Interverbal: Reviews of Autism Statements and Research

Hello and Goodbye

2011-09-25T14:06:00.001-06:00

I am happy to say this is Interverbal’s (the blog’s) 6^thbirthday. I am sad to say this will be the last post on Interverbal. When Icreated Interverbal, I was an undergraduate just about to head out to gradschool. I did most of my best work on this blog during my first year or so as agrad student. I was younger, feistier, and very much believed in doing scienceadvocacy in an aggressive manner. I spent most of my time working onanti-quackery as it pertained to autism.

I have found that over time, my attitude has gentled. Ibecame more patient with mistakes and disagreements. My interest in constantlydebunking anti-quackery also waned. Itis clearly time to try something different. I am placing Interverbal intoretirement, but will leave it up as a resource, as I feel there is some goodwork here.

On the other hand I am pleased to announce my new blog. Which will focus on teaching children with autism.

Reviewing Green et al. (2010)

2011-02-21T13:31:00.003-07:00

Green et al. (2010) used random assignment to assess a parent based intervention for children diagnosed with autism. The study is being discussed as a marked improvement over current research in the autism field. I disagree.

With this study you get:

-Random assignment

-sample (n) >30

And that is it for advantages. I honestly think people see the words "random assignment" and a big (n) size and put this study on a pedestal. It doesn’t deserve it, even compared to what is currently available.

In group design there are the following threats to internal validity:

-History (controlled in this study)
-Experimental mortality (controlled in this study)
-Regression toward the mean (controlled in this study)
-Maturation (a problem in this study)
-Instrumentation (a problem in this study)
-Testing Bias (a problem in this study)
-Instrumentation (a problem in this study)
-Selection Bias (controlled)

I don’t see how the authors can claim fidelity of the intervention. The parents were applying the intervention (or not) as the case might be. Occasional direct measures a la the videotapes or clinical visits are no guarantees of fidelity. This is a not a minor problem when doing consultation. It is a huge problem. Also, non-blinded terminal testing such as the ADOS is a concern. Where are the direct behavioral measures?

This is not a true experimental design; this is an indirect study that uses random assignment. The use of random assignment may be an anomaly, but it is not a step forward in this case.

Notes: For a different view of this research go see Michelle's analysis.

That Annoying Voice

2011-02-19T12:20:00.002-07:00

That voice….you know the one…. Over-calm and too slow. It probably drove you crazy when you heard it at a certain point in your life. If I were to just say “the voice” in relation to education, I bet most of you would know what I am talking about. We were warned about “the voice” in teacher preparation. I have read articles by self-advocates who are not too fond of “the voice”. I typically was unimpressed early in my training whenever I heard someone using “the therapy voice”.

It was with great shame that I recently caught myself using “the voice”. I cried myself to sleep that night. Well okay, I wasn’t nearly that bothered by it. But I was a little bothered by it. Why was I unknowingly using the voice? I began to pay attention and analyze my own behavior. I noticed 3 things were true when it occurred.

1) It occurred when I taught a large group lesson, but not during 1:1 or small group lessons
2) It occurred when some of my students were getting rowdy during the lesson.
3) It occurred when I was personally feeling un-calm.

My large groups tend to be with very young students (ages 5-7). They get rowdy very easily. They are very reactive as a group to my actions and energy level. By talking in a deliberate calm voice maybe I was trying to keep the group’s energy directed. Also, it can be frustrating to try to keep the attention of 10 young persons. Everyone is responding and on task but Susie. I work to gain Susie’s attention, but then Rob and James decide to have a friendly pinching contest. Maybe I am also trying to keep myself calm and on par as I gently redirect Bob and James to find seats that are not next to each other.

There is also the fact that some of my students take longer than average to process directions. By slowing things down and sometimes pausing, I increase the chances of my students successfully following my directions.

“I need everyone to STAND UP……PUSH IN your chair….and line up at the door.”

Combine an overly calm tone with a speech rate that has been slowed down and I think you may end up with something like “the voice”. It is very true that my behavior was shaped by my students. I was reinforced by the gratifying sight of on-task, cooperating students based on how I used my voice. And while older children would have rolled their eyes at me or told me they didn’t like how I was speaking. Younger children are not older children. The avidity with which the Kindergarten set will watch (gag me with a spoon) Blue’s Clues is proof of this.

Now, even though the reason I used the voice had nothing to do with condescension , there are other good reasons not to use it. Such as the fact that it tends to annoy anyone older than 8. So, I began to look for other ways to help lead my big groups using my voice. I make use of some of the following strategies:

1) Whisper instruction very softly
2) Translate spoken drill and practice into a song
3) Deliberately speak or sing very, very fast
3) Deliberately speak or sing very, very slow

None of these are foolproof or always effective. And while they can be used to maintain student’s attention pro-actively, they are not sustainable beyond a few sentences worth of information. You will have to be judicious in their usage. I truly hope someone finds these experiences helpful.

Why Can’t We All Just Get Along

2011-02-18T15:18:00.003-07:00

This is a continuation of a previous discussion between MJ and myself in my last post. This issue has cropped up previously and I realized I wanted to prioritize the discussion and make it a little more accessible to others. My apologies to MJ for the change in format.

“That first part is as important as the second because until the community stops tearing itself apart it will be hard to move forward.”

Let’s say the Autism Hub and the AoA merged tonight and became “The Age of the Hub” or something like that. Do you really expect that the AoA editors will lay off vaccines? Reciprocity is a two way street.

When I truly think about it, I don’t agree that laying off legitimate criticism is ethically justified. Let’s say Muchoverbal (fictitious) and Interverbal are having a fight, about whether a new autism treatment study is dangerous. Should they abandon their fight so that they can both better advocate on a shared issue. Training police to effectively differentiate being high from being autistic, perhaps? It produces a good, but I am not sure it is ethically justified.

But wait, couldn’t Muchoverbal and Interverbal still work together on the police matter? Unlike the treatment study, the gaps are not ideological. They could work together on the police matter and agree to disagree on the study. Really, the gaps are only emotional.

So….. why haven’t they already? Maybe there are other gaps here as well?

Geraldine Dawson Disappoints

2011-01-25T08:16:00.000-07:00

In a New York Times, letter to the editor Dawson writes:

The latest British Medical Journal paper about autism and vaccines, which provides evidence that the initial report linking autism and vaccines was fraudulent, and the media coverage that ensued, miss an important point: Until science discovers the causes of autism and explains its dramatic increase, parents will continue to reach their own conclusions and desperately try a wide range of treatments, whether there is evidence to support them or not.

The answer is not to look to the past and look for blame, but rather to look to the future. We need increased research financing directed toward rigorous science that can provide the answers that parents are looking for and deserve. Until this happens, we will continue to wallow in controversy, and people with autism and families will continue to struggle with autism on their own.

Geraldine Dawson
Chief Science Officer, Autism Speaks
New York, Jan. 13, 2011

I do not agree with Dawson about “missing the point”. The BMJ article deals in part with the foundations of the vaccine etiology of autism movement, not its continuing trajectory. To advocate that an author call for more research in an article devoted to indentifying fraud feels like a patent absurdity. Frankly, it feels agenda based.

Also, I do not think better research would resolve the issue. I think even if damningly conclusive research were to come out tomorrow on all the issues Dawson raises, the hard-core of vaccine etiology advocates would roll on with lots of accusations of giant conspiracies. And I think a lot of the soft-core people would drink the cool-aide and stay with them.

Dawson talks about missing the point. I think this is ironic, because the obvious point Dawson misses is the vaccine etiology of autism movement may roll along in spite of all the science in the world.

Finally, I do not appreciate the way Dawson says “The answer is not to look to the past and look for blame”. Wakefield committed fraud, a very deliberate act where he knowingly misled others. And this led to harm. To advocate that we ignore this misconduct so as to better focus on upcoming research is contrary not just to ethical standards, but to scientific standards as well. Frankly, this is outrageous. I do not see scientific integrity as a priority for Dawson, and given her current position this disturbs me.

Abuse

2010-12-02T23:23:00.002-07:00

Please read the post and watch the video at Ed's blog. It indentifies a case of school based physical abuse and what appears to be the effort to suppress/punish the whistle blower.

I do think there is systemic enablement of this sort of thing. How do address this problem would be a very worthwhile post all by itself.

Silly Speculations

2010-11-17T20:36:00.002-07:00

A lot of fun is being had at the expense of a certain editor of the Age of Autism. Frankly, it seems richly deserved. Read his claims here.

A Reply to Jake

2010-10-09T13:23:00.002-06:00

Hmmmm... For some reason I can’t seem to post to the Bloomington Alternative anymore; technical issues perhaps? However since Jake was kind enough to post one last time there. I would like to offer him an answer.

“We must appreciate that this issue is not just about science - far from.”

Oh, no arguments from me on that one.

“Which in this case is just fine.”

The logic of arbitrarily picking a point that looks like it fits your guess and then drawing your parameters around it is so circular my head spins trying to follow it. I heavily criticized the Geiers for doing just that in their correlative study on this issue.

“All the CDDS was good for was finding correlations anyway, not associations.”

Not even that. The CDDS has made is crystal clear that the changes between quarters are not to be considered new cases.

I think we have boiled down to a few points where it looks to me as if we are echoing what has already been said. I think it is time to introduce new arguments or go our separate ways.

Help Vote

2010-09-23T09:38:00.001-06:00

"There are two subjects, indeed, which I shall claim a right to further as long as I breathe: the public education, and the sub-division of counties into wards.
-Thomas Jefferson

I am writing in appeal that the readers will help with our PAWS program. The Presenting Academics with Success (PAWS) Program is an ambitious notion bringing together broad segments of the community to benefit elementary aged students. The PAWS program uses High School students, grandparent volunteers, and University Students to serve as academic tutors and appropriate role-models for our students. The PAWS volunteers will serve in a variety of sub-programs such as additional classes during the summer for at-risk students, English as a Second Language, Special Education, and afterschool/homework club.

After having seen the mock-up for the program this summer and having noted the measurable increases in student performance, I strongly urge everyone to help us pursue funding via a Pepsi Refresh grant. We need more votes to win and gain the grant money. One can vote by simply sending a text to the number 73774, and enter 102480 as the message. Or go to www.refresheverything.com
Go under the $250,000 category and vote for the PAWS program. You can vote once per day.

Book Review: The Dumbest Generation

2010-09-06T21:58:00.000-06:00

Probably the most interesting argument Mark Bauerlein makes, is to insist upon his concern for...even high regard of the millennial generation. His second most interesting comment is insist that his words are obvious conclusions based on an objective review of data. Sadly, neither appears to be true.

Mark Bauerlein is a professor of English and produces the most data for his arguments concerning civics and humanities (surprise surprise). He trots out scary statistic after scary statistic. The problem is that his scary statistics are in isolation. He trots out the tragic performance scores of High School seniors concerning the foundation of our Nation, but fails to share any similar statistics for previous generations. References for previous scores that go back even just as far as the 80s are rare enough to be notable. Is it pitiful how few US High School Seniors know who James Madison is? Of course it is, but how do they compare to their peers in the 70s...60s...50s...40s? Having that sort of data to compare is not trivial to Bauerlein’s argument, in fact it is everything. He is arguing that there is something different about the current young generation... and that the difference is the technological culture popular among the under 30 crowd.

His arguments concerning science and technology are even feebler. He gravely informs us that roughly 3% less College students want to be engineers in the years post 2000 compared to the 90s. However, the most abysmal thing about Bauerlein’s work is the sense that it is cultural whining masquerading as concern for the state of the citizenship of the young. When the good professor laments the fact that in 2002 only 11.4% of young people saw a play and only 2.4% saw a ballet, I admit that I begin to view this former director of Research for the National Endowment for the Arts with a very jaundiced eye. Generationally based, cultural snobbery dressed up as alarmism I call it.

Interesting New Study

2010-05-29T23:26:00.000-06:00

Liu, King,& Bearman have published a fascinating new epidemiological paper.

Here is the abstract:

“Despite a plethora of studies, we do not know why autism incidence has increased rapidly over the past two decades. Using California data, this study shows that children living very close to a child previously diagnosed with autism are more likely to be diagnosed with autism. An underlying social influence mechanism involving information diffusion drives this result, contributing to 16% of the increase in prevalence over 2000-2005. We eliminate competing explanations (i.e., residential sorting, environmental toxicants, and viral transmission) through seven tests and show that information diffusion simultaneously contributed to the increased prevalence, spatial clustering, and decreasing age of diagnosis.”

I cannot offer firm opinion based on the abstract alone, but I would be somewhat skeptical as to how well they could account for residential sorting, environmental toxicants, and viral transmission. However, I will reserve criticism until I can read the study in full.

On the other hand, what a completely fascinating study! This is an interesting insight that might actually lead to some good follow up research. Time will tell.

Struck Off: Dr. Wakefield

2010-05-24T23:26:00.002-06:00

Dr. Andrew Wakefield has been struck off the medical register in the United Kingdom. He has been in effect, de-licensed. Dr. Wakefield drew a connection between the Measles Mumps and Rubella vaccine and autism, which evolved into a number of movements. He didn’t begin these movements (they predated him, possibly significantly in some circles), but he gave them credibility.

Way back in 2005, I wrote about some of the problems these movements caused. And also why the premise was flawed. What was true then is still true today, but even more so. It is easy to search and find an extensive list of Dr. Wakefield's sins, which we didn't know about in 2005.

New GFCF Study

2010-05-22T10:32:00.001-06:00

A new GF/CF study will be presented at IMFAR. Hyman et al (2010) took a challenge based approach, which is different from what has been seen so far. The authors enrolled 22 pre-school aged children and placed them all on a GF/CF diet. The children were given a snack once a week that either contained gluten/casein or placebo. Snacks that contained gluten and/or casein were designed to be indistinguishable from the snacks that did not. This was described by the authors as an “exercise in innovative cooking.”

Strengths:

Innovative design
Nice use of a challenge based methodology
Solid, double blind methodology
Smart controls over history and maturation threats

Weaknesses:
22 participants is a respectable number, but it still could have been higher.
Can’t answer for the diet’s efficacy for children with actual bowel conditions (Celiac etc)

Conclusions:
The autism community has been waiting a long time for a study like this. The best we have seen up till now has been the Elder (2006) study. The methodology is simply rock solid.

Predictions:

I do not predict that this study will have any effect on the advocates of the GF/CF diet. For some reason the GF/CF advocates have been more polite than some of their colleagues. They have typically responded to negative GF/CF studies by trying to find flaws in the study methodology, rather than silly accusations about “shills”.
They will do the same here, I think. My guess is that they will target the number of participants (which is silly in this case). They will also target the time-span (18 weeks) the children were on the GF/CF study in total and on the diet before the first gluten/casein snack was given (4 weeks). Such criticism will be irrelevant however, as there are no standards in this regard. I expect plenty of goal posts to be shifted. I am convinced at this point that being an academic GF/CF advocate means never having to pick an actual study length.

Medical Hypotheses

2010-05-18T23:01:00.002-06:00

Medical Hypotheses is a non-peer reviewed journal founded by the late David Horrobin. The way Dr. Horrobin is described varies greatly. I have heard him described as a brilliant, if somewhat eccentric scientist. A serious researcher with over 900 peer reviewed articles. An entrepreneur who marketed his products without having demonstrated their safety. And according to an obituary published in the British Medical Journal “he may prove to be the greatest snake oil salesman of his age”.

Dr. Horrobin founded Medical Hypotheses in part to serve a unique niche. It was to be a place where hypotheses and ideas could be published in the absence of a sometimes stifling peer review process. It was a sort of book of the month club, with articles picked by the editor because they were “interesting and important”. And to be fair, some undoubtedly produced good in the world.

However, this journal also left the door open for quacks. It gave the appearance of “science” without its discipline or rigor. And while maybe something like Medical Hypotheses was necessary in 1975 to serve as the coffee house for novel scientific ideas, it is obsolete in 2010. That role is better served by the internet; which is more accessible, has a bigger audience, is even less censored, and lacks stifling page limits. The only thing that an internet blog lacks is the assumed stamp of quality science.

Long story short, Elsevier, the publisher of Medical Hypotheses has had enough. They fired the current editor and are about implement peer review. In my view this came a dollar short and day late, but I am genuinely glad. It strips away an undeserved authenticity for those using Medical Hypotheses to promote autism quackery.

Full story here

About Interverbal

2010-05-11T21:50:00.002-06:00

About Interverbal, both the person and the blog.

I am employed in the field of Special Education. I am current or past member of several behavior analytic, gifted/talented, and special educational professional organizations. I formally declare that I am financially vested in none of these societies.

All visitors to this blog are welcome to comment in a manner they see fit. Vehement disagreement is permissible; however comments must be on topic, and must involve actual argumentation. No drive by character assassination or trolling please. Also, no services, events, or research recruitments may be advertised on this blog…period.

Violating posts will be removed.

Confusing Differentiation with Belief

2010-04-18T13:23:00.002-06:00

A fellow school teacher, Julie Obradovic posted an interesting article over at the Age of Autism. She compares the educational practice of differentiation to help meet individual needs, to what she presents as the one-size-fits-all practices in medicine. I think this is a great comparison, if one’s goal is to move away from science based medicine and towards a far looser interpretation of evidence in medicine. I am not convinced this is a good thing at all.

Differentiation is a buzzword in the educational world right now. Differentiation is also part of the triad that makes up current zeitgeist in US education. Along with evidence based practice; the idea that we should be able to substantiate and make hard decisions based on collected data i.e. (testing data or other sources). And Response-to-intervention (RTI) a philosophy of using various interventions, pre-referral to special education and/or a replacement to the discrepancy model for determining if students meet criteria for Learning Disability.

With these facts I mind let’s take an in depth look at the post.

“In one class, for example, I may have to address 15 different things in just one aspect of one lesson. Suzie can't hear well out of her right ear so I have to make sure to stand where she can. Johnny doesn't do well without paper and pencil tasks, so I have to make sure to modify whatever we're doing to meet his needs. Peter is visually sensitive to print on stark white paper so I have to make sure I used colored paper when making copies.”
“I could go on with one hundred more modifications.”

No doubt she could, this is part of what it means to be a teacher. Some researchers suggest that we make 130 or more decisions an hour when directly providing instruction. However, the examples given here are simply accommodations; this is only one type of differentiation.

“As a parent, I strive every day to treat my student's academic needs as I would want my children's to be treated. And I know that the overwhelming majority of my colleagues do the same.”

When we talk about simple accommodations and the Gardnerian tailoring of lesson to meet multiple learning styles then we usually get good acceptance. When we begin to talk about modifying according to product for the exceptional (in any regard) child or differentiating by grouping in such a way that effects our pet classroom formatting, then in my experience teacher buy-in tends to decline. Let’s not present the broad concept of differentiation as overwhelmingly beloved and accepted… because it is not.

“We don't necessarily have to differentiate our student’s instruction. We do it because it's best for them, in spite of the fact that it is time consuming and inconvenient to do so.”

“Necessarily” being the key word. As Julie herself notes, we are required to do some modifications/accommodations via Section 504 plans or IEPs. As for other reasons we differentiate… I am all for recognizing teacher nobility, but not at the expense of creating a dichotomy between caring, concerned teachers, and square-peg-filing medical professionals. Especially, since this is a false dichotomy.

“Same content. Same outcome. Different methods of getting there.”

That’s not the totality of differentiation. Rather we should be saying….Sometimes different content… sometimes different outcomes…. Often different methods. I think Julie is limiting the concept of differentiation so as to be convenient to her point.

“When we advocate for safer vaccines and safer vaccine schedules, isn't all we are asking of our physicians is to have our children be treated as individuals?”

Look at what Julie just wrote, she is asking specific questions, not broad philosophical ones. She is trying to equate her specific beliefs with ideals that I suspect few professionals have an issue with. The problem isn’t the broad concept the problems are specific science based issues dressed up as a broad and noble ideals.

“I can't imagine in this day and age presenting my student's parents with a syllabus and saying this is what we cover, this is the only way I do it, and there will be absolutely no exceptions to this regardless of how your child is doing.”

Sweeping generalization, I feel no need to defend against what is obviously untrue.

“Alternative help is a waste of money.”

Maybe, maybe-not, if advocates or such can present well conducted research that demonstrates an effect, maybe it is worth our consideration. So, can they?

“It sounds funny when put in an educational context, but that's precisely what is happening in the pediatric one.”

Only if you strawman the situation in way that actually represents neither.

"It's their JOB to identify susceptibilities to heavy metals and other vaccine ingredients.”

So, it’s their job to substantiate an alternate hypothesis you happen to believe? This has nothing to do with differentiation, it is belief based medicine.

“It's their job to work with you and listen to you. It's their job to make sure your child is healthy and thriving and meeting their milestones, and it's their job to figure out why they aren't...with REAL, CONCRETE, MEASURABLE EVIDENCE from which to draw their conclusion.”

1) It is indeed medical professional’s job to listen to you; it is not their job to substantiate what you believe.

2) If there are hard data that support some alternative beliefs in autism, then where are they?

3) Drawing a conclusion as to what exactly? There are no hard guidelines…. there are no genuine standards as to how we differentiate. Some of the gurus of differentiation admit as much. I have heard them talk about “artful practice” and “exercising professional judgment”. Julie is using some of the popular terms, but only to the extent that they are convienent.

Here is what Julie leaves us with:

1 A mish-mash of various education concepts

2 A misrepresentation of the concept of differentiation

3 An appeal that this misrepresentation be applied to the medical field

4 An ultimate argument of belief based medicine

I’ll keep my differentiation in my classroom thank you.

What I Have Learned

2009-11-17T22:43:00.002-07:00

A few years back when I was still a Masters student, I found myself in discussion with a mother of a young child diagnosed with autism. She predicted that when I had begun my professional career that my opinions on a variety of topics such as the vaccine etiology of autism and the value of Neurodiversity would change dramatically. I did not find her suggestion to be dismissive. In fact I found it worthwhile as an evaluative exercise.

Well, I have spent several years now in a professional capacity. The time seems ripe to engage in a full analysis. In short, some of my opinions have certainly changed or altered, and some have not. Some of my readers may disagree or even feel annoyed by my comments, but….. no apologies. The one thing that truly has changed is that I now feel better about the opinions I hold than in any time in the past.

1) I believe as strongly as I ever did that autistics themselves are the primary stakeholders in discussions about autism. That autistics need to be on the directory and executive boards of major autism advocacy/education groups.

2) I believe that seeing autism, only in terms of a collection of deficits is really bad idea. I do not think this is a good approach in any developmental difference, delay, or disorder.

3) However, I have also seen that some of our parents truly are heroic. Some of our kids meeting criteria for autism take significantly more time and care. I have seen profound labors of love. Such parents are heroes, and they deserve recognition as such…. Period…. and this is a change of opinion for me.

4) I feel much better about collaborating with non-behaviorists than I have in the past. It has at least been refreshing and interesting. Also, I take satisfaction in the event that our analyses conflict, that I produced the decidedly superior analysis (just kidding…. Well mostly).

5) I have enjoyed doing voluntary additional coursework towards gaining a Gifted and Talented teaching endorsement, in the event (it has already happened) that some of my students with special needs also have areas of genuine giftedness. G&T teaching is mostly run by the constructivist school of thought, which is very different from behavior analysis. However I am fond of it. I have learned some valuable tips about how to better direct intrinsic reinforcers with high ability students

6) G&T education has also taught me some perspective. I have learned than some problems that I thought or heard were special problems within behavior analysis are actually endemic to the whole field of education. I cite insularity as a particular example. Also like the autism field, I have noticed that G&T education also has a whole range of popular lousy arguments that pop up time and time again. My least favorite being the argument that we should provide specialized educational services to gifted and talented kids because it might later benefit us in some way (i.e. They invent a cure for cancer).

7) So, I suppose you can say that in some ways, I like behavior analysis even more than I did in the past. I like the way my behavior analytic colleagues in public education do it; down to earth, practical, fun. They do more with fewer resources and I think they might even have more fun sometimes.

8) At the same time, because I am one of the few people with a strong interest in behavior analysis itself in our district, I feel more separated from some of the aspects of behavior analysis as a field that I do not like. And I think this has been a good thing.

9) It used to drive me crazy when people would bag on behavior analysis. I spent a lot of time trying to convince people why they were wrong or mistaken about some problem they had with ABA. It used to truly upset me. I no longer feel the same desire to engage them, especially when I know they are grievously wrong, as opposed to just having a minor misunderstanding.

10) Probably the biggest change of all is that I no longer feel much patience with poor or illogical academic arguments, whatever the flavor. I do not feel the same interest in deconstructing the latest bit of alternative autism medicine from our friends elsewhere on the internet. Or explaining why anyone who says that prevalence rate of autism was 1 per 10,000 and it is now 1 per 100 should have their license to practice amateur epidemiology promptly revoked. Or showing how an anti-vaccine internet group that reviews vaccine epidemiology isn’t even doing basic addition problems correctly.

11) And this is just as true within the neurodiversity community. There have been times I have gone to read a post on a neurodiversity blog, and I realized, that I did not agree with a single thing that was written. This doesn’t bother me the way it did in years past. It also bothers me less now when I tell someone “you know what, I completely disagree”.

12) At the same time I have the same love of a good academic analysis that I always had. In fact I have come to see the dichotomy between academic and practical analyses as being somewhat artificial.

13) So, there you have it. Maybe we will try this again in another 3 years and see what, if anything has changed.

The Hub and Ideas

2009-09-19T21:28:00.002-06:00

I am going to start by offering a bold premise; there are other good autism information groups, but nothing else that blends science and advocacy as well the Hub. I say this not to assign a “good job”, gold star to the hub, but simply to recite a fact. I feel comfortable recommending others to the hub when searching for basic or advanced autism information. This is not a privilege I extend to other places or groups; even one’s who claim good science or advocacy.

So, it is an honor to write a blog included in the hub and yet…. It also is not. I think the “honor” is in the quality of our thinking and writing, it comes from us. It is not implicit; it can diminish or even go away entirely. The seeming goals of Hub; namely, the countering of bad autism science and promotion of autistic rights might be worthy goals, but not enough in themselves. I suppose then you could say that I find the Hub honorable, but only as long as we behave honorably. We behave honorably by neither sacrificing science, nor losing our strong ethical base. Also, by keeping our logic intact even on difficult issues and by carefully explaining in such a way that teaches others and not merely engaging in drive-by ethics or the scientific, intellectual variant of schoolyard bullying.

To challenge and substantiate, that is the direction I want to see us take….. and largely, we do.

Since its founding in 2006, the Hub has only gotten bigger. I swear, it almost seems impossible to keep track of all the newly added blogs. And with this expansion have come new faces, new ideas, and sometimes more disagreements. Sometimes I almost feel, as if I wish the Hub would go back to the originals. But not really…..

I think it was always the intention for the Hub to grow, and even important…. maybe even inevitable, that it do so. I also think that the neurodiversity movement, as it pertains to autism, to still be in its tumultuous childhood. This is in spite of it being at least 15 years old and the broader disabilities rights movement being older still. I think because this movement is still developing there are questions yet to be formally answered.

I am also going to offer a prediction. I predict that these questions below will not spontaneously go away. And that they will persist and be a continuing source of conflict among various persons in the hub (and not just a few individuals).

1. What constitutes respectful language toward autistics on the Hub.

2. To what extent is intra-Hub debate permissible, on what issues, and by whom?

3. To what extent is criticism of the Hub’s general direction permissible?

4. To what extent is one obligated to deal with unscientific or unethical comments that appear on one’s blog?

5. What are the goals of the Hub, stated more specifically than they are now?

Happy Birthday Interverbal

2009-09-15T21:08:00.002-06:00

This blog is four years old today.

I am going to reprint one of my favorite posts for this occasion.

Way back from Nov 2006:

Shall I compare thee to a norm referenced score?
Thou might just be two deviations from the mean.
Rough charting makes it hard to know for sure.
And lack of data may create a lean.

Sometimes, too great the fallacy exists.
And often is the reasoning post hoc.
And in irrationality the issue mists.
By natures design we are fetter’d; such is thy lot.

But by this, thy reasoning, good data shall not fade.
Nor lose possession of great virtue, epistemological.
Nor shall any reliable measure be un-made.
When under scrutiny most logical.

So long as logicians syllogize, and parents sigh.
So, long as we push, and continue to try.

Bullying: II

2009-09-08T19:46:00.002-06:00

From what I can tell, different situations lead to different types of bullying. Maybe some of these are not really bullying, but they are grey areas and still a concern.

Age discrepant rough-and-tumble play

This occurs when an older child plays too roughly with a younger one. This may not be true bullying per se; in fact we probably wouldn’t consider it as such if both children were the same age. Understand that there are probably not bad intentions here, just a case of the older child not understanding his/her strength. Often just a reminder to both children about what the expectations are for acceptable play e.g. (no wrestling, tripping, etc) is sufficient.

Teasing

Sometimes teasing and jokes are fine and sometimes it turns into bullying or is interpreted as such. When dealing with young children it falls to adults to keep an eye on the situation and control it if necessary. However, if things do get grey area, it doesn’t require a nuclear level response. Often a simple verbal prompt is sufficient. Also, providing specific training where students learn to indicate that they do not like or appreciate certain jokes can be helpful.

Opportunistic Bullying

Occurs when there is a true power differential by age, size, behavior, or cultural factors. The bully engages is physically aggressive or verbally demeaning behavior meant to hurt or harm. This occurs in situations where the bully is unlikely to be caught. In school providing adequate supervision in hallways, recess areas, and lunch rooms goes a long way to helping prevent problems. Popular culture likes to present this type of bully as coming from a disadvantaged or broken home. In my experience sometimes this is true and sometimes it is not. Bullying seems to be a trait that can appear even in kids from very stable homes.

“Good citizenship training” for everyone in a school (including potential bullies) is purported to help reduce instances of bullying, but I am ignorant of any method with sufficient quantities of research behind it to back up that claim. I think that it is most important to remember that there is no perfect solution for this type of bully. Remember that bullying is an ancient human behavior and that like all such traits it is impossible to totally eradicate even on the small scale.

Remember that:

While not exclusive to children, in some cases bullying is an age specific behavior that will be naturally countered by other contingencies as maturation occurs.

Bullying is more likely to occur among children among different ages and sizes, simply by benefit of the children not realizing their own strength.

Rather than repel potential bullies, the tough-guy act can actually attract people looking for a fight.

Training kids to be polite and assertive and to bring in an adult’s help is usually a better tactic when dealing with a bully.

Some young people of a certain age (read: some teenagers) like to make silly or flippant remarks, especially to strangers. This can be interpreted as bullying, but often it is simply young people engaging in an age-appropriate misbehavior (an oxymoron….. I know). Often smiling or telling an appropriate joke of your own is sufficient to set everyone at ease.

Some people seem to be naturally intimidated by teenagers, even ones who are not big and strong. Don’t be, they are just young-adults/big-kids. I have seen adults put on a tough-guy act around teenagers and honestly I think it is because they are intimidated by them. In my experience this usually alienates the kids.

Opportunistic bullies work by isolating the person they bully. Teach others not to be afraid to seek help.

While bullying as a human trait may never go away, that does not mean that specific cases of bullying are hopeless. Some sort of help is almost always available.

Bullying: Part I

2009-09-07T11:42:00.001-06:00

Introduction

A few years back I was supervising an afternoon recess. I was watching Mike, a young man with various disabilities (not autism), playing American football with some other boys his age (about 10). The boys were practicing hiking the football (the initial quick pass backwards that officially begins each play), when rather suddenly Mike jumped forward and called out “hike!”. The ball was passed, but another young man rather roughly pushed him back and took his place and the other laughed.

I was angry; this smacked of bullying, and the young man who had done the pushing had a reputation as sometimes getting up to mischief (sassing teachers, sulking, etc.). I headed over to have a little talk with this young man. However, while I was on my way he stepped back and another young man took his place, and then another boy hopped forward. A few turn later Mike went forward and received his hike without concern. I looked again at the group of boys and I realized there was something of a line. It wasn’t a very traditional line, I do not think it would have passed muster in a school hallway, but it was a line none the less.

Mike had jumped this line pure and simple; he had cut in front of the other boy. Nor was he the only one to try, as I continued to watch, other kids also tried to cut and this generally ended with the same results. I did not quite grasp why they occasionally tried to line- jump. However, they seemed to think it was funny whenever someone tried.

In this case what I saw wasn’t bullying, it was young people engaging in rough-and-tumble play. This type of play appeals to certain kids, both boys and girls, students with and without disabilities. Far from being an opportunistic bully, the young man was treating Mike exactly as he would any of his typically developing peers. And Mike clearly grasped this little group’s rules as he demonstrated by laughing after he was pushed and later correctly only stepping in on his appointed turn. I would later come to know this young man as a true friend to Mike and that he had been friendly and welcoming toward him for years.

This was inclusion, but inclusion based on this little group’s rules. There is this teacher’s ideal vision where play-based inclusion involves an orderly board game, or kite flying, or polite discussion of one’s favorite colors. This is true in certain cases, but it isn’t going to fly with a set of rough- and- tumble 10 year olds who are on their outside play-time. And if a student with disabilities gravitates towards that set, and is naturally fully included, then this is typical play. You want inclusion…. you got it.

Part II to follow shortly…..

Why I support ABA Insurance Billing Changes

2009-03-28T09:14:00.002-06:00

I am aware there is some concern over proposals in various States to force insurance providers to cover ABA as it relates to autism. I am going to take what may be an unpopular position and argue in favor of such. I understand this may frustrate some of my fellow bloggers; and while this is unfortunate, I think most of our peers at the hub will at least hear my reasons. Maybe a question-answer format will best address this?

Q. Why support the proposals regarding Insurance support for ABA and autism?
A. All students have a right to an educational method that actually can successfully teach them. The idea of what constitutes appropriate goals of education is in debate. Regardless, the zeitgeist in the human service field is toward evidence based practice. This concept props up research based teaching and begins to fade pure theory based teaching.

Currently there are four methods of teaching relative to autism that have some level of support. One is ABA, also TEACCH, Occupational therapy, and speech therapy. That is it…. There is nothing else with an evidence base beyond quasi-experimental designs. I will advocate for any of these four, although speech and OT are often alreadt covered under insurance.

Q. But ABA has been called into question?
A. The groups designs have been questioned to a degree, not the single case designs, of which there are multiple examples and which are consistent and well designed for a number of techniques. ABA literature in autism has developed to the point where there are often multiple research based techniques available for teaching the same skill. This is not opinion, it is fact.

Q. So, why support the law if it only supports ABA?
A. I am all for allowing TEACCH to written in as well, but I am not going to pull my support for that reason. It is not personal; I would still support this proposal even if it was TEACCH that was being promoted.

Q. But ABA targets autistic behaviors, not just academics, right?
A. Yes it does…. so advocate for a focus on academics and what you believe to be more appropriate behavioral goals. I am not unsympathetic, but I will not pull my support for what would have to be a shift of the whole human service field. If you think that general eclectic or Floortime programs are somehow even one mote more respectful of inherent autistic differences then you are simply wrong. In fact I cannot think of any programs that can be considered exemplary in this regard, not even Montessori schools. If that changes I am happy to revise my opinion.

Q. This medicalizes autism, don’t you think?
A. Autism is already deeply medicalized. It is a billable code for many… many services. The services range from the evidence based to Jungian/Tibetan sand play therapy, under the guise of counseling for teens with autism.

Q. Well, then we shouldn’t feed further into the medicalization of autism, right?
A. Fine, so advocate that terms be changed to better fit the view of autism you wish to promote. The reality is some autistic students need tutoring or additional educational work, just like some typically developing students do. They still have a right to have substantiated practices used to educate them….again… just like their typically developing students do.

Q. Then why not put them into standard tutoring, just like their typically developing peers?
A. Do not confuse equality and equity. They are not the same thing.

As always, comments welcome below.

Using the Word “Retard”

2009-03-22T18:57:00.006-06:00

It is disappointing for me whenever I hear someone use the word “retard” as an insult. I am sure this is not a unique experience amongst hub bloggers. Nor are we likely to be the only ones who feel this way. The Special Olympics has even come out with an r-word petition.

But in some ways… maybe many ways, this isn’t going to change things. I am prepared to argue that the use of word “retard” as a pejorative is most common (although grown ups make this sort of error too) among teens. I want to focus on that in this post. In my view, there are rather unique motivation factors that influence teen behavior and make this behavior particularly likely.

There seems to almost be a mystique attached to teenage verbal misbehavior by our culture. References are made to hormonal imbalances and changing brain structures as if layman’s appeals to the medical model are somehow a sufficient answer in and of themselves.

In contrast I tend to look at the fact that teens are by definition at a point of transition. The simple and often direct contingencies of behavior management that have governed their lives up till this point are being faded and more cognitive or delayed rule-based-behavior contingencies are replacing them. Concepts, memes, and ideals become increasingly important. As these shifts take over, the teens become more able to discriminate contradictions, exceptions, and inconsistencies.

However, until these discriminations are firm, there will be uncertainty as to what constitutes acceptable limits of a given contingency. The teens will, as we say “test the boundaries”. Moreover, if a teacher or caregiver adds in a simple contingency to counter this, there may well be an inadvertent counter contingency. This happens all the time with swearing. It is punished when emitted in front of a teacher, but reinforced in the presence of peers. This reinforcing aspect is possibly increased by aggression reinforcers, based on a time when emitting the same word was punished. In other words, the more it is punished in one situation the more reinforcing it is in another.

I have spent a fair amount of time working with teens both with and without disabilities. It seemed the more I discouraged the use of this term the more the teens employed it. Some used it, I think; to get a reaction out of me. So, I made a classic mistake. I increased the severity of my reaction. Whereas before, I gave a verbal reprimand, I now gave written write-ups. This did eliminate the behavior around me, but it continued when I was not around. I wonder in the end, if my actions made a lick of difference in this regard.

Upon reflection maybe there was another strategy. Maybe instead of punishment I could have employed a specific explanation illustrating the rule based contingencies that controlled my own behavior. In other words, I could explain why I chose not to use the word “retard” as a pejorative. This may or may not result in a shift in the contingencies.

Ultimately, if I am correct about the managing contingencies, then strategies where the use of the word “retard” is turned into the equivalent of a swear word, will only increase the usage of this expression.

There is yet another strategy too. I think it is inevitable that many teens are going to at one point or another emit comments that are rude, cruel, or derogatory toward an entire classification of people. Perhaps then, another strategy is to tolerate the misbehavior to degree. This does not imply acceptance, it implies that we understand that this is likely to be an age specific misbehavior that will be intrinsically countered as maturation occurs. If this is true, then our duty is then to provide appropriate models of the verbal behavior employed by adults in our society.

A Review of Insidevaccines’ “Scary Stats IV: Polio”.

2009-03-08T23:44:00.002-06:00

I would like to take this opportunity to review “Scary Stats IV: Polio”. This is my third review of an article from the Insidevaccines blog. Some might wonder why I am reviewing a science issue not related to autism. Well, as said before, Insidevaccines is sometimes described as a model of good science. They are quoted on occasion by those advocating a vaccine etiology theory of autism.

I was very interested to see how well this claim held up. Vaccines are by no means perfect, they do cause injury, and it is possible that they cause at least some cases of autism. Any clarity on vaccine science, even if it points toward an uncomfortable truth, is a good thing. However, one will not find that at Insidevaccines. The first two articles I reviewed had rather remarkable errors of logic and science, this one was no different.

The worst problem in the article is the graph of polio over the years that appears early in the article. It correlates polio with DDT and other chemicals. This is cherry picking on an absolutely epic level. The authors at Insidevaccines state that the discussion will not address the relationship between DDT and polio. The authors give their rationale for using this graph as being that it begins earlier and gives a more accurate picture of the pattern and extent of disease notifications prior to the Salk vaccine. Further, Insidevaccines links to the same or similar graph stretching back further into the 1800s and based on general historical commentary to produce the data points.

The source of the graph is a New Age site promoting a range of metaphysical ideas and alternative medicine, complete with advertising tours for sacred places of power. However, what is interesting is that the site author does not even get simple ideas like incidence correct. Further still, the site author doesn’t mention how s/he obtained the data for the first half of the 20th century.

So, this is what Insidevaccines leaves us; a graph the veracity of which we cannot check, which attempts to correlate DDT and other chemicals to Polio. I argue that their choice was an inappropriate and ill served their readership. That they did not address the argument for DDT as a cause of polio is no excuse. In the realm of science, even in the realm of popular science you present what you mean. If the authors at Insidevaccines do not agree with the DDT argument then they should have created their own graph. Or if they did agree they should have offered their support for this idea. By leaving it as is, their actions do lend themselves to charitable description.

The authors write (references removed):

“Depending on whether you consult the CDC data compiled for parents or the CDC data compiled for medical professionals, the fatality rate for paralytic polio is between either 2-5% or 5-10%."

If one journeys to the source one will see that the CDC is providing a general rate and then a rate for a specific age group.

“The actual historical data from the peak years: 19,794 avg. acute cases in 1941-1950, which is 0.6% of the total average births for the US from 1941-1950”

Actually, based on the sources the authors’ provide, they miscalculated here. It should be 1.0% of the total average births.

“In 1951-1954, an avg. 16,316 paralytic cases (notice that this data conveniently stops at the time of the definition change and the introduction of the Salk vaccine, thus implying that subsequent reduction in incidence is due to the vaccine. Unfortunately for this hypothesis, the Salk vaccine was shown to have very little positive effect, prompting the switch to the Sabin vaccine)”

A lesser effect is not the same as “little positive effect”. In fact in the field trials, the Salk vaccine was found to be over at least 60% effective for all subtypes of polio and often more than 90% effective (Smith, 1990).

“Based on Table 1, using the hypothetical birth cohort of 3,803,295 infants as stated in the article, we get 1,179 paralytic cases per year, with an estimated 23 (2%) to 118 (10%) deaths. For 60,974 cases of polio, using CDC metrics of 200:1 inapparent:paralytic (leaving aside how they can project an estimate for an inapparent infection), we would get 3,048 cases of paralytic polio, resulting in 61 (2%) to 305 (10%) deaths, rather than 723.”

The Insidevaccines authors are taking a rate from a single age group and trying to apply it across ages. This comparison has no validity.

“So, what can we conclude from these discrepancies and contradictions? The data doesn’t support the headlines. The numbers presented by vaccine defenders do not stand up to scrutiny.”

Actually it is the poor mathematical practice used by Insidevaccines that is the problem here.

“Our analysis above shows that data are not consistent within an individual publication, or from one publication to the next.”

Offering different rates based on age cohorts or via total should not be a problem for a careful reader. The authors at Insidevaccines have failed to exercise this concept.

“Sometimes, they do not even correlate with numbers from the CDC, an organization whose primary objective appears to be the defense of vaccines!”

This is a ridiculous claim. One does not have to like the CDC or even think they are good people, to recognize this claim as absurd.

“Is their work just sloppy, erroneous, or intentionally misleading? Are they so focused on marketing the vaccines that they are unwilling to critically parse the data? Perhaps they think parents aren’t paying attention.”

Insidevaccines has made basic errors in mathematics, reasonable comparison, data checking, and graphical presentation. Are they prepared to argue that they are paying attention?

In the first article I reviewed from Insidevaccines the authors note that many who advocate for vaccines want nothing to do selective or delayed vaccinators. The authors challenge this stance, as delayed or selective vaccinators may be allies who advocate for certain vaccines. In response, I wrote a number of concerns I think should be addressed before any collaboration was considered. I would like to add a few more.

I think potential allies:

Should accurately quote science

Should not pull graphical shenanigans

Should not mis-compare data

There is room for disagreement and debate in the world of vaccines and autism. Any site that offers science or criticism that illuminates the issue is a blessing. Unfortunately, it is clear that this role will not be fulfilled by Insidevaccines.

Reference

Smith, Jane S. (1990). Patenting the Sun: Polio and the Salk Vaccine.

Mercury challenge misunderstandings: A guide especially for parents new to autism

2009-02-24T19:14:00.001-07:00

Making decisions as a parent of a child diagnosed with autism can be tough. This doesn’t mean it has to be, just that it can be. One of the reasons it can be tough is that popular culture or the internet will bombard you with a variety of education plans, treatments, or therapies, many of which will claim to be scientifically proven or evidence based, but very few of which even come close.

One of the popular theories in the US, is that autism is caused by one or more forms of mercury. Where the mercury comes from depends on who you talk to, vaccines, dental fillings, fish, lights, computer screens, forest fires, and cremations have all been named as suspect. That may seem tricky enough, but the real question is in how children diagnosed with autism deal with the mercury.

Some sources claim that children diagnosed with autism are poor excretors of mercury. In other words for some reason they don’t get rid of the mercury their body accumulates (either in a fast or slow way) and that it poisons them and results in autism. For this group the advocates claim that mercury poisoning is difficult to assess. They may recommend assessing other biological factors as evidence. Or they may recommend a challenge (provoked) test for mercury.

Just to be clear, a provoked test is when a chelating agent is given to the patient and then the mercury test is administered. Some chelating agents bind to mercury and/or other heavy metals making it much more likely that they will be cleared from the body. This step is important for advocates of the poor excretor hypothesis, because they argue that the chelating agent captures mercury in the body. An increase between a non-provoked test and a provoked test is evidence of this according to certain parties. Or even without this non-provoked test, a provoked test that comes back in an elevated range can be evidence of this all by itself. However, others who advocate a mercury etiology of autism theory do not seem to put stock in the poor excretor theory. They advocate straightforward testing without a provoked test.

For a parent considering heavy metals testing a good first step is to decide which variant you believe in. These theories cannot both be true, they are exclusive. Children with autism are either poor excretors or they are not. And while some might try to be ingenious and claim that sometimes it is one and sometimes it is the other, I would ask the reader to decide whether this is truly a valid argument.

If a parent decides that the poor excretor hypothesis is unlikely, then there is no need for a provoked test.

If on the other hand a parent decides the poor excretor hypothesis is valid then a provoked test may seem reasonable. This is where my concerns begin.

My core concern is this; there is no mercury scale that was normalized with participants who were first given a provoking agent. This means that any of the provoked measurement will have to be compared to a scale established only with non-provoked samples. This is innately invalid, and yes, invalid is the right word here.

This is why: When one wants to establish a statistical scale, one must first create the conditions under which data will be collected. After data are collected a mean (average) is determined as is the standard deviation, which is simply a statistical way of determining how far away (in either direction) a given score is from the average. However, if you try to compare a given score taken under different conditions from how the scale was formed, it is no longer meaningful.

These data taken under different conditions were not included when the mean or standard deviations were calculated. For them there is neither mean nor standard deviation. The comparison is meaningless, and there is no way right to compensate for this problem at the moment. And while this may be a standard practice for many labs and practitioners, anyone who tells you these tests can be used to determine mercury poisoning is not using any recognized standard of science or statistics.

If you are a parent please be aware of these facts when you consider a provoked test.

Mercury Autism Tests Are Flawed

2009-02-20T19:18:00.000-07:00

Please everyone go read the Quackwatch article on urine metal testing. The article makes it crystal clear what the problems with this technique are. If you are a parent of a child diagnosed with autism who is considering or has done heavy metals testing you will especially find this article interesting.

Confusing Literary Criticism for Science

2009-02-15T12:26:00.002-07:00

Continuing to read up on the Insidevaccines group blog I decided to search their blog on my own interest which is Autism. I then found and read Helen Tucker’s “Bad Writing Can’t Save a Bad Study” published by Insidevaccines under a new title of “Vaccine Science??? Part II”. Having read Tucker’s piece, I read the article she reviewed, and then re-read Tuckers criticism. There are indeed a number of problems with Barlow et al. (2001), but what is remarkable, is that Tucker cannot seem to correctly identify a single one of them. Instead what Tucker offers us might be called a form of literary criticism.

“The entire paper was a convoluted description of how Barlow et al whittled the 679,942 children they said they studied in the abstract, to the 624 children they actually did study. The procedure was so complex that they used up most of the “Methods” section to explain it, and then resorted to a flow chart to present the final sample size as one of the results of the study.”

First, the entire paper is not a description of the ascertainment procedure, but instead contains all the appropriate components we should expect to see. Anyone who has thirty seconds can verify this. Second, saying the authors “used up” the methods section is silly. The methods section is as long as it needs to be. In fact in some research with complex procedures, the methods section is notably longer than what we find here. What is an actual concern in writing up research is a page limit for a given journal. This means authors must sometimes weigh what get the most attention. However, this is not the same thing as what Tucker describes.

Continuing, in the methods section the authors do describe a complex procedure. They are both scrupulous and clear in the description of ascertainment. This does not mean they lack the necessary parts. They have headings for (1) Study Sites, Sources of Data, and Identification and Classification of Cases, (2) Data on Immunization, (3) Statistical Analysis, and (4) Follow-up Study. Moreover, in the results section the authors do use a flow chart to present data on what they found in terms of unanalyzed data for seizures. Frankly, so what? Tucker’s criticism here has absolutely zero bearing on statistical problems or internal validity.

“They did not find any increased risk for nonfebrile seizures for either vaccine, compared to the control group (the non-recently-vaccinated). Any increased risks were then downplayed by comparing study seizure rates with “background” seizure rates obtained from the same HMO’s.”

No, they didn’t downplay increased risk. The authors are very clear here; there is no room for confusion and no reason to state that risks were downplayed. Here is what the authors actually said:

“Using the background rates of seizure in the Group Health Cooperative, we found that there were 5.6 and 25.0 additional febrile seizures per 100,000 children receiving DTP and MMR vaccines, respectively. Using published background rates of seizure from Kaiser Permanente of Northern California, we found that there were 8.9 and 34.2 additional febrile seizures per 100,000 children immunized with DTP and MMR vaccines, respectively.16 For these calculations, we used the estimated relative risks in Table 1 for each period of exposure, since these are the best estimates.”

“This paper is so muddled that it is tempting to suspect that it is muddled on purpose, as if to obscure fundamental flaws in its design. However, in the end, the flaws are too monumental to hide behind a fog.”

And yet Tucker never seems able to cogently present what flaws these might be.

“A relative risk study should have never been retroactive in the first place–it would have been easier and more scientifically valid to follow children who were either vaccinated or not vaccinated.”

Again, Tucker misses the boat. Relative risk studies can be, and are indeed done all the time using databases that were already in existence. That data have already been collected is in itself a frivolous criticism. The actual concern should be how well the given database controls for the 6 types of random and systematic statistical error and how well the authors collect those data. Building a case for how they collected data from the Vaccine Safety Database (VSD) is something the authors spend a fair amount of time doing in their methods section.

“The risk ratios are meaningless without knowing how many study and control children did not have seizures.”

Huh? Yes they did! The way data were collected there is a bias towards missing seizures that did not require hospitalization. However, there is no reason to think that severe seizures should bias the association, as the authors themselves note. Based on what the data indicate the authors can calculate how many children did not have seizure… at least severe enough to warrant hospitalization.

“The control group itself was poorly distinguished from the study group (recently vaccinated vs. non-recently-vaccinated), especially in a long-term study.”

From the article:

“The reference group at the time of the seizure was composed of children matched for
age, calendar time, and HMO but who had not had a vaccination in the preceding 30 days.”

So, actually the difference was between groups was quite clear. As to the long-term follow up why would it be different if not explicitly stated? The authors noted at least one such explicit difference in their description of the follow-up study.

“Inclusion in and exclusions from the study were inadequately justified, yielding a sample that cannot be considered representative–of anything.”

The authors explicitly describe who was included and who was not. As to her comment about not representative, I have no idea what logical process she took to reach such a conclusion.

From the article:

“716 were confirmed to have had a first seizure during the study period. The primary
reason for nonconfirmation was the identification of an earlier seizure.”

So, the author didn’t include kids who had an earlier seizure. In other words the study is representative of kids who didn’t already have seizures at the time of their DTP and MMR…. seems pretty fair to me.

“And perhaps the most glaring of all, the follow-up study excluded the most widely reported neurobehavioral diagnoses temporally associated with vaccines: non-infantile autism and pervasive developmental disorders. Murkiness on details can’t hide errors this egregious.”

The authors use the clinical manual of the ICD-9, this is appropriate as this is what the doctors used to report to the HMOs in the United States. And while some of the PDD criteria are used in current autism epidemiology via the ICD-10, the practical everyday reporting happens with the ICD-9-CM. However, most of the recent autism epidemiology in the West is done using the DSM-IV-TR, a completely different manual altogether.

Tucker’s criticism here is unfortunate, because at the year of publication there was little evidence that other PPDs and specifically PDD-NOS make up the majority of the PDDs in the epidemiology. In fact the good epidemiology such as Bertrand et al. (2001) and Chakrabarti & Fombonne (2001) used to help establish this fact would first appear in the same year as Barlow et al., but wouldn’t receive confirmation until Chakrabarti & Fombonne (2005) several years later.

In summary, Tucker indentifies no statistical problems, nor concerns with instrumentation, history, or selection bias. In fact Tucker identifies no threats to the validity of Barlow et al. I like reading science criticism and I like reading literary criticism, but I prefer a cleaner delineation between the two.

Further, some criticism needs to be directed at Insidevaccines. This may not have been their article, but they selected to reprint it in full with author permission, but without comment and give it blog-time on their site. Again they are the ones promoting it and so can be held in part accountable for its lack of quality. That one or more of them didn’t write it is irrelevant; it is re-printed in full on their blog, this is what matters.

For a blog that gets promoted as a model of good science I have thus far been very disappointed by Insidevaccinesm both in the current post and in the one I reviewed the other day. More time will be needed to see if some of their other “heavy science” articles are better than this. And while forming a group that looks at vaccine issues from a variety of viewpoints might be a good thing, sacrificing science in the process is not.

References

Bertrand, J., Mars, A., Boyle, C., Bove, F., Yeargin-Allsop, M., & Decoufle, P.(2001). Pediatrics, 108, 1155-161.

Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. Journal of the American Medical Association, 285,3093-3099.

Chakrabarti, S., Fombonne, E., (2005). Pervasive developmental disorders in preschool children: confirmation of high prevalence. American Journal ofPsychiatry, 162(6), 1133-1141.

A Review of “Vaccines? Safe. Parents? Dangerous”.

2009-02-14T01:59:00.004-07:00

“Inside Vaccines” is an interesting blog that offers views from a variety of standpoints concerning vaccines issues. Like many group blogs the articles differ massively in quality. This blog is seen by some as a model of good debate and scientific advocacy and is promoted by certain parties as such. For my part, I think someone really ought to systematically review “Inside Vaccines” and see how well this claim holds up to scrutiny. Some of the articles seem a bit creative in their interpretation of epidemiology.

Relative to our topic today, I would like to review “Vaccines? Safe. Parents? Dangerous”. I cannot determine whether this post has one or many authors. This is of no concern. What is a concern is the attitude toward science promoted within the posting. I will quote large chunks of the post and my reply to them below.

“Lately I’ve been noticing an increasing number of journal articles, blog articles and opinion pieces on a terrible problem: Parents have questions about vaccines.”

This is not a problem. It is reasonable and perhaps necessary to inspect both current health issues and older science from time to time. Scouring for merit and questioning are the tools by which correction of science may occur. However, what is a problem is the promotion of pseudo or anti-science under the guise of self-correction. For many of us, this is our concern, not the legitimate questioning of science.

“You would have to look far and wide to find anyone who thinks that these questions are valid and should be taken seriously.”

Perhaps the author(s) of the post have done neither.

“Common explanations are:1) It is all about the parents who think they are really smart.2) It is all about the parents who are very stupid and read stuff on the Internet.3) It is all about the bad stuff on the Internet which is deceiving the parents who aren’t very smart and who think they are smarter than doctors. And infinite variations on this theme, which is really one argument…and the real argument is (drum roll)…vaccines are perfect and parents are the problem.”

And do we see this among the science based bloggers or scientists that are well known? Or is this a reference to Mr. Haggen-Daas, your grumpy and opinionated old neighbor down the street. If you mean the former, I think I am going to have to ask for quotes or call straw argument at this point.

“Oddly, however, the number of parents with questions seems to be increasing. Perhaps the vaccine defenders need to reconsider their approach.”

Yes, the numbers do seem to be going up. That is okay, questioning is not the problem. I don’t think science has anything to fear from questions. On the other hand, there is a big problem when information is dressed up as science, but is actually.... not science.

Let me be direct here. I do not care if people question vaccines. For that matter I do not care if the majority people hear a variety of argument and adopt a very different view from the one I hold. What I do care about is the consistent application of science; this is a concern based on logic. What I also care about is that people have a right to be given accurate even if emotionally hurtful information; this is a concern based on ethics.

“Here are some suggestions, kindly meant, from an admirer of their efforts. These guys have put a lot of sweat equity into defending vaccines and they ought to be getting better results”

Why so? People exposed to our arguments will still make up their own minds. Our efforts do not somehow intrinsically merit the greater popularity. Of actual concern to me and those like me is how science is used and promoted.

“One argument which comes up over and over again is herd immunity.”

This actually seems to be a talking point of the vaccine etiology of harm theory advocates, not of those bloggers who hold a similar view to myself. I am not saying that it is never used, but that it is rare. In fact, I would argue that herd immunity is one of the favored whipping-boys of those who advocate a vaccine etiology of harm theory and that mention of it is disproportionate. I think a great little “study” would be to look at the Autism Hub and look at the Age of Autism blog and see how many times “herd immunity” pops up and who uses it. The results could be quite interesting no matter what they find.

“In addition to the defenders acting as though all vaccines are identical in their efficacy, safety and relevance, they also tend to act as though all vaccine questioners are identical. Anyone who has a question, is, in the defenders view, anti-vaccine.”

You treat us as monolithic; moreover you offer no quotes or references for such an opinion. Your comment here should not be mistaken as being logically sound.

“And people who are anti-vaccine are bad people. As a result the defenders respond with sarcasm, rudeness and repetition.””

There are indeed people who are largely or wholly anti-vaccine. They are not the majority, but they are out there. I do not think of them as bad people. I do not think of them as fools. I understand too, that all people are going to occasionally land on a stupid, illogical, or anti-scientific comment, perhaps in spite of their general inclinations. To counter-act this, I select to make my own arguments which attack and correct the errors that I see. Some people may be hurt by the information I provide or by the questions I pose. Even so, I am obligated to speak up if I see a problem, this is the same for anyone and everyone. I would cite failure to do so, as a form of unethical behavior.

“Some parents who raise concerns are just raising concerns. They haven’t gone over to the dark side. But with enough rudeness and sarcasm from the vaccine defenders they will definitely be moving in that direction.”

They may, but that is their choice. Do not misplace their decision on others. Please note, I am advocating neither the appropriateness of rudeness nor sarcasm, but only that people can select a course based on what they value. In my view however, this course of action is particularly illogical. It is not their emotions or desire to be treated with respect that is illogical, but their decision based on their emotions. Most of us will have had a teacher at some point in our lives we could not stand. Does this somehow make what they taught us untrue? Do we now have license to reject fact, because we were mistreated?

“Which leads me to the next problem. It is not, absolutely not, all about autism and vaccines.”

True, but for many of us coming from many views, this is indeed the main bone in contention.

“Try being polite and sympathetic. I know this is tough and doesn’t come naturally, but it is absolutely essential if the vaccine defenders want to get anywhere in this battle.”

I understand polite, but what do you mean by sympathetic? Do you mean that I should:

A) Consider the author’s view and try to understand their feelings?
B) Accept (or at least avoid questioning) certain accounts that my inclination towards science has taught me to question?
C) Both A and B
D) None of the above

There are two choices above that I am going to reject as being unethical.

“The articles on this blog provide good models for a sympathetic, thoughtful and scientifically oriented approach.”

I would be interested to know which of the above your particular post models.

“Vaccine defenders need to deal with the science. Saying that the science is all on the vaccine side, without actually presenting said science is a hollow argument.”

Here we stumble upon some agreement.

“A sub-point on science: the scandals about faked science in medical journals are undermining people’s faith in doctors and science in general. If Merck did some bad stuff with Vioxx, is it unreasonable to have questions about their trustworthiness when it comes to Gardasil? The defenders need to be able to explain why vaccines are an exception to dirty dealing from the pharmaceutical companies. I’m wondering about this one myself and look forward to seeing what the vaccine defenders come up with.”

It has been tackled before…. multiple times in fact. The blogosphere is a big place, no doubt explaining why you missed it. The answer is this; vaccines should not be a special case, but the general case. Because companies are run by imperfect beings they occasionally deal dishonestly. This is a very good reason to be careful, scientifically conservative, to expect replication, and to revisit old issues. This is no excuse at all to offer a carte blanche dismissal of well designed science.... no matter who funded it.

“Calling people anti-vaccine isn’t actually an argument.”

Exactly, it is a description that may or may not be accurate.

“Selective and delayed vaccinators are potential allies who will fight for vaccines, but currently the vaccine defenders want nothing to do with them. Some of these parents are quite knowledgeable and have done extensive research into vaccines. They know more of the science than the defenders, frankly.”

If you are going to offer an argument, then offer an argument please.

“But defenders want nothing to do with them, because in a black and white world you are either with us or against us and there is no middle ground. Pushing away allies is dumb.”

If we both advocate for certain vaccines then we are already allied on this particular issue, right? If this is the goal then we simply press on. But if what you mean is actually mutually coordinated advocacy then I would want to know to what extent you will be simultaneously advocating your other views that I do not agree with. And to what extent will I be creating a platform for you to advocate such views. Also, I would want to know whether I am expected to put aside our disagreements, because of our coordinated advocacy. Based on this cost-benefit analysis I may or may not see our collaboration as the best option. Perhaps too, the people who want nothing to do with the selective and delayed vaccinators see a proposed collaboration as creating more problems than it solves. I think mutually coordinated advocacy is possible, but a number of issues would have to be resolved first.

“Now comes a truly tough one: The vaccine defenders should be strongly, passionately, in favor of a philosophical exemption to vaccines.”

I am in favor of such, but not for scientific or practical reasons. My agreement here is based on an ethical reason, the right to self-determine, in this case via proxy. My agreement here is neither strong nor passionate. Instead it is tentative, quite possibly to be removed. The post author(s) predict that this would actually increase the vaccine rates. I see zero evidence for that. It may be true, but then maybe not. If not and certain vaccine rates plummet, then one or more very serious health issues could arise. If so, then I would argue that a significant amount of parents have failed to be a reasonable proxy for their child in this regard, and that philosophical vaccine exemptions should be removed.

“Now, listen carefully, because this is the most important point of all. Defenders should stop denying vaccine damage.”

Illness or injury from vaccination happens. A new or newly modified vaccine may not be as safe as initial tests suggest. A batch may go bad. An individual may have a unique or rare reaction. Although there may very well be disagreements about rates of injury, that fact that injury itself occurs is not a point of contention among any players in the debate.

“When a parent testifies that their child was damaged by a vaccine they should fall all over themselves to acknowledge what happened, to agree that vaccines can, indeed cause injuries, to encourage the parent to report what happened to VAERS, to sympathize if they say the doctor denied the incident and refused to report it.”

Wouldn’t this depend on the case? If you said that your child regressed a month after her MMR and now meets criteria for Autistic Disorder, I am probably going to question whether there is a connection. These events are not that close in proximity. I have reason to question and/ or to suggest that you question your assumptions. If I offer nothing but sympathy, then I am probably helping you feel better, but I am also engaging in enabling behavior towards anti-science. It seems to me that the author(s) try to assume the mantle of science, but reject it when expedient.

“They even see, as I recently did, a vaccine defender proclaiming gleefully that the VAERS system is useless and cannot be used as a source of information about the risks of vaccines. What sort of message are vaccine defenders sending out to the public? Clear enough, unfortunately.”

The VAERS does a good job doing what it was designed to do. Being a rapid and ongoing system to monitor and hopefully detect problems with vaccines. It is an imperfect system, but it does the job it was designed for. When it is forced fit into epidemiology then the VAERS has very little utility. It is a database that controls for none of the 6 types of statistical threats. It has been used this way by a variety of people working on a variety of issues. The VAERS data are un-refereed and uncontrolled. Don’t confuse monitoring and formal epidemiology, and don't twist a data set into something it is not.

“On the same note, a good study comparing vaccinated and unvaccinated populations will obviously prove that vaccines are safe, right? So why don’t the vaccine defenders fight for such a study? Vaccines make children healthier and the evidence should be easy enough to find. Yes?”

I have no problem with additional research. However, since this is what you are calling for, this is your burden.

“Are they really fighting to defend vaccines or are they just out there to tell everyone how smart they are? Some of us are wondering.”

Using an ad hominem to close I see.

Well, thank you for the advice. I would like to reciprocate your gesture and offer some advice too.

1) Do not claim to be an admirer of our efforts and then slander us with ad hominem arguments, we will note the inconsistency.

2) Do not claim your blog as a model of science then abandon it when an emotive issue arises, we will note that your work is not as scientifically oriented as you claim.

3) Do not claim your advice is kindly meant and then deploy arguments that are really quite snotty. We will question your work's intellectual integrity.

Thank you for your time.

ABA and Misrepresentation

2008-10-26T23:20:00.000-06:00

Every few years the issue of whether ABA is quackery or not kicks up on the Hub. It seems to be cyclical. It is a debate I have been a part of before and seems that I have the opportunity to do so again. Recently some discussion along these lines has popped up again. I believe the dissenter’s criticism can be summarized as one or more of the following:

1. ABA is best summarized as quackery.
2. ABA does not have affirmative research.
3. ABA destroys or reduces a different autistic style of learning.
4. ABA is emotionally traumatic to autistics.
5. ABA intrinsically leads to physical or emotional abuse.

Criticism can be good, it is certainly necessary that criticism be given, but not all criticism has merit. It is our job (that means all of us) to scour what is said for merit. Because the five points listed above are troubling, I believe they deserve to be addressed in a serious and frank manner. I have selected to do so on my blog because it is the most powerful and open advocacy tool I posses and I believe the issue merits it.

My responses:

1. ABA is best summarized as quackery.

Quackery is best defined not by possessing an outlandish theory, but by failing to allow research to inform theory. In quackery the rules are set, the theory is inviolate. The more things change the less quackery does. However, behavior analysis does change in accordance with research. The theory is not inviolate. It adapts. For example as an upper level undergraduate I was impressed and quite taken with some research that suggested that stimulus-stimulus pairing might help non-verbal students increase their vocalizations. It made crystal clear sense theoretically. There was an article or two that showed an effect. So, I busily engaged myself drawing up research that could help replicate or extend the initial research. However, new research appeared by time I began to work on this issue. The research showed little to no effect via this technique.

I was severely disappointed. I had worked hard in the initial stages or writing and now my idea was shot all to pieces. That is the way it goes in science. If you are not willing to look stupid you can’t do science and I certainly felt foolish at the time. But it wasn’t just myself….. others who were interested in the area also moved on when the new research emerged. The field adapted in response to the research.

But there are other examples as well; evidence shows problems with the extinction burst and humans. All of this is discrepant with theory. Further, a major review was done several years past concerning all existing applied research in the area of verbal behavior. The authors found some ideas were well supported, others not so well at all. These are just a few exmaples.

If one searches, one can probably find an anti-scientific or quackish remark from one or more behavior analysts somewhere. Probably even from Dr. Skinner somewhere. I see this as irrelevant however. The best description of the general case of behavior analysis is a field of study that changes in response to research findings. That rules out quackery.

2. ABA does not have affirmative research.

First I want to distinguish between two types of research. Group design and single case design. Both, if designed correctly can answer a question in a powerful and legitimate way. However, it depends on the question and upon the specific design. There is no such thing as a one size fits all research design.

In autism and ABA there have been a number of research examples using group design. Some of these studies have received a fair bit or criticism (of varying merit) some of which has come from other practitioners of ABA. I accept some of the criticism of certain studies as correct, but not so for others.

However, the majority of the work concerning applied research of ABA in autism comes not from group studies, but from single case design. For specific techniques the evidence record is excellent and very broad (well over 1000 studies). One can correctly assess the efficacy of ABA without assessing the single case design. Moreover some techniques researched in ABA are shared concepts with the cognitive paradigm. Mutual exclusivity comes to mind. The research here has even been a cooperative effort for certain research examples. Moreover there are shared research endeavors between speech pathologists and behavior analysts. Again, the research record for certain techniques is very strong.

3. ABA destroys or reduces a different autistic style of learning.

I admit the above idea is possible, but I don’t think so. Nor does it have anything like an adequate proof at this time. But one can make predictions based on the theory and see how well the theory holds up. For example based on this theory we might predict that ABA reduced or destroys an autistic child’s ability to acquire high level splinter or savant skills. But I myself know several examples of children who participated in ABA who acquired savant skills while they were still in ABA or just after. So, already we know from anecdote alone that ABA and the acquisition of savant skills are not exclusive.

However, this does not answer the question of whether ABA interferes to a lesser degree with the acquisition of these skills. The way to test this would be to assess a large group of students in ABA against a large group in an alternative learning situation that is as unlike ABA as possible. A matched pairs design could be used with the matching to be done along the lines of the existence of certain materials in the home and school environment. The numbers children with savant skills could then be compared.

This would be a good first step in proving the above theory. But this burden falls entirely on the shoulders of the advocates of the theory. And of this time, it is merely theory.

4. ABA is emotionally traumatic to autistics.

I have no doubt that this is the case for some autistics. I know of none, but I am sure it is the case. Just like it is the case for certain non-autistic persons going to a mainstream school. However, I believe it is incorrect to generalize from a specific case to the general case in both instances. In my experience it is not true that autistic children in contemporary ABA problems cry more than any other program with children of comparable age. Nor do they seem less happy to from what I can tell. Nor is there any data to suggest that ABA causes PTSD.

5. ABA intrinsically leads to physical or emotional abuse.

This is rubbish pure and simple. There is not a shred of data to support this. I know certain behavior analysts who are incredibly conscientious about this issue. I remember being taught by a well known behavior analyst to avoid even mildly aversive procedures like time-out like the plague and how to “go to a knee” or even sit down to avoid being intimidating to a student if we had to talk about a behavior problem.

I believe this to be relatively close to the general contemporary case. I know there was physically abusive behavior committed by early behavior analysts in the 60s-90s. I feel no inclination to answer for these which I have clearly stated I am against, than I do about physically abusive behavior committed by non- behaviorists during that same time span or even today.

Why Did the Chicken Cross the Road?

2008-09-15T07:35:00.001-06:00

This is blog is 3 years old today. For the last two years I have done something special and lighthearted on this anniversary and this year will be no different. And what do I intend to do? Well…. I plan to shamelessly steal a theme Skeptico used a few years back for his Blog’s Birthday.

And so…. let's ask some folks enagaged in autism internent debate....

Why did the chicken cross the road?

Maria: You say that the evidence does not suggest that the chicken crossed the road. However, the researchers did not in fact assess this question with the permutations of anti-icing surfaces, humidity control, cloud coverage, breed of chicken, maturity of said chicken, relative wind velocity, relative traffic that day, the traffic consisted of a hybrid vehicle, the quality testing of said vehicle, and whether the chicken was in fact bearing any coconuts…… taken into account.

Mark Blaxill: If you think your ridiculous critique of the theory of chickens crossing roads is valid. You should submit it to an academic journal. We shall now thoroughly discuss my supplemental and supporting research of this issue here on my blog.

A certain set of researchers: We were quoted as citing an article that shows chickens do in fact cross Freeways. Unfortunately, somebody….. showed that our supporting article merely had a chicken crossing a deer path in the woods. However, we feel that deer paths and superhighways are quite similar and see no need for further clarification on this issue.

Michelle Dawson: Has anyone bothered to ask what the ethics are of chickens crossing roads?

Alyric: Did the chicken choose of its own free will to cross the road?

McEwen: Chicken crossing a road… chicken crossing a road…. Now dears, that reminds me of an amusing anecdote that happened last week on the way to the grocery store….

Kathleen Seidel: [Kathleen locks her vision upon the road, and the road suddenly becomes mobile and passes beneath the chicken, leaving it startled but completely unharmed.]

Autism Diva: The chicken was running away, because it didn’t want to be chelated. Smart chicken.

Do’C: If you have evidence of chickens crossing roads, you may present it, otherwise….. have a nice day.

LB/RB Team: We are going to go ahead and suggest that it was to get to the other side.

Interverbal: You ask “Why did the chicken cross the road?”

“Chickens cross”

Is an assumption on your part. You are assuming what you should be proving, and therefore employing the fallacy of begging the question.

Proud of the Hub: 3 Years Later

2008-09-14T12:43:00.000-06:00

Tomorrow this blog will be 3 years old. I suppose that this would be a good opportunity for reflection. I have seen lots of writing, lots of effort, lots of really good discussions, and a few highly interesting disagreements. It has been very educational for me and I would hope that one or two others have taken some sort of benefit from this blog as well. It is both frustrating and sad that I no longer have the time to blog as actively as I once did. However, I am happy that so many new blogs have joined the Hub and are actively participating.

I am happy too, that the core values of the Hub remain intact. When the Hub was first formed a few years back it was somewhat smaller than it is today. When this blog was invited to join the brand new (at the time) Hub, it was only with some trepidation that I accepted. This type of venture often fails and I worried that philosophical disagreements between the original members would result in the implosion of the Hub. One of the fundamental truths about the Autism Hub is that its constituent members align to some degree with the philosophy of Neurodiversity. And that those who attune with Neurodiversity are... well …….. diverse!

However, despite the expected disagreements, the expected implosion never occurred. Cleary there is something different about the Hub…. Something that lends cohesion. I think this relates to the core values of the Hub, both what is stated and what has become unwritten Hub policy. The respect we ask for autistics, the encouragement of self- advocates, the finding the good, the humorous, and even the beautiful as it concerns autism in our own lives, or in the lives of our families, or in our profession. And we accomplish all this in spite of, but not in disregard to…. Our differences.

Interverbal
Proud member of the Hub since 2006.

Much Better MSN Feingold Article

2008-07-26T15:13:00.000-06:00

After a highly credulous Feingold article last summer, MSN manages to get someone who knows what they are talking about. Our favorite online news-source medical expert….Dr. Rob does a reasonable job providing factual information about food sensitivities and ADHD.

For the casual reader, the Feingold diet was an elimination diet that gained some popularity in the 70s and 80s as a treatment for hyperactivity and ADHD. There was some early research that indicated it might be useful, but by the mid 90s it was clear that the larger, better controlled studies were not showing an effect.

As always none of this deterred the believers, as the comments from last year show. But that is another story for another day. Thank you MSN!

Criticism and Behavior Analysis

2008-07-06T18:25:00.002-06:00

Well here we are again, in what is quickly turning into a very broad disagreement. Christschool's latest response "But this is Sparta!" is now out. My reply will be in point-counterpoint format.

"My Rebuttal: I never stated that there hasn't been group studies in which non Lovaas behaviorists have done. What I stated, which is contained in the quote you used was that the 47% myth has "never been replicated independent of Lovaas' small group of behaviorists"."

Oh I see; but I notice that a little bit of verbal dexterity is required to make this work. There has been a replication that produced 48% by a Lovaas student and there have been other non-Lovaas students who produced statistically significant research in this regard. However, there has certainly never been a non-Lovaas student who produced the famous 47%. Well then, I cheerfully cede the point.

"Thus, using Interverbal's own self selected reference we can see that there has been no replication of Lovaas' 1987 47% myth according to Sallow, Graupner (2005)."

To support this, Christschool sites the following from Sallow and Graupner (2005):

"There have now been several reports of partial replication without using aversives"

Of course, this is not what Sallows and Graupner argued at all. By defintion we can only produce a partial or systematic replication, because a portion of the indepedent variable (aversives) are absent. Sallows & Graupner are clear and up front about this.

However, a systematic replication is still a replication. This type of replication either extends the population parameters of the original study (external validity) or allows us to analyze changes in the independent variable. Sallows & Graupner do both. It is a different sort of replication, but it is a replication regardless.

"Based on my background as a commercial bankerHYPERLINK "http://www.careeroverview.com/commercial-banking-careers.html", I would make an educated guess that 800 employees would translate into about a revenue number of nearly $30 - $ 50 million per year ( I have no proof of this number, but like Interverbal states when he says behaviorists are qualified to discount possible PTSD complications from ABA because behaviorists work with lots of autistics and are qualified to make this determination, I too wish to employ my expert background in commercial banking to assert that revenue number)."

I do not take issue with Christschool's argument, but I wish he would not misrepresent mine either. I do not argue that behavior analysts are qualified to discount PTSD, unless of course they have credentials and experience in the area. Some behavior analysts do have expertise in PTSD. One of my undergraduate mentors was an expert and researcher in PTSD. However, I argue that we see no evidence of it. If we see no evidence of it and no science exists to the contrary why would we study it?

I analyzed this in my last post using a rhetorical device; namely, displacing certain words words into Christschool's argument to create a new argument that accurately reflects another view of autism that both Christschool and I oppose. The point I made was that Christschool's logic was poor in this regard.

"For instance, and I don't mean to pick on Interverbal here, but when I stated that vaccines have caused autism in children (based on information supplied to me by 2 children who had been diagnosed with autism as a result of undergoing vaccines as children) and that there aren't any studies that have been done to look into possible complications from vaccines such as autism, his response wasn't what I would expect from a curious and science based person."

I think this was a poor argument when it had the words ABA and PTSD and I think it is still a poor argument now.

"Afterall, DAN! has scienceness studies too and all produced by DANNITES!"

No, it does not have applied science. This is a false comparison. The biom advocates have some basic lab science, but not applied science. Although, there have been some limited studies of both the GF/CF diet and Mb12 shots. Both studies indicated no effect.

"Similarly, researchers outside Lovaas' circle can't produce the 47% figure either, only those "certified" Lovaas replication sites can produce the 47%, oops, I mean the 48% indistinguishable criteria."

A callous argument to the point of error. A change from 47 to 48% will be within the band of error. Moreover, despite the verbal dexterity used to frame this argument, there is existing research with statistically significant results which was not produced by Lovaas' students.

"I purposely did not refer to Sallows in my previous post, "Skinner Confuses Science with Terminology", because he is just too easy to discredit on circumstantial grounds alone"

Only if we employ a fallacy.

"Is this what passes for ethics in Behaviorism? Is this what passes for science in Behaviorism? Lies, damn lies and emotive marketing. No different than DAN! and just as scienceness."

Individuals make their own choices. The WEAP site does not reflect the way I or others discuss ABA. Nor does this tell us anything about behavior analysts' ability to accept criticism.

"Interverbal, I stand by my statement. No replication has ever occurred outside one of Lovaas' inner circle of behaviorists and I disagree with you. This is Sparta!"

I acknowledge that with the specific wording you are right. Frankly, I think the point is worthless? My concern is that a replication exists at all, not who did it. Although, I notice once again that others also achieved statistical significance who were not in Lovaas' group.

As to Sparta, I think I have demonstrated that behavior analysts can and do accept criticism when it is shown to have merit. You have not cogently argued this point. Instead you give an example of one center advertising in a way we would both disagree with.

Christschool, if you had argued that "sometimes behavior analysts incorrectly quote ABA science or autism science", then we would not be having this debate. We would be in total agreement. Instead you argued broadly that behavior analysis, is unscientific, a point you have massively failed to support. The best evidence you have for your original argument, that behavior analysis is unscientific (in other words that this is Sparta) are the dancing Spartan heads on your blog.

Not Sparta

2008-07-05T23:45:00.004-06:00

The following post is offered as a reply to Christschool's recent post "Skinner Confuses Science with Terminology". - Noam Chomsky". My responses to Christschool will be in a point by point basis.

"It's been my experience that behaviorists are quick to recoil and become defensive with inquiry that challenges their "science". From my observation, behaviorist's reaction to skepticism is very similar to the alternative/biomed advocates."

I think it first necessary to draw a distinction between the science of behavior analysis and the philosophy of behaviorism. These are not quite the same thing. It is possible to practice the techniques of behavior analysis and not philosophically be a behaviorist. I would argue this happens regularly in clinical psychology.

Some may ask; doesn't it seem strange that there is both a science and a related philosophy? But I would argue that this is not strange at all. I myself belong to several philosophies which complement and direct my inclination to science, but are not part of science itself. These include the philosophies of skepticism, empiricism, determinism, and materialism.

But to return to the point, yes, some behavior analysts can be very quick to dismiss criticism. Our approach can be dogmatic. I would even argue that as a field, behavior analysts have been worse than average at accepting criticism from those outside the field. One of the ways I have selected to help counter this trend is to operate a blog, which at least on occasion, delves into behavior analytic issues.

However, it would be faulty logic, a non-sequitur in fact, to assume that because behavior analysts are on average worse at accepting criticism from the outside, that the science of behavior analysis is a pseudo-science.

"Both groups cite as evidence studies, anecdotes and faux terminology to support their positions."

The idea that it is faux terminology is the idea one would need to first prove. This is the fallacy of begging the question. As to the anecdotes, he is correct, even though this is a person specific error.

"The behaviorists use Lovaas' 1987 study and his unique 47% indistinguishable criteria HYPERLINK "http://www.autismpartnership.com/test/ibt.htm"(which has never been replicated independent of Lovaas' small group of behaviorists) to sell their "services".""

This is simply not true. There have been any number ABA autism group studies that were not conducted by Lovaas' immediate students. An even basic review of literature will show this to be the case. Also, Sallows & Graupner (2005) state:"We found that 48% of all children showed rapid learning, achieved average posttreatment scores, and at age 7, were succeeding in regular education classrooms. These results are consistent with those reported by Lovaas and colleagues (Lovaas, 1987; McEachin, Smith, & Lovaas, 1993)."

One can argue that Sallows & Graupner (2005) also had unresolved threats to the validity of their study (and I would agree) but one can not argue that they produced different results from Lovaas (1987).

Furthermore, it is the ad hominem fallacy, to argue that one is wrong and/or dishonest because of whom one is. The fact that some of the research has originated by Lovaas' students should not bias us in interpreting the results. I do not argue that Christschool is wrong for the following reason, but I will point out that the group I usually associate with this fallacy are the vaccine etiology of autism advocates. This seems like an appropriate comparison for the sake of accuracy, since Christschool states that his latest article compares behaviorism and the alternative/biomed advocates.

"However, they conveniently leave out from their marketing materials the fact that the children in that study were never randomized and were subject to physical aversives. Is that honest or is that protecting the dogma of behaviorism?"

Fair question, behavior analysts like any human service providership must make sure the public and specifically consumers have enough information to make an accurate judgment. This has not always been done correctly in my view. However, Christschool had best be careful to acknowledge that this is individual specific. It is not nearly true of all behavior analysts.

"Do scientists leave out very relevant facts (no randomization and the use of physical aversives) in discussing their results with prospective customers?"

Yes, sometimes they do. I don't agree with this practice, but this failure is hardly limited to behavior analysts. One of the most common (and most valid) criticisms we hear from the anti-vaccine movement, is the lack of correct sharing of information by pediatricians and vaccine manufacturers. Nor is it even specific to the sciences in the human service fields. This is a valid criticism of behaviorism (in some cases), but to be consistent, Christschool would have to be willing to apply this criticism broadly across many fields of science. I don't want a problem that exists in the broader subfields of science to be attached merely to behavior analysis.

"If challenged, both groups simply recoil like a viper"

Yes, some behavior analysts and advocates can react this way to criticism. Not all do. Some of my formative experiences in behavior analysis were learning the polite (or mostly so) give and take during debate about behavior analysis with course instructors and professors. So, when faced down by a glaring 19 year old angry about the accuracy of the Matching Law, what do you suppose the much older and well known professor did? Tell him to be quiet? Tell him he just didn't get it? Mark down his grade in participation points? No, he invited me to have an in depth discussion after class. The professor and I spent two hours going over the issue. During which time I was treated with patience and politeness.

That issue has still never been resolved to date. But that professor provided a wonderful example of how to approach disagreements. How many venerable professors in any field could be so patient and selfless with their time? Now the point of my anecdote is not that a dogmatic approach never occurs, but that here is at least one example were it did not. I would argue that there are others..... Many others.

"ready to strike rather than acknowledging that perhaps they could be wrong."

But doesn't this depend on the quality of the criticism? And why criticism may always be necessary to guard against dogma, not all criticism has merit. It is not the job of scientists to acknowledge any criticism, but to scour it for merit and see if it contains it. Not all criticism has this. There is some criticism so bad, it merits serious criticism in and of itself. That is the catch in science or scientific criticism. You can easily end up looking like a fool. And if you are not willing to take this risk, then you can not really do science of scientific criticism. And this is true for any advocacy movement as well.

"For instance, and I don't mean to pick on Interverbal here, but when I stated that ABA has caused PTSD in autistics (based on information supplied to me by 2 autistics who had been diagnosed with PTSD as a result of undergoing ABA as children) and that there aren't any studies that have been done to look into possible complications from ABA such as PTSD, his response wasn't what I would expect from a curious and science based person.

Me:"The field hasn't done any studies that I know of that look at PTSD in those that went through ABA

"Interverbal:"Nor should they. There is no real suggestion of an ABA-PTSD connection. The suggestion there could be, was made and continues to be echoed mostly by those in the psychodynamic paradigm. There are lots of genuinely good criticisms of behavior analysis and ABA in autism specifically. A possible PTSD connection isn't one of them. This is the type of comment that behavior analysts laugh off and correctly so.""

Christschool asks me to accept as evidence second hand information I have no way of checking. I can't possibly weigh this information against what I know about science, because I can't possibly access this information at this time. I do not accept this argument for behavior analysis and I would not accept it at any other time either. I am happy when I see that I have made an error to acknowledge it in full and move on. However, there is no error here. I completely reject Christschool's criticism in this regard.

Here is a rhetorical exercise that helps show this point:

"For instance, and I don't mean to pick on Interverbal here, but when I stated that vaccines have caused autism in children (based on information supplied to me by 2 children who had been diagnosed with autism as a result of undergoing vaccines as children) and that there aren't any studies that have been done to look into possible complications from vaccines such as autism, his response wasn't what I would expect from a curious and science based person."
"Based on Interverbal's representation of behaviorist's views, there is no need to accumulate empirical data in order to draw a scientific conclusion."

This was not my argument. My argument was there is insufficient evidence to justify a study in the first place. Also, behavior analysts will laugh this off and rightly so. Not because it is a criticism, but because it is a very poor criticism. Many behavior analysts in the field have worked with hundreds of children and adults with autism. None of the ones I have spoken to see evidence of this. Even I, a novice of behavior analyst must have worked with and collected data on over 100 people by now. Nowhere in my experience and in the experience of the people I have spoken to, was there a hint that PTSD was or could be an issue. Where is the reason I should take this criticism seriously?

"One would think that those interested in human behavior would be curious about how their "therapy" might affect the emotional well being of autistics?"

Well, I am "one" and here is what I would think. I think the whole ABA = PTSD is a residue left over from the psychodynamic tradition in autism (and they still say this). They argue that autism is caused by some psychological trauma, leaving the child with autism emotionally more vulnerable to PTSD. I think that this criticism has been adopted by certain parties in the self-advocacy/ally movement in the absence of clear thought on the issue. I think it is telling the some of the more scientifically oriented critics of ABA in this movement do not offer this specific criticism.

"Noam Chomskey is a professor of linguistics at M.I.T. and perhaps one of the most engaging and prolific intellectuals of the 20th century. In 1971, The New York Review of Books published his essay "The Case Against B.F. Skinner"HYPERLINK "http://www.chomsky.info/articles/19711230.htm". Chomsky makes the case that Skinner's theory of Verbal Behavior isn't really science but a sort of secular dogma (dogma is my interpretation)."

I am afraid I must argue against an engaging intellectual. However, first I will note that Christschool confuses the linked Chomsky article and Chomsky's earlier analysis of Skinner's 1957 book "Verbal Behavior". As to the earlier analysis: Some have argued that Chomsky in just 50 pages or so demolishes both Verbal Behavior and behavior analysis in general. I think this is a very fair analysis of these works. Provided one has actually read neither.

Skinner, created a classical book of theory, based on arm chair analysis and on observation of his daughters. This technique has a long history. The developmental psychologist Jean Piaget did just the same in his detailed and excellent "The Origins of Intelligence in Children". Chomsky himself does his fair share of arm chair analysis, as do I.

I won't try to break down Chomsky's criticisms here, some of which are quite sophisticated and good. And some of which have nothing to do with science and a great deal to do with wrangling over terminology (sound familiar?) and musings on just how important free will is.

However, if Chomsky's main criticism is a lack of science to back up Skinner, then I would agree this was a very fair criticism in the 70s. But, I respectfully submit to the reader that it is not 1967 anymore. Both the study of verbal behavior and behavior analysis has matured a great deal since the 60s and 70s and both of Chomsky's critiques. I myself was involved as a research assistant in a major review of all existing research in verbal behavior. In our review, we learned some ideas are well supported and some are not.

Verbal behavior being an interest of mine, I had a topic a few years back that fascinated me. It was stimulus-stimulus pairing to produce speech in non-verbal children. It made crystal clear sense theoretically. But, as more research came out, it did not support it. As pseudo-scientists shouldn't we have cried some intellectual variant of "This is Sparta!" and brushed off the results? Where was my... where was our.... arrogant and dogmatic dismissal of evidence?
Criticism must be able to be given, in the absence of which dogma may creep.

However, I have offered my arguments as to why a number of Christschool's criticisms were without merit. I now leave it to the reader to proceed from here.

Peer Review in the Hub

2008-07-04T14:55:00.003-06:00

Christschool and I seem to be getting in our fair share of disagreements these days.Recently he critiqued and old article on punishment that I had done. I responded here, with a rebuttal and some criticisms of my own. Our main bone of contention was the definition of torture. In response to the article and to our subsequent discussion, Christschool retiled his article; it now begins in part with "Interverbal defends Matthew Israel". A hand grenade tossed into a debate, if ever there was one.

Also, in the comments here on my rebuttal, the topic began to shift from whether physical aversives = torture, to the problems of behavior analysis. This has led to a new article from Christschool that addresses some of the broader problems he sees in behavior analysis. It also features quotes from myself to help prove the point, surprise, surprise.

I think, this sort of issue frightens some of our fellow bloggers. They might worry that here are two Hub bloggers having a serious disagreement. Some might wish us to drop the issue and focus on shared points of advocacy. However, I truly think this would be the wrong approach. Any view can become dogmatic. I would argue that if we fail to guard against this, dogma may creep in.

I would also propose that what makes us different here at the hub, is not just a more positive view of autism (something unbelievable to other parties), but that we allow ourselves to dissent if we see the need. I directly contrast this with other options such as the Age of Autism Blog.Don't let Christschool's and my disagreement frighten you merely because we disagree. It is a very serious debate, but it may help both us and our readers better understand the issues at hand.

It is also healthy for the Hub itself. The process of peer review which the hub provides, although casual, is also excellent. Here are statisticians, and geneticists, and professionals, and self-advocates, and parents all come together. But peer review only functions when it is free. And to be free, dissent must be able to be given in a fearless manner.

Some, readers may wonder why I bother to write such a disclaimer (I have already done so before after all), but I would mention that the Hub occasionally picks up new members and also there are always readers who are new to the hub. And even for the older members, it may serve as a healthy reminder. And I hope the reader keeps this in mind as s/he reads Christschool and myself.My reply to Christschool's latest article will follow in a day or so.

So.. Lincoln or Darwin?

2008-07-02T11:56:00.001-06:00

I just finished reading an outstanding comparative piece, looking
at Lincoln and Darwin. It asks who was the more influential man.
Despite being an inherently absurd question and leading to the inevitable
peeing contest in the comments, the article is simply just excellent. It is also
mostly accurate.

Coming from a scientific and skeptical viewpoint, it is excellent to see Darwin's
life presented correctly in a major media source. Also, the comments are great deal
of fun. Put on a hard hat and grab some popcorn and have at it!

A Reply to Christschool

2008-07-01T00:11:00.001-06:00

Back in November in 2006, I wrote a somewhat controversial article detailing a portion of the history of behavior analysis and aversives. Some people liked it and some people didn't like it one bit. However, no one has challenged its factual basis. Until now.....

Christschool is the maker of excellent and well known autism advocacy YouTube videos. He is also a fellow Autism Hub member. Very recently he wrote an article criticizing my post for inaccuracy. Specifically, he writes:

"Contrary to Interverbal's analysis that Professor Skinner was "strongly against punishment" and the "behavior analytic community abandoned Skinner's argument", B.F. Skinner was not only an advocate of extreme aversives, but he was literally the architect of the aversives that led to the death of Mr. Milletich.To be Continued...."

To this end he cites the following, culled from this article. "Professor Skinner said: ''I don't like punishment at all. But some people are temporarily out of the reach of positive reinforcement, and a small amount of punishment may help bring them within reach of therapy.'' He also defended Mr. Israel, saying, ''The critics who call what he's doing torture don't know what they're talking about."

I have significant problems with all of this. Beginning with Christschool's title. His title reads:

"Critics of Mr. Israel don't know what they are talking about." - B.F. Skinner"

This quote appears nowhere in the New York Times article. It seems to be based on the following Skinner quote; ''The critics who call what he's doing torture don't know what they're talking about". Christschool's quote is inaccurate and misleading. By adding a few words and taking a few more out, he has radically changed the meaning of Skinner's comment.

Moreover, Skinner is right. It is not torture. The word "torture" means something specific. What certain parties did in terms of using physical aversives in the past, or still do now, might be disagreeable and I would certainly argue against it on ethical lines, but it is not torture. This sort of argument is like accusing parents who choose to use EDTA of poisoning their children. We might disagree with it, we might argue that it is unsafe, but it is not poisoning. This would be a very poor argument and some readers, even if they dislike aversives, are likely to recognize it for what it is, a fallacious appeal to emotion.

Moving on, Skinner consistently wrote concerning his stance against punishment. I argued this in my previous post and very carefully referenced my assertions. I feel no obligation to do so again. Christschool may argue that by backing aversives in unusual circumstances, for a brief period of time, and to a small degree, Skinner should no longer be considered to be considered "strongly against" aversives. Fine, but.... in such a case, I too can no longer be considered strongly anti-aversive. This is news to me, and probably news to a number of other folks both behaviorist and non-behaviorist alike. If the case arises (and indeed it has) of a choice between life-and-death and aversives, I would choose the aversives. In my ethical analysis, death is certainly the greater evil compared to limited and context specific delivery of physical pain.

Christschool, also evidently took issue with my statement that the wider behavior analytic community rejected Skinner's arguments. This is bizarre; I can only guess that Christschool misunderstood what my words meant. Skinner certainly did argue early in his career that punishment is weak. The behavior analytic community did not take this to heart.

I rather carefully detailed the journal articles starting in the 1950s when punishment based research for humans began to appear with some regularity. The existence of punishment focused research, the green light by peer reviewers, and the lack of dissent in letters to the editor, is a clear indicator of a general lack of agreement with Skinner in this regard. In fact, in an extremely telling moment, one of the first letters to the editor where dissent is provided concerning aversives; the letter writer actually congratulates the researcher for abandoning the Skinnerian dogma that punishment is ineffective.

Finally, Christschool writes, "B.F. Skinner was not only an advocate of extreme aversives, but he was literally the architect of the aversives that led to the death of Mr. Milletich."

This would be most unusual. There is no journal record to suggest that Skinner researched these techniques, they are not made reference to in any of his major works for a certainty, and in none of his minor works either from what I can tell. Nor did he employ them with his daughters as they themselves have made very clear. I can only hope that he will provide some sort of evidence for this, in part-two of his series. Although I confess, I am openly skeptical of his claim.

Advocacy, no matter how worthy the cause, needs to be factually accurate. No real service is done in its absence.

Being Indigo: Not just foolish, Its Dangerous

2008-06-27T17:33:00.002-06:00

If you are familar with current autism news, then you probably have heard of the New Age Indigo/Crystal Children. And what are Indigo Children? According to this site they are:

"extremely powerful children, whose main purpose is to take us to the next level in our evolution, and reveal to us our inner power and divinity. They function as a group consciousness rather than as individuals, and they live by the" Law of One" or Unity Consciousness. They are a powerful force for love and peace on the planet."

Most of us would recognize this as a bunch of twaddle and move on. However, there is a problem here and that problem is that children with autism and ADHD are often said to be Indigo Children. As the author of the site quoted above makes clear:

"In my book "The Care and Feeding of Indigo Children", I wrote that ADHD should stand for Attention Dialed into a Higher Dimension. This would more accurately describe that generation. In the same vein, Crystal Children don't warrant a label of autiem. They aren't autistic! They're AWE-tistic!"

However, this idea, has at least one well known advocate, Jenny McCarthy. This individual is a mother of a child with autism and is already known to advocate for alternative biomedical therapies for autism, on top of being independently famous.

Some in the biomedical autism community have been slow to acknowledge that Ms. McCarthy is in fact a believer in the Indigo Children concept. But, Ms. McCarthy herself, makes it clear that she is a believer. Perhaps they have observed that believers in this idea seem to be fairly tolerant of differences in children. However, there is an inherent problem here. My fellow blogger Joseph, excellently describes this problem:

"But wait, if the child is a highly evolved Indigo, why does he need biomed treatment?"

Fair question, I would think......

However, the most disapointing aspects about the biomed movement are not the flat out denialist concerning Jenny and this New Age belief; it is those who make excuses for it and/or say it doesn't matter. They claim that this is a religious belief and is therefore inviolate.

This is a vacuous and dangerous position. It is dangerous, because of the misinformation it supplies about children diagnosed autism.

"The diagnostic criteria for autism is quite clear. It states that the autistic person lives in his or her own world, and is disconnected from other people. The autistic person doesn't talk because of an indifference to communicating with others."

and

"Crystal Children are quite the opposite. They are among the most connected, communicative, caring and cuddly of any generation. They are also quite philosophical and spiritually gifted. And they display an unprecedented level of kindness and sensitivity to this world. Crystal Children spontaneously hug and care for people in need. An autistic person wouldn't do that!"

From this I conclude two things.

1) The author has never actually read the diagnostic criteria for autism, as the criteria say nothing of the sort. Instead one hears about the "own world" bit from those offering a rather simplistic explanation to the lay public.

2) Goodness knows which children the author observed in order to offer this conclusion, because even a very minimal observation of a variety of children with autism would quickly show it to be false. Many children with autism certainly express affection, even profound affection for their family, although if it is not always expressed in a typical fashion.

This misinformation isn't just incorrect, it perpetuates the myth of the child with autism as "The Person Alone". It is a step backwards into the dark ages of autism knowledge. It also has the ability to influence and mislead others in the type of dealings they have with people diagnosed with autism.

The fact that this is a religious belief, doesn't change the fact that it is dangerous and unscientific. The issue isn't whether one can believe in the Indigo Chidlren Idea, or any other sect that teaches a perjorative view of people with autism, but whether one should.

This is as true for the Evangelicals who get it into their head to try to excorcise the "demons" in a child with autism, to Scientology beliefs concerning the Travlota's child with autism, to Martin Luther calling a likely autistic child a "massa carnis" (souless flesh) and advocating that he be promptly strangled.

This was all based on the deeply held beliefs of certain people, as it pertained to autism. It was religion, something that most of us have and that most us put on a pedestal. But it was also, stupid and harmful. Religious beliefs do not free us from criticism, nor should it. This is something worth remembering I think, when we reflect on why the Indigo movement really isn't such a good thing for people with autism.

Mark Blaxill and Looking at the Data

2008-02-05T22:17:00.000-07:00

Some people are pretty mad at Do’C and me right now. They are furious, because we wrote a critique and several follow-up critiques of DeSoto & Hitlan (2007). These authors noticed several data entry errors in the Ip et al. paper on mercury levels in the blood and hair. DeSoto & Hitlan point out these errors, but exceed this and use a new statistical analysis and argue for a reinterpretation of what these data mean.

On first glance this issue looks like a healthy textbook example of the corrective nature of science. That Do’C, myself, and others may not be happy about loosing a proof of what we support is irrelevant. Our first obligation is to science, personal feelings don’t play a part, or rather, shouldn’t. However, things aren’t so simple in this case. We noticed some genuine errors in DeSoto & Hitlan’s reinterpretation.

In response, to the problems we noted, we wrote out own critique. This angered DeSoto & Hitlan who posted a FAQ in reply to many of our points. Do’C and I studied the FAQ carefully, acknowledged a few errors we made, but then found even more errors in the DeSoto & Hitlan analysis. The really indisputable error (although maybe not the most important) made by authors was an incorrect reference of another article in their introduction section.

In a nutshell, the authors claim that an 11 month old boy was presumptively diagnosed with autism, until an actual diagnosis of mercury poisoning was made. This is not what those authors say; the reference is in error and we believe that this error deserves formal correction. A simple paragraph in an erratum ought to do the trick and could resolve this singular issue.

But DeSoto & Hitlan’s anger with us, pales compared to some advocates of the mercury etiology of autism theory. They seemed understandably pleased when DeSoto & Hitlan provided a critique of Ip et al., as the latter authors provided data that do not support the thimerosal theory. Imagine their annoyance, when we pointed errors in the “correction” provided by DeSoto & Hitlan. I have received maybe a dozen emails from different folks on this issue. Most were supportive some were critical, but tended to deal with either a novel form of interpretation of statistics or other issues not related to our critique. None were actually rude.

As our critique got time on other blogs, news sources, and forums, we began to pick up some ruder comments. No one has actually offered a rebuttal of our critique or subsequent follow-ups.

Enter Mark Blaxill. This gentleman is a well known advocate of the thimerosal etiology of autism theory. He has himself, written numerous critiques of studies he finds fault in. He and I both deal with matters of autism epidemiology and so, we have already bumped heads once or twice in the past, albeit in a polite, low key way. I had always considered him a gentleman.

But this time, Mr. Blaxill was evidently quite furious that we have a critique. Do’C and I were called “cowards” and “wackos” because we use pseudonyms, even though I use my real name as often as my pseudonym when online. He was so angry that he censored our names and Do’C blog name, when he quoted DeSoto & Hitlan.

I am not sure, why he did this, especially with regard to needing to censor the blog title. Perhaps he was worried about libel, or perhaps he didn’t want people to actually go read our critique; which is probably prudent considering that he calls our critique “trivial and unimportant” yet fails to even attempt to show how it could be seen as such.

I wrote to Mr. Blaxill politely expressing my displeasure at being called a coward and a wacko. This is the reply I received:

Jonathan,I called people who make unfounded attacks and don't use their real names cowards. Since you use your real name here, you shouldn't take the criticism personally. For those of your friends who choose to promote confusion and discord, if the shoe fits, wear it.

I have no interest in debating you or your friends. Your work is simply trivial and unimportant. If you disagree and think you have an important and valid critique of DeSoto's work, feel free to submit it to the journal editor.

More to the point, you have taken personal pleasure in advancing ideas that harm my child. You have described yourself with glee as "an evil ND enforcer." In an open society, you have every right to express those views in open venues of your own or those that will accept you.

But you are not welcome here.
Mark

This is the reply I wrote on his blog The Age of Autism, or at least attempted to write. Evidently Mr. Blaxill is not about to let it through.

Since my presence is not welcome here, this will be my last post. However, since you imply things about my character I think it is appropriate that I get to offer a final response; especially since I have always been courteous to both you and the authors in question.

I and others have been sometimes called names. It doesn't happen as often to me when compared to others, but it happens. Autism science is a contentious issue and being called bad names goes with the territory. However, I do find it to be an illogical and desperate strategy. When Kev posted t-shirts which were a parody of the all too common insults we hear mocking those of us with mainstream medical opinions in autism, I found it to be quite funny. I do not actually believe myself to be an "evil ND enforcer" nor do I wear terminator style sunglasses and carry around assault rifles, if I remember correctly what was on the t-shirt.

My statement does not mock children, nor parents who simply seek answers (whether or not they happen agree with me).

My statement does reflect my exasperation with personal insults that are rude, illogical, and ultimately... cowardly.

Thank you for your time.

Critique of DeSoto & Hitlan (2007)

2008-01-28T18:41:00.000-07:00

Do'C and I have published part 3 of our reponse to DeSoto & Hitlan (2007)
and their FAQ page based on our previous criticisms. Please go take a look at
what we wrote.

Recognizing Our Errors

2008-01-24T07:29:00.000-07:00

It is good to recognize the errors others have made, but
it is just as important to recognize the errors that we as
individuals make. Please go see a joint post by Do'C
and myself citing some of our own errors concerning
our analysis of the DeSoto & Hitlan article.

The Onion and Thimerosal

2008-01-11T10:35:00.000-07:00

I think everyone knows that The Onion provides satire or parody
concerning news. They also have "interviews" where people react
to current events.

Go see their take on the recent autism and thimerosal study.
Only the first one is funny, but parody is rarely this accurate.

Facilitated Communication: A Further Comment

2007-11-30T07:43:00.000-07:00

A short time ago wrote a post reviewing the research on Facilitated Communication (FC). I found a fair amount of research that did not support this method and a limited number of studies that did. One of the studies I referenced was Weiss, Wagner, Bauman, (1996). This study involved a single participant; a 13 year boy diagnosed with autism and severe mental retardation. The authors concluded the the young man’s communication was genuine.

I listed this study as a support for FC after having read the authors abstract. It is usually a dangerous policy to offer a review on an article having only read an abstract. I did so in this case, because I had already read many of the articles I cited in my review. And because I simply couldn’t imagine that the Weiss et al. article would be so methodologically poor as to cause me to not even inlcude it in a review.

I received a tip in the comments section of my previous post that several of the supporting research articles for FC, had significant problems. Some especially damaging points about Weiss et al. were brought. After a online link to the article was found, I took the time to review the article in depth.

I was rather horrified by what I read. Weiss et al. isn’t just a study with a few small problems, it is a study whose problem negate any worth this study may have had. I will detail these problems below. I am withdrawing my inclusion of this article in my research that supports FC section. It doesn’t merit it.

The most glaring flaw in Weiss et al. is that the participant was asked many of the same questions about the same story before the test condition. The researchers called this practice phase “consolidation”. It involved an experimenter who knew the correct answers to the questions “facilitating” for the participant prior to the test condition with the “naive” facilitator.

Here is an example in trial 1:

Consolidation question “What game did they play?”

Test question “What game did they play in the story”

I have honestly never seen contamination this bad in peer reviewed research.

There are other flaws in this research as well. Please go to the comments of my previous post and see for yourself.

Tall Tails and Stats

2007-11-18T05:32:00.000-07:00

Do'C and I team up to critique DeStoto & Hitlan (2007).

Please go read A Tale of Two Tails.

Educational Technique #5: Stepping Back

2007-11-17T13:02:00.000-07:00

Stepping back

I am going to make the claim that one of the universally agreed upon concepts in special education (or regular education for that matter) is scaffolding. Scaffolding is the idea that a learner begins in a situation of high prompts and high control and as s/he demonstrates mastery the prompts and controls are removed. One doesn’t usually hear of critiques of scaffolding. Yet, despite its popularity, fading the scaffold can be difficult.

There are multiple reasons it may be tough to fade a prompt back. Probably the biggest reason is habit. If we help a student practice writing their name with hand- over- hand guidance everyday then this might be difficult to be as vigilant as we should. This is especially true if we are in a hurry. And good scaffolding is very progressive. We would have to periodically try to offer gentler support to see what the student can do. And this is not just for the whole name, but even for small parts, maybe just for the curve in a lowercase “d”. I think it is easy to imagine a little support becoming a hindrance.

There are several ways around this. Probably the biggest way is to be diligent about testing fading back the assistance. A better way would be to set some sort of criteria for fading back. However this is also a lot of work. To do this means one has to do some sort of data collection on a daily basis. This is however, a systematic way to approach the problem. This is also the way I like to approach the issue. And remember this isn’t just true for handwriting.

Formally Reviewing Facilitated Communication

2007-11-13T23:06:00.000-07:00

For Hub Members, please read this before continuing with the current article.

Looking at Facilitated Communication

Facilitated Communication (FC) is used for individuals who have difficulty using vocal speech. It has been used for people with Cerebral Palsy, Down’s Syndrome, other health impairments, and autism. The premise is that FC is appropriate for people whom have specific motor issues, but are still able to make use of their arms, hands, and fingers. The individual is then paired with a trained facilitator. This person provides physical and/or other support that allows the person to communicate using a keyboard or pad.

FC had its origins in the 1977 in Australia. Rosemary Crossley, a teacher in a hospital used facilitated communication to elicit communication from 12 students with Cerebral Palsy. Later on this idea (Rosemary’s baby if you will) traveled to the United States and elsewhere.

Douglas Biklen, now the Dean of the College of Education at Syracuse University helped to popularize this idea in the US. He created the Facilitated Communication Institute at Syracuse. The center provided training, consultation, and advocacy for FC. It even produced t-shirts with the slogan "Not being able to speak is not the same as having nothing to say".

Controversies

The major concern in FC is that the individual being facilitated is not really doing the communicating. It has been argued that FC is just/usually an artifact of the facilitator’s communication. It can be argued that the same ideomotor phenomena we see with Ouija boards and dowsing rods is also in play here.

Another point is the abuse scandals surrounding FC. Skepdic claims that facilitators are taught that 13% of their clients have been abused. In my opinion a surprising number of facilitators have accused parents of abusing the client. Also unsurprisingly, most of these cases turn out to be garbage. And PBS Frontline episode from 1993 chronicles one such case proven to be false. However, the author of FC Wikipedia page reassures us that “numerous abuse allegations made via FC have been found to be valid” and then cites a paper with 4 cases with some degree of evidence out of 13 cases that were reviewed.

The Research

Much of the research in FC is qualitative as opposed to quantitative. This means that the research doesn’t attempt to answer whether FC is legitimate, but instead looks to how it affects the quality of life for the user or their family members. Some of the FC supporters also have the habit of forgoing peer review and publishing research in books as opposed to academic journals as seems to be the case for Biklen & Cardinal (1997).

In the quantitative realm, in general, as methodology shows increased control results tend to worsen. Biklen et al. (1995) argue that negative results tend to be associated with higher control, and that positive results tend to originate in naturalistic settings.

An example of positive results found in naturalistic setting would be Simon, Toll, & Whitehair (1994) which involved 7 students were reported prior to the study to be communicating via facilitation at levels far above what was previously thought possible given their level of intellectual ability. The authors found that 1 child out of the 7 could answer correctly on 2 of the trials.

Montee, Miltenberger, & Wittrock (1995) assessed FC for 7 adults in naturalistic conditions. Again, only 1 of the 7 subjects had any correct answers in the unknown or false conditions. The evidence suggested that facilitator control was active in the other conditions. Also, Vasquez (1995) involved a naturalistic setting. Among the 3 autistic children who participated in the study, no valid results were found in the facilitator blinded conditions.

There have been some other positive results such as Cardinal, Hanson, & Wakeham, (1996). The authors used 48 student and 3,800 trials. They randomly selected a word, presented to the student; the student had to type with the aid of their naïve facilitator. Other positive results can be found as well in the literature. Calculator and Singer (1992) have a letter to the editor of Topics in Language Disorders.

The negative results for FC include (Beck & Pirovano, 1996; Eberlin, McConnachie, Ibel, & Volpe, 1993; Regal, Rooney, & Wandas, 1994) as well as the largely negative studies already mentioned (Montee, Miltenberger, & Wittrock, 1995; Simon, Toll, & Whitehair, 1994). In addition, the large study, Howlin (1997) looked at 45 trials of FC involving over 350 participants. The data validated communication by 6% of the participants. The authors showed that over 90% of the cases were influenced by the facilitator. A large review by Mostert (2001) also showed mostly negative results.

Discussion of the Data

The data support the idea that FC may lead to authentic communication in a minority of cases. The data also support the assertion that the majority cases where FC is said to produce communication beyond what was previouly thought, are not authentic. Likewise the data support the criticism that facilitator influence is an active phenomena in the majority of cases in FC.

The data do not support the criticism of the negative findings offered by Biklen et al. that more naturalistic settings tend to produce better results. In fact the available data contradict this (Montee, Miltenberger, & Wittrock, 1995; Vasquez, 1995). No data are available to assess the claim that better results are obtained when the researchers attempt to reassure the participant. There is some data to validate the idea that FC users will improve if given time to practice the testing protocol (Cardinal, Hanson, & Wakeham, 1996). However, this repeated presentation may act over time as a sort of teaching process in and of itself. A group design where individuals are randomly sorted in a short and long testing group, has yet to be done, but is feasible. Such a design could help answer the question.

Champions and Critics

FC has has no lack of famous advocates and detractors. Critics of FC have included Carl Sagan, in “The Demon Haunted World: Science in Candle in the Dark”. The famous skeptic James Randy is a signatory of the anti- FC, BAAM petition. Also, numerous articles critical of FC have appeared in the two skeptical flagship magazines “Skeptic” and the “Skeptical Inquirer”.

On the other side we find Morton Ann Gernsbacher, the past president of the deeply scientific American Psychological Society, and is a sometime publisher in no less a prestigious journal than “Science”. Another noted advocate would be the late Arthur Leonard Schawlow the winner of the 1981 Nobel Prize for his work with laser spectroscopy. He and his wife felt the technique was helpful with their autistic son in the 1980s. I think it would be important to note some of the people who were users of FC have gone on to become adovcates of FC themselves.

Several groups have become advocates of FC. These include TASH and AutCom. Other groups such as The American Psychological Association, The American Association on Mental Retardation, the American Academy of Child & Adolescent Psychiatry, The American Speech-Language-Hearing Association, and the Behavior Analysis Association of Michigan, have offered positon statements agaisnt FC.

Review of the Defence of Facilitated Communication

Here I will look specifically at the claims offered by FC advocates. I will be blunt and say that I think this is weakest area of FC. Below, specific advocates are named and their comments will be scoured for merit.

Dr. Schawlow wrote

“However, most of these studies have given negative results because of serious flaws in their methods, resulting from a failure to understand what was being tested. In fact, all that these studies have shown is that it is possible to interfere with the process of facilitated communication.”

Dr. Schawlow proposes that in a more relaxed setting, positive results will be gained. This is directly in conflict with the data. Moreover, Dr. Schawlow asserts that the negative research proves it is possible to interefere with FC. Here he is assuming that positive results would have been found, had the protocal been different. This is assuming what he should be proving, or the fallacy of begging the question.

Dr. Schawlow wrote

“Clearly, there is an enormous amount of evidence that, under proper conditions, facilitated communication really does work.”

One might ask where is this enormous amount of evidence? Is it peer reviewed? This is where citations can should be given, they are absent in this case.
Dr. Schawlow then rebukes the skeptics by asserting

“It is scandalous that some people are using the unscientific "validation" experiments as an excuse to describe facilitated communication as fraudulent.”

And yet Dr. Schawlow has only ad hoc hyptheses to demonstrate why the controls were actually “fraudulent”. The data that could back his assertions are either absent or actually not in his favor.

Dr. Gernsbacher is the mother of a young man diagnosed with autism. She is a valued and important ally of autistic self-advocates. I will unashamedly profess my respect for her and her work. Her good example has been a model for me as a student. Her article debunking several baloney proofs of an autism epidemic, is an exercise in lucid thought. But she also has offered one opinion on FC that I think is fallacious.

She is reported to have answered a question concerning criticism of FC, by claiming the critics didn’t want to acknowledge the language capability of autistic persons. If this report is an accurate description, then Dr. Gernsbacher employed the psychogenic fallacy. She dismissed the criticism and shifts the focus onto the critics. Those who report this story as a “proof” to challenge criticisms of FC engage in the fallacious appeal to authority.

Finally we come to Biklen

Biklen writes

“Despite the controversy over facilitation, thousands of teachers, parents, and researchers continue to use the method nationally and internationally. We might ask why. What do practitioners point to as evidence that convinces them that the words typed are those of the people with disabilities, not of the facilitators?”

Biklen seems to have crossed the border into both a pragmatic fallacy (it look like it works) and an argumentum ad populum.

Biklen in one chapter, quotes a young man who proved in a non pulished replication of an earlier study that his communication is authentic. After proving the authenticity of his writing the young man was inspired to write the following:

“Today I retook the test, and I passed it, Mayer says brilliantly. But I feel sad. Sad for people who can't do it and are silenced. Sad for those who will run from the depressing truth that I was right and they were wrong. Sad that I will be fighting this fight for years to come. And sad that this was even necessary. Friends will celebrate, but then the work must continue.”

If this communication was not authentic, then a fascinating insight into the FC facilitators world view is revealed. But if so, I would argue that the young man severely misses the point of such testing. What does such an attitude tell us about the FC culture, if anything?

Conclusion

The data support the comment that FC may lead to authentic communication for some individuals with autism. The research suggests that these are the minority of cases. The research suggests that facilitator influence is an active factor in FC.

Caution is advised towards FC. I do not advocate the total dismissal of it. However, until safety guidelines are employed, there is reason to doubt the authenticity of communication by those who use it unless there other forms of communication also in use by the individual and at comparable levels.

References

Cardinal, D, N., Hanson, D, & Wakeham, J. (1996). Investigation of authorship in facilitated communication. Journal of Autism and Developmental Disorders. Mental Retardation. 34(4), 231-42.

Calculator, S.N. & Singer, K.M. (1992). Preliminary Validation of facilitated communication. Topics in Language Disorders (Letter to the editor), 12(6), 9-16.

Biklen, D. & Cardinal, D. N. (1997). Contested Words, Contested Science: Unraveling the Facilitated Communication Controversy. Teachers College Press, New York.

Biklen, D., with Richard Attfield, Larry Bissonnette, Lucy Blackman, Jamie Burke, Alberto Frugone, Tito Rajarshi Mukhopadhyay and Sue Rubin. Autism and the Myth of the Person Alone. New York University Press, (2005)

Beck, A.R. & Pirovano, C.M. 1996. “Facilitated Communicators’ Performance on a Task of Receptive Language.” Journal of Autism and Developmental Disorders, 26 (5), 497–512.

Eberlin, M., McConnachie, G., Ibel, S., & Volpe, L. 1993. “Facilitated Communication: A Failure to Replicate the Phenomenon.” Journal of Autism and Developmental Disorders, 23 (3), 507–530.

Howlin, P. Autism: preparing for adulthood. London: Routledge, 1997. pp. 5-6.

Montee, B, B., Miltenberger R, G., & Wittrock D. (1995). An experimental analysis of facilitated communication. Journal of Applied Behavior Analysis. 28, 189-200.

Mostert M.P. Facilitated communication since 1995: a review of published studies. Journal of Autism and Developmental Disorders, 2001, 31(3), pp. 287-313.

Regal, R.A., Rooney, J.R., & Wandas, T. 1994. “Facilitated Communication: An Experimental Approach.” Journal of Autism and Developmental Disorders, 24 (3), 345–355.

Simon, E, W., Toll, D, M., & Whitehair, P, M. (1994). A naturalistic approach to the validation of facilitated communication. Journal of Autism and Developmental Disorders. 24(5), 647-657.

Vazquez, C, A. (1995). Failure to confirm the word-retrieval problem hypothesis in facilitated communication. Journal of Autism and Developmental Disorders. 25(6), 597-610.

Facilitated Communication: And how it affects the Hub

2007-11-12T21:42:00.000-07:00

Before I begin this series I would like to first have a Look at the Hub. For the unaware the Autism Hub is an aggregation of bloggs by autistic person, parents of autistic persons, and professionals. The Hub offers diverse views, but focuses on advocacy, rights, acceptance of autistic persons, and a positive outlook towards autism.

Facilitated Communication is one of those divisive issues lurking under the surface at Autism Hub. The issue tends to pit the strong science/skeptic types in the Hub against the self-advocates and those well known for being their allies. Of course it is not really that simple. Some of the self-advocates are also notable skeptics and/or scientists.

I think this is one more reminder that we members of Autism Hub are not lockstep.... we are not monolithic. It is inevitable that we will disagree strongly on some autism issues. I think it is also important to recognize that this is okay, this is healthy. It would be far more troubling to me, if we had only had some absolute stance on the subject; some sort of dogmatic approach that forbade dissent and critical commentary.

It would be sad if a divisive issue (FC is really just one example) caused to forget all our points of agreement…. of shared advocacy. However, it would be just as bad, if we suppressed our criticisms, if for the sake of unity, we engaged in groupthink. I have written before why it is so important to express criticism for both ethical and logical reasons.

I suppose I ought to plainly state that I fall into the traditional skeptic camp on this issue. I will warn the viewer that in the second part of this series I am going to be very critical of certain aspects of Facilitated Communication. I hope that even the advocates of this idea are able to take something productive from my criticism and do not merely find that reading it is an exercise in frustration.

That said, comments and rebuttals are always welcome.

Dealing with Criticism

2007-11-11T14:51:00.000-07:00

On of the occupational hazards on blogging on science issues, is that some people will disagree, and not just disagree but they will frame the disagreement with some teeth. Bloggers of science issues, tend to deal with this in various ways. Some of us take mom’s advice and “don’t argue with an angry person”. Some people make fun of the dissenters. Some people offer one liners and snappy rebuttals. Others try to sincerely answer the points.

It’s tough to know what the right response is. In the autism realm the issues often concern deeply personal issues like the health of one’s children. Emotions are inevitably going to run a bit high in such circumstances.

I am really not sure I know the best response in such cases. However, it is my choice to attempt to deal with such disagreements by trying to tackle the issue in a serious and calm manner. To do this I have to take the criticisms seriously. I have to acknowledge that perhaps the criticisms contains merit even if couched in ad hominems. I then can scour the criticism for merit and see if any is actually contained.

With this in mind let’s take a look at some feedback I received on another autism blog that contains a different view towards science and evidence. My responses are in gray.

“Such a one trick pony with one line of thinking. Its like all you ND types just can't get past the small stuff. The California incidence rates are going up and to you that means Kirby is wrong and Jenny is wrong and there is no autism epidemic and.. you win somehow [snip].

Well I admit I do tend to worry about the details. It is in the details that we find the difference between physics and metaphysics, between science and pseudo-science, and certainly between good math and bad math. And math is the very basis of epidemiology. No math, no scientific epidemiology.

Kirby did claim the autism CDDS data should be/are dropping in response to the removal of thimerosal. So did the Geiers and several other advocates of the thimerosal etiology of autism theory. If this is what they have claimed I think it would be reasonable to put the claim to the test. In fact I am going to insist upon it. Of course none of this proves that there is no autism epidemic. What this proves is that one of the tests offered by several well known advocates isn’t going in their favor.

“The longer the bullshit stays in people's minds (and the internet is where most people used to get info on autism), the more time that insurance companies can stall on calling autism a medical condition and not a pre-existing genetic condition, like down's syndrome.”

This is called the argument from adverse consequences. The fact that some people disagree about causes or cures, has no ability to make criticisms of these untrue, just because such dissent might slow down insurance companies handing over money. In addition it needs to first be proved what the causes and cures are, via valid science. If you don’t have this, then you are engaging in circular reasoning.

“Just looking at your blog, anyone can see how narrow your thinking is. Here is gow you interpret that data. The autism rates in California are going up and mental retardation rates are also. There is an epidemic of autism and it is environmental (a likely culprit is mercury since it is sill in vaccines given to pregnant women and to babies at birth and is in the air, and pesticides - don't you already know this?). If you cannot see that then your are stupid or evil [snip].”

For use to recognize an epidemic we need to first know the rates of autism before and after an event or period of time. The high prevalence of a disability does not an epidemic make. In this case we would have to measure the same thing in the same way in the same area. Incidentally this has been done on a small scale. Chakrabarti & Fombonne (2005) measured autism in the same way in Staffordshire England in the early and late 90s. They found the same prevalence rate.

Are you proposing that thimerosal which has been removed and was formerly found in several pediatric vaccines, is now not only being equaled in terms of the autism it causes, but actually exceeded, via a single prenatal vaccine? That claim is possible, but seems quite extraordinary.

As to the air, ice cores show that mercury air levels where the highest in the years following the eruption of Mount St. Helens where tons of the mercury laden mineral, cinnabar were vaporized. So, why didn’t we see a spike in 1980-1981? It should have been there if air mercury levels are a statistically notable influence.

And where else might the mercury be hiding… computer screens, lights,
cinnabar… crematoriums, Chinese forest fires? After a while it become a shell game; is it here, is it there, keep your eye on the mercury. I think before science can give you the answer you seek, we would first need to know exactly what we should look for. We need to have a firmly defined independent variable. That’s what the advocates of the thimerosal etiology of autism need to agree on and then research. In the absence of this, we are playing a shell game. I think recognition of this is the difference between keeping an open mind, and not keeping so open a mind that the rain can slip in.

“There are stories on ABC on Biomed for f@$%’s sake now, a company that is practically swimming in Pharma money. Can't you see it is over for your little team. Why argue with ---- ----? He is the least of your worries. Better clean up you blogs and remove the insults to parents helping their kids and the denial of an autism epidemic or you will be erasing hate mail 24 hours a day from the flood of new autism parents [snip].” [edited for language and anonymity]

Yes, there was a biomed advocate on Oprah. This talk show host has also had psychics and assorted non scientific practitioners of alternate medicine on her show. That’s because Oprah interviews people who interest herself, or her audience. Time on Oprah, is simply that. It is no proof of the scientific validity of a theory. Also at roughly the same time Jenny was on Oprah, a major correlational study, Thompsen et al. (2007) came out. The authors showed no association between thimerosal dosage and adverse cognitive effects.

Why is it do you think, that the advocates spend more time talking about a fellow advocate on a talk show than the what a large study indicates? What are values are reflected here do you think”

As to my blog, I don’t believe I have any insults that I have written to anyone, parent or otherwise. If you find an insult that I have written on this blog, please notify me and I will apologize and then remove it promptly.

As the theory of the autism epidemic, you first need to prove there is one, something neither yourself nor anyone has done yet. If you would like to offer irrefutable proof or even a minor proof, you are welcome to post it.

I have never yet received hate mail or even hate comments at Interverbal. I tend to advocate polite even if heated conversation. As an alternative to hate mail you may wish to try that instead. I suppose that if I really did receive hate mail I would consider it as more of a statement about the author, then about myself.

Thank you for your time.

Educational Technique #4 Backwards Chaining

2007-11-10T14:40:00.000-07:00

Backwards Chaining

A lot of educational activities are in fact a chain or sequence of behaviors. Taking off your coat, typing a word, writing you name, all consist of a series of small finite behaviors. For young students, some of these chains can be quite hard. Finishing a puzzle or learning one's phone number comes to mind.

In backwards chaining we first learn to do the very last step, then the second to last, then the third to last, etc.

If I were to use this technique to teach a child to write her name, then I myself would write all the letters in the childs name except the last one. "Susie" would then have to write the final "e" on her name. As she progressed she would learn to add the final "ie" to "Sus", etc.

Hidden Horde Found

2007-11-07T07:22:00.000-07:00

Matson, J, L., Wilkins, J., Boisjoli, J, A., Smith, K, R. (2007). The validity of the autism spectrum disorders-diagnosis for intellectually disabled adults (ASD-DA). Research in Developmental Disabilities. [Epublished ahead of print].

50% of the adults in this study were diagnosed with an PDD (Autistic Disorder or PDD-NOS). The article does not make it clear whether these were rediagnoses or not.

Abstract

"Psychologists interviewed direct-care staff using a battery of assessment measures including the autism spectrum disorders-diagnosis for intellectually disabled adults (ASD-DA), the Diagnostic Assessment for the Severely Handicapped-II (DASH-II), the Matson Evaluation of Social Skills for Individuals with Severe Retardation (MESSIER), the Socialization domain of the Vineland Adaptive Behavior Scales (VABS), and a checklist containing criteria for autism and PDD-NOS from the DSM-IV-TR and ICD-10. Three hundred and seven intellectually disabled (ID) adolescents and adults ranging in age from 16 to 88 were assessed. Participants were diagnosed with either ID and ASD (autism or PDD-NOS; n=156) or ID and no Axis I diagnosis (n=151). A modification of the multitrait-multimethod approach was used to establish the convergent and discriminant validity of the ASD-DA. The scale proved to have robust convergent validity when correlated with the DSM-IV-TR/ICD-10 checklist, MESSIER, and Socialization domain of the VABS. Additionally, discriminant validity was demonstrated by comparing the ASD-DA to items from the DASH-II (measure of general psychopathology). The implications of these data are discussed."

Educational Technique #3:

2007-11-03T09:51:00.000-06:00

Tinkering

One of the techniques that I have come to embrace in what I call tinkering. Tinkering is taking a
formalized lesson plan that gets used the same way day after day and systematically changing various aspects of it.

The advantage of tinkering is that we sometimes land on alteration that immediately improves the number of correct answers, or improves the level of student's attending, or the rate of their reponses. Another advantage is that it can help promote generalization by altering the stimuli used in the lesson.

For example, I used to teach a calender group. The old lesson plan had me labeling months or the days of the week. I tinkered with this plan by mislabeling different dates at random. The students thought it was pretty funny. It increased their amount of attending. It also gave them a way to practice being assertive while being polite.

There are a few caveats to tinkering. The first being that it very often doesn't produce anything helpful. The second is that in a formalized lesson plan where data are collected, tinkering should be done at the end, when all data have been collected. This is because altering the format may invalidate the data. New tutors or teachers are often avid tinkers. However, it has been my experience that they usually require guidance as to when to tinker and when to stick to formalized lesson plan.

A Radical Behaviorist?

2007-11-01T07:20:00.000-06:00

There seems to be be some misinformation floating around the blogs of late. I would like to take a minute and try to correct some of this.

Myth #1: B.F. Skinner advocated punishment.

At no time in his carear was Skinner an advocate of punishment. This is directly said both in his early and later books.

Myth #2: Radical Behaviorists believe in using punishment.

That's funny because I am a radical behaviorist and I don't believe in using punishment. Skinner was the first radical behaviorist and he didn't believe in using punishment. Radical behaviorists are not "radical" because we are really, really behavior analytic, or because we condone punishment. We are radical because we seperated from earlier forms of behaviorism, namely in that we consider thoughts and feelings to be objects worthy of formal study.

Comparing Group Design and Single Case Design

2007-10-28T19:19:00.000-06:00

One of the claims that I hear from the more scientifically oriented readers or other commenters in the blogosphere is that the way to be really certain of an answer in science is to use some variant of the blinded methodology with random assignment.

My thoughts are “Well…. not exactly”. The group designs are the right tool to assess certain scientific questions, but not others. It really depends on the nature of the question. Below I have created a brief list of some of the differences between single case design and group design research logics. My objective is not to thoroughly explore the differences, but merely to be a brief introduction.

Group Design

-Tests the null hypothesis

-Uses deductive logic

-Uses inferential statistics

-Washes out the individual variance in data

-Effect significance is assessed in objective terms

-Compares the experimental group to the

-Control group

-Uses reliable and valid assessment

Single Case Design

-Uses inductive logic

-Answers the question of to what extent the change in the independent variable caused the change in the dependent variable

-Uses graphical analysis

-Can detect patterns in the data that might otherwise be missed

-Effect significance is determined in a more subjective manner, gray area is possible

-Systematically alters the level/presence of the independent variable

-Uses objective behavioral definitions and inter-rater reliability checks

Education Technique #2: Taking a Break

2007-10-27T11:48:00.000-06:00

Starting about the 1st grade (ages 6-7) the general pattern in a classroom is work….. then recess. This often works well for both typically developing student and student with autism. Sometimes however, it just doesn’t shake out. The student does alright for the first little bit, but eventually they start to go down hill. Maybe this happens during a particularly hard activity for the student, or a particularly long one.

One of the ways I think is beneficial to work with this situation is to re-think my approach to breaks. I find that allowing the student frequent small breaks, is often more meaningful in terms of preventing tantrums and maintaining the student’s contentedness, than infrequent large breaks, such as recess.

If a teacher or parent decides that this plan is appropriate in a specific child’s case, then the first step would be to determine when the problem occurs. Is it perhaps that Sue doesn’t like her reading program where she has to speak out loud? Or maybe John starts to head downhill when he has to sit more than five minutes?

If we know when the problems occur, we can make a plan. For a stressful program, brief breaks where the student can get up, walk around a bit, maybe go get a drink of water in the hall, both before and after the program, often can prevent the issue from arising. Sometimes if the aversive program is highly aversive, or if it is really long, breaks can be added within the program itself. Another strategy would be to break up the aversive program into very small chunks and intersperse them into other activities.

Dealing with a longevity based issue is usually easier. If you know that John has issues if he has to work for more than 5 minutes. Then the solution is usually is to pick a point a bit before the 5 minutes and give the student a break. In this case I would probably choose 4 minutes. But if that didn’t work, then I might bump it down to three minutes.

I might deliver the above non-contingently. In other words no matter what John was doing when the three minutes were up, I would give him the break. Or I might make it contingent. I would start the timer only when John was working. I would pause the timer if he went off task, and restart it when he went back to work.

There is a third option and this is the one I typically use. It is also the easiest to use, but it involves careful monitoring and awareness of how the student is holding up. I informally keep track of time. I make sure that roughly every five minutes John gets a break. However, I observe if John is showing signs of fatigue, loosing interest, or stress. When I observe this, I ask for one more correct response, and when I get it I offer the break. But I would be careful to always get a correct response before I give the break.

Using non-contingent breaks are usually done if the student has a sever tantrums, or if the break program is first starting out, or if the teacher does not know much about the student yet. Using contingent formally timed breaks are useful when the student is doing independent seat work. If a teacher is roaming between several students and can’t give total attention to the student. The third option works very well for 1:1 work, where the teacher is very familiar with the student.

What A Beard Can Teach About Autism

2007-10-26T18:08:00.000-06:00

The fallacy of the beard (fallacy of the spectrum) is to claim that because two points exist on a continuum, that they are indistinguishable, due to the fact that at some point they both blend. The famous example is that of a man with a beard is indistinguishable from a man with a clean shave, because it can be hard to tell at some point what exactly is still a clean shave and what is a beard.

With that in mind I like the reader to consider autism. Persons meeting criteria for Autistic Disorder seem distinct from persons who are typically developing. Many of us, on different sides of the debate would go so far as to consider autism and typical development, entities in and of themselves.

However, the criteria for autism and the categories have not been static. These have changed and expanded over the years. One of the things we have learned from this is that there are many people who fit some of the criteria for autism, but are in other ways more typically developing.

It seems that while autism is distinct from typical development, it is still part of the same continuum. This of course is no deep revelation at all. Most of us recognize that autism is a spectrum. And that many behavior are in fact shared, even if they differ is frequency, topography, and function.

What I would like to argue that might be a bit unusual is that we should not place Autism and typical development on one single continuum. I would argue that these things exist as smaller distinct behaviors on hundreds or maybe even thousands of continuums. I would argue that while the general patterns of autistics or typically developing persons might be similar across these continuums that they are inevitably individualized and distinct to the person.

Making Fun of Homeopaths

2007-10-25T21:11:00.000-06:00

The 72nd Skeptic's Circle is up. The circle is mostly focused on Homeopathy this time.
It makes an informative read about alternative medicine though.

Do Old Teachers Claim an Epidemic

2007-10-24T16:49:00.000-06:00

One of the more interesting claims from our friends in the biomedical advocacy camp is “That if one talks to a veteran special education teacher then they will tell you that the rise in autism is real and not due to changing criteria”.

I certainly have seen this claim a number of times and I suspect that many of my readers will have as well. It seems fair to put this to a test. After all, the way the point is usually written tries to reflect the opinion of most/all the special educators and not just one or two special educators.

Recently I attended a meeting with 20 or so special education teachers. A total of 6 of them had 25+ or more years of experience. The opportunity as not lost on me and I took a moment to ask: “Is the prevalence of autism increasing, decreasing, or staying static and why do you think this is the case?” The answers are summarized below.

Teacher 1: The prevalence seems to be increasing. She had no ideas why, and didn’t care to speculate.

Teacher 2: The prevalence is truly increasing. Unspecified environmental toxins are most likely to blame

Teacher 3: Prevalence seems to be increasing. No ideas why, claimed not be very familiar with the issues. Didn’t want to guess.

Teacher 4: Prevalence is static. Political issues related to special education law, allow parents to choose a more desirable autism label compared to what the testing says. Claimed she had seen it before with ADHD in the late 80s. She also mentioned that placement is a IEP category does not constitute diagnosis.

Teacher 5: Prevalence is static. Better diagnostics and broader definitions are the cause. Claimed that no one heard of Asperger’s Disorder before 5 years or so ago.

Teacher 6: Prevalence is increasing. No ideas why and didn’t care to speculate.

So the total is 4 who didn’t know why and/or refused to try to guess.
1 person who thought that the increase was due to IEP issues.
1 person who thought that the increase was due to better diagnostics and definitions.
And 1 person who thought that environmental toxins were the cause.

So, what does all this prove? Well, very little to be honest. This type of informal survey can tell us almost nothing about popularity or what the majority veteran special educators think. The only thing is proves, is that bowling up to a special education teacher and asking if the autism increase is real or not, is not for sure, going to be met with a certain answer. This is contrary to claim or myth as it is usually given. The morale here is: “Don’t buy it!”

Education Technique #1

2007-10-20T18:12:00.000-06:00

This is the first installment of a series I will run every Saturday through November. The series will be on educational techniques that have used in the past.

Education Technique #1: High Probability Response

I am philosophically committed to trying to minimize the use of exclusionary or aversive techniques to the extent reasonable in a child’s life. I offer this technique as an alternative to “time-out”.

The use of a high probability response uses the idea of behavioral momentum. This is the general observation that the types of behavior we engage in tends to continue in the same direction for a time. Off task or inappropriate behavior tends to precede more off task behaviors, and on task behavior tends to precede more on task behavior.

The technique here, involves the attempt to disrupt the chain or hierarchy of inappropriate behaviors and start a new chain of appropriate behaviors. The teacher/parent would deliver rapid instructions using a lesson or modality the child has already shown mastery of. The moment the child in only engaging in appropriate behavior, they are redirected back to the task. Skillful users of this technique can usually have a child back into the regular activity in less than a minute, although that is not always the case.

The activity should be something the child has mastered and that can be done quickly. But it should not be a highly preferred activity. It not supposed to be reinforcing or soothing, or aversive for that matter; it is supposed to be neutral. The idea is redirection. The idea is catch the child as they head “downhill” in terms of behavior and quickly build up some momentum in a positive direction. And then to get them back into their regular activity as quickly as possible.

My Answer to the Charge

2007-10-19T22:35:00.000-06:00

One of the most interesting aspects of being a blogger is the feedback I receive. Take for example my previous post “Are Hub Science Blogs are Unfair”. The feedback of course, showed many different opinions. Some commenters felt that the autism science bloggers, myself included, may be quick to jump on the logical errors or bad science of others, but showed a reluctance to do so for theories that we support. And others thought that our pattern of analysis was reasonable, within the confines of our interests.

Probably the most interesting question that emerged from the comments concerned if what the authors write about should be determined in part or whole by the readership’s interest. I think there are some good reasons to do so, the most obvious reason is, that if you don’t produce posts interesting or relevant to your readership, then they won’t visit and your ideas won’t be promulgated.

However, there are also some reasons not to. The first and foremost, would be that it may not mesh with the purpose of the blog. A second is reason would be that the desired theme has little of worth that can be said about it at the moment.

I think that one of the things I learned when considering the above, is that there is a time and place for writing a requested article. One of the times I have found it appropriate to do so, was when the readers request closely matched my own interest. When the issue involved a strong accusation against a theory I advocate for. And also when answering a challenge.

I have traditionally stayed shy of issues like education and advocating for what I think evidence suggests works. Yet, I find some of commenters asking for just that. My reasons for avoiding these issues include the fact that to address these points is beyond the scope of this blog.

Other issues include the fact that advice is always necessarily very individual, and should be in my view confidential, neither of which is realistic on the internet. I would prefer that readers deal with their local education teams or visit specific advocacy sites to learn what to do.

I think one of the effects of this has been to somewhat isolate this blog, into a more academic niche. This is a place were one could go to dig into meaty issue of autism science and statistics. This also means that my blog may not be right for new parents or those first learning about autism.

I think however, since there is interest in education, that there may be room for an occasional discussion of some educational technique or issue. To this end I am creating a series to be run every Saturday through November. It will begin tomorrow.

Are Hub Science Blogs Unfair

2007-10-17T17:48:00.000-06:00

Some helpful anonymous person expressed the idea to me that Autism Hub bloggers are very unfair. We only tackle mercury and ignore other autism science. This person proposes that we should criticize all autism science.

I put up this thread in the hopes that this person would have a place to have his/her/it’s concerns discussed. And that if so, then the so called “autism science” blogs will really be shown to be totally one sided and really un-critical in the nature of their reasoning.

So, how ‘bout it, anyone want to agree/disagree that the hub blogs that focus on science are not critical of bad science that supports what they think?

Any takers?

CDDS Quarterly Report

2007-10-16T16:58:00.000-06:00

(CLICK TO MAKE LARGER)

Well its that time again. Let's have a look at the incidence data in the 3-5 age group in the California Deparment of Disability Services. These "incidence" data (the CDDS says you can't use their data to calculate incidence, but who pays attention to little things like that) are from the CDDS system which some people like to say is the "gold standard" in autism epidemiology (its not) and only measures Autistic Disorder (it doesn't). Anyway, let's look at the most recent datum point on the graph.

So..... the expected autism decrease has not appeared. You know it has been a while since thimerosal was removed from childhood vaccines. The only thing really left is flu shots for pregnant mothers. So, when are we going to see the numbers drop? I mean if you take a way the cause, then the numbers should drop right?

Of course this fact might be lost on the advocates of the thimerosal theory. Because when it is Jenny McCarthy vs science....I suspect I know who is going to be seen as more important in woo woo circles.

Goodbye LB/RB

2007-10-15T07:39:00.000-06:00

Kev is closing his excellent blog Left Brain/ Right Brain. This is a blow, because not only was LB/RB an interesting and very readable blog, but it was by far the most popular autism blog. The really sad part however is why it is closing. An individual named John Best runs a blog called “Hating Autism” (I refuse to link to it). He has over the course of the last several days written several articles from the imagined pro- quackery viewpoint of Kev’s autistic daughter.

The health of one’s children is obviously an extremely important and emotive issue. Some folks, put great stock or faith is questionable theories like the vaccine etiology of autism or quacky therapies like HBOT. Pointing out that these may not be good things, even when done to the nth degree of politeness does not always go over well. Ask any autism science blogger and they will tell you that sometimes people can’t separate the issue from their personhood. These people get mean, they get incredibly personally insulting.

What seems to have inspired John Best to write these articles, is Kev’s and others, quoting the most outrageous, ridiculous, or horrific statement from certain pro-quackery groups. Quoting these folks is direct proof for what many of us have suggested, that certain treatments are stupid and dangerous. Further, many of the most “outstanding” quotes show that instead of biomed becoming more popular with the masses, it ahs instead become more popular with folks much deeper into other forms of quackery.

John Best seems to argue that because Kev and others do this, sometimes even naming names of the kids exposed to such, we are mocking the children. Well no….. Saying that a treatment given to a child is dangerous or unscientific is not equivalent to mocking the child. Notice how these involve different matters.

Kev, I am sorry you have left us. However, you are doing this to protect your daughter and not only is that a good reason, it is the very best reason. I am proud to have been associated with you.

Allyship: My Story

2007-10-14T12:39:00.000-06:00

Returning visitors here know that I usually write objective reviews about science in autism. Today’s post will be quite different. This will be a subjective article about experiences with autism advocacy. Specifically this is my journey. It is the brief tale about learning to be an ally and my experiences with the philosophy of nuerodiversity. In the post I try to define some difficult concepts. Others may disagree with the way I have defined such. I should say that my objective here is not to offend or to speak for the group, but to speak for myself.

My story begins as university Sophomore. A friend talked me into… well actually she made me… be a volunteer in a local special education school to get some “resume building” done. It wouldn’t be so bad she suggested, it was just two hours a day and we would get to work together. My friend was placed in classroom for students with a cognitive impairment. It turns out though that they had enough help there. They said they could use me more with in a pre-school classroom for children with autism. And thus did my journey with autism begin.

I had already worked a little bit in my last semester in High School as a teacher’s aid with students with autism. I didn’t know very much however, except that these folks were an interesting mix of strength and weakness. But now, I was completely fascinated. I spent my nights studying the late, but much missed “Oops Wrong Planet Syndrome” and various related autism websites.

I was also in a tricky time in my own life. I was trying to decide whether I should zig and stick with psychology, or zag into pre- med. To help me reach this decision I elected to take a Philosophy of biology course in my second semester. The course was tremendously hard and tremendously fascinating. It was a revelation. I remember being caught up in Gould’s clear gift for prose, Dawkin’s lucidity, and Oyama’s complexity. And the topics that were drawn into the class were amazing; red shift, cryogenic earth, the central dogmatic fallacy. For the first time in this class I was told what a “strawman” was. Up to this point I had figured that college had nothing to teach, that my undergrad years were here to “fill in the gaps” from High School.

This one class taught me more new information than the sum of my Freshman year. It also left me three world views that have lasted since. It directed me (not on purpose I think) into behavior analysis and into skepticism. It also humbled my newly found behavior analytic bent by having me read “As Nature Made Him”, a powerful reminder that no animal is a tabula rasa (blank slate), and thus directed me into Oyama’s developmental systems theory.

I spent my Junior year learning the basics of behavior analysis and I continued to read books old and new about autism and visit autism based websites. Then late in my Junior year I began to stumble across sites very critical of ABA. Some of these criticisms seemed vacuous at the time, and years later, I am even more certain that they are vacuous. However a few sites made good points. I began to interact and debate with these better sites.

This all went on several years. It was a tremendous education. Suddenly I had to go back, check references, and explain things in a logical manner. If I couldn’t do so, I had to cede the point and modify my worldview in small ways. I honestly think that I understand behavior analysis on the level I do compared to my peers, because I spent so much time debating the basics of it on the internet.

But more than that changed, I met people who didn’t talk about autism just as a collection of behavioral excesses and deficits. The reminded me what psychology often teaches, but sometimes forgets, that normalcy is a statistical matter, not a yardstick to which others must be bent. The autistic persons and their allies, who held these views, were passionate, strongly opinionated, and vocal. But they were also like all groups of people. They were not homogenous. Some argued using science and logic, some argued using ad hominems.

I was turned off. Many of the points weren’t just too tart; they were plain not very well thought out in the first place. I strongly disagreed with a lot of what I read or heard from these folks. Being called an “ally” (no one said “ND” yet) wasn’t something I saw a good thing, at this time. I told myself that “I drink no ones cool-aid”, whether it be behavior analytic or otherwise. I had a real set to with a few such people over certain issues. I came very close a few times to stopping my discussion with them at one point. I think that it was the presence of a few solid science based arguments that kept me around.

In September 2005, I started this blog. Initially most of my work was graphing or discussing the autism epidemiology. My blog was not so much pro ND as it was against the argument for an epidemic. It wasn’t even anti- quackery or pro- skepticism at first. These are changes that happened later.

However, this blog was relatively popular (in a small way) with autistic self advocates and their allies. But even at this time I wouldn’t have strongly identified with them. It was inclusion in the Autism Hub that finally caused the change in my view. The hub became a locus for other excellent science and logic based blogs on autism. Not mercury, Do’C, Prometheus, Autism Diva, Joseph, Caitlin, the gang at LB/RB, and Michelle (Love ‘em or hate, their work and criticisms are science based).

I think I learned that Neurodiversity is partly, but best summed up as remembering the old psychology lesson that the average alone does not = what everyone should be.

I think that I have learned that being an ally is very similar to being a true friend. Meaning that an ally both supports those with differences in terms of maximizing their ability to self- determine and being able to tell them when you think they are wrong, without hesitation.

The Parable of the Shoe

2007-10-13T10:20:00.000-06:00

We usually require that children tie their shoes, as to prevent possible tripping. No research needed here in my opinion. Maybe kids who do not tie their shoes don't actually trip more often than kids who do; however, the issue is so petty, that it doesn't seem worth the effort it would take to research it.

But now let's say that I was a concerned advocate. I noticed a massive increase in ankle and knee injuries among students. I notice a trend among kids to wear their shoes untied. I suspect based on my own knowledge and experiences that the two are linked. Being a concerned person I advocate a law be passed that would require kids to have tied shoes. To enforce this law, a small fine can be assessed if a child is caught with untied shoes.

Maybe my observation that when kids have untied shoes they trip more isn't a good enough standard. I have taken a petty issue and made it a more serious one. Now it is time for research.

When the research comes back we find that "yes" lots of kids do have untied shoes, as is fashionable, but the style requires short laces that can not possibly trip the child. Also, there has been an impressive increase in both sandlot and organized soccer, which upon investigation seems to be the cause of the increase in injuries.

What I am hinting at, is that there are all sorts of things that quickly modify a petty issue, into suddenly requiring real research. This includes:

1. The possible danger of treatment

2. The expense of the treatment

3. The time involved in the treatment

4. The required participation of others, in the treatment

5. The legislation of some issue related to the treatment

6. And the claim that an anecdote is sufficient proof for broader acceptance or usage

The last claim in particular is what we see so often in alternative medical circles. Unfortunately, the advice of our myth busting friend Adam Savage to “reject your reality and substitute my own” doesn’t work in real science. When you advertise or give a testimonial about the effect of a treatment, you intrude into the realm of science and epistemology. What you say will be put under scrutiny, to see how well it holds up.

Behavioral Progression Paradox

2007-10-12T20:21:00.000-06:00

It has been a while since I have done a behavior analytic post. So, below I will dabble with a concept that really deserves much more than a brief blog entry. I hope that readers will find it at least mildly interesting.

I have previously written about a well known paradox in behavior science. That whenever a reinforcement contingency occurs, a shadow contingency of aversive control is simultaneously established. This theory implies that there can be no purely positive interventions or education.

And this theory is broader than just ABA or some other application of behavior analysis. Anytime a consequence is given (whether appreciated or not) and this consequence affects the rate or likelihood of a behavior, then the above paradox is put into play. There doesn’t have to be behavior analysts and gaggle of therapist, or even someone who knows the first thing about behavior analysis; there just has to be a consequence.

But there is another related paradox, that I wish to discuss. This is what I would call the “progression paradox”.

As any child, including one with autism, begins with relatively few contingencies that are overtly aversive in nature. Work is brief and closely monitored by others. But then, progressively, the number and type of interactions multiplies. If one analyzed what maintains these contingencies, then largely (but not exclusively) they are aversive in nature, they are usually avoidance or loss or avoidance of the presentation of an aversive outcome contingencies. For example, homework must be turned in by a certain day, the alarm clock annoyingly goes off, chores must be done by supper time, friends expect you to be with them at inconvenient times, the computer keyboard has an “K” key that is jammed and extremely irritating, you must correctly discriminate between the voice level that is appropriate in the gym and voice level that is appropriate in the class or home.

And so it goes…… But herein sits the paradox. We expect that education not only be done in a way that minimizes the unpleasant or aversive, but even that it moves a child towards learning to avoid the unpleasant or unfortunate. If this theory is true, then the further a child moves in their education, then the greater the amount of aversive contingencies they contact.

So if this theory is true what does it change? And the answer is “not much”…..
This theory doesn’t change the ethical value many of us place on avoiding aversive contingencies in teaching children to the extent possible. Or for that matter, on education that maximizes independence and development interests.

The only thing this paradox could really alter is the way we talk about aversives. We can’t say that we only use reinforcement. We can only say that we try to minimize aversives.

A Review of the Challenge- Dechallenge- Rechallenge Design

2007-10-11T18:55:00.000-06:00

Most of the readers here are probably familiar with testimonials that claim a given treatment was implemented for a young child and then caused drastic improvement. Many of us on the skeptical side of the argument would correctly note that this is a post hoc, ergo propter hoc fallacy and that just because a change was noted after the treatment doesn’t mean the treatment caused the change.

I think it goes it without saying that pointing this out doesn’t always go over well. These issues deal with the core of what different people consider to be acceptable evidence. It also inevitably ties into an extremely emotive issue; their children’s health and wellbeing. Sometimes though, the people the people who have been accused of using such a fallacy do take the criticism to heart. They want to know what they could do to offer proof and be convincing.

I have been asked this several times. Frankly it is a frustrating question for me to answer, because I know the answer itself is unfortunate and unsatisfactory. And the answer is: “Not much”. The very limited list of possibilities includes:

1. Volunteering their child to be a participant in trials of their preferred treatments.

2. Conducting group based research like a double blind, placebo controlled, crossover design.

3. Advocate for studies to be undertaken concerning their preferred treatment.

4. Conducting a well controlled single case design.

The first option is unlikely because such trials are rare and the logistics of the thing make having the opportunity difficult. The second option is exceptionally hard because it requires significant technical expertise and well as considerable time and money. The third option is very indirect and often feels unsatisfying. It takes the ball out of the advocate’s court and places it into the hands of some third party.

This leaves the fourth option. This seems to be the option that many of the caregivers who accept the criticism of the post hoc fallacy, attempt to use. Specifically they attempt to make use of the Challenge- Dechallenge- Rechallenge Design. Said another way, this design has three phases, a treatment phase, followed by a baseline (non- treatment) phase, followed by another treatment phase. The advocates or caregivers claim this is a scientific design, which proves that a treatment was effective for their child.

To such advocates it may look like a good plan. This design is well considered in some mainstream scientific circles; it doesn’t involve the expense and difficulty recruiting for a group design or the detailed knowledge of inferential statistics. The basic mechanics of the design are easy enough to understand. It puts the ball back in the caregiver’s court. And maybe best of all, it seems to provide a direct answer about the effectiveness of a treatment, for someone very dear to the advocate or caregiver.

Unfortunately, a certain cliché is apt here: nothing is ever easy. The treatment- baseline- treatment design, even in the best possible case is a quasi- experimental design. It has reduced validity to answer if the treatment is what caused the improvement for the child. This has nothing to do with the fact that there is only one child. In fact there are several excellent single subject designs that allow us to be quite confident that treatment caused the improvement. Unfortunately, this design isn’t one of them.

What worse is that even though this design when conducted under excellent conditions and high control might have some validity, this still requires years of study, guided practice, and hard work to understand. Single subject has its own quirks and trip falls just like any other type of research from epidemiology to double blind designs. The point is you are not going to be competent in this type of design from reading a book or researching the topic on the internet. They could become so, but it takes years of hard study and practice.

The concerned caregiver or advocates who claim that they administered a treatment, withdrew, it administered it again, are not drawing level with trained researchers who use this design. They don’t have the same safeguards and controls. A good research project isn’t just the basal design, it is the level and appropriateness of the controls in the design. A trained researcher’s design might have:

1. More than one participant being investigated at the same time or in sequence to control for maturation or outside factors.

2. Specific targeted behaviors, with objective definitions, as opposed to someone’s general impression of “wellness” or competency.

3. Appropriate reliable and valid assesment.

4. Inter- observer agreement assessment, to make sure that those who give the assessment or record the behaviors are doing so in a valid and reliable manner.

5. Careful notation of possible confounds that emerge over the conditions.

6. Appropriate graphical analysis to observe trend, level, variability, and possible patterns indicative of additional or outside concerns e.g. (cyclical behavior).

7. Careful control of the context and environment in which the child is exposed to the treatment.

8. Submission and analysis in peer reviewed publications, where ones knowledgeable peers can point out problems, weakness, or graphical shenanigans.

9. Knowledge of what type of questions the design can and can not answer in the first place.

10. Knowledge that the conditions can not be arbitrarily switched, that there are rules for when we can transition to the next condition.

If one doesn’t have at least some of the above and especially 2, 3, 8, 9, and 10 intact, then they have no real design to speak of.

Look at Figure 1. This a graph of a hypothetical treatment- baseline- treatment design. There are only two points of comparison in this design; the first treatment phase to the baseline, and then the baseline to the second treatment phase. We have absolutely no idea what was going on before the first treatment phase implemented. And even if there was a dip in the baseline condition we have no idea if this was an artifact from an outside event or maybe based on a cyclical pattern of behavior. If you only have two points of comparison it is very hard to know.

This is figure 2. This is what happens when someone tries to use a treatment- baseline- treatment design, for a task that involved learning. You get stability where we should see variability between the phases. So, even if the treatment was biomedical and the measure was on something not easily lost like acquisition of language, the negative effect would not be observed during the language tests.

The next time someone says they used a Challenge- Dechallenge- Rechallenge which is a appropriate scientific research design, ask them if they can send you the write up so you can see if they used the same controls the trained scientists do.

Woo! Happy Birthday Interverbal

2007-09-28T19:02:00.000-06:00

Woo! Happy Birthday Interverbal

Well this blog is two years old. We are just shy of 30,000 unique visitors. Not bad for a blog that was meant to practice my writing and critical thinking skills.

So, what should we do for my birthday hmmmm….

Write a poem?

Try to do a post about some deep issue?

Make some more autism graphs?

Ah, well, you know what…. let’s just play Bingo! But this is a very special type of Bingo! This is autism woo bingo. The rules are simple. All you have to do is try to get one straight line (horizontal or vertical) filled in with chips, goldfish crackers, pennies, or whatever based on what you see in an website. Now, the rules state that it has to be on a single screen or part of the same article/post. You can’t flip around trying to win.

When you get a straight line filled out, you get to shout “Woo!”. Simple easy and fun! Huffpo articles are usually a good place to start. Good hunting!

(click to make larger)

My philosophy of education

2007-09-27T19:49:00.000-06:00

Recently I was asked to write my philosophy of education. This is a copy of the answer to that question:

My philosophy of education can be summarized as: An effort to move a student towards as much independence as can be attained. The philosophical goal of special education that I embrace is social mobility, which is to provide students with maximum personal choice as to what their goals are, and to provide them with the training and credentials necessary to achieve this.

I hold that education should always move towards increased choices and freedoms for the student. So, while I support and utilize non-naturalistic reinforcement and non-naturalistic teaching, I temper this with Vygotsky’s scaffolding, which is the progressive removal of supports and prompts as the student demonstrates mastery of a concept. I argue that supports are only useful to the extent that they move or allow a student to obtain greater independence.

In terms of ethics I attempt to balance my support for the IEP process and safeguards, which I argue brings a good to the most people and which I consider to be an example of Mill’s Utilitarianism. I also balance this with my belief in Kant’s Deontology which holds that ends and means are equal in importance and that teaching should be done to the extent possible in a way that avoids bringing unpleasant experience to the student. To this end I advocate the use of positive reinforcement and the minimal use of aversive control, similar to what is discussed by Sidman.

I also hold that students with disabilities fall under the same protections and rights as accessed by students without disabilities the same age. I also believe that while students with disabilities may have a mix of strengths and weaknesses, that difference alone, even if it involves a significant departure from the norm does not constitute disability in and of itself.

In terms of epistemology, I assert that the universe is orderly and this order can be understood as described by Russell. I advocate the use of use of science in the attempt to understand the world including the sub-field of human behavior and learning. I also believe that overarching scientific theory progresses ad infinitum as described by Popper and that specific science moves through stages of evidence as described by Gould. I also hold that the perception of a theory in science changes as described by Kuhn and that science should not only consist of methodology, but also of logic as noted by Feyerabend.

Specifically in the field of science, I align with the radical behaviorism of Skinner. This is to say that while I look to contingencies for the cause of a behavior, I believe that to tell the whole story, we must include thoughts and feelings in our research. I also embrace and the attitude and words in which Skinner received his award as the 1972 Humanist of the Year, for: “Helping to create a less punishing world”.

I believe that teaching that is not in accord with community expectations may result in tension between the teachers and community as described by Wolf. I believe that the teaching must be aesthetically pleasing to the community and must also be seen to bring to bring benefit or have an axiological value, to the community. To this end I support organizations such as the PTA and other feedback systems.

NEJM Study

2007-09-27T07:52:00.000-06:00

A new study has just come out in the New England Journal of Medicine (NEJM). It was a correlational study, looking at 1047 children ages 7-10 that had complete records of immunization. The study assessed for 42 types of neuropsychological outcomes. This did not include autism which will be assessed in a different study. This study authors concluded that there is no association between neuropsychological disorders and thimerosal in vaccines.

Even before this study was released yesterday, there was publicized dissent from advocates from the idea of a mercury etiology of neuropsychological harm. One of them came from a well known advocate, Sallie Bernard, who was invited to be a collaborator in this study. It seems that she was involved in the planning of this study, but the lead author indicated that she withdrew her support after the results began to be circulated.

That is not how science works. If you have a problem with a study design then you dissent before you begin collecting data.

Skeptic's Circle

2007-08-30T16:33:00.000-06:00

The newest circle is up, go check it out.

A Review of the Goals of Education in the United States

2007-08-29T18:00:00.000-06:00

Introduction

Almost no aspect of education is free from controversy. Simply put, this is because we as a society disagree what the goals of education should be. I argue that by reviewing the history of education in the United States one can see that conflicts are inevitable. In essence, these conflicts occur, because our community, State, and Nation, do not agree what the goals of education should be. This post is specific to the US and is not a review of the goals of education outside of that context.

There are three distinct large scale goals involved in this conflict; these are social mobility, social efficiency, and democratic equality. There is an additional; fourth goal in the field of autism education that must be named because of its popularity. This is the ecologic argument at the family level.

Democratic Equality

Democratic equality is a potential goal of education. This goal states that in a democratic society all students must be trained to be competent democratic citizens and it is means to remediate social differences (Labaree, 1997). Democratic equality was seen as a way to break down the old barriers of the class system and the inequalities inherent in the newly formed Nation where some children were born into privilege. It was feared by early politicians that in the absence of democratic training, democracy would fail to work. This goal also mandates that social inequality must not grow too great, or the democracy may also fail (Reese, 2000).

When the public schools were first founded as “Common Schools” in the late 1840’s the justification for these schools was distinctly based in Democratic equality (Labaree, 1997). Whig politicians, who pushed for the founding of these schools such as Horace Mann, believed that in order for the still young United States to survive it would require all citizens to be politically competent. Since that time, no major debate in education in the US has come without someone or a group advocating the importance of democratic equality (Labaree, 1997).
Social Efficiency

Social efficiency is another goal of education. This goal dictates that students should be prepared in their education to members of the work force (Labaree, 1997). This goal could be called practical or pragmatic. The advocates saw school as means to prepare students to contribute and uphold society as workers. Curriculum was designed to applicable to the workplace.

A period of strength in this movement occurred in the late 19th century during the vocationalism movement. The fear was that schools were danger of becoming socially irrelevant and economically damaging (Labaree, 1997). The reformers in this period viewed a politically competent citizen as less important in society when compared to a technologically skilled worker. These reforms can perhaps be viewed as artifacts of the industrial revolution which was in full swing at this time.

Social Mobility

Social Mobility is the third goal of education relevant to this discussion. Social mobility asserts that the purpose of education is to provide students with the credentials or training to promote themselves in the market economy (Labaree, 1997). Social mobility is similar to social efficiency in that they both accept the premise that inequality is inherent in our economy (Labaree, 1997).

However, whereas social efficiency trains workers to primarily benefit society as a whole, social mobility trains workers to primarily benefit themselves and their families. Another difference is that social mobility unlike both democratic equality and social efficiency views education as a private good (Labaree, 1997). Public goods, or benefits that all citizens access such as street maintenance are viewed as “free rides” in the context of social mobility (Labaree, 1997).

Social mobility has been an issue in public education for at least 150 years. This is shown by the rapid increase in higher education in that period (Labaree, 1997). Another aspect of social mobility is the defense of programs that provide differentiation between students. Gifted education and even separate reading groups are usually defended from a social mobility perspective (Labaree, 1997).

Ecologic Argument

The ecologic argument in this sense is at the level of the family. The question here is not how the education benefits the student or prepares the student for employment and society, but how does the student’s education benefit the family itself. This goal is particularly popular in autism. I argue that 3 special contexts enable this.

First I would cite the history of autism itself as critical. As during the 50s and 60s in the US was seen as having arisen from a psychological trauma occurrence with the parents intentionally or not, at fault. At least part of the attempt was to analyze the family dynamic. In current psychodynamic practice in autism part of the intervention itself happens at the family level. I suspect that these early practices set precedent which helped influence current practice.

Second, many of the autism treatments require total family buy-in. Certain ABA programs require total family participation in enforcing certain teaching contingencies. Certain play based therapies require all family members to participate so bonding may occur. Also, more than one parent of a child using the GF/CF diet has written of the need for all family members to be on the diet otherwise the child will sneak food. No wonder then that the family members may expect some family based benefit. A very clear example of this is the PDRF; an autism analysis tool designed for parents, by parents. In one question, the PDRF very clearly asks about the improvements in the quality of life for other members of the family, that the treatment of the child with autism has yielded.

And third, I propose a connection to the type of family itself. Certain families with children with autism pursue alternative therapies. Those who do so seem to be amenable to alternative practices in medicine in general, although this is not always the case. Such families from by subjective observations seem to prize their independence from larger establishments in the field of medicine at least. They do however, put tremendous emphasis on the family unit itself. A comment that is sometimes heard among representatives of this group is that if a child has autism, then the family has autism. If this is the view, then it makes sense that the goal would be improvement for the family itself.

References

Labaree, D. (1997). Public Schools for Private Advantage: Conflicting Goals and the Impact of Education. In D. Labaree (Ed.), How to Succeed in School Without Really Learning (pp. 15-22). New Haven: Yale University Press.

Cuban, L. (2000). Why is it so Hard to Get ‘Good Schools. In L. Cuban and
D. Shipps (Eds.), Reconstructing the Common Good in Education (pp. 148-169).
Stanford: Stanford University Press.

Reese, W. J. (2000). Public Schools and the Elusive Search for the Common Good. In L. Cuban and D. Shipps (Eds.) Reconstructing the Common Good in Education. (pp. 13-31). Stanford: Stanford University Press.

The State of Autism Science in France Could be Better

2007-08-28T18:31:00.000-06:00

Just one more example of how bad science, hurts people.

Taken from: HHK online medical/health news:

"A French treatment for autistic children with psychiatric problems which involves wrapping the patient in cold, wet sheets from head to foot is undergoing a clinical trial for the first time, which critics hope will see an end to the controversial practice.

The treatment, known as "packing", involves wrapping a child in wet, refrigerated sheets in order to produce a feeling of bodily limitation and holding, before psychiatrically trained staff talk to the child about their feelings. Critics have called the procedure cruel, unproven and potentially dangerous, but its proponents say they have seen results.

Pierre Delion, is head of the child and adolescent psychiatry unit at Lille Regional University Hospital in northern France, and pioneered the technique, which has its roots in other envelopment or encasement therapies, for example those using mud or clay. He says that packing reinforces childrens' consciousness of their bodily limits, which in some psychiatric conditions becomes fragmented.

Delion says the technique is indicated for severely autistic children who self-harm; psychotic children; and, more rarely, children with anorexia. He has claimed that it often results in a disappearance of self-harming behaviour. The process was brought to France by a US psychiatrist, Michael Woodbury, where it was taken up by the psychoanalytic movement founded by Sigmund Freud, which wields strong influence in French psychiatry.

In developmental psychological theories, "holding" and the sense of the skin's limitations that it brings, is conceived as a key component of the infant's sense of itself and its relationship with its mother. However, this model has been subjected to recent challenges, most notably by the French National Consultative Ethics Committee for Health and Life Sciences, which published a report in 1996 stating that there was no evidence to substantiate psychoanalytic models of autism, nor that therapies based on this model were effective.

The authors were also concerned that, in France, childhood autism was classified as an infantile psychosis, rather than as the now internationally recognised description as a pervasive developmental disorder.At the the Pitié-Salpêtrière Hospital in Paris, where the neurologist Pierre Janet once developed an extensive classification system for psychological disorders, packing is used alongside specialised education and medication for some severely autistic and schizophrenic children.

David Cohen heads the child and psychiatry service at the hospital, and he views packing as a form of bodily mediation like massage, which relaxes the child while he receives psychotherapy. It combines, he says, the body and the image of the body, both of which are crucial to each other for psychological integrity. Experts are awaiting the results of the clinical trial, taking place at Lille, with interest."

Giant Robots?

2007-08-16T09:45:00.000-06:00

What the..... Oh it's Bronze Dog nevermind.

BD is a fellow child of the 80's D&D playing,
old school nintendo type. I don't know how he
managed to mix skeptics and robots, but it was awesome.

Skeptic's Circle

2007-07-19T09:00:00.000-06:00

A 4th grade class will be visiting the Museam of Skepticism.
You can too.

I’m Gonna Buy Me, One of Ben’s T-Shirts

2007-07-16T22:32:00.000-06:00

This morning, I was reading the daily web news and generally minding my own business when I came across this little gem on that bastion of internet truth, MSN. I recognized this diet as it was was popular in the 70's and 80’s for hyperactivity and because I had the opportunity to be on it as a child.

This was perhaps a little surprising considering how much research shows the Feingold Diet doesn’t help ameliorate ADHD or hyperactivity and that most serious science in the field doesn’t give the Feingold Diet the time of day anymore. But that can happen when the last piece of serious science on the subject was published over ten years ago.

Krummel et al., (1996) are pretty direct when they say:

“Numerous double-blind studies of the Feingold hypothesis have led to the rejection of the idea that this elimination diet has any benefit beyond the normal placebo effect. Although sugar is widely believed by the public to cause hyperactive behavior, this has not been scientifically substantiated. Twelve double-blind, placebo-controlled studies of sugar challenges failed to provide any evidence that sugar ingestion leads to untoward behavior in children with Attention-Deficit Hyperactivity Disorder or in normal children. Likewise, none of the studies testing candy or chocolate found any negative effect of these foods on behavior. For children with behavioral problems, diet-oriented treatment does not appear to be appropriate.”

Now, the role of Nutritionist is one I would like to have a lot of respect for; after all, who is against nutrition? However, it turns out that just about anyone can call themselves a Nutritionist. It also seems that my general lack of respect for the title of “Nutritionist” isn’t limited to just me.

The Feingold Diet, for the uninitiated, was named after pediatrician and allergist Ben Feingold. It is a so called, elimination diet, where certain foods or additives are removed from a child’s diet. This leads to a theoretical improvement in a child’s behavior. Among the usual suspects are various food additives and dyes e.g. (red #40).

The Feingold Diet has never officially included sugar in its banned substances list. However, Feingold practitioners may advise the removal of sugar (of one sort or another) in addition to the complete Feingold Diet, if the diet by itself is not enough to reduce behavior problems. Dr. Feingold himself mentioned that cane sugar was suspect.

The diet does have some empirical support (Conners et al., 1976; and Rowe & Rowe, 1994). It looked fairly legitimate at one point in time. It also had its champions. At least one name should be familiar to those of us in the autism world. The late Bernard Rimland, who was better known in his latter years for his alternative theories; encouraging chelation for kids with autism; was an outspoken defender of the Feingold Diet.

Dr. Rimland raised a number of interesting criticisms including the fact that the disproving studies couldn’t possibly have studied all 3,000 additives prohibited in the diet. Of Dr. Rimland didn’t explain how anyone could have accomplished this feat. He also mentions that the darn kids were sneaking “illicit food” during the study.

In a very interesting passage he writes:

“Who needs artificially colored and flavored food anyway? For millennia the human body - and mind - has evolved and thrived on real food. It is prudent to feed our children and ourselves real food, not the denatured, "refined," additive-laden artificial foods that emanate from factories. What is the cost to us, to our country, and to our civilization of allowing ourselves to be seduced into consuming the gaudy colors and deceptive flavors that are used to make non-nutritious food appear desirable?”

Anyone reading the above passage shoudl quickly note the logical fallacies present. Such fallacies inlcude the argument by rhetorical question. Argument from tradition. The fallacy of the false dilemma. Argument from adverse consequences. And another false dilemma. So, Dr. Rimland racks of 5 fallacies in 4 sentences.

But it isn’t just Dr. Rimland. There seems to be a fundamental logic problem in the whole nutritionist cum Feingold culture.I remember the first time I realized there might be something funny with Feingold Diet was in High School, when I read a pro-Feingold book that stated that even if what the Feingold Diet treated was not really an allergy, it was okay to call it such, because the problem was analogous to an allergy.

However, that book was written in the late 70’s and it was already 20+ years old when I read it. Different time….right? Different standard of proof.

In the early days the Feingold supporters had a very scientific looking way to help parents and caregivers navigate through which foods were a problem and which were not. The simply would add or take away a food item and over the course of a week see what would happen. And just like that, post hoc, ergo propter hoc, the answer would be made plain.

This represented a can do attitude on the part of Feingold and company. It involved the parents, it put the power and control in their hands. In today’s alternative medical circles some people would call them “health care freedom fighters” or some such title.

However, we have reason to be a bit cautious here. Hoover & Millch (1994) found that after giving supposedly sugar sensitive children artificial sweetener and telling their parents it was sugar, the parents rated the children’s behavior significantly worse than controls. This result seems to indicate that even the people who know a child the best, can still fall victim to the confirmation bias and other self-trickery. Post hoc logic, even when dressed up to look like science, still isn’t science.

Keeping the above fact in mind look here. It is a bit disappointing to see the same pseudo-science being pushed 30 years after the fact to justify a diet that is largely negated by the research, and that hasn’t been seriously researched since 1994.

At one time the Feingold diet seemed like a plausible treatment. That day has come and gone, because the majority of the research didn't back it up. But the Feingold advocates are still promoting their theory which has seen little or no change since the last bit of science on the issue. Once again, the observation that the more science changes, the less woo does, is proved to be true.

References

Conners CK, Goyette CH, Southwick DA, Lees JM, Andrulonis PA. (August 1976). "Food additives and hyperkinesis: a controlled double-blind experiment.". Pediatrics 58(2): 154-66.

Hoover, D. W., Milich, R. (1994). Effects of sugar ingestion expectancies on mother-child interactions. Journal of Abnormal Psychology. 22(4), 501-15.

Krummel D. A., Seligson, F. H., Guthrie, H. A. (1996). Critical Reviews in Food Science and Nutrition. 36(1), 31-47.

Rowe KS, Rowe KJ (1994). "Synthetic food coloring and behavior: A dose response effect in a double-blind, placebo-controlled, repeated-measures study". Journal of Pediatrics 125: 691–698.

CDDS Autism Zombie

2007-07-13T19:22:00.000-06:00

(click to make larger)

I have already written extensively about the California Department of Disability Services autism data. Its getting to hard to imagine that there is something to still say.

But at least 4 times a year, I find myself writing something about the latest CDDS report. This is because the CDDS issues a quarterly report and a group of individuals who advocate a vaccine etiology of autism analyze the data in manner that inevitably supports their theory. This happens every quarter. This happens no matter how many times we criticize the use of the CDDS data because it is not supposed to be used as epidemiologic data, as the CDDS themselves clearly state. Just like Ouija Boards and astrology, there are always a few who resurrect this undead creature, and send it growling off towards public consumption.

What is more, this zombie seems impervious to attack. If the data indicate a continued rise, this is proof that vaccines cause autism and even though much of the thimerosal has been removed, there is still some being used in the flu vaccines and this is the likely culprit. But, if the numbers drop, this is also proof that the vaccines cause autism, because the sudden drop can be correlated to the not quite complete removal of thimerosal.

I should say that some take a more reasonable approach. They accept the criticism that these data are not meant to be used for epidemiology. However they then argue that it is the best that can be had. And that if one sees trends here, even if the data are flawed, this is still indicative of an actual effect. This argument is actually somewhat widespread.

But the argument is still flawed. If one refers to the graph, it should be clear that the natural statistical variation allows for an occasional decrease; even one extending for a few quarters before an uptake is noted. That is the nature of statistics; one is going to see an occasional slight downswing. Moreover, the fact that the CDDS data are so regular does not make them reliable or valid.

The CDDS uses a form version from 1986. It has the following categories.

0 = 'None''

1 = 'Full Syndrome''

2 = 'Residual State''

9 = 'Suspected, not Diagnosed

The form counts the 1’s and 2’s. These categories are not part of DSM-IV-R. They are older categories based on earlier ideas. Thus, it can not be correctly said that CDDS offers services only to Autistic Disorder as defined by the DSM-IV. Full syndrome includes both PDD-NOS and Autistic Disorder.

An Autistic Spectrum Disorders Best Practice Guidelines For Screening, Diagnosis and Assessment statewide standards was held in 2002. A revision to this practice that conforms to the DSM-IV and ICD-9 will not be implemented until 2008.

These data are not good measures of Autistic Disorder, as they have been advertised by some persons, almost unceasingly. Moreover, there are no reliability checks conducted to make sure the State diagnosticians are conforming to recommended practices. This makes them an unreliable and invalid, source of autism data. For these reasons any attempt to use these data for purposes of epidemiology is ill-founded.

MMR Shenanigans

2007-07-08T17:31:00.000-06:00

For those of you who may have missed the recent hoopla. A study by Simon Baron-Cohen’s lab has been leaked to the British press. It describes a prevalence of 1 per 58; using a tool that lacks evidence showing that it is appropriate for use in the general public. It seems that a research assistant in the study who now works for Andrew Wakefield had attempted to connect the 1 per 58 number to the MMR.

I have learned via Bad Science that a connection to the MMR is not the study authors’ conclusion. Seems like there is some funny reporting going on.

2007-07-07T14:42:00.000-06:00

7 Myths of Science

The following are the 7 most common myths about science and research that I have seen. I have attempted to refute them in brief, even while recognizing that short answers to such widely held ideas are almost never satisfactory. As always, your comments are welcome.

1 Anything can be proven with statistics; therefore such-and-such a study which did/did-not show an expected result is bogus because the authors could have shown anything with their stats.

Reply: A knowledgeable statistician can arrange a situation so that it appears as if a negative result is actually a positive. However, this is one of the reasons for peer review in scientific journals. It is one thing to get statistical manipulation past the general public; it is another to get it past one’s peers who have also been trained in depth in statistics. In fact one of the major focuses in statistics and research courses is detecting statistical and graphical shenanigans.

2 Science changes its mind all the time, so why should I accept what the research shows on such-and-such an issue.

Reply: In science particularly in broad explanation based theories; paradigm shifts do occur. Numerous examples of this in physics or medicine should familiar to everyone. However, smaller bits of descriptive science can be more robust. For example, our knowledge of how genetics influences health is likely to alter significantly in the indeterminate future (maybe even cause a paradigm shift), but this fact will not likely invalidate the studies showing penicillin to be effective for such-and-such a strain of bacteria. This is sometimes true even in broader applications. Newtonian physics may have been displaced in the broad sense by relativity, but as many a sore handed college student can attest, differential and integral calculus is still with us and still has utility.

3 Science can not explain the entire human experience.

Reply: Science can only deal with the objective, or what two or more people can detect in the same way, at the same time. However, this fact can be twisted into justifying certain beliefs. Because science has this basic requirement it can not effectively assess a great deal of the human experience including thoughts, feelings, dreams, and perceptions. However, it is a logical error to assume that because science has this gap, we can or should believe in the issues science can not assess.

4 Science can not answer metaphysical questions.

Reply: That really depends on the specific metaphysical question. If there is measurable outcome and a detectable initial cause, then science can indeed assess the question. For example we can not measure divine intervention, but we could assess the effect of prayer on the recovery of heart surgery patients.

5 Law courts convict or release people, on far less and weaker evidence than what passes in science.

Reply: The systems are considerably fundamentally different. In courts (in many places) the people making the decision are limited in the type of answer they can give. They also have a distinct time limit in which they must reach a decision. They also are by no means experts in the necessary elements of the issues at hand. They are also restricted in the type of evidence they can hear.

Compare this to science where the people are experts in the specific areas of question, they have unlimited time, the nature of the arguments they are permitted to hear is not limited, and the type of answer they can give after assessing the evidence is not nearly as limited.

6 Science at times seems to violate common sense, therefore such-and-such a scientific result is false.

Reply: Common sense, when invoked merely means one person’s perception of what most people believe. That perception may be incorrect. Also, no matter how many people hold the same view in common, doesn’t mean the view is factual.

7 Science is a religion and well known scientists are the high priests of the religion.

Reply: This line of thinking is so underdeveloped, as to scarcely be worth the time. I offer a refutation only because it seems to be so popular. The word “religion” means something specific, the methods and logic used in science, do not fall under the umbrella of religion. Well known scientists are well known because of their contributions to science and/or the clarity of their writing. If ever they cease to be clear in their quality of thought, they may no longer be quite so esteemed e.g. (Linus Pauling).

2007-07-06T20:52:00.001-06:00

Study abstract:

“Autism is a developmental disability characterized by severe, pervasive deficits in social interaction, communication and range of interests and activities. The neurobiologic basis of autism is well accepted, although the specific etiology is unknown. It has been theorized that autism may result from a combination of predisposing genes and environmental factors. While autism has a known association with environmental factors such as rubella and valproic acid exposure in utero, other proposed environmental mechanisms such as mercury toxicity or other heavy metal exposure have minimal research support. Despite this fact, interventions including oral and topical chelation therapy are being used to treat autism following evaluation of hair, blood, or urine samples for heavy metal toxicity.
In this study, hair samples were obtained from 15 children with autism between the ages of 2 and 6 years and 16 controls in the same age range who are the siblings of the subjects. The hair samples were obtained according to lab. specifications and submitted in a blind fashion to Doctor's Data Lab. for measurement of mercury levels. Data from the two groups were then compared using T-test. No significant differences were found between mercury levels for the two groups. This study raises questions about the theory that mercury toxicity causes autism and points to the difficulty in quantifying chronic mercury exposure through currently available laboratory measures.”

Notes:

The research was supported in part by a grant from the University of Louisville Pediatric Research Foundation.

Reference

Williams, G. P., Hersh, J. H., Allard, A., & Sears, L. A. (2007). A controlled study of mercury levels in hair samples of children with autism as compared to their typically developing siblings.

Skeptics Circle

2007-07-05T13:16:00.000-06:00

Check out the good posts on autism and other assorted critical thinking.
Although I admit I have a favorite.

Skeptics + Ninjas = Awesome

Another Look at Soden et al.

2007-06-02T23:48:00.000-06:00

I covered Soden et al. a few days ago.
After carefuly thinking about the study I have some further comments and descriptions.

Participants

-15 chidlren with AD were included and 4 typically developing children.
-Aged 3-7, mean age of 4.62
-Past chelation experience was not permitted
-Only children diagnosed with Autistic Disorder were included
-Diagnosis was confirmed using standardized assesments and direct observation.

Study Limitations

-Only 24 hours were used, some have theroized that 72 might be needed for various reasons in chidlren with autism
-No treatment integrity data were taken on parent adherence to the procedure.
-Study can not rule out chelation as a useful treatment for autism, for reasons other than removing heavy metals

Statistics

-Confidence interval was 0-22%, so a larger sample of autistic children was unlikely to change the result
-Statistical analysis was appropriate and adequate, however a MANOVA statistical design may have provided additional data.

Other

This study was completely funded from a Bridege Grant from
Cure Autism Now

Punishment?

2007-05-31T20:46:00.000-06:00

I will make a bold assertion that scientists of human behavior have an obligation to study punishment. I am willing to make this assertion because:

1. Punishment is a natural part of the human experience

2. Behavior scientists have a duty to attempt to understand the different parts of the human experience.

3. It has been suggested that natural punishment contingencies make up a significant portion of our learning experiences, maybe more so than reinforcement.

The problem is research in punishment often has low social validity and can even spark rejoinders from concerned parents (Shea & Shea, 1976). Social validity is important in behavior analysis (Wolf, 1978) and other science. Also, various codes such as the Nuremburg Codes and the APA code make it clear that ethics must be taken seriously in research with human participants.

A particular point of concern is punishing research conducted with non-consenting or ill informed participants. A review of even recent history shows this to be a legitimate concern. The Milgram experiment, the Stanford prison experiment, the US government studies giving radioactive calcium to mentally retarded boys, the Willowbrook vaccine study, and the Tuskegee experiment, all horrifically demonstrate what can happen even in recent years when informed consent or lack of concern for the wellbeing of participants is not given.

Beyond the codes and laws now in place to protect ethics. I would propose an number of additional steps that could be taken to help protect those in the experiment.

1. While in some experiments some deception is permitted provided that the risk of the harm of doing so is especially low, no experiment involving punishment shall any deception be used.

2. Those participating in punishment based research be full, legal adults, given full disclosure of methods and intent, and be of judged capable of making their own decisions. No consent by proxy shall be permitted.

3. The individual will be informed and reminded at least once early in the first session of the experiment of their right to withdraw, without fear of loss, or retribution.

4. If the participant(s) are also the investigators, all the same rules still apply.

That's my idea at least. Ideas, criticisms, concerns, hate mail, etc. welcome in the comments section.

New Study

2007-05-23T21:13:00.000-06:00

Soden et al. (2007) just came out. The authors compared both children diagnosed with autism and without autism. The study included a baseline 24-hour urine collection, and a DMSA-provoked urine collection.

The results showed “In the absence a proven novel mode of heavy metal toxicity, the proportion of autistic participants in this study whose DMSA provoked excretion results demonstrate an excess chelatable body burden of As, Cd, Pb, or Hg is zero”.

I will offer a guess that the advocates of complementary and alternative practices in autism, will not respond to this article well. I will predict that the authors will be called shills within the next 2 weeks. I will post a link or citation if this occurs.

Reference

Soden, S, E., Lowry, J, A., Garrison, C, B., Wasserman GS. (2007). 24-hour provoked urine excretion test for heavy metals in children with autism and typically developing controls, a pilot study. Clinical Toxicology, 45(5), 476-481.

Trying to Define Skepticism

2007-05-20T18:25:00.000-06:00

Skepticism is one of those words like “diversity” or “autism” that can be tricky to define. If you were to go on the street an ask people what it skepticism means you would probably get some real variety in terms of answers.

The publication Skeptic has an editorial that attempts to define skepticism. It is a crisp, interesting article with a brief reference to ancient Greek skepticism and a conclusion with a rephrasing of Descartes’ famous metaphysical equation.

However, the article really caught my attention because, it defines skepticism as a methodology. The editorial states “Skepticism is a method leading to provisional assent”. And that is a fine definition; unfortunately it isn’t true.

Skepticism is not a methodology, at the very least not in the singular sense of the word. People using skepticism do not address uniform problems. The method one would take to assess the statement “Some cows are black and white” look very different from assessing “I remember a past life as a ship captain”, which in turn looks different from trying to determine whether a Chi-square analysis was adequate, or a matched-pairs design was sufficiently well controlled.

It is not simply the complexity, that makes these examples different, it is the nature of the hoops we have to jump through, and the level of certainty we can have after investigation. If anything, it would have to be many smaller methodologies specific to each type of problem.

I would argue that even that, is not enough, you need to have logic is your assessment. I would define logic as:

The valid rationalizations by which we could potentially withhold provisional assent.

And methods as:

The controls one places in a trial in an attempt to see if we can withhold provisional assent.

Now maybe some of you are wondering why my language was worded so strangely. I didn’t say “give provisional assent” or “prove”. That is because in research (or in group based statistical research) we don’t try to prove an effect; arguably we can’t prove an effect. So, instead we try to see if there is no relationship, we call this the null hypothesis. We are attempting to show that there is not a relationship, and to do this we have to make our ideas potentially falsifiable. And that is why; we do not prove the hypothesis, but reject the null hypothesis.

Again, I want to stress why logic and methods must go hand in hand. I will provide examples below:

1) I hypothesize that 1 + 1 equals 2. Logically I know that I should be able to add 2 objects together to test this hypothesis. I choose to do this using water. I add 1 drop, then a second, but I end up with only 1 larger water drop. My logic was impeccable, but my methods, were not well suited to the task.

2) I hypothesize that the ability to sling webs out of one’s hands comes from watching television. I compare the number of reported cases of people with web slinging abilities in New York to the average amount of television viewed by New Yorkers. My logic does not allow me to determine a relationship here, even if my statistical methods were appropriate and rigorous.

3) I opine that a particular Polar Bear is white. I observe the bear in the sunlight and I notice that it is white; I later observe it by accident in the shade and notice that it was distinctly brown. In this case both the methods and the logic need some work.

Please go see......

2007-05-19T22:46:00.000-06:00

Doc's takedown of the Adam's tooth study. It is particulalry excellent
and letter to the editor worthy.

United Methodist Women’s Division

2007-05-16T19:26:00.000-06:00

Please take a moment to review Kathleen’s correspondence with the Women’s Division, of the Methodist Church.

It seems that one reverend, managed to sucessfully campaign within this group to have them take a position agaisnt and even host an anti-thimerosal event. Unfotunately this same reverend, is a litigant in a case involving thimerosal and autism.

It seems the Women’s Division dismissed this conflict of interest, because “her personal judicial advocacy extends from a desire to seek justice for children suffering from mercury poisoning”. In other words an ethics problem is not an ethics problem, because they feel the reverend has good intentions.

Updates

2007-04-20T14:58:00.000-06:00

1. CDDS data is still rising as of March 2007.

2. Kurt Vonnegut, an author who's humor and insight was important to me in my teenage years died last Wednesday.... so it goes.

3. My youngest siblings just recieved their ACT scores. They both did quite well and outperformed my scores. They have since informed me that I have been "pwned like a nOOb".

The Best of Intentions

2007-03-22T15:06:00.000-06:00

Early in my undergrad years I had a conversation with an old school (as it were) special education teacher who had been in the business for 30+ years. In his presence, I expressed anger and frustration with some parents who had made a poor educational decision for their child. The teacher relayed to me a view that I have since heard repeated many times; that ultimately, parents just want the best for their children.

That argument made sense; it reminded me (A 19 year old undergrad at the time) that just because I might vehemently disagree with someone’s decisions or values, that it doesn’t make them a lousy human being. And so this attitude has value, it is simply one more way of reminding us that the world is very often a shade of grey and that we should avoid ad hominem reasoning.

Moreover, it can be aversive for people to experience criticism. It can cut into their enjoyment of an experience or hope in an idea. If a person is already frustrated or struggling, this could be emotionally devastating. Also, many people are increasingly aware that we live a diverse world that encompasses many views. The attitude of biting our tongues is defended so that a kind of harmony and cooperative spirit is maintained.
This is an ethical argument and perhaps could be described as Utilitarian in that it produces a “good” for the greatest amount of people. And for these reasons, focus exclusively on the positive or at least neutral is sometimes defended. There are many common formulations which represent this idea. Thumper’s Rule states: “If you can’t say something nice, don’t say anything at all”.

But recently this issue has returned to my thought and there are some aspects within it that trouble me. I expect this is due to my world view having evolved considerably since the time when I first heard these formulations.

I now operate under certain assumptions that would have been unthinkable to me as a 19 year old; namely, that even criticism and doubt may hold value. It is not that they intrinsically hold value, but simply that they can contain it. Nor would I argue that criticism must be given for the sake of criticism. Instead I would argue that criticism should only be given when merited. I contrast this with “scrutiny” which can and must always be given to decisions and ideas. I will even argue that proper “scrutiny” which I define as the scouring of an idea for merit, always precedes good criticism.

Moreover, criticism may help others realize a problem which may allow this issue to be reduced or resolved. It seems that by the non delivery of the criticism people may be exposed to harm. What is more, when a criticism leads to broad change it also brings a “good” to many people.

Therefore, we now have a conflict between the ethical arguments for avoiding criticism and the ethical arguments in favor of offering them when merited. Harm may come either way, so how can we read this issue?

To resolve this I call into play a philosophy of ethics, known as Deontology. This philosophy, declares that humans have a right to self-determine. It also states that we should treat ends and means as equally important.

In the deontological view we are bound by a duty, to speak the truth. In the absence of full truth we may not grant others the right to fully self-determine. And the harm the truth may emotionally cause does not outweigh the right of the individual to be treated as a “full person” and given the true ability to make a decision and given the entire truth.

In the US, these deontological points are the basis for the idea of informed consent, or the standard in which patients have a right to give, withhold, or withdrawal consent to a procedure. In the US, persons under the age of 18 are considered minors with the inability to make certain decisions. A proxy (Usually the parent) therefore makes these decisions for the child’s benefit; the law having made the assumption that the proxy’s informed consent matches what the minor would have consented to had they been of legal age. This is relevant to this case, because the parents making the decision are not making it for themselves, but for their child.

But while this assumption might be generally true it is also imperfect and this has been noted. There are cases where parents have refused blood transfusions for their badly injured child based on their religious beliefs and been overruled by court order. The informed refusal of the parents on behalf their child, was no longer considered a reasonable stand in for the child’s consent. It seems that in this case, the best of intentions of the parents, could lead to harm for the child.

And this takes us to several new fallacies for my list:

#72 Special Pleading

To argue against a general rule in a singular case, because of metaphysical, experiential, or emotional circumstance.

Example:

You don’t understand that how parents perceive things, so of course certain treatments seems ridiculous to you.

#73 The fallacy of Self-Righteousness

This is a subtype of Special Pleading. This fallacy confuses good intentions with an actual good or facts. This fallacy is almost the same as the Fallacy of Samaritan Intent. The difference is that the Fallacy of Samaritan Intent attempts to excuse an argument when harm has already been caused, whereas in this fallacy harm does not have to be present.

Example:

Mary: Why is your child on a drug that has a high rate of serious side effects?

Rick: I want him to be successful in school.

And this takes us to the last fallacy and the one most relevant to the topic of this post.

#74 The Fallacy of Good Intentions

This fallacy is used to try to avoid any future criticism of a given group based on that group’s good intentions. It is similar to self-righteousness, but it does not argue against specific criticism, instead it tries to totally avoid present criticism and prevent any future criticism. It is also similar to an appeal to the gallery, as it invokes specific groups’ sympathies. There is a cliché that encapsulates this idea: The road to Hell is paved with good intentions.

Example:

Parents just want the best for their children, so please don’t make any negative statements about what they choose for their children.

My conclusion on this issue is that remaining silent violates the deontological responsibility of any individual to speak up when others are offering false or misleading information. The excuse that those who offer such misleading statement are parents is no real excuse at all and that the best of intentions, is not enough by itself.

A Review of Discover’s Autism: it’s not just in the head

2007-03-14T19:07:00.000-06:00

Overview

“Autism: it’s not just in the head” contain reference to real science and some careful and respectable theoretical statements. It also includes errors of fact, a lack of a skeptical perspective, and defense of credulity.

Introduction

In the April 2007 edition of “Discover”, Jill Neimark presents a thesis that autoimmune and gastrointestinal issues cause the differences in the brain in children with autism. Anecdotes and interviews from doctors and parents who theorize such a connection are given in support of this view.

Review of Graphics

The author offers picture of a distended stomach of a child with autism, and claims that such are comment with children with autism. A claim not supported by well designed research.

The author offers a graphic of Texas comparing the counties with the highest toxicity and the rates of autism. Seemingly these are special education data, of assignment to the autism service category and not recordings of actual cases.

The author offers us two samples of handwriting of a home-schooled autistic child taken a month apart, before and after a child started treatment with antifungal medication. However, the author does not offer us multiple samples let alone a month’s worth of samples. We have no idea of the conditions at the time of these writing, whether the child was hurrying to get the former done in time for a favorite show or activity. These factors would be good to know.

Review of Article

In the article begins with a quote from a mother of two autistic children. I relates to her suicidal thoughts upon learning that her second child also met criteria for autism. The anecdotes of suicidal thoughts of mothers of autistic children has recently been popular making several appearances in documentaries or written work where the mothers advocated a vaccine etiology of autism or a specific treatment modality.

The author writes “and a 2003 report by the Center for Disease Control suggests that as many as one in every 166 children is now on the autism spectrum, while another one in six suffers from a neurodevelopmental delay.”

However the 1 in 6 statistic includes autism as well as other disorder. Furthermore, these disorders include thing like Attention Deficit Hyperactivity Disorder, which are not delays, but disorders or differences. Moreover, 1 in 6, corresponds to 16%. This is the percentage, equal to or below one standard deviation from the mean in a normalized curve. In terms of a given measure such as adaptive behavior or academic achievement, I should (based on the statistics) expect that 1 in 6 children to be at least 1 standard deviation below the average. The confusion here is similar to the confusion that leads to shocked outcries, when it is revealed that ½ of the population perform below average on an IQ test.

Further, it is worth mentioning that many of the advocates of alternative treatments in autism or the vaccine etiology of autism are inconsistent as to whom this 1 in 6 applies to. It can range from describing brain disorders to asthma and food allergies depending on the source.

Another doctor, Martha Herbert states “In spite of so many years of assumptions that a brain disorder like this is not treatable, we’re helping kids get better. So, it can’t just be genetic, prenatal, hardwired, and hopeless”.

It should be asked here for what studies show that any biomedical treatment improves the quality of life for children meeting criteria for autism. At the moment there are no studies that indicate this, perhaps in the future this will change, but it seems that Dr. Herbert’s statement has moved ahead of the data.

In addition, more than one disorder that is genetic and pre-natal offer problems or complications that can be treated, outgrown, or overcome via medical treatment or education. The examples are too numerous to name. What is more, no one who has an even rudimentary familiarity with autism research in the last 20 years would call autism “hopeless”. This is a caricature or straw man fallacy, of those who advocate a theory of idiopathic or genetic etiology of autism.

Dr. Herbert goes on to state “On very striking piece of evidence that many of us have noticed is that when autistic children go in for certain diagnostic tests and are told ot to eat or drink anything ahead of time parents often report that their child’s symptoms improve – until they start eating again after the procedure.”

This statement is reminiscent of one by Dr. Krigsman, who advocates a biomedical treatment approach to autism and a gastrological etiology theory. The endoscopies he performs requires only clear liquid be drunk for a period before hand, so as to offer better vision during the procedure. He mentions that on such a clear liquid diet, the parents claim the child’s behavior improves. Such a diet is devoid of gluten or casein and is somewhat similar the gluten free and casein free diet that Dr. Krigsman advocates. It is notable that this diet did not show improvement in the only controlled study of the subject thus far (Elder et al. 2006). Moreover the majority of parents in the previous study couldn’t tell if their child was on the control diet or the GF/CF diet. Perhaps there are parallels to Hoover & Millch (1994) who found that after giving children artificial sweetener and telling parents it was sugar, the parents rated the children’s behavior significantly worse than controls.

The author mentions an emotional reaction reading the original 11 case studies by Dr. Kanner, the first person to organize autism under a given name. The author finds evidence of autoimmune and gastrointestinal problems within the original case studies. However, this is unfortunate as not every child in those case studies had either sort of problem. This seems like an example of shoe-horning or confirmation bias.

Furthermore, the correlation that struck many more professionals at that time was that many of the children had highly educated parents. This helped give birth to the cold-mother etiology of autism theory, which was propped up, for at least a generation by the lack of organized and consistent biological findings.

At another point Dr. Herbert say’s “I can’t think of it as coincidence anymore that so many autistic kids have a history of food or airborne allergies”. However, these findings are demonstrated within the research. Many typically developing children have a history of environmental allergies as well. Dr. Herbert needs to demonstrate that these occur more frequently in children meeting criteria for autism for this point to stand.

The author states that a ‘Copernican-scale” shift in under way in the world in autism. The author then goes on to site improvement of several children via chelation. The author may indeed by right. However, one may hope that if so, this theory like the theory of a heliocentric universe, will be propped up by excellent proof rather then the anecdotal proofs any faith healer of witch doctor could likewise provide.

The author later cites Dr. Jill James work tracking 8 nchidlren who were treated with folinic acid, trimethylglycine, and methyl-B12. Dr. James found that an increase in markers for methylation and glutathione production within the children. Which is good news, because the researchers theorize that autistic behavior may be related to oxidative stress which might be eliminated by treatment with the above named factor. Unfortunately one of those treatments has been assessed and found to not produce statistically significant results (Deprey et al., 2006). Perhaps these factor in combination will produce notable effect. We will have to see.

A particularly disturbing statement by the author summarizing a statement by Dr. Herbert is: “In other words treat now before the gavel of science strikes a final judgment which might be decades away”. And then the author gives examples of parents ding just that. It seems that the author has assumed what the science will eventually say. This looks like faith based reasoning, not actual logic or science. But, even if the author actually means that at the moment we don’t know what the science will say, but certain treatments anecdotally looks promising so they should be tried, is still poor logic. Some of these treatment are expensive and or dangerous. And even the lowest risk treatment that costs very little money such as the GF/CF diet still takes time and effort on the part of child, the parents, and sometimes that other siblings and grandparents. And diet based intervention are by definition restrictive and can be alienating.

Also, the author points out a anecdote from a mother who’s child broke out in welts after the child was no longer provided with milk. The mother states that is seems that the child was going through a detoxification reaction. The mother seems to have persevered and stuck to the restriction whereas other mothers might have stopped withholding milk or looked for allergens in whatever alternatives where being provided, such as soy milk. This reaction seems similar to what is called a “healing crisis” or “Herxheimer reaction” in alternative medical circles.

Late in the article the author refers to Dr. Yasko’s work concerning polyphorisms and methylation. The author states that Dr. Yasko “seems immune to controversy”, which is a very interesting statement to a skeptic. The author quotes Dr. Yasko (on her decision to focus on treatment rather the scientific publication) as saying “I was on those cliffs you see in the movies and you’re going to jump. You don’t know if there is water below, or enough momentum to get to the other side, but you just jump.” One rather hopes there is enough momentum or at least deep water and that no child will be hurt by Dr. Yasko’s decision to jump off the cliff.

The final statement of the article says “If we can crack the puzzle of autism and be clear about how we did it, that may have huge implications for other chronic environmentally triggered systematic illness. Autism may be a much-needed wake-up call to us all”.

It seems that the author will end as several others have done, will a canary in the coal mine simile.

Conclusion

This article does offer some service in that it explains certain basic research and provides quotes from certain players in the field. Howver, there are factual problems, a reliance on anecdote, and lack of a skeptical voice. Autism may not just be in the head, but if certain treatments are to be used, then research offered must show that "effective biomed treatments" are not just in the advocates' heads.

References

Elder, J, H., Shankar, M, Shuster, J., Theriaque, D., Burns, S., Lindsay Sherrill. (2006). The Gluten-Free, Casein-Free Diet In Autism: Results of A Preliminary Double Blind Clinical Trial. Journal of Autism and Developmental Disorders. 36(3), 413-420.

Deprey LJ, et al "Double-Blind, Placebo-Controlled, Cross-Over Trial of Subcutaneous Methylcobalamin in Autism: Preliminary Results" AACAP 2006; 33:F47.

Hoover, D. W., Milich, R. (1994). Effects of sugar ingestion expectancies on mother-child interactions. Journal of Abnormal Psychology. 22(4), 501-15.

A Review of the Critiques of Fombonne et al. (2006)

2007-03-07T21:52:00.000-07:00

Overview

The critiques of Fombonne et al. (2006) do point some relevant problems with that study. However, they also use some considerably problematic arguments themselves.

Introduction

Fombonne et al (2006) attempts to correlate data between an increase in the number of cases of the Pervasive Developmental Disorders and vaccine use in school children residing in Montreal, Canada. That research failed to reveal any such correlation. In addition the researchers found a prevalence rate of the PDD’s which match what is seen in the US (Bertrand et al., 2001), the UK (Chakrabarti & Fombonne, 2001; and Chakrabarti & Fombonne, 2005), the Faroe Islands in Northern Europe (Ellefsen et al., 2006), and matches data on Autistic Disorder in Japan (Honda et al., 2005)

Recently, two web based articles have been released and promoted based out of the National Autistic Association website. These articles were written by Dr. David Ayoub & Monica Ruscitti for one letter and Dr. Edward Yazbak for the other. These authors raise important and damaging points which call into question the validity of Fombonne et al. (2006). I note however, that not all the points raised in these critiques have equal merit; in fact some of the points raised are most notable for their lack of merit. The points raised in the critiques are discussed below.

Review of Ayoub & Ruscitti

The authors point out that Fombonne et al. (2006) only uses data from only one of Montreal’s five school districts. This district is specifically an English speaking section. The authors accurately point out that a selection bias may have occurred here. In addition the authors note that Fombonne et al. (2006) claimed they could not gain access to the other school districts’ data. The authors then claimed they gained access to this data and make specific claims about a notably higher rate of autism in the school district Fombonne et al. used. I note that these data and analysis methods are absent.

The authors note that English is only the third most common language in Quebec, the largest group being French and the second largest being assorted foreign languages. The authors note that access is restricted to the English speaking school district by a law designed to help protect the French language. However, the authors simultaneously make the claim that this English speaking school is more inclusive than the others. This claim seems contradictory. It is possible that while the English speaking district is more exclusive in general it is in fact more inclusive towards students with disabilities. However this point is not explained.

The authors correctly criticize Fombone et al. (2006) for describing thimerosal laden shots as “nil”. The authors go on to describe vaccines in Canada that continue to use thimerosal. However, the authors fail to note that none of these vaccines are actually required any longer and for that reason exposure should not be comparable.

The authors mention that fourth graders largely participated in a voluntary vaccination program for Hepatitis B, which contains thimerosal. However, the DSM-IV mandates that Autistic Disorder first appear in a child by age 3, even if it is diagnosed later. Fourth graders do not develop autism. Also, and rather remarkably the authors cite Roy et al. (1999) which is concerned with the health and safety including vaccination based on high risk behaviors of street youth in Montreal. The median age of that study was 19.5.

The authors criticize Fombonne in the following terms:

“he ignored the fact that autism rates increased following a doubling of the MMR exposure after 1996 when a second MMR shot was added to the immunization schedule and chose to emphasize that a rise in PDD rates coincided with a decline in MMR coverage rates. Obviously the increased amount of administered viral load to the population was far greater influenced by a doubling of shots administered than by a marginal drop in immunization coverage rates. He likewise ignored the potential impact of mass measles immunization campaigns in Quebec that delivered a second dose of measles to a large number of infants and children throughout 1996. (11) The subsequent rise in PDD shortly after that campaign is clearly depicted in their figures and would lead us to believe this observation supports an association between PDD and MMR exposure.”

The above assumes that the drop in thimerosal was not only made up, but actually exceeded by the increase in MMR dosage. For this explanation to work, one must simultaneously assume that both thimerosal and the MMR can cause autism. A more parsimonious explanation would be that the rate of autism would have risen regardless, which is certainly what we see in other locations including the no longer mandatory thimerosal exposure in California.

The authors also state:

“Numerous reports of higher PDD rates among immigrants have been reported in Canada and other industrialized countries.”

This claim is demonstrated no where in any research. It even seems to contradict some actual research (Kamer et al., 2004).

The authors go on to assert:

“Finally the paper’s observation about rising PDD rates seems to contradict Dr. Fombonne’s well-known contention of the lack of evidence of an autism epidemic. In an Inserm interview, Dr. Fombonne said, “to declare an epidemic, or sensible increase of the prevalence, it would take incidence studies, always the same, year after year, but this data is not available in any country.” (12) The database we obtained from the MEQ represents the type of dataset Fombonne stated was required to detect true increases in PDD. According to one Montreal-based autism organization, data from the MEQ revealed an increase in annual PDD cases in Quebec from 410 (1990-1991) to 4,483 (2005-2006), a nearly 1,000% increase over 15 years. (13) This is staggering and is strong evidence of a real rise in neurodevelopmental illnesses that cannot possibly be solely genetic in nature but supports an environmental etiology.”

The above statement is presents a false problem. An increase in this data set may not be attributable to real change in the actual number of cases. The system could be open to a lack of control for the six threats to statistical validity. This is a well known problem in other administrative data sets in the world of autism.

Review of Yazbak

The author submitted an letter to the editor detailing concerns about uptake of the MMR rate in Montreal and the increase in the PDDs. The editor forwarded this comment from Dr. Fombonne:

"This person is known to pursue the MMR-autism agenda at all
costs in order to 'demonstrate' a link he strongly believes in. The only way ahead is to encourage him to do independent research. All controlled epidemiological research thus far has concluded to the absence of such a link."

the editor of the journal had this to say:

“As a note, I believe the evidence of no link between MMR and Autism is sufficient. It's not worth publishing more on this subject. We will not be publishing this exchange of correspondence.”

I disagree with Dr. Fombonne’s approach to this situation. It is not relevant that Dr. Yazbak believes in a vaccine etiology of autism. I also disagree with his failing to address Dr. Yazabak’s criticisms which are specific and serious.

I also heartily disagree with the editor’s refusal to publish Dr. Yazbak’ criticism. While it is certainly his job to ensure that all matters within the journal merit inclusion under a serious scientific aegis, Dr. Yazbak’s criticisms are specific and fall into known categories of scientific criticism. Whether or not he believes it has no bearing on his responsibility to publish scientific criticism.

However, given the title Dr. Yazbak selected “Far-Fetched”, perhaps the editor had ground to refuse this letter or at least demand that it be re-titled. Pediatrics is a serious academic journal of high standard. In most such journals while a given level of sarcasm and dismissiveness is permitted, this seems to have crossed the line of acceptability.

Dr. Yazbak goes on to assert:

“When he was in France, Dr. Fombonne was a well known psychiatrist who published articles on psychiatric topics. He was still a psychiatrist when he moved to England …until Andrew Wakefield suggested that the link between MMR vaccination and autism should be further investigated and suddenly …Dr. Fombonne became a “psychiatrist / epidemiologist” and a consultant to the UK medical authorities on MMR vaccination and autism”

The Wakefield controversy began in 1998. So:

Fombonne, E. (1996). Is the prevalence of autism increasing? Journal
of Autism and Developmental Disorders, 6, 673–676.

Fombonne, E. (1997). The prevalence of autism and other pervasive
developmental disorders in the UK. Autism, 1, 227–229.

QED.

The author further asserts that:

“It is obviously customary to disclose sources of funding, Disclosing sources of “Non-Funding” on the other hand is unusual. In any case, it is nice to know that Dr. Fombonne’s research was never funded by the “Industry”.”

This is easily explainable in that Dr. Fombonne’s work has been informally criticized as being supported by the pharmaceutical industry, possibly with the intent that he would manipulate the data in favor of finding no association. This statement may have been given to help put such non-sense to rest.

Conclusion

It is important to remember that the weak criticisms in the critiques above do not remove the genuine and quality criticisms. The authors do point some genuine problems. The failure of both editor and Dr. Fombonne to make adequate response is also disagreeable.

By the same token some of the criticisms are remarkable for their lack of relevancy or factual basis. There are problems with these critiques that have a real potential to mislead others. It is to be hoped that the NAA and the authors will take steps to amend this, leaving their better criticisms intact.

References

American Psychiatric Association. (2000). Diagnostic and Statistical Manual ofMental Disorders, Fourth Edition, Text Revision. Washington, DC:American Psychiatric Association; 1994.

Bertrand, J., Mars, A., Boyle, C., Bove, F., Yeargin-Allsop, M., & Decoufle, P. (2001). Prevalence of autism in a United States population: the Brick Township, New Jersey, investigation. Pediatrics, 108, 1155-161.

Chakrabarti, S., & Fombonne, E. (2001). Pervasive developmental disorders in preschool children. Journal of the American Medical Association, 285,3093-3099.Chakrabarti, S., Fombonne, E., (2005). Pervasive developmental disorders in preschool children: confirmation of high prevalence. American Journal ofPsychiatry, 162(6), 1133-1141.

Ellefsen, A., Kampmann, H., Billstedt, E., Gillberg, I. C., Gillberg, C. (2006). Autism in the Faroe Islands. An Epidemiological Study. Journal of Autism and Developmental Disorders. [Electronically published ahead of print]

Fombonne, E. (1996). Is the prevalence of autism increasing? Journal
of Autism and Developmental Disorders, 6, 673–676.

Fombonne, E. (1997). The prevalence of autism and other pervasive
developmental disorders in the UK. Autism, 1, 227–229.

Fombonne, E., Zakarian, R., Bennett, A., Meng, L., McLean-Heywood, D. (2006). Pervasive developmental disorders in Montreal, Quebec, Canada: Prevalence and links with immunizations. Pediatrics. 118(1) 139-150.

Friis, R. H., Seller, T. A. (2004). Epidemiology for public health practice, 3rd ed. Sundbury, MA: Jones and Bartlett Publishers.

Honda, H., Shimizu, Y., Imai, M., & Nitto, Y. (2005). Cumulative incidence of childhood autism: a total population study of better accuracy and precision. Developmental Medicine And Child Neurology. 47(1), 10-8.

A. Kamer, A. H. Zohar, R. Youngmann, G. W. Diamond, D. Inbar, & Y. Senecky. (2004). A prevalence estimate of pervasive developmental disorder among Immigrants to Israel and Israeli natives. Social Psychiatry and Psychiatric Epidemiology. 39 (2), 141-145.

Roy, E., Haley, N., Lemire, N., Boivin, J. F., Leclerc, P., & Vincelette. J. Hepatitis B virus infection among street youths in Montreal. Can Med Assoc J. 1999;161(6):689-93.

Another Verbal Grad Student?

2007-02-15T14:26:00.000-07:00

I recently learned that my younger sister has been accepted in a several speech pathology graduate programs. This is the sibling who is closest in age to myself. This is also the sibling who seems to disagree on everything with me. She votes democratic, I tend to vote for 3rd parties. I do the Blues and 70s rock and she does (shiver) club music. I like outdoor activities and she likes a well-appointed shopping mall. I like Sagan, Vonnegut, and Bill Bryson, she likes books by Gregory Maguire and romantic comedies. I imagine you get the picture.

I couldn’t say why we see things so differently; we share a sizable portion of genetic material and a similar rearing environment after all. Perhaps that’s just simply one more example of the natural variation that arises, even in members of the same families.

For certain her strengths are not my strengths and vice versa. But without that variation her unique strengths would be lost. Her ability to spot things others missed and to find things that I simply could not see dumfounded and sometimes amused me as a child may be an aid to her here, as will her patience, and persistence.

And it will certainly make for interesting dinner conversation during the holidays. We had this delightful debate over turkey this year concerning what constitutes pragmatic skills.

Intra-verbal: That’s not what pragmatic skills are!

Interverbal: Can you define what pragmatic skills are then?

(Mutual younger sibling whispering to Intra-verbal): Shhhhhh.. don’t get him going he’s worse than dad.

Ahhh.. Holiday memories!

Skeptics Gone Wild!

2007-02-01T21:33:00.000-07:00

Okay, okay... it is not that cool. But it is still pretty cool.

Check out the 53rd Skeptic's Circle.

Anthropology and Archaeology Circle

2007-01-17T21:26:00.000-07:00

An interesting new Archaeology Carnival is now being offered.

Worth checking out, if you have a few moments.

The one on out of place artifacts was my favorite.

My Newfound Psychic Ability!

2007-01-14T00:06:00.000-07:00

December 5th 2005 I offered a post on Interverbal, that contained a number of guesses of how the mercury etiology of autism advocates would react if, come 2007, the CDDS data weren’t decreasing. And so, just for fun lets see how I did!

Predictions:

1) Ignore it.

By and large we hear silence on this one. That’s a hit.

2) Invoke the possibility that the vaccines caused autism in a very small (compared to the whole) subset of children. The subset is too small to be noticed in the data.

Yep, I am two for two so far.

3) Call it a statistical blip.

Haven’t seen this one, so that’s one miss.

4) Say that it will take more time to see the effects.

Yes sir, I have seen that one.

5) Invoke other things that could take of the slack e.g. "flu shot, dental fillings, out gassing of coal run power plants".

Ding!Ding!Ding! [Confetti and streamers burst forth] We have a winner!!!

6) Present a new theory that involves accumulated mercury in parents slowing having been built up and now being manifested irregardless of the removal of thimerosal causing vaccines.

Haven’t seen it for thimerosal specifically, so that’s a miss.

7) Accuse the DDS of altering the data sets due to pressure from the vaccine manufacturers.

Miss,

8) Take a new interest on how the DDS really isn't epidemiology and was never supposed to have been used that way.

That is a big old hit! That issue, was a major contention point in some internet discussion recently.

9) Take a new interest in the fact that correlation isn’t causation.

Nope, that is a miss.

So, 5 hits, 4 misses, heck, with odds like that I could have my own psychic TV show! “The Other Side of Reality with your host Interverbal!”

Still No Drop in the CDDS Data

2007-01-10T23:24:00.000-07:00

This is a graph including the December 2006 CDDS data. Still no drop in the 3-5 year old cohort.

At the Bar with B.F. Skinner

2006-12-31T12:53:00.000-07:00

(Note: This is an first post in a series that I plan to do over the next year and a half. This series will introduce and talk about well known psychologists/psychiatrists/neurologists, who have now passed on. The goal of this is to show the basic premises and ideas that these persons advocated. The format will be an informal conversation at a bar). While creative modifications were inevitable, I think this captures an accurate picture of the ideas and defenses used by Dr. Skinner.

Interverbal: Dr. Skinner, thanks for coming to get a drink with me

Skinner: Oh, you are welcome. What did you want to talk about?

Interverbal: So, much mythos seems to surround you. Some people hold you in the profoundest sort of respect as a great humanitarian and some accuse you of being a stepping stone to full dictatorship, the door-keeper to the loss of all the makes us human. So……maybe you can explain yourself and your position more fully….

Skinner: Well…for myself I want to see human culture develop so that we can accomplish two goals, 1, to survive, 2, to have all of us be happy. You see, what we do is a reflection of what we learn...

Interverbal: [Interrupting] But not everything we do is learned…..What about reflexes, what about innate behavior, what about behavior related to problems in the neurology, like seizures?

Skinner: There is behavior that is not related to classical or operant conditioning, but much of it is and it is that portion that I choose to look at. I will say this though; no good student would ever say that behavior is purely conditioning or that we are a tabula rasa (scraped tablet/blank slate).

Interverbal: So, then John Locke is out of the picture.

Skinner: In that regard, yes, Locke is out of the picture.

Interverbal: So, would you say that the fields of neurology and genetics play an important role in teaching us about our behavior.

Skinner: To an extent, yes.

Interverbal: And cognitive neuroscience?

Skinner [hesitates] Not necessarily, that depends on their use of mentalism and circular explanations for phenomena.

Interverbal: So, if they invoke thought process in their answer they are wrong?

Skinner: No, a mentalism is not the invocation of a process we can’t see. What I mean by “mentalism” is the circular explanation of phenomena. Why is the boy crying? Because, he is hungry. How do we know he is hungry, because he is crying.

Interverbal: So, you believe in parts of our mind?

Skinner: I think this type of labeling is tip-toeing into a mentalistic fallacy. However, yes, I do think there is thought and feelings and that these things are important in human behavior. I will go so far as to say that if we are to tell the whole story we must include those things in our analyses.

Interverbal; What about cognitive psychology?

Skinner: I view cognitive psychology as mentalistic and archaic. I see it as for psychology, what creationism is for evolution.

Interverbal: That seems very strong, many people must disagree, even behavior analysts.

Skinner: Correct….

Skinner: Before we go much further, I would like to switch roles and ask you a few questions.

Interverbal: Sure…

Skinner: Why are you here tonight?

Interverbal: Because, I wanted to talk to you.

Skinner: And how do you know you wanted to talk to me?

Interverbal: [laughs] you are trying to get me…

Skinner: [smiles] To be honest I have no problem with you describing your own feelings as “wants”. It is simple and efficient, just like we say that “sun rises”, or the “Stars come out”.

However this sort of simplistic language has no place in a genuine discussion of a science of human behavior. This is the precise problem we face in psychology; it is analogous to some astronomer telling us to really believe the sun orbits around the earth.

Although to be fair this really was true at one time. But here is the difference; biology and astronomy and medicine have all moved on beyond the earliest theoreticians; not so in psychology. Aristotle could stroll into a professional presentation of many types of psychology here and now and probably keep up with the conversation.

Interverbal: [smirks] Probably, he might even do better than some.

Skinner: You laugh, but that is true. Psychology is rutted down in simplistic descriptions that have little to do with science and a great deal to do with language.

Skinner: Sir, you are sounding all Wittgenstein-ish now.

Skinner: And for good reason, the logical positivism makes some good points, it actually was necessary for behaviorism to arise.

Interverbal: A lot gets made of the fact that you are a determinist. Our genes in combination with our environment determines how we will behave.

Skinner: That is a concise summery.

Interverbal: That seems so simple to disprove. I mean…I can get up on the bar right now and sing a song about how I have free will. That IS free will…

Skinner: [smiles] Unless of course your behavior was controlled by the reinforcing feeling of supposing you proved me wrong….

Interverbal: I could do it much later too, maybe just by spontaneously remembering.

Skinner: What would precede the behavior?

Interverbal: Well, my thought of proving you wrong…

Skinner: Exactly…

Interverbal: Okay, but people do off the wall things all the time. I mean let’s just start with kids. How many times does a kid do some ludicrous thing and when we ask them why they did it, what do they always say….”I don’t know”.

Skinner: I think you are confusing the fact that you don’t always know why a child does something with the idea that they must have done so because of free will. But I would argue that you probably haven’t even really looked for a reason why.

The more I look, the more it seems that people behavior is logical, even if they themselves can not determine this system. Research backs this up by the way.

Interverbal: So, why don’t people behave the same…. or at least the people within the same culture?

Skinner: Careful, you are bouncing into illogic. It would be a mistake to assume that culture alone tells you what you need to know to determine behavior. In reality culture almost never tells us enough to determine why a person does a given behavior. That is much more specific.

Interverbal: So you discount the work of social scientists.

Skinner: No, but I often wonder if their work searches too broadly and misses critical details.

Interverbal: Well what about a class then. In a classroom, the same rules apply for everyone and produce the same outcomes.

Skinner: Actually that is simply not always true. Also, maybe it shouldn’t be true, but that is another story. Anyway the classroom is not a child’s only environment, maybe not even the most important one.

Also, I think you are gunning for “all or nothing” comparisons. You see the most extreme options, but miss the subtle middle ones. You simply can’t ignore these.

Remember a child does not walk into a class as a bundle of unwritten and untapped potential. They arrive with several years of previous learning and possibly a different set of established reinforcers and preferences.

Skinner: Anyway I have another question fro you. What kind of beer are you drinking?

Interverbal: Duffs..

Skinner: And why do you drink Duff’s?

Interverbal: Well let see…. That would be because it’s a rich hops mix with excellent texture and smooth taste.

Skinner: You misunderstand me a bit. What I mean was why do you drink Duff’s as opposed to McCallagans?

Interverbal: Because Duff’s tastes better.

Skinner: Yes, and that is a perfectly acceptable answer all by itself. Answer me this though; are you more likely to order Duff’s or McCallagan’s.

Interverbal: Duff’s, clearly.

Skinner: We are talking about what you as one individual value. You would prefer Duff’s when given a choice. Humans are like that, we value different things, possibly because our genes determined that we would, possibly because it was paired with another reinforcer at some earlier time.

This fact permeates us and it deeply relates to our behavior. There is individuality in this deterministic system. We can never be totally sure even after lots of successful reinforcement that a person will do a given behavior at the “right time”. We can not speak of probability in out science only of likelihood or what we expect to happen.

Interverbal: This ties in well with certain mathematical theories I think.

Interverbal: Dr. Skinner thank you very much for having a drink with me. I deeply appreciate it.

Skinner: You’re welcome

Interverbal: And now, [smirks] let us choose of our own free will to have another round…

Skinner: I will drink to that.

Tribute to Carl Sagan

2006-12-21T15:05:00.000-07:00

The 50th Skeptic's Circle is up and involves a loving and fitting tribute to one of my
childhood heroes.

A Review of Informed Consent #1: Philosophical Overview

2006-12-20T12:29:00.000-07:00

Ethics is a major branch of philosophy. It concerns rights, behavior, treatment of others, and dichotomies of good and evil.

Ethics are established in the field of human services by stating a rationale for should be done and reconciling the rationale to ethical guideline and positions. The implication of this is that more than one ethical position is possible and that the depth of the ethics of an action is related to the excellence of reconciliation to ethical guidelines.

In research we rarely deal with ethical vs. unethical. Usually it is more subtle. We must consider and attempt to match ideals or guidelines to the behavior of ourselves and others. Using this method to understand ethics, the best way to be unethical, is to fail to provide ethical justification for a treatment.

It is my observation that creating ethical guidelines calls into use another field of philosophy, being “natural law”. Natural laws, are the inherent rules of our existence, inalienable and independent of political law. The following could be said to be natural laws:

1. Children are cared for until ready to live on there own.

2. People have a duty for the welfare of one another

It should be noted that natural laws often are almost always legislated, examples of legal documents heavily based on natural law would be the Magna Carta and the US Constitution.

Interpretations of natural law, however, may lead to differences in views of ethics, different ethics may lead to different actions. I would strongly argue in favor of clearly understanding this connection when attempting to debunk the ethics of an action.

Pub Skep

2006-12-07T14:36:00.000-07:00

Get thee hence

A Review of the Parent Designed Report Form

2006-12-06T18:50:00.000-07:00

The Parent Designed Report Form is an assessment method designed to record the potential change in autistic child undergoing therapy and specifically methyl-B12 injections. This tool, while embracing some of the qualities of objective assessments does not embrace them all. The threats to the validity and reliability of this method are numerous and have the potential to mislead the decision makers in a child’s life. Methods of alleviating these problems are discussed.

Introduction

The Parent Designed Report Form is an assessment tool created by parents, for parents to measure the progress of their autistic children under specific treatments. It is advertised as the most specific and sensitive measure of change via methyl-B12, by its advocates. It’s creation and use seems closely, but not exclusively tied to the treatment protocol of methyl-B12 injections for autistic children.

The purpose of this paper is to 1) give a loose overview of the Parent Designed Report Form (PDRF). 2) Point out the problems present in within the PDRF and the justification of this tool. 3) Suggest specific changes that might help validate this tool.

Overview of PDRF

The PDRF is an assessment tool. It is periodically filled out by the parents who are often using the vitamin B12 injection treatment for their children’s autism. The tool is a retrospective Likert based scale assessment. This means that the child is not necessarily being directly observed by the parents at the time the scale is being filled out. The scales are to be filled out based on parent impression of child behavior within the recent period (6 weeks). The question include a second portion where parents are asked for specific examples of the change.

The Likert scale is based on 1-5, 1 being “Mild”, 5 being “Significant”. The questions typically refer to a “behavior” and a “change”.

For example:

# 125 “Tasks: New things never done before or never accepted before: Give the before and after examples necessary to explain you observation”.

#76 “Laughter, more normal amounts and ore normal types of laughter: Why are you saying this? Support your observation as to what is was before and now.”

An additional part of this assessment tool involves the Parents Specifics Documentation Letter. In this portion the parents are invited to write down in detail the changes they have seen in their child in what can accurately be called an emotional format.
Criticisms

There seems to be no evidence in support of the claim that the PDRF is the most subtle measure of a child’s progress. This claim is offered by the creators or advocates of this measure. It is seemingly based on the types and number of questions asked. Moreover there are no data that shows any sort of inter-observer-agreement on the test. We have no idea if the test is reliable between, two caregivers who were with the child over the same period. Further, we have no idea what the validity of this test might be. It has not been compared meaningfully to other established scales or to quantitative behavior assessments.

I report that some advocates of this measure claim that an affect is noticed following treatment via this measure, but not on other measures and that this constitutes a proof that this measure can detect smaller changes than the larger and better established tools. However, that is not necessarily the case, these could be false positives; I note again, that there has never been an attempt to validate this measure, the validity is assumed.

One of the great advantages claimed by proponents of this tool is that objective diagnosticians, using a reliable/valid observation based tool, only watch for a limited amount of time. They might miss the rare but increasing utterances of child first beginning to use words. The parents, they argue, who are always with the child, can observe this, remember it, and regurgitate it on the form. This seems acceptable, accept that parents like all people, are prone to the fallacy of confirmation bias, or only identifying those data, which confirm their current position possibly overlooking those data which could refute it, such as the child already increasing her utterances before the treatment began. I am reminded in this situation, of the claims of ESP advocates; it seems the really great evidence is never present when the objective skeptic is looking (Sagan, 1996).

The wording within the questions also seems to invite subjective opinion rather than objective observations on numerous occasions. For example:

#84 “Mood swings, fewer: Describe.”

#47 “Flexible, less rigid, can be redirected: Describe why you feel this to be a true statement. Be specific and give as many examples as you can think of”

#141 “Improvement in the quality of life of others e.g. therapists, etc. (indicate a title or position of the person)”

#82: Loving, cuddly, more so now than prior to the shots even though your child may always have been loving.

I identify particular problems with the Parents Specifics Documentation Letter.
It would not be an error to say that the description of this letter is a remarkable invitation to anti-science.

“Please note that a piece of paper with your “facts”, no matter how well written, will not convey some of the most important information for us to determine how well methyl b-12 is working for your child- that information being the “emotion of the moment”, that you felt when something your child did for the first time or at a special moment.”

“The specifics Documentation Letter is so much more powerful, and so much more believable, when you let us into your hearts and feelings by describing those items that made an impact or created a special memory.”

“We only want you to include comments on the responses that “blew you away”, had you utterly amazed!”

“it is this that MAKES MUSIC AND GIVES BEAUTY to being alive and working together with your child and you”.

The above being an excellent description of a post hoc, ergo propter hoc fallacy and a non-sequitur, the feeling of the parents, has absolutely no ability to establish the accuracy of a change caused by methyl B12.

Next, I wish to take issue with the claim via advocates of this measure, that researchers must find a way to validate parental experiences that show improvement via certain treatments in autism. This assertions seems to be assuming what it should first be proving, that parental observations in such situations are in fact “valid”. We know from research that parent’s description of child behavior changes based on what they are told, irregardless of the reality of the situation. This was demonstrated by Hoover & Millch (1994) who told parents to rate their child’s behavior as much worse following the children being given a sweet drink that the parents were told contained sugar (It contained an artificial sweetener).

My final problem with this assessment is that, it the comparison is not to a normed distribution, but to the child’s previous assessment. These assessments are typically done every six weeks for up to two years. The problems presented here are the concept of regression to the mean and maturation for eh child. Pre-school aged can and do mature rapidly (if unevenly at times). Moreover several of the questions in the form seem to focus on behaviors very closely tied to a developmental schedule as opposed to learning.
For example:

#92 (Concerning the child having opinions)

#81 (Listening better)

#78 (Use of language)

#110 (self confidence is greater)

#111 (Better structuring of sentences)

#112 (Less silliness)

#114 (New level of singing)

#100 (Reading at higher levels)

#115 (Improved sitting behavior)

#124 (Can multi-task)

#25 (Less clumsy)

#26 (More intelligent)

#27 (Improved compliance)

#45 (Able to better express feelings)

#1 (Abstract thinking)

#23 (Understands cause and effect)

There is not a single one of the above that is unlikely to improve, perhaps even significantly on a pre-school aged child, and especially a younger pre-school aged child over the course of 12 weeks. As matters stand the PDRF seems to be focusing on developmental tasks that are very likely to increase on just about any child.

Recommendation

I propose that in attempt to gain an understanding of the reliability of this measure that the following be investigated by those who took the time and effort to create this measure.

1) Typically developing children be assessed and their average scores compared to autistic children both in and out of the methyl-B12 program.

2) That objective data counts by observers (observing for a prolonged time) be compared to parent’s outcomes for this test.

3) That an attempt be made to assess this tool against other tools whose reliability validity is already established

4) That inter-observer reliability of this measure be assessed by comparing scores between caregivers of the same child.

References

Deprey LJ, et al "Double-Blind, Placebo-Controlled, Cross-Over Trial of Subcutaneous Methylcobalamin in Autism: Preliminary Results" AACAP 2006; 33:F47.

Hoover, D. W., Milich, R. (1994). Effects of sugar ingestion expectancies on mother-child interactions. Journal of Abnormal Psychology. 22(4), 501-15.