Life in a Parallel World
ADAM ELDER, 8, SPENDS AN HOUR A day tearing paper and cereal boxes into confetti. Words must be wrested from him like an impacted molar; it is a small miracle when his mother gets him to say "cheetos." His sister, Lily, 6, lives in a parallel universe, too, whose impassable borders are defined by autism. She flaps her hands and covers her ears obsessively. She is so afraid of open eyes that she doesn't look at people. She even blacks out the eyes of the figures in her coloring books.
The cause of autism remains largely unknown, and a cure isn't even on the horizon. But a few scientists are taking a wholly new approach to the syndrome. They are defining autism as a "spectrum" disease. At one end is the child crouched in a corner; at the other is, for example, Mark Romoser, 31, a research assistant at Yale University who has also managed to hold corporate jobs--as long as they don't require interacting with customers. If autism can present such a range of symptoms and severity, suggests the new model, then it strikes not 2 to 5 people per 10,000, but 15 per 10,000, says Dr. Eric Hollander of Mount Sinai Medical Center in New York, who is presenting a sort of unified field theory of autism this week at the annual meeting of the American Psychiatric Association.
The new approach doesn't just redefine the incidence of autism. It also suggests that there are three core components of the syndrome, each with its own cause in the brain and, possibly, its own cure. Autistic childrenfour times more boys than girlshave huge difficulty communicating and cannot read emotions on faces. They shrink from people. They often behave compulsively; if it is not Adam's paper-tearing, then it is Dustin Hoffman's meticulous arranging of pens in the movie "Rain Man." Although about 80 percent of children with autism are mentally retarded, about 5 percent are "autistic savants," with unusual abilities that involve rote memory or visual skills. Child psychiatrist Fred Volkmar of Yale knows one autistic boy who has an IQ of about 60 but can recite the daily lottery numbers for the past several years. Think of the components of autism--social phobia, compulsive behavior, trouble communicating and, rarely, savantism--as the colors on a child's paint palette. Different mixes of red, blue and yellow produce a rainbow of hues. Similarly, different combinations of autism's components produce the array of conditions known by the umbrella term autism.
Obsessive-compulsive disorder, for instance, is linked to low levels of the brain chemical serotonin. Prozac, which increases the amount of serotonin sloshing around brain circuits, seems to reduce the compulsivity of autism. The social phobia of autism may be linked to the brain chemical oxytocin. This molecule, best known for inducing labor and lactation, also promotes maternal and other bonds and so has come to be known as the sociability molecule. When Hollander administered oxytocin to five autistic patients, it made them four times more talkative and, according to the patients, twice as "happy."
What causes the abnormalities in brain chemistry? Scientists suspect a subtle interplay of the DNA we inherit and the experiences we have. The case for "autism genes" is circumstantial, says Dr. Edwin Cook of the University of Chicago: if one identical twin is autistic, there is a 90 percent chance that the other twin will be, too. But there must be more to autism than genetics. Almost no autistics have children--most can't even manage a date--so any genes that directly caused autism would disappear from the population. Unless, that is, they remained quiescent, not causing any disease until triggered by some event such as brain damage. "Without the brain damage," Hollander suggests, "you get a disorder marked by great social phobias, or else these 'odd' family members who have special skills such as being human calculators." But with brain damage, "you get autism."
Finding the cause of that brain damage represents the next frontier for autism research. One suspect is a virus that disturbs the migration of neurons in the fetal brain. Ellen Feifarek of Towson, Md., whose 10-year-old son is autistic, has long wondered whether the viral infection she got in her 10th week of pregnancy could have anything to do with Scott's condition. "One searches one's heart of hearts all the time," she says. A more controversial theory focuses on pitocin, a hormone given to women to speed up their labor. Pitocin is the manmade analogue of oxytocin. "Most of the mothers of patients we see have had pitocin-induced labor," says Hollander. He suspects that pitocin somehow messes up the newborn's oxytocin system, producing the social phobias of autism. This idea is very preliminary, but it's an improvement on the theory hatched when autism was first identified 53 years ago. Then, scientists blamed it on unloving mothers.