Autism vs. Asperger's--Is it Really a Spectrum?

Asperger's EEG patterns are distinct from classical autism--from Duffy, et al. Citation at end.

A new study was just released by researchers at Boston Children's Hospital and Harvard Medical School entitled, “The relationship of Asperger’s syndrome to autism: a preliminary EEG coherence study” which found that although participants with Asperger’s had EEG patterns that were closer to autism than controls, when compared with autism, Asperger’s is distinctly separate.  Children with Asperger's syndrome show patterns of brain connectivity distinct from those of children with autism, according to Duffy, et al (the paper is cited at the bottom). These findings suggest the two conditions, which are now in one category in the DSM-V, may actually be biologically different.

 

From Duffy, et al--see citation at end.

This agrees with my admittedly non-scientific observations.  I’ve had a lot of interactions with individuals who I would firmly label as having Asperger’s, but they are nothing like my severely autistic son or the other autistic children I know.  Being an engineer who spent a number of years working for a three-letter intelligence agency placed me routinely among people who were highly-intelligent who might be described as geeks, lacking social skills or the ability to make eye contact.

What they could do, however, was solve sophisticated equations, program computers and break codes—oh, and hold a conversation and use the toilet on their own.  I am still waiting for the day Ryan can speak to me, is potty-trained, stops eloping, engaging in other dangerous behaviors, stops uncontrollably shaking, loses these miserable allergies and rashes, and has a healed gut. 

 

I worked with a lot of people just like him  :-)

Because the current school of thought tells us autism is a spectrum, we have thought of individuals with Asperger’s as being high functioning autistics.  There has been a great deal of conflict between some individuals with Asperger’s who favor what they call “neurodiversity” and those of us who want to cure our sick kids. I personally see little relationship to someone like Temple Grandin or John Elder Robison and Ryan. They are highly-accomplished and do not suffer the medical conditions so many of our children do. I do appreciate the awareness they bring to autism, but I am concerned that they inadvertently convey a message that autism is simply a form of genius accompanied by eccentric behaviors.

 

Autism Rockstar John Elder Robison (credit Rick Colson)--I can only hope Ryan will grow up to be like John.

In my mind, this study begs the question of whether Asperger’s is a condition one is born with or is acquired like classical autism seems to be in many cases—although mainstream medicine would like us to believe otherwise.  I have sons on both ends of this supposed spectrum and they could not be more different.  One was a difficult child from the get-go, but is brilliant and has no allergies, gut issues or other obvious neurologic impairments.  Although he had worldclass meltdowns when younger, he has matured into a composed young man who now attends a university.  While he will never be the life of the party, he has a pleasant and calm demeanor, makes friends and leads a normal life.  I am not worried about his future.  

On the other hand, Ryan was a normally-developing kid with a sunny disposition, who laughed, made eye contact, said a handful of words and was very social…then he changed when he was just over a year old.  He stopped making eye contact and would sit in the corner lining up trains for hours.  He completely stopped babbling or trying to talk and became very quiet.  I know many people who have had the same experience.  They have a normally-developing child and they just fade away—or in some cases, suddenly lose the ability to speak, make contact and lose physical coordination.  These children often develop epilepsy, allergies, unexplained rashes, diarrhea, constipation and are just generally sick children.  Doctors would like us to believe this is all a coincidence--that our children had autism all along and we simply didn’t notice. What a load of crap.

I have read a great deal of literature that suggests what we call autism isn’t autism at all, but rather occurs when microglia, the primary immune defenses of the central nervous system, destroy connections in the brain.  Recent studies bear this out; our children have suffered brain-damage.  Autism was Ryan's secondary diagnosis from Kennedy Krieger, his primary diagnosis was encephalopathy--a fancy word for brain damage. 

I find the immune system dysfunction theory very believable because it coincides with what I have observed empirically, but it appears scientists are on to what we autism moms have observed for years.  Below is a list of recent research about the role of the immune system and autism (from https://stopcalling it autism.org):

Evidence of microglial activation in autism and its possible role in brain underconnectivity (2012)  Juan I. Rodriguez and Janet K. Kern Evidence of microglial activation in autism and its possible role in brain underconnectivity. Neuron Glia Biology, Available on CJO doi:10.1017/S1740925X120

Does microglial dysfunction play a role in autism and Rett syndrome? (2012)
Does microglial dysfunction play a role in autism and Rett syndrome? Neuron Glia Biology, Available on CJO 2012 doi:10.1017/S1740925X1200004X

Microglial Activation in Young Adults With Autism Spectrum Disorder (2013)
Microglial Activation in Young Adults With Autism Spectrum Disorder. JAMA Psychiatry. 2013;70(1):49-58. doi:10.1001/jamapsychiatry.2013.272

Microglia in development: linking brain wiring to brain environment (2012)
Rosa C. Paolicelli and Cornelius T. Gross Microglia in development: linking brain wiring to brain environment. Neuron Glia Biology, Available on CJO doi:10.1017/S1740925X12000105
Nobel winner ties mental illness to immune defect - microglial activation (2010)
Published: Thursday, May 27, 2010 - Link to Video
Microglia in the Cerebral Cortex in Autism (2012)  
Tetreault NA, Hakeem AY, Jiang S, Williams BA, Allman E, Wold BJ, Allman JM. J Autism Dev Disord. 2012 Mar 31.
Abnormal microglial-neuronal spatial organization in the dorsolateral prefrontal cortex in autism (2012) Morgan JT, Chana G, Abramson I, Semendeferi K, Courchesne E, Everall IP. Brain Res. 2012 May 25;1456:72-81.
The role of enteric glia in gut inflammation (2010) 
Georg von Boyen and Martin Steinkamp (2010). The role of enteric glia in gut inflammation. Neuron Glia Biology, 6 , pp 231-236 doi:10.1017/S1740925X11000068
Sex, glia, and development: Interactions in health and disease (2012)
Jaclyn M. Schwarz and Staci D. Bilbo (2012). Horm Behav. 2012 Feb 22. [Epub ahead of print]
Duke University, Department of Psychology and Neuroscience, 572 Research Dr. Rm 3017, Durham, NC 27705, USA
Microglia and neuronal cell death (2012)
José L. Marín-Teva, Miguel A. Cuadros, David Martín-Oliva and Julio Navascués Microglia and neuronal cell death. Neuron Glia Biology, Available on CJO 2012 doi:10.1017/S1740925X12000014
The role of microglia at synapses in the healthy CNS: novel insights from recent imaging studies (2012)
Marie-Ève Tremblay The role of microglia at synapses in the healthy CNS: novel insights from recent imaging studies. Neuron Glia Biology, Available on CJO 2012 doi:10.1017/S1740925X12000038

Nitric oxide signaling in brain function, dysfunction, and dementia (2010) - Pubmed Link
Steinert JR, Chernova T and Forsythe ID (2010). Neuroscientist. 2010 Aug;16(4):435-52

Neurotoxicity at the Synaptic Interface, MRC Toxicology Unit, University of Leicester, Leicester, UK.

NIH-supported study shows how immune cells change wiring of the developing mouse brain (2012)
Schafer, D. et al. “Microglia sculpt postnatal neural circuits in an activity and complement-dependent manner” Neuron, May 24, 2012.

These studies tell us there is a critical role for the immune system in the development of autism.  The question becomes, what is causing microglial dysfunction? How do we stop it?

Money is being poured into research trying to pinpoint a solely genetic cause for autism.  More resources need to be applied to finding what it is that triggered our children's autism/encephalopathy.  There is no such thing as a genetic epidemic, and with the significant increase in autism becoming expected and routine, it's time to look for another cause.  It's time to take the raw emotion out of the vaccine question and think about it in more nuanced terms than "vaccines - good/diseases - bad".  Is there really a legitimate reason our children receive so many vaccines prior to starting school? Is there room for compromise? For example, do one-day old infants really need a vaccine against Hepatitis B, a disease that is sexually transmitted or blood borne, often afflicting drug addicts who share needles?

 

The Duffy study raises important questions about how we think about autism and if it is in fact a spectrum.  Autism presents with a heterogeneity of symptoms, depending on how much brain damage has occurred. This study confirms my personal opinion that Asperger's is a distinct condition from classical autism, despite some similarities.  I have always thought of Asperger's as a congenital condition, while Ryan's autism was acquired or triggered. He has a medical condition, complete with neurological, gastrointestinal and autoimmune disorders. Ryan's immune system has suffered a tremendous assault.

He was not born with it.

   

Reference:

Duffy, F. H., Shankardass, A., McAnulty, G. B., & Als, H. (2013). The relationship of Asperger’s syndrome to autism: a preliminary EEG coherence study.  BMC Medicine 2013. Vol 11:175.