In a news conference this past week ¹, Secretary of the HHS, Robert Kennedy Jr. managed to broadly insult persons with autism and their families with remarks suggesting that they will never be quite "normal" in his eyes, and went on to generalize all persons on the Autism Disorder Spectrum as equally affected and seemingly "disabled" and "impaired." Needless to say, his remarks - apparently intended to garner an awkward sympathy - were met with a broad outrage and consternation.

Dr. Ken Springer of the Satisfied Substack recently posted a superlative analysis of the "5 myths" of Kennedy's view of ASD, among which are, quite predictably, related to cause. Apparently, far too few "influencers" are simply unaware, or have developed an improbable set of reasons to reject the long list of studies that have consistently and unanimously refuted any connection between the Measles, Mumps, & Rubella vaccine [MMR], which the World Health Organization estimates has been administered billions of times, as a cause or contributor to ASD. Studies have likewise consistently pointed to genetics as the primary influence for the development of ASD, with epigenetic factors (e.g. later age parental births, maternal obesity, deficits or over-abundance of significant nutritional factors, disturbances in balance of the gut microbiome, etc.) as contributing or "triggering" factors that do not disturb the underlying genome, or any combination of factors, or perhaps unknown epigenetic factors that combine with genetic factors. Any reason(s) why those opposed to vaccines would be opposed to such voluminous data regarding the genetic influences underlying ASD - which most experts believe account for >at least 40%, if not more, of the cause of ASD, would be somewhat speculative, but a number of studies ^{2, 3, 4} have spoken to the issues of parental sense of guilt & responsibility; socially stigmatizing; and expressions of the projective rejection of medical authority generally.

Sec. Kennedy spoke of persons with ASD as people who will "never pay taxes, they'll never hold a job, they'll never play baseball, they'll never write a poem, they'll never go on a date." Apparaently Sec. Kennedy is convinced that ASD is not only a recent phenomenon, but it is always a severely manifest phenomenon. Obviously, nothing could be further from the truth. We are reminded of our own bias, so perfectly expressed by Dr. Oliver Sacks in the introduction to the chapter of the same name as his volume, An Anthropologist on Mars, published in 1996. In that opening, he compares the "clinical perceptions" of two classic authors, Dr. Leo Kanner and Dr. Hans Asperger.

In 1943, Kanner wrote a paper entitled, Autistic disturbances of affective contact ⁵, and Asperger wrote as similar paper in 1944, but both seemed to be describing a different body of patients. As Sacks notes, the difference seemed to reflect the "“wide range of phenomena and symptoms in autism," with Kenner seeming to describe a patient in terms aligning with Sec. Kennedy:

A majority are retarded, often severely; a significant proportion have seizures and may have “soft” neurological signs and symptoms—a whole range of repetitive or automatic movements, such as spasms, tics, rocking, spinning, finger play, or flapping of the hands; problems of coordination and balance; peculiar difficulties, sometimes, in initiating movements, akin to what is seen in parkinsonism. There may also be, very prominently, a large range of abnormal (and often “paradoxical”) sensory responses, with some sensations being heightened and even intolerable, others (which may include pain perception) being diminished or apparently absent. There may be, if language develops, odd and complex language disorders—a tendency to verbosity, empty chatter, cliché-ridden and formulaic speech - a “semantic-pragmatic deficit.”⁶

Asperger, on the other hand, described in his article ⁷ the children he saw in clinic not as the "unmitigated disaster" of Kanner, but rather that they "“might have certain positive or compensating features— particular originality of thought and experience, which may well lead to exceptional achievements in later life.” In clinical practice, "Asperger's Syndrome" (which has now been condensed in the DSM V into the broad category "Autism Spectrum Disorder," angering those with the previous diagnosis of Asperger Syndrome) had come to be understood as a cohort of "high functioning" ASD individuals, or "mildly affected" individuals on the autism spectrum. While it is difficult to predict with precise certainty, it is generally accepted that the proportion of ASD persons as described by Kanner & Kennedy is less than a third of affected individuals. In fact, in a study published in the Public Health Reports in 2023, "The percentage of 8-year-old children with profound autism among those with autism was 26.7%." ⁸ As is typical of the rhetoric of Sec. Kennedy, his remarks were without substantiation.

While Sack's comments on the nature of ASD seem outdated for our time, the focus of his narrative does not, as it relates to an extraordinary individual, Dr. Temple Grandin, and in doing so, raises the ironic point that speaks to a primary criticism of Sec. Kennedy: "Indeed, in a strange way, most people speak only of autistic children and never of autistic adults, as if the children somehow just vanished from the earth." ⁹ Sec. Kennedy seems incapable of appreciating that adults with autism actually existed and continue exist. In any case, Temple Grandin provides a particular insight into the "thinking" of an ASD affected individual, as Sacks discovered:

What is it, then, I pressed her further, that goes on between normal people, from which she feels herself excluded? It has to do, she has inferred, with an implicit knowledge of social conventions and codes, of cultural presuppositions of every sort. This implicit knowledge, which every normal person accumulates and generates throughout life on the basis of experience and encounters with others, Temple seems to be largely devoid of. Lacking it, she has instead to “compute” others’ intentions and states of mind, to try to make algorithmic, explicit, what for the rest of us is second nature. She herself, she infers, may never have had the normal social experiences from which a normal social knowledge is constructed. ¹⁰

In any case, Sacks spends considerable time parsing Grandin's autobiography, Emergence: Labeled Autistic, where she appears to fit his stereotype of a severe, Type 3 level ASD child pursuant to the DSM V categorization. Yet, with the help of a loving mother, aunt, and several persistent teachers who sense her level of intelligence and capacity for intellectual development is able to surpass and "emerge" from the entrapment of her grave disability. This causes Sacks to reflect,

How, I had to wonder, had she ever moved from this almost unintelligible childhood, with its chaos, its fixations, its inaccessibility, its violence—this fierce and desperate state, which had almost led to her institutionalization at the age of three—to the successful biologist and engineer I was going to see? ¹¹

In our own experience, after reading this chapter in Sack's volume and hearing an NPR interview, we emailed Dr. Grandin at her faculty office at Colorado State University with several questions. She promptly responded, asking for clarification as to our specific interests. Within a week, we received a large mailing tube with a personal letter offering further help, blueprint plans for several humane slaughter houses she had designed with full explanations, and a large pack of professional articles she had written about autism, animal husbandry, and the humane treatment of animals. This, then, begs the question, is Temple Grandin typical of ASD (Asperger Syndrome) individuals? In our clinical experience with high functioning ASD adolescents, she and they would seem to be, in the sense that ASD is an impairment of emotions and not intelligence, and as Sacks observed, "autism, being a developmental disorder, tends to become less extreme as one grows older, and one may learn to cope with it better." ¹².

In the next section we will discuss Dr. Springer's further "myths" in detail.

¹ https://www.pbs.org/newshour/politics/fact-checking-robert-f-kennedy-jr-s-statements-on-autism

² Olsen, O., Berry, B., Kumar, N. Addressing parental vaccine hesitancy towards childhood vaccines in the united states: a systematic literature review of communication interventions and strategies. Vaccines.8 October 2020.https://doi.org/10.3390/vaccines8040590.

³ Nowak, GJ, et al. Addressing vaccine hesitancy: The potential value of commercial and social marketing principles and practices. Vaccine. 33 (2015) 4204–4211. http://dx.doi.org/10.1016/j.vaccine.2015.04.039.

⁴ Smith, TC. Vaccine rejection and hesitancy: a review and call to action. Open Forum Infectious Disease. https://doi.org/10.1093/ofid/ofx146

⁵ Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, 217-250.

⁶ Sacks, Oliver. An Anthropologist on Mars, p.219.

⁷ Asperger, H. (1991). ‘Autistic psychopathy’ in childhood. In U. Frith (Ed. & Trans.), Autism and Asperger Syndrome (pp. 37–92). Cambridge University Press.

⁸ Hughes, MM, et al. The prevalence and characteristics of children with profound autism, 15 sites, United States, 2000-2016. Public Health Reports. 2023, Vol. 138(6) 971­ –980. https://doi.org/10.1177/00333549231163551

⁹ Sacks, Ibid., p.214. Comments suggest that Kennedy seems to believe that ASD did not exist prior to his recent memory

¹⁰ Sacks, Ibid. p.263.

¹¹ Sacks, Ibid., p.250.

¹² Sacks, Ibid., p.263.