A history of mom blaming: The case of autism

Published on Psychology Today

Last month, US Health and Human Services (HHS) Secretary Robert F. Kenney Jr. alongside President Donald Trump announced that taking acetaminophen—the active ingredient in Tylenol—during pregnancy is linked to autism. This quickly turned the heads of most doctors, clinicians, and parents, as Tylenol has long been used by pregnant women as a pain reliever. Indeed, the US Food and Drug Administration (FDA) has a grading system for over-the-counter medications based on what research says about their risk to a developing fetus. Drugs that receive an A have been thoroughly tested in pregnant women and there is no evidence of abnormalities for the fetus when taken during any trimester. Tylenol, or acetaminophen, has always gotten straight A’s across the board.

As a result, the announcement received immediate pushback from various medical associations including the American Academy of Pediatrics (AAP), who all affirmed the safety of Tylenol during pregnancy when used as directed. Further, the announcement was made with no evidence from scientific research for a link between acetaminophen and autism. In fact, a recent study of over two million children born between 1995 and 2019 not only reported zero link between taking Tylenol and risk for autism, but they also found zero link between the drug and other developmental disabilities including ADHD (Ahlqvist et al., 2024).

However, regardless of the fact that this announcement has come without medical evidence, it is sure to send mothers in a tailspin of guilt and anxiety, as it suggests that if your child is diagnosed with autism, it is directly linked to mother’s behavior during pregnancy. This isn’t new; and in fact, blaming mothers for autism is as old as the diagnosis itself.

It started back in the 1940s when psychiatrist Leo Kanner pointed out that many of his autistic patients tended to have well-educated mothers that (according to Kanner) were “cold and distant” when interacting with their children. This mere observation turned into the “refrigerator mother” theory which Bruno Bettelheim ran with and popularized in the 1950s and 1960s, claiming that a lack of maternal warmth is what ultimately causes autism.

In 1977, a twin study debunked this theory, by comparing the commonality of autism among sets of identical twins (who share all of the same genes) and fraternal twins (who only share half). If genes play a role in producing a developmental disability, the concordance rate—or the likelihood that both twins have the same disability—should be higher in identical twins than in fraternal twins. If developmental disabilities are purely caused by something in the environment, like Tylenol, you’d expect the concordance rate to be the same across twin types. As predicted, the 1977 study showed that the concordance rate among identical twins was higher than for fraternal twins (Folstein & Rutter, 1977), and in 1995 another group of researchers went on to report that genetic factors accounted for up to 95% of the incidence of autism in their subjects (Colvert et al., 2015). This suggests that genetics plays a pretty big role in determining whether someone ends up developing autism.

But even strong evidence that autism’s roots are in our biology didn’t stop the mom blaming. In 1998, researcher Andrew Wakefield and his colleagues published a paper reporting that vaccinations—and specifically the MMR vaccine—were linked to autism (Wakefield et al., 1998), again putting the blame back on parents’ behaviors. This time, it wasn’t just that there was zero evidence of a link between vaccines and autism—Wakefield made up his data, the paper was later retracted, and he ended up losing his job and medical license. Following Wakefield’s study, other researchers tried to find a link between vaccinations and autism and every one of them has failed (e.g., Maglione et al., 2014; Taylor, Swerdfeger, & Eslick, 2014). In fact, more recent studies have only reiterated that the predictors of autism are almost entirely genetic (e.g., Tick et al., 2017).

So why blame parents? It is possible that government agencies feel pressure to find a single cause and cure for autism, and blaming parents, especially moms, is easier than swallowing the more complicated truth—namely that autism is called a “spectrum disorder” for a reason; namely that most people who have it experience it quite differently, so it will be difficult to nail down one single cause, and one single treatment.

That doesn’t mean we should stop looking for answers, but the answers should be scientifically vetted and responsibly reported. Statements about autism that are made without scientific evidence could cause more problems than they solve. For example, even though there is absolutely no scientific evidence that vaccinations cause autism, belief in the link between autism and vaccines continues to flood the news cycle, vaccination rates have plummeted, and people are dying of previously eradicated diseases, like measles and whooping cough. Now that Tylenol has been added to the list of unproven risk factors, anxious mothers are going to feel pressure not to relieve their pain by taking a safe, over the counter drug, which could leave actual illnesses during pregnancy left untreated.

So expecting parents: If you’re worried about taking Tylenol during pregnancy, or whether you should vaccinate your infants, try to follow research-based best-practices, and listen to your doctors. Know that if your child has autism, it isn’t because you aren’t a warm enough parent, or because you took Tylenol while you were pregnant, or because you vaccinated your child; instead, it was likely that the genetic makeup for autism was always there and has nothing to do with the choices you made as a parent.  

Image source: Pexels/free stock image

References

Ahlqvist, V. H., Sjöqvist, H., Dalman, C., Karlsson, H., Stephansson, O., Johansson, S., ... & Lee, B. K. (2024). Acetaminophen use during pregnancy and children’s risk of autism, ADHD, and intellectual disability. Jama, 331(14), 1205-1214.

Folstein, S., & Rutter, M. (1977). Infantile autism: a genetic study of 21 twin pairs. Journal of Child psychology and Psychiatry, 18(4), 297-321.

Kanner, L. (1943). Autistic disturbances of affective contact. Nervous child, 2(3), 217-250.

Maglione, M. A., Das, L., Raaen, L., Smith, A., Chari, R., Newberry, S., ... & Gidengil, C. (2014). Safety of vaccines used for routine immunization of US children: a systematic review. Pediatrics, 134, 325-337.

Taylor, L. E., Swerdfeger, A. L., & Eslick, G. D. (2014). Vaccines are not associated with autism: an evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32(29), 3623-3629.

Tick, B., Colvert, E., McEwen, F., Stewart, C., Woodhouse, E., Gillan, N., ... & Rijsdijk, F. (2016). Autism spectrum disorders and other mental health problems: Exploring etiological overlaps and phenotypic causal associations. Journal of the American Academy of Child & Adolescent Psychiatry, 55(2), 106-113.

Wakefield, A., Murch, S., Anthony, A., et al. (1998). Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 351 (9103): 637–41.