Over the past couple of decades, skyrocketing rates of autism spectrum diagnoses (ASD) have led to countless theories about why people are increasingly showing social communication difficulties. Currently, estimates are that 1 in 42 boys in the United States have symptoms consistent with this diagnosis while the estimated rate for girls is 1 in 189. Whether it is increased exposure to environmental toxins (e.g., through pollution, household chemicals) or dietary/gut issues and/or just wider screening and broader diagnostic categories, researchers and clinicians alike are trying to understand the root cause of poor social interaction and increased repetitive/restricted areas of behavior.
Like any highly charged, personal topic, attributions of cause must be met with a healthy degree of caution and skepticism. It was less than 60 years ago when the prevailing theory of autism focused on “refrigerator mothers” – mothers whose supposed lack of warmth and nurturing resulted in children with severe autistic delays. However, gradually over time, it became clear that this theory did not explain the breadth of ASD cases, and sadly, it left many women feeling undeserved guilt for the struggles their children showed.
Yet in coming back to the “rising” rates of ASD, we are left with questions about whether societal and/or cultural factors could be at play with this supposed epidemic. I must admit that I believe much of the change in diagnostic rates has to do with our increasing awareness of socially-impairing circumstances, and our increasing labeling of these difficulties as a diagnosis itself. It is critical to note that Asperger’s (now part of the autism spectrum) did not become an official diagnosis until 1992 (International Classification of Diseases – 10th Edition). Thus, prior to this, a diagnosis on the autism spectrum (previously just autistic disorder) meant an individual had to have severe social communication delays and repetitive/restricted areas of behavior—the kind that made it very difficult for them to function in a mainstream setting. Today, almost every school has children with an ASD diagnosis, some of whom are able to manage with minimal accommodations. Twenty-five years ago or more, these children would have been called “weird”, “nerdy”, or the like. Today, they are classified with an official medical condition.
Furthermore, if we consider a statistical perspective, a rate of 1 in 40 (which is just about the rate of suspected ASD diagnoses in boys) means that a condition occurs in 2.5% of the population. While this may sound like a lot when it comes to ASD, we should remember that with every other area of basic functioning (e.g., attention, intellectual skills, mood/anxiety level), individuals at the bottom 2.5 percent (and often more) have long been given diagnoses. Whether it is an Intellectual Disability, Major Depression, Generalized Anxiety Disorder, or ADHD, diagnoses have been used for upwards of a century or more to define states of dysfunction in these areas. For various reasons, it just took the medical community longer to define a social dysfunction (with or without isolated, repetitive behaviors) as an actual diagnosis. Whether or not you or I consider this a positive or negative development, it is important to understand that both statistics and diagnostic changes are playing a huge role in the supposed ASD epidemic.
All this considered, though, there looms this question about whether massive changes in our society or culture over the past few decades are directly linked to the reported social dysfunction of today. And this is where technological changes must become a serious consideration because nothing has altered our social functioning like the internet and mobile devices have.
For starters, there is a general consensus that mobile devices are changing the way we interact, especially among native users (i.e., those that have grown up in the mobile era). As Sherry Turkle described in her book Alone Together, youth and young adults especially are increasingly gravitating towards modes of interaction that do not involve face-to-face contact. In the process, many professionals such as myself are pointing to signs that this trend is affecting their ability to handle the intricate details of a direct conversation, especially nonverbal skills (e.g., eye contact, gestures, use of pauses, reciprocal exchanges). Like any challenging skill (and yes, social skills can be quite challenging), less practice combined with appealing alternatives (e.g., texting) sets the stage for a decline in ability. In fact, research has indicated that when mobile devices and other screen technology is not available, negative effects may be reversible as indicated in the book, Irresistible: The Rising Use of Addictive Technology and the Business of Keeping Us Hooked. In it, the author describes a study (pg. 237) in which a group of youth enrolled in a camp where no electronics were allowed. Both at the beginning and the end of camp, their nonverbal skills were assessed, and findings indicated improvement in this area just after a week of abstaining from devices.
Still, as concerning as the impact that devices are having on social skills & practices, there is even a newer body of research that suggests that early, intensive exposure to screens in infancy might actually be a causal factor for ASD. Coined “virtual autism” by Romanian clinical psychologist Dr. Marius Zamfir, findings from a study of young children in Romanian hospitals mirrored other case studies, which provided evidence that early screen exposure was associated with development of ASD. Researchers found that children who presented to children’s hospitals with screen exposure that routinely exceeded four or more hours were found to be at significantly greater risk than those who did not. Today in Romania, removing screen exposure is utilized as one routine way to treat early ASD symptoms in youth.
In 2016, a review was published that looked deeper into this question. Researchers posited that for infants who were genetically predisposed to be at higher risk for development of ASD, the constant presence of screens in their environment may very well result in localized changes in the brain that focus on non-social sensory experiences, such as repetitive sounds or visual patterns. As had been seen in prior research, the theory was that particular areas (e.g., sensory) of the brain became hyper-developed in a way that interfered with neurological changes that are needed to handle social demands. Infants are naturally attracted to audio-visual devices that emote various lights and sound combinations, but have no experience to recognize their lack of social relevance; thus, researchers are concerned that the brains of infants with high amounts of screen time may show development that more greatly mirrors the output of devices and not human interactions.
While prior studies have shown a connection between infant screen time and ASD, the real question is one of causality or correlation. Said another way, can screen time result in a development of ASD symptoms or does having early ASD symptoms make it more likely that young infants are drawn to the screen? Research is limited in this area, but two studies suggest more than just a correlation. The first study found that cable subscription rates were significantly linked with ASD diagnoses in children under the age of three. Given that these children were very unlikely to influence parents in purchasing cable, it suggests that greater opportunity for screen exposure increased the risk for ASD symptoms. A second study found that ASD rates were higher for youth that had higher screen exposure prior to six months of age, when infants are unable to express a desire for, or turn on a screen.
Questions continue to abound about just how much mobile/screen technology is associated with social communication deficits of the young and old alike. Yet even as researchers continue to grapple with this question, we as parents, teachers, developmental therapists, and all caregivers/professionals continue to be faced with serious concerns that tech trends are contradicting basic human needs on many fronts. Even as researchers sort out how screens may affect early social development, the lineage of research that ties our technology with negative health and developmental outcomes, especially in our youth, is becoming impossible to ignore. That is, unless we are content to exchange convenience/experience for what is truly sacred—the health of our minds, bodies, and the bonds with each other. Otherwise, it is time for our practices to change.