Laughter and autism

Whilst appreciating that this blog is primarily about autism research and the (supposed) objectivity of science - see yesterdays post - there are times that I read through my various entries and question whether I am guilty of casting autism in too negative a light. Y'know things like 'autism is associated with this', or 'autism puts a person at greater risk of that'. Cumulatively whilst being based on the existing cold, hard, unfeeling science, maybe it doesn't help with any positive PR of autism as a person not just a condition and the experiences of people with autism or parents raising a child with autism, which whilst being fraught with struggles also have their 'sunshine' moments.

In this post, I am happy to talk about a real 'feel-good' piece of research on autism. This paper* by Hudenko and colleague published in the journal Autism looked at laughter from children with autism, and found that compared with controls, the laughter from children with autism was preferential to listeners over the control group laughter. I haven't read many research papers on autism down the years which convey such a positive message.

Interestingly this is not the first paper to look at laughter in connection to autism. Indeed, William Hudenko has published on it before in this paper, noting differences in the way that laughter was expressed in autism but not necessarily differences in its duration or on other parameters. The theme of laughter in autism being more internally-driven was also reported in this study; one could suggest that people with autism tend to laugh in reaction to what they pick out as being funny rather than 'just going with the crowd'. Is that such a bad thing?

I know a few people might say about such research 'so what'. But I don't. I think there are some very important points to take from such studies. For example, acknowledgement that children with autism have the propensity for enjoyment (the same as other children) and being able to express such enjoyment through gestures such as laughter. I doubt anyone would actually believe that children with autism don't laugh at all, but if the DSM or ICD descriptions were your only guide, you never know.

Given that autism is clinically defined by problems with reciprocal social interaction including the use of gestures, I find it interesting that listeners in the current study actually prefer the laughter from children with autism. Laughter is after all one of the most common social interactions outside of overt verbal discourse; indeed one could suggest that it is one of the most important.

Hudenko completes the abstract by stating that laughter from children with autism can help in relationship formation. This takes me back to some videos I saw quite a few years ago demonstrating play and music therapy with young children with autism. If I remember rightly, laughter was a core element of those relationships and one could argue the primary reinforcement of learning?

What gets me laughing? Well aside from my monthly phone and broadband bill which leaves me in stitches, I have been known to chuckle along to these two now and again. Now, is that four candles or folk handles?

* Hudenko WJ, Magenheimer MA. Listeners prefer the laughs of children with autism to those of typically developing children. Autism. 2011 Aug 2.

Illogical garbage and ill-informed speculation

A short post this one. And I am almost in Hulk mode "Mr McGee, don't make me angry.." (almost).

Normally a fairly quiet and placid character, I am a little bit irritate right now. Irritate because of some comments raised on this post about the effect of social media and the Internet on autism. Don't get me wrong, I am not in anyway adverse to the main message of the post, "don't talk about things where you have very little evidence of effect or association" but I am disheartened about some of the comments about autism and what may or may not be involved in causation(s).

To quote from the post (not my words): "You may not realise just how much illogical garbage and ill-formed speculation parents of children with these conditions are exposed to. Over the years, they’ve been told that their children’s problems are caused by their cold style of interaction, inoculations, dental amalgams, faulty diets, allergies, drinking in pregnancy - the list is endless".

What do I disagree with? Well a few things. First, autism is not autism but rather autisms. To my mind, it is not beyond the realms of possibility that there may be more than one reason why people have autism, although not necessarily caused by any of the above. Second, parents of children with autism, from my experience, get pretty good at sniffing out BS. To say that they are 'told' what caused their child's autism implies passivity. On the contrary, most parents I know or have talked to are quite the opposite; mostly because they have had to be on behalf of their child. Finally, whilst there is still some degree of speculation about 'faulty diets' and their connection or not to autism, I would probably suggest that diet and autism is not yet ready for the 'illogical garbage and ill-informed speculation' bin just yet. Certainly putting diet in the same category as Bettelheim is rather too much I think. Coeliac disease and autism? Hyperpermeability of the gut and autism? Allergy and autism? Apparently none of these matter.

OK, so now I have to change my torn clothes as my transformation from Green monster back to quiet and placid me starts. Deep breaths Paul... deep breaths (cue the sombre Hulk piano music).

Immune profile during pregnancy and autism

The question of a possible connection between the immune system and autism, at least some cases of autism spectrum conditions, continues onwards with this (open-access) paper* published in the journal Molecular Autism. I am going to be fairly brief with this study, because it is open-access and so you can read it yourselves. In essence the authors were looking to establish whether a specific maternal immune profile during pregnancy could somehow offer some insight into the 'risk' of a child developing autism or a developmental delay.

I don't need to say too much about risk that has not already been said (risk is risk, not causation) but there are some interesting findings reported from this paper:

• Maternal serum samples collected between 15 - 19 weeks gestation were analysed for 17 cytokines and chemokines. Interestingly there was a comment about temperature control during transit of the original sample which may or may not be relevant to any results obtained.
• Based on children subsequently diagnosed with either an autism spectrum disorder (ASD) or developmental delay (DD) compared with general population (GP) controls, some interesting patterns emerged.
• Maternal increasing serum interferon-gamma (sorry can't do with Greek letter) during pregnancy was associated with an increasing 'risk' of ASD compared to GP controls irrespective of whether the ASD was categorised as early-onset or regressive and irrespective of the presence of co-morbid intellectual disability.
• A couple of other cytokines, IL-4 and IL-5 also conferred some risk to the child being diagnosed with ASD.
• Levels of IL-10 seemed to be the common denominator when it came to risk of ASD or DD over GP controls.
• Elevated levels of interferon-gamma and IL-6 (both inflammatory in their role) present in mums with children with ASD were slightly counter to what would normally be expected during pregnancy, where a degree of 'tolerance' is expected to prevent immune rejection of the developing foetus.

I'm not going to say much more than that about this study. It is an interesting one and if replicated, opens up a whole new area of early screening and possible intervention opportunities either in-utero or post-partum and beyond following on from previous studies by some of the same authors. This could on the one hand be a good thing but also could potentially lead to some darker places previously discussed by Prof. SBC. I will leave that debate for another post perhaps.

* Goines PE. et al. Increased mid-gestational IFN-gamma, IL-4, and IL-5 in women giving birth to a child with autism: a case-control study. Molecular Autism. 2011

A tragic story

A quick post to link to a very sad story which appeared in the UK press a few days back reporting the death of a 14-year old girl with autism from acute peritonitis and acute gangrenous appendicitis after being mistakenly diagnosed with gastroenteritis by her family doctor.

There are so many issues which this tragic story covers: communicating pain and discomfort, touch sensitivity affecting the ability to make a diagnosis, the role of healthcare providers when seeing patients with autism spectrum conditions. It reiterates the need to remain vigilant and attuned to the fact that a diagnosis of autism is seemingly protective against nothing, as well as observing that pain and discomfort experienced by some people with autism may not necessarily present in the way one would expect.

Women and girls on the autism spectrum

This post is a short blog-formerical following the recent National Autistic Society (NAS) conference about women and girls on the autism spectrum. Copies of the various presentations (in PDF format) from the conference can be downloaded for free from the NAS conference site. The presentations cover quite a lot of ground on autism in females and the various debates on potential under-diagnosis.

Hikikomori: the birth of a psychiatric condition?

A friend of mine* sent me this link a few days back. Hikikomori is a Japanese term describing when people withdraw from social life, seek isolation and refuse to leave their house for a period of 6 months or more. Digging deeper, there are some very interesting perspectives on this 'condition' (if I can call it that) and in particular, the culturally-based explanations put forward for hikikomori based on Japanese society and its history celebrating the nobility of solitude.

I don't quite know if I understand or believe such cultural and historical explanations for all cases of such enforced solitude. It's a little bit like saying that everyone who commits suicide in Japan is doing so as part of an honourable death; a simplistic and one dimensional view which takes no account of other factors like depression, which although socially-mediated is not necessarily a 'social illness'.

Back to hikikomori, I was quite astounded by the figures being put around estimating prevalence of the condition: 1.2% over a lifetime. That's 1.2% of people in Japan aged between 20-49 years old, isolating themselves for 6 months or longer. I have to admit some ignorance with the intricacies of Japanese society so please excuse my surprise with the figures reported. Although originally thought to be a condition only present in Japan, the emerging data seems to suggest that such symptoms are present in various countries and cultures worldwide - at least according to the psychiatrists questioned in that study.

There are also proposals that hikikomori should formally enter the realms of psychiatry, with this paper suggesting potential diagnostic criteria for possible inclusion in DSM V on the basis that the presentation of some cases do not meet criteria for other DSM defined conditions. I don't want to enter this debate at this time but certainly it strikes me that hikikomori might show more than a passing connection to a few other conditions including some characteristics potentially present in some autism spectrum cases.

I would like to raise one last point on hikikomori in relation to my recent post on the autism figures in South Korea. Whilst I stress that I am not suggesting any connection not least because of the age difference, I do wonder to what extent the SK study reporting 1 in 38 children having an autism spectrum condition might overlap with the hikikomori group given the 'cultural' overlap between SK and Japan. Is the psychological and behavioural profile of autism, high-functioning autism in particular in childhood, similar, the same or different from that of hikikomori? If similar, what does this tell us about the SK figures and would they be replicated in Japan?

For those of you who are perhaps interested in reading more about this, perhaps take a look at this book at your local library (not an endorsement by the way).

* Many thanks to Suzanne for her emails about hikikomori.