Autism spectrum disorder (henceforth referred to as autism) is a neurodevelopmental disorder. Other examples of neurodevelopmental disorders are attention-deficit hyperactivity disorder (ADHD), specific learning disorder (SLD), etc.
These are not diseases, but divergence from neurotypicality.
There are multiple factors that contribute to the prevalence of autism, with a complex interplay of genetic and environmental factors. The cause of these conditions has not been established, and there is no magic pill to prevent or cure them. Attempts at finding a method to prevent or cure autism indicate a lack of respect for autistic individuals and their families as it is not a disease.
There has been an increase in the prevalence of autism in the past 50 years. This has caused concern in some quarters. There are many reasons for this reported increase.
Main factors are better recognition, a broader definition of autism, and increased screening efforts such as the use of an autism screening questionnaire in the Malaysian public health record book for children, with opportunistic screening at the ages of 18 months, 24 months, and 30 months.
When a condition is actively looked for by enhanced screening the anticipated result is an increase in prevalence, and this reflects the success of the screening effort.
Therefore, this is not a cause for alarm, but a reflection of improvement in awareness and recognition.
There are multiple conflicting and controversial statements that have been circulating, and this position statement aims to clarify the scientific viewpoint.
It is imperative that scientific rigour is established when appraising any research. This means that objective review of methodology, analysis, and interpretation of research findings are all crucial components when trying to understand its implications.
When reading scientific literature, these definitions have important distinctions in meaning:
- Causation or Causal Link: Relationship between an event or situation and a possible reason or cause.
- Association: A general relationship between two variables. If the response of one variable changes with the different states/categories of the other variable, then they have an association. Even if an association is found to be ‘statistically significant’ the strength of the association needs to be determined. Thus, there is a difference between an association that is statistically significant, but weak, and a statistically significant but strong association
- Correlation: This also studies a relationship between two variables, but is used when the variables are along a continuum, e.g.: increase in height over time with age. Depending on the spread of the data and whether the appropriate test to test the correlation was selected, results can widely differ. Also, a correlation does not mean cause-and-effect, as two variables can be ‘correlated’ without either having an influence on the other.
The best quality studies are studies of studies (meta-analyses), which research multiple sources of results before conclusions are drawn. Experts agree that autism is a complex neurodevelopmental disorder influenced by many genetic and environmental factors, with no known single cause.
Therefore, it is important for the public to be aware of three things:
- There are many studies which do not adhere to strict scientific methods and thus their results may be flawed.
- Erroneous conclusions can be drawn if results of any study are misinterpreted.
- All studies, even the best, have limitations which need to be acknowledged when drawing conclusions.
There are a few myths regarding neurodevelopmental conditions and autism:
Myth: Acetaminophen (found in paracetamol, Tylenol and other products) use in pregnancy is linked to autism: Acetaminophen has been used safely in pregnancy for many years. It is one of the most studied drugs in pregnancy and given the current evidence on its safety profile, when used appropriately it is safe for pregnant mothers. Not treating fever in pregnant mothers carries risks to the foetus and thus, prompt medical consultation and treatment are imperative.
Myth: Vaccinations, especially multiple vaccinations given together, particularly before the age of two years, have been linked with autism: There is no established link between vaccinations or grouping of multiple vaccinations with autism. To date, there is an absence of good quality and strong evidence of any causal link between vaccinations and autism.
Autism is often detected around the age that children receive the measles, mumps and rubella (MMR) vaccination. The coincidental timing is the reason that numbers appear to increase at that time.
There was a previously debunked and retracted study that produced incorrect conclusions of a link between the MMR vaccination and autism.
Withholding vaccinations without a justifiable medical reason poses the risk of a child contracting preventable communicable diseases, with potentially significant complications.
Myth: Leucovorin (folinic acid) supplementation is a cure for autism: There is no known cure for autism. There is no evidence for routine folinic acid supplementation for children with speech delay or autism. Similarly, routine supplementation of vitamins and minerals has not been proven to have any consistent effect on features of autism.
Myth: Stem cell transplantation, chelation therapy, hyperbaric oxygen, intravenous immunoglobulin, neurofeedback, mineral supplements, holding therapy, infrared therapy, weighted vests, craniosacral therapy, and cannabidiol (CBD) are treatments for autism: There are numerous alternative therapies available that purport to treat autism. Thus far, there is a paucity of evidence to support the use of the abovementioned therapies.
Research evidence thus far is inconclusive. Furthermore, many of these therapies have safety risks. Stem cell transplantation and chelation therapy are utilised for very specific medical conditions (not autism), under supervision of specialised doctors and teams.
It is not advisable for children to undergo any alternative therapies in an attempt to cure autism.
Myth: Restrictive diets improve the symptoms of autism: There is a risk that when a child’s diet is limited, they may not get an appropriate and adequate amount of nutrients for health and growth.
Some autistic children may have selective eating patterns due to sensory differences, with resultant self-selection of food. Further restricting their intake can risk nutrient deficiencies.
This is a field whereby misinformation is rife. There will likely continue to be new sensational news and claims in the future. We urge the public to have a healthy scepticism of any unsubstantiated statements on causes, links, associations, and cures that can be misleading.
All new information should be subject to unbiased, objective scientific and critical appraisal before it is accepted as truth.
Speak to your doctor and get professional advice. Explore information from evidence-based and verified sources. In conclusion, the most popular argument is not necessarily the correct or best option.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
