Speaker 1: Today, we're going to be speaking with Dr. Amy Klin, who's director of the Marcus
Autism Center at Emory University School of Medicine and Children's Health Care of Atlanta.
Dr. Klain, thanks for joining me.
I really appreciate your time today.
Speaker 6: It's my pleasure.
Speaker 1: So we're going to talk about autism.
I think maybe a good starting point is what is our understanding today in 2023 of what
autism is?
Because over the decades, there have been discussions, both well-intentioned and sometimes
not, about whether autism is a, quote, mental illness or is it a neurological disease or
what is it?
What is our understanding today of what autism is?
Speaker 6: Autism is a developmental condition, which means that it is visible from a child
from the time that a child is is born.
And it has genetic origins primarily, which basically means that it runs in families.
And if I have a child with autism, for example, one or two in every five younger siblings
would also have autism.
So it is a highly heritable, it's a strongly genetic condition.
I say developmental because it impacts the development of the social brain.
Autism is a condition that impacts the child's ability to to develop relationships, to acquire
speech, language, communication, to be able to navigate the demands of everyday social
life successfully.
And it's something that is considered to be a genetic trait.
And whether or not it becomes a disability, it happens over time.
And it's a very broad spectrum from children who are very significantly affected to individuals
who are much less so from individuals who have intellectual disabilities to individuals
who are much brighter than you or I.
So it's the most common, complex, neurodevelopmental condition.
Speaker 1: So when we think about genetically based and to some degree heritable, it's not
like you said, it's not a guaranteed heritability, but there is this idea that it runs in families.
There's this question of that when autism develops, are we to understand that based
on what you're saying, this is something that is sort of set and fixed in the womb?
Speaker 6: It is not.
It is not.
And that's a really important message to your listeners.
Autism is strongly genetic, but it's very complex with many hundreds and hundreds and
hundreds of of genes already implicated in autism, each one of them conferring a very
low amount of risk.
And so it's a little bit like traits that a child is born with, which means that they
have an attenuated sense of others.
And and this and as a result of that, they accrue hundreds and hundreds, thousands of
thousands of missed opportunities of social learning.
And so the autistic symptoms they emerge in the second year of life as a result of the
divergence in their development from that of their peers in what that and what that
means is that where we to be able to identify the children very early on and provide them
with early treatment and services and supports their outcomes could be optimized.
So it's absolutely not inevitable.
And most importantly, it's now within our reach to be able to optimize their outcomes.
And our ultimate goal really is to change the narrative of autism from one up disability
to one of promise and diversity.
Speaker 1: When we talk about intervention and treatment, what are we talking about?
In other words, what what are what are we say?
What do we mean when we say treatment of autism?
Speaker 6: A treatment for autism would mean different things at different stages of a
person's life.
And depending on the level of disability of an individual child, adolescent or adult.
But in regards to early treatment and services, meaning for children who are infants and toddlers,
it goes back to the fact that what moves a brain development forward early on is the
mutually reinforcing choreography between infant and caregiver.
Is that dance this back and.
Fourth.
That is that the basis of the child's ability to speak, to acquire language and to communicate
with others.
And so all of the treatments that are available to us early in people's lives have to do with
strengthening that connection between infants and caregivers and ensuring that this back
and forth moves forward so that they can acquire all of the skills that they need to to communicate
with others and develop relationships.
Therefore, a lot of those treatments are caregiver mediated, meaning we train parents to engineer
that connection so that they can do that in the home or in every different or in every
possible setting so that they can have a role in advancing their own child's growth.
Speaker 1: Let's talk about prevalence.
Prevalence is cited in many different contexts, including some we'll talk about a little bit
later when it comes to phenomena in society.
We'll get back to that.
But when we talk about prevalence, how does prevalence today compare to our understanding
of the prevalence of autism at times past?
Do we have a better understanding?
So now we have changed the threshold for diagnosis, or are there genuinely more autistic people
being born today than in times past?
Help us understand that a little bit.
Speaker 6: Sure.
And you're absolutely right.
Right.
Prevalence has been rising for for for many years.
When I was in training, we used to say that there was one person in autism for every 2005
hundred individuals.
And nowadays, according to this, the Centers for Disease Control and Prevention, that is
one in 36.
That's an enormous increase.
We say, for example, now that in this country, 95,000 children will be born in the U.S. every
year who will have autism.
And if we went by the prevalence of, say, 40 years past, it would be only about 2400.
And that's not even the number in one of the 50 states.
So absolutely, prevalence has been rising.
And what the science has shown is several things.
Number one, we're finally getting things right, meaning that the number of individuals with
autism that we find in a community depends on how we go about trying to find them.
Yeah.
And so there was a time in which we waited in our clinics to count the individuals who
walked through our doors.
The CDC has changed those those kinds of methodologies.
And what we have seen is a much more comprehensive survey of the population.
And those studies happen every two years.
And what we have seen is that the prevalence has been rising every two years.
And every time we got a little bit better in reaching a particular community, because
in the past, minorities, low income families and rural families were not truly represented
in the population that we survey.
In order to get a sense of how many individuals have autism out there.
So that's one of the factors.
Speaker 1: So one factor is we are better at serving the whole population.
The second part is do you, as a top person in this field, believe that there is actually
a higher prevalence among the population separate from our ability to measure it?
Speaker 6: A very important factor is the one that you alluded before.
Our understanding of autism has changed dramatically in the past 30 years or so.
So the definition of autism or what we recognize autism is much broader than what we used to
think.
The on and of course the moment that you Braga that the definition you will going to find
more people.
There is no there is no question about that.
But I have to tell you, there is a difference in terms between prevalence and incidence.
Mm hmm.
And you mentioned, do you believe that there are more children being born with autism now
than before?
The answer is very likely no, because incidence means the truth about a condition in the community.
Right.
What we have seen is that that might not be the case.
And what is the case is the children or the individuals that we are able to ascertain
and find and document their autism.
And I'll just give you a brief example for you.
A few years ago, there was a dramatic increase in the prevalence of autism, and in one community
in particular, the Latino community.
The prevalence has risen by over 110%.
So it did not mean that all of a sudden there are more children from Latino communities
being born advocates.
And what it really meant is that we're finally knocking on their doors and now counting them,
too.
Speaker 1: When it comes to some of the controversies as to autism's cause.
No doubt you're aware that there is a conversation that has been going on for 15 years about
vaccines.
BPA lining in food cans has been discussed.
Why FI signals our diets, lack of exercise, the wrong exercise, video games.
You know, I mean, I don't have to give you the full list.
Some of these are more commonly discussed than others very generally.
Do we have any sense about causal or lifestyle factors right now as they relate to autism?
Speaker 6: I understand why when a condition is poorly understood.
There are plenty of theories, but if your listeners include parents and I hope they
are listening to us, this these various different theories have proven have been proven over
and over and over to be wrong.
So, for example, vaccines don't cause autism.
Vaccines save lives.
Other environmental factors that have been studied have not been shown to be causal of
autism.
So it's very important for people to understand that autism is not a disease.
Autism is not like cancer.
You asked me beforehand if if autism was inevitable and I was telling you.
No, it's not inevitable.
What does that mean?
It means that it is a trait.
Children are born with an attenuated sense of the people, and because they fail to engage
others in this back and forth we call social interaction.
They end up developing the symptoms called autism.
And there are many ways in which this dance between infants and caregivers can be disrupted.
The most important one in autism is this genetic trait.
We talked about this autism being highly heritable and strongly genetic.
That is the the most well substantiated cause of autism.
But you can also develop autism if you disrupt infant caregiver interaction through things
such as, for example, prematurity, or if a child goes through, say, repeated surgical
interventions, if the child is born with congenital heart disease, are 8 to 12% of very low gestational
age, children develop autism, as do children with congenital heart disease.
It's basically if you disrupt that, either because you have a neurological insult or
because you have a genetic trait like what autism is.
You can end up showing the symptoms of autism, but there is no substantiation of any environmental
factor whatsoever to date.
Having said that, among low income families, the fact that there are what we call social
determinants of health, that basically puts families at a disadvantage because there is
trauma or because of poverty or because there is a very, let's say, impoverished linguistic
environment in the home.
Well, those factors can aggravate autism, but they don't cause autism.
Speaker 1: I know we only have a few minutes left, but there were a couple of other things
I wanted to ask about.
As you said, if the term cure may not be an appropriate term because, as you say, autism
is not a disease in the way that cancer is a disease.
Given what we know about the likely genetic basis, do you think that as we move forward
with gene therapies, that gene therapies may come into play a role when it comes to autism
in some way?
Speaker 6: Unlike other genetic disorders that are caused by a single gene or a small
number of genes, autism, the genetic basis of autism includes hundreds.
And probably by the time we finish discovering all of the genes that are implicated in autism,
there will be over a thousand.
It's very, very unlikely that a genetic therapy is going to make, let's say, a contribution
to add to individuals who have autism.
Quality of life.
It is much more likely and much more pressing and much more imminent that we as a society
are going to identify children earlier and provide treatments that are already available
to us as the ones that we discussed before.
And the notion here, just as you said, it's not to cure autism, is not to eradicate that
trait, is to ensure that children with that trait have the very best possible outcome
they can have.
And the fact is that the majority of individuals with autism do not have intellectual disability
and they are making extraordinary contributions to society every day.
What we want is that all children have an opportunity to make that contribution and
to live fulfilling lives.
Speaker 1: We've been speaking with Dr. Amy Klin, who is director of the Marcus Autism
Center at Emory University School of Medicine.
I really appreciate your time and insights today.
Thank you.
Speaker 6: It's my pleasure.
Thank you.