Sunday, November 27, 2005

Aging Americans prefer "disciplined" children

I didn't really have the heart to read much beyond the lead of this article: Kids Gone Wild - New York Times. It's perfectly predictable that aging boomers with older children will lose their tolerance for younger children. Predictable, but tedious.

This is a minor matter for most, though the enthusiasm for "discipline" is likely to lead to more use of physical punishment. I expect spanking to become fashionable in a "naughty" sort of way. We will rediscover that it is very hard to hit in a measured manner. Some lessons need to be relearned every twenty years.

It is not a minor matter for autistic, severe ADHD and other special needs children. We can avoid restaurants and public places (though the price may be high for our children), but we do need to take planes, trains and airplanes. The scorn and loathing of the privileged will now be amplified by the righteous indignation of those scorning our lack of "discipline".

It's good training for me to bear such scorn, and perhaps it will chop another thousand years off my stay in purgatory. It will be harsh on our children however. May God spare me the intolerance of the aging when my time comes.

Ironically we do have one "perfect" child, who even at 3 dines with grace, style, and uplifted pinky. It has nothing to do with discipline or training, it is simply her nature. We gracefully accept the associated praise when she alone dines with us, as well as the envious stares of other parents. If only they knew ...

Saturday, November 26, 2005

The cruelty of the autism quack

Prometheus debunks the toxic quackery of Dr. Buttar, a cruel parasite upon autistic children and their families. I think I can understand the terrible desperation that drives some parents into the arms of quacks and frauds; but those that prey upon them are the kin of Philip Morris and the corner meth dealer. I'm no libertarian; I think one of the responsibilities of government is to protect these parents and their children -- especially since some of these therapies may be toxic. Even if they are not directly toxic, they suck money and resources that should be used elsewhere.

The old-time Democrats and Republicans were equally guilty of failing to protect vulnerable families from such quackery, but our current regime takes neglect to new levels. The Bushies attacks on logic, rationalism and science only strengthen Dr. Buttar and his peers.

Tuesday, November 22, 2005

Autism and hypnosis: an interesting research possibility?

I studied hypnosis as a medical student. It was fascinating, but I never did work it into my clinical practice. For one thing, it takes practice to do and time to apply. I'd mostly forgotten about that course, but a New York Times review brought some of it back. The article's research descriptions of hypnotism, belief, perception, and the relationship to hyperconcentration led me to wonder how the studies would work if the subjects were autistic. How would the functional MRIs compare? A google search finds many uninteresting references to hypnotism and autism, but a PubMed search comes up with almost nothing. An interesting research opportunity?

Monday, November 21, 2005

Very annoying: the diagnostic criteria for Asperger's are not all that useful

More confirmation that Asperger's is a very vague clinical concept.
Three diagnostic approaches to Asperger syndrome: implications for research
J Autism Dev Disord. 2005 Apr;35(2):221-34.
Klin A, Pauls D, Schultz R, Volkmar F.
Yale Child Study Center, 230 South Frontage Road, New Haven, CT 06520, USA. ami.klin@Yale.Edu

OBJECTIVE: To examine the implications for research of the use of three alternative definitions for Asperger syndrome (AS). Differences across the three nosologic systems were examined in terms of diagnostic assignment, IQ profiles, comorbid symptoms, and familial aggregation of social and other psychiatric symptoms. METHOD: Standard data on diagnosis, intellectual functioning, comorbidity patterns, and family history were obtained on 65 individuals screened for a very high probability of having autism without mental retardation (or higher functioning autism, HFA) or AS. Diagnoses of AS were established based on three different approaches: DSM-IV, presence/absence of communicative phrase speech by 3 years, and a system designed to highlight prototypical features of AS. RESULTS: Agreement between the three diagnostic systems was poor. AS could be differentiated from HFA (but not from PDD-NOS) on the basis of IQ profiles in two of the three systems. Differences in patterns of comorbid symptomatology were obtained in two of the three systems, although differences were primarily driven by the PDD-NOS category. Only one of the approaches yielded differences relative to aggregation of the "broader phenotype" in family members. CONCLUSIONS: Diagnostic assignments of AS based on three commonly used approaches have low agreement and lead to different results in comparisons of IQ profiles, patterns of comorbidity, and familial aggregation of psychiatric symptoms across the approach-specific resultant groups of HFA, AS, and PDD-NOS.
Researchers need to find more reliable ways to partition their study groups. Asperger's and Autism in general is a "garbage bag" type of diagnosis and is likely to be eventually retired.

Half of Aspergers children have ASD in paternal family history

Half of boys with asperger syndrome have a paternal family history of ASD.
Entrez PubMed J Autism Dev Disord. 2005 Apr;35(2):159-66.
Asperger syndrome: familial and pre- and perinatal factors.
Gillberg C, Cederlund M.
Department of Child and Adolescent Psychiatry, University of Goteborg, Sweden.

OBJECTIVE: Study familial and pre- and perinatal factors in Asperger Syndrome (AS). METHODS: One hundred boys with AS had their records reviewed. "Pathogenetic subgroups" were defined according to presence of medical syndromes/chromosomal abnormalities, indices of familiality, and pre- and perinatal risk factors predisposing to brain damage. RESULTS: No major index of pathogenetic factors was found in 13%, a syndrome/chromosomal abnormality in 8%, pre- or perinatal risk 13%, combined pre- or perinatal risk and family history in 11%, and family history only in 55%. COMMENT: About 50% of all boys with AS have a paternal family history of autism spectrum disorder. Pre- and perinatal risks appear to be important in about 25% of cases.
Why paternal only? Might be an artifact of males being more vulnerable to expressing the genetic foundation of the disorder, since the "father" is a large part of paternal history.

Clarifying autism: two types of core behaviors vary independently

More guidance in understanding autism. Core traits, like social impairment and obsesssions, don't necessarily go together.
The genetic relationship between individual differences in social and nonsocial behaviours characteristic of autism.

Dev Sci. 2005 Sep;8(5):444-58. Related Articles, Links
Ronald A, Happe F, Plomin R.
Social Genetic and Developmental Psychiatry (SGDP) Centre, Institute of Psychiatry, King's College London, UK.

Two types of behaviours shown in children - those reflecting social impairment and nonsocial obsessive repetitive behaviours - are central to defining and diagnosing autism spectrum disorders (ASDs). Parent and teacher data on social and nonsocial behaviours were obtained from a community sample of >3000 7-year-old twin pairs. Social and nonsocial behaviours were only modestly correlated, and it was found that some individuals had extreme scores on either social or nonsocial scales but not both. Genetic model-fitting showed that social and nonsocial behaviours are both highly heritable, but their genetic overlap is modest, with most of the genetic influence being specific to either social or nonsocial behaviours. Considering these behaviours separately might help clarify gene-brain-behaviour pathways in future research.
The impliction is these are different genetic syndromes, and clinical autism occurs when an unlucky child gets stuck with either an extreme form of one of them or parts of both. It also relates autism more closely to OCD.

Sunday, November 20, 2005

Synthesasia and high IQ autism - case report

[original point via medlogs]

Daniel has fairly severe autism, a high IQ, some extraordinary intellectual abilities, and synesthasia. It's an unusal combination; such case reports define new countries of the mind. Daniel is a generous explorer. One of the most interesting aspects of his story is that he appears to have compensated for some of his core autistic disabilities ...
ABC News: Savant Gives Window to World of Autism

June 11, 2005 — - Daniel Tammet of England can verbally reel off the number pi to 22,500 decimal places in just over five hours -- though he admitted after a recent demostration that it made him "very tired."

Tammet, 26, is a phenomenon. He has done lots of amazing things -- like learning Icelandic, one of the world's most difficult languages, in just seven days.

That's because Tammet is an autistic savant. His extraordinary abilities stem from a combination of autism and a condition known as synesthesia...

... There are perhaps fewer than 50 autistic savants in the world, according to estimates by experts. Those few are people with remarkable, often staggering skills and challenges.

... he doesn't like to come to a beach just a few minutes from his home because it is made up of pebbles — too many even for him to count. That makes him uncomfortable.

Tammet can't drive or do many other things that require basic coordination. Just walking is something he had to do through an effort of will.

"I had to teach myself how to look and how to walk," he said, "how to move myself, how to coordinate myself without falling over, without looking down, without getting absorbed in my own self, my own world."

... After years of effort, Tammet has overcome many of his autistic disabilities. Now living outside of London, not only can he relate to people, he can describe what the experience of autism is like from the inside.

He loves silence, for instance.

"I experience it as like a silvery texture around my head, like condensation running down a window," he said. "If there's a sudden noise, it's like a shattering of that feeling."

... one might say Tammet has come back from the country of autism, which is a very difficult place for researchers and for parents to reach.

"I've come from a place where I felt so lonely, and so unwanted in a way," Tammet said. "And I've come along this road, and I've found this bridge, and I've come across it. And I don't know how, I don't know why, but I'm here and I'm able to talk to you today. And, for me, that's amazing."
There's an emerging meme in autism and brain research that in some people a specialized brain subsystem can compensate for a deficit in a related subsystem. Perhaps the frontal cortex, for example, may compensate for missing capabilities in the prefrontal cortext. If this does occur we may be learn to induce such compensation through training and therapy, even in children and adults who are not gifted.

Thursday, November 17, 2005

Autism-like findings in relatives of autistic children and the evolutionary biology of autism

I came to this reference via medlogs. It's quite fascinating. The more we learn about congenital structural and organizational disorders of the brain and mind, like schizophrenia and autism, the more oddity we see in how they're expressed. Here we learn that some structural aspects of "autism", a "disorder" that seems to be strongly inherited, may manifest in high functioning "non-autistic" adults ...
Brain deficits found in relatives of autism sufferers
Unaffected family members show characteristic abnormalities.
Jim Giles

People can have physical brain abnormalities similar to those found in autistic individuals without having the disorder themselves. These results come from two studies, which were presented at a conference over the weekend. Brain scans show striking similarities between the brains of autistic patients and those of their non-autistic parents and siblings.

... In one study, Eric Peterson of the University of Colorado at Boulder and his colleagues scanned the brains of 40 parents of autistic children and compared the results with functional magnetic imaging (MRI) scans from 40 [jf: normal, non-related] controls. The data look much like those obtained for comparisons between autistic and non-autistic brains, says Peterson. The results were discussed on 13 November at the annual meeting of the Society for Neuroscience in Washington.

Some areas of the brain region known as the prefrontal cortex were smaller than normal in the parents of autistic children, for example. This part of the brain is involved in understanding other peoples' motivations, something that autistic people find difficult and is thought to lie behind the problems they face in interacting socially.

Another typical symptom of autism is the tendency to avoid making eye contact. This behaviour was studied by Brendon Macewicz and colleagues at the University of North Carolina, Chapel Hill. He gave nine families with an autistic child and unaffected brother a digital camera and told them to take pictures of friends and family. Macewicz then mixed up the shots with images of strangers and tracked the childrens' eye movements while asking them to say whether the people they saw in the pictures were familiar or not.

Most people rely heavily on looking at the eyes when asked to complete this task. But autistic children are known to avoid the eyes and focus on other areas of the face. To Macewicz's surprise, the non-autistic siblings did almost exactly the same.

"This piqued our curiosity," he says. The team then ran MRI scans on the brothers, focussing on the part of the brain known as the amygdala. This area is involved in fear and is typically smaller in autistic people. "It was very interesting," says Macewicz. "The children showed a similar decrease in amygdala size to their autistic siblings." The difference was around 5-10%.

The results are intriguing, say the researchers, because the parents and siblings had not been diagnosed with autism. Macewicz says it is likely that in the unaffected siblings other brain areas, perhaps in the frontal lobes, are helping to regulate the amygdala and compensate for its smaller volume.

It may be that a core set of brain abnormalities has to be present for autism to occur, adds Peterson, and that the parents he studied do not have them all. He points out that some autism-related behavioural traits have previously been seen in the relatives of people with the condition, but that these current studies are among the first to show similarities in brain anatomy.
The clinical concept of "autism" is very vague. It's a"diagnosis" made by school systems, social services, psychiatricsts, psychologists, and researchers. There are children than all would label "autistic", but there's no doubt the concept is itself ill-defined. The group studied here is probably more homogenous than the general "autistic" population.

The results are fascinating. I do wonder how many of the parents would have been labeled as "autistic", were they children today.

This study lends credence to the "Silicon Valley nerds" theory of the increasing prevalence of autism -- that many high IQ "autistic" children are the result of increased rates of marriage between persons with autistic traits, who congregate in the tech indutries. It also strengthens the long suspected link between pre-autistic traits and "geekiness".

Classic autism is not a very adaptive condition in most human environments. Autistic children would probably die quickly in a harsh environment. So why is autism a relatively common disorder? We know from many, many examples in human evolution that a serious genetic disease (ex. sickle cell anemia) will persist when some of its component traits have adaptive advantage. It's very likely that some pre-autistic "traits" or genetic components have adaptive advantages.

I would like to know what the correlation of autism is in identical twins ...

Update 2/24/07: Correlation in identical twins can be very high, probably depending on the subtype of "autism":
... different studies have shown that if one identical twin has autism then there is a 63-98% chance that the other twin will have it. For non-identical twins (also called fraternal or dizygotic twins), the chance is between 0-10% that both twins will develop autism. The chance that siblings will be affected by autism is about 3%.
The population risk is supposedly about .7%, so siblings have about a 500% relative risk. The large spread in co-occurrence for twins is very compatible with diverse genetic causes; again we see that the word "autism" is used for a wide variety of distinct but unnamed disorders.

Tuesday, November 15, 2005

iPods for visually impaired users

Helpful for audio book use by the visually or motor impaired:
MacInTouch: timely news and tips about the Apple Macintosh

We also received suggestions about making iPods friendlier for elderly users:

[Dan Frakes] Laurence Mettam was looking for a 'large size external remote-control for an iPod.' Of the remote controls currently on the market, the one with the largest buttons is Kensington's Stereo Dock, which also includes an AC-powered dock base for connecting your iPod to your home stereo. Although the remote is basic -- just play/pause, forward/back, and volume up/down buttons -- the buttons are fairly large, backlit, and easy to use. You can see a picture of the remote here.

[Joe Savelberg] Laurence Mettam asked about a remote control for the iPod. Griffin Technologies produces the AirClick, which is a remote control with large buttons. Hope this helps.

[MacInTouch Reader] Regarding the enquiry about remote controls for iPods, another alternative would be to buy the new Apple Universal Dock and Apple Remote, along with any suitably-sized universal learning remote control (for example, Sony [URL below] sells a few with fairly large buttons). Then duplicate the controls from the Apple Remote to the universal remote. I haven't tried this, but in theory it should work. For thorough reviews of universal remotes, Remote Central is a great place to go.