"If you want to support Greta Thunberg, don’t do it by defending her autism – stand up for her beliefs instead"

The quote titling this post - "If you want to support Greta Thunberg, don’t do it by defending her autism – stand up for her beliefs instead" - comes from a recent newspaper report by James Sinclair on the noble actions of the 16-year old Greta Thunberg, the current poster person for student activism.

Many people will have heard of Greta and her school strike for climate which snowballed into an international movement demanding action on global warming and climate change. She's subsequently been named as "one of the 100 most influential people of 2019" and could even be in the running for a Nobel prize later this year (2019). Not many teenagers can add those sorts of credentials to their CV...

Alongside the important message that Greta has spread, the revelation that she has a diagnosis of autism - Asperger syndrome - has not escaped media and indeed, social media attention. Her autism diagnosis (Asperger syndrome is now pretty much defunct as a clinical diagnosis) has, in many ways, been placed front-and-centre of her story, but not always in the politest of terms.

The Sinclair feature on Greta caught my eye for several different reasons. Diagnosed himself with autism, Sinclair approaches an important part of the Greta Thunberg story: how autism is not necessarily relevant to the important climate change message that is being promulgated. Indeed, some stand-out quotes from his article are worthwhile circulating widely: "This is why many including myself struggle with sharing our diagnosis with people, as once we do everything is viewed through a person’s past experiences and expectations of autism" and "It suggests that autism is still perceived as something we must all scramble to protect at a moment’s notice."

Why is this relevant? Well, potentially for lots of different reasons, some of which have kinda been picked up in a recent paper by Lily Cresswell & Eilidh Cage [1] which was blogging fodder (see here) not so long ago. The message then - albeit a message derived from a small participant number - was that autism is not necessarily the 'identity' that some would like it to be represented as. For example, as reported in the Cresswell/Cage result: "less than half of participants mentioned autism in their identity descriptions", inferring that many young people potentially see themselves and their achievements/struggles as so much more than due to the receipt of a clinical diagnosis. And one can perhaps see that the continual pressure to make autism a part of any successful narrative, whilst noble in intent, seemingly does little for either the individual and their personal accomplishments nor the masses, on the basis of the significant heterogeneity of autism and how autism for some means things like early mortality (see here) and lots and lots more besides. It perhaps should also be noted that depression has also been mentioned by Greta too: "After learning about climate change when she was 8, Greta later developed depression when she was 11, which she links partly to the issue" but this point doesn't seem to have been widely picked up on even bearing in mind that autism / autistic traits and depression have some important links (see here for example).

I appreciate that my ramblings about autism not necessarily being an identity for all nor not always relevant to a person's socio-political messages aren't likely to be received well by everyone. That's fine. I'll end however with comments from Greta herself and her views of autism and other labels "not being a gift." The caveat she makes to that point being that with appropriate adjustments, support and resources, there are things that can make life easier for those on the autism spectrum and beyond. Bearing in mind that is, the need for 'personalisation' of such supports and a move away from any 'one-size-fits-all' philosophy.

And whilst I'm on the topic of Greta Thunberg, it seems as though her autism diagnosis is now being dragged into the 'autism wars' too (see here). Yet another example of her important climate message seemingly being overshadowed...

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[1] Cresswell L. & Cage E. ‘Who Am I?’: An Exploratory Study of the Relationships Between Identity, Acculturation and Mental Health in Autistic Adolescents. J Autism Dev Disord. 2019. April 19.

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Increased rate of offspring autism among migrants

In the eternal search for the various potential factors (yes, there are probably going to be several) to account for the quite staggering increases in diagnosed cases of the autism spectrum conditions, no stone is seemingly being left unturned. Accepting the important and oft-cited sentence "correlation is not the same as causation" and accepting that the reasons for the increase in the autisms (plural) might differ from location to location, country to country and people to people, retrospective reviews of registries and case notes have featured quite a bit in this search for reasons.

The paper by Suzanne Bolton and colleagues* follows in this methodological tradition, suggesting: "an observation of increased rates of ASD [autism spectrum disorder] among a migrant population derived particularly from children born to mothers originating in Sub-Saharan Africa" based on a review of some 366 children presenting at a child development service in Ireland (Éire).

Based on those 366 case reports, autism or rather an ASD, was diagnosed in 131 and speech and language issues in 132 children. This in itself is interesting data based on the proportion of children coming to use the child development services - I assume because someone, somewhere had observed something worthy of the referral - and those eventually diagnosed with autism. Even more interesting in light of further genetic connections being made between autism and language impairment**.

No mind, when looking at those born to mothers born themselves in Africa "a higher proportion of the African cohort 13/18 (72.2 %) presented with moderate/severe cognitive disability compared to the Irish group 9/55(16.3 %)". In other words, the presentation of autism and intellectual (learning) disability towards the more severe end of the spectrum seemed to be more pronounced in the migrant population than those born to mothers themselves born in Ireland.

This is not the first time such a finding has been reported. I hark back to my post on the work of Cecilia Magnusson and colleagues*** who also reported a similar trend in their registry-based study following on from similar suggestions from other work.

So, what might one surmise from this growing body of work. Well, if I were to use the paper by Rai and colleagues**** as my starting point (see a previous post here) I might say that we should be looking at factors such as socio-economic status (SES) among those families arrived from Africa compared to Irish families to see if they could account for the differences raised by Bolton et al. Rai concluded that "Lower, not higher, socioeconomic status was associated with an increased risk of ASD" and without making any sweeping generalisations, one has to wonder whether demographic disparities might exist on the basis of indigenous and naturalised status.

That all being said, Ireland has some pretty comprehensive measures when it comes to the screening and diagnosis of autism (see here) no matter what side of the border you are on. If we are talking about children presenting with "a more severely affected" type of autism, it's highly likely that if not parents, nursery or school or other services would pick up on the need for a referral for assessment even if not knowing that it might be autism. Language and cultural differences about autism (see here) may impact on this process but I'd hazard a guess that not as much as one might first think.

Other potential explanators please. Well, without getting too bogged down in the debate about different ethnicities and different genetics, one has to wonder whether the risk of autism might be somehow reduced or elevated among different peoples. At the moment, we can't say for sure because worldwide, not everyone has access to the same screening, assessment and diagnostic resources that we perhaps take for granted in the modern Western world (see here). Autism research is also not exactly thriving in some parts of the world. Throw in again those language and cultural issues - even in our supposedly developed world***** - and the big question mark on this area still remains.

Then to environment. Lots of potential factors here including the stress of moving to and integrating into a new country, the introduction of a very new environment and climate - Ireland vs. Sub-Saharan Africa, mmm? - new foods, new microbes/infections, etc. Take your pick of what might be important or not. With my current interest in all things sunshine and vitamin D, I'm minded to suggest that this might be a factor worth considering given all the research attention that has been paid to vitamin D and autism. That and the whole solar intensity and ADHD link (no, really).... Likewise, I'm sure lessons can be learned from other research highlighting a similar pattern of risk in relation to other conditions such as schizophrenia and its link to immigration status******.

Whatever the reasons for the disparity being highlighted by the studies by Bolton and others, from a practical point of view it is perhaps more important that measures are put in place to accommodate this potentially heightened risk of offspring autism in immigrant populations. This might mean additional screening and assessments being offered to communities (language-appropriate) as well as providing any advice and education that may be required about autism and raising a child with autism.

And while we're on the topic, I'll also throw the paper by Lehti and colleagues******* (open-access) into the mix and their suggestion that "In Finland, children who are born to immigrant mothers with or without an immigrant partner, have an increased risk of childhood autism".

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* Bolton S. et al. Autism in a recently arrived immigrant population. Eur J Pediatr. 2013 Oct 2.

** Bartlett CW. et al. A Genome Scan for Loci Shared by Autism Spectrum Disorder and Language Impairment. Am J Psychiatry. 2013.

*** Magnusson C. et al. Migration and autism-spectrum disorder: population-based study. British Journal of Psychiatry. February 2012. DOI: 10.1192/bjp.bp.111.095125

**** Rai D. et al. Parental socioeconomic status and risk of offspring autism spectrum disorders in a Swedish population-based study. J Am Acad Child Adolesc Psychiatry. 2012 May;51(5):467-476.e6.

***** Zuckerman KE. et al. Pediatrician Identification of Latino Children at Risk for Autism Spectrum Disorder. Pediatrics. 2013; 132: 445-453.

****** Cooper B. Immigration and schizophrenia: the social causation hypothesis revisited. Br J Psychiatry. 2005; 186: 361-363.

******* Lehti V. et al. The risk of childhood autism among second-generation migrants in Finland: a case--control study. BMC Pediatrics 2013, 13:171

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Bolton S, McDonald D, Curtis E, Kelly S, Gallagher L. (2013). Autism in a recently arrived immigrant population Eur J Pediatr DOI: 10.1007/s00431-013-2149-6