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I first want to introduce myself. My name is Dr. Lindsay Oberman. I am a researcher in Boston Massachusetts and am currently working at Beth Israel Deaconess Medical Center of Harvard Medical School. My research over the past several years has focused on the brain basis of autism spectrum disorders. If you are interested in reading about some of my research I invite you to visit my website where I have posted some of my recent papers that are available for downloading. My website is tmslab.org/faculty/loberman. I can also be reached by e-mail at loberman@bidmc.harvard.edu.
Now a few small caveats. 1. I will be posting topics for the blog that are intentionally somewhat controversial. My opinions on these topics are just that, and should be taken as such. 2. The most truthful answer to most of the topics I will post is "We don't know" but I will try to share some of the research that I am aware of that speaks to the topic. 3. Often times I will speak of autism spectrum disorders, or ASD. Though I acknowledge that autism is qualitatively different than Asperger's Syndrome (a topic that I look forward to discussing in the future) for the purposes of certain topics, I will be speaking of them as a spectrum of one disorder. 4. I am neither a clinician, nor an expert on every child with autism. I cannot diagnose your child nor recommend the best treatment for any given child or adult with ASD. Each individual's diagnosis and treatment plan should be discussed with a local clinician trained in working with individuals with autism spectrum disorders.
That being said, I invite you to share your thoughts, stories, and questions with the blog and look forward to a lively discussion on topics related to autism spectrum disorders.
Topic 1.
Are Autism Spectrum Disorders really just varying degrees of the same disorder or could Asperger's Disorder be a result of a completely different etiology than autism?
Autism Spectrum Disorders are currently categorized under the Diagnostic and Statistical Manual... as mental disorders. As such they are diagnosed based on behavioral symptoms. Though it is appreciated that atypical behavior (and for that matter behavior in general) is a result of activity in the brain (no one will claim that autism is a result of a problem in your big toe!) the exact neurological origin of autism is not currently known. There are certainly more theories out there than one can count, but the data is extremely messy and there are very few markers that all or even most individuals with ASD show.
Why is this? Well, let me give an analogy. Imagine instead of ASD we are talking about a fictitious disorder that I will call "Can't Walk Disorder." Imagine your child is around 12-18 months and you notice that most of his playmates are beginning to walk, but your child does not. You bring the child to the doctor and he asks you a list of questions "Can he walk if his weight is supported?" "Can he move his legs in any way" "Can he crawl?" You answer "No" to all the questions and the doctor says "Well, your child meets the criteria for ‘Can't Walk Disorder.' The current treatment for this is crutches. They will help your child function better in the world and compensate for his deficits." Though this treatment is better than nothing, it treats the symptoms, not the fundamental biological basis of the problem. It is possible in this example that the child broke his legs, or perhaps he is paralyzed, or perhaps he has a muscular problem.
Research into the brain basis of autism spectrum disorders is thus somewhat of a circular problem. We define our inclusion criteria for our study based on a behavioral diagnosis of ASD and try to find a biological marker that all or most participants share. However, if there is not a singular etiology that leads to the behavioral disorder, then looking for a singular marker may be fruitless if in fact we have a heterogeneous group. So, why even try? Well, I believe that crutches aren't good enough. I feel that in order to effectively treat (and perhaps some day cure) autism spectrum disorders, then one needs to identify the underlying cause.
So, what do I think? I have known many children and adults with autism and Asperger's Syndrome and though each is unique, I find not simply quantitative, but rather qualitative differences in their behaviors. For example while some individuals with autism do not interact socially, while individuals with Asperger's Syndrome tend to make social overtures, but these overtures are often scripted, inappropriate or narcissistic in nature (relating to the individual's specific interests). As with many of the topics I will discuss in this blog, the truth is we don't know, but if I had to make a guess, I would predict that the underlying cause of ASD will be as complex as the disorder itself.
