Asperger's Conversations

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."

More Insurance Rant

In a previous rant about Harvard Pilgrim Health Care I mentioned that they couldn't get my child's age right.  But the worst, of course, is their chronic problem of losing claims and failure to pay reimbursement in a timely manner.  Most recently they lost my claim following an out of town medical procedure and failed three times in a row to send me certain information in the mail ("We don't know why you didn't get that information").  And when they finally did get me the information, it was incorrect.

Now of all things I did (finally) receive payment, only Harvard Pilgrim tells me they overpayed:

Unfortunately due to an inadvertent error you have been issued an over payment of $500.
Because your services were out of network, you are responsible for reaching your 2008 out of network cost sharing.  I apologize for this error as I realize you have experienced many unforeseen delays and prior issues in claims processing.  Please let me know if you have received this payment so thatwe can discuss a resolution to this issue.

This is the response I would like to send them in return:

Dear Harvard Pilgrim Health Care:

When I am "in receipt" of your claim for overpayment ("in receipt" defined as having received your claim followed by having it scanned in to our system, uploaded to our main system, and transferred to my account) I will take up to (or longer in certain circumstances) 30 business days to respond either with payment or an "explanation of payment" (i.e., a notice explaining why I am unable to provide payment at this time).  Please note that New Hampshire law on turnaround time does not include claims pertaining to procedures done out of state, thereby allowing me as much time as I damn well please to provide you with reimbursement or an explanation of payment.  Also, if I lose your claim (which is likely) please note that I will not inform you of that fact and that you will be responsible for resending your request.  If you would like to use my online claim system for monitoring the progress of the processing of your claim, please request a passcode and user ID which I will fail to send you for several weeks.  After that I assure you that I will send a user ID and passcode that does not work.

Of course, I don't really have the nerve to send such a letter.  Hey, is there anyone left in the USA who thinks that the coporate approach to managing healthcare which lops off about 25% of our costs and gives it to corporate robber barons is a good idea?

Stretching classroom boundaries: Web 2.0, Asperger's, Primary Source

An extraordinary event occured this week in my Abnormal Psychology class at the College.  For several years I have required that my students maintain blogs of weekly reflections on class material and commentaries on assigned readings.  Most recently, my students read "Look me in the Eye" by John Elder Robison, which is about is childhood struggles with Asperger's.  Robison found some of my students blogs and posted comments with his own critiques of their critiques.  My student Jenna discovered that Robison had strong words to say about her synopsis in which she took the author to task for what she felt was unreasonable justification of some of his vengeful acts toward others, including a school teacher.  You can read Jenna's blog and click on the "comments" to read Robison's comments.  You can also read Jenna's response to Robison's comments under that section.  After that I discovered that Robison had commented on several of my students blogs, often with tough (would he prefer "direct") words.

These events were fascinating for several reasons:

1. In little Keene, NH a college student can write about a famous author's book and get a response from that author...not by going to the author, but by having the author go to her!  Imagine how exciting it is for a college student to suddenly be dialoguing about a book with the real life author!

2. Jenna was able to experience directly a central issue in the field of Asperger's.  Robison pushing hard the "respect for neurodiversity" model which is being picked up by many of the major patient advocacy groups (e.g., GRASP, AANE) as a contrast to a more traditional "DSM Psychopathology" model.

But that's not all!  The boundaries of the classroom were further expanded by email responses to Robison's comments by others who had read Robison's book, but were not in my class.  For example, here's an excerpt from a former student who caught wind of the blog posting:

Sean came home from class today and told me that John Robison actually responded to a students critique of his book. I have to say that I really enjoyed his book and I was actually somewhat happy that he managed to teach himself to socialize. However, if he actually got upset about someones opinion on his book, then, in my opinion, he has not come as far as he gives himself credit for.

The former student added:

It is pretty cool that he responded to her blog though

These events have jazzed my Abnormal Psychology class (it's like a famous person has entered the room through their blogs) and makes you think of even more possibilties for education.  For example, instead of bringing in famous authors to give one-shot talks at colleges (for large sums of money where few will attend, let alone talk directly with the speaker), why not invite them in to classrooms "virtually" by commenting on student papers or participating in class discussion boards?  Student papers could be posted on Google Documents so that famous writers (who can stay home and communicate on their laptops) can view those documents and post comments (without slipping and falling on the ice on campus which I did today!).