Tuesday, March 31, 2009

More on Ozonoff et al. (2005)

In a previous post, I spoke about a 2005 study on the MMPI profiles of "high-functioning" autistics. In that post, I mentioned that there were aspects of the study that I couldn't comment on too much as I lacked critical knowledge.

One of the advantages of being a grad student, however, is access to university resources. At Nova, this includes an entire (small) library dedicated to psychological testing. Given that the MMPI is the most commonly used psychological test -- period -- the fact that it included a good bit of relevant documentation should be no surprise.

It took me less than five minutes to find information on the PSY-5 scales. It took me somewhat longer to photocopy the relevant pages, but a good bit of that time was spent looking for a copy machine.

The RC scales, on the other hand, weren't covered in the books that I looked through. Fortunately, however, another benefit of being a grad student is access to the faculty. I plan to ruthlessly exploit that to gain relevant knowledge.

In any event, I forgot to mention a few things in my last commentary, namely the validity scales. The autistic group in Ozonoff et al.'s study scored higher on the L, F, Fb, and Fp scales overall.

Those scales are primarily intended to detect attempts to misrepresent yourself by appearing as other than you are. While Ozonoff et al. do not discuss any of these results other than the L scale, they attribute that effect to "limitations in insight and self- and other-awareness". I believe that this explanation is somewhat contrived.

Given that this study was authored in part by the personnel responsible for diagnosing the persons involved, given that this study was authored by at least in part by personnel at the clinic that the subject pool was recruited from, given that the authors take a psychopathological approach to autism treatment, given that the test was presumably administered by the personnel in question, and given that the treatment methods based on that approach usually involve what amounts to training the autistic individual to pretend that they are neurotypical, I suspect that the real explanation is just a bit simpler.

On the PSY-5 scales, which are based around something akin to the Big 5 Personality Factors, the autistic group typically scored lower on the aggression and disconstraint scales. The aggressiveness scale is exactly what it sounds like... which is interesting, given the stereotype of autistic children as aggressive.

The disconstraint scale, on the other hand, is a measure of risk-taking, impulsivity, untraditionality, and lack of preference for routine... among other things If this sounds a bit backward, it is. Most of the PSY-5 scales are defined as the opposite of Big 5 personality traits.

Finally, the autistic sample scored higher on the introversion scale. This... shouldn't be a surprise given that a low score typically means that the person is highly social in nature. While I think that this is a real effect, I have to wonder about the possibility of they study's use of psychology students as a sample contaminating this result.

And that is all I can add until I get around to talking to someone who can help me interpret the RC scales.

The Pace of ABA Research

My class on behavior models in ABA (effectively a survey on the various things ABA has been used for) has just started its unit on ABA-based autism interventions. As part of this, we were instructed to read our textbook's chapter on stimulus preference assessment.

One paragraph stood out the most to me. Namely,

One antecedent condition that obviously affects the momentary effectiveness of a reinforcer is the continuum of deprivation and satiation of a stimulus. In animal research, the use of ongoing schedules of food and water consumption are commonly used techniques for maintaining the effectiveness of stimuli used as reinforcers. Naturally occurring events are rarely, if ever, disrupted in applied research. However, it has recently been demonstrated that reinforcers are more and less effective at different moments during a routine day. Vollmer and Iwata (1991) demonstrated the differential effectiveness of food, music, and attention during periods of satiation and deprivation....

In other words, food acts more powerfully to motivate people when they're hungry. What really bugged me, however, was the date of that citation. It's referring to a study published in 1991.

My initial reaction was something along the lines of, "It took you fifty years to figure that out!?!"

Then, of course, I realized that the paper in question might not be a seminal work.

Then I started pondering how the hell the word "seminal" acquired the meaning it holds in science today.

After eventually dismissing that as a pointless etymological tangent, I decided to look the paper (which is publically available) up.

In a moment of horror, I realized that it was.

Monday, March 30, 2009

Autistic Personality Disorder?

Someone e-mailed the ASAN mailing list recently seeking advice about seeking services. Part of the delemma involved her local vocational rehab service paying for a doctor who concluded that she had schizotypal personality disorder instead of Asperger syndrome, which she already had a diagnosis of.

According to the message, this conclusion was based on the results of a test that sounded an awful lot like the MMPI.

Beyond the clinical malpractice involved (the MMPI shouldn't be used as the sole basis for a diagnosis), there's the issue of the test's validity in assessing autism. Specifically, it isn't any more valid for that than it is for assessing brain damage.

I can say that with confidence now, thanks to Michelle Dawson. When I commented on the matter, explaining the MMPI and how it works, I added a comment that I wasn't aware of any attempts to validate the test for an autistic population. She then mentioned that there was a paper on the MMPI-2 and autistics and provided me with the citation. When I mentioned that my university didn't have access to the 2005 issues of the journal it was in (NSU does have access to the 2003 and 2004 issues), she e-mailed me a copy.

I've done a citation search and a reverse citation search on the paper as well -- and a keyword search in PsycInfo for good measure -- so I can say with a good degree of confidence that it's the only published paper on the topic. There may be more in press, of course, but that's not reference material that a clinical practitioner would have access to, barring highly unusual circumstances.

I estimate the odds of these circumstances (such as the clinician being on the research team for a follow-up study) to be somewhere between the odds of me getting struck by lightning within five minutes of finishing this blog entry and the odds of me winning the next lottery.

For the record, I haven't purchased any tickets.

The study itself is pretty interesting. I have my fair share of issues with the intro, of course, mainly due to the purely psychiatric/psychopathological approach that it takes to explaining what autism is. Others have written extensively on this topic and the sort of harm that this sort of thing can do, however, so I won't go there.

The experiment itself was actually pretty simple. They gave the MMPI-2 to 21 "high-functioning" autistics and Aspies, then did the same to a control group. Following this, they compared the resulting profiles.

I have my fair share of criticisms of what they did. For one thing, the sample sizes were far, far too small. The initial autistic group was composed of 21 adults (a mix of "high-functioning" autistics -- defined as those who could score in the normal range on the WASI -- and Aspies), which isn't even enough to expect a decent standard distribution, much less an adequate comparison between groups. Of these, one was disqualified from consideration (he left too many questions blank) meaning that the final autistic sample was only 20 people.

Similarly, the initial non-autistic sample consisted of 25 college students, recruited from an introductory psychology class. Of these, one was disqualified... apparently for trying to just answer everything with the same response regardless of what the question said. The TRIN scale (one of the MMPI's validity scales) measures attempts to do that.

The experimentors did try to match the samples, at least, and did so based on WASI results, age, and gender. Unfortunately, college students aren't representitive of the general population, and students from an intro psychology class are less so than most. I am not certain how this may have effected the study, mainly because I'm not sure about differences between college students and the general population on the MMPI. I will note, however, that this fact introduces confounds.

Fortunately, however, the authors acknowledge most of the above in their discussion.

Judging by the results, it looks like my initial concern (that the correlational relationships that the MMPI is based on might not hold true for an autistic population, thereby rendering the test results invalid) isn't the case, at least for adult, "high-functioning" autistics and for adult Aspies. That said, the reporting conventions are one area where I have... issue... with the study. Simply put, no statistical significance testing was conducted.

Fortunately, there's enough data reported that you could, theoretically, go back and conduct significance testing yourself. Unfortunately, this is a pain in the butt when you have to do it for 61 sets of data. I suppose that I could use a spreadsheet to do it for me, but it's still an annoyance... especially since it's standard practice to report this stuff.

The explanation given in the paper is as follows:

Because the sample sizes in this study were modest and this investigation is exploratory and descriptive in nature, effect sizes (e.g., the magnitude of group differences), ds, are reported, rather than statistical significance.

This makes sense, after a fashion, but it makes replication with a larger sample essential... and doesn't really excuse the annoyance. Given the way most statistical packages are set up, reporting the relevant data is roughly five minutes' work.

On the plus side, this has rather forcibly reminded me that I'm getting somewhat out of practice with calculating statistics and solving equations by hand.

So, that taken care of, what were the findings? On the core scales of the MMPI, the autistic sample scored higher on the tests for depression (even after five autistic participants who had a diagnosis of major depression were excluded), social introversion, and schizophrenia. This last would be more meaningful were it not for the fact that the MMPI's schizophrenia scale really measures social alienation and ways of thinking that are different from the norm. Autistics also typically scored lower on the hypomania scale.

One issue that this brings up is the issue of exogenous versus endogenous depression. The autistic sample was recruited from the University of Utah Child and Adolescent Specialties Clinic, meaning that all of them were treated there. This means that they all had at least one life event in common, and, in fact, the article mentions a second: all of them were diagnosed by either Dr. Sally Ozonoff or Dr. Janet E. Lainhart. The possiblity of a relationship is not considered in the paper... and the MMPI does not make a distinction between the two types of depression. Although, as a personality test, it is presumably designed to focus on depression as a personality trait, I know of at least one study that uses the MMPI to evaluate non-trait depression in the form of postpartum depression. While vulnerability to postpartum depression may be a trait, it is difficult to consider the depression itself to be such.

This is not to accuse Dr. Ozonoff or Dr. Lainhart of malpractice. I know very little about either of them... and less about their clinical practice. This is, in fact, precisely why I point out the above possiblity. The paper does not even begin to address this challenge.

On the content scales, the largest group difference was that autistics scored higher on the social discomfort scale. This... should not be a surprise. Their higher scores on the low self-esteem scale is probably related to a combination of environmental effects and the depression difference noted above. This is also backed up by an elevation of the negative treatment indicators scale, which measures physical and emotional distress.

I'd also like to mention an elevation in the work interference scale, which measures personal difficulties that interfere with work. This, too, is hardly news to the autistic community.

For the supplementary scales, the autistic group scored higher on the repression and anxiety scales. Again, this can easily be explained by life events. Certain nasty things, like bullying, tend to happen to us.

On the other hand, the autistic sample scored lower on the MacAndrew Alcoholism-Revised scale and the Addiction Potential scales, both of which measure vulnerability to substance abuse. Way to go, us!

On the other hand, this may be because we're painfully aware of the dangers thereof.

Then, we come to the ego strength scale, which is a bit tricky to explain. While it was originally intended to asess the degree to which a client can benefit from psychotherapy, this is by the standards of psychoanalytic theory. As such, it seems to measure adaptability, personal resources, tendency to seek help, ability to deal with others, and good physical health... among a host of other things. The autistic group scored lower, overall, on this measure... but, given the sheer variety of things that it assesses, I'm reluctant to ascribe meaning to this.

The rest of the results pertain to the revised clinical (RC) and PSY-5 scales. Unfortunately, I lack critical knowledge needed to properly interpret this and will be seeking information over the next week or so as I try to avoid spending the eighty bucks or so needed to buy a proper assessment book. I have an old copy of Graham's textbook on the MMPI (I picked it up at a book-sale), but it doesn't provide information on them. As such, I'll need to do some more searching.

Another interesting set of data provided is the percentage of the sample who provided clinically significant scores on the various scales. 40% of the sample provided clinically-significant elevations in the schizophrenia scale (I discuss the meaning of this briefly above, but suffice it to say that I doubt it means that the description of autism as "childhood schizophrenia" was even partially right)... and the post-traumatic stress disorder scale.

I don't believe I need to explain why that last bit is worrying.

The discussion for the paper was, overall, well-researched as far as I can tell (I'm not familiar with all of the papers cited), but every bit as... off... in tone as the intro.

And, of course, the article does absolutely nothing to change my opinion that the MMPI is completely inappropriate as a diagnostic measure for autism.

Alphabet Soup!

Back when I was a kid, I used to like Campbell's Alphabet soup. Part of this was the preschool fascination with letters. Part of it was the taste.

Kids, in general, like alphabet soup. It's a great thing educationally, as well as being... well, better than some things... nutritionally.

To many adults, on the other hand, a different kind of alphabet soup is the bane of their existence. In a real way, this sort of alphabet soup has invaded our lives, thrusting such arcane acronyms as FBI, CIA, NSA, IRS, USSS, DEA, and NCIS... just to name a few of the more commonly mentioned examples within the US government.

Medicine, too, has its own alphabet soup. Ranging from HIPAA to MRI, it bombards us with labels like IRB that seemingly have no relevance to our day-to-day life. Every diagnosis seems to have its own inpenetrable jargon... to most people, anyway.

It should be no surprise that autism, too, has its own fair share of related alphabet soup, words like ABA, IBI, DTT, IEP, PT, and AS, just to name a few examples. Many of these acronyms are often misused.

To someone new to the world of autism, this can be... confusing, to say the least. As such, I've put together a little guide to them.

Do not expect this guide to be complete. If someone mentions an acronym to me that's not on this list, I'll go back and add it in (with a little thank you), but this initial version is just a guide to the ones I could think of offhand.

I've grouped these acronyms into two categories: those which are ABA-based and those which are not. There's some room for debate here, my classification of PBS as not-ABA being a prime example, but that would have been the case regardless of which direction I chose to in that case.


ADOS - The Autism Diagnostic Observation Schedule, a tool used to access the "symptoms" of autism.
AS - Asperger Syndrome, often (debatably) referred to as a "mild form of autism".

ASD - Autism Spectrum Disorder(s), any of the conditions classed as PDDs under the DSM.

NT - Neurotypical. Depending on use, either someone of "normal" neurology or having to do with non-autistic attitudes and/or society.

MMR - Vaccines used to immunize against measels, mumps, and rubella. Often blamed for kids "becoming" autistic despite a lack of evidence to support the view.

IDEA - the Individuals with Disabilities Education Act, a United States law which has considerable impact on the education of autistic individuals.

OT - Occupational Therapy. Also occasionally used to refer to an Occupational Therapist.

SLP - Speech-Language Pathology. Also, occasionally, Speech Language Pathologist.

PBS - Positive Behavioral Support, a breakoff movement from ABA. PBS methods typically differ from ABA methods mostly in marketing and attitudes.

PDD - Pervasive Developmental Disability, one description of what autism is. Other conditions classed as PDDs under the DSM-IV are Childhood Disintegrative Disorder, Rett Syndrome, Asperger Syndrome, and PDD-NOS.

PDD-NOS - Pervasive Developmental Disability - Not Otherwise Specified, the DSM-IV's catch-all diagnosis for anyone on the spectrum who can't be given a diagnosis of CDD, Rett Syndrome, AS, or autism.

CAN - Cure Autism Now, a predecessor group to Autism Speaks.

DAN - Defeat Autism Now!, a network of physicians, researchers, and so on who advocate nonstandard treatment methods for autism. Many accuse them of being quacks.

FEAT - Families for Effective Autism Treatment, a movement consisting primarily of the families of autistic individuals which is dedicated to the advocacy of intensive ABA-based treatment programs.

ASA - the Autism Society of America.
DSM - The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders.

DSM-IV - The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth (IV) Edition.

CDD - Childhood Disintegrative Disorder.
ASAN - the Austic Self Advocacy Network, an autistic-run group dedicated to championing the rights of autistic individuals.


ABA - Applied Behavior Analysis, the science of applying behavior analytic principles and theory to real-world situations.
BACB - the Behavior Analysis Certification Board, the group responsible for certifying behavior analysts.

BCBA - Board Certified Behavior Analyst, someone certified to design and oversee a course of ABA-based therapy (among several other things).

BCABA - Board Certified Associate Behavior Analyst, someone certified to implement behavior plans and conduct the day-to-day work of ABA-based therapy.
BIP - Behavior Intervention Plan, a plan (or document detailing a plan) to alter behavior.

NET - Natural Environment Teaching, a blanket term for teaching methods conducted in a natural or nautralistic setting.

IBI - Intensive Behavioral Intervention

EIBI - Early Intensive Behavioral Intervention, IBI starting at a young age.

DTT - Discrete Trial Teaching, a teaching method used as the basis of most early ABA-based autism interventions. In many minds and documents, DTT is equated with ABA.

PRT - Pivotal Response Training, a teaching method designed to target so-called "pivotal responses" such as motivation,

PECS - the Picture Exchange Communication System, a teaching strategy for communication skills.

VBA - Verbal Behavior Analysis, either the application of ABA to human interaction or a specific approach to language intervention.

AVB - Analysis of Verbal Behavior, another name for VBA.

JABA - the Journal of Applied Behavior Analysis, the flagship academic journal of ABA.

JEIBI - The Journal of Early Intensive Behavioral Intervention, a major ABA-based jounal and the flagship journal of the IBI movement.

This, of course, is an incomplete list. If you think of any others, feel free to comment with them and I'll consider adding them... with, of course, appropriate credit.

Thursday, March 26, 2009

The ABA Establishment

As a grad student, I often read research articles -- more often than not because my teachers assign them. They like to assign articles, great big stacks of them that seem to take forever to work through... and, then, when I'm finally finished, it's just in time to start on the next stack.

Every now and then, however, one of them is particularly interesting or noteworthy. A 1999 paper by Koegel, Koegel, Harrower, and Carter published in the Journal of the Association for Persons with Severe Handicaps (24(3), 174-185) is one such.

The paper is entitled "Pivotal Response Intervention I: Overview of Approach" and is interesting for a number of reasons. On one level, the basic concept behind pivotal response intervention itself is fairly interesting and quite ingenious in a way.

More importantly, however, the paper seems to make a number of the things that are wrong with the behavior analytic establishment readily apparent.

After things which are common to the autism establishment as a whole (e.g. the strict-disability model), a disturbing pattern emerges.

For instance, take the following quote:

As mentioned, over the years, a substantial amount of research has identified a specific attentional characteristic displayed by many children with autism. This characteristic has been called "stimulus overselectivity" (Lovaas, Schreibman, Koegel, & Rehm, 1971). It refers to the tendency of certain children with autism to respond on the basis of a limited number of (frequently irrelevant) components in their environment (see Schreibman, 1997, for review).... Many children with autism, however, tend to respond to fewer and more irrelevant components (e.g. a bend in a picture card, as opposed to the relevant feature of the picture). Thus, children with autism may identify a stimulus by an irrelevant cue (Schreibman, 1997).

Given the sensory issues autistic people have -- often in manifold and varied form -- it's quite likely that the issue here is one of salience, and lies on a sensory level. Despite this, none of the relevant literature is cited... and the possibility is not referenced. Were this just a matter of this paper, I'd be less concerned, but this is a systematic thing across most of the ABA literature I've read.

It is not ethical to bury your head in the sand in this manner, especially in clinical practice. The fact that past research was not behavior analytic in nature does not give behavior analysts an excuse to ignore it!

Another revealing quote is the following:

... The term motivation, as used here, refers to observable characteristics of a child's responding. An improvement in motivation is broadly defined as an increase in responsiveness to social and environmental stimuli (R. L. Koegel, Carter, & Koegel, 1998). For example, characteristics reflective of motivation include increases in the number of responses a child makes to teaching stimuli, decreases in response latency, and changes in affect (e.g., interest, enthusiasm, happiness) (R. L. Koegel et al., in press).

This is not, by any reasonable definition, what motivation is. Motivation is an internal variable; what that list includes are signs of it. Behavior analysts have often been accused of denying the existence of the mind. Items like the above are a large part of why.

Perhaps even more revealing, however, is the opening of the next paragraph:

Traditionally, interventions for children with autism did not consider these characteristics and how they may have covaried with the actual intervention goal, thus limiting the effects of such approaches. Additionally, disruptive behaviors seemed to be at lower levels or absent and greater generalization occured when motivational variables were incorporated (R. L. Koegel et al., in press).

In other words, older interventions didn't pay any attention at all to the child's happiness, interest, or enthusiasm. They didn't care about that. They didn't even look into ways to minimize boredom as an ethical issue.

The thought -- or lack thereof -- involved makes me so incredibly sick that I cannot even begin to describe it.

Also, note the dates of those citations. Behavior analytic research into autism treatment has been going on since the '60s.

Now... what does paying attention to these things look like?

These variables include the use of child choice, frequent task variation, interspersing previously learned tasks with new acquisition tasks, using less intrusive prompting, reinforcing the child's attempts, and incorporating turn taking within the interactions.

... yeah. It's worth noting that "child choice" is defined as including letting a kid select the toy he wants to play with.

I don't think I need to say anything else here.

This, of course, is not a complete list of my gripes, and it is true that the ABA establishment is changing. These are all references to older methods -- that is, ones in common use prior to the publication of this paper.

Unfortunately, those older methods are still used today... and that paper was published in 1999.

Wednesday, March 25, 2009

An Expression of Outrage

Despite the title of this post, I cannot even begin to truly express my outrage at some recent news from Staten Island, New York.

The short version of it is this: a bus driver, named Robert Fischetti, was responsible for taking an eight-year-old autistic boy, P.J. Rossi, to school. P.J.'s parents aparently thought that something was off about his treatment there because one day, they sent him to school with a tape recorder in his packpack.

What the tape recorder captured was unconscionable. To give just one example, the bus matron responded to P.J.'s screams of pain with, and I quote: "Shut up, shut up, shut up, you little dog!"

Not, mind you, that the driver was much better. Fischetti's response? "Good one!".

The Department of Education called their behavior "inhuman" and promised that he would be kept away from kids.

Now, a few years later, Fischetti's back on the road, driving kids to school.

Disabled kids, at that.

And I feel sick. It's a shame -- I was having a pretty good day before I heard about this.

Sunday, March 22, 2009

Why I Don't Like Parties

Once a year, NSU's Center for Psychological Studies holds its annual spring formal. Thinking that it would be a good opportunity to meet people, make friends, and at least try to establish a social network around here, I decided to attend this one.

It was a mistake.

While I started this blog to cover autism-related issues and not my personal life, the event served to remind me of exactly why I don't usually go to parties. Seeing as many of these issues are faced by many autistic people throughout the world, thus providing a good bit of overlap, I hereby present the Top Five Reasons Why I Don't Usually Go to Parties... in ascending order.

(5) I'm allergic to tobacco.

In and of itself, this isn't that much of a problem, but it means that even second-hand smoke can be an immediate health risk for me. This problem can make getting in and out of buildings (especially when people like to smoke immediately outside of them during their breaks) annoying, but only restricts me from a fairly small proportion of parties.

(4) My alcohol tolerance is subject to existential debate.

Simply put, I can't drink. There are three separate medical reasons for this, but again... it's not that big of a deal.

(3) My dietary restrictions are manifold and annoying.

It kinda puts a damper on your enjoyment of a party when you can't eat the party food. None of my dietary restrictions are crippling on their own (my allergy to shellfish, for instance, will often prevent me from eating one or two dishes on a buffet), but the cumulative effect is worse.

Of my dietary restrictions, only one is due to a sensory issue or a personal preference, and that's the fact that I can't eat spicy food. Given that I was recently told not to eat spicy food (among other things) due to gastroesophageal reflux, that item's status as such is debatable.

My other dietary restrictions include my aforementioned shellfish allergy, intolerances to mushroom and pineapple, and a variety of other similar problems.

(2) I get rapidly awkward in group social situations.

I have almost no real social instincts, so I have to rely on conscious decision-making processes. This is fine one-on-one, or with kids -- both involve keeping track of a fairly small number of things.

When I'm dealing with two other people, however, things get a bit more complex. In addition to monitoring and making decisions based off of my interaction with one person, I have to keep track of my interactions with two separate people. If this was the only problem, it wouldn't be that bad, but I also have to keep track of the interactions between the two other people I'm dealing with. As such, I'm making decisions based off of three separate social interactions -- mine with person A, mine with person B, and person A's interactions with person B. This makes it roughly three times as hard as one-on-one interactions.

Fortunately, I can handle that.

Three other people, however, is stretching it. In that set of circumstances, I'm actually dealing with six sets of interactions (me/A, me/B, me/C, A/B, A/C, B/C) and that pushes my limits.

Four... results in considerable awkwardness. I'm decent enough at hiding it, but I have to use methods based on artificial heuristics and selective attention, and that leads to me making far, far more of the stereotypical autistic social mistakes.

(1) My sensory issues prevent me from enjoying anything in that environment.

As autistics go, I have fairly minor sensory issues... which is really just a way of saying that I don't have problems with day-to-day life. I can't eat spicy food, for example, but there are plenty of non-autistics who have that problem.

Where my sensory issues tend to cause problems is with certain smells (I can't stand certain air fresheners) and loud noises. It's the latter that's relevant.

My sensory issues mean that certain things, notably including the music played at the volume used at most dance clubs and concerts, is literally painful to me. The general volume of music in the dining area for the CPS formal this year was close to the former.

In other words, I couldn't even step foot into the dining room. I eventually bought some ear plugs, but that meant that I couldn't participate in the dinner conversation... or even socially interact at the table.

And what's the point of a social event if you can't socialize?

Wednesday, March 18, 2009

Idle Speculation, Part Three

Autistic people are often good at certain things. They are also almost universally poor at others.

When thinking of the later category, social skills are the first thing that usually comes to mind. Speech is another... but language isn't, as exhibited by autistic persons such as Amanda Baggs. While it'd be accurate to say that there are times when she has difficulties with language, it certainly wouldn't be accurate to say that she's bad at it!

Thinking about this issue led me to think about what common elements the things in those two categories have in common. While it's pure speculation on my part (hence the title of this post), I suspect that the reason for the difference lies in the way that they're taught.

As I see it, teaching methods can be rougly grouped into three broad categories. There may be a fourth, but I haven't thought of it. Remember that this is mainly speculation on my part.

First, there are those methods that break down a skill into its component parts or steps and teach those before teaching the integrated whole. For instance, when I teach origami, I typically start by teaching how to perform basic folds. Subsequent to this, I teach the steps of a basic pattern, composed of those folds. Later, I move on to more and more complex patterns, teaching them step-by-step. We can call these methods teaching by component parts.

If you have to wonder where I got that name, please look at the first sentence of that paragraph. Yes, I know it's uncreative. Feel free to sue.

Math, for instance, is typically taught this way. So are most subjects related to science and engineering, as well as some craft skills.

Secondly, we have those methods that teach an approximation to the desired skill before modifying it into a closer approximation which is then modified again and again until the desired skill is mastered. We can group these teaching methods together and call them teaching by successive approximation.

Social skills are typically taught in this manner in modern Western cultures. Speech is another example of a skill taught like this.

If you see where I'm going with this, give yourself a cookie.

The third category -- methods that mix the two methods describe above -- is largely unimportant in this analysis. I will, however, note that my experience has been that autistic people are typically better at these skills than they are at skills typically taught entirely through methods that fall under the second category and worse than at skills taught through the first.

In other words, I suspect that this plays rather nicely into some of my earlier speculation.

Idle Speculation, Part Two

There are a number of theories as to what autism is. These range from Cohen's extreme male brain theory to neuroanatomical theories such as those involving the mirror neuron system and cognitive theories such as weak central coherence theory.

About the only thing we can really agree on is that no one knows for sure what the cause or causes of autism is or are.

I have a number of ideas of my own. I hope to one day be able to investigate them. These range from one that's connected to a meditation technique properly called mushin no shin to another, more basic, hypothesis.

My actual reasoning for this is connected to something called neural networking theory. As the human brain can be described as a neural network, this has considerable relevance. Unfortunately, my reasoning also involves fractal algorythms, which are something that I've found that the English language is fairly poor at expressing.

No, explaining the concepts is actually fairly easy. The problem is that my original reasoning was framed in terms of them. English kinda sucks at describing fractal patterns, especially when it comes to following a chain of reasoning that's framed in terms of them. While it's not that difficult with simpler fractals like the Sierpinski Triangle or the Koch snowflake, I actually think in a form of what can be called semi-fractal, recursive pseudocode. Were I to try to explain my actual thoughts on the matter in English, I'd quickly get bogged down in the details.

This is hardly a new experience for me.

That said, the hypothesis itself is actually fairly elegant. While it's possible to view mental retardation as a defecit in the ability to learn (i.e. acquire new information, new mental circuitry, and/or new schemata), I suspect that autism may be related to a defecit in the ability to unlearn (i.e. the ability to forget existing information, revamp existing mental circuitry, and/or engage in accomodation for matters in which there are existing cognitive schemata).

On the flip side, this could also be phrased as a statement that autism is simply an overabundance of the ability to retain existing skills and remember things, which would help explain autism's suspected connection to genius.

There is, of course, a great deal more to this theory, but I'm saving it for a potential future research paper.

Thursday, March 12, 2009

Idle Speculation, Part One

Be forewarned: the following is purely idle speculation on my part. Do not take this too seriously -- it's nothing but random thoughts on my part. I may be entirely wrong here.

When I think of the autistic community, certain "big names" come to mind. Most notably, I tend to think of Temple Grandin, Donna Williams, Jim Sinclair, Amanda Baggs, and Michelle Dawson (not in any particular order). Oddly enough, all but one of those names are female... and the sole exception is physically intersex and was raised as a girl.

At the same time, however, about 80% of diagnosed autistics are male.

In other words, we should expect that, all else equal, a list of notable autistics should have four men for every woman. The chance of this arising out of sheer coincidence is around .032% (0.2 to the fifth power), which, in my opinion, is fairly miniscule.

If it's not random chance, though, there has to be a reason. Unfortunately, there is an overabundance of potential causes for this, ranging from biological (e.g. hormonal) differences between the genders to differences in Western childrearing practices for boys and girls.

I suspect that the explanation involves the latter, in combination with differences in social expectations between the genders.

Wednesday, March 11, 2009

More MMR stupidity

And the MMR stupidity continues. Well said, Dr. Goldacre. Well said.

Honestly, if you want a scare, stick with the real dangers. There are certainly enough of them.

Tuesday, March 10, 2009

Functional Analysis

Functional analysis methodology was born out of the understanding that most (if not all - this is debated) behavior has a function. Put another way, people do the things they do for a reason.

Behavior analysts actually realized this back in the 1950s. It wasn't until the '80s, however, that they realized that understanding the function of a behavior could be helpful in treating it.

Yeah. I know.

This was actually a great leap forward for clinical behavior analysis. To illustrate just how much of one, let's take a hypothetical kid. For the sake of argument, we can call him "John". John scores 63 on IQ tests and can't speak. Once upon a time, John stubbed his toe and started crying. Not knowing why his son was crying, John's father reassured him, held him, and generally comforted him through the fit. In time, this became a pattern: every time John cried, his father would come in and comfort him.

John liked being comforted.

It didn't take John long to notice the pattern. Soon enough, he was throwing a fit whenever his father was nearby, trying to entice his father to reassure him.

Eventually, however, his father caught on to what John was doing and stopped responding to his son's crocodile tears. As he became desperate for the attention that he was no longer getting, and not knowing any other way to get it, John intensified his tantrums. During the middle of one of these fits, John bumped his head against a wall. Horrified at the possibility that his son might have hurt himself, John's father ran over and checked him for injuries, generally making a big fuss.

To John, however, this was the attention he'd been so desperately craving!

As such, John quickly learned that banging his head against a nearby object would bring his father running. Eventually, his father, desperate for help, ran to a behavior analyst.

Before functional analysis came along, the behavior analyst would have likely chosen what's called a "punishment approach". Given that this specific behavior falls under the umbrella of what are referred to as "self-injurious behaviors", there's a good chance that the specific approach chosen would've been what's politely termed "contingent electrical stimulation".

In other words, they'd have zapped John with a cattle prod every time he banged his head.

Okay, so it wouldn't always have been a cattle prod. There's actually a pretty extensive, if sadistic, collection of technology for doing this, ranging from SIBIS to the Judge Rotenberg Center's GED series of devices. As a note, JRC seems to have used a good bit of it.

That's not to imply, however, that cattle prods haven't been used. A 1995 study by Mudford, Boundy, & Murray is pretty blatant in illustrating this.

Under a functional analysis approach, however, a behavior analyst would ideally have puzzled out the above scenario and taught John a more appropriate way to seek attention.

And yes, things like that have happened. There are plenty of examples in the literature.

This isn't to say, however, that modern functional analysis methods are perfect. One concern (not, by any means, the only one) is that, as conducted in a clinical environment, they tend to have trouble distinguishing between a behavior's function and any relevant motivating operations.

While the above is fairly heavy on the technical jargon (i.e. "behavior", "function", and "motivating operation" all have specific, technical meanings), the problem is fairly easy to illustrate by example.

As such, let's take a second case - let's call him "Bob". Bob is an autistic boy with normal intelligence but poor communication ability. He is insatiably curious, but has poor communication skills.

Periodically, he sees something interesting. Whenever this happens, he desperately wants to ask his mom what it is... but gets extremely frustrated at his inability to do so. He gets so frustrated, in fact, that he bangs his head against a nearby hard object.

The problem that I mentioned earlier is that most functional analysis methods in clinical use today can't distinguish between John and Bob's cases.

Because of this, many behavior analysts would consider John and Bob to have the same problem. More specifically, they'd consider Bob to have John's behavioral problem... and treat him accordingly.

And yes, contingent electrical stimulation is still used. It's not nearly as common as it used to be, but there are places...


Mudford, O., Boundy, K., & Murray, A. (1995). Therapeutic shock device (TSD): clinical evaluation with self-injurious behaviors. Research in Developmental Disabilities, 16, 253-267.

Sunday, March 8, 2009

The Latest and Greatest

As a grad student, I read a lot. In the process of this, I come across a lot of rather interesting material. Some of it's interesting in a good way. Some of it... not so much.

Take, for instance, the concept of derived stimulus relations. In the 1990s, these were the Great New Discovery that behavior analysts were researching. What are they? Well... my book's explanation involves the following:

... subjects in the Steele and Hayes (1991) experiment learned that A1 was the opposite of B3 and C3 and the same as B1 and C1. Testing showed that the subjects then derived that B3 and C3 were the same, and that each of these were the opposite of B1 and C1. When they later learned that the arbitrary stimulus D1 was opposite to C3 during a test phase, they then treated D1 as the opposite and not the same as B3. (p. 234)

Yes, really. That's a direct quote. Grad school textbooks tend to overcomplicate things.

Now... this research does have its applications. For instance, this work let them make the following observation:

A derived stimulus relation based view of language suggests that the event and the description of the event interact bidirectionally with one another. If so, verbal self-awareness will be painful when what is known is painful. For example, a trauma survivor may avoid thinking and talking about the trauma, because the very process of contacting it verbally will bring some of the stimulus functions of the original experience to bear in the description (Hayes & Gifford, 1997). (p. 235)

In other words, people tend to avoid doing things that are painful and talking about painful events in your past is painful because thinking about them is painful.


Note the date on that citation, too. The book's citing a 1997 paper.

Skinner published The Behavior of Organisms in 1938. Behavior analytic research has been going on ever since... and its history goes back even further.

In other words, it took behavior analysts nearly sixty years to figure that out.

By contrast, Anna Freud published Ego and Mechanisms of Defense in 1936.

Similarly, the "Great New Thing" in the 1980s was what's called "functional analysis". It boils down to an acknowledgement that people do things for a reason, and that knowing the reason why someone does something is helpful in getting them to do something else instead.

I have my issues with functional analysis methodology, but it was a great leap forward. It's hardly enough, but it's a great improvement and a step in the right direction.

Ethically speaking, we need to take into account things which current behavior analytic theory doesn't even acknowledge as existing. Far too many practitioners of the techniques that ABA has developed tend to forget that.


Hayes, S. & Bissett, R. (2000). Behavioral psychotherapy and the rise of clinical behavior analysis. In Ausin, J. & Carr, J. (Eds.), Handbook of applied behavior analysis (pp. 231-245). Reno, NV: Context Press.

Saturday, March 7, 2009

A Look From the Boundaries

This is my first time blogging. I'd considered it before, of course, but never really gotten involved with the whole so-called blogosphere.

Then I started reading Michelle Dawson's blog. Then I found Amanda Baggs's.

Each of them is brilliant in their own way. I don't always agree with their opinions, and I've noticed distinct blind spots in each of their writing.

That, of course, is just another way to say that I probably understand a few things that they don't. It doesn't matter; they understand things that I don't, which is a large part of why I follow their blogs. It's part of the fact that we're different people. Similarly, they can express some things far better than I ever could. It is my hope that I'll someday be able to express certain things better than they can.

We also have different philosophical orientations in certain regards. This, too, is part of being different people. It has no impact on the fact that I hold a deep respect for each of them.

I'm not entirely sure why I finally decided to start this blog.

Well, that's not entirely true. I could name a number of reasons. I'm just not sure which of them finally pushed me over the edge.

That said, I suppose that I should introduce myself. My name is Alexander Cheezem. I'm twenty-six (nearly twenty-seven) years old. I live in Weston, Florida. I graduated from Clemson University on May 11, 2007, majoring in psychology and minoring in East Asian studies. I'm currently attending Nova Southeastern University as part of their BCABA/BCBA certification program and completing a clinical practicum in behavior analysis at the Mailman Segal Institute. I will discuss both of these things at length later on.

I'm also an Aspie.

To use the linguistic forms that the parents' groups like to insist on, this means that I "have Asperger's syndrome".

Most Aspies that I've met, however, dislike that way of expressing it. The same goes for auties (or autistics), people who "have autism".

There's a fairly simple reason for this. Autism - or Asperger's syndrome - is both highly pervasive and highly ego-syntonic.

Simply put, they're labels attached to a part of who you are. You cannot separate the "autism" from the autistic. You cannot separate the "Asperger's" from the Aspie.

Many parents' groups want a cure. Very few Aspies or autistics want to be cured.

This results in a rather substantial conflict, one that becomes readily apparent when reading any number of sources. I've linked to two of them already in this. Simply viewing the comments on any number of Michelle Dawson's blog entries is a pretty good way to get a crash course.

In this blog, I will avoid "person-first" language when referring to Aspies and autistics. The reason for this is simple: it's the form preferred by the Aspies and autistics themselves.

I have, however, gotten rather off-topic, an artefact of the fact that I'm writing this in the middle of the night, when I probably should be sleeping.

I intend for this blog to cover my opinions on a number of issues relating to autism and the so-called "autism spectrum" (which includes Asperger's syndrome). I will probably cover a great deal of what I'm learning about in class, my practicum experiences... and so on and so forth.

The title of this blog comes from the fact that I stand somewhere between two groups, the autistic population (defined here as the group of people who are autistic) and the neurologically typical population (defined here as those people who aren't "on the autism spectrum"). As such, I have occasional insights into each group that members of the other group lack. I also lack understandings of each group that members of that group typically have. Both groups are often strange to me.

On the other hand, I've often been amazed at how little insight into NT behavior NTs themselves have, so it's a toss-up. I may have insight into either group that they themselves lack.