tag:blogger.com,1999:blog-67339026560112552692024-03-15T03:19:04.318-05:00Mosaic of MindsCelebrating all kinds of mindsE.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.comBlogger133125tag:blogger.com,1999:blog-6733902656011255269.post-65593220893541454412017-12-15T12:02:00.000-06:002017-12-15T12:02:55.223-06:00Links to recent writing from my second home on the webThis past year, I've largely switched to using <a href="https://medium.com/@mosaicofminds" target="_blank">Medium</a>, and have gotten behind in cross-posting here. Medium is cognitively accessible, with its clean, easy-to-read formatting. It's linked to Twitter, making it more active these days than Blogspot. I've always had more Twitter followers than regular blog readers, making Medium a better platform for me.<div>
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However, I can't bring myself to completely make the switch. Medium doesn't distinguish between real posts and comments on others' posts, calling them both "stories" and displaying them on the same page. That means real posts intended for a wide audience can be hidden from view behind comments that may not be. Plus, this blog has about ten years' worth of posts (!), too many to conveniently transfer to Medium.</div>
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While I decide how best to resolve the issue, here are the links to my recent Medium posts.</div>
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<a href="https://medium.com/@mosaicofminds/maps-in-the-brain-f236998d544f" target="_blank">Maps in the Brain</a> [Neuroscience for Dummies]</div>
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<i>"The cortex has a surprisingly simple organizing principle...a 'topographic principle.'"</i></div>
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<a href="https://medium.com/@mosaicofminds/how-to-measure-what-language-a-nonspeaking-person-can-understand-is-eye-tracking-enough-e1bb490a0786" target="_blank">How to Measure What Language a Nonspeaking Person Can Understand: Is Eye-Tracking Enough?</a> [Research Review, Neuroscience for Dummies, Advocacy]</div>
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<i>"Innovative methods and surprising findings from a new study of autistic youth with minimal speech."</i></div>
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<a href="https://medium.com/@mosaicofminds/the-curb-cut-effect-how-making-public-spaces-accessible-to-people-with-disabilities-helps-everyone-d69f24c58785" target="_blank">The Curb Cut Effect: How Making Public Spaces Accessible to People with Disabilities Helps Everyone</a> [Advocacy, Research Review]</div>
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<i>"The history of curb cuts teaches us two important principles. 1. Technology designed for disabled people can help everyone... 2. When assistive technology becomes sufficiently ubiquitous and widely used, it is no longer considered assistive technology."</i></div>
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<a href="https://medium.com/@mosaicofminds/two-steps-forward-one-step-back-53381bdcb9fa" target="_blank">Two Steps Forward, One Step Back</a> [Research Review, Advocacy]</div>
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<i>"Researchers are starting to realize that 'regressive autism' is a myth based on poor methodology. The story tells us about the failings of autism research--and the complexity of human development."</i></div>
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Part 1: <a href="https://medium.com/@mosaicofminds/knowing-how-much-to-push-and-when-to-stop-lessons-from-yoga-7de263645d3b" target="_blank">Knowing How Much to Push and When to Stop: Lessons from Yoga</a> [Advocacy, Opinions]</div>
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<i>"To improve one's physical abilities, one must find the middle ground between ease and pain. That's where yoga comes in...Perhaps flow is an evolutionary adaptation to make us seek out the 'sweet spot.'"</i></div>
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Part 2: <a href="https://medium.com/@mosaicofminds/why-people-with-disabilities-struggle-with-how-far-to-push-themselves-and-when-to-stop-6a8b82a0aa8a" target="_blank">Why People With Disabilities Struggle With How Far to Push Themselves (And When To Stop</a>) [Advocacy, Opinions]</div>
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<i>"Adults with disabilities often find it difficult to know how to push themselves because they have rarely been allowed to experience the sweet spot [of effort]."</i></div>
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<a href="https://medium.com/@mosaicofminds/rumors-of-fmris-demise-have-been-greatly-exaggerated-ba23286cf825" target="_blank">Rumors of fMRI's Demise Have Been Greatly Exaggerated</a> [Neuroscience for Dummies, Research Review, Opinions]</div>
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<i>"Software bugs and statistical problems still plague fMRI research, but don't spell doom for the field." </i></div>
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<a href="https://medium.com/@mosaicofminds/why-does-ableism-cause-harm-e2e099154fbf" target="_blank">Why Does Ableism Cause Harm?</a> and <a href="https://medium.com/@mosaicofminds/i-realized-another-reason-why-ableism-is-harmful-while-discussing-with-someone-why-an-offhand-652f7c89319b" target="_blank">Continuation</a> [Advocacy, Opinions]</div>
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<i>"Even with the best intentions, you can't help someone you view as less."</i></div>
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I have a number of posts planned for the new year, plus an update on some major life and career changes.</div>
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Happy holidays and new year to all!</div>
E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-61545391380044942962016-12-14T11:48:00.000-06:002020-05-07T18:44:18.567-05:00All the #NeurodiverseSTEM Chats in One Place, At Last!In 2015, <a href="https://twitter.com/theoriesofminds" target="_blank">Elizabeth Bartmess</a>, <a href="https://twitter.com/CatalyticRxn" target="_blank">Diana Crow</a>, and <a href="https://twitter.com/mosaicofminds" target="_blank">I</a> co-ran the #NeurodiverseSTEM Twitter chats, a <a href="http://bit.ly/neurodiverseSTEM" target="_blank">biweekly forum for discussing the circumstances of neurodivergent people in STEM fields</a>. Elizabeth <a href="https://storify.com/theoriesofminds" target="_blank">Storified each session</a>, but there was no landing page for all, and only, #<a href="https://twitter.com/hashtag/neurodiverseSTEM?src=hash" target="_blank">NeurodiverseSTEM</a> chats. Until now!<br />
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<a href="https://storify.com/theoriesofminds/neurodiversestem" target="_blank">Chat #1</a>, 02/20/2015<br />
<a href="https://storify.com/theoriesofminds/neurodiversestem-chat-2" target="_blank">Chat #2</a>, 3/13/2015: How Our Neurodivergence Affects Our STEM Perspectives, and Vice Versa<br />
<a href="https://storify.com/theoriesofminds/neurodiversestem-chat-3" target="_blank">Chat #3</a>, 3/27/2015: Barriers to Advancement in STEM<br />
<a href="https://storify.com/theoriesofminds/neurodiversestem-communication" target="_blank">Chat #4</a>, 4/17/2015: Communication<br />
<a href="https://storify.com/theoriesofminds/neurodiversestem-chat-5-dual-identities" target="_blank">Chat #5</a>, 5/1/2015: ND and STEM as Dual Identities<br />
<a href="https://storify.com/theoriesofminds/neurodiversestem-chat-6-scicomm" target="_blank">Chat #6</a>, 5/15/2015: Science communication<br />
<a href="https://storify.com/theoriesofminds/neurodiversestem-including-nd-perspectives-researc" target="_blank">Chat #7</a>, 5/29/2015: Including neurodivergent perspectives in research<br />
<a href="https://storify.com/theoriesofminds/neurodiversestem-writing" target="_blank">Chat #8</a>, 6/12/2015: Technical and scientific writing<br />
<a href="https://storify.com/theoriesofminds/neurodiversestem-executive-function" target="_blank">Chat #9</a>, 6/26/2015: Executive Function and Workflow<br />
<a href="https://storify.com/theoriesofminds/neurodiversestem-mentoring" target="_blank">Chat #10</a>, 7/17/2015: Mentoring<br />
<a href="https://storify.com/theoriesofminds/neurodiversestem-networking" target="_blank">Chat #11</a>, 7/31/2015: Networking<br />
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<br />E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com2tag:blogger.com,1999:blog-6733902656011255269.post-52925936090983389652016-09-15T12:01:00.003-05:002016-09-15T12:01:48.828-05:00ADHD Tipping Points: Why people with ADHD suddenly seem to fall apart, and what you can do about itIn a recent webinar, ADHD coach and mother of an ADHD son <a href="http://www.coachingforadhd.com/laurie-dupar/">Laurie Dupar</a> introduced the concept of a "<b><i>tipping point.</i></b>" <div>
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In her coaching practice, Laurie met many people diagnosed as adults as late as middle age. Often, they had functioned well in school, at work, and in their relationships, until their lives suddenly seemed to fall apart--at which point they were finally diagnosed. Laurie developed the concept of a "<a href="http://www.coachingforadhd.com/adhd-blog/adults/inside-a-tipping-point/">tipping point</a>" (similar to what I call "hitting the wall") to describe this phenomenon. She then looked for patterns in her clients' lives to explain why these bright, successful adults were able to function so well for so long, and then suddenly could no longer do so.</div>
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<tr><td class="tr-caption" style="text-align: center;">Like a domino, a tipping point can cause many areas of life to fall apart at once.</td></tr>
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Tipping points occur because undiagnosed people have always had an ADHD brain with ADHD strengths and weaknesses. However, these traits may have never disabled them before because they found ways to compensate, and their physical and social environments allowed them to do so. </div>
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To the person with ADHD, a tipping point may feel like one is falling apart. It might also feel like confirmation that one wasn't good enough and was just pretending all along--"now it's finally caught up with me, and everyone can finally see I'm just faking being good enough." In reality, a tipping point does not reflect a person's intelligence, hard work, or competence. It simply reflects that new life circumstances make it impossible to compensate for, manage, and hide one's ADHD traits. <b>When capable adults can no longer cope, and their strategies either no longer work or actually become counterproductive, their ADHD may suddenly become obvious.</b></div>
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Laurie argued that the best way to deal with tipping points is to predict them in advance and head them off before they begin. Tipping points involve so much pain and confusion that it can be easier to prevent them than to cope with them.</div>
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Laurie most often sees tipping points when:</div>
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<li>A child moves from elementary school to middle school, middle school to high school, or high school to college.</li>
<li>An adult gets promoted at work.</li>
<li>An adult marries, or has a new baby.</li>
<li>An adult woman goes through menopause.</li>
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<a href="http://www.coachingforadhd.com/adhd-blog/strategies/5-warning-signs-that-could-be-your-tipping-point/">Life changes that can trigger a tipping point</a> include:</div>
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<b>Changes in physical environment.</b> Moving to a new home or a new workplace can trigger a tipping point. We often overlook the importance of the light, sound, crowding, traffic flow, and other factors of the physical environment, but they can impact us both directly (in terms of comfort and distraction) and indirectly (in terms of making productivity routines easier or harder to implement).</div>
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<b>New life roles. </b>When a child transitions from one level of schooling to another, they face new expectations for organization, social, and academic functioning. For example, a new middle school student must move between classes with different teachers and track assignments in a planner, while navigating increasingly cliquey peer groups. An adult promoted at work may be expected to spend less time on the tasks where she previously excelled, and more time on managing others doing those same tasks. These role changes involve changes in identity and can stress anyone, but may be even harder for those with ADHD, especially if they involve less time or greater need for executive functions.</div>
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<b>Changes in family dynamics.</b> Sometimes happy changes, such as marriage or a new baby, can trigger an ADHD tipping point. These events involve new demands from others that may push one's executive functioning to the limit--such as when a new partner expects an ADHD person to keep a spotless, organized home. Or, as with a new baby, they might reduce the time one has to implement strategies that used to help them. (As Laurie points out, adults with ADHD often <b>"use time to make up for things we've been missing." </b>New family members also means more stuff and clutter.</div>
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<b>Changes in physical health. </b>Many adult women are diagnosed at menopause because hormonal changes drastically alter their functioning. Laurie Dupar claims that estrogen helps dopamine bind to neural receptors, and thus dopamine becomes less effective when estrogen levels drop. (Note: smaller drops in estrogen levels also occur during menstrual periods, which may explain some women's claims that they have more difficulty managing their ADHD during their period). Hormonal changes during adolescence could also intensify ADHD symptoms or make them harder to manage, but they might be overlooked because teenagers are expected to be "moody" and impulsive.</div>
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<b>Changes in activity level. </b>High school athletes may have difficulty transitioning to college if they do not pursue college sports, both because they lose a great deal of structure to their time and because of the reduced physical activity itself. Physical injuries that cause a sudden drop in activity level can also cause adults to struggle in seemingly unrelated areas of work and school.</div>
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<b>Changes in sleep. </b>Prolonged sleep deprivation can cause people without ADHD to exhibit ADHD symptoms like distractibility. It will only intensify ADHD symptoms in those who actually have ADHD. ADHD traits often mean that it takes more energy to complete everyday tasks than it does for other people, thus sleep becomes more necessary, and lack of sleep more impairing than for the average person.</div>
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<b>Changes in technology usage. </b>While many people with ADHD swear by using mobile phones to set alarms, access their calendar from anywhere, and stay organized, new technology implemented thoughtlessly can disrupt analog organizational strategies without providing a replacement. For example, Laurie has worked with doctors who reached a tipping point during a transition from paper medical records to electronic ones. Doctors could no longer, for example, use the size of the stack of medical records on their desk as a clue to how much time was left to spend on them. Electronic records can also prevent use of tactile strategies. People with ADHD need to ensure that the technology they use offloads working memory demands rather than increasing them (e.g., by requiring one to hold information in working memory from one screen to the next).</div>
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Usually, a combination of these factors triggers the tipping point, because life changes typically affect several of them. For this reason, <b>the transition to college can challenge even the most talented people with ADHD.</b> Many college students are academically prepared for college, but relied on structure from home. They may not know how to structure their own time and tasks, they may not get enough sleep, may engage in less physical activity, and may have less control over their physical environment due to roommates with different preferences. Meanwhile, they face very different (and less clearly-communicated) academic and social expectations. Pretty much every factor listed (with the possible exception of physical health) plays into the transition to college. Incoming college students with ADHD may not realize that the self care and social demands of college may prove challenging even if the academics do not, and the typical disability services office, focused on academic access, may not offer much help.</div>
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This analysis underscores the fluidity of ADHD, and the continuity between those who can be diagnosed and those who cannot. The Diagnostic and Statistic Manual of Disorders (DSM), which provides the basis for diagnosis, emphasizes that ADHD should be diagnosed not based on whether a person displays frequent inattention, hyperactivity, and impulsivity, but based on whether these disable a person and causes them distress. A person may have an ADHD neurotype (for example, dysregulated dopamine systems in their brains, delayed prefrontal cortex development, and reduced prefrontal cortex activity during executive function), but they may only have the disability ADHD when they can no longer compensate for these traits or their environment makes these traits a sufficient liability to cause disability and distress. Thus, <b>a person could theoretically go back and forth over their lives between having ADHD and not having ADHD!</b></div>
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Laurie lays out a simple but powerful approach for dealing with tipping points:</div>
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<li>Try to predict whether a tipping point is coming. Are you or a loved one with ADHD about to transition to a new school or work environment? Are there upcoming changes in family dynamics? Are you about to move?</li>
<li>If a tipping point has already happened, ask yourself what changed. Physical health (including activity level and sleep)? Physical environment? Social environment? Consider all possible variables.</li>
<li>What were you doing before the tipping point that helped you in the same situation? Or, if the tipping point hasn't happened yet, what strategies are working for you now? (Not all of these may have been consciously developed. For example, a woman stopped coming to meetings on time after her promotion, only to realize that she had been relying on a neighboring coworker to see when to get up from her desk). </li>
<li>Create a structure that will work in a similar way. </li>
<li>Laurie Dupar didn't mention this step, but it's extremely important: Test your strategy to see if it works! Maybe you guessed wrong about what aspect of your old environment to replicate. Or, maybe you guessed right, but your strategy was too complicated or too hard to use. If it doesn't work, you may have to start over and develop a new one.</li>
<li>Consider working with an ADHD coach. This coach does not have to be local, because coaches are trained to work with clients remotely. However, because coaching is a new profession with still-developing credentials, Laurie recommends asking coaches where they trained, how long they have worked, and how many clients they have helped. In particular, one should ask how much experience the coach has with people in your situation (e.g., college students, middle-aged women).</li>
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Laurie's stories also highlight the importance of listening to people with ADHD and paying attention to seemingly unimportant details. Sometimes, a life transition can cause a tipping point for different reasons than one might expect. For example, she worked with a young man, formerly a good student, whose grades dropped after moving to a new school. He was happy with the new school, his motivation was high, and he was not discouraged by his poor grades. The change in school did not appear to cause his problems, so Laurie moved on to understanding the changes associated with moving house. It turned out that before he moved, this young man used to set aside a specific amount of time to relax by shooting hoops in the backyard. This left him mentally prepared to focus on studying. At his new house, there were snakes in the backyard and he was afraid to go outside. Thus, he could no longer use this routine, and his concentration (and studying) suffered. Disruptions to one's functioning can often be like this--small, prosaic, and hard to identify without asking the right questions.</div>
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In short, I gleaned the following from Laurie's talk:</div>
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<li>Tipping points are common among people with ADHD, and nothing to be ashamed of. If you are going through a tipping point, do not blame yourself or judge yourself to be inadequate. "Remember, you've always had ADHD...you have the ability to compensate somewhere." The longer you've gone before the tipping point, the more you've used your talents, creativity, and hard work to succeed.</li>
<li>ADHD traits (inattention, hyperactivity, impulsivity) and the neurodevelopment that creates them are lifelong. However, ADHD, the diagnosable disability, may not be, and a person can move into or out of ADHD status over a lifetime. Thus, clinicians and researchers must develop a sensitivity both to ADHD traits and to the subtle changes in the physical and social environment and in physical and mental health that determine disability status.</li>
<li>Certain common life changes can make ADHD traits disabling and can cause people to get diagnosed. These include changes in environment and in role. The interactions between such life changes and ADHD traits needs more attention and research.</li>
<li>ADHD tipping points can be managed, with awareness. You need to figure out what <i>was</i> working for you and how to implement something similar in your new environment or role.</li>
<li>Understanding and treating ADHD requires both an understanding of ADHD traits (which can be approached scientifically by external experts, like researchers and clinicians) and an understanding of the subtle ways ADHD traits manifest in an individual's life (which can be best understood by the person with ADHD). Thus, people with ADHD should be at the center of research and treatment.</li>
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Have you, a family member, a friend, or a student gone through a tipping point? What helped? Do you know of any research that takes the interactions between physical and social environment and ADHD traits into account? Please share your thoughts!</div>
E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com8tag:blogger.com,1999:blog-6733902656011255269.post-79763063928312646942016-07-12T21:15:00.000-05:002016-07-12T21:15:31.692-05:00New edition: How do developmental psychologists think?<i>[This is the new and improved version of an <a href="http://mosaicofminds.blogspot.com/2014/09/how-do-developmental-psychologists-think.html">old post</a>, cross-posted from Medium].</i><br /><br /><img height="267" src="https://cdn-images-1.medium.com/max/900/1*4xoI8nFo8aGWkY4BjupTQw.jpeg" width="400" /><br />Courtesy of Shutterstock.<br /><br /><br />A <a href="https://en.wikipedia.org/wiki/Developmental_psychology">developmental psychologist</a> researches how people’s minds change over their lifetime. Most study babies or children, but some focus on adolescence or old age. They could also investigate other life transitions, like parenthood, middle age, or <a href="https://en.wikipedia.org/wiki/Emerging_adulthood_and_early_adulthood">emerging adulthood</a>. Developmental psychologists care about life stages: How do we change as we move from one to the next? How we change within a life stage? Conversely, what about us stays the same as we move from one stage to another?<br /><br />Developmental psychologists care about processes of continuity and change, not particular things the human mind does. In this respect, they are different from some other sorts of psychologists, who are defined by the functions of the human mind they choose to research (i.e., cognitive psychologists study thought and perception, personality psychologists study personality, and social psychologists study group behavior). Developmental psychology, as a field, is concerned with all these areas of the human mind. Even a developmental psychologist who focuses on cognitive psychology topics, as I do, will know something about personality and social development.<br /><br />Like people in other fields, developmental psychologists are guided by a set of assumptions, which may or may not be discussed explicitly.<br /><br /><b>Assumptions Developmental Psychologists Make</b><br /><br /><b>1)Gene-environment interactions</b><br />While developmental psychologists debate nature vs. nurture just as intensely as other people, they have a unique perspective on it. They argue that you cannot explain human behavior with only genes or only experiences. Instead, they come together in a complex way, with different results than you would get from genes or environment alone. Genes and the environment interact like vinegar and baking soda. Alone, these chemicals are each inert, but they come together to make an explosive reaction. Similarly, genes and the environment come together to create an outcome — like personality traits or intelligence — that neither would have produced alone.<br /><br />The least controversial interaction is probably height. A large amount of variation in people’s heights is genetically determined: tall people tend to have tall children; short people tend to have short children; and siblings tend to have similar heights. However, nutrition determines whether people will grow as tall as their genes permit them to be. For this reason, my grandparents were taller than my great-grandparents, and my parents were taller than my grandparents. Improvements in nutrition seem to have plateaued, and so has height; my generation (millenials) is the first in some time not to exceed their own parents’ height. Notice that the genetic relationships here (parent to child) are constant across the generations from your great-grandparents to yourself, but differences in environment (nutrition) produce large differences in height.<br /><br />More complicated and controversial are theories like the <a href="http://www.theatlantic.com/magazine/archive/2009/12/the-science-of-success/307761/">Orchid Hypothesis</a>, which posits that different people are differentially reactive to their environments, whether these are good or bad. In other words, some people react a lot to their environments, while others react much less. More reactive people will be the most successful in a good environment, but least successful in a bad environment. As far as I know, this theory is still new and not completely accepted, but it’s based on research on stress and resilience that iswidely accepted. Some children who have suffered abuse and neglect will have worse life outcomes than others, and one contributing factor is differences in specific genes. This is a well-known gene-environment interaction.<br /><br /><b>2) Developmental trajectories</b><br />You don’t have to be a developmental psychologist to notice that different individuals develop at slightly different rates. Some children learn to talk and read early and remain skilled speakers and readers throughout their lives, while others develop language and reading skills more slowly and never achieve the same levels. Some children are taller than their peers from an early age, and remain so over time, while others start out short and stay that way.<br /><br />More interesting, though, are children who start behind their peers in a skill and come out ahead, or vice versa. For example, Einstein, though a late talker, developed fine speaking, reading, and writing skills by adulthood, and some late-talking children today follow a similar pattern. Meanwhile, some children with precocious academic skills and high IQ scores in preschool, kindergarten, or first grade may perform <a href="http://jeg.sagepub.com/content/29/4/451.abstract">more like their peers</a> by third grade. (For this reason, experts on gifted children often recommend getting one’s children IQ tested at 6 or 7 years old).<br /><br />Children’s rate of development of a skill can change — not only relative to peers the same age, but also relative to themselves at earlier ages. When developmental psychologists think about growth, they imagine a line graph, where the steepness of the slope of the line represents the speed of development, and changes in the slope represent changes in the rate of development over time.<br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
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<tr><td class="tr-caption" style="text-align: center;">In this example of developmental trajectories, each line represents an autistic preschool child's vocabulary. Parents were given a survey four times, which asked how many words their child could both say and understand.</td></tr>
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<br />Developmental trajectory is especially interesting in two cases: when comparing typical with atypical development, and when comparing different individual children.<br /><br />Language development often follows a different trajectory in autism than in typical development. Speech is often delayed. Also, the rate of growth may seem to slow down for a while, stop entirely (what developmental psychologists call a “plateau”), or even reverse (“regression”). On the other hand, autistic people may continue developing language skills longer than neurotypical peers, sometimes improving into adulthood. And of course, since autism embraces people with a wide range of characteristics, you can find autistic people with every imaginable trajectory of language development. Many recent studies have attempted to find subgroups of autistic children with different trajectories, to predict who will have the best language outcomes, and why.<br /><br />Developmental trajectory is also important when comparing different individuals from the same population. For example, some late talkers eventually catch up with their peers in spoken vocabulary, while others do not. Some developmental psychologists spend a lot of time trying to figure out why these children differ, and what can be done to help the persistently-delayed group catch up.<br /><br /><b>3) Developmental cascades</b><br />While people can and do grow and change throughout their lives, early experiences profoundly shape our abilities and choices later on. The influence of earlier upon later development is called a “developmental cascade,” but I like to think of it as a “developmental avalanche.”<br /><br />For example, let’s say you’re studying children’s vocabulary size from age 3 to age 5.<br /><br /><ul>
<li>Age 3 vocabulary size has an effect on age 4 vocabulary size.</li>
<li> Age 4 vocabulary size has an effect on age 5 vocabulary size.</li>
<li> Age 3 vocabulary has an additional effect on age 5 vocabulary size.</li>
</ul>
<br />Initial vocabulary has both direct and indirect influences, via vocabulary at intermediate ages. It’s like a small snowball that hits more snow and becomes a bigger snowball, which hits more snow and becomes an even bigger snowball, and so on. Eventually, small differences between people early in life can lead to big differences.<br /><br /><b>4) Two-way interaction between child and environment</b><br />Children aren’t just shaped by their environment. Their behavior also shapes the input they get from their environment. For example, a child who is shy from infancy will be treated differently than a more outgoing child. The shy child might be reproached, shamed, pushed hard, or gently encouraged to interact, depending on the parents’ parenting style and values. These actions in turn will shape how the child behaves around other people, and whether he becomes a painfully shy or quietly confident adult. A child who has been told she is smart from an early age will probably think of herself differently, and take different levels of risk in the classroom, than one who has been told that she is average, or even dumb. I’m sure you can think of many more examples.<br /><br />While the role of children in shaping their environment seems obvious when pointed out, it looks different than the description of children in many parenting books*. Too often, the paradigm seems to be “push the right button, receive the desired behavior,” with little focus on children’s reasons for their behavior (good or bad), or on how the children might be triggering parents’own insecurities about parenting. Not surprisingly, many of these books aren’t written by developmental psychologists.<br /><br />These four assumptions lead developmental psychologists to ask a special set of questions.<br /><br /><b>1) Are some capabilities innate? If so, which ones?</b><br />William James pointed out that at any given moment, there are so many shapes, colors, sounds, textures, smells, temperatures, and more that without any inborn means to sort them out, a newborn’s world would seem like a “blooming, buzzing confusion.” I think most developmental psychologists accept that at the least, babies are born with some basic learning abilities, and an inclination to observe and learn about the world. But psychologists differ on how much “software” babies come with. Some people think we’re born with implicit knowledge of all the grammatical rules of human language; a basic understanding of how objects move (e.g., that they fall), and concepts about other people (e.g., that they have minds and intentions). Others think we develop these concepts early in life, but aren’t born with them. This debate has inspired interesting research on what babies understand about people, things, numbers, and more. The debate will likely continue for decades.<br /><br /><b>2) Are there developmental stages, and if so, how do people transition between them?</b><br />Does development have discrete steps, like a staircase, or is it continuous, like a ramp?<br /><br />Piaget thought at certain ages, children transition from one way of thinking to a qualitatively different one. Everyone progresses through the same stages in the same order at a similar age. Also, if children have reached a developmental stage in, say, math, then they must have reached it in all other areas of knowledge. (That is, if you are at the “concrete operational stage” in thinking about the movement of objects, then you must also be at the concrete operational stage in thinking about other people’s behavior). Piaget had an extreme stage theory.<br /><br />His successors, the Neo-Piagetians, were a little more flexible, particularly about different areas of knowledge and individual differences. However, they still thought that development has steps.<br /><br />Whether development looks continuous or stage-like depends on how closely you zoom in. If you observe a child two times a month apart, you will observe more abrupt changes than if you observed the child every day for a month.<br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><img height="400" src="https://cdn-images-1.medium.com/max/900/1*ivaryH8SrVL32Su0nLmCow.jpeg" style="margin-left: auto; margin-right: auto;" width="400" /></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Courtesy of Getty Images. Grandma is much more likely to say "My, how you've grown!" than Mom, because Mom has seen all the gradual changes in between.</td></tr>
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<br />If you ask parents to rate the child’s behavior using a continuous scale, it will look less stage-like than if they use a <a href="https://en.wikipedia.org/wiki/Likert_scale">Likert scale</a>, with discrete numbers on it. It’s hard to tell how much our findings merely reflect our measurement tools, and how much they reflect how children really develop.<br /><br /><b>3) How do individuals differ in their development?</b><br /><br />I think this is pretty self-explanatory.<br /><br /><b>4) How do changes in the brain contribute to development?</b><br />This question is easy to understand, but hard to answer. It’s even harder to study the brain in children than adults.<br /><br /><b>5) What develops, and how does change occur?</b><br />Last year, Anna didn’t understand the principle of “<a href="http://www.intropsych.com/ch10_development/conservation_experiments.html">conservation of matter</a>,” but this year she does, and she passed Piaget’s conservation of matter task. How exactly is she thinking differently now than she did last year? How did she get from the understanding she had last year to the one she had this year? This difficult, abstract question is <i>the</i> central question of developmental psychology, and probably the hardest to answer.<br /><br /><b>6) How does the social world contribute to development?</b><br />We are constantly observing, imitating, and being taught by other people. We grow up in cultures that provide us with tools for thinking, such as language, writing, the abacus, or the internet. Our cultures also determine how we spend our time, and who we spend it with, at different ages (for example, do children spend more time with age peers, or adults?)<br /><br />People interact with various institutions either directly or indirectly, including schools, churches, and governments. We are assigned to categories of age, gender, ethnicity, religion, and more, all of which come with messages about how a person in our category should and should not behave. We also generally have innate desires to learn from and connect emotionally with other people, and make them like us. All these things shape both what we experience and how we choose to behave.<br /><br />So next time you talk to a developmental psychologist or read about a new study, know that development is all about change — and change is a complicated mass of factors that changes over time and differs between individuals. Their goal is to sort out that complex system.<br /><br /><br />*This generalization is based on parenting books read between 1995 to 2008, so it may not apply to books published since then, or to books I might have missed. There are also some brilliant exceptions, such as The Heart of Parenting, which explains how to help children recognize and verbalize their emotions.<br /><br /><i>[This post was inspired by a developmental psychology seminar I took with <a href="http://psych.indiana.edu/faculty/bbertent.php">Dr. Bennett Bertenthal</a> at Indiana University].</i>E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com2tag:blogger.com,1999:blog-6733902656011255269.post-53496169413857245902016-07-12T20:55:00.000-05:002016-07-12T20:55:22.861-05:00Can we diagnose autism using a brain scan?[Crossposted from Medium].<br />
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It seems like every day, a news story breathlessly <a class="markup--anchor markup--p-anchor" data-href="http://time.com/3614487/fmri-autism-diagnosis/" href="http://time.com/3614487/fmri-autism-diagnosis/" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">claims</a> that neuroscientists have found a way to reliably diagnose autism using neuroimaging (usually, fMRI). So, could you go to a hospital, ask for an MRI scan, and be told within a few days whether you or your child are autistic?</div>
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<a class="markup--anchor markup--p-anchor" data-href="http://crackingtheenigma.blogspot.com.au/2010/08/describing-brain-in-autism-in-five.html" href="http://crackingtheenigma.blogspot.com.au/2010/08/describing-brain-in-autism-in-five.html" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">Not right now</a>, and probably not any time soon.</div>
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Why not?</div>
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<figcaption class="imageCaption" style="color: rgba(0, 0, 0, 0.6); font-family: medium-content-sans-serif-font, "Lucida Grande", "Lucida Sans Unicode", "Lucida Sans", Geneva, Arial, sans-serif; font-feature-settings: 'liga' 1, 'lnum' 1; font-size: 14px; left: 0px; letter-spacing: 0px; line-height: 1.4; margin-top: 10px; outline: 0px; position: relative; text-align: center; top: 0px; width: 700px; z-index: 300;">Above: Neuroscientist Russell Poldrack in an MRI scanner.</figcaption></figure><div class="graf--p graf-after--figure" id="5ae2" name="5ae2" style="background-color: white; color: rgba(0, 0, 0, 0.8); font-family: medium-content-serif-font, Georgia, Cambria, "Times New Roman", Times, serif; letter-spacing: -0.003em; line-height: 1.58; margin-top: 38px;">
<span class="markup--strong markup--p-strong" style="font-weight: 700;">Limitations of neuroimaging</span></div>
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Structural neuroimaging won’t tell us anything about autism, because autistic gross anatomy is usually normal. You won’t find any missing parts, tumors, or swollen, inflamed areas. Sometimes, very young children have unusually large heads, but it’s <a class="markup--anchor markup--p-anchor" data-href="http://crackingtheenigma.blogspot.com/2012/01/do-kids-with-autism-have-big-brains.html" href="http://crackingtheenigma.blogspot.com/2012/01/do-kids-with-autism-have-big-brains.html" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">uncommon, and rarely lasts long</a>.</div>
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Many of the studies in the news use functional neuroimaging, or fMRI. Participants perform a task while the scanner measures the changes in blood flow that follow neural activity (see <a class="markup--anchor markup--p-anchor" data-href="https://neurologism.com/2013/01/23/what-does-fmri-measure-anyway/" href="https://neurologism.com/2013/01/23/what-does-fmri-measure-anyway/" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">this post</a> by Neurologism for more information on what exactly fMRI measures and how it relates to brain activity). A statistical analysis then determines whether an autistic brain’s activity during the task differs from a non-autistic brain’s more than you would expect by chance.</div>
<h4 class="graf--h4 graf-after--p" id="d6bc" name="d6bc" style="background-color: white; color: rgba(0, 0, 0, 0.439216); font-family: medium-content-sans-serif-font, "Lucida Grande", "Lucida Sans Unicode", "Lucida Sans", Geneva, Arial, sans-serif; font-weight: 300; letter-spacing: -0.022em; line-height: 1.22; margin: 30px 0px 0px -1.75px;">
<span style="font-size: large;">Currently, functional neuroimaging can tell us a lot about groups, but not so much about individuals. In other words, an entire group of autistic brains looks reliably different from a group of neurotypical brains. But we might not be able to look at an individual participant’s brain and determine whether it belongs to an autistic or neurotypical person. Why?</span></h4>
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In order to get statistically significant changes during a task, you need to collect many trials from many people. The changes in brain activity you’re looking for are very small, and embedded in noise, so you need large numbers to reach statistical significance. Furthermore, each time any given person performs the task, her brain activity is a little different. One time, she might be thinking about the task; another time, what she’s going to have for dinner; another time, the scanner noise. You need a lot of trials from a lot of participants to make up for that variability.</div>
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In order to determine where group differences in brain activity are located, you have to map everybody’s brain onto a 3D coordinate system. But everybody’s brain is different — even neurotypicals of the same age. So, a little distortion necessarily occurs.</div>
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[TANGENT FOR PEOPLE WITH MORE OF A NEUROSCIENCE BACKGROUND: One could also use <a class="markup--anchor markup--p-anchor" data-href="http://en.wikipedia.org/wiki/Resting_state_fMRI" href="http://en.wikipedia.org/wiki/Resting_state_fMRI" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">resting state fMRI</a>, where participants lie in the scanner doing nothing instead of performing a task. The participant’s experience is similar to an anatomical scan, but the data resembles a functional scan — you’re still looking at changes in blood flow that reflect brain activity. Resting state scans look at patterns in <em class="markup--em markup--p-em" style="font-feature-settings: 'liga' 1, 'salt' 1;">functional connectivity — </em>which parts of the brain activate (or deactivate) together. It takes a long time to collect data in these studies, because the variability over time is even greater (since participants aren’t even performing a consistent task). Interpreting resting state fMRI can be controversial, and right now, autism studies using this technique are plagued by <a class="markup--anchor markup--p-anchor" data-href="https://spectrumnews.org/opinion/what-to-make-of-contradictions-in-connectivity-findings/" href="https://spectrumnews.org/opinion/what-to-make-of-contradictions-in-connectivity-findings/" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">conflicting results</a> and <a class="markup--anchor markup--p-anchor" data-href="http://sfari.org/news-and-opinion/news/2012/movement-during-brain-scans-may-lead-to-spurious-patterns" href="http://sfari.org/news-and-opinion/news/2012/movement-during-brain-scans-may-lead-to-spurious-patterns" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">confounds</a>. We’re not ready to diagnose autism yet using resting state fMRI, either.]</div>
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<span class="markup--strong markup--p-strong" style="font-weight: 700;">Autism is too heterogeneous.</span></div>
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Autism is heterogeneous. As they say, “if you’ve met one person with autism, you’ve met one person with autism.” It probably isn’t a single type of brain at all. More likely, it’s a <a class="markup--anchor markup--p-anchor" data-href="http://crackingtheenigma.blogspot.com.au/2011/03/theories-of-autism-lessons-from-dr.html" href="http://crackingtheenigma.blogspot.com.au/2011/03/theories-of-autism-lessons-from-dr.html" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">bunch of different disabilities</a> with different causes that all happen to lead to the same sorts of behavior. If the autisms have different causes, then the brain signatures are likely to be different, too.</div>
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The difference between the brains of any two autistic people might be at least as big as the difference between an autistic and a non-autistic brain. And if so, it will be impossible to find a test that can cleanly separate the two groups.</div>
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<span class="markup--strong markup--p-strong" style="font-weight: 700;">Autism overlaps with other conditions.</span></div>
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Most of the studies in the news compare autistic to neurotypical brains. That’s the easy comparison. In practice, people would only be scanned if they had some sort of developmental problem that caused concern. So autistic children would be <a class="markup--anchor markup--p-anchor" data-href="http://med-fom-psychiatry.sites.olt.ubc.ca/files/2015/03/handout1.pdf" href="http://med-fom-psychiatry.sites.olt.ubc.ca/files/2015/03/handout1.pdf" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">compared to those with</a> various developmental delays, or those with overlapping disabilities, such as ADHD, sensory processing disorder, or specific language impairment. Adults seeking a diagnosis, if not autistic, are also likely to have another disability that affects them enough to make them seek help. Not only does autism resemble other developmental delays and disabilities, but can <a class="markup--anchor markup--p-anchor" data-href="http://download.springer.com/static/pdf/993/art%253A10.1186%252F1744-859X-11-16.pdf?originUrl=http%3A%2F%2Fannals-general-psychiatry.biomedcentral.com%2Farticle%2F10.1186%2F1744-859X-11-16&token2=exp=1454536414~acl=%2Fstatic%2Fpdf%2F993%2Fart%25253A10.1186%25252F1744-859X-11-16.pdf*~hmac=4bd8ce60df6f010396696b224befaf0eb004d24f21a88ceaaeb30fa3ec9fa535" href="http://download.springer.com/static/pdf/993/art%253A10.1186%252F1744-859X-11-16.pdf?originUrl=http%3A%2F%2Fannals-general-psychiatry.biomedcentral.com%2Farticle%2F10.1186%2F1744-859X-11-16&token2=exp=1454536414~acl=%2Fstatic%2Fpdf%2F993%2Fart%25253A10.1186%25252F1744-859X-11-16.pdf*~hmac=4bd8ce60df6f010396696b224befaf0eb004d24f21a88ceaaeb30fa3ec9fa535" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">co-occur with them</a>, and share <a class="markup--anchor markup--p-anchor" data-href="http://www.nature.com/ejhg/journal/v22/n2/full/ejhg2013100a.html" href="http://www.nature.com/ejhg/journal/v22/n2/full/ejhg2013100a.html" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">genetic causes</a>. If a scan can’t reliably distinguish an autistic brain from these other, similar sorts of brains, it’s not ready for real-world use.</div>
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<span class="markup--strong markup--p-strong" style="font-weight: 700;">Autism occurs in a tiny percentage of the population.</span></div>
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So far, all these problems seem like they could be fixed with better methods and better technology. But a statistical issue — the rarity of autism in the population — places a hard limit on the accuracy of diagnostic tests <em class="markup--em markup--p-em" style="font-feature-settings: 'liga' 1, 'salt' 1;">in principle</em>.</div>
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Despite the media hysteria about rising autism rates, autism still affects only about <a class="markup--anchor markup--p-anchor" data-href="http://www.cdc.gov/ncbddd/autism/data.html" href="http://www.cdc.gov/ncbddd/autism/data.html" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">1–2%</a> of the population. Even the best tests will give you a lot of false positives: most of the people diagnosed with autism will not have it. Even with a 90% accurate test, only 8% of people with “autistic” brains would actually be autistic, as shown in the graph below. This <a class="markup--anchor markup--p-anchor" data-href="http://crackingtheenigma.blogspot.com/2012/09/a-genetic-test-for-autism.html" href="http://crackingtheenigma.blogspot.com/2012/09/a-genetic-test-for-autism.html" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">post</a> by autism researcher Jon Brock explains the problem (and the graph) in more detail.</div>
<figure class="graf--figure graf-after--p" id="be9b" name="be9b" style="background-color: white; box-sizing: border-box; clear: both; color: rgba(0, 0, 0, 0.8); font-family: -apple-system, BlinkMacSystemFont, "Segoe UI", Roboto, Oxygen, Ubuntu, Cantarell, "Open Sans", "Helvetica Neue", sans-serif; line-height: 25.2px; margin: 43px 0px 0px; outline: 0px; position: relative;"><div class="aspectRatioPlaceholder is-locked" style="margin: 0px auto; max-height: 261px; max-width: 320px; position: relative; width: 320px;">
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<figcaption class="imageCaption" style="color: rgba(0, 0, 0, 0.6); font-family: medium-content-sans-serif-font, "Lucida Grande", "Lucida Sans Unicode", "Lucida Sans", Geneva, Arial, sans-serif; font-feature-settings: 'liga' 1, 'lnum' 1; left: 0px; letter-spacing: 0px; line-height: 1.4; margin-top: 10px; outline: 0px; position: relative; text-align: center; top: 0px; width: 700px; z-index: 300;">The likelihood of false positives remains high until a test has well over 90% accuracy. It may not be realistic to develop a test that accurate. Source: Jon Brock.</figcaption></figure><div class="graf--p graf-after--figure" id="4788" name="4788" style="background-color: white; color: rgba(0, 0, 0, 0.8); font-family: medium-content-serif-font, Georgia, Cambria, "Times New Roman", Times, serif; letter-spacing: -0.003em; line-height: 1.58; margin-top: 38px;">
Importantly, the same argument applies no matter what sort of screening test one uses. It doesn’t matter if it’s based on neuroimaging, genetics, a parent survey or the child’s behavior. The same signal detection problem applies.</div>
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Whether a high rate of false positives is acceptable is a moral issue, not a scientific one. But autistic children are subjected to stigma, described as burdens who are “<a class="markup--anchor markup--p-anchor" data-href="https://www.autismspeaks.org/news/news-item/autism-speaks-washington-call-action" href="https://www.autismspeaks.org/news/news-item/autism-speaks-washington-call-action" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">missing</a>” from their own lives (perhaps a reason why people fear labels, saying things like “<a class="markup--anchor markup--p-anchor" data-href="https://unstrangemind.wordpress.com/2014/04/20/labels-are-for-soup-cans/" href="https://unstrangemind.wordpress.com/2014/04/20/labels-are-for-soup-cans/" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">labels are for soup cans</a>”). The hours of therapy they endure involve an <a class="markup--anchor markup--p-anchor" data-href="http://deevybee.blogspot.com/2015/08/opportunity-cost-new-red-flag-for.html" href="http://deevybee.blogspot.com/2015/08/opportunity-cost-new-red-flag-for.html" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">opportunity cost</a> — denying them the opportunity to <a class="markup--anchor markup--p-anchor" data-href="http://www.squidalicious.com/2013/10/letting-our-autistic-kids-have-chill.html" href="http://www.squidalicious.com/2013/10/letting-our-autistic-kids-have-chill.html" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">relax</a>, play, and interact with their families. Children with an autism diagnosis are often denied an <a class="markup--anchor markup--p-anchor" data-href="https://www.disabilityscoop.com/2014/09/08/inclusion-rates-sped-state/19652/" href="https://www.disabilityscoop.com/2014/09/08/inclusion-rates-sped-state/19652/" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">equal education with their peers</a>, put in <a class="markup--anchor markup--p-anchor" data-href="http://abcnews.go.com/Blotter/law-targets-padded-rooms-autistic-kids/story?id=18892197" href="http://abcnews.go.com/Blotter/law-targets-padded-rooms-autistic-kids/story?id=18892197" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">isolation rooms or physical restraints</a>, and are <a class="markup--anchor markup--p-anchor" data-href="https://unstrangemind.wordpress.com/2014/10/07/aba/" href="https://unstrangemind.wordpress.com/2014/10/07/aba/" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">physically manhandled</a> and denied the right to say no to such treatment, which some <a class="markup--anchor markup--p-anchor" data-href="https://sociallyanxiousadvocate.wordpress.com/2015/05/22/why-i-left-aba/" href="https://sociallyanxiousadvocate.wordpress.com/2015/05/22/why-i-left-aba/" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">autistic people</a> and <a class="markup--anchor markup--p-anchor" data-href="http://loveexplosions.net/2013/01/30/the-cost-of-compliance-is-unreasonable/" href="http://loveexplosions.net/2013/01/30/the-cost-of-compliance-is-unreasonable/" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">parents</a> <a class="markup--anchor markup--p-anchor" data-href="http://smallbutkindamighty.com/2015/06/16/aba-and-autism-the-thorny-problem-of-control-and-consent/" href="http://smallbutkindamighty.com/2015/06/16/aba-and-autism-the-thorny-problem-of-control-and-consent/" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">fear</a> set them up for later abuse. No child should be treated this way, <a class="markup--anchor markup--p-anchor" data-href="http://www.speakforyourself.org/2014/02/22/accept-behavior-towards-non-autistic-child/" href="http://www.speakforyourself.org/2014/02/22/accept-behavior-towards-non-autistic-child/" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">autistic or not</a>. But certainly, nobody would want to risk this sort of treatment for a child who society does not even deem to “need” it.</div>
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Since we are unwilling to risk false positives, an autism screening test will probably not exist any time soon.</div>
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Does that mean we must give up on recognizing autism altogether? Not necessarily. Although, as we’ve seen, a perfect screening test isn’t possible, clinicians do a pretty good job of recognizing autism in children, based on their observed behavior and parent reports, and they can do so <a class="markup--anchor markup--p-anchor" data-href="http://mosaicofminds.blogspot.com/2014/04/the-difficulties-of-early-diagnosis.html" href="http://mosaicofminds.blogspot.com/2014/04/the-difficulties-of-early-diagnosis.html" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">as early as two years old</a>. Furthermore, diagnoses are <a class="markup--anchor markup--p-anchor" data-href="http://prognosismethods.cochrane.org/sites/prognosismethods.cochrane.org/files/uploads/Woolfenden%202012.pdf" href="http://prognosismethods.cochrane.org/sites/prognosismethods.cochrane.org/files/uploads/Woolfenden%202012.pdf" rel="nofollow" style="-webkit-tap-highlight-color: rgba(0, 0, 0, 0.439216); background-color: transparent; background-image: linear-gradient(rgba(0, 0, 0, 0) 50%, rgba(0, 0, 0, 0.6) 50%); background-position: 0px 22px; background-repeat: repeat-x; background-size: 2px 2px; text-decoration: none;">pretty stable</a>. That is, a child diagnosed with autism often meets criteria for the diagnosis a few years later. So, we can diagnose autism reasonably well — and we don’t even need an expensive MRI scan to do it.</div>
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<span class="markup--strong markup--p-strong" style="font-weight: 700;">Take Home Message: </span>We cannot diagnose a person with autism using brain scans for several reasons. These include the limits of the technology, the variability within autism, the overlap between autism and other conditions, and the statistical problems with diagnosing any rare condition.</div>
E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-637291520856900622015-10-05T23:24:00.000-05:002016-11-17T11:20:28.230-06:00Neurotypical babies' social behavior takes off as their attention to social input plummets: Why we should be wary of autism theories based on attention to people vs. objectsDuring the second half of the first year, usually around nine months, most babies learn to <a href="http://mosaicofminds.blogspot.com/2014/11/what-is-joint-attention-and-are-we.html" target="_blank">share attention with others by</a> alternating their gaze between another person and an object. Their repertoire of social gestures expands enormously, too. With such a rapid spurt of social development, typically developing babies must be paying more attention to people and less attention to other things in their environment, right?<br />
<br />
As it turns out, when you measure what babies are actually looking at, the opposite is true.<br />
<br />
<i>Babies' visual environments</i><br />
There are lots of theories about what babies learn from their environment, how much they <i>can</i> learn from the environment, and how much must be present innately. For example, is the language babies hear complex and varied enough to allow them to figure out the grammatical rules of language? Or, is an innate grammar-understanding part of the brain necessary to explain it (a "<a href="https://en.wikipedia.org/wiki/Poverty_of_the_stimulus" target="_blank">poverty of the stimulus</a>" argument)? Do babies need lots of exposure to faces to learn to recognize them, or are they just born with a specific part of the brain that processes faces in a unique way that supports recognition? These issues are easy to speculate about, but hard to actually test: you need a way to measure what babies see and hear in their homes and communities. And until recently, this was very hard to do.<br />
<br />
One particularly important aspect of babies' environments is the other people they see, particularly their faces. Faces are a particularly important part of the visual environment because they are vital for recognizing others, contain emotional and social information, and convey cues that are helpful for language perception (e.g., mouth movements). So, Swapnaa Jayaraman, Caitlin Fausey, and Linda Smith [1] wanted to measure the faces babies saw during their first year, at home and in the community. How often did they see faces? Whose faces did they see? How close up were they, and what parts were visible? Did these variables change as babies grew?<br />
<br />
They measured the faces babies saw using small head cameras mounted on top of a hat, which babies wore1. The cameras showed a broad view of whatever was directly in front of the child's head. Parents were shown how to use the camera and asked to try to capture 4-6 hours of video during a variety of daily activities while the baby was awake and alert. They were given up to two weeks to make the recordings.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-OnrNKVn5dAQ/VXrtgwNPhFI/AAAAAAAADKo/sfFgfR-Xp7I/s1600/jayaraman%2Bfausey%2Bsmith%2B1.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="Left: A baby sits in a toy-covered baby seat at home, wearing a blue soft hat with a head camera on top. Right: Examples of three 5-second frames recorded by the head camera, showing a woman spooning out food and bringing it towards the baby. Her head takes up a large percentage of the frame." border="0" height="111" src="https://4.bp.blogspot.com/-OnrNKVn5dAQ/VXrtgwNPhFI/AAAAAAAADKo/sfFgfR-Xp7I/s400/jayaraman%2Bfausey%2Bsmith%2B1.jpg" title="" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Above: a) A baby at home, wearing the head camera mounted on a hat. b) Example frames coded during data analysis.<br />
<span style="font-size: 12.8000001907349px;">From Jayaraman, Fausey & Smith (2015).</span></td></tr>
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Families of 22 babies ranging from 1 to 11 months old participated, providing over 100 hours. Most of the recordings were in the child's home (84%), but some took place outdoors or in group settings (11%), in the car (4%), or other locations (2%), such as during errands. From this data, one still frame per five seconds of video was coded (a total of 72,150 frames). Coders looked for the following:<br />
<br />
<ol>
<li>Is there a face, or part of a face, in the frame?</li>
<li>Whose face is in the image?</li>
<li>Estimated distance of the face from the head camera. This estimate was made by comparing the face or face parts in the frame with templates created by filming a female face at increments of 1 foot (1 foot, 2 feet, etc.) from the camera.</li>
<li>Are both eyes visible?</li>
</ol>
<br />
Smith's team wanted to know how many faces babies saw, to determine how much experience they actually had looking at faces. They also wanted to know how close-up and clear the faces would be, because quality might matter as well as quantity. Further, they wanted to know how many people's faces babies saw. If babies only saw a few faces, such as those of family members, they might get very good at recognizing their family's and similar-looking faces, but might be less skilled at recognizing very different-looking faces. Lastly, the researchers wondered how these variables changed as babies learned to crawl and walk, and their visual acuity improved.<br />
<br />
Smith's team found that babies saw an average of 8 unique people during the videos--but the number ranged from 2 to 20. The number of different faces babies saw wasn't related to age. However, the most frequently-viewed faces (generally parents) appeared proportionally less often for older babies. (This was true for the most frequent, two most frequent, and three most frequent faces).<br />
<br />
Babies are born with very poor eyesight, which gradually gets more acute. So, not surprisingly, faces were under two feet from the youngest babies, and higher distance correlated with greater age.<br />
<br />
Regardless of age, babies typically saw faces from the front, with both eyes visible. Thus, they usually get fairly high-quality views of faces.<br />
<br />
There was one surprising finding: <i>The proportion of frames containing faces dropped dramatically with age</i>. The youngest babies saw faces nearly 15 minutes out of every recorded hour, while the oldest saw them only about 5 minutes per hour. So as babies are becoming more competent at social interaction behaviors, <i>they are actually getting less exposure to social stimuli.</i><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="http://4.bp.blogspot.com/-8l2sAXLM27I/VXrvSuiI84I/AAAAAAAADK0/dfgQKQAiisg/s1600/jayaraman%2Bfausey%2Bsmith%2B2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="371" src="https://4.bp.blogspot.com/-8l2sAXLM27I/VXrvSuiI84I/AAAAAAAADK0/dfgQKQAiisg/s400/jayaraman%2Bfausey%2Bsmith%2B2.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Above: The proportion of frames containing faces drops by about half between 1 and 11 months. <br />
From Jayaraman, Fausey & Smith (2015).</td></tr>
</tbody></table>
<i><br /></i>
<i>A brave new world of objects</i><br />
So, if older babies are seeing fewer faces, what are they looking at instead? Another head camera study by the same research team [2] suggests an answer.<br />
<br />
Smith and colleagues compared head camera views from six 1-3 month old babies, who could neither sit independently nor hold objects, with five 7-9 month olds, who could crawl and manipulate objects. Forty-four hours of video were sampled every 5 seconds. Younger babies saw mostly faces, ceiling, and walls, with very few objects. By contrast, older babies typically saw hands, objects within close reach, and floors. In order to see objects, younger babies have to have these objects placed within their view by others, or the objects must be coincidentally present near where the babies are lying or being held. But when babies learn to crawl (typically around six months), they spend a great deal of time on the floor and can maneuver themselves within reach of many objects.<br />
<br />
Objects, not faces, dominate the visual worlds of babies at the very age they are developing joint attention and social gestures.<br />
<br />
Researchers in my department are highly aware of this dynamic, and argue that <b>a central problem for babies in the second half of the first year is to balance the competing demands of attending to others with attending to objects. Because attention control is still limited at this age, this is a big challenge.</b><br />
<br />
<b>This increased focus on objects and decreased focus on faces should not be assumed to reflect a lack of social motivation </b>by these typically developing babies (as would be assumed if they were autistic). Rather, developing motor skills are changing what babies see, and therefore what they can attend to.<br />
<br />
How do typically developing babies solve the problem of maintaining social engagement in a world of fascinating objects? They use <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0079659" target="_blank">cues produced by others interacting with objects</a> to share attention. Parents' hand movements are coordinated with their eye gaze, and babies can use these movements to determine what parents are attending to. In so doing, babies consistently look at the same object at the same time as parents, an experience that may allow them to appreciate shared attention before they start using eye gaze or facial expressions as a cue.<br />
<br />
<i>Implications for social attention theories of autism</i><br />
Some researchers speculate that autistic children are biased to look at "nonsocial" stimuli, such as <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709851/" target="_blank">objects</a> or <a href="http://www.fyiliving.com/wp-content/uploads/2010/09/eyetrackingautism.pdf" target="_blank">interesting geometrical patterns</a>, more than faces early in life. This in turn limits their exposure to faces and the information they convey, potentially delaying their social development.<br />
<br />
Ami Klin's team--well-known <a href="http://archpsyc.jamanetwork.com/article.aspx?articleid=210109" target="_blank">proponents of this explanation</a> of autism--even <a href="http://www.ncbi.nlm.nih.gov/pubmed/24196715" target="_blank">argued that</a> whether male "high-risk siblings" were later diagnosed autistic themselves could be predicted based on how much they looked at the eyes while watching short video clips of a female caregiver. Although this study was widely reported in the media, Jon Brock <a href="http://crackingtheenigma.blogspot.com/2013/12/does-babys-eye-gaze-really-predict.html" target="_blank">points out</a> a number of fatal flaws with this study--including that the trajectories of the later-diagnosed-autistic and low-risk control groups did not actually differ until the final test session at 24 months. When the analyses are carefully restricted to 2-6 month olds only, boys who developed autism showed declining eye gaze while low-risk controls showed increasing eye gaze--but this can be explained simply by the fact that <i>the high risk babies had higher eye gaze than the controls to begin with. </i><br />
<i><br /></i>
So, there is plenty of reason to be skeptical about this account of autism even on its own terms.<br />
<br />
But it's the research with typically developing babies that truly suggests we should take social attention theories of autism with a large dose of salt. Typically developing babies are reducing their attention to faces and increasing their attention to objects, so if the autism theorists are right, their social development should decline. In fact, it soars. Moreover, rather than distracting babies from social engagement, objects and the hands that manipulate them offer new ways to share attention with others. If attention to objects over faces doesn't necessarily impair social development in neurotypical children, there is no reason to assume that it does in autism, either.<br />
<br />
Too often, researchers assume a specific trait, such as social disability in autism, and then reach backwards looking for something to explain it. Or, they might see two traits--social disability and avoidance of eye contact--and link them together, because intuitively, eye contact seems related to social functioning. This is not good science, and the flaws of this approach become especially obvious when it is done without reference to how the trait <i>typically</i> develops, as happened here. <br />
<br />
To determine the real explanation, we need to use head camera measures like these, along with eye tracking, to better understand what autistic babies are seeing and doing during this crucial developmental stage. How does this compare with typically developing babies? Are they seeing the same amount and type of faces? Do they see fewer faces and more objects during the second half of the first year, too--or might delays in motor development affect this pattern? Do autistic babies also use others' manipulations of objects to share attention and maintain social engagement? If there are differences here, whatever they are, they are likely to be more subtle and interesting than any social attention theories that have so far been proposed.<br />
<i><br /></i>
<u>References</u><br />
[1] Swapnaa Jayaraman, Caitlin M. Fausey, and Linda B. Smith (2015). The faces in infant-perspective scences change over the first year of life. <i>PLoS ONE</i> vol. 10 iss. 5, e0123780. <a href="http://www.plosone.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pone.0123780&representation=PDF" target="_blank">Open access PDF</a>.<br />
<br />
[2] Swapnaa Jayaraman, Caitlin M. Fausey, and Linda B. Smith (2013). Visual statistics of infants' ordered experiences. Meeting <a href="http://jov.arvojournals.org/article.aspx?articleid=2142842" target="_blank">abstract</a> presented at Vision Science Society 2013.<br />
<br />
<br />
1 A limitation of head cameras is that the head and eyes are not always perfectly aligned, although they usually are--especially for babies. Another limitation is that they miss peripheral information; however, babies' central vision is much more acute and probably more used anyway.E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-35226738683996058082015-09-19T21:20:00.003-05:002015-09-19T21:20:59.966-05:00Does language develop differently in autism? [Summary of book chapter]<div class="separator" style="clear: both; text-align: center;">
<a href="http://images.gizmag.com/hero/childspeech.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://images.gizmag.com/hero/childspeech.jpg" height="179" width="320" /></a></div>
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<span style="font-size: x-small;">Image courtesy of ShutterStock.</span></div>
<br />
When autism first appeared in the "diagnostic bible," the 1980 Diagnostic and Statistical Manual, one of the few criteria for diagnosis was "gross deficits in language development" (APA, 1980). Autism was once associated with:<br />
<blockquote class="tr_bq">
"marked abnormalities in the production of speech, including volume, pitch, stress, rate, rhythm, and intonation" (1987)<br />"marked abnormalities in the form or content of speech, including stereotyped and repetitive use of speech" (1987)<br />"delay in, or total lack of, the development of spoken language." (1994, 2000).</blockquote>
Today, in the most recent version, language disabilities are not even referenced (2013).<br />
<br />
So, as the definition of autism expanded, abnormal language development started out as a defining characteristic, then became an optional trait, and now is no longer part of the diagnosis.<br />
<br />
This change might seem strange to most people exposed to autism in the media, and even many who know autistic people personally. After all, many autistic children still do not produce spoken language, and some people who speak fluently sound "odd" in their volume, pitch, or even choice of words. So, what is autistic language like? Has it really changed in the past forty-odd years, or have researchers and clinicians just deemed it less essential?<br />
<br />
Morton Ann Gernsbacher, Elizabeth Grace, and I tried to find out. We read hundreds of papers on the topic that came out since 2000. These studies examined every imaginable language skill, in every imaginable age group, with every imaginable method. What we learned might surprise you. Details can be found in our book chapter <a href="http://store.elsevier.com/Neurobiology-of-Language/isbn-9780124077942/" target="_blank">here</a>, but since it will likely be hard to access, I'm summarizing the important points here.<br />
<br />
<b><i>Autistic Language is Often Delayed.</i></b><br />
Studies often find that autistic children develop language more slowly than typically-developing peers, especially when it comes to spoken language. They may be delayed in speaking their first words, first combinations of words (e.g., "blue-car") and first grammatical sentences<span style="font-size: x-small;">1-7</span>.<br />
<br />
Parents report that young autistic children say fewer words than age peers<span style="font-size: x-small;">1,8-14</span>. In fact, their concern about late talking often leads them to seek out a diagnosis<span style="font-size: x-small;">15</span>. <br />
<br />
Parents also often report autistic children <i>understand</i> fewer words<span style="font-size: x-small;">1,8,10,11,16-20</span>. However, parents can easily either underestimate or overestimate what a young autistic child knows. If an autistic child responds with atypical words or body language, or does not respond at all, a parent may mistakenly assume the child does not understand. Alternatively, a parent may think a child understands language associated with a routine (e.g., "let's go outside") when the child really only understands the behavior that accompanies it (e.g., taking the child's coat and shoes out of the closet).<br />
<br />
Fortunately, there are more objective ways to measure children's language understanding, which involve testing them directly. These include standardized tests such as the Peabody Picture Vocabulary Test (PPVT) and its equivalent, the British Picture Vocabulary Scale (BPVS); the Preschool Language Scale; or the Clinical Evaluations of Language Fundamentals (CELF). Many studies using such tests indicate delays in understanding language, not just speaking<span style="font-size: x-small;">8,9,10,17,20-29.</span><br />
<br />
<br />
<b><i>Autistic Language is Variable.</i></b><br />
Some studies do not find any difference between autistic people and age peers<span style="font-size: x-small;">30-34</span>. These studies range from toddlers to adults, and evaluate skills as various as spoken vocabulary, understood vocabulary, and quality and quantity of writing.<br />
<br />
Typically, studies find a wide range of performance in autistic groups. The majority are often unimpaired, while a minority may have significant delays<span style="font-size: x-small;">35,36</span>. Some examples:<br />
<br />
<ul>
<li>One group surveyed parents of a large sample of autistic toddlers with a wide range of IQ scores. Over three quarters of this group said their first words before 18 months, which is within the range of typical development. However, a little over 5% had still not spoken their first words by six years of age--a huge delay.<span style="font-size: x-small;">37</span></li>
<li>In a group of autistic children and teenagers, half had average receptive vocabulary scores (on the BPVS). One quarter performed one to two standard deviations below average, and another quarter scored over two standard deviations above average.<span style="font-size: x-small;">38</span></li>
</ul>
<br />
<a href="http://psychology.wikia.com/wiki/Standard_scores" target="_blank">Standard scores</a> often range from as low as 4 standard deviations below average to two standard deviations above<span style="font-size: x-small;">28,39-41</span>. Thus, autistic people can rank among the most language impaired--or the most verbally gifted.<br />
<br />
When researchers measure the <i>rate</i> of language development--instead of ability level at a given moment in time--autistic people are similarly variable.<br />
<br />
Sometimes, despite lower initial performance, autistic people develop language skills faster, and for longer, than age peers<span style="font-size: x-small;">6,42.</span> Vocabulary may even improve into adulthood<span style="font-size: x-small;">43</span>.<br />
<br />
However, different individuals have very different rates of language development. The graph below shows the growth in spoken vocabulary development for 35 autistic preschoolers<span style="font-size: x-small;">44</span>. Parents reported these children's vocabulary (using the MacArthur-Bates Communicative Development Inventory) four times over two years.<br />
<br />
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All the children started with a spoken vocabulary of fewer than 60 words, but they ended up with very different vocabulary sizes two years later. Those with the steepest growth could say nearly 700 words at the end of the study; another group showed little change at all. All these children were the same age, with similar levels of autistic traits, and similar measured IQ. Interestingly, they were also all undergoing the same interventions--which included speech and language therapy.<br />
<br />
Overall, it seems that language development can be slower than normal during the first few years of life<span style="font-size: x-small;">45</span>, but more rapid later on. However, individuals differ so greatly that it would be hard to identify a "typical rate" of autistic language development.<br />
<br />
<b><i>Autistic Language is Similar to that of People with Similar Language Skills.</i></b><br />
Psychologists often draw a distinction between "delay" and "deviance." Delay is when a person develops in the same way as others, but does so more slowly. For example, someone with delayed spoken vocabulary might have the vocabulary of the typical two year old at the age of six. Deviance is when a person develops in a qualitatively different way. They might develop a different pattern of skills, or they might develop the same skills in a different order. For example, some people have claimed that autistic people have a unique difficulty understanding nonliteral language, such as metaphors. A person with a disability could, in theory, be delayed, deviant, or both. So, do autistic people have "deviant" language, or are they just more likely to be delayed?<br />
<br />
In order to answer this question, we have to compare autistic people to those with similar levels of language development, but who are not autistic. Such comparison groups might include younger typically-developing children, late talkers, or children with specific language impairment. If autistic people are simply delayed, they will learn the same language skills in the same order as these "language-matched" peers.<br />
<br />
And in fact, they do.<br />
<br />
Autistic children do not have a unique difficulty with learning social or emotional words, or an advantage in learning words associated with special interests. They learn the same words in the same proportion and in the same order as younger typically developing children. For example, they are no less likely to learn words for people or social routines, and no more likely to learn words for vehicles.<span style="font-size: x-small;">1</span> They also are no less likely to say emotion words<span style="font-size: x-small;">46</span>.<br />
<br />
Autistic people also do not have any reliable difficulty with understanding and using nonliteral language, once their general language delays are taken into account. Autistic children in grade school learn to understand metaphors, draw inferences from stories, and structure their own narratives at the same time as language-matched peers<span style="font-size: x-small;">47-52</span>. Their level of language impairment, <i>not</i> their degree of autistic traits, predicts how much difficulty they have with nonliteral language<span style="font-size: x-small;">47-51</span>.<br />
<br />
Autistic children sometimes develop language for a time, then seem to abruptly lose it--this is called "regression." Some people have argued that regression is characteristic of, and unique to, autism.<br />
<br />
Regression is hard to define and measure. However, it seems that only a subgroup of autistic children lose language this way. Interestingly, those who lose language were previously experiencing little or no delay<span style="font-size: x-small;">53,54</span>. Language loss also occurs in a seizure disorder called <a href="https://rarediseases.org/rare-diseases/landau-kleffner-syndrome/" target="_blank">Landau-Kleffner syndrome</a>.<br />
<br />
Some people have claimed that autistic children use language in unique ways--for example, echolalia (repeating what they or others say), or pronoun reversal (e.g., switching "you" for "me" and vice versa). These characteristics appear to occur in only a small minority of autistic children, and are reported less and less frequently now that they are no longer included in the diagnostic manual. They also occur in other disabled groups.<br />
<br />
Pronoun reversals do not occur in all autistic children, and they also occur in other populations (see my earlier post <a href="http://mosaicofminds.blogspot.com/2013/05/why-do-autistic-people-reverse-pronouns.html" target="_blank">here</a>, and Dr. Jon Brock's <a href="http://crackingtheenigma.blogspot.com/2011/08/curious-case-of-reversed-pronoun.html" target="_blank">here</a>). Young typically developing children sometimes confuse first- and second-person pronouns for a short time while learning them<span style="font-size: x-small;">55</span>. Children with other developmental disabilities, such as Down Syndrome, also reverse pronouns<span style="font-size: x-small;">56</span>. Like these other groups, autistic children are more likely to have difficulty producing the correct pronouns when using more complex sentences, or complex types of pronouns<span style="font-size: x-small;">57-60</span>. Thus, pronoun reversals may be a normal part of early language development; it simply lasts longer in autistic children and those with Down Syndrome because their language develops more slowly.<br />
<br />
Echolalia was once viewed as unique to autism. However, very young typically developing children also produced echolalia--that is, they imitate all or part of the preceding utterance without any change. As they get older, they produce less echolalia<span style="font-size: x-small;">61,62</span>. Similarly, autistic children also may produce less echolalia as their language improves. The majority of children who were reported to have "lost" their autism diagnosis by age nine had once exhibited echolalia, but no longer did so<span style="font-size: x-small;">63</span>. A longitudinal study followed autistic and non-autistic children with language delay and measured their increase in language comprehension. During this time period, both groups made fewer immediate, exact repetitions, and increased their use of mitigated echolalia (e.g., making small changes to the repeated sentence to better express the desired meaning)<span style="font-size: x-small;">64</span>. Echolalia appears to be a stepping stone to full self-generated language, and it may last longer in autistic children when their language develops more slowly.<br />
<br />
Some people, after observing young autistic children progress from repeating whole phrases unchanged to self-generated speech, have concluded that autistic children must learn language in an entirely different way than typically developing ones. That is, whereas typically developing children first learn what words mean and then how to put them together, autistic children first learn whole phrases, and only later learn what the words mean and what grammatical rules link them together. As far as I know, this hypothesis has yet to be directly tested with a large group of young autistic children. However, there is also nothing more than anecdotal evidence for it. If every known population learns language in one way, the burden of proof must be very high to show that one group learns it in the opposite way.<br />
<br />
<b><i>What can we conclude about language in autism?</i></b><br />
In short:<br />
<br />
<ul>
<li>Autistic people's language is heterogeneous. Their language ability at any given time ranges from the most delayed to the most advanced possible. Their rate of development ranges from virtually nil<span style="font-size: x-small;">44</span> to nearly ten times that of typically developing peers<span style="font-size: x-small;">42</span>. </li>
<li>Language delays are common in autism.</li>
<li>Autistic language is "delayed, not deviant." Researchers have yet to identify any characteristics of autistic language that are universal in autism or cannot be found in other groups. Autistic language is not unique, but continuous with typical development and language disabilities.</li>
</ul>
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<br /></div>
<div>
<b><i>References</i></b></div>
<div>
<span style="font-size: x-small;">1. </span><span style="font-size: x-small;">Charman, T., Drew, A., Baird, C., & Baird, G. (2003). Measuring </span><span style="font-size: x-small;">early language development in preschool children with </span><span style="font-size: x-small;">autism spectrum disorder using the MacArthur Communicative </span><span style="font-size: x-small;">Development Inventory (Infant Form). Journal of Child Language, </span><span style="font-size: x-small;">30, 213 -236.</span></div>
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<span style="font-size: x-small;">2. Matson, J. L., Mahan, S., Kozlowski, A. M., & Shoemaker, M. </span><span style="font-size: x-small;">(2010). Developmental milestones in toddlers with autistic disorder, </span><span style="font-size: x-small;">pervasive developmental disorder-not otherwise specified, </span><span style="font-size: x-small;">and atypical development. Developmental Neurorehabilitation, 13, </span><span style="font-size: x-small;">239 -247.</span><br />
<span style="font-size: x-small;">3. Grandgeorge, M., Hausberger, M., Tordjman, S., Deleau, M., </span><span style="font-size: x-small;">Lazartigues, A., & Lemonnier, E. (2009). Environmental factors </span><span style="font-size: x-small;">influence language development in children with autism spectrum </span><span style="font-size: x-small;">disorders. PLoS ONE, 4.</span><br />
<span style="font-size: x-small;">4. Kenworthy, L., Wallace, G. L., Powell, K., Anselmo, C., Martin, A., & </span><span style="font-size: x-small;">Black, D. O. (2012). Early language milestones predict later language, </span><span style="font-size: x-small;">but not autism symptoms in higher functioning children </span><span style="font-size: x-small;">with autism spectrum disorders. Research in Autism Spectrum </span><span style="font-size: x-small;">Disorders, 6, 1194 -1202.</span><br />
<span style="font-size: x-small;">5. Pry, R., Peterson, A. F., & Baghdadli, A. M. (2011). On general and </span><span style="font-size: x-small;">specific markers of lexical development in children with autism </span><span style="font-size: x-small;">from 5 to 8 years of age. Research in Autism Spectrum Disorders, 5, </span><span style="font-size: x-small;">1243- 1252.</span><br />
<span style="font-size: x-small;">6. Anderson, K., Lord, C., Risi, S., DiLavore, P. S., Shulman, C., Thurm, </span><span style="font-size: x-small;">A., et al. (2007). Patterns of growth in verbal abilities among children </span><span style="font-size: x-small;">with autism spectrum disorder. Journal of Counseling and </span><span style="font-size: x-small;">Clinical Psychology, 75, 594- 604</span><br />
<span style="font-size: x-small;">7. Wodka, E. L., Mathy, P., & Kalb, L. (2013). Predictors of phrase and </span><span style="font-size: x-small;">fluent speech in children with autism and severe language delay. </span><span style="font-size: x-small;">Pediatrics, 131, e1128- e1134.</span><br />
<span style="font-size: x-small;">8. Fulton, M. L., & D’Entremont, B. (2013). Utility of the psychoeducational </span><span style="font-size: x-small;">profile-3 for assessing cognitive and language skills of children </span><span style="font-size: x-small;">with autism spectrum disorder. Journal of Autism and </span><span style="font-size: x-small;">Developmental Disorders, 43, 2460- 2471.</span><br />
<span style="font-size: x-small;">9. Kover, S. T., McDuffie, A. S., Hagerman, R. J., & Abbeduto, L. (2013). </span><span style="font-size: x-small;">Receptive vocabulary in boys with autism spectrum disorder: </span><span style="font-size: x-small;">Cross-sectional developmental trajectories. Journal of Autism and </span><span style="font-size: x-small;">Developmental Disorders, 43, 2696- 2709.</span><br />
<span style="font-size: x-small;">10. Luyster, R. J., Kadlec, M. B., Carter, A., & Tager-Flusberg, H. (2008). </span><span style="font-size: x-small;">Language assessment and development in toddlers with autism </span><span style="font-size: x-small;">spectrum disorders. Journal of Autism and Developmental Disorders, </span><span style="font-size: x-small;">38, 1426- 1438.</span><br />
<span style="font-size: x-small;">11. Luyster, R., Lopez, K., & Lord, C. (2007). Characterizing communicative </span><span style="font-size: x-small;">development in children referred for autism spectrum </span><span style="font-size: x-small;">disorder using the Mac-Arthur Bates Communicative </span><span style="font-size: x-small;">Development Inventory (CDI). Journal of Child Language, 34, </span><span style="font-size: x-small;">623- 654.</span><br />
<span style="font-size: x-small;">12.Miniscalco, C., Fra¨nberg, J., Schachinger-Lorentzon, U., & Gillberg, </span><span style="font-size: x-small;">C. (2012). Meaning what you say? Comprehension and word production </span><span style="font-size: x-small;">in young children with autism. Research in Autism </span><span style="font-size: x-small;">Spectrum Disorders, 6, 204- 211.</span><br />
<span style="font-size: x-small;">13. Sandercock, R. K. (2013). Gesture as a predictor of language development </span><span style="font-size: x-small;">in infants at high risk for autism spectrum disorders (unpublished </span><span style="font-size: x-small;">doctoral dissertation). Pittsburgh, PA: University of </span><span style="font-size: x-small;">Pittsburgh.</span><br />
<span style="font-size: x-small;">14. Stone, W. L., & Yoder, P. J. (2001). Predicting spoken language level </span><span style="font-size: x-small;">in children with autism spectrum disorders. Autism, 5, 341 -361.</span><br />
<span style="font-size: x-small;">15. Agin, M. C. (2004). The “late talker”—When silence isn’t golden. </span><span style="font-size: x-small;">Contemporary Pediatrics, 21, 22 -32.</span><br />
<span style="font-size: x-small;">16. Maljaars, J., Noens, I., Scholte, E., & Van Berckelaer-Onnes, I. (2012). </span><span style="font-size: x-small;">Language in low-functioning children with autistic disorder: </span><span style="font-size: x-small;">Differences between receptive and expressive skills and concurrent </span><span style="font-size: x-small;">predictors of language. Journal of Autism and Developmental </span><span style="font-size: x-small;">Disorders, 42, 2181- 2191.</span><br />
<span style="font-size: x-small;">17. Miniscalco et al., 2012</span><br />
<span style="font-size: x-small;">18. Paul, R., Chawarska, K., Cicchetti, D., & Volkmar, F. (2008). </span><span style="font-size: x-small;">Language outcomes of toddlers with autism spectrum disorders: </span><span style="font-size: x-small;">A two year follow-up. Autism Research, 1, 97 -107.</span><br />
<span style="font-size: x-small;">19. Paul, R., Chawarska, K., Fowler, C., Cicchetti, D., & Volkmar, F. </span><span style="font-size: x-small;">(2007). “Listen my children and you shall hear”: Auditory preferences </span><span style="font-size: x-small;">in toddlers with autism spectrum disorders. Journal of </span><span style="font-size: x-small;">Speech, Language, and Hearing Research, 50, 1350- 1364.</span><br />
<span style="font-size: x-small;">20. Vanvuchelen, M., Roeyers, R., & DeWeerdt, W. (2011). Imitation </span><span style="font-size: x-small;">assessment and its utility to the diagnosis of autism: Evidence </span><span style="font-size: x-small;">from consecutive clinical preschool referrals for suspected autism. </span><span style="font-size: x-small;">Journal of Autism and Developmental Disorders, 41, 484- 496.</span><br />
<span style="font-size: x-small;">21. Grigorenko, E. L., Klin, A., Pauls, D. L., Senft, R., Hooper, C., & </span><span style="font-size: x-small;">Volkmar, F. (2002). A descriptive study of hyperlexia in a clinically </span><span style="font-size: x-small;">referred sample of children with developmental delays. </span><span style="font-size: x-small;">Journal of Autism and Developmental Disorders, 32, 3 12.</span><br />
<span style="font-size: x-small;">22. Howlin, P. (2003). Outcome in high-functioning adults with autism </span><span style="font-size: x-small;">with and without early language delays: Implications for the differentiation </span><span style="font-size: x-small;">between autism and asperger syndrome. Journal of </span><span style="font-size: x-small;">Autism and Developmental Disorders, 33, 3 13.</span><br />
<span style="font-size: x-small;">23. Sigman, M., & McGovern, C. W. (2005). Improvement in cognitive </span><span style="font-size: x-small;">and language skills from preschool to adolescence in autism. </span><span style="font-size: x-small;">Journal of Autism and Developmental Disorders, 35, 15 23</span><br />
<span style="font-size: x-small;">24. Wisdom, S. N., Dyck, M. J., Piek, J. P., Hay, D., & Hallmayer, J. </span><span style="font-size: x-small;">(2007). Can autism, language, and coordination disorders be differentiated </span><span style="font-size: x-small;">based on ability profiles? European Child and Adolescent </span><span style="font-size: x-small;">Psychiatry, 16, 178 186.</span><br />
<span style="font-size: x-small;">25. Sutera, S., Pandey, J., Esser, E. L., Rosenthal, M. A., Wilson, L. B., </span><span style="font-size: x-small;">Barton, M., et al. (2007). Predictors of optimal outcome in toddlers </span><span style="font-size: x-small;">diagnosed with autism spectrum disorders. Journal of Autism and </span><span style="font-size: x-small;">Developmental Disorders, 37, 98- 107.</span><br />
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<span style="font-size: x-small;">30. Goodwin, A., Fein, D., & Naigles, L. R. (2012). Comprehension of </span><span style="font-size: x-small;">wh-questions precedes their production in typical development </span><span style="font-size: x-small;">and autism spectrum disorders. Autism Research, 5, 109- 123.</span><br />
<span style="font-size: x-small;">31. A°</span><span style="font-size: x-small;">sberg, J. (2010). Patterns of language and discourse comprehension </span><span style="font-size: x-small;">skills in school-aged children with autism spectrum disorders. </span><span style="font-size: x-small;">Scandinavian Journal of Psychology, 51, 534 -539</span><br />
<span style="font-size: x-small;">32. Henderson, L. M., Clarke, P. J., & Snowling, M. J. (2011). Accessing </span><span style="font-size: x-small;">and selecting word meaning in autism spectrum disorder. Journal </span><span style="font-size: x-small;">of Child Psychology and Psychiatry, 52, 964-973.</span><br />
<span style="font-size: x-small;">33. Paul, R., Augustyn, A., Klin, A., & Volkmar, F. R. (2005). Perception </span><span style="font-size: x-small;">and production of prosody by speakers with autism spectrum </span><span style="font-size: x-small;">disorders. Journal of Autism and Developmental Disabilities, 35, </span><span style="font-size: x-small;">205- 220.</span><br />
<span style="font-size: x-small;">34. Troyb, E. (2011). Academic abilities in children and adolescents with a history </span><span style="font-size: x-small;">of autism spectrum disorders who have achieved optimal outcomes </span><span style="font-size: x-small;">(unpublished master’s thesis, paper 189). Storrs, CT: University of </span><span style="font-size: x-small;">Connecticut.</span><br />
<span style="font-size: x-small;">35. Jones, C. D., & Schwartz, I. S. (2009). When asking questions is not </span><span style="font-size: x-small;">enough: An observational study of social communication differences </span><span style="font-size: x-small;">in high functioning children with autism. Journal of Autism </span><span style="font-size: x-small;">and Developmental Disorders, 39, 432 -443.</span><br />
<span style="font-size: x-small;">36. A°</span><span style="font-size: x-small;">sberg, J., & Dahlgren Sandberg, A. (2012). Dyslexic, delayed, precocious, </span><span style="font-size: x-small;">or just normal? Word reading skills of children with autism </span><span style="font-size: x-small;">spectrum disorders. Journal of Research in Reading, 35, 20 -31.</span><br />
<span style="font-size: x-small;">37. Wilson, S., Djukic, A., Shinnar, S., Dharmani, C., & Rapin, I. (2003). </span><span style="font-size: x-small;">Clinical characteristics of language regression in children. </span><span style="font-size: x-small;">Developmental Medicine & Child Neurology, 45(8), 508 -514.</span><br />
<span style="font-size: x-small;">38. McCann, J., Peppe´, S., Gibbon, F. E., O’Hare, A., & Rutherford, M. </span><span style="font-size: x-small;">(2005). Prosody and its relationship to language in school-aged children </span><span style="font-size: x-small;">with high-functioning autism (working paper WP-3). Queen </span><span style="font-size: x-small;">Margaret University College Speech Science Research Center.</span><br />
<span style="font-size: x-small;">39. Nation, K., Clarke, P., Wright, B., & Williams, C. (2006). Patterns of </span><span style="font-size: x-small;">reading ability in children with autism spectrum disorder. Journal </span><span style="font-size: x-small;">of Autism and Developmental Disorders, 36, 911- 919.</span><br />
<span style="font-size: x-small;">40. Joseph, R. M., McGrath, L. M., & Tager-Flusberg, H. (2005). </span><span style="font-size: x-small;">Executive dysfunction and its relation to language ability in verbal </span><span style="font-size: x-small;">school-age children with autism. Developmental </span><span style="font-size: x-small;">Neuropsychology, 27, 361 378</span><br />
<span style="font-size: x-small;">41. Ricketts, J., Jones, C. R. G., Happe´, F., & Charman, T. (2013). Reading </span><span style="font-size: x-small;">comprehension in autism spectrum disorders: The role of oral </span><span style="font-size: x-small;">language and social functioning. Journal of Autism and </span><span style="font-size: x-small;">Developmental Disorders, 43, 807- 816.</span><br />
<span style="font-size: x-small;">42. Cariello, A., Bigler, E. D., Tolley, S. E., Prigge, M. D., Neeley, E. S., </span><span style="font-size: x-small;">Lange, N, et al. (2011, May). A longitudinal look at expressive, receptive, </span><span style="font-size: x-small;">and total language development in individuals with autism spectrum </span><span style="font-size: x-small;">disorders. Paper presented at the International Meeting for </span><span style="font-size: x-small;">Autism Research, San Sebastian, Spain.</span><br />
<span style="font-size: x-small;">43. Mawhood, L., Howlin, P., & Rutter, M. (2000). Autism and developmental </span><span style="font-size: x-small;">receptive language disorder—A comparative follow-up in </span><span style="font-size: x-small;">early adult life. I: Cognitive and language outcomes. Journal of </span><span style="font-size: x-small;">Child Psychology and Psychiatry, 41, 547- 559.</span><br />
<b><span style="font-size: x-small;">44. </span></b><span style="font-size: x-small;"><b>Smith, V., Mirenda, P., & Zaidman-Zait, A. (2007). Predictors of </b></span><b style="font-size: small;">expressive vocabulary growth in children with autism. Journal of </b><b style="font-size: small;">Speech, Language, and Hearing Research, 50, 149- 160.</b><br />
<span style="font-size: x-small;">45. Landa, R., & Garrett-Mayer, E. (2006). Development in infants with </span><span style="font-size: x-small;">autism spectrum disorders: A prospective study. Journal of Child </span><span style="font-size: x-small;">Psychology and Psychiatry, 47, 629 -638.</span><br />
<span style="font-size: x-small;">46. Ellis Weismer, S., Gernsbacher, M. A., Stronach, S., Karasinski, K., </span><span style="font-size: x-small;">Eernisse, E. R., Venker, C. E., et al. (2011). Lexical and grammatical </span><span style="font-size: x-small;">skills in toddlers on the autism spectrum compared to late </span><span style="font-size: x-small;">talking toddlers. Journal of Autism and Developmental Disorders, 41, </span><span style="font-size: x-small;">1065- 1075.</span><br />
<span style="font-size: x-small;">47. Norbury, C. F. (2004). Factors supporting idiom comprehension in </span><span style="font-size: x-small;">children with communication disorders. Journal of Speech, </span><span style="font-size: x-small;">Language, and Hearing Research, 47, 1179- 1193.</span><br />
<span style="font-size: x-small;">48. Norbury, C. F. (2005a). Barking up the wrong tree? Lexical ambiguity </span><span style="font-size: x-small;">resolution in children with language impairments and autistic </span><span style="font-size: x-small;">spectrum disorders. Journal of Experimental Child Psychology, 90, </span><span style="font-size: x-small;">142- 171.</span><br />
<span style="font-size: x-small;">49. Norbury, C. F. (2005b). The relationship between theory of mind and </span><span style="font-size: x-small;">metaphor: Evidence from children with language impairment </span><span style="font-size: x-small;">and autistic spectrum disorder. British Journal of Developmental </span><span style="font-size: x-small;">Psychology, 23, 383- 399.</span><br />
<span style="font-size: x-small;">50. Norbury, C. F., & Bishop, D. V. M. (2002). Inferential processing and </span><span style="font-size: x-small;">story recall in children with communication problems: A comparison </span><span style="font-size: x-small;">of specific language impairment, pragmatic language </span><span style="font-size: x-small;">impairment and high-functioning autism. International Journal of </span><span style="font-size: x-small;">Language Communication Disorders, 37, 227- 251.</span><br />
<span style="font-size: x-small;">51. Norbury, C. F., & Bishop, D. V. M. (2003). Narrative skills of children </span><span style="font-size: x-small;">with communication impairments. International Journal of </span><span style="font-size: x-small;">Language Communication Disorders, 38, 287- 313.</span><br />
<span style="font-size: x-small;">52. Young, E. C., Diehl, J. J., Morris, D., Hyman, S. L., & Bennetto, L. </span><span style="font-size: x-small;">(2005). The use of two language tests to identify pragmatic language </span><span style="font-size: x-small;">problems in children with autism spectrum disorders. </span><span style="font-size: x-small;">Language, Speech, and Hearing Services in Schools, 36, 62 -72.</span></div>
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<span style="font-size: x-small;">53. Baird, G., Charman, T., Pickles, A., Chandler, S., Loucas, T., </span><span style="font-size: x-small;">Meldrum, D., et al. (2008). Regression, developmental trajectory </span><span style="font-size: x-small;">and associated problems in disorders in the autism spectrum: The </span><span style="font-size: x-small;">SNAP study. Journal of Autism and Developmental Disorders, 38, </span><span style="font-size: x-small;">1827- 1836.</span><br />
<span style="font-size: x-small;">54. Pickles, A., Simonoff, E., Conti-Ramsden, G., Falcaro, M., Simkin, Z., </span><span style="font-size: x-small;">Charman, T., et al. (2009). Loss of language in early development </span><span style="font-size: x-small;">of autism and specific language impairment. Journal of Child </span><span style="font-size: x-small;">Psychology and Psychiatry, 50, 843 -852.</span><br />
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E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com4tag:blogger.com,1999:blog-6733902656011255269.post-74805945116143962782015-07-28T09:36:00.000-05:002015-07-28T09:49:07.835-05:00Disability, difference, and impairment: What's the difference?<div>
If you've spent much time in the autism community, you've probably seen people arguing about whether autism is a difference, a disability caused by autism itself (an "impairment"), a disability caused by society, or a disability caused by both. So, what do these terms mean, and why does it matter? </div>
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To make these issues clearer, let's look at some examples that have nothing to do with autism.</div>
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At one time, left-handedness was considered bad. Children were punished for writing using their left hands, and forced to write with their right. This occurred until quite <a href="http://www.anythinglefthanded.co.uk/being-lh/children/teaching.html#sthash.iin8zs0c.dpbs" target="_blank">recently</a>, and still seems to occur occasionally <a href="http://www.anythinglefthanded.co.uk/being-lh/children/teaching/forced-change.html" target="_blank">in the U.K</a>. President Obama <a href="http://www.whitehousedossier.com/2013/03/20/obama-hit-child-left-handed/" target="_blank">reports that</a>, as a child in Indonesia, his teachers hit him with a ruler for writing with his left hand. President Obama explains that left-handedness was viewed as impolite in Indonesia, and a variety of other <a href="https://en.wikipedia.org/wiki/Bias_against_left-handed_people#Unfavorable_cultural_associations" target="_blank">negative associations exist</a>. In cultures that developed a practice of eating, interacting and handling food with the right hand while cleaning their bodies with the left, the left hand was considered "unclean" and regarded with disgust. In Christianity, Jesus sits at God's right hand, while those who have lost God's favor are described as "sent to the left."<br />
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A <b><i>disability</i></b> is when people's characteristics do not fit with the society in which they live, which leads to bad treatment, diminished opportunities, and ultimately, less success in life. See, for example, the Americans with Disabilities Act's <a href="http://www.ada.gov/cguide.htm" target="_blank">definition</a> of "disability," whose last sentence hints at the important role of society:<br />
<blockquote class="tr_bq">
An individual with a disability is defined by the ADA as a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or <b>a person who is perceived by others as having such an impairment. </b></blockquote>
Left-handedness was then a disability, for several reasons. First, left-handed people were viewed and treated negatively. Second, the environment was not accessible to them: everyday tools and furniture (e.g., desks) were set up for right-handers, making them difficult for left-handed people to use. Lastly, the educational system was dedicated to eliminating left-handedness. </div>
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Today, many of us see this discrimination against left-handed people as backward. We realize there is nothing inherently wrong or harmful about using the left hand. If society had not chose to view left-handedness as bad, it would not be a disability. Left-handedness is not an <i><b>impairment</b>,</i> something that would make it hard for people to do important activities no matter how they are treated. It is simply a harmless <i><b>difference</b>. </i>Choosing to view a trait like left-handedness as an impairment <i>makes </i>it into a disability. </div>
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However, if we could talk to the teachers who punished children for using their left hand, we would probably find that they believed left-handedness <i>was</i> an impairment. They probably thought they were doing the child a favor. If they could just make the child more like the right-handed majority, he would never face stigma or lose access to jobs and relationships. In other words, they probably were like many teachers and clinicians working with disabled children today. They saw that left-handedness was a disability, and instead of blaming the true cause--society--and trying to change it, they blamed the trait and set out to eliminate it. The only difference between those teachers then and special educators today is whether their culture considered left-handedness an impairment or a difference. </div>
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That should make us alert to the possibility that some of the disabilities we currently consider impairments are just differences, like left-handedness. Our children will probably look back at our treatment of stuttering, learning disabilities, autism, or ADHD with the same disgust and pity we have when considering how our ancestors treated left-handed people.</div>
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That, in fact, is the great <a href="http://neurocosmopolitanism.com/throw-away-the-masters-tools-liberating-ourselves-from-the-pathology-paradigm/" target="_blank">insight</a> of the <a href="http://neurocosmopolitanism.com/neurodiversity-some-basic-terms-definitions/" target="_blank">neurodiversity movement</a>--that people come with a wide variety of traits, and that this diversity makes the human species healthier and more likely to survive. While it's natural for humans to devalue minorities, like left-handed people, the world would be worse off without them in it. Because we are prone to view all differences as impairments whether or not they really are, we should be cautious about attempts to eliminate their disabilities--especially if it involves treating them in ways we would never treat a non-disabled person. Furthermore, the more subjective the impairment (e.g., "inappropriate" social interaction), the more skeptical we should be.</div>
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Some things we currently consider impairments may<i> really</i> be impairments. Even so, stigmatizing people and limiting their access to the world only makes their impairments <i>worse</i>. A person who cannot walk can still move around at will and live independently <i>if</i> there are wheelchairs, sidewalks and curb cuts, but <a href="https://www.washingtonpost.com/posteverything/wp/2015/07/24/why-the-americans-with-disabilities-act-mattered" target="_blank">could not before the Americans with Disabilities Act</a> (ADA) made these technologies widespread. </div>
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It would be hard to imagine any impairment that could cause as much suffering as being excluded from school, fired from jobs (if you are even hired at all), unable to access transportation, denied the right to vote, forcibly sterilized, forbidden to enter into contracts, or denied medical treatment. This was the <a href="https://www.washingtonpost.com/posteverything/wp/2015/07/24/why-the-americans-with-disabilities-act-mattered" target="_blank">normal state of affairs for people with disabilities before the ADA</a>, and some of this treatment continues today.</div>
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One reason many people with disabilities like the term "disability" is because it acknowledges the importance of society in making people disabled, while embracing the whole spectrum from those who are a little different to those who are severely impaired. This invites people with a variety of disabilities--and attitudes about their own disability--to work together. (I have seen fewer parents of disabled children who are comfortable with the term "disability"). </div>
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In short: A difference is a harmless trait, like left-handedness. An impairment is a trait that makes important activities difficult or impossible. A disability can be either a difference or an impairment. The distinction matters. However, for both, the way society treats people with disabilities may be what holds them back most.</div>
E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com1tag:blogger.com,1999:blog-6733902656011255269.post-22209209729973808732015-06-18T15:24:00.000-05:002015-06-18T16:03:27.337-05:00Is all research really "me-search?" And is "me-search" bad?<div class="MsoNormal">
J. Sumerau at “Write Where it Hurts” makes a provocative
<a href="http://www.writewhereithurts.net/what-is-me-search" target="_blank">argument</a> that the word “me-search” is used as a slur, and that all scientific research is, in a
sense, “me-search”:<o:p></o:p></div>
<blockquote class="tr_bq">
"In my experience, many scholars refer to work that engages some aspect of personhood as me-search. While this is a cute phrase, it is generally used to bolster claims to objectivity and/or to marginalize scholars who work in areas that have personal significance for them. ...On the surface, the best answers I have been able to find for this question at conferences, online, in departments, and in informal conversations suggests the therm refers to any case where someone conducts research in an area or with a population that is personally relevant to them. Based on this suggestion, me-search could actually just be considered a synonym for science. When, for example, an American demographer studies American population trends, ze is conducting me-search because ze is studying zir own population...One could even go so far as to say that if science is the study of the natural world, all science is me-search because all of us are parts of the natural world, and both influence and are influenced by this phenomena. Unless someone can find some area of study that does not influence human life or somehow become non-human prior to doing any kind of research, all research is ultimately me-search because all research seeks to make sense of the world we (or me) live in to the best of our current abilities."</blockquote>
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Sumerau seems to be right about how the term “me-search” is
used. A heterosexual psychologist who studies heterosexual couples would not be accused of doing “me-search,” while a gay man studying homosexual couples would
be. Heterosexual psychologists studying mainly heterosexual couples are quite
common in relationship research, and they often appear to present themselves as
researching the relationship of <i>couples
in general</i>, regardless of sexual orientation. They can get away with this
because the vast majority of people are heterosexual or in opposite-sex relationships,
so even if many individuals are completely different from these research
participants, the <i>average</i> person is
like them. Because homosexual couples are in the minority, a researcher
studying them could not claim to be studying couples in general, even if she
wanted to.</div>
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<o:p></o:p></div>
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Thus, I agree that “me-search” is in the eye of the
beholder. “Me-search” is a way of denigrating the subjectivity of those in the
minority while ignoring that of those in the majority. However, subjectivity comes with problems that Sumerau does not even mention. The problem is not that people ask minority researchers
engaged in “me-search” to question their assumptions and biases. The problem is
that they are <i>not</i> asking majority
researchers to do the same.<o:p></o:p></div>
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("Me-search” is a continuum, not a binary.
Sumerau’s first example—American demographers studying American population
trends—is uncontroversially “me-search,” while his last example, a physics or
geology study, seems much less so. In a trivial sense, yes, studying the
natural world is “me-search” because we live in the world and understanding it
better will change our technology, our behavior, and the way we understand the
world. But, are our identities bound up in whether the Higgs boson exists? Frankly,
most of us don’t care if there is a Higgs Boson, both because the phenomenon
itself is distant from our experience, and because we don’t think discovering
it will have much effect on our lives. By contrast, determining whether people
have free will could alter how we see ourselves and perhaps administer justice.
Discovering what makes people happy would not only affect our lives, but also
directly concerns our experience. Physics seems “objective” and not like “me-search”
and sociology the opposite because physics is more remote from our experiences,
concerns, and identities than sociology. So, I disagree with Sumerau’s claim
that everything is me-search, and therefore nothing is me-search. Different
research areas can involve more or less me-search, and the difference matters).<o:p></o:p></div>
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I believe “me-search” should be undertaken with a great deal
of critical thinking and self-examination. When our identities are at stake, we
tend to engage in two behaviors that hamper our reasoning and communication:
motivated reasoning and non-constructive arguments. Guarding against these
requires constant vigilance. When our identities become part of our work, the opportunities for motivated reasoning and non-constructive arguments multiply.<o:p></o:p></div>
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<b>The first pitfall of Me-search: Motivated Reasoning</b></div>
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No one is immune to motivated reasoning: the tendency, when our values and identities are at stake, to cling to evidence that supports our beliefs while ignoring or rejecting counterevidence. We look for ways to discredit those with whom we disagree, while ignoring the misdeeds of our own side. If you regularly read scientific papers, for example, you might find yourself poring over tiny details of the methods and statistics in papers you disagree with, while skimming papers you want to cite to support a point you were already planning to make in your introduction. When no legitimate evidence comes to hand, people even build elaborate conspiracy theories, and if all else fails, attack their opponents' motivations. For example, in the absence of evidence that vaccines cause autism, people with this belief <a href="http://www.snopes.com/medical/disease/cdcwhistleblower.asp" target="_blank">allege a government coverup</a> of the evidence, or claim their opponents are <a href="http://leftbrainrightbrain.co.uk/2011/01/11/fact-checking-the-age-of-autisms-defense-of-andrew-wakefield/" target="_blank">funded by drug companies</a>. Attacking their opponents' funding works because drug companies are associated with corruption and untrustworthiness, which provides a convenient excuse to ignore the researchers' message. Of course, funding isn't a magic button you press to get exactly the result you want. Just because someone is funded by a corrupt source does not mean that their results are wrong, or were obtained with unethical methods. This argument is only convincing if you are already looking for an excuse to disbelieve).</div>
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Ironically, descriptions of motivated reasoning, like this
one from <a href="http://skepdic.com/">Skepdic.com</a>,
are often good examples of motivated reasoning themselves. They use examples
that are far outside the mainstream of public opinion (or at least, educated
public opinion), such as “the Apollo moon landing was a hoax,” “the Holocaust
did not happen,” or “evolution is a hoax.” This makes it seem as if only
conspiracy theorists and the extremely religious engaged in motivated reasoning,
while educated, skeptical people—like the audience of Skepdic.com—would never
fall prey to such an error. This is an example of all the key ingredients of
motivated reasoning—a self-serving belief, hypersensitivity to opponents’
errors, and blindness to one’s own. No one is more susceptible to motivated
reasoning than those who believe themselves immune to it. <o:p></o:p></div>
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<b>The second pitfall of Me-search: Destructive emotional reactions</b></div>
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When identities are at stake, heated disagreements can go
from productive debates to feuds, or cutting off communication entirely. The
intense arguments that blow up occasionally on the Thinking Person’s Guide to
Autism’s website and facebook page are a great example. A certain sort of non-disabled parent of
autistic children has invested an identity in being an “autism mom,” a “<a href="http://www.amazon.com/Mother-Warriors-Parents-Healing-Against/dp/B002HREKD2" target="_blank">warrior</a>” “fighting autism” in order to “get their kid
back.” It follows directly from the messages about autism promulgated by the
media and the largest autism charity, <a href="http://mosaicofminds.blogspot.com/2013/12/creating-culture-of-death-long-major.html" target="_blank">Autism Speaks</a>. And to a parent who feels overwhelmed by parenting a child with a disability,
resents it, and doesn’t feel supported, this narrative gives them control and purpose, making them feel more heroic and less helpless. The problem, of course, is
this ideology comes from attacking a basic part of their child that cannot be
removed, and easily leads to <a href="https://ballastexistenz.wordpress.com/2006/05/16/exactly-who-is-unresponsive-here/" target="_blank">ignoring the child’s communication</a>, <a href="http://mosaicofminds.blogspot.com/2012/12/why-assume-autistic-people-are-listening.html" target="_blank">treating them</a> with <a href="http://neurowonderful.tumblr.com/post/102907206441/a-long-sad-story-about-the-attitudes-that-autism" target="_blank">utter disrespect</a>, making them <a href="http://adiaryofamom.com/2013/03/21/hate/" target="_blank">feel hated</a>, <a href="https://ischemgeek.wordpress.com/2015/04/19/why-i-interfere/" target="_blank">traumatizing them </a>for years, <a href="http://timetolisten.blogspot.com/2013/09/here-try-on-some-of-my-shoes.html" target="_blank">abusing them</a>, putting them in <a href="http://tinygracenotes.blogspot.com/2014/12/aba-by-sparrow-rose-jones.html" target="_blank">abusive therapy</a>, or even <a href="http://mosaicofminds.blogspot.com/2013/12/creating-culture-of-death-long-major.html" target="_blank">murdering them</a>.
When parents talk about parenting their child this way, it <a href="http://autisticacademic.com/2014/10/09/how-tpgas-mods-failed-me/" target="_blank">presses all thebuttons </a>of autistic people who have been traumatized by parents who behaved that
way. Often, autistic adults lash out. But even if they find the commendable
patience to politely explain why these parents are being hurtful, the parents
<a href="https://ischemgeek.wordpress.com/2014/10/07/istandwithkassiane" target="_blank">react even more viciously</a>. While parents’ rhetoric is an existential threat to autistic adults’
identities, autistic adults’ claim that parents might be hurting their child
hits them in the part of their identity that matters most—their role as a
parent. Most <a href="https://theconnorchronicles.wordpress.com/2013/12/30/boycott-the-thinking-persons-guide-to-autism/" target="_blank">react defensively</a>, although a few have listened and have <a href="http://emmashopebook.com/2013/06/17/from-cure-to-celebration/" target="_blank">transformed</a> the way they view their
role and parent their child—a change that <a href="http://blogs.plos.org/neurotribes/2013/04/01/what-i-learned-from-my-autistic-son-a-guest-post-by-brenda-rothman/" target="_blank">improved</a> their mental health. In short, both autistic adults and nondisabled parents feel their
identity is threatened and react defensively, leading to over-the-top
arguments, people being <a href="http://ialwayslikecats.blogspot.com/2014/10/i-love-youi-hate-you-i-admire-youi-ban.html" target="_blank">banned from the community</a>, and many of the debaters cutting off communication by blocking each other on
Twitter and Facebook. Emotional reactions based on identity can prevent people from
communicating and working together. <o:p></o:p></div>
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Less extreme versions of these blowups occur in research,
not just in the autism community. Psychology is full of theoretical
disagreements that sometimes border on personal feuds, such as the old one
between <a href="http://mental.psych.northwestern.edu/people.html" target="_blank">Lance Rips</a> and <a href="https://psych.princeton.edu/~psych/psychology/research/johnson_laird/index.php" target="_blank">PhilipJohnson-Laird</a>, or the more recent one between <a href="http://www.vanderbilt.edu/psychological_sciences/bio/isabel-gauthier" target="_blank">Isabel Gauthier </a>and <a href="http://mcgovern.mit.edu/principal-investigators/nancy-kanwisher" target="_blank">Nancy Kanwisher</a> .
Since I am closely connected with people on one side of each of these debates I
will not discuss any details. Each involves a long series of papers, so I
invite you to read them and see for yourself. Personally, I think that the
papers would have been clearer and more inviting to read had they been written
in a less emotional context.<o:p></o:p></div>
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<b>The Benefits of Me-search</b></div>
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So, if bringing identity into research can lead to motivated
reasoning and personal feuds, does that mean everyone should avoid doing “me-search?”
I think not, for two reasons.</div>
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<o:p></o:p></div>
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First, lived experience provides knowledge that might be
difficult or impossible for outsiders to gain. Autistic people talked about sensory
overload and other sensory processing problems for <a href="http://speapsl.aphp.fr/pdfpublications/2008/2008-7.pdf" target="_blank">decades</a> before neurotypical researchers took an interest. Many autistic people and
parents noticed echolalia can be a first step towards generating one’s own
communicative language; only a handful of neurotypical researchers, such as
<a href="http://www.barryprizant.com/" target="_blank">Barry Prizant</a> in the 1980’s bothered testing the hypothesis. Many proclaimed the opposite and a few recent papers <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205715/" target="_blank">still do</a>. In fact, behavior programs have tried to
discourage echolalia (e.g., <a href="https://trumpetcareers.silkroad.com/map_images/main/SiteGen/TrumpetCareers/Content/Uploads/Documents/TMPublications/DecreasingEcholaliaoftheInstructionSayDuring.pdf" target="_blank">this</a>). Yet, although <a href="http://gernsbacherlab.org/wp-content/uploads/papers/1/Gernsbacher_reciprocity.pdf" target="_blank">responsive communication</a> from caregivers <a href="http://cdp.sagepub.com/content/23/2/121.abstract" target="_blank">helps typically developingchildren develop language</a>, (and also <a href="https://www.ucdmc.ucdavis.edu/mindinstitute/research/abbeduto_lab/publications/Haebig%20et%20al%202013%20JADD.pdf" target="_blank">autistic children</a>), we don’t even know if having their best
language ignored or discouraged by therapists stunted generations of autistic
children’s development. Autistic people have known for a long time that
stimming has many <a href="https://storify.com/theoriesofminds/stimmingmeans" target="_blank">positive functions</a>;
researchers are still looking for new ways to stop them from doing it through
behavior modification or even <a href="https://www.google.com/patents/US6447772" target="_blank">drugs</a>.</div>
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Autism viewed from the outside is different from autism
experienced from the inside, and both are aspects of what autism, the
phenomenon, actually is—a set of genetic, brain, mind, and behavior states. If
only neurotypical clinicians research autism, then we will not have the
complete picture—we will only learn about autism as viewed from the outside.
While autism-viewed-from-the-outside is real and sometimes important, it is not
necessarily the most important part of autism. Without understanding
autism-from-the-inside, we risk confusing the outward appearance of autism with
what it really is. We would not have been stuck with obviously inadequate <a href="http://deevybee.blogspot.com/2012/01/psychoanalytic-treatment-for-autism.html" target="_blank">psychoanalytic</a>,
<a href="http://www.autism-community.com/wp-content/uploads/2010/11/TOM-in-TD-and-ASD.pdf" target="_blank">theory of mind</a>,
or “<a href="http://cogsci.bme.hu/~ivady/bscs/read/bc.pdf" target="_blank">extreme male brain</a>” explanations of autism for so long had
autistic people been involved sooner in researching their own condition.<o:p></o:p></div>
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Me-search is also important in so-called “translational” or “clinical”
research fields, where the goal is to learn something that will improve people’s
lives. People in a particular group do not always focus on the same outcomes as
those outside of it. For example, autistic people often want to see less emphasis
on finding causes and cures, and more emphasis on services, education, and
employment. By contrast, people with ME or chronic fatigue syndrome would like
to see <a href="http://www.meresearch.org.uk/information/publications/what-do-patients-want" target="_blank"><i>more</i> basic biochemical research</a> on the causes behind their symptoms. In both cases, those with the condition disagree with those doing the research—who
do not have it. When people in a specific group have a say in what outcomes are
considered helpful, research is more likely to actually help them. <o:p></o:p></div>
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<b>Me-Search: Approach, with Caution</b></div>
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I support neurodivergent people researching their own and
similar diagnoses, so long as they observe themselves carefully to avoid
motivated reasoning and unhelpful emotional reactions. I would also like to see
neurotypical psychologists and neuroscientists recognize that they are engaged
in “me-search,” and take similar precautions.<o:p></o:p></div>
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We need to be careful about endorsing theories that fit our
experiences regardless of the strength of the evidence. For example, many
autistic and other neurodivergent people describe being sensitive and
overreactive to other people’s emotions. Thus, even before learning the
details, I am predisposed to support the intense world theory of autism,
<a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.292.8685&rep=rep1&type=pdf" target="_blank">proposed by</a> Kamila and Henry Markram. Intense World Theory proposes <i>specific</i> neural mechanisms behind this
hypersensitivity, based on rodent research. They also propose a specific way of
raising autistic children that <a href="http://sfari.org/news-and-opinion/viewpoint/2014/intense-world-theory-raises-intense-worries" target="_blank">contradicts findings in typically development research</a>: Because autistic people are hyperaroused all the time, the Markrams recommend
providing very little stimulation,
whereas in typically developing humans and animals, deprivation of stimulation
can actually cause developmental delays. While I and others may be tempted to
adopt Intense World Theory because it fits experience well, it need not be the
correct mechanism. Not every promising finding in rats translates to humans. Even
if this mechanism is correct, that may not imply that drastically reducing
sensory input is good for autistic development. For example, maybe gradual
increases in exposure would help them learn to tolerate the environment better.
Or maybe the optimal level of stimulation is lower than typical, but not as low
as the Markrams suggest. The Markrams’ research program will have to follow two
steps: demonstrating that intense world theory applies to a significant portion
of autistic humans, and determining whether reduced stimulation really does
help. These are separate programs requiring very different research skills, and
each will likely take years.<o:p></o:p></div>
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We also need to be careful to avoid dismissing any research
evidence that contradicts our experiences. When our identities are involved, we
may be more tempted to explain away contradictory evidence, for example, by
calling it a methodological problem. (Maybe they didn’t design their task
right, or choose the right participants, or explain their task properly). This is easy to do because there are lots of small factors that go unreported that affect how a study comes out, and sometimes there really <i>are</i> methods
problems. But we have to be willing to admit when our theories are wrong—even when
they’re based on personal experience—or we’re not doing science.<o:p></o:p></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.easterbrook.ca/steve/wp-content/science-youre-doing-it-wrong.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://www.easterbrook.ca/steve/wp-content/science-youre-doing-it-wrong.jpg" height="256" width="320" /></a></div>
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Many researchers probably have difficulty acknowledging
their mistakes, and not all of them do me-search. Me-search simply increases
the temptation. Me-searchers might have an easier time letting go of theories
based on experience if they remind ourselves that they may not be
representative. What they know about themselves may not be true of the whole
population they study.<o:p></o:p></div>
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Sumerau seems insufficiently concerned with these pitfalls
of “me-search.” However, he or she lays bare the unequal way “me-search” is
used, to discredit those in the minority and reassure those in the majority. Neurodivergent
researchers who want to research similar groups need both sorts of knowledge.
They need to know the sociology of terms like “me-search” so they can combat
this prejudice. They also need to understand the biases that come with me-search so
their identities help, not harm, their science. Armed with this knowledge, they
could transform their fields.<o:p></o:p></div>
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For their part, neurotypical psychology and neuroscience researchers who study the general population need to recognize that they are doing "me-search," and are just as susceptible to biases as those in the minority. If anything, they may be more so. Because those in the majority encounter more people like themselves, they can more easily have their "people are like me" biases confirmed. If researchers recognized identity-based biases as a normal part of researching human beings, not some weird property of minority researchers, they would do better science. </div>
E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-81701430874125517582015-06-11T11:41:00.000-05:002015-06-12T07:43:35.828-05:00How can you measure a non-speaking person's understanding of language?The autism community has become increasingly concerned about understanding people with no spoken language, and often, severe developmental delays. Such people have previously been excluded from many research studies, in favor of more convenient subjects. However, psychology offers a variety of tools for learning about the mental life of people who cannot speak, most of which involve measuring eye movements. Some of these, such as <a href="http://en.wikipedia.org/wiki/Habituation#Uses_of_the_habituation_procedure" target="_blank">habituation</a>/<a href="http://en.wikipedia.org/wiki/Preferential_looking" target="_blank">preferential looking</a>, come from research with babies. This makes sense, because working with babies means making inferences about the thoughts of people with little or no speech or gesture. Surprisingly, another paradigm comes from research on how adults interpret language, and is called the "looking while listening" or "visual world" paradigm.<br />
<br />
<i>Visual World Paradigm</i><br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td><img alt="Image result for visual world paradigm" height="284" src="data:image/jpeg;base64,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" 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<tr><td class="tr-caption" style="font-size: 12.8000001907349px;">Example of the visual world paradigm, using the words "peach," "beach," "sheep," and "lock."</td></tr>
</tbody></table>
Back in 1974, a researcher named Cooper measured people's eye movements while they listened to short narratives and looked at pictures of common objects. Some of the objects were referred to in the spoken narrative, while others were not. Participants were told their pupil size was recorded, but they could look anywhere they wanted. The listeners tended to look at objects that were being mentioned in the narrative--either while the word was still being spoken, or within about 200 ms after it [4]. In the 1990's, when eye movements became easier to measure, Tanenhaus's research team found something similar. The method, dubbed the "visual world paradigm," quickly took off [4].<br />
<br />
While people do not consciously <i>choose </i>to look at the objects they are thinking about, and may not even realize they're looking at them, their eye movements still reflect their thoughts. That makes the visual world paradigm attractive for understanding language comprehension.<br />
<br />
Researchers used this method because they were interested in how people's language abilities interacted with their non-language ones (such as the ability to recognize objects)[4]. They were also interested in when and how we distinguish a word from other, similar-sounding words. While it feels like one recognizes short words all at once, they actually take several hundred milliseconds to say. During this time, information about the word gradually accumulates, and your brain uses it to predict what word the person is saying. The visual world paradigm can be used to measure how long it takes to distinguish a word (e.g., "beaker") from another word that sounds the same at first (e.g., "beetle"), as opposed to a rhyming word (e.g., "speaker") or a completely unrelated one ("dolphin") [1]. The <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965566/" target="_blank">first study I ever worked on</a> [2] used the visual world approach with these exact types of words, while measuring brain activity with EEG.<br />
<br />
An important aspect of this method is <i>timing.</i> It doesn't just matter which picture people look at, it matters <i>when</i> they look at it. The timing for the eye movement data is matched up very precisely with the timing of the audio and the picture, or "time locked." Then one can say, for example, that at the point where the speaker has said "bea," the listener glances at both the beetle and the beaker, but by the time the word finishes, the listener is only looking at the beaker.<br />
<br />
<i>Looking While Listening</i><br />
A simpler version of the visual world paradigm, the "<a href="http://www-psych.stanford.edu/~babylab/pdfs/LWL.2008.pdf" target="_blank">looking while listening</a>" procedure, is used to measure very young children's language comprehension [3]. Children look at a pair of pictures while listening to speech that names one of the pictures. Just as with visual world, their gaze patterns are measured and time-locked to the speech signal.<br />
<br />
One difference is that only two pictures appear onscreen instead of four. Fewer distracters is suitable for very young children, or those with limited ability to control their attention. The pictures are also very carefully matched on how bright and interesting they are. <br />
<br />
Researchers code where the child is looking during each trial a frame at a time. Trials are categorized depending on where children are looking when the word begins and ends [3].<br />
<br />
For example, if a child starts out looking at the correct object (the "target") and continues looking at it the entire time the word is presented, this is a "target-initial" trial. This pattern reflects comprehension. If the child starts out looking at the distracter picture, but shifts during the word to looking at the correct picture, this is a "distracter-initial trial," and it also indicates comprehension.<br />
<br />
Certain patterns indicate the child probably does not comprehend the spoken language presented, including:<br />
<ul>
<li>The child starts out looking at the distracter picture and never shifts to looking at the correct picture.</li>
<li>The child starts out looking at the target picture and switches to the distracter.</li>
</ul>
<br />
Other patterns suggest that the child was not performing the task at all, and his or her comprehension can't be judged:<br />
<ul>
<li>The child was looking somewhere between the pictures the whole time and not directly at either of them.</li>
<li>The child was looking away (not at the display at all) the whole time.</li>
</ul>
Data can be plotted continuously, like this, to see how children's comprehension gradually unfolds, and how it improves with age:<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://4.bp.blogspot.com/-ojX-EwOzL0M/VXmxqSFTavI/AAAAAAAADKM/QN3pd57uWPQ/s1600/fernald%2Beye%2Btracking%2Bfigure.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="316" src="http://4.bp.blogspot.com/-ojX-EwOzL0M/VXmxqSFTavI/AAAAAAAADKM/QN3pd57uWPQ/s400/fernald%2Beye%2Btracking%2Bfigure.png" width="400" /></a></div>
Above image is from Fernald and colleagues (2008) [3].<br />
<br />
However, other measures are more intuitive and easier to compare between groups. Perhaps the most intuitive is accuracy, the proportion of time spent looking at the correct picture as opposed to the distracter (or anything else) [3]. If the child consistently looks at the labeled picture for most of the time, then he or she probably understands that the label refers to that picture.<br />
<br />
Children look more consistently at the correct picture as they get older and develop higher language skill. Looking while listening comprehension might also reflect individual differences in language abilities in general. For example, typically-developing children with higher looking while listening comprehension at 25 months may have higher standardized language scores (<a href="http://www.pearsonclinical.com/language/products/100000442/clinical-evaluation-of-language-fundamentals-fourth-edition-celf-4.html" target="_blank">CELF</a>-4) at 8 years [3].<br />
<br />
<i>Using looking while listening with autistic children</i><br />
Looking while listening has been used to measure young autistic children's language in their own homes [5]. Children view videos with two side-by-side images, accompanied by audio that only matches one of the images. If children understand which image matches the audio, they will look at it rather than the distracter. Videos were used instead of static pictures because these are better for measuring children's understanding of verbs, including who did what to whom. This <a href="http://www.jove.com/video/4331/portable-intermodal-preferential-looking-ipl-investigating-language" target="_blank">video</a> by Letitia Naigles and Andrea Tovar [5] show how the videos are designed and presented to children. It's a great example of how high-quality, well-controlled research can be done outside the lab, so participants can be comfortable.<br />
<br />
Of course, this method isn't perfect. One question to be resolved is how well it works for people with difficulty making eye movements. Difficulty making controlled eye movements sometimes <a href="http://www.molecularautism.com/content/5/1/47" target="_blank">occurs in autism</a>, and may be especially common in <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1467-7687.2012.01188.x/abstract" target="_blank">those with language impairments</a>. The eye movements made during the looking while listening paradigm are not deliberate, so I am not sure if a person with difficulty making controlled eye movements would also have difficulty with these. If so, this task won't be suitable for every nonspeaking person. But no assessment method is suitable for everyone, and this is more accessible than most standardized tests.<br />
<br />
Measuring people's understanding of nouns, verbs, and sentences is very far from understanding a person's <a href="http://mosaicofminds.blogspot.com/2015/04/what-is-it-like-for-disabled-person-to.html" target="_blank">experience</a>. So, the looking while listening paradigm and similar methods do not completely solve the problem of understanding nonspeaking people. However, they might help with <a href="http://emmashopebook.com/2014/07/21/presuming-competence-revised/" target="_blank">presuming</a> <a href="http://emmashopebook.com/2013/03/07/presume-competence-what-does-that-mean-exactly/" target="_blank">competence</a> <a href="http://emmashopebook.com/2013/05/22/taking-action-presuming-competence/" target="_blank">and</a> <a href="http://blog.brookespublishing.com/presuming-competence-what-it-is-what-it-looks-like/" target="_blank">offering an appropriate education</a>. <b>When we can actually measure whether a nonspeaking person can understand what we say to them, we no longer have any excuse for assuming they do not understand. </b>Most likely, many nonspeaking autistic people will demonstrate comprehension beyond what their parents or teachers predicted.<br />
<br />
<u>References</u><br />
<br />
<ol>
<li>Paul D. Allopenna, James S. Magnuson, and Michael K. Tanenhaus (1998). Tracking the time course of spoken word recognition using eye movements: Evidence for continuous mapping models. <i>Journal of Memory and Language</i> vol. 38, pp. 419-39.</li>
<li>Amy S. Desroches, Randy Lynn Newman, and Marc F. Joanisse (2009). Investigating the time course of spoken word recognition: Electrophysiological evidence for the influences of phonological similarity. <i>Journal of Cognitive Neuroscience </i>vol. 21, iss. 10, pp. 1893-1906. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3965566/" target="_blank">Full text HTML</a>.</li>
<li>*Anne Fernald, Renate Zangl, Ana Luz Portillo, and Virginia A. Marchman (2008). Looking while listening: Using eye movements to monitor spoken language comprehension by infants and young children. In: Irina A. Sekerina, Eva M. Fernandez, & Harald Clahsen (editors), <i>Developmental Psycholinguistics: On-line methods in children's language processing</i> xviii, pp. 97-135. Open access <a href="http://www-psych.stanford.edu/~babylab/pdfs/LWL.2008.pdf" target="_blank">PDF</a>.</li>
<li>*Falk Huettig, Joost Rommers, and Antje S. Meyer (2011). Using the visual world paradigm to study language processing: A review and critical evaluation. <i>Acta Psychologica</i> vol. 137, pp. 151-71.</li>
<li>*Letitia R. Naigles & Andrea T. Tovar (2012). Portable intermodal preferential looking (IPL): Investigating language comprehension in typically developing toddlers and young children with autism.<i> Journal of Visual Experimentation</i> 70, e4331 (Paper & video). <a href="http://www.jove.com/video/4331/portable-intermodal-preferential-looking-ipl-investigating-language" target="_blank">URL</a>.</li>
</ol>
E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-35208640684517393322015-06-02T19:50:00.001-05:002015-06-12T07:55:38.641-05:00Intense focus on specific topics isn't unique to autismOften, when we think of a smart, verbal autistic person, we imagine someone talking our ear off about a favorite interest.<br />
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<a href="https://s-media-cache-ak0.pinimg.com/236x/24/95/a4/2495a4605621e0d847d26cd1d2c75cd1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="A meme showing a camera shaped like a face, with the caption "Let me tell you what I like for the next 2 hours."" border="0" height="191" src="https://s-media-cache-ak0.pinimg.com/236x/24/95/a4/2495a4605621e0d847d26cd1d2c75cd1.jpg" title="Special interests meme" width="200" /></a></div>
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The current diagnostic criteria for ASD (DSM-5) include the following:<br />
<blockquote class="tr_bq">
"Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests").</blockquote>
The previous version (DSM-IV) also described an:<br />
<blockquote class="tr_bq">
"Encompassing preoccupation with one or more stereotyped patterns of interest that is abnormal either in intensity or focus."</blockquote>
So, there are two aspects of autistic people's interests that are considered unusual: "intensity," the <i>presence</i> of things like intense emotions, drive to engage in the interest, or time spent; and "focus," the <i>absence</i> of interest and attention to other things.<br />
<br />
But, are either of these unique enough to autism to be diagnostic? It turns out, children in the general population <i>also </i>have interests that are extremely intense. The jury's still out on focus, as far as I know. My guess is, it won't be unique to autism either. After all, if what you love most is trains and you want to learn and talk about and look at trains all the time, you'll do that whenever you have a choice--and therefore, you'll do other things less.<br />
<br />
Researchers on intense interests didn't set out to learn about autistic traits. In fact, they stumbled on these interests while studying other things. <a href="http://www.faculty.virginia.edu/deloache/" target="_blank">Judy DeLoache</a>'s team studied how children develop abstract concepts, and <a href="http://cogs.indiana.edu/people/profile.php?u=joalexan" target="_blank">Joyce Alexander</a>'s team researched children's knowledge about science topics. Alexander's group in particular focused on children with "<a href="http://mosaicofminds.blogspot.com/2015/03/how-expertise-changes-way-you-see.html" target="_blank">expertise</a>" in specific topics--children with lots of well-organized knowledge--and noticed that they tended to be extremely interested in their topic of expertise. So, these researchers started examining what these intense interests were like and how common they were.<br />
<br />
<i><b>The Studies</b></i><br />
Judy DeLoache and colleagues [2] recruited parents of 177 children, ages 11 months to 6 years, who had participated in other studies. They were mostly white and middle class. Parents initially filled out a questionnaire to screen for children who might have intense interests. They were asked only about their child's <i>most</i> intense interest ever. Parents who claimed their child had an intense interest were interviewed by phone. However, a parent's belief that their child had an intense interest was not enough for the researchers. Children's interests were given a score ranging from 1 (moderate interest) to 5 (extremely intense interest) based on duration, the number of different settings where the interest was observed, the number of objects and activities involved in the interest, and the extent to which other people noticed the interest. Only if two raters gave the child a score of 3 or higher were they judged to have an "extremely intense interest."<br />
<br />
Joyce Alexander and colleagues [1, 4, 5] did a large longitudinal study, recruiting 215 4 year olds and following up every 2 months for two years. Unfortunately, these children were also mostly white and middle class. Parents were interviewed 13 times about their child's preferred activities during free play, amount of free play time available, preferred TV shows, videos and books, and whether the child had focused interests. Researchers measured the proportion of interviews where children had a focused interest, total number of interest topics over the two years, and the length of the interests.<br />
<br />
As part of a neuroimaging study on expertise, Thomas and Karin James [3] recruited 10 8-12 year olds with intense interests in Pokemon. They used a parent questionnaire based on Alexander's and DeLoache's studies to identify these children. Participants had no record of learning disabilities and had typical scores on the Childhood Autism Screening Test (CAST).<br />
<br />
<i><b>How common are intense interests?</b></i><br />
Between 20% and 30% of children seem to have extremely intense interests in one or two topics.<br />
<br />
In DeLoache's [2] sample of 177 children, parents reported that two thirds (116) had an intense interest. Of these, researchers judged 65 to have only moderately strong interests. So 51 children, or 29% of the whole sample, had extremely intense interests.<br />
<br />
Joyce Alexander's team reported in 2008 [1] that 21% always had a focused interest during the two years of the study.<br />
<br />
These studies suggest that intensity and focus are continuous traits. At one end of the continuum, some children have extremely intense interests focused on one or two topics. At the other end, children never have any focused or strong interest at all. Interestingly, a total lack of focused interests seems rare--only 34% in DeLoache's study [1], and 10% in Johnson's [4].<br />
<br />
The majority of the population seems to be in the middle, with several different patterns observed:<br />
<ul>
<li><u>Interests are less intense</u>: Similarly focused on 1 or 2 topics, but less intense.</li>
<li><u>Interests are less focused</u>: Interests are still highly intense, but are spread across more than 1 or 2 topics.</li>
<li><u>Interests are shorter</u>: Interests may still be highly intense but are short--rapidly shifting from one interest to another. For example, while 21% of Alexander's [1] participants had focused interests, only 7% were interested in only a single topic all 24 months, suggesting many were shifting from one interest to another.</li>
<li><u>Combination</u><b>:</b> Alexander's studies [5] included some children who had an average of 6 interests lasting up to 10 months, and others with an average of 3 interests lasting up to 22 months. The former group could be considered to have both shorter and less focused interests.</li>
</ul>
<i><b>When do intense interests start?</b></i><br />
Children's intense interests start early. In DeLoache's study, interests emerged between 3 and 42 months, with the average age being 18 months. Almost 40% of interests were reported to have appeared within the first year, and 90% had developed by age 2. Several parents reported that their children's object of intense interest was among their first words.<br />
<br />
Perhaps because these interests appeared so early, almost 80% of the parents had no idea what triggered them; they said these interests had "just always been there." <br />
<br />
<i><b>How long do intense interests last?</b></i><br />
Intense interests often last for a long time. DeLoache and colleagues found that these interests lasted from 6 to 36 months, or an average of 22 months. Given that these children were, on average, 35 months old, they had had these interests for most of their lives.<br />
<br />
Alexander and colleagues [1] reported a shorter but still respectable duration--an average of 11 months.<br />
<br />
<i><b>What topics are children intensely interested in?</b></i><br />
Topics of interest vary widely,with some being typical for age and gender, and others highly idiosyncratic.<br />
<br />
Typical interests included vehicles, balls, books, dolls, and dinosaurs [2]. Interests were often in objects (e.g., tea sets, puzzles, tools) but sometimes in fiction (e.g., the Wizard of Oz) [2]. Interests were often gender-stereotyped [1], with half the boys interested in vehicles and machines, and almost half the girls interested in things like dress-up, babies, and teasets [2].<br />
<br />
Importantly, unusual interests aren't unique to autism. About 12% of DeLoache's children from the general population also had unusual interests for their age, including [2]:<br />
<br />
<ul>
<li>The Blue Angels</li>
<li>Pouring liquids</li>
<li>Bodies and injuries</li>
<li>U.S. Presidents</li>
<li>Brooms, brushes, and mops</li>
<li>Inventing and building</li>
</ul>
Parents of children with idiosyncratic interests believed these interests had originated from the child, not the parents [2]. For example, a 3 year old boy developed an intense interest in the Blue Angels, a fighter pilot squadron of the U.S. Navy, when he saw a clip of them flying on TV during a program on another topic.<br />
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<i><b>Who has intense interests?</b></i><br />
<u>Children with high IQ</u><b>. </b>Children with intense interests may have higher IQ than average.<br />
<br />
Eight to twelve year olds intensely interested in Pokemon had higher overall, verbal, and nonverbal IQ on the <a href="http://en.wikipedia.org/wiki/Wechsler_Intelligence_Scale_for_Children" target="_blank">WISC</a> than age peers, as well as higher working memory [3].<br />
<br />
Alexander's team [4] found that four year olds with intense interests in scientific topics or vehicles had higher receptive vocabulary (on the <a href="http://en.wikipedia.org/wiki/Peabody_Picture_Vocabulary_Test" target="_blank">Peabody Picture Vocabulary Test</a>-III). While vocabulary is <i>not</i> the same thing as verbal intelligence, it is highly correlated in the general population and was used as a proxy for it in this study. Children with intense interests also had higher working memory for shapes (SHAPE SPAN 2).<br />
<br />
Another study by the same team [5] found that children with long-lasting "conceptual" interests in science or vehicles had IQ (<a href="http://en.wikipedia.org/wiki/Alan_S._Kaufman#Overview_of_Kaufman.27s_tests" target="_blank">Kaufman Brief Intelligence Test</a>) about 1 standard deviation above the normative mean (average standard score=114).<br />
<br />
<u>Boys</u>. Most children with intense interests are boys. In DeLoache's study, 75% of the children with intense interests were boys. (By contrast, 43% of the children with moderate interests and 30% of those with no strong interests at all were boys). Researchers also judged boys' intense interests to be more extreme than girls'.<br />
<br />
It's not yet clear why there are such strong gender differences. Unfortunately, these researchers cite old work with rather unsophisticated gender concepts by Simon Baron-Cohen as a possible explanation [1, 2, 4]. But better explanations exist.<br />
<br />
One clue is that the interest topics themselves are often gender-stereotyped [1, 2, 4]. Even if children are too young to be aware of gender stereotypes, their parents largely control their environment, and may surround their children with gender-stereotyped objects. A boy without access to dressing-up materials is unlikely to develop an intense interest in this activity; a girl without access to Legos would be unlikely to develop an intense interest in them, either.<br />
<br />
Another clue is that girls' interests start equally early [2] and last an equally long time [1, 2]. They simply seem to be focused on different topics or activities--ones that are treated differently by some researchers. Specifically, they were more likely to have interests in creative activities (e.g., drawing), writing, and pretend play, and less likely to have interests in building things or pursuing information about scientific topics and vehicles [1, 4]. To the extent that researchers focus on interests in objects or scientific topics, they may be biased towards finding more boys. So the methods researchers use may also contribute to finding gender differences.<br />
<br />
<i><b>Are intense interests ever a nuisance in the general population?</b></i><br />
Parent interviews sometimes hinted that their child's interest could be seen as annoying and was sometimes discouraged [2].<br />
<br />
For example, one little girl's intense interest was in pouring liquids from one container into another. "So constant was this activity that she was banned from visiting the next-door neighbors for repeatedly creating messes by her pouring," DeLoache and colleagues report. Another little boy was fascinated by brooms, mops, rakes, hairbrushes, toothbrushes, and vacuum cleaner attachments. His mother bought him his own and locked the rest in a closet and an out-of-reach cupboard "to keep him from playing with them." One little boy's teacher ended up putting his favorite table with Thomas the Tank Engine trains on it into storage because the boy spent all the time there and stood guard to prevent other children from playing there. Another boy was forbidden to pretend to be a dinosaur at preschool because it was scaring other children.<br />
<br />
<i><b>How does the family influence the development of intense interests?</b></i><br />
While parents may not be crucial for generating an interest, their encouragement can help maintain it.<br />
<br />
In DeLoache's study, over a third of the intense interests emerged during the first year of life, without any parental encouragement. In fact, some children developed interests their parents found odd, potentially dangerous (e.g., fans), or even disgusting (e.g., injuries and roadkill).<br />
<br />
However, parents sometimes give children a gift or engage in an event with them that sparks their interest. [5] Moreover, the majority of parents do support their children's interests [2], and this might help them maintain these interests longer. For example, children are more likely to maintain "conceptual" interests (in scientific topics or vehicles) when parents [4]:<br />
<ul>
<li>Value consistency and structure in the home. </li>
<li>Provide lots of opportunities for free play <i>and</i> emphasize educational activities <i>and</i> emphasize communication.</li>
</ul>
Parents of children with lasting "conceptual" interests tend to support their children's interest through educational activities, such as trips, reading, collecting things, and watching videos together [4, 5]. Parents of children with other lasting interests, such as arts, music, or sports, tended to support the child's interest through playing with them [4].<br />
<br />
Parents also share their child's interest, or a related one, almost seventy percent of the time [4]. That makes it likely that they and their child discuss the interest and do activities relating to it frequently.<br />
<br />
<i><b>Perceptual nature of early intense interests</b></i><br />
Parents of autistic children have noted the perceptual nature of their children's interests, such as the pattern of circles and rotation involved in <a href="https://autismandoughtisms.wordpress.com/2012/09/07/making-sense-of-novelty-and-obsession-in-autism-aka-questioning-the-circle/" target="_blank">one child</a>'s fascination with clocks, wheels, and planets.<br />
The same may be true in the general population. Children with intense interests in balls initially attended to <i>anything</i> spherical in shape, regardless of size, type of object, or material. Children interested in trains started out fascinated with train tracks, and later with fences and zippers--all sharing a similar pattern of intersecting vertical and horizontal lines [2].<br />
<br />
DeLoache and colleagues seem bemused by why a "meaningless perceptual image" should come to dominate children's lives for such a long time. Children younger than three or four are too young to have the knowledge to determine that these images are meaningless, and to focus on "meaningless" misses the point--this is clearly an aesthetic and emotional experience. The first few chapters of autistic poet Tito Mukhopadyay's book "<a href="http://www.amazon.com/How-Talk-Lips-Dont-Move/dp/1611450225" target="_blank">How can I talk if my lips can't move</a>?" provides a glimpse of how it might feel to be in the grip of an aesthetic experience with everyday objects (in his case, a mirror).<br />
<br />
<i><b>Are intense interests in the general population like special interests in autism?</b></i><br />
Young children in the general population have interests that are, statistically speaking, "abnormal in intensity and focus" (given that they are the top 20-30% of the population). These interests are noticeable to others in many contexts, suggesting that they truly dominate children's lives, and may not yet be hidden in the interests of social acceptability. Like autistic interests, these often concern idiosyncratic topics or objects with specific perceptual characteristics. Like autistic interests, intense interests can be viewed as weird or a nuisance to others.<br />
<br />
One explanation for these similarities is that at least some of the children with intense interests were on the autism spectrum or at least had strong autistic traits. Most studies of children with intense interests, interestingly, do not report screening for autism spectrum disorder or measuring "autistic traits." One study that did found that 8-12 year olds intensely interested in Pokemon scored normally on the Child Autism Screening Test (<a href="https://psychology-tools.com/cast/" target="_blank">CAST</a>), and actually had <i>lower</i> "systematizing" traits than peers on the Systematizing Quotient-Empathizing Quotient test (<a href="http://personality-testing.info/tests/EQSQ.php" target="_blank">SQ-EQ</a>). [3] (Autistic children typically score higher). A single study with 21 participants can't resolve this question. But, if this finding is replicated, it would suggest intense interests aren't solely the product of autism or autistic traits. They really do occur in the non-autistic population, too.<br />
<br />
More likely, the predisposition to develop intense interests is a continuous trait. High levels of this trait might be more common in autism, but occur in others, as well<i>1</i>.<br />
<br />
Intense interests and special interests look very similar, and they seem to have a positive side and a negative side. The positive side is that they are enjoyable, and seem to motivate people to learn [4, 5]. The negative side is that they can be disruptive [2], and perhaps consume time and attention that could be spent on other things. Yet, research on intense interests has focused mostly on its positive role in learning, with only one study reporting negative aspects. And while autistic people talk about the <a href="http://www.shiftjournal.com/2011/11/30/the-obsessive-joy-of-autism/" target="_blank">joy of special interests</a> and their <a href="http://autisticnotweird.com/autistic-obsessions/" target="_blank">importance for learning</a>, studies of autistic children prefer to focus on how atypical or disruptive they are [e.g.: <a href="http://psychology.msu.edu/kid/Publications/klin_danovitch_merz%26volkmar2007.pdf" target="_blank">8</a>; 9, 10]--with the exception of <a href="http://watsonliferesources.org/wp-content/uploads/2014/07/resource-for-Power-of-pairing-or-Stories-and-Motivators-From-Toilet-Brushes-to-Tarantulas.pdf" target="_blank">this study</a> by Mary-Ann Winter-Messiers, the mother of an autistic son [11].<br />
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<a href="http://3.bp.blogspot.com/-410L8tjSSAk/VW3_546GF5I/AAAAAAAADGk/4XljoLH509o/s1600/intensity%2Bhas%2B2%2Bsides.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img alt="At center is a box with a smily face on the left side and a storm cloud on the right. A smiling man looks at the left side and says, "Intense." A frowning doctor looks at the right side and says, "Restricted...obsessive...perseverative."" border="0" height="160" src="http://3.bp.blogspot.com/-410L8tjSSAk/VW3_546GF5I/AAAAAAAADGk/4XljoLH509o/s400/intensity%2Bhas%2B2%2Bsides.png" title="The two sides of intense/special interests" width="400" /></a></div>
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I suspect that intense and special interests are a single phenomenon with both positive and negative aspects, but that we focus on the positive aspects in typical development and the negative ones in autism.<br />
<br />
So how do we determine whether these are, in fact, the same thing?<br />
<br />
First, we must apply the same measures to typically developing and autistic populations. To my knowledge, this has not yet been done yet.<i>2 </i>Furthermore, questionnaires for the general population seem to provide more fine-grained information about the length of children's interests and the way they behave when engaged in their interest.<br />
<br />
Second, we would need to start looking at negative aspects of interests in the typical population and positive ones in the autistic population. Parent questionnaires for the general population have generally been neutrally to positively worded, while those for the autistic population have used negative wording and emphasized the weirdness or disruptiveness of the interests. Key questions here: do <i>non</i>-autistic children's interests <i>also</i> tend to get in the way of doing other things? And, can research confirm that autistic children both love and learn a lot from their interests?<br />
<br />
One could use an existing general population measure and an existing autistic measure with both groups. Or, better still, one could develop a new set of questions to be used with both groups.<br />
<br />
Right now we're assuming that non-autistic interests have more positive consequences (e.g., learning new things) and autistic interests have more negative ones (e.g., socially unacceptable, distracting from schoolwork). This is theoretically possible, but we can't know unless we actually ask both autistic and non-autistic groups the same things.<br />
<br />
<i>References</i><br />
<ol>
<li>Joyce Alexander, Kathy E. Johnson, Mary E. Leibham, & Ken Kelley (2008). The development of conceptual interests in young children. <i>Cognitive Development</i> 23, pp. 324-334. PDF <a href="http://portal.education.indiana.edu/Portals/206/Alexander%20Johnson%20et%20al%20COGDEV%202008.pdf" target="_blank">here</a>.</li>
<li>Judy S. DeLoache, Gabrielle Simcock, & Suzanne Macari (2007). Planes, trains, and automobiles--and tea sets: Extremely intense interests in very young children. <i>Developmental Psychology</i> vol. 43 no. 6, pp. 1579-86. PDF <a href="http://www.faculty.virginia.edu/deloache/Planes%20trains%20and%20automobiles.pdf" target="_blank">here</a>.</li>
<li>Thomas W. James and Karin Harman James (2013). Expert individuation of objects increases activation in the fusiform face area of children. <i>Neuroimage</i> vol. 67, pp. 182-192. PDF <a href="http://www.indiana.edu/~canlab/assets/2013-tjames---kjames_expert-individuation.pdf" target="_blank">here</a>.</li>
<li>Kathy E. Johnson, Joyce M. Alexander, Steven Spencer, Mary E. Leibham, and Carin Neitzel (2004). Factors associated with the early emergence of intense interests within conceptual domains. <i>Cognitive Development</i> vol. 19, pp. 325-343. PDF <a href="http://groups.psych.northwestern.edu/biothought/articles/johnson%202004.pdf" target="_blank">here</a>.</li>
<li>Mary E. Leibham, Joyce M. Alexander, Kathy E. Johnson, Carin L. Neitzel, & Fabiola P. Reis-Henrie (2005). Parenting behaviors associated with the maintenance of preschoolers' interests: A prospective longitudinal study. <i>Applied Developmental Psychology</i> vol. 26, pp. 397-414. Abstract <a href="http://www.sciencedirect.com/science/article/pii/S0193397305000341" target="_blank">here</a>.</li>
<li>American Psychiatric Association (2000). <i>Diagnostic and Statistical Manual of Mental Disorders</i> (4th ed., text revision). Washington, DC: APA. Autism criteria found <a href="http://www.autism-society.org/dsm-iv-diagnostic-classifications/" target="_blank">here</a>. </li>
<li>American Psychiatric Association (2013). <i>Diagnostic and statistical manual of mental disorders </i>(5th ed.). Washington, DC: APA. Autism criteria found <a href="http://www.cdc.gov/ncbddd/autism/hcp-dsm.html" target="_blank">here</a>.</li>
<li>Ami Klin, Judith H. Danovich, Amanda B. Merz, & Fred R. Volkmar (2007). Circumscribed interests in higher functioning individuals with autism spectrum disorders: An exploratory study.<i> Research & Practice for Persons with Severe Disabilities</i> vol. 32, iss. 2, pp. 89-100. PDF <a href="http://psychology.msu.edu/kid/Publications/klin_danovitch_merz%26volkmar2007.pdf" target="_blank">here</a>.</li>
<li>Lauren M. Turner-Brown, Kristin S.L. Lam, Tia N. Holtzclaw, Gabriel S. Dicther, & James W. Bodfish (2011). Phenomenology and measurement of circumscribed interests in autism spectrum disorders. <i>Autism</i> vol. 15, iss. 4, pp. 437-456. Full text <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709861/" target="_blank">here</a>.</li>
<li>Simon Baron-Cohen & Sally Wheelwright (1999). "Obsessions" in children with autism or Asperger syndrome. Content analysis in terms of core domains of cognition. <i>British J. of Psychiatry</i> vol. 175, pp. 484-90. PDF <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.177.9250&rep=rep1&type=pdf" target="_blank">here</a>.</li>
<li>Mary Ann Winter-Messiers (2007). From tarantulas to toilet brushes: Understanding the special interest areas of children and youth with Asperger syndrome. <i>Remedial & Special Education,</i> vol. 28 no. 3, pp. 140-152. PDF <a href="http://watsonliferesources.org/wp-content/uploads/2014/07/resource-for-Power-of-pairing-or-Stories-and-Motivators-From-Toilet-Brushes-to-Tarantulas.pdf" target="_blank">here</a>.</li>
<li>Michelle Dawson, Laurent Mottron, & Morton Ann Gernsbacher (2008). Learning in Autism. In H.L. Roediger, III. (editor), Cognitive Psychology of Memory. Vol. [2] of Learning and Memory: A Comprehensive Reference, 4 vols., pp. 749-772. Oxford: Elsevier. PDF <a href="http://gernsbacherlab.org/wp-content/uploads/papers/1/Dawson_AutisticLearning.pdf" target="_blank">here</a>.</li>
<li>Chloe Jennifer Jordan & Catherine L. Caldwell-Harris (2012). Understanding differences in neurotypical and autism spectrum special interests through internet forums. <i>Intellectual & Developmental Disabilities</i> vol. 50, no. 5, pp. 391-402. PDF <a href="http://s3.amazonaws.com/academia.edu.documents/30837671/Jordan_Caldwell-Harris_IDD2012.pdf?AWSAccessKeyId=AKIAJ56TQJRTWSMTNPEA&Expires=1433294759&Signature=LnGclMBHkDaqc%2BpC%2Brd0kqm1WJY%3D&response-content-disposition=inline" target="_blank">here</a>.</li>
</ol>
<br />
<i>Footnotes</i><br />
<i>1</i>This is purely speculation, but I notice another similarity with autism, as well. Particularly in DeLoache's study, children with intense interests developed their interests independently and often without encouragement from parents. This reminds me of the self-motivated self-teaching that often occurs in autism, which Michelle Dawson, Laurent Mottron and Morton Ann Gernsbacher describe <a href="http://gernsbacherlab.org/wp-content/uploads/papers/1/Dawson_AutisticLearning.pdf" target="_blank">here</a> [12]. In autism, the tendency to teach oneself often comes with difficulty learning from others, which need not be true of non-autistic children who teach themselves. However, I still wonder if there is a relationship between self-motivated intense interests and self-taught learning in general. Is this another relationship common in autism, but existing in the general population?<br />
<br />
<i>2</i> One study does directly compare the "special interests" of neurotypical and autistic adults through internet forums (Wrongplanet for autistic and LiveWire for neurotypical) [13]. However, it analyzed forum content that was already produced, rather than measuring and comparing the intensity of each individual member's interests. It is thus unclear clear whether neurotypicals' interests are intense at all, much less similarly intense and focused to autistic participants'. The researchers were also unable to determine how many of the participants on the "neurotypical" forums were in fact autistic.E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com1tag:blogger.com,1999:blog-6733902656011255269.post-77760264874914544792015-04-07T08:00:00.000-05:002015-06-08T08:16:44.867-05:00Autism Acceptance Month Links: On AcceptanceApril has been dubbed Autism Awareness Month, but most people these days are aware that autism exists. However, they may not know much about what autism is, what it's like to have autism, or what autistic people need. Moreover, they likely remain blissfully unaware of the stigma that denies autistic people equal access to education, work, friendship, medical care, and even freedom from abuse and <a href="http://mosaicofminds.blogspot.com/2013/12/creating-culture-of-death-long-major.html" target="_blank">filicide</a>. Thus, I and many others instead observe Autism <i>Acceptance</i> Month.<br />
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<img src="http://thautcast.com/drupal5/images/AutismAcceptanceMonth.jpg" height="320" width="320" /><br />
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What acceptance means can be difficult to define. We do not wish to "love the person, hate the autism," which is as far from real acceptance as "love the person, hate the gay" or "love the person, hate the Jew." Neither, however, do we wish to deny that autism can involve real impairments--weaknesses in various abilities that create needs for services and accommodations which others may not require. Many people struggle with how to accept the whole person, autism and all, while acknowledging that its effects are not always or entirely positive for every person.</div>
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Moreover, talk of acceptance can often be abstract, and leave unanswered some important questions: </div>
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<ul>
<li>How does an accepting parent talk to, talk about, and discipline their child?</li>
<li>How does an accepting parent or teacher set reasonable expectations, providing enough challenges to respect the child and stretch their capabilities, without demoralizing them by demanding they do things they can't yet?</li>
<li>What is an accepting way to deal with challenges like meltdowns, self-injurious behavior, or difficulties coping with everyday stressful situations (e.g., going to the grocery store or school assemblies)?</li>
<li>What is an accepting way to teach skills, like daily living/self care skills and getting along with nonautistic peers?</li>
<li>What does education based on acceptance look like?</li>
<li>What do accepting services look like?</li>
<li>What does an accepting workplace look like?</li>
<li>What does an accepting friend do? (And what should we teach nondisabled children about how to be a good friend?).</li>
<li>What does an accepting romantic partner do?</li>
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Fortunately, people have started addressing these questions. This post includes the blog posts that I think best explain what acceptance is, how it differs from awareness, and why it's important. Next week's links will discuss accepting parenting, the week after will focus on acceptance in education and services, and the last week of April's will examine acceptance in the media and broader culture. </div>
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<i>What is acceptance and how is it different from awareness?</i></div>
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<a href="http://yesthattoo.blogspot.com/2013/03/autism-acceptance-is.html" target="_blank">Autism Acceptance Is</a>... by Alyssa</div>
<blockquote class="tr_bq">
"We need to be accepted for who we are. We need to hear that we're OK, we need to hear that the things we have trouble with don't make us broken or lazy or horrible people...We need people to listen when we say we need help, and we need people to listen when we say we don't. We need to be taken as the whole people that we are, and we need to be met with the understanding that we are the experts in our own lives and abilities...Regardless of neurology, <i>people need those things. </i>Autism Acceptance is just reminding us that Autistic people are people, and that as such, we need these things too."</blockquote>
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Companion piece: <a href="http://yesthattoo.blogspot.com/2013/04/autism-acceptance-is-not.html" target="_blank">Autism Acceptance is Not</a> by Alyssa</div>
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It's not acceptance, as in the stage of grief.</div>
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<br />
And speaking of stages, this image shared by <a href="http://disabilityableismautismandmotherhood.blogspot.com/2013/06/my-spectacular-breakdown-acceptance.html" target="_blank">Kezza</a> shows what the journey to acceptance looks like for some autistic people and parents:<br />
<img height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh8J0RHnIsQyBCHEUmOykWNOtb8pKYKBtd75rOF27J3x2at9ZnLmTlBbyE9vPRcZON29DNH6BNWEFGI1GlL4PhvovY59DiNSHoD3a76NxENkMAv6CXwdXRvxbAoXfJ3t33Rf7uhiopbIDQ/s320/1064439_574081085964229_1258289003_o.jpg" width="190" /><br />
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<a href="https://www.psychologytoday.com/blog/aspergers-diary/201304/what-acceptance-means-me" target="_blank">What Acceptance Means to Me</a> by Lynne Soraya</div>
<blockquote class="tr_bq">
"When I look at those teachers who were most impactful in my life...they were the ones who treated me with compassion and acceptance. Teaching me to work with my differences instead of against them made a massive acceptance in how I approach life, how I value myself, and how far I've been able to get in life. ...Those who did not honor my differences, who held as their goal the idea that I should be made more 'normal,' more 'indistinguishable from my peers,' were not the ones who made the difference. In fact...their approach harmed me, in many ways."</blockquote>
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<a href="https://thethirdglance.wordpress.com/2011/12/19/the-third-glance/" target="_blank">The Third Glance</a> by E.</div>
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Acceptance as taking the third glance and seeing who a person really is, "because everyone deserves to be seen."</div>
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<a href="http://blogs.plos.org/neurotribes/2012/04/02/autism-awareness-is-not-enough-heres-how-to-change-the-world/" target="_blank">Autism Awareness isn't enough. Here's how to change the world</a> by Steve Silberman</div>
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Scroll down to the lists by Julia Bascom, Lydia Brown, Rachel Cohen-Rottenberg, Shannon Des Roches Rosa, Liz Ditz, Todd Drezner, Paula C. Durbin-Westby, Carol Greenberg,Jennifer Byde Myers, Ari Ne'eman, Stephen Shore, Kassiane Sibley, Nick Walker, Garret Westlake, Emily Willingham.</div>
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<br /></div>
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The <a href="http://autismacceptanceday.blogspot.com/" target="_blank">Autism Acceptance Day blog</a></div>
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<br />
@<a href="https://twitter.com/theoriesofminds" target="_blank">Theoriesofminds</a>' storify (summary) of a Twitter discussion, #<a href="https://storify.com/theoriesofminds/acceptancemeans" target="_blank">AcceptanceMeans</a>.<br />
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<a href="https://bjforshaw.wordpress.com/2014/06/22/the-joy-of-acceptance/" target="_blank">The Joy of Acceptance</a> by Alex Forshaw<br />
<blockquote class="tr_bq">
"Acceptance...creates a sense of safety: it allows me to feel that I don't need to hide behiind masking behaviors. I don't need to watch every single move I make, everything I say, in case I let my guard down and draw attention. I am free to act naturally, to truly be myeslf without fear of being mocked,c criticized, or otherwise made to feel that the way I am is somehow 'wrong.' <i>That</i> is acceptance. What does it require of other people for acceptance to happen? Not much--only that they allow me to live my life my own way. So long as it doesn't harm them, what possible problem could they have with that?"</blockquote>
<a href="http://musingsofanaspie.com/2014/09/17/what-acceptance-is-not/" target="_blank">What acceptance is not</a> by Musings of an Aspie</div>
<blockquote class="tr_bq">
"Acceptance is not giving up. Acceptance is not doing nothing. Acceptance is not what happens after you've fixed someone to your liking. Acceptance is not throwing away all manners, education, skills, and coping strategies."</blockquote>
<a href="http://realsocialskills.org/post/94541270040/acceptance-is-the-opposite-of-giving-up" target="_blank">Acceptance is the Opposite of Giving Up</a> by Real Social Skills<br />
<blockquote class="tr_bq">
"Acceptance isn't about denying that some aspects of disability can be awful, and it's not about categorically rejecting medical treatment. It's about working with yourself rather than against yourself, and pursuing life now rather than waiting for a cure."</blockquote>
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<a href="http://themighty.com/2015/04/the-people-who-show-me-the-difference-between-awareness-and-acceptance/" target="_blank">The people who show me the difference between awareness and acceptance</a> by Karen Copeland<br />
<blockquote class="tr_bq">
"When I think about our champions, I realize they, too, accept our child and our family for who we are. They help us identify our strengths and our gifts. They encourage us to embrace our challenges and meet them with strength and confidence. They let us know it's OK to be different and do things differently...You see, it wasn't until we started accepting our child for who he is--his strengths, gifts, and challenges--that we started to experience success. It was when we stopped trying to make him become who <i>we</i>...wanted him to be that the real change started to happen."</blockquote>
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<a href="http://autismacceptance.org/page/why-autism-acceptance" target="_blank">Why autism acceptance?</a> by the Autism Society</div>
<blockquote class="tr_bq">
"Acceptance...is the first step to building true understanding and inclusion...individuals with autism are and should be recognized as valuable members of our families, schools, workplaces, faith communities, and neighborhoods...Acceptance reinforces that not only do autistic individuals have equal rights, but they are equal in worth and have just as much value to society as any other member."</blockquote>
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<a href="http://neurowonderful.tumblr.com/post/66386003279/whydoesitmatter" target="_blank">Active Acceptance: Why does it matter</a>? by Amethyst Schaber</div>
<blockquote class="tr_bq">
"Acceptance isn't passive. Acceptance isn't 'giving up.' ...Acceptance is looking at your child and seeing exactly who they are...and loving them for exactly who they are right now. Acceptance means meeting your autistic child where they are right now, accommodating their needs and growing their strengths, so that your child can grow up to become a happy, healthy autistic person who can trust and love the people around them."</blockquote>
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<a href="http://www.autreat.com/dont_mourn.html" target="_blank">Don't mourn for us</a> by Jim Sinclair (a classic)<br />
<blockquote class="tr_bq">
"You lost a child because the child you waited for never came into existence. That isn't the fault of the autistic child who does exist... We need and deserve families who can see us and value us for ourselves, not families whose vision of us is obscured by the ghosts of children who never lived. Grieve if you must, for your own lost dreams. But don't mourn for <em>us</em>. We are alive. We are real. And we're here waiting for you."</blockquote>
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<a href="http://autistictimestwo.blogspot.com/2014/09/i-wanted-you.html" target="_blank">Who would want a disabled child? I do</a>. by Lei</div>
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<br /></div>
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<a href="http://www.onthetrainwithsophie.com/2014/01/how-to-accept-your-child-has-autism.html" target="_blank">How to accept your child has autism</a> and <a href="http://www.onthetrainwithsophie.com/2013/01/accepting-autism.html" target="_blank">Accepting autism, even when people are watching</a> by Sophie's Trains</div>
<blockquote class="tr_bq">
"These are some reflections that helped me reach a place of peace and optimism and perhaps can be of benefit for others, too."</blockquote>
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<a href="https://unstrangemind.wordpress.com/2014/06/26/your-children-are-listening/" target="_blank">Your Children are Listening</a> by Unstrange Mind<br />
<blockquote class="tr_bq">
"Your children are listening. Stop thinking about how hard all of this is for you and think about how hard it is for your children. You have the difficult struggle of raising a disabled child. Your child has the life-long struggle of feeling like they never should have been born."</blockquote>
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<a href="http://musingsofanaspie.com/2015/01/14/acceptance-as-a-well-being-practice/" target="_blank">Acceptance as a Well-Being Practice</a> by Musings of an Aspie</div>
<blockquote class="tr_bq">
"For most of my life, my view of myself was predicated on what I had achieved...my fragile self-esteem was buttressed by a constant need to outdo myself...Acceptance meant embracing myself as I am, in the present. It meant letting go of the idea that I would some day magically become a more competent, mature, socially adept version of myself. It meant acknowledging that I'm not perfect, and, more importantly, I don't need to be...Acceptance...means unconditionally embracing yourself as you are."</blockquote>
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<a href="http://musingsofanaspie.com/2013/09/23/focusing-on-assets-building-on-strengths/#more-1638" target="_blank">Focusing on Assets, Building on Strengths</a> by Musings of an Aspie<br />
<blockquote class="tr_bq">
"Imagine that child moving through school, trailing this long list of things he can't do behind him. That's twelve-plus years of people emphasizing what he's bad at and what he neds to fix. If he's lucky, he has at least one cheerleader in his corner, telling him what he's good at. Because when he sits down to fill out his college applications or goes for his first job interview, no one is going to ask him what his worst subject is or what he can't do. Transitioning into adult life requires knowing your assets. The tension between building on assets versus fixing deficits is at the core of what we face as autistic people living in a neurotypical world...My social skills are never going to pass for neurotypical...building on assets feels more doable, and ultimately better for my self-esteem. If I'm working from strength...I have a foundation, no matter how small, to build myself up from."</blockquote>
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Lastly...</div>
<blockquote class="tr_bq">
"If autistic people were accepted we would not need Autism Awareness Month." -<a href="http://amazingadventuresautism.blogspot.com/2015/03/autism-acceptance-2015.html" target="_blank">Michelle Sutton</a></blockquote>
E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-71010908792784134712015-04-06T11:00:00.000-05:002015-06-07T12:51:21.592-05:00What is it like for a disabled person to be disabled? Why people (wrongly) assume disabled people have lower quality of life<img src="http://www.shellistevens.com/wp-content/uploads/2014/06/life.jpg" height="214" width="320" /><br />
Many people assume without reflection that people with disabilities have lower quality of life than others. Philosophers have a particularly troubling tendency to make this assumption1, as Silvia Yee points out in her fascinating <a href="http://www.slate.com/blogs/future_tense/2015/03/06/people_with_disabilities_shouldn_t_be_defined_by_technology.html?wpsrc=sh_all_dt_tw_top" target="_blank">review</a> of a prejudiced bioethics paper by Robert Sparrow:<br />
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<blockquote class="tr_bq">
"Philosophical arguments that devalue the experience of living with a disability tend to be written without any discernable reference to the lived experience of an actual person with a disability." -Silvia Yee</blockquote>
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Only a philosopher would have the hubris to make sweeping assertions about the quality of people's lives without even thinking of asking them if they agree.<br />
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Yet, laypeople make similar assumptions all the time. They do so, I think, because the way we normally try to imagine what someone else's life is like <a href="http://opinionator.blogs.nytimes.com/2015/06/06/imagining-the-lives-of-others" target="_blank">doesn't actually work</a> for people whose lives are very different from our own, and completely falls apart when imagining the lives of people with disabilities.<br />
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Suppose you are looking at someone who can't walk and imagining what their life must be like. Most likely, you imagine your own life, only with walking removed. Of course, if you've been walking all your life and you suddenly can no longer walk, you can no longer do many things you enjoyed. You may not know how to find new ways to work, visit friends, run errands, and travel. Thus, life will seem narrower and unhappier, and <a href="http://www.thinkingautismguide.com/2014/10/disability-considering-insider-vs.html" target="_blank">you will assume</a> the disabled person's life is as narrow and unhappy as you imagine it to be. But chances are, they will not agree. In fact, abled people consistently rate disabled people's quality of life and happiness lower than the latter rate their own2. An example would be this <a href="http://www.ncbi.nlm.nih.gov/m/pubmed/21910246/" target="_blank">survey</a> of 284 people with Down Syndrome belonging to national organizations, 99% of whom like their lives, 97% of whom like themselves, and 96% of whom like how they look. This suggests our approach to assessing their quality of life is faulty.<br />
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I am ashamed to admit that as a child who did not know anyone with visible disabilities, I made this mistake, so I know from the inside how it works. I remember wondering whether it would be sadder to be deaf and not be able to hear music or blind and not be able to see color! (Besides the obvious ableism here, I also completely misunderstood how being deaf works. Deaf people can usually still hear vibrations, and sometimes other sounds, and thus can still experience a lot of music, just in a different way than hearing people). The only thing I got right was recognizing that babies who can't talk yet, and show no evidence of thinking in words, are still thinking.<br />
<br />
Anyway, the abled person here is making the same mistake as someone who <a href="http://www.amazon.com/Nickel-Dimed-Not-Getting-America/dp/0312626681" target="_blank">pretends to be poor</a> for a few months or a year, never having otherwise been poor, and assumes they have learned something about what it's like to be poor. (Such people are well-intentioned and do an excellent job of highlighting the ways society mistreats poor people; however, they are not experiencing these problems the way an actual poor person would). For example, actual poor people know all sorts of tricks for taking care of themselves without spending money that someone "playing poor" would not. Consider the strategy of buying your bread and produce at the end of the day from stock that is still basically good, but the shopkeepers would otherwise throw away. When someone who has been poor tells you about doing this, it seems obvious, but I would bet most people who haven't been poor wouldn't automatically consider this shopping possibility.<br />
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Just as someone "playing poor" doesn't know what it's like <i>for a poor person to be poor,</i> so someone imagining what it would be like to be disabled can't imagine what it's like <i>for the disabled person</i> to be disabled. And just as poor people resourcefully navigate poverty and lead full lives, disabled people find ways to work, make friends, have hobbies, and run errands. They just do so in ways others don't, and maybe couldn't imagine.<br />
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This is why, as Emily Ladau <a href="http://www.huffingtonpost.com/emily-ladau/i-wont-disability-simulation_b_4936801.html" target="_blank">explains</a>, disability simulations don't work.<br />
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Thomas Nagel3, in his brilliant essay "<a href="http://organizations.utep.edu/portals/1475/nagel_bat.pdf" target="_blank">What is it like to be a bat</a>?" points out that when we try to imagine what it's like to be a bat, we imagine what it would be like for <i>us</i> to be a bat. We add fur, or better hearing, subtract eyesight, imagine looking at things from above because we're flying, or inverted because we're hanging upside down. We have no other choice because we've only been us; we know no other way of being. But these additions and subtractions may have nothing to do with what it's like for <i>a bat</i> to be a bat. I don't know if Thomas Nagel thought of applying this distinction to people with disabilities, but it explains why disabled people's own assessments of their quality of life are always higher than abled people assume).<br />
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(This example suggests another point relevant to disabilities. Occasionally, as when thinking about savants or "troubled geniuses," we imagine what it would be like to be them by adding rather than subtracting. We might add "intense mood swings" or "divergent thinking" or "the ability to calculate large numbers in my head," although I doubt anyone without such traits can imagine them very accurately. But imagining-by-adding is no more realistic than imagining-by-subtracting. Vincent Van Gogh wasn't you with some extra creativity and mental illness tacked on, any more than an intellectually disabled person is you with IQ and academic skills subtracted away. So, don't make the mistake of thinking you're doing right by people with disabilities if you simply stop imagining-by-subtracting. The problem goes deeper than that).<br />
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The question, "what it's like for whom?" may seem like an academic issue when considering it in the context of an academic paper, but when you're assessing the value of a disabled person's life, it becomes anything but academic. You cannot imagine a disabled person's life simply by imagining what it would be like for you to suddenly have a disability. <i>A disabled person's life is not your life with something subtracted, or even added. It is a different sort of life entirely.</i> You cannot imagine it accurately; they are the experts on their own lives. But if you listen, if you practice empathy and imagination, you can learn <i>something</i> about what it is like to be them.<br />
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UPDATE: FURTHER READING<br />
To see how these principles apply to attempts to simulate living with a disability (and why these are ableist as well as ineffective), see Emily Ladau's "<a href="http://www.huffingtonpost.com/emily-ladau/i-wont-disability-simulation_b_4936801.html" target="_blank">I won't pretend that disability simulations work</a>."<br />
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Brenda Rothman makes a very Nagel-like argument <a href="http://www.huffingtonpost.com/brenda-rothman/parenting-and-disabilities_b_2807620.html" target="_blank">here</a>, where she addresses fears that her autistic son might be "missing out" on "normal childhood experiences."<br />
<blockquote class="tr_bq">
"Children with a disability do not have a life 'minus.' They have a life,
period. It's their life. It's not some other child's life, their
parent's life or their peers' life. It's their life."</blockquote>
Amanda Forest Vivian explains why insider and outsider perspectives on disabilities are so different <a href="http://www.thinkingautismguide.com/2014/10/disability-considering-insider-vs.html" target="_blank">here</a>. Disabled people have integrated disability into their self-image in ways that non-disabled people haven't, and however they feel about their disability, that transforms how they view and talk about it.<br />
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These issues also apply to all sorts of people, not just those with disabilities. In "<a href="http://opinionator.blogs.nytimes.com/2015/06/06/imagining-the-lives-of-others" target="_blank">Imagining the Lives of Others</a>," Paul Bloom outlines a paradox: we are fascinated by what others experience, but are in fact very bad at knowing what it's like to be someone with a very different life experience. He, too, notes the limitations of attempts to take on other identities, like Norah Vincent's posing as a man in "Self-Made Man" and John Howard Griffin's disguise as a black man in "Black Like Me." Paul Bloom suggests that rather than give up on understanding others' experiences or put faith in simulations, we should listen to others' descriptions of their experiences with respect and humility:<br />
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<blockquote class="tr_bq">
"These failures should motivate a certain humility when it comes to
dealing with the lives of others. Instead of assuming that we can know
what it is like to be them, we should focus more on listening to what
they have to say. This isn’t perfect — people sometimes lie, or are
confused, or deluded — but it’s by far the best method of figuring out
the needs, desires and histories of people who are different from us. It
also shows more respect than a clumsy attempt to get into their skins; I
agree with the essayist Leslie Jamison, who describes empathy as
“perched precariously between gift and invasion.<br />
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<div class="story-body-text" itemprop="articleBody">
...None of this is to say
that the project of experiencing the lives of others should be
abandoned. Under the right circumstances, we might have some limited
success — I’d like to believe that novels and memoirs have given me some
appreciation of what it’s like to be an autistic teenager, a geisha or a
black boy growing up in the South. And even if they haven’t, most of us
are <span class="ins cts-3" title="Inserted by Peter Catapano - 06/5/2015 6:00pm">still </span>intensely curious about <span class="ins cts-3" title="Inserted by Peter Catapano - 06/5/2015 5:29pm">the lives of other people</span>, and find the act of trying to simulate these lives to be an engaging and transformative endeavor. We’re not going to stop.</div>
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<div class="story-body-text" itemprop="articleBody">
But we’re not good at
it, particularly when the stakes are high, and empathic engagement is
far too fragile a foundation to ground public policy. To make the world
better, we shouldn’t try to put ourselves in the shoes of Eric Garner or
anyone else. Our efforts should instead be put toward cultivating the
ability to step back and apply an objective and fair morality." </div>
</blockquote>
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1 If you want to keep your blood pressure at healthy levels, don't read anything by the notoriously ableist Peter Singer.<br />
2 Morton Ann Gernsbacher, personal communication, 2014.<br />
3 Ironically, while philosophers seem particularly susceptible to assuming they know what it's like for a disabled person to be disabled, the person who best articulates their fallacy is himself...a philosopher.E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-62209843833247178702015-03-17T12:27:00.001-05:002015-03-17T12:27:36.860-05:00How expertise changes the way you seeWhen you know a lot about something, it doesn't just change how you think--it also changes how you see.<br />
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Stock image courtesy of RGBStock.</div>
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A long tradition in psychology, education, and business involves comparing people with little experience in an area to others with some amount of expertise (e.g., novice chess players vs. grandmasters, medical students vs. doctors). Despite this two-group approach to studying it, expertise is actually a continuum, with "experts" in studies ranging from typical competent members of a profession (e.g., doctors) to world-class performers (e.g., chess grandmasters). When "experts" are trained in the lab to recognize artificial <a href="http://www.sciencedirect.com/science/article/pii/S0042698997004422" target="_blank">creatures</a>1, the level of expertise is lower still--as few would volunteer to spend the famous "<a href="http://www.bbc.com/news/magazine-26384712" target="_blank">10,000 hours</a> of practice"2 in a lab learning to categorize such items. Yet, even this sort of "expert" both thinks about and sees artificial creatures differently than people who have never seen them before. They haven't just memorized a set of images, either: this change in perception extends to members of the category that they have never seen before.<br />
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This shift in perception that comes with expert knowledge is called <i><a href="http://tdlc.ucsd.edu/research/research-perceptual-expertise-network.html" target="_blank">perceptual expertise</a>.</i> It is highly category-specific. <a href="http://link.springer.com/article/10.3758/APP.72.7.1865" target="_blank">For example</a>, a car expert might display perceptual expertise when viewing modern cars but not antique ones, or vice versa3. Perceptual expertise is not limited to vision, but it has been studied less in other senses, so I will only talk about vision here.<br />
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Perceptual expertise affects many aspects of vision, including...<br />
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<i>1) Memory for Visual Patterns</i><br />
Many areas of expertise involve learning to recognize complex visual patterns. Chess is a great example. A chess grandmaster can look at an arrangement of pieces on the board and tell you who is attacking and who defending, what each player's likely next move will be, and perhaps even what famous games involved this arrangement. (Some arrangements, called "positions," are named). They are seeing not just the placement of each piece, but a meaningful whole defined by the relationship between them.<br />
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A series of classic studies by <a href="https://chessprogramming.wikispaces.com/William+Chase" target="_blank">Chase</a>, Simon, and Gobet demonstrated this elegantly by asking chess masters and ordinary players to remember the positions of a large number of pieces. These positions were either taken from actual master-level chess games, or were completely random (and often would never occur in an actual game). This experiment is shown in part B of the image below:<br />
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<a href="http://1.bp.blogspot.com/-8gTLvXZwWr8/VNUKXN4qGhI/AAAAAAAACxQ/-qSwHmmZ28c/s1600/perception%2Bin%2Bchess.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-8gTLvXZwWr8/VNUKXN4qGhI/AAAAAAAACxQ/-qSwHmmZ28c/s1600/perception%2Bin%2Bchess.png" height="170" width="320" /></a></div>
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<span style="text-align: start;">The image comes from this </span><a href="http://en.chessbase.com/Portals/4/files/news/2014/topical/leone01.png" style="text-align: start;" target="_blank">description </a><span style="text-align: start;">of Chase, Simon, and Gobet's chess studies.</span></div>
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If chess experts are learning the meanings of configurations of pieces, then they should have an advantage over the novice players for real game positions, but not for random positions. And that's exactly what the studies found.<br />
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The research team also tested the working memory spans of both groups, and these were similar. So chess masters don't remember arrangements of chess pieces better than novices because they're better at keeping in mind large amounts of arbitrary information in general. Instead, they are able to group pieces with particular configurations into a meaningful "chunk" which can then be recalled as a unit, instead of 15 separate pieces.<br />
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<i>2) Focus on the Whole Over the Parts</i><br />
In chess, experts learn to recognize configurations <i>across</i> a set of objects. However, some domains of expertise lead experts to recognize configurations of parts <i>within one</i> object.<i> </i>This phenomenon was first studied in face perception (in which most people can be considered experts). However, it has since been noted in several other areas of expertise, such as cars. It should be found for any objects where the arrangement of parts is important for recognizing an object, but not for objects where specific features, like color or texture, are the defining ones4.<br />
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How do we know people are focusing on the relationship between an object's parts rather than the parts themselves? One way is to turn the object upside down. This disrupts the spatial relationship between the parts more than it disrupts the look of the parts themselves. As a result, experts are slower to recognize a specific object upside-down than they are when the same object is right-side-up. This disruption is called the "inversion effect."<br />
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<a href="http://www.ncbi.nlm.nih.gov/pubmed/20402240" target="_blank">Rossion and Curran</a>4 examined the "inversion effect" in car experts, by showing them pictures of faces and cars that were either upright or inverted. Car expertise was determined not only by self-report, but by the ability to match 112 images of cars based on model. The faces served as a comparison condition. We know that inversion affects faces; the question was whether for car experts, inversion would also affect cars, and to a similar extent.<br />
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<a href="http://3.bp.blogspot.com/-3Xhn2ax8yj0/VNUKycuLymI/AAAAAAAACxg/mrrRRVePGx8/s1600/rossion%2Bcar%2Bexperts%2Bfig%2B1.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://3.bp.blogspot.com/-3Xhn2ax8yj0/VNUKycuLymI/AAAAAAAACxg/mrrRRVePGx8/s1600/rossion%2Bcar%2Bexperts%2Bfig%2B1.png" height="283" width="320" /></a></div>
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Above: face and car stimuli from Rossion & Curran (2010).</div>
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Interestingly, for novices, who have extensive familiarity with faces but less with cars, inversion reduced accuracy for both faces <i>and</i> cars. This is different than you might expect if expertise alone is responsible for inversion effects. However, it makes sense when you consider that even novices have often viewed cars right-side-up, but never upside-down. <br />
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For novices, inversion affected faces more than cars, both in terms of accuracy and reaction time. For experts, inversion reduced reaction time for both faces and cars similarly, and in fact, it non-significantly hurt performance for cars a bit more. Furthermore, the degree of expertise (ability to accurately match car models) correlated with the degree to which inversion slowed car identification.<br />
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This correlation is important. It makes it less likely that some random factor is responsible for the differences between experts and novices in car perception. Given that expertise is a continuous phenomenon, it's also much more convincing to find that the amount of expertise correlates with the size of the inversion effect.<br />
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In short, just as most people learn to recognize upright faces by their configuration of features, so car experts had learned to recognize upright cars by theirs.<br />
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Other studies have found similar inversion effects with various objects of expertise, including <a href="http://www.sciencedirect.com/science/article/pii/S0042698996002866" target="_blank">artificial objects</a>5, <a href="http://www.sciencedirect.com/science/article/pii/S0042698904004365" target="_blank">fingerprints</a>6, <a href="http://www.jneurosci.org/content/31/28/10206.short" target="_blank">chess boards</a>7, and <a href="http://www.sciencedirect.com/science/article/pii/S0010945209001427" target="_blank">words</a>8 . As in all areas of research, some studies have <a href="https://www.msu.edu/course/psy/802/altmann/802/Ch2-3-RobbinsMcKone07.pdf" target="_blank">not found</a> any significant effects9, perhaps because the categories of stimuli used were broader than the categories of objects participants were actually expert in. While these studies were part of a debate about whether <i>faces</i> are objects of extreme expertise or innately "special", that's not what makes them interesting. Whatever you think about faces, what matters is that developing expertise with recognizing other specific kinds of objects leads you to view them as a whole, not just as the sum of their parts.<br />
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<i>3) Detecting and Recognizing Objects</i><br />
We all know that people are good at recognizing objects that are important to them. Objects of expertise are important to experts, so it won't surprise you that they notice them better. For example, bird experts notice birds that to anyone else, might seem to blend into the background. (For a beautifully-written meditation on how expertise transforms the look of an ordinary city block, <a href="http://www.amazon.com/gp/product/1439191255/ref=pd_lpo_sbs_dp_ss_1?pf_rd_p=1944687682&pf_rd_s=lpo-top-stripe-1&pf_rd_t=201&pf_rd_i=1439191263&pf_rd_m=ATVPDKIKX0DER&pf_rd_r=0QD56H6DT3QXCXHK8C29" target="_blank">see</a> On Looking: Eleven Walks with Expert Eyes by Alexandra Horowitz).<br />
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In the lab, you can show people a large number of objects, including objects of expertise and other common objects. On some trials, you ask people to identify their object of expertise and on others, to pick out some other sort of object. Experts are faster and more accurate at finding objects of expertise than other sorts of objects. Novices find all sorts of objects equally well (all other things being equal).<br />
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Below is an example of this task from a study by <a href="http://link.springer.com/article/10.3758/APP.71.7.1478" target="_blank">Hershler and Hochstein</a>10. Experts were car or bird experts, and control images were either faces or "other objects" (miscellaneous).<br />
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<a href="http://4.bp.blogspot.com/-z55TqxnvBK0/VNUKjEsoybI/AAAAAAAACxY/RYRGQNAb0sY/s1600/hershler%2B09%2Bvis%2Bsearch.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://4.bp.blogspot.com/-z55TqxnvBK0/VNUKjEsoybI/AAAAAAAACxY/RYRGQNAb0sY/s1600/hershler%2B09%2Bvis%2Bsearch.png" height="278" width="320" /></a></div>
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Unfortunately, I don't know of studies that investigate visual search in a naturalistic context, like a living room scene or a beach scene. The problem with arrays of objects like this one is that it's difficult to control variables like color, texture, and brightness for all objects or all arrays. But such variables can make some objects easier to find than others, <i>regardless</i> of what type of object they are. It gets even more complicated when you include some experts in living objects (like birds) and others in nonliving objects (like cars), since these likely differ in their low-level visual properties. For this reason, I don't use (and don't plan to use) this sort of visual search task in my own research.<br />
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<i>Other Perceptual Changes?</i><br />
In the interests of completeness, I should note that a further, controversial set of studies on video games has suggested that some types of expertise may improve people's ability to quickly spread attention across large areas of space or multiple objects. Because these studies are less well-accepted, though, I will save discussion of them for a future post. However, I can safely conclude that the perceptual changes I've discussed in this post are the best established but not the only ones. We will likely discover more as we investigate further areas of expertise.<br />
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<i>What we know...and what we still need to figure out</i><br />
From birdwatching to chess, developing expertise seems to change how you see.<br />
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This basic principle seems to hold true across areas of expertise. However, different areas of expertise seem to impose different perceptual demands. For example, chess appears to improve perception of relationships <i>between</i> objects, leading to better pattern recognition, while car expertise improves perception of relationships between features <i>within</i> an object, leading to better object recognition.<br />
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Research groups tend to focus on one area of expertise in isolation, and then draw conclusions from their group of experts about expertise in general. For expert <i>knowledge</i>, this works fine. The conclusions about problem-solving Michelene Chi drew about <a href="http://onlinelibrary.wiley.com/doi/10.1207/s15516709cog0502_2/pdf" target="_blank">physics experts</a>11 and <a href="http://www.sciencedirect.com/science/article/pii/S0885201486800028" target="_blank">young dinosaur experts</a>12 seem to be accepted in domains as diverse as medical diagnosis and business leadership, as even a cursory Google search will indicate. However, <i>perceptual</i> expertise seems to be more domain-specific. Yet I know of no systematic examination of which areas of expertise will change perception in what ways. This is something I might work on during my PhD, so rather than speculate further, I'll simply note that this is an important problem to solve. Ideally, it would be possible to determine how <i>any</i> area of expertise changes how people see.<br />
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References<br />
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<ol>
<li>Isabel Gauthier, Pepper Williams, Michael J. Tarr, and James Tanaka (1998). Training "greeble" experts: A framework for studying expert object recognition processes. <i>Vision Research</i> 38:15-16, 2401-2428.</li>
<li>K. Anders Ericsson, Ralf T. Krampe, and Clemens Tesch-Romer (1993). The role of deliberate practice in the acquisition of expert performance. <i>Psychological Review</i> vol. 100 iss. 3, 363-406. http://psycnet.apa.org/index.cfm?fa=search.displayRecord&uid=1993-40718-001 </li>
<li>Cindy M. Bukach, W. Stewart Phillips, and Isabel Gauthier (2010). Limits of generalization between categories and implications for theories of category specificity. <i>Attention, Perception, & Psychophysics</i> vol. 72, iss. 7, 1865-1874.</li>
<li>Bruno Rossion and Tim Curran (2010). Visual expertise with pictures of cars correlates with RT magnitude of the car inversion effect. <i>Perception</i> vol. 39, pp. 173-183.</li>
<li>Isabel Gauthier and Michael J. Tarr (1997). Becoming a "Greeble" expert: Exploring mechanisms for face recognition. <i>Vision Research</i> vol. 37, iss. 12, 1673-1682. Open access! http://www.sciencedirect.com/science/article/pii/S0042698996002866</li>
<li>Thomas A. Busey & John R. Vanderkolk (2005). Behavioral and electrophysiological evidence for configural processing in fingerprint experts. <i>Vision Research</i> vol. 45 iss. 4, 431-448. Open access paper: http://www.sciencedirect.com/science/article/pii/S0042698904004365 </li>
<li>Merim Bilalic, Robert Langner, Rolf Ulrich, and Wolfgang Grodd (2011). Many faces of expertise: Fusiform face area in chess experts and nonvices. <i>Journal of Neuroscience</i> vol. 31 iss. 28, 10206-10214.</li>
<li>Chien-Hui Kao, Der-Yow Chen, and Chien-Chung Chen (2010). The inversion effect in visual word form processing. <i> Cortex</i> vol. 46 iss. 2, 217-230. http://www.sciencedirect.com/science/article/pii/S0010945209001427</li>
<li>Rachel Robbins & Elinor McKone (2007). No face-like processing for objects-of-expertise in three behavioral tasks. <i>Cognition</i> vol. 103, 34-79. https://www.msu.edu/course/psy/802/altmann/802/Ch2-3-RobbinsMcKone07.pdf </li>
<li>Orit Hershler and Shaul Hochstein (2009). The importance of being expert: Top-down attentional control in visual search with photographs. <i>Attention, Perception, & Psychophysics</i> vol. 71 issue 7, pp. 1478-1486.</li>
<li>Michelene T.H. Chi, Paul J. Feltovich, and Robert Glaser (1981). Categorization and representation of physics problems by experts and novices. <i>Cognitive Science</i> vol. 5 iss. 2 121-152. http://onlinelibrary.wiley.com/doi/10.1207/s15516709cog0502_2/pdf </li>
<li>Camilla Gobbo and Michelene Chi (1986). How knowledge is structured and used by expert and novice children. <i>Cognitive Development</i> vol. 1 iss. 3, 221-237. http://www.sciencedirect.com/science/article/pii/S0885201486800028</li>
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E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-66348069931691942792015-02-09T11:11:00.000-06:002016-12-02T08:45:40.615-06:00Why we reason badly about people with DSM diagnoses, but we should use these labels anywayOne extremely powerful aspect of human reasoning is our ability to draw inferences about members of a category. For example, let's say you've just learned that there is such a thing as an <a href="http://animals.sandiegozoo.org/animals/okapi" target="_blank">okapi</a>, and it's a mammal. You will conclude that the okapi probably has fur or hair, has a heart, a brain, and a spinal cord, gives birth to live young, and feeds its babies with milk.With even greater biological knowledge, you can make inferences about the size and structure of its brain. Both kids and adults do this, and it's an incredibly powerful way of gaining at least tentative knowledge about something without ever having to see it.<br />
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<tr><td style="text-align: center;"><a href="http://bloximages.newyork1.vip.townnews.com/stltoday.com/content/tncms/assets/v3/editorial/5/1f/51f05176-404e-5827-b419-331dcde40756/520b974fc02c1.image.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="287" src="https://bloximages.newyork1.vip.townnews.com/stltoday.com/content/tncms/assets/v3/editorial/5/1f/51f05176-404e-5827-b419-331dcde40756/520b974fc02c1.image.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A mother and baby okapi from the St. Louis zoo.</td></tr>
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Like most human abilities, though, it leads us astray in certain situations we create, just as most people's understanding of <a href="http://www.psychologie.tu-dresden.de/i1/kaw/diverses%20Material/www.illusionworks.com/assets/auto_generated_images/img_2549c002.jpg" target="_blank">perspective</a>, <a href="https://classconnection.s3.amazonaws.com/680/flashcards/557680/png/ebbinghaus-illusion1308364027834.png" target="_blank">relative size</a>, and <a href="http://www.huevaluechroma.com/pics/3-4.jpg" target="_blank">color constancy</a> leaves them prey to illusions, and neurotypicals' normally helpful tendency to perceive certain movements as intentional leads them to incorrectly ascribe intentional acts like "chasing" to <a href="http://brain.oxfordjournals.org/content/125/8/1839.long" target="_blank">animated shapes</a> [link goes to a free full text paper, Castelli et al. 2002]. Here, the problem is a little more complicated, and it happens when we attempt to make inferences about people based on their diagnostic categories.<br />
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Let's say, for example, that a teacher is told a new student, Alex, has ADHD. The teacher may assume that Alex is male, hyperactive, will disrupt the class, will have difficulty with reading or math, will have a short attention span whether interested or not, will excel at multitasking but not focusing on a single thing, will think and talk too fast, and will benefit from stimulant medication. All these characteristics are true of some people with ADHD. However, Alex might turn out to be a girl with inattentive type ADHD who zones out instead of disrupting the class, excels academically (when interested), can focus for hours when interested, can focus on a single thing but not multitask, thinks, moves and talks slowly, and can't use stimulant medication because it gives her migraines and lessens her appetite to an unhealthy degree. </div>
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Now, one might object that some of these incorrect inferences come from the teacher only knowing public stereotypes of ADHD, not the actual DSM definition. The equivalent in autism might be someone whose mental image of autism is a mix of Rain Man, Temple Grandin, and an Autism Speaks ad. </div>
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But the problem persists even among people who focus strictly on DSM categories. For example, if a few years ago a clinician was told that a child has "autistic disorder" or "classic autism" rather than "PDD-NOS" or "Aspergers," they might assume the child lacked spoken language and communicative gestures, did not attempt to interact with others, did not engage in pretend play, walked on their toes and flapped their hands, made poor eye contact, had below average IQ, melted down frequently, and so on. But as there are <a href="http://yesthattoo.blogspot.com/2013/09/autism-not-very-specific.html" target="_blank">2361</a> <a href="http://crackingtheenigma.blogspot.com.au/2011/02/exactly-how-many-ways-are-there-to-get.html" target="_blank">combinations</a> of characteristics that could lead to this diagnosis in <a href="http://www.autism.com/tools_dsm4" target="_blank">DSM-IV</a>, the child could just as easily speak fluently but reverse pronouns and have difficulty making requests, attempt to interact with others but be ignored, act out elaborate superhero stories on their own, make frequent eye contact, have average IQ but poor self-care skills, shut down rather than melt down, or spin in circles and twist their hair rather than toe walk and flap their hands. Similarly, a person with "high functioning autism" or "Aspergers" might not be a male "little professor" with better verbal than spatial skills, a love of facts over stories, good academic skills, and a muted affect. They could be a female, have better spatial than verbal skills, love creating imaginary worlds and telling stories, perform poorly in school, or appear overly emotional rather than unemotional. Even if the traits being assumed really are diagnostic traits and true of many people in the category, we will often be wrong if we assume them of any individual.</div>
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Below: From Jon Brock's <a href="http://crackingtheenigma.blogspot.com.au/2011/02/exactly-how-many-ways-are-there-to-get.html" target="_blank">blog</a>, an example of 2 children with a DSM-IV autism diagnosis despite having no diagnostic characteristics in common.</div>
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<img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgEmra2rJNG9sJbmmbijrAJGenEsr-KKKguPKnC2M_0OXm9UpOIgKXKDwTpX8oNeCdRN50mqKdoPVNAHhb75R26czxBuTZEkQZxn887T71ITjxwctu9ZbrtroMSXKmuE58D8v3xye_ZgYk/s320/Slide5.jpg" /></div>
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<img src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiK-ShHKJFYci_6MmePm7V5jWkkiw0IHOg3vVzecCh5hbOLMJembV8mT_Xj0h_4ppLdutWDoP5ywcXoRSRVEiBjNejPehJbuFKYLVbqr-yaSLSMMYXPu_O83-4jepQzMx8rFhGPy0okoPQ/s320/Slide4.jpg" /></div>
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This is one reason why we <a href="http://mosaicofminds.blogspot.com/2012/08/what-gifted-education-field-needs-to.html" target="_blank">insidiously assume</a> the same behavior must have different motivations in people with different diagnostic labels. For example, we assume inattention stems from boredom in a child labeled "gifted" and poor executive function in a child labeled "ADHD" when the former could also have poor executive function, and the latter could also be bored, or both could be inattentive for another, less stereotypical reason (e.g., the class is boring). We ascribe specific sorts of motivations to each diagnostic category and so when we see a behavior, like inattention, we reason from the category and forget to consider other possibilities.</div>
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Why are we led astray when we make assumptions about people based on diagnostic category, but not when we reason about the biological features of an unfamiliar animal? One reason might be that biological categories, like "mammals," are "natural kinds" where certain characteristics consistently cluster together for real reasons, whereas diagnostic categories are human-created, and the co-occurring characteristics selected developed historically from clinical observation of a set of people who happened to have those characteristics in common (e.g., <a href="http://neurodiversity.com/library_kanner_1943.pdf" target="_blank">Leo Kanner's</a> and Hans Aspergers' cases for autism). However, we do not know <i>why</i> these people have these characteristics in common--are there common causes, as with mammals, is it pure coincidence, or are there cultural and historical reasons? As a result, human diagnostic categories are what I call "<a href="http://mosaicofminds.blogspot.com/2012/02/what-do-giftedness-and.html" target="_blank">cluster concepts</a>," while biological categories probably aren't, or are less so.</div>
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So what does all this imply for the debate over whether diagnosis is a good thing?</div>
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First, the obvious. Both ignorant and more knowledgeable people will make inaccurate inferences about someone with a diagnosis, and diagnosed people and their parents will continually have to combat these assumptions. </div>
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Furthermore, the diagnosed person could start to make these sorts of assumptions about <i>themselves.</i> Or they might wonder if there's something wrong with them because they don't do something other people with the label often do. I've seen internet posts by people diagnosed with ASD wondering if there's something wrong with them because they don't, say, stim in certain ways. Or, people <a href="http://archive.autistics.org/library/more-autistic.html" target="_blank">ask if</a> knowing they're autistic led them to behave "more autistically." That's certainly possible, if one doesn't try to avoid stereotyping oneself.</div>
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So, does that mean it's better not to diagnose someone at all? I still think not, because whether a person is diagnosed or not, they are behaving in the same way, and looking just as different from the norm. Their differences will <a href="https://ischemgeek.wordpress.com/2014/02/09/tell-your-kids-theyre-autistic-dammit/" target="_blank">not be read</a> as "normal," they will simply be assigned to a different set of "diagnostic" categories. Instead of a disability category, they might be assigned to categories like "<span id="goog_1522839278"></span><a href="http://www.amazon.com/You-Mean-Lazy-Stupid-Crazy/dp/0743264487" target="_blank">lazy</a><span id="goog_1522839279"></span>," "spoiled and badly parented," "doesn't care about other people," "<a href="http://www.amazon.com/You-Mean-Lazy-Stupid-Crazy/dp/0743264487" target="_blank">stupid</a>," "<a href="http://ballastexistenz.wordpress.com/2010/04/11/on-growing-up-with-strange-sensory-reactions-and-the-difference-between-passing-and-being-passed-off/" target="_blank">on drugs</a>," and so on. I have <a href="https://chavisory.wordpress.com/2013/11/01/you-should-tell-your-kids-that-theyre-autistic/" target="_blank">yet to meet</a> someone who would rather have their difficulties explained this way. To be honest, I think it's more psychologically damaging to view one's character as fundamentally flawed for things one can't help doing, despite one's best efforts, than it is to view oneself as having to cope with having difficulty doing things other people don't, or being naturally inclined to behave in ways most people don't like. Surprisingly, there's actually <i>more</i> room for agency with a disability label, because instead of being an irredeemably lousy human being, you have some weaknesses other people don't have that you can <i>choose</i> how to manage.</div>
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Rather than avoid diagnostic labels entirely, we should use them while understanding their limits and taking care to avoid making the same inferences from them that we would with biological categories.</div>
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E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-77631616439854909842015-01-19T19:09:00.000-06:002015-01-22T10:39:34.526-06:00Heterogeneous and sometimes opposite connectivity patterns in autistic brains<div style="color: #444444; font-family: 'Helvetica Neue', HelveticaNeue, Helvetica, Arial, sans-serif; font-size: 14px; line-height: 19.6000003814697px;">
There's a method of looking at the brain, called "resting-state connectivity," a form of fMRI. fMRI indirectly estimates where areas of higher and lower brain activity are occurring. (Areas that are more active consume more glucose, and require more blood flow in order to supply them with that glucose. fMRI measures these changes in blood flow). "Connectivity" measures the co-occurrence of brain activity--which regions are active at the same time, and therefore might be working together. "<a href="http://en.wikipedia.org/wiki/Resting_state_fMRI" target="_blank">Resting state</a>" means that connectivity is being measured while a person sits still in the MRI machine, not doing any particular task. This is different from fMRI studies that look at "functional connectivity," which is the co-occurrence of activity <em>while performing a specific task.</em></div>
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Resting-state activity can be hard to interpret and is still somewhat controversial. That's because people aren't doing anything in particular, they're just mind-wandering, or worrying about problems, or thinking how bored they are and wondering when the experiment will be over, or finding patterns in the scanner noise--or any number of other things. The experimenter has no control over what you're thinking or perceiving during a resting state experiment. What's amazing is that researchers can still find consistent brain networks during experiments like this. This might be because we habitually use our brains in certain ways while thinking, and these relationships exist even when we're not performing any particular task. It may also occur for mind-wandering in particular because mind-wandering is a task with its own <a href="http://www.pnas.org/content/106/21/8719.abstract" target="_blank">brain network(s)</a>, just like other (better-defined) tasks.</div>
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Not surprisingly, a research group decided to compare resting-state connectivity in autistic and neurotypical adults. You can find an abstract <a data-mce-href="http://dx.doi.org/10.1038/nn.3919" href="http://dx.doi.org/10.1038/nn.3919" style="color: #444444;" target="_blank">here</a> and a summary for non-scientists <a data-mce-href="http://neurosciencenews.com/voxel-deviation-autism-neuroimaging-1718/" href="http://neurosciencenews.com/voxel-deviation-autism-neuroimaging-1718/" style="color: #444444;" target="_blank">here</a>. (The research team was <a data-mce-href="http://www.cmu.edu/research/brain/experts/alpha-list/behrmann-marlene.html" href="http://www.cmu.edu/research/brain/experts/alpha-list/behrmann-marlene.html" style="color: #444444;" target="_blank">Marlene Behrmann</a>'s group at Carnegie Mellon, which does a lot of autism research and is especially interested in perception). The group was trying to address conflicting results about whether autistic brains are "underconnected" or "overconnected." Some studies find less connectivity in autistic than neurotypical brains, others find greater connectivity. It's not clear whether the conflicting results come from different study methods, artifacts (i.e., autistic people <a href="http://sfari.org/news-and-opinion/news/2012/movement-during-brain-scans-may-lead-to-spurious-patterns" target="_blank">move more in the scanner</a>), heterogeneity in the autistic population, or some other factor. My personal theory was that in addition to heterogeneity, the explanation comes from connectivity in autism being atypically high in some brain areas or networks, and atypically low in others, and that furthermore the pattern varies based on what task a person is doing. So, whether you find overconnected or underconnected autistic brains depends on what you're having people do, and what parts of the brain you're looking at.</div>
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Behrmann's group specifically recruited autistic adults with IQ in the normal range, perhaps because this made it easier to explain the task and ensure participants stayed still in the scanner. They looked at connectivity both between the brain's left and right hemisphere, and within each of these hemispheres.</div>
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As I would have predicted, they found that some areas were more highly connected in the autistic group and other areas were less connected. </div>
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But here's where it gets interesting: </div>
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<em>"Connectivity patterns were pretty similar between neurotypical participants. Their brains all looked roughly the same. By contrast, there was a LOT of variability in the ASD group. Connectivity patterns were 'idiosyncratic.'"</em></blockquote>
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The boring part of this finding is that participants who were rated as having stronger "behavioral symptoms of ASD" also differed more from the normal "template." Well, of course, autism is by definition different than the norm, so we shouldn't be surprised when autistic brains differ from "average" brains, or even that more autistic people should have more divergent brains. The interesting result is that <em>autistic brains were different from each other.</em></div>
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<img alt="This image shows two brain scans which compare the extent of the voxel deviation in people with autism." src="http://neurosciencenews.com/files/2015/01/voxel-deviation-autism-nf.jpg" height="135" width="400" /></div>
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<i>Above: Image from the described paper, accessed via the Neuroscience News writeup, which describes it as follows: "This image shows a comparison in the extent of the vowel deviation from the typical profile of two individuals with autism [a voxel is a 3d pixel that is the unit of measurement in an fMRI study]. The individual with the more severe autism symptoms (right) showed greater deviations, both positive (more red) and negative (lighter blue) from the typical inter-hemispheric connectivity pattern compared to the individual with the less severe autism symptoms (left)."</i></div>
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While in some cases the pattern is qualitatively similar in the two brains (e.g., increased connectivity in frontal areas and in ventral temporal areas), other regions show opposite patterns. For example, the area where the occipital lobe (back of the brain) meets the parietal lobe (top/back of the brain) has atypically low connectivity in the "less severe" brain on the left and atypically high connectivity in the "more severe" brain on the right. The same is true for the medial temporal region (just below the dark indentation in the middle of the brain).</div>
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This result seems like the neural flip side of a point Mel Baggs (<a href="http://ballastexistenz.wordpress.com/" target="_blank">Ballastexistenz</a>/<a href="http://withasmoothroundstone.tumblr.com/" target="_blank">Withasmoothroundstone</a>) often makes about behavior: for any trait you can think of, autistic people are often found at both extremes while neurotypical people are usually in the middle. You can find autistic people with extremely high and extremely low pain sensitivity, language ability, spatial ability, empathy, tendency to introspect, and so on. Not only are their abilities extreme and often opposite of each other, but so, it turns out, are their patterns of brain connectivity. We need to remember "heterogeneity" can mean not just "variable" but sometimes "opposite," both for behavior and brains.</div>
E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-29462187364813463822014-11-10T13:28:00.000-06:002016-12-17T18:37:45.077-06:00What is joint attention, and are we defining it wrong?Most humans have an important skill: the ability to share attention. That is, they can pay attention to the same thing, knowing that the other person is also attending to and thinking about it. The ability to share attention with another person enables all sorts of other activities, such as having a coherent conversation, or working together to put together a puzzle or construct a house. It may even help babies learn language. When parents name an object in the environment, babies are more likely to understand the referent if they are paying attention to the same object as the parent. Researchers call the act of sharing attention "joint attention." Not surprisingly, they find it to be an integral part of social and language development in neurotypical people. They also find it to be delayed or absent in young autistic children, and theorize that this may cause all sorts of social and language delays.<br />
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When you define an important concept in psychology, you must decide how to measure it. Psychologists who study social and language development have generally settled on one, highly specific definition. A person has joint attention if they can look back and forth between another person and an object, and lacks it if they cannot. Notice that this definition focuses on only one sense (vision), and on a <a href="http://mosaicofminds.blogspot.com/2009/11/slow-visual-attention-shifting-in.html" target="_blank">highly demanding motor skill</a>: the ability to rapidly move one's eyes between two things. <br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://3.bp.blogspot.com/-CilaByDl3ls/WFXZ5vznUcI/AAAAAAAAIqI/Jgm4Gwij9UItP1xZpnZxwdizA6zUBRmDQCLcB/s1600/joint%2Battention%2Bgillespie-lynch.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="198" src="https://3.bp.blogspot.com/-CilaByDl3ls/WFXZ5vznUcI/AAAAAAAAIqI/Jgm4Gwij9UItP1xZpnZxwdizA6zUBRmDQCLcB/s400/joint%2Battention%2Bgillespie-lynch.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">A boy engages in joint attention with his mother under this definition.
He looks at her, sees she's looking at the toy, looks at the toy himself, and
understands that he and his mother are looking at the toy together. From
Gillespie-Lynch (2013). Response to and initiation of joint attention:
Overlapping but distinct roots of development in autism? OA Autism 13,
http://www.oapublishinglondon.com/article/596.</td></tr>
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The advantage of this definition is that it <i>is</i> a common way that people share attention (in the U.S., at least), and it's easily measured when you bring people into the lab. The disadvantage is that when researchers start to identify this operationalization of joint attention with joint attention <i>itself</i>, they ignore the myriad other ways people can share attention. This may not matter much when considering typical development, but it definitely matters when trying to explain why autistic people have trouble sharing attention.</div>
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Two researchers, <a href="http://www.gernsbacherlab.org/" target="_blank">Morton Ann Gernsbacher</a> and <a href="http://www.indiana.edu/~dll/" target="_blank">Chen Yu</a>, have written two very different critiques of why joint attention should not be considered synonymous with alternating eye gaze between another person and an object. Morton Ann Gernsbacher's <a href="http://gernsbacherlab.org/wp-content/uploads/papers/1/Akhtar_JointAttention_CDP.pdf" target="_blank">theoretical paper</a>1 explains that such a theory of joint attention cannot explain how people share attention in many of the world's cultures. Chen Yu's <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0079659" target="_blank">experimental study</a>2 indicates even the typical research subjects, middle-class U.S. toddlers, rarely coordinate joint attention through alternating eye gaze, and instead do so through other means. </div>
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<i>Vision isn't the only way to share attention</i></div>
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<a href="http://gernsbacherlab.org/wp-content/uploads/papers/1/Akhtar_JointAttention_CDP.pdf" target="_blank">Akhtar and Gernsbacher (2007)</a> lay out a variety of other ways that children and parents in other cultures share attention.</div>
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In some cultures (e.g. Kaluli people in New Guinea, Palestinian families in Israel), babies are not only constantly held but are held facing outward, rather than face to face. This can occur when babies are carried in the mother's arms, on her shoulders, on her back, or in her lap. As a result, these babies get very little face-to-face experience with their caregivers compared to U.S. babies.<br />
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However, in such non-Western cultures, mothers interact with their babies less through eye contact and talking and more through touching and holding. These babies' early social engagement occurs through other sensory modalities more than through vision. Thus, one would expect shared attention to develop out of the other senses more than, or earlier then, it would develop out of vision.</div>
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When babies are held, they adjust to the movements of the person holding them, and they're sensitive to changes in posture very early in life. Changes in the caregiver's posture can convey similar information to changes in their gaze direction--a caregiver is likely to lean towards something they are focused on or interested in. Thus, babies in these low-eye-gaze cultures have access to the same information that U.S. babies get from eye gaze, but they get it from a different sensory modality.</div>
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In addition to postural changes, other tactile cues may be important for establishing shared attention. If a child sits in his mother's lap while they both handle a toy, he can tell from her posture, touch, and hand movements that she is attending the same toy.</div>
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Blind children do not utterly lack the ability to share social engagement and attention with others, as would follow if joint attention were truly nothing but the alternation of visual attention. Instead, they do so through nonvisual modalities instead. Caregivers also provide tactile cues that direct the child's attention and cue them to engage in intentional communication. They use touch to get the child's attention, either before signing in the child's visual field, or simply to maintain contact when one partner has looked away. </div>
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In short:</div>
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"Although it is possible that gaze is the primary sense for typically developing, sighted infants in Western middle-class contexts, we cannot assume that gaze is primary without exploring other senses and other populations. By examining variations across cultures and across typical and atypical development, researchers may uncover multiple pathways to achieving social engagement and intentional understanding of others' behaviors."</blockquote>
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<i>Alternating gaze may not be the best measure of shared reference</i></div>
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Both Gernsbacher and Yu argue that even for sighted U.S. babies, gaze alternation may not be the best measure of shared attention.</div>
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To display joint attention, it's not enough to be looking at the same object as a parent. A child must also gaze into the caregiver's face. We've already seen one problem with this--that babies raised in other cultures with less eye contact will be unlikely to do so. Another problem is that the child might look up at the caregiver for reasons other than trying to share attention. They might be looking for comfort, if anxious in the unfamiliar laboratory setting. Or, they might be looking for information, when confronted with odd and ambiguous laboratory toys. </div>
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Furthermore, even U.S. babies who appear to be following eye gaze may not actually be doing so. Changes in gaze direction are usually accompanied by changes in head orientation, body posture, and voice direction, all of which come together to indicate the person's direction of attention. Studies of joint attention that define joint attention as alternating eye gaze do not necessarily attempt to separate gaze cues from these other visual and auditory cues--which may be the truly informative ones for babies. </div>
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Enter Chen Yu's study, which uses sophisticated real-time measures to determine how U.S. toddlers playing with their mothers really <i>do</i> share attention. These researchers have an innovative procedure: in addition to using overhead camera to provide a third-person view of their behavior, they have mothers and babies each wear head cameras with built-in eye-tracking equipment so that researchers can literally see the world from each participant's point of view.<br />
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Here's what the setup looked like:<br />
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<a href="http://1.bp.blogspot.com/-SwFFhgSAXWE/VGEON4l5H2I/AAAAAAAACtk/yKpSAiqEAC8/s1600/yu%2Bjoint%2Battn%2Bexperimental%2Bsetup.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="275" src="https://1.bp.blogspot.com/-SwFFhgSAXWE/VGEON4l5H2I/AAAAAAAACtk/yKpSAiqEAC8/s1600/yu%2Bjoint%2Battn%2Bexperimental%2Bsetup.png" width="400" /></a></div>
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They brought in seventeen 11-15 month olds and their parents for a play session in the laboratory. There were six toy objects at the table, displayed in sets of three, with which the pair could play freely. As seen above, the room was white and minimally distracting, which could be a strength or weakness of the study depending on your point of view.<br />
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Researchers measured frame by frame where the babies looked, where the parents looked, and when both shifted to look at a new object, which partner led and which one followed. They suspected that social coordination would involve babies and parents <i>looking at the same object at the same time.</i> If one partner looks at a new object, to maintain coordination, the other will soon follow, <i>but they might do so without making eye contact.</i><br />
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That was, in fact, what they found. Babies and their parents frequently looked at the same object (about 33-42% of the time, depending on the measure), sharing over 23 bouts of joint attention per minute by one measure. Yet babies rarely looked at their parent's face (about 5 times per minute), certainly not often enough to coordinate their looking behavior with parents. Indeed, babies did not consistently look at a parent's face when following their gaze to an object. (It's important to note that babies and parents did look at each other's faces at times, just that this was rare and did not seem to relate to their coordinated looking at objects. Also, parents <i>did</i> frequently look at the child's face and used this cue to follow their child's attention. Children just didn't do the same with the parent).<br />
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So what cues were babies using to share attention with their parents? Parents or babies were holding an object almost all the time, and hand cues overlap well with eye gaze cues. Babies tended to look at the hands of whomever was acting on the object, whether that was themselves or their parent.<br />
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Above: Gaze and joint attention data from Yu & Smith (2013). a,b) Comparison of where child and parent were gazing, showing that both were often looking at the same thing; that parents looked at the face more than children did; and that children maintained gaze fixation longer than parents, overall (perhaps related to slower attention shifting in this age group). c) and d) are two different ways of measuring the synchrony between child and parent gaze. e) isn't important for the purposes of this post, but it compares the cross-recurrance of parent-child gaze to a random baseline, where the x axis represents time.<br />
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<i>Why does it matter how we measure shared attention?</i></div>
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Since Simon Baron-Cohen proposed3 that autistic children's language delays stem from their inability to alternate joint attention between another person and an object, a line of autism research investigating the relationship has arisen, based on this assumption. But if joint attention is not identical with triangulated eye movements even in typical development, then our explanations for disabilities in autism rest on a faulty foundation. If this misinformed research informs interventions, then much effort may be spent trying to teach triadic eye movements that may be painful, or even impossible for young autistic children (given their difficulties with rapid eye movements in general). Efforts would be better spent developing ways to teach language skills and desired social behavior using more accessible cues.<br />
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Stigma also arises when we assume that a person who cannot triangulate eye movements between a person and an object also cannot share attention with another person. From here, people often make the leap to claiming that autistic children cannot be emotionally engaged with others or realize that other people have mental states, too, which leads to viewing them as alien at best and sociopathic at worst. These conclusions do not follow, of course, but given the difficulty even researchers have with recognizing that, it may be best to emphasize the distinction between the ability to perform a particular pattern of eye movements and the ability to share attention.<br />
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<i>References</i><br />
Nameera Akhtar & Morton Ann Gernsbacher (2007). On privileging the role of gaze in infant social cognition. Child Development Perspectives 2, pp. 59-65.<br />
Chen Yu & Linda Smith (2013). Joint attention without gaze following: Human infants and their parents coordinate visual attention to objects through eye-hand coordination. PLoS ONE 3, e79659.<br />
Simon Baron-Cohen, Dare A. Baldwin, & Mary Crowson (1997). Do children with autism use the speaker's direction of gaze strategy to crack the code of language? Child Development 68, pp. 48-57.</div>
E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com4tag:blogger.com,1999:blog-6733902656011255269.post-16385395280194022542014-10-24T11:46:00.000-05:002014-10-24T11:46:32.900-05:00What should a blogger do with their old posts when they change their mind?I recently reread some old entries from 2009 and winced. I still stand behind the main ideas of these posts, but would now express them very differently.<br />
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For one, my attitude towards autism and other disabilities has changed immensely since beginning this blog. When I began, I was just starting to read both autism research and blogs by autistic people and their parents. Although in the abstract, I <a href="http://mosaicofminds.blogspot.com/2009/07/new-approach-to-learning-disabilities.html" target="_blank">thought of disabilities as</a> traits that could be positive, negative, or neutral depending on the situation, I viewed autism in particular as entirely negative, as a source of disability only. This perspective came from watching my brother struggle with the disabilities themselves, the way others treated him as a result, and the anxiety produced by both. I saw his positive traits--his brilliant, independent mind, his sardonic humor, his sense of justice and compassion for others--as completely unrelated to autism. They were just part of who he was. But I didn't see autism that way. As Zoe Gross would put it, I was still partially seeing autism as a sort of add-on, <a href="http://illusionofcompetence.blogspot.com/2012/08/disability-first-autism-is-not-accessory.html" target="_blank">like the detachable cape</a> on a Magneto action figure. Granted, I was seeing it as an add-on that affected the way people perceive, move, think, and feel in various ways, but I still saw it as a basically negative add-on. When I first started reading autism research (the first papers I read were from the Yale group), a lot of it rang false, and the coldly clinical writing style made me wonder if the writers knew and loved anyone autistic. But the deficit-focus and deficit-language used didn't bother me yet--I just thought that they were focused on the wrong disabilities and were too far removed from the people they studied.<br />
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Then I learned more about the up-sides of autistic ways of perceiving and learning. Autistic people can quickly hone in on details within a complex visual display. They have reduced attentional blindness. They can better perceive and appreciate pitch in music than most. They can learn challenging skills like reading without being taught, often at a young age. They're immune to various illusions, including the one where moving triangles appear to carry out intentional actions like "chasing." And it's not like these are anomalies unrelated to the disabling aspects of autism, either. These positive traits are likely related to the traits that are disabilities. A bias towards focusing on sensory details can be positive or negative depending on whether the situation demands perceiving the details (e.g., when drawing) or the configuration (e.g., when perceiving faces). The ability to learn rapidly through self-teaching is the flip side of a difficulty learning from being taught by typical educational methods. Lacking the neurotypical mind "bug" of perceiving everything as intentional could contribute to missing social cues. And you can flip it the other way, too--disabling traits come with up-sides in the right situations and with the right support. Thus, parents, teachers, clinicians, and researchers have an ethical imperative to seek out and build on the positive. <br />
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So now, I would talk about autism very differently. This poses a problem: should I edit the posts to bring them in line with my current understanding, or leave them unchanged as a testament to the process of change itself? Perhaps I should edit them, as the technically-savvy can find old versions of most webpages anyway? What do you think? What would you do--or, if you've had a similar change in perspective while blogging, what have you done?E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com1tag:blogger.com,1999:blog-6733902656011255269.post-73224772994215321022014-09-22T09:07:00.003-05:002014-09-22T09:07:53.809-05:00If "X Changes the Brain!!!", When Should We Care?In <a href="http://blogs.discovermagazine.com/neuroskeptic/2014/09/21/warning-this-will-change-your-brain/#.VCAiOvldWVM" target="_blank">a post</a> catchily titled "Warning: This Post Will Change Your Brain," Neuroskeptic describes media coverage that breathlessly reports that a single dose of an antidepressant changes the brain. <br />
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As Neuroskeptic points out, evidence from brain damage supports the idea that everything the mind does involves corresponding brain activity. Therefore, we should expect, at some level, that everything we think about, do, or perceive will change the brain in some way. There are a lot of philosophical positions you could take that are compatible with this notion--that "the mind is what the brain does," that "the mind is the brain," that "the brain causes the mind to do stuff," that "the mind and the brain just happen to perfectly parallel each other," and so on. Regardless, if something is happening in the mind, then something must be happening in the brain, too. Therefore, the mere existence of a change in the brain isn't necessarily headline news. Neuroskeptic has a great example of trivial brain changes we experience every day:<br />
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<span style="background-color: white; color: #333333; font-family: georgia, serif; font-size: 16px;">"Every time you open your eyes, for example, </span><a href="http://en.wikipedia.org/wiki/Alpha_wave" style="background-color: white; color: red; font-family: georgia, serif; font-size: 16px; outline: none; text-decoration: none;">widespread changes in your brain activity result</a><span style="background-color: white; color: #333333; font-family: georgia, serif; font-size: 16px;">. But every time you close your eyes, these changes are reversed."</span></blockquote>
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<a href="http://1.bp.blogspot.com/-GqvyA1xq1Vg/VCAqfL-5_MI/AAAAAAAACqA/sDWCxyjnG0w/s1600/insomniapic.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://1.bp.blogspot.com/-GqvyA1xq1Vg/VCAqfL-5_MI/AAAAAAAACqA/sDWCxyjnG0w/s1600/insomniapic.jpg" /></a></div>
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<span style="background-color: white; color: #333333; font-family: georgia, serif;">Above: "Sleep changes the brain?! I'd better not sleep any more, then!"</span></div>
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Given all the headlines with titles like "New brain study explains why people do/like/think X," journalists <i>do </i>seem to believe that the brain either is or causes what happens in the mind. So if they really believe this, they should also recognize that mind changes necessarily involve brain changes, so not every brain change is likely to be exciting or important.<br />
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So if some brain changes are trivial, how are we supposed to evaluate whether a change reported in a news story should matter to us?<br />
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It may not always be possible to tell, given either the limitations of the study or the article reporting on it. But here are some questions one can ask:<br />
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<i>1) At what time scale does the brain change?</i><br />
Brain plasticity acts at two major time scales. One, on the order of milliseconds, involves changes in the pattern of neural firing, and the biochemical processes that affect it--neurotransmitter release and the like. Different neurons in your visual cortex fire when you look at a perfectly vertical line versus when you look at a perfectly horizontal line, for example. Different assemblies of neurons will fire when you look at (or think about) a cat and when you look at (or think about) a dog; or when you smell Lysol vs. your grandmother's cookies. And each time you think about something new, the pattern of neurons that fires changes again. These changes are so fast that fMRI is too slow to catch them. On the other hand, over years, memories form and solidify through changes in the strength and structure of synapses. <br />
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<i>2) How long does the change last?</i><br />
Brain plasticity at the millisecond scale lasts as long as the thought or behavior it signifies. <a href="http://en.wikipedia.org/wiki/Long-term_potentiation" target="_blank">Long term potentiation</a>--the brain changes that enable memory formation--can potentially last as long as an individual lives.<br />
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<i>3) What sort of change is it? How big is it?</i><br />
The birth of new neurons and the creation of new synapses is a big deal. For example, a major factor in developmental changes is a proliferation of synapses in a particular brain region, followed by a pruning of the synapses that turn out not to be useful. Some regions, such as primary visual cortex at the very back of the brain, both proliferate and prune earlier than others, such as the frontal lobe, and this has real behavioral consequences. Long-term changes in the pattern of short-range and long-range white matter connections in the brain also seem important, as do changes in the functional communication between brain regions that they enable. Look for evidence of large, long-lasting, long-time-scale changes of this sort. <br />
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<i>4) How and why does the change happen?</i><br />
This is really a question about the mechanisms of the brain change, which, for a neuroscientist, means understanding its effects at all levels, from the molecular up to the whole brain level. But a layperson can approach the question in a less technical way. Suppose the brain change is caused by a drug or therapy. Do these changes simply reflect the transient action of the drug or therapy, and end once the patient is no longer in treatment? Or does the drug or therapy change the brain in some sort of meaningful way that persists even when the patient is no longer receiving treatment? For example, people helped by cognitive-behavioral therapy for anxiety may develop habits of examining and correcting their thinking that become so effective that they no longer needs the therapy, because they have been trained to provide their own. One might expect to see a long-lasting, long-time scale brain change of one of the sorts described in Question 3.<br />
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<i>5) What is the real-world, behavioral consequence of this brain change? Is there one at all?</i><br />
As Dorothy Bishop <a href="http://deevybee.blogspot.com/2014/01/what-is-educational-neuroscience.html" target="_blank">points out</a>, teachers don't really care if a dyslexia intervention changes the structure or function of the brain in some way; they care if it teaches dyslexic children to read faster and more accurately, and if this improvement lasts. A depressed person evaluating possible therapies wants to know if changes in the brain reflect an actual reduction in depression symptoms. In cases like this, brain changes are interesting because they may inform us about <i>how</i> the behavioral change occurs, but <a href="http://deevybee.blogspot.com/2011/06/brain-scans-show-that.html" target="_blank">the real measure of interest is behavioral</a>, not neurological.<br />
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Next time you read a headline about how something changes the brain, keep these questions in mind and ask yourself what sort of brain changes are actually involved. The reality may be less exciting, or terrifying, than it first appears.E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-42249534155076081382014-09-15T17:30:00.000-05:002014-09-15T17:30:22.239-05:00An Open Letter to Issy StapletonDear Issy,<br />
I don't know if you have free access to the internet, or if you'll ever see this. But I wanted to tell you something.<br />
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I can't even imagine what it's like to live knowing that your mom tried to kill you. That would traumatize anybody. Worse, to have to listen to her tell the world that it was your fault, that you didn't deserve to live, and having famous people like Dr. Phil agreeing with her. Well, I know it hurts, and it's probably infuriating, but I want you to know, <i>it's not your fault. You don't deserve this. </i>No one does. <br />
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Please know that there are a lot of people who support you, who want the best for you, who wish we could protect you. A lot of people are trying to make the world see that what your mom did to you was wrong. We couldn't help you, but maybe we can stop it from happening to another child.<br />
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And Issy, you're not alone. There is a whole community of people affected by autism who are very different from your mother. There are autistic adults* who talk to each other online and meet in person. An incredibly diverse group of people, many of whom were called "difficult" and treated horribly when they were children, but who now are friends and support each other. There are parents of autistic kids who treat them kindly and want to understand them, who don't see their children as a burden. There are siblings, like myself, who know their lives are infinitely better because of their autistic sibling. There are professionals who actually care about the happiness of the people they work with, not just about making them look "normal." We're all here waiting to welcome you. <br />
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With love,<br />
Emily "Mosaicofminds"<br />
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*I don't know if you prefer "autistic" or "with autism" or if you care one way or the other. This is the term I use, but please fill in whatever you prefer.E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com3tag:blogger.com,1999:blog-6733902656011255269.post-35627951342967830782014-09-10T17:59:00.002-05:002015-06-02T20:06:48.673-05:00Want to learn how something works in psychology? Make it up!(No, I don't mean that you should invent numbers and call them experimental data, although <a href="http://www.apa.org/science/about/psa/2011/12/diederik-stapel.aspx" target="_blank">some people</a> have done that).<br />
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There are a lot of theories psychologists have been unable to prove, either because they lack the control over the world necessary to test them, or because it would be unethical to do so. For example, the nature/nurture problem would be a lot easier to solve if one could separate twins at birth and assign them, say, to a "learn a spoken language" and a "learn a sign language" condition, or an "authoritarian parent" and a "laissez faire parent" condition. But, since they can't do such things, psychologists have come up with a creative alternative.<br />
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They create artificial versions of the things they want to study.<br />
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Want to know how people learn a language? Make up an artificial language, change the parameters of its grammar and other qualities in specific ways, and watch how people learn it. There are a number of studies that have used invented artificial languages to study language learning in kids and adults. On a smaller scale, studies routinely examine toddlers' word learning by asking them to learn the names of toys or unfamiliar household objects--names like "blicket" or "dax."<br />
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Want to understand how we learn to recognize specific types of objects, such as faces? One <a href="http://gauthier.psy.vanderbilt.edu/" target="_blank">research group</a> invented little creatures called Greebles (see <a href="http://io9.com/want-to-understand-how-facial-recognition-works-youll-1687050799" target="_blank">IO9's</a> layperson-friendly description of the study). The researchers trained people to recognize individual Greebles and categorize them into families. They varied what methods were used to train people to recognize the Greebles, how participants were tested, and various other parameters in order to find out more about the learning processes involved. They also observed (using fMRI) how learning to recognize these artificial objects changed activation in a <a href="http://en.wikipedia.org/wiki/Fusiform_face_area" target="_blank">specific area of the brain</a> important for object recognition.<br />
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<img src="http://media.tumblr.com/tumblr_m4rkjoq0Nq1r97emf.jpg" height="203" width="400" /><br />
Above: Greebles, from Isabel Gauthier's paper in Nature Neuroscience.<br />
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<img alt="Want To Understand How Facial Recognition Works? You'll Need A Greeble" src="http://i.kinja-img.com/gawker-media/image/upload/s--iWkblTVk--/c_fit,fl_progressive,q_80,w_636/uapzp99zqhuvy1uhjcgf.jpg" height="237" width="400" /><br />
Above: Greebles arranged by family and gender, from the same paper via <a href="http://io9.com/want-to-understand-how-facial-recognition-works-youll-1687050799" target="_blank">IO9</a>.<br />
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<a href="http://www.indiana.edu/~canlab/Home.html" target="_blank">My own lab</a> even used 3D printers to create Greeble-like creatures for children to play with while learning (Sorry, no pictures available at present). Doing so allows them test whether the experience of touching and looking at the Greebles from different angles helps children learn them. They also investigate whether it matters exactly how children explore the objects. There are families of Greebles living on my desk and they are <i>adorable. </i>(And these are just the most appealing of a wide variety of artificial objects my lab has used to study how young children learn).<br />
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Other than writers and video game designers, how many people in other fields can say they made up a language or a new type of creature? How many can say they did it for science?E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-29028515626598154752014-09-09T18:17:00.001-05:002014-09-09T18:17:17.046-05:00How do developmental psychologists think?<i><span style="font-size: x-small;">[The basic structure and ideas for this post come from a developmental seminar I'm taking with <a href="http://psych.indiana.edu/faculty/bbertent.php" target="_blank">Dr. Bennett Bertenthal</a> at Indiana University. I'm sharing these concepts more broadly because not everyone has access to a class like this, but anyone interested in child development can benefit from understanding the thinking style and assumptions of the people who research it.] </span></i><br />
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A <a href="http://en.wikipedia.org/wiki/Developmental_psychology" target="_blank">developmental psychologist</a> is someone who researches how people's minds change over their lifetime. Most study babies, children, or adolescents, but some focus on old age, and they could also investigate parenthood, middle age, or emerging adulthood. Developmental psychologists care about life stages, how we change as we transition from one to the next, how we change within a life stage, and conversely, what about us stays the same as we move from one stage to another.<br />
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<a href="http://psychologydegreelink.com/sites/psychologydegreelink.com/files/styles/large/public/field/image/shutterstock_159529073_0.jpg?itok=NKwZYtE1" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://psychologydegreelink.com/sites/psychologydegreelink.com/files/styles/large/public/field/image/shutterstock_159529073_0.jpg?itok=NKwZYtE1" height="213" width="320" /></a></div>
Above: A developmental psychologist playing with a child.<br />
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Developmental psychologists are concerned with processes of continuity and change rather than in particular things the human mind does. In this respect, they are different from some other sorts of psychologists, who are defined by the functions of the human mind they choose to research. (I.e., cognitive psychologists study thought and perception, personality psychologists study personality, and social psychologists study group behavior and influences). Developmental psychology, as a field, is concerned with all these areas of the human mind. Even a developmental psychologist who focuses on cognitive psychology topics--as I do--will have some familiarity with personality and social development.<br />
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First, I'm going to lay out some assumptions developmental psychologists make. Then I'll list some big questions they like to ask.<br />
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<b>Assumptions</b><br />
<b>1) Gene Environment Interactions</b><br />
While the nature-nurture debate is at least as intense among developmental psychologists as elsewhere, they have a unique perspective on it. They argue that you cannot explain human behavior with only genes or only experiences. Instead, they come together in a complex way, with different results than you would get from genes or environment alone. They claim that the interaction between genes and environment resembles that between vinegar and baking soda. Vinegar and baking soda are each inert, but come together to make an explosive reaction. Similarly, genes and environment come together to create an outcome--like personality traits or intelligence--that neither would have produced alone.<br />
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The least controversial interaction is probably height. A large amount of variation in people's heights is genetically determined; tall people tend to have tall children, short people tend to have short children, and siblings tend to have similar heights. However, nutrition determines whether people will grow as tall as their genes permit them to be. For this reason, my grandparents were taller than my great-grandparents, and my parents were taller than my grandparents (and the same will likely be true for you, as well). However, improvements in nutrition seem to have plateaued, and so has height; my generation (millenials) is the first in some time not to exceed their own parents' height. Notice that the genetic relationships here (parent to child) are constant across the generations from your great-grandparents to yourself, but differences in environment (nutrition) produce large differences in height.<br />
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More complicated and controversial are theories like the <a href="http://www.theatlantic.com/magazine/archive/2009/12/the-science-of-success/307761/" target="_blank">Orchid Hypothesis</a>, which posits that different people are differentially reactive to their environments (whether these are good or bad). As far as I know, this theory is still new and not completely accepted, but it's based on research on stress and resilience that <i>is</i> widely accepted. It's pretty well known that some children who have suffered abuse and neglect will have worse life outcomes than others, and that one factor affecting this is differences in specific genes.<br />
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<b>2) Developmental Trajectory</b><br />
You don't have to be a developmental psychologist to notice that different individuals develop at slightly different rates. For example, some kids are early talkers and readers and remain ahead of their peers in language skills; other children are slower than their peers in developing language and reading skills. Some kids are taller than their peers from an early age, and maintain this status over time, while others start out short and remain that way. More interesting than that, though, are children who start out behind their peers in a skill and come out ahead, or vice versa. For example, Einstein, though a late talker, developed perfectly adequate speaking, reading, and writing skills by adulthood, and some late-talking children today follow a similar pattern. Meanwhile, some children with precocious academic skills and high IQ scores in preschool, kindergarten, or first grade, may perform more like their peers by third grade (for this reason, experts on gifted children tend to recommend getting one's children IQ-tested at 6 or 7 years old). Children's rate of development of a skill can change, both relative to themselves at earlier ages, and relative to peers of the same age. Basically, when developmental psychologists think about growth, they imagine a line graph, where the steepness of the slope of the line represents the speed of development, and changes in the slope represent changes in the rate of development over time. <br />
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Developmental trajectory is especially interesting in two cases: when comparing typical with atypical development, and when comparing outcomes for different individual children.<br />
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For example, language development often follows a different trajectory in autism than in typical development. Speech is often delayed. Also, the rate of growth may seem to slow down for a while, stop entirely (what developmental psychologists call a "plateau"), or even reverse ("regression" or loss of language). On the other hand, language development may continue longer in autistic people than in neurotypical peers, with language skills sometimes improving into adulthood. And of course, since autism embraces people with a wide range of characteristics, you will find autistic people with pretty much every imaginable trajectory of language development. There have been lots of recent studies that attempt to find subgroups of autistic children with different trajectories, in the hopes of predicting who will have the best language outcomes, and why.<br />
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Developmental trajectory is also important when comparing different individuals from the same population. For example, some late talkers eventually catch up with their peers in spoken vocabulary, while others do not. Some developmental psychologists spend a lot of time trying to figure out why these children differ, and what can be done to help the persistently-delayed group catch up.<br />
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<b>3) Developmental Cascades</b><br />
While people can and do grow and change throughout their lives, earlier experiences profoundly shape our abilities and choices later on. The influence of earlier upon later development is called a "developmental cascade." A better term would probably be "developmental avalanche."<br />
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For example, let's say you're looking at vocabulary size from age 3 to age 5.<br />
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Age 3 vocabulary size has an effect on age 4 vocabulary size.<br />
Age 4 vocabulary size has an effect on age 5 vocabulary size.<br />
Age 3 vocabulary has an additional effect on age 5 vocabulary size.<br />
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So you have a sort of snowball where initial vocabulary has both direct influences and indirect ones, via vocabulary at intermediate ages. It's like a small snowball that hits more snow and becomes a bigger snowball, which hits more snow and becomes an even bigger snowball, and so on. Eventually, small differences between people early on can lead to big differences later on.<br />
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<b>4) 2-Way Interaction between child and environment</b><br />
Children aren't just shaped by their environment. They can act in different ways, and their behavior in turn shapes the input they get from their environment. For example, a child who is shy from infancy will be treated differently than a child who is outgoing from infancy. They may be reproached, or gently encouraged to interact, or pushed hard to interact, or shamed into interacting, depending on their parents' parenting style and values. This in turn will shape how the child behaves around other people, and whether they become painfully shy and retiring or quietly confident adults. A child who has been told from an early age that they're smart will probably think of themselves differently, and take different levels of risk in the classroom, than a child who has been told that they're just average, or even dumb. I'm sure you can think of many more everyday examples. <br />
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While the role of children in shaping their environment seems obvious when pointed out, it's very different from how your average parenting book describes children1. Too often, the paradigm seems to be "push the right button, receive the desired behavior;" there is little focus on the children's reasons for their behavior (good or bad), or on how the children might be pushing the parents' buttons and triggering their own insecurities about parenting or other issues. Not surprisingly, many of these books aren't written by developmental psychologists.<br />
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The four assumptions listed here lead cognitive psychologists to ask a certain set of questions.<br />
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<b>Questions Developmental Psychologists Ask:</b><br />
<b>1) Are some capabilities innate? If so, which ones?</b><br />
William James pointed out that at any given moment, there are so many shapes, colors, sounds, textures, smells, temperatures, and more that without any inborn means to sort them out, a baby's world would seem like a "blooming, buzzing confusion." I think most developmental psychologists accept that at the very least, babies are born with some basic learning mechanisms and an inclination to observe and learn about the world. But they differ on how much "software" babies come with. Some people think we're born with (tacit) knowledge of all the grammatical rules of human language, a basic understanding of how objects move (e.g., that objects fall), and/or a set of basic concepts about other people (e.g., that they have minds and intentions). Others think that we develop these concepts early in life, but aren't born with them. This debate has led to a lot of interesting research on what babies understand about people, things, quantities, and more, and is far from being resolved.<br />
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<b>2) Are there developmental stages, and if so, how do people transition between them?</b><br />
Piaget thought there were certain qualitatively different ways of thinking that everyone progressed through in a certain order at roughly the same age, and that was consistent across domains of knowledge. (I.e., if you are at the concrete operational stage in thinking about the movement of objects, then you must also be at the concrete operational stage in thinking about other people's behavior). This is a fairly extreme stage theory. His successors, the Neo-Piagetians, were a little more flexible, particularly regarding different domains of knowledge and individual differences. However, they still thought that development has discrete steps, like a staircase, rather than continuity throughout, like a wheelchair ramp. Whether a particular study seems to provide support for stage-like or continuous development seems to depend whether it uses continuous or discontinuous measures of the behavior in question, so this question is also far from being resolved.<br />
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<b>3) How do individuals differ in their development?</b><br />
I think this is fairly self-explanatory.<br />
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<b>4) How do changes in the brain contribute to development?</b><br />
This question is similarly easy to understand--but it's even harder to answer in kids than it is in adults.<br />
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<b>5) What develops, and how does change occur?</b><br />
Let's say that last year, Anna didn't understand <a href="http://www.intropsych.com/ch10_development/conservation_experiments.html" target="_blank">conservation of matter</a>, but this year she does, and can pass a Piagetian conservation of matter task. How exactly is she thinking differently now than she did last year? How did she get from the understanding she had last year to the one she has this year? This is a very difficult and abstract question, is probably the most central question in developmental psychology, and is also probably the hardest to resolve.<br />
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<b>6) How does the social world contribute to development?</b><br />
We are constantly observing, imitating, and listening to explicit teaching from other people. We grow up in cultures that provide us with tools for thinking like language, writing, the abacus, or the internet. Our cultures also determine how we spend our time at different ages, and whether we spend our time more with age peers or with people of all ages. We interact with various institutions either directly or indirectly, including schools, churches, and governments. We are assigned to categories of age, gender, ethnicity, religion, and more, all of which come with messages about how a person within our category "should" and "should not" behave. We also (in general) have innate desires to learn from and connect emotionally with other people, and get them to like us. All these things shape both what we experience and how we choose to behave. <br />
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So next time you talk to a developmental psychologist or read about a developmental study, know that development is all about change--and change is a complicated mass of factors that changes over time and differs between individuals. Their goal is to sort out that complex system.<br />
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1 I read parenting books from about 1995, when my brother was a fetus, to about 2008, when I got too busy with college to read them. So it's quite possible I've missed books from before or after these dates that take a better approach. (And for that matter, I'm glossing over a few exceptional parenting books that appeared during this time, like <a href="http://www.amazon.com/The-Heart-Parenting-Emotionally-Inteligent/dp/1559274352" target="_blank">The Heart of Parenting</a>, which is based on the concept of emotional intelligence, and involves helping kids recognize and verbalize their emotions).E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-3042721221228272952014-08-22T21:20:00.003-05:002014-08-22T21:23:29.022-05:00Eye movements in ADHD: Not a "foolproof" diagnostic method, but interesting and important<div class="separator" style="clear: both; text-align: center;">
<a href="http://cdn.medindia.net/health-images/eye-movements.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="http://cdn.medindia.net/health-images/eye-movements.jpg" /></a></div>
Above: Eye movements. Are they really a foolproof clue to ADHD?<br />
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Science Daily <a href="http://www.sciencedaily.com/releases/2014/08/140813131055.htm" target="_blank">claims that</a> measuring "Involuntary movement [is] a foolproof indication for ADHD diagnosis." Specifically, they believe it will reduce the rate of misdiagnosis in children:<br />
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<span style="background-color: white; color: #070809; font-family: Helvetica, Arial, sans-serif; font-size: 13px; line-height: 15.600000381469727px;">Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed -- and misdiagnosed -- behavioral disorder in American children. Now a new study can provide the objective tool medical professionals need to accurately diagnose ADHD. The study indicates that involuntary eye movements accurately reflect the presence of ADHD.</span></blockquote>
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Unfortunately, the <a href="http://www.sciencedirect.com/science/article/pii/S0042698914001187" target="_blank">actual study</a>, by Fried and colleagues1, indicates nothing of the sort.2<br />
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The study did, in fact, measure involuntary eye movements--specifically, blinking and "microsaccades," small jerky eye movements.<br />
<br />
22 adults with ADHD took the TOVA twice, the first time unmedicated and the second time while taking methylphenidate (Ritalin).2 The <a href="http://www.tovatest.com/" target="_blank">TOVA</a>, which stands for Test of Variables of Attention, is a common, computerized diagnostic test for ADHD. While participants took the test, their involuntary eye movements were measured. The unmedicated ADHD adults made more microsaccades and blinks than neurotypical adults immediately before the onset of the stimulus. When they took the test a second time on methylphenidate, they did not differ from the control group. The researchers argued that measuring involuntary eye movements is more precise, quantitative, and harder to "game" than many current diagnostic methods, such as questionnaires and self-report.<br />
<br />
Unfortunately, this study cannot possibly generalize enough to a wider population to imply anything about diagnosing ADHD in the real world. First of all, although the Science Daily press release focused on children, and parents' concern about their taking stimulants unnecessarily, Fried's study only examined adults. Furthermore, the study measured eye movements only during a single specific task, the TOVA. It's not clear whether the same finding would occur during other tasks, or even at rest. And of course, a sample of 22 participants may not generalize well to the millions of people with ADHD.<br />
<br />
And even if the findings generalize to other ages and tasks, further conditions would need to be met to ensure the method worked in practice. It would have to be tested in a real-world school or clinical setting, with a large population of people referred for possible ADHD (on the order of hundreds or even thousands). It would have to successfully distinguish ADHD not only from typical development but from other forms of atypical development--which is much harder. While most of the hysteria about ADHD misdiagnosis assumes that the misdiagnosed children are "normal" children treated as if they have a developmental disorder, it's probably more common for children to be misdiagnosed as having ADHD because of real symptoms caused by mental illness (such as depression), physical illness (such as sleep problems) or another developmental disability. Furthermore, the method would have to be shown to be cheap, fast, and practical in real-world contexts. For example, the TOVA is a common diagnostic test among neuropsychologists and other specialists, but to the best of my knowledge, it is less so among pediatricians who may also be called on to diagnose ADHD. If the TOVA is essential to obtaining this pattern of eye movements, the method may not generalize well to all diagnostic settings.<br />
<br />
This is not even the first study to identify increased anticipatory saccades as a marker of ADHD. In <a href="http://www.fss.uu.nl/psn/web/people/personal/stigchel/rommelsereview.pdf" target="_blank">a review</a>, Rommelse and colleagues report five others (Castellanos et al., 2000; Mostofsky et al. 2001a & 2001b; Rommelse et al., 2008, & Ross et al., 1994; see reference list). Bittencourt and colleagues' <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783508/" target="_blank">review</a> described a study by <a href="http://www.ncbi.nlm.nih.gov/pubmed/15336515/" target="_blank">Feifel and colleagues</a>, who tested ADHD adults who went unmedicated at least 48 hours. These participants generated more anticipatory saccades when a task required them to shift their attention from central fixation to a target appearing randomly onscreen.<br />
<br />
Furthermore, Richard N. Blazey, David L. Patton, and Peter A. Parks have a U.S. <a href="http://www.google.com/patents/US6652458" target="_blank">patent</a> for a method of detecting ADHD through saccades, or what they call "angular movements of the eyeball." Their patent differs from Fried's method in one crucial respect. Eye movements are measured while the person sits staring at a blank screen, wearing noise-canceling headphones, rather than while doing a demanding test like the TOVA.<br />
<br />
So Fried's study doesn't offer a foolproof way to diagnose ADHD, and measuring unconscious eye movements isn't a new way to diagnose ADHD in the first place. But the paper still offers an important insight, one left unexplored by the Science Daily article. ADHD adults make more anticipatory saccades than neurotypical adults, and it turns out that anticipatory saccades play an important role in perception and tell us something about the strengths and weaknesses of vision in ADHD.<br />
<br />
In order to understand why the finding matters, let's briefly go over the research on what anticipatory saccades do and why they matter.<br />
<br />
First of all, a saccade is a rapid, jerky eye movement that brings something new into focus on the fovea, the most sensitive part of the eye. It is not the only sort of eye movement (there are also smooth pursuit eye movements that smoothly track a moving object already in focus). However, it is extremely common and essential to vision. As Michael F. Land <a href="http://www.cis.rit.edu/pelz/scanpaths/papers/eye-movements-every-day-life-land-2006.pdf" target="_blank">explains</a>:<br />
<br />
<blockquote class="tr_bq">
<span style="font-family: Times, Times New Roman, serif; line-height: 115%;">“Throughout
the animal kingdom, in animals with as diverse evolutionary backgrounds as men,
fish, crabs, flies, and cuttlefish, one finds a consistent pattern of eye
movements which can be referred to as a ‘saccade and fixate’ strategy. Saccades
are the fast movements that redirect the eye to a new part of the surroundings
and fixations are the intervals between saccades in which gaze is held almost
stationary. As Dodge showed in 1900, it is during fixations that information is
taken in: during saccades we are effectively blind.” </span></blockquote>
Saccades can take in varying amounts of the visual field (measured in degrees). Microsaccades, like the ones in the Fried ADHD study, are generally <a href="http://www.sciencedirect.com/science/article/pii/S0042698910005924" target="_blank">defined as</a> extending to less than 15 minutes of arc in the visual field. <br />
<br />
Even a cursory Google search reveals that anticipatory eye movements play an important role in a variety of tasks at all ages. Anticipatory eye movements have been used to study <a href="http://www.goalkeeper.pl/upload/image/dan_pawlowski/journals/Visual_searchanticipation_and_expertise_in_soccer_goal_keepers.pdf" target="_blank">expertise in soccer goalkeepers</a>, <a href="http://homepage.psy.utexas.edu/HomePage/Class/Psy394U/Hayhoe/perceptionaction/2008/week11readings/Johnson04Infancy.pdf" target="_blank">object perception</a> and <a href="http://wexler.free.fr/library/files/haith%20(1988)%20expectation%20and%20anticipation%20of%20dynamic%20visual%20events%20by%203.5-month-old%20babies.pdf" target="_blank">expectations</a> for "dynamic visual events" by babies, <a href="http://onlinelibrary.wiley.com/doi/10.1207/s15516709cog0000_29/pdf" target="_blank">discourse comprehension in typical adults</a>, <a href="http://www.psycholinguistics.com/gerry_altmann/research/papers/files/Kamide_et_al_03.pdf" target="_blank">sentence processing</a> in adult readers, and the influences of language and knowledge about the world on <a href="http://www.researchgate.net/publication/222046757_The_real-time_mediation_of_visual_attention_by_language_and_world_knowledge_Linking_anticipatory_(and_other)_eye_movements_to_linguistic_processing/file/72e7e52713d91484cd.pdf" target="_blank">adults' real-time visual attention</a>. These lines of research reflect an understanding that anticipatory <a href="http://www.sciencedirect.com/science/article/pii/S0042698910005924" target="_blank">eye movements are overt indicators of otherwise hidden attention shifts</a>. It's worth noting that not all anticipatory eye movements are microsaccades like the ones in Fried's ADHD study. <a href="http://www.sciencedirect.com/science/article/pii/S0042698910005924" target="_blank">Some are smooth pursuit eye movements</a> (the smooth, rapid eye movements used to track moving objects over a longer period of time). However, saccades are often used for anticipatory eye movements, and the two overlap in neural areas, task demands, and the cognitive processes believed to be involved.<br />
<br />
As Ellen Kowler put it:<br />
<span style="font-family: Times, Times New Roman, serif;"><br /></span>
<br />
<blockquote class="tr_bq">
<span style="font-family: Times, Times New Roman, serif;">"<span style="background-color: white; color: #2e2e2e; line-height: 115%;">Work
over the last 25 years has also converged on the notion that the saccadic
system is inherently predictive, using pre-saccadic shifts of attention and
signals representing planned saccades to encode the location we are about to
fixate, and to prepare visual neurons, in advance, for the post-saccadic image.
These predictions may be instrumental in processes ranging from the control of
saccadic accuracy (by means of adaptive saccadic adjustments) to the weaving
together of discrete glances in a way that gives us the impression of a clear
and stable perceptual world despite the continual displacements of the retinal
image produced by saccades."</span></span></blockquote>
Anticipatory or "look ahead" saccades occur during a variety of real world tasks,<a href="http://www.cis.rit.edu/pelz/scanpaths/papers/eye-movements-every-day-life-land-2006.pdf" target="_blank"> including</a> text and sheet music reading, typing, looking at pictures of scenes, drawing, walking over difficult terrain, driving, sports, and cooking. In reading, saccades select a span of 7-9 letters or 1-3 notes for processing. Typists keep their eyes about 1 second ahead of the currently typed letter. Sketching involves rapid cycles of gaze shifts between the person being drawn and the drawing. People instructed to walk in specific, effortful ways will look ahead by 1 to 2 steps. When steering around a turn, driving instructors look at points their car will not reach for another 2-3 seconds, whereas their students, who have not yet learned to anticipate this way, look straight ahead instead. Tennis players' saccades anticipated the bounce of a tennis ball by about 0.2 seconds, while cricket players can anticipate the ball by about 0.1 seconds. When making tea or a sandwich, at the end of each action, the eyes move on to the next object about half a second before beginning the next action. When there are two objects involved (e.g., a kettle and lid), multiple saccades and fixations must be made between the two objects. In general, saccades followed by fixations <a href="http://www.cis.rit.edu/pelz/scanpaths/papers/eye-movements-every-day-life-land-2006.pdf" target="_blank">proceed a step ahead of action</a>. This avoids reliance on visual memory.<br />
<br />
All this anticipation is believed to help people do things better. For example, they help people <a href="http://www.ski.org/Renninger_Lab/BSullivan/MennieEtAl_LookAheadFixations2006.pdf" target="_blank">aim their reaching and grasping</a> movements accurately. Crucially, these saccades may improve performance on visual tasks and arm movements <a href="http://www.sciencedirect.com/science/article/pii/S0042698910005924" target="_blank">even when</a> attention is directed elsewhere.<br />
<br />
In general, we see, hear, act on, and think about things better when we are attending them. Therefore, the visual system needs to predict what objects or locations in the visual field will be important and start attending to them before they do anything important. Anticipatory eye movements are the mechanism for doing this. As such, extra anticipatory eye movements should be an advantage. They should increase the likelihood of attending the right thing and perceiving it accurately. Or, at least, that is the picture presented by research on vision in the general population.<br />
<br />
ADHD research describes anticipatory eye movements quite differently. It <a href="http://www.fss.uu.nl/psn/web/people/personal/stigchel/rommelsereview.pdf" target="_blank">describes</a> them <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783508/" target="_blank">as</a> "premature," "impulsive," and a sign of inhibitory difficulties--even when the tasks being studied do not involve inhibition of any kind.<br />
<br />
So, is there any real difference between "premature saccades" and "anticipatory" ones, or are they just a negative and a positive label for the same behavior? I asked <a href="https://twitter.com/SueReviews" target="_blank">Sue Fletcher-Watson</a> about this, and it appears that there is a difference, which is <i>only</i> apparent in studies designed specifically to test learning visual patterns. In studies like this, anticipatory saccades reflect an accurate prediction of where a stimulus will appear, based on learning; premature saccades are the eyes' tendency to flick around randomly looking for stimuli when a person gets bored. Unless a person making premature saccades is lucky, their saccades will have no tendency to land where a new stimulus will appear, so the "success rate" should be measurably lower for premature saccades than truly anticipatory ones. <br />
<br />
However, many of the ADHD studies under discussion do <i>not</i> appear to use this sort of learning task. Instead, they measure individuals' control over their eye movements during an experiment that is static and does not encourage or require learning. I suppose individuals <i>could</i> learn in such studies, and their learning could be measured and analyzed, but that's not what these researchers were doing. They might need to reanalyze their data to measure and compare learning in typically developing and ADHD groups. (And perhaps someone should).<br />
<br />
Furthermore, I don't think that the ADHD researchers were even asking that question, trying to determine whether ADHD behavior was anticipatory or just premature. Instead, they seem to be simply assuming "ADHD is a disorder of inhibition, so group differences must be due to an inhibition deficit." This is an example of <a href="http://gernsbacherlab.org/wp-content/uploads/papers/1/Gernsbacher_Biased_Research.pdf" target="_blank">biased research</a>, as explained by Morton Ann Gernsbacher--if you take away the labels of the group members, the interpretation no longer makes sense. It also fails to take into account the more positive picture of anticipatory eye movements painted by the general vision literature. <br />
<br />
Researchers on atypical development often say we should take typical development as a starting point, so let's do just that and see what it actually implies for vision in ADHD.<br />
<br />
Let's say for the sake of argument we reanalyze the data or do new studies to make sure the eye movements actually are anticipatory--and they <i>are.</i><br />
<br />
Increased anticipatory eye movements in ADHD could have positive effects, which could be viewed either as a simple advantage or as compensation. The trait may also carry a disadvantage.<br />
<br />
When viewed as an advantage, it implies that people with ADHD may be better at noticing and directing their attention to changing and salient things in their environment.3 This ties in well with the theory (described to me by <a href="http://faculty2.ucmerced.edu/jgilger/people/index.html" target="_blank">Jeff Gilger's research team</a>) that ADHD vision is well-adapted to dealing with rapidly-changing, highly-salient stimuli, but ill-suited to maintaining attention on static and less motivating stimuli. <br />
<br />
When viewed as compensation, extra anticipatory saccades could be seen as a way of increasing the likelihood of focusing on the right things when attention is hard to control by other means. Anticipatory eye movements could also compensate for lack of visual working memory. In the general population, people who have to copy drawings or models make lots of saccades to the thing being copied, <a href="http://171.67.113.220/content/11/5/9.full" target="_blank">instead of</a> looking back at the object less and relying mostly on visual memory. Since <a href="http://www.jaacap.com/article/S0890-8567(09)61489-1/abstract" target="_blank">children</a> and <a href="http://www.sciencedirect.com/science/article/pii/S088761770500048X" target="_blank">adults</a> with ADHD may have less visual working memory than neurotypical people, they may need to make even more saccades.<br />
<br />
However, there may be a disadvantage to the ADHD pattern. Remember that we are effectively blind while making saccades or blinking. The more saccades and blinks a person makes, therefore, the less time they spend taking in visual information from their environment. This can be a disadvantage when performing a task that requires taking in lots of visual information over a long period of time (e.g., certain sustained attention tasks).<br />
<br />
These interpretations of Fried's study are merely my speculations, based on putting aside assumptions about ADHD and instead looking at what we know about how vision works, in general. So please don't quote them as if they were established research. Rather, these represent a possible blind spot in ADHD research--and a set of hypotheses we can test. Even if they turn out to be wrong, we will learn something about the strengths and weaknesses that come with ADHD.<br />
<br />
Many thanks to Sue Fletcher-Watson for helping me figure out how to tell the difference between anticipatory and premature saccades and offering encouragement.<br />
<br />
1 Interestingly, Moshe Fried himself <a href="http://www.sciencedaily.com/releases/2014/08/140813131055.htm" target="_blank">has ADHD</a>.<br />
2 At least, so far as I can tell from the abstract and media descriptions from the study. This post will be updated when I get access to the full text.<br />
2 Notice the obvious confound: improved performance on the second testing could have been due to practice taking the test rather than the stimulant medication.<br />
3 Note that having an advantageous pattern of anticipatory saccades, which are unconscious and not deliberately controlled, does not preclude difficulty with more controlled eye movements. In fact, a line of research indicates that ADHD people have difficulty controlling and inhibiting eye movements, just as they do with other behavior. ADHD could simply involve deficits in controlled, but not necessarily uncontrolled, perception and behavior4.<br />
4 Whether or not uncontrolled ("reflexive") saccades are also impaired in ADHD is still under debate. Some studies seem to find slower, more variable responses, while others observe no difference from neurotypical peers.<br />
<br />
<u>Citations:</u><br />
Note: The basic point about the strengths and weaknesses of anticipatory eye movements in normal development can be found in James Enns' <a href="http://smile.amazon.com/Thinking-Eye-Seeing-Brain-Explorations/dp/0393977218/ref=sr_1_1?ie=UTF8&qid=1408760230&sr=8-1&keywords=the+thinking+eye+the+seeing+brain" target="_blank">The Thinking Eye, The Seeing Brain</a> (one of the few readable, layperson-friendly textbooks I have ever seen).<br />
<br />
Other citations reflect a limited amount of time to survey the role of anticipatory eye movements in ADHD and typical development, so they are mostly reviews and are necessarily incomplete.<br />
<br />
<ul>
<li>American Friends of Tel Aviv University (2014). Involuntary eye movement a foolproof indication for ADHD diagnosis. <i>Science Daily</i>, 13 August 2014. www.sciencedaily.com/releases/2014/08/140813131055.htm </li>
<li>Moshe Fried, Eteri Tsitsiashvili, Yoram S. Bonneh, Anna Sterkin, Tamara Wygnanski-Jaffe, Tamir Epstein, & Uri Polat (2014). ADHD subjects fail to suppress eye blinks and microsaccades when anticipating visual stimuli but recover with medication. <i>Vision Research</i> 101, pp. 62-72. http://www.sciencedirect.com/science/article/pii/S0042698914001187</li>
<li>Juliana Bittencourt, Bruna Velasques, Silmar Teixeira, Luis F. Basile, Jose Inacio Sailes, Antonio Egidio Nardi, Henning Budde, Mauricio Cagy, Roberto Piedade, & Pedro Ribeiro (2013). Saccadic eye movement applications for psychiatric disorders. <i>Neuropsychiatric Disease and Treatment,</i> 9, pp. 1393-1409. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783508/</li>
<li>F.X. Castellanos, F. F. Marvasti, J. L. Ducharme, J. M. Walter, M. E. Israel, A. Krain, et al. (2000). Executive function oculomotor tasks in girls with ADHD. <i>Journal of the American Academy of Child & Adolescent Psychiatry,</i> 39, pp. 644-650.</li>
<li>D. Fiefel, R.H. Farber, B. A. Clementz, W. Perry, & L. Anilo-Vento (2004). Inhibitory deficits in ocular motor behavior in adults with attention-deficit/hyperactivity disorder. <i> Biological Psychiatry,</i> 56:5, pp. 333-339. <span style="color: #303030; font-family: Arial, sans-serif; font-size: 10pt; line-height: 115%;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/15336515/">http://www.ncbi.nlm.nih.gov/pubmed/15336515/</a></span></li>
<li>Eileen Kowler (2011). Eye movements: The past 25 years. <i>Vision Research</i> 51:13, pp. 1457-1483 http://www.sciencedirect.com/science/article/pii/S0042698910005924 </li>
<li>Michael F. Land (2006). Eye movements and the control of actions in everyday life. <i>Progress in Retinal & Eye Research,</i> 25, pp. 296-324. <span style="font-family: "Calibri","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN-US; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: "Times New Roman"; mso-bidi-language: AR-SA; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Calibri; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin;"><a href="http://www.cis.rit.edu/pelz/scanpaths/papers/eye-movements-every-day-life-land-2006.pdf">http://www.cis.rit.edu/pelz/scanpaths/papers/eye-movements-every-day-life-land-2006.pdf</a></span></li>
<li>Neil Mennie, Mary Hayhoe, & Brian Sullivan (2006). Look-ahead fixations: Anticipatory eye movements in natural tasks. <i>Experimental Brain Research</i> http://www.ski.org/Renninger_Lab/BSullivan/MennieEtAl_LookAheadFixations2006.pdf</li>
<li>S. H. Mostofsky, A. G. Lasker, L. E. Cutting, M. B. Denckla, & D. S. Zee (2001a). Oculomotor abnormalities in attention deficit hyperactivity disorder: A preliminary study. <i>Neurology,</i> 57, pp. 423-430.</li>
<li>S. H. Mostofsky, A. G. Lasker, H. S. Singer, M. B. Denckla, & D. S. Zee (2001b). Oculomotor abnormalities in boys with Tourette syndrome with and without ADHD. <i>Journal of the American Academy of Child & Adolescent Psychiatry,</i> 40, pp. 1464-1472.</li>
<li>Nadia N. J. Rommelse, Stefan Van der Stigchel, & Joseph A. Sergeant (2008). A review on eye movement studies in childhood and adolescent psychiatry. <i>Brain & Cognition</i>, 68, pp. 391-414 http://www.fss.uu.nl/psn/web/people/personal/stigchel/rommelsereview.pdf </li>
<li>N. N. J. Rommelse, S. Van der Stigchel, J. Witlox, C. J. A. Geldof, J. B. Deijen, J. Theeuwes, et al (2008). Deficits in visual spatial working memory, inhibition, and oculomotor control in boys with ADHD and their non-affected brothers. <i>Journal of Neural Transmission</i>, 115, pp. 249-260.</li>
<li>R.G. Ross, D. Hommer, D. Breiger, C. Varley, & A. Radant (1994). Eye movement task related to frontal lobe functioning in children with attention deficit disorder. <i>Journal of the American Academy of Child & Adolescent Psychiatry,</i> 33, 869-874.</li>
<li>Alexander C. Schutz, Doris I. Braun, & Karl R. Gegenfurtner (2011). Eye movements and perception: A selective review. Journal of Vision 11:5, http://171.67.113.220/content/11/5/9.full. </li>
</ul>
E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com12tag:blogger.com,1999:blog-6733902656011255269.post-82348147821428876382014-07-01T12:10:00.001-05:002014-07-01T12:10:25.635-05:00Things You Can Do to Help Disabled People that Don't Cost a Cent (Guest Post)This list of ways to respect and offer an accessible environment to people with disabilities is reposted with permission from <a href="http://neurodiversitysci.tumblr.com/post/90010347131/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Neurodiversitysci,</a> and includes all comments with attributions. (Where no attribution is given, the point comes from the original post by Neurodiversitysci; where an attribution is made, it comes from another person). I've broken the list into a few categories to make for easier reading and corrected some typos.<br />
<br />
<a href="http://neurodiversitysci.tumblr.com/post/90103855171/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Neurodiversitysci says</a>, "This list should probably have a huge disclaimer of YMMV [your mileage may vary], since disabled people often have different experiences and live in different social environments with different social barriers. It's pretty much guaranteed some things won't apply to everyone. More importantly, some of the points on the list are based on conditions and experiences I have personally, while others are just based on listening to people."<br />
<br />
Also, disabilities (as defined here) include: developmental and learning disabilities (e.g., autism, dyslexia, intellectual disability); chronic illnesses (e.g., MS); mental illness (e.g., depression, Bipolar Disorder, schizophrenia); and physical disabilities (e.g., blindness, deafness, inability to walk).<br />
<br />
<i>Respect</i><br />
<br />
<ul>
<li>Do not talk about an obviously disabled person in front of them as if they can't hear you.</li>
<li>Do not talk to a disabled person's companion instead of them.</li>
<li>Ask permission before touching people, or their wheelchairs or other equipment, even if you want to help.</li>
<li>Ask permission before touching people's service animals. "Service animals are just that: animals trained to serve the needs of people with disabilities. Please do not distract them from doing their jobs. If you want to pet them or interact with them, ask their owner!" -<a href="http://lightles.tumblr.com/post/90075947609/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Lightles</a></li>
<li>Ask disabled people about their lives and really listen to their answers. (Within reason. For example, asking people personal questions about their sex lives is rude unless you're very close to them and they've communicated they're OK with that).</li>
<li>Listen to what they say, whether they are speaking, writing, typing, using text to speech, using a letterboard, using PECS, gesturing, using sign language, or using any other form of communication. People who can't speak can still communicate.</li>
<li>Understand that "people with disabilities are, first and foremost, people, not saints or martyrs. We have virtues, faults, interests, dreams, and ambitions that have nothing to do with the things our bodies and minds are or are not capable of doing. Please remember this and treat us accordingly." -<a href="http://lightles.tumblr.com/post/90075947609/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Lightles</a></li>
<li>"Don't assume that disabled people...must have miserable/inferior lives. We are different, not lesser." -<a href="http://queerautisticmra.tumblr.com/post/90105942634/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">QueerAutisticMRA</a></li>
<li>Understand that disabled people don't just need friends, they can be friends. [Inspired by <a href="http://www.judyendow.com/advocacy/autistics-can-be-friends/" target="_blank">Judy Endow</a>].</li>
<li>Stand up for people you see getting bullied.</li>
<li>When talking to someone who has trouble speaking or stutters, and takes a long time to speak, please <i>wait for them to answer.</i> Don't keep repeating the question or pressure them. Yes, if you are like me and your mind is going really fast and you forget what people are saying if they take too long, it can be hard to be patient. Do it anyway.</li>
<li>When talking to someone who cannot say a word correctly (or at all), it doesn't help to keep asking them to say the word over and over again until they get it right. It will likely frustrate them, and they may still be unable to say the word; in fact, the stress and pressure might make it harder. [<a href="http://astroayla.tumblr.com/post/90187317296/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Astroayla</a>]. (This point assumes you're not their speech and language therapist. Even so, there are probably better ways to handle the situation).</li>
<li>A disabled person with intellectual disability who has the academic skills or IQ of, say, a 7 year old, does not actually have the mind of a 7 year old. They have different life experiences, needs, stages of life, bodies, and so on.</li>
<li>Understand that a disabled person's talents, however esoteric, are real, not unimportant "<a href="http://www.oafccd.com/lanark/poems/language.html" target="_blank">splinter skills</a>."</li>
<li>"Do not tell anyone with any kind of disability or illness that it's not real. Nothing makes it more apparent that you don't actually care about or respect a person than to tell them that their illness/disability isn't real...Like I'm going to take the words of some guy I barely know over my therapists and doctors." -<a href="http://wojojojo.tumblr.com/post/90407314188/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Wojojojo</a> </li>
<li>Do not tell a person with ADHD or mental illness that they should not be taking medication. This is a personal decision. Furthermore, since medications often have wide-ranging effects on bodies and minds and unpleasant side effects, most people taking medications have thought through the issue, done a cost-benefit analysis, and decided that functioning better is worth it. Their decision should be respected.</li>
<li>Conversely, do not tell a person with ADHD or mental illness who is not taking medication that they should be [Suggested by <a href="http://lichgem.tumblr.com/post/90044040113/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Lichgem</a> and <a href="http://shinobody.tumblr.com/post/90094752597/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Shinobody</a>].</li>
<li> Not all disabilities are obvious or visible to the naked eye. This is true for physical, mental, and emotional disabilities. Sometimes this includes difficulty with things like standing for a long time, and requires accommodations like using the elderly/disabled seats on a train. Do not assume that someone you see doing this is faking. [<a href="http://lawless523.tumblr.com/post/90097660944/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Lawless523</a>]. Also, if such a person, without glasses/cane/wheelchair/etc., tells you they have a disability, accept this and treat them with the consideration you would show to a person with an obvious disability. [<a href="http://lightles.tumblr.com/post/90075947609/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Lightles</a>].</li>
<li>"Think long and hard before complaining about the "special privileges" people with disabilities get. Yes--the parking places reserved for the disabled are closest to the door of your favorite restaurant, but that's because the people who need the space find walking to be difficult, painful, or impossible. The people who use these spaces would almost certainly rather park further away than have to use a wheelchair." -<a href="http://lightles.tumblr.com/post/90075947609/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Lightles</a></li>
</ul>
<br />
<br />
<i>Interpretation</i><br />
<br />
<ul>
<li>Recognize that failure to make eye contact does not necessarily mean someone is lying to you. It could simply be uncomfortable for them.</li>
<li>Recognize that unwillingness to go to loud, crowded bars does not necessarily mean someone isn't interested in socializing with you. They may simply find the noise and crowds painful, or be unable to understand what you're saying in that sort of environment.</li>
<li>Recognize that a person can need time alone and it doesn't mean they're avoiding you. It's just something they need so they can function at their best.</li>
<li>If a person does not recognize you, do not assume they don't care about you. They may be face-blind.</li>
<li>If a person does not remember your name, do not assume they don't care about you. They may simply have a bad memory. [<a href="http://autisticvelociraptor.tumblr.com/post/90013929868/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Autistic Velociraptor</a>].</li>
<li>If a person does not remember your birthday (or other major names, numbers, or dates), don't assume they don't care about you (or whatever it is they've forgotten). They may simply have a bad memory.</li>
<li>If someone has difficulty spelling, or using the appropriate jargon/terminology, do not assume they're stupid. Some people have difficulty with these aspects of language. You may need to paraphrase some "jargon" for them.</li>
<li>Understand that a person can be working incredibly hard to do something and may still not perform as well as you'd like them to, as well as the average person would, or as well as the situation demands. They are still trying, and it hurts when you tell them they're not.</li>
<li>Recognize that even if a person is unable to respond in a way you can understand, they can still hear you. Don't suddenly start talking about everything you hate about them, or wave your hand in their face. Instead, talk to them the way you normally would. That doesn't mean using an overly exaggerated "I'm pretending everything is normal" voice, which they may be able to see through even though they can't communicate. It means talking to that person the way you'd talk to anyone else. Although they may not be able to tell you right away, it makes all the difference in the world. "I cried the first time this happened to me. Even my friends had never done it, up to that point." -<a href="http://youneedacat.tumblr.com/post/90043481450/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Youneedacat</a></li>
<li>Colorblindness affects more than just knowing what color something is. To a colorblind person, colors they can't see will look the same if they have the same degree of lightness/darkness, which can change the level of contrast between things. To a red-green colorblind person, for example, a red rose on a green background can blend in instead of contrast starkly, and the Chicago CTA El map can be hard to understand. Understand that something that stands out and seems obvious to you may literally not be visible to a colorblind person.</li>
<li>Understand that for some people, particularly autistic ones, it may be inappropriate to read more into what a person says than what they literally say. "If I ask you to skip a song on your playlist because there's a high noise in it that bugs me, <b>all I am saying is what I just said.</b> I'm not implying that you should let me pick the music. I'm not dissing your taste. I'm saying there's a high noise in that song that bugs me. That's it, that's the whole meaning." -<a href="http://jumpingjacktrash.tumblr.com/post/90280142129/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Jumping Jack Trash</a></li>
<li>"Also, when we ask for clarification on something, please provide clarification. It might be obvious to you what you mean, but it might not be to everyone. In the case of humor, we're not trying to spoil the joke. We might even get that you just said something that is supposed to be humorous, but we don't necessarily know WHY it's humorous. That's why we're asking, so we can get the joke next time." -<a href="http://ihasapolitics.tumblr.com/post/90421987127/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">I Has a Politics</a></li>
</ul>
<br />
<br />
<i>Accessibility</i><br />
<br />
<ul>
<li>Every public place does not need to have loud, blaring music and TVs with flashing screens</li>
<li>"For the love of God, don't touch people without asking! It may not seem like a big deal to you...[and] I understand sometimes it just happens, rushing and brushing against someone, but some of this is either intentional or could easily be avoided. Not everyone needs or wants a hug from someone they don't know. In fact, it might be a huge stresser." -<a href="http://nuclearvampire.tumblr.com/post/90283089552/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Nuclear Vampire</a></li>
<li>If you blog, put bright, flashing images that can trigger seizures under a cut so that people with seizures can avoid looking at them.</li>
<li>If a job can possibly done without a person driving, don't require candidates to drive or have a driver's license. Don't interview candidates and then reject them because they can't or don't drive. Lots of people with disabilities cannot drive safely, including those with low vision, slow reflexes/response time, and some with autism or ADHD.</li>
<li>If you are talking to a deaf person, make it easier for them to lip-read by facing towards them while looking at them, and not covering your mouth with your hands.</li>
<li>If you are talking to someone with hearing impairment or auditory processing disorder, it is more helpful to slow down, face them, or rephrase what you're saying than to just speak more loudly.</li>
<li>Some disabled people have difficulty understanding nonliteral language such as metaphors and idioms (e.g., "a stitch in time saves nine"). If you're talking to someone like this, try explaining what you mean by these figures of speech, or just avoid them. Also, if nonliteral jokes confuse or upset them, you should avoid them and especially avoid using these jokes on purpose to make fun of them [<a href="http://antimonegrey.tumblr.com/post/90283143716/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Antimone Grey</a>].</li>
<li>If you're talking to someone who has difficulty understanding nonliteral language, do not use <i>only</i> nonliteral language to convey your point. "Say what you mean...don't use hints, implications, analogies, hyperbole, or metaphor <i>in place of</i> actual information. Whether analogies, hyperbole, etc. can help in illustrating your point depends on the individual; many of us are fine with figurative language in a lot of cases, especially if we have context to place the phrase in. But if you want us to know a thing, tell us the thing itself instead of or in addition to talking around it." -<a href="http://jumpingjacktrash.tumblr.com/post/90280142129/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Jumping Jack Trash</a></li>
</ul>
<br />
<br />
<br />
<i>Others</i><br />
<br />
<ul>
<li>Don't tell them "but you look so normal!" Or "you don't look like [x]." It will not be taken as a compliment. [<a href="http://rosslynpaladin.tumblr.com/post/90274354587/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Rosslyn Paladin</a>]. But, if they accomplish something you know they were working really hard to do, it's great to compliment them on it.</li>
<li>"Don't tell someone they're 'not really ___' because they don't have something in common with the average ___. For example, I'm not bothered by loud jittering noises; in fact, anybody who knows my taste in music knows that I love them, but that doesn't make me 'not autistic' because some people who are also autistic ARE bothered by jittering noises...not everyone with a disability is the same." -<a href="http://blindskywatcher.tumblr.com/post/90289860098/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Blind Skywatcher</a></li>
<li>"Please don't ask if they are getting better, or will get better." -<a href="http://littleredchucks.tumblr.com/post/90066828321/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Little Red Chucks</a>. Most disabilities and chronic illnesses are permanent, while mental illnesses tend to be long lasting, and even if a person recovers, can recur over the course of a person's life.</li>
<li>"Please do not assume that a child's disability is the fault of their parents or carers." -<a href="http://littleredchucks.tumblr.com/post/90066828321/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Little Red Chucks</a>. Except for genetics (e.g., a disabled parent having a child with the same disability) or extremely rare and specific cases, like Fetal Alcohol Syndrome, a child's disability is not their parents' or caretakers' fault. </li>
<li>If someone has a major medical problem, disability, or chronic illness, then just eating some special healthy diet or exercising more isn't going to cure it. It might help, it might hurt, it might do nothing, but the person has probably heard the advice before, and unless you're their doctor, it's none of your business in any case.</li>
<li>A person with OCD <i>knows</i> that checking or counting or whatever compulsive action they perform won't <i>really</i> prevent disaster from happening, it's just a compulsion. That doesn't stop them from feeling the need to do it anyway. A person with anxiety may know that at least some of their fears are irrational or unlikely to occur. That doesn't stop them from feeling anxious. A person with trichotillomania may know it hurts them to pull out their hair or pick at their skin, but they have difficulty stopping themselves anyway. A depressed person may know that they would feel better if they got out of their house and talked to people, but that doesn't make them feel any more up to doing those things. A person who hallucinates may know the hallucinations aren't real, but that doesn't make them go away or feel less upsetting. Do you see the pattern? You can't cure people with mental illnesses by telling them they're being irrational or hurting themselves. If it were that easy, they'd have cured themselves already.</li>
<li>Telling people they're inspirational simply for living their lives or getting out of the house is not a compliment. It's telling them that you think their lives are so unbearably awful that just living is an inspiration--which is insulting. It's different to tell them you admire them if they do something truly impressive, or that you know is hard for them personally and they worked hard to accomplish it.</li>
<li>Accept stimming.</li>
<li>"Do not play the "how many fingers am I holding up?" game with a blind or visually impaired person. It's just rude." -<a href="http://lightles.tumblr.com/post/90075947609/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Lightles</a></li>
<li>Disabled people having a meltdown look like they're throwing a tantrum or being aggressive, but they are not. People can have anger meltdowns [<a href="http://blackwingedrose.tumblr.com/post/90095543770/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Blackwinged Rose</a>], but people assume all meltdowns are about anger, and that's not necessarily true--they're often caused by terror. Having a meltdown means a person has gone into fight or flight. The best thing you can do is remain calm yourself and help them calm down. It may help to keep your distance, keep your voice low and calm, let them retreat to a safe place if they know to do that, or remind them to do so if they forget. Reasoning with them won't work well because they're unlikely to be able to hear and understand you. The worst thing you can do is start yelling yourself, threatening them, be violent to them, cut off their escape route, or get right up in their personal space.</li>
<li>Most of all: even the identical disability affects different people differently. The preferences of the specific person you're interacting with take priority over any generalized rules, including this list! "There's no catch all method to treat every disabled person appropriately to their own desires. Just try to exercise the best judgment you can and ask before assuming. They often appreciate your intentions even if your assistance isn't needed. They're a lot more capable than people give them credit for." -<a href="http://spudfuzz.tumblr.com/post/90269324472/things-you-can-do-to-help-disabled-people-that-dont" target="_blank">Spud Fuzz</a></li>
</ul>
<br />
Comments are welcome, and further ideas will be added to this list. Advice relating to physical or intellectual disabilities would be particularly welcome.<br />
<br />E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com0tag:blogger.com,1999:blog-6733902656011255269.post-84624176680838608832014-05-22T22:50:00.002-05:002014-05-22T22:50:33.146-05:00An Open Letter to Jeffrey HoweDear Jeffrey Howe,<br />
I read <a href="http://parenting.blogs.nytimes.com/2014/05/14/the-language-of-autism-disease-or-difference/?_php=true&_type=blogs&_r=0" target="_blank">your piece today in Motherlode</a>. I wanted to comment and speak to you directly, but didn't have an account on the site, so I will write to you here and hope my readers here and on Twitter will share it with you.<br />
<br />
I am the older sister of a young man who was diagnosed on the spectrum as a child and has not lost the diagnosis. I am also a cognitive neuroscience researcher in training, and hope to study people on the autism spectrum in the future.<br />
<br />
I was pleased to see you listened to the autistic adults who wrote to you--people who share some experiences with your son, and who, if all goes well, he might even resemble some day. Not all parents are willing to do this. It's not easy to hear that you might inadvertently be doing something that might hurt your child, and embarrassing to realize that you didn't imagine autistic people might read what you wrote. But you listened and acknowledged these mistakes, and that takes empathy and integrity.<br />
<br />
But I was disappointed with where you ended up. You said:<br />
<blockquote class="tr_bq">
"In the same way I hope that the other patrons at our local diner will accept the child doing a headstand in our booth, I hope that autism advocates accept that we require every meager word at our disposal to describe our unique experiences...Let us accept words for the blunt, imperfect tools that they are."*</blockquote>
First of all, please understand: you <i>can</i> write about your child's difficulties, and the effort and expense of raising him, without saying things that autistic readers find dehumanizing and hurtful. You've already done it, in fact. You said:<br />
<br />
<blockquote class="tr_bq">
"Last year Finn climbed out his bedroom window, falling two and a half stories, breaking his pelvis and fracturing two vertebrae. He had pushed his stuffed animals out the window, and lacking any understanding of gravity or height, he simply wanted to join them in our yard... </blockquote>
<blockquote class="tr_bq">
He used to point to an object he desired, his one concrete method of communication. Now he uses American Sign Language for music and movie and dog and shoe and food and drink and up and help and stop and wait and candy. He is beginning to shake his head for no and nod for yes, and when I look into his eyes I see now that he loves us as fiercely as we love him. He only rarely bites us anymore, or wraps an angry hand around his sister's hair."</blockquote>
A very evocative description of Finn at two points in his life, and no offensive language in sight. <br />
<br />
The thing about labels like, yes, "low functioning," is that they are not only hurtful but vague. What does a low functioning person look like? A non-speaking child who is constantly hugging, smiling at, and initiating interactions with their parents could be called low-functioning. So might a child who can speak but has frequent meltdowns, or whose independent living skills are so poor they cannot be safely left alone for long and cannot cross the street unaided. A child <a href="http://autismcrisis.blogspot.com/2010/08/are-you-high-or-low-functioning.html" target="_blank">with low IQ</a> might be called low-functioning, but so might an average-IQ child who simply cannot fit into a mainstream classroom or who has all the DSM autism traits to an extreme degree. Wouldn't it be better to describe what your child is actually like, what he can do and can't do right now--as you've started to do here? Wouldn't that better achieve your goal of describing what life with him is like?<br />
<br />
I should also note that not all the negative words you've singled out ("nonverbal," "impaired," and "low functioning") are all harmful, so your palette is less limited than you may have feared. For example, I've yet to hear anyone object to "nonverbal," which is a simple statement of fact--that a person cannot speak.<br />
<div>
<br /></div>
Suppose, though, that hurtful labels actually <i>were</i> a sufficiently precise way to describe life with your child. I still don't think achieving this description is worth the pain it would cause. Let's compare the costs and benefits. <br />
<br />
If you use the language you like, you will be happy at expressing how you feel, and some of your parent readers will feel validated and cheered. On the other hand, you will have, unwittingly, reinforced views of autistic people that, when acted on, cause a lot of pain. More directly, any autistic people reading will wince, feel hurt and angry at best and outright traumatized at worst. Many have some very painful histories with terms you use such as "low-functioning." They have experienced <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCkQFjAA&url=http%3A%2F%2Fjuststimming.wordpress.com%2F2011%2F10%2F05%2Fquiet-hands%2F&ei=G8N-U_K7ApehyATZnIDwAw&usg=AFQjCNE5-jmaEfGNL8jRp_OaHDIBNmNpWA&sig2=0a5FFLJC_crrV4B_l8_8-w&bvm=bv.67720277,d.aWw" target="_blank">abuse from therapist</a>s and <a href="http://www.thinkingautismguide.com/2014/01/here-try-on-some-of-my-shoes.html" target="_blank">even parents</a>, have been treated as if they weren't "really there," and sometimes <a href="http://ballastexistenz.wordpress.com/2011/09/26/what-it-means-to-be-real/" target="_blank">been in institutions</a>. When people deemed "low-functioning" go out in public, others address their nonautistic companions instead of them, or <a href="http://emmashopebook.com/2014/01/15/unable-to-speak-does-not-mean-unable-to-think/" target="_blank">talk about them in front of them as if they weren't really there</a>. People deemed low-functioning are <a href="http://idoinautismland.blogspot.com/2014/02/a-challenge-to-autism-professionals.html" target="_blank">denied a complete education</a>. And if they are deemed too "severe" or "low functioning" by too many people, they may get sent to centers of last resort, like the <a href="http://www.motherjones.com/politics/2007/08/school-shock" target="_blank">JRC, where they are electro-shocked into submission</a>.<br />
<br />
Saying someone is "unable to communicate" or "in their own world" probably doesn't lead to as much outright abuse as "low functioning." But here's the thing--people unable to speak, with limited gestures, still do try to communicate, through the only means available to them--<a href="http://ollibean.com/2013/08/20/world/" target="_blank">behavior,</a> such as <a href="http://loveexplosions.net/2013/01/" target="_blank">flopping down in the middle of the floor</a>, or<a href="http://unstrangemind.wordpress.com/2014/01/11/why-do-we-flap-our-hands/" target="_blank"> flapping their hands</a>, or <a href="http://emmashopebook.com/2013/02/05/self-injurious-behaviors-lets-discuss/" target="_blank">biting themselves</a>, or even just screaming. Not the ideal communication method, we can all agree--but how often do parents, clinicians, or teachers attempt to interpret the meaning of this behavior, and how often do they simply call it a behavior problem and attempt to squash it? These severely disabled kids, thus, are the ones who are most hurt by words like "unable to communicate," not "quirky Intel programmers." And people who seem "unable to communicate" don't just communicate through challenging behavior, either. They communicate through touch--they lead parents to something they want to show them; they gently touch their parents to comfort them. Lacking the ability to create sentences of their own, they <a href="http://momnos.blogspot.com/2006/03/dr-strangetalk-or-how-i-learned-to.html" target="_blank">communicate using other people's word</a>s--what researchers call "echolalia." Maybe there are a few people utterly unable to communicate, maybe your child is even one of them, but I would bet that most kids whose parents describe them as unable to communicate are, in fact, trying to communicate, but <a href="http://ballastexistenz.wordpress.com/2007/05/14/knew-the-moment-had-arrived-for-killing-the-past-and-coming-back-to-life/" target="_blank">their atypical signals are being misunderstood or ignored</a>. I suppose eventually, such kids might give up as they get older and realize they won't be understood, but that's not everyone. And while autistic kids are often focused on very different things than we are--the toys they're lining up, or the sensory stimuli or special interests that absorb their attention to the exclusion of all else--that doesn't mean they're "in their own world." In fact, it's dangerous to assume autistic kids are "in their own world" because it's just a step from there to "they're not aware of anything that's going on" and from there, <a href="http://mosaicofminds.blogspot.com/2012/12/why-assume-autistic-people-are-listening.html" target="_blank">only a step to "it doesn't matter what we do or say to them, because they won't care anyway," and that's when teachers and therapists and others start to abuse</a>. And if we think autistic kids are "stuck" in their own world,<a href="http://ollibean.com/2013/08/20/world/" target="_blank"> how much effort will we make to integrate them</a> into our schools or public places? Autistic kids live in the same world we do, however differently they may perceive it.<br />
<br />
So if you use words like "low functioning" or "unable to communicate" or "stuck in his own world," you could hurt any autistic people who may be reading, while contributing to the assumptions that make people abuse them and excuse that abuse. On the other hand, you could please some parent readers in need of validation. On any reasonable cost-benefit analysis, using expressions like these just isn't worth it, even if they <i>were</i> useful. <br />
<br />
I wish that language were as neutral and unimportant as you make it out to be when you say you hope "that autism advocates will accept that we require every meager word at our disposal to describe our unique experiences...it comes down to tolerance." You may have noticed that as a parent, most people in the general public see you as an authority on autism. They may even see you as more of an authority, and listen to you more attentively, than they would an autistic person. This power to shape opinions means, unfortunately, that every word you say carries immense weight. You have the power to create a more hospitable world for people with your son's diagnosis--or reinforce the same prejudices that currently make life harder for them. Look at it this way: your son already carries a burden other children do not, because of his disability. Does he need to carry an additional burden of stigma and the presumption of incompetence from everyone around him? It may be hard to lighten the burden of the disability, so it becomes all the more important to ease the burden of stigma. I have heard calls to stop disagreeing about words in the interests of "unity," but "unity" should not come at the expense of those who are most disabled, and do not have the words yet to speak out against what hurts them.<br />
<br />
Lastly, please understand that however "abstract" the distinction between disability and disease may seem for you, this is because you yourself do not have autism and can afford to ignore the issue. Autistic people do not have that luxury, which is why those who can write and blog discuss the issue so much. It directly affects their lives and their self-worth. And from a practical perspective, there is a huge difference between therapy <a href="http://timetolisten.blogspot.com/2013/09/the-cost-of-indistinguishability-is.html" target="_blank">that attempts to make a child look exactly like his peers</a> and therapy that doesn't worry about appearances, aiming only <a href="http://musingsofanaspie.com/2013/06/18/a-cognitive-defense-of-stimming-or-why-quiet-hands-makes-math-harder/" target="_blank">to teach skills</a>. There's an even bigger gulf between <a href="http://www.psychologytoday.com/blog/aspergers-diary/201304/what-acceptance-means-me" target="_blank">therapy that teaches children to achieve better results with the brain they have</a> and therapy that attempts the impossible task of turning their brain into a very different type of brain. Dismissing this issue as unimportant would be myopic and unwise.<br />
<br />
I hope Finn continues to grow and learn to communicate better, and that his and your lives get easier. I also hope that he will never feel wounded by what you have said or written about him.<br />
<br />
You may also enjoy reading books written by nonspeaking autistic young people. You might want to start with <a href="http://www.amazon.com/The-Reason-Jump-Thirteen-Year-Old-Autism/dp/0812994868" target="_blank">"The Reason I Jump" by Naoki Higashida</a>, who uses a question-answer format to address questions people often have about what it's like to be him and why he behaves the way he does. <a href="http://www.amazon.com/Am-Intelligent-Heartbreak-Healing---Daughters-ebook/dp/B008D1ESU6/ref=sr_1_1?s=books&ie=UTF8&qid=1400816169&sr=1-1&keywords=Peyton+Goddard" target="_blank">"I Am Intelligent," by Peyton Goddard</a>, is a harder and more upsetting read, but worth it, I think. I personally wasn't crazy about Tito Mukhopadyay's style in <a href="http://www.amazon.com/How-Talk-Lips-Dont-Move-ebook/dp/B00CKXAAKK/ref=sr_1_1?s=books&ie=UTF8&qid=1400816085&sr=1-1&keywords=how+can+i+speak+of+my+lips+don%27t+move" target="_blank">"How Can I Talk if My Lips Don't Move?"</a> but it brings his very different perceptual world to life like nothing else, and you'd probably enjoy seeing how his mother, Soma Mukhopadyay, taught him. My favorite, though, is <a href="http://www.amazon.com/Ido-Autismland-Climbing-Autisms-Silent-ebook/dp/B00AOUN01W/ref=sr_1_1?s=books&ie=UTF8&qid=1400816009&sr=1-1&keywords=IDo+Kedar" target="_blank">"Ido in Autismland: Climbing Out of Autism's Silent Prison" by Ido Kedar</a>. It's telling, I think, that he characterizes his autism as a prison and <i>still</i> seems more hurt by the way others treated him and denied him an education. All are very different from each other and probably from your son, but they offer an amazing glimpse into the world of people who were called "low functioning" and "unable to communicate," and offer a basis for hope and faith.<br />
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*By the way, this is a false analogy. The worse damage Finn's headstand can do to other restaurant patrons, on the single occasion where they see him, is a bit of distraction or annoyance. Whereas the worst damage certain words by parents can do involves eliciting traumatizing memories of abuse and reinforcing the exact prejudicial attitudes that caused that abuse in the first place.E.M.http://www.blogger.com/profile/07258276540400935661noreply@blogger.com3