More than Developmental: Environmental Impacts as Chronic and What This Means for Treatment, Research and Policy

Environmental factors affect brain development, but the problem does not stop there. Environmental exposures persist as body burden, they continue to accumulate, and they have ongoing and active impacts on metabolic and immune function at the subcellular, cellular, organ and systems levels. Therefore autism is more than a developmental disorder. The chronic and persistent features of autism include many treatable features as well as a component of alteration of brain development; the relative contributions of these different aspects is virtually unevaluated, but responsiveness to treatment suggests we have been underestimating the importance of chronic and persistent contributors. Understanding this aspect of autism further underscores the importance of treatment, the importance of research oriented toward environmental contributors and interventions and toward optimization of health and brain plasticity, and the allocation of major resources toward reducing unnecessary suffering.

Martha Herbert, MD, PhD is an assistant professor of neurology at Harvard Medical School, a pediatric neurologist at the Massachusetts General Hospital in Boston, a member of the MGH Center for Morphometric Analysis, and an affiliate of the Harvard-MIT-MGH Martinos Center for Biomedical Imaging. She is director of the TRANSCEND Research Program (Treatment Research and Neuroscience Evaluation of Neurodevelopmental Disorders), which utilizes multimodal imaging techniques including MRI, EEG and MEG and is particularly aimed toward using imaging in coordination with clinical observation, metabolic biomarkers and animal studies in shedding light on the physiological level of changes in autism and other neurodevelopmental disorders, and on potential domains of plasticity and targets for intervention. Dr. Herbert earned her medical degree at the Columbia University College of Physicians and Surgeons. Prior to her medical training she obtained a doctoral degree at the University of California, Santa Cruz, studying evolution and development of learning processes in biology and culture in the History of Consciousness program. She then did postdoctoral work in the philosophy and history of science. She trained in pediatrics at Cornell University Medical Center and in neurology and child neurology at the Massachusetts General Hospital. Dr. Herbert received the first Cure Autism Now Innovator Award. She is the co-chair of the Environmental Health Advisory Board of the Autism Society of America and directs their Treatment Guided Research Initiative, is on the Scientific Advisory Committee of Autism Speaks and is a co-PI of the ATN site at the Massachusetts General Hospital. Her research program includes studying what makes some autistic brains unusually large, how the parts of the brain are connected and coordinated with each other, and how we can develop measures sensitive to changes in brain function that could result from treatment interventions. She is also pursuing multisystem prospective at-risk infant sibling research to monitor medical and physiological development in parallel with behavioral development.