Why Are Autism Rates Steadily Rising?
Stefania Sterling was just 21 when she had her son, Charlie. She was young and healthy, with no genetic issues apparent in either her or her husband's family, so she expected Charlie to be typical.
"It is surprising that the prevalence of a significant disorder like autism has risen so consistently over a relatively brief period."
It wasn't until she went to a Mommy and Me music class when he was one, and she saw all the other one-year-olds walking, that she realized how different her son was. He could barely crawl, didn't speak, and made no eye contact. By the time he was three, he was diagnosed as being on the lower functioning end of the autism spectrum.
She isn't sure why it happened – and researchers, too, are still trying to understand the basis of the complex condition. Studies suggest that genes can act together with influences from the environment to affect development in ways that lead to Autism Spectrum Disorder (ASD). But rates of ASD are rising dramatically, making the need to figure out why it's happening all the more urgent.
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Indeed, the CDC's latest autism report, released last week, which uses 2016 data, found that the prevalence of ASD in four-year-old children was one in 64 children, or 15.6 affected children per 1,000. That's more than the 14.1 rate they found in 2014, for the 11 states included in the study. New Jersey, as in years past, was the highest, with 25.3 per 1,000, compared to Missouri, which had just 8.8 per 1,000.
The rate for eight-year-olds had risen as well. Researchers found the ASD prevalence nationwide was 18.5 per 1,000, or one in 54, about 10 percent higher than the 16.8 rate found in 2014. New Jersey, again, was the highest, at one in 32 kids, compared to Colorado, which had the lowest rate, at one in 76 kids. For New Jersey, that's a 175 percent rise from the baseline number taken in 2000, when the state had just one in 101 kids.
"It is surprising that the prevalence of a significant disorder like autism has risen so consistently over a relatively brief period," said Walter Zahorodny, an associate professor of pediatrics at Rutgers New Jersey Medical School, who was involved in collecting the data.
The study echoed the findings of a surprising 2011 study in South Korea that found 1 in every 38 students had ASD. That was the the first comprehensive study of autism prevalence using a total population sample: A team of investigators from the U.S., South Korea, and Canada looked at 55,000 children ages 7 to 12 living in a community in South Korea and found that 2.64 percent of them had some level of autism.
Searching for Answers
Scientists can't put their finger on why rates are rising. Some say it's better diagnosis. That is, it's not that more people have autism. It's that we're better at detecting it. Others attribute it to changes in the diagnostic criteria. Specifically, the May 2013 update of the Diagnostic and Statistical Manual of Mental Disorders-5 -- the standard classification of mental disorders -- removed the communication deficit from the autism definition, which made more children fall under that category. Cynical observers believe physicians and therapists are handing out the diagnosis more freely to allow access to services available only to children with autism, but that are also effective for other children.
Alycia Halladay, chief science officer for the Autism Science Foundation in New York, said she wishes there were just one answer, but there's not. While she believes the rising ASD numbers are due in part to factors like better diagnosis and a change in the definition, she does not believe that accounts for the entire rise in prevalence. As for the high numbers in New Jersey, she said the state has always had a higher prevalence of autism compared to other states. It is also one of the few states that does a good job at recording cases of autism in its educational records, meaning that children in New Jersey are more likely to be counted compared to kids in other states.
"Not every state is as good as New Jersey," she said. "That accounts for some of the difference compared to elsewhere, but we don't know if it's all of the difference in prevalence, or most of it, or what."
"What we do know is that vaccinations do not cause autism."
There is simply no defined proven reason for these increases, said Scott Badesch, outgoing president and CEO of the Autism Society of America.
"There are suggestions that it is based on better diagnosis, but there are also suggestions that the incidence of autism is in fact increasing due to reasons that have yet been determined," he said, adding, "What we do know is that vaccinations do not cause autism."
Zahorodny, the pediatrics professor, believes something is going on beyond better detection or evolving definitions.
"Changes in awareness and shifts in how children are identified or diagnosed are relevant, but they only take you so far in accounting for an increase of this magnitude," he said. "We don't know what is driving the surge in autism recorded by the ADDM Network and others."
He suggested that the increase in prevalence could be due to non-genetic environmental triggers or risk factors we do not yet know about, citing possibilities including parental age, prematurity, low birth rate, multiplicity, breech presentation, or C-section delivery. It may not be one, but rather several factors combined, he said.
"Increases in ASD prevalence have affected the whole population, so the triggers or risks must be very widely dispersed across all strata," he added.
There are studies that find new risk factors for ASD almost on a daily basis, said Idan Menashe, assistant professor in the Department of Health at Ben-Gurion University of the Negev, the fastest growing research university in Israel.
"There are plenty of studies that find new genetic variants (and new genes)," he said. In addition, various prenatal and perinatal risk factors are associated with a risk of ASD. He cited a study his university conducted last year on the relationship between C-section births and ASD, which found that exposure to general anesthesia may explain the association.
Whatever the cause, health practitioners are seeing the consequences in real time.
"People say rates are higher because of the changes in the diagnostic criteria," said Dr. Roseann Capanna-Hodge, a psychologist in Ridgefield, CT. "And they say it's easier for children to get identified. I say that's not the truth and that I've been doing this for 30 years, and that even 10 years ago, I did not see the level of autism that I do see today."
Sure, we're better at detecting autism, she added, but the detection improvements have largely occurred at the low- to mid- level part of the spectrum. The higher rates of autism are occurring at the more severe end, in her experience.
A Polarizing Theory
Among the more controversial risk factors scientists are exploring is the role environmental toxins may play in the development of autism. Some scientists, doctors and mental health experts suspect that toxins like heavy metals, pesticides, chemicals, or pollution may interrupt the way genes are expressed or the way endocrine systems function, manifesting in symptoms of autism. But others firmly resist such claims, at least until more evidence comes forth. To date, studies have been mixed and many have been more associative than causative.
"Today, scientists are still trying to figure out whether there are other environmental changes that can explain this rise, but studies of this question didn't provide any conclusive answer," said Menashe, who also serves as the scientific director of the National Autism Research Center at BGU.
"It's not everything that makes Charlie. He's just like any other kid."
That inconclusiveness has not dissuaded some doctors from taking the perspective that toxins do play a role. "Autism rates are rising because there is a mismatch between our genes and our environment," said Julia Getzelman, a pediatrician in San Francisco. "The majority of our evolution didn't include the kinds of toxic hits we are experiencing. The planet has changed drastically in just the last 75 years –- it has become more and more polluted with tens of thousands of unregulated chemicals being used by industry that are having effects on our most vulnerable."
She cites BPA, an industrial chemical that has been used since the 1960s to make certain plastics and resins. A large body of research, she says, has shown its impact on human health and the endocrine system. BPA binds to our own hormone receptors, so it may negatively impact the thyroid and brain. A study in 2015 was the first to identify a link between BPA and some children with autism, but the relationship was associative, not causative. Meanwhile, the Food and Drug Administration maintains that BPA is safe at the current levels occurring in food, based on its ongoing review of the available scientific evidence.
Michael Mooney, President of St. Louis-based Delta Genesis, a non-profit organization that treats children struggling with neurodevelopmental delays like autism, suspects a strong role for epigenetics, which refers to changes in how genes are expressed as a result of environmental influences, lifestyle behaviors, age, or disease states.
He believes some children are genetically predisposed to the disorder, and some unknown influence or combination of influences pushes them over the edge, triggering epigenetic changes that result in symptoms of autism.
For Stefania Sterling, it doesn't really matter how or why she had an autistic child. That's only one part of Charlie.
"It's not everything that makes Charlie," she said. "He's just like any other kid. He comes with happy moments. He comes with sad moments. Just like my other three kids."
Surfing for Science: A Fin Sensor Is Making Waves
For David Walden, a Southern Californian, surfing is a lifestyle, not a hobby. The 38-year-old works nights at a seafood restaurant to leave his mornings free for surfing.
While the surfers are doing what they love, they are also collecting information that is helping scientists better understand the ocean.
"Once you fall in love with the ocean, you need it like a daily cleanse or refresher," he says. "The positive mental and physical effects of the ocean, the endorphins and dopamine, keep you addicted in a good way."
Given his dedication to surfing, Walden was delighted when he became one of more than 200 surfers last year to test Smartfin, a 5-1/2-inch surfboard fin that contains a circuit board, a rechargeable battery, a GPS device, a sensor that captures temperature to one-hundredth of a degree, and a motion sensor that tracks the movement of the waves. While Walden and his fellow surfers are doing what they love, they are also collecting information that is helping scientists better understand the health of the near-shore ocean and how its chemistry is shifting due to climate change.
"I'm excited to be a part of it," Walden says. "I like to tell people I surf for science."
Back on shore, the surfers download the Smartfin data via a smartphone app so they can be accessed by scientists and other interested parties. (You can see where Smartfin surfers go at this interactive map.)
By putting sensors directly onto surfboards, oceanographers can collect data to help them better understand the global-warming related changes occurring in coastal oceans in temperature, salinity, and pH, all properties that have huge implications for the species that live in near-shore ecosystems.
There is much unknown about coastal waters because it's so difficult to obtain meaningful measurements. Traditional methods to monitor the close shore, such as bottle samples and buoys, are time consuming and expensive and tend to get damaged by the surf.
The Smartfin is the brainchild of Dr. Andy Stern, a retired neurologist. He and his brother-in-law, sculptor and filmmaker Todd McGrain, run The Lost Bird Project, a nonprofit devoted to raising awareness about climate change and other environmental issues. Stern brought his super fin idea to engineer Benjamin Thompson, who spent several years creating a prototype in his garage workshop. Smartfin was further developed by scientists at the Scripps Institution of Oceanography at the University of California at San Diego.
"The big challenge was to make a sensor small enough to fit in the fin but still produce good measurements," says Andreas Andersson, an associate professor of geoscience research at Scripps.
The Surfrider Foundation, a surfer-led nonprofit environmental organization, came aboard two years ago to distribute the Smartfin to its San Diego members.
Smartfin has also made a splash with scientists at the University of the Sunshine Coast in Queensland on the eastern coast of Australia. They are using the fin's temperature sensor to better understand how climate change is affecting the movement and distribution of marine life. And at the Plymouth Marine Laboratory in Plymouth, United Kingdom, the Smartfin's precise temperature readings of the near-shore ocean's surface are being used to improve the accuracy of satellites that monitor the ocean from hundreds of miles away.
"It's hard to talk about climate change in a way that's not boring or gloomy, but there's nothing gloomy or depressing about surfers and Smartfin."
"The hope is that Smartfin will improve the satellite measurements, which could improve the retrieval of temperature data around the world," says Dr. Phil Bresnahan, Smartfin's lead engineer at Scripps. In the future, the fin will include sensors to measure pH, chlorophyll (algae), dissolved oxygen, and turbidity (water clarity).
Stern envisions a time when thousands of surfers, paddle boarders, and other water enthusiasts worldwide will have Smartfins and be downloading data for scientists and environmentalists. Right now, there are approximately 70 surfers in the San Diego area using Smartfin and an additional 30 globally.
Scientists have plenty of evidence that global warming is largely caused by humans. Now they are trying to figure out what the long-term effects of climate change may be. For example, scientists are trying to predict which sections of coral reef, which house 25 percent of marine species, are most vulnerable so interventions can be developed to save them. Because of its small size, Smartfin is ideal to measure temperature changes in coral reefs.
Smartfin was also intended to be an educational tool. "It's a great way to start a different conversation about climate change," says Stern. "It's hard to talk about climate change in a way that's not boring or gloomy, but there's nothing gloomy or depressing about surfers and Smartfin. People want to hear more."
Turning surfers into citizen scientists makes perfect sense, says David Pasquini, 35, a longtime surfer who works for the British Consulate General's office in Oceanside, Calif. "Anyone who spends a lot of time in the ocean is aware of the changes happening in the ecosystem, the climate," says Pasquini. "Everyone asks, 'What can I do?'" Surfing with Smartfin, Pasquini feels like he is giving back.
"I know the data will be analyzed and eventually used to make a policy that helps with climate change. That's a great feeling--just by surfing, doing something you love, you're contributing."
Would you leave your small child in the care of a robot for several hours a day? It may sound laughable at first, but think carefully.
"Given the huge amounts of money we pay for childcare, a [robot caregiver] is a very attractive proposition."
Robots that can care for children would be a godsend to many parents, especially the financially strapped. In the U.S., 62 percent of women who gave birth in 2016 worked outside the home, and day care costs are often exorbitant. In California, for instance, the annual cost for day care for a single child averages over $22,000. The price is lower in some states, but it still accounts for a hefty chunk of the typical family's budget.
"We're talking about the Holy Grail of parenting," says Zoltan Istvan, a technology consultant and futurist. "Imagine a robot that could assume 70 percent to 80 percent of the caregiver's role for your child. Given the huge amounts of money we pay for childcare, that's a very attractive proposition."
Both China and Japan are on the leading edge of employing specially designed social robots for the care of children. Due to long work schedules, shifting demographics and China's long-term (but now defunct) one-child policy, both countries have a severe shortage of family caregivers. Enter the iPal, a child-sized humanoid robot with a round head, expressive face and articulated fingers, which can keep children engaged and entertained for hours on end. According to its manufacturer, AvatarMind Robot Technology, iPal is already selling like hotcakes in Asia and is expected to be available in the U.S. within the next year. The standard version of iPal sells for $2,499, and it's not the only robot claimed to be suitable for childcare. Other robots being fine-tuned are Softbank's humanoid models Pepper and NAO, which are also considered to be child-friendly social robots.
iPal talks, dances, plays games, reads stories and plugs into social media and the internet. According to AvatarMind, over time iPal learns your child's likes and dislikes, and can independently learn more about subjects your child is interested in to boost learning. In addition, it will wake your child up in the morning and tell him when it's time to get dressed, brush his teeth or wash his hands. If your child is a diabetic, it will remind her when it's time to check her blood sugar. But iPal isn't just a fancy appliance that mechanically performs these functions; it does so with "personality."
iPal robot interacting with a boy.
The robot has an "emotion management system" that detects your child's emotions and mirrors them (unless your child is sad, and then it tries to cheer him up). But it's not exactly like iPal has the kind of emotion chip long sought by Star Trek's android Data. What it does is emotional simulation--what some would call emotional dishonesty--considering that it doesn't actually feel anything. But research has shown that the lack of authenticity doesn't really matter when it comes to the human response to feigned emotion.
Children, and even adults, tend to respond to "emotional" robots as though they're alive and sentient even when we've seen all the wires and circuit boards that underlie their wizardry. In fact, we're hardwired to respond to them as though they are human beings in a real relationship with us.
The question is whether the relationships we develop with robots causes social maladaptation, especially among the most vulnerable among us—young children just learning how to connect and interact with others. Could a robot in fact come close to providing the authentic back-and-forth that helps children develop empathy, reciprocity, and self-esteem? Also, could steady engagement with a robot nanny diminish precious time needed for real family bonding?
It depends on whom you ask.
Because iPal is voice-activated, it frees children to learn by interacting in a way that's more natural than interacting with traditional toys, says Dr. Daniel Xiong, Co-founder and Chief Technology Officer at AvatarMind. "iPal is like a "real" family member with you whenever you need it," he says.
Xiong doesn't put a time limit on how long a child should interact with iPal on a daily basis. He sees the relationship between the child and the robot as healthy, though he admits that the technology needs to advance substantially before iPal could take the place of a human babysitter.
It's no coincidence that many toymakers and manufacturers are designing cute robots that look and behave like real children or animals, says Sherry Turkle, a Professor of Social Studies and Science at MIT. "When they make eye contact and gesture toward us, they predispose us to view them as thinking and caring," she has written in The Washington Post. "They are designed to be cute, to provide a nurturing response" from the child. "And when it comes to sociable AI, nurturance is the killer app: We nurture what we love, and we love what we nurture."
What are we saying to children about their importance to us when we're willing to outsource their care to a robot?
The problem is that we get lulled into thinking that we're in an actual relationship, when a robot can't possibly love us back. If adults have these vulnerabilities, what might such lopsided relationships do to the emotional development of a small child? Turkle notes that while we tend to ascribe a mind and emotions to a socially interactive robot, "Simulated thinking may be thinking, but simulated feeling is never feeling, and simulated love is never love."
Still, is active, playful engagement with a robot for a few hours a day any more harmful than several hours in front of a TV or with an iPad? Some, like Xiong, regard interacting with a robot as better than mere passive entertainment. iPal's manufacturers say that their robot can't replace parents or teachers and is best used by three- to eight-year-olds after school, while they wait for their parents to get off of work. But as robots become ever more sophisticated, they're expected to become more and more captivating, and to perform more of the tasks of day-to-day care.
Some studies, performed by Turkle and fellow MIT colleague Cynthia Breazeal, have revealed a darker side to child-robot interaction. Turkle has reported extensively on these studies in The Washington Post and in her 2011 book, Alone Together: Why We Expect More from Technology and Less from Each Other. Most children love robots, but some act out their inner bully on the hapless machines, hitting and kicking them and otherwise trying to hurt them. The trouble is that the robot can't fight back, teaching children that they can bully and abuse without consequences. Such harmful behavior could carry over into the child's human relationships.
And it turns out that communicative machines don't actually teach kids good communication skills. It's well known that parent-child communication in the first three years of life sets the stage for a child's intellectual and academic success. Verbal back-and-forth with parents and caregivers is like food for a child's growing brain. One article published in JAMA Pediatrics showed that babies who played with electronic toys—like the popular robot dog AIBO—show a decrease in both the quantity and quality of their language skills.
Anna V. Sosa of the Child Speech and Language Lab at Northern Arizona University studied 26 ten- to 16-month-old infants to compare the growth of their language skills after they played with three types of toys: Electronic toys like a baby laptop and talking farm; traditional toys like wooden puzzles and building blocks; and books read aloud by their parents.
The play that produced the most growth in verbal ability was having books read to them, followed by play with traditional toys. Language gains after playing with electronic toys came dead last. This form of play involved the least use of adult words, the least conversational turn-taking with parents, and the least verbalizations from the children. While the study sample was small, it's not hard to extrapolate that no electronic toy or even more abled robot could supply the intimate responsiveness of a parent reading stories to a child, explaining new words, answering the child's questions, and modeling the kind of back-and-forth interaction that promotes empathy and reciprocity in human relationships.
Most experts acknowledge that robots can be valuable educational tools, but they can't make a child feel truly loved, validated, and valued.
Research suggests that the main problem of leaving children in the care of robots on a regular basis is the risk of their stunted, unhealthy emotional development. In Alone Together, Turkle asks: What are we saying to children about their importance to us when we're willing to outsource their care to a robot? A child might be superficially entertained by the robot while her self-esteem is systematically undermined.
Two of the most vocal critics of robot nannies are researchers at the University of Sheffield in the U.K., Noel and Amanda Sharkey. In an article published in the journal Interaction Studies, they claim that the overuse of childcare robots could have serious consequences for the psychological and emotional wellbeing of children.
They acknowledge that limited use of robots can have positive effects like keeping a child safe from physical harm, allowing remote monitoring and supervision by parents, keeping a child entertained, and stimulating an interest in science and engineering. But the Sharkeys see the overuse of robots as a source of emotional alienation between parents and children. Just regularly plopping a child down with a robot for hours of interaction could be a form of neglect that panders to busy parents at the cost of a child's emotional development.
Robots, the Sharkeys argue, prey upon a child's natural tendency to anthropomorphize, which sucks them into a pseudo-relationship with a machine that can never return their affection. This can be seen as a form of emotional exploitation—a machine that promises connection but can never truly deliver. Furthermore, as robots develop more intimate skills such as bathing, feeding and changing diapers, children will lose out on some of the most fundamental and precious bonding activities with their parents.
Critics say that children's natural ability to bond is prime territory for exploitation by toy and robot manufacturers, who ultimately have a commercial agenda. The Sharkeys noted one study in which a state-of-the-art robot was employed in a daycare center. The ten- to 20-month-old children bonded more deeply with the robot than with a teddy bear. It's not hard to see that starting the robot-bonding process early in life is good for robot business, as babies and toddlers graduate to increasingly sophisticated machines.
"It is possible that exclusive or near exclusive care of a child by a robot could result in cognitive and linguistic impairments," say the Sharkeys. They cite the danger of a child developing what is called in psychology a pathological attachment disorder. Attachment disorders occur when parents are unpredictable or neglectful in their emotional responsiveness. The resulting shaky bond interferes with a child's ability to feel trust, pleasure, safety, and comfort in the presence of the parent. Unhealthy patterns of attachment include "insecure attachment," a form of anxiety that arises when a child cannot trust his caregiver with meeting his emotional needs. Children with attachment disorders may anxiously avoid attachments and may not be able to experience empathy, the cornerstone of relationships. Such patterns can follow a child throughout life and infect every other relationship they have.
An example of the inadequacy of robot nannies rests on the pre-programmed emotional responses they have in their repertoires. They're designed to detect and mirror a child's emotions and do things like play a child's favorite song when he's crying or in distress. But such a response could be the height of insensitivity. It discounts and belittles what may be a child's authentic response to an upsetting turn of events, like a scraped knee from a fall. A robot playing a catchy jingle is a far cry from having Mom clean and dress the wound, and perhaps more importantly, kiss it and make it better.
Most experts acknowledge that robots can be valuable educational tools. But they can't make a child feel truly loved, validated, and valued. That's the job of parents, and when parents abdicate this responsibility, it's not only the child that misses out on one of life's most profound experiences.
So consider buying a robot to entertain and educate your little one—just make sure you're close by for the true bonding opportunities that arrive so fast and last so fleetingly in the life of a child.