Friday, August 31, 2007

Regressive Autism was Childhood Schizophrenia

The following is from Leo Kanner's 1943 paper.

The outstanding, “pathognomonic,” fundamental disorder is the children’s inability to relate themselves in the ordinary way to people and situations from the begining of life. Their parents referred to them as having always been “sel-sufficient”; “like in a shell”; “happiest when left alone”; “acting as if people weren’t there”; “perfectly oblivious to everything about him”; “giving the impression of silent wisdom”; “failing to develop the usual amount of social awareness”;“acting almost as hypnotized.” This is not, as in schizophrenic children or adults, a departure from an initially present relationship; it is not a “withdrawal” from formerly existing participation.

(Emphasis mine)

There you have it, from the horse's mouth. It's not only true that regressive autism could have been confused with childhood schizophrenia. It was childhood schizophrenia even after Kanner first characterized autism, and I don't know for how long after that.

Today, of course, childhood schizophrenia seems to have all but disappeared.

While on the topic of Kanner, let me also debunk the myth that he claimed no one had ever observed autism before. Here's another excerpt.

These characteristics form a unique “syndrome,” not heretofore reported, which seems to be rare enough, yet is probably more frequent than is indicated by the paucity of observed cases. It is quite possible that some such children have been viewed as feebleminded or schizophrenic. In fact, several children of our group were intorduced to us as idiots or imbeciles, one still resides in a state school for the feebleminded, and two had been previously considered as schizophrenic.

(Emphasis mine)

I'll also add a link to Dr. Traffert's AWARES paper here, as it's relevant to this discussion: Dr Down and 'Developmental' Disorders.

Wednesday, August 29, 2007

My Anecdotal Evidence is Better Than Everyone Else's!

Whenever someone claims that they know some biomed treatment is useful, even in the absence of clinical trials, I like to remind them of Secretin. See Lessons from Secretin (Volkmar, 1999). Secretin was once believed to be a "cure" of autism. Bernie Rimland was a fan of Secretin and claimed it had an improvement rate of 70% to 75%. The mom who first noticed her son started to speak after getting Secretin had been referred to as a "hero" for discovering the "cure". There were even multiple case reports and at least one non-controlled study noting substantial improvement with Secretin.

Then the double-blind placebo-contolled studies came. Nearly all of them showed no difference in outcome between Secretin and placebo. Some of them seemed to show that Secretin was, in fact, a little bit worse than placebo. (That's right, something that was believed to be a "cure" might have been causing damage instead). The studies generally demonstrated what are now believed to be robust placebo effects in autism. Naturally, Bernie Rimland was reluctant to accept the results of the studies, I'm not sure for how long.

There's obviously some level of self-deception in discussions about biomed treatments that appear to "work". When I bring up Secretin, some parents will say that it's a good point, but then they'll turn around and use what I will call the my-anecdote-is-better-than-everyone-else's gambit. They will say things like "I've been very careful in my observations of the eye contact improvements" and so on. They will claim self-deception could never apply to them, and seem to be offended by the suggestion. They also often appear to mistake "placebo effects" with "you are lying".

You see, even if a non-verbal child turns into a great conversationalist at around the same time that you give him [horseshit of choice here], this doesn't prove the treatment had any effect. It's not just that correlation does not imply causation, but also that anecdotes of this nature occur all the time in autism. Consider that if 10-15% of all autistic children lose their diagnosis eventually, there must be tens of thousands of such children around the world. One more anecdote of that nature doesn't tell us much.

You will find anecdotes of recovery for nearly anything you can think of: homeopathic remedies (chemical formula: H2O), exorcism, holding therapy, removal of TV, juice from an Amazonian fruit, etc. Heck, even Bettleheim had glowing testimonials.

Really, why should I take any anecdote on the latest biomed fad seriously?

Tuesday, August 28, 2007

Bullying and Autism in the Literature

[Time to dust off the old blog here. I'm not sure it will be active once again, but I've disabled comment moderation for now.]

I was searching PubMed for papers on bullying and autism. To my surprise, I found only one entry, Montes & Halterman (2007), a very recent paper. Check out the abstract. I was perplexed when I first read it. Doesn't the language seem to suggest that autistic children are at high risk of being bullies? I had to read it a couple times before I concluded that the authors have to be referring to autistic children being the victims of bullying. That's only because any other interpretation would be absurd (and note that I'm not saying autistic children are incapable of bullying). The "younger age" bit helps. My guess is that the way the abstract is presented has to do with the notion that autistics are bullied because there's something wrong with autistics, not with the bullies.