Tuesday, 6 September 2016

"The maternal body as environment in autism science"

Although I'm not really one for deep philosophical discussions or anything related (unless linked to a specific galaxy far, far away...), I was recently interested to read the paper by Martine Lappé [1] talking about how "complex narratives of autism’s causes and social anxieties surrounding child development have helped situate autism risk in women’s bodies before and during pregnancy."

I'm as guilty as anyone for discussing the pretty constant stream of peer-reviewed research evidence suggesting that what goes on before and during the nine months that made us might have some important bearing on offspring in terms of behaviour and development. The wide range of potential variables laid at mum's pregnancy doorway with autism risk in mind have grown to overwhelming proportions in recent time, as just about every week some factor or another is said to show involvement.

Lappé suggests that such research has turned pregnancy into 'environment' when it comes to discussions about possible autism aetiology and involves "three characteristics: the molecularization of the environment, an individualization of risk, and the internalization of responsibility."  The result being that 'larger questions' have been put to one side, particularly related to the continued medicalisation of the autism label (and various other labels), alongside the idea that within the large heterogeneity of autism, pregnancy factors might not necessarily figure significantly in every single case.

I can kinda see where the author is coming from in this article, particularly how suggestions that factor X or Y during pregnancy might increase offspring autism risk does to some extent mirror the darker days of autism research in terms of 'blame'. Where once popular opinion was that autism was due to parenting issues, so now the suggestion that maternal obesity for example, might somehow increase the risk of offspring autism continues the blame-game and indeed, pushes the 'blame window' further back temporally speaking. Yes, parenting style and obesity are not one and the same thing but the common element they possess is the perception that somehow there is a choice being made; a choice to parent one way or another, to become obese or not. That idea of 'choice' moves some people's minds to the concept of blame, and onwards the blame-game once again gathers momentum. The same logic around choice can similarly hold when it comes to whether pharmaceutic A or B taken during pregnancy might elevate offspring autism risk too...

There is no easy answer to what to do about turning the maternal [pregnancy] body into 'environment' when it comes to the big question: how does autism come about? Generalising the word 'autism' to denote 'all autism' means that we don't know really know how autism comes about or whether anything can be done more generally to modify a person's risk of autism. Accepting that some people don't even wish to see the words 'modify' and 'risk' in the context of autism, I personally see such philosophical discussions in a more plural context as per all that chatter about 'the autisms' and the label(s) not necessarily existing in some sort of diagnostic vacuum (see here).

I for example, look towards the increasingly important idea that for all the different 'types' of autism out there, there may be a similar number of genetic and non-genetic factors playing some role; for some, issues during pregnancy are likely to impact on offspring autism risk more than others. The specific idea that immune function and/or 'inflammation' during critical periods of pregnancy might have offspring outcomes (see here for example) is particularly appealing, given that the whole concept of immune function is moving well outside of the realms of just infection or pathogen identification and control. Accepting also that pregnancy is characterised by a change in maternal immune function (y'know, to accommodate that foreign entity that resides inside mum's body) there is plenty of scope for such tolerance to be affected by one or more agents in quite a few ways.

Ultimately, 'the maternal body as environment in autism science' is probably here to stay. The language however of how we chose to represent and transmit information about pregnancy risk factors and autism perhaps requires some further philosophical discussions...

And speaking of philosophy, a link to a book that I once enjoyed reading.

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[1] Lappé M. The maternal body as environment in autism science. Social Studies of Science. 2016; Aug 19.

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ResearchBlogging.org Lappe, M. (2016). The maternal body as environment in autism science Social Studies of Science DOI: 10.1177/0306312716659372