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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.

We'll get there... when we get there

Cedar seems to be counting, which is super cute. He doesn't really talk, but he started chattering (it's like babbling but sounds purposive and has intonation to it, similar to spacepook though I'm not sure whether it was at the same age.) He has a few words at a time, like go and uh-oh, but as has been the case over the last year he has two or three at a time, then retires one to start saying something else. P.S. The counting sounds like "uh, doo, rhee, or." He counts up and back.

Slice of Life 1

I suppose I'll always have my early intervention notes. I guess what I was wishing for as I was looking for books at the library today is how it is living with Cedar, my toddler. I guess the part that is strange for me is having lived through this twice before and the inevitable tendency to make comparisons. We're told we shouldn't, but it's kind of an automatic process. I'm mining my past experience looking for hope, I suppose. Was my oldest this quiet? Was she this odd? When she babbled, was it the same? I didn't record very much from that time because I was so anxious about her. Am I the same? Am I hiding from the reality of it as I did for the first couple months after Cedar was diagnosed? Hekka was diagnosed at a much older age (first through third grade), because her speech was not especially delayed. I went the long way around, looking for another explanation of her deficits. And a big part of finally accepting her diagnosis was seeing the disorder in myself. So there was double the grieving process and on the heels of that, Cedar's diagnosis. And somewhere in there, Sputnik spending a lot of time in the assistant principal's office.

dys hors d'oeuvres

I had a discussion with some friends online recently where someone threw out the term aspie, and I said I didn't like the way that tries to make a cute pet name out of a disorder, and they said it was just short for Asperger's Syndrome, which the third person (who was indirectly being called aspie) said they felt was less stigmatizing than ASD. I suppose I could make a comic of it, only it wouldn't be a comic, it would be an illustration.

A: I am frustrated by an interpersonal interaction

B: The dilemma of the aspie in a neurotypical world

Me: I don't like the term aspie. It diminishes ASD.

A: I don't like ASD.

Me: Disorder means a condition that impairs function.

A: I think a syndrome is less bad than a disorder.

Me: A syndrome is actually set of problems. I don't think it's less bad.

There was probably some pictures of cats and dictators with humorous captions blended in, but that was the conversation.

Today I decided to pick up a book about ASD, Paul G. Taylor's A Beginner's Guide to Autism Spectrum Disorders and pretty quickly ran into this same concept, the desire to destigmatize disorder. It's probably a particular annoyance I have as a linguist, when people try to water down the language.

In the case of A, I probably have to grant that he doesn't have a disorder, since he was about to find a career where his qualities were an asset, attract a spouse, reproduce, and otherwise lead a functional life. He just gets into a lot of arguments with people on the internet.

We have the case of my older daughter, and I'm not sure what the argument is there. She seems pretty successful at this point and was never diagnosed, but we got her into an early reading program due to her language delay and she had one year of speech therapy during kindergarten. So she's successful, but I believe it was due to identification of a problem and early intervention.

In my own case, I feel disordered. I have married and reproduced, but I've been sadly underemployed most my life. Eta: Understanding that this was the product of a disorder allows me to feel less anger at myself. Naming the disease from self is a two edged sword. Sure it can make you feel stigmatized, but it may also frees you from the limitations of the disease if you are able to move past it. ASD may not have been the most important reason for my lack of career progress since I had MDD, but I think it definitely figured into it.

I certainly believe there are aspects of ASD that suit one better for life, such as the ability to focus and diminished impact of peer pressure. But I think there is a quantum of identity deeper than brain architecture. I suppose that makes me superstitious. 3.

The grammar of intention

For my biology class I needed to choose an article from a specific date range from the Public Library online Science (PLoS). Just by way of explaining why I am talking about an article from 2005. I could see if there's been more recent inquiries along this line, but this is the one I just wrote a summary of so I'll be talking about it. So the article is "Grasping the Intentions of Others Using One's Own Mirror Neuron System" by Iacaboni et al.

This article came up in a search for articles on autism, even though autism is only referred to briefly in the abstract. But if you know people with autism, the whole article is very interesting as it ties together the autism triad of language disorder, social dysfunction, and motor atypicality. (The language disorder connection is not as obvious, hence the title of this blog, but does come up in the references.)

Mirror neurons are neurons in the brain that respond the same whether the subject is making an action or observing another making the same action. What this experiment looked into is whether mirror neurons are mirroring the just the action or the reason for the action (the intention). The took a couple dozen people and scanned their brains by MRI while showing them pictures of a tea cup being lifted either by the handle with two fingers or gripping the cup with the entire hand. These actions were imposed over a blank background, an orderly pre tea setting, and a disorderly after tea setting. The brain scans showed activity greater than the sum of action and context, possibly coding of intention.

What would be interesting about this coding of intention is if the intention of picking up a cup to drink were a relationship between the action of lifting the cup and the action of drinking (if I understood the discussion correctly). Rather than the brain being a like dictionary with the label of actions in one place and their meanings in another, intention was a chain of "logical association" between the actions. So the social dysfunction of autism could be the same variation (if you don't like the word failure) in reading people as in speaking words.

Of course I remember how exciting Theta grid theory first sounded when I took Morphology and the Lexicon, the idea that the meaning of words was their relationships with each other. Thought there always comes a point where this theory breaks down. Of course, that's with the limitation that a word is symbolic, while anything encoded in the mirror neuron system has an actual correlate to reality.

My experience with Aspergers/HFA is that the connections are there, but they don't follow the regular rules. The ASD child seems clueless about some situations but is inflexible about others. Think of echolalia applied to actions and intentions.

Darmok

My toddler, Cedar, is 30 months old now. He's been doing a couple of imitative things. One is the O-Re-O chorus from Wreck it Ralph, and "Uh-Oh." And I swear when he takes a little tumble he makes an utterance the general shape of "Are you OK." It's a little hard to check. But this is apparently part of how they operate, is not slicing language into constituent parts.

There's a Star Trek episode about an alien race that only communicates in stories. I was always bothered by this story since if they were incapable of using discrete words how would they tell the story? I don't know, maybe they had a complete language and something happened where the holists came to dominate the society. They had some technological superiority to the humans, they were interstellar travellers and could kidnap Captain Picard with a transporter that when around the Enterprises shields. So they apparently had well developed technical abilities. Maybe their day to day communication was sciencey and the mythological tropes were the best they could come up with for the diplomatic protocols prior humans had attempted.

Anyway, yesterday when his brother came home, Cedar smiled and turned around and walked backward to the gate in the doorway, apparently hoping to be picked up. That's what it's like. He doesn't see that if you want to be picked up, you hold your arms out to someone. Instead he assumes the posture that makes it easy for him to be picked up. We saw this kind of thing with spacepook (who was never diagnosed, but was a hand flapper) and Hekka will just kind of tackle me instead of asking in any conventional way for a hug. It's a kind of gestural hyperliteralism. How would he learn the gestures toddlers normally use?

He's the only toddler around here. He does go to a toddler class at church, but doesn't necessarily see them in interaction with their parents. He is finally going in without a fuss, which has been a big step for us.

Back to school

Today I start classes for Nursing prerequisites at SLCC. Nursing is something I've thought about doing since 2007, but then we relocated and I was working, and it always looked as though I had a couple of years of prerequisites ahead of me before I could even be a Nursing major. So I wound up taking a couple of semesters of GIS classes. If everything goes as I would wish, I would wind up being a Psychiatric Nurse Practitioner, which at the U is a doctoral program.

So the chronology is that I was thinking about my life choices in late June. Not becoming a nurse is something I don't regret for my original bachelors, but regretting something that happened 20 years ago is different from not taking an opportunity now, apparently. Two most recent posts here explain more: http://vtisha.blogspot.com/ Of course I talk about MPH there, but I that is closely allied with my goals that involve Nursing.

I guess I was thinking a lot about the MPH program in May, and then I was thinking about the SLP program in July, and I got registered at the U but then talking to my daughter about collegey things and contemplating my schedule (with an autistic toddler) gave me cold feet. But I still felt I should explore my online options, and I found a couple of online classes at the U (for SLP prereqs) and then I felt I should look again at the nursing program. It turned out to be simpler than what I recalled from looking at it 5 years ago. They have a second bachelors program, though the soonest I could apply to that is January 2015 (to start Summer 2015).

And then I thought that if I was trying to go online, I should look at SLCC. They have a lot of classes online, and the ones that aren't online have sections at night. The soonest I could apply to that program, which is an AAS, would be June 2014 (to start January 2015). The second bachelors program at the U involves a couple more prereqs and they only take applications once a year.

Another consideration in all this is the relative cost, which is much less for SLCC.

The Savage of Aveyron

Yesterday we were at the library and I saw a book about Victor, the so called Savage of Aveyron. I read it while the baby slept and the story reminded me a lot of my brother with high functioning autism. It got me reading about the Genie case and thinking back to my college days studying linguistics, and how at that time the focus was a lot on second language acquisition and the immigration wave. And because I had missed TESOL, I didn't pursue it. Applied linguistics didn't interest me as much as cognitive linguistics.

But these days with the autism epidemic, maybe there is more for me in the field. We are so reliant on language as an indicator of what goes on inside our children's heads. I've watched as my children have gone through school and have defied classification. My oldest was a late talker but became a stellar student. My second was an early talker but has run into some serious problems having to do with social function, somewhat with peers but even more with authority. Hekka has redefined my whole relationship with the brain and was diagnosed with PDD-NOS and ADHDI. And now my youngest has been diagnosed with high functioning autism and is in early intervention. He seems to be the least inclined to speak of any of my children. Though it's hard to know for sure. The home videos suggest that. But he does seem curious and social and the developmentalist said he shows good concentration.

I guess the plan is to provide him a warm and varied environment and see if things pick up around 30 months, when abstract thought actually kicks in according to the Brain Rules guy. Up until then, children speak imitatively. To my mind, it is like the language some apes have demonstrated acquiring. We have encouraged signing (we have the videos and use baby signs with him) but he doesn't use them either. The thing about signing, and what the psychiatrist who evaluated him recommended, is you can make a toddler sign.

Something that occurred to me last week is that my oldest sang before she could talk. She also had some rhymes she could repeat, but her natural language was a concern and when she played she would jibber jabber to herself.

But then it might be me. Hekka gave me one of those mother's day cards where they fill in the blanks about you. And the card said "My mom always says_____" "Nothing".

First World Problems?

Mild autism doesn't seem like a first world problem. It's a bit like obesity in that it's only a problem if you live in the first world.

Yesterday we had some time between the dentist and music, which is near the school where Hekka attended kindergarten. There's a fenced footpath between houses to the schoolyard so I parked by that and told her she could run ahead while I fed the baby. She came back in 5 min saying she didn't see the playground and I said "It's right on the other side of this house." I'd taken Cedar there during her music class a few weeks before.

15 minutes later it's about time to retrieve her for class so I carry Cedar down the path and where the playground used to be is a pile of gravel and a couple of backhoes. And no sign of Hekka. I start to wonder how far north she could have walked in 15 minutes. I started to walk around the school when she calls me from the other direction. She had also circled the school.

I was just glad to find her, of course, but tried to see if she could surmise that the playground was being replaced. It's one of those things about PDD, they can seem sort of like they know what's going on but will miss the relevance of certain things.