Showing posts with label Autism. Show all posts
Showing posts with label Autism. Show all posts

Thursday, September 12, 2019

Greta Thunberg and Young Idealism

Watching Democracy Now! last night I saw 16 year old Swedish climate change activist Greta Thunberg being interviewed for the hour about her activism, her Asperger's, dealing with cyberbullies, and her trip to the US on a purely wind powered sailboat provided by Prince Albert of Monaco.  She came to the US in much the same way her Viking Ancestors did to Newfoundland.  According to her, she is vegan and does not use any technology that contributes to climate change.  You can see her interview above.

Watching her made me think of Malala Yousafsai, a teenager in Pakistan who was attacked for going to school by the Taliban.  She later became an outspoken advocate for girls education in the world and was later awarded the Nobel Peace Prize.  Her struggles were different from Thunberg's but their stories are similar in how young people who were in the right place and the right time can make change.

Another person I was thinking of was Temple Grandin, another person with Asperger's who became an expert on cattle and how better to design slaughterhouses.  Thunberg may not approve of Grandin's work with cattle but they share a singular determination on what interests them.  

Amy Goodman, host of Democracy Now! asked her about her plans of activism while she is in the western hemisphere including going to the White House to protest and the COP25 summit in Santiago, Chile.  One thing that Democracy Now! host did not ask her about if she would like to meet with President Trump or James Inhofe, the leading climate change denier in the US Senate.  I can't help but wonder how she would handle such a meeting.  

Thunberg is someone with strong principles while Trump is a man with no principles except making money and being cruel to immigrants.  It would make a funny Saturday Night Live sketch though she might not see the humor in it.  If she were to go on Sean Hannity's show she would be walking into the belly of the beast like Thor taking on the Kraken.  

She does respond to eloquently a New York Times article by Christopher Caldwell saying that she has to wait to persuade more people and not take a my way or the highway approach.  It would be great to be a fly on the wall at a meeting between Trump and Thunberg.

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Saturday, July 27, 2019

The Agony of Not Knowing Why

I thought I would take a break from politics and healthcare to discuss this 29 minute documentary about these two parents with two special needs kids for whom doctors can find no definitive cause for their disability.  The documentary was moving to watch.  

While I was watching I was wishing that I had some special insight that the doctors might have missed.  The parents said that its hard hearing other people say "you were given this because you can handle it."  I was wondering how they respond to parents of other special needs kids who have similar struggles but they know more about their children's conditions because they have a diagnosis.  They know what to expect and they may know what caused their condition.  

I don't have any answers for them and it's best not to judge when you don't know.

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Monday, May 6, 2013

Controversy over the New Psychiatric Diagnostic and Statistical Manual

Since 1952, the American Psychiatric Association has published the Diagnostic and Statistical Manual of Mental Disorders (DSM for short) which has spelled out the criteria for diagnosing all of the known psychiatric disorders.  It has undergone four editions and two revisions with the fifth one due out this year.  In the past there were controversies such as whether or not homosexuality should be included in the manual and it was dropped from the DSM in the 1970s.  New changes are made to the manual as new information is brought to light and cultural views of what is and what is not a disorder change.

This year the fifth edition of the DSM proposes changes to 13 current diagnoses.  The most controversial of these is Asperger's Syndrome which is being eliminated as a separate diagnosis and is being placed under the  Autism spectrum of disorders.  Unlike the gay community in the 1970s, has deletion been met with resistance by those who have been previously diagnosed with Aspergers.  Other changes have been made to dyslexia, ADHD and other diagnoses.  At least 10 new diagnoses are included in the DSM such as post-traumatic embitterment disorder, skin picking disorder, and compulsive hoarding (maybe the American Psychiatric Association all watches TLC). 

Previously the DSM has been accepted as the Bible of psychiatric diagnosis but, right before the DSM-V comes out the National Institutes of Mental Health (NIMH) has announced that it will not use it as a standard for diagnosis in their research.  This means that they will not be funding studies that use the DSM-V as a diagnostic criteria.   The reason given by the NIMH is that Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure."  This suggests a desire for exactness which the behavioral sciences have lacked relative to the physical sciences sometime termed physics envy.

There have been advances in neuroscience and genetics which shed light on many of these disorders and made many pharmacological treatments possible but the main reliance for diagnosis is still on behavioral symptoms.  The NIMH is creating a Research Domain Criteria for Diagnoses (RDoC) based on biological criteria which it believes are more objective.  The behavioral symptoms are often subject to interpretation and often still not enough is known about the brain and genetics to differentiate between pathologies.  Consider the figure at left.  Is this a rabbit with its head held high or a duck?  This image is subject to interpretation just as all behaviors and incomplete scientific data are.  Science is fundamentally a human endeavor where politics often plays a role.  

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Thursday, January 6, 2011

Cause & Effect, Slip Slidin' Away

Much has been made recently of autism being linked to the measles mumps and rubella vaccine (MMR) in 1998 Lancet study being shown to be a fraud. Because of that study, a social movement led by former Playmate of the Year Jenny McCarthy who sadly had a son diagnosed with autism after being vaccinated for MMR in 2005. After hearing of this study and blaming her son's diagnosis on the immunization, she has used her celebrity to discourage parents from getting their kids immunized. This study has now been shown not only to have been methodologically shaky but to have had some of the facts fabricated. The blog The Incidental Economist has a good review of it here:

The Autism/MMR Fraud | The Incidental Economist

Ms. McCarthy and her followers may have been sincere in wanting to protect children from Autism and it is sad that they have been mislead into doing more harm than good. Even if the study had not been fraudulent, extreme caution would be needed to establish a causal link between Autism and the MMR vaccine. They followed 12 children after being vaccinated. It's hard to make any generalizations from that small of a sample. I could go on and on about problems with this study but there are lots of larger more sound studies that lead many otherwise brilliant people jump to conclusions about cause and effect (especially when it justifies what they already believe).

Merely establishing an association between two variables does not establish a cause and effect relationship between the two. In my post Income and Life Expectancy. What does it Tell Us About US? the video from the documentary The Joy of Stats compellingly shows an association between income adjusted per person and life expectancy over 200 years in 200 countries. It is tempting to infer that there is a cause and effect relationship between wealth and life expectancy. However even here there are many potential third variables such as with what is that wealth used to purchase? My analysis in that post should shed light on some of those complexities. Stephen Colbert has a humorous take on this fallacy by spoofing Glenn Beck's promotion of gold on his program.

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The best way to determine cause and effect relationships is in an experiment. Ideally an experiment is a study where every variable is controlled and accounted for by the researcher in a treatment group and a comparison group. Unknown variables are controlled for by randomly assigning patients or subjects to groups.

When it comes to autism and the MMR vaccine, it is neither practical nor ethical to do an experiment to see if there's a causal relationship. Experiments are often done on animals first when feasible but for mental disorders like autism or schizophrenia there is no good animal model. Correlational studies are often the best that can be done. It's hard enough to interpret even when the study is not fraudulent.

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The Joy Of Stats: Meaningless and meaningful correlations