“And then the guilt starts again because I have brain-eating blood that attacked Hayden.”

So says Dee Cogdill of Benton, Ohio in the April 21st Cleveland Banner; Hayden is 11 years old and autistic. Cogdill and her husband, Ed, took Hayden to Johns Hopkins University to participate in a research study about maternal antibodies (more about this here). In the study that the Cogdills participated in, “an antibody in all mothers of autistic children was found in their blood that was not present in mothers with typical children.” It’s from this finding that Dee Cogdill’s comment about “guilt” comes in, and also the worry that she may have contributed or even caused her son to become autistic.

I’ve noted a similar line of thinking in parents agonizing that their genes may have “given” autism to their child, or that if only they hadn’t done something (had their child vaccinated; eaten fish while pregnant), their child might not be autistic. I still remember the mother of a friend whispering to me “She did everything right when she was expecting him” as we watched her daughter splash water on her son (also autistic) and Charlie in a little wading pool.

While the refrigerator mother theory of autism—that mothers who were “cold” and “withdrawn” actually caused their young children to become autistic—has been widely discredited, sometimes it seems that the theory continues to have a curious sort of half-life. Mothers (and fathers, if they are older) now worry that some biological cause of autism could be found that points the finger of blame at them. Perhaps this legacy of worry that “maybe I caused it” fuels efforts to find some external cause of autism, such as mercury in vaccines. Isn’t the fear that they may “cause” their child to become autistic behind some parents choosing not to vaccinate a child?

As Cynthia Whitfield, whose son Jalen is 9, wrote yesterday in Autism data grows, but not answers:

The cause of autism is poorly understood. Is it hereditary or environmental? A combination of the two? Are there factors not yet discovered?

To add to the confusion, a tidal wave of studies published over the last two years point to a wide variety of suspected causes, including advanced paternal age, advanced maternal age, mitochondrial dysfunction, genetics, alcohol use, prematurity, low birth weight, and pregnancy and birth complications.

As each year with Charlie passes—-and soon, come May, it will be the eleventh—I have been loosening myself from worrying about what cause him to be as he is, and what I may have “contributed” to this. Yesterday I took Charlie to the pediatrician’s for his annual check-up and the whole visit was practically a piece of cake: When we entered the waiting room, he sat on a bench and waited quietly. He followed the nurse’s directions to be measured and weighed and have his blood pressure taken. He followed the nurse practitioner’s instructions to sit and lie down and put her stethoscope on his chest and sat still when he got his vaccines. “He’s really healthy,” said the nurse. He pulled on his clothes after that and followed me out to the car, and that was that.

As each year with Charlie passes, I see more of myself in him, and of him in me. We like order yet appreciate spontaneity. We like, love, need music. We’re overly fond of brown noodles, be they Chinese fun, Pad Thai, or Vietnamese mian; maybe one of these days I’ll introduce Charlie to Japanese udon and soba. We don’t mind some silence.

Apologies for lapsing into sappiness (I’ve started to see ads reminding me that Mother’s Day is coming; cue up those violins!): Perhaps a mother feeling that twinge of guilt is part of being a mother—part of a mother’s love?

Just a thought.

Genetic and environmental factors are frequently cited as causes for autism (and, just to be upfront about it, the genetic studies best explain why my son is autistic). Three recent studies suggest that immunological factors ought also to be considered.

Earlier this month, two studies conducted by researchers at the University of California-Davis M.I.N.D. Institute suggested links between autism and mothers’ immune systems. According to one study, some cases of “regressive autism” (in which a child seems to be developing normally and then loses skills and becomes autistic, in contrast to “early onset autism”) may be connected to the immune systems of mothers during pregnancy; researchers hope to further study IgG antibodies as a potential factor for autism (IgG antibodies are responsible for long-term immune system responses to infection and can also contribute to autoimmune diseases such as arthritis, multiple sclerosis and lupus). Another study found that an interaction between fetal brain cells and antibodies in mothers’ blood could be linked to “stereotypies” such as flapping, toe-walking, spinning, and other repetitive behaviors often noted in autistic children.

A third study reported in the February 25th Science Daily has found that mothers of some autistic children may have produced antibodies during pregnancy that affected their fetus’ brain tissue. The antibodies crossed the placenta and may have caused changes that led to autism:

Mostly anecdotal past evidence of immune system involvement has emerged from unusual antibody levels in some autistic children and from postmortem brain tissue studies showing immune abnormalities in areas of the brain. Antibodies are proteins the body makes in response to viruses and bacteria or sometimes mistakenly against its own tissues. Yet, the majority of children with autism have no clinical evidence of autoimmune diseases, which prompted researchers to wonder whether the antibodies transferred from mother to child during pregnancy could interfere with the fetal brain directly.

To test their hypothesis, the research team used a technique called immunoblotting (or Western blot technology), in which antibodies derived from blood samples are exposed to adult and fetal brain tissue to check whether the antibodies recognize and react against specific brain proteins.

Comparing the antibody-brain interaction in samples obtained from 100 mothers of autistic children and 100 mothers of children without autism, researchers found either stronger reactivity or more areas of reactivity between antibodies and brain proteins in about 40 percent of the samples obtained from the mothers of autistic children. Further, the presence of maternal antibodies was associated with so-called developmental regression in children, increasingly immature behaviors that are a hallmark of autism.

While the findings suggest an association between autism and the presence of fetal brain antibodies, the investigators say further studies are needed to confirm that particular antibodies do indeed cross the placenta and cause damage to the fetal brain.

“The mere fact that a pregnant woman has antibodies against the fetal brain doesn’t mean she will have an autistic child,” [Harvey] Singer [M.D., director of pediatric neurology at Johns Hopkins Children's Center] says.

The new study will be published in the February issue of the Journal of Neuroimmunology.

Since these studies connecting maternal antibodies to autism are focused on the immune system of mothers, it will be interesting to see if there is a greater focus on how a mother’s health might affect her fetus and its development, and what this might have to do with autism.