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Is Asperger Syndrome nature or nurture?

Arran

I was recently discussing ASD with an Indian medical doctor who has lived and worked in the US. He is (like myself) an old believer that AS is a sufficiently distinctive condition for the purpose of diagnosis and the provision of services. As he is a medical doctor he uses ICD rather than DSM for diagnoses.

He is intrigued at the (almost exponential?!) rise in the number of children with AS in India since the mid 1990s, and he thinks that it is far too great and too rapid to be explained by genetics alone, but is instead the result of changes in the upbringing and lifestyle of children. India is a country that has changed almost beyond recognition in the last 25 years. So has the lifestyle of children.

He does not believe that the rise in the number of children with AS is the result of greater awareness and diagnosis. Indian culture 25 years ago was one that favoured extroversion and a gregarious lifestyle, along with quite sophisticated unwritten rules and non-verbal communication, so that any kid with AS (diagnosed or undiagnosed) 25 years ago would have stood out like a sore thumb and looked upon as being weird. Around 25 years ago you would probably find no more than one or two 'weird kids' with AS in a medium sized town. Now it's not uncommon to find at least one 'weird kid' with AS in every class in every school.

Over in the US he is equally intrigued about why AS is very rare amongst African Americans although it is encountered amongst children from other non-white races. Again, he doesn't think there is a lack of diagnosis amongst African Americans, because like with Indians 25 years ago, African Americans have a culture where any kid with AS will stand out like a sore thumb and be looked upon as being weird. However, traditional or Kanner type autism with speech and language delay is probably just as common amongst African Americans as it is amongst white Americans. As a sideline, people from more recent immigrant groups in the US – such as Indian Subcontinent, Chinese, Middle Eastern, and even black Africans – often find African Americans, and their culture and lifestyle, bewildering. They also tend not to get on well with each other due to a clash of culture and aspirations

He is wondering whether the rarity of AS both in India 25 years ago and amongst African Americans today is a result of a laid back and gregarious lifestyle, where children are not pushed into academics and encouraged to socialise and play. Indian parents both in India and the US want clever children who go into technical and professional careers, so they push them hard with Academics. In contrast, African American parents tend to push their children with sports and music, and deter them from excelling in academic subjects. Even black African parents in the US tend to push their children down an academic or business pathway.

It is crushingly unfashionable to dare to think that ANY type of ASD is a result of parental upbringing, but from his observations both in India and the US he can't help wondering whether AS really is nurture rather than nature. Something else he has noticed is that the eldest boy in the family is more likely to have AS than any of his other siblings.

Parents

  • Usually I'd be writing a huge spiel on this but my guess is nature exacerbated to some degree by nurture (genes and environment thrash it out together and the resulting cocktail of life experience bubbles over after a combination of risk factors fizzle with varying degrees over time). I wonder how much of the impact of my quirks would have been mediated had my upbringing been different. 

    As for increasing prevalence it's not a phenomenon specific to India - and is a question that's been pinged at various times over the last couple of decades.

    Suggestions, as you've mentioned, have included:

    Change in diagnostic criteria and/or over-diagnosis 

    Environmental factors (the paper I read linked this to birth trauma - premature and/or low weight birth babies)

    Change in research methodologies in estimating prevalence

    Cultural awareness and recognition

    There's a paper here https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4520794/ which explores some of the options - I'd imagine access to and willingness to engage with diagnostic services is another as an explanatory factor as why prevalence varies across cultures. 

    It's a really interesting question though- I'd happily dig through more of the research if I'd the time - to weigh up some of his observations.  

  • in reply to Ethan
    Ethan said:
    As for increasing prevalence it's not a phenomenon specific to India - and is a question that's been pinged at various times over the last couple of decades.

    Take into account that India has changed, along wth the lifestyle of its children, more than any nation in western Europe or North America.

    India in 1995

    Families were larger – 4 to 6 children were common.

    People didn't move around very much. It was the norm to live in the same community where your parents, and grandparents lived, along with the parents and grandparents of your classmates at school.

    Extended families tended to live in the same community. It was quite common for children to have no relatives living elsewhere in India even if they had relatives living abroad.

    A significantly higher proportion of the population lived in villages in rural areas than today.

    Children grew up in neighbourhoods where the vast majority of the children were local.

    Society was more laid back. Parents tended not to push their children hard with academics but instead just wanted them to go with the flow at school.

    School was less academic than it is today. Children with tutors at home were perceived to be slow learners and behind academically.

    Parents didn't push their children hard into careers. They were happier for them to have a basic job.

    Children used to play out and engage in sports and social activities regularly. Parents encouraged them to do so.

    Televisions were ubiquitous but digital devices were rare. If children wanted to play a video game then they would use a public arcade machine – and meet other children in the process.

    India today

    Families are smaller (more so in urban areas) – 2 or 3 children are common.

    Millions of people have moved hundreds of miles from where they were born, and started new lives in new places.

    Longstanding communities and extended families in towns and villages have been broken up by people moving here there and everywhere.

    The population has become much more urban as people move from villages to cities in pursuit of careers.

    Children now grow up in neighbourhoods and attend schools with lots children who are complete strangers.

    Society has become career driven whereas in the past parents were happy for their children to have a basic job.

    Parents obsess over grades and qualifications, so push their children to excel in academics whilst social activities and having fun are sidelined.

    Children with tutors at home have them in order to achieve the best grades so they can go to the top universities.

    STEM subjects are most highly regarded by employers, so parents emphasise excellence in them over humanities.

    Children don't play out and engage in sports and social activities anywhere as much as they used to, and more often than not their leisure time involves being glued to digital devices at home for long periods.

    Has there even been much official research into ASD in India?

  • in reply to Arran

    There's quite a few papers, The (undated!) reference I found was about 160 articles (National Centre for Autism India) http://www.autism-india.org/research.php which also has a brief history of how the condition has been recognised and studied http://www.autism-india.org/history-autism-india.php

    Reading University looked at the prevalence of autism in India in 2017. https://www.reading.ac.uk/news-archive/press-releases/pr727389.html I've only skim read it so I don't t think it fully addresses your question of increase in diagnosed cases.

    One I found really interesting was one in 2017 suggesting a low prevalence of autism in schools https://www.spectrumnews.org/news/school-survey-india-reveals-low-autism-prevalence/ but linked this with the possibility that around 20% of children do not attend school (Unicef puts this at 30%) - those who do not attend are the most marginalised - my guess is that children with autism would fall into this group.

    Reading your observations the suggestion is that autism is triggered by socio-cultural factors over biological/genetic ones. From my (very brief) wander in the literature socio-cultural factors have been studied in the context of diagnostics and adaptive behaviour (ability to adjust to the environment). 

    The challenge is that autism is diagnosed through a behavioural observations -so there's no physiological test in diagnosis. However there are researchers out there pushing to understand the interaction in gene-environment interactions https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3513682/ 

    There' was a large study examining the causation of autism across 5 countries in 2019, didn't include India sadly, but it may still be of interest, and suggested 80% of autism traits were due to heritage https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2737582?resultClick=1 although again the authors note "The contributions of gene-environment interactions or correlations between genes and environment to ASD risk are important unanswered questions". 

    I think you have a point in social/cultural factors - although personally I would hesitate to attribute these as explanatory ones over genetics. Based on the quick look I had at the research I think there's interplay at work between genetics and environment but the what and how still needs to be understood.

    Speaking anecdotally I wonder how much of my experience is down to environmental factors - I have those occasions where I'm wary of diagnosis based on behavioural observation or self-report (I think I naturally have a preference to objective physical measures). My father was undiagnosed autistic and I wasn't raised in the most social or supportive of environments so a lot of my strategies for everyday living were maladaptive. But then did that exacerbate my autistic traits or cause them? I'm leaning towards the former. Biographical material, and I appreciate the limitations of these, from Temple Grandin and Sean Barron indicate how expressions of their traits were curtailed with parental support but they also recognise that they still process and interpret information, especially in the social-relational sphere, very differently from other people. 

    I'd love a clear cut answer - but then I also read Michael Blastland's excellent book "The Hidden Half". He's not a scientist - he's a journalist. His point was that when science begins to think it understands things there's a whole load of hidden factors which can introduce variation and put the kybosh on received wisdom from research.

    It's an excellent question though- thank you for posing it Grinning

  • in reply to Mark (NicheMarket)

    The mind's of young children are shaped by the environment that they grow up in, and this shaping extends to conventions, social norms, and expectations of society.

    It's something to do with the pattern of how the neurons interconnect.

    Therefore if children are pushed too hard academically at a young age at the expense of social development, then the neurons will interconnect in a particular way. Conversely, if children are subject to more social development at a young age at the expense of academic development, then the neurons will interconnect in a different way.

Reply
  • in reply to Mark (NicheMarket)

    The mind's of young children are shaped by the environment that they grow up in, and this shaping extends to conventions, social norms, and expectations of society.

    It's something to do with the pattern of how the neurons interconnect.

    Therefore if children are pushed too hard academically at a young age at the expense of social development, then the neurons will interconnect in a particular way. Conversely, if children are subject to more social development at a young age at the expense of academic development, then the neurons will interconnect in a different way.

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