Unraveling mitochondria’s mysterious link to autism

Unexplained origins: Some researchers say there is a real
association between autism and mitochondria.

In the past two weeks, autism researchers and advocacy groups have been agog with news that autism could be linked to an extremely rare group of metabolic diseases.

The controversy began when leaked court documents suggested that the U.S. Court of Federal Claims had ruled that when triggered by a vaccination, defects of the mitochondria — the ‘power plants’ of every cell that turn food into energy — could cause autism.

In November 2007, the court heard a case alleging that routine vaccinations caused severe neurological damage to a nine-year-old girl named Hannah Poling. Poling’s doctors testified that the five vaccinations she received at age 19 months aggravated a preexisting ‘mitochondrial respiratory chain disorder’ and led to degenerative brain disease with “features consistent with autistic spectrum disorder.” For these injuries, the court ruled that the Polings are entitled to government compensation.

For most autism researchers, the mention of a link to mitochondria came as a complete surprise. “We’re all wondering where the science is to back this up,” says pediatrician and vaccine expert Paul Offit.

Only a handful of case studies have been published addressing the link between autism and mitochondrial disease, but they all indicate that there is a real association. The debate is focused on just how large the association is, and whether vaccinations have any impact on the underlying biological mechanism.

“Autism is probably caused by many, many things, most of them genetic, and this is one of them,” says mitochondrial expert Salvatore DiMauro of Columbia University, who published one study¹ of five autistic individuals with mitochondrial disease.

The only way to know for sure, DiMauro says, is to perform a thorough epidemiological study looking for mitochondrial defects in a few hundred autistic patients. “I don’t think we’ll find a lot of them. But that would be worthwhile,” he says.

Others insist the link is more common. A small group of scientists originally affiliated with the Poling case is drafting a report of about 30 children under age five with both mitochondrial disease and regressive autism. One of the authors, Richard Kelley, a biochemical geneticist at Johns Hopkins University who first diagnosed Poling with mitochondrial disorder, estimates that “at least 10 percent” of children with autism have an underlying mitochondrial disorder.

“We’ve moved very slowly and carefully in gathering data because we knew it would be extremely difficult to convince people that this is a real phenomenon,” Kelley says. “It takes something big to wake everyone up to something that's been staring them in the face for years.”

Rare cases:

Genetic mitochondrial diseases are as varied as they are rare. Hundreds of types exist. Depending on the country, prevalence estimates range from 1 in 3,000 to 1 in 5,000 adults, according to molecular neurologist Anu Suomalainen-Wartiovaara, whose lab at the University of Helsinki specializes in mitochondrial dysfunction. “Maybe 5 or 10 percent of all our genes are making mitochondrial proteins,” she says. “So it's a huge group of diseases.”

Some people with the disease get sick just after birth, and may die after an especially violent epileptic attack. Others develop normally for several years before seeing any symptoms. In these cases, the disease is usually triggered by stresses to the immune system, such as a minor respiratory infection or, some claim, a vaccination.

Because mitochondria are vital to producing energy in most of the body’s cells, many organ systems can be affected by their dysfunction. The most common symptoms include muscle weakness, epilepsy, diabetes, liver failure and — as in Poling’s case — encephalopathy or regressive brain disease.

“Psychiatric symptoms are quite common in these patients,” says Suomalainen-Wartiovaara. With severe encephalopathy, she adds, “it’s hard to make the diagnosis of autism because so many different structural changes are happening and causing psychiatric symptoms.”

This means that autism could either be over- or under-diagnosed in these patients. Unlike certain types of diabetes, which have been definitively shown to be associated with specific point mutations in mitochondrial DNA, “there’s just no hard data on autism,” she says.

A handful of case studies and small population studies have explored how genetic mitochondrial disorders might be associated with autism. The largest², published in 2005, was led by pediatrician Guiomar Oliveira of Portugal’s Centro de Desenvolvimento da Criança. Oliveira found that 5 out of 69 autistic children (or 7.2 percent) had an underlying mitochondrial respiratory chain disorder — the same type as Poling.

Though this is a much higher prevalence than in the general population, “we don't know if it is a primary cause of autism,” Oliveira wrote in an email. The autism could be caused by another metabolic or genetic defect that is also controlled by the mitochondria, she explained.

Cause and effect:

According to the leaked court documents, within hours of vaccination, 19-month-old Hannah Poling showed a host of physical and behavioral deficits, including loss of language skills, eye contact and the ability to relate to other people — all of which are also common features of autism spectrum disorders.

Kelley says mitochondrial disease has a significant link to this kind of regressive autism, in which a child develops normally until about 18 months. “Most kids I’ve assessed with regressive autism have an underlying mitochondrial problem,” he says.

In 2003, he presented an abstract at the Current Trends in Autism Conference in Boston, stating that for kids diagnosed at the Kennedy Krieger Institute with developmental disabilities, mitochondrial disease was the most common diagnosis, accounting for as many as 20 percent of autistic children.

“It’s a very distinctive biochemical fingerprint of abnormalities that we see, and it’s very consistent from patient to patient,” he says.

During brain development, timing is everything. Kelley theorizes that if children with specific types of mitochondrial disease are exposed to a “stressful event” — which might include an immune reaction — between the age of one and two years, “they’ll often develop the phenotype of autism.”

If that stress comes during a different period of brain development, the disease might manifest into other symptoms.

He bases this theory partly on work done in mice by his colleague Michael Johnston, who found that the density of a certain brain cell protein, called the NMDA receptor, peaks around 18 months of development.

NMDA receptors are important for chemical communication between brain synapses and require energy to function. A higher density of receptors, Kelley reasons, requires more energy — which is difficult to produce without fully functional mitochondria. This could have a huge impact on brain maturation and the pruning of neurons, the developmental processes occurring at that time.

“Overstressing that system might create a massive pruning at a time when you’re only supposed to have a little bit of pruning,” Kelley says, possibly leading to regressive autism.

Bolstering this hypothesis, he says, is that many children with regressive autism also have an “inflammatory phenotype,” meaning they have ear infections or multiple allergies. “Their immune systems might be especially tuned up, causing them to overreact to stress,” he says.

A scientific study testing this theoretical mechanism in humans has not yet been published.

Kelley says his biochemical approach to studying the mitochondrial origins of autism has delivered insights missed by most autism experts. “Most people dealing with autism don’t understand metabolic [science], so I understand why they’re skeptical,” he says.

The vaccination trigger is the most controversial part of the theory, and of Poling’s court case. “I reject that part of [the Poling case] completely,” says DiMauro. “Mitochondrial diseases are caused by mutations in genes,” he explains. “There is no way a vaccination can cause a mitochondrial disease.”

References:

Source url: http://sfari.org/news/unraveling-mitochondria-s-mysterious-link-to-autism

Wired Magazine - Issue 9.12 - Dec 2001

The Geek Syndrome

Autism - and its milder cousin Asperger's syndrome - is surging among the children of Silicon Valley. Are math-and-tech genes to blame?

By Steve Silberman

Nick is building a universe on his computer. He's already mapped out his first planet: an anvil-shaped world called Denthaim that is home to gnomes and gods, along with a three-gendered race known as kiman. As he tells me about his universe, Nick looks up at the ceiling, humming fragments of a melody over and over. "I'm thinking of making magic a form of quantum physics, but I haven't decided yet, actually," he explains. The music of his speech is pitched high, alternately poetic and pedantic - as if the soul of an Oxford don has been awkwardly reincarnated in the body of a chubby, rosy-cheeked boy from Silicon Valley. Nick is 11 years old.

Nick's father is a software engineer, and his mother is a computer programmer. They've known that Nick was an unusual child for a long time. He's infatuated with fantasy novels, but he has a hard time reading people. Clearly bright and imaginative, he has no friends his own age. His inability to pick up on hidden agendas makes him easy prey to certain cruelties, as when some kids paid him a few dollars to wear a ridiculous outfit to school.

One therapist suggested that Nick was suffering from an anxiety disorder. Another said he had a speech impediment. Then his mother read a book called Asperger's Syndrome: A Guide for Parents and Professionals. In it, psychologist Tony Attwood describes children who lack basic social and motor skills, seem unable to decode body language and sense the feelings of others, avoid eye contact, and frequently launch into monologues about narrowly defined - and often highly technical - interests. Even when very young, these children become obsessed with order, arranging their toys in a regimented fashion on the floor and flying into tantrums when their routines are disturbed. As teenagers, they're prone to getting into trouble with teachers and other figures of authority, partly because the subtle cues that define societal hierarchies are invisible to them.

"I thought, 'That's Nick,'" his mother recalls.

Asperger's syndrome is one of the disorders on the autistic spectrum - a milder form of the condition that afflicted Raymond Babbitt, the character played by Dustin Hoffman in Rain Man. In the taxonomy of autism, those with Asperger's syndrome have average - or even very high - IQs, while 70 percent of those with other autistic disorders suffer from mild to severe mental retardation. One of the estimated 450,000 people in the US living with autism, Nick is more fortunate than most. He can read, write, and speak. He'll be able to live and work on his own. Once he gets out of junior high hell, it's not hard to imagine Nick creating a niche for himself in all his exuberant strangeness. At the less fortunate end of the spectrum are what diagnosticians call "profoundly affected" children. If not forcibly engaged, these children spend their waking hours in trancelike states, staring at lights, rocking, making high-pitched squeaks, and flapping their hands, repetitively stimulating ("stimming") their miswired nervous systems.

In one of the uncanny synchronicities of science, autism was first recognized on two continents nearly simultaneously. In 1943, a child psychiatrist named Leo Kanner published a monograph outlining a curious set of behaviors he noticed in 11 children at the Johns Hopkins Hospital in Baltimore. A year later, a pediatrician in Vienna named Hans Asperger, who had never seen Kanner's work, published a paper describing four children who shared many of the same traits. Both Kanner and Asperger gave the condition the same name: autism - from the Greek word for self, autòs - because the children in their care seemed to withdraw into iron-walled universes of their own.

Kanner went on to launch the field of child psychiatry in the US, while Asperger's clinic was destroyed by a shower of Allied bombs. Over the next 40 years, Kanner became widely known as the author of the canonical textbook in his field, in which he classified autism as a subset of childhood schizophrenia. Asperger was virtually ignored outside of Europe and died in 1980. The term Asperger syndrome wasn't coined until a year later, by UK psychologist Lorna Wing, and Asperger's original paper wasn't even translated into English until 1991. Wing built upon Asperger's intuition that even certain gifted children might also be autistic. She described the disorder as a continuum that "ranges from the most profoundly physically and mentally retarded person ... to the most able, highly intelligent person with social impairment in its subtlest form as his only disability. It overlaps with learning disabilities and shades into eccentric normality."

Asperger's notion of a continuum that embraces both smart, geeky kids like Nick and those with so-called classic or profound autism has been accepted by the medical establishment only in the last decade. Like most distinctions in the world of childhood developmental disorders, the line between classic autism and Asperger's syndrome is hazy, shifting with the state of diagnostic opinion. Autism was added to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders in 1980, but Asperger's syndrome wasn't included as a separate disorder until the fourth edition in 1994. The taxonomy is further complicated by the fact that few if any people who have Asperger's syndrome will exhibit all of the behaviors listed in the DSM-IV. (The syn in syndrome derives from the same root as the syn in synchronicity - the word means that certain symptoms tend to cluster together, but all need not be present to make the diagnosis.) Though Asperger's syndrome is less disabling than "low-functioning" forms of autism, kids who have it suffer difficulties in the same areas as classically autistic children do: social interactions, motor skills, sensory processing, and a tendency toward repetitive behavior.

In the last 20 years, significant advances have been made in developing methods of behavioral training that help autistic children find ways to communicate. These techniques, however, require prodigious amounts of persistence, time, money, and love. Though more than half a century has passed since Kanner and Asperger first gave a name to autism, there is still no known cause, no miracle drug, and no cure.

And now, something dark and unsettling is happening in Silicon Valley.

In the past decade, there has been a significant surge in the number of kids diagnosed with autism throughout California. In August 1993, there were 4,911 cases of so-called level-one autism logged in the state's Department of Developmental Services client-management system. This figure doesn't include kids with Asperger's syndrome, like Nick, but only those who have received a diagnosis of classic autism. In the mid-'90s, this caseload started spiraling up. In 1999, the number of clients was more than double what it had been six years earlier. Then the curve started spiking. By July 2001, there were 15,441 clients in the DDS database. Now there are more than seven new cases of level-one autism - 85 percent of them children - entering the system every day.

Through the '90s, cases tripled in California. "Anyone who says this is due to better diagnostics has his head in the sand."

California is not alone. Rates of both classic autism and Asperger's syndrome are going up all over the world, which is certainly cause for alarm and for the urgent mobilization of research. Autism was once considered a very rare disorder, occurring in one out of every 10,000 births. Now it's understood to be much more common - perhaps 20 times more. But according to local authorities, the picture in California is particularly bleak in Santa Clara County. Here in Silicon Valley, family support services provided by the DDS are brokered by the San Andreas Regional Center, one of 21 such centers in the state. SARC dispenses desperately needed resources (such as in-home behavioral training, educational aides, and respite care) to families in four counties. While the autistic caseload is rising in all four, the percentage of cases of classic autism among the total client population in Santa Clara County is higher enough to be worrisome, says SARC's director, Santi Rogers.

"There's a significant difference, and no signs that it's abating," says Rogers. "We've been watching these numbers for years. We feared that something like this was coming. But this is a burst that has staggered us in our steps."

It's not easy to arrive at a clear picture of whether there actually is a startling rise in the incidence of autism in California, as opposed to just an increase in diagnoses. One problem, says Linda Lotspeich, director of the Stanford Pervasive Developmental Disorders Clinic, is that "the rules in the DSM-IV don't work." The diagnostic criteria are subjective, like "Marked impairment in the use of nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction."

"How much 'eye-to-eye gaze' do you have to have to be normal?" asks Lotspeich. "How do you define what 'marked' is? In shades of gray, when does black become white?"

Some children will receive a diagnosis of classic autism, and another diagnosis of Asperger's syndrome, from two different clinicians. Tony Attwood's advice to parents is strictly practical: "Use the diagnosis that provides the services."

While diagnostic fuzziness may be contributing to a pervasive sense that autism is on the rise, Ron Huff, the consulting psychologist for the DDS who uncovered the statistical trend, does not believe that all we're seeing now is an increase in children who would have previously been tagged with some other disability, such as mental retardation - or overlooked as perfectly healthy, if quirky, kids.

"While we certainly need to do more research," says Huff, "I don't think the change in diagnostic criteria will account for all of this rise by any means."

The department is making its data available to the MIND Institute at the University of California at Davis, to tease out what's behind the numbers. The results of that research will be published next year. But the effects of a surging influx are already rippling through the local schools. Carol Zepecki, director of student services and special education for the Palo Alto Unified School District, is disturbed by what she's seeing. "To be honest with you, as I look back on the special-ed students I've worked with for 20 years, it's clear to me that these kids would not have been placed in another category. The numbers are definitely higher." Elizabeth Rochin, a special-ed teacher at Cupertino High, says local educators are scrambling to create new resources. "We know it's happening, because they're coming through our schools. Our director saw the iceberg approaching and said, 'We've got to build something for them.'"

The people scrambling hardest are parents. In-home therapy alone can cost $60,000 or more a year, and requires so much dedication that parents (particularly mothers) are often forced to quit their jobs and make managing a team of specialists their new 80-hour-a-week career. Before their children become eligible for state funding, parents must obtain a diagnosis from a qualified clinician, which requires hours of testing and observation. Local facilities, such as the Stanford Pervasive Development Disorders Clinic and its counterpart at UC San Francisco, are swamped. The Stanford clinic is able to perform only two or three diagnoses a week. It currently has a two- to six-month waiting list.

For Rick Rollens, former secretary of the California Senate and cofounder of the MIND Institute, the notion that there is a frightening increase in autism worldwide is no longer in question. "Anyone who says this epidemic is due to better diagnostics," he says, "has his head in the sand."

Autism's insidious style of onset is particularly cruel to parents, because for the first two years of life, nothing seems to be wrong. Their child is engaged with the world, progressing normally, taking first steps into language. Then, suddenly, some unknown cascade of neurological events washes it all away.

One father of an autistic child, Jonathan Shestack, describes what happened to his son, Dov, as "watching our sweet, beautiful boy disappear in front of our eyes." At two, Dov's first words - Mom, Dad, flower, park - abruptly retreated into silence. Over the next six months, Dov ceased to recognize his own name and the faces of his parents. It took Dov a year of intensive behavioral therapy to learn how to point. At age 9, after the most effective interventions available (such as the step-by-step behavioral training methods developed by Ivar Lovaas at UCLA), Dov can speak 20 words.

Even children who make significant progress require levels of day-to-day attention from their families that can best be described as heroic. Marnin Kligfeld is the founder of a software mergers-and-acquisitions firm. His wife, Margo Estrin, a doctor of internal medicine, is the daughter of Gerald Estrin, who was a mentor to many of the original architects of the Internet (see "Meet the Bellbusters," Wired 9.11, page 164). When their daughter, Leah, was 3, a pediatrician at Oakland Children's Hospital looked at her on the examining table and declared, "There is very little difference between your daughter and an animal. We have no idea what she will be able to do in the future." After eight years of interventions - behavioral training, occupational therapy, speech therapy - Leah is a happy, upbeat 11-year-old who downloads her favorite songs by the hundreds. And she is still deeply autistic.

Leah's first visit to the dentist required weeks of preparation, because autistic people are made deeply anxious by any change in routine. "We took pictures of the dentist's office and the staff, and drove Leah past the office several times," Kligfeld recalls. "Our dentist scheduled us for the end of the day, when there were no other patients, and set goals with us. The goal of the first session was to have Leah sit in the chair. The second session was so Leah could rehearse the steps involved in treatment without actually doing them. The dentist gave all of his equipment special names for her. Throughout this process, we used a large mirror so Leah could see exactly what was being done, to ensure that there were no surprises."

Daily ordeals like this, common in the autistic community, underline the folly of the hypothesis that prevailed among psychologists 20 years ago, who were convinced that autism was caused by a lack of parental affection. The influential psychiatrist Bruno Bettelheim aggressively promoted a theory that has come to be known as the "refrigerator mother" hypothesis. He declared in his best-selling book, The Empty Fortress, "The precipitating factor in infantile autism is the parent's wish that his child should not exist. ... To this the child responds with massive withdrawal." He prescribed "parentectomy" - removal of the child from the parents - and years of family therapy. His hypothesis added the burden of guilt to the grief of having an autistic child, and made autism a source of shame and secrecy, which hampered efforts to obtain clinical data. The hypothesis has been thoroughly discredited. Richard Pollak's The Creation of Dr. B exposed Bettelheim as a brilliant liar who concocted case histories and exaggerated both his experience with autistic children and the success of his treatments.

One thing nearly everyone in the field agrees on: genetic predisposition. Identical twins share the disorder 9 times out of 10.

But the debates about the causes of autism are certainly not over. Controversies rage about whether environmental factors - such as mercury and other chemicals in universally administered vaccines, industrial pollutants in air and water, and even certain foods - act as catalysts that trigger the disorder. Bernard Rimland, the first psychologist to oppose Bettelheim and promote the idea that autism was organic in origin, has become a leading advocate for intensified investigation in this area. The father of an autistic son, Rimland has been instrumental in marshaling medical expertise and family data to create better assessment protocols.

The one thing that almost all researchers in the field agree on is that genetic predisposition plays a crucial role in laying the neurological foundations of autism in most cases. Studies have shown that if one identical twin is autistic, there's a 90 percent chance that the other twin will also have the disorder. If parents have had one autistic child, the risk of their second child being autistic rises from 1 in 500 to 1 in 20. After two children with the disorder, the sobering odds are 1 in 3. (So many parents refrain from having more offspring after one autistic child, geneticists even have a term for it: stoppage.) The chances that the siblings of an autistic child will display one or more of the other developmental disorders with a known genetic basis - such as dyslexia or Tourette's syndrome - are also significantly higher than normal.

The bad news from Santa Clara County raises an inescapable question. Unless the genetic hypothesis is proven false, which is unlikely, regions with a higher than normal distribution of people on the autistic spectrum are something no researcher could ask for: living laboratories for the study of genetic expression. When the rain that fell on the Rain Man falls harder on certain communities than others, what becomes of the children?

The answer may be raining all over Silicon Valley. And one of the best hopes of finding a cure may be locked in the DNA sequences that produced the minds that have made this area the technological powerhouse of the world.

It's a familiar joke in the industry that many of the hardcore programmers in IT strongholds like Intel, Adobe, and Silicon Graphics - coming to work early, leaving late, sucking down Big Gulps in their cubicles while they code for hours - are residing somewhere in Asperger's domain. Kathryn Stewart, director of the Orion Academy, a high school for high-functioning kids in Moraga, California, calls Asperger's syndrome "the engineers' disorder." Bill Gates is regularly diagnosed in the press: His single-minded focus on technical minutiae, rocking motions, and flat tone of voice are all suggestive of an adult with some trace of the disorder. Dov's father told me that his friends in the Valley say many of their coworkers "could be diagnosed with ODD - they're odd." In Microserfs, novelist Douglas Coupland observes, "I think all tech people are slightly autistic."

Though no one has tried to convince the Valley's best and brightest to sign up for batteries of tests, the culture of the area has subtly evolved to meet the social needs of adults in high-functioning regions of the spectrum. In the geek warrens of engineering and R&D, social graces are beside the point. You can be as off-the-wall as you want to be, but if your code is bulletproof, no one's going to point out that you've been wearing the same shirt for two weeks. Autistic people have a hard time multitasking - particularly when one of the channels is face-to-face communication. Replacing the hubbub of the traditional office with a screen and an email address inserts a controllable interface between a programmer and the chaos of everyday life. Flattened workplace hierarchies are more comfortable for those who find it hard to read social cues. A WYSIWYG world, where respect and rewards are based strictly on merit, is an Asperger's dream.

Obviously, this kind of accommodation is not unique to the Valley. The halls of academe have long been a forgiving environment for absentminded professors. Temple Grandin - the inspiring and accomplished autistic woman profiled in Oliver Sacks' An Anthropologist on Mars - calls NASA the largest sheltered workshop in the world.

A recurring theme in case histories of autism, going all the way back to Kanner's and Asperger's original monographs, is an attraction to highly organized systems and complex machines. There's even a perennial cast of hackers: early adopters with a subversive streak. In 1944, Asperger wrote of a boy "chemist [who] uses all his money for experiments which often horrify his family and even steals to fund them." Another boy proved a mathematical error in Isaac Newton's calculations while he was still a freshman in college. A third escaped neighborhood bullies by taking lessons from an old watchmaker. And a fourth, wrote Asperger, "came to be preoccupied with fantastic inventions, such as spaceships and the like." Here he added, "one observes how remote from reality autistic interests really are" - a comment he qualified years later, when spaceships were no longer remote or fantastic, by joking that the inventors of spaceships might themselves be autistic.

Clumsy and easily overwhelmed in the physical world, autistic minds soar in the virtual realms of mathematics, symbols, and code. Asperger compared the children in his clinic to calculating machines: "intelligent automata" - a metaphor employed by many autistic people themselves to describe their own rule-based, image-driven thought processes. In her autobiography, Thinking in Pictures, Grandin compares her mind to a VCR. When she hears the word dog, she mentally replays what she calls "videotapes" of various dogs that she's seen, to arrive at something close to the average person's abstract notion of the category that includes all dogs. This visual concreteness has been a boon to her work as a designer of more humane machinery for handling livestock. Grandin sees the machines in her head and sets them running, debugging as she goes. When the design in her mind does everything it's supposed to, she draws a blueprint of what she sees.

"In another age, these men would have been monks, developing new ink for printing presses. Suddenly, they're reproducing at a much higher rate."

These days, the autistic fascinations with technology, ordered systems, visual modes of thinking, and subversive creativity have plenty of outlets. There's even a cheeky Asperger's term for the rest of us - NTs, "neurotypicals." Many children on the spectrum become obsessed with VCRs, Pokémon, and computer games, working the joysticks until blisters appear on their fingers. (In the diagnostic lexicon, this kind of relentless behavior is called "perseveration.") Even when playing alongside someone their own age, however, autistic kids tend to play separately. Echoing Asperger, the director of the clinic in San Jose where I met Nick, Michelle Garcia Winner, suggests that "Pokémon must have been invented by a team of Japanese engineers with Asperger." Attwood writes that computers "are an ideal interest for a person with Asperger's syndrome ... they are logical, consistent, and not prone to moods."

This affinity for computers gives teachers and parents leverage they can use to build on the natural strengths of autistic children. Many teenagers who lack the motor skills to write by hand find it easier to use a keyboard. At Orion Academy, every student is required to buy an iBook fitted with an AirPort card. Class notes are written on electronic whiteboards that port the instructional materials to the school server for retrieval. (At lunch, the iBooks are shut off, and if the kids want to play a two-person game, they're directed to a chess board.) The next generation of assistive technology is being designed by Neil Scott's Archimedes Project at Stanford. Scott's team is currently developing the equivalent of a PDA for autistic kids, able to parse subtle movements of an eyebrow or fingertip into streams of text, voice, or images. The devices will incorporate video cameras, head and eye tracking, intelligent agents, and speech recognition to suit the needs of the individual child.

The Valley is a self-selecting community where passionately bright people migrate from all over the world to make smart machines work smarter. The nuts-and-bolts practicality of hard labor among the bits appeals to the predilections of the high-functioning autistic mind. The hidden cost of building enclaves like this, however, may be lurking in the findings of nearly every major genetic study of autism in the last 10 years. Over and over again, researchers have concluded that the DNA scripts for autism are probably passed down not only by relatives who are classically autistic, but by those who display only a few typically autistic behaviors. (Geneticists call those who don't fit into the diagnostic pigeonholes "broad autistic phenotypes.")

The chilling possibility is that what's happening now is the first proof that the genes responsible for bestowing certain special gifts on slightly autistic adults - the very abilities that have made them dreamers and architects of our technological future - are capable of bringing a plague down on the best minds of the next generation. For parents employed in prominent IT firms here, the news of increased diagnoses of autism in their ranks is a confirmation of rumors that have quietly circulated for months. Every day, more and more of their coworkers are running into one another in the waiting rooms of local clinics, taking the first uncertain steps on a journey with their children that lasts for the rest of their lives.

In previous eras, even those who recognized early that autism might have a genetic underpinning considered it a disorder that only moved diagonally down branches of a family tree. Direct inheritance was almost out of the question, because autistic people rarely had children. The profoundly affected spent their lives in institutions, and those with Asperger's syndrome tended to be loners. They were the strange uncle who droned on in a tuneless voice, tending his private logs of baseball statistics or military arcana; the cousin who never married, celibate by choice, fussy about the arrangement of her things, who spoke in a lexicon mined reading dictionaries cover to cover.

The old line "insanity is hereditary, you get it from your kids" has a twist in the autistic world. It has become commonplace for parents to diagnose themselves as having Asperger's syndrome, or to pinpoint other relatives living on the spectrum, only after their own children have been diagnosed.

High tech hot spots like the Valley, and Route 128 outside of Boston, are a curious oxymoron: They're fraternal associations of loners. In these places, if you're a geek living in the high-functioning regions of the spectrum, your chances of meeting someone who shares your perseverating obsession (think Linux or Star Trek) are greatly expanded. As more women enter the IT workplace, guys who might never have had a prayer of finding a kindred spirit suddenly discover that she's hacking Perl scripts in the next cubicle.

One provocative hypothesis that might account for the rise of spectrum disorders in technically adept communities like Silicon Valley, some geneticists speculate, is an increase in assortative mating. Superficially, assortative mating is the blond gentleman who prefers blondes; the hyperverbal intellectual who meets her soul mate in the therapist's waiting room. There are additional pressures and incentives for autistic people to find companionship - if they wish to do so - with someone who is also on the spectrum. Grandin writes, "Marriages work out best when two people with autism marry or when a person marries a handicapped or eccentric spouse.... They are attracted because their intellects work on a similar wavelength."

That's not to say that geeks, even autistic ones, are attracted only to other geeks. Compensatory unions of opposites also thrive along the continuum, and in the last 10 years, geekitude has become sexy and associated with financial success. The lone-wolf programmer may be the research director of a major company, managing the back end of an IT empire at a comfortable remove from the actual clients. Says Bryna Siegel, author of The World of the Autistic Child and director of the PDD clinic at UCSF, "In another historical time, these men would have become monks, developing new ink for early printing presses. Suddenly they're making $150,000 a year with stock options. They're reproducing at a much higher rate."

Genetic hypotheses like these don't rule out environmental factors playing a role in the rising numbers. Autism is almost certainly not caused by the action of a single gene, but by some orchestration of multiple genes that may make the developing child more susceptible to a trigger in the environment. One consequence of increased reproduction among people carrying some of these genes might be to boost "genetic loading" in successive generations - leaving them more vulnerable to threats posed by toxins in vaccines, candida, or any number of agents lurking in the industrialized world.

At clinics and schools in the Valley, the observation that most parents of autistic kids are engineers and programmers who themselves display autistic behavior is not news. And it may not be news to other communities either. Last January, Microsoft became the first major US corporation to offer its employees insurance benefits to cover the cost of behavioral training for their autistic children. One Bay Area mother told me that when she was planning a move to Minnesota with her son, who has Asperger's syndrome, she asked the school district there if they could meet her son's needs. "They told me that the northwest quadrant of Rochester, where the IBMers congregate, has a large number of Asperger kids," she recalls. "It was recommended I move to that part of town."

For Dov's parents, Jonathan Shestack and Portia Iversen, Silicon Valley is the only place on Earth with enough critical mass of supercomputing resources, bio-informatics expertise, genomics savvy, pharmaceutical muscle, and VC dollars to boost autism research to the next phase. For six years, the organization they founded, Cure Autism Now, has led a focused assault on the iron-walled fortress of the medical establishment, including the creation of its own bank of DNA samples, available to any scientist in the field on a Web site called the Autism Genetic Resources Exchange (see "The Citizen Scientists," Wired 9.09, page 144).

At least a third of CAN's funding comes from donors in the Valley. Now Shestack and Iversen want to deliver the ultimate return on that investment: better treatments, smarter assistive technology - and, eventually, a cure.

"We have the human data," says Shestack. "Now we need the brute-force processing power. We need high-density SNP mapping and microarray analysis so we can design pharmaceutical interventions. We need Big Pharma to wake up to the fact that while 450,000 people in America may not be as large a market as for cholesterol drugs, we're talking about a demand for new products that will be needed from age 2 to age 70. We need new technology that measures modes of perception, and tools for neural retraining. And we need a Web site where families with a newly diagnosed kid can plug into a network of therapists in their town who have been rated by buyers - just like eBay."

The ultimate hack for a team of Valley programmers may turn out to be cracking the genetic code that makes them so good at what they do. Taking on that challenge will require extensive use of technology invented by two people who think in pictures: Bill Dreyer, who invented the first protein sequencer, and Carver Mead, the father of very large scale integrated circuits. As Dreyer explains, "I think in three-dimensional Technicolor." Neither Mead nor Dreyer is autistic, but there is a word for the way they think - dyslexic. Like autism, dyslexia seems to move down genetic pathways. Dreyer has three daughters who think in Technicolor.

One of the things that Dan Geschwind, director of the neurogenetics lab at UCLA, finds fascinating about dyslexia and autism is what they suggest about human intelligence: that certain kinds of excellence might require not just various modes of thinking, but different kinds of brains.

"Autism gets to fundamental issues of how we view talents and disabilities," he says. "The flip side of dyslexia is enhanced abilities in math and architecture. There may be an aspect of this going on with autism and assortative mating in places like Silicon Valley. In the parents, who carry a few of the genes, they're a good thing. In the kids, who carry too many, it's very bad."

Issues like this were at the crux of arguments that Bryna Siegel had with Bruno Bettelheim in a Stanford graduate seminar in the early '80s, published in Bettelheim's The Art of the Obvious. (Siegel's name was changed to Dan Berenson.) The text makes poignant reading, as two paradigms of scientific humanism clash in the night. Siegel told "Dr. B" that she wanted to do a large study of children with various developmental disorders to search for a shared biochemical defect. Bettelheim shot back that if such a marker were to be uncovered it would dehumanize autistic children, by making them essentially different from ourselves.

Still an iconoclast, Siegel questions whether a "cure" for autism could ever be found. "The genetics of autism may turn out to be no simpler to unravel than the genetics of personality. I think what we'll end up with is something more like, 'Mrs. Smith, here are the results of your amnio. There's a 1 in 10 chance that you'll have an autistic child, or the next Bill Gates. Would you like to have an abortion?'"

For UCSF neurologist Kirk Wilhelmsen - who describes himself and his son as being "somewhere on that grand spectrum" - such statements cut to the heart of the most difficult issue that autism raises for society. It may be that autistic people are essentially different from "normal" people, he says, and that it is precisely those differences that make them invaluable to the ongoing evolution of the human race.

"If we could eliminate the genes for things like autism, I think it would be disastrous," says Wilhelmsen. "The healthiest state for a gene pool is maximum diversity of things that might be good."

One of the first people to intuit the significance of this was Asperger himself - weaving his continuum like a protective blanket over the young patients in his clinic as the Nazis shipped so-called mental defectives to the camps. "It seems that for success in science and art," he wrote, "a dash of autism is essential."

For all we know, the first tools on earth might have been developed by a loner sitting at the back of the cave, chipping at thousands of rocks to find the one that made the sharpest spear, while the neurotypicals chattered away in the firelight. Perhaps certain arcane systems of logic, mathematics, music, and stories - particularly remote and fantastic ones - have been passed down from phenotype to phenotype, in parallel with the DNA that helped shape minds which would know exactly what to do with these strange and elegant creations.

Hanging on the wall of Bryna Siegel's clinic in San Francisco is a painting of a Victorian house at night, by Jessy Park, an autistic woman whose mother, Clara Claiborne Park, wrote one of the first accounts of raising a child with autism, The Siege. Now 40, Jessy still lives at home. In her recent book, Exiting Nirvana, Clara writes of having come to a profound sense of peace with all the ways that Jessy is.

Jessy sent Siegel a letter with her painting, in flowing handwriting and words that are - there is no other way to say it - marvelously autistic. "The lunar eclipse with 92% cover is below Cassiopeia. In the upper right-hand corner is Aurora Borealis. There are three sets of six-color pastel rainbow on the shingles, seven-color bright rainbow on the clapboards next to the drain pipe, six-color paler pastel rainbow around the circular window, six-color darker pastel rainbow on the rosette ..."

But the words aren't the thing. Jessy's painting is the thing. Our world, but not our world. A house under the night sky shining in all the colors of the spectrum.

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Think Different?

Autism researcher Simon Baron-Cohen on "mindblind" engineers, hidden pictures, and a future designed for people with Asperger's.

Interview by Oliver Morton

Sally has a marble. She puts her marble into the box, and then she goes outside. Anne comes in, takes the marble out of the box, and puts it in her basket. When Sally comes back, where will she look for the marble?

By the age of 4 or so, most children who watch this scenario played out by puppets - including children with Down's syndrome and other developmental problems - know the answer. But some do not. They do not understand that what they know and what Sally knows are different, that Sally has a mind of her own. The children who expect Sally to look in the basket, because they know that's where the marble is and can't believe that she doesn't, are the ones likely to be diagnosed with autism or its relative, Asperger's syndrome.

Simon Baron-Cohen, a tall, soft-spoken clinical psychologist at the University of Cambridge, has spent two decades studying autism - how to help the people disabled by it and what the syndrome tells us about normal minds. Baron-Cohen is interested in the brain and in genes (his group at Cambridge is collaborating with geneticists in new studies of Asperger's syndrome), but his key interest is in minds: their workings, their malfunctions, their origins, and their care.

From the beginning, his work has been centered around what's called a theory of mind - that is, an innate ability to understand other people as having feelings, intentions, and pictures of the world that are not the same as our own. A theory of mind is a basic requirement for empathy or, for that matter, deceit. And according to an approach to autism that has become increasingly influential in Britain over the past decade or so, a theory of mind is what people disabled by autism and its related conditions lack. They are, in Baron-Cohen's nicely coined word, "mindblind." More recently, Baron-Cohen has looked at another aspect of the autistic mind: a proclivity for systemizing - for understanding and constructing rules-based systems to explain our experience. To understand the social world, such rules are a poor replacement for a theory of mind; to understand the natural world, they are very useful.

It is another focus of his research, though, that has made Baron-Cohen an occasionally controversial figure. In 1997, he and his colleagues looked for and found some evidence of a link between autism in children and a propensity for engineering in their parents. Further work with students at Cambridge has suggested that engineers, mathematicians, physicists, and computer scientists have a way of thinking that is quantifiably "more autistic" than that of their peers in the humanities, arts, and social sciences. To some, this sounds like a medicalized stigmatization of nerdiness. Others fear that linking children's disabilities to their parents' inclinations is a new way of blaming the parent. Baron-Cohen rejects this. He argues that linking the styles of thinking that society has come to value is helpful, not harmful. Minds come in different shapes just as bodies do, and we must learn to accept that. Indeed, we must learn to value it.

Wired: How common is autism?

Baron-Cohen: Current studies suggest that the incidence is about 1 in 200 children for all disorders in the autism spectrum. That's much, much higher than the textbooks quote: Textbooks say 4 in 10,000.

Why the gap?

It's probably due to growing public awareness. Also, we're now looking for children at the higher end of functioning, children with autism who have normal intelligence. In the past we tended to look in special schools or in child psychiatric clinics for children with learning disabilities and a range of other problems; nowadays we look in the community at large.

Is there a danger that broadening the definition of autism might trivialize the problems of those with profound disabilities, equating a severe disorder that requires lifetime care with something much milder?

A PhD student with Asperger syndrome might be just as disabled as a person with learning disabilities and classic autism. Both may end up in need of considerable support, though of different kinds. The people being diagnosed at a rate of 4 in 10,000 needed more clinical support than the 1 in 200 diagnosed today. But I'd be hesitant to say that those cases were more severe.

Autism spectrum disorders are linked to other problems: Most of the people we see in our Asperger clinic for adults also suffer from clinical levels of depression. At any point on the spectrum, a diagnosis of Asperger is only given if the symptoms are causing a significant impairment to how someone functions. So "mild" cases, which don't really interfere, should not be diagnosed at all.

You argue that people with autism lack an innate capacity to draw inferences about what others know or think or feel - a "theory of mind." Is this ability separate from the ability to think about the world in general?

One of the papers I've written with colleagues describes three individuals who have Asperger syndrome. One won the Olympiad in physics and math right through his teens, and when presented with a physics or math problem he could solve it very, very rapidly. Yet he couldn't decode facial expressions of emotion in photographs. The second was a professor of mathematics, the winner of the equivalent of the Nobel Prize for math, the Fields Medal. No difficulties at all in abstract reasoning, but given photographs of facial expressions that somebody without any mathematical ability could read easily, he performed significantly below the average level. The third example was a computer scientist who could write programs without any effort at all, but again, just looking at a face, he couldn't tell what a person was feeling. It can't be a general problem that's affecting the mind as a whole. It must be a specific deficit.

These ideas have helped you develop tests for autism that can be administered surprisingly early in a child's development.

Yes, the Checklist of Autism in Toddlers is used by doctors and health visitors during the routine 18-month checkup, looking for the absence of two key behaviors that should be there if the child is developing normally. One is the pointing gesture; normally children point at things to communicate. Autistic children don't do that. If they point at all, it's to request something, but a normal child will point just to share interest, as if to say, "Look at that." The pointing gesture is a great piece of evidence for the theory-of-mind approach because, when you point at something, you have to take into account that somebody else may not have seen what you've seen, that somebody else may be interested to see what you've seen. It's about sharing minds.

The other key behavior is pretend play. By that age, in normal cases, children are pretending in an imaginative way. They'll pick up an object and attribute properties to it that it doesn't have; they'll pretend a pen is a spoon and feed themselves. In children with autism, their play is much more reality-based. They're interested in how things work.

So if they want to play with a telephone, they'll pick up a telephone.

Yes, but they won't have an imaginary dialog - they'll try to figure out what the buttons do.

Parents sometimes say they feel that the autism begins after this stage of development. If the problem is innate, how do you explain that?

It could be that around the time of joining a peer group, between 18 months and 2 years old, the child increasingly recognizes that he or she doesn't understand the dynamics of even a small social group - three or four kids - and gives up trying. The other thing is language development. In the normal case, children learn words in a very social way; they hear a new word, "tape recorder," and see that the speaker is looking at that object on the table, and they're able to work out that the word they just heard must map onto that object as opposed to another one.

And people with autism don't do that.

No. They don't use the direction of people's gazes as a cue to breaking the code of language.

Does this sort of insight help parents and caregivers?

It immediately suggests a method of special education or intervention. If the child isn't naturally learning how to recognize people's feelings and how to attribute intentions, then he or she will benefit from being taught those things in a very stepwise way. We've produced a book aimed at teaching primary-school children this way. Now we're developing a CD-ROM that will contain photographs of actors producing every known human expression of emotion with their faces and voices. It will be like having an electronic encyclopedia of emotion to consult.

So by being explicit enough about things, one can get feelings across?

For many individuals with autism, when it's pointed out to them that they have hurt somebody's feelings, they feel very bad about it. But they wouldn't know how to avoid doing it in the future without formulating an explicit rule.

Along with mindblindness, you've studied the propensity in people with autism to systemize. But the idea that there might be a trade-off between these two abilities - between having a theory of mind and having a capacity to imagine or construct rule systems - sounds odd. The mind's not a zero-sum game.

It's not that there is necessarily any trade-off or compensation. The new look at autism just suggests that there are two factors, not one. There are difficulties in "mind reading," and at the same time, possibly independently, an intact or even superior talent for understanding systems.

But if the two are truly independent, why do they crop up together?

It may be true in the case of autism that if you start off with a deficit in terms of empathy or mind reading, you've just got more time to devote to understanding the world by systemizing.

So the enhanced systemizing could be a response to the primary deficit, like upper body strength in a paraplegic using a wheelchair.

Yes, that might be.

Autism is now seen as largely genetic in origin. But that leads to a seeming contradiction: One would expect genes that cause the disability not to be very good at getting transmitted to future generations.

Everything seems to be conspiring against the genes to persist, because they're interfering with social relationships, which are usually a prerequisite for reproduction. But if the genes for autism are persisting in the gene pool, it may be that in milder forms attributes of autism are adaptive. They're maladaptive in some circumstances - in conditions where social sensitivity is important - but they may be very adaptive in other environments, for example where high systemizing might be needed.

This led you to look at the parents of people with autism, and in some early research you found that, like their children, these parents are better than average at "embedded figures" tests, which involve picking specific geometrical shapes out of complex pictures. Did that surprise you?

I was impressed by the degree of talent. Among both individuals with high-functioning autism or Asperger and their parents, many are superfast at spotting details. You hardly have time to get the experimental materials out on the table before they've spotted the target. You've hardly managed to get the stopwatch going. The normal brain, as it were, takes much longer.

Do you think they are doing the same thing someone with a normal brain does, only faster, or performing a different sort of visual search?

It's impossible to know just from these studies. In a different task, called the block design task, where you have to construct a pattern from individual elements, autistic people are faster irrespective of whether or not the design they're copying has been pre-fragmented, whereas normal people find it easier with the pre-fragmentation. In the person with autism, the brain may already be seeing the part and be less distracted by the whole, and in the person without autism the brain may have to set aside its picture of the whole to analyze the detail. There may be two different strategies at play.

Would that explain aspects of autism beyond the visual realm?

Some people have suggested that when it comes to understanding the social world, it pays to be good at gestalt processing, because the social world is not about attention to detail - it's about a broad-brush approach. It's not about the fact that a person's hand is moving through space and you're tracking it frame by frame; it's about the global interpretation that he wants a drink. So it could be that all the theory-of-mind problems are just a downstream consequence of difficulties in getting the gist, getting the gestalt.

Further work on the relatives of children with autism showed that the parents had a more-than-chance likelihood of being engineers, compared with the parents of children with Tourette's syndrome or Down's syndrome.

Yes, there was significant over-representation of engineering among the fathers and grandfathers. The rate was about 12 percent, whereas, in the general population among males, the rate of engineering is about 5 percent. So that is statistically significant, but it has to be treated with caution. It is easy to misinterpret the result, saying there is a strong link between being an engineer and having a child with autism, whereas in fact all it shows is that 12 percent of fathers, rather than 5 percent, worked in engineering.

Does this mean that only the father's genes count?

No. Most of the mothers worked in the home and so we don't know what path they would have followed. There's no evidence for a link to sex as yet.

Is there other evidence for a link to engineering?

We did a study of students, in Cambridge, split between the natural scientists and the humanities students. The study looked at the likelihood of having a relative with autism. And what we found was that the students in the disciplines of mathematics, engineering, and physics had a higher likelihood of having an autistic relative - a sibling or a parent's sibling, or a first cousin. We asked about other conditions, too, to check that we were controlling for reporting bias, but we found that autism was the only disorder, among a set of six, that was significantly associated with disciplines that require a talent for systemizing.

How have your colleagues in engineering reacted to this?

We've had a mixed reaction. A professional magazine for engineers picked up the story, and we had one or two letters that suggested this was simply perpetuating an image of engineers as socially inept. But we had a lot of letters from people saying, for example, that they had an autistic child and that they had engineering going back many generations in their families. So it was bound to be a sensitive issue, which is why we're at pains to stress what you can and can't conclude from this.

Can you conclude that engineers, physicists, mathematicians, and the like have a higher relative risk of a child with autism?

No, because we haven't done that study. All we've found is that if you take a group of people studying engineering, they tend to score slightly higher in terms of number of autistic traits, but we don't know that they are at greater risk of having a child with autism.

Surely, though, that is the implication of the finding that children with autism are more likely to have an engineer as a parent.

That is why I draw attention to it being only 12 percent; 88 percent of the fathers of children with autism are not engineers, and it probably follows that the majority of engineers have no link with autism.

If parents have some attributes associated with autism, does that have any developmental effects on the autistic child?

Possibly, but that may not be bad. Let's say there was a father who had quite an obsessive interest in, I don't know, bird-watching. He could tell you not just the names of all the species that tend to migrate through his part of the world but when they migrate and patterns of coloration and all that. If the child had a similar way of thinking - liked to collect information on a category of the world in a complete way - you could have a very beautiful opportunity for a father and a son to go out bird-watching, with their minds working in a very similar way. A normal child, on the other hand, might get quite bored.

What are the implications of finding certain professional aptitudes linked to autism?

Mainstream education expects children to be all-rounders, to be good at socializing on the playground and good in the classroom at doing math and science. That's just unrealistic - children come in all shapes and sizes. So part of what has to happen is a change in expectations. None of us are all-rounders, especially when we get to higher levels and can't maintain every skill at an equivalent level.

Are there role models for people with autism?

A lot of people with autism haven't yet come out or been recognized. There are people who suspect that Bobby Fischer has autism, and he may be a good role model for chess players. It's very hard when you don't have definite diagnoses, and it's irresponsible to be diagnosing at a distance; a diagnosis takes a proper clinical assessment.

So I guess I can't ask about Bill Gates. There's been a suggestion that Sherlock Holmes might be a candidate - great at systemizing, not misled by the seemingly obvious gist of the situation.

It's a nice example, but all you can do is speculate.

If you can't be drawn to speculate about that, how about this: Computers make some parts of the world more rules-driven; does that mean the world is becoming a better place in which to have an autistic disorder?

Yes. There's a niche now for people with that sort of profile. There always was a niche, otherwise the genes would have died out, but maybe that niche is now much more accessible.

Source:  http://www.wired.com/wired/archive/9.12/baron-cohen.html

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Monday, March 17, 2003

Diet used to calm autism

Advocates say gluten, casein stir symptoms

HOWELL -- Charlotte Clark's daughter was diagnosed with autism when she was 3 years old. She was placed in a pre-primary impaired program for students with disabilities.

At age 4, Clark put her child on a special diet and by the time she was old enough for kindergarten at age 5, she no longer required special-education services.

"Today, at age 7, my daughter is normal, fine, and growing. She's a student-of-the-month, top-of-her-class, and takes karate," Clark said. "She's a bright young lady."

Clark, who has a master's degree in education, founded the autism dietary intervention group in Livingston County two years ago after seeing the results of placing her daughter on a gluten-free, casein-free diet.

The rate of autism diagnosis in the United States has risen from one in 10,000 in 1940 to between 2 to 6 per 1,000 in 2001, according to the federal Centers for Disease Control and Prevention.

The Livingston Educational Service Agency reports serving 252 children identified as autistic in 2001-02, up from 43 in 1995-96.

Deanna Seng's 4-year-old son Andrew was diagnosed with autism when he was 26 months old.

Sick with infections since birth, he didn't eat, didn't sleep, hated to be touched, couldn't bear the feel of water and banged his head and screamed for hours every day.

Andrew was evaluated by a team of specialists from the Livingston Educational Services Agency and was diagnosed as autistic impaired with severe sensory problems.

"As soon as we had the diagnosis I started researching and the first thing you learn is diet can have a huge impact," Seng said.

Seng began by giving Andrew whole-food dietary supplements. She removed processed foods from his diet and worked on improving the nutritional quality of the foods Andrew would eat.

In January 2002, when Andrew turned 3, Seng removed gluten and casein from his diet.

"We saw amazing results within a week of reducing gluten and casein," Seng said. "His bus driver said what kind of miracle pill did we give him."

The diet works, according to the network for dietary intervention, because many cases of autism result from an immune-system dysfunction that affects the body's ability to break down the protein in milk -- casein -- and the protein in wheat -- gluten.

Eliminating the proteins eliminates the symptoms, according to the diet's advocates.

"A lot of these kids have damaged systems, so that partially digested proteins act as neuro-toxins," said Dr. Rick Ng of the Center for Holistic Medicine in West Bloomfield Township. "The diet cannot hurt them and we've seen miracles with it."

But nutritional therapy is considered alternative medicine. No insurance company will pay for nutrition testing or consultation and few conventional physicians are trained in nutrition therapy, Ng said.

"The mothers are really taking this into their hands because the medical profession has not given them what they need," Ng said.

"You cannot run a school that feeds our children French fries, potato chips and pop for lunch and expect them to have great brain function."

The food service departments in county schools follow the U.S. Department of Agriculture's regulations for accommodating children with special dietary needs.

They are required to follow a doctor's prescription for all disabled students. Life-threatening allergies are defined as disabilities.

Special diets for nondisabled students are decided on a case-by-case basis and must be accompanied by a physician's statement of needs.

"We have a form that parents take to their physician and the physician prescribes the food substitutions we can make for the student," said Kathleen Kane, director of food and nutrition services for the Fowlerville Community Schools.

"A lot of times people think we are dietitians and we can prescribe the diet," Kane said. "We can't do that.

"Students need to be diagnosed by a physician and the physician must designate what the student can and cannot have and we will follow that recommendation."

The most common food issues the districts deal with are diabetes and lactose and peanut allergies.

They provide carbohydrate counts for diabetics and substitute juice for milk in most cases. Some have peanut-free tables in lunchrooms. None reported requests for gluten-free, casein-free meals.

"It's much easier to make my child lunch and send it every day," Charlotte Clark said.

Linda Theil is a Metro Detroit free-lance writer.

Source: http://www.detnews.com/2003/schools/0303/17/c05l-110293.htm

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Learning Styles and Autism

'Learning styles' is a concept which attempts to describe the methods by which people gain information about their environment. People can learn through seeing (visually), hearing (auditorily), and/or through touching or manipulating an object (kinesthetically or 'hands-on' learning). For example, looking at a picture book or reading a textbook involves learning through vision; listening to a lecture live or on tape involves learning through hearing; and pressing buttons to determine how to operate a VCR involves learning kinesthetically.

Generally, most people learn using two to three learning styles. Interestingly, people can assess their own interests and lifestyle to determine the ways in which they obtain much of their information about their environment. In my case, when I read a book, I can easily understand the text. In contrast, it is difficult for me to listen to an audiotape recording of that book -- I just cannot follow the story line. Thus, I am a strong visual learner, and a moderate, possibly poor, auditory learner. As far as kinesthetic learning, I am very good at taking apart objects to learn how an object works, such as a vacuum cleaner or a computer.

One's learning style may affect how well a person performs in an educational setting, especially from junior high on through college. Schools usually require both auditory learning (i.e., listening to a teacher) and visual learning (i.e., reading a textbook). If one is poor at one of these two ways of learning sources, he/she will likely depend mostly on his/her strength (e.g., a visual learner may study the textbook rather than rely on the lecture content). Using this logic, if one is poor at both visual and auditory learning, he/she may have difficulty in school. Furthermore, one's learning style may be associated with one's occupation. For example, those individuals who are kinesthetic learners may tend to have occupations involving their hands, such as shelf stockers, mechanics, surgeons, or sculptors. Visual learners may tend to have occupations which involve processing visual information, such as data processors, artists, architects, or manufacturing part sorters. Moreover, auditory learners may tend to have jobs which involve processing auditory information, such as sales people, judges, musicians, 9-1-1 operators, and waiters/waitresses.

Based on my experience as well as those of my colleagues, it appears that autistic individuals are more likely to rely on only one style of learning. By observing the person, one may be able to determine his/her primary style of learning. For example, if an autistic child enjoys looking at books (e.g., picture books), watching television (with or without sound), and tends to look carefully at people and objects, then he/she may be a visual learner. If an autistic child talks excessively, enjoys people talking to him/her, and prefers listening to the radio or music, then he/she may be an auditory learner. And if an autistic child is constantly taking things apart, opening and closing drawers, and pushing buttons, this may indicate that the child is a kinesthetic or 'hands-on' learner.

Once a person's learning style is determined, then relying on this modality to teach can greatly increase the likelihood that the person will learn. If one is not sure which learning style a child has or is teaching to a group with different learning styles, then the best way to teach could be to use all three styles together. For example, when teaching the concept 'jello,' one can display a package and bowl of jello (visual); describe its features such as its color, texture, and use (auditory); and then let the person touch and taste it (kinesthetic).

One common problem evidenced by autistic children is running around the classroom and not listening to the teacher. This child may not be an auditory learner; and thus, he/she is not attending to the teacher's words. If the child is a kinesthetic learner, the teacher may choose to place his/her hands on the child's shoulders and then guide the student back to his/her chair, or go to the chair and move it towards the student. If the child learns visually, the teacher may need to show the child his/her chair or hand them a picture of the chair and gesture for the child to sit down.

Teaching to the learning style of the student may make an impact on whether or not the child can attend to and process the information which is presented. This, in turn, can affect the child's performance in school as well as his/her behavior. Therefore, it is important that educators assess for learning style as soon as an autistic child enters the school system and that they adapt their teaching styles in rapport with the strengths of the student. This will ensure that the autistic child has the greatest chance for success in school.

Source: http://www.autism.org/styles.html