Brain scans for autism diagnosis - a lesson in press interpretation

There will probably be some discussion about a diagnostic test for autism that sounds very accurate ...

[citation needed] - trouble with biomarkers and press releases

... The latest issue of the Journal of Neuroscience contains an interesting article by Ecker et al in which the authors attempted to classify people with autism spectrum disorder (ASD) and health controls based on their brain anatomy, and report achieving “a sensitivity and specificity of up to 90% and 80%, respectively...

It's being marketed as a screening test for autism.

Not.

In a technical but very well written post Tal Yarkoni adds to a takedown by Carl Henegan writing for the Guardian (he's Director of the Center for Evidence Based Medicine at Oxford). Briefly, it's interesting science, but the spin is a load of hooey.

Yarkoni and Henegan walk through the basic statistics of pre-test and post-test probability. I say "basic" because the math is high school, but there's nothing simple about the underlying concepts. Most physicians learn them for an epi exam, and forget them within a week. The true summary of the research is "The method relies on structural (MRI) brain scans and has an accuracy rate approaching that of conventional clinical diagnosis."

So, no, it won't be useful for screening any time soon. On the other hand, it might be a big help in understanding many brain disorders, and even in redefining the classification of developmental disorders of the brain.

iPad, iPod Touch and iPhone in autism

When the iPad was first unveiled last January, one excited blogger wrote ...

Gordon's Notes: Computing for the rest of us: The iPad and the ChromeBook

... Think about your family. If it's big enough, your extended family will have at least one person who's, you know, poor. They may have cognitive or psychiatric disabilities. Or you may have a family member who, like most of American, can't keep a modern OS running without an on call geek. These people are cut off...

By 2011 the combination of a $400 iPad (and iTouch for less) and $15/month VOIP access will start to replace a number of devices that are costly to own and acquire, while providing basic net services at a rate that other family members can subsidize. Not to mention something pretty, which, speaking as someone who grew up poor, ain't a bad thing.

Steve Jobs - friend of the poor and the outcast. I wouldn't have guessed (ok, so I did predict this a year ago)..

Since then I've noted how well an iPad can work in practice for special needs persons (most elderly people are special needs, but don't tell them that) and I've configured an iPad-mini (aka an iPhone) for an adolescent with autism, ADHD, anxiety and low IQ.

Now we're reading slightly breathless reports of magical interactions of autistic persons with the iPad environment. I suspect there's some hype and wishful thinking going on, but I also believe there's some reality. These platforms are bringing communication and support technologies to populations that were previously unserviced. They are also making it possible for neurotypical non-geeks to deploy and maintain these tools at a price most families can afford.

The current iPad generation still require a desktop computer (relatively modern PC or a Mac). That's a serious roadblock to widespread deployment. There's no technical reason for this, but there may be business reasons. Apple may be unwilling to wipe out their legacy devices sales just yet. I think there's a 70% chance, however, that iPad 2 will not require a desktop device.

If you have the money and the geekiness, there's no real issue with buying and using an iPad 1.0 with your special needs person of any age (do read my writeup on the iPhone for special needs adolescents though). For most people, however, the iPad 2 or iPad 3 will be more interesting. You want to watch for a device that doesn't require a legacy desktop machine. (In our new world, Windows 7, for example, is legacy.)

 

Adolescent computing - the iPhone and iOS solution

I've written over 30 posts about computer use and the low IQ special needs child. Now I'm dealing with computer use and the low IQ ADHD/Explosive special needs adolescent. This has some special concerns.

One is vulnerability. Most special needs adolescents are vulnerable netizens, susceptible to abuse, fraud, and manipulation. This is also true, incidentally, of many neurotypical adults and most elderly adults.

Another issue is judgment and self-control. This is an issue for any adolescent (was for me, anyway), but for the "explosive child" external restrictions are particularly important. Unfortunately recent changes in net technology (https, multiple data streams, etc) have broken a lot of parental control software. OS X parental controls, in particular, are utterly broken.

Even as one computing platform wanes, however, another waxes. The iOS (iPhone, iPad, iPad Touch) platform is a better match to the needs of many special needs children and adolescents. You can read about one iPhone setup through this post and related links.

The first steps are to active iOS "restrictions", including disabling Safari, YouTube and App installation. The next steps are to add apps that further the parental agenda, while engaging your special needs child. These are some of the apps we use (note despite his disabilities my son has a knack for software, not all persons of similar IQ will use the same apps):

1. Calendaring: His iPhone Calendar app shows our family calendar, school calendar, and his calendar as well as birthdays and holidays. He is very anxious when he doesn't know his schedule. The calendar anchors him. He can edit it, he can see what's coming up. All calendars synchronize to Google Calendar feeds. (See setup link, above).
2. Contacts: I edit them for him on our Google App domain. They help him remember people. I will show him how to add pictures to them.
3. Notes: He likes to make notes in the basic app. I will introduce Dragon Dictate soon to make note taking even easier.
4. iPod: His music of course, but also all loaded with ultra-high quality educational documentaries such as BBC's 2001 documentary "The Blue Planet" ($6.40 for 8 hours). When he's dying of boredom he can now watch TV even without a data connection. Some TV, that is. (Cue evil parental laughter.)
5. Camera: He loves to take pictures. I do need to monitor this. Not all his pictures are equally appropriate.
6. Maps: Learning his environment.
7. Google Earth: obviously
8. Weather, Clock (timer is valuable), Light, Calculator, Voice Memos -- all frequently used.
9. NYTimes - he reads the sports (follows the Mets).
10. Public Radio - so far he hasn't used it.
11. SkyVoyager and Star Walk: wishful thinking. He won't use these without some thought from me.
12. Games -- all serving some educational end - Checkers, tChess Lite, UNO, Solitaire, Virtuoso (piano), Matches (memory), MemoryMtrx (short term memory), Mental Maths and Math Drills.
13. Wolfram Alpha and Wikipanion: Homework aid without Google search.
14. MobileMe iPhone location: we know where his phone is, anyway.

In future posts I'll update and revise the list of helpful apps.

Update 8/10: I received a comment praising the use of a browser product, "mobicip" that claims to substitute for Safari on the iPhone.

Unfortunately there are two reasons to be concerned about this product.

The first is that comment was fraudulently submitted. It purported to be from a user, but "DrJim" was a link to the vendor site. The comment appeared to be machine generated. These techniques violate Google's terms of service, and they are a good marker for a fraudulent enterprise.

The second reason is that mobicip's pricing is deceptive. In addition to the product purchase you must sign up for an annual subscription to get the "whitelist" functionality you truly need.

A NYT times bits post has the best available information on this topic from a source I trust. In addition to mobicip they mention:

• iWonder Surf for $15: includes whitelist abilities
• Safe Eyes Mobile for $20: they also make desktop apps

If I had to choose one I'd look first at iWonder Surf.

Update: In the space of a week this $@! kid of mine has found two loopholes in the security I set up. He discovered that Google Earth has a wikipedia layer, and that clicking on those links triggers an embedded browser than runs when Safari is disabled. He eventually found ways to navigate to places he's not allowed to go. Then he found that a suite of utilities included, for no good reason, the ability to run iGoogle within the app.

Sometimes I wonder about quite low IQ test results.

Thus far he's been so delighted in his discoveries that he shares them with me. I reward him with for the invention, but then delete the app. (Good-bye Google Earth.)

Update 8/28/10: Wikipanion bit the dust. He found some interesting topic pages and pictures. Too bad there's no World Book app. A surprisingly large number of apps have embedded WebKit browsers that are not disabled when Safari is disabled. Apple needs to provide parental controls for disabling WebKit use. I wish Apple would hire me to run their parental controls effort.

Update 9/20/10: #$#$%! Public Radio.app has a $#$@ embedded web browser. Forget the thesis of this post, Apple's iPhone parental controls are as broken as can be. The good news is my son delights in showing them to me. When you have a sub 5th percentile measured IQ, and read 3 grade levels behind, it's a real confidence builder to show your Dad you've outfoxed his security.

Update 10/31/10: Today he was caught again. This time he'd learned to use the New York Times.app search function, then to click on a hyperlink, then to escape to full web search. I've stripped every non-Apple app from the phone. This really is a serious problem.

Update 9/20/2013: Many years later, iOS 7 finally fixes the webkit hole.

Cognitive evaluation and motivation - trickier than it looks

One of my sons has substantial measured cognitive disabilities including base IQ and a range of social functions. By most recent evaluations he's borderline "mentally retarded". (A nasty phrase that's enshrined by legal statutes. Of course there's no true binary state, this is all continua.)

Which is why our titanic struggles over his misuse of internet resources are puzzling. This ought to be the mismatch of the decade. In every measure of knowledge and cognitive measurement there should be no contest between him and me.

And yet it is a struggle. Mostly I win, but he wins some too. He's proven OS X Parental Controls, for example, are utterly broken. (I have more to write about iPhone for special needs adolescence. There's more promise there, starting with disabling Safari and YouTube.)

Yes, he has a knack for software. It's not savant level, but he might be 60% for age -- that's far beyond his other cognitive skills. It's not only that however. He can be very inventive in solving the problems I create for him.

It has something, I think, to do with his alien motivations. He's not particularly motivated by neurotypical concerns like parental approval or even peer approval. This means he barely exerts himself in measurement settings where most people would at least make a go of it. Where he is motivated, therefore, he performs significantly better than his testing would suggest possible.

Of course in most domains he can't perform in the neurotypical range no matter his motivation, but the reality of his peculiar (and highly problematic) motivational structure does mean most testing will underestimate his maximal abilities (though they do predict his performance in the settings we care about).

I suspect he is not unique.

Treating autistic symptoms with oxytocin

Oxytocin plays some roles in human social behavior and empathy. Back in 2005 I wrote about the possibility of using this in autism treatment.

Alas, five years later the studies are still pretty modest -- Promoting social behavior with oxytocin in high-fu... [Proc Natl Acad Sci U S A. 2010]

Since the drug is off-patent, there may not be enough money to motivate research and production. Frustrating. We need better treatments ...