
An Immune Disorder at the Root of Autism - tokenadult
http://www.nytimes.com/2012/08/26/opinion/sunday/immune-disorders-and-autism.html
======
jdietrich
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.

~~~
sridharvembu
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.

~~~
jdietrich
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.

~~~
wololo
> 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>

------
jmillikin
Does anyone have references to studies regarding this? The author has a long
history of advocating a link between parasite load and auto-immune disease
(c.f. [http://www.nytimes.com/2008/06/29/magazine/29wwln-
essay-t.ht...](http://www.nytimes.com/2008/06/29/magazine/29wwln-
essay-t.html?_r=1) from 2008), and since the Wakefield scandal I'm generally
skeptical of non-journal articles attempting to link autism and inflammation.

The article is advertisement for the author's book, and I can't find any
indication that the author has an educational background in biology. Based on
his book's Amazon page, he's a journalist.

~~~
tokenadult
_Does anyone have references to studies regarding this?_

Thank you for asking that essential follow-up question for most submissions on
HN. Some of the references that turn up in a Google Scholar search

[http://scholar.google.com/scholar?as_ylo=2008&q=autism+a...](http://scholar.google.com/scholar?as_ylo=2008&q=autism+autoimmune)

include free full-text download links, so we can follow up on this.

 _The author has a long history of advocating a link between parasite load and
auto-immune disease_

Yes, I also checked out the author as I submitted this article. He has
postgraduate training in science writing, has worked for The Christian Science
Monitor (a dodgy publication for medical reporting), and has been published in
other professionally edited publications for his freelance science reporting.
I thought the submitted article had enough caution of statement and names of
actual researchers to be worth discussing here. The article is certainly far
from the last word on the subject, but may point to a line of research that
will be helpful in SOME (but certainly not all) efforts to reduce the
incidence of autism in the future and to help children after they develop
autism.

AFTER EDIT:

Some readers here may be interested in looking at the original case report by
Leo Kanner that first described autism.

<http://www.neurodiversity.com/library_kanner_1943.html>

An author who I think provides a helpful intercultural perspective on autism
and its diagnosis is Roy Grinker,

[http://www.pbs.org/newshour/bb/health/jan-
june11/grinkerext_...](http://www.pbs.org/newshour/bb/health/jan-
june11/grinkerext_04-19.html)

who has studied autism in cultural contexts outside the United States.

~~~
tptacek
Why is CSM dodgy for medical reporting?

~~~
tokenadult
A fair question. It's my understanding that the Christian Science Monitor
attempts to be phenomenological and "objective" in all of its reporting, and
some readers have long prized that publication for precisely those
characteristics. But it's important to note that the Christian Science Monitor
is the house publication of the Christian Science religious denomination, and
that the denomination has a view of health and disease that is not mainstream
and not evidence-based. (I write this as someone who has visited the Mother
Church in Boston and has heard about both the denomination and the newspaper
at their headquarters offices as an interpreter for officials from China who
were studying religious diversity in the United States.) Thus, on this story I
was much more inclined to submit a link from the New York Times (different
editorial tendencies) than I would be to submit an article by the same author
from the Christian Science Monitor. Most journalists benefit from submitting
their work to an editor.

~~~
tptacek
The CSM is not an organ for the Christian Science church. Is there some reason
we believe the guy who wrote this post is a Christian Scientist?

You called this piece into question in part because of a _past affiliation_
with the CSM. The CSM is a credible journalism venue; it's not fair to
attribute fundamentalist Christian Science beliefs on people who happened to
have worked there.

~~~
tokenadult
<http://www.csmonitor.com/About/The-Monitor-difference>

~~~
tptacek
Right; this is a lengthier restatement of what I just said. The CSM isn't
_L’Osservatore Romano_. It's a serious (if lately diminished) news venue.

Anyways, my point is simple: fundamentalist Christian Science devotees might
lack credibility in medical debates. But people who have merely at some point
in their careers affiliated with the CSM do not.

------
lutusp
If the immune-response hypothesis pans out (it's only a correlation at the
moment), it would lead to an irony of modern times -- a modern household's
level of cleanliness can cause:

* Asthma

* Autism

* Allergies

* Immune system dysfunctions

All these conditions are now "linked" to the "hygiene hypothesis," the idea
that we're not doing ourselves any favors by creating near-sterile living
environments. A quote from the article:

"Scientists have repeatedly observed that people living in environments that
resemble our evolutionary past, full of microbes and parasites, don’t suffer
from inflammatory diseases as frequently as we do."

I emphasize about the linked article that it represents a correlation, not a
cause-effect relationship. We won't be able to say with any certainly what
causes autism until we can trace its evolution step by step, from a specific
environmental stimulus to a biological mechanism, with all the steps fully
described. We're not yet close to that goal.

~~~
ams6110
Yeah but we are also much less likely to die at 6 months due to chronic
diarrhea caused by cholera.

~~~
lutusp
You're posing a false choice -- between well-understood public health threats
on one hand, and sterile environments on the other. There's a large,
unexplored territory between the two.

~~~
Evbn
The unexplored territory might be better, or it might not. Still, cleanliness
has far more I think it's favor than the previous state of the world.

------
zdw
The TL:DR; I get from this is: "we're clean freaks, and thus our immune
systems go wonky and start attacking good things because they lack bad things
to go after, including unborn children that get autism as a result"

This totally validates my need to go play in the mud and eat sketchy food from
carts on the street.

~~~
ams6110
We're "clean freaks" because we've learned that there are harmful microbes and
parasites in the world. Millions die/have died of disease such as cholera and
typhoid that are spread chiefly by poor hygiene. The parasites we don't get as
a result of having clean water and sanitary sewers are on balance harmful to
us.

I'm not sure I buy the "hygiene is harmful" argument or that we've gone
overboard with it. I think a lot of other factors that have changed in the
past 60 years might factor in, including a misguided government/agribusiness
lead food pyramid that is way out of balance with our pre-civilization diets,
as well as the introduction of highly processed and sweetened food that for
many of us forms the majority of our diets.

~~~
olliesaunders
> I'm not sure I buy the "hygiene is harmful" argument or that we've gone
> overboard with it.

You can be hygienic and still cultivate behaviors that increase your exposure
to safe levels of microbes. For instance, I always wash my hands after using
the toilet but I’m less concerned than most about the use-by dates on food
products and prefer to make decisions based on my sense of smell and taste.
Not sure if that’s a good example.

------
jasonlotito
Without getting into too much detail, my wife had complications during her
pregnancies. My older son (3) is autistic. My younger son might be as well.
I'm not sure of the science behind what is being discussed here, but the
specific elements it discusses match up with certain things that occurred
during the pregnancy.

Oddly off-topic and yet on-topic for HN, I'm working on a startup idea to
assist families with special needs. I've been trying to go it alone, but not
having a partner is tough. No one to speak with, no one to work with. If
anyone is interested, even if it's just to chat, email me (found in my
profile). I'm bad at asking for help. =/

~~~
verisimilidude
Would you like some anecdotal encouragement?

My mom had a serious liver infection during her second trimester while
carrying my older brother. He turned out autistic. After years of dressing
down people about vaccines and other snake-oil causes of autism, she forwarded
this article to me with one line, "This must be the reason." FWIW.

Anyway, I came two years later without complications. I also exhibited many
odd behaviors that worried my parents at first, but wound up not being
autistic.

Hang in there and keep your chin up. Your younger son might be fine.

~~~
jasonlotito
> Hang in there and keep your chin up. Your younger son might be fine.

He is fine. I know that's not what you mean, but regardless of the diagnosis,
he is a wonderful child, and I would not have him any other way. My worry
isn't for my children, but for the way society treats those with autism.

It's hard to explain. Thanks though. =)

------
agravier
I would like to remind HN that autism being a syndrome, it is likely to be
several distinct illnesses with different genetic and environmental factors.

~~~
yummyfajitas
That's not correct. If something is a syndrome it is _more_ likely to be a
single distinct illness rather than multiple distinct ones.

I.e., suppose 50% of people suffer headaches, 50% suffer nausea, and 50%
suffer aching back. Further, suppose 12.5% (= 50% x 50% x 50%) of people
suffer all three symptoms - in this case, the three symptoms put together are
NOT a syndrome.

On the other hand, suppose 40% of people suffered headaches, nausea and aching
back _together_. In that case the three symptoms together are a syndrome.

A syndrome is probabilistic evidence that there is an underlying cause of
multiple co-occurring symptoms.

~~~
agravier
You are right, I should have written more explanations. Autism is quite
special in that the symptoms are behavioral: impairments in social interaction
and communication, restricted interests and repetitive behavior (this list is
on Wikipedia). These are very different from aches and other simple physical
manifestations. In fact, when we try to look for simpler symptoms, the set of
symptoms becomes blur, in that no other symptom can be found always present
together with to those core behavioral ones. The variety of more physical
manifestations of autism hints at a variety of root causes. E.g.,
gastrointestinal issues are common but not always there. Cerebellar anomalies
too. etc...

Sorry, I wrote that up fast, if you are interested you can write a reply, I'll
try answering tomorrow, it's late for me now.

------
akkartik
Just last week I read that it could be caused by an older father:
[http://www.latimes.com/health/boostershots/la-heb-older-
fath...](http://www.latimes.com/health/boostershots/la-heb-older-fathers--
genetic-mutations-autism-schizophrenia20120822,0,4956716.story)

~~~
billswift
Greg Cochrane mentions that here,
<http://westhunt.wordpress.com/2012/08/22/paternal-age/> , in the context of
the influence of paternal age on mutation rates, and excessive numbers of
mutations having negative influences on fitness and health.

------
ahi
A story on This American Life about a guy who got hookworms intentionally to
deal with his immune disorder: [http://www.thisamericanlife.org/radio-
archives/episode/404/e...](http://www.thisamericanlife.org/radio-
archives/episode/404/enemy-camp-2010?act=3)

~~~
btilly
I have a friend who did the same.

It worked. He has now gone a year and a half without medication, and is in
massively better shape than he was on the (expensive and only marginally
effective) medications.

~~~
pacaro
Here's my anecdote.

I suffer from psoriasis and psoriatic arthritis. For the most part the
psoriasis is not a big deal, it's disfiguring, but only on my legs, and it
itches to the point that I'm perfectly capable of scratching long past the
point that I'm bleeding. The psoriatic arthritis is another matter, untreated
I live somewhere between 5-7 on the pain scale, shaking hands is nerve-
wracking (please, no bone crusher handshakes - I do suffer from hand squeezy
death) and I can barely walk.

On meds I'm basically fine. I use Humira which if I understand correctly is a
human monoclonal antibody glued to a receptor that interferes with something
to do with T-cells. I.e. it causes a specific immune suppression that
massively reduces the process that causes the psoriasis and arthritis symptoms
- oh and I'm 100x more likely to get skin cancer.

I've been off meds for over 6 months now with very limited impact on my life.
All I did was cut out refined sugars and grain from my diet.

I discovered this by accident (too lazy to refill my prescription, then
realized that I hadn't refilled in ages and yet wasn't in pain)

I think that there's a huge load we don't understand in the relationship
between inflammation and autoimmune conditions; there are many things that are
involved

Just my 2¢, I love science so please disregard my anecdotal ramblings

------
boothead
It's worth mentioning the GAPS diet here I think: <http://www.gaps.me/>. It
seems that autoimmune/inflammatory problems are being associated with more and
more diseases.

------
veven
I have multiple sclerosis and acquired hookworms about 3 years ago as an
attempt to prevent further relapses. HN isn't exactly the place for this, but
if anyone has any questions I'd be happy to answer.

------
bluekeybox
If the hygiene hypothesis is correct, then month of birth/conception should
have an effect on the risk of autism. Here is a report about a study which
found that autism is most likely in children conceived in winter:
[http://articles.latimes.com/2011/may/05/news/la-heb-
autism-w...](http://articles.latimes.com/2011/may/05/news/la-heb-autism-
winter-conception-20110505). There was another study which "debunks" the month
of birth claim, but I cannot find a link to it.

~~~
Evbn
On the other hand, perhaps due to school schedules in the US, or perhaps
highly intelligent people having less sex in the summer time due to other
correlations, winter conceptions correlate to higher academic success as well.

------
septerr
What I find most interesting about this article is that it offers a way to
diagnose autism with something more than behavioral symptoms. I don't know if
it will be reliable, but it might be something parent with kids on the fringes
of autistic spectrum would want to try. There's always advice floating around
that their kid is fine, just a little slow etc. If we can do brain scans and
find out if their levels of inflammation are above normal, there would be more
certainty.

------
mkopinsky
_> And yet, a trial is under way at the Montefiore Medical Center and the
Albert Einstein College of Medicine testing a medicalized parasite called
Trichuris suis in autistic adults._

Montefiore representin'! (Too bad they failed to mention the names of any of
the people involved at Montefiore/Einstein so I could walk over to their lab
and look at their posters or talk to them.)

------
rdl
Pre-birth genetic testing (e.g. <http://www.lineagen.com/>) seems like a
pretty effective way to end autism. It works effectively with Down's Syndrome.

~~~
darkarmani
> Pre-birth genetic testing

What exactly will that do? Unless it is fragile-X or something that can be
proven using genetic testing, it won't help at all.

------
w0nderlust
If this is true, then it makes sense that vaccines could trigger the symptoms
of autism. Looks like the Internet owes Jenny McCarthy an apology.

~~~
tokenadult
Your comment is untrue. As the author of the submitted article notes about a
related proposed explanation for autism incidence, "First, in the broadest
sense, the epidemiology doesn’t jibe." And that has always been the problem
with the lawyer-profit-motivated hypothesis about vaccines and autism: it
never matched the epidemiological evidence.

<http://www.cdc.gov/vaccinesafety/concerns/autism/index.html>

<http://www.nap.edu/catalog.php?record_id=10997>

<http://www.vaccinesafety.edu/cc-mmr.htm>

<http://briandeer.com/mmr/lancet-summary.htm>

[http://scienceblogs.com/insolence/2012/08/04/andrew-
wakefiel...](http://scienceblogs.com/insolence/2012/08/04/andrew-wakefield-
dismissed/)

[http://www.sciencebasedmedicine.org/index.php/jenny-
mccarthy...](http://www.sciencebasedmedicine.org/index.php/jenny-mccarthy-jim-
carrey-and-green-our-vaccines-anti-vaccine-not-pro-safe-vaccine/)

[http://www.sciencebasedmedicine.org/index.php/dr-google-
and-...](http://www.sciencebasedmedicine.org/index.php/dr-google-and-mr-hyde/)

[http://www.sciencebasedmedicine.org/index.php/an-
antivaccine...](http://www.sciencebasedmedicine.org/index.php/an-antivaccine-
tale-of-two-legal-actions/)

~~~
w0nderlust
I'm merely arguing that vaccines could possibly bring out or affect the
severity of the symptoms of autism. None of the studies seem to study the
severeness of autisms... just the rates, which would be unaffected if autism
is already determined by a different factor (apparently age of the father may
be one).

It's so scary to see how many people refuse to open their minds to
possibilities outside their preconceived notions. The responses in this thread
are a prime example.

~~~
billswift
"You should have an open mind, but not so open all your brains run out."

In fact, the "hygiene hypothesis" is almost the diametric opposite; vaccines,
by challenging our immune systems, would reduce the risk of autism. Not that
it does that either, studies have repeatedly found no correlation between
vaccination and autism.

~~~
flackian
Question: What of the chemical load that a vaccine or schedule of vaccines
might carry? What if immune dysregulation has a tipping point? The tipping
point could be a variety of things, including a vaccine. A second question:
What if we need the full blown disease, along with the fever to properly train
our immune systems? Mr. Manoff's article may have been well-written and
fascinating and short on citations but it will raise important questions that
need to be asked and answered without fear that everybody will skip their
vaccines and we will all die of polio. I am certainly NOT directing this last
sentence at you Mr. Swift. I am generally noting with a view to the entire
discussion above that sometimes the scientific guild, like all of us, has
allowed fear of what might happen to shape their answers to important
questions.

