Autism: Who’s the Culprit? Mother Nature or Mother Nurture?

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. [1]

– 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. [2] Several genes have beenidentifiedthat potentially may be linked to autism. [3]

– Immunologic: Researchers have identified certain molecules within the immune system that may impact, negatively, the developing fetal brain, causing autism. [4]

– Parental age: Mothers, but particularlyfathers of advanced age, have a higher chance of having a child with autism. [5]

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. [6]

– 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. [7]

– 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. [8]

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.”

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