Theories of Autism: Lessons from Dr. House

I’ve just been watching House.  I say watching.  To be honest, the details of this week’s plot passed me by as I was trying to follow it whilst simultaneously eating my dinner and having a conversation-slash-argument about of all things carbon taxing.  Trust me, House was way more interesting.

Anyway, the plot is pretty much the same each week:  patient shows up in the hospital with a weird combination of symptoms; House and team conduct various ethically dubious tests; initial diagnosis is  disconfirmed, usually by some new symptom; finally House ends up with the correct diagnosis and a single cause that explains all of the symptoms.  The patient this week had some extremely rare syndrome that gave her photographic memory and kidney failure.

So here’s the question I found myself asking:  what lessons does House’s anarchic approach to medicine have for autism research?  I’m not talking of course about his dodgy ethics, the lack of informed consent or the disregard for proper procedures.  We’ve had enough of that recently thank you very much.

The crucial point is that for House the cause he ultimately identifies has to explain everything.

In case you missed Autism 101, autism is defined in terms of impaired social and communication skills, co-occurring with repetitive behaviours and/or restricted interests.  But it’s oh so much more than that.  Associated features include intellectual disability, epilepsy, sensory hypersensitivity, motor coordination problems, memory difficulties, face processing impairment, and so on.  Autism is also associated with certain strengths, particularly in perceptual processing, and a disproportionate (but still rare) incidence of savant skills including amazing feats of artistry, musicianship, and calculation.  None of these affect everyone with an autism diagnosis but they all co-occur with autism to an extent that can’t just be down to blind chance.

All of this demands an explanation and it’s perhaps not too surprising that people can’t help but find autism fascinating.  If House could explain autism, it would be the best episode ever.

The genius behind House (and yes I do realise he’s a fictional character) is the premise that, although there are many potential explanations for a given individual symptom, start looking at combinations of symptoms and suddenly the plausible underlying causes are reduced drastically.

I do wonder whether autism researchers may be missing a trick by not doing this as much as they could.  Social difficulties on their own could have multiple causes.  But social difficulties combined with motor discoordination and epilepsy?  Suddenly the possibilities are no longer endless.

But here comes the big “however.”  House is dealing with a single patient.  He knows that all of the symptoms affect that one patient.  With autism, on the other hand, we’re dealing with a group of people who, in a very general sense, have some things in common, but as individuals are all different from one another. We know, for example, that people with an autism diagnosis tend to have issues of social anxiety and also that many are hypersensitive to sound.  But we don’t know if it’s the same individuals in both cases.  So should we be thinking in terms of a common mechanism that could neatly account for both features, or would this be trying to explain the co-occurrence of two things that never actually co-occur?

Over the years, a number of grand unifying theories of autism have been proposed that try and link together different symptoms (my first ever paper, speculative as it was, arguably falls into this category).  But they are all theories of autism, assuming that autism is a single entity.

I’m not suggesting that we need a completely new theory for every individual.  But I do genuinely believe that if we’re ever going to make sense of autism, we need to recognise the fact that the core symptoms that define autism can come about by a number of different means.  Any given theory probably won’t apply to everyone.

The lesson from House is that looking at all the ‘symptoms’ might help identify these different causal pathways.

As ever, I’d love to hear your thoughts.

Jon Brock is a research fellow at the Macquarie Centre for Cognitive Science in Sydney, Australia.  He blogs at Cracking the enigma.

Theories of Autism: Lessons from Dr. House appears here by permission.


on 03/25/11 in Autism, featured | 3 Comments | Read More



Comments (3)

 

  1. A lawn is just grass right?

    All grass is grass after all.

    Wrong, a lawn is made up of a great varieties of what is called grass, is there a single explanation for it all besides the lawnmower?

    There is no single explanation for the many things that are called autism beyond the use of a single word for the collection. It tells you more about the way the mind creates it’s categories than it tells you about what is categorised.

  2. Stephanie says:

    Autism diagnoses are behavioral in nature; someone external to the patient observes a category of behaviors, and if sufficient quantity of those behaviors coincide, then autism becomes the diagnosis.

    However, as diagnostics goes, this seems rather rudimentary. While much in the DSM relies predominantly on observed behaviors, House (as a fictional MD) is often dealing with things that are provable. You can test kidney functioning and the like. We have very few testable things (as far as I’m aware) regarding autism.

    I’m not stating that as an excuse–I happen to agree that looking for commonalities among the autisms is more likely to bear fruit than sticking to one explanation for autism–but it does make it a rather different scenario.

    Where do you begin?

    (For the record, I do not watch House. The previews make him too dislikable for me. My mom does, however. Hopefully she’ll chime in.)

  3. Diane says:

    Ah yes, House, the Dr we love to hate… thinks beyond “the box”, and “pushes the envelope” on a regular basis – but an excellent Diagnostian… shows how difficult it is to put all the symptoms together, mostly because too many patients don’t recognize all their different symptoms have a single cause, or they don’t realize they have “symptoms” – it’s just some things little they’ve been explaining away until something bigger shows up they can’t handle or is now life threatening… or how much other Dr’s don’t see the whole picture/patient.

    Autism – many symptoms, some little, some medium, and some large, put together that explains one thing – the one thing no one really understands the cause or effects. And like some of House’s patients – individuals with autism have reactions to certain symptoms or medications that aren’t usual or predictable.

    Twirling and spinning is a normal part of childhood “fun”, unless it is excessive – but when does it become excessive, and a symptom of autism? Organization, it’s suppose to be a good thing, most people would agree. But then if you are overly organized or rigid in your organization habits/tendencies then perhaps you have a compulsive disorder at best, or ate autistic at worst.

    Someone, or a group of some ones decide what “normal” is and everything outside that range is… autism or somewhere on the spectrum, or a completely different “disorder”. But certainly not “normal”. But that is why autism is a “spectrum disorder”, because not everyone with autism fits into a nice little package with set symptoms, or a set range of symptoms.

    While some people are indeed helped by dietary changes, in cases of food allergies, not everyone is helped, and the dietary changes only help some of the symptoms in some of the people. So while the the idea of a Master Diagnostian going through all the symptoms and coming up with a reasonable explanation to help everyone sounds nice – this also sounds like more of a way to cure autism than except that God only makes individuals.

    Theories of cause aside, and I realize to some, God is only a theory – let’s continue the focus on helping the individuals with autism to live up to their full potential and be honored for who they are – instead of who we’d like them to be.

    Afterall, there is no one in a relationship with anyone, whether that be spousal, parent/child, friends, employment, or any type of relationship you can name, where someone is completely happy about every aspect of the other person and wouldn’t like to change something about that person…

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