Training | 2010.08.25
No magic wand with autism | Charlotte Moore
ASD could soon be diagnosed with a brain scan. But trying to get an autistic child into the scanner is just one of the problems
Until now, diagnosing autism has been dependent on professional observation of the "patient". Does he or she exhibit the "triad of impairments" – of communication, imagination and social interaction? Are there obsessive behaviour patterns? Are there sensory abnormalities? The signs can be subtle; diagnosis can be a frustratingly lengthy process.
A London University study could change all this. MRI scans of the brains of a group with ASD (autistic spectrum disorders) have been compared with those of a neurotypical group: significant differences in the brain were detected with enough consistency to raise hopes that soon autism will be detectable by a single 15-minute scan .
The implications are important and interesting. My mind leaps to the possibility of prenatal testing. It does seem only a matter of time before a potentially autistic brain can be detected during pregnancy. Would one wish to terminate such a pregnancy? As the mother of two autistic sons and one neurotypical one, I regard this as an ethical minefield, and I\'m glad I never had that choice. It will be a long time, however, before scanning techniques are sophisticated enough to make the choice possible.
To return to the present: I was struck by the positive reactions of those who took part in the experiment. All were consenting adults with IQs within the "normal" range; they expressed interest in and relief at the findings. There is a well-meaning but, I think, mistaken belief that it is unkind to "label" high-functioning autists who can just about "get by" in our neurotypical world. I believe, on the contrary, that knowledge is power, and that most autists find it helpful to be given an explanation for the profound sense of difference that has dogged them all their lives.One man said he hadn\'t fully believed in his autism when it was expressed verbally, as someone else\'s opinion. Looking at the scan showing the difference between his brain and a neurotypical one highlighted in blue, he felt he had concrete evidence, and was glad.
The technique could be used on young children at high risk of autism – the siblings of autists, for instance. The earlier the diagnosis, the earlier educational intervention can start, and most agree that this is a good thing.
Parents enraged by the scepticism of schools and social workers will be delighted by the possibility of scientific proof that their child\'s problems are not a passing phase, or the result of overindulgent parenting. But though the idea of a quick snapshot of a differently constructed brain is attractive, this is not actually on offer.
"A quadrature birdcage head coil was used for radio-frequency transmission and reception. Foam padding and a forehead strap were used to limit head motion," says the experiment report. When life is a nonstop struggle with your insomniac, refusenik five-year-old, when washing his hair or strapping him into his car seat is almost beyond your powers, can you imagine inserting him into a quadrature birdcage head coil? That\'s if you can get him through the door of the hospital at all.
Watching the participants on the TV news being fed into the huge scanner, I remember when I took my sons to Addenbrooke\'s hospital in Cambridge eight years ago. I had volunteered them for an MRI study of autistic brain activity. I soon realised my mistake. The boys had to wear earplugs: Sam, then 10, tried to eat his. A furry snake was wriggled to induce them to enter the tunnel, but 12-year-old George refused to be enticed. Not even a giant sack of jellybeans could persuade them to lie flat on their backs and slide into the unfamiliar machine. Four-year-old Jake was the only one who co-operated, but his mainstream little brain wasn\'t the point of the experiment. His brothersreturned home triumphantly, stuffed with jellybeans but unscanned.
The London University findings open new directions for the study of this complex, confusing, yet common condition. But for the foreseeable future, diagnosis will continue to rely on a back-up of behavioural observation by trained professionals. There\'s no magic wand to wave. There never is.
For more information, please visit
http://www.guardian.co.uk/commentisfree/[...]g/12/no-magic-wand-with-autism
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