Where Neurodiversity Meets Feminist Theory (Part I)

There's an interesting article by Amherst College's Kristin Bumiller in this past summer's issue of the University of Chicago's women's-studies journal Signs, titled "Quirky Citizens: Autism, Gender and Reimagining Disability."

It's a long article, but it still seems to jump around a lot between subjects. That's one of two major gripes I have with this piece, that once Bumiller gets deep enough into a topic to say really interesting things about it, she moves on. (The other gripe I have is with her tendency to depict the neurodiversity movement in what I think are overly broad strokes, which might be remedied by providing more quotes to back up assertions about what neurodiversity is, and by acknowledging controversies within neurodiversity where they exist. It would be really hard to do all that and have something short enough to have much of a shot at publication, though, so I can hardly blame her for oversimplifying the stuff that's not part of her argument).

The article is kind of complicated, narratively and structurally: she seems to tell the story of the history of autism, and the slow change in attitudes toward it, but at the same time she takes frequent breaks to discuss questions of gender as they arise. Since she does not advance a single, sustained argument but instead jumps around to look at a bunch of different topics, my responses to (some of) her points will be similarly scattershot.

The most interesting thing that stuck out to me was her categorizing of the different strategies of integrating autistics into society: she draws a distinction between "normalization" strategies that seek to bring marginalized groups more in line with the majority group (and thereby enjoy a wider range of social privileges) and "antinormalization" strategies that, rather than make it easier for more people to act like the standard white, male, middle-class person, try to make society more tolerant of differences.

Here's Bumiller explaining the rationale for "normalization" strategies:

Feminist theories have emphasized how in modern capitalist societies the privileges of citizenship are contingent on one's ability to embody the norm. In fact, citizenship often defines the primary dimensions by which we measure normality; the good citizen is an avid consumer in the market, makes appropriate demands on the state, and conforms to conventional family forms. The disabled, who experience a disproportionately high poverty rate in most Western societies (Burchardt 2004), are a variant of citizen outside the norm and are often seen as presenting an unwanted drain on the market economy like other groups that are considered undesirable because of their class, race or criminal record.
...Disability programs often state their objectives in terms that suggest their capacity to assure more normal social participation (e.g., promoting independent living, employability, functional social skills, and self-management). As applied, such goals often preclude individuals with disabilities from resisting norms that counter the political ideal of independence (like choosing to live in the company of one's family of origin rather than independently). (Smith 2001)

Now, here's her explanation of "antinormalization" strategies:

Antinormalization strategies potentially form the basis for a more far-reaching project whose aim is to shift the goal of the disability movement from simple demands for inclusion to a utopian vision of a society that values human diversity. This kind of activism has been adopted within the gay liberation movement, including, for example, actions that deliberately destabilize assumptions about proper sexual conduct in public places. To a lesser extent it has caught on among disability rights activists and has been applied in protests that hope to destabilize conventional images of the disabled. In its most radical form, antinormalization is devoted to pushing for the acceptance of difference and its full expression in an open democratic process. As it is put into practice, activists are likely to promote antinormalization side by side with normalization, either as mutual or contingent empowerment strategies (Meeks 2001). This grander scheme for social inclusion raises expectations for accommodating those identities that traditionally have been marginalized. This is important to a feminist politics that hopes to value disabled people's lives, respond to gender-based disadvantage, and expand our views of meaningful citizenship. (emphasis mine)

This scheme --- normalization vs. antinormalization --- makes for a pretty odd way of grouping different approaches to social integration. In the article itself, both the Americans with Disabilities Act and ABA for autistic children --- two things that could hardly evoke more markedly opposite reactions from most autistic self-advocates --- are classed as normalization strategies. Because of that, I'm not sure how useful those terms are for someone trying to navigate the confusing thicket of choices available to a novice advocate or self-advocate. Particularly, I think the "normalization" group ought to be broken down further, possibly along the lines of what is being normalized, and to whose benefit. For instance, there's a world of difference between, say, environmental supports that allow greater participation by disabled people in "normal" society by removing whatever physical, logistical or social barriers had previously kept them out, and "educational" strategies geared toward teaching socially or behaviorally "disordered" people to look, act and speak in ways that are already socially acceptable. The first benefits all disabled people; even if not every disability is accommodated immediately, the legal framework and political precedent exists to make it likelier that they will be. The primary beneficiary of the second strategy is society, whose institutions do not have to reconsider their approaches to dealing with a diverse population when the outliers can just be persuaded to suppress their differences. Also, besides its fundamental conservatism, the second strategy also creates a hierarchy among disabled people that favors those who can more easily pass as normal.

The Arty Aspie Strikes Again

This is the same character I drew in my earlier Arty Aspie post. I revisited her for two reasons: first, that I wanted to do a painting that gave a better view of her --- the other painting is a top-down view, which shows her only as a skirt, a ponytail and a pair of outstretched arms. That made for an interesting composition, but I wanted to do a picture that was more about her. So here it is.

I also wanted, at some point, to find a way to render, graphically, the way in which I see the world --- the perceptual hyperacuity that characterizes my autism and makes my world such a vivid, dreamlike and sometimes scary place. This picture, with its colorful background, is a step on that path. Now, the trick is to incorporate that level of intense color and light/shadow contrast into a more detailed scene.

"More Focus on Compliance": An Addendum to My Last Post

While I was writing the last post, it occurred to me that the emphasis on "compliance" within classrooms that Stephen Camarata noted in that AP article might be a resurgence of the educational philosophy of the Cold-War 1950s. When I talk with my mom about education, she always tells me that her classwork was mostly rote learning --- she learned French by memorizing dialogues, she memorized and recited speeches and poems --- while my siblings and I have tended to get a lot more creative or analytical assignments.

A few factors stick out to me as possible reasons the pendulum might be swinging back: first, we're in the middle of a huge panic over a perceived loss of American "competitiveness," economically and militarily. We're losing a lot of good-paying, high-skilled jobs overseas, and every year our students seem to fall further behind the rest of the world on science and math tests.

I wonder if this kind of cultural climate of fear of losing status in the international community might be one reason for periodic vogues of "back-to-basics" educational philosophies. After all, in the Cold War Americans worried mightily about what would happen if Russia's engineers and scientists got ahead of ours in the Space Race. Now, we might not be as worried about military threats (all the wars we're involved in, after all, are hugely asymmetrical in terms of firepower), but we see ourselves as extremely vulnerable economically. Globalization means that companies will probably choose to base most of their production in other countries, where labor is cheaper and fewer regulations are in place, while more and more countries are turning out bright, well-educated young workers from their colleges and universities. The West in general, and America in particular, no longer holds a monopoly on highly-skilled labor, and the model of pure, untrammeled capitalism America espouses (as opposed to Europe's more tempered, safer version) will admit of no incentive but profits, which leaves no room for policies geared toward growing a local economy.

Of course, the need corporations have for highly technically skilled grunt workers is only part of the equation describing educational policy in America. Much of the standardization of education can also be blamed on No Child Left Behind, which makes standardized testing just about an annual event, and distorts curricula accordingly. Finally, a related factor that surely contributes to it is the chronic lack of funding and staff that make it down to the classroom level. If a teacher is already taxed to the extent of his or her abilities just by the sheer number of students and volume of material, they're going to place a high value on sitting down, shutting up and letting them get on with it.

Back to the theme of the changing global economy, and its ramifications for education, I've wondered for quite some time why it is that when people see that their institutions are leaving them behind, the idea that comes first into their heads is, not to abandon or reform the institution, but to change themselves to keep up with it?

How Not to Handle "Behavior-Disordered" Kids

This article in today's Kansas City Star is appalling.

The short version, for those who don't want to click the link, is that schools are increasingly choosing to lock disruptive children --- often children who have autism or other developmental disabilities --- in small, isolated "time-out rooms," sometimes for hours at a time.

There's a quote, midway through the article, from Vanderbilt University's Stephen Camarata, that I think is right on the money:

I believe [the use of time-out rooms by schools is] because classrooms are much less flexible, with more focus on compliance.

That's probably the worst possible outcome of mainstreaming: that the special-needs kids' special needs are completely forgotten, and they are either ignored (if they're quiet) or punished (if they're not quiet).

When I think about myself as a child (and, really, even up into young adulthood), I see someone who takes what she is told absolutely literally, and who has a hard time recognizing the signs of physical distress. While a normal child, if she were getting hungry, dehydrated, feeling faint or having to go to the bathroom, would raise a fuss or decide to leave the room anyway to take care of herself, I would not have had the maturity or the self-awareness to do that.

I don't think teachers always realize just how vulnerable their autistic students are.

Rational Choice Theory: Not as Dead as You Think

Though much of classical economics and political theory is based on the idea that each person makes choices by carefully weighing each option's effect on their own self-interest and choosing the one that benefits them the most, it's now believed that people mostly make emotional snap judgments which are easily swayed by the terms in which the choice is cast.

That's called the "framing effect," and it's usually tested by proposing a hypothetical choice to groups of volunteers in different terms: the same choice described in terms of what they could gain or what they could lose. When the choice is "framed" in terms of potential gains, people tend to take more risks than people faced with the same choice framed in terms of potential losses.

However, not everybody ultimately responds in the same way to the framing effect. This 2006 study (summarized in the above-linked BBC article) by Caltech neuroscientist Benedetto de Martino had 20 people (all college students or college graduates) make a choice, given some hypothetical sum of money, to either keep a portion of it or to "gamble," with a 40% chance of keeping the whole sum and a 60% chance of losing it all, while inside an fMRI machine. While there was a definite overall framing effect --- the subjects for whom the choice was framed as a gain (i.e., "out of $50*, you keep $20, or take a chance to win, or lose, all of it") tended to be more conservative, opting for the smaller, surer payout, while those given the opposite spiel ("out of $50, you can either lose $30 or take the chance") --- not everybody ended up making the choice suggested to them by the framing.

So far, so predictable, right? Most people are susceptible to the framing effect, but individuals differ in their degree of susceptibility, some to the effect of not being swayed at all. That's hardly earthshattering news.

No, the interesting tidbit to come out of that study is this piece of fMRI data: amygdala activity did not differ between those people susceptible to the framing effect and those who are not. What distinguished those two groups was, instead, activity in the medial and orbital prefrontal cortex, where higher reasoning and suppression of impulses occur. In anatomical terms, that means everybody, regardless of how "rational" their ultimate choice was, reacted emotionally to the choice; the people who resisted the framing successfully were just better at second-guessing their emotional reactions with calculations.

And now, finally, the thing I really wanted to talk about: in this study published in last Wednesday's Journal of Neuroscience (summarized here on Science Daily), de Martino and his colleagues posed the same scenario (i.e., the decision to keep a portion of the money or gamble for all or nothing) to a group of fourteen people on the autism spectrum and fifteen age-, sex- and IQ-matched NT controls. However, instead of using fMRI to track the subjects' brain activity during the choice, de Martino et al measured skin conductance, which is a measure of physiological arousal (i.e., anxiety). I was not as impressed with that choice of metric, as skin conductance seems to be a much less direct measure that gives us less insight into what's going on in the brain.

Quibbling aside, what they found was that the autistic group a) showed no significant framing effect and b) showed no difference in skin-conductance response to different frames. (The control group had lower skin-conductance measurements for the "gain" frame than for the "loss" frame, indicating a lower level of anxiety when the choice was phrased as one between gains rather than losses). The autistic group did show a higher overall level of skin conductance, which the study's authors attribute to greater anxiety levels in general. The inference they draw from these findings is

...that ASD subjects, although having an absolute emotional response, crucially fail to differentially engage (sic -- split infinitive!) emotional processes in response to the framing manipulation. (Italics and emphasis mine)

I thought I would pre-empt any objection that this research might be used to justify the "emotionless robot" stereotype of autistic people. Nowhere does this article deny that we experience emotions --- indeed, the autistic group was the group with the higher recorded emotional responses! It's just that our emotions aren't as readily influenced by external cues, and maybe also that our emotions are not as closely involved in our decision-making process.

De Martino leans more heavily on this latter hypothesis than I do --- I think only the former is demonstrated by this study.*** Here, he enlists his own earlier study, and some other studies of the neuroanatomy of autism, to try to bolster this point:

In a previous fMRI study (De Martino et al., 2006; Kahneman and Frederick, 2007), we showed that the engagement of an amygdala-based emotional system played a key role in underpinning a framing effect. These previous results, combined with the [skin-conductance] data shown here, suggest that the failure to assign emotional salience to contextual cues and the consequential lack of behavioral bias in ASD may result from an amygdala based mechanism. A wealth of empirical data supports this hypothesis. First, histopathological abnormalities of the amygdala such as increased cell density and a reduced dendritic arborization have been described in autism (Bauman and Kemper, 1994). Moreover, Howard et al. (2000) suggested that persons with high-functioning autism showed a similar neuropsychological profile to that seen in patients with amygdala lesions ... Last, several imaging studies demonstrate blunted activation of the amygdala in ASD during tasks which involved processing of facial expressions (Baron-Cohen et al., 2000; Critchley et al., 2000).

Interestingly, I took the findings from de Martino's 2006 study as indications that autistic people aren't necessarily detached from their emotions during decision-making. If you scroll back up and look at the results of that study, you'll find that all subjects, regardless of susceptibility to framing effect, had the same level of amygdala activation. The difference was in the prefrontal cortex. At minimum, I'd want to see the 2008 study replicated with fMRI rather than skin-conductance, so that investigators could look at the roles played by both of these brain regions in autistic decision-making.

That said, this is exactly the kind of autism research I like to see. It's descriptive, and highlights the differences between NT and autistic cognitive styles without assuming that autistics simply aren't thinking.

*In the original study, the amounts are in British pounds. I didn't bother to convert because it's a hypothetical scenario, and will work with almost any** arbitrary sum of money.

**An exception to this rule would be really large amounts of money. This game has been played with huge hypothetical sums of money, like $1 million for the sure payout and $2.5 million for the gamble. The ratio between those sums is the same as the $20 and $50 mentioned above, but more people choose to keep the sure payout in the high-value game because both numbers are so high. With those stakes, people would rather play it safe and get rich for sure than take a less-than-favorable chance to get even richer.

***You could make an argument that the lack of a risk-aversion corresponding in significance to the skin-conductance readings in the autistic group argues for a disconnect between emotions and decision-making in autism, but I don't think there's enough of a basis here to proclaim that as fact.

De Martino, B. (2006). Frames, Biases, and Rational Decision-Making in the Human Brain Science, 313 (5787), 684-687 DOI: 10.1126/science.1128356

De Martino, B., Harrison, N., Knafo, S., Bird, G., & Dolan, R. (2008). Explaining Enhanced Logical Consistency during Decision Making in Autism Journal of Neuroscience, 28 (42), 10746-10750 DOI: 10.1523/JNEUROSCI.2895-08.2008

Blog Love!

So, I got this blog award from Shiva, and now I need to pass it on to seven other blogs.

This is kind of a tough decision, since I would ideally pick less-widely-read blogs than my own to help clue new people into them. Unfortunately, I don't know that many Cool Little New Blogs that more people should be reading, so my list will be a mix of Cool Little New Blogs, older blogs that still aren't as widely read as they should be, and blogs that are fairly well-known but still awesome.

Here goes:

Sarah of Cat in a Dog's World certainly qualifies as a new blogger, and I really like what she has to say. She mostly blogs about autistic self-advocacy, and has recently critiqued both presidential candidates from an autistic-rights perspective.

Another autistic-rights blogger who writes insightful, informative posts about politics is ABFH from Whose Planet Is It Anyway? Most of you probably already read her, but she's awesome and I'm going to nominate her anyway.

The third autism blogger I want to recognize is Ettina from Abnormaldiversity, whose blog is sort of a mix of personal reflections and critiques of autism research and autism in the media.

No blog-love list of mine would be complete without Arthur Silber, whose blog Once Upon a Time is hard to explain briefly. It's a political blog in the sense that all social life is political; he writes about subjects as diverse as American exceptionalism, Wilsonian Progressivism and its relation to American imperialism, racism, misogyny, torture, authoritarianism and the psychology of Alice Miller, and manages to tie them all together in a cohesive picture of American mass psychology. I don't think his work is of interest only to Americans, either, so don't let that stop you from going over there. Also, while he doesn't seem to allow comments, he does read, and answer, reader emails.

Another blog you should all be reading, if you aren't already, is Junkfood Science. Sandy Szwarc is a nurse, and does a great job debunking hysterical news articles (and, sadly, equally hysterical journal articles) about the grave dangers of being fat.

There's also Body Impolitic, which deals mostly with feminism, body image and disability, although it touches on a lot of other ways in which human bodies can fall outside the standards and categories people try to shoehorn them into.

Finally, there's Hell On Hairy Legs, an Australian radical-feminist blogger who's still in high school. She blogs mostly about gender, sexuality and race, and is unusually smart, perceptive and funny. (I'd say she is smart and perceptive for her age, but that's patronizing and, really, she's smart and perceptive period.) Anyway, I direct you to her, not only for that reason, but because I think that, as a high-school student, she probably experiences a lot of sexism, heterosexism, and other bigotry in her daily life and would likely appreciate all the friendly, non-bigoted readers she can get.

Animals in Translation, revisited

While poking around Science Daily, I came across this article summarizing a recent essay in PLoS Biology disputing the central thesis of Temple Grandin's Animals in Translation --- the idea that animal cognition and autistic human cognition share an ability to "think in detail," to perceive consciously (and remember) all the raw sensory data that normal humans' brains filter out and replace with a simplified mental construct. (An example of this tendency would be what happens when you look at a field of grass --- or a beach, as in the example given in the article. Odds are, you don't register every individual blade of grass or grain of sand as you walk along; you just notice grass or sand. For Grandin, for me and for most, if not all, autistics, these vistas that seem boring and uniform to an NT person are as dynamic and heterogeneous as a crowd of people appears to that same NT. We see each part individually, note the movement of each blade of grass in the wind, or the glare of each grain of sand in the sun).

Grandin had posited in her book that many animals shared this characteristic --- that birds, for example, used this amazingly detailed visual memory to remember where they had hidden food caches, or that horses and cattle might panic at the sight of some intense visual signal, like a brightly colored T-shirt flapping in the wind, that most humans would not even register. While the authors of the article (Giorgio Vallortigara, Allan Snyder, Gisela Kaplan, Patrick Bateson, Nicola S. Clayton and Lesley J. Rogers) do not dispute that animal intelligence can involve this kind of specialized storage of massive amounts of sensory data, they disagree that all animal cognition is like that. They reference studies done on pigeon perception and intelligence, and found that pigeons (and other birds) are capable of both holistic, gestalt-type "global" perception and detailed, piecewise "local" perception. They also observe that animals with the capacity for prodigious spatial memory do not ever seem to experience sensory overload, nor do they show "deficits" in other areas of cognition or behavior*, both of which they identify with autism in humans. Other discrepancies they find between animal brains and autistic human brains are the intact mirror-neuron systems** that have been found in some animals, and the lack of a relationship between social behavior and intensive use of spatial cognition. These things lead them to decide that certain animals' highly-developed use of visual and spatial perception and memory are not so much features of a larger cognitive style as they are specific adaptations to each kind of animal's environment and lifestyle.

Temple Grandin has also written a response to this article (it's in the green box embedded in the article's text), in which she says that more study is needed to verify Vallortigara et al's claims about the cognition of spatially-gifted animals; specifically, she would want to test their abilities in areas related to but distinct from their particular skill, to see if that skill is "hyperspecific," or restricted to a particular context, which she claims would make it more like an autistic savant's skill.

*I don't think every autistic savant necessarily has "deficits" in skills that are not his or her savant skill; Daniel Tammet is one example I can cite right off as a savant who is also thought to have a high level of general intelligence. I think the defining characteristic of a savant would be the highly developed, hyperspecific "islets of ability," regardless of the person's level of ability in other areas. I think the stereotype of the "idiot savant" might lead people to notice savantism more in people with profound impairments in other areas, and also that those instruments we have to test intelligence are so narrowly specific to one type of intelligence that it is reasonable to suppose that it would tend more often to fail to identify intelligent people whose minds work in unusual ways, like savants.

**At some point I intend to do a post on mirror neurons. They're the Latest Thing in autism research, but I'm still not sure there's any there there.

A Postscript on Demand Avoidance

Though the bit about having an involved fantasy life and doing a lot of pretend play definitely describes me, the rest of the description of Demand Avoidance does not hold true for me. Indeed, my capacity to pretend is the one way in which I am not a textbook Aspie.

Specifically, the things in Newson's diagnostic criteria for PDA that stick out as obviously not me are "essentially socially manipulative" avoidance strategies, normal ability and inclination to interact socially, people-directed interests, and demand avoidance*. In all of those things, the notes in the sidebar contrasting PDA children with autistic/AS children are more likely to describe me than is the main body of text describing only PDA children.

PDA characteristics I do have are (obviously) imagination, but also mood lability, passivity and identification with adults/ignorance of what is age-appropriate. Many of these are also part of AS, and the last one would seem to go hand-in-hand with any kind of atypical development pattern. If you aren't developing at the same rate or in the same order as your peers, of course you'll have a shaky grasp of what's "normal" for your age!

I think my lack of social awareness and total inability to read the emotions of people around me clearly mark me as AS rather than PDA, imagination notwithstanding.

*When I do avoid demands, it tends to be more incidental than purposeful. I miss a lot of socially relevant signals, and missed even more as a child.

The Autism Spectrum Is (Still) Expanding

Ettina recently piqued my interest with a comment she left on one of my earlier posts, referring to "Pathological Demand Avoidance" as a subtype of autism/PDD. I follow autism research pretty closely, and had never heard of such a category, so naturally I had to read all about it. I found not only a description of PDA, but also of several other emerging autismlike categories.

Not surprisingly, there is a considerable gap between Ettina's writing about her own demand avoidance (she does not consider it "pathological") and the official descriptions I've been able to find online, which emphasize manipulation of others and deliberately provocative acts. The areas in which Ettina's self-assessment matches the official description are:

• clumsiness
• vivid imagination*
• good eye contact; able to pass as NT
• flying into sudden rages when told to do something
• mild, often barely-noticeable social difficulties**

Where the accounts begin to diverge is in the interpretations offered for the sudden defiant or emotional outbursts. Elizabeth Newson (who first described PDA) says people with PDA are "obsessed" with avoiding the "ordinary demands of life" and lack the core of personal identity (and the corresponding faculties for self-discipline: pride and shame) that normal children begin developing by around preschool age. Digby Tantam, in his brief article describing a bunch of PDA teenagers (whom he labels as having a subtype of Asperger syndrome) says people with PDA create confrontation and chaos because they cannot read other people's emotions, and desire situations in which the emotional content is obvious (i.e., crises).

In her open letter to Tantam, Ettina contradicts the latter hypothesis.

I am terrified when others are mad at me, and very upset when others are sad around me. It would make no sense for me to deliberately induce such an unpleasant situation. If I'm scared because I don't know how someone is feeling, I withdraw and try not to be noticed. I don't try to provoke them to attack me or induce sympathetic anguish in me by being upset!

She clearly doesn't need to provoke extreme reactions in order to notice other people's emotions; indeed, so sensitive is she to what others are feeling that such scenes cause her great distress. Neither does her writing give any indication of an underdeveloped sense of self. However, these two experts' bafflement at PDA children's unexpected outbursts and noncompliance --- and the insistence that it must be either willful or indicative of some profound lack of selfhood --- evoke earlier autism experts' confusion over sensory overload. It took a long time, and listening to the voices of actual autistics, before unusual sensory experiences were accepted as being part of autism, and autistic people's reaction to those experiences began to be seen as reactions, rather than bizarre behavior indulged in just to annoy others. I think that Ettina, and others with PDA, are probably so hypersensitive to the emotions of people around them that tension and conflict, however slight, literally incapacitate them, as certain sensory stimuli are already known to incapacitate some autistics. That would mesh with the inclusion of PDA under the PDD umbrella, since the inability to mute or filter one's perceptions figures in both PDA and autism.

*Interestingly, vivid imagination and a love of pretending are characteristics that often show up in autistic girls and women. Probably not coincidentally, PDA has a much higher female-to-male ratio than do autism or AS (1:1 as opposed to 1:4 and 1:9, respectively).
**Ettina describes these as specific to particular areas of social understanding. She does perfectly well at reading emotions and nonverbal signals in one-on-one interactions, but has trouble recognizing group dynamics.

Human Diversity and the Surveillance State

This post by ABFH got me thinking about all the ways in which the climate of suspicion that prevails in post-9/11 America (and in police/surveillance states in general) tends to single out those who differ in some way from social and cultural norms for scrutiny, harrassment and disenfranchisement. People of color, immigrants, foreign nationals (especially those from non-European countries), youth, members of religious, cultural, ethnic or linguistic minorities, people with disabilities or mental illnesses, civil libertarians and left-wing political activists are the canaries in the coal mine when it comes to civil-rights violations; as the margins of society are slowly pared down closer to the core, all it will take to flag a person as suspicious may be a left-of-center voting record, unorthodox books checked out on a library card, donations to the wrong charities, or even buying habits that don't match the typical pattern for your demographic. (Make $100,000 a year and haven't bought a new car? Why not? You're not planning to blow yourself up, are you??)

I've mentioned previously how the TSA's methods of screening for terrorists using subtle behavioral cues would also implicate many disabled, mentally ill or simply stressed-out air travelers with no criminal intent whatsoever. Proposals for requiring voter identification at the polls, which are ostensibly to prevent fraud but would have the effect of screening out voters without proper identification, like those without driver's licenses (disproportionately elderly, poor or disabled) or birth certificates (disproportionately elderly and black), constitute another example of how difference can be criminalized.

The last piece of the puzzle I want to address is the use of personal data of the type I listed in the first paragraph --- travel history, TV viewing habits, movie rentals, online purchases, library checkouts --- to create electronic dossiers on every American for whom such data exist. Since no one owns these data, anyone with the power to dig them up and analyze them (which, given the processing power needed to do that for any appreciable number of people, limits that pool to fairly large corporations and the government) can do so.

According to the "Talk of the Nation" segment linked above, those tools are mostly being used by corporations (and political candidates --- they're selling something, too) to develop precision-targeted advertising, but there was a brief mention of counterterrorism applications as well. Specifically, agents would be combing through those banks of personal data looking for anything "suspicious." An example that had actually been considered (although scrapped) was to track falafel consumption nationwide, and boost surveillance of areas where the rate rose sharply!

As silly as that sounds, there are serious implications to it. If the general MO is going to be tracking innocuous cultural markers like food, reading and media consumption, that sets the stage for Fahrenheit 451-style policing of culture. Indeed, it's already happening a bit; among those detained at Guantanamo Bay are a number of scholars of Islam whose areas of study flagged them as potential terrorists. The technology doesn't distinguish between an Islamic scholar researching a book on, say, the theological underpinnings and historical context of Wahhabism and an al-Qaeda recruit reading Wahhabi texts to psych himself up for a suicide bombing. In the eyes of the surveillance state, all contact with the Forbidden Other is equally suspect.

This is why a surveillance state can't handle human diversity. If the goal is to be able to tell, at a glance, which individuals in a large, ever-changing crowd might make trouble, the ideal scenario is one in which law-abiding citizens all look one way and terrorists all look another way.

"Reparative Therapy" Still Being Used on Gender-Variant Kids

I was surprised to read, in this entry on Shiva's blog, that today, in 2008, children who display gender-atypical behavior can be put through intensive behavior-modification regimes to get the "correct" gender role drilled into them.

When I saw that, I had a strange sense of deja vu. A lot of the rhetoric used in support of these therapies --- and the actual treatment itself --- strongly resembles the language and techniques used in George Alan Rekers and O. Ivar Lovaas's now-infamous 1974 use of painful punishments to suppress young boys' preferences for feminine clothing and activities.

Here is Kenneth Zucker (whose invitation to speak before England's Royal Society of Medicine is the occasion for Shiva's post) on the necessity of preventing children from growing up to become transsexual or transgendered (quoted in J. Michael Bailey's 2003 book The Man Who Would Be Queen):

Zucker thinks that an important goal of treatment is to help the children accept their birth sex and to avoid becoming transsexual. His experience has convinced him that if a boy with GID (Gender Identity Disorder) becomes an adolescent with GID, the chances that he will become an adult with GID and seek a sex change are much higher.
...
Failure to intervene increases the chances of transsexualism in adulthood, which Zucker considers to be a bad outcome. ... Why put boys at risk for this when they can become gay men happy to be men?

Now, here's Lovaas and Rekers, in 1974:

It appears to be the case, in boys at least, that substantial deviation from appropriate sex-role behavior at age 5 yr leads to substantial gender problems in adulthood in the majority of cases (cf. Green and Money, 1969). Adult cross-gender problems not only develop early in childhood, but also contribute developmentally to difficulties in social relationships, so that by adulthood, the syndrome is frequently accompanied by other serious emotional, social and economic maladjustments. ... A third reason for treating (gender-variant children) is that intervention on deviant sex-role development in childhood may be the only effective manner of treating (i.e., preventing) serious forms of sexual deviance in adulthood ...

I don't detect much difference at all between those two passages in terms of the fundamental attitude toward unusual gender expressions or sexualities. Both stress that "deviance" must be nipped in the bud, extinguished while the person is still a malleable child, that society might be spared the *horror* of a gender-variant adult. Really, the only thing that suggests to me that these are not passages from the same era is the inclusion in the first quote of gay manhood as an acceptable outcome for a feminine boy. (I'm sure that Rekers and Lovaas would have considered that, too, a "maladjustment").

As I said in a comment on Shiva's post, the same bigotry towards gender variance is evident now as was common thirty-five years ago; the line separating acceptable difference from pathology has just moved a little.

Sanity Prevails at NIH

I read today in the Kansas City Star that the NIH's Trial to Assess Chelation Therapy for coronary artery disease had been suspended. This comes after I read last week that NIMH's similar study of chelation therapy for autistic children had also been stopped altogether. While the TACT has only been put on hold, with no new subjects being recruited, until an independent review board authorized by the Department of Health and Human Services's Office for Human Research Protections has investigated its informed-consent procedures and made sure the subjects were actually informed of all the relevant risks of the medication they'd be taking (I blogged before that they were not), the autism study has been cancelled altogether.

Why did they just now realize that chelation with DMSA is dangerous, and should not be used on children who do not have lead poisoning*? According to this article, the results of this 2007 study convinced a NIMH review board that the risks of giving DMSA to children with normal blood and tissue lead levels were greater than they had previously thought. The study, done with rats, showed that exposure to DMSA in rats without any previous exposure to lead impaired those rats' performance on tests of attention and learning.

From the study's discussion of the results:

The present study also revealed the unexpected finding that a single 3-week course of succimer treatment during early development produced lasting dysfunction in cognition and arousal regulation in rats not previously exposed to Pb. Note that these four behavioral tests were administered across a 7-month period following cessation of succimer treatment, suggesting lasting brain changes. ... These various impairments were similar in magnitude to those produced by the High-Pb exposure. (Emphasis mine).

Faced with this new information, NIMH decided to cancel the study and instead use its funding to pursue other autism-related research topics.

While I am gratified that the NIH decided not to go forward with either of these irresponsible investigations, I remain puzzled as to why they even approved them in the first place. In the case of the autism study, there is already a huge body of evidence showing no relation between heavy-metal poisoning and autism, and in the case of the TACT, the medication being studied was contraindicated for the category of patient making up the entire study population! And this information didn't even make it into the consent form. They should have quashed these studies while they were still in the planning stage.

*Yes, lead, not mercury. While there are a few cases of DMSA being used to treat mercury and arsenic poisoning, they do not constitute sufficient evidence that it is safe and effective for use with those metals. Consequently, DMSA has only been FDA-approved to treat lead poisoning.

On Drawing

I've always liked to draw, and always been fairly good at it. For a while I wondered if I might be a drawing savant, but decided my drawing skill had changed and developed too much for that. For me to be a savant, I would have to have started drawing with much more detail and grasp of perspective than I did.

Even if I wasn't a savant, I still wonder if my autism hasn't played a role in shaping my drawing ability and making me like to draw. I don't draw the same kinds of things most autistic artists do --- I think of autistic artists as all choosing to draw the sort of sprawling, imposing cityscapes that Stephen Wiltshire draws, while I draw mostly human figures*, with occasional natural landscapes. I do tend to draw insanely detailed line drawings, with very dark and heavy lines, though. Also, I've always drawn pictures piecewise --- do small parts one by one, in great detail, and see if they fit together --- which sometimes gives me trouble with proportions. But I have even more trouble when I try to sketch out a general plan for a picture; when I do that, things quickly get too large. It seems the only way I can stay on the paper is to keep the part I'm working on very small. This difficulty maintaining scale looks a bit like the fragmentation observed by Fein, Lucci and Waterhouse in their 1990 study comparing 34 autistic children to 32 normal children in their ability to reproduce drawings of geometric figures they were given and their ability to draw a child freehand. (If you can access the full article, it includes some sample drawings.) I also can draw about equally well from memory, from direct observation and from photographs, although my ability to draw something from memory depends on my understanding of what I see. I don't have a perfect photographic memory, so conceptual understanding of the structure of whatever I'm trying to draw is needed to fill the gaps in my memory of it. That can go the other way, too; as I draw something, I usually come to understand it better.

That's probably the biggest difference between my drawing and a savant's drawing: for me, drawing is a long, intense, highly intellectual process, while they just seem to bang them out automatically.

*I was interested to see this article, which apparently unearths an autistic drawing savant who prefers to draw human figures, and also who doesn't draw from memory. She is also female, which led me to wonder if this might be another sex difference within autism --- just as autistic girls tend to be more interested in pretending and fiction writing and art than autistic boys, maybe female autistic artists tend to choose different subject matter for their pictures. Most of the famous drawing savants are boys and men, after all...

Study: Women Do Better Than Men on Citalopram

Via The F-Word, I found this article on Science Daily describing one of the largest studies ever done on sex differences in response to antidepressant drugs. The study was published in the online version of the Journal of Psychiatric Research, and I was unable to get to it from the journal's website, which apparently only archives the print version.

This study differs from most previous studies of sex differences in antidepressant response in that it is larger (it enrolled 2,876 participants, while most of the studies it references enrolled only a few hundred or less), less selective in terms of the kind of patient it enrolled (previous studies, mostly clinical trials, tended to exclude a lot of potential participants, like those with additional co-morbid psychiatric disorders, who might introduce confounding factors, which means that their sample populations were not very representative of the general antidepressant-taking public), and uses three depression rating scales, scored by independent raters.

The study found that, while the women had more severe depressive symptoms, earlier age of onset, more overall life stress (they were poorer, more likely to be black or Hispanic, and slightly more likely to be divorced), and more likely to have family histories of depression, drug and alcohol abuse, and suicide, and more likely to have personal histories of attempting suicide, they had a significantly greater chance of seeing their depression go away entirely (29.4% of women vs. 24.1% of men). This is even though the women had higher rates of co-morbid anxiety disorders, which another study associates with poorer response to antidepressants.

The authors cite one other study with a large sample size: this 2005 study followed 5,452 patients who were given sertraline for their depression. They found no sex differences in patient response, but they were using a much lower (subtherapeutic) dose, and were dealing with different demographics than Young et al had. Also, Young et al failed to use a control group, and failed to blind either the study participants or the raters. They therefore acknowledge that the placebo effect could be boosting their response rate, though they claim the placebo effect works on both sexes equally, so theoretically should not disrupt a study of sex differences.

Though their study was not designed to pinpoint a mechanism for the observed difference in response, the authors propose that, as has been shown in other primates, estrogen acts in several ways to boost serotonin levels. One way you might investigate that would be to study the response of a large group of women to an SSRI, and compare the remission rates of, say, postmenopausal and premenopausal women, or women on hormonal birth control versus not. If it is estrogen, you would expect to see differences between women along those lines.

One final thing: while searching the Journal of Psychiatric Research's website for the original article, I happened across this article, which argues that large sample sizes in antidepressant trials tend to skew the results, probably due to a loosening of the criteria near the end of the recruitment phase. Not sure what to make of that; I had always thought that, with clinical trials, bigger was better, or at least more indicative of a drug's effect on the general population.


Thiels C, Linden M, Grieger F, & Leonard J (2005). Gender differences in routine treatment of depressed outpatients with the selective serotonin reuptake inhibitor sertraline. International clinical psychopharmacology, 20 (1), 1-7 PMID: 15602108

Young EA, Kornstein SG, Marcus SM, Harvey AT, Warden D, Wisniewski SR, Balasubramani GK, Fava M, Trivedi MH, & John Rush A (2009). Sex differences in response to citalopram: a STAR*D report. Journal of psychiatric research, 43 (5), 503-11 PMID: 18752809

Unintentionally Hilarious Quote of the Day

This one comes courtesy of the Kansas City Star's Business section, in this mini-review of a new book, Leadership and the Sexes.

Subtitled Using Gender Science to Create Success in Business, this book goes beyond the stereotypes in sharing what the latest scientific studies reveal about male/female brain differences. My "a-ha" moment: Men's brains are wired to more often enter a rest or zone-out state.

I had to laugh aloud at that. "Don't bother those busy men with all your lady-prattle, dearie, you don't want to bore them!" I wonder if they looked at whether men were able to attend longer to the words of superiors as opposed to peers or underlings, or to other men as opposed to women?

Don't get me wrong, I love neuroscience, and think more research into the ways that human brains do differ could give us valuable insights into human relations, individual psychology and ways to maximize human happiness. I tend to be very skeptical, though, when the differences neuroscience "discovers" correspond to existing notions of race or gender. Are women really so much more empathic than men, or is it that we are more likely to be in support roles (secretaries, nurses, assistants, receptionists) than working independently or calling the shots? I think it's lazy research just to look at men's and women's brains and assume any difference you find there must be innate. Given what we know about the effect of habit on the architecture of the brain, we should be particularly vigilant about controlling for life experience in these kinds of studies.

There's a particularly instructive cautionary example of this sort of shoddy writing in recent memory: when Louann Brizendine first published her opus The Female Brain in 2006, she claimed in its pages that women spoke an average of 20,000 words per day to men's 7,000. Imagine that! Almost three times as many words. That would certainly go a long way toward explaining the inter-gender communication problems that are the basis for so many movies and sitcoms, if only it were true. It turns out Brizendine just made that number up. When called on it, she backed down some, saying she meant that women used more "communication events" (words, but also gestures, facial expressions and other such ephemera) than men per day. Sadly, that turns out to be wrong, too.

I think the persistence of the "women talk more than men" meme and the conventional wisdom that men just don't listen very well are related, and both have to do with the marginalization of women's speech. Men won't listen to women if they think they don't have to (and you don't really have to listen to someone lower than you in a hierarchy; you can always ask them to repeat it, send you a memo or, ultimately, blame them for your ignorance of whatever they were trying to tell you), and, as long as women are seen as illegitimate newcomers to the public sphere, any speech uttered by a woman will be seen as excessive, because men will be used to her silence, or her absence.

Because I am an Arty Aspie ...

... I saw this picture and decided I had to cut it out and save it, and then paint my own version of it, sans suitcase.

Why did this picture speak to me? Well, without the suitcase to provide an excuse for her twirling, the Lady in Blue is just spinning for the sake of spinning. She's taking solitary pleasure in the sensation of motion, the feel of her skirts swirling around her, and of her hair streaming out behind her head. She's in her own world, completely absorbed in what her senses are telling her.

She is stimming, in other words.

Thank You, Sarah Palin

I have conflicting feelings about Sarah Palin. As an environmentalist, I am alarmed at her desire to open the ANWR for drilling (and the rest of the Alaskan wilderness to drilling, logging, mining, commercial fishing and whatever other ways exist to turn tundra and forest into dollars), at her dismissal of efforts to protect the salmon, beluga whale and polar bear, and at her endorsement (and practice) of shooting wolves while sitting in an airplane. As a feminist, I am discouraged by her opposition to keeping legal abortion the law of the land, and dismayed by her endorsement of one-word sex education (The word? "Don't."). As a bisexual woman and general LGBTQ ally, I am saddened that she does not consider everyone's committed relationships worthy of civic recognition. Finally, as the proud holder of a science degree, I do not want anyone sympathetic to creationist crankery allowed within fifty feet of the White House (or the House, or the Senate, or any state legislatures, governor's mansions, local school boards ...).

In fact, if it weren't for this:

Children with special needs inspire a special love. To the families of special-needs children all across this country, I have a message: For years, you sought to make America a more welcoming place for your sons & daughters. I pledge to you that if we are elected, you will have a friend & advocate in the White House.

... I would have no trouble recognizing her as anathema to everything I consider important.

Even with this avowed support for families with disabled children (which I believe, due to her personal connection to the issue and her past endorsement of the ADA as "one of the most compassionate and successful civil-rights laws in American history," is sincere), I do not think a McCain/Palin administration would necessarily bring about a kinder, gentler America for disabled people, for all the reasons ABFH lists. Indeed, McCain/Palin's commitment to cutting domestic spending and sticking with a market-based health-care system seem to indicate that lower- and middle-income families with disabled members couldn't count on much help from their administration, should they be elected.

However, there is one invaluable service Sarah Palin has done for disabled Americans, and will continue to do throughout her hypothetical Vice Presidency, and as long as she remains in the public eye. She has used her bully pulpit to speak lovingly and optimistically of her son, Trig; to call him a blessing rather than a burden, and to acknowledge his "special challenges" without bemoaning the normal baby she might have had, or making lists of things Trig will never be able to do, or calling for the eradication of Down syndrome in general.

Autism advocacy groups could learn a lot from her.

Hyperlexia?

Since I first encountered the term in the autism literature, I figured I was probably hyperlexic. After all, I have a humongous vocabulary* and have always read and written compulsively. No-brainer, right? Hyperlexia: too much language!

This definition makes it look less like anything I've got: my ability to get the gist of a passage has always matched my vocabulary, and the wiki stipulates that general comprehension must lag word recognition. Now, the American Hyperlexia Association's webpage says that the diagnostically relevant discrepancy is between written and spoken language --- and, indeed, I retain much more of, and notice finer details in, what I read than what I hear. Similarly, I am far more articulate in print than I am in person or on the phone. Some of it is because I can take more time in choosing the words, but in media like instant messaging the advantage in editing is negligible. Yes, you can proofread and rephrase before you send an IM, but the conversation is happening in real time, so you can hardly spend a day picking just the right synonym for "ridiculous" that adequately renders all the subtle shades of contempt and exasperation you want to convey. (Not that anyone I know has ever spent a day doing that ...)

There is also an enlightening discussion of hyperlexia in the comments on this post of Ballastexistenz's.

*I've gotten to Level 50 on Free Rice, and typically hover around Levels 47-49. I also got a 770 on the Verbal SAT; the three questions I missed were all sentence-ordering questions.

Happy Blogiversary to Me!

I've been blogging for exactly one year now, it seems. As I've never had a blogiversary before, I don't know what one ususally does to celebrate it, so I will just make something up.

...

I know! I'll make my blogiversary a time to revisit my first and second entries, which lay out the general scheme of the blog as I first envisioned it, and try to chart the blog's progress along that path (or branching off of it, as the case may be). It will be a time of reflection and introspection. And cake.

Well, the most obvious divergence from the initial plan is the inclusion of posts that aren't about books. I mostly did that because, if I only posted after I finished a book having to do with autism, I'd be posting only once every month or two.

Another thing that follows somewhat from that is that I've brought a lot more of myself to the blog than I had initially intended. In blogging about autism research, I bring the scientific part of myself to the front, and in blogging about feminism and about my own life, I allow more of my personality, philosophy and ethics to show through. I do not think these are bad things.

In my second entry, I have a list of themes I hoped to track through their various permutations in different works. I've only gotten to some of these, though I definitely have posts waiting about others. Also, it was part of my general plan to review a bunch of books before jumping into compare-and-contrast mode.

By far, I've written the most posts about autism and gender. I've also managed to write a fair amount about empathy and metaphor, and maybe obliquely dealt with distance in these posts. I haven't done much with the idea of first contact, or anything at all with narrative.

I also think I'm slowly adding another theme to the list: context. This refers both to the environment through which a given autistic character moves, and its effect on him or her, but also the extent to which the whole society in which he or she lives defines autism (and, by extension, the character). I think sci-fi is most conducive to this kind of analysis, if only because sci-fi writers make up whole societies, so they have to spend more time describing them than plain old fiction writers, who are free to restrict their scope to the characters' private lives.

I'm also gearing up to do another series of posts, this time on basic autism science. Look out, Internet!

Thoughts on the "Extreme-Male-Brain" Theory of Autism

I've been skeptical of Simon Baron-Cohen's Extreme Male Brain theory of autism ever since I first heard about it; my thought then was that, even granting that there are two distinct, gender-specific cognitive styles, the likelihood is much greater that autistic cognition would differ radically from both than that it would resemble one or the other.

(I think the example I was reading about when I had that thought was navigation: supposedly, men navigate using a mental map, while women use landmarks. "Well," I thought, "I navigate by playing a mental video of myself walking the route I'm supposed to take." Landmarks are part of it, but equally important is remembering turns and orientation. And both of those approaches are a lot more abstract than mine --- the archetypal man constructs a mental map he works from, and the archetypal woman remembers a list of landmarks. I record a complete visual memory of myself walking the entire route, and play bits of it back at will. It's less efficient, but more comprehensive.)

Over the course of the long article I linked to in the first paragraph, Baron-Cohen develops a concept of the male brain autistics are supposed to exemplify: it excels at mathematical reasoning, navigation and spatial reasoning, spotting single elements within larger visual wholes (e.g., the Embedded Figures Task), rotating objects, and aiming and targeting projectiles, and does poorly at verbal tasks, inferring another person's state of mind, cooperation and social judgment. It is also more strongly lateralized than the female brain, with a smaller corpus callosum and more exaggerated handedness. The female brain, by contrast, specializes in language, empathy and cognitive dexterity (e.g., rapidly coming up with a list of objects that are blue, or a list of words beginning with a given letter, or quickly categorizing or matching objects).

As Baron-Cohen suggests, this theory would quite neatly wrap up the past decade's major observations about autistic cognition: deficits* in theory of mind, central coherence and executive function. As defined above, Baron-Cohen's "male" brain type encompasses all three of these: poor theory of mind is practically written into the definition of the male brain (it is, after all, defined in opposition to the highly empathic female brain), so that one's a freebie; weak central coherence is evident in the male brain's focus on detail at the expense of broader patterns, and you would expect executive function to be weaker in someone with a strongly lateralized, weakly interconnected brain than in someone whose brain is more unified.

Unless Baron-Cohen can prove that all these variables (sex, language ability, empathy, brain lateralization, autism etc.) are directly related, all his theory will have accomplished will be redefining normal maleness as a state of mild autism. So far, the evidence is inconclusive. Yes, the few male-female differences in cognitive style that exist (male advantage in mentally rotating 3-D objects, female advantage in verbal fluency) are consistent with Baron-Cohen's ideas of the male and female brains, but other areas he predicted would show differences haven't, or have shown them inconsistently (empathy, mathematical and language ability, interest in social vs. mechanical stimuli) --- and even the differences that have been shown to exist are small ones, with a substantial zone of overlap between the sexes.

Language ability is also quite readily shown to be independent of social understanding by the example of Asperger syndrome. Baron-Cohen conflates autism with Asperger syndrome in his article, and speaks of both as involving a delay or impairment in language acquisition and use. This isn't true; one of the diagnostic criteria for Asperger syndrome is that language acquisition must occur on time or precociously. Baron-Cohen places AS on a continuum between the normal male brain and the "classically autistic" brain, which is problematic given AS's normal or superior verbal capacities and its higher male-to-female ratio (9:1, as opposed to 4:1 in classical autism).

Neuroanatomically, the theory is on ground as shaky as it is in cognitive psychology. Baron-Cohen invokes differences in the size of the corpus callosum to explain the contrast between the strongly lateralized male brain and the adapatable, bilateralized female brain, ascribing the female advantage in verbal fluency to speedy communication between hemispheres. Unfortunately, this 1997 meta-analysis of 49 studies and this current study indicate that there is no difference between male and female corpora callosa that cannot be accounted for by overall differences in brain size --- which favor men. Also, autistic people (who are definitely less fluent overall in their use of language than NTs) tend to display very weak brain lateralization and handedness, which Baron-Cohen acknowledges.

I can understand the appeal of a theory relating male gender and autism --- it would explain both the preponderance of men on the spectrum and the trouble many female autistics have fitting into the feminine social role. I think it would ultimately obscure more than it illuminated, though, both about autism and about the nature of gender. Defining maleness as mild autism would enshrine in biology a very culturally specific ideal of geeky masculinity, and legitimize (again, via biology) the delegation of all familial and relationship responsibilities to women, who, after all, have specialized nervous systems that can handle all that stuff.

*Autism research tends to find "deficits" in autistic cognition wherever it goes looking for them, even when the actual results indicate an autistic advantage --- e.g., findings that we tend to do better on visual-search tasks getting interpreted as showing "defects in central coherence," "can't see the forest for the trees."