There is huge motivation for gain: children with autism receive very high levels of service. Caregivers have been taught to believe that 40 hours a week of specially designed therapies such as Discrete Trial Training, a one-on-one learning method with instructor feedback at every step, are required to help children recover from, in my opinion, a condition they never had.
Even more telling was the comment I heard made by the editor of the diagnostic guide DSM-IV, who expressed regrets on National Public Radio for including the category of Asperger's. He said, to paraphrase, that to get services for children who “looked odd,” schools and mental health providers used the diagnosis of Asperger's. Yet that condition, according to this editor, has a “diminishingly small frequency of occurrence.”
Elkins Park, Pa.
RICHLER REPLIES: Misdiagnosis is indeed a problem in some purported cases of autism. In both studies I described in the article, however, the diagnosticians were highly trained and experienced. The researchers in the retrospective study used a rigorous review process to minimize the chance of initial misdiagnosis.
The other study was longitudinal; the same experts who did the initial diagnosis were the ones who followed the participants over time. In both studies, the experienced diagnosticians should have been able to recognize subtle signs of autism, even in someone who had “memorized responses that give the impression of social engagement when it is not present.”
Your autism article was fascinating reading. When my son was diagnosed 15 years ago at age three, we were told categorically by the doctor that autism is a lifelong, untreatable condition. Fortunately, we chose not to accept that, and now he is very largely recovered, although with a few remaining issues connected to socialization.
Alongside behavioral training in his early years, we believe that his gluten- and dairy-free diet has a lot to do with his recovery, a possibility not mentioned in your article. We often wonder why trying the diet for six months is not recommended to all parents as a possible if not guaranteed route to recovery. Perhaps it has to do with experts' reluctance to admit that at least some of what discredited physician Andrew Wakefield has said about autism being linked to gut function is right after all!
Newcastle upon Tyne, England
RICHLER REPLIES: Although there are anecdotal reports of improvement in the symptoms of autism spectrum disorder following the introduction of a gluten-free, casein-free diet, to my knowledge there is no high-quality research (that is, double-blind, randomized controlled trials) that supports these claims. I would imagine most responsible doctors and other professionals are reluctant to recommend any kind of special diet in the absence of such evidence.
NEURONS CONTROL BLOOD FLOW
Justin Rhodes asserts in the column Ask the Brains that “part of the reason exercise enhances cognition has to do with blood flow…. More blood means more energy and oxygen, which makes our brain perform better.” This phrasing implies that the brain performs suboptimally until the heart pumps more vigorously, akin to a car engine awaiting the flooring of the accelerator pedal to deliver more gas.
A different article in the same issue, “Can Caresses Protect the Brain from Stroke?” by Stephani Sutherland, provides the better conceptualization: “the brain's vasculature might be at the beck and call of the very neurons it serves.” I would add that, in fact, the beautiful pictures from functional MRI scans are possible because neurons actively regulate essentially all brain blood flow.