Monday, July 24, 2006

Autism and compensatory reasoning by imagery

[Via FMH]

Many, but not all, of persons with the label 'autism spectrum disorder' do a great deal of visual reasoning. Temple Grandin in particular has written about her own way of problem solving. It's widely assumed that the brain is 'routing around problems' by repurposing visual subsystems to solve language and reasoning problems. The adaptive brain does some things better than conventional brains, and some things less well.

A recent neuroimaging study fills out this picture:
New Scientist Breaking News - How people with autism miss the big picture

Brains scans of people with the condition show that they place excessive reliance on the parietal cortex, which analyses images, even when interpreting sentences free of any imagery. In other people, the image centre appears to be active only when the sentences contain imagery.

The results agree with anecdotal reports that people with autism are fixated on imagery but struggle to interpret words and language. They frequently excel at recording visual detail, but overlook the bigger picture and the context that comes with it.

Researchers led by Marcel Just of Carnegie Mellon University in Pittsburgh, Pennsylvania, scanned volunteers' brains while they were deciding if certain statements were true or false. Some of the statements relied on analysis of language alone, while others could only be understood by considering the imagery they conjured up. "The number 8, when rotated 90 degrees, looks like a pair of spectacles", for instance, needs both arithmetic interpretation and visualisation of the rotated number.

Just says that the observed over-reliance on the parietal cortex might have arisen to compensate for poor brain connections to the prefrontal cortex, which interprets language (Brain, DOI: 10.1093/brain/awll64)...
I'd like some evidence based recommendations on how to teach reading to someone who problem solves with the parietal cortex ...

Saturday, July 22, 2006

Create a lightweight screen reader in OS X

[This is a complete rewrite of my original post, because the initial post was misguided.]

Once upon a time if you wanted a reading aide for a child with learning disabilities you could invest hundreds of dollars in complex applications that were slow, quirky, unreliable, hard to use, and difficult to integrate into real world behaviors.

Now, if you have a Mac that can run OS X 10.3 or later, you can create a de facto reading aide that's available everywhere, from your web browser to your word processor to your PDF viewer (Preview or Acrobat). It works the same way in all of these applications -- highlight the text, type a shortcut, hear the word. (Children with motor disabilities can use OS X accessibility features to help with shortcut key use.)

You say you'd never heard of this? Well, it's not advertised. Even I (geek, special needs parent, etc) hadn't put the pieces together until now -- despite having played with this once. It turns out to be easy to do if you know the path to follow.

First, you must avoid the misleading alternative paths. OS X Tiger (10.4) includes screen reader services for visually impaired persons (VoiceOver). It's not appropriate as a reading aide however, it's too complex and designed for a very different function. Alternatively the 'services' options available for modern OS X applications (Cocoa based) includes an obscure command to read highlighted text, however the user interface is extremely awkward, shortcut key assignment is buggy in 10.3, and it doesn't work in Firefox (not Cocoa), Acrobat or Microsoft Word.

What you need to do is enable text-to-speech; it's disabled by default.

You can read the directions in the above link, or follow along here. Go to the System Preferences and look for the Speech icon (see below if this is grayed out). Click on it.

[This is from Tiger, OS X 10.4. The layout in 10.3 is a bit different but it works just as well.]

You'll probably see the Speech Recognition tab, but click on Text to Speech. The only one you want is 'Speak selected text when the key is pressed'. You'll be asked for a shortcut key.

I typed Option-S to get this. So far it works, though it's so simple there's a risk I might have change it.

Double key combinations are less likely to have conflicts, but they (Option-Control-S for example) are harder for some children to type. I may put a special mark on the option button as well as it's easy for the child to type Cmd-S (save menu) instead. If I change the shortcut combination I'll update this post.

Now if a child or adult is reading and finds a word he or she can't read the sequence is:

  1. Click twice to select word or click and drag (if you extend the selection by triple-clicking or dragging all words selected will be read).
  2. Hold the option key and tap the S key. The word is read.
PS. You can't select this preference, it is grayed out: If the preference is not available then this user has a 'managed account' and their privileges have been restricted. Annoyingly, even 10.4 does not allow one to enter an Admin username and password and get access to the preferences. You have to logout of the user account, login as an Admin, escalate user privileges, login to the user account, make the changes, logout from the user account, switch to Admin, and restrict user privileges again. I assume 10.5 will fix this ...

Update 7/31: There's definitely a bug with this functionality. I thought it was OS X 10.3 specific, but it happens with 10.4 too. I think it happens more often with slower machines. The OS seems to "miss" the keystroke. My son has learned to hold the option key and tap the S several times until the word is spoken. After the first trial it works better. The 10.4 "voices" are better than 10.3.

Reading exercises for older novice readers: ESL (English as second language)

This is yet another example of intelligence amplification by Google.

I'd been wondering where I could find readable texts for an older novice reader. My son reads at a first grade level, but his interests are age appropriate. There's not much that combines the right reading level and topic.

On a whim I typed "reading exercises" into Google. The first hits I got back were for teaching English as a second language (ESL), including this overview.

Duh. Of course, obvious in retrospect.

I'll report how well these work with the OS X word reader services and Safari.

Update: Well, the good news is I figured out how to create a lightweight OS X 10.3 reading tool by assigning a keyboard shortcut to the Safari-compatible OS X speech service. The bad news is the ESL texts I found were awful. I suspect there's much better stuff locked on Chinese web sites, but I'd need to read Chinese. I've gotten another idea though, and it might be a good one. More to say if it works ...

Wednesday, July 19, 2006

CHARGE: an ambitious study of autism seeking causal agents

I'm not sure what to make of this. It sounds exceedingly ambitious, but do we really have a good enough definition of the disorder to do this kind of study? Maybe they figure by the time it really gets going we'll have better genetic markers to use for inclusion criteria. It will likely be many years before the study yields results.
Environ Health Perspect. 2006 Jul;114(7):1119-25. The CHARGE Study: An Epidemiologic Investigation of Genetic and Environmental Factors Contributing to Autism. Hertz-Picciotto I, Croen LA, Hansen R, Jones CR, van de Water J, Pessah IN.

.... In light of major gaps in understanding of autism, a large case-control investigation of underlying environmental and genetic causes for autism and triggers of regression has been launched. The CHARGE (Childhood Autism Risks from Genetics and Environment) study will address a wide spectrum of chemical and biologic exposures, susceptibility factors, and their interactions. Phenotypic variation among children with autism will be explored, as will similarities and differences with developmental delay. The CHARGE study infrastructure includes detailed developmental assessments, medical information, questionnaire data, and biologic specimens. The CHARGE study is linked to University of California-Davis Center for Children's Environmental Health laboratories in immunology, xenobiotic measurement, cell signaling, genomics, and proteomics....
Note that when they say "environmental" they're talking about "expression may be influenced, in some cases strongly, by the prenatal and early postnatal environmental milieu". I don't know what they mean about "early postnatal". Do they mean months or years? My guess is they're looking a the first few months of life.

They definitely have enough buzzwords, I'll cross my fingers and hope they can stick with the project.

Sunday, July 09, 2006

A deluge of research on the genetics of autism

My online blog reader (bloglines) regularly checks the RSS feed I set up on PubMed to monitor autism genetics. Today I got caught up after a missing a few weeks. Lord, what a deluge. There must be forty articles, including:
  • discussion of animal models for autism (how else to find out if deep brain stimulation would help?)
  • Pten gene deletion in the mouse activates a pathway that produces disordered neurons and dysfunctional social relations (did you say ... animal model?)
  • Yep, Pten might give us an animal model ...
  • A good review (from last year?)
    .... There is no single biological or clinical marker for autism, nor is it expected that a single gene is responsible for its expression; as many as 15+ genes may be involved. However, environmental influences are also important, as concordance in monozygotic twins is less than 100% and the phenotypic expression of the disorder varies widely, even within monozygotic twins. Multiple susceptibility factors are being explored using varied methodologies, including genome-wide linkage studies, and family- and case-control candidate gene association studies. This paper reviews what is currently known about the genetic and environmental risk factors, neuropathology, and psychopharmacology of autism. Discussion of genetic factors focuses on the findings from linkage and association studies, the results of which have implicated the involvement of nearly every chromosome in the human genome. However, the most consistently replicated linkage findings have been on chromosome 7q, 2q, and 15q. The positive associations from candidate gene studies are largely unreplicated, with the possible exceptions of the GABRB3 and serotonin transporter genes. No single region of the brain or pathophysiological mechanism has yet been identified as being associated with autism. Postmortem findings, animal models, and neuroimaging studies have focused on the cerebellum, frontal cortex, hippocampus, and especially the amygdala. The cerebello-thalamo-cortical circuit may also be influential in autism...
  • the usual mixture of articles pounding more stakes into the undead heart of the MMR/thimerasol mercury meme ...
The hounds are lusting for the fox, but there's much confusion ahead ... A mouse model for autism would be a huge boon ...

Teaching special needs children to ride a bicycle: the bike camp

The web site for this bicycle camp is excellent:
Learn How to Ride a Bicycle at Lose The Training

One of the pieces for us this summer is a "Kids on 2 Wheels, Inc." week-long bike "camp" in River Falls, WI next week. (One and a half hours each day at the bike camp, 2 hours in the car!) We are hoping our son, Brandon, will realize a life-long dream and master riding a 2-wheel bike. I'll give you a review later this summer. There are great tips for teaching your child to ride at:
I've had some success using more traditional approaches, but it's been touch and go. It's hard to be patient enough, and to come up with the right mix of incentives. I found one area where the combination of packed earth, grass, and slope allowed the children to steer into terrain that gradually slows the bicycle ...

These people use modified two wheelers that look incredibly stable -- big angular momentum in the front wheel, easy to touch down. A wonderful web site and resource.

Wednesday, July 05, 2006

Science and the alternative: Autism and immunization

Years ago, my wife and I wrote an article for the Journal of Family Practice (then a respectable academic journal) called Science and the Alternative. The point of the article was that it's hard to beat Science as a foundation for action. The results of internally consistent models that survive testable predictions are far from omnipotent, but science is light years ahead of every other method humans have used for understanding our universe.

That's why this is sad:
BBC NEWS | Health | Jabs link to autism 'dispelled'

... Jackie Fletcher, from campaign group Jabs, a support network for parents who believe their children have been damaged by vaccines, said the study still did not prove there was not a link.

"What we need, and what we have always called for, is a full and open review into the link so we cann establish once and for all what the truth is."
It's over Jackie. Give it up. When belief persists in the presence of contrary evidence it shades into delusion. Sure there's a chance that all the studies are wrong and that there's some connection between immunization and autism -- but after so many negative studies that's not fertile territory. Jackie and the immunization-autism die-hards are stuck panning for gold in a stream gone dry, surrounded by a vast and promising land. This persistence is harming our autistic children by draining resources and attention, not to mention harming all children by discouraging immunization.

Credit to my medical school for nice work, probably done on a shoestring budget:
... Mercury-based vaccines and MMR jabs do not lead to an increased risk of autism, a Canadian study says.

McGill University Health Centre looked at patterns between the development disorder and jabs in 28,000 children, the Pediatrics journal reported.

They found autism rates were higher in children given jabs after thimerosal was eliminated from vaccines and after MMR vaccination coverage decreased.

...This has come at a time when autism rates have been rising across the world.

Before the 1980s, one in 2,500 children was diagnosed as autistic, a developmental disability that affects the way a person communicates and interacts with others. Now the figure is closer to one in 250.

... The team found that after thimerosal was phased out in Quebec in 1996, the autism rate rose from 59.5 per 10,000 to 82.7 per 10,000.

And after MMR coverage fell in the late 1990s, the rate rose to 102.5 per 10,000 compared to 40.6 in the late 1980s.

Lead researcher Dr Eric Fombonne said: "There is no relationship between the level of exposure to MMR vaccines and thimerosal-containing vaccines and rates of autism.

.... And he added the rise in autism rates was likely to be caused by a broader definition of autism and greater awareness of the disorder...
I wish, I hope, I pray the Autism Society of America will read this study and drop their own immunization obsession. Inflexibility is a common autistic trait, now the parents who've fought this campaign can teach by example.

Why is autism increasingly diagnosed? Well, in Minnesota at least, you don't get much help in school if you're diagnosed with "mental retardation".

Renaming accounts for a lot of the growth in the diagnosis of "autism" and seemingly related disorders. There may be other causes, but we need much better science to characterize the atypical and/or dysfunctional brain. The first task in understanding is classification, and we have never had a reliable system for classifying neurodevelopmental disorders like autism and its siblings. The good news is that the science is coming.

State of Minnesota Personal Care Assistance Guidebook

PCAs are available in Minnesota for children with cognitive and motor disorders. parents can work with a home health agency (traditional) or run their own program (Consumer directed/PCA choice).

Although we use the program, we have had surprisingly little information about how it works or what our options are. This web site seems potentially interesting. The state seems to favor the consumer directed model -- which is more work for parents.
PCA Program Consumer Guidebook

The PCA Program Consumer Guidebook has been developed to provide information about Minnesota’s Personal Care Assistance (PCA) program and the many options you have. DHS strives for a consumer directed service model so YOU make decisions about your PCA services.
Seems there's a business opportunity for outsourcing some of the work of the consumer directed model.

Monday, July 03, 2006

Healing brains, healing minds - lessons for autism

In his introduction to Grandin's 'Thinking in Pictures', Oliver Sacks writes: "What is remarkable is that Temple, now in her fifth decade, has developed some genuine appreciation of other people and other minds ..."

New cognitive capabilities in late middle-age. We're not used to thinking that way. We think of brains pretty much peaking around age 25, then entering a long decline offset by learning and experience. That may be so for neurotypical brains, but what about the injured brain? Might healing take place into the third, fourth and fifth decades?

A tantalizing thought. It's long been noted that the "personality disorders" (the term is archaic, it's likely they are fundamentally developmental disorders affecting social functions) tend to improve in middle-age. Is the brain continuing to route around damaged subsystems, slowly healing over time?

Other clues have emerged from brain injured patients who show a slow healing over years and decades, migrating from stimulus response to communication attempts to social interaction to self-awareness ... (emphases mine)
Studying a Brain Healing From 19 Lost Years - New York Times

... Mr. Wallis, 42, wears an open, curious expression and speaks in a slurred but coherent voice. He volleys a visitor's pleased-to-meet-you with, "Glad to be met," and can speak haltingly of his family's plans to light fireworks at his brother's house nearby.

For his family, each word is a miracle. For 19 years — until June 11, 2003 — Mr. Wallis lay mute and virtually unresponsive in a state of minimal consciousness, the result of a head injury suffered in a traffic accident...

... In a paper to be published on Tuesday, researchers are reporting that they have found strong evidence that Mr. Wallis's brain is healing itself, by forming new neural connections since 2003.

The paper, appearing in The Journal of Clinical Investigation, includes a series of images of Mr. Wallis's brain, the first such pictures ever taken from a late-recovering patient...

..."We read about these widely publicized cases of miraculous recovery every few years, but none of them, not one, has ever been followed up scientifically until now," said Dr. Nicholas Schiff, a neuroscientist at Weill Cornell Medical College in Manhattan and the senior author of the new imaging study...

... His mother, Angilee Wallis, said: "He is starting to learn things now. That right there is new."

In recent weeks, she said, he has also shown hints of self-awareness, alluding to his disabled condition for the first time.

... Terry Wallis was lanky 19-year-old back in 1984, with a gift for elaborate pranks and engine work, when he and two friends skidded off a small bridge in a pickup truck, landing upside down in a dry riverbed. The family never found out exactly what happened, and the crash left their son alive but unresponsive, breathing but immobilized, there but not there, his father said.

Terry Wallis showed no improvement in the first year, and doctors soon pronounced him to be in a persistent vegetative state and gave him virtually no chance of recovery, his parents said.

About 52 percent of people with traumatic wounds to the head, most often from car accidents, recover some awareness in the first year after the injury, studies find; very few do so afterward.

But at some point after his accident, probably within months, Mr. Wallis, a mechanic before his injury, entered what is called a minimally conscious state, Dr. Schiff said....

... In 2004, Dr. Schiff contacted the family, asking if they would allow their son to be studied. He helped arrange to have the Wallises flown to New York in April of that year, and again 18 months later, for brain scanning. A research team from New York, New Jersey and New Zealand spent more than a year analyzing the results, comparing them to images from healthy brains and from another minimally conscious patient who had not recovered.

Using a novel technique that allows researchers to gauge the direction and density neural fiber growth, they saw evidence of new growth in the midline cerebellum, an area involved in motor control, as Mr. Wallis gained strength and range in his limbs. Another area of new growth, located along the back of the brain, is believed by some experts to be a central switching center for conscious awareness.

The daily exercises, the interactions with his parents, his regular dose of antidepressant medication: any or all of these might have spurred brain cells to grow more connections, the researchers said...

There's a growing consensus that there are 'step functions' between coma and what we consider "full" consciousness. Arousal precedes communication precedes self-awareness. We are beginning to identify a few of the key subsystsems [1] that enable "selfhood". All fascinating, but this story also strengthens the case for decades long healing of injured brains, with improvements well into middle-age.

What are the lessons for autism and other developmental disorders? If we consider these as profound disorders of brain development, with a clinical presentation that is the result of injury and and the healing response to injury, is it not reasonable that we should see healing well into adulthood and middle-age? If we take this approach, how would we change management of autistic adults? Might those who are quite disabled at age 20 be able to find work at age 30? There's much research to be done, and little money to pay for it. Perhaps we can interest Mr. Buffett ...

[1] An eccentric genius I once knew (college roommate) told me @1981 that consciousness was mediated in part by components of the brain speaking to themselves through muscle and action. He was also into 10-12 dimensional physics around the same time. He had quite a long healing period himself, but that's another tale.

PS. The NYT journalist is perceptive and sympathetic, pointing out that Mr. Wallace's family has gained little from their media moments and mentioning the existence of a trust fund seeking donations.

Update: I forgot to comment on the antidepressant use.

Saturday, July 01, 2006

A good book for siblings of difficult children

Siblings of difficult children grow up with quite a bit of stress. This excellent book can sibs understand that anger and aggression may have roots in anxiety and sadness: (review is mine) Peace And Pancakes: Books: Anne M. Picard

...I'm told this book was self-published, the first-time author couldn't find a publisher. We live in an odd world, this is a terrific work. Publication should have been a no-brainer.

The book tells the story of an angry giant who terrorizes the forest. A young dragon learns the lessons of patience, listening, and seeing with the heart. Finally he confronts the giant, and wins the day with wisdom and pancakes.

The illustrations are excellent, the book comes with a CD as well, suitable for storing on an iPod.