From the blanket coverage he’s getting in today’s Guardian you might think that Professor Simon Baron-Cohen of the Cambridge University Autism Research Centre had made some kind of major scientific breakthrough:
New research published today will bring prenatal testing for autism significantly closer, prompting experts to call for a national debate about the consequences of screening for the disorder in the womb and allowing women to terminate babies with the condition.
The breakthrough study by Cambridge University’s autism research centre has followed 235 children from birth to the age of eight. It found that high levels of testosterone in the amniotic fluid of pregnant women was linked to autistic traits, such as a lack of sociability and verbal skills, in their children by the time they are eight.
It raises the possibility of an amniocentesis (the same procedure used to test for Down’s syndrome) to detect autism.
Then, as typically happens when you go on to read the rest of the article, and the Guardian’s two other articles on the same piece of research in today’s edition, you very quickly come to realise that while this research may add a little something to our current understanding of autism by way of indicating an avenue for further research that may be worth pursuing, it doesn’t take us much further in our understanding of the causes of autism nor, as the Guardian claims, does it bring prenatal testing for autism any closer at all, as Baron-Cohen freely admitted only last week:
Research is not yet at the stage where autism can be detected prenatally using a biological test, but this may not be far off.
Such a test will need to prove itself clinically in terms of whether it is highly specific (in detecting just autism).
Autism is a phenomenally complex disorder and, as things stand, we don’t understand very much about its causes – there’s some evidence that points to it having a genetic element and some that indicates that environmental factors may also play a part in its development.
We also, if we’re entirely honest, don’t fully understand quite how prevalent it is or even, in many cases, whether we’re correctly diagnosing it in many individuals who appear to display some personality traits associated with autism but without showing the severe impairments in social cognition associated with the full-on condition, which affects relatively few people when compared to the half a million individuals who’ve been diagnosed as having an ‘autistic spectrum disorder’ of some description.
This explosion in diagnosed ‘cases’ of autistic spectrum disorders coincides with increased public awareness of autism which began with the release of the film ‘Rain Man’ and raises a number of significant and, as yet, unanswered questions as to whether and to what extent this rise in the number of diagnosed cases means that the prevalence of autism is actually increasing, whether is merely a function of greater parental awareness and better diagnostic practices or whether the diagnosis of autistic spectrum disorder has become, today, what schizophrenia was back in the 1950s and 60s, a catch-all diagnosis used by psychiatrists and psychologists in lieu of an admission that they really don’t know what the problem is, or even, in some cases, whether there is even a genuine problem.
What Baron-Cohen’s research add to the overall picture is, at this stage, nothing more than a line of future enquiry that, on the evidence thus far, appears to be worth pursuing. There appears to be a correlation between the appearance of high levels of testosterone in amniocentesis tests and the later development of autistic ‘traits’, data which fits what appears to be an emerging pattern in such traits are more closely correlated with the male gender, with the age of the mother at the time that the child is born and with it being the first child. What there isn’t, is any proof of causation nor can it be said, at this stage, that there is even evidence of a ‘link’ between these factors and autism or ‘autistic spectrum disorder’ – the correlations that have been found in recents may quite easily be linked to as yet unknown factor which may easily turn out to be entirely unconnected to the development of, allegedly, autistic traits.
And yet, from this thin bowl of scientific gruel, Baron-Cohen has fashioned a story which has netted him and his team at Cambridge University, a degree of media coverage out of all proportion to the merits of his discovery, which fair demands some consideration of exactly how and why that’s happened.
There are three things which have massively elevated this story beyond the normal degree of news coverage that such a minor scientific development.
One is simply that Baron-Cohen brings to the table an element of reflect celebrity value by virtue of have a considerable more famous cousin, Sascha Baron-Cohen.
The second reason is quite obviously that, even without sight of the press releases put out by Cambridge University, its clear that Baron-Cohen has launched a major media offensive in order to obtain as much coverage for thios story as possible.
And the third reason lies in the fact that, in order to elevate the perceived newsworthiness of his research, Baron-Cohen has openly raised the possibility of pre-natal screening for autism and called for an ethical debate on the subject even though its far from clear whether his research genuinely takes us any closer to such a practice and, in fact, its extremely likely that it doesn’t and that even if the correlation he’s uncovered is found to be valid, merely for the presence of elevated levels of testosterone will prove to be far too crude a screenign method to be viable, if screening of this kind is even ethical and/or desirable.
In all this, there is a very important public debate that needs to undertaken, but its one that has nothing whatsoever to do with pre-natal screening. At the opposite end of the ‘autistic’ spectrum from Rain Man and from the majority will full-on autism, who get all the social and psychiological deficits of the condition without demonstrating any kind of savant abilities (and who, therefore, are completely ignored by the media) there are serious ethical questions about the validity of the diagnostic process.
We will all have grown up with and know very well, individuals who are preternaturally shy and introverted, who obviously find social environments uncomfortable and have difficulting adapting to and interacting with other people in social settings. Some may come across as being tactless or lacking in warmth and empathy. Some may appear just a little bit obsessive about certain things, a little bit too engaged with a particular personal interest for the comfort of others. In the past, the most we would say of such an individual is that they’re just ‘not a people person’. Today, some will undoubtedly wonder if such an individual may be ‘a little bit autistic’, if not voice the question openly.
This raises some very major questions about the seemingly rising trend in the diagnosis of autism.
Are all these diagnoses valid or, in some cases, are we unnecessarily labelling and medicalising personality traits and characteristics that, in reality, lie well with the normal parameters of human social behaviour and interaction?
And, if so, just how badly are we overshooting the mark and what are the individual, social and societal consequences of misapplying the label of ‘autistic spectrum disorder’?
To what extent is diagnosis of ASD turning into a palliative that some psychiatrists use to ‘buy off’ the overbearing attentions of over-anxious middle class parents who can’t brings themselves to face up to the fact that their a member of cosseted and massively over-protected brood simply isn’t as bright or capable as they would prefer them to be?
To what extent are ‘conditions’ such as autistic spectrum disorder, ADHD and dyslexia creating/contributing to a narrowing of social perceptions of what constitutes ‘normality’, enabling parents to avoid facing up to realities such as the fact that we can’t all have above average intelligence – and there are no shortage of studies which demonstrate that a significant number of people tend to massively over-estimate their own intelligence. In some studies, 85-90% of respondents asserted that they had above average intelligence even though, quite obvious, only half the population can actually be above-average.
Such misperceptions matter, and they matter in ways that are, sometimes, not entirely obvious until you drill down into the detail. In 2007, in his tenth budget speech, Gordon Brown asserted that long-term economic forecasts indicated that, by 2020, the British economy would require only a matter of 600-900,000 unskilled workers – Brown was, of course, pitching the now-familiar government line about the critical importance of education and training to Britain’s economic prospects for the future. So far as I can ascertain, although some questioned the validity of that forcast in terms of the numbers Brown cited, no one – other that the Disability Alliance – drilled down beyond that forecast to consider what it actually meant in terms of the UK’s adult population.
IQ is far from being an entirely reliable measure of intelligence, but for the purposes of illustrating an important point it will do for what I want to show you, provided you understand one important fact, which is that IQ scores are periodically renormalised to ensure that an individual with absolutely average intelligence will score exactly 100.
So, on a standard IQ scale, a score of 100 indicates someone of average, 140+ is ‘genius’ level as per the membership criteria used by MENSA and a score of 70 or less indicates an individual whose intellectual capacity is almost always insufficient to allow them to function adequately in society without significant levels of care – in practice, an individual with such a low IQ is unemployable outside of a dedicated employment scheme of the kind provided or arranged by Remploy.
900,000 job is roughly 3% of the UK employment market and, were the government to intervene in the market such that unskilled jobs were allocated according to intelligence, i.e. we reserve the entire pool of jobs for those with an IQ score at only just above 70, the minimum level at which they are are notionally employable, we would run out of unskilled jobs to allocate to the least intelligent members of society at an IQ score of around 75, at which point we would still need to find a further 1.5 million low-skilled jobs just to cover the number of people who have a recognised learning disability and further 1.5-2 million to cover the number of adults who are functionally illterate and have level of literacy at or below the level expected of an average 11 year old child. So, unless we’re going to offer massive employment subsidies in order to artificially create and sustain something like 3-4 million unskilled and low-skilled jobs then, by 2020, we could be looking at a structural level of unemployment of something of the order of 3 million adults, if the demand for unskilled labour declines in line with Brown’s forecast.
So what do we do with all these unemployed (and unemployable) individuals? Do we simply accept the inevitability of that level of structural unemployment and use the welfare system to sustain it?
Do we keep on throwing money at the education system and at training providers in the vain hope that someone will uncover the alchemical formula for successfully polishing turds.
Do we intervene and use public money to subsidise unskilled and low-skilled jobs that the market wouldn’t otherwise sustain in the belief that its better spend money on emploment subsidies than on welfare payments?
Or maybe we go with the flow and medicalise the problem by labelling the congentially unintelligent as having an autistic spectrum disorder, or ADHD or dyslexia or any one of a number of other conveniently vague conditions which, at least, make it a bit easier to justify sustaining such a large proportion of the adult population on welfare benefits?
This is massive issue and the one we should be researching and debating, not Baron-Cohen’s minor discovery, one that may well never yield any kind of viable pre-natal test for autism, and even if it does prove to be a useful milestone along the way to such a test, is unlikely to lead to such a test within the next 10 years and maybe longer.
So, taking all that into account, why is Baron-Cohen currently mounting such a major offensive in order to promote a discovery that seems to be, at best, of marginal value in the context of studying a complex neurological condition the mechanics and cause(s) of which we, still, barely understand. Its worth pointing out they we cannot even state with any degree of certainty, at this stage, that autism has a definite cause. Such is the complexity of the disorder that we could be looking at a range of different pathologies all of which produce similar, if not near identical, cognitive deficits. Although full-on Autism and Asperger’s Syndrome appear to be related conditions in terms of their outward symptoms this offers no guarantees that they are related disorders in terms of the cause or pathology and each could easily turn out to be no more than a generic label for a whole range of disorders, most of which we’ve yet to identify.
The answer, if its not simply a question of Baron-Cohen seeking a bit of ego-stroking, seems, most plausibly, to lie in the manner in which is his research is, and has been funded…
…through research grants provided by a charity called ‘Research Autism’, one that is, itself, funded via a mix of corporate sponsorship and grants from a number of other charities.
With the UK entering a recession (and maybe we’re already there) research funding, particularly funding for speculative research of this kind, which doesn’t automatically lead towards a marketable end product, is inevitably going to be more difficult to come by. The state of economy will inevitably prompt corporate sponsors to concentrate on maintaining their own bottom line at the expense of both charitable donations and investment in research and development, which is traditionally one of the budget areas thats amongst the first to be squeezed when the economic going gets tough. Meanwhile, cuts in interest rates and a major fall in stock markets will inevitably impact on the value of investments and and income from endowments which finance charitable giving by the kind of charitable trusts that typically support research of this kind.
So, what we have here may well be the first clear and obvious example of ‘Credit Crunch Science’, in which researchers go all out to promote, to the media, what are otherwise interesting but relatively minor discoveries and research outcomes, in the hope that securing a high profile will ensure that when this year’s research allocations are determined, their research is not on the list of projects which gets the ‘we’d love to continue supporting you, but…’ letters.
There may be no way of accurately predicting whether or not Baron-Cohen is really on to something with this research, but what I think I can safely predict is that, over the coming months, we’ll see many more attempts by scientists to put the hard media sell on any positive results their research manages to generate, regardless of whether their outcomes either justify such interest or have any significant scientific merit. We are also, on the opposite side of the equation, much more likely to see research which generates negative or inconclusive outcomes being quietly buried away in filing cabinets because thats the kind of research that’s unlikely to attract funding when times are tough, even though it can be, and often is, as if not more valuable in scientific terms, than research which generates positive results.