Autism --- A Cognitive or a Behavorial Disorder?

Edward J. Harshman, MD, MBA
Article Type: 
Winter 2002
Volume Number: 
Issue Number: 

Autism, the cognitive disorder of extreme social withdrawal, living in one's own world, has no proven etiology. Current theories include neurotransmitter imbalance, improper nutrition, and genetic predisposition. While these theories do partially explain autism, parental behavior has been generally overlooked.

Autism is associated with firstborn children, with boys, and with unusually good looks. It is also becoming more common in our society. Autistic people often seem preoccupied with spinning objects or with making themselves spin.

No known genetic or infectious process preferentially affects firstborn children. But firstborns often receive different treatment from their parents than do their younger siblings. Inexperienced parents, specifically parents of one young child, are more likely than others to try to demand that their children's opinions and feelings be what the parents want them to be.

Boys are more likely than girls to become autistic.(1) Genetics aside, our society tolerates a wider range of behavior in girls than in boys, as with women relative to men, because of recent social changes. A boy, if troubled by social pressures, is less likely than a girl to share his feelings openly and have them handled constructively by sympathetic parents or friends. He therefore risks reacting dysfunctionally, perhaps by severing his emotional link to the rest of the world to insulate himself from pain.

Autistic children are "often described as very attractive"(2); if a child is beautiful or handsome, then the risk of autism is apparently slightly higher than average. Attractive children elicit aggressive attention from adults. Suppose a small child, after a few minutes on a visitor's lap, has had enough and wants to be put down. That's fine, if he gets his way and gets socially handled only as much as he readily accepts. But if an unwelcome visitor insists on pawing him over and his parents tell him not to disapprove, then he will learn that his opinion in a social setting is worthless, and he has no defense if his personal space is invaded. Dissonance results from the apparently favorable attention plus the reminder of defenselessness. That dissonance discredits the child's emotional connection with the outside world.

Autism is becoming more common in the U.S. today.(3) The American culture, in particular how children are treated, has changed. People born in and since the 1960s are now having their own children. That decade was the start of de-emphasizing intelligence and productivity, substituting unearned self-esteem and getting along with other people. Competent people, including children, proudly display their skills and acquire self-respect from the pleased reactions of others. Modern U.S. education tries to bypass the arduous but natural process of developing various competences, favoring the quick fix of self-importance. By diverting children's natural opinions and eagerness to learn into a morass of confusion, with psychology discussion groups and similarly destructive processes, schools repress independent thought. This process makes independent thinking hazardous for children. They are under pressure to have unwelcome beliefs and opinions imputed to them.

Any experienced mental health professional knows how often patients seek social approval. In our culture, it's more important to feel good about ourselves than to nurture the skills from which such feelings naturally derive. Because of the intrinsically artificial nature of that cultural force, dissonance can result --- and so can autism.

Autistic people can seem fascinated by spinning objects,(2) but carefully observing the face of an autistic person who studies such an object shows frustration and not eagerness. As do computers, which are programmed to have limited interruption capabilities, autistic persons can encounter infinite loops. An infinite loop is a set of computer instructions that repeat themselves forever, necessitating an interruption (turning off the computer, for example). Apparent fascination with spinning objects is an infinite loop. An autistic person won't necessarily watch a spinning object for a few seconds and say, "Oh. That's all it is. I think I'll do something else." Such a decision, for us, is automatic, but not for someone less able to handle interruptions, who gets into a mental endless loop and who should be tactfully interrupted, distracted, from it.

If you tell your child (a boy, for example) that you and he are going to do something, for example go to the store, he may dislike the idea. Then you overrule him and he learns to yield to superior force or, you hope, comply under mild protest. "Oh, all right, I don't want to, but I'll go." Open dissent keeps the disagreement explicit so that no subconscious damage can occur.

You can try to convince him that going to the store will be enjoyable. If you and he are always aware that he has the right to disagree, then there is no problem --- and you may even succeed in convincing him.

Or you may punish him. Then he may learn to keep his opinions to himself. If asked by someone he trusts, he will remember what happens: "Mommy and Daddy punish me if I disagree with them." Unfair to the boy, but it can be identified.

But what if he is pressured to change his opinion? "You really like going to the store, don't you?" If he loves you and wants to cooperate, then he will let you distort his opinion to suit your convenience.

Now he has an internal contradiction, a tension, a dissonance, that needs some resolution. Modern psychology ignores the consequences; and it cannot explain autism. Coincidence?

The behavioral pattern I describe does not always lead to autism, and there must therefore be an additional explanation for why some children get it and some do not. Diet and neurotransmitters may indeed constitute that explanation.

To prevent autism, preserve children's right to have feelings and opinions that are inconvenient. Permit disagreement; confine your discipline to actions and behaviors.


1. Sadock BJ, Sadock VA. Kaplan & Sadock's Comprehensive Textbook of Psychiatry, Seventh Edition. Lippincott Williams & Wilkins, 2000; p. 2668.
2. Ibid., p. 2667.
3. Fombonne E. The epidemiology of autism: a review. Psychological Medicine 1999;(29):769-786.

Dr. Harshman is a physician in Dade City, Florida, and has an MBA in health care administration. His e-mail is:

Originally published in the Medical Sentinel 2002;7(4):126-127. Copyright©2002 Association of American Physicians and Surgeons (AAPS)

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The cerebellum in autism

An impressive book was released a couple of years ago on this topic. It is entitled CELLULAR AND MOLECULAR BIOLOGY OF AUTISM SPECTRUM DISORDERS, Anna Strunecka (Ed) Bentham eBooks, 2010.

This book is well-edited, comprehensive, and scholarly written. Pathophysiology, pharmacology, histology, endocrinology, immunology, risk factors, neuro-imaging, clinical studies, environmental toxins, and possible therapies of the autistic spectrum disorders (ASDs) are discussed in 14 chapters written by four scientists and specialists in these disorders. The book is well annotated and has a good index.

Chapter 2, "The Cerebellum in Autism Spectrum Disorders," was carefully-researched and eloquently written by Russell L. Blaylock, M.D., an old friend and fellow Associate Editor-in Chief of Surgical Neurology International (SNI). Dr. Blaylock reviews the functions, anatomical circuitry, and the cerebral-cerebellar connections involved in the mental model of the cerebellum necessary to formulate cognition and modulate activity, during actual as well as anticipated cognition and motor actions — fascinating cerebellar-cortical functions. He then goes on to lucidly point out that the cerebellum is the most commonly affected part of the brain in ASDs with the loss of Purkinje and granule cells of the cerebellar vermis and neocerebellar cortex, particularly in the Posterior lobe. He also describes evidence of abnormal pathway development, neural degeneration, and immunoexcitatotoxicity, suggesting intrauterine or early postnatal neural damage to the cerebellum in ASDs.

Widespread involvement of the cerebellum in ASD should not be surprising, for as Dr. Blaylock discloses, there is ample evidence the cerebellum plays a significant role "in language function that goes beyond motor speech," and may have "significant cognitive and higher cortical functions, either by way of its connections to prefrontal-limbic areas or more indirect pathways."

I'm not an expert in ASDs but I still do hold a fascination for the cerebellum, one of my areas of expertise from the time I was a medical student. I enjoyed Dr. Blaylock's basic but magnificent review of the cerebellum-cortical
connections, neural circuitry, error correcting mechanisms, neurotransmitter interactions, etc. I was also delighted to see that he did not neglect to cite the contributions of the Czech scientist Dr Purkinje and the Spanish physician and physiologist, Ramon y Cajal, to histological delineation of the cells and fibers of the cerebellum with the Golgi and silver staining techniques.

The etiology of ASDs remains elusive to scientists and clinicians alike but this book goes a long way to compile information and research and effectively discusses the present state of knowledge of ASDs. This eBook should be essential to the clinician ministering patients suffering with autistic spectrum disorders (ASDs), workers in the field, and the scientists arduously researching it.

Miguel A. Faria, Jr., M.D.

Clinical Professor of Surgery (Neurosurgery, ret.) and
Adjunct Professor of Medical History (ret.) Mercer University School of Medicine

An Associate Editor-in-Chief and a World Affairs Editor, Surgical Neurology International (SNI; 2011-present)

Ex-member of the Injury Research Grant Review Committee of the Centers for Disease Control and Prevention (CDC; 2002-05)

Founding Editor in Chief of The Medical Sentinel (1996-2002); now editor emeritus. Author, Vandals at the Gates of Medicine (1995); Medical Warrior: Fighting Corporate Socialized Medicine (1997); and Cuba in Revolution: Escape From a Lost Paradise (2002).


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