Different MRI Findings in Autism - Autism not a Single Entity

A research group from France seemed surprised at wide variations in MRI findings seen among children diagnosed with autism, but they shouldn't have. Though the group took care to exclude cases of Aspergers and PDD-NOS, as well as a significant list of exclusionary criteria, half of the children had MRI abnormalities, and within this group, very different MRI abnormalities were seen - white matter and gray matter (e.g. micropachygyria) abnormalities, different brain regions - e.g. temporal lobe, callosal fibers, etc.

Excerpt: "Such unusual association of MRI abnormalities is, to our knowledge, not linked to any specific pediatric pathology."

Studies such as this point out the problems of using only behavioral criteria to make the diagnosis of autism. In this study, a multidisciplinary team consisting for child psychiatrists, child psychologists, and speech therapists were used to make the diagnosis. With no hubris intended, we think a neurologist should be included on every autism team. Understanding the specific neurological challenges a child faces can help much more than a more one-size-fits-all approach to intervention.

When we have assessed children with an autism or possible autism diagnosis, we have seen the same very wide clinical variation in terms of neurological exam - you would not treat a child with visual processing disorders with purely behavioral modification, nor a child with auditory and language processing problems with facial recognition training.

Historically, autism was first recognized as an entity by a psychiatrist, but as it becomes even more clear that the behavioral label subsumes many different neurological conditions, it's time for business-as-usual to come to an end.

MRI Abnormalities in Autism pdf

Listening to Experts Inhibits Decision Making in the Brain and How Learning Can Be Illusory

From Wired Science, college students given "expert opinions" before making choices in a financial decision-making paradigm, turned off executive function areas when decisions had to be made. The expert in this case was an Emory University economist who advises the Federal Reserve. "But students tended to follow his advice regardless of the situation, especially when it was bad. When thinking for themselves, students showed activity in their anterior cingulate cortex and dorsolateral prefrontal cortex — brain regions associated with making decisions and calculating probabilities. When given advice from Noussair, activity in those regions flat lined."

Certainly these days, its easy to point fingers at mistakes made by financial experts, but in Nicholas Kristof's Learning How to Think article, he reminds us of the "Dr. Fox effect" to which it seems all sorts of educated groups (college students, medical professionals, academics) are susceptible (..but one wonders whether less educated groups are less susceptible?)

The Dr. Fox lectures originated in the 1970s when researchers invited a small group of psychiatrists, psychologists, and social worker educators for a training session. The session was led by "Dr. Myron L. Fox", who was in reality a trained actor who looked authoritative and distinguished and was preceded by an impressive, but fictional curriculum vitae.

"Dr. Fox's topic was to be "Mathematical Game Theory as Applied to Physician Education." His source material was derived from a complex but sufficiently understandable scientific article geared to lay readers. One of the authors, on two separate occasions, coached the lecturer to present his topic and conduct his question and answer period with an excessive use of double talk, neologisms, non sequiturs, and contradictory statements. All this was to be interspersed with parenthetical humor and meaningless references to unrelated topics."

What was the result? The lecture was overwhelmingly a success, favorable opinions significantly outnumbering unfavorable opinions: "Excellent presentation, enjoyed listening. Has warm manner. Good flow, seems enthusiastic...Extremely articulate. Interesting, wish he dwelled more on background. Good analysis of subject that has been personally studied before. Very dramatic presentation. He was certainly captivating. Somewhat disorganized. Frustratingly boring. Unorganized and ineffective. Articulate. Knowledgeable."

With access to the Internet, "experts" are even more accessible than ever before - so it is wise for students to develop a regular habit of thinking critically and analyzing what they see or read. UCLA professor Patricia Greenfield goes as far as to suggest that technology is producing a decline in critical thinking and analysis

If you think you may be immune to the Fox effect, you are probably not. Experts come in all different varieties - including mentors, peers, and social networks. From famous experiments in the 1950s, Dr. Solomon Asch showed that, if surrounded by people (7 in this case) who come to an apparently incorrect conclusion, only 1 in 4 resist the incorrect conclusion - and still this person is likely to conform 50% of the time.

Decision-making by committee
Eide Neurolearning Blog: fMRI of Peer Pressure
HT: /http://futuramb.tumblr.com

Bill Passed to Improve Dyslexia Instruction in Washington State

Good news for dyslexic students and their families in Washington state - Senate Bill 6016 establishes:

1. An educational program for identifying and addressing the academic needs (reading, writing, and spelling) of dyslexic students.

2. Develop a "Dyslexia Handbook" for Washington state (modeled after other state handbooks)

3. Each educational district must report to the superintendent for public instruction to account for the number of individuals being trained in dyslexia programs.

Washington schools fall woefully short in their understanding of dyslexia and dyslexic students - this legislation is very needed. Although dyslexia may be the most common learning disability, in our practice it is often missed or misdiagnosed as poor effort, low intelligence, or attention deficit disorder.

An example of another state's dyslexia handbook can be found here: Dyslexia Handbook for Texas pdf

Dyslexia Bill for Washington State

ADHD Drugs No Long-Term Benefits

The 8 year follow-up data from the ADHD MTA Study (Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder)are out and the results argue against the use of ADHD drugs longer than 2 years. Most families tended to stopped the drugs by two years anyway, but some vocal medication-proponents had suggested this was endangering children's health. In fact, besides medications having less symptomatic benefit with chronic use, the latest study also comments on observation that long-term medication may also impair growth (children who took medication for 36 months or longer were 6 lbs lighter and one inch shorter)

Excerpt NIMH summary:

"A majority (61.5 percent) of the children who were medicated at the end of the 14-month trial had stopped taking medication by the eight-year follow-up, suggesting that medication treatment may lose appeal with families over time...Children who were no longer taking medication at the eight-year follow-up were generally functioning as well as children who were still medicated, raising questions about whether medication treatment beyond two years continues to be beneficial or needed by all."

Washington Post: Debate over drugs for ADHD reignites:

"One principal scientist in the study, psychologist William Pelham, said that the most obvious interpretation of the data is that the medications are useful in the short term but ineffective over longer periods but added that his colleagues had repeatedly sought to explain away evidence that challenged the long-term usefulness of medication. When their explanations failed to hold up, they reached for new ones, Pelham said.

"The stance the group took in the first paper was so strong that the people are embarrassed to say they were wrong and we led the whole field astray," said Pelham, of the State University of New York at Buffalo. Pelham said the drugs, including Adderall and Concerta, are among the medications most frequently prescribed for American children, adding: "If 5 percent of families in the country are giving a medication to their children, and they don't realize it does not have long-term benefits but might have long-term risks, why should they not be told?"

More from the Post:

"As the MTA study continued to find smaller and smaller behavioral differences between children who were medicated and those who were not, use of the drugs soared. Pelham said most parents and doctors took away the message that the study had found drug therapy effective over the long run. In 2004, physicians wrote 28.3 million prescriptions for ADHD drugs; last year, they wrote 39.5 million, according to data provided by IMS Health...

The subgroup analysis found that children in homes that were socially and economically stable did the same in the long term with or without medication. Children from troubled or deprived backgrounds slid backward as soon as the intensive therapy stopped and they went back to their communities. About one-third -- those with the least impairment to begin with -- continued to improve over the long term.

"If you want something for tomorrow, medication is the best, but if you want something three years from now, it does not matter," he said. "If you take medication long-term beyond three years, I don't think there is any evidence that medication is better than no medication."

This latest information should be made available to parents making difficult decisions about beginning or continuing their children on the medication. At the end of the Washington Post article, Pelham added that in a soon-to-be published report, he found that "95 percent of parents who were told by clinicians to first try behavioral interventions for ADHD did so. When parents were given a prescription for a drug and then told to enroll their children in behavioral intervention programs, 75 percent did not seek out the behavioral approaches." His take-home point was that if medications are being prescribed, they should be taken alongside a behavioral program.

All this news will add to the continuing fiery debate over drug prescription in the classroom. The recent discovery that a leading vocal advocate of use of more psychiatric medications in elementary and preschool children (Harvard child psychiatrist Dr. Joseph Biederman) failed to report receiving over 1.7 million dollars in consulting fees from drug companies over the years 2000-7, further stirs the pot. Dr B seems to be in even more trouble in recently released court documents: from the Wall Street Journal's blog, read more about Biederman's serious protocol violations in his research study treating preschoolers with antipsychotics here.


NIMH: ADHD medications not likely to improve long term outcomes for children with ADHD
MTA at 8 Years - J Am Acad Pediatrics
Washington Post: Debate over drugs for ADHD reignites
New York Times: Researchers fail to reveal drug pay

Policy Change for the Better: Eligibility Requirements for Accommodations on the SAT

Until recently, college-bound students with learning difficulties faced a huge obstacle qualifying for accommodations for the SAT (much better for the ACT - so we generally recommended students choose that test over the SAT, all other issues being equal). The reason for this was an elaborate requirement for 3-part documentation (including recent IQ testing), but the good news now is that the latest posted eligibility guidelines have changed, are much more reasonable and in line with ACT requirements, and posted here. Many of the same tests are listed (e.g. WIAT-II, Nelson-Denny), but there seems to be a more flexible pathway for determining eligibility.

The change may have occurred because the passage of the ADA Amendments Act late last year. The ADA Amendments Act overrides some narrowly written Supreme Court decisions that put undue burdens on people with learning or other disabilities to prove their need for accommodation.

The ADA Amendments Act is also likely to affect several court cases regarding students with disabilities. For example the case of Jenkins vs. the National Board of Medical Examiners Although 3rd year medical student Kirk Jenkins had a nearly life-long diagnosis of dyslexia and appropriately received time accommodations for the ACT and MCAT, the National Board of Medical Examiners declined his request for accommodations. With the passage of the ADA Amendments Act though, the court decision is being returned to the court.