The characteristic patterns of behavior exhibited by a particular individual tend to remain, within limits, constant over time. This is how we can define traits in our personality but also, in the case of autism, how we achieve diagnostic criteria. Indeed, barring situational factors, autistic individuals consistently behave in a certain way and are easy to predict. Temple Grandin, in her book entitled “Unwritten Rules of Social Relationships”, claims that she adjusted her behavior by following a set of “if-then” rules or commandments. These rules allow her to adapt to environmental exigencies. “If” this happens to me, “then” I will do this or that. I have to believe that with aging Temple’s patterns of responses, how she answers her commandments, have become more habitual. However, what really called my attention is the fact that Temple felt compelled to develop such a system. I have to believe that Temple’s system reflects her inclination to be socially conscientious, that is, to be accepted by society.
A strong desire for acceptance evolved with humans as a selective trait to keep them alive. This desire goes hand in hand with procreation. A few decades ago there was a misconception that autistic individuals were not interested in sex or procreation. Family studies in Utah, in the mid-1980s, shattered that myth. Ed Ritvo in collaboration with Carmen Pingree canvassed the state and were able to identify most autistic children within that particular state. They found multiple families having several autistic children. Furthermore, the parents of these children either had traits or the full diagnosis of autism. Autistic individuals did indeed had an interest in procreation! In those families the odds ratio of having a sibling with a diagnosis of autism was close to 10%- a prevalence rate way higher than in the general population. This was more so the case as many families decided to stop procreation immediately after their child received a diagnosis.
It is striking that such an important study received acerbic criticisms from journal reviewers. According to Dr. Ritvo, the publication was rejected seven times before finally being accepted. Back then a common misconception was that autistic children would not be able to grow up, get married and have children. Besides battling this misconception the study underlined other important findings. In very detailed analysis autistic children as compared to neurotypicals had the same rate of colds, ear infections, allergies, vaccinations, immune deficiencies, celiac and digestive disorders. Although a lot has been said about vaccines and immune deficiencies in autism, the UCLA-Utah study found no evidence that these were correlated.
Another major finding of the early study was the heterogeneity of symptoms in affected individuals. Although some exhibited symptoms of classical Kanner’s autism others were quite subtle, having mild developmental delays and mild symptoms. These subtle cases were called subclinical or “forme frustres”.
The original study is still ongoing and occasional publications of this cohort have appeared over the years. These ongoing studies have revealed that often “classical” cases can transform into the subtle variants (Asperger). In this regard Dr. Ritvo has been as strong advocate that Asperger and autism differ in severity but not in kind. More recently the study of Dr. Ritvo has prompted other researchers to study the genetics of families having more than one affected individual. In this regard Dr. Ritvo’s legacy will keep growing over the years.
One of the reasons in writing this blog is that I have been told that Dr. Ritvo is recovering from a recent stroke. I hope he may find strength with each passing day.
Casanova MF. Autism Updated: Symptoms, Treatments, and Controversies. Amazon Publishing, 2019.