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Rethinking Autism - 1st Edition - ISBN: 9780124159617, 9780123914132

Rethinking Autism

1st Edition

Variation and Complexity

Author: Lynn Waterhouse
Hardcover ISBN: 9780124159617
eBook ISBN: 9780123914132
Imprint: Academic Press
Published Date: 12th September 2012
Page Count: 480
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The media, scientific researchers, and the Diagnostic and Statistical Manual all refer to "autism" as if it were a single disorder or a single disorder over a spectrum. However, autism is unlike any single disorder in a variety of ways. No single brain deficit is found to cause it, no single drug is found to affect it, and no single cause or cure has been found despite tremendous research efforts to find same. Rethinking Autism reviews the scientific research on causes, symptomology, course, and treatment done to date…and draws the potentially shocking conclusion that "autism" does not exist as a single disorder. The conglomeration of symptoms exists, but like fever, those symptoms aren’t a disease in themselves, but rather a result of some other cause(s). Only by ceasing to think of autism as a single disorder can we ever advance research to more accurately parse why these symptoms occur and what the different and varied causes may be.

Key Features

  • Autism is a massive worldwide problem with increasing prevalence rates, now thought to be as high as 1 in 38 children (Korea) and 1 in 100 children (CDC- US)
  • Autism is the 3rd most common developmental disability; 400,000 people in the United States alone have autism
  • Autism affects the entire brain, including communication, social behavior, and reasoning and is lifelong
  • There is no known cause and no cure
  • Funding for autism research quadrupled from 1995 to 2000 up to $45 million, and the Interagency Autism Coordinating Committee has recommended $1 billion funding from 2010-2015


Developmental psychologists, child clinical psychologists, child psychiatrists, pediatric neurologists, and autism researchers.

Table of Contents




Chapter 1. Autism Heterogeneity

Autism Heterogeneity is Extensive and Unexplained

Autism Heterogeneity has Blocked Medical Treatment Discovery

Diagnostic Criteria have not Constrained Autism Heterogeneity

Variation in Autism Diagnostic Features

Variation in Genetic Risk Factors for Autism

Variation in Environmental Risk Factors for Autism

Summary: Variation Exists in all Autism Domains

Autism Subgroups and Unifying Theories for Autism have Addressed Heterogeneity

Subgroups and Unifying Theories have not Explained the Variation in Autism

Has Autism been Reified?

Saving the Phenomena of Autism Variation

How Should We View the Variation in Autism?

Serious Concerns for Maintaining the Autism Diagnosis

Eight Claims Concerning Autism Variation and the Autism Diagnosis


Chapter 2. Autism Symptom Heterogeneity Exists in Family Members

Four Pairs of Siblings with Varying Autism Symptoms

Important Research Questions Raised by Variation in the Four Sibling Pairs

Infant Sibling, Twin, and Family Studies of Autism

Autism Symptoms in Identical and Fraternal Twins

Heterogeneity in the Broader Phenotype of Autism

Two Alternate Hypotheses about the Structure of the Broader Autism Phenotype

Conclusions: Recurrence Risk Rates and Family Phenotypes Reflect Aggregates


Chapter 3. The Social Brain is a Complex Super-Network

The Phrenology Problem

What Brain Circuits Support Social Behaviors?

Mechanisms of The “Dark Matter” of Human Social Cognition

Current Findings for “Social Brain” Deficits in Autism

The Range and Variation in Autism Social Brain Deficits Suggest that Multiple Disorders have been Aggregated in Autism

Conclusion: No Plausible Comprehensive Model of Social Deficits in Autism


Chapter 4. Genetic Risk Factors Link Autism to Many Other Disorders

Many Gene Variants Contribute to Autism

Many Types of Genetic Mutations Contribute to Autism

Three Fundamental Questions for Autism Genetics

Question One: What are the Genetic Causal Patterns for Autism?

Question Two: How Do Gene Variants Cause Autism Brain Deficits?

Question Three: What Does it Mean that Autism Shares Genes with Other Disorders?


Chapter 5. Environmental Risk Factors Link Autism to Many Other Outcomes

The Lingering Effects of Two False but Influential Theories of Environmental Cause

Environmental Causes Link Autism Symptoms to Symptoms of Many Other Outcomes

Epigenetic Risk Factors for Autism Symptoms

Immune System Reactivity, Dysfunction, and Neuroinflammation in Autism

Conclusion: Prenatal, Perinatal, Epigenetic, and Immune System Risk Factors Link Autism to Other Outcomes and Lack Causal Specificity for Autism


Chapter 6. Savant Skills, Special Skills, and Intelligence Vary Widely in Autism

Unanswered Questions Regarding Savant, Prodigious, and Special Skills

What are the Prevalence Rates of Savant and Prodigious Skills?

Practice, Practice-Induced Brain Changes, and Atypical Brain Function Contributions to Savant, Prodigious, and Special Skills

Intelligence, Savant and Superior Skills, and Sensory Abnormalities in Autism

Conclusions: Theories of Savant Skills Do Not Explain Variation, and Public Attention to Savant Skills Supports an Unhelpful Stereotype of Autism


Chapter 7. Increasing Prevalence and the Problem of Diagnosis

Pressing Problems for the Diagnosis of Autism

Conflicts in Stakeholder Ownership of the Diagnosis of Autism

The Difficulties Inherent in the DSM System of Classification

Problems with DSM-5 Autism Spectrum Diagnostic Criteria

Conclusion: An Originalist View of Autism Avoids the Complexity of Evidence


Chapter 8. Autism Symptoms Exist but the Disorder Remains Elusive

The Autism Male to Female Ratio is Likely to be a Composite

Much Research is Still Focused on Trying to Unify Autism as a Single Disorder

Abandoning Autism as a Single Disorder Would Eliminate Three Inferential Problems in Autism Research

The Existing Quandary and the Argument for Autism as Symptoms

Conclusion: Autism Symptoms without a Disorder


Subject Index


No. of pages:
© Academic Press 2013
12th September 2012
Academic Press
Hardcover ISBN:
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About the Author

Lynn Waterhouse

Lynn Waterhouse

Dr. Lynn Waterhouse was the Director of Child Behavior Study at The College of New Jersey for 31 years, and is currently a Professor in Global Graduate Programs at the College. NIMH, NICHD, and private funding agencies supported her autism research. She worked with Dr. Lorna Wing on the APA DSM-III-R diagnostic criteria for autism.


"A seminal book forcing a much-needed change in the way in which we think about autism.  Impressively well-researched and well-argued.  A 'must-read' for all autism researchers."

--Prof. Jill Boucher, City University, London, UK



"This book by Lynn Waterhouse will ruffle some feathers, with its bold conclusion that "there is clear detriment to maintaining the diagnostic category of autism spectrum disorder." However, the evidence she presents is compelling. In every domain she investigates - symptoms, neurobiology, etiology, correlates – she finds that there is considerable heterogeneity in autism. As well as striking differences among children with an ASD diagnosis, there is also a lack of specificity in symptoms and causes. For instance, genetic variants and environmental risks that are associated with increased risk of autism are also associated with other neurodevelopmental disorders.

Waterhouse is not denying that there are children with severe developmental difficulties involving social interaction, communication and stereotyped behaviours. Rather, she is questioning whether their needs are best served by grouping them all together under a single umbrella label.

Her view is that research efforts directed at finding a unifying theory of autism are misguided, and that we should be focusing on symptoms rather than an abstract diagnostic category that can obfuscate rather than clarify our understanding."

--Prof. Dorothy Bishop, University of Oxford, UK


"The book is an argument, not an opinion piece or political manifesto. It presents a pile of research findings, and makes a case for what they tell us…I’m grateful for Lynn Waterhouse’s book and fervently hope it will help knock autism research out of a rut (not to mention help improve everyday thinking about autism)… Rethinking Autism moves the conversation forward and I hope it will change our thinking for the better."--Intellectualizing blog, December 17, 2013

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