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Maxine Aston and CADD - A Different Level of Crankery

Posted Apr 25 2009 11:32pm
I'm sure readers are aware fellow blogger Alyric passed away last week. Subsequent to her passing, there has been some discussion about something called (CADD), which Alyric had felt strongly about. (See the ASAN Petition , this post by Gonzo , and this older post by ABFH with over 60 comments.)

I have to admit this CADD thing had completely passed me by. It was only after I read the documentation related to the recent activity that I realized it pertained to yours truly in a personal sense. But I wanted to see if the claims around CADD had any merit from a more objective point of view, personal implications aside.

The Syndrome

Maxine Aston claims to have discovered a new syndrome called CADD, observed in the significant others of autistic adults. Unfortunately, the only definitions of the syndrome are found in websites and books that simply list the characteristics of the alleged syndrome. I could find no mention of it in the scientific literature.

I haven't found a "how to" on making up new syndromes. But it's possible to research how it has been done historically.

In order to define a syndrome, it's not sufficient to just come up with a list of symptoms. You have to show that it exists. Testimonials are not sufficient. Consider Kanner (1943), which defined autism for the first time. Kanner wrote the case histories of 11 autistic children in detail, based on meticulous research observations.

This was not sufficient, though. For "autism" to be considered valid, subsequent research was required. For example, if autism had been found to be the same as other constructs like mental retardation or schizophrenia, say, when you match groups by IQ, then it would've been deemed an invalid construct.

The syndrome should also have some usefulness (e.g. Does it help predict something useful? Does it help define unique needs the individual might have?)

In fact, today there's some controversy about the validity of Asperger's Syndrome, since the differences between HFA and Asperger adolescents and adults (when matched by IQ) are nearly non-existent. Asperger's could very well be an unnecessary construct. But I digress.

For CADD to be considered valid, there not only needs to be a write-up of case histories in the scientific literature, you also need to show that it is different to everything that has been reported previously. Unhappy significant others and failed relationships abound. Are the relationships with autistic adults unique in this sense, say, when matched for socio-economic status and disability in one partner? And if so (which I don't doubt is true) are they uniquely bad, or are they simply different? Can any problems be explained by lack of acceptance?

Causes

The existence of the syndrome has not been established, so it seems a little spurious to talk about causes. Nevertheless, let's look into what the alleged causes are.

As far as I can tell, "sufferers" of CADD claim that it is caused by lack of empathy and lack of emotional reciprocity in the part of the autistic significant other.

Regarding empathy, there's some recent research that shows adults with Asperger's Syndrome score lower in measures of cognitive empathy, but not in affective empathy. Persons with Asperger's actually experience higher levels of distress when observing others in distress.

These findings bring into question the means by which empathy is measured in research.

I'd also recommend reading Dr. Gernsbacher's Toward a Behavior of Reciprocity .

Symptoms

The symptoms of CADD are claimed to be essentially the same as the symptoms of Seasonal Affective Disorder (SAD), including sleeping problems, depression, etc.

Again, in order to make these sorts of claims, some evidence, perhaps in the form of a case-control study, is needed. Testimonials are not sufficient. It would also be necessary to show that the symptoms can't be explained by socio-economic status, assortative mating, or disability in the significant other.

There are more far-fetched claims attributed to Aston, like CADD resulting in cancer. I'm sure this is based on one or a few anecdotes. Since cancer is fairly common in adults (the lifetime risk of developing some form of cancer is over 40%) such anecdotes are nearly useless.

Besides, there's some evidence that psychological stress does not contribute to cancer risk (e.g. Johansen & Olsen, 1997 ). The matter appears to be unresolved.

Conclusion

What we have here is a syndrome that has not been shown to exist, with alleged causes that might be erroneously attributed to autism, and with symptoms that haven't been shown to be associated with the alleged causes.

Sound familiar? This is no different to crankery like "autistic enterocolitis" or "mercury-induced autism." Except the promotion of CADD has the potential to result in a lot more direct damage to the personal lives of autistic adults.
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