Sunday, April 8, 2012

NYT on the Rising Incidence of Autism

Autism causes a lag in language ability for mental age, social isolation from poor relatedness, and stereotypic movements (purposeless repetitive movements that go away when busy, such as hand flapping, or finger flicking).  One should think of it as a very broad final common pathway for likely hundreds of undiagnosed conditions. It is similar to the word, fever, or the phrase, mental retardation. It does not exist as a unified disease. Asperger Syndrome differs from autism in that that language is fluent, and the patient talks too much, lecturing on a narrow subject, even to people who are not interested.

These features overlap with the negative symptoms of schizophrenia, another likely very broad syndrome. They are reliable predictors of a poor, outcome, unified by the lack of social interest or relatedness. One should think of all these patients as mentally retarded. Even if the autistic person has an IQ of 110, he will always come from families with IQ's of  140, and is thus mentally retarded for that family.  All of the high IQ patients operated markedly below their expected level of tested function.That was the traditional way to make the diagnosis.

How did the rate go from 1 in 2000 to 1 in 100?

1) Services attracted parents to school districts. Open a program, and the autism rate will shoot up. Do not investigate the water, just the school system for a cause of increased rates. 

2) Doctors are making the diagnosis in merely immature children, often with ADHD. It is not well known that 20% of boys will not have spoken by age 3. So they get enrolled in expensive special education programs, with rich parents hiring aggressive lawyers to intimidate school systems for more services at taxpayer expense. Come age 5, these kids become chatter boxes, and the aggressive bullying now appears to hav been justified. It is just spontaneous onset of speech. The most famous of these children was, of course, Albert Einstein. He did OK for himself.

3) The assault on the American family by the feminist lawyer is nearly victorious. Bastardy is associated with out of control child behavior. The immaturity and poor socialization is misdiagnosed as a serious condition because of the massive benefits of this diagnosis, compared to the criticism of the mother's promiscuity and the bastardy of her offspring. Such criticism is taboo, and would result in the firing of any child welfare worker. The reason is that bastardy and its huge increase in social pathologies generates massive government make work jobs. Any criticism of the mother would threaten government jobs, and there is zero tolerance for it. Thus the absence of this most likely of all causes in the article.

Monday, February 6, 2012

It’s not Ritalin That Has Gone Wrong, It is the NY Times That Has Gone Wrong

I suggest an instant increase in credibility for all left wing extremist propaganda outlets. Have a brief counterpoint box inserted into the article so people can see there two sides to the discussion. The author is a psychologist who bemoans the lack of funding for the psychological aspects of Attention Deficit-Hyperactivity Disorder (ADHD). He fails to disclose he is arguing in the economic interest of his specialty. This piece is to pressure the government to increase funding for psychological research, and self-dealing. I have no argument with self-advocacy as long as it is transparent and disclosed.

The author has no idea what ADHD is. We move around while alive. We move the most around age 2. The amount of movement steadily declines with age to 100 years old. This decline happens to parallel the loss of dopamine neurons of about 1 half percent a year.  One may therefore think of a 12 year old boy with ADHD as someone who moves like a normal ten year old. Put a six year old in a class of 12 year olds, and she will appear hyperactive, inattentive, easily distracted, and impulsive. This is despite being a normal 6 year old. At puberty, nearly all children lose the hyperactivity part of the disorder, and retain the inattention and impulsivity parts, most into adulthood. The best judge of this deviation from age based standards is the teacher observe a class of kids the same age, engaged in the same activity.

Activity level has a great deal of environmental input. Are you praying or running a foot race?  So case controls are tough in the absence of a similar environment, such as being classmates. That makes the teacher the best judge of the deviance from norms. That is not mentioned in the article.  The teacher is also the real consumer of the medication, because without it, the child cannot be controlled and no one else is able to do any learning. No mention of the deleterious impact of the untreated disorder on the entire class or family. Other children shun them, as well.

Everyone agrees insulin is a miracle drug. It controls diabetes, it does not work, “long term.”  Why hold Ritalin to a higher standard than the miracle drug insulin. It markedly changes the quality of life day to day, and that is pretty good. Parents have to choose to give it daily. The idea that an academic psychologist knows more about the interest of their families or their chid has no validity, just arrogance.

About 20% of children have a small slowing of their height growth. Stopping the drug in the summer restores these children to their pre-treatment growth line. So growth effects are temporary if unusual.

Why is a stimulant given to children who are impulsive and hyperactive? In low doses, it stimulates the parts of the brain that quiet the other parts of the brain down. That is why children do not feel much on these medications. Their own brains are quieting other parts down.

There is a tolerance to the medication, and to the side effects. One may increase doses. Then, try to stop the medication in the summer. If the child has not grown out of the disorder, restart at the lower dose.

There is a rebound hyperactivity at the end of its effect in the evening. Small doses will stop that form of drug withdrawal. However, there is no feeling sick from drug withdrawal.

All medical conditions have a response to the environment, such as stress. ADHD is no exception to the long list.

As far as habit forming. No. The opposite is true. Kids do well, have no side effects, have improved grades, are popular on medication ad the opposite off medication. They are likely to refuse to take it. If there is an opposite to addiction, kids with ADHD have it Int heir oppositionality, they refuse to take medicine and must be coerced into doing so. Why refuse if grades are high, adults are praising the work. Friends are willing to play with the patient again? Because it is a noxious feeling to not be yourself anymore, however popular and successful.

So how are motorcycle gang members getting high? They are injecting a full day’s high dose intravenously. If they ever took a prescribed dose, they would slow down, treat their old ladies better, clean up, pay the bills, and become responsible.

The data make the case for even more prescriptions to under-treated kids, and for a low quality of life off these medications.

Saturday, February 4, 2012

Yes. It is an Excellent Idea for Middle Aged Professionals to Attend Law School

I recommend attending law school, and staying in one’s field of expertise.
Workers know a lot about their field, not much about the law. Lawyers know law, but nothing about nothing else.
1) The powers of the animal that is an expert in a field and knows some laws is yet unknown. So the boss may send a contract to a lawyer who knows nothing about his business, and has to explain the basics, or to a co-worker with a law degree. What a difference that will make.
2) One is less likely to be puzzled and intimidated during legal actions. One can predict the tactics of the other side and craft replies. 
3) One can bully adversaries with credible legal threats. That advantage has returned several times the cost of tuition of attending internet law school.
4) One can supervise and force one’s lazy, stupid personal lawyer to better assert one’s legal rights in legal disputes.