Down with refrigerator theory
More years ago than I care to count, I was presenting housing cases to a multi-disciplinary team so that we could assess the housing needs of each individual or family. Referring to one child with developmental difficulties, I asked whether the effects of social deprivation could mimic autism. What I mean here by social deprivation is not, say, living in poverty or poor housing conditions, but that parents or care-givers are not emotionally attuned to the child, so that the child is less able to learn to relate to others emotionally and socially. Judging by the eye-rolling of one very senior doctor, I might as well have asked whether a blood transfusion could fix a broken leg.
I guess I wasn’t aware of the recent history, that the profession had not so long ago disproved and ditched the ‘refrigerator mother theory’. This is the idea that disruption of the relationship of a child with its mother, because she is a cold or distant or neglectful, causes autism. My enquiring whether social deprivation might mimic autism could well have smacked somewhat of that discredited idea. Either way, this question still holds some validity in my mind and has bugged me ever since.
I was recently fascinated, therefore, by a paper by William Mandy & Meng-Chuan Lai 2016 (*) on the role of non-genetic factors in the development of autism. The paper explores the issue of how non-genetic factors contribute to the development of autism. It doesn’t set out to address my rather different question as to whether the impact of one specific non-genetic factor – social deprivation – could mimic autism. Nonetheless, selectively plucking what I need from it, it provides the first pointers to what I am looking for. Here is what it says.
Anecdotal reports suggested that very severe deprivation in the first year of life may lead to autistic-like difficulties. This was tested in studies of children adopted in the UK and Netherlands who had previously experienced this severe deprivation in their early years, whilst living in Romanian orphanages or institutions.
In the UK study, of 144 children aged six, 11% showed features which closely resembled autism. Such difficulties were more common in the children who had suffered the worst environmental deprivation, meaning very little reciprocated social and emotional contact with adults. Comparable results were found for 16% of children aged 8 in the Netherlands study; and in another study of such children, aged 10, they also had difficulties with social communication.
Critically though, the condition of the six year olds was labelled ‘quasi-autism’ as many of the children aged six showed features that were not classically autistic and their condition did not follow the trajectory normally found in autism. Also, the equal male-female ratio was different from the male predominance found in autism.
In a study of nurses, women with high autistic traits in adulthood were more likely to have experienced abuse in childhood, again showing the impact of the social environment. In other studies, children who lacked reciprocal social experience in their early years due to congenital blindness (rather than poor care) sometimes met the criteria for autism but were not quite typical of it. They also fared much better in later life than those with autism and tended not to qualify for that diagnosis by adolescence.
So what can I draw from this?
My original question was motivated by wondering whether someone might be supposed, or even diagnosed, to be autistic when their difficulties were in fact caused by social deprivation. The answer seems to be that, yes, social deprivation at the more severe end of the scale can produce autistic-like difficulties in young children, including increased social communication and flexibility difficulties that persist in later life. In the case of the nurses, for example, this was seen to persist into adulthood, though this was a correlation and not cited as being causally linked.
As a rather big aside, it is also interesting to read that, though autism is considered one of the developmental conditions believed to be most rooted in genetic causes, the pendulum has swung somewhat the other way, with genetic factors now estimated to account for just a little more than half. Not only that, but environmental interventions can potentially reduce susceptibility to autism, reduce symptoms and modify the course of its development.
However, returning to my question, the paper concludes that the autistic-like difficulties arising from social deprivation did not generally lead to a syndrome identical to idiopathic autism or fulfil the autism diagnosis. I am not clear from this one paper how easily or how early a psychologist or paediatrician would be able to distinguish between the two. However, it seems there are observable differences so that, given sufficient time, the developmental impact of social deprivation on a child can be distinguished from autism.
Just the beginning…
Happily for me, the paper seems to give some validity to my original question, as well as several citations to follow up. I have long since forgiven the doctor for his impatience and condescension, but I couldn’t help feel a little satisfied that my question was not quite so silly after all. All I need now is to know how to distinguish one condition from the other.
* Mandy, W. & Lai, M-C. (2016). Annual research review: the role of the environment in the developmental psychopathology of autism spectrum condition. Journal of Child Psychology and Psychiatry 57:3, 271-292