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Last month was Autism Awareness month and I’m writing today to remind us that autism continues to be a compelling global issue that consumes the tireless efforts of families and professionals throughout the year.
In our human family, there are many ways the now seven billion (and rising) of us live in the world. Our culture shapes our communication with each other interconnecting us across the planet in our fast-moving digital age. Human societal change unfolds as cultural evolution influences us by way of how our interactions with each other shape us across the generations. Genetic evolution, in contrast, is shaped by how our DNA (and the epigenetic non-DNA molecules shaping gene expression) is passed to us from our parents and shapes how our body grows and functions. One part of that body is our brain, composed of the basic cells, our neurons. And since the manner in which our neurons link with each other through synaptic connections shapes how the brain functions, many factors can influence “who we become.” DNA itself and the epigenetic regulatory molecules we inherit, exposure to toxins, stress in our mother’s womb, the experiences we ourselves have in and out of the womb—all these factors shape our neural architecture.
We can observe variations in neural architecture through advances in technology which enable us to see that, for some individuals, an “atypical” neural pattern emerges in which the brain is larger even in utero (Eric Courchesne PhD), and then continues to show more neurons but less differentiated connections (Marcus E. Raichle). Our term for this “condition” or neurological variation from “typical” development is Autism Spectrum. Though some would formally call this a “disorder,” it is important to state that challenges to adapting to our common world are experienced by individuals with this neurological set-up.
I recently had the opportunity to explore autism spectrum issues with a number of clinicians who collectively have had well over two hundred years of experience working with “people on the spectrum.” When I trained in pediatrics before moving over to psychiatry, autism was four in ten thousand individuals—but now, with changing criteria, we see the incidence on the average as 1 in 68 individuals (CDC). April was Autism Awareness Month, such a high number reminds us of how important understanding what this variation in our typical human family’s neurological development really means for all of us—those on the spectrum, near it in themselves, and living with individuals along this continuum.
The first important point is to note that studies suggest that when these new criteria are applied across the lifespan, the frequency of occurrence of being on the spectrum is actually fairly uniform. What this means is that if you are in your seventies, or sixties, or fifties, or forties, for example, you are just about as likely be on the spectrum (a bit more than one percent chance) as a child or adolescent is growing up today. So while we need to look for “causes” we need to stay calm in the face of our understandable distress that there is a huge epidemic unfolding. That being said, even if the increase that might really be there is less than what we thought, we still need to think deeply about what might be the most helpful strategies for families and individuals struggling with this spectrum of challenges. So here’s what I’ll summarize is the collective wisdom of the writings and input of those individuals who’ve been living with or devoting their professional lives to being on the spectrum.
The major issues are three fold: 1. Social communication; 2. Sensory Integration; and 3. Emotional Regulation. These three may actually be best understood as manifestations of the same fundamental issue. One way to sense their deep connections is the following view, inspired by a number of individuals who have described their inner experience of “being on the spectrum” and supported by a breadth of clinical observation.
With input to the senses—sight, hearing, taste, smell, touch—creating an overwhelming flood of disparate elements all at once in one’s inner mental life, anything that can decrease that flood of autonomic over-arousal can be sought. For some, this sensory integration challenge is particularly prominent not so much with the external senses, but the social sense—the input from other individual's inner lives. We are inherently social creatures, and the social world of others is registered in the brain in ways that, if not filtered and processed well, can be flooding. This overwhelming sensory input can lead to the avoiding of direct face-to-face communication and eye contact, diminishing social situations in general, and also by finding sensory stimuli that can be controlled, like twirling objects or staring at lights. In this way, atypical behaviors that are often called “self-stimulation” may actually be a form of self-soothing. Those isolating behaviors that are thought of as social avoidance may actually be adaptive strategies for self-regulation as well. Without the experience of social interactions, however, the needed expertise derived from repeated engagement with others leaves someone on the spectrum without the practice they need to develop competence as social communicators. And so studies that have suggested impairment to social systems such as the mirror neuron system or decreased fusiform gyrus activation to facial stimuli may in fact be lack of use to reduce flooding (Susan Bookheimer).
Using these scientific findings, we can imagine, create, and implement new approaches to helping those with these three challenges in social communication, sensory integration, and emotion regulation to find a way to have the constructive social engagements that will build the brain in the most adaptive and integrative ways, supporting healthy development from the earliest years onward. The time is now to make such strides in both our cultural understanding and practical application of science to support our human family across the spectrum of our varied and challenging lives.
