Article being edited 26 March 2023
Can the impact of social deprivation can affect child development in a way that looks like autism? This question has always interested me.
By social deprivation I don’t mean, say, living in poverty or poor housing conditions. It refers to the family or caring environment in which the child’s emotional development takes place. For example, if parents or care-givers are not emotionally attuned to the child, the child may be less able to learn to relate to others emotionally and socially [1]. This is also a feature of autism.
What causes autism?
False starts in linking autism to social deprivation
Many years ago, I was presenting housing cases to a mental health panel, so that we could assess the needs of each individual or family. Referring to one child with developmental difficulties, I asked whether the effects of social deprivation could mimic autism. Judging by the eye-rolling of one psychiatrist, I might as well have asked whether a blood transfusion could fix a broken leg.
Back then, I did not realise that theory on the origins of autism was so contentious. Or that the profession had only recently debunked the ‘refrigerator mother’ theory. This is the idea that disruption of the mother-child relationship because she is cold or distant or neglectful causes autism. The psychiatrist’s eye-roll may have been impatience at my seeming to revisit a discredited idea. But the question of how to tell them apart has intrigued me ever since.
Non-genetic factors in the development of autism
Unsurprisingly Mandy and Lai’s 2016 paper on the role of non-genetic factors in the development of autism [2] caught my eye. Research has suggested that autism is one of the developmental conditions most rooted in genetic causes. However, the pendulum seems to have swung a little the other way. The paper cites genetic factors as accounting for 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.
The paper does not focus on my question, namely whether the impact social of deprivation can mimic autism. Nonetheless, it provides some pointers on this issue.
Research on the role of non-genetic factors in autism
Mandy and Lai summarise existing research on the role of non-genetic factors. This suggests that very severe deprivation in the first year of life may lead to autistic-like difficulties. This conclusion derives from studies of children adopted in the UK and Netherlands who experienced severe deprivation whilst living in Romanian orphanages.
In the UK study, 11% of the children, aged six, showed features which closely resembled autism. Such difficulties were more common in the children who had suffered the worst, meaning very little reciprocated social and emotional contact with adults. The Netherlands study found comparable features in 16% of children aged 8. And in another study of such children, aged 10, they also had difficulties with social communication.
Critically, the condition of the six year olds was labelled ‘quasi-autism’ as many of them showed features that were not classically autistic. Moreover, 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 other studies, children who lacked reciprocal social experience 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 were not regarded as autistic on reaching adolescence. A study of nurses with high autistic traits found they were more likely to have experienced abuse in childhood.
Social deprivation causes autistic-like traits
The paper suggests that the autistic-like difficulties arising from social deprivation do not generally lead to a syndrome identical to unexplained autism or fulfil the autism diagnosis. It seems there are observable differences. So, given sufficient time, the developmental impact of social deprivation on a child can be distinguished from autism.
However, my original question stemmed from wondering whether someone might be mistakenly diagnosed as autistic when their difficulties were in fact caused by social deprivation. The answer seems to be: ‘potentially yes’. Social deprivation at the more severe end of the scale can produce autistic-like difficulties in young children. This includes includes increased difficulties with social communication and flexibility that persist in later life. This was true for the nurses, for example, though this was a correlation and not shown to be causally linked.
I am not clear from this paper how easily or how early in a child’s development a psychologist or paediatrician would be able to distinguish between the two. However, it does seem very likely that it would need a specialist to do so. Since I first wrote this post in 2018, it seems the research is pointing in that direction too. Let’s look at this further.
Co-existing social deprivation and autism
In all of this, we must not overlook the obvious. The impact of social deprivation and autism might be present together. And that there might after all be some sort of relationship between them. Let’s look at child maltreatment and neurodevelopmental conditions in general. In this context maltreatment is a more extreme version of social deprivation.
One large study of 9-year olds [x] shows that maltreated children are nearly ten times more likely than than children who are not maltreated to have symptoms across a range of neurodevelopmental conditions. Importantly, it also shows that the maltreatment did not cause those symptoms. In fact, the reason for this co-arising of these is not known. However, the beginning of maltreatment in a child who already has a known neurodevelopmental condition is likely to worsen its symptoms [x].
Slightly off the the point of this article is that adverse childhood experiences and neurodevelopmental symptoms are each associated with increased health risks. Each of these also increases the risk of difficulties managing stress. And adolescents who, by the age of 9 years old, have experienced both mistreatment and neurodevelopmental symptoms have twice the risk of developing a severe psychiatric disorder. On seeing these symptoms, how does one know whether they are caused by adverse experiences or autism or both? And so we do come back, after all, to what lies behind my question. Can the impacts of social deprivation be distinguished from each other? Could the impact of maltreatment be diagnosed as autism or vice versa?
The expert view now seems to be that this is a risk that needs to be actively managed and mitigated. Based on their research, Gajwani and Minnis [x] recommend that holistic assessments be offered as standard which take account of both adverse child experiences and neurodevelopmental conditions. This is on the basis that it would reduce misdiagnosis and provide care tailored to both.
Final thoughts as a psychotherapist
The increased public awareness of autism affects how my psychotherapy clients think about their difficulties. These days, clients are now much more likely to tell me that they think a family member or their partner is ‘on the spectrum’ or or ask me whether I think they are. Younger clients are now much more likely to tell me that they think they are ‘neuro-atypical’.
The ever-increasing internet sources on childhood experience as a predictor of difficulties in adulthood works the same way. As a child, the most I could find on the subject was to steal from my Mum’s bookcase Axline’s still wonderful book, Dibs: In Search of Self. These days, a client is more likely to tell me what they have learnt about their attachment style on Tic Toc or tat. Or that they now understand their parent or sibling or partner has one or other personality disorder.
As a psychotherapist working every day with people whose childhoods have impacted heavily on how they experience life in adulthood. With an ever-increasing number of people diagnosing themselves, family members and especially partners, it is important for me to understand, as best I can, how a particular client’s difficulties may have developed.
Research on autism and related conditions continues apace and I am always glad to hear of further research in this field.
Further reading
[1] For an example of social deprivation at home and also later in institutions, have a read of https://julinecounselling.com/2018/05/02/story-of-child-abuse-post-war-england/ [2] 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[3] More on counselling for abuse and neglect in childhood
More about this post
This article was first posted on 19 May 2018. the latest edit was on 27 March 2023.