Thursday, July 28, 2011

Michael for President

My grandson Michael and our daughter Rebecca visited over last weekend from New Jersey.  Michael is 14 years old and handsome, with very dark brown hair and eyes resembling his older brother Alex, and is about 5ft -9 inches tall.  He has an Autism Spectrum Disorder.  Michael is entering a regular high school this year, with some pull-out support from Special Education, to which he is looking forward with mostly positive anticipation, though he acknowledges it is a little scary, much like any other kid his age.  He plays drums in the school band. 
Michael in 2009
We went out for lunch at Mexican restaurant with one of Michael’s aunts (he had a small plain steak and fries), and had dinner at Chili’s (chicken strips and fries).  We visited the Minneapolis Art Institute to see the African masks, the mummy case and mechanical bank exhibit, and Minnesota Science Museum. At the Science Museum he was fascinated by the machine that created “tornados” out of mist by manipulating columns of air.   He also visited the Minnesota History Center featuring an exhibit of underwear made by Munsingwear, an old Minnesota company, which he found amusing and embarrassing.  We had a birthday dinner at our home with two other adult daughters and grandchildren, a situation which Michael found difficult… too many unfamiliar people and too much hub-bub. He disappeared periodically and put his hands over his eyes.   
Being with Michael these past few days reminds me of how very difficult communication and social situations are for many young people on the autism spectrum.  It is easier to tune out than try to process and react to ongoing, multipart adult comments, meaning that Michael spends a good deal of time “in his own head.”  While many typically developing kids also tune out, Michael does so very visibly the majority of the time he is with adults.  Many adult-initiated conversation attempts appear unpleasant to him, though he seems to greatly enjoy being with other people and wants to be part of family events.  When a comment or question is directed to him, there is usually a considerable delay while he appears to be trying to understand what is said and conjure up an answer.  Sometimes he answers and others not.  When he responds it is often with age-appropriate vocabulary, sometimes surprisingly complex, indicating a high degree of comprehension.  The process appears to be laborious for him, so it is easy to understand why he avoids adult questions when possible.  Scripted language is much easier for him because he doesn’t need to create a novel verbal response from whole cloth; unfortunately the scripted language doesn’t always fit the situation well, but most of the time he does very well.

Michael likes to play soccer and Wii, watching movies and kid programs on TV, and playing video games.  Sometimes he plays drums with his brother Alex. His dad is also a skilled drummer.  He knows nearly everything there is to know about The Beatles, each recording and its year, list of songs, such as "In what year was "Abbey Road" recorded and which songs did the Beatles perform?"  No problem. He has a best friend his age in NJ who also has a high functioning ASD. He and 6-7 other boys his age get together at someone’s house to hang out, some of whom have no disability.  His teachers say he enjoys school and often volunteers answers, usually appropriate to the question.  He tends to rock and makes unusual hand and arm gestures when he is not actively engaged, which unfortunately are stigmatizing.   His Mom, Dad and Stepmom are working with Michael on that.

Michael headed back to NJ a few days ago with a spiffy new bright blue T shirt with Science Museum of Minnesota printed on it in red, and a book and cylindric plastic container with liquid and some kind of precipitate in it he can use to make his own tornados. He also has a postcard from the Art Institute with photo of a bronze statue on it from ancient China that Michael referred to as “that Dude.” Unfortunately, the TSA confiscated his “tornado in a bottle” memento at the airport in Minneapolis on his return flight.  Maybe I can find a replacement and send it to him.

When I asked Michael what job he wants to do when he is older he replied, “President, and make things better for people."  Very cool. When asked whether there was a second choice of jobs, he replied “Fireman.”  Those seem to be the same job these days, given the rigid unrealistic stance of the Republicans in Washington who are trying to eliminate programs to assist people like Michael.  He may be just the right guy for the job. 

Monday, July 25, 2011

Right Wing Terrorist Tantrums

The Right Wing Christian Fundamentalist Norwegian terrorist who killed 93 of his countrymen and youths, in the belief it would promote his radical cause, described his acts as “outrageous” but “necessary,” much as Timothy McVeigh had done before him in Oklahoma City.  Anders Breivik took it upon himself, apparently together with a small group of fellow radical members of the European Military Order and Criminal Tribunal of the Knights Templar, to change the direction of his government, no matter the views of those in elected power nor the vast majority of citizens of his own country.  Indeed, like a petulant teenager outraged with his elders because they hadn’t granted him what he wanted, he threw a terrorist tantrum.

When a minority holding radical views attempt to impose their will upon their countrymen, whether by physical terrorism, as in this case, or by economic terrorism, as is being carried out by the Tea Part wing of the Republican Party, the principal is the same. The goal is to impose their will by acts of physical violence or threats of acts having similar effects, such as bringing the United States to economic collapse.  Bin Laden’s terrorist goal was to bring the US to economic ruin, and the Tea Party is helping him achieve his goal even after his death by causing the US Government to default on its debt obligations.  In addition to precipitating another Great Depression, the Tea Party’s current act of economic terrorism would have disastrous consequences on the health and well being of Americans.

If Paul Ryan’s Republican Budget Plan were enacted as proposed, it has been predicted based on years of health care research evidence, many more elderly, poor and disabled Americans would ultimately suffer and die due to lack of minimally adequate health care via Medicare.  Kanuk in Open Salon, April 29, 2011 calculated that over the first ten years of the Ryan Republican Budget plan, vulnerable people in the US would experience approximately 500,000 premature deaths due to lack of Medicare services.  That’s obviously a lot more people than Anders Breivik, Timothy McVeigh and Bin Laden killed directly. I know that sounds unbelievable, but the numbers are based on solid estimates from many years of actuarial research on medically preventable deaths (see Decker and Remler, 2004 in Applied Health Economics and Health Policy 3(4), pp 205016).   To paraphrase Shakespeare, a terrorist by any other name is still a terrorist.

Decker, S.L., Remler, D.K. (2004) How much might universal health insurance reduce socioeconomic disparities in health? A comparison of the US and Canada. Applied Health Economics and Health Policy, 3 (4), pp. 205-216.

Thursday, July 21, 2011

Fibonacci Republican Policy

Republicans politicians figuratively favor an economic system in which our (but not their) efforts are paid off under a variable ratio reward schedule composed of randomly arranged numbers from the Fibonacci series. For non-Behavior Analysts, in a typical VR 5 schedule, the numbers 1,2, 3, etc. to 10 would be scrambled up randomly so you never now how much work you’re going to have to do for the next payoff (or reinforcement occurs), but on average it would be five responses.  Leonard Fibonacci was a 12th century mathematician who discovered this phenomenon of rapidly escalating numerical values while sipping grappe and contemplating his navel in the shade of a Cypress Tree protecting him from Tuscan sun.

According to my version of the Republican Fibonacci Series plan, with each passing year of one’s life, an additional number corresponding to the sum of the two preceding numbers in the sequence becomes an additional value making up the average amount of work imposed upon a person before being rewarded.  By the time one reaches 40 years of age, suddenly the value corresponding to 102,334,155 responses becomes part of the sequence of numbers (up from 63,245,986 the previous year), making up the average amount of work that we face, which is really a stinker.  But then you already know that.  You probably thought you were no longer being rewarded for your efforts, but “fortunately” you only have 102,334,154 responses to go, i.e. pairs of shoes to sell, hotel rooms to clean, driveways to shovel, etc. the kind of work lots of Americans do. One of the reasons Republicans hate unions is that smart employees insist on having some say in these pay off schedules.  If you’re a Republican politician, on the other hand, their average Fibonacci value never exceeds that of a five or six-year old, or 8-13 responses until the next pay off…golden spoon in the mouth, and all of that, don’t you know.

This recursive property of numbers is the basis for the old trick your math teacher pulled on you in school. She said, “Which would you rather have, one penny on day, plus two pennies on day two, plus three pennies on day three and so on for 30 days, or $100? Kids nearly always pick $100, but they would better off taking the recursive penny sequence that totals $35,245.76 at the end of a month.

Related are the consequences of tax cuts as a function of income level.  If the size of tax cuts remain the same, but income increases, the absolute amount of money balloons at incomes above $500,000 (see enclosed graph from Rachel Maddow comparing tax cuts proposed by Democrats and Republicans. Now you see why the Right Wing in Congress so strongly favor keeping the Bush tax cuts for the rich.  It makes them a lot richer and has limited advantage for the rest of us and has devastating effects on the budget deficit.

During the earlier budget fiasco, the last time Barrack Obama caved in, he said, that never again would he allow continuation of the Bush Tax cuts for the rich… that is until next time, now.

If you find this stuff about the Fibonacci sequence confusing you can read more about it at\

By the way, I'm aware most Republicans have never heard of Leonard Fibonacci but they are thoroughly familiar with the concept of imposing outrageous escallating work demands upon American workers nonetheless, as well as the tax advantage of rapidly escalating values at higher incomes.

See also: J R MIllenson (1963) Random interval schedules of reinforcement. J. Exp. Anal. Behavior 6: 437-43

Friday, July 15, 2011

The Great Fire of 2011

The Great Fire of Rome occurred in AD 64.  Only four of the fourteen districts of Rome  escaped the fire; three districts were completely destroyed and the other seven suffered serious damage. It was said that Nero, the emperor sang and played the Lyre as the city burned.  Substitute Eric Cantor or Jim deMint for Nero and that pretty much sums up the current situation regarding the Great Fire of Washington DC of 2011.  While President Obama offers realistic solutions, some Democrats might say overly generous solutions,  Cantor and Bachman shout, "My way or the highway!"  Protect the rich at all costs.

Eric Cantor, Rand Paul, Michelle Bachman, Louie Gohmert and a couple dozen or so other radical Right Wing House politicians stubbornly dig in their heels like two year olds in the midst of a tantrum, while the nation teeters on the brink of economic disaster. They say utterly stupid things in the face of overwhelming contrary evidence.  Despite the fact that there will be insufficient monthly revenue coming in to cover actual expenses, for example, to pay the nation’s monthly checks for members of the arms forces, for social security and Medicaire payments for elderly in nursing homes, and other expenses beginning in August, Bachman and others say “there is plenty of money.”  That amounts to political malpractice.

Nearly all economists agree that while it is important to reduce the federal deficit in the long run, slashing the Federal budget at this tenuous time will greatly worsen the recession, further undermining jobs and eliminating essential services to economically disadvantaged and elderly people and those with disabilities.  These are the same people who ran for office in 2010 on a platform of producing jobs for Americans, but instead have pushed legislation to ban abortions in more than half of the states, bills to undermine voter rights in 32 states and increase subsidies to oil and other large corporations.  And now this. 

Here in Minnesota early behavioral intervention programs for children with autism are reeling from the financial consequences of such cuts. School districts are deciding which personnel will need to be laid off and programs eliminated.   Some community autism treatment  programs may not survive without Medicaire funding to cover the cost of their therapy employees’ wages. Their therapist have to pay their rent and buy food for their own families.  Such essential service programs cannot afford to go into debt and survive very long.  That is one of dozens of examples of services to people with disabilities, the elderly, battered women and other disadvantaged groups that face disaster because of these House members’ ignorant intransigence.  

Is it really worth bringing the nation to economic ruin in an attempt to defeat Barrack Obama in 2012, which as Senator Mitch McConnell has stated is the Republicans’ number one legislative priority?  Shall we wait for Washington to burn, this time not at the hands of the British during the War of 1812,  but instead the Republican Tea Party?

Wednesday, July 6, 2011

Two Cheers for “Double Hit” Autism Theory

A recent study in the July 4th Archives of General Psychiatry by Joachim Hallmeyer and colleagues at Stanford University indicates recurrence of strict autism within both identical and fraternal twins is lower than found in previous studies.  This suggests that a larger component of the cause of autism in such individuals may be exposure to something either prenatally or after birth that increases autism risk, but mainly in the more severe forms of autism.  Reports in the popular press would have you believe the study indicates genetics are not a major cause of autism, and some kind of "environmental" factor, is likely responsible for autism.  To put is succinctly, hokum.  That is not what the evidence showed.

The study showed that for Autism Spectrum Disorder (including PDD-NOS, Asperger and higher functioning autism not meeting the more severe cutoff score) recurrence in males was 0.77 for identical and 0.31 for fraternal twins; for female the concordance* was 0.50 for identical pairs and 0.36 for fraternal pairs.  The recurrence of ASD within twins reported here is similar to earlier studies, but somewhat lower, while the findings for “strict autism”(i.e.more severe autism) are not.  For example, Ritvo, Freeman et. al (1985) ) [Am J Psychiatry. Jan;142(1):74]  reported concordance for autism of 95.7% in the identical twins and 23.5% in the fraternal twins, and a more recent study reported concordance was 31% for fraternal and 88% for identical twins. Female and male identical twins were 100% and 86% concordant, i.e. if one had autism so did the other (Rosenberg, [2009] Arch Ped Adolesc Med 163:907)

So the long and short of it is, for people who would like to believe there is a significant non-genetic contribution to autism, they can point to the Hallmeyer findings for the more severe forms of autism and shout “Whooopeee!”   For those who think the primary causes of autism are of genetic origin, they can point to the findings for people with the less severe Autism Spectrum Disorder phenotype, and say, “See, I told you so,” though there is evidence of another factor in autism outcome in this latter group as well. By the way, few experts ever doubted that. 

It’s important to note that the Hallmeyer study provides no evidence concerning what kind of non-genetic factors may be involved.  The vaccine and mercury folks will no doubt find this encouraging for their cause, though there could be other far more plausible explanations.  

It possible the “non-genetic” effect is actually a different type of gene effect called epigenetic.  The best-known case is called imprinting. Angelman syndrome and Prader Willi syndrome can both be caused by the same genetic error on Chromosome 15, and the particular syndrome that will develop depends on whether that genetic error is inherited from the child's mother or from their father.  Such “parent of origin” effects modify the way other genes function. Various chemicals, such as some cancer causing toxins can also cause epigenetic changes leading to bad developmental outcomes.  There is no direct evidence at this time that any of those factors are related to autism, but it is possible. There are laboratory
animal studies that show severely stressful conditions can change the way some genes function, another example of an epigenetic influence.  This is a very plausible idea, but the evidence isn't in yet. 

However, in a companion study to the Hallmeyer article it was found there was increased risk of giving birth to a child with autism among mothers taking SSRI antidepressants (like Prozac or Celexa) during pregnancy. The authors say they controlled for whether the person had a mental health problem or not.  But there are several types of mental health problems that might be expected to yield very different results, e.g. OCD vs. major depression.  Depending of how many of one versus the other "mental health condition" were included, the results could vary. There have been numerous studies of prenatal effects of antidepressants, and this is the first to come up with this finding.  It is widely known that anticonvulsants during pregnancy can lead to adverse developmental outcomes, but this is the first strong evidence linking antidepressants and autism.  So if you are taking antidepressants and pregnant, talk with your doctor before stopping medication or thinking about starting an antidepressant. 

The fact that these two new studies have yielded quite different results from similar types of earlier studies warrants further examination of the study methodologies and samples. For the time being, it’s “Two Cheers for the Double Hit Theory, ” the notion that genes alone do not cause autism, but must be impacted by another factor, such as an environmental condition or an epigenetic condition. 

* Concordance or Recurrence measures how likely it is if one pair of a twin has a condition, the other will as well (blue eyes).

Friday, July 1, 2011

Spurious Correlations: Bars and Churches

You've likely heard that there is a positive correlation between the number of bars and the number of churches in small towns, which raises the question, "Do churches drive people to drink?"  Or maybe drinking causes people to attend church?

Periodically I receive email messages from helpful people commenting on the connections they see between autism and other conditions or events, usually vaccines, but sometimes other health conditions, most often gastrointestinal problems but occasionally other neurological conditions as well.

I received a very touching note recently from a person who read one of my blog entries in which I mentioned I have Meneire’s Disease, a progressive disorder of the inner ear associated with ringing of the ear, severe vertigo, vomiting and loss of low frequency hearing.  The empathetic email writer suggested that Meniere’s is related to autism, B12 deficiency, herpes virus infection, including chickenpox and shingles, candida infection, celiac disease, thyroid insufficiency, migraine disorder (Migraine-Associated Vertigo), Lyme Disease and Vitamin D deficiency.  Another website suggested Aspartame, MSG, HVP, Cysteine, HSV-1 virus and Lack of lipase enzyme are all causes or probable causes of Meniere’s (and by implication, may also be related to autism).  Many of such helpful people believe Meniere’s Disease and Autism are autoimmunie disorders, which while an interesting idea is far from proven to be the case.

While it is possible autism and Meniere’s Disease may be related (I received another message from an English physician suggesting such a connection), it seems unlikely damage to a centimeter of my inner ear could be selectively caused by all of those very different factors. There actually is a correlation between susceptibility to migraine and susceptibility to Meniere’s Disease.  That may make a little more sense since they are both related to blood vessel diameter in the head, which seems to be regulated by the release of the neurochemical, serotonin inside the brain and also among blood vessels on the surface of the skull, like the temporal artery.  Some Meniere’s correlations make sense, like consuming too much sodium increases fluid retention (including in your ears), drinking too much coffee or alcohol tends to increase blood vessel diameter, same deal.  Those are not causes, they are non-specific exacerbating conditions.  These are a bit like the admonition, “If you have a headache, stop banging your head against the wall.”

I mention this because it is very easy to get snookered into seeing correlations between things that are entirely spurious and reveal nothing regarding the cause of the condition of interest, such as autism. There is a professional journal devoted to such issues, the Journal of Spurious Correlations.  There are also correlations that are epiphenomenal, i.e. they are caused BY the condition rather than being a cause OF the condition.  Example: Children with autism are often very finicky eaters and fail to eat a balanced diet, which makes them prone to gastrointestinal problems, such as constipation, or in some cases when too much juice is consumed, loose-stools.  Parents see the gastrointestinal problem and conclude that a GI disorder is a biological cause of autism, rather than a result of having autism.

So, thanks for your thoughts about Meniere’s Disease and autism and other possible related conditions.  In the meantime I’m going to keep an eye on research being reported by the Meniere’s Society, a scientific organization devoted to diagnosis and treatment of the condition based in the UK and the National Institute on Deafness and Other Communicative Disorders in the US.