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Simon Baron-Cohen and Autism - 70 Years Later and Psychiatry Still Gets It Wrong

Posted Aug 01 2013 12:00am
Wrongway By Teresa Conrick

It's been 70 years since Dr. Leo Kanner first diagnosed those original eleven children as having inborn autistic disturbance of affective contact.

"We must, then, assume that these children have come into the world with innate inability to form the usual, biologically provided affective contact with people, just as other children come into the world with innate physical or intellectual handcaps"
As the calendar pages fall, like a montage in a film, autism is now being seen as a whole-body medical illness, affecting the gastrointestinal system, the immune system and the brain.  Kanner was correct in his gathering of clues but so, so wrong on the true origin of autism's inception. The trigger for many children who regressed into autism has been reported to be vaccines, the mercury in them, mercury in the environment   and/or an immune response that is dysfunctional .  There is overlap as it is shown that mercury/thimerosal as well as bacteria and viruses, components in vaccines, can trigger immune and autoimmune issues.

Now read this recent conclusion  from Simon Baron-Cohen , Professor of Developmental Psychopathology in the Departments of Psychiatry and Psychology at the University of Cambridge
"Traditionally, anorexia has been viewed purely as an eating disorder. This is quite reasonable, since the girl’s dangerously low weight, and their risk of malnutrition or even death has to be the highest priority. But this new research is suggesting that underlying the surface behaviour, the mind of a person with anorexia may share a lot with the mind of a person with autism."
There is something similar here between Kanner and Baron-Cohen.  Psychiatry, a field of the mind, often with a focus on Freud or theory of mind...theories, continues to look at the clues of autism and mangle the hell out of them. The children and often times, the families, have been evaluated solely on behavior. That is wrong. Much research is showing that these disorders often times are immune-mediated.

In a nut shell, his study
"The team led by Prof Simon Baron-Cohen tested 66 teenage girls with anorexia and found they had a higher than average number of autistic traits, a lower than typical empathy score and an above average interest in systems. This profile is parallel to that visible in autistic people but is less pronounced.....They were also less empathetic and had a higher interest in repeating patterns and predictable rule-based systems than the typical teenagers to whom they were compared."
But why does psychiatry not dig deeper?  Could there be connections here -- medical symptoms -- that need attention?  I did dig a bit and for starters, this whole autism and anorexia research seems to be years old -- and not originating from Baron-Cohen
Anorexia could be linked to autism   25 April, 2009 | By Tulasi Sivapatham 

"In a study, published online in the International Journal of Eating Disorders, Janet Treasure and her colleagues found that there were significantly more people with eating disorders who have trouble modifying their behaviour in response to changing goals, something which is seen in ASDs.
In treating people with anorexia to not only see the fine details but also the bigger picture, mental health professionals hope patients will be less likely to obsess over body weight.

Janet Treasure, of the Institute of Psychiatry, said: ‘Eating disorders and autism spectrum disorders are obviously not the same thing, but they do have some things in common.’

Some things in common?  That should be what is being researched , so let's take a look at the clues   --

"Clinical and research observations have led to the hypothesis that a post-infectious and autoimmune process may cause or exacerbate certain cases of obsessive-compulsive disorder (OCD), with or without tic disorders (Am J Psychiatry 1998;155: 264), autism (Am J Psychiatry 1999;156: 317), and anorexia nervosa (AN) (J Child & Adolesc Psychiatry 1997;36:1128). These disorders are described by the acronym PANDAS (Pediatric Auto-immune Neuropsychiatric Disorders Associated with Streptococcus), when they occur in children and when the causative agent is Group A Streptococcus, the bacterium that causes strep throat. PANDAS may be part of a larger category: PITANDs (Pediatric, Infection-Triggered, Autoimmune Neuropsychiatric Disorders). PITANDs may be caused by a number of infectious agents, such as bacteria and viruses...."

Now that makes sense - Autism, PANDAS and Anorexia - might just all be connected via an immune/autoimmune response.  PANDAS and Autism  have many connections.  Here's a case study example
Certain Eating Disorders May Be a Neuropsychiatric Manifestation of PANDAS: Case Report
"The patient is an eight year old boy who presented with a two month history of significant weight loss, behavioural abnormalities, and a history of recurrent culture-proven Group A Beta-Hemolytic Streptococcal (GABHS) pharyngitis. Three months prior to admission (PTA) he had been taught ‘healthy eating’ at school. He subsequently started reading labels on food packages, avoided all trans-fats, and minimized his fat and simple carbohydrate intake. He was concerned about weight gain and believed that he was ‘too fat’. He then began looking at his abdomen and at himself in the mirror numerous times daily. He became suspicious of what his mother might be putting in his food and began only eating packaged foods that he could prepare himself, which amounted to about 200 calories daily. Two months PTA his scheduled tonsillectomy for recurrent GABHS pharyngitis had to be cancelled because the patient had developed pneumonia and pharyngitis. One month PTA and one to two weeks after an episode of pharyngitis, he developed choreoform-like running spurts. He began engaging in ritualistic behaviours, particularly prior to eating, but not exclusively. He would nod his head several times, followed by arm flapping and tapping his mouth before he would take a bite of food. ....

.....His weight dropped 8kg secondary to his food refusal and he was admitted to hospital at 75% ideal body weight with a score of 33 (extremely severe OCD) on CY-BOCS (Children’s Yale-Brown Obsessive Compulsive Scale) (Scahill et al., 1997). The patient did not have pharyngitis on admission. In addition, the following were negative: Group A Strep Direct antigen test, throat culture, and blood culture. His blood chemistry was normal. His Anti-Nuclear Antibody and Anti-Streptolysin-O Antibody titres and Rheumatoid Factor were within normal limits. His IgG was low at 4.63. His Anti-DNase B titre was elevated at 1:960 on admission and further elevated to 1:1360 after three weeks. It was our opinion that he had PANDAS and he was diagnosed with OCD and AN."

Good information.  Here is more testing -- medical -- to help determine how anorexia could manifest
PANDAS and anorexia nervosa --a spotters' guide: suggestions for medical assessment. 

" Existing tests may be categorized as: (i) Non-specific markers of inflammation or immune response (Erythrocyte sedimentation rate, ESR; C-reactive protein, CRP; Neopterin), (ii) specific markers of streptococcal infection (throat swab and anti-streptococcal antibodies, Anti-streptolysin, ASO; Antideoxyribonuclease B, antiDNaseB), (iii) non-specific markers of auto-immune reaction (Antineuronal antibodies, AnAb; D8/17). No one test reliably identifies PANDAS. The lack of specificity and methodological problems may lead to errors of diagnosis....."
Errors of diagnosis?  Sounds like what has happened for YEARS with many of these children who have been examined as systematic, DSM candidates rather than children, often acutely and chronically ill, with infections and immune dysfunction. Is there a treatment to help reduce the immune issues, thus improve the behaviors?

Infection-triggered anorexia nervosa in children : clinical description of four cases.

..."Four youngsters (ages, 11-15 years) with PANDAS AN [Anorexia Nervosa] were treated with an open trial of antibiotics, in addition to conventional treatment. They were evaluated for eating disorder and obsessive-compulsive symptoms, and for weight gain. Evidence of streptococcal infection came from clinical evaluation, throat cultures, and two serological tests:

anti-deoxyribonuclease B (anti-DNase B) and anti-streptolysin O (ASO) titers. The "rheumatic" marker D8/17 was also measured. This B-cell alloantigen is associated, in several publications, with poststreptococcal autoimmunity: Rheumatic fever (RF), Sydenham's chorea (SC), and possibly PANDAS obsessive compulsive disorder (OCD) and tic disorders.

There was clinical evidence of possible antecedent streptococcal infection in all four patients, two of whom had comorbid OCD, with possible infection-triggered AN. All four had the rheumatic marker: A percentage of D8/17-positive B cells of 28-38%, with a mean of 33% (12% or more is considered positive for the marker). The patients responded to conventional treatment plus antibiotics with weight restoration and decreased eating disorder and obsessive-compulsive symptoms. Three needed to gain weight and did so....."

Apparently, immune treatments can ameliorate the anorexia - the ocd - thus, the psychiatric symptoms disappear. 

But how is D8/17 involved? 

....D8/17 expression also has been reported to be elevated in youngsters with OCD (Am J Psychiatry 1997;154:110; Am J Psychiatry 1997;154:402); tics (Am J Psychiatry 2001;158:605); autism (Am J Psychiatry 1999;156:317); and in four cases of AN [anorexia nervosa] where clinical characteristics of PANDAS were present (J Child & Adol Psychopharmacol 2000;10:133). Although the diagnostic value of D8/17 remains uncertain, it may provide insight into the underlying processes in these illnesses."
Here's another, relevant and with an ironic title: What every psychiatrist should know about PANDAS : a review --

"In a study investigating D8/17 in PANDAS, Swedo and colleagues compared 27 children who met the diagnostic criteria with 9 patients with Sydenham's chorea and 24 healthy controls, and found a significantly higher percentage of B cells that bind D8/17 monoclonal antibody in children with both diseases than in controls (89% in Sydenham's chorea, 85% in PANDAS, 17% in controls) [65]. Another study of patients with child-onset OCD or Tourette disorder found 100% positive reactions for D8/17 in patients compared with 5% in the control group [13]. Subsequent studies investigated D8/17 positive B-cells in obsessive-compulsive spectrum disorders, as well as in other neuropsychiatric disorders. High percentages of B-cells expressing D8/17 were found in patients with autism (78%) [15], anorexia nervosa (100%–81%) [66,67], adult OCD (59%–92%) [68,69], tics (61%) [70] and trichotillomania (59%) [68]."
It seems that the connections are there.  If  some patients truly have immune dysfunction, it seems negligent to not be testing ALL patients so that appropriate immune treatments could be started.
Here is more 
D8/17 expression on B lymphocytes in anorexia nervosa.  
"The authors' goal was to determine whether D8/17, a rheumatic fever susceptibility trait marker, identifies a possible type of anorexia nervosa: pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS) anorexia nervosa. METHOD Using immunofluorescence, the authors measured the percentage of D8/17-positive B lymphocytes in the peripheral blood of 16 subjects 7-21 years old who had not had rheumatic fever but who had possible PANDAS anorexia nervosa. The comparison subjects were 17 psychiatric patients with no eating disorder and no PANDAS characteristics. Subjects were considered D8/17 positive if they had 12% or more D8/17+ cells. RESULTS There were more D8/17-positive individuals among those with PANDAS anorexia nervosa (81%) than among the comparison subjects (12%). The subjects with PANDAS anorexia nervosa had a higher percentage of D8/17+ cells (mean=27.1%, SD=17%) than the comparison subjects (mean=5.3%, SD=7.4%). ....."
And let's not forget that Leo Kanner made similar mistakes by not looking at the medical issues and instead, only at the behaviors.  Here he talks about "Donald T" who is now known to be Donald Triplett from the research of Olmsted and Blaxill
"Eating," the report said, "has always been a problem with him. He has never shown a normal appetite."
Donald, like so many others, had issues with eating yet Kanner did not see this as medical but instead twisted it to fit his theory of affective contact 
"Food is the earliest intrusion that is brought to the child from the outside. David Levy observed that affect-hungry children, when placed in foster homes where they are well treated, at first demand excessive quantities of food. Hilde Bruch, in her studies of obese children, found that overeating often result~d when affectionate offerings from the parents were lacking or considered unsatisfactory. Our patients, reversely, anxious to keep the outside world away, indicated this by the refusal of food. Donald, Paul ("vomited a great deal during the first year"), Barbara ("had to be tube-fed until 1 year of age"), Herbert, Alfred, and John presented severe feeding difficulty from the beginning of life."
Mercury was also a common denominator, a toxic thread in the eight so far found, of the original eleven. Mercury can cause immune and autoimmune disease.  More connections?
Anorexia Nervosa and Mercury Toxicity - The American Journal of Psychiatry, VOL. 165, No. 11 

Autism: A Unique Type of Mercury Poisoning
"Anorexia; feeding problems/vomiting"
"Rheumatoid arthritis with joint pain has been observed as a familial trait in autism (Zimmerman et al, 1993). A subset of autistic subjects had a higher rate of strep throat and elevated levels of B lymphocyte antigen D8/17, which has expanded expression in rheumatic fever and may be implicated in obsessive-compulsive behaviors (DelGiudice-Asch & Hollander, 1997). "
Donald also developed rheumatoid arthritis after his autism diagnosis. When he was given medical interventions with a focus on his immune system (gold salts), both Donald's rheumatoid arthritis and his autism symptoms greatly diminished, to the point of becoming almost indistinguishable.
Some current research on the connection of autoimmunity and microbes -
Voices from within: gut microbes and the CNS
And this research actually included Anorexia - Fig 2
The human microbiome and autoimmunity.
"To demonstrate how dysbiosis of the human microbiome can drive autoimmune disease."
After seventy years, these children deserve so much more than Psychiatry has ever offered. Medical testing should become standard treatment for these symptoms presented.  If the immune system seems to be faulty in so many of these disorders, it is imperative that appropriate research reflects that. 

Teresa Conrick is Contributing Editor to Age of Autism.

Posted by Age of Autism at August 08, 2013 at 5:45 AM in Teresa Conrick Permalink

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