Saturday, August 28, 2010

"I Had to Get Through School by Going Through the Back Door": Temple Grandin on Gatekeeping in Higher Education

Here's an excerpt from Temple Grandin's book Thinking in Pictures, about how educational institutions tend to keep bright but unconventional thinkers out of science, engineering and academia, rather than steering them toward these professions:
There are few Einsteins today. Maybe they all flunk the Graduate Record Exam or get poor grades. I had to get through school by going through the back door, because I failed the math part of the Graduate Record Exam. My grades in high school were poor until I became motivated in my senior year. In college I did well in biology and psychology but had great difficulty with French and math. Most of the great geniuses have had very uneven skills. They are usually terrible in one subject and brilliant in their special area. Richard Feynman had very low scores on the Graduate Record Exam in English and history. His physics score was perfect, but his art score was in the seventh percentile.

Even Einstein, after graduating from the Zurich Federal Institute of Technology, was not able to obtain an academic appointment. He annoyed big important professors when he told them that their theories were wrong. He had to take a job at the Swiss patent office. While he was a patent clerk, he wrote his famous theory of relativity and got it published in a physics journal. Today it would be extremely difficult for a patent clerk to get a paper published in a physics journal. If Einstein had lived today, his paper probably would have been rejected and he would have stayed in the patent office.

There are many examples of great scientists, artists, and writers who were poor students. Charles Darwin, the father of evolutionary theory, was not able to master a foreign language. When he left school, he was considered only an ordinary student. Darwin wrote in his autobiography, Life and Letters, which was edited by his son Francis, "I was considered by all my masters and by my father as a very ordinary boy, rather below the common standard of intellect." He found life at Cambridge University dull and did poorly in mathemathics. Darwin's saving grace was his passion for collecting. This provided the motivation to go on his famous voyage on the Beagle, where he first formulated the theory of evolution.

Gregor Mendel, the father of modern genetics, was unable to pass the exam to get a high school teaching license, according to Guinagh Kevin in his book Inspired Amateurs. He conducted his classic experiments in the corner of a monastery garden with pea plants. When he presented the results at his university thesis defense, he failed to get his degree. Nobody paid any attention to his wild theories, but fortunately 120 copies of his paper survived and were recognized as the works of genius that they are after his death. Today his principles are taught in every high school science class.

During my career, I have met many brilliant visual thinkers working in the maintenance departments of meat plants. Some of these people are great designers and invent all kinds of innovative equipment, but they were disillusioned and frustrated at school. Our educational system weeds these people out of the system instead of turning them into world-class scientists.
Anemone has also covered this issue in some depth: her essays about struggling to find a niche in both the academic and work worlds deal as much with the difficulties of gifted (but not necessarily autistic) people as with those of autistic people (who may or may not also be gifted).

Anemone also has some very similar thoughts about the generalist bias in education and how that puts autistic students at a particular disadvantage:

[Tyler Cowen, writing in the Chronicle of Higher Education] suggests that academia is a favourable environment to the autistic adult, because it allows for specialization in great detail. Personally I found that even an undergraduate education was too generalized for me, and while I did enjoy grad school much more, it was too little too late, and I lacked sufficient training to get into a PhD. Maybe it depends on which department you're in, or maybe it depends on what you look like. Or maybe you need to get into a field where you hit it off with your instructors, so you can tap into the informal half of your education, something I did not do.

I suspect that both science and the arts are favourable to autistic people, precisely because they do allow a person to focus on one thing to the point of excellence. I have pointed out before that this desire to focus on one thing in detail is characteristic of both gifted/successful people and autistic people. I suspect that it is also true of athletes, since a great deal of successful athleticism comes from the brain, too.

I wonder what would happen if all people with specialist brains were put on a different track by high school, on the basis of how their brains worked rather than their interests, with fewer, more concentrated courses each year, so that the generalists could continue to generalize, but the specialists could commit to excellence. As it is now, it's on the basis of whether you're interested or not (at least in North America), and some of us specialists are unable to get into specialized programs because we get elbowed out of the way, or don't know how to make the transition, or don't even know we're allowed to. I wanted to switch to a fine arts high school as a teenager, but I thought you could only switch at the beginning of grade 9, plus I thought you had to be some sort of super-genius, with a portfolio that would knock over God. All without any help from anyone.
I also think a generalist bias might prevent some children who are gifted in one area from being recognized as gifted at all --- with our educational system's focus on grade point averages and standardized test scores (which measure, and average, a person's ability across a wide range of cognitive skills --- sometimes with very different skills lumped together in the same category, like including geometry and algebra questions in a single math category, when geometry and algebra use different kinds of reasoning, and many people find they are good at one and poor at the other), a child who scores very high in some areas and very low in others averages out to be merely mediocre.

I also think it's important to point out that neither Anemone nor Temple Grandin is talking about only autistic people in their discussion of gifted people with wildly uneven abilities; both concede that this sort of cognitive profile is a common one in autistic people, but Anemone stresses that it is also very common among intellectually gifted folks, most of whom are not autistic. Grandin believes that a lot of the same cognitive traits underlie autism, certain mental illnesses and exceptional creativity, and that the balance between giftedness and disability depends on how extremely one manifests a particular trait. A little bit of hyperfocus can enable you to become an expert on something; too much, and you're stuck with unproductive, debilitating obsessions.

Sunday, August 22, 2010

PLoS ONE: Children from Wealthier Families More Likely to Meet Criteria for an ASD

EXECUTIVE SUMMARY: A recent study shows that wealthier families are somewhat likelier than middle- and low-income families to have autistic children. The study compares surveillance data on a cohort of eight-year-old children in fourteen areas of the U.S. in 2002 and 2004 whom the CDC decided, based on school and medical records, met diagnostic criteria for ASDs with U.S. Census data from 2000 on eight-year-old children living in those same areas of the U.S. Statistical analyses were done on both groups' demographic data, which showed that the autistic children tended to come from somewhat better-off neighborhoods than the general population of eight-year-old children. Because of the study's use of public-school records, and its inclusion of a sizable group of never-before-diagnosed autistic children, its authors believe the association they found between higher socioeconomic status and higher rates of autism prevalence is not solely due to richer people's unfettered access to diagnostic services, but instead might also reflect some other factor that positively correlates with both autism and higher SES: the authors suggest both advanced parental age and excessive hygiene as potential candidates for this mystery factor.

This article in the Kansas City Star alerted me to a study published in PLoS ONE on July 12, giving the first indications I've seen that the conventional wisdom about autism and social class --- that autism is mainly a disorder of the upper classes --- might have more to it than just the simple fact that people with unfettered access to health care are a lot more likely than people without such access to get diagnosed with autism-spectrum conditions.

The way I had understood it, there was no big mystery there: people who can afford to see a doctor in non-emergency situations are going to get all sorts of things diagnosed at a higher rate than people who can't afford that kind of preventive care. In that framework, a higher rate of autism diagnoses among children from wealthy families says nothing about autism per se; it just serves as one more example of the huge inequality of access to health care here in the U.S.

The study I mentioned --- carried out by Dr. Maureen S. Durkin and her colleagues --- tries to address how much of the association between autism and higher socioeconomic status (which Durkin says shows up about half the time in the existing literature on the topic) is due to this gap in access to health care and how much may be due to other factors yet to be uncovered.

To try to include autistic children lacking formal diagnoses in their analysis, Durkin et al. relied on the CDC's Autism and Developmental Disabilities Monitoring Network, whose methodology is described here* on the CDC's website:
In 2000, CDC established the Autism and Developmental Disabilities Monitoring (ADDM) Network to track the prevalence and characteristics of ASDs in the United States. The ADDM Network is a multiple-source, active, population-based surveillance system that reviews developmental records at educational and health sources and employs a standardized case algorithm to identify ASD cases.
There is also a flowchart showing where they get their data from and how they decide which children are actually autistic; unfortunately, the flowchart is still pretty vague about which "educational and health sources" they use. It does mention that they use "multiple" of each, though.

So, in the years 2002 and 2004, the ADDM Network collected data on 407,578 (in 2002) and 172,335 (in 2004) eight-year-old children living in fourteen areas around the country: the northern half of Alabama; the central region of North Carolina; the Coastal and PeeDee regions of South Carolina; the entire states of Arkansas and West Virginia; parts of the cities of Denver, Colorado; Atlanta, Georgia; St. Louis, Missouri; and Salt Lake City, Utah; and the cities and surrounding areas of Phoenix, Arizona; Baltimore, Maryland; Newark, New Jersey; Philadelphia, Pennsylvania; and Milwaukee, Wisconsin**. Of these children, 2,685 met diagnostic criteria for an ASD in 2002; in 2004, the number was 1,376.

Durkin et al. took the data on all the children determined to be autistic --- minus the ones living in Utah and West Virginia, since those sites didn't provide enough information to determine socioeconomic status for the children living there --- and compared prevalence rates for ASDs across three socioeconomic "tertiles": high, middle and low socioeconomic status, as determined by three factors: 1) percentage of people in the area living above the poverty line, 2) percentage of adults 25 and over in the area who have at least a bachelor's degree, and 3) median household income for the area. They also compared those factors between the autistic children and the general population of eight-year-olds living in the same areas at the time of the 2000 census.

Compared with the general population of eight-year-olds living in the same areas, autistic eight-year-olds are somewhat less likely to live in "poverty areas," or areas defined in the 2000 census as having 20% or more of its families with children living on poverty-level incomes, with 16.8% of autistic children living in such areas and 25.8% of all children living in them.

Similar small-but-noticeable differences show up with respect to the other two factors, median household income and proportion of adults with college degrees. Among the general population, the median household income was $42,898; among families with autistic children, it was $50,114. Autistic children, on average, tended to live in census blocks where a larger proportion of adults 25 and older had bachelor's degrees; 30.3% had them compared with the general-population figure of 24.8%.

These differences kept showing up, even when the comparisons were set up differently: besides comparing autistic children with their (approximate) peers on measures of socioeconomic status, the researchers also compared autism prevalence rates across the three socioeconomic-status categories they'd created, and found that the richest group had the highest proportion of children meeting criteria for autism, the middle-income group had the second-highest, and the poorest group had the lowest. This pattern showed itself across all the racial categories included in the study, too.

Now, the question is, does the design of this study correct sufficiently for (well-established) class differences in access to specialized medical and educational services? Can its findings of autism prevalence increasing with socioeconomic status be taken at face value?

Part of the reasoning behind the authors' contention that at least part of the association between autism and wealth is real lies in their use of school-based, as well as clinic-based, documentation. Theoretically, all children in the U.S. going to public schools are going to be monitored by their teachers and screened for learning and developmental disabilities if they start to have problems with classwork, behavior or social interaction. But not all schools have the resources to make this sort of individualized attention a reality. It probably won't surprise you to hear that schools in districts where poor people live have less money than schools in districts where richer people live, and accordingly the poorer school districts are less likely to employ psychologists, paraprofessionals or even college-educated teachers. With less space and less staff, also, even very dedicated, insightful and observant teachers aren't able to give individual attention to every student they see struggling.

The U.S. educational system might be more equitable than its health-care system --- last I heard, public schools were still legally required to educate every student living in their districts --- but similar issues of accessibility plague both systems. Even if our educational system is technically socialized --- available for free to everyone, paid for with taxes --- there are still huge differences between the kind of education (including special education) you can get at a well-funded school in a primarily upper- or middle-class district and the kind of education you can get at a school in a poor district. The richer districts can levy additional taxes to give more money to their schools, and students going to those schools also pay student fees to cover equipment and activities.

All of this leads me to suspect that ascertainment bias can be just as big a factor in an educational setting as in a medical setting.

The study authors tackle this issue in their Discussion section:

An important limitation of this study was that the ADDM Network surveillance system relies on information for children who have access to diagnostic services for developmental disabilities. We could not rule out the possibility that the quantity and quality of evaluations and the information available for case ascertainment might have varied by SES. We looked for evidence of this by examining the number of evaluations per child with ASD recorded in the ADDM Network surveillance system, reasoning that if the higher prevalence of ASD among children of higher SES was due to increased access to diagnostic services, high SES might be associated with a higher number of diagnostic evaluations per child. However, we found no association between the number of evaluations per child and SES. We also examined the mean ages at diagnosis by SES and found that children of high SES received an ASD diagnosis at an average age of 58.0 months, 1.1 month earlier than those of middle SES (p = 0.2838) and 2.7 months earlier than those of low SES (p <>

The other important factor that somewhat mitigates the effect of differential access to the educational and medical professionals who can diagnose autism and provide autism-related services on this study's outcome is the inclusion of a subgroup within the group of autistic children they studied who had no prior diagnosis of autism; there were enough of these children (1,244) to do a separate statistical analysis of this group to determine whether the association between autism and socioeconomic status still holds up among children who had never been evaluated. The association did still stand: even among those children with no previous diagnoses of ASDs, the ratio of autism prevalence as determined by the CDC of low- to middle- to high-SES children was 0.78:1:1.09. (That is, the poorest children were somewhat less likely to be autistic than the middle-income children, who in turn were somewhat less likely to be autistic than the wealthiest children). It's worth pointing out that the ratio for children with previous ASD diagnoses is stronger in both directions, at 0.70:1:1.25.

While I'm not sure this study goes far enough to correct for huge systemic inequities in availability of services, those two findings --- that number of evaluations per child does not vary with SES, and that autism prevalence does vary with SES among never-diagnosed children --- introduces some doubt in my mind where there had been none before. Maybe there *is* more to this socioeconomic-status thing than just access to diagnostic services. I remain skeptical, but no longer absolutely convinced that ascertainment bias explains everything.

*A more complete description exists in this 2007 article in Pediatric and Perinatal Epidemiology, for which I cannot find the full text anywhere online for free.

**The list of fourteen areas applies to 2002; in 2004, only eight of those areas participated --- Alabama, Arizona, Georgia, Maryland, Missouri, North Carolina, South Carolina and Wisconsin. That's why the numbers are so much lower for 2004.

Durkin, M., Maenner, M., Meaney, F., Levy, S., DiGuiseppi, C., Nicholas, J., Kirby, R., Pinto-Martin, J., & Schieve, L. (2010). Socioeconomic Inequality in the Prevalence of Autism Spectrum Disorder: Evidence from a U.S. Cross-Sectional Study PLoS ONE, 5 (7) DOI: 10.1371/journal.pone.0011551