Tuesday, June 16, 2009

Dr. Mottron, how can Dr. Souleries new study help educators capitalize on autistic's abilities?

In yet another study that has come from a disciple of Dr. Laurent Mottron, Isabelle Soulières, we see that Dr. Mottron is once again giving his $.02 to the media. Mottron makes the very optimistic statement:

"This study builds on our previous findings and should help educators capitalize on the intellectual abilities of autistics," says senior researcher Laurent Mottron, the new Marcel & Rolande Gosselin Research Chair in Autism Cognitive Neuroscience of the Université de Montréal and psychiatry professor. "The limits of autistics should constantly be pushed and their educational materials should never be simplified."

I emailed Dr. Soulie'res, asking her for a .pdf copy of the study and she was nice enough to promptly reply with a copy of the study. I have done my best to read the study though I did not understand a lot of it. I am curious as to how this study which shows a subset of persons with autism to be significantly faster at processing questions on the Raven's matrices than typical controls can be utilized as a real world application which would allow persons to use the results to help autistics learn or function better in society, which it seems to me what Dr. Mottron is implying. He and his sidekick Michelle Dawson also coauthored the article, though Soulieres was the lead author.

On perusal of both the statement to the media, the abstract of the study and in fact the study itself there seem to be problems with this interpretation. First we see the initial sentence of both the abstract and the actual study itself which may serve as a potential red flag:

Recent behavioral investigations have revealed that autistics perform more proficiently on Raven's Standard Progressive Matrices (RSPM) than would be predicted by their Wechsler intelligence scores.

The study cites Dawson(2007) as evidence for this assertion in which huge differences were found between the scores of autistics on the Wechsler IQ test as opposed to much higher scores on the Raven's matrices. After the study was published Dawson seemed to think her findings should influence all public policy towards autism with the statement:

I hope this paper will have the practical effect of making it less likely that autisics will be written off, as autistics are so routinely written off by autism advocates in Canada and elsewhere.

Souleries also cites a study done by Hayashi showing that persons with Asperger's who were matched with typical controls on Wechsler IQ outscored them on the Raven's. The problem with this interpretation was that Souleries only included persons with speech delay and problems in her paper who would have an autism diagnosis and excluded those with Asperger's so Hayashi would most likely not apply.

Another problem is that a study Boelte(2009) has largely failed to replicate Dawson(2007) so the question is still open as to the superior of Raven's scores versus Wechsler in autistics. Though Boelte found that some autistics scored higher on the Raven's than the Wechsler, the effect was much less pronounced than the one found by Dawson. It was also limited to lower functioning autistics (meaning those with an IQ of less than 85). The subject pool used by Boelte was also different than those by Dawson-they were a lower functioning group. Had Boelte used a group more similar to Dawson's the effect of Wechsler's versus Raven's would likely be negligible.

In contrast to Dawson's pollyannish statement Boelte makes a more guarded statement:

in conclusion, the claim that intelligence has been underestimated in autism seems somewhat premature.”

Kim Bodner who works in Nancy Minshew's group has also studied this question with high functioning autistics. She has found no significant difference in the scores of HFAs in the Raven's vs. Wechsler. I think her work has only been confined to a limited group of autistics, only high functioning ones. Also, I don't think her work has yet been published in a peer reviewed journal, but so far has only been presented as an IMFAR poster. I think her study will be published either at the end of 2009 or the beginning of 2010.

While there is a subset of persons on the autistic spectrum who score substantially higher on the Raven's than on the Wechsler it would appear to be mostly confined to lower functioning autistics who would not necessarily even be in the majority of all autistics. Further studies by the Mottron group, Boelte, Minshew's group and others may shed more light on this question.

In the latest study there is about a 6:1 ratio of male versus female autistics as opposed to the 4:1 ratio found in the general population. Souleries does not acknolwedge any limitations in this work. Of note, the autistics were also of normal intelligence with IQs of about 100, so whether or not these findings are applicable to lower functioning autistics is in question. Since they were matched with the typical controls they were different than at least some of the subjects in Dawson (1987) who had lower Wechsler IQs overall than typically matched controls. It is possible that the lower functioning subjects in Dawson (2007) would have to be excluded from the Souleries study due to the fact they would make too many head movements, creating artifacts on the fMRI scans.

Another germane issue is the lack of discrepancy between the performance IQ scores and the verbal IQ scores of the subjects, an average of about 99 on the verbal portion of the Wechsler and about 103 on the perfomance. This might indicate these autistics were less impaired than other persons with autism such as myself who have a 40 point discrepancy between the two tests. My verbal IQ has been tested in about the low 120s and my performance IQ in the low 80s. I am good in arithmetic, general knowledge, similarities, high average on vocabulary and below average in comprehension. On the performance test I score in the severely retarded range in both the block design and the object assembly test (which entails putting together puzzles) which I have great difficulty in due to my perceptual motor problems. There are probably also examples of a number of autistic persons who have the opposite profile, relatively high scores on the performance test as compared to verbal IQ. I wonder if this research could be applicable to myself or those on the spectrum who conversely have a discrepancy with a substantially higher performance than verbal IQ.

In at least one paragraph of her paper Souleries is more cautious about the interpretations of her work than coauthor Mottron:

Although theresponse time advantage for difficult RSPM problems weobserved may reflect an underlying processing advantagein reasoning mechanisms enjoyed by autistics, additionalstudies directed at this specific question will be requiredto fully explore this possibility.

In the last paragraph of the study unfortunately she makes a statement similar to Mottron's about how this work could be applied in the real world to help persons with autism. Not just the study's subjects who are clearly not an extremely representative sample of autistics, but all autistics, as she does not seem to acknowledge the limitations of this study due to the characteristics of the experimental group.

On a more positive note, in spite of problems with the interpretations the author's claim have real world applications, some of the things in the study were quite fascinating (at least to me). Dr. Souleries talked about how faster processing times may have reflected the lack of neural connections in autistics that had been cited by other studies in various brain areas, resulting in compensatory mechanisms in other areas:

Regarding possible developmental mechanisms leadingto the atypical autistic activity patterns seen in our study,clues may be found in recent studies of white mattermicrostructure [Barnea-Goraly et al., 2004; Courchesne etal., 2001; Herbert et al., 2004; Ke et al., 2008; Keller et al.,2007] and functional connectivity differences in autism[Just et al., 2004]. In autistics, Just et al., have observedreduced functional connectivity between frontal and parietalcortex in a variety of tasks, including sentence comprehension[Just et al., 2004; Kana et al., 2006], n-backworking memory tasks [Koshino et al., 2005, 2008] andresponse inhibition tasks [Kana et al., 2007]. Similarly,reduced functional connectivity between early visual areas(BA17) and inferior frontal cortex was found in autisticsduring a visuomotor coordination task [Villalobos et al.,2005], but this decrease was concomitant with increasedfunctional connectivity between the thalamus and its frontaltargets [Mizuno et al., 2006]. Given existing reports ofatypical connectivity in autism, there are several availableexplanations for our findings.One possibility, based on proposals advanced by Just etal. [2004], is that increased use of occipital brain regions inautistics reflects compensatory activity arising from anatypical neurodevelopmental trajectory, based on significantcommunication restrictions between prefrontal andoccipital regions. In this scheme, inefficiencies in engagingprefrontal mechanisms could result in the development ofcompensatory strategies and processing mechanisms moreheavily reliant on occipital and posterior parietal corticalregions. These compensatory mechanisms would have tobe as effective in supporting reasoning as the more typicalmechanisms relying on prefrontal function.......

So even though I find Mottron's statement to the media to be offensive, this study, I must concede, may not actually be useless. It may actually give some clues to how the brain in at least a subset of persons with autism functions and processes information. The compensatory mechanisms of the occipital lobes in persons with autism as opposed to the deficient connections in the frontoparietal areas of autism that have been reported. These findings also seem to be consistent with the mirror neuron hypothesis that Marco Iacobonni and Mirella Dapretto have pushed as an etiology in autism. It may be similar to a blind person who has compensated hearing and can be prodigious in music or reports of deaf people being able to see more easily out of the corner of their eyes. Whether it could actually have any applications for even a subset of autistics developing compensatory mechanisms could be used in the real world is another question, however.

So, Dr. Mottron, I would like to ask you. What is the basis of this research, given all of its limitations, being able to help all autistics in educational and other achievements? What difference will it make in their lives? If you are going to make such sweeping statements to the media, why can't you be more specific? I really wonder what the answer to these questions are.






13 comments:

Autism Reality NB said...

Jonathan if I understand your comment correctly Dr. Soulieres selected some high functioning, intelligent autistic persons and found out surprise, surprise that they can perform better on some tests than non-autistic persons in control groups. (I don't know anyone who doubts that there are many very intelligent autistic persons).

At one time Dr. Mottron used to specify in his study reports that the study involved persons with HFA, Aspergers or were autistic savants.

Was this study group pre-selected based on their intellectual abilities? If so what is the value of the study?

jonathan said...

Harold, the participants in Dr. Soulieres' study had Intelligence, as measured by the Wechsler IQ test in the average range of about 100. They did not perform better on these tests but were able to do them faster than the nonautistic controls. This research might not be applicable to Conor let's say if he had a tested IQ of less than 100. This is also true of other "lower functioning" autistics, whom the work is probable not applicable to.

I don't know if the subjects were "pre-selected" in any way, but they were recruited from a data base at Dr. Mottron's institute.

It is unlikely that substantially lower functioning autistic children would have been eligible for participation in this study because they would have behavioral problems that would influence the results, such as moving around in the fMRI scanner causing artifacts in the readings.

The study might have some utility in terms of showing how the brains of a limited group of autistic persons processes information, but I don't believe it has any relevance for those on the spectrum with IQ's well below average. I also don't believe the spin that Mottron and company are presenting to the media, that it could be helpful in presenting educational strategies that will help autistic people. Certainly these strategies would not be applicable for lower functioning persons with IQs less than 100.

Roger Kulp said...

I don't know if this is the case with all autistics,but I have had two different testings done a week apart,and the results of one group was significantly different than the other.Especially the Wechsler, which was MUCH higher the first time around.

In my case there are medical issues that have a direct impact on my intellectual abilities at a given time.Something that neurodiversity minded researchers like Laurent Mottron choose to ignore.

My performance on the Wechsler,was always much higher than the RSPM.(I had to use Google to see which was which.)I found the RSPM to be much more taxing on my cognitive abilities.

Were autistics who have been diagnosed as learning disabled included in the study?

jonathan said...

Hi Roger, I am not sure if any of them would be considered learning disabled or not, I might have to reread the study. As I said before in the blog post, they were of about average intelligence as measured on the Wechsler with no apparent discrepancies between the verbal portion and performance portion of the Wechsler that is not uncommonly seen in various autistics who have scattered levels of ability/disability in various areas. Soulieres did not list any of the subtest scores of the Wechsler which would have been interesting as it might have given an indication of certain abilities/disabilities in various areas and one might have been able to infer from that if there were any subjects who might be considered learning disabled (by the American rather than British definition of the word-which refers to someone with retardation in England) or not learning disabled.

SM69 said...

How could you criticize something like this?:

I hope this paper will have the practical effect of making it less likely that autistics will be written off, as autistics are so routinely written off by autism advocates in Canada and elsewhere.

Jonathan, I cannot help myself but comment here- your post is so circumvallated. Why do you keep on all the time repeating that autistic brains are defective? Some individuals needs help no doubt but it is rarely with their brain, it is much more to do with the peripheral physiology that affects their brain, this is very different (you will refute this statement no doubt as your mind is set). Autism is not associated with mental retardation, as you know yourself recent epidemiological studies show a decline within this population of low IQ and as you rightly pointed out before evaluating IQ in autism is a very unreliable matter.
Every single parent of an ASD child face this barrier- the child is seen as being stupid or not sufficiently intelligent because of his autism, this is true from the lower functioning to the higher functioning end of the spectrum. It is a huge disfavor to ASD people to hold this belief because it automatically comes with limitation of expectation. And with limitation of expectations we have limitations of opportunities. This is a downwards spiral. When you limit someone’s opportunities you limit his/her development as a person.

jonathan said...

I am not limiting the opportunities of anyone on the spectrum. They will go as far as they can regardless of what research shows or does not show. Dawson's research certainly did not prove anything in that regard. There are just as many persons on the spectrum with retardation as there ever were. There is just greater recognition of persons with normal or above average intelligence can have autism that is all.

I keep repeating that autistic brains are defective because they are. We may have limited knowledge of the neuroanatomy and biochemistry of autism, but still research has shown there is little question that they have less cells in certain parts of the brain in autopsy and Casanova's work shows problems with minicolumns. One of the most replicated findings on autopsies are reduced purkinje cells in the cerebellum. A person with autism is handicapped. They have limitations because their brains do not work correctly. They would not be receiving a diagnosis of autism otherwise.

I won't believe there is scientific evidence that it has to do with the peripheral problems that affect their brain. You are only saying this because you are a DAN practitioner and you need to hold onto this theory to make money. From what I have read in the article "The great autism ripoff" you charge people about $200 (based on the current rate of exchange with pounds) just for a consultation. You charge them about $400-$500 for a follow-up. I don't know what the laws are in the UK, but I think it is likely that what you are doing would be ilegal in the U.S.A. as you are not a licensed physician. This is what motivates your statement that it is just the periphery of the brain. The research of Margaret Bauman, Edward Ritvo, manuel Casanova, Eric Courchesne and many others refutes this view. You are only motivated in making this statement because it helps you make money from desperate parents of autistic children.

SM69 said...

Jonathan

The article you are referring to is incorrect and the journalist involved had been presented with all the facts fully. He decided to misrepresent what I have said, it was all planned and you will note a very interesting point. That is none of the practitioners at Breakspear Hospital were attacked. Now, Breakspear went bankrupt once because of a TV report 15 years ago. They rebuilt every thing and managed to prosecute the Journalist involved, got lot of compensation money for this. Do you know why they were not attacked? Because they knew the story behind breakspear, even though it is not common knowledge. This investigation was all orchestrated, there is nothing else. I was also pulled out of Autism Today conference programme, in London in July last minute. This is also political and I know who is behind this. Now, if you want to get your information about what I do from these sources when you clearly can ask me as we are in touch, then you really are biased. Now, do you want to know what I do and how much it is charged? I am happy to say this, this is totally transparent, I have nothing to hide. The cost you mention is incorrect anyway. Plus 45% of our families do not pay anything at all (the lower social end of them) because all is covered by supporting charity in 2 years grants to be repeated when run out. Our situation in the UK is way more ethical than anything I have come across in the US. I have also discussed the Autism Speak form 990 with our accountant who was amazed by the expenditures and confirmed with me that we would never received a charitable status if we had any of this type of account. Just unethical.

Again, if you want to know ask me.

You misunderstand autism in my opinion. You misunderstand what can be done to help children with autism today. But I can see now where you get your information from.

Please understand that I will respond to open-minded questions and comments, not personal attacks. I have seen how you dealo with people you disagree with and I am not willing to play that game with you. I have much better things to do, I hope you can appreciate this.

Ender said...

Another, much simplier to read, study that you might be interested in was done by the Belin-Blank Center at the University of Iowa (some of the leaders in gifted and talented education). While I believe it primary focused on those aspies with above average IQs comparing them to NTs with above average IQs it did come to some interesting results on how being gifted and asperger's is beneficial to just being gifted and how to best educate such students (and like i said before, they would know.)

P.S. After writing all this (and being too lazy to change it) I found the article:

http://www.education.uiowa.edu/belinblank/pubs/nagc/ bout halfway down the page, you will recognize the title. Though they have another one that isn't a powerpoint that explains a lot more that you will have to ask them for. And I will readily admit that was as difficult as can be to understand.

jonathan said...

Ok Lorene, lets have your side of the story which you have not fully presented in your last post. Are you in fact a DAN practitioner? Do you call yourself a "DAN doctor"? What of the other 55% of families who do pay for some of your services? What are they charged, what does this treatment entail and what is the scientific basis for this treatment and how do you square it with the evidence of Bauman, Ritvo, Casanova and Courchesne and many others who would refute your hypothesis that it is not the autistic brain itself that is impaired but something peripheral to it which affects it?

What are the laws regarding licensing of physicians in the UK? I know that in the United States you have to be licensed to hang out your shingle and call yourself a "doctor" to practice any kind of medicine. Are you not calling yourself a "DAN doctor" in spite of the fact you have a ph.d. degree and no m.d. degree and undoubetdly no license to practice medicine. Are you not practicing medicine without a license?

I only said from what I had read in that article. I can't be sure of its veracity, but plenty of stories about people being DAN doctors without proper credentials are circulated and I don't think all of them are complete lies.

You now have your opportunity to answer me and provide your side of things if you wish. you can either do so here or answer my questions in a private email as you have my email address.

SM69 said...

Jonathan

I intend to reply to your provocations one more time, though I know this is a lost cause. You want to fail me, but my conscience is clear, so you will never be able to achieve this. I have every day the proof that what I do helps, even if some days are harder than others, I will keep going as long as I can continue to help and my conscious remains clear about my integrity and honesty. I know you are not here to learn from me or from anyone. It does not bother me much.

I am busy over the next 2 days, but you can expect an answer from me sometimes at the weekend.

L

jonathan said...

Lorene: These are not provocations and I am not trying to grade you in anyway. I am just posing to you what I feel are polite legitimate questions which I believe deserve legitimate answers in light of the fact that you are claiming that I am wrong about the prognosis of a disease for most people that I have had personal experience with my entire life-more than 11 years than you have been alive, I think. If you are going to challenge me on my own blog I can certainly ask you the basis of your challenge and possible conflicts of interests and activities as they relate to your work.

I look forward to reading your replies. I have a couple of other questions for you too that I hope you won't mind answering. Is it true that the extent of your clinical training was two days spent in the USA under the tutelage of Jaquelyn McCandles and Anju Usman in which you became accredited as a 'DAN practitioner'? Did you have any experience clinical or otherwise related to autism prior to October of 2005? Is the basis of the treatment that you apparently charge money for at the Edinburgh clinic the paper that you coauthored with Richard Lathe on precoproporphyrin? Have the findings produced by you and Lathe ever been replicated? These are not meant to attack or insult you in any way, again I believe they are legitimate questions in light of what you are posting on my blog. I hope you will come back to answer these as well as the other questions. I look forward to reading your responses.

SM69 said...

Let’s me answer that bit for now:

Jonathan I don’t owe you any explanations what so ever. Do you know more about autism than I do just because you have it and I don’t? I married an AS man, I have a son with severe autism and epilepsy, most likely many of my families are on BAP and I love more than one person with autism in different ways. I know about science, a lot more than you will ever know. I know about education and caring for children. I know about what can make people feel and be better. I have a high degree of empathy and interest for others, I like to constantly learn and be challenged. I progress in my thinking all the time. I can cover a range of evidences from papers to anecdotal and be analytical.

I have never pretended to be a medical doctor and no I don’t call myself a DAN doctor, what a childish comment, do you think we are in for a game of some sort? I got my training from some of the most reputable universities in the world, despite very unique and uncommon education paths, that could have equally led me to delinquency. That shaped my mind in very different ways, you don’t know me, you have not met me and we have never spoken face to face, you don’t know. I have always been someone who think outside the box and challenge opinion. I am unable to lie. I could fight until I die, but not the silly little wars like the ones you like to set on your blog. I am a scientist and I have the training required to understand biology, physiology, genetic, neuroscience and biochemistry, and that is very relevent to autism. I have knowledge in some areas that surpasses what a medical doctor can have, of course, as they have knowledge I do not have. I work with medical doctors to complement what they do. They like working with me and I do like working with them, as I do like working with other scientists, as I do like to hold the hand of a child and listen to his parent’s stories. I analyse data, I analyse papers, I analyse what to do next, in concert with other people. I think of the others before I think of me. I have a lot more than 2 days of stupid DAN! conference that have not taught me anything (other than given me the chance to travel to the US as I like very much). I am in constant communication with doctors, on conference calls with medical teams in main UK hospitals on a weekly basis. I write to them daily. Tonight I got an e-mail from an Irish medical doctor, I almost feel like copying it to you. Sent to my personal e-mail address, asking me about treatment options for such person. Now does it occurs to you why that could be the case?

You systematically dismiss valid information and arguments, only to brush your fragile egos, and hold on to your beliefs that have now become the way you define yourself. Too hard to shake this off and see things afresh, but you really ought to, because you hold no solution what so ever to autistic people.

The porphyrin paper, hell, why don’t you set up a study to replicate this or disprove it. I am all for it! Anyone can do it, amongst many other avenues to cover in autism, some of which are more important that this particular of course.

Your arguments are angers, jealousy and lack of curiosity. Nothing else, every single ones of your points can be easily argued, even if you will NEVER understand this.

SM69 said...

Trying to stay polite and patient here, let me repeat one more time that I am trained as a scientist in areas that are relevant to autism and I work as a scientist with doctors and dietician to assist families of children with autism (and a few autistic adults) to implement the best dietary, nutritional and pharmacological intervention to meet their individual needs based on laboratory testing. I do not give any medical advice, but I work with doctors who give these medical advices. I help with analysis of data, I help with face to face meeting with individuals. I have also some training in special education and I give advices on issues of communication, play, socialization and behaviours. Again I refer to other professionals to deliver these advices. My advices are across the board, sometimes I focus on the parents only. Sometimes, I tackle their anxiety. Sometimes, I tackle the situation at school. There is no one case that is similar to another.

People can come from very far to meet me and discuss their child; I have recently counted to have seen people from 12 different countries. I am trying every time to give something unique and to be right at the heart of the issues that matter for the child. I am trying to empower parents with relevant information, assisting them to tap in their local and national resources and services they should have access to. I want to assist them to get their child better with what ever it takes, but I want also them to become independent of that extra support 2-3 years down the line. I want to dispense myself. I have been negotiating school dinners, traveling conditions on the plane, facility to park in the street (disabled parking badge), level of disability living allowing, support funding from various sources, discussion with school, doctors, consultants. I am trying to get the NHS involved in providing tests, so parents don’t have to pay and very commonly what I advice leads to a referral to a specialized consultant being for GI investigations, immune problems, or endocrinology issues. I work with all backgrounds, not uncommonly with translators, as I have 8% of our families for example that originate from Somalia. I don’t favour any particular social class. When people cannot travel to me, I’ll travel to them. I have even been seen driving for 11hr in a day to visit a child with severe epilepsy who spent most of his time restrained on a chair whilst at school. I have seen the most horrendous situations and abuse. I have been on psychiatric wards. And what I want most of all on the top of this is to report what I see, research it, provide sufficient documentation and level of evidence to influence policy markers at every levels, dialogue with other charities, education authorities and gov. And this is exactly what I do indeed, and it actually works. I am getting there. I make a difference every day and I have the proof all the time. But I am also pretty tired, I don’t even know why I taking the pain to justify myself here.

I am almost constantly dealing with autism, there is almost no rest in my life and in my mind.