Asperger's Conversations

Interview with Terry Anderson of Bellevue Hospital

A couple months ago I visited my friend and former Internship supervisor, Lowell T. Anderson, Ph.D., who is a senior psychologist at New York's Bellevue Hospital and Associate Professor at NYU Medical Center.  We talked about his 30 years of cultivating a Behavior Clinic at Bellevue where he trains medical residents and psychology interns in the brief delivery of advice for a range of behavioral and psychological problems.  Terry has published articles in the areas of childhood Autism, Lesch-Nyhan Disease, as well as ABA and operant analysis of behavior.  Terry always drops pearls of wisdom and this visit was no different...where he manages to "diss" his own field (he told me that "Behaviorism has made little contribution to psychotherapy") while at the same time still encouraging people to change if it is possible.

Click on the MP3 file below to hear today's podcast: Download TerryAnderson.mp3 (9mins,32sec; 3.27MB)

Pause from grading finals: Animator vs. Animation

Alan Becker's latest video raises interesting questions about subject vs. author and even persuades us to ask what the difference is between our computer and ourselves.  As we watch many of our kids with autism spectrum issues "become one with the computer" we might wonder if they are "ahead of the game" rather than suffering from some social disease.

AtomFilms.com: Funny Videos | Funny Cartoons | Comedy Central

Florida Vote on Insurance for Autism is Good

The recent move by the Florida legislature to require insurance companies to pay for evidence based treatments for autism is a good one for parents and kids.  Insurance companies in the U.S. are simply "middle men" and "paper pushers" who care nothing about the well being of its' customers and only care about making money.  I have blogged about how my own Insurance Company has betrayed my own interests on numerous occasions, and my conversations with my colleagues on campus reveal that I'm not alone!

Here in Keene, NH we have ramped up early childhood autism services by training lots of college students in ABA and related approaches, but still it's hard to get affected kids enough program time.  Insurance companies will say they are interested in supporting evidence-based treatments, but in fact mostly respond to outside pressures (e.g., no problem in getting reimbursed for non-evidence based chiropractic procedures, but trouble getting reimbursed for "real" medical procedures at major medical centers).  So here's my question for Harvard Pilgrim Healthcare Insurance Company:  Will you provide reimbursement, up to $36,000, for evidence based ABA procedures for early childhood autism?  Probably not...let the kid move to Florida...or get "adjusted" instead.

Sarcasm aside, let's be happy about the Florida decision.

Got Ethics? Who's writing these journal articles anyway?

Astonishing piece in the NY Times about top academic medicine researchers letting drug companies write their articles.   An example is Merck using hired guns to write up published reports on Vioxx, but lapses have been linked to other areas, including psychiatry.  I need to read more, but heck, down here in small "college land" we try hard to teach our students about something called "ethics."  Our students are getting so cynical they yawn when we bring this stuff up. 

More on Speechmatch Study

In my previous post I wrote about my student, Dana Githmark, presenting pilot data on our speechmatch project.  I have attached the poster she presented at the Keene State College Academic Excellence Conference which highlights student work across all areas of study:

Download danaPoster.ppt

I am wondering if other academic bloggers have posted their students' conference posters?  Some time back I blogged about the pros and cons of academic blogging versus formal journal publication, and of course I still think there's room for both.  The problem with formal publication routes is the delay in getting information out.  Also, as blogger Jon Udell points out, it's a good thing to get our "half baked" ideas out there, so others can contribute and help create more "fully baked" ones.

We've been using audacity to train individuals on the autism spectrum to match the speech patterns of their conversational patterns.  Audacity provides visual feedback of the non-content aspects of speech (not "what you say" but rather "how you say it") including pauses, vocal intensity,  and lengths of speech:

Dana has completed trials with 4 individuals (see the poster for more info); gathered independent ratings of "degree of match" between the person with ASD and the student experimenter, and found preliminary support for the idea that this method improves the match:

This graph represents collapsed ratings of match across subjects and lots of questions remain.  Is the effect "clinically meaningful" as opposed to "statistically meaningful?"  Will results generalize to "real life" situations?  Is the feedback specific enough to matter?  We will move forward, test more subjects, improve our data analysis methods and, hopefully, get helpful feedback from friends and colleagues, and those who read this.

Academic Excellence Conference: Speechmatch Poster

I attended the Academic Excellence Conference last week at Keene State College to support my student, Dana Githmark, who has done an excellent pilot study of my Speechmatch program for training individuals with Autism and Asperger's in matching the speech patterns of their conversational partners.  I forgot to bring my digital camera, but that doesn't matter, does it?  Scores of other people did remember, including my colleague, Kristen Porter-Utley from Biology.  I used to compulsively carry my camera everywhere...but now I know someone will always have one...same with a cell if you need to make a call.  What's next?  Who's got a Garmin GPS?  Satellite phone?  Provigil?

Uneven Services for Individuals with Autism and Asperger's

In my talk yesterday at the University of Hawaii's Social Science Research Insititute I was asked about how other states are faring with providing adequate services to students with autism.  While both Hawaii and my home state of New Hampshire have now issued guidelines for best practices, it is difficult to say "which states are doing best" since ideal situations are found more in particular school districts or towns.  My friend and former Kamehemeha Schools colleague, Larry Loganbill, an educational filmmaker from Kauai, passed this article from Edutopia today which does a good job summing up the state of schools and what's up with offering evidence based practice for autism.  But enough about autism and Asperger's...the tradewinds have slowed a bit, so I'm off to do some snorkeling, followed by the UH Rainbows baseball game tonight with an old UH friend.

Point Light for Training in Autism and Asperger's

In previous work I suggested using a free downloadable audio editing program called Audacity as at type of "language feedback" system for training individuals with autism spectrum disorders in "matching" of non-content aspects of speech.  My student, Dana Githmark, and I have been collecting data which will be presented at the upcoming Academic Excellence Conference.

My colleague, Gary Bonitatibus, Ph.D., passed on Point Light from BioMotions Lab which I've been playing around with and hoping to study in a similar way.  I've made a screencast of Point Light in which I suggest studying it's use as a clinical tool for "BodyMotionMatch" (as opposed to "speechmatch"):

Mental Health in Hawaii

I just arrived in Hawaii (nice respite from Keene, New Hampshire where it's cold and snowy) to meet with Michael Wylie, Ph.D., Associate Professor and Director, Mental Health Services Research, Evaluation, and Training Program of the University of Hawaii's  Social Sciences Research Institute.  I hope to talk about transition plans for individuals with autism spectrum disorders and to learn more about how to study problems of mental health utilization and delivery of services.

I received a message this morning from Shelley Viles who developed what I think is the first graduate certificate program in autism spectrum disorders asking me to let people know about the upcoming Autism and Asperger's Exposition at Antioch University in Keene, NH on April 5th, 2008.  Several of my students will be there to talk about our Peer Mentoring Program as well as research in speechmatch.

Bruce Levine says psychiatrists aren't as smart as plants

Psychologist Bruce Levine, who I have never met, is coming to Keene, NH to promote his new book, Surviving America's New Depression Epidemic, with a reading at my favorite bookstore, The Toadstool at the Colony Mill on West Street.  I watched his video on blip tv and was impressed.  He rails against a purely pharmacologic approach to problems in living and argues that there is so much more we can do to handle the stressors in life than "taking the pill."  While I return that day from meeting with friends and colleagues at the U. of Hawaii in Honolulu (poor me) I'm going to try to make it to his 2pm reading and then interview him for a podcast at 3:30 pm.

Levine's arguments are reminiscent of Thomas Szasz, MD (remember "The Myth of Mental Illness").  I've been playing audio clips of the Szasz/Ellis debate to my students in Clinical Psychology and I think Szasz, while dramatic, makes important points when he says that psychiatry is often about "money and power."  Here's an excerpt from Szasz:

...Chemotherapy is a fancy term for drinking martinis under medical auspices, except the martinis are much more poisonous, much less effective and much more expensive and Blue Cross pays for it. It's a racket, of infinite proportions now! It validates the patient as a patient, and the psychiatrist as a doctor. They are both crooks in this situation.

With Ellis responding in kind:

...I think that Dr. Szasz and many of his supporters do paranoid thinking when he makes statements like “physicians are arch criminals.” That is a demagogic statement! Some physicians, some of the time, very damn few, but the ones for example who served Hitler, some of them were arch criminals. But most physicians are merely incompetent, stupid, misguided, etc....

When it comes to Asperger's, I have seen very little real help from psychiatrists and pharmacotherapy, other than treating co-morbid depression and related problems.  As for Asperger's, per se, there is clearly no medication therapy and any implication that one exists is nonsense.  This also is true for very misguided physicians who promote chelation for autism, which has no scientific support and which is probably dangerous.

Bruce Levine says "psychiatrists are not as smart as plants" when he discusses their obsession with medication for common mental health problems, such as depression and anxiety, while ignoring practical changes that might help.  I'll be sure to ask him what he thinks of the Szasz position that psychiatrists are "corrupt" or Ellis's that they are "merely stupid."