The Fusiform Face Area: Not a Site of Autistic Difference After All?

In a comment on one of my old posts, Amanda pointed me to this intriguing review article (full text here) questioning whether the widely-reported impairment of face processing in autistic people actually exists.

The authors review three different bodies of evidence having to do with face processing: behavioral studies (i.e., comparing autistic and neurotypical people's accuracy in identifying/distinguishing individual faces, or classifying facial expressions, from videos or photos; faces might be those of strangers, or of people known to the subjects, and might also be turned upside down or partially covered up in some experiments), electrical and magnetic evoked potential studies (i.e., doing EEGs or MEGs of people as they look at images of faces), and brain-imaging studies (doing fMRIs or PET scans of people as they look at images of faces).
The behavioral literature on how autistic people perceive faces shows that, though we are not necessarily any worse at identifying faces, or facial expressions*, we tend to go about it using different methods.

We look at different parts of the face: some studies --- like Joseph and Tanaka, 2003 (full text here); and Klin et al., 2002 --- find that we spend a lot more time looking at the lower parts of faces, particularly the mouth, while others --- among them van der Geest et al., 2002 (full text here); Dalton et al., 2005 (full text here); Lahaie et al., 2006 (full text here); Bar-Haim et al., 2006 (full text here) and de Wit et al., 2008 (full text here) --- find that we don't direct our gaze** to the lower face any more often than nonautistic people do. Some other studies have found that we attend to lots of different visual details --- both within the face and outside it --- that neurotypical subjects ignore.

Examples of studies finding a greater degree of attention to "irrelevant" visual details: Pelphrey et al. (full text here) found that the five*** autistic men they studied looked more often at "nonfeature areas of the face", like the hairline, chin, jawline, ear, temples, etc., while the five neurotypical men who served as a control group mostly looked at the triangle-shaped region in the center of the face, encompassing the eyes, nose and mouth. More recently, de Wit et al. also found this to be the case: their autistic subjects spent less time than controls did looking at either the eyes or the mouth --- about half of all their viewing was directed at areas of the face other than eyes, nose or mouth. Also, Dalton et al. found that, while the autistic young men they studied did not focus particularly on the mouth, or on any other particular feature, they definitely avoided the eyes.

Since Dalton et al. were monitoring brain activity along with gaze direction, they noticed intense activity in the amygdalae and orbitofrontal cortices of the autistic subjects whenever they focused on the eyes of the faces they were supposed to be looking at. This effect was totally absent in the nonautistic subjects, which led the authors to consider the possibility that maybe autistic people shy away from meeting people's eyes to spare themselves this nerve-wracking emotional stress:

Notably, the autistic group showed greater activation in the left amygdala and orbitofrontal gyrus than did the control group in response to the standardized emotional facial photographs, and greater right amygdala activation in response to the familiar and unfamiliar facial photographs. These are the areas associated with emotional processes, and these results suggest that processing of faces is associated with a heightened activation in affective central circuitry in autism. Together, these findings suggest that the increased activation in subjects with autism in the orbitofrontal cortex occurs specifically in response to the emotional content of the faces and not to faces in general, whereas activation in the amygdala is not specific to the emotional content of the faces but [is] a response to faces in general.

These findings indicate that the commonly reported hypoactivation in the fusiform gyrus during face processing in autism may be a function of how individuals with autism scan the face rather than a group difference in which area of the brain is used to process faces. ...
...
On the basis of these findings, we suggest that within the autistic group, eye fixation is associated with negatively valenced overarousal mediated by activation in limbic regions such as the amygdala. We propose that diminished gaze fixation within the autistic group may facilitate reduction of overarousal to social stimuli. According to this model, face-processing deficits in autism arise from hyperactivation in the central circuitry of emotion that produces hypersensitivity to social stimuli, leading to characteristic diminished gaze fixation, which in turn results in atypical activation of the fusiform gyrus. Additional studies including those involving direct measures of arousal (both self-reported and physiological) are warranted to further test this model.

This hypothesis --- that autistic people are actually hypersensitive, rather than oblivious, to the emotional content of faces, especially in the eyes --- gets some additional support from de Wit et al.'s main finding. They showed a group of autistic children and a group of typically developing children four photographs of faces --- two with "positive" emotional expressions (a calm face and a smiling face) and two with "negative" ones (a frightened face and an angry face) --- while tracking where the children directed their gaze. They found that both groups looked more at the eyes of the "negative" faces, which seems to me an indication that the autistic children were able to detect, and attend to, the socially threatening messages encoded in the angry and fearful faces. (However, the hyperarousal hypothesis does have some contradictory evidence in the findings of Pierce et al., 2004 --- they found no significant differences in amygdalar activity between autistic and nonautistic people looking at faces).

This 2006 article by Dirk Neumann, Michael Spezio, Joseph Piven and Ralph Adolphs, published in Social Cognitive and Affective Neuroscience (and not cited by Jemel, Mottron and Dawson), might help shed some light on the issue of whether or not, and in what contexts, autistic people rely on "looking you in the mouth" to decipher socially salient information: they found no differences whatsoever between their autistic and nonautistic subjects' gaze direction and accuracy at face-reading, except when they asked them to interpret images of faces that had been digitally obscured, making the task of identifying the emotion pictured very difficult.

We asked high-functioning subjects with autism to identify emotional facial expressions, a task people with autism often perform normally. In line with previous findings, we also observed normal accuracy and normal face gaze, provided that whole upright faces were used as the stimuli. When the difficulty of the task was increased and only sparse regions of a face were revealed using the bubbles technique, we still observed normal performance levels in the autism group. However, their gaze onto these sparse facial features became dramatically abnormal. People with autism looked more often and longer (autism, 27.3%; control, 8.7% of all saccades) at the mouth.

In other words, we can interpret faces one of two ways, one of which we are as good at using as nonautistic people are (i.e., the normal way, looking primarily at the eyes) and the other of which works even better, and seems to be autism-specific (i.e., looking primarily at the mouth). The study participants seemed to use the typical, eye-centered face-processing strategy as their default method, switching to the other only when the task became much more difficult, and the image from which they were to extract meaning very poorly visible.

(Fig. 4 from Neumann et al., 2006. Top image is of areas of gaze fixation for the "bubbled" images; bottom image is a graph of how much time autistic vs. nonautistic subjects spent looking at eyes vs. mouth on "bubbled" faces)

Here's what Neumann et al. have to say about their findings:

Our results are consistent with earlier findings that autism subjects are impaired when judging complex social information from the eyes, but not from the mouth (Baron-Cohen, 1995), and that they rely more on information from the mouth for emotional judgments (Spezio et al., 2006). The differences in attentional processing suggest a possible general mechanism for the neurodevelopmental progression of impaired face gaze in autism (Dawson et al., 2005). We failed to observe a deficit in using low-level visual saliency cues, or bottom-up attention, while we found differences in top-down modulation for saccades made to the mouth. We propose that this evidence is consistent with a neurodevelopmental progression that begins in infancy with a failure in directing attention to the faces and more specifically to the eyes in a face, along with preservation of bottom-up attentional processing. This is consistent with the major deficits in social engagement rather than in nonsocial areas when autism is evident in early infancy (Kanner, 1943). Reported signs of lower social engagement in infants with autism include less interest in people (Volkmar et al., 2005) and less looking at faces (Osterling et al., 2002). The abnormal top-down attentional processing of faces may be due to abnormal reward circuitry (Dawson et al., 2005) or to abnormal circuitry for emotional salience (Schultz, 2005). Over the course of development, via learning, top-down attention may cause the propensity for mouth gaze in autism. This hypothesized mechanism adds to previous hypotheses about the causes of deficits in top-down attention to the face, and draws on our findings that bottom-up attention to the face is normal in high-functioning people with autism.

Another possibility is that the bubbles stimuli reveal an impairment in how attention is directed to local vs. global features. In contrast to earlier reports, we observed a normal eye gaze to whole faces. This could also be due to a social training program most of our autism subjects participated in. Despite their overall normal gaze to whole faces, the sparse bubbles stimuli might reveal an underlying impairment in deploying attention to local (vs. global) features (Dakin and Frith, 2005).

Whatever the reasons may be for using one or another, it is certainly clear from these studies that autistic people have a wider range of face-perception strategies, the neuroanatomical correlates are unclear. So it seems to me that, unless a gaze-tracking apparatus is also used, and brain activity correlated to the part of the stimulus actually being viewed, as in Dalton et al. (2005), researchers hoping to pin down the neurophysiological underpinnings of autistic facial perception have no way of knowing that their experimental and control groups are actually doing the same task.

*Some of us are indeed "face-blind," or prosopagnosic. Prosopagnosia is not only seen in autistic people, though; it's a totally different phenomenon.

**You might be wondering how researchers can tell where their subjects are looking. There are several methods, but all the ones used in these studies seem to rely on some sort of head-mounted camera recording the infrared light that reflects off of a subject's corneas.

***The n for many of these studies is very small. I mentioned that for Pelphrey et al. (2002), n = 5; while that is the smallest sample size of any study I cite, most of the others aren't a whole lot bigger. Klin et al. (2002) have 15 autistic and 15 control subjects; Joseph and Tanaka have ~60 typically developing children and ~40 autistic ones; Neumann et al. have ten autistic subjects and ten NT ones; for van der Geest et al., the numbers are 16 autistic and 14 NT; Dalton et al. did two separate experiments, one involving eleven autistic subjects and twelve NT ones, the other involving 16 autistic subjects and 14 controls; Lahaie et al. have 16 autistic and 16 control subjects; and Bar-Haim et al. have twelve autistic and twelve typically developing subjects.

Dalton KM, Nacewicz BM, Johnstone T, Schaefer HS, Gernsbacher MA, Goldsmith HH, Alexander AL, & Davidson RJ (2005). Gaze fixation and the neural circuitry of face processing in autism. Nature neuroscience, 8 (4), 519-26 PMID: 15750588

Jemel, B., Mottron, L., & Dawson, M. (2006). Impaired Face Processing in Autism: Fact or Artifact? Journal of Autism and Developmental Disorders, 36 (1), 91-106 DOI: 10.1007/s10803-005-0050-5

Neumann D, Spezio ML, Piven J, & Adolphs R (2006). Looking you in the mouth: abnormal gaze in autism resulting from impaired top-down modulation of visual attention. Social cognitive and affective neuroscience, 1 (3), 194-202 PMID: 18985106

Pelphrey KA, Sasson NJ, Reznick JS, Paul G, Goldman BD, & Piven J (2002). Visual scanning of faces in autism. Journal of autism and developmental disorders, 32 (4), 249-61 PMID: 12199131

Neurodiversity-Themed Christmas Graphic by Kowalski

Kowalski has created this lovely holiday image (with one of my vintage magazine-illustration scans as a centerpiece --- yay teamwork!) in response to some of the more obnoxious autism- and other disability-awareness themed Christmas swag:

Why Are So Many Awesome Bloggers Named Amanda?

Seriously, it seems like a whole lot of wonderful feminist and disability-rights bloggers have that name.

There's Amanda Baggs, of course, autism/neurodiversity/anti-oppression blogger extraordinaire; she and Michelle Dawson were the first online writers I ever read, and if anybody can be said to have inspired me to do online writing, it's probably those two.

There's also Amanda Marcotte, whom I love for combining feminist blogging with atheism, skepticism and Bad-Science debunking; Amanda W. of Three Rivers Fog, whom I mostly read on FWD/Forward; Amanda Hess, who writes The Sexist; and now, most recently, I find Amanda Forest Vivian, an autistic American college student living in England, who wrote this amazing post* about an ABA school she interned at over a summer, where the staff were directed to try to stop students from stimming, or from being weird in the most harmless of ways:

...I started out thinking: wow, ABA is so cool. I've heard negative things about it from other Not Really Autistic people, but who am I to talk about what these Really Autistic kids need? They can't even talk. They might bite themselves or something. What the hell do I know about that?

And then I met Danny and the other kids in his class. High-functioning kids. Verbal kids.

Tony, who had been nonverbal a few years before, was incredibly hardworking and sweet. When he went into the school director's office and turned out the lights as a joke, I laughed, but she said, "Tony. Look at my face. How do you think that made me feel?" She stood there looking grim until he apologized.

James was stressed out and upset; one of his teachers leaned towards him, staring
fiercely into his eyes, talking with cold, strained-sounding words, the kind of voice I called "static" when I was a kid. James looked scaredly back at her, wriggling his hands around in his lap. "James," she said. "I know you're upset. But what you're doing with your hands looks silly." This boy, all the tension in him being channeled into something harmless, something she had to look under the table to see. His tension was silly. His discomfort was an inconvenience. He was eight or nine years old.

And Danny with his words. ...

Danny just liked words. When he was using his special words, the weird words he scrounged for or made up himself, he would find himself jerkily hopping across the room, speaking in a squeaky voice, his small face tense with excitement. "Presentation" was a weird word for movie, "document" was a way to talk about the letter he had typed on the computer for his parents. "I went to the barber," he said when I commented on his newly short hair, and then, with a rush of joy, "but I like to call it the hair shop!"

I like words, too. It was hard to watch Danny's teachers nudge him, sit down with him, say, "Danny, the word 'presentation' is a little weird; you need to say 'movie'." It was hard to watch the way they looked at him, pointedly, until he stilled his hopping and lowered his voice to a more standard pitch. When Danny found out my middle name is Wood, he completely tripped out on it, hammering pretend nails into my stomach and giggling, "I'm gonna build something out of you!" "Danny," a teacher said, "Don't be weird. You and Amanda were talking about names."
...
So from specific to general, from Danny to James and Tony, to Max and John. John's teacher made him walk, in stiff, clean steps, and if he started doing anything that looked like skipping or jumping, she grabbed his arm, said "No," forced him again and again. Max liked to move his arm in circles while he was watching TV, so he was hauled off into an office, pushed down into a chair, had mouthwash forced into his mouth until he cried. They told me they were narrowing it down, he was moving less and less. Max and John didn't talk. James and Tony didn't talk as well as I do. But I move too much, and I move wrong, especially when I was a kid, and in that school I saw what they do to kids who move wrong.

While I am not categorically anti-ABA --- I think it can be a valuable teaching tool, since it breaks down complicated tasks and skills into discrete, simple components --- that post (like this older post of Chaoticidealism's) does a great job of showing how some uses of ABA (yes, even without aversives) can be cruel and harmful.

In a Pedantic Linguistic Aside to this earlier post, I explain why I hate the common use of "learning" or "education" to describe methods that are essentially authoritarian in nature:

While the mental and behavioral adaptations people make to survive in a prison/institution environment ... might be called "learning," in the Skinnerian sense of that word, they also tend to sabotage a person's capacity for any other kind of learning. You get really good at surviving that hostile environment, but the price you pay is that you lose those parts of yourself that don't help you do that.

I think this also happens to kids in really intensive ABA programs. You lose initiative; you become afraid to try something before you've been told how to do it, because you're used to the teacher/therapist/whomever criticizing your attempts, telling you "No, that's wrong" whenever you do something that differs even a little bit from the response they're looking for.

So, I think that, since there is a significant cost to the kid who undergoes such training (in time if nothing else --- how're you supposed to have a childhood if you're in therapy for forty hours a week?), parents considering an ABA-based school or camp or other structured activity should ask themselves what their kid is likely to get out of it. Will they master important motor, executive, social, emotional or coping skills they've been having trouble picking up on their own? Will those skills help them become more independent (or, if you raise a skeptical eyebrow at the "independence" ideal, more productively interdependent)? Will your kid actually get something out of it that ze can use, or are you just hoping to make hir look more normal?

*Thank you, Sarah, for linking that post; I wouldn't have found it otherwise!

Health Care for All --- Except You, Lady!

On Sunday, the House of Representatives passed the Democrats' health-insurance reform bill, but not without some "collateral damage," to use Echidne's phrasing.

The bill that was passed contained an amendment, the Stupak-Pitts amendment (full text here), which would bar any government-sponsored health insurance from covering abortions. More than that, it would require any private insurance plans that might receive government subsidies, or be purchased by individuals receiving government subsidies, to strip abortion coverage from their publicly available plans, and put it into a separate category of coverage that people would have to buy for themselves (or get through their employer).

The amendment would remove all references to abortion coverage from the parts of the bill describing "Essential Benefits" (Title II, Subtitle C) --- i.e., coverage to be extended to everyone, whether directly through a government-run public insurance option or indirectly through government subsidies or exchange programs intended to make private or employer-based insurance more generally accessible --- and add this text at the end of Title II (Protections and Standards for Qualified Health Benefits Plans):

SEC. 264. LIMITATION ON ABORTION FUNDING.

a) IN GENERAL. --- No funds authorized under this Act (or an amendment made by this Act) may be used to pay for any abortion or to cover any part of the costs of any health plan that includes coverage of abortion, except in the case where a woman suffers from a physical disorder, physical injury, or physical illness that would, as certified by a physician, place the woman in danger of death unless an abortion is performed, including a life-endangering physical condition caused by or arising from the pregnancy itself, or unless the pregnancy is the results of an act of rape or incest.

b) CONSTRUCTION ON OPTION TO PURCHASE SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. --- Nothing in this section shall be construed as prohibiting any non-federal entity (including an individual or a State or local government) from purchasing separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes coverage for such abortions, so long as ---

1. such coverage or plan is paid for entirely using only funds not authorized or appropriated by this Act; and
2. such coverage or plan is not purchased using matching funds required for a federally subsidized program, including a State's or locality's contribution of Medicaid matching funds.

c) CONSTRUCTION ON OPTION TO OFFER SEPARATE SUPPLEMENTAL COVERAGE OR PLAN. --- Notwithstanding section 303(b), nothing in this section shall restrict any [Qualified Health Benefit Plan] offering entity from offering separate supplemental coverage for abortions for which funding is prohibited under this section, or a plan that includes such abortions, so long as ---

1. premiums for such separate supplemental coverage or plan are paid for entirely with funds not not authorized or appropriated by this Act;
2. administrative costs and all services offered through such supplemental coverage or plan are paid for using only premiums collected for such coverage or plan; and
3. any nonfederal QHBP offering entity that offers a plan that includes coverage for abortions for which funding is prohibited under this section also offers a plan that is identical in every respect except that it does not cover abortions for which funding is prohibited under this section.

As Ezra Klein, Jodi Jacobson, and Jenn all point out, this will seriously aggravate the systemic inequality of access that already pervades both health care in general, and abortion and contraception in particular, in this country.

The Hyde amendment already barred women on Medicaid, women in (federal) prison, federal employees, and military personnel from receiving insurance coverage for abortion, and now the Stupak amendment will ensure that lots of other categories of women join them.

Robin Marty also points out that the amendment --- containing as it does such restrictive language surrounding when publicly-funded abortions are permissible --- could have the unintended consequence of forcing women who've miscarried to go through with their already-aborted pregnancies, because removing the dead fetus would technically be an abortion, and thus ineligible for public funding (or --- to reiterate, because I think this is the most invasive aspect of this law --- private funding by any insurance plan participating in a public insurance-exchange program or open to people receiving federal subsidies):

Hospitals and doctors in general do not have terminology to classify a difference between the termination of a live pregnancy and one in which the fetus has already died. To them, a D&C is a D&C, regardless of the state of the "conception materials" removed. Regardless of how many times I made sure to mention to the staff, either for the sake of my sanity or to spare me some sort of imagined shame, that I was ridding myself of my "dead fetus," to them it was all the same.

I also could not fail to notice the amendment's omission of mental illnesses from the list of acceptably serious health problems sufficient to justify terminating a pregnancy with federal assistance.

That omission is interesting to me, because pregnancies resulting from rape and incest are on the okay-to-abort list, even though such pregnancies may not be particularly dangerous or life-threatening. You might think that Rep. Stupak included those categories out of respect for the intense mental and emotional suffering a woman (or girl) is likely to feel, giving birth to her attacker's child, but then you wonder, if he really is so concerned about suffering, where's his consideration for women suffering suicidal depression, or terrifying psychotic breaks? Many psychiatric medications can't be taken during pregnancy, after all, and depression in particular can worsen dramatically as soon as the depressed pregnant woman gives birth.

Those incongruities suggest to me that either Rep. Stupak is really ill-informed about mental illness, pregnancy and women's health (which wouldn't surprise me --- Rep. Stupak is not a doctor), or he ascribes to the distressingly common, misogynistic view that women abort pregnancies on a whim, and that female sexuality, decoupled from marriage and socially-sanctioned procreation, is an inherently destabilizing force that must be contained.

If restricting abortion is not really about fetal life, but about female sexual agency, as Amanda Marcotte frequently --- and quite persuasively --- argues, then it makes sense that abortion bans almost always contain rape and/or incest exceptions. If the sex wasn't chosen, the woman isn't a threat; she's a pitiable victim. In the usual "elective abortion" narrative, a woman who chooses to have sex is obliged to accept the "consequences" of her decision --- i.e., pregnancy --- and any attempt by her to exert further control over her fate, say, by taking emergency contraception or, if she should become pregnant anyway, having an abortion, is an overreach; she sins, she cheats, she gets away with too much. Her impunity makes people nervous. The victim of rape or incest is not "overreaching" in this way; she's just trying to get back to normal.

DSM-V to Unify Autism Spectrum, Emphasize Autism "Severity"

Sarah and Sadderbutwisergirl have both posted about this article in last Monday's New York Times, which discusses the American Psychiatric Association's possible abandonment of Asperger syndrome as a separate category in the upcoming DSM-V.

The last time I blogged about autism in the DSM-V, almost a year ago, the Neurodevelopmental Disorders Work Group was still gathering evidence, asking questions and trying to determine its priorities. Among the questions they asked in their November 2008 report were:

1) How to describe the "spectrum" of disorders now known as ASD (e.g., how many domains will define the disorder);
...
5) Whether Asperger's disorder is the same as "high-functioning autism";
...
7) How to include considerations of severity and impairment in diagnosis (currently defined as "qualitative impairments") ...

By the time of their April 2009 report, the work group seems to have found answers to these questions.

The Workgroup is considering a change in DSM-V that would replace the Pervasive Developmental Disorder (PDD) category with the title "Autism Spectrum Disorders" (ASD). The change would utilize a single diagnosis for the disorders currently entitled: Autism, PDD-NOS and Asperger disorder. Several factors support making this change:

• A single spectrum better reflects the pathology and symptoms.
• Separation of ASD from typical development is reliable and valid, while separation of disorders within the spectrum is variable and inconsistent.
• Individuals with autism, PDD-NOS or Asperger disorder often are diagnosed by severity, rather than unique, separate criteria defining the three diagnoses.

The Times article quotes several work-group members on their reasoning behind the proposed merger of autism-spectrum subcategories:

"Nobody has been able to show consistent differences between what clinicians diagnose as Asperger's syndrome and what they diagnose as mild autistic disorder," said Catherine Lord, director of the Autism and Communication Disorders Centers at the University of Michigan, one of 13 members of a group evaluating autism and other neurodevelopmental disorders for the manual.

"Asperger's means a lot of different things to different people," Dr. Lord said. "It's confusing and not terribly useful."

...

Dr. Susan E. Swedo, a senior investigator at the National Institute of Mental Health who heads the diagnostic manual group working on autism, acknowledges the difficulty of describing such a variable disorder. Dr. Swedo said the plan was to define autism by two core elements -- impaired social communication and repetitive behaviors or fixated interests -- and to score each of these elements for severity.

The trick is to "walk the tightrope of truth," Dr. Swedo said, between providing clear, easily used diagnostic guidance to clinicians and capturing the individual variation that is relevant to treatment. "People say that in autism, everybody is a snowflake," she said. "It's the perfect analogy."

The proposed elimination of autism subtypes comes at the very moment when research suggests the disorder may have scores of varieties. Investigators have already identified more than a dozen gene patterns associated with autism, but Dr. Lord, of Michigan, said the genetic markers "don't seem to map at all into what people currently call Asperger's or P.D.D."

Nor have many of these genes been linked to distinct sets of symptoms. Until research can identify reliable biological markers for autism subtypes, Dr. Lord and other experts say, it is better to have no subtypes than the wrong ones.

I do think it's a step in the right direction to collapse all these categories --- autism, Asperger's and PDD-NOS (which was always just a catchall, "Everything Else" category anyway) --- into a single, more flexible one. The criteria for all the different existing categories are really arbitrary, having more to do with one's developmental history (i.e., at what age did you learn to talk?) than with one's current capabilities, and I think the current organization of the PDDs is more a historical artifact than it is logically or empirically based.

However, I have problems with the concept of autism severity they're proposing.

The two domains they propose as being diagnostically relevant, and which will form the basis of a given autistic person's "severity" rating --- social communication and repetitive behavior/fixated interests --- don't seem to have a lot to say about an autistic person's actual strengths and weaknesses. While I can see a communication impairment causing problems in someone's life, and a diagnosis of autism helping that person get the right therapies, services and accommodations they need to minimize those problems, I don't think that unusual social interactions, repetitive behaviors or eccentric choices of hobbies pose many problems for autistic people in themselves. Such "pathological" pursuits can actually be highly successful coping strategies, helping to defuse the intense, chronic stress and anxiety many of us feel. They might also be avenues through which we can develop, or exercise, a talent or skill.

I see no mention in the work group's discussion of what constitutes "severe" autism of any of the sensory, motor, cognitive, emotional or executive-functioning difficulties that can pose serious problems for everyday functioning, self-care and independent-living skill acquisition by autistic people. While communication impairment (on both the sending and receiving ends!) and social agnosia can be severely disabling as well, I still think these criteria are more a list of traits that mark us as Other than they are an accurate gauge of our mental well-being.

That bothers me because, by focusing on such external, superficial characteristics, the new criteria ignore the reasons for our behaviors --- and thus, the question of whether a given behavior is helpful, harmful or neutral --- to consider only the extent to which they differ from "normal" behaviors. Thus, an autistic person who can pass for neurotypical is automatically assumed to be better off than one who can't.

To the extent that simple discrimination accounts for many (but not all) of the problems autistic people face in life, that might well be true. But to the extent that there are sometimes severe impairments associated with autism, that may or may not correlate with one's ability to pass, I think this single-minded focus on appearances does autistic people no favors.

Michelle Dawson critiqued these proposed changes in June, and came to similar conclusions:

The assumption that having more obvious autistic traits and abilities is bad ("more severe") has resulted in prejudicial judgments in the literature. An autistic boy (who has accomplished more as a child and young adult than most people, autistic or otherwise) with a full-scale IQ of more than 100 and a strong performance on numerous tests is judged to be "low-functioning," because he is so obviously atypical. That is, he is judged to be very "severely" autistic (Bonneh et al., 2008; Belmonte et al., 2009), and this must solely be a bad thing. In Aldred et al. (2004), preschool autistic children are falsely judged to be "low-functioning" or "high-functioning" solely on the basis of presumed autism "severity" falsely drawn from ADOS scores. It is being falsely and prejudicially assumed that an autistic whose traits and abilities are more obvious must function poorly.

The proposed DSM-V changes will enhance societal prejudices against autistic traits and abilities. These prejudices already serve to prevent autistics whose traits and abilities are more obvious from being considered able to learn, to communicate, to make decisions about our lives, to walk around freely, to be employed, etc. Under the proposed DSM-V changes, autistics who are highly and obviously atypical would be even more harshly judged, without there being anything approaching a sufficient empirical rationale for this. Autistics whose communication and social interaction is highly atypical, or who most strongly pursue their focused abilities and interests (something which has widely been acknowledged leads to good outcomes, but this has largely not interested researchers; Howlin, 2005), will now be at risk of being regarded as "most severe." This is at a time when the term "severe autism" is popularly equated with low expectations, hopelessness, dread and horror.

Dawson goes on to point out that "severe autism" is commonly invoked to justify abuses committed in the name of therapy. I think this is an excellent point, and well worth considering in a society where autistic people (as well as many other people with developmental disabilities or mental illnesses) are at such risk for abuse.

Halloween

I love Halloween. It's always been my favorite holiday, for lots of reasons. Anymore, my primary mode of celebrating it is to carve outrageous jack-o'-lanterns, the bigger the better.

Here's this year's entry in the "Holy $#?! that's a huge pumpkin" arms race with myself, being interrogated by two of the cats.

You can see they're a bit mystified as to what manner of thing the humans have brought them this time. (The third cat loathes the smell of pumpkin, so she fled the scene).

Boots (the black-and-white one pictured above) was able to discover fairly quickly that this pumpkin was big enough for him to jump into:

Of course, it didn't take him very long after making this discovery for him to lose interest entirely and wander off, as cats will do. But he made this very eloquent expression of disdain before he left:

(It's like he's trying to wave it away with his paw. So cute!)

I Have an Etsy Store!

I just recently got everything together to start selling jewelry on Etsy; I even have a couple of items listed.

My store is called Shards of Elegance.

As of now, you can buy this turquoise bracelet

and this green one

there. Both were made to fit my wrist: the turquoise one is about six and two-thirds inches (approx. 17 cm); the green one is a little looser at seven and one-sixteenth inches (17.8 cm). I have another, slightly shorter green bracelet (6.5 in./16.5 cm) and can make more if you need them bigger or smaller than that. I can't make any more of the turquoise one, although I could resize it.