Mercury and autism. These two words go together as well as matches do in a dynamite factor. For more than the a decade, a controversy has raged about whether exposure to mercury can cause autism.
Some think that the mercury that used to be contained in vaccines played a role in the rise of autism while others think that mercury is completely harmless and would drink it like Kool-Aid if they could.
Regardless of your opinion about mercury, you have to admit that it is a health risk and it is concerning that our exposure to it from the environment is on the rise.
But do children with autism have a higher exposure to mercury than typical children? A recent study from the UC Davis M.I.N.D. institute seeks to answer that question.
Blood Mercury Concentrations in CHARGE Study Children with and without Autism
(This study is open access so I suggest reading it for yourself if you are interested)
In this well-designed study, which is part of the larger CHARGE study, researchers looked a group of 452 children to determine whether the subset of children with autism (249) had a higher blood concentration of mercury than did typical children (143), or children with other developmental delays (60).
On average, children with autism had a lower blood concentration (0.19 ug/L) than did typical children (0.28 ug/L). But, after adjusting the results for environmental exposures to mercury, the children with autism had about the same level (0.26 ug/L) as did the control group (0.24 ug/L). And, unlike some prior results, the levels of mercury that were found were in line with other national surveys of children.
I don't think anyone should be surprised by this result. The mercury that is circulating in your blood is there because of your recent exposures to mercury - either from your diet, dental fillings, air pollution, or other sources. Once it gets into your blood it goes one of two places - either out of your body through the normal channels or it will get stored inside your body.
I think the surprising result here is that children with autism eat that much less fish than typical children do. I know that there can be food selectivity issues, but I would not have expected the result to have been so pronounced.
The other surprise here is just how much mercury children get from eating fish. If I remember my childhood correctly, kids aren't that big on eating fish to begin with. So if the presumably small amount that they eat can cause a large change in the amount of mercury you consume then it might be best to limit your fish intake. And you thought I was joking when I said to not eat the fish because it might give you autism.
Unfortunately, this study is not going to put to rest the controversy that surrounds mercury and autism because it does not address what some feel is the central question. Do children with autism have a problem in eliminating mercury from their bodies and does the build up of mercury cause problems that lead to autism?
If this is a problem in (some) children with autism (emphasis on IF), you would not see an increased level in the blood but would rather see a build-up in other tissues in the body. But since there is no good way to measure this value (short of an autopsy), it is hard to address this question directly. One possible way would be to look at the total intake amount of mercury and the total amount eliminated from the body. What was left at that point would be the amount left in the body. But, this too would be hard to do.
Regardless, I am sure that the debate will rage on.
Wednesday, October 28, 2009
Monday, October 26, 2009
Left Brain Right Brain's Jabberwocky
Jabberwocky (noun)
Consider the recent anonymous stalking of the mother whose child has autism. I don't like to resort to name calling but I have no other words to describe this post where some pathetic person calling themselves "Guest Blogger" vomited years worth of hatred towards a mother simply because she was trying everything she could to help her child. You may agree or disagree with what this mother did but you do not do what this "Guest Blogger". You do not stalk a person online for years and then publish their correspondence to e-mail lists on a blog, out of context, and then hold them up for public ridicule.
This post represents mean-spiritedness at its worst and illustrates quite clearly the divide in the autism community. I think it also shows how far Left Brain Right Brain has sunk.
Moving out of the slime pit, we come to a series of posts that are an attempt to analyze the recent NSCH data. If you want a case study in how to do a poor job analyzing data, these posts are it. In them we are treated to direct comparisons of prevalence to incidence, miss use of survey data, and a distortion of the meaning of time. I took the time to debunk one of the posts but I didn't bother to address the others; it was too much like playing whac-a-mole (but without the fun).
But, I have to say that my favorite was the last one that looked at the "recovered" group in the NSCH data. The group refers to the children who once had a label of autism but no longer do. If you look at the number of this group compared to the total number of children who had autism and you end up with a controversial figure that has been dubbed the "recovery rate". Some groups claim that is shows that children can be recovered from autism while others, like LBRB, say that the whole thing is just nonsense.
However, the only definitive nonsense is the analysis on LBRB. Here the writers on LBRB apparently seem unable to distinguish between a child's birth year and the linear progression of time. The result is a claim that this "recovery rate" is going down "with time". Yet, if you look at the helpful graph on the page what you will see if that this "recovery rate" isn't going down with time, it is going down with the child's age. Or to put it another way, the older the child, the higher the chance that they will be "recovered". Since children tend to age from younger to older and since a hypothetical recovery would take time, I would have to conclude that the data actually says the opposite of what the writers claim.
Good thing LBRB didn't let a little thing like reality get in the way of a good story.
Anyway, moving forward in time (real time, not child birth years), we come to the latest of the absurdities, the posts about the IACC.
First up, we have the top seven mistakes that were made in the Dr. Landis issue. Strangely absent from this list of mistakes is Dr. Landis writing down inappropriate comments in the first place. Call me silly, but I think that was the first, largest, and most important mistake made in the whole mess. If you are going to write trash about someone, you really should make sure that the trashee doesn't find out about it or read it online.
But, apparently writing the comments down was just fine with the rational people at LBRB. According to them, the problem was that Dr. Landis was careless with her notes AND she should have stood up for her right to imply that her committee college was distorting the work of the IACC for their own personal ends.
That would have been a great way to rebuild the missing trust in the autism community.
The other beef that LBRB had? That "Age of Autism decided that a surprise attack was more important that gathering all the facts and published the blog piece without comment from Dr. Landis."
I have to wonder if they gave the mother that they attacked the same courtesy?
Next, we have a call to "stop the intimidation tactics towards the IACC". The arguments in this post get a little strange, but I think the main point is that criticizing the actions of members of the IACC should not be allowed. I am not sure how this is intimidation, as far as I can see their are are threats or midnight visits to peoples houses. No one has been kidnapped nor is their any blackmail. But there has been (gasp) calls for a congressional investigation, a lawsuit, disagreements about research, and calls for committee members to resign.
In other words, politics as usual for this country.
The primary target of the post, here again, is Age of Autism. Did you know that Age of Autism is apparently a cabal that represent all of those "anti-vaccine" groups. Don't they know that they lost the autism omnibus and that less families are filing claims in vaccine court?
Wait, that didn't make any sense, but then again, neither did the post.
Finally, we have the declaration of war that has apparently been made against Tom Insel and the IACC by those "anti-vaccine" groups. You know, the "anti-vaccine" cabal headed by Age of Autism. They have their "friendly forces" which must mean it is an all out war against the IACC (no, the original post didn't make any sense either).
So, how was the war started, what was the shot heard around the world? Simple, Age of Autism ran a post that called for Dr Insel to resign.
You know, there ought to be a law preventing just anyone from voicing their opinion about their government. Maybe at the very least a questionnaire that asks something like "have you, or anyone you know, ever questioned the safety and effectiveness of vaccines". If they answer yes, then by all means, prevent them from speaking or writing anything online, they could be dangerous.
I have to wonder when it became unacceptable to question the status quo. I also have to wonder why anyone who questions the party lines of "autism is genetic" and "there is no epidemic of autism" suddenly gets labeled as "anti-vaccine". It must be all of the open mindedness.
Anyway, it took just two days in LBRB time for the "intimidation" to become an all-out "war" against the IACC. I know that time moves faster on the internet, but I would have at least thought there might have been some posturing, chest thumping, or skirmishes between the two groups.
Then again, is it even possible for a small group of private citizens to intimidate a government committee, let alone declare war on it? I think the only war here is Left Brain Right Brain's war on reality.
But seriously, Left Brain Right Brain used to be a good site, even if only to act as a counter point in the ever-present autism-vaccines debate. You can never get any closer to the understanding something if all you have to compare notes against are people who agree with you.
Left Brain Right Brain, may it rest in peace.
Nonsensical speech or writing
I think this one word sums up quite nicely where the once interesting site Left Brain Right Brain is heading. I may not have agreed with much of what they have said but at least they were able make their points clearly and intelligently. But lately, clarity and intelligence seem to be heading out the window to be replaced with dogma, nonsense, and mean-spiritedness.
Consider the recent anonymous stalking of the mother whose child has autism. I don't like to resort to name calling but I have no other words to describe this post where some pathetic person calling themselves "Guest Blogger" vomited years worth of hatred towards a mother simply because she was trying everything she could to help her child. You may agree or disagree with what this mother did but you do not do what this "Guest Blogger". You do not stalk a person online for years and then publish their correspondence to e-mail lists on a blog, out of context, and then hold them up for public ridicule.
This post represents mean-spiritedness at its worst and illustrates quite clearly the divide in the autism community. I think it also shows how far Left Brain Right Brain has sunk.
Moving out of the slime pit, we come to a series of posts that are an attempt to analyze the recent NSCH data. If you want a case study in how to do a poor job analyzing data, these posts are it. In them we are treated to direct comparisons of prevalence to incidence, miss use of survey data, and a distortion of the meaning of time. I took the time to debunk one of the posts but I didn't bother to address the others; it was too much like playing whac-a-mole (but without the fun).
But, I have to say that my favorite was the last one that looked at the "recovered" group in the NSCH data. The group refers to the children who once had a label of autism but no longer do. If you look at the number of this group compared to the total number of children who had autism and you end up with a controversial figure that has been dubbed the "recovery rate". Some groups claim that is shows that children can be recovered from autism while others, like LBRB, say that the whole thing is just nonsense.
However, the only definitive nonsense is the analysis on LBRB. Here the writers on LBRB apparently seem unable to distinguish between a child's birth year and the linear progression of time. The result is a claim that this "recovery rate" is going down "with time". Yet, if you look at the helpful graph on the page what you will see if that this "recovery rate" isn't going down with time, it is going down with the child's age. Or to put it another way, the older the child, the higher the chance that they will be "recovered". Since children tend to age from younger to older and since a hypothetical recovery would take time, I would have to conclude that the data actually says the opposite of what the writers claim.
Good thing LBRB didn't let a little thing like reality get in the way of a good story.
Anyway, moving forward in time (real time, not child birth years), we come to the latest of the absurdities, the posts about the IACC.
First up, we have the top seven mistakes that were made in the Dr. Landis issue. Strangely absent from this list of mistakes is Dr. Landis writing down inappropriate comments in the first place. Call me silly, but I think that was the first, largest, and most important mistake made in the whole mess. If you are going to write trash about someone, you really should make sure that the trashee doesn't find out about it or read it online.
But, apparently writing the comments down was just fine with the rational people at LBRB. According to them, the problem was that Dr. Landis was careless with her notes AND she should have stood up for her right to imply that her committee college was distorting the work of the IACC for their own personal ends.
That would have been a great way to rebuild the missing trust in the autism community.
The other beef that LBRB had? That "Age of Autism decided that a surprise attack was more important that gathering all the facts and published the blog piece without comment from Dr. Landis."
I have to wonder if they gave the mother that they attacked the same courtesy?
Next, we have a call to "stop the intimidation tactics towards the IACC". The arguments in this post get a little strange, but I think the main point is that criticizing the actions of members of the IACC should not be allowed. I am not sure how this is intimidation, as far as I can see their are are threats or midnight visits to peoples houses. No one has been kidnapped nor is their any blackmail. But there has been (gasp) calls for a congressional investigation, a lawsuit, disagreements about research, and calls for committee members to resign.
In other words, politics as usual for this country.
The primary target of the post, here again, is Age of Autism. Did you know that Age of Autism is apparently a cabal that represent all of those "anti-vaccine" groups. Don't they know that they lost the autism omnibus and that less families are filing claims in vaccine court?
Wait, that didn't make any sense, but then again, neither did the post.
Finally, we have the declaration of war that has apparently been made against Tom Insel and the IACC by those "anti-vaccine" groups. You know, the "anti-vaccine" cabal headed by Age of Autism. They have their "friendly forces" which must mean it is an all out war against the IACC (no, the original post didn't make any sense either).
So, how was the war started, what was the shot heard around the world? Simple, Age of Autism ran a post that called for Dr Insel to resign.
You know, there ought to be a law preventing just anyone from voicing their opinion about their government. Maybe at the very least a questionnaire that asks something like "have you, or anyone you know, ever questioned the safety and effectiveness of vaccines". If they answer yes, then by all means, prevent them from speaking or writing anything online, they could be dangerous.
I have to wonder when it became unacceptable to question the status quo. I also have to wonder why anyone who questions the party lines of "autism is genetic" and "there is no epidemic of autism" suddenly gets labeled as "anti-vaccine". It must be all of the open mindedness.
Anyway, it took just two days in LBRB time for the "intimidation" to become an all-out "war" against the IACC. I know that time moves faster on the internet, but I would have at least thought there might have been some posturing, chest thumping, or skirmishes between the two groups.
Then again, is it even possible for a small group of private citizens to intimidate a government committee, let alone declare war on it? I think the only war here is Left Brain Right Brain's war on reality.
But seriously, Left Brain Right Brain used to be a good site, even if only to act as a counter point in the ever-present autism-vaccines debate. You can never get any closer to the understanding something if all you have to compare notes against are people who agree with you.
Left Brain Right Brain, may it rest in peace.
Wednesday, October 21, 2009
What about Dr. Thomas Insel?
Photo Courtesy of U.S. Army
Dr. Thomas Insel is the Director of the National Institute of Mental Health as well as the chair of the Interagency Autism Coordinating Committee (IACC). These two roles put him in a key position to dictate the direction of autism research for the foreseeable future and to determine how federal funds are spent in this country. Given what the success he has achieved, I have to assume that he is an intelligent person and is knowledgeable about mental health issues.
But I have to wonder at some his actions relating to autism. Consider the following.
First is the matter of the public members of the IACC. The IACC holds tremendous power to set the agenda for autism research for the foreseeable future. It is composed of 12 representative from federal agencies and six members for the public at large. Because of what is at stake, every autism organization, large and small, wanted a seat on this committee. Or to put it in a nutshell, these seats are very important as such should be given to those who are extremely knowledgeable about autism and would be able to make a strong contribution.
Yet, if you look at the public members, one of them stands out - Christine McKee. Now, I do not have any first hand knowledge of this person or their qualifications but she does not appear to be associated with any major autism organization. The only things I know about her comes from the IACC press release announcing the committee members -
Christine McKee, J.D., has developed and manages an in-home therapy for her autistic child, creating and/or assembling all of the therapy related materials. Ms. McKee participates in monthly consultations with a Board Certified Behavior Analyst/Speech Pathologist. She applies the therapeutic measures in her daily parenting and childcare routines.This sounds like a description of every parent whose child has autism. While I know first hand that this is not an easy job to do, how does this qualify her for a seat of the IACC? Is she supposed to represent the view of the "typical" parent-advocate, if there even is such a thing? How was Ms. McKee selected for this seat?
I believe the answer is that Ms McKee is Dr. Insel's neighbor. I would like to think that Ms. McKee has more qualifications than just being a parent and choice of house but I can't imagine that she would be on the committee if she didn't live next door to Dr. Insel.
Why would Dr. Insel put his neighbor on the IACC?
Moving on, we come to the matter of the early adjournment of an IACC meeting that happened a few months ago. At the end of this particular meeting, there was time allocated for public comments. In order to make a comment you had to submit your questions, in advance, so they could be pre-approved. One mother did just this - she submitted, in advance, questions that her son, who has autism, would be asking at the meeting. The questions were approved and she was told that the comment time was at 3:30 on the day of the meeting.
The mother went through all of the preparations that were required to help her son get ready to ask the committee his questions. Given the nature of autism and the nature of the event, I can imagine that the family had to do significant prep work.
On the day of the meeting, the mother decides to skip most of the meeting and to arrive at the scheduled time for comments. I think we can all agree that sitting through a long meeting with a child with autism would not be anyone's idea of a good time (especially for the child). So they arrive at the meeting at the proper time only to find that the meeting had been prematurely ended over an hour before. The poor kid was left giving his comments to an empty room.
Needless to say, the mother was not pleased by this turn of events. If it were me, I would be equally upset.
To be fair, Dr. Insel did call and apologize to the mother afterwards. But at the same time, I am not sure that makes much of a difference. The people commenting were pre-approved, so the committee knew that they were coming. Given what the committee is responsible for and the fact that it was a child speaking, I have to think that they would at least guess that the child had a form of autism. You would think that the members of the committee would understand the challenges that a child with autism would have with this experience and do everything they could to make the experience a successful one for the child. In this case all that would have meant was sticking to the published schedule and not leaving early.
Why did Dr. Insel let the meeting be adjourned early? Did he simply not think it through or did he not care enough?
Which leads me to what is potentially the most disturbing item. Let me just first say that I do not like reporting what is basically gossip and normally I don't give much credence to unsubstantiated stories. However, in this case, the person reporting this story tends to be reputable and, even if the story below is only partially true, it would be a still be disturbing.
With that said, an allegation has been made that Did Dr. Insel refused to ride in an elevator with a child who had autism. From the Adventures in Autism blog -
On April 17, 2007, Holly Bortfeld attended an autism hearing in the Senate Appropriations Subcommittee run by Senator Tom Harkin. At that hearing Dr. Thomas Insel, Director of the National Institute of Mental Health, now current head of the Interagency Autism Coordinating Committee, was there to testify.
Beforehand, Ms. Bortfeld, was waiting with her 11 year old son Max, who has autism, at an elevator on the way up to the hearing. When the doors opened they got on. After they did, Thomas Insel and a female companion approached and entered the elevator just before the doors closed. Ms. Bortfeld reports that once they were on the elevator together...
"...Max stimmed. Insel looked at him, looked at me (yes, he had his little name tag on, so he knew that I knew he was) then he hit the open door button and ushered his coworker off. As the doors were closing, he said "I'm not riding up with them", looking at my son."I initially had a hard time believing that anyone would do this, especially a trained medical professional.
But then I remembered all of the looks and comments that my family has received while out in public. And the sorts of comments on stories like these that show the complete lack of understanding that the public at large has of autism. And then I look at incidences like the above two items and the other controversies that Dr. Insel has been involved in as part of his tenure at the IACC.
And suddenly parts of the above story become more believable. I still can't bring myself to believe that Dr. Insel would say "I'm not ridding up with them" but I could see him getting out of the elevator and even doing that small thing would say volumes about his character.
So I have to wonder, how much does Dr. Insel care about children with autism and is he the right person to be leading the IACC?
Tuesday, October 20, 2009
Dr. Landis Leaves a Trail of Genius at the IACC
Note to self - if I pass notes at a public committee hearing that disparage a college, parents, or an advocacy group, remember to take they with me next time.
I imagine that Dr. Landis, director of the National Institute of Neurodevelopmental Disorders and Stroke (NINDS) and former member of the Interagency Autism Coordinating Committee (IACC) is telling herself something along those line today.
I usually try and stay away from stories that are run on Age of Autism but I think this one is kind of important. According to the story at Age of Autism, Dr. Landis was observed at a recent IACC meeting exchanging notes with one of her colleges, Dr. State. After the meeting was over, one of the parents attending the meeting saw that there were notes on the floor near were the good doctors were sitting. People being who they are, the parents picked up the notes and the contents made their way to the Age of Autism site.
The contents of the notes are a fascinating glimpse into the mind of one the committee members. There are five scribbled notes on the, four of which I will quote below. If I am reading what was written correctly, Dr. Landis does not care for either the so-called "anti-vax" movement of Age of Autism nor the "anti-cure" movement of Neurodiversity.
This is what Dr. Landis had to say about vaccines and autism -
She also threw a bone to the Age of Autism crowd and implied that her remark about looking at kids who have gotten awards really meant that she was in favor of looking for a link between vaccines and autism.
Yea, right.
Don't get me wrong, it would be a good thing if someone seriously tackled the remaining questions concerning vaccines and autism. But I don't believe for a second that her second remark was talking about doing that.
As for what the ND movement had to say about this? Well, if you need a good laugh go look at the attempted spin on this post at Left Brain Right Brain. Poor Sullivan tries so hard to spin this into something that is isn't but all he ends up with his is own "big oops" that should have been deleted rather than posted. But what else is new.
I think the true importance of what Dr. Landis wrote was the candor of her statements and the insight into what public health officials think of the various factions in the autism world. There is the impression that the vaccine-autism crowd is looking for a quick payday and that the ND crowd is trying to trying to turn a serious condition into a trivial debate on whether autism is a mental health disorder and whether to treat it.
I don't necessarily agree with everything that Dr. Landis had to say but I do find it refreshing that officials in the government show signs of intelligence. At least one of the above views is accurate (in my humble opinion). Here's a hint - most people who have children with autism are looking for answers and a way to help their children - autism is not a get rich quick scheme (if it is, would someone please let me in on the secret?).
I believe the real reason that Dr. Landis is calling it quits is because of what she wrote about fellow committee member Lyn Redwood. If you are going to publicly state that a college is in it for the money, you had best have something to back up your statement. She may not have intended for her comment to become public but it did. In the future perhaps she could prevent this sort of trouble by not passing notes?
I imagine that Dr. Landis, director of the National Institute of Neurodevelopmental Disorders and Stroke (NINDS) and former member of the Interagency Autism Coordinating Committee (IACC) is telling herself something along those line today.
I usually try and stay away from stories that are run on Age of Autism but I think this one is kind of important. According to the story at Age of Autism, Dr. Landis was observed at a recent IACC meeting exchanging notes with one of her colleges, Dr. State. After the meeting was over, one of the parents attending the meeting saw that there were notes on the floor near were the good doctors were sitting. People being who they are, the parents picked up the notes and the contents made their way to the Age of Autism site.
The contents of the notes are a fascinating glimpse into the mind of one the committee members. There are five scribbled notes on the, four of which I will quote below. If I am reading what was written correctly, Dr. Landis does not care for either the so-called "anti-vax" movement of Age of Autism nor the "anti-cure" movement of Neurodiversity.
This is what Dr. Landis had to say about vaccines and autism -
I wonder is Lyn Redwood is pushing autism as a multisystem disorder to feed into vaccine injury?
Would be a good justification for looking at vaccine injured kids who have gotten awards.And about the Neurodiversity movement -
This is like the controversy over cochlear implants and the deafness co
There are advocacy groups claiming its more like homosexualityAs a direct result of these notes being published on Age of Autism, Dr. Landis resigned from the IACC committee on Saturday. And, as David Kirby reports over at the Huffington Post, Dr. Landis issued an apology that her "personal reflections during the meeting have been taken out of context and have been interpreted by the community in ways that I would never intend".
She also threw a bone to the Age of Autism crowd and implied that her remark about looking at kids who have gotten awards really meant that she was in favor of looking for a link between vaccines and autism.
Yea, right.
Don't get me wrong, it would be a good thing if someone seriously tackled the remaining questions concerning vaccines and autism. But I don't believe for a second that her second remark was talking about doing that.
As for what the ND movement had to say about this? Well, if you need a good laugh go look at the attempted spin on this post at Left Brain Right Brain. Poor Sullivan tries so hard to spin this into something that is isn't but all he ends up with his is own "big oops" that should have been deleted rather than posted. But what else is new.
I think the true importance of what Dr. Landis wrote was the candor of her statements and the insight into what public health officials think of the various factions in the autism world. There is the impression that the vaccine-autism crowd is looking for a quick payday and that the ND crowd is trying to trying to turn a serious condition into a trivial debate on whether autism is a mental health disorder and whether to treat it.
I don't necessarily agree with everything that Dr. Landis had to say but I do find it refreshing that officials in the government show signs of intelligence. At least one of the above views is accurate (in my humble opinion). Here's a hint - most people who have children with autism are looking for answers and a way to help their children - autism is not a get rich quick scheme (if it is, would someone please let me in on the secret?).
I believe the real reason that Dr. Landis is calling it quits is because of what she wrote about fellow committee member Lyn Redwood. If you are going to publicly state that a college is in it for the money, you had best have something to back up your statement. She may not have intended for her comment to become public but it did. In the future perhaps she could prevent this sort of trouble by not passing notes?
Sunday, October 11, 2009
Wrong Planet, Right Ad?
I was reading something earlier today on the ever-so sophisticated wrongplanet.net when I ran into something that can only be described as hilarious.
Most of the denizens of site are of the opinion that autism is built into the person and is a part of their identity. They view it not as a disorder but as a characteristic of who they are - like someone else might feel about their race or religion. These folks tend to take a very dim view of people who even hint that autism could be caused by any environmental factor.
That's right, there was an ad about searching for measles at the top of wrongplanet.net, complete with fake little red dots on the kid's faces. Because, you know, if you are thinking about autism, the next thing you are going to want to search for information about measles. And that is so what wrongplanet is all about - measles and autism.
So, imagine my surprise when I happened to glance up to the top of the page and saw the following banner ad -
That's right, there was an ad about searching for measles at the top of wrongplanet.net, complete with fake little red dots on the kid's faces. Because, you know, if you are thinking about autism, the next thing you are going to want to search for information about measles. And that is so what wrongplanet is all about - measles and autism.
Wednesday, October 7, 2009
Autism in Twins
One of the more common things that you will hear about autism is that it is a genetic condition or that it has a "strong genetic component". I think that most people hear this and assume this means that there is some gene or mutation that runs in families that "causes" autism.
Unfortunately, autism is not so simple.
Researchers have spent a lot of time and effort searching for genetic causes for autism, and with the exception of Rett's Syndrome, have come up empty handed. Sure, there have been some small successes here and there but most of the promising leads don't pan out. A study will find a small group with a possible genetic commonality only to have the next study will come along and fail to reproduce the finding.
This leads to the question of why do we think that autism is genetic? If numerous large studies have failed to find anything that people with autism have in common at the genetic level, why exactly do we think that autism is genetic?
The answer is twin studies. There have been several studies done in the past that show that identical twins almost always both have autism while fraternal twins don't. This is taken to mean that autism must be genetic because, if identical twins both have autism and fraternal don't, it must be the shared genetics that makes the difference.
With that in mind I would like to point out the most recent study of autism in twins that was just published in Archives of Pediatrics & Adolescent Medicine -
In this study, researchers from the Kennedy Krieger Institute and Johns Hopkins looked at 227 twin pairs from The Interactive Autism Network (IAN) where at least one of the twins had a form of autism. IAN is an Internet based resource where parents can contribute information about their children with autism which can then be used by researchers. As a result of utilizing IAN, the researchers were able to look at more twins than any study has done before (previous studies had less than 50 sets of twins).
A total of 227 sets of twins took part in this study - 67 pairs of identical twins (58 male, 9 female) and 210 pairs of fraternal twins (97 male-male, 23 female-female, 90 female-male). For those of you who are not familiar with twins, the simple rule here is that fraternal twins are basically the same as siblings that happen to be born at the same time while identical twins share the same genes.
The results show that identical twins were about 88% likely to both have autism as well as (~ 90%) to have the same form and severity. However, what was not expected was that in all in male identical twins this rate was 86% while in female twins the rate was 100% and none had aspergers. Unfortunately, there were not enough female identicals for this finding to reach statistical significance but it was still interesting nonetheless.
Prior studies have shown that identical twins will both have autism somewhere between 60% and 95% percent of the time, so this finding was in line with prior results.
For fraternal twins the overall concordance was 31% which, while higher than was though in the past, is not too badly out of line. The interesting part here is that male-male fraternal twins had a 40% chance of both having autism, which is significantly higher than other types of fraternal twins.
Most other studies studies have placed the rate for fraternal twins to be the same as non-twin siblings, although a recent study out of Japan also showed a higher rate for fraternal twins.
For reference, in non-twin siblings, the rate is thought to be somewhere from 5% up to as high as 20%.
So what does this all mean for autism being genetic?
Well, because the majority of identical twins will both have the same type and severity of autism there clearly is something going on at the genetic level that can cause or predispose someone to autism. But, in at least 10% of cases, identical twins do not share their autism and in another 10% beyond that the severity level can differ.
This tells me that while genetics does play a strong role, it is not the entire story. There is something other than genetics that can determine whether someone will develop autism.
If you look at fraternal twins, they are more likely to both have autism than normal siblings. In the case of male-male fraternal twins that risk can be almost double. Remember, the only difference between fraternal twins and regular siblings is that they share the same prenatal environment and grow up in the same environment at the same time.
If autism was solely genetic there would not be a difference between normal siblings and fraternal twins, and yet there is. And in the case of male-male fraternal twins the risk is much higher than in normal siblings, and that shouldn't be the case either.
If you put these two parts together it becomes clear that there is likely something other than genetics that can cause autism. Or in other words, it is likely that there is a genetic predisposition that is triggered by some sort of environmental influence.
Obviously, I am simplifying things things a bit here and there could very well be other factors at work here. This is one study and, interesting though it is, it does not prove that there are environmental influences. But at the same time it does strongly point in that direction.
Maybe it is time to stop spending so much time looking for the autism's smoking gene and start spending more time looking at what environmental influences could be triggering it? Or here is crazy thought, how about if we devote some time to looking for the physical changes that autism causes in a person. Perhaps if we know what autism is and how it effects the body we might have a better shot at treating it?
Just food for thought.
Scientists and Dead Fish
Over at The Last Psychiatrist today there is a good post called "The Problem With Science Is Scientists" -
In a recent fMRI study, a salmon was shown a series of pictures of human faces showing various emotions: can a salmon distinguish them? and what brain regions are involved. 15 pictures, ten seconds each.I won't bore you with the anatomy. Because of the small size of the brain, exact brain structures could not be distinguished, but something in the brain did light up. A statistically significant number of voxels, comprising an area of 81mm3 in the midline of the brain, were active (p<.0001).So can fish interpret human emotions from a picture? I have no idea. I do know, however, that that fish can't do it: it was dead.
It is definitely worth the time, so go read the rest of it.
Sunday, October 4, 2009
Autism now 1 in 91
In a completely expected move, the CDC announced today that the autism is now thought to affect 1 in 91 children in the US.
This finding is largely based on a new study that was published today in Pediatrics. In the study the researchers looked at the recent results of the National Survey of Children's Health and, after cleaning up the data, arrived at the figure of 110 out of 100,000 children aged 3 to 17 have a form of autism.
The CDC has confirmed, through media sources, that the most recent (and still unpublished) ADDM data agrees with this estimate.
This number should not come as a surprise to anyone as this change has been widely expected for a while now. What concerns me is the reaction from the CDC over this issue. There has been plenty of press coverage today with reports from the Huffington Post, New York Times, CNN, NPR, and many others.
But, if you looked at the CDC's web site earlier today, there was not a word of the announcement. If you looked at the press releases on their site you would see that "Fewer U.S. Schools Selling Less Nutritious Food and Beverages" but you wouldn't see anything about autism. I realize this is a minor nit-pick, but you would think that they would at least have a press release about it on the day of the announcement.
Minor points aside, what really concerns me are comments like the ones attributed to Dr. Thomas Insel, the director of the National Institute of Mental Health and head of the Interagency Autism Coordinating Committee -
"The concern here is that buried in these numbers is a true increase," said Dr. Thomas Insel, director of the National Institute of Mental Health. "We're going to have to think very hard about what we're going to do for the 1 in 100."
He is concerned that, buried in a 60 percent increase, there might be a true increase? First it was 1 in 500, then 1 in 250, then 1 in 166, then 1 in 150, and now 1 in 91 and we are still debating about whether there is a true increase?
The prevalence of a profound disorder like autism increases by 500 percent over a twenty year period and the head of two major governmental agencies charged with addressing the problem needs to "think very hard" about what to do and wonders if the rate is really going up?
I guess the real question here is why the CDC and the US Government aren't doing everything in their power to find answers to some of the most basic questions about autism. These questions have have been asked for over a decade and it is long past for them to be answered.
Are we going to have to wait another few years and hear the same excuses when the rate of autism is approaching two percent?
Absurdities of the day
There must have been something in the air this past week because there have been strange things written in the past couple of days. Perhaps it is being caused by the anticipation of the big announcement coming tomorrow (something like pre-wedding jitters).
This brings us to the first absurdity of the day - tomorrow's big announcement. If all of chatter is correct, the CDC is set to announce that rate of autism in the US has reached 1 in 100 (or possibly higher). This is all due, of course, to the tireless work of the medical community. They have been expanding diagnostic criteria, raising awareness, and getting better at finding autism in children everywhere. Without all of their hard work for the past twenty years, we wouldn't have as much autism as we do today. So, if you happen to be talking to your child's pediatrician tomorrow, make sure you give them a pat on the back for a job well done.
The second absurdity of the day is Michelle Dawson. Michelle Dawson wrote a post yesterday claiming that it is only due to her hard work that people with autism in Canada are recognized as people. Well, actually, it was her suing her former employer for discrimination that she says did the trick. Before that people with autism were apparently not "human beings with human rights". Although, like most things in life, there is a catch - to qualify as human you have to meet Ms Dawson's definition of "most autistics" -
By "most autistics," I mean those of us, the majority of autistics in Canada, who have not received unlimited ABA-based interventions starting early in life.
So, if you are a parent of a child with autism and want to make sure that your child is considered a person you will want to immediately move to Canada and stop any ABA interventions you are doing.
(For a better treatment of this nonsense go see what Harold Doherty has to say on the subject, I can't bring myself to take such absurdities seriously).
And since strangeness, like deaths or weddings, always come in threes, here is the last one. Did you know that Hitler may have had autism?
Scientists and behaviorist have studied the life and mannerisms of Adolf Hitler, some believe he may have had Asperger's Syndrome, which is part of the Autism Spectrum. Michael Fitzgerald, an expert in the field, concludes that Hitler did indeed meet all the criteria set out by Hans Asperger.
I have Asperger's diagnosis (in 2003) and I'm a mother of two children on the autistic spectrum. ... I'm also ethnically Jewish and just the idea that someone who killed millions of Jews AND people with disabilities, including those on the autistic spectrum is claimed to be LIKE ME is preposterous! Hitler was not autistic - he was psychotic and evil.
Comparing Hitler's behaviour to that of autistic people will only further victimise us who are 'different' while giving the real abusers yet another excuse why their abuse of us is 'justified'.
So remember, if you feel the need to diagnosis a famous historical figure with autism, make sure you pick someone who wasn't psychotic and/or evil.
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