By Teresa Conrick
The recent Chicago Tribune hit-and-run piece on autism treatments and those who support them was such an injustice to the true medical issues that our children have that it spurred me into an investigation about the recurring theme that many media outlets employ -- ignore the true medical issues of autism and just discuss treatment of the symptoms (and bash those who disobey). Those treatments, for symptoms only, often include powerful, sedating and off-label psychiatric drugs that have many dangerous side effects.
So again, a look back in time often uncovers some striking parallels and possibly sheds some light about the illness of autism and its behavioral symptoms. Investigating the incidence of medical issues in that population brought me to an AUG. 27, 1949 BMJ study called INCIDENCE OF PHYSICAL DISORDERS AMONG PSYCHIATRIC IN-PATIENTS A STUDY OF 175 CASES by H. E. S. MARSHALL , at Psychiatric Unit, St. George's Hospital in London. (HERE)
The number of patients studied was 175, comprising 124 women and 51 men ."All were in need of psychiatric attention, and no purely physical criterion entered into their selection. But in no fewer than 77 patients (44%) ... some physical condition needing attention was found." And this was equally interesting -- "In 39 patients (22%) the physical condition was considered to contribute to the development of the psychological illness."
That's an interesting conclusion - that a physical condition contributed to the development of a psychiatric condition.
In 1996, while my Megan was sick with mysterious viral illnesses, rashes, chronic ear infections, GI pain, diarrhea and vomiting, she received a diagnosis of "autism" which then began the detour of true medical help. Ironically, this journal article appeared that same year in "Health and Social Work, Vol. 21", "STUDIES ON MENTAL HEALTH AND PHYSICAL ILLNESS." (HERE)
"Since the 1930s there has been an increased interest in understanding the relationship between physical disease and mental illness." (I must insert here again, Dr. Leo Kanner, child psychiatrist at Johns Hopkins, unfortunately did not share this interest when he was reporting on the first 11 autism patients born in the 1930's and written in his landmark paper in 1943.) "This interest has taken two directions: Some research has sought to identify the extent to which a relationship exists between mental illness and excessive mortality rates (Allebeck & Wistedt, 1986; Eastwood, Stiasny, & Meier, 1982; Kendler, 1986; Malzberg, 1934), and other research has taken a similar approach to the presumed relationship between mental illness and excessive rates of disease (Herridge, 1960; Koranyi, 1979; Maguire & Granville-Grossman, 1968; Marshall, 1949). At least 13 studies completed during the past 60 years have confirmed that individuals with various forms of mental illness have rates of physical illness far in excess of the expected frequency of such illnesses in the general population (for example, Davies, 1965; Koran, 1989; McCarrick & Manderscheid, 1986). In 1936, Comroe conducted one of the earliest studies and noted that in a sample of 100 individuals diagnosed with neurosis, 24 percent developed a significant physical illness over the eight months of the study. Koranyi's (1979) work was among the first to use large samples of patients. In a study of over 2,000 psychiatric patients, he found that 43 percent had at least one medical illness. Nearly 46 percent of these illnesses had previously gone unrecognized by the physicians who made the referral for psychiatric examination and treatment. Koranyi also noted that in 20 percent of the patients, the physical illness was the only identifiable cause of the psychiatric symptoms that formed the basis of the initial referral. He observed that the failure to recognize illness was highest (84 percent) when the patient was self-referred, second highest (83 percent) when the patient was referred by a social services agency, and third highest (48 percent) when the patient was referred by a psychiatrist."
What was that? Referred by a psychiatrist, the failure to recognize illness was 48%! On that note, let's go back to Kanner and those first autism patients. I have mentioned that I have a keen interest in Dan Olmsted and Mark Blaxill's investigations of the original eleven Kanner patients as well as their exploration of the natural history of autism. As a result, I have read many correlations with those first eleven and our children today. Leo Kanner described each in really two papers, the original in 1943, "Autistic Disturbances of Affective Contact" and then a follow up report in 1971, where he added on bits of new information over those twenty-nine years. So what did Kanner miss? What "failure to recognize illness" did he demonstrate as he painted his picture of "Autistic Disturbances of Affective Contact"?
Knowing what we see in our children today through medical tests and labs, the Kanner Eleven show similar manifestations:
Donald T.: "Eating," the report said, "has always been a problem with him. He has never shown a normal appetite. He gained weight but developed the habit of shaking his head from side to side. He continued spinning objects and jumped up and down in ecstasy as he watched them spin. He wandered about smiling, making stereotyped movements with his fingers, crossing them about in the air. He shook his head from side, whispering or humming the same three-note tune. He spun with great pleasure anything he could seize upon to spin. Most of his actions were repetitions carried out in exactly the same way in which they had been performed originally." He had an acute attack of rheumatoid arthritis in 1955.
Frederick W: He doesn't want me to touch him or put my arm around him, but he'll come and touch me. His occiput and frontal region was markedly prominent. There was a supernumerary nipple in the left axilla. Reflexes were sluggish but present. All other findings, including laboratory examinations and X-ray of his skull, were normal, except for large and ragged tonsils.
Richard M.: Following smallpox vaccination at 12 months, he had an attack of diarrhea and fever, from which he recovered in somewhat less than a week. Richard was found to be healthy except for large tonsils and adenoids, which were removed on February 8, 1941.
Paul G.: He was born normally. He vomited a great deal during his first year, and feeding of formulas were changed frequently with little success. He had measles, chickenpox, and pertussis without complications. His tonsils were removed when he was 3 years old.
Barbara K.: She nursed poorly and was put on bottle after a week. She quit taking any nourishment at 3 months. She was tube-fed five times daily up to 1 rear of age.
Virginia S. : Not one medical fact. A big question mark about her health.
Herbert B.: ...he vomited all food from birth through the third month.
Alfred L.: For the first two months, "the feeding formula caused considerable concern ...had been kept in bed often because of colds, bronchitis, chickenpox, streptococcus infection, impetigo, and a vaguely described condition which the mother insisted was "rheumatic fever". While in the hospital, he is said to have behaved "like a manic patient."
Charles N.: As a baby, he was "slow and phlegmatic." He would lie in his crib "almost as if hypnotized." Thyroid extract medication had no effect.
John F.: There is a long story of trying to get food down. The anterior fontanelle did not close until he was 2 ½ years of age. He suffered from repeated colds and otitis media, which necessitated bilateral myringotomy. In December 1942, and January 1943, he had two series of predominantly right-sided convuIsions, with conjugate deviation of the eyes to the right and transient paresis of the right arm. Neurologic examination showed no abnormalities. His eyegrounds were normal. An EEG indicated "focal disturbances in the left occipital region." John died suddenly in 1966 at 29 years of age.
Elaine C. : Because of a febrile illness at 13 months, her increasing difficulties were interpreted as possible postencephalitic behavior disorder. For 18 months, she was given anterior pituitary and thyroid preparations. "Some doctors thought she was a normal child and said that she would outgrow this." A report, dated September 25,1970, says: "She has epileptic seizures occasionally of grand mal type and is receiving antiepileptics and tranquilizers."
What really stands out with the Kanner Eleven and children with an autism diagnosis today are some eerily familiar medical disturbances:
Bacterial infections, especially what appears to be streptococcus --- "large and ragged tonsils;" "streptococcus infection;" "rheumatoid arthritis"; "large tonsils and adenoids;" "tonsils were removed when he was 3 years old;" "rheumatic fever;" "otitis media, which necessitated bilateral myringotomy;" "bronchitis;" "impetigo."
Gastrointestinal issues, which can also be bacteria-related -- see HERE: --- "Eating," the report said, "has always been a problem with him;" "attack of diarrhea and fever;" "tube-fed five times daily up to 1 year of age;" "vomited all food from birth through the third month;" "For the first two months, the feeding formula caused considerable concern;" "a long story of trying to get food down."
Viral illness: --- "smallpox vaccination at 12 months--attack of diarrhea and fever;" " He had measles, chickenpox ;" "in bed often because of colds, bronchitis, chickenpox;" " He suffered from repeated colds;" "a febrile illness at 13 months, her increasing difficulties were interpreted as possible postencephalitic behavior disorder."
Kanner missed seeing these as an etiological connection. Instead he has included them as part of the picture, as "comorbid" pieces to the children. I think we can acknowledge that he didn't have the retrospective view that we have now, that many of these children with an autism diagnosis have more bacterial, viral, and fungal infections than their neurotypical peers. Is it because of a dysfunctional immune system and if so, why? Was it fragile or did something make it that way, like vaccines and/or mercury-thimerosal for example, altering it and the consequences of that showing up in behaviors?
This would be a good time to describe that word, "comorbid" because it's a word that has more than one meaning and purpose especially with regards to autism:
Dorland's Medical Dictionary for Health Consumers.
comorbid - adj. Coexisting or with an unrelated pathological or disease process.
So this means a separate entity. He has autism but he has a seizure disorder- unrelated and thus he has at least one "comorbid" condition to his autism....but is that correct?
Here's another definition:
"The term "comorbid" currently has two definitions: 1) to indicate a medical condition existing simultaneously but independently with another condition in a patient (this is the older and more "correct" definition) 2) to indicate a medical condition in a patient that causes, is caused by, or is otherwise related to another condition in the same patient"....now check out the comment here on Wikipedia, while not a fact but a telling opinion........... "(this is a newer, nonstandard definition and less well-accepted)". Interesting...."less well-accepted" and I sense that this might be indicative of the resistance of looking at the "core" issues of any of these chronic illnesses so we see the birth of "comorbid" and its ugly cousin "concomitant" popping up in more and more studies as an attempt to dismiss the true roots of autism.
If bacterial, viral, and fungal infections occur more often in children with an autism diagnosis, the question remains as to why that is? If the behaviors associated with autism, those core issues -- language, repetitive movements, poor social skills -- are the body's reactions to these medical issues, then that is a significant paradigm shift. It is very possible that comorbid in autism really means the cause of the disorder.
It has been 66 year since Dr. Kanner wrote about those eleven children who had a great deal of illness and infection inside their bodies and we are still seeing that today. Kanner did not see it but it is very obvious that we are dealing with a medical illness with roots from these infections. It’s very likely that the recipe for autism has not changed but sadly instead, the ingredients have just increased.
Teresa Conrick has two beautiful daughters. When she is not teaching, she is researching the biomedical implications of autism, both past and present.