Monday, 25 July 2011

Dune, water and autism

I like my Sci-Fi films. It all started round about Star Wars and just went (downhill) from there, particularly during that golden age of TV and cinema that was the 1980s. Why the 80s? Well where else can you find Gil Gerard as Buck Rogers or Jane Badler as Diana, leader of the Visitors. And that's just TV.

The latest film being rediscovered is that David Lynch classic, Dune. I won't bore you with the film details including a North-East son, Sting appearing amongst the star-studded cast, but those in the know might recognise the words 'never one drop of rain on Arrakis'. This very tenuous link from Dune to water leads me into the main event of this post, water drinking behaviour in relation to autism and a few other conditions.

It goes without saying that we all need water to survive. Indeed whereas we can survive without food or on minimal food for some time, a few days without water and its curtains pretty quickly. I've always been a little bit interested as to why H2O is so important, after reading a small part of the very large literature on why the body needs water, and what happens when we either drink too much or too little.

There are various conditions associated with water drinking behaviour. Diabetes insipidus is one of them; whereby the passing of large volumes of urine is accompanied by excessive and prolonged thirst (polydipsia) not suitably quenched by drinking water. Conditions such as schizophrenia have also been tied into fluid intake and thirst. Indeed whilst researching this part of the post, I came across that of the late Robert Cade, inventor of Gatorade and a man close to my own research heart following his work in autism and schizophrenia.

Various medications also carry side-effects associated with thirst. Lithium for example, used in the management of conditions such as bipolar disorder carries a risk of excessive thirst as a side-effect in some cases, possibly as a result of its impact on our thirst regulation. On the other side of the pharmacotherapy fence, the neuroleptic drug risperidone has shown some promise in treating 'psychogenic' polydipsia.

With autism in mind, water has been mentioned a few times. Outside of the possible environmental drinking water connection vis-a-vis my previous post on chlorination by-products including also speculation on things like fluoride in water, a lot of the research has focused on water drinking behaviour in autism, and in particular problems such as polydipsia or excessive thirst. I should point out that like many things related to autism, there is always the possibility that the behaviour we see is there as a consequence of the core areas associated with autism. One could therefore envisage a situation where excessive drinking habits are either a learned response or part of some routine or ritual rather than having any immediate somatic or physiological undertone. I dare say that there might even be a perceptual side to excessive water drinking in autism. Possible at least.

This paper found that polydipsia was more commonly reported in autism over learning disability, corroborating quite a few case studies and first- and second-person accounts on the web of this unusual behaviour. The possible biological mechanisms behind polydipsia are a little more of a mystery, assuming that conditions such as diabetes insipidus are not co-morbid and having an effect. I was interested by some comments made in this paper about polydipsia in a learning disability population potentially being co-morbid to pica and something called Kleine-Levin syndrome. Certainly pica has perhaps more than a passing relationship to autism, although at this point I wouldn't like to speculate too much as to whether pica and polydipsia might show any causal effect on one another outside of the effect of eating things like sand and earth which may well make one thirsty.

Whilst I have, once again, only paid lip service to excessive water intake and its possible relationship to autism, there are a few details which will get even less attention in this post. Conditions such as hyponatremia, and other disorders of electrolytes are perhaps possible risk factors as a result of excessive water consumption and the limited research so far suggests more work is needed specifically for autism. One might also expect that excessive water intake might have some effect on functional bowel patterns also; indeed one might assume that in moderation, increased water intake levels could be a useful complementary strategy at least in some cases. Finally, although polydipsia has received the most research attention in autism, I do wonder about those people with autism who might demonstrate the opposite behaviour... erm, low water intake (dont' know the Greek or Latin term) and the potential effects that this might have either on autistic symptoms or well-being in general.

To end a spot of Handel and some water music to jolly up anyone's day.