Autism --- A Cognitive or a Behavorial Disorder?

Commentary

Autism --- A Cognitive or a Behavorial Disorder?

Edward J. Harshman, MD, MBA

Autism, the cognitive disorder of extreme social withdrawal, living in one's own world, has no proven etiology. Current theories include neurotransmitter imbalance, improper nutrition, and genetic predisposition. While these theories do partially explain autism, parental behavior has been generally overlooked.

Autism is associated with firstborn children, with boys, and with unusually good looks. It is also becoming more common in our society. Autistic people often seem preoccupied with spinning objects or with making themselves spin.

No known genetic or infectious process preferentially affects firstborn children. But firstborns often receive different treatment from their parents than do their younger siblings. Inexperienced parents, specifically parents of one young child, are more likely than others to try to demand that their children's opinions and feelings be what the parents want them to be.

Boys are more likely than girls to become autistic.(1) Genetics aside, our society tolerates a wider range of behavior in girls than in boys, as with women relative to men, because of recent social changes. A boy, if troubled by social pressures, is less likely than a girl to share his feelings openly and have them handled constructively by sympathetic parents or friends. He therefore risks reacting dysfunctionally, perhaps by severing his emotional link to the rest of the world to insulate himself from pain.

Autistic children are "often described as very attractive"(2); if a child is beautiful or handsome, then the risk of autism is apparently slightly higher than average. Attractive children elicit aggressive attention from adults. Suppose a small child, after a few minutes on a visitor's lap, has had enough and wants to be put down. That's fine, if he gets his way and gets socially handled only as much as he readily accepts. But if an unwelcome visitor insists on pawing him over and his parents tell him not to disapprove, then he will learn that his opinion in a social setting is worthless, and he has no defense if his personal space is invaded. Dissonance results from the apparently favorable attention plus the reminder of defenselessness. That dissonance discredits the child's emotional connection with the outside world.

Autism is becoming more common in the U.S. today.(3) The American culture, in particular how children are treated, has changed. People born in and since the 1960s are now having their own children. That decade was the start of de-emphasizing intelligence and productivity, substituting unearned self-esteem and getting along with other people. Competent people, including children, proudly display their skills and acquire self-respect from the pleased reactions of others. Modern U.S. education tries to bypass the arduous but natural process of developing various competences, favoring the quick fix of self-importance. By diverting children's natural opinions and eagerness to learn into a morass of confusion, with psychology discussion groups and similarly destructive processes, schools repress independent thought. This process makes independent thinking hazardous for children. They are under pressure to have unwelcome beliefs and opinions imputed to them.

Any experienced mental health professional knows how often patients seek social approval. In our culture, it's more important to feel good about ourselves than to nurture the skills from which such feelings naturally derive. Because of the intrinsically artificial nature of that cultural force, dissonance can result --- and so can autism.

Autistic people can seem fascinated by spinning objects,(2) but carefully observing the face of an autistic person who studies such an object shows frustration and not eagerness. As do computers, which are programmed to have limited interruption capabilities, autistic persons can encounter infinite loops. An infinite loop is a set of computer instructions that repeat themselves forever, necessitating an interruption (turning off the computer, for example). Apparent fascination with spinning objects is an infinite loop. An autistic person won't necessarily watch a spinning object for a few seconds and say, "Oh. That's all it is. I think I'll do something else." Such a decision, for us, is automatic, but not for someone less able to handle interruptions, who gets into a mental endless loop and who should be tactfully interrupted, distracted, from it.

If you tell your child (a boy, for example) that you and he are going to do something, for example go to the store, he may dislike the idea. Then you overrule him and he learns to yield to superior force or, you hope, comply under mild protest. "Oh, all right, I don't want to, but I'll go." Open dissent keeps the disagreement explicit so that no subconscious damage can occur.

You can try to convince him that going to the store will be enjoyable. If you and he are always aware that he has the right to disagree, then there is no problem --- and you may even succeed in convincing him.

Or you may punish him. Then he may learn to keep his opinions to himself. If asked by someone he trusts, he will remember what happens: "Mommy and Daddy punish me if I disagree with them." Unfair to the boy, but it can be identified.

But what if he is pressured to change his opinion? "You really like going to the store, don't you?" If he loves you and wants to cooperate, then he will let you distort his opinion to suit your convenience.

Now he has an internal contradiction, a tension, a dissonance, that needs some resolution. Modern psychology ignores the consequences; and it cannot explain autism. Coincidence?

The behavioral pattern I describe does not always lead to autism, and there must therefore be an additional explanation for why some children get it and some do not. Diet and neurotransmitters may indeed constitute that explanation.

To prevent autism, preserve children's right to have feelings and opinions that are inconvenient. Permit disagreement; confine your discipline to actions and behaviors.

References

1. Sadock BJ, Sadock VA. Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Seventh Edition. Lippincott Williams & Wilkins, 2000; p. 2668.
2. Ibid., p. 2667.
3. Fombonne E. The epidemiology of autism: a review. Psychological Medicine 1999;(29):769-786.

Dr. Harshman is a physician in Dade City, Florida, and has an MBA in health care administration. His e-mail is: ejharshman@earthlink.net.