More info on autism (and Obsessive Compulsive Disorder (OCD), ADHD, SZ)

[Sara PA]

(If you read nothing else in the article, skip down to the paragraph I bolded which mentions the Obsessive Compulsive Disorder (OCD) part.)

http://www.latimes.com/news/nationworld/nation/la-na-autism29-2008may29,0,518709.story

Brain's role in autism probed
A researcher spots areas linked to repetitive behavior.
By Delthia Ricks
Newsday

May 29, 2008

MELVILLE, N.Y. — A psychology researcher has pinpointed regions of the brain that are linked to "ritualistic repetitive behavior" in autistic children -- the insatiable desire to rock back and forth for hours or to tirelessly march in place.

Keith Shafritz, an assistant professor of psychology at Hofstra University on Long Island, compared brain images of autistic children with those of neurologically normal youngsters. He and collaborators at Duke University and the University of North Carolina in Chapel Hill used a form of magnetic resonance imaging to explore sites in the brain.

They reported their findings in the current issue of Biological Psychiatry.

Repetitive behavior is one of autism's core traits. It has driven parents to extremes as they try to distract a child to engage in other activities.

Mapping the brain constitutes a journey into the inner labyrinths of a three-pound cosmos where countless frontiers have yet to be explored.

In children with autism, Shafritz found deficits in specific regions of the cerebral cortex, the outer layer of gray matter linked to all higher human functions, including repetitive behavior. He also mapped deficits in the basal ganglia, a region deep below the cerebral hemispheres.

"We like to think about the research process as discovering clues why people engage in certain behaviors," Shafritz said. "We were able to identify a series of brain regions that showed diminished activity when people were asked to alter certain behaviors and were not able to do so."

Autism is a neurodevelopmental disorder that is becoming a major public policy issue. Federal health officials estimate that it afflicts 1 in every 150 children, which affects not only families but communities.

School systems don't have enough appropriately trained teachers. Social services departments are overwhelmed by parents who need support and respite care.

For clues to the disorder, some scientists are scanning the human genome for suspect DNA.

Others, like Shafritz, are exploring the geography of the brain.

Edward G. Carr, a psychology professor at Stony Brook University in New York, said Shafritz's discovery was important because it helped demystify repetitive behavior.

"Repetitive behavior is sometimes called self-stimulatory behavior. A very common form of it is body-rocking. A child will do it for hours," Carr said. "Another child may wave his or her hands back and forth in front of their eyes. This is very common, and it's called hand-flapping. They extend their arms forward and wave their hands in front of them. It's like a light show."

Shafritz said the brain areas associated with repetitious behavior were not associated with another autism problem, self-injury. Some children repeatedly slam their heads against a wall, for instance.

Still, Shafritz found a relationship between the newly identified brain areas and overlapping regions linked to schizophrenia, obsessive compulsive disorder and attention-deficit hyperactivity disorder.

Dr. Anil K. Malhotra, director of psychiatric research at Zucker Hillside Hospital in Glen Oaks, N.Y., said he was not surprised. He too is studying links between autism and schizophrenia, and autism and obsessive-compulsive disorder.

 

[Sara PA]

I've been thinking about this since I posted it....well, since I first read it.

I think we are approaching the time when we will be dropping many of the diagnostic terms we are so familiar with. If indeed, damage or malfunctioning of the same area of the brain causes the behaviors that lead to the diagnosis of autism, Obsessive Compulsive Disorder (OCD), SZ and ADHD, it may be that some day those diagnoses are discarded in favor of diagnoses that state what part of the brain is damaged/malfunctioning.

As is stands, the diagnoses we use are virtually totally subject because there are few objective tests available. Seizure disorders (which can cause behavioral issues) can often be diagnosed by EEGs but it is believed that only 50% of temporal lobe seizures (where many emotions are controlled) are detectable by that test. Diagnosis is based on observed behaviors, reports of behaviors and response to medications. Even so, the focus is on behaviors not the physiological cause of the behaviors. What diagnosis is made is often more dependent on who is making the diagnosis than who is being diagnosed.

At some point we will know enough about the brain and have the technology available to diagnose based on the activity within the brain, not on how the person acts. And maybe some day we will have treatments that correct the physiological defecits that cause the unwanted, abnormal behaviors rather than change the brain chemistry to override the behaviors caused by the damaged/malfunctioning brain.

 

[ML]

Great article. Your post really makes me think. Thank you for sharing it!

 

[Christy]

Interesting. I really wish we were at the point where brain imaging could aid in making a diganosis. Everything is so subjective in psychiatry.

 

[TerryJ2]

Interesting.
It doesn't surprise me.

 

[susiestar]

Thanks for the article and your comments. I have long thought Obsessive Compulsive Disorder (OCD) adn autism were related. Esp when I started doing research on Obsessive Compulsive Disorder (OCD) after Wizard was diagnosed with it.

Susie

 

[Marguerite]

A very interesting article. Thank you, Sara.

I do wonder, though - should we always be thinking in terms of curing disorders? For example, we have a deaf community here in Sydney who are very militant about deafness not being seen as a disorder. They do not feel handicapped and resent attempts to "cure" them as a trade-ff for something less satisfactory. Cochlear implants are seen as a poor quality imitation of hearing which, if given to a child, can prevednt the child from ever learning other communication methods such as sign language. They feel that deaf people should be allowed to learn sign language and that hearing people should learn it too, and by doing so make more attempt to include deaf people.

While I feel that view is extreme, I do feel that they have a point in that we sometimes are too quick to label and want to eradicate all infirmity and disability, without acknowledging that sometimes there is a good side to it. For example, people with colour-blindness are the best equipped for seeing camouflage netting from the air. People with Obsessive Compulsive Disorder (OCD) can do meticulously detailed work (Willard Wigan is a shining example http://www.willard-wigan.com/).

Temple Grandin has said that if someone gave her the choice to wake up tomorrow morning and no longer ba autistic, she would refuse. Autism gives her abilities she would lose, and which she values as an important part of herself.

When difficult child 3 was younger and attenting mainstream school his scripture teacher (remember, we do have optional religious instruction in Aussie schools) prayed with him that hisw autism would be healed. I was angry about that, because it sent a number of very bad messages to difficult child 3: first, that we see his autism as something we want eliminated (when in fact it is an integral part of who he is); and second, that prayer is like a magic wish bag which will always be granted - but what happens to a little boy's faith when it is not? (As I type this, "Narnia" is on our TV and the allegory is obvious. I feel the line "He's not a tame lion" needs to be kept in mind when people try to use prayer as a magic wish granter).

We have raised our boys to value themselves as they are and this includes their autism as part of the package deal. Again referring to Temple Grandin, she said she feels autistic people have in large measure what, in small measure, produces genius. If in fact autism is so connected with high intelligence, and we try to eradicate autism, what will this do to intelligence in the population?

I am not against trying to heal; but like a lot of progress, we need to consider all the implications and ramifications before we categorise something as all bad or all good and try to put it in the relevant pigeon-hole.

That said, I would always welcome a better understanding of the mechanisms of what we observe in behaviour especially when it becomes a handicap in any way (ie interferes with an individual's ability to carry out the usual tasks of daily living).

Marg

 

[Sara PA]

You did, I'm sure, notice that I didn't use the word "cure" but rather "correct'. Maybe "correct" wasn't exactly the best choice, but I deliberately chose not to use "cure".

If I had a child whose autism was so severe that he was self harming and/or non-functioning, I suspect I would move heaven and earth to "correct" the condition. But remember that the artcle discussed "ritualistic repetitive behavior" associated with autism, not autism itself. That's what I meant about the terms we now use becoming obsolete. Perhaps what we now call autism doesn't exist as we think it exists. Perhaps it's a gene cluster that is really a number of separate brain areas malfunctioning. Perhaps the cause is that these areas are indiviually sensitive to the same toxins. Perhaps we will some day be able to "correct" the "ritualistic repetitive behavior" (while leaving untouched other aspects of what we now call autism) as well as those "ritualistic repetitive behavior" associated with Obsessive Compulsive Disorder (OCD), SZ and ADHD (which I wasn't aware existed, to be honest).

I have a much broader concept of what constitutes "normal" than most people, certainly more than the psychiatric/psychological community. I think much of what is currently being diagnosed ADHD and Aspergers is totally normal behavior. I believe what is diagnosed in many people as various disorders are traits that our species needed to survive and evolve over eons but suddenly don't fit our modern lifestyle (particular our school structure). I think the definition of "normal" has been narrowed and fine tuned to the point where "normal" is now some politically correct, sedatentary lifestyle form of perfect. Much of what we use to call "personality" is now called "disorders". This increase of pathologicalizing previously accepted.....no, more than accepted -- needed and valued - traits has arisen in the past 50 years and coincided with the rise of pop psychological thinking, our ever increasing sedentary lifestyle and the rise of Big Pharma's mass marketing. (Truth be told, much of what we are being sold is snake oil, snake oil sold to treat "disorders" that are really variations of normal.)

Perhaps 'ritualistic repetitive disorder" isn't a part of autism. Perhaps we will soon be thinking of "ritualistic repetitive behavior" as part of the Obsessive Compulsive Disorder (OCD) spectrum, a disorder spectrum caused by malfunction in a particular part of the brain that is often co-morbid with other brain area malfunctioning. Perhaps.