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  • May 7, 2015
  • 04:44 AM
  • 144 views

Parent training vs parent education for disruptive behaviour in autism

by Paul Whiteley in Questioning Answers

I have to say that historically I've never been a great fan of the words 'parent training' when applied to the autism spectrum disorders (ASDs). For me, the idea that parents of children with autism need 'training' to parent their child with autism always seemed a little condescending with overtones harking back to the bad old days of 'blame the mother' [1].My attitude to the idea of parent training has however softened in recent years on the back of some peer-reviewed evidence suggesting that little things like praise for example, can potentially make a difference for some on the spectrum (see here). A shocker, I know. The idea also that early parent-led intervention might, after a slightly shaky start, show some benefits to those at-risk of autism (see here) has also played a role in changing perceptions, albeit with caveats including my not being misconstrued as suggesting that parents of children with autism don't praise their children enough.I was therefore interested to read the paper published by Karen Bearss and colleagues [1] looking at parent training versus parent education when it comes to tackling disruptive behaviours associated with autism. Disruptive behaviours casts a wide net when it comes to potential definition (I assume overlapping with some of those 'challenging behaviours' that seem to be mentioned from time-to-time in the autism research literature) but for the purposes of the Bearss study, the outcome measures give us a flavour of what was being examined: "the Aberrant Behavior Checklist–Irritability subscale (range, 0-45) and the Home Situations Questionnaire–Autism Spectrum Disorder (range, 0-9)."Using a randomised-controlled study design, where 89 parents of children with autism received parent training that "provided specific strategies to manage disruptive behavior" and 91 parents received parent education sessions that "provided information about autism but no behavior management strategies", researchers followed families for 24 weeks. Comparisons between baseline scores and endpoint (24 week) scores indicated some potentially interesting results based on those schedules previously described alongside a blinded clinician who "rated the Improvement scale of the Clinical Global Impression [CGI] (range, 1-7)."As per another write-up of the Bearss study (see here): "All the children showed improvements." There were however some potential differences between the parent education vs. parent training groups suggestive that parent training might trump just education. With analysis based on the the groups as a whole: "the Aberrant Behavior Checklist–Irritability subscale declined 47.7% in parent training... compared with 31.8% for parent education. The Home Situations Questionnaire–Autism Spectrum Disorder declined 55%... compared with 34.2% in parent education." Further, those 'objective' clinician reports based on the CGI also showed some potentially important differences: "The proportions with a positive response on the Clinical Global Impression–Improvement scale were 68.5% for parent training vs 39.6% for parent education." A statistically significant difference.Ergo, parent education alone could be useful but add in some parent training and things might ramp up quite a bit in terms of tackling disruptive behaviours in cases of autism as per other findings [3]. In case you'd like a few more details about the parent training program used by Bearss et al, I might refer you to another publication [4] (open-access) on this topic.There are quite a few implications for the Bearss results. Not least is the idea that 'educating' parents about autism might not be enough in terms of giving them the tools to cope with and tackle disruptive behaviour as and when it occurs. Providing direction and those all-important strategies to manage disruptive behaviour is important and may very well reflect on a child's behaviour and development bearing in mind that there may be lots of reasons for disruptive behaviour, not all just behavioural in nature.But such additional parent training does have cost and resource implications. The parent training method employed by Bearss et al covered "11 core, 2 optional sessions; 2 telephone boosters; 2 home visits" in 24 weeks. Multiply all that by the increasing number of children receiving a diagnosis of autism and well, one can imagine what that might mean in these times of continued austerity. By saying all that, I'm not opposing such intervention, merely pointing out a stark reality to quite a bit of autism research: results may show improvement in behaviour and a better quality of life but is it a practical and affordable intervention? [5]To further prove to you that I'm not trying to poo-poo the idea of parent training, there are potential solutions on the horizon that may help the real-life delivery of such programmes. Take for example the increasing focus on telemedicine and the results from Vismara and colleagues [6] for example, on the use of "a video conferencing and self-guided website to provide parent training in the homes of children with ASD." I don't think telemedicine has quite reached the heady heights of mainstream healthcare provision, but there are quite a few moves in the peer-reviewed domain towards such remote delivery of healthcare with autism in mind [7].And whilst I have your attention, I might also refer you to the paper by Wendy Machalicek and colleagues [8] (open-access) covering parent training where intellectual disability in diagnosed, and issues and features perhaps overlapping into autism...Music: The Fall and Hit the North.----------[1] Waltz MM. Mothers and Autism: The Evolution of a Discourse of Blame. AMA J Ethics. 2015 Apr 1;17(4):353-358.[2] Bearss K. et al. Effect of Parent Training vs Parent Education on Behavioral Problems in Children With Autism Spectrum Disorder. JAMA. 2015; 313: 1524-1533.[3] Kaat AJ. & Lecavalier L. Disruptive behavior disorders in children and adolescents with autism spectrum disorders: A review of the prevalence, presentation, and treatment. Research in Autism Spectrum Disorders. 2013; 7: 1579-1594.[4] Bearss K. et al. Toward an exportable parent training program for disruptive behaviors in autism spectrum disorders. Neuropsychiatry (London). 2013 Apr; 3(2): 169–180.[5] Penner M. et al. Cost-Effectiveness Analysis Comparing Pre-diagnosis Autism Spectrum Disorder (ASD)-Targeted Intervention with Ontario's Autism Intervention Program. J Autism Dev Disord. 2015 May 5.[6] Vismara LA. et al. Preliminary findings of a telehealth approach to parent training in autism. J Autism Dev Disord. 2013 Dec;43(12):2953-69.[7] Hepburn SL. et al. Telehealth delivery of cognitive-behavioral intervention to youth with autism spectrum disorder and anxiety: A pilot study. Autism. 2015 Apr 20. pii: 1362361315575164.[8] Machalicek W. et al. Training Parents of Children with Intellectual Disabilities: Trends, Issues, and Future Directions. Current Developmental Disorders Reports. 2015. April 9.----------... Read more »

  • May 6, 2015
  • 03:26 PM
  • 135 views

Researchers find new clues in treating chronic pain

by Dr. Jekyll in Lunatic Laboratories

A chemical in the brain typically associated with cognition, movement and reward-motivation behavior — among others — may also play a role in promoting chronic pain, according to new research. The chemical, dopamine, sets the stage for many important brain functions, but the mechanisms that cause it to contribute to chronic pain are less well understood.... Read more »

Kim, J., Tillu, D., Quinn, T., Mejia, G., Shy, A., Asiedu, M., Murad, E., Schumann, A., Totsch, S., Sorge, R.... (2015) Spinal Dopaminergic Projections Control the Transition to Pathological Pain Plasticity via a D1/D5-Mediated Mechanism. Journal of Neuroscience, 35(16), 6307-6317. DOI: 10.1523/JNEUROSCI.3481-14.2015  

  • May 6, 2015
  • 09:42 AM
  • 120 views

Video Tip of the Week: Human Phenotype Ontology, HPO

by Mary in OpenHelix

Typically, our Tips-of-the-Week cover a specific software tool or feature that we think readers would maybe like to try out. But this week’s tip is a bit different. It’s got a conceptual piece that is important, as well as referencing several software tools that work with this crucial concept to enable interoperability of many tools, […]... Read more »

Deans Andrew R., Eva Huala, Salvatore S. Anzaldo, Michael Ashburner, James P. Balhoff, David C. Blackburn, Judith A. Blake, J. Gordon Burleigh, Bruno Chanet, & Laurel D. Cooper. (2015) Finding Our Way through Phenotypes. PLoS Biology, 13(1). DOI: http://dx.doi.org/10.1371/journal.pbio.1002033  

Kohler, S., Doelken, S., Mungall, C., Bauer, S., Firth, H., Bailleul-Forestier, I., Black, G., Brown, D., Brudno, M., Campbell, J.... (2013) The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research, 42(D1). DOI: 10.1093/nar/gkt1026  

Köhler, S., Schulz, M., Krawitz, P., Bauer, S., Dölken, S., Ott, C., Mundlos, C., Horn, D., Mundlos, S., & Robinson, P. (2009) Clinical Diagnostics in Human Genetics with Semantic Similarity Searches in Ontologies. The American Journal of Human Genetics, 85(4), 457-464. DOI: 10.1016/j.ajhg.2009.09.003  

Zemojtel, T., Kohler, S., Mackenroth, L., Jager, M., Hecht, J., Krawitz, P., Graul-Neumann, L., Doelken, S., Ehmke, N., Spielmann, M.... (2014) Effective diagnosis of genetic disease by computational phenotype analysis of the disease-associated genome. Science Translational Medicine, 6(252), 252-252. DOI: 10.1126/scitranslmed.3009262  

Girdea, M., Dumitriu, S., Fiume, M., Bowdin, S., Boycott, K., Chénier, S., Chitayat, D., Faghfoury, H., Meyn, M., Ray, P.... (2013) PhenoTips: Patient Phenotyping Software for Clinical and Research Use. Human Mutation, 34(8), 1057-1065. DOI: 10.1002/humu.22347  

  • May 6, 2015
  • 08:00 AM
  • 122 views

Plants Aren’t Just Male Or Female

by Mark Lasbury in As Many Exceptions As Rules

It’s hard enough to believe that flowering plants have different sexes, but how about plants that have three sexes? One trioecious plant varies it sex ratio depending on how much water is around, while another only shows three sexes when it lives near a particular bat. But most amazing, man made the papaya into a three-sex plant. Your tropical fruit salad is made with a hermaphrodite.... Read more »

VanBuren R, Zeng F, Chen C, Zhang J, Wai CM, Han J, Aryal R, Gschwend AR, Wang J, Na JK.... (2015) Origin and domestication of papaya Yh chromosome. Genome research, 25(4), 524-33. PMID: 25762551  

  • May 6, 2015
  • 04:40 AM
  • 117 views

Features of dyspraxia in childhood epilepsy

by Paul Whiteley in Questioning Answers

Developmental coordination disorder (DCD) or dyspraxia is a condition affecting 'planning of movements and coordination'. No-one really knows exactly how and why DCD comes about but various risk factors are associated with the condition (see here) including the possibility of acquired problems through head injury or a stroke for example.I was recently interested to read the paper published by Colin Reilly and colleagues [1] and their findings that: "Parent-reported symptoms of DCD are very common in childhood epilepsy." This follows other work from this group looking at various other potential comorbidities accompanying epilepsy including autism [2] (covered in a previous post), attention deficit hyperactivity disorder (ADHD) [3] and pathological demand avoidance (PDA) [4] or Newson's syndrome as I believe it should be called (see here).It's probably no coincidence that included in the authorship of the various papers by Reilly et al describing epilepsy plus (+) we find the name Gillberg, as in Christopher Gillberg. This is one and the same person who has, alongside other researchers, brought the concept of ESSENCE - early symptomatic syndromes eliciting neurodevelopmental clinical examinations - to autism research (see here) and the idea of autism plus [2]. It looks to me that they are working on similar principles when it comes to epilepsy too.Insofar as their recent study results, Reilly et al base their findings on a parent report questionnaire - the DCD Questionnaire (DCD-Q). They further noted: "Significant predictors of higher scores on the DCD-Q included the presence of autism spectrum disorder, CP [cerebral palsy], and early seizure onset" indicating how complicated the clinical picture might be when it comes to the presentation of dyspraxia in cases of epilepsy. Their relatively small participant number (n=85) means that further replication of their results is warranted.There's little more for me to say about this topic over and above what has already been mentioned. Using the label of autism as an example, more and more the research base is suggesting that behavioural / psychiatric / neurological issues rarely appear on their own and should perhaps reflect a move away from just talking about comorbidity towards the labelling of lots and lots of different individual conditions variably manifesting symptoms crossing multiple labels. Yes, this is a daunting prospective given the potential number of permutations (ordered combinations) potentially present, but at least then there is the possibility of focusing on the important factors linked to the presence of such symptoms in individuals or smaller cohorts...Music: Pixies - Monkey Gone To Heaven.----------[1] Reilly C. et al. Features of developmental coordination disorder in active childhood epilepsy: a population-based study. Dev Med Child Neurol. 2015 Apr 16.[2] Gillberg C. & Fernell E. Autism plus versus autism pure. J Autism Dev Disord. 2014 Dec;44(12):3274-6.----------Reilly C, Atkinson P, Das KB, Chin RF, Aylett SE, Burch V, Gillberg C, Scott RC, & Neville BG (2015). Features of developmental coordination disorder in active childhood epilepsy: a population-based study. Developmental medicine and child neurology PMID: 25882788... Read more »

Reilly C, Atkinson P, Das KB, Chin RF, Aylett SE, Burch V, Gillberg C, Scott RC, & Neville BG. (2015) Features of developmental coordination disorder in active childhood epilepsy: a population-based study. Developmental medicine and child neurology. PMID: 25882788  

  • May 5, 2015
  • 02:36 PM
  • 146 views

Mind reading: Researchers observe moment a mind is changed

by Dr. Jekyll in Lunatic Laboratories

Researchers studying how the brain makes decisions have, for the first time, recorded the moment-by-moment fluctuations in brain signals that occur when a monkey making free choices has a change of mind. The findings result from experiments led by electrical engineering Professor Krishna Shenoy, whose Stanford lab focuses on movement control and neural prostheses – such as artificial arms – controlled by the user’s brain.... Read more »

  • May 5, 2015
  • 12:38 PM
  • 134 views

3 Reasons Octopus Locomotion Is the Weirdest

by Elizabeth Preston in Inkfish



Of course there's nothing ordinary about an octopus. It's the animal that showed us spinelessness doesn't have to mean a lack of smarts. But when researchers brought some octopuses into the lab to study exactly how the animals move, their findings were bizarre—both predictably and unpredictably.

Scientists at the Hebrew University of Jerusalem studied nine common octopuses (Octopus vulgaris) that fishers had scooped out of the ocean for them. Once the animals got comfortable in the lab, t... Read more »

  • May 5, 2015
  • 08:55 AM
  • 122 views

Journal Club: Birdfeeding favours non-native bird species

by GrrlScientist in Maniraptora

SUMMARY: Feeding wild birds on bread and seed encourages high densities of introduced bird species at the expense of native species, thereby altering urban bird communities, according to a new study... Read more »

  • May 5, 2015
  • 08:44 AM
  • 131 views

Journal Club: Birdfeeding favours non-native bird species

by GrrlScientist in The Invisible Scientist

SUMMARY: Feeding wild birds on bread and seed encourages high densities of introduced bird species at the expense of native species, thereby altering urban bird communities, according to a new study... Read more »

  • May 5, 2015
  • 04:25 AM
  • 151 views

Childhood cat ownership and risk of later life schizophrenia?

by Paul Whiteley in Questioning Answers

'I' before the 'E' except after 'C'."Is childhood cat ownership a risk factor for schizophrenia later in life?"That was the rather peculiar question posed and partially answered in the paper by Fuller Torrey and colleagues [1]. They concluded that "cat ownership in childhood is significantly more common in families in which the child later becomes seriously mentally ill."For those new to this topic, it might sound rather strange that cat ownership in childhood might elevate the risk of mental illness. But just before you smirk and click away, please read on a little further.Previous research had hinted that cat ownership during childhood might be one of a number of factors linked to the presentation of psychosis [2] based on findings from some of the authorship group as part of their feline zoonosis theory of schizophrenia [3]. Zoonotic diseases, by the way, are diseases that can be transmitted from animals to people. The idea intersecting with a growing evidence base specifically suggesting that Toxoplasma gondii, a protozoan that finds a home in some cats and is shed in cat poo(p), might be linked to quite a few cases of schizophrenia (see here) following the potential crossing of the gondii from cats to humans.I've covered the possibility of a link between T. gondii and cases of schizophrenia quite a few times on this blog (see here and see here for example). I have to say that the evidence is getting pretty strong for the possibility of a link between T. gondii exposure and risk of [some] schizophrenia with the requirement for quite a bit more investigation into the possible mechanisms involved. The idea that T. gondii, once it has found a home in someone, might be able so extremely affect a person's behaviour is also not as outlandish as it may first sound. 'Rats attracted to cats' was a post a few years back (see here) demonstrating the potential of T. gondii to affect animal behaviour and drive rats to become sexually attracted to cat urine followed by an almost certain death to the rat but continued survival for the parasite. Human are slightly more complicated creatures than rats but the idea of T. gondii leading to/causative of other behaviours has been entertained in the research literature [4].Before anyone gets any ideas that I'm somehow 'anti-cat' based on this and other posts, I'm not. Whilst myself allergic to cats, I'm as sold on the cuteness of the Lego movie 'believe' poster as the next person. What however this line of scientific investigation does suggest is that one should always be a little bit cautious about the potential risks specifically associated with cat ownership. How, as well as being relevant to pregnant women, young family members should know about the potential issues of T. gondii when it comes to keeping a cat and in particular, keeping clear of places they poo(p). Some common sense guidance has been recently published with this in mind (see here).Music: Arctic Monkeys - Mardy Bum (spoken in my best Sheffield accent).----------[1]  Fuller Torrey E. et al. Is childhood cat ownership a risk factor for schizophrenia later in life? Schizophrenia Research. 2015. 18 April.[2] Fuller Torrey E. et al. The antecedents of psychoses: a case-control study of selected risk factors. Schizophr Res. 2000 Nov 30;46(1):17-23.[3] Fuller Torrey E. & Yolken RH. Could schizophrenia be a viral zoonosis transmitted from house cats? Schizophr Bull. 1995;21(2):167-71.[4] Ling VJ. et al. Toxoplasma gondii Seropositivity and Suicide rates in Women. The Journal of nervous and mental disease. 2011;199(7):440-444.-----------Fuller Torrey, E., Simmons, W., & Yolken, R. (2015). Is childhood cat ownership a risk factor for schizophrenia later in life? Schizophrenia Research DOI: 10.1016/j.schres.2015.03.036... Read more »

  • May 4, 2015
  • 04:59 AM
  • 146 views

Responding to parental concerns about possible offspring autism

by Paul Whiteley in Questioning Answers

"In conclusion, despite early parental concerns, children with ASD [autism spectrum disorder] receive less proactive provider responses to these concerns than children with ID/DD [intellectual disability/developmental delay]. Less proactive/more passive provider responses are associated with delays in diagnosing ASD."So said the paper from Katharine Zuckerman and colleagues [1] (open-access) who using "nationally representative data from the 2011 Survey of Pathways to Diagnosis and Treatment" tried to answer the following questions: "(1) Did child age at first parental concern and first parental conversation with provider differ among children eventually diagnosed with ASD compared with those diagnosed with DD or ID?; (2) Did provider response to concerns differ among these conditions?; and (3) Among children with ASD, was a more proactive/less reassuring provider response to parental concerns associated with earlier ASD diagnosis?"What they found has been reported by various media (see here for example) and indicated that when it comes to early parental concerns about the behaviour and development of their offspring: "compared with parents of children with ID/DD, parents of children with ASD reported concerns earlier and had earlier provider conversations about these concerns, but were more likely than to receive reassuring/passive provider responses to those concerns." Indeed, the authors implied that healthcare provider behaviour might be an important factor in 'delayed autism identification'.As it is in many areas of autism research, we've been here before. In a previous post titled ''You know what boys are like' and the autism pre-diagnostic experience' (see here) I discussed the paper by Sara Ryan & Helen Salisbury [2] (open-access). How for example, the UK experience of autism diagnosis might not be so different from the US experiences talked about by Zuckerman et al specifically with the idea that for some parents, premature reassurance by health professionals about their concerns about their child's behaviour/development may not sit too well with parents and may result in delays in assessment/diagnosis for the child. By saying this, I'm not trying to tarnish medical reputations. Children do not uniformly develop in the same way with lots of stopping and starting in skills learned in the early years which does not necessarily mean 'autism' or any other label. But Zuckerman et al are right to highlight this issue.From the collected peer-reviewed evidence currently available, we know that there are many variables potentially affecting age of diagnosis when it comes to autism (see here). We also know that autism assessment/diagnosis is one part science and one part of art in terms of the skills of those charged with such tasks and the path does not always run as smoothly as we would wish (see here). Late, delayed or mis-diagnosis however, can be a source of significant stress to both families and children/adults alike (see here) particularly when parental views and opinions have been shown to be pretty accurate when it comes to the appearance of something like autism (see here). I might also direct you to the paper by Sacrey and colleagues at this point [3].The best way forward? Accepting that resources are being stretched for many different reasons and that assessments cost both in terms of finance and human resources, perhaps give parents/significant others the benefit of the doubt when they say they think there might be 'issues' for someone. Dedicate greater resources towards how screening and assessment could be done more cost-effectively and reliably in the digital age (remember that YouTube work?) and focus on how early diagnosis might offer so much to a person (see here). Oh, and consider that "screening for ASD may need to be repeated multiple times in the first years of life" [4].As is customary on this day: May the 4th be with you...----------[1] Zuckerman KE. et al. Parental Concerns, Provider Response, and Timeliness of Autism Spectrum Disorder Diagnosis. The Journal of Pediatrics. 2015. 14 April.[2] Ryan S. & Salisbury H. 'You know what boys are like': pre-diagnosis experiences of parents of children with autism spectrum conditions. Br J Gen Pract. 2012 May;62(598):e378-83.[3] Sacrey L-A R. et al. Can Parents’ Concerns Predict Autism Spectrum Disorder? A Prospective Study of High-Risk Siblings From 6 to 36 Months of Age. JAACAP. 2015. March 27.[4] Ozonoff S. et al. Diagnostic stability in young children at risk for autism spectrum disorder: a baby siblings research consortium study. J Child Psychol Psychiatry. 2015 Apr 29.----------Katharine Elizabeth Zuckerman, Olivia Jasmine Lindly, & Brianna Kathleen Sinche (2015). Parental Concerns, Provider Response, and Timeliness of Autism Spectrum Disorder Diagnosis The Journal of Pediatrics : 10.1016/j.jpeds.2015.03.007... Read more »

Katharine Elizabeth Zuckerman, Olivia Jasmine Lindly, & Brianna Kathleen Sinche. (2015) Parental Concerns, Provider Response, and Timeliness of Autism Spectrum Disorder Diagnosis. The Journal of Pediatrics. info:/10.1016/j.jpeds.2015.03.007

  • May 3, 2015
  • 11:08 PM
  • 104 views

Recent Advances: Phage Therapy for Antibiotic Resistant Staph Infections

by Geoffrey Hannigan in Prophage

Most of us have experienced, know someone who experienced, or have at least heard of Staph infections. As their name implies, these infections are caused by Staph (short for the bacterial genus Staphylococcus), occur on the skin, are often acquired in hospitals...... Read more »

  • May 2, 2015
  • 03:48 PM
  • 166 views

Walking an extra two minutes each hour may offset hazards of sitting too long

by Dr. Jekyll in Lunatic Laboratories

Eat less, workout more, these are the messages we are being sent almost on a daily basis. But how do we quantify “more” and who really should listen to that advice? Well a new study suggests that engaging in low intensity activities such as standing may not be enough to offset the health hazards of sitting for long periods of time. On the bright side, adding two minutes of walking each hour to your routine just might do the trick.... Read more »

  • May 2, 2015
  • 02:01 PM
  • 138 views

Spontaneous Events Drive Brain Functional Connectivity?

by Neuroskeptic in Neuroskeptic_Discover

A new study claims that Functional Connectivity in MRI Is Driven by Spontaneous BOLD Events

The researchers, Thomas Allan and colleagues from the University of Nottingham (one of the birthplaces of MRI), say that their results challenge the assumption that correlations in neural activity between 'networks' of brain regions reflect slow, steady low frequency oscillations within those networks. Instead, they report that the network connectivity is the result of occasional 'spikes' of coordinate... Read more »

Allan TW, Francis ST, Caballero-Gaudes C, Morris PG, Liddle EB, Liddle PF, Brookes MJ, & Gowland PA. (2015) Functional Connectivity in MRI Is Driven by Spontaneous BOLD Events. PloS one, 10(4). PMID: 25922945  

  • May 2, 2015
  • 05:55 AM
  • 111 views

Humans Navigate Naturally With Built-In GPS

by RAZ Rebecca A. Zarate in United Academics

Humans have a built-in neural map, and it’s shaped like a honeycomb.
... Read more »

Langston RF, Ainge JA, Couey JJ, Canto CB, Bjerknes TL, Witter MP, Moser EI, & Moser MB. (2010) Development of the spatial representation system in the rat. Science (New York, N.Y.), 328(5985), 1576-80. PMID: 20558721  

Solstad T, Boccara CN, Kropff E, Moser MB, & Moser EI. (2008) Representation of geometric borders in the entorhinal cortex. Science (New York, N.Y.), 322(5909), 1865-8. PMID: 19095945  

Tolman, E. (1948) Cognitive maps in rats and men. Psychological Review, 55(4), 189-208. DOI: 10.1037/h0061626  

  • May 2, 2015
  • 04:03 AM
  • 132 views

Healthcare experiences and autism

by Paul Whiteley in Questioning Answers

In today's brief post I want to highlight the important findings reported by Christina Nicolaidis and colleagues [1] who suggested that quite a bit more could be done to improve the success of "healthcare interactions" when it comes to the autism spectrum.Based on the experiences of 39 adults with autism and "16 people who had experience supporting autistic adults in healthcare settings" researchers came up with a few "patient- and provider-level factors" that might impact on said healthcare interactions and thus the quality of service received by this group. Quite small changes such as improving healthcare provider's knowledge of autism - specifically adult autism - including a realisation that factors such as "verbal communication skills, sensory sensitivities, [and] challenges with body awareness" might impact on the quality of healthcare received are detailed. The idea that 'if you've met one person with autism, you've met one person with autism' might also be a useful phrase for healthcare providers to keep in mind given the significant heterogeneity and heightened risk of comorbidity normally attached to the 'autisms' (plural) label.I've always been rather interested in the disparities in healthcare quality and provision attached to behavioural and/or psychiatric labels derived from books such as ICD and DSM. Having previously covered some of the extremes of "catastrophic illnesses [that] were misdiagnosed due, at least partially, to their autism" (see here) on this blog, I have a flavour for just how bad things can get when healthcare provider knowledge of autism is poor and phrases like 'it's just part of their autism' are used willy-nilly."Further efforts are needed to empower patients, adequately train providers, increase the accessibility of the healthcare system, and decrease discrimination." I don't think many people would disagree with the conclusions from Nicolaidis et al although the precise ways and means that such changes can be practically made still requires some flesh on the bones. As per another article from this research group [2] "the recognition of associated conditions" potentially comorbid to a diagnosis on the autism spectrum might also help healthcare providers plan for what they might expect, bearing in mind the considerable number of conditions/labels that might follow such a diagnosis (see here) and the idea that a label of autism is seemingly protective of nothing in healthcare and other terms [3]. But let's start with the simple things...Music: The White Stripes - Fell In Love With A Girl (video pre-Lego movie). And assuming you are 'falling in love with a girl [or boy]' you might want to see how she/he might see you with the new Microsoft 'How old do I look' tool. After analysing a few mugshots of mine I'm not afraid to say that I might be visiting Boots the Chemists quite soon...----------[1] Nicolaidis C. et al. “Respect the way I need to communicate with you”: Healthcare experiences of adults on the autism spectrum. Autism. 2015. 16 April.[2] Nicolaidis C. et al. Primary care for adults on the autism spectrum. Med Clin North Am. 2014 Sep;98(5):1169-91.[3] Croen LA. et al. The health status of adults on the autism spectrum. Autism. 2015 Apr 24. pii: 1362361315577517.----------Nicolaidis, C., Raymaker, D., Ashkenazy, E., McDonald, K., Dern, S., Baggs, A., Kapp, S., Weiner, M., & Boisclair, W. (2015). "Respect the way I need to communicate with you": Healthcare experiences of adults on the autism spectrum Autism DOI: 10.1177/1362361315576221... Read more »

  • May 1, 2015
  • 03:05 PM
  • 135 views

US clinics avoiding government oversight of ‘stem cell’ treatments

by Dr. Jekyll in Lunatic Laboratories

Clinics across the United States are advertising stem cell treatments that attempt to take advantage of what they perceive as exceptions in FDA regulations.The therapies in question are adipose-derived autologous stem cell treatments, in which fat cells are removed from a patient, broken down to separate components that purportedly contain stem cells, and are then reinjected into the same patient.... Read more »

  • May 1, 2015
  • 10:56 AM
  • 164 views

Lizards in Long-Term Relationships Can Skip the Foreplay

by Elizabeth Preston in Inkfish



Why would two stubby-legged, blue-tongued Australian reptiles want to stay together not just for a mating season, but for decades? A 31-year study of the reptiles has suggested an answer. While newly formed couples are still getting to know each other, lizards in long-term relationships can start mating earlier in the season. And dispensing with the foreplay might give them a reproductive advantage over their casually dating neighbors.

Tiliqua rugosa is a species of blue-tongued skink tha... Read more »

  • May 1, 2015
  • 05:00 AM
  • 171 views

Severe mental illness and victims of crime

by Paul Whiteley in Questioning Answers

"In conclusion, victimisation among people with SMI [severe mental illness] is more prevalent and associated with greater psychosocial morbidity than victimisation among the general population."That was the finding reported by Hind Khalifeh and colleagues [1] (open-access here) following their analysis of "the prevalence and impact of crime among people with SMI compared with the general population." SMI, by the way, covered various labels including: "people with psychotic disorders (such as schizophrenia or bipolar disorder), as well as those with other diagnoses (for example depression or personality disorder) of a severity requiring intensive service contact."Eventually examining the experiences of nearly 350 community-dwelling adults diagnosed with a SMI "under the care of community mental health teams" compared with data from over 2000 asymptomatic controls - "participants in the 2011/2012 CSEW [Crime Survey for England and Wales]" - researchers interviewed participants about their experiences of crime in the past year. Various definitions of 'crime' were used covering 'personal crime' (assaults, personal acquisitive crimes such as theft) and 'household crime' including burglary.Quite a few results were reported in line with the finding that: "40% of the [SMI] patient group compared with 14% of the control group were victims of a crime in the preceding year." Accepting that: "People with SMI had greater levels of social deprivation than the comparison group", the experience of personal crime such as being the victim of an assault was significantly more frequently reported for the SMI group than controls for example. Worryingly: "Women with SMI were at particularly high risk of violence, both community and domestic" even when "sociodemographics, substance misuse and violence perpetration" variables were taken into account. Researchers also reported that being a victim of crime also lead to some pretty significant "adverse psychological effects (depression, anxiety or panic attacks)" for the SMI group when compared to controls.Such findings do not make for great reading but are consistent with other research in this area. This research group have for example, previously published other work focussing on the experiences of violence against people with disability [2] and how having a 'mental illness' seemed to particularly elevate the risk of being a victim of crime. Once again, crime had its after-effects: "Disabled victims were more likely to suffer mental ill health as a result of violence than non-disabled victims." The gender gap has also previously been highlighted in work from this group too [3].Accepting the often difficult relationship between mental illness and crime, particularly when it comes to the issue of violent crime [4] complicated by factors such as substance abuse (as per yet more and more results), the Khalifeh and other data suggest that strategies to support those diagnosed with a SMI potentially at higher risk of being a victim of crime might be something to consider. Set against a backdrop of the most saddest of events where mental health issues are once again thrust into the media spotlight, the sweeping generalisations made about severe mental illness and the concept of 'dangerousness' might perhaps also entertain the notion that various psychiatric diagnoses may themselves also put someone at a very real risk of becoming a victim of crime. Sometimes with the most serious of outcomes [5].----------[1] Khalifeh H. et al. Violent and non-violent crime against adults with severe mental illness. British Journal of Psychiatry. 2015. April 1.[2] Khalifeh H. et al. Violence against people with disability in England and Wales: findings from a national cross-sectional survey. PLoS One. 2013;8(2):e55952.[3] Khalifeh H. & Dean K. Gender and violence against people with severe mental illness. Int Rev Psychiatry. 2010;22(5):535-46.[4] Fleischman A. et al. Schizophrenia and violent crime: a population-based study. Psychol Med. 2014 Oct;44(14):3051-7.[5] Rodway C. et al. Patients with mental illness as victims of homicide: a national consecutive case series. Lancet Psychiatry. 2014; 1: 129-134.----------Khalifeh H, Johnson S, Howard LM, Borschmann R, Osborn D, Dean K, Hart C, Hogg J, & Moran P (2015). Violent and non-violent crime against adults with severe mental illness. The British journal of psychiatry : the journal of mental science PMID: 25698767... Read more »

Khalifeh H, Johnson S, Howard LM, Borschmann R, Osborn D, Dean K, Hart C, Hogg J, & Moran P. (2015) Violent and non-violent crime against adults with severe mental illness. The British journal of psychiatry : the journal of mental science. PMID: 25698767  

  • May 1, 2015
  • 04:16 AM
  • 47 views

Neuroblastoma may arise from problems with embryonic nerve development

by lukeawylie in the Node

Neuroblastoma is a tumour derived from the peripheral nervous system and is the most common cancer diagnosed within the first year of life. Although is a fairly rare disease, it does account for 15% of all pediatric cancer deaths. However, neuroblastoma is quite unique in that some, particularly very young, patients spontaneously regress requiring only […]... Read more »

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