Sunday, March 15, 2015
Friday, September 19, 2014
Push me, pull you. Also, The Rosie Project
A number of years ago when I was pregnant, I was diagnosed with Anxiety disorder and OCD. Hopefully the fact that I was pregnant at the time was accounted for in the diagnosis, but I guess it's not that big a deal. I made a lot of progress through cognitive behavioral modifications of various kinds. As we discussed anxiety disorder in abnormal psych last night I wasn't really sure whether I had more OCD or more GAD (General Anxiety Disorder), if it's just a case of comorbidity, or if (departing from the diagnostic manual) my symptoms would fall under Broader Autism Phenotype.
But what is interesting is how OCD and Anxiety disorders (and PTSD) are all separate chapters now (plus OC personality disorder). Not just different codeable diagnoses, but new and different chapters in the DSM-V. So much for a move toward spectra and dimensional diagnosis. I get that these disorders, especially the PTSD, have different apparent causes. Another argument is that they also involve different brain structures: the amygdala in the case of anxiety, and the cingulate gyrus in the case of OCD.
It feels like what has happened with Autism is that it's been shelved as far as etiology goes. Psychiatry is just going to look at symptoms until we can catch up to the neuroscience. My suspicion is that we will eventually find it is a pattern of alternate structures in the anxiety area, the OCD area, and also a social function area (such as the mirror circuits). Lately I've been thinking about the nature of the struggles I have in higher level social interaction. Intention is part of it, but so is relevance. One theory I've seen is that autistic toddlers have less neural pruning, so it's like they're always drinking from a firehose, in sensory terms.
Something I haven't really written about is my responses to The Rosie Project which I read this summer. A blurb on the cover talks about how everyone wants to fit in. My immediate reaction to that is "everyone wants to belong, not necessarily fit in." I also wondered about some of his reflections toward the end, about what it means to empathize with someone, and how that relates to the experience of love. The author gave into the idea that people with Asperger's don't feel romantic love. In my experience, it's not that I don't feel, but that feeling is difficult because I feel too much. It's the firehose again. Granted I'm a girl, but I think my brother is like this too. It's not that he doesn't understand people, it's that they are painful to be around.
But what is interesting is how OCD and Anxiety disorders (and PTSD) are all separate chapters now (plus OC personality disorder). Not just different codeable diagnoses, but new and different chapters in the DSM-V. So much for a move toward spectra and dimensional diagnosis. I get that these disorders, especially the PTSD, have different apparent causes. Another argument is that they also involve different brain structures: the amygdala in the case of anxiety, and the cingulate gyrus in the case of OCD.
It feels like what has happened with Autism is that it's been shelved as far as etiology goes. Psychiatry is just going to look at symptoms until we can catch up to the neuroscience. My suspicion is that we will eventually find it is a pattern of alternate structures in the anxiety area, the OCD area, and also a social function area (such as the mirror circuits). Lately I've been thinking about the nature of the struggles I have in higher level social interaction. Intention is part of it, but so is relevance. One theory I've seen is that autistic toddlers have less neural pruning, so it's like they're always drinking from a firehose, in sensory terms.
Something I haven't really written about is my responses to The Rosie Project which I read this summer. A blurb on the cover talks about how everyone wants to fit in. My immediate reaction to that is "everyone wants to belong, not necessarily fit in." I also wondered about some of his reflections toward the end, about what it means to empathize with someone, and how that relates to the experience of love. The author gave into the idea that people with Asperger's don't feel romantic love. In my experience, it's not that I don't feel, but that feeling is difficult because I feel too much. It's the firehose again. Granted I'm a girl, but I think my brother is like this too. It's not that he doesn't understand people, it's that they are painful to be around.
Saturday, September 13, 2014
Welcome to Pluto
So I'm taking Abnormal Psychology this semester, and this week we learned about diagnosis and the DSM-V, which did away with diagnoses of Asperger's Syndrome, PDD-NOS, and High Functioning Autism in favor of a single Autism Spectrum Disorder, with a system of quantifying a range of symptomology.
My lecturer guessed that personality disorders would come next, with others to follow. As she went on to discuss the issues of standardizing the language of diagnosis, I wondered to myself why they would start with Autism, a group that often features literalism and seeks semantic consistency. Maybe it's like New York, if you can make it there, you'll make it anywhere.
I have ultimately come to appreciate what they are trying to do. If you think of a map of the world, we previously had the disorders like continents you might be on. But what if you're in Asia minor Central America, or Greenland (which my son asked why it isn't considered a continent.) How is Europe its own continent, if you think about it?
What the new ASD diagnosis tries to accomplish is set up something like a coordinate system of the primary symptoms:
1. Social communication and social interaction deficits
2. Patterns of restricted or repetitive behavior/interests
Other conditions:
- Present from early childhood
- Impairment of function (social, occupational)
- Not better explained by intellectual disability or global developmental delay.
I think what a lot of self-proclaimed "Aspies" have been unhappy with in the category collapse (aside from the fact that it's a change) is that autism has been highly associated with intellectual disability. The new diagnosis places intellectual disability under specifiers that may co-occur with ASD, but is not an integral or expected symptom. There is no need to specify high functioning, because it is now assumed that ASD occurs alongside normal intellectual function.
So like Pluto, our disorders are no longer what we grew up thinking they were. But as with the demotion of Pluto, there should be an increase in general understanding of what it means to be a planet, and what the relative properties of bodies in our solar system are.
My lecturer guessed that personality disorders would come next, with others to follow. As she went on to discuss the issues of standardizing the language of diagnosis, I wondered to myself why they would start with Autism, a group that often features literalism and seeks semantic consistency. Maybe it's like New York, if you can make it there, you'll make it anywhere.
I have ultimately come to appreciate what they are trying to do. If you think of a map of the world, we previously had the disorders like continents you might be on. But what if you're in Asia minor Central America, or Greenland (which my son asked why it isn't considered a continent.) How is Europe its own continent, if you think about it?
What the new ASD diagnosis tries to accomplish is set up something like a coordinate system of the primary symptoms:
1. Social communication and social interaction deficits
2. Patterns of restricted or repetitive behavior/interests
Other conditions:
- Present from early childhood
- Impairment of function (social, occupational)
- Not better explained by intellectual disability or global developmental delay.
I think what a lot of self-proclaimed "Aspies" have been unhappy with in the category collapse (aside from the fact that it's a change) is that autism has been highly associated with intellectual disability. The new diagnosis places intellectual disability under specifiers that may co-occur with ASD, but is not an integral or expected symptom. There is no need to specify high functioning, because it is now assumed that ASD occurs alongside normal intellectual function.
So like Pluto, our disorders are no longer what we grew up thinking they were. But as with the demotion of Pluto, there should be an increase in general understanding of what it means to be a planet, and what the relative properties of bodies in our solar system are.
Monday, July 21, 2014
Head in the sand
The other day I was picking up a book from the library for my husband and saw a shelf of books about autism, and I was puzzled by my reaction. I didn't want to pick any of them up. I would happily read a book written by, say, my sister who is a psychiatrist who does genetic research and has autistic relatives. Just the last book I picked up got into the "Aspie" thing (that is, using a cute, not necessarily accurate label so we don't damage self esteem). I guess it bugs me because I used to be there, and have run that course and seen where it lands (a kid who thinks they are more normal than they are, crippled with anxiety). That's where it landed for us, at any rate.
And maybe my aversion to picking up a book was nothing more than knowing I don't have time to be sitting here blogging right now, because I'm wrapping up a semester and prepping my house for an appraisal. :/
Monday, June 30, 2014
Gender, autism and the corpus callosum
I heard a couple of things in anatomy classes having to do with the corpus callosum that I thought were pretty interesting. My lab instructor said that Kim Peek, the inspiration for Rain Main, had no corpus callosum. Though it turns out he had FG syndrome which is an x linked condition. I guess we could call that a know etiology that might be mistaken for autism, and who knows how many things we lump with autism that may be like that.
The other thing that was in my textbook was that women have more mass in their corpora callosa than men. When I was assuming Kim Peek was autistic, this seemed significant relative to what some scientists call a "protective effect" being female has for autism. I guess it still might be. Though what I observe in my children (and myself?) could be more a disruption in communication between motor and sensory, anterior and posterior in the brain rather than left and right. Though there are also correllaries to the Wernicke and Broca areas in the (generally speaking) right brain that code emotion and stuff. I should really go back and reread that paper about motor neurons and intent now that I know my way around the brain better.
Here's some links I was chasing down that I may come back to in my spare time (heh).
http://www.medicalnewstoday.com/releases/47193.php (this was used as a reference on wikipedia, but I googled the scientists)
http://www.ncbi.nlm.nih.gov/pubmed/15215213
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4041005/
Thursday, June 19, 2014
The syndrome formerly known as Asperger's
Someone linked me to the XKCD foot fetish strip
I was discussing this with someone because they said a phonologist friend didn't get it right away. In defending my position that "foot" isn't the first thing a phonologist associates to stress, I did some reading and wound up walking down memory lane with autosegmental (and nonconcatenative phonology). Naturally it came back to ASD.
I looked it up and it appears the person I was assisting worked in autosegmental phonology, even though there was reference to The Sound Pattern of English. Here's an interesting bit, to me dealing with a language delayed child: Quote 1. the features or feature-complexes which are independent in child-speech should be precisely those which may be autosegmental in adult grammar; 2. The process of language acquisition includes a task of "deautosegmentalization" or to use a less awkward term, restructuring of phonetics into linear segments.... http://hum.uchicago.edu/~jagoldsm/Papers/AimsAutosegmental.pdf pg 215 (This isn't the person I assisted, this is someone else's paper but recruits many references that are familiar to me.) This is interesting because children with the syndrome formerly known as Asperger's seem to adopt an expanded tier of interpretation. It appears they process language on the phrase or sentence level rather than the word level, evidenced by a burst of language around age 3, sometimes talking in full sentences all at once. The tendency to repeat entire phrases (often from books or TV) persists, and the difficulty in analyzing intention could also support this idea.
Wednesday, June 18, 2014
One culture is hard enough
Hekka was just talking to me about a flag retirement ceremony, in which a flag that is too worn for display is quartered and burned. (people often skip the quartering step, which bothers me, but yeah...)
I tried to explain to her that it was like in a show we saw recently, where a beloved leader's body was set adrift on a burning boat.
Why?
That's just how they do it in their culture.
It's hard enough grasping the meaning of many cultural observances, when there is such a fine line between shame and honor. In that same vein is the perennial argument over Washington's NFL team name, which was denied trademark registration this week. Is the team owner more like an autistic kid or the neurotypical berating the autistic kid with their chorus of "But I didn't intend to offend you. I meant to compliment you." I don't know. The word means something different to me than it does to you.
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