Monday, November 19, 2007

Impact of Treatment on Self-Concept

This doesn't exactly have to do with autism, but I thought it would be of interest to my readers nonetheless.

Strength training can have unexpected effects on the self-concept of children with cerebral palsy.
Dodd KJ, Taylor NF, Graham HK.
Musculoskeletal Research Centre, School of Physiotherapy, Faculty of Health Sciences, La Trobe University, Victoria, Australia.

PURPOSE: This study was designed to evaluate the effect of a home-based progressive resistance strength-training program on the self-concept of children with cerebral palsy. METHODS: A randomized, controlled trial was used to evaluate the effects of a six-week strength-training program on self-concept immediately after completion of the program (week six) and at a follow-up session held 18 weeks after the initial assessment. Seventeen children [eight boys, nine girls; mean age 12.1 years (SD 2.5)] with spastic diplegic cerebral palsy were recruited. Participants in the experimental group completed a home-based progressive resistance strength-training program using three exercises to strengthen the major support muscles of the lower limb. Participants in the control group undertook their normal daily activities. Self-concept was measured by the Self-Perception Profile for Children. RESULTS: Overall, the self-concept of both groups was positive at baseline and at six and 18 weeks. However, compared with controls, the experimental group showed decreased self-concept in the domain of scholastic competence and a trend for a decrease in social acceptance at six weeks. At follow-up, the experimental group had reduced self-concept in the domains of scholastic competence and social acceptance compared with the control group. CONCLUSION: These unexpected results suggest that participation in a relatively short home-based strength-training program may have an inhibitory effect on the self-concept of children with cerebral palsy. Despite the inhibitory effect, self-concept in the experimental group remained positive after strength training, suggesting that clinicians should not be overly concerned about the psychological effects of the intervention.

I believe this study has implications of note on the kinds of outcome measures that should be considered in disability treatment trials. Effectiveness is obviously not the only consideration that matters.

Saturday, November 03, 2007

Quick Note About Low vs. High Functioning

The other day Harold Doherty wrote a post where he proclaimed that science had demonstrated that what are called high functioning and low functioning autism are different entities.

I believe this highlights a basic misunderstanding of the criticism of the validity of the low vs. high functioning labels. No one has ever claimed that those classifed as low functioning are biologically exactly the same as those classified as high functioning. In fact, I'm not surprised at all that neurological differences would be found when you make group comparisons of this nature. I would expect the same to be true when you compare almost any two behavioral phenotypes. (I also questioned Harold's view that Jenny McCarthy could yet be proven correct, in light of the neurological findings whose significance he was endorsing, but that's neither here nor there.)

I believe a similar misunderstanding occurs when I speak of autism as a cultural construct. This seems to be taken as "autism does not exist" or "autism is basically the same as normality" which is not at all what that means.

The main technical criticism of the low vs. high functioning classifications, in my view, is that they are inconsistent. Sometimes autistic disoder means "low functioning" whereas Asperger's means "high functioning." It's not clear where PDD-NOS is. Other times, high IQ means "high functioning" whereas mental retardation means "low functioning." Then again, lack of speech could mean "low functioning" while having good speech indicates "high functioning." Some like Harold would seem to want to redefine "low functioning" to be associated with behaviors such as self-injury. None of these different ways to separate low from high functioning - none - are consistent with one another.

There are also critiques of the classification from the perspective of disability rights. Joel discussed this recently.