In a 1956 paper entitled "Early Infantile Autism 1943-1955," Kanner and Eisenberg distilled the former's five diagnostic criteria down to these two features...
1. A profound lack of affective contact
2. Repetitive, ritualistic behavior, which must be of an elaborate kind
They stated that if these two features were observed, the rest of the typical clinical picture--as described in Kanner's 1943 breakthrough paper entitled "Autistic Disturbances of Affective Contact"--would also present. It was noted that this condition might be observed in one to two children per 10,000. The numbers on today's autism, of course, are far higher--1 in 110, with some sources citing an incredible 1 in 50 children!
How can we explain this astounding increase in incidence? As was argued in this column some months ago, the only logical explanation is that today's "autism" is something different from what Kanner was describing, even if certain elements remain.
A growing group of experts, led by Michael J. Goldberg, MD, insist that classic Kanner autism--a genetically-based psychological/developmental disorder--is not what the vast majority of the affected kids have today. Contrary to Kanner's precepts, most of today's "autistic" kids are affectionate, and have lost gross or fine motor skills.
As to today's so-called "epidemic" of autism, bear in mind that there is no such thing as an epidemic of a genetic or developmental disorder. How could there be? On the other hand, there have been countless epidemics of organic medical diseases.
Isn't it time, Goldberg suggests, that we accept that today's autism is not psychological or developmental, but a medical disease? A medical disease, he says, that mimics certain symptoms of classical Kanner autism. Today's autism is better called "Autism Spectrum Disorder" (ASD). Goldberg insists that ASD is caused by a dysfunction in the neuro-immune system, and often by secondary neurotropic viruses that impact the neuro-immune system and brain.
Or, to put it another way, as much as the psychiatrists would like to keep this windfall within the DSM-5, it must urgently be brought back to a medically based, ICD-9/ICD-10 categorization. The term "neuro-immune disease" refers to a group of illnesses that are the result of acquired dysregulation of both the immune system and the nervous system, often resulting in lifelong disease and disability.
According to Goldberg: "Illnesses such as autism, ADD/ADHD, and chronic fatigue syndrome all might have different names, but are actually variations on the same theme: Neuro-immune dysfunction syndrome (NIDS)."
What about the innate immune system connection? In humans and most advanced vertebrates, two systems work in concert: Nonspecific or innate immunity and specific or acquired immunity. Nonspecific protective mechanisms repel all microorganisms equally, while the specific immune responses are tailored to particular types of invaders, and are based on lymphocytes.
The innate immune system includes a variety of defense mechanisms such as the skin, chemical barriers such as antimicrobial proteins that harm or destroy invaders, and cells that attack cells containing infectious agents. Also included is the inflammatory response.
In the past few years, a number of studies have conclusively linked dysfunction in the innate immune system with ASD--even if some of the investigators are reversing cause and effect. A 2013 paper found anomalies in dendritic cells (important in modulating immune response) in children with ASD. Another 2013 paper found activation of an innate immune system receptor--the Toll-like receptor 4--as a common marker in a host of illnesses, including autoimmune disorders and neuroinflammatory disorders such as ASD. These results mirror work from 2008 and 2009.
This raises the big question: What causes the innate immune system in these kids to go haywire, thus triggering ASD and who knows what else? Since virtually all children with ASD become this way after appearing normal in the first 15-18 months of life, logic and reason point to some sort of exposure--or perhaps lack of exposure.
The lack of exposure group argues that our overly antiseptic environment retards development of the innate immune system in a manner that some antigen will eventually cause it to overreact. Sorry, but to me that sounds like voodoo.
Inasmuch as elimination diets have proved effective in quieting down immune system overreaction, it seems far more likely that errant feeding is to blame. We already know that the mindless touting of high carb/low fat is a prime reason why we have an obesity and Type 2 diabetes epidemic. How much of a reach is it to blame innate immune dysfunction on the overfeeding of grains to immature GI tracts?
Michael D. Shaw
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