Monday, January 14, 2013
Dear Ms. Gilman:
As individuals affiliated with the Association for Science in Autism Treatment (ASAT), we were eager to read your op-ed, “Don’t Blame Autism for Newtown.” The public is all too painfully aware that the shocking tragedy in Newtown, CT on December 14, 2012 resulted in the loss of 27 lives—including the gunman, Adam Lanza. You aptly present how the media quickly moved from insinuation to declaration of Lanza’s autism diagnosis. Relatedly, following the deadly shooting in a Colorado movie theater this past year, MSNBC’s Joe Scarborough (Morning Joe, 7/23/2012) told viewers that he believes shooters such as these to be “somewhere…on the autism scale.”
Because of the incomprehensible actions of these perpetrators, many grapple to understand why an individual would engage in such violence. Understanding why something happened helps us to form explanations, thereby setting up expectations and behaviors for the future; this is a natural human inclination. However, ASAT agrees that it is potentially detrimental to individuals with autism (and their families) to associate a horrific event such as a mass shooting with an autism diagnosis. An autism diagnosis is not indicative of violent or homicidal tendencies – a point which you clearly express in your story. Spreading this misleading message may set up expectations of individuals with autism as a whole, which will ultimately negatively affect how individuals behave toward others with autism. It is important for the public to understand that beyond this potentially harmful association, individuals affected by autism are vastly heterogeneous; it is very difficult to make any generalized statements about this group. Furthermore, individuals with autism are far more likely to be the victims of crimes than the perpetrators. In fact, researchers have found that children with autism are more likely than their typical peers to be the victims of bullying (Cappadocia, Weiss, & Pepler, 2012; Carter, 2009).
We would also like to respond briefly to your distinction between mental illness and neurodevelopmental disorders. In your article you state that autism is a neurodevelopmental disorder, present from before the age of three, and that most mental illnesses do not appear until the teen or young adult years. This distinction may become problematic, as the potential to develop a mental illness is considered to be present from conception according to the diathesis-stress model, which is a widely accepted model for the development of disease (Gazelle & Lad, 2003; Keenan et al., 2010; Russo et al., 2005; Walker & Diforio, 1997). The susceptibility to developing the disorder is present in the genes of the individual; a stressor within the environment interacts with the susceptibility gene(s) to express the specific disorder. Furthermore, a recent report by Rapoport and colleagues (2012) reviews the substantial evidence that schizophrenia is a developmental disorder. The distinction between neurodevelopmental and psychiatric disorders is also blurred by recent research showing that certain genetic abnormalities that cause autism also cause intellectual disability, epilepsy, schizophrenia, mood disorders, and other conditions (Miller et al., 2009; Moreno-De-Luca et al., 2010). Thus, attempting to separate ‘mental illness’ from ‘neurodevelopmental disorder’ is challenging, as there is often no clear scientific distinction. Perhaps it is more important in these situations to focus not on the diagnostic label, but rather on the unmet treatment needs that may play a contributing role in these criminal acts.
We appreciate that you eloquently warn against the danger of associating autism and mental illness with “psychopathic, sociopathic, or homicidal tendencies.” In an attempt to explain these tragedies, the media is often eager to label individuals; labels help us understand, move forward, and prepare for the future. Correcting the misconception that autism is associated with violence is essential, and you expressed this well in your article. However, it is not necessary to make a distinction between neurodevelopmental disorders and mental illnesses based on apparent time of symptom onset to make this point. It is likely that advances in genetics and neuroscience will continue to break down the mind-brain dichotomy and blur the boundaries of diagnostic classifications. Ultimately, it is important that we continue to promote scientific research and access to effective treatment for all neurodevelopmental and psychiatric conditions. Gun violence is a complex matter, and your article was much appreciated as it highlighted the importance of delivering both sensitive and accurate information about autism.
Caitlin Reilly, M.A., David Celiberti, Ph.D, BCBA-D, and Scott M. Myers, MD
Association for Science in Autism Treatment
Cappadocia, M. C., Weiss, J. A., & Pepler, D. (2012). Bullying experiences among children and youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(2),
Carter, S. (2009). Bullying of students with Asperger syndrome. Issues in Comprehensive Pediatric Nursing, 32(3), 145-154.
Gazelle, H., & Ladd, G. W. (2003). Anxious solitude and peer exclusion: A diathesis–stress model of internalizing trajectories in childhood. Child Development, 74, 257–278. doi: 10.1111/1467-8624.00534
Keenan, K., Hipwell, A., Feng, X., Rischall, M., Henneberger, A., & Klosterman S. (2010). Lack of assertion, peer victimization, and risk for depression in girls: Testing a diathesis–stress model. Journal of Adolescent Health, 47(5), 526-528.
Miller, D. T., Shen, Y., Weiss, L. A., Korn, J., Anselm, I., Bridgemohan, C., Wu, B. L. (2009). Microdeletion/duplication at 15q13.2q13.3 among individuals with features of autism and other neuropsychiatric disorders. Journal of Medical Genetics, 46, 242-248.
Moreno-De-Luca, D., SGENE Consortium, Mulle, J.G., Simons Simplex Collection Genetics Consortium, Kaminsky, E.B., Sanders, S.J., et al. (2010). Deletion 17q12 is a recurrent copy number variant that confers high risk of autism and schizophrenia. The American Journal of Human Genetics, 87, 618-630.
Rapoport, J. N., Giedd J. N., & Gogtay, N. (2012). Neurodevelopmental model of schizophrenia: Update 2012. Molecular Psychiatry 17, 1228-1238.
Russo, J., Vitaliano P. P., Brewer, D. D., Katon, W., & Becker, J. (1995). Psychiatric disorders in spouse caregivers of care recipients with Alzheimer's disease and matched controls: A diathesis-stress model of psychopathology. Journal of Abnormal Psychology, 104(1), 197-204. doi: 10.1037/0021-843X.104.1.197
Walker, E. F., & Diforio, D. (1997). Schizophrenia: A neural diathesis-stress model. Psychological Review, 104(4), 667-685.