April -- which annually serves as Autism Awareness Month -- brought showers of awareness on the condition and with it tremendous debate. Having completed a lot of research on the subject before putting pen to paper, I have come to the conclusion that a lot is known... about theunknownnature of the disease. Conflicting literature exists as to the definition, the prevalence, etiology and treatment options for the disorder.
So to begin, some basic information:
- What is autism? The definition hasevolvedover the decades to reflect a spectrum of neuro-developmental disorders characterized by varying degrees of intellectual disabilities, difficulties in verbal/nonverbal communication, poor social interactive skills and deficits in motor coordination.
- What is the prevalence of autism? While numbers vary considerably pending the source, the estimated number of children affected in the U.S. by autism spectrum disorder 1 in 88 children, with a 4:1 male vs. female preponderance. 
- What causes autism? Herein lies the rub; no definitive etiologic factor has been identified to date, no test exists to diagnose it either prenatally or during childhood.
So, who's the culprit in the genesis of the disease: Mother Nature (internal cause), or Mother Nurture (external cause)? Let's evaluate some internal components.
- Genetics: Autism tends to run in some families.Studies looking at identical twins have noted when one twin has the disease, in the vast majority of cases, so does the other.  Several genes have beenidentifiedthat potentially may be linked to autism. 
- Immunologic: Researchers have identified certain molecules within the immune system that may impact, negatively, the developing fetal brain, causing autism. 
- Parental age: Mothers, but particularlyfathers of advanced age, have a higher chance of having a child with autism. 
What about external components?
- Environmental: There is a lot of research that looks at pesticides, plastics, metals (ex. lead, mercury), air pollution as afactor; the commonality here is they all in some fashion negatively impact the normally functioning hormonal or genetic systems within the body. 
- Drugs: Anti-seizure meds (ex. Valproic acid), anti-depressive medications, particularlySSRIs(like Paxil, Prozac) have been associated with potentially impacting the fetal brain during development and increasing autism's risk. 
- Inflammation: Certain disease processes like obesity and diabetes reflect a chronic inflammatory state within the body -- again associated with anincreasing riskof autism in the offspring of those so affected. 
So in the final analysis, what are we really seeing, and what can be done? Let me introduce another topic -- that of epigenetics -- basically the concept that non-genetic factors influence the way that genes express themselves. Is autism a symptom of this Pandora's Box? It gets "curiouser and curiouser."