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.

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.

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. :/

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/

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.

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.

Allostasis, epigenetics, and autism

This week I studied dementia in human development, and I guess one thing that is interesting is that there are many causes for dementia. Most are not Alzheimers. Maybe collapsing the diagnosis of autism wasn't such a bad idea, until we've got a bead on some causes, which I'm now thinking there will be more than one of. I'm also considering the concept of allostasis. Some are critical of the concept. It's embodied in the book "Zebras don't get ulcers". I'm not sure if allostasis is the best word for something like metabolic syndrome. Though I think the concept that insulin resistance is a defense against oxidative stress might fall into that realm. I think addiction is a similar flavor of problem (as it involves the enzymatic manipulation of intracellular messenging). If we expand this idea to behavioral addictions, it's not such a leap to autism. Some people are looking at attenuation to stress as an epigenetic problem, as with the study of cortisol in 9/11 babies. Though for it to be truly epigenetic, it would have to be children born from gametogenesis of 9/11 survivors. In utero transmission of cortisol management would point to an allostatic situation. You could think of this as the Scarlet O'Hara effect. In the novel, Scarlet is constantly disappointed in her own behavior, measuring herself against her mother. And she observes that she seems to be more like what people remember about her grandmother. The classic epigenetic study from Sweden found diabetes in people whose parents experienced famine; in utero for mothers and pre-adolescent for fathers. It takes a long view.

Social Learning and Learning Disability

My human development class as been exposing me to the theories of Vygotsky and Bandura, and it finally dawns on my why ADHD is such a problem for someone already struggling with ASD. I suppose it's symptomatic of my own ASD tendencies that I've never considered social learning to be that important. The theories of Piaget and Chomsky have always seemed more compelling to me, that the unfolding of cognition is an inherent process. Relationships had a mysterious quality for me, like the notion that a relationship has a life of its own. It is strange for me to consider it a tool for learning. Of course the truth will lie somewhere in between for most people. There are other theories as well. I use cognitive behavior tools and speak of Maslow's hierarchy. I throw evolutionary explanations around on occasion. But if socialization is a learned process and learning is a challenge, where does that leave us?

Broader Autism Phenotype

I came across this phrase today when I was raking pubmed for hits on progesterone and the brain. Well, first I'll post the link to an article about progesterone and autism: http://www.ncbi.nlm.nih.gov/pubmed/24485701 And here's an article from the 90's discussing BAP. http://ajp.psychiatryonline.org/data/Journals/AJP/3673/185.pdf The 90's is a long time ago, so I'm not sure if BAP is considered a thing or not. I guess I'll ask my sister.

Preschool evaluation

In the peculiar yin and yang of raising kids with ASD, I spent my morning with a team of folks from the school district observing Cedar for special education preschool, and then I spent the afternoon driving my oldest to and from an interview for an Ivy League college. While in general he has a vocabulary of maybe 6 words, Cedar will do something surprising now and then like count his fingers or sing the last several bars of the sandman song. The language specialist at his evaluation yesterday thought he said "red car", even though I've never heard him using a noun or an adjective before. It's probably echolalia, but I guess you start somewhere. Spacepook had a song she used to butcher, and I think she may have been this age. It was a song from Barney, "Ha ha ha, Hee hee hee, come on get silly and laugh with me." She had the first part, but then it became "gwanaiooo." I think it was supposed to be "go on you." My sisters used to say "Oh come on!" a catchphrase from Tommy Boy. Spacepook would say "Oh, go on!" Like, on some level she knew that go and come were related meanings, but inverted it likely due to an autistic theory of mind. I also remember how she used to build a 25 piece puzzle upside down, relying on the shapes of the pieces rather than the pictures. It occurred to me this little parlor trick may be analogous to their acquisition of language. Perhaps all the features that are readily noticeable are just seem like noise, when the autistic child sees structure as the important thing.

Opioid Excess theory

I was surprised that my nutrition textbook said there was some evidence for Gluten Free Casein Free diet (GFCF). There are studies, though the methodology is disputed, especially by the pediatrics establishment. What I learned about it today makes me willing to try a dietary change for a few reasons. 1) As I understand it, we shouldn't need to be utterly GFCF to see any benefit, while a lot of the Gluten Free movement in society more generally makes a big stink that you can't have a speck or you're back to square one. I was not willing to eliminate gluten AND casein on this basis. But I can do my best to come up with alternative sources of carb, protein and calcium. 2) My kids' tuning out and retreating behavior is consistent with a concept of opioid excess. 3) Me and my middle child have a marked preference for sweets, also could indicate opioid sensitivity. It goes with the lability characteristic of ASD. In other news Cedar has been humming some recognizable tunes. We thought the Dr. Who song might be wishful thinking, but the Timmy Time recess tune was clearer and now he does the chorus of "I am a Child of God." What's interesting is these seem to be fairly complex.