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News- Page 2
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Chronicles : Savant Syndrome: Frequently Asked Questions
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Posted by Sylvia on Saturday, December 27, 2003 (23:45:44)
written by Dr. Darold A. Treffert
What is savant syndrome?
Savant Syndrome is a rare, but spectacular, condition in which persons with various developmental disorders, including autistic disorder, have astonishing islands of ability, brilliance or talent that stand in stark, markedly incongruous contrast to overall limitations. The condition can be congenital (genetic or inborn), or can be acquired later in childhood, or even in adults.
The savant skills co-exist with, or are superimposed upon, various developmental disabilities including autistic disorder, or other conditions such as mental retardation or brain injury or disease that occurs before (pre-natal) during (peri-natal) or after birth (post-natal), or even later in childhood or adult life. The extraordinary skills are always linked with prodigious memory of a special type — exceedingly deep but very, very narrow.
How common is savant syndrome?
Approximately one in ten (10%) of persons with autistic disorder have some savant skills. In other forms of development disability, mental retardation or brain injury, savant skills occur in less than 1% of such persons (approximately 1:2000 in persons with mental retardation).
Since these other forms of mental disability are much more common than autistic disorder however, it turns out that approximately 50% of persons with savant syndrome have autistic disorder, and the other 50% have some other form of developmental disability, mental retardation or brain injury or disease. Thus not all savants are autistic, and not all autistic persons are savants.
What is the range of savant skills?
Savant skills exist over a spectrum of abilities. The most common savant abilities are called splinter skills. These include behaviors such as obsessive preoccupation with, and memorization of, music and sports trivia, license plate numbers, maps, historical facts, or obscure items such as vacuum cleaner motor sounds, for example. Talented savants are those persons in whom musical, artistic, mathematical or other special skills are more prominent and highly honed, usually within an area of single expertise, and are very conspicuous when viewed against their overall handicap.
The term prodigious savant is reserved for those very rare persons in this already uncommon condition where the special skill or ability is so outstanding that it would be spectacular even if it were to occur in a non-handicapped person. There are probably fewer than 50 prodigious savants living worldwide at the present time who would meet this high threshold of special skill.
What are the typical savant skills?
Particularly striking is the consistent observation also over this past century that savant skills typically, and curiously, are generally confined to only about five general areas of expertise — music, art, lightning calculating or other mathematical skills, calendar calculating and mechanical/spatial skills.
This very limited, but spectacular, array of special skills is noteworthy considering the much wider palette of skills in the human repertoire, and the rarity of the obscure skill of calendar calculating in the general population, which seems an ability almost universal, innately so, among savants.
Music is the generally the most common savant skill-usually playing piano by ear and almost always with perfect pitch. Other percussion instruments such as marimba or drums can be mastered as well, but much less frequently. Musical performance abilities predominate, but outstanding composing skills have been documented as well, most often linked to performance ability, but not necessarily so. The triad of mental disability, blindness and musical genius occurs with a curious, conspicuous frequency in reports over this past century, particularly when one considers the relative rarity of each of those circumstances individually.
Artistic talent, usually painting or drawing, is seen next most frequently. Other forms of artistic talent can occur as well, such as sculpting. Lightning calculating or other mathematical skills, such as the ability to compute multi-digit prime numbers contrasted with the inability to perform even simple arithmetic, has often been reported. Mechanical ability, constructing or repairing intricate machines or motors for example, or spatial skills such as intricate map and route memorizing, or being able to compute distances with precise accuracy just from visualization, do occur, but are seen somewhat less frequently.
Calendar calculating is curiously and conspicuously common among savants, particularly considering the rarity of that obscure skill in the general population. Beyond being able to name the day of the week that a date will occur on in any particular year, calendar calculating includes being able to name all the years in the next 100 in which Easter will fall on March 23rd, for example, or all the years in the next 20 when July 4 will fall on a Tuesday. The so-called 'calculating twins' reported extensively in the literature, have a calendar calculating span of over 40000 years backward or forward in time. They also remember the weather for every day of their adult life.
Other skills are occasionally seen including multilingual acquisition ability or other unusual language (polyglot) skills, exquisite sensory discrimination in smell or touch, perfect appreciation of passing time without access to a clock face, or outstanding knowledge in specific fields such as neurophysiology, statistics, history or navigation, to name a few. While always controversial, there have been some reports of extra-sensory perception skills occurring in savants as well.
Typically a particular one of these skills occurs singly in each person with savant syndrome. However in some instances multiple skills occur in the same person. Regardless of the type of skill, it is always combined with prodigious memory, and it is this special kind of memory-extraordinarily deep but very, very narrow — that cuts across all the various special skills and welds the condition of savant syndrome together.
Why is savant syndrome seen more frequently in males than females?
Savant syndrome does occur four to six times more frequently in males than females. Partly that is due to the fact that savant syndrome occurs in as high as 10% of persons with autistic disorder where that same disproportionate male:female ratio is seen. Even beyond that, however, research by Geschwind and Galaburda, explained in greater detail elsewhere on this site, demonstrated in the developing human fetus the left hemisphere of the brain always completes its development later than the right hemisphere. Therefore the left hemisphere of the brain is exposed for a longer period of time than the right to brain insult or injury of any kind.
One such type of neuronal damage can be produced by circulating testosterone, which in the male fetus, reaches very high levels and can be, in some instances, neurotoxic. This same testosterone mediated developmental injury, causing left hemisphere brain damage before birth in males may account for the same highly disproportionate male:female ratio seen in some other forms of CNS injury such as stuttering, dyslexia, hyperactivity, other learning disabilities and autistic disorder itself.
When was savant syndrome first discovered?
No doubt savants have been present throughout history. Although the term 'savant' was not applied to these special people until 1887 by Dr. J. Langdon Down, as described below, a report describing Jedediah Buxton, a prodigious lightning calculator who performed the most complicated multiplications and divisions swiftly in his head, appeared in a German Psychology Journal, Gnothi Sauton, as early as 1751.
Then in 1789, Dr. Benjamin Rush, often referred to as the father of American Psychiatry, described in detail the lightning calculating skills of Thomas Fuller "who could comprehend scarcely anything, either theoretical or practical, more complex than counting." When Fuller was asked how many seconds a man had lived who was 70 years, 17 days and 12 hours old he gave the correct answer of 2,210,500,800 in 90 seconds even correcting for the 17 leap years included.
But it was in 1887 that Dr. J. Langdon Down gave a series of lectures before the Medical Society of London based on his 30-year experience as Superintendent of the Earlswood Asylum. In those lectures he described 10 cases in careful detail of instances in which there was a striking contrast of superiority and disability in the same person. The special abilities included extraordinary musical, artistic, mathematical and mechanical skills always coupled with phenomenal memory in each and every case.
One individual built exquisite model ships from hand-fashioned parts and could recite complex texts verbatim. Another boy, after attending opera, would come away with a perfect recollection of all the arias. Another lad had memorized The Rise and Fall of the Roman Empire in its entirety and could recite it forward or backward. Still another young man could multiply multi-digit figures in his head as quickly as they could be written down on paper.
Dr. Down is best known for having named Down's Syndrome. But the cases of special abilities in otherwise severely disabled persons caught his attention as well and he coined the term idiot savant for these extraordinary individuals, linking those two words together because at that time the term idiot was an accepted scientific term for IQ below 25, and savant, or "knowledgeable person", was derived from the French word savoir meaning "to know". Dr. Down meant no harm by the term "idiot", and in fact he apologized for having to apply it — "I have no liking for the term. It is so frequently a term of reproach" he cautioned — but it was the accepted scientific term for a level of mental retardation at that time.
While descriptive perhaps, the term idiot savant was actually a misnomer since almost all reported cases since that time occur in persons with IQ above 40. In the interest of accuracy and dignity the term Savant Syndrome has been substituted and widely accepted. That term is preferable to autistic savant because only about one-half of persons with savant syndrome are autistic, and the other half have developmental disabilities or other forms of central nervous system injury or disease.
What is the relationship of savant syndrome to IQ?
When Dr. Down originally named the condition idiot savant, he linked its name with a classification of IQ of less than 25, but almost all reported cases have occurred in persons with an IQ above 40. However a low measured IQ score, or 'mental retardation' either as a symptom or separate disorder, is not what determines whether a person is or is not a savant. Instead the term savant syndrome encompasses a number of different mental disabilities including, but not limited to, the separate disorder of mental retardation itself. When applied to savant syndrome, the term 'mental disability' can include disorders as Autism, Asperger's, Hyperlexia or Williams Syndrome, for example.
In some of these persons measured IQ can be normal or even superior, although when that is the case, usually the IQ sub-scores show a wide scatter among the various sub-tests that make up the overall IQ test battery with some sub-tests showing severe limitations and other showing extremely high scores. Thus a low IQ score, while often present in savant syndrome, is not necessarily the case in all instances, and it is not a finding essential or requisite to savant syndrome. Some savants do score in the normal or superior range on commonly used IQ tests, or at least on some of the sub-tests that make up the overall IQ test battery.
IQ is a measure of so-called 'general intelligence'. While some scatter is common in most persons on the sub-tests of the IQ test battery, sub-test scores do tend to cluster in certain ranges for a given individual producing, when averaged, an overall 'general' intelligence score, or IQ. That IQ score does tend to be correlated with a general level of overall intellectual functioning. But the very wide scatter of abilities seen in some savants on the IQ sub-scores, which is much more pronounced than in most persons, has raised the question of whether it would be more accurate to view all persons as a series of multiple intelligences, rather than having what has been designated general intelligence, or IQ.
Indeed some investigators view savants as refuting the notion of 'general intelligence' and argue, instead, that each of us have multiple intelligences and testing & measurement of "IQ" in all persons should be revised to reflect that reality.
Further, in viewing 'mental retardation' one needs to differentiate between 'actual' retardation (measured IQ below 70) and 'functional' retardation. The latter can occur in someone with seemingly normal or even superior intellectual capacity whose mental disability, from whatever etiology, causes them to function at a much lower level over all than one might expect from estimated or even measured IQ.
It is not uncommon to see some autistic persons, for example, function at a superior level in some areas such as mathematics, verbal skills or memory, but be so severely disabled in other areas so as to 'function' at much lower level overall. The present IQ sub-tests, such as digit span, for example, are not sufficiently tailored to realistically assess certain areas of superior function in savants, and do need to be revised and tailored accordingly to be able to get a true measure of savant capabilities for comparative studies in the area of 'intelligence'.
In summary, measured IQ levels in savant syndrome most often are below 70. However while savant syndrome can occur in persons where Mental Retardation is the basic CNS disorder, savant syndrome can also be seen in persons with IO's below 70 as a finding or symptom where the basic developmental disorder is instead Autism, Asperger's, Hyperlexia, PDD or Williams Syndrome, for example, or a number of other conditions following CNS injury or disease.
While it is true that in most persons with savant syndrome measured IQ is below 70, savant syndrome includes a number of mental disorders in which IQ function, in scattered areas of functioning at least, can be normal or even superior. In short, savant syndrome is not synonymous with, nor limited to mental retardation, and in some persons with savant syndrome IQ can be in the normal, or even superior range.
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Chronicles : MMR RIP? Part II
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Posted by duane on Tuesday, December 16, 2003 (05:53:11)
The Times online 14/12/2003
Report by ROBERT SANDALL
Conventional diagnosis attributed the concurrence of autistic behaviour and severe bowel problems to coincidence, or held that disturbed minds naturally led to upset tummies. Wakefield wondered if the reverse might be true. Could "leaky guts" play a role in developmental problems? And if so, could these problems be alleviated by addressing the inflamed intestines?
Other specialists regarded autistic children as medically untreatable, and none of Wakefield's business: he was a gut man. But the interventions he proposed seemed to work. Among the 200 or so children he oversaw, on average four times a year each at the Royal Free, their behavioural problems appeared to subside, though not disappear, as their guts healed. "These kids were often in extreme pain, and that was why they were screaming or banging their heads on the wall."
In the 12 cases that he and his team examined in detail, the children's bowel problems coincided with evidence suggesting that measles was lurking in the intestinal wall. Given the known propensity of measles to linger in the gut and, in extreme cases, to attack the brain, might this implicate MMR in their children's autism?
It was, to put it mildly, an awkward question. Wakefield had already raised eyebrows by treating patients traditionally cared for by psychiatrists, virologists and community paediatricians. One of the latter had complained in a letter to a colleague in 1987 about "a zealot surgeon who thinks that MMR is the cause of all the problems in the western world". Now others accused him of over-egging the Lancet article. "Anecdotal reporting of a biased sample,"one complained. "This has no place in a peer-reviewed journal."
And soon the fur started to fly. Wakefield had cooked the evidence by concentrating on just 12 cases. His research facilities were contaminated. He couldn't replicate his own results. The last of these charges was true enough. For the first few years, his research results were inconsistent and contradictory. He blames this on the measuring technology.
He says that changed in 1999 with Professor John O'Leary and his TaqMan viral detector, a machine sensitive enough to pick up minute traces of measles vaccine DNA in 75 autistic children with disorderly bowels. O'Leary has refused to finger MMR but he has demanded "extensive and immediate investigation" into the link. The presence of vaccine-strain measles, as opposed to the "wild" variety, O'Leary referred to as "a smoking gun".
The Department of Health (DoH) was not impressed. Despite Wakefield's submissions to the then chief medical officer, Kenneth Calman, six months prior to publication of the 1998 Lancet article, public-health officials were understandably resistant to a hypothesis that queried their vaccination programme on the basis of one small group of children in north London.
But not as resistant as the drug companies who, as they generally do in teaching hospitals, sponsored a large chunk of the Royal Free's research. Everybody, Wakefield and co included, agreed that more studies were needed before MMR could be shown as a cause of autism. Not everybody, though, was urging that these should take place.
Over the next three years, Wakefield saw his research funding dry up. He blames his bosses at the Royal Free for discouraging potential donors. They blamed him for being "evangelical" and needlessly scaring parents. Two key members of his team, Paul Ashwood and Scott Montgomery, found themselves with little to do, and took up new posts, in California and Stockholm, from where they have continued the collaboration.
Not all of Wakefield's team were as convinced as him that MMR was the culprit. One of the co-authors of the 1998 Lancet paper, Simon Murch, senior lecturer in paediatric gastroenterology at the Royal Free, recently declared his belief that MMR is safe in a letter to The Lancet headlined "Separating Speculation from Inflammation in Autism".
Murch made his move on the eve of publication of a study, by himself, Wakefield and others, which compares the aggressive behaviour of gut measles to HIV, adding more fuel to the conspiracy-theorists' view that scientists connected with Wakefield are being pressurised to recant. When asked, Murch declined to comment.
Unlike Murch, who stayed put, Wakefield left the Royal Free, "because it became increasingly obvious that if we were going to get an answer to this, we had to work outside of an environment where I was getting more involved in personal wrangles and the attrition of grants", he says. Robert Sawyer jumped ship at the same time to set up a charity, Visceral, that investigates gut-mediated illnesses and supports projects that test Wakefield's theories.
Visceral's head, and only, office is a converted broom cupboard in the centre of Bath from which Sawyer describes himself as running "a virtual medical school", one that has paid out £1.8m grants to 31 lab scientists around the world. His funding sources are mainly small charitable foundations in the UK and US, set up to support independent research (there are around 50,000 in the UK alone). Visceral, he says forcefully, will not take money from cranks who believe that all vaccinations are the devil's work.
They are currently funding work on genetic mechanisms that may be perverted by a malign viral presence in the gut, and which lead the body's immune system to turn on itself — "aberrant signalling". The search for the virus that sets it off is a clinical whodunnit in which he and Wakefield still have measles vaccine down as their chief suspect.
Almost everybody who speaks out on MMR has a defined stake in it. My reason for getting into all of this is simple: Anita and I have a 16-month-old daughter, and we have a tricky decision to make.
How her developing immune system will benefit from getting three vaccines in one go, rather than having them singly and spread out over a few months, has not been adequately explained. On the other hand, Wakefield's belief in "viral interference" — a tendency for invading viruses to do more damage when they're combined — sounds plausible. He quotes three papers published in America and Japan between 1969 and 1974, identifying the dual presence of the mumps and measles viruses as a factor that can make the measles more virulent and dangerous.
The DoH derides this as a "myth" but doesn't explain why on its web page: MMR The Facts. And there is another fact to be considered: the British government's recent acknowledgment that "Gulf-war syndrome"exists. Most of the military personnel afflicted believe it was brought on by multiple vaccinations prior to the 1991 conflict. The government hasn't publicly confirmed this but, tellingly, when British troops were sent to Iraq this year, their jabs were not all given at once.
Multiple vaccinations are not my thing. I am of an older generation that was expected, even encouraged, to catch measles and mumps in early life and get over them. The first I knew that I had survived a killer illness was when Edwina Currie, the health minister who introduced MMR in 1988, revealed that we were "losing a child a month in this country" to measles.
Which was not strictly true. In the year before MMR came in, the Public Health Laboratory Service counted six deaths from a reported 42,000 measles cases. That rate has subsequently declined from 1 in 7,000 to 1 in 10,000. SSPE (subacute sclerosing panencephalitis), in which measles destroys the brain in a manner similar to variant CJD, hits about 1 in 8,000 children who catch the disease before the age of two. Measles epidemics are undoubtedly nasty: 130 children died in the last big outbreak in the United States in 1989.
When the single measles jab was introduced here in 1968, it was urged not so much as a life-saver, but as a means of relieving pressure on GPs during epidemics. Its early popularity related to other side effects that afflict measles sufferers, such as impaired eyesight. Mumps vaccine, on the other hand, was a harder sell.
Mumps can cause sterility in adults but only rarely damages children, and the single mumps jabs did not catch on. Bundling these two vaccines with the rubella jab, previously given only to girls at age 12, and offering the package to all children at 15 months, seemed from the outset to have more to do with administrative convenience than with public health.
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Chronicles : MMR RIP? Part I
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Posted by duane on Tuesday, December 16, 2003 (05:44:45)
The Times online 14/12/2003
Report by ROBERT SANDALL
A conspiracy of silence or paranoid scaremongering? Is the MMR vaccine a cause of autism — or is it a vital health programme undermined by this medical maverick?
In March, seven mentally disturbed British children and an escort of parents, carers, two doctors and three lawyers flew to Detroit, Michigan, for a medical test that had been denied them in the UK.
The procedure, a lumbar puncture to extract specimens of cerebral spinal fluid (CSF), is uncomfortable and requires anaesthetic — but it is routinely carried out in advanced western countries in the treatment of many chronic ailments, such as leukaemia. In the cases of these children, all of whom were prone to seizures as well as a range of self-harming antics, an analysis of the liquid that bathes the brain had been separately recommended by two neurologists.
Over the course of a year, the 246 private and NHS hospitals in Britain equipped to carry out CSF taps had declined to touch them, usually on the grounds that the test amounted to human experimentation, not treatment. In November 2002 one hospital briefly assented before putting the matter before its ethics committee, which decided four months later not to proceed for the same reason: the children were being used as guinea pigs.
It was an arguable point. Before an illness can be treated, it must be fully understood, and the root of these children's problems hadn't been ascertained. By the time a hospital outside Detroit agreed to accept them in March, their parents and advisers were worrying that the tests would never take place. They were nearly proved right.
On the night before the children arrived at the hospital, lawyers acting for GlaxoSmithKline (GSK), Merck and Aventis Pasteur MSD, manufacturers of the MMR triple vaccines that have been used in the UK since 1988, approached a High Court judge in London for an injunction to prevent the CSF taps going ahead. Two of these combination jabs had been called into question before: Pluserix, by Smith Kline (pre-Glaxo), and Aventis Pasteur's Immravax were withdrawn in 1992 after the "urabe" strain of mumps virus used in them was deemed responsible for a meningitis outbreak by the health authorities in Canada.
That strain was replaced and M-M-R II, patented by Merck but licensed to GSK, became the triple jab most often offered in the UK. Now the possible misbehaviour of the measles component was at issue. The drug companies wanted a delay because their medical representative needed to be present at the procedure, but couldn't get to Port Huron, Michigan, in time. The injunction, however, was denied.
The children were the claimants in a "class action" — legal-speak for a case launched jointly by victims with the same grievance. If successful, it would validate the claims of 1,300 other British families and trigger international damages awards that could top $1 trillion. The proposed test, to look for traces of measles-vaccine virus in the children's CSF, could provide evidence that it can pass from the gut's lining into the brain, where measles is known to affect cerebral processes.
This is one of the most contentious issues in the row about what, if anything, brings on a disease described, but not universally accepted, as "autistic enterocolitis". In the UK, the condition was first identified by Dr Andrew Wakefield, but scientists in Japan, Norway, Ireland and the US (including Buie, Winter and Kushak, based at Harvard) have also published research supporting a link between intestinal disease and autism.
The theory that a malfunctioning or "leaky" gut sends partially digested food — in the form of opioid compounds known as peptides — up to the brain is one of the less controversial aspects of the hypothesis under investigation. Whether measles vaccine is what gives rise to the gut disease in the first place is the trillion-dollar question.
So far, the sum of Wakefield et al's discoveries has not met the exacting medical standards that establish causation. All it points to is an "association". But the importance of the spinal-fluid link was well understood by the defendants in the class action. Merck's QC had recently referred to it in court as "a significant result when trying an issue as to whether or not MMR vaccine causes autism".
Time was running out for the claimants. Their action was being financed by the Legal Services Commission (LSC), a successor to the Legal Aid Board, which had set a July deadline for the submission of expert medical evidence, after which funding would be reviewed. Having lost a year trying to get the CSF samples in the UK, they now had to fly seven severely autistic, occasionally violent children — most of whom had never been in a plane before — halfway round the world.
Another bid by the defendants to secure an injunction, this time in the US, also failed. Then the hospital called the British party in Detroit to cancel their appointment.
Although lumbar taps on autistic children are common in the US, this batch, Lansing hospital now felt, constituted unwarranted human experimentation.
But the children's camp had an undisclosed back-up plan. They had made an arrangement with another hospital in Port Huron, two hours along the shore of Lake Michigan, and this time, despite further delaying tactics from the lawyers in London, the CSF taps went ahead. One of the seven children reacted badly to the anaesthetic and couldn't be tested; the other six were fine.
Now the party and the fluid samples had to be flown home for analysis. There was bedlam on the bus as the anaesthetic wore off: one child tried to exit the moving vehicle by the back door, while another was restrained by his mother in the toilet. At the airport, the container of dry ice carrying the CSF was deemed too large to be carried on as hand luggage, and another business-class seat had to be specially purchased for it.
After the KLM flight had boarded, five US customs officers arrived to take the lawyers and doctors off the plane — the only passengers they apprehended — for separate, 30-minute taped interviews. They weren't asked any questions pertaining to passenger safety and their large container: the issue was why the children hadn't been tested back in the UK. In transit at Schiphol airport in Amsterdam, they were again singled out for more questioning.
By now, several tired minds were stoking their paranoia that these interventions might, just might, have been orchestrated to delay delivery of the samples, allowing them to spoil. So when the virologist in the party, Colin Fink, got them back to his private lab, Micropathology, in Coventry, he took the unusual precaution of placing an armed guard outside overnight.
The next day the CSF samples were couriered to their final destination: Professor John O'Leary's laboratory at Trinity College in Dublin, a facility whose viral-testing kit had previously identified the DNA of measles in the guts of autistic children. Rather disconcertingly, the package appeared to have been opened en route, but with the war in Iraq only two days old, customs everywhere were on high alert.
The analysis proceeded: three of the six samples tested positive for the vaccine strain of measles virus, but only in minuscule genetic fragments — and not enough to count as a valid research sample. According to medical-research protocol, that result had now to be compared to the CSFs of a "control" group of non-autistic patients. Acquiring these took several months, during which the claimants missed the LSC's July deadline and had their funding temporarily suspended awaiting an appeal on September 30.
When the doctors finally assembled their evidence, the children's lawyers felt confident. Only 1 in 20 of the control group — all leukaemia sufferers, specifically chosen for their high susceptibility to random viral infections — was found to be carrying measles virus in their CSF.
The defendants' analysis of the same samples, carried out by Dr Peter Simmonds at Edinburgh University, had found no trace of measles in the children's CSF. But Simmonds had chosen to use a different viral tracker, Nested, rather than the claimants' TaqMan process. Given the accepted centrality of findings in this area, they felt that their case against MMR looked strong enough to take to court in April 2004.
But the four adjudicators on the LSC's funding-review committee disagreed with them. Justifying the £15m already spent as having served the "wider public interest", the committee stated that the £10m needed to see the action through "would not prove a link between MMR vaccine and Autistic Spectrum Disorder".
The claimants' lawyers suspected that the committee had made up their minds before considering the CSF test results, as these offered fresh evidence of just such a link. At the hearing, they were told to await a decision at the end of the day, and written reasons for it two days later. But if the answer was yes, they wondered, why would the reasons not be immediately forthcoming?
They were not reassured to discover, when they looked more closely, that the LSC's e-mailed press release dropping the case had been originated the day before the hearing.In a footnote to editors, the LSC admitted that its decision reflected a change of policy rather than an assessment of evidence. "In retrospect it was not appropriate for the LSC to fund research. The courts are not the place to prove new medical truths." That judgment is itself up for judicial review in the new year — though the LSC is not bound to accept its recommendations.
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Chronicles : Asperger's Disorder and Savant Syndrome
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Posted by duane on Sunday, December 14, 2003 (06:41:22)
Darold A. Treffert, M.D.
In 1944 an Austrian pediatrician, Hans Asperger, wrote a doctoral thesis in which he described four patients with rather severe but characteristic psychiatric and social impairments who showed exceptional skill or talent disproportionate to very uneven intellectual ability. Usually the skill included extraordinary memory. He applied the term "autistic psychopathy" to these four patients.
Dr. Asperger, in Austria, had never heard of Dr. Leo Kanner, in the United States. But surprisingly, only one year earlier, a continent away, Dr. Kanner independently applied the term Early Infantile Autism to a group of 11 patients he had seen with also very unique, but nearly uniform symptoms. It is interesting that both Dr. Asperger and Dr. Kanner independently latched onto and included the word autism to describe the syndromes they separately witnessed. But both were apparently drawn to the word "Autism" as a clinical term originally coined by the Swiss psychiatrist Eugen Bleuler in 1919; Bleuler had also coined the word "Schizophrenia".
Asperger used the term "autism" by itself frequently in his paper, and his use of the word "psychopathy" could have as easily been "personality", as he himself pointed out. Thus the term "autistic personality" might have better characterized the condition he so carefully described, and would have captured better the overall tone of his patients, and would be better understood and better accepted than "psychopathy".
Actually Asperger did not name the condition after himself. The condition we now know as Asperger's Syndrome was given that name by Dr. Lorna Wing in 1981, in a paper entitled "Asperger's Syndrome: A clinical account", 37 years after Asperger's original paper, and one year after his death.
Traits and symptoms that Dr. Kanner described in his group of autistic patients included withdrawal and aloneness; mutism or language that fails to convey meaning; delayed developmental milestones; phenomenal rote memory; echolalia; concrete thinking; reference to self in the third person; obsessive desire for sameness; good relation to objects but not to people; fascination with spinning objects and rhythm; staring through people rather than at them; handsome faces that give an impression of serious-mindedness; anxiousness in the presence of others, with a placid smile of beatitude, often accompanied by happy though monotonous humming and singing. In that original group the male:female ratio was 4:1.
Traits and symptoms that Dr. Asperger described in his group of Asperger's patients were similar in many respects to Autistic Disorder, but included some unique characteristics as well. In one of his patients, Fritz V, he noted, for example, very early speech, with learning to talk before learning to walk; the ability to express himself in complete sentences, soon "talking like an adult"; the absence of normal speech "melody" or tone such that the natural flow of speech was impaired producing instead a very monotone conversation; stereotypical movements and habits; highly intellectual family history, in this case on the mother's side; little eye contact with a "gaze directed into the void" rather than directly at people; social relations that were very limited; clumsiness; intellectual abilities which were very scattered and "highly contradictory"; exceptional memory; and a remarkable calculating ability, mastery of negative numbers and fractions as a "special interest".
While Asperger described only four patients in detail in this original paper, by the time he wrote his thesis he had observed over 200 such patients over a ten year period of time. In the aggregate he listed, in part, these findings and characteristics: a lack of eye contact, not being sure whether the child is looking into the far distance, or inward; paucity of facial and gestural expression; flat, emotionally toneless language not directed to the addressee but often as if spoken into empty space; special abilities interwoven with disabilities; unusual interest in natural sciences, complex calculations or calendar calculating; exceptional rote memory; limitations in social relationships; intellect generally above average, but very scattered in distribution and lacking harmony between intellect and affect; pronounced likes and dislikes with respect to taste; hypersensitivity to tactile sensation and/or to sound, although hyposensitivity to sound can be seen as well; intense interest in collecting things with strong attachment to those objects, compared to attachment to persons; absence of a sense of humor; marked predominance of boys to girls with this disorder; predilection for only children; a marked genetic component with related family traits in every single case where it was possible to trace such; many fathers who occupied high positions and ancestors of intellectuals for several generations; a high proportion of such autistic persons in whom work performance can be excellent and which can provide some social integration.
Dr. Asperger describes one case he observed over three decades, from boyhood to manhood, who in college discovered an error in Newton's work, made that the subject of his doctoral dissertation and went on to become a faculty member in a University Department of Astronomy.
As Autistic Disorder and Asperger's Disorder have been compared and contrasted through the years, some similarities, as well as differences, have emerged. As in autism, males outnumber females approximately 6:1 in Asperger's Disorder. Unlike Autistic Disorder however, in Asperger's Disorder onset of speech is usually not delayed; but like autism, speech in Asperger's is repetitive, with monotone intonation and absence of first person pronouns. In both Autistic Disorder and Asperger's non-verbal communication is flat with staring through, rather than, at persons and repetitive activities are preferred with resistance to change and intense attachments to particular possessions.
Often commented upon as a special trait of Asperger's is poor motor coordination with clumsy, peculiar gaits. Memory is often prodigious in Asperger patients with extraordinary preoccupation and mastery of one or two subjects such as bus schedules, sports statistics, or history trivia, sometimes to the exclusion of learning in all other areas.
Language overall is rather limited in Asperger's Disorder, but in the area of special expertise, conversation can be expansive, pedantic and seemingly scholarly but shows little grasp of the meaning of words put forth so liberally. Even those dissertations tend to be carried out by rote memory.
Kanner's work received wide distribution, but Asperger's work was largely ignored until 1981 when Asperger's work was translated into English for the first time, and his name was attached to the disorder. Since then there has been continuous debate as to whether Asperger's Disorder and Autistic Disorder are simply different points on a spectrum of the same disorder, or whether they are in fact two different conditions that happen to share a number of symptoms in common. While not everyone agrees, there is a general consensus emerging these days that Autistic Disorder and Asperger's Disorder are similar if not the same conditions, differing only as to where they sit on a spectrum of disability encompassed in the overall term of Pervasive Developmental Disability (PDD).
Asperger's Disorder is at the higher end of that spectrum, in fact sometimes being referred to as High Functioning Autism. In a 1966 review of this question, Trevarthen and his co-authors, (Children with autism: diagnosis and interventions to meet their needs), after examining the data on this topic, concluded that autistic disorder and Asperger's disorder are better viewed as differing in level of impairment on a continuing spectrum of severity rather than being viewed as two separate conditions.
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Chronicles : Autism Through the Ages
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Posted by Sylvia on Friday, December 05, 2003 (07:31:50)
By Robert Williams Jr.
For years past people with autism were placed in institutions all over the world. Autism is not a modern problem, even though it has only recently gained vast recognition.
It is difficult to discuss the history of autism treatment without paying particular attention to the history of "autism" as a concept and the ways in which autism has been conceptualized and theorized about over the past 100 years.
The ways in which we understand and think about autism have directly and indirectly formed our conceptual responses to autism over the years. The very concept of "treatment" carries with it many presumptions about the nature of autism, its origins and its potential outcomes.
The history of autism is not a linear one, and regardless of the past or present debates over treatment, origin or outcome, as more and more studies and research are conducted the greater the understanding of autism will become.
Swiss psychiatrist Eugen Bleuler first introduced the term autism in 1911. Autism and autistic stem from the Greek word "autos," meaning self. The term autism originally referred to a basic disturbance in schizophrenia, in short, an extreme withdrawal of oneself from the fabric of social life, but not excluding oneself.
Bleuler also coined the term ambivalence to designate one of the major symptoms of schizophrenia, the others being autism, disturbances of effect (emotion) and association (thought disorders). Ambivalence is a coexistence of two opposing drives, desires, feelings or emotions toward the same person, object or goal.
The ambivalent person may be unaware of either of the opposing wishes. Bleuler felt that there were normal instances of ambivalence — such as the feeling, after performing an action, that it would have been better to have done the opposite; but the normal person, unlike the schizophrenic, is not prevented by these opposing impulses from deciding and then acting.
Bleuler’s schizophrenia differs in terms from the Freudian theories, in which ambivalence was described as feelings of love and hate toward the same person. (E.L. Horwitz, "Madness, Magic, and Medicine: The Treatment and Mistreatment of the Mentally Ill." [Lippincott, 1977])
In the early 1900s, psychologist Carl Gustav Jung introduced the well-known personality types, extroverts and introverts, further broadening Sigmund Freud’s psychoanalytical approach. However, this approach appears to have indirectly classified the autistic person as a schizophrenic introvert.
Jung saw the activity of the extrovert directed toward the external world and that of the introvert directed inward upon him- or herself. Jung, who removed from the term the sexual character ascribed to it by Freud, called this general activity or drives of the individual the libido.
The extrovert is characteristically the active person who is most content when surrounded by people; carried to the neurotic extreme, such behavior appears to constitute an irrational flight into society, where the extrovert’s feelings are acted out.
The introvert, on the other hand, is normally a contemplative individual who enjoys solitude and the inner life of ideas and the imagination. Severe introversion was believed to be characteristic of autism and some forms of schizophrenia. (C.G. Jung, "Psychological Types." [tr. 1923, repr. 1970]).
Jung did not suggest strict classification of individuals as extroverted or introverted, since each person has tendencies in both directions, although one direction generally predominates. Jung theorized a patient could achieve a state of individuation, or wholeness of self. (E.H. Ackernecht, "A Short History of Psychiatry." [Hafner, 2d ed., rev., 1970])
In 1944, American Bruno Bettelheim directed the Chicago-based Ortho-genic School for children with emotional problems, placing special emphasis on the treatment of autism. Bettelheim believed that autistic children had been raised in unstimulating environments during the first few years of their lives, when language and motor skills develop.
He saw parents unresponsive to their child as an underlying cause of autistic behavior. (L. Wing, ed., "Aspects of Autism." [1988]) Although subsequent studies of the parents of autistic children have discredited Bettelheim’s psychological explanation, his ideology carried into the general populace for generations to follow, germinating red herring terms like "refrigerator mother."
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