Sunday, February 28, 2010

Is Depression an ASD?

I was reading this article in the New York Times Magazine about the possible evolutionary upsides of depression (the analytic-rumination hypothesis - that depression may cause an increased ability to focus on problem-solving, resulting in a net mental benefit) that would explain why depression has persisted through so many generations worldwide.  As a person who has dealt with major depression for half my life, I was drawn to the idea that there might be some greater purpose to my cycles of suffering.  But the bit that really caught my attention was this:
The capacity for intense focus, they note, relies in large part on a brain area called the left ventrolateral prefrontal cortex (VLPFC), which is located a few inches behind the forehead. While this area has been associated with a wide variety of mental talents, like conceptual knowledge and verb conjugation, it seems to be especially important for maintaining attention. Experiments show that neurons in the VLPFC must fire continuously to keep us on task so that we don’t become sidetracked by irrelevant information. Furthermore, deficits in the VLPFC have been associated with attention-deficit disorder.

...Human attention is a scarce resource — the neural effects of depression make sure the resource is efficiently allocated.
Both ADD and depression frequently co-occur with autism, perhaps because of similar misfiring in the brain.  Rumination is certainly a common trait - just last night I was kept awake half the night obsessively ruminating about how I would escape from my bedroom if the rest of the apartment were on fire; my solution involved a Phillips-head screwdriver and a wet towel.  Ryan's ruminations come in the form of scripting and perseverative behavior and language.  He can get so wrapped up in quoting every line of Sesame Street that he is unable to execute simple tasks (like getting undressed), nor is he able to pay attention to my instructions that would guide him through the order of operations involved in taking off his socks.

Further proof of the connection between depression and autism: a study in 2000 concluded that "children with high-functioning autism or Asperger syndrome are at greater risk for anxiety and depression compared with the general population."

Great.  Something to look forward to

I used to wonder if I had somehow caused Ryan's PDD because I used antidepressants during my pregnancy.  It seems more likely that whatever genetic predisposition I have toward depression was passed on to Ryan and has been expressed as an autism spectrum disorder.  I chose not to breastfeed because I didn't want to further expose Ryan to SSRIs; there's still not enough research out there to confirm what the consequences might have been.  I chose to continue my course of SSRIs throughout my pregnancy because I felt the potential dangers of the drugs were outweighed by the tremendous benefit of my being available to my child as a fully-present parent, and not a depressed mommy neglecting her baby.

It's provocative to think of depression as a point on the spectrum.  Our obsessions may be different and our anxieties may express themselves in different ways, but Ryan and I might have more in common than I would like to admit.  One more step on my journey from confusion to empathy.

Thursday, February 25, 2010

Kindergarten's Coming

The wheels are in motion to put my kid in kindergarten this fall.  His psych evaluation is slated for tomorrow (assuming it's not a snow day), his annual IEP review is in two weeks, school district-sponsored parent workshop on the CPSE to CSE transition is next month. 

Chrissy thinks the benefits of the academic challenge will outweigh the social risks that go along with being four years old and delayed among a class of typical six-year-olds.  I'm inclined to trust her judgment, but there's still a big old rock in my stomach.  I'm hoping at one of these meetings I'll learn about a small-class option, either inclusion or special needs only (my preference). 

I've been avoiding thinking about my nightmare scenario, in which the only public school option involves my baby thrown in the middle of 20 typical kinderg√§rtners, not speaking to anyone, getting pushed around and teased.  I'm going to be calm and wait for these meetings to fun their course.

If nothing else, my kid has good looks going for him. 

Seriously, how freaking cute is this kid?!?  That smile will take him far.  Maybe he'll be able to charm his way out of being teased.

Sunday, February 21, 2010

Everything is going to kill you.

We all know that eating too much sugar is bad for you, and most of us know that the insidious ingredient high-fructose corn syrup is really bad for you.  But I just learned HFCS can be really, really bad for you.

Apparently the process of manufacturing HFCS requires caustic soda, which is sometimes made using mercury, and a recent study found traces of mercury in about 1/3 of HFCS-containing products.  So not only is processed food making us fat, it may also be harming our brains, hearts, kidneys, lungs, and immune systems.

So could processed food be contributing to the recent increase in autism diagnoses?  Discuss.  I hope that the activists who were instrumental in getting drug manufacturers to remove thimerisol/mercury from vaccines will be as invested in lobbying to rid our food supply of this toxic garbage.

Thursday, February 18, 2010

What We Did During School Vacation

We've played in the snow every day.  Lots of sledding, snowmen, painting the snow with spray bottles of colored water, jumping in slush puddles.

We made great use of the long hallway between the buildings in my complex.  Tricycle riding.  Rollerblading.  Endless games of tag.  Running around with the 2-year-old neighbor.

There's been lots of Play Doh and connect-the-dots.  We've gotten pretty good at writing the letter A.

Ryan spontaneously ran up to me, threw his arms around me, and shouted "I LOVE YOU, MOMMY!"  I think this was the second time ever; I got choked up.  Then he spent the rest of the day giggling maniacally while declaring, "I am not a peanut butter!"  I wanted to choke him.

And we learned many things.

On Sunday we discovered that if you play with an iPod too much, it will break and won't be able to sit in the speaker dock. 

On Monday we learned that our kitchen canisters are really fragile, and that they contained BPA so we shouldn't have been using them anyway.

On Thursday we learned that when you stick your shirt sleeve under the faucet, the color gets darker.  We learned this is true of the rest of the shirt as well.

Only three more days off before school resumes.  But there's a 30% chance of snow Monday night, so who knows if this vacation will ever have to end...

Sunday, February 14, 2010

My Superpower

Some people have GayDar.  I have AutDar. 

And I'm not the only one.

I brought Ryan to the ball pit this afternoon; Stu stayed home due to a snow-shoveling-induced injury.  Riding the elevator up with us was a man with his seven-year-old daughter.  I was pretty sure the girl had autism because of the way she was clutching her four Sesame Street stuffies; I was even more sure when she dropped to the floor of the elevator and started meowing.  When the door opened, she ran off into the golf pro shop.  I called to her father, "She reminds me of my kid."

Once Ryan was settled in playing, I considered how to start a conversation with the girl's father in a way that would subtly confirm my suspicions so we can talk about the wonderful world of special needs parenting if I were right, but which wouldn't offend him if I were wrong.  I made my way over toward where he had parked himself.

This man clearly had AutDar, too, because he opened the conversation by asking me where Ryan goes to school.  "Oh, Katie used to go there.  Then she went to Popular Local ABA School and now she's at..." 

Once you know what you're looking for, you find special needs kids everywhere.  While we were chatting this guy was pointing them out left and right - kids blending in pretty well, but just different enough that he felt confident diagnosing them from across the room.

Then he asked me if I was married, and things started getting weird.

While the kids were playing, I learned way too much about his first wife, his current wife (mentally unstable! on new meds!), his 20-year-old son with ADHD, how five years post-diagnosis he's thoroughly exhausted by his daughter and fears for her future.  And there was the adorable anecdote about his daughter swiping the parts of her teacher's picture schedule that represent classroom activities she doesn't like.

Around when this guy was starting to ask me what kind of music I listen to, Ryan announced it was time to go.  Good boy.  Captain Awesome's always got my back.

Thursday, February 11, 2010

Updating the DSM

Among other proposed changes to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, due in 2013, Asperger's, PDD-NOS, and all the other diagnoses on the spectrum would be classified as Autism Spectrum Disorders, instead of having separate entries.  I have no problem with this: it makes sense to refer to all those shades of functionality - from Aspergian genius to the most severely-affected, wordless recluse - as points on the same spectrum.

But some folks with Asperger's are upset about this change, because they don't want to have to call themselves Autistic.  I read this on NPR's site, and it annoyed me a bit:
But the change is going to be hard for some people with Asperger's, says Michael John Carley, executive director of the Global and Regional Asperger Syndrome Partnership in New York and author of Asperger's From the Inside Out. "I personally am probably going to have a very hard time calling myself autistic," says Carley, who was diagnosed with Asperger's years ago.

Many people with Asperger's take pride in a diagnosis that probably describes some major historical figures, including Albert Einstein and Thomas Edison, Carley says. Under the new system, those people would represent just one extreme of a spectrum. On the other extreme is "somebody who might have to wear adult diapers and maybe a head-restraining device. This is very hard for us to swallow," he says.

Yet Carley says he agrees with the decision to fold Asperger's into the autism spectrum disorder diagnosis.
I'm certainly glad that Aspies like Mr. Carley are proud of this element of their personal identities, but they could do a great service for others elsewhere on the spectrum by embracing them.  Maybe if high-functioning people tell the world, "Hey, this is autism, too," they would help to reduce the stigma for those in the middle of the spectrum, like Ryan.  By showing neurotypical people that individuals with autism are characterized not only by their challenges but also by their strengths, they would help foster understanding from NTs and self-esteem in people with mid-functioning autism.

Someone at Psychiatric Times pissed me off, too.  Explaining why she thinks lumping Asperger's in with other ASDs, she writes:  
Those with Asperger’s (which is much less impairing) will be stigmatized by the association with classic autistic disorder.
It's this stigma that we have to work on.  I hope that the proposed changes to the DSM-5 take a significant step toward that end.

Wednesday, February 3, 2010

Autism isn't caused by vaccines. Really. No, REALLY.

You all know my opinion on the whole vaccines-cause-autism argument: bullshit.  The medical journal Lancet now agrees: it has redacted the famous 1998 research paper that started the controversy.  the Lancet says:
"several elements of the 1998 paper by Wakefield et al are incorrect.... Therefore we fully retract this paper from the published record."

Can the controversy be over now?  Will parents please go back to having their children vaccinated so kids don't needlessly die of measles in the 21st freaking century?

Tuesday, February 2, 2010

Mike's retiring. Welcome back, Ryan!

It just feels dishonest.  In a couple of years I will change the privacy setting on this blog so it is available only to a select few who I give passwords.  In the meantime, all I ask is that family members on Stu's side refrain from attaching their last name to their comments, so that a Google search for Ryan [last name redacted] won't point here.

I've re-edited all of the old posts, reinstating Ryan and kicking Mike to the curb.  I feel good about this.

Monday, February 1, 2010

Meet Mike, or, Responses to the Exploitation Post

I got lots of great feedback through Facebook and personal email, and I thought I'd share readers' thoughts here, too, and my responses to them:

Stu has the same ambivalence about this subject as I do:
It's one thing to voluntarily open your own life to the rest of the world, another someone else (your mother of all people) doing it for you. Assuming that he is able to mainstream in the next couple of years, is he going to want to keep it quiet that he used to get Special Ed and "rode the short bus" for his first couple years of school? The question is whether he gets to make that choice himself, or have we already done it for him? There is also the various phases of life where your appreciation of these things changes radically - he might be indifferent as a child, mortified as a teenager, and understanding as an adult.
As Stu is my son's father, I have to give his opinion greater weight than anyone else's.  So in light of this, I went through all my 81 previous posts and changed our son's name to the alias Mike in every freaking one.  It felt totally dishonest and unnatural writing that way, and re-reading our stories that way.  When I revealed to Stu that "Our son's new name is Mike," he was even more uncomfortable with my choice than I had been.

"I wouldn't change his name," he said.

"Then what would you suggest I do?"

"I don't know, but it wouldn't be that."

He suggested that I leave things alone for now, and that a couple of years from now I password-protect the blog to make it available to approved subscribers only.  This idea is appealing, but I don't know if changing the access policy also limits what strangers can stumble upon during a Google search.  Any of you have experience with this?

There were several of you in the this-is-not-exploitation camp.  The common argument was that we're living in a different world than the one in which Molly grew up - kids today grow up with everyone's personal business exposed online, and all parents who post photos/stories about their kids on the web are in the same boat and have the same questions to answer that I do, special ed or otherwise.

Yeah, but, like Stu said, there's a big difference between choosing to put your own info on the web and having your mother talk about you.

One friend wrote,
It seems unlikely that some middle schooler will find your blog and torture your child with it. I'm sure my kids are equally mortified by the stories I tell about them. 
I don't know if I want to bank on that.  It seems totally plausible to me that middle school kids would Google a classmate for the purpose of finding fodder for torturing him.

I chatted with my friend Will (who insisted I use his real name) about this, and he offered this:
After my mother passed [he was 18] I read her journals and I was glad to have had them ( I know this is not the same - but nonetheless).  what I realized was more of her full life outside of mine, and that my struggles were her struggles and vice versa.

that being said, i do think it would help the conundrum should you anonymize. I think that you should take whatever measures you think are necessary to protect your blog from his friends' eyes later on, which could be fairly simple.  perhaps real names and photos would be best on a personal and protections-enabled webspace like your facebook page, and the able-to-and-should-be-widely-publicly-read blog should have made up names along with a stressed point that the pseudonyms are not a result of shame but a result of the public/private struggle, because what's amazing about your blog and you is the honesty, and you dont want to have to sacrifice that because of worry about what your child may read in the future.

And there were lots of supportive, broadly positive comments, for which I am grateful.  Like this from SN:
I don't think you're doing anything wrong. As mothers we are each other's greatest support and greatest resource. Sadly, because life has changed so much and people no longer have the time to sit together in their living rooms to talk, we now have to use the internet. I think you help other mothers with your blog, and not just the mothers of neuro-atypical children. Many of your posts resonate with me and my parenting experience...

In short, I'm totally confused and don't really know what's best for me in the present and my son in the future.  So for now, the kid shall be referred to as Mike, and the blog shall be called Not An Affliction. I'm not really happy with that, and I haven't ruled out the possibility of changing his name back again in all my old posts, so I'm just going to sleep on it.

A bit of housekeeping: the Facebook group now has the wrong name, and FB doesn't let you change the name of a group, so I'll probably have to invite you to join a new group, called "Not An Affliction."  Also, I don't know how to edit the comments attached to old blog posts, so I might just have to delete the ones that reference Mike's real name.  I'm in no great rush to do this, as Mike and his peers can't really read yet, but these changes are on the horizon.