: just that the number of people who are diagnosed is larger, and possibly still much larger (even with "many" real cases), than the number of people who truly have the issue and should be diagnosed.
(To be very explicit: nothing I have said here relies on specific information about autism, nor can it, as I know absolutely nothing about that disorder.)
A quote: "...several epidemiological studies were conducted supporting this concept and generating novel ideas for the underlying mechanisms that were then followed up by use of well-defined animal models and human studies."
There is inadequate evidence of a link between the hygiene hypothesis and autism, which is what the article was about. I agree that there seems some fairly good support for the hygiene hypothesis and immunological problems, like allergies and asthma.
EDIT: replaced "no evidence" with "inadequate evidence", as lutusp noted, the article is claiming a correlation, which is at least weak evidence.
> There is no evidence of a link between the hygiene hypothesis and autism, which is what the article was about.
The article shows a correlation between the hygiene hypothesis and autism. A correlation, by itself, could mean anything or nothing, but it is certainly evidence.
Are you using "evidence" as a synonym for "proof", as in law? I ask because science doesn't work that way.
This correlation may simply evaporate with further work, or reveal some connection not now apparent, but saying there's no evidence for the correlation is simply false.
To understand why this is true, consider rain and puddles. A naive alien, seeing a correlation between rain and puddles, might conclude that the puddles caused the rain, or the reverse, or both rain and puddles are caused by an unevaluated third cause.
Because A might cause B, or B cause A, or A and B be caused by C, and without researching the true cause-effect relationships, the observed correlation means precisely nothing. No. Thing. It is not weak evidence, it is not evidence at all.
And "hearsay and anecdotes" are not any kind of evidence of interest to a scientist. The plural of anecdote is not data.
He is not talking about causation or not. He is talking about using evidence to affect his (subjective) posterior probability of the truth of a statement.
Of course he is. Here's a quote from the post to which I replied:
> There is inadequate evidence of a link between the hygiene hypothesis and autism ... the article is claiming a correlation, which is at least weak evidence.
But the above is false. A correlation is not "weak evidence" for a cause-effect relationship, or a "link", as the poster put it. We need to be perfectly clear that a "link" suggests a cause-effect relationship, but without specifying which way cause and effect run.
A correlation is an observation that can only lead to further work, and it is never, in and of itself, evidence of a cause-effect relationship, absent discovery of a mechanism.
This reminds me of one of my pet peeves about science journalism -- use of the word "link" to describe a correlation. It's tendentious and misleading. There are lots of studies that find "links" between utterly unrelated things, by simple data mining (searching for coincidental correlations devoid of meaning). Such meaningless correlations are often published as though they mean something, and they're nearly always described with the word "link" or another tendentious word.
> There is some evidence that autism may be caused by an immune disease; One publication speculated that the lack of early childhood exposure could be a cause of autism.
The hygiene hypothesis has wider use than just autism - that a bunch of allergy and auto-immune stuff is caused by excessive cleanliness. There is strong evidence that might be true. But the link between autism and excessive cleanliness is, to quote one link that you provided, "speculative".
The abstract of the other study doesn't mention ASD; maybe I'm missing something?
(Just to be clear, because sometimes I'm not: The hygiene hypothesis is strong and important when talking about allergy and maybe auto-immune diseases; I need convincing that there's any link to ASD.)
Yes -- but my remark is about the hygiene hypothesis, not about autism. Read the post to which I replied. The poster said "There is no evidence for the hygiene hypothesis." I replied to that specific remark.
> The hygiene hypothesis has wider use than just autism ...
What? The evidence for the hygiene hypothesis is strong in many areas, but as to autism, it's mere speculation.
> But the link between autism and excessive cleanliness is, to quote one link that you provided, "speculative".
Yes -- and on what basis do you think I have taken any other position?
> The hygiene hypothesis is strong and important when talking about allergy and maybe auto-immune diseases; I need convincing that there's any link to ASD.
So does everyone else. There's no basis for this assumption in present evidence.
The comment you responded to was clearly talking about the hygiene hypothesis and autism. I'm not sure how you read it otherwise.
Since the post you responded to was saying that there is no evidence for the hygiene hypothesis (as a cause for autism) and you then replied to say that there was strong evidence for the hygiene hypothesis it's a reasonable assumption that you're still talking about causes of autism.
"The autoimmune hypothesis is yet another autism hypothesis that is advanced primarily by parents, because it offers more hope than a neurological etiology."
I haven't done any research on this, but at the same time virtually every other chronic illness is caused, causes, and/or is exacerbated by chronic inflammation, so if inflammation during pregnancy doesn't have any effect on neurological development it would be extremely surprising.
Yep. Reading the article I was a little put off by how banal the hypothesis really is. Inflammation, including neuroinflammation, is involved in many pathologies. Whether it is a cause or a symptom is unclear, partially because it is unclear what is going on in neurons exposed to stressors that causes their dendrites to recede. If inflammation is the main cause and best treatment vector for autism, autism is in the same boat as Alzheimer's and other difficult-to-treat inflammation-related neurological conditions.
Thank you for this. Trying to pin Autism down to a simple cause is foolish. Not only is autism often (thusfar not 100%) caused by a malfunction in the genes it is implicated in thousands of different genes and not even necessarily inherited (in large part being due to denovo mutations). Nonetheless the brain is a wide surface area of attack, there are many ways to assault it that could result in impaired intelligence.
Worth noting is that the connection between inflammation, intelligence and health could be more related to the heritable trait of how stable or robust your phenotype is to noise (mutations and stochastic alike).
What I also find interesting is that the fear for a disease being genetic will likely flip in the next 2 decades. Genetic diseases will be more easily corrected than diseases that will evolve a slip right under your nose.
> Trying to pin Autism down to a simple cause is foolish.
Foolish unless true. We just don't know, and it's too soon to be abandoning theories. Science doesn't proceed by categorically denying possibilities before they've been fully investigated.
> Genetic diseases will be more easily corrected than diseases that will evolve a slip right under your nose.
On the contrary, genetic diseases will with rare exception remain incurable.
1.) We are not disagreeing. Anyone who wants to pin it to autoimmune effects is missing the genetic causes, anyone looking for simple mendelian causes is missing out on multiple gene susceptibilties or denovo mutations, etc.
2.) This is a testable hypothesis and will be known in time. I believe that we will have a good enough understanding and control over genetics such that effective therapies even for adults will be possible in the stated time frame. Also notice I used the word correct not cure, not a mere play in semantics but a subtle change that strongly alters meaning.
> This is a testable hypothesis and will be known in time.
Wait -- if resolution requires the simple passage of time, then it's not testable, indeed it's not really a test. A "testable hypothesis" means a notion that's subject to practical test in the present. Waiting for a future yea/nay outcome isn't, strictly speaking, a test. More of a waiting game.
> I believe that we will have a good enough understanding and control over genetics such that effective therapies even for adults will be possible in the stated time frame.
Gene therapies have a pretty terrible track record to date. Nevertheless, if your "time frame" is 100 years, then I would have to agree it's likely, based on Clarke's First Law:
Quote: "When a distinguished but elderly scientist states that something is possible, he is almost certainly right. When he states that something is impossible, he is very probably wrong."
> Also notice I used the word correct not cure, not a mere play in semantics but a subtle change that strongly alters meaning.
Yes, agreed, and if this era arrives, treatment recipients will have to be told that their improved condition by no means implies that their offspring won't be similarly afflicted.
>It also bears repeating that what we call "severe autism" is really "some amount of autism comorbid with very low IQ".
Ah, that... actually explains a lot. I've worked with several people with Autism diagnoses, and yeah, they were nerdy... really nerdy and socially inept, but also smart, productive individuals able to lead independent lives; People I'd be happy to call friend. Yeah, I have to go out of my way to figure out how to effectively communicate with them, but it's worth it. If I had a kid that grew up to be like them, I'd be proud.
I hear people talking about autism like it's this terrible thing, and I don't really understand, Your kids could very easily turn out a lot worse than the Autistic people I know.
Of course, if any of these people were low-IQ, or really, anywhere near average, they'd have a difficult time indeed.
>If it's genetic, as you assert, then what hope is there?
Recognizing what their specific problems actually are, there is significant variation in the strength of the particular difficulties individual autistics face.
Teaching autistics to work around their disabilities; there has been significant progress on this approach for recognizing and dealing with other peoples emotions, for example.
Getting them the support they need for problems they cannot work around.
> If it's genetic, as you assert, then what hope is there?
Um... plenty? Tons of genetic diseases are treatable. This is where Genzyme, for example, makes most of its money. Cerezyme for Gaucher's disease or Fabrazyme for Fabry disease to name two.
It also bears repeating that what we call "severe autism" is really "some amount of autism comorbid with very low IQ". Autism is routinely overdiagnosed in preference to a more accurate diagnosis of intellectual disability because parents prefer it, again because it offers more hope, largely due to the popular trope of the autistic savant.
Parents of severely disabled children naturally hold out for any source of hope and I don't judge them for that in any way, but we can't let that get in the way of the science that really is their child's best hope. There is no evidence for the hygiene hypothesis.