Showing posts with label high functioning autism. Show all posts

Neurodiversity Author and Ideologue Steve Silberman ALMOST Acknowledges Low Functioning vs High Functioning Autism Reality


Neurodiversity autism author and ideologue Steve Silberman ALMOST acknowledged the common sense reality of differences in autism function levels but at the last minute he turned and walked away once again. In an article at Scientific American  titled Contributors Lee Billings and Steve Silberman talk autism, space travel, and extraterrestrial life (Part 1)  Silberman talks briefly about the realities of low functioning autism and how the challenges they present COULD lead one to conclude that there really are differences in functioning levels. Then he abruptly struts away and denies those same differences. He, once again, takes the decidedly Non-Scientific American  ideological perspective that parents and clinicians who recognize differences in functioning levels are simply wrong and that the high functioning autistic persons he knows and adores  who claim that HFA and LFA are meaningless labels are right:

Lee: Is there any emerging consensus about the wide variations in the severity of autism?
Steve: I would say that one emerging consensus is that the idea that there is a single, unified condition called “autism” is little more than a useful fiction. This fiction allows us to address certain similarities across a very broad and diverse spectrum of conditions, and enables government agencies and insurance companies to offer services based on a single box labeled “autism” that can be ticked on a form. But that monolithic notion doesn’t reflect the actual reality, which is much more complex. What we call autism is probably a cluster of many different conditions, rooted in a wide variety of genetic predispositions and epigenetic triggers, which exhibit themselves in many different ways, including variations in severity.  The truth is that there are many “autisms,” rather than one “autism.”
Lee: Could you talk more about the problematic distinctions between “low-functioning” versus “high-functioning” people with autism? What alternative is there to this classification structure?
Steve: Obviously, the language of “high-functioning” versus “low-functioning” is very tempting to use, and most people—that is, parents and clinicians—use it. If you have a kid who can’t talk or use the toilet, rarely seems to connect with the people around her, appears to be profoundly intellectually disabled, and bangs her head against the wall, it seems appropriate to classify her as “low-functioning.” On the other hand, if you have a guy with an Asperger diagnosis who has a job writing code or fixing luxury cars and has a wife and kids of his own—it seems easy to call him “high-functioning.But the autistic adults I know hardly ever use those two terms, because they know better. Even people who are classified as high-functioning—like John Elder Robison and Temple Grandin—really struggle with some aspects of life that most neurotypical people don’t have to struggle with.  At the same time, some research into “low functioning” individuals in recent years indicates that they may have much more going on inside them than is usually visible from the outside. That’s one reason why the development of alternate forms of communication for people who have difficulty with spoken language—and we’re talking about iPads here, an “assistive technology” that many neurotypicals find indispensable these days—is so important. I’ve interviewed some autistic people who would be written off as “low-functioning” by most people, but once they get an iPad with text-to-speech apps in their hands, they become as eloquent as poets.
Personally, I avoid using the terms “high-functioning” and “low-functioning” because I think they’re both misleading. The term “high-functioning” makes certain kinds of challenges invisible, while the term “low-functioning” makes certain kinds of intelligence and capability harder to see. Many “low-functioning” kids will eventually learn self-care skills and be able to communicate with some form of assistive technology. Once they can make their thoughts visible to others, you find out that they have very rich inner lives, and were always listening to what was being said around them. We need to find out what has worked in the lives of people like Robison, Grandin, and Stephen Shore—a guy who was considered low-functioning when he was young, and whose parents were told to put him in an institution. He’s now a professor at Adelphi University, and a delightful person. Once we find out what has worked for them, we can apply those lessons to the next generation of autistic people. That’s why Jenny McCarthy’s claim that “there were no autistic adults, it’s all now” is not just wacky and incorrect, it’s dangerous, because it deprives the huge population of autistic kids of visible mentors and role models whom they can learn from."

Silberman's claim is that because some persons once considered low functioning went on to communicate and excel in life it is therefore wrong to distinguish between low and high functioning autism disorders. This claim is absurd and lacking in common sense. As he has stated some persons with LFA have difficulty with the most basic functions in daily life like toilet training. Some engage in serious self injurious behavior. He could also have mentioned the autistic adults who live their lives not with assistive technology but in assisted living in varying levels of residential care including full time 24-7 institutional care. The realities of life for these people by any common sense measure are fairly described as low functioning compared to the very high functioning Friends of Silberman club ...  the Robisons, Grandins and Shores. 

Steve Silberman either lacks common sense and can not distinguish between these different functioning levels or he has simply chosen to turn and walk away from that truth in the interest of promoting his career and books as a leading author of the irrational ideology known as Neurodiversity. His public denials of the challenges, the more severe challenges facing low functioning autistic persons puts  him in the group of people who are obscuring public discussions about the natue of autism disorders and the needs of those who suffer from low functioning autism. 

I have visited Low Functioning severely autistic adults living in psychiatric hospitals. I have talked by phone with Michelle Dawson and I have met John Robison at the recent IMFAR conference in Toronto.  I have met very capable persons with High Functioning Autism and Aspergers here in New Brunswick.  These people are much higher functioning in their abilities to function in the real world than those living in residential and institutional care and Steve Silberman should know that. 

Shame on you Silberman.

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Autism, Killarney Lake and The Conor Gift





Last night there were no pictures taken but Mom and Dad were walking the trail around Killarney Lake on either side of Conor when he put his arms through each of ours and walked along  looking back and forth at Mom and Dad with a huge smile, even a bit of a giggle at times. Loads of affection for his Mom and Dad.  It is the Conor gift.

Conor will not be featured in a highlight reel of autistic young people performing amazing feats.  He will not be going to work at Dr. Laurent Mottron's lab as one of his allegedly "typical" autistic persons.  He will not stand before national media organizations in Washington, serve on US national committees or pose for the New York Magazine and tell the world that autism is a personal identity not a disability.  

The pictures above have been posted on this blog site for some time.  The picture of Conor by himself is from one of his favorite spots ... Killarney Lake.  The other two show Conor's amazing smile which, by itself, is always a gift for Mom and Dad.    Despite Conor's type of autism, the actual disability/disorder type, he brings great joy to his Mom and Dad as he did last evening at Killarney Lake. His autism, unlike Ari Ne'eman's, is a disorder and his smile is not a gift brought courtesy of his autism disorder.  It is the Conor gift. 

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FOX News Autism Experts Worry About DSM5 Impact on High Functioning Autistic Children, No Concern for Low Functioning Autistic Children


FOX News has published a report, Some Experts Worried Over Revised Autism Guidelines, in which two autism experts, Dr. Keith Ablow, a psychiatrist and Fox News contributor, and Dr. Thomas Frazier, who treats children with autism at the Cleveland Clinic Children’s Hospital, express their concerns about the possible impact of the DSM-5`s new Autism Spectrum Disorder category on high functioning autistic children. They are concerned that some high functioning autistic children might lose their diagnoses, and access to autism specific education services, although the FOX report does not provide much detail on the basis for their concerns:

These new guidelines would place an emphasis on preservative and repetitive behaviors – but many children who were originally diagnosed with autism may be reclassified. Ablow said this can leave some people who are still suffering with some of the symptoms or less severe symptoms out in the cold. “If we don’t loosen it a little bit, I suspect that some of these high-functioning kids may actually either get shifted into a different diagnosis,” said Dr. Thomas Frazier.” 

There is no mention however of the possible negative impact on low functioning autistic children, those with intellectual disabilities who might be excluded by the DSM5 Autism Spectrum Disorder mandatory criterion A which excludes an autism diagnosis where a person is also intellectually disabled:


A.    Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:.....`

Like so many autism experts and professionals the FOX experts are concerned about high functioning autistic persons but not about low functioning autistic persons who remain the invisible autistics abandoned by health care professionals and the mainstream media alike.

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Autism Research Studies Exclude Low Functioning Autistic Participants

Discrimination against persons with low functioning autism disorders takes many forms. It is particularly rampant in the autism research world where studies purporting to inform us about autism almost invariably exclude low functioning autistic participants. Conclusions are again being drawn about persons with autism spectrum disorders based on a study which excluded low functioning autistic participants.  The study examined the effectiveness of the antidepressant Prozac in treating repetitive behavior and obsessive-compulsive behavior in adults with "autism". 

Presumably physicians will be prescribing Prozac either as a consequence of this study and similar confirming studies. If all their clients are persons with high functioning autism and Aspergers they will at least have done so on some evidence basis.  If physicians prescribe Prozac to low functioning autistic adults based on this and similar studies however they will be doing so without any evidence basis. 

The antidepressant Prozac may alleviate repetitive behavior and obsessive-compulsive symptoms in adults with autism, reducing these defining symptoms of the disorder, according to new research.

The research, which included 37 high-functioning autistic adults, mainly diagnosed with Asperger's syndrome, followed participants for 12 weeks. Taking Prozac (fluoxetine) doubled the chances that a patient would show overall improvement, measured by their clinicians. Half of the participants taking Prozac had significant reductions in obsessive-compulsive symptoms, compared with 8% taking placebo. Side effects were mild to moderate and participants taking Prozac did not show increases in suicidal thoughts or ideas.

"Repetitive behavior is a core symptom of the illness," says lead author Dr. Eric Hollander, medical director of the Autism and Obsessive-Compulsive Spectrum Program at Montefiore Medical Center in New York, explaining that "from a very early age, these children have rituals and routines. For example, they like to line up their toys and they get very bent out of shape if there is any deviation."


The abstract for the study, A Double-Blind Placebo-Controlled Trial of Fluoxetine for Repetitive Behaviors and Global Severity in Adult Autism Spectrum Disorders, published in The American Journal of Psychiatry,  refers to the participants as adults with ASD's, or Autism Spectrum Disorders, but does not indicate that the study does not involve any low functioning autistic participants. The title of the study report also refers to adult autism spectrum disorders without identifying the exclusion of low functioning autistic participants.

Aspergers? CHECK High Functioning Autism? CHECK Low Functioning Autism? NO, not in the "autism" research world.

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Will DSM5 Result In Some Very High Functioning Autism Personalities Losing Their Autism Disorder Diagnoses?


I have a son with a DSM-IV Autistic Disorder diagnosis who is also assessed with profound developmental "delays".  I have expressed my concerns on several occasions about the terms of category A of the new Autism Spectrum Disorder in the DSM5:

A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following: [emphasis added -HLD]

My concern has been that people like my son who are currently considered autistic with intellectual disabilities will lose the autism diagnosis with serious repercussions both in receipt of services, and in research and understanding affecting their  disabilities.

With the newest round of "beautiful mind", autism is an advantage not a disorder, activism by autism "researchers" Mottron and Dawson I have wondered again whether the DSM5's new Autism Spectrum Disorder could result in loss of autism diagnoses for several prominent "autism" personalities.  By autism I am referring to the tendency today to refer to PDD-NOS and Asperger's Disorder as also constituting autism along with Autistic Disorder.  Contrary to the activist ideologies and beliefs of Mottron and Dawson persons with diagnoses from any  of these categories will clearly and expressly require impairments in daily functioning in order to qualify for an Autism Spectrum Disorder diagnosis under the DSM5:

"Autism Spectrum Disorder


Must meet criteria A, B, C, and D:


D. Symptoms together limit and impair everyday functioning."


Even without the clear language of the DSM5 requiring impairment of everyday functioning, further divided by levels of severity of impairment, it has always been difficult for me to understand how or why some very high functioning autism personalities ever received a mental health disorder diagnosis  under the DSM-IV when they are obviously very high functioning.  

Autism personalities, including Michelle Dawson, Ari Ne'eman and John Elder Robison have all realized considerable success in life, in university, in self owned business activities, in challenging work environments like Canada Post Corporation, in making legal representations to administrative tribunals and the Supreme Court of Canada, in acting as researchers and as activists promoting their views of autism disorders before government committees. Some have married and raised children while others have maintained professional relationships lasting several years. It has never been at all clear to me why any of them would want a label which reflects a mental disorder under the DSM-IV given their great successes in meeting life's challenges.

With great regularity these autism personalities also appear in various major media productions advocating  their perspectives on what it means to be an "autistic" and, in Dawson's case, advocating against government funding of ABA treatment for autistic children, other people's autistic children.   When the public turns on their television, reads their daily newspapers or browse the internet for news of autism they do not see, with any regularity, the many persons with autism disorders engaging in serious self injurious behavior, wandering from their homes and schools, and into dangerous traffic and waters.  The public does not see the many persons with autism living in group homes, hospitals and psych wards. No, the public sees Michelle Dawson, Ari Ne'eman, J E Robison and other very high functioning "autistics" and they see them over and over and over again. 

The DSM5's new Autism Spectrum Disorder label is actually misleading in so far as the condition could now more accurately be called Asperger's Spectrum Disorder. But it does expressly require, as a mandatory condition for receiving an ASD diagnosis, that Symptoms together limit and impair everyday functioning.

Will Dawson, Ne'eman and Robison be able to demonstrate, despite their well known abilities and successes in various areas of life, that somehow they possess social and communication challenges, along with restricted, repetitive patterns of behavior, interests, or activities and that together these deficits limit and impair their everyday functioning?  


Or will the day arrive when very high functioning autism and Neurodiversity  activists practice some reality acceptance and acknowledge that they do not suffer from an autism disorder, or any other mental disorder,  and that they are in fact capable, competent and accomplished individuals who should not be trying to dictate to parents and professionals alike what it means to have autism ... autism disorder?

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High Functioning Autism fMRI Brain Scan Study Misrepresented to the Public



"research in ASD has tended to use overwhelmingly White, middle to upper middle class samples, and has often excluded children with multiple disabilities and/or severe to profound intellectual disabilities". [underlining added - HLD]


Yet another fMRI brain scan study, The neural basis of deictic shifting in linguistic perspective-taking in high-functioning autism,  has been published in which Low Functioning, Intellectually Disabled autistic subjects are, by design, excluded  in favor of subjects with High Functioning Autism. This study published in the journal "Brain" by researchers Marcel Just, Akiki Mizuno and their collaborators at CMU's Center for Cognitive Brain Imaging (CCBI) and described in a PR Newswire Release found that errors in choosing a self-referring pronoun (eg. "you" instead of "I") "reflect a disordered neural representation of the self, a function processed by at least two brain areas — one frontal and one posterior". 

As evidenced by the above quote from autism expert Catherine Lord low subjects with low functioning autism, which would include the 80% or persons with Autistic Disorder (DSM-IV) and intellectual disability, are often excluded from autism research.  That exclusion of low functioning, intellectually disabled subjects from  recent  fMRI "autism" brain scan  studies has been even more obvious.  

The Carnegie Mellon researchers should be commended for describing their conclusions, as their study title expressly states,  in terms of High Functioning Autism given that their study subjects were all high functioning autistic persons.   Unfortunately the press release, which identifies Carnegie Mellon as the source of its information,  is not as meticulous and generalizes the study to the entire autism spectrum  in its title and content, including quote from lead research Marcel Joust:

New CMU Brain Imaging Research Reveals Why Autistic Individuals Confuse Pronouns


...


The results revealed a significantly diminished synchronization in autism between a frontal area (the right anterior insula) and a posterior area (precuneus) during pronoun use in the autism group. The participants with autism also were slower and less accurate in their behavioral processing of the pronouns. In particular, the synchronization was lower in autistic participants' brains between the right anterior insula and precuneus when answering a question that contained the pronoun "you," querying something about the participant's view.


"Shifting from one pronoun to another, depending on who the speaker is, constitutes a challenge not just for children with autism but also for adults with high-functioning autism, particularly when referring to one's self," Just said. "The functional collaboration of two brain areas may play a critical role for perspective shifting by supporting an attention shift between oneself and others.


"Pronoun reversals also characterize an atypical understanding of the social world in autism. The ability to flexibly shift viewpoints is vital to social communication, so the autistic impairment affects not just language but social communication," Just added.


...


Ongoing research at the CCBI is assessing the white matter in detail, measuring its integrity and topology, trying to pinpoint the difference in the autistic brain's networks.


"This new understanding of what causes pronoun confusion in autism helps make sense of the larger problems of autism as well as the idiosyncrasies," Just said. "Moreover, it points to new types of therapies that may help rehab the white matter in autism."

Presenting the results of a study of High Functioning Autism subjects as representing all persons with autism, including the low functioning, intellectually disabled excluded from the study is  misrepresentation. It helps promote ignorance, both in the general public about the many intellectually disabled persons with low functioning autistic disorder identified by CDC autism expert Dr. Marshalynn Yeargin-Allsopp as autistic disorder's "vast majority". 

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Laurent Mottron's Dangerous Anti Autism Cure Beliefs Resurface

Dr. Laurent Mottron has spent his entire career studying persons with high functioning autism and Aspergers.   Even as the parents of autistic children and good hearted people everywhere feel sadness and grief over the loss of another autistic child presumed lost Dr. Mottron promotes and oversells a study he led which according, to the good Doctor, supports his belief that autism should not be cured.

I have been unable, in the several years that I have been aware of his anti autism cure ideology,  to find any indication that Dr. Mottron has spent any time working with, or studying, those severely affected by autism disorders, whether they be the 75-80% of persons with Autistic Disorder and Intellectual Disability, those who engage in debilitating and dangerous self injurious behavior or those who wander from home and caregivers to danger, and sometimes, death.  The loss last year of James DeLorey in a snow storm, the Australian child who wandered from home into automobile traffic, the still ongoing tragedy  but now presumed death, of Adam Benhamma near Montreal, will have no impact on the entrenched "autism is beautiful beliefs" of Dr. Laurent Mottron. 

I admit straight up that I personally do not subscribe to Laurent Mottron's anti autism cure ideology and do not trust any study by him  like the one now being touted, which he led, concerning "autistic" brains.  I would ask the professionals who actually work trying to help autistic children lead  fuller lives, including those who actually work with autistic children with severe autism disorders, to analyze carefully and critically Dr. Mottron's new study.  I will be very surprised if the "autistic" brain Dr. Mottron reports on is anything other than a snapshot of some of the very high functioning autistic subjects he has worked with for decades to the exclusion of  severely affected, intellectually challenged persons with autism disorders.

Dr. Laurent Mottron is not just a researcher who has devoted decades to studying high functioning autistic persons.  He has also removed himself from the realm of scientific detachment and objectivity and  involved himself in Canada's legal system in an effort to prevent medicare coverage of ABA treatment for autistic children in British Columbia in the Auton case Auton (Guardian  ad litem  of)  v. British Columbia (Attorney General), [2004] 3 S.C.R. 657, 2004 SCC 78  case.  In Auton  Mottron helped launch the career of high functioning autism researcher and anti ABA advocate Michelle Dawson  with his affidavit in support of her intervention, as an "autistic", before the Supreme Court of Canada.   In his supporting affidavit the good Doctor solemnly declared and affirmed the following statement of expert opinion:

5.
Ms. Dawson has a tremendous understanding of both the difficulties faced by autistic individuals in our society, as well as the tremendous inherent strengths of many of these individuals. 


Personally I have never seen Michelle Dawson make any statement that reflects any understanding, let alone a "tremendous" understanding of the difficulties faced by autistic individuals in Canadian society.  I have never seen or heard statements by her acknowledging the existence of the many persons with Autistic Disorder and Intellectual Disability. I don't know how her life experience as a very intelligent, adult diagnosed "autistic" gives her tremendous, or any,  insight into the challenges faced by low functioning, intellectually disabled autistic children.  Nor have I seen her, or the good Doctor, make any statements describing or addressing in any intelligent fashion the many serious behavior challenges faced by those severely affected by autism disorders.  What is clear though is that Michelle Dawson and Dr. Laurent Mottron both believe that autism is a good thing that should not be cured.  They have long held these anti cure, including anti ABA treatment,  autism beliefs. 

Dr. Mottron also appeared as an unidentified expert witness "the mysterious Dr. M" in Ms Dawson's case before a Canadian Human Rights Tribunal, Dawson v. Canada Post Corporation, 2008 CHRT 41 in which he described the idea of curing autism as nonsense:

[86] Ms. Dawson testified that autism is a neurological disability and that people generally do not have a good understanding of this reality. Ms. Dawson stated repeatedly that autism was not a mental illness. For her, a mental illness has an onset, various treatments, and there is a return to the previous state to a greater or lesser degree. Both Ms. Dawson and Dr. M., as will be seen, pointed out that the notion of curing autism was nonsensical. Still many people want to cure autism.

....

b) The testimony of Dr. M

[99] At the beginning of his testimony, Dr. M., who is a psychiatrist, was qualified by the Tribunal as an expert in autism. Dr. M. filed a report as well as three letters pertaining to Ms.Dawson’s condition.

[100] Dr. M. testified on the nature of autism, autistic individuals as well as on Ms. Dawson’scondition. The credibility of Dr. M. as well as the accuracy of his statements and opinions wasnot challenged by the Respondent. The Tribunal finds Dr. M.’s testimony highly credible even if the evidence shows that in recent years, Ms. Dawson has worked with him and has co-authored scientific articles with Dr. M.

And now, surprise, surprise, surprise,  Dr. Mottron has published a study which, according to the good Doctor, supports his long held belief that autism should not be cured.  I wonder how many low functioning, severely challenged, intellectually disabled autistic subjects were included in Dr. Mottron's study? I do not buy what the mysterious Dr. M is selling and I doubt that most parents with autistic children, and most professionals tasked with addressing some of the serious and dangerous challenges faced by autistic children and adults,  will buy it either.  

Dr. Mottron is not necessarily an objective, detached medical professional or scientific researcher.  He has long held a belief that autism should not be cured and his latest study conclusions are used to support  his own beliefs. Given his long held personal beliefs his study, and his public commentaries about what conclusions can be drawn from that study, should be given close, careful scrutiny.   In particular his conclusion that the study supports his belief that persons with autism should not be cured should be given very close examination.  As Dr. Mottron stated in the Vancouver Sun:

""While this study does not conclusively show a causal effect between brain activity and the enhanced abilities of those with autism, lead researcher Laurent Mottron of the University of Montreal said it is the most "robust" evidence yet suggesting a link. He said it adds another argument against attempts to "cure" autistics.

When we try to turn an autistic toddler into a non-autistic toddler, it's painful, it's expensive and it does not work," he said. "We should not try to assimilate or break the difference (between autistics and non-autistics), but just admit that it's a difference that has good and bad consequences."

High functioning autism researcher Dr. Laurent Mottron has been promoting his anti autism cure belief for many years.  Hopefully his latest efforts to thwart treatment and cure of autism disorders will enjoy no more success than his previous efforts.  The chance to improve the lives of autistic children and adults is too big a price to pay for the promotion of Dr. Mottron's personal belief system.

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