To the Editor:
After nearly seven decades of investigation, autism continues to be a widespread disorder of childhood with no known cause. The prevailing hypotheses are genetic susceptibility and environmental toxic exposure. Nutritional, allergic, and infectious conditions are also possible contributors. A review of recent research suggests that migraine with aura could be a mechanism beginning in early infancy that contributes to the fear-conflict patterns and developmental failures associated with infant autism.
Autism and migraine with aura have several characteristics in common. Both occur in infancy and have a lifelong imprint on the development of cognition, socialization, and language.1 The two disorders are also similar in their subjectivity, with barriers that make it difficult to report clinical histories. Otherwise healthy infants are routinely diagnosed on the basis of observed behaviors, as there is no direct test for either disorder.
There are remarkable visual-perceptual-cognitive aspects of early infant development related to mother-child interactions, including the visual alertness of neonates, infant visual tracking by the first month, a newborn’s ability to imitate adult facial gestures, and a child’s episodic memory and recall at 18 months.2 These first social interactions allow a healthy child to form the distinction between self and nonself. During the prelinguistic period, eye contact plays a powerful role as a signal of readiness for interaction, attention, and intimacy. Through referential eye contact, the mother leads her infant in sensorimotor tasks and the infant begins to understand the permanence of objects in time and space. The mother’s smiles, mutual gaze, and coordination of vision correlate with attachment during this critical stage of infant development.3
Research has shown that the neural circuitry within the right hemisphere of the infant’s developing brain responds rapidly to the emotional signals of stress and perceived danger, which in turn produce the self-protective behaviors of avoidance and escape.4 The sudden loss of sight, unexplained movements, and zig-zag patterns of migraine with aura may upset the unique dynamics of successful attachment between mother and child.5 It is possible that the experience of migraine aura disturbs the infant’s perception of a stable reality and threatens the security of the mother-child relationship. The visual distortions and disappearances of a migraine aura could produce behaviors characteristic of infant autism, such as fear and conflict, language deficits, gaze aversion, and approach avoidance.6,7 Further research is encouraged to explore the potential relationship between migraine with aura and infant autism. If such a link exists, it could lead to significant advances in diagnosis, early treatment, and prevention of this childhood disorder.
Sarah D. Fors
Los Angeles Unified School District (Ret.)
Grand Rapids Public Schools Special
Grand Rapids, MI
Matt F. Fors
1. Hartmann HHowells JG. Modern perspectives—1956–66. In: Modern Perspectives in Psychiatry. 1971 New York Brunner/Mazel Publishers:660
2. Meltzoff AMelzoff A, Prinz W. Elements of a developmental theory of imitation. In: The Imitative Mind: Development Evolution and Brain Bases. 2007 Cambridge, UK Cambridge University Press:19–41
3. Bowlby J Attachment and Loss. Vol. 1, Attachment. 1969 New York Basic Books
4. Schore ANBaradon T. Relational trauma and the developing right brain. In: Relational Trauma in Infancy. 2010 New York Routledge:19–47
5. Schott GD. Exploring the visual hallucinations of migraine aura: the tacit contribution of illustration. Brain. 2007;130(Pt 6):1690–1703
6. Hutt C, Ounsted C. The biological significance of gaze aversion with particular reference to the syndrome of infantile autism. Behav Sci. 1966;11:346–356
7. Hachinski VC, Porchawka J, Steele JC. Visual symptoms in the migraine syndrome. Neurology. 1973;23:570–579