#138 Can we Understand Autism?
A Review of Autism Revealed by Dr. Andrea Amalfitano
When parents and family members are told that their precious child has autism, they go scrambling for information. Yes, they get reliable information from healthcare professionals. Likely, they go online for information and recommendations on how to proceed. Can lay people tell the difference between reliable information outlets and the hundreds of sites peddling misinformation and snake oil cures? Where can desperate parents go?
Dr. Andrea Amalfitano has a long and unique understanding of pediatrics and medical genetics that inspired him to write an extensive resource titled: Autism Revealed: Clarity Through Understanding Its Causes: A Cutting-edge, Holistic Summary That Answers Your Questions about Autism. Andrea Amalfitano, DO, PhD, was the Dean of Michigan State University’s College of Osteopathic Medicine (MSUCOM), and is now the Osteopathic Heritage Foundation Professor of Pediatrics, Microbiology and Molecular Genetics.
In a world filled with information and mis-information, Amalfitano serves as a trustworthy and optimistic voice of reason for families and patients diagnosed with autism. The book should also serve as a reference for allied professionals, general pediatricians, child and adolescent psychiatrists to understand the syndrome, and to make more referrals for genetic testing.
The Value of Genetic Testing
Dr. Amalfitano explains that 90% of Autism cases are related to an underlying genetic cause, many of which can be identified with testing. With several of these diagnoses, a tailored treatment plan can be made to head off future complications and morbidity. Informed decisions can also be made in family planning.
The author makes a strong case for considering autism as a symptom then undertaking a thorough investigation to find the cause of why the individual has autism. The history and definitions surrounding the diagnosis are explained in depth with an extensive reference section for those who want to go back to original sources. The electronic version contains dozens of active hyperlinks to scientific articles and useful websites.
Only 3% of autism cases undergo genetic testing and that child and adult psychiatrists are the least likely to order genetic testing as compared to other specialties. Dr. Amalfitano emphasizes the importance of following the guidelines on genetic testing:
“Undergoing genetic testing is a difficult decision to make, and in the case of autism, becomes more difficult given some of the psychological barriers and obstacles faced by patients and caregivers alike. Yet it should be very clear that the importance of identifying the cause of autism in an individual can lead to several beneficial outcomes, including preservation of health, and avoidance of adverse outcomes such as worsening of autism symptoms and potential avoidance of catastrophic medical complications, such as cancer.” (Page 252)
Tackling Important Questions
Why are more people being diagnosed with Autism? The author discusses the broadening diagnostic criteria in each new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is a comprehensive guide published by the American Psychiatric Association (APA) used by mental health professionals to diagnose and classify mental health conditions.
The latest edition of the DSM provides an even more detail for descriptions, symptoms, and criteria for the autism spectrum disorders. The broader criteria can help clinicians make accurate diagnoses and develop treatment plans.
Dr. Amalfitano also notes the incentivized motivation for attaining the diagnosis in that families could get much needed support from state and locally funded programs.
“In short, improved abilities to provide meaningful interventions to those affected by autism spurred a strong desire among physicians and healthcare providers to seek out and identify patients more aggressively.” (page 258)
With Dr. Amalfitano’s sophisticated understanding of all the factors surrounding the high diagnostic rate (CDC 2023: 1 in 36 children incidence), he concludes the following:
“One could suggest that the number of individuals affected by autism diagnosis has not actually changed in our population over time, it is just that our ability to identify them has increased! They were always there!” (page 262)
Busting the Myths around the Causes of Autism
One very useful chapter is entitled “What does NOT cause Autism?” The author reviews all the biggies bandied about on the internet. Poor parenting, vaccines, environmental agents, medications (such as acetaminophen), and exposure to milk or gluten do not cause autism. Again, the author has the references linked to back up his considerable expertise and clinical experience.
Dr. Amalfitano categorically states that childhood vaccines do not cause autism. In chapter 24 of his book, offers ample evidence, with lengthy explanations of twin studies and other research supporting this conclusion. He discusses the widely cited and discredited Wakefield 1998 paper in the journal Lancet that cast suspicion on the MMR vaccine.
He states, “It has always been disheartening to me that one scientific paper could cause so much harm to so many, propelled by people’s fear of the unknown… In 2010, Lancet fully retracted Wakefield’s 1998 paper. (page 266)
Practical Advice for Parents
The book offers useful and empowering advice for families facing an autism diagnosis.
“Coming to grips with having a child affected with a serious disorder such as autism many times comes with overwhelming amounts of emotional and psychological stress. In fact, this is an incredible understatement, the reality of accepting that you, your child or loved one is affected by autism is emotionally comparable to the stress induced by something as extreme as the death of a child.” (page 9)
One useful way to use this book would be to go directly to those chapters with titles that address questions that most family members have. For example, in Chapter 28: Can Autism be Prevented or Cured, the author dispels many myths surrounding causes and treatments. There is no known “cure” for autism. The companies and people saying that there is a cure, are cruelly misleading and extracting money from vulnerable families.
“Autism is in most cases a lifelong condition that affects individuals differently and many times this is dependent on the specific underlying cause for one’s autism symptoms… It is important to keep in mind that autism is not a condition that needs to be “cured” and that individuals affected by autism can, and most times will lead happy and successful lives. (Page 294)
Professionals working with autistic individuals may be the group that would benefit the most from reading and consulting with this book. When and to whom to refer a family for more testing or treatment is an invaluable resource provided here.
The good doctor concludes, “Identifying the cause of autism in their child, although difficult to accept and then undertake, can allow parents to regain control, and have meaningful capabilities to guide their child to an ultimate best outcome despite an autism diagnosis. I hope that with a clearer understanding as to what the causes of autism are, and are not, more parents can shed themselves of unnecessary guilt and feelings of helplessness.” (Page 305)
