Saturday, August 12, 2017

The Increase in Social Media and Autism - Coincidence or Causal?

Over the last 4 decades, the number of children diagnosed with autism and related disorders has grown at an astonishing rate.  In the 1970s and 1980s, about one out of every 2,000 children was estimated to have autism.  In the year 2,000, with a broader definition and better diagnosis, the CDC estimated that one in 150 8-year-olds in the U.S. has an autism spectrum disorder, or ASD.  

Since that time, prevalence rates have increased 10 - 17% annually.  By 2012, the ASD estimate had risen to 1 in 68 8-year-olds.  “There is no established explanation for this increase.” 

Autism/ASD is mental disorder caused by variations in the brain’s development.  These disorders are characterized by difficulties in social interaction, verbal and nonverbal communications, and repetitive behaviors.  More specifically, children with autism demonstrate either “deficits in social-emotional reciprocity, deficits in nonverbal communicative behaviors, and deficits in developing, maintaining, and understanding relationships.”

I became interested in this issue because a close friend of mine has custody of a grandchild who has ASD.  Recently my friend asked me, because I had written the book, Raising a Happy Child, if I had any ideas on what might help his interactions with the child.  Knowing very little about the disorder, I did some quick research which uncovered the information conveyed above.

What do we know about the cause of autism/ASD?  Prior to the 70s, autism was thought to be caused by bad parenting, “unloving mothers.”  That theory has been thoroughly debunked. 

Instead, research has shown that a number of genes are connected with autism.  Further, a number of environmental factors before and during birth, that influence early brain development and thus increase the risk, have been identified.  They include advanced parental age, maternal illness, extreme prematurity, very low birth weight, and certain difficulties during birth involving periods of oxygen deprivation.  Also, mothers exposed to high levels of pesticides and air pollution may be at greater risk of having an autistic child.

Clearly, the factors identified by science to-date could not even begin to explain this rapid increase in the rate of autism/ASD.  In looking briefly at several recent symposia on the subject, no new ideas were identified.  There was just hope in identifying “modifiable risk factors” as we better understand why the prevalence of ASD has increased.

When I first read the definition of autism noted above, I had a “duh” moment.  The definition, with the possible exception of repetitive behaviors, almost exactly tracks what researchers are finding is the negative result of compulsive use of modern technology … the internet, computer games, smart phones, social media.  

We’ve all seen the phenomenon.   Whether on the subway, in the theater, on the street … people of all ages, not just the young but older Americans as well, seem unable or unwilling to be disconnected from their technology tool, their new umbilical cord, for an unnecessary moment.  It has become an addictive behavior. 

I knew from research I had done when writing my book that “stress in the womb can affect a baby's temperament and neurobehavioral development. ‘Who you are and what you’re like when you are pregnant will affect who that baby is,’ says Janet DiPietro, a developmental psychologist at Johns Hopkins University. ‘Women's psychological functioning during pregnancy – their anxiety level, stress, personality -- ultimately affects the temperament of their babies. It has to ... the baby is awash in all the chemicals produced by the mom.’” Source: http://www.medicinenet.com/script/main/art.asp?articlekey=51730&page=3.  So it certainly seemed possible that an obsessive compulsive social media addiction would have an impact.

After I had done my initial research, I responded to my friend and indicated my hunch that the appearance of the new technology and its compulsive use during pregnancy probably has a strong correlation with the increase in ASD prevalence.  He responded by telling me that, interestingly, the ASD boy’s mother had been a compulsive computer gamer, including during pregnancy, and also didn’t take very good care of herself.  The boy is also a compulsive gamer.

With that single confirmation, I decided to delve deeper into the existing research.  The new definition and diagnostic criteria for ASD was developed in the early 1990s.  It’s probably reasonable to assume that the difference between the estimated prevalence prior to the broadened criteria for ASD diagnosis and post are mostly due to the new criteria as well as greater awareness.

However, in the period since ASD was defined, the criteria has been constant and the awareness consistently high.  So what accounts for the rapid increase since that time?

If one looks more closely at the CDC prevalence estimates, one sees a pretty stable figure prior to 1996 births, 1 in 150.  This finding is almost identical with a British study done during the early 90s.  Between 1996 and 2004 births, however, the prevalence increased to 1 in 68 children.  

More recent CDC data are not available (the report on 8-year-olds in 2012, thus born in 2004, was issued in 2016).  However a report from a 2015 government survey of parents found that 1 in 45 children, age 3  - 17, have been diagnosed with ASD.  Since the source of the data is different, though, one can’t conclude that the prevalence has increased further.  It may indicate an increase or it may indicate that the CDC data source is not as accurate and that the earlier prevalence rates were actually higher.  Either way, it’s not good.

During this period of rapid ASD prevalence growth, commercial internet and social media use took off (in the late 1990s) and grew exponentially.  A Pew Research study found that between 2005 and 2013, the use of social media by adults increased from 7% to 62%.  Since then the increase has leveled off and the last reading was 65% in 2015.  This survey, however, did not measure frequency or duration of use, which from observation appears to have increased significantly.

While the Pew data start where the CDC data leave off, we nevertheless know from it that between the late 1990s when social media started to 2005, the usage rose from 0 - 7%.  A huge percentage increase.  If I’m on the right track, the scary question is what the set of CDC data will look like from children born after 2010.

And there’s one more point.  The current research assumes that all factors impacting ASD development cease the moment one is born.  It considers no post-birth environmental factors.  Yet research has shown that a child’s brain continues significant structural development at least until age 3, with further development continuing until adolescence.  

It’s a very common sight these days to see even 2-3 year-olds staring at their little screens, watching a program or game while in their strollers, accompanying their parents at a restaurant, or elsewhere.  It’s becoming the new pacifier.  I cannot but think that it will have an impact on autism prevalence.

I cannot go any further with this line of reasoning from the available data.  However, I think that the connection, being both evident and sufficiently strong, points to the need for the CDC, or other appropriate federal agency, to gather information on the computer/social media habits of mothers during pregnancy.  And that data needs to include not just how many sites she visits (as was the case with the Pew data), but the frequency and duration of her visits.  Since it does not appear that such data would be able to be retrieved through the CDC’s ADDM data gathering system, a survey would most likely have to be employed.  Data on toddlers’/young children’s exposure to computer games/programs also need to be gathered.

Testing my hypothesis is of upmost importance.  I would even say urgent, given the ubiquitous nature of obsessive social media use prevalent today in our society.  If indeed more children are being born with ASD due to this risk factor, then every pregnant woman needs to be given a health advisory to stay off social media during her pregnancy.  This should be treated no differently than advice given to pregnant women to avoid other harmful behavior, whether it’s smoking, taking drugs, or eating fish from contaminated rivers.  And the use of devices by toddlers should be restricted.

If my hypothesis is correct but left unaddressed, this development could have more impact on the future health and vitality of our country than almost any problem we are currently facing.