Autism and Education; Science and Me

Autism 101

• Thomas Herrera • Season 1 • Episode 1

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Autism 101:
Why, hello there! Welcome welcome welcome. I hope you are ready to think today, because now is the time! Welcome to Autism and Education; Science and Me. I am your host, Thomas Herrera. What is the topic today? 

Today on Autism and Education; Science and Me, our topic is Autism 101: Autism Basics. Today we will define autism, describe its history and levels, discuss classic autistic symptoms, discuss the major controversy about autism and finish with pros and cons of the disorder. So, sit back, relax, take out a notepad and pencil, and listen to Autism 101. 

 So, we will begin our crash course on autism. Let us start with a full disclosure. I am not an expert on autism. I am not a doctor, and have no medical license. I am not capable of diagnosing anyone of autism, and anything I describe should be further analyzed yourself. All this information was researched thoroughly through various scientific journals and websites. If you need a diagnosis, seek a neurologist, or talk to your doctor. As an educator, I often say seek out the experts. Okay, moving on. 

Autism, comes from the Greek word autos, meaning self. We hear that word thrown around a lot. But how prevalent is it? How many people can have autism? Does gender impact autism? Both genders have autism, but not in equal amount. Boys are more likely to have autism then girls, with a ratio of 4:1 male-to-female4. But how many are we talking? A study performed in 2016 says that 1 in 54 children in the US were diagnosed with autism. This equates to 18.5 out of 1000 children10. Well, that is all fine and dandy, but let me put this into perspective. According to the United States Census Bureau, the US population on April 15, 2020 was 329,519,667, rounding up to 330 million. Roughly 24% of those individuals, 79,200,000 people, were children, ages 18 and below2. If we keep the statistic proposed by the study in 2016, then as of 2020, there are 1,466,666 children with autism. That is a lot of children. So how we do define autism?

It depends on who you ask. But most definitions describe basically the same thing. The National Institute of Mental Health defines autism spectrum disorder, or ASD, as a developmental disorder that affects communication and behavior13. The American Psychiatric Association defines ASD as having difficulty communicating and interacting with other people, having restricted interests and repetitive behaviors, and other symptoms that prevent people from functioning “properly” in schoolwork and other areas of life1. This is also described in their Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Another paper defines Autism as a pervasive development disorder (PDD) that is characterized by three core deficits, impaired communication, impaired social interactions, and restricted/repetitive patterns of behavior and interests.4

Every definition describes issues with two main areas: communication and restricted and repetitive behavior. ASD is also a spectrum, meaning that there is a wide range of symptoms represented by ASD. In addition, not everyone who has ASD exhibits the same exact symptoms. Over time, the types of ASD have changed. Here is a brief history of autism diagnosis. Starting in 1943, an American psychiatrist named Leo Kanner, used the term “early infantile autism” to describe children who lacked interest in other people. The next year, an Austrian pediatrician, Hans Asperger, independently described another group of children that had the similar behaviors, but were less severe and had higher intellectual abilities compared to Kanner’s group. The work of Hans later became known as Asperger’s syndrome. More on that in another episode. In the 1980s, the term pervasive disorders were first used. Over the years, ASD included the following five conditions, as described by DSM-IV: Autistic Disorder, Asperger disorder, Rett disorder, Childhood disintegrative disorder, and pervasive developmental disorder-not otherwise specified (PDD-NOS)4. In 2013, with the revamp of the manual from DSM-IV to DMS-V, the criteria for ASD was further changed. Now, ASD combines Autistic disorder, Asperger’s disorder, childhood disintegrative disorder, and PDD-NOS into one category. Rett’s syndrome was excluded as it was considered a different neurological disorder entirely6. 

Oh wait. Autism and Asperger’s syndrome I have heard of you say. But what are the other two? Childhood disintegrative disorder (CDD), or Heller’s syndrome is a rare condition of three or more years of development delays in language, social function, and motor skills. Some characteristics include regression of receptive and expressive language skills (understanding language and spoken language respectfully) and/or social skills or adaptive behaviors. Other characteristics include abnormal functioning in restricted, repetitive, and stereotyped behavior, an inability to start/maintain conversations, and/or impaired nonverbal behaviors3. Rett syndrome is a genetic neurological disorder, occurring almost exclusively in the female population, that leads to severe impairments that affect nearly every aspect of the child’s life including the ability to speak, walk, eat, and breathe easily15. All caught up? Cool.

We mentioned earlier the difference between Autism and Asperger’s Syndrome. ASD has various levels as described by the DSM-V. The following levels are as follows in least severity to most severity: Level 1 Requiring support, Level 2 Requiring substantial support, and Level 3 Requiring very substantial support. Level 1 individuals have difficulty initiating social interactions, and their problems of organization and planning hamper their independence. Their inflexibility of behavior causes significant interference in one or more aspects of their life. Level 2 individuals have limited initiation of social interactions and reduced or abnormal responses to social interactions. Their restricted/repetitive behaviors interfere with most of the areas of life. Level 3 individuals have severe deficits in verbal and nonverbal social communication. This means they have extremely limited initiation of social interactions and minimal responses to social interactions. Their restricted/repetitive behaviors interfere with all areas of their life, and they have great distress when things change, and they have extreme difficulty coping with change11. 

Okay. Let’s take a step back and review these levels and what they mean in common lingo. The least severe level is Level 1: Requiring support. Level 1 individuals have mild autism, and they may struggle in social situations. They can communicate verbally, and have meaningful relationships with others. However, they may have problems maintaining conversations, and keeping friends. They have restrictive and repetitive behaviors that they stick to. They feel uncomfortable when disrupted. (This would be me) 

The middle range would be Level 2 Requiring Substantial support. Level 2 individuals may or may not communicate verbally. If they do communicate verbally, the conversations are short, and are usually focused on specific topics. They may also have trouble maintaining eye contact, expressing emotion, and showing facial expressions. They have established routines and habits that they must complete. If these habits are interrupted, they became extremely uncomfortable or upset. 

The most severe is Level 3 Requiring very substantial support. Level 3 individuals have their entire lives impacted by their behaviors and communication. They have significant difficulty with social communication and social skills. Most do not communicate verbally, but some can. They struggle with unexpected events, and are either overly or under sensitive to sensory stimuli5. 

Congratulations! You are now halfway through our crash course. It’s all downhill from here. So, we listed the levels and definitions of autism. What are some classic symptoms? There are many symptoms of ASD. I will divide them into social behaviors and the restrictive and repetitive behaviors. Neurotypical people understand the basic rules of having a proper conversation. Maintain proper eye contact, pay attention to those who are speaking, try not to interrupt, and respond when called. Those with ASD may struggle with all of these. They may not pay attention when their name is called, or even not look you in the eye. They may also have troubles following the conversation, including pauses between speech, whose turn it is to talk, etc.. 

Young children like to share their interests. Young children may share their toys or point out objects to get your attention. This is a bonding technique that you may not experience with ASD individuals. Another bonding technique is conversation. ASD individuals can often talk at great length about topics they are interested in. But they fail to notice others disinterest in that subject. They may not give others a chance to respond either. These conversations are more of a monologue than a dialogue. They also will have trouble understanding someone else viewpoint or predict other people’s actions. They may be surprised why someone acts a certain why or be unable to follow someone’s next move. 

Now, let us talk about the restrictive and repetitive behaviors they exhibit as well. ASD individuals may repeat certain or unusual behaviors. They may eat at the same time every day, wake up at the same time every day, or go to bed at the same time every day. They may perform the same ritual every day without fail. (Counting the same things every day, rubbing the same stone every day, organizing things etc..) ASD individuals will become upset when their routines are changed, even slightly. They may also have a lasting interest in certain topics such as cars, animals, or sports, and learn new topics in great detail and remember that information for long periods of times. Finally, they may be more or less sensitive to external stimuli, such as sound, smell, sight, texture, etc..13. ASD are also known for having meltdowns. A meltdown is described as “an intense response to overwhelming situations”. They occur because individuals are completely overwhelmed by the current situation, and results in a loss of temporary control expresses either verbally, physically, or both12. Meltdowns could be considered analogous to the cries of a baby or child. It is the same raw emotion. 

As I stated at the beginning of this podcast, I am not an expert in this field. I am also not qualified to diagnosis anyone of anything. If you want to understand more about the classic symptoms, please research for yourself. 

Autism is a complex syndrome that we have heard of a lot lately. It is becoming more and more common as we are getting better and better at diagnosing. But there is still one major case of misinformation that is being further spread and spread that is not helping anyone. I am of course talking about vaccines and autism. The mistaken belief that vaccines cause autism. As someone who is autistic, and as someone who has been vaccinated, I really think the link is stupid. Vaccines do not cause autism, and even if they did, it’s not the end of the world. If vaccines truly do cause autism, and my loving parents in an attempt to inoculate me from various deadly diseases, actually gave me my autism: I would not hold it against them at all. I am still alive. I am not diseased, and I am well protected from viruses and other harmful bacteria. I think having autism is a small price to pay to pay if I am going to remain alive. Truly ask yourself this: which is worse, having a child with mental issues or having a dead child. To me, as an educator, I would rather have an entire class of 30 kids with various mental disorders, than having an entire class of 30 dead kids. There is no comparison. No debate. 

So what is the link? Where did it originate? The controversy started in 1998 when a paper published by a man named Andrew Wakefield, and 12 others linked the MMR vaccine to autism7. What did the paper actually say or do? Wakefield measured 12 children who had received measles, mumps, and or rubella vaccinations. 67% (8/12) children showed behavior symptoms similar to autism18. This would be a big deal except for a few issues. Since the paper’s publication the findings were revisited, as all good science does. In 2004, ten of the twelve coauthors retracted the paper because they feared the paper could damage public health efforts. Three years earlier, Britain, Japan and Finland all found no connection between the MMR shots and autism. Not only that, it was revealed that Wakefield committed several breaches of ethics. Firstly, he cherry picked his data and only showed data he wanted to show. Some of the children he selected in the experiment were part of a lawsuit against MMR manufacturers. Wakefield was paid for his advisory work on the same lawsuit. Wakefield also had a patent for a competing vaccine being developed16. These are all beg no-nos. Another paper published in 2011 described other violations Wakefield committed during the study. In addition to financial interests, such as the lawsuit, he also violated ethics too. He conducted invasive investigations on the 12 children in his study without ethical clearances. This paper also found out he misrepresented his findings in addition to his cherry picked data14. 

All of these reasons are clear violation of scientific practices and ethics. It’s no wonder the paper was retracted. The findings did not fit the correct way of science. Wakefield clearly had an agenda to “prove” vaccinations caused autism. But people still tote this paper as proof of their claims, completely disregarding the fact the paper was retracted. However, in an attempt to provide devil’s advocate, maybe it is not enough. Well, there was a large study conducted in 2014 that performed a deep dive into the literature and the findings. This paper looked at the vaccines that were rumored to give autism such as the measles, mumps, rubella vaccines, and other vaccines that contained thimerosal such as diphtheria, tetanus, or pertussis vaccines. This massive study looked at 46 papers included five cohort studies involving 1,256,407 children and five case-control studies involving 9,920 people17. If you are unfamiliar with the terms cohort study and case-control study, let me catch you up. A cohort study is any study that investigates the causes of a disease and establishes any links between the risk factors and health outcomes9. A case-control study is a study that is designed to determine if an exposure is associated with an outcome, or if a treatment leads to a disease8. So, this 2014 study that looked at 46 different scientific papers determined the following: the cohort date revealed no relationship between vaccination and autism, ASD, MMR, thimerosal, or mercury. The case-control study showed no evidence for an increased risk of developing autism or ASD after being exposed to MMR, mercury, or thimerosal17. This large study, involving 1,266,327 people, close to the predicted amount of people who have ASD in the US, showed that there is no link between vaccinations and autism. The vaccines containing mercury, MMR, or thimerosal, will not lead to the development of autism. Let me say it one more time. THERE IS NO LINK BETWEEN AUTISM AND VACCINATIONS. Think back to the first part of this segment. Which would you rather have, a dead child or a child with some mental issues? I really think, there is no contest. 

All right, let’s wrap this up. Before I leave you, what are some pros and cons of autism? Negative first then positive. There are quite a few cons of autism. 

Those with ASD may be difficult to take outside, because of the many sounds, smells, and sights they see. The stimuli outside may be more than they can take. ASD individuals have a hard time expressing themselves; they cannot accurately describe why they are upset, or what is bothering them. This makes getting along with others difficult. ASD individual must repeat themselves all day the long. To people who do not like monotony, this can be taxing, boring, and limiting. When you are stuck doing the same thing repeatedly, you rarely reach your full potential. Everyone wants their child to be the best they can be. Sadly, ASD have one more hurdle to jump over. 

But the pros are just as numerous. Those with ASD are often predictable. You always know where they are at any given time of day. After all, ASD individuals are predictably predictable. ASD individual are often very smart. They usually have one, or several, fields of information they love. They read many things about it and often study it religiously. They are like mini-experts in these areas. It makes learning easier for them in those areas. 

So, to sum up, ASD is a complex process, but really interesting when you sit down and look into. 

            Next time on Autism and Education, Science and Me our topic will be Autism 102: Causes and Behaviors. Look forward to it. 

            Thanks for listening. At times the stream of consciousness of an autistic person can be hard to follow. But keep in mind we try our best to learn and adapt. I hope today’s topic brought more insight into the mind of other people. Thanks for tuning in. Please give a like, comment, and share with your friends. I hope you engage in others about the wonders of autism, education, and science. Until next time, have a good day. 



 

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