Is There an Up Side to Autism?

 

 

Dr. Laurent Mottron

 

 

Society’s Negative Bias Toward Autism Needs Rethinking, Expert Says

 

 

Medscape.com, by Yael Waknine, November 9, 2011 — Autism may be an advantage in some settings and should not be viewed as a defect that needs suppressing, according to a provocative article published online November 2 in Nature.


“Recent data and my own personal experience suggest it’s time to start thinking of autism as an advantage in some spheres, not a cross to bear,” author Laurent Mottron, MD, PhD, from the University of Montreal’s Center for Excellence in Pervasive Development Disorders, told Medscape Medical News.

According to the article, the definition of autism itself is biased, being characterized by “a suite of negative characteristics,” focusing on deficits that include problems with language and social interactions. However, in certain settings, such as scientific research, people with autism exhibit cognitive strength.

“We think that the kind of strengths and cognitive profile that we find in autistics are much more specific than scientists usually acknowledge,” said Dr. Mottron.

“Unfortunately, there is no gold standard for the diagnosis of autism. Clinical diagnoses are reliable among scientists, but it is just a consensus…everybody may fail.”

He noted that as a result of a diagnosis, many individuals with autism end up working at repetitive, menial jobs despite their potential to make more significant contributions to society.

“After 18 years of age they’re not kids anymore, and they’re forgotten,” he said. “People have a cliché, that if he’s autistic you can do nothing with him. That’s not true. The fact that you have some terrible autistic life is not representative of autism in general.”

Advantages

Autism should be described and investigated as an accepted variant within human species, not as a defect to be suppressed.

Dr. Mottron has 8 individuals with autism people in his research group including 4 assistants, 3 students, and 1 researcher, Michelle Dawson, whom he met almost 10 years ago during a television documentary about autism.

Following the show, Ms. Dawson experienced problems in her job as a postal worker and was asked by Dr. Mottron to edit some of his papers.

“She gave exceptional feedback, and it was clear that she had read the entire bibliography,” Dr. Mottron noted. Her single-minded autistic abilities to discern patterns out of mountains of data and instant recall of correct information made her perfectly suited to a career in science, he said.

Though lacking a formal doctorate, Ms Dawson has since coauthored 13 papers and several book chapters.

Dr. Mottron said Ms. Dawson and other individuals with autism have convinced him that more than anything, people with autism “need opportunities, [and] frequently support, but rarely treatment.”

As a result, he believes that “autism should be described and investigated as an accepted variant within human species, not as a defect to be suppressed.”

Dr. Mottron noted that autistic brains do function differently, relying less on verbal centers and demonstrating stimulation in regions that process both visual information and language.

Advantages may include spotting a pattern in a distracting environment, auditory tasks such as discriminating sound pitches, detecting visual structures, and mentally manipulating complex 3-dimensional shapes.

Individuals with autism also perform Raven’s Matrices at an average of 40% faster than nonautistics, using their analytical skills to complete an ongoing visual pattern.

Other benefits of autism include the ability to simultaneously process large amounts of perceptual information as data sets and the presence of instantaneous and correct recall.

Because data and facts are of paramount importance to people with autism, they also tend not to get bogged down in career politics or seek popularity via promotional publishing; online essays such as those posted by Ms. Dawson in her blog may instead receive unintentional acclaim.

Intellectual Disability Not Intrinsic

What we know is that if we reach these individuals at a young age, when their brains are malleable, we can cognitively redirect the transmission of information via the corpus callosum to the speech areas in the left hemisphere of the brain and oftentimes speech and language will kick in.

“I no longer believe intellectual disability is intrinsic to autism,” Dr. Mottron said, noting that intelligence in people with autism should be measured with nonverbal tests.

In his article, Dr. Mottron cites recent data, including an epidemiological study that showed the disorder is 3.5 times more prevalent than common statistics suggest.

He noted that the study showed that many of those with autism have “no adaptive problems at all,” and can function relatively normally.

However, he added, a focus on “normocentrism” prevails in some countries. France, for example, has proposed mandatory interventions aimed at forcing children with autism to adopt “typical” learning and social behaviors, rather than allowing them to make the most of their differently wired brains.

Dr. Mottron finds such a concept concerning.

“There is no current treatment for autism, just educational strategies that do not put the emphasis on learning abilities for nonsocial information…. [W]e need to take their learning style for what it is and feed it,” he said.

 

Joanne Lara

 

Some of these therapies may include engaging children with autism in a music and movement program, said Joanne Lara, MA, founder of Autism Movement Therapy, Inc, in an interview with Medscape Medical News.

“What we know is that if we reach these individuals at a young age, when their brains are malleable, we can cognitively redirect the transmission of information via the corpus callosum to the speech areas in the left hemisphere of the brain, and oftentimes speech and language will kick in.”

She continued: “The audio processing of music in the brain combined with the forward, backward, and side-to-side movements stimulate and activate the dormant areas of the brain that, in autism, do not generally receive transmission of neurons.

“Movement and music, when combined with gross motor and visual processing, oftentimes helps the areas of the brain of the individual with autism to work together to allow for a whole-brain processing approach,” she added.

Counterpoint

 

Dr. Jonathan Tarbox

 

“I think it’s critically important to acknowledge the potential strengths associated with autism, but it’s equally important, if not more important, to reiterate the notion of the right to effective treatment,” Jonathan Tarbox, PhD, BCBA-D, director of research and development at the Center for Autism and Related Disorders, Tarzana, California, told Medscape Medical News.

“If an individual with [autism] is having a difficult time in their life because they don’t know how to do something that they want to do, and there is a proven effective method to teach that skill, then we as fellow humans have a moral and ethical responsibility to provide the treatment that addresses it,” he said.

Behavioral intervention programs, he said, should be used in a supportive environment to treat skill deficits in individuals with autism wanting to learn, similar to those used for literacy and mathematics. He added that autism is no different: People who have skill deficits and want to learn have a right to effective treatment.

Dr. Tarbox took exception to Dr. Mottron’s contention that individuals with autism need opportunity more than treatment.

Environmental support, he said, does create opportunity. In addition, he noted that research shows that early intensive behavioral intervention increases the ability to communicate and function independently.

“How can a newly found ability to communicate not be considered an opportunity?” he said.

One of Dr. Mottron’s main points is that the performance of individuals with autism on visual intelligence tests is often overlooked, showing that the true intelligence of people with autism is higher overall than verbal intelligence tests would indicate.

“This is, of course, true, but true intelligence is of little relevance to a person’s everyday quality of life. What really matters is one’s ability to do what one wants to do in life independently; that is, without having to rely on support from others,” said Dr. Tarbox.

There are many people, autistic and nonautistic, who have superior intelligence, but still have much difficulty in life and suffer for it.

“There are many people, autistic and nonautistic, who have superior intelligence but still have much difficulty in life and suffer for it. Unfortunately, vocal language is the medium with which most humans interact, so deficits in one’s ability to vocally communicate are going to create barriers for people.”

Dr. Mottron also states that no education programs are tailored to the unique ways that people with autism learn.

However, Dr. Tarbox noted that there are “many tens of thousands of special education teachers, speech and language pathologists, and applied behavior analysts working to change what they do to help individuals with autism learn.”

The aim of behavioral interventions, he added, is not to try to teach individuals with autism to adopt typical learning and behavior but, rather, to teach skills that help increase independence.

Such programs, he said, “teach skills that open doors for individuals with autism, but they do not dictate which door to take.”

First-Hand Experience

I think what Dr. Mottron was getting to is the idea that autism is a different way of being, not necessary a disordered way of being, and the difference can give us strengths and abilities that other people may not have.

“I think what Dr. Mottron was getting to is the idea that autism is a different way of being, not necessary a disordered way of being, and the difference can give us strengths and abilities that other people may not have,” said Stephen M. Shore, EdD, assistant professor at Adelphi University in Long Island, New York, in an interview with Medscape Medical News, citing the well-known accomplishments of Temple Grandin, PhD.

“At the same time, there are many challenges that come with being on the autistic spectrum, such as sensory issues, communication, interacting with others. These things are challenges, and we do have to address them,” Dr. Shore noted.

 

 

Dr. Stephen M. Shor

 

Diagnosed himself with autism at age 2 and a half years, and nonverbal until age 4 years, Dr. Shore was originally recommended for institutionalization. With the help of family and others, he completed a doctoral dissertation at Boston University in Massachusetts that was focused on matching best practice to the needs of people on the autism spectrum. He now spends his time researching, teaching, writing books, and conducting autism workshops around the world.

According to Dr. Shore, the best way to address those issues is to find a way to use a person’s strengths to overcome their challenges.

“There is a point in time when you have to get off the remediation and start moving on to finding a way the person can be successful in communication,” he said. Methods may include use of a computer keyboard, rather than a pen, to write, or pointing at pictures to communicate, he said.

Adjusting the environment also plays a vital role and often benefits people without autism.

“Many autistics have sensory issues and perceive fluorescent lights as most people strobe lights, which will really affect productivity at work and school,” Dr. Shore said. “Research shows that everybody’s productivity is affected by fluorescent lamps, so everyone benefits by using alternate lighting.”

With respect to the plethora of methodologies used to address autism in children, Dr. Shore notes that the wide variety of diversity within the autism spectrum disorders necessitates a tailored approach.

Parents and educators are encouraged to pick one or more approaches that best suits the child’s needs and abilities. This may include use of Applied Behavioral Analysis, Treatment and Education of Autistic and Related Communication-Handicapped Children, Daily Life Therapy, the Miller Method, the Developmental/Individual Difference/Relationship-based method, relationship development intervention, and social communication/emotional regulation.

“You can have a right or wrong approach on an individual basis, but not on a generic basis,” he said.

 

 

Temple Grandin PhD – Autistic From Childhood

 

Temple Grandin PhD – On Mark Zuckerberg and More…..

By Crystal Phend, Senior Staff Writer, MedPageToday.com
Published: November 10, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

 

 

Children with autism appear to have bigger brains with more neurons than normal for their age, a small preliminary study affirmed.

Postmortem examinations of seven boys with autism showed 67% more neurons in the prefrontal cortex (1.94 billion), which controls social and emotional development as well as communication, compared with six controls (1.16 billion, P=0.002), Eric Courchesne, PhD, of the University of California San Diego, and colleagues found.

Autistic brains also weighed 17.6% above normal for age (P=0.001), the group reported in the Nov. 9 issue of the Journal of the American Medical Association.

Neuron counts in the autistic children should have been accompanied by brain weights of 29.4% versus the observed 17.6% enlargement, they said. “Thus, the size of the autistic brain, overlarge though it is, might actually underestimate the pathology of excess neuron numbers,” the group explained.

Researchers have long documented abnormal enlargement of the brain during childhood that persists for about 20% of individuals with autism.

These new findings are the first direct evidence that neurons, and not glial or other cell types, appear to be responsible, the researchers pointed out.

Neurons in nearly all regions of the brain are generated before birth and the excessive head and brain growth also occur before clinical manifestations of the disorder, an accompanying editorial noted.

Thus, the results “add significantly to mounting biological evidence that the developmental neuropathology of idiopathic autism begins before birth in some, possibly all, cases,” Janet E. Lainhart, MD, of the University of Utah in Salt Lake City, and Nicholas Lange, ScD, of Harvard University Schools of Medicine and Public Health in Belmont, Mass., wrote in the editorial.

What may be happening is unchecked proliferation of neurons, or a failure of the normal process of neuronal pruning through apoptosis in the third trimester and early postnatal period, Courchesne’s group suggested.

They obtained brains from several tissue banks and had expert anatomists, blinded to diagnosis, conducted unbiased stereotactic cell counts for the entire dorsolateral and mesial portions of the prefrontal cortex, rather than just estimating counts from density in small blocks.

The donors were all boys, ages 2 to 16 years, who had died in 2000 to 2006, largely due to hypoxia (drowning, hanging, or electrocution). There also was one death from a car crash, one from rhabdomyosarcoma, and one from possible cardiac arrest.

The seven autism cases fell across the spectrum of disability, with some having had normal language and daily functional abilities and others being highly impaired on both counts. None had Asperger’s syndrome or pervasive development disorder-not otherwise specified.

Neuron counts in the children with autism were:

  • 79% higher in dorsolateral prefrontal cortex at 1.57 billion compared with 0.88 billion in controls (P=0.003)
  • 29% higher in the mesial prefrontal cortex at 0.36 billion versus 0.28 billion in controls (P=0.009)

These differences as well as the overall prefrontal cortex counts remained significant between groups after controlling for age and time since death.

Whereas brain weight in controls correlated strongly with their number of prefrontal neurons (P=0.004), the same wasn’t true for the children with autism.

Glia counts overall and in the prefrontal cortex regions came out similar between groups.

The researchers cautioned that their sample of autism cases wasn’t big enough to determine any links with behavior, nor could the small sample of controls be taken as representative of all healthy young children.

Importantly, girls with autism may differ, so further studies may be needed to test whether that is the case, they noted.

This study was supported by Autism Speaks, Cure Autism Now, The Peter Emch Family Foundation, the Simons Foundation, The Thursday Club Juniors, and the University of California San Diego-National Institutes of Health Autism Center of Excellence, and by a grant from the National Institute of Mental Health.

Tissue was provided by the National Institute of Child Health and Development Brain and Tissue Bank for Developmental Disorders, the Brain and Tissue Bank for Developmental Disorders, Autism Tissue Program, and direct donations to the Courchesne laboratory.

One of the researchers reported being owner and employee of Sinq Systems, a contract research organization that performed data collection and analysis for the study, and also being an applicant on a pending patent for analysis of microscopic structure.

Lainhart and Lange reported having no conflicts of interest to disclose.

 


Primary source: Journal of the American Medical Association
Source reference:
Courchesne E, et al “Neuron number and size in prefrontal cortex of children with autism” JAMA 2011; 306(18): 2001-2010.

Additional source: Journal of the American Medical Association
Source reference:
Lainhart JE, Lange N “Increased neuron number and head size in autism” JAMA 2011; 306(18): 2031-2032.

 

 
Start Up Company Hires Only Autistic Programmers
 

 

In this photo,, Aspiritech co-founder Moshe Weitzberg works with employees at the nonprofit enterprise that specializes in finding software bugs, as they test a new program in Highland Park, Ill. Aspiritech hires only people with autism disorders. Traits that make great software testers _intense focus, comfort with repetition, memory for detail _ also happen to be characteristics of autism. (AP Photo/M. Spencer Green)

 

By Carla K. Johnson, Sept 2011, HIGHLAND PARK, Ill. (AP) — The software testers at Aspiritech are a collection of characters. Katie Levin talks nonstop. Brian Tozzo hates driving. Jamie Specht is bothered by bright lights, vacuum cleaners and the feel of carpeting against her skin. Rider Hallenstein draws cartoons of himself as a DeLorean sports car. Rick Alexander finds it unnerving to sit near other people.

This is the unusual workforce of a U.S. startup that specializes in finding software bugs by harnessing the talents of young adults with autism.

Traits that make great software testers — intense focus, comfort with repetition, memory for detail — also happen to be characteristics of autism. People with Asperger’s syndrome, a mild form of autism, have normal to high intelligence and often are highly skilled with computers.

Aspiritech, a nonprofit in Highland Park, Ill., nurtures these skills while forgiving the quirks that can make adults with autism unemployable: social awkwardness, poor eye contact, being easily overwhelmed. The company’s name plays on the words “Asperger’s,” ”spirit” and “technology.”

Clients, nine companies in Aspiritech’s first two years, have been pleased.

“They exceeded my expectations,” said Dan Tedesco of Shelton, Conn.-based HandHold Adaptive, which took a chance on Aspiritech to test an iPhone application. “There is a pride in their product you don’t usually see in this type of work.”

Aspiritech was founded by Moshe and Brenda Weitzberg after their son, Oran, now 32, was fired from a job bagging groceries. Oran was diagnosed with Asperger’s syndrome when he was 14. He now works at Aspiritech.

“He went from failing at bagging groceries to being one of the best software testers on our team,” said Brenda Weitzberg.

The Weitzbergs modeled Aspiritech on a successful Danish company called Specialisterne, or “the Specialists.” Specialisterne also employs software testers with autism. Its satisfied clients include Oracle and Microsoft.

Other companies in Belgium, Japan and Israel are either hiring or training adults with autism as software testers.

This year, Aspiritech projects $120,000 in revenue, with 60 percent coming from donations and 40 percent from clients. The Weitzbergs hope to raise the client revenue to 50 percent next year.

“There have been a couple of attempts in the U.S. and Aspiritech is the one that’s making it,” said Scott Standifer of the University of Missouri’s Disability Policy and Studies office and the organizer of a national conference on adults with autism and employment.

The exact unemployment rate for adults with autism is unknown, but it’s thought to be high, Standifer said.

“We don’t know how many adults have autism and, because of that, we don’t know their rate of unemployment,” he said. “We do know from tracking adults just emerging from high school that they are having great difficulty finding jobs.”

A 2009 U.S. Department of Education survey found the employment rate for young adults with autism was on par with that for deaf-and-blind young adults, and well below the rate of those with blindness alone or learning disabilities or traumatic brain injuries, Standifer said.

Since Asperger’s syndrome didn’t become a standard diagnosis until the early 1990s, many of Aspiritech’s software testers were adults when they first learned they were on the autism spectrum. They are pioneers, the first generation of adults with Asperger’s.

Katie Levin, 35, was diagnosed in her late 20s with Asperger’s. As a child, she’d been labeled as mentally ill.

“Asperger’s is not a mental illness,” she said. “I definitely feel like I identify with the Asperger’s community more than I did with the mental illness community.” She tests software and runs Aspiritech’s Facebook page and Twitter feed.

Rick Alexander, 24, another tester, has a degree in computer science from the Illinois Institute of Technology and completed an internship developing software for the city of Chicago.

“I have a lot of social anxiety. I don’t like meeting new people,” said Alexander, who was diagnosed with Asperger’s syndrome as a teenager. Like many of the other testers, he lives with his parents.

He’d rather be a software developer than a tester, he said. But selling himself in a job interview is “very difficult for me.”

“When you’re a child, the school is very concerned with you, the state is very concerned with you,” Alexander said. Organizations help adults with autism, he said, but “you need to approach them and for somebody with Asperger’s syndrome, it’s very difficult to do the approaching.”

Most research dollars have gone toward studying children with autism while adults have been neglected, said Molly Losh, an autism researcher at Northwestern University.

“Our vocational structure really isn’t suited to funnel people with autism into the workforce,” Losh said. Aspiritech “is a magnificent and innovative venture,” she said.

Many businesses hire offshore companies to test software. Mike Mestemaker, director of engineering for Schaumburg, Ill.-based ISI Telemanagement Solutions, chose Aspiritech because it offered competitive rates but was based in the United States.

“They dove right in and worked very quickly,” Mestemaker said. “They were very detail-oriented people. They really got the job done.”

ISI was happy with the work and has hired Aspiritech for a second project, he said.

Aspiritech provides meaningful work (pay is $12 to $15 an hour) in a relaxed environment where bosses never yell if you’re late and nobody minds if you need to be alone for a while. What’s more, the company is building social skills. The software testers, who are in their 20s and 30s, are trained to work together and they take part in organized outings: miniature golf, bowling, eating at a restaurant.

“We want to improve social skills among people who tend to be socially isolated,” said Marc Lazar, Aspiritech’s autism specialist. For many of them, software testing is not going to be their lifelong career, Lazar said, “but while they’re here they’re going to improve their job skills and they’re going to learn what kind of behavior is expected on the job and they’re going to have more to put on their resumes.”

___

AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson

AIDS Free Generation

 

 

 

MedPageToday.com, By Emily P. Walker, Washington Correspondent
Published: November 10, 2011, WASHINGTON — The United States will, for the first time, make it a policy goal to have an “AIDS-free generation” in the near future, Secretary of State Hillary Clinton announced.

The administration’s new AIDS-free generation goal will focus on “combination prevention strategy,” combining three interventions that have been proven to slow the spread of the disease: ending mother-to-child transmissions; expanding voluntary male circumcision; and making greater use of antiretroviral medications.

Scientist now have a better understanding of the virus that has infected 60 million people and killed nearly 30 million since the first case of HIV was reported in 1981. And that better understanding of a once-mysterious virus makes it an achievable goal to eradicate AIDS, Clinton said during an event at National Institutes of Health (NIH) on Tuesday.

“HIV may be with us well into the future, but the disease that it causes need not be,” Clinton said.

She outlined the three main areas of focus for the government’s AIDS-free generation plan.

  • Prevention of mother-to-child transmissions, which are responsible for one in seven new infections worldwide — it’s already a global goal of the President’s Emergency Plan For AIDS Relief (PEPFAR) to eliminate new infections in babies by 2015
  • Increase rates of voluntary male circumcision — the procedure has been shown to reduce the risk of female-to-male transmission by more than 60%
  • Use treatment to prevent new infections — recent studies show that treating HIV-positive patients with anti-retroviral drugs helps reduce transmission of the virus to a non-infected partner by 96%

Clinton said the U.S. government would commit an additional $60 million beyond the $50 million it’s already spent to explore which prevention tactics work best in sub-Saharan Africa, where AIDS is the leading cause of death.

In 2003, when President George W. Bush signed the PEPFAR legislation, only 50,000 people in sub-Saharan Africa were receiving anti-retroviral drugs. Today, more than five million sub-Saharan Africans receive the drugs, along with another one million people in other regions of the world. Most of those drugs are paid for by the U.S., either through PEPFAR or through the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

Speaking with MedPage Today after Clinton’s speech, Anthony Fauci, MD, director of the NIH’s National Institute of Allergy and Infectious Diseases, said he thought an AIDS-free generation was an achievable goal, especially in light of the relatively recent findings from the HPTN 052 trial that, in heterosexual discordant couples, if the HIV-positive partner is treated with antiretrovirals it “remarkably diminishes” the likelihood of infecting the HIV-negative partner.

“Within a reasonable amount of time, we could have an AIDS-free generation,” he said.

Another physician in the audience, Thomas Quinn, MD, director of the Johns Hopkins Center for Global Health, said that science achieved a “home run” with the HPTN 052 trial, but the challenge is convincing policymakers to fund scientifically-proven interventions. But Clinton’s message convinced him that at least one policymaker is sure that ramping up the nation’s effort to combat HIV is something that needs to be done.

“Science here has led to a policy change,” he said.