res ipsa loquitur

The thing speaks for itself. A wonderful phrase for an autist who doesn’t like to speak. It arises in negligence law. Negligence does not always have to be proved; in some circumstances negligence can be assumed. If an elderly man confined to a wheelchair falls down a flight of stairs, we can assume his caretaker was negligent. It speaks for itself.

It’s like “The emperor has no clothes.” That too speaks for itself. It’s obvious, indisputable, irrefutable. Anyone can see the emperor is not wearing clothes. Congressman Al Sharpton described a scene from his childhood. His mother made a blueberry pie, and he and his friends ate it while she was gone. Of course they denied it, but blueberry pie was all over their faces. res ipsa loquitur.

Lawyers and scientists call it a “smoking gun” – virtually conclusive evidence. Relief of autistic behavior by fever is like that – compelling evidence that autistic disorders are more metabolic than structural. Cotterill described it in 1985: “When autistics have a moderate fever, they invariably display dramatically more normal behavioural patterns, including a greater desire or ability to communicate.” Brown reported his personal observations: “[T]he changes that occur in these autistic children are . . . dramatic, more like a metamorphosis in which the autistic child suddenly becomes almost normal. These children experience increased alertness, a decrease in social isolation and self-injurious behavior, an increase in verbal behavior, and an attempt to reach out and communicate with adults. And they don’t appear to be that sick.” Sullivan concluded: “[T]he change in the autistic child’s behavior is more than quiet – it is a lucid calmness, as though he suddenly has a better understanding of what is happening around him.”

If relief by fever speaks for itself, what does it say? For one, it says the ability to communicate and relate to others is not absent in these children, nor even necessarily immature – only consistently compromised or suppressed. It says autism is not primarily a structural disorder, despite many developmental anomalies detected in these brains. Brain disorders that are not structural are called metabolic encephalopathies – primary examples are hepatic encephalopathy from liver damage (e.g. cirrhosis), and urea cycle disorders – inborn difficulty detoxifying ammonia. Martha Herbert is convinced autism is a metabolic disorder – more “state” than “trait”  – largely because autistic behavior so often reverses dramatically during fever.

What is so unique about fever? For one, an increase in brain temperature much greater than the hypothalamus normally allows. Kiyatkin observed: ‘‘While data in humans are limited, it appears that fluctuations [in brain temperature] due to stress, environmental warming, etc. are relatively weak (up to 1.0–1.5 ℃), but during fever this increase is much larger, especially in children.’’ Because metabolism increases 13% for each ℃ of temperature, and blood flow increases accordingly, does this explain how fever elicits almost normal behavior in these children?

But that doesn’t explain how improvements sometimes persist days after body and brain temperature return to normal. In The Autism Revolution, Herbert and Weintraub described a young autistic child whose improved speech lasted weeks after fever ended.