Historically, England and Scotland have perhaps not enjoyed the best of relationships. Anyone who has watched the blood and guts of the film Braveheart, very, very, very loosely based on the life and times of Sir William Wallace, will get an idea of what the main problems were in terms of conquest, lands, identity and freedom. Down the years some degree of one-upmanship still survives as evidenced by little things like the 'anyone but England' slogan during the recent World Cup. Those who watched the 2010 World Cup will know that the English football (soccer) team did pretty well on their own in early-exiting the tournament without the help of the ABE campaign.
As an Englishman living fairly close to the Borders, I don't want to get too involved in the politics. My geographical proximity to Scotland does however give me a little bit of a flavour of the climate in Scotland and its relevance to this post on vitamin D.
I was intrigued by a comment made to me quite recently when discussing measuring levels of vitamin D. The comment included the term 'normal for Scotland' when interpreting some biochemical results on vitamin D levels in various patient groups. I found out that day that 'normal for Scotland' is usually taken to mean vitamin D results are not abnormal when compared to the Scottish population but neither do they show a particularly healthy level of vitamin D to be present assuming accuracy of the testing procedure. One of the possible reasons: well whilst the sun does shine in Scotland (sometimes), there is quite a bit of evidence to suggest that it doesn't necessarily translate into an all-year round adequate vitamin D level for many, many people living at certain geographical coordinates all of which cover Scotland; indeed also where I live.
I should perhaps back-up a little and provide a little more description of vitamin D first. Vitamin D is a fat-soluble vitamin. Although having multiple uses throughout the body, vitamin D is perhaps most famous for its role in aiding in the absorption of calcium; see my recent post on this subject. There are a few ways of getting vitamin D; through our modern fortified diet (assuming you eat breakfast cereals for example) and also by contact with sunshine, or more specifically via exposure to ultraviolet B light. I suppose a third way is via supplementation.
Vitamin D is a vitamin in the spotlight at the moment. There is quite a lot of research coming out telling us how much we need vitamin D for lots of different health reasons, ranging from cancer prevention to maintaining good cognitive health to potentially helping to tackle growing health problems like diabetes. Looking at childhood health in particular, there is some pretty good evidence that conditions classically associated with vitamin D like rickets might be making an unwelcome return here in the UK and beyond. Although not altogether clear as to what is driving our vitamin D deficiency, it seems as though lifestyle is a possible factor; so sitting reading blogs from a home PC indoors rather than reading them on an iPad outdoors, our use of barrier creams to prevent excessive sun exposure and its onward effects, but also physiological factors such as skin colour (although research in this area is not cut and dried).
There is also some suggestion that vitamin D might show some connection to various childhood developmental conditions including autism. Vitamin D and psychiatry have, what might be called, a blossoming relationship. PubMed lists over 100 entries based on the keywords vitamin D and schizophrenia, covering various angles of a possible connection from genes to biochemistry, even including psychology. I would not be so bold as to say that the link is in anyway definitive, but it makes for some interesting reading.
With autism in mind, vitamin D has also received more than passing mention. As with all dietary components, the possible influence of unusual eating habits and patterns attributed to many cases of autism, would perhaps predispose some people on the autism spectrum to a reduced intake of dietary-derived vitamin D. The research in this area does seem to corroborate this suggestion. One of the bigger names in all things vitamin D, Dr John Cannell, wrote an interesting paper about vitamin D and autism not so long ago (here). Putting the universality of the vitamin D-autism hypothesis to one side, there are some interesting points raised in his paper which are beginning to be borne out by the accumulated research in this area. In particular are the various research on autism in specific ethnic populations such as the Somali community, and the evidence put forward for some increase in autism prevalence in such groups when resident in more Northern climes. I would reiterate the old 'correlation does not imply causation' adage at this point also.
Another interesting area of research relates to the various work on the gastrointestinal (GI) co-morbidities noted alongside some cases of autism, and whether malabsorption as a result of coeliac disease or hyperpermeability of the gut might play a hand in hypovitaminosis D as has been suggested elsewhere. This research published on Egyptian children might be relevant to this side of the hypothesis given that I am sure that sunshine is at a premium in the land of the Pharaohs. Finally, although there is no contemporary epidemiological evidence to speak of, autism does not seem to be protective against the development of rickets as witnessed by this study (one of the study authors being also involved in this paper on iron deficiency and autism) and this study.
Taking into account the evidence currently available, I don't think that we can say that autism, or any one condition, has a monopoly on low levels of vitamin D. Many people from many different ethnic, geographic and symptomatic groups seem to be on the low side of what would be considered to be 'adequate' levels of vitamin D. There is also the 'chicken and egg' situation in terms of whether vitamin D levels are 'causative' of anything (outside of rickets or other classically related conditions) as complicated as autism or schizophrenia, etc. or just symptomatic of some other underlying mechanism or dysfunction. I will leave you to make your decision on this issue. Finally, vitamin D might be only one part of any association as can be seen by this editorial on how UVB sunlight might also have some other interesting effects.
To finish, this Sassenach wonders how many miles would you walk?
Saturday, 16 July 2011
Thursday, 14 July 2011
What does detox mean?
Ever seen the original TV series 'V'?
I'm not talking about that new-fangled attempt with the fancy CGI effects; no, the 1980s one with the reptilian aliens, or at least the very plastic-mask looking reptilian aliens, wanting to turn humans into food. Even Freddy Krueger was a Visitor! (or the actor Robert Englund at least). Not a pretty thought I know, but if humans were ever to be sold as meat, by modern day standards, I question whether many of us would be fit to appear on the Visitors dinner table.
Sorry for the opening paragraph but what I wanted to suggest is that most people wouldn't disagree with the fact that modern day life, whilst presenting us with lots of comforts and labour-saving devices and technologies including those which have saved and extended our lives, also has it's downside. One downside of our romance with industrialisation is that we live in a very different environment from that only a few hundred years ago in terms of our exposure to lots of different things as a result of globalisation (viruses, bacteria, etc) and particularly our exposure to the various natural and man-made, synthetic chemicals. I kinda hinted at this in my last post on chlorination byproducts in the water.
I could write a whole thesis using the volumes of research done on what we could readily be exposed to on a daily basis from cradle to grave but I won't. Instead, here are a few references (here and here) to strengthen my point. Some of the compounds in question are pretty scary in terms of their potential biological activity and also their persistence in the environment. Asbestos, whilst being a natural product, is perhaps one of the archetypal industrial bad guys. For many compounds we just don't know what the long-term effects might be following either acute or chronic exposure and even worse, how they may interact with each other to potentially produce a more potent effect.
I read what I have written so far and think to myself, I don't live too near an incinerator or a chemical plant, I don't live too close to a busy road, I don't smoke, how would I be exposed? Well, easily. I need to drink, I need to eat, I need to breathe and I need to travel - traces of our industrial society are all around me (and you). In one way or another I will be exposed to many of them over the course of my lifetime. How my body handles them will depend on what the compounds are, the amount I am exposed to (and how frequently) and whether my genes-biology can metabolise them safely.
It is perhaps with all this in mind, that we have witnessed the rise of 'detoxification' as a suggested solution to relieving our chemical burden. I say chemical burden but detoxification has been put forward as an intervention for many different aspects of modern day life including that related to diet, medication and pollution.
Detox (to those in the know) means different things to different people. To some it is a trendy term which is used almost indiscriminately to denote some process of removing harmful compounds via 'natural' means. I remember people like Gillian McKeith using it in almost every second sentence coupled with words like 'superfoods', etc. To others, detoxification has a more 'scientific' meaning as related to things like the important function of the liver and its various enzymes for xenobiotic metabolism. Whatever your translation of the meaning, its use is part and parcel of the modern day dictionary.
A few months back I happened upon a very interesting article by Stephen Genuis. Some people might have heard his name before, particularly his recent work looking at the co-morbidity of coeliac disease in some selected cases of autism (and what happened to autistic symptoms when a gluten-free diet was implemented as part of the coeliac treatment regime). The article in question for this post is here* and is basically a review of what detoxification is and the various ways that is has been suggested to be useful.
I am sorry that I can't post a full-text copy of the paper (copyright y'know) because it is a very, very good review of detox which covers everything from description to the various challenges for toxicology research to summarising the various detox methods and their supporting evidence. I have supplied the reference at the foot of this post for anyone who is interested in popping through to their nearest academic library for a look. Genuis does not mince his words in this article in either his review of the evidence on the size of our chemical toxicity, the need for 'proof of safety not proof of harm', and his support for the budding environmental health sciences.
There is a case study included towards the end of his review paper about a previously healthy woman who developed many of the symptoms of psychosis. She was previously employed at a printing company which itself suggested several things in terms of potential environmental exposure. After various pharmacological treatments including antipsychotics, she was assessed by a separate physician who discovered high levels of bioaccumulated lead. Supervised chelation to bring down her lead levels correlated with an abatement of her psychiatric symptoms. I know this is only one case study and is limited to the findings of this n=1 but it does quite nicely illustrate our whole body relationship with contaminants. I made reference to lead in a previous post on the suggested reasons why the US crime figures are falling. I perhaps need to look at this with a more critical eye in the future.
There are a number of sensible take-home messages from Genuis and his review of other research being conducted in this area including:
To finish, a song from the Chemical Brothers - "the time has come to... galvanize".
*Genuis SJ. (2011) Elimination of persistent toxicants from the body. Human & Experimental Toxicology. 30: 3-18.
I'm not talking about that new-fangled attempt with the fancy CGI effects; no, the 1980s one with the reptilian aliens, or at least the very plastic-mask looking reptilian aliens, wanting to turn humans into food. Even Freddy Krueger was a Visitor! (or the actor Robert Englund at least). Not a pretty thought I know, but if humans were ever to be sold as meat, by modern day standards, I question whether many of us would be fit to appear on the Visitors dinner table.
Sorry for the opening paragraph but what I wanted to suggest is that most people wouldn't disagree with the fact that modern day life, whilst presenting us with lots of comforts and labour-saving devices and technologies including those which have saved and extended our lives, also has it's downside. One downside of our romance with industrialisation is that we live in a very different environment from that only a few hundred years ago in terms of our exposure to lots of different things as a result of globalisation (viruses, bacteria, etc) and particularly our exposure to the various natural and man-made, synthetic chemicals. I kinda hinted at this in my last post on chlorination byproducts in the water.
I could write a whole thesis using the volumes of research done on what we could readily be exposed to on a daily basis from cradle to grave but I won't. Instead, here are a few references (here and here) to strengthen my point. Some of the compounds in question are pretty scary in terms of their potential biological activity and also their persistence in the environment. Asbestos, whilst being a natural product, is perhaps one of the archetypal industrial bad guys. For many compounds we just don't know what the long-term effects might be following either acute or chronic exposure and even worse, how they may interact with each other to potentially produce a more potent effect.
I read what I have written so far and think to myself, I don't live too near an incinerator or a chemical plant, I don't live too close to a busy road, I don't smoke, how would I be exposed? Well, easily. I need to drink, I need to eat, I need to breathe and I need to travel - traces of our industrial society are all around me (and you). In one way or another I will be exposed to many of them over the course of my lifetime. How my body handles them will depend on what the compounds are, the amount I am exposed to (and how frequently) and whether my genes-biology can metabolise them safely.
It is perhaps with all this in mind, that we have witnessed the rise of 'detoxification' as a suggested solution to relieving our chemical burden. I say chemical burden but detoxification has been put forward as an intervention for many different aspects of modern day life including that related to diet, medication and pollution.
Detox (to those in the know) means different things to different people. To some it is a trendy term which is used almost indiscriminately to denote some process of removing harmful compounds via 'natural' means. I remember people like Gillian McKeith using it in almost every second sentence coupled with words like 'superfoods', etc. To others, detoxification has a more 'scientific' meaning as related to things like the important function of the liver and its various enzymes for xenobiotic metabolism. Whatever your translation of the meaning, its use is part and parcel of the modern day dictionary.
A few months back I happened upon a very interesting article by Stephen Genuis. Some people might have heard his name before, particularly his recent work looking at the co-morbidity of coeliac disease in some selected cases of autism (and what happened to autistic symptoms when a gluten-free diet was implemented as part of the coeliac treatment regime). The article in question for this post is here* and is basically a review of what detoxification is and the various ways that is has been suggested to be useful.
I am sorry that I can't post a full-text copy of the paper (copyright y'know) because it is a very, very good review of detox which covers everything from description to the various challenges for toxicology research to summarising the various detox methods and their supporting evidence. I have supplied the reference at the foot of this post for anyone who is interested in popping through to their nearest academic library for a look. Genuis does not mince his words in this article in either his review of the evidence on the size of our chemical toxicity, the need for 'proof of safety not proof of harm', and his support for the budding environmental health sciences.
There is a case study included towards the end of his review paper about a previously healthy woman who developed many of the symptoms of psychosis. She was previously employed at a printing company which itself suggested several things in terms of potential environmental exposure. After various pharmacological treatments including antipsychotics, she was assessed by a separate physician who discovered high levels of bioaccumulated lead. Supervised chelation to bring down her lead levels correlated with an abatement of her psychiatric symptoms. I know this is only one case study and is limited to the findings of this n=1 but it does quite nicely illustrate our whole body relationship with contaminants. I made reference to lead in a previous post on the suggested reasons why the US crime figures are falling. I perhaps need to look at this with a more critical eye in the future.
There are a number of sensible take-home messages from Genuis and his review of other research being conducted in this area including:
- Quite a lot more finance and resources need to be put into investigating the whole area of chemical exposure and detoxification. An interesting study is just starting in the States regarding the possible impact that the Deepwater Horizon fiasco might have had on human health. Whether the financial onus should be on Government or the chemical production sector, I don't know.
- We have a very close, yet very complicated relationship, with our environment (and our genes). Just look at the recent post on genes and environment in the autism research world.
- With particular reference to one of our most sensitive organs, the brain, one should never underestimate how much our behaviour (and mis-behaviour) might be influenced by our natural and synthetic chemical surroundings. I should also point out that studying such a relationship is not easy.
- Detox, a widely used (and abused) term, is a legitimate concept.
To finish, a song from the Chemical Brothers - "the time has come to... galvanize".
*Genuis SJ. (2011) Elimination of persistent toxicants from the body. Human & Experimental Toxicology. 30: 3-18.
Wednesday, 13 July 2011
Chlorinated byproducts and autism
Brick Township in New Jersey (USA) enjoys a few accolades. According to the 2003 FBI statistics, Brick Township was the 2nd safest place to live in America. It also features highly in terms of its educational provisions and is generally seen to be quite a nice place to live. Like every other place, Brick Township (BT) does however also enjoy a not-so-enviable part of its community. In the case of BT it is its history with landfill and in particular French's landfill.
Landfill is a world-wide issue in terms of the staggering amounts of waste we as a population produce and what we do with it. We, here in the UK, are unfortunately particularly wasteful still, having previously been dubbed the 'landfill dustbin of Europe'. We are getting better I might add, but still that label persists.
French's landfill in BT has been in the US Environmental Protection Agency's sights for quite a few years. So much so that there is a dedicated EPA entry on their website showing the various strategies and progress being made in cleaning up French's landfill. It makes for unpleasant reading in terms of the types of contaminants identified and the history of potential contamination from the site.
The reason for my interest is this paper which has recently appeared in the journal NeuroToxicology. The paper by Guariglia and colleagues appears to question the outcomes from a previous report on BT drinking water and the occurrence of autism (which can be read here). They undertook to examine how water treated with compounds similarly detected in the BT municipal drinking water supply might affect specific breeds of mice. The compounds in question were trihalomethanes (THMs) and perchloroethylenes (PCEs) which carry some pretty significant risks following continued exposure including being carcinogens. The mice (and their mothers) were given the contaminated water both whilst pregnant and post-natally.
The findings, bearing in mind that this is a study based on a mouse model:
I appreciate that undertaking such studies on mice is not really to anyone's taste. Even though mouse models are used widespread in science (including autism research) it doesn't necessarily make it right. Keeping the ethical aspects in mind, the results deliver some very interesting leads. Interesting because of the various associations made and how they link with quite a few aspects of autism including the gender preference. Of course, correlation does not imply causation.
This is not the first time that BT has cropped up on the autism research radar. Readers may remember this study from a decade ago which hinted that BT might be a 'hotspot' for autism diagnoses. I remember quite a lot of the media interest in this at the time, and the various links being made between environment, the superior schooling provisions in BT, etc. to account for the results. Nowadays, autism spectrum prevalence rates of 0.6% look positively low compared to the emerging data.
I would like to see a little more study undertaken based on the recent mice findings. Population sampling for similar metabolites present in humans might be a good start, particularly in BT; for which various methods for analysing various biological mediums are available (indeed some very sensitive methods available). Given the amount of data amassed by the EPA within BT, I would assume some very powerful results could be produced to contribute to any 'cause or association' discussions that could follow, if only to discount any relationship.
To end on a slightly happier note, Brick Township is dealing with French's landfill. Hopefully with the completion of these clean-up operations in future months, BT can focus on its more beautiful assets and turn the page on landfill and its potential environmental effects.
Landfill is a world-wide issue in terms of the staggering amounts of waste we as a population produce and what we do with it. We, here in the UK, are unfortunately particularly wasteful still, having previously been dubbed the 'landfill dustbin of Europe'. We are getting better I might add, but still that label persists.
French's landfill in BT has been in the US Environmental Protection Agency's sights for quite a few years. So much so that there is a dedicated EPA entry on their website showing the various strategies and progress being made in cleaning up French's landfill. It makes for unpleasant reading in terms of the types of contaminants identified and the history of potential contamination from the site.
The reason for my interest is this paper which has recently appeared in the journal NeuroToxicology. The paper by Guariglia and colleagues appears to question the outcomes from a previous report on BT drinking water and the occurrence of autism (which can be read here). They undertook to examine how water treated with compounds similarly detected in the BT municipal drinking water supply might affect specific breeds of mice. The compounds in question were trihalomethanes (THMs) and perchloroethylenes (PCEs) which carry some pretty significant risks following continued exposure including being carcinogens. The mice (and their mothers) were given the contaminated water both whilst pregnant and post-natally.
The findings, bearing in mind that this is a study based on a mouse model:
- Male mice seemed to be affected more by the cocktail given.
- Behaviours indicative of anxiety were increased.
- Vocalisations in response to being separated from mother mouse were decreased.
- Social behaviours were reduced.
I appreciate that undertaking such studies on mice is not really to anyone's taste. Even though mouse models are used widespread in science (including autism research) it doesn't necessarily make it right. Keeping the ethical aspects in mind, the results deliver some very interesting leads. Interesting because of the various associations made and how they link with quite a few aspects of autism including the gender preference. Of course, correlation does not imply causation.
This is not the first time that BT has cropped up on the autism research radar. Readers may remember this study from a decade ago which hinted that BT might be a 'hotspot' for autism diagnoses. I remember quite a lot of the media interest in this at the time, and the various links being made between environment, the superior schooling provisions in BT, etc. to account for the results. Nowadays, autism spectrum prevalence rates of 0.6% look positively low compared to the emerging data.
I would like to see a little more study undertaken based on the recent mice findings. Population sampling for similar metabolites present in humans might be a good start, particularly in BT; for which various methods for analysing various biological mediums are available (indeed some very sensitive methods available). Given the amount of data amassed by the EPA within BT, I would assume some very powerful results could be produced to contribute to any 'cause or association' discussions that could follow, if only to discount any relationship.
To end on a slightly happier note, Brick Township is dealing with French's landfill. Hopefully with the completion of these clean-up operations in future months, BT can focus on its more beautiful assets and turn the page on landfill and its potential environmental effects.
Tuesday, 12 July 2011
Coffee does not always mean coffee
The title of this post is based on an episode of Seinfeld. I wasn't a huge Seinfeld fan but happily bumped into the odd episode late night on BBC2 now and again. To quote:
Donna: Would you like to come upstairs for some coffee?
George: Oh, no, thanks. I can't drink coffee late at night, it keeps me up.
And with that comes George's realisation that 'coffee doesn't mean coffee, coffee means sex!'
I am hoping that this post manages to get through the many Internet filters and does not single this blog out as being one of 'those' kinds of blogs (which, in my best British prudish voice, 'it most certainly is not'). I want to talk about sex (education) in this post and how information about sex, sexuality and relationships are being transmitted to people with autism spectrum and related conditions. This is going to be quite a candid post, so please do not get too offended. It is quite a long post also.
I will readily admit that I am not an expert on this (or any) area of autism, merely an interested follower of the various discussions and research being carried out. I do know a few people in the psychology and autism research world who specialise in this topic in terms of either being research active or being at the coalface when it comes to teaching sex education to children and young adults with autism. Having seen one or two of them talk about this issue and present some data, I have to say it made for some interesting listening.
Parents the world over, whether with children with autism or not, will eventually be faced with the issue of 'the birds and the bees' and how to communicate an effective message about sex and relationships. Even where older children and adults present with profound difficulties in areas like cognitive skills or language, the chances are that sex or sexual behaviour will at some point emerge and need to be discussed. Of course such issues might be barriers to communicating about sex, but experience would tend to suggest not to under-estimate a person's capacity to receive such information.
In the more general world of sex education research, there is still quite a bit of discussion about how and when parents should communicate information about sex. I heard one speaker talk about this at a conference last year; some of her findings can be seen here. There are perhaps a few lessons from this research which are just as applicable to boys and girls with autism, as they are to everyone else. Things like:
I'd like to think that these same issues are pertinent the world over, and across things like autism and other developmental conditions. When specifically applied in the context of autism, there is perhaps an even greater requirement to ensure that sex education is imparted timely and properly given issues like the increased 'vulnerability' of some people on the spectrum when it comes to sex and the perhaps greater potential for abuse or being manipulated. Unfortunately this scenario does happen.
One of the best people I have heard talk about sex and autism is Lynne Moxon. Lynne is a bit of an expert in this area as well as being a resident here in the bracing North-East of England. You can download one of her (fairly) recent Powerpoint presentations here from a conference back in 2008 (scroll down the speaker list to download her talk titled: Issues within puberty and sexuality in people with autism spectrum disorders). I won't go through her presentation in rote fashion but would like to draw out a few important points that she raises.
Puberty (or should that be PUBERTY!). A previous post on this blog has discussed that most taxing of times for children and parents, puberty, in relation to autism. Bearing in mind the more generalised 'guidance' being suggested about the timing of sex education (earlier rather than later), I think most parents would have been confronted with sex education issues with their children before the start of puberty. I don't say this in such a way as to say 'it must have been discussed' because the situation is likely to be different between different children and different families. Given the physical changes associated with puberty, one could perhaps expect that this might be a good time to 'top-up' the knowledge about sex and relationships.
Communicating the message. There are a variety of ways of talking about sex and relationships. I know some parents have talked about how their child with autism liked to hear about it 'textbook' fashion - so getting out the pictures and going through the biological details one by one, using the proper names (not our social inventions) for the various bits and pieces, and importantly explaining that the pictures are representations, and different people come in different shapes and sizes. Techniques such as social stories might also come in handy in these descriptions to discuss tricky things like masturbation and the 'right' and 'wrong' times to do it. I would also draw attention to the fact that Lynne does also talk about other important issues: personal hygiene (making sure that everything is kept clean), how sex is portrayed in the media (and often does not reflect 'real life'), sexual diseases and the various types of contraception available.
Outside of Lynne's work, there are a few other valuable sources of information. The writings of Marc Segar have been linked to in a previous post. For those who don't know, Marc was a young man with Asperger syndrome who wrote a very useful 'survival guide' based on his life and experiences nearly 15 years ago now (it can be download for free here). Marc talks quite a bit about the various social nuances related to sex and relationships; more to do with the social situations where sex and relationships might crop up. So things like the use of chat-up lines (p.16), what to do when you like someone (pp.14-15) and even little details, such as when someone is a virgin, the various intricacies about not communicating this fact when in a social group of men in particular. I found Marc's writings to be insightful and worth a read.
I do hope that I have not offended anyone with some of the content used in this post, given that most [all] parents will have to discuss such issues at one time or another. I will restate my non-expertise in this area of autism; please do not take this as anything but a post on how people have talked about sex education and autism and the various issues involved. People with autism are as different, complicated and individual as anyone else, so it is unlikely that there is a 'one-size-fits-all' method for imparting advice on sex and relationships. Parents however know their children best and therefore should be in the driving seat as to when and how the message about sex is communicated.
Donna: Would you like to come upstairs for some coffee?
George: Oh, no, thanks. I can't drink coffee late at night, it keeps me up.
And with that comes George's realisation that 'coffee doesn't mean coffee, coffee means sex!'
I am hoping that this post manages to get through the many Internet filters and does not single this blog out as being one of 'those' kinds of blogs (which, in my best British prudish voice, 'it most certainly is not'). I want to talk about sex (education) in this post and how information about sex, sexuality and relationships are being transmitted to people with autism spectrum and related conditions. This is going to be quite a candid post, so please do not get too offended. It is quite a long post also.
I will readily admit that I am not an expert on this (or any) area of autism, merely an interested follower of the various discussions and research being carried out. I do know a few people in the psychology and autism research world who specialise in this topic in terms of either being research active or being at the coalface when it comes to teaching sex education to children and young adults with autism. Having seen one or two of them talk about this issue and present some data, I have to say it made for some interesting listening.
Parents the world over, whether with children with autism or not, will eventually be faced with the issue of 'the birds and the bees' and how to communicate an effective message about sex and relationships. Even where older children and adults present with profound difficulties in areas like cognitive skills or language, the chances are that sex or sexual behaviour will at some point emerge and need to be discussed. Of course such issues might be barriers to communicating about sex, but experience would tend to suggest not to under-estimate a person's capacity to receive such information.
In the more general world of sex education research, there is still quite a bit of discussion about how and when parents should communicate information about sex. I heard one speaker talk about this at a conference last year; some of her findings can be seen here. There are perhaps a few lessons from this research which are just as applicable to boys and girls with autism, as they are to everyone else. Things like:
- Children and adolescents generally want information about sex and relationships from their parents. Gone are the days (like mine) where boys and girls were separated off at school and taught about each others 'bits' by nervous biology teachers alone and without the aid of parental support. Children want parents to get involved.
- Mums in particular are seen to have an integral role in disclosing information and advice about sex to their children. Dads play a role but I assume that girls especially might perhaps feel a little more comfortable with a 'female' perspective. Whether this is due to societal conditioning (Dad's can't talk about menstruation apparently) or merely the fact that mums have been there and done that, I don't know. Both parents can contribute.
- Boys are perhaps more likely to use other 'sources' of information for their sex education particularly in the age of the Internet. This may or may not give a 'distorted' idea about certain 'normalities' (if there is such a concept) in sex and relationships depending on which sources are used. Not every plumber or gas engineer for example provides 'that kind of service' to lonely housewives.
- Parents generally want to be able to talk to their children about sex, but perhaps feel uncomfortable or lacking in the necessary schemes and plans to communicate such issues in an effective way. Starting the evening meal with the words 'let's talk about sex' is probably going to make for an interesting evening and some subsequent interesting playground conversations among young offspring.
I'd like to think that these same issues are pertinent the world over, and across things like autism and other developmental conditions. When specifically applied in the context of autism, there is perhaps an even greater requirement to ensure that sex education is imparted timely and properly given issues like the increased 'vulnerability' of some people on the spectrum when it comes to sex and the perhaps greater potential for abuse or being manipulated. Unfortunately this scenario does happen.
One of the best people I have heard talk about sex and autism is Lynne Moxon. Lynne is a bit of an expert in this area as well as being a resident here in the bracing North-East of England. You can download one of her (fairly) recent Powerpoint presentations here from a conference back in 2008 (scroll down the speaker list to download her talk titled: Issues within puberty and sexuality in people with autism spectrum disorders). I won't go through her presentation in rote fashion but would like to draw out a few important points that she raises.
Puberty (or should that be PUBERTY!). A previous post on this blog has discussed that most taxing of times for children and parents, puberty, in relation to autism. Bearing in mind the more generalised 'guidance' being suggested about the timing of sex education (earlier rather than later), I think most parents would have been confronted with sex education issues with their children before the start of puberty. I don't say this in such a way as to say 'it must have been discussed' because the situation is likely to be different between different children and different families. Given the physical changes associated with puberty, one could perhaps expect that this might be a good time to 'top-up' the knowledge about sex and relationships.
Communicating the message. There are a variety of ways of talking about sex and relationships. I know some parents have talked about how their child with autism liked to hear about it 'textbook' fashion - so getting out the pictures and going through the biological details one by one, using the proper names (not our social inventions) for the various bits and pieces, and importantly explaining that the pictures are representations, and different people come in different shapes and sizes. Techniques such as social stories might also come in handy in these descriptions to discuss tricky things like masturbation and the 'right' and 'wrong' times to do it. I would also draw attention to the fact that Lynne does also talk about other important issues: personal hygiene (making sure that everything is kept clean), how sex is portrayed in the media (and often does not reflect 'real life'), sexual diseases and the various types of contraception available.
Outside of Lynne's work, there are a few other valuable sources of information. The writings of Marc Segar have been linked to in a previous post. For those who don't know, Marc was a young man with Asperger syndrome who wrote a very useful 'survival guide' based on his life and experiences nearly 15 years ago now (it can be download for free here). Marc talks quite a bit about the various social nuances related to sex and relationships; more to do with the social situations where sex and relationships might crop up. So things like the use of chat-up lines (p.16), what to do when you like someone (pp.14-15) and even little details, such as when someone is a virgin, the various intricacies about not communicating this fact when in a social group of men in particular. I found Marc's writings to be insightful and worth a read.
I do hope that I have not offended anyone with some of the content used in this post, given that most [all] parents will have to discuss such issues at one time or another. I will restate my non-expertise in this area of autism; please do not take this as anything but a post on how people have talked about sex education and autism and the various issues involved. People with autism are as different, complicated and individual as anyone else, so it is unlikely that there is a 'one-size-fits-all' method for imparting advice on sex and relationships. Parents however know their children best and therefore should be in the driving seat as to when and how the message about sex is communicated.
Monday, 11 July 2011
Summarising birth risk factors for autism
Hot on the heels of the various evidence published last week on the rise and rise of variable gene-environment interactions in relation to autism aetiology, an entry on the Autism Speaks blog directed me to a study published in the Pediatrics today which takes an overview look at the collected data on birth factors in relation to risk of developing autism. The abstract to the paper can be found here.
Based on a meta-analysis of several studies looking at various perinatal and neonatal risk factors analysed in connection to autism, several issues are suggested to be potentially related by Gardener and colleagues, although like many things about autism, no one factor or pattern of factors seems to show a universal connection.
So, issues such as umbilical cord 'complications' (I assume this means things like knots and/or being wrapped around baby's head), low birth weight and small for dates are a few of the risks which seem to show some possible connection. Others which have already come up on this blog in one shape or form include: hyperbilirubinemia, neonatal anaemia, feeding difficulties, and being a summer birth. I note also a possible connection with blood or rhesus incompatibility which is something I perhaps will go into in a future entry. There were a few other conditions not found to be associated with any increased risk including head circumference and prematurity. I was a bit taken aback by prematurity not showing association when the data were joined. Having said that, studies like this one have perhaps indicated that such issues might be more related to any co-morbid cognitive problems attached to the autism diagnosis. The head circumference factor is something that is due to be discussed in a separate post in the coming weeks.
I don't want to jump on to any bandwagon with these findings because, as the authors note, they were often comparing oranges and apples with the array of research reviewed. I do however think that this paper provides some important data when starting to look at both 'risk' factors in developing autism and possibly mechanisms; building on what is known about some of the birth factors listed and the risk of other physical and behavioural developmental conditions outside of autism.
Based on a meta-analysis of several studies looking at various perinatal and neonatal risk factors analysed in connection to autism, several issues are suggested to be potentially related by Gardener and colleagues, although like many things about autism, no one factor or pattern of factors seems to show a universal connection.
So, issues such as umbilical cord 'complications' (I assume this means things like knots and/or being wrapped around baby's head), low birth weight and small for dates are a few of the risks which seem to show some possible connection. Others which have already come up on this blog in one shape or form include: hyperbilirubinemia, neonatal anaemia, feeding difficulties, and being a summer birth. I note also a possible connection with blood or rhesus incompatibility which is something I perhaps will go into in a future entry. There were a few other conditions not found to be associated with any increased risk including head circumference and prematurity. I was a bit taken aback by prematurity not showing association when the data were joined. Having said that, studies like this one have perhaps indicated that such issues might be more related to any co-morbid cognitive problems attached to the autism diagnosis. The head circumference factor is something that is due to be discussed in a separate post in the coming weeks.
I don't want to jump on to any bandwagon with these findings because, as the authors note, they were often comparing oranges and apples with the array of research reviewed. I do however think that this paper provides some important data when starting to look at both 'risk' factors in developing autism and possibly mechanisms; building on what is known about some of the birth factors listed and the risk of other physical and behavioural developmental conditions outside of autism.
Sunday, 10 July 2011
The fragile male
'It's a man's world' according to James Brown but 'would mean nothing without a woman or a girl'.
Mr Brown may well portray it as a man's world, but according to this paper from a few years back, us chaps are fighting an uphill struggle right from our very earliest days. The paper, from child and adolescent psychiatrist Sebastian Kraemer who is no stranger to gender research, reviews in quite some detail the many reasons why we men are more vulnerable than our female counterparts. 'Vulnerability' might seem a little at odds with our social models and conditioning of the genders (men not crying when watching Watership Down, but crying when your favourite football (soccer) team is relegated), but unfortunately men face a greater likelihood, throughout all stages of life, for adversity and an early death compared to women.
I touched briefly upon such gender discrepencies in a previous post on risk. I would in this post like to explore the male 'fragility' bit a little further and hopefully discuss some important issues along the way. It's funny but when I think about male fragility the first thing that comes to mind are our friends in the spider world, and those David Attenborough moments showing how female spiders tend to be bigger than males and after the je t'aime moment has finished have been known to eat their Mr Right too. Nature had possibly only a peripheral role for the male of the species in mind?
There are some interesting points raised in the Kraemer paper which I didn't know about previously. I have listed a few which include:
Added to the fact that males on average die quite a bit younger than females and show a greater risk of death throughout their lifetime than females and I get the distinct impression that our Maker might have a soft spot for women.
Searching the literature it does seem to be quite apparent that males are somehow 'hard-wired' for more serious potential issues than females. When I say 'hard-wired' I don't necessarily just mean genetics being the be all and end all, although genes may very well be a primary factor. From conception to early infancy, males fare significantly worse than females. Things don't really get any better from there afterwards. Men don't take to gastrointestinal surgery as well as women according to a recent paper described here. Take also for example the concept of addiction, and the gender splits on who is more likely to become addicted to things like alcohol and drugs of abuse. One could argue that alcohol addiction is to a large part mediated by social factors and the norms of society but still there might be some underlying tendency for men to more likely become addicted and show alcohol problems if not only because of overall gender differences in the way that alcohol is metabolised. I think back also to an older post on theory of mind and its links to things like alcoholism bearing in mind the gender and cognitive styles debates on-going in several domains including autism. It's potentially the same pattern when it comes to illicit drug use also, and opens up some potentially interesting research into brain differences and gender.
The male domination (but not exclusivity) of developmental and behavioural conditions is never more stark than when looking at the overall sex ratio in autism. Autism is perhaps the condition which shows the most gender disparity (maybe alongside ADHD) when it comes to development; the figures for reading disorder for example, tend to be slightly less skewed. A good overview comparing the various data on sex ratios in childhood developmental conditions can be found in this recent paper from Prof. Simon Baron-Cohen and colleagues. The precise reasons for the gender disparity are as yet unknown but likely multiple.
I think that there are some interesting issues raised from this area of research although as always, one has to treat such generalised associations with some caution. It does seem almost contradictory to the way modern society has modelled itself that males, as a group, may be the 'weaker' sex from a biological perspective. Kraemer in his conclusions makes some interesting comments about how many of the variables which contribute to the fragile male hypothesis may have had good evolutionary reasons at one time or another. He may be right although let's not get carried away with ourselves.
I opened with James Brown and his 'man's world'. After reading about the fragile male, and in the words of that dino-favourite Laura Dern, perhaps it is destiny that 'woman [not man] inherits the earth'?
Mr Brown may well portray it as a man's world, but according to this paper from a few years back, us chaps are fighting an uphill struggle right from our very earliest days. The paper, from child and adolescent psychiatrist Sebastian Kraemer who is no stranger to gender research, reviews in quite some detail the many reasons why we men are more vulnerable than our female counterparts. 'Vulnerability' might seem a little at odds with our social models and conditioning of the genders (men not crying when watching Watership Down, but crying when your favourite football (soccer) team is relegated), but unfortunately men face a greater likelihood, throughout all stages of life, for adversity and an early death compared to women.
I touched briefly upon such gender discrepencies in a previous post on risk. I would in this post like to explore the male 'fragility' bit a little further and hopefully discuss some important issues along the way. It's funny but when I think about male fragility the first thing that comes to mind are our friends in the spider world, and those David Attenborough moments showing how female spiders tend to be bigger than males and after the je t'aime moment has finished have been known to eat their Mr Right too. Nature had possibly only a peripheral role for the male of the species in mind?
There are some interesting points raised in the Kraemer paper which I didn't know about previously. I have listed a few which include:
- At conception, there are quite a few more male than female embryos but for one reason or another this advantage is cut when it comes to live births (the ratio being somewhere about 105 boys : 100 girls).
- A newborn girl is more physiologically advanced that a newborn boy.
- There is a male excess in most developmental and behavioural conditions. (OK I knew this one).
- There is a male excess in fatal and non-fatal accidents.
Added to the fact that males on average die quite a bit younger than females and show a greater risk of death throughout their lifetime than females and I get the distinct impression that our Maker might have a soft spot for women.
Searching the literature it does seem to be quite apparent that males are somehow 'hard-wired' for more serious potential issues than females. When I say 'hard-wired' I don't necessarily just mean genetics being the be all and end all, although genes may very well be a primary factor. From conception to early infancy, males fare significantly worse than females. Things don't really get any better from there afterwards. Men don't take to gastrointestinal surgery as well as women according to a recent paper described here. Take also for example the concept of addiction, and the gender splits on who is more likely to become addicted to things like alcohol and drugs of abuse. One could argue that alcohol addiction is to a large part mediated by social factors and the norms of society but still there might be some underlying tendency for men to more likely become addicted and show alcohol problems if not only because of overall gender differences in the way that alcohol is metabolised. I think back also to an older post on theory of mind and its links to things like alcoholism bearing in mind the gender and cognitive styles debates on-going in several domains including autism. It's potentially the same pattern when it comes to illicit drug use also, and opens up some potentially interesting research into brain differences and gender.
The male domination (but not exclusivity) of developmental and behavioural conditions is never more stark than when looking at the overall sex ratio in autism. Autism is perhaps the condition which shows the most gender disparity (maybe alongside ADHD) when it comes to development; the figures for reading disorder for example, tend to be slightly less skewed. A good overview comparing the various data on sex ratios in childhood developmental conditions can be found in this recent paper from Prof. Simon Baron-Cohen and colleagues. The precise reasons for the gender disparity are as yet unknown but likely multiple.
I think that there are some interesting issues raised from this area of research although as always, one has to treat such generalised associations with some caution. It does seem almost contradictory to the way modern society has modelled itself that males, as a group, may be the 'weaker' sex from a biological perspective. Kraemer in his conclusions makes some interesting comments about how many of the variables which contribute to the fragile male hypothesis may have had good evolutionary reasons at one time or another. He may be right although let's not get carried away with ourselves.
I opened with James Brown and his 'man's world'. After reading about the fragile male, and in the words of that dino-favourite Laura Dern, perhaps it is destiny that 'woman [not man] inherits the earth'?
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