Tuesday, August 31, 2010

The State Fair

My wife and I went to the Minnesota State Fair last Thursday. There were, according to the news, 179,000 people there on opening day.

I hate crowds and noise, but did okay at the fair. One reason is I knew exactly what I wanted to see, where those things were, and where the fair was least crowded. It helps to have a plan.

My priority was the animals. I love the small mammals: rabbits, hares, and other little creatures. I always loved wandering the 4H and FFA displays back in Central California, too. There's something wonderful about animals. Plus, people are busy doing other things at an urban fair, so the livestock areas are a good place to be.

I guess people here care more about the rides and food, but I think fairs should be a celebration of the farm life.

The only problems I had were in the art exhibits. The people smelled bad, which sounds funny after wandering livestock areas. Too many people here smoke. How much do you have to smoke to smell like ashtrays? Apparently smoking and art go together.

I like walking around in the areas away from the Midway and concert stands. The farm equipment, trucks, trailers, and other large things are on display far away from the main buildings -- and away from people. The old tractors, the giant trucks, and the trailers larger than many homes are fascinating. I like machinery.

My wife and I are returning to the fair later today. This time, we're going to spend time looking for great photography opportunities. We believe it should be less crowded since the opening weekend has passed.

She wants to try some of the food, too.

It is hard on her when I can't deal with a place. Nothing is more disappointing than arriving somewhere and not being able to stay. Last year, I wasn't doing well and the fair was difficult. I'm glad this year has been better.

Sunday, August 29, 2010

Anti-Vax Leaders and Epidemiology

Tonight I read yet another post from an anti-vaccine advocate citing epidemiologists who can prove a link between vaccination and autism. Those must not be very ethical epidemiologists. Science is seldom certain of anything. It is rare that a researcher can say X is definitely, undoubtedly, always caused by Y.

Only in public policy debates do we make science seem certain of things. In academic papers, everything is reduced to correlation and likelihoods, seldom are there certainties. Being certain can lead to embarrassment later in most fields.

Epidemiologists are professionally constrained from stating that "X causes Y." They can offer correlation, probability, and other measures of statistical significance, but they are not experts in causation.

In fact, the U.S. Code prohibits the use of epidemiology as the sole or even primary evidence in a case relating to causation. The British and Canadian courts have similar restrictions on epidemiologists.

An epidemiologic study published in a medical or scientific journal, is legally "hearsay." An epidemiologic study that is performed by the government, or funded by and subject to oversight bodies, such as one performed by/for the Centers for Disease Control (CDC), may be admissible based on the hearsay exception for government records contained in Federal Rules of Evidence 803(8)(c).

Epidemiology is, at least legally, only evidentiary in rare instances. Usually, authors of university studies are not permitted to testify as paid experts (COI regulations), and the CDC/NIH have even more restrictive policies.

Quoting from the Federal Judicial Center (fjc.gov):

"A final caveat is that employing the results of group-based studies of risk to make a causal determination for an individual plaintiff is beyond the limits of epidemiology."

Epidemiology is, at best, able to recommend what other fields study and test. That's extremely important, undoubtedly, but epidemiologists are not research scientists — they are statistical experts from fields such as bioinfomatics and empirical sociology.

I doubt the explanation matters, though. I have heard "epidemiologists" working for private groups make claims beyond what the professional organization allows.

The Association for Professionals in Infection Control and Epidemiology is the main body, followed by the American College of Epidemiology. APIC doesn't even include the "E" in their official logo, though — epidemiology is not viewed as existing within the medical field, but as an advisory field.

Epidemiologists have no state boards, no licensing requirement, and are not regulated as medical professionals would be. You can call yourself an "epidemiologist" with any degree specializing in statistical analysis of infection and/or disease.

Seriously, these are the ACE requirements:

Doctoral degree, or doctoral equivalent, as follows: In epidemiology or in any field relevant to epidemiology, with specific formal training in epidemiology of at least one year's duration.

I admire many epidemiologists, including one I worked with as an undergraduate during the start of the AIDS crisis in the 1980s, but I also know the risk of including epidemiological data in a paper. Such data are almost always challenged as "not also considering factors X, Y, and Z." Correlation is not causation. Not in science.

Epidemiology is a guide. It is a needed and important empirical field that helps researchers. At its best, epidemiology can help locate where and how events started. It can also exclude some causes, statistically, but it can never answer with perfect certainty what caused X infection or disease in a population.

Thursday, August 19, 2010

Medical News: Autistic Children Slower to Integrate Multiple Stimuli - in Pediatrics, Autism from MedPage Today

Medical News: Autistic Children Slower to Integrate Multiple Stimuli - in Pediatrics, Autism from MedPage Today

The combined responses of all the children exceeded the sum of the single responses -- an indication of multi-sensory integration. But the autistic children had less pronounced differences, the researchers said, suggesting their integration was less effective.

As well, the multi-sensory integration took place within about 100 to 200 milliseconds of the stimuli in the typical children, the researchers found, but only occurred after about 300 milliseconds in the autistic children.

It was a small pilot study, but once again there seems to be an indication that neurological differences are, eventually, going to be quantifiable in some forms of autism.

Sunday, August 15, 2010

(Not) Back to School

For students and teachers, and a great many families, it is "Back-to-School" month. In many states, school starts in August, while there are a few that still stubbornly cling to a post-Labor Day start. Like most Americans, I view back-to-school as the real start of a new year. For the last six years, I bought new notebooks, pencils, pens, and even crayons for the start of school. Last week, I caught myself wandering the "seasonal" displays at Target and Walmart with a sense of nostalgia.

I am ambivalent.

I'm not exactly sure what it is, but I will miss the school year. And yet, I'll never miss teaching what I was teaching or being a student where I studied.

I did not like my four years as a doctoral student. With the exception of the third year, during which I had no classes and was not yet trying the job market, would have been the only acceptable year -- I was left alone to read and teach. However, I ended up hospitalized with serious medical problems that year. The medical issues with my vision, internal bleeding, et cetera, ruined the one year of peace I might have enjoyed.

There is the constant thought that I should have studied within another discipline, or at least another department. There is the hope that I will be able to craft a career in the creative aspects of media, which I love. My degree is merely evidence that I can work unsupervised. I'm not sure what else it proves.

I know I have a lot I could offer students. What I don't know is when, where, or even what I might teach in the future.

For now, I will write and write and write. I will be my own student and teacher, assisted by hundreds of books, magazines, movies, music, and the Internet.

Maybe I'll use the crayons along the way, after all.

Thursday, August 12, 2010

Socially Constructed Autism

To call autism a social construct is accurate according to the rhetoric / philosophy of science. "Autism" is observational, phenomenological, as long as it is defined in the DSM by traits and not a set of etiologies.

That does not mean "autism" is not real. It means we define it imprecisely and experientially by committees and standards organizations. We have no "one" definition even within research or clinical practices because some insist on the broadest definitions (the "spectrum" of which I am increasingly leery) and others want a return to Leo Kanner's rigid definition that excluded "full quadrant" IQs over 100.

If I assign the name "red" to a 650 nm wave, it is measurable and quantifiable. We can argue over the name chosen, but the wave itself is what it is.

Autism is not like "red" because we don't have measurements that are precise. We have DSM-III, IV, and V definitions that conflict. We have Wang debating Cohen debating Attwood over what should or shouldn't be Asperger's Syndrome (or is it "Disorder").

It's a label. It's nothing more than a checklist created by people to define what they themselves admit cannot be located and proved even within their profession. Clinicians argue with researchers constantly over "autism" because researchers are very rigid with the definition; many don't even accept the DSM-IV-TR vs. the DSM-IV because that alters the subject population for researchers.

The only label I reject that has been assigned to me is "mentally retarded." That was the ignorance of the 1960s/70s. But, the other labels represented the best of their time and the evolving DSM. If the DSM weren't socially constructed, my label wouldn't have changed every X years.

Tuesday, August 10, 2010

Birth Trauma and Autistic Traits

A study reported today concludes that birth trauma resulting in neonatal intensive care increases the likelihood a child will develop autistic traits.The article appears on several websites. Here is the link to USA Today:

http://www.usatoday.com/news/health/2010-08-09-autism-babies_N.htm

The assertion that autism can be predicted in some cases within the first month of life indicates that at least some cases are not caused by post-birth exposure to toxins. No one has been immunized at a month, and I seriously doubt most month-old children have been chewing toxic toys. (We should ask what common experiences the parents, especially mothers, have.)

Signs of autism may show up in babies as young as 1 month old, a new study shows.
But the tip-offs are not the usual red flags, such as a lack of eye contact or smiling, the researchers noted.

Instead, they found babies who needed neonatal intensive care and were later diagnosed with an autism spectrum disorder were more likely to have abnormal muscle tone and differences in their visual processing than babies who went on to develop normally after time in the neonatal intensive care unit (NICU).

The ICU link is interesting to me because my arrival was complex. I was, in fact, in NICU due to a number of complications. If there is a link between birth complications and autistic traits, I would be an exemplar.

At 1 month, infants later diagnosed with autism were more likely to show "persistent neurobehavioral abnormalities" after hospital discharge than other babies. About 40% of babies later diagnosed with autism showed abnormalities in the way they visual tracked objects compared to about 10.5% of babies who did not get an autism diagnosis.

The doctors assumed I was likely mentally retarded, the label of the time. I was not reactive in the expected way. Again, it is a fascinating correlation. Reading the following leaves me even more impressed by the research:

More than half of babies later diagnosed with autism had abnormal arm tone — either too floppy or too rigid — compared to 22% of babies that developed normally.

I have atrophied muscle development of the right arm. My brachial-plexus muscle group is weak, as well. My back muscles, despite various exercises, remain slack, aggravated by scoliosis. Without more detail, it is sufficient to state that I definitely parallel the research population.

Intervention by age 2 offers the best outcome, the authors wrote.

As I have said and written many times, my mother was constantly engaged in physical therapy and intellectual stimulation during my early childhood. I have no doubt that her efforts helped me adapt to the world and achieve whatever I have accomplished.

Tuesday, August 3, 2010

Employment and Identity

I have been on the academic job market since last summer. In a few cases, I managed to be a finalist for posts, but the reality is that the economy forced state and private universities to freeze hiring or even cut positions. However, since I completed my doctorate in May it is not as if I am a "stale" candidate, thankfully. I made the wise decision to search early and learn what universities need.

My ability to continue freelance writing is also a good thing, meaning I remain active intellectually instead of focusing only on the job market. I cannot imagine doing nothing but pursuing work -- it would definitely leave me more dispirited. Writing fiction is also a great outlet and holds some promise.

I am writing about employment and autism, a project I will post to The Autistic Place as the research and writing progress.

Work matters. I describe myself as a writer and teacher. These labels, for a variety of reasons, are my identity. If I were a parent, I'd probably list that as my most important role in life, but the vocational interests would remain important to how I view myself.

Not having a teaching job at the moment does affect me. I enjoy teaching about writing, design, programming, and more. I like to learn and teaching is a great way to learn. I view writing, even my fictional works, as a way of teaching others.

Some people with ASDs have told me they answer "What do you do?" in unexpected ways. One person with autism, who has a job, said the answer is "Play with my dog." I like that answer, since I love my cats, but I can see why that would confuse an employer. For a lot of people, that answer seems to downplay vocational identity. How important is this person's job to him or her? An employer might not be able to tell.

Work is important, even what one does is "volunteer work." We do identify and understand people by their daily roles. I'm wondering how my answers during interviews represent me to employers. Memorized answers do not work for me, though I have tried to calculate the "correct" answers to demonstrate who I am.

At least I know I'm far from alone on the job market.